Book Review

Making Monsters: False memories, psychotherapy, and sexual hysteria

N Engl J Med 1995; 333:132-133July 13, 1995

Article

Making Monsters: False memories, psychotherapy, and sexual hysteria
By Richard Ofshe and Ethan Watters. 340 pp. New York, Charles Scribner, 1994. $23. ISBN: 0-684-19698-0

One hundred years ago, psychotherapy was born of Breuer and Freud's attempt to cure mental illness by recovering memories of trauma that had, according to their theory, been denied to conscious awareness. Today, classical psychoanalysis has largely been replaced by other forms of treatment. Nevertheless, Breuer and Freud's essential theory and technique have been revived in the guise of ``recovered-memory therapy,'' in which patients are encouraged to remember forgotten instances of incest, abuse (including ritual satanic abuse), and trauma that are supposed to lie at the heart of their problems. Through a proliferation of professional and self-help books, journal and magazine articles, training seminars, and special clinics (including residential treatment centers), the movement has become an increasingly salient aspect of both professional practice and popular culture.

In this book, Richard Ofshe, a social psychologist at the University of California, Berkeley, and an expert on cults who shared the 1979 Pulitzer Prize for the expose of Synanon, a California drug rehabilitation program, and Ethan Watters, a freelance journalist, argue that the contemporary proponents of recovered-memory therapy are repeating the mistakes of the past. They show that the rationale of recovered-memory therapy is based on a misunderstanding of the nature of memory; that the clinical evidence on which the technique is based is largely anecdotal and rarely meets scientific standards of acceptability; and that its methods have more to do with persuasive communication than with the recovery of memory. ``Through the process of therapy,'' Ofshe and Watters argue, ``patients often come to believe that their childhoods were abusive wastelands and their parents were the worst sort of monsters''; furthermore, ``Patients often re-create themselves in the mold of the [abuse] survivor, their beliefs forming the basis of a new identity and world view.''

In their book, Ofshe and Watters wisely avoid the temptation to give a body count. It does not really matter to them whether the number of false and uncorroborated memories proves to be small or large (though they imply it is large). Rather, their focus is on the scientific base for recovered-memory therapy, which they find exceptionally thin, and on the techniques of recovered-memory therapists, which they find impermissibly suggestive and even coercive. Their critiques of the relevant clinical and experimental literature are very compelling, and they illustrate their points with systematic analyses of a number of famous cases in which memories of abuse and trauma have ostensibly been recovered. Sometimes, however, they miss the mark. For example, they argue that recovered-memory therapy is based on an unproved doctrine of ``robust repression,'' whereas much of the recovered-memory literature invokes a mechanism of dissociation. In fact, their criticisms of repression apply with equal force to dissociation, but their focus on the historical connection to Freud blunts the force of their critique somewhat. In the final analysis, the mix of scientific analysis and investigative journalism provided by Ofshe and Watters makes for fascinating reading. And the harsh conclusion is compelling: that recovered-memory therapy is at best a Romantic effort, relying on myth, metaphor, and inspiration, and at worst a pseudoscience, built on unfounded consensus among its practitioners and unconstrained by either systematic data or empirically validated theory.

There is nothing dispassionate about this book. Ofshe and Watters are angry, and for good reason: recovered memory is not merely another therapeutic fad. In their view, it is an unscientific and dangerous practice. People in distress have been distracted from problems that are real and solvable, families have been unnecessarily disrupted, insurance companies have doled out millions of dollars in reimbursements for treatments that have not been proved safe or effective, and states have changed their laws to permit hearsay evidence. As the failings and excesses of recovered-memory therapy have become more widely known, its proponents and their employers are increasingly being sued for malpractice, and they are losing. In the process, the entire field of psychotherapy is in danger of being discredited. Ofshe and Watters have written a jeremiad, calling the field to police itself before the fall of recovered-memory therapy takes legitimate psychotherapy down with it.

John F. Kihlstrom, Ph.D.
Yale University, New Haven, CT 06520-8205