by Oliver Sacks
A quite different sort of visual shutdown—a withdrawal—seemed to be associated with situations of great emotional stress or conflict. And for Virgil this period was indeed as stressful a time as he had ever known: he had just had surgery, he had just been married; the even tenor of his blind, bachelor life had been shattered; he was under a tremendous pressure of expectation; and seeing itself was confusing, exhausting. These pressures had increased as his wedding day approached, especially with the convergence of his own family in town; his family had not only opposed the surgery in the first place but now insisted that he was in fact still blind. All this was documented by Amy in her journal:
October 9: Went to church to decorate for wedding. Virgil’s vision quite blurry. Not able to distinguish much. It is as though sight has taken a nosedive. Virgil acting “blind” again—Having me lead him around.
October 11: Virgil’s family arrives today. His sight seems to have gone on vacation—It is as though he has gone back to being blind! Family arrived. Couldn’t believe he could see. Every time he said he could see something they would say, “Ah, you’re just guessing.” They treated him as though he was totally blind—leading him around, giving him anything he wanted—I am very nervous, and Virgil’s sight has disappeared—Want to be sure we are doing the right thing.
October 12: Wedding day. Virgil very calm—vision little clearer, but still blurry—Could see me coming down aisle, but was very blurry—Wedding beautiful. Party at Mom’s. Virgil surrounded by family. They still cannot accept his sight, he could not see much. Said goodbye to his family tonight. Sight began clearing up right after they left.
In these episodes Virgil was treated by his family as a blind man, his seeing identity denied or undermined, and he responded, compliantly, by acting, or even becoming, blind—a massive withdrawal or regression of part of his ego to a crushing, annihilating denial of identity. Such a regression would have to be seen as motivated, albeit unconsciously—an inhibition on a “functional” basis. Thus there seemed to be two distinct forms of “blind behavior” or “acting blind”—one a collapse of visual processing and visual identity on an organic basis (a “bottom-up” or neuropsychological disturbance, in neurological parlance), the other a collapse or inhibition of visual identity on a functional basis (a “top-down” or psychoneurotic disturbance), though no less real for him. Given the extreme organic weakness of his vision—the instability of his visual systems and visual identity at this point—it was very difficult, at times, to know what was going on, to distinguish between the “physiological” and “psychological.” His vision was so marginal, so close to the border, that either neural overload or identity conflict might push him over it. 77
77. When a specific organic weakness exists, emotional stress can easily press toward a physical form; thus, asthmatics get asthma under stress, parkinsonians become more parkinsonian, and someone like Virgil, with borderline vision, may get pushed over the border and become (temporarily) blind. It was, therefore, exceedingly difficult at times to distinguish between what was physiological vulnerability in him, and what was “motivated behavior.”
Marius von Senden, reviewing every published case over a three-hundred-year period in his classic book Space and Sight (1932), concluded that every newly sighted adult sooner or later comes to a “motivation crisis”—and that not every patient gets through it. He tells of one patient who felt so threatened by sight (which would have meant his leaving the Asylum for the Blind, and his fiancée there) that he threatened to tear his eyes out; he cites case after case of patients who “behave blind” or “refuse to see” after an operation, and of others who, fearful of what sight may entail, refuse operation (one such account, entitled “L’Aveugle qui refuse de voir”, was published as early as 1771). Both Gregory and Valvo dilate on the emotional dangers of forcing a new sense on a blind man—how, after an initial exhilaration, a devastating (and even lethal) depression can ensue.
Precisely such a depression descended on Gregory’s patient: S.B.’s period in the hospital was full of excitement and perceptual progress. But the promise was not fulfilled. Six months after the operation, Gregory reports:
…we formed a strong impression that his sight was to him almost entirely disappointing. It enabled him to do a little more—but it became clear that the opportunities it afforded him were less than he had imagined—He still to a great extent lived the life of a blind man, sometimes not bothering to put on the light at night—He did not get on well with his neighbours [now], who regarded him as “odd”, and his workmates [previously so admiring] played tricks on him and teased him for being unable to read.
His depression deepened, he became ill, and, two years after his operation, S.B. died. He had been perfectly healthy, he had once enjoyed life; he was only fifty-four.
Valvo provides us with six exemplary tales, and a profound discussion, of the feelings and behavior of early blinded people when they are confronted with the “gift” of sight and with the necessity of renouncing one world, one identity, for another. 78
78. In his ironically titled Letter on the Blind: For the Use of Those Who Can See (1749), the youthful Diderot maintains a position of epistemological and cultural relativism—that the blind may, in their own way, construct a complete and sufficient world, have a complete “blind identity” and no sense of disability or inadequacy, and that the “problem” of their blindness and the desire to cure this, therefore, is ours, not theirs.
