Memory, Trauma Treatment, and the Law

The backdrop and impetus for this book is the often contentious debate taking place over the past decade about the interrelated phenomena of "repressed" or "dissociated" memory, "recovery" or "delayed recall" of memory, and "implanted" or "false" memory, particularly in relation to memories of childhood abuse.

As the authors (and many others) note, the debate is both scientific and political. The initial chapters detail the sociopolitical context for the recent rediscovery of child maltreatment and its profound psychological impact, the zealotry and therapeutic excesses of the 1980s in searching out and prosecuting perpetrators of childhood abuse, and the current predictable backlash, which threatens to reinstate a societal attitude of disbelief and denial about childhood abuse. The authors are each established experts in their respective fields of clinical psychology and law, and they also share a common expertise in the use of hypnosis in clinical and forensic evaluation.

The book is organized around the subject of memory, what we know and what we do not know about this complex and variable mental function—or, more accurately, set of functions. One of the great strengths of this volume is that each of the authors is clinically grounded and has personally confronted the challenges and uncertainties of listening to the "memories" of individuals reporting extreme traumatic experiences. They present the large body of clinical observations and research detailing the form and extent of memory disruptions following severe traumatic experiences, including sometimes full amnesia for the traumatic events and subsequent remembering. Readers will appreciate the thoroughness of this review.

The authors also document research on the fallibility of remembering, presenting opposing perspectives that challenge the credibility of recovered memories. However, they conclude that the clinical evidence for both amnesia and recovered memory is compelling, and they interpret the contradictory evidence as a basis for caution in the assessment of traumatic memory, but not as a basis for discrediting these memories.

One can accept the empirical fact of traumatic amnesia without knowing the mechanism. The authors clearly espouse the theory that severe trauma causes a disruption of the usual mechanisms of cognitive processing and remembering, resulting in the formation of a special form of memory, "traumatic memory." As such it is segregated from the normally integrative cognitive and memory functions and, in the extreme case, is inaccessible to normal consciousness and mental processing. It is important to recognize that proponents of this theory, including, for example, Horowitz (1) and van der Kolk and van der Hart (2), are not merely acknowledging the clinical phenomenology of dissociated memory, but are also postulating a distinct neuropsychiatric mechanism. In accepting this dichotomy of normal memory versus traumatic memory, the authors (and others) are also explicitly rejecting alternative explanatory theories for amnesia for traumatic experiences, such as unconsciously motivated repression.

The theory of dissociated memory is currently extremely popular and has considerable face validity and explanatory power. However, it may not be comprehensive enough to describe the full range of human psychological reactions to trauma. The rather exclusive focus on this model by the authors narrows the overall discussion.

The chapters on evaluation and treatment ("Phase-Oriented Trauma Treatment" and "Trauma Treatment and the Standard of Care") provide an extensive review of the modern clinical literature about "phase-oriented treatment"—that is, stabilization, integration, and postintegration development—of victims of childhood trauma. Given the theoretical orientation noted above, it is not surprising that the treatment orientation emphasizes the accessing and gradual psychological integration of dissociated traumatic experience, and it pays little attention to more psychoanalytically oriented issues, such as the victim's unconscious fantasies related to the trauma.

The treatment is conceptualized largely within behavioral, cognitive, and relational frames. Nevertheless, the authors apply current knowledge about trauma and memory to suggest reasonable treatment guidelines that judiciously balance the manyfold therapeutic tasks of remembering, cognitive restructuring, affective reworking, and personal and relational development with the demands of legal and ethical practice.

On the book jacket, this volume is described as "an essential reference on memory for clinicians, researchers, attorneys, and judges," clearly indicating the authors' intention to provide a comprehensive reference source for a very broad audience. The authors do provide an encyclopedic review of the available data from cognitive neuroscience, cognitive psychology, clinical investigations, and forensic research pertinent to the current debate about the fallibility and malleability of memory.

Each chapter was seemingly written to stand on its own. However, that is both a positive and a negative aspect of this large volume, because the chapters frequently include redundant discussions. I wish the book had been more tightly constructed to minimize this duplication. At times the same points are repeated even within the same chapter, creating a frequent déjà vu experience as one reads.

At a more basic level, the copyediting is variable. Some chapters, such as those on "Hypnosis and Memory" and "Repressed Memory and the Law," are carefully constructed and edited, while others contain numerous errors in spelling, grammar, referencing, or even reporting of research data—for example, errors in Table 7.7 on page 195. Such careless editing clearly detracts from the clarity and flow.

One of the most controversial topics that weaves through the volume is the use of hypnosis for remembering or processing personal events. The authors all have studied, used, and taught hypnosis for many years and thus bring a wealth of real-world experience to the subject. All are advocates for the use of hypnosis, at least under particular circumstances, with appropriate training, and with clear recognition of the potential limitations and pitfalls. Their review of the literature is thorough, and their conclusions are well argued, although they often do not agree with current consensus and standards. The authors provide a service in keeping open the discussion about a technique that many still believe to have therapeutic and forensic value but that has fallen under a shroud of negative connotations and skepticism.

Overall, Memory, Trauma Treatment, and the Law is an impressive summary of the broad issues under debate, and it provides a valuable reference for a diverse audience. Furthermore, along with other recently published volumes (3,4), this book helps to move the debate beyond polemics to a more scientific level of discourse.

Dr. Matthews is associate professor of clinical psychiatry and associate director of psychiatric education and training at the University of Massachusetts Medical School in Worcester.