Pseudoscience, Cross-examination, and Scientific Evidence in the Recovered Memory Controversy
Abstract: The recovered memory controversy is a contentious mix of conflicting claims, theories, and research. For example, reports of recovered memories of child sex abuse may be described as the result of implanting, false memory syndrome, repression, dissociation, motivated forgetting, directed forgetting, amnesia, betrayal trauma, retroactive inhibition, suggestion, self-induced hypnotic trance states, personality disorder, thought suppression, retrieval inhibition, cognitive gating, or biological protective processes. These terms may be used without clear definition or scientific basis, and may unintentionally foster pseudoscientific beliefs. Drawing on Daubert and other sources, this article suggests using 6 basic sets of cross-examination questions to assess the material in this area and to expose pseudoscience. These 6 questions focus on (1) research basis, (2) unclear terms and deductive fallacies, (3) inferential errors and confirmation bias, (4) links in the chain of reasoning, (5) ad hominem fallacies, and (6) original sources.
The recovered memory controversy has emerged kicking and screaming during the last decade or so, a daunting arena of science and pseudoscience, of claims and conclusions in the absence of adequate data and data lacking adequate explanatory theories, of elegant research, bullying dogma, thoughtful questions, extreme positions, and no shortage of confusion.
Attempts to understand how adults could come to report newly emerging memories about having experienced child sex abuse have become all but lost in a bewildering blizzard of conflicting terms and concepts. Such reported memories may be described as the result of repression, dissociation, implanting, motivated forgetting, directed forgetting, amnesia, betrayal trauma, retroactive inhibition, suggestibility, self-induced hypnotic trance states, personality disorder, thought suppression, retrieval inhibition, cognitive gating , biological protective processes, a clinical syndrome, and so on. These terms and concepts may be used without clear definition or scientific basis, and may foster pseudoscientific beliefs.
A useful approach to the booming, buzzing confusion in this area may be to approach it as if it were an expert witness and to use the fundamental questions of cross-examination to search out relevant information, to assess accuracy, and to expose pseudoscience. The 6 sections that follow illustrate this process of cross-examination, emphasizing the importance of examining closely: (a) research basis, (b) unclear terms and deductive fallacies, (c) inferential errors and confirmation bias, (d) links in the chain of reasoning, (e) ad hominem fallacies, and (f) original sources.
The Research Basis
One of the landmark shifts in the cross-examination of expert witnesses occurred with the United States Supreme Court's 1993 rendering of the Daubert v. Merrell Dow Pharmaceuticals decision (509 U.S. 579). Prior to Daubert, the admissibility of scientific testimony was most often determined by some version of the 1923 Frye rule (Frye v. United States, 293 F. 1013; D.C. Cir. 1923). Frye focused on whether a concept, finding, theory, or claim had been generally accepted by the scientific community. Daubert, interpreting the 1974 Federal Rules of Evidence, broadened the focus to include questions such as whether the matter had been subjected to methodologically sound research and scientifically sound inference and whether it had appeared in peer-review journals.
When considering the area of recovered and false memories, it is crucial to determine the degree to which scientific research supports any specific claim. For example, consider the following two statements. Blume (1990) wrote that "it is not unlikely that more than half of all women are survivors of childhood sexual trauma" (p. iv; italics in original). Martinson (1994) wrote that, "In the process of growing up, it is almost inevitable that a child will have one or more encounters of a sexual nature in which the other party is either too young or too old to be regarded as a peer" (p. 75). What, if any, scientific research supports such claims?
It appears that there are no scientific studies published in the peer reviewed scientific literature that establish the validity of these statements. It is not just conclusions, such as those above, but also evaluative instruments that may lack a basis in research providing scientific evidence of their validity or reliability. Unfortunately, there seems to be no shortage of unvalidated checklists used by those at either extreme in this controversy (for a discussion of unvalidated checklists in this area, see Olio, 1996; Pope & Brown, 1996).
Although many concepts, claims, and instruments in this area clearly lack any research basis, in other instances determining whether there is a solid research basis is more challenging. The concept repressed memories shows how complex and difficult making this determination can be.
Recovered memories of child sex abuse,whether accurate or false,are often termed repressed memories. The use of this term (often with ambiguity and confusion as to whether it simply means "forgotten" for a period of time or implies a specific mechanism of forgetting) has grown common in the popular media, legal cases, and some of the scientific literature. Interestingly, those at both ends of this controversy's extremely polarized spectrum have used the term to describe the relevant mechanism, for example, Repressed Memories: A Journey to Recovery from Sexual Abuse (Fredrickson, 1992) and The Myth of Repressed Memory: False Memories And Allegations of Sexual Abuse (Loftus & Ketcham, 1994).
Does the concept of repression rest on a sound research basis? Early in the century, a wide variety of laboratory experiments and other studies seemed, at least according to the investigators, to provide sound scientific support for the concept. In "Functional Abnormalities of Memory with Special Reference to Amnesia," Sears (1936) focused on Freud's discussion of repression and how it could be tested experimentally. Stewart (1962) reviewed 17 studies of repression and concluded that this "research has refined methodology since the work of Sears and has related repression to other personality facets. In the future, research on perceptual defense, subception, and vigilance may lead to a more complete explanation of repression" (p. 93). In their textbook Theories of Learning, Hilgard and Bower (1966) reviewed an array of laboratory experiments and concluded:
Where do these studies lead us? The facts of amnesia, without additional experiments, make abundantly clear that repression occurs, and that memories once lost can be recovered without relearning. While therefore experiments are not needed to establish the phenomenon of repression, they may help us to delineate the precise circumstances under which repression occurs. Clarification of repression phenomena is today more important than establishing their genuineness. (p. 290)
Hilgard and Bower also noted a trend among some experimental psychologists that had grown quite strong in the 1950s and 1960s and would continue to gather force: a turning away from impartial consideration of repression and other psychoanalytic concepts toward emotional attacks:
These attacks on the psychoanalytic method of treatment presently spread to attacks on psychoanalytic theory generally. These have turned out to be rather intemperate, seeking through debater's tactics to find flaws in psychoanalysis without making any effort to determine what there is to be learned from it. . . . (p. 295).
