Speak, Memory

Editorial Note: In light of the responses we have received regarding this article by Richard Noll, PhD, that was posted on our website on December 6, 2013, the article has been reposted with a modification. Additionally, we are posting responses from certain of the individuals mentioned in the article and from Dr Noll in order to leave analysis of the article up to our readers.

Some mass cultural phenomena are so emotionally charged, so febrile, and in retrospect so causally incomprehensible, that we feel compelled to move on silently and feign forgetfulness.

Historian Alfred Crosby noted these “peculiarities of human memory” in the 1976 first edition of his book America’s Forgotten Pandemic: The Influenza of 1918.¹ “Why have (Americans) so thoroughly forgotten it since?” he asked.^1(p319) Until Crosby’s book appeared, even historians had avoided the painful subject for 50 years. Without resorting to psychiatric or psychoanalytic explanations, Crosby speculated that any mass event that had “enormous influence” but that “utterly evades logical analysis” might justify our ignorance of it “because the alternative would be to sink into the quicksand of speculation without any limits.”^1(p322)

Just 25 years ago, American psychiatry was infected by a psychic pandemic that originated outside the profession. In 1983 it broke out of a reservoir of religious, legal, psychotherapeutic, and mass media mixing bowls. Children in US day-care centers and adults in psychotherapy told 2 distinct versions of their malady. By 1988, some elite members of the American Psychiatric Association (APA) were making it worse. They had become its vectors. Then other elite psychiatrists stepped in to quarantine the profession. Eventually, just like the last wave of the influenza pandemic, after 1994 it ended as suddenly and incomprehensibly as it had started.

As our medical schools and graduate programs fill with students who were born after 1989, we meet young mental health professionals-in-training who have no knowledge or living memory of the Satanic ritual abuse (SRA) moral panic of the 1980s and early 1990s. But perhaps they should. Cautionary tales may prevent the recurrence of pyrogenic cultural fantasies and the devastating clinical mistakes they inspire.

But who should tell this tale? To those of us who are old enough to have been there, that era already seems like a curious relic of the past, bracketed in our memory palaces behind a door we are loathe to open again.

In the 1980s thousands of patients insisted that they were recovering childhood memories of physical and sexual abuse during Satanic cult rituals. In addition to the red or black robes of the abusers and other paraphernalia of devil worship familiar to any horror film devotee, these memories often included the ritual sacrificial murder of children, blood-drinking, cannibalism, bestiality, and incest. Famous believers in SRA ranged from Gloria Steinem to Pat Robertson. A prominent historian of religion has argued that “the emergence of SRA motifs” served as “a kind of feminist and evangelical Christian pornography.”^2(p208)

Clinicians who then believed in the factual basis of the claims (and there were many) have probably spent the last 30 years asking themselves, “How could I have been so . . . ?” (fill in the blank). Or perhaps they are still saying to themselves, as the authors of one book suggest in their title, Mistakes Were Made (But Not By Me).³

Their silence is understandable. But even many of the most pivotal of the skeptical psychiatrists of that era have not shared their personal memories in a public forum. Why were they so immune and how did they decide that such clinical narratives had no basis in historical truth?

Might historians of psychiatry offer us something here? Unfortunately, like those generations of historians following the 1918 pandemic, they too have repeated the compulsion to dissociate themselves from an ugly cultural and medical disaster. Revulsion is a human reaction we can certainly all understand.

Despite the discomfort it brings, we owe it to the current generation of clinicians to remember that an elite minority within the American psychiatric profession played a small but ultimately decisive role in the cultural validation, and then reduction, of the Satanism moral panic between 1988 and 1994. Indeed, what can we all learn from American psychiatry’s involvement in the moral panic?

Dissociation: The celebrity metaphor of the 1980s

The creation of a new category of dissociative disorders in DSM-III (1980) resurrected “dissociation” as a double-duty metaphor for both a causal (defense) mechanism and a descriptive term for the splitting apart of consciousness, complexes within memory systems, and the subjective sense of a unitary self. Disoriented by the loss of a formal Freudian paradigm and the newly energized discourse of biological psychiatry, psychoanalytic clinicians found asylum among the dissociative disorders and their presumed reactive, trauma-induced origins. Within a few short years multiple personality disorder (MPD) would emerge as the most frequently diagnosed entity in this group and would be the subject of several large clinical studies that seemed to validate its existence. The research of 3 psychiatrists in particular caught the profession’s attention: Richard P. Kluft of the Institute of the Pennsylvania Hospital in Philadelphia; Frank W. Putnam of the National Institute of Mental Health; and Bennett G. Braun of Chicago’s Rush Medical College.

These 3 men were then asked by Robert Spitzer to be new members of the Advisory Committee for Dissociative Disorders for the forthcoming DSM-III-R, which finally appeared in 1987. Other new members were psychiatrists Philip M. Coons and Marlene Steinberg and social worker Janet B. W. Williams. Spitzer was the only holdover from DSM-III.

The DSM-III-R revisions for the dissociative disorders were extensive. The sequence of the disorders in the chapter was changed, with MPD placed first because it “is in many ways both the paradigm and the most pervasive expression of the spectrum of dissociative phenomenology.”^4(p40) Severe physical, sexual, and emotional abuse in childhood were its predisposing factors. Described as “apparently extremely rare” in DSM-III, in the years 1984 to 1987 large numbers of cases were reported in the literature by Kluft (200 cases), Putnam (100), Coons (20), and Braun and co-authors (355).^4(p40)

In order to further study the epidemic which they did so much to create, in 1983 they founded the International Society for the Study of Multiple Personality and Dissociation (ISSMP&D). By 1990 there were approximately 2000 members. The ISSMP&D’s annual conferences were carnivals of workshops by and for many varieties of mental health professionals. The first, in December 1983, drew more than 300 participants. Beginning in 1986 some taught tales of cults and childhood Satanic ritual abuse.⁵ In March 1988, the first issue of the peer-reviewed journal Dissociation appeared, with Kluft as the chief editor, Braun as associate editor, and 2 additional assistant editors.

Psychiatry battles the devil

The DSM-III-R Advisory Committee on Dissociative Disorders was conscious of the historical implications of the MPD diagnosis, noting that MPD “and its attenuated forms are, historically, the secularized descendants of the Judeo-Christian possession syndrome.”^4(p44) In other words, they knew they were expanding the jurisdictional boundary of “scientific” psychiatry and colonizing the supernatural. Treatment rationally follows from diagnosis. Psychiatrists soon claimed for themselves superior therapeutic expertise for techniques that had formerly been the province of magico-religious practitioners (exorcists).^6-8 What they did not anticipate was that the blurring of this boundary would backfire, pulling many of them off into the rip tide of Satanic panic.

Bennett Braun was the first and most fervent DSM-III-R Advisory Committee member to join the crusade against Satan. His public expression of interest in cults and MPD dates at least to 1986. But at an ISSMP&D conference in Chicago in 1988, Braun presented a workshop in which he directly linked the MPD epidemic to the abuse committed against children by devil-worshipping cults. He argued that these Satanic cults were everywhere in the US, internationally organized with a structure similar to communist cells, with local regional, district, national, and international councils.^{9(p395-396),14(p46-47,232-233)} Braun also argued that Satanic cults were transgenerational family traditions that had been going on in secret for at least 2000 years.

