Dissociation and the Fragmentary Nature of Traumatic Memories:
Overview and Exploratory Study.
Bessel A. van der Kolk
The nature and reliability of traumatic memories has been a controversial issue in psychiatry for over a century.
Traumatic memories are difficult to study, since the profoundly upsetting emotional experiences that give rise to PTSD cannot
be approximate d in a laboratory setting: even viewing a movie depicting actual executions fails to precipitate post-traumatic
symptoms in normal college students (Pitman, personal communication,1994). If trauma is defined as an inescapably stressful
event that overwh elms people's existing coping mechanisms, it is questionable whether findings of memory distortions in normal
subjects exposed to videotaped stresses in the laboratory can serve as a meaningful guides to understanding traumatic memories.
Clearly, there is little similarity between viewing a simulated car accident on a TV screen, and being the responsible driver
in a car crash in which one's own children are killed. While stress evokes homeostatic mechanisms that lead to self-conservation
and resource-re- allocation (e.g. Selye, 1956), PTSD involves a unique combination of learned conditioning, problems modulating
arousal, and shattered meaning propositions. Shalev (1995) has proposed that this complexity is best understood as the co-occurrence
of several interlocking pathogenic processes including (a) an alteration of neurobiological processes affecting stimulus discrimination
(expressed as increased arousal and decreased attention), (b) the acquisition of conditioned fear responses to trauma-related
stim uli, and (c) altered cognitive schemata and social apprehension.
Without the option of inflicting actual trauma in the laboratory, there are only limited options for the exploration of
traumatic memories: 1) collecting retrospective reports from traumatized individuals, 2) post-hoc observations, or 3) provoking
of tr aumatic memories and flashbacks in people with PTSD. Surprisingly, since the early part of this century, there have
been very few published systematic studies that explore the nature of traumatic memories based on detailed patient reports.
Provocation stu dies of traumatic memories have been done in psychophyisology laboratories (e.g. Pitman, Orr, Forgue, de Jong,
& Claiborn, 1987; Rauch et al., 1995), and in tests where patients with PTSD are given drugs that alter neurotransmitter
function that seem to p romote access to trauma-related memories (Rainey et al., 1987; Southwick, et al., 1993).
This paper first will review the studies that have collected data on people's memories of highly stressful and of traumatic
experiences, and examine the differences between recollections of stressful and traumatic events.We will then review the evidence
implicating dissociation as the central pathogenic mechanism that gives rise to PTSD and present evidence that traumatic memories
are retrieved, at least initially, in the form of dissociated mental imprints of sensory and affective elements of the traum
atic experience by presenting the results of a systematic exploratory study of 46 subjects who reported on their memories
of childhood or adult trauma. .
The Stability and Accuracy of Memories of Stressful Events
At least since 1889, when Pierre Janet (1889) first wrote about the relationship between trauma and memory, it has been
widely accepted that what is now called declarative, or explicit memory is an active and constructive process. What a person
remembe rs depends on existing mental schemata: once an event or a particular bit of information is integrated into existing
mental schemes it is no longer be available as a separate, immutable entity, but is liable to become distorted both by associated
experie nces, demand characteristics and the emotional state at the time of recall (Janet, 1889; van der Kolk & van der
Hart, 1991). As Schachtel (1947) defined it: "Memory as a function of the living personality can be understood as a capacity
for the organiza tion and reconstruction of past experiences and impressions in the service of present needs, fears, and interests".
However, accuracy of memory is affected by the the emotional valence of an experience: studies of people's subjective reports
of personally highly significant events generally find that their memories are unusually accurate, and that they tend to remain
stable over time (Bohannon, 1990; Christianson, 1992; Pillemer, 1984; Yuille & Cutshall, 1986). It appears that evolution
favors the consolidation of personally relevant information. For example, Yuille and Cutshall (1989) interviewed 13 out of
22 witnes ses to a murder 4-5 months after the event. All witnesses had provided information to the police within two days
after the murder. These witnesses were found to have very accurate recall, with little apparent decline over time. The authors
concluded that emotional memories of such shocking events are "detailed, accurate and persistent" (p.181). They suggested
that witnessing real "traumas" leads to "quantitatively different memories than innocuous laboratory events".
Researchers also have studied the accuracy of memories for culturally significant events, such as the murder of President
Kennedy and the space shuttle Challenger. Brown and Kulik (1977) first called memories for such events "flashbulb memories".
While p eople report that these experiences are etched accurately in their minds, research has shown that even those memories
are subject to some distortion and disintegration over time. For example, Neisser and Harsch (1990) found that people changed
their reco llections of the space shuttle Challenger disaster considerably after a number of years. However, these investigators
did not measure the personal significance that their subjects attached to this event. Clinical observations of people who
suffer from PTS D suggest that there are salient differences between flashbulb memories and the post-traumatic perceptions
characteristic of PTSD. As of early 1995, we could find no scientific literature that had demonstrated that intrusive recollections
of traumatic ev ents in patients suffering from PTSD become distorted over time.
