Saturday, February 11, 2012

I don't remember you, but I love you: The story of Clive Wearing

The latest tenant in my dashboard CD player is Musicophilia by Oliver Sacks, the distinguished physician best known for Awakenings. In Musicophilia, Sacks explores the myriad modes of interaction between music and the human brain from a neurologists’s perspective. Topics range from the various components of musical awareness to the infinity of ways in which it can go haywire – musical hallucinations, impaired perception of pitch, harmony, melody, or timbre, and even hypermusicality induced by a lightning strike. However, one of the most intriguing and touching stories in the book concerns the tragic amnesia of musician and musicologist Clive Wearing.

In 1985, after a rare case of viral encephalitis, Clive acquired one of the most severe cases of amnesia ever documented. He lost not only decades of prior memories (retrograde amnesia), but also his ability to form new memories (anterograde amnesia). As a result, he lives entirely in the present, with only about thirty seconds of conscious memory. This transcends mere forgetfulness, impinging on his very sense of continuity from moment to moment. As his wife Deborah wrote:
It was as if every waking moment was the first waking moment. Clive was under the constant impression that he had just emerged from unconsciousness because he had no evidence in his own mind of ever being awake before… “I haven’t heard anything, seen anything, touched anything, smelled anything,” he would say. “It’s like being dead.”

It’s difficult to imagine how utterly terrifying this would be. On some level, Clive seems to be aware that he is an adult with a history, and has even retained some memories of events earlier in his life. Yet, at any given instant he has no conscious memory of having been awake, or even alive, before. At one point, hoping that it would help him to maintain some continuity from moment to moment, his caretakers encouraged him to keep a journal of his thoughts. This only resulted in page after page of entries like the following (taken from Wikipedia):
8:31 AM: Now I am really, completely awake.
9:06 AM: Now I am perfectly, overwhelmingly awake.
9:34 AM: Now I am superlatively, actually awake.

What kind of life can one hope to lead with such an impenetrable fog occluding both past and future? Yet Clive has been able to live with some measure of comfort and happiness. On some deep emotional level, he does remember his wife, and greets her with a shower of hugs and kisses when she comes to visit (or even when she drifts from his awareness for a minute or two and then he realizes, as if for the first time, that she is there). An accomplished pianist, he can still sight-read, improvise, and play many songs from memory with great musicality, even if he is convinced he has never played them before:
In these moments, it is clear that Clive’s amnesia is not complete. Human memory is a multi-dimensional complex of episodic recollections mingled with deeper emotional and procedural memories, and these latter two are still largely intact for him. He has adapted to his condition to some extent, and can hold conversations and enjoy the company of others in his own way. But it must have been an extremely difficult adjustment, not only for Clive, but for Deborah and their family members as well. I truly admire their courage.
In Total Recall, a perennial favorite of teenage boys, the psychic mutant Kuato offers Arnold Schwarzenegger’s character this admonition: “You are what you do! A man is defined by his actions, not his memory.” Clive certainly doesn’t completely remember the man he was before his encephalitis, but when he sees Deborah, or plays the piano, or directs a choir, he is very much alive.

Deborah Wearing’s Forever Today
Oliver Sacks’s Musicophilia

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