Citing examples from After the Fact, discuss some of the problems with the reconstruction of historical events. Is it ever po

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An Anthropologist on Mars

SEVEN PARADOXICAL TALES

Oliver Sacks

Copyright © 1995ISBN 0679437851

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To the seven whose stories are related here

The universe is not only queerer than we imagine, but queerer than we can imagine.

J . B. S. Haldane

Ask not what disease the person has, but rather what person the disease has.

(attributed to) William Osler

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Contents

Acknowledgments 5

Preface 7

The Case of the Colorblind Painter 10

The Last Hippie 33

A Surgeon's Life 51

To See and Not See 66

The Landscape of His Dreams 88

Prodigies 108

An Anthropologist on Mars 143

Selected Bibliography

Contents

Acknowledgments

5

Acknowledgments

First, I am deeply grateful to my subjects: "Jonathan I.," "Greg F.," "Carl Bennett," "Virgil," Franco Magnani, Stephen Wiltshire, and Temple Grandin. To them, their families, their friends, their physicians and therapists, I owe an infinite debt.

Two very special colleagues have been Bob Wasserman (who was my co-author onthe original version of "The Case of the Colorblind Painter") and Ralph Siegel(who has been a collaborator in other books)-we formed a sort of team in thecases of Jonathan I. and Virgil.

I owe to many friends and colleagues (more than I can enumerate!) information,

help, and stimulating discussion. With some there has been a close, continualcolloquy over the years, as with Jerry Bruner and Gerald Edelman; with othersonly occasional meetings and letters; but all have excited and inspired me indifferent ways. These include: Ursula Bellugi, Peter Brook, Jerome Bruner,

Elizabeth Chase, Patricia and Paul Churchland, Joanne Cohen, Pietro Corsi,

Francis Crick, Antonio and Hanna Damasio, Merlin Donald, Freeman Dyson, GeraldEdelman, Carol Feldman, Shane Fistell, Allen Fur-beck, Frances Futterman,

Elkhonon Goldberg, Stephen Jay Gould, Richard Gregory, Kevin Halligan, LowellHandler, Mickey Hart, Jay Itzkowitz, Helen Jones, Eric Korn, Deborah Lai, Skipand Doris Lane, Sue Levi-Pearl, John MacGregor, John Marshall, Juan Martinez,

Jonathan and Rachel Miller, Arnold Modell, Jonathan Mueller, Jock Murray, KnutNordby, Michael Pearce, V. S. Ramachandran, Isabelle Rapin, Chris Raw-lence, BobRodman, Israel Rosenfield, Carmel Ross, Yolanda Rueda, David Sacks, MarcusSacks, Michael Sacks, Dan Schachter, Murray Schane, Herb Schaumburg, SusanSchwartzen-berg, Robert Scott, Richard Shaw, Leonard Shengold, Larry Squire,

John Steele, Richard Stern, Deborah Tannen, Esther Thelen, Connie Tomaino,

Russell Warren, Ed Weinberger, Ren and Joasia Weschler, Andrew Wilkes, HarveyWolinsky, Jerry Young, Semir Zeki.

Many people have shared their knowledge and expertise in the field of autismwith me, including, first and foremost, my good friend and colleague IsabelleRapin, Doris Allen, Howard Bloom, Marlene Breitenbach, Ginger Clarkson, UtaFrith, Denise Fruchter, Beate Hermelin, Patricia Krantz, Lynn McClannahan,

Clara and David Park, Jessy Park, Sally Ramsey, Bernard Rim-land, Ed and RivaRitvo, Mira Rothenberg, and Rosalie Winard. In relation to Stephen Wiltshire,

I must thank Lorraine Cole, Chris Marris, and above all, Margaret and AndrewHewson.

I am grateful to innumerable correspondents (including the now-unknowncorrespondent who sent me a copy of the 1862 Fayetteville Observer), some ofwhom are quoted in these pages. Many of these explorations, indeed, startedwith unexpected letters or phone calls, beginning with Mr. I.'s letter to mein March 1986.

There are places, no less than people, that have contributed to this book, byproviding shelter, calm, stimulation. Foremost among them has been the NewYork Botanical Garden (and especially the now- dismantled fern collection), myfavorite place for walking and thinking; the Lake Jefferson Hotel and itslake; Blue Mountain Center (and Harriet Barlow); the New York Institute forthe Humanities, where some of the testing of Mr. I. was done; the library atthe Albert Einstein College of Medicine, which has

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helped me track down manysources; and lakes, rivers, and swimming pools everywhere- for I do most of mythinking in the water.

