AMNESIA AND EMOTIONAL AROUSAL

by Sven-Ake Christianson

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Doctoral dissertation to be publicly discussed in lecture room 2, at the Department of Psychology, University of Umeå, on May 25, 1984, at 10.15 a.m., for the degree of Doctor of Philosophy.

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1984 ABSTRACT

Christianson, S.-A. Amnesia and emotional arousal. Doctoral Dissertation, Department of Psychology, University of Umeå, S-901 87 Umeå, Sweden, 1984. ISBN 91-7174-160-7.

The purpose of the present thesis was twofold. First, to study the role of emotional arousal in memory processes, and secondly, to relate this concept to empirical findings of amnesia. In both clinical and experimental settings it has been observed that remembering is impaired for events occurring prior to, and after a traumatic critical event. This memory impairment is also demonstrated for the traumatic event per se. In relation to these phenomena an interaction is commonly observed such that remembering of events aquired in a state of high emotionality, or arousal, is inferior to events aquired in neutral low arousal conditions at short test intervals, but superior at delayed test intervals. The general notion to be tested was how and to what extent these phenomena are mediated by an increase in emotional arousal. In order to test this hypothesis a series of experiments was designed so that retrograde and anterograde amnesia, and amnesia for the traumatic event, could be studied so as to evaluate the locus of the emotional arousal and amnesia effects with respect to encoding (attention), storage (consolidation), and retrieval (reconstruction). Emotional arousal was induced by sources associated with the to-be-remembered (TBR) material (traumatic pictures), and by sources not associated with the TBR-material (injections of adrenalin). Memory performance was measured by recall and recognition techniques. Amnesia was obtained only when the source of arousal was associated with the TBR-items. It was concluded that amnesia in connection to hightened emotional arousal depends on attention demanding characteristics of the traumatic event, rather than physiological properties of hightened arousal per se. An interaction between factors at encoding and retrieval was proposed as an explanation for the amnesia effects obtained. An interpretation in terms of consolidation has, throughout this thesis, been shown to be invalid in explaining the memory phenomena referred to.

Key words: Amnesia, Memory, Psychological trauma, Emotional arousal, Adrenalin. To Monica and John Acknowledgements

I am deeply indebted to my supervisor Professor Lars-Göran Nilsson for his extensive support and advise, his readiness to discussions beyond the call of duty throughout every stage of my work, including critical reading of this thesis. Thanks to his comprehensive knowledge of psychological theory and research, his professional guidance and personal encouragement, conditions were created for allowing a loosely formulated prospect to grow into being the present thesis.

I would also like to thank Dr. Bo Molander for very valuable support and constructive discussions especially through the initial part of this research.

Deep gratitude is expressed to Dr. Tom Mjörndal, Department of Pharmaco ­ logy, for his methodological, and practical help in Study 3 and Study 4.

Thanks are due to Professor Carlo Perris and to Mr. Gunnar Tjelldeh, Department of Psychiatry, Umeâ University Hospital, for very stimulating collaboration in Study 4.

I am grateful to Professor Sigfrid Blom, Clinical Neurophysiology, and to Dr. Herbert Silfvenius, Department of Neurosurgery, Umeâ University Hospital, for guidance in clinical practice.

Special thanks go to my close friend Mr. Timo Mäntylä, B. A., for innumerous discussions regarding various issues related to this research, and to related "topics’' just outside the window of our office.

I also wish to express my appreciation for the stimulating competive spirit provided by my colleagues Dr. Jerker Rönnberg., and Mr. Lars Bäckman, B.A.

With deep affection I thank Ms. Margareta Json Lindberg for her extra­ ordinary skill in typing my sloppy manuscripts, applications and letters, and for her warm support throughout regressions and advances in my work. I also which to express my sincere appreciation to Mr. Rolf Eklund and Mr. Rolf Lind for professional photographical work in constructing the stimulus material, to Mr. Jan-Ake Åkerlund for technical assistance, to Mr. Per Asplund, B. A., Mr. Erik Lindberg, B. A., and Mr. Tommy Nordquist, B. A., for statistical assistance, to Ms. Mona Wiklund and Ms. AnnLouise Söderlund for typing the manuscript faster than the mind can accept, to Ms. Brita Westling for diverse sectretarial help, to Ms. Siw Jungebjörk for drawing all the figures, to Mr. Stig Lindkvist for reproduction, and Mr. to David Chalom for taking care of the most obvious faults in my prose.

Finally, I want to thank Monica from the deepest of my heart for showing invaluable support, and for putting up with all the inconveniences caused by me during the course of this work. And to John, my son and inexhaustible source of inspiration, born into this work with a great deal of emotional arousal.

This research was economically supported by a predoctoral fellowship from J. C Kempes memory foundation, and by grants to Professor Lars-Göran Nilsson from the Swedish Council for Research in the Humanities and Social Sciences, and to Professor Lars-Göran Nilsson and Dr. Tom Mjörndal from the Council for Medical Research of the Swedish Life Insurance Companies. The present doctoral dissertation consists of a summary and the following studies:

(1) Christianson, S.-A. The relationship between induced emotional arousal and amnesia. Scandinavian Journal of Psychology, in press.

(2) Christianson, S.-A., & Nilsson, L.-G. Functional amnesia as induced by a psychological trauma. Memory & Cognition, in press.

(3) Christianson, S.-A., & Mjörndal, T. Adrenalin, emotional arousal, and memory. Manuscript submitted for publication, 1983.

(4) Christianson, S.-A., Nilsson, L.-G., Mjörndal, T., Perris, C., & Tjelldeh, G. Physiological and cognitive determinants of emotional arousal in mediating amnesia. Manuscript submitted for publication, 1983.

The number in parenthesis are used in the text to refer to these studies. Contents

Introduction 9

Organic origins of amnesia 11 Korsakoff's syndrome 11 Cases H.M. and N.A. 12 Electroconvulsive shock 14 Anesthetics and amnesia 15 Intracarotid sodium Amytal memory testing 15 Transient global amnesia 16 Post-traumatic amnesia 17 The locus of organic amnesia 18

Psychological origins of amnesia 21 Hysterical amnesia 21 Posthypnotic amnesia 24 Further laboratory analogues of amnesia 24

Arosual and memory 26 The concept of arousal 26 Manipulation of arousal 27 Emotional arousal and memory performance 28 The Kleinsmith & Kaplan studies 29 The Walker Hypothesis 30

Aims of the Experimental Studies 31 Experimental studies 33 Study 1 34 Study 2 36 Study 3 41 Study 4 42 Discussion of Study 1-4 43

Concluding Remarks 50

References 52

9

Introduction

The pathology of memory is a problem of long standing in clinical research and practice. In fact, amnesic phenomena have been explored ever since Ebbinghaus (1885) presented his important work of the intact memory (see e g. Breuer & Freud, 1895/1955; Korsakoff, 1889/1955; Ribot, 1882). As pointed out by Schacter & Tulving (1982) there is an apparent connection between experimental studies of the intact human memory and clinical research of disordered memory. In spite of this, the two fields have not merged into a systematic and productive integration until the last couple of decades (see Cermak, 1982a; Kihlstrom & Evans, 1979a; Talland & Waugh, 1969; Whitty & Zangwill, 1977). A primary aim of the present thesis is to advance knowledge about memory deficits, and moreover, to do this within a framework which may increase our understanding of memory processes in general.

Various disorders of memory, and dissociative findings reported in the clinical and experimental literature, will first, by way of introduction, be reviewed briefly in this thesis. This review comprises only the most common types of amnesia and is by no means meant as a complete theoretical and methodolo ­ gical summary of the amnesia literature. However, it will serve the primary aim of providing a background to the paradigm and to those amnesic phenomena referred to later on in this dissertation. Although it is beyond the scope of the present paper to give an exhaustive review of all different types of amnesia, the interested reader is supplied with reference literature for a closer description of various amnesic phenomena.

In the amnesia literature two general classes of memory pathology have been described: (1) loss of memory due to different kinds of traumas to the nervous system (i.e. organic amnesia), and (2) loss of memory caused by psychological factors, usually described as functional amnesia.

The first introductory section describes organic annetta and presents a review of some main findings outlining the theme of this thesis. The central features of this type of amnesia are that the individual suffers from a loss of memory of events occurring prior to a critical event like an insult to the brain (retrograde amnesia), and an inability to remember new events 10

occurring after the critical event (anterograde amnesia). These individuals usually have no problems with recollection of remote memories prior the onset of amnesia. This general pattern is commonly described in the literature as the amnesic syndrome (see Rozin, 1976; Talland, 1965 for a discussion of this concept).

The second section in this introduction presents a review of the functional amnesia literature, with a focus on those concepts which the thesis itself deals with. A central pattern in clinical functional amnesia is memory loss of events preceding and succeeding a critical, psychologically traumatic event. Moreover, a memory loss of the traumatic events per se is typically found as well. In both neuropsychological and psychiatric studies of amnesia a recovery of amnesia has been observed, such that previously unavailable events are properly remembered. Such a recovery occurs as a function of time and as a function of various retrieval conditions. A similar pattern of recovery has also been observed in studies of arousal and memory. This similarity in data pattern found in studies of amnesia, and of arousal and memory, constituted the actual point of departure for the design of the experiments reported at the end of this thesis. Prior to the description of these experiments, the literature of arousal and memory will be reviewed in a third introductory section. Thus, regarding the experimental studies conducted, one of the main concerns was to establish a laboratory situation which captures both the major features of clinical amnesia and some of the cardinal findings demonstrated in studies of remembering under different states of emotional arousal.

A general aim of the introductory sections of this thesis is to demonstrate that there are several kinds of amnesia (amnesic syndromes), and presumedly no universal memory mechanism underlying various memory deficits. In the amnesia literature various types of disorders of memory have been analyzed in quite different settings. In spite of this strong divergence in patients or subjects studied, and memory tasks employed, conclusions are often made with reference to the "amnesic syndrome" or to statements about amnesia in general. Usually, attempts have been made to find a common explanation to all sorts of amnesia. In most cases the explanation given, refers to one of the different hypothetical subprocesses of remembering (i.e. encoding, consolida­ tion, storage, and retrieval) as the locus of amnesia. By and large, consolida- 11

tion is commonly seen as the most significant subprocess underlying various memory impairments. The consolidation view is thus specifically focused upon throughout the various sections. The author strongly believes the search for a general theoretical model proposing factors at encoding, consolidation, storage or retrieval, which could account for different types of memory deficits, to be a far too simplistic approach. A more adequate framework would be to analyze different phenomena in terms of an interaction between encoding and retrieval processes (Schacter & Tulving, 1982; Tulving, 1976, 1979; Tulving & Thomson, 1973) rather than analyzing the single subprocesses in isolation. The view assumed by the author emanates to some extent from a functionalistic view of memory processes proposed by Nilsson (1979, 1980, 1981, 1983, 1984) in which an interaction between cognitive capabilities and task demands in remembering is considered, rather than a hypothetical memory entity in isolation. Proof for such an interactional relationship will be pointed out in the introductory sections below, and successively connected to the results of the experimental studies reviewed in the last part of the thesis.

