The Man Who Mistook His Wife for a Hat: Introduction to Part Two

Thus a disease which is ‘ebullient’ or ‘productive’ in character challenges the basic mechanistic concepts of neurology, and this is doubtless one reason why such disorders—common, important, and intriguing as they are—have never received the attention they deserve.

They receive it in psychiatry, where one speaks of excited and productive disorders—extravagances of fancy, of impulse...of mania.

Classical, ‘Jacksonian’ neurology never considers such disorders of excess—that is, primary superabundances or burgeonings of functions (as opposed to so-called ‘releases’).

Thus Luria’s two clinical biographies are nicely balanced: The Man with a Shattered World is about loss, The Mind of a Mnemonist about excess.

In Awakenings there was an internal balance, so to speak, between the terrible privations seen before L-Dopa—akinesia, aboulia, adynamia, anergia, etc.—and the almost equally terrible excesses after L-Dopa—hyperkinesia, hyperboulia, hyperdynamia, etc.

And in this we see the emergence of a new sort of term, of terms and concepts other than those of function—impulse, will, dynamism, energy—terms essentially kinetic and dynamic (whereas those of classical neurology are essentially static).

We see in the Mnemonist—or in my own overenergised, galvanised patients on L-Dopa—a sort of animation gone extravagant, monstrous, or mad—not merely an excess, but an organic proliferation, a generation; not just an imbalance, a disorder of function, but a disorder of generation.

We see in the Mnemonist—or in my own overenergised, galvanised patients on L-Dopa—a sort of animation gone extravagant, monstrous, or mad—not merely an excess, but an organic proliferation, a generation; not just an imbalance, a disorder of function, but a disorder of generation.

We might imagine, from a case of amnesia or agnosia, that there is merely a function or competence impaired—but we see from patients with hypermnesias and hypergnosias that mnesis and gnosis are inherently active, and generative, at all times; inherently, and—potentially—monstrously as well.

It is with these living (and often highly personal) dispositions of brain and mind—especially in a state of enhanced, and thus illuminated, activity—that we shall be concerned now.

Enhancement allows the possibilities not only of a healthy fullness and exuberance, but of a rather ominous extravagance, aberration, monstrosity—the sort of ‘too-muchness' which continually loomed in Awakenings, as patients, over-excited, tended to disintegration and uncontrol; an overpowering by impulse, image and will; possession (or dispossession) by a physiology gone wild.

Enhancement allows the possibilities not only of a healthy fullness and exuberance, but of a rather ominous extravagance, aberration, monstrosity—the sort of ‘too-muchness' which continually loomed in Awakenings, as patients, over-excited, tended to disintegration and uncontrol; an overpowering by impulse, image and will; possession (or dispossession) by a physiology gone wild.

Growth can become over-growth, life ‘hyper-life'. All the ‘hyper' states can become monstrous, perverse aberrations, ‘para' states: hyperkinesia tends towards parakinesia—abnormal movements, chorea, tics; hypergnosia readily becomes paragnosia—perversions, apparitions, of the morbidly-heightened senses; the ardours of ‘hyper' states can become violent passions.

The paradox of an illness which can present as wellness—as a wonderful feeling of health and well-being, and only later reveal its malignant potentials—is one of the chimaeras, tricks and ironies of nature.

It is one which has fascinated a number of artists, especially those who equate art with sickness: thus it is a theme—at once Dionysiac, Venerean and Faustian—which persistently recurs in Thomas Mann—from the febrile tuberculous highs of The Magic Mountain, to the spirochetal inspirations in Dr Faustus and the aphrodisiac malignancy in his last tale, The Black Swan.

In Migraine I spoke of the high which may precede, or constitute the start of, attacks—and quoted George Eliot's remark that feeling ‘dangerously well' was often, for her, the sign or harbinger of an attack.

People complain of feeling ill—not well. Unless, as George Eliot does, they have some intimation of ‘wrongness', or danger, either through knowledge or association, or the very excess of excess.

...patients profoundly ill, with the profoundest deficits, for many decades, might find themselves, as by a miracle, suddenly well, only to move from there into the hazards, the tribulations, of excess, functions stimulated far beyond ‘allowable' limits.

And similarly, with more or less insight, in most of the others—as with Leonard L., as he passed from repletion to excess: ‘his abundance of health and energy—of “grace", as he called it—became too abundant, and started to assume an extravagant form...'

His sense of harmony and ease and effortless control was replaced by a sense of too-muchness...a great surplus, a great pressure of...[every kind], which threatened to disintegrate him, to burst him asunder.

‘Everything is too bright, too powerful, too much. It is a feverish energy, a morbid brilliance.'

'Dangerous wellness', ‘morbid brilliance', a deceptive euphoria with abysses beneath—this is the trap promised and threatened by excess, whether it be set by Nature, in the form of some intoxicating disorder, or by ourselves, in the form of some excitant addiction.

The human dilemmas, in such situations, are of an extraordinary kind: for patients are here faced with disease as seduction, something remote from, and far more equivocal than, the traditional theme of illness as suffering or affliction.

In disorders of excess there may be a sort of collusion, in which the self is more and more aligned and identified with its sickness, so that finally it seems to lose all independent existence, and be nothing but a product of sickness.

This fear is expressed by Witty Ticcy Ray in Chapter Ten when he says: 'I consist of tics—there is nothing else', or when he envisages a mind-growth—a ‘Tourettoma’—which might engulf him.