Remembering and forgetting

May 19, 2023

by Ron Epstein, MD

When I am teaching, I frequently quote Shunryu Suzuki-Roshi’s aphorism “The most important thing is to remember the most important thing.” In this world filled with innumerable distractions, some of which we wear on our wrists or carry in our pockets and purses, it is remarkably difficult to remember the most important thing. Less important things crowd our awareness and the important recedes into less accessible recesses of our memory. The word sati, in the ancient Pali language, usually translated as “mindfulness,” literally means “remembering,” and is embedded in an ethical-moral structure that values “right mindfulness:” remembering the right thing.

Forgetting is also important. In a recent essay in The New York Review of Books, the Scottish family physician-author-philosopher Gavin Francis reviews and expands upon two new books about the dual arts of remembering and forgetting (https://www.nybooks.com/articles/2023/03/09/the-dream-of-forgetfulness-primer-for-forgetting-lewis-hyde/). He presents some provocative and counterintuitive ideas. I learned that, during wakefulness, we create new connections in our brains, and during sleep, we prune the dendrites that connect neurons; without dream-induced forgetting, our brains would be overloaded. Forgetting allows us to see the world in different ways and not be overwhelmed. Forgetting might be one element of a beginner’s mind, helping us be more creative, more playful, and not be locked into implicit and explicit biases. In healthcare, forgetting might promote diagnostic accuracy and individualized care, an antidote to the Sisyphean tasks of memorizing vast quantities of facts and information in medical education. Forgetting may be part of overcoming individual and collective trauma, and may be part of healthy responses to burnout and moral distress. Amnesty comes from the same root as amnesia and selective forgetting have helped countries recover from war and move forward. Even artificial intelligence algorithms need to be programmed to “forget” to solve complex problems more flexibly.

I had not thought much about forgetting until my mother developed Alzheimer’s disease. As devastating as it was, within a few months of her diagnosis, she seemed to have forgotten many of the fears that fueled her previously anxious self. She became more relaxed, less rigid and controlling, and more playful. She expanded her previously limited diet, restricted by habit and lack of imagination. She could adapt to others’ agendas with greater ease. Her sense of humor flourished. She knew her memory was terrible but didn’t seem to be traumatized by that realization. A year later, when she developed stage IV lung cancer, she had enough memory and awareness to recall her earlier expressed wishes not to be hospitalized, receive surgery or arduous treatments, and to focus on comfort. Then, within minutes, she forgot that she had cancer. She never forgot, though, that many people loved and cared for her. Remembering the most important thing and forgetting the rest helped her to live with calmness, agency, gratitude, and dignity. While none of us would want to develop dementia, perhaps, through awareness, we can achieve some of the same goals of clarity on what is important and learning to forget the rest.

Several years ago, I was passed along some advice; make two lists each morning. The first should include important things, and essentials to do. The second should include things that you don’t need to do, that are less important, to be forgotten temporarily, and perhaps maybe forever. Paradoxical, a list to remember to forget. But useful, nonetheless.

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