Bioethics, healthcare policy, and related issues.
You come alert on a subway train in a bleak part of town you’ve never seen before. You don’t know why you’re there or how you got there. Thinking about it some more you realize you can’t recall anything that’s happened to you recently, or in fact anything that has ever happened to you, or what your own name is. You’re carrying a backpack; you open it up and it contains no ID or money, nothing with your name on it. It holds only a few cryptic items, a set of keys you don’t recognize, and a scrap of paper with a name and phone number you also don’t remember. The train stops. You’re at Coney Island, early in the morning, and you don’t know why you’re there, or who you are.
The above scenario is real. It happened to a young man living in New York just a few years ago. He still lives in New York, and he still can’t remember his past. The incident is the subject of a just-released documentary titled Unknown White Male; it’s brilliant, provocative, and deeply, deeply engaging. It’s not just a fascinating story; it instantiates in real life questions of personal identity that philosophers usually treat in fanciful hypothetical scenarios, and illustrates how fragile and process-dependent the notion of “personhood” is. I can’t recommend this film strongly enough.
Total retrograde amnesia of this type is not unknown, but it is extremely rare. (By TV-movie standards, of course, it happens to about1 in 10 people and is triggered by sagging ratings, but the real figure is vanishingly low.) The documentary features a psychologist who explains that retrograde (past-related) amnesia involves loss of ability to access “episodic memory” – memory of things learned or experienced in life – while leaving intact “semantic memory” – language abilities – and “procedural memory” – simple physical tasks performed by rote action without thinking. This explains why the documentary subject can get dressed, leave his apartment, walk on and off the subway, and speak correct English (with his characteristic British accent still intact), but can’t remember his past or do any of the things that require conscious recollection. (By contrast, anterograde amnesia, usually resulting from surgery or a brain injury, involves the inability to form new memories; the subject remains stuck at the point in their past when memory formation stopped, unable to remember or build on anything that happens thereafter. In many ways it is even more debilitating than retrograde amnesia. The fictional film Memento is a gripping exploration of this situation.) The subject of Unknown White Male – for reasons that are totally unknown – suffered both complete retrograde amnesia (the rarest and worst form) and a brief “fugue state” of temporary anterograde amnesia – he “blacked out” for the period between the previous night and the morning he found himself on the subway and remembers nothing of that time, which is the period in which he also lost his prior memories as well. He continues to form new memories starting from the morning on the train, but has never recovered any of his prior memories or any of the lost hours in between.
The film is directed by a real-life friend of the subject, who heard about his problem and became involved about 8 months afterward. The first part of the film retells the incident and its immediate aftermath; the latter part is shot in real time and illustrates the subject’s attempt to rebuild his life and reconnect with relatives and former friends – none of whom he remembers.
After wandering off the train at Coney Island, the subject turned himself over to the police, who at first assumed he was on drugs, then shipped him to the nearby ER. The hospital admitted him with an ID bracelet reading “Unknown White Male”, and transferred him to the psych ward, where he was informed that he would not be permitted to leave until someone came forward to identify him and take responsibility for him. It was here, too, that somebody finally asked him to sign – as opposed to say – his name, and he unthinkingly scrawled off his signature (procedural memory), realizing for the first time that his name was not “John”, as they’d taken to calling him for convenience. Unfortunately, he himself couldn’t read his own signature, so they only knew that his name began with a “D”.
The only other link to his life was the scrap of paper in his backpack with a phone number on it. They called the number and an older woman answered who claimed she had no idea who he was, and though his voice sounded vaguely familiar she couldn’t place him. This becomes the most frightening sequence in the film: the woman’s daughter is put on camera, and blithely explains that her mother has a tendency to get taken in by needy people and she encouraged her strongly not to get involved. She complained at length about the inconvenience of being sucked into this scenario, and explained how she tried to get her mother to drop the whole thing. Somehow, the mother convinced the daughter to call the hospital, and she reluctantly did so but the number was busy each time. She called one last time and got through, and they asked her to speak to the patient – she had refused to drive to the hospital to look at him in person, claiming it would take “3 hours” – when she heard his voice, she instantly remembered him as a guy she had dated a few times before breaking up, and she told the staff his name: Douglas Bruce. To her credit, she then immediately drove to the hospital (amazingly, she made the “3 hour” trip in 30 minutes), took him home with her, and remained closely involved as he tried to put his life back together. Bruce is now close friends with this woman and her mother, but it’s disturbing to recall that she was so uninterested and uncaring at first that she did everything she could to leave him adrift, knowing she was his only possible link to the world.
