People don’t remember their earliest experiences,
right? Unless you’re a member of the Association for Pre- and Perinatal Psychology
and health (APPPAH), you probably agree with Freud that there is a normal “infantile
amnesia”. (If you belong to APPPAH, you may think babies remember their births
and can tell you about them.) So why is there “amnesia” for the early years?
Some have argued that unless we have the words to encode memories, we can’t
later access them in verbal form, and since there is little language ability
until after age two years, this would explain why we don’t remember those early
experiences.
Other people claim that we cannot remember early
experiences, even (or especially) dramatic ones, because we have repressed
them. The idea of repression is that human beings have the capacity to defend
themselves against anxiety by becoming unable to know or remember frightening
events. Proponents of the repression concept usually also posit that repressed
memories continue to exist in a way inaccessible to the conscious mind, and
that they can have a variety of impacts on both mental and physical life.
J.F. Kihlstorm has summarized these beliefs as “the
trauma-memory argument” (see http://socrates.berkeley.edu/~kihlstrm/Tsukuba05.htm).
Here are the elements of Kihlstrom’s summary:
1. Traumatic experiences can cause the activation of
mental defenses that result in amnesia for the stressful event.
2. Only explicit memory is affected, but there may
remain implicit memories like “body memory”.
3. If there are “body memories”, this is evidence
that there was a traumatic event.
4. The traumatic memory may be recovered in explicit
form spontaneously, or as a result of guided imagery, hypnosis, or sedation
with barbiturates.
5. It can be inferred that the recovered memory is
correct if it seems to explain the person’s symptoms, or if he or she gets
better after the memory is recovered.
6. Without recovering the memory, the person cannot
cope with the traumatic event.
(Please note that this is Kihlstrom’s summary, not
his own position.)
The trauma-memory argument and the concept of
repression assume that all experiences are remembered, no matter when they
occurred, and a failure to have an explicit memory is due to the activation of
a mechanism that defends against trauma. Infantile amnesia presumably occurs
because there are so many traumatic experiences young children undergo. (Of
course, we get into some interesting side issues when we think about other
forms of forgetting. Does my husband really forget to mail the letter because
he found it so traumatic when I asked him to do it? Do students fail exams
because they were traumatized by the material they were trying to study—or even
found it linked mentally to some already-repressed memories? We do seem to need
some other explanations of forgetting, in addition to-- or instead of-- repression.)
A recent study on memory has supplied a likely
candidate for explanation of the forgetting of frightening or painful events.
This candidate is a normal process, neurogenesis, the creation of new neurons.
And while I am usually the first to query generalization from a study using
mice to conclusions about humans, I do think there are interesting implications
here.
Katherine Akers and her colleagues published in the
May 9 issue of Science an article
entitled “Hippocampal neurogenesis regulates forgetting during adulthood and
infancy” (pp. 598-602). Neurogenesis occurs at a high rate during infancy, but
it continues to occur in adulthood. Also, it can be speeded up or slowed down
by drug treatment or by exercise like forced running in a wheel. Mice easily
learn fear of a place when they receive electric shocks to the feet in that
place, and they later show their learned fear by “freezing” rather than running
around exploring when put back in that place. Adult mice remember their
frightening experience over time and continue to “freeze” after as much as 28
days after the original learning. Infant mice, on the other hand, have already
forgotten their experience and do not “freeze” a day later.
Akers and her co-authors showed that adult mice
forgot their painful experience more quickly when they exercised—an event that
leads to increased neurogenesis. And, drug treatments that slowed neurogenesis
in infant mice also made them less likely to forget the experience, as they
showed by being more likely to “freeze” in the situation where they had
experienced shock. The investigators also compared their results with mice to a
similar study using guinea pigs and degus, rodents that unlike mice are “precocial”,
or capable of caring for themselves soon after birth, and that have a
relatively slow rate of neurogenesis in infancy. These animals showed the same
level of memory for a shock in infancy and in adulthood, but could be made more
“forgetful” by forced running (again, this increases neurogenesis).
These results did not explain all events of memory
or forgetting, but did explain events related to the hippocampus, which
supports explicit, declarative memories.
The real difficulties in moving from this work to
treatment of problem memories of trauma in human beings are obvious, and Akers
and her colleagues certainly did not suggest in their article that PTSD
patients should be given an exercise wheel to run in. However, their evidence
clearly shows a mechanism for restructuring memories that leads to genuine
forgetting and that does not require repression to make traumatic memories
inaccessible; those memories cannot be accessed because they are actually no
longer there. Many years of argument to the effect that memories are not
repressed and recovered are now buttressed by systematic evidence about neural mechanisms
that support forgetting of traumatic events.
And propranolol (or Inderal) seems to be a useful medication for treating PTSD in that memories can be smoothed out, so to speak, by counteracting their adrenaline-mediated glue with this beta-blocker.
ReplyDeleteIt's not the memories, per se, that are so harmful, it appears, but the hyer-arousal and nightmares associated with them.
So, both Prolonged Exposure (PE), where a patient becomes desensitized to traumatic memories through repetition of them in a new context, and propranolol therapy, where traumatic memories are not allowed to take hold (immediate propranolol treatment, within 6 hours of the traumatic event) or where traumatic memories are retrieved and then not allowed to be reconsolidated (later propranolol treatment, during a reprocessing of the traumatic memory), can be effective in disarming the trauma.
Then there is the alpha-adrenergic antagonist Prazosin, which is helpful in decreasing nightmares associated with PTSD, and the alpha-adrenergic antagonist Clonidine, which is helpful in reducing exaggerated startle responses, hyperarousal, and general autonomic hyperexcitability
I think I have a point, but I can't seem to find it ...
Well, I suppose, something along these lines: that you can work a patient up into a froth by planting "repressed" memories and if you prime that patient with enough of your own adrenaline you can glue them in firmly, and thus traumatize a susceptible person (perhaps an adult adoptee, wondering if there is something inherently defective about him or her).
But if you're a science-minded clinician practicing in 2015, you will be wanting to help the patient release the hold of any traumatic memories instead, and you will be trying to do so with the rather imperfect tools that evidence-based medicine has to offer.
I think there are two good points here: first, that there is some understanding of how to treat the unpleasant later experiences that follow an initial bad experience (I'm avoiding the word trauma here), and second, that it's possible that in the course of treatment for something,, new sources for later unpleasant experiences can be created. Again, we don;t need the idea of repression to explain these things..
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