Posts Tagged 'memory'

Depression and Deja Vu

DoodleThere is a flood of depression-related info online, but still there are fairly common aspects of depression that only rarely get attention. One of those underexposed things is how (in some of us) depression can occasionally trigger a stream of confusing, unsettling Deja Vu experiences.

    You don’t need to be depressed to get an incidental Deja Vu; everyone can have it once in a while. It may be a weird experience, but by itself it is not abnormal. Depression however sometimes seems to generate several such experiences in a row, within a short time. Let’s take a look into this.

Emile Boirac    To begin with, what exactly is a Deja Vu? In French, “Déjà Vu” means “already seen” or “seen before”.

    The term was first used by the French researcher Émile Boirac in 1876 in the magazine Revue Philosophique, and came back more prominently in his 1918 book L’Avenir des Sciences Psychiques, or The Future of Psychology. That book is now of course completely outdated, but if you’re interested: the full English version (with a wrongly translated title) can be downloaded as a free E-book from Archive.org.

    Basically, a Deja Vu is when a specific sight, sound, taste or smell suddenly evokes a vivid recollection of something you’ve experienced before: a memory that at the same time you know cannot be true, because you’ve not really experienced that thing before. You seem to remember quite clearly having been somewhere before, having done or said or felt something before, even though on a rational level you know this just cannot be right.

Deja VuMy old Facebook friend Sigmund Freud theorized a hundred years ago that such events might be caused by repressed desires or traumatic memories that people could no longer access as regular memory. He called it “paramnesia”. Modern psychiatrists are more inclined to think it has to do with some abnormal reaction in our parahippocampal gyrus: a part of our brain’s medial temporal lobe that appears to regulate what we feel as familiar and what we don’t.

    Let me tell you about the Deja Vu stream I had a few days ago. I was sitting in a rather depressed state at my table when Deja Vus began to appear, one after another. I had some music on the radio and suddenly I recognized the song: I knew I knew it, had heard it before, and I even got back the same slightly sad feeling I’d had the first time when I heard it, long ago. It took a short while before I realized that this was a new song: one that I could never have heard in the past.

    A waft of scent came in from the garden through the open window and suddenly reminded me of an elaborate dinner I once had: it was this grassy, aromatic thyme-or-oregano smell of when I sat with formally dressed strangers at a grand white-draped table with large bowls of high cuisine food. Something I never did, I can tell you.

Never Been There    A few minutes later, the wooden top of my table made me suddenly recall again how I once stood in a museum-like chamber, in some English country house perhaps, where all the walls had been completely paneled from top to bottom with this very same brown kind of wood. A place where I’d never actually been. More such involuntary associations kept coming for about twenty, thirty minutes. Then it stopped.

    Not everyone who has serious depressions will get such Deja Vu moments in a row, but I know from others that similar experiences are not uncommon.

I have two theories about the relation between depression and Deja Vus.

    A first one has to do with the fact that research has established that Deja Vu experiences occur significantly more often among people with temporal lobe epilepsy. They often get them right before a seizure.

ECT StuffThis had me thinking: could it have something to do with damage caused by ECT, electroshock treatments? After all, ECT does induce epileptic fits – that’s how it works, actually. I myself never had any form of spontaneous epilepsy, but (like more serious depression patients) I did get many ECT treatments in the past. Would people who’ve had ECT treatments perhaps be much more susceptible to Deja Vu experiences? Unfortunately, as far as I know, no psychiatrist has ever researched this possible connection.

    My second theory is about a direct relation between depression and Deja Vus. It has to do with the “broken filtering” mechanism that I’ve discussed here before (see my post Broken Filtering, over a year ago).

    What is this filtering? A kind of pre-selection that normally, for everyone, is provided by our brain on an unconscious level. In real life, thousands of little things happen every minute all around us. Pre-filtering ensures that we’re not continuously and completely overwhelmed by a deluge of sensory events and impressions: only a selected, limited amount of them is allowed to enter our brain on a more conscious level.

    In many of us, depression tends to break this filtering. This can go either way. Filtering can run out of control and become much too strong: we will start feeling very numb. Even important “outside events” will no longer enter our brain. We just sit apathetic, our head feeling like it’s filled with wool, without noticing what’s going on around us anymore.

    Or, the other way around, due to depression our filtering can become much too weak: with the result we’re getting overwhelmed by more (and more intense) sensory experiences than we’re able to handle.

