Internet Archive's 25th Anniversary Logo. Search icon An illustration of a magnifying glass. User icon An illustration of a person's head and chest. Sign up Log in. Web icon An illustration of a computer application window Wayback Machine Texts icon An illustration of an open book. There is Lilian, a concert pianist who becomes unable to read music and eventually even to recognize everyday objects; and Sue, a neurobiologist who has never seen in three dimensions, until she suddenly acquires stereoscopic vision in her fifties.
There is Pat, who reinvents herself as a loving grandmother and well-loved member of her community, although she has aphasia and cannot utter a sentence; and Howard, a prolific novelist who must find a way to continue his life as a writer even after a stroke destroys his ability to read.
And there is Dr. The main characters of this non fiction, science story are ,. Please note that the tricks or techniques listed in this pdf are either fictional or claimed to work by its creator. We do not guarantee that these techniques will work for you. Some of the techniques listed in Hallucinations may require a sound knowledge of Hypnosis, users are advised to either leave those sections or must have a basic understanding of the subject before practicing them. She thought the di culty must have something to do with her eyes.
If she was tired or ill, she could hardly read them at all, though when she was fresh, her sight-reading was as swift and easy as ever. When she was at ease, with friends or students, her playing seemed as good as ever.
So, through inertia, or fear, or a sort of adjustment, it was possible for her to overlook her peculiar problems in reading music, for she had no other visual problems, and her memory and ingenuity still allowed her a full musical life. In , three years or so after she had rst noticed problems reading music, Lilian started to have problems with reading words.
Here again, there were good days and bad, and even times when her ability to read seemed to change from moment to moment: a sentence would look strange, unintelligible at rst; then suddenly it would look ne, and she would have no di culty reading it. Her ability to write, however, was quite una ected, and she continued to maintain a large correspondence with former students and colleagues scattered throughout the world, though she depended increasingly on her husband to read the letters she received, and even to reread her own.
But Lilian was the rst person I had encountered whose alexia manifested rst with musical notation, a musical alexia. By Lilian was beginning to develop additional visual problems. She had sometimes wondered whether her strange problem with reading might be neurological rather than ophthalmological in origin. She had chuckled when she had rst read it, but now she started to wonder whether her own di culties might be eerily similar in nature.
Finally, ve years or more after her original symptoms, she was referred to a university neurology department for a full workup. Given a battery of neuropsychological tests—tests of visual perception, of memory, of verbal uency, etc. She could read, but only slowly, letter by letter. In contrast to these severe visual problems, her speech comprehension, repetition, and verbal uency were all normal.
An MRI of her brain was also normal, but when a PET scan was performed—this can detect slight changes in the metabolism of di erent brain areas, even when they appear anatomically normal—Lilian was found to have diminished metabolic activity in the posterior part of the brain, the visual cortex.
This was more marked on the left side. This would probably continue to worsen, though very slowly. In the three years or so that had elapsed between this neurological exam and her rst visit to me, Lilian told me, she had continued to perform, though not as well, and not as frequently. She found her repertoire diminishing, because she could no longer check even familiar scores by vision.
Fed visually, she meant—for she felt that her auditory memory, her auditory orientation, had increased, so that she could now, to a much larger degree than before, learn and reproduce a piece by ear. She could not only play a piece in this way sometimes after only a single hearing ; she could rearrange it in her mind. She continued to play in more informal settings and to teach master classes at the music school.
But she showed gross problems in other areas. She was unable now to recognize individual letters or numerals even though she still had no di culty writing complete sentences. She had, too, a more general visual agnosia, and when I presented her with pictures to identify, it was di cult for her even to recognize pictures as pictures—she would sometimes look at a column of print or a white margin, thinking it was the picture I was quizzing her about. The V was a sling; the helicopter was unloading food supplies for refugees.
Shown a photograph of a face, she could perceive that the person was wearing glasses, nothing else. Could be a violin … a pen. Or did it re ect a higher-order di culty with the perception of representation as such? Would she do better with real objects?
