In this issue, Dr Joel Paris (1,2) provides a considered and moderate review of the controversial issue of "recovered memories" in psychotherapy, in particular, memories of severe childhood trauma such as physical and sexual abuse, including incest. As he notes, we are having to accept that such dreadful events are much commoner in the life-histories of individuals than we had ever suspected. But are we to accept, as is being claimed, that they are direct causes of specific psychopathologies later in life? And do we know for a fact that memories of trauma can be repressed in early life, be well-nigh unavailable for many years thereafter, and then be recovered in vivid detail in the course of treatment?
Dr Paris rebuts many of the claims put forward in recent years by those psychotherapists who specialize in helping individuals to "recover" memories, and he emphasizes the shaky theoretical foundations for concepts of memory suppression or repression and of associated phenomena like dissociation. One thing he does not mention is that his critique is equally true of the bases of many other types of psychotherapy that use these or similar constructs.
There is little that is polemical in Dr Paris's articles, and he repeatedly makes a plea for experimental investigation of the claims about recovered memories. He clearly believes, however, (although he does not himself belabour the term "false") that the process of attempting to recover lost memories is fraught with the danger of inducing false recollection. Because he is skeptical about the theory and practice of memory recovery, it is unlikely that anyone who feels differently will read his arguments dispassionately or will try to answer them with demonstrable proof, since that tends to be the way in this field.
A good book of quotations is indispensable to any writer, and this writer is addicted to quotations. Consider the following by Paul Valéry (1871-1945): "The folly of mistaking a paradox for a discovery, a metaphor for a proof, a torrent of verbiage for a spring of capital truths, and oneself for an oracle, is inborn in us" (3). A sad comment on the human situation, and how applicable to the subject Dr Paris is discussing. We live in an age of evidence-based medicine, and we will increasingly be expected to justify the methods we use in psychiatry as in the rest of medicine. Can the proponents of recovered memory therapy give us any reasoned evidence that would convince a skeptical onlooker of the validity of either their theories or their practices? If so, they should produce it immediately, since there seems to be a growing groundswell of opinion against them.
We are reading increasingly about the disastrous situations that can arise when certain patients are encouraged to fantasize (for that is often what appears to happen) about traumatic events in their early lives and who histrionically produce an escalation of horror stories involving relatives, friends, teachers, and others. So dramatic and convincing were these revelations at first, and so often did they appear corroborated by other and similar stories, that many thought they must ipso facto represent a reality. Because childhood sexual abuse is certainly much commoner than was realized, it seemed not illogical to think that it must be responsible for far more adult psychiatric sequelae than had ever been imagined.
As always, there has been no shortage of people coming forward to support such propositions, some of them genuine victims at last being given an opportunity to legitimize their claims of abuse, some of them unhappy people searching for any answer to their protean distress, and some of them individuals who have, for whatever reason, set themselves up as therapeutic experts in this area. Because of the inherent tragic drama of the subject, public interest has been stimulated, but recently we have been hearing more about the ill effects of recovered memory therapy and of at least one therapist being successfully sued for the untoward consequences of misguided treatment.
Human knowledge advances when speculation goes beyond current belief, but true advance occurs only when speculation is tested in the crucible of scientific experiment. Any scientist working with rats accepts that, but how many people who devise forms of therapy that may have profound effects on patients accept it? Too often, it is a case of, "I believe it, therefore it must be so."
If psychotherapy in general and its underlying theories were part of a truly experimentally tested system, we would have fewer arguments about its efficacy and no need for its hundreds of varieties. If psychotherapists were constrained from introducing new forms of treatment until these were proven, as physicians are prevented from using drugs until their safety and effectiveness are reasonably demonstrated, we would have more opportunity to assess the therapies that already exist. What seems to be happening in the recovered memory saga is not unlike what happened years ago with thalidomide: the premature release of an apparently promising medication produced such disastrous side effects that it had to be withdrawn.
Dr Paris judiciously reviews the current "recovered memory" scene and implies that, as so often happens, a theory relating to mind function has attained pseudovalidity with little or no reference to the facts of the brain and how it works. He makes some worthwhile suggestions about how to amend this in terms of "recovered memory," but I think he could have generalized a great deal more.
In criticizing this field, he criticizes psychotherapy in its entirety. When we practise psychotherapy, what general standards do we accept, what body of accepted knowledge do we adhere to, what external review--either scientific or ethical--are we subject to, and what prevents us from being idiosyncratic? Why can anyone practising psychotherapy devise virtually his or her own methodology without peer scrutiny? If psychotherapy is as powerful as its proponents claim, how do new and untried forms acquire such a degree of license?
Dr Paris's review is a cogent one and is essentially a plea for reason. Should not that reason be applied to all of the dynamic psychotherapies, with scrutiny of every basic tenet of theory and practice? Should there not also be some system to prevent patients, their families, and the society they live in from being made to suffer because a biased and untried hypothesis has been masqueraded as an evidence-based methodology?
To return to my book of quotations, Sir Isaac Newton said it better: ". . . whatever is not deduced from the phenomena is to be called an hypothesis; and hypotheses, whether meta- physical or physical, whether of occult qualities or mechanical, have no place in experimental philosophy" (3).
Sir Isaac also said, "Errors are not in the art but in the artificers" (3).
2. Paris J. A critical review of recovered memories in psychotherapy: part II--trauma and therapy. Can J Psychiatry 1996;41:206-210.
3. Beck EM, editor. Bartlett's Familiar Quotations. 15th ed. Boston: Little Brown and Company; 1980.