ho believe \\'ith certainiy in the truth of recovered memories' .... I realized, when I was alone driving home, that none of us had mentioned the awful news. Had.
Clinical complexities in the memory debate Phil Mollon
Certainty versus uncertaintY between those who believe The extraordinary debate about memorv is often seen as polarized believe such apparent who those and there can be recovered memories of childhood trauma certaintv and between polarization memories are false. t p"r."i.." a slightly different memories' recovered of truth the in uncertainty. There are those *,ho believe \\'ith certainiy are also There possible. not are memories There are also those who are certain that recovered those who are certain
of the source of
pseudo-memories
-
implantation by malpractising
therapists.
in the field; some whose have noticed a peculiar effect on the n'ork of some scientists qualities make a shift scholarly and previous writings are characterized bv admirable baiance space for thinking if the as is it into polemical discourse based arouird a single argument; may be highly discourse u.balanced becomes narrowed and d1storied. Polemica-l anJ have a extremes these I think b.tt persuasive to those sympathetic to the e.spoused position are They confusion' u'as there rl'here delusional Structure,'fu'nctioning to bring certaint' and information confirmatorv sustained by selective attentioi to er-id;nce, highlightlng in the light of assumptions' one avoiding that which is contradictorl,. Evidence is interpreted abuse; memories of abuse sexual to position argues that 'manY emotion-a1 problems are due repression of the indicates abuse oi indicate that there was abuse; an absence of memories therefore: possible; not are memories'. Another position ar8ues: 'recovered memories This malpractice'' therapeutic of recovered memories are false; such memories are evidence u"O debate appears to impair people's loPl:ity to thinkThe.underir''"gt:* :tt::It'o"better to is it of course' but, anxiety seems to genJ;te pseudo-thinking and pseudo-claritv stay with confusion and alrxiety'
I
be true. I would. like to state a few general principles which i believe to
memories of childhood trauma are False or pseudo memories of childhood are possible' True for certain periods' Later' thesememories possible. A person may be able to av-oid thinking about in a safe environment' or when child), i. r"rpo^r" to certain cues (especially having one's own
pro."r. oi t.ansfJrence in therapy, the memories mav intrude into have begun to intrude' Memory awareness; sometimes p"oit" seek therapy because memories perceptions o{ past events' our is prone to error; we interpret and reinterpret and-remix
ot.
*h"rl
triggered by the
is like telling ourselves interweaving memory and ctnfabulation; aufobiographic remembering of 'true' and 'faise' extremes the Between a story - uria the stlry may evolve and change. memory lies a vast area of uncertainty and ambiguity'
'Memories' as psychodynamic Products mixing elements from various New memories (perhaps even old memories) are not unlike dreams, and fantasies in the present experiences sources, both extemal and intemal, in order to represent abuse might represent sexual of as well as the past. For example, a sudden image/memory/dream sense of the therapist a representing an abusive experience in therapy - a sexualiied metaphor interpretation, intrusive an making being pushy, breaking boundaries, imposing a point_of view, images of generate repeatedly could or attempting to penltrate defences. thrt .Io"..i re therapy therapy' the upon abuse whichire not memories but unconscious commentaries
are subiect to defensive manipulation' Memories and the significance attached to them but the tnif, over time, the theme of serual abuse remaining constant Narratives of abuse had father his that ^"], rna.n ttsed to believe identity of the urrrr"r-Jnimng. For example a youllg that th'erapist the tc 1'.i su.1c1enl' al-rnou''Lced sexuaily abused r",i*. eii", u f"u, 11tw"o oi theripy
herealizedhehadmadeamistake;itwashismother,sicr-erir-lrohadabuserlhim.lVlrat too perception of his n-Lother's lo'er as ai:ruser rvas appeared to have 1r^pf"""a r-t"re was that the more been had it to be a secret; because ihe existence of this *u. *'i, meant threatening had abused hirn' comfortabie for him to think that his father