The Complexity of Memory Systems
Contemporary memory research has demonstrated the existence of a great complexity of memory systems, with multiple components,
most of which are outside of conscious awareness. Each one of these memory functions seems to operate with a relative degree
o f independence from the others. To summarize: 1) declarative, (also known as explicit) memory refers to conscious awareness
of facts or events that have happened to the individual (Squire & Zola Morgan, 1991). This form of memory functioning
is seriously affected by lesions of the frontal lobe and of the hippocampus, which also have been implicated in the neurobiology
of PTSD (van der Kolk, 1994). 2) Non-declarative, implicit, or procedural memory refers to memories of skills and habits,
emotional respo nses, reflexive actions, and classically conditioned responses. Each of these implicit memory systems is associated
with particular areas in the Central Nervous System (Squire, 1994). Schacter (1987) has referred to the descriptions of traumatic
memories made by Pierre Janet as examples of implicit memory.
The Apparent Uniqueness of Traumatic Memories
The DSM definition of PTSD recognizes that trauma can lead to extremes of retention and forgetting: terrifying experiences
may be remembered with extreme vividness, or totally resist integration. In many instances, traumatized individuals report
a combin ation of both. While people seem to easily assimilate familiar and expectable experiences and while memories of ordinary
events disintegrate in clarity over time, some aspects of traumatic events appear to get fixed in the mind, unaltered by the
passage o f time or by the intervention of subsequent experience. For example, in our own studies on post traumatic nightmares,
subjects claimed that they saw the same traumatic scenes over and over again without modification over a fifteen year period
(van der Kol k, Blitz, Burr & Hartmann, 1984). For the past century, many students of trauma have noted that the imprints
of traumatic experiences seem to be qualitatively different from memories of ordinary events. Starting with Janet, accounts
of the memories of tr aumatized patients consistently mention that emotional and perceptual elements tend to be more prominent
than declarative components (e.g. Grinker & Spiegel, 1946; Kardiner, 1941; Terr, 1993). These recurrent observations about
the nature of traumatic mem ories have given rise to the notion that traumatic memories may be encoded differently than memories
for ordinary events, perhaps via alterations in attentional focusing, perhaps because of extreme emotional arousal interferes
with hippocampal memory fun ctions (Christianson, 1992; Heuer & Rausberg, 1992; Janet, 1889; LeDoux, 1992; McGaugh, 1992;
Nillson & Archer, 1992; Pitman, Orr, & Shalev, 1993; van der Kolk, 1994).
Amnesias and the Return of Traumatic Memories.
Trauma can affect a wide variety of memory functions For convenience sake, we will categorize these into four different
sets of functional distubances: a) traumatic amnesia, b) global memory impairment, c) dissociative processes, and d) the sensorimotor
organization of traumatic memories
A. Traumatic amnesia. While the vivid intrusions of traumatic images and sensations are the most dramatic expressions
of PTSD, the loss of recollections for traumatic experiences, followed be subsequent retrieval is well documented in the literature.
Amnesias for some, or all , aspects of the trauma have consistently been noted in a wide variety of traumatized patients,
starting with Pierre Janet (1889). Amnesia for the traumatic experience, with later return of memories for all, or parts of
the trauma, has been noted follow ing natural disasters and accidents (Janet, 1889; Madakasira & O'Brian, 1987; van der
Kolk & Kadish, 1987; Wilkinson, 1983). Sargeant and Slater (1941) observed the presence of significant amnesia in 144
out of 1000 consecutively admitted combat soldiers to the Sutton Emergency Hospital during the second World War.Similar findings
have been reported in other studies of combat soldiers (Archibald & Tuddenham, 1956; Grinker & Spiegel, 1945; Hendin,
Haas, & Singer, 1984; Kardiner, 1941;Kubie, 1943; Myers, 19 15; Sonnenberg, Blank, & Talbott, 1985; Southard, 1919;
Thom & Fenton, 1920), in victims of kidnapping, torture and concentration camp experiences (Goldfield, Mollica, Pesavento,
& Faraone, 1988; Kinzie, 1993; Niederland, 1968), in victims of physical an d sexual abuse (Briere & Conte, 1993;
Janet, 1893; Loftus, Polensky, & Fullilove, 1994; Williams, 1992), and in people who have committed murder (Schacter,
1986). A recent general population study of 485 subjects by Elliot and Briere (unpublished) reporte d significant degrees
of traumatic amnesia after virtually every form traumatic experience, with childhood sexual abuse, witnessing domestic violence
as a child, and combat exposure yielding the highest rates. Traumatic amnesias are age- and dose-related : the younger the
age at the time of the trauma, and the more prolonged the traumatic event, the greater the likelihood of significant amnesia
(Briere & Conte, 1993; Herman & Shatzow, 1987; van der Kolk, Roth, Pelcovitz & Mandel, 1993).
Amnesia for these traumatic events may last for hours, weeks, or years. Generally, recall is triggered by exposure to sensory
or affective stimuli that match sensory or affective elements associated with the trauma. It is generally accepted that the
memo ry system is made up of networks of related information: activation of one aspect facilitates the recall of associated
memories (Collins & Loftus, 1975; Leichtman, Ceci, & Ornstein, 1992). Affect seems to be a critical cue for the retrieval
of informati on along these associative pathways. This means that the affective valence of any particular experience plays
a major role in determining what cognitive schemes will be activated. In this regard, it is relevant that many people with
trauma histories, suc h as rape, spouse battering and child abuse, seem to function quite well, as long as feelings related
to traumatic memories are not stirred up. However, under particular conditions, they may feel, or act as if they were traumatized
all over again. Fear i s not the only trigger for such recall: any affect related to a particular traumatic experience may
serve as a cue for the retrieval of trauma-related sensations, including longing, intimacy and sexual arousal.
