Memories of Child Sexual Abuse: A Response to Lindsay, Read

Applied Cognitive Psychology. Vol. 8, 379-387(1994)

Authors: Lucy Berliner, Linda Meyer Williams

Lindsay and Read make a mostly scholarly argument that what is known about the weaknesses of memory and the characteristics of some therapeutic approaches may provide the necessary ingredients for certain individuals to come to believe falsely that they were abused in childhood. Presumably Lindsay and Read's critique is concerned with what has been called abuse-focused therapy. This approach is predicated on the idea that current psychological distress may be related to prior traumatic events and that directly addressing the feelings and beliefs about the experience can be helpful in reducing symptoms (Briere, 1989, Herman, 1992) Recalling the experience during therapy is usually considered an important element of the process. It is the presumed emphasis on remembering which seems to be the target of the cognitive psychologists and memory researchers. This emphasis also has been critiqued by psychotherapists (Haaken and Schlaps, 1991), who suggest that such a focused approach may detract from other important therapeutic issues, ignoring other important life events and relationships.

Many of the points the authors make are reasonable. Memory is not perfect: it is the rule that more is forgotten than is remembered. It is common for people to have no clear, detailed memory for much about their childhoods. Memory can be influenced and distorted. It has been demonstrated in laboratory studies that subjects can be persuaded to believe they remember hearing and seeing things which they have not and even to having had experiences which they have not. Further, subjects can convincingly describe, and often strongly believe, these inaccurate memories.

Variables associated with suggestibility have been identified. Certain individual contextual and probably societal factors increase the likelihood that memory can be influenced. Of particular relevance to adult memories of abuse are: the passage of time, an influential interviewer seeking to confirm a preconceived idea, repeated interviewing and individual differences in monitoring and critically analyzing information. The current zeiteist in which there is a great deal of exposure to the idea that abuse is common and that it explains many problems of adult life may also be an important contributor.

Some or all of these factors may be present when highly distressed individuals enter therapy with a therapist who believes most psychological symptoms can be attributed to a sexual abuse history, that many survivors "repress" their memories of abuse, that remembering the experience is a central task of therapy and who engages in specific practices designed to elicit such memories. Lindsay and Read conclude that a certain co-occurrence of these variables in come equation will lead some individuals to come to believe falsely some or all of the abuse experiences they say they recall.

Lindsay and Read's arguments are strongest when they rely on the most basic scientific research which has been conducted on the properties of memory. Much of this is not disputed. The argument is less persuasive when based on research which was specifically designed to demonstrate weakness in child and adult memory in analogue situations purportedly similar to child abuse investigations and therapy. In these studies researchers often conclude that they have problems of ecological validity. Some such studies are cited authoritatively even though there was no peer review or scientific scrutiny.

For example, Bruck, Ceci, Francouer, and Barr (in press) found that after a year of repeated false suggestions, they were able to convince some very young children that it was the doctor, not the assistant, who gave them an injection and to persuade some children who had been upset at the time that they really were not. This is offered as evidence that it is quite easy to mislead children about personally salient events and therefore statements about abuse are suspect. In another example, the informal effort by Loftus (1993) to implant memories has been touted as a scientifically conducted study which proved the ease of creating memories for traumatic events. In that case a "memory" for a universally feared and high base rate childhood event (separation from a parent), which was actively confirmed by an older family member who claimed to have been present, was produced in five convenience subjects. Or that, an apparently successful attempt by a highly skilled interviewer to suggest a plausible event to a man who had just confessed to other acts of sexual abuse (Ofshe, 1992) proves that false confessions to crimes are easily induced. It is not that reports such as these examples do not demonstrate that memories can be influenced. Rather the investigators exaggerate the significance of such examples in drawing conclusions about abuse allegations. Lindsay and Read's apparent acceptance of these conclusions weakens their position.

One of the most curious aspects of the scientific literature on the memories of events from childhood is the recurring tendency for cognitive psychologists to rely on interesting, but strictly anecdotal accounts of supposed wrongly recalled events from childhood. Stories about Piaget, Mark Twain, or a friend or relative abound. Lindsay and Read engage in this practice as well. At the same time that these critics employ anecdotes in support of their arguments for the fallibility of memories of early childhood events, they seem to ignore or downplay some important findings based on larger samples and more sophisticated research designs. For example, Usher and Neisser (1993), in their research on childhood amnesia, report on 222 college students' memories. They found that the subjects' mothers judged most of their children's memories as accurate. The study provides evidence for accurate memories from substantially earlier ages than has previously been reported and suggests that certain significant events of early childhood, such as the birth of a sibling are more likely to be remembered. There is certain selective use of research to support the following illogical argument: If abuse really happened, it would be remembered all along, and as many of the reported memories are for experiences from very young ages, this proves the memories are false, because people ordinarily cannot recall early events.

