LIFE WITHOUT MEMORY

posting a transcript of a video.. answer questions on that transcript.

LIFE WITHOUT MEMORY
Deborah Wearing:
Do you know how we got here?

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Clive Wearing:
No.

Deborah Wearing:
You don’t remember sitting down?

Clive Wearing:
Nope.

Deborah Wearing:
I reckon we’ve been here about ten minutes, at least.

Clive Wearing:
Do you? Well, I have no knowledge of it; my eyes only started working now. And all I’ve seen, the whole time I’ve been seeing anything at all is that.

Deborah Wearing:
And do you feel absolutely normal?

Clive Wearing:
Not absolutely normal now. Yes, if you’ve never eaten anything, never tasted anything, never touched anything, smelled anything, what right have you to assume you’re alive?

Deborah Wearing:
But you are.

Clive Wearing:
Apparently, yes. But I’d like to know what the hell has been going on.

[Music]

Terry:
Clive was an outstanding musician.

Chris Rosen:
He would take his work if he sees it. At the same time, he had loved music so much that he just really threw himself into it totally.

Deborah Wearing:
Clive was a musician of enormous integrity.

Neil Lunt:
He was the world’s expert on Lassus, one of the faithful great composers of the Renaissance.

Deborah Wearing:
And he also worked a great deal in contemporary music. He was the chorus master of the London Sinfonietta, which is Europe’s foremost group.

Terry:
Music flows out of him, whether he is singing or playing or conducting.

George Page:
Clive Wearing, through a cruel twist of fortune shows us how fundamental consciousness and memory are to our lives.

Clive Wearing:
[Sings out] Well, well, well… isn’t that a surprise, a smashing surprise. [Laughs] Why have I not seen you before?

Deborah Wearing:
I don’t know, have you not seen me before?

Clive Wearing:
Nope, this is the first time.

Deborah Wearing:
Are you pleased to see me?

Clive Wearing:
Oh, you bet I am. Yes, there’s nobody else I care about in this world at all, except for this.

Deborah Wearing:
Oh, darling thanks you. So how are you feeling this morning?

Clive Wearing:
I am conscious for the first time. This is the first time I’ve seen anybody at all.

Deborah Wearing:
You’ve not been conscious before?

Clive Wearing:
No.

Deborah Wearing:
I’ve been here before this morning.

Clive Wearing:
I haven’t seen you before.

Deborah Wearing:
You haven’t?

Clive Wearing:
No, I’ve not seen anything at all before. I’ve been completely blind the whole time. No taste at all. This is the first taste I’ve had.

Deborah Wearing:
That’s the first coffee you’ve had.

Clive Wearing:
Yes, cheers.

Deborah Wearing:
Cheers. And how are you seeing things?

Clive Wearing:
Absolutely normal for the first time.

Deborah Wearing:
Full color?

Clive Wearing:
Yes, I’ve never seen anything the whole time I’ve been ill, no black and whites, nothing.

Deborah Wearing:
Do you remember me arriving?

Clive Wearing:
No. I don’t remember any arrival at all. I don’t remember writing in that at all. Nothing to do with me consciously, it’s been unconscious writing.

Deborah Wearing:
What are you doing here?

Clive Wearing:
Oh, I don’t know, presumably playing patient, but I know it’s the first time I’ve seen any cards.

No.

Deborah Wearing:
It all started with a headache. Clive came home one day and said he had a very bad headache. The headache didn’t life, it didn’t respond to analgesics, by the fourth day, he developed quite a high fever. And on the evening of the fourth day, for a little while, he forgot his daughter’s name. By the fifth day, he was very delirious.

Dr. Alan Parkin:
Clive suffered from viral encephalitis which has led to the damage of the left and the right temporal lobes, plus a good portion of the left frontal lobe. Now the temporal lobes contain a structure called the hippocampus which we know is implicated in memory function and in Clive it has almost certainly been completely destroyed in both sides of his brain. It is this that is primarily responsible for his severe memory impairment. In addition, the damage to his frontal lobes also causes a number of additional memory problems which manifest mostly in terms of him repeating himself a lot and generally showing highly emotional behavior.

