“Gross disturbances of the organization of impressions of events and their sequence in time can always be observed in such patients,” he wrote. “In consequence, they lose their integral experience of time and begin to live in a world of isolated impressions.” -- Luria
Further, there may be a profound retrograde amnesia in such cases. My colleague Dr. Leon Protass tells me of such a case seen by him recently, in which the patient, a highly intelligent man, was unable for some hours to remember his wife or children, to remember that he had a wife or children. In effect, he lost thirty years of his life—though, fortunately, for only a few hours. Recovery from such attacks is prompt and complete—yet they are, in a sense, the most horrifying of "little strokes" in their power absolutely to annul or obliterate decades of richly lived, richly achieving, richly memoried life. The horror, typically, is only felt by others—the patient, unaware, amnesiac for his amnesia, may continue what he is doing, quite unconcerned, and only discover later that he lost not only a day (as is common with ordinary alcoholic"blackouts"), but half a lifetime, and never knew it. The fact that one can lose the greater part of a lifetime has peculiar, uncanny horror.
There could be only one thing worse—and that would be to lose one's entire lifetime. My friend Dr. Isabelle Rapin, author of Children with Brain Dysfunction: Neurology, Cognition, Language, and Behavior, tells me that very rarely, in consequence of certain brain tumors or degenerative diseases, children may develop a severe Korsakov's syndrome. If this happens, it has been thought, they risk losing their childhood and even their infancy from a retrograde amnesia which may extend back to birth. Such children may not only become as helpless as newborns but may also become deeply "autistic" as they lose and forget all human relationships, even the most elemental—the memory of mother love.
In adulthood, life, higher life, may be brought to a premature end by strokes, senility, brain injuries, etc., but there usually remains the consciousness of life lived, of one's past. This is usually felt as a sort of compensation: "At least I lived fully, tasting life to the full, before I was brain-injured, stricken, etc." This sense of "the life lived before," which may be either a consolation or a torment, is precisely what is taken away in retrograde amnesia. The "final amnesia, the one that can erase a whole life" that Buñuel speaks of may occur, perhaps, in a terminal dementia, but not, in my experience, suddenly, in consequence of a stroke. But there is a different, yet comparable, sort of amnesia, which can occur suddenly—different in that it is not "global" but "modality-specific."
Thus, in one patient under my care, a sudden thrombosis in the posterior circulation of the brain caused the immediate death of the visual parts of the brain. Forthwith this patient became completely blind—but did not know it. He looked blind—but he made no complaints. Questioning and testing showed, beyond doubt, that not only was he centrally or "cortically" blind, but he had lost all visual images and memories, lost them totally—yet had no sense of any loss. Indeed, he had lost the very idea of "seeing"—and was not only unable to describe anything visually, but bewildered when I used words such as "seeing" and "light." He had become, in essence, a nonvisual being. His entire lifetime of seeing, of visuality, had, in effect, been stolen. His whole visual life had, indeed, been erased—and erased permanently in the instant of his stroke. Such a visual amnesia, and (so to speak) blindness to the blindness, amnesia for the amnesia, is in effect a "total" Korsakov's, confined to visuality.
A still more limited, but nonetheless total, amnesia may be displayed with regard to particular forms of perception. Thus, in one patient whose history I have already described ("The Man Who Mistook his Wife for a Hat," London Review of Books, vol. 5, no. 9, May 1983), there was an absolute "prosopagnosia," or agnosia for faces. This patient was not only unable to recognize faces, but unable to imagine or remember any faces—he had indeed lost the very idea of a "face," as my more afflicted patient had lost the very idea of "seeing" or "light." Such syndromes were described by Anton
in the 1890s. But the implication of these syndromes—Korsakov's and Anton's—what they entail and must entail for the "world," the lives, the identities, of affected patients, has been scarcely touched on even to this day.