Peas, please: a case report and neuroscientific review of dissociative amnesia and fugue.
Dissociative amnesia that encompasses one's entire life and identity is a rare disorder, as is dissociative fugue. In evaluating such cases, a dichotomy is often invoked between functional and organic etiologies. However, this dichotomy suffers from both conceptual and ethical flaws. Conceptually, putative brain-based, organic etiologies for many dissociative disorders-including dissociative amnesia-exist. Ethically, such dichotomies may result in dismissive care for patients with distress-based disorders like dissociative amnesia. In support of humane, neurobiologically informed treatment of patients with dissociative amnesia, we present excerpts from 2 post-event interviews with a patient who suffered and recovered from an episode of dissociative amnesia and fugue. Following this, we review current neurobiological models of dissociative amnesia that undermine the dichotomy of functional versus organic, and suggest that the crucial distinction in such cases is between a patient's willful, conscious deceit and processes that occur without conscious intent.
MacDonald
Kai
K
Department of Psychiatry, University of California, San Diego, San Diego, California 92103, USA. ksmacdonald@ucsd.edu
MacDonald
Tina
T
D000328:Adult; D000647:Amnesia / Q000145:classification / Q000209:etiology / Q000523:psychology* / Q000628:therapy; D004213:Dissociative Disorders / Q000209:etiology / Q000523:psychology* / Q000628:therapy; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D011379:Prognosis; D011574:Psychoanalytic Theory; D012307:Risk Factors; D014754:Violence / Q000523:psychology