Organic origins of amnesia

Korsakoff's syndrome Korsakoff amnesics are by far the most numerous of all amnesics studied (for reviews se Butters & Cermak, 1980; Squire, 1982a, b; Talland, 1965). This syndrome (extended retrograde amnesia combined with a severely deficient recall of recent events), first described by the Russian neurologist about a century ago, is considered to be strongly related to thiamine (vitamin B) deficiency resulting from chronic abuse of alcohol. From an anatomical point of view it is currently believed that damage in the dorsomedial thalamus, the mammillary bodies, as well as a generalized cerebral atrophy, could be responsible for this memory deficit. However, from a neuropsychological point of view, there is a considerable divergence in interpretations regarding the locus of this memory deficit. Neuropsychological evidence has been presented showing that the Korsakoffs syndrome most plausibly involves a frontal lobe damage because of the specific deficits in memory planning or organization, and a deficiency in making temporal order judgements of recent events (see Moscovitch, 1982; Rozin, 1976). According to Warrington & Weiskrantz (1970) the amnesia exhibited by Korsakoffs is caused by a 12

deficiency at retrieval. This hypothesis emanates from several experimental studies in which Warrington Sc Weiskrantz have demonstrated that amnesics presented with different types of cues (word fragments, initial letters of words, category information etc.) improve their performance to a great extent, sometimes even to a level equal to the controls (e.g. Warrington Sc

Weiskrantz, 1968, 1970, 1974; Weiskrantz Sc Warrington, 1970a, b). According ­ ly, Warrington Sc Weiskrantz (1970) suggested that an impaired control over stored information causes the amnesics to retrieve too much informaton, which in turn makes them more vulnerable to interference than normals. Partial cuing, which narrow the range of response alternatives, should therefore aid memory performance for amnesics. In opposition to this retrieval explanation, Huppert Sc Piercy (1982) argued that the memory deficit exhibited by Korsakoff patients is restricted to a deficit at encoding. This notion is based on empirical facts showing that Korsakoff patients, if compensated with a prolonged time at aquisition, are able to perform equally well as normals, irrespective of retention interval (Huppert Sc Piercy, 1977, 1978). According to Huppert and Piercy this finding suggest that Korsakoff amnesics simply need more time for encoding than normals.

It makes little sense to speculate upon whether the findings reported by e.g.

Warrington Sc Weiskrantz, or those reported by e.g. Huppert Sc Piercy, are more appropriate for explaining Korsakoff amnesia. Instead, these data and these interpretations ought to be regarded as evidence for the need of analyzing amnesia in terms of an interaction between encoding and retrieval processes (Christianson & Nilsson, in press; Schacter Sc Tulving, 1982) rather than focusing on one stage of processing (i.e. encoding vs. retrieval) or one cognitive mechanism in isolation. Thus, the study of remembering or the memory capacity of different patients/subjects purports to an analysis in which aspects of the to-be-remembered (TBR) material, task demands, and available cognitive capabilities are considered as interacting (Nilsson,

Christianson, Silfvenius Sc Blom, in press).

Cases KM. and N.A. As witnessed in the clinical literature of amnesia, there has been a considerable interest in the anatomical aspects of amnesia. One of the most influential findings in this context emanates from studies of amnesia resulting from temporal-lobe surgery, which is a treatment used for curing patients 13

suffering from medically refractory epilepsy. Upon a resection of the medial parts of both temporal lobes, including the hippocampi, the now famous patient, H. M., developed a severe retrograde and anterograde amnesia but without any intellectual deterioration (Scoville & Milner, 1957). However, despite a severe memory deficit on tests of kinesthetic memory, of memory for words, and of visual location, H.M. is competent in several perceptual tasks, in motor learning, and he can also recall remote events prior the surgery (see Milner, 1972 for a review). He is also able to remember some new events after prolonged repetition. Follow-up studies of this patient (e.g. Milner, Corkin & Teuber, 1968; Sidman, Stoddard & Mohr, 1968), and other studies of temporal-lobe surgery (e.g. Corsi, 1972; Milner, 1966, 1970, 1972; Nilsson, Christianson, Silfvenius & Blom, 1984) as well as studies of stimulation with electrodes implanted in the hippocampus (Chapman, Walter, Marnham, Rand & Crandell, 1967), have confirmed the reliability of amnesia following damage in the region of the hippocampus and the temporal lobes.

Another well-known patient, N.A., has also been thoroughly studied (Squire & Moore, 1979; Teuber, Milner, Vaughan, 1968). Following a fencing accident, resulting in a lesion located in the left dorsomedial thalamic nucleus, this patient became severely amnesic. This amnesia consisted of a deficit in remote memory and a severe impairment especially in the ability to learn verbal material. The amnesia exhibited by N.A. reflects in general the amnesia pattern shown by Korsakoff patients for whom neuropathological data have similarly shown damage to the dorsomedial thalamic nucleus (Squire, 1982a). In a review, Squire (1982b) has assumed, on the basis of neuropsychological and anatomical data, that diencephalic amnesia (e.g. damage to the dorsomedial thalamic nucleus) comprises a deficit at an early stage of encoding. This is based mainly on the finding that these patients show a normal forgetting rate after extensive repetition- On the other hand, patients suffering memory deficits resulting from damage to the hippocampus (c.f. case H.M.) show almost no improvement after extensive repetition and this is accordingly interpreted as due to a deficit of consolidation (Squire, 1982b).

The act of consolidation has usually been viewed as time dependent. It is assumed that a neural fixation process continues for a short time after a subject has been confronted with the item to be learned (see Glickman, 1961 14

for a review). In an early statement of such a consolidation hypothesis Muller Sc Pilzer (1900) postulated the existence of neural perseveration processes. This statement was later advanced by, for example, Hebb (1949) who proposed that activity in reverberating circuits maintains the ”memory" until a permanent change of the trace has been completed. According to Hebb (1949) disruption of this neural activity shortly after aquisition deteriorates consolidation and learning. A similar interference at a later occasion does not have the same effect.

Several clinical reports supporting this view have been presented (Meudell, Mayes Sc Neary, 1979; Milner, 1959, 1965, 1966, 1970, 1978; Russell Sc Nathan, 1946; Scoville Sc Milner, 1957). In these studies it is generally assumed that the amnesic patient suffers from an impaired ability to transféré information from a temporary storage system to a more permanent storage. In the case of H.M., Scoville Sc Milner, (1957) concluded that the hippocampal formation is most significant to the process of consolidation. Due to a bilateral hippocampectomy, this patient could not remember new information (anterograde amnesia) because no consolidation was taking place, i.e. there was no formation of lasting structural changes at storage. According to this view, retrograde amnesia is assumed to occur because some critical event (e.g. a physical lesion) interrupts the perseverating neural activity responsible for the formation of a long-term trace. It was then proposed by Milner, Corkin Sc Teuber (1968) that retrograde amnesia comprises recent rather than older memories, because older memories have experienced more neural activity and are therefore less susceptible to disruption. However, retrograde amnesia has also been reported for memories occurring several months preceding the amnesic onset (Russell Sc Nathan, 1946). This phenomenon is dealt with by Deutsch Sc Deutsch (1966) by proposing two different consolida­ tion processes, one for short-term memories and another for long-term memories.

Electroconvulsive shock Adverse memory impairments, although temporary, have frequently been reported in the extensive literature on electroconvulsive therapy, ECT (see reviews by Miller Sc Marlin, 1979; Robertson & Inglis, 1977). This treatment is normally used for patients with affective disorders or acute psychoses. Memory testing after series of ECT-treatments have shown that bilateral 15

Stimulation of the temporal regions produce a reversible retrograde and anterograde amnesia. These memory deficits have also been obtained after unilateral stimulation of the dominant hemisphere and after chemically induced convulsions using insulin, metrazol, or Indoklon shock (Robertson & Inglis, 1977). In conditions of unilateral administration of ECT to the non-dominant hemisphere, or by ECT stimulation to other regions than the temporal lobes, the memory disturbances have been found to be minimized. In accordance with observations from temporal lobe surgery, the memory effects resulting from this type of reversible neural malfunction thus confirms the significance of the temporal lobe region as most critical to memory functioning. However, it should be noted that different factors such as differences in the mental health of the subjects, post-treatment confusion, effects of muscle relaxants administrated prior to the ECT, as well as manipulations of the electrode placement, the material learned, time of acquisition and test, and type of test, have produced a large divergence in memory output. Thus, considerable difficulties have emerged when attempts have been made to draw definite theoretical conclusions about the amnesia induced by ECT. Hence, it has been almost impossible to identify the memory impairments in terms of e.g. a consolidation/storage failure as proposed by Squire (1982a), or a retrieval failure as proposed by e.g. Miller & Marlin (1979) and Mortensen (1980).

Anesthetics and amnesia Temporary and reversible amnesia have also been produced through the use of various anesthetics (see Adam, 1979 for a review). It has been demonstrated that lower concentrations of anesthetics cause a transient retrieval deficit primarily for verbal material. High doses, almost causing a loss of conscious­ ness, have been found to produce complete amnesia for verbal material, and for personal experiences during the state of anesthetic influence. Memory recovery, mainly of the nonverbal material, after recovery from the drug effects, has been taken as evidence for temporary inaccessible traces. It is thus proposed that amnesia caused by various anesthetics is due to a deficit in active verbal processes which are critical to encoding and retrieval of verbal information (Adam, 1979).

Intracarotid sodium Amytal memory testing In connection with epilepsy surgery (temporal lobe excisions) remembering has 16

also been studied after intracarotid injections of sodium Amytal (see e.g. Blume, Grabow, Darley & Aronson, 1973; Milner, 1978; Milner, Branch & Rasmussen, 1962; Silfvenius, Blom, Nilsson & Christianson, in press). By this technique, developted by Wada (1949) and Wada & Rasmussen (1960) to determine cerebral speech lateralization, it is possible to study whether inactivation of one hemisphere, due to a unilateral carotid Amytal injection, produces a state of generalized amnesia. Prior to the injection, the patient is presented with a few verbal and non-verbal items and is told to remember them. Then sodium Amytal is injected into one hemisphere. While the subject is affected by this barbiturate new items are presented. After the drug effect has worn off (the sedative effect usually lasts for 4-3 minutes) the memory performance is tested for all items presented. The main finding in such studies (in case of a unilateral temporal lobe epileptic lesion and an injection contralateral to the deficient hemisphere) is amnesia for items presented during that period of time when the drug is effective. Patients suffering from a bilateral temporallobe epileptic foci usually show amnesic effects irrespective of which hemisphere is injected. Based on the fact that many patients show a permanent amnesia for the period of hemispheric suppression, Milner (1978) has proposed that failure in storage and not in retrieval, is responsible for this type of memory deficit. Given such a standpoint and the assumption that consolidation is time dependent (Hebb, 1949; Walker, 1958) interference in terms of anesthization should also affect processes of items presented immediately preceding an injection of sodium Amytal (Christianson <3c Nilsson, 1984). Such an effect has, however, not been obtained. While indeed sodium Amytal memory testing seems to be sensitive in detecting brain damages localized to one hemisphere, further development of this test (using various tasks and materials) has to be carried out before it is possible to infer exactly which cognitive capabilities have been affected by the manipulations made.

