Psychiatrist David Spiegel, M.D., of Stanford University Medical School finds it amazing that some of his colleagues will not accept the notion that young people who suffer through traumas such as physical or sexual abuse can have no memory of the events and recall them only years later during psychotherapy.

While "recovering" abuse memories is not an automatic signal that the remembered events actually occurred, or occurred in the way the person recalls them, patients and others routinely repress these memories and later "restructure the meaning of trauma" in part as a form of protection, he suggested. "If we remembered everything, we’d be completely immobilized. Most of the time we operate on the basis of partially forgotten information," he said.

Spiegel made the case that recovered memories of trauma can be an important—and appropriate—part of the psychiatric treatment of trauma patients and should not be dismissed just because a therapist doesn’t find them plausible. They should also not be rejected because of the condemnation some therapists have attracted after misusing such memories during questionable forms of psychotherapy, he stressed.

Spiegel was half of the affirmative side in a debate last month at APA’s 2000 annual meeting in Chicago on whether recovered memories can be ethically and appropriately interpreted into the treatment of trauma patients. His partner, attorney Alan Scheflin, LL.M., a professor of law at Santa Clara University, insisted that evidence proving the validity of the recovered memory concept "is clear."

Challenging the view of those who maintain that recovered trauma memories are an artifact of misguided psychotherapy, he said that he conducted a research review of 68 studies in which data proved that traumatic amnesia or repressed memories exist. "Not one study supported the view that so-called robust repression is a myth or fantasy," he noted.

This finding does not give therapists a license to "engage in an archeological search" for repressed trauma memories just because their instincts tell them that such memories exist. But with substantial evidence that people do repress these events, discussing them is a legitimate and appropriate part of psychotherapy, suggested Scheflin, who specializes in mental health law. Therapists who treat trauma victims "should let the science guide them," he stated.

Debate panelist Paul McHugh, M.D., was quick to denounce the arguments of his opponents. "The concept of repressed and recovered memories [of abuse] has been a clinical, intellectual, social, and moral disaster for our discipline," insisted McHugh, who is chair of the psychiatry department at Johns Hopkins University School of Medicine.

Psychiatrists and others have willingly cooperated in the media’s enthusiasm for so-called recovered memory cases. Even when the cases did not garner media attention these therapists have contributed to the breakup of families, McHugh said, and disregarded long-held standards of psychiatric assessment and care as they preyed on "vulnerable patients who are naturally suggestible."

"We don’t deny that trauma happens, and people need therapy for it," said McHugh. "We just don’t accept the idea that trauma can be created as it was in Sybil, alien abduction claims, and accounts of satanic ritual abuse."

Psychiatrist Sally Satel, M.D., a widely read essayist and newspaper columnist, was somewhat less dogmatic than her partner on the negative side of the debate, but still maintained that too many therapists are willing to accept a patient’s report of past abuse at face value without doing the kind of questioning apt to separate the truth from the "subtle or overt misperceptions" underlying the problems that bring many people to psychotherapy. It is incumbent on psychiatrists to "reality test" their patients’ recollections of events in their lives, she said.

The push by some psychiatrists and mental health professionals over the last decade to market "trauma-sensitive services" is based on the "worst impulses" of recovered memory theories, Satel said. Therapists do their patients far more good when they "concentrate on concrete and practical tasks" rather than allowing them to "ruminate on memories and whether to sue someone and fall into a morass of obsessions with events that may or may not have occurred," she emphasized.

Spiegel took strong exception to his opponents’ characterization of repressed and recovered memories as something manufactured by therapists to serve their own ends. "Dissociation has existed longer than psychiatry and has been observed across cultures for hundreds of years," he said. It is not "a creation of psychiatrists" as McHugh contended, Spiegel argued. Psychiatrists should not assume that patients’ reports of past trauma are necessarily true, he cautioned, "but we should not dismiss them out of hand either."

McHugh disagreed with Spiegel’s contention, however, about the scientific evidence for dissociative amnesia, stating that the studies have multiple flaws such as the inclusion of individuals with neurological insults, children under age 5, and patients who have particular agendas for claiming they were abuse victims.

In fact, McHugh insisted, the notion stems from the elimination of the diagnosis of hysteria from the official nomenclature, a decision that turned out to be "a major mistake" and left proponents searching for a substitute. What they came up with, he said, were "shabby metaphors like dissociation."

McHugh claimed that using theories of recovered abuse memories as a way to deal with trauma "along with its companion, multiple personality disorder, are a shameful episode in the history of psychiatry that is now ending, not with a bang or even a whimper, but with a querulous whine."