Academic journal article American Journal of Psychotherapy

Ethical Issues in the Search for Repressed Memories

Academic journal article American Journal of Psychotherapy

Ethical Issues in the Search for Repressed Memories

Article excerpt

The origins and present status of the concepts of repression and dissociation are discussed, followed by a brief account of the emergence of the recoveredmemory movement and the objections made to it on the grounds that it produces a false-memory syndrome. The impact of these arguments on psychotherapy and their legal and ethical problems are considered. It is suggested that recovered-memory therapy, as currently practiced, is unsound in principle and often harmful.

The concepts of repression1 and dissociation2 are probably more controversial today than at any time since they were originally proposed. Social factors are much responsible for this flux of opinion, although questions have long been raised about the validity of the concept of repression.3 Dissociation, conceptually linked to repression, has also come under scrutiny because of its increasing use and perhaps abuse. I first discuss these two concepts and then the social and professional settings in which ethical problems have emerged.

DEVELOPMENT OF CONCEPTS

The concept of repression is based on the paper by Breuer and Freud: "On the Psychical Mechanism of Hysterical Phenomena: Preliminary Communication" (republished in Studies on Hysteria1). Freud is credited for developing this seemingly powerful explanation of behavior, a concept almost universally accepted in psychiatry. Although classical hysteria, for which psychoanalysis was first proposed, has declined in prevalence4 psychiatrists continued to practice psychotherapy, noting that patients may benefit by exploring supposedly repressed material related to past conflicts. War-time experience showed how severe stress could readily produce hysterical symptoms,4 although little attention was paid to the fact that most cases of "battle neurosis" were not due to long-term conflicts but relatively transitory problems. Thus, the view persisted that emotional conflicts could be removed from consciousness, becoming accessible again in their pristine form, if the right psychological levers were moved.

This position ignored a serious twofold problem that has only been considered recently. First, some academics objected that, despite ingenious research by capable investigators, repression had never been demonstrated experimentally; proof depended solely on anecdotal observation.3 Second, the possibility of accurate recall of material was challenged by research findings in cognitive psychology, especially work on memory.5

According to Janet,2 dissociation depends upon a defect in the person when faced with a problem; Freud1 saw repression as an active process. Most theories of repression assume that it entails dissociation, in the sense of splitting off two sections of awareness. Current supporters of Recovered Memory therapy (RM) more often use dissociation than repression, arguing that it more accurately deals with the supposed alterations of consciousness caused by prolonged child sexual abuse. The facts however remain uncertain and valid criteria for dissociation in such cases are lacking. Dissociation is often regarded as a form of selective attention to which we are all subject. This may merely be concentrating on the topic in hand. If it is part of a hysterical mechanism, it will include gross splitting of ideas and feelings into conscious and unconscious (or accessible and inaccessible) domains, in which case it is virtually indistinguishable from repression. Dissociation is also used as a convenient explanation for changes of behavior produced by suggestion or in role playing, as in multiple personality disorder.

Other phenomena have been linked with dissociation. For example, "numbing," seen in acute anxiety and posttraumatic stress disorder, is sometimes called dissociative. Depersonalization is accepted in DSM-IV as a dissociative phenomenon. The WHO International Classification of Diseases has rejected this position asserting that depersonalization may occur in circumstances not indicative of repression or dissociation. …

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