B . Global memory impairment. While amnesias following adult trauma have been well-documented, the mechanisms for
such memory impairment remains insufficiently understood. This issue is even more complicated when it concerns childhood trauma,
since children have fewer mental capacitie s to construct a coherent narrative out of traumatic events. More research is needed
to explore the consistent clinical observation that adults who were chronically traumatized as children suffer from generalized
impairment of memories for both cultural a nd autobiographical events. It is likely that the combination of autobiographical
memory gaps and continued reliance on dissociation makes it very hard for these patients to reconstruct a precise account
of both their past and current reality (Cole & Putn am, 1992). The combination of lack of autobiographical memory, continued
dissociation and of meaning schemes that include victimization, helplessness and betrayal, is likely to make these individuals
vulnerable to suggestion and to the construction of e xplanations for their trauma-related affects that may bear little relationship
to the actual realities of their lives.
C. Trauma and dissociation. Recent research has shown that having dissociative experiences at the moment of the
trauma (peritraumatic dissociation) is the most important long term predictor for the ultimate development of PTSD (Holen,
1993; Marmar, et al., 1994; Spiegel, 1991). Brem ner et al. (1992) found that Vietnam veterans with PTSD reported having experienced
higher levels of dissociative symptoms during combat than men who did not develop PTSD. Koopman, Classen and Spiegel (1994)
found that dissociative symptoms early in the course of a natural disaster predicted PTSD symptoms seven months later. A prospective
study of 51 injured trauma survivors in Israel (Shalev, Orr, & Pitman, 1994) found that peri-traumatic dissociation explained
30% of the variance in the six months fo llow-up PTSD symptoms, over and above the effects of gender, education, age, event-severity,
and intrusion, avoidance anxiety and depression that followed the event. Peri-traumatic dissociation was the strongest predictor
of PTSD status six months after the event.
Dissociation refers to a compartmentalization of experience: elements of the experience are not integrated into a unitary
whole, but are stored in memory as isolated fragments and stored as sensory perceptions, affective states or as behavioral
reenactme nts (Nemiah, 1998, van der Kolk & van der Hart, 1989, 1991). While dissociation may temporarily serve an adaptive
function, in the long range, lack of integration of traumatic memories seems to be the critical element that leads to the
development of the complex biobehavioral change that we call Post Traumatic Stress Disorder. Intense arousal seems to interfere
with proper information processing and the storage of information into narrative (explicit) memory. This observation was first
made by Pierre Ja net, and is confirmed by a subsequent century of clinical and research data.
Christianson (1982) has described how, when people feel threatened, they experience a significant narrowing of consciousness,
and remain merely focussed on the central perceptual details. As people are being traumatized, this narrowing of consciousness
s ometimes evolves into amnesia for parts of the event, or for the entire experience. Students of traumatized individuals
have repeatedly noted that during conditions of high arousal "explicit memory" may fail. The individual is left in a state
of "speech less terror" in which the person lacks words to describe what has happened (van der Kolk, 1987). However, while
traumatized individuals may be unable to givea coherent narrative of the incident, there may be no interference with implicit
memory: they may "know" the emotional valence of a stimulus and be aware of associated perceptions, without being able to
articulate the reasons for feeling or behaving in a particular way.
More than eighty years ago, Janet observed: "Forgetting the event which precipitated the emotion ... has frequently been
found to accompany intense emotional experiences in the form of continuous and retrograde amnesia" (Janet, 1909b, p. 1607).
He clai med that when people experience intense emotions, memories cannot be transformed into a neutral narrative: a person
is "unable to make the recital which we call narrative memory, and yet he remains confronted by (the) difficult situation"
(Janet 1919/1925 , p. 660). This results in "a phobia of memory" (p. 661) that prevents the integration ("synthesis") of traumatic
events and splits off the traumatic memories from ordinary consciousness. Janet claimed that the memory traces of the trauma
linger as what he called "unconscious fixed ideas" that cannot be "liquidated" as long as they have not been translated into
a personal narrative. Failure to organize the memory into a narrative leads to the intrusion of elements of the trauma into
consciousness: as te rrifying perceptions, obsessional preoccupations and as somatic re-experiences such as anxiety reactions
(Janet, 1909b, van der Kolk & van der Hart, 1991).
Similar observations have been made by other clinicians treating traumatized individuals. For example, in 1945 Grinker
and Spiegel noted that some combat soldiers developed excessive responses under stress which they thought to be responsible
for the dev elopment of a permanent disorder: "Fear and anger in small doses are stimulating and alert the ego, increasing
efficacy. But, when stimulated by repeated psychological trauma the intensity of the emotion heightens until a point is reached
at which the eg o loses its effectiveness and may become altogether crippled. ..." (p. 82). Grinker and Spiegel described
traumatic amnesias in these soldiers, accompanied by confusion, mutism and stupor. Kardiner, in describing the "Traumatic
Neuroses of War (1941) not ed that when patients develop amnesia for the trauma, it tends to generalize to a large variety
of symptomatic expressions: "(t)he subject acts as if the original traumatic situation were still in existence and engages
in protective devices which failed o n the original occasion"(p. 82). Kardiner noted that fixation occurs in disscociative
fugue states: triggered by a sensory stimulus, a patient might lash out, employing language suggestive of his trying to defend
himself during a military assault. He note d that many patients, while riding a subway train that entered a tunnel, had flashbacks
to being back in the trenches. Kardiner also viewed panic attacks and hysterical paralyses as the re-experiencing of fragments
of the trauma. Piaget (1962) claimed tha t dissociation occurs when an active failure of semantic memory leads to the organization
of memory on somatosensory or iconic levels. He pointed out: "It is precisely because there is no immediate accommodation
that there is complete dissociation of the inner activity from the external world. As the external world is solely represented
by images, it is assimilated without resistance (i.e. unattached to other memories) to the unconscious ego".
