THE+MAN+WHO+MISTOOK+HIS+WIFE+FOR+A+HAT



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1. THE MAN WHO MISTOOK HIS WIFE FOR A HAT **There is the expression of "not being able to see the forest from the trees" to describe someone who grasps details, but fails to comprehend the** **bigger picture. The first case study presented is an extreme case of this idea. When we think of the sense of sight, we assume that the eye (and brain) operates like a camera that simply records objects as they are. What we sometimes overlook is all the data gathered by our senses must be filtered and organized by the brain. Recently, psychiatrist Iain McGilchrist suggests that most of what the brain does is to filter out information so that it only processes a manageable amount (think of people who are sensitive to noise, light, or touch). In addition, there is some evidence that the different hemispheres of the brains focus on different tasks: one lobe on close detail, the other on the "big picture."** media type="youtube" key="ze8VVtBgK7A" height="400" width="552" align="center"

**Our brain allows us to "chunk" sense data so that we can see "wholes" instead of just "parts." Most reading difficulties come from the inability to see words independently of letters, which is also a reason why we miss obvious misspellings: our mind interpolates the letters that //should// be there. Think of how small children read (one letter/phoneme at a time). Think about reading Chinese (or Japanese) -- can you see where words begin or end? Another example illustrating this problem are cartoons and caricatures: we can associate a person with an especially dramatic feature, such as overly large ears, a unibrow, or big teeth and small children recognize a cartoon face, despite having little literal resemblance to an actual face. For example, no adult would confuse a Teddy Bear's eye with a real animal's eye, but children can instantly make the connection.** media type="youtube" key="DANgA5qCWAI" height="400" width="552" align="center"

**When this ability breaks down, it reveals how the brain and eye function and how they coordinate to produce our sense of sight. Dr. Sacks describes his patient's difficulty in viewing a picture.**
 * pg. 10-1. "His responses were very curious. His eyes would dart from one thing to another, picking up tiny features, as they had done with my face. A striking brightness, a colour, a shape would arrest his attention and elicit comment--but in no case did he get the scene-as-a-whole. He failed to see the whole, seeing only details, which he spotted like blips on a radar screen. He never entered into relation with the picture as a whole--never faced, so to speak, //its// physiognomy. He had no sense whatever of a landscape or scene. I showed him the cover, an unbroken expanse of Sahara dunes. 'What do you see here' I asked. 'I see a river,' he said. 'And a little guest-house with its terrace on the water. People are dining out on the terrace. I see coloured parasols here and there.' He was looking, if it was 'looking', right off the cover into mid-air an d confabulating nonexistent features, as if the absence of features in the actual picture had driven him to imagine the river and the terrace and the coloured parasols."


 * Sacks goes further to present the patient with abstract designs to see if these produced a different result. His patient was able to recognize wholes from distinctive elements and features.**
 * pg. 12. "Abstract shapes clearly presented no problems. What about faces? I took out a pack of cards. All of these he identified instantly, including the jacks, queens, and kings, and the joker. But these, after all, are stylised designs, and it was impossible to tell whether he saw faces or merely patterns. I decided I would show him a volume of cartoons which I had in my briefcase. Here, again, for the most part, he did well. Churchill's cigar, Schnozzle's nose: as soon as he had picked out a key feature he could identify the face. But cartoons, again, are formal and schematic. It remained to be seen how he would do with real faces, realistically represented."


 * Pushing further with his diagnoses, he discovers that his patient cannot pick on the emotions or persona that lies behind faces. Although most of us do this unconsciously, we pick up a lot of information visually from facial expressions and body posture. Think of how a dog reacts to tone of voice or the dilation of its master's eyes (the same can be said about babies -- big mouth & big eyes = happy baby; pursed mouth and narrow eyes = unhappy baby).**
 * pg. 13. ". . .he approached these faces -- even of those near and dear -- as if they were abstract puzzles or tests. He did not relate to them, he did not behold . . . A face, to us, is a person looking out -- we see, as it were, the person through his //persona,// his face. But for Dr. P. there was no //persona// in this sense -- no outward //persona,// and no person within."

