The Trauma Trap

1.

Every now and then a book appears that can be instantly recognized as essential for its field—a work that must become standard reading if that field is to be purged of needless confusion and fortified against future errors of the same general kind. Such a book is Remembering Trauma, by the Harvard psychology professor Richard J. McNally. To be sure, the author’s intention is not revolutionary but only consolidating; he wants to show what has already been learned, through well-designed experiments and analyses of records, about the effects that psychological trauma typically exerts on our memory. But what has been learned is not what is widely believed, and McNally is obliged to clear away a heap of junk theory. In doing so, he provides a brilliant object lesson in the exercise of rational standards that are common to every science deserving of the name.

McNally’s title Remembering Trauma neatly encapsulates the opposing views that, for a whole generation now, have made the study of trauma into psychology’s most fiercely contested ground. Are scarring experiences well remembered in the usual sense of the term, or can some of them be remembered only much later, after the grip of a self-protective psychological mechanism has been relaxed? This is the pivotal issue that McNally decisively resolves. In the process, he also sheds light on a number of related questions. Does memory of trauma stand apart neurologically from normal memory? Does a certain kind of traumatic experience leave recognizable long-term effects that can vouch for its historical reality? What memory problems typify post-traumatic stress disorder, and does the disorder itself “occur in nature” or is it a cultural construct? And is memory retrieval a well-tested and effective means of helping adults to shed depression, anxiety, and other psychological afflictions?

One extended trauma, a public one, that won’t be soon forgotten by the involved parties is central to McNally’s argument. I refer to the great sex panic that gripped this continent from about 1985 to 1994. It wasn’t just an epidemic of runaway fear, rumor, and persecution but a grimly practical test of the theories whose currency made it possible. And the theories at issue were precisely those that are exhaustively reviewed in Remembering Trauma. McNally uses that chapter of our history to show just how much damage can be done when mistaken ideas about the mind get infused with ideological zeal.

In the 1980s, as McNally relates, day care workers risked prosecution and imprisonment on the coerced testimony of bewildered and intimidated three-year-olds who were prodded to “remember” nonexistent molestations. Meanwhile, poorly trained social workers, reasoning that signs of sexual curiosity in children must be “behavioral memories” of rape, were charging parents with incest and consigning their stunned offspring to foster homes. And most remarkably, whole communities were frantically attempting to expose envisioned covens of Satan worshipers who were said, largely on the basis of hypnotically unlocked “memories,” to be raising babies for sexual torture, ritual murder, and cannibal feasts around the patio grill.

In the same period many psychotherapists, employing hypnosis, dream analysis, “guided imagery,” “age regression,” and other suggestion-amplifying devices, persuaded their mostly female patients to “remember” having been molested by their fathers or stepfathers through much of their childhood, in some cases with the active participation of their mothers. The “perpetrators” thus fingered were devastated, embittered, and often publicly shamed, and only a minority of their accusers eventually recanted. Many, in fact, fell in with their therapists’ belief that young victims of sexual trauma, instead of consciously recalling what was done to them, are likely to develop multiple personalities. Disintegrating further, those unfortunates were then sent off to costly “dissociative identity” wards, where their fantasies of containing five, a dozen, or even hundreds of inner selves were humored until their insurance coverage expired and they were abandoned in a crazed condition. At the height of the scare, influential traumatologists were opining that “between twenty and fifty percent of psychiatric patients suffer from dissociative disorders”¹—disorders whose reported incidence plummeted toward zero as soon as some of the quacks who had promoted them began to be sued for malpractice.²

