University of Washington
Scientific work on memory distortion has captured the attention of the the wider mental health field, of the legal profession, and of the general public. One reason is this: In the last decade, hundreds if not thousands of patients have emerged from psychotherapy accusing their fathers and mothers, their uncles and grandfathers, their former neighbors, their former teachers and therapists, and countless others, of sexually abusing them years before. The patients often claim that they have repressed or dissociated the "memories" until various therapeutic interventions excavated the mental contents and made their presence known. After recovering these new memories, patients have confronted their alleged abusers, and sometimes taken them to court, forcing them to pay sizable sums in damages. In many cases, accused people have found themselves dragged through the criminal justice system, and occasionally, to their shock, sent off to prison.
One representative case received multi-page coverage in Time Magazine (Gorman, 1995). This "daughter against father" case was that of Laura B. who claimed that her father, Joel Hungerford, molested her from the ages of 5 to 23, including raping her just days before her wedding. She allegedly totally repressed all memories of her abuse until she entered therapy a couple of years later and the violent ordeals resurfaced. She recounted her detailed recollections in a small courtroom in New Hampshire in a 1995 criminal case against her father. In the United States, the vast majority of repressed memory cases have been brought in the civil courts.
In 1989, legislation went into effect in the State of Washington that permitted people to sue for recovery of damages for injury suffered as a result of childhood sexual abuse any time within three years of the time they remembered the abuse (Washington, 1989). The legislature invoked a novel application of the "delayed discovery doctrine", that essentially says that the statute of limitations does not begin to run until the plaintiff has discovered the facts that are essential to the cause of action. The argument in repressed memory cases was that the memory for abuse was hidden away - sometimes for decades- until it was ultimately discovered and only then does the plaintiff possess the facts that are essential to the cause of action. Washington State which gives plaintiffs three years from the time the victim discovered or reasonably should have discovered the abuse and its causal connection to adult psychological problems.(See Wash. Rev. Code Ann $4.16.340, West Supp. 1994).
Since Washington's original statute, at least 28 other states have adopted similar legislation. An excellent discussion of the positions taken by various state legislatures, and of their uncritical proclamations about the reality of repressed memories, can be found in a recent law review article. Of the 28 statutes, at least 25 provide for a period ranging from two to ten years to bring suit after the "discovery" of the sex abuse injury. (In Wisconsin it is two, in Nevada it is 10.) Several statutes do not follow Washington's model precisely, but instead provide for lengthened periods after a triggering event, such as the age of majority. (In Connecticut, for example, it is l7 years after the age of majority; in Idaho it is 5 years after the age of majority.) As a consequence of this recent legislative activity, juries are now hearing cases in which plaintiffs are suing their parents, relatives, neighbors, teachers, and others for acts of childhood sexual abuse that allegedly occurred 10, 20, 30 even 40 years earlier, but were only recently remembered.
Often after developing new memories, accusers also sue the cruise ship or day care or hospital or school where they claim that the abuse occurred. These cases are difficult to defend. Typically, defendants try to show the highly suggestive nature of the therapeutic process. Frequently that process of excavating the "repressed" memories involves invasive therapeutic techniques such as age regression, guided visualization, trance writing, dream work, body work, hypnosis, and sodium amytal (truth serum). One psychiatrist has explicitly cautioned that pseudomemories can result from "suggestion, social contagion, hypnosis, misdiagnosis, and the misapplication of hypnosis, dreamwork, or regressive therapies." (Coons, 1994, p 1377). Numerous research and clinical psychologists have raised grave concerns that these activities are fostering the creation of false beliefs and memories that implicate innocent people (Frankel, 1993; Hochman, 1994; Lindsay & Read, 1994). The "recovered memory" therapy that accomplishes this tragic ending has been called the "lobotomy for the 90s."(Ofshe, 1995, p. 21) - a reference to the pre-frontal lobotomy surgery procedure used by the medical profession in the 1940's.
This is not to say that people cannot forget horrible things that have happened to them; most certainly they can. But there is virtually no support for the idea that clients presenting for therapy routinely have extensive histories of abuse of which they are completely unaware. Yet an unfounded faith in the repressed memory ideology, has lead some clinicians to engage in practices that are risky if not dangerous in terms of their potential for creating false beliefs and memories. In numerous cases, patients have been encouraged towards litigation based upon these new-found recollections (Poole, Lindsay, Memon & Bull, 1995). Hundreds of civil plaintiffs have now taken advantage of new legislation and brought suits in which they claim their memories resurfaced in therapy.
