Synagogue teens work with kids from troubled homes
Friday, December 22, 1995
Synagogue teens work with kids from troubled homes
By BARRY LANK
Jewish Bulletin of Northern California - December 22, 1995
Sarah Nathan, a teenager from San Francisco's Congregation Emanu-El, said she wanted abused kids to know there are good people in the world. Children who grow up with abuse "find it hard to believe that most people aren't beaten," she said.
Another girl volunteered to work with abused children because a friend showed up at school with bruises. Still another said a relative had suffered.
They didn't name the people they were talking about. But as the teens introduced themselves last week at a Jewish Family and Children's Services' training session at San Francisco's Parents Place, one reason for volunteering came to the fore: They wanted to learn what to do when someone they knew was in an abusive relationship.
The six girls, ages 15 and 16 and confirmation students at Congregations Emanu-El and Beth Shalom in San Francisco, are participating in an outreach program sponsored by JFCS' Dream House, transitional housing for women and children.
On Monday, the first day of Chanukah, the teens hosted an art workshop for school-age children from Rosalie House, a San Francisco shelter for battered women and children that refers clients to Dream House.
At last week's training session, Cindy Perlis, director of Art for Recovery, prepared the teens to work on the art project, which involved cutting out paper silhouettes of hands and pasting them on cloth in a collage with words and other patterns.
The interaction between kids and teen counselors while working on the project is more important than the art itself, said Perlis. "In the end, I hope it's a beautiful project. But I don't care."
JFCS program coordinator Amy Cooper agreed. "The main thing is to have some fun together," she told the girls. "This is an opportunity for kids who are isolated to get out and have some fun."
The children are not approaching the workshop with the thought, "I'm a kid from domestic violence," she said. They're viewing it as "going to a party."
Many of the teenagers at the training session already had their own perspectives on the matter.
When Julie Bernstein of Congregation Beth Shalom heard about this project, her reaction, she said, was "How could anyone not want to do this?"
Revital Heller of Congregation Beth Shalom said she would try to be the older high school friend to whatever child she was assigned to work with. Heller reflected that the children would look to the counselors as the counselors themselves had once looked up to older teen-aged girls.
"I thought my baby sitter was so cool," Heller said.
Therapists and coordinators training the counselors also emphasized that the main job was to be friends to the kids, not to push them in any way to talk about violence.
Rachel Kesselman, coordinator of volunteer services for Dream House, said Monday's "coming together of teen mentors and kids from Rosalie House was a wonderful success, both for the kids and the young women. There was a lot of interaction, a lot of sharing."
She expects the association between the teens and other groups of children served by JFCS will be ongoing. "It looks like it's going to be the beginning of a group of young women who seem committed to work together to learn about how they can impact the community, [becoming] part of the cycle of serving."
Saturday, November 18, 1995
This is a historical article, written many years ago. Please note that The fields of memory are like a rich archeological site with layers upon layer of artifacts from different periods, which through some geological upheaval, got mixed up.
Dissociation: Nature's Tincture of Numbing and Forgetting
© (1995) By David L. Calof
Originally published in 1995 - Treating Abuse Today, 5(3), 5-8
© (1995) By David L. Calof
Originally published in 1995 - Treating Abuse Today, 5(3), 5-8
Some years ago my good friend Anastasia suffered a severe knee injury in a bicycling accident. Facing emergency surgery with a poor prognosis, she chose to forego general anesthesia in favor of a spinal anesthetic with no sedative, so she could stay awake to watch and ask questions. If nothing else, my friend told herself, she could keep close watch over the delicate operation. Anastasia remembers being lifted onto the surgical table and getting the spinal injection. She also remembers the anesthesiologist testing the soles of her feet with a needle until she couldn't feel them anymore. But that's all. Next thing she knew, she found herself "waking up" in the recovery room, shocked and disappointed that she had "fallen asleep and missed the surgery."
As she pondered her perplexing "sleep," the surgeon walked in and enthusiastically thanked her for "a great discussion." He commended Anastasia for her pinpoint curiosity and incisive observations during the surgery, and he expressed his astonishment at her "clinical" comments throughout the difficult procedure. At first his praises puzzled Anastasia even more than her puzzling "nap," but at last it dawned on Anastasia that she must have carried on a technical discussion for nearly two hours, a very long talk that she'd totally forgotten.
To this day, she remembers neither the discussion nor the procedures she underwent during and immediately after the surgery, though she has it on good authority that she remained "conscious" throughout the operation. For over nineteen years, this traumatic memory loss has perplexed Anastasia, otherwise known for her practiced control, demanding self-discipline, and sharp memory. She finds herself less puzzled by the fact she suffered no post-surgical pain, despite an arduous rehabilitation. Because of her training as a long-distance runner and bicyclist, Anastasia knew then (and knows now) how to block out pain and discomfort so she can "go the distance." To shunt aside her stress during the surgical ordeal, to block her pain, to compartmentalize her traumatic knowledge afterward, Anastasia called upon an innate biological ability to dissociate, an ability sharpened in her case by years of training and competition.
We can't adequately explain this incident by the mechanism of repression alone; instead, we must understand it as a compelling example of dissociation, the dissociation of knowledge, emotion, sensation, and memory. Dissociation refers to those discontinuities of the brain, the disconnections of mind that we all harbor without awareness. Take, for example, the feelings from your feet. Until I brought them to mind, these feelings most likely sparked and synapsed through some dim center in your brain, some distant cubbyhole of your mind, far removed from your conscious awareness. Now, pay no mind to your feet. Pay no mind to the part of you that keeps track of time. Pay no mind to the part of you that tends to your thirst. Pay no mind to the part of you that carries your worst nightmare. Hard to do now? A moment ago it wasn't.
Such is the way of dissociation. Dissociation lets us step aside, split off from our own knowledge (ideas), our behavior, emotions, and body sensations, our self-control, identity, and memory. Dissociation, the splitting of mind and the pigeon-holing of experience, is a natural adaptation to the complex demands of daily life. Think back to the time when you first learned to drive a car. At first, didn't you find driving overwhelming, so greedy for your conscious attention? You had so much to "pay mind to": the steering wheel, the turns in the road, the gas pedal, the fog late at night, the clutch (or lack thereof), the brakes, the rearview mirror, the other cars, the road signs, the lions and tigers and bears. Oh my. In those first early days, caught up in the act of driving itself, it must have been hard to "keep in mind" that you actually meant to get somewhere! But you did mean to get somewhere, so you did learn to drive. Eventually.
Nowadays, you pretty much drive without really "minding" the road. To do so, you had to learn to split off an auto-pilot who could keep watch over all those things that once demanded your "single-minded" attention. In effect, while driving you can go to a land far far away, because you've got an auto-pilot who'll shake you by the ears when it needs your conscious attention.
The most common form of dissociation involves spontaneous trance. You may have heard it called "highway hypnosis," "spacing-out," "daydreaming," "lost in another world." By their very nature, these trance states demand dissociation from aspects of on-going experience.
Dissociation makes us all more resilient to life's daily miseries. Who hasn't at some time or another "cracked up" or "gone to pieces" or "numbed out?" Have you ever been "beside yourself" or "out of your senses?" These idioms all refer to the splitting off of aspects of consciousness. Greater loads of traumatic stress create greater demands to dissociate. Dissociation offers trauma victims the ability to blunt traumatic realities. During the 1991 fires in the Oakland, California hills, for example, homeowners with dissociative symptoms were twice as likely as others to try to cross police barriers and rush back into the flames (Goleman, 1994). Following the 1989 San Francisco Bay Area earthquake, Stanford researchers Cardena and Spiegel (1993) found, among a sample of Bay Area graduate students, a significant increase in the prevalence and severity of transitory dissociative symptoms, including time distortion and memory alterations.
I've experienced the practical value of dissociation in blunting my own traumatic reality. Once I participated as the hypnoanesthetist during major reconstructive surgery to the face of one of my long-term clients. As I watched the surgeon literally roll up my client's face toward her nose (after cutting it free), I felt a sharp stab of abject terror, followed by nausea and a weakening in the knees. Then came a massive shift in my consciousness. Suddenly I grew quiet all over. All the fear and dread snapped away. I could breathe and my vision tunneled. I felt as though I were floating about an inch in front of my body. In that instant, I gave my rapt, undivided, and unselfconscious attention to the fascinating scene before me.
I remained in that dissociative, surreal state until well after the surgery. As I walked to my car afterward, I played back the surgical scenes again and again, without emotional reaction except awe, until I got to my car and put the key in the door. As I did so, my knees buckled, I wanted to vomit, and the color drained out of my vision. Grabbing the door handle to support myself, I took in the full load of the terror and revulsion I had dissociated during the surgery. All the feelings and sensations that would have overwhelmed me during the surgery came crashing in from their temporary dissociative containers. I nearly passed out on the spot.
During this surgery I made an adaptive choice to compartmentalize my mind. Dissociation gave me the ability to stay present and emotionally unreactive in my professional role during a traumatic and demanding experience.
