RECOVERED MEMORY THERAPY AND FALSE MEMORY SYNDROME: RECENT LEGAL TRENDS John Hochman, M.D. 72764,2647 Thousands of patients (mostly women) in the United have undergone or are undergoing attempted treatment by psychotherapists for a non-existent memory disorder. As a result, these same therapists have unwittingly promoted the development of a real memory disorder: False Memory Syndrome. To make sense of this unfortunate situation, I need to offer a few definitions. Some psychotherapists believe that childhood sexual abuse is the specific cause of numerous physical and mental ills later in life. Some term this Incest Survivor Syndrome (ISS). There is no firm evidence that this is the case, since even where there has been documented sexual abuse during childhood, there are numerous other factors that can explain physical or emotional complaints that appear years later in an adult. These therapists believe that the children immediately Repress all memory of sexual abuse shortly after it occurs, causing it to vanish from recollection without a trace. The price for having repressed memories is said to be the eventual development of ISS Therapists attempt to "cure" ISS by engaging patients in Recovered Memory Therapy (RMT), a hodge-podge of techniques varying with each therapist. The purpose of RMT is to enable the patient to recover into consciousness not only wholly accurate recollections of ancient sexual traumas, but also repressed body memories (such as physical pains) that occurred at the time of the traumas. In actuality, RMT produces disturbing fantasies which are misperceived by patient and misinterpreted by the therapist as memories. Mislabeled by the therapist and patient as Recovered Memories, they are actually False Memories. The vast majority of false memory cases developing from RMT are in women, which is why this article assumes patients to be female. INITIATION OF PATIENTS INTO RMT A woman consults a psychotherapist for relief of various emotional complaints. The therapist informs her that she have been molested as a child and doesn't know it, and this could explain her symptoms. Some patients think this idea is absurd and go to another therapist; others accept the therapist's suggestions and stay on. More than a few women have heard about repressed memories from talk shows or tabloids even prior to coming to the therapists office, and may even make the appointment believing they too could be "victims" Though the patient has no memories of abuse, she becomes motivated for "memory recovery" since she is told this will cure her symptoms. The therapist will offer encouragement that "memories" will return. Suggestive dreams or new pains are interpreted by the therapist as proof that repressed memories are lurking. The therapist may refer the patient to a "survivor recovery group." There she will meet women who further encourage her to keep trying to remember. Attendance at these support groups, as well as assigned reading in self-help books, surrounds the patient with validation for the therapist's theories. The vast majority of women with FMS are white, middle class, and above average in education. This corresponds to the profile of a typical woman who enters long term psychotherapy, and who perceives such activity as an important way to solve life's problem. GENERATING FALSE MEMORIES Unlike courts of law where which attempt to obtain evidence where allegations of evildoing are made, RMT solely directs the patient to attend toward her inner world for "proof" she was sexually abused. Such RMT techniques may include: ---amytal interviews where the patient is given sodium amytal, a short acting barbiturate, which is incorrectly described as a "truth serum" that will jar ancient memories from the hidden chambers. ---hypnosis (including "age regression" where the patient is told she is temporarily being transformed into the way she was when she was five years old). ---guided imagery in which patients are told to close their eyes and are talked through a state of heightened imagination which has a quasi- hallucinatory quality. Often this produces a hypnotic state with neither the patient or the therapist realizing that hypnosis is taking place. ---Spontaneous fantasy production through drawings, associations to dreams, and stream of consciousness journal writing. ---Hearing or reading about the "recovered memories" of other women. as inspirations. ---Combing family albums for telltale signs; the patient is told that if she looks sad or preoccupied in some of her childhood photos, this is further confirmation that abuse occurred. THE DARK SIDE OF "RECOVERY" Patients start out RMT with the hope that things will be better once they recover their repressed memories. But usually life becomes far more complicated. The FMS patient will often become estranged from the "perpetrator" (most often her father). If the patient has small children, they will be off limits to "perpetrators" as well. Relationships with other family members become contingent on their not challenging the patient's beliefs. Therapists may urge parents to come for a "family conference" in order to allow the patient to surprise the "perpetrator" with a rehearsed confrontation. Family members are usually too shocked and disorganized to coherently respond to accusations. The rationale for this scenario is that since "survivors" feel powerless, they need "empowerment." FMS patients may file belated crime reports with local law enforcement agencies and may go one to sue "perpetrators." A