Submissão:
05/10/2019 Aprovação: 28/11/2019 Publicação: 18/12/2019
Dossiê
Filosofias da memória
Psychogenic
amnesia: implications for the diachronic sense of selfhood
Amnésia psicogênica: implicações para o senso de si mesmo diacrônico
Beatriz Sorrentino Marques
Professor of the Philosophy Department at
the Federal University of Mato Grosso, Cuiabá, MT.
Abstract: Traditionally, the issue of
personal identity has been considered as the question about what makes one the
same across time. Recently though, attention to one’s own phenomenal experience
has brought a new perspective to the debate. In light of this change of
perspective, Klein suggests that individuals with retrograde episodic amnesia
retain a notion of who they are, as well as a sense of continuity. He,
therefore, argues that episodic memory is not necessary for a diachronic sense
of selfhood. I challenge Klein’s conclusion by pointing out that there are more
extreme kinds of amnesia—e.g. psychogenic amnesia—that seem problematic to his
proposal—according to which a sense of continuity is enough for a diachronic
sense of self. This is the case because some instances of psychogenic amnesia
are cases of dissociative amnesia, which show that having continuous conscious
experience does not solve the issue.
Keywords: Episodic Memory; Diachronic
Sense of Self; Dissociation
Resumo: Tradicionalmente, a questão da identidade pessoal é
considerada a questão a respeito ao que faz uma pessoa ser a mesma ao longo do
tempo. Recentemente, porém, atenção à experiência fenomênica trouxe uma nova
perspectiva ao debate. À luz dessa mudança de perspectiva, Klein sugere que indivíduos
com amnésia episódica retrógrada retêm uma noção de quem são, além de terem
senso de continuidade. Ele, portanto, argumenta que a memória episódica não é
necessária para se ter sensação de si mesmo diacrônica. Desafiamos a conclusão
de Klein apontando que existem tipos mais extremos de amnésia—amnésia
psicogênica—que parecem problemáticos à sua proposta de que o senso de
continuidade é suficiente para se ter sensação de si mesmo diacrônico. Esse é o
caso, porque alguns exemplos de amnésia psicogênica são casos de amnésia
dissociativa, que mostram que ter uma experiência consciente contínua não
resolve o problema.
Palavras-chaves: Memória Episódica; Sensação de Si Mesmo
Diacrônico; Dissociação
Introduction
The
problem involving personal identity has captured the attention of philosophers
because we commonly tend to believe that we are the same throughout life.
Furthermore, several important issues depend on personal identity; for
instance, whether I care about my future, whether I take responsibility for my
past actions, whether I re-identify the people I care about when I meet them at
a future moment, among others. Traditionally the issue of personal identity has
been framed, roughly, as the question about what makes one the same person
across time. There have been several approaches to the issue, as well as a
range of solutions. One of the views that have gained a fair amount of
acceptance proposes psychological criteria to answer the question about what
constitutes identity across time. Amongst the most cited criteria is episodic
memory. Recently though, Klein[1]
has focused on one’s own phenomenal experience to answer questions about
personal identity, switching the focus to the
sense of continuity[2]
instead of personal identity itself. In light of this change of perspective, Klein[3]
has suggested that individuals with retrograde episodic amnesia retain a notion
of who they are; they have trait self-knowledge[4] as well as a sense of continuity[5]. He, therefore, argues
that episodic memory is not necessary for the
diachronic sense of self, which can be understood as a sense of oneself as
the same self at a different time. It is important to note that trait
self-knowledge is distinct from remembering episodes from one’s subjective
past. Trait self-knowledge is the semantic knowledge about one’s own character
traits, while episodic memory is a representation of an episode from one’s
personal past, which encompasses a specific phenomenology. I disagree with
Klein that simply knowing one’s character traits, as well as having continuous
awareness, is enough when it comes to personal identity issues. Thus, being
aware of who one is requires more than trait self-knowledge; it requires at
least being able to be aware of oneself in one’s subjective past while being aware
of it as one’s own subjective past.
I
challenge Klein’s conclusion by pointing out that there are more extreme kinds
of amnesia—e.g. psychogenic amnesia—that seem problematic for his proposal that
a sense of continuity is enough for a diachronic sense of selfhood. Some
instances of psychogenic amnesia are cases of dissociative amnesia, such as
fugue, in which the subject seems to dissociate from all kinds of
autobiographical information. Additionally, some psychogenic amnesia cases make
the sense of continuity seem too frail to matter to what we care about in
relation to the issue of personal identity. In order to advance this argument,
in section one, I briefly review the issue of personal identity. In section
two, I present some relevant points about recent theories of episodic memory,
and I sketch my proposal for a diachronic sense of self. In section three, I
present a case of psychogenic amnesia. In section four, I draw on this case to
show its implications for Klein’s proposal. In section five, I answer a
possible objection.