Deborah Wearing:
Clive’s world now consists of a moment with no past to anchor it and no future to look ahead to. It’s a blinkered moment. He sees what is right in front of him, but as soon as that information hits the brain it fades. Nothing makes an impression, nothing registers. Everything goes in perfectly well, because he has all his faculties. His intellect is virtually intact, and he perceives his world as you or I do. But, as soon as he ‘s perceived it and looked away, it’s gone for him. So it’s a moment to moment consciousness as it were, a time vacuum. And he feels as if he is awakening afresh the whole time.

Clive Wearing:
Ahh, what a lovely hand you’ve got, beautiful, marvelous to kiss our hand. You’re the first person I’ve seen. How long has it been?

Woman:
It’s been about two and a half years now, Mr. Wearing.

Clive Wearing:
Can you imagine a night two and a half years long? I’ve not seen anything before this game. Do I have the impression of being consciously awake? Not true.

Deborah Wearing:
He always thinks he has been awake for about two minutes and that is why he looks at his watch all the time to record it, to record the fact, “Oh, I have woken up. This is an important event, therefore I will write it down in my diary.” So he writes, “11:54 AM: I am now completely awake for the first time,” and he underlines “first time.”

Patience begins because he is always playing patience. And the whole diary, every page is a succession of entries saying almost the same thing of first awakeness and when he goes back and looks at his own entries, he does not acknowledge that they are genuine. He says – he knows that it is his handwriting, but as far as he is concerned, he was unconscious when he wrote them. So he quite often – he will score out what he has written before and so his life is an ever repeating moment of first wakening.

The strongest thing in his life I believe in his diary is his love for me. And that is absolutely raw. And each time I walk into that room, it is as if it is the first time he see me for years.

Clive Wearing:
Good heavens, [laughing] well darling.

Deborah Wearing:
Hello. Are you surprised to see me?

Clive Wearing:
It’s the first time I’ve seen anybody at all. You’re the first person I’ve seen.

Deborah Wearing:
You’ve not seen me before this morning?

Clive Wearing:
No. No, I haven’t.

Deborah Wearing:
So how are you feeling this morning?

Clive Wearing:
I’m conscious for the first time. It’s the first time I’ve seen anybody at all.

Deborah Wearing:
You’ve not been conscious before?

Clive Wearing:
No.

Deborah Wearing:
I’ve been here this morning.

Clive Wearing:
I haven’t seen you before.

Deborah Wearing:
You haven’t.

Clive Wearing:
No, I haven’t seen anything at all before. I’ve been completely blind the whole time.

Deborah Wearing:
You don’t remember actually arriving at all?

Clive Wearing:
No, no I don’t remember that at all. No idea at all.

Deborah Wearing:
But you know who I am, or do you kiss all women like that? [Laughs]

Clive Wearing:
You know I love you, I don’t kiss anybody else.

Deborah Wearing:
Yes, I do know, I do know. You’ve written it all over your diary. Look. I bet you that if I’d look to see what you’ve written, now you haven’t mentioned me on that page. You’ve mentioned me on this page. “My first thought, I adore Deborah for eternity.

Clive Wearing:
That’s right.

Deborah Wearing:
“People’s entries in the diary are rubbish,” what does that mean?

Clive Wearing:
I have no idea.

Deborah Wearing:
Did you write that?

Clive Wearing:
No, not conscious of it at all. I’m seeing it now for this first time.

Deborah Wearing:
Is it your handwriting?

Clive Wearing:
Yes it is, but I know nothing about it at all.

Deborah Wearing:
So how do you think it got there?

Clive Wearing:
I have no idea at all. I presume the doctors don’t know.

Deborah Wearing:
But you must have some idea of how it got there.

Clive Wearing:
No! I haven’t. You listen to me, please for heaven’s sake. When I say no, I mean exactly that. I haven’t seen the book at all till now.

