Trauma and Memory: Clinical and Legal Controversies

Calm books about turbulent topics are appealing. Trauma and Memory succeeds on many grounds and contains excellent chapters, although it suffers somewhat from lack of integration. Psychiatric readers will probably admire Paul Appelbaum’s final reflective chapter, which uses pertinent memories of his own and partly comments on and summarizes the book. Many psychiatric readers, however, will also wish the Appelbaum chapter had been longer and that some of the preceding chapters had been shorter.

Many aspects of memory are currently the subject of serious scientific inquiry as well as less serious public media exploitation. The lively interest is stimulated by, but not limited to, recent controversies about recovered memories and false memories and their uses and abuses in therapeutic practice and in court. In fact, one of the probable points of this widely educational book is to help rescue the study of memory from the courtroom-dominated sensational realm of false memory syndrome and from the excesses of those on one hand who deny abuse of children and those on the other who find abuse of children everywhere. In the 1980s and early 1990s, the latter group of “therapists” often pushed and bullied children and adults into reporting the traumatic “memories” that they wanted to hear.

The editors of Trauma and Memory are a well-known forensic psychiatrist (Dr. Appelbaum), a psychiatrist-psychoanalyst (Dr. Uyehara), and a neuropsychologist (Dr. Elin). The chapter authors, generally knowledgeable and articulate and with special relevant interests (e.g., in trauma centers), include many psychiatrists, a few psychologists, and two lawyers. Some of the chapters more or less bypass or ignore data and issues raised in other chapters. I would have enjoyed having the chapter authors invited to comment briefly, in print, on one or more of one another’s chapters. (Might something of that sort be a possible format for an enterprising electronic publisher?)

Catching our attention at once, the first section of the book is on the controversy over the delayed recall of traumatic memories. Its two chapters are by prominent voices often opposed in the legal and clinical memory wars of the past decade. Ira Hyman and Elizabeth Loftus write on recovering memories of childhood trauma that never existed, and Richard Kluft writes on the reality of delayed recall of trauma.

A more general section, Current Concepts of Memory, follows. This section includes the currently obligatory chapter on anatomy and physiology of memory (although a few things are known, this is still a new and little explored field). Several cognitive psychology chapters cover pertinent ground but will, I think, seem long to psychiatric readers, as well as a bit naive (or should one say overly clean, or uncontaminated?) about longstanding clinical observations and theories. There is a fairly tidy summary of psychoanalytic theories of memory and trauma by Robert Galatzer-Levy and an attempt at an integrated developmental-psychological model for trauma and memory by Mark Elin.

The third section considers the memory of trauma, which is probably, in some important ways, different from nontraumatic memory. The chapters in this section are “Memory and Posttraumatic Stress Disorder” by Julia Golier, Rachel Yehuda, and Steven Southwick; “Traumatic Memories” by Bessell van der Kolk; “Continuous Memory, Amnesia, and Delayed Recall of Childhood Trauma: A Clinical Typology” by Mark Harvey and Judith Herman; and “Traumatic Experiences: The Early Organization of Memory in School-Age Children and Adolescents” by Robert Pynoos, Alan Steinberg, and Lisa Aronson.

Section 4 is on evaluation and treatment and includes a sensible psychoanalytic summary of psychoanalysis, reconstruction, and the recovery of memory, by Howard Levine; a chapter on psychodynamic therapy for patients with early childhood trauma, by Julia Matthews and James Chu; a tidy note on hypnosis and hypnotherapy, by Fred Frankel and Nicholas Covino; a chapter that left me somewhat skeptical on cognitive therapy with dissociative identity disorder, by Colin Ross; a sensitive chapter on memories of trauma arising in the treatment of children, by Maria Sauzier; and a clear review chapter, by Lisa Uyehara on diagnosis, pathogenesis, and memories of childhood abuse.

Section 5 is about trauma, memory, and the legal system. Wendy Murphy writes on the legal rights of trauma victims; Rose Zoltek-Jick discusses reasons for, and exceptions to, statutes of limitations; Robert Simon and Thomas Gutheil, both major educators in forensic psychiatry, cooperate in firmly discussing ethical and clinical risk management principles in recovered memory cases, emphasizing the maintenance of neutrality; and Diane Schetky, an experienced child forensic psychiatrist, usefully discusses many aspects of having children testify in court.

The field of memory remains central to much of psychiatry—fascinating, complex, and only partly understood. Progress is being made on many fronts, sometimes stimulated and sometimes contaminated by publicity and excesses. Trauma and Memory is a widely helpful book, many of whose chapters will be of interest and help to psychiatrists, even if a considerable measure of integration of ordinary and traumatic memory data and theory remains elusive.