Transcript Chapter 14

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Functional Disorders
of Memory
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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Classifications of Hysteria
 Dissociative
disorders
 Posttraumatic
 Somatoform
 Sleep
stress disorder (PTSD)
disorders
disorders
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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
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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
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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
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HBO Documentary on MPD (1993)
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http://video.google.com/videoplay?docid=1078314996890815904#
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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.
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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
 May
triggered by stress.
result from sexual abuse, results in a pattern of
disruptive behavior in childhood continuing into
adulthood.
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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.
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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, selfmonitoring
 Narratization (autobiography, hierarchical
organization of life events).
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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.
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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.
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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.
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Repetition-Compulsion
 PTSD
is caused by close-calls rather than
injury.
 Repetition
memory.
occurs in the form of intrusive
 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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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Fallacies
 Hypnotic
responding is no better than nonhypnotic 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.
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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
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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.
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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.
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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.
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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.
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Example of Spirit Possession
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http://www.spiritualresearchfoundation.org/spiritualresearc
h/difficulties/Ghosts_Demons/violent_manifestation.php
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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.
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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
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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.
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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
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Witchcraft in Salem, MA
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http://www.youtube.com/watch?v=qbFDBrOlE9k&feature=related
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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.
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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.