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The Lost Mariner

You have to begin to lose your memory, if only in bits and pieces, to realize that memory is what makes our lives. Life without memory is no life at all…. Our memory is our coherence, our reason, our feeling, even our action. Without it, we are nothing…. (I can only wait for the final amnesia, the one that can erase an entire life, as it did my mother’s….)

Luis Buñuel

This moving and frightening segment in Buñuel’s recently translated memoirs raises fundamental questions—clinical, practical, existential, philosophical: what sort of a life (if any), what sort of a world, what sort of a self, can be preserved in a man who has lost the greater part of his memory, and, with this, his past, and his moorings in time?

It immediately made me think of a patient of mine in whom these questions are precisely exemplified: charming, intelligent, memoryless Jimmie R., who was admitted to our Home for the Aged near New York City early in 1975, with a cryptic transfer note saying, “Helpless, demented, confused and disoriented.”

Jimmie was a fine-looking man, with a curly bush of gray hair, a healthy and handsome forty-nine-year-old. He was cheerful, friendly, and warm.

Hiya, Doc!” he said. “Nice morning! Do I take this chair here?” He was a genial soul, very ready to talk and to answer any questions I asked him. He told me his name and birth date, and the name of the little town in Pennsylvania where he was born. He described it in affectionate detail, even drew me a map. He spoke of the houses where his family had lived—he remembered their phone numbers still. He spoke of school and school days, the friends he’d had, and his special fondness for mathematics and science. He talked with enthusiasm of his days in the navy—he was seventeen, had just graduated from high school when he was drafted in 1943. With his good engineering mind he was a “natural” for radio and electronics, and after a crash course in Texas found himself assistant radio operator on a submarine. He remembered the names of various submarines on which he had served, their missions, where they were stationed, the names of his shipmates. He remembered Morse code, and was still fluent in Morse tapping and touch-typing.

A full and interesting early life, remembered vividly, in detail, with affection. But there, for some reason, his reminiscences stopped. He recalled, and almost relived, his war days and service, the end of the war, and his thoughts for the future. He had come to love the navy, thought he might stay in it. But with the GI Bill, and support, he felt he might do best to go to college. His older brother was in dental school and engaged to a girl, a “real beauty,” from California.

With recalling, reliving, Jimmie was full of animation; he did not seem to be speaking of the past but of the present, and I was very struck by the change of tense in his recollections as he passed from his school days to his days in the navy. He had been using the past tense, but now used the present—and (it seemed to me) not just the formal or fictitious present tense of recall, but the actual present tense of immediate experience.

A sudden, improbable suspicion seized me.

What year is this, Mr. R.?” I asked, concealing my perplexity under a casual manner.

Forty-five, man. What do you mean?” He went on, “We’ve won the war, FDR’s dead, Truman’s at the helm. There are great times ahead.”

And you, Jimmie, how old would you be?”

Oddly, uncertainly, he hesitated a moment, as if engaged in calculation.

Why, I guess I’m nineteen, Doc. I’ll be twenty next birthday.”

Looking at the gray-haired man before me, I had an impulse for which I have never forgiven myself—it was, or would have been, the height of cruelty had there been any possibility of Jimmie’s remembering it.

Here,” I said, and thrust a mirror toward him. “Look in the mirror and tell me what you see. Is that a nineteen-year-old looking out from the mirror?”

He suddenly turned ashen and gripped the sides of the chair. “Jesus Christ,” he whispered. “Christ, what’s going on? What’s happened to me? Is this a nightmare? Am I crazy? Is this a joke?”—and he became frantic, panicky.

It’s okay, Jim,” I said soothingly. “It’s just a mistake. Nothing to worry about. Hey!” I took him to the window. “Isn’t this a lovely spring day. See the kids there playing baseball?” He regained his color and started to smile, and I stole away, taking the hateful mirror with me.

Two minutes later I reentered the room. Jimmie was still standing by the window, gazing with pleasure at the kids playing baseball below. He wheeled around as I opened the door, and his face assumed a cheery expression.

