Flashbulb memories and other repetitive images: A psychiatric perspective

Flashbulb Memories and Other Repetitive Images: A Psychiatric Perspective

Mauricio Sierra and German E. Berrios

The term "flashbulb memory" was used by Brown and Kulik in 1977 to refer to the vivid recollections that humans may have of events considered to be of particular significance to the individual or group. These memories are described as having a photographic quality and as being accompanied by a detail-perfect apparel of contextual information (weather, background music, clothes worn, etc.) pertaining to the t ime and place where the event was first known. They may even evoke emotions similar to the ones felt upon hearing the news. It has been suggested that flashbulb memories are formed by the activity of an ancient brain mechanism evolved to capture emo- t ional and cognitive information relevant to the sur- vival of the individual or group. Some of the original assumptions made by Brown and Kulik have since been challenged, but the phenomenon in question remains an important area of research. However, the latter is often marred by the fact that flashbulb memories are studied as if they were unique psychological events wi thout parallel in clinical practice. Psychia-

trists, however, should consider flashbulb memories as being members of a broad family of experiences that include drug flashbacks, palinopsia, palinacusis, posttraumatic memories, and the vivid and haunting memories experienced by subjects wi th some forms of mental disorder (e.g., phobias, panic attacks, obsessional disorder, phantom-l imb phenomena, and depressive melancholia}. All of these experiences share clinical features such as paroxysmal repetit ion, sensory vividness, a capacity to tr igger emotions, dyspho- ria, and a tendency for the rememberer to shift from the role of actor to that of observer and for the reminiscence to become organized in a stereotyped narrative. Some of these clinical phenomena are discussed, and the suggestion is made that seeking phenomenological and neurobiological common de- nominators to all of these experiences may be a superior research strategy versus studying flashbulb memories alone. Copyright © 1999 by W.B, Saunders Company

I T IS AN OLD observation i that life events with particular emotional or cognitive relevance

leave behind "images" or "memories" that may include vivid background detail (normally not remembered) such as the color of clothes wom at the time, weather conditions, background music, etc. On account of being like a photograph, such recollections have been called "flashbulb" memo- ties.1 This metaphor has helped neither their description nor their understanding, ii Equally unhelpful has been the fact that the original research per- tained to parochial events, which may have introduced into the structure of flashbulb memories a social confound, iii

It is suggested in this review that for psychiatry, "vivid personal memories" should be studied against the wider canvas of other repetitive phenomena involving images or cognitions such as drug flashbacks, palinopsia, palinacusis, musical hallucinations, posttraumatic memories, and the vivid and haunting memories experienced by subjects with some mental disorders (e.g., phobias, panic attacks, obsessional disorder, phantom-limb phenomena, and depressive melancholia). The reason for this is twofold: firstly, there is little evidence that flashbulb memories are a special phenomenon; and secondly, it is more parsimonious (and in keeping with empirical findings) to consider that, like all

other mnestic acts, flashbulb memories are also governed by the rules of narrative. The latter is particularly important, for the very term flashbulb memories (and the fact that some have been reported as detail-perfect sensory images iv) may have caused the misleading impression that they (1) may be impervious to the influence of narrative templates, v and (2) constitute clinical evidence against a "reconstructivist" view of memory, vi

FLASHBULB MEMORIES

Brown and Kulik and Others

The boundaries of a clinical phenomenon are often constrained by its original description, and much of what is currently discussed about flashbulb memories remains determined by the definition of Brown and Kulik. 1 According to these authors, to create a flashbulb memory, an event must be "surprising" and "consequential." To test their view, they chose nine such events: the murders of Medgar Evers, John F. Kennedy, Malcolm X,

From the Department of Psychiatry, University of Cam- bridge, Addenbrooke's Hospital, Cambridge, UK.

Address reprint requests to German E. Berrios, M.D., Depart- ment of Psychiatry, University of Cambridge, Addenbrooke's Hospital (Box 189), Hills Road, Cambridge, UK, CB2 2QQ.

Copyright © 1999 by W.B. Saunders Company 0010-440X/99/4002-0011 $10. 00/0

Comprehensive Psychiatry, Vol. 40, No. 2 (March/April), 1999: pp 115-125 115

116 SIERRA AND BERRIOS

Martin Luther King, and Robert Kennedy, the attempted assassinations of George Wallace and Gerald Ford, the drowning of a woman in which Ted Kennedy was allegedly involved, and the death of Francisco Franco. A tenth (control) event con- cerned a "private shock." Information from 40 blacks and 40 whites was scored in terms of categories such as the place, ongoing event, infor- mant, affect in others, own affect, and aftermath (some of these were considered "canonical" categories). It was concluded that the creation of a flashbulb memory depended on a high level of "surprise," a high level of "consequentiality" (perceived relevance to the individual), and high level of "arousal."

