Foreword to the 1987 Edition
Oliver Sacks
Aleksandr Romanovich Luria’s extraordinarily productive life spanned the greater part of this century (1902–1977) and saw the profoundest changes in our approaches to brain and mind. His own lifetime endeavor was to explore the texture of human thought, perception, and action, the ways in which it could be damaged or disordered, and the ways in which it could be reconstituted after the ravages of injury or disease. His interests ranged very widely, and in the course of fifty-five incessantly productive years (his first book, on psychoanalysis, was published in 1922; his last books, on memory, language, and cognitive development, were all published in the last year of his life) he gave us profound explorations of subjects as diverse as neurosis, Parkinsonism, language disorders, disorders of will and action, behavioral and cognitive disorders in children, complex forms of “mental blindness, ” and – what I suspect was his favorite subject – the nature of memory and imagination. He wrote a score of books and some hundreds of articles, all marked by a crystalline transparency of thought and style, passionate honesty, and, above all, love for his work. He was the most significant and fertile neuropsychologist of his time and raised neuropsychology to a subtlety and simplicity which could not have been imagined fifty years ago.
What was distinctive in his approach from the start, and formed a constant thread in all his explorations, was his sense that even the most elemental functions of brain and mind were not wholly biological in nature but conditioned by the experiences, the interactions, the culture, of the individual – his belief that human faculties could not be studied or understood in isolation, but always had to be understood in relation to living and formative influences. This “social” viewpoint was especially shared with his great teacher Lev Vygotsky, and Luria often spoke of his work as an extension of Vygotsky’s. Other influences, notably those of Freud and Pavlov, were highly significant for him at different times; but above all Luria was an original who thought in his own way.
His earlier studies – on the development of language and mind in the child, on play, and on cross-cultural cognitive development – were, indeed, essentially “Vygotskian.” But then, feeling that studies of the development of mental function needed to be supplemented by studies of their breakdown, Luria turned in the late 1930s to the classical method of clinical analysis, which was to occupy him for the remainder of his life. Looking at the effects of brain lesions (such as injuries, strokes, and tumors) on perception, memory, imagery, language, “mind” – all the mental qualities of the afflicted – has always been the staple method of classical neurology. But through Luria’s radically new concepts of and approaches to brain and mental functioning, new ways of understanding neurological processes were opened up, ways which were also, potentially, therapeutic (in contrast to the “old” neurology, which had no power to do anything).
The Second World War, with its tragic incidence of severe brain injuries, provided an enormous testing ground for the new neuropsychology, and Luria’s work The Restoration of Function after Brain-Injury gave new understanding and hope in the treatment of such patients. After the war, and most especially in relation to cerebral aneurysms and tumors (the casualties of civilian life), his studies expanded, became more focused and intense, leading to the most comprehensive explorations of language, memory, perception, imagery, judgment – all the functions that constitute, or take part in, Mind. These studies are to be found in a series of important books: Human Brain and Psychological Processes, Traumatic Aphasia, Basic Problems of Neuro-linguistics, The Neuropsychology of Memory, and, most monumental of all, Higher Cortical Functions in Man.
This is the grand, “classical” side of Luria, but there is another side equally important – he liked to speak of this as “Romantic Science.” Luria contrasts “classical” and “romantic” science in this way:
Classical scholars are those who look upon events in terms of their constituent parts. Step by step they single out important units and elements until they can formulate abstract, general laws. One outcome of this approach is the reduction of living reality with all its richness of detail to abstract schemas. The properties of the living whole are lost, which provoked Goethe to pen, “Gray is every theory, but ever green is the tree of life.”
Romantic scholars’ traits, attitudes, and strategies are just the opposite. They do not follow the path of reductionism, which is the leading philosophy of the classical group. Romantics in science want neither to split living reality into its elementary components nor to represent the wealth of life’s concrete events in abstract models that lose the properties of the phenomena themselves. It is of the utmost importance to romantics to preserve the wealth of living reality, and they aspire to a science that retains this richness. (The Making of Mind, p. 174)
This notion of “Romantic Science,” which haunted him from his earliest years, only found full expression in the last years of his life, in his two extraordinary “neurological novels”: The Mind of a Mnemonist and The Man with a Shattered World.