The Guggenheim Foundation very generously supported my work on "A Surgeon's Life" with a 1989 grant for research on theneuroanthropology of Tourette's syndrome.

Earlier versions of "The Case of the Colorblind Painter" and "The Last Hippie" were published in The New York Review of Books, and of the other casehistories in The New Yorker. I have been privileged to have worked with RobertSilvers at the NYRB, and John Bennet at The New Yorker, and the staff of bothpublications. Many others have contributed to the editing and publication ofthis book, including Dan Frank and Claudine O'Hearn at Knopf, Jacqui Graham atPicador, Jim Silberman, Heather Schroder, Susan Jensen, and Suzanne Gluck.

Finally, someone who has known all the subjects in this book, and has helpedto give it impetus and shape, has been my assistant, editor, collaborator, andfriend, Kate Edgar.

But to return to where I started-for all clinical studies, however widely theyadventure, or deeply they investigate, must return to the concrete subject,

the individuals who inspired them, and whom they are about. So to the sevenpeople who have trusted me, shared their lives with me, given so deeply oftheir own experience-and who, over the years, have become my friends-Idedicate this book.

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Preface

I am writing this with my left hand, although I am strongly right-handed. Ihad surgery to my right shoulder a month ago and am not permitted, not capableof, use of the right arm at this time. I write slowly, awkwardly-but moreeasily, more naturally, with each passing day. I am adapting, learning, allthe while-not merely this left-handed writing, but a dozen other left-handedskills as well: I have also become very adept, prehensile, with my toes, tocompensate for having one arm in a sling. I was quite off balance for a fewdays when the arm was first immobilized, but now I walk differently, I havediscovered a new balance. I am developing different patterns, differenthabits& a different identity, one might say, at least in this particularsphere. There must be changes going on with some of the programs and circuitsin my brain-altering synaptic weights and connectivities and signals (thoughour methods of brain imaging are still too crude to show these). Though someof my adaptations are deliberate, planned, and some are learned through trialand error (in the first week I injured every finger of my left hand), mosthave occurred by themselves, unconsciously, by reprogrammings and adaptationsof which I know nothing (any more than I know, or can know, how I normallywalk). Next month, if all goes well, I can start to readapt again, to regain afull (and "natural") use of the right arm, to reincorporate it back into my body image, myself, to become a dexterous, dextral human being once again.

But recovery, in such circumstances, is by no means automatic, a simpleprocess like tissue healing-it will involve a whole nexus of muscular andpostural adjustments, a whole sequence of new procedures (and theirsynthesis), learning, finding, a new path to recovery. My surgeon, anunderstanding man who has had the same operation himself, said, "There aregeneral guidelines, restrictions, recommendations. But all the particulars youwill have to find out for yourself." Jay, my physiotherapist, expressedhimself similarly: "Adaptation follows a different path in each person. Thenervous system creates its own paths. You're the neurologist-you must see thisall the time."

Nature's imagination, as Freeman Dyson likes to say, is richer than ours, andhe speaks, marvellingly, of this richness in the physical and biologicalworlds, the endless diversity of physical forms and forms of life. For me, asa physician, nature's richness is to be studied in the phenomena of health anddisease, in the endless forms of individual adaptation by which humanorganisms, people, adapt and reconstruct themselves, faced with the challengesand vicissitudes of life.

Defects, disorders, diseases, in this sense, can play a paradoxical role, bybringing out latent powers, developments, evolutions, forms of life, thatmight never be seen, or even be imaginable, in their absence. It is theparadox of disease, in this sense, its "creative" potential, that forms thecentral theme of this book.

Thus while one may be horrified by the ravages of developmental disorder ordisease, one may sometimes see them as creative too-for if they destroyparticular paths, particular ways of doing things, they may force the nervoussystem into making other paths and ways, force on it an unexpected growth andevolution. This other side of development or disease is something I see, potentially, in almost every patient; and it is this, here, which I amespecially concerned to describe.

