Paul Broks: The Neuropsychology of Pat Martino

Victor L. Schermer BY

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1. Martino Reflects on Martino Unstrung 2. Filming Pat Martino's World
3. The Neuropsychology of Pat Martino 4. Review of Martino Unstrung

Pat Martino / Paul BroksPaul Broks is a prominent British neuropsychologist who is featured in the documentary film, Martino Unstrung, where he conducts a real-life study of guitarist Pat Martino's famed memory loss and recovery.

Broks conceived the movie with director Ian Knox, and they completed the film with the help of a grant from the Wellcome Trust. In the film, Broks uses psychological testing, an updated MRI scan of Martino's brain, and other data, to arrive at tentative conclusions about the guitarist's well-known medical condition and his miraculous comeback as a jazz musician, spanning from the late 1970s into the 1980s. This is the most in-depth study of Martino's memory disorder and its implications yet to be done. In the process, Broks conducted himself with a rare combination of scientific objectivity and human compassion. Here are Broks' reflections soon after the filming was completed.

Chapter Index

  1. Background and Filming
  2. Getting to Know Martino
  3. Martino's Memory Loss
  4. Broks on Broks

Background and Filming

All About Jazz: What is the history of your friendship and association with film director Ian Knox?

Paul Broks: Ian wrote me a letter sometime in 2004. He set out Pat's story, which I didn't know, and invited me to join him on the project. I didn't take much persuading. We became friends along the way. I admire Ian's vision and energy. He can do things I can't and I think it's good to recognize that in an artistic collaboration.

AAJ: How did you and Knox first get the idea for Martino Unstrung?

PB: It was Ian's idea. We talked first about developing a fictional treatment, but it was the availability of funding that tipped us toward documentary. It was my idea to approach the Wellcome Trust for funding. It seemed to me the Pat Martino story was perfect material for their Sciart program—which encourages collaborations between artists and biomedical scientists. So we applied to Wellcome and here we are. They've been hugely supportive.

AAJ: When and under what circumstances did you first meet Martino?

PB: I first met Pat when he played at the Pizza Express jazz club in London in January 2006. Ian and I got together with Pat for a post-show beer and then we all met for lunch in Soho the following day.

AAJ: The film is done compassionately, yet it is almost brutally honest in some ways, for example with an MRI-scan of Pat's brain made explicitly for the film. What led to such frankness, as opposed to what could have been an idealized or softened portrait of Pat?

align=center>Pat Martino / Paul Broks / Ian Knox Paul Broks with Martino's surgeon, Dr. Fred Simeone

PB: Pat was courageous in allowing us to make the film the way we did. We were clear right from the start that we saw the project as a three-way collaboration. Four-way for the times that the brilliant cinematographer Nyika Jansco was working with us. But it required a degree of trust on Pat's part that neither Ian nor I had to invest. We were not interested in doing a hagiography—which would have been an artistic disservice to Pat - nor was there any temptation to sensationalize. Pat's story is sensational enough. He knew the kind of film we wanted to make and if at any stage he'd said he wasn't happy with the way things were going, we would have listened and taken stock. But the question never came up. Pat's approach to the film, I think, was somewhat like his approach to his music. Integrity is the word.

AAJ: What about the MRI?

PB: I saw the MRI scan as part of the continuing story. We really didn't know the extent of the surgery that Pat underwent. The original surgical records and CT brain images no longer exist and, in any case, brain imaging has moved on enormously since 1980. It seemed important—dare I say historically important—to establish definitively the condition of Pat's brain. What exactly was it that he'd recovered from?

This was, in fact, the first MRI scan that Pat had ever had and we ran a state-of-the-art volumetric procedure, measuring brain structure to a high resolution. Pat had undergone a CT (CAT scan) before his surgery, although not to my knowledge post-surgery. CT yields much less detailed images.

AAJ: What can you say in retrospect about Pat's aneurysm?

PB: In Pat's case, aneurysm is not quite the correct terminology, although it's often been referred to as such. An aneurysm is a balloon-like swelling in the wall of an artery. An arteriovenous malformation (AVM), which is what Pat had, is a tumorous (space-occupying) malformation of veins and arteries. Both are congenital (present from birth) and both are liable to hemorrhage, which indeed eventually happened in Pat's case. The neuropsychological significance in Pat's case is that his AVM was large and so quite likely led to some reorganization of brain function from an early age, perhaps with the right hemisphere taking charge of some functions that would ordinarily be controlled by the left. I speculate on this toward the end of the film. An aneurysm, being less bulky, would be less likely to result in reorganization of brain function.


