11. UNCOVERING SECRETS: THE PROBLEM OF TRAUMATIC MEMORY
by testsuphomeAdminYou 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.
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