Personal identity
The
fundamental concepts discussed in the personal identity debate are person, time, and identity. These
concepts appear in the philosophers’ framing of the question and in their
proposed solutions. Parfit[6], for instance, frames
the issue of personal identity in the following way: “[...] what it is that
makes us now and ourselves next year the same people”[7]. Locke famously offered
a solution to the problem. He claimed that “[...] as far as this consciousness
can be extended backwards to any past action or thought, so far reaches the
identity of that person; it is the same self now that it was then; and this present
self that now reflects on it is the one by which that action was performed”[8].
The
fact that persons change throughout time is at the core of the issue of
diachronic personal identity. If the question were whether S is identical to
herself at moment T1, then we would no longer be talking about
diachronic personal identity. Things change when we start to think about the
same self in two different moments in time, and questions concerning change are
at the core of the diachronic personal identity issue. Therefore, time is an
important element to personal identity because it is time that allows relevant
change in psychological components to occur, change being the underlying
problematic element of diachronic personal identity[9].
Usually,
the debate on diachronic personal identity can orbit a metaphysical or an
epistemological approach to the issue. (i) The
metaphysical approach focuses on what constitutes diachronic personal identity,
and (ii) the epistemological approach focuses on the belief that a person A is
now the same person as she was in the past, and its justification. Issue (i) is focused on the criteria for personal identity, and
(ii) is more concerned about the evidence for belief in personal identity, or
evidence that someone has diachronic personal identity.
The discussion has
mostly focused on (i), on what has been called the
psychological criteria for personal identity. Locke inaugurated this kind of
solution. Often Locke’s readers have interpreted him as proposing that
memory—of the kind we would call episodic memory nowadays—is the criterion for
personal identity. Whether memory is the appropriate criterion is a point of
debate by those who endorse psychological criteria; the proposal, nonetheless,
has remained a strong contender in the debate.
I
will not focus on these traditional aspects of the dispute. Klein[10]
has offered a fresh perspective of the debate by focusing on its phenomenal
aspects, which, for instance, allow one to accept responsibility for past
actions, and plan for the future. Klein’s[11]
proposal, however, questions Locke’s episodic memory criterion. Klein claims
two things. First, that individuals with extensive retrograde episodic
amnesia—encompassing their whole lives, such as patient D.B.[12]—retain a notion of who
they are. Second, that their continuous conscious experience is enough to claim
that they have a sense of continuity
in time. Being that the case, one can have knowledge about oneself based on
sources other than episodic memory. Klein[13]
focuses, for instance, on the fact that D.B. preserved his trait
self-knowledge. Therefore, episodic memory is dispensable for the sense of
continuity. This proposal makes sense if one takes Klein to be suggesting that
the sense of continuity is the best we can get, or that it suffices to answer
the philosophical questions that usually surround personal identity. I disagree
with Klein, but before I explain why, I will summarize his position.
I
cannot do justice to Klein’s view here, but given its ingenuity and influence,
I will consider its main conclusions. Being aware “and now and now and now”[14]
is what he calls the sense of personal
synchronicity, which depends on continuous conscious experience. Klein’s
proposal seems to presuppose that awareness from one moment to the next
provides continuity of conscious experience, and considering that conscious
experience is necessarily consciousness of my
experience, it provides a sense of self that is synchronic (i.e., at the
moment, as opposed to extended in time). Klein’s proposal also aims at answering
the question about whether D.B. and other patients with similar (or even more
severe) limitations can be considered selves or persons. I have no problem
agreeing with Klein that they are selves, and that sense of personal
synchronicity is enough for being a self. I limit my discussion to the issue of
diachronic personal identity; i.e., whether and how one can be aware of oneself
as the same person that one was at past moments of time.
I do
not deny that we have continuous conscious experience, or that it might provide
a sense of continuity. I disagree, however, with Klein’s proposal, because the
sense of continuity does not seem to be the best we can get concerning the
issue of diachronic personal identity. A
patient who suffers from dense retrograde amnesia[15], for
instance, could conclude that she is the same person as the one that she
knows—based on semantic knowledge—from a story about her own past. Nonetheless,
she cannot be aware of herself as the same person that she was in the
past. She lacks the necessary kind of consciousness (autonoetic
consciousness[16], which is specific to
episodic memory), and the phenomenal experience that accompanies it. Although
she knows she is the same person, I claim that she cannot feel as the same person. The problem is that she lacks the
phenomenology that accompanies autonoetic
consciousness (see section two for clarification). Moreover, a sense of
continuity does not address the related issues that make personal identity so
important to us. I will argue that episodic memory is necessary for the
diachronic sense of selfhood, and that Klein’s proposal does not address the
crucial points of the issue.
Episodic memory
As
mentioned above, Locke’s influential answer to the issue of diachronic personal
identity focuses on episodic memory. Here, I accept recent theories of episodic
memory that have proposed an innovative view of this cognitive system as part
of a larger Mental Time Travel (MTT) system, which encompasses, for instance,
imagination and counterfactual thinking[17].
Therefore, episodic memory is not part of a dedicated system for remembering.
The proposal is that the MTT system is a system of hypothetical thought[18]
or simulation[19].
