What do you remember from your childhood? How far back do you remember? I believe that I have memories from the second house I lived in, close to downtown Pembroke, Ontario where I was born. In my memory, I am with my older cousin who is taking me to a Lumber Kings hockey game. I was just under 4 years old and I didn’t know what a hockey game was, although I thought it might be like checkers. I was so surprised and pleased by this special outing with my favourite cousin and I have always considered this to be my first memory – and one of my happiest memories.
So many of my patients cannot remember their lives before school started. In fact, many of them say they recall very little before age 10 and their favourite memories are often quite recent. Many of them have no good memories at all. Anamnesis refers to a patient’s account of their medical history but this account takes on particular significance in psychiatry where memories and their meaning in the life of a person can be difficult and can even affect how they recover emotionally from trauma they have experienced.
An anamnesis is the patient’s story. The word anamnesis is derived from two Greek words: “against” and “forgetting”. I like to think that a part of my work is to help people not forget the memories they have that are positive and healing.
I often work with youth and their families to develop memory books of good family times. I believe these can balance the impact of traumatic memories. Some of the most effective family therapy techniques involve asking families to build devices to protect their happiest memories. For example, if I ask each member of a family to bring in the family picture they like best and to speak about it, they may remember that the youth who is now surly and sullen was a little boy, eager to help and always kind. A picture of this boy with a little sister in their lap is the reminder. That picture, and its story, worked “against” “forgetting” that important fact.
The other memory problem that patients and their families often want to discuss concerns the “need” to “work through” traumatic memories. I have always been horrified by the belief so many have that you cannot recover from trauma until you have been forced to remember what your mind wants you desperately to forget. At these times, I think anamnesis can work against a patient, which is what we observe when someone’s traumatic memories “trigger” them. I have no difficulty listening to my patient’s traumatic memories, but I have a lot of difficulty with the view that they should be “encouraged” to have those memories if they’re not sure this is a good idea, and the research is beginning to show exactly that. Having said this, the research is also demonstrating that the stories that go with our memories may contact as much fiction as fact. In other words, the way we remember things may not be accurate. Why then, I ask, “work through” them?
I have been contemplating this problem of the meaning of the patient’s story, as they remember it, since I hear so much at this time of year about patients’ “best” and “worst” Christmas. I have observed that people can be healed by hearing and telling their own stories. There is research that supports this clinical observation and so I listen to all the stories people want me to hear even as I wonder about the value of the research, and hope that I’m helping.
I believe it helps because I remember the wonderful afternoon I believe I spent with my cousin, learning that hockey was not much like checkers. If the research is accurate, then the whole thing likely never happened. But, if you don’t mind, I’ll ignore this. This is my first memory of what it means to come from a large family – the kind that looks after you when you’re twelve and your dad dies. That’s my story and I’m sticking with it.
(Watching the Pembroke Lumber Kings)