At the time of the publication of Michael Sandel's Liberalism and the Limits of Justice in 1982, Oliver Sacks was writing many of the “clinical tales” for his remarkable The Man Who Mistook His Wife for a Hat. This chronological parallelism notwithstanding, nothing would seem more improbable than a bringing into dialogue of these two works, for not only do they spring from disciplines breathtakingly remote from one another (political theory, neurology), they appear to have radically different centers of interest. Sandel wishes to refute the moral epistemology underlying John Rawls' A Theory of Justice and thereby call the entire Rawlsian contractual scheme into question. Sacks narrates episodes from his experience as a neurologist. As his patients suffer from bizarre afflictions like Tourette Syndrome, anosmia (loss of the sense of smell), and deficient proprioception (the ability to sense one's own body), there is an unmistakable “freak show” appeal to the book. This accounts for its commercial success but also would seem to render it quite irrelevant to the preoccupations of Harvard political philosophy.
But whoever reads Sacks carefully will recognize the ample scope of his agenda. The neurological investigations consistently reach a philosophical level. Key “conversation partners” for Sacks are Plato, Kant, Hume, Kierkegaard, Wittgenstein, Frege, and Freud. Moreover, the work contains an extended argument with the “classical” neurology of Hughlings Jackson and Kurt Goldstein, who, according to Sacks, maintained that “the mind, man's glory, lies wholly in the abstract and categorical, and the effect of brain damage . . . is to cast him out of this high realm into the almost subhuman swamplands of the concrete.” In his “defense” of the realm of the concrete and the “simple” people who. Sacks believes, have special access to it, he tries to offer an alternative view of the sources of their identity and dignity. But—albeit without reference to the mentally handicapped—this is exactly the issue addressed by Michael Sandel. One might even say that Kant and Rawls are to Sandel what Jackson and Goldstein are to Sacks. Thus, far from being irrelevant, both Sacks' research and his critique of his predecessors will have everything to do with Sandel's effort.
Sacks allows us to see that, interesting and persuasive as Sandel's account is, it is almost unbearably “thin.” This is odd, because Sandel wishes to defend a communitarian vision of “constitutive attachments,” a vision populated by “thickly constituted selves” with characteristics of moral depth, “weight,” character, history, substantive friendships, and political passions which form them in their core. A reading of Sacks serves both to reveal the sparseness of Sandel's constructive program and to offer new avenues of exploration. When he speaks both of richly identified and “de-identified” patients. Sacks summons a vocabulary that is importantly different than that of Sandel. Sacks' key categories are memory, feeling, play, music, and, above all, narrative.
My primary attempt here is thus to show how Sacks functions as an indispensable supplement to Sandel— how any next formulation that Sandel makes will necessarily take up many of the concerns and notions that render Sacks' book such a milestone in philosophical medicine. I also wish to assemble from its several expressions a coherent statement of Sacks' notion of narrative as “the science of the concrete,” for it seems to me that he offers important new ways of understanding the philosophic status of narrative.
As Sandel explains it, Kant objected to utilitarianism because it presupposed the invariability of the content of the desire for happiness. This presupposition is an empirical one, Kant pointed out, and it will not bear scrutiny, for “our desires and the means of satisfying them typically vary, both between persons and over time.” A moral theory may not be placed on so unstable a foundation. Moreover, given the variability of people's conceptions of happiness, it will inevitably happen that a just desire will be overridden by a consideration of general utility. The way out of this dilemma, maintained Kant, was to turn away from the ends which persons pursue to persons themselves qua sources of ends. Morality must be grounded in a non-empirical subject capable of an autonomous will: “a subject of ends, namely a rational being himself, must be made the ground for all maxims of action.”
Thus, Kant's revolutionary move in moral theory parallels his “Copernican Revolution” in metaphysics: the re-location of principles (like temporality and causality) in the knowing subject. This strategy gives rise to the moral-philosophical thesis of the priority of the right over the good, since the latter pertains not to the self (the sole source of moral value) but to the ends which the self chooses for itself.
