Adult Recovered Memories of Childhood Sexual Abuse

Stella Blackshaw, MD, FRCPC, Praful Chandarana, MBChB, ABPN, FRCPC, Yvon Garneau, MD, FRCPC, Harold Merskey, DM, FRCPC, Rebeka Moscarello, MD, FRCPC

This paper was prepared by the Education Council of the Canadian Psychiatric Association, chaired by Dr Yvon Garneau, and approved by the Board of Directors of the Canadian Psychiatric Association on March 25, 1996.

Background

Sexual abuse of children is a serious and common problem in our society, although exact estimates of its frequency are understandably difficult to obtain. Sexual abuse involves both girls and boys, but all population studies concur in finding that girls are more frequently affected. Broad definitions of sexual abuse include incidents of exhibitionism and touching nongenital areas of the body. More narrow definitions are confined to incidents of unwanted genital touching or penetration by significantly older persons. Until recently, attention to these problems was limited, and their scope was not recognized.

Sexual abuse, like other types of abuse or trauma, is now considered to be a nonspecific risk factor for many psychiatric conditions. These include disorders of anxiety, mood, dissociation, personality, and substance abuse. Although many sexually abused persons do not become psychiatric patients, studies of inpatient and outpatient psychiatric populations have found a higher than expected incidence of a history of sexual abuse. The psychiatric profession is acutely aware of the need for the prevention of sexual abuse and the treatment of victims.

There are many survivors of childhood sexual abuse. This position statement does not refer to survivors of childhood sexual abuse with continuous memories of their ill-treatment, nor does it deal with individuals who have recovered memories that have been corroborated. Serious concern exists about uncorroborated memories recovered in the course of therapy that is narrowly focussed on the enhancement of memory of what is hypothesized to be repressed sexual abuse. Differences of opinion have emerged about the frequency and the veracity of such recovered memories of sexual abuse, which have also been referred to as part of a "false memory syndrome." A further important concern is that poorly trained or misguided therapists have been urging patients, as a specific part of their therapy, to confront and accuse the alleged perpetrators of the abuse once they have been identified. As a consequence of this type of therapy, members of the patient's family are most often identified and accused. When recovered memories are found to be false, family relationships are unnecessarily and often permanently disrupted. Furthermore, such therapists have been sued for malpractice.

In well-conducted psychotherapy, the focus is on the patient's perceived experience, and a search for proof of the veracity of memories has not been customary. However, when others are publicly accused, especially if legal action is undertaken, the veracity of memory becomes a fundamental issue. The issue then is whether or not recollections of earlier events can be relied upon when they appear after an interval of time (usually years) during which they were not available in consciousness until questions, pressure to recall, suggestions of abuse, or "memory recovery techniques" like hypnosis or narcoanalysis were employed. It is argued that these memories are less reliable than memories that have always been available in consciousness.

Developmental psychology casts doubt upon the reliability of recovered memories from early childhood. The older the child at the time of the event, the more reliable is the memory. Cognitive psychology further finds that memory is an active process of reconstruction that is susceptible to fluctuating external events and to internal effort or drives. If memories of events have not been revisited and cognitively rehearsed in the interval between the occurrence of the events and attention being paid to them some years later, it is not clear that such memories can endure, be accessible, or be reliable.

The controversy over recovered memory has been compounded by certain therapists who use a list of symptoms that are said to indicate the likelihood of individuals having been abused. Common symptoms such as depression, anxiety, anorexia or overeating, poorly explained pains, and other bodily complaints have all been used as proof of alleged sexual abuse. There is no support for such propositions. Psychotherapy based on these assumptions may lead to deleterious effects. Increases in self-injury and suicide attempts have been reported in some patients given recovered memory treatment.

In response to this controversy, at least four separate bodies have issued statements. These include the American Psychiatric Association (December 12, 1993), the Australian Psychological Society Ltd (Board of Directors, October 1, 1994), the American Psychological Association (November 11, 1994), and the American Medical Association (1994 Annual Meeting). All of these statements recognize and emphasize the seriousness of childhood sexual abuse and of false accusations of childhood sexual abuse. The American Medical Association took the view that it is not yet known how to distinguish true memories from imagined events and that few cases in which adults make accusations of childhood sexual abuse based on recovered memories can be proved or disproved.

The present position statement of the Canadian Psychiatric Association offers brief advice to all members involved in circumstances where recovered memories of sexual abuse play a role. This advice is set out in the form of conclusions and recommendations.

Conclusions and Recommendations