Michael Lemonick, opinion editor at Scientific American, talks about his most recent book, The Perpetual Now: A Story of Amnesia, Memory and Love, about Lonni Sue Johnson, who suffered a specific kind of brain damage that robbed her of much of her memory and her ability to form new memories, and what she has revealed to neuroscientists about memory and the brain.

Steve Mirsky:    Welcome to Scientific American, Science Talk, posted on March 30, 2018. I'm Steve Mirsky. On this episode:

Mike Lemonick: Lonny Sue Johnson had been an accomplished amateur musician, a very successful professional commercial artist, and she was a private pilot. So when neuroscientists heard about her case, they realized they could do much more sophisticated memory testing because she had so much that she had once known.

Mirsky:               That's Mike Lemonick, he's the opinion editor here at Scientific American, after a long stint at Time magazine. And his most recent book, his seventh, is The Perpetual Now: A Story of Amnesia, Memory and Love, about a woman named Lonny Sue Johnson, who suffered a specific kind of brain damage that robbed her of much of her memory and her ability to form new memories. And what she has revealed to neuroscientists about memory and the brain. We spoke at Scientific American's offices. The origin story for this book is pretty interesting, because you're just walking down the street one day.

Lemonick:         Just walking down the street one day and a woman walks up to me, and I recognize her right away because I went to middle school with her. This is 50 years ago or something. But I recognized her, in fact I began bringing up scenes from middle school in my mind before she even talked to me. And she came up and said, "my name is Aline Johnson, I don't know if you remember me." And of course, I was already remembering her. And she asked, "do you know what happened to my sister?" And I said no, and she began to explain that her sister, who had been a pretty successful artist, very successful commercial artist, had come down with a brain infection.

                           She had come down with encephalitis about six or seven years before, and it had destroyed her hippocampus and surrounding tissues in the center of her brain. And being a science journalist who's written about memory, I already knew what that meant, because there was a famous case in the 1950s of a guy named – he was only known by his initials, H. M., who had the same thing happen to him as a result of surgery. And as a result, he could no longer remember much of his past. He had amnesia, but he also had – he was not able to form new memories going into the future. So he was trapped in this sort of slice of time, and I'd always thought about what a weird state that would be, to be in.

                           I heard about him when I was a college student, taking an intro to psych class.  

Mirsky:               And what were they trying to cure again?

Lemonick:         They were trying to cure epilepsy with H. M. They thought that the seizures that he was having, these terrible seizures, were originating in the hippocampus. And it was an experimental surgery to pull out the hippocampus, destroy it and cure the seizures, which it did. Unfortunately, nobody knew that this was the seat of memory.

Mirsky:               And that happened in the 50s?

Lemonick:         That happened in the 1950s, and as soon as people realized what had happened to him, he became an object of serious neuroscientific investigation, because nobody knew at that time where memory was located in the brain. Or, how it worked. And suddenly they had a way to get at this problem.

Mirsky:               And so researchers learned a lot from him, but this new case that your book is about presented such unparalled opportunities because of the incredibly rich, intellectual and artistic and mental life that she had lead up until this tragedy befell her.

Lemonick:         Right, so H. M. was – because of his seizures, he never had a higher education, he never had a job more sophisticated than working on an assembly line. So they could study him and look at some of the most basic functions of memory, but Lonny Sue Johnson, the sister that I was being told about, had been an accomplished amateur musician, a very successful professional commercial artist. She –

Mirsky:               With New Yorker cover art works.

Lemonick:         New Yorker cover art, yes. She did, I think, five or six covers and they ran about five of them. She was very much in demand as an illustrator for books and for magazine articles. She did a regular thing with the New York Times for its business section.

Mirsky:               She was a pilot?

Lemonick:         And she was a private pilot. She owned two planes, she – and which is a very complex skill involving a lot of knowledge and information. So when neuroscientists heard about her case, they realized that it was a much richer source of information about memory, they could do much more sophisticated memory testing because she had so much that she had once known. And so she was kind of a H. M., the second generation.

Mirsky:               And before we talk about some of the specifics of the testing, her life without her memory, or her ability to form many new memories, she still maintained some ability to form new memories of very emotionally charged events.

Lemonick:         Right, emotionally charged events or if you – you know, if you repeat a fact to her 100 times or 200 times in a short duration, she'll probably retain it.

Mirsky:               And she was able to learn without realizing it, some new pieces of music?

Lemonick:         Yes, and that gets into the testing. And it's – again, it builds on what people learned from H. M.

