Greg F. grew up in the 1950s in a comfortable Queens household, an attractive and rather gifted boy who seemed destined, like his father, for a professional career—perhaps a career in songwriting, for which he showed a precocious talent. But he grew restive, started questioning things, when he was fifteen; started to hate the conventional life of his parents and neighbors, and the cynical, bellicose administration of the country. His need to rebel, but equally to find an ideal and a guide, to find a leader, crystallized in the “Summer of Love,” in 1967. He would go to the Village, and listen to Allen Ginsberg declaiming all night; he loved rock music, especially acid rock, and, above all, the Grateful Dead.
Increasingly he fell out with his parents and teachers—was truculent with the one, secretive with the other. In 1968, a time when Timothy Leary was urging American youth to “tune in, turn on, and drop out,” Greg grew his hair long and dropped out of school, where he had been a good student; he left home and went to live in the Village, where he dropped acid, and joined the East Village drug culture—searching, like others of his generation, for utopia, for inner freedom, and for “higher consciousness.”
But “turning on” did not satisfy Greg, who stood in need of a more codified philosophy, doctrine, and way of life. In 1969 he gravitated, as so many young acid heads did, to the Swami Bhaktivedanta, and his society for Krishna Consciousness, on Second Avenue. And under his influence, Greg, like so many others, stopped taking acid, finding his religious exaltation a replacement for his acid highs. “The only radical remedy for dipsomania,” as William James wrote, “is religiomania.” The philosophy, the fellowship, the chanting, the rituals, the austere and charismatic figure of the swami himself came like a revelation to Greg, and he became, almost immediately, a passionate devotee and convert.1 Now there was a center, a focus, to his life. In those first, exalted weeks of his conversion, he wandered around the East Village, dressed in saffron robes, chanting the Hare Krishna mantras; and early in 1970, he took up residence in the main temple in Brooklyn. His parents objected at first, then went along with this. “Perhaps it will help him,” his father said, philosophically. “Perhaps—who knows?—this is the path he needs to follow.”
Greg’s first year at the temple went well, he was obedient, ingenuous, devoted, and pious. He is a Holy One, said the swami, one of us. Early in 1971, now deeply committed, Greg was sent to the temple in New Orleans. His parents had seen him occasionally when he was in the Brooklyn temple, but now all communication from him virtually ceased.
One problem arose in Greg’s second year with the Krishnas—he complained that his vision was growing dim, but this was interpreted, by his swami and others, in a spiritual way: he was “an illuminate,” they told him; it was the “inner light” growing. Greg had worried at first about his eyesight, but was reassured by the swami’s spiritual explanation. His sight grew still dimmer, but he offered no further complaints. And indeed, he seemed to be becoming more spiritual by the day—an amazing new serenity had taken hold of him. He no longer showed his previous impatience or appetites, and he was sometimes found in a sort of daze, with a strange (many said “transcendental”) smile on his face. It is beatitude, said his swami: he is becoming a saint. The temple felt he needed to be protected at this stage—he no longer went out or did anything unaccompanied—and contact with the outside world was strongly discouraged.
Although Greg’s parents did not have any direct communication from him, they did get occasional reports from the temple—reports filled, increasingly, with accounts of his “spiritual progress,” his “enlightenment,” accounts at once so vague and so out of character with the Greg they knew that, by degrees, they became alarmed. Once they wrote directly to the swami, and received a soothing, reassuring reply.
Three more years passed before Greg’s parents finally decided they had to see for themselves. His father, a man of nearly fifty when Greg was born, was now elderly and in poor health, and feared that if he waited longer he might never see his “lost” son again. On hearing this, the temple finally permitted a visit from Greg’s parents. In 1975, then, not having seen him for four years, they visited their son in the temple in New Orleans.
When they did so, they were filled with horror: their lean, hairy son had become fat and hairless; he wore a continual “stupid” smile on his face (this at least was his father’s word for it); he kept bursting into bits of song and verse, and making “idiotic” comments, while showing little deep emotion of any kind (“like he was scooped out, hollow inside,” his father said); he had lost interest in everything “current”; he was disoriented—and he was totally blind. The temple, surprisingly, acceded to his leaving—perhaps even they felt now that his ascension had gone too far, and had started to feel some disquiet about his state.
Greg was admitted to the hospital, examined, and transferred to neurosurgery. Brain imaging had shown an enormous tumor of the pituitary gland, destroying the adjacent optic chiasm and tracts, and extending on both sides into the frontal lobes. It also reached backward to the temporal lobes, and downward to the forebrain, or diencephalon. At surgery, the tumor was found to be benign, but it had swollen to the size of a small grapefruit or orange, and though the surgeons were able to remove it entirely, they could not undo the damage it had already done.
Greg was now not only blind, but gravely disabled neurologically and mentally—a disaster which could have been prevented entirely had his first complaints of dimming vision been heeded, and had medical sense, and even common sense, been allowed to judge his state. Since, tragically, no recovery could be expected, or very little, Greg was admitted to Williamsbridge, a hospital for the chronically sick, a twenty-five-year-old boy for whom active life had come to an end, and for whom the prognosis was “hopeless.”
I first met Greg in April 1977, when he arrived at Williamsbridge Hospital. Lacking facial hair, and childlike in manner, he seemed younger than his twenty-five years. He was fat, Buddha-like, with a vacant, bland face, his blind eyes roving at random in their orbits, while he sat motionless in his wheelchair. If he lacked spontaneity, and initiated no exchanges, he responded promptly and appropriately, and with wit, when I spoke to him. But his answers were short, never expanded the question, never gave rise to associations or reflection. Between questions, if the time was not filled, there tended to be a deepening silence; and if this lasted for more than a minute, he would fall into Hare Krishna chants, or to a soft muttering of mantras. He was still, he said, “a total believer,” devoted to the group’s doctrines and aims.
I could not get any consecutive history from him—he was not sure, for a start, why he was in the hospital, and gave different reasons when I asked him about this; first he said, “Because I’m not intelligent,” later, “Because I took drugs in the past.” He knew he had been at the main Hare Krishna temple (“a big red house, 439 Henry Street, in Brooklyn”), but not that he had subsequently been at their temple in New Orleans. Nor did he remember that he started to have symptoms there—first and foremost a progressive loss of vision. Indeed he seemed unaware that he had any problems: that he was blind, that he was unable to walk steadily, that he was in any way ill.
Unaware—and indifferent. Ill, blind, incorrigibly disabled, he had been dumped in a hospital for the chronically sick with no prospect of ever getting out or recovering; but nothing of this seemed real to him at all. He seemed bland, placid, emptied of all feeling—it was this unnatural serenity which his Krishna brethren had perceived, apparently, as “bliss,” and indeed, at one point, Greg used the term himself. “How do you feel?” I returned to this again and again. “I feel blissful,” he replied at one point, “I am afraid of falling back into the material world.” At this point, when he was first in the hospital, many of his Hare Krishna friends would come to visit him; I often saw their saffron robes in the corridors. They would come to visit poor, blind, blank Greg, and flock around him; they saw him as having achieved “detachment,” as an enlightened one.
