- Short-term memory
- Repetition is key
- Memories are Personal
- Sense of ‘self’
- Dealing with Expectations
- How it feels on the inside
- From the Outside
- Tips and Tools
There are many different types of memory.
Most of us are aware of short-term or ‘working’ memory, and of the broad label of ‘long-term’ memory.
Short-term memory isn’t the same thing as working memory, it is a part of the working memory. This is explained further under the short-term memory section.
Part of our long-term memory includes ‘explicit’ memories, which are about the things that have happened to us, i.e. ‘event,’ or episodic memories. It also includes ‘data’ or semantic memories, which include general facts and information.
The way psychologists and philosophers view memory is quite different – the later using a tripartite classification of experiential or ‘personal’ memories, propositional/factual memory, and practical/procedural memory.
The difference here is significant. When we come to an understanding of how it feels to struggle with memory difficulties, it helps us to understand the depth of loss that some people experience.
Things aren’t always as black and white as they may seem. Memories are incredibly personal, and their loss can affect emotional responses and behaviour.
There was a time when it was believed we store memories in one part of the brain. There is a lot of research into cellular memory that shows memories can be found throughout the body and in other organs – such as the heart.
Very often, the things that most concern people following a brain injury are whether or not memories will return, together with the problems associated with the sense of self and communicating with others.
People can feel very lost when they try and say or think something, and the data, event or experiential memories that should be there, can’t be found.
Some things belie understanding because experiences can be so personal. Taken as a whole, we can understand that any issues with memory also plays a part in the overall struggles of living with brain injury outcomes.
Looking for the positives when you have no idea where you or anyone else fits in, or when memories or memory function may return, can be worrying and frightening.
Many people feel a sense of loss and frustration, even anger, at not being able to think of the things they want to or know they need to bring to their awareness and should be there.
Impairments to short-term memory can make it feel as though nothing will stick.
Even when we struggle to live a life beyond what seems like the ‘two-second count’ after brain injury, and no matter how hard it seems to follow life, we have far more at our disposal than we imagine.
There are many strategies we can use to help with day-to-day living, and our attitude is probably the most important.
When we understand just how much we can help ourselves by accepting that things may need to be done differently now, we can start to move mountains.
Short-term memory is really more of a prompt than something we need to remember. The information is transitory and what is relevant to what we are trying to do or say is taken-up by the working memory for rapid processing. It is the working memory that ‘does the work’ of grabbing other ‘matched and useful memories’ so that we can shape our perceptions to our sense of self and preferences.
When we talk about short-term memory problems following brain injury, we are talking about the inability of the brain to grasp details in the environment that we need to be able to compute a response.
For example, you might be trying to load the washing machine. You can’t remember how to work it, so you look at the dials. By the time you are looking at the dials, you can’t remember why you are. Your short-term memory has failed. It is the working memory that should notice the failure.
When you have impairments to both short-term and working memory everything you try and do can feel insurmountable.
It doesn’t always follow that those who had a strong working memory pre-injury will fare better than those who didn’t. It very much depends on the extent and nature of the damage.
The main thing to remember is that even though it doesn’t feel like it – everything is going ‘in there’ somewhere.
It is the recall of moment-to-moment events that is the main contributor to frustration. Learning to be patient and learning to let things go is vital for self-esteem. This ability is also essential if you share a home with other people because constant displays of frustration can cause an atmosphere.
Acknowledge that for now, you have difficulty following what you are doing, accept this as part of the journey, and release stress because this only worsens the problems you have. Slowing down and being methodical will support the brain and make the journey through this phase more comfortable.
BEST Suite apps give you the tools you need to learn how to do things for yourself again. They encourage cognitive rehabilitation so that you can learn to take back control.
Repetition is key to learning
Repetition is paramount when it comes to building memories.
Although it doesn’t always feel like it, the subconscious is always working on trying and helping.
When there are memory problems it can feel as though you have to hold all ‘unfiled’ information in your conscious mind. In turn, this can add to problems with feeling that we have the space to think.
Frustration is a natural response when your brain feels like sludge and as though it won’t do anything to help you. However, being curious can be a useful alternative because it switches our focus from what we can’t do, to studying what we can.
Another useful strategy is to focus on giving direct commands to the brain about the things we want ‘it’ to do.