I always hear the same thing. A dead end. It is depressing, when I think of it—frustrations daily. But I have many good days and years ahead. Going home in the taxi, she realized that she had taken the wrong bag when she saw a red-tipped object sticking out of it my long, red-tipped re ex hammer.
It had attracted her attention, by its color and shape, when she saw it on my desk, and now she realized her mistake. How did she recognize a taxi, for example? How could she recognize her own home? How could she shop, as she told me she did, or recognize foods and serve them on a table? All this and much more —an active social life, traveling, going to concerts, and teaching—she did by herself when her husband, who was also a musician, went to Europe for weeks at a time.
I could get no idea of how she accomplished this from seeing her dismal performance in the arti cial, impoverished atmosphere of a neurology clinic. I had to see her in her own familiar surroundings. Claude was a charming, genial man about the same age as his wife.
They had met as music students at Tanglewood nearly fty years earlier and had pursued their musical careers in tandem, often performing onstage together. The apartment had a friendly, cultured atmosphere, with a grand piano, a great many books, photographs of their daughter and of friends and family, abstract modernist paintings on the wall, and mementos of their trips on every available surface. It was crowded —rich in personal history and signi cance, I imagined, but a nightmare, a complete chaos, for someone with visual agnosia.
This, at least, was my rst thought as I entered, negotiating my way between tables full of knickknacks. But Lilian had no di culty with the clutter and threaded her way confidently through the obstacles. Since she had had such di culty on the drawing- recognition test, I had brought a number of solid objects with me, wondering if she would do better with these.
I started with some fruit and vegetables I had just bought, and here Lilian did surprisingly well. She was momentarily uncertain whether the third object was an apple or a tomato, though she soon decided, correctly, on the former. A baby elephant, perhaps?
The recognition of representations may require a sort of learning, the grasping of a code or convention, beyond that needed for the recognition of objects. Thus, it is said, people from primitive cultures who have never been exposed to photographs may fail to recognize that they are representations of something else. If a complex system for the recognition of visual representations must be specially constructed by the brain, this ability might be lost through damage to that system by a stroke or disease, just as the learned understanding of writing, say, or any other acquired ability may be lost.
I followed Lilian into the kitchen, where she set about taking the kettle o the stove and pouring boiling water into the teapot. She seemed to navigate her crowded kitchen well, knowing, for instance, that all the skillets and pots were hung on hooks on one wall, various supplies kept in their regular places. I could see at a glance that there were eight—two rows of four— but Lilian, I suspect, could not perceive the eightness, the gestalt, easily and had to enumerate the eggs one by one.
I do it by feel—cook, try, see if it needs a bit more. Things were categorized not by meaning but by color, by size and shape, by position, by context, by association, somewhat as an illiterate person might arrange the books in a library.
Everything had its place, and she had memorized this. Seeing how Lilian inferred the character of the objects around her in this way, using color, above all, as a marker, I wondered how she would do with objects of similar appearance, like the sh knives and the steak knives, which looked almost the same.
This was a problem, she confessed, and she often confused them. Perhaps, I suggested, she could use an arti cial marker, a little green dot for the sh knives, a red one for the steak knives, so that she could see the di erence at a glance. What would her guests think of color-coded cutlery and dishes, or a color-coded apartment? But if objects were not in their place, major di culties could appear.
This showed itself startlingly at the end of my visit. The three of us—Lilian, Claude, and I—had sat down at the dining room table. Lilian had laid the table, put out biscotti and cakes, and now brought in a steaming pot of tea. Claude and I chatted for a few minutes—our rst talk alone—pushing the plate of biscotti between us. She seemed to have no strategy for looking.
She was, however, quite startled to see my umbrella on the table. She failed to recognize it as an umbrella, noticing only that something curved and twisted had appeared—and wondered, for a half-serious moment, if it was a snake. Before I left, I asked Lilian to go to the piano, asked if she would play something for me.