Not all of experimental psychology turned in this direction. Loftus, in her earlier work, exemplifies those who continued to argue that repression rested on a firm empirical basis. A decade after Hilgard and Bowers wrote of the intemperate attack on psychoanalytic concepts, Loftus wrote:
Memories that may cause us great unhappiness if they were brought to mind often appear to be "forgotten." However, are they really lost from memory or are they simply temporarily repressed as originally suggested by Freud (1922)? Repression is the phenomenon that prevents someone from remembering an event that can cause him pain and suffering. One way that we know that these memories are repressed and not completely lost is that the methods of free association and hypnosis and other special techniques used by psychotherapists can be used to bring repressed material to mind and can help a person remember things that he has failed to remember earlier. (Loftus & Loftus, 1976, p. 82)
Loftus maintained that laboratory experiments demonstrated the process of repression. Describing Zeller's (1950) research, she noted:
This experiment indicates that when the reason for the repression is removed, when material to be remembered is no longer associated with negative effects, a person no longer experiences retrieval failure. (p. 83)
If there is a motivation to avoid memories "that can cause. . .pain and suffering" and to ensure that memories causing "great unhappiness" should remain "forgotten," is it not possible that removing or overcoming this motivated forgetting might cause unhappiness? Loftus discussed a case in which a college professor, R.J., experienced a massive and robust forgetting (e.g., of her own name, what she did for a living, where she lived, or who her friends were) after a series of traumatic events including the breakup of her marriage and witnessing her mother's death.
Eventually, R.J. was able to remember all of her traumatic experiences; when they returned, so did all of her other lost memories. Even though the return of her memories made her wiser, she was also much sadder. More than most of us ever will, R.J. understood the true meaning in Christina Rossetti's words in Remember: "Better by far you should forget and smile than that you should remember and be sad." (1988, p. 73).
In the article "Memories of Childhood Abuse: Remembering and Repressing," Loftus, Polonsky, and Fullilove (1994) studied the extent to which repression and even "robust repression" occurred in a sample of women in regard to child abuse. They obtained a rate of about 1 in 5 women in this particular sample, but speculated that this may overstate the degree to which repression of child abuse actually occurs. "There is a reason to believe that the 19% figure we obtained in the current study may actually be an overestimate of the extent to which repression occurs" (Loftus, Polonsky, & Fullilove, 1994, p. 81); "One could argue that this means that robust repression was not especially prevalent in our sample" (p. 80).
Do these laboratory and survey studies of repression constitute an adequate research basis for the concept of repression? Many believe that the answer is no. Voicing the minority view at a 1986 conference on Repression and Dissociation at Yale University (see Singer, 1990a, 1990b), Holmes stated: "I want to point out that, despite over sixty years of research involving numerous approaches by many thoughtful and clever investigators, at the present time there is no controlled laboratory evidence supporting the concept of repression" (p. 96). Other scholars, however, have pointed out difficulties with Holmes' decision about what research to exclude from his review, his analysis, and the potentially misleading ways in which he states his conclusions (see, e.g., Braude, 1995; Gleaves, 1994, 1996; Gleaves & Freyd, 1997).
Is the laboratory research inconsistent with the concept of repression? Gleaves (1996) wrote:
In summary, Holmes' (1990) conclusion, which generally differed from the original investigators of much of the research, was that the memory-related phenomena that were observed in the laboratory studies could be best explained by mechanisms other than repression. Thus, although his conclusions have been cited as being that there is no scientific support for the concept of repression, a more accurate description of his conclusions would be that, although many data are consistent with repression theory, Holmes found no evidence for repression that could not (in his opinion) be explained by a mechanism other than repression (p. 9; italics in original).
Thus, for example, Holmes reviewed one set of controlled laboratory studies and found that when conditions were experimentally manipulated, participants in an experimental group were less able to recall the stimulus material than participants in a control group. However, when the negative manipulation was removed, participants were then able to recall the material at comparable rates to those in the control group. As Gleaves observed, while the results, even according to Holmes, were consistent with predictions made on the basis of the repression hypothesis, the experiments were not able to prove that there was no other possible explanation beside repression for the phenomenon. Holmes conceded that "the performance of the subjects in these experiments is consistent with what would be expected on the basis of repression" but argued that "it is also possible that the decrement in recall was due to the interfering effects of stress" (p. 91).
The literature examined in this section illustrates the process and sometimes difficulty of pursuing questions about whether a concept, claim, or instrument rests solidly on scientific research. One of the reasons why establishing that scientific basis is so difficult is that practitioners and scientists sometimes lapse into the use of confused terms, concepts, and definitions.
Unclear Terms and Deductive Fallacies
A skilled cross-examiner recognizes instantly when an expert witness is equivocating, exploiting ambiguity, escaping into vagueness, trying to baffle and confuse, or simply doesn't know what he or she is talking about. It is the cross-examiner's job to pin the witness down, to ensure that the terms are well-defined and used in a consistent, logical manner. The energy and resourcefulness some experts devote to evading clarity and the anguish when all escape routes are cut off was vividly captured by a trial lawyer, who compared the process to a hunter who finally trees an evasive quarry.
Have you ever seen a "treed" witness? Have you ever had the experience of watching a witness's posterior involuntarily twitch? Have you ever seen them wiggle in their chairs? Have you ever seen their mouths go dry? Have you seen the beads of perspiration form on their foreheads? Have you ever been close enough to watch their ancestral eyes dilating the pupil so that they would have adequate tunnel vision of the target that was attacking? (Burgess, 1984, p. 252)
The hunter's dogged determination is essential in the pursuit of clarity in this area. Attempts to understand how adults could come to report newly emerging memories about having experienced child sex abuse have become all but lost in a bewildering blizzard of conflicting terms and concepts. As noted earlier, such reported memories may be conceptualized as the result of repression, dissociation, implanting, motivated forgetting, directed forgetting, amnesia, betrayal trauma, retroactive inhibition, suggestibility, self-induced hypnotic trance states, personality disorder, thought suppression, retrieval inhibition, cognitive gating, biological protective processes, a clinical syndrome, and so on. Such terms and concepts may be used without clear definition or differentiation, contributing to confusion, misunderstandings, and logical fallacies.
