Musicophilia: Tales of Music and the Brain (23 page)

I decided to widen the testing and asked Clive to tell me the names of all the composers he knew. He said, “Handel, Bach, Beethoven, Berg, Mozart, Lassus.” That was it. Deborah told me that at first, when asked this question, he would omit Lassus, his favorite composer. This seemed appalling for someone who had been not only a musician but an encyclopedic musicologist. Perhaps it reflected the shortness of his attention and recent immediate memory— perhaps he thought that he had in fact given us dozens of names. So I asked him other questions on a variety of topics that he would have been knowledgeable about in his earlier days. Again, there was a paucity of information in his replies and sometimes something close to a blank. I started to feel that I had been beguiled, in a sense, by Clive’s easy, nonchalant, fluent conversation into thinking that he still had a great deal of general information at his disposal, despite the loss of memory for events. Given his intelligence, ingenuity, and humor, it was easy to think this on meeting him for the first time. But repeated conversations rapidly exposed the limits of his knowledge. As Deborah writes in her book, Clive “stuck to subjects he knew something about” and used these islands of knowledge as “stepping stones” in his conversation. Clearly Clive’s general knowledge, or semantic memory, was greatly affected, too— though not as catastrophically as his episodic memory.
4

Yet semantic memory of this sort, even if completely intact, is not of much use in the absence of explicit, episodic memory. Clive is safe enough in the confines of his residence, for instance, but he would be hopelessly lost if he were to go out alone. Lawrence Weiskrantz comments on the need for both sorts of memory in his book
Consciousness Lost and Found:

This uselessness of semantic memory unaccompanied by episodic memory is also brought out by Umberto Eco in his novel
The Mysterious Flame of Queen Loana,
where the narrator, an antiquarian bookseller and polymath, is a man of Eco-like intelligence and erudition. Though amnesic from a stroke, he retains the poetry he has read, the many languages he knows, his encyclopedic memory of facts; but he is nonetheless helpless and disoriented (and recovers from this only because the effects of his stroke are transient).

It is similar, in a way, with Clive. His semantic memory, while of little help in organizing his life, does have a crucial social role; it allows him to engage in conversation (though it is occasionally more monologue than conversation). Thus, Deborah wrote, “he would string all his subjects together in a row, and the other person simply needed to nod or mumble.” By moving rapidly from one thought to another, Clive managed to secure a sort of continuity, to hold the thread of consciousness and attention intact— albeit precariously, for the thoughts were held together, on the whole, by superficial associations. Clive’s verbosity made him a little odd, a little too much at times, but it was highly adaptive— it enabled him to reenter the world of human discourse.

In the 1986 BBC film Deborah quoted Proust’s description of Swann waking in a strange room, not knowing at first where he was, who he was, what he was. He had only “the most rudimentary sense of existence, such as may lurk and flicker in the depths of an animal’s consciousness” until memory came back to him, “like a rope let down from heaven to draw me up out of the abyss of not-being, from which I could never have escaped by myself”— this gave him back his personal consciousness and identity. No rope from heaven, no autobiographical memory will ever come down in this way to Clive.

F
ROM THE START
there have been, for Clive, two realities of immense importance. The first of these is Deborah, whose presence and love for him have made life tolerable, at least intermittently, in the twenty or more years since his illness.

Clive’s amnesia not only destroyed his ability to retain new memories, it deleted almost all of his earlier memories, including those of the years when he met and fell in love with Deborah— he told Deborah, when she questioned him, that he had never heard of John Lennon or John F. Kennedy. Though he always recognized his own children, Deborah told me, “he would be surprised at their height and amazed to hear he is a grandfather. He asked his younger son what O-level exams he was doing in 2005, more than twenty years after Edmund left school.” Yet somehow he always recognized Deborah as his wife when she visited and felt moored by her presence, lost without her. He would rush to the door when he heard her voice, and embrace her with passionate, desperate fervor. Having no idea how long she had been away— since anything not in his immediate field of perception and attention would be lost, forgotten, within seconds— he seemed to feel that she, too, had been lost in the abyss of time, and so her “return” from the abyss seemed nothing short of miraculous.

“Clive was constantly surrounded by strangers in a strange place,” Deborah wrote,

How, why, when he recognized no one else with any consistency, did Clive recognize Deborah? There are clearly many sorts of memory, and emotional memory is one of the deepest and least understood.

