The Man Who Mistook His Wife for a Hat: “Hands”

Madeleine J. was admitted to St. Benedict's Hospital near New York City in 1980, her sixtieth year, a congenitally blind woman with cerebral palsy, who had been looked after by her family at home throughout her life.

Quite the contrary: she spoke freely, indeed eloquently (her speech, mercifully, was scarcely affected by spasticity), revealing herself to be a high-spirited woman of exceptional intelligence and literacy.

She held them up, derisively. ‘Useless godforsaken lumps of dough—they don't even feel part of me.'

Miss J.'s hands were mildly spastic and athetotic, but her sensory capacities—as I now rapidly determined—were completely intact: she immediately and correctly identified light touch, pain, temperature, passive movement of the fingers.

There was no impairment of elementary sensation, as such, but, in dramatic contrast, there was the profoundest impairment of perception.

She could not identify—and she did not explore; there were no active ‘interogatory' movements of her hands—they were, indeed, as inactive, as inert, as useless, as ‘lumps of dough'.

Was there any precedent? Had anything like this ever been described—or tried?

The condition they were describing was quite different in origin: they described a similar ‘alienation' of the hands in some two hundred soldiers following massive injury and surgery—the injured hands felt ‘foreign', ‘lifeless', ‘useless', ‘stuck on', despite elementary neurological and sensory intactness.

Leont'ev and Zaporozhets spoke of how the ‘gnostic systems' that allow ‘gnosis', or perceptive use of the hands, to take place could be ‘dissociated' in such cases as a consequence of injury, surgery and the weeks- or months-long hiatus in the use of the hands that followed.

The injured soldiers described by Leont'ev and Zaporozhets had normal hands before injury. All they had to do was to ‘remember' what had been ‘forgotten', or ‘dissociated', or ‘inactivated', through severe injury. Madeleine, in contrast, had no repertoire of memory for she had never used her hands—and she felt she had no hands—or arms either.

This then was the challenge that faced us: a patient with perfect elementary sensations in the hands, but, apparently, no power to integrate these sensations to the level of perceptions that were related to the world and to herself; no power to say, ‘I perceive, I recognise, I will, I act', so far as her ‘useless' hands went.

‘In the beginning is the deed,' Goethe writes. This may be so when we face moral or existential dilemmas, but not where movement and perception have their origin.

We could not say to Madeleine, ‘Do it!’ but we might hope for an impulse; we might hope for, we might solicit, we might even provoke one...

‘Leave Madeleine her food, as if by accident, slightly out of reach on occasion,' I suggested to her nurses. 'Don't starve her, don't tease her, but show less than your usual alacrity in feeding her.'

'Recognition' had somehow to be achieved by a curiously roundabout sort of inference or guesswork, for having been both blind and 'handless' since birth, she was lacking in the simplest internal images (whereas Helen Keller at least had tactile images).

A bagel was recognised as round bread, with a hole in it; a fork as an elongated flat object with several sharp tines.

But then this preliminary analysis gave way to an immediate intuition, and objects were instantly recognised as themselves, as immediately familiar in character and 'physiognomy', were immediately recognised as unique, as 'old friends'.

She asked for clay and started to make models: her first model, her first sculpture, was of a shoehorn, and even this was somehow imbued with a peculiar power and humour, with flowing, powerful, chunky curves reminiscent of an early Henry Moore.

There were limits, after all, to the interest and expressive possibilities of things, even when transfigured by a sort of innocent, ingenuous and often comical genius.

Her hands, only such a little while ago inert, doughy, now seemed charged with a preternatural animation and sensibility.

One was not merely being recognised, being scrutinised, in a way more intense and searching than any visual scrutiny, but being ‘tasted’ and appreciated meditatively, imaginatively and aesthetically, by a born (a newborn) artist.

One was not merely being recognised, being scrutinised, in a way more intense and searching than any visual scrutiny, but being ‘tasted’ and appreciated meditatively, imaginatively and aesthetically, by a born (a newborn) artist.

And who could have dreamed that in this blind, palsied woman, hidden away, inactivated, over-protected all her life, there lay the germ of an astonishing artistic sensibility (unsuspected by her, as by others) that would germinate and blossom into a rare and beautiful reality, after remaining dormant, blighted, for sixty years?

While Mr K. had normal strength and sensation in his hands, he scarcely ever used them—and was extraordinarily inept at handling, exploring, or recognising anything.

Typically this feeling of de-realisation, if it occurs, is absolutely sudden...and the return of reality, if it occurs, is equally sudden. There is, as it were, a critical (functional and ontological) threshold.

With this there is apt to occur a sudden re-realisation—a sudden leap back into subjective reality and ‘life’...provided there is sufficient physiological potential (if the neuropathy is total, if the distal parts of the nerves are quite dead, no such re-realisation is possible).

For patients with a severe but sub-total neuropathy, a modicum of use is literally vital, and makes all the difference between being a ‘basket-case’ and reasonably functional (with excessive use, there may be fatigue of the limited nerve function, and sudden de-realisation again).

It should be added that these subjective feelings have precise objective correlates: one finds ‘electrical silence’, locally, in the muscles of the hands and feet; and, on the sensory side, a complete absence of any ‘evoked potentials’, at every level up to the sensory cortex.