In summary, a stimulus or event that caused (a high degree of) surprise and was reinforced by (high) consequentiality may generate an inchoate flashbulb memory which is then strengthened by rehearsal. The memory itself was formed by a putative vestigial brain mechanism (like Livings- ton's "now print" neurobiological device z) which "must have evolved because of the selection value of permanently retaining biologically crucial, but unexpected events" (p. 97). Brown and Kulik's views have been challenged from both the struc- tural and phenomenological standpoint 3,4 and also from an etiological-evolutionary perspective. 5

Neisser 3 criticized the "accuracy" claim by stating that many memories were not detail-perfect and that in many cases "rehearsal" may in fact be involved. He also believed that because the consequentiality criterion was post hoc, it could not be part of the explanation. Lastly, he called into question the efficiency of the high-arousal condi- tion for the "printing of the memory," arguing that emotional situations often cause a narrowing of attention that would lead to ignoring much background detail. In a later book, Winograd and Neisser 4 reported data on the 1986 Challenger disaster and wondered whether (1) memories were in fact accurate, (2) it was necessary to postulate a special mechanism, (3) the phenomenon revealed anything about the relationship between emotion and memory, and (4) the determinants of the flashback memory operated only at the time of putative encoding or continued shaping it for a long time after the event.

In an elegant conceptual and empirical analysis of the phenomenon, Conway 6 sought to explain flashbulb memories in terms of a general theory of

autobiographical memories and concluded, "Brown and Kulik were correct: there is a distinct class of memories for events that are emotional and person- ally important, and sometimes surprising. These memories are more detailed and long-lasting than most everyday autobiographical memories, play a central role in autobiographical memory, support many different uses of memory in interpersonal relations, and facilitate cultural processes such as the expression of generational identity. Further- more, the evidence from neurobiological studies of memory, although provisional at this stage, never- theless strongly points to the possibility of some type of preferential encoding of flashbulb memo- ties" (pp. 126-127).

CLINICAL FEATURES

Phenomenology

Whether a special visual imagery memory system is involved in the formation of flashbulb memories vii is unclear. 7 Earlier research focused on visual phenomena, e.g., particularly the featural accuracy and stability of the recollection. In their study of the Challenger explosion, Neisser and Harsh 8 found that "visual images" were more frequent than auditory ones. In his study of the assassination attempt on President Reagan, Pille- mer 9 found that 71% of subjects reported "visual memories." Likewise, Rubin and Kozin 1° found that about 58% of subjects rated visual images as being "as vivid as normal vision." Lastly, Brewer 11 showed that when memory "episodes" are experi- mentally singled out for subsequent recollection by the random activation of an alarm, subjects more frequently report vivid "visual imagery."

The accuracy (report reliability) of flashbulb memories can be assessed by comparing successive accounts of the same experience by the same individual. However, inconsistencies between such accounts could be due to reasons other than unstable sensory features (e.g., changes in temporal tagging, 11 different personal context and con- straints, varying testing instructions, etc.). On the whole, flashbulb memories seem more accurate and stable than ordinary memories. 5,9,~2,13 However, they are not immune to changeS; for example, the regular finding of a change in "visual perspective" or shift toward an "observer's perspective" (i.e., the subject reports his memory as if he was actually watching it from the outside) suggests that flashbulb memories undergo reconstruction. 14

FLASHBULB MEMORIES AND OTHER REPETITIVE IMAGES 117

The Observer's Perspective

In a nineteenth century study of childhood memories in adults, Henri and Henri 15 found that subjects could see themselves as external observ- ers: " I can see myself during an episode of illness as somebody outside myself" (p. 193). Freud, 16 and more recently von Leyden, 17 regarded this as evidence that the images for some memories are not just unchanged copies of the original experience: "I might, for example, remember falling downstairs, but when I remember it, I 'see' it, in my image, as if I were a spectator watching myself fall. This could not possibly have been my experience at the time. Clearly, then, our images in remembering are not the original experiences produced again, nor even present reproductions or representations of those original experiences" (our emphasis) (pp. 88-89). 18

Nigro and Neisser ~4 have also reported that an important proportion of personal recollections are of this type, particularly "old events or those associated with heightened self-awareness." Inter- estingly enough, it has been recently suggested that a reduction in the affect attached to a memory may encourage this shift toward the observer's perspective. 19 In the literature on trauma, a similar shift is considered to be the result of a "dissociative detachment" which is assumed to occur at the time of the traumatic event itself. For example, Spiegel 2° reported the case of a young woman who recalled her accidental fall from a third-floor balcony "as though she had been standing on a nearby balcony watching her falling body" (p. 261). At what stage the shift and/or reconstruction involved in these recollections takes place remains unclear.