**Sacks compares Dr. P's visual processing to a computer that focuses in on details, but does not grasp the construction or relationship between elements.**
 * pg. 15. "Visually, he was lost in a world of lifeless abstractions. Indeed he did not have a real visual world, as he did not h ave a real visual self. he could speak about things, but did not see them face-to-face . . . It wasn't that he dispalyed the same indifference to the visual world as a computer but -- even more strikingly -- he construed the world as a computer construes it, by means of key features and schematic relationships. The scheme might be identified -- in an 'identi-kit' way -- without the reality being grasped at all."

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**Sacks wonders about how Dr. P. is able to accomplish simple, everyday tasks that require sight and finds that he uses music to overcome his visual agnosia. However, when his music is interrupted, he is unable to complete the task.** **Sacks draws a broader point from the case of Dr. P, namely, the importance of judgment and feeling as elements in neuropathologies. The brain is not simply a machine that functions or malfunctions, but entails an irreducible personal dimension.**
 * pg. 17-8. "How does he do anything? I wondered to myself. What happens when he's dressing, goes to the lavatory, has a bath? I followed his wife into the kitchen and asked her how, for instance, he managed to dress himself. 'It's just like the eating,' she explained. 'I put his usual clothes out, in all the usual places, and he dresses without difficulty, singing to himself. He does everything singing to himself. But if he is interrupted and loses the thread, he comes to a complete stop, doesn't know his clothes--or his own body. He sings all the time--eating songs, dressing songs, bathing songs, everything. He can't do anything unless he makes it a song.' . . .music, for him, had taken the place of image. He had no body-image, he had body-music: this why he could move and act as fluently as he did, but came to a total confused stop if the 'inner music' stopped. And equally with the outside, the world . . ."
 * pg. 19-20. ". . . abstract attitude, which allows 'categorisation', also misses the mark with Dr. P -- and, perhaps, with the concept of 'judgment' in general. For Dr. P //had// abstract attitude -- indeed, nothing else. And it was precisely this, his absurd abstractness of attitude -- absurd because unleavened with anything else -- which rendered him incapable of perceiving . . . incapable of judgment. Neurology and psychology, curiously, though they talk of everything else, almost never talk of 'judgment' -- and yet it is precisely the downfall of judgment . . . which constitutes the essence of so many neuropsychological disorders . . . the brain //is// a machine and computer -- everything in classical neurology is correct. But our mental processes, which constitute our being and life, are not just abstract and mechanical, but personal, as well -- and, as such, involve not just classifying and categorising, but continual judging and feeling also.

**2. THE LOST MARINER** **This case study deals with the dynamics of memory, specifically with the dysfunctions that arise when the brain can no longer translate short-term memories into long-term memory. In short, the brain can no longer make //new// memories. The video below shows you an extreme case of someone with only short-term memory that can only hold attention for a few seconds. This memory resembles the memory of lower animals, such as fish, ("goldfish memory") who cannot hold more than a few seconds before forgetting everything about their environment.** media type="youtube" key="WmzU47i2xgw" height="400" width="552" align="center"


 * Memory in the human brain does not operate like a computer that stores imprints (or fragments of imprints) of sense experience in storage. Part of our brain focuses on direct experience and stores it temporarily, while another part decides what is important and relevant and selects certain things for long-term storage, paying particular attention to what it finds most relevant (this is why we can be good at memorizing certain things, like the lyrics to our favorite songs, but bad at others like medical terminology). The brain stores it in networks the give individual bits of information meaning; this is why we can remember things better if we "chunk" the information through the use of mnemonics or acronyms. Most of our skills (as well as dreams) are constructed from stored memories. When we face a familiar task, like driving home, the brain simply accesses the stored routine and executes it.**

