Who The Hell Are You?

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You are Your Brain. Image via Google

There is a scenario that many of us have had the painful privilege of experiencing. That moment when your eyes flutter open and you glance around while your heart picks up a few beats per minute and your muscles twitch with a sudden increase of adrenaline. Confused, your inner monologue shouts out, “Where the hell am I and how did I get here?”

Perhaps, this is the first waking moment after a night of too many drinks on an empty stomach that led to a swirling vortex of blackness. Maybe it’s the first eye opening moments after anesthesia was withdrawn from your veins.

How ever you got there and where ever you were, after the brief wave of confusion and mild anxiety rushed across your body, you were aware of a few things:

  • You were never drinking again (in the case of scenario number one)
  • You knew who You were
  • You may be able to piece together a few flashes here or there and tie together the last hours or days of your existence.

Chances are you woke up not too far from where you started and a moment of reassurance floods over you.

Now, if you are familiar with the aforementioned scenario, lets take a minute to journey into the horrifying thought experiment I will present to you.

Imagine your eyes fluttering open to survey the unfamiliar world around you and you end up asking yourself, “where am I, how did I end up here and who the hell am I?” In addition to this terrifying scenario, imagine waking to find yourself half way across the country or in the case of one man – who may or may not have known who he was or how he got there – all the way to another continent on your bare feet (Read that HERE).

The Tale of The Disappearing Firefighter

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Case of the Missing Firefighter. Image Via Google

There was a news story that surfaced a few weeks ago about a Toronto firefighter  who disappeared from a New York state mountain side during a ski trip and re-emerged in a Sacramento California airport – an astonishing 4,500 kilometers away. He had gotten himself a spiffy new hair cut, withdrew 1,000 dollars in cash and purchased a new iPhone which he used to call his wife. He was picked up by police and medical personal who believed he had suffered a head injury (you think?). He was still wearing ski gear in the California winter and had a vague recollection of riding in a big rig at some point on his journey. He, however, had no idea how he made it halfway across a country that was not even his own. Furthermore, his nonchalant demeanor appeared to unnerve the first responders that snagged him from the California airport. One would anticipate panic in a situation such as this, and yet he was cool as a cucumber. ( HERE).

So what happened to our firefighter friend?

Well, the jury is out of that one. The media states that he was not a victim of a crime and had possibly obtained a head injury.  But how did he wander so far away from home?

Now, I am asking you to follow me on a little weird theory here. Pure speculation, let me remind you.

How about we call it a dissociative fugue state brought on by a bump to the head after a fall from his skis during his mountain decent.

Dissociative what, you say?

Let’s suspend our disbelief for a moment and explore this hypothesis.

You bump your head, discharge some electrical impulses and end up kilometers from where you started without any recollection of how you got there.

Sounds implausible? Did he need a little breather from his firefighter buddies? Was he pulling a Walter White naked at the grocery?

Let’s jump into the disorienting world of amnesia and dissociative fugue states.

Electricity and Clean Slates

Tabula Rasa, Latin for “Blank State”, is a philosophical stance that views the mind as empty and pure. Individuals are born as a blank page awaiting the ink from our perception and experience of the world. We are merely subjected to that which we encounter; there is no inherent narrative to our life, no underlying monologue, no free will.

We are all subjected to fate and his fountain pen.

Tabula Rasa could be a way to view the blank slate of the brain when there is a radical disruption that leads to amnesiac states. Something jams the signal and certain things are wiped clean – like chalk being brushed off a board.

There are various types of amnesia and varying conditions, or disease states, that involve loss of memory. To complicate the matter further, there are a multitude of things that influence these states in varying magnitude. This list includes: seizures, physical trauma, pharmaceuticals and high states of emotion.

Let’s define and break down amnesia in to easily digestible components for us to choke, er, swallow down.

Eternal Sunshine of The Spotless Mind

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Electricity Image via Google

Amnesia is pretty straightforward and really quite the dauntingly broad term. It is an umbrella word meaning “pathological loss of memory.”

How delightfully vague.

