Links to a list of papers on the trauma-memory argument.
Note: Invited Commentary on Gleaves, D.H., Smith, S.M., Butler, L.D., & Spiegel, D., "False and Recovered Memories in the Laboratory and Clinic: A Review of Experimental and Clinical Evidence". Clinical Psychology: Science & Practice, in press.
In their overview of relevant clinical and laboratory research, Gleaves et al. (2003) downplay laboratory evidence concerning false memories, and exaggerate laboratory support for the blocked and recovered memories of trauma. They also exaggerate clinical evidence for blocked memories of trauma, while downplaying the very real possibility of false memories. The result is an unbalanced view of the literature on trauma and memory that, if left uncorrected, will deepen the split between science and practice, and further undermine the status and autonomy of clinical psychology as a profession.
In their paper, Gleaves, Smith, Butler, and Spiegel (2003) draw on clinical and laboratory research to persuade the reader that traumatic memories can be repressed, that recovered memories of trauma are valid, and that false memories of trauma are not too important -- thus supporting both the trauma-memory argument and recovered-memory therapy. Although the authors adopt an ostensibly balanced position that "both false and genuine recovered memories may exist" (p. 4), their actual presentation is seriously unbalanced. As a result, the reader is encouraged to discount laboratory evidence of false memories while accepting laboratory evidence of repression and recovered memories, and to discount clinical evidence of false memories while accepting clinical evidence of repression and recovered memories.
Clinical Studies of False Memories
With respect to false memories, Gleaves et al. (2003) discuss the clinical evidence in a little over a page of text. While it may be true that much of this evidence comes in the form of anecdotal case reports published in the popular press, that is no reason to discount them. Journalists, lawyers, judges, and other "laymen" can read and reason too, as exemplified by Frederick Crews, the literary critic whose articles on the "memory wars" did so much to bring our attention to the problems raised by the recovered memory movement (Crews, 1995); and Dorothy Rabinowitz, the Wall Street Journal columnist who won a 2001 Pulitzer Prize, in part, for her critical commentaries on the "Kelly Michaels" and "Amirault" cases of preschool child sex-abuse allegations (Rabinowitz, 2003). At least responsible journalists are required to confirm their sources before their stories are published. Psychotherapists, or at least psychotherapists of a certain kind, are content with "narrative" or "personal" truth, regardless of the fact of the matter (Spence, 1982; Spence, 1994). It took a journalist, interviewing a psychiatrist for a literary journal, to expose Sybil as – shall we say – misdiagnosed (Borch-Jacobsen, 1997).
What really matters, of course, is not the professional affiliation of the investigator, or the means by which the investigation was published, but the actual evidence produced by the investigation. On this score, Gleaves et al. (2003) have remarkably little to say. They do not confront Moira Johnston’s (1997) account of the Ramona case, a landmark court decision in which practitioners paid heavy penalties and lost their licenses for implanting false memories, and which established the precedent, entirely new in tort law, that third parties can sue practitioners for damages caused by malpractice. And although we can quibble about the details of who said what, when, and under what circumstances, can anyone read Lawrence Wright’s (1994) account of the Paul Ingram case and not come away wondering whether he really participated in hundreds of episodes of ritual infanticide and cannibalism, including the rape of his own children by his poker buddies while their mother watched? Unfortunately, neither of these book-length analyses is even cited by the authors, much less discussed.
Turning to the "professional" literature, Gleaves et al. (2003) cite Williams’ (1994) study as evidence that self-reports of abuse have been independently "documented" (manuscript, p. 12). But this is something of a red herring, because the issue is not whether Williams’ survey respondents had been abused. The issue is whether any of them showed trauma-induced amnesia for their abuse. On that matter, Williams’ study is simply unconvincing (Kihlstrom, 1995, 1996, 1997, 1998). It is more likely that the events in question were subject to normal forgetting processes or to infantile and childhood amnesia. It is also likely that many informants were simply unwilling to disclose their histories to the interviewer -- a common and well-known problem with crime reports of any type (Widom & Morris, 1997; Widom & Shepard, 1996).
