Body memory, Cellular memory, False memory, Memory bias, Confabulation, Cryptomnesia, Anosognosia,

Body memory is a hypothesis that the body itself is capable of storing memories, as opposed to only the brain. This is used to explain having memories for events where the brain was not in a position to store memories and is sometimes a catalyst for repressed memory recovery. These memories are often characterised with phantom pain in a part or parts of the body – the body appearing to remember the past trauma. The idea of body memory is a belief frequently associated with the idea of repressed memories, in which memories of incest or sexual abuse can be retained and recovered through physical sensations.^[1] The idea is pseudoscientific as there are no hypothesized means by which tissues other than the brain are capable of storing memories.^[1]^[2] Some evidence suggests that such means be available to simpler forms of life.^[3]

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Cellular memory[edit]

Cellular memory is an additional hypothesis that memories can be stored outside the brain. However, unlike body memory, the cellular memory hypothesis states that these memories are stored in all the cells of human bodies, not in the bodies’ organs.^[4] The idea that non-brain tissues can have memories is also believed by some individuals who have received organ transplants, though this is also considered impossible.^[4]

In the 1950s and 1960s James McConnell conducted experiments on flatworms to measure how long it took them to learn a maze. McConnell trained a group of flatworms to move around a maze and then chopped them into small pieces and fed them to an untrained group of worms. The untrained group learned to complete the maze faster compared to other worms that had not been fed the trained worms. McConnell believed the experiment indicated a form of cellular memory.^[5] It was later shown that the training involved stressing the worms with electric shocks to avoid mistakes in the maze. This kind of stress releases hormones that stay in the body, thus there was no evidence for memory transfer. Similar experiments with mice being trained in a maze and being fed to untrained mice also showed improved learning. It was not a memory that was transferred but a hormonally enriched heart or liver.^[5]

Skepticism[edit]

In 1993, a psychologist Susan E. Smith, in a paper – which was first presented at a false memory syndrome Conference – relating to the idea of "Survivor Psychology", stated that:

"body memories are thought to literally be emotional, kinesthetic, or chemical recordings stored at the cellular level and retrievable by returning to or recreating the chemical, emotional, or kinesthetic conditions under which the memory recordings are filed. She wrote in the abstract of the paper that "one of the most commonly used theories to support the ideology of repressed memories or incest and sexual abuse amnesia is body memories."
^[1]

Smith makes her position clear when she goes on to say:

"The belief in these pseudoscientific concepts appears to be related to scientific illiteracy, gullibility, and a lack of critical thinking skills and reasoning abilities in both the mental health community and in society at large"^[1]

False memory syndrome (FMS) describes a condition in which a person's identity and relationships are affected by memories that are factually incorrect but that they strongly believe.^[1] Peter J. Freydoriginated the term,^[2] which the False Memory Syndrome Foundation (FMSF) subsequently popularized. The term is not recognized as a mental disorder^[3] in any of the medical manuals, such as the ICD-10^[4] or the DSM-5;^[5] however, the principle that memories can be altered by outside influences is overwhelmingly accepted by scientists.^[6]^[7]^[8]^[9]

False memories may be the result of recovered memory therapy, a term also defined by the FMSF in the early 1990s,^[10] which describes a range of therapy methods that are prone to creating confabulations. Some of the influential figures in the genesis of the theory are forensic psychologist Ralph Underwager, psychologist Elizabeth Loftus and sociologist Richard Ofshe.

Definition[edit]

False memory syndrome is a condition in which a person's identity and interpersonal relationships center around a memory of a traumatic experience that is objectively false but that the person stronglybelieves it occurred. Note that the syndrome is not characterized by false memories as such. We all have inaccurate memories. Rather, the syndrome is diagnosed when the memory is so deeply ingrained that it orients the individual's entire personality and lifestyle—disrupting other adaptive behavior. False memory syndrome is destructive because the person assiduously avoids confronting evidence that challenges the memory. Thus it takes on a life of its own; the memory becomes encapsulated and resistant to correction. Subjects may focus so strongly on the memory that it effectively distracts them from coping with real problems in their life.^[11]

The FMS concept is controversial,^[12]^[13] and the Diagnostic and Statistical Manual of Mental Disorders does not include it. Paul R. McHugh, member of the FMSF, stated that the term was not adopted into the fourth version of the manual due to the pertinent committee being headed by believers in recovered memory.^[2]

Recovered memory therapy[edit]

Main article: Recovered memory therapy

Recovered memory therapy is used to describe the therapeutic processes and methods that are believed to create false memories and false memory syndrome. These methods include hypnosis, sedatives and probing questions where the therapist believes repressed memories of traumatic events are the cause of their client's problems.^[14] The term is not listed in DSM-IV or used by any mainstream formal psychotherapy modality.^[10]

Memory consolidation becomes a critical element of false memory and recovered memory syndromes. Once stored in the hippocampus, the memory may last for years or even for life, regardless that the memorized event never actually took place. Obsession to a particular false memory, planted memory, or indoctrinated memory can shape a person's actions or even result in delusional disorder.

