Psychogenic amnesia and fugue

“Bernice L., a 42-year-old housewife, was brought to the clinics by her family, who stated that the patient had disappeared from her home four years previously, and had recently been identified and returned from R_________a small town over a thousand miles away. On rejoining her parents, husband and child she had at first appeared highly perturbed, anxious, and indecisive. Soon, however, she had begun to insist that she really had never seen them before, that her name was not Bernice L. but Rose P. and that it was all a case of mistaken identity; further, she threatened that if she were not returned to her home in R_________immediately, she would sue the hospital for conspiracy and illegal detainment. Under treatment, however, the patient slowly formed an adequate working rapport with the psychiatrist, consented to various ancillary anamnestic procedures, such as, amytal interviews and hypnosis and eventually dissipated her amnesia sufficiently to furnish history of the amnesic period. Fortunately, her husband proved unexpectedly understanding and cooperative, and the patient eventually readjusted to a fuller and more acceptable life under happily changed circumstances. In R_________she had begun to earn a living playing and teaching the piano, and was so rapidly successful that within two years she was the assistant director of a conservatory of music.”
Amnesia is partial or total inability to recall or identify past experience. It may occur in neurotic and psychotic conditions and in brain pathology that includes brain injury and diseases of the nervous system. If it is the outcome of brain pathology, it occurs, more specifically, due to actual failure of retention. It does mean that either the information is not retained and does not enter memory storage, or, if stored, the retrieval of it is not possible; or it is, in actual effect, lost.

Psychogenic amnesia , in other words, is, invariably, limited to a failure to recall. The material ” forgotten” by the individual is still there in the subconscious or unconscious as it can be retrieved under hypnosis or narcosis interviews and in case if amnesia spontaneously clears up. Four types of psychogenic amnesia are recognized:1.Localized (the individual cannot remember anything that happened in first few hours following some traumatic event); 2.Selective (the individual cannot remember some but not all of what happened during a specific period);3.Generalized ( the individual forgets one’s entire life history); 4. Continuous (the individual cannot remember anything beyond a certain point in the past). Third and fourth types occur only very rarely.

Psychogenic amnesia is common in initial reactions to intolerably traumatic experiences immediately after catastrophic events. However, under neurotic conditions amnesias develop in the face of situations that are stressful but with which most individuals deal more effectively. In a typical case of psychogenic amnesic reactions, the individual cannot remember one’s name, age,  or place of one’s inhabitation and does not recognize one’s parents, relatives, or friends.

Besides, the individual’s basic habit patterns, such as, one’s ability to read, talk, and so on-remain intact, and one seems quite normal being an amnesic. It is called a fugue state. A fugue reaction is a defense by actual flight-the individual wanders away from home in an amnesic state, and under false assumption of a partially or completely new identity.Days, weeks, or sometimes even years’ later amnesic state is gone and the individual finds oneself in a strange place, not knowing how he or she got there and with complete amnesia for the period of fugue. Any type of inner conflict, that is, anxiety-arousing may serve as the basis of the amnesic reaction and fugue. The threatening information is inaccessible may be due to some sort of automatic cognitive blockage or to deliberate suppression. The individual experiencing psychogenic amnesia is egocentric, immature, highly suggestible that is faced with an extremely unpleasant situation from which one sees no escape. The impulse to “forget” and run away from it are well rehearsed by the individual previously and may be unconsciously.

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