MECHANISMS

The Role of Emotions

It has been suggested that concomitant "emotional arousal" plays a role in the vividness and accuracy of flashbulb memories. 1,9,1°,21,22 However, it is unclear whether emotions are directly involved in memory encoding 23viii or simply increase rehearsal frequency. 21 However, circumstantial evidence from clinical practice supports the "encoding hypothesis." Thus, recollections of their first panic attack by anxious patients are sometimes as detailed as flashbulb memories. 24 On the other hand, the fact that the frequency of retelling per se

does not improve the quality of the memory 1,8,9 suggests that rehearsal alone is insufficient.

The way in which emotions modulate memory encoding remains unclear: for example, in the short term, emotional arousal seems to have a detrimen- tal effect on memory, but in the long term, the effect is reversed, for emotions seem to attenuate the rate of forgetting. 25 The vividness of memory compo- nents (regardless of "relevance") also seems to be enhanced by emotional arousal. For example, the memories of movies seen 6 months earlier (or before) were assessed, and target scenes were categorized as "emotional or non-emotional." The memories for "emotional scenes" were found to be significantly more accurate in relation to "plot- irrelevant details" such as the color of clothes, phrasing of dialogue, etc. 2s According to these authors, the fact that the emotionality of the scenes did not enhance the recollection of the plot itself suggests that the effect may be specific for "image memories." The potential mechanisms involved in the dissociation between narrative-encompassed memories and sensory-encompassed memories have been further clarified by recent research on split- brain patients. It is now believed that the narrative and reconstructive function of memory is likely a function of the left hemisphere. In this regard, it has been shown that the left hemisphere seems far more inaccurate than the right with regard to the veridical- ity of memories, suggesting that the left hemisphere creates its narrative by "contextualizing" the target experience. On the other hand, the right hemisphere, on account of the fact that it is constrained by sensory data, is believed to generate a more "accurate" version of the target experience. 26 These findings are relevant to our main theme in that studies criticizing the concept of flashbulb memory have emphasized the "inaccura- cies" identified in the narrative but failed to assess the truth status of the constellation of "irrelevant" details that are also recollected during the phenomenon in question.

The effect of emotions on memory consolidation have lately been further illuminated by the elegant studies of, Cahill et al. z7 Evidence from animal studies suggests that activation of 13-adrenergic stress hormone systems during and after an emotional experience is involved in the enhancement of memories associated with emotional arousal. In this regard, Cahill et al. 27 evaluated the effect of propranolol (a [3-blocker) on long-term memories


related to both emotionally charged and neutral (matched) short stories. Propranolol significantly impaired the memory of the emotionally arousing story but did not affect the memory of the emotionally neutral story. This effect is unlikely to have resulted from a nonspecific sedative or attentional effect or from a reduction in emotional responsive- ness caused by propranolol. 27 These results support the hypothesis that memory enhancement seem- ingly caused by emotional arousal involves activation of the [3-adrenergic system. Further studies by the same group have established that the locus for such activation is the amygdala. 28

Evolution and Adaptation ix

The fact that flashbulb memories were originally conceived of as a "memory picture" invited the explanatory metaphor that they were "printed" onto the brain. 1 In this regard, Pillemer 9 has written, "Walking in the tall grass, near an unfamil- iar waterhole, with few companions, at dusk, these characteristics must trigger an emotional reaction and recollection of the earlier tragedy. To depend solely on purposeful, deliberate reconstruction of prior similar episodes is risky--an attack may occur before relevant information is accessed" (p. 78). Thus, a sort of "vestigial preverbal memory system," available from birth, would remain opera- tional throughout life. 29 Supporting this view, Terr 3° has suggested (in a nonreplicated study) that before the age of 3, traumatic events seem to be exclu- sively encoded as visual images; verbal processing only becomes available afterward. In broader terms, "memory recollections" are encoded as images and "autobiographical facts" as verbal proposi- tional knowledge. 31 Clinical cases showing a "double dissociation" suggest that these two forms of autobiographical memory have a different brain location. Patients with "psychogenic amnesia" are reported to experience intrusive images of forgot- ten events without having factual knowledge of the episode32; on the other hand, an amnesic patient who could remember autobiographical facts such as visiting his parents' country home claimed not to have any image recollection of being there. 33

Although mnestic images are described as less detailed and color-saturated and more blurred and unstable than those pertaining to ordinary perception,31 x in clinical practice, cases are found of mnestic images of unusual vividness where the

original event appears before the mind's eye in glorious sensory apparel.

