Memory, Perception and Bipolar Disorder

Hospital CorridorI am currently sitting on a train in the last hour or so of my biweekly journey to work.  A journey that should take just under three hours but on this wonderful occasion is set to take just over five.  I am tired and crotchety, but then I’m also in the low cycle of my manic depression so that’s just normal.  So, cue a rant about the inefficiencies of the British transport system? No, actually, the transport system is pretty good (if overpriced).  The reason this journey has taken so long is me and the perception and memory issues that come with my illness.

A little talked about symptom in bipolar disorder is a marked deficit in short term memory and the inability of some sufferers to plan effectively.  Some evidence exists that these deficiencies are markedly worse in men and that they worsen over time (as a male of the species who is getting older I don’t particularly appreciate this insight).  What’s more even if we recognise this deficit and try to find strategies to control it something about bipolar disorder makes the use of verbal memory strategies less effective (not only do we score lower than control, we score lower than OCD sufferers and they have a lot of mental clutter to contend with).  Reading on this I start to wonder how the hell we remember anything at all.  There is one light for us, although our thinking I slower our ‘executive function’ (our ability to connect things like past and future in order to draw conclusions) apparently remains unchanged – so we’re not talking about the same issues seen in people with learning disabilities or the latter stages of Alzheimer’s.  We can still be geniuses, just slower and with a few more holes.

Oh yeah, one study suggested our emotional learning abilities were deficient as well, let’s hope that wasn’t replicated.

I’ve read every book ever written about decluttering my life and improving recall, and I may one day write a management book based on the rehashing of the ten thousand management books that I have absorbed (there’s nothing wrong with my long term memory).  None of it works for me and the research is starting to help me understand why.  Today, when I went to the station, I read the departure board and noted my train was leaving in ten minutes.  I went to the correct platform, stood in my usual place (at the point where, if it’s a short train I get in the last carriage but if it’s a long one I can walk to the emptier rear carriages) and I listened to the announcements.  Because everything was happening as it usually does when the announcements come over the tannoy I heard the London train being announced (at least that’s what my memory tells me I heard) but the fact that the wrong train isn’t filled with people who thought they were going to London means that I have to concede my memory is faulty.  My personal theory, the one that fits my facts, is that I have trouble processing the huge amount of ambient information in my environment and therefore my brain walls my consciousness off from it and simply manufactures or at least edits a reality out of the din based partly on actual reality but partly on my brains re-creation of reality in a simpler and easier to process form.  This seems to be backed up by other observations such as my inability to read if the television is on or if people are talking near me (I cannot hold my attention), and the fact that social situations are incredibly exhausting to me as I am having to process so much all at once.  So, I believe I got on the wrong train because my brain relied on an overly simplistic set of cues to identify the state of things surrounding it and in this situation those cues did not gel with reality.

Of course the fact that bipolar sufferers experience innate memory problems has another, depressing, side to it (bipolar pun!).  Lithium and other common bipolar medications can have a significant and long term effect on memory.  Add the fact that our disease leads us to develop memory deficits to the fact that our medication leads us to develop memory deficits and I start to wonder how the hell we remember anything at all (memory pun! I’ll stop now).

Before anyone asks, the doctors do admit it’s real, they can measure it with all sorts of tests and actually see the deficits in functional MRI brain scans (which rates as significantly more convincing to them than the fact we’ve been shouting about it for over 100 years).  For all this diagnostic technology the doctors don’t know why any of this is the case and there are no known treatments. It’s a case of suck it up and get on with it.

Oh, sidenote, our emotional functioning under the MRI is apparently much closer to schizophrenics than to controls as is our working memory. What does that mean? No one knows.

So, back to the train journey.  I just got off at the wrong stop.  The stations really clearly signposted and there was no reason I should have thought I had reached my destination but in my disordered mind I was there.  I saw the cues (brown brick buildings, white picket fence etc.) and my brain embraced the reality of the location instead of checking further.  No help the fact that I have been repeatedly telling myself to check before I move and have had Google maps open to check where I am.  More strange is the cognitive dissonance of not being able to find the gate that I usually use to exit the correct station – of actually pushing against the fence where the gate should be because I know it is there but reality is stubbornly hiding it.  I’m writing this sitting on a metal bench in the dark and waiting for the next train and I’m actually finding it really calming.  I am in the eye of the bipolar thought storm and have surrendered myself to it, what will be will be.  I think that will make this journey six hours now.

