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(7) Miss J.’s hands were mildly spastic and athetotic, but her sensory capacities — as I now rapidly
determined — were completely intact; she immediately and correctly identified light touch, pain,
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temperature, passive movement of the fingers. There was no impairment of elementary sensation, as such,
but in dramatic contrast, there was the profoundest impairment of perception. She could not recognize or
identify anything whatever — I placed all sorts of objects in her hands, including one of my own hands.
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She could not identify — and she did not explore; there were no active «interrogatory» movements of her
hands — they were, indeed, as inactive, as inert, as useless, as «lumps of dough».
(8) This is very strange, I said to myself. How can one make sense of all this? There is no gross sensory
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«deficit». Her hands would seem to have the potential of being perfectly good hands — and yet they are
not. Can it be that they are functionless — «useless» — because she had never used them? Had being «pro-
tected», «looked after», «babied» since birth prevented her from the normal exploratory use of the hands
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which all infants learn in the first months of life? Had she been carried about, had everything done for her,
in a manner that had prevented her from developing a normal pair of hands? And if this were the case — it
seemed far-fetched, but was the only hypothesis I could think of — could she now, in her sixtieth year,
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acquire what she should have acquired in the first weeks and months of life?
(9) Was there any precedent? Had anything like this ever been described — or tried? I did not know, but
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I immediately thought of a possible parallel — what was described by Leont’ev and Zaporozhets in their
book, «The Rehabilitation of the Hand» (Pergamon Press, 1948). The condition they were describing was
quite different in origin; they described a similar «alienation» of the hands in some two hundred soldiers
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following massive injury and surgery — the injured hands felt «foreign», «lifeless», «useless», «stuck on»,
despite elementary neurological and sensory intactness. Leon’tev and Zaporozhets spoke of how the
«gnostic systems» that allow «gnosis» 1), or perceptive 2) use of the hands, to take place, could be «disso
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ciated» in such cases as a consequence of injury, surgery, and the weeks— or months-long hiatus 3) in the
use of the hands that followed. In Madelaine’s case, although the phenomenon was identical —
«uselessness», «lifelessness», «alienation» — it was lifelong. She did not need just to recover her hands,
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but to discover them — to acquire them, to achieve them — for the first time; not just to regain a
dissociated gnostic system, but to construct a gnostic system she had never had in the first place. Was this
possible?
(10) The injured soldiers described by Leon’tev and Zaporozhets had normal hands before injury. All
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they had to do was to «remember» what had been «forgotten» or «dissociated», or «inactivated» through
severe injury. Madelaine, in contrast, had no repertoire of memory for she had never used her hands — and
she felt she had no hands — or arms either. She had never fed herself, used the toilet by herself, or reached
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out to help herself, always leaving it for others to help her. She had behaved, for sixty years, as if she were
a being without hands.
(11) This then was the challenge that faced us; a patient with perfect elementary sensations in the hands,
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but, apparently, no power to integrate these sensations to the level of perceptions that were related to the
world and to herself; no power to say, «I perceive, I recognize, I will, I act», so far as her «useless» hands
went. But somehow or ot her (as Leon’tev and Zaporozhets found with their patients), we had to get her to
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act and to use her hands actively, and, we hoped, in so doing, to achieve integration: «The integration is in
the action», Roy Campbell wrote.
(12) Miss J. Was agreeable to all this, indeed fascinated, but puzzled and not hopeful. «How can I do
anything with my hands», she asked, «when they are just lumps of putty?»
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(13) «In the beginning is the deed», Goethe wrote. This may be so when we face moral or existential
dilemmas, but not where movement and perception have their origin. Yet here too there is always
something sudden: a first step (or a first word, as when Helen Keller said «water» 4), a first movement,
100 a first perception a first impulse — total, «out of the blue», where there was nothing, or nothing with sense
before. «In the beginning is the impulse». 5) Not a deed, not a reflex, but an «impulse», which is both more
obvious and more mysterious than either…. We could not say to Madelaine «Do it!» but we might hope for
105 an impulse: we might hope, we might solicit, we might even provoke one….
(14) I thought of the infant as it reached for the breast. «Leave Madelaine her food, as if by accident,
110 slightly out of reach on occasion», I suggested to her nurses. «Don’t starve her, don’t tease her, but show
less than your usual alacrity in feeding her». And one day it happened — what had never happened before.
Miss J., impatient, hungry, instead of waiting passively and patiently, reached out an arm, groped, found a
115 bagel, and took it to her mouth. This was the first use other hands, her first manual act, in sixty years, and it
marked her birth as a «motor individual» (Sherrington’s term for the person who emerges through acts). It