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**Sacks' case study deals with a patient who has lost the ability to make new memories because the transmission process from short to long-term memory has broken down. He is still able to recall past memories perfectly well, but is trapped inside an eternal present where he believes that he is still 18 years-old even though he has aged considerable more. He is constantly reminded, and made anxious and panicked, by evidence (such as looking in a mirror) that remind him that his memory is not accurate. Sacks notes many instances of his memory loss, which as anyone who has watched Adam Sandler's //50 First Dates//, can be humorous to someone on the outside, but frightening to the person living them. Memory is central to personal identity and a person without memory can be a "lost soul" as Sacks describes.**
 * pg. 29. "'He is, as it were,' I wrote in my notes, 'isolated in a single moment of being, with a moat or lacuna of forgetting all round him . . . He is a man without a past (or future), stuck in a constantly changing, meaningless moment.' And then, more prosaically, 'The remainder of the neurological examination is entirely normal. Impression: probably Korsakov's syndrome, due to alcoholic degeneration of the mammilary bodies.' . . . who and what and where this poor man was -- whether indeed, on could speak of an 'existence', given so absolute a privation of memory or continuity. I kept wondering, in this and later notes -- unscientifically -- about a 'lost soul', and how one might establish some continuity, some roots, for he was a man without roots, or rooted only in the remote past."

**It is worth noting how Sacks' patient's condition resembles other, more well-known, conditions such as depression, Alzheimer's, and dementia. It resembles depression in that depression is often distinguished from ordinary sadness by the absence of hope, that things will not get better. Someone trapped in an eternal present has no future. In Alzheimer's and dementia, the breakdown of the brain parallels the alcoholism of Sacks' patient, where the destruction of memory leads to unfamiliarity causing confusion and disorientation as the Bunuel quote at the beginning notes:**
 * pg. 23. "You have to begin to lose your memory, if only in bits and pieces, to realise that memory is what makes our lives. Life without memory is no life at all . . . Our memory is our coherence, our reason, our feeling, even our action. Without it, we are nothing . . .(I can only wait for the final amnesia, the one that can ease an entire life, as it did my mother's . . .)
 * Sacks spends some space discussing the history of Korsakov's and A.R. Luria's work with patients with this conditions as he traces the origins of his patient's memory break (which seems due to heavy alcoholism). However, the main point may be how Jimmy is able to reintegrate his personality despite the loss of memory. In his consultation with Luria, Sacks is told not to focus on the neuropathology, but on the personal and moral.**
 * pg. 34. "What could we do? What should we do? 'There are no prescriptions,' Luria wrote, 'in a case like this. Do whatever your ingenuity and your heart suggest. There is little or no hope of any recovery in his memory. But a man does not consist of of memory alone. He has feeling, will, sensibilities, moral being -- matters of which neuropsychology cannot speak. And it is here, beyond the realm of an impersonal psychology, that you may find ways to touch him, and change him . . . Neuropsycholgoically, there is little or nothing you can do; but in the realm of the Individual, there may be much you can do."


 * Sacks notes a potential solution when he observes Jimmie in the home's chapel. His religious devotion is able to give his life, personality structure that overcomes the deficit from his memory loss. Religion produces a metaphysics and cosmology that provides an explanation of what the world is, how it came to be, and what is real and not and therefore can fill in the gaps left by lack of memory.**

**3. THE DISEMBODIED LADY** **The next few case studies deal with the loss of proprioception, the brain's body-image and awareness of the body that allows it to control body movements and sensation when it cannot be detected by other senses such as sight. The simplest way to understand it is to think of how one knows one's body position or orientation when one closes one's eyes. For example, close your eyes and touch your index finger to your nose.**

**Or, to understand its loss, think of walking down a staircase in the dark when you miss a step. In addition, this sense gives the brain a sense of ownership and self-recognition over the body, i.e., that your leg is your leg or even that you think your mind is inside your body.** media type="youtube" key="wvDi5B_7Cv0" height="400" width="552" align="center"

