http://www.nybooks.com/articles/16951
The New York Review of Books
Volume 51, Number 4
Review
The Trauma Trap
By Frederick C. Crews
Remembering Trauma
by Richard J. McNally
Belknap/Harvard University Press, 420 pp., $35
Memory, Trauma Treatment, and the Law
by Daniel Brown, Alan W. Scheflin, and D. Corydon
Hammond
W. W. Norton, 768 pp., $100.00
1.
Every now and then a book appears that can be instantly recognized as essential
for its field--a work that must become standard reading if that field is to be
purged of needless confusion and fortified against future errors of the same
general kind. Such a book is Remembering Trauma, by the Harvard psychology
professor Richard J. McNally. To be sure, the author's intention is not
revolutionary but only consolidating; he wants to show what has already been
learned, through well-designed experiments and analyses of records, about the
effects that psychological trauma typically exerts on our memory. But what has
been learned is not what is widely believed, and McNally is obliged to clear
away a heap of junk theory. In doing so, he provides a brilliant object lesson
in the exercise of rational standards that are common to every science
deserving of the name.
McNally's title Remembering Trauma neatly encapsulates the opposing views that,
for a whole generation now, have made the study of trauma into psychology's
most fiercely contested ground. Are scarring experiences well remembered in the
usual sense of the term, or can some of them be remembered only much later,
after the grip of a self-protective psychological mechanism has been relaxed?
This is the pivotal issue that McNally decisively resolves. In the process, he
also sheds light on a number of related questions. Does memory of trauma stand
apart neurologically from normal memory? Does a certain kind of traumatic
experience leave recognizable long-term effects that can vouch for its
historical reality? What memory problems typify
post-traumatic stress disorder, and does the disorder itself "occur
in nature" or is it a cultural construct? And is memory retrieval a
well-tested and effective means of helping adults to shed depression, anxiety,
and other psychological afflictions?
One extended trauma, a public one, that
won't be soon forgotten by the involved parties is
central to McNally's argument. I refer to the great sex panic that gripped this
continent from about 1985 to 1994. It wasn't just an epidemic of runaway fear, rumor, and persecution but a grimly practical test of the
theories whose currency made it possible. And the theories at issue were
precisely those that are exhaustively reviewed in Remembering Trauma. McNally
uses that chapter of our history to show just how much damage can be done when
mistaken ideas about the mind get infused with ideological zeal.
In the 1980s, as McNally relates, day care workers risked prosecution and
imprisonment on the coerced testimony of bewildered and intimidated
three-year-olds who were prodded to "remember" nonexistent
molestations. Meanwhile, poorly trained social workers, reasoning that signs of
sexual curiosity in children must be "behavioral
memories" of rape, were charging parents with incest and consigning their
stunned offspring to foster homes. And most remarkably, whole communities were
frantically attempting to expose envisioned covens of Satan worshipers who were
said, largely on the basis of hypnotically unlocked "memories," to be
raising babies for sexual torture, ritual murder, and cannibal feasts around
the patio grill.
In the same period many psychotherapists, employing hypnosis, dream analysis,
"guided imagery," "age regression," and other
suggestion-amplifying devices, persuaded their mostly female patients to
"remember" having been molested by their fathers or stepfathers
through much of their childhood, in some cases with the active participation of
their mothers. The "perpetrators" thus fingered were devastated,
embittered, and often publicly shamed, and only a minority of their accusers
eventually recanted. Many, in fact, fell in with their therapists' belief that
young victims of sexual trauma, instead of consciously recalling what was done
to them, are likely to develop multiple personalities. Disintegrating further,
those unfortunates were then sent off to costly "dissociative
identity" wards, where their fantasies of containing five, a dozen, or
even hundreds of inner selves were humored until
their insurance coverage expired and they were abandoned in a crazed condition.
At the height of the scare, influential traumatologists
were opining that "between twenty and fifty percent of psychiatric
patients suffer from dissociative disorders"[1]—disorders whose reported incidence plummeted toward zero as
soon as some of the quacks who had promoted them began to be sued for
malpractice.[2]
What we experienced, McNally shows, was a
perfect storm, with forces for mischief converging from every side. The
fraudulent 1973 bestseller Sybil had already helped to relaunch
the long-dormant fad of multiple personality and to link it to childhood sexual
abuse.[3] Beginning in the early
1980s, the maverick Swiss psychoanalyst Alice Miller taught many American
readers what Sigmund Freud had once believed, that memories of early abuse are
typically repressed and must be therapeutically unlocked if the resultant
neuroses are to be cured. Jeffrey Masson's melodramatic book The Assault on
Truth (1984), misrepresenting Freud's "seduction" patients as
self-aware incest victims rather than as the doubters that they remained,
fanned the feminist anger that Miller had aroused, encouraging women to believe
that molestation by fathers must be pervasive.[4] Self-help
manuals such as The Courage to Heal (1988) then equipped scientifically
ignorant psychotherapists with open-ended "symptom checklists,"
ensuring that their patients would be diagnosed as suffering from buried memories
of violation. And all the while, Geraldo Rivera and less cynical alarmists were
whipping up fear of murderous devil cults.