Transient global amnesia A rare type of memory pathology is the transient global amnesia, TGA (see Jensen & Oliviarius, 1981; Whitty, 1977 for reviews). This amnesic syndrome is characterized by a sudden memory dysfunction during a short period of time (usually 2-12 hours). During the amnesic attack the patient exhibits a retrograde amnesia ranging from a couple of days up to several years, and an anterograde amnesia for events occurring during the amnesic attack. After 17

the attack there is a recovery from the retrograde amnesia of events to a few hours before onset. For recollections of events made immediately before and during the amnesic attack there is a permanent amnesia. In physiological terms this syndrome is believed to be due to transient cerebral ischemia in the vertebrobasilar arterial system and the inferomedial portion of the temporal lobes (Jensen & Olivarius, 1981). Unfortunately, reports of the memory impairment in these patients are sparse, and it seems as if no systematic examinations have been made in order to determine the underlying cognitive mechanisms in this type of amnesia. This lack of basic knowledge, however, is partly due to the actual time limit (the sudden onset and the short duration) which is associated with the occurrence of this amnesic syndrome.

Post-traumatic amnesia The amnesic effects following head-traumas are more common than those cases of amnesia already described. Such cases of post-traumatic amnesia appear after mild concussions, as for example among, American football- players (Yarnell & Lynsch, 1970) and after more severe damage to the brain (see Russel, 1971; Russel & Nathan, 1946; Whitty & Zangwill, 1977b). Following a closed head-injury the patient usually develops a state of general mental and physical deterioration for a short period of time. In the clinical literature these effects have been described as the post-concussional syndrome (Richardson, 1979) or as post-traumatic amnesia (Russel & Nathan, 1946). The traumatic amnesia usually comprises an extended retrograde amnesia, and a servere anterograde amnesia lasting from some minutes to several months after the accident. Upon recovery the retrograde amnesia gradually recedes to just a few seconds or minutes prior to the head injury (Russel, 1971; Russel & Nathan, 1946; Whitty & Zangwill, 1977b). This pattern has also been found for the anterograde amnesia and is described as a recovery of ”islands of memories ” (Russel, 1971; Whitty & Zangwill, 1977b).

In clinical neurological practice, amnesia has also been observed in connec ­ tion with senility (Krai, 1969), various forms of presenile dementia; Alzheimer's disease (Miller, 1971) and Huntington's disease (Butters, 1980), brain tumors (McEntee, Biber, Perl & Benson, 1976), and various cerebral vascular disorders (e.g. stroke, cerebral hemorrhage). Transient disorders of memory can follow infection-inflammatory diseases (meningitis, encephalitis), 18

anoxia, and drug intoxication (Walton, 1971, 1977; Whitty, Stores & Lishman, 1977). However, the memory dysfunction observed in these amnesic states is often accompanied by a generalized cognitive malfunction which is more pronounced in these cases than among the amnesics described above, and thus, severely obscure the analysis of the memory deficit.

The locus of organic amnesia Although the brain structures crucial for memory have not yet been definite ­ ly localized, damage to the frontal and to the temporal lobes of the cerebral cortex, and to subcortical structures (such as hippocampus, mamillary bodies and the thalamic nucleus) appears to be significant for remembering (Penfield & Mathieson, 1974; Rozin, 1976; Squire, 1982; Victor, Adams & Collins, 1971; Watson, 1981). From a psychological viewpoint descriptions of memory deficits following damage to these areas are characterized by numerous dissociations observed in different clinical and experimental settings. One such dissociation is that between intact retention of events which are currently in consciousness and tested immediately after presentation (c.f. short-term or primary memory), and defective retention of events when there is a delay between study and test or when attention is distracted between study and test (see Baddeley & Warrington, 1970; Milner, 1966; Talland, 1965; Warrington, 1982). The notion of an intact short-term capacity among amnesics is, however, questioned in several studies (see e.g. Cermak, 1982a; Parkinson, 1982). Another dissociation emanates from studies regarding semantic encoding deficiency among amnesics (see e.g. Butters & Cermak, 1980; Cermak, 1979). Using Wicke'ns (1970) release-from-proactive interference (PI) paradigm Cermak, Butters & Moreines (1974) demonstrated that Korsakoff patients (as opposed to normals, Craik & Tulving, 1975), do not benefit when the items at the end of a series of word triads are from a different semantic category (i.e no release from PI). However, release effects were obtained when the categorical shift included a change at a superficial level (letters-numbers). The same semantic non-release effect has also been demonstrated in a case-study of traumatic amnesia (Zatorre & McEntee, 1983). A hypothesis suggesting that amnesic patients in general show an impairment in semantic encoding is however opposed by release effects of PI in a study of encephalitic amnesia (Cermak, 1976) and by experiments on patients showing preserved semantic content of sentences but loss of surface structural information (Saffran & Marin, 1975 cited in Rozin, 1976). 19

Differences are also found between groups of patients regarding the phenomena of retrograde amnesia; for Korsakoffs the loss of events cover the most recent decades and is characterized by a temporal gradient, as opposed to patients with Huntingtons disease, who also show a retrograde amnesia extended over decades, but with an equal loss for all periods of time (Butters & Alberg, 1982). While the recovery of retrograde amnesia is commonly thought to be organized according to a gradual, temporally organized shrinkage with the remote memories returning first (see Rozin, 1976 for a review), several cases are presented describing recovery through islands of memories independent of recent and past organization (e.g. Russel, 1971; Whitty & Zangwill, 1977b).

It is generally considered to be the case that the left and right hemisphere can be functionally dissociated (see reviews by Bradshaw & Nettleton, 1983; Springer & Deutsch 1981). This in turn implies that memory deficits sometimes are material specific (Milner, 1974). That is, amnesics with damage to the right hemisphere are usually impaired in experiments using visual and spatial materials whereas amnesic with a left cortical lesion are primarly impaired in remembering of verbal tasks (Teuber, Milner & Vaughan, 1968; Squire & Slater, 1978). In general, it has been found that amnesic effects are significantly reduced in tests of pictorial or non-verbal information as compared to verbal material (Huppert & Piercy, 1982). A striking feature common to several groups of amnesics is the inability to retrieve episodic memory information (autobiographical memories for specific events) while the ability to remember semantic memory information (i.e memory of general knowledge), is preserved (Kinsbourne & Wood, 1975, 1982; Schacter & Tulving, 1982).

However, despite an obvious pathology of remembering among different kinds of brain damage patients it has been demonstrated that the memory impairment could be reduced by means of compensation in different ways. For example, by repeated learning (Baddeley & Warrington, 1970, Experiment 6), by prolonged time at study (Huppert & Piercy, 1977, 1978), or by partial cuing (Warrington & Weiskrantz, 1970). Usually memory functions such as well-learned skills, perceptual motor skills, immediate memory (i.e. events remembered without withdrawal of attention, see Baddeley, 1982a), and remote memory (i.e. event occurring several years prior the amnesia onset) 20

are described as unaffected in various amnesic states.

It should be kept in mind that clinical amnesia research is obscured by many aggravating circumstances. One shortcoming is that in many clinical studies conclusions are drawn from single cases such as H.M. and N.A. who have been subjected to thousands of memory experiments, and thus constitute a rather dubious basis for making inferences about amnesia and memory in general. Furthermore, as has been pointed out by Baddeley (1982b), states of amnesia as well as states of recovery from amnesia are often accompanied by other cognitive changes (emotional, personality etc), making inferences about the memory impairment per se somewhat hazardous. Finally, a considerable shortcoming in studies of organic amnesia is that joint detail analyses of both psychological and physiological aspects of the amnesic state are rare.

Thus, considering the great divergence in memory dysfunction among various patients (of which the above listed phenomena are only a few among all those described in the amnesia literature as a whole), it seems to be impossible to find a universally accepted theoretical account identifying amnesia to one specific memory mechanism. Nevertheless, the search for a hypothetical basic memory process (i.e. encoding, consolidation or retrieval) which may underly various amnesia phenomena has been frequently discussed in the amnesia literature. Among those general theoretical explanations of amnesia offered, the consolidation hypothesis has then been the dominating one in both clinical and experimental literature. While such an explanation could be considered for anterograde (post-traumatic) amnesia, it is hard to believe that consolidation processes would be involved in loss of memories acquired several years prior to the amnesic onset, or, in explaining the frequently reported phenomena of recovery of previously lost memories (Adam, 1979; Miller & Marlin, 1979; Nemiah, 1969; Russel, 1971; Russel & Nathan, 1946; Talland, 1965; Whitty & Zangwill, 1977b). However, during the last two decades a number of different theoretical accounts have been presented suggesting that amnesia is due to e.g. a chunking deficit, semantic encoding deficit, context encoding deficit, susceptibility to interference etc (see Baddeley, 1975; Cermak, 1982; Stern, 1981 for reviews). A considerable amount of articles have then been presented in favour of a retrieval explana ­ tion. Thus, the amnesic person is able to learn but fails in consciousness of 21

memories or in access to the memories properly encoded and stored (Ervin & Anders, 1970, cited in Detterman, 1976; Kinsbourne & Wood, 1975; Miller & Marlin, 1979; Mortensen, 1980; Piercy, 1977; Warrington & Weiskrantz, 1968, 1970 1973, 1974; Weiskrantz & Warrington, 1975). However, a sole retrieval explanation renders difficulties for understanding why recent rather than remote memories are those which are most succeptible to amnesia, and for understanding the various amnesic effects obtained for different types of TBR~material.

It is evident that clinical amnesia research has stimulated to an increased interest for memory functions (or memory dysfunction) and has contributed clinical findings which have been of great importance in validating experi ­ mental memory theory. However, theoretical contributions from this field has been rather restricted, and a certain delay could be noted in relation to the mother dicipline of basic memory research. The condensed review of types and patterns of organic memory deficits presented above, has therefore been concentrated primarily on those amnesic phenomena underlying the paradigm used in the experimental studies which this thesis is built upon.

Psychological origins of amnesia

Hysterical amnesia. The inability to remember unpleasant or emotionally traumatic events is a topic which has received much attention in clinical and experimental psychology. An early interpretation of this phenomenon is through the repression hypothesis (see Breuer & Freud, 1895/1955; Freud, 1915/1957; MacKinnon & Dukes, 1962). The essence of this view is that emotional traumas are repressed from a conscious state by the individual in order to avoid, and cope with, an intolerable psychological pain. This may suggest that such events are properly encoded and consolidated, but that the memory deficits occur because of difficulties at retrieval. Several clinical observations of forgetting, in cases of traumatic neurosis or hysterical symptoms, have been referred to as support for such a notion. In the psychiatric literature, hysterical neuroses have been described either in terms of dissociative or conversion reactions (Buss, 1966). Dissociative reactions comprise cognitive symptoms such as memory loss, split personality and 22

somnambulism. Loss of memory is seen in instances as hysterical amnesia, hysterical fugue and multiple personality (see Nemiah, 1979 for a review). Hysterical amnesia refers to a limited and transient inability to recall past events, and events associated with an emotional trauma (see e.g. Breuer & Freud, 1895/1955). The onset is usually acute and the patient is typicality found wandering aimlessly, disorientated in time and place. In the neurologi ­ cal literature, this state is assumed to develop as a method of escaping from intolerable stress and interpretated as a process of psychological ”inability to reopen voluntarily the pathways where memories are retained ” (Walton, 1971, p. 106). Central to hysterical fugue is a loss of personality identity and a loss of all identity-related memories of the patient's past life, (see e.g. Hodgson, 1892). In extreme cases (multiple personality) the patient develops two or more different states of mind with varying degree of awareness between each state (see e.g. Thigpen & Cleckley, 1957). An interesting feature common to hysterical loss of memory is the state of unconcern, called ”la belle indifference ”. Conversion hysteria refers to a state in which the patient exhibits physiological/sensorimotor symptoms (paralysis, numbness etc) without any organic basis for the symptoms. Generally, these conversion symptoms have been interpreted as a kind of unconscious indirect recall of aspects central to a repressed emotional trauma (Breuer & Freud, 1895/1955; Erdelyi & Goldberg, 1979).

