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The Last Hippie

Oliver Sacks's An Anthropologist on Mars is an interesting and, at times, extremely useful compilation of professional narratives about human mind. A professional neurologist, Oliver Sacks attempts to look beyond the diagnosis and understand the hidden triggers of neurological diseases and their effects on cognitive functioning. The Last Hippie is no exception: a story of a young male with a brain tumor and neurosurgical experiences, The Last Hippie sheds light on the complexity of human cognitive mechanisms. The Last Hippie tells a story of a young male who underwent a neurosurgery, followed by profound cognitive alterations and severe retrograde and anterograde amnesia. The story of the Last Hippie teaches a tragic lesson of carelessness and negligence and suggests that most cases of brain damage could have been easily prevented. The story discusses and evaluates the tragic experiences of a young man with retrograde and anterograde amnesia caused by the destruction of the memory system in his temporal lobe. Amnesia prevents his brain from learning and retaining new events and experiences.

The Last Hippie: Greg and Oliver Sacks

The Last Hippie is one of the seven paradoxical stories in Oliver Sacks's An Anthropologist on Mars. Written from a professional neurological perspective, The Last Hippie incorporates medical terms and excessive details which, nevertheless, do not make it too complicated. The tragic story of Greg, a young blind hippie with impaired cognitive functioning following a neurosurgery, suggests that human cognition is a complex phenomenon that involves a multitude of processes, reactions, and decisions but can be easily damaged as a result of physiological changes, namely brain tumors. The story of Greg reveals the complexity of the true mechanisms of cognitive functioning in humans, since many aspects of Greg's amnesia question the relevance of conventional neurological diagnoses. In this story, Oliver Sacks tries to go beyond simple neurology and creates a complex picture of human life which, because of these cognitive impairments, is no longer human.

Greg: History and Assessment

The Last Hippie is the story of a young male, Greg F., who suffers profound cognitive alterations and brain damage as a result of a midline tumor. Greg F. was born and grew in the 1950s, in a comfortable household in Queens, with both parents (Sacks, 1995). He used to be a gifted boy, with an ambition for songwriting (Sacks, 1995). With time, Greg started to question the principles and conventions of his life with parents; a teenager in the late sixties, he developed some kind of hatred toward conventional life and wanted to rebel against the cynicism and materialism in his society (Sacks, 1995). His relationships with parents gradually deteriorated; he dropped out of school and left home, in search for spiritual enlightenment (Sacks, 1995). He turned to drugs, which had to inspire him, turn him on, and lead him down his path toward higher consciousness (Sacks, 1995). However, drugs could not create and encode a doctrine of Greg's life; for this reason, he decided to join the International Society for Krishna Consciousness (Sacks, 1995).Greg was fascinated by his new way of life: he would wander around the East Village, "dressed in saffron robes, chanting the Hare Krishna mantras, and early in 1970, he took up residence in the main temple in Brooklyn" (Sacks, 1995, p.34).

In 1971, Greg began to experience serious problems with his health. Gradual loss of sight was the first and, probably, most important neurological symptom (Sacks, 1995). Greg complained that his vision was getting dim, but his swami interpreted it in a different, spiritual way (Sacks, 1995). Gregg's sight was getting dimmer, but he no longer complained; rather, he seemed to be growing more spiritual day by day (Sacks, 1995). He no longer cared about his food or appetites (Sacks, 1995). He was in a state of continuous daze (Sacks, 1995). A strange smile on his face never left him (Sacks, 1995). He stopped going out and was discouraged from any further contacts with the outside world (Sacks, 1995). Unfortunately, it was not until 1975 that Greg's parents were allowed to see their son (Sacks, 1995). By that time, Greg would have become bald and fat; he would have worn a stupid smile on his face, made idiotic comments, with little or no emotions in them (Sacks, 1995). By that time, he would have had no further interest in the surrounding reality (Sacks, 1995). He would have been completely disoriented and totally blind (Sacks, 1995). Upon his admission to the hospital, Greg was transferred to neurosurgery - brain imaging detected an enormous midline tumor that had destroyed his pituitary gland, the adjacent optic chiasm, and had extended on both sides into the frontal lobes (Sacks, 1995).

During the neurosurgery, a midline tumor as large as an orange was removed, but the damage it had caused to Greg's brain was enormous (Sacks, 1995). The tumor did not merely destroy the optic chiasm but severely damaged his medial temporal lobes and the diencephalon region (Sacks, 1995). The brain tumor had altered Greg's cognitive functions - at the time of the neurosurgery he was twenty-five years old but his cognitive life had virtually come to an end (Sacks, 1995). The damage which the brain tumor had caused to his medial temporal lobes manifested through severe memory impairments (Sacks, 1995). Greg suffered the symptoms and neurological consequences of global amnesia, which had the signs of retrograde and anterograde amnesia (Sacks, 1995). In terms of retrograde amnesia, Greg remembered everything that had happened to him before 1970, when his brain tumor just started to grow (Sacks, 1995). The brain tumor had damaged Greg's temporal lobes, leading to profound alterations and impairments in Greg's memory and cognition (Sacks, 1995). Greg could no longer function normally and cope with his social or personal obligations. The young man lost most of his life memories and could not formulate any new ones (Sacks, 1995).

