Good News and Bad News: The Burden is Ours
Terence W. Campbell1
ABSTRACT: Though the issue of "repressed memory" has likely received more media attention than any other mental health issue, the professional organizations representing massive numbers of psychotherapists have responded less than responsibly to it. Rather than carefully examine the many scientific controversies related to
"repressed memory therapy," these professional organizations regularly retreat behind a smokescreen of misinformation. Fortunately, emerging legal standards will likely limit the testimony of self-proclaimed experts who rely on their clinical experience when appearing in courts of law.
Since March of 1992, the False Memory Syndrome (FMS) Foundation has continually sought to alert the major professional organizations representing mental health professionals of the crises related to what might best be termed,
"repressed memory therapy." Though the issue of "repressed memory" has likely received more mass-media attention than any other mental health issue, these professional organizations
the American Psychological Association, the
American Psychiatric Association, the National Association of Social
Workers, and others
have responded less than responsibly to this crisis.
For example, in February of 1993, the Council of Representatives of the American Psychological Association appointed a task force to study the many issues related to memories supposedly repressed but apparently recovered in psychotherapy. At that time, the Council of Representatives voted 55 to 52 against obtaining input from its own Board of Scientific Affairs regarding who would be appointed to this task force (Miller, 1994). Rather than carefully examine the scientific evidence related to the FMS phenomenon, the majority of the Council gave greater credence to accumulated clinical experience regarding this issue.
Not surprisingly, then, when this APA task force issued an interim report, in November of 1994, addressing
"Adult Memories of Childhood Sexual Abuse," it indicated:
However it is possible for memories of abuse that have been forgotten for a long time to be remembered. The
mechanism(s) by which such delayed recall occur(s) is/are not well understood (American Psychological Association, 1994).
There is absolutely no scientific evidence to support this conclusion (Campbell, 1995; Loftus, 1994; Ofshe, 1994). Nevertheless, accumulated clinical experience still enjoys a much more favorable reputation than it deserves, and scientific evidence is regularly ignored.
Clinical Experience vs Scientific Evidence
Dr. Lenore Terr a staunch proponent of conventional thinking about repression
has also advocated that clinical experience is more important than scientific evidence when examining the validity of repression. In the 1993 criminal trial of California vs Akiki, for example, the following dialogue transpired as Dr. Terr was cross-examined.
Q: ". . . is there some question about the scientific validity of the theory of repression, Yes or No?
A: Yes. But I think that they are wrong. They are not clinicians, and they are not entitled to make that decision.
Q: Is it your position that only clinicians can make a decision concerning the scientific foundation of psychiatric or psychological principles?
A: Not all principles, but repression is a clinical principle, and I thought we were talking about repression.
Q: Is it your position that repression can only be addressed by clinicians and not by researchers.
A: The kind of researchers that are bringing this to question, Sociology researchers, researchers who are doing cognitive psychology experiments, are not the ones who can make a value judgment on repression. It is the clinicians who can."
The kind of thinking advocated by Dr. Terr is tantamount to practicing physicians insisting
"Biology Chemistry, we don't need those basic sciences to support our clinical work, we'll just wing it on our own." Unfortunately, this is also the kind of thinking embraced by the American Psychological Association's Council of Representatives.
Another sobering development involving the American Psychological Association occurred in 1993. At that time, its Division of Family Psychology proposed the following amendment to the Ethical Principles of Psychologists and Code of Conduct:
"Psychologists discuss with clients or patients as early as is possible in the therapeutic relationship appropriate issues, such as . . . the possible impact of therapy on close interpersonal relationships . . . (Eldridge &
Scrivner, 1994, p. 5).
Some members of the Division of Family Psychology responded positively to this proposed change in the ethical code. Others were
at best lukewarm, but still others expressed grave concerns that:
". . . the proposed wording could leave the therapist open to all kinds of lawsuits by persons who might be negatively impacted by a change in relationship of a client who was working on relationship issues in therapy. The example of the False Memory Syndrome Foundation was given" (Eldridge &
Scrivner, 1994, p. 5).
