Sex, lies and therapy

Finally theories of false memory syndrome are crumbling. It's taken too long, says Elaine Showalter

WE DON'T usually look to committees for boldness, let alone commitment; but a stunning report this week by a working group set up by the Royal College of Psychiatrists has firmly declared that there is no empirical evidence for the truth claims that have been made about recovered memory, multiple personality and satanic ritual abuse. And that memories "recovered" through the use of hypnosis, drugs or regression therapies are almost certainly false. The report further concludes that these treatments have made patients worse, and have led to false accusations and the destruction of families.

Members of the Royal College are so bitterly split over these issues that a revised version of the original report, first submitted last summer, had to be published without its official imprimatur in the British Journal of Psychiatry. Still, this clear, dispassionate study, chaired by Sydney Brandon of Leicester University, says what has needed to be said for a long time.

Recovered memory of childhood sexual abuse, and accusations by adult women against elderly parents, has become an international epidemic, as feminists, therapists, social workers and journalists have fuelled the controversy. In the US, the best-selling self-help book for female "survivors" of forgotten sexual abuse, The Courage to Heal, TV talk shows, prize-winning novels such as Jane Smiley's A Thousand Acres and celebrity confessions have made incest a household word. More than 300 cases involving repressed memory had been filed in the courts by 1994. Over 18,000 desperate American families had sought information from the False Memory Syndrome Foundation established in Philadelphia in 1992 by two accused parents.

But now the tide is beginning to turn, as patients retract their accusations, and sue their therapists. In America, Patricia Burgus was awarded $13.5m damages last autumn. In Britain, where the False Memory Syndrome Society represents 1,000 families, a father and daughter are suing the Perth and Kinross Healthcare Trust for damages after she falsely accused him of rape and murder while being treated in the psychiatric unit of the Murray Road Hospital. The case is the first of its kind in the UK.

Professional associations of psychiatrists and psychologists have been timid about confronting the legitimacy and dangers of recovered-memory therapies. Some clinicians have even accused writers and doctors who have questioned theories of repression of endangering children, even of colluding with abusers. Therapists claim an authority based on personal contact with suffering patients, and make emotional appeals couched in sensational metaphors of a sex war, Holocaust or conspiracy. The Brandon report, however, sides with scientists such as Dr Harrison Pope who maintain that, in evaluating the recovered-memory hypothesis, "careful attention of study methodology is more important than clinical observation".

Reviewing all the research that has been done on recovered memory, the Brandon report distinguishes between sexual abuse that is reported in childhood or kept secret although unforgotten; and recovered memories of childhood sexual abuse, previously completely forgotten, that emerge in adulthood under therapy, usually in women in their thirties or forties. For some patients recovered memory can escalate into false memory syndrome, in which "a person's identity" comes to centre around the "memory of a traumatic experience which is objectively false but in which the person strongly believes ... The individual avoids confrontation with any evidence that might challenge the memory and may be effectively distracted from coping with the real problems of living."

RM therapists draw on a popular understanding of memory as akin to a video recording that can never be erased, and which can be retrieved intact under the right therapeutic conditions. They believe that the phenomenon of "robust repression" allows traumatised children to disassociate from or forget severe, prolonged and even repeated trauma. But the Brandon report refutes these hypotheses, drawing on numerous studies which show that memory is unreliable and highly susceptible to suggestion. People adopt, and subsequently remember as vivid experienced events, implanted false stories which they hold with absolute certainty. The more the story is repeated, the more the tellers fill in narrative gaps and rationalise inconsistencies.

In studies comparing cases of sexual abuse reported in childhood, or never forgotten, with therapeutically recovered memories, researchers have found striking disparities. First, nine out of ten recovered-memory patients are women, while in documented abuse cases the sexual ratio is more like 50-50. Second, while only 3 per cent of RM accusations are made against stepfathers, in childhood abuse stepfathers are much more likely to be involved. Third, while documented abuse usually involves older children or adolescents, RM cases recall abuse before the age of four, or even as early as infancy. Scientific studies, however, attest to "infantile amnesia" and only very slight and partial memory before the age of four, because the brain is insufficiently developed. Moreover, scientific studies have produced no empirical evidence for either repression or disassociation. Despite the beliefs of therapists, there is no empirical evidence to support the idea that memory is retained in the body, either in the sensorimotor system or cellular DNA; and there is no evidence that traumatic memories are neurologically different from other ones.

Furthermore, the Brandon report rejects the idea of a "pathogenic post- abuse syndrome", with adult symptoms like eating disorders. It is most forceful in its scepticism about such interventionist forms of alleged memory enhancement as the use of check lists of symptoms, drug-induced reliving of traumatic events, hypnosis, dream interpretation, art therapy, and participation in survivor groups. Rather than aiding memory in any reliable way, the authors of the report conclude, these widely practiced techniques are "powerful and dangerous methods of persuasion". They offer therapists a set of guidelines for dealing with cases of recovered memory of sexual abuse, which recommends extreme caution about suggesting or implanting memories, or accusing alleged abusers. They also warn that "memories of satanic abuse or other bizarre events" such as alien abduction and multiple personality, early childhood memories, and memories of abuse forgotten until therapy, are not credible, and may "wither away if not reinforced through attention".

Recovered-memory hysterias seem to be on the defensive, and already beginning to wither away. In Speak of the Devil: Tales of Satanic Abuse in Contemporary England (1998), the anthropologist Jean La Fontaine finds no independent corroboration of the claims of widespread satanic ritual abuse reported in Britain in the 1980s, when the founder of a children's charity group expressed her belief that at least 4,000 children a year were being sacrificed in the UK. In the New Yorker this week, a long article on "the politics of hysteria" by Joan Acocella examines the rise and fall of multiple-personality disorder.

But, despite reasonable refutation, these hysterical epidemics die hard. They are hydras: as soon as we chop off one head, another grows in its place. I watched a feature on BBC2's Newsnight this week on the Brandon report, which expressed much indignation over the role of irresponsible therapists in spreading RM. The very next, equally indignant, report featured a man with mysterious complaints of tiredness, headaches, bad dreams and general malaise. The diagnosis? Brain damage by his mobile phone, covered up by a conspiracy of powerful business tycoons.

Meanwhile in the United States, police in Jonesboro, Arkansas, are hot on the trail of the real villain in the shooting of four children - an unknown leader of a coven of witches who had allegedly lured the boy-killers into a satanic cult. In Washington a Starr fundamentalist inquisitor pursues rumours and allegations of presidential ritual abuse. In Paris, Dr Samuel Lepastier, a psychiatrist at the Salpetriere Hospital, reports that he has seen more "sexually abused" patients in the last year than in the previous 20 years put together. Conspiracy theories grow out of abuse narratives; in France, fan clubs for the popular TV series The X- Files have been organised by members of Jean-Marie Le Pen's National Front. And probably the worst case of Gulf war syndrome was Timothy McVeigh, the Oklahoma bomber who came back from the Persian Gulf convinced that the government had planted a microchip in his buttocks.

Even the Brandon report equivocates at the end, when the authors concede that it might be "legitimate not to question the validity of a recovered memory while it remains within the privacy of the consulting room". But while some individual cases may remain private, medical collusion with a patient's false beliefs risks encouraging public belief in superstition and suspicion over truth. If we really want to stop the flood of accusations, false memories and conspiracy theories, and to treat psychosomatic illnesses with seriousness and sympathy, we must be vigilant and outspoken about hysterical epidemics whenever they occur.