It gets more specific when you start adding in phrases, such as the very descriptive “retrograde” and “anterograde.”

Retrograde, or traveling backwards in time, describes the inability to retrieve the memories that you laid down before whatever event left your squishy friend rattled and in tatters. This can include a wide time frame and even extend into core pillars of your personhood—such as the inability to remember your name and very self.

Who the hell are you even?

Anterograde, or traveling towards the future, is the inability to lay down new memories. You remember who you are and where you came from. You may even remember how you got to the point where you experienced the damage that shook some connections loose. Unfortunately, if you venture too far passed those trees you enter woods so dense that there are places sunlight can no longer touch.

For a much lighter example, perhaps you remember the awful early 2000 Rom-Com 50 First Dates? That is a very apt example (also quite annoying).

However, things start to drift further from away Adam Sandler and into Twin Peaks territory after those two major categories.

Transient Global Amenesia involves both these amnesia subtypes. Like a chocolate and vanilla swirl ice cream cone of forget. The heaviest element at play is the anterograde amnesia. The afflicted will have difficulty remembering what occurs during the event. Retrograde is still a player. The past is vague and fuzzy– especially the moments leading up to the state.

Generally, people still remembered who they are and hold on to more core memories, such as a childhood memory of petting their dog or the time they cried at their ninth birthday party.

This weird state of memory loss lasts for several hours, perhaps a day, before mysteriously disappearing back into the ether.  Good news, people in this state aren’t destined to date Adam Sandler over and over again like poor Drew Barrymore.

Transient global amnesia is characterized by its eerily and insidious nature.  Its cause is generally quite subtle in nature and can come on in an instant.

A quick dip in a cold water, overwhelming negative emotions or a routine medical procedure, such as an endoscopy, have been cited as possible instigators of a TGA attack.

And of course we must also include physical exertion.

And by that, I mean sex.

There have been a few transient global amnesia attacks brought upon after some vigorous sheet disturbing activities. Many of the poor individuals affected where between 50 and 75 years old and recovered from their event in the expected period of time. No need to panic.

My personal favourite anecdotal piece is the story of one man from several decades ago.  Upon orgasming he was struck with a TGA attack which caused him to shout out during the throes of passion, “Where am I? What’s happened?”

Not the words you expect to hear.

Now that I have filled my sex quota for this post (this is becoming a reoccurring theme), let’s recap what we know about amnesia.

It comes in many shapes and sizes – subtypes and specific pathological conditions included. It can be caused by trauma (both physical and emotional), brain injury, seizures, drug use (including anesthesia or ketamine) and (apparently) orgasms.

What ever happens, the brain is not a fan of it. The cause, however, is still not well understood.

So where in your brain is this strange storm of forgetting occurring?

Generally, it’s the temporal lobe, specifically a snug little corner of the hippocampus (CA1 and CA3 regions) that is the most affected during these memory loss events. Remember this lobe, we will come back to it soon.

Now what makes run of the mill amnesia differ from that which the Toronto Firefighter experienced?

It’s the tendency to wander.

He ended up a very long way from where he started with no idea how he got there. And he isn’t the only story like this.

Not all those who wander are lost

 

Dissociate fugue is a much more descriptive term than those we explored previously. Dissociation refers to the removal of one’s self. “Fugue” has its origins the romantic languages as meaning to “flee” or “flight”.

Dissociate from myself and flee.  It’s vaguely poetic.

You don’t remember who you are, where you come from or even what is happening right at that very moment. This is coupled with the urge to go somewhere, any where, any how.

Sounds like a past Saturday night filled with regret.

But how does this happen?

Drugs like anesthesia (or if you are looking to party, ketamine) can cause dissociative states and memory loss.

If you have ever had the pleasure of experiencing general anesthesia, there is really nothing quite like the feeling that over comes you right before you check out. A sudden sensation that is both hot and cold travels through your veins and every trepidation you had about what was about to occur suddenly has vanished. You are a compliant, happy little clam staring up at a OR light that, with all of its light bulbs inside one circular ring, is the spitting image of a giant fly’s eye.