particular benefit for therapists is that in many states, filing a crime report permits bills to be paid through a state crime victims fund. Preoccupied with the continuing chores of "memory recovery," the FMS patient may come to ignore more pressing problems with her marriage, family, schooling, or career. Often the time demands and expense of the therapy itself become a major life disruption. Some patients during the course of RMT are told by their therapists that variations in their moods or thought patterns during the course of a week is a symptom of separate personalities that have been repressed along with repressed memories. Therapists who advise patients that they also have "multiple personality disorder" (MPD) are told that their recovery requires that each personality become aware of each other so that "reintegration" can take place. "The Three Faces of Eve" meets hyperinflation, and some women come to believe they are repositories of dozens of hidden personalities ("alters"), with their own names and characteristics; some alters seem to male or even animal personalities. An increasing number of psychiatrists and psychologists are coming to view MPD as a product of environmental suggestion and reinforcement, since the diagnosis was hardly made prior to ten years ago. One area where there is no controversy: once MPD is diagnosed, therapy bills become astronomical. Some FMS patients become convinced that their abuse was actually "Satanic ritual abuse" (SRA), due to participation by relatives in a secret Satanic cult. Some therapists believe SRA is the work of a vast underground cult network in these United States. One clinician on the lecture circuit explained to spellbound audiences that the cult was brought to the US by a Hasidic Jew who was protected by the Nazis in exchange for his teaching them the secrets of Kaballah; this mystical troupe was purportedly brought to the U.S. after the War to help the CIA in mind control research. No evidence beyond "recovered memories" has ever been offered as proof that such a cult exists. Therapists who lecture on the topic have explained away the lack of evidence that such a cult exists, by claiming that no defectors speak out due to iron-clad secrecy via brainwashing and terror. Miraculously, none of these outspoken "satan-experts" has ever been a target of assassination. THE CARE AND MAINTENANCE OF FALSE MEMORIES FMS involves a combination of mistaken perceptions and false beliefs. The fledgling FMS patient is encouraged to "connect" with an environment that will reinforce the FMS state, and is encouraged to "disconnect" from people or information that might lead her to question the results of RMT. The FMS subculture is victim-oriented. Even though they have not undergone anticancer chemotherapy or walked away from airplane crashes, FMS patients are told they too are "survivors." This becomes a kind of new identity, giving FMS patients the feeling of a strong bond with other "survivors" of abuse. Patients will often start attending "survivor" support groups, subscribe to "survivor" newsletters, or even attend "survivor" conventions (sometimes with their therapists). For some, this gives previously empty lives a stirring core of meaning and purpose They will read books found in "Recovery" sections of bookstores. The best know book, The Courage to Heal, is weighty, literate, and thus appears authoritative. Authors Laura Davis and Ellen Bass have no formal training in psychology, psychiatry or memory. This paperback, modestly priced at $20, has sold over 700,000 copies. Patients are told to shy away from dialogue with skeptical friends or relatives, since this will hinder their "recovery." "Perpetrators" who proclaim their innocence can't be taken seriously since they are "in denial" and incapable of telling the truth. Aside from these social influences, people by nature often resist seeing themselves as being in error. It can be terribly painful to acknowledge having made a big mistake, particular when harmful consequences have resulted. RMT exploits the tendency within each of us to blame others for our problems, and to latch onto simple answers for life's complicated problems. The RMT therapists suggest that aside from entirely ruining childhoods, childhood sexual abuse can explain everything and everything that goes wrong during adulthood. RMT becomes the ultimate crybaby therapy HOW MEMORY REALLY WORKS In Freud's theory of "repression," the mind automatically banished traumatic events from memory to prevent overwhelming anxiety. Freud further theorized that repressed memories caused "neurosis," which could be cured if the memories were made conscious. While all this is taught in psychology 101 and has been taken by novelists and screenwriters to be a truism, Freud's repression theory has never been verified by rigorous scientific proof. Freud, were he alive today, would be traumatized to see how RMT has redefined his pet concept. While Freud talked of the repression of single traumatic episodes, today's therapists maintain that dozens of similar traumatic episodes occurring over years are repressed with 100% efficiency, within minutes of each trauma occurring. The well known syndrome of Post Traumatic Stress Disorder shows us that verifiable traumatic events, rather than disappearing from memory, leave trauma victims haunted by intrusive memories in which the victim relives the trauma. For those who were in Nazi concentration or underwent torture as POWs in Vietnam, this can become