Mainstream psychiatric and psychological professional associations now harbor strong skepticism towards the notion of recovered memories of trauma. They argue that self-help books, and recovered memory therapists can influence adults to develop false memories.^{[citation needed]} According to this theory, psychologists and psychiatrists may accidentally implant these false memories.^{[citation needed]} TheAmerican Psychiatric Association and American Medical Association condemn such practices, whether they are formally called "Recovered Memory Therapy" or simply a collection of techniques that fit the description. In 1998, the Royal College of Psychiatrists Working Group on Reported Recovered Memories of Sexual Abuse wrote:^[15]

No evidence exists for the repression and recovery of verified, severely traumatic events, and their role in symptom formation has yet to be proved. There is also striking absence in the literature of well-corroborated cases of such repressed memories recovered through psychotherapy. Given the prevalence of childhood sexual abuse, even if only a small proportion are repressed and only some of them are subsequently recovered, there should be a significant number of corroborated cases. In fact there are none.

^{[citation needed]}

That such techniques have been used in the past is undeniable. Their continued use is cause for malpractice litigation worldwide.^[16] An Australian psychologist was de-registered for engaging in them.^[17]

Evidence for false memories[edit]

Human memory is created and highly suggestible, and can create a wide variety of innocuous, embarrassing, and frightening memories through different techniques—including guided imagery, hypnosis, and suggestion by others. Though not all individuals exposed to these techniques develop memories, experiments suggest a significant number of people do, and will actively defend the existence of the events, even if told they were false and deliberately implanted. Questions about the possibility of false memories created an explosion of interest in suggestibility of human memory and resulted in an enormous increase in the knowledge about how memories are encoded, stored and recalled, producing pioneering experiments such as the lost in the mall technique.^[18] In Roediger and McDermott's (1995) experiment, subjects were presented with a list of related items (such as candy, sugar, honey) to study. When asked to recall the list, participants were just as, if not more, likely to recall semantically related words (such as sweet) than items that were actually studied, thus creating false memories.^[19] This experiment, though widely replicated, remains controversial due to debate considering that people may store semantically related items from a word list conceptually rather than as language, which could account for errors in recollection of words without the creation of false memories. Susan Clancy discovered that people claiming to have been victims of alien abductions are more likely to recall semantically related words than a control group in such an experiment.^[20]

The lost in the mall technique is a research method designed to implant a false memory of being lost in a shopping mall as a child to test whether discussing a false event could produce a "memory" of an event that did not happen. In her initial study, Elizabeth Loftus found that 25% of subjects came to develop a "memory" for the event which had never actually taken place.^[21] Extensions and variations of the lost in the mall technique found that an average of one third of experimental subjects could become convinced that they experienced things in childhood that had never really occurred—even highly traumatic, and impossible events.^[22]

Experimental researchers have demonstrated that memory cells in the hippocampus of mice can be modified to artificially create false memories.^[23]^[24]

Court cases[edit]

Sexual abuse cases[edit]

The question of the accuracy and dependability of a repressed memory that someone has later recalled has contributed to some investigations and court cases, including cases of alleged sexual abuse orchild sexual abuse (CSA).^[25] ^[26] ^[27] while others have been deemed confabulations or "false memories" that were not legally admissible.^{[citation needed]} The research of Elizabeth Loftus has been used to counter claims of recovered memory in court^[21] and it has resulted in stricter requirements for the use of recovered memories being used in trials, as well as a greater requirement for corroborating evidence. In addition, some states no longer allow prosecution based on recovered memory testimony. Insurance companies have become reluctant to insure therapists against malpractice suits relating to recovered memories.^[28]^[29]^[21]

Supporters of recovered memories believe that there is "overwhelming evidence that the mind is capable of repressing traumatic memories of child sexual abuse."^[30] Whitfield states that the "false memory" defense is "seemingly sophisticated, but mostly contrived and often erroneous." He states that this defense has been created by "accused, convicted and self-confessed child molesters and their advocates" to try to "negate their abusive, criminal behavior."^[31] Brown states that when pro-false memory expert witnesses and attorneys state there is no causal connection between CSA and adult psychopathology, that CSA doesn't cause specific trauma-related problems like borderline and dissociative identity disorder, that other variables than CSA can explain the variance of adult psychopathology and that the long-term effects of CSA are non-specific and general, that this testimony is inaccurate and has the potential of misleading juries.^[32]

Malpractice cases[edit]

During the late 1990s, there were multiple lawsuits in the United States in which psychiatrists and psychologists were successfully sued, or settled out of court, on the charge of propagating iatrogenicmemories of childhood sexual abuse, incest and satanic ritual abuse.^[33]

Some of these suits were brought by individuals who later declare that their recovered memories of incest or satanic ritual abuse had been false. The False Memory Syndrome Foundation uses the termretractors to describe these individuals, and have shared their stories publicly.^[34] There is debate regarding the total number of retractions as compared to the total number of allegations,^[10] and the reasons for retractions.^[35]

Characteristic features[edit]

Confabulation is associated with several characteristics:

Typically verbal statements but can also be non-verbal gestures or actions.
Can include autobiographical and non-personal information, such as historical facts, fairytales, or other aspects of semantic memory.
The account can be fantastic or coherent.
Both the premise and the details of the account can be false.
The account is usually drawn from the patient’s memory of actual experiences, including past and current thoughts.
The patient is unaware of the accounts’ distortions or inappropriateness, and is not concerned when errors are pointed out.
There is no hidden motivation behind the account.
The patient’s personality structure may play a role in their readiness to confabulate. ^[2]

Theories[edit]

