Richard J. McNally, Remembering Trauma. Cambridge (Mass), The Belknap Press of Harvard University Press, 2003. pp. 420. ISBN 0-674-01082-5.
Harrison G. Pope, Jr. Psychology Astray: Fallacies in Studies of „Repressed Memory“ and Childhood Trauma. Boca Raton (FL). Upton Books, 1997. pp. 139. ISBN 0-89777-149-4.
Over a quarter of a century ago, Elizabeth Loftus published an important early paper on the difficulties of relying on accurate memory recall and on the dangers of the intrusive capacity of leading questions on eyewitness reports in court. The four well-designed experiments detailed in this paper deal neither with trauma nor with sex, nor even with memory per se. They do, however, deal very carefully with the perception of experience and the ways in which the recall of that perception may be variously „constructed“ after the event in accordance with „leading questions“ from the interviewer. The reason that this early paper is still so important is that it addresses fundamental issues (of accuracy of recall and of reporting) that were in later years (roughly from the 1980s on) to emerge during what have been termed „The Memory Wars“. Elizabeth Loftus, now at the University of California, Irvine, has since become one of the leading investigators in the highly politicized area of so-called „repressed memories“.
In 1994 she produced with K. Ketcham The Myth of Repressed Memory, a work that is cited by both McNally and Pope. Harrison G. Pope, Jr. is a professor of psychiatry at Harvard Medical School and Chief of the Biological Psychiatry Laboratory at McLean Hospital in Belmont, Massachusetts. His little book (it is no more than 139 pages) has been well received internationally for its clarity, lucidity and intellectual integrity. As the late English psychologist Stuart Sutherland noted in Nature: „Pope’s careful analysis of possible sources of error should be useful to intending epidemiologists, and regrettably some practising ones, and to other disciplines within the social sciences.“
As his title indicates, Pope has doubts about the reality of „repressed memory“. His very first chapter, „Repression by Any Other Name“, refers to Sigmund Freud’s famous statement that repression was „the corner-stone on which the whole structure of psycho-analysis rests“ and throughout the whole of this little book Pope cogently argues that repression of memory — as opposed to amnesia or forgetfulness — is not a human capacity. He carefully refutes the findings of Linda Meyer Williams (pp. 39-40, 61-62, 65-73) who is, as Sutherland notes, „the one most cited by believers in repressed memory“. Whether Pope’s suggestion that „repression“ is a 19th-century invention owing its elaboration to the Romantic School is valid is another question. It may very well be that, in Western European literature at least, there was no representation of „repression“ as such prior to the Romantic period. Shakespeare’s heroes and heroines, for example, may suffer from depression, from sleep-walking, from nightmares, from visionary dreams, from a haunted sense of guilt („Thou canst not say I did it: Never shake thy gory locks at me“ Macbeth, III, iv, 50) and so on; but they do not exhibit what is now called repression. Is, therefore, what Freud called „the corner-stone of psychoanalysis“ merely a 19th-century concoction which has no scientific, or simply empirical, value whatsoever? Pope’s answer is a resounding „Yes“. His jargon-free and deliberately popular text is a provocatively direct attack on the varieties of mumbo-jumbo that the „caring disciplines“ have offered their helpless clients.
Richard McNally, also of Harvard Medical School, has produced with Remembering Trauma what is likely to remain for many years the most substantial and the most rigorously researched work on trauma and memory. This book, with almost a hundred pages of „works cited“, and twenty-five pages of discursive endnotes, is beautifully written in a clear expository prose which is accessible to the informed layman as much as to the academic. Like Pope and Loftus (whom he cites), McNally is at pains to write a clear and evidentially validated work on the vexed question of „trauma“ (what is it? what does it imply? how does it occur? how many kinds of trauma are there? – from the various kinds of closed head injuries to the many varieties of emotional and existential shock, those for instance of Vietnam war veterans or Holocaust survivors) and „memory“ (can it be „repressed“? can it, after „repression“, be „recalled“, can it be „invented“?). Can „false memories“ be implanted? As Elizabeth Loftus amusingly notes in a recent interview in New Scientist, she has succeeded in implanting such false memories. They do exist, they can be manufactured. And the example she offers is the happily incontrovertible one of „remembering“ shaking hands with Bugs Bunny at Disney World! (The witty rabbit Bugs, I should point out for the non-cognoscenti, is a creature of the rival Warner Bros enterprise, and hence unlikely to be found wandering around a Disney enclosure.)
