An Anthropologist on Mars (1995)

by Oliver Sacks

  Much of their time recently had been spent shopping—there had been the wedding to prepare for, and Amy wanted to show Virgil off, tell his story to the clerks and shopkeepers they knew, let them see a transformed Virgil for themselves. 70

  70. Robert Scott, a sociologist and anthropologist at the Institute for Advanced Behavioral Study at Stanford, has been especially concerned with societal reactions to the blind, and the social contempt and stigmatization so often accorded them. He has also lectured on “miracle cures”, the extravagance of emotion that may attend the restoration of sight. It was Dr. Scott who, some years ago, sent me a copy of Valvo’s book.

  It was fun; the local television station had aired a story about Virgil’s operation, and people would recognize him and come up to shake his hand. But supermarkets and other stores were also dense visual spectacles of objects of all kinds, often in bright packaging, and provided good “exercise” for Virgil’s new sight. Among the first objects he had recognized, just the day after his bandages came off, were rolls of toilet paper on display. He had picked up a package and given it to Amy to prove he could see. Three days after surgery, they had gone to an IGA, and Virgil had seen shelves, fruit, cans, people, aisles, carts—so much that he got scared. “Everything ran together”, he said. He needed to get out of the store and close his eyes for a bit.

  He enjoyed uncluttered views, he said, of green hills and grass—especially after the overfull, overrich visual spectacles of shops—though it was difficult for him, Amy indicated, to connect the visual shapes of hills with the tangible hills he had walked up, and he had no idea of size or perspective. 71

  71. Sensation itself has no “markers” for size and distance; these have to be learned on the basis of experience. Thus it has been reported that if people who have lived their entire lives in dense rain forest, with a far point no more than a few feet away, are brought into a wide, empty landscape, they may reach out and try to touch the mountaintops with their hands; they have no concept of how far the mountains are.

  Helmholtz (in Thought in Medicine, an autobiographical memoir) relates how, as a child of two, when walking in a park, he saw what he took to be a little tower with a rail at the top and tiny mannikins or dolls walking around behind the rail. When he asked his mother if she could reach him down one to play with, she exclaimed that the tower was a kilometer away, and two hundred meters high, and these little figures were not mannikins but people on the top. As soon as she said this, Helmholtz writes, he suddenly realized the scale of everything, and never again made such a perceptual mistake—though the visual perception of space as a subject never ceased to exercise him. (See Cahan, 1993.)

  Poe, in “The Gold Bug”, relates an opposite story: how what appeared to be a vast, many-jointed creature on a distant hill turned out to be a tiny bug on the window.

  A personal experience, the first time I used marijuana, comes to mind here: gazing at my hand, seen against a blank wall. It seemed to rush away from me, while maintaining the same apparent size, until it appeared like a vast hand, a cosmic hand, across parsecs of space. Probably this illusion was made possible by, among other things, the absence of markers or context to indicate actual size and distance, and perhaps some disturbance of body image and central processing of vision.

  But the first month of seeing had been predominantly positive: “Every day seems like a great adventure, seeing more for the first time each day,” Amy had written, summarizing it, in her journal.

  When we arrived at the house, Virgil, caneless, walked by himself up the path to the front door, pulled out his key, grasped the doorknob, unlocked the door, and opened it. This was impressive—he could never have done it at first, he said, and it was something he had been practicing since the day after surgery. It was his showpiece. But he said that in general he found walking “scary” and “confusing” without touch, without his cane, with his uncertain, unstable judgment of space and distance. Sometimes surfaces or objects would seem to loom, to be on top of him, when they were still quite a distance away; sometimes he would get confused by his own shadow (the whole concept of shadows, of objects blocking light, was puzzling to him) and would come to a stop, or trip, or try to step over it. Steps, in particular, posed a special hazard, because all he could see was a confusion, a flat surface, of parallel and crisscrossing lines; he could not see them (although he knew them) as solid objects going up or coming down in three-dimensional space. Now, five weeks after surgery, he often felt more disabled than he had felt when he was blind, and he had lost the confidence, the ease of moving, that he had possessed then. But he hoped all this would sort itself out with time.

  I was not so sure; every patient described in the literature had faced great difficulties after surgery in the apprehension of space and distance—for months, even years. This was the case even in Valvo’s highly intelligent patient H.S., who had been normally sighted until, at fifteen, his eyes were scarred by a chemical explosion. He had become totally blind until a corneal transplant was done twenty-two years later. But following this, he encountered grave difficulties of every kind, which he recorded, minutely, on tape:

  During these first weeks [after surgery] I had no appreciation of depth or distance; street lights were luminous stains stuck to the window panes, and the corridors of the hospital were black holes. When I crossed the road the traffic terrified me, even when I was accompanied. I am very insecure while walking; indeed I am more afraid now than before the operation.