At that same conference, Sally Hill, a social worker in private practice in Chicago, and Jean Goodwin, a psychiatrist and professor of medicine at the Medical College of Wisconsin in Milwaukee, presented a paper that attempted to validate Braun’s claims by citing historical accounts of allegations of “the Satanic black mass” and other obscene cult behaviors going back to at least A.D. 100. Reproducing these accounts without regard to context, these clinicians read them as fundamentally true reports of actual events. Professional historians who specialize in those eras tend to interpret such material as a discourse of propaganda aimed at undesirable minority groups, whether real or imagined.

A few months later, in March 1989, this conference paper was published in Kluft and Braun’s journal, Dissociation.¹⁰ It quickly became a citation success in the SRA literature as evidence in favor of the historical continuity of Satanic cults and their rituals.^{9(p393),19 (p177)} The message to the public and the mental health professions was clear: elite members of the American psychiatric profession seemed to be sanctioning the SRA moral panic. Satanic cults were probably real, had probably been around for almost 2 millennia, and were abusing children and creating the MPD epidemic.

As for the other members of the DSM-III-R Advisory Committee and the leadership of the ISSMP&D, there was only one response: public silence.

But shouldn’t somebody say something?

That’s what I asked myself after I read Hill and Goodwin’s article and heard audiotapes of Braun’s public lectures. As a 29-year-old newly minted clinical psychologist in private practice, with no academic or clinical institutional affiliation, I was in no position to have anyone listen to me if I spoke up. I knew I was not alone in my skepticism and horror. But the resounding silence of the elite psychiatrists could only be interpreted in 3 ways by those of us “in the trenches” who looked up to them for guidance: these Satanic cults were real (despite the lack of corroborating physical or forensic evidence); the experts did not know if they were real and were afraid of insulting the patients; or there was an abject failure of ethical leadership.

The December 1989 issue of Dissociation brought the first public statements of SRA skepticism to appear in a peer-reviewed psychiatric journal. Psychiatrist George Ganaway wrote a rather convoluted article on “historical truth versus narrative truth,” avoiding any direct rejection of SRA claims while doing his best to raise significant doubts.¹¹ In a “letter to the editor” I contributed a short critique of the historical sources and methods used by Hill and Goodwin, and-with the brashness of youth-declared that most SRA claims were nothing more than “a modern version of (a) paranoid mass delusion-and one in which all too many clinicians and law enforcement officials also share.”^12(p252)

Richard Kluft opened the same issue of Dissociation with an impassioned editorial in which he cited the Hill and Goodwin article with approval as a foundational contribution that scientific investigators could use to study clinical material.^13(p193) While careful not to explicitly advocate or reject it himself, Kluft also invoked the specter of a possible “hidden holocaust” perpetuated by Satanic cults.^13(p192) Kluft’s editorial, rightly or wrongly, may have been interpreted by many as his public defense of Braun’s international conspiracy fantasies. To the many SRA believers who read Kluft’s remarks, their biased cognitive filter could reasonably lead them to conclude there were now two members of the DSM-III-R Advisory Committee on Dissociative Disorders deeply involved in granting legitimacy to the Satanic moral panic through the linkage of MPD to SRA claims.

Another year of silence, then alternatives

Throughout most of 1990 no American psychiatrist, and certainly no other member of the DSM-III-R Advisory Committee for the Dissociative Disorders, made any formal public or published statement explicitly rejecting Braun’s Satanic cult conspiracy. No one objected to Kluft’s “hidden holocaust” analogy. These were the true plague years as the moral panic continued to rage in day-care centers and the courts, destroying reputations and lives.^14,15

But by the autumn of 1990, Frank Putnam of the NIMH decided to break his skeptical silence. In preparation for the 7th annual ISSMP&D conference to be held in Chicago in November, Putnam arranged to open the event with a special plenary panel of 4 presentations of “alternative” views of the interpretation of SRA claims.¹⁶ The plenary session was held in a large hotel ballroom filled with most of the more than 700 conference attendees. Television crews were on hand to witness the event. So was Gloria Steinem. So was I.

The 4 members of the plenary session panel were Putnam, George Ganaway, anthropologist Sherrill Mulhern, and me. Putnam had read my Dissociation critique and wanted me to present my argument in person. Putnam and Ganaway presented carefully balanced arguments that did not directly reject the reality of SRA. Instead they expressed concerns about the linkage of MPD to such controversial claims, noting it would hurt future research on child abuse and trauma.

Mulhern and I were strident in our outright rejection of the veracity of SRA claims. She cited anthropological and sociological research while I hammered home the view of historians that ancient accounts of bizarre cult practices had to be read in context. Along with my fellow panelists, I, too, mentioned the October 1989 preliminary report of an investigation by Supervisory Special Agent Ken Lanning from the FBI Behavioral Science Unit at Quantico which found no corroborating evidence of the existence of Satanic cults engaged in any criminal activity, let alone kidnapping and ritually sacrificing thousands of American babies. Lanning’s findings had emboldened Putnam to organize the special plenary session and go public with his private skepticism. The full FBI report appeared 3 years later.¹⁷

Gloria Steinem approached me after my talk and suggested materials to read that she felt would help me change my opinion of SRA accounts. During the conference I attended one of Bennett Braun’s legendary SRA workshops (“See the Satanism!” he screamed as he pointed to a patient’s red crayon scratching on a sketch pad. “There it is!”). Several persons-all licensed mental health professionals-approached me and let me know I wasn’t fooling them. They knew I was a witch or a member of a Satanic cult who was there to spread disinformation. But apparently the panel presentations had a different effect on others. As one conference attendee, an SRA believer, later wrote, “Mulhern and Noll cut a line through the therapeutic community. A minority joined them in refusing to believe sacrificial murder was going on; the majority still believed their patients’ accounts.”^18(p17)

The fade out into forgetfulness

In 1991, Putnam and Ganaway continued to distance themselves from SRA.^19,20 Braun and others who shared his beliefs continued to exploit the medical literature to bolster the construct validity of SRA.²¹ Kluft continued his editorship of Dissociation. In the years that followed, the pages of Dissociation kept possession and exorcism alive as relevant psychiatric issues in diagnosis and treatment.²² Psychiatry could not abandon its jurisdictional claim on the supernatural.

When the new diagnostic manual finally appeared in 1994, MPD had vanished. Renamed and revised as dissociative identity disorder (DID), it also had been dethroned from first place in the sequence of dissociative disorders. “I don’t want it to be seen as some sort of circus sideshow,” said the chair of the new DSM-IV work group.^23(p19) DSM-IV reinstated the order of DSM-III. The new guards at the APA were doing their best to quarantine the profession from not only the men who had enabled the MPD epidemic but also from any lingering connection to the moral panic.

In May 1994, the ISSMP&D dropped “Multiple Personality” from its name. In December 1997, Dissociation produced its 39th and last issue. The journal’s demise reduced the volume of MPD/DID contributions to the medical literature. But by then the “multiple movement,” as philosopher Ian Hacking termed it, had already begun to wane.²³

The False Memory Syndrome Foundation was formed in Philadelphia in March 1992. It became a clearinghouse of legal and scientific information that countered false claims of “recovered memories” of child abuse (Satanic or otherwise).²⁴ Noted scientists such as Elizabeth Loftus and Carl Sagan became its advocates. Ganaway eventually joined its board of scientific advisors. Its newsletters vilified clinicians such as Bennett Braun and others who had done so much to legitimize the paranoid mass delusion of Satanic cults.²⁵

After 1993, the day-care ritual abuse panic subsided. By 1994, even the mass media had become critical of SRA. Everyone just wanted to move on.