Deborah Wearing:
No, all I’m saying…

Clive Wearing:
That means I haven’t seen it. I have no knowledge of it at all. That’s all. There’s no knowledge of that book. It’s entirely new to me.

Deborah Wearing:
But I’m only saying…

Clive Wearing:
Just use your intelligence.

Deborah Wearing:
I’m sorry darling, but who would put something like that.

Clive Wearing:
I don’t know. Oh, for heaven’s sake, use your intelligence, for heaven’s sake. I haven’t read the bloody thing. Well, use your intelligence.

Deborah Wearing:
Clive gets extraordinary angry. And who wouldn’t? Cause here, you’re not dealing with somebody who is demented, who is oblivious, who is gaga. You’re dealing with a perfectly lucid, highly intelligent man who has been robbed of knowledge of his own life. And he feels deeply humiliated to be put in that position, very, very frustrated that he can’t grasp what’s wrong with him. Because he even as you’re telling him, he’s forgetting the previous sentence.

Dr. Alan Parkin:
Clive has lost a form of memory which probably distinguishes human beings from perhaps all other animals. He’s lost the highest form of memory, the form of memory that enables you to relate yourself to the past and project yourself into the future. So in a sense, he feels like a man adrift.

Clive Wearing:
Well, as far as I’m concerned, I haven’t heard a note of music, seen any music, hand any contact with music at all.

Deborah Wearing:
You’re still a very good conductor and a very, very good player. And you still sing with a beautiful voice.

Clive Wearing:
Completely unknown to me.

Deborah Wearing:
Do you think if you sat down at the organ..?

Clive Wearing:
I dread to think. That’s a private thing for me. I don’t know what will happen, do I?

Deborah Wearing:
I know because I’ve heard you play. You play beautifully still.

Clive Wearing:
I haven’t heard a note of music.

Deborah Wearing:
You know the saying, you never forget how to ride a bicycle. Well, to Clive, singing, playing, sight reading, score reading music is as automatic as riding a bicycle or eating a meal, or getting dressed.

It’s an ingrained skill. It’s something you never forget.

When Clive finishes a piece, the reason he almost always goes into that sort of belching, choking, fitting convulsion is because the moment the music stops, he’s let down out of what was a sort of safety net for him. And suddenly, he’s lost again.

Whatever the damage, however devastating the damage, his being, his center, his soul is absolutely functioning as it ever did. The very fact that he is so despairing, so much in anguish, so angry, so much in love with me – those are all real human passions. And he’s showing them to the – almost to the exclusion of everything else. All he shows us is raw human passion, straight from the heart of the mind.

Ed Nesselroad:
In 1985, Clive Wearing was stricken with viral encephalitis, leaving him with a profound memory deficit. Now at the age of 60, he remains a prisoner of the present moment. He has very little memory of his life either before or after his illness. Because of concern for his safety, it has never been possible for Clive to live independently. He initially spent seven years in a London hospital, seven months in a general medical ward and the rest of the time, in an acute psychiatric ward. At that time, Britain had no long-term residential facilities for individuals with brain injury.

In 1989, Ticehurst House Hospital located in rural England, opened a specialized brain injury rehabilitation service. In 1991, Ticehurst opened Highlands Lodge, a home to provide supportive living for those with profound memory disorders. Clive moved there in 1992 and he lives there today. His wife Deborah visits him as often as possible. His memories of her and his feelings for her make these visits very emotional for them both.

Clive Wearing:
I knew you were coming. I saw you through the window.

Dr. Michael Oddy:
What we are trying to provide for Clive is a quiet, calm atmosphere basically because he has no memory for events leading up to the current moment, anything which really places at the moment to know what is happening is upsetting for him. So, we, he does not like going to places where he is unfamiliar. He does not really like visiting local towns or visiting places where there are lots of people because for him, he will keep “waking up” as he puts it in these strange places not knowing where he is. Where as if, he is here in the house or going for walks in the ground then it is less demanding on his memory and he remains much calmer.