Hiya, Doc!” he said. “Nice morning! You want to talk to me—do I take this chair here?” There was no sign of recognition on his frank, open face.

Haven’t we met before, Mr. R.?” I asked casually.

No, I can’t say we have. Quite a beard you got there. I wouldn’t forget you, Doc!”

Why do you call me ‘Doc’?”

Well, you are a doc, ain’t you?”

Yes, but if you haven’t met me, how do you know what I am?”

You talk like a doc. I can see you’re a doc.”

Well, you’re right, I am. I’m the neurologist here.”

Neurologist? Hey, there’s something wrong with my nerves? And ‘here’—where’s ‘here,’ what is this place anyhow?”

I was just going to ask you—where do you think you are?”

I see these beds, and these patients everywhere. Looks like a sort of hospital to me. But hell, what would I be doing in a hospital—and with all these old people, years older than me. I feel good, I’m strong as a bull. Maybe I work here…. Do I work? What’s my job?… No, you’re shaking your head, I see in your eyes I don’t work here. If I don’t work here, I’ve been put here. Am I a patient, am I sick and don’t know it, Doc? It’s crazy, it’s scary…. Is it some sort of joke?”

You don’t know what the matter is? You really don’t know? You remember telling me about your childhood, growing up in Pennsylvania, working as a radio operator on submarines? And how your brother is engaged to a girl from California?”

Hey, you’re right. But I didn’t tell you that, I never met you before in my life. You must have read all about me in my chart.”

Okay,” I said. “I’ll tell you a story. A man went to his doctor complaining of memory lapses. The doctor asked him some routine questions, and then said, ‘These lapses. What about them?’ ‘What lapses?’ the patient replied.”

So that’s my problem,” Jimmie laughed. “I kinda thought it was. I do find myself forgetting things, once in a while—things that have just happened. The past is clear, though.”

Will you allow me to examine you, to run over some tests?”

Sure,” he said genially. “Whatever you want.”

On intelligence testing he showed excellent ability. He was quick-witted, observant, and logical, and had no difficulty solving complex problems and puzzles—no difficulty, that is, if they could be done quickly. If much time was required, he forgot what he was doing. He was quick and good at tic-tac-toe and checkers, and cunning and aggressive—he easily beat me. But he got lost at chess—the moves were too slow.

Homing in on his memory, I found an extreme and extraordinary loss of recent memory—so that whatever was said or shown or done to him was apt to be forgotten in a few seconds’ time. Thus I laid out my watch, my tie, and my glasses on the desk, covered them, and asked him to remember these. Then, after a minute’s chat, I asked him what I had put under the cover. He remembered none of them—or indeed that I had even asked him to remember. I repeated the test, this time getting him to write down the names of the three objects; again he forgot, and when I showed him the paper with his writing on it he was astounded, and said he had no recollection of writing anything down, though he acknowledged that it was his own writing, and then got a faint “echo” of the fact that he had written them down.

He sometimes retained faint memories, some dim echo or sense of familiarity. Thus five minutes after I had played tic-tac-toe with him, he recollected that “some doctor” had played this with him “a while back”—whether the “while back” was minutes or months ago he had no idea. He then paused and said, “It could have been you!” When I said it was me, he seemed amused. This faint amusement and indifference were very characteristic, as were the involved cogitations to which he was driven by being so disoriented and lost in time. When I asked Jimmie the time of the year, he would immediately look around for some “clue”—I was careful to remove the calendar from my desk—and would “work out” the time of year, roughly, by looking through the window.

It was not, apparently, that he failed to register in memory, but that the memory traces were fugitive in the extreme, and were apt to be effaced within a minute, often less, especially if there were distracting or competing stimuli, while his intellectual and perceptual powers were preserved, and highly superior.

Jimmie’s scientific knowledge was that of a bright high school graduate with a penchant for mathematics and science. He was superb at arithmetical (and also algebraic) calculations but only if they could be done with lightning speed. If there were many steps, too much time, involved, he would forget where he was, and even the question. He knew the elements, compared them, and drew the periodic table—but omitted the transuranic elements.

