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Book Review | January 01, 1999

Trauma and Memory: Clinical and Legal Controversies

Laura S. Brown, Ph.D.

Psychiatric Services 1999; doi:

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edited by Paul S. Appelbaum, M.D., Lisa A. Uyehara, M.D., and Mark R. Elin, Ph.D.; New York City, Oxford University Press, 1997, 552 pages, $55

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The controversy over delayed recall of childhood sexual trauma has had the serendipitous effect of generating a wealth of new research and vigorous reanalysis of old verities about how trauma affects memory and, in turn, how the process of psychotherapy impacts on recall (1). This book is among a number of recent volumes attempting to address the issues inherent in the debate.

As is true of any edited volume, some unevenness is present. Some of the chapters do an excellent job of illuminating the complexities underlying the intersection of trauma and memory. Others appear to represent either restatements of by-now well-worn polemics or interesting, although merely theoretical, musings about how it might be that some adults sexually abused in childhood have delay or fragmentation of memory for events that should, according to principles of usual memory, be easily and well recollected. Because space does not permit a detailed analysis of this lengthy volume, I will focus on chapters that I believe will be of particular value to the general mental health practitioner, for whom neither trauma nor forensic practice are a focus.

Chapters by Douglas Bremner and his colleagues, Wilma Koutstaal and Daniel Schacter, and Michelle Leichtman and her colleagues provide a thorough review of the neurobiological, cognitive, and developmental aspects of remembering, forgetting, and recollection. Each chapter is balanced and cautious, not making sweeping generalizations from one set of findings, nor do any of these chapters assume isomorphism between laboratory and clinical contexts.

The chapter by Leichtman and others was particularly provocative for me because it offered a solid, science-based foundation for understanding how very early, preverbal memories can now be demonstrated to be present in children, contrary to the prior stance taken by many in the field of cognitive science that memory had an absolute age limit. Bremner and associates' chapter, which expands on research published previously by this group in professional journals in the fields of psychiatry and traumatic stress studies, underscores the importance of looking at the impact of trauma on brain anatomy. It offers cogent arguments against the notion propounded by some adherents of the so-called "false memory" perspective that all memory will be similarly stored and thus subject to precisely the same rules.

Clinicians will find that chapters by Mary Harvey and Judith Herman, Julia Matthews and James Chu, Maria Sauzier, and Lisa Uyehara are especially useful in honing a therapist's critical thinking skills when presented with ambiguous clinical information that might suggest a trauma history, yet might also offer itself to other equally good interpretations. Uyehara's narration of her careful differential diagnosis of a client through the course of treatment was one that I found compelling and instructive, and that clearly cautions treatment professionals against premature cognitive commitment to any given theory of a client's symptoms.

All of these authors offer strong arguments against the stance being proposed by some professionals allied with the false-memory movement that would require therapists who treat adults to give a negatively special status to reports of abuse and to require corroboration over and against a patient's desires for privacy and treatment. Clinicians concerned with the intrusion of forensic realities into their practice will also find the entire section on the legal system to be helpful in resisting overly defensive approaches to practice with clients who report a childhood sexual abuse history.

This book makes for dense reading, and a few of the chapters seem bogged down in specialized terminology or rhetoric. For a novice to this topic, it offers some good basic research foundations for clinical work with the remembering adult. It does not stand alone, however, and readers should be reminded that the science and standards of practice in the field of trauma and memory change rapidly. It is certainly a valuable addition to my collection of works on this topic.

Dr. Brown practices clinical and forensic psychology in Seattle, specializing in the treatment and forensic evaluation of victims of trauma and psychotherapeutic malpractice. She was a member of the American Psychological Association's working group on recovered memories.

References

Pope KS, Brown LS: Recovered Memories of Abuse: Assessment, Therapy, Forensics. Washington, DC, American Psychological Association, 1996

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Laura S. Brown; Trauma and Memory: Clinical and Legal Controversies. Psychiatric Services. 1999 Jan;50(1):119-120.

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