**Parkinson's disease is characterized by the loss of proprioception: the brain can no longer control body movement. We also see this in the cognition of young children whose brain's have not yet fully developed. The young child is not able to tell the difference between self and others; it think that her mother is an extension of herself and not someone else. This is also why they are attracted to games like peek-a-boo; they literally think the world disappears when they close their eyes, only to be restored when they open them. In addition, they think that when they close their eyes, you can't see them (this may explain why people touch their nose when they lie, they are hiding behind their hand. And, if you can't see them, you did not see the lie.).** **Proprioception is so taken for granted that we are often not aware of it. Therefore, its loss can be particularly disconcerting, as Sacks notes** **In this case study, Sacks considers the case of a woman who became "disembodied" -- her brain lost its sense of self and control over her body -- right before she was to come in for a gall bladder operation. While under observation, it was deduced that this total loss of proprioception was due to polyneuritis. Sacks explained to her that body sense is the combination of three systems working together, and she had lost control of one, and suggested using the other mechanisms to compensate.**
 * pg..43. "Our other senses -- the five senses -- are open and obvious; but this -- our hidden sense -- had to be discovered, as it was . . . its indispensability for our sense of //ourselves//; for it is only by courtesy of proprioception, so to speak, that we feel our bodies as proper to us, as our 'property', as our own . . . What is more important for us, at an elemental level, than the control, the owning and operation, of our own physical selves? And yet it is so automatic, so familiar, we never give it a thought."
 * pg. 47. "The sense of body, I told her, is given by three things: vision, balance organs (the vestibular system), and proprioception -- which she'd lost. Normally all of these worked together. If one failed, the others could compensate, or substitute -- to a degree . . . 'What I must do then,' she said slowly, 'is use vision, use my eyes, in every situation where I used -- what do you call it? -- propprioception before . . . This proprioception is like the eyes of the body, the way the body sees itself. And if it goes, as it's gone with me, it's like my body's blind, My body can't 'see' itself if it's lost its eyes, right? So //I// have to watch it -- be its eyes. Right?'"


 * Sacks describes how she consciously uses sight to compensate and gain some control over her body. This is a main element of physical therapy and rehabilitation where medical professionals help patients "relearn" how to do "normal" things such as walking, eating, etc.**
 * pg. 49-50. "Thus at the time of her catastrophe, and for about a month afterwards, Christina remained as floppy as a ragdoll, unable even to sit up. But three months later, I was startled to see her sitting very finely -- too finely, statuesquely, like a dancer in mid-pose. And soon I saw that her sitting was, indeed, a pose, consciously or automatically adopted and sustained, a sort of forced or wilful or histrionic posture, to make up for the continuing lack of any genuine, natural posture. nature having failed, she took to 'artifice', but the artifice was suggested by nature, and soon became 'second nature'."


 * Sacks notes that while she is able, through will and effort, to make a recovery of her physical functions, her condition makes her feel hollowed out inside: her body is not hers in a sense.**
 * pg. 51-2. "She continues to feel, with the continuing loss of proprioception, that her body is dead, not-real, not-hers -- she cannot appropriate it to herself. She canfind no words for this state, and can only use analogies derived from other senses: 'I feel my body is blind and deaf to itself . . . it has no sense of itself' -- these are her own words . . . 'Yes, of course, that's me!' Christina smiles, and then cries: 'But I can't identify with that graceful girl any more! She's gone, I can't remember her, //I can't even imagine her.// It's like something's been scooped right out of me, right at the centre . . .that's what they do with frogs, isn't it? They scoop out the centre, the spinal cord, they //pith// them . . .That's what I am, //pithed,// like a frog."

