Department of Psychiatry, University of California, San Diego, San Diego, California 92103, USA.
J Trauma Dissociation. 2009;10(4):420-35. doi: 10.1080/15299730903143618.
Dissociative amnesia that encompasses one's entire life and identity is a rare disorder, as is dissociative fugue. In evaluating such cases, a dichotomy is often invoked between functional and organic etiologies. However, this dichotomy suffers from both conceptual and ethical flaws. Conceptually, putative brain-based, organic etiologies for many dissociative disorders-including dissociative amnesia-exist. Ethically, such dichotomies may result in dismissive care for patients with distress-based disorders like dissociative amnesia. In support of humane, neurobiologically informed treatment of patients with dissociative amnesia, we present excerpts from 2 post-event interviews with a patient who suffered and recovered from an episode of dissociative amnesia and fugue. Following this, we review current neurobiological models of dissociative amnesia that undermine the dichotomy of functional versus organic, and suggest that the crucial distinction in such cases is between a patient's willful, conscious deceit and processes that occur without conscious intent.
广泛性失忆症（包含一个人的整个生活和身份）和分离性神游症都是罕见的疾病。在评估这些病例时，人们通常会在功能性和器质性病因之间进行二分法。然而，这种二分法存在概念和伦理上的缺陷。从概念上讲，包括分离性失忆症在内的许多分离性障碍都存在基于大脑的器质性病因。从伦理上讲，这种二分法可能会导致对以痛苦为基础的疾病（如分离性失忆症）的患者的护理被轻视。为了支持对分离性失忆症患者进行人道的、基于神经生物学的治疗，我们从一位遭受并从分离性失忆症和神游症发作中恢复的患者的两次事后访谈中摘录了一些内容。之后，我们回顾了当前关于分离性失忆症的神经生物学模型，这些模型破坏了功能性与器质性之间的二分法，并表明在这种情况下，关键的区别在于患者的故意、有意识的欺骗和无意识意图下发生的过程。
