Brain Damage Saved His Music

Five years ago, when neurosurgeon Marcelo Galarza saw images from jazz guitarist Pat Martino’s cerebral MRI, he was astonished. “I couldn’t believe how much of his left temporal lobe had been removed,” he said. Martino had brain surgery in 1980 to remove a tangle of malformed veins and arteries. At the time he was one of the most celebrated guitarists in jazz. Yet few people knew that Martino suffered epileptic seizures, crushing headaches, and depression. Locked in psychiatric wards, he withstood debilitating electroshock therapy.

It wasn’t until 2007 that Martino had an MRI and not until recently that neuroscientists published their analyses of the images. Galarza’s astonishment, like that of medical scientists and music fans, arises from the fact that Martino recovered from surgery with a significant portion of his brain and memory gone, but his guitar skills intact. In a 2014 report in World Neurosurgery, Galarza, of the University Hospital in Murcia, Spain, and colleagues from Europe and the United States, wrote, “To our knowledge, this case study represents the first clinical observation of a patient who exhibited complete recovery from a profound amnesia and regained his previous virtuoso status.”¹

Martino is now 70 and has released over 30 albums. He continues to tour around the world and according to many jazz critics and musicians he plays with more felicity and creativity than ever. And in Martino’s case that is really saying something. Since he was a teenager, the guitarist has been known for fleet fingers and surprising improvisations. Grammy Award-winning guitarist George Benson told an interviewer that he saw himself as the young phenom around New York City in the 1960s until he saw Martino play one night in Harlem. “I was flabbergasted, man!” Over the years, Benson said, Martino “stayed on my mind because I knew that there was another standard out there that all guitar players had to recognize, and he was setting it. He showed us that there was much more to the guitar than we were hearing.”

Martino has also put on a show for neuroscientists. His case demonstrates neuroplasticity, the brain’s remarkable ability, during development and learning, to “optimize the functioning of cerebral networks,” wrote Hugues Duffau, a professor and neurosurgeon at Hôpital Gui de Chauliac at Montpellier University Medical Center in France, who studied Martino’s case. The guitarist’s recovery epitomizes the ability of the brain to improvise—to compensate for malformations or injuries by wiring new connections among brain regions that restore motor, intellectual, and emotional functions. For an encore, say neuroscientists, Martino’s story is about music and how it helped shape his brain in ways that revived his life.²

Martino was born and raised in Philadelphia, where he lives today. Although he had hallucinations and seizures since he was 10 years old, he was misdiagnosed by psychiatrists and psychologists for more than two decades. Invariably they told him he suffered from manic depression, bipolar disorder, or schizophrenia. It wasn’t until 1980, when he was 35, that Martino learned, following his first computed tomography (CT) scan, that the cause was an arteriovenous malformation, or AVM—an abnormal entanglement of veins and arteries that formed in the part of his brain located just behind his left ear. It looked like “a bundle of worms,” said Frederick Simeone, the surgeon who saved Martino’s life, in a 2009 documentary, Martino Unstrung: A Brain Mystery.³

The AVM may have been there from birth, posing an obstacle to the normal development of his left temporal lobe functions—primarily the ability to store and express memories. Even so, Martino could only recall a single instance when a seizure struck while he was performing on stage, in 1976. He was just outside of Marseille, France, at the Riviera Jazz Festival, playing on a mountaintop outdoors with over 200,000 people in attendance. “Right in the midst of a really heavy-duty, burning section, I stopped playing and stood there for about 30 seconds,” Martino wrote in his 2011 autobiography Here and Now! “During these moments of seizure, it feels like you’re falling through a black hole.”⁴

Four years later, while he was in Los Angeles teaching at the Guitar Institute of Technology, he had a near-fatal seizure that left him hospitalized. John Mulhern, a good friend of Martino’s, who would head the recording department at GIT, was there when the seizure struck and remembered seeing Martino on his bed, “bobbing up and down like a toy.” At the Los Angeles hospital, doctors diagnosed the AVM, which they believed had hemorrhaged. Martino was told he had two hours to live. But the native Philadelphian wanted to travel home for the surgery.

