Bookmarkers beware: Bookmarks to pages other than the home page may not work after we change our server in April Editor's Choice | This Week in BMJ | Press releases BMJ No 7130 Volume 316 Editorial Saturday 14 February 1998 Recovered memories of childhood sexual abuse The Royal College of Psychiatrists issues important precautions Harrison G Pope The Royal College of Psychiatrists has just issued a set of recommendations for good practice in treating patients with "recovered memories" of childhood sexual abuse.(1) The college advises strongly against persuasive or suggestive psychotherapeutic techniques designed to unearth sexual abuse of which the patient has no memory and encourages psychiatrists to voice any doubts which they may have about the historical accuracy of patients' recovered memories. These recommendations will figure strongly in the widely publicised current debate on "recovered memory therapy" and the possibility that such therapy may encourage so-called false memories. When false memories occur patients may become convinced that they were victims of long repressed childhood sexual abuse, often at the hands of their parents or other trusted figures. These memories may become a raison d'Írtre for certain patients, diverting them from any other therapies, alienating them from their families, and often producing devastating aftershocks in the courtroom. In a recent American case, for example, a young woman in psychotherapy recovered the memory that at the age of 13 she was raped by her schoolteacher, became pregnant, and underwent an abortion. No corroborating evidence existed. In fact, she apparently did not reach menarche until the age of 15, so the pregnancy would have been medically impossible. Nevertheless, she filed criminal charges against the teacher, who was forced to spend his life savings in a legal defence that spanned several years. His case terminated only when the New Hampshire supreme court finally ruled that repressed and recovered memory lacked sufficient scientific foundation to be admissible.(2) In another recent case a woman and her two young children were admitted to hospital in Illinois with diagnoses of multiple personality disorder. The woman recovered memories of having been a high priestess in a satanic cult and of having engaged in cannibalism, bestiality, and numerous bizarre sexual acts. After years of treatment, and millions of dollars in medical bills, she retracted all of her memories and sued the therapists and hospital for malpractice. The case has recently been settled for 10.6 million dollars.(3) The recovered memory debate reduces to a central question: can someone endure a seemingly unforgettable traumatic experience, such as repeated rape, and then expel the memory completely from conscious awareness for many years? This process, variously termed repression, dissociative amnesia, or psychogenic amnesia, is sometimes discussed without question, as if everyone knew it to be true. But is it? Our forebears did not seem to think so. I have not found any clear cases of repressed memory in classical literature, Shakespeare, or any literature before the romantic writings of the nineteenth century. Only then, in the novels of James Fenimore Cooper, in Charles Dickens's Dr Manette, and in the poetry of Emily Dickinson, does repression begin to appear.(4) And it was still several decades more until Freud(5) and Janet(6) "discovered" the concept. One must ask therefore whether repression is a scientifically established phenomenon, or whether it is simply a romantic notion that has infiltrated our cultural belief system. And indeed, on critical examination, the scientific evidence for repression crumbles. Admittedly, various published case reports and retrospective studies exist, describing individuals who currently remembered an alleged traumatic experience but reportedly had forgotten it during a previous period of their lives.(7) But asking individuals if they "remember whether they forgot" is of dubious validity.(4)(8) Furthermore, in most retrospective studies corroboration of the traumatic event was either absent or fell below reasonable scientific standards.(9) The only convincing test of the repression hypothesis would be a prospective study, in which victims of a documented trauma were systematically followed up and asked whether they remembered the event. We have recently reviewed the available prospective studies of this type.(10) Throughout these studies, when subjects were asked directly about traumatic experiences, all reported memories. Non-reporting occurred only in those studies where subjects were never asked directly about the event, leaving open the possibility that these individuals simply did not disclose events even though they did remember them. This problem, together with several other methodological limitations, effectively invalidates the few remaining prospective studies purporting to show evidence of repression (especially the oft cited study of Williams(11)) - leaving no prospective data of adequate methodology to show that individuals can actually repress memories of traumatic experiences. Of course, some might still argue that we have not disproved the possibility that repressed memories might occur. But this objection turns logic on its head: in the 500 years since William of Ockham first propounded his principles of parsimony, scientists have acknowledged that the burden of proof rests with whomever proposes a novel theory of causation, and not the reverse. Repression may be the stuff of Victorian novels and Hollywood movies, the darling of television dramas, and an object of widespread popular belief. But popular belief in repression does not spare investigators the burden of providing a rigorous, methodologically convincing demonstration of its existence. Until such a demonstration is provided, the recommendations of the royal college seem only prudent. Harrison G Pope, Jr Associate professor of psychiatry Harvard Medical School, Boston, MA 02115, USA References 1 Royal College of Psychiatrists. Reported recovered memories of child sexual abuse: recommendations for good practice and implications for training, continuing professional development and research. Psychiatric Bull 1997;21:663-5. 2 Supreme Court of New Hampshire: the State of New Hampshire v Joel Hungerford and the State of New Hampshire v John Morahan. Ruling of 1 July, 1997. 3 Belluck P. "Memory" therapy leads to a lawsuit and big settlement. New York Times 1997; 6 Nov:A1. 4 Pope H G, Jr. Psychology astray: fallacies in studies of "repressed memory" and childhood trauma. Boca Raton, FL: Upton Books, 1997. 5 Freud S. The standard edition of the complete psychological works of Sigmund Freud. Strachey J, trans and ed. London: Hogarth Press, 1953-1974 (see vol 14, p16). 6 Janet P. L'automatisme psychologique. Paris: FÍelix Alcan, 1889. 7 Sheflin A W, Brown D: Repressed memory or dissociative amnesia: what the science says. J Psychiatry Law 1996; Summer: 143-88. 8 Melchert T P, Parker R L. Different forms of childhood abuse and memory. Child Abuse and Neglect 1997;21:125-35. 9 Andrews B. Forms of memory recovery among adults in therapy: preliminary results from an in-depth survey. In: Read D, Lindsay S, eds. Recollections of trauma: scientific research and clinical practice. New York: Plenum (in press). 10 Pope H G Jr, Hudson J I, Bodkin J A, Oliva P. Questionable validity of "dissociative amnesia" on trauma victims. Br J Psychiatry (in press). 11 Williams L M. Recall of childhood trauma: a prospective study of women's memories of child sexual abuse. J Consult Clin Psychology 1994;62:1167-76. Home | Current issue | Past issues | Classified ads | Career Focus | Feedback Collections | About this site | About the BMJ | BMA | Medline