A CASE STUDY AND LESSON IN MEMORY

From: The Emotional Calendar

Gloria
Not long after the sudden death of her husband of 32 years, my patient Gloria moved from their home in rural Massachusetts to a one-bedroom condo in the city of Cambridge. This constituted a dramatic change. Gloria had lived most of her adult life in the farmhouse she and her husband had renovated together and where they had created and managed a riding facility. Gloria loved training horses, and was an accomplished rider, too - she trained for the Olympics as a dressage competitor. Yet within a year of her husband's death, Gloria sold the farm and moved to the city.

As much as Gloria loved her husband and enjoyed her equestrienne life, she had actually had a difficult time coping with that lifestyle - far more than it had appeared to her friends and neighbors and perhaps even to herself. Gloria has bipolar disorder and has suffered with it for decades. She feels its effects most acutely during the fall and winter and has very dark memories of time spent in psychiatric wards during those months. The emotional effects of her experiences with the disorder continue to influence her mindset and behavior to this day; she associates fall and winter weather with traumatic episodes of her illness. Thunderstorms remind her of the times she had to be handcuffed during her most severe bipolar episodes.

The winter holidays particularly pained Gloria. Although she remembers loving the holidays as a young woman before she was married, she found her husband's demands regarding the holiday celebrations to be oppressive. "He didn't understand my bipolar disorder," she explains. Rather than try to make him understand, she chose to retreat from the holiday proceedings. She would delegate most of her responsibilities to family members. She would shut herself in her room and play loud music, or slip out of the house and take long rides through the woods on their property. She wasn't completely absent. She'd force herself to show up at the last minute to attend the parties her husband had planned. When family and friends came to visit them at the farm Gloria did her best to be gracious and she generally enjoyed their company. But her feelings of detachment persisted. Everybody else seemed to be having a wonderful time, enjoying the decorations and activities that her husband loved, while Gloria felt that nobody understood how unhappy the winter weather made her and how isolated she felt for not wanting to take part in the festivities.

The cold, dark days of winter affect Gloria physically as well as emotionally. Her body has always been sensitive to cold, and she always felt that she couldn't get warm enough in the winter. This was a particular problem in the drafty, old farmhouse, especially since her husband wouldn't let her turn the heat up as high as she would have liked. (Now that she's living on her own, she keeps the heat at 80 degrees.) She finds it stressful to get dressed in cold weather. A former model, Gloria likes to look her best, and she finds that all the bulky clothing and extra layers she needs to keep warm hide her attractiveness. "I don't like all the clothes that I have to wear. Just getting them out of storage depresses me," she says. Snow frightens Gloria and makes her feel anxious. "When it snowed [on the farm] it felt like I was trapped. I'd get very depressed. I had lots of friends and my dogs and lots of people working on my farm, but they didn't make any difference. I had old glass windows around the deck. I'd look out these doors and the drifts would keep coming and coming." On top of everything else, she says, "I have to go to the bathroom like crazy in the winter. No matter what. It's just annoying as hell."

Moving into the city produced a very positive change in Gloria's overall state of well-being. She enjoys living on her own terms, though it took her a few years to really embrace her newfound freedom. The first holiday season after her husband's death, Gloria followed her old routine, steering clear of the festivities as much as possible. But she realized that this response to the season was not making her happy. Over time, she became aware of what she was doing and accepted that she had long since forgotten how to proceed gracefully through the holidays. She had grown so used to her solitary time in her room and her lonely rides through the woods that it took a while to wake up to the fact that she missed the holidays in the way she had known them in her early years and now wanted to experience them differently.

But how? After much consideration, Gloria decided that she would have to play the holidays a little more loosely, rather than filling them up with a series of carefully-planned events, as her husband had done. She chose not to get in touch with some of her husband's habitual holiday guests, especially the ones she was not particularly close to. She saw the few people that she really wanted to celebrate with, but in informal settings. No big parties. No elaborate preparations. As a result, she had a much more relaxed holiday season and genuinely enjoyed herself for the first time in years.

Gloria then decided to take same attitude toward the rest of the winter. She bought two VitaLights - a lamp that simulates sunlight - and keeps them on for six hours per day. This is twelve times as long as the recommended usage, but Gloria has decided to do what feels right for her. She also forces herself to leave the house during the winter, which she had found very hard to do in the country. She volunteers at a hospital and ventures out even when the weather would otherwise tempt her to stay in bed.