Episodic
memory is of interest to personal identity for additional reasons encompassing
its phenomenological characteristics. It involves autonoetic
consciousness, “consciousness of self in subjective time”[20],
and chronesthesia, consciousness of subjective time[21].
These are the conscious elements that allow the person to be aware of herself,
her actions, and experiences in different times. Tulving’s
definition of episodic memory focuses on these elements to characterize it:
Episodic
memory is a recently evolved, late-developing, and early-deteriorating
past-oriented memory system, more vulnerable than other memory systems to
neuronal dysfunction, and probably unique to humans. It makes possible mental
time travel through subjective time, from the present to the past, thus
allowing one to re-experience, through autonoetic
awareness, one’s own previous experiences. Its operations require, but go beyond,
the semantic memory system[22].
This definition makes
clear that autonoesis and chronesthesia,
the phenomenal elements of episodic memory, are crucial to it, because these
elements allow mentally traveling in time to the recalled episode; also, they
allow placing it in subjective time. Moreover, this kind of memory does not
simply involve access to information about the episode; it is as if the subject
experiences the episode, which highlights the phenomenal character of episodic
memory.
In
the taxonomy of memory, there is non-cognitive memory (e.g., procedural memory)
and cognitive memory (e.g., declarative memory). Episodic memory is one of the
varieties or memory of the cognitive type[23].
It is distinguished mainly from semantic memory, the other variety of cognitive
memory. While semantic memory refers to factual and conceptual information,
such as that Paris is the capital of France or that H2O is the
molecular formula of water, episodic memory, as the name makes clear, is memory
of episodes, specifically from one’s own personal past. It is important to note
that episodic memory is different from autobiographical memory—the kind of
memory that includes both semantic memories of information about oneself, such
as date of birth and trait self-knowledge, as well as one’s own episodic
memories. There are two varieties of autobiographical memory. On the one hand,
there is episodic autobiographical memory (EAM). On the other hand, one can
also have purely semantic autobiographical memory, which involves factual or
conceptual information about oneself, but it is distinguished from episodic
memory because it has no phenomenal aspects and no episodic character.
I
propose that autonoesis and chronesthesia
are relevant to the Lockean criterion of personal
identity. Taking Locke’s claim in a literal sense, the consciousness of past
actions and experiences constitutes diachronic personal identity, and this is
what episodic memory allows one to do; it allows one to mentally travel in time
to past actions and experiences. Autonoesis and chronesthesia are forms of consciousness associated with
the phenomenal aspect of episodic memory, which allow one to be conscious of
one’s experiences and actions, and to re-experience them in subjective time.
Through mental time travel, one re-experiences the remembered event. Hence, I
defend that episodic memory engenders the diachronic sense of self. When the
person is conscious of herself as the one who had a certain experience in the
subjective past, she has a diachronic sense of self; i.e., a sense of herself
at a time different from the objective time.
Stanisloiu, Markowitsche, and Brand[24]
relate episodic memory to trait self-knowledge (knowledge of one’s own
character traits or personality). I mention this only as a tangential point
because Klein seems to accept that trait self-knowledge might be relevant to
what he calls the diachronic sense of self (see section four). If Stanisloiu, Markowitsche, and
Brand are correct, however, episodic memory is important to the formation of
trait self-knowledge. Although I will not develop
this argument here, roughly, they accept that children[25] and
adolescents seem to rely on episodic memory for self-evaluation, while adults
rely on semantic memory. Therefore, adults suffering from amnesia may maintain
some trait self-knowledge, even knowledge about the self in time[26], although they caution
that sustaining personal identity probably requires periodic updating that
depends on episodic memory. On the other hand, Klein and Gangi[27]
seem to disagree. They claim that semantic memory is enough to maintain trait
self-knowledge. I will not take sides on this dispute; I will focus on a
specific kind of amnesia to illuminate my disagreement with Klein.
Psychogenic amnesia
Psychogenic
amnesia (also called dissociative or functional amnesia)[28] provides a reason to
think that episodic memory is fundamental to the diachronic sense of selfhood.
Before I concentrate on a case that supports this claim, it is necessary to
explain what this memory impairment is. Psychogenic amnesia is a broad term used
to describe a problem or condition related to episodic amnesia, mostly
retrograde (but it can also be anterograde), which differs from the usual use
of the term amnesia in the sense that it occurs without identifiable brain
damage[29].
This kind of memory retrieval blockage can impair one’s ability to access
episodic memory as well as autobiographical semantic memory, and, in some cases
trait self-knowledge.
Despite
the fact that a lack of identifiable brain damage characterizes psychogenic
amnesia, some experiments have been conducted to investigate a possible
neuronal correlation to this kind of impairment[30].
Brand et al. used fluorodeoxyglucose-positron
emission tomography (FDG-PET) in order to investigate the neural correlates of
this condition. When the regional glucose utilization between patients and
control was compared, it revealed “a metabolic reduction in the right inferolateral prefrontal cortex”[31]
in relation to the control group. The researchers conclude that “[…] deficits
in patients with dissociative amnesia are related to stress-associated
dysfunctions in the inferolateral prefrontal section
rather than to active and motivated forgetting of memories”[32].