To my knowledge, nobody has ever claimed that all adult memories of childhood sexual abuse are false, so it should come as no surprise that some such memories can be corroborated. But what are we to do with those self-reports that are not corroborated? Should we simply accept them at face value? Just because some memories are valid does not mean that all memories are valid. But that seems to be the implication of the authors’ argument. When therapists speculate that their patients’ current problems are causally linked to events in childhood, it would seem that they incur some obligation to determine whether the alleged events actually occurred. But apparently, therapists rarely seek independent corroboration of their patients’ autobiographical narratives (Shobe & Kihlstrom, 2002). If indeed there is an absence of clinical literature bearing on the problem of false memory, to a great extent this may be attributed to a sort of "pact of ignorance" between patients, who do not wish to have their self-narratives challenged, and therapists, who have no wish to challenge them.
People can also quibble forever about the scientific status of "false memory syndrome", but no one who uses such concepts as "battered woman syndrome" (Walker, 1988, 1991) or "Stockholm syndrome" (Graham, Rawlings, & Rimini, 1988; Graham et al., 1995) in clinical discourse should have any principled objection to the term. Still, Gleaves et al. (2003) are quite right that the essence of the syndrome is not merely the existence of a false memory. Rather, the syndrome refers to the re-orientation of an individual’s identity and personality around a mental representation of his or her personal past -- in other words, a memory -- which is objectively false. Consider, for example, the well-documented case of Binjamin Wilkomirski -- author of the award-winning Holocaust "memoir" Fragments (Eskin, 2002; Gourevitch, 1999; Lappin, 1999; Mächler & Wilkomirski, 2001). Fragments now appears to have been the work of an author who was actually born in neutral Switzerland to an unmarried Protestant woman, and raised and schooled there by foster parents who died before he published his book. Apparently, Wilkomirski incorporated details of the Holocaust gleaned from his voluminous reading into what is essentially a work of the imagination -- but one in which he himself devoutly believed. Following a detailed investigation, Wilkomirski’s publisher withdrew Fragments from publication. Yet, when confronted with the facts, the author angrily replied, "I am Binjamin Wilkomirski!". In an interesting twist, at one point a woman who claimed to have been in the camps as a child herself, and to have known Wilkomirski there ("He’s my Binje!"), was found to have been born in Tacoma in 1941, and raised in Washington State as a foster child by devout Presbyterians.
Laboratory Studies of False Memories
In stark contrast to their relatively brief overview of the clinical evidence of false memories, Gleaves et al. (2003) provide a detailed analysis of laboratory studies of false memories -- but one that is written in such a way as to blunt the impact of the laboratory findings, and convey the impression that they are not too important for clinicians. For example, the reader is informed that there are several different explanations for both the post-event misinformation effect (Loftus & Palmer, 1974) and the associative memory illusion (Roediger & McDermott, 1995) -- as if that mattered, given that both effects are so robust that they can be demonstrated under classroom conditions. In the final analysis, it is the robust nature of these and similar effects that should give clinicians pause, because they are created by the very forces that go on in recovered-memory therapy -- the presentation and discussion of themes related to incest, sexual abuse, and the like (Shobe & Kihlstrom, 2002). In fact, the clinical situation may be even more conducive to the formation of illusory memories than the laboratory.
Instead, we are reassured that because laboratory phenomena do not necessarily occur in the real world, we do not have to worry about them after all. The authors barely mention studies indicating that people with histories of self-reported childhood sexual abuse and other traumas show elevated levels of the associative memory illusion (Bremner, Shobe, & Kihlstrom, 2000; Clancy, Schacter, McNally, & Pitman, 2000). Moreover, they push the conclusion that false memories for unusual or infrequent events are difficult to implant (Pezdek, Finger, & Hodge, 1997), without any mention of later studies that show otherwise (Mazzoni, Loftus, & Kirsch, 2001; Porter, Yuille, & Lehman, 1999). In a psychotherapeutic context, a therapist who believes in both the traumatic etiology of syndromes like anxiety, depression and eating disorder, as well as the theory of repression, will very likely communicate these ideas to the patient, who may already share them by virtue of exposure to the popular media. Under such circumstances, repressed childhood sexual abuse may become quite plausible indeed.