Questioning him about current events and people, I found the depths of his disorientation and confusion. When I asked him who was the president, he said “Lyndon,” then, “the one who got shot.” I prompted, “Jimmy…” and he said, “Jimi Hendrix,” and when I roared with laughter, he said maybe a musical White House would be a good idea. A few more questions convinced me that Greg had virtually no memory of events much past 1970, certainly no coherent, chronological memory of them. He seemed to have been left, marooned, in the Sixties—his memory, his development, his inner life since then had come to a stop.
His tumor, a slow-growing one, was huge when it was finally removed in 1976; but only in the later stages of its growth, as it destroyed the memory system in the temporal lobe, would it actually have prevented the brain from registering new events. But Greg had difficulties—not absolute, but partial—even in remembering events from the late Sixties, events which he must have registered perfectly at the time. So, beyond the inability to register new experiences, there had been an erosion of existing memories (a retrograde amnesia) going back several years before his tumor had developed. There was not an absolutely sharp cutoff here, but rather a temporal gradient, so that figures and events from 1966 and 1967 were fully remembered, events from 1968 or 1969 partially or occasionally remembered, and events after 1970 almost never remembered.
It was easy to demonstrate the severity of his immediate amnesia. If I gave him lists of words, he was unable to recall any of them after a minute. When I told him a story and asked him to repeat it, he did so in a more and more confused way, with more and more “contaminations” and misassociations—some droll, some extremely bizarre—until within five minutes his story bore no resemblance to the one I had told him. Thus when I told him a tale about a lion and a mouse, he soon departed from the original story and had the mouse threatening to eat the lion—it had become a giant mouse and a mini-lion. Both were mutants, Greg explained when I quizzed him on his departures. Or possibly, he said, they were creatures from a dream, or “an alternative history” in which mice were indeed the lords of the jungle. Five minutes later, he had no memory of the story whatever.
I had heard, from the hospital social worker, that he had a passion for music, especially for rock-and-roll bands of the Sixties; I saw piles of records as soon as I entered his room, and a guitar lying against his bed. So now I asked him about this, and with this there came a complete transformation—he lost his disconnectedness, his indifference, and spoke with great animation about his favorite rock bands and pieces—above all, of the Grateful Dead. “I went to see them at the Fillmore East, and in Central Park,” he said. He remembered the entire program in detail, but “my favorite,” he added, “is ‘Tobacco Road.”‘ The title evoked the tune, and Greg sang the whole song with great feeling and conviction—a depth of feeling of which, hitherto, he had not shown the least sign. He seemed transformed, a different person, a whole person, as he sang. “When did you hear them in Central Park?” I asked.
“It’s been a while, over a year maybe,” he answered—but in fact they had last played there eight years earlier, in 1969. And the Fillmore East, the famous rock-and-roll theater where Greg had also seen the group, did not survive the early 1970s. He went on to tell me he once heard Jimi Hendrix at Hunter College, and Cream, with Jack Bruce playing bass guitar, Eric Clapton, lead guitar, and Ginger Baker, a “fantastic drummer.” “Jimi Hendrix,” he added reflectively, “What’s he doing? I don’t hear much about him nowadays.” We spoke of the Rolling Stones and the Beatles—“Great groups,” Greg commented, “but they don’t have the soul, they don’t space me out, the way the Dead do. What a group,” he continued, “there’s no one like them. Jerry Garcia—he’s a saint, he’s a guru, he’s a genius. Mickey Hart, Bill Kreutzmann, the drummers are great. There’s Bob Weir, there’s Phil Lesh; but Pigpen—I love him.”
This narrows down the extent of his amnesia. He remembers songs vividly from 1964 to 1968. He remembers all the founding members of the Grateful Dead, from 1967. But he is unaware that Pigpen, Jimi Hendrix, and Janis Joplin are all dead. His memory cuts off by 1970, or before. He is caught in the Sixties, unable to move on. He is a fossil, the last hippie.
At first I did not want to confront Greg with the enormity of his time loss, his amnesia, or even to let involuntary hints through (which he would certainly pick up, for he was very sensitive to anomaly and tone)—so I changed the subject, and said, “Let me examine you.”
He was, I noted, somewhat weak and spastic in all his limbs, more on the left, and more in the legs. He could not stand alone. His eyes showed complete optic atrophy—it was impossible for him to see anything. But strangely, he did not seem to be aware of being blind, and would guess that I was showing him a blue ball, a red pen (when in fact it was a green comb and a fob watch that I showed him). Nor indeed did he seem to “look”; he made no special effort to turn in my direction, and when we were speaking, he had often failed to “face” me, to “look” at me. When I asked him about seeing, he acknowledged that his eyes weren’t “all that good,” but added that he enjoyed “watching” the TV. “Watching” TV for him, I observed later, consisted of following with attention the soundtrack of a movie or show, and inventing visual scenes to go with it (even though he might not even be looking toward the TV). He seemed to think, indeed, that this was what “seeing” meant, that this was what was meant by “watching TV,” and that this is what all of us did. Thus he had apparently lost the very idea of seeing.
I found this aspect of Greg’s blindness, his singular blindness to his blindness, his no longer knowing what “seeing” or “looking” meant, deeply perplexing. It seemed to point to something stranger, and more complex, than a mere “deficit,” to point, rather, to some radical alteration within him in the very structure of knowledge, in consciousness, in identity itself.2
I had already had some sense of this when testing his memory, finding his confinement, in effect, to a single moment—“the present”—uninformed by any sense of a past (or a future). Given this radical lack of connection and continuity in his inner life, I got the feeling, indeed, that he might not have “an inner life” to speak of, that he lacked the constant dialogue of past and present, of experience and meaning, which constitutes consciousness and inner life for the rest of us. He seemed to have no sense of “next,” and to lack that eager and anxious tension of anticipation, of intention, that drives us through life.
Some sense of ongoing, of “next,” is always with us. But this sense of movement, of happening, Greg lacked; he seemed immured, without knowing it, in a motionless, timeless, moment. And whereas for the rest of us, the present is given its meaning and depth by the past (hence it becomes “the remembered present,” in Gerald Edelman’s term), as well as being given potential and tension by the future, for Greg it was flat and (in its meager way) complete. This living-in-the-moment, which was so manifestly pathological, had been perceived in the temple as an achievement of “higher consciousness.”
Greg seemed to adjust to Williamsbridge with remarkable ease, considering he was a young man being placed, probably forever, in a hospital for the chronically ill. There was no furious defiance, no railing at fate, no sense, apparently, of indignity or despair. Compliantly, indifferently, Greg let himself be put away in the protective environment, the backwater of Williamsbridge. When I asked him about this, he said, “I have no choice.” And this, as he said it, seemed wise and true. Indeed, he seemed eminently philosophical about it. But it was a philosophicalness made possible by his indifference, his brain damage.
