Organize Your Mind, Organize Your Life (16 page)

Flex your memory muscles

In
AARP The Magazine
articles about how to help delay the onset of Alzheimer's or senile dementia, you'll hear about the importance of keeping your brain active by doing puzzles. While Pasinski agrees with the importance of training your brain, she suggests other ways to give your memory a mental workout. “I think a better use of your time is to learn something new,” she says. “That's a wonderful way to challenge your brain, it's fun, and gives you a sense of accomplishment.”

If you're retired or someone with time on your hands, maybe French lessons, stamp collecting or learning how to play the guitar would be an excellent investment of energy. If you're reading this book, though, chances are you don't have a lot of time for those kinds of pastimes or hobbies, rewarding as they may be. I suggest you make your mind-stimulating, learning exercises practical.

One way to do this is to direct your reading toward something you don't normally look at. Instead of, say,
Time
or
Fortune,
read
The Economist
and get a global view of politics and the economy. Instead of
Sports Illustrated
or
Woman's Day,
check out
Wired
or
Salon.
Instead of
The New York Times,
read
The Wall Street Journal.

This tip isn't limited to newspapers and magazines. If you spend a good deal of time in the car, purposive listening to books on tape is an excellent way to sharpen memory. Wolf suggests structuring it for maximum memory-building benefits. “Listen to one chapter or section a day,” she says. “Then before you listen to it on the drive home or the next day, make a point to summarize in your mind exactly where you left off…what's happened in the plot.” That, she notes, will not only enhance your enjoyment of the book but also make it more valuable as memory training (and of course, if you don't spend a lot of time in the car and instead read your books the conventional way—in print or on a digital reader—you can do the same thing).

The key point in all this reading and media cross-training: “You're challenging your brain by learning, by making new connections,” says Pasinski.

And there's a bonus here: No matter what your industry or profession, it never hurts to expand your perspectives and broaden your horizons. You never know where the next great idea or nugget of information will come from that can help you in your career—and the fact that you'll be more likely to remember that idea or nugget because you've been training your memory muscles makes it even more worthwhile!

Create a memory book

Throughout this book, I've talked about the importance of writing things down: your goals, your visions, your observations on your own behavior. Martha Wolf has another kind of writing assignment for you that could be very beneficial. Here's how she explains it:

“Sometimes we can improve our memory, sometimes we just need a crutch. That's why I talk about things like putting the items you need in a place where you most need them. We get crazed because we can't remember where we put something. So don't make yourself crazy!”

To help keep track of these items, Wolf suggests creating a memory book. This is a tool that she has used with the families of her patients, who very often find themselves facing a situation where a parent is incapacitated and they, the children, have no clue where any of their parents' important papers, accounts or keys are located. But the idea can be adapted for those who are having trouble with more mundane household items of their own.

“It's a good thing for everybody to do,” she says. “And it takes a lot of pressure off.”

Wolf suggests an old-fashioned composition book for her patient families, but you can create a document online as well. “Make a list of the things you use most frequently—extra sets of keys, eyeglasses,
wallet—and find the most logical spot for them. So, for example, if you read before you go to bed, you would probably put the eyeglasses on your nightstand. Then write it down in the memory book.”

Argue to improve working memory

Wolf frequently speaks to senior citizen groups. Inevitably, one of the first questions she is asked is how to keep mentally sharp. “I used to tell them, ‘Go start an argument,'” she says with a laugh. “Then I realized that didn't sound very nice so I modified it.”

Her point is that arguing—not screaming and yelling but reasoned debate—is one of the best mental exercises you can do. “When you have a difference of opinion, you're listening intently to information, and while you're listening you're formulating your response,” she says. “You have to be mentally agile and nimble. It's like a game of cognitive ping-pong.”

Short of joining your local debating society, a good way to get the mental benefits of arguing is to watch one of the all-news cable channels where the polarization of the American political scene may actually have a salutary effect. “If you normally watch CNN, turn to Fox,” Wolf says. “If you watch Fox, turn to CNN. Listen to what their commentators are saying, develop your response, put the television on mute and talk back to them. Yes, it's okay to talk back to your television…just make sure you let anyone else in your house know beforehand so they don't think you've gone crazy.”

Talk with your hands

One of the more unusual but intriguing tips for improving memory comes from another Harvard colleague, psychologist Jeff Brown, coauthor of
The Winner's Brain.
“Gesturing in a meaningful way while you are learning may help you when recalling the concept,” Dr. Brown says. “The idea is that you are storing at least two different types of
information about something you'll need to recall later. A good example of this is when kids speak math problems aloud but also ‘work them' in the air.” (We know some adults who still perform arithmetic that way, so it's not just children who rely on this method!)

