Ground Lost: The False Memory/Recovered Memory Therapy Debate

The recovered memory debate has been the most acrimonious, vicious and hurtful internal controversy in the history of modern psychiatry. From its very beginning in the late 1980s, it has been more an "ad hominem" war, appealing to feelings and prejudices, rather than a matter of reasoned professional disagreement. As such, it has demonstrated the wisdom of Louis Nizer's cogent observation that "mud thrown is ground lost" (Nizer, 1966). In this case, as we shall see, the ground lost has been considerable, and science, law and psychiatry have suffered the main casualties.

Common Ground

Until recently, the false memory/recovered memory controversy has been defined by zealots from both ends of the spectrum. Because the squeakiest wheel gets the most grease, the courts, legislators, public and professionals have heard, and acted upon, more diatribe than dialogue. To quiet this cacophony, we must make one fundamental observation: there is a crucial difference between opinion and belief on the one hand and science on the other. It is only by separating them that we can hope to understand and benefit from this unquiet controversy.

For hundreds of years, people believed that the earth was flat and the center of the universe. Their belief did not make it so. When science was able to demonstrate otherwise, people's beliefs changed. Sometimes, however, people prefer fiction to fact. Folklore is often more powerful than fact, as twentieth-century propagandists have proven time and time again. In discussions concerning false and repressed memories, a great deal depends upon what one believes, and what the science shows.

Perhaps we can find common ground with the understanding that the debate is most fundamentally about science, not belief. The important questions are all questions of science: whether repressed memories exist, whether they are accurate, whether false memories can be implanted, and how far suggestion can influence memory, thoughts and conduct. Regardless of what we may want to believe, as a civilized people we must be governed by what the science tells us is truth.

It is in this spirit that my colleagues and I wrote

Memory, Trauma Treatment, and the Law (Brown et al., 1998)

. Apparently we were successful, because the book was the recipient of the American Psychiatric Association's 1999 Manfred S. Guttmacher Award. Reviewers have consistently praised the book for its "rare evenhandedness" (Behavioral Science Book Review, 1999). Other critics described its merits thusly: "The authors are always careful to discriminate between areas of well-established scientific consensus and areas of uncertainty or speculation" (Herman, 1999) "in a manner which is rigorously respectful of evidence" (Mollon, in press). Although some critics will quarrel with our interpretation of some of the science, praise has been universal for our attempt to turn the debate from rhetoric to reason.

Common ground should also be found in the commonsense observation that the term

recovered memory

is used exclusively as a pejorative. In fact, by definition, every memory is recovered. Furthermore, there are no known schools of recovered memory, no conferences on how to practice recovered memory therapy, nor are there any textbooks on the topic. The term was a clever rhetorical invention and, as such, it has even fooled many otherwise cautious scientists.

In the service of science, we must examine what the shouting is all about, even if it means that we must sacrifice some of our fervently held beliefs.

Shaky Ground

Courts have been treated to a parade of alleged experts (who shall remain unnamed) who have written or testified under oath to a truly astonishing array of opinions, including:

• There is only one memory system, therefore traumatic memories are not handled differently by the brain than ordinary memories.

• Repressed memory does not exist.

• Repressed memories are never accurate.

• Implanting false memories of horrific events that never occurred is easy and frequently done by therapists.

• Hypnosis, guided imagery and visualization are unduly suggestive techniques that always contaminate memory.

• Recanting of childhood sexual abuse proves that the abuse never happened.

• Repressed memories are always true.

• If you think you were abused, you were.

None of these claims is supported by science (Brown et al., 1998; Brown et al., 1999). Space permits brief discussion of only the two most central topics. At the root of the debate is the question of whether repressed memory exists. If it does, is it accurate? We know, and the courts have heard, what various people believe about these issues, but what does the science say?

Solid Ground

Does repressed memory exist?

Although courts and legislatures use the term

repressed memory,

the proper term is

dissociative amnesia

. This is the definition that appears in the

DSM-IV,

section 300.12: "Dissociative amnesia is characterized by an inability to recall important personal information, usually of a traumatic or stressful nature, that is too extensive to be explained by ordinary forgetfulness."

