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aquatico
09-02-2009, 08:25 PM
Does anybody know if there is there any mental illness or other disorder that someone might have which would lead a psychiatrist to suspect that none of their memories are true? If so, what kind of treatment would they suggest to help a patient recover from such a condition? Would psychotherapy be able to convince them that they are wrong or would they be advised to take medication. Is there any drug that might help them recover? Also, what, if anything, might cause someone to suffer from something like this?

Smiling Ted
09-02-2009, 09:04 PM
Yes. In fact, it's common enough to have a psychological term: Confabulation.
Check it out in Wikipedia. (http://en.wikipedia.org/wiki/Confabulation)

Wiskel
09-02-2009, 11:59 PM
The answer depends a bit on whether you're talking about firmly held memories or not.

Supposing I asked your character to tell me their story, then came back tomorrow and asked them for their story again. Would I get the same answer on both days?


If the answer is no, then confabulation is a solid and common answer. Confabulation is something that usually occurs when someone has very significant memory problems, and especially when they have anterograde amnesia....ie they aren't forming new memories. Someone with anterograde amnesia could start watching a film they've never seen before and by the time the film is finished they'll have very little memory of ever watching it. If I ever get this I'm planning on finding one great film and watching it over and over until the end of my days. My future contentment may depend on how good Pirates of the Carribean 30 is.


People usually confabulate when they're confused, or there's a syndrome called Korsakoff's syndrome which is caused by thiamine deficiency. Thiamine deficiency is often linked to alcoholism and this condition can respond to giving someone thiamine. Otherwise you treat the confusion and it might get better.


If your character is going to give me the same false memories no matter how often I ask him, then he's not confused. It's possible for people with a psychotic illness to form delusional memories where they remember something that didn't happen, or commonly then can misinterpret memories and twist them to make them fit their delusions, but this would usually be a corruption of a genuine memory, not a completely false one.

Other psychotic syndromes, such as one that makes you think someone close to you is an imposter, might influence memories....so you may think your Mum is an alien and then twist all of your memories to fit that belief.....within limits. You might remember her taking your temperature as a kid and think she was probing you with some wierd machine, or you might remember her going out and believe she was going to her spaceship, but you won't invent a memory of seeing her spaceship hovering over your house.

If someone has amnesia it would be possible to convince them that something happened that didn't, and with enough persistance you might even make them think they remember it, but it will never be an absolutely clear memory in the way you or I experience them.

If someone has a mood disorder they'll often twist their memories to fit their mood...so remember something that was happy as a sad time, but it won't be a false memory.

If someone was confused and remembers a fragment of the confabulation then they might believe that it actually happened.

It's also possible for someone to want to believe something so much that they manage to convince themselves it's true.


There isn't a clear psychiatric syndrome that strips a person of genuine memories and replaces them with completely false, clear and lasting memories though, at least none I've ever come across.....unless the aliens made me forget it so I couldn't thwart their plans for word domination.

Craig

backslashbaby
09-03-2009, 12:57 AM
Awesome answers, imho.

I'll give a couple of personal anecdotes and let those with higher degrees than mine [;)] tell you if it's relevant. This is not nearly "all their memories" but may be helpful.

A relative who is bipolar - extremely bipolar: She has a huge problem that she doesn't believe. She thinks she mentioned something, and that we answered. It may cause her to wonder why we didn't do X when we said we would. It might just be something she swears she told us and remembers what we said.

I've noticed that what she thinks happened follows how she'd have things happen - that is, I sound more like her than me in 'what I said'. This is probably just delusional [kind of delusional?] because of her manic state, imho.

Me with PTSD years ago: I had conflicting memories; both things couldn't have happened. For about 2 years, I didn't remember the event that caused PTSD, and this is what I got. They weren't clear, and I knew that I didn't remember well. Still, they both seemed entirely as real as each other, when both couldn't be true. That's just the nature of PTSD, as far as I've been told.

aquatico
09-03-2009, 04:04 AM
Awesome answers indeed, and thank you.

It seems the character in question appears to be suffering from the psychiatric syndrome mentioned by Craig in his last sentence, which he has never come across.

