Saturday, July 19, 2014

More on Memory

After posting the last installment on this blog, a blog I did not expect to maintain after returning from Australia in 2011, I continued, and continue, to think about memory.  Due to a sequence of events and readings I came across Paul McHugh's book, Try to Remember: Psychiatry's Clash Over Meaning, Memory and Mind.  This is the first time in a long time I found myself lying in bed, reading, and trying to hold my eyes open manually for a just a few more pages.  Fascinating book.  After three days I'm halfway through (I've got several books going at one time including two in French).  McHugh is the retired chief of psychiatry at Johns Hopkins and a very significant player in the world of psychiatry.  Superb writing. 

The first half of the book deals with one of the most shameful and embarrassing episodes in the history of psychiatry: "recovered memories," "multiple personality disorder," and  "ritual satanic abuse," (this last is my all-time favorite) weirdness that was peaking when I began psychiatric residency in 1989.  Though I could not articulate why at the time the whole movement struck me as bizarre and wrong.  It was, and is, wrong and wrong-headed.  It would be difficult to estimate the amount of suffering endured by innocent  men, women and families who were wrongly and, to use a word that is out of fashion in American society, sinfully accused of heinous acts that never happened. 

I remember being aghast that there were two "multiple personality disorder units" in Philadelphia when I was a resident even though I didn't have the vocabulary to explain why.  Two.  Both were at prestigious institutions though I can't recall which two.  A lecture to our class by one of the "leaders", alas a psychiatrist, only strengthened my cynicism.  WHAT KIND OF MAN shows up to give a lecture to psychiatry residents wearing a black leather blazer??????  The only thing missing was a riding crop.  We had a field day mocking him in the residents' room after the lecture. 

I had the unhappy opportunity to deal with a "survivor of ritual satanic abuse" at one point in my career, fortunately not in a treatment relationship.  She was psychotic at times and horribly over medicated. Her descriptions of the rituals that the satan worshippers used would have been laughable had they not been so sad.

McHugh is eloquent in his writing against the memories that were implanted in the minds of vulnerable women (90% of patients were women).  Even when they denied that anything happened, insistent questioning and an interrogation and conversation manner generally reserved to Edward G. Robinson movies, eventually wore away many patients' resistance. Then the damaging false accusations flowed.   McHugh's description of the "therapists" who conducted the work, the vast majority of them non-physicians, was succinct.  Incompetent.  Unfortunately many judges were gullible and meted out long sentences to the falsely accused.

One of the fascinating factors in memory is the role of the limbic system (George Murray's favorite part of the nervous system), a primitive part of the brain that attaches emotional valence to experience.  The evolution of the limbic system can be traced back to amphibians.  It is an early warning system that does not operate in shades of gray.  Rather it is black or white.  No subtlety.  Dangerous v. Safe.  Over the years research has shown that the limbic system appears to be more efficient at attaching valence to negative, dangerous and harmful memories than to happy pleasant ones.  The survival value of such a system is obvious.  If a seven year-old places his hand on a hot stove burner the limbic system will encode that experience so that it doesn't happen again.  And I didn't.  Indeed, whenever I was in my mom's kitchen until her death 53 years later I checked the burner very carefully and gingerly rather than placing the entire flat of my hand against the burner as I did then.  The whole scene would replay in my memory including the fact that mom watched me do it.  She couldn't stop it because I acted so fast; she could only react after the fact. 

A number of years ago I had to work with a patient who was being "treated" by a non-physician "therapist" for "multiple personality disorder."  It was an unusual case in that the patient was a man.  He did not have MPD but rather a not rare form of non-convulsive seizure disorder.  The "MPD" responded beautifully to anti-seizure medication and having him end "therapy" that was suggesting symptoms to keep the MPD train moving.  Unfortunately I have no follow-up beyond six months.

The Broadway musical, "The Happy Time" opened on Broadway in early 1968.  It ran for fewer than 300 performances and has the distinction of being the first Broadway musical to lose $1 million.  I saw it (and very much enjoyed it) with my oldest sister in the summer of '68 a few months before it closed.  The entire story takes place in the memory of a sybarite photographer from a French Canadian village.  Several of the songs are meditations on memory. I've listened to the soundtrack several times this week while putting down thoughts on memory for the conference in Florida. As the opening line of the first song points out "The memory plays tricks."  Weirdly enough, in the context of what I've been writing, that trip to New York with my sister created a hilarious memory that only she and I can share.  No one else finds it even remotely funny.

