THE CEILING OUTSIDE

A lucid examination of the self in crisis.

For 18 months, Arikha, a philosopher and author of Passions and Tempers: A History of the Humours, attended weekly clinical meetings in the neuropsychiatry unit of the Pitié-Salpêtrière hospital in Paris, observing patients who presented difficult, sometimes bizarre, symptoms to their assembled medical team. Like neurologists Oliver Sacks and Antonio Damasio, Arikha, who calls herself a “science humanist,” reflects on these patients in her investigation of overarching questions about consciousness, identity, affliction, and memory. The many cases include a woman in her 30s who could not recall 10 years of her life; a man whose personality split into two identities; an 82-year-old woman, nearly blind, experiencing visual hallucinations; a 50-something married father of five who felt haunted, hearing things and sensing invisible presences. Some symptoms were somatic: One woman’s hand became “the locus for all her anxiety, fear and frustration.” One man lost all feeling on his left side and then could not form new memories. Prominent among these cases was Arikha’s mother, a poet and memoirist who was sinking inexorably into dementia, her memory “shunting her from place to place, as if she were ice skating blindfolded.” Her mother’s mind takes a central place in this wide-ranging, engaging study that encompasses philosophy, history, medicine, memoir, and science. “This book,” she writes, “is about both the self as it studies itself, and the self as it loses itself”; how each of us makes our felt experiences coherent; how memory affirms our identity; and the ease with which our “planned trajectories” can rupture and plummet us into illness. “Our self in time,” writes the author, “is but a thin gauze wrapped around the shifting elements we are made of.” The book is also about the limits of medical and scientific knowledge to treat patients who defy categorization, to empathize with their experience, and to ameliorate their pain.

A luminous, intellectually dense meditation on mind.