For the Benefit of Those Who See: Dispatches from the World of the Blind

by Mahoney, Rosemary

  For people who were born blind or who lost their sight at a young age, the prospect of gaining sight rarely inspires the excitement and joy that those of us who already have it would naturally expect. The congenitally blind who have fared well and been comfortable all their lives with what their four senses have been telling them can certainly be forgiven for not jumping at the chance to change it all by throwing the mystery of eyesight into the equation. They have no way of knowing whether eyesight would be, for them, a curse or a gift. The unknown and the inexplicable are not immediately appealing.

  The fact is that suddenly gaining sight is not the miraculous revelation we might suppose it to be. In almost all of the known case studies, those people who have surgically gained sight after a lifetime of blindness have inevitably found the experience psychologically disturbing, confusing, and dispiriting. In a representative case in Vienna in 1777, a fourteen-year-old congenitally blind girl who had regained her sight through surgery expressed her eventual despair in words strikingly similar to those uttered by many others who found themselves in precisely the same position: “How comes it that I now find myself less happy than before? Everything that I see causes me a disagreeable emotion. Oh, I was much more at ease in my blindness…if I were always to feel such uneasiness as I do at present at the sight of new things, I would sooner return on the spot to my former blindness.”

  The human infant is not born with useful vision. He is born with eyes that see but a brain that does not yet know how to process the visual information the eyes transmit to it. What the infant sees makes no immediate sense to him; the world appears a brilliant chaos of light, shape, and motion. Learning to see is one of the most difficult mental tasks we accomplish in a lifetime; in that process, the brain is taxed perhaps more than it will ever be again.4 Vision is a slowly acquired skill that depends wholly on physical experiences combined with the type of exceptionally malleable and receptive neurons found only in a very young brain. The brain learns to make sense of what the eyes are showing it in a complex process similar to the way one learns to speak, and it learns all of this during a period of great flexibility—the first seven to ten years of childhood. Once that period of receptivity has passed, it cannot be retrieved or re-created. A newly sighted person can adapt to his rudimentary vision and use it to his advantage, but he cannot learn how to see with the thoughtless, carefree facility of those who have always had sight.

  In 1020, a man named Ammar recorded the case of a thirty-year-old congenitally blind man whose sight was surgically restored. Since then, there have been remarkably few cases of sight restored to a person who had been blind since birth or who lost sight at age three or younger, a condition known as lifetime blindness. In his unique and unexpectedly moving book Space and Sight: The Perception of Space and Shape in the Congenitally Blind Before and After Operation, which was first published in Germany in 1932, the German scientist Marius von Senden collected all the available case studies of patients whose sight had been surgically restored. On the evidence of these cases, von Senden concluded that a person born blind who gained vision at a later age could not develop a truly useful conception of shape, form, or depth. Most could perceive color and motion with relative ease, but all other visual tasks proved extremely confounding.

  As an example of the formerly blind person’s inability to comprehend space and size, von Senden told of a sixteen-year-old French girl who, when asked to show her doctor how big her mother was, “did not stretch out her hands, but set her two index-fingers a few inches apart.” Similarly, a twenty-year-old Swiss man who had gained sight for the first time could not “imagine a great distance in any other way save in terms of the time one has to spend walking in order to get there.…He sees contours and colors; but when I talk to him about a very long distance, it does not seem as though he can imagine any such thing.” In 1728, the thirteen-year-old whose cataracts William Cheselden had removed understood that “the room he was in…[was] but part of the house, yet he could not conceive that the whole house could look bigger.” In another case, an American woman named Joan could conceive of a skyscraper only as being “indefinitely higher than a blind man can reach.” On first gaining vision, one man had to practice spatial distance and depth by taking off his boot, throwing it ahead of him, and then trying to gauge how far away it was. “He takes a few steps towards the boot and tries to grasp it; on failing to reach it, he moves on a step or two and gropes for the boot until he finally gets hold of it.” Von Senden remarked that even after some weeks, the same man still had no concept of space beyond what he saw directly before him. “He does not yet have the notion that a larger object (a chair) can mask a smaller one (a dog), or that the latter can still be present even though it is not directly seen.”

  In all the recorded cases of vision restored, the subjects have had excruciating difficulty making sense of human faces. This passage from the case of a thirty-year-old Scottish man who has just opened his eyes after surgery is virtually identical to the experience of many others: the patient can guess that he is looking at a face only because he hears a voice coming out of it:

  The first thing he actually perceived was the face of the house-surgeon. He says that at first he did not know what it was he saw, but that when Dr. Stewart [who was bending over him] asked him to look down, the sense of hearing guided his eye straight to the point whence the sound came, and then, recalling what he knew from having felt his own face, he realized that this must be a mouth, and that he must be looking at a face.

