Sacks Appeal – The Mind’s Eye – Part 2

Lilian Kallir, a child prodigy who made her debut on the radio as a pianist at the age of four, was born in Prague on May 6, 1931.   She was therefore sixty-seven going on sixty-eight at the time she wrote a letter to Oliver Sacks in January of 1999 that would become the opening for the first chapter of his book, The Mind’s Eye.  It was eight years earlier, at the age of sixty, that she first sensed something was amiss with her eyes.  Widely renowned for playing Mozart and Beethoven Concertos with most of the major American and European orchestras, Lilian was a favorite at the Mostly Mozart Festival from its inception.

As Oliver tells the story, Lilian was about to perform a Mozart piano concerto when, to her chagrin, she found the musical score completely unintelligible.  The print was perfectly clear but the lines and notes didn’t cohere into anything that made visual sense.  She thought the difficulty might have something to do with her eyes, but proceeded to play the concerto flawlessly from memory, and dismissed the episode as “one of those things”.  But the problems recurred and her ability to read musical scores intensified, the degree of difficulty fluctuating with fatigue.

About three years after Lilian first noticed problems in reading music, she began to have problems reading words.  Having had a brief stint as a pianist at the Settlement Music School in Philadelphia, I’ve always been attracted to the borderland of music by eye and by ear.  Lilian’s alexia sine agraphia rendered her unable to sight read words or music on the printed page, though her ability to write words and play music by ear was preserved.

Her visual problems spread and, as Oliver notes, she began to suspect that her difficulties were centered more in her brain than in her eyes.  She recognized that if individual letters were clear to the bottom line of the eye doctor’s chart, yet she was unable to read, then something deeper must be amiss.  She also began to experience what Sacks describes as a right sided visual inattention and poor facial recognition.  Although an MRI was normal, a PET scan showed diminished metabolic activity in the visual cortex.

By the time Oliver examined Lilian she was unable to recognize individual letters or numbers, though she had no trouble writing complete sentences.  Her alexia had progressed to a more generalized visual agnosia, a difficulty in recognizing anything by its visual characteristics.  She had stopped seeing neurologists because they offered no substantive suggestions, and her resilience enabled her to carry on though performing became progressively more difficult.  MRIs ultimately revealed shrinkage of visual areas on both sides of the brain, principally involving occipital and occipitotemporal cortex.  The diagnostic entity that Sacks settles on for Lilian is PCA – Posterior Cortical Atrophy.

Lillian’s visual abilities continued to deteriorate, though her eyesight remained sharp.  As Oliver notes, if a complex system for the recognition of visual representations must be specifically constructed by the brain, that ability can be lost through damage to the system by injury or disease, as any other acquired ability may be lost.  His last reported visit with Lilian was in 2002, two years before she passed away, and it is particularly poignant.  Read it, and you will never look at the keys on a piano keyboard or at the visual system in the same way again.

Leonard J. Press, O.D., FCOVD, FAAO