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Sudden amnesia showed me the self is a convenient fiction | Psyche

Photo by Greg Rosenke/Unsplash

Sudden amnesia showed me the self is a convenient fiction

Photo by Greg Rosenke/Unsplash

We were flying up a two-lane state road, passing everyone in sight. ‘Babe, why are you driving so fast?’ I asked. ‘What’s the emergency?’

My wife looked back at me in panic, and said: ‘Something’s wrong with you, and we’re going to the hospital.’

‘OK… why are we going to the hospital?’

‘You’re not right. Here, you need to put on a mask.’

‘Why do I need a mask?’

‘The COVID-19 pandemic.’

‘Where are we going?’

She hit the gas even harder.

Vanessa and I had been talking after we’d both got home from work. I asked her what we were doing about dinner, and she looked at me in surprise, because we’d just had that conversation a few minutes ago. I didn’t remember it. ‘I don’t feel right,’ I told her. She started asking me questions – when is our anniversary, when is my daughter’s birthday, what month is it, what holiday is coming up – and I didn’t know the answers to any of them. I didn’t remember driving home, picking up the mail or teaching my classes at the university. Thursday had just disappeared. ‘We need to take you to the hospital,’ she said. I was confused but compliant.

At the hospital, I was competency-tested at intake, an exam that I failed spectacularly (if cheerfully – ‘Do you know what month it is?’ ‘Nope!’) Within 10 minutes of our arrival, I was inside a CT scanner while they looked to see if I’d had a stroke. It was negative. Back in my room, a neurologist did a video consult, with Vanessa answering most of the questions. Getting a patient history from someone clearly suffering from amnesia was fairly pointless. ‘My brain can’t be broken,’ I offered, ‘It’s my best part.’ Vanessa reported that I’d complained of a bad headache the night before, which had lasted all day. I had (and have) no memory of a headache, or indeed of anything I’m recounting here. This is all pieced together later. The doctors gave me an IV of the migraine special: a cocktail of over-the-counter analgesics, magnesium and Benadryl, which pretty well knocked me out.

First thing the next morning was an MRI scan of my head. That too came back negative. No stroke, no tumours, no history of epilepsy or other seizure disorder, no drugs, no alcohol – nothing. I’m prone to headaches but, as far I know, I’ve never had a migraine. Diagnosis: transient global amnesia (TGA).

Elizabeth Loftus compares our memories to Wikipedia: we can go back and edit the entries, but so can other people

Nobody knows what causes TGA. There are just some nebulous indicators, such as sex, sudden and extreme temperature changes, and acute emotional distress. The biggest risk factors are migraines and being older than 50. But no one really knows what’s going on; there’s not even a working theory of causation. The plus side is that it’s a rare event, and very unlikely to happen again.

Losing memories is eerie, like a discontinuity in the narrative of the self. In An Essay Concerning Human Understanding (1689), John Locke wondered what made him the same person as a particular individual who saw the River Thames flood last winter. His answer was that he had the same consciousness as the man who saw it overflow. Locke argued that he was the same person who just sat down at his desk because he is conscious of having done it; he remembers doing it. He gives the exact same reason for believing that he’s the same person who saw the Thames overflow. He remembers having seen the flood at a particular time, from a specific location and perspective. The present Locke is connected backwards through time to the man who saw the river flooding through continuing consciousness. That’s what makes the two of them temporary parts of one persisting person.

We all forget things, of course – who your 6th-grade social studies teacher was or what you had for lunch a month ago are washed away by the river of time. Looking at memory alone (as some of Locke’s early critics did) is much too narrow a way to think about what it is to be psychologically connected to earlier versions of oneself. There are many overlapping strands of psychological connection: personality, tastes, beliefs, memories, interests, preferences, desires and ambitions, to name a few. These are woven together like the strands in a rope. No one thread continues from one end of the rope to the other, and that’s to be expected. While the fibres that compose a rope are relatively short, they overlap, interlock and twist together so that the rope itself is strong and whole. The same is true of one’s psychological history: it is the time-spanning rope that ties together the different temporal parts and makes us complete.

Amnesia frays the rope. In looking back on my temporary encounter with it, there’s a feeling of fracture, of my brain trying but failing to keep synthesising my mind, like a camera lens gone badly out of focus and then gradually sharpened. I can call up images of my being in the hospital, or doing routine things that I know I must have done that day, but they’re psychologically distant, faded and lifeless. The memory researcher Elizabeth Loftus compares our memories to Wikipedia: we can go back and edit the entries, but so can other people. I believe any feeling of recall I have is no more than the edits of others; Vanessa told me what I said or did during my bout of TGA, and the memory of her telling me gets infused with my own imaginings of those scenes. But I am Locke without a genuine conscious connection to Thursday’s flooding Thames.

