The Trauma Trap

The book of Richard J. McNally REMEMBERING TRAUMA has been re-viewed  in an earlier article by Prof. Robert Wilcocks on INFC’s (English)  site, already. The fact that it has been reviewed now also by another prominent  scholar from the ranks of Freud critics, Prof. Frederick Crews, underlines the importance of McNally’s deliberations for the debate of the humanities.

THE TRAUMA TRAP has appeared in The New York Review of Books, Volume 51, Number 4 ·     March 11, 2004.

We are publishing Part Three of this article and point for the full text to www.nybooks.com/articles/16951         It is one of the most informed and closely argued pieces that have been written on this topic.

Frederick Crews is Professor Emeritus and former chair of the Department of English at the University of California, Berkeley. Among his many publications are several major books (Skeptical Engagements, 1986; The Memory Wars: Freud’s Legacy in Dispute, 1995; Unauthorized Freud: Doubters Confront a Legend, 1998) dealing with the subject of psychoanalysis and the writings and influence of Sigmund Freud. The immense scholarship and careful investigation of Professor Crews have been largely responsible for the complete re-evaluation of the status of psychoanalysis that is currently taking place in the United States of America. The Canadian scholar Phyllis Grosskurth has written of The Memory Wars (1995):
        „Frederick Crews‘ voice of common sense has cut through the mass hysteria about repressed memory syndrome. Always fearless and provocative, he has finally exposed a fashionable fad which has ruined many innocent people.“

Frederick C. Crews

The Trauma Trap

Remembering Trauma
by Richard J. McNally Belknap/Harvard University Press, 420 pp., $35
Memory, Trauma Treatment, and the Law
by Daniel Brown, Alan W. Scheflin, and D. Corydon Hammond
W. W. Norton, 768 pp., $100.00

… As I have noted on several occasions,[13] and as McNally confirms, in the 1990s recovered memory therapy made significant inroads into the practice of North American psychoanalysis. Even today, feminist clinicians bearing diplomas from analytic institutes are probing for missing memories of abuse and vigorously defending that practice in psychoanalytic books and journals. But the American Psychoanalytic Association, representing over 3,000 members, has turned a blind eye to this trend—and one can understand why. The psychoanalytic movement is already embattled, and too much about the historical ties between Freudianism and recovered memory would prove embarrassing if attention were called to it. The elected custodians of Freud’s legacy have no desire to confront his early phase as a self-deceived abuse detecter; or to admit the precedent he set, during that phase and thereafter, in treating dreams, tics, obsessional acts, and agitation in the consulting room as „behavioral memories“ of inferrable traumas; or to revisit the grave doubts that have been raised about repression; or to be reminded of the way psychoanalysts, until quite recently, insulted real victims of molestation by telling them that their „screen memories“ covered a repressed desire to have sex with their fathers.[14] No longer given to excommunicating dissidents, the tottering Freudian patriarchy has made its peace with „recovered memory psychoanalysis“ by pretending that it doesn’t exist.

The largest of the three societies riven by the issue of recovered memory, the 95,000-member American Psychological Association (hereafter APA), is nominally responsible for quality control in the administration of therapy by the nation’s clinical psychologists. Hence one APA division’s commendable effort in the 1990s to identify the most effective treatment methods for specific complaints such as phobias and obsessive-compulsive disorder. That initiative, however, met with disapproval from APA members whose favorite regimens had not been found to give superior results. Some practitioners worried that insurers would use the list of approved treatments as an excuse to cut off reimbursement for all but the preferred therapies, and others complained that the association seemed on the verge of putting soulless experimentation ahead of clinical know-how. For now at least, the organization as a whole is not recommending treatments, to say nothing of disavowing dangerous ones.[15] Recovered memory thus gets the same free pass from the APA as „attachment therapy,“ „therapeutic touch,“ „eye movement desensitization and reprocessing,“ „facilitated communication,“ and the hypnotic debriefing of reincarnated princesses and UFO abductees.[16]

This reluctance to challenge the judgment of its therapist members is deeply rooted in the APA’s philosophy. Ever since 1971, when the association gave its blessing to Ph.D. and Psy.D. programs that omitted any scientific training, the APA has guided its course by reference to studies indicating that the intuitive competence of clinicians, not their adherence to one psychological doctrine or another, is what chiefly determines their effectiveness.[17] Those studies, however, were conducted before recovered memory practitioners, using a mixture of peremptory guesswork and unsubstantiated theory, began wrenching patients away from their families and their remembered past.

