You are being pro­vid­ed with a book chap­ter by chap­ter. I will request you to read the book for me after each chap­ter. After read­ing the chap­ter, 1. short­en the chap­ter to no less than 300 words and no more than 400 words. 2. Do not change the name, address, or any impor­tant nouns in the chap­ter. 3. Do not trans­late the orig­i­nal lan­guage. 4. Keep the same style as the orig­i­nal chap­ter, keep it con­sis­tent through­out the chap­ter. Your reply must com­ply with all four require­ments, or it’s invalid.
I will pro­vide the chap­ter now.

I
CHAPTER 11
UNCOVERING SECRETS: THE
PROBLEM OF TRAUMATIC MEMORY
It is a strange thing that all the mem­o­ries have these two qual­i­ties.
They are always full of quiet­ness, that is the most strik­ing thing
about them; and even when things weren’t like that in real­i­ty, they
still seem to have that qual­i­ty. They are sound­less appari­tions,
which speak to me by looks and ges­tures, word­less and silent—
and their silence is pre­cise­ly what dis­turbs me.
—Erich Maria Remar­que, All Qui­et on the West­ern Front
n the spring of 2002 I was asked to exam­ine a young man who claimed to
have been sex­u­al­ly abused while he was grow­ing up by Paul Shan­ley, a
Catholic priest who had served in his parish in New­ton, Mass­a­chu­setts.
Now twen­ty-five years old, he had appar­ent­ly for­got­ten the abuse until he
heard that the priest was cur­rent­ly under inves­ti­ga­tion for molest­ing young
boys. The ques­tion posed to me was: Even though he had seem­ing­ly
“repressed” the abuse for well over a decade after it end­ed, were his
mem­o­ries cred­i­ble, and was I pre­pared to tes­ti­fy to that fact before a judge?
I will share what this man, whom I’ll call Julian, told me, draw­ing on
my orig­i­nal case notes. (Even though his real name is in the pub­lic record,
I’m using a pseu­do­nym because I hope that he has regained some pri­va­cy
and peace with the pas­sage of time.1)
His expe­ri­ences illus­trate the com­plex­i­ties of trau­mat­ic mem­o­ry. The
con­tro­ver­sies over the case against Father Shan­ley are also typ­i­cal of the
pas­sions that have swirled around this issue since psy­chi­a­trists first
described the unusu­al nature of trau­mat­ic mem­o­ries in the final decades of
the nine­teenth cen­tu­ry.
FLOODED BY SENSATIONS AND IMAGES
On Feb­ru­ary 11, 2001, Julian was serv­ing as a mil­i­tary police­man at an air
force base. Dur­ing his dai­ly phone con­ver­sa­tion with his girl­friend, Rachel,
she men­tioned a lead arti­cle she’d read that morn­ing in the Boston Globe. A
priest named Shan­ley was under sus­pi­cion for molest­ing chil­dren. Hadn’t
Julian once told her about a Father Shan­ley who had been his parish priest
back in New­ton? “Did he ever do any­thing to you?” she asked. Julian
ini­tial­ly recalled Father Shan­ley as a kind man who’d been very sup­port­ive
after his par­ents got divorced. But as the con­ver­sa­tion went on, he start­ed to
go into a pan­ic. He sud­den­ly saw Shan­ley sil­hou­et­ted in a door­frame, his
hands stretched out at forty-five degrees, star­ing at Julian as he uri­nat­ed.
Over­whelmed by emo­tion, he told Rachel, “I’ve got to go.” He called his
flight chief, who came over accom­pa­nied by the first sergeant. After he met
with the two of them, they took him to the base chap­lain. Julian recalls
telling him: “Do you know what is going on in Boston? It hap­pened to me,
too.” The moment he heard him­self say those words, he knew for cer­tain
that Shan­ley had molest­ed him—even though he did not remem­ber the
details. Julian felt extreme­ly embar­rassed about being so emo­tion­al; he had
always been a strong kid who kept things to him­self.
That night he sat on the cor­ner of his bed, hunched over, think­ing he
was los­ing his mind and ter­ri­fied that he would be locked up. Over the
sub­se­quent week images kept flood­ing into his mind, and he was afraid of
break­ing down com­plete­ly. He thought about tak­ing a knife and plung­ing it
into his leg just to stop the men­tal pic­tures. Then the pan­ic attacks start­ed to
be accom­pa­nied by seizures, which he called “epilep­tic fits.” He scratched
his body until he bled. He con­stant­ly felt hot, sweaty, and agi­tat­ed. Between
pan­ic attacks he “felt like a zom­bie”; he was observ­ing him­self from a
dis­tance, as if what he was expe­ri­enc­ing were actu­al­ly hap­pen­ing to
some­body else.