This proposed amendment to the ethical code was rejected, suggesting that political considerations provoked by the reputation of the FMS Foundation can dictate the policies of the American Psychological Association. In other words, the American Psychological Association seems compelled to rapidly revise its collective thinking if it
finds itself supporting a position that the FMS Foundation would also endorse. To do otherwise would apparently be politically incorrect.
Marketing and Public Relations Agenda
In July of 1994, another interesting development related to the public relations endeavors of the American Psychological Association transpired. Its monthly newspaper, the APA Monitor, reported that the Division of Clinical Psychology was seeking ways to inform both practitioners
and the public about psychotherapy treatments that have been proven effective (de
Groot, 1994). If these recommendations were actually instituted, the American Psychological Association would be obligated to acknowledge:
1. Given the extent to which suggestibility and imagination persistently undermine the reliability of long-term memory (Dawes, 1994; Henry et al., 1994; Ross, 1989), treatments preoccupied with a client's childhood history are doomed to failure.
2. Rather than any of its specific techniques, psychotherapy reduces psychological distress as a result of the supportive relationships therapists provide clients
(Kazdin, 1986; Luborsky, Singer, & Luborsky, 1975; Stiles, Shapiro, & Elliot, 1986;
Strupp, 1989; Stubbs & Bozarth, 1994). Therefore, blame-and-change maneuvers
persuading clients that therapy necessarily blames your family in order to change you
are exceedingly ill-advised (Campbell, 1992). Such maneuvers only reduce the availability of psychological support in the lives of clients, while also increasing their dependence on their therapist.
There is little likelihood that the American Psychological Association is about to acknowledge the extent to which problems such as these are inundating the profession. Instead, APA and the other professional organizations respond to considerations of marketing and public relations while neglecting intellectual honesty. At a time when Congress deliberates massive changes in our health-care system, marketing and public relations endeavors are compelling priorities for these organizations. Preoccupied with whom to market, and how to market, these organizations regularly disregard what they are marketing.
In other words, then, it seems evident that the American Psychological Association has responded to the crises of
"recovered memory therapy" in such a manner that (1) clinical intuition takes precedence over scientific evidence, (2) political correctness prevails over ethical responsibility, and (3) marketing concerns triumph over the dissemination of accurate information. Basically, these are the agenda of a guild; and in particular, the guild-driven agenda of the American Psychological Association is not about to deal responsibly with the crises of
"repressed memory therapy."
Rather than honestly examine the many scientific issues related to
"repressed memory therapy," the American Psychological Association as well as the other professional organizations
regularly retreat behind a smokescreen of misinformation. Allow me to digress for a few moments to illustrate examples of misinformation undermining the reliability of my profession's data base. Specifically, allow me to take you back in time
approximately 74 years ago to Baltimore, Maryland, and in particular to
In what is now one of the most widely known studies in the history of psychology, John Watson demonstrated the acquisition of a conditioned fear response using 9-month-old
"Little Albert" (Watson & Raynor, 1920). Little Albert was brought into Watson's laboratory at John Hopkins; and every time he approached a white lab rat, one of Watson's assistants created a frighteningly loud noise behind Albert's head by banging a metal bar with a hammer. Albert subsequently exhibited a strong fear of the rat
even when there was no banging on the bar behind him. Albert also exhibited a milder
but still pronounced fear of various objects similar to the rat such as a rabbit, a white glove, cotton balls, and a white beard.
Interestingly enough, however, there are many other outcomes attributed to Watson's experiment with
"Little Albert" that never occurred (Harris, 1979). And this consideration underscores the extent to which misinformation is too often alive and well in the behavioral sciences. For example, a well-respected psychologist reported that,
"Albert developed a phobia for white rats and indeed for all furry animals."