Of course I'm not alone in these experiences. In the summer of 1993, traumatic dissociation saved Donald Wyman's life. While working in a remote Pennsylvania area clearing timber, Wyman suffered a terrible accident. A huge tree fell on him, pinning his left leg. He screamed for help for an hour, all the while trying in vain to dig his leg out from under the huge tree. Then Wyman made a decision. Because of the seriousness of his injuries and the remoteness of the area, he knew that he would die before anyone found him. So he made a tourniquet from a rawhide bootlace and used his chainsaw wrench to tighten it. Then, using a pocket knife, he set about methodically cutting off his left leg about six inches below the knee. When he'd severed the leg, he crawled to a bulldozer 500 feet away, drove it about 2,000 feet to his pickup truck, then drove the truck about two miles to a farmhouse. The farmer, who called paramedics, described Wyman as "sharp and mentally strong" (Pro, 1993).
Wyman remained conscious and kept his wits throughout the ordeal because of his capacity to dissociate knowledge, body sensations, and emotions. Had he truly been aware of the enormity of his decision (knowledge), or felt the totality of the pain (body sensations), or let terror overtake him (emotions), he would not have survived. Instead, he summoned the truly remarkable human capacity for dissociation.
For victims of sadistic and violent abuse, dissociation offers a way to sanity and survival. Whether in bloody Bosnian back rooms, Nazi death camps, or childhood holocausts in abusive homes, victims use dissociation to escape intolerable terror and pain, to cope with terrible loss. Because they're enjoined to repress their suffering and dissent, victims of sadistically abusive systems must split off these sentiments. Dissociation allows the compartmentalization of experience, giving victims relief from the stress of horrible secrets by putting them out of consciousness. Victims of sadistic systems know that, sometimes, it's best not to know the things they know. The dissociation of knowledge gives victims the chance to manifest "plausible deniability."
Elizabeth Loftus, PhD (ironically a member of the False Memory Syndrome Foundation, Inc. Scientific Advisory Board, which generally holds that people do not forget traumatic experiences) described this very phenomenon in trauma victims as "motivated forgetting" (1980, p. 71-73). She states that "forces seem to operate to help people forget [traumatic experience], especially when such forgetting would make life more bearable" (p. 82). To illustrate this concept, Loftus cites several cases of airplane crash survivors who forgot both their crashes and subsequent rescues. She also discusses a case study (from Zimbardo & Rush, 1975) of a college professor who lost her memory traumatically: It seems that she had suffered an incredible series of traumatic events within the past year climaxing with the breakup of her marriage and the sudden death of her mother before her eyes. Amnesia put all that past ugliness, and more, out of awareness. In its place this motivated forgetting had given her peace of mind. (1980, p. 73) Though the woman dissociated her identity and much of her memory, she held onto her professional knowledge (English literature) "so that she was able to teach again even before the rest of her memory returned" (Loftus, 1980, p. 72). Over time, the patient pieced together the memories that had led to her massive traumatic amnesia. With words seeming almost to bless dissociation, Loftus quotes from Christina Rosetti's Remember: "Better by far you should forget and smile than that you should remember and be sad." This sentiment is a far cry from the "false memory syndrome" hypothesis, which holds that people "forget" a happy childhood in order to "remember" terrifying "false" memories.
For victims of severe abuse, motivated forgetting (otherwise known as dissociation) offers not only a means to cope, but also the way to invisibility. Abuse victims are universally enjoined not to show their pain, suffering, rage, and dissent. They must learn to wall off and contain these reactions. "Crying, are you? Well then, I'll give you something to really cry about." Recounting his experiences while a prisoner in the Nazi concentration camps at Dachau and Buchenwald (1938-1939), the late psychoanalyst Bruno Bettelheim described the universal injunction laid on prisoners by the Nazi camp guards: "Don't dare come to my attention." Drawing parallels with the traditional qualities of the "good" child, Bettelheim said that, to the demand "to be seen and not heard (never talk back or express an opinion) was . . . added the further injunction that the prisoner . . . should also be unseen . . . . Invisibility was thus a primary rule of defense" (1960, p. 210-211).
Of his own traumatic dissociation, Bettelheim (1960) wrote that a "split was soon forced upon me, the split between the inner self that might be able to retain its integrity, and the rest of the personality that would have to submit and adjust for survival" (pp. 126-127). In a passage clearly describing a dissociative response, he states: Anything that had to do with present hardships was so distressing that one wished to repress it, to forget it. Only what was unrelated to present suffering was emotionally neutral and could hence be remembered . . . . It was not just coercion by others into helpless dependency; it was also a clean splitting of the personality. (p. 197) Bettelheim stressed that his reactions to varieties of events closer to normal were "distinctly different from [these] reactions to extreme experiences" (p. 129). He emphasized that these reactions (amnesia, denial, emotional detachment, and so on) emerged specifically as defenses to extreme traumatic events.
Arguably, the child's experience of abuse happening secretly within their own family poses an even greater threat to integration than that of the adult concentration camp prisoner. At least (and this is a terrible reduction) the prisoners face anonymous persecutors, and they're not altogether alone in their horror. Such is not the case with children caught in a secret horror. To function in daily life, children in acutely abusive families may dissociate the knowledge of their on-going abusive experience so they can hold onto an idealization of their caregivers. Other demands also contribute to the dissociation of knowledge. These include powerlessness, threats against disclosure, injunctions not to trust personal perceptions, attributions of fault laid on the victim, and the stigma of the secret acts themselves.
Dissociation used as an acute means of coping with traumatic stress is virtually synonymous with the hypnotic state. Soldiers fight on, oblivious to their mortal wounds. A mother wholly "forgets" her chronic arthritic pain as she dashes after her child who has run into traffic. Sexually abused children often report "leaving"their bodies when the pain of the assault became unbearable. Chronically abused children learn to go into trance to endure repeated acts of sexual aggression. Concentration camp prisoners perform their daily grim labors by drifting in and out of daydreaming, a state that Primo Levi (a survivor of the Auschwitz concentration camp) called "the hypnosis of interminable rhythm" (1959, p. 45). Farmers who lived within earshot of the railroad tracks--which often carried people in cattle cars to the Nazi death camps--learned to "forget to hear the screams" coming from the boxcars, just to go on with daily life.
Severe traumatic dissociation of knowledge is amnesia. A wealth of studies have documented traumatic amnesia (partial and complete) in victims of trauma, including survivors of combat, natural and man-made disasters, violent crime, sexual assault, torture, concentration camps, cults, child abuse, and vehicular or industrial accidents. Winnie Smith, for example, a former army nurse, says (1992) that she forgot, for 16 years, whole segments of her traumatic experiences as a critical care nurse in Vietnam.
At the farthest end of the dissociative continuum lies dissociative identity disorder (DID, formerly MPD), with its characteristic amnesia, derealization, depersonalization, and personality-splitting. DID, an autohypnotic disorder, usually comes into being to cope with prolonged traumatic childhood demands (often sadistic abuse). Early, repetitive, sadistic abuse overwhelms the child's unified personality and calls upon the psyche to use massive dissociation and personality compartmentalization. Massive dissociation typically occurs when the traumatic experiences happen at a time when the child's brain is still malleable to influences of any kind. The demands to contain and manage the effects of massive trauma and paradoxical realities ("I'm Daddy's favorite by day. By night Daddy likes to hurt me.") may engender a compartmentalized, dissociative structuring of consciousness.
People with DID may fragment traumatic memories into pieces that are then held by unrelated personality fragments. One alter personality, for example, may remember the events leading up to abusive acts, another may remember participating in the preliminary activities, and others may carry the actual sensations and knowledge of the assault. For trauma victims, visual memory sometimes takes leave of kinesthetic memory, as when the abuse victim "floats" above her body. Likewise, auditory memories may be cleaved and disowned, only to return later as the haunting sound of intrusive voices. Without therapy, these fragments usually remain disintegrated. This compartmentalization serves many purposes. Most important, it allows abuse victims to bear unbearable experiences. Without a strong demand for integration, personality fragmentation can continue for a lifetime. The fragments of the traumatic storyline gradually coalesce as the patient gathers sufficient ego strength to contain and work through them, a process usually occurring only with therapy.
The alters in a system often hold incredible dissociative strength. Even under oath, alters without knowledge of particular events will testify "truthfully" that the events never happened. They'll even pass a polygraph test. At the same time, other alters in the system will testify "truthfully" that the events did indeed happen. This dissociative strength characterizes the victim as well as the victimizer. Sex offenders with dissociative disorders may spontaneously dissociate sexual offenses (Bliss & Larson, 1985; Ondrovik & Hamilton, 1991; Schwartz, 1992; Stamatiou, 1994).
Out of sight, though, is not out of mind, but in "parallel mind." Sometimes dissociated traumatic experiences "leak" across dissociative barriers. Old feelings and body sensations may intrude on present-day experience. Clinically, present day anxiety or panic disorders often turn out to be unexpressed affects from earlier traumatic events that leak from their dissociative container to affect present emotions and behavior. For a rape victim, a whiff of the wrong aftershave in an elevator triggers pervasive panic and dread. A WW II psychiatrist noted that bombing raid convalescents scanned the sky and "became upset by the sight of a harmless sparrow" (Mira, 1943, p. 102).
