Is There A False Memory Syndrome?

A Review of Three Cases
Robert Kaplan and Vijaya Manicavasagar
The controversy over recovered memories of childhood sexual abuse (CSA) is whether such experiences can be forgotten for long periods and retrieved later in therapy or in response to cues or triggers from the environment. False memory syndrome (FMS) is caused by memories of a traumatic experience—most frequently CSA—which are objectively false, but in which the person strongly believes. Personality factors often play a role in the development of FMS. Because CSA is such a devastating experience, false accusations of sexual abuse have enormous, if not shattering, consequences for families. We present three case reports to illustrate features of the FMS. FMS should be listed for further study to establish valid criteria for making the diagnosis under the category of “factitious disorders,” and a subcategory of “false memories/beliefs of abuse,” with a further subdivision of “induced by therapy.” The FMS controversy occurred in the context of a general moral panic about sexual abuse in the early 1980s. Psychiatrists should have a high degree of scepticism to moral panics. Copyright © 2001 by W.B. Saunders Company


VER THE LAST DECADE there has been considerable debate over the veracity of reports of childhood sexual abuse (CSA) derived from “recovered memories.” A recovered memory is defined as “the emergence of an apparent recollection of childhood sexual abuse of which the individual had no previous knowledge.”1 Recovered memory therapy (RMT) describes “the practices of a heterogenous group of clinicians who share a particular set of beliefs,” namely, that a wide range of somatic and physiological symptoms are caused by past sexual abuse, the memory of which is lost to consciousness.2 A key tenet of RMT is that recovery of these memories is an essential aspect of the treatment process. The debate on recovered memory extends from scientific circles in psychiatry and psychology to the public arena and has important clinical, social, and legal ramifications.3 In essence, the controversy is whether CSA occurring at a very early age can be forgotten for long periods and then retrieved, or recovered, later in therapy or in response to cues or triggers from the environment. CSA has been associated with psychiatric disorders in later life, including mood, personality, and eating disorders. Estimates of CSA in women range from 3% to 63% (with little distinction made between incidence and prevalence).4 A considerable body of evidence has shown that the longFrom the Liaison Clinic, Wollongong, Australia. Address reprint requests to Dr. Robert Kaplan, The Liaison Clinic, 310 Crown St, Wollongong, NSW 2500 Australia. Copyright © 2001 by W.B. Saunders Company 0010-440X/01/4204-0013$35.00/0 doi:10.1053/comp.2001.24588

term effects of CSA are largely nonspecific: there is no pathognomonic post-abuse syndrome.5,6 There are numerous studies of personality-disordered subjects reporting CSA (Medline search). For example, in parents who raise allegations of CSA, up to 80% have personality disorder, about six times the rate one would expect in the general population.7 Many researchers have concluded that CSA is the cause of borderline personality disorder. As is increasingly the nature of controversies, much of the debate has taken place in public, with scientific debate occurring on a secondary and often reactive basis. The appeal of the recovery paradigm is the explanatory power of its jargon: “healing,” “victim,” “repression,” “remembering,” “disclosure,” “perpetrator,” and “survivor.” Critics, such as Ofshe and Watters,8 Crews,9 and Pendergrast,10 have cogently questioned the irrational, emotive and inconsistent basis of the recovery movement. The theoretical underpinning for RMT was derived from the early work of Freud on hysteria.11 Severe trauma was repressed to the unconscious mind because it was too painful to tolerate. The preserved memory could emerge years later under therapy when the traumatic events were re-experienced in accurate detail. However, Freud recanted from his initial belief that hysterics suffered reminiscences of sexual abuse, establishing instead the concept of the Oedipal complex.12 Thus, sufferers from hysteria were victims of fantasies about their fathers, not actual abuse. However, after 60 years of study, there has been no scientific validation of the concept of repression.13 Workers like van der Kolk and Kadish believe

Comprehensive Psychiatry, Vol. 42, No. 4 (July/August), 2001: pp 342-348

