Thursday, November 13, 2014

What Hath Freud Wrought?

It feels new, modern and advanced. And yet, the idea goes back to Freud.  In fact, it was the basis for Freud’s first efforts to treat hysteria.

In his Studies on Hysteria Freud, along with his colleague Josef Breuer posited that hysterics were suffering because they had forgotten childhood sexual traumas. If only they could recall what had happened and recount it in narrative form they would be cured of their hysteria.

So Freud and Breuer claimed. They wrote up case studies in which their hysterics had been cured. In reality, as numerous scholarly studies have shown, they were lying.

Freud founded a new therapy on lies.

After a time, Freud did change his mind. He decided that it was not about sexual abuse but about fantasies. Even if the patient had been abused, a real event was not a necessary condition of the neurosis.

By Freud’ new idea hysterics were suffering because they refused to admit that they really wanted to be abused. It wasn’t repressed abuse, but repressed desire that was making them sick.

All good Freudians will tell you that Freud abandoned his first theory of forgotten traumas when he posited a theory of repressed desire. Apparently, it feels more pure and clean.

And yet, when Freud treated a man he called the Wolf Man two decades or so later he insisted that the patient’s problems derived from a forgotten a primal scene. In it, the Wolf Man, as a young child, had witnessed his parents copulating one summer afternoon.

After constructing this version of events, Freud insisted that the primal scene had really happened. For the record, the Wolf Man did not believe a word of it. He later told a journalist that it could not possibly have happened.

We can happily believe that Freud abandoned the theory of repressed or forgotten traumas, but his conduct of the case of the Wolf Man suggests otherwise.

Moreover, Freud’s theory of repressed desire was morally depraved in its own special way. After all, Freud was not denying that childhood sexual abuse had happened. He was saying that, even if it did happen, the problem was that the children in question refused to accept that they had really wanted it to happen.

(For a further account of this and other salient aspects of the history of psychoanalysis, see my book The Last Psychoanalyst.)

Either way, Freud began his career by constructing a compelling fiction, a compelling narrative explanation for hysteria. Eventually, he changed the terms of the narrative but he never gave up on the idea that the truth lay in narrative fiction, like the story of Oedipus.

One likes to believe that the therapy world has gotten beyond Freud. Yet, the notion that adults can be cured of mental illness by recovering memories of childhood sexual traumas came back from the dead some two decades ago. With a vengeance.

At Pacific Standard, Ed Cara (via Maggie’s Farm) fills in some of the more recent history:

THOUGH THERAPEUTIC ACCOUNTS OF repressed memories appear as far back as the days of Freud, it was during the mid-20th century that they garnered popular attention. In 1957, The Three Faces of Eve, a pseudobiographical novel written by two psychiatrists, presented the case study of a woman with severe gaps in her memory as a result of a traumatic childhood experience. Later, Flora Schreiber’s Sybil retold psychiatrist Cornelia Wilbur’s journey with the then anonymous patient Shirley Mason, and the uncovering of Mason’s suppressed history of abuse by her mother. With an Emmy-winning television adaptation coming shortly after the book’s publication in 1973, Sybil captivated the public’s imagination. Before long, the belief that memories of abuse could disappear from consciousness right after the abuse happened, and stay hidden for decades—only to be retrieved intact during therapy—became accepted wisdom both with the general public and many in the mental health community. This new theory of how the mind reacted to trauma gained momentum from the growing cultural acceptance that sexual abuse had long been underestimated and ignored.

Note well, Sibyl’s case was a captivating narrative, a story of redemption and recovery from severe mental illness.

It turns out that it was not all true. It also turns out that the diagnosis of multiple personality disorders leaves much to be desired.

And yet, the narrative was compelling. If it was not science, so what. Many people believed it and it was eventually used to persecute and prosecute hapless fathers and even more hapless childcare workers, both male and female.

Funnily enough, the idea produced something akin to mass hysteria.

Cara writes:

The therapeutic vogue for memory recovery in the early 1990s fueled a nationwide moral panic over ritual sex abuse, satanic cults, and other supposedly repressed traumas. Today, for most of us, the fad seems like a strange, self-contained, and very much closed chapter in recent cultural history.

You recall how nursery school teachers were prosecuted and sent to jail for having committed horrific sexual abuses. Kelly McMichaels, the Amirault family, the McMartin family… all were tried, many were convicted for having committed crimes that they could not possibly have committed.

It was not just overzealous prosecutors. Overzealous mental health professional took preschool children aside and convinced them that they had been sexually molested.

Once children learned the game they concocted some of the most appalling instances of sexual abuse. The problem was, if the abuse had really happened as it was described, it would have left marks on the children’s bodies. No such marks were found.

No one cared. The teachers were convicted anyway. Dorothy Rabinowitz reported on it in her book: No Crueler Tyrannies.

In his article Cara tells the story of Tom Mitchell, a man who was accused of having sexually molested his daughter. When his daughter Anna was being treated by therapists in an upscale treatment center outside of St. Louis, they induced her to believe that she had become anorexic because she had refused to remember that she had been sexually abused by her father. They also made her believe that she had multiple personalities.