In fact all her memories are perfectly accurate and the shrinks who attempt to convince her otherwise have been deliberately deceived by her own relatives to avoid revealing anything that might embarrass her family when she has a nervous breakdown. The story is about her attempts to prove she isn't deluded, which turns out to be impossible, and the effect this has on the rest of her life.

I hope this doesn't sound totally implausible!

Wiskel
09-03-2009, 10:35 AM
Is this woman just seeing a psychiatrist in a routine therapy session or are you implying that her family are trying to have her detained......what's stopping her from politely saying "no thanks, I don't need you" and walking out of the door? My patients do it all the time and unless I can prove they're ill I have to let them.

I'm exaggerating here, but if a calm and rational woman tells me that her mother is a crack using prostitute who beat her as a child and her brother is a serial adulterer and about to have a sex change, but that all she wants to do is cut herself off from her family and carry on going to work then why would a psychiatrist want to detain her?

We'd care if the woman was deeply distressed about being called a liar as the distress might make us think she was ill. We'd care if she told us she was going to expose her family to the world as this might be a risk to others. We'd definately care if she told us she couldn't take it and wanted to die, or that she was going to get revenge on her mother as that is evidence of risk.

You're only going to be made to see a psychiatrist if someone says you're mentally ill....even then you'll only have to see them once for assessment. If they feel you're ok and you don't want to see them again then they can only detain you if there is

1. Evidence of a mental disorder
2. A risk to self or others.

Your family are going to have to lie enough to convince everyone that the woman is totally delusional, or fabricate a risk to self or others as well.....possibly stage a failed suicide attempt or something similar. Most psychiatrists are cynical gits as well (it comes from being told so many untrue things) and if a woman tells them her family are lying and she seems calm, rational and with it, with no other psychotic symptoms at all then they might even be tempted to believe her.

If you have a family going to such great lengths to fabricate illness in your MC then you're into the realms of factitious illness (used to be Munchausen's Syndrome by proxy) and it might be worth reading up on that.

It all depends on whether your story is simply about a woman wanting to demonstrate that she isn't making this up and seeing a psychiatrist because she wants to while going about her day to day life, or whether you've got a more sinister plot about a family trying to have her sectioned to protect their secrets.


Craig

Kenzie
09-03-2009, 01:30 PM
Confabulation is a confabulous word.

DavidZahir
09-03-2009, 09:13 PM
Then again, families can exert emotional pressure for your MC to see a therapist.

Or, she could already be seeing a therapist for a pre-existing condition (bi-polar, post-partum<sp?> depression, etc.). In that case the therapist would probably already know her well. Were the therapist in cahoots with the family, that would work. Or perhaps something has happened to force a temporary or permanent replacement. Then again, maybe this therapist isn't a particularly good one for her--having unresolved issues and/or in love with a pet theory they tend to project onto some patients, etc.

It would be more realistic--and perhaps more compelling for purposes of story--if her memories, while essentially correct, are a tad confused. Perhaps she remembers someone wearing a specific tie that he doesn't in fact own, but had in fact given as an Xmas gift to someone (who wore it once then never again). Or some such. Having a few tiny details "off" puts her reliability into question, while perhaps offering further psychological clues as to the dynamics of what was really going on.

I'll give a purely hypothetical example (and a crude one at that). Mrs. Smith remembers Mr. Smith taking her to a cabin for a weekend. He later denies it, insisting he went hunting with a friend. She particularly remembers him wearing a garish tie that he doesn't own and no one else can remember seeing. Eventually she recalls that tie was something her roommate in college gave her boyfriend, which he hid away not liking it. The reason for the her memory lapse is because she found a receipt in her husband's clothes for lingerie. In fact he is having an affair, but because things were so confused and busy at the time she found the receipt it slipped her mind (partially because she didn't want to deal with it). So her mind tries to remind her about another "unwanted" gift with the tie.

Like I said, crude but something along those lines might work.

aquatico
09-03-2009, 09:41 PM
Hi Craig and thanks for your professional perspective.