His parents, so estranged from him when he was rebellious and well, came daily, doted on him, now that he was helpless and ill; and they, for their part, could be sure, at any time, that he would be at the hospital, smiling and grateful for their visit. If he was not “waiting” for them, so much the better—they could miss a day, or a few days, if they were away; he would not notice, but would be cordial as ever the next time they came.
Greg soon settled in, then, with his rock records and his guitar, his Hare Krishna beads, his Talking Books, and a schedule of programs—physiotherapy, occupational therapy, music groups, drama. Soon after admission he was moved to a ward with younger patients, where with his open and sunny personality he became popular. He did not actually know any of the other patients or the staff, at least for several months, but was invariably (if indiscriminately) pleasant to them all. And there were at least two special friendships, not intense, but with a sort of complete acceptance and stability. His mother remembers “Eddie, who had MS…they both loved music, they had adjacent rooms, they used to sit together,…and Judy, she had CP, she would sit for hours with him too.” Eddie died, and Judy went to a hospital in Brooklyn; there has been no one so close for many years. Mrs. F. remembers them, but Greg does not, never asked for them, or about them, after they had gone—though perhaps, his mother thought, he was sadder, at least less lively, after they had gone, for they stimulated him, got him talking and listening to records and inventing limericks, joking and singing; they pulled him out of “that dead state” he would otherwise fall into.
A hospital for the chronically ill, where patients and staff live together for years, is a little like a village or a small town: everybody gets to meet, to know, everybody else. I often saw Greg in the corridors, being wheeled to different programs, or out to the patio, in his wheelchair, with the same odd, blind, yet searching look on his face. And he gradually got to know me, at least sufficiently to know my name, to ask, each time we met, “How’re you doing, Dr. Sacks? When’s the next book coming out?” (a question which rather distressed me in the seemingly endless interim between the publication of Awakenings and A Leg to Stand On, an eleven-year period in which I thought I would never write again).
Names, then, he might learn, with frequent contact; and in relation to them he would recollect a few details about each new person. Thus he came to know Connie Tomaino, the music therapist—he would recognize her voice, her footfalls, immediately—but he could never remember where or how he had met her. One day Greg began talking about “another Connie,” a girl called Connie whom he’d known at high school. This other Connie, he told us, was also, remarkably, very musical—“How come all you Connies are so musical?” he teased. The other Connie would conduct music groups, he said, would give out song sheets, play the piano-accordion at sing songs at school. At this point, it started to dawn on us that this “other” Connie was in fact Connie herself, and this was clinched when he added, “You know, she played the trumpet.” (Connie Tomaino is a professional trumpet player.) This sort of thing often happened with Greg, when he put things into the wrong context, or failed to connect them with the present; it was particularly startling to hear him talk to Connie about “another” Connie.
His sense of there being two Connies, his segmenting Connie into two, was characteristic of the bewilderments he sometimes found himself in, his need to hypothesize additional figures because he could not retain or conceive of an identity in time. With consistent repetition Greg might learn a few facts, and these would be retained. But the facts were isolated, denuded of context. A person, a voice, a place would slowly become “familiar,” but he remained unable to remember where he had met the person, heard the voice, seen the place. Specifically, it was context-bound (or “episodic”) memory which was so grossly disturbed in Greg—as is the case with most amnesiacs.
Other sorts of memory were intact; thus Greg had no difficulty remembering or applying geometrical truths which he had learned in school. He saw instantly, for example, that the hypotenuse of a triangle was shorter than the sum of the two sides—thus his semantic memory, so-called, was fairly intact. Again, he not only retained his power to play the guitar, but actually learned to type while at Williams-bridge—so his procedural memory was also unimpaired.
Finally, there seemed to be some sort of slow habituation or familiarization—so that he became able, within three months, to find his way about the hospital, to go to the coffee shop, the cinema, the auditorium, the patio, his favorite places. This sort of learning was exceedingly slow, but once it had been achieved, it was tenaciously retained.
It was clear that Greg’s tumor had caused damage that was complex and curious. First, it had compressed or destroyed structures of the inner, or medial, side of both the temporal lobes—in particular, the hippocampus and its adjacent cortex, areas crucial for the capacity to acquire new memories. Episodic amnesia such as Greg’s follows destruction of these regions, not only in human beings, but in some experimental animals as well. With such an amnesia, the ability to acquire information about new facts and events is devastated—there ceases to be any explicit or conscious remembrance of these. But while Greg is so often unable to recall events or encounters or facts to consciousness, he might nonetheless have an unconscious or implicit memory of them, a memory expressed in performance or behavior. Such implicit ability to remember allowed him to become slowly familiar with the physical layout and routines of the hospital and with some of the staff, and to make judgments on whether certain persons (or situations) were pleasant or unpleasant.3
While explicit learning requires the integrity of the medial temporal lobe systems, implicit learning may employ more primitive and diffuse paths, as do the simple processes of conditioning and habituation. Explicit learning, however, involves the construction of complex percepts—syntheses of representations from every part of the cerebral cortex—brought together into a contextual unity, or “scene.” Such syntheses can be held in mind for only a minute or two—the limit of so-called “immediate” memory—and after this will be lost unless they can be shunted into permanent memory. Thus higher-order memorization is a multistage process, involving the transfer of perceptions, or perceptual syntheses, from immediate to permanent memory.4 It is just such a transfer which fails to occur in people with temporal lobe damage. Thus amnesiacs may have perfect, intact “immediate” memories, but lack the ability to transfer them into permanent memory. Greg can repeat a complicated sentence with complete accuracy and understanding the moment he hears it, but within three minutes, or sooner if he is distracted for an instant, he will retain not a trace of it, or any idea of its sense, or any memory that it ever existed.
Larry Squire, a neuropsychologist at the University of California, San Diego, who has been a central figure in elucidating this shunting function of the temporal lobe memory system, speaks of the brevity, the precariousness, of immediate memory in us all; all of us, on occasion, suddenly lose a perception or an image or a thought we had vividly in mind (“Damn it,” we may say, “I’ve forgotten what I wanted to say!”), but only in amnesiacs is this precariousness realized to the full.
Yet while Greg, no longer capable of transforming his perceptions or immediate memories into permanent ones, remains stuck in the Sixties, when his ability to learn new information broke down, he has nevertheless adapted somehow and absorbed some of his surroundings, albeit very slowly and incompletely.5
Some amnesiacs, like Jimmie (the Korsakov’s patient whom I described in “The Lost Mariner”6 ) have brain damage largely confined to the memory systems of the diencephalon and medial temporal lobe; others, like Mr. Thompson (described in “A Matter of Identity”7 ) are not only amnesiac, but have frontal lobe syndromes as well; yet others—like Greg, with immense tumors—tend to have a third area of damage as well, deep below the cerebral cortex, in the forebrain, or diencephalon. In Greg, this widespread damage has created a very complicated clinical picture, with sometimes overlapping or even contradictory symptoms and syndromes. Thus though his amnesia is chiefly caused by damage to the temporal lobe systems, damage to the diencephalon and frontal lobes also has a part. Similarly there are multiple origins for his blandness and indifference, for which damage to the frontal lobes, diencephalon, and pituitary gland is in varying degrees responsible. In fact, Greg’s tumor first caused damage to his pituitary gland; this was responsible not only for his gain in weight and loss of body hair but also for undermining his hormonally driven aggressiveness and assertiveness, and hence for his abnormal submissiveness and placidity.