She hesitated. It was clear that she had lost a good deal of her con dence. She started beautifully, on a Bach fugue, but broke o , apologetically, after a few bars. Seeing a volume of Chopin mazurkas on the piano, I asked about those, and, encouraged, she closed her eyes and played two of the Opus 50 mazurkas without faltering, and with great brio and feeling. It had clearly advanced somewhat since her neurological examination three years before, and there were hints—though no more than hints —that her problems might no longer be purely visual.
I had ordered a new MRI to compare with her earlier one, and it showed that there was now some shrinkage of the visual areas on both sides of the brain. Was there any sign of real damage elsewhere? It was di cult to tell, although I suspected that there might have been some shrinkage in the hippocampi, too—parts of the brain crucial for the registration of new memories.
But the damage was still largely con ned to the occipital and occipitotemporal cortex, and it was clear that the rate of advance was very slow. Clearly, this had been much on their minds. One should see it as something rarer—and more benign. But Benson et al. People with PCA preserve elementary aspects of visual perception, such as acuity or the ability to detect movement or color.
But they tend to experience complex visual disturbances—di culties reading or recognizing faces and objects, occasionally even hallucinations. Sometimes patients with PCA may be able to recognize and match colors but unable to name them, a so-called color anomia. More rarely, there can be a di culty in visual targeting and tracking movements. In contrast to these di culties, memory, intelligence, insight, and personality tend to be preserved until late in the course of the disease.
I could not help making a comparison, as Lilian herself had, with my patient Dr. The actual ways in which Lilian and Dr. He showed a sort of levity or indi erence, and little insight into the fact that he was ill, and he often confabulated to make up for the fact that he could not identify what he was seeing.
Lilian could still identify objects by inference, using her intact perception of color, shape, texture, and movement, along with her memory and intelligence.
He was, in general, almost wholly dependent on doing things, on action, on ow. And singing, which for him was the most natural, irrepressible activity in the world, allowed him to bypass his agnosia to some extent.
He had all sorts of songs that he would hum or sing: dressing songs, shaving songs, action songs. Music, he had found, could organize his activities, his daily life. Her great musicality was also preserved, but it did not play a comparable role in her daily life; it was not, for her, a strategy for dealing with agnosia.
When I arrived, I saw that Lilian had been sending cards to her friends all over the world—there were envelopes addressed to Korea, to Germany, to Australia, to Brazil, scattered all over the table.
Her alexia, clearly, had not diminished her correspondence, though the names and addresses sometimes straggled over the envelope. She seemed to be managing well in her own apartment, but how did she deal with shopping and the challenges of a busy New York neighborhood, even her own? In the elevator, she was greeted by some neighbors.
It was not clear to me whether she recognized them visually or by their voices. She instantly recognized voices, sounds of all sorts; indeed, she seemed hyperattentive here, as she was to colors and shapes. They had assumed a special importance as cues. She had no di culty crossing the street. She pointed out a synagogue on the corner opposite; other shops she identi ed by shapes or colors, as with her favorite diner, which had alternating black and white tiles. She had no di culty in nding the fruit and vegetable section, or in identifying apples, pears, carrots, yellow peppers, and asparagus.
Lilian squinted, hesitated. She had obviously mapped the entire supermarket in her head. This is her most immediately visible cue, recognizable when nothing else is. For that reason, fearing we might be separated, I had dressed entirely in red for our visit, knowing that it would allow her to spot me instantly if we did.
But color was not always enough. If confronted with a plastic container, she might have no idea whether it contained peanut butter or cantaloupe. Often, she found that the simplest strategy was to bring in a used can or carton and ask someone for help in matching it. As we left the market, she accidentally crashed the shopping cart into a pile of shopping baskets to her right.
Such accidents, when they happen, are always to the right, because of her impaired visual awareness to this side. S ome months later, I arranged to see Lilian in my own o ce rather than at the clinic, where she had come before.