That which is fundamentally real in the Kantian moral world is thus a cosmopolis of noumenal selves, free and equal and rational and self-legislating, whose autonomy is qualified by the categorical imperative. Rawls' original position adopts this “kingdom of ends” scheme but interprets it as the key to a model procedure (the social contract), thereby rescuing Kant from his entrapment in a transcendent realm. Most of A Theory of Justice works out these procedural and (hence) political-ethical consequences of the veil of ignorance and the original position, and it is this material that has occupied most commentators. But Sandel insists that the Kantian moral subject which launches Rawls' endeavor remains determinative throughout. “We must be prepared to live with the vision contained in the [Rawls'] original position, mutual disinterest and all,” he writes, “prepared to live with it in the sense of accepting its description as an accurate reflection of human moral circumstance, consistent with our understanding of ourselves.”
Sandel's task thus becomes that of bringing to full clarity the theory of person, agency, and attachment that resides in Rawls' work. Moving skillfully through Rawls' account of such issues as meritocracy, common assets, ownership, contract theory, and affirmative action, Sandel finds the following:
(1) For Rawls, the plurality of subjects is given prior to their unity. Sandel often refers to this as “the notion of the antecedent individuation of the subject.” This means that there is, so to speak, an a priori validation of the realm of distinct individuals; cooperative arrangements and relationships receive validation a posteriori, and instrumentally, in the light of experience.
(2) With respect to the self and its ends, Rawls' theory requires that “I must be a subject whose identity is given independently of the things I have, independently, that is, of my interests and ends and my relations with others.” Sandel contrasts this “voluntarist” view with a “cognitive” one, in which “the ends of the self are given in advance . . . [and] the subject achieves self-command not by choosing that which is already given (this would be unintelligible) but by reflecting on itself and inquiring into its constituent nature, discerning its laws and imperatives, and acknowledging its purposes as its own.”
(3) This distinction is extremely far-reaching, argues Sandel; e.g., it involves entirely different views of how it is that the self becomes disempowered and dispossessed. In the cognitive view, dispossession (and loss of self-command) involves a manner of forgetting which of the ingredients in a rich set of possible ends and purposes is most essential to the self's identity. In the voluntarist interpretation, ends consistently “drift away” from the self; the self, its bounds firmly pre-established, “invulnerable to transformation by experience,” must “reach beyond itself, to grasp as an object of its will the ends it would possess, and hold them, as it always must, external to itself.”
(4) Closely related to this view of agency is Rawls' understanding of the relation of self and community. Sandel's most compact formulation is this: for Rawls, “as a person's values and ends are always attributes and never constituents of the self, so a sense of community is only an attribute and never a constituent of a well-ordered society.” In Sandel's cognitive or “intersubjective” understanding, it makes sense to speak both of a single moral subject as being the locus of a “plurality of selves” and of obligations attaching to families, communities, classes, or nations. The cognitive view sustains the claim that communities can become “constitutive” in the sense that persons are essentially describable in terms of them.
Perhaps the most persuasive element of Sandel's analysis of Rawls' “deontological vision” is his insistence that for Rawls' theory to work Rawls must in fact borrow from fuller accounts of community than his premises permit. For conservative readers, the hardest part of Rawls is his theory of distributive justice (or, as some would say, re-distributive justice) based on the difference principle. The core of that theory is the notion of “common assets.” Those gathered behind the veil of ignorance accept that all endowments of the self, both natural and acquired, are in Rawls' phrase “arbitrary from a moral perspective.” They come to agree that the assets which individuals wind up generating in the post-contract world must be allocated according to the difference principle. This is philosophically possible because, for Rawls, such assets are not me; they are not essential constituents of my identity but “alienable attributes of the self.” Therefore, I am not being used as a means—my assets are.
This leaves Rawls with a radically disembodied subject, points out Sandel. As a consequence, Rawls is forced by his theory of justice to enrich the concept of “my assets,” giving it intersubjective meanings not warranted by his theory of the self. Subtly—and, for Sandel, impermissibly—Rawls' language begins to suggest a distinctively social understanding of the notion of assets. Such language makes it seem plausible that, to propose an example, I as a talented surgeon might vote for some form of socialized medicine because I recognize how much “my skills” attest to the actions of others in, for, and upon me. But in doing so I must acknowledge a possessor of these assets which is a “we” in the constitutive sense. For Sandel, such a corporate “subject of possession” is officially ruled out by Rawls' deontological, individualist premises. Sandel discovers in A Theory of Justice a great number of notions and phrases suggestive of Rawls' parasitic attachment to corporatist views and intersubjective perspectives. For example, Rawls says that “only in the social union is the individual complete”; or, again, “the self is realized in the activities of many selves.”
