Memories of Sexual Betrayal:
Truth, Fantasy, Repression and Dissociation
Richard B. Gartner, Ph.D.
Copyrighted material, all rights reserved
Introduction
and
Chapter 1, "The Controversy in Context"
Introduction
This book is very much a product of its time. In 1980, hardly anyone was writing about sexual abuse. Most psychoanalysts considered incest a rare occurrence whose veridicality should be questioned, a holdover from the later Freud position that incest reported in psychoanalysis was most often fantasy or wish fulfillment. By 1985, Judith Herman had published Father-Daughter Incest and Diana Russell was publishing her work on the incidence of sexual abuse among women. Some psychoanalysts had begun to write about incest and sexual abuse, and in 1986 a panel at a William Alanson White Institute Symposium included three papers on father-daughter incest. (This panel was given the unfortunate title "Current Views of the Role of Childhood Sexuality [Incest]," demonstrating that confusion still remained about the difference between incest and childhood sexuality.) In 1988, two books were published, Bass and Davis' The Courage to Heal and Mike Lew's Victims No Longer, books for both the general public and professionals about the sexual abuse of, respectively, girls and boys.
By 1990, a significant literature had begun to emerge about the sequelae of sexual abuse and incest. Psychoanalysts and trauma-centered clinicians working with sexually abused patients were getting more sophisticated about how to work with them in treatment. The likelihood of adults sexually abused in childhood not always having continuous memory for these experiences was more and more apparent. Such symptomatology as dissociated affect, interpersonal isolation, night terrors, boundary difficulties, sexual and relationship dysfunction, self-mutilation, and addictive and compulsive disorders was noted again and again in this population.
Within another year or two, a different point of view forcefully emerged. This position maintained that reports of childhood sexual abuse were exaggerated, and, particularly, that we should not trust recollections of adults who regained memories of incest following a period in which those memories had been "forgotten."
Disturbing reports began to circulate about families and reputations destroyed because of doubtful childhood abuse memories recovered in adult psychotherapies. A foundation was set up to combat what was dubbed the "false memory syndrome" (a term that has not been adopted by any official professional organization). Originally organized by people who claimed to have been falsely accused of abuse, the foundation gathered professionals who also questioned these memories, and convinced an important medical center to give it its imprimatur. "Recovered memory therapists" who were thought to have "implanted" sexual abuse memories were demonized in the popular press as well as in professional papers. Suits were brought against some of these therapists, and some were won.
By 1995, the debate was bitter. Charges flew back and forth about irresponsible and reckless treatment on the one hand, and clinical naïveté and credulousness in the face of abusers' denial on the other.
In that year, we in the Sexual Abuse Program of the White Institute's Center for the Study of Psychological Trauma were concerned about the rising stridency in this public debate, a debate in which the ethics and efficacy of psychoanalysis itself were often questioned. We also felt it was important to respond to those who seemed to assume that most if not all therapists and psychoanalysts who work with sexually abused patients are overly eager to encourage their patients to have memories and to tell them that these implanted memories are true. We decided to host a Symposium of psychoanalysts who would discuss their views on memories of childhood sexual betrayal, incest, and sexual abuse. As founder and director of the Sexual Abuse Program, I organized and chaired the Symposium, inviting psychoanalysts both from within and outside the White Institute who I felt would add unique clinical and scholarly viewpoints. While I was very pleased with the acceptances I got, I note that every analyst I invited whom I believed to be a skeptic in the memory debate declined to participate in the conference.
The Symposium was held on March 18th, 1995, at the New York Hilton Hotel, with 425 conferees. The program consisted of Opening Remarks by Marylou Lionells, Director of the White Institute; a morning panel entitled "The Controversy About Memories of Sexual Betrayal," with papers by myself, Adrienne Harris, and Jody Messler Davies, and discussions by Donnel Stern and Sue A. Shapiro; and an afternoon panel entitled "Processing Memories of Sexual Betrayal," with papers by Helene Kafka, Michelle Price, and Elizabeth Hegeman, and discussions by Mary Gail Frawley (now Frawley-O'Dea) and Gilead Nachmani. All these papers and discussions appear in this volume. Several are longer or enhanced versions of those read at the original conference. In addition, I have asked three other distinguished psychoanalysts, Sue Grand, Jonathan H. Slavin, and Judith L. Alpert, to write commentaries on the entire Symposium. Each of these commentators was present when the papers were first read, each made cogent remarks that day in the question-and-answer periods, and each has wide experience working with adults sexually betrayed in childhood.
