Mind Matters — Transient Global Amnesia and Emotional Stress

One client, one colleague, and two friends. What do they all have in common? They all have been diagnosed with transient global amnesia (TGA), which is supposed to occur to in 0.004% of the population. I feel statistically singled out, on the “long tail.” Statistics don’t really disallow my experience, but I do find it peculiar that this rare neurological syndrome would cluster in this way (or as my husband quips, maybe I’m the “typhoid Mary” re-incarnated as “TGA Kayta”).

Perhaps, TGA is more prevalent than we realize, so allow me to define it briefly. Transient global amnesia is a fortunately fleeting and probably benign syndrome with an abrupt onset. For anywhere between four and twenty-four hours, a person has no short-term memory. The individual knows who he or she is, and knows family and friends, and is able to perform rote tasks—driving a car, shopping, etc. All of a sudden, however, the questions arise, “What just happened?” “Where am I?” or “We’re doing what?” With TGA, there are no physical manifestations as there are with, e.g., a TIA, transient ischemic attack. That is, there is no slurring of speech, no loss of words, no facial muscle drooping. No loss of balance or immobility.

The person may be in this short-term amnesia state for hours, then some awareness of confusion and of being lost in time arises. (Sometimes the disorientation is first observed by another.) One friend, upon return to linear time as we know it, described her state as “being in limbo.” Another friend says that the “loss of time still haunts me … twelve hours of my life totally gone.”

Fortunately, TGA doesn’t usually linger and leaves as subtly as it appears. Of all the neurological events that can occur to a human, perhaps it is the one with the least lasting effects. Its recurrence is rare and there doesn’t seem to be any deleterious results to the brain.

However, as a psychologist, I think there may be an emotional component, that, while mentioned in the literature as a possible precipitating factor, may be getting short shrift in the ER.

Research has found over the years that anxiety and stress can engender panic attacks that mimic heart attacks. Pardon my waxing simplistic for wondering if TGA’s couldn’t be considered a sort of “panic attack” of the brain. There have been some brain studies (PET—positive emission tomography—scans) of patients while enduring TGA. These point to amygdala and hippocampus involvement. This is the part of the brain most affected by trauma and stress and is important in memory.

While there may be other physiological factors involved (strenuous exercise or diving into cold water where the breath is held), I would like to see more attention given to the emotional components. A neurological assessment to differentiate the diagnosis from TIA’s, brain tumors, infections, bleeds, etc., is, of course, important. Yet, any psychological stressors also need to be explained.

Could the TGA be a part of a stress response to an emotional trauma? Is there an anniversary reaction to a past event that needs to be addressed? What part does grief or loss play in the onset of a TGA? What part does repressed anger play?

I facilitate a grief group for those whose loved ones died suddenly, often violently. The members of this group recognize full well that anniversaries can trigger severe emotional reactions—anniversaries of the death, birthdays, holidays. While no one in this group (that I know of) has been diagnosed with TGA, I do know of others who have had TGA where the onset coincided with a grief anniversary.

The emotional loss or trauma that precipitates the TGA may not be about a person either. It may also be about a place or lost part of one’s life. In one case of TGA, I encountered a young man who had an emotional attachment to a house where he had lived and where his box of poetry and journals had been inadvertently left behind. Unlucky for him, in what I believe to be an occurrence of TGA, he was arrested and taken to jail for trespassing at his former residence. He had no knowledge of how he had gotten there and was thoroughly confused at the police station. For him, TGA was a nightmarish, Kafka-esque situation. And the diagnosis was given qualitatively only after the fact of his arrest.

Better to have loving family or friends (or knowledgeable police, for that matter) take thee to a hospital ER than to jail when TGA might have occurred.

But at the ER, after all the neurological workups, I trust that a thorough history-taking would include questions about any and all emotional stressors, about anniversary reactions, including grief and its emotional charge.

Emotional stress creeps in on cat feet and CAT scans don’t show the tiger’s scars.

Our bodies and our minds are not as separate as Descartes thinks. When mental /emotional stress—be it financial anxiety, profound grief, post-traumatic memories, fear, anger, sadness, is not expressed in healthy ways, our bodies bear the burden.

No, we can’t control life, but our attempt to control (not the same as healthy containing) our feelings in the face of our fears is never the solution.

Take a moment to reflect on your own life when different events have occurred. Might you consider an emotional precipitant you never considered before?

I certainly know in my own life there are emotional connections to a few “accidents.” I have several broken bones as a result of some angry feelings turned inward. Sure, they were “accidents”—falls—a slippery rock, a funky step—but they were also the result of mental pre-occupation with my feelings that were not being resolved in healthy ways.

That is, I was imploding with my feelings, which is a form of emotional reactivity. Emotional reactivity can take opposite forms but neither is healthy. Turning a feeling inward onto oneself is emotional reactivity that is implosive (gestalt psychologists call it retroflection); turning the feeling on another is explosive reactivity—e.g., when a person reacts hostilely and aggressively to another. Neither is the solution.

The solution is to be able to fully acknowledge the feeling in oneself first of all and then to find healthy ways to express or discharge the feeling. (In the case of anger at another, this could take the form of airing of grievances in a way that respects both parties—the giver and the receiver of the communication).

In the case of grief reactions, to know that we can give ourselves permission to feel whatever arises.

Our bodies carry emotional wisdom that needs to be heard. If we don’t take the time to listen, our bodies will slow us down one way or another, giving us legs akimbo or putting us in limbo.

For more on the emotions and the body, see: Waking the Tiger by Peter Levine; Healing Through the Dark Emotions by Miriam Greenspan; Courage to Feel by Andrew Seubert; and The Body Remembers by Babette Rothschild.