  One surgeon tested his sixteen-year-old patient’s vision by inviting her beloved uncle to come silently into the room and sit by her bed. The surgeon then positioned himself behind the uncle and asked the girl to look at the face before her. She did so and immediately informed the surgeon that the face she was looking at was his own. When he invited her to put out her hand and feel the face, “she stretched out her forefinger and ran it over a quite small surface of her uncle’s cheek, and immediately her face beamed and she cried: ‘It’s my uncle!’” The surgeon who operated on Joan, the American woman, stated that, postsurgery, “faces are so bewildering to [her] that she still judges people by their voices.”

  Almost all of these patients were incapable of identifying three-dimensional objects by sight alone and were compelled to stretch out their hands to feel them, whereupon they would recognize the objects instantly. They would, for example, know a fork by feeling it, but if they saw it lying on a table, they would have no idea what it was until they touched it. Cheselden’s patient had a pet cat and dog; on gaining his vision, the boy could see them but could not tell which was which. He would pick up the cat, know it by touch, and swear that the next time he saw it he would know it was the cat. But no matter how many times he practiced with the two animals, he repeatedly mistook one for the other. According to Cheselden, the boy “learned and forgot a thousand things in a day.” Similarly, the twenty-year-old Swiss patient was unable to identify objects on his first day after surgery, leading his surgeon to assume that the operation had been a failure. On the second day, the patient was shown a watch and was able to identify its color but could not say whether it was a square or round object until he was allowed to hold it in his hand, and he then immediately knew that it was round. Again and again all the physicians’ experiments revealed the same thing: the newly sighted patient could determine color and motion but could not make sense of any form until he was allowed to touch it.

  Distance and depth perception prove to be equally confounding. When the anthropologist Colin Turnbull spent time with Pygmies in the Amazon rain forest, he came to understand that their experience of living in the dense jungle limited their visual perception of distance. Since the vegetation in their environment was never more than, say, ten feet away, their visual understanding was necessarily limited to a distance of ten feet. When Turnbull drove out of the jungle and into wide-open space in the company of a Pygmy man who had never before left the closeness of the jungle, he was astonished t
o realize that his companion had no understanding of the vast distances he was looking at. At the sight of buffalo grazing a mile or two away in an open valley, the Pygmy asked Turnbull, “What insects are those?” In The Forest People, Turnbull wrote:

  At first I hardly understood; then I realized that in the forest the range of distance is so limited that there is no great need to make automatic allowance for distance when judging size.…When I told Kenge that the insects were buffalo, he roared with laughter and told me not to tell such stupid lies.…As we got closer, the “insects” must have seemed to get bigger and bigger.…[Kenge’s] only comment was that they were not real buffalo, and that he was not going to get out of the car again until we left the park.

  One newly sighted patient believed that a table at the center of a room was really flat against a far wall, and several others defined a sphere as nothing more than a circle, and a cube as nothing more than a square. In a case in Italy in 1846, a patient was asked to take an orange that was held in front of him, and he gravely miscalculated its position, raising “his hand so that it almost touched his eye, and then clenched his fist, which he was astonished to find empty.” Joan had a poetically surreal perception of the world around her: a black coat on the floor looked to her “like the mouth of a well,” smoke from a chimney looked like “a great crack in the bright sky,” and the spots on her dog, Muffy, looked like “alarming holes in him.” Paintings and pictures also made little sense to the newly sighted, appearing as patches of color; the patients who touched the surfaces of pictures were astonished to find that the images were flat. When presented with a realistic painting of a table laden with food, one patient jumped up and nearly poked his hand through the painting, and when it was explained to him that the images he saw were painted on a canvas, he “had to be suffered to convince himself of the fact by repeatedly feeling with the greatest care the length and breadth of the painting.” When Joan was given photographs and paintings, she asked, “Why do they put those dark marks all over them?” Her mother explained to her that the dark marks were actually shadows. “If it were not for shadows, many things would look flat.” Joan responded, “Well, that’s how things do look. Everything looks flat with dark patches.”

  All the studies have shown that the experience of newfound sight is extremely difficult. A young man who regained his sight in London in 1840 found walking the city streets “disagreeable and wearisome” and “tedious” because too much of what he saw he couldn’t understand.

  He said, seeing so many different things and the quick movements of the multitude of people, carriages, etc., confused his sight to such a degree that at last he could see nothing; that the sensation produced by the object last seen had not yet disappeared from the retina, when the next object made its impression thereupon, by which means confusion of ideas, great anxiety, even vertigo were occasioned, from which he could only free himself by closing his eyes for a few moments.

