Memorial For A Brain

When I was in medical school I was fascinated by neuroanatomy and neuroscience. I enjoyed reading popular science books like Broca's Brain and The Three Pound Universe. I liked reading about the classic clinical cases studies that taught us a lot about how the brain works---cases like Phineas Gage, the Nineteenth Century railroad foreman whose brain injury revealed the purpose of frontal lobes, or the case of H.M., the man whose temporal lobectomy taught us about the how memory works.

Patient H.M. had parts of both his temporal lobes removed in order to treat a seizure disorder. After the surgery he was unable to form new memories at all, and he became one of the most-studied subjects in the field of neuropsychology. From H.M. we learned that there are two types of memory, declarative and procedural memory. Declarative memory is the what we use when we learned facts. Procedural memory is what we use when we learn how to do things, like brush our teeth or ride a bike. H.M's temporal lobectomy destroyed his declarative memory, but his procedural memory was left intact.

I'm bringing this up now because of an article in Wednesday's New York Times, "Dissection Begins on Famous Brain". Patient H.M., whose name we now know is Henry Molaison, died last year and donated his brain to a neuroscience project at M.I.T. They are in the process of sectioning his brain to learn more about what went wrong with it. There is even a web site, the Brain Observatory, where you can watch the sectioning as it happens.

I read the story and checked out the sectioning web site, but my reactions are mixed. As a psychiatrist it's fascinating to see that we can study a lesion from an individual patient all the way down to the microscopic level, but as a human being it leaves me feeling rather sad for this guy. It was noble of him to donate his brain, and years of his life, to science but on the other hand I can't help wondering if he ever just wished people would leave him alone.

Have I Told You This?

I've been told that I have a tendency to repeat stories. I've been told that several times, usually with the implication that I'm starting to "lose it". Finally, in today's New York Times there's an article that proves I'm normal.

According to "Story? Unforgettable. The Audience? Often Not.", researchers have demonstrated that there's a difference between "source memory" (a memory of where you learned certain facts) and "destination memory" (the memory of the person you told a fact to). The story talks about a study done by two Ontario psychologists. They took a group of college students and gave them a list of 50 facts. Half of the students were told to read the list quietly to themselves and were shown a picture of a celebrity immediately afterward. The other test subjects were told to pretend that they were "telling" the facts to a picture of a celebrity. All of the subjects were then tested to see if they could remember which celebrity-fact pairs they were given. Students had significantly worse memories for the celebrities they were "talking" to than for the celebrity they were "learning" from.

The psychologists say this is normal, because when someone tells a personal story they are self-involved in the process and less able to attend to the person they are speaking to---making the audience forgettable, in a sense. This also serves an adaptive function:

"The tendency to blank on who-I-told-what may in fact reflect the workings of a healthy memory. Psychologists have found evidence that when people reset a password or a new phone number for an old friend, their brain actively suppresses the out-of-date digits. The old numbers are a competing memory, and potentially confounding."

In other words, if you spend a lot of memory power keeping track of what you've told and to whom, you're going to forget more things overall.

So there. I'm going to pass this little item along to the person who teases me about my repetitive personal anecdotes. Or maybe I've sent this to him already, I don't remember.

Watch Real-time "Memories" Forming

This is pretty cool. Hopkins neuroscience researcher, Dr. Richard Huganir, and his postdoc, Da-Ting Lin, created a fancy microscope that allows one to easily visualize synaptic memory activity (specifically, insertion of AMPA receptors) as green flashes in the video. Find out more here.

Shrink Rap: Grand Rounds is up at TBTAM

Shrinky links include: couples therapy for anorexia; working memory training; and how to apologize. 

Check out this week's Medical Grand Rounds on The Blog That Ate Manhattan.

GotGigs? How many gigs are in YOUR pocket?

It occurred to me recently that most of us carry a fair about of memory devices around in our pockets, purses, and belts.  I pointed out to Dinah at dinner recently my new 16GB thumb drive (Buy.com, $25).  After making some sort of dirty crack, I realized that I typically carry around over 40GB of memory on my person (new 16gig thumb drive, old 8gig thumb drive, 1GB thumb drive on keychain, 16GB iPhone 3G, and my Treo has a 500MB flash memory card in it).

So, I want to know... How many gigs are in YOUR pocket?

Let us know below.  Then post a picture of your gigs to Flickr, using the tag "gotgigs".  I'll put the pics here (as soon as I figure out how to do a flickr gadget).