Yet Gloria's seasonal issues are by no means at an end. She will always be sensitive to cold, and the memories of her difficult experiences continue to distress her. These are part of her physical and mental makeup, and she must continue to cope with them on a daily basis, just as she does with her bipolar disorder. But by knowing how her body and her mind work, and understanding the implications of those effects, Gloria is learning to master her emotional calendar.

A Big Lesson in Memory
As we process the stories of our lives, our brains organize our experiences into three basic categories. Lifetime periods are the most general categories, comprised of broad swaths of memory that we recall in indefinite terms, like "when I was a child." General events are somewhat more specific, and encompass facts like "I studied fine arts at Harvard" or "I grew up in Louisiana" or "I gave birth to my son in 1992." This is the information we tend to access most often in our day-to-day lives. The third category is event-specific memory. These are the stories that we construct about events in our past. These memories are the most rich in detail and the most complex in meaning.

Although it is in our event-specific memory that the depth of our past is contained, we also group these specific memories into the broader categories of general events and lifetime periods. But individuals with certain kinds of brain damage sometimes lose their ability to conduct this kind of contextualization of their specific memories. They can recollect all of the details of the day their son was born, for example, but they think it happened yesterday. Although they retain memories, they are unable to understand the long-term patterns of their life or to draw conclusions about the present. In a healthy mind, it is the ability to categorize and generalize that allows us to draw these conclusions. The more effectively we construct the general categories of the past, the more meaningful those conclusions will be.

This is where the emotional calendar comes in. While understanding broad lifetime periods helps us structure the past, it fails to allow for the ways in which our past interacts daily with our present. When we consider our memories in an annual, recurring construction, however, we can see these patterns more clearly.
People often think of memories through analogies, as a roll of film, for example, or a bookshelf. To access a memory, all we need to do is rewind to the desired point in the film or pull out the appropriate book and relive the experience. But these analogies are misleading. In fact, recollection is a much more complicated process. All of the sensory input we receive is sent to discrete parts of the brain that specialize in interpreting one such type of input. Because of this, our memories are more like constellations of data stored throughout or brains. To retrieve a memory, we need to activate a memory pathway that connects all of these points of information and reconstructs the event. This reconstruction is unique each time it occurs.

Thus Gloria, when speaking about her late husband, recalls him differently depending on her mood, or on the emotions that a specific memory triggers. When she thinks of her marriage in general terms, or as a lifetime period, she says, "He was a wonderful man in trying to please me." The fox hunt pattern on the set of fine china in her home reminds her of her husband, because, she says mischievously, "We were always chasing each other around and around." Yet when asked about him in the context of her memories of winter, her tone changes entirely. "My husband and I didn't get along, but I would say the biggest difference [between us] I learned first was when he said he loves Lara's theme from Dr. Zhivago. And I'm thinking of this snowy scene in her fur coat. That's your most romantic scene in the world?" And of feeling imprisoned in her house during snowstorms, she adds, "Well, I was in an unhappy marriage. So there was no escape."

Scientists generally distinguish between two kinds of memory retrieval. Strategic retrieval is the act of digging through memory to find an experience. Do you remember the last sports event you attended? This recall might require you to think about different kinds of sports you enjoy, different places you've been lately, and various friends you have who prefer athletics, before suddenly you find a cue - something which triggers the correct memory pathway - before recalling that it was when you went to see a tennis match at the US Open last summer. You might remember the journey to Flushing Meadows, the unbearable humidity of the summer day, the gasps of the crowd. The second kind of memory retrieval is called associative retrieval, and it is closely related to something known as the petite madeleines phenomenon. The reference is to Marcel Proust's famous book, Remembrance of Things Past:

