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

Topic: Memory - Remembering Goals and Decisions

Question:

Dear Kathy M.,

My brain injury was several years ago. Around this time of year I always make New Years Resolutions. I know that it's hard for any of us to keep all of them, but this year I noticed that I don't even remember them. Don't you think this is odd, even if you have a so-called "memory problem." My memory had been getting better, so I'm wondering if, in my case, I've started to get worse. I've done all the therapies I've been given -- especially the memory ones -- so this is very upsetting.

Another thing I've noticed is that I sometimes forget really important things, like my son's football games or the dates of an important family gathering. This is starting to make me look bad (not to mention, feel bad). I used to use a big wall calendar, but haven't gotten around to getting one for the new year. I've resisted too, because I feel that if I continue relying on external things (like calendars), I'm never going to train my memory to get stronger.

I've worked so hard on this and now feel like giving up. Any help you could give me would be appreciated.

Pam in Atlanta


Kathy's Response:

Dear Pam,

Contrary to popular belief, those of us with brain injury cannot rely on our brains to remember "important things." This is a misconception. You are NOT alone!

Remembering "important" things

Part of the problem is that common wisdom tells us that we all remember things that are important to us. When we lose a thought, we often hear (and tell ourselves), "If it's important, I'll remember what I wanted to say." Right?

Well, for many/most of us with brain injury, this is not the way it works! We are fully capable of spacing the most important things in our lives -- and it's not because these things are not really important to us, it's because brain injuries are like that.

I call it "swiss cheese memory." There are always holes in it. It doesn't matter if the thing we're trying to remember is important or not. It may or may not "stick" in our brain. Nor can we count on a particular memory being retrievable to us at the time we need or want it.

Not only is it possible for a person with brain injury to forget important-to-them events, but even things like decisions they/we have made. Also goals we have set. I remember making a decison early in my rehab, to change careers. I communicated this to my Voc. Rehab. counselor, and then made plans to do something completely different. The classes he paid for were now irrelevant to me. I probably thought he was lying to me when I reconstructed things in my head. It was only until much later (when I reviewed some old "Memory Notes") that I realized I had totally mis-remembered the desion I had made about a new career goal.

So...the short answer to your question is, "No, I do NOT find it odd that you do not remember your New Years resolutions!"

The irony of "memory getting better"

Yes, our memory can improve. That does NOT mean it will end up being as reliable as it once was. It also doesn't mean that it will be as reliable as we want it to be -- especially when our lives become more complex. The irony is that the better our memory gets, the more some of us tend to take on, which can mean, in turn, that our memory fails us more often, and we think we are "getting worse."

In my case (so-called "moderate" brain injury diagnosis), when I was first injured, I could not remember what happened during the day. I did not remember family visits during the week. I could not remember the content of conversations with people. I could not read a paragarph in the newspaper and tell you 10 minutes later what the topic was. I could not remember homework assignments from therapy sessions (or the content of the session, often times). And I generally could not recall the context of notes I had written down (if the notes were not detailed enough), nor even the fact that I wrote a particular note (the only proof I had was that the note was in my handwriting, which I recognized as mine).

As time went on, my "organic" memory improved. More "stuck to the walls," as it were. I remember one day, in particular (perhaps nine months post), where so many "things" (memories) came back to me -- out of the blue -- that I felt confident I would be one of the exceptions to the rule, and would be able to completely recover (in the way the medical community uses the word). I "remembered" what I had done the day before. I remembered the content of a previous conversation. I remembered what I'd had for breakfast. It was positively THRILLING!

Good News/Bad News

The downside was that this experience gave me a false sense of confidence. I thought I was "cured" (or well on the way to being cured). I considered throwing away my dayplanner and going back to work as a business executive. I had hope that I would once again have an intact short-term memory that resided between my ears. This was short-lived.

Because of this experience, I started expanding my life. I started doing more. I challenged myself more. I scheduled more things for myself to do. I took on more complex work assignments (I was in Voc. Rehab. doing "practice work" at the time). And I FAILED miserably! I would get conversations with one person confused with conversations I'd had with a different person. I would show up on the wrong day or at the wrong time for an important appointment. I would get some of the more important or complex things done, but would forget to put my clothes in the dryer (so I wouldn't have anything to wear to work on Mondary morning). I thought I was "getting worse."