What we experienced, McNally shows, was a perfect storm, with forces for mischief converging from every side. The fraudulent 1973 bestseller Sybil had already helped to relaunch the long-dormant fad of multiple personality and to link it to childhood sexual abuse.³ Beginning in the early 1980s, the maverick Swiss psychoanalyst Alice Miller taught many American readers what Sigmund Freud had once believed, that memories of early abuse are typically repressed and must be therapeutically unlocked if the resultant neuroses are to be cured. Jeffrey Masson’s melodramatic book The Assault on Truth (1984), misrepresenting Freud’s “seduction” patients as self-aware incest victims rather than as the doubters that they remained, fanned the feminist anger that Miller had aroused, encouraging women to believe that molestation by fathers must be pervasive.⁴ Self-help manuals such as The Courage to Heal (1988) then equipped scientifically ignorant psychotherapists with open-ended “symptom checklists,” ensuring that their patients would be diagnosed as suffering from buried memories of violation. And all the while, Geraldo Rivera and less cynical alarmists were whipping up fear of murderous devil cults.

If the origins of our mass delusion were complex, its dissipation in the mid-1990s is easily explained. Like the Salem witch hunt three centuries earlier, the sex panic had no internal brake that could prevent its accusations from racing beyond all bounds of credibility. The stirring motto “Believe the children” began to sound hollow when preschoolers who finally agreed that they must have been inappropriately touched went on to describe having been dropped into a pool of sharks or turned into a mouse. The medical records of some alleged rape victims showed that they had still been virgins at a later period. In one notorious case, influential at first in promoting recovered memory but later in discrediting it, a woman who got her father sentenced to life in prison for a murder/rape she had remembered in hypnotic trances went on to recall his killing of another person who proved to be wholly imaginary. And many patients, when urged to dig deeper after producing a vague scene or two, reduced the process to self-travesty by conjuring surreal orgies with Daddy’s bridge partners, visiting uncles, and the family pets.

One recovered memory case in particular, less absurd than most but nevertheless lacking in prima facie plausibility, set in motion what the movement’s loyalists now bitterly characterize as “the backlash.” In 1991 the future “betrayal trauma” psychologist Jennifer J. Freyd, after her therapist had pointedly asked her in their second encounter whether she had ever been abused, suddenly “remembered” that her father had continually molested her between the ages of three and sixteen. It was Freyd’s mother, Pamela, convinced that she would surely have noticed some effects of countless domestic sex crimes against her daughter, who then made contact with other recently accused parents and established the False Memory Syndrome Foundation. Under Pamela Freyd’s leadership, the foundation (on whose advisory board I serve) gathered and disseminated the most authoritative scientific judgments about trauma, memory, and suggestive influence—judgments that swayed enough jurists, legislators, and journalists to bring a healthy skepticism into play.

What put Jennifer Freyd’s “memories” in question wasn’t just their dissonance with her mother’s close observation. By alleging fourteen years’ worth of molestations that had been unknown to her conscious mind prior to a therapist’s prompting, Freyd was invoking an outlandish new defense mechanism. Granted, some psychologists still believed in repression, or the sequestering of a disagreeable thought or memory inside “the unconscious”; and others subscribed to dissociation, the more radical knack of “splitting the self” so quickly that no narrative memory of the trauma gets formed at all. But Freyd’s story, like many others that surfaced during the sex panic, stretched those principles to cover any number of serial traumatic incidents, as if a person could be subjected to the same outrage hundreds of times without taking cognitive note of it.
This cumulative forgetting of harmful experience is what the social psychologist Richard Ofshe disdainfully named robust repression—a startlingly maladaptive behavior that, if actual, ought to have aroused wonder and consternation from the earliest times until now, if indeed it didn’t lead to the extinction of our species. Before the American 1980s, however, it had apparently never once been remarked. Could robust repression itself have been robustly repressed throughout the millennia?

Most recovered memory advocates have ducked the conundrum of robust repression, and some have dismissed it as an alien notion devised by their adversaries. But the alleged phenomenon, McNally shows, is nothing other than the “massive repression” posited by such prominent traumatologists as Judith Lewis Herman, Judith L. Alpert, Lenore C. Terr, and Jennifer J. Freyd herself, each of whom understood that claims of sudden access to a long string of previously unsuspected horrors require a basis in theory. What could that basis be? McNally makes short work of the only systematic attempts, Terr’s and Freyd’s, to maintain that serial traumas are easier to forget than single ones. Moreover, all such efforts are doomed to be question begging, because the only evidence favoring robust repression consists of the very memories whose authenticity hangs in doubt.