Theories of confabulation range in emphasis. Some theories propose that confabulations represent a way for memory-disabled individuals to maintain their self-identity.^[7] Other theories use neurocognitive links to explain the process of confabulation.^[10] Still other theories frame confabulation around the more familiar concept of delusion.^[11] Other researchers frame confabulation within the fuzzy-trace theory.^[12]Finally, some researchers call for theories that rely less on neurocognitive explanations and more on epistemic accounts.^[13]

Neuropsychological theories[edit]

The most popular theories of confabulation come from the field of neuropsychology or cognitive neuroscience.^[10] Research suggests that confabulation is associated with dysfunction of cognitive processes that control the retrieval from long-term memory. Frontal lobe damage often disrupts this process, preventing the retrieval of information and the evaluation of its output.^[14]^[15] Furthermore, researchers argue that confabulation is a disorder resulting from failed “reality monitoring/source monitoring” (i.e. deciding whether a memory is based on an actual event or whether it is imagined.^[16] Some neuropsychologists suggest that errors in retrieval of information from long-term memory that are made by normal subjects involve different components of control processes than errors made by confabulators.^[17] Kraepelindistinguished two subtypes of confabulation, one of which he called simple confabulation, caused partly by errors in the temporal ordering of real events. The other variety he called fantastic confabulation, which was bizarre and patently impossible statements not rooted in true memory. Simple confabulation may result from damage to memory systems in the medial temporal lobe. Fantastic confabulations reveal a dysfunction of the Supervisory System,^[18] which is believed to be a function of the frontal cortex.

Self-identity theory[edit]

Some argue confabulations have a self-serving, emotional component in those with memory deficits that aids to maintain a coherent self-concept.^[7] In other words, individuals who confabulate are motivated to do so, because they have gaps in their memory that they want to fill in and cover up.

Temporality theory[edit]

Support for the temporality account suggests that confabulations occur when an individual is unable to place events properly in time.^[7] Thus, an individual might correctly state an action they performed, but say they did it yesterday, when they did it weeks ago. In the Memory, Consciousness, and Temporality Theory, confabulation occurs because of a deficit in temporal consciousness or awareness.^[19]

Monitoring theory[edit]

Along a similar notion are the theories of reality and source monitoring theories.^[8] In these theories, confabulation occurs when individuals incorrectly attribute memories as reality, or incorrectly attribute memories to a certain source. Thus, an individual might claim an imagined event happened in reality, or that their friend told them about an event, they actually heard about on television.

Strategic retrieval account theory[edit]

Supporters of the strategic retrieval account suggest that confabulations occur when an individual cannot actively monitor a memory for truthfulness after its retrieval.^[8] An individual recalls a memory, but there is some deficit after recall that interferes with the person establishing its falseness.

Executive control theory[edit]

Still others propose that all types of false memories, including confabulation, fit into a general memory and executive function model.^[20] In 2007, a framework for confabulation was proposed that stated confabulation is the result of two things: problems with executive control and problems with evaluation. In the executive control deficit, the incorrect memory is retrieved from the brain. In the evaluative deficit, the memory will be accepted as a truth due to an inability to distinguish a belief from an actual memory.^[7]

In the context of delusion theories[edit]

Recent models of confabulation have attempted to build upon the link between delusion and confabulation.^[11] More recently, a monitoring account for delusion, applied to confabulation, proposed both the inclusion of conscious and unconscious processing. The claim was that by encompassing the notion of both processes, spontaneous versus provoked confabulations could be better explained. In other words, there are two ways to confabulate. One is the unconscious, spontaneous way in which a memory goes through no logical, explanatory processing. The other is the conscious, provoked way in which a memory is recalled intentionally by the individual to explain something confusing or unusual.^[21]

Fuzzy-trace theory[edit]

Fuzzy-trace theory, or FTT, is a concept more commonly applied to the explanation of judgment decisions.^[12] According to this theory, memories are encoded generally (gist), as well as specifically (verbatim). Thus, a confabulation could result from recalling the incorrect verbatim memory or from being able to recall the gist portion, but not the verbatim portion, of a memory.

FTT uses a set of five principles to explain false-memory phenomena. Principle 1 suggests that subjects store verbatim information and gist information parallel to one another. Both forms of storage involve the surface content of an experience. Principle 2 shares factors of retrieval of gist and verbatim traces. Principle 3 is based on dual-opponent processes in false memory. Generally, gist retrieval supports false memory, while verbatim retrieval suppresses it. Developmental variability is the topic of Principle 4. As a child develops into an adult, there is obvious improvement in the acquisition, retention, and retrieval of both verbatim and gist memory. However, during late adulthood, there will be a decline in these abilities. Finally, Principle 5 explains that verbatim and gist processing cause vivid remembering. Fuzzy-trace Theory, governed by these 5 principles, has proved useful in explaining false memory and generating new predictions about it.^[22]

Epistemic theory[edit]

However, not all accounts are so embedded in the neurocognitive aspects of confabulation. Some attribute confabulation to epistemic accounts.^[13] In 2009, theories underlying the causation and mechanisms for confabulation were criticized for their focus on neural processes, which are somewhat unclear, as well as their emphasis on the negativity of false remembering. Researchers proposed that an epistemic account of confabulation would be more encompassing of both the advantages and disadvantages of the process.

