http://www.theatlantic.com/health/archive/2012/12/amnesia-and-the-self-that-remains-when-memory-is-lost/266662/
Tom was one of those people we all have in our lives -- someone to
go out to lunch with in a large group, but not someone I ever spent time
with
one-on-one. We had some classes together in college and even worked
in the same cognitive psychology lab for a while. But I didn't really
know him. Even
so, when I heard that he had brain cancer that would kill him in
four months, it stopped me cold.
I was 19 when I first saw him -- in a class taught by a famous
neuropsychologist, Karl Pribram. I'd see Tom at the coffee house, the
library, and around
campus. He seemed perennially enthusiastic, and had an exaggerated
way of moving that made him seem unusually focused. I found it
uncomfortable to make eye
contact with him, not because he seemed threatening, but because his
gaze was so intense.
"Please forgive me for asking this, but I do this with everybody. Could
you tell me your name again and how it is that I know you?"
Once Tom and I were sitting next to each other when Pribram told the
class about a colleague of his who had just died a few days earlier.
Pribram paused to
look out over the classroom and told us that his colleague had been
one of the greatest neuropsychologists of all time. Pribram then lowered
his head and
stared at the floor for such a long time I thought he might have
discovered something there. Without lifting his head, he told us that
his colleague had
been a close friend, and had telephoned a month earlier to say he
had just been diagnosed with a brain tumor growing in his temporal lobe.
The doctors said
that he would gradually lose his memory -- not his ability to form
new memories, but his ability to retrieve old ones ... in short, to
understand who he was.
Tom's hand shot up. To my amazement, he suggested that Pribram was
overstating the connection between temporal-lobe memory and overall
identity.
Temporal lobe or not, you still like the same things, Tom argued --
your sensory systems aren't affected. If you're patient and kind, or a
jerk, he said,
such personality traits aren't governed by the temporal lobes.
Pribram was unruffled. Many of us don't realize the connection
between memory and self, he explained. Who you are is the sum total of
all that you've
experienced. Where you went to school, who your friends were, all
the things you've done or -- just as importantly -- all the things
you've always hoped to
do. Whether you prefer chocolate ice cream or vanilla, action movies
or comedies, is part of the story, but the ability to know those
preferences through
accumulated memory is what defines you as a person. This seemed
right to me. I'm not just someone who likes chocolate ice cream, I'm
someone who knows, who
remembers that I like chocolate ice cream. And I remember my
favorite places to eat it, and the people I've eaten it with.
Thoth,GodofKnowledge/Flickr
Pribram walked up to the lectern and gripped it with both hands.
When they had spoken last, his colleague seemed more sad than
frightened. He was worried
about the loss of self more than the loss of memory. He'd still have
his intelligence, the doctors said, but no memories. "What good is one
without the
other?" his colleague had asked. That was the last time Pribram
spoke to him.
From a friend, Pribram had learned that his colleague had decided to
go to the Caribbean for a vacation with his wife. One day he just
walked out into the
ocean and never came back. He couldn't swim; he must have gone out
with the intention of not coming back -- before the damage from the
tumor could take
hold, Pribram said.
The room was silent for 10 or 15 seconds -- stone silent. I looked
over at Tom's notebook. "Neuropsychologist contemplates losing his
mind," Tom had
written.
If he had lived, Pribram's colleague would have experienced what
neuroscientists call retrograde amnesia. This is the kind of amnesia
that is most often
dredged up as a plot element in bad comedies and cheap mystery
stories; so-and-so gets hit on the head and then can't remember who he
is anymore, wanders
around aimlessly, finding himself in zany predicaments, until he
gets hit on the head again and his memory remarkably returns. This
almost never occurs in
real life. Although retrograde amnesia is real, it's usually the
result of a tumor, stroke, or other organic brain trauma. It isn't
restored by a knock on
the head. Because they can still form new memories, patients with
retrograde amnesia are acutely aware that they have a cognitive deficit,
are painfully
knowledgeable about what they are losing.
***
Tom and I crossed paths years again later when we were both working
for a research company. He was part of a team designing virtual musical
instruments for
non-musicians, like Guitar Hero or Rock Band, seeking to give
customers an awesome music-playing experience after zero hours of
practice. I saw Tom in the
halls from time to time, said hello, saw him at a couple of company
jam sessions; he was a really good keyboard player.
Sometime after I left the research company to begin my first
academic job, I ran into a woman from the company who asked if I'd heard
the news about Tom.
"He has an inoperable brain tumor, temporal lobe. The doctors say he
has four months to live. I just visited him. You might want to drop by
and say hello."
"Well I ... I don't really know him. I mean, we said hi in the halls
and stuff. But, I don't know him ... I don't think we've ever had a
conversation
longer than two minutes."
"It doesn't matter," she said. "He doesn't really have anything to
do, other than to visit with people. I think he'd really appreciate it."
She gave me
Tom's number, saying I should phone first, because he has good days
and bad.
I phoned and a caregiver answered. We made an appointment for the
following Thursday at 1:00 pm. "He's not so good first thing in the
morning. The drugs. And
some days aren't good at all. Call first, around 11:00 in the
morning, and I'll let you know how he's doing. Apart from that, I should
warn you, he doesn't
remember very much -- the tumor has wiped out his memories of the
past."
Retrograde amnesia.
Thursday came, and I phoned. The caregiver answered again and said I
could come over at 1. I asked if I could bring anything. "He likes Abba
Zabba candy,
but they're hard to find, so don't worry if you can't."
