The Man Who Mistook His Wife for a Hat: "Reminiscence"

One night, in January 1979, she dreamt vividly, nostalgically, of her childhood in Ireland, and especially of the songs they danced to and sang.

She was bright, alert, not delirious or mad, but with a remote, absorbed look, as of someone half in a world of their own. I could find nothing neurologically amiss.

And, manifestly, she had been normal the day before.

This confirmed that she was indeed having temporal-lobe seizures, which, as Hughlings Jackson guessed and Wilder Penfield proved, are the invariable basis of ‘reminiscence' and experiential hallucinations.

She tried, therefore, to avoid thinking of them, but the avoidance of thinking was as provocative as the thinking.

She would hear countless songs—sometimes several simultaneously; sometimes she would hear an orchestra or choir; and, occasionally, voices, or a mere hubbub of noises.

'Musical epilepsy' sounds like a contradiction in terms: for music, normally, is full of feeling and meaning, and corresponds to something deep in ourselves, 'the world behind the music', in Thomas Mann's phrase—whereas epilepsy suggests quite the reverse: a crude, random physiological event, wholly unselective, without feeling or meaning.

Penfield was not only able to locate their origin in the temporal lobes, but was able to evoke the ‘elaborate mental state', or the extremely precise and detailed ‘experiential hallucinations' of such seizures by gentle electrical stimulation of the seizure-prone points of the cerebral cortex, as this was exposed, at surgery, in fully conscious patients.

Such stimulations would instantly call forth intensely vivid hallucinations of tunes, people, scenes, which would be experienced, lived, as compellingly real, in spite of the prosaic atmosphere of the operating room, and could be described to those present in fascinating detail, confirming what Jackson described sixty years earlier, when he spoke of the characteristic ‘doubling of consciousness'...

We know, all too well, from the study of ‘free associations’ that the most seemingly trivial or random thoughts may turn out to have an unexpected depth and resonance, but that this only becomes evident given an analysis in depth.

I have gone back to Mrs O’M. briefly, to elicit her associations, her feelings, to her ‘songs’.

Although, consciously, she cannot attribute to the three songs special feeling or meaning, she now recalls, and this is confirmed by others, that she was apt to hum them, unconsciously, long before they became hallucinatory seizures.

I put Mrs O’M. on anticonvulsants, and she forthwith ceased her musical convulsions.

There was, for the first 72 hours, an almost continuous seizure, or seizure ‘status’, associated with an apoplexy of the temporal lobe.

A representative, 31 (Case 2770), had major epilepsy induced by finding himself alone among strangers.

He gets gooseskin, goes hot and cold, and either the attack subsides or proceeds to a convulsion.

For Mrs O'C., nearly ninety, approaching the end of a long lonely life, this recapturing of ‘sacred and precious' childhood memories, this strange and almost miraculous anamnesis, breaking open the closed door, the amnesia of childhood, was provided, paradoxically, by a cerebral mishap.

You all, healthy people, can't imagine the happiness which we epileptics feel during the second before our fit...I don't know if this felicity lasts for seconds, hours or months, but believe me, I would not exchange it for all the joys that life may bring.

She too knew, in her seizures, an extraordinary felicity. But it seemed to her the acme of sanity and health—the very key, indeed the door, to sanity and health. Thus she felt her illness as health, as healing.

As she got better, and recovered from her stroke, Mrs O'C. had a period of wistfulness and fear. ‘The door is closing,' she said. 'I'm losing it all again.'

What is peculiarly important, and moving, in the case of Mrs O’C., is that epileptic ‘reminiscence’ here seized on something unconscious—very early, childhood experiences, either faded, or repressed from consciousness—and restored them, convulsively, to full memory and consciousness.

‘It was the healthiest, happiest experience of my life. There’s no longer a great chunk of childhood missing. I can’t remember the details now, but I know it’s all there. There’s a sort of completeness I never had before.’
These were not idle words, but brave and true.

She suffered from a Jacksonian ‘reminiscence', but this served to moor and heal her, as a Freudian ‘anamnesis'.

What, we may ask, could be played in such a way as to reconstitute an experience? Is it something akin to a film or record, played on the brain's film projector or phonograph?

Is it something akin to a film or record, played on the brain's film projector or phonograph? Or something analogous, but logically anterior—such as a script or score?

What is the final form, the natural form, of our life's repertoire? That repertoire which provides not only memory and ‘reminiscence', but our imagination at every level, from the simplest sensory and motor images, to the most complex imaginative worlds, landscapes, scenes? A repertoire, a memory, an imagination, of a life which is essentially personal, dramatic and ‘iconic’.

Analogous questions about the nature of knowing (or gnosis) are raised by our patients with agnosias—the dramatic visual agnosia of Dr P. (‘The Man Who Mistook His Wife for a Hat'), and the auditory and musical agnosias of Mrs O'M. and Emily D.

And similar questions about the nature of action (or praxis) are raised by the motor bewilderment, or apraxia, of certain retardates, and by patients with frontal-lobe apraxias—apraxias which may be so severe that such patients may be unable to walk, may lose their ‘kinetic melodies', their melodies of walking...

Computational representations—even of the exquisite sophistication envisaged by Marr and Bernstein (the two greatest pioneers and thinkers in this realm)—could never, of themselves, constitute ‘iconic' representations, those representations which are the very thread and stuff of life.

Thus a gulf appears, indeed a chasm, between what we learn from our patients and what physiologists tell us. Is there any way of bridging this chasm? Or, if that is (as it may be) categorically impossible, are there any concepts beyond those of cybernetics by which we may better understand the essentially personal, Proustian nature of reminiscence of the mind, of life?

Such patterns of meaning would indeed transcend purely formal or computational programmes or patterns, and allow the essentially personal quality which is inherent in reminiscence, inherent in all mnesis, gnosis, and praxis.

The score of ‘Easter Parade’, I conjecture, is indelibly inscribed in Mrs O’M.’s brain—the score, her score, of all she heard and felt at the original moment and imprinting of the experience.

The score of ‘Easter Parade’, I conjecture, is indelibly inscribed in Mrs O’M.’s brain—the score, her score, of all she heard and felt at the original moment and imprinting of the experience.

Similarly, in the ‘dramaturgic' portions of Mrs O’C.’s brain, apparently forgotten, but none the less totally recoverable, must have lain, indelibly inscribed, the script of her dramatic, childhood scene.

And let us note, from Penfield’s cases, that the removal of the minute, convulsing point of cortex, the irritant focus causing reminiscence, can remove in toto the iterating scene, and replace an absolutely specific reminiscence or ‘hyper-mnesia’ by an equally specific oblivion or amnesia.

And let us note, from Penfield’s cases, that the removal of the minute, convulsing point of cortex, the irritant focus causing reminiscence, can remove in toto the iterating scene, and replace an absolutely specific reminiscence or ‘hyper-mnesia’ by an equally specific oblivion or amnesia.

There is something extremely important, and frightening here: the possibility of a real psycho-surgery, a neurosurgery of identity (infinitely finer and more specific than our gross amputations and lobotomies, which may damp or deform the whole character, but cannot touch individual experiences).

Since the original publication of this book I have been consulted for innumerable cases of musical ‘reminiscence’—it is evidently not uncommon, especially in the elderly, though fear may inhibit the seeking of advice.

Patients with severe nerve-deafness may have musical ‘phantoms’. But in most cases no pathology can be found, and the condition, though a nuisance, is essentially benign.

(Why the musical parts of the brain, above all, should be so prone to such ‘releases’ in old age remains far from clear.)