Korsakoff’s Embodiment: The Inseparability of Experience and Ideas

by Adam Shatsky

 

Maurice Merleau-Ponty was a 20th century existential phenomenologist who changed the way we understand perception. [1]  In Phenomenology of Perception, he makes extensive use of examples of psychological and physiological disorders such as the Schneider case, phantom limbs, and anosgnosia, none of which, he claims, can be explained psychologically or physiologically. [2]  Thus, for Merleau-Ponty, the use of these examples highlight certain inconsistencies for an explanation of a philosophical phenomenon or medical explanation of the disorder.  He claims that these syndromes can be explained through his account of embodied perception.  But what would Merleau-Ponty’s account be regarding a subject with severe retrograde amnesia?  A subject who is unable to generate new memories, has difficulty remembering old ones, and consequently fills in the gaps with ingenious confabulation [3]—a subject who has Korsakoff’s psychosis. [4]  Oliver Sacks, a physician, author, and neurologist, has performed numerous case studies involving intriguing patients with neurological disorders, one of whom has Korsakoff’s.  Sacks refers to him as “Jimmie G.”  Using Merleau-Ponty’s approach in Phenomenology of Perception, I will argue that neither Intellectualism nor Empiricism have a sufficient account for the phenomenon of Korsakoff’s psychosis by appealing to Merleau-Ponty’s account of bodily being-in-the-world, i.e., embodiment.  In addition to Merleau-Ponty’s embodied perception, memory will show that experience and ideas are not ontologically separate but, instead, mutually dependent on one another and are, thus, epistemologically inseparable.  

 

I.  The Lost High Schooler

 

Avoiding a long, drawn out medical explanation, suppose the following situation.  It is the year 2011 and you receive a patient from another hospital with a file reading “helpless, demented, confused, and disoriented.” [5]  You expect this patient to radiate these qualities because dementia and confusion in a patient are unlikely to hide themselves.  However, when you walk in your office, you find a “fine-looking man, with a curly brush of gray hair, a healthy and handsome forty-nine-year-old.  He [is] cheerful, friendly, and warm.” [6]  Suddenly, you become the one who is confused.  How can it be that the file you read refers to this man who is sitting in front of you?  To clear up your perplexity, you begin to question him: “Where are you from?  Where did you go to high school?” and “tell me about your past.” You notice he is giving very detailed responses to all of your questions.  It seems that the transfer file must have been a mistake; it clearly does not describe this particular man.  You, however, further notice something rather interesting.  He answers your questions about his past as if they were in the present.  When asking him of his freshman year, he speaks only within the past tense, but when asking him about his later years in high school, he talks as if he is no older than a junior.  His change in tense from past to present did not represent a “fictitious present tense of recall, but the actual present tense of immediate experience.” [7]  The confusion continues to overwhelm you.  You could not have mistaken the change in tense, and, thus, you ask him how old he is.  He responds, rather hastily, “I’ll be 19 this winter.”  You continue with, “What year is it?”  “It is … ‘90.  Yes, 1990.”  You hand him a mirror.  His reflection shows an older man, one who is “helpless, demented, confused and disoriented.” [8]  You decide to draw his attention to the window to look out at the natural surroundings.  Strangely, by the time he looks back, he has no recollection of the conversation or who you are.  

In order to grasp the full experience of Korsakoff’s, it is important to imagine oneself not merely as an onlooker to the situation, but as the patient himself.  You are answering mundane questions about yourself, such as relating how old you are.  It is clearly 1990, and you are clearly 19.  However, something horrifying happens.  You are handed a mirror to look into, and reflected back at you is a full grown man with gray hair and there are even wrinkles to be found on your face.  This is not a soon to be 19 year old; this is not you.  Your doctor directs your attention to the birds sitting on the tree outside of his office.  You look back and suddenly you find yourself sitting with a man you do not know, and you cannot recollect how you have gotten where you are.  He may even ask you questions such as “how old are you?” and you will simply tell him “19” without hesitation.