The prior section noted that some of the most prominent writers at both extremes of this controversy have helped popularize the unsupported notion that "recovered memories" of child sex abuse must inherently be conceptualized and defined as "repressed memories." Using these terms interchangeably creates confusion and misleadingly contributes to flawed arguments such as the following:
- Recovered memories of sex abuse must be due to repression;
- There is no valid experimental evidence that repression exists;
- Therefore there is no scientific support for recovered memories.
- Recovered memories of sex abuse are a form of repression;
- There is experimental research demonstrating repression;
- Therefore there is research demonstrating recovered memories of sex abuse.
Controversy often encourages oversimplification and confusion, and lays the ground for such fallacies. It may be important to avoid any unwarranted assumption that a single mechanism such as repression (or dissociation, etc.) is the sole possible explanation for forgetting or retrieving such experiences. Rather than looking for one mechanism at work in all instances in which memories of child sex abuse might be lost and later recovered, it may make more sense to ask: What mechanisms, if any, enable the loss or recovery of child sex abuse memories for what individuals at what developmental levels under what conditions?
Inferential Errors and Confirmation Bias
While maintaining many of the outward forms of a science, pseudoscience tends to allow beliefs and expectations to over-ride objective evidence and rationality. Beliefs and expectations may profoundly affect both a person conducting an evaluation (e.g., a research study, a forensic or clinical assessment, a review of the literature by an expert witness) and anyone who is the focus of an evaluation.
Practicing trial lawyers are unlikely to be surprised by the occasional tendency, however unintentionally, of expert witnesses called by the defense to be more alert to and rely more on information favoring the defense, and the tendency, however unintentional, of experts called by the plaintiffs or prosecution to be more alert to and to rely more on information favoring the plaintiff or prosecution. It is possible that each side's experts have simply been exposed to essentially different sets of information. However, attorneys cross-examining such experts also need to consider the possibility of a common inferential error in which the expert has not been equally open to the full array of available and relevant information.
Confirmation bias is perhaps the best known and most widely accepted notion of inferential error to have come out of the literature on human reasoning. The claim . . . is that human beings have a fundamental tendency to seek information consistent with their current beliefs, theories or hypotheses and to avoid the collection of potentially falsifying evidence. (Evans, 1989, p. 41)
Freud's study of Leonardo da Vinci provides a vivid example of confirmation bias (Coles, 1973a, 1973b; see also Fischoff, 1982). Freud based his psychoanalytic interpretation on da Vinci's reminiscence of his infancy. Da Vinci's distant memory was that a vulture swooped down from the sky and lightly touched da Vinci on the lips while he was a tiny infant.
Freud brought a stunning diversity of knowledge to help illuminate the impact of this event on da Vinci's life. He emphasized, for example, that the Egyptian hieroglyph for "vulture" is identical to that for "mother." Little else was known about da Vinci's earliest years, but the themes of an intimate relationship with his mother that was reflected in this remembered event enabled an extensive psychoanalysis.
The problem with this analysis was discovered later. The translation that Freud had relied on contained an error: the Italian word for "kite" had been mistranslated into the German word for "vulture." Da Vinci's reported memory had involved a kite, rather than a vulture, that had supposedly touched his lips as he lay in his cradle.
Whenever a scientist, practitioner, or expert begins an investigation with beliefs or expectations about the results, or gains such beliefs and expectations early on, the subsequent aspects of assessment may be severely biased. Judge Dennis Yule highlighted a version of this inferential fallacy when he wrote in regard to expert witness Richard Ofshe:
Finally, Dr. Ofshe characterizes plaintiff's memories as a progress toward ritual, satanic cult images, which he states fits a pattern he has observed of false memories.
It appears to the court, however, that in this regard, he is engaging in the same exercise for which he criticizes therapists dealing with repressed memory. Just as he accuses them of resolving at the outset defining repressed memories of abuse and then constructing them, he has resolved at the outset to find a macabre scheme of memories progressing toward satanic cult ritual and then creates them. (Crook v. Murphy, 1994, p. 27)
It is possible that beliefs or expectations have significantly influenced how many scientists, professionals, and others have attempted to respond to questions about the nature, extent, and validity of reported recovered memories of abuse. It is worth noting, for example, that when clinical and counseling psychologists address the issue of therapists implanting false memories, they are confronting questions about their own profession causing harm to those who come to them for help. When a large part of professional identity involves seeing oneself as a source of help for those hurting from other causes, it may be difficult to believe or expect that one's own profession is a significant cause of harm to patients. Pope and Vasquez (1998; see also Pope, 1994) provide detailed examples of diverse areas in which individual psychologists and the profession as a whole have experienced difficulty acknowledging harmful behaviors in therapy or other contexts, have denied or diverted responsibility, and have engaged in rationalization.
