Try to Remember
Psychiatry's Clash Over Meaning, Memory, and Mind
by Paul R. McHugh
Dana Press, 300 pp., $25
In 1993, an elderly couple in Lowell, Massachusetts, were convicted of trapping their grandchildren in a cage in their basement, force-feeding them a murky green potion, and molesting them with a machine the size of a room. The accusation was brought by their daughter, who believed that she, too, had been abused--although she had no recollection of it until the age of 24, when her therapist interpreted a recurring nightmare as evidence of repressed trauma. On the basis of her testimony, and "information" gleaned from contorted questioning of the grandchildren, with no corroborating evidence, Ray and Shirley Souza were found guilty.
Was the courtroom haunted by the spirits of the witchcraft victims of nearby Salem, which had 19 people put to death and more than 150 imprisoned on the basis of "spectral evidence"--visitations, pains, and hauntings that only they could know?
This ghostly explanation of events is scarcely more implausible than the one put forward at the time: that the Souzas were two among thousands of perpetrators in a nationwide epidemic of child molestation and satanic ritual abuse; that the events of the abuse went unnoticed for decades because the victims totally repressed their experiences and no one else was clued in to what was going on; that to cope with the submerged trauma, people "dissociated" into multiple personalities, as distinct from one another as wholly separate individuals and often unaware of the others' existence (one woman counted a duck among her 120 "alters"); and that the whole sordid affair was finally brought to light by the efforts of psychotherapists, who expertly plumbed the depths by means of hypnosis, insisting that their patients "try to remember."
Enter Paul McHugh, the distinguished former chief of psychiatry at Johns Hopkins, who stepped onstage in time for the second act of this strange drama. McHugh is that rare combination, a no-nonsense empirical thinker with a deep appreciation for the qualitative aspects of human life. Steering psychiatry away from Freud's world of symbols and shadows and toward a firmer footing in the brain sciences has been his great project. The program he built up at Hopkins is not, in short, the sort of place where the following sentiment (uttered by the influential psychoanalyst Elvin Semrad) would find itself at home: "We're just big messes trying to help bigger messes, and the only reason we can do it is that we've been through it before and survived."
After hearing several weird reports of extra-medical proceedings in other clinics--born of an exotic, exploding breed of therapy that psychiatry was, by that point, unable or unwilling to contain, allowing it instead to run into the courts--McHugh became involved as an expert witness for the defense. Try to Remember is his meticulously argued history of the "memory wars."
Multiple Personality Disorder (MPD), considered very rare until the late 1980s, is supposed to be the mind's response to some severe trauma, usually sexual. The trauma, being too egregious to cope with, is repressed from conscious memory and left to the purview of the eventually emergent alters. Only by recovering and confronting these lost memories is the patient able to truly travel past them--so the theory
goes. The idea was first popularly aired--as an interesting aberration, rather than an epidemic--in the 1950s, with The Bird's Nest and The Three Faces of Eve and their movie tie-ins. It was picked up again in the 1970s with Sybil, another book-and-movie combination, which took root in the therapeutic turf of that decade and combined with a mutant strain of Freudianism to proliferate.
Although it makes for great TV, MPD as a product of submerged memories has no basis in neurology. It is, instead, a form of hysteria: a manifestation of symptoms with a psychological rather than physical source. The patient does not deliberately choose or comprehend the fraud, but it is induced by external situations and suggestions rather than by a natural internal cause. The modern epidemic was produced by an army of therapists--a profession whose members outnumber dentists two-to-one--who drew their clientele down into the "subconscious," a mystic, ghoulish realm of unsuspected evil that they must confront in order to find "the courage to heal" (the name of a blockbuster 1988 book promoting this technique).
Patients' forays into this realm in search of rotten treasure were scheduled frequently, sometimes daily, for months or years on end, fostering--instead of the psychic resources to get on with life that good therapy provides--an extreme reliance on the therapist, that indispensable creature, for continuing the spooky insights. Along the way, everything the patients thought they knew, the coherence of their very identities and knowledge of their own past, exploded.
The resulting supernova had public consequences far beyond what its incendiaries had probably thought through. Families such as the Souzas were caught up in a tragically bizarre miscarriage of justice in which the truth was of no use to them because no one wanted to be seen as defending the damned. It is revealing of our cultural psychology to consider what crimes are so unthinkable that the mere suspicion of them renders the suspect forever outcast: Better to be a good clean killer than what these poor souls were charged with. And yet, with all of its unthinkability, this crime was readily believed to be ubiquitous, the sort of thing that "happens in the best of families"--a paradox sustained by an unholy fascination.
After some defensive scuffling in the criminal courts, McHugh and his allies at the False Memory Syndrome Foundation went on the offensive, testifying in civil suits against the therapists and clinics responsible for all the trouble. They enjoyed some success on these fronts, and the "epidemic" went into remission. But the proponents of MPD never acknowledged their error, instead retreating into metaphors and fiddling around with terminology so that they could go on peddling the same basic theory.
"History does not repeat itself," Mark Twain is rumored to have said, "but it does rhyme."
To stave off such a stanza, McHugh devotes the latter half of his book to a guided tour of related topics in psychotherapy, the structural features of the discipline that gave rise to this "hysterical response to hysteria." The Diagnostic and Statistical Manual, psychiatry's central reference book, played its part in lending scientific credence to an unscientific condition in the way it classifies disorders by symptoms without regard to cause. As the new edition, DSM-V, is being prepared for release in 2012, its authors would be well advised to heed Dr. McHugh's suggestions for reform.
More fundamentally, McHugh traces the philosophical roots of the recovered memory craze to ideas of hidden conflict and "foundational viciousness" in family life central to the dominant school of thought at Harvard during his training there. And as goes Harvard, so goes the nation.
Boston, town and gown, had taken to Freudian psychology and psychotherapy like a religious awakening. Especially for young men and women, Freudian ideas seemed to explain so much about human nature and to suggest even more about the reforming of society that an enthusiasm of almost Salvationist hope carried them along.
In the mold of other great Northeastern awakenings--mesmerism, abolitionism, Transcendentalism, Christian Science--its bold vision of a bright new world sold itself with a seductive beneficence. The small, dreary work of mending social cracks, conserving, protecting, and improving what is there, was pitted against razing civilization to the ground and building up a dream to take its place. But the dream, brought into the light of day, became a nightmare, and when everyone awoke, it was not to step into a great new shining world, but to move among the battered structures of the old one.
That more of them are still standing than might have been is thanks, in part, to Paul McHugh, M.D.
Caitrin Nicol is managing editor of the New Atlantis.