Book Review: The Perpetual Now

Ten years ago, in December 2007, an artist named Lonnie Sue Johnson lost her short term memory. She was admitted to the emergency room in the midst of a blizzard due to severe confusion and a fever of 104 degrees Fahrenheit. Awakening in bed the next morning, she couldn’t speak, move her limbs, or understand her situation. By the new year, Lonnie Sue could speak again, but her memory couldn’t store information for longer than five seconds.

She never fully recovered.

The Perpetual Now (2016) is the story of memory and how it is studied by scientists. Written by science journalist Michael D. Lemonick, the book fits neatly into the genre of modern science non-fiction. The Perpetual Now captures the reader with sympathy and solidarity for its major character, amnesia patient Lonnie Sue, as compulsion to keep reading.

But the overarching story here isn’t about Lonnie Sue, it’s about memory: how we study it, how we think about it, and its centrality to who we are. The Perpetual Now doesn’t answer these questions, but instead inches readers closer to an understanding of how scientists and individuals come together in the search for memory.

It is easy to understand why Lemonick may have written about Lonnie Sue and the mysteries of memory. Lemonick, a long-time science writer for publications like Time and Scientific American, is no stranger to big topics in science. The Perpetual Now, however, is a departure from Lemonick’s previous writing on astronomy and cosmology. Some might argue that the brain is even more vast in scope than black holes or dark matter.

Lemonick’s foray into neuroscience explores memory through the life of Lonnie Sue Johnson, an artist and pilot whose life has taken a bizarre turn: She’s a research subject in top-tier labs that study memory. Her unusual ailment? Viral encephalitis.

Viral encephalitis is rare, affecting between 10,000 – 20,000 individuals per year in the US. Most individuals with this virus die at onset of the attack, and those who survive live with devastating neurological outcomes. The specific virus in the case of Lonnie Sue (and patients like her) is herpes simplex virus-1, the same virus that causes cold sores. Awakening of the virus and its viral attack on the central nervous system causes encephalitis. This brain inflammation preferentially preys on neurons in part of the brain known as the medial temporal lobes.

The medial temporal lobes (MTL) are home to the hippocampus, a brain structure critical for learning and memory. Damage to this region can irreparably impair these functions, rendering victims to a life without basic memory abilities. Lonnie Sue, for instance, can’t remember that her dad died years ago. Even after partial recovery and extensive rehabilitation, she still can’t remember anyone she meets after 15 minutes. But why? The workings of memory are still mysterious to scientists, and Lonnie Sue’s brain is a phenomenon for researchers hoping to tap into the MTL.

Lonnie Sue’s unique artistic background provides researchers insight into the way memory and identity are linked. Prior to the amnesia, art was her way of speaking. Following her memory loss, art remained a link to her identity. After months in rehab, Lonnie Sue could play the viola and illustrate beautifully again. Yet, she couldn’t—and still cannot—recall the fact that she’s been learning to re-engage in these artistic behaviors. This is likely due to widespread damage in her brain, beyond the MTL. Her sister, Aline—an advocate for Lonnie—is still shocked but pleased to see that, while Lonnie Sue may not be able to draw at the same technical level, her whimsical artistic persona is still bubbling beneath the amnesia.

These aren’t easy scenarios to depict to either novice or advanced readers. To this end, Lemonick’s writing is technically accurate and maintains an easy language that never strays into the “textbook” realm. Some readers might find his journalistic presence in the clinical efforts of Lonnie Sue controversial. Specifically, it might seem strange that a writer is following the every move of Lonnie Sue and her research team. However, by the end of the book, it’s clear that this presence is never intrusive, but well-integrated into Lonnie Sue’s daily life.

But by placing himself in Lonnie Sue’s life (and thus, the labs that study her brain), Lemonick confronts the complexity of memory. He takes readers through the scientific method rather than falling back onto the power of narrative. (In fact, Lemonick is so successful at this that it took me a few chapters to remember that he’s a science writer by trade—not a scientist.) Along with Lonnie Sue’s story, readers of this book will be treated to tasty morsels explaining decades of work in memory research.

This brings us to another character: Henry Molaison, the famous Patient H.M., whose participation in similar research spurred important discoveries about the MTL’s function. Henry was known for losing his short term memory, much like Lonnie Sue, after his bilateral MTL was lesioned in an attempt to cure his epilepsy. Early on in the book, it seems like Henry’s life may intertwine in narrative with that of Lonnie Sue’s. Yet, three-fourths of the way through the book, Henry is dropped from Lemonick’s narrative; this is one of few disappointments in the book.

I came to The Perpetual Now as a neuroscience researcher. To my specific field (human cognitive neuroscience), or any fan of memory research, Lemonick’s access to and reporting from labs and scientists is remarkable. This allows his writing to portray a very human side to neuroscience– for instance, Dr. Suzanne Corkin of MIT visited Patient H.M. regularly in his nursing home until his death in 2008.

Unlike other authors who have gained popularity by writing about case studies in neuroscience (e.g. Oliver Sacks), Lemonick is strikingly adept at discussing the research behind the clinical cases central to his book. In order to describe issues in memory, Lemonick interviews an impressive array of characters that make for an all-star neuroscience cast, starring Neal Cohen, John Gabrieli, and Eric Kandel. Lemonick even describes the famous studies of learning in the Aplysia sea slug (the animal that contributed to a Nobel Prize for studies on memory storage). He then easily switches into describing day-to-day conversations between Lonnie Sue and her sister. These narrative choices raise awareness of the roles that human collaboration plays in scientific progress. The most moving scenes in the book are those of interactions between Lonnie Sue’s caretakers, which have become a mix of her family, friends, physicians, and scientists.

The case of Lonnie Sue also portrays just how far we are from arriving at a full understanding of memory. Her case also illustrates the many relationships that other cognitive behaviors have with broad memory abilities. How are her artistic and musical preferences retained? What mechanisms allow Lonnie Sue to relearn her illustration skills? To what extent are these mechanisms dependent upon memory, and to what extent are they separate mechanisms impacted by her widespread brain damage? This is what the scientists interviewed by Lemonick are discovering. Unknowns remain.

Finally, the book shows our progress since the early era of cognitive neuroscience. Patient H.M., for instance, was injured during a bike ride without his helmet in the 1930s. The need for helmets and protection of the brain were not understood then. This highlights the perennial and critical need for science, as well as our naïveté.

Will Lonnie Sue ever become for neuroscience what Patient H.M. has been for the field? It’s interesting to think about what the findings from her team of scientists might find. One woman’s perpetual now might become the future for neuroscience.

By Michael D. Lemonick
264 pages. Doubleday. $27.95

Disclaimer: This book was received for review, and views offered here are independent of any incentives.