We try to train the staff so that they do not ask Clive questions or begin discussions, which put a load on his memory. For example, if you ask Clive, “How are you today,” there is an implicit demand on, “Well I am better today than I was yesterday.” And he gets quite upset and he will then start to talk about how he is being ill and how he can see and hear for the first time. So what we do is talk about the here and now. We ask him if he would like the coffee. We enter into conversation and Clive is still an excellent conversationalist, but it is all about current events, it is about the surroundings.

So we might comment on, “Oh, the sun is shining up the window.” But we would not say, “Oh, it is a nice day today,” because that implies that he knows what day it is and then he knows what the weather was like yesterday and so on. So we have to try to be careful not to place those demands on his memory because he then does become upset. And we want him to have a calm and content life.

Clive Wearing:
Oh Darling, I didn’t know you were here. What have you got there?

Deborah Wearing:
I’ve brought you some plates. [To Clive] Would you like a Danish pastry?

Clive Wearing:
That’s a lovely idea.

Deborah Wearing:
[To Dr. Oddy] Would you like one?

Dr. Michael Oddy:
I would actually

Clive Wearing:
Oh good. We’ve got enough too. That’s marvelous.

[Conversation among Clive, Dr. Oddy and Deborah]

Deborah Wearing:
One of the things that characterizes Clive’s day is that he continually makes entries in his diary. Now I say makes entries in his diary rather than keeps a diary, because in fact he is not keeping the diary. It is an inner compulsion to record the momentous event of waking up. Because Clive’s perception of his own condition is that because he has no memory whatsoever up to the current 10 or 20 seconds or maybe half a minute depending on whether that has been distracted any proactive interference.

On the whole, his conscious working span memory is that current minute. So everything else behind the minute is blank. So everything until now is unknown and is void. So he uses the analogy of feeling as if he has just woken up. He says it is like just waking up for the first time. It is like just becoming conscious. It is as if I have been unconscious for however many years. And because this is a continual state, unless he is actually engaged on a conversation or in playing Patience or Solitaire which he does a lot or on playing the piano or on taking a walk, unless his mind is elsewhere engaged, that is his experience of life which is, “Oh! It is as if I have just woken up.” “Oh! You are the first person I have seen.” And it is this amazement that – I mean, can you imagine, what would it be like if you were unconscious and you just came to but you did not have a lot of people around your bed saying, “Oh! You have been unconscious, you are in a hospital.” You have just got people eating a meal or watching TV as if nothing has happened.

So he is habituated to that condition. He realizes that it is not surprising but he uses that as an analogy for the experience of having that memory, it is as if I have just woken up. And because for him it is momentous, he HAS to write it down and he HAS to write it down on any available surface. If the diary is in front of him, he will write it down there, he will record the time, “10:50 AM: awake first time.” And then he looks at the previous entry which was “10:48 AM: awake first time,” and he says, “No, I was not awake then, that was not me. That was not proper awakeness. This is the first real awakeness.” So he goes through the diaries scoring out previous entries and underlining the current new entry because now is the real awakeness, all the previous awakenesses are unknown to me.

So what he is saying is something about ego. He is saying something about identity. He is saying, “I know now, I know this moment now. I have no conscious recollection of those previous entries in my handwriting though I acknowledge all these either with me.” Therefore, this is the real awakeness and you have to take notice of that. So he will underline it many times. And what is interesting is that over the years is the diary has stocked up, the diaries – the pages had become written in a more and more frenzied way as if to say, it is really important, you take notice of this. Just as a prisoner has described to the fact of his existence on the prison cell ward, “I was here today and I am alive now.” “The world, you have to know this,” that is what Clive is doing with his diary. And I think he is telling us something quite important about his perception of his condition. And he is the best eyewitness to his condition.

Clive Wearing:
I have nothing to say about it. It is just like death. No thoughts of any kind. No dreams. No difference between day and night. No sight no sound. No taste. No touch. No smell. Exactly like death. No difference in day and night. No thoughts. Nothing. No dreams. Nothing at all. To question you have, the answer, “I do not know.” There is nothing to say. No dreams. No sight. No sound. No taste, no touch, no smell. Nothing at all, no thoughts, nothing.