The same stricture applies, however, to repression and dissociation per se. Those notions became current in the 1880s and 1890s when Freud and Pierre Janet independently attempted to trace the then fashionable complaint of hysteria to pathogenic hidden memories and to expunge the ailment through hypnotically induced recall. Freud, by far the more influential figure, clung to repression—though rendering it progressively more elastic and ambiguous—even while repeatedly distancing himself from the diagnostic and curative claims he had inferred from its supposed workings.

Before he was finished, Freud had conceived of repression as both a conscious and an unconscious process acting upon feelings, thoughts, ideas, and fantasies as well as memories. Such profligacy left repression without any operational meaning; “the repressed” was simply any material that Freud, who was given to ascribing his own punning associations to his patients’ minds, chose to identify as having been dismissed from awareness. Yet the long vogue of psychoanalysis kept the concept alive, enabling it to be virulently readapted, a century after its formal introduction, to the same task of recruiting patients to victimhood that had preoccupied its champion in 1895-96.
As McNally explains through deftly analyzed examples, it isn’t just therapists and their patients who fail to ask prudent questions about the repression or dissociation of trauma. The body of research purporting to validate those mechanisms is riddled with procedural errors, most of which stem from naÌøve trust in the retrospection of subjects who have already been led to believe that they must have undergone a trauma that was then sequestered from memory. Along with such other inquirers as David Holmes and Harrison G. Pope, Jr., McNally understands that a good test of repression or dissociation has to be prospective. That is, it must track down people who are known with certainty to have lived through ordeals that would be expected to have triggered a self-protective loss of memory, and it must then ascertain how many of those people are unable to recall the event.

Holocaust survivors make up the most famous class of such subjects, but whatever group or trauma is chosen, the upshot of well-conducted research is always the same. Like Holmes and Pope, McNally finds that no unanswerable evidence has been adduced to prove that anyone, anywhere, has ever repressed or dissociated the memory of any occurrence. Traumatic experiences may not always remain in the forefront of memory, but, unlike “repressed” ones, they can be readily called to mind again. Unless a victim received a physical shock to the brain or was so starved or sleep deprived as to be thoroughly disoriented at the time, those experiences are typically better remembered than ordinary ones. Thus Judith Herman’s much-quoted maxim, “The ordinary response to atrocities is to banish them from consciousness,”⁵ would appear to be exactly opposite to the truth. And once that fact is understood, the improvised and precarious edifice of recovered memory theory collapses into rubble.

2.

It would be a serious mistake, however, to assume that reckless traumatology has now been permanently laid to rest. The conviction that fathers are naturally prone to incestuous rape is still current. In some academic departments, a dogged literalism about the repression/dissociation of trauma has become oddly wedded to postmodernist suspicion of science.⁶ Furthermore, most of the “trauma centers” that sprang up in the 1990s to study and treat psychogenic amnesia are still operating under the same premises as before. As for the theoreticians of recovered memory, they continue to use their positions of authority in universities, hospitals, and professional organizations to advance the views whose hollowness McNally has exposed, and they can still count on a surprising level of support from their colleagues.

