Truths that heal

THE issue of repressed memory has been raised in the national media recently, partly associated with the royal commission’s investigation into institutional childhood sex abuse.

There are questions about the worth or appropriateness of therapy techniques that encourage recollections of past abuse.

It has been questioned whether trauma victims can truly forget events that are usually recalled all too vividly.

A related issue is whether therapists can unwittingly implant false memories of abuse by being overzealous in seeking evidence for them.

Having seen hundreds of clients for psychological trauma, including sexual abuse and war trauma, I find much of the commentary disturbingly simplistic and naive.

There is a huge amount of documented evidence over the past century for the existence of psychogenic amnesia, or spontaneous forgetting of stressful personal experiences.

Indeed, one of the defining symptoms of post-traumatic stress disorder is the inability to remember key features of a traumatic event.

This PTSD symptom, as others, is based on long-standing objective research. Another well-established research finding is that many PTSD sufferers can benefit greatly from exposure-based therapy, meaning they are encouraged to directly recall the traumatic situation and associated painful emotions.

This helps further process the trauma memories, defusing their emotional impact. In my experience few therapy interventions can lead to such profound benefit so quickly.

Any trauma therapist worth their salt knows that one of the potential complications of exposure therapy is that other related, or even unrelated trauma memories can be triggered that were previously forgotten. For example, one war veteran I was treating suddenly reported a memory of sexual abuse by a family member that he had not recalled since childhood.

This helped us make much more sense of his disturbing reactions and behaviour in many other situations. His recollection was supported by his wife’s report of what other family members had confided to her.

Many experienced trauma therapists would know of dozens of such situations where clients have reported spontaneous recall of distressing circumstances that they had previously forgotten.

Sometimes the recovery of trauma memories is of huge benefit. For example, one Vietnam veteran with severe PTSD told me he was sure that he had forgotten something signifi- cant that might be a key to his recovery. He urged me to offer him a therapy intervention that might uncover whatever that might be. Despite being fully aware of the fallibility of memory and the potential for people to recall false as well as true details, there seemed little to lose. He was so distressed and detached from family members he described himself as a piece of furniture in his house.

Soon after initiating exposure-based therapy, he described a disturbing recollection of launching a grenade he believed had deflected off a tree and fallen a short distance away, potentially killing his friend, who had not survived the night.

Even though the truth of the situation could never be known, his recovered memory helped make sense of his inexplicable guilt and sense of unworthiness. He was more able to accept himself and his reactions. He went from being one of the most severely afflicted veterans to displaying an uncommonly positive level of recovery. He became much better connected with his family.

Evidently, recovered memories can apply to adults as well as children. It would likely have done him a great disservice to explain that I wouldn’t attempt to help him recover a potentially forgotten memory because it might not be completely accurate and I might inadvertently implant a distressing but false war memory in his head.

What has partly disturbed me over the years is the emphasis since the mid-1990s on the risks of therapists implanting false memories, rather than first highlighting the harm resulting from unacknowledged sexual abuse.

When several clinicians highlighted such concerns in local psychiatric services around 1990, the most senior clinician dismissively observed, “What’s all this about sexual abuse?” The most harmful aspect of psychological trauma is its invalidating effect on the sufferer. Many who have reported sexual abuse have been further invalidated and further traumatised. It seems that “false memory syndrome” is perhaps the only mental health syndrome that was not introduced by a professional. In fact the term was coined by an alleged perpetrator. How concerning is that! Chris Mackey is a Fellow of The Australian Psychological Society and has presented on psychological trauma at numerous international conferences