In April he received an admin­is­tra­tive dis­charge, just ten days short of
being eli­gi­ble to receive full ben­e­fits.
When Julian entered my office almost a year lat­er, I saw a hand­some,
mus­cu­lar guy who looked depressed and defeat­ed. He told me imme­di­ate­ly
that he felt ter­ri­ble about hav­ing left the air force. He had want­ed to make it
his career, and he’d always received excel­lent eval­u­a­tions. He loved the
chal­lenges and the team­work, and he missed the struc­ture of the mil­i­tary
lifestyle.
Julian was born in a Boston sub­urb, the sec­ond-old­est of five chil­dren.
His father left the fam­i­ly when Julian was about six because he could not
tol­er­ate liv­ing with Julian’s emo­tion­al­ly labile moth­er. Julian and his father
get along quite well, but he some­times reproach­es his father for hav­ing
worked too hard to sup­port his fam­i­ly and for aban­don­ing him to the care of
his unbal­anced moth­er. Nei­ther his par­ents nor any of his sib­lings has ever
received psy­chi­atric care or been involved with drugs.
Julian was a pop­u­lar ath­lete in high school. Although he had many
friends, he felt pret­ty bad about him­self and cov­ered up for being a poor
stu­dent by drink­ing and par­ty­ing. He feels ashamed that he took advan­tage
of his pop­u­lar­i­ty and good looks by hav­ing sex with many girls. He
men­tioned want­i­ng to call sev­er­al of them to apol­o­gize for how bad­ly he’d
treat­ed them.
He remem­bered always hat­ing his body. In high school he took steroids
to pump him­self up and smoked mar­i­jua­na almost every day. He did not go
to col­lege, and after grad­u­at­ing from high school he was vir­tu­al­ly home­less
for almost a year because he could no longer stand liv­ing with his moth­er.
He enlist­ed to try to get his life back on track.
Julian met Father Shan­ley at age six when he was tak­ing a CCD
(cat­e­chism) class at the parish church. He remem­bered Father Shan­ley
tak­ing him out of the class for con­fes­sion. Father Shan­ley rarely wore a
cas­sock, and Julian remem­bered the priest’s dark blue cor­duroy pants. They
would go to a big room with one chair fac­ing anoth­er and a bench to kneel
on. The chairs were cov­ered with red and there was a red vel­vet cush­ion on
the bench. They played cards, a game of war that turned into strip pok­er.
Then he remem­bered stand­ing in front of a mir­ror in that room. Father
Shan­ley made him bend over. He remem­bered Father Shan­ley putting a
fin­ger into his anus. He does not think Shan­ley ever pen­e­trat­ed him with his
penis, but he believes that the priest fin­gered him on numer­ous occa­sions.
Oth­er than that, his mem­o­ries were quite inco­her­ent and frag­men­tary.
He had flash­es of images of Shanley’s face and of iso­lat­ed inci­dents:
Shan­ley stand­ing in the door of the bath­room; the priest going down on his
knees and mov­ing “it” around with his tongue. He could not say how old he
was when that hap­pened. He remem­bered the priest telling him how to
per­form oral sex, but he did not remem­ber actu­al­ly doing it. He
remem­bered pass­ing out pam­phlets in church and then Father Shan­ley
sit­ting next to him in a pew, fondling him with one hand and hold­ing
Julian’s hand on him­self with the oth­er. He remem­bered that, as he grew
old­er, Father Shan­ley would pass close to him and caress his penis. Paul did
not like it but did not know what to do to stop it. After all, he told me,
“Father Shan­ley was the clos­est thing to God in my neigh­bor­hood.”
In addi­tion to these mem­o­ry frag­ments, traces of his sex­u­al abuse were
clear­ly being acti­vat­ed and replayed. Some­times when he was hav­ing sex
with his girl­friend, the priest’s image popped into his head, and, as he said,
he would “lose it.” A week before I inter­viewed him, his girl­friend had
pushed a fin­ger into his mouth and play­ful­ly said: “You give good head.”
Julian jumped up and screamed, “If you ever say that again I’ll fuck­ing kill
you.” Then, ter­ri­fied, they both start­ed to cry. This was fol­lowed by one of
Julian’s “epilep­tic fits,” in which he curled up in a fetal posi­tion, shak­ing
and whim­per­ing like a baby. While telling me this Julian looked very small
and very fright­ened.