Despite the authors' efforts to blunt the impact of the laboratory evidence, everything we know about memory from laboratory research suggests that false memories can be a real problem in the clinic, and in the courtroom as well -- as indicated, for example, by the extensive literature on false eyewitness identification (Loftus, 1979; Wells & Olsen, 2003). This body of memory research is supplemented by a wealth of literature on persuasion, conformity, and other aspects of social influence that are relevant to the therapeutic situation (Forgas & Williams, 2001; Zanna, Olson, & Herman, 1987). Psychotherapy, including psychiatry and clinical psychology, must be the only part of healthcare where basic laboratory research is routinely dismissed when inconvenient. Maybe that's why psychotherapy is in the shape it's in.
Clinical Studies of "Blocked" and "Recovered" Memories
Turning to clinical evidence for "blocked and recovered" memories, Gleaves et al. (2003) begin by offering an argument from authority -- that blocked memories have been recognized by clinicians since the beginning of the 19th century. Unfortunately, they fail to distinguish between clinical folklore, which indeed contains abundant references to repression and other forms of trauma-induced amnesia, and the evidentiary basis for this folklore. While it is true that functional (psychogenic, dissociative) amnesia, fugue, and multiple personality disorder (dissociative identity disorder) have long been recognized in the psychiatric nosology, the evidence for a traumatic etiology in these rarely observed syndromes is remarkably thin (Kihlstrom, 2001a; Kihlstrom & Schacter, 2000). The term "dissociative", as applied to these disorders, is better construed as a descriptive label (referring to loss of conscious access to memory) than any pathological process instigated by trauma.
Gleaves et al. (2003) also make reference to the clinical literature on combat trauma -- a good rhetorical device, because amnesia has been part of the folklore of war neurosis, and a staple of many movies, since World War I. But this evidence is totally unanalyzed. How well were the clinicians able to rule out brain insult, injury, and disease as causal factors? How well were the clinicians able to independently corroborate the combat memories ostensibly recovered by their patients after hypnosis or narcosynthesis? They also cite the widely discussed case study of Jane Doe (Corwin & Olafson, 1997) as a compelling "existence proof" of recovered memory, despite subsequent evidence that the alleged abuse might not have occurred at all, and that Jane Doe’s alleged recovery of abuse memories may have been nothing more than her remembering what she said, rather than what she experienced, 11 years previously (Loftus & Guyer, 2002a, 2002b).
Going beyond anecdotal case evidence, Gleaves et al. (2003) attempt to bolster their case for trauma-induced amnesia by referring to studies of amnesia for childhood sexual abuse (CSA) reviewed by Brown, Scheflin, and Whitfield (1999), and quote approvingly those authors’ statement that "Not a single one of the 68 data-based studies failed to find it" (manuscript, pp. 19-20). Unfortunately, re-examination of this body of evidence, as well as of studies of trauma other than CSA, shows the facts to be otherwise (Piper, Pope, & Borowiecki, 2000; Pope, Hudson, Bodkin, & Oliva, 1998; Pope, Oliva, & Hudson, 2000). All too often, researchers in the area of trauma and memory fail to obtain independent corroboration of the traumatic event in question. Or, when the trauma has been satisfactorily documented, they fail to distinguish memory failure from reporting failure. Or, in cases of genuine forgetting, they fail to distinguish functional amnesia induced by psychological trauma, and presumably mediated by processes such as repression and dissociation, from other causes of forgetting -- including normal forgetting over a long retention interval, the effects of infantile and childhood amnesia, and "organic" amnesia associated with brain insult, injury or disease. Nor, in cases where trauma was forgotten and subsequently remembered, do they distinguish memories recovered by the lifting of repression or breaching of dissociation from other causes of remembering -- including the normal effects of shifting retrieval cues, reminiscence, and hypermnesia. Nor is there any distinction drawn between the recovery of a forgotten memory of trauma and a reinterpretation of an event that had always been remembered.
