‘The Adventure’: Charles-Ferdinand Ramuz’s Extraordinary Stroke Diary

Stroke is an extraordinary, traumatizing event, as reported by the patients themselves. For that reason, it is of particular interest to examine how artists and writers may have experienced a stroke, which often led to significant changes in their creative production [1]. Unfortunately, there have been only few writers who have written on their stroke. Charles Baudelaire developed aphasia, and could only reply ‘crénom’ (‘damn’) to verbal solicitations, while Valéry Larbaud repeatedly muttered ‘Bonsoir les choses d’ici-bas’ (‘Farewell, material things from this earth’), with no other verbal expression [2, 3]. One of the consequences may be the loss of literary creativity itself, especially when stroke is associated with aphasia.

By many, Charles-Ferdinand Ramuz (1878–1947) is considered the most prominent and famous Swiss novelist (fig. 1). In October 1943, he had a stroke with hemiparesis and language dysfunction, which slowly recovered over a few months. While biographers usually speak of a ‘brain hemorrhage’, it is likely that the stroke corresponded to infarction in the superficial territory of the right middle cerebral artery. We do not know in detail about Ramuz’s risk factors, but he was a smoker (fig. 2). From the beginning, Ramuz was able to write down perceptions, feelings and remarks in his diary, and these pages probably constitute the most extraordinary literary report on suffering a stroke and recovering from it. The luck was that Ramuz, a right-hander, probably had crossed aphasia with left-sided weakness, so that he remained able to write normally with his right hand after language disturbances, which remained only moderate, had recovered.

Ramuz later introduced his own stroke experience in one of the novels he wrote only a few months after his stroke [4], which he initially entitled Brain Shock, before choosing Accident, and where he states: ‘One says, an attack: I was struck with briskness ... I was hit from behind, without having seen anything coming.’ The recurring item throughout the unpublished drafts of that novel is the theme of a deep cut between before and after: ‘There is on one hand the one I was and on the other hand the one I am now.’

Charles-Ferdinand Ramuz was born in Lausanne. He was given the first names of his 2 elder brothers who had died before he was born. After classical studies, he spent some time in Germany and in Paris, where he improved his literary production, focusing mainly on novels, after having also written poetry. After returning to Switzerland in 1914, he met Igor Strawinsky and Ernest Ansermet, with whom he created the famous musical play Histoire du soldat in 1918. Subsequently, his local literary activities, including a series of successful novels, made him become the most famous writer in French-speaking Switzerland. The novels focus on simple stories mainly from the countryside and peasants’ lives, but with a very personal and sophisticated literary style, which made him the sole Swiss writer to enter (only in 2005) the ‘Bibliothèque de la Pléiade’, the Olympus of French literature publishing [5].

These are the words used by Ramuz in his diary to name his stroke, which occurred between October 28 and November 3, 1943 [4]. Ramuz was admitted to hospital for several days, but unfortunately, no chart or clinical report has been retrieved. The first notes were written in bed on pieces of paper, which Ramuz subsequently pasted in his diary, probably without a reliable chronology. The examination of the actual diary shows that the writing was initially coarser, with a few phonemic paragraphias. Ramuz’s first words already emphasized his efforts to recover (‘to try to go back to life; to go ten times along the corridor and come back’), while the stroke itself is not really well detailed [‘impression of imbalance (is it in my legs – or in my head)’]. But Ramuz underlines a feeling of vital loss, which will accompany him for months, along with a loss of creativity: ‘Everything is half dead in front of me, and I am only half alive.’ Ramuz’s description of the ‘adventure’ is very subtle: ‘The adventure is sweetness ... this is a caress but the result of the caress is the suppression of yourself or of a part of yourself. Something like the soft flight of a bat upon you, and then nothing will ever be the same.’ He also reports an inner feeling of distortion: ‘It seems to me that there is a transverse line from the right eye to the left hip, like these cards figures, and everything which is on one side of that line is more or less under influence, contrary to what is on the other side or above [.] One digests obliquely.’ And this distortion leads to an inner dissociation: ‘There is one part of me which is clashing against another one ... [I am] excluded from myself.’ This statement is reminiscent of what Ramuz wrote in Histoire du soldat 30 years before: ‘You have no right to share what you are and what you were.’ His immediate attempt to observe and analyze the effects of stroke is fascinating: ‘I could have the opportunity to observe from the inside and to experience better certain phenomena, which doctors can study only from outside.’ This ability to observe, analyze, and report in nearly any circumstance is typical of Ramuz, who immediately realized his fascinating, though critical, situation due to the stroke.

