Science as Careful Questioning:
Are Claims of a False Memory Syndrome Epidemic Based on Empirical Evidence?
"Memory, Abuse, and Science: Questioning Claims About the False Memory Syndrome Epidemic" (Pope, September 1996) suggested that recent claims about the existence of an alleged false memory syndrome (FMS) epidemic and its possible causes and consequences deserve careful scientific evaluation. The article's approach was "not to provide a simplified set of supposed answers or support a sense of certitude but rather to suggest that an essential task of psychologists is careful, informed, and comprehensive questioning" (Pope, 1996, p. 957).
The article examined various claims about this supposed epidemic and suggested "types of questions that psychologists may find useful in evaluating these. . . claims" (p. 957).
The premise of the article (Pope, 1996) was that psychology rests on science and that claims--no matter how popular, authoritative, or institutionalized--must be dispassionately examined in light of the empirical evidence available to support them. If psychology is a scientific discipline, then claims by FMS proponents should be subject to the same scrutiny and held to the same scientific standards as those that are routinely applied to other claims. The article concluded by emphasizing this responsibility:
Science works best when claims and hypotheses can be continually questioned. That which tends to disallow doubt and discredit anyone who disagrees is unlikely to foster the scientific venture or promote public policies and clinical practices based on Scientific principles. Each scientific claim should prevail or fall on its research validation and logic. (Pope, 1996, p. 971)
A Controversial Topic
I appreciate that many readers took the time to write comments on my article (Pope, 1996) and that those comments chosen for publication are five from those whose claims were discussed in my article as well as five from those who engage in questioning those claims. It is possible that this controversy's deep divisions are reflected in characterizations of my article and its approach: one set of letters confining themselves to such descriptions as "thoughtful" and "careful" (Spiegel, 1997, this issue), "scholarly" (Alpert, 1997, this issue), "admirably reasoned and thorough" (Gold, 1997, this issue), and "scientific" and "bringing reason and civility into an emotionally charged . . . debate" (Saakvitne, Pratt, & Pearlman, 1997, this issue); the other seasoning positive comments with use of such terms as "deep disdain" (P. Freyd, 1997, this issue), "pious" (Pendergrast, 1997, this issue), "outrageous" (P. Freyd. 1997), "verged close to ad hominem" (Kihlstrom, 1997, this issue), "an effort to mislead people" (Poole, Lindsay, Memon, & Bull, 1997, this issue), and defamation of over one million people (P. Freyd. 1997).
Psychology's Scientific Foundation:
Empirical Validation for Assessment Approaches
Responding briefly to comments about my article (Pope, 1996), I'd like to start by emphasizing fundamental areas of agreement. Kihlstrom (1997) advocates a close relationship between science and practice and emphasizes the importance of clinical psychology being firmly based on scientifically validated principles and techniques. As I stated in my article, I firmly agree with this view of psychology as a scientific discipline. Theory and practice must rest on empirical validation. "Claims grounded most firmly in the scientific tradition are those emerging from hypotheses that are falsifiable. Scientists bear an essential responsibility to examine primary data, research methodology, assumptions, and inferences" (Pope, 1996, p. 971).
Kihlstrom (1997) criticizes the use of assessment concepts, such as Blume's (1990) checklist, to conclude that child abuse occurred. Kihlstrom and I are in solid agreement that to rely on such approaches is scientifically impermissible if they lack empirical validation. "Psychology bases claims regarding the effectiveness of an intervention or the accuracy of assessments or predictions on impartial, systematic investigation . . . [and] refrain[s] from making claims for validity that are not supported by empirical evidence" (Pope, Butcher, & Seelen, 2000). The use of unvalidated "signs" to conclude that childhood sexual abuse occurred is impermissible in psychological assessment (Pope & Vasquez, 1998). Various assessment instruments may have been validated for other purposes, but they still lack validation with regard to abuse.
Whenever standardized psychological tests are used as part of an assessment, it is essential that the tests be adequately normed for the relevant population and adequately validated for the task to which they are put. Unfortunately, standardized tests may often be misused in the area of sexual abuse. Especially in forensic assessments but also in other contexts, a test or test battery may be put faith as showing that a person did experienced a certain instance of abuse or did not experience a certain form of abuse . . .all in the complete absence of any successful attempt to validate the test or test battery for that purpose. (Pope, 1994, pp. 106-107; see also Pope, Butcher. & Seelen, 2000)
Is There Empirical Evidence Validating False Memory Syndrome?