The surgery had two phases: first, surgeons removed a blood clot that had formed. Then they gave Martino a cerebral angiography, a procedure in which a dye is introduced into the brain’s blood flow so that, using an X-ray, the surgeons could see where they would have to cut. To remove the “bundle of worms,” Simeone sliced away 70 percent of Martino’s left temporal lobe.

“You don’t remember me, do you?” the actor Joe Pesci said to Martino. “I’m going to tell you what you used to drink
in 1963.”

In his autobiography, Martino wrote that he felt like a zombie after the operations. He didn’t know his name, recognize his parents, or know he was a musician. In fact, Martino had severe retrograde amnesia, an inability to recall events and knowledge prior to the seizure that nearly killed him. In a recent interview with Nautilus, Martino said the blankness and limbo he experienced after surgery reminded him of a film released that year, The Lathe of Heaven. It was adapted from a 1971 dystopian science-fiction novel of the same title by Ursula K. Le Guin, in which a man is horrified to find that his dreams rewrite the past. “It was a terrible place to be,” Martino said.

It was also a distressing place for his father, Mickey, a musician himself. Martino said that as a boy he wanted to be a jazz guitarist because he loved his father and thought becoming one would make him proud. It did, and that made it all the more painful for Mickey to see his son forget his love of music. With Martino living back at home in Philadelphia after the surgery, his father, hoping to bring his lost memories back, began to play his son’s jazz records in the house for him to hear. “I would lie in my bed upstairs and hear them seep through the walls and the floor, a reminder of something that I had no idea that I was supposed to be anymore, or that I ever was,” Martino wrote.

Upset that Martino kept walking past his guitar without interest, his father asked Mulhern to come over and play for him. Mulhern had taken guitar lessons from Martino and often, to Martino’s aggravation, had played a major seventh chord when Martino wanted a minor ninth. Now, working through a book of Martino’s old guitar exercises, Mulhern struck a major-seventh chord. “Move over!” Martino said. He grabbed his guitar and began playing with his old drive. Over the coming months the pain and misery of his amnesia and post-surgery depression began to lift.

“As I continued to work out things on the instrument, flashes of memory and muscle memory would gradually come flooding back to me—shapes on the fingerboard, different stairways to different rooms in the house,” Martino wrote. “There are secret doorways that only you know about in the house, and you go there because it’s a pleasurable thing to do. And that’s how you remember how to play; you remember the pleasure of it.” Seven years after his surgery, and 10 years after his previous album, spookily titled Exit, Martino released The Return.

Martino’s return to virtuosity, say neuroscientists, exposes the rooms and secret doorways of memory in the brain. In the 2014 World Neurosurgery report, Galarza noted that after carving out 70 percent of somebody’s left temporal lobe, with some underlying damage to the hippocampal region, physicians might expect a patient to have “almost complete memory loss.”

The left temporal lobe, Galarza explained, is “directly involved” with verbal auditory memory, talking, and understanding speech. A battery of cognitive tests in 2007 revealed Martino had a hard time relaying the meaning of some abstract and uncommon words and defining more common ones. Shown a picture of a corkscrew, for example, he was only able to muster, “It’s used to drill off … a wine bottle.” When asked when the Beatles came to America, Martino said sometime between 1961 and 1963 (he was close; it was 1964). But when asked to name a Beatles song, the musician said he couldn’t name a single one.

Martino’s case underscores three key levels of memory. Semantic memory, which stores impersonal knowledge and facts like names and dates, is associated with the temporal lobes. Martino’s lobectomy could explain why he couldn’t recall the names of Beatles songs, as it’s possible the surgery sliced away the ability to recall semantic memories.