McNally begins appropriately with an extensive review of what he calls „The Politics of Trauma“. He is clearly aware of the minefield of received opinion on which he is about to embark. But he has faith in empirical scientific investigation and honest reporting and in a sense his whole book is dedicated, implicitly, to the splendid argument in favour of free speech by Milton in his Areopagitica:
Though all the winds of doctrine were let loose to play upon the earth, so Truth be in the field we do injuriously, by licensing and prohibiting, to misdoubt her strength. Let her and Falsehood grapple; who ever knew Truth put to the worse, in a free and open encounter?
Quoting from this opening chapter, the psychologist Carol Tavris in her excellent Times Literary Supplement review writes:
What is a trauma and why do some people continue to have emotional symptoms when most recover? McNally resists the conciliatory impulse to take the middle ground, perhaps along the lines of „recovered memories occur more often than some people think but less than others think“. Nonsense, he says. Some people think the world is round and others may say that it is flat, but „neither science nor reason requires us to conclude that the world is oblong“. There are no oblong compromises in Remembering Trauma, only the most scrupulous conclusions based on what the evidence shows, or fails to show.
One of the great strengths of McNally’s book is his tireless examination of hostile published research material with, in every case, a substantial and substantiated rebuttal of its inadequacies. In this respect, his monumental undertaking is similar in spirit to the more limited excursions of Harrison G. Pope, Jr. Research contrary to his own scientific and clinical findings is not only not ignored, it is fully reported and carefully challenged (in a way that Milton would have admired). Truth is indeed „in the field“ in this extraordinary book.
In his second chapter, „How we remember“, McNally reminds us of the difference between research and „armchair speculation“ and raises the question of memory itself, irrespective of context or circumstances. At 50 pages, this is the longest chapter in the book; it is also the most technically demanding and the least anecdotal, except perhaps for the references to the celebrated „H.M.“ „who had undergone a bilateral temporal lobectomy to treat his intractable epilepsy. Surgeons removed his amygdala and about two-thirds of his hippocampus, structures located deep within the brain’s temporal lobes. H.M.’s epilepsy improved, but he became almost entirely incapable of remembering any new facts or events . . . His memory for most information stored before his surgery was intact, and he could retain new information for about 30 seconds. But once his attention shifted to another topic, he immediately forgot everything that had just been on his mind. That is, H.M. was incapable of transferring the contents of short-term memory into long-term memory.“ (McNally, pp. 28-29)
Using the computer metaphor (with an awareness of its partial value), McNally discusses the various aspects of the „encoding“ of experience. He debates the distinctions between „declarative memory“ and „non-declarative memory“ (two aspects of which are episodic memory and semantic memory). As far as the issue of „infantile amnesia“ is concerned, McNally takes the position long accepted by neurologists and neuro-psychologists that the immature brain of the infant does not „encode“ (or, rather, cannot encode) memories of experience in any long-term pathway. This does not lead him to immediately confront doctrinaire Freudianism however, for the next three chapters deal respectively with: „What is psychological trauma?“; „Memory for trauma“; and „Mechanisms of traumatic memory“.
