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OARMHP
OHIO ASSOCIATION
OF RESPONSIBLE MENTAL HEALTH PRACTICES
May
2003
Hi readers,
I hope the May flowers are
blooming in your city. It has been a long winter. Here are some
interesting articles by Elizabeth Loftus and Margaret Wente. Let me hear
from you. Share your story with our readers.
Carole
Dispatch From the Repressed-Memory Legal Front
by Elizabeth F. Loftus, Ph.D., and Deborah
Davis, Ph.D.

Elizabeth F. Loftus
Several years ago, in a widely
circulated Peanuts cartoon, Lucy hung out her shingle and offered
psychiatric help in recovering repressed memories. She told Charlie Brown:
"The fact that you can't remember being abducted by aliens and
satanically abused is proof that it really happened."
About that same time, Walter Goodman reviewed Ofra Bikel's award-winning
television program Divided Memories for the New York Times. His review,
"Growth Industry: Helping Recall Sexual Abuse," asked if
repressed-memory therapy was a cure or a fad.
By the time that Divided Memories
aired, thousands of people, mostly women,
had recovered memories of extreme sexual abuse that had allegedly been
totally repressed. A small percentage later recanted their stories, and
some sued their therapists for planting false memories. A handful of
parents whose grown-up children had not recanted also sued their
offsprings' therapists, claiming that false memories had been planted
during the therapeutic process.
One example is the Ramona case, in which Holly Ramona sued her father,
Gary Ramona, after "de-repressing" more than a decade of sexual
abuse and rape (Johnston, 1997). The case captured significant attention
in the psychiatric community when the father successfully sued his
daughter's therapists for planting false memories and won a
half-million-dollar jury verdict.
While much of the public now thinks that the repressed memory carnage is
over, in fact, it is not. The number of new cases has dramatically
declined and numerous alleged victims have recanted their accusations or
reestablished ties without saying they were wrong. However, many of the
afflicted families are still estranged, many proponents of
repressed-memory therapy remain angry, and more than a few innocent people
remain imprisoned, convicted of crimes that did not occur. Legal cases
involving testimony about repressed memories continue to wreak havoc on
the lives, emotions and bank accounts of hundreds of individuals.
Statutes of Limitation for Legal Cases
Cases proceed in part because of extensions in the length of time alleged
victims have to pursue civil actions and the length of time that
prosecutors have to try the case in criminal court. An article by attorney
Jeffrey Dion (2001), chief counsel for public affairs for the National
Crime Victim Bar Association, aimed at lawyers who represent plaintiffs in
civil cases, praised time extensions and advised
litigators to be aware of them and how they differ from state to state.
Dion applauded the fact that most states stop running (tolling) the
statute of limitations for claims of sex-abuse injury to a minor until the
child reaches age 18, saying such extended statutes are justified by the
severe emotional, psychological and physical harm suffered. He added,
"Some victims are so traumatized that they repress memories of the
events." He noted that at least 15 states require that a civil action
be brought within a specific number of years after the injury was, or
should have been, discovered. States, however, vary, and some don't cover
child sex abuse outside the family or allow the statute extended beyond
the plaintiff's 18th birthday.
Of particular interest to mental health care professionals are the civil
cases that allege sexual abuse by a counselor or therapist. In Iowa, for
example, these cases must be brought within five years of the date the
victim was last treated by the therapist. Dion applauded this lengthy
extension on the grounds that it recognizes that the continuing influence
and control that a perpetrator may have over a victim may prevent prompt
reporting. Extensions to file against therapists mean, of course, that
dubious cases are filed at great personal cost to therapist-defendants.
This occurred in a case in which one of us testified. A woman sued her
former psychiatrist after recovering long-since repressed memories of
molestation allegedly occurring during her prior therapy. A psychiatrist
of some renown supported the patient's claims, opining that the evidence
provided "the greatest support to the hypothesis that this is a valid
sexual abuse case." Two defense experts, after reviewing extensive
materials, found serious reasons to doubt that abuse had occurred at all,
and the jury found in the psychiatrist's favor. Despite the verdict, the
doctor suffered greatly.
