DSM-5. Abnormal Forgetting: The Repressed Memories Debate

DSM-5 - Gender Incongruity: Repressed Memories, Social Epidemics & Diagnosis Creep. (Part 1)

Artists Depiction

According to the DSM-IV a psychiatric disorder, is "A clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress or disability or with a significantly increased risk of suffering death, pain, disability or an important loss of freedom."
http://www.duhaime.org/LegalDictionary/M/MentalDisorder.aspx

Few people would suggest that psychiatric/psychological diagnosis is a science.  Some might consider it an  art, or perhaps even a form of divination. Psychiatric maverick, Thomas S. Szasz has argued that...

Thomas Szasz MD

"...psychiatrists and their allies have succeeded in persuading the scientific community, courts, media, and general public that the conditions they call mental disorders are diseases--that is, phenomena independent of human motivation or will. Because there is no empirical evidence to back this claim (indeed, there can be none), the psychiatric profession relies on supporting it with periodically revised versions of its pseudo-scientific bible, the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders."

"The official view is that these manuals list the various "mental disorders" that afflict "patients." My view is that they are rosters of officially accredited psychiatric diagnoses, constructed by task forces appointed by officers of the American Psychiatric Association. Psychiatrists thus have constructed diagnoses, pretended that the terms they coined were morally neutral descriptions of brain diseases, and few in political power have challenged their pretensions."

MENTAL DISORDERS ARE NOT DISEASES
http://www.szasz.com/usatoday.html

Arguably, Szasz's thesis has a great deal merit in some diagnostic categories, schizophrenia and manic depression being prime examples.  But regarding the psychological narrative that has evolved around 'gender' theory and 'transgederism', some clinicians apparently see the process as a spiritual experience, a voyage of discovery, shared between a therapist and a client.

This view was supported by WPATH President, psychotherapist Lin Fraser. Following her election to the presidency in 2009 Fraser was invited to prepare a paper giving her views on the future role of psychotherapy as an adjunct to the WPATH standards of care (SOC). In part she wrote...

WPATH President, Lin Fraser

"... As Ettner (2007) has suggested, “provider[s] working with transclients need to forswear nearly every  timeworn sacred canon of allopathic Western medicine” (p. xxiii), since there is no observable disease, diagnostic test, or organ deficiency. She suggests the metaphor of “soul retrieval,” where the clinician, during the therapy helps retrieve and return the lost  essence of  the person."

Psychotherapy in the World Professional Association for Transgender Health's Standards of Care: Background and Recommendations
Author: Lin Fraser
http://www.informaworld.com/smpp/content~db=all~content=a912976017~frm=titlelink

The belief that an identity or a memory might lie buried in some nether region of the mind, so suppressed or buried that the individual goes about their life virtually unaware of its existence, has its roots buried firmly in Freudian psychology.

"At the end of [the 1800's], Freud and very soon a group of his disciples began to develop ideas about a variety of subtle processes which shaped behaviour. One thing which evolved from this was the concept that because of early childhood experiences troubled people had developed individualised yet repetitively employed ways of dealing with life’s challenges which were inherently dysfunctional. The individuals were regarded as unaware of the actions of these psychological habits, although through their repetitive use, their presence could be inferred..."

"Among the most primitive defence mechanisms was repression, which was basically pushing an issue so deeply out of consciousness that it is extremely difficult to bring it back into consciousness. Among the more mature defences was suppression, which amounts to conveniently distancing oneself from anxiety-provoking memories, although no so far that they cannot be retrieved with a little effort."

 Dr Brent Waters, Recovered Memory and Adult Disclosure of Child Sexual Assault.
http://www.lawlink.nsw.gov.au/lawlink/pdo/ll_pdo.nsf/pages/PDO_recoveredmemory

Repression can be made to account for a raft of otherwise inexplicable behaviours or emotional responses. Various childhood traumas, though hidden from the conscious mind,  were and are still thought to exert an influence on adult behaviours.  Consequently much of Freudian psychotherapeutic technique is devoted to traversing past memories attempting to identify the historical source of individual problems. This may be beneficial with regard to the client's sense of self understanding, even though the memories being recalled are not necessarily accurate.

Memory is a fickle thing and not all memories are of real events.  False memories are defined as:

"a condition in which a person's identity and interpersonal relationships are centred around a memory of traumatic experience which is objectively false but in which the person strongly believes."