The diencephalon is especially a regulator of basic functions—of sleep, of appetite, of libido, etc. And all of these were at a low ebb with Greg—he had (or expressed) no sexual interest; he did not think of eating, or express a desire to eat, unless food was brought to him; and, if he was not stimulated, he fell not into sleep, but into a sort of daze—though he could be “awakened” from this as long as a stimulus was present.
Thus, left alone, Greg would spend hours in the ward without spontaneous activity. This inert state was at first described by the nurses as “brooding”; it had been seen in the temple as “meditating”; my own feeling was that it was a profoundly pathological mental “idling,” almost devoid of content, of affect, of attention, and even of arousal. It was difficult to give a name to this state, so different from alert, attentive wakefulness, but also, clearly, quite different from sleep—it had a blankness resembling no normal state. It reminded me somewhat of the vacant states I had seen with some of my post-encephalitic patients, and, as with them, went with profound damage to the diencephalon. But as soon as I talked to him, or if he was stimulated by sounds (especially music) near him—and with his blindness he now showed a heightened sensitivity to these, an almost exclusively auditory orientation—he “came to,” “awakened,” in an astonishing way.
Once Greg is “awakened,” once his cortex comes to life, one sees that this animation itself has a strange quality—an uninhibited and quirky quality of the sort one tends to see when the orbital portions of the frontal lobes (i.e., the portions adjacent to the eyes) are damaged, a so-called orbitofrontal syndrome.8 The frontal lobes are the most complex part of the brain, concerned not with the “lower” functions of movement and sensation, but the highest ones of integrating all judgment and behavior, all imagination and emotion, into that unique identity which we like to speak of as “personality” or “self.” Damage to other parts of the brain may produce specific disturbances of sensation or movement, of language, or of specific perceptual, cognitive, or memory functions. Damage to the frontal lobes, in contrast, does not affect these, but produces a subtler and profounder disturbance of “identity.”
And it was this—rather than his blindness, or his weakness, or his disorientation, or his amnesia—which so horrified his parents when they finally saw Greg in 1975. It was not just that he was damaged, but that he was changed beyond recognition, had been “dispossessed,” in his father’s words, by a sort of simulacrum, or changeling, which had Greg’s voice and manner and humor and intelligence but not his “spirit” or “realness” or “depth”—a changeling whose wisecracking and levity formed a shocking counterpoint to the fearful gravity of what had happened.
This sort of wisecracking, indeed, is quite characteristic of such orbitofrontal syndromes—and is so striking that it has been given a name to itself: Witzelsucht, or “joking disease.” Some restraint, some caution, some inhibition, is destroyed, and patients with such syndromes tend to react, immediately and incontinently, to everything around them, and everything within them—to virtually every object, every person, every sensation, every word, every thought, every emotion, every nuance and tone.
There is an overwhelming tendency to wordplay and puns. Once when I was in Greg’s room another patient walked past. “That’s Bernie,” I said. “Bernie the Hernie,” quipped Greg. Another day, when I visited him he was in the dining room, awaiting lunch. When a nurse announced, “Lunch is here,” he immediately responded, “It’s time for cheer”; when she said, “Shall I take the skin off your chicken?” he instantly responded, “Yeah, why don’t you slip me some skin.” “Oh, you want the skin?” she asked, puzzled. “Nah,” he replied, “it’s just a saying.”
He is, in a sense, preternaturally sensitive—but it is a sensitivity that is passive, without selectivity or focus. There is no differentiation in such a sensitivity—the grand, the trivial, the sublime, the ridiculous, are all mixed up and treated as equal.9 There may be a childlike spontaneity and transparency about such patients, in their immediate and unpremeditated (and often playful) reactions. And yet there is something ultimately disquieting, and bizarre, because the reacting mind (which may still be highly intelligent and inventive) loses its coherence, its inwardness, its autonomy, its “self,” and becomes the slave of every passing sensation. There is now, it seems, no boundary, no “psychological distance” (as Lhermitte would say), between Greg and his environment—he seizes it, he is seized by it, he cannot distinguish himself from it.
Though, as a neurologist, I had to speak of his “syndrome,” his “deficits,” I did not feel this was adequate to describe Greg. I felt, one felt, he had become another “kind” of person; that though his frontal lobe damage had taken away his identity in a way, yet it had also given him a sort of identity or personality, albeit of an odd and perhaps primitive sort.
Dreaming and waking, for us, are usually distinct—dreaming is enclosed in sleep, but enjoys a special license, because it is cut off from external perception and action; while waking perception is constrained by reality.10 But in Greg the boundary between waking and sleep seems to break down, and what emerges is a sort of waking or public dream, in which dreamlike fancies and associations and symbols proliferate, and weave themselves into the waking perceptions of the mind. These associations are often startling and sometimes surrealistic in quality. They show the power of fancy at play, and, specifically, the mechanisms—displacement, condensation, “over-determination,” etc.—which Freud has shown to be characteristic of dreams.
One felt all this very strongly with Greg; that he was often in some intermediate, half-dreamlike state,11 in which, if the normal control and selectivity of thinking was lost, there was a half-freedom, half-compulsion of fantasy and wit. To see this as pathological was necessary, but insufficient: it had elements of the primitive, the childlike, the playful. Greg’s absurdist, often gnomic utterances, combined with his seeming serenity (actually blandness), gave him an appearance of innocence and wisdom combined, gave him a special status on the ward, ambiguous but respected, a Holy Fool.
If Greg was alone, in a corridor, he seemed scarcely alive; but as soon as he was in company, he was a different person altogether. He would “come to,” he would be funny, charming, ingenuous, sociable. Everyone liked him; he would respond to anyone at once, with a lightness and a humor and an absence of guile or hesitation; and if there was something too light or flippant or indiscriminate in his interactions and reactions, and if, moreover, he lost all memory of them in a minute, well, this was one of the results of his disease. Thus one was very aware, in a hospital for chronic patients like ours, a hospital where feelings of melancholy, of rage, and of hopelessness simmer and preside, of the virtue of a patient such as Greg—who never appeared to have bad moods, who, when activated by others, was invariably cheerful, euphoric.
