Abstract
Psychiatric practice has an intimate relationship with memory. Memories are the currency of our emotional experience, and many aspects of mental illness can be framed in terms of how well memory is functioning. Flashbacks relating to past trauma, exaggerated behavioural responses in anxiety disorder, and depressive ruminations on the past, are familiar ‘positive symptoms’ of memory disorder which may be characterised in terms of failure to regulate memory function; the forgetfulness in depression and schizophrenia, and frank amnesia in severe dissociation are ‘negative symptoms’ – a paucity of memory. Memory dysfunction takes centre stage in what are typically thought of as neuropsychiatric conditions such as temporal lobe epilepsy, Korsakoff's syndrome, delusional paramnesias such as Capgras syndrome, and in Alzheimer's disease. Given memory is such a central concept in psychiatry, it is surprising that there has not been a book devoted to memory disorders in psychiaric practice until now.
Berrios and Hodges’ edited volume fills the gap perfectly. This scholarly work covers the role of memory in defining and disrupting our mental state with impressive depth and clinical insight. It enlightens us about the importance of the memory complaint in clinical practice, and brings memory disorder out of the neurology/ geriatric clinic and into mainstream psychiatry. The contributors are eminent in the main, and provide what I perceive to be a predominantly European angle on the topic. Part I of the book begins by setting a historical context – Berrios is a celebrated medical historian as well as a neuropsychiatrist – covering the views of ancient philosophers through to 19th and 20th century psychological measurements of memory performance. A general chapter on mood and memory, followed by a treatment of metamemory (how we use our memory and perceive how well it is functioning), cover broad aspects which relate to everyday scenarios encountered by mental health practitioners. Two following chapters cover neurocognitive aspects of memory: Neuropsychology is given a fine treatment, with admirable canvassing of contemporary cognitive models of memory; the psychopharmacology of memory is outlined in terms of the major neurotransmitter systems.
Part II comprises a series of chapters which provide up-to-date accounts of memory failure (and other features) in common neuropsychiatric conditions. A multidisciplinary approach to the assessment of memory and its interaction with mental state is described, using the authors’ memory clinic at Cambridge as a model. The dementias are covered in depth, with rich detail provided on distinguishing features (cognitive and otherwise) which allow their differential diagnosis to be made – a great resource chapter. A chapter devoted to amnesic syndromes echoes material from the earlier neuropsychology chapter, but the points bear reinforcing. Transient global amnesia and the newly recognised transient epileptic amnesia deserve their own chapter, as does depressive pseudodementia; memory in the functional psychoses covers depression again, as well as bipolar illness and schizophrenia. Part II closes with a useful treatment of practical issues in managing memory disorder – essential reading for psychiatric case managers and other players in multidisciplinary treatment teams.
Part III is where the book really stretches its legs – paramnesias and delusional states, deja vu and the (seldom seen) jamais vu, confabulations, flashbulb and flashback memories, hypochondriasis, and dissociation blend together cognitive, neurological, and psychoanalytic thinking in rich doses. The closing chapters on recovered and false memories, and malingering and feigning of memory disorder, segue nicely to the sobering final chapter on legal aspects of memory disorders (which attempts to achieve multinational relevance).
There are not many flaws with this book. The few instances of redundancy in coverage of topics across different chapters are not serious flaws; triangulation of the topic is achieved, and memory for the material is better consolidated! I would have liked the chapter headings to have dropped the terms ‘functional psychoses’ and ‘pseudodementia’, to be consistent with contemporary views about the neurobiological nature of psychosis, and the bona fide cognitive changes in depression; indeed, the authors of the respective chapters make these points themselves. But that's just being picky.
The book has a wide potential readership: The historical chapter and the coverage of uncommon and fascinating conditions in Part III will intrigue all kinds of mental health professionals as well as lay readers. The introduction to the neuropsychology and psychopharmacology of memory will be useful for those who interact with neuropsychologists, and the practical pieces on memory clinics and management of memory problems will be of general interest, but particularly relevant to neuropsychologists and clinical psychologists.