Similar considerations were brought up by A. R. Luria, who, more than anyother neurologist in his lifetime, studied the long-term survival of patientswho had cerebral tumors or had suffered brain injuries or strokes-and theways, the adaptations, they used to survive. He also studied deaf and blindchildren as a very young man (with his mentor L. S. Vygot-sky). Vygotskystressed the intactness rather than the deficits of such children:

A handicapped child represents a qualitatively different, unique type ofdevelopment&If a blind or deaf child achieves the same level of developmentas a normal child, then the child with a defect achieves this in another way,

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by another course, by other means-, and, for the pedagogue, it is particularlyimportant to know the uniqueness of the course along which he must lead thechild. This uniqueness transforms the minus of the handicap into the plus ofcompensation.

That such radical adaptations could occur demanded, Luria thought, a new viewof the brain, a sense of it not as programmed and static, but rather asdynamic and active, a supremely efficient adaptive system geared for evolutionand change, ceaselessly adapting to the needs of the organism-its need, aboveall, to construct a coherent self and world, whatever defects or disorders ofbrain function befell it. That the brain is minutely differentiated is clear: there are hundreds of tiny areas crucial for every aspect of perception andbehavior (from the perception of color and of motion to, perhaps, theintellectual orientation of the individual). The miracle is how they allcooperate, are integrated together, in the creation of a self1. 1This sense of the brain's remarkable plasticity, its capacity for the moststriking adaptations, not least in the special (and often desperate) circumstances of neural or sensory mishap, has come to dominate my ownperception of my patients and their lives. So much so, indeed, that I amsometimes moved to wonder whether it may not be necessary to redefine the veryconcepts of "health" and "disease," to see these in terms of the ability of the organism to create a new organization and order, one that fits itsspecial, altered disposition and needs, rather than in the terms of a rigidlydefined "norm."

Sickness implies a contraction of life, but such contractions do not have tooccur. Nearly all of my patients, so it seems to me, whatever their problems, reach out to life-and not only despite their conditions, but often because ofthem, and even with their aid.

Here then are seven narratives of nature-and the human spirit-as these havecollided in unexpected ways. The people in this book have been visited byneurological conditions as diverse as Tourette's syndrome, autism, amnesia, and total colorblindness. They exemplify these conditions, they are "cases" inthe traditional medical sense-but equally they are unique individuals, each ofwhom inhabits (and in a sense has created) a world of his own.

These are tales of survival, survival under altered, sometimes radicallyaltered, conditions-survival made possible by the wonderful (but sometimesdangerous) powers of reconstruction and adaptation we have. In earlier books Iwrote of the "preservation" of self, and (more rarely) of the "loss" of self, in neurological disorders. I have to come to think these terms too simple-andthat there is neither loss nor preservation of identity in such situations, but, rather, its adaptation, even its transmutation, given a radically alteredbrain and "reality."

The study of disease, for the physician, demands the study of identity, theinner worlds that patients, under the spur of illness, create. But therealities of patients, the ways in which they and their brains construct their own worlds, cannot be comprehendedwholly from the observation of behavior, from the outside. In addition to theobjective approach of the scientist, the naturalist, we must employ anintersubjective approach too, leaping, as Foucault writes, "into the interiorof morbid consciousness, [trying] to see the pathological world with the eyesof the patient himself." No one has written better of the nature and necessityof such intuition or empathy than G. K. Chesterton, through the mouth of hisspiritual detective, Father Brown. Thus when Father Brown is asked for hismethod, his secret, he replies:

Science is a grand thing when you can get it; in its real sense one of thegrandest words in the world. But what do these men mean, nine times out often, when they use it nowadays? When they say detection is a science? Whenthey say criminology is a science? They mean getting outside a man andstudying him as if he were a gigantic insect; in what they would call a dryimpartial light; in what I should call a dead and dehumanized light. They meangetting a long way off him, as if he were a distant prehistoric monster; staring at the shape of his "criminal skull" as if it were a sort of eeriegrowth, like the horn on a rhinoceros's nose. When the scientist talks about atype, he never means himself, but always his neighbour; probably his poorerneighbour. I don't deny the dry light may sometimes do good; though in

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onesense it's the very reverse of science. So far from being knowledge, it'sactually suppression of what we know. It's treating a friend as a stranger, and pretending that something familiar is really remote and mysterious. It'slike saying that a man has a proboscis between the eyes, or that he falls downin a fit of insensibility once every twenty-four hours. Well, what you call"the secret" is exactly the opposite. I don't try to get outside the man. Itry to get inside.

