When the mind plays tricks

Observations on sexual abuse

What do stories of alien abduction and false memories of child sexual abuse have in common? Most of them, it seems, emerge during some form of psychotherapy.

The dangers of misguided therapy were highlighted when psychologists from Britain and the US met at a conference, Remembering Trauma, at the Royal Society of Medicine in London this month. According to one survey, 3.7 million Americans believe they have been abducted by space aliens and experimented upon, or forced to have sex to produce hybrid children as part of an extraterrestrial fast-breeder programme. A recent BBC poll found that at least 300 people in Britain hold similar beliefs.

In the late 1980s and early 1990s, in a panic that spread across the English-speaking world, people claimed to have recovered long-forgotten memories of "Satanic" abuse in bizarre rituals by devil-worshipping cults which raped and murdered children, drank blood, ate faeces and impregnated women to breed babies for sacrifice. As no forensic evidence has been found anywhere to corroborate any such stories, most of us would conclude they, too, were false.

But claims by adolescents and adults that they have suddenly realised that they were sexually abused in their childhood are less easily dismissed. During the 1990s, many psychotherapists latched on to a theory that victims of incest and sexual abuse had been so traumatised that they repressed the memory. And so therapists used techniques including hypnosis and regression therapy to assist memory recovery. Most doctors in the mental health field now accept that some so-called recovered memories can be false memories unwittingly induced in therapy by leading questions and suggestions.

Now some researchers go further, arguing that it is impossible to have forgotten a truly traumatic event. All recovered memories are therefore necessarily false in the same way as memories of alien abduction. Richard McNally, professor of psychology at Harvard University, says: "The notion that the mind protects itself by repressing or dissociating memories of trauma, rendering them inaccessible to awareness, is a piece of psychiatric folklore devoid of convincing empirical evidence." McNally studied Vietnam veterans who suffered from post-traumatic stress disorder and concluded that their memories were all too clear and had never been forgotten. But research on people who claimed to have been abused during rituals of secret Satanic cults showed that most of them recovered the "memories" during psychotherapy. And when he studied people who believed they had been abducted by aliens, he found that the majority had undergone "quasi-hypnotic" memory recovery sessions.

Is the same true of many "victims" of "ordinary" childhood sexual abuse? Janet Boakes, head of psychotherapy services at St George's Hospital, London, told the conference: "Most clinicians now accept the reality of the 'false memory syndrome', but few recognise that they could themselves be responsible for creating or fostering false memories."

In the past five years, Boakes has been retained by the defence in nearly 100 cases involving "historical" allegations of sexual abuse. Of these, 65 cases involved criminal prosecutions and, in more than three-quarters of them, the complainant had received a "therapeutic intervention" that ranged from counselling to long-term psychiatric in-patient care.

And those responsible for engendering false memories were not just unregistered, unqualified quacks. Boakes reported that 73 per cent of the therapists involved were employed by the NHS and 7 per cent by social services departments, with just 20 per cent in private practice.

"Sometimes," she said, "clinicians seem to suspend all critical faculties when given a history of abuse and fail to recognise a prima facie unlikely tale. I think of a young woman who claimed that her father raped her on the grand piano in the garden shed. Her father was a local music teacher working from home. One imagines that if he really kept his piano in the garden shed, he would have been the talk of the neighbourhood."

Boakes cited another "but not untypical" case of a woman with gynaecological problems, who, after hearing a talk about incest, became anxious when she saw a pillow and hot-water bottle. As her mental health deteriorated, she was referred to a community psychiatric nurse who gave her The Courage to Heal, known as the bible of the recovered-memory movement. The book encourages a belief that many of life's problems are rooted in forgotten sexual abuse. Over a few weeks, the patient recovered "memories" of being sexually abused by her grandfather, father and husband. Eventually, she accused five men and two women of abusing her. "Often, she would announce a couple of days in advance that she felt a memory coming through," said Boakes.

She advises therapists: "Avoid any treatment aimed at facilitating or recovering memory. If the patient gets worse, review the case from the beginning. Consider whether you could have got it wrong. There is good evidence that the mental health of patients treated for sexual abuse that did not happen may deteriorate alarmingly as their view of themselves and their world is rewritten. Some of them never recover."