by Oliver Sacks
11 I saw similar phenomena, and had similar thoughts, regarding another patient (Sam G.), whose story, alas, I didn’t tell in the original Awakenings (though his face appears on the front cover of the 1976 edition). Sam used to be both a car buff and racing driver, bizarrely helped in the latter by his preternaturally quick reactions and his sudden, “frivolous” moves. He had to give it up around 1930 due to envelopment in a profound Parkinsonism. “Awakening,” for him, had some of the “nostalgic” quality it had for Rose R. In particular, the moment he found himself “released” by L-DOPA, he started drawing cars. He drew constantly, with great speed, and was obsessed by his drawing; if we did not keep him well supplied with paper, he would draw on the walls, on table-cloths, on his bedsheets. His cars were accurate, authentic, and had an odd charm. When he was not drawing, he was talking, or writing—of “the old days” in the twenties when he was driving and racing—and this too was full of vividness and immediacy, minute, compelling, living detail. He would be completely transported as he drew, talked, or wrote, and spoke of “the old days” as if they were now; the days before 1930 were clearly much more present than the real now; he seemed, like Rose R., to be living (or reliving) the past, even though (like her) he was perfectly “oriented.” He knew that it was 1969, that he was aging, ill, and in hospital, but felt (and conveyed) his racing youth of the twenties.
12 When Rose did “awaken” with the administration of L-DOPA in 1969, she was extremely excited and animated, but in a way that was strange. She spoke of Gershwin and other contemporaries as if they were still alive; of events in the mid-twenties as if they had just happened. She had obsolete mannerisms and turns of speech; she gave the impression of a “flapper” come suddenly to life. We wondered if she was disoriented, if she knew where she was. I asked her various questions, and she gave me a succinct and chilling answer: “I can give you the date of Pearl Harbor,” she said, “I can give you the date of Kennedy’s assassination. I’ve registered it all—but none of it seems real. I know it’s ’69, I know I’m 64—but I feel it’s ’26, I feel I’m 21. I’ve been a spectator for the last forty-three years.” (There were many other patients who behaved, and even appeared, much younger than their years, as if their personalities, their processes of personal growth and becoming, had been arrested at the same time as their other physical and mental processes.)
Note (1990): Edelman describes how consciousness and memory (which he sees as dependent on continual “recategorization”) are, normally, continually “updated”; and how this updating depends, in the first place, on movement, on free and smooth and orderly movement. The basal ganglia are necessary for this—Edelman calls them “organs of succession.” The absence of “updating” in Rose R., and in all our immobilized basal-ganglia–damaged patients, is in striking accordance with this notion.
13 The following is based on notes provided by our speech pathologist, Miss Marjorie Kohl. I myself was away during August.
14 This colleague, Lucy K., is so expert a speaker and lip-reader that I did not realize at first that she was deaf. It was only when I chanced one day to turn my head to one side as we were talking, inadvertently cutting off communication instantly, that I realized she was not hearing me but lip-reading me (“lipreading” is an extremely inadequate word for the complex art of observation, inference, and inspired guesswork which goes on). When the diagnosis of deafness was made, at about twelve months, Lucy’s parents had immediately expressed their passionate desire that their daughter should speak and be a part of the hearing world, and her mother devoted hours every day to an intensive one-to-one tuition of speech—a grueling business that lasted twelve years. It was only after this (at the age of fourteen) that Lucy learned Sign; it has always been a second language, and one that does not come “naturally” to her. She continued (with her excellent lip-reading and powerful hearing aids) in “normal” (hearing) classes in high school and college, and now works, with hearing patients, at our hospital. She herself has mixed feeling about her status: “I sometimes feel,” she once said, “that I am between two worlds, that I don’t quite fit into either.”
15 Wright uses Wordsworth’s phrase, “eye-music,” for such experiences, even when there is no accompanying auditory phantasm, and this is used by several deaf writers as a metaphor for their sense of visual patterns and beauty. It is especially used of the recurrent motifs (the “rhymes,” the “consonances,” etc.) of Sign poetry.