Dr Kathryn Gow,  The Complex Issues in Researching "False memory Syndrome"
http://www.massey.ac.nz/~trauma/issues/1998-3/gow1.htm

Recovering the memory of some forgotten event is commonplace.  Smell is a well recognised stimulator, but a snatch of music or conversation can easily act to create recall of a situation hitherto 'forgotten'.
http://www.bioedonline.org/news/news.cfm?art=985

A 2008 study on recovered memory conducted for the British Psychological Society showed that whilst spontaneous memory recovery was generally reliable,  memories recovered during the process of psychotherapy were not.  The author's went on to note:

"The current laboratory findings point out that one cannot discuss ‘recovered memories’ as a unitary phenomenon. One should make a distinction between at least two types of recovered  memory  experiences:  those  that  are  gradually  recovered  throughout  the course of suggestive therapy versus those that are spontaneously recovered, without extensive  prompting  or  any  attempts  to  reconstruct  the  past."

Elke Geraerts et.al, "Recovered memories of childhood sexual abuse: Current findings and their legal implications"
http://www.clinicalcognitionlab.com/pdf/Geraerts_et_al_LCP_2008.pdf

The validity or 'realness' of memories acquired during psychotherapy might have gone unchallenged, at least publicly, were it not for popularisation of the belief that memory repression was a common result of childhood sex abuse. (CSA)

As Elizabeth Loftus writes, "All roads on the search for popular writings inevitably lead to one, The Courage to Heal (1988), often referred to as the "bible" of the incest book industry."
The Reality of Repressed Memories
http://faculty.washington.edu/eloftus/Articles/lof93.htm

"The Courage to Heal
 Bass, E. & Davis, L. (1988). The courage to heal. (New York: Harper & Row)   [was] written by feminist activists Ellen Bass, a poet and creative writing teacher, and Laura Davis, [herself] an incest survivor ...While working with students, Bass and Davis came to believe that the stories of some students were trying to convey painful memories of incest. From this idea, the two developed methods to assist students in recovering memories of abuse in childhood."

http://en.wikipedia.org/wiki/The_Courage_to_Heal

"The 1990s brought a blossoming of reports of awakenings of previously repressed memories of childhood abuse. One reason for the increase may be the widespread statistics on sex abuse percentages that are published almost daily..." (see Final Remarks, Loftus, supra)

Elizabeth Loftus

In 1992, just four short years after 'The Courage to Heal' was published, the False Memory Support Foundation was formed by parents claiming to be wrongly accused of incest and sceptical mental health professionals.  Its purpose was to act as a counter to charges of childhood sexual abuse arising from memories supposedly recovered during psychotherapy.
http://www.fmsfonline.org/

Repressed memory is currently included in the DSM-IV (TR) under the label "Dissociative Amnesia" adjacent to its close cousin, Dissociative Identity Disorder.

"The primary symptoms are memory gaps related to traumatic or stressful events which are too extreme to be accounted for by normal forgetting."
http://allpsych.com/disorders/dissociative/amnesia.html

But what is 'normal' forgetting - as opposed to 'abnormal' forgetting?  How do we know that such a thing exists, or that abnormal forgetting, in the form of suppressed memories, can exert the kinds of subconscious influences postulated by its exponents?

We have seen that memories recovered spontaneously, outside of the psychotherapeutic interaction, are more reliable than those recovered as result of psychotherapy. That may not necessarily mean that all memory recovered as during the course of therapy is inaccurate,  though it does indicate the need for caution and, in a legal sense, for corroboration.

Like much else in the world of psychiatric and psychological theory, the concept of repression - whether it be of memories or identities - teeters precariously between the purely speculative and the vaguely possible.

Consequently, belief one way or another, is an act of faith with proponents and opponents on either side, each claiming to have evidence that disproves the other's case.  The ensuing  contest is no bad thing,  for it was precisely that which placed a brake on the early excesses of the recovered memory movement, such as these, described by Loftus.
http://faculty.washington.edu/eloftus/Articles/lof93.htm
http://faculty.washington.edu/eloftus/Articles/price.htm

The next  article in this series will examine the multiple identities phenomenon (Dissociative Identity Disorder) and at its relationship to recovered memories.