The film traces his efforts at putting himself back together. There is video footage shot of him in the psych ward the morning of his memory loss, when he is plainly terrified and completely confused. After his name is learned, he returns to his apartment and tries to discover who he is and what his life is like; he has to piece it together from clues in his apartment. He finds out that his life is actually pretty good: when younger he had lived in England for 15 years (acquiring an accent) and traveled widely; back in the States he had been a Wall Street stock broker for a few years and did so well he was able to retire at 30 and afford an absolutely breathtaking loft apartment in Greenwich Village. (For this non-financially-secure New Yorker, it was distinctly unsettling to watch him roam this gigantic open-plan space noncommittally grunting “so, this is my apartment?” – I wanted to go find him and explain that, no, it isn’t his apartment because he had given it to me just the week before he lost his memory.) He then indulged his taste in art by becoming a photo student and planning a career as a photographer. The only problem is he can’t remember the slightest bit of it. On a visit to his parents, he at first couldn’t recognize them in the crowd, then walked up to his father and said “Nice to meet you.” He has no memories of his adoring younger sister, with whom he had been inseparable. He has to review all of history just to know what the world is like – he doesn’t know what countries exist, who won WWII, or that there was aWWII. There are real-time shots of his reunion with his British mates, who have years of memories of him and whom he doesn’t recall – both Bruce and the director ask the question why he should want to meet them since he doesn’t know who they are anyway. As time goes on, he recovers his equilibrium and carries on with his life – finishing his photo degree (after a crash course to recover the first two years’ material, which he couldn’t recall), gradually building old and new friendships, and getting engaged to a lovely woman he met after the memory-loss incident. He still lives in New York, is pursuing his photo career, and is doing well.
All this touches on the relationship between in-the-worldness and personal identity. Obviously, there is a continuity of experiences between the “new” Doug and the “old” Doug – intuitively, it seems obvious that the new Doug is the inheritor of the old Doug’s identity – that he is Doug Bruce, and the same Doug Bruce as was previously in existence. The only problem is that he himself doesn’t know himself to be Doug Bruce. Can he have an identity that he himself does not feel to be his?
The respected philosopher Mary Warnock is interviewed in the film saying that “he is certainly the same man, but possibly not the same person“. This makes sense in a certain way – there is continuity of identity between the old Doug’s body and the new Doug’s body, so there can be no sense that the one individual human being ceased to exist and the new one suddenly came into being. So the two share what philosophers call “object identity” – they are the same physical object. But all the defining features of distinct personal identity are lacking in the new Doug – values, interests, distinct experiences recorded in memory, etc. If the things that make us distinct have been wiped away, so that the only features of personality that remain are those that we share with many other people (language skills, etc.), it may no longer make sense to say we are the same person as before. And as new, distinctly personal features of identity are acquired – new memories, new tastes and values, new relationships – a unique identity emerges that shares very little in common with the old. (Doug with a photography career and a new girlfriend, but no past memories, is a very different person from the Doug whose new career and new relationship are built on a35-year history of other experiences.) This conforms well with traditional philosophical hypotheticals such as the “brain transplant” scenario, in which a person’s brain is transplanted to another body, or their personality is downloaded into a computer, with no loss of memory or personality traits; in these cases it is usually agreed that personal identity remains stable even as object identity changes. So perhaps Warnock is right: personal identity is tied to the cumulative experiences of one’s life, and when that continuous chain is broken, one’s identity changes.
As a kind of thought experiment, however, it would presumably have been possible, if the attempt had been made right away, to convince the new Doug that he was not Doug Bruce but was really somebody else – Bill Clinton, Adolf Hitler, or whoever – and to get him to adopt that role. In this case, though, I suspect we all would be tempted to agree that he really is Doug Bruce if he adopts the persona of Doug Bruce (and is therefore entitled to use Doug Bruce’s apartment and bank account), but we would not be tempted to agree that he really is Bill Clinton even if he were molded into thinking and feeling “as” Bill Clinton. More to the point, we would still believe he was Doug Bruce no matter who else he said he was, and notwithstanding that he does not feel like Doug Bruce or share his definitive traits of personality. In other words, he is Doug Bruce whether he likes it or not, because of his physical body continuity with Doug Bruce. This intuitive result suggests that object identity trumps personality content, even for questions of personal identity – the opposite of traditional philosophical thinking.