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II.  Intellectualism or Empiricism

 

The intuitive analysis of the phenomenon of this syndrome would seem to favor an Empiricist account.  A subject who, as Sacks states, “was a man without roots, or rooted only in the remote past ... had been reduced to a ‘Humean’ being … a gruesome reduction of a man to mere disconnected, incoherent flux and change.” [9]  The syndrome does disconnect a subject from the present, but not, as I will show, in the same way an Empiricist like Hume would claim. [10]  The underlying assumption for an Empiricist is that experience comes first, and, from there, one learns to develop ideas or concepts.  Without the experience of sense data, Empiricism argues, one cannot form the ideas or concepts one typically comes to know.  There are two reasons why this epistemological distinction of experience preceding ideas or concepts is quite controversial.  First, in a cognitively healthy being, there should be a direct relation between experience and ideas.  However, for example, an infant can experience the sensation of redness but never subsequently develop the idea of redness, so there is not necessarily any relationship—much less a direct and necessary relationship—between the experience and the idea of it.  Second, for a subject with Korsakoff’s, it would seem as though they could be this “Humean” being, as Sacks states, however, this is a superficial explanation for an Empiricist because it cannot account for the memory of the subject.  An Empiricist would have to argue that there is a problem with the subject’s senses, or that the dysfunction lies within the perception of sense data after a certain age.  But, a subject with Korsakoff’s experiences the world just as we do; his or her senses are all intact.  Such subjects are still within the world, interacting, experiencing sense data, but there is some cognitive dysfunction, for which Empiricism cannot account.  

 

In sum, Empiricism says that impression X, which can be any sense experience whatsoever, comes first, and from impression X one develops ideas or concepts that then allows one to know something about X.  Korsakoff’s is very difficult to explain if one assumes this epistemological position.  An Empiricist would need a new explanation for the phenomenon of memory being directly related to experience.  It tries to account for this by arguing that the dysfunction lies in the loss of experiencing sense data after a certain age.  However, a subject with Korsakoff’s does not perceive or experience sense data at a particular moment any differently than a subject whose sense data is intact.  Since the account for an Empiricist states that the dysfunction lies in the senses, the explanation is not sufficient.

 

Seeing that an Empiricist account could not explain the dysfunction in the correct manner, I will now turn to a discussion for an Intellectualist account.  An Intellectualist argument for the phenomenon of perception is opposite of the Empiricist’s.  It claims that ideas or concepts are essentially innate.  For an Intellectualist, ideas or concepts precede experience.  This metaphysical distinction, like that of the Empiricist’s, is unclear.  For a cognitively healthy being, an Intellectualist claims that a subject must say that he or she has some idea or concept of, for example, where my coffee cup is, and that idea or concept helps me navigate the experience.  The Intellectualist would say it is not the case that he or she learns where my coffee cup is by means of experience.  To go back to the idea of redness in regards to Intellectualism, I must first posses the idea of redness to know the sense experience that I am having is an example or instance of that particular idea.  As for a subject with Korsakoff’s, the Intellectualist would say that the innate ideas or concepts are scrambled, and, as a result, the subject is unable to reason properly.  However, one objection would be that despite the subject’s amnesia, he or she often reasons properly due to ingenious confabulation.  So, the result of a subject’s scrambled ideas or concepts should be that it is possible for an amnestic subject to not reason properly.  A second objection would be that Intellectualism reinforces mind-body dualism even more with the explanation of Korsakoff’s.  Thus, Intellectualists overlook the reality of past experience playing a role in the ideas or concepts one possesses, which would seem reasonable for a subject with Korsakoff’s.  For an Intellectualist, what is overlooked is the role that experience plays when we interact with the world.  In sum, Intellectualism says that this conceptual schema is innate (exactly opposite of the Empiricist), making Korsakoff’s very difficult to explain due to the fact that it is not a dysfunction that leaves a subject scrambled with his or her ideas.

 

Neither Empiricism nor Intellectualism adequately account for the importance of memory being directly related to experience and the intelligence of the subject.  There is no distinction between us and the world.  The phenomenon needs not to be explained via sense data.  Instead we are in the world, i.e., embodied.  Merleau-Ponty overcomes this issue of the gap between experience and ideas by saying that neither one is primary or exists independent of the other.  Thus, experience and ideas are the wrong distinctions to use when making sense of human existence.  Merleau-Ponty claims that we are already in the world by means of our bodies and, as such, we can never truly separate ideas from experience or experience from ideas.  