Feeling Overwhelmed    It’s the latter situation that may be important here. You probably know this effect of depression, where filtering doesn’t seem to work properly anymore. You open your curtains when you get up and the light hurts your eyes; normal household sounds begin to come in like an ongoing cacophony of pistol shots so unbearably loud you’re getting a headache and feel like driven to madness; simply touching the fabric of your couch with your hand already feels crude and painful; and so on.

    Perhaps in such a situation, Deja Vus work as a kind of surrogate filtering mechanism: some kind of last line of self-defense by your overwhelmed brain. By randomly converting a few of all those incoming sights, sounds, tastes, smells into fake memories, they get redirected and you get a little refocused. From the meaningless cacophony all around you, in this way the brain reconstructs some arbitrary new meaning for you: a memory – even though it is a false memory – that you can temporarily focus on.

    Maybe this is what such Deja Vus really are: small limited moments of confusion that actually help to prevent or at least to contain the utter, more complete, meaningless, overwhelming confusion.

    You can take my theories for what they are: just some wild guesses. In the meantime I do think it’s a pity that psychiatrists have never bothered to really research the relation between serious depression and frequent Deja Vu occurrences. Hopefully they will get to it, some time.


 tip: Getting several Deja Vu experiences in a row can be unsettling. But it does not mean you’re going mad. Maybe it’s just a normal, perhaps even sensible reaction of your brain that helps you contain your general, depression-induced confusion.
    If you find your Deja Vus disturbing, or if they don’t stop after a while, what will help is – as so often – concentration: using a little bit of the Mindful approach. Try to concentrate fully on your own body or on one simple thing that is happening right before your eyes, and the Deja Vus will go away.

• note: A good, readable seven-page introductory article on Deja Vus in general can be found at the HowStuffWorks site: How Déjà Vu Works. Written by Lee Ann Obringer, it covers the different kinds of Deja Vu, a little of the existing research, and some of the theories I had to leave out here. However, it does not go into the possible relations between depression and Deja Vus.


 

Try a Journal

Doodle Mood Meter

One aspect of depression can be that in your day-to-day life, nothing memorable seems to happen anymore. All days look and feel more or less the same. Your life has become something like drifting around in a gray, flat ocean where nothing can be seen but this endless expanse of water. Behind you lies the same. And before you, towards and past the horizon? Nothing but the same.

    Any boats that once might have sailed there, appear to have sunk. Any faraway islands seem to have been swept away by these slow, never-ending, relentless waves. Even your last seagull has drowned long ago:

This “ocean effect” demoralizes you in several ways. Because the perspective is so endless, monotonous, bereft of any orientation points, we can just as well say it leaves with you no perspective at all. This not just kills any shimmer of hope. One of the other things this does, is it drowns your memory into the same sea: because all your days seem equally gray and shapeless, if someone were to ask you what exactly you did three days ago, you would find it hard to tell.

    To prevent your memory becoming such a shapeless blur (and to lift you up a little by reminding you that you actually did do something) therapists will often advise you to keep some kind of diary. Every evening, jot down briefly whatever you did that day. Just record your activities, things that happened: from getting up to work chores, shopping, meeting someone, afternoon naps, cooking a dinner, watching a news show, and so on.

    But in the case of serious depression, my own experience is this general diary idea can be too ambitious and will not always work well. There are two main problems here.

Empty Diary    In the first place, sitting down to systematically remember everything you did during a day requires focus, some degree of clarity, and discipline. Your depression may already have gone deep enough to rob you of those requirements. Then your diary assignment may easily become a task too difficult and time-consuming to keep up. Writing an actual diary will become a burden, and in your mind it may turn into one of those many failures you feel guilty about.

    The second problem is of course that if your depression has already gone far enough to render you fairly inactive and passive, keeping a diary can also expose and stress that fact in a stark, undeniable way. Every night you begin to fill that diary, you are going to describe how your day had too little activities again, too little variety, too much mulling or sleeping or failing. So faithfully recording your complete days may become a kind of recurring evaluation that can depress you even more than you already were.

    If this applies to you, I want to propose an alternative strategy that is simpler, safer, and may work out in a more positive way. Instead of keeping a complete diary, try keeping a one-item-per-day journal.

    You should see this not as a full-fledged journal, but more like a notebook where after each day you need to write down only one short note: of the thing or things you think you’ve done best (or not entirely wrong) that day. Even if you think you did nothing well, there may have been some small thing you still managed to notice or even enjoy, more or less. However insignificant it may seem.