16 Mainstream psychiatrists and psychologists approached CSA on the basis of feminist beliefs. was a reaction to being forced to perform oral sex. Written by two feminist counselors who did not have formal training in psychology. and by continually insisting that all problems were due to sexual abuse. . . Abuse therapists followed a “one size fits all” approach. a leading authority on dissociative disorders. The most famous (or alternately. these included panic attacks. their findings were drawn from sexual abuse victims in women’s groups. a child represses. Using an unabashedly directive approach. both promiscuous behavior or sexual avoidance could be seen as a reaction to being abused. the usual approach was to close off all other means of confirming what had happened with external sources. hypnagogic hallucinations. the repressed memories emerged in highly symbolic fashion. multiple personality.19 Frank Putnam. studying problems. is the one most often credited with reintroducing the public and mental health professions to the syndrome of multiple personality. The misunderstanding of common symptoms resulted in a similar interpretation. and bulimia. On the same basis. as Freud.14 They expect that the recall during therapy will lead to recovery from a condition they term “complex posttraumatic stress disorder. trancemediumship. . The Courage to Heal became the bible of the repressed memory movement and it was not too long before recovered memories of sexual abuse were a regular feature on talk shows. rendering them incapable of differentiating confirmed events of their childhood from experimentally implanted false narratives. anxiety. notorious) came from The Courage to Heal. low self-esteem. each instance of sexual abuse until it is recalled in therapy. This was explained by the concept of body memories.15 Loftus has demonstrated how to trigger false recall in normal volunteers. Vomiting. borderline states.”20 RMT was made popular by a number of books which implicated a wide range of symptoms and signs said to be indicative of childhood sexual abuse.22 These therapists usually had limited or minimal training and could be considered marginal in relation to registered psychologists or social workers.17 Dissociation comes as much from the work of Janet. baggy shapeless clothing was indicative of a desire to reduce sexual attractiveness. Once the patient believed that they had been abused. alcohol and drug abuse. a fact which has not received wide publicity. Typically. So-called “abuse therapists” proliferated in the 1970s and 1980s in response to growing awareness of the extent of CSA. Therapists would refuse to see parents to hear their side of the story on the grounds that it would interfere with their relationship with the client. sleep paralysis. Patients were encouraged to confront the alleged abuser and then cut off all contact. Advertising for clients was often placed on bulletin boards at women’s centers. in which physical changes were regarded as mnemonic of the repressed trauma.21 a best seller that ran into many editions. brain disorders. or on the internet. hysteria. therapists wore down the resistance of any patient who had doubts whether it actually had occurred. and psychosis reveal that memory associated with these states is qualitatively different from that found in laboratory studies of healthy individuals. a symptom of bulimia. or involuntarily forces out of awareness. stated “The case of Sybil . the so-called condition seconde. epilepsy. poor relationships. in the alternative press. seen as a more sophisticated and less simplistic explanation of the problem than repression. others had a special interest in dissociation. Any problem in life. According to repressed memory theory. Patients who insisted that they did not remember being abused were regarded as “in denial” and encouraged to hold the belief of being abused in their minds until they did believe it—scarcely an objective means of confirming matters of considerable legal significance.18 Dissociation was first linked with repression and sexual abuse with the publication of the book Sybil by Flora Rheta Schreiber. emotional difficulties. eating disorders. Diagnosis by therapist and patient was facilitated by the use of check lists.IS THERE A FALSE MEMORY SYNDROME? 343 that traumatic memories of CSA are laid down in the brain through a unique process that does not apply to other forms of trauma. In their view.” Studies of hypnotism. including depression. He later retracted this belief. Janet postulated a “split” in the psyche where traumatic memories were disconnected from normal consciousness. difficulty with assertiveness.23 For example. or marital problems was considered to be a pointer to CSA.