When Shattered World was first published, I was so excited by it that I wrote a review which turned into an essay on Luria.1 It was an even greater excitement when he sent me a reply (getting a letter from Luria was like getting a letter from Freud!) defining, among other things, his attitude to his own work:
Frankly said, I myself like very much the type of “biographical” study, such as on Shereshevsky (the Mnemonist) and Zazetski . . . firstly because it is a kind of “Romantic Science” which I wanted to introduce, partly because I am strongly against a formal statistical approach and for a qualitative study of personality, for every attempt to find factors underlying the structure of personality . . . only the style of these two books is different from the others; the principle remains the same. (letter of July 19, 1973)
And, in another letter, a few days later:
I was ever conscious and sure that a good clinical description of cases plays a leading role in medicine, especially in Neurology and Psychiatry. Unfortunately, the ability to describe which was so common to the great Neurologists and Psychiatrists of the 19th century . . . is almost lost now. (letter of July 25, 1973)
Luria saw his own task (one of his two life tasks) as the refounding of a romantic science (the other being the founding of neuropsychology, a new analytical science). The two enterprises were not antithetical, but complementary at every point. Thus he spoke of his need to write two sorts of books: “systematic” books (like Higher Cortical Functions), and “biographical” or “romantic” books (like The Mnemonist and Shattered World). He saw the latter not as being “lightweight,” or less important than the former, but as a different (and, in its way, equally rigorous) form of science, as necessary as the classical, and complementary to it. That it was eminently readable and accessible was not just by chance, but followed from the nature of the enterprise, which was to present a patient, a man, in his wholeness, while delineating simultaneously the intimate structure of his being, that fusion of painting and anatomy of which Hume dreamed.
Such an enterprise – picturing and at the same time anatomizing a man, the dream of a novelist and a scientist combined – was first realized by Freud; and Freud’s magnificent case histories instantly spring to mind when one reads Luria. Luria’s case histories, indeed, can only be compared to Freud’s in their precision, their vitality, their wealth and depth of detail (though, of course, they are also quite different, as neuropsychology is different from psychoanalysis). Both explore, fundamentally, the nature of man; both are new ways of thinking about human nature.
Luria’s “biographies” are further distinguished by being case histories thirty years in length – neither Freud nor anyone else has ever given us a case history of this length. But their real uniqueness lies in their style, the combination of rigorous, analytical description with a deeply personal, empathetic feeling for the subjects. The rigorous analysis serves to delineate a “syndrome,” the totality of disease or disposition or altered function; but the syndrome, thus anatomized, is embedded in a person, an individual presented with almost novelistic ease and force. And these are conjoined – the syndrome is always related to the person, and the person to the syndrome – the personal and the scientific are always, hopefully, fused. Whether Luria succeeds in this fusion is up to the reader to judge; what must be stressed is that the enterprise was bold and new. No one had conceived a neurological “novel” before Luria.
“I have tried to follow,” Luria writes, “in the steps of Walter Pater in Imaginary Portraits . . . except that my books were unimagined portraits.” Unimagined, but not unimaginative, for a tremendous act of creative synthesis and imagination was needed to transform the bare facts about Shereshevsky and Zazetsky to the powerfully alive and beautiful case histories Luria finally gives us. These are, not unnaturally, case histories of extremes, for it is extremes which are exemplary and uniquely instructive, whether these deal with the hypertrophy of particular powers (as in the Mnemonist’s enormously powerful imagery and memory), or the devastating breakdown of specific brain and mind functions, as in the afflicted, brain-wounded Zazetsky.
A great physician of a former era, Ivy McKenzie, wrote: “The physician is concerned (unlike the naturalist) . . . with a single organism, the human subject, striving to preserve its identity under adverse circumstances.” As a neuropsychologist, Luria studies diseases and syndromes, the makeup and breakup of brain and mind; but as a romantic scientist and physician he is always and centrally concerned with identity, feeling it, seeing its vicissitudes, caring for it, fortifying it, as it struggles with adversity. Thus his “biographic” works, beyond their specifics, are first and last studies and stories of individuals as a whole – their minds, their lives, their worlds, their survival.
In The Mind of a Mnemonist, Luria not only provides us with a dazzling analysis of the Mnemonist’s mind, but shows a deep concern for the human plight of the Mnemonist. This sense of concern and compassion is still more evident in The Man with a Shattered World, where the plight of the patient is so excruciating and intense.
Both books, as Jerome Bruner emphasizes in his foreword to The Mind of a Mnemonist, go beyond a purely medical or scientific form and establish a new literary genre, one marked by an overarching conception of the narrative as a whole, and a language as unself-consciously beautiful as it is lucid. In Shattered World the sense of dramatic tension, of a story, is present from the start (though, as in most true stories, it is a story with no ending). Although the author of this life story, Luria tells us, is its hero, Zazetsky, we should in fact see them as coauthors and collaborators at every point. One can think of no precedents in this century for such a book; one has to return to the nineteenth-century, anonymous Confessions of a Tic-queur, interlarded with comments by his physicians, which begins Meige and Feindel’s book on tics. Luria looks back to this older tradition but revives it in a form which is radically new.
