- The Washington Times - Sunday, April 20, 2003

REMEMBERING TRAUMA
BY Richard J. McNally
Harvard University Press, $35, 420 pages
REVIEWED BY RICHARD RESTAK

"How victims remember trauma is the most divisive issue facing psychology today," according to Richard J. McNally, professor of psychology at Harvard University in his informative and engrossing new book "Remembering Trauma."
On one side of the issue are those who believe that such things as rape, child abuse, wartime atrocities, and other traumatic experiences are never forgotten. They cite post-traumatic stress disorder (PTSD) as the paradigmatic example of how traumatic memories endure over a lifetime. Successful treatment according to the proponents of this view, requires medications or various forms of deconditioning aimed at reducing flashbacks, numbing and hypervigilance the core features of the illness.
Those on the opposite side of the issue claim that people react to traumas by excluding them from conscious awareness and, as a consequence, cannot remember their experiences. For example, therapists specializing in the treatment of "adult incest survivors" believe that the suffering of many distressed women and men (almost all of the studies have involved women) stems from amnesia for brutal sexual and physical abuses experienced during childhood. Treatment here, therefore, demands recovering and processing the hidden memories; healing through remembering.
Since Mr. McNally is an international expert on the subject, he directs most of his attention in this book to PTSD, which contrary to popular opinion rarely occurs in individuals who aren't afflicted with other psychiatric conditions, usually depression and alcoholism. Mr. McNally's research efforts have identified below average intelligence as another risk factor that explains why some trauma-exposed people are more vulnerable than others to the disorder.
Nor should we be surprised that those with lower intelligence are at higher risk for PTSD, according to Mr. McNally. "If general intelligence reflects problem-solving ability, then it is little surprising that higher intelligence is related to diminished risk for PTSD. Certainly, coping with the emotional aftermath of exposure to horrific events is a 'problem to be solved.'"
Aware that many readers may be put off by findings that appear to blame the victims for their plight, Mr. McNally reminds us "science cannot guarantee that data will always conform to our wishes, politics or ideological preferences. Sometimes it will, sometimes it will not." As he cautions, the only alternative to frankness about risk factors is ignorance, "and ignorance is an unreliable basis for treatment and prevention of any disorder, including PTSD."
But probably the most controversial aspect of PTSD is the current "conceptual bracket creep" whereby increasingly trivial events are considered sufficiently traumatic to trigger the onset of PTSD. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM IV) definition the causative event for PTSD must involve "actual or threatened death or serious injury, or a threat to the physical integrity of self or others."
Despite such stringent requirements, many of the people presently diagnosed as suffering from PTSD attribute their condition to experiences that many people wouldn't consider all that unsettling: being abruptly fired from a job, experiencing sexual harassment, living within a few miles of an explosion (although unaware that it had happened), being kissed in public, seeing the movie "The Exorcist," and (trust me, this is an actual case) accidentally killing a group of frogs with a lawnmower.
Granted, such experiences may sometimes result in various degrees of emotional trauma, it seems a stretch, at least to me, to equate them with threats of death or serious bodily injury. Certainly, many of the factors that now qualify as PTSD precipitants would be considered only minor irritants in earlier eras.
"The threshold for classifying an experience as traumatic is lower when times are good. In the absence of catastrophic stressors … specialists in traumatic stress turn their attention elsewhere, discovering new sources of victims of previously unrecognized trauma," according to Mr. McNally.
In addition, as Mr. McNally makes clear, one doesn't have to concentrate on PTSD or alleged "Incest survivors" to discover a vast discrepancy between popular notions about memory and how memory actually works. A moment's reflection on one's own memory failures confirms that memories don't remain encoded within the brain like a tape placed within a VCR but can be lost, drastically altered, even created.
Thanks to the work of social ecologist Elizabeth Loftus and others we now know that people can even be made to believe in the reality of childhood experiences that never happened. Examples include being lost in a shopping mall, being rescued from drowning by a lifeguard, or surviving a vicious attack by a dog. In one especially fascinating example a researcher created a fake picture purportedly taken years earlier of a child and a grown relative sitting together in a hot air balloon. Despite the fact that such a trip had never occurred, 50 percent of the adult subjects shown such a fictitious picture of themselves taken during childhood recalled a trip in a hot-air balloon. Some of them even supplemented their narrative with vivid details of the "trip."
Such findings in "normals" cast serious doubt about the reliability of childhood and infant recollections of abuse dredged up years later by alleged "victims" in response to inquiries from their psychotherapists. Further, careless and subtly intimidating interviewing techniques by the therapists and law enforcement have been shown in several instances to create rather than elicit memories of abuse. And there is final reason to be suspicious about memories about alleged traumatic experiences during infancy. The infant brain is insufficiently developed to encode memories and, in the absence of encoding, retrieval is impossible.
Nor is the situation much better during early childhood. Most perfectly normal people cannot remember events happening to them before 3 or 4 years of age. In fact, fewer than 10 percent of childhood episodes recalled by adults occurred prior to their fourth birthday, with a substantial proportion of adults remembering hardly anything that happened to them before the age of seven.
Therapists specializing in the area of "recovered memory" ignore these awkward facts about memory and claim that the abuse sufferer has "repressed" the traumatic event. As Mr. McNally points out, this is highly unlikely since, as with PTSD, terrifying events remain highly memorable. What's more, harm can result from attempts to dredge up memories of events that either never happened at all, or happened so early in life that the brain wasn't mature enough to encode them. The more psychotherapy patients try to remember their childhood, including suspected incidents of abuse, the more surprised they will be by how little they remember. Mistakenly believing that other people can remember their childhoods much better, these patients are likely to claim substantial amnesia for their childhood. They may conclude that something terrible must have happened that caused them to suppress it.
Mr. McNally also makes a useful distinction between a willful failure to think about something (put it out of mind) because of the painful memories it arouses, and being unable to remember the experience. "Not having something come to mind for a period of time is not the same as having amnesia for the experience," writes Mr. Mc Nally. "The notion that the mind protects itself by repressing or dissociating memories of trauma, rendering them inaccessible to awareness, is a piece of psychiatric folklore devoid of convincing empirical support."
Although "Remembering Trauma" is sometimes overly pedantic and includes more citations from the psychological literature than the average reader may be interested in pursuing, I highly recommend it to anyone curious about human memory and its vicissitudes.

Richard Restak is a neurologist and neuropsychiatrist who has written on medical ethics, neuroscience and behavior. His books include "The Brain" and "The Mind."


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