T. S. Eliot wrote:
Along the reaches of the street
Held in a lunar synthesis,
Whispering lunar incantations
Dissolve the floors of memory
And all its clear relations,
Its divisions and precisions,
Every street lamp that I pass
Beats like a fatalistic drum,
And through the spaces of the dark
Midnight shakes the memory
As a madman shakes a dead geranium.
In the hands of Trevor Nunn, with the music of Andrew Lloyd Weber, those words become
Midnight, not a sound from the pavement
Has the moon lost her memory?
She is smiling alone
In the lamplight, the withered leaves collect at my feet
And the wind begins to moan
Memory, all alone in the moonlight
I can smile at the old days
I was beautiful then
I remember the time I knew what happiness was
Let the memory live again
Chances are you can hear the music as you read or hear the words. “Memory” may be one of the best-known songs from a musical to have ever been recorded. The song is sung by the character Grizebella, an old, beleaguered cat to whom life has been far from kind. All she wants is to be accepted, to be loved, and it’s only in the play’s final moments does she sing that a new day has begun, and one is left wondering whether she has finally received the acceptance she wanted or if, perhaps, she has passed on to a brighter world. Cats is a strange musical so there’s plenty of room to question the meaning of everything, assuming it has any meaning at all.
Memories, though, the kind you and I have, are strange things. We hold on to them tightly, trying to maintain a grasp on things that we know happened, or we think we know happened, and when we sometimes find out that what we thought we remembered wasn’t really a thing at all, it’s disturbing, unsettling, and disruptive to our entire thought process. If we can’t trust our own memory, what can we trust?
What Is Memory, Anyway?
When we talk about memory, we often think we understand the subject without really understanding the subject. Memory, defined concisely, is our ability to recall events, items, or pieces of relevant data that we have experienced in some form prior to the moment we remember them. That part seems easy enough, doesn’t it?
But chip off that brightly colored, heavily enameled paint a little bit, and things get a lot more complicated rather quickly. First, there’s the matter of whether we’re defining memory as a biological function of the brain, or as a cognitive function of the mind. They’re not the same thing and cannot be studied in the same fashion. Let me see if I can explain this without getting too terribly academic.
When I ask my neurologist if I’m losing memory function or just going insane, he divides memory first between short-term and long-term. Long-term memory is then divided between explicit or conscious memory and implicit or subconscious memory—memories you know you have versus memories you don’t know you have. Explicit/conscious memory is then divided between episodic memory, things that happened to you, and semantic memory, things you know about the world for whatever reason. Implicit/subconscious memory is divided between priming, memories that help us define objects or words, and procedural, motor memories that are automatic, like how to drink from a cup without spilling coffee all over your shirt. Those are all functions of the brain that can be measured and studied if your insurance is willing to pay for it.
Not everyone agrees that those are the best ways to define memory, though. Some will define memory as a set of processes, just like the calls that computer software makes to the processors on a motherboard. Those processes would be divided between encoding, storage, and retrieval. This is more of a mind-based function than a brain-based operation, making it degrees more difficult to study. Encoding is dependent upon the quality of the data and the means through which it is input. If one has a negative learning experience, then the encoding of those memories is going to be deficient and we will say we’ve forgotten them by the time the class is over. Storage is subjective, based on what we want to remember, and retrieval gives precedence to the memories we use most often. As such, the process definition of memory seems to give us far better excuses for why we don’t remember things or remember them correctly.
Then, among some facets of medicine, there is this thing called working memory, the ability to retrieve information within seconds of having obtained it, such as a person’s name or why you just walked into the kitchen carrying your car keys. Working memory peaks in our 20s and slowly declines thereafter, which helps explain why Kat is continually having to remind me that she’s already answered my questions about her schedule fifteen times in the past thirty minutes. There are hundreds of cognitive neuroscientists studying different ways to help us extend our working memory with everything from dietary supplements like spearmint, to mnemonic games and physical ques. The challenge is that no one method has a high rate of success across a broad range of individuals, and when something like epilepsy is added to the equation, few of those methods show any level of success at all.