by flashback images of her uncle abusing her' A tvoman,s admission to hospital was precipitated maltreated urir-to"gn she had been,sexuallr'abused and These had been horrifying to her becaur" figure in good one the her uncle had bee, by a variety or p"opt"'i,r?'"*y-art,".9"a .nitafr"oa, in a bowl her bathing uncle o'-'" was of her hlr life. Two images had particularly disturbeJh"',being red coloured; the second image was of tr-,u *ut"t of water and washing her private parts, push them very afraid of ihes-e images and had tried to felt She liid being in bed with hJ;;;. did so she she \\1en out'' deciied she would 'let ii alt away, but on coming *i" r.,rrpi"1 had she had after her washing were to do with her uncle experienced a 'realization' thai the images been had rvay this in and *u, pri,i"g her to bed afterwards been abused by the others - that he
t"pt"'entations of something that actually trying to look after her. Are the i.r'rug., i,i" no of their significance is correct? We have int-rp.eiations happened? If so, which (if any) of her way of knowing. and false there is no means of distinguishing true In the absence of independent corroboration mt'mories' tlue can just as detailed, vivid and persuasive memories; false memories can apPear fits the material' the svmptoms' the The fact that a mem ory, ora psychoanatytit '"to'1'truction being literally true' not mean that it is collect in the sense of rnoods, the anxieties und ,o orl., do", Amemorycouldhavethematictruth,butnotliteraltruth(itcouldalsohavenotruth).Although be preserr,ed accurately, flashback images it is possible that traumatic memory imagestomav we will srrpply i context and create a narrative' fypically lack contex' as soon as we attemit patient's a of truth objective u po'iiio'-t to know the introduce distortion. The therapist is rarely'in understandings of the be to ilri;; a 'ariet)' oftopossibie childhood. It is crucially important to these too' For the open be ur',a tJ ireip the patient patient,s history ,^;-d;;'i;'p*"ni to define reality - a authbritv u q'it" univarranted therapist to presume to know is to assume to relieve rt'ish the therapist at times position that must be avoided, even though lhe fahentrmav therapist is one ihe for
of
deep
appropriate-tiu":" their uncertainty in this way. The only to of the human psvche - and I believe this vast the humility and modesty in the face '-i'-ti";*'" but ro ail aspects ot pslzchotherapv' be rrue not only i" ;;i"iir; to memories
Forgetting and remembering Theunreliabilityofmemoryisessentiallyunrelatedtothequestionofamnesiaandrecoveryof r;"; t" puzzleiby the idea of motivated amnesia memory. tt purztes me-ii,J, ,o*" p"opi" as a surprising, complex' exotic ,f (whether we call it repression or somethingelse) . "; .l]t":"en 'mechanism" perhaps ior-some it seems to imply a mysterious or ,counterintuitive, process. Uo*"t'"r, I would like to try to reveal this defensive quite beyond th" ,"uih of introspectior-t. and human' a'mnesia'as being essentially very ordinary' said she had not her years of sexuai abusg-by u lodger' She Recently a patient was taiking about asked i'#^py, tn" i99".d,.'I iept forgettlng afout it'' IPeople tatked about it to anyone before seeking it''
,forgetting about it'. in" ,'uii, 'w"tt I didn't want to think about what she meant by w'hich to remember' People learn to a-zoid stimuli forget, especially if it is-dangerous or painful People may or urr"t" *uy be that kind of phobic stimulus' cause them anxiety or pain; a memory that patient- l'as overwhelmed b1 Fo' remember when they'are remindea ty ",r",-'tt' "'u"'tple' r,", own child and this was why she sought therapv' memories ot uurr"'7*,lri;;;;;ilin to
I once interviewed a man in prison awaiting trial on a charge of serious assault of another man who rvas alleged to be a child abuser. What had happened, he explained, was that he had been hearing more and more about this paedophile man's activities, including how he had abused a tvoman rrho lt as a good friend of his. Suddenly, one day whiist sitting at home looking at pictures of his o\.vn son on the -wa11, he had 'remembered'that he had himself been sexualiy abusr:d. He described
an authentic sounding account of being groomed and sexually abused over several years by a paedophile neighbour u,ho paid a lot of attention to him, exploiting the absence of his father. The ibuse had stopped in early adolescence r,r,hen the paedophile had moved al{ay. I asked about his apparent lack of awareness of the abuse until recent events. He looked embarrassed and said '\bu'11 think this sounds completei,v stupid, but I'd forgotten about it - I just didn't remember it it r,r,as as if something was sleeping in n-rv head.' He also explained that when he was a boy he haci not reaiized this was abuse - the significance of abuse was retrospectivelv attributed. Apparently on the day of the serious assault he had been drinking and brooding about the abuse, the present and the past (and the tw'o abusers) fusing together in his mind.