Claims by FMS proponents should not be exempt from these fundamental requirements of psychological science. Did Kihlstrom present adequate (or any) empirical evidence validating his use of the formal diagnosis of FMS, which, as my article (Pope, 1996) noted, he defined and which has been set forth in the False Memory Syndrome Foundation's (FMSF's) brochure and amicus briefs? Kihlstrom claimed that there is a
False Memory Syndrome -- a condition in which a person's identity and interpersonal relationships are centered around a memory of traumatic experience which is objectively false but in which the person strongly believes. Note that the syndrome is not characterized by false memories as such. We all have memories that are inaccurate. Rather, the syndrome may be diagnosed when the memory is so deeply engrained that it orients the individual's entire personality and lifestyle, in turn disrupting all sorts of other adaptive behaviors. The analogy to personality disorder is intentional. False Memory Syndrome is especially destructive because the person assiduously avoids confrontation with any evidence that might challenge the memory. Thus it takes on a life of its own, encapsulated, and resistant to correction. The person may become so focused on the memory that he or she may be effectively distracted from coping with the real problems in his or her life. (Kilhstrom, 1993; Kihlstrom, 1998, p. 16; also cited in FMSF, 1995a. 1995b, 1995c, 1997a)
Kihlstrom (1997) mistakenly indicates that Carstensen et al. (1993) and I (Pope, 1996) questioned the use of FMS diagnosis because they believed that only the medical profession should use the term syndrome or because the word syndrome should be re-served exclusively for disorders approved by a majority of the American Psychiatric Association. Neither Carstensen et al.'s statement nor my article made any reference to such notions. Rather, as was explicitly stated in the major heading for that section of my article ("False Memory Syndrome: Claims of a Scientifically Validated Syndrome and Epidemic"), the essential question is whether there is any empirical validation for Kihlstrom's diagnostic construct.
Although there seems to be a never ending stream of popular books whose titles use the word syndrome preceded by some fictional character's name or some scientific language, psychological science requires more. Psychology requires that diagnostic categories be empirically validated. The validity of this diagnosis can be evaluated scientifically only if Kihlstrom reports the methodology and research data of empirical validation. For example, how did he select the sample of patients from whom this diagnosis was supposedly derived, how many did he select, how did he determine whether they met all the diagnostic criteria, and so on?
My article (Pope, 1996) was clear and specific in its focus on such questions. Beginning on page 959, I suggested additional questions useful in evaluating the empirical validation on which this diagnosis supposedly rests. For example, what methodology did Kihlstrom and other researchers use to determine in each case that the memory was "objectively false" (Kihlstrom, 1994, p.2)? What methodology was used to assess an "entire personality and lifestyle" (Kihlstrom, 1994, p. 2)? When claims are made about a new diagnosis, it is the responsibility of psychologists to obtain from those who make the claims an adequately detailed description of the methodology and data on which the claims are based and to evaluate the degree to which a diagnostic construct that has allegedly reached epidemic proportions rests solidly on adequate empirical validation.
Is There Empirical Evidence Validating De Rivera's Checklist?
De Rivera (1997, this issue) sets forth a checklist of seven criteria "to establish the innocence of families accused on the basis of recovered memories" (p. 996). De Rivera's checklist emerged from interviews with nine families who had contacted FMSF. "In order to select a representative sample of families who had contacted the FMS Foundation, the investigator chose a telephone area code and contacted all families within that code who met [certain] criteria" (de Rivera, 1994, p. 149). The investigator conducted one interview of several hours duration with each pair of parents, one or both of whom had been accused. The person who claimed to have been abused and who made the allegations that were being evaluated was not interviewed.
De Rivera (1994) demonstrated scientific responsibility by presenting adequate, specific information about his methodology of a kind that is too often missing from claims by FMS proponents. Regardless of agreement or disagreement with de Rivera's approach, rationale, or conclusions, readers understand clearly how many participants were selected, how they were selected, and how data were obtained from them. Informed discussion can address the question, Does this seven-point checklist demonstrate adequate empirical validity to justify its use to establish that a parent did not abuse a child? Does the process set forth as validating the checklist process in which no information is obtained from the person who claims to have been abused and no evidence is sought beyond statements of those who claim to have been falsely accused meet minimal scientific criteria for validation? It is possible to imagine a situation involving a false memory of abuse that meets none of these seven criteria or a situation involving an accurate memory of abuse that meets all seven. More important is that this checklist is unsupported by any validation study in which whether or not the abuse occurred has been adequately verified.
