Elsevier

Consciousness and Cognition

Volume 19, Issue 3, September 2010, Pages 778-801
Consciousness and Cognition

Psychogenic amnesia – A malady of the constricted self

https://doi.org/10.1016/j.concog.2010.06.024Get rights and content

Abstract

Autobiographical–episodic memory is the conjunction of subjective time, autonoetic consciousness and the experiencing self. Understanding the neural correlates of autobiographical–episodic memory might therefore be essential for shedding light on the neurobiology underlying the experience of being an autonoetic self. In this contribution we illustrate the intimate relationship between autobiographical–episodic memory and self by reviewing the clinical and neuropsychological features and brain functional imaging correlates of psychogenic amnesia – a condition that is usually characterized by severely impaired retrograde memory functioning, in absence of structural brain damage as detected by standard imaging. We demonstrate that in this disorder the autobiographical–episodic memory deficits do not exist in isolation, but occur with impairments of the autonoetic self-consciousness, emotional processing, and theory of mind or executive functions. Furthermore functional and metabolic brain alterations involving regions that are agreed upon to exert crucial roles in memory processes were frequently found to accompany the psychogenic memory “loss”.

Introduction

Memory connects innumerable single phenomena into a whole, and just as the body would be scattered like dust in countless atoms if the attraction of matter did not hold it together so consciousness – without the connecting power of memory – would fall apart in as many fragments as it contains moments.” (Ewald Hering, 1870/1895, p. 12).

Memory requires more than mere dating of a fact in the past. It must be dated in my past. In other words, I must think that I directly experienced its occurrence.” (William James, 1890/1950, p. 650).

Autobiographical–episodic memory (AEM) has a close connection to self and self understanding, which is concisely captured by Tulving’s (2005) last definition of AEM. According to this, AEM could be viewed as a threefold cord that results from the uniting of subjective time, autonoetic consciousness and the experiencing self (Tulving, 2005). As William James’ quotation suggests, the appearance of AEM on the one hand, reflects and occurs in the context of the attainment of a new stage of self understanding and self awareness (Nelson, 2003). On the other hand, the emergence of AEM supports further self development and the capacity – that is crucial to at least highly individualized societies – for maintaining a consistent feeling of identity and a coherent awareness of self‘s continuity over time (Nelson, 2003, Nelson, 2005, Newen et al., 2009, Vogeley and Kupke, 2007, Welzer and Markowitsch, 2005).

In the field of clinical psychiatry and psychoanalysis the role of AEM for one’s sense of self coherence and “trans-temporal sameness” (Metzinger, 2008), well-being or capacity to reconstruct oneself has been emphasized since Freud and “beyond”, despite differences in the working models of the self, which ranged from a vertically-organized self, with areas of conflict “buried” by repression to a horizontally aligned and sequenced view of self, with territories of incompatibility separated by dissociation (S.A. Mitchell & Black, 1995). Patients with psychogenic amnesia have been described for more than a century, providing evidence for the significant influence of social environment on AEM (cf. Markowitsch, 1992).

In this review, after defining psychogenic amnesia, we outline the memory systems and the main brain structures that are involved in AEM and the processes necessary for building an episodic memory. We then illustrate the ways in and by which stress-related and psychological factors could lead to both a severe compromise of AEM and disturbances of several functions underlying the experience of being a self.

Section snippets

What and where (in the international classifications of diseases) is psychogenic amnesia?

Borrowed from Greek (Pearce, 2007) the word amnesia describes the most severe form of memory impairment and refers to an inability to learn new information or recall previously learned information. The term is nowadays used to refer to a symptom of a disorder, a syndrome or a specific disease. In the latter case, its employment is congruent with the traditional view of amnesia as a memory impairment that occurs in an alert, responsive person in the absence of (or out of proportion in comparison

Autobiographical–episodic memory system and its place within memory systems

Memory is not unitary, but is divided along a chronological and content axis, respectively. Along the time axis, memory is classified in short-term and long-term memory. The term short-term memory has been employed to describe the online holding of information such as telephone numbers. It has a limited capacity of a few bits (4–7) (G.A. Cowan, 2001, Miller, 1956) and encompasses a time range of seconds to minutes. Any information that is not lost and exceeds the limited capacity of short-term