**4. THE MAN WHO FELL OUT OF BED** **This case is a slight variation of the previous one, but with an emphasis on the lack of recognition of one's own body: seeing one's own body as foreign and a desire to be rid of it, leading to his falling out of bed. I cannot summarize it better than in the video below. This story was also central to another of Sacks' collection of case studies: //A Leg to Stand On//.** media type="youtube" key="qvrSRvniu_A" height="400" width="552" align="center"

** 5. HANDS ** media type="youtube" key="Q6pWdIjAdn8" height="400" width="552" align="center" **It is a conventional belief that learning precedes doing. First, we learn how to do something, then we demonstrate our learning by doing something based on that knowledge or skill. However, most of how the brain learns is "learning-by-doing." Babies are able to learn, in part, because they are fearless: they do not know their limitations and are not afraid to make mistakes. Babies do not learn to walk by being taught, but learn bodily control through experimentation. They learn to talk by babbling and experimenting with different sounds, not by understanding what they are doing. Sacks' point about hands is that his patient's hands have become useless not because of physical or neurological limitations, but created by her failure to use them and then her belief that they were useless.**
 * In psychology, there is a concept called "[|learned] helplessness." In brief, it is the notion that the belief that one cannot do something causes a real inability to do something. For example, if I think that I cannot ride a bike, I do not ride bikes, which reinforces my inability. Individuals who suffer from diseases that do not believe they can heal, will not take the actions required for healing, and therefore, contribute to their malady. Like the previous case of the "Lost Mariner" the inability to create a new future caused despair and anxiety in Jimmie. The opposite of depression is not happiness, but hope: the belief that the future will be better than the present. This does not mean that one can will oneself to do anything through the power of positive thinking, there is still an objective reality, but as the sociologist Max Weber concluded that "we must arm ourselves with the steadfastness that will withstand the crumbling of hopes, otherwise we will not be able to do that which is now possible."**
 * The medical predicate of this is that doctors and nurses, in their effort to aid patients, may undermine their ability to heal themselves. As a result, an constant reminder today is to promote the patient's autonomy and self-reliance as much as possible, both in hospitals and long-term care facilities. Now let us return to the case study. Sacks renders his initial judgment, upon examination, that there is not neurological or physical limitation**
 * pg. 60. "There is no gross sensory 'deficit'. her hands would seem to have the potential of being perfectly good hands -- and yet they are not. Can it be that they are functionless -- 'useless' -- because she had never used them? Had being 'protected', 'looked after', 'babied' since birth prevented her from the normal exploratory use of the hands which all infants learn in the first months of life? Had she been carried about, had everything done for her, in a manner that had prevented her from developing a normal pair of hands? And if this was the case -- it seemed far-fetched, but was the only hypothesis I could think of -- could she now, in her sixtieth year, acquire what she should have acquired in the first weeks and months of life?


 * However, learned helplessness is a powerful belief and Dr. Sacks devising a way to make his patient use her hands to encouraged the belief that they can be used. He instructs the nurses to leave her food just out of her reach and not made large efforts to feed her to see if this would prompt her to use her hands.**
 * pg. 61-2. "'Leave Madeline her food, as if by accident, slightly out of reach on occasion,' I suggested . . . And one day, it happened -- what had never happened before: impatient, hungry, instead of waiting passively and patiently, she reached out an arm, groped, found a bagel, and took it to her mouth. This was the first use of her hands, her first manual act, in sixty years . . . It also marked her first manual perception, and thus her birth as a complete 'perceptual individual'. Her first perception, her first recognition, was of a bagel, or 'bagelhood' -- as Helen Keller's first recognition, first utterance, was of water ('waterhood'). After the first act, this first perception, progress was extremely rapid. As she had reached out to explore or touch a bagel, so now, in her new hunger, she reached out to explore the whole world."

