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Fear can interrupt the continuum of memory
  1. PETER HARVEY, Emeritus Consultant Neurologist to the Royal Free Hospital, London, UK

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    I had always thought that the existence of post-traumatic amnesia, characterised by gaps in the patient's memory of events after an accident, particularly if the remaining “snapshots” of memory were particularly vivid, meant that the patient must have been knocked out, albeit briefly. I had always rejected the concept that fear, acute anxiety, panic, that which the layman calls “shock”, could be responsible for the phenomena of post-traumatic amnesia. That is until about 6 months ago.

    I was driving in the wet, too fast, in a convoy in the outside lane. The conditions were appalling; I was alert. Six or seven cars in front of me were involved in a “front to rear shunt”, precipitated by a car that had been stuck on the inside lane behind a slow moving vehicle, darting without warning into the outside lane.

    I remember seeing this car do this, I have a vivid image of seeing a car, perhaps two away from me, suddenly appearing at right angles—I could see its rear end to the left of, and the front end to the right of the car in front of me. I have no recollection of putting my brakes on, and then I have a very clear image of the car in front of me coming towards me as I skidded. This was a crystal clear isolated image, associated with an absolute conviction that I was about to die—the car was a small red Honda saloon, the front passenger was wearing a flowery hat, and there was a black and white soft toy dangling in the rear window. I have no recollection of avoiding this car, or steering or skidding to the offside, I have no recollections until that of my car slithering to a bumpy halt on the grass verge at the central reservation of the road. I remember thinking that the antiskid mechanisms had not worked. My next recollection is of looking down through my opened door (without any memory of opening it) at the thick mud of the central reservation and thinking that I would have to clean my shoes after walking on it. At that point clear and continual memory is restored and I went to see if I could assist the people in the other cars, and eventually I drove off.

    As I continued on I ruminated on events, and realised that there was no doubt about it—there were significant blanks in my memory of events, and that furthermore those memories I did have were extremely vivid—the hat, the dangling toy, the sure fire knowledge that I was about to die, and the light brown slimy mud on the central reservation.

    There is no question at all of my having hit my head, or being subjected to any violent to and fro acceleration or deceleration forces—this was peritraumatic amnesia in which the trauma was wholly psychological.

    I am grateful to my anonymous referees for drawing my attention to two reviews—by van der Kolk and Fisler1 and by Kopelman2—on the subject of psychological trauma and amnesia. Neither papers describe precisely what I am describing and neither accentuates what to me is a most remarkable phenomenon and that is the very vivid nature of these memories. Now, 6 months later, some of the memories are beginning to fade, but interestingly it is not the conviction of impending death that persists but it is the image of the mud. This vivid nature of post-traumatic amnesic memories was described by Russell and Nathan.3 I think that this is what differentiates my experience from a dissociative state—although I am obviously open to correction on this.

    In answer to the inevitable question from my fellow medicolegal report writers—no I did not develop any of the features of “post-traumatic stress disorder”.

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