I Am Now Truly Awake

by Irida Altman

Blink. Open your eyes to a world you have never seen before. And imagine that happening every time you blink. New, original, surprising every single time. A dream come true? No. It is a nightmare that the eminent English musicologist Clive Wearing has been living in for the past twenty-two years. And if you ask him, he would not even be able to tell you what exactly he is experiencing; even if he could, by the end of the reply, he will have probably forgotten the question. As we learn from Oliver Sacks's essay "The Abyss" [1], Wearing was struck by a brain infection which left him with an unprecedented acute case of amnesia. As chances for recovery diminished, Wearing and his wife, Deborah, fought to find a thread for his consciousness to grasp, a thread through time and space which could remain unaffected by amnesia for at least a little longer than the thirty seconds between blinks. That thread was music.

Amazingly, Wearing's improvisation talent at the piano and knowledge of music and conducting remained untouched by his amnesia. While he plays, sings, or conducts, time has its natural flow; Wearing is in sync with the rest of the world. Once the music stops, he falls back into "the abyss"—the world of turmoil in which there is no past, no future, and a nagging feeling that you cannot remember why you cannot remember. At the very beginning of his illness, Wearing was acutely conscious of the fact that he stopped being part of the time continuum the moment the music was gone. This was vividly illustrated by choking, hiccuping fits somewhat similar to small convulsions. They would occur when the continuum was broken, as captured in the videos from the series Life without Memory: the Case of Clive Wearing [6]. How is it that amnesia did not affect the "music dimension"? Sacks discusses Wearing's illness from the perspective of a neurologist. From Sacks's viewpoint, Wearing is good at "procedural" memory, which allows him to do things he does routinely, such as shower, shave, prepare tea, but what surprises is that Wearing's playing goes beyond just a procedure, for "his playing is infused with intelligence and feeling…" [1], very uncharacteristic of someone with such a severe disorder. Is musical intelligence so deeply rooted that a conscious memory of events is not necessary? To answer this question now with any significant degree of accuracy would mean to instantaneously resolve many issues researched for decades, thus we must satisfy ourselves with answering a much simpler question: if music indeed helps Wearing or others with brain disorders, why does it help? Because music evokes emotion. Because emotion drives music. And emotions are hard to kill.

How the brain understands music and how exactly music sparks emotions has been the subject of many debates. Is there a particular region in the brain, perhaps in the left or the right hemisphere, maybe in the temporal or frontal lobe, that is responsible for "understanding" music? It may make one feel better to know that locating their musicality to a particular brain region will not require anatomy classes or any knowledge of Latin, for research implies "that there is no 'music centre' in the brain" [3]. What's more, it is now known that "both the left and right auditory cortices [outer layer of the brain] are involved" in musical processing [3]. A conclusion such as this could be a double-edged sword. On the one hand, it could imply that most types of brain damage are unlikely to completely impair one's ability to appreciate music (for the undamaged parts continue in their role). On the other hand, it could mean that losing even a small amount of brain functionality in either hemisphere would impair all music abilities. The latter, however, is clearly not what happens, at least not in the majority of cases. We may take Wearing as a living counter-example to that theory, along with the many victims of strokes, autistic individuals, and other people whose brains have been damaged.

Autism is "a developmental disorder that affects physical, social, and language skills" [4]. It appears to be the consequence of "abnormalities of the brain (particularly in the cerebellum brain stem, and limbic system) [that] are likely to have occurred during early development" [4]. What happens then, when autistic individuals are exposed to music? In a short email interview with eminent Serbian psychologist, Milena Jerotijevic, we discover that in her thirty-year-long experience in working with autistic children, she finds that "Autistic children decidedly like music… they are very inclined towards high-quality music…[namely] music that has been considered by generations to have high artistic value [for example, classical music]." She goes on to say that it is remarkable "that these children, who are otherwise unable to concentrate on any kind of activity, listen through an entire concert (an hour or a little longer) sitting still." [Author's Note: The questions I asked and the answers I received were in Serbian; I have attempted to make the translation as accurate as possible, yet have it read in the spirit of the English language.] The fact that these children have trouble concentrating otherwise makes them in that sense comparable to Wearing. Unlike Wearing, however, most of these children had no opportunity to receive a musical education, so why are they too mesmerised by music? It would be relatively safe to say that these children remain unable to focus in most situations, not due to intelligence, but due to inner drives, emotions and disturbances, which shatter their focus. If so, then music allows them to forget and somehow suppress these emotional "disturbances," and unites their attention and their emotions—and occupies them. The continuum of music carries this united state of emotion through until the end of the concert. When the magic disperses, they are left again with their own selves, like Wearing, at the mercy of their illness. Therefore, chances seem to be considerable that one possesses the power to process at least some aspect of music despite a brain injury, damage or disorder.

Then why not use music as a way to communicate with those individuals suffering from brain damage—either physical or psychological? The emerging scientific discipline called neuromusicology explores the effects of music on the brain, while "biomedical research in music concentrates on [ways of applying music] to motor therapy, speech, autism, pain management, memory, and attention" [2]. Music as a true therapeutic medium belongs to the future, however. Guided by Wearing's example, we can but hope that music will at some stage provide all people, not just the musically gifted, with the "thread" which could pull them out of their inner pain and back into society.

