The man who mistook his wife for a hat

by Oliver Sacks

  As I approached, she heard my footsteps and turned, gave me a broad smile, and wordlessly gestured. 'Look at the world,' she seemed to say. 'How beautiful it is.' And then there came out, in Jacksonian spurts, odd, sudden, poetic ejaculations: 'spring', 'birth', 'growing', 'stirring', 'coming to life', 'seasons', 'everything in its time'. I found myself thinking of Ecclesiastes: 'To everything there is a season, and a time to every purpose under the heaven. A time to be born, and a time to die; a time to plant, and a time . . . ' This was what Rebecca, in her disjointed fashion, was ejaculating-a vision of seasons, of times, like that of the Preacher. 'She is an idiot Ecclesiastes,' I said to myself. And in this phrase, my two visions of her-as idiot and as symbolist-met, collided and fused. She had done appallingly in the testing-which, in a sense,

  was designed, like all neurological and psychological testing, not merely to uncover, to bring out deficits, but to decompose her into functions and deficits. She had come apart, horribly, in formal testing, but now she was mysteriously 'together' and composed.

  Why was she so decomposed before, how could she be so re-composed now? I had the strongest feeling of two wholly different modes of thought, or of organisation, or of being. The first schematic-pattern-seeing, problem-solving-this is what had been tested, and where she had been found so defective, so disastrously wanting. But the tests had given no inkling of anything but the deficits, of anything, so to speak, beyond her deficits.

  They had given me no hint of her positive powers, her ability to perceive the real world-the world of nature, and perhaps of the imagination-as a coherent, intelligible, poetic whole: her ability to see this, think this, and (when she could) live this; they had given me no intimation of her inner world, which clearly was composed and coherent, and approached as something other than a set of problems or tasks.

  But what was the composing principle which could allow her composure (clearly it was something other than schematic)? I found myself thinking of her fondness for tales, for narrative composition and coherence. Is it possible, I wondered, that this being before me-at once a charming girl, and a moron, a cognitive mishap- can use a narrative (or dramatic) mode to compose and integrate a coherent world, in place of the schematic mode, which, in her, is so defective that it simply doesn't work? And as I thought, I remembered her dancing, and how this could organise her otherwise ill-knit and clumsy movements.

  Our tests, our approaches, I thought, as I watched her on the bench-enjoying not just a simple but a sacred view of nature- our approach, our 'evaluations', are ridiculously inadequate. They only show us deficits, they do not show us powers; they only show us puzzles and schemata, when we need to see music, narrative, play, a being conducting itself spontaneously in its own natural way.

  Rebecca, I felt, was complete and intact as 'narrative' being, in

  conditions which allowed her to organise herself in a narrative way; and this was something very important to know, for it allowed one to see her, and her potential, in a quite different fashion from that imposed by the schematic mode.

  It was perhaps fortunate that I chanced to see Rebecca in her so-different modes-so damaged and incorrigible in the one, so full of promise and potential in the other-and that she was one of the first patients I saw in our clinic. For what I saw in her, what she showed me, I now saw in them all.

  As I continued to see her, she seemed to deepen. Or perhaps she revealed, or I came to respect, her depths more and more. They were not wholly happy depths-no depths ever are-but they were predominantly happy for the greater part of the year.

  Then, in November, her grandmother died, and the light, the joy, she had expressed in April now turned into the deepest grief and darkness. She was devastated, but conducted herself with great dignity. Dignity, ethical depth, was added at this time, to form a grave and lasting counterpoint to the light, lyrical self I had especially seen before.

  I called on her as soon as I heard the news, and she received me, with great dignity, but frozen with grief, in her small room in the now empty house. Her speech was again ejaculated, 'Jack-sonian', in brief utterances of grief and lamentation. 'Why did she have to go?' she cried; and added, 'I'm crying for me, not for her.' Then, after an interval, 'Grannie's all right. She's gone to her Long Home.' Long Home! Was this her own symbol, or an unconscious memory of, or allusion to, Ecclesiastes? 'I'm so cold,' she cried, huddling into herself. 'It's not outside, it's winter inside. Cold as death,' she added. 'She was a part of me. Part of me died with her.'