Deborah Wearing:
Since how long ago?

Clive Wearing:
A few years. That’s all I know. The whole time I’ve been ill. Nothing at all. No thoughts. Nothing.

Deborah Wearing:
What’s it like now?

Clive Wearing:
I can see. First time. First time I had any evidence that I was alive.

Deborah Wearing:
Do you feel sort of normal now?

Clive Wearing:
Yes. Ever since I sat down here. I don’t remember sitting down here.

Deborah Wearing:
You do not remember sitting down?

Clive Wearing:
No I’ve never seen any human being now and I can see the three of you now. No touch no smell. Nothing at all.

Deborah Wearing:
Do you know what happened to you?

Clive Wearing:
No.

Deborah Wearing:
Any idea?

Clive Wearing:
No idea at all. Just like death.

Deborah Wearing:
Do you know how long you’ve been like this?

Clive Wearing:
No idea, just a few years.

Deborah Wearing:
Any idea what year you got ill?

Clive Wearing:
No.

Deborah Wearing:
Have a guess.

Clive Wearing:
Some time in the ’80s.

Deborah Wearing:
Some time in the ’80s, yes.

Clive Wearing:
That is all I can say.

Deborah Wearing:
Early ’80s, mid ’80s, late ’80s?

Clive Wearing:
I have no idea. I can’t remember.

Deborah Wearing:
Guess?

Clive Wearing:
Middle ’80s.

Deborah Wearing:
Middle ’80s, yeah. That’s correct and do you know what year it is now?

Clive Wearing:
No.

Deborah Wearing:
Have a guess.

Clive Wearing:
It’s the ’90s I suppose.

Deborah Wearing:
Yeah. How far in would you say?

Clive Wearing:
Anything between ’91 and ’99, I don,t know.

Deborah Wearing:
You have no feeling for that?

Clive Wearing:
No.

Deborah Wearing:
Well it’s now 1998. Any idea what month it is?

Clive Wearing:
[Looking out window]

Deborah Wearing:
It’s alright to have a look out the window.

Clive Wearing:
It looks like about March, April or …February or March something like that.

Deborah Wearing:
It is April. You were right the first time, yeah.

So who’s birthday is it the next month?

Clive Wearing:
Mine. (And my brother’s.)

Deborah Wearing:
Yeah. Do you have any idea how old you would be?

Clive Wearing:
93,000.

Deborah Wearing:
No.

Clive Wearing:
No?

Deborah Wearing:
How old do you think really?

Clive Wearing:
21.

Deborah Wearing:
No. How old do you think… How old do you feel?

Clive Wearing:
22.

Deborah Wearing:
You feel 22. And how old up do you think you are?

Clive Wearing:
67.

Deborah Wearing:
No. Do you really think you are 67?

Clive Wearing:
I have no idea what it is. I haven’t a clue. It could be 90 or a 100 for all I know about it. No difference between day and night. No dreams. Nothing at all…

Deborah Wearing:
Do you think your hair is grey or white?

Clive Wearing:
I have no idea. I’ve never seen it.

Dr. Barbara Wilson:
But it’s perfectly okay to guess.

Ed Nesselroad:
Neuropsychologist Barbara Wilson has evaluated Clive’s cognitive functions on 15 occasions since 1985.

Dr. Barbara Wilson:
This is another front door. This is a stable door. Front door. Garage door. A city hall door. An English cottage door. Shed door. English pub door. Stable door and a garage door.

So one of those doors, Mr. Wearing, you saw just now. Would you have a guess?

Clive Wearing:
No, not at all. I cannot remember anything. It is just like being dead what I have had. I’ve never seen anything. You are just flipping them so fast, I can’t remember a thing.

Deborah Wearing:
Any one not more familiar?

Clive Wearing:
No.

Deborah Wearing:
Guess?

Clive Wearing:
No, no idea what I am looking at just now. It’s a waste of time.

Dr. Barbara Wilson:
Which one is more aesthetically pleasing?