If the origins of our mass delusion were complex, its dissipation in the
mid-1990s is easily explained. Like the
One recovered memory case in particular,
less absurd than most but nevertheless lacking in prima facie plausibility, set
in motion what the movement's loyalists now bitterly characterize as "the
backlash." In 1991 the future "betrayal trauma" psychologist
Jennifer J. Freyd, after her therapist had pointedly
asked her in their second encounter whether she had ever been abused, suddenly
"remembered" that her father had continually molested her between the
ages of three and sixteen. It was Freyd's mother,
Pamela, convinced that she would surely have noticed some effects of countless
domestic sex crimes against her daughter, who then made contact with other
recently accused parents and established the False Memory Syndrome Foundation.
Under Pamela Freyd's leadership, the foundation (on
whose advisory board I serve) gathered and disseminated the most authoritative
scientific judgments about trauma, memory, and suggestive influence—judgments
that swayed enough jurists, legislators, and journalists to bring a healthy skepticism into play.
What put Jennifer Freyd's "memories" in
question wasn't just their dissonance with her mother's close observation. By
alleging fourteen years' worth of molestations that had been unknown to her
conscious mind prior to a therapist's prompting, Freyd
was invoking an outlandish new defense mechanism. Granted, some psychologists
still believed in repression, or the sequestering of a disagreeable thought or
memory inside "the unconscious"; and others subscribed to
dissociation, the more radical knack of "splitting the self" so
quickly that no narrative memory of the trauma gets formed at all. But Freyd's story, like many others that surfaced during the
sex panic, stretched those principles to cover any number of serial traumatic
incidents, as if a person could be subjected to the same outrage hundreds of
times without taking cognitive note of it.
This cumulative forgetting of harmful experience is what the social
psychologist Richard Ofshe disdainfully named robust
repression—a startlingly maladaptive behavior that,
if actual, ought to have aroused wonder and consternation from the earliest
times until now, if indeed it didn't lead to the extinction of our species.
Before the American 1980s, however, it had apparently never once been remarked.
Could robust repression itself have been robustly repressed throughout the
millennia?
Most recovered memory advocates have ducked the conundrum of robust repression,
and some have dismissed it as an alien notion devised by their adversaries. But
the alleged phenomenon, McNally shows, is nothing other than the "massive
repression" posited by such prominent traumatologists
as Judith Lewis Herman, Judith L. Alpert, Lenore C. Terr,
and Jennifer J. Freyd herself, each of whom
understood that claims of sudden access to a long string of previously
unsuspected horrors require a basis in theory. What could that basis be?
McNally makes short work of the only systematic attempts, Terr's
and Freyd's, to maintain that serial traumas are
easier to forget than single ones. Moreover, all such efforts are doomed to be
question begging, because the only evidence favoring
robust repression consists of the very memories whose authenticity hangs in
doubt.
The same stricture applies, however, to
repression and dissociation per se. Those notions became current in the 1880s
and 1890s when Freud and Pierre Janet independently attempted to trace the then
fashionable complaint of hysteria to pathogenic hidden memories and to expunge
the ailment through hypnotically induced recall. Freud, by far the more
influential figure, clung to repression—though rendering it progressively more
elastic and ambiguous--even while repeatedly distancing himself
from the diagnostic and curative claims he had inferred from its supposed
workings.
Before he was finished, Freud had conceived of repression as both a conscious
and an unconscious process acting upon feelings,
thoughts, ideas, and fantasies as well as memories. Such profligacy left
repression without any operational meaning; "the repressed" was
simply any material that Freud, who was given to ascribing his own punning
associations to his patients' minds, chose to identify as having been dismissed
from awareness. Yet the long vogue of psychoanalysis kept the concept alive,
enabling it to be virulently readapted, a century after its formal
introduction, to the same task of recruiting patients to victimhood
that had preoccupied its champion in 1895-96.