Are we ready now to reopen a discussion on this moral panic? Will both clinicians and historians of psychiatry be willing to be on record? Shall we continue to silence memory, or allow it to speak?

Dr Noll is Associate Professor of Psychology at DeSales University in Center Valley, Pa. His most recent book, American Madness: The Rise and Fall of Dementia Praecox (Cambridge, Mass: Harvard University Press; 2011), was the winner of the 2012 Cheiron Book Prize and a 2012 BMA Medical Book Award, Highly Commended in Psychiatry, from the British Medical Association.

References
1. Crosby AW. America’s Forgotten Pandemic: The Influenza of 1918. New Edition. Cambridge: Cambridge University Press; 2003.

2. Frankfurter D. Evil Incarnate: Rumors of Demonic Conspiracy and Satanic Abuse in History. Princeton: Princeton University Press; 2006.

3. Tavris C, Aronson E. Mistakes Were Made (But Not By Me): Why We Justify Foolish Beliefs, Bad Decisions and Hurtful Acts. New York: Mariner Books; 2008.

4. Kluft RP, Steinberg M, Spitzer RL. DSM-III-R revisions in the dissociative disorders: an explanation of their derivation and rationale. Dissociation. 1988;1:39-46. https://scholarsbank.uoregon.edu/xmlui/bitstream/handle/1794/1329/Diss_1_1_4_OCR_rev.pdf?sequence=4

5. Mulhern SA. Satanism, ritual abuse, and multiple personality disorder: A sociohistorical perspective. Int J Clin Exp Hypn. 1994;42:265-288.

6. Goodwin JM, Hill S, Attias R. Historical and folk techniques of exorcism: applications to the treatment of dissociative disorders. Dissociation.1990;3:94-101. https://scholarsbank.uoregon.edu/xmlui/bitstream/handle/1794/1530/Diss_3_2_12_OCR_rev.pdf?sequence=4

7. Bowman ES. Clinical and spiritual effects of exorcism in fifteen patients with multiple personality disorder. Dissociation. 1993;6:222-238. https://scholarsbank.uoregon.edu/xmlui/bitstream/handle/1794/1680/Diss_6_4_5_OCR_rev.pdf?sequence=4

8. Fraser GA. Exorcism rituals: effects on multiple personality disorder patients. Dissociation. 1993;6:239-244. https://scholarsbank.uoregon.edu/xmlui/bitstream/handle/1794/1681/Diss_6_4_6_OCR_rev.pdf?sequence=4

9. deYoung M. One face of the Devil: the satanic ritual abuse moral crusade and the law. Behav Sci Law. 1994;12:389-407.

10. Hill S, Goodwin, JM. Satanism: similarities between patient accounts and pre-Inquisition historical sources. Dissociation. 1989;2:39-44. https://scholarsbank.uoregon.edu/xmlui/bitstream/handle/1794/1408/Diss_2_1_6_OCR_rev.pdf?sequence=4

11. Ganaway GK. Historical truth versus narrative truth: clarifying the role of exogenous trauma in the etiology of multiple personality disorder and its variants. Dissociation. 1989;2:205-220. https://scholarsbank.uoregon.edu/xmlui/bitstream/handle/1794/1496/Diss_2_4_8_OCR_rev.pdf?sequence=4

12. Noll R. Satanism, UFO abductions, historians and clinicians: those who do not remember the past . . . Dissociation. 1989;2:251-253. https://scholarsbank.uoregon.edu/xmlui/bitstream/handle/1794/1485/Diss_2_4_1_OCR_rev.pdf?sequence=4

13. Kluft RP. Editorial: Reflections on allegations of ritual abuse. Dissociation. 1989;2:191-193. https://scholarsbank.uoregon.edu/xmlui/bitstream/handle/1794/1486/Diss_2_4_10_OCR_rev.pdf?sequence=4

14. deYoung M. The Day Care Ritual Abuse Moral Panic. Jefferson, NC: McFarland & Co; 2004

15. deYoung M. The Ritual Abuse Controversy: An Annotated Bibliography. Jefferson, NC: McFarland & Co; 2002.

16. Braun BG, Carlson, EB. Dissociative Disorders, 1990: Proceedings of the 7th International Conference on Multiple Personality/Dissociative States . . . November 9-11, 1990. Chicago: Dissociative Disorders Program, Dept. of Psychiatry, Rush University. 1990

17. Lanning KV. Investigator’s Guide to Allegations of “Ritual” Child Abuse. Quantico, Va: Federal Bureau of Investigation; 1992.

18. Lockwood C. Other Altars: Roots and Realities of Cultic and Satanic Ritual Abuse and Multiple Personality Disorder. Minneapolis, Minn: CompCare Publishers; 1993.

19. Putnam F.W. The satanic ritual abuse controversy. Child Abuse Negl. 1991;15:175-179.

20. Ganaway GK. Some additional questions: a response. J Psychol Theol. 1992;20:201-205.

21. Young WC, Sachs RG, Braun BG, Watkins RT. Patients reporting ritual abuse in childhood: a clinical syndrome. A report of 37 cases. Child Abuse Negl. 1991;15:181-189.

22. Kluft RP. Editorial: A few good persons: toward a dialog on possession and exorcism. Dissociation. 1993;6:199. https://scholarsbank.uoregon.edu/xmlui/bitstream/handle/1794/1676/Diss_6_4_1_OCR_rev.pdf?sequence=4

23. Hacking I. Rewriting the Soul: Multiple Personality and the Sciences of Memory. Princeton: Princeton University Press; 1995.

24. McHugh PR. Try to Remember: Psychiatry’s Clash Over Meaning, Memory and Mind. New York: Dana Press; 2008.

25. Editor’s comment: How do therapists come to believe? FMS Foundation Newsletter. December 1998; 7(6). http://fmsfonline.org/fmsf98.n28.html

----------------

RESPONSESTwo Wrongs Don’t Make a Right

David Spiegel, MD
Willson Professor & Associate Chair of Psychiatry and Behavioral Sciences
Stanford University School of Medicine

Dr Noll unearths memories of a period during which what was then called Multiple Personality Disorder was linked to reports of satanic ritual abuse. He treats us to accounts of heated meetings involving this. I recall speaking to the International Society of Multiple Personality Disorder and Dissociation and informing them that the name of the disorder would be changed to Dissociative Identity Disorder in DSM-IV. I asked for a show of hands and, to my surprise, given the fact that this would require changing the name of the Society, about two-thirds voted in favor. A group of people sitting in the front rows were wearing T-shirts that read “D.I.D.,” which I took to be a good sign. When they turned to leave, I saw that they had printed “D.I.D. NOT” on the back. I appreciated their sense of humor about a serious and often contentious issue. I wish Dr Noll had the same sense of balance. His piece has a “good guys” and “bad guys” tone that does everyone a disservice.  