Getting to Know Martino

AAJ: From your close working relationship with Pat on the film, what are your impressions of him as a person and a musician?

PB: I got on well with Pat from the start. I'd taken a serious interest in his music in the year before we first met and had grown to love it. It also helped, I think, that he'd read my book, Into the Silent Land. Ian had sent him a copy. I was nervous about his reaction. It's a disturbing book in some ways, challenging our deepest intuitions about what it means to be a person. I wrote, among other things, about people who, like Pat, have undergone the severest possible challenges to their selfhood. But Pat grasped it straight away. He'd been there. He understood what I was trying to say.

AAJ: What did you get from your off-screen experiences and talks with Pat?

PB: Over the course of the days and weeks we spent together making the film Pat and I had many conversations on matters of psychology and philosophy, and much else besides. He has a sharp mind and is relentlessly inquisitive. I get the sense it's that aspect of his personality that drives him as a musician: plain curiosity. He is constantly in search of creative insight. In another life maybe he would be a neuroscientist or a philosopher, but thankfully for those of us who love music, not in this one.

Pat has remarkable energy and stamina. As a musician he is incredibly disciplined and professional. When he last came over to London to play Ronnie Scott's, I went to see him backstage before the show. He had a chest infection and looked so frail and ill he could have been at death's door. I was seriously concerned for him. And yet he went out and gave one of the finest performances I've seen him give. The guitar seemed to have a life of its own that night.

AAJ: Did you experience Martino's wry sense of humor along the way?

align=center>Pat Martino / Paul Broks / Ian Knox Pat Martino (wife, Ayako Akai, in background)

PB: Yes, that aspect really was contagious. There was a lot of laughter on this journey. Here's just one example. Pat had just played the Iridium in New York City and afterward we were sitting in a bar. There's a keyboard player and people are getting up from the floor to sing their party pieces—mostly old musical theatre stuff. It's a good atmosphere. Then a guy with the most astounding voice starts to sing. It's a deep wobbly voice, getting deeper and wobblier as he goes. It's so weird it could be an acoustic weapon designed to destabilize the rhythms of your internal organs. People start to look at one other in disbelief. I look at Pat. He looks at me. It's a question of who's going to give in first. Then the accompanist stops playing and says to the singer, I think with genuine curiosity, "Are we doing the same song?" At which point Pat and I are simultaneously just helpless with laughter.

AAJ: What further impressions of Martino occurred to you?

PB: Pat is the consummate professional, dedicated to his art, perfectionist, obsessive even, but with a capacity to totally let go and wind down once he's done the business. There is a darker side too, no doubt, the volcanic temperament that the film hints at. The moment, as Pat puts it, in the film, "when the ego steps forth." But I honestly never saw any hint of that, even though at times we must have really tested his patience; long, long days of filming and psychological testing. Invariably, at the end of the day Pat was ready to go out and eat and share a bottle of wine and talk late into the night.

AAJ: Pat's emphasis on living in the moment seemed to help him turn his memory loss into an asset. Do you think he acquired that attitude from Buddhism and other religious studies prior to the memory loss, or that the latter led him to such a philosophy?

PB: I think Pat is an original thinker. By that I don't mean he is a great intellectual or guru. But let's say he has a "turn of mind" which can be truly impressive. Perhaps that's what he expresses in his music. If I can make a sports analogy, elite players are all super fit and super skilful. They are capable of remarkable things in terms of technique, agility and stamina. What separates the great from the merely remarkable is "turn of mind," invention and originality, a certain way of anticipating moves and patterns, a unique way of seeing things.

Pat seems to have had a very spiritual outlook well before his illness and surgery. How much of that was shaped by the underlying brain disorder we can never know. I would very much like to look further into Pat's in-the-moment philosophy. And what, incidentally, is more in-the-moment than musical improvisation? The focus on "the now" is something that is very much a genuine part of his experience, it seems to me. I recently gave a talk about Pat at a neuroscience meeting. Professor Richard Gregory, a senior statesman of neuropsychology and a very distinguished neuroscientist, was in the audience. He immediately picked up on the question of Pat's perception of time and that's something I'd like to look at experimentally.