The realization of the role of dissociation in the processing of traumatic memories was revived for contemporary psychiatry
when Horowitz described an “acute catastrophic stress reaction” in civilian trauma victims, characterized by panic, cognitive
diso rganization, disorientation and dissociation (1976) . Such dissociative processing of traumatic experience complicates
the capacity to communicate about the trauma. In some people the memories of trauma may have no verbal (explicit) component
at all: the memory may be entirely organized on an implicit or perceptual level, without an accompanying narrative about what
happened. Recent symptom provocation neuroimaging studies of people with PTSD support that clinical observation: during the
provocation of t raumatic memories there was decreased activation of Broca's area, the part of the CNS most centrally involved
in the transformation of subjective experience into speech. Simultaneously, the areas in the right hemisphere that are thought
to process intense emotions and visual images had significantly increased activation (Rauch et al., 1995). . Ongoing dissociation
in traumatized people.
People who have learned to cope with trauma by dissociating are vulnerable to continue to do so in response to minor stresses.
The continued use of dissociation as a way of coping with stress interferes with the capacity to fully attend to life's ongoing
challenges. The severity of ongoing dissociative processes (often measured with the Dissociative Experiences Scale (DES)-
Bernstein & Putnam, 1986) has been correlated with a large variety of psychopathological conditions that are thought to
be associat ed with histories of trauma and neglect: severity of sexual abuse in adolescents (Sanders & Giolas, 1991),
somatization (Saxe et al.,1994), bulimia (Demitrack et al, 1990), self-mutilation (van der Kolk, Perry, & Herman, 1991)
and borderline personality d isorder (Herman, Perry, & van der Kolk, 1989). The most extreme example of this ongoing dissociation
occurs in people who suffer from dissociative identity disorder (multiple personality disorder), who have the highest DES
scores of all populations studi ed and in whom separate identities seem to contain the memories related to different traumatic
incidents (Putnam, 1989).
D. The sensori-motor organization of traumatic experience. Numerous authors on trauma, for example Janet (1889;
van der Kolk & van der Hart, 1991), Kardiner (1941) and Terr (1993), have observed that trauma is organized in memory
on sensori-motor and affective levels. Having listened to the narratives of traumati c experiences from hundreds of traumatized
children and adults over the past twenty years, we frequently have heard both adults and children describe how traumatic experiences
initially are organized without semantic representations. Clinical experience a nd reading a century of observations by clincians
dealing with a variety of traumatized populations led us to postulate that "memories" of the trauma tend to, at least initially,
be predominantly experienced as fragments of the sensory components of the e vent: as visual images, olfactory, auditory,
or kinesthetic sensations, or intense waves of feelings (which patients usually claim to be representations of elements of
the original traumatic event). What is intriguing is that patients consistently claim that their perceptions are exact representations
of sensations at the time of the trauma. For example, when Southwick and his group injected yohimbine into Vietnam veterans
with PTSD, half of their subjects reported flashbacks that they claimed to be "jus t like it was" [in Vietnam] (Southwick
et al, 1993).
In the present study we designed a methodology for examining traumatic and non-traumatic memories in individuals with PTSD,
in order to record whether, and how, memories of traumatic experiences are retrieved differently from memories of personlly
signif icant, non-traumatic events. In order to examine the retrieval of traumatic memories in a systematic way, we designed
an instrument, the Traumatic Memory Inventory (TMI) that specifically inquires about sensory, affective and narrative ways
of remembering , about triggers for unbidden recollections of traumatic memories, and ways of mastering unwanted intrusions
of traumatic memories in subjects' lives.
Subjects Subjects were recruited in the local newspapers from advertisements that invited people who were haunted
by memories of terrible life experiences to submit to a two hour interview about these memories. Subjects were paid $10.00
for their participation.Su bjects were screened by telephone, and again in one-on-one interviews for exclusion criteria of
organic mental disorders, schizophrenia, bipolar illness, substance abuse and alcoholism. All subjects met DSM III-R diagnostic
criteria for PTSD, as measured on the CAPS. Ten of the subjects were men, 36 were women. Average age at time of the interview
was 42.0 years (range 18-67).
Instruments Subjects were asked to sign an informed consent and filled out self-rated questionnaires, after which
they participated in the interview. The instruments used were:
- Traumatic Antecedents Questionnaire (self-rating version) (TAQ [S]), a 78 item questionnaire to identify exposure to taumatic
life events (self-rated version of the TAQ, Herman, Perry & van der Kolk, 1989, van der Kolk, Perry & Herman, 1991)
- The Dissociative Experiences Scale (DES- Bernstein & Putnam, 1986).