This experience underscored for me the fact that the situation was and is complex, so we need to, indeed, let memory speak. Dr Noll mentions 3 psychiatrists as promoters of belief in SRA. One of them, Dr Bennett Braun, was the founder of the Society, subsequently left it, relocated, and withdrew from the dissociative disorders field. The other two, Drs Richard Kluft and Frank Putnam, have gone on to have long and distinguished careers studying, writing about, and treating people with dissociative disorders. Dr Kluft participated actively and constructively in the DSM-IV process. Dr Noll himself was not then as scornful of reports of extreme abuse of children as he appears to be now. In 1989, he wrote the following in a letter to the editor of Dissociation: “'What, then, are we to make of our patients' recalled childhood experiences of ritualized abuse at the hands of satanists? Some experiences are undoubtedly true. Most, however, fit [British Historian] Cohn's fantasy [beliefs in witches] much too closely to be taken as reports of actual experience.” (Dissociation. 1989;II:4:253.)  

It is very clear that dissociative disorders are associated with traumatic experience, and child abuse is, sadly, common, not rare.¹ Who would have thought 25 years ago that we would learn of widespread abuse of children by clergy, along with institutional cover-ups and failures to report criminal activity to the police and social welfare agencies? There is now a Dissociative Subtype of PTSD in the DSM-5, involving depersonalization/derealization in addition to the other PTSD symptoms.^2-4 So it is clear that trauma and dissociation are linked. The False Memory Syndrome Foundation, presented in Noll’s article as the “answer,” was highly critical of the diagnosis of DID, those who treated people with the disorder, and vigorously cast doubt upon reports of childhood sexual abuse (not just Satanic Ritual Abuse). Indeed, the FMSF started over credible abuse allegations by the daughter of its founder, well-known psychologist Jennifer Freyd, of abuse by her father. If one can have a false memory that childhood abuse occurred when it did not, one can also have a false memory that abuse did not occur when it did.⁵ In addition, one who has been physically, sexually, or emotionally traumatized may provide both true as well as exaggerated reports.⁶ Those who have been abused are terribly damaged, as are those who are falsely accused. Systematic denial of abuse is every bit as wrong as exaggeration of it.  

References
1. Dalenberg CJ et al. Evaluation of the evidence for the trauma and fantasy models of dissociation. Psychol Bull. 2012;138:550-588.
2. Spiegel D et al. Dissociative disorders in DSM-5. Annu Rev Clin Psychol. 2013;9:299-326.
3. Lanius RA et al. Emotion modulation in PTSD: clinical and neurobiological evidence for a dissociative subtype. Am J Psychiatry. 2010;167:640-647.
4. Stein DJ et al. Dissociation in posttraumatic stress disorder: evidence from the world mental health surveys. Biol Psychiatry. 2013;73:302-312.
5. Geraerts E et al. The reality of recovered memories: corroborating continuous and discontinuous memories of childhood sexual abuse. Psychol Sci. 2007;18:564-568.
6. Baars BJ, McGovern K. Steps toward healing: false memories and traumagenic amnesia may coexist in vulnerable populations. Conscious Cogn.1995;4:68-74.

-----------

A Reply to Dr NollRichard P. Kluft, MD, PhD

In discussions of a subject that is relatively unfamiliar, a powerfully articulated stance unchallenged by data and arguments to the contrary may appear to be persuasive and conclusive. When such a stance promotes a polarized perspective that has an a priori resonance with widespread preconceptions and misconceptions, its force is magnified, irrespective of its merit or accuracy. These considerations make it all the more important to subject Dr Noll’s curious and vehement communication to close scrutiny.

Discourse can be conducted with or without dignity. Without the preservation of dignity conflicts become difficult if not impossible to resolve.¹ In my response I will not counter-attack Dr Noll for his egregious and regrettable ad hominem remarks. Here I will simply state my aversion to attacks against individuals, and my conviction that they distract from rather than enhance one’s argument. Dr Noll seems oblivious to the fact that he is talking about real people. His remarks may cause pain and hurt, and his inaccurate allegations are potentially harmful to the professional reputations of several individuals. I will leave Dr Noll’s readers to contemplate his approaches in the context of the remarks I will make below, and encourage them to draw their own conclusions.
    
Dr Noll's “history” brings to mind a wonderful undergraduate seminar on allegory in literature. We learned that as Christianity rose in prominence, early Christian scholars, eager to find the anticipation of Christ as the Messiah in pre-Christian literature and to discover various affirmations of Christian meanings in both current and older works of literature, established several principles of exegesis, rules with which creative works were to be read and interpreted. These guidelines were designed to discover and confirm specific religious interpretations in whatever had been written.

Dr Noll appears to subscribe to a particular model of exegesis which modern researchers would understand as motivated skepticism toward everyone/everything of which he disapproves, and confirmatory bias toward everyone/everything that pleases him. His “history,” albeit riddled with inaccuracies, affirms his faith in his beliefs and justifies the denigration of those who may not share them. All too often his account falls short of objectivity. At times Dr Noll relies on opinions, inaccurate statements, innuendos, and mischaracterizations to buttress and confirm his “faith” and presents the total package as an objective understanding.

Dr Noll makes the remarkable statement that the International Society for the Study of Trauma and Dissociation was founded by a small number of individuals to study the epidemic they did so much to create. Unfortunately for Dr Noll, this is a dubious line of reasoning. Interest in DID, then called multiple personality, may not have been mainstream, but it was already widespread. George Greaves’ 1980² article generated over 5000 requests for reprints. This suggests that a remarkable interest in DID existed prior to the publications of the individuals whom Dr Noll accuses of fomenting an epidemic of DID cases, and prior to the establishment of any organization for their study. Please note that Dr Greaves’ article was published in the same year as the publication of Michelle Remembers,³ often described as the spark that ignited widespread interest in satanic ritual abuse. Any statement that either Michelle Remembers or that authors like Braun, Kluft, and Putnam, who were unpublished in the field in 1980 or before had any connection with the outpouring of interest that greeted Greaves’ article cannot be accurate. Patients suspected of or diagnosed with DID were referred by many others to the experts now accused of creating large numbers of DID cases. I am the only person mentioned by Dr Noll who is somewhat vulnerable to the type of accusations he makes. Many of the cases I identified were discovered in the course of my efforts to develop and test a screening measure for DID. I made active efforts to screen patients I saw in a psychiatric emergency unit and patients assigned to me in rotation at a general hospital psychiatric unit with a primitive diagnostic instrument. It is important to appreciate that while the underdiagnosis of DID is well-documented in several studies, the overdiagnosis of DID remains in the realm of strongly voiced opinions. After stating the above, I should add that by the mid-1980s my own larger early series included referrals from over 80 colleague clinicians.⁴

Noll weakens his argument by lumping together his concerns about satanic ritual abuse, the iatrogenic creation of DID, and, by example and implication, the recovered memory debate. There is every reason to argue that many reports of satanic ritual abuse were ill founded, and to doubt the extent of what these reports alleged. There is also good reason to avoid going to the extreme of dismissing them completely.