As McNally explains through deftly analyzed examples, it isn't just therapists
and their patients who fail to ask prudent questions about the repression or
dissociation of trauma. The body of research purporting to validate those
mechanisms is riddled with procedural errors, most of which stem from naïve
trust in the retrospection of subjects who have already been led to believe
that they must have undergone a trauma that was then sequestered from memory.
Along with such other inquirers as David Holmes and Harrison G. Pope, Jr., McNally understands that a good test of repression or
dissociation has to be prospective. That is, it must track down people who are
known with certainty to have lived through ordeals that would be expected to
have triggered a self-protective loss of memory, and it must then ascertain how
many of those people are unable to recall the event.
Holocaust survivors make up the most famous class of such subjects, but
whatever group or trauma is chosen, the upshot of well-conducted research is
always the same. Like Holmes and Pope, McNally finds that no unanswerable
evidence has been adduced to prove that anyone, anywhere, has ever repressed or
dissociated the memory of any occurrence. Traumatic experiences may not always
remain in the forefront of memory, but, unlike "repressed" ones, they
can be readily called to mind again. Unless a victim received a physical shock
to the brain or was so starved or sleep deprived as to be thoroughly
disoriented at the time, those experiences are typically better remembered than
ordinary ones. Thus Judith Herman's much-quoted maxim, "The ordinary
response to atrocities is to banish them from consciousness,"[5]
would appear to be exactly opposite to the truth. And once that fact is
understood, the improvised and precarious edifice of recovered memory theory
collapses into rubble.
2.
It would be a serious mistake, however, to assume that reckless traumatology has now been permanently laid to rest. The
conviction that fathers are naturally prone to incestuous rape is still
current. In some academic departments, a dogged literalism about the
repression/dissociation of trauma has become oddly wedded to postmodernist
suspicion of science.[6] Furthermore, most of the "trauma
centers" that sprang up in the 1990s to study
and treat psychogenic amnesia are still operating under the same premises as
before. As for the theoreticians of recovered memory, they continue to use
their positions of authority in universities, hospitals, and professional organizations
to advance the views whose hollowness McNally has exposed, and they can still
count on a surprising level of support from their colleagues.
Consider, in this regard, the following example of deafness to the lessons of
the sex panic. Each year the American Psychiatric Association, the body that
sets the most basic guidelines for sound practice in our mental health
professions, bestows its Manfred S. Guttmacher Award
on what it deems to be the best recent publication on legal psychiatry. The
prize for 1999 went to a 768-page tome by Daniel Brown, Alan W. Scheflin, and D. Corydon Hammond, Memory, Trauma Treatment,
and the Law. The authors characterize themselves as "voices of moderation
in the middle" opposing "zealots on both sides" (p. 1). Their
book, however, consists largely of sophistical
pleading for already lost causes: the forensic value of therapeutically
retrieved memories, the genuineness of multiple personality disorder, the
likelihood that some reports of ritual abuse cults are accurate, and the
desirability of allowing evidence obtained through hypnosis to be admissible in
court.
Memory, Trauma Treatment, and the Law isn't just a disingenuous book, hiding
its partisanship behind a screen of sanctimony; it is also a noxious one.
Lightly granting the possibility that therapy may occasionally lead to pseudomemories, it trivializes the problem, deeming it
serious only "when the patient takes legal action or publically
[sic] discloses abuse" (p. 37)--as if the suffering of privately shattered
families counted for nothing. And the book's strategy of superficially
"reviewing the literature," citing both skeptical
and (always more numerous) credulous studies and then tilting the scales toward
the latter, merely simulates scientific neutrality.