16 There is, of course, a “consensus” of the senses—objects are heard, seen, felt, smelt, all at once, simultaneously; their sound, sight, smell, feel all go together. This correspondence is established by experience and association. This is not, normally, something we are conscious of, although we would be very startled if something didn’t sound like it looked—if one of our senses gave a discrepant impression. But we may be made conscious, very suddenly and startlingly, of the senses’ correspondence, if we are suddenly deprived of a sense, or gain one.
17 This hearing (that is, imagining) of “phantasmal voices,” when lips are read, is quite characteristic of the postlingually deaf, for whom speech (and “inner speech”) has once been an auditory experience. This is not “imagining” in the ordinary sense, but rather an instant and automatic “translation” of the visual experience into an auditory correlate (based on experience and association)—a translation that probably has a neurological basis (of experientially established visual-auditory connections). This does not occur, of course, in the prelingually deaf, who have no auditory experience or imagery to call upon. For them lipreading—as, indeed, ordinary reading—is an entirely visual experience; they see, but do not hear, the voice. It is difficult for us, as speaker-hearers, even to conceive such a visual “voice,” as it is for those who have never heard to conceive an auditory voice.
The congenitally deaf, it should be added, may have the richest appreciation of (say) written English, of Shakespeare, even though it does not “speak” to them in an auditory way. It speaks to them, one must suppose, in an entirely visual way—they do not hear, they see, the “voice” of the words.
18 This is the stereotypical view, and it is not altogether true. The congenitally deaf do not experience or complain of “silence” (any more than the blind experience or complain of “darkness”). These are our projections, or metaphors, for their state. Moreover, those with the profoundest deafness may hear noise of various sorts and may be highly sensitive to vibrations of all kinds. This sensitivity to vibration can become a sort of accessory sense: thus Lucy K., although profoundly deaf, can immediately judge a chord as a “fifth” by placing a hand on the piano and can interpret voices on highly amplified telephones; in both cases what she seems to perceive are vibrations, not sounds.
19 As early as the sixteenth century some of the deaf children of noble families had been taught to speak and read, through many years of tutoring, so that they could be recognized as persons under the law (mutes were not recognized) and could inherit their families’ titles and fortunes. But before 1750, for the generality, for 99.9 percent of those born deaf, there was no hope of literacy or education.
20 There have been, however, purely written languages, such as the scholarly language used for over a thousand years by the elite Chinese bureaucracy, which was never spoken and, indeed, never intended to be spoken.
21 De l’Epée exactly echoes his contemporary Rousseau, as do all the eighteenth-century descriptions of Sign. Rousseau (in his Discourse on the Origin of Inequalityand his Essay on the Origin of Language ) conceives of a primordial or original human language, in which everything has its true and natural name; a language so concrete, so particular, that it can catch the essence, the “itness,” of everything; so spontaneous that it expresses all emotion directly, and so transparent that it is incapable of any evasion or deception. Such a language would be without (and indeed would have no need for) logic, grammar, metaphor, or abstractions—it would be a language not mediate, a symbolic expression of thought and feeling,
but, almost magically, an immediate one.
22 This notion that sign language is uniform and universal, and enables deaf people all over the world to communicate with one another instantly, is still quite widespread. It is quite untrue. There are hundreds of different signed languages that have arisen independently wherever there are significant numbers of deaf people in contact.
23 We lack sufficient direct knowledge of the evolution of ASL, especially in its first fifty years, when a far-reaching “creolization” occurred, as French Sign Language became Americanized. There was already a wide gulf between French Sign and the new creole ASL by 1867—Clerc himself commented on this—and this has continued to grow in the past hundred and twenty years. Nonetheless, there are still significant similarities between the two languages—sufficient for an American signer to feel somewhat at home in Paris.