Presentation[edit]

Associated neurological and psychological conditions[edit]

Confabulations are often symptoms of various syndromes and psychopathologies in the adult population including: Korsakoff's syndrome, Alzheimer’s Disease, Schizophrenia, and traumatic brain injury.

Wernicke–Korsakoff syndrome is a neurological disorder typically characterized by years of chronic alcohol abuse and a nutritional thiamine deficiency.^[23] Confabulation is one salient symptom of this syndrome.^[24]^[25] A study on confabulation in Korsakoff’s patients found that they are subject to provoked confabulation when prompted with questions pertaining to episodic memory, not semantic memory, and when prompted with questions where the appropriate response would be “I don’t know.”^[26] This suggests that confabulation in these patients is “domain-specific.” Korsakoff’s patients who confabulate are more likely than healthy adults to falsely recognize distractor words, suggesting that false recognition is a “confabulatory behavior.”

Alzheimer’s Disease is a condition with both neurological and psychological components. It is a form of dementia associated with severe frontal lobe dysfunction. Confabulation in individuals with Alzheimer’s is often more spontaneous than it is in other conditions, especially in the advanced stages of the disease. Alzheimer’s patients demonstrate comparable abilities to encode information as healthy elderly adults, suggesting that impairments in encoding are not associated with confabulation.^[27] However, as seen in Korsakoff's patients, confabulation in Alzheimer’s patients is higher when prompted with questions investigating episodic memory. Researchers suggest this is due to damage in the posterior cortical regions of the brain, which is a symptom characteristic of Alzheimer’s Disease.

Schizophrenia is a psychological disorder in which confabulation is sometimes observed. Although confabulation is usually coherent in its presentation, confabulations of schizophrenic patients are often delusional^[28] Researchers have noted that these patients tend to make up delusions on the spot which are often fantastic and become increasingly elaborate with questioning.^[29] Unlike patients with Korsakoff's and Alzheimer's, patients with schizophrenia are more likely to confabulate when prompted with questions regarding their semantic memories, as opposed to episodic memory prompting.^[30] In addition, confabulation does not appear to be related to any memory deficit in schizophrenic patients. This is contrary to most forms of confabulation. Also, confabulations made by schizophrenic patients often do not involve the creation of new information, but instead involve an attempt by the patient to reconstruct actual details of a past event.

Traumatic brain injury (TBI) can also result in confabulation. Research has shown that patients with damage to the inferior medial frontal lobe confabulate significantly more than patients with damage to the posterior area and healthy controls.^[31] This suggests that this region is key in producing confabulatory responses, and that memory deficit is important but not necessary in confabulation. Additionally, research suggests that confabulation can be seen in patients with frontal lobe syndrome, which involves an insult to the frontal lobe as a result of disease or traumatic brain injury (TBI).^[32]^[33] Finally, rupture of the anterior or posterior communicating artery, subarachnoid hemorrhage, and encephalitis are also possible causes of confabulation.^[34]^[35]

Location of brain lesions[edit]

Confabulation is believed to be a result of damage to the right frontal lobe of the brain.^[2] In particular, damage can be localized to the ventromedial frontal lobes and other structures fed by the anterior communicating artery (ACoA), including the basal forebrain, septum, fornix, cingulate gyrus, cingulum, anterior hypothalamus, and head of the caudate nucleus.^[36]^[37]

Developmental differences[edit]

While some recent literature has suggested that older adults may be more susceptible than their younger counterparts to have false memories, the majority of research on forced confabulation centers around children.^[38] Children are particularly susceptible to forced confabulations based on their high suggestibility.^[39]^[40] When forced to recall confabulated events, children are less likely to remember that they had previously confabulated these situations, and they are more likely than their adult counterparts to come to remember these confabulations as real events that transpired.^[41] Research suggests that this inability to distinguish between past confabulatory and real events is centered on developmental differences in source monitoring. Due to underdeveloped encoding and critical reasoning skills, children's ability to distinguish real memories from false memories may be impaired. It may also be that younger children lack the meta-memory processes required to remember confabulated versus non-confabulated events.^[42]Children's meta-memory processes may also be influenced by expectancies or biases, in that they believe that highly plausible false scenarios are not confabulated.^[43] However, when knowingly being tested for accuracy, children are more likely to respond, “I don’t know” at a rate comparable to adults for unanswerable questions than they are to confabulate.^[44]^[45] Ultimately, misinformation effects can be minimized by tailoring individual interviews to the specific developmental stage, often based on age, of the participant.^[46]

Provoked versus spontaneous confabulations[edit]

There is evidence to support different cognitive mechanisms for provoked and spontaneous confabulation.^[47] One study suggested that spontaneous confabulation may be a result of an amnesic patient’s inability to distinguish the chronological order of events in his memory. In contrast, provoked confabulation may be a compensatory mechanism, in which the patient tries to make up for his memory deficiency by attempting to demonstrate competency in recollection.

