Brain damage saved his music

After guitarist Pat Martino had his brain removed, he was able to get back the music

Eight years ago, when neurosurgeon Marcelo Galarza saw MRI scans of the brain of jazz guitarist Pat Martino, he was amazed. “I could not believe how much of his left temporal lobe was removed,” he said. Martino had surgery on his brain in 1980, when a lump of tangled, improperly grown veins and arteries was removed. At that time he was one of the most revered guitarists in jazz. However, few people knew that Martino suffered from epileptic seizures, terrible headaches and depression. He was locked up in psychiatric hospitals and subjected to electroconvulsive health debilitating treatment.

Only in 2007, Martino made an MRI, and only recently neuroscientists published their analysis of these images. Galarza's surprise, as well as medical scientists and music fans, was caused by the fact that Martino recovered from the operation, despite the fact that he lost a significant part of his brain and memory, however, he retained his guitar playing skills. In 2014, in a report for World Neurosurgery magazine, Galarza from the University Hospital in Murcia, Spain, and his colleagues from Europe and the USA, wrote: the status of a virtuoso. [Galarza, M., et al. Jazz, guitar, and neurosurgery: The Pat Martino case report. World Neurosurgery 81, 651.E1-651.E7 (2014)]

Now Martino 73, he has released more than 30 albums. He continues to perform around the world, and, according to many jazz critics and musicians, plays as talented and creative as ever. And in his case, this is something, yes worth it. From adolescence, the guitarist was known for his fast fingers and unexpected improvisations. The Grammy winner, guitarist George Benson, told the reporter that he considered himself a young phenomenon in New York in the 60s, until he saw one evening in Harlem how Martino played. “I was shocked, man!” Over the years, Benson said, Martino “didn’t get out of my head because I knew that there was another standard that all guitarists had to admit, and he appointed this standard. He showed us that there is much more to the guitar than we hear. ”

Martino surprised and neurosurgeons. His case demonstrates neuroplasticity, a remarkable ability of the brain during development and training to “optimize the performance of cerebral networks,” wrote Hughes Dufo, professor and neurosurgeon from the Guy de Chaliac Hospital at the University of Montpellier in France, who studied the case of Martino. The guitarist's recovery characterizes the ability of the brain to improvise - compensating for defects and injuries by building new connections that bypass brain regions that restore motility, intellectual and emotional functions. Martino's story is a story about music and how it helped shape his brain so as to save his life [Duffau, H. Jazz improvisation, creativity, and brain plasticity. World Neurosurgery 81, 508-510 (2014)]

Martino was born and raised in Philadelphia, where he lives today. Although he had had hallucinations and seizures since he was 10 years old, psychiatrists and psychologists have given him wrong diagnoses for more than twenty years. They constantly told him that he was suffering from manic depression, bipolar disorder or schizophrenia. Only in 1980, when he was 35, did Martino recognize from the first CT scan that the cause was arteriovenous malformation , AVM — an abnormal lump of veins and arteries formed in the brain region located just behind his left ear. He looked like a “wad of worms,” said Frederick Simeon, a surgeon who saved Martino's life, in the 2009 documentary “The Loose Martino Strings: Brain Mystery” [Knox, I. Martino Unstrung: A Brain Mystery Sixteen Films, London (2008)]

AVM could be present there from birth, and interfere with the normal development of the functions of the left temporal lobe - mainly the ability to save and retrieve memories. And nevertheless, Martino can recall only one example of when an attack caught him on stage in 1976. It was not far from Marseille in France, at the Riviera Jazz festival, which was played in the mountains in the open air in front of an audience of 200,000 people. “Right in the middle of a hard, burning section, I stopped playing and stood motionless for about 30 seconds,” wrote Martino in his 2011 autobiography “Here and Now!”. “During attacks, it seems to me that I am falling into a black hole” [Martino, P., with Milkowski, B. Here and Now! The Autobiography of Pat Martino Backbeat Books, Montclair, NJ (2011)]

Four years later, when he was teaching at the Guitar Institute of Technology in Los Angeles, he experienced an almost fatal attack that caused him to go to hospital. John Malen, a friend of Martino, who later headed the institute's recording department, was with him when he had a seizure, and he remembers how Martino lay on the bed, “jumping up and down like a doll”. At the Los Angeles Hospital, doctors diagnosed AVM, which, in their opinion, had a hemorrhage. Martino was told that he had two hours left to live. But the born Philadelphian wished to go home to have an operation there.

