Functional Disorders of Memory

1. 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. HBO Documentary on MPD (1993) • http://video.google.com/videoplay?docid=-1078314996890815904#

16. 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.

17. 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.

18. 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.

19. 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).

20. 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.

21. 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.

22. 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.

23. 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.

24. 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.

25. 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.

26. 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.

27. 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.

28. 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.

29. 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. • Lady Macbeth is an example.

30. Myth of Hypnosis • Spanos is a critic of traditional views of hypnosis. • He argues against the idea of hypnosis as an altered state of consciousness in which people: • Have unusual experiences. • Have abilities not available to them normally. • Cannot lie and will do things without question.

31. Sociocognitive View of Hypnosis • Hypnotic behaviors can be explained using normal psychological processes. • The term hypnosis refers to a historically rooted conception of hypnotic responding held by the participants. • Responding is context-dependent: • Determined by the willingness of subjects to adopt the role • Modified by their understanding of that role.

32. Components of Hypnotic Situations • An induction procedure • Now, includes suggestions that the subject is becoming relaxed or sleepy. • Administration of suggestions calling for specific behavioral or subjective responses. • Arm levitation (raising) • Hypnotic responding is stable over time.

33. What is Hypnotic Responding? • Traditional view says that a trance state is induced in which people respond involuntarily to suggestions. • Sociocognitive view says that responding reflects expectations and attitudes people bring to the session. • Hypnotic subjects retain control over their actions, even when experienced as involuntary.

34. Fallacies • Hypnotic responding is no better than non-hypnotic responding to suggestions. • Neither produces long term change in smoking, wart removal, etc. • There is no unique quality to hypnotic trance that cannot be simulated. • People are not necessarily faking, but anything a hypnotized person can do, a non-hypnotized person can too.

35. Explaining Dramatic Behaviors • Negative hallucinations – deafness, blindness. • Delayed auditory feedback – “deaf” hypnotized subjects behaved like non-hypnotized. • Demand characteristics – depends on how the question is asked. • Fading number 8

36. Involuntariness • One of the chief demands of the hypnotic situation is the loss of will. • Sociocognitive view says subjects retain control and use it in goal-directed ways. • Subjects interpret their responses as involuntary in order to conform to social demand – woman swatting fly. • Wording of suggestions affects involuntariness.

37. Studies of Spirit Possession • Spanos argues that other “dissociative” experiences are the result of cultural suggestion, enacting a social role. • Not all cultures have multiple personality disorder (DID or MPD), but some enact multiple personalities as spirit possession. • Human occupant of a body is temporarily displaced by another self that takes over.

38. Speaking in Tongues • Glossolalia (speaking in tongues) occurs in the context of a religious ceremony. • May be accompanies by convulsions, eye closing or unconsciousness, etc. • Interpreted as the holy spirit taking over and speaking in His own language. • Interpretation may follow, with amnesia. • Learned and practiced behavior.

39. Spirit Mediums • The medium becomes possessed by a spirit or series of spirits who help the client. • The ceremony involves behaviors marking the transitions, and observer responses the validate the performance.

40. Example of Spirit Possession • http://www.spiritualresearchfoundation.org/spiritualresearch/difficulties/Ghosts_Demons/violent_manifestation.php

41. Learning the Possessed Role • In some families, being a medium runs in the family and the spirit moves from one relative to another. • In some cases, people apprentice to learn the role. • Kardec introduced spirit mediums into Puerto Rico where “espiritistas” replaced folk healers. • The first possession may arise during distress.

42. Peripheral Possession • A person with little social status or power becomes possessed by a member of another person’s family. • That possessing spirit begins making demands that must be met by the other family. • Women may adopt peripheral possession roles in order to engage in behavior otherwise not tolerated – e.g., Malaysian factory workers. • Tevye’s dream (Fiddler on the Roof) – a way of letting a spirit ask his wife for what he cannot: http://www.youtube.com/watch?v=NoEFmf76MJo&feature=related

43. Historical Demon Possession • Symptoms of demon possession from the New Testament: • Convulsions, sensory and motor deficits, enactment of alternate identities, loss of voluntary control, increased strength, amnesia • These symptoms ultimately coalesced into a relatively stereotypic social role. • Largely a conversion tool, so possession increased with competition among religions.

44. Witchcraft and Demon Possession • In the 15-17 centuries, demon possession was associated with witchcraft (part of a Satanic conspiracy). • Compendium Maleficarum – witchhunting manual from the 17th century. • People who were of low social status but intelligent, well-traveled, or privy to thoughts and actions of others were suspected. • Behaviors of those possessed were involuntary

45. Witchcraft in Salem, MA • http://www.youtube.com/watch?v=qbFDBrOlE9k&feature=related

46. Socialization of Demoniacs • Clerics taught those possessed their role. • Initially symptoms were ambiguous. • Later, became convulsions, being bitten, and seeing spectres of witches attacking them. • Catholic & Protestant treatment of demons varied. • Enactments sometimes used strategically.

47. Evidence of Social Construction • Incidence of demon possession has varied widely across cultures and across time periods with inconsistent symptoms. • Some experts diagnose many more cases than others. • The more attention paid to the symptoms, the more elaborate they become. • Rearrangement of biographies to fit role.