The brain tumor and the damage it had caused to Greg's frontal lobes were responsible for the subsequent changes in his cognition and personality. The absence of appetite and sexual desire was due to the profound changes in his diencephalon's functioning (Sacks, 1995). He would not ask for food and eat, until the food was brought to him (Sacks, 1995). His speech was incoherent and resembled a waking dream: from time to time, Greg produced immediate but weird and unexpected utterances and answers (Sacks, 1995). The brain tumor had damaged Greg's frontal lobes, the pituitary gland, and the diencephalon, which made him entirely indifferent to everything in the outside world (Sacks, 1995). Due to the problems with frontal lobe and diencephalon, Greg could not motivate himself but, once stimulated, he would demonstrate remarkable intelligence and ability to engage in a logical conversation, especially when music was the main topic of discussion (Sacks, 1995). Greg had a passion for music, and The Grateful Dead was his favorite music band; unfortunately, Greg could not know that, at the time of his neurosurgery, his favorite rock stars had already been dead (Sacks, 1995).

That Greg failed to recognize and understand the fact of his own blindness was one of the most remarkable and confusing aspects of his disease (Sacks, 1995). "I found this aspect of Greg's blindness, his singular blindness to his blindness, his no longer knowing what 'seeing' or 'looking' meant, deeply perplexing" (Sacks, 1995, p.34). Greg's denial of his blindness exemplified one of the most confusing and radical deviations from normal identity and cognitive functioning. Sacks (1995) suggests that Greg's localized unawareness of blindness could result from the destruction of the visual cortex; it is due to the destruction of the visual cortex that patients cannot understand that they are blind. In case of Greg, unawareness and confusion were far more serious, since he was not merely unaware of his blindness but lacked awareness of being ill (Sacks, 1995). At some point of his analysis, the author decided to take Greg to a concert of The Grateful Dead (Sacks, 1995). Greg was so enthusiastic at being at the concert that people around him could not tell he was neurologically deficient (Sacks, 1995). Despite the obvious progress, the next day Greg could not remember the fact of being at the concert (Sacks, 1995). With time, he learned the names of the people who attended him frequently and familiarized himself with the hospital environments; unfortunately, the cognitive impairment that occurred as a result of the brain tumor could have been prevented, if not for Greg's negligence toward his health.

Global, Retrograde, and Anterograde Amnesia

Despite the growing body of scholarly literature, the nature of global, retrograde, and anterograde amnesia remains poorly understood. In the meantime, cognitive impairments are popular objects of medical and scholarly analysis: neurosurgery and the rapid development of medical technologies increase the rates of patient survival but do not help to reduce the incidence of neurological and cognitive impairments following a neurosurgery (Svoboda & Richards, 2009). Memory impairments are believed to be the most common results of neuropathological damage: individuals with severe amnesia cannot acquire new information (Svoboda & Richards, 2009). Consequentially, they find it extremely problematic to meet their family and social obligations (Svoboda & Richards, 2009). Greg exemplifies a complex case of severe global amnesia, with the signs and symptoms of retrograde and anterograde amnesia. Retrograde and anterograde amnesia commonly occurs as a result of brain injury and brain tumors (Miller et al, 2001).

How anterograde and retrograde amnesia emerges and develops is a difficult question. However, that retrograde amnesia is a direct result of organic brain damage cannot be denied (Miller et al, 2001). It should be noted, that "retrograde amnesia is usually time-limited with a temporal gradient, such that the patient is better at recalling the more distant past than the more recent" (Miller et al, 2001, p.1038). This is particularly the case of Greg: his life stopped somewhere around 1970, when the tumor in his skull just started to develop. The fact that retrograde amnesia usually extends backward suggests that the hippocampal region is responsible for memory consolidation, whereas the storage of memories usually involves diffuse cortical networks, which have little to do with the hippocampal system itself (Miller et al, 2001). At times, patients with retrograde amnesia demonstrate severe deficiency in semantic knowledge recall but have their procedural knowledge intact (Miller et al, 2001). Sacks (1995) claims that Greg, despite severe retrograde amnesia, had his semantic knowledge preserved.

