Alex Constantine - April 3, 2013
Alan Scheflin is a professor of law at Santa Clara University School of Law in Santa Clara, Calif. He is the only nonpsychiatrist to win the Manfred S. Guttmacher Award twice. In addition, Professor Scheflin has received five other awards for his work in the field of mental health, particularly memory and hypnosis.
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?
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
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