What Dr Noll experienced in terms of over-energetic confrontations by those trying to force their beliefs on him is all too familiar to me. There was ample reason to conclude that at times things got out of hand. I would not consider Ms Steinem’s simple offer of information as inappropriate. I am sorry that Dr Noll was mistreated. I saw and personally experienced similar encounters. I was booed by audiences in many settings for my more agnostic stance and my refusal to be pushed one way of the other on the SRA issue. Sadly, Dr Noll’s current publication is reminiscent of the intemperate confrontations both he and I experienced. I will return to the SRA issue at the close of my remarks.
    
Before moving on, I feel obliged to the readers of this article to share something Dr Noll omitted. The symposium in which Noll and others skeptical about SRA made their presentations was put on the program of that meeting by the same Bennett Braun whom Dr Noll attacks with such vigor. Braun understood that there was considerable conflict about the subject, and was determined to give all perspectives a fair hearing. Dr Noll seems to have forgotten this.

Having acknowledged an element of veracity in Dr Noll’s account, there is ample reason to dispute many of the other aspects of his argument. Dr Noll’s accusation that there has been widespread iatrogenesis of DID in persons initially without a dissociative disorder is worthy of particular notice. Despite the vociferous opinions of many, there is no objective data to support it.⁵ That being said, it is clear that iatrogenic pressures may lead to the development of additional self-states in already dissociative individuals.⁶ Further, evidence has accumulated to demonstrate that while false memories may be induced in a small percentage of vulnerable individuals, the recall of once inaccessible memories that can be documented as accurate is a well-documented phenomenon.⁷ Noll’s style of argumentation links phenomena commonly attacked together, but he fails to note that even the most complete refutation of every single satanic ritual abuse allegation would leave his skepticism about the possibility of accurate recovered memories and his accusations about the iatrogenesis of DID unproven. In a 1995⁸ article, I demonstrated the recovery of initially unavailable accurate memories of trauma, false memories, and the fact that both could coexist in traumatized dissociative patients.
  
Some of the most intriguing statements Dr Noll made were news to me. I never realized that I was considered among the nation’s elite psychiatrists. Perhaps such inflated attributions, however ironic and tongue in cheek, enhance the target value of those said to be elite. I have never before heard anyone state that the Goodwin and Hill article and my comments on it were widely understood as validations of rather than simply perspectives on the "satanic panic" and efforts to understand it in a historical context. Nor, since the 1918 influenza epidemic was discussed at length and in depth in at least 3 courses during my medical education, was I aware that it had been forgotten.

Among the most shockingly inaccurate statements made by Dr Noll is his assertion that “psychoanalytic clinicians found asylum among the dissociative disorders and their presumed reactive, trauma-induced origins.” Nothing could be further from the truth. During the period of time Dr Noll purports to study, there were only a handful of psychoanalysts in the dissociative disorders field and the mainstream of psychoanalytic thinking minimized the role of actual trauma as defined in the DSM. Trauma was a central concept, but defined in intrapsychic terms. In the years under discussion, mainstream psychoanalysis remained inclined to treat reports of childhood mistreatment as fantasies, and showed aversion rather than interest toward dissociation. A relevant article taking note of these problems was entitled “Incest. See Incest Fantasy.”⁹ The author, Simon, noted that the denial of attention to severe trauma was so pervasive in the analytic community that the subject of actual incest was not even included in major psychoanalytic indexes. Hence the title of his article. Of the three discussants of a paper on Holocaust-related trauma, one dismissed the importance of the Holocaust-related trauma, one approached it from a poetic and metaphoric perspective, and only the third considered it important in and of itself.^10-14 There have always been a few voices in psychoanalysis concerned with trauma as defined in the DSMs, but even today these colleague remain a minority. Dr Noll’s assertions in connection with psychoanalysis are completely inaccurate.

I am deeply troubled by Dr Noll’s misunderstanding or misrepresentation of the DSM process. He stated that the guardians of the profession quarantined those who participated in DSM-III-R from participation in DSM-IV. This is not true. The procedures for developing new editions of the DSM do not remain unchanged from one edition to the next. Also, DSM work groups are different from advisory committees in function, and the ways in which work groups and committees have related have not been the same in all DSM processes. Among those individuals whom Noll states were excluded from the DSM-IV process were several who in fact remained active participants in advisory committee work for the newer editions. Dr Noll’s gratuitous misstatements are detrimental to the professional reputation of those individuals, who actually continued to be involved. As for myself, far from being banished, I was asked to write a first draft for the text of Dissociative Identity Disorder for DSM-IV. Then others provided input and the Chair, David Spiegel, generated a final draft. While the gist of what I wrote was retained, only 2 sentences emerged unmodified by the process. Dr Noll simply does not have his facts straight. He has drawn and promulgated provocative and unwarranted conclusions. When Dr Spiegel, whom Noll does not mention by name, spoke of wanting to avoid a circus, he was not talking about the process of the DSM revision. He was talking about problematic attitudinal issues both within the profession and among the lay public. The condition’s name was changed with the hope of defusing the polarized debates that surrounded the condition, not because the condition itself had been invalidated in any way.

I found Dr Noll’s comments about my editorship of Dissociation to be somewhat out of contact with reality, but consistent with his rules of exegesis. He makes disparaging remarks about my publishing certain articles, and then makes significant omissions about my publication of others. Yes, I encouraged serious articles on controversial subjects in which no firm resolution had been reached, hoping to promote further scholarly study and interchange. Of course I accepted a special issue on exorcism and possession! The United States is a religious nation, and modern “exorcism light” or “Christian Deliverance” was ascending in popularity. Dissociative individuals were being encouraged to leave therapy, convert to fundamentalist sects, and be cured by exorcistic procedures. That issue of Dissociation took up the risks associated with exorcism, outlined the unfortunate misuses of exorcistic procedures, and demonstrated that their therapeutic power was minimal and that often such procedures were destructive. It was especially important to publish this information because one of the modern pioneers of DID treatment had indeed advocated exorcism-like interventions in the 1970s. Although their use had already been marginalized and largely abandoned, it was crucial to place appropriate warnings in the literature and discourage any return to such procedures. Yet Dr Noll describes my publication of that special issue as an ongoing effort to co-opt the supernatural.

Curiously, Dr Noll neither faults nor compliments me on publishing his contributions or those of George Ganaway. I received a good deal of criticism for publishing them, and strongly defended Drs Noll and Ganaway. Dr Noll is probably unaware of this.

An alternative to Dr Noll’s disparaging remarks/innuendos about my editorship is available. Perhaps he should have accused me of being open-minded and encouraging of various perspectives on issues that were as yet unresolved, but there appears to be no place for such an observation within his curious rules of exegesis.

I remember Dr Noll’s contribution well. In it he stated, “What, then, are we to make of our patients’ recalled childhood experiences of ritualized abuse at the hands of satanists? Some experiences arc undoubtedly true.”^15(p253) In view of his blatant endorsement of the reality of satanic ritual abuse in this publication, I find his current approach to this subject matter perplexing.