Is that complete?” I asked when he’d finished.

It’s complete and up-to-date, sir, as far as I know.”

You wouldn’t know any elements beyond uranium?”

You kidding? There’s ninety-two elements, and uranium’s the last.”

I paused and flipped through a National Geographic on the table. “Tell me the planets,” I said, “and something about them.” Unhesitatingly, confidently, he gave me the planets—their names, their discovery, their distance from the sun, their estimated mass, character, and gravity.

What is this?” I asked, showing him a photo in the magazine I was holding.

It’s the moon,” he replied.

No, it’s not,” I answered. “It’s a picture of the earth taken from the moon.”

Doc, you’re kidding! Someone would’ve had to get a camera up there!”

Naturally.”

Hell! You’re joking—how the hell would you do that?”

Unless he were a consummate actor, a fraud simulating an astonishment he did not feel, this was an utterly convincing demonstration that he was still in the past. His words, his feelings, his innocent wonder, his struggle to make sense of what he saw, were precisely those of an intelligent young man in the Forties faced with the future, with what had not yet happened, and what was scarcely imaginable. “This more than anything else,” I wrote in my notes, “persuades me that his ‘cut off’ around 1945 is genuine. … What I showed him, and told him, produced the authentic amazement which it would have done in an intelligent young man of the pre-Sputnik era.”

I found another photo in the magazine and pushed it over to him.

That’s an aircraft carrier,” he said. “Real ultramodern design. I never saw one quite like that.”

What’s it called?” I asked.

He glanced down, looked baffled, and said, “The Nimitz!”

Something the matter?”

The hell there is!” he replied hotly. “I know ‘em all by name, and I don’t know a Nimitz…. Of course there’s an Admiral Nimitz, but I never heard they named a carrier after him.”

Angrily he threw the magazine down.

He was becoming fatigued, and somewhat irritable and anxious, under the continuing pressure of anomaly and contradiction, and their fearful implications, to which he could not be entirely oblivious. I had already, unthinkingly, pushed him into panic, and felt it was time to end our session. We wandered over to the window again, and looked down at the sunlit baseball diamond; as he looked his face relaxed, he forgot the Nimitz, the satellite photo, the other horrors and hints and became absorbed in the game below. Then, as a savory smell drifted up from the dining room, he smacked his lips, said “Lunch!,” smiled, and took his leave.

And I myself was wrung with emotion—it was heartbreaking, it was absurd, it was deeply perplexing, to think of his life lost in limbo, dissolving.

He is, as it were,” I wrote in my notes, “isolated in a single moment of being, with a moat or lacuna of forgetting all round him…. He is man without a past (or future), stuck in a constantly changing, meaningless moment.” And then, more prosaically, “The remainder of the neurological examination is entirely normal. Impression: probably Korsakov’s syndrome, due to alcoholic degeneration of the mammillary bodies.” My note was a strange mixture of facts and observations, carefully noted and itemized, with irrepressible meditations on what such problems might “mean,” in regard to who and what and where this poor man was—whether, indeed, one could speak of an “existence,” given so absolute a privation of memory or continuity.

I kept wondering, in this and later notes—unscientifically—about “a lost soul,” and how one might establish some continuity, some roots, for he was a man without roots, or rooted only in the remote past.

Only connect”—but how could he connect, and how could we help him to connect? What was life without connection? “I may venture to affirm,” Hume wrote, that we are “nothing but a bundle or collection of different perceptions, which succeed each other with an inconceivable rapidity, and are in a perpetual flux and movement.” In some sense, he had been reduced to a “Humean” being—I could not help thinking how fascinated Hume would have been at seeing in Jim his own philosophical “chimera” incarnate, a gruesome reduction of a man to mere disconnected, incoherent flux and change. But a Humean being would not be a being at all, would have no human or personal identity. And Jim was human—all too human—or was he?