And that's the irony! The more our memory improves, the more we are tempted to take on. And our lives can actually get more confusing (scattered) so we end up feeling we are doing "worse" -- not so much because our memory has gotten worse, but because we continue to rely on our "organic memory" to get it all done.

Another factor is that our self awareness can improve over time. Combined with improved short-term memory, we are able to remember that we foget things. You see, another irony (and frustration therapists have when working with us), is that those of us with brain injury are fully capable of forgetting that we forget things! It's only after we are able to remember better that we can develop enough insight and self awareness to know that there are things we have previously forgotten about.

Therapies for memory

This brings us to the topic of "memory therapies." I am going to guess that the kind of therapy you are talking about is therapy designed to improve short-term memory. "Of course," you might say, "what other kind of therapy is there?"

Good question. And the answer is important!

In my experience, the most important "therapy" I received for "improving" my memory was not directed at improving my organic memory at all. It was focused on learning new skills -- skills related to compensation.

Compensation skills help us learn how to RETRIEVE information, not improve our memory. If you think about it, information retrieval is what "memory" is all about. So if one's memory is impaired, but one can still retrieve information, basically, you don't have to worry about improving your memory at all! How well your organic memory works becomes less and less important, as you are able to accomplish more by improving information retrieval skills.

In my case, this meant mastering the art of using "Memory Notes" -- writing them in such a way that hey had meaning to me, organizing them in a way that I could find them when I needed them, and knowing what to do with them so I could follow up on things and get stuff done. All too often, those of us with brain injury are coached to "write stuff down," but we are not taught strategies for finding and using our notes. This is a tragic flaw with much of the "cognitive therapy" we are given.

Another problem with traditional approaches to cognitive therapy (which includes therapy dealing with memory), is that the focus is often on IMPROVING memory, not learning other information retrieval skills. As odd as this might sound, too much focus on improving memory can lead to massive frustration, lost opportunity and even dispair. Depending on the situation, it can be like giving persons with profound hearing impairment "hearing therapy" -- to improve their hearing. Or advice to practice memory exercises. Hmmm.... would we give a profoundly hearing-impaired individual advice to "practice hearing"? Or giving a person with blindness advice to "practice seeing"?

Or would we consider it more productive (and humane) to counsel these individuals to learn compensation skills -- use of a TTY machine or other assistive devices, training to lip read or use a talking computer, etc. Talk to many of us with memory impairment who have battled back, and I think you will find that some of the advice we were given to "improve memory" maybe considered as silly as giving a hearing impaired individual the advice to "practice hearing" -- or telling a person with blindess to "practice seeing."

Most of us have learned to function well by compensating -- with paper and/or electronic memory aides. With wall calendars, dayplanners, BRAIN BOOK's, Palm Pilots, Peat Systems, special watches, special pagers, oven timers, color coded filing systems -- you name it!

Outsmarting vs. outmuscling memory impairment

Brain injury is something that is best outsmarted, not outmuscled. Trying harder to remember may be less effective in the long run, than mastering compensation skills. Many of my students worry about using compensation tools and skills (at first) because of the same fear you mentioned, Pam -- compensating to the point where their brains get "weak." But no, using your wall calendar will not "weaken" your brain. It will strengthen your life!

Choices

We all ha ve choices about the goals we want to pursue (and if we want to remember them, it would be wise to write them down and display them in our home in such a way that we can cue ourselves (remind ourselves) what they are. The strategies we choose to focus on are a matter of choice too.

For me, the choice was between (1) focusing on compensation, or (2) focusing on medical-model type "recovery." I never lost the dream of recovering (getting my organic memory back), but I also made a decision early on to put most of my energies toward learning compensation skills and mastering the use of assistive devices (tools). At the time it seemed like I could make bigger gains -- functionally -- by focusing on compensation. It is a decision I do not regret.

I am doing more, with less organic brain power, than I ever thought possible (also more than my test scores indicate I should be able to do). My organic memory has improved along the way, but I am convinced a large part of the improvement can be attributed to the fact that I have mastered many, many compensation tools and strategies. Frankly, an improved organic memory is just icing on the cake for me.

If your goal is FUNCTIONAL improvements (meaning, being able to do more things), you might want to redirect your energy. Use the wall calendar if it works for you, and look for other tools too! Talk to those of us who have battled back and find out what works.

Instead of focusing on medical-model type "recovery," see if changing your focus to mastering compensation skills works in your life. You may be pleasantly surprised!

Hope this helps.

Kathy M.

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