The Magazine

The End of a Delusion

The psychiatric memory wars are over.

May 26, 2003, Vol. 8, No. 36 • By PAUL R. MCHUGH
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Remembering Trauma

by Richard J. McNally

Belknap, 420 pp., $35

AT THE END of the nineteenth century, Sigmund Freud--ever anxious to present an overarching, universal explanation for mental unrest--suggested that "repressed memories" of childhood sexual abuse are a common cause of adult mental disorders.

He quickly abandoned the idea (replacing it with the concept of infantile sexuality) when he saw that it harmed rather than helped his patients. But such ideas seem to have lives of their own, and a hundred years after Freud first proposed it, the idea of repressed memories rose again in new and even gaudier clothing. Grown beyond Freud's unadorned view of domestic misconduct, it came to include beliefs that many of these sexual traumas--which the troubled patients' shocked minds had repressed--took place during Satanic rituals and experiments aboard alien spacecraft.

It is today almost impossible to understand how anyone ever believed this absurd and ridiculous notion, but it was less than a decade ago that the idea was flourishing in America. The American psychiatric and psychological establishment bears a shame that will be hard ever to wash away. Thousands of patients--thousands of sick, damaged people who had come to medical professionals for help--were destructively misdirected into trolling through their pasts in search of hidden sexual trauma. By the late 1980s, wards and clinics in university psychiatric departments, eminent hospitals, and even the National Institute of Mental Health were devoted to uncovering these repressed memories.

The craze for this psychiatric madness was never universal, and, to their credit, some theorists and practicing psychiatrists resisted the practices and ideas in what Frederick Crews aptly dubbed the "memory wars." The importance of Richard J. McNally's new book "Remembering Trauma" lies not just in the superb and definitive survey McNally makes of the history of repressed memories, but also in what the book stands for: "Remembering Trauma" is the monument built to mark the end of the memory wars. The repressed-memory diagnosis has finally been repressed.

WHEN THESE WARS STARTED, orthodox Freudianism--the concepts of psychoanalysis based on infantile sexuality and the dynamic unconscious that Freud developed on abandoning his child abuse idea--was losing influence after dominating psychiatric thought for over two generations in America. The Freudian explanation and treatment were weak in practice, whatever their intrinsic intellectual interest. New and simpler treatments of psychiatric patients, as with medication and cognitive counseling, were emerging to replace it.

The idea of repressed memories was in many ways anti-Freudian, anathema to the orthodox Freudian view. But the explosion of interest in repressed memories was nonetheless a result of Freudianism--a notion born from the Freudian movement's death throes, something we might have anticipated had we reflected on the situation faced by therapists accustomed for so long to remarkable social and professional standing in America as keepers of the deep secrets of our minds.

More clamor about the Oedipus complex, castration anxiety, penis envy, and all the rest of the classic Freudian elements was not going to revive attention and energy for the sect. New kinds of secrets about human mental life and its disorders were needed. And what better than the idea that our parents--particularly our fathers--betrayed us as children and used us as sexual objects? Our failure to remember such abuse presented no problem. Surely the abuse was so shocking, so villainous, we could not believe it was happening. Hence, the theory held, we repressed all memory of the experience into the unconscious where it would work its mischief over time, all unknown and even unsuspected.

If this wasn't Freudian in content, it was nonetheless Freudian in shape--not orthodox Freudianism, but what we might call "manneristic Freudianism." The mannerists lacked Freud's originality and literary gifts, of course, but they tried to follow him as best they could.

So, for instance, both the orthodox and the mannerists believed that Western society is the primary source of mental distress: Freud taught that society restricted the expression of our drives, producing conflicts and neurosis; the mannerists claimed that society protected the sexual predators by its paternalistic structure. Meanwhile, both believed in a dynamic unconscious roiling with suppressed secrets: Freud supposed that the unconscious hid our selfish impulses and hungers from consciousness and thus from censure by a repressive culture; the mannerists held that the unconscious hid the shocking memories from consciousness so that family life could go on. Finally, both believed that therapy should bring the unconscious issues to light: Freud said this would spare the subject from wasting psychic energy repressing his drives and so allow him to flourish in "love and work"; the mannerists believed that acknowledging the "repressed" abuse would lead to a life free of the nightmares, failures in personal relationships, and self-destructive behaviors generated by the unconscious memories.