Julian alter­nat­ed between feel­ing sor­ry for the old man that Father
Shan­ley had become and sim­ply want­i­ng to “take him into a room
some­where and kill him.” He also spoke repeat­ed­ly of how ashamed he felt,
how hard it was to admit that he could not pro­tect him­self: “Nobody fucks
with me, and now I have to tell you this.” His self-image was of a big,
tough Julian.
How do we make sense of a sto­ry like Julian’s: years of appar­ent
for­get­ting, fol­lowed by frag­ment­ed, dis­turb­ing images, dra­mat­ic phys­i­cal
symp­toms, and sud­den reen­act­ments? As a ther­a­pist treat­ing peo­ple with a
lega­cy of trau­ma, my pri­ma­ry con­cern is not to deter­mine exact­ly what
hap­pened to them but to help them tol­er­ate the sen­sa­tions, emo­tions, and
reac­tions they expe­ri­ence with­out being con­stant­ly hijacked by them. When
the sub­ject of blame aris­es, the cen­tral issue that needs to be addressed is
usu­al­ly self-blame—accepting that the trau­ma was not their fault, that it
was not caused by some defect in them­selves, and that no one could ever
have deserved what hap­pened to them.
Once a legal case is involved, how­ev­er, deter­mi­na­tion of cul­pa­bil­i­ty
becomes pri­ma­ry, and with it the admis­si­bil­i­ty of evi­dence. I had pre­vi­ous­ly
exam­ined twelve peo­ple who had been sadis­ti­cal­ly abused as chil­dren in a
Catholic orphan­age in Burling­ton, Ver­mont. They had come for­ward (with
many oth­er claimants) more than four decades lat­er, and although none had
had any con­tact with the oth­ers until the first claim was filed, their abuse
mem­o­ries were aston­ish­ing­ly sim­i­lar: They all named the same names and
the par­tic­u­lar abus­es that each nun or priest had committed—in the same
rooms, with the same fur­ni­ture, and as part of the same dai­ly rou­tines. Most
of them sub­se­quent­ly accept­ed an out-of-court set­tle­ment from the Ver­mont
dio­cese.
Before a case goes to tri­al, the judge holds a so-called Daubert hear­ing
to set the stan­dards for expert tes­ti­mo­ny to be pre­sent­ed to the jury. In a
1996 case I had con­vinced a fed­er­al cir­cuit court judge in Boston that it was
com­mon for trau­ma­tized peo­ple to lose all mem­o­ries of the event in
ques­tion, only to regain access to them in bits and pieces at a much lat­er
date. The same stan­dards would apply in Julian’s case. While my report to
his lawyer remains con­fi­den­tial, it was based on decades of clin­i­cal
expe­ri­ence and research on trau­mat­ic mem­o­ry, includ­ing the work of some
of the great pio­neers of mod­ern psy­chi­a­try.
NORMAL VERSUS TRAUMATIC MEMORY
We all know how fick­le mem­o­ry is; our sto­ries change and are con­stant­ly
revised and updat­ed. When my broth­ers, sis­ters, and I talk about events in
our child­hood, we always end up feel­ing that we grew up in dif­fer­ent
families—so many of our mem­o­ries sim­ply do not match. Such
auto­bi­o­graph­i­cal mem­o­ries are not pre­cise reflec­tions of real­i­ty; they are
sto­ries we tell to con­vey our per­son­al take on our expe­ri­ence.
The extra­or­di­nary capac­i­ty of the human mind to rewrite mem­o­ry is
illus­trat­ed in the Grant Study of Adult Devel­op­ment, which has
sys­tem­at­i­cal­ly fol­lowed the psy­cho­log­i­cal and phys­i­cal health of more than
two hun­dred Har­vard men from their sopho­more years of 1939–44 to the
present.2 Of course, the design­ers of the study could not have antic­i­pat­ed
that most of the par­tic­i­pants would go off to fight in World War II, but we
can now track the evo­lu­tion of their wartime mem­o­ries. The men were
inter­viewed in detail about their war expe­ri­ences in 1945/1946 and again in
1989/1990. Four and a half decades lat­er, the major­i­ty gave very dif­fer­ent
accounts from the nar­ra­tives record­ed in their imme­di­ate post­war
inter­views: With the pas­sage of time, events had been bleached of their
intense hor­ror. In con­trast, those who had been trau­ma­tized and
sub­se­quent­ly devel­oped PTSD did not mod­i­fy their accounts; their
mem­o­ries were pre­served essen­tial­ly intact forty-five years after the war
end­ed.