Confidence in false memories[edit]

Confabulation of events or situations may lead to an eventual acceptance of the confabulated information as true.^[48] For instance, people who knowingly lie about a situation may eventually come to believe that their lies are truthful with time.^[49] In an interview setting, people are more likely to confabulate in situations in which they are presented false information by another person, as opposed to when they self-generate these falsehoods.^[50] Further, people are more likely to accept false information as true when they are interviewed at a later time (after the event in question) than those who are interviewed immediately or soon after the event.^[51] Affirmative feedback for confabulated responses is also shown to increase the confabulator’s confidence in their response.^[52] For instance, in culprit identification, if a witness falsely identifies a member of a line-up, he will be more confident in his identification if the interviewer provides affirmative feedback. This effect of confirmatory feedback appears to last over time, as witnesses will even remember the confabulated information months later.^[53]

Among normal subjects[edit]

On rare occasions, confabulation can also be seen in normal subjects.^[17] It is currently unclear how completely healthy individuals produce confabulations. It is possible that these individuals are in the process of developing some type of organic condition that is causing their confabulation symptoms. It is not uncommon, however, for the general population to display some very mild symptoms of provoked confabulations. Subtle distortions and intrusions in memory are commonly produced by normal subjects when they remember something poorly.

Diagnosis and treatment[edit]

Spontaneous confabulations, due to their involuntary nature, cannot be manipulated in a laboratory setting.^[8] However, provoked confabulations can be researched in various theoretical contexts. The mechanisms found to underlie provoked confabulations can be applied to spontaneous confabulation mechanisms. The basic premise of researching confabulation comprises finding errors and distortions in memory tests of an individual.

Deese–Roediger–McDermott lists[edit]

Confabulations can be detected in the context of the Deese–Roediger–McDermott paradigm by using the Deese–Roediger–McDermott lists.^[54] Participants listen to audio recordings of several lists of words centered around a theme, known as the critical word. The participants are later asked to recall the words on their list. If the participant recalls the critical word, which was never explicitly stated in the list, it is considered a confabulation. Participants often have a false memory for the critical word.

Recognition tasks[edit]

Confabulations can also be researched by using continuous recognition tasks.^[8] These tasks are often used in conjunction with confidence ratings. Generally, in a recognition task, participants are rapidly presented with pictures. Some of these pictures are shown once; others are shown multiple times. Participants press a key if they have seen the picture previously. Following a period of time, participants repeat the task. More errors on the second task, versus the first, are indicative of confusion, representing false memories.

Free recall tasks[edit]

Confabulations can also be detected using a free recall task, such as a self-narrative task.^[8] Participants are asked to recall stories (semantic or autobiographical) that are highly familiar to them. The stories recalled are encoded for errors that could be classified as distortions in memory. Distortions could include falsifying true story elements or including details from a completely different story. Errors such as these would be indicative of confabulations.

Treatment[edit]

Treatment for confabulation is somewhat dependent on the cause or source, if identifiable. For example, treatment of Wernicke–Korsakoff syndrome involves large doses of vitamin B in order to reverse the thiamine deficiency.^[55] If there is no known physiological cause, more general cognitive techniques may be used to treat confabulation. In a recent case study, Self-Monitoring Training (SMT)^[56] was shown to reduce delusional confabulations. Furthermore, improvements were maintained at a three-month follow-up and were found to generalize to everyday settings. Although this treatment seems promising, more rigorous research is necessary to determine its efficacy in the general confabulation population.

Research[edit]

Although significant gains have been made in the understanding of confabulation within recent years, there is still much to be learned. One group of researchers in particular has laid out several important questions for future study. They suggest that more information is necessary regarding the neural systems that support the different cognitive processes needed for normal source monitoring. They also proposed the idea of developing a standard neuropsychological test battery that is able to discriminate between the different types of confabulations. Furthermore, there is a considerable amount of debate regarding the best way to organize and combine neuroimaging, pharmacological, and cognitive/behavioral approaches to understand confabulation.^[57]

In a recent review article, another group of researchers contemplate issues concerning the distinctions between delusions and confabulation. They question whether delusions and confabulation should be considered distinct or overlapping disorders and, if overlapping, to what degree? They also discuss the role of unconscious processes in confabulation. Some researchers suggest that unconscious emotional and motivational processes are potentially just as important as cognitive and memory problems. Finally, they raise the question of where to draw the line between the pathological and the nonpathological. Delusion-like beliefs and confabulation-like fabrications are commonly seen in healthy individuals. What are the important differences between patients with similar etiology who do and do not confabulate? Since the line between pathological and nonpathological is likely blurry, should we take a more dimensional approach to confabulation? Research suggests that confabulation occurs along a continuum of implausibility, bizarreness, content, conviction, preoccupation, and distress, and impact on daily life.^[58]

Early use[edit]

The word was first used by the psychiatrist Théodore Flournoy,^[2] in reference to the case of medium Hélène Smith (Catherine-Élise Müller) to suggest the high incidence in psychism of "latent memories on the part of the medium that come out, sometimes greatly disfigured by a subliminal work of imagination or reasoning, as so often happens in our ordinary dreams."