Here is a verv personal erample. On the day of the terrible events in Dunblane (r.vhich traumatized the whole nation) I heard the news on the 6pm bulletin. I felt profoundly shocked and preoccupied .ivith this. Shortlr. afterrvards I had a restaurant date with some friends and colieigues. W" nua not met for some time and had much to discuss. After an enjoyable evening I realized, when I was alone driving home, that none of us had mentioned the awful news. Had i forgotten? Certainiv I had not u'anted to think about it - and I had not thought about it in the restaurant. If it is possible to pui something painful out of one's mind for a limited period there is no reason in principie r,r,hv it should not be put out of consciousness for an indefinite time. Supposing the situation u-ere such that a terrible event had happened but no-one ever spoke about lt, urrd th"r" were no nervs reports; and supposing that if I attempted to speak about it the response was alwavs to ignore tvhat I said, or to threaten me n'ith severe punishment for speaking of it - I might then succeed in not thinking about the event for prolonged periods.
If I have experienced or done something shameful or t-hich I feel guiltv about, I might trv to minimize it in my own mind, avoid thinking about it, or reinterpret it ln rn"avs u-hich are more comfortable for me. If I were really desperate, and ii i *-ere a chilci, I might decide I n'ould pretend that whatever it was did not happen. I might do so especiallr- ii there seemed no
possibility of speaking to anyone about it. On the other hand, I might become tormented bv an experience ar-,d the memory of it and magnify it in my mind and har-e difficultr- thinking of anything else. In practice, patients with memories of abuse usually seem to be aware of partial memories before t""kir'rg therapy; these then develop further as they allow themselves to think more about childhood events. A patient I have seen over quite a long period presented first n'ith a history of
sexual abuse by a grandfather (according to her own account). Although airvavs tending towards a manic-chaotjc and alcoholic lifestyle, she had become more disturbed after having her own children; she would often appear to resort to heavy drinking or promiscuous activitv in respollse to the intrusion of images of sexual abuse. Some time later she developed memories (rt hether true or false) of her father abusing her. She spoke to her mother about these. Her mother told her that the abuse was her own fault. The patient became confused and psychotic, excitedlv generating all manner of unlikely scenarios of abuse within her familv. A long time later she became very disturbed again after suddenly remembering how she, as a ten-year-o1d, had sexually abused two younger girls; these memories 'were associated with tremendous anxiety, shame and guilt - and a great fear that the therapist would condemn her. She was then able to see (and this was her own insight) that she may have become disturbed after having her orvn children (girls) partly because of a fear that she would abuse them.
l\Ihat I am describing about forgetting and remembering should not be seen as implicitly adr.ocating some kind of 'recovered memory therapy'. There are two main problems that might arise from a deliberate search for memories of trauma: (1) false memories might be created; and
(2) the patient may be overwhelmed and retraumatized by the memon.. Forcrng the mind is never to be recommended. Psychoanalytic work should focus on the conflicts rr-ithir, the mind especially as they are manifest in the transference - whilst taking accoutlt of meaning and fantasies alound such memories as arise naturally. Cognitive therapv u-ili fc,cus -.rpcr-L r-noclifying the beiief systems that arise as a result of childhoorl experiences. Nelther therar.r rreed ficu-s directly upon the trauma.
Disturbed states of consciousness In my lr.'ork in a psychiatric setting, I see manv extremely damaged and disturieil :eLrple l,vhose backgrounds were traumatising and depriving in a variety of ways. Such la::er.,ts ira.,,e verv disturbed and abnormal states of mind. Their consciousness (including their n'Le::r i :r' r is altered - or perhaps one might say 'mutilated'. I think the failure to recognize this n-,a-, r-e one reason why for some academic psychologists (whose consciousness is probablv not i:irilr-.::e.1) the idea of forgetting trauma may seem counterintuitive.
What are the features of these abnormal states of mind? Often there is a rarrowing of consciousness, a restricted field of thought, rvith limited capacity to reflect upor', corrsciousness and upon memory. The person may be hypen-igilant, constantly scanning for danqer from other people. They may spend time in switched off, rrance-like states. They n-rav erperience (nonschizophrenic) hallucinatory voices, located intemallv; linked to these there n-Lat be 'internal controllers' - a kind of internal and secret police state or mafia organization, r\F,erienced at controlling what the person should do, think or cornmunicate. The person/s perception of others may be deeply distorted in a paranoid direction, but in a way that is concealed bv a superficial adaptation. There may be no expectation of being r-rnderstood empathicallr,, others rvill be perceived as hostile, exploitative and dangerous. There may be an inabilitv to inlrospect or reflect upon mental life, as if consciousness is suspended - frozen between internal and external terror. There may be an absence of transitional space (in the Winnicottian sense), so that fantasy and hallucination are experienced as real. There mav be rapid and unpredictable alterations in mood and behavioural state, with shifting idenhties and rvith iittle capacity to relate one to another. Often the patient seems engaged in an acfir-e struggle to avoid thinking about abusive events, and to avoid cues which might remind him,.her of trauma (or traumatic fantasy) including an avoidance of sexual activity.