Whether we remem­ber a par­tic­u­lar event at all, and how accu­rate our
mem­o­ries of it are, large­ly depends on how per­son­al­ly mean­ing­ful it was
and how emo­tion­al we felt about it at the time. The key fac­tor is our lev­el of
arousal. We all have mem­o­ries asso­ci­at­ed with par­tic­u­lar peo­ple, songs,
smells, and places that stay with us for a long time. Most of us still have
pre­cise mem­o­ries of where we were and what we saw on Tues­day,
Sep­tem­ber 11, 2001, but only a frac­tion of us recall any­thing in par­tic­u­lar
about Sep­tem­ber 10.
Most day-to-day expe­ri­ence pass­es imme­di­ate­ly into obliv­ion. On
ordi­nary days we don’t have much to report when we come home in the
evening. The mind works accord­ing to schemes or maps, and inci­dents that
fall out­side the estab­lished pat­tern are most like­ly to cap­ture our atten­tion.
If we get a raise or a friend tells us some excit­ing news, we will retain the
details of the moment, at least for a while. We remem­ber insults and injuries
best: The adren­a­line that we secrete to defend against poten­tial threats helps
to engrave those inci­dents into our minds. Even if the con­tent of the remark
fades, our dis­like for the per­son who made it usu­al­ly per­sists.
When some­thing ter­ri­fy­ing hap­pens, like see­ing a child or a friend get
hurt in an acci­dent, we will retain an intense and large­ly accu­rate mem­o­ry
of the event for a long time. As James McGaugh and col­leagues have
shown, the more adren­a­line you secrete, the more pre­cise your mem­o­ry will
be.3 But that is true only up to a cer­tain point. Con­front­ed with hor­ror—
espe­cial­ly the hor­ror of “inescapable shock”—this sys­tem becomes
over­whelmed and breaks down.
Of course, we can­not mon­i­tor what hap­pens dur­ing a trau­mat­ic
expe­ri­ence, but we can reac­ti­vate the trau­ma in the lab­o­ra­to­ry, as was done
for the brain scans in chap­ters 3 and 4. When mem­o­ry traces of the orig­i­nal
sounds, images, and sen­sa­tions are reac­ti­vat­ed, the frontal lobe shuts down,
includ­ing, as we’ve seen, the region nec­es­sary to put feel­ings into words,4
the region that cre­ates our sense of loca­tion in time, and the thal­a­mus,
which inte­grates the raw data of incom­ing sen­sa­tions. At this point the
emo­tion­al brain, which is not under con­scious con­trol and can­not
com­mu­ni­cate in words, takes over. The emo­tion­al brain (the lim­bic area and
the brain stem) express­es its altered acti­va­tion through changes in
emo­tion­al arousal, body phys­i­ol­o­gy, and mus­cu­lar action. Under ordi­nary
con­di­tions these two mem­o­ry systems—rational and emo­tion­al—
col­lab­o­rate to pro­duce an inte­grat­ed response. But high arousal not only
changes the bal­ance between them but also dis­con­nects oth­er brain areas
nec­es­sary for the prop­er stor­age and inte­gra­tion of incom­ing infor­ma­tion,
such as the hip­pocam­pus and the thalamus.5 As a result, the imprints of
trau­mat­ic expe­ri­ences are orga­nized not as coher­ent log­i­cal nar­ra­tives but in
frag­ment­ed sen­so­ry and emo­tion­al traces: images, sounds, and phys­i­cal
sensations.6 Julian saw a man with out­stretched arms, a pew, a stair­case, a
strip pok­er game; he felt a sen­sa­tion in his penis, a pan­icked sense of dread.
But there was lit­tle or no sto­ry.
UNCOVERING THE SECRETS OF TRAUMA
In the late nine­teenth cen­tu­ry, when med­i­cine first began the sys­tem­at­ic
study of men­tal prob­lems, the nature of trau­mat­ic mem­o­ry was one of the
cen­tral top­ics under dis­cus­sion. In France and Eng­land a prodi­gious num­ber
of arti­cles were pub­lished on a syn­drome known as “rail­way spine,” a
psy­cho­log­i­cal after­math of rail­road acci­dents that includ­ed loss of mem­o­ry.