Brown suggests that when you've just learned someone's name, “write” it down on the palm of your hand with your finger. The act of tracing the letters on your palm can help your brain remember it, says Dr. Brown. Or, he says, “air-write on an imaginary map of your grocery store or mall as you name aloud the items or stores you need to remember when shopping.” (As you would when you're arguing with your television, make sure you perform this memory-enhancing drill discreetly!)

Remember to exercise, and exercise will help you to remember

I've been touting the benefits of regular exercise throughout this book. If we haven't convinced you yet of the mental benefits of physical activity, here's one more piece of evidence.

A 2009 study published in the journal
Hippocampus,
found a positive relationship in older adults between physical fitness and the size of the hippocampus—a key brain structure thought to be the central processing area for memory and learning. Unlike some other parts of the brain, neuroscientists say it is “plastic”—malleable and dynamic. Although the hippocampus begins to degrade as you get older (its volume shrinks about 1 percent a year after age fifty-five), it can respond to positive stimuli, suggesting that it is a “use it or lose it” organ. In the study, neuroscientist Kirk Erickson of the University of Pittsburgh wanted to see if physical exercise might have a positive effect on the hippocampus. His team tested the fitness levels of 165 adults who were over age fifty-five and also gave them brain scans and spatial memory
tests. The findings: “The fitter subjects had hippocampuses that were about 35 to 40 percent greater in mass than sedentary individuals,” Erickson says. The result surprised him. “I wasn't expecting that big a difference,” he says.

How much exercise do you need to get the brain benefits? Although the fitness levels of the subjects ranged from sedentary to moderately fit, Erickson says, “None were super athletes.” In other words, you don't need to run marathons to keep up brain size, just regular exercise.

This echoes similar findings in other recent research: A 2008 study in the journal
Neurology
found that seniors who regularly took walks had a lower risk of developing vascular dementia, a kind of memory loss associated with inadequate blood flow to the brain (it's the second most common form of dementia, behind Alzheimer's). The study, which was conducted in Italy, followed 750 older men and women over four years and found that those who were the most active—the top third—were 27 percent less likely to develop vascular dementia than those who walked the least.

The results, notes the website Alzinfo.org, are consistent with other studies on the relationship between moderate physical activity and brain health, including a 2004 study of more than 2,200 older men living in Hawaii, which found that those who walked the least—less than one quarter mile per day—had nearly twice the risk for developing Alzheimer's and other forms of dementia than men who walked more than two miles a day. That same year, the even larger Nurses' Health Study from Harvard reported that women in their seventies who engaged in regular physical activity like walking did better on memory tests than women who were less active.

The findings of all of these studies are indeed encouraging for older adults, but it's important to note that the value of walking also applies to younger minds and memories with far fewer years to reflect
upon. “Getting your heart going and increasing the blood flow to your brain with a twenty-minute walk can have very positive effects on your brain,” says Pasinski.

This prompts her to offer a suggestion—which is healthier and a lot cheaper than the questionable one on that radio commercial I heard: “When you're in a so-called ‘brain fog,'” says Pasinski, “get up and get out. The exercise, and just the change of scenery, will get you out of that feeling of mental staleness and help make your memory sharper.”

N
ICK WANTED TO BE AN EMT,
and at first glance, he appeared as if he was well suited for the job. Certainly, he seemed able to meet the basic requirements for that job, as specified by the Massachusetts Office of Emergency Medical Services.

He was over 18. (Nick was 23 when I first met him.)

He could speak English. (Nick grew up in the Greater Boston area; he could also speak Spanish.)

He could lift 125 pounds. (Or at least I'd be willing to bet he could. When we shook hands on first meeting, I thought my fingers had been put in a vise.)

His desire to be an EMT was laudable. I got the sense in just a few minutes talking with him that he was driven by a genuine desire to help people and save lives. First, however, he had to work out a problem. The state certification course consisted of thirty-three lessons, involving one hundred hours of classroom and field training, plus ten hours of in-hospital observation and training. Like every
other aspiring paramedic, Nick was going to have to study hard. And while I could tell he was determined to do well, he was already falling behind and feeling overwhelmed. That's what had brought him to my office.

“Tell me about it,” I said. “What's going on in the classes?”

“It's very interesting—what we're learning,” he said, “but I'm having trouble.” He told me what had happened during a recent lecture. The topic was how to respond to someone who might be having a stroke. First, the instructor needed to explain what a stroke was, how and why it occurs, symptoms, risk factors and so forth.

“There was a lot of information, so of course I took notes,” Nick said.

“Of course,” I agreed.

As Nick went on to describe it, the notes he took were voluminous and involved. He even started drawing pictures and diagrams of the brain, based on what the instructor was saying about the causes of strokes. About halfway through the lecture, however, he realized he was the only person taking notes.