These authors' activism in the cause of
recovered memory was well known long before they collaborated on their
prize-winning volume. Daniel Brown and Alan Scheflin
had often served as expert witnesses minimizing the hazards of memory
retrieval, claiming to have found overwhelming experimental support for the
concept of repression, and denying that a therapist could ever deceive a
patient into thinking that she suffered from multiple personality; and their
collaborative papers were similarly one-sided.[7] In 1995,
moreover, Scheflin had delivered a warmly received
address to a Texas conference held by the Society for the Investigation,
Treatment and Prevention of Ritual and Cult Abuse, whose other speakers
asserted, inter alia, that there were 500 Satanic
cults in New York City alone, committing 4000 human sacrifices per year, that
Bill Clinton was serving as the Antichrist in the worldwide Satanic fraternity
of the Illuminati and that the False Memory Syndrome
Foundation is "a Central Intelligence Agency action." Expressing
solidarity with the assembled psychotherapists whose diagnoses of ritual abuse
were exposing them to malpractice suits, Scheflin counseled them on the best means of foiling the legal
machinations of "the false memory people," whom he characterizes as
"the enemy."[8]
But it is hypnotherapist D. Corydon Hammond, well
known for his low regard for experimental research on memory,[9]
whose name on the title page of Memory, Trauma Treatment, and the Law ought to
have prompted especial wariness among the Guttmacher
judges. Like Scheflin,
In a notorious 1992 lecture at a conference on sexual abuse and MPD,
… is that they want an army of
Manchurian Candidates, tens of thousands of mental robots who will do
prostitution, do child pornography, smuggle drugs, engage in international arms
smuggling, do snuff films, . . . and eventually the megalomaniacs at the top
believe they'll create a Satanic order that will rule the world.[10]
These colorful fantasies are significant, but not because they
point to a failure of reality testing on
The illogicalities
and distortions in Memory, Trauma Treatment, and the Law do not go unremarked in McNally's Remembering Trauma. Thus, when
Brown et al. cite one study as evidence that "amnesia for Nazi Holocaust
camp experiences has also been reported," McNally quotes that study's
rather different conclusion: "There is no doubt that almost all witnesses
remember Camp Erika in great detail, even after 40 years" (p. 192). And
when Brown et al., again straining to make psychologically motivated amnesia
look commonplace, cite another study to the effect that "two of the 38 children
studied after watching lightning strike and kill a playmate had no memory of
the event," McNally informs us that those two children "had
themselves been struck by side flashes from the main lightning bolt, knocked
unconscious, and nearly killed" (p. 192).
Such corrections, however damning, are peripheral to McNally's fundamental
critique of Brown and his colleagues. The heart of the matter is that Brown et
al. have miscast the entire debate over recovered memory by marshaling
evidence against a straw-man "extreme false memory position."
Supposedly, the extremists hold that all refreshed memories of abuse are
necessarily wrong. Then one could put the extremists in their place just by
citing a few cases of authenticated recall. But as McNally shows, critics of
recovered memory fully allow that a period of forgetfulness can precede a
genuine recollection. Indeed, that pattern is just what we would expect if the
young subject at the time of the act, never having been warned against sexual
predators, was unsure how to regard that act. What the critics deny is that
"memories" of trauma, surfacing for the first time many years later,
are so intrinsically reliable that they can serve as useful evidence that the
experience was real. Brown, Scheflin, and Hammond
want that extremism to be embraced once again by the legal system that has
finally learned to distrust it.
It would be reassuring to think that the the American
Psychiatric Association's Guttmacher jury merely
skimmed Memory, Trauma Treatment, and the Law and misconstrued it as a bland
eclectic survey. Already in 1991, however, another Guttmacher
Award had been bestowed on co-author Scheflin for a
work that made several of the same legal arguments.[12] A more likely explanation for the subsequent prize
is that Brown et al., having mounted a brief for the deep knowledge and expert
testimony of theory-minded clinicians, were gratefully perceived as siding with
mental health providers against their adversaries. If so, a larger question
comes into view. What role did our major societies representing
psychotherapists--the American Psychoanalytic Association, the American
Psychological Association, and the American Psychiatric Association itself--play
in condoning or actually facilitating the recovered memory movement, and how
much enlightened guidance can we expect from them in the future?
3.
As I have noted on several occasions,[13] and as McNally
confirms, in the 1990s recovered memory therapy made significant inroads into
the practice of North American psychoanalysis. Even today, feminist clinicians
bearing diplomas from analytic institutes are probing for missing memories of
abuse and vigorously defending that practice in psychoanalytic books and
journals. But the American Psychoanalytic Association, representing over 3,000
members, has turned a blind eye to this trend—and one can understand why. The
psychoanalytic movement is already embattled, and too much about the historical
ties between Freudianism and recovered memory would prove embarrassing if
attention were called to it. The elected custodians of Freud's legacy have no
desire to confront his early phase as a self-deceived abuse detecter;
or to admit the precedent he set, during that phase and thereafter, in treating
dreams, tics, obsessional acts, and agitation in the
consulting room as "behavioral memories" of
inferrable traumas; or to revisit the grave doubts
that have been raised about repression; or to be reminded of the way
psychoanalysts, until quite recently, insulted real victims of molestation by
telling them that their "screen memories" covered a repressed desire
to have sex with their fathers.[14] No longer given to
excommunicating dissidents, the tottering Freudian patriarchy has made its
peace with "recovered memory psychoanalysis" by pretending that it
doesn't exist.