Episodic memory, the kind of autobiographical, experiential memory that William James once compared to a “direct feeling … suffused with a warmth and intimacy,” was clearly affected in Martino’s case.⁵ After all, he couldn’t remember he was a musician, recall his family and friends, or relive his experiences with them. That failure might seem puzzling, as episodic memory is associated with the hippocampal and prefrontal cortex regions of the brain, not damaged by his surgery. However, Paul Broks, a British neuropsychologist, co-writer of the documentary Martino Unstrung, and a co-author of the World Neurosurgery report, has said Martino’s surgery may have had “nonspecific effects” on the areas that store and activate episodic memory, and those effects “subsided as the brain readjusted physiologically post-surgery.”

Another level, procedural memory, explains what might seem like the most incredible aspect of Martino’s story—his ability, given a chunk of his brain is gone, to play the guitar with such dexterity and command. Professional musicians and athletes often say they are not conscious of their fingers flying across a fretboard or connecting with a 100 mph fastball. That’s because those actions, due to years of practice and repetition, are so deeply embedded that performers are not aware of them. These “sensorimotor skills” are stored in procedural memory, associated with the largest anatomical component of the basal ganglia, which resides above the spine in the forebrain’s core, central in the control of movements. In Martino’s case, the brain structures associated with procedural memory were unaffected by the AVM and lobectomy. The memories were dormant, waiting to be reawakened.

The guitarist’s recovery epitomizes the ability of the brain to improvise—to compensate for damage by wiring new connections.

It’s noteworthy, say neuroscientists, that embedded memories, whether episodic or procedural, can be unlocked with a single thought or action. Layers of memory are not regimented but interconnected.

Lynn Nadel, a psychologist who specializes in memory at the University of Arizona, read the World Neurosurgery report on Martino, and looked at his cognitive tests. He declared that Martino’s memory defects ruled out claiming the guitarist had a complete recovery from surgery. “All the evidence suggests that he still has the subtle and in some cases not-so subtle deficits that a person with his kind of damage would have,” Nadel said. However, he added, it’s “very interesting” to consider why Martino was able to remember who he was because it could have turned out that Martino became a jazz expert again without knowing he was one before. Perhaps he was able to retrieve his identity, Nadel said, “because those skills, and the things associated with those skills, were so deeply embedded in his life.”

It could be that traces of Martino’s identity left after the surgery were bound up with his procedural memory for guitar-playing. Once they were activated by his playing, it made retrieval of episodic and semantic memories possible. Galarza noted in World Neurosurgery that it’s interesting that a surviving structure of Martino’s brain, the left temporal pole, has been proposed to have the function of connecting “visceral emotional responses” with “complex auditory stimuli,” or music. Playing the guitar literally struck the chords of Martino’s personal life.

One night in the early 2000s, after a Martino concert at the Blue Note jazz club in New York City, the actor Joe Pesci visited the guitarist backstage. Martino was flattered and told Pesci he enjoyed My Cousin Vinny, Goodfellas, and Raging Bull. “You don’t remember me, do you?” Pesci said. “I’m going to tell you what you used to drink in 1963 at Small’s Paradise.” A Grasshopper.

“At the moment he described the drink, a series of images appeared in my mind,” Martino wrote in Here and Now! “I flashed back to Small’s Paradise; I remembered the bartender and the stage and the position of the instruments that remained on the bandstand in between sets.” Back then, Pesci was a singer and guitar player and used to hang out in Small’s Paradise, a Harlem club, with Martino, where the two became close friends. But, Martino wrote, “I had forgotten all about that—until he used that word, that name of the drink, which was the trigger for me to reclaim those memories.”

The interplay of memory is not the only light that Martino’s recovery shines on the brain. It illuminates the impact that music, particularly playing an instrument, has on the brain. “Musical activity involves nearly every region of the brain that we know about, and nearly every neural subsystem,” wrote neuroscientist and musician Daniel Levitin in his 2006 book, This Is Your Brain on Music. Neuroscientists have shown that musical skill like a sizzling Martino guitar solo requires a suite of neural processes firing in tandem: perceptual, cognitive, motor, and executive. Making a career as a musician is like being a professional body-builder of the mind. “After all, brain is muscle,” Galarza said.