Therefore, although it is a psychogenic kind of amnesia, investigation about
this condition does not rely solely on the patients’ reports. Neurocognitive
investigation can contribute to understanding these reports, as it will be seen
in the case of N.N..
The
severe consequences of psychogenic amnesia to the patients, and its association
to what has been considered the loss of personal identity, has led to a
discussion about the relevance of episodic memory and some of its key
phenomenal and emotional elements for one’s identity. Reinhold and Markowitsch[33]
highlight the importance of episodic and semantic autobiographical memories to
identity, or personality.
Next
to subjective time and autonoëtic consciousness the
experiencing self amounts to the concept of episodic
memory. Building up autobiographical memories enables us to experience our self
as an entity over time and therefore enables the formation of an identity or
“personality.” Our personality relies on past experiences, is strongly
associated with our personal beliefs and allows us to consistently behave with
our own beliefs and desires. The experiencing self assures
the autobiographical memory to be a continuous memory system that is built up
along a subjective time line […]. Although the term ‘experiencing self’ can
also be used to name the ‘rememberer’, the concept of
the experiencing self implies the perceptual component of remembering a
specific event from one’s own biography with contextual information like time,
space, emotional state. However, the experiencing self has to be distinguished
from the concept of the self as the self constitutes
a multidimensional (moral, physical, personal, social, etc.) and outlasting
construct, while the experiencing self refers to a momentaneous
state[34].
Reinhold and Markowitsch emphasize that the concept of experiencing self
is also important to episodic memory. This concept highlights the perceptual
component of remembering, which involves temporal information. Additionally,
the ability to remember past experiences allows the formation of identity. This
suggests that what the authors are calling identity[35] or personality (I call it character traits) depends, at least
partially, on episodic memory because autonoetic
consciousness and chronesthesia allow one to experience
oneself in different moments in subjective time, thus enabling the construction
of a so-called identity. This is in agreement with Stanisloiu,
Markowitsche, and Brand’s claims, briefly discussed
in the previous section. Reinhold and Markowitsch[36] advance that identity relies on experiences
along time, and on what one eventually knows about oneself based on these
experiences.
Reinhold
and Markowitsch also point out that together with autonoetic consciousness and chronestesia,
they consider the experiencing self a
relevant element for episodic memory, but it should not be confused with the
self, which has several dimensions. The experiencing self, according to them,
is a perceptual component specific to remembering, it is the perception of the
remembered autobiographical event in the context of the time, space, and
emotional state during the remembered event. It emphasizes the importance of
one’s experience of the recalled event in a way that it is re-experienced, in
the sense that one re-experiences it in its context, temporal and spatial
elements, as well as emotional content. Additionally, in episodic memory, the
self that remembers the episode is experienced as the same that lived the
episode.
Staniloiu, Markowitsch, and Brand[37]
espouse a similar view. They claim that episodic memory integrates personal
events and emotions with the autonoetic self.
Episodic autobiographical memory (EAM) is affectively laden, which is suggested
by the fact that EAM engages networks associated with cognition and emotion,
such as the right temporal-frontal areas and right amygdala. These views are
aligned with what has been said about episodic memory in the previous
section—which means that EAM also involves autonoesis
and chronesthesia. Therefore, research about psychogenic
amnesia seems to take into consideration the recent MTT theories about episodic
memory. If the abovementioned is correct, episodic memory impairments have a
significant impact on patients who suffer from psychogenic amnesia. I will
focus on a few kinds of cases to show the relevance of episodic memory to the
diachronic sense of self.
Dissociative fugue is a type of
psychogenic amnesia which Staniloiu and Markowitsch[38]
characterize as retrograde dissociative amnesia accompanied by sudden departure
from usual environment and compromised personal identity[39]. In these cases, it
seems that access to the patient’s past is blocked, resulting in what they call
loss of personal identity[40]. A patient in this
condition is unaware of any information about herself and has no episodic
memory of her past. Patients suffering from severe psychogenic amnesia, such as
fugue cases, do not know anything about themselves, not even their names or
addresses. They also do not express recognition when doctors or family members provide
information about them. There are cases in which patients with severe
psychogenic amnesia do not recognize their home or family. Patient N.N.
exemplifies such a case. He did not express recognition or any connection to
his past self, i.e. the self that he was before the fugue episode. To my
knowledge, it was never asked to him whether or not he felt that he was the
same person that he was before the fugue episode. Notwithstanding this fact, I
dare say that after the fugue episode he did not feel as if he was the same
person that the pre-fugue N.N. was—the person who he came to know through the
descriptions provided by his family. It is worth detailing this example.
One
day N.N. went to the bakery, and on his way suffered an episode of fugue.
