Dr Raj Persaud in conversation with Institute of Psychiatry
neuropsychiatrist Professor Tony David: Does the latest
neuroscience research support Freud?
Neural correlates of recall of life events in conversion
Aybek S, Nicholson TR, Zelaya F2, O'Daly OG, Craig TJ, David AS,
JAMA Psychiatry. 2014 Jan;71(1):52-60. doi:
The paper is a brain imaging investigation of conversion
disorder or hysteria. The study probes a neuroscience explanation
for conversion symptoms, where a traumatic experience is
transformed into a symptom, such as paralysis of a leg.
If you are interested in further information on CPD Online or
wish to earn CPD credit points, please visit the Royal College of
Psychiatrists CPD Online website for further information at
A related article which may be of interest originally published
in The Huffington Post
The UK media reports that a man with severe amnesia, who still
cannot remember even his own name, or where he comes from, but who
was discovered in Peterborough, suffering from severe amnesia two
months ago, is baffling mental health experts.
They are now appealing to the public for help, in the hope that
someone might recognise him.
'Robert' is reportedly suffering from an upsetting and very severe
case of amnesia where he cannot recall any details of his life,
including his own name, age, where he is from; or his job.
One key clue is that although 'Robert' (a name given to him by
hospital staff) speaks English, his accent seems to be eastern
European, and he also appears to understand some Lithuanian and
Similar cases, which could explain this mysterious incident,
include a clinical case report, published in 2010, entitled
'Running towards a different life: A case of Dissociative Fugue',
by Dr M. Santos and Dr E. Gago from Hospital Magalhães Lemos,
The paper, published in the academic journal 'European Psychiatry',
explains that the diagnosis of fugue in psychiatry derives from the
Latin word for flight-- fugere. Dissociative fugue is an extremely
rare psychological condition - the sufferer suddenly and without
warning travels far from home, completely unable to recall their
These episodes are usually linked, explain Santos and Gago, with
severe stress or trauma, such as disasters, losses of loved ones or
intolerable burdens at work or home. The amnesia appears completely
genuine, with patients displaying no conscious understanding of the
psychological reason for the flight. This is usually accompanied by
muddles over personal identity and sometimes even complete
assumption of a new self.
Santos and Gago report that the journeying associated with
'Dissociative Fugue' can last for several months. Some patients
travel thousands of miles from home while in this state.
Another recent study entitled 'Dissociative memory impairments and
immigration' also published in 'European Psychiatry' in 2010, by Dr
A. Staniloiu, Dr S. Borsutzky and Dr H.J. Markowitsch, suggest
there is even a possible link between this kind of psychological
problem and immigration.
The authors from the University of Bielefeld, Germany, argue that
stressful experiences arising during migration could precipitate
these symptoms, though a delayed onset at times occurs reflecting
an 'incubation' effect.
Another recent study suggests an effective treatment for
'Dissociative Fugue' which appears to have fallen out of favour
recently, which might explain why it may not have been used in more
The case study entitled 'Amytal interview using intravenous
lorazepam in a patient with dissociative fugue', reports a
middle-aged white female picked up by emergency medical services in
the USA, who could not remember her name, address, and did not know
the name of the city.
Lorazepam (a sedative drug a bit like Valium) was given
intravenously by the psychiatrist. Although relaxed and sleepy the
patient was kept awake by asking her to restate the name of her
present in-patient psychiatrist, whom she had become close to. She
was led back in fantasy to the gas station where she was picked up
and was requested to identify it. Once she successfully named a
location from her personal history, she was led to give her name,
hometown, birthday, social security number, employment, motherhood
and marital status.
The investigation, published in the journal 'General Hospital
Psychiatry' in 2006, reports that after she awoke the patient
described past and recent sexual assaults. The recent rape was
about 10 days before hospitalization. A final diagnosis of
Dissociative Fugue was made, and the patient was discharged to
outpatient follow-up and the Victims of Violent Crime clinic.
The authors of this paper, Dr Sunday Ilechukwu, from the Ann Arbor
Health Care System and Dr Thomas Henry, then at Wayne State
University, USA, argue that procedures like this provide the
patient with an opportunity for the recall and review of recent
emotional crisis, linkage to past trauma and provision of context
to current experience.
The authors contend that the simple but critical process of naming
her identity under sedation, probably helped her come to terms with
the precipitating conflict.
The authors also argue care needs to be taken to minimize the risk
of introducing false or distorted memories. The use of
video-recorded feedback may also help consolidate gains made during
The authors conclude that the so-called 'sodium amobarbital'
interviews have been in use for about 70 years and refers to the
use of an older barbiturate type drug, could be brought back into
modern psychiatric practice. The study suggests that such
pharmacological-facilitated interviews continue to be a useful
procedure with such cases, but that a safer more modern drug, such
as lorazepam, can be used as an alternative.
But why should trauma lead some people to forget even who they are?
Another study entitled 'A case of persistent retrograde amnesia
following a dissociative fugue: Neuropsychological and
neurofunctional underpinnings of loss of autobiographical memory
and self-awareness', argues that, since memories can be vivid,
threatening and painful, they may be removed from consciousness as
a way of protecting the self-concept.
The authors, Kristina Hennig-Fast, Franziska Meister , Thomas Frodl
, Anna Beraldi , Frank Padberg, Rolf Engel , Maximilian Reiser ,
Hans-Jürgen Möller and Thomas Meindl, brain scanned an individual
suffering from these fugue like symptoms. The results highlighted
the key role of visual and emotional properties of autobiographical
memory in the maintenance of this kind of amnesia.
The study published in the journal 'Neuropsychologia', found
reduced neural activity within the brain network producing
autobiographical memory retrieval. The authors based at
Ludwig-Maximilians-University, Munich, Germany, posit a protective
defence mechanism caused by neuronal inhibition that serves to
prevent an overﬂow of intensive aversive emotions.
The authors suggest that visual imagery plays a central role in the
recall of autobiographical memories. Defects in the way the brain
visually processes memory which might help explain puzzling
phenomena such as Dissociative Fugue.
Their patient regained only three remote and strongly negative
childhood memories dating from the time before the dissociative
fugue. All were highly negative, vivid and fragmented episodes
comparable to frozen images, e.g. of the cofﬁn at his grandfather's
It must surely be one of the most disturbing experiences of all,
not to recall anything of our past except alarming fragments.
Psychiatric investigation of this kind of suffering is helping to
reveal how the normal sense of personal identity is achieved.
Visual aspects of memory may be more important than we previously
realised. The fact that it can be lost suggests we shouldn't take
it for granted.
Trying to uncover who 'Robert' really is, could also help us find
Raj Persaud is joint podcast editor for the Royal College of
Psychiatrists and also now has a free app on iTunes and google play
store entitled 'Raj Persaud in conversation',
which includes a lot of free information on the latest research
findings in mental health, plus interviews with top experts from
around the world.