Gwen Q., an avid birder, belongs to an organization focused on her hobby. They discuss bird physiology, where and how they live and migrate, and trade stories about the best locations to observe birds.
Gwen, whose husband of forty-five years recently died, sat in the monthly meeting listening to an expert from the local zoo. She turned to a friend beside her, and with an odd look on her face, asked, “Where’s Bill?” referring to her late husband.
This was the first indicator of an episode of psychogenic amnesia, and doctors and friends later found out it wasn’t her first.
Many of us may think of amnesia as an illness on its own; in reality, amnesia is a symptom of another, less obvious problem. Neuroscientists generally agree that two types of amnesia exist: organic, which results from physical injury to the brain, and psychogenic. Psychogenic amnesia, also known as dissociative amnesia, is a memory disorder in which an alert and responsive person loses memories but displays no sign of brain injury or lesion.
The concept of psychogenic amnesia remains controversial, as some researchers contend the physical causes may be so slight they are undetectable. Certain lesion studies even indicate that fearful traumatic memories are transmitted along amygdaloid circuits, which have abundant connections to the emotional circuitry of the brain and the autonomic nervous system, unlike normal memory pathways.
In some cases of psychogenic amnesia, the patient suffers both retrograde (long-term) and anterograde, or short-term, memory loss in which new material cannot be learned or recalled. While psychogenic amnesia is typically retrograde, it can also be anterograde or a combination of the two.
Organic amnesia originates from an identifiable physical cause such as head trauma, stroke, or epilepsy. All incidents of psychogenic amnesia are defined by a characteristic lack of brain illness or injury. In addition, some form of psychological trauma typically precedes psychogenic amnesia. Psychogenic amnesia affects about 2.6% of women and 1% of men. Those rates increase during war or following a natural disaster.
Dissociation is a disconnection between a person’s sense of self and their memories, emotions, or actions. Dissociation occurs normally during daydreams, movie-watching, or thinking so deeply you may forget your surroundings. Dissociation may be helpful during moments of trauma such as a traffic accident or rape. Victims may feel as if they are separated from their bodies and may even be observing the person under attack in order to escape the feelings of horror and pain.
Patients with dissociative identity disorder (formerly called multiple personality disorder) may display psychogenic amnesia when the person switches from one personality to another. Each personality appears to be ignorant of information specific to the other personalities. For example, personality “A” may recall the existence of certain items while personality “B” has no knowledge of them. Multiple personality disorder is believed to be caused by extensive childhood abuse.
Simulated amnesia is the attempt by a person to “fake” symptoms, often for monetary gain. Psychiatrists who know the real behaviors of amnesiacs can determine if the person really experiences amnesia.
Before treating a person for psychogenic amnesia, doctors usually obtain a complete medical history, blood work, and other laboratory tests to rule out a physical cause.
After referral to a mental health professional, specialized tests may be used to evaluate the patient’s condition in addition to a clinical interview. The Structured Clinical Interview for Dissociation (SCID-D) is a standard interview used during clinical evaluations of suspected psychogenic amnesia.
Symptoms of psychogenic amnesia take different forms.
A person in a psychogenic fugue forgets all autobiographical information, including identity while other memory remains intact. For example, this person will recall the meaning of words and how to perform tasks, even retain knowledge of historical events, but his personality has vanished. Autobiographical memory, also called episodic memory, is the memory type most frequently affected by amnesia. The memory loss may be brief, or it may last for years. Patients with this condition have been known to travel to a new location and adopt a new identity.
With this condition, the patient loses all retrograde memories while anterograde (new) memories remain unaffected. These individuals may not recognize family members after onset, but “relearn” who they are as time passes.
A patient with this form of amnesia experiences sudden-onset anterograde and variable retrograde amnesia that lasts from minutes to hours followed by complete recovery. Anterograde amnesia, or loss of the ability to make new memories, affects semantic memory. Semantic memory contains definitions, rules, and concepts that allow us to learn. The affected person retains motor skills such as playing the piano, but cannot memorize or retain new facts. It occurs as a sudden attack, and the patient may ask the same questions repeatedly without recalling either the questions or the answers. This individual generally knows his identity and the identities of family members, but remains disoriented and may not know the year or where he lives. In most cases, patients believe they had a memory loss due to a stroke.
The purpose of semantic memory is to access episodes (events you have experienced) from long-term (episodic) memory, remove them from their original context, and associate them with new information. For example, if you once had an allergic reaction to shellfish at a specific restaurant, you can generalize that you would probably experience that reaction again in a different setting. Semantic memory allows humans to generalize information about different events accumulated over a lifetime.
Although the term “psychogenic” implies psychological causes, psychogenic amnesia can be induced by physical stress and injury as well emotional stress.
While antidepressant or anti-anxiety medications may help patients with dissociative disorders, successful treatment also depends on support from family and friends. The primary goal of treatment is the safety of both the patient and the people around him. Additionally, a variety of therapies may help the person recover the lost memories.
Stress reduction has multiple benefits, including psychological. According to the American Psychiatric Association, breathing exercises offer an easy way to reduce stress. The patient uses these exercises to control the rate, rhythm, and depth of breathing. Breathing therapy does not interact with medications and has no side effects.
In a study of relaxation techniques involving people who had survived a tsunami, those who took part in eight hours of training experienced significantly reduced PTSD. They learned simple breathing, sound relaxation, and meditation. By comparison, a control group that did not receive the training continued to have heightened symptoms of anxiety and depression.
Doctors, family, and friends should treat the person with sympathy rather than confrontation. Doctors will try to diagnose and treat other issues at the same time, such as depression or substance abuse. Individuals should be encouraged to return to normal activities, including employment.
Occupational therapy can help improve a patient’s memory. One case study showed that a patient who could not solve a puzzle improved his skills with repeated sessions. Why? Because the neural pathways that control procedural memory are believed to be different from the pathways for biographical memories. Throwing a baseball or tying shoelaces are good examples of procedural memories.
Friends and family members may help restore biographical memories by looking at family photos with the patient or playing the patient’s favorite music. Either of these may stimulate memory.
Hypnosis, however, is considered controversial by some practitioners. Patients may become highly suggestible during hypnosis and can be led to “recall” false memories. Also, the controversial practice of sedating patients to help them recover memories is in decline. The use of drugs can and does elicit a combination of truth and fantasy from a patient.
Clearly, preventing a recurrence of psychogenic amnesia may or may not be under our control. If long-standing family issues caused the amnesia and the family situation does not change, symptoms will persist. The longer amnesia lasts, the less likely the patient is to experience complete recovery.
Consider, however, pursuit of a lifestyle that incorporates relaxation techniques, close, positive relationships, even family therapy and creative therapy. If family members do not cooperate, individuals can still seek therapeutic solutions for themselves. Building a healthier psychological environment may lessen the chance of experiencing psychogenic amnesia.