believers in repressed memory. she became convinced that she had been the victim of extensive sexual abuse involving a number of men and women over a period of 16 days while traveling. R. R. it can take on a life of its own.” which apparently confirmed that some of these people were drug dealers. convinced that she was repeatedly anally and vaginally raped in a drugged state by the people with whom she had stayed in Europe. R.344 KAPLAN AND MANICAVASAGAR A range of treatments was used by therapists to uncover repressed memories. she went on a trip lasting a month. was not depressed or anxious. She also developed anal pain. such as the death of her father and the break-up of her first marriage. she had been in a state of distress. the False Memory Syndrome Foundation was established. R.’s description of what purportedly happened to her during her travels defied rational belief that it could have occurred over . even when the case could defy rational belief that it had occurred or was contradicted by the material evidence. Five months before presentation. The recovered memories often rule the individual’s personality and lifestyle and overrule adaptive behavior. had a sense of “something wrong. R. She did not accept treatment or return for follow up. Sister organizations were soon established in the United Kingdom. hypnosis. she developed anal pain and what can be regarded as hysterical stigmata: red wheals on her arms. which is usually in pre. After the first session. thought to be consistent with marks caused by the insertion of intravenous needles. arose during a therapeutic relationship and were reported to start at a much younger age than never-forgotten abuse.26. Increasingly frightened by these concerns. R. or confused. Further sessions confirmed and reinforced these memories. To find an explanation. become encapsulated. These included validation.24 Some psychiatrists used drug interviews or abreactions. The false memory syndrome (FMS) is defined as a condition in which a person’s identity and interpersonal relationships are centered around the memory of a traumatic experience that is objectively false but in which the person strongly believes. she did not appear to be manic. On presentation. CASE REPORTS Case 1: R. age regression.”25 RMT had the most impact in the legal arena. which reinforced her beliefs. After she returned home.29 This was in marked contrast to the large body of work on CSA. she kept in regular contact by phone with her husband. she saw a hypnotherapist for four or five sessions. where the majority of abusers were stepfathers.” which she could not explain. The Netherlands.. thought disordered. art therapy. The sessions were conducted in the presence of her husband. dream interpretation. Age 40 R. survivor groups. A study of accused family members of the British False Memory Society showed that 87% of the accusers were women. any indication of sexual trauma. He initially doubted what she remembered and accused her of having sexual relationships with other men. She was leading a normal life and going to work when the opportunity presented. rather than biological fathers. Individuals with FMS often avoid confrontations that challenge the resulting beliefs and are effectively distracted from coping with real problems of living and family relationships. and Israel.30 Accusations were often nonspecific. despite overwhelming evidence that chemical abreaction was discredited and notorious for producing “fantastic stories. 50% of accusations were made against biological fathers and only 3% against stepfathers. in particular. Australia. including the belief that she had been drugged and hypnotized during this time to remove all memories of what had happened. disorientated. While away.28. There was further evidence when she developed red wheals in her antecubital fossae. In trials held across America (and in other countries). R. Her manner was breathless and her account of what happened appeared to be melodramatic. Visits to a neurologist and gynecologist however excluded physical pathology and. sometimes speaking twice daily. Her relationship with her husband had been difficult since the revelations emerged. There was no history of past psychiatric problems. who gave testimony. people were convicted by juries on evidence that accepted the existence of repressed memories. the “truth drug” technique. We present three brief cases that illustrate aspects of the FMS. R. Much of the credit for conviction went to prominent psychiatrists. which she denied. said she would consider this but did not believe that it was correct. then saw another hypnotist for a similar number of sessions. Since then. She was competent at her job and had coped well with family problems. she terminated the sessions when the hypnotist insisted he see her alone to clarify her recollections.27 As the controversy over convictions based on repressed memory increased. As a result. and her husband made “investigations. and other activities intended to bring the memories to consciousness.or early adolescent children. traveled to Europe on a regular basis for business purposes. When it was suggested that hypnosis may have induced her beliefs. guided visualization. On examination. Treatment reinforced her belief that she was a victim of multiple sexual abuse. and is often resistant to correction. described herself as not “suggestible” in nature. was treated by two hypnotherapists. who insisted on accompanying her.

