Mental health from both sides

Memory & more

I used to think that being present in any particular situation ensured accuracy. By this I mean accuracy of observation and also of recall; that standing witness to events was always reliable. As a child, I thought of the years as a climbing staircase, with different events, schools and holidays marking out the way. In my second decade the staircase flattened out, but remained clear. Sometimes I would think about those first few steps, and of the hollowness that came before, but there was nothing there to remember. My life started in glimpses – on a swing, pushed by someone I didn’t know, walking in some woods, sitting with my grandmother and aunt (my grandmother saying, she’s only little). I think these are memories from before we moved to Scotland when I was two, but they may well have become memories of memories over the years. In the same way, the changing emotions of one’s own little children are remembered by us, but not by them.

I have quite a good memory, if learning lots of facts for medical school and beyond is proof. I remember things in words, my visual memory being quite poor– I was never one of those who memorised the look of a page, and I don’t easily remember visual detail or even what people look like. I always knew I couldn’t remember everything, and I knew I forgot things (for example when exams where over), and, as a result, I never questioned the perception that led to the memory, I just accepted it.

Now I am much more doubtful. My memory was sorely tested by ECT, and although I think and hope my cognitive function remains unchanged, that is only my view, which will never be objective. I remember this most recent time of treatment thinking – I won’t forget anything this time.But of course I did. It’s hard to describe – lost detail in the run up to treatment, then some definite holes, for example my husband going away for ten days, which I ought to remember, then a period of gradual recovery. Some of the lost memories return, but many never do. Each time I have had ECT, the pattern has been similar, probably depending on the number of treatments. This is not a minimal side effect, although, as I have said before, the benefits of ECT can be great.

Following this, I have found myself wondering more about memory in other states. Times of great and heightened emotion seem to enhance memory, although whether accurately is anyone’s guess. When I am depressed, my memory is less good, but I also worry about it more. The effect from ECT is entirely different, and it irritates me when people suggest that my memory loss is more likely to be due to illness. Both can indeed affect memory, but it’s not the same. Medication may also do so, and I have noticed this when I am taking more sedating drugs. I have rarely been prescribed benzodiazepines, but they certainly screw with one’s perception of events. Does this matter? It might if one needs to process things, especially difficult things.

As doctors, we sometimes assume that someone who is distressed may benefit from sedation. I wouldn’t dispute this, particularly when someone is very sleep deprived (another memory grabber); but sometimes it is actually worse when memories are blurred or muddled as a result. Because of both illness and treatment, I have times when I think things happened, but remain unsure, which is disturbing. I think sometimes that these may be memories of dreams, which are themselves proof, if any, that memory remains unstable. Most will experience that strange experience of waking after a long and complicated dream, and thinking about it briefly, but in detail. Then, oddly, it is rapidly stripped away. I wonder if perhaps the bits one has been able to process, while waking, are sometimes remembered, even partially, the rest lost. I have suspected that I have a store of dream memories that mostly remain inaccessible but are sometimes remembered in further dreams, when they once again make sense. The few sightings of this other world are minimal in daytime hours, and can be confusing and unsettling. 

I also dream, not infrequently, of being ill. Usually this is a dark and all-consuming depression, and somehow a depression from which I know I will not recover; but I also dream, less often, of elevated mood, where things are simply going too fast. And even in the dream, my fear is of descent into depression. The moment of waking is odd, the feelings cling, and then like the memory of a dream they evaporate, leaving only relief.

Like many I fear dementia. I can’t imagine what it’s like, but disintegration of memory and thinking is terrifying. Maybe this is worse if one is aware of the process; or maybe worse if not. But memory makes up what we are, and losing that suggests that we may return to that nothingness that came earlier, even before we die.

And sometimes, during these periods of existential angst, I ask myself the simple questions – why me, why here, why now? Is it like this for others? The fact that they are unanswerable is comforting, and the knowledge that memory is fragile, that it may not represent what we like to think of as the truth, is actually reassuring. It is fascinating to think about life and our thoughts and memories, but not if you’re hoping to get answers. Which of us hasn’t thought that we might be the centrepiece in some sort of Truman Show, that time might go backwards (or sideways), or that we live with multiple parallel realities? Or something? For me, I like to delve back into the time before I was born. I have one or two memories that don’t make sense, and that are probably dreams, but that I want to keep unexplained.

The vagaries of memory should remain a mystery; and to know for sure what happens before life, and after death – or even during – would be crushing. We can and should all have our own beliefs, but certainty may be disastrous.

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