Mirsky:               Right, so again, before we get into the testing specifics –

Lemonick:         Yeah.

Mirsky:               She seems pretty happy.

Lemonick:         She seems… not just happy, joyful. She seems to be delighted with life and… everything around her. The – I think the most… apt word to use to describe her is joyful.

Mirsky:               She has created within her intellectual constraints this world of mental challenges for herself to perform. She's – she does puzzles all day and drawing.

Lemonick:         Yes, so before this injury, this infection, she was really a driven person. She was always working, she was always creating, she was always looking for new things to do. We didn't mention that in addition to everything else she did, she ended up on a farm in upstate New York where she and a neighbor set up an organic dairy farm. So, she was also a business woman, running an organic dairy. She's just tireless and she could not stand inactivity, and then she gets this brain infection and it destroys so many of her functions and she's not capable of doing anything. At first at least, in the immediate aftermath of the infection. And, she's miserable.

                           She's just – she's lethargic, she can't bring herself to initiate any  behavior, and finally at a certain point, her mother and her sister relentlessly working with her to try and bring back her functions, get her to start drawing and get her interested in word puzzles. And it's like you lit a fire under her. Suddenly she becomes obsessed with creating and illustrating these puzzles, she's working all the time, and yes, she's created this whole world of mental exercise for herself.

Mirsky:               There must be some kind of a pleasure circuit that gets activated by her solving problems that was always true for her, and now within her current situation, is still true but the puzzles are the thing that can activate it.

Lemonick:         Right, and yeah, she – and she gets actually kind of impatient and upset if she's not allowed to work on her puzzles. For a while, she was not sleeping because she didn't wanna stop working. Her sister had to you know, go make sure that the light was out and she was, you know, lolling her off to sleep.

Mirsky:               She even has sort of assignments for what she should be doing while she's sleeping. She sets up this system –

Lemonick:         Right, to dream about this particular thing or that particular thing.

Mirsky:               Yeah.

Lemonick:         Yeah.

Mirsky:               So some of the testing is really fascinating. The musical testing, their – her questions are asked of her about what flying is like and this kind of thing, she has some ability to bring back. And you talk about episodic and semantic memory. Maybe we should define those and then talk about what she's actually able to bring back in terms of those two kinds of memories.

Lemonick:         Okay, so episodic memories are memories of specific episodes in your own life. They're also called autobiographical memories. So I start the book talking about this memory of standing up in front of the entire eighth grade and playing a bugle call on my trumpet for every assembly. And I screwed it up every time and it was profoundly embarrassing and my – people would come up to me and say, "hey, you screwed it up again." It was awful. That was a very specific thing that happened to me, and I still remember it vividly. So, that's an episodic memory. A semantic memory is a memory of general facts, so I know that Charles De Gaulle was the President of France.

                           I never met the guy, never thought about him much, but it's a fact, it's a general fact. Or that Pittsburgh is in western Pennsylvania, or… that I grew up in a particular town. It's about me, but it's just a general fact about me.

Mirsky:               Right.

Lemonick:         And so those are, turns out, are two very different kinds of memory. And when the hippocampus is destroyed, you tend to be better at remembering the general facts than the specific memories. So if we go back to H. M., the original case, that – he's the one that taught them this – they could ask him about the – where did you grow up? Oh, I grew up in Hartford, Connecticut. Did you ever go on vacation? Yes, my parents would take us on the Mohawk Trail in Massachusetts. Tell us something that happened to you on one of those vacations? He couldn't remember a thing. Tell us something specific that happened to you in high school? Couldn't remember.

                           There were only two episodic memories of his entire life that he could bring back after he had this amnesia, and that's when neuroscientists learned that they're – not only are they different, but they must be processed differently in the brain. So, Lonny Sue Johnson, similar damage. She cannot remember specific episodes about her life, essentially at all, but she can remember general facts. She remembers that she – or she knows that she flew a plane, she knows that she loved flying a plane. She knows she was an artist.

Mirsky:               And she can describe the sensation of taking off and landing?

Lemonick:         She could do that in a very poetic way, remarkably poetic way. But it's not a specific landing, it's just the feeling of landing a plane, the feeling of taking off in the plane, what the ground looks like from a plane. She could talk about that.

Mirsky:               And the ability to learn a new musical tune, they gave her a tune to practice. And she didn't remember each time that she had already practiced it, but they had three different melodies and she learned two of them. And one was used as a control where she was shown it once, but then wasn't trained on it.