Accomplished musicians can expect their auditory and motor cortices, as well as the corpus callosum—the communication bridge between the left and right hemispheres—to beef up in both gray and white matter, which comprise, respectively, all of the brain’s neurons and the axons that link them together. It’s been shown that a large tract of white matter called the arcuate fasciculus, connecting the regions responsible for the production and perception of sound—the frontal and temporal lobes—is bulkier in singers and instrumentalists than in non-musicians.

A musician’s brain is a confirmation of what Santiago Ramon y Cajal, a founder of neuroscience, wrote in 1904. “Every man, if he so desires, can become the sculptor of his own brain.”⁶ That goes double for a jazz musician. A 2008 neuroscience study showed that jazz improvisation, compared to playing by memory or sheet music, has a profound neuroplastic effect, activating sensorimotor and language areas in a widespread fashion throughout the brain.⁷ Neuroscientists are interested in improvisation because it showcases the neural activity of spontaneous creativity. Notably they’ve found that improvisation also involves the same brain activities as dreaming and meditation; it shuts down executive function areas and inhibits the tendency to self-monitor.

Although Martino has never played a guitar in an MRI machine, it’s safe to say that being a master of jazz improvisation for more than 50 years has amplified his neuroplasticity. In his 2014 report, “Jazz Improvisation, Creativity, and Brain Plasticity,” Duffau suggested that Martino’s language and music functions likely shifted from his left hemisphere to a more distributed orientation, incorporating part of the interior occipital lobe, which is normally dedicated to processing visual information. Duffau even suggested Martino’s “jazz improvisation participated in cerebral reorganization (even before AVM bleeding) and served as a cognitive rehabilitation” following his surgery. In other words, being a brain-damaged musician may have helped save his life.⁸

Martino looked at a black void on one of his brain images. “I would say that what is missing is disappointment, criticism, judgment of others.”

It’s not as far-fetched as it sounds. A 2014 study in Neuropsychology Review maintained that, “training-related changes that take place in the brains of musicians may have a beneficial effect on their cognitive outcome and recovery following neurological damage.” The study examined the medical cases of 35 musicians, including Martino.⁹

Diana Omigie, lead author of the study, and a research fellow at the Max Planck Institute, explained that larger gray matter volumes in motor and auditory regions in musicians than in non-musicians would create a “brain reserve,” which “in turn might be enough to fuel relearning or recovery of a musical function.” Musical training, she added, “often results in the development of alternative strategies with which the brain is able to solve a musical problem or task,” and so those alternative strategies might take over in the event of neural damage. “It is possible that Pat Martino’s ability to redevelop his abilities was due in part to the presence of alternative and dormant strategies, which needed to be rediscovered,” Omigie said.

Omigie echoes the point that Martino’s brain, long before it hemorrhaged or Martino even knew about his tangled veins, reorganized itself in a way that might shield it from damage. “In our review,” Omigie said, “we observed that musicians who underwent surgery for early lesion, cerebral malformations, or slow growing tumors, showed a larger likelihood of recovering cognitive function than those who, for instance, had a stroke and therefore suddenly lost a large amount of healthy normally functioning tissue. The reason is that in the case of slow-forming lesions, some reorganization might have occurred such that over time, the musical function was able to transfer to other parts of the brain and leave the damaged portions less necessary.”

Some neuroscientists have stated it might be possible that plasticity in an abnormal brain could lead to a musician’s originality. “Although the neurological basis of creativity remains speculative, it is tempting to suggest that Martino’s lifelong and most likely slowly enlarging AVM resulted in some of his temporal lobe functions being relegated to neural pathways outside the temporal lobe,” said neurologist Robert Burton, author of A Skeptic’s Guide to the Mind: What Neuroscience Can and Cannot Tell Us About Ourselves. “It wouldn’t be surprising if alternative anatomic circuitry contributed to Martino’s originality as a guitarist in the first place, and provided the basis for a degree of recovery beyond what would normally be expected following a temporal lobectomy.”