Neal J. Cohen has written about the famous experiment of Édouard Claparède, a Swiss physician, in 1911:

For Claparède’s patient, some sort of memory of the pain, an implicit and emotional memory, persisted. It seems certain, likewise, that in the first two years of life, even though one retains no explicit memories (Freud called this infantile amnesia), deep emotional memories or associations are nevertheless being made in the limbic system and other regions of the brain where emotions are represented— and these emotional memories may determine one’s behavior for a lifetime. And a recent paper by Oliver Turnbull et al. has shown that patients with amnesia can form emotional transferences to an analyst, even though they retain no explicit memory of the analyst or their previous meetings. Nevertheless, a strong emotional bond begins to develop. Clive and Deborah were newly married at the time of his encephalitis, and deeply in love for a few years before that. His passionate relationship with Deborah, a relationship that began before his encephalitis, and one that centers in part on their shared love for music, has engraved itself in him— in areas of his brain unaffected by the encephalitis— so deeply that his amnesia, the most severe amnesia ever recorded, cannot eradicate it.

Nonetheless, for many years he failed to recognize Deborah if she chanced to walk past and even now, he cannot say what she looks like unless he is actually looking at her. Her appearance, her voice, her scent, the way they behave with each other, and the intensity of their emotions and interactions— all this confirms her identity, and his own.

The other miracle was the discovery Deborah made early on, while Clive was still in the hospital, desperately confused and disoriented: that his musical powers were totally intact. “I picked up some music,” Deborah wrote,

Miller’s film showed dramatically the virtually perfect preservation of Clive’s musical powers and memory. In these scenes from only a year or so after his illness, his face often appeared tight with torment and bewilderment. But when he was conducting his old choir, he did this with great sensitivity and grace, mouthing the melodies, turning to different singers and sections of the choir, cuing them, encouraging them, to bring out their special parts. It is obvious that Clive not only knew the piece perfectly, how all the parts contributed to the unfolding of the musical thought, but also retained all the special skills of conducting, his professional persona, and his own unique style.

Clive cannot retain any memory of passing events and experience and, in addition, has lost most of the memories of events and experiences
preceding
his encephalitis— how, then, does he retain his remarkable knowledge of music, his ability to sight-read, to play the piano and organ, sing, conduct a choir, in the masterly way he did before he became ill?

H.M., a famous and unfortunate patient described by Scoville and Milner in 1957, was rendered amnesic by the surgical removal of both hippocampi along with adjacent structures of the medial temporal lobes. (This was considered at the time the best treatment for his intractable seizures; it was not yet realized that autobiographic memory and the ability to form new memories of events depended on these structures.) Yet H.M., though he lost many memories of his former life, had not lost any of the skills he had acquired, and indeed he could learn and perfect
new
skills with training and practice, even though he would retain no memory of the practice sessions.

Larry Squire, a neuroscientist who has spent a lifetime exploring mechanisms of memory and amnesia, emphasizes that no two cases of amnesia are the same. He wrote to me,

Yet H.M.’s case made it clear that two very different sorts of memory could exist: a conscious memory of events (episodic memory) and an unconscious memory for procedures— and that such procedural memory is unimpaired in amnesia.

This is dramatically clear with Clive, too, for he can shave, shower, look after his toilet, and dress elegantly, with taste and style; he moves confidently and is fond of dancing. He talks fluently and abundantly, using a large vocabulary; he can read and write in several languages. He is good at calculation. He can make phone calls, and he can find the coffee things and find his way about the home. If he is asked how to do these things, he cannot say, but he does them. Whatever involves a sequence or pattern of action, he does fluently, unhesitatingly.
5

But can Clive’s beautiful playing and singing, his masterly conducting, his powers of improvisation be adequately characterized as “skills” or “procedure”? For his playing is infused with intelligence and feeling, with a sensitive attunement to the musical structure, the composer’s style and mind. Can any artistic or creative performance of this caliber be adequately explained by “procedural memory”? Episodic or explicit memory, we know, develops relatively late in childhood and is dependent on a complex brain system involving the hippocampi and temporal lobe structures, the system that is compromised in severe amnesiacs and all but obliterated in Clive. The basis of procedural or implicit memory is less easy to define, but it certainly involves larger and more primitive parts of the brain— subcortical structures like the basal ganglia and cerebellum and their many connections to each other and to the cerebral cortex. The size and variety of these systems guarantees the robustness of procedural memory and the fact that, unlike episodic memory, procedural memory can remain largely intact even in the face of extensive damage to the hippocampi and cerebral cortex.

Episodic memory depends on the perception of particular and often unique events, and one’s memories of such events, like one’s original perception of them, are not only highly individual (colored by one’s interests, concerns, and values), but prone to be revised or recategorized every time they are recalled. This is in fundamental contrast to procedural memory, where it is all-important that the remembering be literal, exact, and reproducible. Repetition and rehearsal, timing and sequence are of the essence here. Rodolfo Llinás, the neurophysiologist, uses the term “fixed action patterns” (FAPs) for such procedural memories. Some of these may be present even before birth (fetal horses, for example, may gallop in the womb). Much of the early motor development of the child depends on learning and refining such procedures, through play, imitation, trial and error, and incessant rehearsal. All of these start to develop long before the child can call on any explicit or episodic memories.