Fundamentación: Educativa

The relationship between AHP and motivation has a long tradition, starting from early theories that conceptualised AHP as a motivated defence mechanism (e.g. Weinstein, & Kahn, 1955). The study described in Chapter 7 was the first to examine the relationship between AHP and motivation, on memory. Specifically, the aim of the study was to investigate whether motiva- tion led AHP patients to increased forgetting (repression) of actions they could not perform. This was investigated by using a version of the Directed Forgetting (DF) paradigm, in which unilateral and bilateral, manual and pedal items were presented, in form of pictures accompanied by action phrases. A pilot study was also conducted, in young and older participants, to establish the validity of the task, as well as a baseline performance.

As far as the basic hypothesis of the task is concerned, the results showed that in both clinical and pilot studies the cost effects of the task were mostly elicited but no benefit effects were found, while recognition scores al- so yielded some important results, contrary to the literature of the task. Moreover, with regards to the specific hypotheses, in both studies pedal items were better recalled than manual, while the pattern of recognition of the sub-categories (unimanual – unipedal; bimanual – bipedal) was relatively consistent between the two studies, and discrepancies were speculated to be due to difference in sample size and performance. As discussed in Chap- ter 7, it cannot be excluded that results were, in fact, confounded by method- ological issues. Overall, the study did not provide evidence of repression in AHP.

The absence of experimental evidence of memory repression is in contrast with clinical observations that very much resemble repression. Ra- machandran (1994) describes a characteristic example, in which an AHP pa-

tient temporarily regained awareness by means of caloric vestibular stimula- tion. During the effect of the stimulation, the patient was able to acknowledge her paralysis and admitted she was paralysed for days, indicating that the events she had been denying (her paralysis) had nevertheless been suc- cessfully encoded in long term memory. When the effect wore off, the patient became anosognosic again, and, most importantly, although she could de- scribe the episode of the stimulation in great detail, she had no explicit memory of her admitting the hemiplegia. Consequently, Ramachandran (1994) concluded that this episode was a manifestation of repression. Turn- bull et al. (2014), based on these clinical observations, recently proposed a theory, according to which the brain damage in AHP patients could produce cognitive deficits otherwise essential for normal emotion regulation. As a consequence, ‘wishful’ emotions (e.g. what the person wanted to do) seem to undermine realistic cognition. The clinical findings described above are not in line with the findings of the study, but before proceeding to providing alter- native explanation, a brief overview of the concept of repression should be given.

According to the psychoanalytic doctrine, people tend to forget trau- matic experiences, which can then be retrieved by special means (e.g. see Breuer, & Freud, 1895). Freud viewed repression as the foundation of psy- choanalysis, but despite research efforts, today, over a century later, there is still great controversy surrounding the validity of this concept (Kihlstrom, 2002; seeRofé, 2008). Several aspects of repression are debated, including its very existence (for reviews see Erdelyi, 2006; Pope, et al., 1999). Contra- ry to the aforementioned original psychoanalytic assumption, a number of studies have demonstrated that traumatic experiences can, in fact, enhance memory (e.g. McNally, 2003; Pope, et al., 1999), while others, using the Di- rected Forgetting (DF) paradigm, found that trauma survivors do not show superior inhibition for trauma-related words (McNally, et al., 2004; McNally, et al., 2005; Geraerts, et al., 2006; Devilly, et al., 2007). On the other hand, there are a handful of studies that have indeed reported increased inhibition of trauma-related words in people with traumatic experiences (Moulds, & Bryant, 2005; DePrince, & Freyd, 2004). Whether or not repression is a con-

scious or a directed procedure is also a subject of debate (Erdelyi, 1990), as are, consequently, the mechanisms underlying it. Specifically, Anderson & Green (2001) conducted a memory study, which found that when participants intended to forget a word and inhibited its recollection, the word would even- tually be forgotten. In other words, they claimed to have found the experi- mental analogue of repression. On the other side, it was claimed that their findings were merely the effect of intended forgetting, while the material was not emotional and therefore no direct analogies can be drawn with repres- sion where an event causing negative feelings is forgotten. It is important to mention that Freud’s ideas about repression changed over time, from de- scribing it as an intentional attempt to prevent distressing materials from conscious awareness, to considering it one of the several defence mecha- nisms operating outside conscious awareness.

A review of the literature on repression was not the scope of this sec- tion. Instead, the aim was to highlight the controversies and inconclusive findings on this much-debated field. Taking together the above findings and propositions, it is possible that clinical observations of AHP typically thought of as repression in AHP might in fact not be repression in the classical, Freudian sense, which involves inhibitory procedures blocking the memory from retrieval. Instead, as proposed by Turnbull et al. (2014) these presenta- tions could be the manifestation of an emotion dysregulation, prioritizing what the patient wants (e.g. “I want to walk”) over the realistic cognition (“I cannot walk”). In fact, it could be tentatively argued that this was manifested in the study in Chapter 6, where results found that AHP patients updated more cognitively than emotionally. In other words, they remained abnormally fixat- ed to their prior emotions, despite being better able to cognitively update and acquire a more realistic approach of their motor deficits.