THE PSYCHIATRIC PERSPECTIVE: VIVID MEMORIES AS HALLUCINATIONS

It has been suggested above that because flashbulb memories, drug-related flashbacks, eidetic imagery, palinopsia, vivid memories of a variety of psychiatric disorders, pain hallucinations, etc. have a number of phenomenological features, they may constitute a family of mnestic events sharing similar neurobiological mechanisms. The testing of this hypothesis has not been pursued in earnest for two main reasons: one is that it remains customary in descriptive psychopathology to consider these phenomena as independent; the other is that some seem to be rare events. Thus, subjects with enhanced eidetic memory are now only considered to be an interesting curiosity; palinopsia is but a neurologi- cal rarity; the hallucinatory images seen in obsessional disorder are only of interest to Continental psychiatrists; pain hallucinations are more likely to be seen in the orthopedic clinic; and flashbacks are mainly dealt with in the context of posttraumatic stress disorder (PTSD) and substance abuse.

FLASHBACKS

The Original Model

The term flashback refers to different clinical phenomena. 34 It was originally introduced to de- scribe "returns of [visual] imagery for extended periods after the immediate effect of hallucinogens has worn off. The most symptomatic form is recurrent intrusions of the same frightening image into awareness, without volitional control" (p. 565). 35 Flashbacks could also occur in the taste, smell, touch, kinesthetic, and auditory modalities. The term was extended to include "spontaneous recurrence of earlier drug-induced experiences" after Horowitz 35 suggested that the imagery of these experiences was identical to (or derived from) images experienced during actual drug intoxication. For example, a patient continued to have the recurrent intrusive images of a lizard: "I see this giant iguana, all the time man. Green, in corners . . . ]unlike other kinds of thought images] it's real green" (p. 566). 35

This broader concept was also supported by Shick and Smith 36 and Matefy et al . , 37 who found that 57% of subjects rated their flashbacks as "exact" phenomenological replicas of previous


drug experiences. On the other hand, Siegel and Jarvik, 38 in an 18-month follow-up study of six patients experiencing flashbacks after ketamine anesthesia, reported that the hallucinatory experiences changed in nature, oscillating between complex experiences and geometric patterns (pp. 132- 134). This type of study is marred by the fact that retrospective ascertainment is often unreliable and may capture different clinical phenomena; furthermore, some of these experiences are "state- dependent," namely, they are better recalled when the subject is in a similar state of intoxication as the one in which he acquired it. 39

Flashbacks in Psychological Trauma

During the 1980s, flashbacks were used to refer to the "re-visualisation of the trauma scene that occurred with realistic intensity" in PTSD. 4° How- ever, the indeterminateness of the concept allowed for the inclusion of a variety of other PTSD "symptoms" such as nightmares, illusions, and vivid imagery. The high frequency with which visual experiences are reported should not obscure the fact that subjects also experience auditory and olfactory phenomena. Whatever the sensory modal- ity, intense levels of emotional arousal equivalent to the levels of anxiety in panic attacks are often present.hi xi Behavioral acting-out also suggests that the subject ma~; be "reliving the experience."

Flashbacks are triggered by fatigue and certain mood states, and also by environmental cues as- sumedly related to the original situation, suggesting the operation of a context-dependent retrieval mechanism (e.g., in Vietnam veterans, the sound of a helicopter or the smell of blood, etc.). 42 Verbal accounts of these experiences are as detailed as the exact narratives commonly associated with flashbulb memories.1 For example, a patient reported, "I was stationed in the New Hebrides. I was onshore unloading a ship, when an offshore destroyer hit a mine. I was called upon to assist in the recovery and burial of bodies. I was soaked from head to toe with ocean water, floating diesel fuel, and blood. In order to bury the sailors who had washed ashore, we had to use makeshift coffins. The best we could do for coffins was boxes we made from propeller wood. One of the boxes broke apart, exposing a body. The smell was horrendous. There were flies everywhere, millions of them. They swarmed on the body and all over me. I was covered almost instantly. I put down the box, took off all my

clothes, and walked away. To this day, whenever I smell diesel fuel and salt water together, I remember that burial detail and smell those rotting bodies" (p. 384). 42 Such phenomenological similarities suggest a continuum for which PTSD flashbacks would just be the extreme expression. According to Pillemer, 9 "the [evolutionary] success of the flashbulb memory system would seem to require a flashback mechanism" (p. 78).