The woman in this case, who comes from a privileged background, is admitted informally when she has a breakdown caused by stress and exhaustion, and has no idea that her family have anything to hide or that the psychiatrists don't believe her when she talks about her childhood. She is assumed to be suffering from delusions of grandeur because they don't know that her father, who was a British ambassador, got married again soon after her mother died, or that her stepmother's uncle was a former Prime Minister.

She is sectioned because she refuses to stay voluntarily after she is sexually assaulted by another patient. When she complains about this she is told it is her own fault and her family are informed that she is extremely disturbed. Her stepmother, who doesn't want want the shrinks to know when or why she married the patient's father, tells them her stepdaughter has always been a liar and says there is a history of mental illness in her family. She blames her biological mother, who was an orphan, for neglecting and abusing her when she was little, which isn't true, but the shrinks, who believe her, think it's much more plausible than any other explanation for their poor patient's condition, which they agree is both chronic and congenital.

This is based on a true story, which happened thirty years ago when psychiatrists may not have been as cynical as they are these days, but as far as I know they do still tend to assume that the information provided by their patients' relatives is more reliable than what their patients tell them. In my experience they also believe that the information in a patient's medical records is gospel, which is why it is so difficult for a patient to prove that the information is wrong. The damage and distress caused to the woman in this case was considered to be a symptom of her mental illness until recently. Challenging the opinions of the psychiatrists involved led to additional diagnoses of paranoid, schizotypal and/or borderline personality disorders.

What could, or should, she have done to avoid this?

aquatico
09-03-2009, 10:00 PM
Hi David, sorry I spent so long trying to reply to Craig's post that I didn't see yours until after I uploaded it.

My MC certainly was confused because she couldn't understand what was happening to her or why, but by then she was drugged up to the eyeballs and unable to see properly or speak coherently because of the appalling side effects of a cocktail of anti-psychotics and sedatives she was forced to take, including large doses of largactyl, haloperdol, droperidol, valium, and mogadon, with some lithium thrown in for good measure. In any other context this would probably be considered actual bodily harm. I'm surprised she survived as long as she did!

Wiskel
09-03-2009, 10:49 PM
I'll certainly buy the "30 years ago things were a shambles" argument, and I'm honestly not criticising your story, but for completeness I'll add the safeguards against this happening in red in the body of your text.

Keep in mind that I work in the UK system so US safeguards might not be the same.....and I'm talking about modern safeguards, not those of 30 years ago which were pretty much "whatever doctor says goes"





The woman in this case, who comes from a privileged background, is admitted informally when she has a breakdown caused by stress and exhaustion, and has no idea that her family have anything to hide or that the psychiatrists don't believe her when she talks about her childhood. She is assumed to be suffering from delusions of grandeur because they don't know that her father, who was a British ambassador, got married again soon after her mother died they've met her stepmother...isn't that proof he remarried? , or that her stepmother's uncle was a former Prime Minister Why don't they believe her? She's being admitted voluntarily. She gets to tell her story. Relatives of ambassadors and prime ministers get stressed too.....and if I was being grandiose I'd be a hell of a lot more grandiose than that. I've got my eye on Emperor of the Universe :) .

She is sectioned because she refuses to stay voluntarily after she is sexually assaulted by another patient (Not enough to section her on in the UK. There needs to be evidence of risk to self or others. If she is sectioned, in the UK, next step is to appeal against the section,and she can hire a solicitor to act as her advocate. She can even hire a solicitor if she doesn't want to appeal. The ward cannot deny her any reasonable visitor she wants to see. If she instructs the solicitor to go and get proof that her story is true and she presents it to the appeals tribunal and proves that she's been sexually assaulted on a ward where she was being wrongfully detained because a doctor assumed a true story was grandiose, then you've got a very stupid looking doctor and a big lawsuit.) When she complains about this she is told it is her own fault (a psychiatric ward has no right to stop her phoning the police to report a sexual assault. Happening on a ward doesn't make it less of a crime.) and her family are informed that she is extremely disturbed. Her stepmother, who doesn't want want the shrinks to know when or why she married the patient's father, tells them her stepdaughter has always been a liar and says there is a history of mental illness in her family. She blames her biological mother, who was an orphan, for neglecting and abusing her when she was little, which isn't true, but the shrinks, who believe her, think it's much more plausible than any other explanation for their poor patient's condition, which they agree is both chronic and congenital What makes it chronic?...she'll have been in hospital somewhere between a few weeks and a few months by now with no previous psychiatric history that you've revealed.

