BHS 499-07 Memory and Amnesia

1. BHS 499-07Memory and Amnesia Functional Disorders of Memory

2. Functional Disorders (Hysteria) • Functional disorders are not disorders of structure but of function. • Such disorders are classified as hysteria by the DSM (Diagnostic & Statistical Manual). • They were the only disorders retaining a psychological explanation & etiology, rather than being defined by symptoms.

3. Sources of Symptoms (Psychodynamic View) • Strangulated affect is converted into physical symptoms by the repressed memory – called conversion symptoms. • Symptoms disappear if the repressed emotion associated with an event is released – called abreaction. • Therapy is needed to overcome resistance to remembering and thereby relive the trauma.

4. History of Hysteria • In the mid-1800’s hysteria was considered either: • Irritation of the female sexual organs (floating womb) • Imaginary, play-acting by women • Charcot rejected both explanations, calling it a neurosis also shown by men. • Charcot thought it required hereditary brain degeneration.

5. Charcot shows colleagues a female hysteria patient at Salpetriere Hospital (Paris). Freud studied with Charcot in 1885.

6. History (Cont.) • Symptoms included: • Paralysis • Convulsions, contractures (muscles won’t relax), seizures – arc de cercle (arching back in rigid posture) • Somnambulism (sleepwalking) • Hallucinations • loss of speech, sensation or memory • Charcot recognized parallels between hysteria and hypnosis and found he could remove symptoms using hypnosis.

7. Janet’s View of Hysteria • Symptoms arose from subconscious beliefs isolated and forgotten, thus disassociated from consciousness. • Memory pools are normally disconnected but become connected through mental effort. • Traumatic shock disrupts the mental effort needed to associate memory pools.

8. Janet (Cont.) • Memory pools may be associated with fixed ideas that motivate repeated actions. • These are seen in fugue states or sleepwalking or the emotions seen in multiple personality disorder’s alternative selves.

9. Freud’s View of Hysteria • Freud studied with Charcot and later wrote “Studies in Hysteria” with Breuer, based on the case study of Anna O. • He thought “hysterics suffer mainly from reminiscences”: • Traumatic memories are pathogenic (disease-creating) • Banishment of memories requires repression • Affect is damned up or strangled.

10. Freud’s Seduction Theory • Repressed memories nearly always revealed seduction or sexual molestation by an adult. • The patient doesn’t know what is repressed so the therapist must overcome resistance to uncover it. • Later, Freud decided that fantasies, impulses and wishes caused repression.

11. Classifications of Hysteria • Dissociative disorders • Posttraumatic stress disorder (PTSD) • Somatoform disorders • Sleep disorders

12. Dissociative Disorders • Disruption of the usually integrated functions of memory, consciousness, identity or perception of the environment. • These include: • Dissociative amnesia • Dissociative fugue • Dissociative identity disorder (DID, also MPD) • Depersonalization disorder

13. Dissociative Amnesia • Impairment is reversible and usually reported retrospectively (in past tense). • Types of disturbance: • Localized – affects a few hours around a traumatic event. • Selective – affects some but not all events during a period of time, or some categories. • Generalized – affects entire past. • Continuous – a specific time up to the present

14. Dissociative Fugue • Sudden, unexpected travel away from one’s home or workplace with inability to recall the past. • The person may assume a new identity or be confused about his or her identity. • Wandering may be motivated by a fixed idea (repetition compulsion). • Return to pre-fugue state brings amnesia

15. Dissociative Identity Disorder (DID) • Also called multiple personality disorder (MPD). • Presence of two or more distinct identities or personality states with memory loss across states. • Failure to integrate identity, memory and personality. • Primary personality is passive, guilty, dependent, depressed. Alternates may be hostile, aggressive, controlling.

16. DID (Cont.) • Frequent gaps in memory. • Amnesia may be asymmetrical: • Passive identities have more constricted memories. • Active or protector identities have more complete memories. • Transitions triggered by stress. • May result from sexual abuse, results in a pattern of disruptive behavior in childhood continuing into adulthood.

17. Depersonalization Disorder • A feeling of detachment or estrangement from one’s self. • A person may feel like an observer of their own mental processes or body. • Includes sensory anesthesia, lack of affect, a feeling of lack of control of one’s actions. • Voluntarily induced in religious and trance experiences.

18. An Identity View of Dissociation • One function of consciousness is to construct a mind-space that includes: • Space and time • Abstractions of meaning (gist) and making sense of what happens • A self, an imagined or idealized self, self-monitoring • Narratization (autobiography, hierarchical organization of life events).

19. Cultural Examples of Dissociation • All cultures have some kind of spirit possession: • Amok syndrome • Historical examples of demonic possession • Current religious and spiritual possession • Amnesia is often associated with such possessions.

20. Social Construction of Dissociative States • Spanos considers possession to be a social construct: • Society provides special status and historical factors affect its manifestation. • The possessed role is learned. • There are benefits to performing the possessed role and it is frequently acted by the powerless. • DID may be a socially constructed role.

21. Physiological Theories of Dissociation • Only a tiny percentage of individuals exposed to stressors or trauma show dissociative symptoms. • True cases of DID can be distinguished from socially constructed cases through childhood behavior. • True cases of DID, fugue or other amnesias usually show histories of early childhood brain injury or recent damage.

22. Repetition-Compulsion • PTSD is caused by close-calls rather than injury. • Repetition occurs in the form of intrusive memory. • Normally anxiety protects us from fright but with an unexpected shock there is no chance for anxiety. • Repetition creates retrospective anxiety which builds defenses after the event.

23. PTSD (Cont.) • Avoidance of reminders of the event can include amnesia for some aspect of the event. • Reexperiencing includes dreams and intrusive recollections. • Dreams and recollections are not factual but recreations of idealized or feared features of an event. • Content changes during therapy.

24. Somatoform Disorders • Unintentional symptoms of a medical disorder without a medical cause: • Somatization disorder – multiple symptoms (formerly just called hysteria) • Conversion disorder – voluntary motor or sensory dysfunction with psychological cause. • Hypochondriasis – fear of illness. • Pain disorder – pain whose onset, severity and maintenance have a psychological cause.

25. Conversion Disorder • Pseudoneurological – related to voluntary motor or sensory function. • Symptoms include impaired coordination or balance, paralysis, weakness, difficulty swallowing or lump in throat, double vision, blindness or deafness, seizures. • The more medically naïve the person, the more implausible the symptoms.

26. Conversion Disorder (Cont.) • The symptom represents a symbolic resolution of an unconscious conflict. • Primary gain is keeping the conflict out of awareness. • Secondary gain is external benefits and relief from responsibilities. • Neurological conditions such as MS can be misdiagnosed as conversion disorder.

27. Sleep Disorders • Dyssomnias – sleep problems. • Parasomnias – abnormal behavior associated with sleep. • Nightmares and sleep terrors – nightmares are not memories, sleep terrors usually cannot be remembered. • Hypnagogic hallucinations – occur at sleep onset, vivid, accompanied by wakefulness.

28. Sleepwalking Disorder (Somnambulism) • Repeated episodes of complex motor behavior initiated during sleep, with limited recall upon waking. • Difficulty being awakened, with confusion upon awakening. • As with fugue, the person may attempt to carry out a fixed idea.