It is not until Chapter 6 entitled „Theories of repression and dissociation“ that McNally fully addresses the many issues raised by the history of Freud’s „Seduction theory“ and his later abandonment of it. He relies for a large part of his information on the several closely-argued and well-researched articles by the British Freud historian Allen Esterson. In my view, McNally’s tone is restrained; but even he is evidently irritated by the fabulous concatenation of lies (to his patients, to his peers, to the public at large) by Sigmund Freud which has resulted in so much psychological – and indeed economic! – grief in the last century. He writes, trenchantly, at one point:
The notion that Freud listened while his patients remembered and disclosed memories of having been raped by their fathers is pure nonsense. As the historian of psychoanalysis Allen Esterson [reference omitted] points out, Freud’s letters to Fliess show that Freud formulated his theory that repressed memories of infantile abuse caused hysteria before „uncovering“ any evidence of incest. And as soon as Freud had abandoned his seduction theory, he ceased to „uncover“ any more repressed memories of infantile sexual abuse. (McNally, p. 163)
McNally’s damning dismissal of any empirical value in the Freudian fantasmagoria is backed up by his extensive reading of the critical literature on the history of the psychoanalytic movement, including researchers such as Frank Cioffi (1972, 1984), Mikkel Borch-Jacobsen (1996), Malcolm Macmillan (1997) and Han Israëls and Morton Schatzman (1993). The „Oedipus Complex“ scenario is given short-shrift: „The cover-up [of the lies relating to the seduction hypothesis treatments] concerns Freud’s claim to have discovered the Oedipus Complex, unconscious infantile sexual fantasies, and so forth in his patients, and his use of this claim to conceal the real sources of these notions: his suggestive technique and his own extravagant imagination.“ (McNally, pp. 167-168)
This leads naturally to a section called „Repression, suppression, and cognitive science“ where McNally deftly disassembles what may be called the postFreudian writings and treatment practices of modern North American therapists still persuaded of the value of „recovering“ memories of infantile abuse. Of particular relevance is the fact that victims of abuse do not „forget“ their experiences, quite to the contrary! The problem therefore becomes one of understanding what may have been encoded and dealing with the consequences of such material in the memory and current life of the patient. A quite different proposition, and not one involving any conception of „repression“!
The next chapter, „Traumatic Amnesia“ is the second longest in the book and deals, in contramotion as it were, with the converse of the memory problems discussed in Chapter 2. This chapter is as crucial as the earlier one on memory and it may be helpful simply to quote the opening paragraph:
Because the most contested issue in the field of trauma concerns whether people can experience amnesia for their traumatic experiences, it is essential to clarify what amnesia really means. Amnesia is an inability to remember certain facts and experiences that cannot be attributed to ordinary forgetting. Merely not thinking about something for a period of time is not the same as amnesia. A diagnosis of amnesia requires an inability to remember. (McNally, p. 186)
In a sense, this is the key chapter in the book. McNally is fully aware of the problems involved in claims of „amnesia“. He notes, „Disentangling organic and psychogenic causes of amnesia can be difficult, especially when physical or psychic precipitants seem relatively minor. Sometimes psychological stressors trigger retrograde amnesia in a person with preexisting neurological impairment, thereby blurring the distinction between psychic and organic causation.“ (McNally, pp.186-187) This is also a medical, and indeed forensic, area where conscious deception may be involved. What is one to do then? And how is such deception to be determined? McNally raises the issue: „. . . some murderers report amnesia for their crimes. Some may fake their memory loss, hoping to gain leniency in the courtroom.“ (McNally, p. 187)
Does „psychogenic amnesia“ exist? Yes, replies McNally, it does. But he has a whole section in this chapter which is entitled „Psychogenic Amnesia versus Traumatic Amnesia“. He writes of psychogenic amnesia that „the restoration of memory rarely requires psychotherapy. These features of classic psychogenic amnesia differ dramatically from those of alleged repressed and recovered memories of abuse.“ (McNally, p. 189) In the following section, „Evidence Adduced for Amnesia for Trauma“, McNally, quoting the work of Harrison G. Pope and his colleagues, argues that „there is no convincing evidence that people can banish, and then later retrieve, memories of horrific experiences.“ (McNally, p. 190) He shows that research papers used to demonstrate the contrary have been misread and that what appears in the literature to show support for „traumatic amnesia“ in fact does not do so.
