DESCRIBE THE DIFFICULTIES OF LURIA'S "Z" (THE MAN WITH THE SHATTERED
WORLD) AND HOW (AND TO WHAT EXTENT) HE OVERCAME THEM.
On March 2nd 1943 Zasetsky ("Z") was wounded in the temple whilst
fighting on the western front. He had vague recollections of being
on an operating table but subsequently his head felt completely flat
and empty, it contained no thoughts or memories. He had seemingly
lost the ability to think, to remember or to recognise himself, he
appeared "new born". Sometimes images would flash into his mind and
occasional instantaneous memories would present themselves but
essentially he had lost his past. This initial losses did improve
slightly as the period of recovery began but this was not continuous
and after about 6 weeks no great changes occurred.
This was only one of a number of symptoms that presented themselves
to be the result of his injury, the following will attempt to
describe these difficulties and the ways in which "Z" attempted to
overcome them. His vision was affected and initially he could not
perceive anything, i.e. what he saw he could not make sense of (this
appears to improve with time) he had forgotten what most objects
were like because of the damage from scar tissue that stimulated the
nerve cells that retain visual memory. He also had the problem that
he could not see anything out of the right side of either eye which
meant that he had no visual field on the right side and there were
gaps on the left side. What he did see was badly distorted and
things appeared to be buzzing around and unstable.
A similar example was written about by Oliver Sacks when referring
to a stroke patient who could see nothing on her left side and would
complain whilst in the hospital that she did not have enough food on
her plate. She could only see half of the portion she overcame this
by acquiring a rotating wheelchair that enabled her to move round to
the right in a circle until the plate became visible and she was
able to eat a further half of what was on the plate. Her natural
tendencies were movements to the right, she had no understanding or
concept of what was meant by left in either the world or her body.
This meant that she became quite upset and distressed when mirrors
enabled her to see her left side because it had no feeling and so in
her mind did not exist. Luria does not mention any attempts to
overcome this difficulty with "Z" but as his problems were manyfold
it would not have been so straightforward to correct a single
symptom.
Another case described by Sacks referred to Dr P. ("The Man who
Mistook his Wife for a Hat"), this patient also had visual field
deficits which affected his imagination also, this is in direct
contrast to "Z" who maintained a complete and active imagination, he
could not describe anything that could be imagined on his left side;
for example if asked to imagine himself walking down a known street
the description given of the journey would only include the
buildings on the right hand side and yet if he was then asked to
imagine walking back the other way again only the buildings of his
right hand side would be described, i.e. those which were ignored
the first time round. In the account of "Z", Luria points out that
"Z"s imagination was unimpaired, making it even more difficult to
pin point the specific areas of damage.
Another symptom that "Z" faced was that of what he described as
`bodily peculiarities'. One aspect of this was associated with his
visual deficits in that when he looked at his body, the right side
of it had gone (as with Mrs S., Sacks' stroke victim), he could feel
his fingers on his left side but was unaware of those on his right.
He could not get used to the idea that his field of vision was
limited and in this respect did not successfully overcome this
particular handicap Linked with these bodily peculiarities were the
feelings he had occasionally that parts of his body changed such
that his head suddenly felt large, his torso small or his legs
became displaced or separated from the rest of him, his body
appeared fragmented. he could not locate parts of his body but had
to hunt for them, as with other problems he faced, which will be
described later, he had difficulty naming his body parts i.e.
associating works with reality. Luria suggests in his book that "Z"
was able to adjust to these peculiarities but does not expand
further on how he does this.
As well as `bodily peculiarities' he also faced `spatial
peculiarities' whereas very soon after his injury he realised his
difficulties in judging distances, this problem continued and showed
no improvements over time. he could not attempt to shake hands, sit
down in a chair or hold a pencil without exhausting himself or using
up vase amounts of nervous energy. He was afraid to reach out and
touch things and was unable to perceive direction, he could not
understand directions such as left, right, forward or backward -
this made map-reading an almost impossible task and he felt
constantly disoriented, even when retracing his steps along what
should be familiar pathways. As with the vision, his world was
fragmented, shattered and broken up into thousands of separate
parts, space `made no sense', its lack of stability frightened him.
An important contributor to `Z"s problems concerned his memory.