In ocean terms: you don’t write about the wideness of that endless dull ocean or how depressing the entire day at sea has been. Instead you just note that for one brief moment you were able to appreciate the sight of the sunrise over the water. Or that you actually did catch a small fish. A sardine.

    In real-life terms, typical end-of-day notes might be like this:

“Because X came in this morning, made a pot of real coffee instead of instant stuff. First time in weeks.”
Or: “Got postcard from grandma today. She’s a bore, but she means well.”
Or: “Out of cigarettes, so forced myself to go to the shop. Back with a stash.”
Or: “Cat was out again for most of the day, but tonight sat in my lap for a while.”
Or: “Finally got online to pay the electricity bill.”

    That’s all. You get the idea. For each day, one such small note of one small, unimportant, but slightly positive event is really all you need. And believe me, however depressed you are, there always is one such small thing that will come to your mind. Just try to think of something. It will work. Didn’t you at long last wash your stack of dirty dishes, even if this was only because you didn’t have any clean ones left?

    This works not just as a modest exercise in positive thinking. After a while, when your notebook has several such one-a-day notes, every glance through this journal will demonstrate clearly that even though you were very depressed, in fact you were still a little bit alive somehow. You were seeing, noticing things. Maybe even doing something.

Ashore    Of course if after some weeks or months you succeed in climbing out of the deepest ravine of your depression again – drifting ashore from your ocean, I should say – you should keep the habit of leaving one daily note in your booklet. When you begin to feel a little better, more small positive events may surface that deserve to be written down. So in the end, your notebook might gradually evolve into a real journal or diary.

    For a brief general view on keeping a journal, see the post Journal, Diary, What’s the Difference? in the blog of creativity coach Quinn McDonald.


 tip: umm… this post was the tip.


 

Shocking 4: Blast Past

This post is part 4 of a 4-piece series about ECT.
Here are links to the other three parts:

Shocking 1: Waking Up,
Shocking 2: Into the Void,
Shocking 3: On Wheels.

Burning HeadSome eight or nine years ago, my father died. I cannot recall what illness – apart from old age – caused his death. I believe he was in hospital for a while, but I have no idea when or where or how I last saw him. People tell me I made a fine speech at his funeral service (and how in spite of being a non-believer I managed to touchingly recite a traditional psalm). But I myself do not remember anything of that funeral. Not a thing, not a place, not a face, not a word, not a feeling. I just don’t remember. Nor for that matter do I recall anything of how and where my wife and I first met, or of our wedding day. I don’t really remember the events of the day our daughter was born, or how I used to care for her when she was a child. I had to be told my wife once had a miscarriage: I didn’t remember.

    My past is broken, and with it I miss not just an important (defining and guiding) part of my own identity. Because much of the common past I am supposed to share with others is broken, important relationships are damaged as well. A past that needs to be reconstructed from what someone tells you or shows you, is never the same as a shared, remembered past. In daily life this effect is often very unsettling both for myself and for others: it can make people you ought to know well into relative strangers.

    Over the years I kept most of my skills, such as riding a bike or speaking some German and French. Probably (and maybe just because I no longer have my university job) I lost some of my academic experience and knowledge, some elements of my former professional background. But most of all I did lose the actual recollection of many specific events in my life, small and big, happy and sad, trivial or important. From writing books to family vacation trips: I have my own books on a shelf, I have old travel photos to stare at, but I don’t really remember doing all that. Since the time when psychiatrists treated me with ECT (electroshocks, see here and here and here) much of my life between age 25-55 is a blank.

    In an experiment in 1950, when electroshock therapy was still new, a researcher (Irving Janis) asked patients a series of biographical questions both before their ECT treatment, and some weeks and months later. He found that nearly all patients had forgotten parts of their personal history. Whether this memory loss was just a temporary effect or a more permanent problem, remained unclear. Later research (especially since the 1980s) confirmed that many ECT patients did experience memory loss, but such studies often show very contradictory results on the matter of the problem’s scope and permanency. For example, while in the 1990s the American Psychiatric Association claimed that only 0.5% of ECT patients suffered memory loss, official (state-required) statistics for California at the same time showed that 20% of all ECT patients were affected.

Vacation Photo Memory BlurSpeaking just for myself, I can only say that my own memory loss is substantial and real. This memory problem became apparent to me four years ago, when I stopped having frequent ECT treatments. At that time, I awoke from a long-term kind of daze induced by the combination of ECT treatments and strong medication cocktails. Regaining some clarity of mind meant I also became more acutely aware of my memory loss. Over the last four years this has remained a serious problem – my memory seems like a harddisk where some of the folders have simply been wiped. Viewing an old photo and still not being able to remember or recognize its context: a File Not Found effect.