The presence of the spirit of Elizabeth Loftus makes itself felt in the next section „Amnesia for Sexual Abuse?“. This „most contentious issue“ is a veritable minefield where the framing of the wrong question (or, perhaps, the wrong framing of a genuine question) may create havoc on serious empirical investigation for the truth. McNally is sensitive to the dilemmas of the wrong questioning phrase, allied to the affirmation of the wrong inferences from the answers. He writes:
A serious problem in these studies is the wording of the key question: subjects were asked whether there had ever been a time when they were unable to remember the abuse. An affirmative answer implies that the subject has spent a period of time unsuccessfully trying to remember having been abused. But if a person has repressed all memories of abuse, on what basis would he or she attempt to remember it in the first place? How are we to make sense out of affirmative responses to this question? (McNally, p. 197)
How indeed? McNally’s following chapter is mischievously entitled „FalseMemories of Trauma“. He covers the by-now famous incidents of „Abduction by Space Aliens“ „Satanic Ritual Abuse“ and „Ritual Abuse of Children“ and concludes with a section called „Retractors“. In the final pages of this chapter, he writes:
The popular notion that recovered memory is needed for one to be reminded of unpleasant childhood experiences is simply not true. Subjects in these studies have cited many different kinds of cues (such as beginning a family, returning to one’s former neighborhood) that reminded them of abuse they had not thought about in years. Of course, the fact that a trauma memory surfaces outside therapy does not guarantee its accuracy. But it can eliminate one possible source of memory contamination — suggestive psychotherapy. (McNally, pp. 258-259)
I have only one reservation about my otherwise wholehearted admiration for the scholarship, the argumentation, and the sheer welcome sanity of this splendid book. In his final chapter „Controversies on the Horizon“, McNally ventures into the realm of what might be called international-comparative-psychiatry where he asks questions about the universal cross-cultural value of a concept like PTSD (Post Traumatic Stress Disorder). He worries about a Western-imposed system of values that may not be appropriate to other cultures. He writes:
For example, the fact that female genital surgery horrifies Westerners who regard it as institutionalized mutilation and abuse, but is valued by African women (Schweder 2000), reminds us not to ignore culture when investigating trauma. (McNally, p. 283; my emphasis)
In fact it does nothing of the sort! (I have personally encountered many „African women“ who are far from „valuing“ this procedure.) This shows a cultural naivety on the part of McNally who has not, I suspect, lived and worked for years in Africa (as I have). It also, alas, shows a certain naivety about what „human rights“ means and implies. Human Rights are, precisely, that: Human Rights. Not „Western“ rights, not „American“ rights, not „European“ rights; but rights acknowledged for all humans, irrespective of culture. If there is a conflict between „rights“ and „Culture“, Rights should always prevail. I hold it as a „human“ right not to be surgically invaded (with or without anaesthetics or properly sterilized instruments) for no medical reason whatsoever; I would like to believe that, in his heart of hearts, McNally agrees with me. I accept that this argument can be hideously subverted by our current canting postmodernists who would argue that a Cannibal surely has „Rights“ to devour his victim. He doesn’t. But that is for another discussion. As the great `Dictionary‘ Johnson exclaimed, in a moment of exasperation: „Clear your mind of cant, Sir!“
.Elizabeth Loftus (1975), „Leading questions and the eyewitness report,“ Cognitive Psychology, 7, pp.560-572.
.The linguistic care in inventing the test „leading questions“ is shown by the acute attention to the difference in implication between the use of the indefinite article „a“ or the definite article „the“. What may appear to be irrelevant or inconsequential to the casual reader is demonstrated (by the follow-up surveys) to be crucial. Loftus writes:
For half the subjects, all the critical questions began with the words, „Did you see a . . . “ as in, „Did you see a broken headlight?“ For the remaining half, the critical questions began with the words, „Did you see the . . . “ as in, „Did you see the broken headlight?“
Thus, the questions differed only in the form of the article, the or a. One uses „the“ when one assumes the object referred to exists and may be familiar to the listener. An investigator who asks, „Did you see the broken headlight?“ essentially says, „There was a broken headlight. Did you happen to see it?“ His assumption may influence a witness‘ report. By contrast, the article „a“ does not necessarily convey the implication of existence. (Loftus, 1975, p. 562)
.See for example Frederick Crews (1995). The Memory Wars: Freud’s Legacy in Dispute. New York: New York Review of Books.
.E. F. Loftus & K. Ketcham. The Myth of Repressed Memory: False Memories and Allegations of Sexual Abuse. New York: St. Martin’s Griffin.
