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The concept of self is a construct. It is not a ‘natural kind’ sited somewhere in the human brain. The western concept of self emphasizes individualism and autonomy but this view is cultural and no more scientific or truthful or advanced than the syncytial or collective view of self developed in other cultures and which revolves around family or clan rather than individual. Originally meant by St Augustine to be just a metaphorical or virtual space within which theological models of responsibility, guilt and sin could be played out, the self regained importance in the hands of Luther who started its reification as a private cave where god and man would regularly meet to sort out their differences. During the seventeenth century, the metaphors of the Reformation become secularized and built into liberalism and capitalism. The self survived by becoming a conceptual prop for bourgeois notions such as individual ownership, natural rights and democracy.
Wanting to reinforce the political status quo, nineteenth-century science transformed the political self into a psychological entity and proceeded to ‘naturalize it’ (i.e. render it into a natural kind). This additional reification engendered curious inferences. One was the belief that a ‘self’ really existed inside the European mind and brain. This self was characterized as driving, organized, executive and with a capacity for leadership and domination.
This chapter concentrates on the issue of insight and memory function. Both awareness of memory dysfunction and awareness of memory function have been studied in relation to focal brain disease and generalized brain disease (dementias). With respect to 'normal' or non-ill subjects, self-reports of memory function have been treated mainly in experimental psychology where, rather than 'insight' or 'awareness', somewhat different frameworks are used. With respect to stage of the dementia, most studies suggest that insight is preserved early in the disease and diminishes with progression of the disease. In line with 'neurological' research, where associations have been described between 'anosognosia' and frontal lobe pathology attempts have been made to examine the role of the frontal lobe in the relationship between loss of insight and dementia. The different conceptualizations of insight influence the way in which the 'clinical' phenomena of insight/awareness and anosognosia are perceived and measured.
This chapter reviews the clinical features of memory complaints in subjects with no objective memory deficits, and reports in the said group the existence of two syndromes. It suggests a model to explain the 'functional cognitive disorganization' syndrome, and proposes a new way (echoing model) to understand complaints (including memory ones). Research into the concept of memory complaint is beset with conceptual difficulties. In a medical context, 'complaint' refers to utterances conveying negative personal assessments with regard to the functioning and efficacy of a bodily or mental function. The two syndromes are called 'mnestic hypochondria' (seen predominantly in bright, well-educated, obsessional males, with high-achievement motivation, no attentional deficit and marked anxiety) and the 'functional cognitive disorganization' syndrome (seen predominantly in females with low education and intelligence, low anxiety, and chronically dependent upon relevant others for the organization of their cognitive environment).
With respect to mechanisms underlying paramnesias, Kraepelin was less clear. He mentioned 'alterations of consciousness' which occurred with varying severity and caused a reduced capacity to differentiate between reality and fantasy. During the nineteenth century, the generic term paramnesia was used to refer to a group of clinical phenomena amongst which déjà vu, confabulations, and delusions and hallucinations of memory remain the more salient. These phenomena had been known since earlier but it was only after the work of Sander that they began to be considered as 'memory' disorders. In Kraepelin's taxonomy the paramnesias are included as 'qualitative' disorders of memory affecting either recognition or recollection. Déjà vu remains a curiosity seen in some forms of epilepsy and occasionally in the normal affected by fatigue. Delusions of memory are occasionally mentioned in the literature but hallucinations of memory have disappeared altogether.
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