The Man Who Mistook His Wife for a Hat and Other Clinical Tales

If a man has lost a leg or an eye, he knows he has lost a leg or an eye; but if he has lost a self—himself—he cannot know it, because he is no longer there to know it.

If we wish to know about a man, we ask 'what is his story--his real, inmost story?'--for each of us is a biography, a story. Each of us is a singular narrative, which is constructed, continually, unconsciously, by, through, and in us--through our perceptions, our feelings, our thoughts, our actions; and, not least, our discourse, our spoken narrations. Biologically, physiologically, we are not so different from each other; historically, as narratives--we are each of us unique.

To be ourselves we must have ourselves – possess, if need be re-possess, our life-stories. We must “recollect” ourselves, recollect the inner drama, the narrative, of ourselves. A man needs such a narrative, a continuous inner narrative, to maintain his identity, his self.

he wanted to do, to be, to feel- and could not; he wanted sense, he wanted purpose- in Freud's words, 'Work and Love'.

For here is a man who, in some sense, is desperate, in a frenzy. The world keeps disappearing, losing meaning, vanishing - and he must seek meaning, make meaning, in a desperate way, continually inventing, throwing bridges of meaning over abysses of meaninglessness, the chaos that yawns continually beneath him.

Very young children love and demand stories, and can understand complex matters presented as stories, when their powers of comprehending general concepts, paradigms, are almost nonexistent.

The miracle is that, in most cases, he succeeds - for the powers of survival, of the will to survive, and to survive as a unique inalienable individual, are absolutely, the strongest in our being: stronger than any impulses, stronger than disease.

Dangerously well’— what an irony is this: it expresses precisely the doubleness, the paradox, of feeling ‘too well

The pleasure we obtain from music comes from counting, but counting unconsciously. Music is nothing but unconscious arithmetic.

One must go to Dostoievsky who experienced on occasion ecstatic epileptic auras to which he attached momentous significance, to find an adequate historical parallel. "There are moments, and it is only a matter of five or six seconds, when you feel the presence of the eternal harmony ... a terrible thing is the frightful clearness with which it manifests itself and the rapture with which it fills you. If this state were to last more than five seconds, the soul could not endure it and would have to disappear. During these five seconds I live a whole human existence, and for that I would give my whole life and not think that I was paying too dearly …

But who was more tragic, or who was more damned—the man who knew it, or the man who did not?

But the saddest difference between them was that Zazetsky, as Luria said, 'fought to regain his lost faculties with the indomitable tenacity of the damned,' whereas Dr P. was not fighting, did not know what was lost. But who was more tragic, or who was more damned -- the man who knew it, or the man who did not?

إذا فقد رجلٌ رجلاً أو عيناً ، فهو يعرف أنه فقد رِجلاً أو عيناً. ولكن إذا فقد نفساً - نفسه- فليس بإمكانه أن يعرف ذلك، لأنه لم يعد موجوداً هناك ليعرف

Thus the feeling I sometimes have - which all of us who work closely with aphasiacs have - that one cannot lie to an aphasiac. He cannot grasp your words, and cannot be deceived by them; but what he grasps he grasps with infallible precision, namely the expression that goes with the words, the total, spontaneous, involuntary expressiveness which can never be simulated or faked, as words alone can, too easily.

إذا فقد رَجُلا رِجلا أو عَينا، فهو يعرف أنه فقد رِجلا أو عَينا، و لكن إذا فقد نفسا-نفسه-فليس بإمكانه أن يعرف ذلك، لأنه لم يعد موجودا هناك ليعرف

إذا أردنا أن نعرف فلاناً فنحن نسأل : " ما قصته - قصته الحقيقية الأعمق ؟ - " لأن كل واحد منا هو سيرة وقصة . كل واحد منا هو حكاية فريدة يتم تركيبها باستمرار ودون وعي بواسطتنا ومن خلالنا وفينا من خلال إدراكاتنا ومشاعرنا وأفكارنا وأفعالنا وليس أقله بواسطة حديثنا وحكاياتنا المنطوقة . نحن لا نختلف عن بعضنا بعضاً كثيراً بيولوجياً وفسيولوجياً ، أما تاريخياً ، كقصص ، فكل من فريد !