a disabling lifelong problem. People forget most of what occurs to them, including some events that were significant to them at the time. If an event is lost from memory, there is no objective way to prove whether it was "repressed" or simply forgotten. And there is no reason that memories of sexual abuse should be handled any differently than childhood memories of physical abuse or of emergency surgery. Events that have slipped away from memory cannot be recalled with the accuracy of a videotape. Individuals forget not only insignificant events in their entirety, but also significant events. Some events (traumatic or not) are recalled, but with significant details altered. A study of children whose school was attacked by a sniper showed that some who were not on the school grounds later insisted they had personal recollections of being in school during the attack. These false memories apparently were inspired by exposure to the stories of those who truly experienced the trauma Memories can be deliberately distorted in adults by presenting a display of visual information, and later exposing subjects to verbal disinformation about what they saw. This disinformation often becomes incorporated into memory, contaminating the ultimate memories that are recalled. Some who enter therapy were abused as children, and have always remembered this abuse. They don't need special help in "memory recovery" to tell the therapist what happened to them. WHY RECOVERED MEMORY THERAPY IS BAD THERAPY RMT purportedly is undertaken to help patients recover from the effects of sexual abuse from childhood; however, at the onset of RMT there is no evidence that such abuse ever occurred. Thus, instead of a therapist having some evidence for a diagnosis and then adopting a proper treatment plan, RMT therapists use the "treatment" to produce their diagnosis. Some RMT therapists overattribute common psychological complaints as signs of forgotten childhood sexual abuse. In their zeal to find memories, these therapists overlook any and all alternative explanations for the patient's complaints. RMT therapists ignore basic psychological principles that all individuals are suggestible, and that patients in distress seeking psychotherapy are particularly likely to adopt beliefs and biases of their therapist. Many RMT therapists have neither studied basic sciences related to memory, or the diagnosis of actual diseases of memory. Their knowledge is often based on a single weekend seminar as opposed to formal training in any graduate program they attended to get their license. Hypnosis and sodium amytal administration ("truth serum") are unacceptable procedures for memory recovery. Courts reject hypnosis as a memory aid. Subjects receiving hypnosis or amytal as general memory aids (even in instances where there is no question of sexual abuse) will often generate false memories. Upon returning to their normal state of consciousness, subjects assume all their refreshed "memories" are equally true. RMT therapists generally make no attempt to verify "recovered memories" by interviewing third parties, or obtaining pediatric or school records. Some have explained that they don't verify the serious allegations that arise from RMT because they their job is simply to help the patient feel "safe" and "recover." Many patients who have known all their lives that they were mistreated or neglected by their parents, decide as adults to be friends with the offending parents. By contrast, RMT therapists encourage their patients, on the basis of "recovered memories," to break off relationships with the alleged "perpetrators" as well as other relatives who disagree with the patient's views. This is completely at odds with the traditional goals of therapists: to allow competent patients to make their own important decisions, and to improve their patient's relationships with others. Patients undergoing RMT often undergo an increase of symptoms as their treatment progresses, with corresponding disruption in their personal lives. Few therapists will seek consultation in order to clarify the problem, assuming instead that it is due to sexual abuse having being worse than anyone might have imagined. In a recent statement, the American Psychiatric Association cautioned that there is no way to establish the veracity of accusations that arise out of RMT in the absence of objective supporting evidence. The American Medical Association has restated prior positions that Hypnosis is unreliable as aid for valid memory recovery. OTHER KINDS OF FMS Some individuals come to believe that they lived "past lives" as a result of having undergone "past life therapy." This phenomenon generally develops in participants who are grounded in the New Age zeitgeist and already open to "discovering" their past lives. They enroll in seminars which can run up to an entire weekend and will involve some measure of group hypnotic induction and guided meditations. This sort of FMS also involves continuing group reinforcement. In contrast to horrific images of sexual abuse, recollections of "past lives" are generally pleasant and interesting. Few participants will recall spending prior lives in lunatic asylums or dungeons. The whole experience is assumed to be therapeutic by helping participants better understand the situation of their present lives. A small number of individuals develop "recovered memories" of being abducted by aliens from outer space. Almost always, these individuals had some curiosity about this area and were hardly