Category Archives: ptsd

August 20, 2012 · 2:33 pm

Of Babies and Bath Water: Navigating the Controversies of Repressed and Recovered Memory


Recently I ran a conference about abuse within the church. In these kinds of venues (this blog and conferences) I am asked about a couple of related problems—the problem of false memories of abuse and the reliability of recovered memories of abuse.

While I intend to address these matters here (and in future blogs), I want to reiterate something that I think gets lost in most conversations about recovered and/or false memories.

Sexual abuse is real. The vast majority of adult reporters of abuse during childhood never forgot the details.

Why say this first? Discussions of rare and extreme cases (i.e., repressed memories, recovered memories, and false memories) tends to create undue suspicion for all adults who choose to reveal their child abuse later in life. It is my experiences that conversations about false memories or recovered memories lead many to assume that a report of extensive or horrific abuse is probably false. So, let us remember that as we take up the matter of fully repressed memories of abuse, we are talking about a very small percentage of people.

But, the issue of repressed and/or recovered memories and the construction of false memories is indeed worthy of a careful review given the strong feelings on both sides of the recovered memory debate. In order to be as careful as possible, I want to consider a few topics that may help us understand the issue. First, I will explore foundational topics (memory, forgetting, repression, and dissociation). Then,  I’ll explore the how trauma is known to create confusion, self-doubt, and “motivated” forgetting. Finally, we’ll take up the practice of counseling victims of sexual abuse and the particular matter of dealing with memory retrieval in counseling. Strap in!

Just in case you NEED to know my opinion at the outset…

I find Partlett and Nurcombe’s 1998 summary of an APA report on the topic to be fairly comprehensive,

The plain point here is the consensus set forth by the Working Group:
1. Controversies regarding adult recollections should not be allowed to obscure the fact that child sexual abuse is a complex and pervasive problem in America that has historically gone unacknowledged.
2. Most people who were sexually abused as children remember all or part of what happened to them.
3. It is possible for memories of abuse that have been forgotten for a long time to be remembered.
4. It is also possible to construct convincing pseudomemories for events that never occurred.
5. There are gaps in our knowledge about the processes that lead to accurate and inaccurate recollections of childhood abuse.[1]

I would add one more point: most people (myself included) in this debate are motivated by strong feelings as well as “facts.” These feelings may be the result of experiences with those who appear to be abused or appear to be falsely accused.

Issue one: Memory and Memory Retrieval

Let me start by stating the obvious: this isn’t a neuropsychology primer on memory and I am not an expert in memory. However, there are a few things on which I think we can agree:

  1. memory is a whole brain biochemical process. While structures like the hippocampus are clearly involved in memory storage, no one structure handles all aspects of memory storage or recall.
  2. memory is multi-faceted. Researchers differentiate between recognition and recall memory, explicit and implicit memory, short-term, long-term, and working memories…and much more.
  3. memory-making is a process.  The formation of memory requires attention, perception, encoding, storage, and retrieval. Thomas Insel calls it a 5 act play. A person moves from perception to long-term encoding to retrieval and finally, expression of memory.
  4. relational and affective context influences memory formation and memory retrieval
  5. the act of recall may change memory,

The concept is simple: memories are not fixed; they are periodically retrieved, and modified each time they are retrieved. This process of strengthening a memory by retrieval is called reconsolidation. One profound implication of this concept is that what you recall is not only a reflection of what you first learned, but also a product of each time you have recalled the original information.

How does this relate to our issue of recall of abuse?

  • memories are both fragile and yet not so. You recall what the house you grew up in looks like, even if you haven’t seen it in 30 years. And yet, your recall may or may not be particularly accurate. You may remember a large house even when it is much smaller to your adult eyes.
  • repetitive recall along with high levels of emotion may solidify memory. Most of us know exactly where we were on the morning of September 11, 2001.  You remember this because you talked about it, played it over in your mind, and because of the powerful biochemical process kicked off when you heard of the first plane crashing into the twin towers.
  • Most child sexual abuse has little corroborating evidence, especially when revealed decades later. This leaves victims by themselves to sort through the narratives they and others tell about their history.  The result? Ample opportunities for both denials of actual abuse as well as false memory.

