From Scientific American
Many science books earn praise for taking a topic that the public might consider dull or irrelevant and turning it into a fascinating drama. But there is something to be said for doing the oppositestripping down a controversial topic to the science at its core. "How victims remember trauma is the most divisive issue facing psychology today," writes Harvard University psychologist Richard J. McNally in the opening lines of Remembering Trauma. It is also central to headlines about whether men are accurately portraying childhood abuse by their clergy. McNally quickly summarizes the history of the repressed-memory debate to help readers frame the science he later presents. The issue first became big in the 1980s, when therapists began to diagnose sufferers of depression and other mental health problems as victims of childhood sexual abuse, the memories of which were said to be repressed as a defense mechanism against reliving the pain. Reports of recovered memories of sexual abuse peaked in the mid- to late 1990s and were followed by a backlash from accused family members who denounced what they called false-memory syndrome. Practitioners of recovered-memory therapy defended their methods, even as some patients retracted their claims of abuse and sued their former therapists. At the same time, extensive clinical research on the nature of memory and trauma was being conducted. Indeed, McNallys analysis of it makes up the bulk of the book. From simple word memorization experiments in the laboratory to interviews with Vietnam veterans suffering from post-traumatic stress disorder, the author summarizes dozens of studies while providing clear explanations of psychological concepts and expert insight into the strengths and limitations of the findings. The overwhelming evidence leads him to conclude that people do not forget experiences that were truly traumatic. Although some victims can go for long periods without thinking of past events, this should not be confused with an inability to remember their ordeals. Even though at times McNally may overgeneralize, he ultimately debunks theories of repressed memory and the "trauma industry" that has sprouted to cater to this purported condition. Although his exhaustive recounting of cases may be tedious for casual readers, those with an interest should appreciate the wealth of information and McNallys sober approach to this emotionally charged subject.
From The New England Journal of Medicine
Books with nearly 100 pages of references, not to mention notes, are treasures as resources, even if their content and the discussion they contain require much work of the reader. Remembering Trauma is such a book. It is not, however, about remembering trauma. Rather, it is about the debate over the recall of childhood sexual trauma. It also is not without a point of view of its own. McNally begins with a useful and dramatic history of the debate about the recall of childhood sexual abuse. In this debate, issues of science, clinical care, and the legal system have come together, often without any acknowledgment of their differences. The failure, inability, unwillingness, or reluctance to recall an event leads to different hypotheses regarding the phenomenon we casually call "forgetting." To complicate matters further, we know that people often forget the times when they did remember. Evidence, data, methods of obtaining data, and criteria for establishing proof are quite different in the fields of science, clinical care, and the law. McNally provides a good review of the literature of cognitive psychology on the recall of traumatic events, reminding us that recall is a function of our experience, the neurobiologic limitations of our memory apparatus, and our present context. The process of recall often involves remembering an event that one knows but may not have thought of recently or even for a long time, rather than "remembering" an event of which one was never before aware. The book covers many aspects of this question, from amnesia to belief, perhaps dwelling too much on post-traumatic stress disorder, repression, and dissociation. Among the studies McNally discusses are two sets that address the specific questions of the recall of sexual abuse particularly well. The first set comprises prospective studies of abused children who were followed as adults. Although McNally tends to interpret these studies as supporting the view that adults nearly always recall documented childhood sexual abuse, the studies also indicate that some adults (10 to 22 percent) do not. Yes, this finding supports the conclusion that forgetting childhood sexual abuse is not the norm. However, it also indicates, within the limits of these studies, that such forgetting does occur. The second set of studies compares aspects of memory function in three groups of adults: those reporting unconfirmed recovered memories of childhood sexual abuse, those reporting repressed memories of childhood sexual abuse (i.e., they do not recall the sexual abuse, but they think they were abused), and those reporting no history of childhood sexual abuse. The author leads the reader by suggesting that there "should have been" differences in memory function among these groups according to whether the sexual trauma was repressed, dissociated, or forgotten. However, a more neutral interpretation of these studies would be that the null hypothesis was not rejected and that the three groups were therefore surprisingly similar. Interestingly, persons who reported repressed memories were more likely than those in the other groups to score high on tests that measure psychological distress. Either some adults with psychological distress come to believe they have been sexually abused in childhood or, equally possible (although inexplicably demoted to less importance in the book), those who report repressed memories do indeed have more psychological distress. The proverbial chicken-and-egg problem cannot be resolved by these studies. Is trauma a problem of memory? The recall of traumatic events (and post-traumatic stress disorder) is as much a problem of forgetting as of recalling. The inability to forget and the resultant generalization of the threat result in impairment rather than in protection from danger. The enduring questions regarding memory and traumatic events are not solved in this book, but we are educated about them. The recall of childhood sexual abuse is never established without independent confirmation -- a lesson that is taught well in this book and one that our scientists, clinicians, and legal system must not forget. Robert J. Ursano, M.D.
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