He seemed, in an odd way, and in consequence of his sickness, to have a sort of vitality, or health—a cheeriness, an inventiveness, a directness, an exuberance, which other patients, and indeed the rest of us, in small doses, found delightful. And where he had been so “difficult,” so tormented, so rebellious, in his pre-Krishna days, all this anger and torment and angst now seemed to have vanished; he seemed to be at peace. His father, who had had a terrible time in Greg’s stormy days, before he got “tamed” by drugs, by religion, by tumor, said to me in an unbuttoned moment, “It’s like he had a lobotomy,” and then, with great irony, “Frontal lobes—who needs ’em?”12
In a note about Greg of March 1979, I reported that “games, songs, verses, converse, etc. hold him together completely…because they have an organic rhythm and stream, a flowing of being, which carries and holds him.” I was strongly reminded here of what I had seen with my amnesiac patient Jimmie, how he seemed held together when he attended Mass, by his relationship to and participation in an act of meaning, an organic unity, which overrode or bypassed the disconnections of his amnesia.13 And what I had observed with a patient in England, a musician with profound amnesia from a temporal lobe encephalitis, unable to remember events or facts for more than a few seconds, but able to remember, and indeed to learn, elaborate musical pieces, to conduct them, to perform them, and even to improvise at the organ.14 In Greg’s case, of course, there was not just an amnesia, but a severe frontal-lobe syndrome as well, tending to “shallow” him, to remove genuine feeling and meaning, to replace these with a sort of indifference or frivolity.
Music, songs, seemed to bring Greg what, apparently, he lacked, to evoke in him a depth to which he otherwise had no access. Music was a door to a world of feeling, of meaning, a world in which Greg could, if only for a while, recover himself. Music drew back the constraints of the disease, aroused him from his blandness, released him from his levity. One felt Greg was “a different person” at such times—this was a phrase everyone used. He no longer seemed to have a frontal lobe syndrome at such times, but was (so to speak) temporarily “cured” by the music. Even his EEG, so slow and incoherent most of the time, became calm and rhythmical with music.
I observed, in this same note, that he not only had an excellent musical memory for songs of the Sixties, but was also able to learn new songs—even though, apparently, he could not absorb new “facts”; it was apparent that quite different memory mechanisms were involved.
He also possessed the ability to learn verses and limericks (these too have a rhythm and impetus of their own, very different from mere “facts”). Soon after his admission, I tested him with the following limerick:
Hush quite a lot
Bad babies get rabies
And have to be shot
Greg immediately repeated this, without error, laughed at it, asked if I’d made it up, and compared it to “something gruesome, like Edgar Allan Poe.” But two minutes later he could not recall it. When I repeated it each time I met him for a month, he did learn it, and thereafter recited it whenever he met me. What, I wondered, if one gave him political or satirical limericks, limericks not about babies and rabies, but about the current national or world situation? Would these, indeed, enable him to grasp some meaning?
It seemed natural, at this time, given Greg’s blindness, and the revelation of his potentials for learning, that he should be given an opportunity to learn Braille. Arrangements were made with the Jewish Institute for the Blind for him to enter intensive training, four times a week. It should not have been a disappointment, nor indeed a surprise, that Greg was unwilling to learn any Braille—that he was startled and bewildered at finding this imposed on him, and cried out, “What’s going on? Do you think I’m blind? Why am I here, with blind people all around me?” Attempts were made to explain things to him, and he responded, with impeccable logic, “If I were blind, I would be the first person to know it.” The institute said they had never had such a difficult patient, and the project was quietly allowed to drop. And indeed, with the failure of the Braille program, a sort of hopelessness gripped us, and perhaps Greg too. We could do nothing, we felt; he had no potential for change.
Greg by this time had had several psychological and neuropsychological evaluations, and these, besides commenting on his memory and attentional problems, had all spoken of him as being “shallow,” “infantile,” “insightless,” “euphoric.” It was easy to see why they had thought this; Greg was like this for much of the time. But was there a deeper Greg beneath his illness, beneath the shallowing effect of his frontal lobe loss and amnesia? Early in 1979, when I questioned him, he said he was “miserable…at least in the corporeal part,” and added, “It’s not much of a life.” At such times, it was clear that he was not just frivolous and euphoric, but capable of deep, and indeed melancholic, reactions to his plight. The comatose Karen Ann Quinlan was then very much in the news, and each time her name and fate were mentioned, Greg became distressed and silent. He could never tell me, explicitly, why this so interested him—but it had to be, I felt, because of some sort of identification of her tragedy with his own. Or was this just his incontinent sympathy, his falling at once into the mood of any stimulus or news, falling almost helplessly, mimetically, into its mood?
This was not a question I could decide at first, and perhaps too I was prejudiced against finding any depths in Greg, because the neuropsychological studies I knew of seemed to disallow this possibility. But these studies were based on brief evaluations, not on long-continued observation and relationship of a sort which is, perhaps, only possible in a hospital for chronic patients, or in situations where a whole world, a whole life, is shared with the patient.15
Greg’s “frontal lobe” characteristics—his lightness, his quick-fire associations, were fun; but beyond this there shone through a basic decency and sensitivity and kindness. One felt that Greg, though damaged, still had a personality, an identity, a soul.16
When he came to Williamsbridge we all responded to his intelligence, his high spirits, his wit. All sorts of therapeutic programs and enterprises were started at this time, but all of them—not just the learning of Braille—ended in failure. The sense of Greg’s incorrigibility gradually grew on us, and with this we started to do less, to hope less. Increasingly, he was left to his own devices. He slowly ceased to be a center of attention, the focus of eager therapeutic activities—more and more he was left to himself, left out of programs, not taken anywhere, quietly ignored.
And it is easy, even if one is not an amnesiac, to lose touch with current reality in the back wards of hospitals for the chronically ill. There is a simple round which has not changed in twenty, or fifty, years. One is awakened, fed, taken to the toilet, and left to sit in a hallway; one has lunch, is taken to bingo, has dinner, and goes to bed. The television may indeed be left on, blaring, in the television room—but most patients pay no attention to it. Greg, it is true, enjoyed his favorite soap operas and westerns, and learned an enormous number of advertising jingles by heart. But the “news,” for the most part, he found boring and, increasingly, unintelligible. Years can pass, in a sort of timeless limbo, with few, and certainly no memorable, “markers” of the passage of time.
As ten years or so passed, Greg showed a complete absence of development, his talk seemed increasingly dated and repertorial, for nothing new was being added to it, or him. The tragedy of his amnesia seemed to become greater with the years, although his amnesia itself, his neurological syndrome, remained much the same.
In 1988 Greg had a seizure—he had never had one before (although he had been on anticonvulsants, as a precaution, since the time of his surgery)—and in the seizure broke a leg. He did not complain of this, he did not even mention it; it was only discovered when he tried to stand up the following day. He had, apparently, forgotten it as soon as the pain eased, and as soon as he had found a comfortable position. His not knowing that he had broken a leg seemed to me to have similarities to his not knowing he was blind, his inability, with his amnesia, to hold in mind an absence. When the leg caused pain, briefly, he knew something had happened, he knew it was there; as soon as the pain ceased, it went from his mind. Had he had visual hallucinations or phantoms (as the blind sometimes do, at least in the first months and years after losing their sight), he could have spoken of them, said, “Look!” or “Wow!” But in the absence of actual visual input, he could hold nothing in mind about seeing, or not-seeing, or the loss of a visual world. In his person, and in his world, now, Greg knew only presence, not absence. He seemed incapable of registering any loss—loss of function in himself, or of an object, or a person.