In contrast, American signers have great difficulty understanding British Sign Language, which has quite different origins. Indigenous sign dialects may be extremely different: thus prior to 1817, a deaf American traveling across the States would encounter sign dialects incomprehensibly different from his own; and standardization was so slow in England that until quite recently signers in adjacent villages might be mutually unintelligible.
24 The old terms “deaf and dumb” and “deaf-mute” referred to a supposed inadequacy of those born deaf to speak. They are, of course, perfectly capable of speech—they have the same speech apparatus as anyone else; what they lack is the ability to hear their own speech, and thus to monitor its sound by ear. Their speech, therefore, may be abnormal in amplitude and tone, with many omitted consonants and other speech sounds, sometimes so much so as to be unintelligible. Since deaf people cannot monitor their speech by ear, they have to learn to monitor it by other senses—by vision, touch, vibration-sense, and kinesthesia. Moreover, the prelingually deaf have no auditory image, no idea what speech actually sounds like, no idea of a sound-meaning correspondence. What is essentially an auditory phenomenon must be grasped and controlled by nonauditory means. It is this which poses great difficulties, and which may require thousands of hours of individual tuition to achieve.
25 There had, of course, been other novels, like Carson McCullers’s The Heart Is a Lonely Hunter. The figure of Mr. Singer, an isolated deaf man in a hearing world, in this book is quite different from the protagonists of Greenberg’s novel, who are vividly conscious of their deaf identities. A huge social change, a change in social outlook, has occurred in the intervening thirty years, with above all, the emergence of a new self-consciousness.
26 Though there may be early development of a vocabulary of signs, the development of Sign grammar takes place at the same age, and in the same way, as the acquisition of speech grammar. Linguistic development thus occurs at the same rate in all children, deaf or hearing. If signs appear earlier than speech, it is because they are easier to make, for they involve relatively simple and slow movements of muscles, whereas speech involves the lightning coordination of hundreds of different structures, and only becomes possible in the second year of life. Yet it is intriguing that a deaf child at four months may make the sign for “milk,” where a hearing child can only cry or look around. Perhaps all babies would be better off knowing a few signs!
27 Sicard imagined such a community:
Could there not be in some corner of the world a whole society of deaf people? Well then! Would we think that these individuals were inferior, that they were unintelligent and lacked communication? They would certainly have a sign language, perhaps a language even richer than ours. This language would at least be unambiguous, always giving an accurate picture of the mind’s affections. So why would this people be uncivilized? Why wouldn’t they in fact have laws, government, police less mistrustful than our own?
The deaf themselves have had occasional impulses to deaf separatism or deaf “Zionism.” In 1831 Edmund Booth suggested the formation of a deaf township or community, and in 1856 John James Flournoy the establishment of a deaf state, “out west.” And in fantasy the idea is still active. Thus Lyson C. Sulla, the deaf hero of Islay, dreams of becoming governor of the state of Islay and making it a state “of, by, and for” deaf people.
28 There have been and are other isolated communities with a high incidence of deafness and unusually benign social attitudes to the deaf and their language.
There is an isolated village in the Yucatán where thirteen adults, and one baby, out of a population of about four hundred, are congenitally deaf—here again the whole village uses Sign. There are other deaf relatives—cousins, second cousins, etc.—in nearby villages.
The Sign they use is not “home sign,” but a Mayan Sign that is clearly of some antiquity, because it is intelligible to all of these deaf people, even though they are scattered over hundreds of square miles, and have virtually no contact with each other. This is quite different from the Central Mexican Sign used in Merida and other cities—indeed, they are mutually unintelligible. The well-integrated, full lives of the rural deaf—in communities that accept them wholly, and have adapted by themselves learning Sign—is in great contrast to the low social, informational, educational, and linguistic level of the “city” deaf in Merida, who find themselves fit (after years of inadequate schooling) only for peddling or perhaps riding bike-taxis. One sees here how well the community often works, while the “system” does badly.