It is these
people who can be traumatized bv a psvchotherapeutic consultation because the freedom to speak to one who will listen, with minimal cues as to',r,hat should be spoken about, threatens to undermine their desperate attempts to keep their n-rind under control. These are also people whose sense of reality and relationship to knorr'1edge are impaired; they may be highly susceptible to suggestion, perceiving truth as a matter of feeling or as something determined by an external authority.
With many of these patients (who might be described as having se\-ere borderline personality disorders, accompanied by dissociative tendencies), one might hear a narrative of abuse presented in a frightened, confused and childiike state of mrnd, perhaps narrated in the present tense, and dissociated from the more adult state of mind. In these circumstances rational and adult discussion with the narrator is impossible.
In these states of dissociative pathology, w'here the unity of consciousness (always illusory) is sharply breached, we are faced with another puzzling question. Who is remembering? Who has forgotten? Is it a matter of memory at al1? One state of consciousness seems to know something (or fantasize something) which another part does not know. Perhaps it is better to think of this as a kind of epistemologic pathology. particularly ambiguous example - a patient was referred to me after having reported to the psychiatrist a childhood involving sexual abuse by her mother. As she talked about this To give one
well as she became very anxious, especiaily as her narrative began to include other abusers as her mother. In the second seision sire mentioned a dream which she said was very strange and irigl-rtening. She then spontaneously before my eyes entered a frightened child state of mind and belan to iarrate in the present tense this 'dream', a scene of ritual abuse involving a group. \Viren she emergecl from this state she appeared to have only a dim recollection of what she had the same described. The next session she again entered a frightened child state and described seemed scene of abuse. When she emergeJ from this I commented that what she had presented by r-erv similar to the dream described last u'eek. She replied 'What dream?', seeming puzzled mv comment. Dream, hallucination or reality? We have no w'ay of knowing'
\{any patients with very disturbed backgrounds show some degree of dissociative tendencies. of Thisis most developed ln the full Dissociative Identity Disorder (DID). In my understanding is this severe state of mental mutilation, it is a creation of trauma and pretence The personality
relation structured around the trance-1ogic of being a multiple personality. The problem here,-in is built to memo* is that there probabiv rn as real abuse in the background, but the personality with DID out of p."t"r-r." and coniabulation. I suggest that the memory narratives of patients may be particularly unreliable in relation to literal truth'
other sources of memory distortion - confusion between internal and external figures
does not allow There are many possible factors contributing to distorted memories, and space internal me to list them all. I would like to drarv attention to just one - the confusion between and external figures.
partlv based During the course of der.elopment the chl1d develops parts of the mind that are fantasv and much rvith combined of parents, representations and around identifications 'internal objects'b-v ca11ed be to tended have These self; of the parti with protective confusions but actual-parents, the to reiationship some bear figures internal these psychoanalysts . Usually patients disturbed verv rvith some arlse can Pioblems different. very sometimes thuy .ur-r be figures whereby the internal objects are severely abusive, and the patient confuses the rnternal as concretelv \-erv obiects internal their experience may patients Such with thl actual parents. abuse at foreign bodies in the mind. ThLy may experience these inner parts as voices screamit1g their abusive them. lt is not uncommon for this kind of patient to believe that s/he can get ric-1 of objects internal the projecting a fantasy.of on depends this parents; the killing internal objects by mav engage objects Internal complex. are objects internal of deierminants The into the parents. in all kinds of abuse; whether or not the actual parents did so is a different matter'
A patient,s disturbed relationship to reality may often be reveaied bv their
frequent
misperceiving and misremembering of what the therapist says' With some patients I an-t frequently astonished and horrified when thev quote back to me what thev believe I have said what I remember saying, but or-r io-" previous occasion; often this may sound not only uniike also unlike anything I could imagine myself ever saying'
Concluding comments i began r,t,ith a plea for a tolerance of uncertainty and I.return.to this. Cognitive psychologists (anJ therapists with sirnpler rnodels of mental life, derived from but different from
psychoanalvsis) may belie.,.e they knoll'what is going on in these debates about memory. i claim ihe right and the rnental space not to have to pretend to know (to pretend to myself or to others). I realiy do not knolr, -what to rnake of recorrered memories as they arise in clinical practice, nor horv 5est tc respond to these therapeut.ically. This uncertaintY is not comfortable - but false certainty .or-, o^iy iead to delusion ancl turmoil ancl the most appalling professional fighting, ,clrch as lve find currently in the USA.
