Memory Box

What are memories?  They seem fuzzy and subjective.  Sometimes they’re vivid, but rarely are they true.

A year or so ago a patient came to see me in my clinic.  He was a middle-aged, white, working class man.  He looked so normal in his jeans and t-shirt.  I thought it was going to be just like any other consultation, that is until he started to speak:

“I want to kill myself.  I have a bottle of vodka.  I’m going to get drunk and crash my car on purpose.  I’ve written a note and left it for my loved ones”.  

My heart sank.  Not only because this was a last-ditch cry for help before he committed suicide, but also because it was a Friday evening and I wanted to go home!  I knew right from the first sentence that this consultation was going to take at least fourty minutes to get through instead of the allocated ten minutes.  Plus the Friday traffic meant that I’d get home around 7pm instead of 6pm.  Sigh…

Yes, you can call my reaction heartless, but I’ve seen  loads of patients with similar mental health presentations.  Would you prefer a doctor that gets emotional or someone that can sort you out?  If a patient came in with a cardiac arrest, a bad doctor would panic and get overwhelmed, a competent doctor would fall back on their knowledge and get on with the ALS algorithm.

So, instead of these cases triggering an emotional response in me, it triggers another part of my brain.  I automatically go into problem solving mode.  Who is at home?  Has he got any friends?  Does he take any illicit drugs?  How soon is he planning on committing suicide?  Has he gotten his affairs in order (which makes him much more likely to commit suicide)?

The bottom line was that this man was going to kill himself if I were to let him out of my sight.  I had to sit with him for fourty minutes until the “Crisis Team”, who specialise in suicidal patients, organised an urgent review.

Despite having so many risk factors for suicide, this patient ended up doing very well and managed to get back to his regular life really quickly.

One of the main reasons this patient and many of the other suicidal patients I’ve seen have made such a rapid recovery is due to Cognitive Behavioural Therapy (CBT).  A lot of people don’t realise how much power they have over their own minds and thought processes.  Imagine that you’re in a meeting and a work colleague gives you a funny look from across the room, you may think that you’ve done something wrong to annoy your colleague.  You may end up avoiding that person and feel bad about yourself for some unbeknownst reason.  On the other hand someone else with the same experience may think that their work colleague looks worried about something and would go and talk to her after the meeting to make sure she is ok.  This is the essence of CBT – to “reframe” situations in our own mind and not attach negative thought patterns and emotions to events in our life for no reason.

This may seem a little “woo” for some people.  But there is a lot of science and research backing CBT.  Some people may be surprised to find that placebos (in one study I’ve read the placebo was water!) have been found to be just as effective as antidepressant tablets in several studies.  If this is true, then CBT is surely worth a shot, even for people who don’t believe in it or just think it’s too weird.

I remember seeing one patient after she had been enrolled on an intensive CBT course by the Psychiatric team.  When she came for a review with myself, we started to discuss what techniques she had started to use to cope with her mood.  She was another patient that was doing exceptionally well and had really engaged with her treatment plan.

She started to talk about how she was taught to keep a “memory box”.  I hadn’t heard of this before so asked her more about it.  She said that she had a little tin box which she had filled with cards.  Each card had a positive memory written on it which she could visit whenever she felt down.  She also put this memory box in the same envelope that she kept her suicide note in (she said that she wasn’t quite ready to get rid of her suicide note), so that if she were feeling suicidal she’d have to go through all her good memories before committing suicide.

I left work thinking about my patients memory box that day.  Our memories are really powerful.  I am sure that we all have memories which we try not to think about as they make us experience such visceral negative emotions.  I am also sure we have other memories which when we visit allow us to revisit some of the most amazing experiences of our lives.

What I find interesting though is when our memories start to get mixed up.  My girlfriend and I speak fondly of our time at University.  It was so exciting when we started University, going to a new European City (we studied medicine in Prague), having our own place to live without any parents watching our every move, the night life and meeting people from all over the world.  This is perhaps 5%-7% of the truth.  The rest of the truth was that we were flat out broke, living off of a few pounds a day, living in squalor (I remember how sometimes when you let the water run it would turn brown for some reason?) and we were studying like mad – getting up at 6am, going to University and then studying until we fell asleep at the desk.  This went on for six years.

The fact is that when we revisit our memories it’s likely to be really inaccurate.  We don’t really remember the whole reality of the situation we were in.  It is also true that every time  we revisit a memory more of the “truth” gets lost.  It’s likely that we add or alter something to our fondest memories, until it’s so far removed from reality as to not be relevant to our lives at all.

This is true of negative memories as well.  Every time someone visits a negative memory, it’s likely that they’ve thought about it so much over the years that they’ve altered it beyond all recognition of what actually happened and attributed a lot of meaning to something which is likely completely meaningless.  There’s no reason why if you know how, you can’t keep visiting the memory and make it a little bit more positive each time.

It’s interesting that with things like CBT, we are essentially giving people the tools to alter their memories and experiences in life and literally change a persons perception of reality.  It really does seem that people experience different realities depending on their thought processes, which is part of the reason why we all find it so difficult understand one another.

With time we will learn even more about the science behind thought processes and subsequent behaviours.  It’s not too hard to imagine that one day we will be able to dissect the thought processes, attitudes and perceptions of very successful people and apply them to ourselves so that everyone can reach their true potential.  The world is just starting to understand the science of yoga, meditation and mindfulness.  I am sure that in the near future people will work on their mind in the same way that they go to the gym to work on their bodies.  Can people really expect to be happy and fulfilled without working on their minds?  In my opinion it’s the same as expecting to be six pack shredded by not working out.  Sure, medications may help you on your journey in the same way some medications aid a little bit with weight loss, but it seems that getting the body you want or the mind you want takes real effort.