  She was complete in her mourning-tragic and complete- there was absolutely no sense of her being then a 'mental defective'. After half an hour, she unfroze, regained some of her warmth and animation, said: 'It is winter. I feel dead. But I know the spring will come again.'

  The work of grief was slow, but successful, as Rebecca, even when most stricken, anticipated. It was greatly helped by a sym-

  pathetic and supportive great aunt, a sister of her Grannie, who now moved into the house. It was greatly helped by the synagogue, and the religious community, above all by the rites of 'sitting shiva', and the special status accorded her as the bereaved one, the chief mourner. It was helped too perhaps by her speaking freely to me. And it was helped also, interestingly, by dreams, which she related with animation, and which clearly marked stages in the grief-work (see Peters, 1983).

  As I remember her, like Nina, in the April sun, so I remember her, etched with tragic clearness, in the dark November of that year, standing in a bleak cemetery in Queens, saying the Kaddish over her grandmother's grave. Prayers and Bible stories had always appealed to her, going with the happy, the lyrical, the 'blessing' side of her life. Now, in the funeral prayers, in the 103rd Psalm, and above all in the Kaddish, she found the right and only words for her comfort and lamentation.

  During the intervening months (between my first seeing her, in April, and her grandmother's death that November) Rebecca- like all our 'clients' (an odious word then becoming fashionable, supposedly less degrading than 'patients'), was pressed into a variety of workshops and classes, as part of our Developmental and Cognitive Drive (these too were 'in' terms at the time).

  It didn't work with Rebecca, it didn't work with most of them. It was not, I came to think, the right thing to do, because what we did was to drive them full-tilt upon their limitations, as had already been done, futilely, and often to the point of cruelty, throughout their lives.

  We paid far too much attention to the defects of our patients, as Rebecca was the first to tell me, and far too little to what was intact or preserved. To use another piece of jargon, we were far too concerned with 'defectology', and far too little with 'narratol-ogy', the neglected and needed science of the concrete.

  Rebecca made clear, by concrete illustrations, by her own self, the two wholly different, wholly separate, forms of thought and mind, 'paradigmatic' and 'narrative' (in Bruner's terminology). And though equally natural and native to the expanding human mind, the narrative comes first, has spiritual priority. Very young chil-

  dren love and demand stories, and can understand complex matters presented as stories, when their powers of comprehending general concepts, paradigms, are almost non-existent. It is this narrative or symbolic power which gives a sense of the world-a concrete reality in the imaginative form of symbol and story- when abstract thought can provide nothing at all. A child follows the Bible before he follows Euclid. Not because the Bible is simpler (the reverse might be said), but because it is cast in a symbolic and narrative mode.

  And in this way Rebecca, at nineteen, was still, as her grandmother said, 'just like a child'. Like a child, but not a child, because she was adult. (The term 'retarded' suggests a persisting child, the term 'mentally defective' a defective adult; both terms, both concepts, combine deep truth and falsity.)

  With Rebecca-and with other defectives allowed, or encouraged in, a personal development-the emotional and narrative and symbolic powers can develop strongly and
exuberantly, and may produce (as in Rebecca) a sort of natural poet-or (as in Jose) a sort of natural artist-while the paradigmatic or conceptual powers, manifestly feeble from the start, grind very slowly and painfully along, and are only capable of a very limited and stunted development.

  Rebecca realised this fully-as she had shown it to me so clearly, right from the very first day I saw her, when she spoke of her clumsiness, and of how her ill-composed and ill-organised movements became well-organised, composed and fluent, with music; and when she showed me how she herself was composed by a natural scene, a scene with an organic, aesthetic and dramatic unity and sense.