The exploration of deeply altered selves and worlds is not one that can befully made in a consulting room or office. The French neurologist François Lhermitte is especially sensitive to this, andinstead of just observing his patients in the clinic, he makes a point ofvisiting them at home, taking them to restaurants or theaters, or for rides inhis car, sharing their lives as much as possible. (It is similar, or wassimilar, with physicians in general practice. Thus when my father wasreluctantly considering retirement at ninety, we said, "At least drop thehouse calls." But he answered, "No, I'll keep the house calls-I'll dropeverything else instead.")

With this in mind, I have taken off my white coat, deserted, by and large, thehospitals where I have spent the last twenty-five years, to explore mysubjects' lives as they live in the real world, feeling in part like anaturalist, examining rare forms of life,- in part like an anthropologist, aneuroanthropologist, in the field-but most of all like a physician, calledhere and there to make house calls, house calls at the far borders of humanexperience.

These then are tales of metamorphosis, brought about by neurological chance, but metamorphosis into alternative states of being, other forms of life, noless human for being so different.

New York O.W.S.

June 1994

Notes

1. This, indeed, is the problem, the ultimate question, in neuroscience-and it cannot he answered, even in principle, without a global theory of brainfunction, one capable of showing the interactions of every level, from themicropatterns of individual neuronal responses to the grand macropatterns ofan actual lived life. Such a theory, a neural theory of personal identity, hasbeen proposed in the last few years by Gerald M. Edelman, in his theory ofneuronal group selection, or "neural Darwinism."

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The Case of the Colorblind Painter

Early in March 1986 I received the following letter:

I am a rather successful artist just past 65 years of age. On January 2nd ofthis year I was driving my car

and was hit by a small truck on the passengerside of my vehicle. When visiting the emergency room of a local hospital, Iwas told I had a concussion. While taking an eye examination, it wasdiscovered that I was unable to distinguish letters or colors. The lettersappeared to be Greek letters. My vision was such that everything appeared tome as viewing a black and white television screen. Within days, I coulddistinguish letters and my vision became that of an eagle-I can see a wormwriggling a block away. The sharpness of focus is incredible. BUT-I AMABSOLUTELY COLOR BLIND. I have visited ophthalmologists who know nothing aboutthis color-blind business. I have visited neurologists, to no avail. Underhypnosis I still can't distinguish colors. I have been involved in all kindsof tests. You name it. My brown dog is dark grey. Tomato juice is black. ColorTV is a hodge-podge&

Had I ever encountered such a problem before, the writer continued; could Iexplain what was happening to him-and could I help? This seemed anextraordinary letter. Colorblindness, as ordinarily understood, is somethingone is born with-a difficulty distinguishing red and green, or other colors, or (extremely rarely) an inability to see any colors at all, due to defects inthe color-responding cells, the cones, of the retina. But clearly this was notthe case with my correspondent, Jonathan I. He had seen normally all his life, had been born with a full complement of cones in his retinas. He had becomecolorblind, after sixty-five years of seeing colors normally- totallycolorblind, as if "viewing a black and white television screen." Thesuddenness of the event was incompatible with any of the slow deteriorationsthat can befall the retinal cone cells and suggested instead a mishap at amuch higher level, in those parts of the brain specialized for the perceptionof color.

Total colorblindness caused by brain damage, so-called cerebral achromatopsia, though described more than three centuries ago, remains a rare and importantcondition. It has intrigued neurologists because, like all neural dissolutionsand destructions, it can reveal to us the mechanisms of neuralconstruction- specifically, here, how the brain "sees" (or makes) color. Doublyintriguing is its occurrence in an artist, a painter for whom color has been of primary importance, and who can directly paint as well as describe what hasbefallen him, and thus convey the full strangeness, distress, and reality ofthe condition.

Color is not a trivial subject but one that has compelled, for hundreds ofyears, a passionate curiosity in the greatest artists, philosophers, andnatural scientists. The young Spinoza wrote his first treatise on the rainbow; the young Newton's most joyous discovery was the composition of white light; Goethe's great color work, like Newton's, started with a prism; Schopenhauer, Young, Helmholtz, and Maxwell, in the last century, were all tantalized by theproblem of color; and Wittgenstein's last work was his Remarks on Colour. Andyet most of us, most of the time, overlook its great mystery. Through such acase as Mr. I.'s we can trace not only the underlying cerebral mechanisms orphysiology but the phenomenology of color and the depth of its resonance andmeaning for the individual.