Dissociated, unmetabolized body sensations of sadistic abuse may leak into the present as physical flashbacks, sometimes called body memories. Especially with survivors of sadistic sexual abuse, we often find that body sensations return before other memories, and leaking panic may permeate the therapy process for years before the clients consciously recall the abuse. I once treated an adult client working through a decade-long amnesia for a prolonged, brutal, multiple-perpetrator sexual assault in which she'd been left for dead. She often bled vaginally, though not in session. In one particularly intense therapy session, however, this client suffered a severe vaginal hemorrhage. The heavy flow of blood quickly became visible, understandably alarming both of us, so I took the client to a nearby hospital emergency room.
Following her examination and treatment, which included cauterization to stop the bleeding, the hospital staff called in a rape investigation team. The client, however, adamantly refused to give them a statement, insisting that she had nothing to report; to her mind, and in reality, the rape had occurred many years ago, and she didn't want to discuss it. The rape investigation team replied that, while they understood her reluctance to report the rape, they insisted that my client had indeed suffered a recent rape. They offered as proof the physician's report that the client's tissue wounds were "about three days old." Though it took a long time, this client at last worked through these traumatic memories. When she had fully metabolized the rape experience, her chronic vaginal bleeding stopped.
Early in his career, Sigmund Freud recognized dissociation as a fundamental clinical mechanism in his hysterical patients reporting childhood sexual abuse. He wrote that "the splitting of consciousness . . . exists rudimentarily in every hysteria," and he considered "the tendency to this dissociation [to be] the chief phenomena of this neurosis" (1936, p.8). By 1897, though, Freud stopped believing his patients when they described childhood sexual trauma. About the same time, he also abandoned the dissociative framework, and along with it hypnosis, its primary investigative tool. Freud subsumed dissociative phenomena under his new concept of repression, the central psychoanalytic tenet that people tend to inhibit (and consequently tend not to remember) unacceptable wishes, impulses, affects, and especially unacceptable sexual impulses.
We mistake ourselves when we call the dissociation of a traumatic experience "repression," and we do our clients a disservice when we insist that their late recollection of abusive experiences involves intact memories filtering up from the depths of unconsciousness. Quite often these recollections point to a leakage, a breaking-down of the walls built around memory fragments. "Repressed" memories may not be repressed at all. We must learn to distinguish between not remembering (simple forgetting), burying intact memories (repression), and never consciously knowing the whole of a memory (traumatic dissociation).
Dissociation not only helps manage the painful realities of abuse victims, but also the split realities in abusive family systems. In such systems, family members often use dissociation to compartmentalize experience. They may isolate important incidents, for example, often failing to see any pattern connecting them. Mothers in incestuous families tell belatedly they didn't relate suspicious incidents to one another, thus diluting their cumulative meaning. Other members may use dissociation to live in parallel realities: One father with an alcoholic wife bitterly complained that his adult daughter hadn't known what it had been like to live with an alcoholic woman. In making this complaint, the father "forgot" that the daughter had been the primary caretaker of the often drunk mother.
Memories of shattering childhood events seldom "bubble up" intact. Instead, they live in the apartment next door, they bang on the pipes and shout at you at night, and sometimes they come crashing through the walls to grab at life. Memory work for most trauma survivors means becoming best friends with the worst neighbors imaginable.
Traumatic dissociation gave my friend Anastasia a way to put aside her knowledge, emotions, and sensations of a traumatic event. It gave her a purely clinical autopilot to deal with her situation, as her surgeon will attest. A practiced athletic faculty to dissociate allowed her to block out pain throughout a rigorous rehabilitation to a full recovery. She still runs marathons.
Anastasia's long-term dissociative amnesia doesn't threaten us, so no one will cry "false memory" or start a foundation if she ever regains her memory. But looking back with her to that bloody event, we see that memory is merciful. Traumatic dissociation, the tincture of numbing and forgetting, let's us detach from traumatic suffering until the day comes when we're strong enough to feel again and say, I remember.
- Bettelheim, B. (1960). The informed heart: A study of the psychological consequences of living under extreme fear and terror. London: Penguin Books.
- Bliss, E., & Larson, E. (1985). Sexual criminality and hypnotizability. The Journal of Mental and Nervous Diseases, 173, 522-526.
- Breuer, J., & Freud, S. (1936). Studies in hysteria (A. A. Brill, Trans.). New York: Coolidge Foundation. (Original work published 1895).
- Cardena, E., & Spiegel, D. (1993). Dissociative reactions to the San Francisco Bay Area earthquake of 1989. American Journal of Psychiatry, 150, 474-475.
- Goleman, D. (1994, April 17). Those calmest in crisis may suffer greatest stress. The Seattle Times, p. A7.
- Levi, P. (1959). Survival in Auschwitz. New York: Collier Books, Macmillan Publishing Company.
- Loftus, E. (1980). Memory. Reading, MA: Addison-Wesley.
- Mira, E. (1943). Psychiatry in war. New York: W.W. Norton.
- Ondrovik, J., & Hamilton, D. (1991). Sexual perpetrators: Rule out dissociative disorders. Paper presented at the Second International Conference for the Assessment and Treatment of Sex Offenders, University of Minnesota, Minneapolis, MN.
- Pro, J. (1993, July 21). Trapped, he cut his own leg off. The Seattle Times, p. 45.
- Schwartz, M. (1992). Sexual compulsivity program focuses on trauma work and broken love maps. Masters and Johnson Report, 1(2), 1-8.
- Smith, W. (1992). American daughter gone to war: On the front lines with an army nurse in Vietnam. New York: Morrow.
- Stamatiou, M. (1993, November/December). On recognizing sex offenders diagnosed with MPD in correctional settings. Treating Abuse Today, 3(6), 34-41.
Wednesday, November 01, 1995
The following article appears in the current issue of TREATING ABUSE TODAY magazine, November-December 1995/January-February 1996
NOTES FROM THE CONTROVERSY
APA APPROVES FMSF AS CE SPONSORIn a move that left many APA members puzzled and angry, the American Psychological Association (APA) recently approved the False Memory Syndrome Foundation, Inc (FMSF) as a provider organization able to offer continuing education for psychologists. This approval indicates that the APA recognizes the FMSF as an organization capable of planning and implementing educational programs for psychologists at the post-doctoral level. The APA approved this status despite its own earlier warning that the legislative agendas of many state FMS organizations posed a serious threat to the mental health professions, and to the general availability of quality mental health services. 
In a recent interview, Rhea Farberman of the APA's Public Affairs Office justified the APA's decision as "non-political," based solely on the merits of the FMSF's application for continuing education (CE) provider status. She characterized FMSF stances, including the debated existence of "false memory syndrome" itself, as "unpopular science." She stressed, however, that the APA would not deny CE provider status to any organization simply because its science proved unpopular with most practitioners. She further stated that the APA felt "a real responsibility" to protect "research, data, and science."
Farberman stressed, however, that people shouldn't confuse the CE sponsor approval with any kind of general or specific APA endorsement of the FMSF. She pointed out that, in fact, the APA found many FMSF positions, practices, and actions "troubling." She also stated that many FMSF board members espoused positions and acted in ways unacceptable to the APA.
CRITERIA OF FORM, WITHOUT CONTENT
According to Jill Reich, PhD (the Executive Director of the APA Education Directorate), CE sponsors must offer educational resources that improve professional competence, make available new skills and knowledge, and encourage critical inquiry and balanced judgment. Reich further stated, however, that the APA's Committee for the Approval of Continuing Education Sponsors (CACES) doesn't consider program content during the approval process; rather, the Committee considers only the formal elements of an organization (structure, management, instructors, and so on).
When asked how the APA, without looking at program content, could possibly know whether or not a particular organization met the above criteria, Farberman indicated that an organization's past educational activity and the presence of reputable specialists on the organization's board offered sufficient assurance that it would meet the criteria. In a published statement, Reich confirmed this view when she indicated that the FMSF application "provided ample evidence that the organization is capable of offering continuing education that benefits psychologists and has, in fact, done so in conjunction with another organization, Johns Hopkins University." 
The FMSF, however, apparently takes a much more rigorous view regarding the need for oversight of CE program content. In a recent fundraising letter (dated November 1, 1995), representatives of the FMSF stated:
Professional organizations still do not hold their members accountable. Too many continuing education programs still continue to disseminate unscientific information about memory, repression and therapeutic techniques that destroy families.Assuming that the FMSF includes the APA among these "professional organizations," it appears that the FMSF faults the APA for not scrutinizing the content of CE programs. The FMSF, however, has now taken advantage of the very weaknesses of a system that it earlier condemned. When asked about the apparent contradiction, the APA's Farberman characterized it as "ironic."
Many outraged APA members argue that the FMSF would fail the scientific scrutiny it once called for, because (the members maintain) this advocacy organization regularly participates in activities that make a mockery of the scientific endeavor. Other observers argue that the FMSF fails to meet all three of the APA criteria for approving a CE sponsor, especially regarding the need to encourage critical inquiry and balanced judgment. Charles Whitfield, MD, for instance, stated that "the FMSF's conferences and other educational offerings have always been greatly unbalanced in favor of promulgating their one-sided claims." Other APA members argue that the FMSF goes beyond bias to push a pseudoscience based on a "syndrome" that no reputable medical or psychological body recognizes; yet the very same organization regularly cries "bad science" against researchers, clinicians, and organizations (the APA included) who take a skeptical view of FMSF claims.