Return with me to my first point. Most child sexual abuse is never fully forgotten. Some memories may be lost, others distorted, still others intentionally forgotten. Memory, as we have seen here is not a structure but a narrative.[2] In most cases, the story being told has much merit, even if some important details are perceived rightly. Thus memory retrieval during therapy (something that WILL happen whether therapist or client wants it) plays a powerful role in the re-storying work of therapy.

In my next post on this topic, I will make some comments about forgetting, motivated forgetting, dissociation, and repression.

[1] Partlett, DF & Nurcombe, B (1998). Recovered memories of child sexual abuse and liability: Society, science, and the law in comparative study. Psychology, Public Policy, and Law, 4, p. 1273

[2] “Rememberings—whether valid or invalid—are communicated by means of narratives.” Sarbin, TR (1998). The social construction of truth. Journal of Theoretical and Philosophical Psychology, 18, p. 145.

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June 20, 2012 · 5:44 am

Refusing to report abuse and its consequences


As many Americans know, The Jerry Sandusky trial is well underway. Mr. Sandusky is charged with 52 counts of child sex abuse during his era (and following) as assistant football coach at Penn State University. But equally on trial–at least in the media, the court of public opinion, and most likely civil and criminal courts in the near future–are Penn State officials. Chief among those under scrutiny is former PSU president, Graham Spanier. It appears that Mr. Spanier, along with other important University employees knew of accusations and eyewitness accounts of abuse and failed to report the matter.

I have written here about the reasons why we fail to report. We fail to report because we are protecting our own. We fail to report because we worry about backlash, bad press, and we don’t want to get involved in messy situations. But consider now the consequences of not reporting.

1. Protecting the wrong person or entity. allegedly, one email from Spanier states that he wouldn’t report Sandusky for “humane” reasons. Spanier appears to have made the calculation of negative consequences for reporting Sandusky to law enforcement but failed to do the same calculation for probable victims.

2. Destroying trust for future leaders. Ask the general public how they feel about the trustworthiness of leaders within the Catholic church? Ask if they feel that the church’s response (verbal and in legal settings) has helped improve or continue to erode trust? Sadly, future leaders of organizations (those that failed to report child abuse) likely face unmerited suspicion on the basis of the predecessor’s behaviors. Further, such failure to instill trust does not just impact general trust within a community. Victims who were not protected and helped are much less likely to be willing to report abuse that happens in the future.

3. Increasing PTSD symptoms. Many abuse and interpersonal trauma victims report that something traumatized them even more than the original abuse–the failure of those who knew about the events to do something about it. When those you think should protect you do not, you are more likely to experience PTSD.

4. Having no answer for Matthew 25:31-46. You may remember that this passage tells what will happen on the day of judgment. For those who did not do for the “least of these” (care for, protect, serve), tremendous judgment awaits. Strong words.

41 “Then he will say to those on his left, ‘Depart from me, you who are cursed, into the eternal fire prepared for the devil and his angels. 42For I was hungry and you gave me nothing to eat, I was thirsty and you gave me nothing to drink, 43 I was a stranger and you did not invite me in, I needed clothes and you did not clothe me, I was sick and in prison and you did not look after me.’

44 “They also will answer, ‘Lord, when did we see you hungry or thirsty or a stranger or needing clothes or sick or in prison, and did not help you?’

45 “He will reply, ‘Truly I tell you, whatever you did not do for one of the least of these, you did not do for me.’

46 “Then they will go away to eternal punishment, but the righteous to eternal life. ”

Strong words indeed.

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April 12, 2012 · 5:47 am

Trauma recovery? Healing? Integration? Which words communicate a good outcome to you?


Recovery. Healing? Restoration? These words contain both information, movement, and emotion. What words do you like to use when describing the process of getting better after a traumatic experience? How do you communicate that you are better but not so much better that you have no more bad memories; that you have no more nightmares; that you are not triggered into panic when you see someone who abused you?