Consider, in this regard, the following example of deafness to the lessons of the sex panic. Each year the American Psychiatric Association, the body that sets the most basic guidelines for sound practice in our mental health professions, bestows its Manfred S. Guttmacher Award on what it deems to be the best recent publication on legal psychiatry. The prize for 1999 went to a 768-page tome by Daniel Brown, Alan W. Scheflin, and D. Corydon Hammond, Memory, Trauma Treatment, and the Law. The authors characterize themselves as “voices of moderation in the middle” opposing “zealots on both sides” (p. 1). Their book, however, consists largely of sophistical pleading for already lost causes: the forensic value of therapeutically retrieved memories, the genuineness of multiple personality disorder, the likelihood that some reports of ritual abuse cults are accurate, and the desirability of allowing evidence obtained through hypnosis to be admissible in court.
Memory, Trauma Treatment, and the Law isn’t just a disingenuous book, hiding its partisanship behind a screen of sanctimony; it is also a noxious one. Lightly granting the possibility that therapy may occasionally lead to pseudomemories, it trivializes the problem, deeming it serious only “when the patient takes legal action or publically [sic] discloses abuse” (p. 37)—as if the suffering of privately shattered families counted for nothing. And the book’s strategy of superficially “reviewing the literature,” citing both skeptical and (always more numerous) credulous studies and then tilting the scales toward the latter, merely simulates scientific neutrality.

These authors’ activism in the cause of recovered memory was well known long before they collaborated on their prize-winning volume. Daniel Brown and Alan Scheflin had often served as expert witnesses minimizing the hazards of memory retrieval, claiming to have found overwhelming experimental support for the concept of repression, and denying that a therapist could ever deceive a patient into thinking that she suffered from multiple personality; and their collaborative papers were similarly one-sided.⁷ In 1995, moreover, Scheflin had delivered a warmly received address to a Texas conference held by the Society for the Investigation, Treatment and Prevention of Ritual and Cult Abuse, whose other speakers asserted, inter alia, that there were 500 Satanic cults in New York City alone, committing 4000 human sacrifices per year, that Bill Clinton was serving as the Antichrist in the worldwide Satanic fraternity of the Illuminati and that the False Memory Syndrome Foundation is “a Central Intelligence Agency action.” Expressing solidarity with the assembled psychotherapists whose diagnoses of ritual abuse were exposing them to malpractice suits, Scheflin counseled them on the best means of foiling the legal machinations of “the false memory people,” whom he characterizes as “the enemy.”⁸

But it is hypnotherapist D. Corydon Hammond, well known for his low regard for experimental research on memory,⁹ whose name on the title page of Memory, Trauma Treatment, and the Law ought to have prompted especial wariness among the Guttmacher judges. Like Scheflin, Hammond has affirmed the reality of both Satanic abuse cults and multiple personality disorder. But whereas Scheflin stops short of asserting a proven link between those two phenomena, Hammond is on record as a flamboyant true believer.

In a notorious 1992 lecture at a conference on sexual abuse and MPD, Hammond revealed his conviction that many MPD sufferers have acquired their split personalities through subjection, from early childhood onward, to ritual sexual abuse, sadistic torture, and mind control programming. The aim of the programmers, he disclosed, has been to produce remotely guided “alters” who, unbeknownst to their core selves, will be slaves to a worldwide intergenerational cult that is organized into “Illuminatic councils.” The cult, said Hammond, is headed by a shadowy “Dr. Greenbaum,” a Hasidic Jewish collaborator with the Nazis who once assisted in death camp experiments and later used the CIA to further his nefarious ends. “My best guess,” Hammond confided,

. . . is that they want an army of Manchurian Candidates, tens of thousands of mental robots who will do prostitution, do child pornography, smuggle drugs, engage in international arms smuggling, do snuff films, . . . and eventually the megalomaniacs at the top believe they’ll create a Satanic order that will rule the world.¹⁰

These colorful fantasies are significant, but not because they point to a failure of reality testing on Hammond’s part. Closely related ideas were voiced in the heyday of the recovered memory movement by other prominent MPD specialists such as Bennett Braun and Colin Ross. What matters is that Hammond and the others all claim to have learned about the grand cabal from their hypnotized patients, who, until they were placed in trances, hadn’t even known they were molestation victims, much less robotic smugglers, whores, and assassins.¹¹ As Brown, Scheflin, and Hammond now put it in arguing in favor of hypnotically obtained evidence in the courtroom, “for some victims, hypnosis may provide the only avenue to the repressed memories” (p. 647). Exactly. Without that means of exchanging and embroidering false beliefs, Hammond himself could never have learned from his patients about the evil Dr. Greenbaum and his thirst for absolute power over us all.