A second wave of lawsuits has been brought by "retractors" who claim that they were led to believe they were sexually molested but now realize their memories are false. As of 1994, some 300 individuals had retracted their sex abuse allegations, some had sued their former therapists achieving six figure settlements or jury verdicts (Lindsay & Read, 1995). Invariably the process of therapy is on trial. The largest retractor verdict occurred in 1995 in a case against psychiatrist Diane Humenansky (deFiebe, 1995; Gustafson, 1995). Humenansky, a St. Paul psychiatrist, was accused of subjecting her patient to an increasingly suggestive and coercive program of mind- altering drugs, hypnosis, and threats designed to get her to remember abuse. The patient and her family were ultimately awarded over $2.6 million dollars, making this verdict the largest in the repressed memory domain to date for a retractor of sexual abuse allegations.
Subjects completed the booklets by reading what their relative had told us about each event, and then writing what they remembered about each event.
If they did not remember the event, they were told to write, "I do not remember this." When the booklets were returned, subjects were called and scheduled for two interviews. These occurred approximately 1-2 weeks apart. We told the subjects we were interested in examining how much detail they could remember, and how their memories compared with those of their relative. The event paragraphs were not read to them verbatim, but rather bits of them were provided as retrieval cues. When the subject had recalled as much as possible, they were asked to rate the clarity of their memory for the event on a scale of one to ten, with one being not clear at all and ten being extremely clear. In all, 72 true events were presented to subjects, and they remembered something about 49 (or 68%) of these. This figure did not change from the initial report through the two follow up interviews. The rate of "remembering" the false event was lower. Seven of 24 subjects "remembered" the false event - either fully or partially - in the initial booklet, but in the follow- up interviews only 6 subjects (25%) remembered the event. There were some differences between the true memories and the false ones. For example, subjects used more words when describing their true memories, whether these memories were fully or only partially recalled. Also, the clarity ratings for the false memories tended to be lower than for true memories produced by those same subjects. Interestingly, there was a tendency for the clarity ratings of the false memories to rise from the first interview to the second. Our results show that people can be led to believe that entire events happened to them after explicit suggestions to that effect. We make no claims about the percentage of people who might be able to be misled in this way, only that these cases provide an existence proof for the phenomenon of false memory formation.
A variation of this procedure has also been used with children whose ages ranged from 3 to 6 (Ceci, Huffman et al, 1994). They were interviewed individually about real (parent- supplied) and fictitious (experimenter-contrived) events, and had to say whether each event happened to them or not. One "false" events concerned getting one's hand caught in a mousetrap and having to go to the hospital to get it removed; another concerned going on a hot air balloon ride with their classmates. The children were interviewed many times. As for the false memories, the young children (3-4 years old) assented to them 44% of the time during the first session, and 36% of the time during the seventh session. The false event was remembered at a somewhat lower rate (25% in the first session, 32% in the seventh session) for the older children (5-6 years old). In another study, involving children of the same age but involving more interviews about different fictitious items (ie falling off a tricycle and getting stitches in the leg), the rate at which children bought into the false memory increased steadily with more interviews (Ceci, Loftus et al, 1994).
Taken together, these results show that people will falsely recall childhood experiences in response to misleading information and the social demands inherent in repeated interviews. The process of false recall appears to depend, in part, on accessing some relevant background information. Hyman and his colleagues hypothesized that some form of schematic reconstruction may account for the creation of false memories. What people appear to do, at the time they encounter the false details, is to call up schematic knowledge that is closely related to the false event.
