The Faber Book of Science (58 page)

In common experience one of the following occurs, complicating an auto-erotic experience such as thumb-sucking:

One may suppose that thinking, or fantasying, gets linked up with these functional experiences.

All these things I am calling
transitional
phenomena.
Also, out of all this (if we study one infant) there may emerge some thing or some phenomenon – perhaps a bundle of wool or the corner of a blanket or eiderdown, or a word or tone, or a mannerism – that becomes vitally important to the infant for use at the time of going to sleep, and is a defence against anxiety, especially anxiety of depressive type. Perhaps some soft object or other type of object has been found and used by the infant, and this then becomes what I am calling a
transitional
object.
This object goes on being important. The parents get to know its value and carry it round when travelling. The mother lets it get dirty and
even smelly, knowing that by washing it she introduces a break in continuity in the infant’s experience, a break that may destroy the meaning and value of the object to the infant.

I suggest that the pattern of transitional phenomena begins to show at about four to six to eight to twelve months. Purposely I leave room for wide variations.

Patterns set in infancy may persist into childhood, so that the original soft object continues to be absolutely necessary at bed-time or at time of loneliness or when a depressed mood threatens. In health, however, there is a gradual extension of range and interest, and eventually the extended range is maintained, even when depressive anxiety is near. A need for a specific object or a behaviour pattern that started at a very early date may reappear at a later age when deprivation threatens.

This first possession is used in conjunction with special techniques derived from very early infancy, which can include or exist apart from the more direct auto-erotic activities. Gradually in the life of an infant teddies and dolls and hard toys are acquired. Boys to some extent tend to go over to use hard objects, whereas girls tend to proceed right ahead to the acquisition of a family. It is important to note, however, that
there is no noticeable difference between boy and girl in their use of the original ‘not-me’ possession,
which I am calling the transitional object.

As the infant starts to use organized sounds (‘mum’, ‘ta’, ‘da’) there may appear a ‘word’ for the transitional object. The name given by the infant to these earliest objects is often significant, and it usually has a word used by the adults partly incorporated in it. For instance, ‘baa’ may be the name, and the ‘b’ may have come from the adult’s use of the word ‘baby’ or ‘bear’.

The object is affectionately cuddled as well as excitedly loved and mutilated.

It must never change, unless changed by the infant…

It is not forgotten and it is not mourned. It loses meaning, and this is because the transitional phenomena have become diffused, have become spread out over the whole intermediate territory between ‘inner psychic reality’ and ‘the external world as perceived by two persons in common’, that is to say, over the whole cultural field.

At this point my subject widens out into that of play, and of artistic creativity and appreciation, and of religious feeling, and of dreaming,
and also of fetishism, lying and stealing, the origin and loss of affectionate feeling, drug addiction, the talisman of obsessional rituals, etc.

Dr P. was a musician of distinction, well-known for many years as a singer, and then, at the local School of Music, as a teacher. It was here, in relation to his students, that certain strange problems were first observed. Sometimes a student would present himself, and Dr P. would not recognize him; or, specifically, would not recognize his face. The moment the student spoke, he would be recognized by his voice. Such incidents multiplied, causing embarrassment, perplexity, fear – and, sometimes, comedy. For not only did Dr P. increasingly fail to see faces, but he saw faces when there were no faces to see: genially, Magoo-like, when in the street, he might pat the heads of
water-hydrants
and parking-meters, taking these to be the heads of children; he would amiably address carved knobs on the furniture, and be astounded when they did not reply. At first these odd mistakes were laughed off as jokes, not least by Dr P. himself. Had he not always had a quirky sense of humour, and been given to Zen-like paradoxes and jests? His musical powers were as dazzling as ever; he did not feel ill – he had never felt better; and the mistakes were so ludicrous – and so ingenious – that they could hardly be serious or betoken anything serious. The notion of there being ‘something the matter’ did not emerge until some three years later, when diabetes developed. Well aware that diabetes could affect his eyes, Dr P. consulted an ophthalmologist, who took a careful history, and examined his eyes
closely. ‘There’s nothing the matter with your eyes,’ the doctor concluded. ‘But there is trouble with the visual parts of your brain. You don’t need my help, you must see a neurologist.’ And so, as a result of this referral, Dr P. came to me.

It was obvious within a few seconds of meeting him that there was no trace of dementia in the ordinary sense. He was a man of great cultivation and charm, who talked well and fluently, with imagination and humour. I couldn’t think why he had been referred to our clinic.

And yet there
was
something a bit odd. He faced me as he spoke, was oriented towards me, and yet there was something the matter – it was difficult to formulate. He faced me with his
ears,
I came to think, but not with his eyes. These, instead of looking, gazing, at me, ‘taking me in’, in the normal way, made sudden strange fixations – on my nose, on my right ear, down to my chin, up to my right eye – as if noting (even studying) these individual features, but not seeing my whole face, its changing expressions, ‘me’, as a whole. I am not sure that I fully realized this at the time – there was just a teasing strangeness, some failure in the normal interplay of gaze and expression. He saw me, he
scanned
me, and yet …

‘What seems to be the matter?’ I asked him at length.