**Sacks discusses "acquired agnosia" which is analogous to the psychological concept of "learned helplessness."**

**The brain's body-image -- proprioception -- is independent of other sensory pathways. This is shown in the case of amputees, who no longer have the ability to sense the presence of an amputated limb, but whose brain's body-image still believes, and acts on the belief, that the limb is still there. For example, feeling that one will poke one's eye with a non-existent finger or feeling pain in a limb that is no longer there, or the sense that one's arm or leg is not where it is ("positional phantom")** **While the phenomena of phantoms produces many entertaining episodes and vignettes, the key point may be whether they are functional or not. In one sense, because they are sensations that are not real, one could see phantoms as something that must be cured to bring the brain in line with reality. However, just because it is not real does not mean that they cannot be part of healthy, functional individual, as Sacks explains.** **This will probably be a growing and interesting field of medicine as many veterans returning from the ongoing wars in Iraq and Afghanistan manage amputated limbs. Here is a story about how one soldier is being treated.** media type="youtube" key="YL_6OMPywnQ" height="400" width="552" align="center"
 * 6. PHANTOMS **
 * pg. 68-9. "There is often a certain confusion about phantoms -- whether they should occur, or not; whether they are pathological, or not; whether they are 'real', or not. The literature is confusing, but patients are not -- and they clarify matters by describing different //sorts// of phantoms. Thus a clear-headed man, with an above-the-knee amputation, described this to me: 'There's this //thing//, this ghost-foot, which sometimes hurts like hell -- and the toes curl up, or go into spasm. This worst at night, or with the prosthesis off, or when I'm not doing anything. It goes away, when I strap the prosthesis on and walk. I still feel the leg then, vividly, but it's a //good// phantom, different -- it animates the prosthesis, and allows me to walk.' With this patient, with all patients, is not //use// all-important, in dispelling a 'bad' (or passive, or pathological) phantom, if it exists and in keeping the 'good' phantom -- that is, the persisting personal limb-memory or limb-image -- alive, active, and well, as they need?'

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 * The following is five parts of the first episode of the BBC's documentary "Phantoms of the Brain" that explains some of the neurology behind phantom-limbs. While only the first two segments deal with phantom limbs, I encourage you to watch all the segments of the related medical phenomena. **

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**This case study deals with a different aspect of proprioception, namely, distorted orientation. In this case, the patient walks on a 20-degree tilt, but is not aware of it, believing that he was walking upright. Sacks notes two points. First, that our "sixth sense" is taken for granted, normal, and only noticed when it goes amiss. Second, Sacks notes that balance lies at the nexus of three senses: sight, proprioception, and the labyrinthine (vestibular) systems and it is the coordination of all three that allows us to balance. First, Sacks comments on the invisibility of the normal.** **Sacks diagnoses the patient with symptoms of Parkinson's Disease and how it interferes with the brain's coordination of the various senses. Sacks details** **They devise a method of compensation by embedding an actual level in Mr. McGregor's glasses that allows him to see the level and adjust his body accordingly.**
 * 7. ON THE LEVEL **
 * pg. 72. "We have five sense in which we glory and which we recognise and celebrate, senses that constitute the sensible world for us. But there are other senses -- secret senses, sixth senses, if you will -- equally vital, but unrecognised and unlauded. These sense, unconscious, automatic, ahd to be discovered . . . yet their absence can be qutie conspicious. If there is defective (or distorted) sensation in our overlooked secret senses, what we then experience is profoundly strange, and almost inncommunicable equivalent to being blind or being deaf . . . [he presented] the picture that I love to see: a patient in the actual moment of discovery -- half-appalled, half-amused -- seeing for the first time exactly what is wrong and, in the same moment, exactly what there is to be done. This //is// the therapeutic moment."
 * pg. 73-4. "Mr. McGregor's homely symbol applies not just to the labyrinth but also to the complex //integration// of the three secret senses: the labyrinthine, the proprioceptive, and the visual. It is this synthesis that is impaired in Parkinsonism . . . Purdon Martin emphasizes the threefold contribution to the maintenance of a stable and upright posture, and he notes how commonly its subtle balance is upset in Parkinsonism -- how, in particular, 'it is usual for the labyrinthine element to be lost before the proprioceptive and the visual'. This triple control system, he implies, is such that //one// sense, //one// control, can compensate for the others."