This is based on a true story, which happened thirty years ago when psychiatrists may not have been as cynical as they are these days, but as far as I know they do still tend to assume that the information provided by their patients' relatives is more reliable than what their patients tell them. Can be true In my experience they also believe that the information in a patient's medical records is gospel Lazy but also can be true.....but why is the families' story in the notes anyway? The first history taken would be the patient's own words. The family history would only appear after the patient's.' Your MC would have had to have been in a very bad way for the ward to take the history from someone other than her, which is why it is so difficult for a patient to prove that the information is wrong. The damage and distress caused to the woman in this case was considered to be a symptom of her mental illness until recently. Challenging the opinions of the psychiatrists involved led to additional diagnoses of paranoid, schizotypal and/or borderline personality disorders. Certainly plausible 30 years ago...bit less so now.

What could, or should, she have done to avoid this?


You've got a few problems to overcome if you set this in the modern day.

1. Why is something that isn't especially grandiose or unbelievable seen as being grandiose? Pretty easy to prove Dad was an ambassador, and it's not unbelievable that an ambassador might meet and marry a relative of a dignitary.

2.What risk is going to be named as the reason for detaining her?

3. Why isn't she going to appeal and hire herself a solicitor?

4. Why can't any half decent advocate prove her story is true quite easily?


So, some possible solutions.

1. Make it more grandiose. Add in a story about how her father left her some money and her stepmother stole it. Add in some more grandiose details about her father's job, like her being friends with a princess somewhere or other, or add in something more paranoid like how her stepmother has done something awful but the press covered it up because of who her uncle was.

2. Have her attack the patient who assaulted her in a fit of temper, or threaten a staff member for not believeing her. That gives you your possible risk to others.

3. Can't answer this one very easily. I'd be out of there with a big settlement pretty sharpish....if you want to fudge it you could have her medicated heavily enough that she isn't thinking straight, but this then leaves you with other problems.

4. Civilisation isn't on your side here. Information flows too freely in the present day. Maybe you need to set your story back a little in time.


Sorry to be a pedant :( I like the idea.

Craig

aquatico
09-04-2009, 03:19 AM
Hi Craig, thanks for all your suggestions, some of which are fairly close to the truth, about knowing several princesses at school for instance, and about an old scandal involving her stepmother whch was covered up at the time. You are right that it needs to be set back in time when things really were a shambles. She wasn't interviewed when she arrived late one evening and her stepmother talked to the ward staff first. They didn't believe the connection to the former Prime Minister because her stepmother didn't mention it. Nor did she mention her husband was an ambassador and doesn't explain how she met him or when she married him or whose baby she had too soon afterwards. Instead she says that child is his stepson and pretends they didn't get married until after he was born. She also changes a few other details like the countries they lived in and when her stepdaughter was sent to boarding school. The patient is admitted for observation "with no visitors for a week" and no money either so she can't use the payphone. There is no record at all in the medical notes of any personal history being taken from the patient herself although there are a few comments from the ward staff about her conversation being "fatuous". She gets sedated when she gets upset because the staff won't listen to her.

The reason she's sectioned is because she is supposed to be a risk to herself after absconding from the ward after she is raped and is found wandering around in a distressed state. She doesn't know she can appeal because nobody tells her what her rights are. She can't afford a solicitor. Advocates hadn't been invented yet. She doesn't know she's been stitched up by her stepmother either, because she's not allowed to know what she's told them, and has no way of guessing that her childhood has been rewritten. Nobody bothers to check the details with her father or her younger sister.

She does try to sue them, several years later, when she finds out what happened but she can't get legal aid for various technical reasons and still can't afford a solicitor either or a private psychiatrist to get a second opinion. Nobody believes her story anyway, not even her own family, because it sounds so implausible. She tries to write an autobiography but can't find a publisher who is prepared to risk being sued for libel. This Kafkaesque situation makes her feel suicidal.