The illogicalities and distortions in Memory, Trauma Treatment, and the Law do not go unremarked in McNally’s Remembering Trauma. Thus, when Brown et al. cite one study as evidence that “amnesia for Nazi Holocaust camp experiences has also been reported,” McNally quotes that study’s rather different conclusion: “There is no doubt that almost all witnesses remember Camp Erika in great detail, even after 40 years” (p. 192). And when Brown et al., again straining to make psychologically motivated amnesia look commonplace, cite another study to the effect that “two of the 38 children studied after watching lightning strike and kill a playmate had no memory of the event,” McNally informs us that those two children “had themselves been struck by side flashes from the main lightning bolt, knocked unconscious, and nearly killed” (p. 192).

Such corrections, however damning, are peripheral to McNally’s fundamental critique of Brown and his colleagues. The heart of the matter is that Brown et al. have miscast the entire debate over recovered memory by marshaling evidence against a straw-man “extreme false memory position.” Supposedly, the extremists hold that all refreshed memories of abuse are necessarily wrong. Then one could put the extremists in their place just by citing a few cases of authenticated recall. But as McNally shows, critics of recovered memory fully allow that a period of forgetfulness can precede a genuine recollection. Indeed, that pattern is just what we would expect if the young subject at the time of the act, never having been warned against sexual predators, was unsure how to regard that act. What the critics deny is that “memories” of trauma, surfacing for the first time many years later, are so intrinsically reliable that they can serve as useful evidence that the experience was real. Brown, Scheflin, and Hammond want that extremism to be embraced once again by the legal system that has finally learned to distrust it.

It would be reassuring to think that the the American Psychiatric Association’s Guttmacher jury merely skimmed Memory, Trauma Treatment, and the Law and misconstrued it as a bland eclectic survey. Already in 1991, however, another Guttmacher Award had been bestowed on co-author Scheflin for a work that made several of the same legal arguments.¹² A more likely explanation for the subsequent prize is that Brown et al., having mounted a brief for the deep knowledge and expert testimony of theory-minded clinicians, were gratefully perceived as siding with mental health providers against their adversaries. If so, a larger question comes into view. What role did our major societies representing psychotherapists—the American Psychoanalytic Association, the American Psychological Association, and the American Psychiatric Association itself—play in condoning or actually facilitating the recovered memory movement, and how much enlightened guidance can we expect from them in the future?

3.

As I have noted on several occasions,¹³ and as McNally confirms, in the 1990s recovered memory therapy made significant inroads into the practice of North American psychoanalysis. Even today, feminist clinicians bearing diplomas from analytic institutes are probing for missing memories of abuse and vigorously defending that practice in psychoanalytic books and journals. But the American Psychoanalytic Association, representing over 3,000 members, has turned a blind eye to this trend—and one can understand why. The psychoanalytic movement is already embattled, and too much about the historical ties between Freudianism and recovered memory would prove embarrassing if attention were called to it. The elected custodians of Freud’s legacy have no desire to confront his early phase as a self-deceived abuse detecter; or to admit the precedent he set, during that phase and thereafter, in treating dreams, tics, obsessional acts, and agitation in the consulting room as “behavioral memories” of inferrable traumas; or to revisit the grave doubts that have been raised about repression; or to be reminded of the way psychoanalysts, until quite recently, insulted real victims of molestation by telling them that their “screen memories” covered a repressed desire to have sex with their fathers.¹⁴ No longer given to excommunicating dissidents, the tottering Freudian patriarchy has made its peace with “recovered memory psychoanalysis” by pretending that it doesn’t exist.