We concede, however, the general premise that some individuals, under certain conditions, may come to believe they are abused when they were not and that not all of what all survivors report is literally true. What is disputed is the extent of the problem. Although Lindsay and Read make a point of distancing themselves from some of the more strident critics, we question the evidence for claims that false beliefs of abuse are common or that most of the adults who have recalled memories of abuse did so while in therapy or that most victimization therapists hold the views or engage in the practices which are described by Lindsay and Read. For the most part, the bases for Lindsay and Read's assertion about these points are anecdotal. Popular press accounts, self-help books, statements from aggrieved parents and testimonials from so-called retracters are the primary sources of data. It is particularly ironic that statements from retractors are considered credible when they deny abuse and allege misconduct by therapists, but incredible when they claim to have been abused.

Lindsay and Read's treatment of the extant scientific efforts to understand the phenomenon of not remembering abuse is unduly critical. After all, there are only a handful of reports on the topic due to the recency of the discovery that many victims report periods of not remembering. Herman and Schatzow (1987) should be commended for their early effort to systematically examine a complicated and not well understood concern of abuse survivors who reported prior periods of amnesia for the abuse. Briere and Conte's (1993) single question in a lengthy questionnaire was not designed to be the definitive investigating of psychogenic amnesia. Fifty-nine percent of a sample of 450 women and men in therapy for sexual abuse reported that there had been a time before they turned 18 that they "could not remember the forced sexual experience". While it may not be entirely clear what the respondents meant when they reported "not remembering" for some period of time, it is of interest that there were significant differences found in the type of abuse experience for those who said they had not remembered and those who claim they had always remembered. For example, those with prior periods of forgetting abuse were younger at the time of abuse and had experienced more violent assaults.

Reverse record check methodologies can, perhaps, shed the most light on the possibility of not remembering actual abuse. Lindsay and Read's treatment of the two studies they cite that used this technique (Femina, Yaeger, and Lewis, 190; Williams, in press) does not accurately reflect the studies or their findings. And Lindsay and Read did not have opportunity to review another important contribution to this literature. Widom and Morris (1993), in a major longitudinal follow-up of documented child abuse cases (physical abuse, sexual abuse, and neglect), found a substantial proportion of the sample failing to recall the sexual abuse experience.

Lindsay and REad claim that Femina et al, (1990) found no evidence of women becoming totally amnesic for their abuse. But Lindsay and Read do not make it clear that the study by Femina and colleagues concerned adults' reports of physical (not sexual) abuse. Contrary to their assertion that the subjects were all women, the study included both men and women who had been incarcertated during their youth. The researchers compared information from case records with the subjects adult reports of physical abuse and found that 18 (26 per cent) denied or minimized the abuse experience. What Lindsay and Read fail to mention is that the critical subsample in this study was very small and did not disprove the possibility of amnesia. In fact, only eight of the 18 subjects who denied the abuse experience were recontact\ted for the clarification interview to determine whether they were simply denying the event or had actually forgotten it. Femina et al. made no statements about lack of evidence for amnesia because they knew nothing about the reasons for non-reporting by the majority of the subjects. Some of those cases may represent some form of amnesia or true lack of recall. Furthermore, on of the authors' conclusions is that information from adults about possible childhood abuse is often an underestimate of what actually occurred, not exaggeration or confabulation as the cognitive psychologists so often claim.

The Williams (in press) data are not,a s Lindsay and Read argue, only generalizable to forgetting of single episodes of abuse. some of the women who did not recall the sexual abuse had experienced repeated victimizations by the same offender. Williams found that 38 per cent of a sample of 129 women with documented histories of child sexual abuse did not recall the abuse on reinterview, 17 years post abuse. To assure a conservative estimate of the proportion who did not recall abuse, when a woman reported any instance of sexual abuse by the original offender (even if it was reported to have occurred long after the abuse event which brought her into the study), she was classified as having remembered the abuse and not counted in the 38 per cent who had no recall of the original abuse. Many of the women also reported other child sexual abuse experiences. Lindsay and Read focus on Williams' finding that "only" 12 percent of the women denied ever having been abused to bolster their conclusion that forgetting a history of child sexual abuse is possible but far form normative. but this focus detracts from the importance of the finding that a significant minority (38 per cent) had no recall of their documented history of child sexual abuse. Additional findings (Williams, 1993), which Lindsay and Read did not have the opportunity to review, reveal that a full 47 per cent of the sample experienced some period of no recall, that is, when the calculations include the proportion of women who now recall their abuse but who report there was a time in the past when they did not recall it.