Sandel's alternative to Rawls is, of course, the ideal of “constitutive attachments” and “thickly constituted selves” whose ends are often allegiances. Such allegiances are “more than values” and “natural duties” owed to humans qua humans. They partly define the self, give it a history and a character. “Constitutive attachments” are seen by Sandel as giving agency “moral weight”; the self is “encumbered” with an identity that because of its density, complexity, and rootedness is only partially open to revision. This means that self-knowledge is very difficult and requires others for its achievement. Hence friendship is essential, for my friends can offer insights into my identity that persistently elude me. I do not “use” them for this purpose, for they are “in” me already by virtue of our complex intersubjectivity.
Concludes Sandel: “To see ourselves as deontology would see us is to deprive us of those qualities of character, reflectiveness, and friendship that depend on the possibility of constructive projects and attachments.” So too would deontology attempt to rob us of a vibrant politics, for it insists on rigorously distinguishing public and private and seeing the political as fully external to the self. “By putting the self beyond the reach of politics, it makes human agency an article of faith rather than an object of continuing attention and concern.”
The view of the moral subject which gains expression in Oliver Sacks' “clinical tales” is entirely congenial to that proposed by Sandel. But Sacks' reflections—as well as the particular cases he chooses to reflect upon—provide a much richer picture of the subject and its identity than what Sandel offers. Sacks' “defectological” investigations invite us to locate “constitutive attachments” in games and play, in narrative and ritual, and especially in memory. More importantly, he causes us to re-evaluate the sense and meaning that attach to such notions as loss, asset, and, indeed, subjectivity. Given the prominence of these motifs, it is not surprising that Sacks writes what might be called “narrative neurology.” In what follows, I will focus on three of these narratives—about Dr. P., Jimmie G., and Rebecca—showing how these develop the case for “a romantic science of the concrete” and bringing into play the moral language so wanting in Sandel's account.
Sacks is both sufficiently philosophical and sufficiently witty to have arranged The Man Who Mistook His Wife for a Hat in a particularly intriguing ideational order. Chapter one (after which the hook is named) is uncannily “Kantian,” while chapter two (“The Lost Mariner”) is partly an essay about Hume. Indeed, Dr. P., Sacks' first case study, is unmistakably a German, and the whole ordered texture of his music- teacher life reminds one of no one so much as Kant himself. Moreover, Dr. P.'s strange “visual agnosia” is a thoroughly Kantian affliction. For he has, in effect, lost the very ability to have an empirical experience (at least through the sense of vision). When Sacks places in his hands an object, P. proceeds to apprehend it as “about six inches in length . . . a convoluted red form with a linear green attachment.” He is entirely content with this “identification.” Under prodding he deduces that, because it lacks the simple symmetry of the Platonic solids, it could be “an inflorescence or flower.” Without smelling it—this does not occur to him—he cannot name it as an early rose.
Thus, Dr. P. has in effect been reduced to a pure a priori transcendental subject. Sacks explains that he has even lost judgment in the sense of an ability to perceive identity in particulars. Although Sacks appeals to Kant when claiming that “judgment is the most important faculty we have,” he means by judgment more than what Kant had in mind. For Sacks, the appalling thing about Dr. P. was the inhuman formality of his gaze—his inability to find a “thou” behind the faces presented to him. “Dr. P. had abstract attitude—indeed, nothing else.” He was “positively Martian.” The patient “recognizes” the objects of vision as does a computer, through establishing “marks” and comparing them to a schematism of such marks. Had Dr. P. possessed “judgment” in Sacks' sense, he would have had some feeling for the concrete, the personal, the particular, and for apprehending perceptual objects as wholes.
