+

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.