The appearance in the

DSM-IV

indicates that the concept of repressed memory is generally accepted in the relevant scientific community. This satisfies courts following the

Frye v United States, 293 F.1013 (1923) or Daubert v Merrell Dow Pharmaceutical,

113 S. Ct. 2786 (1993) rules regarding the admissibility of scientific testimony into evidence in court. Opponents of repressed memory are what the law considers, at best, a respectable minority under the two schools of thought doctrine (Jones v Chidester [1992]; Kowalski, 1998). The burden of proof is on the minority school of thought to demonstrate that it is respectable, not on the majority to prove that it is right.

The

DSM-IV

definition provides a mechanism to distinguish dissociative amnesia from ordinary forgetfulness (Scheflin and Spiegel, 1998). It is echoed in the characterization of the repressed memory issue by Pope and Hudson (1995a, 1995b) as follows: A substantially traumatic event occurs of the type not normally likely to be forgotten. Voluntary access to memories about the event is unavailable for a significant period of years. After this passage of time, memories return that can be demonstrated to be accurate.

When functionally defined, the debate about the semantics of repression disappears. According to Pope and Hudson (1995a), "to reject the null hypothesis and demonstrate 'repression,' one need only exhibit a series of individuals who display clear and lasting amnesia for known experiences too traumatic to be normally forgettable." As Pope and Hudson (1995b) point out, in the studies in which the traumatic abuse is known to have occurred, and in which the trauma is so severe that "no one would be reasonably expected to forget it, the postulated mechanism of the amnesia-whether it be called 'repression,' 'dissociation' or 'traumatic amnesia'-is unimportant." As with the DSM-IV definition, Pope and Hudson's formulation eliminates semantic quibbles and provides a mechanism for distinguishing repression from forgetting because the trauma involved is of the type not likely to be forgotten. This point was completely misunderstood by the court in

Doe v Maskell

, 342 Md. 684, 679 A.2d 1087 (1996) when it said that repression and forgetting were identical.

Brown and colleagues (1999) surveyed the world literature and found 68 studies in which the totality of the evidence met the Pope and Hudson criteria. Every one of the studies, which followed several methodological designs, found repressed memory to exist. The first round of studies were surveys that used clinical samples of people in therapy or therapists. Those who do not believe in the validity of repressed memory criticized this method on the grounds that it involved people who were in psychotherapy. A second round of studies sought to correct for this by using community samples. Some of these studies involved forensic cases, such as people who claimed to be victims of Father James Porter. Porter, a priest, confessed to and was convicted of sexually molesting dozens of boys and girls in 1993. This method was criticized on the grounds that there was still sample selection and experimenter bias.

A third round of experiments responded to this objection by surveying nonclinical targeted and/or random samples-people not in or entering therapy. Some of these studies used college students, while others used random samples of people who responded either to advertisements in newspapers, telephone calls or mailed questionnaires. Once again, however, complaints were made that these retrospective studies failed to corroborate sufficiently the existence of the alleged childhood sexual abuse.

To correct for this objection, a fourth round of studies was conducted, this time involving a prospective design. Researchers started with hospital records of actual abuse and located the victims decades later. However, this methodology was also objected to because it failed to add a follow-up clarification interview as described by Femina et al. (1990). A fifth round of studies then used the prospective design and included clarification interviews. This was followed by a sixth round of studies, involving prospective longitudinal designs that began with documented trauma and included repeated follow-up interviews on a regular basis.

This research reached the same conclusion as all of the other studies-a subsection of the population of sexually abused individuals represses the memory of the abuse. As their last refuge, critics have responded that any study involving any self-report is unscientific because self-reports are untruthful or self-deceptive.

Those who do not believe in the validity of repressed memory have argued that most people do not forget trauma. Their point is accurate, but it hardly refutes the argument that some percentage of people do not consciously remember severe trauma. Some of these critics have appeared in court with citations for almost five dozen articles of remembered traumatization. But again, the fact that most people remember trauma is not relevant to the point that some do not. Of even greater importance, Brown et al. (1999) have demonstrated that none of these studies falls within the Pope-Hudson guidelines. Two-thirds of them are irrelevant because they do not address the issue of amnesia one way or the other and fully one-third of them actually do demonstrate dissociative amnesia. While people may continue to believe that repressed memory does not exist, there is no scientific support for that proposition. Expert testimony that repressed memory does not exist should, therefore, be subject to ethical sanctions.