- The interviewer and subject then together made an Inventory of Traumatic Experiences which systematically asked them about
the circumstances and specifics of their trauma(s). After finishing these interviews, subjects were asked to indicate which
par ticular traumatic experience that had had most effect on their lives, and to identify an intense, but non-traumatic experience,
that was used as the "control" experience.
- Subjects were then given the Traumatic Memory Inventory, a 60 item structured interview that systematically collects data
about the circumstances and means of memory retrieval of a traumatic memory, comparing those with the subjects' memories of
a personally highly emotionally significant, but non-traumatic event. The TMI describes 1) nature of trauma(s), 2) duration,
3) whether subject has always been aware that trauma happened, and if not, when and where subject became conscious of trauma,
4) ci rcumstances under which subject first experienced intrusive memories; and circumstances under which they occur presently,
5) sensory modalities in which memories were experienced a) as a story b) as an image (what did you see ?) c) in sounds (what
did you hear ?), d) as a smell (what did you smell ?), e) as feelings in your body (what did you feel ? where?), f) as emotions
(what did you feel, what was it like ?),. These data were collected for how subjects remembered the trauma a) initially, b)
whilesubj ect was most bothered by them, and c) currently. The interview also asked about 6) nature of flashbacks, 7) nature
of nightmares, 8) precipitants of flashbacks and nightmares, 9) ways of mastering intrusive recollections(e.g. by eating,
working, taking drugs or alcohol, cleaning, etc. 10) Confirmation: records: court or hospital, direct witness, relative went
through same trauma, other.
All information was collected first for traumatic events, then for a non-traumatic event, like a wedding, vacation, graduation,
the birth of a child, or an accomplishment in school or at work.
The interviews took about 2 hours and were conducted by staff of the Trauma Center. Information gathered from the TMI was
presented to the members of the Trauma Center memory research group who came to a consensus about the scoring of each item
of the interviews. We were unable to establish a meaningful way for the raters to be blind to whether they were scoring the
answers to traumatic or non-traumatic memories.
Data Analysis Data analysis was conducted by means of cross-tabulation and Kendall's tau computation for ordinal
by categorical variables. Student two tailed t-tests were used to compare ordinal data. Chi-Squared analyses were used to
compare nominal data. General lin ear models procedure for step-wise linear regression with posthoc analysis for comparison
of means was used for continuous variables. Pearson correlation coefficients were calculated for bivariate relationships.
We interviewed 46 adults. Of these, 35 had experienced their most significant traumas in childhood, while 11 had their
first traumatic experience after age 18. The traumas they had experienced are listed in Table 1. Several subjects had experienced
more than one type of trauma. Age of onset ranged from 1- 56, (average 12.4). Only 11 subjects had their traumas start after
age 18 (Adult Trauma - AT). DES scores ranged from 1- 99; 14 subjects scored 10 and under. The average DES score of the overall
sample was 21.8; of the people who were first traumatized as adults the average was 30.9.
Non-traumatic Memory Subjects considered most questions related to the non-traumatic memory non-sensical: none had
olfactory, visual, auditory, kinesthetic re-living experiences related to such events as high school graduations, birthdays,
weddings, or births of their childr en. They denied having vivid dreams or flashbacks about these events. The subjects claimed
not to have periods in their lives when they had amnesias for any of these events; none claimed to have photographic recollections
of any of these events. Environme ntal triggers did not suddenly bring back vivid and detailed memories of these events, and
none of the subjects felt a need to make special efforts to suppress memories of these events
Table 1: Type of Trauma Experienced *
* Note: Several subjects had more than one type of trauma.
|Witnessing death of someone close
|Industrial or transportation accident
Table 2: Traumatic and Narrative Memory Compared
|Images, sensations, affective and behavioral states
||Narrative: semantic and symbolic|
|Invariable -- does not change over time
||Social and adaptive|
|Highly state-dependent. Cannot be evoked at will.
Automatically evoked in special circumstances
|Evoked at will by narrator|
|No condensation in time
||Can be condensed or expanded depending on social demands|
Modalities Table 2 presents the sensory modalities which the subjects reported first having experienced when they
first became aware of the trauma (whether they had always been aware of the trauma, or recovered the memory after a period
of amnesia) . No subject rep orted having a narrative for the traumatic event as their initial mode of awareness (they claimed
not having been able to tell a story about what had happened), regardless of whether they had continuous awareness of what
had happened , or whether there ha d been a period of amnesia. There were no statistically significant differences between
the subjects with childhood (CT) vs adult trauma (AT) in terms of the sensory modalities first experienced, although there
was a trend towards more visual intrusions in the adult trauma group. Figure 1 indicate that all subjects, regardless of age
a which the first trauma occurred, reported that they initially "remembered" the trauma in the form of somatosensory or emotional
flashback experiences. At the peak of the ir intrusive recollections all sensory modalities were enhanced, and a narrative
memory started to emerge. Currently, most subjects continued to experience their trauma in sensorimotor modes, but while 41
(89)% were able to narrate a satisfactory story ab out what happened to them, 5 subjects (11%-all CT) continued to be unable
to tell a coherent narrative, with a beginning, middle and end, even though all of them had outside confirmation of the reality
of their trauma, i.e. a mother who knew, a prepetrat or who confessed, hospital or court records.
Figure 1: Sensory modalities reported when subjects first became aware of the trauma, when the recollections
of the trauma were most intense, and currently.