The largest of the three societies riven by the issue of recovered memory, the 95,000-member American Psychological Association (hereafter APA), is nominally responsible for quality control in the administration of therapy by the nation’s clinical psychologists. Hence one APA division’s commendable effort in the 1990s to identify the most effective treatment methods for specific complaints such as phobias and obsessive-compulsive disorder. That initiative, however, met with disapproval from APA members whose favorite regimens had not been found to give superior results. Some practitioners worried that insurers would use the list of approved treatments as an excuse to cut off reimbursement for all but the preferred therapies, and others complained that the association seemed on the verge of putting soulless experimentation ahead of clinical know-how. For now at least, the organization as a whole is not recommending treatments, to say nothing of disavowing dangerous ones.¹⁵ Recovered memory thus gets the same free pass from the APA as “attachment therapy,” “therapeutic touch,” “eye movement desensitization and reprocessing,” “facilitated communication,” and the hypnotic debriefing of reincarnated princesses and UFO abductees.¹⁶

This reluctance to challenge the judgment of its therapist members is deeply rooted in the APA’s philosophy. Ever since 1971, when the association gave its blessing to Ph.D. and Psy.D. programs that omitted any scientific training, the APA has guided its course by reference to studies indicating that the intuitive competence of clinicians, not their adherence to one psychological doctrine or another, is what chiefly determines their effectiveness.¹⁷ Those studies, however, were conducted before recovered memory practitioners, using a mixture of peremptory guesswork and unsubstantiated theory, began wrenching patients away from their families and their remembered past.
In 1995 the APA did publish a brochure, “Questions and Answers about Memories of Childhood Abuse,” which can still be found on the “APA Online” Web site. The document combined some prudent advice to patients with soothing reassurance that “the issue of repressed or suggested memories has been overreported and sensationalized.” Further inquiry into the phenomenon, it said, “will profit from collaborative efforts among psychologists who specialize in memory research and those clinicians who specialize in working with trauma and abuse victims.”
But the APA directors already knew that such collaboration was impossible. In 1993 they had established a “task force,” the Working Group on the Investigation of Memories of Childhood Abuse, self-defeatingly composed of three research psychologists and three clinicians favorably disposed to retrieval, and the task force had immediately degenerated into caucusing and wrangling. After years of stalemate, the group predictably submitted two reports that clashed on every major point; and the abashed APA, presented with this vivid evidence that “clinical experience” can lead to scientific heterodoxy, declined to circulate photocopies of the two documents even to its own members except by individual demand.

Meanwhile, the organization repeatedly compromised its formal neutrality. In 1994, for example, the APA’s publishing house lent its prestigious imprint to a book that not only recommended recovered memory therapy but recycled the most heedless advice found in pop-psychological manuals. The book, Lenore E. A. Walker’s Abused Women and Survivor Therapy: A Practical Guide for the Psychotherapist, touted hypnotism as a legitimate means of gaining access to “buried memories of incest” and “different personalities” within the victim (pp. 425-426). Walker provided a list of telltale symptoms, any one of which might indicate a history of forgotten molestation. These included “ambivalent or conflict ridden relationships,” “poor body image,” “quiet-voiced,” “inability to trust or indiscriminate trust,” “high risk taking or inability to take risks,” “fear of losing control and need for intense control,” “great appreciation of small favors by others,” “no sense of humor or constant wisecracking,” and “blocking out early childhood years” (p. 113)—years which in fact are not remembered by anyone.
Then in 1996 the APA published and conspicuously endorsed another book, Recovered Memories of Abuse, aimed at equipping memory therapists and their expert witnesses with every argument and precaution that could thwart malpractice suits.¹⁸ The book’s co-authors were well-known advocates of recovered memory treatment, and one of them, Laura S. Brown, was actually serving at the time on the deadlocked task force. She had also supplied a foreword to Lenore Walker’s bumbling Abused Women and Survivor Therapy, calling it “invaluable and long overdue” (p. vii). Unsurprisingly, then, Recovered Memories of Abuse characterized false memory as an overrated problem and drew uncritically on much of the research whose weaknesses Richard McNally has now exposed. The APA’s unabated promotion of that book, even today, suggests that the organization remains more concerned with shielding its most wayward members than with warning the public against therapeutic snake oil.