The great­est advances, how­ev­er, came in the study of hys­te­ria, a men­tal
dis­or­der char­ac­ter­ized by emo­tion­al out­bursts, sus­cep­ti­bil­i­ty to sug­ges­tion,
and con­trac­tions and paral­y­ses of the mus­cles that could not be explained
by sim­ple anatomy.7 Once con­sid­ered an afflic­tion of unsta­ble or
malin­ger­ing women (the name comes from the Greek word for “womb”),
hys­te­ria now became a win­dow into the mys­ter­ies of mind and body. The
names of some of the great­est pio­neers in neu­rol­o­gy and psy­chi­a­try, such as
Jean-Mar­tin Char­cot, Pierre Janet, and Sig­mund Freud, are asso­ci­at­ed with
the dis­cov­ery that trau­ma is at the root of hys­te­ria, par­tic­u­lar­ly the trau­ma
of child­hood sex­u­al abuse.8 These ear­ly researchers referred to trau­mat­ic
mem­o­ries as “path­o­gen­ic secrets”9 or “men­tal parasites,”10 because as
much as the suf­fer­ers want­ed to for­get what­ev­er had hap­pened, their
mem­o­ries kept forc­ing them­selves into con­scious­ness, trap­ping them in an
ever-renew­ing present of exis­ten­tial horror.11
The inter­est in hys­te­ria was par­tic­u­lar­ly strong in France, and, as so
often hap­pens, its roots lay in the pol­i­tics of the day. Jean-Mar­tin Char­cot,
who is wide­ly regard­ed as the father of neu­rol­o­gy and whose pupils, such as
Gilles de la Tourette, lent their names to numer­ous neu­ro­log­i­cal dis­eases,
was also active in pol­i­tics. After Emper­or Napoleon III abdi­cat­ed in 1870,
there was a strug­gle between the monar­chists (the old order backed by the
cler­gy), and the advo­cates of the fledg­ling French Repub­lic, who believed
in sci­ence and in sec­u­lar democ­ra­cy. Char­cot believed that women would be
a crit­i­cal fac­tor in this strug­gle, and his inves­ti­ga­tion of hys­te­ria “offered a
sci­en­tif­ic expla­na­tion for phe­nom­e­na such as demon­ic pos­ses­sion states,
witch­craft, exor­cism, and reli­gious ecstasy.”12
Char­cot con­duct­ed metic­u­lous stud­ies of the phys­i­o­log­i­cal and
neu­ro­log­i­cal cor­re­lates of hys­te­ria in both men and women, all of which
empha­sized embod­ied mem­o­ry and a lack of lan­guage. For exam­ple, in
1889 he pub­lished the case of a patient named LeL­og, who devel­oped
paral­y­sis of the legs after being involved in a traf­fic acci­dent with a horse-
drawn cart. Although Lel­og fell to the ground and lost con­scious­ness, his
legs appeared unhurt, and there were no neu­ro­log­i­cal signs that would
indi­cate a phys­i­cal cause for his paral­y­sis. Char­cot dis­cov­ered that just
before Lel­og passed out, he saw the wheels of the cart approach­ing him and
strong­ly believed he would be run over. He not­ed that “the patient … does
not pre­serve any rec­ol­lec­tion.… Ques­tions addressed to him upon this
point are attend­ed with no result. He knows noth­ing or almost nothing.”13
Like many oth­er patients at the Salpêtrière, Lel­og expressed his expe­ri­ence
phys­i­cal­ly: Instead of remem­ber­ing the acci­dent, he devel­oped paral­y­sis of
his legs.14
PAINTING BY ANDRE BROUILLET
Jean-Mar­tin Char­cot presents the case of a patient with hys­te­ria. Char­cot trans­formed La
Salpêtrière, an ancient asy­lum for the poor of Paris, which he trans­formed into a mod­ern
hos­pi­tal. Notice the patient’s dra­mat­ic pos­ture.