Dissociation The DES score was significantly correlated with the following event-related variables: 1) duration
of the trauma (r =.52 , p<.01), 2) presence of physical abuse (r= .56, p<.01), and 3) presence of neglect (r=.38; p<.05).
Also, dissociation was correlated with 1) affective reliving (r= .54, p<.01), kinesthetic reliving (r=.40, p<.05), lack
of current narrative memory (r=.54, p<.01) and with self-destructive self-soothing behaviors: bingeing and purging (X2=7.41.,
df =1, p<. 01); use of alcohol and drugs ( X2=2.75, df = 1, p<.10); self-mutilation (X2=3.95, df.=1, p< .05), and
sexual activity (X2= 3.0, df= 1, p<.05). Dissociation was not correlated with the following self-soothing behaviors: talking
things over, working, cleaning, sleeping or turning to reli gion).
Nightmares and Flashbacks Of the total sample, 36 (78%) reported current nightmares. Two (18%) of the 11 AT and
15 (42%) of the 35 CT reported that their nightmares were dreams: they included illogical combinations and aspects of non-trauma-related
material (X2=11.0, df= 4, p=.0 2). Four (36%) of the AT and 11(35%) of the CT reported having nightmares that were identical
to their flashbacks: they were life-like presentations of the entire trauma, or fragments thereof, without intermixture of
other perceptual elements.
Confirmation Of the 35 subjects with childhood trauma, 15 (43%) had suffered significant, or total amnesia for their
trauma at some time of their lives. Twenty seven of the 35 subjects with childhood trauma (77%) reported confirmation of their
childhood trauma- from a mother, sibling, or other source who knew about the abuse, from court or hospital records, or from
confessions or convictions of the perpetrator(s). We did not ask them to produce records to prove that this confirmation actually
Our study suggests that there are critical differences between the ways people experience traumatic memories versus other
significant personal events. The study supports the idea that it is in the very nature of traumatic memory to be dissociated,
and t o be initially stored as sensory fragments without a coherent semantic component. All of the subjects in our study claimed
that they only came to develop a narrative of their trauma over time. Five of the subjects who claimed to have been abused
as child ren were even as adults unable to tell a complete narrative of what had happened to them. They merely had fragmentary
memories that supported other people's stories, and their own intuitive feelings, that they had been abused.
All these subjects, regardless of the age at which the trauma occurred, claimed that they initially "remembered" the trauma
in the form of somatosensory flashback experiences. These flashbacks occurred in a variety of modalities: visual, olfactory,
aff ective, auditory and kinesthetic, but initially these sensory modalities did not occur together. As the trauma came into
consciousness with greater intensity, more sensory modalities came into awareness: initially the traumatic experiences were
not conden sed into a narrative. It appears that, as people become aware of more and more elements of the traumatic experience,
they construct a narrative that "explains" what happened to them. This transcription of the intrusive sensory elements of
the trauma into a personal narrative does not necesarily have a one-to-one correspondence with what actually happened. This
process of weaving a narrative out of the disparate sensory elements of an experience is probably not dissimilar from how
people construct anarrati ve under ordinary conditions. However, when people have day-to-day, non-traumatic experiences, the
sensory elements of the experience are non registered separately in consciousness, but are automatically integrated into the
This study supports Piaget's notion that when memories cannot be integrated on a semantic/linguistic level, they tend to
be organized more primitively: as visual images or somatic sensations. Even after considerable periods of time, and even after
acquir ing a personal narrative for the traumartic experience, most subjects reported that these experiences continued to
be come back as sensory perceptions and as affective states. The persistence of intrusive sensations related to the trauma
after the constru ction of a narrative contradicts the notion that learning to put the traumatic experience into words will
reliably help abolish the occurrence of flashbacks.
There were some interesting trends between the adult onset trauma (AT) group and the childhood onset (CT) group. There
were non-significant differences in the modalities in which the trauma was experienced, which a larger sample size might clarify
furthe r: the subjects first traumatized as children tended to first remember their abuse in the form of olfactory images
and kinesthetic sensations. The CT group had significantly more pathological self-soothing behaviors than the adult group,
including self-mu tilation and bingeing. This supports the notion that childhood trauma gives rise to more pervasive biological
disregulation, and that patients with childhood trauma have greater difficulty regulating internal states than patients first
traumatized as adul ts (van der Kolk & Fisler, 1994). Another interesting difference between the adult and the child group
was that the AT group had nightmares that they reported to be exact replicas of the traumatic experience more often than did
the CT group.
It was striking that some subjects, particularly those who never were able to construct a satisfactory narrative of their
trauma, did not have visual flashbacks. Intuitively, it would appear to be difficult to construct a satisfactory narration
that allo ws for the proper placement of the trauma in time and space if an individual cannot visualize what has happened.
We are currently studying the mental organization of traumatic experiences in blind children and adults.
When people receive sensory input, they generally automatically synthesize this incoming information into narrative form,
without conscious awareness of the processes that translate sensory impressions into a personal story . Our research shows
that trau matic experiences initially are imprinted as sensations or feeling states that are not immediately transcribed into
personal narratives, in contrast with the way people seem to process ordinary information. This failure of information processing
on a symb olic level, in which it is categorized and integrated with other experiences, is at the very core of the pathology
of PTSD (van der Kolk & Ducey, 1989).