The extent to which therapists have been sexually exploiting their patients provides an example. For many decades, the profession tended to deny that therapist-patient sex occurred on any but the most rare basis (see Pope & Bouhoutsos, 1986; Pope, Sonne & Holroyd, 1993; Pope, 1994; Pope & Vasquez, 1998). The first study appearing in a peer-reviewed journal that used actuarial data from existing archival information to address the notion that therapist-patient sex might actually occur appeared in American Psychologist in 1971. The data included all malpractice suits that had occurred during a 10 year period under the professional liability insurance plan provided specifically for members of the American Psychological Association. Focusing on the many complaints alleging therapist-patient sex, the report made no mention of any valid allegation of this type. The majority of all malpractice suits were attributed to false allegations made by female patients. The reason for this supposed epidemic of false allegations of sexual violations was set forth as follows:
the greatest number of [all malpractice] actions are brought by women who lead lives of very quiet desperation, who form close attachments to their therapists, who feel rejected or spurned when they discover that relations are maintained on a formal and professional level, and who then react with allegations of sexual improprieties. (Brownfain, 1971, p. 651)
The ways in which psychologists approached the question of therapist-patient sex illustrates another trend that may influence beliefs, expectations, data collections, and inferences in the area of recovered memories: The profession has repeatedly found it difficult to address realistically questions about forms of sexual abuse (such as incest, rape, etc.) in which the vast majority of (but not all) victims are female and the vast majority of (but not all) perpetrators are male. As recently as 1955, for example, a scholarly text stated that there were approximately one or two cases of incest annually for each million United States citizens (Weinberg, 1955). Two decades later, the Comprehensive Textbook of Psychiatry placed the incidence at between 1.1 and 1.9 per million (Henderson, 1975). Amir noted in 1971 that he was unable to find even one book devoted to the topic of rape, and as late as the early 1970s, rape allegations were generally viewed as "lies or fantasies" (Estrich, 1987, p. 43). The 1970 edition of Wigmore's widely used and authoritative text on legal evidence exemplified the extent to which both the legal and the mental health professions accepted as scientifically conclusive the view that virtually all charges of sex abuse reflected false imaginary narratives that had become accepted by the woman as true memories. Wigmore called attention to factors that
may have a direct connection with veracity, viz., when a woman or young girl testifies as complainant against a man charged with a sexual crime,rape, rape under age, seduction, assault. Modern psychiatrists have amply studied. . .girls and women coming before the courts in all sorts of cases. Their psychic complexes are multifarious, distorted partly by inherent defects, partly by diseased derangements or abnormal instincts, partly by bad social environment, partly by temporary physiological or emotional conditions. . . . The unchaste (let us call it) mentality finds incidental but direct expression in the narration of imaginary sex incidents of which the narrator is the heroine or the victim. . . . No judge should ever let a sex offense go to the jury unless the female complainant's social history and mental makeup have been examined and testified to by a qualified physician. . . . The reason I think that rape in particular belongs in this category is one well known to psychologists, namely that fantasies of being raped are exceedingly common in women, indeed one may almost say that they are probably universal. (Wigmore, 1934/1970, pp. 745-746)
This view can be traced in part to the early psychoanalytic tenet that female claims about incest did not represent an actual memory but rather an imaginative process. In renouncing his earlier "seduction theory," Freud set forth this tenet as if it were beyond doubt: "When girls who bring forward this event [incest] in the story of their childhood fairly regularly introduce the father as the seducer, neither the phantastic character of this accusation nor the motive actuating it can be doubted" (Freud, 1924/1952, p. 379).
It is likely that many if not all of us have beliefs and expectations that could interfere with our gathering experimental data in an unbiased manner, reaching fair conclusions about a set of studies, conducting an impartial forensic assessment, testifying as a neutral expert witness, and engaging in other scientific and professional pursuits in this or any other area. What is crucial is that we seek to become aware of such beliefs and expectations and the ways in which they can interfere with our work, that we institute safeguards to help identify and correct for such factors, and that we remain alert to the possibility of such inferential errors in our own work and the work of others.
Links in the Chain of Reasoning
Those to whom the courtroom is familiar territory know the expert witness who, enjoying the unfettered freedom of open-ended questions during direct examination, creates a compelling structure of argument. The expert moves smoothly and efficiently, linking concept to concept in a chain of reasoning with dazzling dexterity. The result is like a seemingly impenetrable chain-link fence that covers and protects the landscape.
The naive attorney may step back in awe and discouragement. Much like not seeing the individual trees for the forest, seeing the fence in its enormous reach and complexity may distract the attorney from the individual links. The skilled cross-examiner questions carefully each link in this chain of reasoning, refusing to let individual assertions gain a false aura of validity through their sheer number, pattern, and interconnectedness.
The argument that there is an epidemic of false memories implanted by therapists provides an example of looking at the individual links in a chain of reasoning. In the scientific and popular literature, one of the most commonly discussed scenarios of implanting false memories of sex abuse is that therapists mistakenly conclude or strongly suspect that a patient has a history of child abuse and then, through questions or other means, implant a false memory of an abuse history. Authors claim that this scenario has occurred with such great frequency that it constitutes an epidemic (see Pope, 1996, 1997, for a review of these claims).
Trauma, Amnesia, and Psychopathology
According to this argument, therapists begin by failing to understand that there is no evidence linking trauma causally to either amnesia or psychopathology. For example, Kihlstrom (1995c) wrote that "there is nothing in the available evidence that would permit us to have any confidence in any exhumed memory, in the absence of independent confirmation, or to have any confidence that there are causal links among trauma, amnesia, and psychopathology" (p. 66; see also Constantine & Martinson, 1981; Henderson, 1975, 1983; Martinson, 1994; Masserman & Uribe, 1989; Wakefield & Underwager, 1994). Gleaves is among those who does not accept this reasoning. Quoting Kihlstrom's sentence above, Gleaves provided the rational for his disagreement by providing a counter-example:
The last part of the sentence is what I find particularly noteworthy. Here you are clearly saying that there is nothing in the available evidence that would allow us to have any confidence that there is a connection between trauma and psychopathology. I find that to be a very extreme statement. For example, given that PTSD is a form of psychopathology, . . . (1995)
Gleaves' reasoning is that the research into the nature, validity, reliability, and other aspects of Post-Traumatic Stress Disorder (PTSD) as a diagnostic category permits confidence in a causal link between this form of psychopathology (PTSD) and trauma. That is to say, when PTSD occurs, it is viewed as a consequence of trauma.
Child Abuse and Presenting Symptoms
The second step in this argument is that therapists reason fallaciously from this false premise (i.e., about trauma as a cause of amnesia or psychopathology). Kihlstrom (1995b; see also Olio, 1995) set forth an absolute prohibition against forming even a suspicion of child abuse no matter what the presenting symptoms might be: "it is not permissible to infer, or frankly even to suspect, a history of abuse in people who present symptoms of abuse." He similarly asserted that "you can never, never, never, never, never, infer a history of sexual abuse from the patient's presenting symptoms. Nevernevernevernevernevernevernevernevernevernever" (1995a).
Kihlstrom reasoned that it is impermissible "even to suspect" because there is no specific association,let alone causal link,between any symptom and child abuse and because to do so would constitute the logical error of affirming the consequent. Olio (1995, 1997) was among those who disagreed, and presented a counter-example: a 3-5-year-old girl, one of whose presenting symptoms is infection by the gonococcus bacterium, Neisseria Gonorrhoeae. According to Olio, a competent clinician might reasonably suspect child sex abuse as one of the diagnostic possibilities to be investigated.
