Author Topic: Dispelling Confusion About Traumatic Dissociative Amnesia  (Read 32 times)

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Dispelling Confusion About Traumatic Dissociative Amnesia
« on: July 02, 2019, 05:46:18 PM »
source: https://www.mayoclinicproceedings.org/article/S0025-6196(11)61370-0/fulltext

I assert that the greater the physical pain, the less memory of it (if any at some point(s)) is accessible. Probably mainly due to endorphins, i'd guess.

some excerpts:

How survivors of trauma remember—or forget—their most terrifying experiences lies at the core of one of the most bitter controversies in psychiatry and psychology: the debate regarding repressed memories of childhood sexual abuse.

Most experts hold that traumatic events—those experienced as overwhelmingly terrifying and often life-threatening—are remembered very well; however, traumatic dissociative amnesia theorists disagree. Although acknowledging that traumatic events are usually memorable, these theorists nevertheless claim that a sizable minority of survivors are incapable of remembering their trauma.

That is, the memory is stored but dissociated (or “repressed”) from awareness. However, the evidence that these theorists adduce in support of the concept of traumatic dissociative amnesia is subject to other, more plausible interpretations.

The purpose of this review is to dispel confusion regarding the controversial notion of dissociated (or repressed) memory for trauma and to show how people can recall memories of long-forgotten sexual abuse without these memories first having been repressed.

CSA (childhood sexual abuse), PTSD (posttraumatic stress disorder)

Are traumatic experiences engraved in memory? Or does the mind protect itself by banishing memories of trauma from awareness? These questions lie at the heart of the bitter controversy regarding the reality of dissociated (or “repressed”) memories of childhood sexual abuse (CSA).

A substantial body of evidence indicates that documented traumatic experiences—those triggering terror and fear of impending death—are seldom, if ever, truly inaccessible to awareness.

Release of stress hormones during trauma fosters consolidation of the experience, rendering it relatively resistant to forgetting. Nevertheless, the mind does not operate like a videotape recorder, infallibly capturing all our sensory impressions. Even memories of trauma may change over time.

However, when the details change or fade, trauma survivors still remember the gist of their experience remarkably well. It is easy to see how the capacity for remembering trauma might constitute an evolutionary adaptation, whereas a capacity for forgetting it would seemingly imperil survival.

This consensus notwithstanding, traumatic dissociative amnesia theorists hold that a sizable minority of survivors develop “massive repression” of their trauma, making it difficult for them to recall it until it is safe to do so, often many years later. In fact, some believe that the more traumatic an event is, the more likely some survivors will be unable to remember it. As Brown et al7p97 argued,

when emotional material reaches the point of being traumatic in intensity—something that cannot be replicated in artificial laboratories—in a certain subpopulation of individuals, material that is too intense may not be able to be consciously processed and so may become unconscious and amnesic.

The traumatic dissociative amnesia theorists believe that these survivors are unable, not merely reluctant, to recall their trauma, precisely because it was so emotionally distressing. Moreover, they affirm that dissociated trauma must be remembered for healing to occur8 and that special techniques are sometimes needed to help patients recover the traumatic memories they are otherwise unable to recall.

As Brown et al. put it, “Because some survivors of sexual abuse will repress their memories by dissociating them from consciousness, hypnosis can be very valuable in retrieving these memories. Indeed, for some survivors, hypnosis may provide the only avenue to the repressed memories.” These beliefs provided the theoretical rationale for what critics have called recovered memory therapy. Critics worried that suggestive methods, such as hypnosis for memory retrieval, increased the risk of patients developing false memories of abuse.

Traumatic dissociative amnesia theorists have not ignored the clinical science of memory. Instead they have often misinterpreted the very studies they cite in support of the alleged phenomenon of dissociated memory of trauma (discussed in detail in published reviews).

The purpose of this article is to dispel confusion regarding the relevant studies and to provide an account of how some people may recall long-forgotten memories of CSA without having first repressed them.

What it is not

* Everyday Forgetfulness Is Not Traumatic Dissociative Amnesia !
(this kind of memory problem refers to everyday forgetfulness that emerges in the wake of trauma; it has nothing to do with difficulty remembering the trauma itself. Indeed, intrusive recollection of the trauma may interfere with everyday memory functioning. Everyday memory problems that develop after a trauma must not be confused with amnesia for the trauma.)

* Organic Amnesia Is Not Traumatic Dissociative Amnesia !

* Psychogenic Amnesia Is Not Traumatic Dissociative Amnesia !
(Psychogenic amnesia is an unusual syndrome characterized by sudden, massive retrograde memory loss that cannot be attributed to physical damage to the brain.)

* Incomplete Encoding Is Not Traumatic Dissociative Amnesia !
(... For example, persons mugged at gunpoint sometimes are unable to recall the face of their assailant, not because they have amnesia but because their attention was so fixed on the gun that they never encoded the assailant's face. Accordingly, incomplete encoding must not be confused with traumatic dissociative amnesia.)