In a recent letter of resignation from the APA, for example, Elizabeth Loftus, PhD  (a prominent FMSF board member) claimed that "APA subgroups and members have moved in directions that are disturbingly far from scientific thinking." She further stated that she decided to resign so she could "devote [her] energies to the numerous other professional organizations that value science more highly and more consistently" than the APA.
In this statement, of course, Loftus doesn't speak for the FMSF generally, although her claims echo other FMSF claims made elsewhere (such as in the fundraising letter cited earlier). Some observers, however, find themselves struck by the oddity of the situation: A prominent FMSF board member resigns from the APA--citing irreconcilable scientific differences--shortly after the APA grants CE sponsor status to the FMSF, so the organization can teach its brand of "science."
Other FMSF critics wonder just how closely the APA scrutinized the FMSF "instructors," presumably the members of the FMSF's Scientific and Professional Advisory Board. Almost exclusively, the Board includes members of the academic staff of colleges and universities, with the odd magician and author thrown in for spice. Despite the impressive variety in the backgrounds of the board members, very few of them command clinical or research expertise in trauma and abuse issues, the very issues that the organization would teach to psychologists through its CE offerings.
In many ways, Reich's published statement regarding the FMSF's CE sponsor approval suggests that the Committee generally adopts a position of assumed helplessness within the strictures of "rules and procedures." At several points in her statement, Reich explicitly absolves the Committee of any responsibility for its decisions. She states, for instance, that "the Committee has no authority to act" as a rational decision-making body; rather, it can only act as a cogs-and-gears mechanism set in motion by higher echelons within the APA. In short, the Committee "follows specific procedures approved by the Council of Representatives, and deals only with the evidence before it."
In true mechanistic fashion, once the Committee winds the spring and sets the approval mechanism in motion, it "has no basis on which to reconsider its decision." In other words, the Committee has no power to change its collective mind. Those APA members dissatisfied with a Committee decision can get it changed only by throwing a wrench into the works. The only acceptable wrench, according to Reich, must come in the form of a written complaint. Farberman also stressed the conditional nature of the CE approval granted to the FMSF, and she stated that the organization will have to follow a standard cycle of review and approval. Reich stands by these procedures, despite the feeling among many APA members that the review and complaint process amounts to a lengthy bureaucratic shuffle to shut the chicken coop after the weasel's already inside.
Despite the aggravation inherent in the APA's after-the-fact approach, a number of APA members have already written letters of complaint. In two open letters, Kenneth Pope, PhD argues that FMSF activists use a number of disturbing tactics, such as: accosting the staff and clients of therapists; maintaining "picket lines" (really gauntlets that clients must walk to get to the offices of their therapists); encumbering resources through legal and administrative ploys; covert investigations using private investigators to infiltrate therapy practices; and making repeated in absentia psychological diagnoses of people (sometimes whole groups of people) who disagree with FMSF stances. Pope argues that such tactics may keep some mental health professionals from publicly expressing disagreement with FMSF stances.
Farberman stated that the APA has no knowledge that the FMSF uses such tactics. She indicated, however, that the Education Directorate would act on complaints received from members who attended an FMSF activity and found any practice objectionable. She expressed particular concern over the possible development and distribution of blacklists, though she stressed that the APA had no evidence that the FMSF had involved itself in such activities.
At an October 1995 Pennsylvania State FMSF meeting, however, Pamela Freyd, PhD (the FMSF Executive Director) stated that her organization's next "big project" involved the development and distribution of a roster listing "thousands" of clinicians that FMSF members have identified as therapists "destroying families." At the meeting, she called for volunteers to help with the daunting task of data input, to get the roster off and running. At the same meeting, an attorney discussed ways to mount media campaigns against "bad" therapists without risking libel, and ways to encumber the resources of "bad" therapists through administrative complaints and legal suits.
ORGANIZATIONAL AND PROFESSIONAL DISSOCIATION
Early last year, the APA recognized that at least one item on the FMSF agenda constituted a severe threat to the psychological profession. In a 1995 APA Action Alert issued under the authority of Billie Hinnefeld, JD, Director of Legal and Regulatory Affairs, the APA warned that FMSF-inspired legislation "threatens to inappropriately curtail psychotherapy and make needed mental health services inaccessible to the public." When contacted for a statement regarding the APA's most recent decision regarding the FMSF, Hinnefeld refused to comment beyond pointing out that the Practice Directorate and the Education Directorate make up two entirely separate APA functions, and that neither has to answer for the decisions of the other.
A source who requested anonymity also pointed out that Ray Fowler, PhD, the Chief Executive Officer of the APA, stated that this controversy amounts only to a "PR" issue with some APA members. According to Farberman, however, Fowler understands that the controversy involves issues that go much deeper than skirmishes in public relations. Fowler didn't return repeated calls asking for comment.
The "organizational dissociation" inherent in the APA's stance reflects the inevitable "professional dissociation" in a field as complex as psychology. Some psychologists, for instance, strongly support the APA's decision despite the fact that the FMSF teaches about a "syndrome" that has no clinical or academic underpinnings, and that the profession itself hasn't recognized. Ira E. Hyman, Jr, PhD, for instance, argues that "the FMSF [can] put together an educational program concerning repressed memories and false memories that would be useful to academics and clinicians" (Internet posting, November 26, 1995). [See note from Dr. Ira Hyman.] After briefly discussing an FMSF conference held at Johns Hopkins Medical Institutions in December 1994, a conference that included an "impressive" list of presenters, Hyman concludes, "If the FMSF can put together such programs, then my view is that they are an appropriate group to offer credits for APA members."
Hyman fails to point out, however, that the presenters at this conference came almost exclusively from FMSF ranks, a fact that hardly bodes well for a rounded treatment of clinical issues. He also doesn't mention that, shortly before the Johns Hopkins conference, the FMSF failed to gain state CE credit for a Washington State (US) FMSF conference, even though this conference featured many of the same presenters as the Johns Hopkins conference. In announcing the failure, John Cannell, MD (the conference organizer) stated that "the Medical Association here commented on the quality of the presenters." Hyman, who lives in Washington State, serves as a faculty member in the Psychology Department of Western Washington University.
According to Farberman, the APA recognizes the shortcomings of current CE approval procedures, and she stated that the organization would undertake a detailed review of the procedures. She stressed, however, that the APA remains committed to an ideal of open inquiry and non-censorship in scientific endeavors.
To directly express your views on this or any other matter involving the American Psychological Association, call or write:
750 First Street, NE
Washington, DC 20002-4242
(202) 336-5500 (voice) (202) 336-5708 (fax) (202) 336-6123 (TDD)
 For a fuller discussion of this earlier APA warning, please see "APA Speaks Out Against Bureaucracy and Barriers to Service" in Vol 5, No 2 of TREATING ABUSE TODAY. Reich appears unaware of the controversy surrounding the odd-bedfellows relationship between Johns Hopkins, a venerable medical institution, and the FMSF, a media-savvy advocacy organization. A great many mental health professionals were astounded when Johns Hopkins apparently embraced "false memory syndrome," when no psychological or medical organization has yet recognized its existence. In fact, Paul McHugh, MD--a prominent Johns Hopkins psychiatrist--orchestrated the partnership between the FMSF and Johns Hopkins. McHugh also serves on the Scientific and Professional Advisory Board of the FMSF. For more information on Loftus's resignation from the APA, please see "Ethics Charges Filed Against Prominent FMSF Board Member," in the same issue of TREATING ABUSE TODAY (Vol 5 No 6/Vol 6 No 1).
Friday, September 01, 1995
What Psychologists Better Know About Recovered Memories, Research, Lawsuits, and the Pivotal Experiment
What Psychologists Better Know About Recovered Memories, Research, Lawsuits, and the Pivotal Experiment
By Kenneth S. Pope
Clinical Psychology: Science and Practice Fall, 1995 vol. 2, #3, pp. 304-315.
Book Review: The Myth of Repressed Memory: False Memories and Allegations of Sexual Abuse. By Elizabeth Loftus and Katherine Ketcham.
By Kenneth S. Pope
Clinical Psychology: Science and Practice Fall, 1995 vol. 2, #3, pp. 304-315.
Book Review: The Myth of Repressed Memory: False Memories and Allegations of Sexual Abuse. By Elizabeth Loftus and Katherine Ketcham.
"I study memory, and I am a skeptic," writes Loftus in The Myth of Repressed Memory (p. 7). A distinguished faculty member of the University of Washington's Department of Psychology and School of Law, she co-authored Witness for the Defense: The Accused, the Eyewitness, and the Expert Who Puts Memory on Trial with Katherine Ketcham in 1991. Like their previous work, The Myth of Repressed Memory is told from Loftus's first-person perspective. Their new book advances the theme of Witness for the Defense: Here the expert puts recovered memory of abuse on trial. In my opinion, The Myth of Repressed Memory will be her most influential work. It goes beyond numerous anecdotes, vividly told. It presents Loftus's critical false-memory experiment, which seized wide-spread attention and seemed to prove the skeptics' central assertion: that therapists could implant false autobiographical memories in their patients. This review will focus on the pivotal experiment and then on six broad issues for the field.