These are serious methodological problems, and one or more of them infect every one of the studies in this body of literature. In a particularly revealing exchange, Brown et al. (1999) offered nine studies "in favor of the existence of traumatic amnesia" (p. 28), only to have each of these studies systematically dismantled by Piper et al. (2000). Nevertheless, Gleaves et al. (2003) conclude that, "collectively, the clinical evidence does seem to suggest that varying degrees of amnesia for traumatic experiences and subsequent recovery of memory are real phenomena (manuscript, p. 20). It would be more accurate to say that this entire body of research has failed to uncover even a single convincing instance of repressive or dissociative amnesia for trauma.
Laboratory Studies of "Blocked" and "Recovered" Memories
Turning to laboratory evidence for "blocked and recovered" memory, Gleaves et al. (2003) attempt to bolster clinical claims of repression and recovered memory by listing a number of experimental paradigms which show either the blocking or recovery of memory or both, including spontaneous recovery from retroactive inhibition and the tip-of-the-tongue phenomenon. The fact is that nobody has ever argued that people cannot intentionally forget things; nor has anybody ever argued that people cannot forget something they once remembered and then remember it again later. The real question is whether the laboratory evidence of "blocked and recovered" memories cited by Gleaves et al. (2003) supports the idea that traumatic memories can be blocked by such psychological processes as repression and dissociation (however broadly defined), or that recovered-memory therapy can generate valid memories of traumatic events.
Consider, for example, the authors' statement that studies by Loftus and Burns (1982) and Christianson and Nilsson (1984) "both found that amnesia was associated with trauma" (manuscript, p. 30). In fact, they found nothing of the sort. In the Loftus and Burns study, for example, subjects in the violent condition showed an average recall of 75.6% correct across the 17 items tested, compared to 80.9% in the nonviolent control group. Both studies did find impairments of memory for peripheral details of an event, in line with the Yerkes-Dodson law (Anderson, 1990; Revelle & Loftus, 1992). But none of the subjects forgot central details -- just as no trauma victim who was old enough to remember, and not brain damaged, was amnesic for his or her experiences in the clinical studies reviewed earlier (Piper et al., 2000; Pope et al., 2000).
Omitted from this discussion is the wealth of laboratory research, including studies of nonhuman animals employing more stressful conditions than can be used with humans, which shows conclusively that emotional arousal, leading to the release of stress hormones, actually improves memory, at least so far as the central details of the arousing event are concerned (e.g, (Cahill & McGaugh, 1998)). The well-known relation between arousal and memory can easily account for the "unforgettable" memories suffered by those with post-traumatic stress disorder, but it cannot account for the repressive and dissociative amnesias claimed by some patients and their therapists (Kihlstrom, 2001b; Shobe & Kihlstrom, 1997).
Consider, too, the authors' favorable discussion of the study by Anderson and Green (Anderson & Green, 2001), which has also been touted elsewhere as evidence for Freud's concept of repression (Anderson & Levy, 2002; Conway, 2001; Levy & Anderson, 2002). In fact, it is woefully inadequate for this purpose (Kihlstrom, 2002). The memories in this study were pairs of innocuous words, deliberately suppressed by the subjects at the request of the experimenter. But even after 16 suppression trials, the average subject still recalled more than 70% of the targets. There was no evidence presented of persisting unconscious influence of the suppressed items, and there was no evidence that the "amnesia" could be "reversed". Moreover, it is extremely doubtful that any of the subjects were induced to forget that they had participated in a laboratory experiment. The fact is, as the clinical research cited above documents convincingly, the vast majority of trauma victims remember what happened to them all too well. The Anderson and Green study is an interesting contribution to an already extensive literature on the self-regulation of memory (Kihlstrom & Barnhardt, 1993), but as support for Freudian repression its reach far exceeds its grasp.