While Dr Noll accuses me of promoting the colonization of the supernatural, an alternative explanation might be that I have studied the literatures of anthropology and the history of psychiatry to appreciate the wisdom of understanding DID as a secularized expression of possession syndromes. The DSM-5 advisory and work groups made room for pathological (as opposed to culturally sanctioned) possession syndromes under the rubric of DID, embracing the varied expression of such psychopathological manifestations in different cultures. (For DSM-5, the Roman numerals used for earlier editions have been replaced with Arabic numerals.) The psychiatric profession has moved to endorse the cross-cultural perspective I put forward in 1991,^16,17 which was based on my reading of the work of Henri Ellenberger,¹⁸ the literature of anthropology, and discussions with several anthropologists about observations they made during their field work. What Dr Noll excoriates may be understood, alternatively, as a cross-cultural sensitivity increasingly embraced by our profession.¹⁹

The following statements are oversimplified generalizations offered to provide a simple frame for approaching a complex issue. The structure of DID and allied conditions is a cross-culturally distributed pattern of coping with profound psychosocial distress and other overwhelming experiences. The natures of the entities encountered in such conditions are highly influenced by cultural and sub-cultural considerations. Beyond that, once the structure of the condition is established, the creation and nature of particular personalities may be quite sensitive to all manner of external influences, including iatrogenic pressures. In my experience, the particular structure of the personality system and the number of alters created seem more related to the nature and amount of unfortunate experiences and to certain idiosyncratic factors unique to the patient.
    
By implication, Noll associates the waning of interest in satanic ritual abuse with the demise of the journal Dissociation, and indicates that with its demise, scientific communications about the dissociative disorders effectively had come to an end. In fact, Dissociation came to an end because the International Society for the Study of Trauma and Dissociation wanted more control over its journal. After a rather nasty dispute, it disenfranchised Dissociation and established the Journal of Trauma and Dissociation as its successor. This successor journal continues to publish scientific and clinical contributions in the field of dissociation. Noll’s obituary for the literature on the study and treatment of dissociation is outrageously premature.

It would be more accurate to state that as an avalanche of false memory lawsuits began in the 1990s, many therapists adopted a more defensive stance, became more apprehensive that the exploration of traumatic memories of any sort might land them in court, and felt that the cost-benefit ratio of continuing an ongoing exploration of the SRA issue had become prohibitive. Many abandoned working with dissociative and traumatized patients. A more detailed discussion of the era of the “memory wars” is beyond the scope of this response.

I will close with a few remarks about why the SRA issue was very difficult to dismiss once it began to become a topic of discourse. Dr Noll mentions his youth when he first attended the meetings of the International Society for the Study of Trauma and Dissociation. Indeed, his youth may be an important consideration, and might account for his reduction of the matters that concern him to failures of intellect and moral courage. To follow H. L. Mencken, “For every complex problem there is a simple solution . . . and it is wrong.”²⁰

I have a different perspective. In general, the therapists who struggled with how to understand and address SRA were considerably older than Dr Noll. They were grappling with the challenge of understanding an amazing amount of confusing and unsettling information. I do not fault my colleagues for their courageous efforts to struggle toward understanding complex and confusing matters.

But let me speak for myself, and not presume to speak for others. Contrary to Dr Noll’s assertions, I have never made a secret of my stance. I have shared my perspectives in many professional settings. I grew up under the shadow of the Holocaust, learning more and more about how many nations, including my own, had failed to acknowledge and/or act responsibly in the face of a genocidal disaster. I discovered how those close to the Holocaust were able to rationalize their denials and/or collaborations. Mine is the generation that heard the FBI strenuously deny the existence of organized crime until the very public 1957 Apalachin meeting of Mafia figures came to widespread attention. Then, my generation watched the FBI do an abrupt and embarrassing about face, reversing its longstanding dismissive position. Mine is the generation that had to deal with Vietnam and the American government’s egregious misrepresentation of the reality of the situation there. Further, my generation witnessed its initial denial of the damage done to the young men who served there, and their frequent misdiagnoses as character disordered or psychotic rather than traumatized. My generation watched the estimated frequency of father-daughter incestuous events soar from 1 case per million in 1975²¹ to 1 of 20 biological father-daughter relationships in 1986,²² and the estimated incidence of therapist-patient sexual exploitation from rare to embarrassingly common.²³ In addition, my generation witnessed the revelation that prestigious mental health professionals had participated in unethical research on human subjects for covert agencies, research that was very destructive to many subjects.²⁴ Further, as the findings of the Lanning report were becoming known, I was in contact with FBI agents in connection with another matter. I learned that many agents in the field did not believe that the official reports denying many aspects of SRA were honest or accurate.

Faced with these repetitive betrayals of trust and contradictory perspectives from our federal law enforcement agencies, I like many others, could not be comfortable with “authoritative” statements that denied the reality of many aspects of SRA. Strong statements from sources that had undermined their own credibility simply were not convincing-they were just more information to consider. Those who remembered the many dishonesties and betrayals of trust listed above were less likely to accord immediate credibility to a governmental agency’s reporting that organized SRA does not exist. For those who had become aware of the numerous instances of mistreatment that had been denied, rationalized, minimized and otherwise kept secret, it was very difficult to believe that something evil and covert was a priori preposterous.

I have often stated that the vast majority of SRA reports I encountered were not credible, and explained how I arrived at that opinion. In brief, I demonstrated that if the atrocities and grotesque rituals allegedly witnessed by a geographical cluster of patients who were convinced that they had victimized in transgenerational satanic abuse had actually occurred, the county in which they resided would have been depopulated in just over a decade. Their claims simply could not be true. Further, I have expressed my concern that the importance of SRA reports as a derivative expression of more mundane abuses that, if acknowledged, would threaten the attachment needs of these patients, has been sorely underestimated. Many patients found it more tolerable to believe that their abusive families simply did to them what they had experienced when they were young and were carrying on a religious tradition than to believe that they had been mistreated because their abusers wanted to abuse them. This stance both rationalizes their abuse experiences and at least partially exonerates their abusers.²⁵

However, that being said, it is undeniable that satanic elements are employed at times by those who wish to exploit the power of such materials for the purposes of intimidation and/or to pursue nefarious purposes. They are encountered in the context of organized satanic religion, in idiosyncratic religious or quasi-religious beliefs, and in deviant individuals and/or splinter groups of practices that themselves normally do not endorse such beliefs or practices. They are experienced as symptoms of psychotic/delusional mental disorders. Satanic elements remain problematic realities in many situations.

I remain troubled about the matter of transgenerational satanic cults. Any scientist or thinker has had to grapple with how difficult it is to prove that something does not exist. I am comfortable in saying that if such situations exist, they exist at a level of far less frequency than was once suspected. That being said, in the mid-1970s, years before the surge of interest in SRA during the 1980s, I encountered situations that involved reports by non-participant eyewitnesses who were neither dissociative nor traumatized patients. In fact, they were without psychiatric illness. I would be dishonest if I allowed the pressures of those with strong convictions that such groups either do or do not exist to push me to endorse either stance. Holmes cautioned Watson, “It is a capital mistake to theorize before one has data. Insensibly one begins to twist facts to suit theories, instead of theories to suit facts.”²⁶ As a corollary, it would be a similar error to follow the model of Procrustes, and cut away facts or stretch or otherwise distort them, discarding them or forcing them to fit a particular model or preconception.

I prefer honest uncertainty to false conviction.