Autobiographical–episodic memory and the brain

The processing of memory has been a source of debate since the beginning of brain research. A waxing and waning interest in theories that proposed a strict mosaic-like localization (Markowitsch, 1994) within specific brain structures alternated with a similarly fluctuating interest in theories which promoted a widespread, Gestalt-like representation within the brain (Markowitsch, 1992). Nowadays, a compromise has generated a theoretical approach to memory processing that integrates both views

Clinical aspects of psychogenic memory loss

As the description of Ewald Hering implies AEM binds and integrates personal events and emotion with an autonoetic self. One view of retrograde “organic” AEM recollection impairments is that they may be accounted for by both loss of information and deficits in binding and reassembling details of the past (Rosenbaum, Gilboa, Levine, Winocur, & Moscovitch, 2009). Being the most advanced acquisition ontogenetically (Tulving, 2005), the AEM system displays a higher vulnerability to insults caused

The Janus head of amnesia: psychogenic and organic

As it is the case with a variety of psychiatric disorders, advances in neurosciences have challenged the validity of the old distinctions in organic and psychogenic (Markowitsch, 1996, Markowitsch, 1999a, Ouellet et al., 2008). Functional imaging studies have delivered evidence for a long searched biological link between the organic and psychogenic amnesia, by demonstrating brain functional and metabolic alterations in psychogenic or functional amnesia, which involve anatomical regions that are

Stress and psychogenic amnesia

Psychogenic amnesias have been described in many cultures and recognized to occur in response to traumatic or psychological stress (Seligman and Kirmayer, 2008, Staniloiu and Markowitsch, in press). They could co-exist with other psychiatric disorders, such as major depressive disorder, bulimia nervosa, alcohol abuse or borderline, histrionic or narcissistic personality disorder (Maldonado & Spiegel, 2008).

Psychogenic amnesias tend to affect younger people (Reinhold and Markowitsch, 2007,

Psychogenic amnesia, emotions/feelings and personal meaning

A central feature of AEM is its relationship with emotions. Emotions have an intimate connection to (one-)self and are used for appraising one‘s own position with respect to environment. Emotional evaluation is of importance for the acts of encoding, storage as well as for the recall of AEM. A “non-specific blurring or flattening” (Markowitsch, 1999b) in AEM (or so called overgeneralization phenomenon; Williams & Scott, 1988) has, for example, been described in patients with major depressive

Psychogenic amnesia and self versus other

AEM, self-consciousness and theory of mind (ToM) seem to be correlated early during the ontogenetic development (Nelson and Fivush, 2004, Perner, 2000). The ToM capacity, which is defined as the ability to attribute and make inferences about the mental states of other people, such as desires, beliefs, intentions and feelings, and to differentiate between own and others’ mental states, undergoes significant and gradual changes during childhood. Between 16 and 24 months of age children pass the

Psychogenic amnesia and future memories of the self

“Time present and time past

Are both perhaps present in time future” (Eliot, 1969, p. 171)

An extended self emerges ontogenetically in conjunction with AEM, which throughout lifetime continues to support the self‘s vigorousness and coherence. Through the medium of autonoetic awareness which accompanies AEM, the extended self is capable of subjective mental time traveling in the past, present and future (Markowitsch, 2003, Tulving, 2005). Though traditionally the AEM was viewed as acting primarily

Searching for the neural signature of the constricted self in the psychogenic amnesia

Despite the risk of being criticized for adding a new form of self to the already existing long list of selves (Legrand & Ruby, 2009), we employed the term constricted self to metaphorically capture the symptomatology of patients with psychogenic amnesia (including the constriction of mental time traveling in the future).

Janet (1907) talked about hysteria as a disorder of “personal synthesis”. As some authors pointed out (Spiegel, 2006, Van der Hart and Dorahy, 2006), he often used the term

Conclusions

The topic of self and self-consciousness has generated the interest of humanity for centuries. Adherents to Aristotelian or Heraclitean views of self (Moldoveanu & Stevenson, 2001) or opponents to the notion of self have all generated a significant amount of sophisticated writings, reinforcing the idea that – in spite of differences of opinions regarding self-specificity or what it means to have a self – self is a topic of universal interest in multiple disciplines.

Similar to the topic of

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