Consequently, he rode his bike through a few cities until he finally stopped in
one of them, unaware of where he was or of any information about himself. When
reunited to his family, N.N. did not recognize his wife or children. After the
episode, he changed his habits—e.g., before the fugue episode he was an avid
driver, but after he no longer liked driving—he also gained weight, and no
longer had allergies. Given these facts, N.N.’s case is consistent with the
diagnosis of psychogenic amnesia. For instance, Staniloiu
and Markowitsch[41]
claim that patients suffering from psychogenic amnesia exhibit a change in
personality (affectivity, behavior, perception, social cognition)[42].
N.N.
eventually re-learned (semantically) his autobiographical information (taught
by his family), but in what Staniloiu and Markowitsch[43]
describe as an unaffected manner. I
assume he re-learned about his previous personality traits when he went back to
living with his family, and that everyday cohabiting probably brought up
conversations about how he was and about his habits, for instance, “his family
told him he had been a better cook before his fugue”[44].
The unaffected manner in which he re-learned the information leads to the
belief that N.N. did not recuperate his episodic memories, for usually this
kind of memory is emotionally laden. He only remembered the information
semantically. If we consider that autonoetic
consciousness is necessary for awareness of self in other times, then we must
conclude that N.N. knows but does not sense (or feel) he is the person in the
semantic autobiographical information, because semantic memory lacks autonoesis. The problem involves a lack of phenomenology.
He may know that a story about his past is about himself, but he does not feel autonoetically
what he knows; i.e., notwithstanding the fact that he has diachronic
self-knowledge, he has no diachronic sense
of self.
Further
evidence corroborates the interpretation that N.N. did not recuperate his
pre-fugue episodic memories:
N.N. was tested neuropsychologically
and with functional imaging. Water-PET was used in combination with the design
of Fink et
al. […],
during which the patient was confronted with events from his personal past.
While the normal probands had predominantly right temporo-frontal activation […], N.N. had a left-hemispheric
activation of these regions. In light of other data on brain activations during
memory retrieval […], this finding was interpreted as suggesting that the
patient perceived his own episodic-autobiographical episodes as if they were
belonging to a third, neutral person[45].
On
the one hand, controls mostly show right temporal-frontal activation when
presented with autobiographic episodic information, associated to episodic
memory. On the other hand, N.N. presents activation associated with semantic
memory. I agree with the authors that the result suggests that N.N.’s memories
are not episodic memories. This is the case because episodic memory encompasses
autonoetic consciousness. The description of a memory
as information that could be third-person information fits better with semantic
memory, “[t]hat is, N.N. seems to process all incoming information in a
neutral, ‘semantic’ manner”[46].
If this
is correct, then N.N. recalls only semantically his re-learned autobiographic
information. Thus, he does not have autonoetic
consciousness—consciousness of himself in subjective time—in the recollection
of these episodes; i.e., he does not mentally travel in subjective time to
simulate a past episode. One may conclude that he simply retrieves the semantic
information about the episode that he re-learned after the onset of his
condition. Considering the change in personality, I assume he also lacks pre-fugue
trait self-knowledge, but may have re-learned some of those traits from what
his family tells him about himself. Semantic information retrieval, however, is
third-person information, such as recalling a story a friend told of a trip she
took to Washington, D.C. In this kind of situation, one does not re-experience
the trip when one retrieves the information because one does not have autonoetic consciousness of the episode. These phenomenal
aspects of episodic memory are not present in semantic memory. Thus, one can
retrieve the semantic information, but one cannot re-experience the episode.
Thus, N.N. regained information that contributed to his pre-fugue
self-knowledge, but if we accept that these are to him as third-person
information, then the dissociation persists; he cannot access the information
in a self-aware way.
N.N.’s
case is significant because it provides an example of loss of episodic
autobiographical memory (EAM) due to the loss of episodic memory that is
documented by neurophysiological information. Additionally, before he
re-learned it, N.N. also suffered the loss of autobiographic semantic
information. Thus, it provides evidence to the discussion of what this kind of
cognitive loss means to my proposal of a diachronic sense of self. After the
fugue episode, and before he re-learned his semantic autobiographical
information, with the condition of a concomitant loss of autobiographic
episodic memory, can it be said that N.N.’s sense of diachronic personal
identity remains the same as before the fugue episode? If one agrees that N.N.
went through a dissociation episode, the dissociation from autobiographical
memory is considered as such because it constitutes a dissociation from his
identity. This brings up the question of whether it is possible for him to
still have a diachronic sense of self.
In
cases in which psychogenic amnesia encompasses loss of episodic memory
(retrograde amnesia), and of semantic autobiographic memory, psychogenic
amnesia is a dissociation of core elements of self-knowledge. Psychogenic
amnesia is a type of dissociation of autobiographical memory, and it has been
argued that it affects other self-related functions and emotional processing[47].
One cannot be aware of oneself in subjective time if autonoetic
consciousness is impaired. This suggests that, when patients suffering from
this kind of amnesia dissociate from their self-knowledge (information about
themselves and about their personality traits) and from their episodic memory,
they no longer can have a diachronic sense of self. This is the case because
they can no longer mentally travel in time, which provides the sense of their
own temporal extension.