 

III.  Constituents of Being-in-the-World

 

Merleau-Ponty’s Phenomenology of Perception is broken into three major sections concentrating on: “(1) the subject who experiences, (2) the object of the experience, and (3) the relationship between the subject and object.” [11]  For (1), the subject of perceptual experience is the body.  For (2), the object of perceptual experience is the world.  And, for (3), the relationship between the subject and the other is consciousness. [12]  Thus, the body’s ability to perceptually experience the world is made possible through a consciousness that is a fundamentally bodily consciousness.  However, this consciousness is between the world that we are in and the body.  There is a bodily consciousness that is the unity between the two—there is no distinction.  This is a unity of the senses that Empiricism and Intellectualism cannot account for because the latter does not typically account for the senses and the former treats the senses as objects in the world.  Embodied perception allows for a new treatment of the senses as our way of experiencing the world.  Perceptual experiences are not objects to be separated form the world, but, again, part of us, and vital to our experience.  

 

Another constituent of embodied perception is habit or habitual action.  Habit is a manifestation of our being-in-the-world. [13]  The ability to form new memories, for Merleau-Ponty, is not always necessary for habitual action.  Instead, bodily consciousness is apt to a familiarity by means of habitual action.  As Merleau-Ponty states, “The body is our general medium for having a world.” [14]  Through habitual action, the body can understand meanings that are in the world and, thus, the subject is able to have access to these meanings.  But, it is not necessary that the subject must be aware of these meanings, due to the fact that the body can have awareness independent of the subject’s awareness.  Thus, Merleau-Ponty’s account for bodily consciousness is not necessarily separate from cognitive intentionality, but cognitive intentionality is not a necessary condition for bodily consciousness.  

 

In sum, there are two elements that I am discussing here: first, the unity of perceptual experience and the body; and, second, the ability to understand meanings through habitual actions.  I will first pursue this latter element, and its relation to Korsakoff’s, because this is the aspect that is most evident in Sacks’ case study.  As Sacks states: 

 

Jimmie began to form “a sense of familiarity;” he slowly learned his way around the home—the whereabouts of the dinning room, his own room, the elevators, the stairs, and in some sense recognized some of the staff, although he confused them, and perhaps had to do so, with people from the past.  He soon became fond of the nursing sister in the Home; he recognized her voice, her footfalls, immediately, but would always say that she had been a fellow pupil at his high school, and was greatly surprised when I addressed her as “Sister.” [15]

 

Regardless of Jimmie’s inability to remember something for more than a minute, his bodily consciousness gained a “sense of familiarity” with the hospital via habit.  Jimmie was able to function accordingly through his daily routines—despite his syndrome.  The paradoxical question that arises is: how was he able to remember, or, at the very least, recognize, the layout of the hospital and the voices of some of the staff while suffering from Korsakoff’s?  Merleau-Ponty’s account for habitual action seems to be congruent with Sacks’ observation of Jimmie’s “sense of familiarity.”  Jimmie’s development of this “sense of familiarity” identifies the controversial aspect of his memory loss, that aspect for which Merleau-Ponty’s analysis of habitual action most persuasively accounts.  The cognitive function of forming new memories is not necessary for acquiring a “sense of familiarity,” since Jimmie was able to “slowly learn his way around the home.” [16]  This “sense of familiarity” is, it seems, only possible because we act within the world; and by acting within the world, we can gain a “sense of familiarity”—even despite Korsakoff’s psychosis.

 

IV.  Radical Reflection’s Localization

 

To conclude that Merleau-Ponty’s account for embodied perception best fits the explanation of Korsakoff’s psychosis, I must return to and further the discussion of the unity of perceptual experience and the body.  

 

The unity of the senses cannot be accounted for by Empiricism or Intellectualism because both are fundamentally flawed in their metaphysical claims of experience preceding ideas or ideas preceding experience.  As a result of their revealed failures, Merleau-Ponty claims that this unity, as is between the senses, can only be accounted for through realizing our essence is as being-in-the-world and experiencing it.  This realization is “radical reflection,” which is provoked when we try to reflect upon prereflective consciousness: “Radical reflection is what takes hold of me as I am in the act of forming and formulating the ideas of subject and object, and brings to light the source of these two ideas …” [17]  We realize, he writes, that “Sensations, ‘sensible qualities’ are then far from being reducible to a certain indescribable state or quale; they present themselves with a motor physiognomy, and are enveloped in a living significance.” [18]  This unity of the senses is what accounts for the subject’s “living significance,” that fact of constantly being-in-the-world and experiencing it.