On getting Mr. I.'s letter, I contacted my good friend and colleague RobertWasserman, an ophthalmologist, feeling that together we needed to explore Mr. I.'s complex situation and, if we could, help him. We first saw him in April1986. He was a tall, gaunt man, with a sharp, intelligent face. Althoughobviously depressed by his condition, he soon warmed to us and began talkingwith animation and humor. He constantly smoked as he talked,- his fingers, restless, were stained with nicotine. He described a very active andproductive life as an artist, from his early days with Georgia O'Keeffe in NewMexico, to painting backdrops in Hollywood during the 1940s, to working as anAbstract Expressionist in New York during the 1950s and later as an artdirector and a commercial artist.

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We learned that his accident had been accompanied by a transient amnesia. Hehad been able, evidently, to give a clear account of himself and his accidentto the police at the time it happened, late on the afternoon of January 2, butthen, because of a steadily mounting headache, he went home. He complained tohis wife of having a headache and feeling confused, but made no mention of theaccident. He then fell into a long, almost stuporous sleep. It was only thenext morning, when his wife saw the side of the car stove in, that she askedhim what had happened. When she got no clear answer ("I don't know. Maybesomebody backed into it") she knew that something serious must have happened.

Mr. I. then drove off to his studio and found on his desk a carbon copy of thepolice accident report. He had had an accident, but somehow, bizarrely, hadlost his memory of it. Perhaps the report would jolt his memory. But liftingit up, he could make nothing of it. He saw print of different sizes and types, all clearly in focus, but it looked like "Greek" or "Hebrew" to him.2 Amagnifying glass did not help; it simply became large "Greek" or "Hebrew."

(This alexia, or inability to read, lasted for five days, but thendisappeared.)

Feeling now that he must have suffered a stroke or some sort of brain damagefrom the accident, Jonathan I. phoned his doctor, who arranged for him to betested at a local hospital. Although, as his original letter indicates, difficulties in distinguishing colors were detected at this time, in additionto his inability to read, he had no subjective sense of the alteration ofcolors until the next day.

That day he decided to go to work again. It seemed to him as if he weredriving in a fog, even though he knew it to be a bright and sunny morning.

Everything seemed misty, bleached, greyish, indistinct. He was flagged down bythe police close to his studio: he had gone through two red lights, they said.

Did he realize this? No, he said, he was not aware of having passed throughany red lights. They asked him to get out of the car. Finding him sober, butapparently bewildered and ill, they gave him a ticket and suggested he seekmedical advice.

Mr. I. arrived at his studio with relief, expecting that the horrible mistwould be gone, that everything would be clear again. But as soon as heentered, he found his entire studio, which was hung with brilliantly colored paintings, now utterly grey and void of color. His canvases, the abstractcolor paintings he was known for, were now greyish or black and white. Hispaintings-once rich with associations, feelings, meanings-now lookedunfamiliar and meaningless to him. At this point the magnitude of his lossoverwhelmed him. He had spent his life as a painter; now even his art waswithout meaning, and he could no longer imagine how to go on.

The weeks that followed were very difficult. "You might think," Mr. I. said, "loss of color vision, what's the big deal? Some of my friends said this, mywife sometimes thought this, but to me, at least, it was awful, disgusting."

He knew the colors of everything, with an extraordinary exactness (he couldgive not only the names but the numbers of colors as these were listed in aPantone chart of hues he had used for many years). He could identify the greenof van Gogh's billiard table in this way unhesitatingly. He knew all thecolors in his favorite paintings, but could no longer see them, either when helooked or in his mind's eye. Perhaps he knew them, now, only by verbal memory.

It was not just that colors were missing, but that what he did see had adistasteful, "dirty" look, the whites glaring, yet discolored and off-white, the blacks cavernous-everything wrong, unnatural, stained, and impure.3Mr. I. could hardly bear the changed appearances of people ("like animatedgrey statues") any

more than he could bear his own appearance in the mirror: he shunned social intercourse and found sexual intercourse impossible. He sawpeople's flesh, his wife's flesh, his own flesh, as an abhorrent grey;

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"flesh-colored" now appeared "rat-colored" to him. This was so even when heclosed his eyes, for his vivid visual imagery was preserved but was nowwithout color as well.