Yet. shy girl who had school phobia in her early years. were minimal. After finishing school. Significantly.’s growing belief that her grandfather was an abuser. Treatment followed along routine lines. D. Features strongly suggestive of FMS in D. came to the belief that she was victimized. although in itself. her symptoms settled and she resumed normal relations with her mother and husband. whose only comment was that her grandfather asked her into his room when she was young and she had felt afraid.. recovered memories extending before the age of 4. D. Her father had been an alcoholic. phoned her husband on a daily basis during the trip without reporting any problems. ceased sexual relations with her husband. During the time that D. R. By the time it finished. .IS THERE A FALSE MEMORY SYNDROME? 345 such a period without her being aware of it. D. Case 2: D. told her mother. This had no benefit and she never stayed with them for long. After a nocturnal panic attack. which was interfering with her daily life. To overcome her problems. she was asked about her recollections of being molested. he said he could not exclude it. Her problem required less attention. and the nature of panic attacks explained. it was noted that there was a family history as her sister also had anxiety. citing the closeness of the family. Age 40 D. had repressed memories of sexual abuse. accusation of her grandfather as the offender. D. Hypnosis had most likely promoted the false memories. Her belief that this had occurred progressively withered over the course of treatment. in a state of panic. The alleged perpetuators of the abuse were business colleagues whom she had regularly dealt with over the years without any problems. She became increasingly agoraphobic and experienced intense depersonalisation. To find evidence to support her claims. At intervals. was attending. she began seeing a psychologist who interpreted her anxiety symptoms as being due to sexual abuse in childhood. it is difficult to avoid the conclusion that it must have been a convenient means for R. this would not have been conclusive. by coincidence. had a mixed response to treatment. occurring within the past few months. without anyone else around her being aware. or that she could have suppressed all memory of what happened in such a short period of time until she went for hypnosis.) for cognitive behavioral therapy.’s case include: a therapist who believed her symptoms were due to CSA in the absence of any memory or history of this. The psychologist would urge her to “go into the fear. D. D.’s husband. which put strain on the marriage.’s anxiety symptoms. Within weeks her panic attacks abated. was seen over 18 months. As he had died.M. D.” by which he meant she should focus intently on the anxiety. had been acutely distressed. she and her husband interpreted minor physical signs and changes as confirmation of what they believed. to believe she had been molested by her grandfather between the age of 4 and 8 years. D.’s anxiety continued to worsen. D. misunderstanding of D. resulting in panic attacks and agoraphobia. married. While this further reinforced her convictions. was abused. Later she visualized having intercourse with him. despite the allegations of extensive and repeated sexual abuse. D. He frequently suggested that D.’s sister was emphatic that no sexual abuse could have occurred. This led D. depersonalization. the issue is not the extreme nature of the beliefs or the tenacity with which they are held in the face of rational contradiction. With FMS.’s husband’s accusation of affairs did not have any factual basis. opportunities for her grandfather to be alone with D. She had been seeing a psychologist but developed an intense fear of dying. Five years before presentation. She attributed this to intense self-consciousness when any attention was drawn to her. namely. and had three children. The issue of “lookism”—drawing extreme conclusions from someone’s expression or gaze—reinforced D. was referred with a history of anxiety and agoraphobia. became convinced that he had intercourse with her a dozen times. to deflect the accusation that something more likely. However. leaving a residual degree of agoraphobia. she felt able to return to work and ended the sessions with the psychologist. hypnotic suggestions that D.31 This case involved recent memories of alleged abuse. D. with sessions twice a week over a period of several years. discussion of this issue was to be postponed until she felt less anxious. but the circumstances in which they occur. D. Nevertheless. in their past relationship. She was a quiet. was quite certain that she had never been molested and expressed anger that she has been misled into believing as such. with more appropriate management. Her sleep was disturbed and she experienced frightening dreams. As a result of her conviction that she had been molested. In particular. Gynecological examination excluded any changes that could be attributed to the repeated and brutal rapes she alleged. Once R. Some corroborative evidence was supplied by her sister. She saw him on an intense basis.’s style at interview was histrionic. Histrionic personality has been associated with high hypnotizability. He interpreted this as a premonition that she was going to die. Her anxiety had become more intense over the 10 years prior to presentation. convinced she was going to die and despairing at the thought of losing her family. and illness phobia. her sister. was commenced on antidepressants. She was referred to a clinical psychologist (V. Since then D. R. Asked if he believed that was possible. At the first session it was pointed out that while the possibility she had been molested was not high. also sought help for panic attacks. Her initial recollection was of feeling uncomfortable in the bath with her sister when her grandfather came in and looked at them. reassured that she was likely to have a full recovery. lost the conviction that she had been abused. had occurred. there was no physical evidence of such events. D. went to work. was the third of five children. she went back to the psychologist. initially suspecting infidelity. the role of suggestion during therapy and the retrospective extension of memories to early youth incompatible with neurological development of valid memory. he could not be confronted about the allegations. an affair. saw several counselors for hypnosis. although it can be questioned whether R. Yet. and the difficulty he would have had molesting D. without detection. later accepted her version of events. not revealed. At interview. Although she had coped with marriage and work. her social phobia worsened. R.