The operation was performed in two stages: first, the surgeons removed a formed blood clot. Then they performed cerebral angiography , in which a coloring matter is injected into the bloodstream so that doctors can see where to make an incision on X-ray images. To remove the “worm lump”, Simeon cut Martino with 70% of the temporal lobe.

In his autobiography, Martino wrote that after operations he felt like a zombie. He did not know his name, did not recognize his parents, did not know that he was a musician. Martino had a strong retrograde amnesia , inability to recall the events that preceded his attack. In a recent interview, Martino said that the darkness and limb he experienced after the operation reminded him of a film released that year, The Lathe of Heaven . It was a screen version of the anti-utopian SF novel by Ursula Le Guin, in which a man with horror discovered that his dreams can change the past and the present of the real world. “It was a terrible place,” said Martino.

And it was also an unpleasant place for his father, Mickey, who was also a musician. Martino said that as a boy he wanted to be a jazz guitar player because he loved his father, and believed that in this way he would force him to dominate himself. And so it happened, and for Mickey, it was that Borean’s sad to watch his son forget his love of music. When Martino returned home to Philadelphia after the operation, his father, hoping to give him back his memories, began to put his son’s jazz records in the house so that he could hear them. “I lay in my bed upstairs and heard them seeping through walls and floor, reminding me of a person whom I didn’t know what was supposed to be, or had ever been,” wrote Martino.

His father, frustrated that Martino walked past his guitar and was not interested in her, asked Mahlern to come and play for him. Malen took guitar lessons from Martino, and often, to the irritation of the latter, he played a large major seventh chord when Martino asked to play a small non-chord. Looking through a book of old exercises for Martino's guitar, Muller played a major seventh chord. “Move over!” Said Martino. He grabbed his guitar and started playing with his former energy. In the following months, the pain and suffering due to his amnesia and post-operative depression began to recede.

“I continued to work with the instrument, and sudden flashes of memory and muscular memory gradually began to appear on me — forms on the neck, various stairs to different rooms of the house,” wrote Martino. “There are secret doors in the house that only you know about, and you go there because it's nice.” This is exactly how you remember the games; remember the pleasure of it. " Seven years after the operation and 10 years since the release of his latest album with the frightening name “Exit” [Exit], Martino released “The Return” [Return].


Before and after surgery

Martino’s return to the virtuosi, neuroscientists say, demonstrates the presence of secret rooms and doors in the brain. In a 2014 World Neurosurgery report, Galarza noted that after removing 70% of the patient's left temporal lobe, taking into account damage to the hippocampal site, doctors can expect an “almost complete loss of memory” in a patient.

Galarza explained that the left temporal lobe "is directly connected" with verbal audio memory, conversations and understanding of speech. The 2007 cognitive test suite found that Martino found it hard to understand the meaning of some abstract and rare words and define more common ones. When he was shown, for example, an image of a corkscrew, he could only give out: “This is used for drilling ... bottles of wine”. When asked when the Beatles came to America, Martino said that somewhere between 1961 and 1963 (he almost guessed it, it was 1964). But when he was asked to name the song Beatles, he could not remember a single one.

The Martino case emphasizes the presence of three key memory levels. Semantic memory storing non-personal knowledge and facts, like names and data, is associated with temporal lobes. Martino's lobectomy can explain why he could not recall the Beatles song titles, as it is possible that during surgery he was removed the opportunity to refer to semantic memory.

Episodic memory , the kind of autobiographical memory associated with the experience that William James once compared with "direct sensation filled with warmth and intimacy," in the case of Martino was clearly affected [James, W. The Principles of Psychology Henry Holt and Company, New York, NY (1890)]. He could not remember that he was a musician, to recall his family and friends, the experience of his communication with them. Such a failure may seem strange, because episodic memory is associated with the hippocampus and the prefrontal cortex, which the operation has not affected. However, Paul Brox, a British neuropsychologist, co-author of The Weakened Martino Strings documentary and report for World Neurosurgery, said that Martino's operation could have a “nonspecific effect” on brain regions that store and activate episodic memory, and this effect “went away when the brain psychologically adapted to the results of the operation. "

Procedural memory , another level, explains the most incredible aspect of Martino's story — his ability to play the guitar with such dexterity and skill after removing a part of the brain. Professional musicians and athletes often say that their fingers unconsciously fly over the fingerboard or catch the ball flying at a speed of 150 km / h. This is because these actions, thanks to years of practice and repetition, are so deeply rooted that the performers do not think about them. These sensorimotor skills are stored in procedural memory associated with the largest anatomical component of the basal ganglia , located above the spinal cord, in the nucleus of the forebrain, and responsible for controlling movements. In the case of Martino, brain structures associated with procedural memory were not affected by AVM and lobectomy. Memories were inactive and awaited awakening.

