Ask Kathy M. Archives
A Collection of Questions and Answers from TBI Advice Expert - Kathy Moeller

Topic: Memory - Selective Memory

Question:

Dear Kathy M.,

After my sister's brain injury last year (April, 1999) she has made amazing progress. When I speak with her about old happenings in our life, she usually remembers them, however, she has difficulty remembering her husband. Almost daily, she will demand that he get out of "her house". She either does not remember that they are married or she thinks she divorced him many years ago. She does not seem to have this problem with other people. In spite of my assurances that she is indeed married to him and that he is the father of her son, she insists that I am wrong and that he is lying and is turning everyone against her.

I do not live close enough to monitor this relationship, but it has been problematic in the past and I am concerned for my sister's safety during these trying and testy arguements.

Does her selective memory sound "normal"?

Joan


Kathy's Response:

Dear Joan,

I am assuming that when you use the term "normal," your question is, "Is this type of memory problem typical after experiencing a brain injury?"

This is a tough one. Most of the time, when I get questions about what is typical after experiencing a brain injury, I am fairly confident that I am either in my sphere of knowlege or am out of my element. This question is on the borderline, but I'll take a stab at it, as long as you take my answer in the context it is given. I would ask you to also send this message to "Ask a Doctor" to get an answer from a doctor, as well.

Because I am neither a doctor nor a brain-injury therapist, I cannot say whether or not your sister is experiencing what is called either "short-term memory loss" or "long-term memory loss" for the particular situation you describe. More importantly, I cannot say whether there are other factors contributing to either her claim of not remembering or her behavior toward her husband with respect to being married (or not being married) to him. Also, I do not know the specifics of her situation, so I'm not comfortable even offering a guess about the particular situation.

On the other hand, I have networked with hundreds of persons with brain injury for over nine years, and as a result I have seen many patterns. When I see a pattern in memory impairment that is common to many or most of us with brain injury, I can comfortably say that something is "normal" or "not normal" (meaning "typical") after a person has experienced a brain injury. I can tell you that we are often accused of having selective memory, when it is not really the kind of "selective memory" people without brain injury generally refer to (the importance of something may or may not be relevant to our ability to remember/retrieve a particular bit of information).

Typical memory-impairment symptoms

It is typical for persons with brain injury to have difficulty "holding onto" facts and figures from their recent past ("recent past" being defined as the last few days, weeks or even months). For example, if we know something has happened, we may get the date or the context mixed up. We may know that someone told us something, but may get the details mixed up or attribute it to someone else. Or we may not have access to ("remember") all the steps to follow for doing a particular task (something as simple as dressing one's self or something more complex like accessing our e-mail account).

If you had asked me if it was normal for a person to remember their childhood, but not what they did yesterday, I would feel comfortable saying, "Yes, a person with brain injury is fully capable of remembering the details of their childhood, but may not be able to accurately reconstruct yesterday, last week, or even the events of the current day!"

Most of the people with brain injury whom I know do have access to their long-term past (in other words, their "long-term memory" is intact) -- at least for many/most events that happened prior to the injury. Examples include remembering people and events from their childhood, or events in their adulthood before the injury. I would need to double-check this, but I believe it is the case that long-term memory loss, in the sense that a person loses memory of all or most of their past, is relatively rare.

Of course, there is something called "pre- and post-amnesia," which is a kind of amnesia that can be experienced "around" the injury itself. Now, this can be several moments, several days, even several months. In my situation, I have intact long-term memory for most of my past, though there is a period of several weeks pre-injury and about a week post-injury, that are lost to me. Others may lose shorter or longer periods of time "around" the injury event itself, but basically remember most everthing that happened prior.

I am curious to know how long your sister was married before the injury occurred? Also, if she met any new people around the same time of her marriage whom she also struggles with knowing (or remembering). If so, this would make sense. If not, the situation may be more complicated.

Long-term memory loss

When I was living in a brain injury rehabilitation facility, another resident had to look at videos of his wedding day before visits were scheduled with his wife so he would remember being married to her. His "default mode" was that he was still dating an old girlfriend. His brain injury was severe, and when he awoke from his coma, he did not recognize his wife and actually asked for a former girlfriend. Now, this conformed to the date he thought it was when he awoke from his coma, as well (about five years prior), so it made sense.

Not only did he not remember meeting or marrying his wife, he also did not remember any of the people or events after a particular date (which was approximately a year before meeting her). In group therapy sessions, he would turn to her and tell her that he would be willing to accept her as his wife and marry her, because he liked her better than he did his former girlfriend (which caused us all to chuckle, including her). He simply did not have access to any of their history together. When I last saw him, they were "dating" so they could both see if they wanted to marry each other (again).

This particular gentleman had a dual problem -- "holding onto" recent information about being TOLD he was married (because his short-term memory was severely impaired), and secondly, knowing that he got married in the first place (long-term memory had been affected).

Compensation strategies for this type of problem

Awareness is the first step. Over time, this gentleman "learned" that he did not have long-term memory. With repetition (both being told, and reading his notes over and over), he gained awareness that his long-term memory had been affected by his injury. He could then accept both the fact that he was indeed married, and that he did not remember meeting or marrying his wife.