Carl Gustav Jung treated the subject in his thesis On the Psychology and Pathology of So-Called Occult Phenomena (1902) ^[3] and in an article, Cryptomnesia (1905),^[4] suggested the phenomenon inNietzsche's Also Sprach Zarathustra. The idea was studied or mentioned by Géza Dukes, Sándor Ferenczi and Wilhelm Stekel as well as by Sigmund Freud in speaking of the originality of his inventions.^[5]

Experimental research[edit]

In the first empirical study of cryptomnesia, people in a group took turns generating category examples (e.g., kinds of birds: parrot, canary, etc.). They were later asked to create new exemplars in the same categories that were not previously produced, and also to recall which words they had personally generated. People inadvertently plagiarized about 3–9% of the time either by regenerating another person's thought or falsely recalling someone's thought as their own.^[6] Similar effects have been replicated using other tasks such as word search puzzles^[7]^[8] and in brainstorming sessions.^[9]

Research has distinguished between two kinds of cryptomnesia, though they are often studied together. The distinction between these two types of plagiarism is in the underlying memory bias responsible—specifically, is it the thought that is forgotten, or the thinker? The first type of bias is one of familiarity. The plagiarizer regenerates an idea that was presented earlier, but believes the idea to be an original creation. The idea that is reproduced could be another's idea, or one's own from a previous time. B. F. Skinner describes his own experience of self-plagiarism:

"One of the most disheartening experiences of old age is discovering that a point you just made—so significant, so beautifully expressed—was made by you in something you published long ago."^[10]

The second type of cryptomnesia results from an error of authorship whereby the ideas of others are remembered as one's own. In this case, the plagiarizer correctly recognizes that the idea is from an earlier time, but falsely remembers having been the origin for the idea (or, having lost the specific memory of encountering it in print or conversation, assumes that it "came to" the plagiarizer as an original idea). Various terms have been coined to distinguish these two forms of plagiarism — occurrence forgetting vs. source forgetting and generation errors vs. recognition errors. The two types of cryptomnesia appear to be independent: no relationship has been found between error rates^[11] and the two types are precipitated by different causes.^[12]

Causes[edit]

Cryptomnesia is more likely to occur when the ability to properly monitor sources is impaired. For example, people are more likely to falsely claim ideas as their own when they were under high cognitive load at the time they first considered the idea.^[13] Plagiarism increases when people are away from the original source of the idea, and decreases when participants are specifically instructed to pay attention to the origin of their ideas. False claims are also more prevalent for ideas originally suggested by persons of the same sex, presumably because the perceptual similarity of the self to a same-sex person exacerbates source confusion. In other studies it has been found that the timing of the idea is also important: if another person produces an idea immediately before the self produces an idea, the other's idea is more likely to be claimed as one's own, ostensibly because the person is too busy preparing for their own turn to properly monitor source information.

Value[edit]

As explained by Carl Jung,^[14] in Man and His Symbols, "An author may be writing steadily to a preconceived plan, working out an argument or developing the line of a story, when he suddenly runs off at a tangent. Perhaps a fresh idea has occurred to him, or a different image, or a whole new sub-plot. If you ask him what prompted the digression, he will not be able to tell you. He may not even have noticed the change, though he has now produced material that is entirely fresh and apparently unknown to him before. Yet it can sometimes be shown convincingly that what he has written bears a striking similarity to the work of another author — a work that he believes he has never seen."

"The ability to reach a rich vein of such material [of the unconscious] and to translate it effectively into philosophy, literature, music or scientific discovery is one of the hallmarks of what is commonly called genius." — Carl Jung, Man and His Symbols.

"We can find clear proof of this fact in the history of science itself. For example, the French mathematician Poincaré and the chemist Kekulé owed important scientific discoveries (as they themselves admit) to sudden pictorial 'revelations' from the unconscious. The so-called 'mystical' experience of the French philosopher Descartes involved a similar sudden revelation in which he saw in a flash the 'order of all sciences.' The British author Robert Louis Stevenson had spent years looking for a story that would fit his 'strong sense of man's double being,' when the plot of Dr. Jekyll and Mr. Hyde was suddenly revealed to him in a dream." — Carl Jung Man and His Symbols

Jorge Luis Borges's story, "Pierre Menard, Author of the Quixote," is a meta-fictive enactment of cryptomnesia. This work is written in the form of a review or literary critical piece about (the non-existent) Pierre Menard. It begins with a brief introduction and a listing of all of Menard's work:

Borges's "review" describes this 20th-century French writer (Menard) who has made an effort to go further than mere "translation" of Don Quixote, but to immerse himself so thoroughly as to be able to actually "re-create" it, line for line, in the original 16th century Spanish. Thus, Pierre Menard is often used to raise questions and discussion about the nature of accurate translation. Or, in this case, the hermeneuticsof cryptomnesia.

Cases[edit]

Nietzsche[edit]

Jung gives the following example in Man and His Symbols.^[15] Friedrich Nietzsche's book Thus Spoke Zarathustra includes an almost word for word account of an incident also included in a book published about 1835, half a century before Nietzsche wrote. This is considered to be neither purposeful plagiarism nor pure coincidence: Nietzsche's sister confirmed that he had indeed read the original account when he was 11 years old; and Nietzsche's youthful intellectual prowess, his later cognitive degeneration due to neurosyphilis, and his accompanying psychological deterioration (specifically, his increasinggrandiosity as manifested in his later behavior and writings) together strengthen the likelihood that he happened to commit the passage to memory upon initially reading it and later, after having lost his memory of encountering it, assumed that his own mind had created it.^[16]

Byron[edit]

In some cases, the line between cryptomnesia and zeitgeist may be somewhat hazy. Readers of Lord Byron's closet drama Manfred noted a strong resemblance to Goethe's Faust. In a review published in 1820, Goethe wrote, "Byron's tragedy, Manfred, was to me a wonderful phenomenon, and one that closely touched me. This singular intellectual poet has taken my Faustus to himself, and extracted from it the strangest nourishment for his hypochondriac humour. He has made use of the impelling principles in his own way, for his own purposes, so that no one of them remains the same; and it is particularly on this account that I cannot enough admire his genius."^[17] Byron was apparently thankful for the compliment; however, he claimed that he had never read Faustus.

