Customer Reviews

Remembering Trauma

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Traumatology is a field concerning the nature and treatment of traumatic stress reactions. Controversies in this field include theoretical contentions (e.g., do psychodynamic mechanisms like repression really exist?), diagnostic and phenomenological controversies (e.g., is psychogenic amnesia a common traumatic stress reaction?), treatment questions (e.g., are treatments like Eye Movement Desensitization really as powerful as their proponents claim?), and societal and political tensions (e.g., is it morally appropriate for scientists to disseminate findings showing that childhood sexual abuse is not as harmful as previously believed?). Each of these issues, along with many others, have been hotly debated, both in scientific journals and in the popular press. Although there are some rigorous, scholarly books in this field, there are probably more volumes of impassioned polemics, based more on vested interests and clinical folklore than on hard data. A welcome, scholarly addition is Richard McNally's new book, Remembering Trauma. This is a superb volume largely about the phenomenology, mechanisms, and modification of traumatic memories. McNally's book targets a broad audience - clinicians and the general reader - as is appropriate for a book on such an important, wide-reaching subject. The book focuses primarily on posttraumatic stress disorder (PTSD), which can be conceived as largely a disorder of memory; a disorder in which traumatic memories exert their influence in a variety of ways, such as by repeatedly intruding into the sufferer's stream of consciousness, and by coloring the way the person experiences and reacts to the world.
McNally focuses on the empirical literature, including the numerous experimental studies conducted by his research group. However, his book is also liberally sprinkled with clinical examples and anecdotes, which complement the empirical reviews to bring the material to life. McNally does a good job of demonstrating the relevance of laboratory studies, which are often dismissed as irrelevant by some traumatologists. He demonstrates how lab findings are quite consistent with data from other sources, such as the methodologically sound field studies (e.g., naturalistic studies of children's memories for stressful medical procedures vs. other events) and the better-designed of the case studies. McNally goes where the data leads him, regardless of whether his conclusions are unpopular among some of the deans of traumatology. Among his important conclusions are the following:

* People remember horrific experiences all too well. There is little, if any, compelling evidence for the repression (inability to recall) of traumatic memories. Trauma survivors, compared to others, do not have a superior ability to banish upsetting memories from awareness; "The notion that the mind protects itself by repressing or dissociating memories of trauma, rendering them inaccessible to awareness, is a piece of psychiatric folklore devoid of convincing empirical support" (p. 275).
* Some people do not think about disturbing events for long periods of time, but that does not mean that they were ever unable to recall the events. There is no reason to postulate a special mechanism of repression or dissociation to explain why people may not think about disturbing experiences for long periods of time - a failure to think about something does not entail an inability to recall it.
* Contrary to the view voiced by some clinicians, there is no compelling evidence that repeated episodes of abuse lead to impaired recollection (repression or dissociation) of abuse. In fact, repetition strengthens memory for abuse, although the person may not be able to recall every specific instance of abuse.
* Contrary to advocates of the concept of "recovered memories", there is evidence that many or perhaps all recovered memories are false memories of horrific trauma. Recovered memory therapies - involving suggestion and leading questions that the patient has been abused, along with guided imagery and hypnosis - can induce false memories. In turn, these memories can induce PTSD or other forms of psychiatric disturbance.
* Contrary to some views, evidence indicates that very high levels of stress do not impair the formation of traumatic memories. With increasing levels of arousal, attention is directed to the central features of the arousing event, at the expense of peripheral features. A robbery victim, for example, may vividly recall the gun shoved in his or her face, but may not recall the face of the assailant. This is not repression or dissociation.
* There is little convincing evidence that traumatic stress damages the brain. Preexisting (e.g., genetic) factors are the most likely explanation for the differences between the brains (e.g., differences in hippocampal volume) of PTSD sufferers compared to controls.

The timeliness and importance of McNally's book is evident in widespread attention it has quickly garnered from the professional community and general public. In my view the book is among the best of its kind. McNally pulls no punches in shattering myths, and presents the reader with an accurate picture of the current state of scientific knowledge on the nature and consequences of traumatic memories.
Although the book is outstanding, a limitation, at least for clinicians reading this book, is that the treatment implications could have been discussed at greater length. The pitfalls of "recovered memory therapies" are amply described, although I would have liked to have seen a discussion of other controversial treatments for traumatic memories, such as Eye Movement Desensitization and Reprocessing, and Thought Field Therapy. Proponents have made extraordinary claims about the efficacy of these treatments. Such claims do not hold up under careful scrutiny. McNally and colleagues have described some of the concerns with these treatments elsewhere, in articles appearing in scholarly journals. These important critiques deserve a wider, general audience, such as the audience intended for Remembering Trauma.

We usually do not think of it this way, but ideas on how people remember trauma have had a profound impact on our society. Just ask the Boston Archdiocese, which now worries that people will come forward with "false memories" of abuse, greatly adding to their financial liability. How are we to know who is telling the truth and who is just making it up out of greed? Feminism, moreover, has been advanced by some writers based partially on the idea of "recovered memory" of widespread sexual abuse of daughters by fathers. The vast therapy and mental healh businesses also have a huge financial interest in whether or not there is merit to the psychoanalytic idea of repressed memory. Concerned parents, further, wonder if stress from war on trauma and related television images damage our children psychologically. What affect might the bombing of Baghdag have on the citizens?

