When you wake up in the morning, how do you know who you are? You might say
something like: ‘Because I remember.’ 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.’
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 ‘anterograde amnesia’, you might be
forced to look elsewhere for your sense of self.
Over the past 15 years working at Headway East
London, the UK-based brain injury charity, I’ve met many people for whom
anterograde amnesia has been the cause of profound existential change.
Sadie, a paediatric 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 contextualise 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.
But I want to caution against the idea, intimated
by Locke, that the ongoing formation of conscious memory is the same thing as
identity. Despite their often-bewildering conditions, every amnesia survivor I
know is a distinct, vivid human being – they each have an inimitable character
and a strong sense of self. What is it, in the absence of recent memories, that
allows them to know who they are?
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 I know prefer to forget who
they used to be. Even when pre-injury memories do play a role, I’m convinced
that few survivors rely on them alone. Instead, Gretha, Sadie and Henry have
all found new ways to stabilise 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 I believe 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. I also remember a day when one of the staff at Headway brought in her
newborn baby to visit. On seeing them, Sadie dropped out of the excitable,
somewhat distractible mode that often occupies her at the centre and calmly
took the baby in her arms. She cradled the newborn with assurance while asking
the mother acute, sensitive questions about its health and sleeping habits.
Sadie has a rich memory of her life before the
injury, including her years as a paediatric nurse. The encounter with the baby
surely evoked both the ‘skills’ associated with that time, or what researchers
would call ‘procedural’
memories, as well as the explicit, autobiographical ones. But I think the
experience was more than the sum of these parts; she hadn’t simply reverted to
the past. For a moment, and perhaps for the first time since her injury, Sadie
was the most centred person in the room: oriented not just to the child in her
arms and to the adults around her but to her own identity. I was watching her
in the throes of a whole-person, embodied memory: a moment that unified her
historical expertise, unconscious physical habits and consciously remembered
experiences with her present intentions, bodily sensations and deeply felt
emotion. I only wish I had asked her, in that moment, how she felt.
The observation I’m trying to
make is that personhood isn’t the sole property of the mind, or of the brain,
or of any one function of these entities. Personhood is a property of the whole
body, and the whole body is implicated in how both personhood and an
individual person can persist in the face of perpetual
forgetting.
It was reading a blog post by
the philosopher Mark Rowlands, discussing his idea of ‘Rilkean memory’, that
finally gave me language for this hitherto unspoken intuition. Rowlands chose
the name because of something that the poet Rainer Maria Rilke wrote in 1910
about how poetry emerges from memories:
… 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 Lockean autobiographical memory, which is a
property of conscious thinking alone, Rilkean memory lives in the action of the
whole body, arising from the ‘behavioural 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 loss’.
This is what I see in brain injury survivors such
as Henry, Gretha and Sadie. When they take part in practices that mean
something to them, they become absorbed in living truths that remind them who
they are. Amnesia survivors, who have lost the conscious memory-formation so
vulnerable to brain injury, are most themselves in contexts that continually
reinforce their embodied tendencies, their bodily dispositions and feelings.
The places where they are most confident in their identities are the ones in
which they are supported not merely to think but to do the
things they love. To support these survivors, we must take seriously the idea
of whole-body, whole-person memory, and look for ways to reinforce it, wherever
we can.
When I wake up each morning, there
are things I recognise as part of ‘me’. 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 I realise it, and I
feel a pang of regret as I break the silence. Then I look at my partner,
stirring next to me, and recognise another whole domain of identity: the people
I share my life with and the feelings they bring to life. It’s a cascade of
embodiment, of tendency, of self, that emerges. Doubtless, if I survived a
brain injury, some of these things might change or disappear. But not all of
them.
https://psyche.co/ideas/memory-involves-the-whole-body-its-how-the-self-defies-amnesia?utm_source=Aeon+Newsletter&utm_campaign=97bb506b7a-EMAIL_CAMPAIGN_2020_10_19_12_27&utm_medium=email&utm_term=0_411a82e59d-97bb506b7a-69453549