Keller[edit]

Helen Keller compromised her and her teacher's^{[citation needed]} credibility with an incident of cryptomnesia which was misapprehended as plagiarism. The Frost King, which Keller wrote out of buried memories of a fairytale read to her four years previously, left Keller a nervous wreck, and unable to write fiction for the rest of her life.^[18]

Stevenson[edit]

Robert Louis Stevenson refers to an incident of cryptomnesia that took place during the writing of Treasure Island, and that he discovered to his embarrassment several years afterward:

...I am now upon a painful chapter. No doubt the parrot once belonged to Robinson Crusoe. No doubt the skeleton is conveyed from Poe. I think little of these, they are trifles and details; and no man can hope to have a monopoly of skeletons or make a corner in talking birds. The stockade, I am told, is from Masterman Ready. It may be, I care not a jot. These useful writers had fulfilled the poet's saying: departing, they had left behind them Footprints on the sands of time, Footprints which perhaps another — and I was the other! It is my debt to Washington Irving that exercises my conscience, and justly so, for I believe plagiarism was rarely carried farther. I chanced to pick up the Tales of a Traveller some years ago with a view to an anthology of prose narrative, and the book flew up and struck me: Billy Bones, his chest, the company in the parlour, the whole inner spirit, and a good deal of the material detail of my first chapters — all were there, all were the property of Washington Irving. But I had no guess of it then as I sat writing by the fireside, in what seemed the spring-tides of a somewhat pedestrian inspiration; nor yet day by day, after lunch, as I read aloud my morning's work to the family. It seemed to me original as sin; it seemed to belong to me like my right eye...^[19]

Harrison[edit]

The precedent in United States copyright law, since 1976, has been to treat alleged cryptomnesia no differently from deliberate plagiarism. The seminal case is Bright Tunes Music v. Harrisongs Music,^[20]where the publisher of "He's So Fine," written and composed by Ronald Mack, demonstrated to the court that George Harrison borrowed substantial portions of his song "My Sweet Lord" from "He's So Fine." The Court imposed damages despite a claim that the copying was subconscious. The ruling was upheld by the Second Circuit in ABKCO Music v. Harrisongs Music,^[21] and the case Three Boys Music v. Michael Bolton,^[22] upheld by the Ninth Circuit, affirmed the principle. (Losing his case embittered Harrison enough to write, compose, and perform "This Song," whose lyrics include the harsh line, "(It) don't infringe on anyone's copyright.")^{[citation needed]}

Eco[edit]

In Interpretation and Overinterpretation, Umberto Eco describes the rediscovery of an antique book among his large collection, which was eerily similar to the pivotal object in his novel The Name of the Rose.

I had bought that book in my youth, skimmed through it, realized that it was exceptionally soiled, and put it somewhere and forgot it. But by a sort of internal camera I had photographed those pages, and for decades the image of those poisonous leaves lay in the most remote part of my soul, as in a grave, until the moment it emerged again (I do not know for what reason) and I believed I had invented it.^[23]

Causes[edit]

Relatively little has been discovered about the cause of the condition since its initial identification. Recent studies from the empirical data are prone to consider anosognosia a multi-componential syndrome or multi-faceted phenomenon. That is it can be manifested by failure to be aware of a number of specific deficits, including motor (hemiplegia), sensory (hemianaesthesia, hemianopia), spatial (unilateral neglect), memory (dementia), and language (receptive aphasia) due to impairment of anatomo-functionally discrete monitoring systems.^[2]^[3] Anosognosia is relatively common following different etiologies of brain injury, such as stroke and traumatic brain injury (e.g. 10%–18% in the case of anosognosia for hemiparesis with onset of acute stroke^[7]), but can appear to occur in conjunction with virtually any neurological impairment. It is more frequent in the acute than in the chronic phase and more prominent for assessment in the cases with right hemispheric lesions than with the left kinds.^[8] However, it is not related to global mental confusion, cognitive flexibility, other major intellectual disturbance, or mere sensory/perceptual deficits. Anosognosia can be selective in that an affected person with multiple impairments may seem unaware of only one handicap, while appearing to be fully aware of any others.^[9] For example, anosognosia for hemiplegia may occur with intact awareness of visuo-spatial unilateral neglect, or vice versa. This phenomenon of double dissociation can be an indicator of domain-specific disorders of awareness modules, meaning that brain damage can selectively impact the self-monitoring process of one specific physical or cognitive function.^[2]^[3]^[10]

The condition does not seem to be directly related to sensory loss and is thought to be caused by damage to higher level neurocognitive processes that are involved in integrating sensory information with processes that support spatial or bodily representations (including the somatosensory system). Anosognosia is thought to be related to unilateral neglect, a condition often found after damage to the non-dominant (usually the right^[11]) hemisphere of the cerebral cortex in which sufferers seem unable to attend to, or sometimes comprehend, anything on a certain side of their body^[12] (usually the left). There are also studies showing that the maneuver of vestibular stimulation could temporarily improve both the syndrome of spatial unilateral neglect and of anosognosia for left hemiplegia. Combining the findings of hemispheric asymmetry to the right, association to spatial unilateral neglect, and the temporal improvement on both syndromes, it is suggested there can be a spatial component underlying the mechanism of anosognosia for motor weakness and their neural processes could be modulated similarly.^[3] There were some cases of anosognosia for right hemiplegia after left hemisphere damage, but the frequency of this type of anosognosia has not been estimated.^[2]

Those diagnosed with dementia of the Alzheimer's type, often display this lack of awareness and insist that nothing is wrong with them.

