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February 26, 2007

BehindTheMedspeak: 'Was Repressed Memory a 19th-Century Creation?'


Dr. Harrison Pope of Harvard Medical School believes that to be the case.

In a paper published in the February 2007 issue of the journal Psychological Medicine, his research team concluded that "the psychiatric disorder known as dissociative amnesia (often called 'repressed memory') is a 'culture-bound syndrome' — a creation of Western culture sometime in the 19th century," wrote Shankar Vedantam in a story in today's Washington Post.

So confident are the Harvard researchers that they're "offering $1,000 to anyone who can produce an example to disprove their theory."

Got one?

Go to biopsychlab.com and click on "Repression Challenge."

Here's the article.

    Was Repressed Memory a 19th-Century Creation?

    There is a pain — so utter
    It swallows substance up
    Then covers the Abyss with Trance
    So Memory can step around — across....

    Emily Dickinson wrote those lovely words sometime in the middle of the 19th century, probably after a love affair broke her heart. Over the next century and a half, that same idea found its way into countless books, plays and movies — when a memory becomes too painful to bear, the mind finds a way to seal it off, to "step around — across."

    But when researchers recently mounted an exhaustive effort to find examples of trauma-related amnesia in literary works before the 19th century, they drew a blank. If repressed memories are one way the brain deals with painful memories, why would there be no literary examples of the phenomenon that are more than 200 years old?

    In an unusual study, a group of psychiatrists and literary scholars, led by Harrison Pope of Harvard Medical School, recently argued that the psychiatric disorder known as dissociative amnesia (often called repressed memory) is a "culture-bound syndrome" — a creation of Western culture sometime in the 19th century.

    Pope pointed out that Shakespeare, Homer and other pre-19th-century writers show numerous characters suffering from other psychiatric disorders: the disjointed thinking that we call schizophrenia, or the persistent sadness that marks depression. Because art draws its inspiration from life, Pope said, this shows that those disorders have been around forever. In the opening lines of "The Merchant of Venice," for example, Antonio vividly describes what it feels like to be depressed:

    In sooth, I know not why I am so sad:
    It wearies me; you say it wearies you;
    But how I caught it, found it, or came by it,
    What stuff 'tis made of, whereof it is born
    I am to learn.

    Pope said a wide search of literary texts in European languages, Arabic, Sanskrit and Chinese has produced no convincing example of a character created before the year 1800 who suffered a traumatic event, repressed the memory and later recovered it. The scientists recently published their findings in the journal Psychological Medicine.

    The researchers are offering $1,000 to anyone who can produce an example to disprove their theory. (To send a suggestion, go to biopsychlab.com and click on "Repression Challenge.") Pope said many intriguing examples have come in, but none has been exactly right. Besides, he says, if dissociative amnesia has its origins in actual brain functioning, there ought to be many examples of it -- just as there are countless examples of characters who have epileptic seizures.

    In "Shakuntala," a play written in ancient India, a king falls in love with a woman. After a curse, the king forgets about his love. But his amnesia, which eventually reverses itself, was not triggered by a traumatic event.

    Examples of trauma-related amnesia proliferated in 19th-century Western literature, said Michael Parker, a professor of English at the U.S. Naval Academy and one of Harrison's co-authors. One of the best examples is in Charles Dickens's "A Tale of Two Cities," published in 1859, in which Dr. Manette is horrifyingly imprisoned in the Bastille but has no memory of the trauma until revelations in the plot cause him to recall some of what happened.

    Movies and television have produced ever more such tales; a recent "Masterpiece Theatre" production of "Jane Eyre" showed her suffering amnesia after finding out on her wedding day that the man she was about to wed was already married. Interestingly, Charlotte Bronte's 1847 novel has no reference to such amnesia; the television version invented it.

    "What that illustrates is repressed memory is such a wonderful dramatic device," Pope said. "Film is such a perfect vehicle for someone to have a flashback that grows back into a memory.... Maybe Hollywood to some extent has kept this concept in the foreground."

    Pope's literary-based study offers an unusual take on the controversy over repressed memory. Over the past two decades, many people have come forward to say they abruptly recovered memories of childhood trauma, especially sexual abuse. Some of the memories have been proved false.

    One implication of Pope's paper, said Richard McNally, a professor of psychology at Harvard who studies reactions to trauma, is that therapists should focus their attention on treating patients for the symptoms they are displaying — such as depression — with tools such as psychotherapy and medication, rather than assuming that hidden memories are the source of their emotional problems. Pope and McNally emphasized that a culture-bound syndrome was no less "real" than a biological brain disorder — the suffering of patients in both cases can be identical.

    Indeed, many experts argue that all psychiatric disorders, including schizophrenia and depression, have cultural aspects. For one thing, the ways people express emotional suffering are informed by the cultures they come from. But given that there are no laboratory tests to diagnose schizophrenia or depression — doctors make those diagnoses based on criteria agreed upon by consensus — one critic of Pope's study argued that it has the effect of belittling dissociative amnesia when it is no less scientific than other psychiatric disorders. Matthew Erdelyi, an experimental psychologist at Brooklyn College, argued that his own experiments show that human memory is indeed malleable and that people's ability to recall distant events can decline or improve with time.

    "I think it is patronizing," he said of the paper. "What is the claim of the article? You can't find repressed memories in historical articles. But that does not argue to the proper therapy for repressed memory."

    Erdelyi said the paper illustrates the enduring tension between modern psychiatry, which emphasizes the treatment of patients' symptoms, and Sigmund Freud's psychoanalytic approach, which emphasizes the exploration of past events as a way to resolve patients' problems. Freud himself worked with patients to recover memories of trauma. But by 1895, Erdelyi said, Freud had modified his idea after he realized that most people were not suffering from a single trauma.

    "He started to emphasize insight," Erdelyi said. "The insight was not, 'Oh my God, my father raped me!' but that 'There is a pattern to my problems.' The task of therapy is not to recover a particular point of memory, but to connect the points and to see a pattern in what makes you depressed."


Here's a link to the abstract of the Psychological Medicine paper, which follows.

    Is dissociative amnesia a culture-bound syndrome? Findings from a survey of historical literature

    Background. Natural human psychological phenomena, such as depression, anxiety, delusions, hallucinations and dementia, are documented across the ages in both fictional and non-fictional works. We asked whether ‘dissociative amnesia’ was similarly documented throughout history.

    Method. We advertised in three languages on more than 30 Internet web sites and discussion groups, and also in print, offering US$1000 to the first individual who could find a case of dissociative amnesia for a traumatic event in any fictional or non-fictional work before 1800.

    Results. Our search generated more than 100 replies; it produced numerous examples of ordinary forgetfulness, infantile amnesia and biological amnesia throughout works in English, other European languages, Latin, Greek, Arabic, Sanskrit and Chinese before 1800, but no descriptions of individuals showing dissociative amnesia for a traumatic event.

    Conclusions. If dissociative amnesia for traumatic events were a natural psychological phenomenon, an innate capacity of the brain, then throughout the millennia before 1800, individuals would presumably have witnessed such cases and portrayed them in non-fictional works or in fictional characters. The absence of cases before 1800 cannot reasonably be explained by arguing that our ancestors understood or described psychological phenomena so differently as to make them unrecognizable to modern readers because spontaneous complete amnesia for a major traumatic event, in an otherwise lucid individual, is so graphic that it would be recognizable even through a dense veil of cultural interpretation. Therefore, it appears that dissociative amnesia is not a natural neuropsychological phenomenon, but instead a culture-bound syndrome, dating from the nineteenth century.

February 26, 2007 at 04:01 PM | Permalink


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