  Rather suddenly, after her grandmother's death, she became clear and decisive. 'I want no more classes, no more workshops,' she said. 'They do nothing for me. They do nothing to bring me together.' And then, with that power for the apt model or metaphor I so admired, and which was so well developed in her despite her low IQ, she looked down at the office carpet and said:

  'I'm like a sort of living carpet. I need a pattern, a design, like you have on that carpet. I come apart, I unravel, unless there's a

  design.' I looked down at the carpet, as Rebecca said this, and found myself thinking of Sherrington's famous image, comparing the brain/mind to an 'enchanted loom', weaving patterns ever-dissolving, but always with meaning. I thought: can one have a raw carpet without a design? Could one have the design without the carpet (but this seemed like the smile without the Cheshire cat)? A 'living' carpet, as Rebecca was, had to have both-and she especially, with her lack of schematic structure (the warp and woof, the knit, of the carpet, so to speak), might indeed unravel without a design (the scenic or narrative structure of the carpet).

  'I must have meaning,' she went on. 'The classes, the odd jobs have no meaning . . . What I really love,' she added wistfully, 'is the theatre.'

  We removed Rebecca from the workshop she hated, and managed to enroll her in a special theatre group. She loved this-it composed her; she did amazingly well: she became a complete person, poised, fluent, with style, in each role. And now if one sees Rebecca on stage, for theatre and the theatre group soon became her life, one would never even guess that she was mentally defective.

  Postscript

  The power of music, narrative and drama is of the greatest practical and theoretical importance. One may see this even in the case of idiots, with IQs below 20 and the extremest motor incompetence and bewilderment. Their uncouth movements may disappear in a moment with music and dancing-suddenly, with music, they know how to move. We see how the retarded, unable to perform fairly simple tasks involving perhaps four or five movements or procedures in sequence, can do these perfectly if they work to music-the sequence of movements they cannot hold as schemes being perfectly holdable as music, i.e. embedded in music. The same may be seen, very dramatically, in patients with severe frontal lobe damage and apraxia-an inability to do things, to retain the simplest motor sequences and programmes, even to walk, despite perfectly preserved intelligence in all other ways. This pro-

  cedural defect, or motor idiocy, as one might call it, which completely defeats any ordinary system of rehabilitative instruction, vanishes at once if music is the instructor. All this, no doubt, is the rationale, or one of the rationales, of work songs.

  What we see, fundamentally, is the power of music to organise-and to do this efficaciously (as well as joyfully!), when abstract or schematic forms of organisation fail. Indeed, it is especially dramatic, as one would expect, precisely when no other form of organisation will work. Thus music, or any other form of narrative, is essential when working with the retarded or apraxic-schooling or therapy for them must be centred on music or something equivalent. And in drama there is still more-there is the power of role to give organisation, to confer, while it lasts, an entire personality. The capacity to perform, to play, to be, seems to be a 'given' in human life, in a way which has nothing to do with intellectual differences. One sees this with infants, one sees it with the senile, and one sees it, most poignantly, with the Rebeccas of this world.

  22

  A Walking Grove

  Martin A., aged 61, was admitted to our Home towards the end of 1983, having become Parkinsonian and unable to look after himself any longer. He had had a nearly fatal meningitis in infancy, which caused retardation, impulsiveness, seizures, and some spasticity on one side. He had very limited schooling, but a remarkable musical education-his father was a famous singer at the Met.

  He lived with his parents until their death, and thereafter eked out a marginal living as a messenger, a porter, and a short-order cook-whatever he could do before he was fired, as he invariably was, because of his slowness, dreaminess or incompetence. It would have been a dull and disheartening life, had it not been for his remarkable musical gifts and sensibilities, and the joy this brought him-and others.

  He had an amazing musical memory-'I know more than 2,000 operas,' he told me on one occasion-although he had never learned or been able to read music. Whether this would have been possible or not was not clear-he had always depended on his extraordinary ear, his power to retain an opera or an oratorio after a single hearing. Unfortunately his voice was not up to his ear-being tuneful, but gruff, with some spastic dysphonia. His innate, hereditary musical gift had clearly survived the ravages of meningitis and brain-damage-or had it? Would he have been a Caruso if undamaged? Or was his musical development, to some extent, a 'compensation' for brain-damage and intellectual limitations? We shall never know. What is certain is that his father transmitted not only his musical genes, but his own great love for music, in the

  intimacy of a father-son relationship, and perhaps the specially tender relation of a parent to a retarded child. Martin-slow, clumsy-was loved by his father, and passionately loved him in return; and their love was cemented by their shared love for music.