The case of Dr. P. certainly causes the reader to consult Kant once again on the issue of how the noumenal self connects with the world. But for our purposes, P. performs a different role. Sandel wants to locate identity in the history of particular communities, networks of friendship, and the molding of character. But the poor man “who mistook his wife for a hat” is finally sustained and identified by something much more specific: music. Dr. P. can finally recognize the world only if he “sings it” to himself. Sacks' therapeutic advice is therefore this: “Music has been the center, now make it the whole, of your life.” Sacks speculates that P. “had no body-image, he had body-music.”
Perhaps one could say that P. had become hab- ituated to a life organized around music, and that when he generated music a system of identity-sustaining habits came into play. Music is partly communal in origin, so one might even say that P. is being sustained by an underlying historical musical community. Sandel has nothing to say about habituation, nor does he seem to be thinking of communities (or is it traditions?) of this type. Yet we have here an attachment that is evidently “constitutive” in the strongest sense of the term. Sacks' work thus invites reflections on forms of attachment that exist in dimensions of community left out of Sandel's account.
While Sandel wants to reject the deontological theory of the person, he does so in a different way than that marked out by what he calls “the sociological objection.” As he explains it (he appears to be talking to Marxists), this view insists on the fundamentally social nature of humans, on their being conditioned “all the way down,” and on the complete non-existence of noumenal selves. Neutrality is impossible, for the political order must embody someone's values; thus, the demands of justice are for a social order directed toward cooperation and an education productive of altruistic and benevolent citizens. Sandel sees this as a misunderstanding of deontological liberalism, which is fully compatible with cooperative virtues. The issue here, he insists, is whether, as Kant would claim, the principles of right are derived in a way that does not depend on any particular ends.
Moreover, Sandel worries about the implications of the sociological critique, for it seems to present an untenable image of selfhood. This image was, in fact, enunciated by Hume, who saw the self as “a bundle or collection of different perceptions, which succeed each other with an inconceivable rapidity, and are in a perpetual flux and movement.” The sociological critic, without something like a Kantian anchor in the noumenal world, must find a principle of continuity of the self through time. Kant only insisted that this principle “precedes all experience, and makes experience possible.” Sandel's answer is, of course, the communally situated self, whose ends are given in and with selfhood, so to speak, and whose character bestows an important component of unity. (Since Sandel does not explain the relation between “ends” and “character,” it is a bit difficult to describe his position.)
Much in Sacks' book touches on this issue, but no case is more relevant than that of Jimmie G., “the Lost Mariner.” A victim of Korsakov's Syndrome (brought on by alcoholism), Jimmie G. has “retrograde amnesia” and can recall only his youth and early adulthood. The profundity of his amnesia is unsettling. He animatedly reviews his life story (i.e., the first nineteen years of it) for Sacks, but after a two-minute pause, he cannot recall a word of what he just said. Quick-witted, very intelligent, he does well with games like checkers, but chess eludes him because it moves too slowly for him to hold its rules in mind. Similarly, quick mathematical computations offer no challenge, yet when problems require a great many steps, he loses orientation.
Sacks' description of the manner and degree of Jimmie's amnesia is poignant—and pertinent to our inquiry. Having quoted the same passage from Hume as did Sandel, Sacks writes of Jimmie: “In some sense, he had been reduced to a ‘Humean' being—I could not help thinking how fascinated Hume would have been at seeing in Jimmie his own philosophical chimaera incarnate, a gruesome reduction of a man to mere disconnected, incoherent flux and change.” Sacks urges him to keep a diary, but finds that Jimmie can neither recognize the entries nor comprehend the fact of his own authorship. Jimmie's brother makes visits; these encounters are joyous and break the reigning pattern of emotional indifference but “do nothing to provide any sense of continuity or history.” Jimmie's deficiency of affect disturbs Sacks, who speaks of a loss of self so complete that “he cannot know it, because he is no longer there to know it.” He wonders if the impression of utter superficiality often made by Jimmie signals his reduction to “a sort of Humean drivel,” a “Humean froth,” “a mere succession of unrelated impressions and events.”