In 1995 the APA did publish a brochure, „Questions and Answers about Memories of Childhood Abuse,“ which can still be found on the „APA Online“ Web site. The document combined some prudent advice to patients with soothing reassurance that „the issue of repressed or suggested memories has been overreported and sensationalized.“ Further inquiry into the phenomenon, it said, „will profit from collaborative efforts among psychologists who specialize in memory research and those clinicians who specialize in working with trauma and abuse victims.“

But the APA directors already knew that such collaboration was impossible. In 1993 they had established a „task force,“ the Working Group on the Investigation of Memories of Childhood Abuse, self-defeatingly composed of three research psychologists and three clinicians favorably disposed to retrieval, and the task force had immediately degenerated into caucusing and wrangling. After years of stalemate, the group predictably submitted two reports that clashed on every major point; and the abashed APA, presented with this vivid evidence that „clinical experience“ can lead to scientific heterodoxy, declined to circulate photocopies of the two documents even to its own members except by individual demand.

Meanwhile, the organization repeatedly compromised its formal neutrality. In 1994, for example, the APA’s publishing house lent its prestigious imprint to a book that not only recommended recovered memory therapy but recycled the most heedless advice found in pop-psychological manuals. The book, Lenore E. A. Walker’s Abused Women and Survivor Therapy: A Practical Guide for the Psychotherapist, touted hypnotism as a legitimate means of gaining access to „buried memories of incest“ and „different personalities“ within the victim (pp. 425-426). Walker provided a list of telltale symptoms, any one of which might indicate a history of forgotten molestation. These included „ambivalent or conflict ridden relationships,“ „poor body image,“ „quiet-voiced,“ „inability to trust or indiscriminate trust,“ „high risk taking or inability to take risks,“ „fear of losing control and need for intense control,“ „great appreciation of small favors by others,“ „no sense of humor or constant wisecracking,“ and „blocking out early childhood years“ (p. 113) – years which in fact are not remembered by anyone.

Then in 1996 the APA published and conspicuously endorsed another book, Recovered Memories of Abuse, aimed at equipping memory therapists and their expert witnesses with every argument and precaution that could thwart malpractice suits.[18] The book’s co-authors were well-known advocates of recovered memory treatment, and one of them, Laura S. Brown, was actually serving at the time on the deadlocked task force. She had also supplied a foreword to Lenore Walker’s bumbling Abused Women and Survivor Therapy, calling it „invaluable and long overdue“ (p. vii). Unsurprisingly, then, Recovered Memories of Abuse characterized false memory as an overrated problem and drew uncritically on much of the research whose weaknesses Richard McNally has now exposed. The APA’s unabated promotion of that book, even today, suggests that the organization remains more concerned with shielding its most wayward members than with warning the public against therapeutic snake oil.

There remains, once again, the American Psychiatric Association—“the voice and conscience of modern psychiatry,“ as its Web site proclaims. Putting aside the fiasco of the 1999 Guttmacher Award, we might expect that a society representing 37,000 physicians, all of whom have been schooled in the standard of care that requires treatments to be tested for safety and effectiveness, would be especially vigilant against the dangers of retrieval therapy. Thus far, however, that expectation has not been fulfilled.

To be sure, the Psychiatric Association’s 1993 „Statement on Memories of Sexual Abuse“ did warn clinicians not to „exert pressure on patients to believe in events that may not have occurred. . . .“ Yet the statement inadvertently encouraged just such tampering by avowing that the „coping mechanisms“ of molested youngsters can „result in a lack of conscious awareness of the abuse“ and by characterizing „dissociative disorders“ as a typical outcome of that abuse. Those remarks constituted a discreet but unmistakable vote of confidence in multiple personality disorder and its imagined sexual etiology. And indeed, a year later the fourth edition of the Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) reaffirmed the validity of MPD under the more dignified and marketable name of dissociative identity disorder.

The Psychiatric Association’s 1993 declaration on abuse memories performed still another service, a subtle one, for the repression/dissociation lobby. In explaining „implicit“ memory—the kind that is exercised in the routine execution of skills or in the coloring of emotions by past impressions that aren’t being explicitly called to mind—the statement proffered a curiously strained example. „In the absence of explicit recall,“ it said, implicit memory can torment „a combat veteran who panics when he hears the sound of a helicopter, but cannot remember that he was in a helicopter crash which killed his best friend.“ Here was an elision of the crucial gap between merely not thinking about a past event, as in the normal operation of implicit memory, and having total, psychologically motivated amnesia for that event.