Despite having discounted the whole silliness of recovered memories, a silliness that Paul McHugh helped stop, it is embarrassing to think that I am a member of the profession that helped create it.  Alas, the DSM continues to use terms such as dissociative identity disorder that fail to correct wrong-headed assumptions that are completely unscientific.  Ah yes, recovered memories.  I prefer the term false memories.  It is more accurate. 

The memory plays tricks.  Incompetent or unscrupulous therapists play even more tricks. 

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The French do not call 14 July Bastille Day.  Some of them are a bit touchy about that.  Referring to the French National Holiday as Bastille Day marks one as a tourist or woefully uninformed.  The day dawned ugly as had the previous nine days.  (See the whining in the previous entry on 14 July.)  Somewhere around 2 or 3 PM I looked out the window to see splendor.  Sun.  Blue sky.  No clouds.  No humidity.  Gentle breeze.  YESSSSSSSS!!!!!!! (with frantic fist pump action).

Went out with the camera at about 8 PM.  Fireworks scheduled for 10:30 PM.  I wandered to Bellecour and then across the bridge toward the school, crossing over the Rhone.  Talk about a 'lead us not into temptation' moment.  Crossing the bridge I encountered the first of the food trucks.  Among the offerings was French fries.  Frites.  Chips.  HEAVEN.  It would have been possible to purchase 1 kg (that is 2.2 pounds folks) for 7 euros, about $10 or $11.  I was kept from indulging not by the four not-there-until-2011coronary blood vessels but by the possibility of getting grease on the camera. 'Tis the greatest treason to do the right thing for the wrong reason.'  Guess it is. 

Because the fireworks were to be shot off on the grounds of the Basilica at Fourviere I went back to the house for the tripod and cable release.  Found a place at the corner, perhaps 200 yards from my room, where I could tuck into a recess in a building, lean against the wall and keep the legs of the tripod out of the way of pedestrian traffic.  I made one boneheaded beginner's error that may have diminished the quality of some of the firework (feu d'artifice) photos but all in all I am pleased.  The viewing area along the banks of the Saone was packed.  I suspect Bellecour was a zoo. What a pleasure having to walk only 200 yards home.  It was going to be ugly on the roads and on public transportation.  (Parking in our part of Lyon makes Boston look good). 


The first photos feature the Basilique ND de Fourviere before the fireworks. 

Just after leaving the house at about 8 PM.  It does not get dark in Lyon until very late in the summer.  Thus this is the only time I've done any nighttime photography. 

I then went to Bellecour, a huge public space where I catch the subway daily.  It is surprisingly devoid of trees in the center.  That fact does, however, allow it to be used as a public performance space in ways that would not be possible otherwise. 



There was a guy there making huge bubbles using two thin poles and rope about the size of clothesline (for those of you who remember what a clothesline was).  Little kids were going berserk chasing the bubbles.  I could not take as many shots as I wanted to because of the girls' shrieking.  The sound hurt.  Yes it was possible to take pleasure in their sheer joy but the shrieking still hurt.  Got similar photos in Sydney on 30 July 2011.  However, that was around noon.  Got much better prismatic effects this time.  


This cafe is just a few steps away from Bellecour.  

This was taken about 9:15 on the way back from the direction of the school through Bellecour again and heading to the house.  I will admit to enhancing the silhouette aspect.  Love to post-process shots like these. 

Just before the fireworks with tripod and long exposure.  This was a test.

And now the fireworks.  They are not easy to photograph.  A tripod and cable release are requirements.  A fast lens helps.  That is the difference from 4 July last year when I was taking photos from a friends balcony in Marblehead.  This was a faster lens.  Overall better results. 








+Fr. Jack, SJ, MD

Monday, July 14, 2014

Do This In Memory of Me

"Do this in memory of Me."

These final words of the consecration have been haunting me for days.  About a month ago I agreed to give two talks in Naples, FL, one to the Collier County Alzheimer's Association, where I've spoken in the past, and the other at a Presbyterian Church in Naples.  Mary Ann, med school lab partner, has had me visit Naples to give talks to the Alzheimer's Association several times over the past years.  While I'm going to rework a talk I've given to the Alzheimer's Association on dementia and spirituality for the Presbyterian Church, I have to write something new for the association.  Indeed, that is one of the reasons I agreed to give the talk.  It will force me into writing something new.

About three weeks ago I was walking home from class when, as the e-mail to Mary Ann explained, the miracle happened.  The title for the talk blasted into my brain.  "Loss, Grief, Anger and All The Rest:  The Emotional Roller Coaster of AD."  As thoughts for the talk are gradually forming the role of memory is assuming an important role.  Thus, the words "Do this in memory of Me."