  We gathered in the kitchen at the back of the house, which had a large white deal table. Bob and I laid out all our test objects—color charts, letter charts, pictures, illusions—on it and set up a video camera to record the testing. As we settled down, Virgil’s cat and dog bounded in to greet and check us—and Virgil, we noted, had some difficulty telling which was which. This comic and embarrassing problem had persisted since he returned home from surgery: both animals, as it happened, were black and white, and he kept confusing them—to their annoyance—until he could touch them, too. Sometimes, Amy said, she would see him examining the cat carefully, looking at its head, its ears, its paws, its tail, and touching each part gently as he did so. I observed this myself the next day—Virgil feeling and looking at Tibbies with extraordinary intentness, correlating the cat. He would keep doing this, Amy remarked (“You’d think once was enough”), but the new ideas, the visual recognitions, kept slipping from his mind.

  Cheselden described a strikingly similar scene with his young patient in the 1720s:

  One particular only, though it might appear trifling, I will relate: Having often forgot which was the cat, and which the dog, he was ashamed to ask; but catching the cat, which he knew by feeling, he was observed to look at her steadfastly, and then, setting her down, said, So, puss, I shall know you another time—Upon being told what things were—he would carefully observe that he might know them again; and (as he said) at first learned to know, and again forgot, a thousand things in a day.

  Virgil’s first formal recognitions when the bandages were taken off had been of letters on the ophthalmologist’s eye chart, and we decided to test him, first, on letter recognition. He could not see ordinary newsprint clearly—his acuity was still only about 20⁄80—but he readily perceived letters that were more than a third of an inch high. Here he did rather well, for the most part, and recognized all the commoner letters (at least, capital letters) easily—as he had been able to do from the moment the bandages were removed. How was it that he had so much difficulty recognizing faces, or the cat, and so much difficulty with shapes generally, and with size and distance, and yet so little difficulty, relatively, recognizing letters? When I asked Virgil about this, he told me that he had learned the alphabet by touch at school, where they had used letter blocks, or cutout letters, for teaching the blind. I was struck by this and reminded of Gregory’s patient S.B.: “much to our surprise, he could even tell the time by means of a large clock on the wall. We were so surprised at this that we did not at first
believe that he could have been in any sense blind before the operation.” But in his blind days S.B. had used a large hunter watch with no glass, telling the time by touching the hands, and he had apparently made an instant “cross-modal” transfer, to use Gregory’s term, from touch to vision. Virgil too, it seemed, must have been making just such a transfer.

  But while Virgil could recognize individual letters easily, he could not string them together—could not read or even see words. I found this puzzling, for he said that they used not only Braille but English in raised or inscribed letters at school—and that he had learned to read fairly fluently. Indeed, he could still easily read the inscriptions on war memorials and tombstones by touch. But his eyes seemed to fix on particular letters and to be incapable of the easy movement, the scanning, that is needed to read. This was also the case with the literate H.S.:

  My first attempts at reading were painful. I could make out single letters, but it was impossible for me to make out whole words; I managed to do so only after weeks of exhausting attempts. In fact, it was impossible for me to remember all the letters together, after having read them one by one. Nor was it possible for me, during the first weeks, to count my own five fingers: I had the feeling that they were all there, but—it was not possible for me to pass from one to the other while counting.

  Further problems became apparent as we spent the day with Virgil. He would pick up details incessantly—an angle, an edge, a color, a movement—but would not be able to synthesize them, to form a complex perception at a glance. This was one reason the cat, visually, was so puzzling: he would see a paw, the nose, the tail, an ear, but could not see all of them together, see the cat as a whole.

  Amy had commented in her journal on how even the most “obvious” connections—visually and logically obvious—had to be learned. Thus, she told us, a few days after the operation “he said that trees didn’t look like anything on earth”, but in her entry for October 21, a month after the operation, she noted, “Virgil finally put a tree together—he now knows that the trunk and leaves go together to form a complete unit.” And on another occasion: “Skyscrapers strange, cannot understand how they stay up without collapsing.”

  Many—or perhaps all—patients in Virgil’s situation had had similar difficulties. One such patient (described by Eduard Raehlmann, in 1891), though she had had a little vision preoperatively and had frequently handled dogs, “had no idea of how the head, legs, and ears were connected to the animal.” Valvo quotes his patient T.G.:

  Before the operation I had a completely different idea of space, and I knew that an object could occupy only one tactile point. I knew—also that if there were an obstacle or a step at the end of the porch, this obstacle occurred after a certain period of time, to which I was accustomed. After the operation, for many months, I could no longer coordinate visual sensations with my speed of walking—I had to coordinate both vision and the time necessary to cover the distance. That I found very difficult. If any walking were too slow or too fast, I stumbled.

  Valvo comments: “The real difficulty here is that simultaneous perception of objects is an unaccustomed way to those used to sequential perception through touch.” We, with a full complement of senses, live in space and time; the blind live in a world of time alone. For the blind build their worlds from sequences of impressions (tactile, auditory, olfactory) and are not capable, as sighted people are, of a simultaneous visual perception, the making of an instantaneous visual scene. Indeed, if one can no longer see in space, then the idea of space becomes incomprehensible—even for highly intelligent people blinded relatively late in life (this is the central thesis of von Senden’s great monograph.) And it is powerfully conveyed by John Hull in his remarkable autobiography, Touching the Rock, when he speaks of himself, of the blind, as “living in time” almost exclusively. With the blind, he writes, this sense of being in a place is less pronounced—Space is reduced to one’s own body, and the position of the body is known not by what objects have been passed but by how long it has been in motion. Position is thus measured by time—For the blind, people are not there unless they speak—People are in motion, they are temporal, they come and they go. They come out of nothing; they disappear.