Knowledgeable readers would have seen that in taking this unusual step, the statement’s drafters were lending their authority to one controversial interpretation of post-traumatic stress disorder (PTSD), which the Psychiatric Association had first stamped as genuine in DSM-III of 1980. But why should a primarily martial ailment have figured even indirectly in a position paper on childhood sexual abuse? The mystery vanishes, however, if we know that the recovered memory movement’s favorite means of courting respectability has been to fold the symptoms of repressed/dissociated abuse into PTSD.

In 2000 the Psychiatric Association’s trustees, eschewing risky flights into theory, approved a lower-profile „Position Statement on Therapies Focused on Memories of Childhood Physical and Sexual Abuse.“ This declaration, however, was more pussyfooting than its predecessor. The validity of recovered memory treatment, it whispered, „has been challenged“ in some quarters. While pointing out that memories can be altered as a result of suggestions from „a trusted person or authority figure,“ the drafters tactfully refrained from mentioning that the suggesting party is usually a therapist. And clinicians were advised to avoid „prejudging the veracity of the patient’s reports“ of abuse, as if false reports were typically delivered to therapists out of the blue, without influence from confabulation-enhancing devices employed within the treatment. The absence of any mention of those devices, such as hypnosis and sodium amytal, marked a step backward from the association’s 1993 statement.

These equivocations neither helped nor impeded the already withering recovered memory movement. As we will now see, however, the movement’s hopes of a comeback have been pinned on the Psychiatric Association’s fateful decision to treat post-traumatic stress disorder as an integral and historically invariable malady. And that decision was a medically unwarranted one. As McNally indicates with reference to several recent studies, PTSD, like Victorian hysteria and like recovered memory itself, can now be understood as an artifact of its era–a sociopolitical invention of the post-Vietnam years, meant to replace „shell shock“ and „combat fatigue“ with an enduring affliction that would tacitly indict war itself as a psychological pathogen.[19] However crippling the symptoms associated with it may be for many individuals, the PTSD diagnosis itself has proved to be a modern contagion.

Once certified by the American Psychiatric Association as natural and beyond the sufferer’s control, post-traumatic stress disorder began attracting claimants, both civilian and military, who schooled themselves in its listed symptoms and forged a new identity around remaining uncured. By now, as McNally relates, PTSD compensation is demanded for such complaints as „being fired from a job, one-mile-per-hour fender benders, age discrimination, living within a few miles of an explosion (although unaware that it had happened), and being kissed in public“ (p. 281). According to Paula Jones among others, PTSD can even be the outcome of a consensual love affair. In view of such examples, the attempt to subsume forgotten abuse under post-traumatic stress makes more cultural than scientific sense; the same atmosphere of hypersensitivity and victimhood brought both diagnoses to life.[20]

As McNally shows in his concise and undemonstrative style, the national sex panic left its mark on each successive version of the Psychiatric Association’s bible, which in turn congealed folklore into dogma. The 1980 DSM-III entry on post-traumatic stress disorder, mindful only of wars and other shocking disasters, had defined a PTSD-triggering event as one that falls „generally outside the range of usual human experience“ and that „would evoke significant symptoms of distress in almost everyone.“ In 1994, however, the fourth edition generously expanded the category of precipitating causes to include „developmentally inappropriate sexual experiences without threatened or actual violence or injury.“ Thus a single-minded therapeutic sleuth could now place a questionably retrieved incident of infantile genital fondling on the same etiological plane as the Bataan death march or an ambush in the Mekong Delta.

It was the diagnostic manual, once again, that removed the largest obstacle of all to the merger of post-traumatic stress and recovered memory. The key sign of PTSD, as first conceived, was that accurate recollections of the trauma keep intruding on the patient’s conscious mind; this was just the opposite of repressed or dissociated memory. But between DSM-III and its revised edition of 1987, PTSD patients were discovered to have been harboring a convenient new symptom. In 1980 they had shown only some incidental „memory impairment or trouble concentrating“ on daily affairs, but the updated edition replaced routine forgetfulness with „inability to recall an important aspect of the trauma“ (emphasis added).