From
the abovementioned, one can conclude that N.N. is not aware of himself at
different times; as a result, he does not satisfy the requirement for my
proposal of a diachronic sense of self. After he re-learns his autobiographical
information, he has knowledge about his life and his personality, but only in
the same way he may know who Chelsea Manning is, for example. He does not feel
it. N.N. is not aware of himself as the same person of the episodes of his past
that he re-learned semantically.
It is
important to note that N.N.’s case is distinct from cases of dense
(non-psychogenic) amnesia, such as the cases of patients D.B. or B.. Patient D.B. had retrograde amnesia encompassing his
whole life, as well as anterograde amnesia. Although D.B. had gaps in his
semantic knowledge about himself, he, nevertheless, knew various facts about
his life and he preserved his trait self-knowledge[48].
Hence, N.N.’s memory impairment is more profound, because it affects his
episodic memory and his personality traits. In fact, Klein seems to be unaware
of the existence of such a severe impairment, “my colleagues and I have yet to
find a patient who could not reliably and accurately report his or her trait
self-knowledge”[49].
Patient B. had impaired short-term memory. After a gas poisoning accident, he
could not remember anything that happened over 1 second before. B. also
suffered from anterograde amnesia, but not retrograde amnesia prior to the
relevant accident. Although his memory impairments were dramatic, B. preserved
his episodic memory from before the accident, differently from N.N.. There is also no mention of B. not knowing his
character traits, so I assume his trait self-knowledge was not impaired.
Klein
supposes that these kinds of episodic memory impairments are enough to show
that one does not need episodic memory to have diachronic sense of self, but B.
relies on episodic memory from prior to his accident for such. I disagree that
D.B. has a diachronic sense of self. He may have what Klein calls a sense of
personal synchronicity; nevertheless, I do not think this sense is relevant to
issues that make us care about personal identity (see section four for a
defense of this point).
N.N.
is not alone in exhibiting psychogenic amnesia. Although this is a rare
condition, several other patients have been studied[50].
Patient D.F.[51]
is not characterized as a fugue case. She was on a trip in China, when she was
found one evening unconscious and undressed. She was examined at the hospital,
but no harm was found to her body, except for a small bump on her forehead.
FDG-PET and magnetic resonance imaging (MRI) revealed no abnormality.
Nevertheless, D.F. exhibited dense retrograde amnesia and she could not
remember semantic autobiographical information, such as her name or address.
When she went home, she could not recognize her parents. Her ability to form
new memories, however, was not compromised, so Reinhold and Markowitsch
claim she was able to build a new identity[52]. N.N. and D.F. show
that loss of semantic self-knowledge—as well as episodic memory—results in
dissociation from autobiographical information. This may be the case, because
episodic memory, and autobiographical information in general, contribute to the
formation of self-knowledge.
Staniloiu,
Markowitsch, and Kordon
describe four cases of fugue, patients D, R, H and K. “All four patients did
not regain conscious, first person access to their past, but were able to
relearn their past”[53]. Although
some patients suffered from la belle
indifference[54], not all of them were unconcerned about
their condition. D.F., for instance, felt guilty for not recognizing her own
parents. Staniloiu, Markowitsch,
and Kordon report that “a substantial number of the
patients has somatic complaints and is eager to obtain advice on health issues”[55]. While
thirteen of the tested patients with various kinds of psychogenic amnesia
exhibited emotional bluntness, fourteen tested normal on the emotional
assessment. Ten of these patients suffered from retrograde amnesia encompassing
their whole lives (patients D, E, F, M, N, O, S, T, V, and X).
It may be said that
N.N.’s condition cannot make a case for the necessity of episodic memory for
diachronic sense of self because N.N.’s impairments seem to encompass more than
episodic memory. This may be the case. Nonetheless, episodic memory was N.N.’s
most affected and permanently impaired cognitive function, considering that he
was able to reacquire semantic information that he had lost. The reacquisition
of self-knowledge, though, did not seem to make a difference to his condition;
for this reason, the case suggests that episodic memory plays a relevant role
in diachronic sense of self.
What does it all mean?
Klein
defends that episodic memory is not necessary in order for a person to have a
diachronic sense of self, because retrograde amnesiacs who lose episodic memory
of their whole lives exhibit diachronic sense of self. According to him, this
is due to the fact that they retain at least some self-knowledge, trait
self-knowledge, which is a subsystem of the semantic memory system “that stores
information about one’s personality in the form of trait generalizations”[56].
Trait self-knowledge would allow an individual with retrograde amnesia to
retain a sense of self, based on her dispositions, manifested in behavior in
various past episodes. This type of self-knowledge is different from
autobiographical semantic memory (factual semantic self-knowledge), which provides
information about self, such as date and place of birth. Therefore, this would
mean that knowing one’s own traits or personality is enough for one to have a
diachronic sense of self[57].
