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Paul Broks: The Neuropsychology of Pat Martino

By Published: November 5, 2008
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Martino's Memory Loss

AAJ: Pat told me that his ability to play the guitar was completely lost. What is your professional opinion about this?

PB: The Pat Martino story is a wonderful legend. I didn't believe for a moment that Pat had literally forgotten how to play the guitar. If that had been the case we would have to radically revise our current understanding of the organization of brain function and I'd now be on my way to a Nobel Prize. It seems extremely unlikely that he completely lost the memory of the guitar, if by that we mean a total loss of skills and knowledge.

There are cases of musicians with dense and persisting amnesia—perhaps most famously the British musician Clive Wearing—who nevertheless retain their musical skills, even whilst denying they have any. In neural terms, musical skills—as "procedural" knowledge—are laid down in phylogenetically old structures of the brain, such as the basal ganglia and cerebellum. These regions were not affected in Pat's case. Other cortical areas are involved in the execution of musical skills, notably the motor regions of the frontal lobe, but these too were not directly affected in Pat's case. Clive Wearing has been studied for many years and his wife Deborah published an account of their story a couple of years ago. It is entitled Forever Today [2006]. Most recently Oliver Sacks has written about him in his recent book, Musicophilia [2007].

Pat certainly seems to have experienced a period of significant amnesia post-surgery and it may be that, like Wearing, he had no knowledge of having played the guitar. Certainly by all accounts he had no interest in picking up the instrument and seems to have been quite alienated from it. So, yes, "seemed foreign to him" would be an apt description. His father's well-meaning but emotionally intrusive efforts to encourage him to play were probably counter-productive.

AAJ: What enabled Martino to resume his guitar artistry after his virtually complete lack of recall for this part of his past life?

PB: At this distance in time it's hard to establish exactly when the amnesia began to resolve and when Pat picked up the guitar again, or indeed whether these phases coincided. I put these questions to guitarist John Mulhearn, perhaps our most reliable witness, who spent time with Pat immediately before the surgery and during the weeks and months that followed. John couldn't say for sure what the tempo of recovery was, but I got the sense it was certainly weeks and possibly a number of months before Pat started playing again.

It is even harder to establish the point at which Pat re-established a continuous sense of his old identity. As John describes it, when Pat finally did pick up the guitar again he seemed to rediscover his passion for the instrument and was playing and transcribing music almost maniacally. So I would say it was a resurgence of motivation and a rediscovery of skills rather than a relearning. This makes complete sense neuropsychologically. Musical skills are represented diffusely throughout the brain and include, as I've already mentioned, subcortical areas not directly affected by Pat's AVM and the surgical procedure to remove it.

AAJ: How does amnesia of Martino's type relate to brain structure and function?

PB: That is a most interesting question about the neuropsychological nature of Pat's post-operative amnesia. Why should he have become amnesic? After all, the key episodic and procedural memory structures are unaffected. In particular, our MRI scan shows the hippocampus to be intact left side and right. There are various possibilities we might speculate on, although his surgeon, Dr. Fred Simeone, would be better placed to offer a comment on the medical and surgical aspects here. One possibility is that the surgery had non-specific physiological effects on certain key brain regions involved in recall of episodic/autobiographical memory, which subsided as the brain readjusted physiologically post surgery.

align=center>Pat Martino / Ayako Martino / Paul Broks Pat Martino and wife, Ayako Akai

There is no clear suggestion that Pat's new learning and recall abilities were affected post-operatively, which would tend to suggest that the hippocampus was functional. In any case, severe amnesia, at least of the sort associated with temporal lobe damage, typically requires damage to the hippocampus bilaterally. In Pat's case it was only structures adjacent to the left hippocampus that might have been affected. My hunch—and it's only a hunch—is that there were relatively temporary diaschetic, or knock-on effects in the frontal lobe in areas important for both motivation and autobiographical recall.

AAJ: What was the impact on Pat's memory over the long haul?

PB: It is difficult to disentangle genuine recall of remote memories from new learning acquired since the surgery. As Pat says in the film, he worked hard to re-learn and assimilate names of family members and to reconstruct his autobiography through the accounts that others were giving him. I'm inclined to think that his autobiographical recall comprises a combination of the two, to some extent, though I'm also confident that a good deal of genuine memory from childhood and early adulthood has been re-established.

Again, this is what you'd expect given the pattern of brain damage. Semantic (fact recall) memory is one area where Pat does seem to have some subtle problems, which is in line with damage to the left temporal lobe. There's a neat illustration of the difference between semantic memory and episodic (event recall) memory in the film. Pouring over a photo album, Pat speaks animatedly, and in detail, about being in Boston in 1963 on the day JFK was shot—episodic memory. But then on another occasion when asked to give the date of the assassination he struggles—semantic memory.

AAJ: Neurologically speaking and otherwise, what would explain Martino's ability to re-learn guitar playing, especially since jazz requires not only rote learning, but improvisation, creativity, and a feeling for the music, all of which are usually based on the sorts of experiences which Martino forgot?

PB: For reasons I've already given, Pat wouldn't have lost his amazing dexterity on the guitar. Nor would one expect him necessarily to lose the ability to improvise and imbue feeling. His emotional systems may have been recalibrated to some extent given the loss of adjacent brain tissue, but the basic brain structures of emotion remain in place. There is evidence to suggest that fluent improvisation depends upon dynamic interaction between different regions of the frontal lobes, which were not structurally affected in Pat's case.

It's interesting, however, that when he started playing again he lacked the confidence for a long time even to play familiar jazz standards without the crutch of having the chord sequences written out in front of him. So he quite likely suffered a loss of musical knowledge—semantic memory again—rather than basic skills. This would be consistent with the temporal lobe damage he suffered. So in some ways it's perfectly true to say that he had to learn his craft again, but not all aspects of the craft. What I'm saying in no way diminishes Pat's achievement in returning to the peak of his art. Given the knowledge we now have, Pat's return seems to me all the more heroic. This was an extraordinary recovery, believe me.

AAJ: On the face of it, music seems to be a luxury or pastime rather than an ingredient of the evolutionary imperative of survival-of-the-fittest. Can you tell us something about what you see to be the role of music in brain function and human evolution?

PB: Ethnomusicologists point to the collective functions of music, its use in ritual and ceremony, its contribution to the continuity and stability of cultures. Singing and dancing draw people together, synchronizing emotions, bonding the group in empathy and reflection or in preparation for action. The power of music lies beyond language and intellect. It comes from an emotional need for communication with other human beings.

But I think there is something prior even to that. Music goes deeper; it perfuses the body. It fuels our most primitive mental machineries, the systems of emotion, bodily sensation and action that constitute the core self, the embodied self of the present moment. Without coherence at this level there is no possibility of developing a stable personal identity or social relationships. Perhaps that's one of the basic functions of music: to tune up those engines of self-awareness. I don't believe, as Steven Pinker seems to, that music is mere "auditory cheesecake" with no primary adaptive function.

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