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Given his intelligence, ingenuity, and humor, it was easy to think this on meeting him for the first time. But repeated conversations rapidly exposed the limits of his knowledge. Yet semantic memory of this sort, even if completely intact, is not of much use in the absence of explicit, episodic memory. Clive is safe enough in the confines of his residence, for instance, but he would be hopelessly lost if he were to go out alone.

The amnesic patient can think about material in the immediate present. He can also think about items in his semantic memory, his general knowledge.

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But thinking for successful everyday adaptation requires not only factual knowledge, but the ability to recall it on the right occasion, to relate it to other occasions, indeed the ability to reminisce. Though amnesic from a stroke, he retains the poetry he has read, the many languages he knows, his encyclopedic memory of facts; but he is nonetheless helpless and disoriented and recovers from this only because the effects of his stroke are transient.

It is similar, in a way, with Clive. His semantic memory, while of little help in organizing his life, does have a crucial social role: it allows him to engage in conversation though it is occasionally more monologue than conversation.

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No rope from Heaven, no autobiographical memory will ever come down in this way to Clive. F rom the start there have been, for Clive, two realities of immense importance. The first of these is Deborah, whose presence and love for him have made life tolerable, at least intermittently, in the twenty or more years since his illness. He asked his younger son what O-level exams he was doing in , more than twenty years after Edmund left school. He would rush to the door when he heard her voice, and embrace her with passionate, desperate fervor.

As Deborah put it:.

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Clive was constantly surrounded by strangers in a strange place, with no knowledge of where he was or what had happened to him. To catch sight of me was always a massive relief—to know that he was not alone, that I still cared, that I loved him, that I was there.

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Clive was terrified all the time. But I was his life, I was his lifeline.


Every time he saw me, he would run to me, fall on me, sobbing, clinging. How, why, when he recognized no one else with any consistency, did Clive recognize Deborah? There are clearly many sorts of memory, and emotional memory is one of the deepest and least understood. The neuroscientist Neal J. A recent paper by Oliver Turnbull, Evangelos Zois, et al. Nonetheless, a strong emotional bond begins to develop. Clive and Deborah were newly married at the time of his encephalitis, and deeply in love for a few years before that.

His passionate relationship with her, a relationship that began before his encephalitis, and one that centers in part on their shared love for music, has engraved itself in him—in areas of his brain unaffected by the encephalitis—so deeply that his amnesia, the most severe amnesia ever recorded, cannot eradicate it.

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Nonetheless, for many years he failed to recognize Deborah if she chanced to walk past, and even now he cannot say what she looks like unless he is actually looking at her. Her appearance, her voice, her scent, the way they behave with each other, and the intensity of their emotions and interactions—all this confirms her identity, and his own.

The other miracle was the discovery Deborah made early on, while Clive was still in the hospital, desperately confused and disoriented: that his musical powers were totally intact. I started to sing one of the lines. He picked up the tenor lines and sang with me. A bar or so in, I suddenly realized what was happening. He could still read music. He was singing. His talk might be a jumble no one could understand but his brain was still capable of music.


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When he got to the end of the line I hugged him and kissed him all over his face. Clive could sit down at the organ and play with both hands on the keyboard, changing stops, and with his feet on the pedals, as if this were easier than riding a bicycle. Suddenly we had a place to be together, where we could create our own world away from the ward. Our friends came in to sing. I left a pile of music by the bed and visitors brought other pieces. In these scenes from only a year or so after his illness, his face often appeared tight with torment and bewilderment. But when he was conducting his old choir, he performed with great sensitivity and grace, mouthing the melodies, turning to different singers and sections of the choir, cuing them, encouraging them, to bring out their special parts.

It is obvious that Clive not only knew the piece intimately—how all the parts contributed to the unfolding of the musical thought—but also retained all the skills of conducting, his professional persona, and his own unique style. Clive cannot retain any memory of passing events or experience and, in addition, has lost most of the memories of events and experiences preceding his encephalitis—how, then, does he retain his remarkable knowledge of music, his ability to sight-read, play the piano and organ, sing, and conduct a choir in the masterly way he did before he became ill?

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This was a desperate attempt at treating his intractable seizures; it was not yet realized that autobiographical memory and the ability to form new memories of events depended on these structures. Yet H. Larry Squire, a neuroscientist who has spent a lifetime exploring mechanisms of memory and amnesia, emphasizes that no two cases of amnesia are the same. If the damage is limited to the medial temporal lobe, then one expects an impairment such as H.

With somewhat more extensive medial temporal lobe damage, one can expect something more severe, as in E. Or perhaps one needs lateral temporal damage as well, or basal forebrain damage. His case is not like H.

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  4. We cannot write about amnesia as if it were a single entity like mumps or measles. This is dramatically clear with Clive, too, for he can shave, shower, look after his grooming, and dress elegantly, with taste and style; he moves confidently and is fond of dancing. He talks abundantly, using a large vocabulary; he can read and write in several languages.

    He is good at calculation. He can make phone calls, and he can find the coffee things and find his way about the home. If he is asked how to do these things, he cannot say, but he does them. Whatever involves a sequence or pattern of action, he does fluently, unhesitatingly. Episodic or explicit memory, we know, develops relatively late in childhood and is dependent on a complex brain system involving the hippocampi and medial temporal-lobe structures, the system that is compromised in severe amnesiacs and all but obliterated in Clive.

    The basis of procedural or implicit memory is less easy to define, but it certainly involves larger and more primitive parts of the brain—subcortical structures like the basal ganglia and cerebellum and their many connections to each other and to the cerebral cortex.

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    The size and variety of these systems guarantee the robustness of procedural memory and the fact that, unlike episodic memory, procedural memory can remain largely intact even in the face of extensive damage to the hippocampi and medial temporal-lobe structures. This is in fundamental contrast to procedural memory, where it is all-important that the remembering be literal, exact, and reproducible.

    Repetition and rehearsal, timing and sequence are of the essence here. Some of these may be present even before birth fetal horses, for example, may gallop in the womb. Much of the early motor development of the child depends on learning and refining such procedures, through play, imitation, trial and error, and incessant rehearsal. All of these start to develop long before the child can call on any explicit or episodic memories. Is the concept of fixed action patterns any more illuminating than that of procedural memories in relation to the enormously complex, creative performances of a professional musician?

    When a soloist such as Heifetz plays with a symphony orchestra accompanying him, by convention the concerto is played purely from memory. Such playing implies that this highly specific motor pattern is stored somewhere and subsequently released at the time the curtain goes up. Without intact explicit memory, Jascha Heifetz would not remember from day to day which piece he had chosen to work on previously, or that he had ever worked on that piece before. In fact, it would not occur to him to have a practice session at all; without close direction from someone else he would be effectively incapable of undertaking the process of learning any new piece, irrespective of his considerable technical skills.

    He needs someone to put the music before him, to get him into action, and to make sure that he learns and practices new pieces. What is the relationship of action patterns and procedural memories, which are associated with relatively primitive portions of the nervous system, to consciousness and sensibility, which depend on the cerebral cortex?