Finally, I have written an additional commentary on the critiques by Frederick Crews of what he calls "recovered memory therapy."
In general, the writers in this discourse are highly critical of those who dismiss recollections of childhood sexual abuse that surface during adult psychoanalytic or psychotherapeutic treatment. In particular, the contributions of nonclinician researchers are rigorously examined (Gartner, Harris, Hegeman) while simultaneously the need to bring in data from other disciplines is supported (Gartner, Shapiro).
But the discourse goes in diverse directions, and these papers do not always agree with one another. The history and current status of the debate are examined (Alpert, Gartner, Lionells, Shapiro). Many contributors write in detail about the process of dissociation, the development of multiple self-states, and other mechanisms by which abused children protect themselves from the onslaught of their horrific experiences (Davies, Gartner, Grand, Hegeman, Kafka, Nachmani, Price, Slavin, Stern). Questions are raised about those who uncritically accept recollections of abuse as veridical (Frawley-O'Dea).
Some writers address the construction of narratives (Alpert, Davies, Hegeman, Nachmani, Price, Shapiro, Stern), as well as the relationship between expressive language and the experience of abuse (Davies, Grand, Harris, Price, Slavin, Stern). Others discuss biological ramifications of trauma, including how traumatic experience results in preverbal body memories (Davies, Frawley-O'Dea, Gartner, Kafka).
Some focus on transference/countertransference reenactments of abuse (Davies, Frawley-O'Dea, Hegeman, Kafka, Price). Several address the possibility that patients will sue those they believe have abused them, bringing therapists into courts of law to testify (Gartner, Hegeman, Lionells, Shapiro). Others delineate the struggles therapists go through in a climate in which they can be sued or otherwise threatened legally if they are thought to legitimize their patients' memories (Alpert, Harris, Hegeman, Shapiro).
The need to address the patient's agency in her or his life is addressed (Slavin). Also, political and social implications of abuse and the memory debate are described. We see this in the postfeminist and postmodern critiques of the false memory movement (Harris, Hegeman, Price, Shapiro); in the exploration of how to understand abusers and the interpersonal process leading to victimization (Nachmani); and in the queries about why the memory research has never been mobilized in support of other accused criminals who may be wrongly convicted on the basis of faulty memory and why conferences are not organized to understand sexual abusers (Harris, Shapiro).
The collective clinical and scholarly wisdom in these papers is remarkable. I believe it will provide grounding to all those who want to understand memories of childhood sexual betrayal and the treatment of the adults who are haunted by them.
Memories of Sexual Betrayal:
Chapter 1
The Controversy in Context
Before describing the context of the sexual betrayal controversy, I want to say what this discourse is not about. It is not about whether sexual abuse of children takes place. Even the most disparaging observers do not make that claim. Indeed, in their critical but balanced review of the literature on recovered memories of child sexual abuse, cognitive psychologists Lindsay and Read (1994) state, "[R]eal sexual abuse of children is a larger problem than therapy-induced memories of abuse. Real abuse has a longer history and is more deeply embedded in our culture than [recovered memory] therapies" (pp. 283-284).
Boys and girls both suffer sexual abuse, including incest. In random nonclinical samples, one-third of women reported direct, penetrating, or tactile childhood sexual abuse (Russell 1983, 1984, 1986). When noncontact seductive and excitatory abuse was included, the figure rose to over half. In analogous studies of nonclinical male populations (Lisak et al. 1996, Urquiza and Keating 1990), about 17 percent described direct sexual abuse as boys, with an additional 9 to 14 percent reporting noncontact sexual abuse. (These figures for men are likely to be underreported [Gartner 1993, Mendel 1995, Peake 1989]. See Bolton et al. 1989, Finkelhor 1986, Herman 1992, Lindsay and Read 1994, and Urquiza and Keating 1990 for fuller discussions of the prevalence of sexual abuse.)