Clive Wearing:
None. None of them at all. I can’t remember what happened. My brain’s not working enough for you.

Dr. Barbara Wilson:
Well, I think Clive Wearing is unique. I have never known another person so amnesic as Clive. I have probably seen about 700 brain injured people, most of them with memory impairment. He is definitely the most amnesic person I have ever known.

I think it is a very dramatic illustration particularly for the public, of what it is like to being without memory. For example, this constant feeling that he has just woken up or he has not tasted anything before. And even if he has seen his own writing in his diaries or videotapes of himself, he acknowledges that i’s him on the video or him conducting or him writing, his handwriting, but he says he was not conscious then. And the fact that he must have been conscious to have written or conducted, he won’t accept it. Now that’s, I’ve never seen that in any other amnesic people, even people with a very dence amnesia. They don’t say, “I was not awake then (or) I wasn’t conscious then.” So I feel that aspect of it is more than the memory impairment.

I think it’s also very striking how his musical skills are intact as far as we know. We haven’t been able to do a formal evaluation of his music. Some people interested in the neuropsychology of music have heard his tapes or seeing videotapes of him playing and it certainly seems that his skills, his musical skills, have not been affected by the illness. He may now be a little rusty and a little bit slower because he is not practicing so much. So I think what that tells us about the functioning of the brain is that what’s been damaged in Clive are not the areas concerned with music.

Another interesting aspect about his deficits now is that he has quite significant semantic memory impairments as well as episodic memory impairments. So not only does he forget things that had just happened or that he is just seen, but he has to some extent lost his general knowledge about things. He doesn’t know for example, if he sees a photograph of the Queen and the Duke of Edinborough, he thinks they might have been in his choir. And it’s very hard for him to tell you in any detail much information, even things he knew prior to the illness. He has been virtually unable to learn anything since the onset of the illness. And again that’s different from some amnesic people. There have been reports of a few, despite a very severe episodic memory, have managed to learn new vocabulary, learn new acronyms, like AIDS or whatever, and Clive by and large hasn’t learned anything.

We were talking earlier today about the new information that he has acquired since the onset of his illness and we think there might be four or five things. He will, if questioned appropriately, tell you about the reunification of Germany, about Hong Kong going back to China, about the breakup of the Soviet Union. Though, if you asked him directly if any of these things have happened, he’ll say, “I don’t know.” But the way we can find out that he does have some knowledge of that is that he says thing like, “Has Hong Kong gone back to China yet?” if you start talking about Hong Kong. But it is very, very tiny little bits of information given the extent that he watches television and he does get a daily newspaper.

Ed Nesselroad:
Magnetic Resonance Imaging scans of Clive’s brain were done in England in 1991. Dr. Erin Bigler of Brigham Young University recently examined and interpreted the scans, to correlate them with Clive’s cognitive abilities and deficits.

Dr. Erin Bigler:
In this three dimensional reconstruction of the brain from an MRI in this subject, what we’ve done is we’ve colorized the surface of the brain in this flesgtone and you can see the Sylvian fissure here very clearly and that divides the frontal lobe from the temporal lobe. And then we make this cut across at about this level here that allows us to look face on to the subject, in this view right here. This is the coronal view and so there is the Sylvian fissure. There is a healthy temporal lobe down in this region right here. This is where the hippocampus and the amygdala reside.

If we now look at Clive’s scan, we see an extensive area of missing brain tissue. There is no brain tissue there. That is filled with cerebrospinal fluid. There is a small remnant of the superior temporal gyrus of the temporal lobe. Everything else is gone on the left side. On the right side, we have extensive wasting also of the mesial temporal lobe, but some of the lateral temporal lobe remains on the right side. It is of interest that he has retained the musical abilities that he has. Some musical abilities maybe more dependent on right temporal function.

Also notice the extensive enlargement of the ventricular system. These are the anterior horns of the lateral ventricle. Here’s the size that they should appear. This very small area is a more normal size of this part of the lateral ventricles. The enlargement is associated with a massive loss of brain substance as spread throughout the brain not just the temporal and inferior frontal damage but some generalized loss of tissue.

