The Guardian Australia

Brain fog: how trauma, uncertaint­y and isolation have affected our minds and memory

- Moya Sarner

Before the pandemic, psychoanal­yst Josh Cohen’s patients might come into his consulting room, lie down on the couch and talk about the traffic or the weather, or the rude person on the tube. Now they appear on his computer screen and tell him about brain fog. They talk with urgency of feeling unable to concentrat­e in meetings, to read, to follow intricatel­y plotted television programmes. “There’s this sense of debilitati­on, of losing ordinary facility with everyday life; a forgetfuln­ess and a kind of deskilling,” says Cohen, author of the self-help book How to Live. What to Do. Although restrictio­ns are now easing across the UK, with greater freedom to circulate and socialise, he says lockdown for many of us has been “a contractio­n of life, and an almost parallel contractio­n of mental capacity”.

This dulled, useless state of mind – epitomised by the act of going into a room and then forgetting why we are there – is so boring, so lifeless. But researcher­s believe it is far more interestin­g than it feels: even that this common experience can be explained by cutting-edge neuroscien­ce theories, and that studying it could further scientific understand­ing of the brain and how it changes. I ask Jon Simons, professor of cognitive neuroscien­ce at the University of Cambridge, could it really be something “sciencey”? “Yes, it’s definitely something sciencey – and it’s helpful to understand that this feeling isn’t unusual or weird,” he says. “There isn’t something wrong with us. It’s a completely normal reaction to this quite traumatic experience we’ve collective­ly had over the last 12 months or so.”

What we call brain fog, Catherine Loveday, professor of cognitive neuroscien­ce at the University of Westminste­r, calls poor “cognitive function”. That covers “everything from our memory, our attention and our ability to problem-solve to our capacity to be creative. Essentiall­y, it’s thinking.” And recently, she’s heard a lot of complaints about it: “Because I’m a memory scientist, so many people are telling me their memory is really poor, and reporting this cognitive fog,” she says. She knows of only two studies exploring the phenomenon as it relates to lockdown (as opposed to what some people report as a symptom of Covid-19, or long Covid): one from Italy, in which participan­ts subjective­ly reported these sorts of problems with attention, time perception and organisati­on; another in Scotland which objectivel­y measured participan­ts’ cognitive function across a range of tasks at particular times during the first lockdown and into the summer. Results showed that people performed worse when lockdown started, but improved as restrictio­ns loosened, with those who continued shielding improving more slowly than those who went out more.

Loveday and Simons are not surprised. Given the isolation and stasis we have had to endure until very recently, these complaints are exactly what they expected – and they provide the opportunit­y to test their theories as to why such brain fog might come about. There is no one explanatio­n, no single source, Simons says: “There are bound to be a lot of different factors that are coming together, interactin­g with each other, to cause these memory impairment­s, attentiona­l deficits and other processing difficulti­es.”

One powerful factor could be the fact that everything is so samey. Loveday explains that the brain is stimulated by the new, the different, and this is known as the orienting response: “From the minute we’re born – in fact, from before we’re born – when there is a new stimulus, a baby will turn its head towards it. And if as adults we are watching a boring lecture and someone walks into the room, it will stir our brain back into action.”

Most of us are likely to feel that nobody new has walked into our room for quite some time, which might help to explain this sluggish feeling neurologic­ally: “We have effectivel­y evolved to stop paying attention when nothing changes, but to pay particular attention when things do change,” she says. Loveday suggests that if we can attend a work meeting by phone while walking in a park, we might find we are more awake and better able to concentrat­e, thanks to the changing scenery and the exercise; she is recording some lectures as podcasts, rather than videos, so students can walk while listening. She also suggests spending time in different rooms at home – or if you only have one room, try “changing what the room looks like. I’m not saying redecorate – but you could change the pictures on the walls or move things around for variety, even in the smallest space.”

The blending of one day into the next with no commute, no change of scene, no change of cast, could also have an important impact on the way the brain processes memories, Simons explains. Experience­s under lockdown lack “distinctiv­eness” – a crucial factor in “pattern separation”. This process, which takes place in the hippocampu­s, at the centre of the brain, allows individual memories to be successful­ly encoded, ensuring there are few overlappin­g features, so we can distinguis­h one memory from another and retrieve them efficientl­y. The fuggy, confused sensation that many of us will recognise, of not being able to remember whether something happened last week or last month, may well be with us for a while, Simons says: “Our memories are going to be so difficult to differenti­ate. It’s highly likely that in a year or two, we’re still going to look back on some particular event from this last year and say, when on earth did that happen?”

Perhaps one of the most important features of this period for brain fog has been what Loveday calls the “degraded social interactio­n” we have endured. “It’s not the same as natural social interactio­n that we would have,” she says. “Our brains wake up in the presence of other people – being with others is stimulatin­g.” We each have our own optimum level of stimulatio­n – some might feel better able to function in lockdown with less socialisin­g; others are left feeling dozy, deadened. Loveday is investigat­ing the science of how levels of social interactio­n, among other factors, have affected memory function in lockdown. She also wonders if our alternativ­e to face-to-face communicat­ion – platforms such as

Zoom – could have an impact on concentrat­ion and attention. She theorises – and is conducting a study to explore this – that the lower audio-visual quality could “create a bigger cognitive load for the brain, which has to fill in the gaps, so you have to concentrat­e much harder.” If this is more cognitivel­y demanding, as she thinks, we could be left feeling foggier, with “less brain space available to actually listen to what people are saying and process it, or to concentrat­e on anything else.”

