The Man Who Mistook His Wife For A Hat and Other Clinical Tales - читать бесплатно онлайн полную версию книги автора Oliver Wolf Sacks (ч. notes)

Примечания

1

Later, by accident, he got it on, and exclaimed, ‘My God, it’s a glove!’ This was reminiscent of Kurt Goldstein’s patient ‘Lanuti’, who could only recognise objects by trying to use them in action.

2

I have often wondered about Helen Keller’s visual descriptions, whether these, for all their eloquence, are somehow empty as well? Or whether, by the transference of images from the tactile to the visual, or, yet more extraordinarily, from the verbal and the metaphorical to the sensorial and the visual, she did achieve a power of visual imagery, even though her visual cortex had never been stimulated, directly, by the eyes? But in Dr P.’s case it is precisely the cortex that was damaged, the organic prerequisite of all pictorial imagery. Interestingly and typically he no longer dreamed pictonally—the ‘message’ of the dream being conveyed in nonvisual terms.

3

Thus, as I learned later from his wife, though he could not recognise his students if they sat still, if they were merely ‘images’, he might suddenly recognise them if they moved. ‘That’s Karl,’ he would cry. ‘I know his movements, his body-music’

4

Only since the completion of this book have I found that there is, in fact, a rather extensive literature on visual agnosia in general, and prosopagnosia in particular. In particular I had the great pleasure recently of meeting Dr Andrew Kertesz, who has himself published some extremely detailed studies of patients with such agnosias (see, for example, his paper on visual agnosia, Kertesz 1979). Dr Kertesz mentioned to me a case known to him of a farmer who had developed prosopagnosia and in consequence could no longer distinguish (the faces of) his cows, and of another such patient, an attendant in a Natural History Museum, who mistook his own reflection for the diorama of an ape. As with Dr P., and as with Macrae and Trolle’s patient, it is especially the animate which is so absurdly misperceived. The most important studies of such agnosias, and of visual processing in general, are now being undertaken by A. R. and H. Damasio (see article in Mesulam [1985], pp. 259-288; or see p. 79 below).

5

After writing and publishing this history I embarked with Dr Elkhonon Goldberg— a pupil of Luria and editor of the original (Russian) edition of The Neuropsychology of Memory—on a close and systematic neuropsychological study of this patient. Dr Goldberg has presented some of the preliminary findings at conferences, and we hope in due course to publish a full account.

6

In his fascinating oral history The Good War (1985) Studs Terkel transcribes countless stories of men and women, especially fighting men, who felt World War II was intensely real—by far the most real and significant time of their lives—everything since as pallid in comparison. Such men tend to dwell on the war and to relive its battles, comradeship, moral certainties and intensity. But this dwelling on the past and relative hebetude towards the present—this emotional dulling of current feeling and memory—is nothing like Jimmie’s organic amnesia. 1 recently had occasion to discuss the question with Terkel: ‘I’ve met thousands of men,’ he told me, ‘who feel they’ve just been “marking time” since ‘45—but I never met anyone for whom time terminated, like your amnesiac Jimmie.’

7

See A.R. Luria, The Neuropsychology of Memory (1976), pp. 250-2.

8

Such sensory polyneuropathies occur, but are rare. What was unique in Chris-tina’s case, to the best of our knowledge at the time (this was in 1977), was the extraordinary selectivity displayed, so that proprioceptive fibres, and these only, bore the brunt of the damage. But see Sterman (1979).

9

Contrast the fascinating case described by the late Purdon Martin in The Basal Ganglia and Posture (1967), p. 32: ‘This patient, in spite of years of physiotherapy and training, has never regained the ability to walk in any normal manner. His greatest difficulty is in starting to walk and in propelling himself forward ... He is also unable to rise from a chair. He cannot crawl or place himself in the all-fours posture. When standing or walking he is entirely dependent on vision and falls down if he closes his eyes. At first he was unable to maintain his position on an ordinary chair when he closed his eyes, but he has gradually acquired the ability to do this.’

10

Purdon Martin, almost alone of contemporary neurologists, would often speak of facial and vocal ‘posture’, and their basis, finally, in proprioceptive integrity. He was greatly intrigued when 1 told him about Christina and showed him some films and tapes of her—many of the suggestions and formulations here are, in fact, his.