He also feels that intelligence and cultivation may make a fundamental difference to what the blind may understand; may give them, at least, a formal understanding of much that they cannot directly perceive. He is especially drawn to this conclusion by pondering the case of Nicholas Saunderson, the celebrated blind mathematician and Newtonian, who died in 1740. That Saunderson, who never saw light, could conceive it so well, could be (of all things!) a lecturer in optics, could construct, in his own way, a sublime picture of the universe, excites Diderot immensely.
A major conflict in Virgil, as in all newly sighted people, was the uneasy relation of touch and sight—not knowing whether to feel or look. This was obvious in Virgil from the day of the operation and was very evident the day we saw him, when he could hardly keep his hands off the formboard, longed to touch all the animals, and gave up spearing his food. His vocabulary, his whole sensibility, his picture of the world, were couched in tactile—or, at least, nonvisual-terms. He was, or had been until his operation, a touch person through and through.
It has been well established that in congenitally deaf people (especially if they are native signers) some of the auditory parts of the brain are reallocated for visual use. It has also been well established that in blind people who read Braille the reading finger has an exceptionally large representation in the tactile parts of the cerebral cortex. And one would suspect that the tactile (and auditory) parts of the cortex are enlarged in the blind and may even extend into what is normally the visual cortex. What remains of the visual cortex, without visual stimulation, may be largely undeveloped. It seems likely that such a differentiation of cerebral development would follow the early loss of a sense and the compensatory enhancement of other senses.
If this was the case in Virgil, what might happen if visual function was suddenly made possible, demanded? One might certainly expect some visual learning, some development of new pathways in the visual parts of the brain. There had never been any documentation of the kindling of activity in the visual cortex of an adult, and we hoped to take special PET scans of Virgil’s visual cortex to show this as he learned to see. But what would this learning, this activation, be like? Would it be like a baby first learning to see? (This was Amy’s first thought.) But the newly sighted are not on the same starting line, neurologically speaking, as babies, whose cerebral cortex is equipotential—equally ready to adapt to any form of perception. The cortex of an early blinded adult such as Virgil has already become highly adapted to organizing perceptions in time and not in space. 79
79. The Canadian psychologist Donald Hebb was deeply interested in the development of seeing and presented much experimental evidence against its being, in higher animals and man, “innate”, as had often been supposed. He was fascinated, understandably, by the rare “experiment” (if such a term be allowed) of restoring sight in adult life to the congenitally blind and ponders at length in The Organization of Behaviour on the cases collected by von Senden (Hebb himself had no personal experience of such a case). These provided rich confirmation for his thesis that seeing requires experience and learning; indeed he thought that it required, in man, fifteen years of learning to reach its full development.
But one caveat must be made (it is also made by Gregory) with regard to Hebb’s comparison of the newly sighted adult to a baby. It may be that the newly sighted adult must indeed go through some of the learning and developmental stages of infancy; yet an adult, neurologically and psychologically, is nothing like a baby—an adult is already committed to a lifetime of perceptual experiences—and such cases cannot, therefore (as Hebb supposes), tell us what a baby’s world is like, serve as a window into the otherwise inaccessible development of their perception.
An infant merely learns. This is a huge, never-ending task, but it is not one charged with irresoluble conflict. A newly sighted adult, by contrast, has to make a radical switch from a sequential to a visual-spatial mode, and such a switch flies in the face of the experience of an entire lifetime. Gregory emphasizes this, pointing out how conflict and crisis are inevitable if “the perceptual habits and strategies of a lifetime” are to be changed. Such conflicts are built into the nature of the nervous system itself, for the early blinded adult who has spent a lifetime adapting and specializing his brain must now ask his brain to reverse all this. (Moreover, the brain of an adult no longer has the plasticity of a child’s brain—that is why learning new languages or new skills becomes more difficult with age. But in the case of a man previously blind, learning to see is not like learning another language; it is, as Diderot puts it, like learning language for the first time.)
In the newly sighted, learning to see demands a radical change in neurological functioning and, with it, a radical change in psychological functioning, in self, in identity. The change may be experienced in literally life-and-death terms. Valvo quotes a patient of his as saying, “One must die as a sighted person to be born again as a blind person, ” and the opposite is equally true: one must die as a blind person to be born again as a seeing person. It is the interim, the limbo—“between two worlds, one dead I The other powerless to be born”—that is so terrible. Though blindness may at first be a terrible privation and loss, it may become less so with the passage of time, for a deep adaptation, or reorientation, occurs, by which one reconstitutes, reappropriates, the world in nonvisual terms. It then becomes a different condition, a different form of being, one with its own sensibilities and coherence and feeling. John Hull calls this “deep blindness” and sees it as “one of the orders of human being.” 80
80. If blindness has a positivity of its own, is one of the orders of human being, this is equally (or more) so for deafness, where there is not only a heightening of visual (and, in general, spatial) abilities, but a whole community of deaf people, with their own visuo-gestural language (Sign) and culture. Problems somewhat similar to Virgil’s may be encountered by congenitally deaf, or very early deafened, subjects given cochlear implants. Sound, for them, at first has no associations, no meaning—so they find themselves, at least initially, in a world of auditory chaos, or agnosia. But in addition to these cognitive problems there are identity problems, too; in a sense, they must die as deaf people to be born as hearing ones. This, potentially, is much more serious and has ramifying social and cultural implications; for deafness may be not just a personal identity, but a shared linguistic, communal, and cultural one. These very complex issues are discussed by Harlan Lane in The Mask of Benevolence: Disabling the Deaf Community.