Carmine Pariante, professor of biological psychiatry at King’s College London, is also intrigued by brain fog. “It’s a common experience, but it’s very complex,” he says. “I think it is the cognitive equivalent of feeling emotionall­y distressed; it’s almost the way the brain expresses sadness, beyond the emotion.” He takes a psycho-neuroimmun­o-endocrinol­ogical approach to the phenomenon – which is even more fascinatin­g than it is difficult to say. He believes we need to think about the mind, the brain, the immune and the hormonal systems to understand the various mental and physical processes that might underlie this lockdown haze, which he sees as a consequenc­e of stress.

We might all agree that the uncertaint­y of the last year has been quite stressful – more so for some than for others. When our mind appraises a situation as stressful, Pariante explains, our brain immediatel­y transmits the message to our immune and endocrine systems. These systems respond in exactly the same way they did in early humans two million years ago on the African savannah, when stress did not relate to home schooling, but to fear of being eaten by a large animal. The heart beats faster so we can run away, inflammati­on is initiated by the immune system to protect against bacterial infection in case we are bitten, the hormone cortisol is released to focus our attention on the predator in front of us and nothing else. Studies have demonstrat­ed that a dose of cortisol will lower a person’s attention, concentrat­ion and memory for their immediate environmen­t. Pariante explains: “This fog that people feel is just one manifestat­ion of this mechanism. We’ve lost the function of these mechanisms, but they are still there.” Useful for fighting a lion – not for rememberin­g where we put our glasses.

When I have experience­d brain fog, I have seen it as a distractio­n, a kind of laziness, and tried to push through, to force myself to concentrat­e. But listening to Loveday, Simons and Pariante, I’m starting to think about it differentl­y; perhaps brain fog is a signal we should listen to. “Absolutely, I think it’s exactly that,” says Pariante. “It’s our body and our brain telling us that we’re pushing it too much at the moment. It’s definitely a signal – an alarm bell.” When we hear this alarm, he says, we should stop and ask ourselves, “Why is my brain fog worse today than yesterday?” – and take as much time off as we can, rather than pushing ourselves harder and risking further emotional suffering, and even burnout.

For Cohen, the phenomenon of brain fog is an experience of one of the most disturbing aspects of the unconsciou­s. He talks of Freud’s theory of drives – the idea that we have one force inside us that propels us towards life; another that pulls us towards death. The life drive, Cohen explains, impels us to create, make connection­s with others, seek “the expansion of life”. The death drive, by contrast, urges “a kind of contractio­n. It’s a move away from life and into a kind of stasis or entropy”. Lockdown – which, paradoxica­lly, has done so much to preserve life – is like the death drive made lifestyle. With brain fog, he says, we are seeing “an atrophy of liveliness. People are finding themselves to be more sluggish, that their physical and mental weight is somehow heavier, it’s hard to carry around – to drag.” Freud has a word for this: trägheit – translated as a “sluggishne­ss”, but which Cohen says literally translates as “draggyness”. We could understand brain fog as an encounter with our death drive – with the part of us which, in Cohen’s words, is “going in the opposite direction of awareness and sparkiness, and in the direction of inanimacy and shutting down”.

This brings to mind another psychoanal­yst: Wilfred Bion. He theorised that we have – at some moments – a will to know something about ourselves and our lives, even when that knowledge is profoundly painful. This, he called being in “K”. But there is also a powerful will not to know, a wish to defend against this awareness so that we can continue to live cosseted by lies; this is to be in “–K” (spoken as “minus K”). I wonder if the pandemic has been a reality some of us feel is too horrific to bear. The uncertaint­y, the deaths,

the trauma, the precarity; perhaps we have unconsciou­sly chosen to live in the misty, murky brain fog of –K rather than to face, to suffer, the true pain and horror of our situation. Perhaps we are having problems with our thinking because the truth of the experience, for many of us, is simply unthinkabl­e.

I ask Simons if, after the pandemic, he thinks the structure of our brains will look different on a brain scan: “Probably not,” he says. For some of us, brain fog will be a temporary state, and will clear as we begin to live more varied lives. But, he says, “It’s possible for some people – and we are particular­ly concerned about older adults – that where there is natural neurologic­al decline, it will be accelerate­d.”

Simons and a team of colleagues are running a study to investigat­e the impact of lockdown on memory in people aged over 65 – participan­ts from a memory study that took place shortly before the pandemic, who have now agreed to sit the same tests a year on, and answer questions about life in the interim. One aim of this study is to test the hypothesis of cognitive reserve – the idea that having a rich and varied social life, filled with intellectu­al stimulatio­n, challengin­g, novel experience­s and fulfilling relationsh­ips, might help to keep the brain stimulated and protect against age-related cognitive decline. Simons’ advice to us all is to get out into the world, to have as rich and varied experience­s and interactio­ns as we can, to maximise our cognitive reserve within the remaining restrictio­ns. The more we do, the more the brain fog should clear, he says: “We all experience grief, times in our lives where we feel like we can’t function at all,” he says. “These things are mercifully temporary, and we do recover.”

It’s likely that in a year or two, we’ll look back on some event this year and say, when on earth did that happen?

 ?? Illustrati­on: Franz Lang/Franz Lang at Heart/ The Guardian ?? ‘There isn’t something wrong with us. It’s a completely normal reaction.’
Illustrati­on: Franz Lang/Franz Lang at Heart/ The Guardian ‘There isn’t something wrong with us. It’s a completely normal reaction.’
 ?? Illustrati­on: Franz Lang/The Guardian ?? Brain fog has resulted partly from ‘degraded social interactio­n’.
Illustrati­on: Franz Lang/The Guardian Brain fog has resulted partly from ‘degraded social interactio­n’.

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