saying that it had involved “intercourse with other people. In the sense that all illnesses are social constructs. usually but not always occurring in early childhood. F. She stated emphatically that satanic covens were trying to control her mind. had multiple personalities and was making progress in therapy as each personality “cleared up. 7. “voices in her head. Several months later she moved to the area. began reading literature on CSA. has been extensively documented as an artifactual condition which is unlikely to persist when subjected proper scrutiny. was reluctant to discuss her symptoms. 6. as well as protecting the index personalities from their influence. satanic rituals. 4. In her late teens. F. we believe the following features are typical of the FMS: 1. moving to new towns every few years. the previous year and diagnosed her as having multiple personalities. She acted as their counselor and described the aims of treatment as restraining the various alters from continuing to attend satanic rituals. She ran a home for victims of sexual abuse. and was not thought disordered. F. assisted by her mother. specifically passivity events. F. DID. became involved with a distinctly marginal counsellor who worked as an abuse therapist. Absence of medical or forensic confirmation of abuse. commenced counseling and moved into the home run by the Exit Counselor.” She refused to concede that she had no professional qualifications. in the course of therapy without any pre-existing awareness in the patient. Presence of somatization or borderline personality disorder.” Her father died over a decade earlier. F. She denied other psychotic phenomena. or other corroborative evidence. 3. This convinced her she was a victim of “extreme sexual abuse” by her father from an early age. presented as a withdrawn woman with a flat affect. We note the strong association of FMS with claims of satanic ritual abuse and DID. took the latter for a year and thought that it had a beneficial effect on her mood. 2. had several siblings and came from “a background of abuse. She was emphatic F.” She led an isolated life and never had any relationships. She had voices in her head since the age of 2 but did not believe that this was due to external phenomena. was accompanied by her “Exit Counselor. Over this time. United Kingdom. had multiple personality disorder and required assessment for Social Security benefits. this syndrome. We are not claiming that these features are consistent or mutually exclusive and we accept that others would dispute some of these criteria or add their own. F. On examination. She had received media publicity for her work with ritual sexual abuse. she sought psychiatric help for what appeared to be depression and had a long admission to hospital. the condition most frequently attributed to CSA. 5 years before presenting.) on her own. The overall impression was of an articulate. Evidence of suggestion during therapy and/or use of hypnosis or related techniques. and kill her. refused any treatment and would not make a return booking.34 . This case has the most typical features of FMS in view of the association with dissociative identity disorder [DID]. but was not depressed or anxious.’s subsequent lifestyle was peripatetic. Retrieval of dense and extensive memories occurring before the age of 4 years. intelligent woman with a fragile.. Claims of extensive sexual abuse which went on without discovery by other sources. She was reluctant to describe her other personalities or state how many there were.” for which she was treated with chlorpromazine and fluoxetine. F. The retrieval of memories of sexual abuse. was reluctant to discuss the abuse. She alleged extensive and extreme ritual abuse. At the age of 37.346 KAPLAN AND MANICAVASAGAR Case 3: F. had almost two decades of dense amnesia before “recovering” the abuse memories. send electric shocks through her body. who allegedly cooperated in the satanic rituals.32 Investigations of satanic ritual abuse in the United States.” and fears about her security. The Exit Counselor was extremely defensive about her role.33. The two continued a highly unusual relationship by moving into a house where other purported victims with multiple personalities were staying. She had obtained extensive information about CSA. She saw a psychiatrist who thought she had “10% delusions. so she could not confront him. and Australia have revealed no convincing evidence that this exists or is producing the outcomes that are claimed. and multiple personalities. Based on these and other cases we have encountered.” who insisted that she come in to the interview with her. The Exit Counselor met F. Age 42 F. is an example of a disorder that requires scientific validation. 5. but conceded that they took over her index personality and made her speak in different voices. a product of the media-driven junk science era in which we live. Later the Exit Counselor spoke to the psychiatrist (R. F. which had never been discovered or commented on by anyone else. DISCUSSION Objections can be raised to the FMS on the grounds that it is a syndrome and has not received any validation as a formal diagnosis. F. but spoke vaguely of mood swings. dependent personality showing borderline traits.K. F. Association with claims of satanic ritual abuse or DID. F. she had made 10 attempts to kill herself by slashing her wrists. was referred by a family doctor who stated that F.