Perhaps I could find advice or help in the medical literature—a literature which, for some reason, was largely Russian, from Korsakov’s original thesis (Moscow, 1887) about such cases of memory loss, which are still called “Korsakov’s syndrome,” to Luria’s Neuropsychology of Memory (which appeared in translation only a year after I first saw Jim). Korsakov wrote in 1887:

Memory of recent events is disturbed almost exclusively; recent impressions apparently disappear soonest, whereas impressions of long ago are recalled properly, so that the patient’s ingenuity, his sharpness of wit, and his resourcefulness remain largely unaffected.

To Korsakov’s brilliant but spare observations, almost a century of further research has been added—the richest and deepest, by far, being Luria’s. And in Luria’s account science became poetry, and the pathos of radical lostness was evoked. “Gross disturbances of the organization of impressions of events and their sequence in time can always be observed in such patients,” he wrote. “In consequence, they lose their integral experience of time and begin to live in a world of isolated impressions.” Further, as Luria noted, the eradication of impressions (and their disorder) might spread backward in time—“in the most serious cases … even to relatively distant events.”

Most of Luria’s patients, as described in this book, had massive and serious cerebral tumors, which had the same effects as Korsakov’s syndrome, but later spread and were often fatal. Luria included no cases of “simple” Korsakov’s syndrome, based on the self-limiting destruction that Korsakov described—neuron destruction, produced by alcohol, in the tiny but crucial mammillary bodies, the rest of the brain being perfectly preserved. And so there was no long-term follow-up of Luria’s cases.

I had at first been deeply puzzled, and dubious, even suspicious, about the apparently sharp “cut off” in 1945, a point, a date, which was also symbolically so sharp. After this, I wrote in a subsequent note:

There is a great blank. We do not know what happened then—or subsequently … WE MUST FILL IN THESE “MISSING” YEARS—from his brother, or the Navy, or hospitals he has been to…. Could it be that he sustained some massive trauma at this time, some massive cerebral or emotional trauma in combat, in the War, and that this may have affected him ever since?

We did various tests on him (EEG, brain scans), and found no evidence of massive brain damage, although atrophy of the tiny mammillary bodies would not show up on such tests. We received reports from the navy indicating that he had remained in the navy until 1965, and that he was perfectly competent at that time.

Then we turned up a short nasty report from Bellevue Hospital, dated 1971, saying that he was “totally disoriented … with an advanced organic brain-syndrome, due to alcohol” (cirrhosis had also developed by this time). From Bellevue he was sent to a wretched dump in the Village, a so-called “nursing home” whence he was rescued—lousy, starving—by our Home in 1975.

We located his brother, whom Jim always spoke of as being in dental school and engaged to a girl from California. In fact he had married the girl from California, had become a father and grandfather, and been in dental practice for thirty years.

Where we had hoped for an abundance of information and feeling from his brother, we received a courteous but somewhat meager letter. It was obvious from reading this—especially reading between the lines—that the brothers had scarcely seen each other since 1943, and gone separate ways, partly through the vicissitudes of location and profession, and partly through deep (though not estranging) differences of temperament. Jim, it seemed, had never “settled down,” was “happy-go-lucky,” and “always a drinker.” The navy, his brother felt, provided a structure, a life, and the real problems started when he left it, in 1965. Without his habitual structure and anchor Jim had ceased to work, “gone to pieces,” and started to drink heavily. There had been some memory impairment, of the Korsakov type, in the middle and especially the late Sixties, but not so severe that Jimmie couldn’t “cope” in his nonchalant fashion. But his drinking grew heavier in 1970.

Around Christmas of that year, his brother understood, he had suddenly “blown his top” and become deliriously excited and confused, and it was at this point that he had been taken into Bellevue. During the next month, the excitement and delirium died down, but he was left with deep and bizarre memory lapses, or “deficits,” to use the medical jargon. His brother had visited him at this time—they had not met for twenty years—and, to his horror, Jimmie not only failed to recognize him, but said, “Stop joking! You’re old enough to be my father. My brother’s a young man, just going through dental school.”