    Just blaming ECT for this (as radical electroshock opposers usually do) may be a little bit too simple. Many other factors should at least be taken into consideration. To name an important one: it is an established fact that an extended period of severe depression may also cause memory loss by itself. As ECT treatment is usually reserved for patients with severe depression, maybe relatively many ECT patients might have developed memory problems anyway? Another factor to consider is of course that when you are getting older, your memory may also degrade just by aging. Are younger ECT patients less affected by memory loss effects than older ECT patients? I have no idea. Yet another question is about the possible results of the ongoing refinement of ECT methods and devices: over the last few decades, did recent patients experience less memory problems than earlier patients? Existing research about all such memory-related factors appears to be fragmentary, contradictory and therefore inconclusive.

    I can only conclude that within existing formal psychiatry, the problem of memory loss as a potential side effect of electroshock treatment never really got the attention it deserves. Somehow the involved psychiatrists tend to regard this problem too easily as a passing, minor effect. Apparently the main question of the effectiveness of ECT as a depression cure – a question that is still provoking heated discussion – is still overshadowing all other questions. I myself once observed an evaluation gathering where former patients met with ECT professionals. Several patients reported serious memory problems, but this did not appear a main issue here: the personal and social consequences of such memory loss were not really meant to be part of an overall evaluation.

    I feel it is very important that this problem finally gets researched in a more systematic and coordinated way. Equally important, it also should get more attention both in the daily context of regular after-ECT-care, and as a factor in the personal decision whether or not to try ECT in the first place. I myself do remember my last ECT treatments reasonably well, but the period of my first ones – some years before, when I was in very bad shape – is just a haze. So I cannot even remember how people have helped me to make a decision about accepting or refusing ECT treatment. I don’t recall anymore if (and how) I was warned about possible memory effects.

ECT    I do not belong to the group of ECT opponents who simply reject ECT under all circumstances. I am willing to accept the possibility that perhaps it may work as a kind of last-resort therapy, in suicidal depression cases where all other therapies failed. But I would certainly like to see better, more thorough research. In the meantime, for myself I am not in a position to judge whether all those electroshocks have really saved me. Maybe they did – or maybe refusing ECT would in the end have made little or no difference. Who knows? Who can tell? Not me. For some specific kinds of medication I can estimate how the price to pay (such as loss of concentration) relates to the result. But I still do not know if the price I may have paid for my ECT treatments (this long-lasting, serious, sometimes crippling loss of personal memories) was in fact worth the result.

    I want to end here with one interesting idea that came up a few times when talking with some of my fellow ECT patients. Are we sure that memory loss is just a side effect of ECT? What if it actually is the main effect, the thing that makes ECT work for some people? The thought behind this is that in a severe depression, looking back to one’s own past may often be a very traumatic experience: the depression makes one’s entire life history into something that feels somber, gloomy, futile and pointless. Both sad and happy recollections then merge into a kind of traumatic component of the depression itself, keeping you endlessly mulling over the past, again and again, in a very negative and counterproductive way. Maybe, according to this theory, ECT sometimes works because by simply eradicating memories, the shocks also erase some of the memory-associated traumatic feelings generated by depression. In that case, some kind of daily forget-everything pill might work just as well


 tip: In my own experience, when you are afflicted by memory loss, having to reconstruct your own past will often become more painful than helpful. When I see old holiday photos and my lack of memory makes me feel miserable, I stop looking at them. Sometimes I even intentionally avoid places or people that may confront me with my memory loss.
    For what it’s worth, here is my general advice. Do not keep trying forever to reconstruct your lost past: try constructing some present and future instead.


 


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Today In History:

Ethel du PontMay 25, 1965 –
Ethel du Pont (49, former wife of President Roosevelt's son Franklin Delano Roosevelt Jr.) hangs herself in her bathroom with the belt of her dressing gown. She had mentioned suicide several times before and was “under psychiatric care” for her depressions.
   In the 1930s, as a wealthy heiress from the Du Pont family, she had been a well-known socialite. In 1937 her marriage with the President's son had been a major event, with the couple being featured on the cover of Time Magazine. After their divorce in 1949 she had married lawyer Benjamin Warren.
   Following Ethel's suicide, the rich Du Pont family established the Harvard Medical School Ethel du Pont-Warren Fellowship Award to specifically support psychiatric research.

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