International Society for Traumatic Stress Studies

Book Review: Memory Wars Featured in Trauma Book

Posted 1 October 2003 in StressPoints by Frank Putnam

This past summer I took a copy of Richard McNally's Remembering Trauma to the beach. Like a good beach read, the book held my interest, and I found time for a chapter or two every day. McNally is a seasoned PTSD researcher with a great deal to say. The tone is generally reasoned, but sometimes becomes angry. Whether his anger is viewed as justified or merely as self-righteous defines yet another fault line in the epistemological landscape of the memory wars.

He does, however, conduct an informative tour of the territory. McNally is at his best when articulating the issues and critical questions that divide the warring camps. The thrust of the book revolves around his reading of the scientific data on these issues. He is angry about a number of things, most notably: 1) the broadening conceptualization of PTSD, which he calls "bracket creep"; 2) the concept of traumatic amnesia; 3) the treatment Rind et al. (1998) received at the hands of their critics; and 4) the "implantation" of false memories of trauma in susceptible individuals. You do not have to see things McNally's way to learn from this book, but be prepared to become a little angry yourself.

Although the first and last chapters tend to cast things in black and white, a careful reading reveals some grudging admissions that show McNally knows it's not as simple as that. In chapter 3, for example, he truly wrestles with what constitutes psychological trauma. How do we measure it? Is it dose sensitive? Does trauma cause PTSD? Are there risk factors that predispose certain people to become traumatized or increase their vulnerability/resiliency to traumatic experiences? Despite his objections to the subjective definition of what constitutes a DSM-type traumatic stressor, he nonetheless opines, "Taken together, these findings highlight the importance of a person's subjective appraisal of an event for determining whether the event will function as a traumatic stressor" (p. 99).

In much of the book, McNally actually hedges on whether traumatic amnesia and subsequent delayed recall ever occur, using words such as "rarely" to suggest that it could happen on occasion. He summarily rejects as "fatally flawed" the clinical and general population studies advanced by proponents of traumatic amnesia because they did not verify that the recalled trauma actually occurred-despite the fact that elsewhere he admits to having difficulty corroborating past trauma in his own research. The only examples he seems to accept as legitimate are case studies by Schooler, which he takes pains to differentiate from a number of similar cases offered by clinicians for the past two centuries. Although he has a great deal to say in criticism of Freudian theory and the notion of repression, he avoids taking on dissociation directly. Rather than grapple with the hundreds of empirical studies that link dissociation with trauma, he simply dismisses it as an implausible theoretical construct, despite the fact that dissociation is as well-measured a psychiatric construct as depression or anxiety and has been shown in laboratory studies to uniquely influence cognitive and physiological responses to traumatic reminders.

McNally's blind spot for dissociation perhaps is exemplified best by his inadvertent misstatements about a study by Goodman et al., (2003). He reports that her data show that subjects with higher dissociation scores were more likely to remember their abuse (p. 209). The study actually found that dissociation was a significant predictor of non-disclosure and concludes that "More dissociative individuals were less likely to disclose" (p. 117). While this is one of the more glaring errors in the book, there are other instances in which research findings are selectively reported or misinterpreted proving that no matter how scientifically "objective" we believe ourselves to be, we all are subject to misreading data in ways consonant with our cherished hypotheses.

The Rind et al. meta-analysis is another battleground in the memory wars. Perhaps we should turn it into a DMZ by burying the pertinent data in a time capsule and letting a future generation of researchers take a look. Having witnessed some of the action at close hand, I can say that it was not the black and white miscarriage of justice portrayed in the book. I too deplore the intrusion of politicians into what should have been a scientific debate, but it should be recognized that their intrusion is part of a larger trend in our society. Sciences of all types are becoming increasingly politicized as their data are dragged into bitter social and political struggles. This is worrisome, as it undermines the most powerful tools that society has--scientific paradigms--to generate new and useful knowledge.

The issues and data relating to the "implantation" of false memories likewise are far more complex than is evident in the book. As I have said for more than a decade (e.g., Putnam, 1991), there is scientific evidence that false memories do occur and that some techniques such as hypnosis can heighten this process. That said, it becomes a question of how much and how often this happens in clinical and forensic settings and how we distinguish pseudomemories from the legitimate cases of delayed recall, which also clearly occurs. McNally relies heavily on laboratory studies of directed forgetting and the DRM paradigm to investigate proneness to form false memories. Strong arguments can be made that such word list studies--irrespective of whether the lists include traumatic or sexual words--are not particularly valid ways to study memory for past traumatic events, which, as McNally acknowledges, often involve multimodal sensory components. Nonetheless, using a more sophisticated divided-attention, directed-forgetting paradigm, De Prince and Freyd (in press) have shown that high dissociation subjects have significantly impaired memory for trauma-related words. Anyone who has followed memory research for a decade or two recognizes that the field continues to evolve rapidly with many new distinctions being made about the function of the currently identified, multiple memory systems. Scientific knowledge about how powerful memories for traumatic events are encoded, stored and retrieved remains in its infancy, and claims of closure are premature.

While this book is unlikely to be on many summer reading lists, it is deserving of attention by ISTSS members. ISTSS figures prominently in McNally's historical account of how we arrived at the current state of affairs, and many prominent ISTSS members are mentioned--not always kindly. In many respects the book is an impassioned political position statement about PTSD, dissociation, trauma and memory that could become influential with respect to drafting of the DSM-V, rumored to be in the works. It is ironic that the DSM, originally developed to "objectify" psychiatric diagnosis, has itself become the target of the intense political struggles around the legitimacy of various disorders, PTSD and DID included. One only hopes that whoever is entrusted with formulating the next version is worthy of the Solomonic task of weighing the voluminous empirical data on these issues--for the DSM may yet become the apocalyptic battleground of the memory wars.

References
Dallam, Stephanie J., Gleaves, David H., Cepeda-Benito, Antonio, Silberg, Joyanna L., Kraemer, Helena C., and Spiegel, David. (1998). The effects of child sexual abuse: Comment on Rind, Tromovitch and Bauserman. Psychological Bulletin, 127. 715-733.

DePrince A.P., Freyd J.J. (in press). Forgetting trauma stimuli. Psychological Science.

Goodman G.S., Ghetti S, Quas J.A., Edlestein R.S., Alexander K.W., Redlich A.D., Cordon I.M., and Jones D.P.H. (2003). A prospective study of memory for child sexual abuse: New findings relevant to the repressed-memory controversy. Psychological Science, 14: 113-118.

Putnam, F.W. (1991). The satanic ritual abuse controversy. Child Abuse and Neglect 15: 175-179.

Rind, B., Tromovitch, P. and Bauserman, R. (1998). A meta-analytic examination of assumed properties of child sexual abuse using college samples. Psychological Bulletin, 124, 22-53.

Frank W. Putnam, MD, frank.putnam@cchmc.org.