Awareness also helped him deal with his short-term memory problems. By learning to write "Memory Notes" throughout the day, he was able to see that many things happened throughout the day that he only had access to when he wrote and could find and use his "Memory Notes." He would not get angry at family members who "never visited" because he could see that they visited perhaps the day before, perhaps, but he had forgotten about it. He would not try to each lunch twice (and accuse the rehabilitation staff of trying to starve him), because he could see that he had eaten lunch perhaps an hour before. He would follow-through with assignments from therapy sessions because he learned to review his notes, "remember" to do the assignements, and track the steps.

Your sister's particular situation

If your sister is aware that she has either short- or long-term memory loss from her brain injury, she may be ready to start using "Memory Notes" to compensate for the problems she is experiencing. Another strategy that might be useful is for her to create an ORIENTATION page for herself she can refer to daily (or hourly if necessary). This is a very effective strategy for people (1) who have severe short-term memory impairment (and cannot remember moving into a new house, for example), (2) who have long-term memory impairment, or (3) who have both long- and short-term memory impairment.

For example, if a person with both short- and long-term memory impairment, has recently moved, their ORIENTATION page might look something like this:

  • I had a brain injury on November 15, 1999 that makes it difficult to remember things.
  • I hit a bus and was in the hospital for a month.
  • I sometimes have difficulty remembering that my daughter is 10 years old now.
  • I moved into a foster home operated by Jane Doe on January 15, 2000.
  • I used to live in Seattle, Washington, but now live in Medford, Oregon.
  • I have a husband and a 10-year old daughter who are still in Seattle.
  • I talk to them on the phone every evening after dinner.
  • Jane Doe runs the foster home I live in and Mary Smith is also a resident.
  • We live on the east side of town, close to Rogue Valley Hospital. I plan to stay here for several months, while I learn life skills.
  • Breakfast is at 7:00 AM and after that I have therapy sessions at the hospital.
  • I wrote this on January 20, 2000

 

It is best if this page is written by the person him or herself, particularly if they recognize their own handwriting as theirs.

Counseling with a brain-injury savvy therapist

It sounds like your sister needs a good therapist too. The therapist should be very experienced in brain injury as well as family or couple counseling. In the wrong hands, therapy may focus on pre-existing marital problems, when this may or may not be the primary source of the problem.

I have seen people with brain injury suffer greatly by getting "typical counseling" from therapists who do not understand how brain injury affects a person. Since your sister's situation sounds even more complicated than most situations, I would be sure the therapist has worked successfully with persons with brain injury (yes, you can ask for references from former patients and their families).

Also, personalities, goals, and even values can change after a person experiences brain injury, so your sister could be a different person (some of us refer to the old self as "he" or "she"). This is a difficult, yet fascinating aspect of brain injury -- with or without getting into all the psychological or philosophical issues. I can share my personal experience with this sort of thing. I no longer refer to myself as "Kathryn," which is the name I used prior to my injury. The word even looks foreign to me! I use "Kathy," which is what I was called as a child. I know who "Kathryn" is (I remember much of her life, know she got married, remember living with her husband know many of the details of her life and work in New York), but I would be hard-pressed to say that she and I are the same people. A psychologist would probably have a field day with all of this. Suffice it to say that this is simply how I FEEL -- and it all happened right after I hit the bus! Other I know have had similar experiences after their injuries, as well. Is it typical? I don't know. It happens...

Safety

If the arguments between your sister and her husband are "testy" enough to become potentially violent, and they are causing you to worry about your sister's safety, your brother-in-law probably needs some help -- both with helping him understanding brain injury, and perhaps not take things personally, and perhaps with other things. If your sister is also suffering from true "paranoia" (beyond the kind of skepticism those of us with memory impairment typically suffer), both of them need help coping with all of this! The child likely needs some help too!

Accusations of lying and stealing

You stated that your sister thinks you are "wrong" about being married to her husband and also that he is "lying." Does she also think that you are lying? Is there a wedding album she can look at to convince her otherwise? Letters? Cards (perhaps ones she has sent to her husband)?

In my experience (and yes, I thought people were lying to me too), it is helpful to have a network of people you trust who can guide you through this difficult time. I was fortunate to have five months in-residence rehabilitation, and I learned to trust my therapists. They had no vested interest in my life, and also had a way of helping me see for myself, that I had problems with recall and retrieval of information -- also processing oral information (what I heard). Gradually, it all added up, and I was able to see how the "new me" was functioning differently in the world.

Persons with brain injury have been known to think that people are not only lying to them, but also stealing from them. This is "normal," especially early on, because information we are told is not in alignment with what we think we "know." Also because posessions we own that we have misplaced (or even hidden from others, but forgotten about), are lost to us -- when we *KNOW* we would not normally lose such things. This can strain all of our interpersonal relationships.

Again, the solution starts with building self-awareness -- and then to developing strategies to compensate for the problems.

Hope this helps.

Kathy M.

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