All of us have experienced moments in our lives when we couldn’t remember or recollect something from the past. That is normal. Depending on our attentiveness and capacity to form neural connections, memories either stick or don’t stick. But for the most part, we do recollect what we need to and can experience a sense of chronological continuity. In a normal human being, the autobiographical narrative or self or consciousness is more or less intact. We can connect our existence from one moment to another. We can retain enough of the memories generated from the sensory inputs to live life as a continuum, and not as discrete slices. If I am told where sugar is located in the kitchen, I can reach out for it a few hours later. If I have met someone and chatted for some time, I can recollect the person and the chatting, though not the specifics of the chat all the time. In other words, our memories, both episodic and contextual, form the core basis of our self. Without our ability to form memories, we fall into an ontological abyss, a perpetual state of discontinuity and a break in consciousness. Our ability to stitch memories together gives us a sense of time. Without it, time does not exist. Ask a person who has had an alcohol or a general blackout, they will tell you how time can slip through the cracks of consciousness. It is not a question of remembering something, there is just no “remembering” at all; that interval of time simply doesn’t exist, they were not conscious, there are no traces of that experience, that memory, to call it their own. The continuum is missing. All they can say is “I don’t know” — an absolute existential black hole, a state of splintered consciousness.
It is impossible for us, in whom the memory-generating parts of the brain are intact, to imagine a state where the brain loses such an ability. We all live with manageable gaps in recollection, short periods of amnesia here and there; but to lose or take away the very structure and process of memory is unimaginable. Neuroscience has studied many cases of extreme memory losses, but none more extreme than the case of the musicologist and conductor Clive Wearing. Clive was an intellectual colossus in the British western classical music scene of the 1960s and 70s. Handsome, charismatic, brilliant, he worked for the BBC organizing programs on the works of late renaissance composers and chapel choirs. He was a meticulous musician with a prodigious musical sense and aesthetics. In March 1985, Clive fell ill, running a high temperature with splitting headaches. His young wife Deborah, with whom Clive had fallen in love and got married eighteen months ago, called the doctors and solicited their opinion. They dismissed it as flu. Within a week, Clive’s condition deteriorated, and he had to be moved to the hospital. After running a series of tests, they diagnosed the fever to be an extremely rare case of the Herpes encephalitis virus. This virus usually lurks harmlessly in the bloodstream, but in some cases, it starts multiplying and manifests itself as flu. In Clive’s condition, however, this virus had taken its most virulent form. In about one in a million cases, the virus breaches the blood-brain barrier, enters the brain, and destroys critical parts. Clive’s brain scan revealed that the virus had penetrated his brain, and ravaged most parts of his memory-making and holding structures. The doctors, fortunately, were able to halt the spread of the virus and save his life, but they were late in preventing the irrevocable and irreversible damage already done to parts of the brain that dealt with memory. Within a couple of weeks, it was clear that Clive had completely lost his short-term memory and large tracts of the long-term memory. He was fated to live moment to moment, with no past, and no future.
Clive’s case is the worst case of Amnesia ever recorded. Nothing stuck in his brain. Sensory inputs bounced off his brain, leaving no trace whatsoever. His memory was wiped clean every few seconds, and every moment was a new awakening to consciousness for him. He retained no knowledge of any previous moment, or experience, or face, or event. He couldn’t recognize the place he lived in, the people he met, the food he ate, or his own previous actions. Each experience, each fact, was lost in an abyss. Time, in the sense we know and understand it, had stopped for Clive. In her beautifully written and remarkable 2005 memoir “Forever Today, a tale of love and Amnesia” Deborah Wearing, Clive’s wife wrote: “His ability to perceive what he saw and heard was unimpaired. But he did not seem to be able to retain an impression of anything beyond a blink. Indeed, if he did blink, his eyelids parted to reveal an (entirely) new scene”. Clive’s sensory perceptions were intact, but nothing was processed. For processing requires memory, and memory wasn’t available to him. During the initial months and years, Clive would constantly tell people, “You are the first person I have ever met. I am alive just now. I haven’t heard anything, seen anything, touched anything, smelled anything… It’s like being dead”. Clive’s language skills and semantic memory (which is an abstract memory of some event in the past, but not the specifics) improved over time, but he could never recall specifics — which is a must for consciousness and a sense of personal agency. The autobiographical self needs an ongoing sense of past and present, a collection of short and long-term memories, coalescing and re-coalescing together to generate selfhood, an operative agency to function in the world. In its absence, no experience can be truly owned, or willed, or initiated.