Getting upset adds to the problems. Learning to trust that the brain is hurt, and yet, is still trying to help us while it is repairing, is vital to how well we manage disruption to memory.
Repetition is critical when it comes to re-learning anything, including tasks. For example, if you are trying to learn how to make a cup of tea, doing this only once a day may mean that it can take months or even years to re-master the skill.
In the time in between your brain will think this isn’t a skill you want to master so it will turn its’ attention to what it thinks you do want.
However, if you focus on each task and repeat it over and over again for several days, this will help to build the myelin sheath around the new pathway making it stronger.
What you need is to strengthen these paths so often that you form new habits. Habits help us return to doing tasks automatically again. Your goal would be not having to think your way through something from scratch each time.
It is worth spending the time focusing on problematic tasks because the more we ‘re-store’ as a habit, the more thinking ‘space’ there is in the brain to be able to focus on other things, such as communication.
Keeping focused on a task also improves our ability to improve attention and concentration.
Every memory remains stored at some level – the problem people have is how to access the storage units when so many parts of the map are damaged. It is possible that neurological damage only inhibits access to memories, rather than erasing them, which also fits with the testimony of longer-term survivors.
Memories are personal
A point to note here is that not all memories are as important to us as they are to others or vice versa.
We all have our unique preferences and priorities, and these will affect how we file memories.
For example, a loved one trying to help with memory retrieval by using prompts and cues about a known shared event may have prioritised this in their memory differently. It can take a lot of work to find the end of the common thread.
When other people try and ‘infill’ for you, it is essential to note this. You won’t recall all things the same way other people do.
The ‘mechanics’ are different because of our history and the personal importance we relate to specific parts of an event and our differing perspectives and feelings at the time.
The ‘feeling’ we associated to any particular memory or event, what we learnt, what we ‘thought’ at the moment in time, this is an extremely individual thing – it is ‘personal’ to the point of uniqueness.
The individual intricacies and entanglements behind ‘experiential’ memory’ are vast and complex. If you are trying to help someone get their memories back show them photographs they have taken, take them to places they like, and show them things they have made or written.
It is rarely if ever, talked about, but it is ‘experiential’ memory that mostly gives us a sense of self. It gives us a sense of wisdom.
‘Factual’ memories give us a sense of history and a time-line; our data that provides us with knowledge and learning.
If any part of the system ‘goes down,’ another will eventually take over. We do rebuild the links and can again find our own beliefs, truths, and justifications in what we remember.
Our ‘sense of self’ is related to all types of memory.
We feel competent when we can strategically move from one moment to the next without faltering.
We feel a sense of intelligence when we can remember the chronological details of our past.
We feel comforted by knowing that we are doing things in familiar ways.
A lot of people retain their inner core, self awareness and ‘their sense of self,’ following a brain injury.
However, many people lose the connections that help them feel as though they know who they are. It isn’t that ‘they’ have changed, but the way the brain brings together their perceptions and preferences that is different.
Because understanding what is broken or is what links are missing is useful in rebuilding the concept of self.
When key skills no longer work due to damage in the frontal lobes, we can perceive changes in behaviour and characteristic. Families and friends who observe this, can also believe the person they love has changed.
What has actually changed is the way different parts of the brain are able to communicate. What used to ‘match-up’ to give a sense of personality has broken down – not the personality itself.
Using reflective techniques can help people overcome self-doubt and confusion. When you start to understand that it is the innate personality driving your recovery, feelings of self start to re-emerge.
In time, this sense of history and self does come back.
Amnesia, as in the loss of explicit memory is scary and frightening when and as it happens, however, links are re-forged, most noticeably to the memories linked to our ‘current life.’
That memory does have a remarkable propensity to ‘return’ over time, is hopefully of some comfort to people. The more we dig and poke, the more we aggregate and stir things up.
What is less comforting is understanding that ‘experiential‘ memory – the stuff that has the capacity beyond ‘factual’ recall to help us know and understand who we are, is, very often, far more difficult to re-grasp.
It can take time, and can feel as though you are growing up all over again as you re-build this lost functionality. When lost memories include a lost sense of self, it can feel traumatic and adds to the feeling that someone has changed.
With work and diligence you come back to being who you were before; you can find your familiar self again.