Thus, millions of adults have a history of sexual childhood abuse. They cope with these histories in various ways. Some deal with it creatively and heroically on their own. Some become addicted to drugs, alcohol, food, or sex. Some continue an abusive pattern as adults themselves. Some lead seemingly successful lives at great inner cost. Some become severely dissociated. Some come into psychotherapeutic or psychoanalytic treatment to try to put their lives together.
Most remember their abuse, at least partially, all their lives (Alpert et al. 1994, Lindsay and Read 1994). This discourse is about how to understand those who as adults seem to recall hitherto "forgotten" memories of sexual betrayal, especially those who "recover" these memories while in a therapeutic setting.
An Acrimonious Psychoanalytic Debate
The papers in this volume add a new chapter to an old and acrimonious debate about how to understand stories of childhood sexual abuse. The controversy about these memories is as old as psychoanalysis itself. In 1895, Freud and Breuer had just written Studies on Hysteria (Breuer and Freud 1893-1895) and Freud was about to publish Origins of Hysteria (Freud 1896). They remain powerful statements about the later effects of childhood sexual betrayal on its victims. These early papers were highly controversial when they appeared, making psychoanalysis itself a questionable pursuit. But, while Freud may never have absolutely repudiated his so-called "seduction theory" about the origins of hysteria in childhood sexual abuse, he never again considered it a central psychoanalytic concept after deciding that memories of childhood abuse are usually fantasies and wish fulfillments.
Thus began a psychoanalytic tradition in which emerging memories of sexual betrayal were almost universally understood as inventions of the inner world of the oedipal child. This way of looking at abuse memories was firmly entrenched by the time Sandor Ferenczi began to believe the stories of childhood sexual betrayal he heard from a number of patients, including such therapists and analysts as Elizabeth Severn and Clara Thompson (Ferenczi 1932/1988, Fortune 1993, Rachman 1993, Shapiro 1993). Ferenczi was the Hungarian psychoanalyst considered to be among Freud's most brilliant students as well as one of the most gifted clinicians of the time. His belief in his patients led to one of psychoanalysis' most celebrated rifts (see Masson 1984), variously described as "a trauma on the psychoanalytic world" (Balint 1968, p. 152) and "one of the darkest moments in the history of psychoanalysis" (Rachman 1993, p. 89). Freud tried in 1932 to convince Ferenczi not to read his paper "Confusion of tongues between parents and the child" (Ferenczi 1933/1988) at the International Psychoanalytical Congress at Wiesbaden. When Ferenczi did read the paper, still one of the most cogent descriptions of how childhood sexual trauma affects the victim in later life, he did it at great personal and professional cost. Ferenczi was dead of pernicious anemia nine months after reading the paper, arguably a death hastened by the furor his paper caused, and particularly by the continued coldness of Freud, his mentor, analyst, and much-beloved father figure. The paper was suppressed, not published until 1939, and not published in English until 1949. Meanwhile, Ferenczi's detractors, including Ernest Jones, Freud's loyal biographer, said that Ferenczi was psychotic when he wrote this paper (Jones 1957), a rumor forcefully contradicted in my view by Ferenczi's own clinical diary from this period (Ferenczi 1932/1988), as well as by descriptions from others who were with Ferenczi at the time (see Hidas 1993). This pathologizing of Ferenczi, of course, was only one of many times that a clinician or patient has been marginalized by those who disapprove of or won't tolerate discourse about sexual abuse and incest.
Contemporary Approaches to Sexual Betrayal
In the decades that followed, childhood incest and other childhood sexual betrayals were relegated to the realm of fantasy throughout the psychoanalytic, psychiatric, and psychological literatures. As recently as 1976, a leading psychiatric textbook claimed that actual incest between father and daughter occurred only once in a million cases (Freedman et al. 1976).