THE HISTORIC EXPERIMENT
Loftus dedicates the book "to the principles of science, which demand that any claim to 'truth' be accompanied by proof" (p. v). That demand for proof posed a problem. Loftus and those whom she calls her fellow skeptics believed that therapists were implanting false memories of trauma, creating a "false memory syndrome" (Loftus, 1994). The skeptics could identify therapists' potential mechanisms of suggestion, persuasion, or coercion to develop the syndrome. The problem was: Where was the experimental proof that false memory could be created?
The obvious experimental design--researchers assigning a specific autobiographical lie for therapists to implant in patients--could never be implemented. In my opinion, no human subjects committee (HSC) could approve subjecting even the first pilot subject to such deceptive manipulation of autobiographical memory in actual psychotherapy.
Finding a convincing analogue seemed hopeless. The "Chris experiment" showed that it wasn't. A child or adolescent would be used as the patient analogue and a trusted older relative as the therapist analogue. Loftus's student, "Jim Coan, created a false memory in the mind of his 14-year-old brother, Chris" (Loftus, 1993, p. 533). According to Loftus, the implanted pseudoevent was greatly feared and mildly traumatic. The research team "developed a paradigm for instilling a specific childhood memory for being lost on a particular occasion at the age of five. They chose getting lost because it is clearly a great fear of both parents and children.... The technique involved a subject and a trusted family member who played a variation of 'Remember the time that . . . ?"' (Loftus, 1993, p. 532).
A widely publicized experiment, the story of "Chris" has appeared in American Psychologist, the New Yorker, newsmagazines, newspapers, books, scholarly articles, television shows, courtroom testimony, lectures, work-shops, and countless informal discussions. As textbooks begin incorporating his story, he will likely become as well known as Anna 0. How could one experiment seize such attention and profoundly shift our view of memory? The research design and striking findings reflect five essential criteria:
- 1. The bogus event was traumatic. Just as false memory syndrome involves apparent recovery of traumatic memories, the experiment had to induce recovery of a traumatic autobiographical memory. As Loftus (1993) emphasized, "the lost-in-a-shopping-mall example shows that memory of an entire mildly traumatic event can be created" (p. 532).
- 2. Chris, the experimental subject, was not an adult. Had Chris been an adult, it is unlikely that anyone would have viewed this experiment as remarkable, meaningful, or persuasive. There would be no way to ensure that adults took such an experiment seriously and would be any less prone to be truthful with the experimenters than the experimenters were truthful with them. Media coverage of decades of deception research eroded the assumption that adult subjects are naive. Adults can appreciate the opportunity to have a little fun with experimenters, those so-called experts of the mind who recount in print and television shows how easily they fool their subjects. They may give whatever answers they think the experimenter wants. They may give whatever answers will get them out of there as soon as possible, wondering why experimenters expect much work or commitment for such a relatively low hourly wage. But a trusted older relative experimenting on the mind and memory of a minor still living at home was to many a convincing analogue. This design echoed the therapeutic relationship, a relationship of sometimes great importance to the patient, a relationship often reflecting trust, dependence, and the expectation of honesty. Someone only 8 or 14 years old and an older relative, like therapist and patient, have a relationship that is not solely that of researcher and experimental subject. A young child or teen may have great trust in older family members, looking to them for the safe reliability and honesty that cannot always be expected from strangers (e.g., those who conduct psychology experiments), but may be similar to the trust that patients may place in therapists. Certainly the brief, limited relation-ship between experimenters and adult volunteers (some of them college students who are even more aware of deception research) signing up for a university experi-ment does not reflect much at all the deeper seriousness, investment, and involvement that a patient has in therapy and the trust that a patient invests in a therapist. Those less than 15 years old are less likely to be aware that experimenters sometimes do not tell research subjects the truth, and are more likely to be truly naive subjects.
- 3. The manipulation of autobiographical memory seemed convincing. When debriefing led Chris to consider that the relative who had referred to a narrative as true was now saying it was false, he was not quite able to believe it (p. 98). The media have emphasized that the mildly trau-matic memory seemed more real to Chris than memory of actual events. "Chris . . . refused to relinquish his false memory even after he was told it never happened. His implanted recollection ... had become realer than his memory of some actual events. Chris had become, to borrow a term, an honest liar" (Boss, 1994).
- 4. The false memory still seemed real a year later. The experiment showed how persistent a false memory implanted by a trusted figure can be and the difficulty or perhaps impossibility of convincing a minor that what he or she clearly remembers as part of the authentic history of the self is complete fiction. In a videotaped interview conducted a year after debriefing, Chris says that the false memory "still seems like it really happened" (Loftus, 1994). The presentation of data spanning more than a year tends to be much more convincing than what are often called "quick and dirty" experiments.
- 5. The experiment relied on apparent realism. Loftus identified a validity problem in memory research. This prob-lem arises when experimental subjects are aware that the materials they try to remember are stimuli of a memory study (Loftus & Loftus, 1976, p. 110). When subjects sign up for a "memory experiment" and know that the materials to be remembered are stimuli in a memory experiment, the findings may lack validity beyond an atypical, laboratory setting. When an older, trusted family mem-ber, supposedly present when the pseudoevent occurred, presents the bogus event in the form of "Do you remember when . . . ?", the experiment avoids artificiality that can undermine both validity and generalizability.
A similar experiment was piloted on 8-year-old Brittany, whose mother implanted a memory that 3 years previously Brittany and her friend had gotten lost in a condominium complex (p. 9g). A little over 2 weeks later, Brittany encountered another lack of truthfulness when "a friend of the family interviewed Brittany under the pretext of getting information for a school newspaper article on childhood memories" (p 9g).
Here was apparent experimental proof demanded by the principles of science and meeting five crucial criteria, that memory--the memory that allows us to know our own past, gives shape to our reality, and maintains continuity of the self over time--can be manipulated with precision. That the highly publicized "Chris experiment" found quick access to courts, the media, and professional discourse increases the importance of independent attempts at replication. Such work should be undertaken by a wide range of graduate students in search of dissertation topics, psychologists, psychiatrists, researchers, and other scien-tists in diverse settings.
Those responsible for reviewing, approving, and monitoring this research--it is unclear whether the Department of Psychology, School of Law, and University of Washington (UW) review research proposals independently or share responsibility through a single HSC--might, in a joint effort with the research team, make available the HSC documents necessary for replicating the Chris experiment. Publishing the documents--making them readily available in libraries--would make it easier for a wide range of people to gain HSC approval in their own settings and save those at UW the trouble and expense of responding to so many individual requests for such information from researchers, institutes, and other interested people.
The relevant UW investigators, departments, and committees should provide information about three major issues. First, what information convinced them that the experimental procedures piloted on Chris (and Brittany) would be safe and appropriate? A human subject experiment involving a minor or deception (let alone both) requires advance review and authorization before the first pilot subject is run. Loftus (1994) has rightfully condemned those who have perpetrated experiments on subjects who did not give any informed consent, subjects who were subjected to protocols that have not been through any human subjects procedures; by working with others at UW to provide the HSC documents for the Chris experiment, she can help others take account of the full array of risks and relevant information in submitting and reviewing replication proposals. Psychologists have a reminder of such requirements in addition to their ethics code: authors of articles published in APA journals such as American Psychologist are required to sign an affidavit that the research presented was conducted in accordance with the ethics code. Before allowing false memories to be implanted in Chris, what evidence did the HSC, the Department of Psychology, and the university more generally consider sufficient to address such questions as: (a) could convincing a minor that something imaginary actually happened affect the subjects trust in the family member who deceives him? (b) what effect does being used as a subject in a deception experiment have on a minor subject? (c) does a trusted relative telling a minor something that is not true affect the way the minor views the importance of truth in family and other communications? (d) what are the implications and side-effects of a frightening, mildly traumatic, and false autobiographical memory continuing to seem real a year after debriefing? (e) does a minor adequately understand the nature of a psychology experiment in which subjects are deceived--or, to use Loftus vivid phrase in describing another deception experiment, double crossed (Loftus & Loftus, 1976, p. 94)--and the rationales for telling someone who trusts you that he or she experienced something that never happened? (f) what are the possible clinical and developmental effects of such an experiment? (g) if possible clinical effects were not ignored, what procedures were used to assess them, who implemented them, and what were the results?
Second, how was informed consent obtained? What procedures and documents for informing and obtaining consent met the criteria of the HSC and UW? One cannot, of course, begin piloting an experiment using deception on a minor without obtaining prior informed consent from the relevant parents, guardians, or other legal agents. What information was given to the parents about the purpose, nature, intended consequences, and possible risks or unintended side-effects of the Chris Experiment? How, if at all, did they understand that they would be compensated?
Third, how did the investigators, HSC, and UW address subject assent? Minors generally lack legal standing to provide informed consent, but HSCs address the issue of a minors assent. Assent becomes an extremely difficult issue when proposing to implant a false autobiographical memory that will still seem real a year after debriefing. Implanting false memories into research subjects raises other potential dilemmas for HSCs. For example, could false memories of having given informed assent or consent be implanted in research subjects?
In its description of experiments as well as other tales of recovered memories, the Loftus and Ketcham book touches on many of the ethical, professional, and legal issues of this field. Six major questions can be noted: choosing sides, telling stories, requiring proof, remaining silent, bringing suit, and guiding practice and policy.