Next they think about the new information in conjunction with the schema, possibly storing the new information with that schema. Now, when they later try to remember the false event, they recall the false information and the underlying schema. The underlying schema is helpful for supporting the false event - it adds actual background information and provides the skeletal or generic scenes. Imagination inflation One process that may play a role in the creation of false childhood memories may involve imagination. These experimental methods may be inducing subjects to imagine events that they don't recall having happened. To explore the impact of deliberately inducing subjects to imagine a counterfactual past, I and my collaborators have shown that one simple act of imagining a childhood event increases a person's subjective confidence that the event happened to them in the past - a phenomenon called "Imagination Inflation" (Garry, Manning, Loftus & Sherman, 1995). In this study, subjects were asked about a long list of possible childhood events (e.g., broke a window with your hand) and they told us the likelihood that these events had happened to them as a child. Two weeks later, subjects were instructed to imagine that some of these events had actually happened to them. And, finally, they responded for a second time about the likelihood of that long list of possible childhood events. Consider one of the critical items. "Imagine that it's after school and you are playing in the house. You hear a strange noise outside, so you run to the window to see what made the noise. As you are running, your feet catch on something and you trip and fall." While imagining themselves in this position, subjects answer some questions such as What did you trip on? They further imagine: "As you're falling you reach out to catch yourself and your hand goes through the window. As the window breaks you get cut and there's some blood." While imagining themselves in this predicament, they answer further questions such as What are you likely to do next." How did you feel? We confined their analysis to items that subjects explicitly said were unlikely to have happened in the first place. a one-minute act of counterfactual imagination led to positive changes in a significant minority of subjects. After engaging in this act of imagination, 24% of subjects increased their subjective confidence that something like this actually happened to them. For those who had not imagined the event, only 12% showed a corresponding increase. The other seven critical items used in this study similarly showed increased subjective confidence after imagination. These findings show that even a single act of imagining a known counterfactual event can increase the subjective likelihood that the event happened in the past. We and others have expressed concerns that imaginations may be one of the steps down the royal road to creating false memories. These findings suggest caution may be in order before therapists use or recommend imagination strategies for the express purpose of eliciting allegedly buried abuse memories.
Despite the lack of evidence, some therapists treat their patients' dreams as if this were the case, interpreting dream images as a reliable replication of past trauma. Such activities could be creating a problem for their patients in the following way. If therapists discuss a topic during a waking session, material about this topic may, as a consequence, get into the patient's dreams at night. When the dreams are discussed at the next waking session, and (mis)interpreted as if they are evidence of a traumatic past, the patient may come to falsely believe and misremember a past that never happened, except in the patient's dream. Numerous commentators have worried about the potential harm that can occur as a result of sexualized dream interpretation (e.g., Lindsay & Read, 1995). Can dream material be mistaken for reality? Guiliana Mazzoni and I recently reported on three experiments that show that after a subtle suggestion, subjects falsely recognized items from their dreams, and thought these items had been presented during the waking state (Mazzoni & Loftus, 1995). The procedure used in these studies involved three phases.
Subjects studied a list of items on Day l. On Day 2, they received a false suggestion that some items from their previously reported dreams had been presented on the list. On Day 3, they tried to recall only what had occurred on the initial list. Subjects falsely recognized their dream items at a very high rate - sometimes as often as they accurately recognized true items. They reported that they genuinely "remembered" the dream items, as opposed to simply "knowing" that they had been previously presented. These findings, which suggest that dreams can sometimes be mistaken for reality. Dream material might be especially problematic in the hands of a therapist who discusses sexual abuse during the day (causing sexual material to appear in the patient's dreams at night) and then uses dream material as a "resource" to reconstruct supposed past childhood sexual abuse. The danger that these questionable activities might lead a patient to a false belief and memory that sexual abuse actually occurred is more than a passing risk.
The study was designed to simulate certain features that are included in some questionable therapeutic settings. Subjects are given a credible rationale for why they most probably saw a mobile over their cribs on the day after they were born, and why they will probably be able to retrieve memories of the mobile. In the initial research by Spanos and his collaborator Burgess, many subjects reported remembering the mobile, whether they were hypnotized or simply age regressed without hypnosis.
Our adaptation of this procedure used subjects who were interviewed in a therapy clinic room with low light, recliner chairs, and a two-way mirror.