(Eysenck, 1960). Wrong that did not happen. Other textbooks have reported that Albert's fear generalized to a cat (Telford &
Sawrey, 1968), his mother's fur coat (Hilgard, Atkinison & Atkinson, 1975), and even a teddybear (Boring,
Langfeld, & Weld, 1948). Wrong again a careful reading of Watson's original 1920 article establishes that these particular events never occurred. Other texts have reported that Albert's fears were subsequently eliminated via a
"reconditioning" procedure (Whitaker, 1965). Again wrong, these accounts are science
fiction. Watson never undertook any procedure attempting to alleviate Albert's acquired fear.
The extent of misinformation related to Watson's experiment with
"Little Albert" has persisted over time because of the extent to which the behavioral sciences rely excessively on second-hand information
(Gilovich, 1991). Rather than carefully review original research, too many mental health professionals depend on second-hand accounts of that research. Moreover, original research can be misinterpreted in a manner that is consistent with a particular writer's theoretical orientation. For example, many of the textbook authors who misreported Watson's experiment did so in a manner consistent with their theoretical orientation.
Misinformation and FMS
Now consider the "Statement on Memories of Sexual Abuse" issued in December of 1993 by the Board of Trustees of the American Psychiatric Association (American Psychiatric Association, 1993). Included in the various issues it addresses, this statement indicates:
"Children and adolescents who have been abused cope with the trauma by using a variety of psychological mechanisms. In some instances, these coping mechanisms result in a lack of conscious awareness of the abuse for varying periods of time. Conscious thoughts and feelings stemming from the abuse may emerge at a later date."
In view of how misinformation can severely undermine the reliability of the behavioral sciences, it seems necessary and appropriate to ask how this anecdote originated, where it was
first published, and what documentation if any is available to support it. Because this anecdote is not documented, and because we know nothing of its origins, I would insist that it amounts to little more than second-hand information, and consequently, it should be considered potentially misleading. Obviously, this anecdote involves a secondary source. Possibly, it has been disseminated because it is consistent with a particular theoretical view. And as a result, it warrants a good deal of skepticism.
This same statement of the American Psychiatric Association (1993) discussed
"implicit memory," referring to "behavioral knowledge of an experience without conscious recall." As an example of implicit memory, this statement cited an instance of
"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."
Because this anecdote also is not documented, and because we know nothing of its origins, I would again insist that it amounts to little more than second-hand information. As in the case of the previous anecdote, this anecdote also involves a secondary source. Possibly, it has been disseminated because it is consistent with a particular theoretical view. And as a result, it also warrants a great deal of skepticism.
Finally, the statement of the American Psychiatric Association (1993) indicated,
"Many individuals who recover memories of abuse have been able to find corroborating information about their memories." This statement merely raises many more questions than it answers
questions such as (1)
"Exactly who has recovered these memories and found corroboration?" and (2)
"What qualifies as corroboration?" (the agreement of other people sympathetic to the apparent plight of someone who supposedly recovered memories of formative sexual abuse?).
While clinging tenaciously to self-serving misinformation motivated by their collective guild interests, the professional organizations representing massive numbers of psychotherapists have consistently turned their backs on the many tragedies created by
"repressed memory therapy." Preoccupied with their guild-driven agenda, there is little likelihood of these professional organizations acting more responsibly on behalf of the many, many people falsely accused of sexually abusing their own children. Therefore, the burden is ours
despite our past efforts to the contrary, it is now tragically naive to expect that these professional organizations will assist us in contending with this heavy burden.
The good news is that we are carrying that burden quite well. Through the determined efforts of the FMS Foundation and its director, Dr. Pamela Freyd, and other individuals, the mass-media have
more often than not objectively reviewed the issues related to
"repressed memory therapy." The extent to which the media have publicized these issues has profoundly increased the public's awareness about
"repression" and treatment attempts at alleviating its supposed effects.
Emerging Legal Standards
Equally important are recent legal decisions regarding rules of evidence that define what constitutes legitimate scientific data. These emerging legal standards should also help ease the burdens of those who
find themselves falsely accused of abusing their own children. In particular, the U.S. Supreme Court's 1993 decision in Daubert v. Merrell-Dow Pharmaceuticals will likely alter substantially the admissibility of evidence in any trial involving claims of repressed memory (Underwager & Wakefield, 1993).