The first issue involves the choosing of sides. Loftus characterizes it this way:
On one side are the "True Believers," who insist that the mind is capable of repressing memories and who accept without reservation or question the authenticity of recovered memories. On the other side are the "Skeptics," who argue that the notion of repression is purely hypothetical and essentially untestable, based as it is on unsubstantiated speculation and anecdotes that are impossible to confirm or deny." (p. 31)
What are the data supporting and what are the likely consequences of labeling those with whom one disagrees "True Believers"? Loftus makes clear her source by quoting from Hoffer's well-known text The True Believer (1965/1989). If the skeptic demands proof, how does the True Believer decide what to believe in? Hoffer observed that True Believers shut themselves off from facts, ignoring a doctrine's validity while valuing its ability to insulate them from reality (Hoffer, 1965/1989, p. 80). Hoffer described the True Believer's passionate hatred and fanaticism, noting "the acrid secretion of the frustrated mind, though composed chiefly of fear and ill will, acts yet as a marvelous slime to cement the embittered and disaffected into one compact whole" (p. 124).
Similarly, a number of False Memory Syndrome Foundation (FMSF) board members, including Loftus, compare those who are on the other side to the hunters and murderers of "witches." The book returns repeatedly to the central metaphor of the "hysteria" characterizing "an earlier time when God-fearing citizens, gripped by fear, superstition, and religious fervor, cried witch, and a forest of stakes was pounded into the very heart of the community" (p. 228). Quotations from Arthur Miller's The Crucible precede the first page of the book and chapters 2-4. Historically, hysteria typically has been used to label women, in this case the allegedly large proportion of female therapists who seem to implant or otherwise elicit false memories and the allegedly large proportion of women who assert false memories. FMSF claims that at least 90% of those whom they described as "accusing adult children" who are afflicted with the syndrome and about 75% of their therapists were female (Wakefield & Underwager, 1992, p. 486; see also Freyd, Roth, Wakefield, & Underwager, 1993; it is unclear what FMSF means by the oxymoronic term "adult children" and how FMSF scientifically distinguishes adult children from other adults). Wakefield and Underwager (1994) emphasize that psychiatrist Richard Gardner "sees the women who make false allegations based on recovered memories as very angry, hostile, and sometimes paranoid. He believes that all will have demonstrated some type of psychopathology in earlier parts of their lives" (p. 332).
Aside from attributing group characteristics (e.g., True Believers, hysterical murderers of those falsely accused as "witches") to those who disagree with their beliefs about recovered memories, some who have served on the FMSF advisory board have also made attributions about individuals with whom they disagree. Wakefield and Underwager (1994), for example, discuss professor of cognitive psychology Jennifer Freyd "hiding" behind a "dishonest facade," which they describe as "the contemptible last refuge of fools and the beginning of conscious knavery" (p. 289).
Loftus is right to remind us of the demand that proof accompany assertions; many are making assertions about various people who work in this area. Some assertions are quite broad; they characterize all who are on "the other side." Some are extremely personal; for example, in addition to remarks about Freyd cited above are published allegations from other FMSF sources about her sexual relationship with her husband, how she nurses her infant, her mental health, etc. (Doe, 1991); one document containing many such propositions was distributed to her university colleagues while she was being considered for promotion to full professor. Those who make the assertions bear a heavy responsibility to ensure that the published evidence accompanying the assertions meets the highest standards of scientific proof, to state clearly how making allegations about sexual relationships or nursing are valid and relevant forms of professional discourse (as opposed to being a form of ad feminam rather than logical argument), and what limits of civility, respect, or basic human decency are to be recognized in characterizing those with whom one disagrees on an issue.
Concerns about incompetent or malicious therapists remain abstractions until embodied in a specific person. This book uses many anecdotes to illustrate its view of the horrors perpetrated by therapists whose patients experience recovered memories. Loftus tells the story of her friend "Barbara" (a pseudonym), describing her as a crusading, sometimes strident colleague, whose toxic friendship taught Loftus much about how the therapeutic process can be abusive (p. 223). Loftus alleges that a specific individual had sexually molested her when she was g and that she had kept it a secret rather than telling her parents. When Loftus tells the story to her friend Barbara, Barbara does not put this decades-old product of malleable memory on trial or even ask Loftus for external evidence that the event really happened. To the contrary, Barbara apparently begins the True Believer's bizarre, frightening, and almost psychotic activities. Barbara is clearly, in Loftus's word, "abusive." In Loftus's memory, Barbara apparently lacks boundaries and the ability to differentiate other people's feelings from her own; she sends Loftus a horrifying rendering of genital mutilation. Finally, Loftus understands how Barbara had mistreated and victimized her: "I knew what Barbara had done--she had stolen my memory, stuck pins in it, and made it bleed" (p. 226). Loftus's dramatization of her victimization by Barbara and of her own pierced and bleeding memory raises complex questions about psychologists' telling stories about their "friends" to illustrate abusive events or other phenomena.
The path this book uses to dramatic immediacy may exact a high price. The book states, "Certain scenes and dialogue have been dramatically re-created in order to convey important ideas or to simplify the story" (p. xi). Perhaps there is another meaning to this statement, but in context it seems to mean that when the authors did not know what had happened, they made up words and actions based on what they thought the people might have said, and shaped this imaginative exercise to communicate certain ideas or reduce complexity so that a certain story would emerge clearly. How readers can figure out when the book is dramatically re-creating scenes and dialogue involving people and events intended to be real and when it uses other methods of description (e.g., based solely on authenticated documents or solely on the memory of the authors) is unclear. Although the dramati-zation of supposedly actual events by those who were not present has become widespread in books (e.g., McGinniss, 1993), what are the likely results? Loftus herself asserts, "Cognitive psychologists know that when people engage in exercises in imagination, they begin to have problems differentiating what is real and what is imagined" (p. 158).
While the portrayal of Barbara has the persuasive power of narrative, readers have a responsibility, in my opinion, to consider carefully such questions as these: Aside from the distortions of memory, were Barbara's words and behaviors re-created to dramatize a specific point and was a much more complex and ambiguous story simplified so that it would more neatly support Loftus's view of the True Believer? If there were a videotape of what was supposedly an extremely private expression of self-disclosure and friendship, would it differ signifi-cantly from Loftus's account? What are the strengths and weaknesses of using an exchange between friends as a basis for assessing "a great deal about the inherent and potentially abusive power of the therapeutic process" (p. 223)? What responsibilities, if any, does a psychologist have when intending to publicize a friend's attempts to help as a negative example? An additional issue in dramatically recreating scenes and dialogue of actual people is that pseudonyms may be relatively transparent, especially (as in this case) when surrounding information seems to point to a readily identifiable person.
The book's dramatic re-creations and more factual descriptions make it fairly easy to tell the skeptics from the True Believers. If therapists travel in "swarms" (p. 251), have faces "red with anger" (p. 34), or start "swatting" Loftus over the head with a newspaper (p. 211), they are likely True Believers. But if the professionals are noticeable by their "dark, soulful eyes" (p. 252), the description characterizes a skeptic (in this case fellow FMSF advisory board member Richard Ofshe). Readers might ask themselves if such characterizations are relevant and valid, and if so, how they increase our understanding of this area. For example, were Loftus as staunch an advo-cate for True Believers as she currently is for skeptics, would the skeptics in this book be flushed, swarming, and swatting? Would skeptical challenges to her positions be dismissed as unscientific and based on "the prejudices and fears that lie behind the resistance to my life's work" (p. 4)?
The nature of and responses to child abuse have attracted vigorous examination. For example, FMSF executive director Pamela Freyd once wrote as Jane Doe that to oppose child abuse constitutes conformity with the widely ridiculed "pc" movement: "To be against child sexual abuse is a 'politically correct' position" (p. 163; see also Freyd, 1994).
According to Loftus, the scientific proof is supposedly adequate to support the truth of the claim: recalling abuse is inevitably followed by a variety of specific, harmful consequences that seem to constitute a checklist. Loftus and Rosenwald (1993), for example, discuss "the psychological upheaval, the ruined reputations and careers, and the breakup of families that inevitably follow the supposed recall of abuse in childhood" (p. 70). Loftus's conclusion that upheaval, ruin, and family breakup are universal regardless of the specific family, the nature of abuse supposedly recalled, whether the individual discloses the sup-posed recollection to anyone else, and other factors, may powerfully influence the damages phase of legal actions against those who recall memories of abuse and/or their therapists. But where is the proof of this assertion?
Obviously, anyone is free to make an absolute statement about all recall of abuse and may rely upon clinical experience, a collection of anecdotes, an appeal to authority, or countless other justifications. But a scientific approach, according to Loftus, demands that the assertion of truth be accompanied by proof Moreover, readers must have the proof presented in sufficient statistical detail to address questions about whether the sweeping conclusions were warranted in terms of the base rates of psychological upheaval, ruined reputations and careers, and family breakup for the general population on which this research was based.