Changes in cortisol levels represent another aspect of anterograde and retrograde amnesia. The levels of cortisol in healthy individuals increase, when they wake up in the morning. Unlike healthy individuals, amnesic patients demonstrate no cortisol response at the moment of awakening (Wolf et al, 2005). A multitude of factors affects the magnitude of cortisol response in healthy individuals; these include but are not limited to chronic work stress, burnout, post traumatic stress disorder, etc (Wolf et al, 2005). Therefore, the health and cognitive state of patients with global amnesia, including retrograde and anterograde amnesia, can be similar to that in patients with PTSD, stress, and burnout. Whether cortisol can help individuals with severe amnesia to cope with their cognitive difficulties is an open question. The future research must focus on the analysis of the pathophysiological correlates of global amnesia, involving the features of retrograde and anterograde amnesia, in different groups of patients (Bartsch & Deuschl, 2010).

Greg, Amnesia, and Possible Treatment Pathways

The current research suggests that the extent to which individuals demonstrate the signs and symptoms of retrograde amnesia depends on a variety of factors. First, patient age is the matter of primary importance: the older is the patient the more likely he (she) is to demonstrate a temporal gradient in his (her) memories (Kopelman & Kapur, 2001). The presence or absence of a temporal gradient has little to do with the severity of amnesia; however, it is possible that older patients process new experiences in ways that make them more vulnerable to the effects of brain damage (Kopelman & Kapur, 2001). Education, intelligence, and media exposure do play their role in how retrograde amnesia manifests (Kopelman & Kapur, 2001). The relationship between anterograde and retrograde amnesia is particularly problematic, but researchers suggest possible ways to cope with both health conditions.

Greg demonstrated gradual improvements in his cognitive functioning. He learned the names of those who attended him frequently and even learned to type. "Now, whenever I arrive, and he hears my voice, he lights up, and greets me as a fellow Deadhead" (Sacks, 1995, p.52). However, the debate over how to treat amnesia, especially severe global amnesia following a neurosurgery, continues to persist. Newer technologies provide better opportunities for treating retrograde and anterograde amnesia. For example, Svoboda and Richards (2009) used smartphones as an instrument of memory interventions in patients with anterograde amnesia. Smartphones were used as part of the vanishing clues technique, which was profoundly modified (Svoboda & Richards, 2009). The researchers monitored the use of smartphones by patients with anterograde amnesia in daily situations (Svoboda & Richards, 2009). The goal of the study was to evaluate how patients with amnesia would use available technologies to cope with daily memory challenges (Svoboda & Richards, 2009). The study proved technologies to be particularly useful in the process of coping with daily memory challenges and improving social and occupational functioning in patients with anterograde amnesia.

Certainly, the case of Greg is too complicated and smartphones would hardly improve his situation. Exclusive to this case is that Oliver Sacks (1995) goes beyond conventional neurophysiology and shows how the story of Greg's life and cognitive impairments can have profound moral implications for the future generations. Greg's disease was not the result of a tragic incidence and did not occur overnight. Years passed, before Greg's parents finally realized the seriousness of his health and, consequentially, moral and cognitive condition. Greg started to notice eyesight problems early in the 1970s. However, his swami would interpret poor eyesight as the sign of Greg's increased spirituality and commitment to the ideas of enlightenment (Sacks, 1995). Sacks (1995) sends a simple message: most, if not all, health complications can be easily prevented. Negligence and inattentiveness may cause profound negative consequences on individuals' lives and wellbeing. Greg might have been unable to prevent the development of a brain tumor, but he had everything needed to preserve his cognitive functions and mental health. The story of the Last Hippie teaches a lesson of carelessness and negligence and suggests that most cases of brain damage could have been easily prevented. It is through the story of The Last Hippie that readers can look deeper into the tragic experiences of a young man suffering from anterograde and retrograde amnesia, caused by the destruction of the memory system in the temporal lobe.

Conclusion

A professional neurologist, Oliver Sacks created his book in an attempt to look beyond complex neurological disorders. The Last Hippie is one of the seven paradoxical stories in his book, An Anthropologist in Mars. Sacks tells a story of a young male who suffers from anterograde and retrograde amnesia following a midline tumor. The brain tumor and the damage it caused to Greg's frontal lobes lead to the subsequent changes in his cognition and personality. The absence of appetite and sexual desire are due to the profound changes in his diencephalon's functioning. That Greg fails to recognize and understand the fact of his own blindness is one of the most remarkable and confusing aspects of his disease. The current research suggests that the extent to which individuals demonstrate the signs and symptoms of retrograde amnesia depends on a variety of factors. Exclusive to this case is that Sacks goes beyond conventional neurophysiology and shows how the story of Greg's life and cognitive impairments can have profound moral implications for the future generations. The future research must focus on the analysis of the pathophysiological correlates of global amnesia, involving the features of retrograde and anterograde amnesia, in different groups of patients.