Thursday, January 24, 2008

Music upon which hangs his very existence (Books - Musicophilia by Oliver Sacks)

Most people I talk to have not heard of my very favorite books - Cloud Street, Hopeful Monsters, The Goldbug Variations, although everyone who comes here is sick of them by now, but if you're still curious about my faves check out my side bar for a list. So I'm going to skip today's Booking through Thursday prompt and continue instead talking about Musicophilia, Oliver Sacks' latest book. This post along with this one constitute my musings on it.

An entire chapter of the book is devoted not to the subject of music per se, but rather to a particular patient's amnesia, and the temporary relief that music provides him. There is not only one kind of memory, but several, or if you asked the memory scientist Endel Tulving, he would say several hundred! Some of the more common divisions of memory you may have heard of are short-term memory and long-term memory - others divide memory into declarative or explicit memory, which requires consciousness for retrieval, and procedural (implicit) which does not. Explicit memory can be further divided into semantic memory (fact based knowledge, for example the name of the capital of Australia), and episodic memory (memory specific to a place and time). Autobiographical memory is often grouped under the explicit category, but it is arguably a maverick category as one could say our identity stays with us, whether we think consciously about it or not. But how can we retrieve memory without thinking about it? You do it thousands of time each day - you don't have to remember how to eat, how to walk down the stairs, what your name is (most of the time!), what the word 'the' means, where it should come in a sentence, etc.. We could not live or think without our procedural memory.

Multiple kinds of memory means many ways the system can break down. Say the word "amnesia" and a 1950s film might pop into view. The blurry screen clears, a nurse in one of those peculiar hats comes into view. She is looking down at a man in pajamas, who is uttering the words "Where am I? Who are you? I don't know who I am." Amnesia is often selective for memories that occurred before the accident or illness, sparing those that come after, or vice-versa, events up to the accident are remembered but the patient cannot form new memories. Generally there is a blackout period around the time of the accident as well. But sometimes, the victim is not even that lucky. Sacks writes of his patient Clive Wearing, a musicologist and musician, who had everything but his procedural memory completely wiped out by encephalitis while in his forties. He wasn't even lucky enough to be given a span of memory that lasted a few minutes, his lasted seconds.
His ability to perceive what he saw and heard was unimpaired. But he did not seem to be able to retain any impression of anything for more than a blink. Indeed, if he did blink, his eyelids parted to reveal a new scene. The view before the blink was utterly forgotten...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."

One doesn't have direct awareness of one's own amnesia and lacking memory, one makes the most plausible inferences possible to make sense of ones world. Clive is understandably devastated, becomes horribly depressed, is institutionalized for many years but eventually emerges having found some ways of coping moment-to-moment. He develops a constant stream of joking, repetitive chatter - that is an immediate response to whatever is said to him. It consists of puns, rhymes - scripts that are half sense, half nonsense all emerging from somewhere in his procedural memory.
Clive's loquacity, his almost compulsive need to talk and keep conversations going, served to maintain a precarious platform, and when he came to a stop, the abyss was there, waiting to engulf him.

Amazingly, through even the worst of Clive's disorientation, his musical abilities are preserved. He can sing from a score, play the organ:

The momentum of the music carried Clive from bar to bar. Within the structure of the piece, he was held, as if the staves were tramlines and there was only one way to go. He knew exactly where he was because in every phrase there is context implied, by rhythm, key, melody...when the music stopped Clive fell through to the lost place. But for those moment he was playing he seemed normal.

It is as if the autobiographical, episodic, and intellectual framework that is the scaffolding for the rest of us is temporarily supplied for Clive through the music. He still doesn't know who he is, but the context that is the music makes the next moment inevitable, and he can use it as a stepping stone to put one foot forward. It's a remarkable story about a tenuous survival and it alone is worth getting this book for.


verbivore said...

I did not realize that amnesia could be like that. I always assumed you lost a chunk of your memory but not the ability to create new memories at all. How fascinating. And how terrifying that reality must be.

I'm guessing (hoping) not all forms of amnesia are like this?

Ted said...

Verb - Usually there is a chunk of time on both sides of the 'event' that is lost. Beyond that, amnesia can be selective toward the period of time either preceding the 'event' or following it, but often not both. It could futher be for just a particular chunk of time prior to the accident. Or, if it manifests itself as an inability to make new memories, usually the span of memory that is preserved is specific. Clive's was only a few seconds, others have a few minutes. And nearly all of us have amnesia for early childhood (except for a few key events). Neuroscientists posit that that is because those memories were laid down pre-verbally and once we develop language and a "semantic memory" we then access memory this way and therefore memories encoded non-verbally are not erased, but we loose the ability to retrieve them.

verbivore said...

Thank you, I can see I'm going to have to do some more reading on this subject because I really do find it fascinating!