Zazetsky is severely wounded by shell fragments in 1942, with massive damage to the left occipito-parietal region of his brain (interweaving with the narrative voices of Zazetsky and Luria are a number of “digressions” on neuroanatomy and cerebral function, so lucid and simple they cannot be bettered). This fragmentation affects all aspects of his life: he suffers an intolerable, constantly shifting visual chaos – objects in his visual fields (what remains of his visual fields) are unstable, glimmer fitfully, get displaced, so that everything appears in a state of flux. It is impossible for him to see, or even imagine, the right side of his body – the sense of “a right side” has disappeared both from the outer world and his own self. He is subject to continual, almost unimaginable, uncertainties about his body: sometimes he thinks parts of it have changed, that his head has become inordinately large, his torso extremely small, his legs displaced . . . Sometimes he thinks his right leg is somewhere above his shoulder, possibly above his head. He also forgets how parts of his body function – thus, when he needs to defecate, he cannot remember his own anus.
But above all, and infinitely more serious than all these, are the devastations of memory, language, and thought: “My memory’s a blank. I can’t think of a single word . . . Whatever I do remember is scattered, broken down into disconnected bits and pieces.” With this he feels like “some terrible baby,” or like someone bewitched or lost in a hideous dream, although “A dream can’t last this long or be so monotonous. That means I’ve actually been experiencing this all these years . . . How horrible this illness is!” At times he even believes he has been killed, because the old Zazetsky, his former self and his world, has been “lost.” But yet, because his frontal lobes are intact, he is wholly aware of his situation and capable of the most determined and resourceful efforts to improve it. The book is a story of these efforts, in which patient and physician combine in the most intimate, creative, and involved relationship, a sense of relationship beyond anything in The Mnemonist, a relationship – never mentioned, invisible, but ubiquitous – which is the very essence of Medicine, of Care, and which suffuses this book with a special warmth, feeling, and moral beauty; it is a story of these efforts no less than a story of damage and deficits. Thus it becomes a story of survival—survival, and more, a kind of transcendence.
Side by side with Zazetsky’s hopelessness and despair is a fierce and indomitable will to improve, to do everything possible to recover, to return sense to his life. Military metaphors abound here, both in Zazetsky’s and Luria’s language. The original title of the book, Zazetsky’s title, was I’ll Fight On, and from first to last Luria depicts him, and admires him, as a fighter: “This book is about a person who fought with the tenacity of the damned to recover the use of his shattered brain”; “Though in many respects he remained as helpless as before, in the long run he won his fight.”
This book would not have been possible without the writings of Zazetsky himself, who, with his profound amnesia and aphasia (so that he could neither read nor remember what he had written), could only jot down memories and thoughts as they occurred to him, at random, and with the most excruciating difficulty and slowness. He was often unable to remember or write at all, and even at best he was only able to write a few sentences a day. But he nonetheless, by incredible perseverance and tenacity, managed to write three thousand pages over a period of twenty years, and then – and this is the crux – to arrange them and order them, and thus recover and reconstruct his lost life, making a meaningful whole from the fragments. The odds, as Luria says, were overwhelmingly against him; the odds were (and for such a patient are) that he would be “shattered,” “lost,” forever. This was certainly the case with some of his cerebral functions (“in many respects he remained as helpless as before”), but it was not the case with regard to his “life” – to the way in which, through constructing his own narrative, he managed to recapture, and reappropriate, the sense of a life-world, a lived life, the sense (in every sense) of his own life. This is what Luria means, I think, when he says, “there is a sense in which he may be said to have triumphed.”
And perhaps there is a universal here which applies to us all, even if we learn it anew from Zazetsky – the lesson also taught by Socrates, Freud, Proust – that a life, a human life, is not a life until it is examined; that it is not a life until it is truly remembered and appropriated; and that such a remembrance is not something passive, but active, the active and creative construction of one’s life, the finding and telling of the true story of one’s life. It is a profound irony, in these two wonderful and complementary books, that it is the memory man, the Mnemonist, who has in this sense lost his life, and the amnesiac, the shattered man, who gains and regains his life.
1 “The Mind of A. R. Luria,” Listener, June 28, 1973.
Concerning the Book and Its Author
This book describes the damage done to a man’s life by a bullet that penetrated his brain. Although he made every conceivable effort to recover his past, and thereby have some chance of a future, the odds were overwhelmingly against him. Yet I think there is a sense in which he may be said to have triumphed. It is not false modesty on my part to wish no credit for this book. The real author is its hero.
Before me is a pile of notebooks: some of them faded, makeshift affairs dating from the war years; others, thick, oilcloth-covered books covering the recent past. There are almost three thousand pages in these. They represent twenty-five years of work this man devoted to describing the effects of a terrible brain injury.
His only material consisted of fragmentary recollections that came to mind at random. On these he had to impose some order and sense of continuity, though every word he recalled, every thought he expressed, required the most excruciating effort. When his writing went well, he managed to write a page a day, two at the most, and felt completely drained by this. Writing was his one link with life, his only hope of not succumbing to illness but recovering at least a part of what had been lost. This journal recounts a desperate fight for life with a skill psychologists cannot help envying.
