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Functional Disorders
of Memory
+ 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.
+ 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.
+ 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.
Charcot shows colleagues a female hysteria patient at
Salpetriere Hospital (Paris). Freud studied with Charcot in 1885.
+ 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.
+ 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.
+ 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.
+ 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.
+ 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.
+ Classifications of Hysteria
Dissociative disorders
Posttraumatic stress disorder (PTSD)
Somatoform disorders
Sleep disorders
+ 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
+ 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
+ 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
+ HBO Documentary on MPD (1993)
http://video.google.com/videoplay?docid=-
1078314996890815904#
+ 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.
+ 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.
+ 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.
+ 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).
+ 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.
+ 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.
+ 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.
+ 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.
+ 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.
+ 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.
+ 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.
+ 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.
+ 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.
+ 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.
+ 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.
+ 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.
+ 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.
+ 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.
+ 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.
+ 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
+ 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.
+ 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.
+ 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.
+ 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.
+ Example of Spirit Possession
http://www.spiritualresearchfoundation.org/spiritualresearc
h/difficulties/Ghosts_Demons/violent_manifestation.php
+ 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.
+ 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
+ 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.
+ 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
+ Witchcraft in Salem, MA
http://www.youtube.com/watch?v=qbFDBrOlE9k&feature=related
+ 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.
+ 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.
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