Description of Functional Amnesia in the Literature - Essay Example

Paper assignment: Amnesia Introduction Quite commonly, organic brain damage leads to disturbances in memory. However, there is of functional amnesia in the literature, where no organic or anatomical lesions have been described. It is already known that brain states are influenced by environment and life circumstances to a great extent. If memory reflects a state and function of the brain, it has been amply demonstrated through clinical neurology that many organic brain diseases have symptomatic amnesia. This amnesia is characterized by intact recent memory but profound retrograde amnesia. There are other details of amnesia of this kind which vary according to different conditions. In contrast functional or psychological amnesia has been classically retrograde meaning the person is not able to recollect past experience. With the recent surge in awareness of relation between body, cognition, intellect, and mind, a newer branch of science, namely, cognitive neuropsychiatry examines this psychic disease process more intensely. In this assignment two articles, one from the news or popular lay media and the other from scientific experimental literature will be examined critically in order to find out the scientific information and knowledge update related to psychological amnesia with the basic research hypothesis, although no organic brain lesion has been demonstrated in functional amnesia, there is a solid scientific basis and cause effect relationship for this type of amnesia. Part 1: Summary of the First Article Killian (2009) in his article titled "Amnesia put her life on hold; now, she's graduating" in May 15, 2009, NewsRecord describes the case of Marshall, who following a bout of viral encephalitis in the senior year of her high school had amnesia. This followed an illness of high fever, followed by loss of memories. The author quotes Marshall's experience of sudden loss of memory, which led to loss of all touch to her old and acquainted environment, and following this incident, she could not remember anything of her past life, and it was something like "first memory of the world" at all. She could not recognize any one in her family, but she could remember habitual works such as "tying the lace of my shoes." This illness led to her admission to the hospital where her stay lasted for 7 days. During this time, it was diagnosed that the infection involved certain areas of brain where certain types of memories and skills were affected. After coming back home, the previously used practiced tasks were difficult to do, and she needed help in her household chores. There was obviously an identity crises where she failed to recognize herself, family, or even personal things as her own. Her academic achievements in the school before this incident were outstanding, both in studies and extracurricular activities. She had been a outgoing student at North Iredell High School. She was a musician and a drum major in the school band. After this incident, she was withdrawn and shy, and her former friends appeared to her as strangers, and this led to considerable alienation. There was obviously a change in her personality, but her amnesia contributed to it in a greater extent. Her mother pursued her educations, and since she had enough credits from her school, with her grades she was accepted in many schools. On the day of her high school graduation she could not make out what is graduation, and how it was important for her, although her family was very happy for her. A break came while she followed a program Starting Over, when she decided not to join college and decided that she will have to rebuild her connections with the real world. She was growing but very slowly, and in this reality TV show, she came to realize what she had lost and how she can progress in her life with new goals. Meanwhile, she joined college with her brother, and she decided to major in communications. She is expected to graduate soon. This news is a report of an incident where the author has taken poetic license. Although this story is based on a scientific phenomenon of psychological amnesia, the author did not build the story on the scientific aspect of this disease. Here the objective is to demonstrate that with zeal and will power a devastating condition like functional amnesia would also be conquered with self confidence and quest for growth in life. However, there could be a possibility that the author did some research on the disease, so through this news article, people could have some idea and knowledge about the disease. It is evident that the author does not present any original study or information from any original study, and this article is just the story of a girl who lost memory. There are no medical details available which can point to the diagnosis. The story of viral encephalitis further complicates the picture, since organic brain lesions cause amnesia that are not functional. Thus there is no question of sample gathering or concepts that can be defined or measured. There is no reference of any scientific articles which have a methodology, and therefore there is no question of critiquing the methodology, in terms of strengths or limitations. There are no arguments, and the article is narrative. However, there is a potential bias in presentation of the article in that author describes the growth of the central character although slow, however, did not investigate whether the family tried any other medical help or therapy for her condition. Rather, the