References
(In the interests of saving space, I have not duplicated most references made by Dr Noll.)
1. Hicks D. Dignity: Its Essential Role in Resolving Conflict. New Haven, CT: Yale University Press; 2011.
2. Greaves G. Multiple personality: 165 years after Mary Reynolds. J Nerv Mental Dis. 1980;168:577-596.
3. Smith M, Pazder L. Michelle Remembers. New York: Congdon & Lattes; 1980.
4. Kluft RP. Treatment of dissociative disorder patients: an overview of discoveries, successes, and failures. Dissociation. 1993;6:87-101.
5. Gleaves D. The sociocognitive model of dissociative identity disorder: a reexamination of the evidence. Psychol Bull. 1996;120:42-59.
6. Kluft R. Iatrogenic creation of new alter personalities. Dissociation. 1989;2:83-91.
7. Brown D, Scheflin A, Hammond DC. Memory, Trauma Treatment, and the Law. New York: Norton; 1998.
8. Kluft R. The confirmation and disconfirmation of memories of abuse in dissociative identity disorder patients: a naturalistic clinical study. Dissociation. 1995;8:253-258.
9. Simon B. “Incest-See Under Oedipus Complex”: the history of an error in psychoanalysis. J Am Psychoanal Assoc. 1992;40:955-988.
10. Kogan I. On being a dead, beloved child. Psychoanal Q. 2003;72:727-766.
11. Brenner C. Commentary on  Ilany Kogan’s “On being a dead, beloved child.” Psychoanal Q. 1993;72:767-776.
12. Ferro A. Commentary on Ilany Kogan’s “On being a dead, beloved child.” Psychoanal Q. 2003;72:777-783.
13. Herzog J. Commentary on Ilany Kogan’s “On being a dead, beloved child.” Psychoanal Q. 2003;72:785-796.
14. Kogan I. Response to commentaries. Psychoanal Q. 2003;72:797-803.
15. Noll R. Satanism, UFO abductions, historians and clinicians: those who do not remember the past . . . Dissociation. 1989;2:251-254.
16. Kluft R. Multiple personality disorder. In: Tasman A, Goldfinger S, eds. Annual Review of Psychiatry. Washington, DC: American Psychiatric Press; 1991:161-188.
17. Kluft RP. Current issues in dissociative identity disorder. J Pract Psychol Behav Health. 1999;5:3-19.
18. Ellenberger H. The Discovery of the Unconscious. New York: Basic Books; 1970.
19. Lewis-Fernandez R. A cultural critique of the DSM-IV dissociative disorders section. Transcultural Psychiatry. 1998;35:387-400.
20. Mencken HL. John Petrie’s Collection of H. L. Mencken Quotes. 2014.  Accessed March 17, 2014.
21. Henderson D. Incest. In: Freedman A, Kaplan H, Sadock B, eds. Comprehensive Textbook of Psychiatry. 2nd ed. Baltimore: Williams and Wilkins; 1975:1532-1538.
22. Russell D. The Secret Trauma: Incest in the Life of Girls and Women. New York: Basic Books; 1986.
23. Gartrell N, Herman J, Olarte S, et al. Psychiatrist-patient sexual contact: results of a national survey. I: prevalence. Am J Psychiatry. 1986;143:1126-1131.
24. Scheflin A, Opton E. The Mind Manipulators: A Non-Fiction Account. New York: Paddington Press; 1978.
25. Kluft R. An overview of the treatment of patients alleging that they have suffered ritualized or sadistic abuse. In: Fraser G, ed. The Dilemma of Ritual Abuse: Cautions and Guidelines for Therapists. Washington, DC: American Psychiatric Press; 1997:31-64.
26. Conan Doyle A. Arthur Conan Doyle Quotes. 2014. Accessed March 17, 2014.

--------

Bennett Braun, MD
I am surprised and displeased to have learned about the publication of an article that vilifies and disparages me so extensively only such a short of time before its publication. I would have appreciated having enough advance notice to draft a more suitable and complete response.

Here I will only respond to the things in Dr Noll’s article that relate specifically to me, and leave the task of responding to its other unfortunate inaccuracies and mischaracterizations to others.

I have become accustomed to such slander and misrepresentation, and have been misquoted extensively over the years. Neither the Editors nor the readership of Psychiatric Times would appreciate being treated in this manner.
 
Remarks taken out of context can be presented in a manner that misrepresents the overall intent of the speaker. I would suggest that the Editors of Psychiatric Times obtain the tapes of the events to which Dr Noll refers and make their own decisions whether or not I have said what I am alleged to have said, and to place what I have said in the context in which my remarks were made. It is regrettable and shameful that such slanderous remarks will be printed by the world’s most read psychiatric publication, and conveyed to colleagues who will not be in a position to question them or judge their accuracy.

Labeling things with a catch-phrase may provide attractive and compelling shortcuts, but they often take on a life of their own that has a questionable connection to reality. Using a term like “Braun’s international conspiracy fantasies” is an attractive catch-phrase which can easily evoke strong emotion and take on a life of its own. Once such things are said, they join the ranks of “things that never were true, but always will be.” I never referred to any international conspiracy, so how can such a notion be labeled as “Braun's international conspiracy fantasy”? The answer is simple-say it loud enough and long enough and it will be remembered, and what never was true will be regarded as the truth by many.

Dr Noll’s paper is far from scientific as it contains many inaccuracies. For example, the first meeting of what is now the International Society for the Study of Trauma & Dissociation had 125 attendees-not the 300 he stated.

To describe serious educational workshops as a “carnival” demeans the workshops, their faculties, and those who attended them. The proposals for every workshop and paper presented at the meetings of this group were evaluated by 3 reviewers. Only the top 10% to 20%, depending on category, of the proposals were actually accepted for presentation.
 
I did at some point say that I had seen a patient in the Netherlands who reported satanic ritual abuse and that I had heard from others in Europe and Canada who reporting similar things. I never said that satanic ritual abuse was an “international conspiracy structured similar to a system of Communist cells.” I also said that I had seen evidence of transgenerational aspects to the abuse (as is reported in many forms of child abuse), but I very much doubt that I dated it to 2000 years ago.
 
Dr Noll has a flare for the melodramatic. The 1989 workshop he refers to was taped. I never “screamed” anything. I did say the patient who drew the picture stated that it was of a satanic ritual. I passed on what had been communicated to me.
 
Dr Noll states that no one on the Dissociative Disorders Committee for DSM-IV had been on the DSM-III-R committee. The implication is that the American Psychiatric Association wanted to get rid of the problematic people who worked on DSM-III-R. Unfortunately for his argument, his statement is historically inaccurate. David Spiegel convened an advisory committee that included some of the people Dr Noll states were excluded, and even invited the participation of scholars who were very skeptical and wanted to eliminate the disorder from the DSM. I commend Dr. Spiegel’s objectivity. I personally have no significant objection to relabeling Multiple Personality Disorder as Dissociative Identity Disorder. The diagnostic criteria and descriptive text basically convey the same meanings as their predecessors.
 
In my opinion, the major reason the Dissociative Disorders suffered, what has proved to be a temporarily reduced presence in the mental health mainstream, was due to the epidemic of false memory lawsuits, which for several years intimidated therapists and discouraged them from working with this patient population. In response to those lawsuits all too often insurers discouraged fighting these suits and settled them out rather than mount aggressive defenses of their policyholders. Whether this was due to their lack of courage or on the basis of their estimation of the costs of various options is a subject for another time. Unfortunately the results of these tactics often were the ruining of professional reputations and raised insurance rates.   