Neuroscientists consider it necessary to note that deep-rooted memories, be they episodic or procedural, cannot be awakened by a single thought or action. Memory layers are not unified, but interrelated.

Lynn Nadel, a psychologist specializing in memory at the University of Arizona, read the Martino report and looked at his cognitive tests. He announced that the memory defects of Martino make an incorrect statement that the guitarist had fully recovered after surgery. “Everything testifies to the fact that he has the inconspicuous and sometimes noticeable defects inherent in a person with similar brain damage,” said Nadel. However, he added, “very interesting” to understand how Martino could remember who he is, because it may be that Martino became an expert in jazz again, not knowing that he was like that before. Perhaps he was able to recover his personality, Nadel said, "because these skills and everything connected with them were so closely woven into his life."

It is possible that the traces of the personality of Martino, remaining after the operation, were associated with his procedural memory of playing the guitar. After they were activated during the game, it became possible to restore episodic and semantic memories. Galarza noted in the report that the remaining part of the left temporal lobe in Martino's brain supposedly has a function of connecting “internal emotional responses” with “complex sound stimulations”, that is, music. Playing the guitar literally touched the chords of Martino's personal life.

One evening in the early 2000s, after the concert of Martino at the Blue Note club in New York, the actor Joe Pesci visited him behind the scenes. Martino was flattered and said how he liked the films My Cousin Vinny , Goodfellas and Raging Bull . “You apparently don’t remember me?” Peshi said. "I'll tell you what you drank at Small's Paradise in 1963." Cocktail " Grasshopper ".

“As soon as he described the drink, a series of pictures flashed through my head,” Martino wrote in the book Here and Now! “I immediately found myself again in Small's Paradise, I remembered the bartender, the scene, the location of the instruments that stood there between performances.” Then Pesci was a singer and guitarist, and hung out at Small's Paradise, the Harlem club, with Martino, where they became close friends. But, Martino wrote, "I forgot about all this - until he used this word, the name of the drink, which became the trigger for returning these memories."

The interaction of memories is not the only light shed on the work of the brain due to the restoration of Martino. It demonstrates the impact that playing a musical instrument has on the brain. “Practicing music involves practically all parts of the brain known to us, and almost all neural subsystems,” wrote neurobiologist and musician Daniel Levitin in his 2006 book, “This is your brain under the influence of music” [This Is Your Brain on Music]. Neuroscientists have shown that musical skills, such as the stunning martino guitar solo, require a whole set of collaborative neural processes: perceptual, cognitive, motor, and executive. Musical career can be described as professional bodybuilding in relation to the brain. “After all, in the end, the brain is a muscle,” said Galarza.

Successful musicians can expect that their motor and auditory cortex, as well as the corpus callosum - the link between the left and right hemispheres - will be filled with gray and white matter, responsible for the neurons of the brain and the axons connecting them together. It was shown that the large white matter tract, the arcuate beam connecting the regions responsible for sound production and perception - the frontal and temporal lobes - is larger in size for singers and musicians than for ordinary people.

The musician’s brain confirms what Santiago Ramon y Kahal, the founder of neuroscience, wrote in 1904. "Every person can become a sculptor of his brain at will" [Cajal, SRy, et al. Texture of the Nervous System of Man and Vertebrates Springer, New York, NY (2002)]. A study from 2008 showed that jazz improvisation, compared to playing from memory or from a sheet, has a pronounced neuroplastic effect, activates the sensory-motor and language areas throughout the brain [Limb, CJ & Braun, AR FMRI study of jazz improvisation. PLoS One 3, e1679 (2008)]. Neuroscience is interested in improvisation, since it represents the activity of neurons during spontaneous creativity. Interestingly, they found that the same parts of the brain are involved in improvisation as during sleep or meditation; the brain turns off areas with executive functions and suppresses the tendency to self-tracking.

Although Martino never played the guitar on an MRI, it can be said for sure that the skill of jazz improvisation, which he has been practicing for over 50 years, has increased his neuroplasticity. In a report from 2014, "Jazz improvisation, creativity and plasticity of the brain" Duffo suggested that Martino's language and musical functions most likely moved from the left hemisphere and became more blurred, involved part of the internal occipital lobe, which is usually busy processing visual information. Duffo even suggested that "jazz improvisation took part in the reorganization of the brain (even before problems with AVM) and played the role of cognitive rehabilitation" after the operation. In other words, the fact that he is a musician may have saved his life after brain damage [Tomaino, CM Creativity and improvisation). Annals of the New York Academy of Sciences 1303, 84-86 (2013)].