You can see that also when you look at a lateral view of the brain. Here’s a normal lateral view or sagittal cut, and this structure right at midline is called the corpus callosum. And that’s what a healthy corpus callosum looks like. This structure that wraps around right here… This is the fornix. And the fornix is a critical structure for the projection of memory information from the hippocampus. When we look here in Clive, we see that the corpus callosum is smaller in size and there’s only a little remnant of the fornix left and that is because there is massive damage to the hippocampus, essentially complete wasting of the made that section.

This is a normal subject and pay a particular attention to this region here and this is the mesial part of the temporal lobe where all of the damage has occurred in Clive. The infection process spreads in this region and if we now look at his scan, we can see the extensive damage on the left as I mentioned. This is the left side of the brain here, extensive damage at the mesial part of the right, and then here is the inferior frontal damage in this patient, that’s at the posterior part of the inferior frontal region.

Now this particular region of the brain is important in regulatory aspects of behavior and some other dyscontrol that this patient has and the emotional lability and changes that occur are undoubtedly related to the damage at the temporal lobe level but also this involvement at the inferior frontal region of the brain. What I’d like to do now is also show this various two dimensional images, now in three dimensional space. And we can do that by taking each plane and put it in the proper position with the other planes and this is seen in this three dimensional lattice work type array that is on the computer monitor now. And so these vertical lines here, they represent the coronal sections that have been cut across like this.

These horizontal lines here represent the axial views that have been cut across like so. And then we also have the midsagittal view that’s right at midline here. See here’s the nose and there’s the mouth. And now we’re going to rotate this and see we’ll rotate the head. You can see the ears out here, and we’ll just keep rotating. There’s the nose and here are the ears.

Now we can cut back and so we will now cut back and expose the damage and what we’ve done here is we have colorized the damage in red to show how extensive wasting has occurred in the temporal lobe region. And now, we can rotate this image, and you can see the extensive amount of pathology that is present.

Again the greatest amount of loss of tissue is on the left side in the left temporal region but the damage is obviously bilaterally represented as you can see here. And as we turn this around and look towards the back, let’s look a little further here. Again this dark area here, that represents the wasting of the brain in the temporal lobe region. As we tilt the scan back, you can also see where the damages in the inferior frontal region of the brain. And it is the combination of this inferior frontal and bilateral temporal lobe damage that then represents the deficits that we see in this patient that are primarily manifested as a profound loss of any short term memory and the emotional lability and dyscontrol evident.

Deborah Wearing:
I think when most people come across to Clive for the first time or if they would read his neuropsychological test scores, if they would look at his case history, they would assume that he has virtually total loss of short term memory. And because he has to live looked after 24 hours a day, they would assume that there’s nothing much left of him inside.

In fact, there’s a lot left of him inside. There is a lot going on there which tests are not sensitive to. He remains a very intelligent, lucid and articulate person. And the deficits he has are very specific and they don’t affect him in a general way. They affect particular kinds of memory function. Therefore although he has no conscious memory, of anything that’s happened since he was ill. He has no episodic memory for the whole of his life. In any amount of testing, he has never managed to produce a single episodic memory. And we’ll mark his exposure to me, I’ve never witnessed any episodic memory. Nevertheless, he retains an intelligent semantic memory about his life. He knows that he worked for the BBC. He knows that he was a conductor. He knows that he’s married to me. He knows that he has children from the prior marriage. He just doesn’t know the details and he can’t bring those things to mind.