Remarkable for all these kinds of amnesic phenomena (also referred as hypermnesia) is that the patient either spontaneously or by means of various therapeutic techniques (e.g. hypnosis, free association, dream interpretation) manages to remember the previously inaccessible traumatic agent (see Erdelyi & Goldberg, 1979 for a review). Thus, the repressed events are supposed to be registered and retained, but cannot be recalled until associations or ideas make contact with the emotional response appropriate to the repressed material. While Freud argued that the clinical evidence presented was sufficient for stating the validity of the repression hypothesis, others have remained critical because of the difficulties in verifying this hypothesis in a laboratory situation. Yet, some experimental studies of the repression hypothesis have been performed with the results being in line with the ideas suggested by Freud. In a pioneer study, Jung (1906/1972) introduced a word-association method in an effort to demonstrate that emotions are important determinants of remembering. In this method, the subjects were 23

presented with a list of stimulus words and were then asked to say the first word-association which came to mind for each stimulus word. Congenial to the repression hypothesis, responses to emotional-provoking words produced longer latencies than responses to emotionally neutral words. In a modified version of this method, Levinger <3c Clark (1961) asked the subjects to remember the made associations as well. The results from this study revealed, that associations to emotional words evoked longer latencies, and higher galvanic skin responses as compared to neutral words, but also that these emotional associations were more frequently forgotten than neutral associations. Other studies supporting the repression hypothesis have been presented by Flavell (1955), Glucksberg & King (1967), Holmes (1972), Zeller (1950a, b, 1951). Taken together, these studies have shown that events associated with feelings of unpleasantness are remembered worse than neutral e-ents, and in some cases it has been shown that memory performance for emotional events is higher at a delayed as compared to an immediate test. In a study by Erdelyi (1970), recall of briefly flashed stimulus was tested before, and after fantasy generation. The result of this study showed that post-fantasy recall was increased as compared to pre-fantasy recall. Although consistent with Freuds theory as a whole, it was suggested that subjects' sensitivity to memories increased as a consequence of fantasy production rather than as an indication that initially unconscious material had become conscious (c.f Freud, 1915b/1957). While indeed patterns of data obtained in these referred studies fit well into Freuds theory, it is just as reasonable to interpret the outcome according to other theoretical accounts (see p. 29-30, 46-47 in this text). It should also be pointed out that while hypermnesias seem to be restricted to pictorial or imaginary material (Erdelyi & Goldberg, 1979) the experimental simulations are generally concerned with verbal material. Freud was one of the first theorists to propose an interpretation of memory deficits in terms of retrieval failure (Breuer & Freud, 1895/1955; Freud, 1915/1957). In this respect he has inspired later theorists to work along the same line of thinking. In retrospect, however, it seems fair to state that the repression hypothesis is far too vague to warrant any specific predictions. A remark by Erdelyi & Goldberg (1979) in their review of the repression hypothesis is to the point here: "In order to articulate a highly complex theory, Freud was obliged to fracture his mode of expression, utilizing different metaphors for different conceptual features, resulting in a veritable Babel of mixed and mutually foreign metaphors - and inevitable confusion" (Erdelyi & Goldberg, 24

1979, p. 387).

Posthypnotic amnesia A similar type of memory disturbance as that observed in cases of hysterical amnesia has been demonstrated in posthypnotic amnesia (see Kihlstrom & Evans, 1979b for a review). Following a hypnotic state, susceptible subjects have shown an initial difficulty in remembering events and experiences that occurred while being deeply hypnotized. However, by the administration of different prearranged cues, or fragmental information, or alternatively, if the subject is tested by means of a recognition test instead of a free recai? test, the amnesia has been found to recede. An interesting observation is, that subjects exhibiting posthypnotic amnesia, do not recall in the temporal order used under normal conditions (Kihlstrorn & Evans, 1979b). This deficit in temporal organization has been assumed to indicate that posthypnotic amnesia might be due to a loss of cues or strategies by which remembering is normally structured, and that encoding and retrieval, rather than consolida­ tion or storage, seem to be critical in this type of functional amnesia (Kihlstrom & Evans, 1979b).This is a pattern of results which has also been demonstrated in memory testing of epileptic patients (Nilsson, Christianson, Silfvenius & Blom, in press).

Further laboratory analogues of amnesia Several other simulations of amnesia have been employed within experimental memory research. In an elegant study by Tulving (1969), subjects were instructed to free recall a critical item (name of a famous person) in lists of common nouns. The results of this experiment showed first that the critical event was very well remembered, and secondly that the items occurring just before the critical event were significantly less well remembered than corresponding words in a control list which did not include any critical items. This paradigm has later on been adopted for studying amnesia in the labora­ tory situation. Similarly to Tulving (1969) retrograde amnesia has been demonstrated by Fisk & Wickens (1979), Loftus & Burns (1982), Saufley & Winograd (1970), and Schulz (1970). Using the same basic paradigm, retrograde amnesia accompanied by anterograde amnesia have been obtained as well (Bond & Kirkpatrick, 1982; Brenner, 1973; Detterman, 1973, 1976; Detterman & Ellis, 1972; Ellis, Detterman, Runcie, McCarved & Craig, 1971; Runcie & O'Bannon, 1977). Thus, in line with clinical cases of amnesia, these 25

studies have been successful in demonstrating both retrograde and anterograde amnesia. Furthermore, similarly to those clinical observations made, a recovery has been demonstrated for the induced retrograde amnesia but not for the anterograde amnesia (Detterman, 1975, 1976; Detterman & Ellis, 1972). In a study of induced amnesia in a laboratory situation, Detterman (1975) demonstrated a memory impairment in immediate recall for subjects having studied a material which included a critical item simulating a clinical trauma. In a later test the amnesia effects receded, demonstrating an interaction between type of material and retention interval. In the Detterman (1975) study this type of interaction was obtained for retrograde amnesia, but not for anterograde amnesia. The position taken by Detterman was that the causes for the retrograde and anterograde amnesia are different. While retrograde amnesia is assumed to result from an inability to retrieve stored information, the anterograde amnesia is interpretated in terms of an encoding failure.

The amnesic agents used in the experimental studies have usually been a critical event or an item differing in nature from an otherwise homogeneous set of items (e.g. a name of a famous person in a list of common nouns, a word presented at the intensity of a loud shout in a list of words presented in conversational level, or photograph of a nude in a list of common neutral objects). However, while the traumatic critical event in clinical cases is normally less well remembered, the critical event in the laboratory induced amnesia is very well remembered (e.g. Bond & Kirkpatrick, 1982; Brenner, 1973; Detterman, 1976; Detterman & Ellis, 1972; Ellis, Detterman Runcie, McCarved & Craig, 1971; Tulving, 1969). Thus, with respect to remembering the amnesic agent, the laboratory analogue is more accurately defined as a demonstration of a typical von Restorff effect (see Wallace, 1965 for a review) than an ecologically valid simulation of clinical amnesia.

Although not usually defined as research on amnesia, experimental studies of arousal and memory (see Eysenck, 1982 for a review), have shown two primary findings which are charateristic for clinical amnesia. First, it has been found that high arousal items are initially less well remembered as compared to low arousal, or neutral items (tantamount to amnesia of the traumatic event proper). Secondly, a recovery effect has been demonstrated for those events associated with high arousal (tantamount to recovery of 26

retrograde and anterograde amnesia). Apart from a couple of otherwise basic differences, these studies constitute an interesting simulation of amnesia phenomena observed in both experimental and clinical settings. Another relation is that a number of these arousal studies have been put forward as support for a consolidation theory which is also commonly referred to in the clinical literature of amnesia. An unresolved issue is, then, to what extent does a state of high arousal mediate amnesia. In order to incorporate emotionally-arousing experiences into the experimental study of amnesia, research on arousal and memory will be reviewed in the next section.

Arousal and Memory

The concept of arousal From a behavioral point of view, arousal, or activation, has generally been conceived of as a single intensity dimension, ranging from deepest sleep to an extreme degree of excitement, or put into psychiatric terms, from somnambulism to states of panic. While many researchers have treated arousal as a unidimensional concept, assuming that a heightened autonomic arousal corresponds to a concomitant increase in the level of cortical arousal (e.g. Dufty, 1967; Hebb, 1955; Malmo, 1959), others have questioned this assumption and have, instead, proposed several different dimensions of arousal (see Lacey, 1967). According to Lacey (1967) arousal processes should be separated into at least three different forms: electrocortical arousal, as measured by electroencephalography or evoked cortical response, autonomic arousal, defined by means of different peripheral measurements (e.g. heart rate, galvanic skin response, pupillary responses etc.) and behavioral arousal defined in terms of subjective performance. Dissociations have been pointed out by Lacey (1967) such that an increase in skin conductance activity conjointly occurring with a cardiac deceleration is correlated to attended external stimuli (i.e enhanced orienting response or enhanced environmental intake), while an increase in both skin conductance and heart rate activity is correlated to attended internal stimuli (i.e a rejection or defensive response). However, although such a dissociation has been pointed out both between and within the above mentioned categories of arousal, most of the measurements, both in isolation or in combinations, have been used in experimental research when referring to a general concept of arousal underlying changes in behavioral efficiency. 27

From a neurophysiological point of view the reticular activating system (RAS) is considered to be important as an integrative and modulating system of arousal (Luria, 1981). This system receives information from all sensory systems and is connected to cerebral cortex by ascending and descending cortical pathways. While the lower part of RAS is assumed to be sensitive to the overall level of arousal or activation (i.e tonic changes) the upper part is assumed to be more sensitive to transient changes of arousal (i.e. phasic changes) thus alerting the organism to different situational demands (Lindsay

Sc Norman, 1977).

Another activation system, specific with respect to emotional arousal, has been localized to different projection pathways in the area of the hypo­ thalamus (the medial forebrain bundle system), and the limbic system (hippocampus, amygdala and septum). By means of various techniques (e.g. depth-electrode stimulation, injection of drugs, lesions) these subcortical structures have been found to be very critical for the modulation of emotions or emotional tone; thus, affecting the arousal level of the organism (Papez, 1937; Routtenberg, 1968; Watson, 1981).

Manipulation of arousal Several critical distinctions have been made with respect to manipulations of arousal (see reviews by Craik Sc Blankstein, 1973; Eysenck, 1976, 1982). One such distinction is that between the arousal which is induced by a specific event or item presented to a subject, i.e. item arousal, and the arousal which is manipulated independently of the material presented, i.e. subject arousal. Another distinction is that between tonic levels of arousal and phasic arousal responses. An index of arousal can also be defined on an a priori basis (i.e. specific characteristics of an event), or on an a posteriori basis, (i.e. subjective ratings or physiological measurements of arousal). Finally, different states of arousal can be studied in relation to remembering at the time of study and at the time of test.

It is beyond the scope of the present text to review all those various types of manipulations employed in experimental research in order to induce different states of general arousal. However, there are two types of methods used which are of special interest here; (a) presentation of words or pictures with 28

high emotional value, and (b) administration of stimulating drugs, (see reviews by Eysenck, 1982; Mandler, 1975; Schächter, 1971).