She arrived promptly, having made her way to Greenwich Village from Penn Station. She had been in New Haven the night before, where her husband had given a concert, and he had seen her onto a train that morning. Now, if I want to buy the same things, I have to ask people. And she depended increasingly on her memory, her thinking, her logic and common sense to help negotiate what would otherwise be—visually—an unintelligible world. Yet, in my office, she immediately recognized a picture of herself on a CD cover, playing Chopin.
I asked her what she saw on a certain wall of my o ce. I had to take her through it bit by bit. It took a little while to establish that she was looking at a sofa beneath the lights, though its color was commented on at once. She observed something green lying on the sofa, and astonished me by saying, correctly, that it was a stretch cord. She said she had been given such a cord by her physiotherapist. I asked.
Something to do with the ceiling, Lilian hazarded. Or a fan. A clock. But clearly Lilian had no idea that it was a painting, was not even sure that it was a single object, and thought that it might be part of the structure of the room.
I found all this puzzling. How was it that she could not clearly distinguish a striking painting from the wall itself, yet could instantly recognize a small photograph of herself on a CD? How could she identify a slender green stretch cord while failing to see, or recognize, the sofa it was on?
And there had been innumerable such inconsistencies before. I wondered how she could read the time, since she was wearing a wristwatch. She could not read the numbers, she said, but could judge the position of the hands.
I then showed her, mischievously, a strange clock I have, in which the numbers are replaced by the symbols of elements H, He, Li, Be, etc. She did not perceive anything the matter with this, since for her the chemical abbreviations were no more or less unintelligible than numerals would have been. We went out for a walk, I in a bright-colored hat for recognition. Lilian was bewildered by the objects in one shop window—but so was I.
This was a Tibetan- handicrafts shop, but they could have been Martian handicrafts, given the exotic unfamiliarity of everything. The shop next to this one, curiously, she recognized at once, and mentioned having passed it on her way to my o ce. It was a clock shop, with dozens of clocks of di erent sizes and shapes. She told me later that her father had had a passion for clocks. We stopped brie y for co ee; then I took her to my apartment, on the next block. I wanted her to try my grand piano, an Bechstein.
Entering my apartment, she immediately identi ed the grandfather clock in the hall. She sat at the piano and played a piece—a piece that I found puzzling, for it seemed familiar to me in a way, yet unfamiliar, too. Lilian explained that it was a Haydn quartet she had heard on the radio and been enchanted by a couple of years before and which she had longed to play herself. So she had arranged it for the piano, and had done so entirely in her head, overnight.
She had occasionally arranged pieces for the piano before her alexia, using manuscript paper and the original score, but when this became impossible, she found that she could do it wholly by ear. She felt that her musical memory, her musical imagery, had become stronger, more tenacious, but also more exible, so that she could hold the most complex music in her mind, then rearrange it and replay it mentally, in a way that would have been impossible before.
Her continually strengthening powers of musical memory and imagery had become crucial to her, kept her going since the onset of her visual difficulties, nine years earlier. In time, perhaps, if she were to visit a place frequently, she would gradually become more familiar with it, but this would be a hugely complex enterprise, demanding great patience and resourcefulness, a whole new system of categorization and memorization.
Going out, for her, was becoming an increasingly surreal visual challenge, full of fantastic and sometimes frightening misperceptions. L ilian wrote to me again in August of , expressing growing concern. She said she hoped I might be able to come soon for a visit, and I suggested the following weekend. She stood by her door to welcome me, knowing, as she did, my own lifelong defects of visual and topographic recognition, my confusion of left and right, and my inability to nd my way around inside buildings.
She welcomed me with great warmth, but also a touch of anxiety, which seemed to hover throughout the visit. At that time, too, she moved infallibly about her kitchen, never losing anything, working e ciently.
I observed that the kitchen was less organized than it had been before—and organization is crucial in her situation. She felt that she remained quite capable of looking after herself at home when Claude was away. But this may be wrong, and the effect disastrous. What should I say? How much should he intervene when she was faced with perceptual bewilderment?
