When you wake up in the morning, how do you know who you are? You might say something like: ‘Because I remember.’
It is a perfectly good answer and one with a venerable history.
The English philosopher John Locke, for example, considered memory to be the foundation of identity. ‘Consciousness always accompanies thinking,’ he wrote in 1694. ‘And as far as this consciousness can be extended backwards to any past Action or Thought, so far reaches the Identity of that Person.’ Many Indians philosophers later stole this from him and add to it.
For most of us, the question of where identity comes from doesn’t have much bearing on day-to-day life. We don’t have to try to remember who we are; it just happens. But for the growing number of people who survive brain injury every year, it can be a different story.
If you survive an accident or an illness that limits your ability to form new memories, leaving you with what’s called ‘antero-grade amnesia’, you might be forced to look elsewhere for your sense of self.
Experts in the Uk Over the past 15 years were working at Headway East London, the UK-based brain injury charity; they’ve met many people for whom anterograde amnesia has been the cause of profound existential chan. Sadie, a pediatric nurse and mother of two who survived a stroke, Gretha, a city worker who fell ill with an infection. Henry, a greengrocer who suffered heart failure during a violent assault, his brain starved of oxygen. They have all recovered well from a medical perspective but, because of amnesia, they find new conscious memories difficult – or impossible – to form. As a result, they live with great uncertainty and disorientation, not to mention dramatic restrictions on their day-to-day freedoms.
The ability to form new memories underpins almost all aspects of personal and professional responsibility. Sadie, Gretha and Henry all became unemployed after their brain injuries, and lost many of the connections and roles that gave meaning to their pre-amnesia lives. Both Sadie and Gretha were forced to move home to live with elderly parents, Henry to sheltered accommodation. When they aren’t at home or at Headway’s centre, all three of them are shadowed every minute of the day by support workers.
The adjustment to amnesia can take a punishing psychological toll. Sadie, for example, lived with terrible anxiety for several years after her stoke. I remember how, as her frustration and panic peaked, she would fly into rages, often targeted at her blameless support worker. In the absence of any conscious recollection of what had led up to these furies, Sadie was at a loss to explain or contextualize them. It seemed to me that, as in a nightmare, she knew only that she didn’t know what was going on.
This is a frightening lesson about what it means to live without the ability to form the conscious thought-memory described by Locke, what psychologists now term ‘autobiographical’ memory. Recollecting recent events allows a person to orient themselves, ground their sense of identity and maintain a narrative thread that coherently places them in the world.
Many survivors have significant memories of their pre-injury lives, formed before amnesia set in, and these old memories can help anchor their identities. Sadie’s relationship with her children, for example, is still hugely important to her. But, at the same time, Henry barely ever refers to his life before injury, and some survivors prefer to forget who they used to be. Even when pre-injury memories do play a role, few survivors rely on them alone. Instead, Gretha, Sadie and Henry have all found new ways to stabilize and feed their sense of self through action: through habits and roles that allow them to keep growing and learning.
Since his injury, Henry has built a career as an artist. Though his conscious memories of this inevitably fade, he gravitates to the art studio with an unerring reliability, drawn back there by the positive feelings his work produces in him. A couple of years ago he was asked to design a badge for Headway members to wear at an exhibition opening event. It read ‘ARTIST’. He kept his copy and wears it frequently, though he now has no conscious memory of the event it was made for.
Gretha speaks eloquently about how her own drawing practice, which she started at Headway, helps to orient her: ‘I know my own handiwork. I know who I am. It’s not always strong but it’s always me.’ She also speaks of its positive influence on her mood, an influence that works even in the absence of conscious recollection: ‘I’m happier when I’ve been in the art studio even if I can’t remember I’ve been there. It’s like, even if you haven’t got the Champagne glass in your hand anymore, but you drank the Champagne, do you not feel pissed after?’
When Sadie sings during the music sessions at the centre, demonstrating her astonishing range and word-perfect recall of Motown classics, it can feel strange to know how profound her amnesia is outside this context.
Sadie has a rich memory of her life before the injury, including her years as a pediatric nurse. The encounter with the baby surely evoked either the ‘skills’ associated with that time, or what researchers would call ‘procedural’ memories, as well as the explicit, autobiographical ones.
Memories themselves are not important. Only when they have changed into our very blood, into glance and gesture, and are nameless, no longer to be distinguished from ourselves , only then can it happen that in some very rare hour the first word of a poem arises in their midst and goes forth from them.
Unlike Locke an autobiographical memory, which is a property of conscious thinking alone, Rilke an memory lives in the action of the whole body, arising from the ‘behavioral disposition’ or ‘enduring mood’ that’s left behind when conscious, narrative memory fades away. When persistent and entrenched enough, Rowlands says these dispositions and moods become an ‘existential style’, a way of being that can hold a person together in the face of ‘catastrophic memory losses.
Those affected always said that when they wake up each morning, there are things that they recognize as part of ‘them’. The aura of dream is replaced almost immediately by a continuity of thought from the previous day.
And behind this are layers of familiar sensation: the dryness of my skin; the exaggerated sensitivity of my hands; the way my eyes want to hide from the daylight; the empty feeling of my typical morning hunger; and the bodily restlessness that will soon get me out of bed. Words are there even before they realize it. Then they look at their partner, stirring next to them, and recognize another whole domain of identity: the people they share their life with and the feelings they bring to life.
Steve Ramsey, PhD- Public Health
Okotoks, Alberta