Lemonick:         Right. So in fact, the other thing that they learned from H. M., I have to keep going back to him, 'cause he's the one who –

Mirsky:               He's the baseline.

Lemonick:         He's the baseline. Was that – we talked about episodic memory and semantic memory, but those are both things you can talk about. You can verbalize, I remember this. There's a whole different category of memory called procedural memory, which we informally call muscle memory. It's the memory of how to do physical things.

Mirsky:               Right, like when people say you know, it's like riding a bike.

Lemonick:         Exactly.

Mirsky:               It is like riding a bike.

Lemonick:         It's like riding a bike, but you cannot tell me explicitly what you do when you ride a bike. Which – how – you know, how hard do you push down on this leg and what are you doing with this other leg at the same time, and what about the right hand? What about the left hand? And how do you lean, and you can't really describe it.

Mirsky:               Yeah, if you think about walking, you'll probably trip.

Lemonick:         Exactly, same idea. You don't know what you actually do, you just do it. And what they learned with H. M. was that his procedural memory and his ability to learn new procedural memories was intact, even though his declarative, his verbalizable memories were mostly destroyed. So they taught him a new skill. He learned how to look in a mirror and draw while looking at his hand in the mirror, which is very difficult at first. But –

Mirsky:               Unless you're a dental student.

Lemonick:         [Laughs]. Right, unless you're a dental student. But he – anybody can get better at it with practice, and they let him practice every day and he got better, but he never remembered having done the test before. And at one point, he said to the testers, "this is amazing, this should be difficult, but I'm pretty good at it." He did not know that he had been practicing. Similarly, with Lonny Sue Johnson, they actually did an earlier test where they showed – or played her snippets of very well-known melodies. I mean, the wedding march and Pop Goes the Weasel and just very familiar tunes to anyone. She had no idea what they were.

                           For – and for an amateur musician, a good amateur musician, that's a little bit surprising. She also retained the procedural memory of how to play the viola and how to read music, just as she retained language. And so they composed a piece of music specifically for her, put it in front of her and said, "play this." And she played it and they would take it away and put it back again and say, "oh, what's this? It's a piece of music, play it." And we're talking about seconds later, she would not remember that she'd even seen it before.

Mirsky:               And one important point, I think, is that the music was composed in a specific way so that a person with a musical background would not necessarily be able to anticipate what the next note would be. Because music has a certain structure that musicians are used to, so if you hear a note, you're pretty sure what the next note is gonna be in a run, for example.

Lemonick:         Exactly. And yeah, so they specifically created this piece of music to make it very hard to do that with, hard to kind of – it was not a catchy tune, so she never picked up on it – she was never able to sing it. She would just grind her way through the difficult sight reading, then she would do it again, then she would do it again. And each time she thought she was seeing it for the first time, but in fact, she got better at playing it. And so you might think well, it's just another example of H. M. and his mirror drawing, but in fact, sight reading and playing an instrument are much more complicated tasks than just holding a pencil and tracing something in the mirror.

                           They're cognitively intensive, they involve listening to make sure you're playing in tune and feeling the notes on the finger board. And translating the visual stimuli of the notes on the page into… movements of your body. So it's extending that understanding of how much procedural memory is preserved. The one thing that I was very curious about – I mean, I had been since I was a freshman in college, is what is it like to be in this condition? There's no way you can know, but I talked to a neuroscientist who specializes in consciousness. You know, that ephemeral thing called consciousness that we all know what it is but nobody can describe it.

                           And he made a very good point. He talked to me about people have a certain kind of brain injury that destroys the left side of their visual field in both eyes. And so if they were sitting in a room and you asked them to describe the room, they would describe the right half of the room. And if you said well, what else, they'd say, well, that's it, that's everything that's here. They don't know that there's anything missing, even though –

Mirsky:               And even if you ask them about the room they grew up in.

Lemonick:         Yes, they only remember the right side, and it's not – they don't miss it, they don't feel that there's something missing, it's just not there. It's not part of their existence. And he said, "you know, I think that with Lonny Sue, it's very much like that." This whole huge chunk of her memory is gone, but she doesn't know it's gone. She doesn't miss it, she is perfectly happy in this world where she lives. And people have to take care of her, she couldn't function alone, but as far as she knows, there's nothing really missing. And so, she's happy and that sort of explains why she's so filled with joy.

Mirsky:               So what would you summarize as being the types of important things that these two people, H. M. and Lonny Sue have contributed to our understanding of how the brain works?