Since 1980, however, the pendulum has been swinging away from the fantasy theory about sexual betrayal, and a rich literature has emerged in both the psychoanalytic and trauma-based arenas of sexual abuse work. Besides the writers in this volume, I am referring here -- and I apologize both for the length of this list and for the many names I have left off it -- to Briere (1989), Courtois (1988, 1992), Ehrenberg (1987, 1992), Finkelhor (1984, 1986), Gelinas (1983), Herman (1981, 1992; Herman and Schatzow 1987), Hunter (1990a,b,c), Kluft (1990), Levine (1990), Lew (1988), Lisak (1993, 1994, 1995; Lisak and Luster 1994), Russell (1983, 1984, 1986), Sgroi (1988, 1989), Shengold (1989), Simon (1992), and van der Kolk (1987, 1988, 1989, 1991, 1995; van der Kolk and Greenberg, 1987).
The current legalistic and litigious climate in our country has unfortunately encouraged some patients and therapists to look to the legal system for redress of childhood sexual abuse. In some instances court cases have gone on for years, and the outcome rarely makes a patient feel truly better about the abuse experience. In addition, the possibility of a case coming into the legal system vastly complicates how we as psychoanalysts understand the word "truth," since the psychological truth that an analyst may accept when working with a troubled patient is quite different from the legal truth a court of law rightly requires to find an individual guilty of child molestation.
Since 1990, as any reader of this book knows, serious critiques have been made of the sexual abuse literature. In particular, self-help manuals like The Courage to Heal (Bass and Davis 1988) have been denounced for statements like "[if you] have a feeling that something abusive happened to you, it probably did" (p. 21) and for compiling overly generalized lists of symptoms of childhood sexual abuse. Such criticism does not take into account the climate in which these manuals were first written, a climate in which stories of childhood sexual abuse were almost universally discounted, minimized, and thought to be fantasies and wish fulfillments (see Wallen 1994).
Nevertheless, clinicians like Ganaway (1989, 1992), Gardner (1992), and Prager (1993, cited in Read and Lindsay 1994), academics like Loftus (1992, 1993a,b; Loftus and Ketcham 1991, 1994) and Lindsay and Read (1994), and other nonclinician critics like Carol Tavris (1993) and Frederick Crews (1994/1995) have all made powerful - though sometimes shrill - arguments about the questionable nature of repression, the unreliability of memory, and the ethics of techniques that may lead patients to conclusions about their history that are dubious at best. As Dodi Goldman and I noted in a published response to Crews' articles in The New York Review of Books (Gartner and Goldman et al. 1995), these watchdogs have done our field a service in reminding us that some overly zealous, ideologically driven practitioners have at times shown poor judgment and most likely done a therapeutic disservice to their clients as well: "Insufficiently trained therapists may fail to take into account the complexity of the intermingling of fantasy and memory and the way the human mind actively constructs rather than passively registers perceptions. . . .Therapists who insist, through a variety of pressuring and suggestive techniques, on convincing their clients of abuse, are enacting a subtle form of abuse themselves" (Gartner and Goldman et al. 1995, p. 42).
On the other hand, this does not automatically mean that because a memory has been "recovered" in therapy it has no historical basis. When the American Psychological Association appointed a working group to investigate issues about memories of childhood sexual abuse, it included psychologists as diverse as Elizabeth Loftus and Christine Courtois in their beliefs about memory. This entire committee agreed in its interim conclusions (Alpert et al. 1994) that, while "most people who were sexually abused as children remember all or part of what happened to them, . . .it is possible for memories of abuse that have been forgotten for a long time to be remembered . . . (and) it is also possible to construct pseudomemories for events that never occurred" (p. 2).
I believe that every contributor to this volume agrees with that statement.