The "wrongness" of everything was disturbing, even disgusting, and applied toevery circumstance of daily life. He found foods disgusting due to theirgreyish, dead appearance and had to close his eyes to eat. But this did nothelp very much, for the mental image of a tomato was as black as itsappearance. Thus, unable to rectify even the inner image, the idea, of variousfoods, he turned increasingly to black and white foods-to black olives andwhite rice, black coffee and yogurt. These at least appeared relativelynormal, whereas most foods, normally colored, now appeared horribly abnormal.

His own brown dog looked so strange to him now that he even considered gettinga Dalmatian.

He encountered difficulties and distresses of every sort, from the confusionof red and green traffic lights (which he could now distinguish only byposition) to an inability to choose his clothes. (His wife had to pick themout, and this dependency he found hard to bear; later, he had everythingclassified in his drawers and closet-grey socks here, yellow there, tieslabeled, jackets and suits categorized, to prevent otherwise glaringincongruities and confusions.) Fixed and ritualistic practices and positionshad to be adopted at the table; otherwise he might mistake the mustard for themayonnaise, or, if he could bring himself to use the blackish stuff, ketchup for jam.4

As the months went by, he particularly missed the brilliant colors ofspring-he had always loved flowers, but now he could only distinguish them byshape or smell. The blue jays were brilliant no longer,- their blue, curiously, was now seen as pale grey. He could no longer see the clouds in thesky, their whiteness, or off-whiteness as he saw them, being scarcelydistinguishable from the azure, which seemed bleached to a pale grey. Red andgreen peppers were also indistinguishable, but this was because both appearedblack. Yellows and blues, to him, were almost white. 5 Mr. I. also seemed to experience an excessive tonal contrast, with loss ofdelicate tonal gradations, especially in direct sunlight or harsh artificiallight; he made a comparison here with the effects of sodium lighting, which atonce removes color and tonal delicacy, and with certain black-and-white films-"like Tri-X pushed for speed"-which produce a harsh, contrasty effect.

Sometimes objects stood out with inordinate contrast and sharpness, like silhouettes. But if the contrast was normal, or low, they might disappear from sight altogether.

Thus, though his brown dog would stand out sharply in silhouette against a light road, it might get lost to sight when it moved into soft, dappledundergrowth. People's figures might be visible and recognizable half a mile off (as he himself said in his original letter, and many times later, his vision had become much sharper, "that of an eagle"), but faces would often be unidentifiable until they were close. This seemed a matter of lost color and tonal contrast, rather than a defect in recognition, an agnosia. A major problem occurred when he drove, in that he tended to misinterpret shadows as cracks or ruts in the road and would brake or swerve suddenly to avoid these.

He found color television especially hard to bear: its images always unpleasant, sometimes unintelligible. Black-and-white television, he thought, was much easier to deal with; he felt his perception of black-and- white images to be relatively normal, whereas something bizarre and intolerable occurred whenever he looked at colored images. (When we asked why he did not simply turn off the color, he said he thought that the tonal values of "decolored" color TV seemed different, less "normal," than those of a "pure" black- and-white set.) But, as he now explained, in distinction to his first letter, his world was not really like black-and-white television or film-it would have been much easier to live with had it been so. (He sometimes wished he could wear miniature TV glasses.)

His despair of conveying what his world looked like, and the uselessness of the usual black-and-white analogies, finally …

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An Anthropologist on Mars

SEVEN PARADOXICAL TALES

Oliver Sacks

Copyright © 1995ISBN 0679437851

3

To the seven whose stories are related here

The universe is not only queerer than we imagine, but queerer than we can imagine.

J . B. S. Haldane

Ask not what disease the person has, but rather what person the disease has.

(attributed to) William Osler

4

Contents

Acknowledgments 5

Preface 7

The Case of the Colorblind Painter 10

The Last Hippie 33

A Surgeon's Life 51

To See and Not See 66

The Landscape of His Dreams 88

Prodigies 108

An Anthropologist on Mars 143

Selected Bibliography

Contents

Acknowledgments

5

Acknowledgments

First, I am deeply grateful to my subjects: "Jonathan I.," "Greg F.," "Carl Bennett," "Virgil," Franco Magnani, Stephen Wiltshire, and Temple Grandin. To them, their families, their friends, their physicians and therapists, I owe an infi

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