The largest of the three societies riven by the issue
of recovered memory, the 95,000-member American Psychological Association
(hereafter APA), is nominally responsible for quality control in the
administration of therapy by the nation's clinical psychologists. Hence one APA division's commendable effort in the 1990s to
identify the most effective treatment methods for specific complaints such as
phobias and obsessive-compulsive disorder. That initiative, however, met
with disapproval from APA members whose favorite
regimens had not been found to give superior results. Some practitioners
worried that insurers would use the list of approved treatments as an excuse to
cut off reimbursement for all but the preferred therapies, and others
complained that the association seemed on the verge of putting soulless
experimentation ahead of clinical know-how. For now at least, the organization
as a whole is not recommending treatments, to say nothing of disavowing
dangerous ones.[15] Recovered memory
thus gets the same free pass from the APA as "attachment therapy,"
"therapeutic touch," "eye movement desensitization and
reprocessing," "facilitated communication," and the hypnotic
debriefing of reincarnated princesses and UFO abductees.[16]
This reluctance to challenge the judgment of its therapist members is deeply
rooted in the APA's philosophy. Ever
since 1971, when the association gave its blessing to Ph.D. and Psy.D. programs that
omitted any scientific training, the APA has guided its course by reference to
studies indicating that the intuitive competence of clinicians, not their
adherence to one psychological doctrine or another, is what chiefly determines
their effectiveness.[17] Those studies, however, were
conducted before recovered memory practitioners, using a mixture of peremptory
guesswork and unsubstantiated theory, began wrenching patients away from their
families and their remembered past.
In 1995 the APA did publish a brochure, "Questions and Answers about
Memories of Childhood Abuse," which can still be found on the "APA
Online" Web site. The document combined some prudent advice to patients
with soothing reassurance that "the issue of repressed or suggested
memories has been overreported and
sensationalized." Further inquiry into the phenomenon, it said, "will
profit from collaborative efforts among psychologists who specialize in memory
research and those clinicians who specialize in working with trauma and abuse
victims."
But the APA directors already knew that such collaboration was impossible. In
1993 they had established a "task force," the Working Group on the
Investigation of Memories of Childhood Abuse, self-defeatingly
composed of three research psychologists and three clinicians favorably disposed to retrieval, and the task force had
immediately degenerated into caucusing and wrangling. After years of stalemate,
the group predictably submitted two reports that clashed on every major point;
and the abashed APA, presented with this vivid evidence that "clinical
experience" can lead to scientific heterodoxy, declined to circulate
photocopies of the two documents even to its own members except by individual
demand.
Meanwhile, the organization repeatedly compromised its formal neutrality. In
1994, for example, the APA's publishing house lent
its prestigious imprint to a book that not only recommended recovered memory therapy
but recycled the most heedless advice found in pop-psychological manuals. The
book, Lenore E. A. Walker's Abused Women and Survivor Therapy: A Practical
Guide for the Psychotherapist, touted hypnotism as a legitimate means of
gaining access to "buried memories of incest" and "different
personalities" within the victim (pp. 425-426).
Then in 1996 the APA published and conspicuously endorsed another book, Recovered
Memories of Abuse, aimed at equipping memory therapists and their expert
witnesses with every argument and precaution that could thwart malpractice
suits.[18] The book's co-authors
were well-known advocates of recovered memory treatment, and one of them, Laura
S. Brown, was actually serving at the time on the deadlocked task force. She
had also supplied a foreword to Lenore Walker's bumbling Abused Women and
Survivor Therapy, calling it "invaluable and long overdue" (p. vii).
Unsurprisingly, then, Recovered Memories of Abuse characterized false memory as
an overrated problem and drew uncritically on much of the research whose
weaknesses Richard McNally has now exposed. The APA's
unabated promotion of that book, even today, suggests that the organization
remains more concerned with shielding its most wayward members than with
warning the public against therapeutic snake oil.
There remains, once again, the American
Psychiatric Association—"the voice and conscience of modern
psychiatry," as its Web site proclaims. Putting aside the fiasco of the
1999 Guttmacher Award, we might expect that a society
representing 37,000 physicians, all of whom have been schooled in the standard
of care that requires treatments to be tested for safety and effectiveness,
would be especially vigilant against the dangers of retrieval therapy. Thus
far, however, that expectation has not been fulfilled.
To be sure, the Psychiatric Association's 1993 "Statement on Memories of
Sexual Abuse" did warn clinicians not to "exert pressure on patients
to believe in events that may not have occurred. . . ." Yet the statement
inadvertently encouraged just such tampering by avowing that the "coping
mechanisms" of molested youngsters can "result in a lack of conscious
awareness of the abuse" and by characterizing "dissociative
disorders" as a typical outcome of that abuse. Those remarks constituted a
discreet but unmistakable vote of confidence in multiple personality disorder
and its imagined sexual etiology. And indeed, a year
later the fourth edition of the Psychiatric Association's Diagnostic and
Statistical Manual of Mental Disorders (DSM-IV) reaffirmed the validity of MPD
under the more dignified and marketable name of dissociative
identity disorder.