Prior to Daubert, the 1923 Frye test required that expert testimony be supported by scientific principles generally accepted by the relevant scientific or professional community. The Frye standard allowed mental health professionals to offer testimony based on Freudian theory
and its related assumptions concerning repression because Freudian theory was generally accepted by mental health professionals.
In defining its standards of evidentiary reliability, Daubert cites the work of Popper (1959), and other philosophers of science, emphasizing that
"falsifiability" is the hallmark of a legitimate scientific theory or technique. Here, the Court recognized that vague and imprecise theories persistently resist scientific testing because they cannot be falsified. Though frequently riddled with flaws, the enormous shortcomings of these theories can elude detection.
For example, consider how Freudian theorists respond to the overwhelming evidence challenging the viability of repression. Rather than acknowledge that their theory-driven thinking is seriously mistaken, these theorists now invoke considerations of
"post-traumatic amnesia" and "dissociative states" while continuing to claim that traumatic events regularly lead to memory loss (Briere & Conte, 1993). This is an example of an
ill-defined theory avoiding scientific scrutiny because of the impossibility of falsifying it. Advocates of the theory persistently resort to alternative explanations when objective evidence disconfirms one or more of its assumptions
In other words, there are no outcomes allowing the falsification of these Freudian propositions; therefore, they do not possess the
"evidentiary reliability" of a legitimate scientific theory. Consequently, Freudian theory does not qualify as a legitimate scientific theory in view of the many difficulties related to falsifying it. As a result, any testimony in a court of law premised upon Freudian theory is subject to vigorous challenge (Campbell, 1994).
Daubert also specifies the "known or potential rate of error" associated with some scientific or professional procedure as another standard of evidentiary reliability. This standard presents a formidable challenge to those mental health professionals
such as Lenore Terr who claim expertise on the basis of their clinical experience. Reasonable as it may seem to assume that the education, training, and professional experience of mental health professionals confer expertise on their clinical judgments
this assumption is more often mistaken than not (Faust & Ziskin, 1988).
During their interviews, mental health professionals often question clients in a manner that biases the information they obtain (Rosenthal, 1966). As they do so, they fall prey to judgmental errors known as confirmatory bias (Faust, 1989). Assumptions about a patient's drinking, or marriage, or childhood history, for example, increase the frequency of questions directed at those topics
and asking enough questions allows mental health professionals to
find the answers they expected to find (Arkes, 1981). The expectations of mental health professionals can also lead them to believe that symptoms consistent with their diagnostic impressions were exhibited in an interview, when in fact, they were not (Arkes &
Harkness, 1980). Conversely, they are also less likely to recall client characteristics actually evident in an interview, but inconsistent with their diagnostic impressions.
Mental health professionals frequently reach their diagnostic conclusions very early in their interviews. In fact, they can arrive at their diagnostic impressions within the
first two to three minutes, and sometimes as rapidly as 30 seconds (Yager, 1977). Once committed to their own diagnostic conclusions, they cling to their original impressions even when confronted with contrary evidence (Robins &
Helzer, 1986). Not surprisingly, then, there is no relationship between the confidence mental health professionals express in their judgments, and how accurate those judgments actually are (Dawes, 1989).
Therefore, given the rate of error severely undermining the reliability of clinical judgment, mental health professionals who claim expertise on the basis of their
"clinical experience" can expect repeated challenges in courts of law.
In conclusion, the bad news is that the burden of contending with false allegations of sexual abuse
premised upon the recovery of supposedly repressed memories is predominantly ours. The guild-driven agenda of the professional organizations representing legions of psychotherapists preclude them from responding appropriately to this crisis.
The good news is that extensive media coverage that is more often objective than not
and emerging legal standards, will assist us in contending with this burden.
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|1 This paper was
originally presented at the Memory and Reality Conference of the FMS
Foundation, Baltimore, Maryland, December, 1994. [Back]
Terence W. Campbell is a clinical psychologist at
36250 Dequindre, Suite 320, Sterling Heights, MI 48310.