Repression, Dissociation, and Double-Speak
The terms repression and dissociation are both used to describe the process by which events in a person's history are unavailable to the individual's memory. They are not interchangeable terms, and it is important to differentiate them with clarity. Repression, a process first described by Freud (1900), refers to an active mastering of conflictual material by pushing it out of awareness. Dissociation, a process discussed by Bromberg (1991, 1993, 1994), Fairbairn (1954), Janet (1898), and Sullivan (1956), among others, refers by contrast to a passive severing of connections between one set of mental contents and another, often before they enter awareness, so that they dwell side by side without reference to one another. Thus, good and bad feelings about the same object can coexist without conflict in dissociated states. Dissociation is thought to take place as a response to overwhelming trauma, as a means for the self to maintain some fragile sense of functioning. It can occur before traumatic events are verbally encoded, so that they have never gotten out of the realm of what Stern (1983) calls "unformulated experience." Unverbalized, unsymbolized, fragmented, and undigested, dissociated material emerges exactly as it was in its original traumatizing context.
Repressed material, therefore, is considered to have had a previous shape in consciousness, and is thus familiar to the individual once it reemerges (but note Cohler's [1994] point that, for Freud, repression of early childhood material is absolute and can never reenter consciousness). Dissociated material, on the other hand, breaks through as nearly the same terrifying experience it was before the disintegrating self severed the experience's ties to consciousness. When it is a traumatic relationship that must be dissociated, as in the case of chronic incest, then there may be a severe disturbance about relating itself because of terrifying dissociated experiences (Sands 1994). Such chronic disturbances in relationships have been detailed throughout the clinical literature on incest (e.g., Gelinas 1983, Courtois 1988, Ehrenberg 1992, Gartner 1993, 1994, and Davies and Frawley 1994). For further discussions of repression and dissociation, see Davies and Frawley (1994), and Davies's and Stern's papers in this volume).
In addition, it is important to remember that people who have lived through a period of sexual victimization by a trusted caretaker have had to learn a kind of double-speak language (Orwell 1949). This point is also made by Wallen (1994), who says: "[For the incest victim,] pain felt by the body has been called pleasure. Violation has been called love. When the body has actually felt pleasure, or the heart love, [the] mind has felt betrayed, [and is] deeply ashamed for having failed to fully resist the encounter" (p. 38). Thus, as dissociated memories emerge, still in double-speak language, the adult has every reason to mistrust them, deny them, find them illogical, and feel both betraying and betrayed once again, this time by her or his own self.
The Current Research
The literature about childhood sexual abuse is growing so fast that it is difficult to keep current. In the past several years there have been special issues of the Journal of Applied Cognitive Psychology (1994, Vol 8, No. 4), The Journal of Interpersonal Violence (1993, Vol. 8, No. 3) and Psychoanalytic Inquiry (1992, Vol. 12, No. 1) devoted to the subject. Multiple important articles have also appeared in Psychoanalytic Psychology (Brenneis 1994a, Greer 1994, Lerner 1994), American Psychologist (Byrd 1994, Gleaves 1994, Gold et al. 1994, Loftus 1994, Olio 1994, Peterson 1994, and Pope 1996), and the Journal of the American Psychoanalytic Association (Brenneis 1994b, Person and Klar 1994).
While I cannot review this literature in depth here, I would like to discuss briefly two lines of work that promise to add a great deal to our understanding of memories of sexual betrayal. One is about the biology of traumatic memory, and the other is about the prospective study of recall of childhood sexual abuse.
The psychobiology of traumatic memory recall has been of interest to a number of investigators, including Kolb (1987) and van der Kolk (1988, 1989, 1991, 1995; van der Kolk and Greenberg 1987; van der Kolk, McFarlane, and Weisaeth 1996). In a 1994 article in Nature, a group of California investigators (Cahill, Prins, Weber, and McGaugh) corroborate that traumatic memory is encoded differently than conventional memory in humans. They did this by administering propanolol to subjects being exposed to both neutral and traumatic stories. Propanolol is a beta-blocker, a drug that blocks the effects of adrenaline and noradrenaline, both of which are released during emotional arousal. The researchers found that the beta-blocker significantly impaired memory of the emotionally arousing story but not of the emotionally neutral story. Since the drug affected traumatic memory only, the study suggests a separate biological system for encoding and recalling emotional trauma. Specifically, the study supports the idea that enhanced memory for emotional experiences involves activation of the beta-andrenergic system. Blocking this activation therefore blocks traumatic and emotion-laden memory. To my knowledge, this study is thus the first reported experimental induction of the process of dissociation.