Miraculously though, despite the total loss of continuity, and any meaningful residue of memory, there are two things that Clive could do even without the knowledge or explicit memory of doing it. He could recognize Deborah, and his affection for her was overflowing and ecstatic. To those who witnessed Clive’s instant recognition of deborah, It is indeed a mystery, how Clive could connect with Deborah alone, when he had lost all other memories, including those of his children. The answer is hidden, the miracle of the human brain. Memory is not contained within a single part of the brain, it is spread across its intricate structures. Clive’s deep love for Deborah has perhaps made its way, and seared itself into the deeper emotional structures of the brain. Clive’s response to Deborah was visceral, a recognition that perhaps springs from the depths of his organic being, and not from the peripheries of episodic memory or rationality. In Jonathan Miller’s beautiful documentary of Clive made in 1989, the most touching scenes are those where a docile and irritated Clive, suddenly erupts into life on seeing Deborah, runs, and hugs her with such unconditional, irrepressible, and childlike love, as if, her presence has momentarily vindicated his thoughtful-less existence and given it a solid center, which he perpetually lacked. of course, Clive doesn’t remember any of this. Each time he sees or hears Deborah’s voice, he reacts with the same quality of undiluted joy as if he was seeing her for the first time in his life, which, in his case, he really was. In a strange yet marvelous and moving way, Clive’s love for Deborah is never in the past, or of the past, it is always now — fresh, spontaneous, total, and without any pretense. Which wife wouldn’t want to be loved in this manner by their husbands?
The other thing that remained intact in Clive was his musical sensibilities. Clive could play a musical score on the piano to perfection, even managing to improvise along the way. His musical memory was virtually unaffected by amnesia. Though he didn’t remember any score or the composer names, he could sight-read music, play out the melody. In Jonathan Miller’s documentary, one can see Clive conducting his choir in King’s Chapel. If we were unaware that Clive was affected by amnesia, it would be impossible for us to make out from the performance that he had any deficiency at all. Clive’s professional musical personality flowers in full bloom for the duration of the music. Of course, he doesn’t remember anything about the performance afterward, but as long as the music lasted, he was the music. The continuum that Clive tragically lost in his daily life due to amnesia is miraculously restored by music. The musical notes, played one after another, give his being a stream of continuity. It helps to string his life together, giving it a harmonic coherence, a sense of meaning in the present, that somehow transcends, and at the same time, fills the void the loss of memory has left behind.
Clive is seventy years old now, and Deborah is still the anchor of his life. In the intervening twenty-five years, Clive has filled hundreds of journals with brief entries on the time of his awakening, each minute, each hour, scoring out the previous entries because he never remembered writing them or owning them. These diaries are Clive’s means to hold on to his existence. Thousands of entries are there, asking Deborah to come soon -“ at the speed of light” — in Clive’s desperate and loving language. Over the years, his anxiety has lessened a little, and procedural memory has become stronger. He can now do simple things without the need to remember and know. The human brain is superiorly adaptive, and what is lost in one area, is compensated in some other. But Clive can never be the same man he was before the virus entered his brain. He will live out his life moment to moment, forever now and today.
I came across Clive’s case in Dr. Oliver Sack’s wonderful collection of essays titled “Musicophilia”. Since my illness a decade ago, I had firmly come to believe that any disease, deficiency or excess, cannot be separated from the person having it. Modern medicine has become very specialized and functional. We have learned more and more about less and less, and in the process, sometimes miss the forest for the trees. In 2013, almost accidentally, I came across Dr. Sack’s bestselling book “The Man who mistook his wife for a hat”. The essays in the book opened my eyes to a new way of looking at sickness. Since then, I have attempted to study and understand the human brain and the cognitive processes through writers who have made such topics accessible to an educated reader. Most of what we know about the human body is only through a study of diseases, losses, or excesses. The brain is no exception. When we have our memories intact, and go about our daily lives, cribbing and complaining, we don’t realize the tremendous unconscious work that happens each living moment within the human body to even simply keep us alive. In our busy lives filled with this and that, we don’t appreciate what it is like to have memories. When we come across a case like Clive’s, we tend to dismiss it as a sickness and carry on. But such an attitude misses the point. Severe amnesia can teach us about our identities and how we form them. It helps us reflect on those childish and often ill-advised counsel of self-help books and gurus who constantly tells us to “live in the present, and not in the past”. One cannot live in the present if there is no past. Our neurological system needs the sustenance and stimulus of our autobiographical memories to function in the world outside; in its absence, we are left in an existential void.
Nearly five years after reading about Clive in Dr. Sack’s book, last week, I read Deborah Wearing’s moving memoir. The book has been on my shelf for a couple of years now. Deborah writes realistically and with great insight into what it means to live with a man, who cannot remember his wife’s name for more than a few seconds; a man who bombards her with the same agitated questions over and over again twenty-four hours a day; a man who despite his extreme memory deficiency manages to remember her, and only her, and runs to her with all the emotions he has in his possession; a man who has forgotten almost everything about his past, including his marriage; a man who has no hope of ever being the man he was in his prime; and, more importantly, what it means to live empathetically, with a profound understanding of what it means to love someone. Deborah’s life and the love between Clive and her is sacred if the word sacred means that which is pure, unconditional, uncontaminated, and undiminished.
In a haunting sentence, that resonates long after we have closed the book, Deborah writes“ you could lose almost everything you know about yourself, and still be yourself”. The “Cliveness” of Clive was always there, even when he lost his memory. The inner core, that unique essence, of each person, acquired through a lifetime of experiences leaves a deeper mark and makes each one of us a unique individual, a persona that will shine through, in sickness or in health. We are, in essence, our memories, a self pieced together from the residue of sensory, emotional, and intellectual impressions.
God bless…
Yours in mortality,
Bala