In the summer of 1990, Greg’s father, who had come every morning before work to see Greg, and would joke and chat with him for an hour, suddenly died. I myself was away at the time for several weeks, and hearing the news on my return, I hastened to Greg, who had been given the news, of course, when it happened. And yet I was not quite sure what to say—had he been able to absorb this new fact? “I guess you must be missing your father,” I ventured.
“What do you mean?” Greg answered. “He comes every day. I see him every day.”
“No,” I said, “he’s no longer coming…. He has not come for some time. He died last month.”
Greg flinched, turned ashen, became silent. I had the impression he was shocked, doubly shocked, at the sudden, appalling news of his father’s death, and at the fact that he himself did not know, had not registered, did not remember. In this instant, then, he was doubly devastated—not only by the death of his father, but by the sudden revelation of his own amnesia. “I guess he must have been around fifty,” he said.
“No, Greg,” I answered, “he was well up in his seventies.”
Greg grew pale again as I said this. I left the room briefly; I felt he needed to be alone with all this. But when I returned, a few minutes later, Greg had no memory of the conversation we had had, of the news I had given him, no idea that his father had died.
Very clearly, at least, Greg showed a capacity for love and grief. If I had ever doubted Greg’s capacity for deeper feeling, I no longer doubted it now. He was clearly devastated by his father’s death—he showed nothing “flip,” no levity, at this time.17 But would he have the ability to mourn? Mourning requires that one hold the sense of loss in one’s mind, and it was far from clear to me that Greg could do this. One might indeed tell him that his father had died, again and again. And every time it would come as something shocking and new, and cause immeasurable distress. But then, in a few minutes, he would forget, and be cheerful again; and was so prevented from going through the work of grief, the mourning.18
I made a point of seeing Greg frequently in the following months, but I did not again bring up the subject of his father’s death. It was not up to me, I thought, to confront him with this—indeed it would be pointless and cruel to do so; life itself, surely, would do so, for Greg would discover his father’s absence.
I made the following note on November 26, 1990: “Greg shows no conscious knowing that his father has died—when asked where his father is, he may say, ‘Oh, he went down to the patio,’ or ‘He couldn’t make it today,’ or something else plausible. But he no longer wants to go home, on weekends, on Thanksgiving, as he so loved to—he must find something sad or repugnant in the fatherless house now, even though he cannot (consciously) remember or articulate this. Clearly he has established an association of sadness.”
Toward the end of the year Greg, normally a sound sleeper, started to sleep poorly, to get up in the middle of the night, and wander gropingly for hours around his room. “I’ve lost something, I’m looking for something,” he would say when asked—but what he had lost, what he was looking for, he could never explain. One could not avoid the feeling that Greg was looking for his father, even though he could give no account of what he was doing, and had no explicit knowledge of what he had lost. But, it seemed to me, there was perhaps now an implicit knowledge, and perhaps too a symbolic (though not a conceptual) knowing.
Greg had seemed so sad, since his father’s death, that I felt he deserved a special celebration—and when I heard, in August of 1991, that his beloved group, the Grateful Dead, would be playing at Madison Square Garden in a few weeks, this seemed just the thing. Indeed, I had met one of the drummers in the band, Mickey Hart, earlier in the summer, when we had both testified before the Senate about the therapeutic powers of music, so arrangements were made for Greg to come to one of the concerts.19
We received tickets for the concert at the last minute, and I had given Greg no warning, not wanting to disappoint him if we failed to get seats. But when I picked him up at the hospital and told him where we were going, he showed great excitement. We got him dressed swiftly, and bundled him into the car. As we got into midtown, I opened the car windows, and the sounds and smells of New York came in. As we cruised down 33rd Street, the smell of hot pretzels suddenly struck him; he inhaled deeply, and laughed, “That’s the most New York smell in the world.”
There was an enormous crowd converging on Madison Square Garden, almost all in tie-dyed T-shirts—I had hardly seen a tie-dyed T-shirt in twenty years, and I myself began to think we were back in the Sixties, or perhaps that we had never left them. I was sorry that Greg could not have seen this crowd; he would have felt himself one of them, at home. Stimulated by the atmosphere, Greg started to talk spontaneously—very unusual for him—and to reminisce about the Sixties:
Yeah, there were the be-ins in Central Park. They haven’t had one for a long time—over a year, maybe, can’t remember exactly…. Concerts, music, acid, grass, everything…. First time I was there was Flower-Power Day….
Good times…lots of things started in the Sixties—acid rock, the be-ins, the love-ins, smoking…. Don’t see it much these days…. Allen Ginsberg—he’s down in the Village a lot, or in Central Park. I haven’t seen him for a long time. It’s over a year since I last saw him….
Greg’s use of the present tense, or the near-present tense; his sense of all these events, not as far distant, much less as terminated, but as having taken place “a year ago, maybe” (and, by implication, likely to take place again, at any time); all this, which seemed so pathological, so anachronistic in clinical testing, seemed almost normal, natural, now that we were part of this Sixties crowd sweeping toward the Garden.
Inside the Garden we found the special place reserved for Greg’s wheelchair near the soundboard. And now Greg was growing more excited by the minute; the roar of the crowd excited him—“It’s like a giant animal,” he said—and the sweet, hashladen air—“What a great smell,” he said, inhaling deeply. “It’s the least stupid smell in the world.”20
As the band came onstage, and the noise of the crowd grew greater, Greg was transported by the excitement, and started clapping loudly, and shouting in an enormous voice, “Bravo! Bravo!” then, “Let’s go!” followed by “Let’s go, Hypo,” followed, homophonously, by “Ro, Ro, Ro, Harry-Bo.” Pausing a moment, Greg said to me, “See the tombstone behind the drums? See Jerry Garcia’s Afro?” with such conviction that I was momentarily taken in, and looked (in vain) for a tombstone behind the drums—before realizing it was one of Greg’s confabulations—and at the now-gray hair of Jerry Garcia, which fell in a straight, unhindered descent to his shoulders.
And then, “Pigpen!” Greg exclaimed, “You see Pigpen there?”
“No,” I replied, hesitantly, not knowing how to reply. “He’s not there…. You see, he’s not with the Dead anymore.”
“Not with them?” said Greg, in astonishment. “What happened—he got busted or something?”
“No, Greg, not busted. He died.”
“That’s awful,” Greg answered, shaking his head, shocked. And then a minute later, he nudged me again. “Pigpen! You see Pigpen there?” And, word for word, the whole conversation repeated itself.
But then the thumping, pounding excitement of the crowd got him—the rhythmic clapping and stamping and chanting possessed him—and he started to chant, “The Dead! The Dead!,” then with a shift of rhythm, and a slow emphasis on each word, “We want the Dead!” And then, “Tobacco Road, Tobacco Road,” the name of one of his favorite songs, until the music began.
