Psychotherapy

CHAPTER X

DISORDERS OF MEMORY

Many patients suffering from various nervous symptoms insist that they are losing their memory or that it is becoming notably deficient in some ways. If they are a little on in years they are sure that their memory is not as good as it used to be and that they now forget many things that were formerly remembered without difficulty. Especially are they likely to assert that the names of people and certain words will not come to them when they want them, that they often have to seek for facts and dates that should be quite familiar, that they fail to remember acquaintances and the like. These symptoms of which they complain are often sources of considerable worry and serve to emphasize in them the idea that there is something serious the matter with their general health, or some pathological condition developing in their brain. They have heard much of loss of memory as a sign of degenerative nervous diseases and they are prone to think that their own special loss of memory, be it real or imaginary, must be a forerunner, or perhaps even an early symptom, of some important organic lesion.

This idea of progressive memory disturbance as a preliminary of nervous breakdown often becomes so firmly fixed as to be of itself a profound source of anxiety to patients, and an almost unspeakable dread. So it is important to make them understand what the real nature of their condition is and what their loss of memory, supposed or real, is due to. As a matter of fact, what many of these patients need is not treatment for a diseased memory, but reassurance from what we know about the psychology of memory, that their troubles are only quite natural incidents in the life history of their particular memory faculty. Many a man who is worrying about his supposed loss of memory or, at least, impairment of it in some way, is not suffering from a true pathological condition, but is usually the victim only of some functional disturbance of the nervous system with the neurotic anxiety and heightened introspection that accompanies such a condition.

Reasons for Memory Difficulties.—Nervous patients particularly complain that they do not remember what they wish to as easily as they used to a few years before. They say that it is much more difficult for them to impress things upon their memories and, in addition, that it is much easier for them to forget. There are three quite natural reasons for these phenomena as far as they actually exist, which should be pointed out to these patients. The first and most important is that they are incapable of that concentration of mind which they had in earlier years and which enabled them to give themselves up so completely to the consideration of a particular subject that it could not help but be impressed on their minds. They are now so much occupied with many other things, and, above all, most of these patients are so preoccupied with themselves that they cannot hope to have the concentration of mind that was comparatively easy when they were younger and is now impaired, but which is so necessary for the enduring remembrance of things. Secondly, their over-anxiety to remember things sometimes acts as an inhibitory motive in securing that deep, impression that will enable them to remember details very well. Thirdly, their supposed impairment of memory is due to a false judgment with regard to themselves. They are not comparing their power of memory now with what they used to have, but owing to anxiety about themselves they have taken to comparing themselves with others and, after all, the faculty of memory acts very differently for different people and it is well known that what one man remembers with ease another recalls with difficulty, or only because of special attention.

Attention and Memory .—The first of these causes for supposed impairment deserves to be discussed further. It is often said that as we grow older our memory is not so retentive as it used to be, and that while we remember the events of boyhood and the things we learned in the early years of school life, our recollection of recent events and things learned in later years is much less vivid. This is all very true, but the reason usually given, that in the meantime our memories have failed in power is inconclusive. What we learned in early childhood came to us with the surprise of novelty and for this reason we paid close attention, it was new and impressed us with its importance, it was dwelt upon for long periods and often, because there was little else to think about, has been frequently recalled since and, of course, is indelibly impressed upon our memories. The same thing is true with regard to early acquaintances. We got to know them so well that, of course, we cannot forget them. What we have learned in later life, however, has come in the midst of many other things, has not been dwelt on very long, has not been often recalled and, of course, occupies much less place in the memory than the things of earlier life. That is not, however, because of any defect in memory, but because of lack of attention and repetition that means so much for memory.

Age and Memory .—It is often said that people do not learn so readily when they get older. This is, of course, a truth of common experience, but it is not because of dullness of the faculty of memory, but failure to concentrate the attention sufficiently for memorizing. I have known old men who could learn things just as well as any young man and indeed better than most of them. They were men who had been accustomed all their lives to concentrate attention on the subject they had in hand and who did not allow the cares and worries of life to intrude on their studies. Cato learning Greek at eighty is often quoted as an exceptional example, but I have had some dear old friends who could learn things quite as readily as younger men and whose minds were just as bright and clear. Whenever they devoted as much attention to anything that they wanted to remember as they did when they were younger men, I am sure that they remembered quite as well. It is a question of attention and not of any loss of faculty that makes the difference between the memory of the young and the old until, of course, senile impairment actually comes.