I assume that what Klein means by diachronic sense of self is slightly
different from how I have been using the term; he means a sense of oneself
extended in time, while I simply mean a sense of oneself at a different
time.
This
is an odd conclusion for Klein, though. He makes such a clear-cut difference
between what he calls the epistemological self and the ontological self.
Although I do not adopt Klein’s metaphysics, if I understand correctly, the
epistemological self is associated with neuro-cognitive information, and the
ontological self is associated with first-person subjective/phenomenal
experience. Hence, it would be out of line with this distinction to conclude
that semantic information is enough to engender a sense that is characterized
by its phenomenology; the diachronic sense of self. One would expect that in
Klein’s theoretical framework a diachronic sense of self would require
phenomenal subjective experience—i.e. the unity of consciousness. This is why I
assume that a more reasonable interpretation is that Klein means that the
diachronic sense of self springs from trait self-knowledge in addition to
continuous consciousness experience. The latter depends on the phenomenal unity
of consciousness (what Klein would call ontological self): “[w]e all have
direct acquaintance with a self, the apparent source of the phenomenal unity of
our perceptual and introspective experiences”[58].
Conscious experience is also important for Klein because he claims that it
supplies the sense of personal synchronicity[59].
If I
am correct, N.N. contradicts this conclusion. One must keep in mind that N.N.
eventually re-learned semantic information about himself, but the facts
re-learned did not seem to have provided him with an autonoetic
diachronic sense of self related to his pre-fugue existence (a sense of himself
extended in pre-fugue subjective time). N.N. did not manifest diachronic sense
of selfhood in his actions, in his general outlook, or in his feelings towards
people around him. He, for instance, did not go back to his pre-fugue habits,
and he considered his family strangers, while preferring he was still in the
company of fellow patients at the psychiatric ward where he stayed for some
time after his fugue episode[60].
Trait self-knowledge, thus, is not sufficient for a diachronic sense of self.
Finally,
Klein concludes that “diachronicity is not really
sensed at all”[61].
He seems to conclude this from his argument that conscious experience provides
a sense of personal synchronicity, which is ageless. Moreover, a sense of
personal synchronicity would allegedly be enough to settle issues of personal
identity (and related issues). I assume Klein means that, considering that
conscious awareness is timeless—i.e., it involves no reference to time—, there
cannot be a diachronic sense of self in cases such as the case of N.N. Roughly
stated, Klein’s proposal is that a sense of personal synchronicity, based on
continuous conscious experience, settles the debate.
I
would like to stress that the interesting point about N.N. is that re-learning
semantic autobiographical information about his life did not do much to bring
him closer to being his pre-fugue self. He did not go back to his old habits,
he still missed the people he met at the psychiatric ward, and he felt closer
to them than he did to his family[62].
As patient D.F., he seems to have formed a new identity. The point is that,
according to Klein’s theory, N.N. may have preserved a sense of personal
synchronicity, and for the sake of argument, I will grant that he did.
Nevertheless, it does not seem relevant to what makes personal identity
important to us. When humans feel that they are continuous or extended in time,
they do not mean only that they are continuously conscious. Most people would
probably not accept that conscious continuity is enough, even if one changes
drastically and has no memory or information about oneself. Klein’s sense of
personal synchronicity would guarantee at the most that N.N., for instance,
senses he existed a moment ago, considering that it is described as awareness
of “and now and now and now”[63].
For Klein’s proposal to maintain relevance, there must be some sense in which
the person senses herself as herself
at different times.
I
suspect that if Klein’s sense of personal synchronicity were to be relevant to
personal identity issues, it would have to smuggle in tacitly more than
continuous conscious experience. Continuous conscious experience is someone’s continuous conscious
experience. Tacitly, there is the assumption that conscious experience is
integrated with other aspects of self. When this integration does not happen,
the result is dissociation, such as N.N. exemplifies. This is why Klein’s
proposal that a diachronic sense of self encompasses trait self-knowledge seems
a feasible proposal at first. However, N.N.’s re-acquisition of self-knowledge
shows that self-knowledge is not sufficient for a diachronic sense of self,
even if a continuous conscious experience accompanies it.
If I
am correct, psychogenic amnesia cases show that episodic memory is necessary
for the sense of personal identity. What does this mean for Klein’s proposal? I
consider N.N. a problematic case for Klein’s proposal of a sense of personal
synchronicity as a sufficient condition for continuous selfhood because, as far
as we know, N.N. was continuously aware during his dissociation episode and
after that. According to Klein’s theory, he would have to say that N.N. has a
sense of personal synchronicity. That’s plausible, and even consistent with the
available information about N.N.’s case. Going back to the facts, N.N. went to
the bakery, had a fugue episode, and instead of returning home, he kept biking
for five days, crossing a few cities.
In
a city about 200 miles south of his home, he stopped and asked himself: “Why
are you riding a bike here? Where do you want to go to? Where do you come from?
Who are you?” He did not know what he looked like and so he viewed his
reflection in a store window and was surprised to see what he looked like[64].