Is There Empirical Evidence Validating Poole Et Al.'s Checklist?
Poole et al. (1997) provide a third example of a construct lacking empirical validation. Their constellation of practices and beliefs, which was used to conclude that 25% of their respondents were "memory-focused," supposedly demonstrated "evidence that a sizable minority of highly trained psychotherapists have used potentially risky 'memory focused' approaches" (Lindsay, 1995, p. 282). Although they correctly critique the use of unvalidated checklists to indicate a history of sexual abuse as a "hodgepodge of alleged 'indicators'"(Poole et al., 1997, p. 991), they themselves used an unvalidated checklist composed of their selection of eclectic therapeutic practices that allegedly might implant false recollections of abuse in therapy patients. As Olio (1996) noted,
There are no validation studies for this constellation of reported beliefs and practices, therefore no way to determine what is actually being measured by the Poole, Lindsay et al. constellation nor the outcome(s) of particular beliefs and techniques. (p. 288)
The Rationale and Implications of Not Suspecting Child Abuse
Although Kihlstrom (1997) and I agree that psychological concepts must be empirically validated, we disagree on other important matters. For example, in my article (Pope, 1996), I discussed Kihlstrom's (1995) position that "it is not permissible to infer, or frankly even to suspect, a history of abuse in people who present symptoms of abuse." He claimed that it is impermissible "even to suspect" because there is no specific association between any symptom and child abuse and because to do so would constitute the logical error of affirming the consequent. When Kihlstrom (1995) wrote that clinicians must not suspect child abuse no matter what the symptoms, he confused the syllogistic proof of deduction with the formation of diagnostic hypotheses. (For a discussion of the affirming the consequent fallacy in assessment, see Pope & Brown, 1996; Pope, Butcher, & Seelen, 2000.)
Assessment, particularly in the early stages, requires clinicians to begin forming hypotheses based on incomplete data. Additional data provide evidence helping to contradict, support, or refine initial hypotheses as well as suggesting new hypotheses. Clinicians conducting an assessment may legitimately form suspicions about numerous diagnostic, etiologic, or prognostic possibilities. Diverse options may be added to the "rule out" list during the process of differential diagnosis. This process of professional decision making in the face of uncertainty is one for which there is extensive research and theory (e.g., Bell, Raiffa, & Tversky, 1988; Dowie & Elstein, 1988; Kahneman, Slovic, & Tversky, 1982; Pope, Butcher, & Seelen, 2000: Wolf, Gruppen, & Billi, 1985). A set of information may form an adequate, reasonable basis for suspecting a patient may have been abused while forming an inadequate, fallacious basis for determining that abuse must have occurred.
This essential distinction between deductive proof and provisional hypotheses can be illustrated by a collection of presenting symptoms such as dizziness, shortness of breath, heaviness in the chest, and an aching arm or jaw. No qualified health care provider would accept these symptoms as proof that the person was having a heart attack. None of the symptoms have a specific or pathognomonic relationship with a heart attack; the symptoms, singly or in combination, can be caused by an almost infinite variety of psychological or physical phenomena. But is it not only permissible but also responsible practice for a heath care worker to suspect a heart attack as a possible cause and to address this hypothesis during differential diagnosis?
If presenting symptoms must never lead clinicians to include a child abuse hypothesis as part of the process of differential diagnosis, then we are taken back to the age in which presenting symptoms per se never led to a provisional hypothesis of child abuse and additional data were not sought that might contradict, support, or refine the hypothesis. For example, Caffey (1946) described cases in which infants' presenting symptoms were chronic blood clots in the brain and broken arms and legs. Parents and others volunteered no reports of any trauma, intentional or accidental, that might have caused these symptoms. Caffey voiced clinicians' bafflement at what might have caused these symptoms. Should clinicians be prohibited from suspecting that one possible cause of such presenting symptoms in infants might be child abuse? Discussing Kihlstrom's (1995) claim that clinicians must never suspect a history of child abuse on the basis of the patient's presenting symptoms, Olio (1995) presented a hypothetical example: a 3-5-year-old girl, one of whose presenting symptoms is infection by the gonococcus bacterium, Neisseria gonorrhea. Presenting symptoms may legitimately form the basis for a suspicion that a patient may have a history of child abuse. For a more detailed discussion, see Pope and Brown (1996).
