Aspects of psychodynamic neuropsychiatry I: episodic memory, transference, and the oddball paradigm

Psychotherapy has, since the time of Freud, focused on the unconscious and dynamically repressed memory. This article explores a therapy where the focus is on what is known, on episodic memory. Episodic memory, along with semantic memory, is part of the declarative memory system. Episodic memory depends on frontal, parietal, as well as temporal lobe function. It is the system related to the encoding and recall of context-rich memory. While memory usually decays with time, powerfully encoded episodic memory may augment. This article explores the hypothesis that such augmentation is the result of conditioning and kindling. Augmented memory could lead to a powerful "top-down" focus of attention-such that one would perceive only what one had set out to perceive. The "oddball paradigm" is suggested as a route out of such a self-perpetuating system. A clinical example (a disguised composite of several clinical histories) is used to demonstrate how such an intensification of memory and attention came about as a result of the transference, and how the "oddball paradigm" was used as a way out of what had become a treatment stalemate.