Recently we collaborated in a neuroimaging symptom provocation study of some of the subjects who were part of the memory
study reported here. When these subjects had their flashbacks in the laboratory, there was a significantly increased activity
in the areas in the right hemisphere that are associated with the processing of emotional experiences, as well as in the right
visual association cortex. At the same time, there was significantly decreased activity in Broca's area, in the left hemisphere
(Rauch et al. 1995). These findings are in line with the results of this study: that traumatic "memories" consist of emotional
and sensory states, with little verbal representation. In other work we have hypothesized that, under conditions of extreme
stress, th e hippocampally based memory categorization system fails, leaving memories to be stored as affective and perceptual
states (van der Kolk, 1994). This hypothesis proposes that excessive arousal at the moment of the trauma interferes with the
effective memo ry processing of the experience. The resulting "speechess terror" leaves memory traces that may remain unmodified
by the passage of time, and by further experience.
We (van der Kolk & van der Hart, 1991) have earlier writen about Janet's clear distinctions between traumatic and ordinary
memory. According to Janet, traumatic memory consists of images, sensations, affective and behavioral states, that are invariable
a nd do not change over time. He suggested that these memories are highly state-dependent and cannot be evoked at will. Finally,
they are not condensed in order to fit social expectations. In contrast, according to Janet, narrative (explicit) memory is
sema ntic and symbolic, it is social, and adapted to the needs of both the narrator and the listener and can be expanded or
contracted, according to social demands.
The question whether the sensory perceptions reported by our subjects are accurate representations of the sensory imprints
at the time of the trauma is intriguing. The study of flashbulb memories has shown that the relationship between emotionality,
vivi dness and confidence is very complex, and does not necessarily reflect accuracy. While it is possible that these imprints
are, in fact, reflections of the sensations experienced at the moment of the trauma, an alternative explanation is that increased
ac tivity of the amygdala at the moment of recall may be responsible for the subjective assignment of accuracy and personal
significance. Once these sensations are transcribed into a personal narrative, they are subject to the laws that govern explicit
memor y: they become a socially communicable story that is subject to condensation, embellishment and contamination. While
trauma may leave indelible sensory and affective imprints, once these are incorporated into a personal narrative this semantic
memory, lik e all explicit memory, is subject to varying degrees of distortion, .
In this study we have merely confirmed Janet's century-old clinical observations. The time now seems ripe for more detailed
investigations. These should include careful follow-up of both traumatized children and adults to check for memory distortions
ov er time, as well as the use of sophisticated techniques, such as brain imaging, to gain further understanding about the
ways the central nervous system processes traumatic memories. There clearly is a need for further studies of dissociative
processes and their relationship to the develpment and maintenance of PTSD. However, in the process of trying to gain a deeper
understanding of traumatic memories, great caution should be excercised against making careless generalizations that infer
how traumatic memo ries are stored and retrieved from laboratory experiments that do not overwhelm people's coping mechanisms.
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Ethics & Behavior
Vol. 8, No. 2, 1998
Symposium: Science and Politics of Recovered Memories
Reviewed by Linda Chapman, MSW, LCSW
A special issue of Ethics & Behavior has been published (Vol. 8, No. 2, 1998). The theme is "The Science and
Politics of Recovered Memory," and it is based on a program chaired by Gerald Koocher of Harvard Medical School at the APA
This program was also tape recorded and copies of the tape are available from Sidran (ordering details follow). I have
heard this tape, and it's a wonderful assemblage of voices.
Reading the printed word in the special edition of Ethics & Behavior, paper after paper, is uplifting and inspiring.
The participants in this symposium are people of courage and fortitude, and as they speak eloquently to the issues of the
day, it becomes crystal clear that this "memory war," as Anna Salter asserts, "...Is not an academic debate at all; It is
a political fight." (p. 121). I'll leave Salter and the other authors to explain what the fight is about, and why: It's a
fascinating analysis, and not to be missed by anyone who cares about abused children, the adult survivors they become, and
about those mental health professionals who would dare reach out to them in compassion.
Jump to ordering information
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"...Skilled, thoughtful, well-trained clinicians are too often tarred with the same brush that should be reserved
for the quacks of psychotherapy. Not surprisingly, the most vocal attempts to silence competent professionals speaking out
on or treating genuine abuse victims have come from organizations populated or led by individuals who have been ruled abusive
or otherwise discredited in courts of law."
-- Gerry Koocher, Chair JENNIFER J. FREYD, PH.D., is a full professor in the Department
of Psychology, University of Oregon, Eugene, Oregon. She is the author of the acclaimed book, "Betrayal Trauma: The Logic
of Forgetting Childhood Abuse." She writes:
"Despite this documentation for both traumatic amnesia and essentially accurate delayed recall, memory science
is often presented as if it supports the view that traumatic amnesia is very unlikely or perhaps impossible and that a great
many, perhaps a majority, maybe even all, recovered memories of abuse are false....Yet no research supports such an implication...and
a great deal of research supports the premise that forgetting sexual abuse is fairly common and that recovered memories are
sometimes essentially true." Science in the Memory Debate, p. 107 ANNA SALTER, PH.D., is a psychologist
in Madison, Wisconsin. In 1988, she began a study of the accuracy of expert testimony in child sexual abuse cases utilizing
psychologist Ralph Underwager and his wife and practice partner, Hollida Wakefield, as a case study. (Underwager is a co-founder
of the False Memory Syndrome Foundation who resigned after making statements to a Dutch magazine in which he advocated pedophilia.