With so much at stake in terms of money, politics, health care, and criminal court proceedings, scholars have been under severe pressure to lean this way or that even when writing in scholarly and scientific journals. So many controversies and professional attacks have been launched that until now it has been hard for people who need to know the truth to find an objective account of the facts about memories of past trauma and recent trauma.

In his book "Remembering Trauma," Harvard University Professor Richard McNally, one of the world's most distinguished behavioral scientist, has put forth a badly needed objective and balanced account of all major issues concerning how people remember traumatic events; he also covers postraumatic stress disorder and related issues. This is THE scientific, authoritative summary of what is really known about the psychological issues of trauma that have had political and legal impact in the last decade or so. Just the facts, no spin. The book is thoughtful, thorough, and deals even handedly with the major issues. The book is a must read for any thoughtful person with a professional or personal interest in trauma.

What about, moreover, the people who say they remeber alien abduction?

McNally's book is required reading for those interested in the controversies over "recovered memories of trauma." His tone is even, sometimes wry, but never accusatory towards those who may not share his conclusions.

Of particular interest is his attention to various studies that have been used by both "sides" in the debates. For example, in his chapter "Traumatic Amnesia," a reader will find a sober evaluation of theories presented by such worthies as Terr, van der Kolk, and JJ Freyd -- here McNally drills down into the meat of the supporting data used to flesh out the theories, and in so doing, lays out the exact areas of dispute.

Ms Crook's review makes one important error: The Freyd study she notes did not assess for PTSD, and so is not comparable to McNally's laboratory work.

Lynn Crook's review notes a Freyd et al (2003) study that relicated McNally's wordlist experiments, writing that the PTSD subjects experienced greater forgetting of trauma-related words. This is incorrect. No measures of PTSD were taken in the Freyd study. The measure was the DES (Dissociative Experiences Scale).

See: "Forgetting Trauma Stimul1" http://dynamic.uoregon.edu/~jjf/dpfinpress.pdf

Readers of "Remembering Trauma" should be on the lookout for the occasional overgeneralization beyond the data.

For example, the author discusses two studies in which subjects watched videotapes of a simulated crime. The subjects recalled the simulated crime. McNally concluded, perhaps too broadly, that "exposure to a shocking event does not produce `amnesia' for the event itself" (p. 51).

McNally describes a directed-forgetting task he gave to three groups: child abuse survivors with PTSD, survivors without PTSD and subjects without a child abuse history. Subjects viewed a series of words on a computer screen, some words were trauma-related (such as "incest") and some weren't. The PTSD group recalled the trauma words as well as the other subjects.

McNally concluded, again perhaps too broadly, that "if survivors were capable of forgetting memories of abuse, they should have been capable of forgetting words related to their trauma" (p. 269).

McNally overlooked a critical element: trauma. Freyd et al (2003) introduced stress to the directed-forgetting task and the results were much different. The PTSD group recalled the trauma-related words less well.

The occasional repetitions (151-268; 260-265-48; 21-237) are disconcerting. The phrase "all too well" (as in: people remember trauma all too well) appears often enough throughout the book to be distracting. I wondered if the original title was: "Remembering Trauma All Too Well." Proper names are missing from the index. Hopefully the next edition will rectify these minor problems.

Dr. McNally's book systematically exposes and debunks the bogus claims of true believers in so-called "repressed memory syndrome." He meticulously demolishes the entire "trauma industry" of healers and psychologists as an enterprise devoid of convincing empirical support, and one that resembles folklore at its worst.

It is must reading for both the general public and therapists alike. One of the top books of 2003.

McNally wants you to think he is evenhanded and "professional" but he reveals his biases in the introduction by announcing that repression and dissociation are postulated rather than that they exist.
The book is based on academic studies of vets, survivors, normal people, etc, etc, but it is not based on talking to survivors. How much of your deepest pain would you tell to a grad student in a white coat doing a study?
In the 80's, when some of the books he cites so contemptuously, were written, survivors of trauma and their therapists were fighting to be heard. Denial of trauma was universal. PTSD had just been re-recognized in 1980. Gross Stress Reaction was the DSMI (1952) diagnosis, but that dissappeared in the American Psychiatric Association's Diagnostic and Statistical Manual II, which came out in 1968. He's so evenhanded, he doesn't even mention that, nor that psychiatrists were trained to disbelieve allegations of sexual abuse and to think the child wanted it. Kids want attention, love and affection, not sex... Vietnam vets were being told that war hadn't messed them up, although in 1965 Archibald and Tuddenham had published a study about how WWII had messed up those vets. Battered wives supposedly liked it or they wouldn't go back... Only weaklings were affected by trauma.
In my opinion, this is an academic book for academicians who want to insulate themselves from the reality of trauma and pretend that lab studies are the equivalent of traumatic events. Lots of tap dancing around reality. If you are looking for help or for realism, look elsewhere.
Betrayal Trauma by Jennifer Freyd is a far better, more evenhanded book.