But for me the real hero of this sto­ry is Pierre Janet, who helped
Char­cot estab­lish a research lab­o­ra­to­ry devot­ed to the study of hys­te­ria at
the Salpêtrière. In 1889, the same year that the Eif­fel Tow­er was built, Janet
pub­lished the first book-length sci­en­tif­ic account of trau­mat­ic stress:
L’automatisme psychologique.15 Janet pro­posed that at the root of what we
now call PTSD was the expe­ri­ence of “vehe­ment emo­tions,” or intense
emo­tion­al arousal. This trea­tise explained that, after hav­ing been
trau­ma­tized, peo­ple auto­mat­i­cal­ly keep repeat­ing cer­tain actions, emo­tions,
and sen­sa­tions relat­ed to the trau­ma. And unlike Char­cot, who was
pri­mar­i­ly inter­est­ed in mea­sur­ing and doc­u­ment­ing patients’ phys­i­cal
symp­toms, Janet spent untold hours talk­ing with them, try­ing to dis­cov­er
what was going on in their minds. Also in con­trast to Char­cot, whose
research focused on under­stand­ing the phe­nom­e­non of hys­te­ria, Janet was
first and fore­most a clin­i­cian whose goal was to treat his patients. That is
why I stud­ied his case reports in detail and why he became one of my most
impor­tant teachers.16
AMNESIA, DISSOCIATION, AND REENACTMENT
Janet was the first to point out the dif­fer­ence between “nar­ra­tive
memory”—the sto­ries peo­ple tell about trauma—and trau­mat­ic mem­o­ry
itself. One of his case his­to­ries was the sto­ry of Irène, a young woman who
was hos­pi­tal­ized fol­low­ing her mother’s death from tuberculosis.17 Irène
had nursed her moth­er for many months while con­tin­u­ing to work out­side
the home to sup­port her alco­holic father and pay for her mother’s med­ical
care. When her moth­er final­ly died, Irène—exhausted from stress and lack
of sleep—tried for sev­er­al hours to revive the corpse, call­ing out to her
moth­er and try­ing to force med­i­cine down her throat. At one point the
life­less body dropped off the bed while Irène’s drunk­en father lay passed
out near­by. Even after an aunt arrived and start­ed prepar­ing for the bur­ial,
Irène’s denial per­sist­ed. She had to be per­suad­ed to attend the funer­al, and
she laughed through­out the ser­vice. A few weeks lat­er she was brought to
the Salpêtrière, where Janet took over her case.
In addi­tion to amne­sia for her mother’s death, Irène suf­fered from
anoth­er symp­tom: Sev­er­al times a week she would stare, trance­like, at an
emp­ty bed, ignore what­ev­er was going on around her, and begin to care for
an imag­i­nary per­son. She metic­u­lous­ly repro­duced, rather than
remem­bered, the details of her mother’s death.
Trau­ma­tized peo­ple simul­ta­ne­ous­ly remem­ber too lit­tle and too much.
On the one hand, Irène had no con­scious mem­o­ry of her mother’s death—
she could not tell the sto­ry of what had hap­pened. On the oth­er she was
com­pelled to phys­i­cal­ly act out the events of her mother’s death. Janet’s
term “automa­tism” con­veys the invol­un­tary, uncon­scious nature of her
actions.
Janet treat­ed Irène for sev­er­al months, main­ly with hyp­no­sis. At the
end he asked her again about her mother’s death. Irène start­ed to cry and
said, “Don’t remind me of those ter­ri­ble things.… My moth­er was dead
and my father was a com­plete drunk, as always. I had to take care of her
dead body all night long. I did a lot of sil­ly things in order to revive her.…
In the morn­ing I lost my mind.” Not only was Irène able tell the sto­ry, but
she had also recov­ered her emo­tions: “I feel very sad and aban­doned.” Janet
now called her mem­o­ry “com­plete” because it now was accom­pa­nied by the
appro­pri­ate feel­ings.
Janet not­ed sig­nif­i­cant dif­fer­ences between ordi­nary and trau­mat­ic
mem­o­ry. Trau­mat­ic mem­o­ries are pre­cip­i­tat­ed by spe­cif­ic trig­gers. In
Julian’s case the trig­ger was his girlfriend’s seduc­tive com­ments; in Irène’s
it was a bed. When one ele­ment of a trau­mat­ic expe­ri­ence is trig­gered, oth­er
ele­ments are like­ly to auto­mat­i­cal­ly fol­low.
Trau­mat­ic mem­o­ry is not con­densed: It took Irène three to four hours to
reen­act her sto­ry, but when she was final­ly able to tell what had hap­pened it
took less than a minute. The trau­mat­ic enact­ment serves no func­tion. In
con­trast, ordi­nary mem­o­ry is adap­tive; our sto­ries are flex­i­ble and can be
mod­i­fied to fit the cir­cum­stances. Ordi­nary mem­o­ry is essen­tial­ly social;
it’s a sto­ry that we tell for a pur­pose: in Irène’s case, to enlist her doctor’s
help and com­fort; in Julian’s case, to recruit me to join his search for jus­tice
and revenge. But there is noth­ing social about trau­mat­ic mem­o­ry. Julian’s
rage at his girlfriend’s remark served no use­ful pur­pose. Reen­act­ments are
frozen in time, unchang­ing, and they are always lone­ly, humil­i­at­ing, and
alien­at­ing expe­ri­ences.