Laws on reporting child abuse focus on the distinction between syllogistic proof of deduction and the formation of diagnostic hypotheses. As noted in my article (Pope, 1996), reviews of state laws suggest that almost 50% use a form of the verb suspect (e.g., "suspect that a child has been abused") in legislation requiring therapists to report suspected child abuse (Kalichman, 1993). Authoritative claims that it is impermissible to form suspicions based on presenting symptoms may have serious implications for whether clinicians file reports pursuant to these laws.
Do People Ever Recover Memories of Repeated Child Abuse That Actually Occurred?
Pendergrast (1997) states that the real scientific question is whether what he calls "massive repression" of child abuse is possible. He claims that there is "no good science to back up such an assertion, and I could not find even one clear-cut corroborated case of massive repression in my research" (Pendergrast, 1997, p. 990). Pendergrast's conclusion is similar to that stated by FMSF as early as 1992 in its discussion of legal aspects of FMS: "Psychiatrists advising the Foundation members seem to be unanimous in the belief that memories of such atrocities cannot be repressed. Horrible incidents of childhood are remembered" (FMSF, 1992a, p. 2). Similarly, in argument to the court, FMSF (1997a) claimed that no known cognitive mechanism is considered capable of even contributing to an amnesia of a traumatic event: "Although a broad range of mechanisms are known to produce various kinds of memory disturbance and have been examined by memory researchers and theorists, none are, at present, considered capable of contributing to a supposed amnesia for traumatic events" (p. 17). Fraser (1997) wrote that one consequence of the work of FMSF is "that many . . . members of the public have been persuaded to believe that all recovered memories are bogus" (p. D14).
Repression is, of course, but one possible cognitive process that might affect access to memories of child abuse (Gleaves, 1996). Contrary to the FMSF claims, other theoretical models have also been hypothesized to account for amnesia for child abuse experiences (for discussion of research-based models, see, e.g., J. J. Freyd, 1996 [for additional information on J. J. Freyd's betrayal-trauma model, see Fraser, 1997]; Pope, 1995b; Pope & Brown, 1996).
It is important, however, to distinguish between two related but distinctly different questions: (a) whether people can lose access to the memories of repeated child abuse and later recover accurate memories of the abuse, and (b) if such a phenomenon occurs, what theoretical model might explain the phenomenon? As discussed in detail by Pope and Brown (1996), many phenomena have been observed and recognized scientifically for which the underlying explanatory mechanisms are still unknown. For example, the asymmetrical U-shaped curve describing the primacy and recency effects of serial recall has been recognized for more than a century. Stigler (1978) observed that.
nine years before the publication of H. Ebbinghaus's (1885) book on memory, an American physicist, F. E. Nipher, published brief accounts of his own investigations on this topic. . . . Nipher, who used series of numbers rather than nonsense syllables as the meaningless material to be memorized, . . . found 2 memory curves; a binomial relationship for the distribution of memory errors within 6-digit numbers, and a logarithmic relationship for the decay of memory over time. (p. 1)
But even such a seemingly simple, well-researched, and robust phenomenon as this off-center U in serial recall, Murdock (1995) noted, is one for which
we still have no completely satisfactory theory or model to explain. . . . Nipher himself applied a simple binomial model for these data, the same type of probability model one would use for . . . coin tosses . . . . However, such a model is more descriptive than explanatory, and cognitive psychologists would like to know what mental processes underlie the "coin tosses." (p. 110)
Whether access to memories of child abuse can be blocked for a matter of years is an empirical question. In a recent article, Scheflin and Brown (1996) reviewed 25 studies of amnesia for childhood sexual abuse and concluded that all
demonstrate amnesia in a subpopulation including recent studies with design improvements such as random sampling and prospective designs that address weaknesses in earlier studies. A reasonable conclusion is that amnesia for CSA [childhood sexual abuse] is a robust finding across studies using very different samples and methods of assessment. Studies addressing the accuracy of recovered abuse memories show that recovered abuse memories are no more or no less accurate than continuous memories for abuse. (p. 143; see also Fraser, 1997)
The Golden Goose, Hucksterism, and Therapists Milking the System