This is how Ramuz described the acute stroke phase. He did not have many memories of the events which occurred during the acute phase, which he remembered as a ‘darkening, out of which one finally gets out, but only to see that there is nothing in common between what one is and what one was’. This feeling made him think of ‘the passage of [a] razor blade’. While Ramuz emphasized rather the emotional-cognitive changes than motor dysfunction, he immediately reported that ‘the only external sign is this left hand; I cannot move the fingers separately. I cannot join the index finger with the thumb. I cannot bend the fingers against the palm of the hand. Arm atrophy ... I can well hold an object, but I am forgetting what I am holding, so that it falls down, since the hand has no consciousness to hold it ... I am aware to hold it, but there is no constant and spontaneous transmission from the center to the extremities.’

Ramuz developed left hemiparesis with brachial predominance. Three months after stroke, some degree of left hand motor dysfunction was still present. Ramuz reported that he was told that the left hand was moving as well as the right one, but he still felt quite disabled: ‘I am thinking of that keyboard, where the keys just need to be so softly touched to say what they have to say; – what is true for fingers is true for everything. Pianissimos need all your strength.’ Ramuz underscored his difficulties with the left hand, but did not mention facial weakness, while he mentioned gait problems only later. He never mentioned dysmetria or sensory or visual field dysfunction.

Witnesses and photographs show that Ramuz wrote with the right hand, and nothing suggests that he originally was a left-hander. Since he very clearly reported language dysfunction associated with left hemiparesis, it is likely that Ramuz had crossed aphasia. On the other hand, no usual right hemisphere syndrome was present (no anosognosia, hemineglect, or disorientation), suggesting that hemisphere lateralization of cognitive functions was largely inverted in his case. An advantage is that crossed aphasia is usually associated with good outcome [6].

Already in his first notes after the stroke, Ramuz reported language problems, mainly anomia: ‘I have much difficulty in retrieving my words, even the most common ones.’ His initial writing showed a coarser pattern with isolated phonemic paragraphias. He spent a night trying to ‘reconstitute’ poems by Rimbaud, Mallarmé and Verlaine, but the text seemed ‘abominably mediocre’, with changed meanings. He also reported reading difficulties, which suggested alexia: ‘I noticed that I had problems reading and I first thought that my vision was weakened. I now see that this was not the problem, but something upon which it depends.’ He also reported: ‘some difficulty to read and assemble the letters, and then after assembling them, to go to the next line and put both lines together: and when this is a book, to know if what I am reading goes before or after what I have read: I mean, to organize the parts of a whole which I cannot capture, because the parts tend to exist only for themselves ... a lot of words are missing.’ Six months later, Ramuz still complained: ‘I am eating my words; this is also happening while writing.’ However, we have no document suggesting that he had coexisting agraphia. One month later, he noted: ‘My love, oh! When can I start again? The words are pressing themselves from all sides against the walls of my skull, looking for a way that they cannot find.’ In his novel Accident, which he started to write around that time, Ramuz mentioned the language disorder of the old Anselme, who ‘was moving a thick tongue filling his mouth like with some sort of a cream, which precluded him to speak ..., with sentences which he did not finish and with poorly pronounced words which did not follow each other.’

It is possible that certain difficulties with numbers, as well as other cognitive dysfunctions were initially present: ‘some trouble reading time on my watch, the first days.’ Ramuz also noticed that he could not adjust his tie, although his hand mobility was sufficient to allow it.

But what seems to have been especially prominent in the first weeks is a form of inner confusion, with difficulty in organizing his thoughts: ‘I do not remember my novels characters [,] they have become strangers [;] my intentions have gone away, and what determines a style, the choice of words ... I do not know anymore at which point I stand, but to leave things as they are, their disorder, this is still a witness of the problem.’ Six months later, this problem was still present: ‘... loss of memory? I am losing myself into details. I do not know anymore what is to be written and what has already been written’ (June 1944). In November 1944, over 12 months after the stroke, Ramuz was still complaining: ‘Anything which I can still do is to wander in my room until giddiness, with an empty head. I am witnessing all this in a great chaos ... my ideas have no more center, they are destroying each other. They are coming from where they want, they go where they want; I do not discern even the smallest reason why they arise.’ These difficulties do not suggest memory dysfunction, but mainly an attentional disorder, which is typically associated with poststroke fatigue syndrome [7].

The study of emotional changes after stroke is rather recent [6], so that it is fascinating to observe how well Ramuz reported his own disturbances. Already in his first notes, Ramuz emphasized character changes: ‘One is one thousand times more impressionable and irritable, so that one must soon become quite unbearable for surrounding people.’ But Ramuz also found that there was some new sharpness in his feelings: ‘Your inner reactions are much clearer about thousand questions that one can ask to oneself or that are coming from outside ... what one would keep for oneself can now be expressed with violence and without care about oneself or others. And one gets some kind of enrichment of personality, at the very moment when it should have been damaged. What is difficult is that there is now a terrible exasperation of all inner moves, with such a violence that one cannot always control, and with particular angers ... there are mood changes which correspond to total inversions of previous situations.’ These remarks underline extraordinary observation abilities, but also unusual resources leading to new and ‘enriched’ emotional experiences, built upon the consequences of stroke.

