ACADEMY PUBLIC POLICIES

Many patients cannot consciously remember the trauma(s) that they have suffered. This disconnection between events and memory can apply to an overwhelming trauma experienced in childhood that they could reconstruct only by hearing from their family details of the story that they had consciously forgotten.

It might also lead to repression and an inability to remember the regular kind of abuse and/or neglect that they experienced. Clinically, it often seems that one’s anxiety serves as a kind of memory of something experienced earlier in life that was overwhelming.

Many patients will explain that just as they feel things are going well and turning their way, they experience a panic attack or heightened sense of anxiety.

This response appears to be the body’s way of remembering that just as things were feeling good-or he or she was feeling really excited-something perceived as bad actually did happen. Freud referred to this phenomenon when he said that hysterics (patients with physical symptoms stemming from anxiety) suffer primarily from reminiscences. In his paper Repeating, Remembering, and Working Through, he suggested that we repeat patterns over and again as ways of remembering what happened to us earlier.

These ideas harmonize with what we know from modern neuroscience and the work on procedural memory, or memory for common actions that no longer need a conscious thought to correlate with their action.

This principle would explain the onset of certain medical symptoms around the onset of an important anniversary reaction. An apocryphal story from Anna Freud comes to mind. When Ms. Freud ran nurseries in London for displaced children of World War II, a counselor in the nursery worked for three years regularly with a particular little girl, feeding her donuts on Fridays.

Several years later, this counselor went to check on her whereabouts. She easily remembered the child and wondered how she was doing and if she remembered her. The girl said that she seemed to remember once getting a donut from her.

This story is important because it shows that our conscious memory serves as a screen for many ins and outs of day-to-day life history. Similarly, working closely with the nature of someone’s anxiety symptoms can lead to important memories of childhood, which in turn can lead to a relief of symptoms.

In moments of extreme anxiety, total or partial amnesia of the trauma can occur. It seems that either neurologically and psychologically, locking these memories away, or keeping them from ever being stored, serves to protect us from reexperiencing an overwhelming kind of activity.

The concern is that when a medical chart indicates that an individual has had a psychiatric history, including hospitalizations, a genuine physical complaint may be seen as a reflection of that history. Health wise, this can be just as dangerous as overlooking the possible psychiatric component.

This is not just theoretical! As a peer advocate-a person with a diagnosis of mental illness working with others in the mental health system-I’ve heard a number of complaints about just such a thing happening, with the result being a delay in those individuals’ receiving the proper medical attention, or actually finding themselves on a psychiatric unit when their acute symptoms were actually medical.

It is a definite issue, and it’s why many men and women who pursue help for a mental or emotional disorder are concerned about being labeled because of their illness. Labeling-it’s fine for Campbell’s Cream of Mushroom soup, but not for us.