Olio's counter-example not only demonstrates the invalidity of Kihlstrom's prohibition against ever suspecting child abuse on the basis of presenting symptoms but helps illuminate Kihlstrom's mistake in concluding that suspecting child abuse on presenting symptoms such as a young girl's manifestation of gonorrhoeae symptoms constitutes the error of affirming the consequence. Kihlstrom's (1995) claim that therapists must never suspect child abuse no matter what the symptoms confuses the syllogistic proof of deduction with the formation of diagnostic hypotheses. (For a discussion of the affirming the consequent fallacy in assessment, see Pope & Brown, 1996; Pope, Butcher, & Seelen, 2000.)
Forming hypotheses on the basis of incomplete information (such as presenting symptoms) is a necessary, inherent, and useful component of clinical assessment, particularly early in the evaluative process. Gathering additional information guides the process as new data support, refine, or contradict the initial hypotheses and often lead to new hypotheses. Therapists who perform assessments customarily and legitimately form suspicions about various diagnostic, etiologic, or prognostic possibilities. Presenting symptoms and other initial data form a valid basis for such clinical hypotheses. New and varied diagnostic and etiologic possibilities may expand the "ruled out" list during the process of differential diagnosis.
There is a substantial body of research and theory for this process of professional decision making in the face of uncertainty (e.g., Bell, Raiffa, & Tversky, 1988; Dowie & Elstein, 1988; Kahneman, Slovic, & Tversky, 1982; Pope, Butcher, & Seelen, 2000: Wolf, Gruppen, & Billi, 1985). Presenting symptoms such as the symptoms of a venereal disease in a young child may form a legitimate, logical, and valid basis for suspecting a patient may have been abused while forming an inadequate, fallacious basis for determining that abuse must have occurred.
Consider an array of presenting symptoms such as trouble catching one's breath, feeling pressure in the chest area as if someone were stepping on the chest, light-headedness as if one were about to pass out, and a pain in the shoulder, arm, or jaw. This set of symptoms helps illustrate the stark difference between a clinical suspicion (i.e., a provisional hypothesis) and deductive proof. It is likely that no qualified physician would hold up these symptoms as proof of a heart attack. These presenting symptoms, singly or in combination, could have numerous other causes, both physiological and psychological. However, it is completely legitimate for the physician to suspect a heart attack as a possible cause of the symptoms and to consider this hypothesis as a guide to collecting additional data. In fact, it is worth asking under what conditions would a qualified physician not suspect a heart attack as a possible cause of these presenting symptoms?
The distinction between deductive proof and diagnostic hypothesis in this area forms a useful and legitimate basis for public policy and the law. Reviews of state laws suggest that almost half use a variant of the term "suspect" (e.g., "suspect that a child has been abused") in laws requiring therapists to report suspected child abuse (Kalichman, 1993, 1999). Claims that therapists must not suspect child abuse based on presenting symptoms may influence clinicians' decisions about whether to file reports of suspected child abuse pursuant to these laws.
It is worth noting that not long ago in this nation's history, clinicians tended not to suspect child abuse despite even the most striking presenting symptoms. Caffey (1996), for example, presented case histories in which infants' presenting symptoms were chronic blood clots in the brain, broken arms, and broken legs. Neither parents nor others volunteered reports of accidental or intentional trauma that might have caused such patterns of presenting symptoms. Caffey described the clinicians' lack of any hypothesis about what might have caused this pattern of injuries to the infants. In light of its considerable implications for clinical practice, law, and public policy, this second link in the chain of reasoning,i.e., that it is impermissible for clinicians to suspect child abuse on the basis of presenting symptoms,warrants extremely careful questioning.
The third step in this argument is that therapists, acting on the false belief or suspicion that a patient has a history of child abuse, implant,however unintentionally and unknowingly,in the patient a set of false autobiographical memories of child abuse (see, e.g., FMSF, 1995). One of the most common methods of implanting false memories is, according to this line of reasoning, "recovered memory therapy." Lindsay and Read (1994), for example, discussed a study supposedly showing that 25% of therapists used this method, noted that they "refer to such approaches collectively as 'memory recovery therapy'" (p. 282), and expressed the fear "that these powerful techniques are being used in ways that are damaging the lives of many clients and their families" (p. 282). Lindsay and Poole (1995) similarly expressed their fear about these approaches and their effects: "In our view there are solid grounds to fear that tens of thousands of people have developed illusory memories or false beliefs about CSA through suggestive memory recovery techniques and ancillary practices in psychotherapy, self-help, or group therapy" (p. 464).
Recovered memory therapies include some of the most long-standing and extensively studied therapies. Kihlstrom (1996), for example, wrote that "psychoanalysis is a prime example of recovered memory therapy" (p. 298). For a detailed critique of the logic and methodology of attempts to define, assess the extent of, and demonstrate the effects of "recovered memory therapy," see Olio (1996).
According to this reasoning, therapists easily persuade patients that they were abused through just one or a few inquiries or statements. Kihlstrom (1996), for example, wrote that "even a few probing questions and suggestive remarks by an authoritative figure such as a therapist may be sufficient to inculcate a belief on the part of a patient that he or she was abused. . ." (308; see also FMSF, 1995). Lief stated, "The problem arises, however, when counselors overtly ask the question, 'Were you ever sexually abused as a child?'" (Peck, 1993, p. 20). Loftus (1995) wrote: "Individuals are being imprisoned on the 'evidence' provided by memories that come back in dreams and flashbacks--memories that did not exist until a person wandered into therapy and was asked point-blank, 'Were you ever sexually abused as a child?'" (p. 20).