 

Since the problem with Intellectualism and Empiricism, as George Marshal explains: 

 

… is a problem that arises from the very nature of reflection and its relation to experience.  To overcome the problems involved in this controversy, we must be clear about the fact that there are different kinds of reflection, but more importantly we must become aware of the nature of our own investigation. [19]

 

Due to the fact that Intellectualist reflection, as Merleau-Ponty made evident, only redefines the mind-body dualism problem, since it does not properly account for the function of the senses, his account of radical reflection “is a new kind of reflection that overcomes all the paradoxes of Analytic Reflection (synonymous with intellectualist reflection).” [20]  Thus, now, we may unite our entire experience by means of radical reflection.  The underlying distinctions between the two schools of thought, as Marshall said, are controversial due to the relation between reflection and experience.  Thus, in radical reflection we are inevitably “aware of the nature of our own investigation.” [21]  What I mean by this is that there is no ground for a theory of human existence that starts with one aspect preceding the other.  No such theory could properly result in the correct type of reflection.  

 

With this constituent of Merleau-Ponty’s account for embodied perception, as well as the significance of memory being directly related to sense experience in Korsakoff’s psychosis, there is a proper account for the syndrome which radical reflection localizes.  The Empiricist and Intellectualist accounts investigate the wrong nature of experience to correctly account for Korsakoff’s psychosis.  Their fundamental flaws are the distinctions between us and the world.  This phenomenon needs not be explained with any separability.  Instead, we are in the world experiencing it.  Radical reflection shows the correct physiological and psychological functioning in past sense experience and, thus, localizes the psychosis as being what it really is: a neurological dysfunction that results in the inability to radically reflect on sense experience after a certain age.  The unity of the body and mind, the senses, and a subject’s being-in-the-world shows their mutual dependence on one another, along with their ontological or epistemological inseparability.   

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1. I am indebted to Malachi Sullivan and Matt Sanderson for their inspiration and critical analysis of this work.

2. Maurice Merleau-Ponty, Phenomenology of Perception, trans. Colin Smith (New York: Routledge Classics, 2002).

3. Stanley Robbins, Ramzi Cotran, Vinay Kumar, Pathologic Basis of Disease (Philadelphia: W. B. Saunders Company, 1984), 1421.

4. Korsakoff’s psychosis is a dysfunction in the nervous system principally caused by a thiamine deficiency that is most often caused by alcoholism and malnutrition.  For a thorough medical discussion, c.f., “Nutritional, Environmental, and Metabolic Disorders,” Ibid.

5. For a discussion on the following case, c.f., “The Lost Mariner” in Oliver Sacks, The Man Who Mistook His Wife for a Hat and Other Clinical Tales (New York: Touchstone, 1998), 23-42, 24.

6. Ibid.

7. Ibid.

8. Ibid.

9. Ibid., 30.

10. Despite Sacks’ pun about Jimmie being “reduced to a ‘Humean’ being,” he is only implying that he is a seemingly selfless (or soulless) character, invoking Empiricist ideas in general, and not Hume’s philosophy specifically; thus, I, too, will speak of Empiricism in general, and not pursue just the arguments introduced by Hume.

11. George Marshall, A Guide to Merleau-Ponty’s Phenomenology of Perception (Milwaukee: Marquette University Press, 2008), 94.

12. Ibid.

13. Maurice Merleau-Ponty, Phenomenology of Perception, Op. Cit., 166.

14. Ibid., 169.

15. Oliver Sacks, The Man Who Mistook His Wife for a Hat, Op. Cit., 34.

16. Ibid.

17. Maurice Merleau-Ponty, The Phenomenology of Percetion, Op. Cit., 254.

18. Ibid., 243.

19. Ibid.

20. George Marshall, A Guide to Merleau-Ponty’s Phenomenology of Perception, Op. Cit., 133.

21. Ibid.