11

‘Feeling-tone’ is a favourite term of Head’s, which he uses in regard not only to aphasia but to the affective quality of sensation, as it may be altered by thalmic or peripheral disorders. Our impression, indeed, is that Head is continually half-uncon-sciously drawn towards the exploration of ‘feeling-tone’—towards, so to speak, a neurology of feeling-tone, in contrast or complementarity to a classical neurology of proposition and process. It is, incidentally, a common term in the U.S.A., at least among blacks in the South: a common, earthy and indispensable term. ‘You see, there’s such a thing as a feeling tone . . . And if you don’t have this, baby, you’ve had it’ (cited by Studs Terkel as epigraph to his 1967 oral history Division Street: America).

12

A very similar situation happened with muscular dystrophy, which was never seen until Duchenne described it in the 1850s. By 1860, after his original description, many hundreds of cases had been recognised and described, so much so that Charcot said: ‘How come that a disease so common, so widespread, and so recognisable at a glance— a disease which has doubtless always existed—how come that it is only recognised now? Why did we need M. Duchenne to open our eyes?’

13

Indeed such a novel has been written. Shortly after ‘The Lost Mariner’ (Chapter Two) was published, a young writer named David Gilman sent me the manuscript of his book Croppy Boy, the story of an amnesiac like Mr Thompson, who enjoys the wild and unbridled license of creating identities, new selves, as he whims, and as he must—an astonishing imagination of an amnesiac genius, told with positively Joycean richness and gusto. 1 do not know whether it has been published; 1 am very sure it should be. I could not help wondering whether Mr Gilman had actually met (and studied) a ‘Thompson’—as I have often wondered whether Borges’ ‘Funes’, so uncannily similar to Luria’s Mnemonist, may have been based on a personal encounter with such a mnemonist.

14

A similar inability to perceive vocal tone or expression (tonal agnosia) was shown by my patient Emily D. (see ‘The President’s Speech’, Chapter Nine).

15

Somewhat similar states—a strange emotionalism; sometimes nostalgia, ‘reminiscence’ and deja vu associated with intense olfactory hallucinations, are characteristic of ‘uncinate seizures’, a form of temporal-lobe epilepsy first described by Hughlings Jackson about a century ago. Usually the experience is rather specific, but sometimes there is a generalised intensification of smell, a hyperosmia. The uncus, phylogenetically part of the ancient ‘smell-brain’ (or rhinencephalon), is functionally associated with the whole limbic system, which is increasingly recognised to be crucial in determining and regulating the entire emotional ‘tone’. Excitation of this, by whatever means, produces heightened emotionalism and an intensification of the senses. The entire subject, with its intriguing ramifications, has been explored in great detail by David Bear (1979).

16

This is well described by A.A. Brill (1932), and contrasted with the overall brilliance, the redolence, of the smell-world, in macrosomatic animals (such as dogs), ‘savages’ and children.

17

See Jonathan Miller’s critique of Head, entitled ‘The Dog Beneath the Skin’, in the Listener (1970).

18

And yet this was not invariably so. In one particularly horrifying, traumatic case, recorded by Penfield, the patient, a girl of twelve, seemed to herself, in every seizure, to be running frantically from a murderous man who was pursuing her with a writhing bag of snakes. This ‘experiential hallucination’ was a precise replay of an actual horrid incident, which had occurred five years before.

19

All of Luria’s early work was done in these three allied domains, his field-work with children in primitive communities in Central Asia, and his studies in the Institute of Defectology. Together these launched his lifelong exploration of human imagination.

20

See Francis Yates’ extraordinary book so titled (1966).

21

W.A. Horwitz, etal. (1965), Hamblin (1966).

22

Something comparable to Buxton’s mode, which perhaps appears the more ‘unnatural’ of the two, was shown by my patient Miriam H. in Awakenings when she had ‘arithmomanic’ attacks.

23

Particularly fascinating and fundamental problems are raised by the perception and recognition of faces—for there is much evidence that we recognise faces (at least familiar faces) directly—and not by any process of piecemeal analysis or aggregation. This, as we have seen, is most dramatically shown in ‘prosopagnosia’, in which, as a consequence of a lesion in the right occipital cortex, patients become unable to recognise faces as such, and have to employ an elaborate, absurd, and indirect route, involving a bit-by-bit analysis of meaningless and separate features (Chapter One).

24

On the other hand, should this discussion be thought too singular or perverse, it is important to note that in the case of the twins studied by Luria, their separation was essential for their own development, ‘unlocked’ them from a meaningless and sterile babble and bind, and permitted them to develop as healthy and creative people.