The key lawsuit against me was settled in October 1997. On January 17, 1997, the lead plaintiff testified in her deposition that she had originated all the memories herself. I did not implant any memories, she said. As she said, I only passed on to her what the other patients had reported about her. Unfortunately, the insurance companies settled against my will in October 1997, even though I paid an extra 10% premium to give me the right to refuse settlement.
 
In the atmosphere that prevailed, so many people in the mental health field, the legal profession, and the insurance industry were intimidated that the path of least resistance seemed preferable to the more expensive option of fighting for justice. Looking back, the articles to which Dr Noll refers had a powerful impact beyond their lasting merit. Within a few years, those who were not intimidated would be able to mount powerful defenses and demonstrate the shortcomings of the articles that at first many regarded as definitive. But that was not the case during the period of time to which Dr Noll refers.

In this communication, I have taken up the attacks Dr Noll made against me. My sympathy goes out to all of the others who were also treated poorly and mischaracterized, and to all of the patients who undoubtedly will be upset and confused, and whose treatments may be undermined or compromised should they come upon Dr Noll’s article without companion publications that refute his many problematic and inaccurate statements and allegations.
 
 -------
Richard Noll, PhDPsychiatric Times and its editor-in-chief, Dr James Knoll, are to be lauded for reopening a forum for the open exchange of intellectual discourse on the central issue of my historical article: why has the satanic ritual abuse (SRA) moral panic of the 1980s and 1990s been forgotten? It seems that now the time has finally arrived-uncomfortable as it may be-for a discussion of the part that American psychiatry played in this cultural and medical catastrophe.

I am especially gratified that Drs Spiegel, Kluft, and Braun have graciously contributed commentary to my article. As a young man trying to learn his clinical craft from those older and wiser, I learned a great deal from them all. Let me be clear about my esteem for these 3 physicians: within the scientific context of the 1970s to mid-1990s, all 3 men were regarded-and professionally honored-as having made significant contributions to psychiatry. When future historians of American psychiatry write their accounts of the late 20th century, all 3 of these distinguished men will be recognized for their influence in the medicine and popular media of that era. They are all modest men, and as such are naturally reluctant to acknowledge their elite status during those decades. Nonetheless, their stories are pivotal in the history of American psychiatry and they belong to the ages.

History, like clinical work, is an imperfect art. We do our best with the evidence at our disposal to reconstruct the past into a narrative for the purpose of teaching those living in the present. Certain facts cannot be disputed, others can disappear into a cloud of conflicting memories, interpretations or-as in the case of the SRA moral panic-feigned forgetfulness. As a historian of psychiatry I am delighted that Drs Kluft and Braun are open to having their voices added to the historical record. They bring fresh perspectives, insights and new facts to the historians who will certainly be writing about them. At least one book, by journalist Richard Beck, is already in progress. My article was intended as an invitation to open this discussion to professional historians and clinicians. I hope that Drs Kluft and Braun and others publish memoirs of their careers based on their own personal perspectives. I also hope that they grant young historians interviews so that the contextual gaps in the history of American psychiatry in the 1980s and 1990s can be corrected.

Readers of the 3 commentaries on my article may regard them as a bit more emotive than substantive. This quality should not be interpreted by readers as anything more than what it is. We are opening a discussion about sensitive subjects, all of us have feelings, and as humans we sometimes feel hurt.

Dr Braun makes a valid point about my mischaracterization of his vocalizations as screams in a talk he gave in 1990. I claimed this happened during his animated revelation of the satanic themes in the red crayon scribblings so violently made by his patient on a large sketch pad. Whereas I only saw something in that drawing that could have been . . . a muscle spasm? . . . it was clear to me from the wide eyes and parted lips of many in the audience that they were indeed seeing the satanism. I improperly used the words “he screamed” to characterize Dr Braun’s vocalizations, and I do apologize. As a writer trying to convey the power of a memory from 23 years ago, indeed trying also to capture all of the enthusiasm that Dr Braun demonstrated during what many of us in the room felt as the emotional climax of his presentation, simply writing “he said” or “he ejaculated” just would not do. Since even now I cannot think of an appropriate alternative term, I hope, as he is an honored expert on human memory, he will forgive my unintentionally melodramatic mnemonic misstatement. It was a memory of an emotional moment long, long ago. And as cognitive science research on memories teaches us, they are highly prone to distortion and must be challenged if contradictory evidence deems them inaccurate-or blatantly false. This is where historians and clinicians share the same ethical responsibility. Remaining silent is morally unacceptable.

As for the number of persons attending the first proto-ISSMP&D meeting, the source for what I regarded as a minor point in my narrative may have been wrong, and I concede there may have been less than 300 enthusiasts at that prelapsarian conclave. I am sure historians will be hotly debating the true number for decades.

Humans are endlessly surprising creatures. They get mixed up in all sorts of things. As anyone who is old enough to remember Charlie Manson and his Family will agree, the diabolic potential of small group dynamics in isolated environments knows no bounds. My comment in my 1989 letter about the probability of some SRA reports being true was an expression of this reasonable surmise, and nothing more. Ken Lanning of the FBI said in print in 1992 and on camera in the recent New York Times video story on the McMartin day care scandal that he also started off with this same reasonable assumption when he first heard of SRA claims. Philosopher Ian Hacking also expressed such a view in the 1995 book that I cite in my article. But organized Devil-worshipping cults kidnapping, abusing and ritually sacrificing children? Nope. Never. Never for a moment did I believe these stories were true, and just to correct a remark in the comments above, Dr Frank Putnam never did either.

Following standard academic practice, to back up claims in my article I cited sources from what the community of scholars has regarded as reliable historical scholarship about SRA claims and about the role of American psychiatrists in the moral panic. These sources go back almost 25 years, and among the best and most highly regarded are the works of sociologist Mary de Young. Her 1994 article and 2 scholarly books on the moral panic, all cited above, have been regarded as the most scrupulously accurate compilations of the basic facts. Sherril Mulhern, Jeffrey Victor, Robert Hicks, Debbie Nathan, and many others produced a body of scholarship based on primary sources (their own participant observations, transcripts of lectures, audio- and videotapes, etc) some 2 decades ago when these events were fresh. Others who were there, such as Johns Hopkins psychiatrist Paul McHugh in his 2008 book referenced above, have recently contributed new historical evidence about American psychiatry’s role in the SRA moral panic.

If  any one of the facts in this large scholarly literature of the past quarter century has truly been maliciously misinterpreted or is incorrect, as is alleged in the commentaries above, I think it is therefore ethically imperative for Drs Braun and Kluft to offer published historical documentation to contradict such a false claim robotically repeated by decades of scholars. But they need to make a case to the public based on historical and scientific evidence, not on polemics. Let’s all hope they do this. I know they have much to teach us.

None of us are getting any younger. For all those who were witnesses or participants, skeptical or otherwise, during the SRA moral panic of the 1980s and 1990s, now is the time to think about how one’s career and reputation is to be reconstructed by future historians. Now is the time for everyone to share their memories.

With the reposting of a modified version of my article, the vigorous commentaries, and my final response, perhaps the veil is lifted on the past and memory may now be allowed to speak. Let us open more doors within our cultural memory palace and let us learn from our mistakes.