Right before you lose consciousness there is a vague feeling that you are floating away like a piece of paper in the wind.

And then you are awake again. If you are lucky you will even vaguely feel the strange sensation of being extubated – or having a breathing tube removed from your throat. It’s a little like a collapsible straw.

Not unpleasant because you are still high as a kite.

You don’t usually remember too much surrounding the event or even that time has passed.

High intensity emotions can also cause dissociative states. The physiological mechanism behind this is a little hazy but the psychological reasoning is that the brain is trying to protect itself so it removes itself from the event hoping that, when things calm down, it will all be fine. Brilliant!

Spoiler alert. It generally is not fine.

One of the common conditions associated with dissociative states are seizures and, most notably, those that occur with in the temporal lobe.

Did you remember?

Temporal Lobe Hotel

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Hippocampus.  Image via Google

The temporal lobe houses the hippocampus which is a memory hub of sorts. Now the hippocampus is generally heavily involved with your spatial memories. This means he takes note of the layout of your house or how you get to one place and then get back to your original destination. He is great at creating and reading a personalized map. There is evidence, however, that he also has a hand in general memory formation.

Memory formation does not have one specific brain structure and it is known to occur in a lot of different places within the brain. Neurons buzz and spark, sending off the packaged components of a memory to various structures and liminal spaces of white and gray matter to consolidated it where it belongs.

This can be anywhere.

The hippocampus is thought to have a role in keeping short term memories, but long term or consolidated memories, are said to become independent of the hippocampus and are stored else where in the neuronal beehive of your brain.

Temporal lobe epilepsy is characterized by seizures and electrical discharges resonating from the (you guessed it) temporal lobe. This is the one that is located snugly on either side of your ears.

The state that follows a seizure is the funny little word “postictal”. Think “icky”. During this time many epileptics are confused, exhausted and nauseated — just to name a few unpleasant sensations. Some are disoriented while others suffer from episodes of dissociative states.

In fact, one statistic stated that a third of clinical case of temporal lobe epilepsy will experience a dissociative event.

Let’s look at a story, shall we?

A man with temporal lobe epilepsy found himself in a hotel half way across the country. He had driven his car, fueled up and checked himself into a hotel while his brain had checked itself out of his skull. Anyone that encountered him hadn’t the slightest idea that anything was unusual. He was able to operate complex tasks, like driving or signing his name, and yet he had no idea any of those events were occurring.

He is not alone, I read about a surgeon who was on call over night. He was paged for surgery, scrubbed up, completed the task and left. The nurses noted he seemed a little off but not enough to really think twice about. The next day, the surgeon had no recollection of coming in to the hospital.  He could perform the complex task of cutting into a person and not killing them essentially with his eyes closed.

(I can not, despite my greatest efforts find the link to this story online. It is merely from the depths of my memory and, as we know, memories can be liable to error.  It was too good not to mention. Temporal lobe epilepsy hotel is a tale for Sam Kean’s book on the history of neurosurgery).

Although the media has no idea what happened to the fleeing firefighter, after a quick peek into amnesia and dissociative states it is not hard to speculate that one falls down while they ski. This brings the risk of knocking a few neurons loose and wanders away from his friends and family before waking up in an airport with a questionable new hair cut and the wrong outfit for the climate

Pure speculation. Full stop.

But wasn’t that a little fun thought experiment?

Our brain is simply a big, black box filled with electricity and chemicals. When something misfires the result can have very considerable consequences. It’s just once big chemoelectrical roll of the dice.

___________________________________________________________

Biopsychology. J Pinel. 2017
Sex Amnesia
Excuse me, Who am I?
Multiple personality and related dissociative phenomena in patients with temporal lobe epilepsy. Schenk, L.
Dissociative Fugue
Dissasociative Drugs
Dissocative disorder after TBI. Cantagallo. 1999
Focal Lesions of Human Hippocampal CA1 Neurons in Transient Global Amnesia Impair Place Memory. Bartsch. 2010
Memory Storage Fidelity in the Hippocampal Circuit: The Role of Subregions and Input Statistics. 

 

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