Emotional arousal and memory performance It has long been assumed that arousal and cognitive efficiency are strongly interrelated. An early attempt to generalize this relationship was provided by Yerkes & Dodson (1908) in proposing an inverted U-form relation between tension, or arousal, and performance. This function has later on been adopted in a number of different cognitive tasks and has been modified in several versions (see e.g. Eysenck, 1982; Hebb, 1955; Kahneman, 1973; Mandler, 1975). It is generally assumed that an increase of arousal from the basal level to moderate degrees of arousal causes more cognitive resources to be available, and it increases the rate of mental and response operations. However, if the arousal level exceedes an optimal point of a hypothetical arousal continuum, mental efficiency begins to deteriorate. There is ample evidence in the literature showing that this reasoning can be applied to memory function as well (see Eysenck, 1982 for a review). Thus, moderate as compared to low levels of arousal are assumed to facilitate learning and memory performance; successive increases of arousal beyond such an optimal arousal level are to be correlated with successively lower degrees of learning and memory performance.

A model commonly referred to, accounting for the U-formed relationship between emotional arousal and cognitive efficiency is Easterbrook's (1959) cue-utilization theory. According to Easterbrook there is a progressive restriction of the range of cues utilized or attended to, as a function of an increase in emotional state. At states of high emotional arousal this restriction in cue-utilization would be beneficial to performance because central and relevant information is supposed to be attended to, and peripheral cues are those excluded. However, a further increase in emotion, correspon ­ ding to high stress or anxiety, would imply reduction of cues which would also include relevant information and accordingly be deleterious to cognitive efficiency (see e.g. Bacon, 1974; Baddeley, 1972; Korchin, 1964; Mueller, 1979; Wachtel, 1967, 1968). Thus, narrowing of attention at high emotional arousal states would, accordingly, be beneficai to memory performance on tasks considering central information of an event, but detrimental on tasks that require recall of a wide range of cues including peripheral information. 29

Easterbrook's view has later been extended by Mandler (1975) who suggested that attention-demanding characteristics of autonomic nervous system arousal is the critical component that relates emotional arousal to restricted cue-utilization. "Given the limited capacity of attention-consciousness and the presence of additional events that make demands on that limited capacity, it is not surprising that with increasing arousal the number of other events (cues) that can share conscious attention will be decreased" (p. 124). In situations where the sympathetic nervous system arousal, or emotional arousal, becomes very intense, "It floods attentional mechanisms and decreases the amount of information that the organism can recruit effectively either from the environment or from its own memory store" (Mandler, 1975, p 123). This theoretical point of view is summarized by Eysenck (1982) by suggesting that high arousal leads to a reduced ability to engage in parallel or shared processing which might be due to that a "smaller proportion of attentional capacity is available for task processing" (Eysenck, 1982, p. 176).

It should be noted that in addition to those ethical restrictions which are inherent in arousal-and-memory research (i.e manipulations with emotional arousing agents), it is evidently methodologically difficult to induce arousal over a wide section of a hypothetical arousal continuum. Furthermore, due to the absence of an unambigous index of arousal, the variety of ways arousal has been induced, and the varying degree of arousal obtained in different situations, it is very difficult to compare and evaluate the effects of specific degrees of arousal in relation to performance efficiency.

The Kleinsmith & Kaplan studies Although the most common finding is that moderate degrees of arousal facilitate learning and memory performance (see reviews by Berlyne, 1967; Eysenck, 1982; Levonian, 1972; Nuttin, 1978), there are also reported data suggesting a far more complex state of affairs. Some time ago, an interesting although somewhat contraintuitive finding regarding this issue was reported (Kleinsmith & Kaplan, 1963, 1964). The contraintuitive aspect of this finding is (a) that high arousal events are less well remembered than low arousal events at short retention intervals, and (b) that memory performance for high arousal items increases successively (rather than decreases) as a function of 30

the time elapsed between study and test; thereby showing data opposite to the typical curve of forgetting. Thus, an interaction is to be dealt with here, namely that between level of arousal and time of test.

The experimental procedure employed by Kleinsmith and Kaplan (1963) was to present subjects with a sequence of word-number pairs using two types of words. Some words were assumed to produce emotional responses i.e., a high arousal level, (e.g., vomit, rape) while others were selected as being neutral with respect to arousal level (e.g., money, swim). Electrodermal responses were recorded during learning to ascertain the level of arousal. At test, subjects were to recall the number-item of each pair initially presented, as each stimulus word reappeared. Different groups of subjects were tested after various intervals, ranging from 2 min, to one week. The data showed that numbers associated with low arousal words were very well recalled at short retention intervals and then decreased successively for longer intervals. Recall performance for numbers associated with high arousal words was initially quite low, but increased successively as a function of length of retention interval. Thus, according to these data there is an appreciable interaction between arousal level and retention interval. A subsequent study by Kleinsmith & Kaplan (1964) using nonsense syllables of zero association value instead of emotional/neutral words, showed essentially the same results. According to these data Kleinsmith & Kaplan (1964, 1968) concluded that memory ability can be predicted on the basis of arousal change during learning and is independent of the emotional value or other qualities of the TBR-materiaL

This specific interaction has later been replicated only in a few other studies using slightly different experimental procedures ©utter, 1970; Howarth & Eysenck, 1968; Kaplan & Kaplan, 1969; Levonian, 1967; McLean, 1969; Osborne, 1972; Walker & Tarte , 1963), and could hardly be considered as a stable finding in studying the relationship between arousal and memory performance. I will return to this issue later in this thesis.

The Walker hypothesis A theoretical interpretation of the Kleinsmith & Kaplan data presupposes that factors at consolidation or storage rather than encoding and/or retrieval are responsible for this arousal effect. In a re-interpretation of the 31

consolidation view (proposed by Muller <3c Pilzecker, 1900, and developed further by Hebb, 1949), Walker (1958, 1967) suggests that perseverative consolidation of a memory trace can last for a long period of time, and that arousal plays an important role in this consolidation process. For conditions of low arousal, only a small amount of nonspecific neural activity conveys the fixation of the reverberating memory trace, resulting in a weak consolidation and subsequently in a poor long term memory performance. A high degree of arousal (i.e. more non-specific neural activity) will produce greater reverberating activity, a stronger consolidation, and therefore a better permanent memory. The poor performance in immediate memory for conditions of high arousal implies that the memory trace is not available to the organism while the reverberation process occurs. This unavailability follows from the difficulties in re-firing in those neurons which are firing repeatedly in a reverberating circuit. Thus, since the neurons involved in the perseverating circuits are assumed to be limited in re-firing capacity, the trace remains unavailable until the fixating process has been terminated. Under conditions of low arousal, immediate recall is enhanced due to lack of rapid reverberation. As an analogy to this reasoning Walker (1967) referred to a "catch-a-train" methafor. "You have no difficulty getting on board if the train is standing still. If it is moving slowly, you can make it. The faster it is going, the more difficult it is to get aboard" (p. 192).

Aims of the Experimental Studies

The purpose of the present thesis was to investigate the role of emotional arousal in remembering, and to relate this concept to empirical findings of amnesia. On the basis of the general findings reviewed in the introductory sections, three principal questions are to be considered.

First, there are both clinical and experimental evidence supporting the notion that high emotional arousal (traumatic) events are more difficult to remember than neutral events occurring immediately after encountering the traumatic event. One interesting aspect of this finding is the interaction demonstrated between events with high or low arousal inducing properties and the time of test (immediate test or tests after longer intervals). Thus, remembering of high arousal events has been found to be inferior to that of low arousal events at immediate tests but superior to low arousal events at 32

delayed test intervals (e.g. Kleinsmith & Kaplan, 1963, 1964). There are several reasons for focusing on this interaction, but the major concern here is for the curious similarity to some empirical findings of amnesia. The most striking parallel in clinical settings is the earlier referred states of hysterical amnesia, commonly interpreted as a defence to eliminate, or prevent, the individual from undue stress in connection to psychologically traumatic experiences. However, as a function of time, or in a test situation in which more retrieval information is provided, the amnesic effects disappear. It is conceivable that this amnesic phenomenon may have the same underlying explanation as the interaction mentioned involving degree of arousal and time of memory testing.

The second point is about the common finding demonstrated in both clinical and experimental studies of amnesia where the memory deficit might spread to events preceding (retrograde amnesia) and succeeding (anterograde amnesia) the amnesic agent. As demonstrated by e.g. Detterman and his colleagues (Detterman, 1973, 1976; Detterman & Ellis, 1972; Ellis, Detterman, Runcie, McCraver & Craig, 1971) subjects having studied material involving a critical item (simulating a clinical trauma) suffer retrograde amnesia as compared to the memory performance of subjects having studied material involving no such critical item. The purpose here is to try to determine why these effects appear, and also to try to explain the recovery phenomena of the retrograde amnesia and the less common recovery of anterograde (post- traumatic) amnesia reported in the clinical literature. In considering these amnesia effects it seems natural to regard them conjointly with the interactional effects obtained in studies of arousal and memory.

While most researchers seem to agree on the reliability of the empirical phenomena, there is indeed disagreement about theory. Thus, the third point is to elucidate whether it is physiological structural aspects at consolidation and storage, or cognitive functional aspects in relation to encoding and retrieval that are responsible for the interactional effects discussed.

These three closely related issues constituted the basis for the general notion to be tested in the experimental studies conducted: How and to what extent is amnesia mediated by an increase in emotional arousal. 33

Experimental studies The four studies of this thesis are first described and then their implications are discussed.

All studies were carried out in laboratory settings. Subjects (18-35 years of age) in each experiment were naive with respect to experiments of this sort. Those subjects who knew anything about the experiment beforehand were expelled from the pool of potential subjects. The subjects were tested individually and participated on a voluntary basis with a small benefit for their services. Prior to the experiment each subject was interviewed about their physical and psychological status. They were also asked about their sensitivity to different kinds of emotional content in media. The subjects were led to believe that these questions were important for an exact calibration of the physiological measurements. Subjects in Study 3 and Study 4, were also required to undergo a thorough physical examination including electrocardiograms. In all experiments the subjects were in advance given a pseudo-explanation of the experimental purpose (e.g. "a study of physiological responses to simple and complex stimuli”, or, ”physiological correlates to certain socialpsychological judgements ”). No mention was made about the emotional manipulation or memory testing. The subjects were informed about their right to terminate their participation in the experiment at any point and still get paid for their services. After the experiment was completed the subject was interviewed concerning various experiences during the experiment and they were given a close explanation of the purpose of the experiment.

In each experiment measurements of autonomic responses (deflections in skin conductance and heart rate) were used as physiological correlates of emotional arousal. The use of these measurements to indicate emotional arousal is well documented in the literature (see e.g. Graham <5c Clifton, 1966;

Hare, 1973; Hare, Wood, Britain & Shadman, 1971; Klorman, Weissberg <3c Wiesenfeld, 1977; Obrist, 1981). In Study 4, accompaning electroencephalogra- fic recordings were used as a more direct measure of cerebral cortical arousal. In addition to these physiological measurements, emotional arousal was also evaluated by means of postexperimental ratings by the subjects.