They filled out the "Princeton Personality Inventory", which was ostensibly scored by a computer, and were told that they demonstrated the profile of a "High Perceptual Cognitive Monitor." They were further told that this profile suggests that they most probably had visual experiences during a critical period shortly after birth, that they were probably exposed to a colored mobile hung over their cribs in the first few days after birth, the purpose of which was to stimulate coordinated eye movements and visual exploration. They were falsely told that the purpose of the study was to ascertain whether they were born in one of the hospitals that hung such mobiles. To determine this, subjects would under go "guided mnemonic restructuring" - a technique for uncovering early infant memories. They were regressed back to the day of birth, and instructed to see themselves as if looking at a mental TV screen, and to describe what they saw. If they reported the mobile, they were urged to focus and provide as much detail as possible. Afterward, subjects were age progressed and they answered questions about their experience, including an assessment of whether they believed their memories were definitely real, probably real, unsure, probably fantasy, or definitely fantasy. Approximately half the subjects were induced to develop memories not of the first day of life, but of the first day of kindergarten. This was accomplished with parallel false feedback that suggested that they fit the profile of a "High Perceptual Cognitive Monitor" probably due to being exposed to spiral disks hung in the classroom on the first day of kindergarten, designed to stimulate coordinated eye movements and visual exploration. They too were age regressed to ascertain whether they experienced the spiral disks.
We hypothesized that subjects might be even more readily induced to falsely remember spiral disks from kindergarten since they would not have metacognitive beliefs about childhood amnesia to keep them from remembering events from this age. Our preliminary research reveals that over 80% of subjects reported remembering some experience at the target age. In terms of the specific suggested stimulus, approximately 60% claimed some memory of the mobile and 25% claimed some memory of the spiral disk. Thus, the Kindergarten subjects were less likely to create a false memory for the suggested stimulus. Many of the "memories" were quite detailed.
To give the flavor of response, here is one from a 'mobile' subject: "There are little paper baby bottles hanging from the ceiling and there's a yellow bow tied to somebody's, um, crib but I don't know why and the crib I'm in is like, um, a clear plastic thing and there's like a red___along the side. And actually I remember there's a mobile. If I'm laying on my back, it's hanging from the left corner. But it seems to be pastel colors. It's nothing bright." Variations in the false feedback paradigm are now being used in other laboratories. Preliminary reports are consistent with those reported here, namely, that it is possible to induce people to construct false memories and make false memory reports, even to report impossible memories, by giving them a credible rationale for why they might expect to have these specific memories.
It is hard to pin down the precise reason for such widespread criticism of the British report. One specific concrete complaint concerns the omission of certain crucial items that were discovered by the BPS Working party in the course of their work, but omitted from their report . For example, when therapists who were surveyed were asked whether reports of childhood sexual abuse (CSA) from total amnesia can be taken as essentially accurate, 38% said "usually" and 6% said "always." This result was reported, along with the Working Party's inference that these recoveries from total amnesia are undoubtedly accurate because they represent high levels of belief among qualified psychologists who also showed a high level of acceptance of the possibility of false memories. However, these same clinicians had been asked an additional question about whether clients' reports of having experienced satanistic ritual abuse can be taken as essentially accurate; 38% said "usually" and 5% said "always" - virtually identical percentages. This finding was not included in the report, and the very existence of the survey question itself was not mentioned (Freyd, 1995), although its existence would be made known in a later publication (Andrews, Morton, Bekerian, Brewin, Davies & Mollon, 1995). The survey also found that 10% claimed the use of hypnotic regression to uncover traumatic memories and 23% claimed experience with clients reporting CSA that was recovered from total amnesia while in therapy with the respondent. Yet, the BPS Working Party decided that there was no reliable evidence for a widespread problem in the UK. Freud scholar and Berkeley professor Frederick Crews (1994, 1996) would have much to say about mental health organizations that fail to take a strong stand on the techniques that constitute "recovered memory therapy." Crews (1996, p 234-235) has been forceful in his complaints that these treatment techniques smack more of "ideological zeal than of scientific discovery," that their "therapeutic efficacy remains unsubstantiated," that their use has brought "widespread tragedy to many of its clients, their families, and other falsely accused parties," that they have tainted the credibility of "victims who have always remembered their brutalization." These therapeutic methods constitute malpractice, Crews says bluntly, and their toleration by equivocating professional bodies deserves to be regarded as a scandal. Crews would be far more satisfied with the document produced by The Australian Psychological Society (1994), which acknowledged that memories can be "altered, deleted, and created." Moreover, the report stated that " 'Memories' that are reported either spontaneously or following the use of special procedures in therapy may be accurate, inaccurate, fabricated, or a mixture of these", and emphasized that in the absence of independent corroboration, these could not be distinguished. Even the deeply divided American Psychological Association (1994) committee acknowledged the problem of pseudomemories in its interim report. A year later, the American Psychological Association (1995) issued document entitled "Questions and Answers about Memories of Childhood Abuse." Here the organization acknowledged that "it is possible to construct convincing pseudomemories for events that never happened." (p 1).