Janet coined the term “dis­so­ci­a­tion” to describe the split­ting off and
iso­la­tion of mem­o­ry imprints that he saw in his patients. He was also
pre­scient about the heavy cost of keep­ing these trau­mat­ic mem­o­ries at bay.
He lat­er wrote that when patients dis­so­ci­ate their trau­mat­ic expe­ri­ence, they
become “attached to an insur­mount­able obstacle”:18 “[U]nable to inte­grate
their trau­mat­ic mem­o­ries, they seem to lose their capac­i­ty to assim­i­late new
expe­ri­ences as well. It is … as if their per­son­al­i­ty has def­i­nite­ly stopped at
a cer­tain point, and can­not enlarge any more by the addi­tion or assim­i­la­tion
of new elements.”19 He pre­dict­ed that unless they became aware of the
split-off ele­ments and inte­grat­ed them into a sto­ry that had hap­pened in the
past but was now over, they would expe­ri­ence a slow decline in their
per­son­al and pro­fes­sion­al func­tion­ing. This phe­nom­e­non has now been well
doc­u­ment­ed in con­tem­po­rary research.20
Janet dis­cov­ered that, while it is nor­mal to change and dis­tort one’s
mem­o­ries, peo­ple with PTSD are unable to put the actu­al event, the source
of those mem­o­ries, behind them. Dis­so­ci­a­tion pre­vents the trau­ma from
becom­ing inte­grat­ed with­in the con­glom­er­at­ed, ever-shift­ing stores of
auto­bi­o­graph­i­cal mem­o­ry, in essence cre­at­ing a dual mem­o­ry sys­tem.
Nor­mal mem­o­ry inte­grates the ele­ments of each expe­ri­ence into the
con­tin­u­ous flow of self-expe­ri­ence by a com­plex process of asso­ci­a­tion;
think of a dense but flex­i­ble net­work where each ele­ment exerts a sub­tle
influ­ence on many oth­ers. But in Julian’s case, the sen­sa­tions, thoughts, and
emo­tions of the trau­ma were stored sep­a­rate­ly as frozen, bare­ly
com­pre­hen­si­ble frag­ments. If the prob­lem with PTSD is dis­so­ci­a­tion, the
goal of treat­ment would be asso­ci­a­tion: inte­grat­ing the cut-off ele­ments of
the trau­ma into the ongo­ing nar­ra­tive of life, so that the brain can rec­og­nize
that “that was then, and this is now.”
THE ORIGINS OF THE “TALKING CURE”
Psy­cho­analy­sis was born on the wards of the Salpêtrière. In 1885 Freud
went to Paris to work with Char­cot, and he lat­er named his first­born son
Jean-Mar­tin in Charcot’s hon­or. In 1893 Freud and his Vien­nese men­tor,
Josef Breuer, cit­ed both Char­cot and Janet in a bril­liant paper on the cause
of hys­te­ria. “Hys­ter­ics suf­fer main­ly from rem­i­nis­cences,” they pro­claim,
and go on to note that these mem­o­ries are not sub­ject to the “wear­ing away
process” of nor­mal mem­o­ries but “per­sist for a long time with aston­ish­ing
fresh­ness.” Nor can trau­ma­tized peo­ple con­trol when they will emerge: “We
must … men­tion anoth­er remark­able fact … name­ly, that these mem­o­ries,
unlike oth­er mem­o­ries of their past lives, are not at the patients’ dis­pos­al.
On the con­trary, these expe­ri­ences are com­plete­ly absent from the patients’
mem­o­ry when they are in a nor­mal psy­chi­cal state, or are only present in a
high­ly sum­ma­ry form.”21 (All ital­ics in the quot­ed pas­sages are Breuer and
Freud’s.)