29 Besides its exemplary school for the deaf, the town of Fremont, California, offers unrivaled work opportunities for deaf people, as well as a rare degree of public and civic awareness and respect. The existence of thousands of deaf people in one area of Fremont has given rise to a fascinating bilingual and bicultural situation, whereby speech and Sign are used equally. In certain parts of town, one may see cafés where half the customers speak and half sign, Y’s where deaf and hearing work out together, and athletic matches where deaf and hearing play together. There is here not only an interface—and a friendly one, between deaf and hearing—but a considerable fusion or diffusion of the two cultures, so that numbers of the hearing (especially children) have started to acquire Sign, usually quite unconsciously, by picking it up rather than deliberately learning it. Thus even here, in a bustling industrial Silicon Valley town in the 1980s (and there is a somewhat similar situation in Rochester, New York, where several thousand deaf students, some with deaf families, attend the NTID), we see that the benign Martha’s Vineyard situation can reemerge.
30 A further four surfaced (one an ophthalmic surgeon) following the original publication of this piece. In addition to these Tourettic surgeons, I now know of three Tourettic internists, two Tourettic neurologists, but only one Tourettic psychiatrist.
31 Tics can have an ambiguous status, partway between meaningless jerks or noises and meaningful acts. Though the tendency to tic is innate in Tourette’s, the particular form of tics often has a personal or historical origin. Thus a name, a sound, a visual image, a gesture, perhaps seen years before and forgotten, may first be unconsciously echoed or imitated and then preserved in the stereotypic form of a tic. Such tics are like hieroglyphic, petrified residues of the past and may indeed, with the passage of time, become so hieroglyphic, so abbreviated, as to become unintelligible (as “God be with you” was condensed, collapsed, after centuries, to the phonetically similar but meaningless “good-bye”). One such patient, whom I saw long ago, kept making an explosive, guttural, trisyllabic noise, which revealed itself, on analysis, as a very accelerated, crushed rendering of “Verboten!” in a convulsive parody of his father’s constantly forbidding German voice.
A recent correspondent, a woman with Tourette’s, after reading an earlier version of this piece, wrote that “‘enshrinement’ . . . is the perfect word to describe the interplay between life and tics—the process by which the former gets incorporated into the latter. . . . It is almost as if the Tourettic body becomes an expressive archive—albeit jumbled—of one’s life experience.”
32 Some people with Toure
tte’s have flinging tics—sudden, seemingly motiveless urges or compulsions to throw objects—quite different from Bennett’s flinging in rage. There may be a very brief premonition—enough, in one case, to yell a warning “Duck!”—before a dinner plate, a bottle of wine, or whatever is flung convulsively across the room. Identical throwing tics occurred in some of my postencephalitic patients when they were overstimulated by L-DOPA. (I see somewhat similar flinging behaviors—though not tics—in my two-year-old godson, now in a stage of primal antinomianism and anarchy.)
33 This was comically shown on one occasion when I went to a restaurant for dinner with three Tourettic friends in Los Angeles. All three of them at once rushed for the corner seat—not, I think, in any competitive spirit, but because each saw it as an existential-neural necessity. The lucky one was able to sit calmly in his place, while the other two were constantly lunging at other diners behind them.
34 Tourette’s should not be regarded as a psychiatric disorder, but as a neurobiological disorder of a hyperphysiological sort, in which there may occur subcortical excitation and spontaneous stimulation of many phylogenetically primitive centers in the brain. A similar stimulation or release of “primitive” behaviors may be seen with the excitatory lesions of encephalitis lethargica, such as I describe in Awakenings. These were often apparent in the early days of the illness and became prominent again with the stimulation of L-DOPA.
35 Such tendencies, common in Tourette’s syndrome, are also seen in patients with post-encephalitic syndromes. Thus my patient Miriam H. had compulsions to count the number of e’s on every page she read; to say, or write, or spell sentences backward; to divide people’s faces into juxtapositions of geometric figures, and to balance visually, to symmetrize, everything she saw.
