Book reviews
The Nostalgia Factory: Memory Time and Ageing
Edited by Douwe Draaisma (translated by Liz Waters). Yale University Press: New Haven and London; 2013. 158pp.
$25.00 paperback
One of the greatest fears of old age is memory loss. The spectre of dementia is so prominent that it is easy to forget that most of us, thankfully, will never develop Alzheimer's disease. Nevertheless, memory does change as we age. Prof Draaisma's excellent account of memory in later life is a delightful cocktail of anecdote and psychology. It has all the ingredients needed to succeed as a popular science book being expert, entertaining and engaging. The book reads like a conversation with a knowledgeable friend, which is a tribute both to the author and to his translator, Liz Waters.
Nostalgia originated as a medical term. The seventeenth-century Swiss physician Joannes Hofer coined the term in his thesis, translating the Swiss dialect word ‘Heimweh’ meaning homesickness into the Greek form nostalgia (from Nostos, meaning homecoming, and algia, meaning pain). A dissertation by no lesser authority than the psychiatrist and philosopher Karl Jaspers in 1909 characterized the syndrome: longing to return home, compulsive thoughts of home, anorexia, insomnia and apathy. Draaisma cleverly recycles the term suggesting, by analogy, that when older people are cut off from their past by changes in their memory, they develop a longing for past things that now only exist in their own memories.
The book focuses on autobiographical memory. It also challenges the Aristotelian concept that life course follows a parabolic pattern: the developmental climb to the peak of our prime followed by inevitable involutionary decline. What happens to memory in normal ageing is not so much a free-fall decline but an adaptation that has many complex facets. Memory itself is not a simple unified faculty, the author quotes research showing at least 256 concepts that contribute to our account of memory. As we age, we are more self-conscious of our own memory, being particularly sensitive about forgetfulness. Memory is so essential to our sense of self that a perceived unreliability of memory is threatening. All doctors will have witnessed the disintegration of personhood that occurs in dementia and cannot help but be frightened by this prospect.
Prof Draaisma's calm analysis of forgetfulness is reassuring to say the least. Forgetting occurs throughout life, indeed editing memory is essential. Several familiar lapses in memory are explained. Prospective memory (planning future actions) is worse as we get older because the future lacks the associations that we normally use to navigate through past memories. The universal experience having difficulty putting a name to a face of someone one should know well is explained not by dementia but because facial recognition requires three steps: visual recognition, knowing the relationship between the two of you, and finally finding the name. Names are arbitrary and therefore less guided by association than the first two steps. Difficulty in word-finding and the ‘tip of the tongue’ phenomenon again does not herald dementia but does reflect slower retrieval from long-term memory.
Can we take steps to improve our failing memories? Here, the Dutch professor is much less reassuring. He castigates ‘the forgetfulness market’. The memory is not like a muscle. The weight of psychological research shows that the capacity and function of memory cannot be significantly improved by mental training, food supplements or medication (herbal or pharmacological). There exists a large cohort of the worried well, and they are vulnerable to the latest fad or advert that promises to enhance memory and stave off dementia.
As a geriatrician, I was often amazed at the contrast between the vivid and detailed recall patients had of events that occurred 50 or 60 years ago and the vagueness of their more recent memories. Reminiscence helps maintain our self-identity at a time when it is threatened. Studies of cohorts of Dutch emigrants give a clear insight into the reminiscence effect. The spontaneous re-emergence of old memories at a time when other cognitive abilities are declining is an enigma. Most reminiscence concerns memories of youth and early adult life, relating to a time when we are establishing our identity. This reminiscence bulge is shifted to the late twenties and thirties in those who emigrated in their teens and twenties. It seems that nostalgia is strongest for periods in our lives that represent the transition from dependency to independence, and the emergence of our mature selves. Not all the memories are accurate, however. Oliver Sachs recounts to the author a vivid memory from the Blitz, which subsequently turned out to be false as Sachs was an evacuee at the time. What is important about reminiscence is that it supports the narrative of our lives.
The Nostalgia Factory is an enjoyable and informative account of how memory changes as we age. Strong on narrative yet richly imbued with scientific research, it makes interesting reading for any clinician, especially those of us who have already reached the age of nostalgia.
- © 2014 Royal College of Physicians
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