Solicitude and Memory .—Everyone who has had to depend much on his memory knows that over-anxiety with regard to the recollection of anything may seriously inhibit the power to recall it. Public speakers know that to hesitate is to be lost. If they want a particular name or word which they know often escapes them, they must with confidence begin the sentence in which it is to occur, though perhaps wondering all the time whether the word will be on hand or not for them to use it. Occasionally it will not come, but as a rule it turns up just in time. If they allow themselves to be disturbed by the thought that the word or expression may not come, then they know the hopeless vacant blank that stares them in the face when they want it. They have to make a circumlocution in the hope that it may turn up. Some let it go at that, but many start another sentence in the hope to tempt it to come and often it will eventually come, but sometimes it persistently refuses to come. That is not a loss of memory but a failure of neuron connections. There are some of us who know that certain words will always do that with us. Archimedes has bothered me for years and his name will often not come when I want it. Then there are certain words with regard to which transposition is likely to take place. We involuntarily and unconsciously substitute one word for another. We call one man by another's name. We have done it before and we know that we are likely to do it again. Somehow the connections in memory exist along these wrong lines and are constantly mismade. The name of something a man has written comes up instead of his name. This heterophemia is often noted in men of excellent memory.

Peculiarities of Memory.—Memory is an illusive and elusive function at best. All of us have had the sensation of having a word, and particularly a name, on the tip of our tongues. We often know the first letter and sometimes the first syllable of it. What memory brings to us, however, may not always be the first syllable of a word or name, though we are prone to think it must be, and we may go looking for it in the dictionary of names only to discover after a time that we are many letters away from its beginning. Very often we have to give up seeking in sheer inability to get a hint of it and then of itself it will come a little later. Sometimes it will come when we no longer want it. As a rule, words that have escaped us once in this way are prone to do so again. Over and over again the experience will be that a particular word or group of words escapes our memory, or at least fails to be at our command, as most other things are. Those of us who are not much given to introspection take no notice of these difficulties which are common-place experiences enough, but the man or the woman who is looking for symptoms, who is prone to believe for some reason or other that his or her memory is failing, will take these hints of the more or less natural fallacy of memory as confirmations, strong as direct proof of the fact that memory is seriously deteriorating.

Such pauses and lapses of memory are much more likely to occur if we are nervous and over-anxious about possible loss of memory. I was once asked to attend for a few hours before the time fixed for his oration one of the greatest orators of this country, who was about to talk at a university commencement. What surprised me was that this practiced speaker, who had often appeared before very large audiences, took a very light meal in considerable trepidation, immediately after asked to have certain books brought to him and certain facts looked up for him, took notes in a hurried, feverish way and generally displayed all the over-excitement of the schoolboy about to make his first oration. He was a magnificent occasional speaker, often called upon, yet he assured me that it was always thus with him and that the reason for it was that in spite of previous preparation—and the finish of his orations made it clear that he had devoted much thought to them beforehand—certain of his facts and names and dates had the habit of slipping from him in the midst of the development of his theme, unless he had refreshed his memory with regard to them immediately before, and that he feared that sometime he would find himself in the midst of an address with an absolute blank before him and that he would be compelled to sit down in disgrace. He had never done so and never did in the many years that he, lived afterwards, though always with this dread, never trusting his memory as most people do.

Name Memory .—There are certain circumstances in which memory may fail and yet no significance of a pathological nature can be attributed to the fact. All of us probably have had the disturbing experience of undertaking to introduce two friends whom we had known for many years and yet having to ask at least one of them for his name before we could make the introduction. It is not that we did not know the name, but at the moment we were utterly unable to recall it. After this has happened once or twice it is prone to happen again, because when we set about introducing people the thought of the previous unfortunate occurrences of this kind comes to our mind and acts as an inhibition of memory, making it impossible for us to recall names. Not infrequently if we are brought to the pass of having to ask one of the parties for his name we have to ask the other, though it was on the tip of our tongue a moment before, because in the meantime the disturbance of mind incident to having to ask has interfered with the train of recollection. Men have been known to forget their own names under circumstances of great excitement and such a forgetting is not pathological, but only a physiological disturbance of function because of secondary trains of association set to work in the brain which disturb ordinary recollection. Of course, some people have an excellent memory for names and never have such experiences, but they are very rare, though practice in recalling names does much to keep people from such embarrassing situations. On the other hand, there are some people especially gifted with name memories. Napoleon could recall all his soldiers' names.

Fatigue and Memory.—Occasionally it happens quite normally that when we are very tired certain portions of our memory at least become vague and indefinite and may even fail to respond to any excitation on our part. Under these circumstances we seem to be able only with considerable effort to exert the effort necessary to bring about such connections of brain cells as will facilitate recollection and reproduction and we may fail entirely. In a foreign country it is, as a rule, much more easy to talk the language in the morning when we are fresh than in the evening when we are tired. Especially is this true if we are asked to pass from one foreign language to another, which always requires a special effort. Everyone who has traveled must have had the experience that on crossing the frontier suddenly to be addressed in German after he has been talking French for weeks, may quite nonplus the traveler, even though he knows German as well or even better than French. This is especially true if much depends on the answers, if he has been addressed by a railway official or customs inspector. Apparently there must be a momentary wait until some shifting operation takes place in the brain before the German memory can get to work to establish the connections necessary to enable him to talk German. After a man has been talking to a number of people in one foreign tongue he is likely to be quite lost for words for a moment if he has to use another. The effects of fatigue and excitement and unusualness upon memory then must be remembered in order to be able to reassure patients who pervert the significance of the phenomena.