The band began with an old song, “Iko, Iko,” and Greg joined in with gusto, with abandon, clearly knowing all the words, and especially luxuriating in the African-sounding chorus. The whole vast Garden now was in motion with the music, eighteen thousand people responding together, everyone transported, every nervous system synchronized, in unison.
The first half of the concert had many earlier pieces, songs from the Sixties, and Greg knew them, loved them, joined in. His energy and joy were amazing to see; he clapped and sang nonstop, with none of the weakness and fatigue he generally showed. He showed a rare and wonderful continuity of attention, everything orienting him, holding him together. Looking at Greg transformed in this way, I could see no trace of his amnesia, his frontal lobe syndrome—he seemed at this moment completely normal, as if the music was infusing him with its own strength, its coherence, its spirit.
I had wondered whether we should leave at the break midway through the concert—he was, after all, a disabled, wheelchair-bound patient, who had not really been “out” on the town, at a rock concert, for more than twenty years. But he said, “No, I want to stay, I want it all”—an assertion, an autonomy, I rejoiced to see, and had hardly ever seen in his compliant life at the hospital. So we stayed, and in the interval went backstage, where Greg had a large hot pretzel, and then met Mickey Hart and exchanged a few words with him. He had looked a little tired and pale before, but now he was flushed, excited by the encounter, charged and eager to be back for more music.
But the second half of the concert was somewhat strange for Greg: more of the songs dated from the mid- or late Seventies, and had lyrics which were unknown to him, though they were familiar in style. He enjoyed these, clapping and singing along wordlessly, or making up words as he went. But then there were newer songs, radically different, like “Picasso Moon,” with dark and deep harmonies, and an electronic instrumentation such as would have been impossible, unimaginable, in the 1960s. Greg was intrigued, but deeply puzzled. “It’s weird stuff,” he said, “I never heard anything like it before.” He listened intently, all his musical senses stirred, but with a slightly scared and bewildered look, as if seeing a new animal, a new plant, a new world, for the first time. “I guess it’s some new, experimental stuff,” he said, “something they never played before. Sounds futuristic…maybe it’s the music of the future.” The newer songs he heard went far beyond any development that he could have imagined, were so beyond (and in some ways so unlike) what he associated with the Dead, that it “blew his mind.” It was, he could not doubt, “their” music he was hearing, but it gave him an almost unbearable sense of hearing the future—as late Beethoven would have struck a devotee if it had been played at a concert in 1800.
“That was fantastic,” he said, as we filed out of the Garden, “I will always remember it. I had the time of my life.” I played CDs of the Grateful Dead in the car on the way home, to hold as long as possible the mood and memory of the concert. I feared that if I stopped playing the Dead, or talking about them, for a single moment, all memory of the concert would go from his mind. Greg sang along enthusiastically all the way back, and when we parted at the hospital, he was still in an exuberant concert mood.
But the next morning when I came to the hospital early, I found Greg in the dining room, alone, facing the wall. I asked him about the Grateful Dead—what did he think of them? “Great group,” he said, “I love them. I heard them in Central Park and at the Fillmore East.”
“Yes,” I said, “you told me. But have you seen them since? Didn’t you just hear them at Madison Square Garden?”
“No,” he said, “I’ve never been to the Garden.”
Greg has no recollection of the concert, seemingly—but when I was sent a tape of it, he immediately recognized some of the “new” pieces, found them familiar, was able to sing them. “Where did you hear that?” I asked as we listened to “Picasso Moon.”
“I can’t remember,” he said, “didn’t hear it, anything like it, at the Central Park concert.”
I had wondered whether hearing the songs, and especially hearing a tape of the concert itself, with all the sounds of coughing, clapping, singing, and background noise, would bring back the memory of Madison Square Garden. “It was a big concert,” I said. “You went there a few nights ago.”
“I don’t remember it,” he said, “but that’s a real big noise—huge. The place must be as big as a stadium.” But he could not be more specific. Then he became puzzled: “Were you there with me?”
Thus Greg remembers the music—and something about it evokes my presence too—but he cannot say when or where he heard it, he cannot give a frame or context to his learning.
Smells are sometimes even more evocative than music; and the percepts of smells, generated in a very primitive part of the brain—the “smell brain,” or rhinencephalon—may not go through the complex, multistage memory systems of the medial temporal lobe. Olfactory memories, neurally, are almost indelible; thus they may be remembered despite an amnesia. It would be fascinating to bring Greg hot pretzels, or hash, to see whether their smells could evoke memories of the concert. He himself, the day after the concert, spontaneously mentioned the “great” smell of pretzels—it was very vivid for him—and yet he could not locate the smell in place or time. I have visited him, played him tapes, several times, and now, when I arrive, and he hears my voice, he lights up, and greets me as a fellow Deadhead. Thus he has not only acquired new knowledge, he has acquired a new relation to me; he sees me (so to speak) in a new light.
A recently published paper from Endel Tulving and his colleagues at the University of Toronto suggests that factual learning may indeed be possible, and put to use, even in patients with the densest amnesia. Thus they note that “amnesiacs can learn new factual information, despite [their] inability to recollect the learning episodes,” and that though such learning may be slow and laborious, its long-term retention, once learned, is entirely normal. They add, with regard to their own patient, K.C., that
his newly-acquired knowledge represented [for him] ordinary facts of the world…he thought other people would know “rays softened asphalt” [one of his learned sentences] as well as they would know that “dogs chase cats.”
They conclude that their patient “could generalize from his new knowledge, and did not see it, or treat it, as an isolated, ‘free’ fragment.”
Although Tulving and his colleagues were specifically concerned with their subjects’ ability to learn some hundreds of short sentences, they allude to other sorts of learning amnesiacs have been found capable of—learning statements of facts about people, places, and things; learning new computer-related vocabulary or simple computer commands. Such learning, they stress, is invariably slow and inefficient, but it does occur.
With music, for whatever reasons—whether because of his musical giftedness, or the fact that musical memory may use different memory paths—learning for Greg is neither slow nor inefficient, but swift, automatic, and enjoyable. Moreover, music does not consist of sparse propositions (like “rays softened asphalt”), but is rich with emotion, association, and meaning. Songs, quicker than anything, can evoke a character, an epoch, a world—what Thomas Mann, in The Magic Mountain, calls “the world behind the music.”
It is easy to show that simple information can be embedded in songs; thus we can give Greg the date every day, in the form of a jingle, and he can readily isolate this, and say it when asked—give it, that is, without the jingle. But what does it mean to say, “This is December the 19th, 1991,” when one is sunk in the profoundest amnesia, when one has lost one’s sense of time and history, when one is existing from moment to moment in a sequenceless limbo? “Knowing the date” means nothing in these circumstances. Could one, however, through the evocativeness and power of music, perhaps using songs with specially written lyrics—songs which relate something valuable about himself or the current world—accomplish something more lasting, deeper? Give Greg not only “facts,” but a sense of time and history, of the relatedness (and not merely the existence) of events, an entire (if synthetic) framework for thinking? This is something which Connie Tomaino and I are trying to do now. We hope to have an answer in a year.