  The great sorrow of Martin's life was that he could not follow his father, and be a famous opera and oratorio singer like him- but this was not an obsession, and he found, and gave, much pleasure with what he could do. He was consulted, even by the famous, for his remarkable memory, which extended beyond the music itself to all the details of performance. He enjoyed a modest fame as a 'walking encyclopedia', who knew not only the music of two thousand operas, but all the singers who had taken the roles in countless performances, and all the details of scenery, staging, dress and decor. (He also prided himself on a street-by-street, house-by-house, knowledge of New York-and knowing the routes of all its buses and trains.) Thus, he was an opera-buff, and something of an 'idiot savant' too. He took a certain child-like pleasure in all this-the pleasure of such eidetics and freaks. But the real joy- and the only thing that made life supportable-was actual participation in musical events, singing in the choirs at local churches (he could not sing solo, to his grief, because of his dysphonia), especially in the grand events at Easter and Christmas, the John and Matthew Passions, the Christmas Oratorio, the Messiah, which he had done for fifty years, boy and man, in the great churches and cathedrals of the city. He had also sung at the Met, and, when it was pulled down, at Lincoln Center, discreetly concealed amid the vast choruses of Wagner and Verdi.

  At such times-in the oratorios and passions most of all, but also in the humbler church choirs and chorales-as he soared up into the music Martin forgot that he was 'retarded', forgot all the sadness and badness of his life, sensed a great spaciousness enfold him, felt himself both a true man and a true child of God.

  Martin's world-his inner world-what sort of a world did he have? He had very little knowledge of the world at large, at least very little living knowledge, and no interest at all. If a page of an encyclopedia or newspaper was read to him, or a map of Asia's rivers or New York's subways shown to him, it was recorded,

  instantly, in his eidetic memory. But he had no relation to these eidetic recordings-they were 'a-centric', to use Richard Woll-heim's term, without him, without anyone, or anything, as a living centre
. There seemed little or no emotion in such memories-no more emotion than there is in a street-map of New York-nor did they connect, or ramify, or get generalised, in any way. Thus his eidetic memory-the freak part of him-did not in itself form, or convey any sense of, a 'world'. It was without unity, without feeling, without relation to himself. It was physiological, one felt, like a memory-core or memory-bank, but not part of a real and personal living self.

  And yet, even here, there was a single and striking exception, at once his most prodigious, most personal, and most pious deed of memory. He knew by heart Grove's Dictionary of Music and Musicians, the immense nine-volume edition published in 1954- indeed he was a 'walking Grove'. His father was ageing and somewhat ailing by then, could no longer sing actively, but spent most of his time at home, playing his great collection of vocal records on the phonograph, going through and singing all his scores- which he did with his now thirty-year-old son (in the closest and most affectionate communion of their lives), and reading aloud Grove's dictionary-all six thousand pages of it-which, as he read, was indelibly printed upon his son's limitlessly retentive, if illiterate, cortex. Grove, thereafter, was 'heard' in his father's voice- and could never be recollected by him without emotion.

  Such prodigious hypertrophies of eidetic memory, especially if employed or exploited 'professionally', sometimes seem to oust the real self, or to compete with it, and impede its development. And if there is no depth, no feeling, there is also no pain in such memories-and so they can serve as an 'escape' from reality. This clearly occurred, to a great extent, in Luria's Mnemonist, and is poignantly described in the last chapter of his book. It obviously occurred, to some extent, in Martin A., Jose, and the Twins but was also, in each case, used for reality, even 'super-reality'-an exceptional, intense, and mystical sense of the world . . .