The Psychiatric Association's 1993 declaration on abuse memories performed
still another service, a subtle one, for the repression/dissociation lobby. In
explaining "implicit" memory—the kind that is exercised in the
routine execution of skills or in the coloring of
emotions by past impressions that aren't being explicitly called to mind—the
statement proffered a curiously strained example. "In the absence of
explicit recall," it said, implicit memory can torment "a combat
veteran who panics when he hears the sound of a helicopter, but cannot remember
that he was in a helicopter crash which killed his best friend." Here was
an elision of the crucial gap between merely not thinking about a past event,
as in the normal operation of implicit memory, and having total, psychologically
motivated amnesia for that event.
Knowledgeable readers would have seen that in taking this unusual step, the
statement's drafters were lending their authority to one controversial
interpretation of post-traumatic stress disorder (PTSD), which the Psychiatric
Association had first stamped as genuine in DSM-III of 1980. But why should a
primarily martial ailment have figured even indirectly in a position paper on
childhood sexual abuse? The mystery vanishes, however, if we know that the
recovered memory movement's favorite means of
courting respectability has been to fold the symptoms of repressed/dissociated
abuse into PTSD.
In 2000 the Psychiatric Association's trustees, eschewing risky flights into
theory, approved a lower-profile "Position Statement on Therapies Focused
on Memories of Childhood Physical and Sexual Abuse." This declaration,
however, was more pussyfooting than its predecessor. The validity of recovered
memory treatment, it whispered, "has been challenged" in some
quarters. While pointing out that memories can be altered as a result of
suggestions from "a trusted person or authority figure," the drafters
tactfully refrained from mentioning that the suggesting party is usually a
therapist. And clinicians were advised to avoid "prejudging the veracity
of the patient's reports" of abuse, as if false reports were typically
delivered to therapists out of the blue, without influence from
confabulation-enhancing devices employed within the treatment. The absence of
any mention of those devices, such as hypnosis and sodium amytal,
marked a step backward from the association's 1993 statement.
These equivocations neither helped nor impeded the already withering recovered
memory movement. As we will now see, however, the movement's hopes of a
comeback have been pinned on the Psychiatric Association's fateful decision to
treat post-traumatic stress disorder as an integral and historically invariable
malady. And that decision was a medically unwarranted one. As McNally indicates
with reference to several recent studies, PTSD, like Victorian hysteria and
like recovered memory itself, can now be understood as an artifact
of its era--a sociopolitical invention of the
post-Vietnam years, meant to replace "shell shock" and "combat
fatigue" with an enduring affliction that would tacitly indict war itself
as a psychological pathogen.[19] However crippling the
symptoms associated with it may be for many individuals, the PTSD diagnosis
itself has proved to be a modern contagion.
Once certified by the American Psychiatric
Association as natural and beyond the sufferer's control, post-traumatic stress
disorder began attracting claimants, both civilian and military, who schooled
themselves in its listed symptoms and forged a new identity around remaining
uncured. By now, as McNally relates, PTSD compensation is demanded for such
complaints as "being fired from a job, one-mile-per-hour fender benders,
age discrimination, living within a few miles of an explosion (although unaware
that it had happened), and being kissed in public" (p. 281). According to
Paula Jones among others, PTSD can even be the outcome of a consensual love
affair. In view of such examples, the attempt to subsume forgotten abuse under
post-traumatic stress makes more cultural than scientific sense; the same
atmosphere of hypersensitivity and victimhood brought
both diagnoses to life.[20]
As McNally shows in his concise and undemonstrative style, the national sex
panic left its mark on each successive version of the Psychiatric Association's
bible, which in turn congealed folklore into dogma. The 1980 DSM-III entry on
post-traumatic stress disorder, mindful only of wars and other shocking
disasters, had defined a PTSD-triggering event as one that falls
"generally outside the range of usual human experience" and that
"would evoke significant symptoms of distress in almost everyone." In
1994, however, the fourth edition generously expanded the category of
precipitating causes to include "developmentally inappropriate sexual
experiences without threatened or actual violence or injury." Thus a
single-minded therapeutic sleuth could now place a questionably retrieved
incident of infantile genital fondling on the same etiological plane as the
It was the diagnostic manual, once again, that removed the largest obstacle of
all to the merger of post-traumatic stress and recovered memory. The key sign
of PTSD, as first conceived, was that accurate recollections of the trauma keep
intruding on the patient's conscious mind; this was just the opposite of
repressed or dissociated memory. But between DSM-III and its revised edition of
1987, PTSD patients were discovered to have been harboring
a convenient new symptom. In 1980 they had shown only some incidental
"memory impairment or trouble concentrating" on daily affairs, but
the updated edition replaced routine forgetfulness with "inability to
recall an important aspect of the trauma" (emphasis added).
