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Psychology in Action

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At his initial examination with Sacks, Dr. P. was unable to finish dressing, forgetting which object was the shoe and what he should do with it. When Dr. P. was leaving the office, he confused his hat with his wife's head and tried to pick her up instead. When Sacks visited him at home, Dr. P. extended his hand to a grandfather clock in the room. It wasn't until he heard Sacks' voice that he distinguished between the clock and Sacks. Other observations indicated that Dr. P. could not recognize emotions on actors' and actresses' faces on television nor identify their genders. He did not recognize the photographs of relatives in his home--unless they had an unusual facial characteristic. When asked to name a rose, he called it a ”convoluted red form with a linear green attachment.” However, after smelling it, he immediately recognized it as a rose. He described a glove as a “continuous surface enfolded upon itself with five out-pouchings,” but he had no inkling of the “real” name or what one did with it. In contrast, when shown complicated geometrical designs, such as a dodecahedron, he immediately gave the correct names. Interestingly, he no longer dreamed in visual images. With such loss it was amazing that he could still function, but, according to his wife, he set everything to music. When he was dressing, bathing, or eating, he accompanied the activity by some melody. If he were interrupted in the sequence, he became confused and did not remember what he was doing. For example, if he were interrupted while eating a meal, he would stop and stare at the food in confusion-- until he got a whiff of it. Dr. Sacks refers to this as a case of visual agnosia due to some type of degeneration in the occipital cortex. Dr. P. can still see, but the images have no meaning. The impaired process is a judgmental loss concerning the visual images. One can see objects, but one does not know what one should do relative to these objects. They have lost their visual meaning. One interesting aspect of this case is that Mr. P. does not even know that he has lost this ability. He does not remember an earlier time when he responded differently. According to Sacks, not to know that one has lost something can be looked at as either good or bad, depending upon one's perspective. In the second case, "The Lost Mariner," Sacks discusses a case in which the patient's memory was unable to store any new material. Jimmie G., age 49, was brought to a house for the aging (in 1975) because he was showing signs of confusion and dementia. Interviews with Jimmie indicated that he still perceived himself as age 19. He talked of his job with the navy, a brother who planned to become an accountant, and identified Truman as the current president. His memory of the past had stopped at 1945. In what Sacks refers to as a thoughtless response on his own part, he showed Jimmie a mirror, asking him to identify the reflection. As expected, he did not recognize himself and accused Sacks of playing a nasty trick on him. Sacks, after leaving the room for two minutes, returned and reintroduced himself to Jimmie who had no recollection of the earlier encounter.
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