It is important to ask: is there any scientific evidence that therapists are capable of implanting a false history of child sex abuse in their patients simply by including the question "Were you ever sexually abused as a child?" in their clinical interview? Therapists taking a history may ask if the patient has ever been hospitalized, been battered, been forced to engage in sexual activity, lost consciousness (except for sleep, etc.), been in therapy previously, taken psychotropic medications, or made a suicide attempt, to name but a few question relatively standard in taking an adequate history. Is there scientific evidence that these other direct questions give rise to problems and false memories, or is it only "Were you sexually abused as a child?" that should be avoided when taking a history? Moreover, is this link in the chain of reasoning based on sound scientific evidence?
The experimental research basis, supposedly demonstrating that therapists can implant false memories of child abuse in their patients, is comprised of a diverse set of studies showing apparent success in implanting false memories in college students and others (for reviews and discussion, see for example, Loftus & Pickrell, 1995; Pezdek, Figer, and Hodge, 1997; Pope, 1995b, 1996, 1997). Often in such experiments, the research participant's parent (or older relative) is asked whether he or she remembers an event from years ago (e.g., getting lost in a shopping mall, an embarrassing episode at a celebration) as one that did or did not actually occur. In the first of this line of studies, Coan (1993) convinced his younger brother that the younger brother, when a small child, had become lost at shopping mall, an event that supposedly had not occurred. The younger brother reported that he came to believe that this event,a "false memory", had actually occurred. As reported by Loftus (see, e.g., Loftus & Ketcham, 1994), this became known as the shopping mall experiment. [Footnote #1: For dialogue presenting conflicting views of ethics, methodology, and less well-known aspects of this experiment, see Crook & Dean (1999a & 1999b), E.F. Loftus (1999).] These studies supposedly illustrate how therapists or others may implant detailed and compelling false memories of trauma, such as incest. In response to the following skepticism, "But it's just not possible to implant in someone's mind a complete memory with details and relevant emotions for a traumatic event that didn't happen," Loftus responded: "But that's exactly what we did in the shopping mall experiment" (Loftus & Ketcham, 1994, p. 212).
Despite Loftus's assurances, it is worth questioning whether this line of experiments, which do not involve the therapy, therapist, or patients, can be reasonably and validly generalized to the therapeutic process. (For reviews and discussions of this line of analog experiments that have been generalized to therapy, see, e.g., Freyd & Gleaves, 1996; Loftus & Pickrell, 1995; Pezek, Finger & Hodge, 1997; Pope, 1995b, 1996, 1997; Zaragoza & Koshmider, 1989). Stated more powerfully, does leading a subject in a psychology experiment to provide a self-report that he or she now remembers an event that did not occur, such as once becoming lost in a shopping mall, constitute sound and adequate scientific evidence that a therapist can implant a memory of abusive sexual events such as a patient's having been forced to perform felatio and having been anally raped for several years when these events never occurred?
One important task in questioning this link in the chain of reasoning is to examine whether consistent criteria are used in attempting to generalize,in regard both to essentially valid memories that have been lost and recovered and to implanted memories that are completely or essentially false,from the laboratory to therapy, from a mildly traumatic stimulus to child sex abuse, or from a single incident to an incident repeatedly experienced over years.
These attempts to prove that therapists implant false memories of sex abuse rest on experiments that do not involve therapy or memories of sex abuse circumvent the established scientific procedures for identifying harm caused by therapists and the therapeutic process. The realization that the "talking cure" or psychotherapy can cause harm dates back at least to Freud, who compared it to wielding a knife. He observed that the newly developed "talking therapy" was "comparable to a surgical operation" (1924/1952, p. 467) and emphasized that "the transference especially. . .is a dangerous instrument. . . .[I]f a knife will not cut, neither will it serve a surgeon" (p. 471). Recognizing the potential harm that could result from psychotherapy was, according to Freud, fundamental:
[I]t is grossly to undervalue both the origins and the practical significance of the psychoneuroses to suppose that these disorders are to be removed by pottering about with a few harmless remedies....[P]sychoanalysis...is not afraid to handle the most dangerous forces in the mind and set them to work for the benefit of the patient (Freud, 1915/1963, p. 179).
An extensive body of scientific research has underscored Freud's assertion and demonstrated that psychotherapy can result in patients changing for the worse or experiencing iatrogenic harm. Some studies have found that this negative result occurs in perhaps 3-10% of cases (see, e.g., Bergin & Garfield, 1993; Lambert, 1982; Menninger Foundation, 1977; Pope & Vasquez, 1998). A scientifically-sound methodology for determining whether a specific set of therapist behaviors (such as those hypothesized to implant false memories of child sex abuse) must take account of the potential for therapy, as a process, to cause iatrogenic harm in some patients. To determine whether these therapist behaviors are associated with the creation of false memories of child sex abuse or with other forms of harm in therapy would require a 2x2 table (see Olio, 1996; Pope & Brown, 1996). That is to say, a (near) random selection of therapists would each be classified, using a method of demonstrable reliability and validity, into one of the following 4 cells: (a) those who engaged in the identified behaviors and (some of) whose patients developed false memories of child abuse; (b) those who engaged in the identified behaviors and whose patients did not develop false memories of child abuse; (c) those who did not engage in the identified behaviors and (some of) whose patients developed false memories of child abuse; and (d) those who did not engage in the identified behaviors and whose patients did not develop false memories of child abuse.
This approach has been followed when investigating whether other forms of therapist behavior cause iatrogenic effects. A large array of diverse studies, for example, investigated whether therapists' sexual behavior with patients was associated with iatrogenic harm (Pope & Bouhoutsos, 1986; Pope, Sonne & Holroyd, 1993; Pope, 1994; Pope & Vasquez, 1998). Approaches to learning about effects have included studies of patients who have returned to therapy with a subsequent therapist as well as those who undertook no further therapy after their sexual involvement with a therapist. The consequences for patients who have been sexually involved with a psychotherapist have been compared to those for matched groups of therapy clients who have not been sexually involved with a therapist and of patients who have been sexually involved with a (nontherapist) physician. Subsequent treating therapists (of those clients who undertook a subsequent therapy), independent clinicians, and the clients themselves have evaluated the effects. Standardized psychological assessment instruments have supplemented clinical interview, behavioral observation, and other measures.