To ascertain whether the details associated with flashbulb memories are driven by the a priori semantic network of the event or by its context, Pillemer 9 asked a group of subjects to list their initial thoughts after hearing of the assassination attempt on President Reagan. The fact that about 25% of subjects reported thinking about their own circumstances at the time of earlier assassinations was interpreted as supporting the existence of a "flashback mechanism."

Accuracy of Flashbacks

The view that flashbacks are "dissociative" traumatic experiences takes for granted their accuracy. 34xii For example, in a sample of 20 civilian patients complaining of flashbacks after accidents or assaults, Burstein 43 only ascertained the occurrence of the event assuming that the details were correct. However, validation is of importance, as it would seem that some details are better recalled than others. For example, in a recent study when verifying the content of flashback experiences in a Vietnam veteran, Spiegel 44 found that a soldier that the patient thought was "killed" was in fact alive.

Like personal recollections, flashbacks may also be experienced from the perspective of the observer. For example, in a study of sodium lactate- induced flashbacks, Rainey et al. 45 reported that a Vietnam veteran who received a chest injury in combat "saw himself" in surgery watching his own operation, and another "saw himself falling off an armored vehicle, and having a seizure" (p. 1318). The internal contradictions contained in other accounts suggest that reconstructions (or confabula- tion) may have taken place. For example, "after passing out," one patient "saw himself strapped down in a hospital"; another "saw himself repeat- edly killing a North Vietnamese woman: he would kill her, she would get up, and he would kill her again" (p. 1318). In their classification of flashbacks in traumatic hand injury, Grunert et al. 46 list


"projected flashbacks," namely "images of injuries beyond those that actually occurred" (p. 126), once again suggesting that the memory of the original experience was reconstructed.

Electrically Elicited Flashbacks

The vivid image recollections of past personal events elicited by Penfield and Perot 47 in their stimulation studies are also phenomenologically redolent of PTSD flashbacks and flashbulb memo- ties. In general, these authors found a predomi- nance of vivid visual and auditory images, a reexperiencing of original emotions, and even inclusion of irrelevant detail. They proposed the following explanation: "Past experience, when it is recalled electrically, seems to be complete including all the things of which an individual was aware at the time; also that, since the events were often unimportant, it seemed likely that the whole stream of consciousness must also be recorded some- where, quite beyond the reach of voluntary sum- mons" (our emphasis) (p. 289). However, they also believed that a reconstructive process was in operation whereby information from "actual experience, from the individual's reading or from his dream- ing" was also incorporated (p. 224).47

Using more precise stimulation techniques, Gloor et al. 48 have more recently concluded that unlike the verbal narratives used by patients to report their experiences, evoked image experiences are "frag- mentary and often have the quality of a vivid 'flashback' to a specific event in the past without the full sequential re-enactment of the event. They could not be likened to the replay of a videotape" (our emphasis) (p. 113). Importantly, these research- ers also noted that the ongoing mental frame at the time of stimulation modulated the evoked memory experience.

POSTTRAUMATIC NIGHTMARES

Victims of trauma often report "anxious dreams" in which the traumatic event is relived in vivid multisensory images accompanied by the same intense emotions as those of the original event. Although reported as an accurate "playback," these experiences are also subject to a "switching of perspective." Posttraumatic dreams seem unre- lated to conventional REM sleep; thus, reporting a patient with a "post-traumatic nightmare," Hart- man 49 commented that "it may still make sense to

consider post-traumatic nightmares as being some- thing akin to a sub-clinical epileptic discharge."