...One day in winter, on my return home, my mother, seeing that I was cold, offered me some tea, a thing I did not ordinarily take. I declined at first, and then, for no particular reason, changed my mind. She sent for one of those squat, plump little cakes called "petites madeleines," which look as though they had been moulded in the fluted valve of a scallop shell. And soon, mechanically, dispirited after a dreary day with the prospect of a depressing morrow, I raised to my lips a spoonful of the tea in which I had soaked a morsel of the cake. No sooner had the warm liquid mixed with the crumbs touched my palate than a shudder ran through me and I stopped, intent upon the extraordinary thing that was happening to me. An exquisite pleasure had invaded my senses, something isolated, detached, with no suggestion of its origin. And at once the vicissitudes of life had become indifferent to me, its disasters innocuous, its brevity illusory - this new sensation having had on me the effect which love has of filling me with a precious essence; or rather this essence was not in me it was me. I had ceased now to feel mediocre, contingent, mortal. Whence could it have come to me, this all-powerful joy? I sensed that it was connected with the taste of the tea and the cake, but that it infinitely transcended those savours, could, no, indeed, be of the same nature. Whence did it come? What did it mean? How could I seize and apprehend it?

Eventually Proust realizes that, when he was a child, his aunt Leonie fed him petites madeleines dipped in tea every Sunday morning before church. Proust uses strategic retrieval to find the memory. But the first, consuming recollection of joy that he experiences as he eats his cookie is the most powerful written example of associative retrieval. It is the uncalled-for recollection of a past experience cued not by conscious pursuit, but by an external trigger.
Scientists have become increasingly interested in the kinds of cues that trigger associative recall. When Proust writes about his petite-madeleine experience, he associates it with taste, speculating that because he saw the cookies many times a year, the visual cue didn't hold the same resonance as the flavor. In fact, there is evidence that different senses have different powers of evocation, with smells holding the highest position. This is most likely because the olfactory nerve locates information throughout all parts of the brain, creating a tighter link.

This may also explain the unique association between emotions and scent. In one study, scientists had subjects observe pictures while experiencing various smells. They found that when the subjects were exposed, days later, to the same pictures, their olfactory nerve was activated even though the same odor was no longer present. In a similar study, but with different results, a scientist showed subjects unfamiliar paintings while exposing them to various sensory stimuli, like music, or odor. When they were later asked to describe the painting, their accuracy was the same - but the way they remembered the experience was different. Subjects who were exposed to odor had the most emotional memories, describing the painting as "beautiful," "scary," or "happy" more frequently, and describing their memory as "intense." Their memories had created a powerful link between a visual image, a smell, and a feeling.

You may see this effect in your own life when you consider the way you experience the seasons. While language is limited in its ability to describe smells, we all know the scents that we associate with certain times of year: the smell of the earth after a spring shower (a scent so unique and emotionally powerful that it has a scientific term: petrichor); the smells of barbeque or freshly-mowed lawn in summer. Often, these particular scents can cue vivid emotional responses. Sometimes, we feel the joy or anxiety that we associate with a season. Gloria, for example, in thinking about autumn, remembers the smell of apples from the orchard on her farm, and the heady scent of the fallen leaves when her horse tramped over them after a day of rain. "Oh, everything smells beautiful when it's wet," she told me. "You go into the barn on a rainy day and it's very romantic just because of the smell. Just standing there alone you can feel romantic."

Other times, a scent will cue an experience that is associated more closely with a particular time in our past - a childhood spent jumping into leaf piles, the start of spring athletics, the last day of school. These scents can evoke a peculiar emotional response which we refer to as nostalgia. The term nostalgia comes from the Greek words nostos, which means return, and algos, which means suffering: literally, it means "suffering caused by the yearning to return to one's place of origin." One of Gloria's few positive memories of winter is of seeing her horses' breath billowing out in frozen clouds as they stood in the stables. It reminds her, she says, of waiting for the school bus with her friends as a child, and trying to see each other's breath in the crisp air. Thinking of the horses' breath triggers nostalgia for Gloria - the memory makes her yearn to return to the simple days of her childhood, before she was diagnosed with bipolar disorder, began to feel isolated and afraid in the winter, or entered her complicated relationship with her husband.

Nostalgia is such a powerful and curious sensation that it has fascinated - and flummoxed - scientists for centuries. The term was first applied to Swiss mercenaries in the seventeenth century, and it was treated as a physical ailment. One scientist proposed that it was caused by "excessive body pressurization" which drove blood from the heart to the brain, while another thought it was caused by the "vibrations of animal spirits" in the brain. Others believed it was caused by an excess of cowbells in the Alps. In the nineteenth century, the definition of nostalgia shifted, and it came to be understood as a form of melancholia or depression, or even psychosis.