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.


Broks on Broks

AAJ: What were some of your impressions and comparisons of Philadelphia, New York City and London as urban environments as you were making the film?

PB: My work has brought me to New York on a number of occasions over the years and I've always been inspired by the place. I grew up with the New York of the movies, a place firmly established in the geography of my imagination and the reality doesn't disappoint. I hadn't previously been to Philadelphia. I was born and raised in the sprawling industrial conurbation of the West Midlands of England and in some ways, Philadelphia reminded me of our own great industrial cities. There is an earthiness and an edge to the place and, by the same token, an authenticity. I hadn't quite anticipated the atmosphere of the area of South Philly where Pat lives—the row houses and the corner stores and bars. That really did have a northern European feel to it, unexpectedly like the kind of place I was brought up. London? Like New York City, another city of the imagination that doesn't disappoint.

AAJ: How would you compare and contrast your own interests as a neuroscientist with those of Oliver Sacks?

PB: We share similar interests to the extent that we both write about neurological disorder and are drawn to unusual, striking cases. Of course, I followed his lead on that, as he had followed the pioneering Russian neuropsychologist, A. R. Luria. But there are differences in the way Sacks and I write about these things. My writing style veers more to the quasi-fictional; as well as writing about real cases, I sometimes make excursions into speculative fiction. Sacks writes inspiringly about human survival. My vision is darker, though I hope with shafts of illumination and inspiration.

Oliver Sacks is a neurologist and I'm a neuropsychologist by training, so we have taken rather different career paths in terms of clinical work. I've also spent time in basic research posts, including in the pharmaceutical industry. We share similar interests to the extent that we both write about neurological disorder and are drawn to unusual, striking cases.

AAJ: In the film, you become self-admittedly anxious when Martino asked you if you ever saw your own brain scan. What was triggered for you?

PB: First, it just hit me that this was a very unusual situation, like giving a clinical consultation but in front of the camera. I felt conflicted because I would have preferred to discuss Pat's MRI in private, yet here we were by mutual consent making a film and it was important for the film that we captured the moment on camera. And then into this unusual situation Pat flings a perfectly reasonable, but unexpected, question.

One that I would have welcomed in the privacy of the consulting room and perhaps used as an opportunity to talk about different personal reactions to brain imaging, but which now put me under the spotlight. The answer I gave was true. I have never been that much involved with brain imaging for research and have never sought out opportunities to be scanned, in common with most people who do this sort of work. Again, honestly, this is for no particular reason, though scans are still relatively expensive and researchers have budgets to watch so are not inclined to do such things purely for fun. Maybe if Pat agrees to take part in some further brain imaging for us I'll take my turn in the scanner and give him a picture of my brain to hang on his wall.

AAJ: Pat is a very spiritual person. By contrast, you are a neuroscientist and thus are basically materialistic in your work in terms of linking behavior and mentation to causes or correlates in the brain. What, if any, is the place of spirituality in your understanding of the personality and life itself?

align=center>Pat Martino / Ayako Martino / Paul Broks

PB: Spirituality and materialism are not mutually exclusive. I consider myself a spiritual person too—the spiritual intangibles of love, awe, inspiration, beauty, mystery and elevation are as important to me as to anyone else. I'm a materialist—"naturalist" is better—in the sense that I just don't believe in the spooky stuff of supernaturalism.

AAJ: Now that you've made a film, and in addition to your many other accomplishments, what do you see as your career path from here on in?

I still teach and have some involvement in clinical work but my aim now is to devote more time to writing. There's plenty to keep me busy. I'm working on a second book entitled The Laws of Magic, which explores imagination, memory and identity, and I've just been commissioned to write a regular column for the London Times. I also have a new play opening in London later this year, On Emotion, co-written with the brilliant director Mick Gordon. In addition, one hopes there might arise opportunities to develop Pat's story in other ways. Who knows?

Photo Credits

Photos and Stills from Martino Unstrung courtesy of Ian Knox and Sixteen Films

Visit the movie website for Martino Unstrung here and watch the film trailer here.

1. Martino Reflects on Martino Unstrung 2. Filming Pat Martino's World
3. The Neuropsychology of Pat Martino 4. Review of Martino Unstrung

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