Let’s assume we have a handle on the effect this all is having on my train journey (this thing plays itself out every six months or so in some form) and take a quick look at the effect it is having on my life as a whole.  To begin with I have learned not to plan in advance – oh I’ll throw a few societally required things in, I have a pension for example, but I’ll never buy advanced tickets for anything because I cannot guarantee I will be able to arrive at a train station, airport, restaurant or gig  at the time required to use the ticket.  So I never go for the cheap advance rates because, for me, buying them at the point of travel is ultimately cheaper.  When I have to buy in advance, such as for an airfare, I just accept that I will sometimes lose out.  This is probably best illustrated by the time I went to the wrong airport to catch a flight (I went to the airport I usually fly from, all the simplistic cues told me that was where ‘planes left from).

It has an effect on how I manage my day to day work and life.  My job involves a lot of coordination and technical expertise.  With no meaningful capability to plan or ability to reliably recall recent events I place a great reliance on electronic diaries and notes.  If my calendar sends me an email or a pop up saying I have to do something then I do it (there is a great story in their somewhere, unfortunately someone already wrote it).  If that thing seems complex or involved then I will read back through past email, documents and notes to ensure I get it right.  I will do this EVERY SINGLE TIME.  In a quiet environment I can read and absorb information very quickly and my longterm memory for processes (as opposed to specific events) is impeccable.  The fact that I work from home three days a week in a controlled and quiet environment is a godsend, I have also learned not to open my emails until the afternoon because they are distracting and 90% of the urgent things they flag are resolved by the people that flag them anyway.  As an aside, my calendar sends emails and uses pop ups because I will not remember to open the calendar and look at it without such prompts.  The calendar does not objectively exist until it imposes itself upon my reality and that is an important fact for me to remember in all things – they must be set to externally impose.

Another effect is fundamental and personality based.  I tend to be very sanguine when it comes to errors such as those of the train journey.  I have learned that these errors cannot be avoided (or at least I have found no method to avoid them after years of searching) and so have learned to accept them as part of the experience of life.  Moreover I tend to give others excessive benefit of the doubt, no doubt projecting my own failings on to them.  This can be a problem if someone actually does have malicious intent.  Indeed, the truly malicious individual, when my brain finally has the realisation of their existence then becomes a massively disruptive force in my life as they acquire a simplified persona that means that they are actively out to get me as opposed to the more probable subtle reality in which they are trying to achieve a goal that I am in some way impeding them from achieving thus leaving open the possibility of negotiation and reconciliation.

Above and beyond the effect on me these deficits have a terrible effect on my loved ones.  My partner has Chronic Fatigue Syndrome and cannot afford to have three hour train journeys turn into six hour train journeys.  She does not have the luxury of being sanguine about wasted time and energy but equally she does not have the time or energy to take on all of the planning tasks in our relationship (and nor should she have to).  Therefore there is always a tension – she needs to plan far in advance, I need to wait until the last minute.  She reacts to last minute changes with understandable stress and dismay whereas I appear uncaring in my nonchalance.  The effect of this is incalculable but we are starting to find ways to address it.  We often have days apart, where we do our own things.  Or days when we are in the same location but manage our own time, telephoning to arrange for me to go to wherever she is in her plan when I feel like meeting up again.  I have alarms set to remind me to ring her when I am away, not because I don’t care but because I do – not to make contact upsets her and through her me but my brain will not trigger a memory to call without the external prompt.  There are ways, but it is hard and I don’t understand how she can stand it (I’m certainly having trouble with me).

By way of a final musing (for I finally reached my hotel, total journey time 5 hours 45 minutes) I can only expect this condition to get worse with time – possibly to the point where I cannot longer function in my job or perhaps even society.  I hope things won’t advance to the point where the strain on my partner becomes unliveable but I cannot rule it out.  I have no answers, I am staring into an apparent abyss and hoping that, as usual, my perceptions are flawed and that somewhere below is a bottom that I cannot fall beyond.  Whether this is a typically sanguine view of a problem I cannot see a way to influence or a realistic hope only time will tell.

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