See this article for background.) Salter writes:
"The people who support and defend those accused of child sexual abuse indiscriminately, those who join organizations
dedicated to defending people who are accused of child sexual abuse with no screening whatsoever to keep out those who are
guilty as charged, are...not necessarily people engaged in an objective search for the truth. Some of them can and do use
deceit, trickery, misstated research, harassment, intimidation, and charges of laundering federal money to silence their opponents."
-- Confessions of a Whistle Blower: Lessons Learned, p. 122. JENNIFER A. HOULT earned degrees
in harp, computer science and religion, pursued a career in Artificial Intelligence Software Engineering, and later returned
to a career in music. In 1988, she filed a civil suit against her father - a member of the False Memory Syndrome Foundation
- (J. Hoult v. D.P. Hoult), whom she alleged had sexually abused her throughout her childhood. In 1993, this case was unanimously
decided in her favor, and she was awarded monetary damages. However, Hoult has seen the facts of her case twisted and misreported
in the media and by FMS proponents. She writes:
"Since 1995, I have become aware of the parallel between the intimidation and silencing in the microcosm of the
abusive family and in the macrocosm of a society that is ill at ease in dealing with the abuse of children. During my childhood
my father protected himself from being held accountable by threatening me into silence. I believe that published documents
demonstrate how some members and supporters of false memory groups publish false statements that defame and intimidate victims
of proven violence and their supporters. Such altered accounts are used to discredit others in court and in the press." --
Silencing the Victim: The Politics of Discrediting Child Abuse Survivors, p. 125. ROSS E. CHEIT
is a professor in the Department of Political Science, Brown University. Cheit, who as an adult recovered memories of abuse
by a camp counselor, has established an archive of _corroborated cases_ of recovered memories here.
From the Abstract of Cheit's article:
"Some self-proclaimed skeptics of recovered memory claim that traumatic childhood events simply cannot be forgotten
at the time only to be remembered later in life. This claim has been made repeatedly by the Advisory Board members of a prominent
advocacy group for parents accused of sexual abuse, the so-called False Memory Syndrome Foundation. The research project described
in this article identifies and documents the growing number of cases that have been ignored or distorted by such skeptics.
To date, this project has documented 35 cases in which recovered memories of traumatic childhood events were corroborated
by clear and convincing evidence." False Representations About True Cases of Recovered Memory. (p. 141) (Note: The archive
now has 45 corroborated cases.) DAVID L. CALOF is a respected therapist in Seattle, Washington,
and founder and editor emeritus of the professional journal Treating Abuse Today. His latest book is "The Couple Who Became
Each Other: Stories of Healing and Transformation From a Leading Hypnotherapist." Despite the fact that he has never treated
any relative of a member of the False Memory Syndrome Foundation, and for more than 25 years practiced without a single ethics
complaint or lawsuit, proponents of false memory syndrome waged an intensive three-year war of harassment against him and
his practice. His patients often had to cross a picket line just to get to their therapy appointments; He was forced to move
his office several times; His attorney's wife and family were harassed, and he spent many thousands of dollars defending bogus
lawsuits. He writes:
"Psychotherapy clients require privacy and confidentiality, not assault by offensive signs, threats by camera,
stigma, or breach of privacy. They do not benefit from ad hominem broadsides against the clinical community. If we condone
this new self-styled assault on psychotherapy in the name of scientific debate or freedom of speech while we ignore the rights
of speech, privacy, and assembly for patients and clinicians, we might eventually lose the clinical container of psychotherapy
itself to any aggressive third party who comes along with some ax to grind with the field of mental health." -- Notes from
a Practice Under Siege: Harassment, Defamation, and Intimidation in the Name of Science, p. 185. LAURA
S. BROWN, PH.D. was named clinical professor of psychology in 1992 at the University of Washington. Since 1980, she
has maintained a full-time independent practice of clinical and forensic psychology in Seattle. She has edited three books,
authored a fourth, and co-authored a fifth, and has written 44 journal articles and 35 chapters in professional books, and
has been instrumental in the development of theory in feminist psychotherapy. She too, has been picketed by pro-fms individuals
in Seattle, Washington.
As symposium discussant, she writes:
"Denial of perpetration is simply not evidence that none has occurred, because even when there is physical evidence
of abuse, sexual abusers of children may continue to deny that they did anything....The tactics of the false memory movement
have shown remarkable parallels to those of sexual abusers who attempt to silence their victims, and I wonder why this is."
-- The Prices of Resisting Silence: Comments on Calof, Cheit, Freyd, Hoult, and Salter, p. 191.
I strongly urge you to locate this issue in your library, or order a copy, and share it with survivors and professionals
alike. It's heartening to be reminded that there are people of principle in this world who care about those who have experienced
the trauma of child abuse, and who are willing to stand on their convictions and pay a price, if necessary. We can all take
a lesson from their courage of conviction. - Linda Chapman
How to Order
Copies of this special issue may be obtained from the publisher for $20.00, plus
Lawrence Erlbaum Associates
10 Industrial Avenue
(Single copies: Book Department)
To order the audiotape, contact Sidran's phone at 410-825-8888, email them at firstname.lastname@example.org, or visit the website:
Copyright ©1998-2001 Linda Chapman. All rights reserved.