Whatever brain mechanisms may have led to Martino’s revival, both Omigie and Broks, the neuropsychologist who spent months with Martino for the filming of Martino Unstrung, felt compelled to add that science couldn’t leave out the work and determination of the guitarist himself. “This was an extraordinary recovery, believe me,” Broks said.

Talking to Martino today is a pleasure. There is a Zen calmness about him that gives his remarks, which at times veer into tangents like one of his guitar solos, a gentle wisdom. And a hard-earned one. His recovery from surgery to mental health, a “greater purification,” he wrote in Here and Now!, took 19 years.

In a scene in Martino Unstrung, Martino looked at his MRI brain images. As he stared into a black void of his brain, where his left temporal lobe used to be, he commented, “I would say that what is missing is disappointment, criticism, judgment of others—what is missing are all of the dilemmas that made life so difficult,” he said. “That’s what’s missing. And to be honest with you, it’s beneficial.”

Asked to expand, to reflect on the difference between his guitar playing before and after his surgery, Martino said, “My original intentions prior to neurosurgery had a great deal to do with craft and climbing the ladder of recognition by others. It had to do with the desire to achieve five stars as opposed to two stars for the judgment of an album. And then after the neurosurgery, that no longer had any meaning to me. I am more concerned with the reality of the moment, the enjoyment of that moment. I’m more concerned about the players that are with me, about their feelings, about the emanation of compassion and other virtues that we share together in the process. These are the things that I find much more rewarding than my achievement as a famous musician. Now it’s just enjoyment and friendship and compassion and concern. It’s an enjoyment of all things as opposed to the enjoyment of specific things.”

Martino may always have holes in his memory. In fact, said memory expert Nadel, Martino’s testaments to living in the moment are echoed by other patients who have suffered amnesia due to brain damage, and have lost the ability to recall the past or envision the future. But clinical diagnoses mean little to the guitarist these days.

“The greatest, truest essence of creative productivity is joy,” Martino said. “It’s a joy witnessed by those who surround it. They are no longer witnessing a craftsman, they’re witnessing a human being who’s happy about living, who projects that aura.” When he performed now, Martino said, he barely felt the guitar in his hands. Improvising a passage in a song was a spiritual journey. “The brain is a funny thing,” he said. “It’s part of the vehicle, but it’s not part of where the vehicle is going. The vehicle will take you there, but it isn’t you.”

Brian Gallagher is an editorial intern at Nautilus. @brianscottg

References

1. Galarza, M., et al. Jazz, guitar, and neurosurgery: The Pat Martino case report. World Neurosurgery 81, 651.E1-651.E7 (2014).

2. Duffau, H. Jazz improvisation, creativity, and brain plasticity. World Neurosurgery 81, 508-510 (2014).

3. Knox, I. Martino Unstrung: A Brain Mystery Sixteen Films, London (2008).

4. Martino, P., with Milkowski, B. Here and Now! The Autobiography of Pat Martino Backbeat Books, Montclair, NJ (2011).

5. James, W. The Principles of Psychology Henry Holt and Company, New York, NY (1890).

6. Cajal, S.R.y., et al. Texture of the Nervous System of Man and Vertebrates Springer, New York, NY (2002).

7. Limb, C.J. & Braun, A.R. Neural substrates of spontaneous musical performance: an FMRI study of jazz improvisation. PLoS One 3, e1679 (2008).

8. Tomaino, C.M. Creativity and improvisation as therapeutic tools within music therapy. Annals of the New York Academy of Sciences 1303, 84-86 (2013).

9. Omigie, D. & Samson, S. A protective effect of musical expertise on cognitive outcome following brain damage? Neuropsychology Review 24, 445-460 (2014).

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