One interesting feature of the film is the subtle ways the new Doug’s personality does and does not match the old. He clearly wanted to reconnect with his old life and old acquaintances, but clearly felt distanced from it all as he did so. He claimed he could not remember any of his photography classes, but he was able to recap two years’ worth of work in one summer in order to continue with his program – the program Chair said it was as if he already knew the material but couldn’t articulate it. His old friends report that he seems slightly different – more emotionally open, more optimistic, “nicer” – and has different tastes in music and clothing, and has lost his obsession with sports. (His British pub-mate says at one point that he only knew the memory loss was real when Doug claimed not to know anything about his former favorite soccer team – because nobody would joke about a think like that!) As Doug lives more and more of his life with his newly-building identity (it’s been over two and a half years and counting), he reports feeling less and less connected to his old life, and less and less determined to regain his memories. His family and old friends still want him to recapture their lost shared history and restart their old relationships, while his new girlfriend says she worries that he won’t be interested in her anymore if he does so.
I happened to attend the New York premier of the film, and the director appeared for an impromptu Q&A afterward. He said that memory recovery takes place in 95% of cases such as this, and Doug assumes that he will get his memory back someday, but that he has begun talking about the possibility of not getting it back and may actually feel more comfortable that way. He has begun building his new life, and realizes that getting the old memory back – with its associated values, interests, and connections – would be a huge disruption to the new life he now values. (Imagine waking up one day to discover you have dozens of close friends and relationships you hadn’t previously imagined, and your head was now stuffed with facts you had not known and hadn’t cared about – and that these are all somehow significant to you even though you had not previously been aware of them. Suddenly you’re emotionally obsessed with a British soccer team you had not even been aware of the previous day; your “new” friends outnumber your existing friends several times over and they all expect to be a part of your life; you remember the day your mother died, although you hadn’t been aware of having a mother. Which sets of values would you endorse? Which relationships are “real”?) This possibility of recovery raises fascinating questions that neither our intuitions nor our philosophy give us a good sense for: Which of his competing values – his interest in art or his interest in sports – will dominate? Will his old relationships merely add to his new ones, giving him a sum total of more friends than ever, or will he go back to square one with his girlfriend? If he is now Doug Bruce, who is he if his memories come back and greatly alter the balance of his current life? Is he then “Doug Bruce plus“? Is he then not Doug Bruce (while having all the personality traits of the old Doug that had previously defined “Doug Bruce”)? Is he now not Doug Bruce? How can he change so dramatically in (say) one instant and remain the same person? (Yet that’s essentially the reverse of what happened to him when he lost those memories.)
Other questions touch on the psychological source of personal identity: Why did he continue with his photography studies? (If he no longer remembered the factual material, why did he retain his interest in the subject?) Why did his interests change slightly, and why didn’t they change more? Is there a limit to how malleable his “blank slate” state was? If someone really had tried to convince him he was Adolf Hitler, would he have felt compelled to endorse fascism – or would some underlying values come to the surface causing him to reject it? Much personal identity theory focuses on the significance of contituity of experience. Very well – but if that is central, then the “new” Doug is not, as Mary Warnock argues, the same person as the old Doug. Yet if Doug’s memories return, the “new new Doug” will be the amalgamation of all the old memories of the “old Doug” plus the memories and experiences accumulated by the “new Doug” in the interim, independently of the old memories. That “new new Doug” will retain the memories of both the “old Doug” and the “new Doug” – yet we would presumably not hesitate in concluding that he was then really contiguous with the original Doug Bruce (with all his old memories and values intact) and also contiguous with the “new Doug” (whose memories merge seamlessly, in chronological sequence, with the “new new Doug’s”). But if this is so, then the “old Doug” and the “new Doug” must both be the same person, since they are each identical with the “new new Doug” (and identity is transitive) – thus contradicting Warnock. A final question: who was the “new Doug” in the first hours or days before he recovered any sense of identity at all? Clearly he was a person in the philosophical/moral sense: he was sentient, self-aware, and communicative. But which person was he? He had no distinct personal identity markers tying him to any one known person. Was he a new person entirely? Was he a tabula rasa – a person with no identity?
One rarely gets real-life cases that bring these difficult philosophical hypotheticals out so starkly, and on such significant topics. Personhood and personal identity are central to moral reasoning and to so very many bioethical issues. They are, I am convinced, fast becoming the crux moral issue of our times: most of the major moral controversies that the right wing has used to exert disproportional leverage in the political sphere hinge on making distinctions between things of moral value and things of no value – especially persons. If we want to sort out stem cells, cloning, euthanasia, abortion, “enhancement”, longevity, animal rights, and even such issues as professional responsibility, the provider/patient relationship, and healthcare financing, we have got to cut through the fuzzy rhetoric and deliberate obfuscation and get clear on moral personhood in a way that resonates with the public. This film brings some of those issues to the fore in a gripping and mind-boggling way. Look for it.
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