Idiots savant almost invariably belong to the male sex, although Tredgold and Soddy and Holstein have each reported the conditions in the female sex. Two cases have been reported from India.,  Although these individuals are usually described as idiots, they rarely belong to the lowest grade of mental defectives.
A.P., a thirty two year old, right handed, unmarried, Hindu male sought psychiatric consultation. He was accompanied by his parents.
The patient was reported to be forgetful, unable to manage routine affairs or handle money matters. He was shabby, could not keep his personal belongings in their proper place and required constant help.
He was the second of three siblings and was born at full term. His birth weight was 1.8 kg. lie cried about five minutes after delivery. There was no cyanosis, jaundice, convulsions, fever, or ear discharge during neonatal period. He sat up at nine months, spoke monosyllables at eleven months, walked at one and a half years and talked at two years.
At the age of three years, he developed left sided focal convulsions. He had five such attacks at approximately yearly intervals until the age of eight years when they stopped spontaneously. These convulsions lasted for about thirty minutes each time and were not accompanied by unconsciousness. They remained localized to the left side. They occurred either in sleep or early in the morning. A left sided squint was also noticed after the last convulsion. He was not treated with antiepileptic medication.
The patient's scholastic performance was poor and he had failed in the annual examination. Invariably he had to be promoted to a higher class at the end of the academic year. He had appeared for the S.S.C. examination in 1964 at the age of 19 years and had failed. He appeared again in 1976 after intensive coaching and passed the examination at the age of thirty one.
He had been working as a clerk for the last eight months. He was not given independent charge of any important matters at his place of work.
The patient did not socialise in case his behaviour might fall outside the latitude of acceptance and he might be reprimanded for it. He was often nervous when he had to face any novel situation.
He was the only living son of affluent parents. He had an elder married sister aged 39 years.
Examination of the central nervous system showed a left sided divergent concomittant squint. Deep tendon jerks were brisk on the left side. On tandem gait he had a tendency to fall on the right side. He had right sided cerebral dominance. Rest of the general and systemic physical examination was normal.
When the patient was eleven years old it was discovered accidentally that he was good at mathematical calculations. He had performed in public and exhibited this natural talent since then. This ability had gradually declined since the last five years.
At the time of examination the following exceptional abilities could be demonstrated.
(1) Calendar Calculations
He could correctly name the day of the week of given a particular date in the 20th; century. He took about 15 seconds for the correct answer.
He could state accurately those years in which a given date would fall on a particular day e.g., he could name all those years in which the 21st April was on a Sunday.
He could correctly predict future dates e.g., that the 4th Monday in February 1993 would fall on the 22nd of that month.
(2) Feats of Memory
He had phenomenal memory for events in the field of sports, especially cricket. He could correctly recite all sorts of statistics, world records, batting averages, scores etc.
(3) Arithmetical Calculations
He could perform multiplications (3 digits x 3 digits), divisions (and the remainders), calculate correct squares, cubes, and higher powers of two digit numbers. During one such test his answer differed from the answer computed with a calculator. He was informed that his answer was incorrect. He checked his answer again and insisted it was correct, whereupon the calculator was checked and was found to be faulty. All answers were given almost instantaneously and often faster than the calculator.
(4) Magical Numbers
He could arrange numbers in such a way that columns, rows and diagonals added up to the same
ure. He could do this using numbers 1 to 9 or 1 to 25.
In one remarkable feat he requested a volunteer to write a figure consisting of many digits. Immediately he wrote another figure and stated that it was the final answer that he expected to get. He then requested the volunteer to write any three other figures having the same number of digits as the first one. He then himself wrote another three figures. The total oŁ all these seven figures was the number he had written down earlier.
Besides these, exceptional abilities in olfaction, vision, drawing and mechanical dexterity have been also observed in other such cases.
Test Performance Behaviour
When the patient saw that he was competing with a calculator and was being observed, he became restless, took more time to arrive at the correct answer, made more mistakes, and repeatedly requested the observers to maintain silence. His performance was much better if he was alone in a relaxed atmosphere with a sympathetic therapist.
The patient had high baseline manifest anxiety with a high frequency of spontaneous fluctuations of the electrodermal resistance. The frequency of spontaneous fluctuations did not increase when he was asked to perform a task. This was unlike what would be expected to happen in an anxious person with average intelligence, who was performing a similar task.
The EEG showed a low alpha index. Skiagrams of skull were within normal limits. The L Q. was 75 on Kamath's test, 90 on Bhatia's test, and his intelligence was reported as average on Raven's progressive matrices.
Some distortion was seen on the Bender Gestalt Visual Motor Coordination test but it was not suggestive of organic brain damage, The Memory Quotient was 114. The patient's responses were centered around limited topics on the Rorschach test. High `F' score indicated low validity on the MMPI. Testing for dyslexia was negative. A test battery given independently at the Institute of Vocational Guidance and Selection, Bombay, confirmed these findings.
The underlying mental subnormality in such cases has been ascribed to a variety of causes. It may be due to typhoid encephalitis, birth injury, cretinism or due to an autosomal recessive trait when it is also associated with choreoretinitis.
It is suspected that some idiots savant are organic defectives, who might have started life with a good mental capacity, but subsequently sustained a brain injury, at sometime in the course of development. They have then concentrated the remenants of their mental abilities on a special area of interest. The case reported here had low birth weight and focal fits but there was no evidence of gross organic brain damage. In the majority of cases the hypothesis of brain damage seems unlikely as in most instances there is no history of trauma to the brain, or symptoms and signs suggestive of brain injury.
In case of idiots savant who are monozygotic twins it is unlikely that both could have sustained brain injury in exactly the same area.
Scheerer et al postulated impairment in abstract thinking as an etiological explanation for the exceptional abilities. The individual concentrates on those experience which he can grasp and organise at a concrete level and thus attain success and mastery. Initial individual differences in innate intellectual endowment determine whether the individual has any talent and the direction this will take. There is also a suggestion that these patients have an unusual capacity for edetic images. Tredgold and Soddy and Holstein both emphasise that this condition is of emotional origin in which intellectual development has been cut off from the main strain of development and has become obsessionally canalised. An extraordinary capacity for edetic imagery without any impairment of abstract thinking was observed in this case as demonstrated by the patient's performance on Raven's Progressive Matrices.
Page and Hilliard and Kirnan postulated that the strange aberrations may be due to schizophrenia or early infantile autism. Some schizophrenic children may frequently accumulate vast stores of relatively useless knowledge about numbers. dates, locations etc. Such orienting assurances gratify the child by rending comforting pseudostability to his/her uncertain and floating world. The idiot savant is thus a psychotic child, who is displaying this restitutive mechanism. Of the two cases reported from India, one case did have infantile autism. The patient reported here did not show any evidence of infantile autism or schizophrenia.
Thus human organism is motivated to achieve its capabilities through constant practice and use of skilled memory and edetic imagery. This is responsible for the development of special talents. Even if a normal individual were to develop these skills in a specialised way, he or she would probably be able to perform as well as the idiot savant.
The authors thank Dr. C. K. Deshpande, Dean, K.E.M. Hospital and G.S. Medical College for permission to publish this case report.