Moreover, it is scientifically inappropriate to conclude that a few questions or comments or other behaviors by a therapist can implant a false memory of a sex abuse history solely based on research using a different set of factors with a different outcome measure (i.e., not an implanted memory of sex abuse) in a different (i.e., nontherapeutic) situation with a different population.
Scientific rigor, common sense, and reasonable skepticism require the kind of careful studies exemplified by those that have identified therapists' sexual behaviors as associated with harm in psychotherapy.
Ad Hominem Fallacies
Attacking a person rather than the person's evidence or reasoning can be a powerful rhetorical device. It can move listeners or readers not only to modify their beliefs but in some instances to take action, sometimes violently, against the person under attack. However, when occurring in the midst of purported scientific analysis, the argumentum ad hominem is both logical fallacy and a form of pseudoscience. In basic terms the fallacy is:
Person A is associated with X evidence, Y arguments, and/or Z point of view;
Person A is bad in some way (e.g., unethical);
X evidence, Y arguments, and/or Z point of view are bad and should be rejected.
An example of the ad hominem is to scorn those who disagree with one's own particular beliefs as True Believers. This term was originally defined by Hoffer (1951/1989). The True Believer is a fearful, slimy, and malevolent person who is ignorant of facts and actually tries to shut them out:
It is the true believer's ability to 'shut his eyes and stop his ears' to facts. . . which is the source of his unequaled fortitude and consistency. . . . Thus the effectiveness of a doctrine should not be judged by its profundity, sublimity or the validity of the truths it embodies, but by how thoroughly it insulates the individual from his self and the world as it is. . . . [T]he acrid secretion of the frustrated mind, though composed chiefly of fear and ill will, acts yet as a marvelous slime to cement the embittered and disaffected into one compact whole" (Hoffer, 1951/1989, p. 80; 124).
Making clear her reference by quoting from Hoffer's (1951/1989) The True Believer, Loftus claims that there are two sides to the recovered memory controversy and those on the other side (i.e., those who disagree with her) are True Believers. Noting that she identifies herself as a skeptic, Loftus writes: "On one side are the 'True Believers,'. . . . On the other side are the 'Skeptics,'. . ." (Loftus & Ketcham, 1994, p. 31).
Such assertions warrant open, careful analysis on more than one level. First, it is worth asking if the assertion is true and to what extent it has been established by scientific evidence. Do those who are in fundamental disagreement with Loftus in the area of recovered memories have poorer character (e.g., more full of ill will) or less desirable characteristics (e.g., more eager to avoid facts, or more fearful), either as a group or as individual scientists and practitioners, than Loftus and those with whom she groups herself (for additional examples, see Brown, 1998)? Or is it possible that the scientists, clinicians, and others with whom she disagrees are not inferior in these ways, and that the claim that those on the other side are True Believers represents unsupported pseudoscience?
Second, however, even heuristically assuming the truth of her claims about those on the other side of the controversy, should the alleged personal characteristics (e.g., in regard to fear, ill will, etc.) of those who are associated in some way with evidence, arguments, or point of view determine how scientists, practitioners, and others may evaluate the evidence, arguments, or point of view? Is it arguable that a person (or group of people) with spotless character may be wrong about a scientific theory, claim, or conclusion, and that a scoundrel (or group of scoundrels) may make a sound logical argument or set forth a valid hypothesis?
One interesting aspect of the ad hominem argument in the recovered memory controversy is that, although traditionally it was recognized as a logical fallacy inappropriate in scientific discourse, it has begun to find its way into some scientific journals when they address this controversy. For example, in Psychological Science, Crews, after describing a process involving psychoanalysts becoming "converts" to "the recovered memory movement" as part of something "sinister," referred to the "true believers" who had reached a conclusion about repression that differed from the one he held (Crews, 1996, p. 66).
Another interesting aspect is the way in which ad hominem attacks seem to employ increasingly vivid and intense images. For example, Hagen's (1997) discussion of individual researchers who testify about their own and others' research in recovered memory cases appears in a book with the title Whores of the Court: The Fraud of Psychiatric Testimony and the Rape of American Justice. As with any ad hominem claims, one fundamental question is: Do the individuals whom she names and critiques deserve to be viewed as essentially whores and rapists? That is to say, is the charge implied in the book's title and in individual chapters (such as the chapter on recovered memories) valid? What constitutes demonstrably valid and reliable evidence that a specific group of colleagues with whose views the author disagrees have lied under oath in exchange for money or otherwise whored their testimony? Another fundamental question on a different level is the: How do such ad hominem statements influence the degree to which the evidence, arguments, or point of view associated with those termed whores and rapists are fairly and carefully examined?
One important focus of science is the nature, prevalence, and effects of various forms of pseudoscientific thinking and argument. Scientific research might usefully study the degree to which ad hominem arguments have become prominent in the recovered memory controversy, the forms they have taken (for examples of proponents of various points of view in regard to recovered memories being compared to Nazi butchers, etc., see Pope, 1996, 1997); their influence on individual readers in evaluating the evidence or arguments presented by those whose character or characteristics have been attacked, their use of demonstrably false claims (Brown, 1998, discusses an example of a false claim of unethical behavior that was published and its aftermath), and so on.
The competent cross-examiner never simply assumes that an expert witness's characterization of an original source document is necessarily accurate in all details. A thorough cross-examination is guided by a careful comparison of secondary accounts to the original source documents. In this area, it seems particularly useful to return to the fundamental data, to check claims, reports, and conclusions against the original evidence and on which they are supposedly based (Pope, 1995a).
Heated controversy often leads to oversimplification and premature closure, to hardened stances that lead individuals to accept and perhaps even to notice only evidence that supports the stance. Examining original sources is necessary because all of us in this area,the tone of some of our writings to the contrary,are human and subject to error. It is likely that all of us have, at one time or another, made mistakes in characterizing an experiment, a legal case, an article, or some other source of information. Unfortunately, such mistakes may remain in the literature [ Footnote #2: For discussion of an instance of a research team's declining to publish an erratum, see Pope (1997)], may be repeated in second and third hand articles, textbooks, legal cases, or courses, and may become widely accepted as accurate despite discordance with the original source on which it is based [ Footnote #3: For detailed documentation of how errors in describing a prominent child abuse case became widely accepted as fact in scientific and popular literature, see Olio & Cornell, in press. Preprints of this article may be requested from email@example.com].