And it's not as fantastic as it sounds. A study from 2014 in the Neuropsychology Review confirmed that "changes associated with workouts that occur in the brain of musicians are likely to have a positive effect on cognitive outcome and recovery from neurological damage." The study examined the medical histories of 35 musicians, including Martino [Omigie, D. & Samson, S. Neuropsychology Review 24, 445-460 (2014)].

Diana Omidzhi, the lead author of the study, and a researcher at the Max Planck Institute, explained that the increase in the volume of gray matter in the brain regions associated with motility and hearing in musicians, compared to people who are not engaged in music, should create a “brain reserve”, which, in turn, should be enough to retrain or restore the musical function.“Musical workouts,” she adds, “often lead to the development of alternative strategies, using which the brain is capable of solving musical problems,” and these alternative strategies could take over the work in case of damage. “It is possible that Pat Martino’s ability to re-develop his skills has emerged, in part, due to the presence of alternative, inactive strategies that need to be rediscovered,” Omigi said.

Omidzhi means that Martino's brain, long before the bleeding occurred or he found out about his entangled veins, reorganized himself so as to protect himself from damage. “In our review,” Omidzhi said, “we watched as the musicians who underwent surgery due to injuries, the appearance of abnormal formations or slow-growing tumors, showed an increased likelihood of cognitive function recovery compared with those who, say, suffered a stroke , and lost a large amount of healthy, well-functioning tissue. The reason is that when the formations grow slowly, the brain can reorganize, and the musical function can move to other parts of the brain and make the damaged parts less necessary. ”

Some neuroscientists argue that perhaps the plasticity of an abnormal brain could have generated the originality of a musician. “Although the neurological predisposition to creativity remains a matter of controversy, it is rather tempting to assume that Martino’s entire life and gradually increasing AVMs led to the fact that his temporal lobe functions moved to the nerve paths beyond the temporal lobe,” said neurologist Robert Burton, author of the book "Instructions on the Mind for Skeptics: What Neurobiology Can and Cannot Tell Us About Yourself" [A Skeptic's Guide to the Mind: "). "It would not be surprising that the alternative arrangement of the anatomist contributed to the originality of Martino as a guitarist,and provided the basis for some recovery beyond what could be expected after a lobectomy. ”

Whatever brain mechanisms lead to the restoration of Martino, both Omidzhi and Brox, a neuropsychologist who has spent months with Mario on a documentary film, feel they have to add that science cannot ignore the work of the guitarist himself. “This is an extraordinary recovery, believe me,” said Brox.



Today, talking with Martino is a pleasure. He has a Zen serenity, which gives his notes, which sometimes become as florid as one of his guitar solos, quiet wisdom. And it was hard for him. His recovery from surgery to complete mental health, “the great cleansing,” as he wrote in the book, took 19 years.

In the scene of the documentary, Martino looks at an MRI of his brain. Peering into the black void of the brain, where his temporal lobe used to be, he comments: “I would say that now I have no disappointment, criticism, attempts to judge others — there are no dilemmas that made life so complicated. Here is what is missing. And, frankly, it's for the best. ”

When he was asked to tell more about the difference when playing the guitar before and after the operation, he said: “My initial aspirations, before the operation, were mostly related to skill, to climbing the ladder of recognition by others. It was the desire to reach five stars instead of two stars rating the album. And after the operation, it didn’t matter to me. I am more concerned with the reality of the moment, the enjoyment of the moment. I am more concerned about the musicians next to me, their feelings, the expression of complicity and other virtues shared by us in the process. These things seem to me much more useful than my achievements as a famous musician. Now it is only pleasure and friendship and complicity and excitement. Enjoying all things, not enjoying something concrete. ”

Martino may have memory gaps forever. In fact, as the memory expert Nadel said, Martino's confessions about life in the current moment are shared by other patients who suffered from amnesia due to brain damage, and have lost the ability to recall the past or to imagine the future. But for a guitarist, clinical diagnoses mean little today.

“The greatest and most truthful essence of creativity is joy,” said Martino. - This is the joy that people see. They are not observing an artisan, but a man who is happy because he lives, projecting this aura. ” Now during the performance, says Martino, he almost does not feel the guitar in his hands. The improvisation of the passage in the song became a spiritual journey. “The brain is a funny thing,” he said. - This is part of the car, but not part of where this car goes. The car will take you where it is necessary, but she is not you. ”