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BHS 499-07
Memory and Amnesia
Functional Disorders
of Memory
Functional Disorders (Hysteria)
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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.
Sources of Symptoms
(Psychodynamic View)
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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.
History of Hysteria
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In the mid-1800’s hysteria was
considered either:
• Irritation of the female sexual organs (floating
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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.
Charcot shows colleagues a female hysteria patient at
Salpetriere Hospital (Paris). Freud studied with Charcot in 1885.
History (Cont.)
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Symptoms included:
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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.
Janet’s View of Hysteria
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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.
Janet (Cont.)
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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.
Freud’s View of Hysteria
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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-
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creating)
Banishment of memories requires repression
Affect is damned up or strangled.
Freud’s Seduction Theory
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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.
Classifications of Hysteria
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Dissociative disorders
Posttraumatic stress disorder (PTSD)
Somatoform disorders
Sleep disorders
Dissociative Disorders
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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
Dissociative Amnesia
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Impairment is reversible and usually
reported retrospectively (in past tense).
Types of disturbance:
• Localized – affects a few hours around a
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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
Dissociative Fugue
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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
Dissociative Identity Disorder
(DID)
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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.
DID (Cont.)
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Frequent gaps in memory.
Amnesia may be asymmetrical:
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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.
Depersonalization Disorder
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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.
An Identity View of Dissociation
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One function of consciousness is to
construct a mind-space that includes:
• Space and time
• Abstractions of meaning (gist) and making
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sense of what happens
A self, an imagined or idealized self, selfmonitoring
Narratization (autobiography, hierarchical
organization of life events).
Cultural Examples of
Dissociation
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All cultures have some kind of spirit
possession:
• Amok syndrome
• Historical examples of demonic possession
• Current religious and spiritual possession
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Amnesia is often associated with such
possessions.
Social Construction of
Dissociative States
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Spanos considers possession to be a
social construct:
• Society provides special status and historical
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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.
Physiological Theories of
Dissociation
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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.
Repetition-Compulsion
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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.
PTSD (Cont.)
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Avoidance of reminders of the event can
include amnesia for some aspect of the
event.
• Reexperiencing includes dreams and intrusive
recollections.
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Dreams and recollections are not factual
but recreations of idealized or feared
features of an event.
• Content changes during therapy.
Somatoform Disorders
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Unintentional symptoms of a medical
disorder without a medical cause:
• Somatization disorder – multiple symptoms
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(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.
Conversion Disorder
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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.
Conversion Disorder (Cont.)
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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.
Sleep Disorders
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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.
Sleepwalking Disorder
(Somnambulism)
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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.