When she does finally manage to prove that there's nothing wrong with her memory she tries to get the medical records corrected under the new Data Protection Act but discovers that this can't be done. When she complains bitterly about everything to the hospital concerned she is told it is hard to distinguish fact from opinion. When she provides documentary evidence to prove what the facts are it is given to the Trust's solicitors to "determine if it is genuine."

So she threatens to publish the medical records, which give a fascinating insight into the art of psychiatry during the last thirty years, and all the strictly private and confidential correspondence telling her her complaints are unfounded, which are classic examples of the genre.

Which is where I came in, because I thought it would make an interesting novel or even creative non-fiction.

It is encouraging to know you like the idea. I need a pedant with your perspective.

Alex

PS If this had happened in the States she could probably still have sued them for millions of dollars but it is extremely hard to win a case in England against the NHS.

Wiskel
09-04-2009, 09:00 AM
Sadly, it all does hang together if this isn't set in the modern day. Happily, it's easy to see problems if you tried to move the story to the modern day as processes have improved so much. It's also becoming harder to imagine a time before computer networks when verifying information involved either finding someone who had first hand knowledge, or finding the right piece of paper.

Good luck with the story. Feel free to let me know if I can be of any help.


Craig

aquatico
09-04-2009, 06:03 PM
Thanks so much Craig, your insights have been invaluable. It's good to know that it's very unlikely something like that could happen these days. I spent ten years working in the voluntary sector with users of mental health services attempting to improve practices locally and campaigning generally for better conditions on acute wards and so on, which is how I met this unfortunate woman. It's nice to think our efforts weren't totally in vain.

Alex

quickWit
09-04-2009, 06:15 PM
I'd just like to say that false mammories can be a good thing. Srsly.

:D

Carry on.

beqs
09-06-2009, 09:44 PM
Another kind of false memories: Cryptomnesia, or inadvertent plagiarism, is a memory bias (http://en.wikipedia.org/wiki/Memory_bias) whereby a person falsely recalls generating a thought, an idea, a song, or a joke, when the thought was actually generated by someone else.[1] (http://en.wikipedia.org/wiki/Cryptomnesia#cite_note-0) In these cases, the person is not deliberately engaging in plagiarism (http://en.wikipedia.org/wiki/Plagiarism), but is rather experiencing a memory as if it were a new inspiration.

http://en.wikipedia.org/wiki/Cryptomnesia (http://absolutewrite.com/forums/cryptomnesia)

veinglory
09-06-2009, 10:17 PM
I would like to repeat and emphasis the point that having a psychiatric illness, no matter how severe, isn't enough to be involuntarily committed. You have to be at immediate risk of killing or seriously harming yourself or another person. This has been true for some time.

ideagirl
09-07-2009, 10:54 PM
Then again, families can exert emotional pressure for your MC to see a therapist.

Or, she could already be seeing a therapist for a pre-existing condition (bi-polar, post-partum<sp?> depression, etc.). In that case the therapist would probably already know her well. Were the therapist in cahoots with the family, that would work.

It's hard for a family to be in cahoots with a therapist these days, because modern privacy laws and modern ethical standards that therapists (like doctors) are subject to prevent a therapist from doing much talking at all with a patient's family (assuming the patient is in therapy by herself, as opposed to being in family therapy with her family). As late as the seventies it was not difficult for family members to have a person committed, etc., but laws have been passed since then. Even if the family is paying for the therapy, the therapist is still bound by those laws and the ethical standards therapists operate under.

ideagirl
09-07-2009, 10:57 PM
The reason she's sectioned is because she is supposed to be a risk to herself after absconding...


She's "sectioned"? You must be in the UK (or maybe other Commonwealth countries use that term too? In any event, we don't use it in the US).

You'll need to look into UK law and legal history to determine what was the most recent date such a thing could occur.

Keyan
09-09-2009, 01:46 PM
Awesome answers indeed, and thank you.