That Korsakov's Syndrome can produce this very possibility is clear from another sufferer, William Thompson (see chapter twelve, “A Matter of Identity”). The question Sacks asks the Sisters about Jimmie— “Do you think he has a soul?”—is asked also about this identity-less “person” and answered—gingerly, haltingly—in the negative. Sacks exclaims: “But William... is so damned he does not know he is damned.” He continues: “For it is not just a faculty, or some faculties that are damaged, but the very citadel, the self, the soul itself.” Jimmie at least manifests dissatisfaction with his condition: “He wanted to do, to be, to feel.” Sacks assigns him typing tasks, and Jimmie finds some satisfaction at exercising a long-unused skill. He discovers the garden and works in it with uncharacteristic focus. Sacks sees that “Jimmie has moods, and a sort of brooding (or, at least, yearning) sadness, a depth, a soul, which does not seem present in Mr. Thompson.”
Sacks' reflections about the Lost Mariner finally yield the conviction that when memory is gone, a claim to identity is still possible, but the source of this claim comes from an unexpected context of behavior. “Watch Jimmie in chapel,” counsel the Sisters:
I did, and I was moved, profoundly moved and impressed, because I saw here an intensity and steadiness of attention and concentration that I had never seen before in him or conceived him capable of. I watched him kneel and take the Sacrament on his tongue, and could not doubt the fullness and totality of Communion, the perfect alignment of his spirit with the spirit of the Mass. Fully, intensely, quietly, in the quietude of absolute concentration and attention, he entered and partook of the Holy Communion. He was wholly held, absorbed, by a feeling. There was no forgetting, no Korsakov's then, nor did it seem possible or imaginable that there should be; for he was no longer at the mercy of a faulty and fallible mechanism—that of meaningless sequences and memory traces—but was absorbed in an act, an act of his whole being, which carried feeling and meaning in an organic continuity and unity, a continuity and unity so seamless it could not permit any break.
Sacks notices that after chapel, Jimmie's mood of peaceful attentiveness persists for a time. He reports that while Jimmie's amnesia remains unutterably “dense,” there has been spiritual formation. At times, he is “a different man altogether, . . . rich in all the Kierkegaardian categories—the aesthetic, the moral, the religious, the dramatic.” Jimmie has thus avoided the “de-souling” that besets William. And yet even William, Sacks reports, seems to experience surcease from his “identity-delirium” when wandering in the garden. However fleetingly, he seems to be restored to “a sense of being in the world, being real.”
Sandel's “communitarian” challenge to Rawls persistently emphasizes an alternative moral epistemology—the “cognitive” notion of agency. Over and over, Sandel stresses the different meanings that “reflexivity,” “discovery,” “inquiry,” “self- knowledge,” and “self-possession” acquire in his notion of the subject whose ends are “given in advance.” But isn't Sandel's position—despite its superiority to Rawls'—simply too cognitive? Sacks' observations on Korsakov patients force one to engage the issue at pre- and sub-cognitive levels. Dr. P. is directed and unified by music and a musical tradition. Just as Kant would still have taken his philosophic walks even if he had contracted Korsakov's, so P. continues as P. by, so to speak, “waltzing through life.” The Lost Mariner episode reminds us of the vital role of memory in the formation of subjectivity/identity. But here it is not Jimmie's personal memory, but that of a community whose memory is expressed in ritual performance. All the “agents” in the Mass suffered some degree of amnesia—the liturgy restored to everyone involved a “new”/old identity.
In many ways the “Rebecca” chapter
is Sacks' most important, for in it he counters most fully Goldstein's thesis that the "world of the concrete" into which "defectives" are often precipitated is a fallen, dignity-less place. Nineteen-year-old Rebecca certainly dwells in a "concrete" realm "neither complicated, diluted, nor unified by abstraction." With an IQ of 60, severe myopia, cleft palate, congenital abnormalities in her hands, chronic spatial and kineseological inabilities ("a klutz," said one report), she gains little from the "developmental" workshops offered by the institution. Childlike, unable to open a door with a key, she first appeared to Sacks as "a casualty, a broken creature . . . a mere mosaic of higher cortical functions."