Reactions to Repressed-Memory Claims
This case points to a problem with lengthy statutes of limitations, namely
that they will apply not only to victims with continuous memories
accompanied by solid corroboration, but also to individuals who have
recovered allegedly repressed memories with no corroboration and rather
dubious claims. Both types of cases create a horrific situation for
alleged perpetrators who are sometimes very old; have failing memories;
and can only deny, but not disprove, the accusation. Even though the
burden of proof is on the prosecution, the reality is that when one side
presents emotional, detailed stories, the defense has a hard row to hoe.
Before Bikel's Frontline documentary, a number of judges and juries
accepted even the more suspicious claims of massive repression or extreme
brutalization. More recently, however, courts appear to be treating the
claims of total repression or dissociation with significant (although not
universal) skepticism.
In Massachusetts, the highest court ordered a new trial for school bus
driver William Frangipane, who was convicted of raping a teen-ager who did
not recall most details of the assault until five years after it allegedly
occurred (Commonwealth v Frangipane, 2001). The court ruled that
Frangipane was entitled to a new trial because an expert witness used by
prosecutors to discuss the effects of trauma on memory testified outside
her area of expertise. The court noted, "The subject of 'recovered
memory,' particularly of childhood sexual abuse, is highly
controversial."
A comprehensive review of legal cases published by Piper and colleagues
(2000) concluded that while a few courts do allow testimony by individuals
about their allegedly de-repressed memories, the great majority of courts
have refused to acknowledge the validity of repressed and recovered
memory. This was true for cases involving efforts to toll a statute of
limitations, or when there had been an effort to present to the jury the
claim that repressed memories constitute a scientifically established
theory. These courts repeatedly determined that the concepts of repressed
and recovered memory were controversial, not generally accepted and thus
not admissible to a jury.
In one California case, for example, the court denied the plaintiff's
request to toll the statute of limitations based on repressed memories,
stating that repressed memory "is not generally accepted as valid and
reliable by a respectable majority of the pertinent scientific
community" (Engstrom v Engstrom, 1997). In a Rhode Island case, the
defendant was freed after the court ruled, "The State has not met its
burden of establishing that repressed recollection is reliable and
admissible as scientific evidence" (State of Rhode Island v
Quattrocchi, 1999). Similar skepticism was expressed in a newspaper
editorial in Canada's National Post (2001): "The evidence has never
been more compelling that 'repressed' and 'recovered' memories are highly
suspect." After pointing to the real possibility that Canadians were
languishing in jail because a court had taken such evidence seriously, the
editorialists urged the federal justice minister to call for an inquiry.
Blaming the Defendant's Alternate Personalities
Skepticism also abounds in the criminal cases in which individuals have
tried to argue that their crimes should be forgiven because they are
suffering from dissociative identity disorder, a diagnosis often
associated with repressed memories. Death-row inmate David Pellegrini, for
example, tried to block his execution, claiming that when he shot a
convenience store clerk, he was suffering from multiple personality
disorder that his lawyer should have argued that he was innocent by reason
of insanity (Pellegrini v State, 2001). The Nevada Supreme Court rejected
his argument.
Skeptically Received, But Costly
In some states, child sexual assault charges can be brought long after the
alleged victim reaches the age of majority. Under New Hampshire law, for
example, such charges can be brought until a victim's 40th
birthday (Belluck, 2002). Other states have resisted such procedural
vehicles.
In 2001, the Connecticut legislature considered a bill that would have
allowed an alleged victim of child sexual abuse to seek criminal charges
against the accused perpetrator up until the victim attained the age of 48
years. Supporters argued that the bill recognized legitimate delays in
reporting. Opponents stressed that the bill would not give the accused a
reasonable chance to defend themselves, defeating the purpose of the
statute of limitations. Testimony could hardly be particularly reliable 30
years after the complainant reached 18 years of age. The legislation
failed.
