- Paperback: 448 pages
- Publisher: Belknap Press (May 27, 2005)
- Language: English
- ISBN-10: 0674018028
- ISBN-13: 978-0674018020
- Product Dimensions: 6.1 x 1.1 x 9.2 inches
- Shipping Weight: 1.3 pounds (View shipping rates and policies)
- Average Customer Review: 11 customer reviews
- Amazon Best Sellers Rank: #537,400 in Books (See Top 100 in Books)
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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.
Daniel Cho --This text refers to an out of print or unavailable edition of this title.
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.
Copyright © 2003 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS. --This text refers to an out of print or unavailable edition of this title.
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It is must reading for both the general public and therapists alike. One of the top books of 2003.
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.
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.
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.