As a social worker, I have worked with many older adults
(65+) who have been referred to mental health services for problems relating to
memory, mood, perception, - all subsequently reducing their ability to independently
cope with their everyday lives. In this role I collected and collated their unique
personal histories from the individual and from spouses and/or family
members. These life stories are fundamental
in both making a diagnosis, and more importantly, in assessing how the person
will cope with a chronic illness. Life
stories are based on memories that construct the individual's past, present and
future. Holes in recall make
understanding who you are, and who the people around you are, seriously problematic. Loss of memory equates to loss of self.
Common in people with moderate to severe dementia is the
inability to recognize one’s self and one’s closest family members. Individuals question who it is that they see
in the mirror, and can not accept that it is their own reflection. The reason for this ‘disorientation to self’
is the loss of short-term memories essential to secure the individual’s reality
to the present day. Most often, people
with dementia rely on their oldest memories stemming from their own childhood, youth
or early adulthood. The aged face in the mirror does not support the
individual’s perceived self-identity as say, a 10year old child. As a
consequence, the spouse of the last 40 years cannot be explained (or believed),
and adult children become strangers. Further
adding to the distress of all involved, is that the person with dementia will
often seek out parents, siblings (in the childhood form) and persons relevant
to this former phase of their life. As
with most symptoms of dementia, this does not occur in everyone, and it may not
be a constant symptom. Medications may
reduce the distress and anxiety, but are unable to correct how the individual
perceives themselves and their place in the world.
Secondly I would like to relate a conversation that I had
with a woman who sustained a head injury after being knocked off her
bicycle. It was our first meeting and she
mentioned that she had visited my homeland, Australia. When I asked her which parts of Australia she
had visited, she apologized and told me that she had been in an accident and
had no memory of the trip. Hence all her
memories of this holiday, and her life before the accident, have been manufactured from photographs and stories she has been given by family and friends. She has long-term memory loss, and is reliant
on others to create her past for her. Again,
a loss of memory, albeit long-term memory, has made this individual
dependent on others to fill the gaps to create a more complete sense of self.
Final point to diminish any lingering doubts re: the
relationship between loss of memory and self-identity. Alcohol.
Many people have experienced anxiety after being unable to recall what
they did or where they went, following imbibing too many alcoholic drinks. This loss of recall may be restricted to
period of only a few hours – but it does leave the individual with a gap in
their history that can have serious consequences (eg: a pregnancy, car
accident, etc); and that leaves the individual at the mercy of others to fill
in the details of their life that have been erased from their memory.
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