For all the data and all the studies and mountains of scientific evidence and uncertainty, there’s still a lot about memory that we don’t know. The perception we’re left with is that memory is unreliable, sometimes random, can be easily manipulated, and at the weakest moments of our lives, turn our existence into a living nightmare.
More Of That Family History Stuff
I talked last week about my maternal grandfather, the one that was racist. When it comes to memory, I have to talk about my paternal grandfather, Grandaddy, the one whose cognitive function was cut short by dementia and what we now know as Alzheimer’s Disease. In many ways, these are more difficult memories to recall.
First, our parents were careful to protect us from some of the worst incidents in Grandaddy’s decline. After all, we knew him to be that gentle patriarch who always carried candy in his sweater pocket. His back was hunched slightly from years of hard work, first as a farmer and later as a carpenter. When all my cousins got together, we made for a noisy and rambunctious family and Grandaddy loved being in the middle of that. Those are the memories our parents wanted us to preserve.
I can’t say exactly when Grandaddy’s mind first started betraying him. He sold his house and moved in with one of my aunts a couple of years after Granny died. This way, he didn’t have to be alone, we were told, haunted by the memories and loss of someone he loved in a genuinely stoic fashion. As he grew older, he started forgetting things like whether he had taken his medicine, or where he had placed his medicine.
Masking his memory issues, though, were physical deficiencies that made him more feeble. He had trouble getting around, had to use a cane, and experienced more pain. When he stopped smiling as much and failed to laugh at our childish antics, it was easy to pass off his response as one rooted in pain. Alzheimer’s had been defined in 1906 but didn’t reach a significant level of social consciousness until the 1980s. Most doctors still referred to it as dementia, and even then did so in a whisper, more often choosing to blame other frailties.
But over time, Grandaddy’s behavior became more challenging. He would wander away from his apartment and forget how to return. He would forget the names of his children and grandchildren. At this point, our parents tried to explain that the Grandaddy we knew was gone. There were days when he was mean to his care staff, mean to my aunt, and disagreeable about everything. Other days he seemed fine, jovial, and questioned why he needed to stay in a nursing facility.
Then came the day Poppa received a call requesting him to come to Wichita immediately. Grandaddy had stripped naked and left his room, insisting that he needed to be outside plowing the field, that he already had the mules hitched up and they’d start causing trouble if he didn’t get out there. He was so adamant that he hit a nursing assistant.
From that point, he had to spend the majority of his time restrained for both his safety and that of his caregivers. To what degree that contributed to his further decline is speculation at this point. We weren’t allowed to see him often. He missed holiday gatherings more often than not and when he was there, he sat silently in a wheelchair, heavily drugged so as to reduce the risk of him becoming violent around us grandkids.
By the time Grandaddy died at age 82, he had no memory of anyone around him and only the vaguest memories of the past as far as anyone could tell. His speech was all but gone, more indistinguishable mumblings than anything. He’d sometimes squeeze a hand if one held his long enough, but dementia had eaten away all memory-related functionality he’d ever had. His body was little more than a shell.
I think of those last few visits with him and shudder. No one else in the family has been similarly afflicted to this point, but then, I don’t get to see my one remaining uncle and our family isn’t one that ever talks about how challenging life is. They were raised stoics and remain such even now.
I sit at my desk, too well aware of every time my brain fails me, whether I mention it to anyone or not. The moments a leg forgets that I need its support, or a hand forgets how to button a shirt, or I look across the room at Kat and, for a few seconds, don’t remember her name, those all feed a worry of what might lie in store for my future. Is a future that dark worth living? I have to wonder.
Finding A Solution
There is no cure, not even a good way to slow the progress of Alzheimer’s and other dementia and memory-related disease. Funny how the brain doesn’t take well to having its delicately balanced system of neurons altered by outside influences. The best we have at the moment are drugs that treat the symptoms so that life is, perhaps a bit more livable. Current medications are divided into treatments for memory, treatments for behavior, and treatments to address sleep issues.