When I received this information, I was more perplexed still: why did Jimmie not remember his later years in the navy, why did he not recall and organize his memories until 1970? I had not heard then that such patients might have a retrograde amnesia.1 “I wonder, increasingly,” I wrote at this time, “whether there is not an element of hysterical or fugal amnesia—whether he is not in flight from something too awful to recall,” and I suggested he be seen by our psychiatrist. Her report was searching and detailed—the examination had included a sodiumamytal test, calculated to “release” any memories which might be repressed. She also attempted to hypnotize Jimmie, in the hope of eliciting memories repressed by hysteria—this tends to work well in cases of hysterical amnesia. But it failed because Jim could not be hypnotized, not because of any “resistance,” but because of his extreme amnesia, which caused him to lose track of what the hypnotist was saying. (Dr. M. Homonoff, who worked on the amnesia ward at the Boston Veterans Administration hospital, tells me of similar experiences—and of his feeling that this is absolutely characteristic of patients with Korsakov’s, as opposed to patients with hysterical amnesia.)

I have no feeling or evidence,” the psychiatrist wrote, “of any hysterical or ‘put-on’ deficit. He lacks both the means and the motive to make a façade. His memory deficits are organic and permanent and incorrigible, though it is puzzling they should go back so long.” Since, she felt, he was “unconcerned … manifested no special anxiety … constituted no management problem,” there was nothing she could offer, or any therapeutic “entrance” or “lever” she could see.

At this point, persuaded that this was, indeed, “pure” Korsakov’s, uncomplicated by other factors, emotional or organic, I wrote to Luria and asked his opinion. He spoke in his reply of his patient Bel,2 whose amnesia had retroactively eradicated ten years. He said he saw no reason why such a retrograde amnesia should not thrust backward decades, or almost a whole lifetime. “I can only wait for the final amnesia,” Buñuel writes, “the one that can erase an entire life.” But Jimmie’s amnesia, for whatever reason, had erased memory and time back to 1945—roughly—and then stopped. Occasionally, he would recall something much later, but the recall was fragmentary and dislocated in time. Once, seeing the word “satellite” in a newspaper headline, he said offhandedly that he’d been involved in a project of satellite tracking while on the ship Norton Sound, a memory fragment coming from the early or mid-Sixties. But, for all practical purposes, his “cut-off point” was during the mid- (or late) Forties, and anything subsequently retrieved was fragmentary, unconnected. This was the case in 1975, and it is still the case now nine years later.

What could we do? What should we do? “There are no prescriptions,” Luria wrote, “in a case like this. Do whatever your ingenuity and your heart suggest. There is little or no hope of any recovery in his memory. But a man does not consist of memory alone. He has feeling, will, sensibilities, moral being—matters of which neuropsychology cannot speak. And it is here, beyond the realm of an impersonal psychology, that you may find ways to touch him, and change him. And the circumstances of your work especially allow this, for you work in a Home, which is like a little world, quite different from the clinics and institutions where I work. Neuropsychologically, there is little or nothing you can do; but in the realm of the Individual, there may be much you can do.”

Luria mentioned his patient Kur as manifesting a rare self-awareness, in which hopelessness was mixed with an odd equanimity. (“I have no memory of the present,” Kur would say. “I do not know what I have just done or from where I have just come…. I can recall my past very well, but I have no memory of my present.”) When asked whether he had ever seen the person testing him, he said, “I cannot say yes or no, I can neither affirm nor deny that I have seen you.” This was sometimes the case with Jimmie; and, like Kur, who stayed many months in the same hospital, Jimmie began to form “a sense of familiarity”; he slowly learned his way around the home—the whereabouts of the dining room, his own room, the elevators, the stairs, and in some sense recognized some of the staff, although he confused them, and perhaps had to do so, with people from the past. He soon became fond of the nursing sister in the Home; he recognized her voice, her footfalls, immediately, but would always say that she had been a fellow pupil at his high school, and was greatly surprised when I addressed her as “Sister.” “Gee!” he exclaimed, “the damnedest things happen. I’d never have guessed you’d become a religious, Sister!”