presentation of the articles centers around the astounding capability of the reality show in the television which seemed to have changed the course of her life, but it does not mention how. No arguments and counter arguments have been presented, but the lucid writing style that the author uses holds the reader, and reader tends to read till the end to know what happened to Bethany at the end; however, absence of external sources decrease the credibility of this article. Part 2: Summary of the Second Article Brandt and Wilfred (2006) discuss the case of psychogenic or dissociative amnesia which they define as severe impairment of memory without any demonstrable neurological cause or lesion. These cases are those of functional amnesia and these differ from neurologic syndromes of amnesia in that personal life histories and details are affected severely. However, the ability to retain and learn new information is not affected. This makes these cases significant in that they have isolated retrograde amnesia. Recent research indicates some mechanisms for this disorder; however, despite that the current knowledge conceptualizes this disease as an illness-simulating behaviour. Studies have indicated three different diagnostic aspects of this disease which can be diagnosed through neuropsychological assessment. These are performance deficits on the part of the patient in a circumscribed form, usefulness of spared functions to effect rehabilitation, and adequate psychiatric management of the emotional disorders associated with it. This study indicates a paucity of controlled clinical trials and the results thereof to indicate evidence, but isolated case reports suggest that recovery can be facilitated through supportive psychotherapy, hypnosis, systemic relaxation, and sedative or anxiolytic medications. If these treatment approaches are combined with psycoeducational approach, although recovery is not possible, relearning occurs in an effective manner. The purpose of the study was to review the current literature on functional or psychogenic amnesia to build knowledge in that area, so the practitioners can be helped. There is no hypothesis in this review, and the authors have presented findings from a wide body of literature to discuss different aspects of this problem and update knowledge. There is no sample in this study, and therefore size cannot be determined and method of sample selection is irrelevant. Although no methodology has been indicated, it appears that the authors have collated findings from a wide body of scientific literature to classify the findings under different headings which indicate different aspects of this disease. At the end they present case reports and findings from them, so the reader can utilize the knowledge from the review to interpret findings from cases. There is report of one study that used Dissociative Experiences Scale (DES) as a measuring instrument for these experiences. The clinical interview section reports scales such as Structured Interview of Reported Symptoms (SIRS), and the neuropsychological examination section indicates the use of Wechsler Intelligence Scales, Wechsler Memory Scale-III, California Verbal Learning Test-II (CVLT-II), Hopkins Verbal Learning Test-Revised, and Recognition Memory Test. Although these scales are valid scales to determine different symptomatic aspects of functional amnesia, there must be some pilot study to design a randomised control trial to established reliability and validity of these instruments in this disease. The authors are specialists in this field, and the rationality of this review and presentation of the concepts are well established through logical arguments. The methodology was descriptive review and findings were classified and presented, and for this kind of presentation, this methodology is best suitable, which is more so since there is no randomized control trials on this topic. Case reports thus do not bear the rigor of a research, and there can be high probability that treatments used were empirical and hence the conclusion biased, lacking generalizability and reliability. The authors cited external articles, and they placed their counter arguments very effectively, and at the end the reader is left with the current knowledge update on functional amnesia. The authors conclude that the challenge posed by functional amnesia need to be clinically handled by the clinicians. To that end they need to identify the characteristics of the disease discussed here. There is also a clinical necessity to differentiate the patients from malingerers. By definition, the diagnosis is based on identification of severe retrograde amnesia in absence if antegrade amnesia, causative brain lesions, and other cognitive impairments. Imaging technologies now point to metabolic abnormalities, and the successful management strategy must include removal from threats, gentle suggestion and cuing, reteaching, and psychological support. Part 3 The journal article provides scientific and research information, while the news article tells us a story about a similar patient with psychogenic amnesia. None of these articles report sampling, data gathering, measurement, statistical analysis, strengths and limitations. Findings as extracted by this writer indicate conceptual classification of scientific data from literature in the journal article where to prove their points, the authors present other external literature and case reports on the backdrop their professional experiences. On the contrary despite lacking all these, the