The manneristic Freudians made intellectual moves defined by orthodox Freudianism, even while they rejected such politically incorrect Freudian ideas as penis envy. And so the memory wars were launched by the aggressive proposals of the manneristic Freudians. The signal event in this offensive against reason and plausibility was the publication in 1984 of Jeffrey Masson's book, "The Assault on Truth: Freud's Suppression of the Seduction Theory." As the archivist of the Freud papers (many of which are still secret), Masson was an insider amongst the orthodox Freudians, but he turned on his master's memory to resurrect Freud's original claim of childhood sexual abuse as the cause of neurosis. Indeed, Masson claimed that Freud knew it to be true but lacked the courage to press on with it. With the publication of this book--and the consequent dismissal of Masson as Freud's archivist--manneristic Freudianism and the concept of repressed memory moved to the front of psychiatry.

THIS FIRST PHASE of the memory wars demonstrated how quickly an idea about mental life can grow and spread in the public, particularly if it offers an opportunity to identify new victims and new villains. The manneristic Freudians encountered few obstructions as their ideas gained support through the 1980s and early 1990s from psychiatrists and psychologists working in psychotherapy.

Many books were written to encourage the practice of recovering lost memories, the most successful of which--indeed a continuing bestseller--was "The Courage to Heal: A Guide for Women Survivors of Child Sexual Abuse" published in 1988 by two radical feminists with no qualifications in psychology and psychiatry. By 1991 some manneristic Freudians were claiming that up to half of the patients in psychiatric care were suffering from the effects of repressed or dissociated memories of sexual abuse.

It was in the late 1980s and early 1990s as well that many psychiatrists in teaching positions began to receive calls from families reporting how their adult offspring--mostly daughters--were accusing them of the most ferocious forms of sexual abuse when they were children. Casualties began to mount rapidly: mostly family breakup and estrangement, but also growing mental derangement in the accusers. They were under pressure first to "remember" the details of the purported abuse they had "repressed" and then to "relive" these experiences in their psychotherapy sessions for cathartic relief. Why was it a surprise when patients treated in this fashion got worse, not better? More symptoms of depression colored with anger, resentment, and fear emerged, and suicide attempts began to occur. Long hospitalizations were often required. All these unfortunate outcomes replicated Freud's original experience with recovered-memory treatment a hundred years before.

THE SECOND PHASE of the memory wars was the organization of opposition to these ideas and practices. In 1992 a group of accused parents and concerned psychologists and psychiatrists founded the "False Memory Syndrome Foundation" (of which I am a board member) to "provide support and advice to accused family members and to disseminate scientific information about trauma and memory to the public at large." The argument of the foundation was that therapeutic techniques attempting to recover repressed memories actually led to the creation of psychologically compelling but false memories of childhood sex abuse, with all the destructive effects such false beliefs bring to the patient and the family.

The hope in this phase of the memory wars was that common sense would soon prevail and this misdirection of psychiatry from standard practices of evaluation and therapy would promptly stop. But the opposition to the idea of repressed memory received little or no support from official psychiatry or from the editorial policies of such professional journals as the American Journal of Psychiatry. Still, among the most useful efforts in the second phase of the memory wars was the publication of books about the misdirections of thought and misconstrual of evidence represented in the repressed memory claims. An outstanding contribution was Frederick Crews's series of articles in the New York Review of Books, ultimately brought together in 1995 as a book entitled "The Memory Wars: Freud's Legacy in Dispute."

Also in this second phase, many patients treated for repressed memories came to realize that they had been misled by their therapists and retracted their claims against their fathers and mothers. Some of the most egregious examples garnered public attention, and their stories about how they came to have false memories under psychotherapeutic suggestions got attention in periodicals as diverse as Esquire and the American Scholar. Cumulatively, these attacks on repressed-memory syndrome began to take effect, and as the existence of false memories became obvious, the courts began to protect accused parents from prosecution by offspring. Later, many former patients launched civil lawsuits for malpractice against their hospitals and therapists, and juries gave them huge financial settlements.