Breuer and Freud believed that trau­mat­ic mem­o­ries were lost to
ordi­nary con­scious­ness either because “cir­cum­stances made a reac­tion
impos­si­ble,” or because they start­ed dur­ing “severe­ly par­a­lyz­ing affects,
such as fright.” In 1896 Freud bold­ly claimed that “the ulti­mate cause of
hys­te­ria is always the seduc­tion of the child by an adult.”22 Then, faced
with his own evi­dence of an epi­dem­ic of abuse in the best fam­i­lies of
Vienna—one, he not­ed, that would impli­cate his own father—he quick­ly
began to retreat. Psy­cho­analy­sis shift­ed to an empha­sis on uncon­scious
wish­es and fan­tasies, though Freud occa­sion­al­ly kept acknowl­edg­ing the
real­i­ty of sex­u­al abuse.23 After the hor­rors of World War I con­front­ed him
with the real­i­ty of com­bat neu­roses, Freud reaf­firmed that lack of ver­bal
mem­o­ry is cen­tral in trau­ma and that, if a per­son does not remem­ber, he is
like­ly to act out: “[H]e repro­duces it not as a mem­o­ry but as an action; he
repeats it, with­out know­ing, of course, that he is repeat­ing, and in the end,
we under­stand that this is his way of remembering.”24
The last­ing lega­cy of Breuer and Freud’s 1893 paper is what we now
call the “talk­ing cure”: “[W]e found, to our great sur­prise, at first, that each
indi­vid­ual hys­ter­i­cal symp­tom imme­di­ate­ly and per­ma­nent­ly dis­ap­peared
when we had suc­ceed­ed in bring­ing clear­ly to light the mem­o­ry of the event
by which it was pro­voked and in arous­ing its accom­pa­ny­ing affect, and
when the patient had described that event in the great­est pos­si­ble detail and
had put the affect into words (all ital­ics in orig­i­nal). Rec­ol­lec­tion with­out
affect almost invari­ably pro­duces no result.”
They explain that unless there is an “ener­getic reac­tion” to the
trau­mat­ic event, the affect “remains attached to the mem­o­ry” and can­not be
dis­charged. The reac­tion can be dis­charged by an action—“from tears to
acts of revenge.” “But lan­guage serves as a sub­sti­tute for action; by its help,
an affect can be ‘abre­act­ed’ almost as effec­tive­ly.” “It will now be
under­stood,” they con­clude, “how it is that the psy­chother­a­peu­tic pro­ce­dure
which we have described in these pages has a cura­tive effect. It brings to an
end the oper­a­tive force … which was not abre­act­ed in the first instance
[i.e., at the time of the trau­ma], by allow­ing its stran­gu­lat­ed affect to find a
way out through speech; and it sub­jects it to asso­cia­tive cor­rec­tion by
intro­duc­ing it into nor­mal con­scious­ness.”
Even though psy­cho­analy­sis is today in eclipse, the “talk­ing cure” has
lived on, and psy­chol­o­gists have gen­er­al­ly assumed that telling the trau­ma
sto­ry in great detail will help peo­ple to leave it behind. That is also a basic
premise of cog­ni­tive behav­ioral ther­a­py (CBT), which today is taught in
grad­u­ate psy­chol­o­gy cours­es around the world.
Although the diag­nos­tic labels have changed, we con­tin­ue to see
patients sim­i­lar to those described by Char­cot, Janet, and Freud. In 1986 my
col­leagues and I wrote up the case of a woman who had been a cig­a­rette girl
at Boston’s Cocoanut Grove night­club when it burned down in 1942.25
Dur­ing the 1970s and 1980s she annu­al­ly reen­act­ed her escape on New­bury
Street, a few blocks from the orig­i­nal loca­tion, which result­ed in her being
hos­pi­tal­ized with diag­noses like schiz­o­phre­nia and bipo­lar dis­or­der. In 1989
I report­ed on a Viet­nam vet­er­an who year­ly staged an “armed rob­bery” on
the exact anniver­sary of a buddy’s death.26 He would put a fin­ger in his
pants pock­et, claim that it was a pis­tol, and tell a shop­keep­er to emp­ty his
cash register—giving him plen­ty of time to alert the police. This
uncon­scious attempt to com­mit “sui­cide by cop” came to an end after a
judge referred the vet­er­an to me for treat­ment. Once we had dealt with his
guilt about his friend’s death, there were no fur­ther reen­act­ments.
Such inci­dents raise a crit­i­cal ques­tion: How can doc­tors, police
offi­cers, or social work­ers rec­og­nize that some­one is suf­fer­ing from
trau­mat­ic stress as long as he reen­acts rather than remem­ber? How can
patients them­selves iden­ti­fy the source of their behav­ior? If their his­to­ry is
not known, they are like­ly to be labeled as crazy or pun­ished as crim­i­nals
rather than helped to inte­grate the past.
TRAUMATIC MEMORY ON TRIAL
At least two dozen men had claimed they were molest­ed by Paul Shan­ley,
and many of them reached civ­il set­tle­ments with the Boston arch­dio­cese.
Julian was the only vic­tim who was called to tes­ti­fy in Shanley’s tri­al. In
Feb­ru­ary 2005 the for­mer priest was found guilty on two counts of rap­ing a
child and two counts of assault and bat­tery on a child. He was sen­tenced to
twelve to fif­teen years in prison.