All the experiments were examined and approved by the ethical committee at the University of Umeâ. 34

Study 1 This study was designed for the sake of establishing a general experimental paradigm so that remembering could be studied: for the events preceding an emotionally arousing event (Phase 1), for the emotionally arousing event proper (Phase 2), and for the events succeeding an emotionally arousing event (Phase 3), and furthermore to induce retrograde and anterograde amnesia so that the locus of the arousal and amnesia effects could be evaluated with respect to factors critical to encoding and to consolidation. This was accomplished by a presentation of a short thematic story in pictorial form. In one version of the story the middle part was of an emotionally arousing nature, whereas the beginning and end parts were merely neutral. In the other version of this story the beginning and end parts were exactly the same as those in the arousal-inducing version; however, the middle part of this version was neutral as well. Memory performance was measured at a short and at a delayed test interval, and by means of two types of test; recall or recognition. While recall scoring was based on the thematic or central features of each picture, the recognition test was designed as a test of pheripheral detail information. In this recognition test the central features of each slide were held constant and only the peripheral information was manipulated. Thus, the experimental design in this study included manipula­ tions of four factors: Type of material (neutral vs emotional arousal-inducing events), retention interval (test after 12 min or after 2 weeks), and type of test (recall or recognition) were varied between subjects. The fourth factor refers to the three phases of the story (beginning, middle, end) and was varied within subjects.

From an encoding point of view, one would expect as a consequence of the hightened arousal state induced in Phase 2 in the emotional version of the story, a smaller proportion of conscious attention to be available for task processing of the material presented in this phase and from this phase on (c.f. Easterbrook 1959; Eysenck, 1982; Mandler, 1975 earlier in this text). This would lead to a state of attentional selectivity and it would, hence, be beneficai for recall but not for recognition testing in both immediate and delayed testing. According to the consolidation theory proposed by Walker (1958, 1967) a recovery effect is to be expected for events aquired at a state of high arousal as compared to a state of low arousal events. Type of test 35

(recall vs recognition) would be non-critical for the pattern of data according this hypothesis.

The results from this study indicate that the paradigm used is quite applicable to studies of remembering of traumatic events. Subjective self-ratings and autonomic measurements indicate that subjects presented with the emotional version of the story showed a higher degree of arousal in Phase 2 and 3 as compared to the subjects presented the neutral version. More specifically, the experimental group rated the stimulus material as unpleasant and exhibit an increase in palmar skin conductance activity conjointly occurring with a decrease in heart rate activity. This is a typical pattern of autonomic responding referred in the literature as an orienting response, enhanced environmental intake (Graham & Clifton, 1966; Lacey, 1967). Furthermore, a retrograde amnesia effect and tendencies of anterograde effects were obtained. With respect to the anterograde effects the difference was in the appropriate direction but not significant. Regarding the retrograde amnesia, obtained in recognition testing, an interactional pattern was found, such that subjects presented with the arousing version of the story performed at a lower level at the short test interval compared with the control group, but were superior at the delayed test. However, as there was no difference in levels of arousal between the subjects in Phase 1, an explanation in terms of consolidation for these effects seems less probable. Considering remembering of the events in Phase 2, it is important to note that no von Restorff effect (see p. 23) was obtained which otherwise is a typical effect demonstrated for laboratory amnesia but not for clinical amnesia. In the recall test, a von Restorff effect could be seen for both groups, which most probably is explained by the somewhat more thematic nature of the content in this phase of both versions of the story. It was further demonstrated that the unpleasant items presented in Phase 2 were recalled at about the same level as the neutral items at a short test interval, but better at a long test interval. This is a pattern of data which is similar to the ones freqently obtained in studies of arousal and memory performance (e.g. Archer & Margolin, 1970; Berlyne, Borsa, Hamacher, & Koenig, 1966; Corteen, 1969; Farley, 1973; Folkard & Monk, 1980; Hockey & Hamilton, 1970; Kaplan & Kaplan, 1969; Malzman, Kantor, & Langdon, 1966; Sampson, 1969; Schwartz, 1974; Uehling & Sprinkle, 1968) and as such, a more reliable finding as compared to the specific pattern of data reported by Kleinsmith & Kaplan 36

(see p. 30). However, since this pattern of data was not obtained in the recognition test it was concluded that different processes are involved in recall and recognition It was suggested that subjects presented with the emotional version of the story were subjected to a state of restricted conscious attentional capacity. Hence, it was proposed that a smaller amount of information was attended to but encoded in a more elaborated way. While recall testing in this study was beneficial to this type of processing the recognition test was not.

Study 2 The four experiments of this study, were conducted in order to further explore the paradigm employed in Study 1. This was done by making the arousal-inducing material even more traumatic. Furthermore, in order to extend the reasoning and analysis of amnesia, tests were conducted on neutral associative words presented along with the traumatic events. Factors of encoding (attention), storage (consolidation), and retrieval (reconstruction) were considered for their possible role in explaining amnesia caused by an emotional trauma.

The subjects in each of the four experiments employed in this study were presented with a series of 18 pairs of slides consisting of photographs of faces with each face accompained by four words describing the face by different characteristics (a name, an occupation, a hobby, and a personality trait). In one version, presented to the control subjects, all faces were neutral in the beginning (Phase 1), in the middle (Phase 2), and at the end (Phase 3) of the series, with six pairs of slides in each phase. In the other version, presented to the experimental subjects, neutral faces were presented in Phases 1 and 3 (identical to those of the neutral version). However, the faces presented in the middle of the series (Phase 2) were horrible, disfigured and comprised photographs of grotesque facial injuries (Gresham, 1973). The verbal descriptions presented along with the faces were identical in both versions. The subjects were instructed, to read out loud the four aspects presented along with the faces, and then to choose and report out loud the very aspect he or she felt as most appropriate for the face presented. Retention of the verbal discriptors associated with the faces was measured by means of a cued recall test given after a 12 min filler activity after study, in Experiment 1, a cued recognition test, 12 min after study in 37

Experiment 2, a cued recall test (12 min after study) and a cued recognition test (30 after study) in Experiment 3, and a recall test (12 min after study) followed by a recognition test (30 min after study) in Experiment 4.

The arousal data in each of the four experiments revealed strong differences in autonomic reaction such that the subjects presented with the gruesome pictures showed an increase in palmar skin conductance and heart rate activity in Phase 2 and Phase 3. Furthermore, data from subjective self-ratings clearly showed that the wanted emotional state had actually been induced. In the literature this specific pattern of emotional arousal has been described in connection to highly stressful situations, and is commonly referred to as a defensive or a rejection response (see Graham & Clifton, 1966; Lacey, 1967). A more complete presentation of the autonomic arousal data obtained in this study appears in Christianson (1984a).

Experiment 1. In the cued recall test of Experiment 1, the subjects were cued by the faces presented at the study phase and asked to recall as many as possible of those four aspects previously presented along with each face. Memory performance was averaged across the six slides (including the four descriptors) of each phase to produce three values per subject, one value for each phase. The results showed that the subjects exposed to the traumatic materials exhibited an amnesia for the to be remembered (TBR) items in the traumatic phase (Phase 2), and an anterograde amnesia for the items in Phase 3. These amnesic effects are actually the most common findings in different types of clinical amnesia, and in this respect a unique simulation of clinical conditions. In a further analysis of some of these data (i.e. those items selected by the subjects), the anterograde amnesia receded. This specific finding suggest that factors at encoding are involved in this type of amnesia.

Experiment 2. It is generally known from the literature (see e.g. Bahrick, 1970; Kintsch, 1970) that retrieval processes play a more predominant role in recall than in recognition, in that recall involves a search or a retrieval process followed by a decision process. This search process is however assumed to be bypassed in recognition. In order to investigate whether factors at retrieval are critical to the amnesic effects obtained in Experiment 1, a second experiment (Experiment 2) was conducted. This experiment was similar in all respects to Experiment 1 except that a 38

four-alternative forced-choice cued recognition test was employed instead of a cued recall test. The results from Experiment 2 showed a significant Group by Phase interaction, such that the traumatic group was superior to the neutral group in Phase 1, inferior in Phase 2, and with no difference between the two groups in Phase 3. In order to trace the source of this interaction, separate analyses were conducted for each of the three phases. None of these analyses revealed statistical significance.

A comparison between the results of Experiment 1 and Experiment 2 indicate that factors at encoding and retrieval are critical in explaining the amnesia obtained in Experiment 1.

Experiment 3. In studies of arousal and memory performance it has frequently been reported that long-term retention (approximately 20 minutes after aquisition) is facilitated for items perceived in a state of high arousal (see Eysenck, 1976 for a review). This finding is compatible with Walker's (1938) hypothesis, suggesting that high arousal purports to an intensified consolidation process, resulting in an inhibition of immediate recall but with favorable effects upon long-term retention.

The aim of the third experiment in this study was to investigate whether the interactional pattern of the data obtained in Experiments 1 and 2 is a reliable finding, and at the same time elucidate whether the hypothesized improvement of long-term retention (see Walker, 1958, 1967) is applicable to the present amnesia effects obtained in Experiment 1. Thus, Experiment 3 was a replication of Experiment 1 but was extended to include a delayed retention test as well, viz. the same cued recognition test as in Experiment 2. Accordingly, the subjects in this experiment were presented with the same type of material as in Experiment 1 and 2, though, unlike the previous experiments, Type of test (cued recall and cued recognition) varied within subjects. Twelve minutes after the study phase each subject was initially given a cued recall test, followed by a cued recognition test 30 minutes after study.

The cued recall data of this experiment showed that the amnesia effects obtained in Phase 2 and 3 of Experiment 1 is a reliable finding. Furthermore, the recognition data showed that the Group by Phase interaction obtained in 39

Experiment 2 is replicable. The source of this interaction was traced to the difference in Phase 2. Thus, by comparing the cued recall data and the cued recognition data of this experiment it can be concluded that the memory impairment obtained for the items associated with the gruesome facial slides show up irrespective of type of test. Considering that this amnesia was obtained both at a short and at a long retention interval, it seems fair to conclude that the consolidation view advocated by Walker (1958) is less plausible as an explanation of the amnesia obtained in Phase 2. The cued recall data and the cued recognition data are also similar in that no significant retrograde amnesia was obtained. An interesting interaction was however obtained in Phase 3, in that an anterograde amnesia showed up in cued recall but not in the subsequent cued recognition test. With regard to the fact that this recovery effect was obtained 30 minutes after aquisition, this piece of data is compatible with the hypothesis proposed by Walker (1958, 1967). On the other hand, considering that this recovery effect was actually also obtained in the recognition test administrated 12 minutes after acquisition (Experiment 2), this interactional finding obtained in Phase 3, seems less significant to a consolidation point of view. Furthermore, if the high level of arousal per se should be critical to memory performance, one would not expect to find a different pattern of memory data in Phase 2 and Phase 3, since a heightened level of arousal was obtained in both these phases. Rather, it is suggested here that the increase in emotional arousal obtained from Phase 2 on, has severely reduced elaboration of encoding as compared to those items encoded in a neutral condition. Access to these items, encoded only to a shallow level (cf. Craik & Lockhart, 1972; Mueller, 1979), might then depend on the amount of retrieval information presented at the time of test.