.Stuart Sutherland (1997), „Tales of memory and imagination,“ Nature, 388, 17 July 1997, p. 239. This is a double review of Hystories: Hysterical Epidemics and Modern Culture by Elaine Showalter and Harrison G. Pope Jr., Psychology Astray, wrongly identified in the original printing as Junk Psychology: Fallacies in Studies of „Repression“ and Childhood Trauma. The Nature website has since issued a correction. However, the cartoon by Birch which accompanies this review says it all. The male therapist addressing his divan-recumbent female patient states: „You’ve got multiple personalities, but they’ve been abducted by Aliens. I’ll send all their bills to you, though.“
.Sigmund Freud. The Standard Edition of the Complete Psychological Works of Sigmund Freud. Translated and edited by Strachey J. 24 vols. London: Hogarth Press, 1953-1974. See Vol. 14, p. 16. There is, incidentally, a sense (which would not have been appreciated by Freud) in which his celebrated statement is not only entirely true; but also the very reason why any treatment which solely involves doctrinaire psychoanalytic theory is bound to fail!
.Elizabeth Loftus interviewed by Wendy M. Grossman, New Scientist, September 6, 2003, p. 42. This has not prevented the publication of the following piece of misinformation via a reader’s letter (from Thomas Henretta of Meadville, Pennsylvania) in the number of the New Scientist for September 27, 2003. It begins: „The phenomenon of false memories was noted over a century ago by Sigmund Freud, when he used hypnosis as an adjunct to his evolving practice of psychoanalysis.“ (My thanks to Dr Karel de Pauw of Leeds (U.K.) for this snippet.)
.Carol Tavris, „Just deal with it,“ Times Literary Supplement, August 15, 2003, pp. 10-11 (this quotation is from p. 10). In this article Tavris reviews not only McNally’s book but also Out of the Dark: One woman’s harrowing journey to discover her past by Linda Caine and her Jungian analyst Robin Royston.
Carol Tavris’s opening sentence states her considered opinion on the two works with the well-known Tavris flair for steely brevity: „One of these books is the problem; the other, the solution.“ Her quotation from McNally is however approximate. What McNally wrote was: „. . . but a `balanced‘ view of the matter does not compel us to conclude that the earth must therefore be oblong.“ (McNally, p. 4)
.Elizabeth Loftus in the interview mentioned above suggests that the 1970s-1980s metaphorical analog of the computor for brain-memory functions may have run its course and that more recent neurological findings about what appear to be quite disparate brain-sites for aspects of memory-function may reveal our present computor-based metaphors to be inadequate, if not completely beside the point.
[10.This is not entirely the case; or, rather, Freud still continued to „recover“ repressed memories (witness the 1901/1905 case of `Dora‘), but now they were „repressed memories“ of infantile sexual fantasies. That such sexual fantasies were those of the obsessed adult Freud rather than of accurate recall by his (largely) female patients is one (among many) of the reasons for ignoring psychoanalysis as a treatment of choice.
.Freud’s change of position from „seduction“ to „fantasy“ was not, in reality, as great as some have imagined as far as the basic neurological inadequacies of each are concerned. To the end of his life, Freud believed that infantile amnesia was a product of „repression“ — even though there was nothing sufficiently „encoded“ to be repressed! What Freud thought to have been repressed, however, was not so much adult sexual abuse, as memories of infantile masturbation. This idea was borrowed from his intimate Berlin E.N.T. (oto-rhino-laryngologist) friend, Wilhelm Fliess, for whom the Latin term abusus sexualis meant „masturbation“ and not some adult abuse. See Robert Wilcocks, Mousetraps and the Moon: The Strange Ride of Sigmund Freud and the Early Years of Psychoanalysis (Lexington Books, Lanham MD, 2000) particularly Chapters 3 and 5.
.The most powerful example of misreading is by Brown, Scheflin, and Hammond (1998) who „misinterpret findings attributable to direct physical injury to the brain as relevant to psychic trauma. For example, they state that `Dollinger (1985) found that two of the 38 children studied after watching lightning strike and kill a playmate had no memory of the event'(609-610). However, they do not mention that both amnesic youngsters had themselves been struck by side flashes from the main lightning bolt, knocked unconscious, and nearly killed.“ (McNally, p. 192; my emphasis.)
.What is, incidentally, an „African Woman“? This phrase itself, „African women“, is a facile stereotype not worthy of McNally. Females in the Sudan do not face the issue of clitoridectomy in the same way as females in Uganda, for instance. And females in (Muslim) Northern Sudan do not regard the intervention in the same light as Christian or pagan Southern Sudanese women. The issue of the force of cultural pressure over human rights has here been grotesquely mutilated. But I am only talking of metaphorical linguistic matters; not of real, human atrocity.