The Importance of Forgetting, with Dr. Scott Small (S3, Ep20)

Additional Resources
Dr. Scott Small’s profile
Link to Dr. Small’s book
People who remember every second of their life | 60 Minutes Australia

Many of us worry about memory loss, but it’s surprisingly important to forget. Scott Small, MD, director of the Alzheimer’s Disease Research Center at Columbia, says pruning our memories is good for us. We all know “forgive and forget” is key to emotional health, but forgetting is also critical to cognitive health. Find out why a healthy dose of forgetting is not a pathology, but a way of clearing away extraneous information and improving our more important memories. Plus… why their memories keep chimps in a state of rage and fear, while forgetting makes bonobos so happy.

Phil Stieg: Hello, I’d like to welcome Dr. Scott Small, director of the Alzheimer’s Disease Research Center at Columbia University. We are here today to discuss his recent book, Forgetting; The Benefits of Not Remembering. Yes, forgetting is part of our normal life and important in our socialization cognitive ability, creativity, caring, and ethics. In his book, Dr. Small creatively distinguishes between pathologic memory disorders like Alzheimer’s and PTSD from normal and healthy forgetting. Scott, thank you for being with us today.

Scott Small: Thank you. Thanks for inviting me.

Phil Stieg: So let’s start off – what’s the upside of forgetting?

Scott Small: Yeah. And that’s basically the question posed and hopefully partly answered in the book. It used to be thought that the normal forgetting we all experience was a failure of our memory system. I was raised and educated in the belief that all forgetting is bad. It’s a glitch or a nuisance at the very least. But we now understand that it’s actually not there by accident. It’s nature’s gift to improve our minds.

Phil Stieg: Everyone’s always trying to improve their memory. But why do we need to forget?

Scott Small: We need to forget because we need our forgetting to balance our memories. And I think that’s not a bad metaphor. This idea that an engine needs both the braking and an accelerating systems. The science of forgetting does not argue that memory is bad. It’s the balance that’s good. And chapter by chapter, I discuss with other experts why forgetting is good for our emotional well being, for our creativity, and even for our cognition. Our ability to think clearly in a very complicated world requires that balance between memory and forgetting.

Phil Stieg: In your book, you talk about the ability to remember and forget and the importance as it relates to cognitive flexibility. How does that work?

Scott Small: In some ways, I think people intuitively know on the emotional side that we need to forgive, to forget, that it’s good to let go of emotional memories sometimes. But the more interesting part is how we need our forgetting to think clearly. We live in a very complicated world. It’s buzzing with information. One of the things we need to be able to do is to generalize. So when I see my face in the mirror this morning and I see it later this evening, my face has changed, the lighting has changed, yet I can recognize me. And that is just a simple, somewhat obvious example of our ability to generalize. That ability to generalize information is fundamental to having our ability to forget. Because if we would remember with pointless details and our memory and our brains would say, AHA, that’s me in the morning, then I wouldn’t recognize myself in the evening.

Phil Stieg: How important is sleep in memory?

Scott Small: It turns out to be really important. If you think about it, sleep is something we spend nearly a third of our lives doing in a position in a state that were potentially vulnerable to the environment. Why do we do it? What has emerged from the new science of forgetting is that one of the things we do when we sleep, one of the reasons we need to sleep is to get rid of all the extraneous information that our minds and their stickiness to record everything needs to try to forget so we don’t obsess over the details.

Phil Stieg: I’m confused about this because when I talk to memory people, they say how important sleep is to solidifying your memories. So what’s the balance going on there that I don’t quite understand?

Scott Small: You need to forget in order to “topiary like” accentuate the important stuff. You need to mow out all the extraneous lawn in order for the things that are truly important to be crisp in our minds. But if you were to remember everything you record in a day, you would not be able to remember the important stuff. So it’s an editing process.

Phil Stieg: So if you studied insomniacs, do you find that they have poorer memory than people that have normal sleep cycles?

Scott Small: It’s a great way to illustrate that. People have done this either naturally or in laboratories. The first thing to say is that no one could survive if you truly are sleep deprived for more than three days. But when those studies have been done you don’t get the profound memory loss that I see in my patients with Alzheimer’s. What you see is something closer to what our colleagues in psychiatry see in psychosis. You get a mind that is cluttered with information that can’t think clearly that it has no attention span, and that’s probably because it’s a mind with too much information.