Experiment 4. The fourth experiment in this study was conducted for the purpose of more closely investigating the effect of cueing at retrieval. It is known from the literature that retrieval is facilitated by means of cues in recall, but not in recognition (see Tulving, 1976). Tulving (1971) in referring to Thomson (1972), Thomson & Tulving (1970) and Winograd, Karchmer & Russel (1971), discusses the difference between recall and recognition with respect to cue effectiveness. Although conceptually different, this discussion relates to the theoretical position about recall and recognition proposed by Bahric (1970) and Kintsch (1970). The faces presented as cues at retrieval in 40

the foregoing experiments might have disguised a more dramatic amnesia effect. Accordingly, the design of Experiment 4 was the same as in Experiment 3 except for one change: the subjects were not presented with any faces to guide retrieval.

The results of Experiment 4 showed in accordance with Experiment 3 an amnesia in Phase 2 (both in recall and recognition), and an anterograde amnesia in test of recall, which receded in the subsequent recognition test. Furthermore, no significant retrograde amnesia was obtained. These data were also analyzed by separating memory performance for those items selected by the subjects. When cues were given as in Experiment 3 there were no significant effects of the selected items recalled. However, in the present experiment, where no cues were given, amnesia was obtained for these selected items as well. Considering this finding, and also that the difference in overall memory performance was more pronounced between the two groups in this experiment as compared to the results of Experiments 3, it seems likely to conclude that the amount of retrieval information available at test is a critical component for the amnesia phenomena obtained in this study.

Common to the four experiments conducted in this study is that no retrograde amnesia was obtained. It could be argued then that the special scoring technique applied to the data in this study has disguised a retrograde amnesia for the most recent items preceding the traumatic phase. As a control of this possibility two additional analyses were conducted of the four aspects presented in the last descriptor slide of Phase 1, presented just before the traumatic slides in Phase 2. In order to obtain maximum power in the statistics, data in these analyses were combined across the four experiments. The results from these two analyses, conducted on recall, and recognition data respectively, did not reveal any significant memory effects. Additional analyses, combined across the four experiments, were also conducted on data of selected items and data of unselected items separately. These analyses revealed a significant amnesia in Phase 2 for selected and unselected items, and irrespective of type of test (recall or recognition). In Phase 3 amnesia was obtained for selected and unselected items in test of recall but not in test of recognition. 41

Study 3 In the previous study the amnesia effects were accompained by strong changes in autonomic arousal in Phase 2 and also in Phase 3. The primary aim of Study 3 was to investigate whether these amnesia effects are caused by physiological characteristics of the heightened arousal level per se, (i.e. due to emotional arousal) or by psychological characteristics of the sources of arousal (i.e. aspects of the traumatic material proper). From Walker's (1938, 1967) point of view it can be inferred that ”source of arousal” should not be critical to the act of consolidation. According to Mandler (1975) and Eysenck (1982) it is argued, that attention demanding characteristics of autonomic arousal would decrease the proportion of conscious attentional capacity, available for task processing.

In this study emotional arousal was induced by means of injection of adrenalin, described in the literature as an arousal producing drug (see reviews by Breggin, 1964; Manstead & Wagner, 1981; Reisenzein, 1983; Schächter, 1971; Schacter <5c Singer, 1962). Schacter (1971) argues that when a subject is in a state of high autonomic arousal, and has no appropriate explanation for this bodily state, s/he is conceived to relate this state to the immediate situation. With respect to the present study it was suggested that due to a new, unknown, and stressprovoking experimental situation, and given that the subject is injected with adrenalin and not told about the drug and its side effects, it is resonable to assume that this subject probably experience a hightened level of stress or emotional arousal. On the basis of studies by Marshall & Zimbardo (1979) and Maslach (1979) it was furthermore assumed that this state of ”unexplained arousal” would be experienced negatively. Accordingly, subjects in two experiments blindly received a subcutaneous injection of either adrenalin (0,007 mg/kg in a total volyme of 1 ml) or an equivalent volume of physiological saline, and were then exposed to the same neutral stimulus material as presented to the control groups in Study 2. In Experiment 1 of the present study the same cued recall test procedure was employed as used in Experiment 1 of Study 2. In Experiment 2 of the present study the same cued recognition test procedure was employed as that of Experiment 2 in Study 2.

The results showed that the adrenalin and saline conditions produced reliable differences in palmar skin conductance activity and heart rate activity, as 42

well as self-reports of bodily symptoms (hand tremor, palpitations, increased heart rate, etc.)» and in ratings of unpleasantness. The means of the adrenalin group were higher in each case. The higher arousal level displayed by the adrenalin group was not, however, accompained by a significantly impaired memory performance. Thus, no differences were found between the two groups in remembering of the TBR-items. This was true both in test of cued recall (Experiment 1), in test of cued recognition (Experiment 2), and when calculations were made separately for selected and unselected items.

Since the highly aroused subjects performed equally well as the low aroused subjects with respect to memory performance, it was concluded that high emotional arousal emanating from a source not related to the TBR-items is not a critical determinant to memory performance. This finding suggests then that the amnesic effects obtained in Study 2 are basically mediated by emotional arousal in terms of the specific characteristics of the material presented, rather than a hightened autonomic activity or an increase in emotional arousal per se. Thus, the present study extends previous suggestions made by Mandler (1975) by demonstrating that emotional arousal alone does not account for impairments in memory performance. Instead, a decrease in memory performance of emotionally arousing experiences has to be analyzed in terms of an interaction between cognitive and emotional factors.

Study 4 A crucial question is whether emotional arousal induced by traumatic pictures is similar to emotional arousal induced by injections of adrenalin with respect to a concomitant increase in cortical arousal. Regarding Walker's (1958, 1967) trace consolidation theory this would be a very critical point. Thus, the present experiment was designed to elucidate this question, and furthermore, to make a more direct comparison between emotional arousal emanating from two different sources with respect to emotional state and memory performance.

Subjects in this experiment were either injected with adrenalin and presented with the same neutral stimulus material as in Study 3 (emotional arousal caused by an extraneous source not related to the TBR-items) or, injected with saline and exposed to the arousal-producing material as used in Study 2 (emotional arousal related to the TBR-items). To maintain coherence with the 43

previous experiments in Studies 2 and 3, the same design and arousal measurements were used. The present design was, however, extented by using electroencephalographic (EEG) recordings for measuring cortical activity. The memory test employed was the same cued recall test as that used in Experiment 1 of Studies 2 and 3.

The results of Study 4 showed (a) that both groups were subjected to a high emotional arousing state as measured by an increase in skin conductance and heart rate activity, and by subjective self-ratings of autonomic and emotional changes, (b) that there was no significant differene between the two groups with respect to cortical arousal as measured by means of EEG, and (c) that the subjects presented with the traumatic material, exhibited amnesia for the TBR-items associated with the emotional arousing pictures (Phase 2) and an anterograde amnesia for the TBR-items in the succeeding phase (Phase 3). These amnesic effects were obtained both when calculations were made for all TBR-items presented or just those items specifically selected by the subjects.

Taken together, the data of Study 4 suggests that emotional arousal is significant for memory performance only in conditions when the source of the increased arousal state is associated with the TBR-material. No evidence was obtained in favour of the view proposing that high arousal per se, or a generalized increase in cortical arousal, should be critical to memory performance.

Discussion of Study 1-4 The aim of the present thesis was to study amnesia as induced by means of emotional arousing events. Four studies were designed so that remembering could be evaluated with respect to items occurring prior to an emotional arousing event, items related to the arousing event, and items succeeding the arousing event. Manipulations were made with respect to time of test, type of test, an various arousal-producing agents. Factors of encoding (attention), storage (consolidation), and retrieval (reconstruction) were considered as underlying determinants in explaining the loci of amnesic phenomena. Among these subprocesses of remembering, the act of consolidation was put into focus. The reason for this was that consolidation processes are generally assumed to play a dominant role in various amnesic phenomena (Jus <3c Jus, 44

1972; Moscovitch, 1982; Milner, 1966, 1978; Russel, 1971; Russel & Nathan, 1946; Scoville & Milner, 1957; Squire, Slater & Chace, 1975; Tulving, 1969; Wickelgren, 1979) and in related effects in studies of arousal and memory (see e.g. Kleinsmith & Kaplan, 1963, 1964; Walker, 1958, 1967; Walker & Tarte, 1963).

A primary concern in the present work was to determine whether the wanted emotional arousal state had actually been induced. Autonomic changes are then important in the control of sensitivity to noxious stimulation. The mean palmar skin conductance and heart rate activity during the stimulus presentation were used as autonomic response measures, since these have been demonstrated to be the most sensitive autonomic indexes of emotional involvement (see e.g. Lazarus, Speisman, Mordkoff & Davison, 1962; Weinstein, Averill, Opton & Lazarus, 1968). Thus, the level of emotional arousal was estimated by these measurements, and by self-ratings of autonomic and emotional experiences in all four studies. In summarizing the emotional arousal data of the present studies it can be concluded that the utilized arousal-inducing agents brought about a high degree of arousal in Phase 2 and Phase 3 in all four studies.

Another main concern of the reported studies, was to also induce amnesia for the traumatic events, or those items conjointly occurring with the traumatic events. While the traumatic critical event in clinical cases is almost never remembered, the critical event (amnesic agent) in most of the laboratory simulations reported in the literature is very well remembered. Such results have been interpreted to reflect a typical von Restorff effect. This empirical discrepancy has made generalizations to clinical settings very hazardous. With respect to the studies in the present thesis, such von Restorff's effects have successfully been avoided. In fact, amnesia was obtained for items associated with the traumatic events in Studies 2 and 4. In this sense the present work constitutes a more ecologically valid simulation of clinical settings than previous experimental studies in this field.

In a recent study by Christianson (1984b) possible von Restorff effects in this type of design were subjected to a more close investigation. It was argued that since the emotionally critical items presented in the middle phase of each series indeed are different from the preceding and the succeeding items, 45

one should expect a von Restorff effect (see Wallace, 1965). On the other hand, since the nature of these critical items cause a smaller portion of the overall attentional capacity to be available for encoding (see Eysenck, 1982; Mandler, 1975) one would expect a decrease in memory performance of the associated TBR-items. Using the same design as in Study 2 a "positive" von Restorff effect was obtained by Christianson (1984b) when neutral items were presented in the middle of series of otherwise emotional events. However, a "negative" encoding effect was obtained when emotional items were surrounded by neutral materials. It was concluded in that study that attentional demanding characteristics of the emotional materials interfere with memory processing of the associated TBR-items.

The results of Study 1 showed a retrograde amnesia in recognition but not in recall. More specifically, this amnesic effect was found to be an interaction between type of material and time of test. Thus, subjects presented with the traumatic version of the story performed less well as compared to subjects presented with the neutral version at an immediate test, but the reverse result was obtained at a delayed test, i.e. a better performance for the traumatic version of the story. The superior memory performance obtained at delayed testing for the traumatic group was also demonstrated in recall testing of the traumatic items, presented in the middle of the emotional arousing version of the two stories. This interaction between type of materials and time of test has previously been reported in a number of studies on arousal and memory (see Eysenck, 1976 for a review). A common explanation offered in these studies is the consolidation view proposed by Walker (1958, 1967). It is then argued that unpleasant events cause a state of higher cortical arousal than do neutral events. This in turn is assumed to affect the consolidation of memory traces at encoding and storage. The underlying rationale for this view is that perseverative consolidation of a memory trace can last a long period of time and that arousal plays an important role in this consolidation process. For conditions of low arousal only a small amount of nonspecific neural activity conveys the fixation of the reverberating memory trace. This results in a weak consolidation and subsequently in a poor long-term memory performance. A high degree of arousal (e.g., more nonspecific neural activity) will cause greater reverberating neural activity, a stronger consolidation and therefore a better permanent memory. The poor immediate memory performance for conditions 46

of high arousal is interpreted as the memory trace not being available to the individual while the reverberation process is taking place. However, taking into consideration that the retrograde amnesia obtained in Study 1 was not accompained with any differences in arousal, and that this retrograde amnesia effect was obtained in recognition but not in recall, the Walker hypothesis seems less plausible as an explanation of this type of amnesia.