Since he’s been at our Home—that is, since early 1975—Jim has never been able to identify anyone in it consistently. The only person he truly recognizes is his brother, whenever he visits from California. These meetings are deeply emotional and moving to observe—the only truly emotional meetings Jim has. He loves his brother, he recognizes him, but he cannot understand why he looks so old: “Guess some people age fast,” he says. Actually his brother looks much younger than his age, and has the sort of face and build that change little with the years. These then are true meetings, Jim’s only connection of past and present, yet they do nothing to provide any sense of history or continuity. If anything they emphasize—at least to his brother, and to others who see them together—that Jim still lives, is fossilized, in the past.

All of us, at first, had high hopes of helping Jim—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.

I suggested, when I first saw him, that he should keep a diary, and be encouraged to keep notes every day of his experiences, his feelings, thoughts, memories, reflections. These attempts were foiled, at first, by his continually losing the diary: it had to be attached to him—somehow. But this too failed to “work”: he dutifully kept a brief daily notebook but could not recognize his earlier entries in it. He does recognize his own writing, and style, and is always astounded to find that he wrote something the day before.

Astounded—and indifferent—for he was a man who, in effect, had no “day before.” His entries remained unconnected and unconnecting and had no power to provide any sense of time or continuity. Moreover, they were trivial—“Eggs for breakfast,” “Watched ballgame on TV”—and never touched the depths. But were there depths in this unmemoried man, depths of an abiding feeling and thinking, or had he been reduced to a sort of Humean drivel, a mere succession of unrelated impressions and events?

Jimmie both was and wasn’t aware of this deep, tragic loss in himself, loss of himself. (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.) Therefore I could not question him intellectually about such matters.

He had originally professed bewilderment at finding himself amid patients, when, as he said, he himself didn’t feel ill. But what, we wondered, did he feel? He was strongly built and fit, he had a sort of animal strength and energy, but also a strange inertia, passivity, and (as everyone remarked) “unconcern”; he gave all of us an overwhelming sense of “something missing,” although this, if he realized it, was itself accepted with an odd “unconcern.” One day I asked him not about his memory, or past, but about the simplest and most elemental feelings of all:

How do you feel?”

How do I feel,” he repeated, and scratched his head. “I cannot say I feel ill. But I cannot say I feel well. I cannot say I feel anything at all.”

Are you miserable?” I continued.

Can’t say I am.”

Do you enjoy life?”

I can’t say I do….”

I hesitated, fearing that I was going too far, that I might be stripping a man down to some hidden, unacknowledgeable, unbearable despair.

You don’t enjoy life,” I repeated, hesitating somewhat. “How then do you feel about life?”

I can’t say that I feel anything at all.”

You feel alive though?”

” ‘Feel alive’ … Not really. I haven’t felt alive for a very long time.”

His face wore a look of infinite sadness and resignation.

Later, having noted his aptitude for, and pleasure in, quick games and puzzles, and their power to “hold” him, at least while they lasted, and to allow, for a while, a sense of companionship and competition—he had not complained of loneliness, but he looked so alone; he never expressed sadness, but he looked so sad—I suggested he be brought into our recreation programs at the Home. This worked better—better than the diary. He would become keenly and briefly involved in games, but soon they ceased to offer any challenge: he solved all the puzzles, and could solve them easily; and he was far better and sharper than anyone else at games. And as he found this out, he grew fretful and restless again, and wandered the corridors, uneasy and bored and with a sense of indignity—games and puzzles were for children, a diversion. Clearly, passionately, he wanted something to do: he wanted to do, to be, to feel—and could not; he wanted sense, he wanted purpose—in Freud’s words, “Work and Love.”

Could he do “ordinary” work? He had “gone to pieces,” his brother said, when he ceased to work in 1965. He had two striking skills—Morse code and touch-typing. We could not use Morse, unless we invented a use; but good typing we could use, if he could recover his old skills—and this would be real work, not just a game. Jim soon did recover his old skills and came to type very quickly—he could not do it slowly—and found in this some of the challenge and satisfaction of a job. But still this was superficial tapping and typing; it was trivial, it did not touch the depths. And what he typed, he typed mechanically—he could not hold the thought—the short sentences following one another in a meaningless order.