This retroactive infusion of amnesia into
the clinical picture of PTSD explains why the Psychiatric' Association's
illustrative helicopter pilot could have been troubled by a memory that had
left no conscious imprint on his mind. Here, too, was the opening needed to
give dissociation an appearance of hard-scientific concreteness. Post-traumatic
stress, it was now claimed, short-circuits narrative memory and finds another,
precognitive, channel through which it can flood the subject with anxiety.
Accordingly, diehard recovered memory theorists took up a last refuge in
neurobiology, now maintaining that dissociated sexual abuse generates signature
alterations of brain tissue.
With the arrival of McNally's Remembering Trauma, there is no longer any excuse
for such obfuscation. It makes no sense, McNally shows, to count forgetfulness
for some "aspect of the trauma" within the definition of PTSD, because
normal people as well as PTSD sufferers get disoriented by shocking incidents
and fail to memorize everything about the event, even while knowing for the
rest of their lives that it occurred. Likewise, it has never been established,
and it seems quite unbelievable, that people can be haunted by memories that
were never cognitively registered as such. Nor can specific brain markers vouch
for the reality of a long-past sexual trauma, because, among other reasons,
those features could have been present from birth. "It is ironic,"
McNally reflects, "that so much has been written about the biological
mechanisms of traumatic psychological amnesia when the very existence of the
phenomenon is in doubt. What we have here is a set of theories in search of a
phenomenon" (p. 182n.).
Remembering Trauma is neither a polemic nor a sermon, and McNally offers little
counsel to psychotherapists beyond warning them against turning moral
disapproval of pedophilia into overconfidence that
they can infer its existence from behavioral clues
observed twenty or thirty years after the fact. But another lesson is implied
throughout this important book. Attention to the chimerical task of divining a
patient's early traumas is attention subtracted from sensible help in the here
and now. The reason why psychotherapists ought to familiarize themselves with
actual knowledge about the workings of memory, and why their professional
societies should stop waffling and promulgating misinformation about it, is not
that good science guarantees good therapy; it is simply that pseudoscience
inevitably leads to harm.
Notes
[1] Bessel A. van der Kolk and Onno van der Hart, "The Intrusive Past: The Flexibility of
Memory and the Engraving of Trauma," American Imago, vol. 48 (1991), pp.
425-454; the quotation is from p. 432.
[2] The fullest treatment of the recovered memory episode and
its historical antecedents is Mark Pendergrast,
Victims of Memory: Sex Abuse Accusations and Shattered Lives, 2nd ed. (Upper
Access, 1996). For a concise and pointed account of the multiple personality fad, see Joan Acocella, Creating
Hysteria: Women and Multiple Personality Disorder (Jossey-Bass,
1999). The best extended discussion is Nicholas P. Spanos,
Multiple Identities and False Memories: A Sociocognitive
Perspective (American Psychological Association, 1996). On Satanic abuse, see
Jeffrey S. Victor, Satanic Panic: The Creation of a Contemporary Legend (Open
Court, 1993), and Debbie Nathan and Michael Snedeker,
Satan's Silence: Ritual Abuse and the Making of a Modern American Witch Hunt
(Basic Books, 1995). The plight of daycare workers
who remain imprisoned even today is treated by Dorothy Rabinowitz,
No Crueler Tyrannies: Accusation, False Witness, and
Other Terrors of Our Times (Wall Street Press Books/Free Press, 2003).
[3] For the current state of knowledge about "Sybil,"
see Mikkel Borch-Jacobsen, Folie à plusieurs:
De l'hystérie à la dépression (Les Empêcheurs de penser en rond/Le Seuil, 2002), pp. 111-168.
[4] For Masson's errors about Freud's "seduction"
phase, see Allen Esterson, "Jeffrey Masson and
Freud's Seduction Theory: A New Fable Based on Old Myths," History of the
Human Sciences, vol. 11 (1998), pp. 1-21. In his preface to a recently
reprinted edition of The Assault on Truth (Random House, 2003), Masson at last
concedes that Freud's patients in 1895-96 resisted the incest stories that he
tried to force upon them. Bizarrely, however, Masson still counts those
patients among the likely victims of sexual abuse in Freud's day.
