Sack's seems to immerse himself in the exploration of human perception, judgement and comprehension within The Man Who Mistook His Wife For a Hat more extensively that in Awakenings. He is focused, in many cases, upon patient's 'normal' functioning using their abnormal perceptive skills notably in the case of Dr. P. Dr. P is an amazingly talented music teacher who occasionally mistakes objects (fire hydrants in some cases) for human beings due to his lack of ability to identify the "whole" of the items around him. He can not visualize anything but schematic concepts because there is no "real visual self" (pg. 15). There is nothing in his mind that he could visually imagine to explain things verbally and a lack of familiarity to comprehend the most common items (ex. gloves). He is at a loss, concerning his perception (yet, he doesn't consciously realize this), in the body he inhabits, the space he inhabits, and the people that surround him (pg. 15). Being such a visually oriented "thinker" the loss of any form of visual perception is very disconcerting and intriguing to me. I was compelled by Sack's description of Dr.P's tendency to "itemize" features on people's faces (recognition of his brother Paul: "... the square jaw, those big teeth" (pg.13)). He uses his vision to dissect people's specific features to remember them. The reason I found this interesting was because this seems to be the way my memory, and I think most people's memory works. Your brain remember the strangest, yet, most specific details, from a moment in time in order to trigger your brain to the larger "whole" of the memory. Dr. P can remember someone's nose, or mustache, and is, eventually, reminded of who that person is through the details.
Witty Ticcy Ray, another case study of Sack's was that of Ray, a man with severe Tourettes syndrome. Here, the concept of "living with the enemy" arose. Ray identified his disease as "a fight between it and I", an internal struggle with something you've grown to accept and almost appreciate within yourself (pg. 93). This idea that a sort of disease can be a benefit to you is very interesting. I know personally, that for me, the effects of mild OCD and anxiety are completely beneficial. I can't imagine a life without my "craze"---I do feel that it is most definitely a large part of my personality---my idiosyncrasies, my obsessions, my quirks, allow for my specific tempo. Ray seems to have this same personal attachment to certain aspects of his disease. He is drawn to what he feels his Tourettes gives him; a "spunk", an edge that makes him witty and exciting. But, with so many negative effects, Ray decided to begin on Hadol, a medication to eliminate his tics and in fill counteract the effects of Tourettes. After three months of psychologically preparing himself to, in part, disassociate himself from his 'Tourettes persona', Ray was able to successfully take Hadol. But, he complained of feeling dull and unenthusiastic. He decided to take Hadol during the weekdays and let his Tourettes emerge on weekends. This balance between disease and medication, especially in Ray's double existence is very compelling. What is the divide between personality and disease? How much of your personality and temperament lie within your disease? Is Ray still Ray when he is on Hadol?
I found that a very interesting difference between Sacks’s THE MAN WHO MISTOOK HIS WIFE FOR A HAT and AWAKENINGS was that a majority of the patients in the former book were not completely aware (or possibly could not admit to themselves) that they were mentally ill. However, there seems to be a commonality between almost every patient, which is a loss of identity; a sense of self. The patients who are aware that there is something wrong such as Christina, “the disembodied lady,” felt and verbalized a longing for an identity. Another example of this as you have mentioned, Witty Ticky Ray who’s disease actually ends up defining who he is. Without his ticks, Ray loses his sense of self and there is an obvious void in his life. The patients who are not as aware of their mental illness such as William Thompson seem to have this same longing for an identity, but in their case this longing is not as clear cut. It is as if no matter how much loss of memory, or how far from “reality” they truly are, these patients subconsciously long for an “I”. William Thomson ferociously makes up stories in his mind of who he is and experiences he had in his past. Sacks states that, “to be ourselves we must have ourselves--posses, if need be re-possess, our life-stories. We must ‘recollect’ ourselves, recollect the inner drama, the narrative, of ourselves. A man needs such a narrative…to maintain his identity, his self” (111). It is like our brains and bodies must have an identity in order to survive. No matter how ill one is, the body and brain will go in a sort of “survival mode.”
ReplyDeleteI too found Luria's comment about the fight between the "It" and the "I" intriguing. For me, this tied back to our discussion of Awakenings and the fact that many of the Parkinsonian patients had a remarkable capacity for self-reflection on their own cognition. They had incorporated the "It" into their "I"--or, perhaps, never separated the two conceptually until their conditions were pathologized--but could recognize and comment on this incorporation as both the reality and the fantasy. One thing I greatly appreciate about Sacks' approach to his patients is that he begins his work by trying to see the whole person, the "It" and the "I" as inseparable and constructed jointly, then moves towards an understanding of the separation that accounts for the experience and perception of the person he is treating/studying.
ReplyDeleteYour question "what is the divide between personality and disease?" brings us again to the self--how and when is a "disease" constructed from a set of behaviors or conditions and distinguished from the self? Is that view of medicine really useful?
Perception and the ability to recognize, remember and identify are things I definitely take for granted most if not all the time with the few and rare exceptions when a lapse in memory or some mental process occurs for seemingly unknown reasons like for example when one forgets how to spell a very simple word. I remember this happening to me so vividly years ago and it is truly a strange feeling—an unexplainable lapse of an action that seems so simple but really is processed by various parts of the brain and is dependent on memory and conditioning. I too was very interested, after reading the title case by how we understand, how we perceive life. It is a teaming up of the senses, the hidden senses, memory and our developed visual imagination (among many others) that result in visual recognition and representation. I realized while reading that one crucial feature; action; motivation if you will has to be present for recognition and that is will—the will to know, the will to judge, to determine. This can come in many forms: music, a familiar voice, and the ‘body-music’ of a pupil. This is clear in the post-encephalitic patients as well as with the patients described in The Man Who Mistook His Wife for a Hat. Of course it is not as simple as the want, the desire to know, to understand that we all possess. I find again in these texts that I understand (or think I understand) where these phenomena are rooted or by what they possibly could have been caused by and yet again I find myself completely baffled by certain details. The brain is endlessly complicated, dynamic and I imagine misunderstood. Will we ever know why Christina dreamt of her disembodiment and then it was realized hours later?
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