Bipolar Disorder and Memory

Photo by Peter Herrmann on Unsplash

I’ve wasted so much time changing my mind. Varied interests? General knowledge? How about I just want to stick to one thing, and do it well enough to honestly say I tried. As we come of age we discount the past. As our suns set we reconcile what’s left. Far too young my accounts remain unsettled.

I don’t remember having a good memory, but I must have. I learned things. They stuck with me. Hard things. Things you have to work at and build on. Now I’m older, and I sit as if with a photo album, thumbing through the pages, to recall significant events that got me here, for better or worse. And the memories just aren’t there.

I’ve talked to my doctor about my memory for a long time, and he dismissed my forgetting things, things like people I met just days before or conversations I had this morning, to stress and context and age. Nothing unusual. Nothing to be concerned about. Only now he’s concerned. I’ve gotten though to him just how bad my memory is, and how scary that is. He says I’m definitively suffering from cognitive decline, which is doctorspeak for losing all that’s happened right up to now.

There are several possible causes. The first is simply the long-term impact on the brain of bipolar disorder. The average person with bipolar disorder 1 doesn’t make it far into their sixties, so the science is sketchy and new. But if something was wrong with my brain for decades, it would be stupid to think that nothing is wrong now, or tomorrow.

Then there’s treatment. These pills I’ve been taking for years. The possible long-term side effects that may just be presenting themselves, because I‘ve been taking these pills since they first came out. So if any study exists about the long term, that study is me, because no one has taken them longer and, other than the experience of people like me, we don’t know the long-term effects yet.

Then there’s that one particular treatment. In the 1990s, when it was still state of the art and not the horror we think it now, I had 23 ECT treatments. Electro-convulsive therapy. Shock treatments. Each morning two nurses hooked up an IV and wheeled me into a little room. They strapped and tightened a blood pressure cuff around my ankle because, paralyzed by anesthesia, only my cuffed off foot would stay lucid, and when the shocks came my foot would twitch, and that was how the doctor, fiddling with dials and holding electrodes firmly to my temples, would know whether the shocks were strong enough, or too strong. Before I closed my eyes the doctor slipped a rubber block between my teeth, to protect my tongue as the convulsions came, and I drifted off. We know ECT fucks with your memory. Big time. How long that impact lasts, and how much memory is lost, and whether the memories lost are only those formed before the treatment or also those that come later, is still hotly debated. It’s hard to measure memories, and the gaping holes in the memories of those of us subjected to ECT, because only we had those memories, no one else can know them, or that they’re gone, and crazy people are so unreliable anyway. How can we know?

Then there’s the terror of all terrors: early onset dementia. People with bipolar disorder are three times more likely to develop dementia, which, early on, can be indistinguishable from the grinding cognitive decline of BD. But BD is episodic. Dementia always. The thought of putting my family through that stands alongside early death as my biggest fear. I don’t even want to think about it.

Or perhaps my problem is attention. Perhaps I‘m not forgetting things. Maybe, because of a limited and distracted attention span, I’m not laying down new memories at all. My doctor wants me to investigate my executive function. Frontal lobe stuff. Is the problem with single, linear memories, or does it come when I have a task to do that is made up of several smaller tasks and difficulty with the string of small tasks trips me up? The whole thing could come down to attention deficit hyperactivity disorder. 1 in 6 people with bipolar disorder have, or develop, ADHD. Today I can’t get through a chapter of a difficult book, and it seems the thick tomes on intellectual history that I love are gone forever. Even movies, seen a second time, seem brand new. Instead of some deep resonance I’m lost in wavering impressions. Impressions can be beautiful. Beauty comes more readily in a forgotten world. Focus, so difficult, so fleeting, can be revelatory as attention is set. The struggle with attention is worth it.

For years I have set my attention through meditation. But I haven’t been meditating much for a long time. That alone may be the problem. So I begin again, shaking off much of what I was taught, much of what I taught, to return to the simple practice of sitting with my focus on my breath, here now, free of the burden of forgetting.

But with a caution. The stuff I taught about mindfulness, the selfish mantra to live for the moment, seems as empty as moments without the foundation of what came before. Sure, we drag our past with us, and it slows us down and sometimes keeps us from the future we desire. But to have that weight fall away is not liberating at all. It’s desperate. It sets you offshore without a rudder into a torrent you’re only prepared for if you can rely on the experience you have earned. Once the weight is gone you can drift off anywhere, buffeted by changing winds and driven by changing tides, until you don’t know who you are, or why you are, and opportunity sets like the sun. At the end of the movie Nomadland Fern says “What’s remembered lives.” Without memories the darkness of irrelevance sets in. In sleep I don’t dream anymore. Memories gone even as the possibility to be anything I want to be is here. I don’t remember what I wanted to be. Like some spiritual milestone I just am. I just am. Without the context of memory, that is not near enough.