12: A Matter of Identity

If you were asked to describe your life in the means of a title, what would it be? How would you put a label to your inner narrative so that someone who did not know you could identify you? After some thought, most could provide an answer, but what if you couldn’t? What if your self-identity had no continuity? Day by day everything in the world, perceptions, feelings, thoughts, and actions were made up entirely on the spot and forgotten within moments. This unfortunate difficulty is what William Thompson suffered from as a symptom of severe Korsakov’s syndrome.

Korsakov’s syndrome is a chronic memory disorder caused by a severe deficiency of thiamine, vitamin B-1. It is most commonly the result of alcohol abuse and can also be linked to AIDS, chronic infection, or poor nutrition. Vitamin B-1 helps the brain produce energy from sugar; therefore, when its levels are low, brain cells are unable to generate enough energy needed to function properly. It is often preceded by Wernicke encephalopathy, a state consisting of severe episodes of confusion, muscle staggering and stumbling, a lack of coordination, and abnormal or involuntary eye movements. Patients affected with Korsakov’s have problems learning new information, inabilities in remembering recent events, and have significant gaps in their long-term memory. Furthermore, patients “confabulate,” that is, they make up any information they cannot remember and they believe it to be true. Korsakov’s symptoms are due to damages in the brain’s mammillary bodies, and possibly portions of the hippocampus and other areas in the frontal cortex.

Dr. Sacks is brought to Mr. Thompson because of his difficulties with remembering and recognizing people in addition to his lack of understanding that lies within his self-identity. Thompson is described as being fixated into a dozen different personas within the matter of minutes. He jumps back and forth between what he believes reality to be and what he makes it up to be, addressing Dr. Sacks as a butcher and a car mechanic. For short instances, he realizes that he is forgetful and prone to confusion, but immediately resorts to more confabulations. Dr. Sacks describes his improvisations to be a mixture of guesses, beliefs, and ultimately imaginative. Remembering nothing for more than a few seconds, aimlessly disoriented, his world was entirely up to his own interpretations and in coherences-so much so that he believed nothing was wrong.

Dr. Sacks discusses his failed attempts to “reconnect” Thompson back to reality using family, social, and non-human techniques, but unfortunately the attempts only made his confabulations more severe. The presence of others excites him in such a way that his mind races to find some sort of reality as opposed to being left alone within the company of nature where he can find solitude and a place in world that is within tangible existence. Sacks also mentions the commonality of this condition, by referring back to his patient described in Chapter 2, Jimmie G, who had similar experiences with Korsakov’s and confabulations.

Additional Sources:

Korsakoff Syndrome. Alzheimer’s Association. 2015. Web.

Sacks, O. (1985). The Man who Mistook his Wife for a Hat and Other Clinical Tales. New York:

Summit Books.