‘Nothing that I know of,’ he replied with a smile, ‘but people seem to think there’s something wrong with my eyes.’

‘But
you
don’t recognize any visual problems?’

‘No, not directly, but I occasionally make mistakes.’

I left the room briefly, to talk to his wife. When I came back Dr P. was sitting placidly by the window, attentive, listening rather than looking out. ‘Traffic,’ he said, ‘street sounds, distant trains – they make a sort of symphony, do they not? You know Honegger’s
Pacific
231
?’

What a lovely man, I thought to myself. How can there be anything seriously the matter? Would he permit me to examine him?

‘Yes, of course, Dr Sacks.’

I stilled my disquiet, his perhaps too, in the soothing routine of a neurological exam – muscle strength, co-ordination, reflexes, tone … It was while examining his reflexes – a trifle abnormal on the left side – that the first bizarre experience occurred. I had taken off his left shoe and scratched the sole of his foot with a key – a frivolous-seeming but essential test of a reflex – and then, excusing myself to screw my ophthalmoscope together, left him to put on the shoe himself. To my surprise, a minute later, he had not done this.

‘Can I help?’ I asked.

‘Help what? Help whom?’

‘Help you put on your shoe.’

‘Ach,’ he said, ‘I had forgotten the shoe’, adding,
sotto
voce,
‘The shoe? The shoe?’ He seemed baffled.

‘Your shoe,’ I repeated. ‘Perhaps you’d put it on.’

He continued to look downwards, though not at the shoe, with an intense but misplaced concentration. Finally his gaze settled on his foot: ‘That is my shoe, yes?’

Did I mis-hear? Did he mis-see?

‘My eyes,’ he explained, and put a hand to his foot. ‘
This
is my shoe, no?’

‘No, it is not. That is your foot.
There
is your shoe.’

‘Ah! I thought that was my foot.’

Was he joking? Was he mad? Was he blind? If this was one of his ‘strange mistakes’, it was the strangest mistake I had ever come across.

I helped him on with his shoe (his foot), to avoid further complication. Dr P. himself seemed untroubled, indifferent, maybe amused. I resumed my examination. His visual acuity was good: he had no difficulty seeing a pin on the floor, though sometimes he missed it if it was placed to his left.

He saw all right, but what did he see? I opened out a copy of the
National
Geographic
Magazine,
and asked him to describe some pictures in it.

His responses here were very curious. His eyes would dart from one thing to another, picking up tiny features, individual features, as they had done with my face. A striking brightness, a colour, a shape would arrest his attention and elicit comment – but in no case did he get the scene-as-a-whole. He failed to see the whole, seeing only details, which he spotted like blips on a radar screen. He never entered into relation with the picture as a whole – never faced, so to speak,
its
physiognomy. He had no sense whatever of a landscape or scene.

I showed him the cover, an unbroken expanse of Sahara dunes.

‘What do you see here?’ I asked.

‘I see a river,’ he said. ‘And a little guest-house with its terrace on the water. People are dining out on the terrace. I see coloured parasols here and there.’ He was looking, if it was ‘looking’, right off the cover, into mid-air and confabulating non-existent features, as if the absence of
features in the actual picture had driven him to imagine the river and the terrace and the coloured parasols.

I must have looked aghast, but he seemed to think he had done rather well. There was a hint of a smile on his face. He also appeared to have decided that the examination was over, and started to look round for his hat. He reached out his hand, and took hold of his wife’s head, tried to lift it off, to put it on. He had apparently mistaken his wife for a hat! His wife looked as if she was used to such things.

I could make no sense of what had occurred, in terms of conventional neurology (or neuropsychology). In some ways he seemed perfectly preserved, and in others absolutely,
incomprehensibly
devastated. How could he, on the one hand, mistake his wife for a hat and, on the other, function, as apparently he still did, as a teacher at the Music School?

I had to think, to see him again – and to see him in his own familiar habitat, at home.

A few days later I called on Dr P. and his wife at home, with the score of the
Dichterliebe
in my briefcase (I knew he liked Schumann), and a variety of odd objects for the testing of perception. Mrs P. showed me into a lofty apartment, which recalled fin-de-siècle Berlin. A magnificent old Bösendorfer stood in state in the centre of the room, and all round it were music-stands, instruments, scores … There were books, there were paintings, but the music was central. Dr P. came in and, distracted, advanced with outstretched hand to the grandfather clock, but, hearing my voice, corrected himself, and shook hands with me. We exchanged greetings, and chatted a little of current concerts and performances. Diffidently, I asked him if he would sing.

‘The
Dichterliebe
!’ he exlaimed. ‘But I can no longer read music. You will play them, yes?’