What words do you shy away from?

Let’s consider healing first.

I was and am being healed?

Some hear healing language as a completed task. “I have been healed.” Past tense. If I was in a wheelchair but now I walk…would I say I have been healed if I walk with a limp or need a walker to get around? Do you ever hear someone say, “I was healed, in part.” Would it be better to say I am being healed or I am recovering. Compared to Greek verb tenses, our English language doesn’t communicate well the ongoing state of something. In Greek, we can communicate a present perfect tense such as, “I was and am currently being healed” all in one verb form. But in English, we cannot communicate such an ongoing process without more words. Thus, when we use the shortcut, “I am healed,” it sounds like a finished job.

Recovery?

What about recovery? Restoration? Renewal? Recovery words are popular amongst former addicts. For them it connotes that they are no longer using but making the daily choice for sobriety. However, they recognize the danger exists of falling back into drunkenness and so they communicate that they are in a lifelong process. For some, however, recovery sounds like a failure–failure to find victory and failure to accept a new identity.  The truth is, few people outside of AA use the word recovery in every day speech. The other “r” words are more likely used in Christian circles but not so much in discussion of life after trauma.

Can you integrate trauma?

I have just finished reading Wounded I am More Awake: Finding Meaning after Terror by Julia Lieblich and Esad Boskailo (2012, Vanderbilt University Press). Julia helps tell Esad’s (a Bosnian doctor) experience of being held in 6 different concentration camps. He is now a psychiatrist in the US and works with trauma victims. However, he faced much brutality in being treated worse than one would treat an animal and so was not in good physical or psychological shape when he came to the U.S. I commend the book to those who want a basic understanding of trauma and of this thing we are trying to call healing and recovery. Listen to these quotes from Boskailo the psychiatrist,

 I can’t take away what happened” [said to another survivor]. But [I] can help [you] imagine a better future.

“You are fifty, not twenty-five. You will never be the person you were twenty-five years ago. Even if you didn’t have trauma, you would not be the same.”

What Boskailo is arguing for is integrating trauma into one’s present life. One cannot go back and recover what was lost. A trauma survivor is never going to be free from losses suffered. To do so would be to deny truth. Integration means allowing the reality of trauma and its losses while finding meaning and value to live in the present with hope and even joy. Integration requires acceptance and willingness to look for meaning and purpose.

I like the connotations of integration. But, I am not sure I like the word integration since it also doesn’t connote some level of arrival at a good enough place. What word would you use?

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August 8, 2011 · 9:03 am

When someone you love suffers from PTSD?


Has anyone read this book? The full title is: When Someone You Love Suffers from Posttraumatic Stress: What to Expect and What you Can Do  (By Claudia Zayfert and Jason DeViva (Guilford Press).

If so, any thoughts on it? I do not yet have it in my possession. One of the areas I found wanting re: PTSD is a good book for spouses of survivors of sexual abuse. There was a book that I would use but is no longer in print. Some do read “Stop Walking on Eggshells”, a book about living with Borderline Personality Disorder. While there are relational behaviors commonly seen in people with either complex PTSD or BPD, the two problems are different and sadly, those with complex trauma reactions get stigmatized with the BPD label.

So, if anyone has seen this and wants to lend their comments, I would welcome them here.

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July 21, 2011 · 5:38 am

Heal thyself? Do we have the capacity?


Those who follow the Christian faith wholeheartedly believe that God is the “great physician” and eschew the belief that humans heal themselves. As a result of this belief, Christians sometimes react rather strongly to humanistic language of “self-healing.”