Treatments for memory and cognition include a range of drugs such as Cholinesterase inhibitors, that treat symptoms related to memory, thinking, language and judgment; Glutamate regulators that support attention, reason, and the ability to perform simple tasks; and a few drugs that combine the two. Using these drugs requires very careful monitoring, though, and is probably not a viable option for people who have limited outside contact. Someone needs to be able to check on them multiple times a day as the side effects can sometimes be problematic.
Treatments for behavioral issues are likely to change as a person’s condition deteriorates. Early on, issues such as irritability, anxiety, and depression are common, but I read that and immediately think that, to a large degree, those symptoms are present in many of us once we reach a certain stage in life. We have to be careful to not confuse mental health issues with the effect of dementia. Later stages are where more serious behavioral issues are likely to occur and there are treatments for problems like aggression, agitation, hallucinations, and sundowning. However, there are no reliable treatments of yet for the general feeling of distress, verbal or physical outbursts, delusions, or restlessness. Again, I look at that list and see several symptoms I’m already exhibiting, but my doctors continue to assure me I have no measurable decline beyond what is normal for my age, so how will I know?
Many people experiencing Alzheimer’s and dementia-related disease report often severe changes in sleep patterns, but again, many of these mirror symptoms that one has in the natural course of aging. Things such as sleep apnea, restless leg syndrome, and a challenge called “sundowning,” where one becomes restless or agitated late in the afternoon. The good news is that there are a number of non-medical methods of addressing these problems and if they become too severe there are limited medications that can be prescribed with careful oversight. Still, these can all occur normally without any form of dementia. Symptoms are not necessarily significant pointers to causality.
I suppose it’s fitting that June is Alzheimer’s and Brain Awareness Month. More than six million people in the US alone are living with some form of debilitating brain disease, most of which eventually leads to death. If you are inclined to give to such a cause, you can click here to do so safely. You can also do what I do. Go to smile.amazon.com and select the Alzheimer’s Association to receive a portion of the proceeds from your Amazon purchases. If you use Amazon regularly, it can really make a difference. The prevalence of brain disease is not waning and research doesn’t come inexpensively or quickly. I don’t expect there to be any significant leaps in my lifetime, but there could be for my children and that’s more important.
Remind Me Why I’m Here
I want to be sharp-minded, perpetually brilliant, always thinking of new things, new approaches, and new forms of creativity. I never want to lose that ability to sit down at the desk and create something out of nothing. I don’t want to lose the use of words, the ability to string them together in ways that are meaningful, insightful, and maybe, occasionally, even helpful.
Multiple studies show that keeping the brain active, challenging it with new things rather than letting it sit dormant, helps keep brain cells from dying. That’s one of the reasons I’m interested in going back to college. Do I think I’m going to start a new career that leaves millions of dollars to my estate? No, not at all. If anything, it increases the likelihood of dying in debt unless changes are made at the federal level. But it offers me the opportunity to keep alive and functioning that slab of soft meat occupying the majority of my skull.
I am repeatedly being told that the worst thing I can do is sit around the house, alone, and not engage with other people. I need to engage in an intellectually stimulating conversation so that more of my brain is being challenged than what I get from sitting here in the dark reading all the time. The pandemic took that away, though, and as we are slowly, cautiously emerging from those restrictions, the number of places I’m willing to go, the people with whom I’m willing to spend time, is severely reduced from its previous number. I need to find new challenges and being back on a university campus, even if it’s in a limited capacity, offers that possibility.
I’m also aware that part of the issue here could be that if I’m forgetting what I’ve done, the people with whom I’ve worked, the projects I’ve completed in the past, then how quickly have others forgotten me as well? Is there anything I am leaving behind that is memorable? Yes, I’m admittedly conceited enough for that to be an issue. I want there to be something useful, something beautiful, that outlives me and my children. I’m not convinced yet that I’m not doomed to be forgotten long before my own memory dissolves into mush.
Like an old Broadway cat looking for acceptance from those who are younger, prettier, smarter, faster, and more full of life, I offer my memories and hope that’s enough.