Now the interesting thing is that even though on a minute-to-minute basis, he is forgetting everything that happens… he perceives the world around him like you or I would, but everything is erased immediately afterwards. And so, moment-to-moment he forgets exactly what’s just happened, but he does show signs of implicit learning. For example, when he’s been watching a video, the same video everyday, he now anticipates what is going to happen on the video although he has no conscious recollection of ever having seen the video before. In other words, learning is going on at the procedural level as an implicit level, at a nondeclarative level and he, it is not open to his conscious inspection. He can’t, if asked, “Do you know anything about it?” “No, no, no. I never saw anything before in my life.” But it’s there and he can use it and that’s what’s helping him now, 13 years post-injury, is helping him to function as an articulate and communicative human being as a companion. We have very meaningful conversations. Whereas for the first seven years, we had three short loop tape conversations, verbatim, repeated verbatim, with the same inflection, the same intonation, the same expressions on his face… so much so that after having the same conversation for seven years, I couldn’t hear what he will be saying any longer. Now, I can phone him up, “Do you know what happened at work today?” And I can have a very ordinary conversation and he response, he listens, he follows the train of thought and he gives me really good advice.

Clive lives a life deep in the country, isolated from his past, in a way, he’s in a house that he never lived in before. And he has very few visitors now that he’s no longer in London. But in fact, this suits him really well because he requires a constant environment and he finds, people, anyone who doesn’t know how properly to talk to him could very easily make him ill at eas because, just the most simple phrase like, “Good morning Clive, how are you?” contains about four big errors.

First, a complete stranger, because everyone is a complete stranger, other than close family and very old friends. So a complete stranger has just address him by his first name, Clive. Second, “how are you?” How does he know how he is? It’s as if he has just woken up. He has no idea how is or where he is or what to answer. So immediately he’s thrown by, “Hello Clive, how are you?” So you see the people who are around him have had to be sensitive to his perception of them and his perception of his existence.

He has, I would say, in a strange way, he has got used to this this existence. He has made it very clear that he has a sense of time passing. He has a sense at some level of knowing what’s going on because of the way he will abbreviate questions when for the first seven or eight years he is to repeatedly ask me, “How long have I have been ill? How long have I been ill?” That became condensed and condensed, as he said it faster and faster, “How long I have been ill? How long I have been ill? How long I have been…” Because it was such an urgent question and also he knew I knew what the question was.

And then it would just be, “How long?” It became abbreviated. The same way as the vanishing cues technique of helping an amnesic person relearn. He showed that he did have knowledge of having asked the question before. And if you ask him to guess the answer, he’d usually guess the correct answer. He no longer asks those things. The urgent questions and the repetitive loop conversations you have subsided and he’s gotten used to the place he lives in, the staff around him. Even though he doesn’t know… If you say to him, “Where is the kitchen?” He’ll say, “I do not know.” If you say, “Clive, can you go and make a cup of tea?” He walks to the kitchen, opens the right cupboard, and makes a cup of tea. So he has learned things and he is at ease in this setting.

The fact that Clive is now isolated from his previous life completely, is not bad because he lives… amnesia is a state of suspended animation for him. He’s in a kind of limbo and if you are busy being in limbo, you don’t actually want to go out to the movies and have friends around for supper. So living quietly in the country with a few nice nurses bringing him cups of coffee suits him fine. Our time together is much better than it used to be. He doesn’t repeat himself so much. He is not so angry. So we can enjoy the conversations we have on the phone or in person because we can have meaningful conversations and that is an enormous plus and improvement on things.

He misses me very much. You only have to look at his diary and every line it says, “Please come darling! Please come darling” in quite frenzied handwriting. So you would think that there was a terrible underlying anguish there, and perhaps there is but on the whole, what he presents to me, is quite a philosophical acceptance that I have to be elsewhere. I have to be doing things. He knows I am at work. I mean just this morning, he looked at the clock at half past eight in the morning and he said to me, “Good heavens you must be up at the crack of dawn to get here by now.” Which tells you that he knows that I’m not from around here, that I must have had to make a journey to get to him. He knows that you see, but he won’t present that as information but he’ll indicate that he knows certain things. And whenever I leave, he says, “Of course you must go. You must get back before it gets dark” and that sort of thing, so you know how he works.

What do you think the video has to say about the nature of memory and its significance to human existence?

What do you think might be learned about memory from studying cases such as Clive Wearing’s?

How could you apply these lessons in Educational Psychology ?
400-500 words please

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