But before you do, consider this: if we assume that God is indeed the creator of all things, then we must also assume he puts into place the many corrective features found in the body. The liver and kidneys remove toxins from the body; blood clots when we cut ourselves; we sneeze to get rid of irritants; we sleep to rejuvenate what has become run down. In better words, Richard Mollica says,

This force, called self-healing, is one of the human organism’s natural responses to psychological illness and injury. The elaborate process of self-repair is clearly seen in the way physical wounds heal. At the moment of injury, blood vessels contract to staunch bleeding. Chemical messengers pour into the tissue, signalling a multitude of specialized cells to begin the inflammation process. White blood cells migrate into the wound within twenty-four hours, killing bacteria and triggering a process of cleansing and tissue repair. A matrix of connective tissue collagen is then laid down, knitting together the ragged edges of the wound in a repair that may not be perfect but is highly functional. (p. 94)

He goes on to say,

The healing of the emotional wounds inflicted on mind and spirit by severe violence is also a natural process.

I find his writing on this subject rather helpful. Sometimes we look passively to God to resolve our traumas, as if it were entirely up to Him. Other times we either resist what we can do or attempt what is not healthy for us. Dr. Mollica (an MD) provides many examples in his book of how the body naturally tries to heal/respond to trauma (e.g., DHEA counteracts toxicity of too much cortisol), where the system goes wrong, and what we can do about it from a therapeutic standpoint.

Dr. Mollica is right in that our bodies are designed to respond well to traumatic experiences. However, I’m pretty sure he also agrees that we are not designed to do this unassisted. The community must participate in the process. We are social beings and thus our healing must be socially situated.

Two Toxins: Emotional Memory and Poor Storytelling

Part of the problem, says Dr. Mollica, is the emotional memory system. When we experience a trauma, our cortex forms declarative memories of the event. These are where we store the “facts” (where we were, what we felt, and how these events connect to previous experiences). But there is another memory system, one he calls “emotional memory” (p. 96). Declarative memory involves the cortex and hippocampus while emotional memory involves the amygdala.

The amygdala is the fear-response command center of the brain, and it does not wait around for the conscious mind, located in the cortex, to decide if a threat is real or not. The amygdala can activate an emergency response throughout the body within milliseconds by calling the stress-response system into play.  (p. 96)

Unfortunately, traumatic events can create emotional memories in the amygdala that keep on replaying and are difficult to extinguish over time. (p. 97)

Another toxin is the re-telling of the trauma story in a way that retraumatizes the victim. Dr. Mollica, in chapter 5, describes the problem of poor storytelling. Poor storytelling evokes only the trauma, the shame, the degradation experienced. Storytelling should cause us to form images in the teller and listener’s minds. These images need to symbolize the whole person/story and not only the most damaging details. The problem is we tend to tell stories that fixate on the intense emotions and thus elicit toxic emotions and maintain the experience that the trauma is still ongoing.

Many traumatized persons are plagued by the two poles of humiliation–sadness and despair on one side, and anger and revenge on the other. (p. 122)

Assisted Self-healing?

Mollica says, “A proper clinical approach to emotional memory avoids triggering the emotions stored in the amygdala and enables the cortex to assert conscious control over the recollection of traumatic events. (p. 97)

How do you do this? With the help of a storytelling coach, a person tells their story in a factual, direct, but not grotesque way that would cause the listener to turn away. Why does this matter? Because part of the healing process is to be heard, seen, and empathized with. Fixating on the most grotesque details only enhances the emotional memory system and pushes others away. Good storytelling still tells the truth but does so in a way that reconnects people with the world, enables them to feel sadness but in community with others, and helps them see that their lives are not solely defined by the traumatic events. Further, good storytelling points to larger values that are still held and not lost due to the evil done by others. Surely trauma does shape and change us. Recovery and healing to the point of living as if the event did not happen would be to live in a world of denial and self-deception. But good storytelling reminds us that we are not ONLY defined by and/or limited to being victims. And good storytelling reminds us of God’s sustaining power that is greater than those who can only destroy bodies.