OTHER HALLUCINATORY PHENOMENA

For a varied length of time after their original occurrence, hallucinatory replicas may follow the specific event. For example, Stromeyer and Psotka 5° ascertained this phenomenon by presenting subjects endowed with "eidetic imagery ''xiii with an image ("hidden" in a dot pattern) which only if accurately "hallucinated" onto later presentations of a complementary dot pattern would generate a three-dimensional figure. A more recent case is that of Franco Magnani, an Italian painter whose work was partially devoted to making highly detailed pictorial reproductions of Pontito, his hometown, to which he had not returned for more than 25 years. Comparing his paintings with recent photo- graphs of the same locations reveals an outstanding level of accuracy. Even more surprisingly, some of his paintings include aerial perspectives (from a few feet above the ground), which suggests that Magnani was even able to do spatial transforms of his eidetic images. 51

Palinopsia is defined as the recurrence (after varied intervals) of the image of a previously seen object. 52 For example, a patient "peeled a banana and in a few minutes saw multiple vivid images of bananas projected over the wall" (p. 887). s3 More complex scenes can also be hallucinated such as a "man walking in front of a window." It is usually accepted in these cases that the hallucinated image is actually a replica of the original stimulus even when, in the case of moving objects, their speed may be increased. 5n Palinopsia has been conceptu- alized as a "release phenomenon" probably associated with retrochiasmatic lesions of the visual pathways) 5 However, the fact that palinopsic images may frequently display movement suggests that palinopsia reflects a dysfunction of visual memory rather than of the visual system. 56 In palinacusis, patients report voices, music, or random noises "indistinguishable from the original stimulus" (p. 1067). 57 However, no attempt seems to have been made to verify the accuracy of these various forms of hallucination. Clinical observation suggests that there are differences between these phenomena and "normal" image memories and other memory-dependent hallucinations (see below). For example, their vividness seems unre- lated to accompanying emotions or personal rel-


evance; furthermore, their sensory quality is at its best when the hallucination occurs shortly after the original event. These anomalies notwithstanding, the occurrence of this variety of hallucinations suggests the existence of a primitive brain mechanism that accurately processes the sensory component of memories.

Body Memories and Pain Hallucinations

Clinical observation suggests that a memory system for somatic images may also be in play. For example, amputees report pain with the same quality and location as the preamputation pain; this can happen even after cessation of their phantom- limb experience. 58,59 Thus, Leriche 6° reported a patient in whom an ill-fitting plaster cast caused painful ulcerations over the Achilles tendon, and in the event he required an amputation; 6 years later, after an injection into the stump, the patient devel- oped pain in the phantom limb which permanently revived the pain over the ulcerated Achilles tendon. A similar phenomenon has been reported by Nathan61: after having noxious stimuli applied to his stump, an amputee reexperienced the pain of an ice-skate injury he sustained 5 years earlier when his leg was still intact. Sensations associated with the removal or deafferentation of internal bodily organs have also been reported: for example, the feeling of passing gas and feces after the rectum was removed 62 and of labor pain and menstrual cramps after hysterectomy. 63

Relevant to the central idea of this review is the fact that these experiences are also accompanied by great sensory detail; for example, a report of "blood-filled boots or blood trickling down the phantom limb."64 Likewise, amputees (43 % of 68) that reported "somatic memories" in the retrospective study by Katz and Melzack 58 were so detailed in their descriptions that the authors had to create 22 categories for one variety of pain "memory" alone ("cutaneous ulcer," "ingrown toenail," and "arthritis," etc.). Five patients described phantom limb sensations such as a shoe-clad phantom foot, wrapping bandages, the feeling of release of pres- sure after a boot was cut off to free the foot, etc. Another five patients reported visual, tactile, and motor somatosensory memories: a subject with a gangrenous big toe before amputation reported that upon feeling the phantom pain, he also had a mental image of his discolored big toe. Such images were often accompanied by high levels of

anxiety, which again suggests a role for emotional arousal in the coding of their vividness. Moreover, it has been reported that in the phantom limb, pain memories can be triggered by emotional stimuli in a way redolent of posttraumatic flashbacks. For example, Hill et al. 65 reported an amputation patient whose hallucinated pain memories were triggered by talking about her preamputation experience or while watching a television drama showing a man with a leg injury being given nitrous oxide and oxygen to relieve the pain.