K. “when the critical faculty is even slightly loosened . when the revelation of CSA becomes public. above all. FMS is associated with primary gain: the desire to enact the role of a patient.. which were only later established in someone of a highly suggestible nature seeking an explanation and solution to her problems.”40 We could not agree more.” with a subcategory “false memories/beliefs of abuse.36 Precisely because CSA is such a devastating experience. While it is the province of the law to determine the truth of an accusation of sexual abuse. we question whether FMS cases should have access to Social Security benefits without confirmation of the actual diagnosis. divided loyalties.”39 What cannot be disputed is that unfortunate treatment outcomes can occur when the diagnosis of abuse survivorship is mistaken. we are not adopting a particular ideological view or siding with perpetrators. While F. Psychiatrists are vulnerable to social influences. for all their limitations. and directed questioning can lead to false as well as truthful accusations. Hypnosis has a strong capacity for producing false memories or memories that are distorted by therapist suggestion. confusion. which played a not-insignificant role in the presentation. the welter of ambivalence. “induced by therapy. In the words of Harold Merskey.’s case. we have documented the capacity of a new therapy. This augmented the likelihood that she did not have any memories of abuse. moral. The first case was more unusual in that it was not the memory of childhood abuse. if not shattering. the presentation was a blatant request to retain Social Security benefits.) on the stated grounds that her therapist had told her he was a “known perpetrator and retractor supporter. it was an obvious rebuttal to her husband’s accusation that she had been having affairs. an authority on hysteria. The tertiary gain obtained was the financial benefits to her therapist.” Feigon and de Rivera have expressed concern that the approach of some therapists who automatically identify abuse survivorship in their patients will “petrify the diagnostic process and solidify the patient’s belief that he or she is. we are encouraging the study of how such a problem arises. . We have encountered two other cases where contact with the medical profession was only sought to obtain Social Security benefits. it is very much the business of psychiatry and psychology when false accusations arise specifically as a result of misguided. there is no end to the developments that can occur. We present these three case vignettes without any pretence that they are detailed or definitively exclude CSA. Among the limitations are that two of the cases were only seen on one occasion. but events occurring within the previous few months to an adult. By describing cases with features of the FMS. In our cases. secondary gain was an important feature because it led to contact with the medical profession which might not otherwise have occurred. and prevented. especially when associated with DID. but should have a high titer of scepticism to moral panics. Cases 1 and 3. We propose that FMS should be diagnosed under the category “factitious disorders. In one case. and psychiatric implications. essential to fund the group home in she lived. social. A substantial minority of therapists have functioned as “authorities for the disputed core beliefs. this serves to illustrate the point that FMS can apply to a wide range of circumstances occurring at different ages. had difficulty forming relationships and led an isolated life.” and a further subdivision. .IS THERE A FALSE MEMORY SYNDROME? 347 Hypnosis or related techniques are frequently used to elicit symptoms in the FMS. Nevertheless. however. With F. a situation in which false accusations of sexual abuse become accepted as genuine will have enormous. suggest an aspect of the FMS which has not received comment: secondary and tertiary gain. a referred patient refused to see a psychiatrist (R. she had not sought help for many years after leaving home.” This approach occurred in the context of a general moral panic about sexual abuse in the early 1980s. recognized. and how it can be predicted. consequences for families. if not egregious. strongly of the view that memories of sexual abuse arising directly out of therapy in the absence of any previous evidence constitute a significant problem with legal. misguided pressures.” Based on our experience with these cases. . eye movement desensitization reprogramming. therapeutic practices. We are. a survivor. to cause similar problems.35 As a variation on this theme. In describing these cases and attempting to clarify the features of the FMS.37 Furthermore.38 In R.

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