The American Medical Association (1994) has been quite clear in asserting that the current use of recovered memories of childhood sexual abuse is fraught with problems of potential misapplication, in part because it is "not yet known how to distinguish true memories from imagined events in these cases." The American Psychiatric Association (1993) has acknowledged that memories can be significantly influenced by a trusted person who suggests abuse as an explanation for symptoms/problems, and that repeated questioning may lead individuals to report memories of events that never occurred. With both organized medicine, in general, and psychiatry, in particular, having grappled with false memories in this way, it seems time for practitioners to recognize their reality, and imperative that this be done before more families are torn apart by imagined memories, and before more genuine victims of abuse find their experiences trivialized and their suffering increased. Final Remarks In many repressed memory cases, suggestive forces are clearly operating and may be responsible for the creation of false memories (Poole et al, 1995).
One of the most fundamental inconsistencies in the therapists who engage in these questionable practices is that they preach empowerment of the patients while simultaneously disempowering those very patients to whom they are preaching. It is deeply unfortunate that the war over repressed memories has become so acrimonious. We should be able to concede that it is possible for people to forget about traumatic experiences and later remember them, without having to agree that every memory so recovered is an accurate one. We should be able to get behind the pursuit of genuine perpetrators of childhood abuse while still having a healthy skepticism of allegedly de-repressed memories that surface only after suggestive activities. Skepticism is important, one physician has aptly noted, because of their inherent unreliability and the tragic consequences when they are false (Gordon, 1995). Although skepticism may be important, we still need to remind ourselves that courts are horrifying places for both defendants and plaintiffs. When an expert expresses skepticism about the techniques used to recover memories, or about the veracity of memories that occur under suspicious circumstances, or about the fantastical nature of certain memories, this doesn't mean that the expert believes that the holder of those memories is not experiencing very real pain. Sometimes statements of skepticism seem callous and cold, especially compared to the human tragedy at issue. Sometimes these statements may be hard to hear, but they must be made to prevent further pain. Clinicians can help to minimize the human tragedies by trying to keep these cases out of the courtroom in the first place. Numerous clinicians and researchers have provided useful advice and practical examples of how chinical practice might proceed in less risky ways (e.g., Nagy, 1994; Rhoades, 1995). The advice is often simple and straightforward. "It is important for the therapist to be alert to the dangers of suggestion." "The therapist should be alert to a range of possibilities, for example that a recovered memory may be literally true, metaphorically true or may derive from fantasy or dream material" (British Psychological Society, 1994, p. 12) "Be aware of possible contamination effects on memory", "Don't tell your clients that you 'know' that their memories are true", "Don't tell your client that they have the characteristics of an abuse victim", "Don't recommend books, support groups to your clients that you are unfamiliar with." "Don't tell your clients to 'cut off'' their reported abusers/families." (Rhoades, 1995). Following simple advice will minimize the chances of damage - damage to both the genuine abuse victims and to the the falsely accused.
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This manuscript is based upon an invited presentation at the Annual meeting of the American Academy of Psychiatry and the Law, 1995. I thank Park Dietz for inviting me to be one of the keynote luncheon speakers and giving me the opportunity for numerous productive exchanges with talented forensic clinicians. Please address correspondence to EL, Psychology Dept (Box 351525), U. of Washington, Seattle, Wa 98195-1525. email: firstname.lastname@example.org.
1. deFiebe, Conrad (1995, June 19) Psychiatrist is accused of planting memories. Minneapolis Star Tribune, p. A1. Gustafson, Paul (1995, Aug 1)
Jury awards patient $2.6 million. Minneapolis Star Tribune, p lB. 2. Spanos worked with C. Burgess to develop the basic procedure. Sue DuBreill, Ph.D., lead investigator for this study, and former graduate student in the laboratory of N. Spanos, introduced us to this particular false feedback procedure. Maryanne Garry, Ph.D. and Kelly Forrest joined her to contribute significantly to the adaptation conducted at the U. of Washington.