Pendergrast (1997) takes issue with the following sentence in my article: "A relatively recent set of claims hold that many therapists for reasons as diverse as well-meaning naivete, greed, incompetence, and zealotry suggest a history of childhood sexual abuse to clients who have no actual abuse history" (Pope, 1996, p. 957). He writes, "Contrary to Pope's (1996) implication, I do not believe that such therapists are motivated primarily by money. Those I interviewed were, in general, well-meaning, compassionate people" (Pendergrast, 1997, p. 989). The decision to include "greed" in my article was based on a number of published sources, including statements such as the following from Pendergrast's (1995) own book:
Recovered-memory therapy in all its variations, is a lucrative pursuit [italics in original]. The repressed-memory craze has proved to be a bonanza. . . . As long as insurance companies continue to pay for questionable diagnoses of "post-traumatic stress disorder" or "multiple personality," therapists will continue to milk the system for all it's worth. . . .Some advertisements follow in the grand American tradition of hucksterism. . . . Unfortunately, inventive True Believer therapists in search of lucrative repressed memories are already finding ways around the system. . . . It isn't difficult to predict that therapists will diagnose such golden-goose clients with massive amounts of repressed memories that will require years of expensive therapy to root out. (pp. 504-509)
Techniques and Beliefs, or Misinformation?
Poole et al. (1997) respond to a detailed critique of their work presented by Olio in the summer 1996 issue of the Journal of Psychiatry & Law, a special issue devoted to original research reports, review articles, and legal analyses in the area of recovered memories. Olio addressed in careful detail the issues that Poole et al. raise in their comment.
In an effort to assess the use of potentially risky practices in psychotherapy, Poole, Lindsay, Memon, and Bull (1995) focused on the use of particular therapeutic techniques by therapists who report certain beliefs. They assume that therapists who hold these beliefs practice differently than therapists (even those who use similar techniques) who do not hold these beliefs and that these differences in practice create greater risk for the production of illusory memories of childhood abuse.
This emphasis on therapists' attitudes and the use of particular techniques may be misplaced. A review of the scientific research on the misinformation effect seems to indicate that memory reports become distorted when misinformation is systematically and repeatedly supplied by the interviewer (Brown, 1995). Therefore, it may not be the use of a specific technique per se (such as the so-called memory recovery techniques) nor the presence of a specific belief by the therapist that independently causes a risk for the creation of illusory memories of childhood abuse. (For a study of the suggestibility of those who reported recovering memories of childhood abuse as compared with those who did not make such reports, see Leavitt, 1997.)
A recent review of studies using guided imagery may offer important data that are useful in considering this issue (Brown, Scheflin, & Hammond, in press). Brown et al. reported that 2 studies that used repeated questioning (not repeated misleading questioning) without guided imagery showed a slight increase in additional information with little or no increase in the error rate. The 12 studies that used guided imagery with a free-recall format yielded an 11%-96% gain in new information about the target event without a significant increase in the memory error rate, whereas the 4 studies that combined the use of guided imagery with the inclusion of systematic misinformation about the content of the reported event showed a substantial increase in the memory error rate.
There is no empirical evidence that the diverse and dissimilar techniques enumerated in Poole et al.'s (1995) checklist are differentially associated with systematically supplying false or misleading misinformation about child abuse. Poole et al. included no measures to assess whether respondents used interviewing practices that included supplying false or misleading information about a nonexistent history of child abuse. With no validation studies supporting their checklist of supposedly risky behaviors, there is no scientific basis for determining which respondents did or did not engage in behaviors that would tend to elicit reports of false memories of child abuse from at least some patients. Poole et al. did not use a 2 x 2 model (see Pope, 1996) necessary to determine whether patients with whom these techniques were used produced significantly more or less reports of false abuse memories than those patients not encountering these behaviors (or than people who were not in therapy). Poole et al. offered no information concerning whether the reports of recovered memories of abuse by any of the patients were valid (i.e., described abuse that actually occurred) or invalid.