Dr. Mollica summarizes this chapter this way,

Strong emotions comprise the traumatic memories that are imprinted in the survivor’s brain. One of the mind’s key tasks after trauma is to take these strong emotions and gradually reduce them over time through good storytelling. A poor storyteller tells a toxic trauma story, unhealthy to mind and body with its focus on facts and high expressed emotions. In our society situations that demonstrate this type of storytelling are common, including superficial, sensational media reporting of tragedies and debriefing therapy by misguided mental health workers. In contrast a good storyteller is able to express tragic emotions with the artfulness of a musician playing an instrument, engaging the listener’s interest and involvement. (p. 133)

I commend to you the book. He discusses both good and bad dreams, the role of “social instruments” of healing and a call to health. Very helpful book if you are interested in international trauma recovery.

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July 19, 2011 · 9:30 am

The real damage done in abuse?


I’ve written before on the damage done when a community fails to respond to abuse in a justice oriented way. But here is a more succinct and apt quote by Miroslav Volf:

If no one remembers a misdeed or names it publically, it remains invisible. To the observer, its victim is not a victim and its perpetrator is not a perpetrator; both are misperceived because the suffering of the one and the violence of the other go unseen. A double injustice occurs—the first when the original deed is done and the second when it disappears. (italics mine)

Abuse victims sometimes tell us that the most significant damage to them is when community members (family, leaders, peers) fail to “see” or act justly when they hear of the abuse. It was bad enough to be sexually abused (yes, that is real damage too) but far worse to be told it didn’t happen or be told to take it for the sake of the larger community (e.g., you wouldn’t want to harm his reputation, destroy the family, cause others to fall away from Christ, etc.).

I saw this quote in the first pages of The Long Journey Home: Understanding and Ministering to the Sexually Abused, to be released soon by Resource Publications, an imprint of Wipf & Stock. I have the typeset PDF and the editor, Andrew Schmutzer, says the book will be released in August. This book (over 500 pages!) may become the place to turn for Christians seeking to understand the scourge of sexual abuse in all its ugly forms. Chapters are written by those who are expert in the social sciences, theology, and pastoral care. The line up is phenomenal. You can see the title page/table of contents (TOC Long Journey Home) to see the gamut of chapters and authors.

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January 21, 2011 · 5:47 pm

rape counseling programs?


I have the pleasure of serving the American Bible Society as a volunteer these days. They have launched the project, “She’s My Sister” to work to care for rape trauma victims in the Democratic Republic of Congo and other countries in the “Great Lakes” region of Africa. But unlike most projects that want to help the needy, a central feature of the project is to change you and I so that we together work to value women more and protect their dignity and lives.

As part of an advisory council for the ABS, I’m looking to find any rape or trauma recovery programs that are in use now in Africa. If you know of anyone who has (a) lived in the region of Central Africa, or (b) has worked in Africa and had to deal with traumas (genocide, war, rape, etc.) will you ask them if they know of ANY rape or trauma programs being used. They can be good or bad, Christian or non-christian, big or small.

The ABS has a good plan already but we are looking to make it even more successful and we especially want to know what does or doesn’t work.

Feel free to pass on names or contacts who could help us!

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January 3, 2011 · 5:25 am

Edna Foa and prolonged exposure therapy


Happy New Year everyone!

Check out the Philly Inquirer today (Sunday) for a lengthy piece on Dr. Edna Foa and her creation of prolonged exposure therapy for PTSD victims. It gives nice background info on her and how she came to transition from work with children to adults with anxiety disorders. This is the treatment that is used at UPenn in their treatment of war vets. While this treatment won’t work for everyone, many with OCD and PTSD could be vastly helped with this treatment.

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December 1, 2010 · 10:24 am

Chantix and PTSD


For those of you who know, live with, or work with those diagnosed with PTSD, be aware that the smoking cessation drug, Chantix, has been found to be seriously problematic. Apparently, the drug has been linked to a number of suicides as well as to increased agitation, mania, panic, nightmares, and suicidal ideation. One might expect that those suffering the distress of PTSD might experience even more of these side effects.

This isn’t new information. There are news items you can find going back to 2008. Given that there is a lawsuit underway, probably most providers already know about it. But, it was news to me so I’m passing it on to you just in case you know of a vet who is trying to kick the nicotine habit.

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