Dementia affects memory.  Memory loss is the single most common presenting symptom of AD and many other forms of dementia.  However, the focus of my talk is not going to be on memory loss in the patient with AD.  The talk is going to focus on the loss of shared memories and the subsequent emotions for the husband or wife, children, family and friends of the patient.  I haven't seen anything in the literature on this though I suspect a rereading (planned as soon as I get home) of Colin Murray Parkes book Bereavement in its most recent edition will give some good leads. 

I read somewhere that who we are is in large part determined by our memories.  Shared memory is the foundation on which any close enduring relationship with others is built.  The shared memories that are lost not only by the patient but, more painfully because of the degree of insight remaining, by those who are in relationship with the patient.  When a memory can no longer be shared does its nature as memory change?

There are some memories that are so diffusely shared that many people in the patient's life share them and can thus share them amongst themselves even when the patient is incapable of remembering or entering into the sharing.  This is not as much of a problem.  However the loss of the unique memories that were shared only by the two members of a dyad or a very restricted and small group of others, is painful.  When we lose the ability to share those memories we lose a part of ourselves that is integral to our self-definition.  We lose some of the joy of life.

One of the great sorrows of living to extreme old age is losing all those with whom one could share memories.  I never thought to ask Aunt Irene what it was like to be the last surviving sibling of four. Bad and good memories of growing up at the corner of Blair and Main were no longer shareable except through a long explanation of the back story.  Mom outlived most of her friends and all but Irene in her birth family.  Many of her memories died with them well before she died.

All I have to say to my friends Al and Karen for hilarity to break out is a well-timed, "Yeah, just like the policeman's hat."  The memory is unique to the three of us.  Some day one of us will be stuck with it because there will be no one with whom to share the laughter. 

The pain of the lost memories because the other person sharing them is no longer remembers is great.  It is frustrating.  It is one of the drivers behind the grief and anger that will be covered in the talk.

Catholicism is about memory.  The Eucharist exists only because of memory.  Without the mandate "Do this in memory of Me" there would be no cause for daily Mass.  The Holy Week Triduum is far and away the most emotionally draining, ecstatic and fundamental liturgy in the Church because we remember, recall, and even, in some ways, reenact yet again Jesus' institution of the Eucharist, passion, death and resurrection.  Without that ecclesial memory we are lost.
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Photographically it has been a frustrating week and infuriating weekend.  The weather forecast was optimistic a week ago.  Sunny, dry, lovely . . . .Didn't happen that way for the holiday weekend.  Since Tuesday the sun has not been out for more than five minutes in any particular hour.  And those hours were few and far between.  The skies have been a flat gray that makes photography an exercise in futility.  I've been wanting to go to the Parc de la Tete d'Or for the past ten days but the only day there was adequate sun was one on which I was exhausted.  Outdoor gardens don't photograph well in flat gray light.  A flash is never the answer, at least for this amateur.

Today is 14 July, the National Holiday, and thus far it looks like more of the same.  Saw a few small patches of blue and sun while responding to some e-mail but I'm not racing for the camera.  Yesterday during a lovely 15 minute interlude I was preparing to go out with the camera when a twenty minute downpour followed by gray skies hit.  

Unreal.  Three minutes after I wrote the above that I'd seen a patch of blue and sun it began to rain.  Three more minutes and it turned into a downpour. 

Somewhat random photos. 


A Moroccan tea service on display at the international festival at Bellecour a few weeks ago. 


A cafe up toward the end of the shopping district.  I think every cafe in Lyon has outdoor seating.  It may be simply two or three tables but there is always the option for eating al fresco.  This past Friday the weather was more drizzly October in Boston than summer in Lyon but people were eating outdoors in their coats.


This is the sort of photo I enjoy taking on a morning where I am free.  It is the facade of one of the French Courts overlooking the Saone in Vieux Lyon.  It is a study in contrasting geometry and texture.  Have been playing around with it in black and white as well. 




The spires of the Cathedral of St. Jean that is very near the above court building. 



The Eglise St. Georges where Mass is celebrated in the extraordinary form.  I went there yesterday morning as the weather was sufficiently lousy that I didn't want to risk the mile plus walk to St. Bonaventure. 



A corpus hanging in the foyer between the chapel and the large conference room.  The huge chapel was split into a smaller domestic chapel, the foyer, and a largish well-equipped conference room.  



The view from the garden in what would be a cloister garth if this were a monastic community. 



Three first-year novices after an evening of entertainment and recreation. 


+Fr. Jack, SJ, MD