While retrospective studies have added to our understanding of traumatic memory, they are not as persuasive as prospective studies, in which subjects are followed over time rather than asked to recall their history. Linda Meyer Williams (1994) of the University of New Hampshire has done a longitudinal prospective study of the recall of women whose childhood sexual abuse was documented at the time in hospital records. Seventeen years later, she followed up on these girls and found that 38 percent of them recalled neither the abuse for which they had received medical attention at the time nor other molestations by the same abuser. This group of nonrecallers included women who were able to discuss with the researchers other incidents of sexual abuse in their lives with other abusers. When girls younger than seven were eliminated from the sample in order to control for the unreliability of early childhood memory, 28 percent still did not recall the abuse. Williams concludes that "forgetting is associated not only with age but with the relationship to the offender" (p. 1174, italics added). Girls abused at a very young age were most likely to forget, as were girls abused by someone they knew. Abuse by a stranger, however, was more likely to be remembered even when the study controlled for age, thus suggesting that "age-related, cognitive developmental theories are not sufficient explanation for memories of traumatic events" (p. 1174). Thus some women recalled abuse by a stranger that occurred even before age three, while others did not recall repeated abuse by a family member that occurred at much later ages. The Williams study, then, is a powerful support for the idea that sexual abuse trauma is often not remembered by the victim, particularly if it was incestuous and occurred at an early age.
What Does Contemporary Psychoanalysis Offer?
What do we as psychoanalysts and psychoanalytically oriented therapists uniquely have to contribute in our work with sexually abused patients? I believe the most important thing we offer is our training to tolerate and help our patients tolerate ambiguity. This training helps us and our patients to live with the uncertainty of not always knowing what is true, what we believe, or what fits together.
Writing in another context, Earl Witenberg (1978) wrote about the inevitability of uncertainty in psychoanalysis. He warned analysts not to confuse what they believe with what they know, saying, "When one transforms belief into knowledge, one does the patient an injustice. . . . Theories are always necessary to guide us, but there is a great deal of uncertainty in the practice [of psychoanalysis]. . . .[T]he hazard is that we cling to our beliefs . . . and explain the patient in terms of our theories and not attend to how or what the patient is saying" (pp. 278-279). When this is applied to the subject of this volume, Witenberg is sensibly warning us not to approach patients with preconceived ideas about whether sexual betrayal did or did not take place, but rather to allow the material to unfold from the patient without our prior judgment of it. Likewise, we must not allow our patient's or our own anxiety to rush us to conclusions about the veridicality or lack of it in emerging memories of sexual betrayal.
A Poet's Perspective
Before you read the papers on memory that constitute the remainder of this discourse, I want to conclude by reminding you what the playwright and poet Tennessee Williams had to say about it. As is so often true, in this case an artist captures in a few words qualities of human experience that psychoanalysts can only attempt to delineate in lengthy papers such as these.
In the opening monologue of The Glass Menagerie (1944), Williams' semi-autobiographical re-creation of his own traumatizing family, Tom Wingfield, the writer's alter ego and the play's narrator, says: "The play is memory. Being a memory play, it is dimly lighted, it is sentimental, it is not realistic" (p. 341). Williams thus lets us know immediately that memory distorts.
The question for us all to address here is whether these distortions do essential damage to truth. Anyone who sees The Glass Menagerie knows that distorted memory can highlight and communicate human truth. Any therapist who sits with a patient reaching for elusive memories of childhood sexual betrayal also knows that even distorted memories can lead to fundamental and healing psychological truths.
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