On October 31, the cataract in Virgil’s left eye was removed, revealing a retina, an acuity, similar to the right. This was a great disappointment, for there had been hope that it might be a far better eye—enough to make a crucial difference to his vision. His vision did improve slightly: he fixated better, and the searching eye movements were fewer, and he had a larger visual field.
With both eyes working, Virgil now went back to work, but found, increasingly, that there was another side to seeing, that much of it was confusing, and some downright shocking. He had worked happily at the Y for thirty years, he said, and thought he knew all the bodies of his clients. Now he found himself startled by seeing bodies, and skins, that he had previously known only by touch; he was amazed at the range of skin colors he saw and slightly disgusted by blemishes and “stains” in skins that to his hands had seemed perfectly smooth. 81
81. Gregory observes of S.B., “He also found some things he loved ugly (including his wife and himself!), and he was frequently upset by the blemishes and imperfections of the visible world.”
Virgil found it a relief, when giving massages, to shut his eyes.
He continued to improve, visually, over the ensuing weeks, especially when he was free to set his own pace. He did his utmost to live the life of a sighted man, but he also became more conflicted at this time. He expressed fears, occasionally, that he would have to throw away his cane and walk outside, cross the streets, by vision alone; and, on one occasion, a fear that he might be “expected” to drive and take up an entirely new “sighted” job. This, then, was a time of great striving and real success—but success achieved, one felt, at a psychological cost, at a cost of deepening strain and splitting in himself.
There was one outing, a week before Christmas, when he and Amy went to the ballet. Virgil enjoyed The Nutcracker: he had always loved the music, and now, for the first time, he saw something as well. “I could see people jumping around the stage. Couldn’t see what they were wearing, though”, he said. He thought he would enjoy seeing a live baseball game and looked forward to the start of the season in the spring.
Christmas was a particularly festive and important time—the first Christmas after his wedding, his first Christmas as a sighted man—and he returned, with Amy, to the family farm in Kentucky. He saw his mother for the first time in more than forty years—he had scarcely been able to see her, to see anything much, at the time of the wedding—and thought she looked “real pretty.” He saw again the old farmhouse, the fences, the creek in the pasture, which he had also not seen since he was a child,—he had never ceased to cherish them in his mind. Some of his seeing had been a great disappointment, but seeing home and family was not—it was a pure joy.
No less important was the change in the family’s attitude toward him. “He seemed more alert”, his sister said. “He would walk, move around the house, without touching the walls—he would just get up and go.” She felt that there had been “a big difference” since he was first operated on, and his mother and the rest of the family felt the same.
I phoned them the day before Christmas and spoke to his mother, his sister, and others. They asked me to join them, and I wish I could have done so, for it seemed to be a joyful and affirmative time for them all. The family’s initial opposition to Virgil’s seeing (and perhaps to Amy, too, for having pushed it) and their disbelief that he could actually see had been something that he internalized, something that could literally annihilate his seeing. Now that the family was “converted”, a major psychological block, one hoped, might dissolve. Christmas was the climax, but also the resolution, of an extraordinary year.
What would happen, I wondered, in the coming year? What might he hope for, at best? How much of a visual world, a visual life, might still await him? We were, frankly, quite unsure at this point. Grim and frightening though the histories of so many patients were, some, at least, overcame the worst of their difficulties and emerged into a relatively unconflicted new sight.
Valvo, normally cautious in ex
pression, lets himself go a little in describing some of his patients’ happier outcomes:
Once our patients acquire visual patterns, and can work with them autonomously, they seem to experience great joy in visual learning—a renaissance of personality—They start thinking about wholly new areas of experience.
“A renaissance of personality”—this was just what Amy wanted for Virgil. It was difficult for us to imagine such a renaissance in him, for he seemed so phlegmatic, so set in his ways. And yet, despite a range of problems—retinal, cortical, psychological, possibly medical—he had done remarkably well in a way, had shown a steady increase in his power to apprehend a visual world. With his predominantly positive motivation, and the obvious enjoyment and advantage he could get from seeing, there seemed no reason why he should not progress further. He could never hope to have perfect vision, but he might certainly hope for a life radically enlarged by seeing.