Phil Stieg: I was particularly struck in your book by the analogy you used between I don’t know if I’m pronouncing it correctly, but the bonobos and the chimps and the importance of memory in social behavior. Can you explain that to our listeners?

Scott Small: Yeah. It’s always good to do comparative analysis to our cousins in the animal world. And I think people generally know the kind of story about bonobos who are very compassionate, very socializing, enjoy love making and fun, are willing to have females as their leaders, (unlike our resistance for that, for some reason), versus the chimp, who is very aggressive, very hierarchical, and often could really be murderous in their rage. So you have compassion on the one hand and rage on the other. And the question is why? From recent studies, the main difference in the brains of chimps and bonobos is the amygdala, the area of the brain that stores our fear memories. Very simply, chimps who live in a very rough and tumble environment of rage and fear have larger memory stores of their fear memories. The Primatologists now think that that’s one of the reasons why bonobos have a more social, prosocial disposition.

One of the conclusions from that is that one way to become more compassionate, to love better, to just be happier people, is to be able to forget some of our fear memories.

Phil Stieg: Let’s hop back to humans for a moment. I want you to give some hope to people. Again, the difference between Alzheimer’s and normal forgetting. What are the things that we can when we hear ourselves or talk, we can say, okay, that’s just normal forgetting and cut ourselves some slack.

Scott Small: That’s a really important point. And cutting slack is really important. I myself now that I’ve learned that my own forgetting, hopefully at this point in my life is normal, I’ve relaxed on beating myself up. And you know, Dr. Steve, we both went to medical school. We’re both in a world where a lot of stock is given to being able to reel off a differential diagnosis. Memory, memory, memory. The second you relax on whether you forget something, the interesting thing is, the better your memory becomes. The way to really know whether something is going wrong. And again, things do go wrong later in life is if you notice a real worsening from your baseline. And that’s not always easy to detect. But if you notice a real worsening of your baseline, that to me as a neurologist now is an indication that something is not going well in your memory system.

Phil Stieg: In regard to science. You spend a considerable time talking about an infectious disease specialist, Doctor “X”, and I was struck by the distinction you made between humility and a doubting mind and its role in memory.

Scott Small: Yes. This issue of intellectual humility, the idea of are you in your daily to day activities, gut checking yourself against hubris? And it’s that disposition – intellectual humility – which is critical for getting to the truth.

The analogy would be that someone who has to wear glasses. They’re going to be a little bit more humble or doubting on what they see. Right. They might not immediately rely on the first thing they see as an analogy. What Doctor X was suggesting, the doctor who did have poor memory in terms of the memory he was born with, it forced him to be doubting his first decisions that were based on his memories. He had to slow things down. Now that in the field is called intellectual humility. Not to pay an idle compliment, but because it is a form of humility in terms of not being absolutely sure of the first thing that comes to one’s mind.

Phil Stieg: So one shouldn’t feel badly if they feel as though they have a doubt about their thoughts.

Scott Small: Quite the opposite. I would say. Perhaps a mind that has a lot of forgetting is going to be a mind who’s going to be more careful in questioning themselves.

Phil Stieg: Talk to me a little bit about emotional memory and the process of extinction, as it’s used in treating patients with PTSD.

Scott Small: PTSD is, according to our colleagues in the field, is a disorder of too much emotional memory, a memory that’s burning too hot with fears and anxieties. And one of the ways that’s dealt with, whether it’s PTSD or phobias, is called extinction therapy. Right. So if you have a phobia to something, a psychologist might use that item to extinguish the fear. That extinguishing, we now know, is engaging the forgetting mechanisms. Basically, the fear memories are extinguished, and that engages the mechanisms of forgetting.

Phil Stieg: And are the drugs like ecstasy, LSD, cannabis, are they useful in the treatment? Do they induce memory loss, which I think a lot of people would be worried if you say yes to that. But.

Scott Small: A lot of people perhaps would be worried, including perhaps leadership at Columbia, if you are, if we both endorse that. But as we know, there are ongoing clinical trials with ecstasy or MDMA for PTSD, because it is we now understand. And this just came out of the new science of forgetting in the last ten years. What ecstasy does – one of the things it dominantly does is it engages the forgetting mechanisms in that same brain area we talked about that’s enlarged in chimps, it basically induces a form of fear forgetting. And if I could just add, it’s called ecstasy. Not that you and I know this experientially, Dr. Stieg, but it’s called ecstasy because when you induce fear memories, apparently according to the testimonials, you feel ecstatic, Happy. love is included in that description often of what you feel when you relax your fear memories.