Consider the case of Ross Cheit, who was alleged to have had a recovered memory of sexual abuse. Schooler, Bendiksen, and Ambadar's (1997) presentation of the Ross Cheit's documented case history illustrates the importance of checking original sources. Schooler et al. opine that Cheit's case seems to offer reasonable corroborative evidence supporting the hypothesis that recovered memories of child sex abuse can be valid. They based their discussion of the evidence on a 1993 U.S. News & World Report article (Horn, 1993). Schooler et al. considered "multiple sources of indirect corroboration of the event. Specifically, the author of this article was able to find other individuals who had independently recorded instances of [the abuser's] sexual improprieties, both before and after Cheit's recovered memory experience" (p. 261).
The available evidence, as presented by Schooler et al., is amazingly weak, and, even according to Schooler et al., in no way conclusive. The documented evidence, according to them, only supports the possibility that Cheit may have been abused. The evidence, according to their account, is that other children at the camp claimed to have been abused during the same general time-span. Thus, perhaps Cheit was also abused. "Although these sources of evidence do not conclusively demonstrate that Cheit himself was the victim of abuse, their implication of Farmer [the alleged perpetrator] as a sexual abuser clearly supports the possibility that he may have abused Cheit as well" (Schooler et al., 1997, p. 261).
Schooler et al. argue that even this evidence supporting the possibility that Cheit may have been abused comes from a source they view as questionable because the source's personal bias may have tainted the findings. "It should be noted that the reporter who investigated this case was a friend of Cheit's. While such an affiliation need not invalidate the evidence provided, it is possible that the evidence was not collected in a completely unbiased manner" (p. 261). It is important to note that whereas Schooler et al. call into question the reporter's credibility, they cite no instance or evidence that the information in the reporter's article was not gathered and reported in a fair and accurate manner.
But is the evidence supporting Cheit's recovered memories as sparse as Schooler et al. contend? Is the evidence supporting Cheit's recovered memories only indirect, a set of similar allegations by others about other children, gathered and reported by a source of questionable credibility? Examining the original sources reveals a significantly different set of information, remarkable for what has been excluded from Schooler et al.'s secondary account.
For example, although Schooler et al. do not acknowledge it, the U.S. News & World Report article which they identified as the source for their chapter describes a taped confession. "For nearly an hour, Cheit held Farmer on the phone, a tape recorder running all the while. Farmer admitted molesting Cheit in his cabin at night. . . . " (p. 62). Among the other reporters who have listened to the audiotape and reported on its contents, Wagner (1993) transcribed and published excerpts and subsequently (1994, p. B7) reported, "At that time, Farmer admitted molesting Cheit, according to the tape."
Diverse evidence, including this audiotaped confession, was reviewed by the court in Cheit's civil suit against Farmer. Cheit was awarded a "judgment from said defendant in the sum of $457,000" (Cheit v. Farmer, 1994, p. 1). The sponsors of the camp at which Farmer was camp director included explicit mention of this audiotaped confession in their public letter of apology to Cheit.
The camp sponsors stated to Cheit and his parents that they were "deeply sorry for the harm that came to them while Ross Cheit attended the Chorus' summer camp in 1968 and wishes to assure them that the Chorus is doing everything possible to prevent child molestation at the Chorus and at the summer camp" (San Francisco Boys Chorus, 1994, p. 2).
McNeil-Lehrer (1995) and Stanton (1993, 1995) are among other reporters that have described this case. Descriptions and citations of documentation of similar cases as well as larger-scale studies can be found at The Recovered Memory Project.
Deliberations in the areas of psychology, law, and public policy about whether a documented case history supports the validity of recovered memories must be made in light of the full range of available information. If original sources are not carefully reviewed, secondary accounts may become accepted as accurate though presenting an incomplete or misleading review of the available information.
In a thoughtful chapter likely to be helpful to virtually any expert witness and those seeking to study and understand expert testimony, Bruck (1998) provides an illustration of how an attorney can question whether an expert has examined a primary source of data.
Prosecutor: Doctor, did you appear on the show 20/20 in the fall of 1993?
A: Yes, I did.
Prosecutor: Okay. And the segment that you were on was regarding child sexual abuse and the interviewing of children. Is that correct?
Prosecutor: And you made the following answer to the following question, "You think there are dozens of people in jail now who are totally innocent," and your answer was "Yes, I do." Is that correct?
A: That's correct.
Prosecutor: And Doctor in order to come to that conclusion were you present for the trial of these people and listened to the evidence and come to a different conclusion than the jury? (Bruck, 1998, p. 100)
Salter provides an example of how examining the original source of data can be conducted on a systematic basis. In her book Accuracy of Expert Testimony in Child Sexual Abuse Cases (1989), she collected a large set of statements purporting to paraphrase, summarize, or characterize research reports and other original sources as part of expert testimony. She then compared each statement to the original source on which it was purportedly based. Such books could be useful in examining the original data relevant not only to expert testimony but also to textbooks, popular books, and other works that discuss or rely extensively on original sources.
This article presents a process similar to cross-examination as a way of approaching the confusing and contentious area of recovered memories. Those interested in additional sets of questions that may be adapted to this area beyond the 6 suggested here are referred to the chapter "Deposition and Cross-Examination of the Expert Witness: 100 Basic Questions" (Pope, Butcher, & Seelen, 2000).
In closing, it is worth noting one aspect of cross-examination that is the opposite of what is needed in approaching this area. Even the most inexperienced cross-examiner has likely heard the axiom: "Never ask a question for which you don't know the answer." It can be disastrous when the cross-examiner is caught off-guard with a surprise answer. But if we are to make progress in this area of science, and if psychology, law, and public policy are to benefit, our attitude, even in asking the most routine or fundamental question, should be one of not knowing all the answers. Only if we are willing to find out that our expectations, assumptions, and conclusions were wrong, will the data be able to teach us anything. The best cross-examiners are those who are exceptionally good listeners. Asking the right questions is an important part of this process. But it is useful only if we listen to the response.
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