Estimating Frequencies and Inferring Causality
Poole et al. (1997) acknowledge that their "data . . . do not provide a basis for estimating the frequency of therapy-induced illusory memories of abuse" and claim that "we have not used our data elsewhere as the basis for calculating one" (p. 990) and make no claim that "memory-focused" clinicians "used approaches that put their clients at risk" (p. 992). Elsewhere, however, Lindsay and Poole (1995) wrote,
The debate about recovered memories must also be viewed in its numerical context. In our view there are solid grounds to fear that tens of thousands of people have developed illusory memories or false beliefs about CSA through suggestive memory recovery techniques and ancillary practices in psychotherapy, self-help, or group therapy. (p. 464)
Similarly, Lindsay (1995) wrote that Poole et al.'s (1995) data provide "evidence that a sizable minority of highly trained psychotherapists (on the order of l0%-25%) have used potentially risky 'memory focused' approaches" (p. 282). He claimed that "at no time in history have so many therapists used such a panoply of risky memory recovery techniques in attempts to help clients recover suspected hidden memories of CSA" (p. 283). Lindsay and Read (1994) claimed that these approaches "constitute a grave risk for the creation of illusory memories" (p. 327). (For a discussion of the 25% figure, see the following section entitled "Exaggerated Claims, Chilling Effects, and Dangerous Therapists.")
In Poole et al.'s (1995) article, they claimed that the study demonstrated that these therapeutic interventions could produce specific negative effects in terminating family relationships: "Our survey . . . indicates these interventions can have serious implications for clients (e.g., lead some clients to terminate relations with their fathers)" (p. 434).
Similarly, all abuse reported by therapists as having been recalled during the course of therapy (Poole et al., 1995, p. 431) was claimed by the authors to represent memories of abuse caused by therapy (p. 432), which Olio (1996) observed is a form of the post hoc ergo propter hoc (after this, therefore because of this) fallacy.
Poole et al.'s methodology relied on an unvalidated checklist to assess self-reports based on retrospective memories over the past years to produce a valid and reliable measure of consequences for patients (e.g., leading to recovery of false memories of abuse, terminating relationships with fathers) as they were specifically caused by therapist behaviors.
Exaggerated Claims, Chilling Effects, and Dangerous Therapists
Poole et al. (1997) now acknowledge that "exaggerated claims about false memories may have a chilling effect on victim advocacy and support" (p. 992) and express regret about their use of the language of causation. Yet, it is a serious problem when an article claims that its methodology and data establish such conclusions and enters the peer-reviewed literature without a subsequent erratum notice. The claims may become institutionalized in the scientific and forensic literature. For example, Pendergrast (1995) wrote.
Poole and Lindsay's survey indicated that 25 percent of doctoral-level therapists constitute True Believers . . . . Taking that 25 percent figure as accurate . . . we arrive at 62,500 True Believer therapists . . . . Using simple math (62,500 True Believers x 50 clients x 34 percent who recover memories), we arrive at over 1 million cases of "recovered memories" each year . . . . In short . . . there are millions of cases of "recovered memories," each of which represents shattered lives and destroyed families. If two-and-a-half-million women (well over one percent of the U.S. population) identify themselves as "Survivors," then one out of every 25 families has been affected. (p. 491)
Using similar calculations, FMSF Scientific and Professional Advisory Board member Crews (1995) claimed that "it is hard to form even a rough idea of the number of persuaded clients . . . a conservative guess would be a million persons since 1988 alone" (p. 160). In an article whose title and text metaphorically refer to therapists using these techniques as "accidental executioners," Loftus, Milo, and Paddock (1995) used Poole et al.'s (1995) claims as a basis for concluding that as many as 25% of clinicians "may be using techniques that are risky if not dangerous" (p. 304).
Therapists who continued to use such allegedly "dangerous" therapy techniques were themselves termed dangerous. For ex-ample, Utrecht University professor Onno van der Hart's plan to lecture in Israel on his treatment of adults who suffered child abuse met international opposition.
