The Three Destructions of the Brain: Memory, Understanding, and Will from Augustine to the Neurology Clinic.

In the Suscipe prayer concluding his Spiritual Exercises, St. Ignatius of Loyola (1491-1556) offers God his liberty together with three faculties: memory, understanding, and will. This triad, inherited from St. Augustine of Hippo's De Trinitate, identifies within human cognition an image of the divine Trinity inscribed in the architecture of thought. The imago Dei itself, however, belongs to the human person by nature, not by the exercise of cognitive capacities. This essay argues that clinical neurology has independently corroborated the functional distinctiveness of this tripartite scheme. The selective loss of each faculty produces a qualitatively distinct syndrome: amnesia (paradigmatically the amnestic syndrome, and the predominant initial presentation of Alzheimer's disease); an acquired impairment of abstraction and reasoning; and abulia, apathy, or akinetic mutism. These three syndromes dissociate from one another, supporting the notion that the Augustinian triad identifies real joints in the architecture of the mind. Recent evidence of cognitive motor dissociation and preserved covert cognition in apparently unresponsive patients suggests the Augustinian distinction between "will as the soul's deepest orientation" and "will as motor initiation" may be empirically tractable, with direct bioethical implications for patient care. Coma represents the most complete dissolution of these functions; yet, on the tradition's account, the imago Dei belongs to the person by nature and no neurological injury can extinguish it.