An Anthropologist on Mars (1995) (19 page)

Everyone, Virgil included, expected something much simpler. A man opens his eyes, light enters and falls on the retina: he sees. It is as simple as that, we imagine. And the surgeon’s own experience, like that of most ophthalmologists, had been with the removal of cataracts from patients who had almost always lost their sight late in life—and such patients do indeed, if the surgery is successful, have a virtually immediate recovery of normal vision, for they have in no sense lost their ability to see. And so, though there had been a careful surgical discussion of the operation and of possible postsurgical complications, there was little discussion or preparation for the neurological and psychological difficulties that Virgil might encounter.

With the cataract out, Virgil was able to see colors and movements, to see (but not identify) large objects and shapes, and, astonishingly, to read some letters on the third line of the standard Snellen eye chart—the line corresponding to a visual acuity of about 20⁄100 or a little better. But though his best vision was a respectable 20⁄80, he lacked a coherent visual field, because his central vision was poor, and it was almost impossible for the eye to fixate on targets; it kept losing them, making random searching movements, finding them, then losing them again. It was evident that the central, or macular, part of the retina, which is specialized for high acuity and fixation, was scarcely functioning, and that it was only the surrounding paramacular area that was making possible such vision as he had. The retina itself presented a moth-eaten or piebald appearance, with areas of increased and decreased pigmentation-islets of intact or relatively intact retina alternating with areas of atrophy. The macula was degenerated and pale, and the blood vessels of the entire retina appeared narrowed. Examination, I was told, suggested the scars or residues of old disease but no current or active disease process; and, this being so, Virgil’s vision, such as it was, could be stable for the rest of his life. It could be hoped, moreover (since the worse eye had been operated on first), that the left eye, which was to be operated upon in a few weeks’ time, might have considerably more functional retina than the right.

I had not been able to go to Oklahoma straightaway—my impulse was to take the next plane after that initial phone call—but had kept myself informed of Virgil’s progress over the ensuing weeks by speaking with Amy, with Virgil’s mother, and, of course, with Virgil himself. I also spoke at length with Dr. Hamlin and with Richard Gregory, in England, to discuss what sort of test materials I should bring, for I myself had never seen such a case, nor did I know anyone (apart from Gregory) who had. I gathered together some materials—solid objects, pictures, cartoons, illusions, videotapes, and special perceptual tests designed by a physiologist colleague, Ralph Siegel; I phoned an ophthalmologist friend, Robert Wasserman (we had previously worked together on the case of the colorblind painter), and we started to plan a visit. It was important, we felt, not just to test Virgil but to see how he managed in real life, inside his house, outside, in natural settings and social situations; crucial, too, that we see him as a person, bringing his own life history—his particular dispositions and needs and expectations—to this critical passage; that we meet his fiancée, who had so urged the operation, and with whom his life was now so intimately mingled; that we look not merely at his eyes and perceptual powers but at the whole tenor and pattern of his life.

Virgil and Amy—now newlyweds—greeted us at the exit barrier in the airport. Virgil was of medium height, but exceedingly fat; he moved slowly and tended to cough and puff with the slightest exertion. He was not, it was evident, an entirely well man. His eyes roved to and fro, in searching movements, and when Amy introduced Bob and me he did not seem to see us straightaway—he looked toward us but not quite at us. I had the impression, momentary but strong, that he did not really look at our faces, though he smiled and laughed and listened minutely.

I was reminded of what Gregory had observed of his patient S.B.—that “he did not look at a speaker’s face, and made nothing of facial expressions.” Virgil’s behavior was certainly not that of a sighted man, but it was not that of a blind man, either. It was, rather, the behavior of one mentally blind, or agnosicable to see but not to decipher what he was seeing. He reminded me of an agnosic patient of mine, Dr. P. (the man who mistook his wife for a hat), who, instead of looking at me, taking me in, in the normal way, made sudden strange fixations—on my nose, on my right ear, down to my chin, up to my right eye—not seeing, not “getting”, my face as a whole.

We walked out through the crowded airport, Amy holding Virgil’s arm, guiding him, and out to the lot where they had parked their car. Virgil was fond of cars, and one of his first pleasures after surgery (as with S.B.) had been to watch them through the window of his house, to enjoy their motions, and spot their colors and shapes—their colors, especially. He was sometimes bewildered by shapes. “What cars do you see?” I asked him as we walked through the lot. He pointed to all the cars we passed. “That’s a blue one, that’s red—wow, that’s a big one!” Some of the shapes he found very surprising. “Look at that one!” he exclaimed once. “I have to look down!” And, bending, he felt it—it was a slinky, streamlined V-12 Jaguar—and confirmed its low profile. But it was only the colors and general profiles he was getting; he would have walked past their own car had Amy not been with him. And Bob and I were struck by the fact that Virgil would look, would attend visually, only if one asked him to or pointed something out—not spontaneously. His sight might be largely restored, but using his eyes, looking, it was clear, was far from natural to him; he still had many of the habits, the behaviors, of a blind man.
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68. One does not see, or sense, or perceive, in isolation—perception is always linked to behavior and movement, to reaching out and exploring the world. It is insufficient to see; one must look as well. Though we have spoken, with Virgil, of a perceptual incapacity, or agnosia, there was, equally, a lack of capacity or impulse to look, to act seeing—a lack of visual behavior. Von Senden mentions the case of two children whose eyes had been bandaged from an early age, and who, when the bandages were removed at the age of five, showed no reaction to this, showed no looking, and seemed blind. One has the sense that these children, who had built up their worlds with other senses and behaviors, did not know how to use their eyes.

Looking—as an orientation, as a behavior—may even vanish in those who become blind late in life, despite the fact that they have been “lookers” all their lives. Many startling examples of this are given by John Hull in his autobiographical book, Touching the Rock. Hull had lived as a sighted man until his midforties, but within five years of becoming totally blind, he had lost the very idea of “facing” people, of “looking” at his interlocutors.

The drive from the airport to their house was a long one; it took us through the heart of town, and it gave us an opportunity to talk to Virgil and Amy and to observe Virgil’s reactions to his new vision. He clearly enjoyed movement, watching the ever-changing spectacle through the car windows and the movement of other cars on the road. He spotted a speeder coming up very fast behind us and identified cars, buses (he especially loved the bright-yellow school buses), eighteen-wheelers, and, once, on a side road, a slow, noisy tractor. He seemed very sensitive to, and intrigued by, large neon signs and advertisements and liked picking out their letters as we passed. He had difficulty reading entire words, though he often guessed them correctly from one or two letters or from the style of the signs. Other signs he saw but could not read. He was able to see and identify the changing colors of the traffic lights as we got into town.

He and Amy told us of other things he had seen since his operation and of some of the unexpected confusions that could occur. He had seen the moon; it was larger than he expected.
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69. Gregory’s patient, too, was startled by the moon: he had expected a quarter moon would be wedge-shaped, like a piece of cake, and was astonished and amused to find it a crescent instead.

On one occasion, he was puzzled by seeing “a fat airplane” in the sky—“stuck, not moving.” It turned out to be a blimp. Occasionally, he had seen birds; they made him jump, sometimes, if they came too close. (Of course, they did not come that close, Amy explained. Virgil simply had no idea of distance.)

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.
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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.
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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.