Lemonick:         Okay, well first I should say there have been other patients.

Mirsky:               Mm-hmm.

Lemonick:         In between H. M. and Lonny Sue. And each of them was an interesting case in his or her own right, but none of them had the richness of experience that Lonny Sue did, and the intellectual breadth and the love of word play which she had from the time she was a kid.

Mirsky:               And the work with Lonny Sue is ongoing.

Lemonick:         It's ongoing, oh yeah, they've barely scratched the surface, 'cause she poses so many interesting questions that they don't even know what they all are yet. The scientists are still figuring out questions to ask of her, but what we learn from H. M. is that memory is very tied up in this organ within the brain called the hippocampus. It's crucial to forming and retrieving memories, most memories. That we didn't know. We learned from him that procedural memory is located somewhere else, and that was mostly it. With some of these other patients, but especially with Lonny Sue, we're not learning that those simple divisions of memory that I talked about earlier, are actually – they're much more subtle.

                           There are many more distinctions than we thought there were. So as one of the scientists said to me, "okay, so you say well, I went to the senior prom in high school." That's a semantic memory, that's a general fact about your life. If you say, well and then I sat with so and so at dinner, is that now… an episodic memory? I sat with them at dinner and we had roast beef. Now is it episodic? I sat at dinner, had roast beef and talked about the Yankees. At this point, it's pretty clear that it's a specific memory, but when did it make that shift? Nobody really knows. Nobody really knows, and so… and then there are all these things that we do unconsciously that are also part of memory.

                           So, if I'm driving down the street, for example, in my car, my brain is seeing all these cars coming at me on the other side. And you know, things happening all over, but if everything is – if I've learned that that's how it's normally supposed to be by practice and by absorbing that understanding, I'm not tense. If one of those cars suddenly breaks the mold and comes heading right toward me, something is different and I've learned that that means I've gotta wake up and take action. That's another form of memory. So the numbers of forms of memory are many more than people had thought, and the distinctions between them are now becoming murkier and murkier.

Mirsky:               One of the fascinating episodes in the book was Lonny Sue's and Aline, is it –

Lemonick:         Oh, Aline, yes.

Mirsky:               Aline, the sisters, of the death of their mother.

Lemonick:         Yes.

Mirsky:               And this is an event that happens after, well after she has had this condition, and yet, she is able to form this new memory.

Lemonick:         Right.

Mirsky:               Her father having died much earlier, she had to be reminded of it many, many times before it got in there somehow that the father was gone. But the mother died and she knew it from then on.

Lemonick:         Right, and I think that is largely because – well, so when her father died, it was very emotional, but she had normal memory, right. And so that memory was formed before she had her illness, and you're right, she was surprised to learn that her father had died 20 years earlier and they had to – the mother and sister had to repeat it many, many times before she absorbed it. But, she wasn't in the moment of that emotional turmoil when she was re-learning it. With her mother, she was. So, her mother had a stroke and she was in the hospital and then she was in a hospice, and Lonny Sue was there the whole time and Aline was talking about what was going on.

                           And she had very deep ties to both her mother and her sister. And so – but there was still a lot of repetition and a lot of reminders, and… because of the emotional content of this memory, or this fact, it was – it took hold more easily than it would have if it had just been a random, dry fact about something.

Mirsky:               And we see that throughout research on memory, that if it's an emotionally charged situation, there's a much better chance of a solid memory forming.

Lemonick:         Right.

Mirsky:               But it's also possible to implant false memories using this same system.

Lemonick:         That – right, that's right. So yeah, so that's another thing that I knew something about, but really learned much more about working on this book, the idea that our – the memories that we –intact people are certain that we have exactly right, are almost certainly not exactly right. Because of the way memory is altered as you bring it up from the unconscious and think about it and talk about it and then put it back and bring it up again, it changes over time. And the best illustrations are those things that psychologists call flash bulb memories. Memories of just world shaking events, like JFK being assassinated or 9/11 or the Challenger crashing, and it's been shown that when people describe those in vivid detail, those details are sometimes – or almost always wrong to some degree.

                           And similarly, you can create memories that seem like real memories in people by skillfully persuading them through therapy, for example. That no, well, you know, here's something that happened to you, and don't you remember and –

Mirsky:               Bugs Bunny.

Lemonick:         Bugs Bunny and the theme park.

Mirsky:               Yeah.

