Saturday, January 29, 2005

Trauma memories: "Recovered" vs. "False"

I've put my affairs in order, written a hasty will, and disposed of my property. Please tell Mom that when I launched this post, I understood the magnitude of the forces that would be arrayed against me, and expected that I might be vanquished by one (or more) of them. (Deep breath.) All right...I'm going to say a few words about...recovered memories of trauma. To what extent can they be trusted? Skeptics can have a field day with both sides of the debate.

The psychiatrist at Follow Me Here... gets it exactly right when he describes the intensity of feelings on this matter. He's commenting on the trial of former priest Paul Shanley, accused of sexual abuse by a man who claims to have recovered repressed memories, albeit not during psychotherapy.
While traumatic memories are stored in a dissociated way, protectively inaccessible to the victim until recovered, it is also demonstrable that 'recovered memories' can be fictitious after-the-fact creations. Human memory is malleable and, in some instances, how convincing it is is matched by how unreliable it is. I wonder if we are going to see a monumental battle of expert witnesses around the recovered memory issue in the current case. The proponents of the view that these recovered memories are false and the adherents to the trauma model are often zealots who clash as cataclysmically — and unproductively — as any do when they argue about matters of faith. Shanley and his accuser will likely become damaged icons for polemical positions in a prodigious battle played out in the Cambridge courtroom. (emphasis added)

Slate has written an even-handed article about issues raised by the trial:
...whether "repressed memories" represent medical fact or junk science. And the trial itself has become something of a referendum on whether human beings are capable of forgetting, then remembering, details of traumatic, life-changing events.

The notion of repressed memory was floated by Sigmund Freud in the late 19th century. He suggested it occurred when a patient (usually a hysterical female victim of sexual abuse) "intentionally seeks to forget an experience, or forcibly repudiates, inhibits and suppresses" memory. The basic theory of repressed memory, as described by Jacqueline Hough in a 1996 article in the Southern California Law Review holds:

It is often beneficial for victims to forget these events because at the time of the abuse a victim experiences a variety of overwhelming emotions including helplessness, fear, shame, guilt, pain and betrayal. To survive, the victim is forced to mentally cope with these emotions because the victim often cannot physically escape the abusive environment. Blurring of the trauma, denial, repression and amnesia of the experience are common ways children cope with the trauma and the accompanying emotions.

Clinicians argue that repressed memories can be recovered through treatments including hypnosis, age regression, or suggestion therapies, but—as is allegedly the case with Shanley's accuser—some victims experience spontaneous recovery. The American Psychiatric Association formally recognized repressed-memory syndrome in 1994, calling it "dissociative amnesia."

Advocates of repressed-memory syndrome have been well met on the battlefield in recent years by proponents of what's known as the "false memory syndrome." They insist that the recovery of repressed traumatic memories is all bunk and that most repressed memories of sexual abuse are the result of negligent therapists who implant and reinforce false memories during treatment. The APA does not recognize "false memory syndrome," which doesn't help much in the courtroom. But the public is still vaguely aware that repressed memories were fashionable in the '80s and went out again by the late '90s.

The chasm between the two camps in this debate—and the stunning contempt they evince for one another's research—is to some degree a function of warring agendas and approaches. One legal writer claims that "in over 1,000 child sexual abuse, rape and other types of cases in which I have been personally involved, I have not met one real victim who has forgotten that they were assaulted and then remembered it at a later date." On the other hand, Wendy J. Murphy summarily dismisses false memory syndrome, stating, "This simply does not exist as a recognized medical condition. The phrase was coined by the False Memory Syndrome Foundation, an organization formed to provide legal and emotional support to those accused of sexual abuse."

Brain scientists, the proponents of false memory syndrome, must believe that memory is fluid and malleable, whereas clinical therapists who are proponents of repressed memory syndrome have to rely on their patient's autobiographical accuracy in order to treat them. The politics of the parties themselves—with sex-abuse victims on one hand and falsely accused abusers on the other—means the scholarly debate is mired in hate mail, death threats, and near-toxic levels of recrimination...

After reviewing legal aspects of the debate, Slate concludes:
"Still, the bottom line remains that there is probably no one crystalline answer about the scientific truth of repressed memories. As with most overheated scientific controversies in the courtroom, the truth probably lies midway between two bitterly polarized camps: Some witnesses do make up stories, and some therapist do implant memories; but some victims surely do recover lost childhood memories that were too terrible to consider at the time. The reason we have trials—indeed, the reason we have juries—is that sometimes sorting between the "junk" and the "science" has less to do with experts and scientific journals than with the truth behind a witness's eyes.
What to make of that last sentence? If experts and journals are divided, then how will the trial, or the jury, be able to sort the "junk" from the "science," and discern the truth behind witness's eyes? Here's Dr. Robert I. Simon, MD:
The memory debate has polarized most therapists into believers and disbelievers. Strongly held personal biases about recovered memories represent a new occupational hazard for clinicians. Such feelings can undermine the therapists' duty of neutrality to their patients, creating deviant treatment boundaries and the provision of substandard care...Further complicating the matter is the empirical evidence about memory mechanisms, which (as is typical for any emerging science) reveals contradictory findings about how and what persons retain in memory and forget in various settings. Empirical studies often fail to distinguish whether allegedly repressed memories are not retrieved or simply not reported to researchers.
He offers succinct advice to clinicians: Maintain therapist neutrality; do not suggest abuse. Stay clinically focussed. Carefully document the memory recovery process. Manage personal bias. Stay within professional competence; do not take cases you cannot handle. (from Concise Guide to Psychiatry and Law for Clinicians, Third Edition, APA Publishing 2001).

Until research gives us a better understanding of these matters, I'll adhere to his rules. And if anyone wants more from me about this post....should I say that I've forgotten all about it?
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