The Man Who Mistook His Wife For A Hat and Other Clinical Tales

The sort of facetious indifference and ‘equalisation’ shown by this patient is not uncommon—German neurologists call it Witzel-sucht

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 Jimmie). 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.’

science became poetry, and the pathos of radical lostness was evoked.

The testing I had done so far told me nothing about Dr P.’s inner world. Was it possible that his visual memory and imagination were still intact? I asked him to imagine entering one of our local squares from the north side, to walk through it, in imagination or in memory, and tell me the buildings he might pass as he walked. He listed the buildings on his right side, but none of those on his left. I then asked him to imagine entering the square from the south. Again he mentioned only those buildings that were on the right side, although these were the very buildings he had omitted before. Those he had ‘seen’ internally before were not mentioned now; presumably, they were no longer ‘seen’. It was evident that his difficulties with leftness, his visual field deficits, were as much internal as external, bisecting his visual memory and imagination.

animals get diseases, but only man falls radically into sickness.

This brings us to our final question: is there any ‘place’ in the world for a man who is like an island, who cannot be acculturated, made part of the main? Can ‘the main’ accommodate, make room for, the singular?

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

The brain’s record’ of everything—everything alive—must be iconic. This is the final form of the brain’s record, even though the preliminary form may be computational or programmatic. The final form of cerebral representation must be, or allow, ‘art’—the artful scenery and melody of experience and action.

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.’

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 savoury smell drifted up from the dining room, he smacked his lips, said ‘Lunch!’, smiled, and took his leave.