A careful examination of proof with regard to diverse conspiracy allegations would be extremely useful. Repeatedly, claims of powerful groups cooperating in illegal, destructive behaviors seem to arise in this area. For example, those who recover memories may describe conspiracies of Satanists, who perform secret ceremonies involving child abuse and murder. Those who testify for the defense in child abuse cases may describe what seems like a conspiracy of those who seek to protect children. In their recent book, Wakefield and Underwager (1994), for example, claimed: "This child protection system is allied with a law enforcement system that commits illegal acts such as murder and fabrication of evidence" (p. 36).
Ofshe and Singer, two of Loftus's FMSF advisory board colleagues, have raised the issue of a conspiracy directed against them. They filed a federal suit against the American Psychological Association (APA), American Sociological Association (ASA), and various individuals, alleging racketeering activity connected with an effort to destroy Ofshe and Singer's ability to function as professionals and to testify as expert witnesses in certain trials (Singer & Ofshe v. APA et al., 1992, p. 3). One question this suit raises is: Can those who sue an organization be regarded as unbiased experts in other legal actions whose principals are members of the organization?
These plaintiffs also filed a suit in state court alleging that APA, ASA, and others conspired in a number of acts, including attempts to obstruct justice, deceiving federal judges, mail fraud, and defamation (Singer & Ofshe v. APA et al., 1994a, p. 7). The complaint noted that both Singer and Ofshe derived a substantial portion of income from consultations and work as expert witnesses, and discussed how Ofshe was greatly emotionally distressed in light of how his potentially jeopardized credibility could affect his clients. (For additional information, see Singer & Of she v. APA et al., 1993; Singer & Of she v. APA et al., 1994b).
Assessing conspiracy claims and other assertions requires not only requesting proof but also analyzing the methods by which that proof is obtained. Judge Yule, for example, held that Ofshe's methods seemed in some regard to be those of which he is critical when discussing therapists working with recovered memories. "Just as [Ofshe] accuses [therapists] of resolving at the outset [to find] repressed memories of abuse and then constructing them, he has resolved at the outset to find a macabre scheme of memories progressing toward satanic cult ritual and then creates them" (Crook v. Murphy, 1994a, p. 27).
Loftus remains silent on some important issues. She states flatly, "I have stopped arguing statistics" (p. 34). Her reluctance, however, makes it difficult to understand the assumptions underlying descriptive and inferential statistics that she cites. For example, she supports an assertion about therapists that "fully a quarter of them are engaging in beliefs and practices that are risky if not dangerous" (Loftus, 1994) by citing a study in which survey forms were sent to a total of 1,600 U.S. psychologists and 300 British psychologists (Poole, Lindsay, Memon, & Bull, 1995). Findings were presented in terms of country, age, gender, theoretical orientations, experiences, beliefs, and behaviors using 145 forms from the 1,600 U.S. psychologists and 57 forms from 300 British psychologists. Psychologists need to scrutinize the assumptions underlying research in which percentages are reported to the second decimal when bases are less than 100 (see Table 2, p. 429), a number of t tests and chi-squares are conducted without a plan for controlling Type I error, and an inadequate sample size is used for characterizing the large population of therapists in two countries across numerous variables.
Following Loftus's lead in terming those on the other side "True Believers," Pendergrast (1995) has examined the 25% figure and other findings reported by Poole and her colleagues. Pendergrast believes that social workers or master's-level counselors contain a larger percentage of True Believers, but uses the more conservative 25% figure.
Taking that 25 percent figure as accurate, however--and ignor-ing the substantial number of "recovered memories" that arise outside that core group--we arrive at 62,500 True Believer therapists. Poole and Lindsay found that each therapist saw approximately 50 female clients per year, of whom 34 percent recovered memories. The hunt for repressed memories blossomed to full flowering 1988, with the publication of The Courage to Heal. Thus, assuming that these same True Believers have practiced their memory-retrieval arts from 1989 to 1993 (ignoring the first year and 1994), we arrive at an astonishing figure by simple multiplication: 62,500 True Believers x 50 clients/year x 5 years x 34 percent who recover memories = 5.3 million cases of "recovered memories"! And that doesn't include men who have recovered memories. (p. 491)
Skeptical of the result, Pendergrast observes that 5.3 million constitutes slightly over 2% of the U.S. population and would mean that about 1 in 12 American families had already experienced a recovered memory accusation.
Similarly, Loftus might have discussed portions of her own work spanning 3 decades that seem relevant to the book's attack on the myth of repression. Early in 1994, for example, her own data led her to observe: "There is a reason to believe that the 19% figure we obtained in the current study may actually be an overestimate of the extent to which repression occurs" (Loftus, Polonsky, & Fullilove, 1994, p. 81) and "One could argue that this means that robust repression was not especially prevalent in our sample" (p. 80). In the prior decade she discussed "motivated forgetting" and presented a documented study of a college professor who became unable to remember a series of traumas but after a long period of time was able to recover memories of the traumas. "Eventually, R. J. was able to remember all of her trau-matic experiences. . . . Even though the return of her memories made her wiser, she was also much sadder. More than most of us ever will, R. J. understood the true meaning in Christina Rosetti's words in Remember: "Better by far you should forget and smile than that you should remember and be sad" (Loftus, 1980/l988, p.73). Discussing an example of response to a single trauma (i.e., unlike R. J.'s response to a series of traumas), Loftus asserted: "After such an enormously stressful experience, many individuals wish to forget . . . and often their wish is granted" (p. 73). And in the 1970s, Loftus wrote:
Memories that may cause us great unhappiness if they were brought to mind often appear to be 'forgotten." However, are they really lost from memory or are they simply temporarily repressed as originally suggested by Freud (1922)? Repression is the phenomenon that prevents someone from remembering an event that can cause him pain and suffering. One way that we know that these memories are repressed and not completely lost is that the methods of free association and hypnosis and other special techniques used by psychotherapists can be used to bring repressed material to mind and can help a person remember things that he has failed to remember earlier. (Loftus & Loftus, 1976, p. 82).
Discussing the experimental evidence of repression, she reviews an analog experiment by Zeller (1950) and explains: "This experiment indicates that when the reason for the repression is removed, when material to be remembered is no longer associated with negative effects, a person no longer experiences retrieval failure" (p. 83).
SUING PROFESSIONALS AND LITIGATING SCIENCE
As an expert witness, Loftus has testified extensively for the defense. She testified that all of her courtroom testimony in criminal cases was on behalf of defendants and that she had testified only for defendants alleged to have engaged in abuse in civil cases focusing on repression and child abuse (Smith v. Smith, 1993, pp. 4, 6-7).
Her recounting of courtroom experiences encourages us to consider how the methods of science and the meth-ods of litigation differ, their influence on each other, and, in the words of one court, the need for "more papers, more discussion, better data, and more satisfactory models" (Underwager and Wakefield v. Salter, 1994, p. 11). Those who work in the area seem compelled to keep an eye on the courts and their power. FMSF, for example, informed accused parents that they could seek guardianship proceedings by making legal claims that the child who has recovered memories is incompetent ("Legal Aspects of False Memory Syndrome," 1992, p. 3). No action, however, was deemed as desirable as filing a malpractice action against the therapist. "The best course of action is by the child who realized the error of the accusations made, and recants and brings an action for malpractice, against the therapist. It would seem that there is a very real possibility that the parent could join in this action.... Therapists, medical institutions and insurance companies will be seriously threatened by such actions" ("Legal Aspects of False Memory Syndrome," 1992, p.3).
Novel suits in two California cities blamed a popular book for leading people to believe false memories of sex abuse and satanic ceremonies ("Author Target of False-Memories Lawsuit," 1994, p. B3; Butler, 1994).
Two members (actually, one is a former member) of the FMSF advisory board filed an interesting suit. After psychologist Anna Salter wrote a case study exploring the relationship of claims made by psychologists Ralph Underwager (credited with coining the term "false memory syndrome") and Hollida Wakefield to the primary research and original sources, Drs. Underwager and Wakefield sued Salter, claiming defamation. The appellate court noted: "Underwager served on the board of the False Memory Syndrome Foundation until resigning t after being quoted as telling a Dutch journal that sex with children is a 'responsible choice for the individual"' (Underwager and Wakefield v. Salter, 1994, p. g).
The appellate court summarized some salient aspects of Underwager and Wakefield's career:
Psychologists Ralph Underwager and Hollida Wakefield have written two books.... They conclude that most accusations of child sexual abuse stem from memories implanted by faulty clinical techniques rather there from sexual contact between children and adults. The books have not been well received in the medical and scientific press. A review of the first in the Journal of the American Medical Association concludes that the authors took a one-sided approach: " . . . When a given reference fails to support their viewpoint they simply misstate the conclusion. When they cannot use a quotation out of context from an article, they make unsupported statements, some of which are palpably untrue and others simply unprovable." . . .
Underwager's approach has failed to carry the medical profession, but it has endeared him to defense lawyers. He has testified for the defendant in more than 200 child abuse prosecutions and consulted in many others. (pp.1-2)
The court described Underwager's testimony "that children are incapable of correctly remembering or accurately describing sexual contacts" and cited other cases in which courts (e.g., Washington state's Supreme Court) had concluded that Underwager's work was not embraced by the scientific community. In addressing the belief "that Underwager is a hired gun who makes a living by deceiving judges about the state of medical knowledge and thus assisting child molesters to evade punishment,' the court held that
Scientific controversies must be settled by the methods of science rather than by the methods of litigation.... More papers, more discussion, better data, and more satisfactory models--not larger awards of damages--mark the path toward superior understanding of the world around us. (pp. 10-11)
PRACTICE AND POLICY
The Myth of Repression documents how court involvement has raised complex practice and policy questions about memory disturbance, acceptable interventions, and personal responsibility. The highly publicized case of American University President Richard Berendzen illustrates many of these questions. The same day President Berendzen resigned, he entered Johns Hopkins (Spevacek & Gonzales, 1990). The police had caught him making what were described as "terroristic," obscene phone calls (Vatz & Weinberg, 1993, B4).