There remains, once again, the American Psychiatric Association—“the voice and conscience of modern psychiatry,” as its Web site proclaims. Putting aside the fiasco of the 1999 Guttmacher Award, we might expect that a society representing 37,000 physicians, all of whom have been schooled in the standard of care that requires treatments to be tested for safety and effectiveness, would be especially vigilant against the dangers of retrieval therapy. Thus far, however, that expectation has not been fulfilled.

To be sure, the Psychiatric Association’s 1993 “Statement on Memories of Sexual Abuse” did warn clinicians not to “exert pressure on patients to believe in events that may not have occurred. . . .” Yet the statement inadvertently encouraged just such tampering by avowing that the “coping mechanisms” of molested youngsters can “result in a lack of conscious awareness of the abuse” and by characterizing “dissociative disorders” as a typical outcome of that abuse. Those remarks constituted a discreet but unmistakable vote of confidence in multiple personality disorder and its imagined sexual etiology. And indeed, a year later the fourth edition of the Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) reaffirmed the validity of MPD under the more dignified and marketable name of dissociative identity disorder.

The Psychiatric Association’s 1993 declaration on abuse memories performed still another service, a subtle one, for the repression/dissociation lobby. In explaining “implicit” memory—the kind that is exercised in the routine execution of skills or in the coloring of emotions by past impressions that aren’t being explicitly called to mind—the statement proffered a curiously strained example. “In the absence of explicit recall,” it said, implicit memory can torment “a combat veteran who panics when he hears the sound of a helicopter, but cannot remember that he was in a helicopter crash which killed his best friend.” Here was an elision of the crucial gap between merely not thinking about a past event, as in the normal operation of implicit memory, and having total, psychologically motivated amnesia for that event.

Knowledgeable readers would have seen that in taking this unusual step, the statement’s drafters were lending their authority to one controversial interpretation of post-traumatic stress disorder (PTSD), which the Psychiatric Association had first stamped as genuine in DSM-III of 1980. But why should a primarily martial ailment have figured even indirectly in a position paper on childhood sexual abuse? The mystery vanishes, however, if we know that the recovered memory movement’s favorite means of courting respectability has been to fold the symptoms of repressed/dissociated abuse into PTSD.
In 2000 the Psychiatric Association’s trustees, eschewing risky flights into theory, approved a lower-profile “Position Statement on Therapies Focused on Memories of Childhood Physical and Sexual Abuse.” This declaration, however, was more pussyfooting than its predecessor. The validity of recovered memory treatment, it whispered, “has been challenged” in some quarters. While pointing out that memories can be altered as a result of suggestions from “a trusted person or authority figure,” the drafters tactfully refrained from mentioning that the suggesting party is usually a therapist. And clinicians were advised to avoid “prejudging the veracity of the patient’s reports” of abuse, as if false reports were typically delivered to therapists out of the blue, without influence from confabulation-enhancing devices employed within the treatment. The absence of any mention of those devices, such as hypnosis and sodium amytal, marked a step backward from the association’s 1993 statement.

These equivocations neither helped nor impeded the already withering recovered memory movement. As we will now see, however, the movement’s hopes of a comeback have been pinned on the Psychiatric Association’s fateful decision to treat post-traumatic stress disorder as an integral and historically invariable malady. And that decision was a medically unwarranted one. As McNally indicates with reference to several recent studies, PTSD, like Victorian hysteria and like recovered memory itself, can now be understood as an artifact of its era—a sociopolitical invention of the post-Vietnam years, meant to replace “shell shock” and “combat fatigue” with an enduring affliction that would tacitly indict war itself as a psychological pathogen.¹⁹ However crippling the symptoms associated with it may be for many individuals, the PTSD diagnosis itself has proved to be a modern contagion.