Immediately following the injury he could not remember anything at
all but in the initial part of his recovery, some memories of his
childhood did return but they were partial and incomplete and after
a certain time there was no further improvement. There seemed to be
two parts to his memory - that concerning his visual recollections
and that involving the knowledge he had learnt. Some recollections
occurred from the first category in that he began to remember scenes
from his childhood and yet he could not remember anything that he
had learnt. The visual images that returned to him did so
spontaneously, he could not summon them at will, this only added to
his confused and fragmented world.
his reading ability was severely affected by his memory loss.
Initially, he was presented as being illiterate, when he looked at a
letter it was unfamiliar to him and therefore he could not recognise
words in his unstable world. he tried to learn to read again but
associating visual images with letters. His verbal-motor function
was unaffected as he retained the ability to recite the alphabet, he
used this to locate letter when he was trying to identify letters and
words. His visual limitation also restricted his reading as he could
only see three letters on the page at any one time which meant that
once those 3 letters had been `read' and they moved out of the visual
field they were soon forgotten again. His difficulties with reading
increased rather than improved, he developed blocks and the pace got
slower.
Despite his loss of reading ability he retained the ability to
write. Initially he lost this, along with many other things, and
could not even hold a pencil, gradually he tried to learn to write
again in the same way that children learn to write but this did not
prove successful. However, time revealed that the way to overcome
this particular ability was to write as he did as any adult,
spontaneously and without thinking. This strange concept of being
able to write but not read was an unusual one and may bring to the
fore the debate of how interlinked the two functions are. "Z" could
write but he could not read what he had written. Six months
intensive training enabled him to read and write again although
there were no grammatical rules involved in his work.
Grammar fell into that category of his memory involved with
knowledge and his inability to remember what he had previously
learnt. He began by writing down single words and then trying to
make sense of them, problems arose for him when the order of words
in a sentence seriously affected their meaning, i.e. brother's
father or father's brother. Also in this category came the studies
he had undertaken at school and college - all this had gone. When
someone later spent a great deal of time going over mathematical
formulas which were previously known to him, he still could not
remember them, he could not even remember how to count or do basic
arithmetic. He needed to constantly recall information or it was
instantly forgotten.
Yet another frustrating problem he faced may be described as the
`tip-of-the-tongue' phenomena, whereby he had great difficulty
recalling words and associating them with objects, as was described
when discussing his `bodily peculiarities". He would see an object
which he recognised but he could not recall the name of the object
concerned. The converse also happened whereby he could hear a word
that was familiar to him but was unable to associate any meaning
with it. He lacked the ability to link word with meaning or meaning
with word.
Sacks' patient, Dr P., also suffered from this type of disability.
he could not recognise people, at least not by their faces only by
their body movement (or "body-music" as he called it) or if they had
a particularly distinguishing feature, e.g. a birthmark or a beard.
There is no account of how "Z" reacted to people but Dr P. also had
difficulty associating objects with names and relied on other senses
as well as vision, e.g. when shown a red rose, he described it and
suggested that may be a flower, but when he was able to touch and
smell it, he recognised it immediately as a rose. If conversation
helps to unlock "Z"s memories it may well be that by introducing
other senses, his ability to name objects may have been enhanced.
"Z"s problems mirrored those of Dr P. in that the latter did not
know what he had lost, he could be described as being blissfully
unaware of his deficiencies whereas "Z" "fought to regain lost
faculties with indomitable tenacity of the damned." This leads to
the question of who suffers more - he who knows or he who does not?
Despite his many difficulties, "Z" never gave up his fight to
overcome them. His relentless determination to write down his
experiences and thoughts was his most reliable form of communication
and his reason for living. he believed that by introspecting in
this way (i.e. examining his own mental experiences) that it would
serve to aid the doctors in finding a way to recover his memories.
he struggled constantly to interpret and understand the speech of
others in order to formulate and express his own ideas. His memory
was so short that sometimes he would develop an idea and then forget
it again before he had chance to write it down and yet he spent 25
years writing 3,000 words despite the difficulties described here.
An account like this should only make those who read it appreciate
some of what they take for granted and admire the determination of a
man to overcome the multitude of disabilities he faced.
References:
Luria, A R The Man with the Shattered World, Penguin Books Ltd
(1981)
Sacks, Oliver The Man who Mistook his Wife for a Hat, Picador (1986)
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