The accuracy of such somatic memories has been tested. In a prospective study, Jensen et al. 66

collected information about the general location and sensory character of pain experienced the day before the amputation and on three different occa- sions afterward. Eight days after amputation, 74% of patients reported that the location of the phantom- limb pain replicated that of the preamputation pain; 2 years later, this persisted in almost half of the patients. The quality of the phantom-limb pain was similar in 53% and 35% of patients at day 8 and 2 years later, respectively. 66

The reporting of "somatic memories" in subjects sufefing from temporary deafferentation states (e.g., spinal anesthesia) raises the question of whether these experiences may also occur in normal individuals and, so to speak, be superimposed on their ongoing bodily experiences. In this regard, Katz and Melzak 58 comment, "when a missing or completely anaesthetic limb continues to be the source of pain which resembles an old injury, one of the obvious conclusions is that the pain is centrally represented. This conclusion would not be obvious if the painful limb were present and fully functional" (our emphasis) (p. 320). This issue raises conceptual problems akin to those discussed in relation to the inability (both by subject and observer) to distinguish real perceptions from hallucinations in sense modalities where the "relevant" stimulus is not in the public domain (e.g., touch). 67 It is tempting to suggest that somatic memories may be one of the explanations for the bodily complaints found in dissociative disorders when "a traumatic event is recalled in a sensory mode without the patient's awareness of the origin of the symptom" (our emphasis) (p. 600). 68 Arguing along the same lines, van der Kolk 69 has proposed that although memory is ordinarily an active and con- structive process, in posttraumatic conditions, a noninvolvement of declarative memory may lead


to o rgan iza t ion of the t r a u m a on a s o m a t o s e n s o r y

level (as v i sua l i m a g e s or phys i ca l sensa t ions ) tha t

is re la t ive ly i m p e r v i o u s to change . Fo r example ,

Kluf t 7° has r epor t ed a pa t i en t who, in the abs ence o f

organic f indings , c o m p l a i n e d o f p roc ta lg ia and the

sensa t ion o f a fo re ign mass in he r r ec tum; psych ia t -

ric eva lua t ion s ubs equen t l y u n r a v e l e d a h i s to ry o f

pa in fu l anal r ape for w h i c h the pa t i en t had total

amnes ia .

CONCLUSIONS

F l a s h b u l b m e m o r y is a r ecen t (quas i -me taphor i -

cal) n a m e for the recol lec t ion , pu ta t ive ly detai l-

pe r fec t b o t h in t e rms of core con ten t and back-

g round , of some specif ic socia l or pe r sona l even ts

a s s u m e d to b e o f s ign i f icance to the ind iv idua l or

the social group. T h e i r r epu ted p h o t o g r a p h i c qual-

i ty has led s o m e to sugges t tha t they are gene ra t ed

by some evo lu t iona ry m e c h a n i s m for the rap id

capture and s torage o f in fo rmat ion . O f late, some o f

the a s sumpt ions on w h i c h the or ig ina l desc r ip t ion

was based h a v e b e e n ca l led in to ques t ion .

The re has also b e e n a t e n d e n c y in the m e m o r y

l i tera ture to s tudy this p h e n o m e n o n as i f i t were

unique . However , to psychia t r i s t s , f l a shbu lb m e m o -

r ies are bu t one o f a f ami ly of expe r i ences shar ing

fea tures such as p a r o x y s m a l repet i t ion , sensory

v iv idness , t r igge r ing of emot ions , dysphor ia , and a

t e n d e n c y to b e c o m e o rgan i zed in eve r m o r e com-

p lex nar ra t ives . It has b e e n sugges ted in th is r e v i e w

tha t s tudy ing these expe r i ences as a g roup is m o r e

l ike ly to p r o v i d e i n f o r m a t i o n on the u n d e r l y i n g

neu rob io log i ca l m e c h a n i s m than the s tudy o f f lash-

bu lb m e m o r i e s alone.

APPENDIX: FOOTNOTES

i. For example, H Spencer 71 described it fully: "at times when strong emotion has excited the circulation to an excep- tional degree, the clustered sensations yielded by surrounding objects are revivable with great clearness, often throughout life, a fact noticed by writers of fiction as a trait of human nature" (p. 235). The chapter from which this quotation is taken, "The Revivability of Feelings," can be said to be dedicated to behaviors akin to what is now named flashbulb memories. Ribot 72 discussed similar phenomena in the chapter entitled "Exaltations of Memory, or Hypermnesia".

ii. The flashbulb came into wide use no more than 100 years ago. Transposing its features onto a memory phenomenon imposes upon it wrong analogical characteristics by suggesting some sort of one-trial mechanism, and effectively disconnects it from its history. In a way, Brown and Kulik 1 themselves acknowledged this: "an actual photograph, taken by flashbulb,

preserves everything within its scope; it is altogether indiscrimi- nate. Our flashbulb memories are not. . ." (p. 75).