When staff at Johns Hopkins injected sodium amytal, Berendzen began talking about childhood abuse (Brown & Sanchez, 1990, A1).
He was sweaty and woozy and groggy.... And the psychiatrists who surrounded his bed kept bombarding him with questions.... He slept for a few hours, and then ... it was time for group therapy. Still groggy, he staggered down the hallway and slumped into a seat among the child molesters and the rapists and the exhibitionists who were his fellow patients. "And this doctor suddenly riveted me to the wall--wham!--with these questions and everybody's staring at me and he's going back to all these things when I was a kid. And the first thing that jolted me was: How the hell does he know that?" (Carlson, 1990, W12).
During this time, according to a reporter, Berendzen "told them about events that he'd totally forgotten" (Carlson, 1990, p. W12). He himself noted that when he engaged in sex with his parents, "Once it was over, it was erased" (Berendzen & Palmer, 1993, p. xi). In treating Berendzen, the Johns Hopkins staff also used age regression (Berendzen & Palmer, 1993, p.123), guided imagery (pp. 154-155), focus on a famous case of alleged child abuse (p. 122), imaginary letters to his mother (pp. 131-132), and bibliotherapy that included symptom checklists (p .157) . In light of staff assurances that Berendzen would always be treated just like any other patient (p. 152), it may surprise readers to learn of patients' constant access to staff: "McHugh said that even though Berlin was my attending physician, he wanted me to have his home number and told me to call if I ever needed him" (p. 153).
The Johns Hopkins evaluation allowed Dr. Paul McHugh, chief psychiatrist and FMSF board member, to reach a number of specific conclusions. Appearing with Berendzen on television the same day of the court hearing, McHugh compared the phone calls to "a kind of foreign body imprinted in him earlier in his life" ("Berendzen pleads guilty to obscene calls," 1990, p. 2). McHugh concluded that the phone calls were symptoms: "We concluded that Dr. Berendzen is a patient, and this behavior that he has had, of these telephone calls, are symptoms of that patienthood, that he is suffering from--in a kind of post-traumatic disorder, provoked by serious--the most serious kind of sexual abuse to him when he was a child" (p. 2). McHugh's report to the court asserted that the calls were not obscene (Berendzen & Palmer, 1993, p. 187). A woman who had taped some of the calls noted that one involved the graphic description of "a four-year-old Filipino sex slave locked up . . . in a dog cage.... And the only thing that she was fed was human waste" ("Berendzen pleads guilty to obscene calls," 1990, p. 1). McHugh's report to the court emphasized that these nonobscene calls had nothing to do with Dr. Berendzen's prurient interests but were an attempt to bring resolution to his own abuse-caused patienthood (Cohen, 1990, A21). The report submitted to the court emphasized that the patient was now sound psychologically and physically (Spevacek & Gonzales, 1990, A1). Finally, "Dr. McHugh said after the weeks of treatment that Mr. Berendzen will 'never indulge in that behavior again" (Vatz & Weinberg, 1993, B4). The history of child abuse was highlighted in the court hearing less than a month after he had entered the hospital, and he received a suspended sentence.
As reported by McHugh, Berendzen, and the media, these events highlight some intensely discussed questions about working with adults who claim to have been abused as children after a long period during which, in Dr. Berendzen's words, they "somehow don't remember it any more" ("Berendzen pleads guilty," 1990, p. 4). When child abuse is reported 40 years later, can clinicians or forensic specialists decide with certainty that it did or did not occur? Are sodium amytal, age regression, guided imagery, probing memories of famous cases of alleged child abuse, assigning reading materials containing symptom checklists, and similar techniques useful in assessment and intervention? Can interrogations conducted in a darkened hospital room or an intensive therapy group distort findings? Can the possibility that a forensic expert may appear on national television with the patient affect the process and outcome of a forensic assessment? What, if any, are the implications of forensic expert and patient appearing on television shows together? Can a clinician determine whether a patient experienced prurient inter-est during phone calls, and what are the assumptions underlying making this distinction? Have sufficient con-trolled research studies been published in peer-reviewed journals to provide an empirical basis for assuring courts, after less than a month, that someone who has made non-obscene but illegal phone calls in the past will "never indulge in that behavior again"? Can childhood abuse suddenly cause the symptoms of posttraumatic stress disorder 40 years later, and if so, can a course of assessment and treatment of less than one month bring about such a complete recovery that the patient is now sound?
Two profound policy questions are: (a) should a person who only after arrest claims a history of child abuse be exempt from jail and fines for seemingly abusive and illegal behavior? and (b) are the forensic uses of mental health syndromes scientifically based and consistently applied? For example, McHugh's colleague at Johns Hopkins, John Money, criticized the FBI's handling of the complaint against Sol Wachtler, chief justice of New York State's highest court, arguing that no one should hold Wachtler responsible for his actions because he suffered from advanced symptoms of an erotomanic delusional disorder, which is a devastating illness (Derscho-witz, 1994, pp. 323-324).
Leo (1994) comments that the illness afflicting a prominent judge arrested for such symptoms as extortion and threats to kidnap a 14-year-old girl (the daughter of a woman with whom Wachtler, unknown to his wife, had been sexually active) is one that apparently can be diagnosed from 300 miles away, that telephoning the patient or even knowing much about him is unnecessary, and that all the clinician needs to know is that the patient is blameless. Leo has described how Money compared Berendzen's condition, as he did Wachtler's, to epilepsy (i.e., an illness that rendered the individual not responsible for his own acts).
When a 17-year-old patient claimed that a dentist had assaulted her, more than 20 people told the police that he had also fondled them (Gordon & Ordine, 1992, Bl). At the trial, Graboyes, the dentist, admitted that he had begun fondling patients at least 19 years earlier (Gordon, 1991). When Graboyes pled guilty to indecent assault and corruption of a minor, the district attorney's office asked for jail time. Harold Lief, a member of the FMSF advisory board, testified that jail would not be useful because Graboyes was mentally ill and suffered from a sexual disorder. The judge sentenced him to probation and ordered that he obtain treatment for his illness. Afterward, Graboyes observed that his mental illness had rendered him totally disabled and sued to ensure that he would receive $5,000 a month disability payments for life.
Leo (1994) raises a vital issue of policy and practice:
People at the top of society are far more likely to get away with psychologized and neurologized excuses than people in rough neighborhoods. John Money offered his epilepsy analogies, not after drive-by shootings, but in defense of a college president and a chief judge.... The psychologized vocabulary of moral evasion afflicts the whole society, but it is most corrosive when it lets the powerful off the hook.... [I]t is crucial to our sense of justice that high-pla ced perpetrators be held accountable, and not disap-pear into the mists of psychology" (pp. 24-25, 28; for discussion of this issue in the case of the dentist, see Gordon, 1991).
I believe The Myth of Repressed Memory is one of the few books that are must reading among the array that vigor-ously attack those whom Loftus terms True Believers. In only 290 pages, it covers a diversity of anecdotes, ideas, data, and assertions. It addresses crucial issues confronting the profession and the public.
In an area in which so much is at stake, it can be almost irresistible to stake out an extreme position and defend it by attacking those who disagree as True Believers, as comparable to murdering and superstitious witch hunters, as dishonest knaves and fools, and similar characterizations. But the fact that so much is at stake is a compelling reason to avoid such attacks, to rethink the FMSF claim that filing a lawsuit is "the best course of action," to consider the unintended consequences of imaginatively dramatizing supposedly nonfiction accounts, to ensure that no relevant data--one's own or others'--are excluded from evaluations of evidence, to assume responsibility for replicating pivotal experiments, and to assess the degree to which assertions of truth are accompanied by proof.
What I view as flaws in this book (e.g., dismissing those who disagree as True Believers) distract and detract from the value of Loftus's contributions and the serious questions she raises. In my opinion, they do her and the field an injustice. Not only the two sides that Loftus describes but all sides have important ideas, data, questions, creativity, experience, wisdom, and concerns to contribute. The current state of research and the complexity of issues would seem to make blanket claims of "truth" or "myth" at best premature and at worst destructive. Even if I or anyone else were convinced of an extreme and absolute positionthat all recovered memories are true or that all represent a false memory syndromea rethinking of the position, respectful discussion with those who disagree, and another look at the evidence can only be healthy. Both scientifically and clinically, avoiding reflexive acceptance or rejection of an idea or allegation is crucial. Each client, claim, and hypothesis deserves careful, unbiased evaluation in light of the full range of available evidence and context. Even once we have conducted such an evaluation and feel absolutely certain of our conclusions, we can always be wrong and must never overlook that possibility. It is hard to overstate the need for "more papers, more discussion, better data, and more satisfactory models."