I am grateful to Elkhonon Goldberg, who has performed neuropsychological evaluations on Greg F., and has provided, in his articles and personal contact, invaluable insights about frontal lobe function; to Concetta Tomaino, the music therapist at “Williamsbridge,” who has worked closely with Greg for years; to Larry Squire, who has been helpful in discussing mechanisms of memory and problems of amnesiacs; to Mickey Hart, who showed a compassionate interest in Greg and made it possible for us to see the Grateful Dead in concert; to Greg’s parents; and above all, to Greg himself.
March 26, 1992
The swami’s unusual views are presented, in summary form, in Easy Journey to Other Planets by Tridandi Goswami A. C. Bhaktivedanta Swami, published by the League of Devotees, Vrindaban (no date, one rupee). This slim manual, in its green paper cover, was handed out in vast quantities by the swami’s saffron-robed followers, and it became Greg’s Bible at this stage. ↩
Another patient, Ruby G., was in some ways similar to Greg. She too had a huge frontal tumor, which, though it was removed in 1973, left her with amnesia, a frontal lobe syndrome, and blindness. She too did not know that she was blind, and when I held up my hand before her and asked, “How many fingers?” would answer, “A hand has five fingers, of course.” ↩
That implicit memory (especially if emotionally charged) may exist in amnesiacs was shown, somewhat cruelly, in 1911, by Edouard Claparède; who when shaking hands with such a patient whom he was presenting to his students, stuck a pin in his hand. Although the patient had no explicit memory of this, he refused, thereafter, to shake hands with him. ↩
The development of a special highspeed, multistage transfer system for explicit memory seems to be a recent development in evolution, one which perhaps parallels the development of consciousness itself (see Gerald Edelman, The Remembered Present, 1990). It is present in higher mammals, but absent in lower animals, as is consciousness itself. Thus although a rat or monkey could have amnesia, it seems doubtful whether a slug or frog could. ↩
Luria too remarks on this, in The Neuropsychology of Memory (1976), and speaks of all his amnesiac patients, if hospitalized for any length of time, as acquiring “a sense of familiarity” with their surroundings. ↩
The New York Review, February 16, 1984. Reprinted in The Man Who Mistook His Wife for a Hat (Harper and Row, 1987). ↩
Granta, No. 16 (Summer, 1985), reprinted in The Man Who Mistook His Wife for a Hat. ↩
One may see two quite different, indeed opposite, sorts of frontal lobe syndromes. Damage to the outer, or lateral, portions of the frontal lobes tends to cause profound apathy and immobility, while damage to the inner or medial portions causes the opposite, a state of wisecracking and excitement. Although Greg has damage to both, it is especially the medial portions of his frontal lobes which have been compressed by the tumor, hence he shows, predominantly, an excitatory syndrome. ↩
Luria has provided immensely detailed, at times almost novelistic, descriptions of frontal-lobe syndromes—Luria, Human Brain and Psychological Processes (1966)—and sees this “equalization” as the heart of such syndromes. ↩
Rodolfo Llinás, of New York University, comparing the electrophysiological properties of the brain in waking and dreaming, postulates a single fundamental mechanism for both—a ceaseless “inner talking” between cerebral cortex and thalamus, a ceaseless interplay of image and feeling, irrespective of whether there is sensory input or not. When there is sensory input, this interplay integrates it to generate “waking consciousness,” but in the absence of sensory input it continues to generate brain states, those brain states we call fantasy, hallucination, or dreaming. Thus waking consciousness is dreaming—but dreaming constrained by external reality. R.R. Llinás and D. Paré, “On Dreaming and Wakefulness,” Neuroscience, Vol. 44, No. 3 (1991), pp. 521–535. ↩
In 1963, when I first smoked some marijuana, I found it had a singular effect, releasing strings of word rhymes and homonyms which rushed, involuntarily, with great speed through my mind. This immediately made me think of the mechanism of jokes and dreams, and of the forced wordplay in frontal lobe syndromes and schizophrenia. This is “Undermind,” I said to myself—and was intrigued to have, through a reversible intoxication, a brief experience of what, in patients, is usually permanent. ↩
A fascinating account of such a natural “lobotomy” is related by Lytton Strachey concerning Dr. North, a master of Trinity College, Cambridge, in the seventeenth century. Dr. North, it is evident, was a man with severe anxieties, and tormenting obsessional traits, who was hated and dreaded by the fellows of the college for his punctiliousness, his moralizing, and his merciless severity. Until one day, in college, he suffered a stroke. ↩
The nature of the “organic unity,” at once dynamic and semantic, which is central to music, incantation, recitation, and all metrical structures, has been most profoundly analyzed by Victor Zuckerkandl, in his remarkable book Sound and Symbol (two volumes, Princeton University Press, 1973). It is typical of such flowing dynamic-semantic structures that each part leads on to the next, that every part has reference to the rest. Such structures cannot be perceived, or remembered, in part—they are perceived and remembered, if at all, as wholes. ↩
This patient is the subject of a remarkable BBC film made by Jonathan Miller, Prisoner of Consciousness (November 1988). ↩
The great French neurologist F. Lhermitte is especially sensitive to this, and instead of just observing his patients in the clinic, he makes a point of visiting them at home, taking them to restaurants or theaters, or for rides in his car, sharing their lives as much as possible. It is impossible to fully understand frontal lobe syndromes in the impoverished and constraining atmosphere of the clinic, and such a “naturalistic” or “ecological” approach is essential. ↩
Mr. Thompson, who also had both amnesia and a frontal lobe syndrome, by contrast often seemed “desouled.” In him the wisecracking was manic, ferocious, frenetic, and relentless; it rushed on like a torrent, oblivious to tact, to decency, to propriety, to everything, including the feelings of everyone around him. Whether Greg’s (at least partial) preservation of ego and identity is due to the lesser severity of his syndrome, or to underlying personality differences, is not wholly clear. Mr. Thompson’s premorbid personality was that of a New York cabbie, and in some sense his frontal lobe syndrome merely intensified this. Greg’s personality was less aggressive, more childlike, more passive from the start—and this, it seemed to me, even colored his frontal lobe syndrome. ↩
This is in distinction to Mr. Thompson, who with his more severe frontal lobe syndrome had been reduced to a sort of nonstop, wisecracking, talking machine, and when told of his brother’s death quipped, “He’s always the joker!” and rushed on to other, irrelevant things. ↩
The amnesiac musicologist in the BBC film Prisoner of Consciousness shows something both similar and different. Every time his wife goes out of the room, he has a sense of calamitous, permanent loss. When she comes back, five minutes later, he sobs with relief, saying, “I thought you were dead.” ↩
Mickey Hart himself has written fascinatingly about the mind-altering, body-altering powers of rhythm, Drumming at the Edge of Magic: A Journey into the Spirit of Percussion (1990). ↩
Jean Cocteau, in fact, said this of opium. Whether Greg was quoting this, consciously or unconsciously, I do not know. ↩