Ribot gives an excellent personal illustration of this peculiarity of memory in his "Diseases of Memory," which is worth recalling here. He says:

I descended on the same day two very deep mines In the Hartz Mountains, remaining some hours underground in each. While in the second mine, and exhausted both from fatigue and inanition, I felt the utter impossibility of talking longer with the German inspector who accompanied me. Every German word and phrase deserted my recollection; and it was not until I had taken food and wine, and been some time at rest, that I regained them again.

Sensations and Memory.—Just as soon as people compare their memories with others, as they do when they worry and begin to grow introspectively self-conscious, they find noteworthy differences and because of differences they will be prone to think that their memory is pathologically defective when it is only different, or, still more, that because they are not able to remember some things, as others do, their memory must be failing. It is well known that some people have a good memory for things seen, others for things heard, and still others only for things in which they have taken actual part. These are spoken of as visual, auditory and action memories. Memories for things seen are divided into special classes. Some people remember forms very well, while others remember colors. It is evident that our memories are somehow dependent on the special mode in which sensation affects us and that our acutest sensations are the sources of our longest and best memories. Color vision defectives are not affected much by colors and easily forget them. The tone-deaf have no memory for tunes. Every sense defect affects the memory. Sense defects are often unconscious. Their effect on memory may only be noted when introspection begins to bring out the special sensation and memory qualities of the individual. Nature, not disease, may be the basis of some memory troubles thus brought to recognition. All these curious phenomena with regard to memory need to be recalled whenever there is question of a supposed deterioration of it, for it is not easy to decide such a question.

Limits of Normal Forgetfulness.—Curious instances of forgetfulness may occur in the experience of men with excellent memories, which, when they happen to persons morbidly inclined to test their every act, are interpreted to signify something much more serious than they really mean. Nearly everyone has had more than once the experience of telling a story to a particular group of people and then forgetting all about having told it and coming back a few days later to tell it over again. Occasionally a teacher hears the same lesson a week apart and yet does not remember that he went over it before, though the class is almost sure to do so. A man may repeat a lecture that he has given before to the same audience without realizing it. The story has been told more than once of a clergyman delivering the same sermon on two Sundays in succession and, though such lapses are very rare, they do not necessarily indicate a failing memory, but may only mean a lack of concentration of attention on the part of the human mind. Prof. Ribot in his "Diseases of Memory" tells the story of one such case in which the subject was quite alarmed lest it should indicate that he was beginning to suffer from some serious memory disturbance due to brain disease, though there was no ground for his fears:

A dissenting minister, apparently in good health, went through the entire pulpit service one Sunday morning with perfect consistency—his choice of hymns and lessons and extempore prayer being all related to the subject of the sermon. On the Sunday following he went through the service in precisely the same manner, selecting the same hymns and lessons, offering the same prayer, giving out the same text, and preaching the same sermon. On descending from the pulpit he had not the slightest remembrance of having gone through precisely the same service on the preceding Sunday. He was much alarmed and feared an attack of brain disease, but nothing of the kind supervened.

Attention not Memory.—When patients come with complaints of the loss of memory, the most important thing is to analyze their symptoms carefully. This will usually enable us to give patients ample reassurance. I have known men who were convinced that they were losing their memories because of their failure to recall important details in their business affairs in the midst of much hurry and bustle in the winter time, find that when they were living a simpler life in the course of travel or life in the country during the summer time under conditions different from the ordinary, their memory could be absolutely depended on for trains and travel details and all important matters to which they were now devoting attention.

Cultivating Looseness of Memory.—Many people complain of loss of memory in the sense that they do not now remember when things took place as well as they used to. For instance, I have had men of fifty tell me that they were sure that their memories were growing weaker than they used to be because a number of times within a year they had found that events which they thought had taken place only a year or two ago really dated four or five or even more years in the past. Some are considerably disturbed by this. As a matter of fact it is only another instance of lack of attention. Most of what we read in newspapers attracts so little of our serious attention that it is no wonder that we do not recall with exactness when events took place. Events crowd each other out of memory. Newspaper reading is, indeed, the best possible cultivation of looseness of memory that we could have. We do not expect to remember what we read. We would probably grow distracted if we did. At the end of the day if you ask a man what he read in the morning paper he will have no idea at all, unless something especially startling or particularly interesting to him has turned up. After a week we could no more separate Monday's from Tuesday's news of the week before than we could recall a random list of events, having heard it but once. We cultivate looseness of memory with great assiduity. Let us not be surprised if, to some extent, we succeed.