The brain is divided into two hemispheres that govern different parts of the body (left hemisphere = right side of the body; right hemisphere = left side of the body) and perhaps specialize in different sensory, reasoning, and memory functions. This divisions become most apparent in the case of strokes that occur in one hemisphere. This can cause paralysis of one-half of the body as that hemisphere becomes incapacitated. The video below explains the mechanics. ** media type="youtube" key="uEPPPXzLMLo" height="400" width="552" align="center"
 * 8. EYES RIGHT!

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 * This case study deals with the impact on the sensory system, namely the loss of one side ("leftness") from perception. Sacks' patient must turn to the right to perceive things on the left. While the patient can intellectually grasp the existence of left, she is unable to perceive it, and must turn to the right a full circle until objects come into view on the right. There are some indications that some forms of ADD/ADHD and Autism might result from this hemispheric coordination (or lack thereof). A student with ADD/ADHD might be inattentive because objects, words disappear from their view, making it difficult to process information. **

** 9. THE PRESIDENT'S SPEECH ** The last case study in the "Deficits" section of the book look at aphasia, or the inability to comprehend words. The jumping off point is how a group of aphasic patients reacted to a President's speech. Although they could not understand the words, they grasped the meaning from the other communication cues, mostly visual, about what is meant. We experience this when we watch a foreign language program in a language we do not understand, but can get the gist of the communication from alternate clues. media type="youtube" key="dKTdMV6cOZw" height="400" width="552" align="center" **Sacks explains further:** **One common way of explaining this is how animals, particularly dogs, can read fear, joy, playfulness from human tone of voice, irrespective of what was said. As a result, they can detect meanings, as can aphasiacs, that a normal person would not.** **As a result, aphasiacs were able to pick up on President Reagan's non-verbal communication to be entertained by the speech, knowing when to laugh, be serious, etc. (Soundtrack music does the same thing in movies). However, one patient, Emily D., who had tonal agnosia, and therefore could not pick up on the these non-verbal cues and hewed strictly to the literal meaning of the speech, found him incoherent and not cogent.** **Tonal agnosia is a common symptom of individuals with autism spectrum disorders. They hew to literal meaning and have difficulty with metaphors, humor, and social cues in speech.** media type="youtube" key="HLuZ8p_8mxQ" height="400" width="552" align="center"
 * pg. 81. "Why all this? Because speech -- natural speech -- does //not// consist of words alone, nor . . . 'propositions' alone. It consists of //utterance// -- an uttering-forth of one's whole meaning with one's whole being -- the understanding of which involves infinitely more than mere word-recognition. And this was the clue to aphasiacs' understanding, even when they might be wholly uncomprehending of words as such. For though the words, the verbal constructions, //per se,// might convey nothing, spoken language is normally suffused with 'tone'', embedded in an expressiveness, so deep, so various, so complex, so subtle, which is perfectly preserved in aphasia, though understanding of words be destroyed."
 * pg. 82. "We recognise this with dogs, and often use them for this purpose -- to pick up falsehood, or malice, or equivocal intentions, to tell us who can be trusted, who is integral, who makes sense, when we -- so susceptible to words -- cannot trust our own instincts. And what dogs can do here, aphasiacs do too, and a a human and immeasurably superior level. 'One can lie with the mouth,' Nietzsche writes, 'but with the accompanying grimace one nevertheless tells the truth.'"
 * pg. 84. "Deprived of emotional reaction, was she then (like the rest of us) transported or taken in? By no means. 'He is not cogent,' she said. 'He does not speak good prose. His word-use is improper. Either he is brain-damaged, or he has something to conceal.' Thus the President's speech did not work for Emily D. either, due ot her enhanced sense of formal language use, propriety as prose, any more than it worked for our aphasiacs, with their word-deafness but enhanced sense of tone. Here then was the paradox of the President's speech. We normals -- aided, doubtless, by our wish to be fooled, were indeed and well truly fooled . . . And so cunningly was deceptive word-use combined with deceptive tone, that only the brain-damaged remained intact, undeceived."

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