iii. In other words, it suggests that "collective" flashbulb memories may be different from the private and humdrum memories of ordinary people which on occasion may also have a flashbulb quality (for an analysis of this assumption, see Wright et al. 73 Brown and Kulik ~ seem to have made their choice on the basis that the assassination of some political figures was surprising and would have personal relevance to a large number of people (consequentiality). While the former reason may be relevant to the triggering of the encoding mechanism, the latter seems to have been dictated by research expediency.

iv. It goes without saying that accepting such reports implies the assumption on the part of the clinician of the "conventional" view of a visual image. A visual image is defined here as an evocation (by a given subject) of the sensory aspects of an object when this is not within his/her perceptual purview. The visual image is believed to be a representation (on the concept of representation, see Cummins 74) "projected onto" some inner screen and available to an "inner eye." These two elements are constitutive parts of the "perceptual metaphor" which until the late nineteenth century provided the basis of "introspection." The "conventional" view of visual images, predominant since the time of Democritus and Aristotle, reigned supreme until the early twentieth century when, in the Anglo-Saxon world, it was challenged by behaviorism (on this, see the important historical book by Denis75). The view that images have a symbolic and codificatory function never quite disappeared from the Continen- tal philosophy of the mind (see, for example, the superb report by Meyerson76). Interest in visual images has reappeared in Anglo-Saxon psychology in the wake of the new "cognitive psychology"; however, the new sponsors rarely acknowledge Continental work. (For a good account of the conceptual problems, s e e 'rye. 77 For the neuropsychological perspective, see Behrmann and Kosslyn, 7s,79 and for a recent general account of perception, see Rock. s° )

v. Despite the fact that there is evidence that memory images for personal events also undergo reconstruction (see Nigro and Neisser14).

vi. i.e., the view that memories are always stories constituted by morsels of information selected and edited according to social and personal frames, sl,s2

vii. As mentioned, the term flashbulb memory names particularly vivid, long-lasting recollections of the personal circumstances in which the subject first learned of a shocking public or private event. Such memories are said to contain "irrelevant details," e.g., the brand of cigarettes being smoked at the time of the event. Such sensory richness is considered as evidence in favor of the alleged accuracy and stability of flashbulb memories. 1

viii. In this regard, it has been postulated that (1) emotional memories may increase the levels of hormones and glucose, thereby promoting efficient consolidation; (2) participation of the amygdala in emotionally charged memories adds attributes to final memory processing including important cognitive links with the frontal lobes; and (3) flashbulb memories may be multirepresented in terms of Kesner's model (see Conwayr).

ix. We are fully aware of the ongoing conceptual and empirical debate concerning the use of evolutionary arguments in the explanation of psychological and psychopathological phenomena and events. 83 However, the fact that an exact


knowledge of the original evolutionary parameters and the adaptational value of the behavior in question remain limited does not detract from the fact that evolutionary ideas per se provide a legitimate (and often necessary) perspective which can lead to testable predictions. For example, in a recent study, the hypothesis was successfully tested that women should outskill men in certain visual memory tasks; the basis of the prediction and the experimental design were based on current understanding of gender-specific activities during the Pleis- tocene. 84

x. Such distinction has, of course, been made at least since the time of Aristotle. See Chapter 1, "History of Memory and Its Disorders," in Berrios GE, Hodges JR (eds): The Neuropsychia- try of Memory Complaints. Cambridge, UK: Cambridge Univer- sity Press. In press.

xi. The nature of this emotional accompaniment led, between the 1880s and the first World War, to a famous debate in clinical psychology. Known as the "affective memory" debate, it revolved around the issue of whether there was a memory for

emotions, or whether each time the cognitive component or the image of the memory was remembered, it would trigger a fresh token of the emotion in question (see Berrios GE. The Affective Memory Debate. In preparation).

xii. Indeed, such an assumption is implicit in the therapeutic usage of abreaction. 85

xiii. Eidetic refers to "an image that revives an optical impression with hallucinatory clearness, or to the faculty of seeing such images, or to a person having this faculty. ''86 The locus classicus for the study of "eidetics" remains Jaensch87; there are also excellent reports on the traditional approach by Quercy 88 and Jelliffe89; more recently, the concept has been included in the wider definition of "high imager.'90 The concept of eidetic imagery has not been used as frequently as it might be in the context of the psychopathology of perception. However, it has been suggested that "vivid auditory imagery may be a necessary (although not sufficient) pre-requisite for hallucinations in schizophrenics" (p. 311). 91

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Flashbulb memories and other repetitive images: A psychiatric perspective

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