Phil Stieg: I’m fascinated by your life’s choice in terms of profession. Can you tell us how you, number one, got into the study of Alzheimer’s disease, but then more importantly, how you get into normal forgetting?

Scott Small: I became very interested as a late teenager on the importance of memory in general, for our lives, for our creativity, for our happiness. That’s why I was inclined to be interested in becoming an Alzheimer’s doctor. And when I started my training, I discovered that I actually loved interacting with Alzheimer’s patients and their families. In many ways, they taught me so much on the importance of memory, but also on how we sometimes over index memory. Many of my patients, certainly in the early stages, have taught me that they can still live a happy life surrounded by loving family and friends, loving the arts and the Sciences, even though they can’t remember where they put their keys. I think that’s a deep lesson that they’ve taught me, and that’s why I’ve dedicated the book to them.

Phil Stieg: You should know, I really enjoyed your book. I’m going to recommend it to my family because my brother’s going to be 80 years old and he’s always worried about getting Alzheimer’s. Thank you. Actually, my mother passed away from Alzheimer’s, so that adds to the frightening experience.

Scott Small: Yes, my father has it. It’s out there.

Phil Stieg: What are your thoughts about the family members of the patient that has Alzheimer’s? How important is forgetting for them?

Scott Small: Interesting question. Well, I think again, memory is important. I would not say that they should forget the suffering. We all should engage our suffering. It is. I experienced it personally. The one thing I think is really important I talk a lot about this with my patients, mainly because we have very little to do pharmacologically. Yet I’ll spend as much time as my patients and family need. I strongly encourage them to not become the healthcare provider because you want to maintain the memory of the person who has Alzheimer’s intact. The memory, not when their old feeble need help with their toiletries. The memory should be preserved of when they were in their full glories.

Phil Stieg: Yeah. I think that’s a really important point. And thank you for making that. Try to remember the positive things in my circumstance. It was ten years of watching my mother just dwindle. And the last memory I have is when I walked up to my mother and she couldn’t talk to me. Obviously, I don’t think she understood what I said, but a tear came down her eye and I was just. Why this?

Scott Small: Yeah, it’s painful.

(Interstitial Theme Music)

Narrator: Where were you on January 28, 1986? If you recognize that date as the day the space shuttle Challenger exploded, you might be able to recall a lot about what you were doing that day. But what about some other random date? Or on any other day of any other year?

Most of us would be hard pressed to remember where we were, what we were wearing, or what the weather was like. But some people, any date is like yesterday – and that’s not necessarily a good thing.

Those rare people have an unusual neurological condition called Hyperthymesia, also known as “H-SAM” – for Highly Superior Autobiographical Memory, which allows individuals to remember their lives intensely on a day-by-day basis.

It’s called Superior Autobiographical Memory because these indelible memories seem to be limited to personal experiences. Their unusual ability does not seem to extend to other well-known feats of memory – like reciting the digits of pi to a thousand places.

For example; mention a random date like January 12, 1993, and a person with H-SAM can instantly tell you that it was a Tuesday, and that they were late for algebra class that morning because their favorite jeans were still in the dryer and while waiting for the clothes to dry they burned the toast for breakfast and so on – hundreds of details as if it had just happened yesterday.

It is still not known what actually causes Hyperthymesia, but MRI scans performed at University of California Irvine have found one part of the brain called the “caudate nucleus” to be up to seven times bigger than normal in people with H-SAM. It is an area of the brain often associated with ADHD and Obsessive-Compulsive Disorder.

So far, only few dozen people have been identified as having this extremely rare condition. Some consider life with H-SAM as bit of a burden.

New York musician Louise Owen described it this way:

“Sometimes I feel like with all of these dates and all of these memories it’s almost like I’m in charge of about 9,000 rambunctious little children. … Each one represents a different date – a different memory and they’re all vying for my attention all the time.”

