Imagine only living for a couple of seconds at a time.

One moment you feel alive and in the present; you can see and hear and touch and feel. The next moment, however, all that you have just experienced is gone. There is no retention of what you said, heard, or felt, and there isn’t even a remembrance that you were ever alive before.

Such a reality seems impossible to most. No life beyond the span of a few seconds? No retention of the past? No way.

Well, yes way…for Clive Wearing at least. In 1985 while he was in his mid-forties, Clive Wearing was diagnosed with herpes encephalitis and it was determined that the disease had also wiped his memory and his ability to create new memories.

I first read about Clive last week when we dove into the literature of Oliver Sacks – a famous British neurologist, naturalist, and author. In 2007 Sacks wrote an article about Clive titled “The Abyss – Music and Amnesia” for The New Yorker. In Sacks’ typical approach, the article is written as part personal narrative, part exceptionally accessible neuroscience. Sacks writes of Clive’s initial deep confusion with his—“he was acutely, continually, agonizingly, conscious that something bizarre, something awful, was the matter”—and transitions to Clive’s subsequent agony and depression. Indeed, the life of this English musician and conductor had been changed forever.

While Sacks invests in many aspects of Clive’s mental condition and behavior, the author specifically highlights that after the memory damage was incurred, Clive really only had two consistents in his life: that he loved his wife Deborah, and that he could still play and conduct music with the same voracity that he had before his diagnosis. That Clive still loves Deborah with the same enthusiasm that he did when they were newly married in the 80s struck me as romantic and beautiful, and I was most definitely able to reason with Sacks’ suggestion that the emotional intensity of Clive’s love “engraved itself in him—in areas of his brain unaffected by the encephalitis—so deeply that his amnesia, the most devastating case of amnesia ever recorded, [could not] eradicate it.”

However, the reality that Clive could still play an entire piece of music on his piano, and even conduct others as they played music, struck me as unfathomable. Luckily, Sacks went on to explain how such phenomena was possible.

First Sacks refers to H.M., an infamous patient in the realm of psychology and neuroscience who was rendered amnesic after both of his hippocampi and adjacent medial temporal lobe structures were removed in a surgery that was meant to absolve him of “intractable seizures” (Sacks 2007). H.M. developed both severe anterograde amnesia, meaning that he could not form new memories, and moderate retrograde amnesia, meaning that his memory of life up to 11 years before the surgery was largely lost (BigPicture).

Sacks integrated H.M. into his article because even though his memory of past events and his ability to form new events was degraded, he “did not lose any of the skills he had acquired.” To Sacks and oodles of other neuroscientists, the cases of H.M. and Clive demonstrated that two sets of memory could exist: an episodic memory of past places, events, and people, and a separate procedural memory that wasn’t harmed by amnesia.

Though such stark discrepancy perhaps seems unreasonable, the neuroscience behind it adds up. First, Sacks points out that we understand skill memory to be separate in other contexts, such as lifespan development: children begin learning procedures such as walking before they are able to retain and recall episodic memories such as what their first pair of pajamas looked like. To that end, we understand that episodic memory develops on a different trajectory than does procedural memory. While episodic/explicit memory depends on the hippocampi (typically regarded as the home of memory formation) and medial temporal lobes (critical for long term memory formation), procedural/implicit memory relies on more “primitive” parts of the brain such as the basal ganglia (associated with learning and routine behaviors) and the cerebellum (largely a director of muscle coordination). So, in amnesia cases where the hippocampi and medial temporal lobes are not necessarily damaged, it makes sense that the fixed action patterns of procedural memory would still be able to live long and prosper.

That being said, Sacks makes sure to note that procedural memory is still impacted by the loss of episodic memory in that procedural memories need to be ignited by an outside force; Clive would not, for example, think to practice a piece that he knows without first being told to do so.

Yet, nonetheless, when that perfect chord is struck—when Clive is guided to the piano and shown sheets of music and given the space to let his hands carry gracefully over the keyboard in line with a lulling, continuous rhythm—the resounding melodies are memorable indeed.

 

*To watch a short video clip about Clive and his ability to still play music, click here.

*To read about another musician whose musical abilities were retained after being diagnosed with amnesia, click here.

*To read Oliver Sacks’ entire book about music and the brain, click here.

 

References

“Brain Case Study: Patient HM.” (2013, January). BigPicture. Retrieved from https://bigpictureeducation.com/brain-case-study-patient-hm

Lambert, Kelly. (n.d.) “Brain Scene Investigation: Clive Wearing’s Fleeting Memory.” Oxford Presents. Retrieved from http://www.oxfordpresents.com/ms/lambert/brain-scene-investigation-clive-wearings-fleeting-memory/

Sacks, Oliver. (2007, September 24). “The Abyss – Music and Amnesia.” The New Yorker, 100-111.

Vennard, Martin. (2011, November 21). “How can musicians keep playing despite amnesia?” BBC News. Retrieved from http://www.bbc.com/news/magazine-15791973