The Connecticut Law Tribune
(Advisory Board, 2001) called the bill odious and concluded by first
acknowledging the unpleasant reality of sexual abuse and then going on to
say that calling "alleged perpetrators of unthinkable crimes to task
many years after an incident, after memories have faded and witnesses have
passed away, or when a memory is 'restored,' is unjust."
Implications for Patients and Therapists
It does appear that the laws in many states allow patients to legally
pursue their claims based on repressed or dissociative experiences that
are recently revived. But in practice, patients face much skepticism from
judges and juries. The legal allowance thus means that accused defendants
suffer greatly, while patients experience renewed frustrations.
In appreciating these costs, psychiatrists may wish to avoid encouraging
their patients to seek legal redress. In addition, psychiatrists might
consider whether they have an obligation to inform their patients of the
risks of pursuing claims based on de-repressed memories.
A major risk is that, in some cases, the patient may be liable not only
for their own attorney fees, but for the defendant's attorney fees as
well. Often, the patient's medical records will be scrutinized, not only
in civil cases, but also in criminal cases where the records are
frequently subject to in camera inspection.
Finally, patients may face costly counterclaims brought by those whom they
accuse in court. This occurred in a case brought by the 48-year-old son of
a Las Vegas gynecologist. Quincy Fortier Jr. contended he recently
recovered "long-frozen memories" of sexual abuse inflicted on
him by his father (Thevenot, 2002). The father filed a counterclaim,
accusing his son of intentionally inflicting emotional distress and
portraying him in a false light. While the father's counterclaim was
eventually dismissed by the judge, the jury returned a verdict on behalf
of the father in the main claim after deliberating less than an hour. In
other cases involving counterclaims, accusers have been found liable for
defamation or emotional distress and subject to substantial damages.
Once a case does find itself enmeshed in the legal process, psychiatrists
who enter as experts might do well to keep a few things in mind. There is
a relatively new position statement, put out by the American Psychiatric
Association (2000), that acknowledges the problem associated with denying
genuine abuse but also reminds professionals, "Memories can also be
altered as a result of suggestions, particularly by a trusted person or
authority figure." It goes on to caution that, when providing expert
opinion about memories of abuse, psychiatrists should refrain from making
public statements about the historical accuracy of uncorroborated reports
of new memories based on observations made in therapy.
Perhaps the legal system may not be the best place for resolving
repression claims, either for patients or their psychiatrists. Perhaps a
committee should be convened to explore whether some other arena would be
better for arbitrating such disputed claims.
The old Peanuts cartoon showing Lucy's repressed-memory extraction work
reflected that state of affairs. But the cartoonists these days seem to
have changed their tune -- in a positive way -- when they depict mental
health humor. In mid-2001, Lucy again hung out her shingle and offered
psychiatric help for five cents. Charlie Brown complained that he needed
someone to tell him he's doing the right thing. Lucy, instead of talking
to him about his repressed memories, first simply told him he was right
and eventually offered this advice: "You need more in life than just
having someone around to tell you when you're doing the right thing."
Although that last bit of advice cost Charlie another five cents, the
cartoon expresses a much kindlier humor directed toward the mental health
care profession than we saw a decade ago.
Dr. Loftus is professor of
psychology and adjunct professor of law at University of Washington. She
is also past president of the American Psychological Society.
Dr. Davis has taught psychology at University of Nevada, Reno, since 1978.
She is also president of Sierra Trial and Opinion Consultants, a firm
offering jury selection, mock jury research and other trial preparation
services.
Psychiatric Times April 2002 Vol. XIX
Issue 4
Big business: the trivializing of trauma
By Margaret Wente
In the awful days after Sept. 11, some
9,000 trauma experts swarmed like locusts over the stunned citizens of New
York City. They performed official trauma assessments, and pounced on anyone
even remotely connected with the tragedy. They encouraged people in
debriefings and group meetings to relive the nightmare and share their
emotions. That way, people could heal.
It's the modern way. When your body's
wounded, you see a doctor to help make you better. When your soul is wounded,
you summon a grief counsellor.