You Know You've Been Blogging Too Long When

So here at Shrink Rap, we've been at it for a while. Since April of 2006, to be exact, and we have 839 posts now. I think that's a lot of posts.

On my post (was it today or yesterday, or what day is it, anyway?) titled What's In a Name, TigerMom commented, " From the title of the post, I thought you would address what doctors and their patients call one another."

I've written about that, right? I'm sure I have, early on, I don't know what I said, but I'm sure it's been done. If I haven't written it, well one of us has. So I searched. I finally went into our posts, all 839, and went to the oldest page. There's was a post called What's In A Name.

So I have two thoughts:
1) Oy, I reused a post title without even remembering this. If the blog isn't getting old, then maybe I am.
2) Perhaps I'm mellowing, but in the years since, I'm not sure I quite care so much what anyone calls me anymore.

To TigerMom, with regards.

Now I Remember

So in my post from yesterday I talked about the normal process of memory and forgetting. Right after I published that post I started thinking about all the weird little things that I remember.

In order to be a doctor you have to have a pretty good memory. You start out by memorizing muscles and bones and nerves and blood vessels, and work your way into the body by memorizing types of cells and cell processes and biochemical reactions. (How many of you remember how many molecules of ATP are produced in the Kreb's cycle?) The comedian who played Father Guido Sarducci on Saturday Night Live used to have this bit where he'd advertise for the Five Minute College. By sending him lots of money and taking his Five Minute College course, you could get a college degree while learning everything a college graduate remembers five minutes after leaving college.

I'm always surprised by the little factoids and trivia I remember, both in day-to-day life and from college days decades ago. I remember my friend's apartment number because it's the same as the year Jamestown was founded. I remember my childhood phone number (OK, that's an easy one---it's two digits repeated two or three times) as well as the addresses for all the apartments I've ever lived in.

Remembering things too well is rarely a problem for people. When it happens it's usually in the context of unpleasant or horrible memories, memories that intrude on day-to-day life and are upsetting or interfere with one's ability to function, as in post-traumatic stress disorder. These situations are usually managed with therapy, although now people are also experimenting with the use of medications to prevent the formation of intrusive memories after traumatic events. This is still too experimental to be practically useful, however.

Of course, we know that memory is not always a reliable thing. We remember childhood events differently than our older siblings, or not at all. In the 1980's following years of a movement for the treatment of trauma survivors we learned both that bad memories can be repressed, but also they can be created through false memory syndrome. The amazing thing is that false memories can be just as convincing to the individual as real ones.

Speaking of false memory syndrome, here's a practical example. When I started writing this post I was feeling rather pleased with myself that I remembered how many ATP's were produced by the Kreb's cycle. I was wrong. See if your memory is better than mine by checking out this link here.

I Forgot

I was driving home from work the other day and I heard a piece on National Public Radio about professional musicians who forget their instruments. I didn't hear the whole thing, but they mentioned stories about symphony musicians who leave expensive instruments somewhere (the Stradivarius left in the cab, for instance).

They asked a mental health professional who also happened to be a musician why people do these things. The mental health talking head said it happened because the musician was "hyperfocussed" or so concentrated on the upcoming performance that everything else was driven out of the mind. He also speculated that performance anxiety was expressed as an unconscious wish to lose the instrument. What he didn't mention, but the first thing that popped into my head, was sleep deprivation or just simple absent-mindedness.

We all do absent-minded things at some time in our lives. We lock our keys in the car, or ourselves out of the house, or we forget to pay a bill or to mail a bill that's already been paid. We forget birthdays and anniversaries and other important dates that we (and our loved ones) really expect us to remember. Fortunately, we also forget anniversary dates of things that are better left forgotten, although I think it will be a long time before anyone forgets dates like 9/11. (Do young people know the date 12/7? Isn't it amazing what we, as a collective national memory, forget?)

Yet we don't consult mental health professionals about why these things happen. Remembering things, and forgetting, are a natural mental process that happens continously outside our awareness. If the problem becomes too severe---if we start forgetting the names of our spouses or children or where we live, or if the memory problem becomes associated with other brain problems like writing or reading or talking, then it becomes a disease.

Age-related memory changes may concern older people, but they are not necessarily a sign of progressive disease. It can also be a sign of clinical depression, in which case memory problems are temporary and reversible.

Of course, none of this explains why I keep forgetting to take my iPod out of my my car when I get home. It must be an unconscious fear of listening to My Three Shrinks. What I want to know is, what's the unconscious wish for forgetting to pick up your kid?