Correspondence
Recovered Memories
N Engl J Med 1996; 334:274January 25, 1996
- Article
To the Editor:
I am writing in response to Frankel's article on recovered memories (Aug. 31 issue).1 Although I was severely abused physically and sexually throughout my early childhood — abuse later confirmed by family members — I had absolutely no recollection of any traumatic events until my early 30s. I entered therapy because of a pervasive sense of threat that contrasted greatly with the reality of my wonderful husband, caring friends, and successful career. After four therapy sessions, with no hypnosis, suggestions, or discussions about possible abuse — nothing but being able to talk to a caring listener — I recalled the first of many horrifying episodes of abuse.
Now, after several years of therapy, I have a sense of safety, security, and peace. I recognize how extraordinarily useful it was for me to be able to dissociate from and repress the abuse and am glad that I no longer have to depend on these powerful but immobilizing coping techniques.
Clinicians do, as Frankel states in his final paragraph, bear a heavy responsibility to do no harm. It is tremendously harmful to discredit survivors who have finally reached a point at which they can safely remember their trauma, and the incidence of such invalidation has historically been very high. In contrast, serious injury to the lives of innocent people (i.e., alleged perpetrators) from such memories is rare.
1 ReferencesEllen J. Colodney, M.D.
Perspectives Group, Madison, NJ 079401
Frankel FH . Discovering new memories in psychotherapy -- childhood revisited, fantasy, or both? N Engl J Med 1995;333:591-594
Full Text | Web of Science | Medline
To the Editor:
To show that traumatic events are frequent causes of major mental illness requires robust hypotheses that are capable of being tested and falsified. Little evidence has appeared so far, and instead the concept tends to be advanced by ex cathedra pronouncement. There is a major danger when unproved theories of diagnosis and therapeutics gain hegemony by the alternative means of vigorous political advocacy.
To be sure, much of what we do in medicine has an imperfect, or even inadequate, basis of scientific support. But if we expect to improve this condition, the method we must embrace is that of observation and logic, not faith or authority.
Hypotheses that direct courses of treatment, and thus the expenditure of public monies, must be falsifiable, tested, and supported by data. Otherwise we risk all that has been gained in the slow but clear progress of scientific medicine.
William H. Anderson, M.D., M.P.H.
Massachusetts General Hospital, Boston, MA 02114To the Editor:
In Play, Dreams and Imitation in Childhood, Piaget raises “the questions of memories which depend on other people.”1 He recounts an episode from his own childhood that he “can still see, most clearly.” He is the victim of an attempted kidnapping on the Champs Elysées. His nurse fights off the assailant, a crowd forms, a police officer comes, and the man runs away. “I can still see the whole scene, and can even place it near the tube station.”
His nurse was given a watch for her bravery but she returned it 13 years later, after undergoing a socioreligious conversion. She had, it seems, made up the whole story. Decades later, Piaget retains clear visual memories of the events, although aware that they never happened. These memories were formed during the many tellings and re-tellings of the non-event.
The study of any aspect of human cognition is complex — memory particularly so. Considering the social context of many “recovered memories,” I would consider emphatic assertions by the patient to be bits of data. And as Piaget shows, skepticism about the reality of the report can be completely unlinked from questions about the patient's honesty.
1 ReferencesThomas E. Finucane, M.D.
Johns Hopkins Bayview Medical Center, Baltimore, MD 21224Author/Editor Response
Dr. Frankel replies:
To the Editor: I appreciate the comments of Dr. Anderson and Dr. Finucane, both of whom expand on my position. My intention here is to respond to Dr. Colodney. I would refer her to the substance of my paper. On page 592 I stated, “The question is whether we can accept as valid, without corroboration, stories that emerge for the very first time in therapy, totally unsuspected until then by patients now in their 30s and 40s.” Dr. Colodney claims that her abuse, recalled after the first four sessions of psychotherapy, was “later confirmed by family members”; this suggests that the brief and incomplete clinical report she provides lies beyond the reach of my criticism.
Little purpose will be served by my arguing the real or metaphoric nature of dissociation or repression here. As I indicated in my paper, many regard the concepts as useful therapeutically, provided we bear in mind that it is theory we are discussing, not necessarily fact. I indicated that because the scientific debate is unresolved at this stage, clinicians should proceed with caution.
Dr. Colodney's closing statement that the incidence of invalidation of trauma memories has been very high, whereas “serious injury to the lives of innocent people (i.e., alleged perpetrators) from such memories is rare,” lacks the caution I advocate and the data to support it. It has become a forceful argument for those who favor Dr. Colodney's view. However, accusations against alleged perpetrators, a relatively recent phenomenon, have been increasing at an alarming rate. We cannot know without corroboration how many of the accused are guilty, and neither can we know how many are not.
It should be of major concern to all that the victims of abuse as well as those falsely accused be heard and protected. It is my belief that this can be achieved only if the clinicians involved are sensitive to all the issues.
Fred H. Frankel, M.B., Ch.B., D.P.M.
Beth Israel Hospital, Boston, MA 02215