How much do I myself—with no sense of direction—wish to be saved from blundering o in the wrong direction or left to battle out the right way by myself?
The question was especially vexing with Lilian, for, while she needed to work things out, fend for herself, her visual di culties were becoming more severe all the time, and they sometimes threatened, as Claude observed, to throw her into a panic of disorientation. I could suggest no rule, I said to Claude, except that of tact: each situation would call for its own solution.
Some of them, it seemed, went with the reduced and unstable function of her damaged visual cortex—just as, ten years earlier, when the rst problems appeared, her ability to read music would come and go. Some of the variations, I thought, might re ect uctuations in blood ow.
But some of the variations seemed to go with a decreasing ability, for whatever reason, to compensate in her usual way. Her ability to make use of her memory and her intellectual powers in place of direct visual recognition, I now felt, might also be diminishing at this point. It was the rst such personal account to be published, and was doubly remarkable because McDonald himself was both a neurologist and a ne amateur musician. His musical alexia along with other problems, including di culties with calculation, face- blindness, and topographic disorientation was caused by an embolic stroke, and he was to make a complete recovery.
But such uctuations are typical of any neural system that has sustained damage, irrespective of the cause. Patients with sciatica from nerve-root compression have good and bad days, as do patients with impairments of sight or hearing. There is less reserve, less redundancy, when a system is damaged, and it is more easily thrown o by adventitious factors such as fatigue, stress, medications, or infections.
Such damaged systems are also prone to spontaneous uctuations, as my Awakenings patients experienced constantly. Lilian had been ingenious and resilient in the eleven or twelve years since her illness started. She had brought inner resources of every kind to her own aid: visual, musical, emotional, intellectual. Her family, her friends, her husband and daughter, above all, but also her students and colleagues, helpful people in the supermarket or on the street—everyone had helped her cope.
Her adaptations to the agnosia were extraordinary —a lesson in what could be done to hold together a life in the face of ever-advancing perceptual and cognitive challenge. But it was in her art, her music, that Lilian not only coped with disease but transcended it.
Her musical powers, mercifully, remained untouched by her disease. Her piano playing always added a transcendent note to my visits, and it recalled her, no less crucially, to her identity as an artist. It showed the joy she could still get and give, whatever other problems were now closing in on her. When I revisited Lilian and Claude in , I found the apartment full of balloons. She did not look well and seemed somewhat frail, although her voice and her warmth were entirely unchanged. She said that her visual powers had deteriorated further, and this was all too evident as she groped for a chair to sit down on, walked in the wrong direction, and got lost inside her own apartment.
She was still able to write letters, but reading, even the painfully slow letter-by-letter reading that she could do a few years before, had become impossible. She adored being read to—Claude would read to her from newspapers and books—and I promised to send her some audiotapes.
The two of them were closer than ever, with her increasing disability. Despite all this, Lilian felt that her ear was as good as it always was, and she had been able to continue a little teaching, with students from the music college coming to her apartment.
Apart from this, though, she no longer played the piano much. And yet, when I mentioned the Haydn quartet she had played for me before, her face lit up. I asked her to play it for me again. Lilian demurred, and then, persuaded, started for the piano, but went in the wrong direction. Claude corrected her gently.
At the piano, she rst blundered, hitting wrong notes, and seemed anxious and confused. But then she found her place and began to play beautifully, the sound soaring up, melting, twisting into itself. Claude was amazed and moved by this. As she played, Lilian stared upward, singing the melody softly to herself.
I saw Dr. I was puzzled by the picture Dr. PCA, however, is only an anatomical diagnosis; it denotes the part of the brain a ected most but says nothing of the underlying disease process, nothing of why these parts of the brain are damaged. When Benson described PCA, he had no information regarding its underlying pathology. They might even, Benson speculated, have vascular rather than degenerative disease, an accumulation of small blockages in the watershed zone between the posterior and carotid circulations of the brain.
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