I said I would try. On that wonderful old piano even my playing sounded right, and Dr P. was an aged, but infinitely mellow
Fischer-Dieskau
, combining a perfect ear and voice with the most incisive musical intelligence. It was clear that the Music School was not keeping him on out of charity …

I had stopped at a florist on my way to his apartment and bought myself an extravagant red rose for my buttonhole. Now I removed this and handed it to him. He took it like a botanist or morphologist given a specimen, not like a person given a flower.

‘About six inches in length,’ he commented. ‘A convoluted red form with a linear green attachment.’

‘Yes,’ I said encouragingly, ‘and what do you think it
is
, Dr P.?’

‘Not easy to say.’ He seemed perplexed. ‘It lacks the simple symmetery of the Platonic solids, although it may have a higher symmetry of its own … I think this could be an inflorescence or flower.’

‘Could be?’ I queried.

‘Could be,’ he confirmed.

‘Smell it,’ I suggested, and he again looked somewhat puzzled, as if I had asked him to smell a higher symmetry. But he complied courteously, and took it to his nose. Now, suddenly, he came to life.

‘Beautiful!’ he exlaimed. ‘An early rose. What a heavenly smell!’ He started to hum ‘Die Rose, die Lilie …’ Reality, it seemed, might be conveyed by smell, not by sight.

I tried one final test. It was still a cold day, in early spring, and I had thrown my coat and gloves on the sofa.

‘What is this?’ I asked, holding up a glove.

‘May I examine it?’ he asked, and, taking it from me, he proceeded to examine it as he had examined the geometrical shapes.

‘A continuous surface,’ he announced at last, ‘infolded on itself. It appears to have’ – he hesitated – ‘five outpouchings, if this is the word.’

‘Yes,’ I said cautiously. ‘You have given me a description. Now tell me what it is.’

‘A container of some sort?’

‘Yes,’ I said, ‘and what would it contain?’

‘It would contain its contents!’ said Dr P., with a laugh. ‘There are many possibilities. It could be a change-purse, for example, for coins of five sizes. It could…’

I interrupted the barmy flow. ‘Does it not look familiar? Do you think it might contain, might fit, a part of your body?’

No light of recognition dawned on his face.
*

No child would have the power to see and speak of ‘a continuous surface … infolded on itself’, but any child, any infant, would
immediately know a glove as a glove, see it as familiar, as going with a hand. Dr P. didn’t. He saw nothing as familiar. Visually, he was lost in a world of lifeless abstractions. Indeed he did not have a real visual world, as he did not have a real visual self. He could speak about things, but did not see them face-to-face. Hughlings Jackson, discussing patients with aphasia and left-hemisphere lesions, says they have lost ‘abstract’ and ‘propositional’ thought – and compares them with dogs (or, rather, he compares dogs to patients with aphasia). Dr P., on the other hand, functioned precisely as a machine functions. It wasn’t merely that he displayed the same indifference to the visual world as a computer but – even more strikingly – he construed the world as a computer construes it, by means of key features and schematic relationships. The scheme might be identified – in an ‘identiti-kit’ way – without the reality being grasped at all …

When the examination was over, Mrs P. called us to the table, where there was coffee and a delicious spread of little cakes. Hungrily, hummingly, Dr P. started on the cakes. Swiftly, fluently, unthinkingly, melodiously, he pulled the plates towards him, and took this and that, in a great gurgling stream, an edible song of food, until, suddenly, there came an interruption: a loud, peremptory rat-tat-tat at the door. Startled, taken aback, arrested, by the interruption, Dr P. stopped eating, and sat frozen, motionless, at the table, with an indifferent, blind, bewilderment on his face. He saw, but no longer saw, the table; no longer perceived it as a table laden with cakes. His wife poured him some coffee: the smell titillated his nose, and brought him back to reality. The melody of eating resumed.

How does he do anything, I wondered to myself? What happens when he’s dressing, goes to the lavatory, has a bath? I followed his wife into the kitchen and asked her how, for instance, he managed to dress himself. ‘It’s just like the eating,’ she explained. ‘I put his usual clothes out, in all the usual places, and he dresses without difficulty, singing to himself. He does everything singing to himself. But if he is interrupted and loses the thread, he comes to a complete stop, doesn’t know his clothes – or his own body. He sings all the time – eating songs, dressing songs, bathing songs, everything. He can’t do anything unless he makes it a song.’

While we were talking my attention was caught by the pictures on the walls.

‘Yes,’ Mrs P. said, ‘he was a gifted painter as well as a singer. The School exhibited his pictures every year.’

I strolled past them curiously – they were in chronological order. All his earlier work was naturalistic and realistic, with vivid mood and atmosphere, but finely detailed and concrete. Then, years later, they became less vivid, less concrete, less realistic and naturalistic; but far more abstract, even geometrical and cubist. Finally, in the last paintings, the canvases became nonsense, or nonsense to me – mere chaotic lines and blotches of paint. I commented on this to Mrs P.