The End of a Delusion
The psychiatric memory wars are over.
May 26, 2003, Vol. 8, No. 36 • By PAUL R. MCHUGH
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.