This retroactive infusion of amnesia into the clinical picture of PTSD explains why the Psychiatric‘ Association’s illustrative helicopter pilot could have been troubled by a memory that had left no conscious imprint on his mind. Here, too, was the opening needed to give dissociation an appearance of hard-scientific concreteness. Post-traumatic stress, it was now claimed, short-circuits narrative memory and finds another, precognitive, channel through which it can flood the subject with anxiety. Accordingly, diehard recovered memory theorists took up a last refuge in neurobiology, now maintaining that dissociated sexual abuse generates signature alterations of brain tissue.

With the arrival of McNally’s Remembering Trauma, there is no longer any excuse for such obfuscation. It makes no sense, McNally shows, to count forgetfulness for some „aspect of the trauma“ within the definition of PTSD, because normal people as well as PTSD sufferers get disoriented by shocking incidents and fail to memorize everything about the event, even while knowing for the rest of their lives that it occurred. Likewise, it has never been established, and it seems quite unbelievable, that people can be haunted by memories that were never cognitively registered as such. Nor can specific brain markers vouch for the reality of a long-past sexual trauma, because, among other reasons, those features could have been present from birth. „It is ironic,“ McNally reflects, „that so much has been written about the biological mechanisms of traumatic psychological amnesia when the very existence of the phenomenon is in doubt. What we have here is a set of theories in search of a phenomenon“ (p. 182n.).

Remembering Trauma is neither a polemic nor a sermon, and McNally offers little counsel to psychotherapists beyond warning them against turning moral disapproval of pedophilia into overconfidence that they can infer its existence from behavioral clues observed twenty or thirty years after the fact. But another lesson is implied throughout this important book. Attention to the chimerical task of divining a patient’s early traumas is attention subtracted from sensible help in the here and now. The reason why psychotherapists ought to familiarize themselves with actual knowledge about the workings of memory, and why their professional societies should stop waffling and promulgating misinformation about it, is not that good science guarantees good therapy; it is simply that pseudoscience inevitably leads to harm.

 

Notes:

[13] See, e.g., The Memory Wars: Freud’s Legacy in Dispute (New York Review Books, 1995), pp. 15-29; Unauthorized Freud: Doubters Confront a Legend (Viking, 1998), pp. x-xi; and „Forward to 1896? Commentary on Papers by Harris and Davies,“ Psychoanalytic Dialogues, vol. 6 (1996), pp. 231-250. That special number of Psychoanalytic Dialogues became a book edited by Richard B. Gartner, Memories of Sexual Betrayal: Truth, Fantasy, Repression, and Dissociation (Jason Aronson, 1997). My own contribution, however, was excised and replaced by an attack on my earlier criticisms of psychoanalysis.

[14] On this last point, see Bennett Simon, „‘Incest—See Under Oedipus Complex‘: The History of an Error in Psychoanalysis,“ Journal of the American Psychoanalytic Association, vol. 40 (1992), pp. 955-988.

[15] See David Glenn, „Nightmare Scenarios,“ Chronicle of Higher Education, Oct. 24, 2003, pp. 14-17.

[16] A welcome new critique of fad therapies is Science and Pseudoscience in Clinical Psychology, ed. Scott O. Lilienfeld, Steven Jay Lynn, and Jeffrey M. Lohr (Guilford Press, 2003).

[17] See Robyn M. Dawes, House of Cards: Psychology and Psychotherapy Built on Myth (Free Press, 1994), especially pp. 10-22.

[18] Kenneth S. Pope and Laura S. Brown, Recovered Memories of Abuse: Assessment, Therapy, Forensics (American Psychological Association, 1996).

[19] See especially Allan Young, The Harmony of Illusions: Inventing Post-Traumatic Stress Disorder (Princeton Univ. Press, 1995), and Herb Kutchins and Stuart A. Kirk, Making Us Crazy: DSM: The Psychiatric Bible and the Creation of Mental Disorders (Free Press, 1997).

[20] As the Pied Pipers of recovered memory, Ellen Bass and Laura Davis, told prospective survivors in 1988, „When you first remember your abuse or acknowledge its effects, you may feel tremendous relief. Finally there is a reason for your problems. There is someone, and something, to blame.“ The Courage to Heal: A Guide for Women Survivors of Child Sexual Abuse (Harper & Row, 1988), p. 173.

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