Obviously, this was just the beginning:

Unbeknownst to Tom, in accordance with mandatory reporting laws, the facility had reported Anna’s accusations to Child Protective Services—including a long list of abuses that he allegedly committed against his daughter. Among Anna’s claims, Tom says, was that from a very young age, her father molested her on trips they took, and eventually at their home—while the rest of the family slept. Upon learning of Anna’s letter, her mother obtained an emergency order of protection, barring Tom from having any contact with his daughter. According to Tom, Anna claimed her terrifying encounters remained hidden in her unconscious until she got to Castlewood, where grisly recountings of trauma by other patients, and sessions with her primary therapist, brought them bubbling to the surface.

Thus was Tom Mitchell declared a danger to children, and thus began his effort to restore his reputation.

Eventually, he succeeded in having his name struck from the registry of sex offenders, but his daughter still believes in her multiple personalities and refuses to have any contact with him.

While a considerable number of credentialed therapists fell for this recovered memory narrative, others, notably Elizabeth Loftus examined the problem scientifically and drew a very different conclusion:

Psychologist and memory expert Elizabeth Loftus, then at the University of Washington, was already an expert in how memory—particularly in the context of eyewitness testimony—was malleable to suggestion and social influence. Her studies suggested that people could be guided toward unequivocally false recollections. In 1994 she published a book, The Myth of Repressed Memories: False Memories and Allegations of Sexual Abuse, challenging the fundamental tenets of recovered memory therapy. People don’t recall the past, she argued, but reconstruct it, molding it to the demands and beliefs of the present moment. Therapists’ assumptions that their clients held hidden memories of abuse, she asserted, could be a key factor in creating those very “memories.” Other researchers found that, contrary to the proponents’ theory of traumatic repression, people who had survived various atrocities like the Holocaust, torture, and natural disasters did not appear to have the ability to seal away a memory after a traumatic experience, keep it locked away, then recall it with clarity.

As for multiple personality disorder, the research tells a different story:

In 1992, Harold Merskey, a professor of psychiatry from the University of Western Ontario, published a paper in the British Journal of Psychiatry in which he examined all cases of multiple personality disorder-like symptoms in the historical record—and couldn’t find one that wasn’t contaminated by suggestions from clinicians or other forms of social encouragement. “It is likely that MPD never occurs as a spontaneous persistent natural event in adults,” he concluded. “Suggestion, social encouragement, preparation by expectation, and the reward of attention can produce and sustain a second personality. Enthusiasm for the phenomenon is a means of increasing it.”

Eventually, the therapy profession got over its infatuation with the theory of recovered memories.

Cara explains:

By the end of the 1990s, many of the trauma clinics that had specialized in recovered memory therapy had shut down. The daytime talk shows about satanic abuse and multiple personalities became less frequent, and the courts became wary of testimony based on recovered memories. Richard McNally, the director of clinical training in the Department of Psychology at Harvard and author of the book Remembering Trauma, put it bluntly in a friend-of-court brief: “The notion that traumatic events can be repressed and later recovered is the most pernicious bit of folklore ever to infect psychology and psychiatry.”

Keep in mind, the infection was first produced by Freud.

1 comment:

Ares Olympus said...

A few years ago, I read a book by by Donald Kalsched, The Inner World of Trauma: Archetypal Defences of the Personal Spirit.

It helped me see something about what trauma was, specifically it clear isn't simply about external events, but how we process events.

So Donald's model I think was around the idea of splitting, and when something happens to us that is psychologically unacceptable, it causes an inner split between a sort of innocent side that needs to be protected, and a protector persona that you could say contained all our defense mechanisms that attempt to avoid that trauma source to ever happen to us again.

I also recall his experience is that the defender persona was not "educatable", so you could try to identify when it has taken control over a person, but it wasn't a voice you could reason with. Rather a therapist needed to help the client see that defender persona as something not "me", and not mentally associate with its POV.

Its a tricky idea at many levels, most of all because you might imagine there are "accurate" and "inacurate" defenders inside of us, and we need to be able to protect ourselves from dangers, without needing to rationally process a situation to completion.

PTSD is the most obvious example, with physical danger, and so in a wartime situation you need to have the vigilent warrior stance ready against danger, but if you don't have conscious control to disable that defender once real danger is over, then you're in danger of seeing enemies that don't exist, and filtering facts and information at the most primitive levels that reduces everything to black and white.

And I don't think its good to say physical or sexual abuse doesn't exist for children because we don't want to think about it, or because the symptoms from that in older children or adults are ambiguous and memories flawed through self-propaganda of loving one's abuser, or hating valid discipline by caregivers.

I don't know what the current theories are on repressed memories, but I certainly can see there are errors bound everywhere where one person tries to separate another person's fantasy from reality in described memories.

I only see there's a problem with arrogance, to believe any single general theory can clarify all truth, and lead all suffering to healing. It does look like psychology will always be an art rather than a science.

And it's not even clear if truth is needed to set people free. Repression exists, clearly as survival tactic, and it seems like some repressed memories can be reclaimed, and some are best left in the fog, at least if you can avoid that graveyard.

Oh, that reminds me of one of Jordan Peterson's Rules of Living:
32. Do not hide unwanted things in the fog.

The disappointment I find in my life as I read middle age is that people can actually avoid things that hurt them until they die, and maybe that's a bad strategy for the best life, but its a choice we all have, and the lucky or unlucky can succeed.