Anosognosia may occur as part of receptive aphasia, a language disorder that causes poor comprehension of speech and the production of fluent but incomprehensible sentences. A patient with receptive aphasia cannot correct his own phonetic errors and shows "anger and disappointment with the person with whom s/he is speaking because that person fails to understand her/him." This may be a result of brain damage to the posterior portion of the superior temporal gyrus, believed to contain representations of word sounds. With those representations significantly distorted, patients with receptive aphasia are unable to monitor their mistakes.^[1] Other patients with receptive aphasia are fully aware of their condition and speech inhibitions, but cannot monitor their condition, which is not the same as anosognosia and therefore cannot explain the occurrence of neologistic jargon.^[13]

Assessment[edit]

Clinically, anosognosia is often assessed by giving patients an anosognosia questionnaire in order to assess their metacognitive knowledge of deficits. However, neither the existing questionnaires applied in the clinics are designed thoroughly for evaluating the multidimensional nature of this clinical phenomenon; nor are the responses obtained via offline questionnaire capable of revealing the discrepancy of awareness observed from their online task performance.^[8]^[14] The discrepancy is noticed when patients showed no awareness of their deficits from the offline responses to the questionnaire but demonstrated reluctance or verbal circumlocution when asked to perform an online task. For example, patients with anosognosia for hemiplegia may find excuses not to perform a bimanual task even though they do not admit it is because of their paralyzed arms.^[14] Similar situation can happen on patients with anosognosia for cognitive deficits after traumatic brain injury when monitoring their errors during the tasks regarding their memory and attention (online emergent awareness) and when predicting their performance right before the same tasks (online anticipatory awareness).^[15] It can also occur among patients with dementia and anosognosia for memory deficit when prompted with dementia-related words, showing possible pre-attentive processing and implicit knowledge of their memory problems.^[16] More interestingly, patients with anosognosia may overestimate their performance when asked in first-person formed questions but not from a third-person perspective when the questions referring to others.^[2]^[4]^[14]

When assessing the causes of anosognosia within stroke patients, CT scans have been used to assess where the greatest amount of damage is found within the various areas of the brain. Stroke patients with mild and severe levels of anosognosia (determined by response to an anosognosia questionnaire) have been linked to lesions within the temporoparietal and thalamic regions, when compared to those who experience moderate anosognosia, or none at all.^[17] In contrast, after suffering a stroke, people who have moderate anosognosia have a higher frequency of lesions involving the basal ganglia, compared to those with mild or severe anosognosia.^[17]

Psychiatry[edit]

Although largely used to describe unawareness of impairment after brain injury or stroke, the term 'anosognosia' is occasionally used to describe the lack of insight shown by some people who suffer from a mental illness such as bipolar disorder or psychosis. They do not have the insight to recognize that they suffer from a mental illness. There is evidence that schizophrenic anosognosia may be the result of frontal lobe damage.^[18]

Treatment[edit]

In regard to anosognosia for neurological patients, no long-term treatments exist. As with unilateral neglect, caloric reflex testing (squirting ice cold water into the left ear) is known to temporarily ameliorate unawareness of impairment. It is not entirely clear how this works, although it is thought that the unconscious shift of attention or focus caused by the intense stimulation of the vestibular system temporarily influences awareness. Most cases of anosognosia appear to simply disappear over time, while other cases can last indefinitely. Normally, long-term cases are treated with cognitive therapy to train the patient to adjust for their inoperable limbs (though it is believed that these patients still are not "aware" of their disability). Another commonly used method is the use of feedback – comparing clients' self-predicted performance with their actual performance on a task in an attempt to improve insight.

Neurorehabilitation is difficult because, as anosognosia impairs the patient's desire to seek medical aid, it may also impair their ability to seek rehabilitation.^[19] A lack of awareness of the deficit makes cooperative, mindful work with a therapist difficult. In the acute phase, very little can be done to improve their awareness, but during this time, it is important for the therapist to build a therapeutic alliance with patients by entering their phenomenological field and reducing their frustration and confusion. Since severity changes over time, no single method of treatment or rehabilitation has emerged or will likely emerge.^[20]

In regard to psychiatric patients, empirical studies verify that, for individuals with severe mental illnesses, lack of awareness of illness is significantly associated with both medication non-compliance and re-hospitalization.^[21] Fifteen percent of individuals with severe mental illnesses who refuse to take medication voluntarily under any circumstances may require some form of coercion to remain compliant because of anosognosia.^[22]

One study of voluntary and involuntary inpatients confirmed that committed patients require coercive treatment because they fail to recognize their need for care.^[23] The patients committed to the hospital had significantly lower measures of insight than the voluntary patients.

Anosognosia is also closely related to other cognitive dysfunctions that may impair the capacity of an individual to continuously participate in treatment.^[23] Other research has suggested that attitudes toward treatment can improve after involuntary treatment and that previously committed patients tend later to seek voluntary treatment.^[24]

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