Actress Marilu Henner – probably the best known person with H-SAM – has this common experience:

“Every woman asks me if it’s terrible to have to always remember every bad relationship and bad break up – and men always say “Oh my gosh, it must be impossible to be married to you…”

(Interstitial theme music out)

Phil Stieg: In the end of the book, I thought you waxed a little philosophic and we had to go here. You talk about memory and its linkage to caring and ethics. How do you make that linkage?

Scott Small: Yes, I did engage in every chapter with experts in the field, certainly when I was outside of my Homebase and there I discussed the ethics of memory. And implied in that is that there must also be the ethics of forgetting. And the important part there is there’s nothing wrong with remembering deeply and caring deeply about your own self, your own family, your own clan, your own country. Patriotism is a wonderful thing, but if that just like a PTSD patient, if that kind of memory burns too hot, then you become potentially xenophobic hateful of others. And it was very interesting to me to read the original medical thesis by Johannes Hoffer, published in 1583, I believe, where he is the guy who invented the term “nostalgia” . And when you read that thesis, he is basically describing nostalgia as a brain that has a seizure disorder in areas of the brain that store memories of homeland. He really thought it was. Now he was wrong on that. But I think as a metaphor for what happens when you have too much communal memories, not countervailed by healthy forgetting, communal forgetting. It’s not a bad metaphor for the sociology of memory and forgetting.

Phil Stieg: I particularly liked the story you revealed about your mentor, Eric Kandel, and when you were framing for getting in a constructive fashion with his experiences as a child in Vienna, and then when he was called back to be an honored guest, go through that story for us. I thought it was quite good, particularly in this day and age where I think tolerance is something that we need to expand upon.

Scott Small: Yeah. I’m glad you’re asking that, Doctor Stieg. If we acknowledge that memory and forgetting is healthy for our own individual lives, it’s also true for our communal lives. After all, there is communal memory and therefore, there is communal forgetting. And of course, we don’t want to forget the Alamo. There are many communal memories that we want to remember. But at some point, just like in PTSD, if communal memories burn too hot, that could lead to trouble. It could lead to Xenophobia. And so in the personal story with my mentor and academic father, who I beloved, Eric Kandel it was a wonderful experience to talk about this with the world’s leading expert on memory, Eric Kandel, who won a Nobel Prize for clarifying the cellular mechanisms of memory. And his personal story relates to this.

So he grew up, and shortly after Kristallnacht as the Nazis entered Vienna, he and his family were essentially thrown out very aggressively. And he, of course, has that emotional memory and he should not forget. I come from a family of Holocaust survivors we should not forget.

But at some point, Eric was asked after he won the Nobel Prize, the Viennese Mayor said, oh, you were born here. We want to give you the keys to the city. We want you to be our beloved son of the city. And Eric said, hang on 1 second. It’s not that easy. But, he agreed that at some point you should engage in some forgetting enough to forgive and forget. And let me also point out that Amnesty comes from the Latin, which means forgetting amnesia. Amnesty, Amnesty, if it’s done properly and thoughtfully, is part of the is a great example of where you need communal forgetting to balance your communal memories.

Phil Stieg: So where is reconciliation involved with this? And there is a particular story about forgetting the name of the street because it was named after the Mayor that committed all the atrocities.

Scott Small: That’s right. So you don’t want to be forgetting to the point and forgiving to the point where you just eradicate everything and just sort of just be namby-pamby about it. So Eric was very clear in his ability to forgive and forget and to ultimately accept the keys to the city, to being an honored son of Vienna by making some requirements.

There was a street in Vienna named after a truly virulent Nazi, and he requested that that person’s name be deleted, which is a form of forgetting from the communal records. By removing that, he also asked to have an annual meeting on reconciliation, bringing the perpetrators who are still alive with the victims who are still alive. And that’s part of the forgetting and forgiving process to do it in a constructive manner where everyone understands, not just a blanket check. I’m just going to forgive.

Phil Stieg: Yes. Hopefully in this day and age, we can get some more reconciliation going on.

Dr. Scott Small, author of Forgetting the Benefits of Not Remembering, thank you so much for expounding upon the process of forgetting and its importance in terms of cognitive flexibility, our creativity and most importantly, in some of our ethical decision making. It’s really been a pleasure talking with you.

Scott Small: It’s been my pleasure. Dr. Stieg, thank you for your interest and thank you for your probing questions.