news article present a narrative of a similar case but there is no methodological scientific quest in supporting the concepts involved in that narrative. Thus the media article loses its authenticity due to the fact that it does not mention the source, does not provide any proof for the concept, and takes for granted that whatever is reported is correct despite discrepancies. However, being a media article and its audience of lay people, this may be acceptable for some, but as a scientific evidence, its reliability is nil. Some external references and arguments would have made it more reliable. The post-encephalitis episodes of amnesia appear to be retrograde and functional or psychogenic, whereas the doctor reports quoted indicates brain damage. This is a discrepancy which is obviously biased and not corroborated by literature and hence cannot be believed. The media reporting on psychology research is not a scientific document; hence there is less rigor in the presentation, whereas the psychology research on the same topic conceptualizes the basic themes of the disease. Matching up of both these articles would need theory guided investigation of the case in the context of clinical practice of the researchers. It would be very important to know what the disorder that the subject was facing was and on what ground the reality TV intervention could improve her condition The basic differences in these articles are those of audience where lay uncorroborated facts may go as a news, whereas in a scientific article, there is a need to build new knowledge up based on the existing knowledge through a specific methodology and through rational presentation. The only similarity between the two is that they both deal with the topic of functional amnesia where adequate management can lead to positive results. Use of different resources in the journal article sets up the authenticity, reliability, validity, and generalizability of the findings, and the authors have done really an immaculate work in classifying the relevant concepts into different headings. Since there is a paucity of randomized controlled trials which are considered to be the gold standards of research, it was appropriate on the part of the authors to present some cases from their own clinical experiences and other reports, so the reader has no problem exemplifying the concepts elaborated in the conceptual discussion about this disease. As clinicians, it would be very pertinent to discriminate malingering from this functional disorder, and the evidence has been placed in a very rational and argumentative manner so the reader can also question the findings, and all possible questions have been answered. However, due to paucity of literature again although the authors have presented objective imaging data as a means to corroborate this functional problem, they have failed to discuss the concept of gradually diminishing boundaries between functional and organic disorders with the same clinical or symptomatic profile. The authors have also failed to suggest therapeutic advances specifically directed against the etiopathogenesis of this condition. On the contrary, the news report lacks authenticity since any skeptic reader may question whether really this occurred or not. The reader has problem finding all the answers to his questions, and it would have been better if the author would use some theoretical substance as explanation of his findings. In today's world of information boom, it is not intelligent to assume that readers will be lay, and they would not ask questions due to sheer lucidity of the presentation of the news article. At the end many questions remain unanswered, particularly how the relearning process of this accomplished lady became so smooth just by the reality TV program. The basic understanding that she was not able to perform at par was there in her even before joining the TV show, and then the question remains is what was there in the TV show that promoted a sudden change in her leading to accomplishment in the academic field. At the end, there is confusion regarding the aim of this author, whether it was to project the different aspect of functional amnesia in order to raise public awareness or to project the dramatic effect of this reality TV programme to improve the condition of the patients with functional amnesia. On the whole the drama of this incident is clear and explicit due to the lucid style of writing of the author, but that appears irrational and lacks authenticity. Conclusion Psychogenic amnesia is a clinical entity encountered in practice. Retrograde functional amnesia in the absence of brain damage makes it a psychological disease where randomized trials are absent. The only way to regularize findings is through review of literature which through a journal article, the authors have presented. On the other hand, despite drawbacks, the news article presents the hopeful picture of a similar care of functional amnesia where there is no binding on the part of the author to conform to a style and need of scientific writing based on relevant literature. Mixing these two in a layman's language is important so the lay reader may get some reliable knowledge. References Killian, J. (2009, May 15). Amnesia put her life on hold; now, she's graduating. Greensboro News & Record and Landmark Media Enterprises,LLC. Web site: http://www.news-records.com/content/2009/05/15/article/amnesia_put Brandt, J., & Van Gorp, W.G. (2006). Functional ("Psychogenic") Amnesia. Seminars in Neurology, volume 26, issue 3, 331-340. Read More