Gleaves et al. (2003) also review a laboratory study which combined the Anderson and Green (Anderson & Green, 2001) retrieval-inhibition paradigm with the Roediger and McDermott (Roediger & McDermott, 1995) false memory paradigm in an attempt to uncover features that might discriminate between continuously remembered, blocked but accurately recovered, and false created memories (Smith et al., 2003). Of course, the clinically important issue is not the nomothetic question of how these classes of memories might be distinguished statistically, in the aggregate. Rather, it is the idiographic question of whether any discriminanda are reliable enough to be used to evaluate individual memories, in the absence of independent corroboration. In this respect, previous attempts to distinguish memories that are the product of experience from those that are the product of imagination (e.g., (Johnson, Hashtroudi, & Lindsay, 1993; Johnson & Raye, 1981)) hold out little hope. In any event, the principal conclusion from this research was that continuous and recovered memories were associated with higher confidence levels than false memories (dichotomous remember-know judgments are highly correlated with confidence). But surely the authors cannot be suggesting that clinicians use confidence levels as a proxy for accuracy in memory. The weakness of the relationship between accuracy and confidence is one of the best-documented phenomena in the 100-year history of eyewitness memory research (Bothwell, Deffenbacher, & Brigham, 1987; Busey, Tunnicliff, Loftus, & Loftus, 2000; Read, Lindsay, & Nicholls, 1998; Smith, Kassin, & Ellsworth, 1989; Sporer, Penrod, Read, & Cutler, 1995; Wells & Lindsay, 1985; Wells & Murray, 1984). If confidence were an adequate criterion for validity, Binjamin Wilkomirski might have gotten a Pulitzer Prize for history.
The irony of this last section should not go unnoticed: Gleaves himself was among the first to complain (Freyd & Gleaves, 1996) when Roediger and McDermott (Roediger & McDermott, 1995) suggested that their laboratory paradigm had any bearing on the problem of recovered memories in the clinic (for a reply, see Roediger & McDermott, 1996). If Gleaves et al. (2003) are going to discount and dismiss laboratory evidence of false memories, as they seek to do earlier in their paper, why are they so ready to accept laboratory evidence of "blocked and recovered" memories later? The bottom line is that, more than 100 years after Janet and Freud, the proponents of the trauma-memory argument and recovered-memory therapy can point to only a handful of clinical cases to support their views, and even these cases are ambiguous. Theirs is a laboratory model in search of a clinical phenomenon. The irony goes even further, because Gleaves et al. (2003) call on researchers and theorists to "[return] our attention to… naturalistic contexts" and "real life cases of memory blocking and recovery" (p. 39), as if the laboratory research they have reviewed at such length, including their own, is irrelevant after all.
Memory in Science and in Practice
The fact is, there has been plenty of attention to naturalistic contexts in research on trauma and memory (McNally, 2003). Unfortunately, the clinical research purporting to demonstrate the blocking and recovery of traumatic memories is fatally flawed, in many cases due to a failure to demonstrate either that the events in question actually occurred or that the person was actually amnesic. Moreover, research on actual trauma victims has produced hardly a shred of evidence for psychogenic amnesia covering the traumatic event itself. Perhaps, after more than 100 years, we should simply declare the trauma-memory argument bankrupt and recovered-memory therapy passe. This would allow us to break the Freudian death-grip on clinical practice once and for all, and move psychotherapy into the here and now, where patients' problems actually exist, and where their problems must be resolved. Because the status and autonomy of clinical psychology rests on the assumption that its principles and methods are scientifically validated, continued reliance on clinical folklore with respect to trauma, memory, and repression can only serve to undermine the profession.
Preparation of this comment was supported in part by Grant #MH35856 from the National Institute of Mental Health. I thank Frederick C. Crews, Elizabeth F. Loftus, Richard J. McNally, Henry L. Roediger, and Carol Tavris for their comments on a prior draft. Correspondence: John F. Kihlstrom, Department of Psychology, MC 1650, University of California, Berkeley, Berkeley, California 94720-1650. E-mail: firstname.lastname@example.org.
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