Perhaps the greatest scandal of the memory wars lies in this: The official avenues of clinical and scientific debate failed to play a role in ending these practices, while public rebuke and punishment did. Enormous damage is done to a medical discipline when it is forced to advance and retreat under the gun of the malpractice courts--but when the psychiatric establishment was at best absent, and at worst complicit, in the widespread practice of a psychiatric abuse, what alternative was there?

THE RESULT was at least partially effective. No one these days is bragging about how skilled they are at bringing forth forgotten memories, and some of the more crazy ideas, such as "Multiple Personality Disorder" and "Satanic Ritual Abuse" do not get much exposure anymore. But many practitioners still believe in the concept of repression (often translating it into another term, "dissociation") and claim that all the obvious troubles that came to light and led to court action were due not to erroneous ideas but to incompetent practitioners. To this day, one meets intelligent people ready to accept repressed memories as common and to assume that the evidence for their regular occurrence with sexual trauma is strong. The theorists and practitioners who tried to show how these ideas about memory are wrong are still routinely slandered as "biased" and "against children."

The courts, in other words, could only repress some of the worst practices of the repressed-memory diagnosis. The horrendous idea itself needed something more to destroy it--which is the cause of what we might call the third phase of the memory wars.

This phase began with closer study of the cases in the literature that purport to prove the existence of "repressed memories." The first key event of the third phase was the 1997 testimony of the distinguished psychiatrist Herbert Spiegel, which indicated that the classic case of "Sybil" (which purported to demonstrate repressed memories and multiple personalities) was contrived--almost fraudulently so--to gain publicity. Again and again, the standard cases of repressed memory dissolved under close study. Some of the afflicted patients were children caught up in a divorce and persuaded by one of the parents to accuse the other. Others proved ready to retract their accusations when they learned of alternative explanations for their troubles.

This aspect of the memory wars has occasionally turned nasty, as the protagonists for "recovered memories" pressured university committees--claiming invasion of privacy when the published cases were assessed anew--to stop the investigators from exploring their claims. Nonetheless, one by one, all the central examples of repressed memories proved unsubstantial.

In "Remembering Trauma," Richard McNally monitors this final phase of the memory wars. McNally is both an experienced clinician and a prominent scientific investigator of memory. He provides a comprehensive description of both normal memory and memory influenced by time, prejudicial influence, trauma, and emotions. He systematically reviews all the claims and the theories brought forth to defend repressed-memory therapy, and he shows just how distorted the thinking of its champions are. The result is a damning judgment against the basic concepts of the manneristic Freudians.

McNally is so thorough in his reviews of scientific knowledge about memory and every one of the claims for support of the repressed-memory idea--from clinical anecdotes to such neurobiological ideas as brain scars in the hippocampus--that a casual reader may weary. But veterans of the memory wars will be grateful to him for this thoroughness, because he leaves no defense of repressed memory unassailed and thus brings fully to light what went wrong in psychiatry with the manneristic Freudians.

After reading McNally, one has a clear idea of the direction psychiatry must take. Psychiatrists need to cease seeking a generic explanation for mental disorder. They must align themselves instead with psychologists and neuropsychologists to explore the individual faculties of normal mental life--from perception and language, to emotion and drive, all the way down to memory. Most of all, psychiatry must become a medicine, moving toward a structure of reasoning and practice where knowledge of normal function leads to an understanding of just what has gone wrong in particular diseases. Richard McNally's "Remembering Trauma" is more than the final nail in the coffin of the repressed-memory craze. It is the blueprint for how psychiatry can best progress in the years to come.

Paul R. McHugh, a board member of the False Memory Syndrome Foundation, is University Distinguished Service Professor of Psychiatry and Behavioral Science at the Johns Hopkins School of Medicine and former psychiatrist in chief of the Johns Hopkins Hospital.