[5] Judith Lewis Herman, Trauma and Recovery (Basic Books,
1992), p. 1.
[6] See, in this connection, the final chapter of Ruth Leys's Trauma: A Genealogy (
[7] In one paper, for example, Scheflin
and Brown addressed the problem of patients' suggestibility, but the danger
they envisioned from that quarter was only "false litigant syndrome,"
or surrender to "pro-false-memory suggestive influences" emanating
from "plaintiffs' attorneys and expert witnesses" brought into
malpractice suits against their former therapists. See Alan W. Scheflin and Daniel Brown, "The False Litigant
Syndrome: ‘Nobody Would Say That Unless It Was the Truth,'" Journal of
Psychiatry and Law, vol. 27 (1999), pp. 649-705. This same argument surfaces in
Memory, Trauma Treatment, and the Law, which states that pressures exerted in
therapy "pale in comparison" (p. 398) with those that can turn a
patient into a litigious ingrate.
[8] Transcripts of the
[9]"I think it's time somebody called for an open season
on academicians and researchers," Hammond said in 1997; ". . . it's
time for clinicians to begin bringing ethics charges for scientific malpractice
against researchers and journal editors" who disparage recovered memory
theory. "Investigating False Memory for the Unmemorable:
A Critique of Experimental Hypnosis and Memory Research," 14th
International Congress of Hypnosis and Psychosomatic Medicine,
[10] D. Corydon Hammond, "Hypnosis in MPD: Ritual
Abuse," a paper delivered at the Fourth Annual Eastern Regional Conference
on Abuse and Multiple Personality, Alexandria, VA, June 25, 1992.
Understandably, tapes of this talk have been withdrawn from sale; but a
transcript, which repays reading from start to finish, can be found at
www.heart7.net/mcf/greenbaum.htm.
[11] Patients of hypnosis-wielding MPD enthusiasts really have
acquired crippling beliefs about their cult participation. That is why Bennett
Braun, in 1997, had his license to practice suspended and why his insurers paid
one of his tormented ex-patients a sobering malpractice settlement of $10.6
million.
[12] Alan W. Scheflin and Jerrold
Lee Shapiro, Trance on Trial (Guilford Press, 1989).
[13] See, e.g., The Memory Wars: Freud's Legacy in Dispute
(New York Review Books, 1995), pp. 15-29; Unauthorized Freud: Doubters Confront
a Legend (Viking, 1998), pp. x-xi; and "Forward to 1896? Commentary on
Papers by Harris and Davies," Psychoanalytic Dialogues, vol. 6 (1996), pp.
231-250. That special number of Psychoanalytic Dialogues became a book edited
by Richard B. Gartner, Memories of Sexual Betrayal: Truth, Fantasy, Repression,
and Dissociation (Jason Aronson, 1997). My own contribution, however, was
excised and replaced by an attack on my earlier criticisms of psychoanalysis.
[14] On this last point, see Bennett Simon, "‘Incest—See
Under Oedipus Complex': The History of an Error in Psychoanalysis,"
Journal of the American Psychoanalytic Association, vol. 40 (1992), pp.
955-988.
[15] See David Glenn, "Nightmare Scenarios,"
Chronicle of Higher Education, Oct. 24, 2003, pp. 14-17.
[16] A welcome new critique of fad therapies is Science and
Pseudoscience in Clinical Psychology, ed. Scott O. Lilienfeld,
Steven Jay Lynn, and Jeffrey M. Lohr (Guilford Press,
2003).
[17] See Robyn M. Dawes, House of Cards: Psychology and
Psychotherapy Built on Myth (Free Press, 1994), especially pp. 10-22.
[18] Kenneth S. Pope and Laura S. Brown, Recovered Memories of
Abuse: Assessment, Therapy, Forensics (American Psychological Association,
1996).
[19] See especially Allan Young, The Harmony of Illusions:
Inventing Post-Traumatic Stress Disorder (Princeton Univ. Press, 1995), and
Herb Kutchins and Stuart A. Kirk, Making Us Crazy:
DSM: The Psychiatric Bible and the Creation of Mental Disorders (Free Press,
1997).
[20] As the Pied Pipers of recovered memory, Ellen Bass and
Laura Davis, told prospective survivors in 1988,
"When you first remember your abuse or acknowledge its effects, you may
feel tremendous relief. Finally there is a reason for your problems. There is
someone, and something, to blame." The Courage to Heal: A Guide for Women
Survivors of Child Sexual Abuse (Harper & Row, 1988), p. 173.