* Nondisclosure Is Not Traumatic Dissociative Amnesia !
(it is often unclear whether the survivors cannot recall abuse or whether they are merely reluctant to disclose it to a stranger conducting a survey.)

* Childhood Amnesia Is Not Traumatic Dissociative Amnesia !
(People can remember little of their lives before the age of 4 or 5 years. Neurocognitive changes in language capacity and brain maturation make it very difficult for older children and adults to recall events encoded during their preschool years. Accordingly, if a person cannot recall an episode of molestation from the preschool years, one should not assume its inaccessibility is attributable to traumatic dissociative amnesia. Because of normal childhood amnesia, nearly all events from these years will be lost forever.)

* Dissociation During a Trauma Is Not the Same as Being Unable to Remember the Trauma Later !
(The concept of dissociation is extremely broad, embracing diverse processes. All of the following have been deemed dissociative: the sense of being disconnected from one's body (depersonalization), derealization, the sense that time is slowing down, emotional numbing, the inability to remember parts of the trauma, and the ability to remember trauma all too well (ie, flashbacks).

However, the experience of depersonalization does not prevent the survivor from recalling the trauma later. Indeed, dissociation during the trauma predicts later PTSD, a disorder characterized by vivid, intrusive recollections of the trauma.)

* Not Thinking About Something for a Long Time Is Not Traumatic Dissociative Amnesia !
(The most common mistake made by traumatic dissociative amnesia theorists is to confuse not thinking about something with an inability to remember it.)

A Third Perspective on Recovered Memories

In other words, the rules that ordinarily govern remembering and forgetting are suspended for at least some kinds of psychological trauma. If one accepts that memory of CSA (childhood Sexual Abuse) obeys different rules than memory of other events, one can claim that anyone who reports having recalled long-forgotten abuse must have repressed or dissociated the memory.

Traumatic dissociative amnesia theorists postulate special mechanisms because they assume that CSA is nearly always a terrifying, traumatic experience that should otherwise be highly memorable.

The false memory view operates on the (correct, in my opinion) assumption that repetition and emotional arousal should strengthen memory. According to this view, if someone claims to have remembered forgotten traumatic events, especially within the context of “recovered memory therapy,” then the recollection is likely false. Indeed, if we assume that CSA usually counts as a terrifying trauma, then the well-established mechanisms of memory should make amnesia difficult, if not impossible.

More than a “middle ground” between these 2 positions, a third perspective goes beyond blandly affirming that sometimes repressed and sometimes false memories occur.

In our research program, the typical recovered memory participant reports having been nonviolently molested (eg, fondled) by a trusted adult (eg, uncle) on 1 or more occasions, and having been confused and upset, but not terrified. Aged only 7 or 8 years, the average survivor did not fully understand the unpleasant experience as sexual abuse.

Understanding such episodes as sexual abuse likely amplifies its negative emotional impact and hence its memorability. In the absence of such understanding, the episode is less likely to be as memorable as it would otherwise be. Lacking a conceptual framework for the molestation, the CSA survivor managed not to think about the experience for many years, and this ordinary forgetting was fostered by the absence of reminders (eg, perpetrator moved away).

Years later, the abuse survivor encounters reminders that trigger recollection of the long-forgotten experience from the perspective of an adult. Because the event was not understood when it occurred and was not experienced as traumatic, no special dissociative mechanism is needed to explain why the person did not think about it for so long.

Once CSA survivors in our research program have recalled the event as adults, usually outside the context of therapy, they tend to experience intense distress, and nearly one third of them qualify for PTSD.

These data suggest that survivors of CSA may recall memories of sexual abuse without these memories previously having been repressed or dissociated. A recovered memory does not imply a previously repressed or a traumatic memory.

During a period of forgetfulness, some survivors of CSA may forget having previously recalled an aversive event. Geraerts et al. reported that survivors of CSA are more likely to forget having remembered abuse if memories of that abuse (possibly false?) were recalled outside of rather than in psychotherapy.

Even if it is not perceived as terrifying, an act of molestation is no less morally reprehensible. Sexual abuse is a social evil regardless of whether it triggers terror or causes psychiatric illness.

Conclusion

This review of the evidence adduced in support of the concept of traumatic dissociative amnesia raises questions about whether such a phenomenon exists as a natural capacity of the brain.

Most studies cited by traumatic dissociative amnesia theorists either concern other kinds of memory phenomena (eg, everyday forgetfulness emerging after a trauma) or findings that are more plausibly explained in other ways (eg, not thinking about something for a long time).

Indeed, a comprehensive review of the medical and nonmedical literature by Pope et al. implied that the concept of traumatic dissociative amnesia (repressed and recovered memory of a trauma) may be a social construction that arose first in the literary culture of Romanticism.

They were unable to locate any descriptions of a repressed and recovered traumatic memory before the 19th century.

This absence of evidence for repressed memories of trauma contrasts sharply with descriptions of mania, melancholia, auditory hallucinations, and other disorders throughout history and across cultures.
« Last Edit: July 03, 2019, 05:50:05 PM by Chip »
Over 90% of all computer problems can be traced back to the interface between the keyboard and the chair !

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