Interestingly Lindsay and Read concede that not remembering abuse experiences via "normal forgetting", repression or other hypothesized mechanisms' is possible and probably occurs in some cases. Additional data from the Williams (1993) study provide further support for the idea that when previously forgotten experiences are subsequently recalled, they contain many of the characteristics of remembering noted in clinical settings. The women's memories did not come from therapy, but through environmentally triggered cues. The women reported a gradual process of remembering, often initially characterized by vague and fragmentary images. Many said these images were contained in dreams. Although the women who recovered memories were often not highly confident about their memories when their accounts of the abuse were compared to earlier documentation of abuse, they were accurate. In fact, their memories were compared to earlier documentation of abuse, they were accurate. In fact, their memories were as reliable as those of the women who had always remembered their abuse.

It is apparent that many abuse survivors report periods of not remembering (Briere an Conte, 1993); Herman and Schatzow, 1987; Loftus, Polonsky, and Fullilove, 1994, Williams, in press). There are likely to be a variety of explanations for this. In some cases the experience may not be remembered for the usual reason that it was not terribly important and a long time had passed. In cases of relatively less dramatic experiences, especially in lives full of other traumatic events, an episode or two of sexual touching by someone unimportant may simply be forgotten. Probably far more often, the aversiveness of the experience leads victims to engage in active strategies to avoid the memory, which over time may cause the experience to recede, until it is only accessible with certain stimuli (Briere, (1992). But it is also possible that memories of sexual abuse might be encoded, stored, and retrieved differently than other memories (van der Kolk, in press), especially when the abuse occurs under circumstances of high arousal, terror, extreme ambivalence, where escape is impossible, or when the meaning of the abuse, if confronted, could be devastating. The concepts of repression or dissociation as psychologically motivated defenses against knowing cannot be dismissed as fantastic. That the mechanism that might explain such phenomena have not yet been demonstrated in laboratory studies doesn't not make them impossible.

Cognitive psychologists seem to be arguing that current theories and principles of memory can fully account for all of the ways that memory might work. but there have been many scientifically hypothesized phenomena that were not proven until long after their existence was postulated. For example, in the field of physics, scientists have come to believe in certain elements (e.g. atoms) or processes (e.g. the big bang) based on inference rather than laboratory proof and to accept that sometimes the classical laws do not apply (e.g. quantum mechanics). It is perfectly legitimate and scientifically acceptable to make a conceptual or logical argument to explain an observed phenomenon. this applies, as well, to theoretically derived hypotheses about repression. The often-quoted statement that 60 years of research on repression has failed to prove its existence (Holmes, 1990) does not reflect modern interest in scientific exploration of the responses to trauma.

It is unclear why cognitive memory researchers seem so uninterested in pursuing research to clarify further how complete lack of recall occurs, even if it happens in only a small number of cases. In fact, they seem anxious to reduce that possibility to the smallest number of cases and the most limited type of circumstance. Instead of speculating about what accounts for the subset of subjects in the various studies where not is documented, the emphasis is almost entirely restricted to how illusory memories might be created. For example, the major response to the Williams study is to contend that while amnesia for an isolated event might be possible, not remembering repeated events is implausible. It would seem likely that better understanding of lack of recall for single traumatic events might lead to insights about not remembering repeated significant events.

It is hard to escape the conclusion that many cognitive and memory researchers have been drawn into the social and political context of the controversy about memories of child abuse instead of remaining focused on the scientific questions. This impression is reinforced by the repeated expression of concern about the tragic consequences of false allegations, and assertions that this is a problem of huge magnitude. The history of cognitive psychology's involvement in matters pertaining to witnesses and victims has almost always focused on the weakness of memory and the dangers of believing witnesses (Loftus and Ketchum, 1991). Why is it that the number of prominent memory researchers who have joined the scientific advisory board of the False Memory Syndrome Foundation far outstrips the number who are active in the child abuse or victimization field, where the issue of memory is equally important?

On the other hand, one aspect of this debate has been handled with far more grace by Lindsay and Read than has frequently been the case. Unlike many critics, they have gone out of their way to avoid the denigration of therapists and psychotherapy that has so often characterized the argument of other commentators (e.g. Ofshe and Watters. 1993). But the ongoing dispute in the psychology community between the academic researchers and the clinicians is an important subtext to this entire controversy. This issue serves as the perfect vehicle for the expression of a barely disguised contempt for the principles and practices of the therapeutic community (Dawes, 1991). It can hardly be surprising that many therapists and victimization researchers had reacted defensively or on occasion overstated the case in the face of such derision.