Thoughts about change should be kept in context. The changes we go through are experiential – just as happens to everyone else. Change is related to the wisdom we gain – not to changing the innate personality or beliefs. We remain, under the surface, exactly who we were before.
Dealing with self-expectation
Short-term memory loss can hamper our ability to manage day-to-day activities, and there are many tips and tools to help with this (see last section).
It helps to take things slowly and to give yourself time to plan and carry out tasks.
It might be better to approach tasks that include several or many steps with help.
It isn’t always easy to break things down into manageable steps or to think ahead, and it may take time and practice before you grasp the ‘how to’ of something you have always previously been able to do with ease.
Bare in mind that memory problems after a brain injury are caused by the physical damage within the brain, meaning that people cannot remember, rather than them not wanting to remember. Some memories stay, and some are lost, and mostly there is no choice about this.
How memory impairment feels
Living with memory impairments can be very distressing for some people, while others seem to take it in their stride.
There are several reasons why people feel differently, and sometimes, it can be down to how extensive a brain injury was.
For example, someone who also has a loss of self-insight or self-awareness may not be aware of the impact their memory loss has on them. People can be oblivious to the fact there is a problem at all, and may only notice that they can’t remember certain things when events or conversations prompt them.
Some people accept memory loss more readily than others as they realise that they are unable to change anything no matter how hard they try. Other people find it devastating and react with deep levels of confusion and distress becoming easily frustrated or angered when they can’t remember, think, or do something.
Unconsciously people can create psychological coping mechanisms such as ‘gap filling,’ where people say the first thing that comes into their head because they feel pressured to respond. What ‘comes out’ may or may not be relevant, and it can be difficult to stop this happening.
The response is firing directly from the fight/flight centres of the brain and isn’t compared to internal data, as this is missing, or filtered on the way out. It feels as though what comes out should be correct because the intentions and motivations stay the same.
That you hear, or other people relate as not matching can be a massive surprise. Just because you surprised yourself once, doesn’t mean you won’t be surprised every time this happens. It takes time to get used to confabulation.
The information given when you ‘gap fill’ is usually a nearest best guess or can end up being a ‘shaggy dog’ story. You explain everything from every angle you can think of in the hope that something might match or be relevant. The hope will be that the other person will pull the information out that they need and ignore the rest.
It can be incredibly difficult for people to learn to say that they don’t know an answer or to ask if they can think about it. Not being able to remember the information you need, will be an alien concept to the brain.
People need to have the chance and time it takes to become fully conscious of their deficits.
It can feel as though there are hundreds of black holes in the brain where information used to be. You ‘look’ but nothing is there.
From the outside
Family members can also find memory loss in a loved one distressing.
It can be difficult for people to understand why someone can remember one thing but not another.
Try not to take this personally or to make assumptions about someone’s intentions or character. It can seem as though someone has an attitude problem or that they are lazy when, in fact, they are putting enormous efforts into being able to meet expectations.
Some people do give up and retreat and isolate themselves. They may give excuses for not doing things rather than having to admit that they can’t remember how.
Sometimes relatives and friends can think that their loved one is in denial or that they are psychologically protecting themselves from the shock, changes and trauma. However, this is rarely the predominant cause.
Tips and Tools
A lot of people use devices and apps on their mobile phones to help them, for example, the voice recorder, calendar, or note sections can all help.
It can be difficult remembering which device or app you use for each need or event.
Our partners, BEST Connections, provide the BEST Suite of apps which not only keep everything you need together, but is also designed to help you rewire your brain. The apps use cognitive training concepts so when you use it you are learning about your deficits as you go enabling you to learn and take back control.
Other things that help are:-
- Always keeping things in the same place – especially keys, wallets and eyeglasses
- Using a whiteboard or notice board to write down important information and events. Keep this in a prominent place that is easy to see
- Use post-it notes to label things, for example, cupboard doors, so you know the contents without having to open it
- Keeping notepads handy, especially by the bed and telephone
- Using lists and keeping list pads in the same places, e.g. a shopping list pad on in the kitchen – better still use CueMyLists on the BEST Suite
Following a set routine can also help. Other things that impact memory function are nutrition and sleep, so it is crucial to make sure you follow good sleep practices and eat a highly nutritious diet. Meditation and reflective techniques that encourage self-observation often have a much stronger impact than many people think.