Considering
that he was supposedly aware of himself the whole time (except for when he was
asleep), Klein’s proposal applies. However, can we say in any meaningful way
that N.N. had even a sense of continuity? It is clear that he had no diachronic
sense of self, considering either Klein’s proposal or my proposal; i.e., N.N.
did not have either a sense of himself at a past time or a sense of himself as
a self extended in time. A sense of continuity in
this case may be a point of dispute, but what N.N.’s case seems to signal is
that, in typical cases, awareness is not just awareness; it is my awareness. To N.N. the my
of awareness was emptied by dissociation. In fact, this is precisely why it is
a case of dissociation.
The
same cannot be said of episodic memory. Had N.N. been able to recall an episode
of his subjective past, he would experience himself as the subject of the
experience. Episodic memory, through autonoesis, is
an experience of self in an episode in subjective time. Therefore, my episodic memory is not devoid of
content—the autonoetic consciousness involved in it
allows experiencing my remembering as
an experience of the self. Episodic remembering is mine exactly in the sense
that, when I recall an episode of the subjective past, the subject of that
experience is the same as me. This provides a diachronic sense of self in a way
that is relevant to issues surrounding personal identity.
Furthermore, would we
not say that someone who remembers the day they started college or a fun moment
during a trip has a diachronic sense of self regarding that memory? Episodic
memories provide a pre-reflective sense of self, set in a different time from
the present, which is the diachronic sense of self. (It is pre-reflective
because one does not reflect about it being oneself in that memory. Autonoetic consciousness implies that my memory is an experience
belonging to self, placed in subjective time.)
Circularity
A famous objection to the memory criterion for personal
identity is circularity[65].
According to this line of objection, episodic memory cannot constitute personal
identity, because it already presupposes personal identity. Episodic memory is
necessarily my memory; i.e., its
definition encompasses the notion of self. Hence, it is circular to claim that
personal identity (self-identity) depends on episodic memory[66]. The
question then is whether the same objection applies to episodic memory as the
criterion for diachronic sense of self. I will offer two conceivable answers to
this possible objection.
When it comes to episodic memory
as a criterion for a diachronic sense of selfhood, the problem of circularity
is evaded because episodic memory does not depend on a sense of selfhood; it
engenders it. It is possible to think about having episodic memories without
having a sense of a self. A theory that proposes that there is no self, but
just a succession of mental states (this is a simplification of Hume’s view on
the matter of personal identity) would claim that there is no self to engender
a sense of self. A theorist who defends some version of this idea will probably
have to grant that, even if the theory is correct, autonoetic
consciousness provides a sense that these memories are mine[67]. A thin
one, for sure, but still a sense of it being my memory, a weak sense of self. This sense of self springs from
and is dependent on episodic memory; it is not presupposed in the memory. I
will consider that it is not a controversial point that episodic memories feel
like they are mine, or put it differently, that episodic memories encompass a
sense of a or one’s own self. Furthermore, the
recognition of the occurrence of chronesthesia and autonoetic consciousness in episodic remembering enables us
to see how episodic memory engenders a diachronic sense of self.
Another alternative to
answer the circularity objection considers dissociative disorders, which
suggest that a memory may not be owned; i.e., the idea that it may lack mineness. This
may be the case in dissociation identity disorder, in which an alter
personality (or more than one) allegedly is created as a defense to trauma. The
alter personalities protect the conscious self by disowning memories that the
person has trouble handling at the time[68].
They hold the troubling memories and experiences, “so that what is disowned or
‘not-me’ is attributed to her ‘inside people’ instead”[69].
The memories are personified in the alter personality. Thus, even if one does
not subscribe to the idea that there are no selves, there is reason to believe
that the present proposal evades the circularity objection because there may be
episodic memory without the attribution of the remembering to a self, i.e.,
without encompassing a sense of self. However, it is important to note that in
this kind of disorder the disowned episodic memories seem to be relevant to the
creation of alter personalities. The memories may be disowned by the person
suffering of the disorder, but they are still owned by the alter personality.
One may conclude that after all episodic memories must encompass a sense of mineness and that the first response to the circularity
objection is more suitable.
Conclusion
This investigation has focused on answering new challenges
to the episodic memory criterion for personal identity put forward by Klein’s claim
that individuals who suffer from extensive retrograde episodic amnesia still
have a sense of continuity. I have argued that the sense of continuity, as
Klein conceives it, does not add much to the issue of personal identity or
related issues that elicit philosophical concern. Moreover, the relevant sense
of selfhood to these issues is diachronic sense of self, which depends on
episodic memory.
Acknowledgements
I am grateful
for discussions with the participants and audience of the Workshop Philosophy
of Memory and Imagination at the XI Principia International Symposium. I would
like to thank an anonymous referee for helpful comments, as well as Joshua Turkewitz and Grupo de Escrita de Mulheres na Filosofia (Eduarda
Calado, Raquel Krempel, and
Nara Figueiredo) for comments on a previous version
of this paper.
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