But it turns out that trauma counselling
doesn't work. A growing body of evidence shows that, if anything, it makes you
worse. "If this was a drug, we'd take it off the market," says
Richard Gist, a psychology professor at the University of Missouri who
published his own conclusions this week in the British medical journal The
Lancet. "Instead, it has taken on the force of a religious
movement."
The fact that it is a massive (though
well-intentioned) fraud probably won't affect the trauma industry. It's too
entrenched. It's in the schools, where the experts show up any time tragedy
strikes a classmate. It's in the workplace, whenever an employee goes berserk.
It has been adopted by international humanitarian programs. It's the hottest
topic in the military, where soldiers are now obliged to express their
feelings after every whiff of combat in order to maintain their psychological
health. It's in the insurance industry, the unions, the workers' compensation
boards and the lawyers' offices, where posttraumatic stress disorder has
become big business. And most of all, it's in the psychiatric trade, which has
enshrined PTSD in its official manual of disorders and made it one of the most
popular diagnoses of our age. As one psychiatric journal said, it's rare to
find a disorder people like to have. But PTSD is one.
PTSD refers to a broad set of symptoms
experienced by people who have undergone a terrible event. (It's invariably
assumed that the event caused the symptoms.) It's been used to describe the
condition of Cambodian women who lost their entire families to genocide,
endured years of slave labour and torture, and saw their babies hacked to
death.
But "terrible" is relative. PTSD
has also been diagnosed in people who were in car accidents, had a difficult
labour, endured verbal sexual harassment, or fell off a horse. Increasingly,
it's diagnosed in people who are just doing their jobs -- paramedics at
accident scenes, for example. All these people have sought compensation for
their conditions, and sometimes received it.
In British Columbia, a high-school teacher
was so unnerved by a disruptive student in his class that he booked off work
for several months. He was diagnosed with PTSD. The teacher said the trauma of
this situation induced prolonged headaches, chest spasms, cramps, diarrhea,
irritability and fearfulness. Last spring, the workers' compensation board
accepted the diagnosis, and awarded him $43,000 in sick pay.
It's bad enough that we can't distinguish
any more between neurotic teachers and genocide survivors. It's bad enough
that we encourage people to seek victim status, and fan their sense of
grievance. But since when did we decide we need experts to heal the wounds of
war, of loss and distress, and of just being alive? When did we begin
believing that experts can do a better job than families, friends and our
communities?
In fact, they can't. It turns out that the
most effective form of trauma counselling is the old-fashioned, private,
unprofessional, unpaid kind -- the kind delivered by your mother with a pot of
chicken soup, or the folks next door who offer to look after your kids or
drive you to the hospital or cut your grass, or the friend who just hangs out
with you, and takes you for a movie and a beer, and isn't trying to debrief
you.
I've always thought there's something
repulsive to insist that the grieving and the injured share their grief in
public. It's not therapeutic. It's pornographic. It's also false to our
natures. We are vulnerable creatures -- but we're resilient, too. Resilience,
stoicism, fortitude -- these are virtues that are vastly underrated in this
therapeutic age. The grief counsellors mistake them for vices.
Maybe it's because we suffer so few
genuine calamities that we are encouraged to inflate small misfortunes into
something grander. But what happens to the debased coinage of suffering when
the real thing comes along? If your life's ruined by falling off your horse,
what happens when your mother dies? If we're all so traumatized by the death
of Princess Di, what's left for Sept. 11?
But the grief industry has trivialized
grief. It has turned it into a pathology, then promised us the cure. It has
infantalized our culture, and cheapened mourning, and encouraged us to lose
our collective sense of what genuine tragedy is, and how time heals if we let
it.
After the genocide in Cambodia, a group of
women who had themselves lost everything began helping other survivors to
rebuild their shattered lives. They were asked how they had hung onto their
sanity, and what kind of counsel they were giving. "First," said one
women, "we teach them to forget."
On Sept. 11, it will be necessary to
remember, and to mourn. And then it will be time to move on.
mwente@globeandmail.ca
O A R M H P
OHIO ASSOCIATION
OF RESPONSIBLE MENTAL HEALTH PRACTICES
440-356-4544
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