“What was everyone else in the classroom doing?” I asked.

“They were watching the instructor demonstrate on a dummy,” he said. “He was showing the class the best way to transport a stroke victim.” He had also used a teaching assistant as a “victim” to go through the standard questions and assessments that EMTs ask in order to determine whether a stroke has actually occurred and its extent. But while the instructor had stopped lecturing and started demonstrating, Nick was still busily making notes.

“Did you just not realize he had stopped lecturing?” I asked.

“It's hard to say,” Nick said. “I guess, sort of. But I just couldn't pull myself away from the stuff I was writing. I needed to finish that.”

Nick did say he was embarrassed when he noticed some of the other students in the class giving him sideways glances as he continued scribbling away, while everyone else had put down their pens. I also got the sense that it wasn't the first time. “This kind of stuff has happened before,” Nick admitted. “I've never done well in school. For some reason, I'm not good in the classroom.” He attributed his subpar scholarship to deficiencies in his own intelligence or abilities. “I guess I just don't have what it takes to succeed in school,” he said. “I've always had trouble learning. I just can't keep up.”

I suspected that the problem was really not that vague nor that it had anything to do with intelligence. Nick struck me as a bright young man, and based on what he'd told me, he obviously could focus and take notes. But we needed to learn a little more about this apparent inability to shift gears when everyone else in the class had.

“Does anything like that ever happen at home or in your social life, outside the classroom? Do you ever feel sort of set in your ways or unable to change or be flexible about things?”

“You mean like ‘rigid'?” he said, with a grin. “That's what my old girlfriend called me. She said that I was never flexible, couldn't be spontaneous. That's one of the reasons we broke up.”

He went on to relate an example. “Thursday night was our movie night when we were dating,” he said. “Then one Thursday morning, she called me and told me that someone from work had two tickets for that night's Sox game. We're both big Sox fans, so she was really excited about going.”

“What did you do?”

“Part of me wanted me to go,” Nick said. “But I was like, ‘tonight's movie night.' And we had this whole routine. I'd go to the gym after work, we'd meet for dinner and then catch a movie. That's what
I was expecting we'd do. I mean, I really wanted to be spontaneous, but I just…couldn't. That's hard for me.”

There were other examples. He told me that he'd been having trouble in the gym as well. “I've been doing the same workout for years,” he says. “This friend of mine, he's a trainer, told me it would be good for me to get more core strength as an EMT since I'll be lifting stuff around, and your legs and your core muscles are really important for that. He sent me this routine that he's used, it was kinda cool, using medicine balls and other stuff.”

The friend even dropped by Nick's gym to show him how to do these new exercises. But when his buddy arrived, Nick had already started his regular workout—his bench presses, shoulder presses and biceps curls—and he just couldn't bring himself to stop. “I kept saying, ‘let me just finish one more set,'” Nick said. “Finally, my friend just shook his head and did the new workout on his own.”

In the field of psychiatry we define impairment as something that gets in the way, manifesting itself across multiple situations, not just one setting. Simply deciding not to take advantage of the baseball tickets because Thursday was movie night is not by itself evidence of a problem (although I must admit, free Red Sox tickets is not something to be taken lightly in this town!). Still, when it creeps into every aspect of life—in Nick's case, into the classroom, the gym, as well as his personal life—and when he feels stuck with this mind-set, despite evidence that it's causing him problems, then it becomes more serious. Nick's problem was not that he was “just set in his ways,” if only because, in my opinion, he was a little too young to have set ways. Nick's problem was that he was not able to shift his attentional or behavioral set. He could not easily change his focus from one thing, situation or setting to another.

SHIFTING GEARS

Before we look at what Nick's case can tell us about the next Rule of Order, let's step back a moment. By getting to this point in the book, and following some of the suggestions that have been made in the previous chapters, you should have a solid foundation for a more organized and less stressful life. If you've been working on integrating the first four Rules of Order, you should by now be able to

• approach a task more calmly, as you have (to use our terminology) “tamed the frenzy” (or if not tamed, at least held it at bay at key moments!)
  
• sustain your focus
  
• put on the cognitive brakes when it's necessary
  
• use your working memory to mold information
  

This doesn't mean you'll never be flustered or get distracted again. But now at least you have the beginnings of an operating manual so to speak, a plan that can help you start facing the day with greater confidence.

So let's continue to build on these successes.

But as we do that, it's important to remember this: although we have broken these various cognitive skills up into discrete rules or steps, in reality, they are closely interrelated. As we have learned, brain regions tend to work together, not independently. It's less like a weight lifter doing curls that isolate the biceps muscles of the arm and more like a batter using his or her legs, trunk, abdominals and biceps in tandem and in coordinated fashion, in order to swing a bat and drive the ball over the fence.