It seems the character in question appears to be suffering from the psychiatric syndrome mentioned by Craig in his last sentence, which he has never come across.

In fact all her memories are perfectly accurate and the shrinks who attempt to convince her otherwise have been deliberately deceived by her own relatives to avoid revealing anything that might embarrass her family when she has a nervous breakdown. The story is about her attempts to prove she isn't deluded, which turns out to be impossible, and the effect this has on the rest of her life.

I hope this doesn't sound totally implausible!

I don't know if this is any kind of verification, but there was a recent Dear Abby letter from a woman in her 50s. IIRC, the woman's sister accused her father of abusing her; the family was convinced she was delusional, and she was essentially incarcerated in mental institutions from her early teenage years. Then the father died, and the woman writing the letter found, among his effects, Polaroid snaps that made her realize her sister had been right.

Her mother, believing that telling her sister (who was living in sheltered housing) would worsen her condition, destroyed the pictures. The woman wrote asking whether she should talk to her sister about it.

Of course, the fact that it showed up in a column doesn't make it true.

veinglory
09-09-2009, 06:59 PM
In terms of suggesting confabulation of parental sex abuse, this is most likely to occur in psychoanalysis where the "Electra" effect was posited to explain away why so many daughters reported abuse by fathers.

Libbie
09-09-2009, 07:07 PM
A very common cause of false memories/confabulation is hypnotherapy. Yeah, cause. Not treatment. In fact, the link between hypnotherapy/hypnotic regression and false memory is now so clear that memories "retrieved" under hypnotic regression are no longer admissible as evidence in court cases.

aquatico
09-10-2009, 12:39 AM
Sadly I think the case Keyan mentioned is only too plausible. I have heard similar stories from patients who are now in their fifties or older and spent the best part of their lives in institutions, for various reasons, including getting pregnant as teenagers. Unfortunately Freud's theories were (and still are) very influential on psychiatrists in general, so a lot of women who claimed to have been abused were assumed to be confabulating. The idea that someone could forget about being abused didn't become fashionable until later and it wasn't just hypnotherapists who were able to create false memories in their patients. There were a lot of psychotherapists who caused a great deal of damage too, by convincing patients who were vulnerable and suggestible that they had been subjected to appalling abuse when they were little.

Wiskel
09-10-2009, 01:20 PM
Sadly I think the case Keyan mentioned is only too plausible. I have heard similar stories from patients who are now in their fifties or older and spent the best part of their lives in institutions, for various reasons, including getting pregnant as teenagers. Unfortunately Freud's theories were (and still are) very influential on psychiatrists in general, so a lot of women who claimed to have been abused were assumed to be confabulating. The idea that someone could forget about being abused didn't become fashionable until later and it wasn't just hypnotherapists who were able to create false memories in their patients. There were a lot of psychotherapists who caused a great deal of damage too, by convincing patients who were vulnerable and suggestible that they had been subjected to appalling abuse when they were little.

Mental health services now compared to 40-50 years ago are very different beasts. Unfortunately society still likes to label behaviours it doesn't like as mental illness. One big difference is that now doctors raise objections more, decades ago they'd admit people who shouldn't have been anywhere near a psychiatric hospital.

Although the system is better now, society still puts pressure on psychiatry to lock away people with certain sexual behaviours, although which precise behaviours has changed over the decades. It also wants violence to be viewed as mental illness and "dangerous" people to be locked away and treated.

I'm making no comment on any of these behaviours, just commenting that when society has a choice between viewing something as a crime or as a mental illness, it still picks some behaviours, declares them to be symptoms of mental illness and wants to remove the rights of people who fit those patterns.

Decades ago unmarried mothers were on the wrong side of this. Now they're not, but before we get too complacent it's worth me mentioning that a recent update to the english mental health act made it possible for me to section a child on the grounds of behavioural problems.

Society has now decided that there's something wrong with all the unruly and violent kids that makes is appropriate for them to be classified as mentally ill.

It's now possible for a truely bad parent (yes..they do exist) to mess up their child and then try to have them sectioned when they get angry and act out.

Society has made a lot of mistakes in the past. it's still not learnt its lesson.

Craig