“There are events that occur in each of our lives that are experienced with a prescient sense that they will always be remembered.”
This is the opening sentence in this intriguing book by Veronica O’ Keane, professor of psychiatry and consultant psychiatrist at Trinity College Dublin. For her, that event happened some 20 years earlier during the course of therapy with a patient called Edith who was suffering from postpartum psychosis.
Edith “knew” that the baby she had given birth to was not hers, although it looked identical, and had stopped caring for it. She became progressively more distressed and was eventually admitted to the Royal Bethlem Psychiatric Hospital in London where O’Keane then worked. She responded well to anti-psychotic medication, was anxious to be reunited with her baby, but remained traumatised and ashamed of the beliefs she had about her baby while she was psychotic.
On one of her follow-up visits to the outpatient clinic, Edith revealed that on her original journey to Bethlem she had caught a glimpse of a small, slightly tilted gravestone in a local cemetery, and suddenly “knew” that her baby was buried there. Many months later, when she passed the graveyard, she re-experienced the acute distress and terror of her original journey. When asked if she now accepted that her beliefs about her baby were psychotic and had no reality, she said “yes… but the memories are real”.
The memory was a thing apart, capable of overpowering her rational understanding of an event, and it could pack the same emotional punch as the original experience. This insight is what set O’Keane off on her investigation into how the neural circuitry of memory plays out in the world of human experience.
Psychiatrists, she notes wryly, have a mixed bag of skills – pharmacology, neurology, psychology, and intuition derived from their experience, but says that the expertise they exclusively own is their understanding of the nature of experience. Psychologists may rightly demur at that claim of ownership. But what is indisputable is that O’Keane’s curiosity and multilayered approach to human experience, and the neural mechanisms that create experience, is richly textured and scholarly in the best sense of that word.
She sets out to describe how emotional states are intrinsically wired into the laying down of memories and to the experience of recall – what she calls the journey of memory from sensory experiences and inner feeling states to neural memory lattices.
Her starting point is sensations, the raw ingredient of memory. Our understanding of the world arrives via our five senses, and we can’t make memories without those sensations. Yet she notes, it took centuries for that now self-evident fact to be accepted because of the rigid body-mind divide that still bedevils our understanding of their inherent and pervasive interconnectivity.
The information coming from our five senses, and from inside our own bodies, are then transmitted to a part of the brain called the hippocampus, which she calls the “memory maker”, where they are turned into memories. These significant personal memories can be dramatic or low key – “a twinge of sadness, a tiny rush of love, an almost imperceptible knot of loss, a whiff of regret”. They are then integrated into the complex networks of the pre-frontal cortex, “the story maker” part of the brain; and at at a higher level again, memory is consciously manipulated in imagination to form new patterns of thinking that allow us to modify and create and, not least, to develop self-awareness.
Situated directly in front of the hippocampus is the amygdala, the emotional “sparkplug” of memory which has a direct connection to the parts of the cortex that process sensations, and is nearest to the part that processes smell. That is why smell can triggers an immediate emotional memory even before the smell can be consciously identified. Proust, O’Keane reminds us, had that insight long before science could explain it.
In the hippocampus, memories are stored using time-place-person as the organising coordinates, with place in dominant position the “solid thing around which the moving film reel of life events are recorded”.
She quotes French sociologist Maurice Halbwachs, who observed when we have reached the part of our past when we cannot remember, even in a confused way, the place where something occurred, we have then arrived in the region of our past that is no longer accessible to us. That first memory is often the starting point for autobiographical memory, the first moment of self-recognition or self-awareness.
The lived experience
Although firmly grounded in neuroscience, her approach to human experience has none of the gung-ho machismo sometimes on display in those so enamoured by the workings of the brain that mind and human experience are relegated to the second division. In contrast, O’Keane’s style is nuanced, her perspective wider and deeper, taking full account of the complexity of human experience.
Her reference points are rooted in her own personal experiences and those of her patients, and she frequently references the insights of Proust, Samuel Beckett, Virginia Woolf, and other lesser known 19th century authors like Charlotte Perkins Gilman, whose intuitive understanding of the experience of memory preceded its scientific explanation. She uses case studies not just to illuminate her points, but to emphasise how much her patients have taught her. And when she says that it has the ring of truth about it.
In the final chapter, O’Keane strikes an optimistic note. She is hopeful that developments in neuroscience will throw new light on the nature of mental illness, and in the process finally end its stigma, but she acknowledges that her patients do not share this optimistic view. She ends the book by returning to the centrality of experience: “Ideas come and go, adrift in a sea of cultural zeitgeists, but living experience, at the end of the day, is bigger than ideas – just like the brain, experience is irreducible.”
This complex book is challenging to read, and merits a second reading to fully understand. But, to borrow a phrase, il vaut le voyage. At the end of the book, O’Keane expresses her hope that the reader will have enjoyed even a fraction of the pleasure she had in the writing of it. Well, I did.
Dr Maureen Gaffney is a clinical psychologist and author of Flourishing (Penguin 2011). Her new book, Your One Wild and Precious Life, will be published later this year
