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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