One tended to speak of him, instinctively, as a spiritual casualty—a “lost soul”: was it possible that he had really been “de-souled” by a disease? “Do you think he has a soul?” I once asked the Sisters. They were outraged by my question, but could see why I asked it. “Watch Jimmie in chapel,” they said, “and judge for yourself.”

I did, and I was moved, profoundly moved and impressed, because I saw here an intensity and steadiness of attention and concentration that I had never seen before in him or conceived him capable of. I watched him pray, I watched him at Mass, I watched him kneel and take the Sacrament on his tongue, and could not doubt the fullness and totality of Communion, the perfect alignment of his spirit with the spirit of the Mass. Fully, intensely, quietly, in the quietude of absolute concentration and attention, he entered and partook of the Holy Communion. He was wholly held, absorbed, by a feeling. There was no forgetting, no Korsakov’s then, nor did it seem possible or imaginable that there should be; for he was no longer at the mercy of a faulty and fallible mechanism—that of meaningless sequences and memory traces—but was absorbed in an act, an act of his whole being, which carried feeling and meaning in an organic continuity and unity, a continuity and unity so seamless it could not permit any break.

Clearly Jim found himself, found continuity and reality, in the absoluteness of spiritual attention and act. The sisters were right—he did find his soul here. 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.

But perhaps “moral” was too narrow a word—for the aesthetic and dramatic were equally involved. Seeing Jim in the chapel opened my eyes to other realms where the soul is called on, and held, and stilled, in attention and communion. The same depth of absorption and attention was to be seen in relation to music and art: he had no difficulty, I noticed, “following” music or simple dramas, for every moment in music and art refers to, contains, other moments. He likes gardening, and has taken over some of the work in our garden. At first he greeted the garden each day as new, but for some reason this has become more familiar to him than the inside of the Home. He almost never gets lost or disoriented in the garden now; he patterns it, I think, on loved and remembered gardens from his youth in Pennsylvania.

Jim, who was so lost in extensional “spatial” time, was perfectly organized in Bergsonian “intentional” time; what was fugitive, unsustainable, as formal structure, was perfectly stable, perfectly held, as art or will. Moreover, there was something that endured and survived. If Jim was briefly “held” by a task or puzzle or game or calculation, held in the purely mental challenge of these, he would fall apart as soon as they were done, into the abyss of his nothingness, his amnesia. But if he were held in emotional and spiritual attention—in the contemplation of nature or art, in listening to music, in taking part in the Mass in chapel—the attention, its “mood,” its quietude, would persist for a while, and there would be in him a pensiveness and peace we rarely, if ever, saw during the rest of his life at the Home.

I have known Jim now for nine years—and neuropsychologically, he has not changed in the least. He still has the severest, most devastating Korsakov’s, cannot remember isolated items for more than a few seconds, and has a dense amnesia going back to 1945. But humanly, spiritually, he is at times a different man altogether—no longer fluttering, restless, bored, and lost, but deeply attentive to the beauty and “soul” of the world, rich in all the Kierkegaardian categories—the aesthetic, the moral, the religious, the dramatic. I had wondered, when I first met him, if he were not condemned to a sort of “Humean” froth, a meaningless fluttering on the surface of life, and whether there was any way of transcending the incoherence of his Humean disease. Empirical science told me there was not—but empirical science, empiricism, takes no account of the soul, no account of what constitutes and determines personal being. 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.

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    My ignorance. I know now that retrograde amnesia, to some degree, is very common, if not universal, in cases of Korsakov’s. The classical Korsakov’s syndrome—a profound and permanent, but “pure,” devastation of memory caused by alcoholic destruction of the mammillary bodies—is rare, even among very heavy drinkers. One may, of course, see Korsakov’s syndrome with other pathologies, as in Luria’s patients with tumors. A particularly fascinating case of an acute (and mercifully transient) Korsakov’s syndrome has been well described only very recently in the so-called Transient Global Amnesia (TGA) which may occur with head injuries, or impaired blood supply to the brain. Here, for a few minutes or hours, a severe and singular amnesia may occur, even though the patient may continue to drive a car, or, perhaps, to carry on medical or editorial duties, in a mechanical way. But under this fluency lies a profound amnesia—every sentence uttered being forgotten as soon as it is said, everything forgotten within a few minutes of being seen, though long-established memories and routines may be perfectly preserved.