I knew that the Woolworth's in town -- one of the last remaining
ones -- had a huge candy counter. So I picked up a bag of Abba Zabba
peanut butter-filled
taffy.
Tom lived on a street full of identical apartments -- the kind of
street where you'd have to count how many apartment houses from the
corner yours was or
you'd end up in the wrong building. When I knocked at the door, the
caregiver invited me in and asked me to take my shoes off. Then he led
me across a
fluffy white carpet to the living room, pointed me to an old
armchair, and told me that Tom would be out in a minute. I put the
candies on the coffee
table.
joshwept/Flickr
When Tom walked in, I stood up. He came over and shook my hand, and he sang, more than he spoke, "thank you for coming."
Those eyes -- the intense, gripping eyes locked onto mine and stayed
locked as we shook hands, even as we both sat down. I broke the gaze to
look him over
-- his hair was thinning, he'd lost weight, but otherwise he looked
the same as I remembered him. The same narrow face, the same guileless
smile.
"I don't know if anyone told you," he started, still half-singing
and cheerful, "but I have a brain tumor that affects my memory."
I nodded.
"Please forgive me for asking this, but I do this with everybody.
Could you tell me your name again and how it is that I know you?"
"Um...my name is Dan. Dan Levitin."
There was neither recognition nor unrecognition. Just a calm, interested face staring back at me.
"We were students together at Stanford," I continued. "We took a couple of psychology classes together."
"Oh, yes, I have a degree in psychology."
"We were in Professor Pribram's class, and we worked in a lab together, Roger Shepard's lab."
"Who?"
"Roger Shepard. He had a music and perception lab."
"Wow. That sounds like it must have been interesting. What did I work on there?"
"I don't know. I guess ... I guess I was absorbed in my own work. I'm really sorry."
"That's okay. Did I like being in the lab?"
"Yes, I think you did. I mean, you never complained. You always seemed pretty focused."
"That's good. I'd hate to think that I was doing something I didn't
enjoy." He was sitting on the edge of the old sofa and I could see that
the pillows
were caved in under him. "So we were students together. I guess that
was many years ago. Did we stay in touch after that?"
"Well, we ended up working, a few years later, for the same company. A research corporation in Palo Alto."
"Did we work together?"
"No, we were in different divisions. You worked with Joy, and I
worked with Bob. But we saw each other from time to time, and I was
interested in what your
group was doing. Your team gave a really good presentation during
the annual roundup. I remember you had worked on a very clever new
musical instrument
called the 'bead box.' People could move different beads around on
spindles, and the beads would play different musical licks. It was a way
for
non-musicians to have fun with music, without having to devote
themselves to years of practice."
"Huh?" he said, looking at the ceiling, "the 'bead box.' Doesn't
ring a bell. But I don't get many bells ringing these days!"
"Well it was very cool."
He looked over at me. "So, were we friends?"
I just stared. Would it be rude if I told him that I never really
thought of him as a friend? I mean, if one person thought of another as a
friend, and the
other person denied it, that would be hurtful. But Tom had no memory
of me one way or the other. As I was thinking this, he spoke.
"It's okay. There's often this . . . gray area, I guess you'd call
it, in human relationships, isn't there? We meet people, we see them
every day, we say
hello, but we don't really know them. We say they're our friends,
but really, you can't be friends with the hundreds of people you meet,
can you? It's
enough that we had a shared history together. We were in the same
places for a time. We were part of each other's fabric." He made a
rubbing gesture with
his fingers and thumb.
The caregiver came over with a small Dixie cup of water and some pills.
"Excuse me a minute," Tom said. "I'm supposed to take these."
I looked around the room. There were two or three pictures on the
wall and in several places, picture hooks with nothing on them, and the
faded outline of
frames that had once hung there but were now missing. On the wall to
the left was a curio shelf with little objects -- mementos, and a
collection of spoons
from different states of the U.S. arranged in alphabetical order.
But some were missing. Where "Maryland" and "Illinois" had been there
was now just a
dusty outline, and there didn't seem to be any W's at all -- no
Washington, West Virginia, Wisconsin or Wyoming. Round, square, and
hexagonal outlines of
dust were all that remained on other shelves.
"Would you like anything?" Tom asked.
"I, uh. . . "
"I'm not going to be around in three months. I'm telling people who
visit that they can take anything they like. Anything. Pictures off the
wall, musical
instruments. Someone took a conga yesterday. Do you play drums?"
"No, but thank you. I couldn't . . . "
"Really, it's okay. I have a nice collection of spoons from all 50 states. Please, help yourself."
"Thank you, Tom, but I wouldn't feel right. Forgive me for asking,
but aren't you worried that with your memory problems someone could come
in here and
take advantage of you?"
"In what way?"
"Well, I mean, they could come and lie, and just take your stuff."
"That's okay. They're just things."
The phone rang. The caregiver brought it to Tom. It was his mother.
Listening to his end of the call, I understood that she herself was
bedridden and was
not doing well. This was their daily call. I got up to leave but Tom
motioned for me to stay. The caregiver took the phone away when he was
done.
"It was nice of you to come. It was helpful too. It's comforting to
put together the pieces of my life, to see what I've done. To know that
there were kind
people like you who were in it with me. Thank you."
I walked down the stairs, past the rows and rows of identical
apartment buildings, back to my car. Then I sat in my car with the key
in the ignition, not
wanting to move. Professor Pribram felt that when we lose our
memory, we lose our entire sense of self. When I saw Tom, something
fundamentally Tom was
still there. Some of us call it personality, or essence. Some call
it the "soul." Whatever it is, the tumor that took Tom's memory had not
touched it.
