Indian Journal of Psychiatry, 2002,44(3)283-288 AMNESIA FOR AUTOBIOGRAPHICAL MEMORY: A CASE SERIES R.K.CHADDA, N.SINGH & D.RAHEJA. ABSTRACT Functional amnesia for autobiographical memory is a rare but pathognomic sign of dissociative disorders. Amnesia for part of one's personal history is sometimes also seen in other functional disorders like depression and schizophrenia but autobiographical amnesia in these disorders is relatively rare. Phenomenologically the autobiographical memory loss, amnesia for events during the amnestic episode and change of identity (as in fugae and dissociative identity disorder) are all expressions of altered memory organisation. This paper reports three cases of autobiographical amnesia with clinical diagnoses of dissociative disorder unspecified type, dissociative amnesia and schizophrenia that were treated successfully. The phenomenon of autobiographical amnesia is discussed in the background of these cases. Key Words: Amnesia, memory, autobiographical, dissociative disorders Memory disturbances are a common disturbances occur in the context of impaired complaint in clinical practice in psychiatry. The consciousness, with reduced ability to focus, disturbance usually refers to recall of day to day sustain or shift attention, whereas in dementia, events, finances, or some personal information memory impairment may co exist with multiple like addresses, phone numbers, etc. In severe cognitive deficits like aphasia, apraxia, agnosia, cases, the patient may even forget the names of etc. his or her immediate family members and may Organic amnesia involves impairment in not be able to recognise them (Kopelman, 1987). learning and recall of new information, which is Amnesia is a general term for memory disturbance typically absent in dissociative amnesia. Transient and includes both partial as well as complete loss amnesia of organic origin may be, like dissociative of memory that may be anterograde and amnesia, circumscribed to a particular time period retrograde, defined in terms of the onset of an or event with no difficulty in learning and recalling injury or illness. Common causes of amnesia may new information, but in these organic cases, there include organic brain disorders like delirium, is "shrinkage" of retrograde amnesia. This dementia and organic amnesic disorders or indicates a well-observed fact of recall impairment functional illnesses like depression and diminishing as patient recovers Apart from these, dissociative disorders. Amnesia occurring in the the organic amnesia patients during the amnestic absence of any identifiable injury or disease episode have confused or bewildered demeanour. affecting the brain structure is called functional or There is a gradation in degree of memory psychogenic amnesia (Kopelman, 1987; Khilstorm impairment of pre-insult events. The most remote & Schacter, 1995). In delirium, memory events being the least affected and events more 283 R.K.CHADDA etal. closure to the insult, more seriously affected. or implicit (unconsciously expressed memory). Both of these above features are usually not seen The episodic memory concerns people's in amnesia of dissociative origin (Caine & knowledge of particular events that they Lyness,2000). themselves have experienced and is inherently Amnesia for autobiographical memory is autobiographical (Tulving, 1983). A complete relatively rare and is seen more often in media episodic memory describes an event that has reports or movies rather than in general occurred in the past, but it also makes reference psychiatric practice. Functional amnesia involving to the spatiotemporal context, the time and place autobiographical memory is a pathognomic sign in which that event took place. It also necessarily in a major class of mental illnesses known as makes reference to the self as the agent or dissociative (conversion) disorders. Amnesia for experiencer of the event (Khilstorm & an or part of one's personal history is a common Schacter,1995). The episodic memory is feature of dissociative amnesia, dissociative fugue, predominantly explicit in nature but some times and dissociative identity disorder (multiple behaviours acquired during an experience or event personality disorder). may remain implicit. In dissociative amnesia, the core symptom The semantic memory consists of generic is an inability to remember important personal knowledge about the world with respect to oneself, information, typically a traumatic experience (what as self-referent semantic memory. It includes has happened as well as what one has done). In knowledge of one's own name, residence, dissociative fugue, the core symptom is confusion occupation, family members and other information about one's identity, loss of identity, or the that is not associated with a particular time and assumption of a new identity. This amounts to place. The non-self referent semantic memory forgetting who one is, not just what one has done. concerns with knowledge about language, general The change in identity is typically accompanied mathematical rules and facts of life and the world by a loss of memory for events and experiences around us. Semantic memory can be expressed associated with the former identity (Khilstorm & in explicit (facts) or implicit (language rules) Schacter, 1995). This is some times accompanied manner. by moving away from one's native place. When The procedural memory is defined as the fugue state resolves, the person reverts to his individual's repertoire of learned skills like driving, or her original identity, and is able to recall the cooking, singing, playing games and musical original (old) memories. However, the instruments, and writing. This type of memory is autobiographical memories associated with the mainly expressed in implicit or unconscious newly assumed identity are lost. Dissociative manner. The procedural memory is relatively intact identity disorder resembles fugue, except that the in organic amnestic disorders, as opposed to the shift between identities, and associated sets of episodic memory. Similar is the case with the autobiographical memories, is cyclical. It appears dissociative disorders. as if two or more separate identities exist within In pure cases of dissociative amnesia, there the same individual, alternating in control over is loss of episodic, but not semantic memory experience, thought and action (Khilstorm & about oneself. Patient forgets what he did or what Schacter, 1995). Each of these identities (some happened to him, during a specified period of time; times called alter egos) has its own fund of but he does not forget who he is. Mostly the autobiographical memories in form of events and amnesia is reversible in such cases and access experiences and self-referent semantic knowledge. to the episodic (autobiographical) memories The memory is variously categorised as covered by amnesia is eventually restored. episodic, semantic (or declarative) and procedural. In fugue, there is loss of autobiographical It can be expressed as explicit (conscious recall) (self referent) semantic memory as well as 284 * AUTOBIOGRAPHICAL AMNESIA episodic memory. These patients forget who they patient had never been to Varanasi and the family are as well as what they have done. If the patient had no connections in Varanasi. There was no assumes a new identity, a new set of past psychiatric illness and no family history of autobiographical memories (episodic as well as psychiatric illness. semantic) become associated with the new Birth and early developmental history were mental representation of self. When the fugue unremarkable and there was no history of child resolves, the new self as well as associated abuse. During examination, though tense at being autobiographical memories are lost as well. in a hospital in Delhi, she was generally Somewhat similar happens in dissociative cooperative and communicative. Physical and identity disorder, except that there is a kind of neurological examination revealed no abnormality. alteration or exchange of identities and associated She was diagnosed as a case of dissociative autobiographical amnesia. disorder, unspecified type. Abreaction with It is quite interesting to note that while the diazepam was conducted. During abreaction, she dissociative disorders involve profound narrated that she was going with her husband to impairments of autobiographical memory (episodic a hill station On the way they met with an accident as well as self referent semantic, specially the in which her husband was seriously injured. At explicit part of both), the other knowledge stored this , it was suggested that her husband was in memory specially the one that is expressed dead, and she would go to sleep after a while, implicitly (procedural, semantic and sometimes, and on waking up would become 'Ms A'. She woke episodic, when certain event related behaviours up after one hour and was absolutely normal with memorised during some experiences of the no memory of the episode. past are expressed in implicit manner) appears Case 2: Ms. B, a 17-year-old , unmarried female to be relatively unimpaired. The individual's fund studying in 12th standard, presented with a history of world knowledge (the non self referent semantic of loss of memory including personal identity for memory) and repertoire of learned skills (i.e. three days and episodes of loss of consciousness procedural memory) remains relatively unimpaired for five days. She had appeared in one of the paper (Khilstorm & Schacter, 1995). of 12th standard examinations