Lemonick:         Yeah, the one psychologist managed to convince people that they had been to Disney – oh, this was the best part – been to Disney World and that Bugs Bunny had come up and licked them on the ear.

Mirsky:               Right. [Laughs].

Lemonick:         Right, and these people remember this and they can describe it. And at first they said no, no, that never happened. But with the right kind of persuasive techniques, it enters your mind and actually becomes your own memory. And the crazy part is that Bugs Bunny is not a Disney character.

Mirsky:               Right, so there's no possibility –

Lemonick:         He couldn't have been in –

Mirsky:               – that he was there.

Lemonick:         No possibility.

Mirsky:               You know, we're talking about costumed –

Lemonick:         Costumed, right.

Mirsky:               A worker in a costume.

Lemonick:         Right.

Mirsky:               Yeah. But it never happened _____.

Lemonick:         But it never happened, but people believe fervently that it did.

Mirsky:               Yeah. And the… fallibility of memory really comes into play in things like eye witness testimony.

Lemonick:         Right, a number of experiments have been done to show that eye witness testimony is highly unreliable in most cases.

Mirsky:               Yeah. So you actually spent some time with Lonny Sue?

Lemonick:         I did.

Mirsky:               Yeah, what was that like?

Lemonick:         Well, it was a little bit surreal. So I had met her a couple of times in the company of her sister and her mother and the scientists, but Aline, the sister, said to me one day, "well, would you like to interview Lonny Sue?" And I thought, that sounds weird, sure. And so I went to her – the room where she stays, and I sat down and talked to her. And it's – it was a surreal experience because, as I said, her language is intact, she's gracious, she's happy to see you. What's your name – she'd met me 15 times before – what's your name? Oh, do you like music? And this is one of her go to questions.

                           She loves music, so she asks you if you like music. And you talk briefly about that, then she asks you if you like to draw, 'cause she loves to draw. No, I'm terrible at drawing, I hate drawing. Oh, I love drawing. And she'll show me – she did show me, as I was interviewing her, some of these illustrated puzzles she was working on, and explained this very complicated – the complicated rules she follows, she's imposed on herself for creating these puzzles. Which, I could barely follow. She showed me some books that she'd illustrated, 'cause some of her own work is around the room. She talked about flying. Oh, I know, Aline had said, "well, you know, she's interested in astronomy, you should ask her about that."

                           And I said, at one point, "oh, I understand you like astronomy?" She said, "oh yes, we're on the Earth flying through space." And then she immediately started talking about flying, 'cause that's one of her comfortable places. So she segued right into flying, and that's when she did one of these very poetic things that took me by surprise. She said, "you know, flying is like playing the piano." And I honestly didn't know what she was talking about. I said, "what do you mean?" She said, "well, when you're playing the piano, you have both hands on the keyboard and your feet on the foot pedals, and you're swaying back and forth with the music. And when you're flying, you have both hands on the stick, or the wheel, and both feet on the rudder pedals, and you're swaying back and forth in the wind."

                           And I ______ think, wow, that's amazing. So every so often, she would break out of her sort of routine questions and statements that she loved to go back to for comfort, I guess, and just say something out of the blue that was really, really meaningful. And really showed that there's – deep inside, the person she always was is absolutely still there.

Mirsky:               The book is The Perpetual Now: A Story of Amnesia, Memory and Love. And the cover illustration, tell us about that.

Lemonick:         So when Lonny Sue came down with encephalitis, she could not draw at all for the first 11 months or so after her illness. Then finally, with the urging of her mother and her sister, she began to draw and began to create word puzzles that she illustrated more and more elaborately. And now, she's back to creating these very complicated and colorful and beautiful drawings, whimsical drawings, whimsy was a big thing. Her sister – one of the things she used to do in her illustrations was there would often be little tiny people just going about their business, and… so that was a hallmark of her work, and at one point, Aline told me after Lonny Sue had started drawing again, she said, "you know, we never knew if she would get back to where she was. But one day, the little people came back and then we knew it was gonna be okay."

Mirsky:               That's it for this episode. Get your science news at our website, www.scientificamerican.com, where you can check out the winning entry in a short story contest for fiction inspired by physics. For poetry inspired by physics, especially gravity, see such nursery rhymes as Rockabye Baby, Jack and Jill, and of course, Humpty Dumpty. And follow us on Twitter where you'll get a tweet whenever a new item hits the website. Our Twitter name is @sciam. For Scientific American Science Talk, I'm Steve Mirsky. Thanks for clicking on us.