  Although Virgil could recognize letters and numbers, and could write them, too, he mixed up some rather similar ones (“A” and “H”, for example) and on occasion, wrote some backward. (Hull describes how, after only five years of blindness in his forties, his own visual memories had become so uncertain that he was not sure which way around a “3” went and had to trace it in the air with his fingers. Thus the numeral was retained as a tactile-motor concept, but no longer as a visual concept.) Still, Virgil’s performance was an impressive one for a man who had not seen for forty-five years. But the world does not consist of letters and numbers. How would he do with objects and pictures? How would he do with the real world?

  His first impressions when the bandages were removed were especially of color, and it seemed to be color, which has no analogue in the world of touch, that excited and delighted him—this was very clear from the way he spoke and from Amy’s journal. (The recognition of colors and movement seems to be innate.) It was colors to which Virgil continually alluded, the chromatic unexpectedness of new sights. He had had Greek salad and spaghetti the night before, he told us, and the spaghetti startled him: “White round strings, like fishing line”, he said. “I thought it’d be brown.”

  Seeing light and shape and movements, seeing colors above all, had been completely unexpected and had had a physical and emotional impact almost shocking, explosive. (“I felt the violence of these sensations”, wrote Valvo’s patient H.S., “like a blow on the head. The violence of the emotion—was akin to the very strong emotion I felt on seeing my wife for the first time, and when out in a car, I saw the huge monuments of Rome.”)

  We found that Virgil easily distinguished a great array of colors and matched them without difficulty. But, confusingly, or confusedly, he sometimes gave colors the wrong names: yellow, for example, he called pink, but he knew that it was the same color as a banana. We wondered at first whether he could have a color agnosia or color anomia-defects of color association and color naming that are due to damage in specific areas of the brain. But his difficulties, it seemed to us, came simply from lack of learning (or from forgetting)—from the fact that early and long blindness had sometimes prevented his associating colors with their names or had caused him to forget some of the associations he had made. Such associations and the neural connections that underlay them, feeble in the first place, had become disestablished in his brain, not through any damage or disease, but simply from disuse.

  Although Virgil believed that he had visual memories, including color memories, from the remote past—on our drive from the airport he had spoken of growing up on the farm in Kentucky (“I see the creek running down the middle”, “birds on the fences”, “the big old white house”)—I could not decide whether these were genuine memories, visual images in his mind, or mere verbal descriptions without images (like Helen Keller’s).

  How was he with shapes? Here matters were more complicated, because in the weeks since his surgery Virgil had been practicing shapes, correlating their look and their feel. No such practice had been required with colors. He had at first been unable to recognize any shapes visually—even shapes as simple as a square or a circle, which he recognized instantly by touch. To him, a touch square in no sense corresponded to a sight square. This was his answer to the Molyneux question. For this reason, Amy had bought, among other things, a child’s wooden formboard, with large, simple blocks—square, triangle, circle, and rectangle—to be fitted into corresponding holes, and had got Virgil to practice with it every day. Virgil found the task impossible at first, but quite easy now, after practicing for a month. He still tended to feel the holes and shapes before matching them, but when we forbade this he fitted them together quite fluently by sight alone.

  Solid objects, it was eviden
t, presented much more difficulty, because their appearance was so variable; and much of the past five weeks had been devoted to the exploration of objects, their unexpected vicissitudes of appearance as they were seen from near or far, or half-concealed, or from different places and angles.

  On the day he returned home after the bandages were removed, his house and its contents were unintelligible to him, and he had to be led up the garden path, led through the house, led into each room, and introduced to each chair. Within a week, with Amy’s help, he had established a canonical line—a particular line up the path, through the sitting room to the kitchen, with further lines, as necessary, to the bathroom and the bedroom. It was only from this line, at first, that he could recognize anything—though this took a great deal of interpretation and inference; thus he learned, for example, that “a whiteness to the right”, to be seen as he came obliquely through the front door, was in fact the dining table in the next room, although at this point neither “table” nor “dining room” was a clear visual concept. If he deviated from the line, he would be totally disoriented. Then, carefully, with Amy’s help, he started to use the line as a home base, making short sallies and excursions to either side of it, so that he could see the room, feel its walls and contents from different angles, and build up a sense of space, of solidity, of perspective.

  As Virgil explored the rooms of his house, investigating, so to speak, the visual construction of the world, I was reminded of an infant moving his hand to and fro before his eyes, waggling his head, turning it this way and that, in his primal construction of the world. Most of us have no sense of the immensity of this construction, for we perform it seamlessly, unconsciously, thousands of times every day, at a glance. But this is not so for a baby, it was not so for Virgil, and it is not so for, say, an artist who wants to experience his elemental perceptions afresh and anew. Cézanne once wrote, “The same subject seen from a different angle gives a subject for study of the highest interest and so varied that I think I could be occupied for months without changing my place, simply bending more to the right or left.”