In trying to put the scattered pages of this man’s recollections together, I have included observations that I made during the twenty-five years I saw him as a hospital and clinic patient. As I came to know him, I realized what a brilliant mind that bullet had destroyed, and I wished to share some of my impressions and thoughts with others. The result is this small book.
Although this man refers to his account as a “story,” there is not a trace of fiction in it. Each assertion has been verified by hundreds of records and observations.
In short, this is a book about a person who fought with the tenacity of the damned to recover the use of his damaged brain. Though in many respects he remained as helpless as before, in the long run he won his fight.
A. L.
Moscow
1972
From the Author
Perhaps someone with expert knowledge of the human brain will understand my illness, discover what a brain injury does to a man’s mind, memory, and body, appreciate my effort, and help me avoid some of the problems I have in life. I know there is a good deal of talk now about the cosmos and outer space, and that our earth is just a minute particle of this infinite universe. But, actually, people rarely think about this; the most they can imagine are flights to the nearest planets revolving around the sun. As for the flight of a bullet, or a shell or bomb fragment, that rips open a man’s skull, splitting and burning the tissues of his brain, crippling his memory, sight, hearing, awareness—these days people don’t find anything extraordinary in that. But if it’s not extraordinary, why am I ill? Why doesn’t my memory function, my sight return? Why does my head continually ache and buzz? It’s depressing, having to start all over and make sense out of a world you’ve lost because of injury and illness, to get these bits and pieces to add up to a coherent whole.
The title I decided on for my writing was “I’ll Fight On!” I wanted to describe how this disaster came about, and how it has continued to plague me ever since I was wounded. I haven’t given up hope. I’m trying to improve my situation by developing my ability to remember and speak, to think and understand. I’m fighting to recover a life I lost when I was wounded and became ill.
L.Z.
In the beginning it was all so simple. His past was much like other people’s: life had its problems, but was simple enough, and the future seemed promising.
Even now he loves to recall this, the pages of his diary reverting again and again to that lost life:
In 1941, right before the war began, I finished my third year of courses at a polytechnic institute and hoped soon to get some practical experience in a specialized plant. I pictured the kind of work I would do at that plant, which had some of the best projects under way. Some independent work for a better future—it seemed an ideal way to finish my degree and research at the institute.
For some reason, even as a child I was fascinated by science, by knowledge in general, and greedily devoured any information I could pick up—at school, study groups, or simply in my daily life. I longed to become a really versatile person and be able to contribute to my country in a number of ways through science and technology.
Before I was two years old my father died suddenly in a coal mine where he worked as an engineer. After his death my mother had a rough time of it with four young children, since she was illiterate and didn’t know how to go about getting a pension for her children. But she was a hard worker who wasn’t afraid to face up to the hardships of this new life, but contrived somehow to feed and clothe us, keep a roof over our heads, and even send us to school when the time came. I too was sent, did very well in elementary school, and six years later graduated with honors from the middle school.
“Soon,” I thought, “I’ll be graduating from the institute. Two years left to go? That’s nothing! What can possibly stand in my way now? And as soon as I get my degree, I’ll start giving my mother a hand, it’s about time she had a chance to rest! . . .”
At times he remembered his childhood: dimly at first, though later on his recollections were amazingly clear:
It turns out I do remember my childhood, even my first and second year in elementary school. I remember the teacher I had there—Marya Gavrilovna Lapshina, and the names of my best friends—Sanka Mironov, Volodka Salomatin, Tanya Rasina, Adya Protopopova, Marusya Luchnikova.
I can even remember the games we played and the tunes we sang, how, in second grade, I’d write nasty verses about the kids I didn’t like. I was also sent to a Young Pioneers’ meeting in Moscow that somehow never managed to come off, but I remember what their camp was like and the rally we held. I also remember Epifan’—my home town—particular parts of it and the town as a whole. Also . . . my best friends and teacher in elementary school. . . . I recall what people meant by words like earth, sun, moon, stars, and universe (as only a schoolboy, a child, can remember or think of these).
Further on in his journal we find other recollections of life in that peaceful town where he spent his childhood and youth:
Epifan’ was once an old trading center. In the middle of town there’s a big cathedral with various frescoes of the Virgin and the Infant Jesus, and a gold cross, on its spire. From the cathedral the streets extend like rays, the nearest lined with two and three-story houses, those further off with wooden, one-story merchants’ homes. At the edge of town there are three or four other churches, and a kilometer further, a stream running north to south. To get there you have to turn left down a steep block or follow a sharp, winding path near Uspenskaya Church. . . . My family lived on a small block called Parkova—on the second floor. Three houses beyond ours, there’s a small park, where it’s always so quiet and peaceful. . . .