Today, of course, nostalgia is thought of more generally as a "sentimental longing for one's past." No longer an ailment, however, scientists today have begun to identify in nostalgia a powerful restorative function. Researchers found that while nostalgia is often triggered by loneliness, it can restore an individual's feeling of social connectedness. They suggested that perhaps remembering powerful moments in our past can help us remain resilient in the face of challenges in our present.

For Gloria, and for Proust, the associative retrieval of an old memory can cause feelings of joy or comfort. Sometimes, however, associative retrieval can become an emotional problem. Intrusive memories are powerful memories that are usually associated with some sort of trauma. They are called intrusive because they intrude on a person's life in a way that cannot be controlled. Intrusive thoughts, similarly, are ideas that take hold of a person's mind and cannot be shaken. When communities experience shared trauma, they are liable to form a unique type of memory about the event. Event memory is the term used to describe the factual memory we retain for a particular public event: what happened, when it occurred, who was involved. Event memories tend to deteriorate over time, but they can be reinforced by reports about the event in the media.

Flashbulb memories, not to be confused with flashbacks, are our personal memories for the context in which we heard about a surprising cultural event, particularly a traumatic event like the assassination of JFK or the terrorist attacks of September 11. The common question, "where were you when the planes hit the World Trade Center?" requires people to access their flashbulb memories. Researchers have found that these memories are different from other kinds of autobiographical memory because individuals tend to have absolute confidence in the accuracy of their memories. While you might find yourself wavering about the weather on the day of your first kiss, you are unlikely to doubt your memory of the weather on September 11, even though incorrect Google search might prove that your recollection is wrong.

There is yet another kind of memory which is equally as influential as the others, but much more subtle in its working. This is implicit memory, and it can impact your life without your having any awareness of it at all. An explicit memory is any memory that you are aware of recalling. Implicit memory, in contrast, is a subconscious recollection, which can nonetheless influence the present. Scientists began to understand implicit memory when they were working with amnesic patients. They discovered that even individuals with no functional short-term memory were able to learn new things. Although they might never recall visiting the test center, they were able to retrieve knowledge and perform tasks based on earlier visits - they just didn't know where the information came from. This suggests that we know more than we think we know - and that our lives are be influenced by experience recalled unconsciously - beneath the level of our awareness.

In dealing with these various forms of memory, open acknowledgment and awareness are the keys to mastering their effect on one's emotional calendar. The positive emotional impact of awareness on emotional well-being has led to a field of therapy known as mindfulness therapy. The concept of mindfulness originated in early meditation practices. It was first applied to the field of psychotherapy by Ellen Langer at Harvard University, where it is defined as "intentionally bringing awareness to the present moment in a non-judgmental way."

The concept of mindfulness has since been applied to several therapeutic techniques, including mindfulness-based stress reduction (MBSR), mindfulness-based cognitive therapy (MBCT), and is an influence on many others, like acceptance and commitment therapy (ACT). The foundations of mindfulness are acceptance, non-judging, patience, trust, letting go, and compassion. Through regular meditation and daily mindfulness practices, patients and practitioners learn to understand and live with emotional challenges including physical pain, anxiety, and depression.

Mindfulness can be an effective treatment for people with unstable or especially troubling emotional calendars. And, understanding your emotional calendar, in turn, can help improve your mindfulness. A clear vision of your emotional calendar, with full awareness of the emotional links between the past and the present, will empower you to do better and feel better in the immediate future. Awareness of what troubles you can help you to find a way to change your circumstances in a way that brings positive change. For example, Gloria learned that the sensory inputs of winter cause her distress, both because of their physical discomfort and because they trigger intrusive memories of negative experiences. She realized that the best way to cope with winter was to change the sensory input as much as possible.

For years, Gloria and her husband travelled to the Caribbean for two weeks at the end of each winter and those days in the sunlight by the sea are some of her happiest memories. Now in her home, she creates a sensory experience that mimics this wonderful and different climate: the walls are painted in bright yellows and oranges; she cranks up the heat as high as she likes, and uses the VitaLights to create a warm, sunny atmosphere; she plays reggae music to keep herself energized and cheerful. This combination of tropical sensory cues triggers a positive memory that helps her cope with her anxiety and depression. Her strategy is adaptive and gratifying. Gloria has not rid herself of her bipolar disorder, but she has learned much more about how to manage it.

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