Due to his retained musical abilities, Wearing is certainly more a part of society than he would have been otherwise. It was such a wonderful discovery for his wife—that there still was a place they could be together, singing, without "the abyss" separating them. "He could still read music. He was singing," Deborah Wearing wrote enthusiastically to Sacks [1]. Amazing as it was then, it still stands as testament that music remained deeply seated in Wearing's ability spectrum, despite his retrograde amnesia, which slowly takes away bit by bit from his memories before the illness. As Sacks explains, while Wearing's episodic memory may be short, having the span of half a minute or so, his procedural memory remains functional. I would then say that through his procedural memory, Wearing still somewhat has access to specific segments of his semantic memory—the long term memory of general knowledge. When given a little outside stimulus, Wearing regains his knowledge of singing, playing the organ, and conducting a choir through the procedure of doing each of these activities. The link between memory and melody can easily be seen in the many mnemonics we have all learned as children, such as the ABCs, or more exotic ones we have encountered at university. My favourite examples are the basic German prepositions that are accompanied by the dative case. My German professor at Worcester Polytechnic Institute taught us to sing them—Aus-ausser-bei-mit-nach-seit-von-zu—to the Blue Danube Waltz by Strauss.

The link between memory and melody can easily be seen in the many mnemonics we have all learned as children, such as the ABCs or more exotic ones we have encountered at university.

Undeniably, Wearing is still capable of executing musical patterns as a result of procedural memory located at some unconscious level, but how does one interpret his capacity for improvisations, sensitive conducting, and apparent creativity? Music creativity may imply music intelligence, which makes one instantly wonder about the nature of a person's intelligence when forced to work under the burden of amnesia. Such a thought verges on the frightening, for one surely cannot reason only on inner intelligence (whatever that may mean), with just thirty seconds of memory retention. It almost presents the unthinkable, a paradox, which after a fleeing consideration makes one ask, but how can Wearing be at all alive? Well, "It's like being dead" [1], he would say especially at the beginning; the striking effect of his own conclusion only deepens the devastating sense of calamity.

Viewing musical intelligence in light of conventional intelligence, reasoning, and common sense, which make abundant use of episodic memory, may prove to be a significant fallacy in itself. Hopefully we can make up for such a statement, by thinking about music in terms of emotions. Many will agree from their own experience that such a notion is not at all farfetched; what's more, it is so closely related that it appears an inevitable factor of any discussion about music. Where to begin? In Wearing's case, perhaps the most obvious place would be his profession—musicology. Having studied music and its history for so long, he must have been bound to it by more than knowledge. Just imagine all those nights you have spent doing something with passion and love; surely, looking back at those time you feel something. The subjective description of the feeling is irrelevant, it is the existence of a feeling that matters. People who have been playing the piano for years sometimes start drumming their fingers on the table when inspired by a tune or memory; and the drumming doesn't necessarily coincide with anything they have ever played before, it's creative, taps into the whim of the moment, the emotion of the moment. But even in non-musical matters, if you give a mathematician a standard problem, he will solve it through procedural memory; in other words, pencil mechanics. If the problem requires a bit of creative thinking, the mathematician will proceed to wrestle with the problem in some small creative way purely on the whim of the moment, driven by the emotion saying, "you love to do this, you take pleasure in this, keep trying, it's fun." While for a super-original solution one may need more "conventional" intelligence, for a solution of minute creativity, one may find the emotion of pleasure in doing the activity to be enough.

Emotional memory then, is it? If so, it would prove to go beyond the reaches of amnesia and provide some constant drive and sense of direction, perhaps not through time, but at least through something we could call an emotional dimension. This could also explain why Wearing unmistakably recognises Deborah, while he may completely forget the identity of some other visitor many times over the course of a couple of minutes. Clive and Deborah absolutely adored each other for quite a while before his illness, so it is clear that his emotional response to Deborah would have been well formed at the time.

Unfortunately, Wearing does not seem to be forming new emotional bonds with people or towards new things. This indicates that episodic memory is crucial not only for intelligent decisions and intellectual growth, but also for building new emotional ties. Wearing's acute amnesia can then be said to have stripped him of all but one thing that makes him human, and that is his feeling for whom and what he loves most, Deborah and music. While such sparse memory and unnaturally intensified love have been the subject of many studies over the years, it is as human beings, not scientists, that we learn from Wearing's example of how strong an emotion can be: so strong that it is worth getting up for in the morning, even in a world where time stands still.

References: [1] Oliver Sacks, "The Abyss," The New Yorker. Sep 24, 2007. Vol. 83, Iss. 28; pg. 100.; [2] Michael Hugo Thaut, Neuromusicology, in AccessScience@McGraw-Hill, DOI 10.1036/1097-8542.YB031585.; [3] N.M.Weinberger, Music Research at the Turn of the Millenium, "MuSICA Research Notes," Vol. VI, Iss. 3, Fall 1999.; [4] "autism." Encyclopedia Brittanica. 2008. Encyclopedia Brittanica Online.; [5] Life without Memory: The Case of Clive Wearing, Part Ib

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I Am Now Truly Awake

by Irida Altman