An important element contributing to the polarization has been the offensive characterization of those reporting abuse experiences. The clear implication of the critics has been that these clients are neurotic or histrionic individuals who are seeking a simple external solution to problems which allows them to escape personal responsibility for their current unhappiness. they read a book or watch a television program, then are manipulated and brainwashed by incompetent therapists who assume control over their lives. This is insulting and disrespectful to the many individuals who have uncovered unbearable experiences and found comfort in confronting them and eventually moving beyond the legacy of their past. It is to Lindsay and Read's credit that they affirm that the problem of falsely believed abuse memories is far smaller than that of real victims who may not be believed.

The political aspect of the debate can also be seen in the not-so-subtle thread of sexism often woven into the argument. Most often the critics describe young professional women who enter therapy with other young professional women and emerge with suddenly constructed memories. On of the arguments is that these women suffer from unresolved hostile dependence on powerful (but non-abusive fathers) and find soul mates in their therapists who may have their own unresolved abuse experiences (Ganaway, in press). In spite of the fact that mainstream psychiatry endorses the notion of psychogenic amnesia, as evidenced by its inclusion in the DSM III-R (American Psychiatric Association, 1987), it is not the American Psychiatric Association that has taken the brunt of the attack about this phenomenon, but the large cadre of mostly female, lower status, masters level mental health professionals who provide most of the mental health services in the U.S.

This is not to say that there are no incompetent, ill trained, or poorly supervised therapists. It is clearly outside standards of clinical practice to embark on a campaign to convince a patient who has no memory of being abused that he or she was. And it is true that some therapists make the mistake of attributing far too many current problems to a sexual abuse history. Obviously many part traumatic events as well as current conflicts might produce depression, anxiety, poor self-esteem, substance abuse or a host of other psychological difficulties. And there are clearly dangers in assuming that dreams must reflect real experiences or that hypnosis always produces accurate recollections. The responsible therapy community is well aware of these facts, as evidenced by statements by professional societies (American Psychiatric Association 1993).

Lack of rigor or failure to uphold standards of practice in any profession need to be addressed. Indeed, the various professional societies are currently engaged in developing guidelines for practice with regard to therapy and trauma memories (American psychiatric Association 1993). And there is no doubt that professionals working in the abuse field are willing to attend to the criticisms. The best example of this is the response of child abuse professionals to concerns about interviewing children about possible abuse. No topic has received greater attention recent years at seminars and conferences than the importance of proper interviewing techniques. Unfortunately, Lindsay and REad seem to contend that even if therapists try to be attentive and careful, they will still be subject to unconscious biases.

While there is evidence based on laboratory studies for the fallibility of memory, suggestibility and inaccuracy, it has not been proven that full-blown memories for traumatic childhood experiences can be created from nothing. When Lindsay and Read trot out the base rate argument and assume what they consider a charitably low rate of diagnostic error (10 percent), they conclude that an alarmingly high proportion of all clients without abuse histories will be persuaded that they have been abused. This is a speculative and unsupported argument which assumes that such a process is possible and relatively easy to accomplish. It is inflammatory to make such arguments without more factual evidence.

Finally, Lindsay and REad raise several questions about the fundamental value of remembering and dealing with memories as a helpful aspect of resolving the effects of early traumatic experiences. Their implication is that as they are aware of no evidence for its value, perhaps it is better not even to screen for possible abuse, much less probe intentionally for possible abuse memories, because of the presumed likelihood of false positives. Yet there is solid support for the contention that exposure to traumatic memories can reduce symptoms through a process of habituation (Foa, Rothbaum, Riggs, and Murdock, 1991, Resick and Schnicke, 1992). These controlled treatment outcome studies found that interventions with entailed repeated, specific recalling of the rape or assault experience produced significantly greater improvement when compared to other interventions which did not focus as directly on the victimization experience. This research has applied standard, scientifically proven therapeutic strategies which have demonstrated effectiveness in reducing anxiety.

What is perhaps most revealing about the disagreements between the cognitive psychologists and the professionals (clinicians and researchers) concerned with victimization is the focus of interest. The cognitive psychologists who have become involved with this issue appear to be primarily interested in further confirming the fallibility of memory and the possibility that false memories of abuse can be created. Trauma therapists and researchers are more concerned with understanding the mechanisms which produce memory loss and impairment. The dispute would be far less polarized if the cognitive psychologists would devote some of their talents to help clarify the effects of trauma on memory as well as pointing out the dangers of some clinical practices.

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