Dissociative Disorders: Implicit Effects of Dissociated Memories

Implicit Effects of Dissociated Memories

Although information is kept out of consciousness in dissociative amnesia, it may well exert an influence on consciousness: out of sight does not mean out of mind. For example, a rape victim with no conscious recollection of an assault nonetheless behaves like someone who has been sexually victimized. Such individu-als often suffer detachment and demoralization, are unable to enjoy intimate relationships, and show hyperarousal to stimuli reminiscent of the trauma. This loss of explicit memory with re-tention of implicit knowledge is similar to priming in memory research. Individuals who have read a word in a list complete a word stem (a partial word such as “pre” for “present”) more quickly if they have seen that word minutes or even hours earlier. This priming effect occurs despite the fact that they cannot con-sciously recall having read the word, or even the list in which it occurred. When asked in a free recall format to list the word they have seen, they cannot name it, yet they act as though they have seen it and do remember it. Similarly, individuals instructed in hypnosis to forget having seen a list of words nonetheless dem-onstrate priming effects of the hypnotically suppressed list. It is the essence of dissociative amnesia that material kept out of conscious awareness is nonetheless active and may influence consciousness indirectly.

Individuals with dissociative amnesia generally do not suffer disturbances of identity, except to the extent that their identity is influenced by the warded-off memory. It is not un-common for such individuals to develop depressive symptoms aswell, especially when the amnesia occurs in the wake of a trau-matic stressor.

Treatment

Psychotherapy

Often, patients suffering from dissociative amnesia experience spontaneous recovery when they are removed from the stress-ful or threatening situation, when they feel safe, and/or when ex-posed to personal cues from their past (i.e., home, pets, family members). In cases where exposure to a safe environment is not enough to restore normal memory functioning, pharmacologi-cally-facilitated interviews may prove useful.

Hypnosis

Most patients with dissociative disorder are highly hypnotizable on formal testing and are therefore easily able to make use of hypnotic techniques such as age regression. Hypnosis can enable such patients to reorient temporally and therefore achieve access to otherwise dissociated and unavailable memories.

Abreaction

If there is traumatic content to the warded-off memory, patients may abreact, that is, express strong emotion as these memories are elicited. Such abreactions are rarely damaging in themselves but are not intrinsically therapeutic either. They may be experi-enced by the patient as a reinflicting of the traumatic stressor. Such patients need psychotherapeutic help in integrating these warded-off memories and the associated affect into conscious-ness, thereby gaining a sense of mastery over them.

Screen Technique

One technique that can help bring such memories into conscious-ness while modulating the affective response to them is a projec-tive technique known as “the screen technique” (Spiegel, 1981). While using hypnosis, such patients are taught to recall the trau-matic event as if they were watching it on an imaginary movie or television screen. This technique is often helpful for individuals who are unable to remember the event as if it were occurring in the present, either because for some highly hypnotizable indi-viduals that approach is too emotionally taxing or because oth-ers are not sufficiently hypnotizable to be able to engage in such hypnotic age regression. The screen can be employed to facilitate cognitive restructuring of the traumatic memory, for example, by picturing on the left side of the screen some component of the traumatic experience, and on the right side something they did to protect themselves or someone else during it. This makes the memory both more complex and more bearable.

A particularly useful feature of this technique is that it al-lows for the recollection of traumatic events without triggering an uncontrolled reliving of the trauma, as is the case of traumatic flashbacks. The screen technique provides a “controlled dissocia-tion” between the psychological and somatic aspects of memory retrieval. Individuals can be put into self-hypnosis and instructed to get their body into a state of floating comfort and safety. They can do this by imagining that they are somewhere safe and com-fortable: “Imagine that you are floating in a bath, a lake, a hot tub, or just floating in space”. They are reminded that no matter what they see on the screen their bodies are safe and comfort-able: “Do the work on your imaginary screen, not in your body”. In this way the tendency for physiological arousal to accompany and intensify the working through of traumatic memories can be controlled, facilitating the psychotherapeutic work.

The psychotherapy of dissociative amnesia involves accessing the dissociated memories, working through affec-tively loaded aspects of these memories, and supporting the patient through the process of integrating these memories into consciousness.

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