skeptics before they fell into an alien abduction FMS. In contrast to women who are plagued with concerns that they were sexually abused, these varieties of FMS of a much more benign nature and do not disrupt personal functioning or family life. While some of these individuals suffer the ignominy of being perceived as "kooks," they may receive compensating group support from those who share their beliefs. SOME LEGAL ASPECTS OF FALSE MEMORY SYNDROME In spite of the shakey foundations on which RMT is built, in the past five years legislatures and courts in 23 states both tolled the statutes of limitations when molestation is alleged, based on the assumption that individuals should not be penalized for having repressed memories. In Hood v. Herald (Summit County, Ohio, Common Pleas Court) a woman received a $5.15 million dollar judgment, with the evidence hinging on recovered memories filled with misdeeds of her uncle. Women who testify on the basis of their recovered memories are thoroughly convinced of their veracity and can make compelling witnesses. During the years these lawsuits were first being introduced, the vast majority of psychiatrist and psychologists were unaware of the false memory phenomenon, let alone being able to explain it. Much of the legislation supporting the RMT as well as numerous Amicus Briefs, resulted from efforts of zealous therapists sometimes allied with gender feminists within the Women's Movement. (While "equity feminists" are concerned with the struggle for equal opportunities for women in academia or the workplace, "gender feminists" are concerned that men are not only an implicit threat to women, children, and even to worldwide ecology, and thus need to reined in). For the busy legislator, tolling a statute certainly would have seemed to be a good enough idea. It was said to help victimized women, bring unpunished child molesters to justice, and would involve no new taxes. In recent years there have been numerous civil lawsuits based on RMT with grown children suing one or more family members. Even in cases where there is a defense verdict, plaintiffs remain convinced that their recovered memories are indeed accurate. In 1993 in the case of Steven J. Cook v Joseph Cardinal Bernadin et al, the plaintiff announced over CNN that he was sexually molested years earlier when he was a seminary student by two clerics, including the then Archbishop of Cincinnati Joseph Bernadin. However a few months later, Mr. Cook dropped charges against the Cardinal, indicating that these were based on recovered memories from therapy, and he had come to learn that such memories could be unreliable. In the recent case of Ramona v. Ramona, a California winery executive won a malpractice action against his daughter's therapists. Holly Ramona, while a college student, underwent an Amytal interview as part of her RMT. She became convinced as a result that her father had molested her; this led to her father, Gary, losing his job and losing his wife. He was found to have standing to sue because he was seen by one of the therapists in family session. The other end of the case, the civil action filed by the daughter against her father, will be heard later this year. There are an increasing number of women who are retracting their false memories and are suing therapists for malpractice. One such case settled for a very large amount in Texas earlier this year. One malpractice insurance carrier for clinical psychologists in California recently tripled their rates without explanation; this has led to speculation that the carrier is anticipating increasing numbers of lawsuits alleging that psychologists caused FMS. AND NOW, A WORD ABOUT THE FUTURE.... Women who retract their claims of abuse may do so spontaneously when they relocate to another locale and lose contact with their prior therapists and support group. Without the "positive reinforcement" from others to encourage false memory development and maintenance, some women begin to doubt the veracity of what they had believed was true. While some remain suspended in a twilight of doubt, others have fully recanted. These retractors may have a profound influence on getting women with an active FMS to re-evaluate their situation. While FMS patients learn from the FMS culture to dismiss critics as either "perpetrators" or their apologists, the voice of a woman who says she is recovering from FMS is more easily heard. Although most influential among family counselors and social workers, RMT has affected the practices of some licensed psychologists and psychiatrists. Some RMT goes on in special "dissociative disorders units" in psychiatric hospitals. These activities have gone on with little challenge, until recently, and many of these units have been cash cows for hospitals experiencing financial setbacks from restrictions of managed care. Meanwhile, there is a large FMS subculture consisting of women convinced that their "recovered memories" are accurate, therapists keeping busy doing RMT, and of authors on the "recovery" lecture circuit. Skeptical challenges to RMT are met be emotional rejoinders that critics are front groups for perpetrators, and that "some people say the Holocaust didn't happen." RMT will eventually disappear, but not next month. THIS ARTICLE is a revised version of an article published in the Skeptic Magazine earlier this year. The author is a psychiatrist in Encino, California, and is on the Scientific Advisory Board of the False Memory Syndrome Foundation in Philadelphia.