Profound memory loss breaks the rope between one’s past and present so severely that it’s an open question whether there’s any true persistence through time. The musician Clive Wearing suffered brain damage in 1985 as the result of viral encephalitis brought on by the herpes simplex virus, and now has a dense, irreversible amnesia. The disease destroyed both of his hippocampi, located in the temporal lobes, and also a portion of his left frontal lobe. As a result, he’s unable to store new long-term memories, and his short-term memory is vanishingly short. If his wife Deborah is gone for more than a few minutes, Wearing greets her return as if she’s been missing for 20 years, with a tearful, heart-wrenching reunion.

In Wearing’s own view of himself, he constantly feels that he’s in the twilight zone between sleep and consciousness, and that he is just waking up at every moment, with the dream world of the past rapidly slipping into nothingness. When interviewed, he repeatedly insisted that he is just now conscious for the first time, that he has been asleep, that he has been blind, deaf, dumb, with no sense of taste, touch or smell. He has never been visited by anyone before. All of his senses, in the moment he’s aware of them, have just been ‘switched on’. When he viewed himself conducting the London Lassus Ensemble on TV, Wearing declared that the person on TV is not himself, that the person ‘is not conscious to me … no connection to me at all.’ When he looked at earlier entries in his diary, written minutes ago in his own hand, he angrily crossed them out or revised them, and has insisted that ‘these entries were written by other people.’ Most hauntingly, Wearing steadfastly maintains that he has been dead, and just now, in the present moment, lifted out of the abyss of nonexistence.

In the middle of amnesia, my tunnel vision was absolute: the very idea of past and future had no concrete reality for me

Sudden amnesia brings persistence and continuity into sharp relief, and it’s tempting to think that it’s only these strange events at the psychological borderlands that raise issues of identity. But the final unweaving of the rope of ourselves is each our destiny, even if by very slow decay. The swift and permanent changes in Wearing, and temporarily, myself, are no different in kind from the gradual changes everyone experiences.

The Buddha thought there is no true self, that the self is a fiction, a mere name to describe a collection or aggregate of ever-changing components. In one text, he gives an analogy of a chariot – a chariot is made out of parts that are in a sense more real than the chariot itself, which is just a convention, a name we give to a certain assemblage of those parts. The 18th-century philosopher David Hume too insisted that he is no more than ‘a bundle or collection of different perceptions, which succeed each other with an inconceivable rapidity, and are in perpetual flux and movement.’ He described the mind as a theatre, the space in which these ever-changing perceptions and thoughts ‘make their appearance, pass, re-pass, glide away, and mingle’. Genuine identity over time he thought to be a fiction and an act of the imagination; we identify persons over time out of custom, without a more profound or defensible philosophical reason.

If Hume and the Buddha are right, then sudden amnesia is the kind of Zen shock that reveals the truth of anattā, the no-self. We are like bands, clubs, armies and teams – at any given moment, there is some collection of thoughts, ideas and perceptions that makes you up. There are psychological and causal links back in time to what are typically regarded as earlier versions of yourself, and forward in time to future yous. But there’s no true persistence of a self through time any more than a rock band that has gradually replaced all its members. Mick Jones is the only remaining player from the original line-up of Foreigner. Is the present band still Foreigner? Could Foreigner exist 20 years from now, with all-female musicians playing dance electronica? We could know all the facts about the band members, all the facts about rock-and-roll, and still not have an objective, definitive answer to these questions. As Hume said, it’s just a verbal dispute, an argument over words. Perhaps our own sense of self is just as much a convenient fiction, a story promoted by our brains that papers over the holes of loss, change and alteration.

Ordinarily I have a good memory, not just for 18th-century philosophers, but for facts and dates, and hold my own at pub trivia. The cliché is that professors are absent-minded and lost in their own worlds, but the truth is that we tend to have tunnel vision when focusing on something, and everything else is excluded from view. In the middle of amnesia, my tunnel vision was absolute: the very idea of past and future had no concrete reality for me. There was no reflection on identity or how I might (or might not) be a continuation of a past self, because there wasn’t meaningfully a past. It felt like existing moment-to-moment, and the usual conceptual toolkit that philosophers take for granted had nothing to wrench or hammer. My experience with TGA lasted around six hours, and my recovery was gradual; in Marcel Proust’s words, my memory came ‘like a rope let down from heaven to draw me up out of the abyss of not-being.’ It’s only in retrospect that I can make sense of how it seemed at the time and what it might mean. Now I’m left with the feeling of having briefly wandered backstage, behind the scenes, to see the props and pulleys, only to find myself out front again watching the show.

Mindfulness enthusiasts encourage living in the moment, without regret for the past or anxiety about the future. For them, I can recommend amnesia, which is an excellent way to live outside of time. It’s not a state in which to take up residence indefinitely, though, as the story of ourselves is a temporal one. I’m glad to have rejoined the narrative.

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11 January 2021