Are repressed memories accurate?

Both those who argue that repressed memories are always false and those who argue that repressed memories are always true (because, like the fly caught in amber, they are solidified and impervious to later contamination by influence or suggestion) appear to be mistaken. Although the science is limited on this issue, the only three relevant studies conclude that repressed memories are no more and no less accurate than continuous memories (Dalenberg, 1996; Widom and Morris, 1997; Williams, 1995). Thus, courts and therapists should consider repressed memories no differently than they consider ordinary memories.

The science clearly directs us away from the distracting issue of the existence of repressed memories, and toward the psychologically and legally significant issue of the validity of particular memories. The therapy room and the courtroom both benefit from distinguishing true and false memories (Scheflin, 1998). The science of memory shows that 1) memory is remarkably accurate for the gist of events, and less accurate for peripheral details; 2) all memories, repressed or continually remembered, may be influenced by later events or by the method of retrieval; and 3) all memories, whether implicit or explicit, may exert an influence on behavior (Schacter, 1999). With a renewed concentration on how memories are retrieved or influenced, therapists and lawyers might again be able to work as associates, not adversaries.

Lost Ground

It was noted earlier that science, the law and psychiatry have lost ground as a consequence of the repressed memory debate. The fit between law and science has suffered a two-stage assault with regard to memory. In the 1980s, courts were told by many experts that hypnosis and related techniques inevitably contaminate memory. In the 1990s, courts were told that repressed memory does not exist and that memory is easily contaminated by even a hint of suggestion. In both decades, courts were told that memory is fundamentally untrustworthy. These views are wrong, and judicial reliance on science to support them has brought injustice to countless litigants. When the courts looked to experts for guidance, the experts failed to deliver with accuracy what the science said. Some experts have remained resistant to updating their opinions even in light of new studies.

Psychiatry especially has lost ground. From the public's perspective, the repressed memory debate has made the field look foolish, no matter which side of the issue a member of the public supports. One need only read the majority opinion in the first appellate decision dealing with repressed memory (

Tyson v Tyson

, 107 Wash.2d 72, 727 P.2d 226 [1986]) to see how judges have developed highly negative attitudes about the mental health professions. Because mental health professional organizations have failed to provide guidance or clarity to the public or their own constituents and have failed to protect their constituents when under attack in courts of law, they have further added to the perception of the mental health area as a truly "soft" science.

The recovered memory debate includes an internal ideological struggle. Some of the biological psychiatrists are enjoying, if not contributing to, the battering that psychodynamic psychiatrists currently are taking in court. It is not wise, however, to ignore Lincoln's incisive comment, "A house divided against itself cannot stand." The very legal precedents being established to sue psychodynamic psychiatrists now constitute a growing infrastructure for the inevitable subsequent legal assault on the biologically inclined healers. Indeed, the theories for such lawsuits are already under construction and will soon be field-tested in courts. In the acrimony and litigation surrounding the debate over who is right and who is wrong, psychiatry has developed dissociative identity disorder. It is time for the profession to heal itself.

References:

References

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Brown D, Scheflin AW, Whitfield CL (1999), Recovered memories: the current weight of the evidence in science and in the courts. Journal of Psychiatry & Law 27:5-156.

Dalenberg CJ (1996), Accuracy, timing and circumstances of disclosure in therapy of recovered and continuous memories of abuse. Journal of Psychiatry & Law 24: 229-275.

Della Femina D, Yeager CA, Lewis DO (1990), Child abuse: Adolescent records vs. adult recall. Child Abuse Negl 14(2):227-231.

Herman JL (1999), Trauma and memory [Book review]. Am J Psychiatry 156(7):1111-1112.

Jones v Chidester (1992), 531 Pa. 31, 610 A.2d 964.

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Schacter D (1999), The seven sins of memory. Insights from psychology and cognitive neuroscience. Am Psychol 54(3):182-203.

Scheflin AW (1998), Narrative truth, historical truth and forensic truth. In: The Mental Health Practitioner and the Law: A Comprehensive Handbook, Lifson L and Simon RI, eds. Cambridge, Mass.: Harvard University Press, pp 299-328.

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Widom CS, Morris S (1997), Accuracy of adult recollections of childhood victimization: II. Childhood sexual abuse. Psychological Assessment 9:34-46.

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