Once certified by the American Psychiatric Association as natural and beyond the sufferer’s control, post-traumatic stress disorder began attracting claimants, both civilian and military, who schooled themselves in its listed symptoms and forged a new identity around remaining uncured. By now, as McNally relates, PTSD compensation is demanded for such complaints as “being fired from a job, one-mile-per-hour fender benders, age discrimination, living within a few miles of an explosion (although unaware that it had happened), and being kissed in public” (p. 281). According to Paula Jones among others, PTSD can even be the outcome of a consensual love affair. In view of such examples, the attempt to subsume forgotten abuse under post-traumatic stress makes more cultural than scientific sense; the same atmosphere of hypersensitivity and victimhood brought both diagnoses to life.²⁰

As McNally shows in his concise and undemonstrative style, the national sex panic left its mark on each successive version of the Psychiatric Association’s bible, which in turn congealed folklore into dogma. The 1980 DSM-III entry on post-traumatic stress disorder, mindful only of wars and other shocking disasters, had defined a PTSD-triggering event as one that falls “generally outside the range of usual human experience” and that “would evoke significant symptoms of distress in almost everyone.” In 1994, however, the fourth edition generously expanded the category of precipitating causes to include “developmentally inappropriate sexual experiences without threatened or actual violence or injury.” Thus a single-minded therapeutic sleuth could now place a questionably retrieved incident of infantile genital fondling on the same etiological plane as the Bataan death march or an ambush in the Mekong Delta.
It was the diagnostic manual, once again, that removed the largest obstacle of all to the merger of post-traumatic stress and recovered memory. The key sign of PTSD, as first conceived, was that accurate recollections of the trauma keep intruding on the patient’s conscious mind; this was just the opposite of repressed or dissociated memory. But between DSM-III and its revised edition of 1987, PTSD patients were discovered to have been harboring a convenient new symptom. In 1980 they had shown only some incidental “memory impairment or trouble concentrating” on daily affairs, but the updated edition replaced routine forgetfulness with “inability to recall an important aspect of the trauma” (emphasis added).

This retroactive infusion of amnesia into the clinical picture of PTSD explains why the Psychiatric’ Association’s illustrative helicopter pilot could have been troubled by a memory that had left no conscious imprint on his mind. Here, too, was the opening needed to give dissociation an appearance of hard-scientific concreteness. Post-traumatic stress, it was now claimed, short-circuits narrative memory and finds another, precognitive, channel through which it can flood the subject with anxiety. Accordingly, diehard recovered memory theorists took up a last refuge in neurobiology, now maintaining that dissociated sexual abuse generates signature alterations of brain tissue.

With the arrival of McNally’s Remembering Trauma, there is no longer any excuse for such obfuscation. It makes no sense, McNally shows, to count forgetfulness for some “aspect of the trauma” within the definition of PTSD, because normal people as well as PTSD sufferers get disoriented by shocking incidents and fail to memorize everything about the event, even while knowing for the rest of their lives that it occurred. Likewise, it has never been established, and it seems quite unbelievable, that people can be haunted by memories that were never cognitively registered as such. Nor can specific brain markers vouch for the reality of a long-past sexual trauma, because, among other reasons, those features could have been present from birth. “It is ironic,” McNally reflects, “that so much has been written about the biological mechanisms of traumatic psychological amnesia when the very existence of the phenomenon is in doubt. What we have here is a set of theories in search of a phenomenon” (p. 182n.).

Remembering Trauma is neither a polemic nor a sermon, and McNally offers little counsel to psychotherapists beyond warning them against turning moral disapproval of pedophilia into overconfidence that they can infer its existence from behavioral clues observed twenty or thirty years after the fact. But another lesson is implied throughout this important book. Attention to the chimerical task of divining a patient’s early traumas is attention subtracted from sensible help in the here and now. The reason why psychotherapists ought to familiarize themselves with actual knowledge about the workings of memory, and why their professional societies should stop waffling and promulgating misinformation about it, is not that good science guarantees good therapy; it is simply that pseudoscience inevitably leads to harm.