    Further, there may be a profound retrograde amnesia in such cases. My colleague Dr. Leon Protass tells me of such a case seen by him recently, in which the patient, a highly intelligent man, was unable for some hours to remember his wife or children, to remember that he had a wife or children. In effect, he lost thirty years of his life—though, fortunately, for only a few hours. Recovery from such attacks is prompt and complete—yet they are, in a sense, the most horrifying of “little strokes” in their power absolutely to annul or obliterate decades of richly lived, richly achieving, richly memoried life. The horror, typically, is only felt by others—the patient, unaware, amnesiac for his amnesia, may continue what he is doing, quite unconcerned, and only discover later that he lost not only a day (as is common with ordinary alcoholic “blackouts”), but half a lifetime, and never knew it. The fact that one can lose the greater part of a lifetime has peculiar, uncanny horror.

    There could be only one thing worse—and that would be to lose one’s entire lifetime. My friend Dr. Isabelle Rapin, author of Children with Brain Dysfunction: Neurology, Cognition, Language, and Behavior, tells me that very rarely, in consequence of certain brain tumors or degenerative diseases, children may develop a severe Korsakov’s syndrome. If this happens, it has been thought, they risk losing their childhood and even their infancy from a retrograde amnesia which may extend back to birth. Such children may not only become as helpless as newborns but may also become deeply “autistic” as they lose and forget all human relationships, even the most elemental—the memory of mother love.

    In adulthood, life, higher life, may be brought to a premature end by strokes, senility, brain injuries, etc., but there usually remains the consciousness of life lived, of one’s past. This is usually felt as a sort of compensation: “At least I lived fully, tasting life to the full, before I was brain-injured, stricken, etc.” This sense of “the life lived before,” which may be either a consolation or a torment, is precisely what is taken away in retrograde amnesia. The “final amnesia, the one that can erase a whole life” that Buñuel speaks of may occur, perhaps, in a terminal dementia, but not, in my experience, suddenly, in consequence of a stroke. But there is a different, yet comparable, sort of amnesia, which can occur suddenly—different in that it is not “global” but “modality-specific.”

    Thus, in one patient under my care, a sudden thrombosis in the posterior circulation of the brain caused the immediate death of the visual parts of the brain. Forthwith this patient became completely blind—but did not know it. He looked blind—but he made no complaints. Questioning and testing showed, beyond doubt, that not only was he centrally or “cortically” blind, but he had lost all visual images and memories, lost them totally—yet had no sense of any loss. Indeed, he had lost the very idea of “seeing”—and was not only unable to describe anything visually, but bewildered when I used words such as “seeing” and “light.” He had become, in essence, a nonvisual being. His entire lifetime of seeing, of visuality, had, in effect, been stolen. His whole visual life had, indeed, been erased—and erased permanently in the instant of his stroke. Such a visual amnesia, and (so to speak) blindness to the blindness, amnesia for the amnesia, is in effect a “total” Korsakov’s, confined to visuality.

    A still more limited, but nonetheless total, amnesia may be displayed with regard to particular forms of perception. Thus, in one patient whose history I have already described (“The Man Who Mistook his Wife for a Hat,” London Review of Books, vol. 5, no. 9, May 1983), there was an absolute “prosopagnosia,” or agnosia for faces. This patient was not only unable to recognize faces, but unable to imagine or remember any faces—he had indeed lost the very idea of a “face,” as my more afflicted patient had lost the very idea of “seeing” or “light.” Such syndromes were described by Anton in the 1890s. But the implication of these syndromes—Korsakov’s and Anton’s—what they entail and must entail for the “world,” the lives, the identities, of affected patients, has been scarcely touched on even to this day.

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    See A.R. Luria, The Neuropsychology of Memory (Halsted Press, 1976), pp. 250–252.

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