An alternative interpretation of these data suggests that attentional, recoding, and reconstructive processes are involved. On the basis of Easterbrook's (1959), Eysenck's (1982), and Mandler's (1975) conclusions, it is assumed here that an increase in emotional arousal reduces conscious attention available for task processing, thereby resulting in an increase in attentional selectivity. In line with this reasoning, it is proposed here that the exposure of a traumatic event implies that a smaller proportion of features of the stimulus (central details) are attended to. These attended to features are, however, assumed to be encoded in a more elaborate way (cf. Eysenck, 1982$ Mueller, 1979). Due to an attributional search for the course of events, attentional mechanisms would also affect the lasting images of the items preceding the traumatic event. This line of thought is to some extent similar to proposals made by Loftus (1982) and Loftus <3c Loftus (1980) in discussing similar circumstances under which a particular memory representation may be altered (recoded) by postperceptual information. Thus, only those features or details that gain strong associative value or relevance for the course of events, are further elaborated and retrieved. Moreover the significance of the involvement of attentional mechanisms is further supported by the specific directional fractioning in autonomic responding by the traumatic group (increase in palmar skin conductance activity combined with a decrease in heart rate).

Applied to the interaction commonly obtained in studies of arousal and memory, this resoning has been described metaphorically in Study 1 (Christianson, in press). "Let us assume that ten words (tantamount to features describing a neutral event), written in small and fine letters, are projected on a screen. In addition to these words, three other words are projected. However, these are written in large and distinctive letters (tantamount to features describing an emotional/traumatic event). If the focus is sharp and if the viewers' distance to the screen is short (tantamount 47

to a short retention interval) the type of writing should not be critical for accuracy in reading the words. However, the number of words (features) of the neutral event makes reconstruction of the original event easier as compared to reconstruction on the basis of the few features of the traumatic event. If the projection on the other hand is out-of-focus or if distance to the screen is long (tantamount to a delayed retention interval) the finely-written words would be blurred, and only those words written in large distinctive letters would still be visible (thus favouring reconstruction of the traumatic event)".

As an analogue to pathological forgetting this process of narrowed attention might be an underlying mechanism to phenomena such as conversion hysteria or hysterical amnesia (see p. 21-22 in the present text). It has been observed in clinical cases, that subjects going through an emotional crisis, or those who have gone through a psychological trauma, exhibit a memory loss of the traumatic event, but preserve some features or associative cues to the trauma. This cue information could be expressed as a physical symptom or compulsive repetition in thought, and may serve as a type of nonconscious recall of the traumatic experience. It is possible, that this type of selective forgetting is an extreme variant of attentional selectivity under exposure to a high emotional arousing traumatic event. Thus, as a function of time, and in order to avoid psychic pain, it is possible that critical or outstanding details of the traumatic situation are isolated from its initial context with accompaning emotional reactions, and may, hence be the underlying cognitive mechanism in hysterical symptoms described in clinical literature (see Breuer & Freud, 1985/1955; Erdely & Goldberg, 1979; Janet, 1965). As far as in known to the present author a similar interpretation of hysterical amnesia in terms of experimental memory data has not been presented earlier. Hopefully, this attempt might stimulate to additional studies in which clinical and experimental knowledge will be used jointly for analyzing these phenomena.

In Study 2 the emotional arousal was intensified, and the employed experi ­ mental technique extended the memory analysis to a set of neutral items presented along with a series of unrelated traumatic events. Although the emotional arousal was increased in this study (as was indicated by a typical defensive or rejection pattern in autonomic responses) no retrograde amnesia 48

was obtained. In comparison to Study 1, this dissimilarity in pattern of results (i.e. lack of retrograde amnesia despite a more traumatic situation) might be due to the lack of associative content in Study 2, between the items in the traumatic phase (Phase 2) and the items in the preceding phase (Phase 1). Thus, in conditions in which a story or a thematic content is to be remembered, it is assumed that reconstruction of the critical event necessitates a reappraisal of the preceding events. In Study 2 the slides were not related to each other in the same thematic manner, conveying that reconstruction of the items in the three phases is less dependent of surrounding items and less vulnerable to interference from them. Although no significant retrograde amnesia was obtained in Study 2, strong amnesia effects were obtained for the items presented along with the traumatic items, and for the items in the succeeding phase (i.e. anterograde amnesia). This is also a typical pattern obtained in clinical amnesia. While the amnesia of Phase 2 items generally was found to be persistent irrespective of time and type of test, the anterograde amnesia receded as a function of amount of retrieval information presented at test. In spite of the fact that no recovery effects for anterograde amnesia have been reported in previous laboratory simulations of clinical amnesia, similar effects have been observed in clinical settings (see e.g. Nemiah, 1969, 1979; Pratt, 1977; Russel, 1971; Russel & Nathan, 1946; Whitty & Zangwill, 1977b). With respect to the present data, the amnesia obtained for items related to the traumatic events is presumedly caused primarily by a severe restriction in attentional and encoding processes, and by a failure to gain access to these shallow encoded items. Similarly, the anterograde amnesia is most likely caused by disturbances at both encoding and retrieval processes. In line with Eysenck (1982), Mandler (1975), and Mueller (1979) it is assumed that the traumatic events, with an accompaining increase in emotional arousal, reduces available attentional capacity which in turn will lead to a restriction in elaboration of encoding of the TBR material. Thus, the presented traumatic material leads to a re-allocation of attentional resources in which processing activities are divided between the traumatic items per se, the TBR-words, and the hightened autonomic arousal (emotionality). Due to intrusive and stimulus- repetitive thought, i.e. perseveration in thinking about the traumatic pictures (see Howowitz & Wilner, 1976; Zachary, 1982), the items in the succeeding phase as well will be encoded in a less elaborated and efficient way. While the encoding operations made for the Phase 3 items are too shallow to enable 49

success in the reconstructive processes involved in recall, they suffice in the less demanding recognition procedure.

On the basis of the fact that variant and alleviated amnesia effects were obtained as a function of type of material presented (selected vs all items presented, and Phase 2 items vs Phase 3 items), and type of test (recall, cued recall, recognition, and cued recognition) but not time of test (12 min delay vs 30 min delay) or a general increase in arousal, it was concluded that an explanation in terms of consolidation (cf. Walker, 1958, 1967) is less plausible for these amnesic effects.

Having concluded that encoding and reconstructive processes are critical to the amnesic effects obtained in Study 1 and 2, Study 3 was conducted primarily to investigate to what extent these amnesic effects were mediated by the proper heightend level of emotional arousal. The design of this study made it possible to isolate the source of emotional arousal from the TBR-items. The results of this study clearly indicate that high emotional a ousal per se does not generate any differences in memory performance (c f. Runcie & OBannon, 1977; Whinney, Keenan & Reinke, 1982). Thus, a general increase in emotional arousal as induced by an external source is not critical to encoding and retrieval operations in the same sense as when the source of arousal is associated with the TBR material. In opposition to the Walker (1958, 1967) assumption, Study 3 suggests that high arousal per se does not lead to an alternation in memory performance. For a discussion of the effects of adrenalin on the central nervous system see Christianson & Mjörndal (1983).

In Study 4, effects of high emotional arousal, as induced from a source related vis-a-vis not related to the TBR-items, were further investigated with respect to (a) cortial arousal, and (b) memory performance. Despite the fact that all subjects were brought to a high emotional state due to adrenalin and enhanced emotional reactions by the experimental context, or due to sudden and unexpected gruesome slides, with an equally increase in the cortical activity as indicated by the EEG, the same amnesic pattern was obtained as in Experiment 1 of Study 1. These data strongly suggest that the way memory performance is affected by high emotional arousal depends partly on task requirements, and partly on attention demanding properties of the 50

emotional arousing event (compare with the interactionistic view proposed by Nilsson, 1979, 1980, 1981, 1983, 1984). Physiological aspects of high arousal per se do not seem to be critical for laboratory-induced amnesia or for memory performance in general (c.f. Walker, 1938, 1967; Mandler, 1973).

Altogether, the four studies summarized in this thesis indicate that the memory differences obtained in relation to an increase ih emotional arousal is most probably due to an interaction between altered encoding operations and the amount of retrieval information aiding reconstructive processes. Although emotional arousal in it self might be a burden in the act of remem ­ bering, it is evident that the amnesia-emotional arousal relationship is mediated by characteristics of the source of emotional arousal. Thus, arousal is significant as an intervening variable in explaining amnesia only when connections can be made between the source of emotional arousal and the events to be remembered. ”Under these conditions cognitive activity by the subject is assumed to be focused on the critical event itself. In other words coping activities and perseveration in thinking about the critical event expend so much conscious attentional energy that further processing of additional information is severely restricted. This restriction in elaboration of encoding is thus the critical point in the explanation of these amnesia effects ” (Christianson, Nilsson, Mjörndal, Perris <5c Tjellde'n, 1983). This causal relationship has earlier been shown to be true for arousal in mediating emotions (Reisenzein, 1983) and has now also been shown to be significant for emotional arousal and memory. The trace consolidation theory proposed by Walker (1958, 1967) has throughout the four studies in this thesis been found to be invalid as an explanation to the arousal-memory effects obtained.

Concluding Remarks

In clinical studies of amnesia, conslusions about memory of traumatic events (accidents, crimes etc) have been drawn exclusively from eyewitness testimonies or isolated memories recalled by victims. An apparent advantage with the laboratory analogue is the opportunity to use other retrieval techniques which are difficult to use in clinical settings. A more firm control of the traumatic event (the TBR-material), and the conditions in which this event is to be remembered, would provide a significant basis for formulating appropriate hypotheses for evaluation in clinical practice. By this interchange 51

between experimental studies and field studies, it might be possible to advance knowledge about various amnesic phenomena, and the act of remembering in general.

Despite apparent similarities in data, obtained both within and between studies of laboratory-induced amnesia and clinical amnesia, it is believed that great caution should be taken when attempting to incorporate the amnesic effects under one single heading, i.e. the amnesic syndrome. Although it might be appealing to look for one or several common, underlying mechanisms of amnesia (e.g. failure of encoding, consolidation or retrieval) detailed analyses of different types of amnesia (see the review in the introductory sections as well as the experimental studies of the present thesis) clearly indicate that some aspects of memory or cognitive functioning are differently impaired in various amnesic states. Thus, in order to make more appropriate inferences from amnesic studies it is important to investigate which features of memory processing are differently affected (dissociated) in various groups of subjects showing memory deficits, and to determine under which conditions interactions are obtained between normals and amnesics in different kinds of memory tasks. In a discussion of this topic, Schacter & Tulving (1982) argue for a device that incorporates recent knowledge from both experimental memory research and clinical amnesia research. According to Schacter <5c Tulving a preferable strategy in studying amnesia would be to choose a paradigm and be consistent in using it, for evaluation of amnesic phenomena and the intact memory. A general aim in the present thesis has been to work in accordance to such a scheme. 52

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