Such is the case with this next Rule of Order—what we call Shift Set. This refers to the ability to be flexible in your thoughts and behaviors.
In order to be organized, you must be able to effectively and efficiently shift your focus or “set” from one object, action or situation to another. In so doing, you can move on to the next action—take the off-ramp if it leads to a better road or a new opportunity. Without this skill, our attentional system starts looking more like tunnel vision (as was the case for Nick that day in the classroom). We need to be nimble and ready to adjust and to shift our focus and our behaviors when necessary, in both our work and personal lives.

What does it mean in practical terms?

Successful set shifting is you being able to pull yourself off of the interesting news article you were immersed in in order to answer the emergency call from a colleague. She needs some details on the big project you're working on before going into a client meeting, and she needs them now.

Successful set shifting is you at a meeting where you were prepared to present some important data. But when others in the meeting steer its focus on to some other topics, you don't get flustered or annoyed that you're not getting your turn and that the work you planned to present is not going to be heard. Instead, you switch gears to engage and participate in this new discussion.

Successful set shifting is you coaching your kid's basketball team and changing your practice plan because only three kids showed up.

Some people do this naturally. Others (like Nick) have a very difficult time making these shifts. And if you can't—can't switch gears to pull together the information your colleague needs, can't go with the new flow of the meeting or can't modify practice—you're going to find yourself frustrated, overwhelmed and disorganized.

In these examples, perhaps you can also see how set shifting may be inextricably tied to a couple of our previous steps.

How can you shift directions if you haven't first successfully applied the brakes?

And how can you shift with confidence if you aren't using your working memory? As you are shifting your attention, you are leaving a path behind you, one which you may want to hang on to, to remember in your working memory and to guide your way. You should shift with a sense of intent or
planning.
Now that shouts “Organization!”

SCIENCE OF SET SHIFTING

As we have seen before, scientists typically study cognitive processes like set shifting by having experimental subjects perform various kinds of tasks. Thanks to brain imaging, researchers are then able to observe the subjects as they perform these tasks and to see which parts of the brain “light up”—or are activated.

The original test for what we call set shifting, however, far predates the advent of modern brain-imaging technology. One of the oldest and still most reliable tests of cognitive agility, the Wisconsin Card Sorting Test (WCST) was developed at the University of Wisconsin in the 1940s by a team that included the famous American psychologist Harry Harlow (who also conducted groundbreaking primate research on the impact of love and affection in development). The test was first described in a 1948 journal article titled “A Simple Objective Technique for Measuring Flexibility in Thinking.” In the WCST, subjects are asked to sort and stack a series of 132 cards. But the rules of how they are to be stacked change, unpredictably, during the course of the test. The degree to which the subjects can adapt to the new rules is a measure of their mental flexibility—or what we would now call their ability to set shift. It has been found that those with brain (frontal and prefrontal cortex) damage will get stuck in one sorting modality. ADHD sufferers often have a similar problem—an inability to easily shift or adapt to the new rules presented.

While the WCST has had an important role in our understanding of and ability to measure set shifting, current investigations are attempting to isolate the very specific brain regions underlying set shifting in order to understand better how this process works.

In a 2010 study, scientists at Stanford and the Michigan Institute of Technology investigated the brain regions shared between the skills of inhibition (applying the brakes) and set shifting and tried to determine what brain areas are unique to each. In this study, healthy college students were presented with a series of large letters made up of smaller letters in various colors. Subjects were asked to identify large letters or small letters as cued by color. Sometimes the large and small letters were the same (dozens of little
h
's that made up one big letter
H
) or different (little letter
s
's to form a big letter
H
). Sometimes subjects were asked to toggle their focus back and forth between the small-or large-letter components—in other words, shift sets—and sometimes they were asked to simply focus on the large or small letters.

Through brain imaging, the investigators were able to watch which parts of the brain were active as the subjects performed the tasks. They found that one specific brain cortical region was particularly important in the set-shifting process: the inferior parietal cortex, which we talked about earlier in regard to its role in helping us both sustain attention and consolidate memories. But—true to the brain's cooperative nature—the parietal cortex did not work alone. It seems that a network of brain regions (prefrontal, parietal cortex, basal ganglia) all work together during both inhibition and shifting, suggesting that the two are actually
one major process. Or perhaps that inhibition is a needed component or a sort of “prerequisite” for the more complex task of shifting. (That's how we introduced these concepts in the Rules of Order and that makes intuitive sense.)

Given the complexity of this task and the number of brain areas involved, it again makes sense that this ability to shift sets appears to be a skill we develop as we mature. For children, transitioning from one activity to another is often a painful process (and, as any mom or dad can attest to, it's no picnic for their parents either). Of course, there are exceptions such as Nick, who continued into young adulthood to have difficulties making transitions and shifting sets.