  This young man’s experience was similar to many other patients’. One boy, accompanied by his sister, was upset by a ride on a tramcar. At the sight of houses passing rapidly before his eyes outside the tram window, he remarked, “I don’t like that at all. It’s going too fast.” And at the sight of the many wares in a shopwindow, the boy expressed nothing but bewilderment. A French surgeon wrote of his sixteen-year-old patient, “She obviously found the untried experience of seeing somewhat disturbing; and how gladly did she receive permission to close her eyes.”

  When they tried to see the world, the patients generally saw a riot of shapes, colors, and motion untempered by sense or reason. Some found their first impressions beautiful and fascinating, but the euphoria was often quickly replaced by fatigue and apprehensiveness. Most suffered serious psychological crises, lost their confidence, and fell into depression, despair, and disillusionment. Many longed to be once again blind. In 1826, a forty-six-year-old London woman confessed on the sixth day after her surgery that her vision had improved since the previous days, “but I cannot tell what I do see. I am quite stupid.” Her surgeon averred that “she seemed indeed bewildered from not being able to combine the knowledge acquired by the senses of touch and sight, and felt disappointed in not having the power of distinguishing at once by her eye, objects which she could so readily distinguish from one another by feeling them.” The patients didn’t realize that their own brains were preventing them from making sense of what they saw, and it’s no surprise that these patients became disappointed, frustrated, and depressed. Surgeons didn’t understand that asking their patients to see fluently postoperatively was essentially no different from asking them to speak a foreign language fluently—Icelandic, say—when they had never studied it before. The Austrian surgeon Georg Joseph Beer, who restored sight to fourteen people between 1783 and 1813, stated that all of his patients suffered a “rapid and complete loss of that striking and wonderful serenity which is characteristic only of those who have never yet seen.…Gloomy and reserved, they now shun for a time the society of others, which was so indispensable to them while they were blind.” Indeed, many who became despondent simply closed their eyes and reverted to their blind way of life.

  One of the most in-depth case histories of sight regained was conducted by the British psychologist Richard Gregory. Gregory’s study, published in 1963 in the Quarterly Journal of Psychology, was the first of its kind since 1904.5 The subject, Sidney Bradford, was a fifty-two-year-old cobbler who had become blind at the age of ten months. By Bradford’s own account and by the accounts of his sister and teachers, although he could see some light, he had never had useful vision and spent a great deal of his childhood with his eyes bandaged.6 Before his surgery, Bradford had lived a well-adjusted, relatively active, and quite fearless life as a blind man. He rode a bicycle with his hand on the shoulder of a companion riding next to him; he engaged in carpentry with power tools in his shop; he painted his own house, a task that required him to climb ladders. In 1958 Bradford underwent a corneal graft operation and regained his sight. On meeting him forty-eight days after the operation, Richard Gregory observed that at first he appeared to be like any other sighted person, but when Bradford sat down in a room, Gregory noticed that he did not look around the space with any apparent curiosity or recognition and that he paid no attention to material objects unless “his attention were called to them, when he would peer at whatever it was with extreme concentration and care, finally making some almost oracular comment.”

  Gregory was surprised when Bradford looked at a large clock on the hospital-room wall and read the time, and he began to think that perhaps Bradford had not truly been blind before. But Bradford explained his ability by showing Gregory a large watch without a crystal covering it that he had previously read by feeling its hands. He said that since he had felt the position of the hands, he could now understand what they indicated just by looking at them. With color he was less adept and was able to identify only red, white, and black—colors that he claimed had been stored in his visual memory. He was also unfamiliar with the appearance of faces, unable to recognize them and unable to read facial expressions. Bradford told Gregory that when he first opened his eyes after the surgery, he heard a voice near him and turned his head toward it. Like the Scottish patient, he understood that the blur he was looking at must be a face, because a voice was coming out of it; without the voice, though, he would not have been able to identify what he saw as a face. Gregory wrote, “At the time we first saw him, he did not find faces ‘easy’ objects. He did not look at a speaker’s face, and made nothing of facial expressions. On the other hand, he very rapidly distinguished between passing lorries and cars and would get up at six each morning to look at them some way off.” Gregory surmised that Bradford’s interest in vehicles derived from the fact that they made familiar sounds that helped in their identification.

  Bradford had difficulty judging distances, and when looking down from a window forty feet high, he believed that he could lower himself from the window to the ground. Lat
er, standing outside on the ground and looking up at the same window, he understood what a great distance it was and how dangerous it would be to step out of it. Three days after his surgery, Bradford saw the moon for the first time and thought it was a reflection on the windowpane. When told it was the moon, he was surprised and fascinated to see that it had a crescent shape; he had expected a quarter moon to be shaped like a quarter of a cake.