Depression and emotional instability were mentioned early by Ramuz: ‘and extreme depression follows the exaltation state ... your life is divided into two parts while you do not even notice it ... if one gets better this is only a remission.’ On January 1944, the emotional imbalance was still prominent: ‘and then this is an extreme irritability with violent angers about nothing.’ Eight months later, Ramuz still found himself very fragile:‘I am afraid of everything. Much more than before.’ He did not hesitate to use the term ‘ruin’ to describe his state: ‘R̲u̲i̲n̲. I am examining it to see what I can do with it ... Now deprived of any pleasure: the sharp moments of joy which came about anything, and which were always leading to an inner awakening, which itself led to inspiration; nothing, a flower, a colour, on the wall, music, a bird song: well, now, I am insensitive to this: some sort of odd indifference to things and events ... this is the finest part of my senses and of what feeling uses which has been damaged. No more direct contact: as if there was a very thin piece of silk paper between me and what I touch. It is sufficient for not perceiving with freshness.’ In December 1944, over 1 year after stroke, anxiety remains prominent, probably more than depression: ‘I am seeing with anxiety this being who has taken domicile in me, who is not me, who lives inside me, but who nevertheless communicates with the outside only through me, betraying me without cease ... A being who obeys to only one feeling: fear; and even if I resist, it drags me into his own panics ... A being who is like those devils in Holy Books, and whose lair is me ...’

Ramuz’s prestroke personality was not depressive or characterized by doubts as to his literary abilities [D. Maggetti, personal communication]. The poststroke emotional changes are thus even more striking, along with Ramuz’s very critical judgment on his poststroke writings, while literary critics never made any comment on a possible ‘change’ in style or literary quality.

Three months after stroke, Ramuz wrote that he had ‘recovered’, but that he felt deeply different than before the stroke, and he emphasized a sharp cut between who he had been before and who he now was: ‘The adventure lasted two months. But what I am afraid of, now that it seems to have come to an end ... is the impossibility to connect with my recent past, and to link me to myself ... I am not dead, but this is my past which is dead.’ A painful problem, which is not visible by other people, was a loss of literary inspiration: ‘I am waiting for the impulsion. Will it come? I was still in bed when came a big surge for writing, but this is gone ... I am now about like I was. I am well, I have no pain, what frightens me so much is the impossibility that I feel for resuming my work where I left it, and how little it interests me, and how much my thoughts of the time now have become strangers.’ It is likely that mild cognitive and emotional impairment was sufficient to lead to this painful experience, while severer neurological dysfunction had disappeared. Ramuz felt changed and confused, and this compromised his desire to go back to writing: ‘... It is absurd to pretend to give an image of the world when one’s own inner image is so confused. It is absurd to start with novel writing when this is so difficult to put things together. My mind is full of holes, which I am filling with great difficulty ... I do not know what is missing ... something in-between, certain intermediary reflexes, which normally are not conscious. Wait ...’ Although Ramuz restarted to write novels in spring 1944, he was still very unsatisfied with his writing 4 months later: ‘I have lost my memory; and I cannot retrieve my words: this means (definitive?) inability to work. My attempts have been disastrous. Should I try again? Should I nevertheless, desperately, try to take advantage of my own destruction [?]’ But writing remained a necessity for him: ‘Write anything, but write. To force one’s own hand to a mechanical movement. To put line under lines.’ It is interesting that the novels written by Ramuz during that time are very similar to the ones he wrote before, and do not seem to convey a feeling of special difficulty or effort. However, Ramuz remained preoccupied with the image of a brain damage, as shown by a dream he reported 2 years later, in which an elderly man put a gun barrel to his head, and finally shot: Ramuz reported that he could feel very well the bullet ‘progressing through his brain ...’

It must be emphasized that Ramuz’s literary style was not significantly modified after the stroke, as assessed by Ramuz’s experts [D. Maggetti, personal communication]. No language disorder is noticeable, and the contrast between this absence of objective change and Ramuz’s creative difficulties after the stroke is striking. A fascinating aspect is that as other writers or artists [1,2,3], Ramuz ‘used’ his stroke in his own creative work. These ‘devils’ who had taken domicile in him, as he complained, were eventually also the source of new experiences, feelings, and creativity, thanks to what indeed had been an ‘adventure’.

I would like to thank Daniel Maggetti, director of the University of Lausanne Centre de Recherches des Lettres Romandes, for his encouragements, suggestions, and help.