Rebecca is like William, Jimmie, and Dr. P. in that while she has (some) memory, she strikes Sacks as pattern-less, incomplete, "decomposed," "a cognitive mishap." She thus lacks that minimal coherence essential to human agency. Yet as he works with her, Sacks begins to see that his clinical descriptors fail to reveal the deep structure of Rebecca's condition. He notices the poetic reach of her phrases, her quiet delight in watching the spring foliage emerge, her fondness for stories. Though she cannot read, she demands of others that they read to her not only stories but poems, some of them quite complicated. (Her grandmother speaks of her "hunger for stories.") Like Jimmie she has a special responsiveness to liturgy. "She loved the lighting of the Sabbath candles," reports Sacks, "the benisons and orisons which thread the Jewish day." When her grandmother dies, Rebecca derives much from the rites of "sitting shiva."
These observations convince Sacks that neurology is philosophically impoverished. It requires nothing less than "a romantic science of the concrete." The "simpletons" of the world are often curiously "gifted" in their appropriations and apprehensions. To "heal" them means in part to see with them the actual world they inhabit. It is important to note that Sacks not only means by "concrete" a feeling-rich, immediate, intense realm of particulars. He also means a realm illuminated by symbols—not concepts. Thus, Rebecca is both "idiot" and "symbolist." She grasps the world via material taken from dreams and stories. The proper contrast to the concrete is "the paradigmatic" or "the schematic." The concrete is synonymous with "narrative"; thus, "narratology" is "the neglected and needed science of the concrete."
Further, while the paradigmatic and narrative forms of thought are both natural, Sacks emphatically holds that "the narrative comes first, has spiritual priority." As for the musical patterns that held and "composed" Dr. P., Sacks now sees that these also are narrative in form. Rebecca finds her identity in dance, music, drama, liturgy, image. During the time these narrative forms play themselves out, she has both identity and "capacity." That is, in narrative time the entire category of "defect" disappears. Sacks even suggests that notions of equality and "ethical depth" find their meaning most vividly within the enclosing structure of narrative.
I submit that Sacks here goes far beyond Sandel. For all its intriguing possibilities, Sandel's view of agency is impoverished. That his elegant and penetrating account of community could proceed without a single reference to memory, narrative, liturgy, or drama says much about the demands of the "paradigmatic" at Harvard.
In using Sacks' profound observations on an extreme neurological disorder, I have tried to point to dimensions of identity/community that need to be considered by Sandel. In doing so, I run the risk of making Sacks' work appear completely authoritative. Yet there are things to object to in The Man Who Mistook His Wife for a Hat, and, lovely as it is. Sacks' treatment of Jimmie's experience at the Mass is one. Sacks gives us here something like a portrait painting. In the scene, Jimmie "sits" alone for the portraitist, Sacks himself. Or, to change the metaphor, it is as if Jimmie were performing a "one-man show," a sort of eucharistic mime. Yet we know that besides the priest, there were undoubtedly also sisters, doctors, staff, administrators, and other patients worshipping with Jimmie. Are they not, as it were, the guardians and sustainers of this man's identity? Are they not at least the gathered community which the Mass "holds," directs, and reconstitutes—and, so being, the co-authors and co-readers of Jimmie's story as a lost-and-found sinner? Put even more theologically, was not the Christian story of death-and-life at baptism and eucharist here the ultimate "carrier" of Jimmie's identity?
Sacks rests his case on Jimmie's being "wholly held, absorbed, by a feeling" (my emphasis). In reflecting in contrast on William's "damnation," Sacks says: "It is not memory only which has been so altered in him, but some ultimate capacity for feeling which is gone; and this is the sense in which he is 'de-souled'" (my emphasis). He notes that in chapel William's wise- cracking and "confabulations" continue. Sacks seems here to have become a Schleiermacher to the neurologists, locating human salvation in configurations of feeling. But we want to ask (and this seems all too likely): What if Jimmie really doesn't have such feelings? Is he thereby deprived of both identity and salvation?
Christians who speak of "paschal identity" will wish to point to the liturgy as the place where the drama of word, offertory, Great Thanksgiving, and eucharist is enacted by and for all sinners. They will want to accord Jimmie and William a place in the choir, and they will not require of them that special feelings be felt. They will then point out that whatever else they don't have, these men do have bodies. And so when they eat of Christ's body and drink His blood, they receive all the identity they need, i.e., membership in the mystical body which is the company of all faithful people.
Leslie E. Gerber is Associate Professor of Interdisciplinary Studies and Director of Watauga College at Appalachian State University.