And so was Luria, whose words now came back to me: ‘A man does not consist of memory alone. He has feeling, will, sensibility, moral being ... It is here ... you may touch him, and see a profound change.’ Memory, mental activity, mind alone, could not hold him; but moral attention and action could hold him completely.

Perhaps there is a philosophical as well as a clinical lesson here: that in Korsakov’s, or dementia, or other such catastrophes, however great the organic damage and Humean dissolution, there remains the undiminished possibility of reintegration by art, by communion, by touching the human spirit: and this can be preserved in what seems at first a hopeless state of neurological devastation.

كان هناك نوع من العاطفة المرتجفة التواقة، وحنين غريب، لعالم مفقود، نصف منسيَ، ونصف متذكّر

تصاب الحيوانات بالمرض, و لكن الإنسان فقط يمرض جذرياًanimals get diseases, but only man falls radically into sickness.

We have five senses in which we glory and which we recognise and celebrate, senses that constitute the sensible world for us. But there are other senses -- secret senses, sixth senses, if you will -- equally vital, but unrecognised, and unlauded. These senses, unconscious, automatic, had to be discovered.

What is more important for us, at an elemental level, than the control, the owning and operation, of our own physical selves? And yet it is so automatic, so familiar, we never give it a thought.

Astounded—and indifferent—for he was a man who, in effect, had no ‘day before’.

The ‘secret’ of Shostakovich, it was suggested—by a Chinese neurologist, Dr Dajue Wang—was the presence of a metallic splinter, a mobile shell-fragment, in his brain, in the temporal horn of the left ventricle. Shostakovich was very reluctant, apparently, to have this removed:Since the fragment had been there, he said, each time he leaned his head to one side he could hear music. His head was filled with melodies—different each time—which he then made use of when composing.X-rays allegedly showed the fragment moving around when Shostakovich moved his head, pressing against his ‘musical’ temporal lobe, when he tilted, producing an infinity of melodies which his genius could use.

Neurology’s favourite word is ‘deficit’, denoting an impairment or incapacity of neurological function: loss of speech, loss of language, loss of memory, loss of vision, loss of dexterity, loss of identity and myriad other lacks and losses of specific functions (or faculties).

I have traversed many kinds of health, and keep traversing them... and as for sickness: are we not almost tempted to ask whether we could get along without it? Only great pain is the liberator of the spirit.

Here then was the paradox of the President’s speech. We normals—aided, doubtless, by our wish to be fooled, were indeed well and truly fooled (‘Populus vult decipi, ergo decipiatur’). And so cunningly was deceptive word-use combined with deceptive tone, that only the brain-damaged remained intact, undeceived.

judgment is the most important faculty we have. An animal, or a man, may get on very well without ‘abstract attitude’ but will speedily perish if deprived of judgment. Judgment must be the first faculty of higher life or mind—yet it is ignored, or misinterpreted, by classical (computational) neurology. And if we wonder how such an absurdity can arise, we find it in the assumptions, or the evolution, of neurology itself.

But it must be said from the outset that a disease is never a mere loss or excess— that there is always a reaction, on the part of the affected organism or individual, to restore, to replace, to compensate for and to preserve its identity, however strange the means may be: and to study or influence these means, no less than the primary insult to the nervous system, is an essential part of our role as physicians.

All of us, at first, had high hopes of helping Jammie - he was so personable, so likable, so quick and intelligent, it was difficult to believe that he might be beyond help. But none of us had ever encountered, even imagined, such a power of amnesia, the possibility of a pit into which everything, every experience, every event, would fathomlessly drop, a bottomless memory-hole that would engulf the whole world.