Members of the US False Memory Syndrome Foundation and psychologists in various parts of the world charged that van der Hart and his colleagues were "very dangerous." His critics charged that van der Hart's techniques represented a "harmful and unscientific method of pseudotherapy that must be seen as a threat to psychology in Israel. This 'therapy' makes the patient dependent on the therapist by inventing multiple personalities, false memories and accusations, which have already destroyed tens of thousands of families in the US." (Siegel-Itzkovich, 1996, p. 7)
The previous paragraphs contain two examples of the widely cited description of 25% of therapists or clinicians. That statistic can be found in Poole et al's (1995) abstract, which refers specifically to "25% of the respondents" (p. 426). It is worth noting that the description did not actually apply to 25% of the respondents to Poole et al.'s survey. The 25% statistic applied only to a very specific subsample of the respondents. After calculating the return rate based on returned forms, Poole et al. excluded "38% of the respondents" (p. 428) because they did not meet various criteria. One criterion was that the respondent had to have conducted "psychotherapy sessions with 10 or more adult female clients in the past 2 years" (p. 428). There was no comparable criterion for adult male clients. (Using such a criterion in reference to adult female clients is consistent with the belief that women are more likely to accept implantation of false memories that they have been sexually abused; however, there is still no empirical evidence based on adequate methodology (i.e., in which there is demonstrable proof of whether the supposed abuse occurred establishing the validity of this belief.)
In my article (Pope, 1996), I discussed differences between claims and Poole et al's data on which they were supposedly based, of which the "25% of respondents" or "25% of therapists" statistic is but one example (see also Olio, 1996, 1997). It is worth asking whether it is fair to characterize a finding based on 25% of a specific and significantly smaller subsample of respondents as if it were 25% of the respondents and hence supposedly representative of 25% of all therapists.
Poole et al. (1997) argue that they felt "that it was important to take a snapshot of clinicians' attitudes and practices at that point in history" (p. 992). However, the empirical literature suggests that it may be wise to move away from simplistic views of memory, particularly in this context, as a camera or a tape recorder.
Research suggests that sources of potential bias inherent in "memory must be taken into account in interpreting data emerging from retrospective studies" and that not only "the usual biases of self-report" but also other factors affecting "memory may be considerable in any form of survey research" (Pope, 1990, p. 479; see also Pope, 1979; Pope, Sonne, & Holroyd, 1993; Pope, Tabachnick, & Keith-Spiegel, 1987; Pope & Vasquez, 1998).
In this case, generalizations about therapists from two countries (based on 145 survey forms from the United States and 57 from England) were made from inferential and descriptive statistics obtained from reports of retrospective memory of beliefs and complex events over years as assessed by an unvalidated checklist that only a minority of the selected sample filled out and returned (return rate = 39%) and from which, moreover, an additional 38% of the respondents' surveys were discarded to select a specific subsample.
ARE THE FALSE MEMORY SYNDROME FOUNDATION'S
CLAIMS SEFTLED AND BEYOND QUESTION?
P. Freyd (1997), FMSF's executive director, objects to my having asked the foundation and its board to provide information about the methodology and data supporting their claims. A fundamental thesis of both my award address (Pope, 1995a) and my subsequent article (Pope, 1996) was that psychology as a science requires careful, informed, and comprehensive examination of the empirical evidence for claims.
FMSF has highlighted its reliance on its board, emphasizing not only that "board members make substantial donations to the Foundation both in time and money" but also that "it is the presence of the Advisory Board that has given our efforts credibility" ("FMSF Advisory Board Meeting," 1993, p. 3). When these names are listed in the False Memory Syndrome Foundation Newsletter, the FMSF amicus briefs, and other FMSF materials, their impressive prestige and affiliations do indeed lend credibility to the statements in those documents. Therefore, to ask the board about empirical evidence or practical implications of FMSF claims or statements seems to fall squarely within the scientific tradition of open inquiry.
QUESTIONS ABOUT THE FALSE MEMORY SYNDROME FOUNDATION'S CLAIMS OF A FALSE MEMORY SYNDROME EPIDEMIC
FMSF (1993) stated its fundamental purpose as follows: "FMSF is first a research organization that is documenting the extent of this phenomenon" (p. 7). When FMSF (1996) claimed that FMS "has affected tens of thousands of individuals and families worldwide," scientists and others should be able to ask to examine the methodology used to diagnose individual cases in what has, according to claims, reached epidemic proportions. The same questions I suggested in both my address (Pope, 1995a) and my article (Pope, 1996) that were applicable to Kihlstrom's research establishing the scientific validity of this diagnosis are applicable to FMSF's empirical evidence that so many individuals meet the diagnostic criteria. Similar questions to FMSF and its board would be relevant to FMSF claims that the reports received are accurate as reported by the accused parties:
Remember that three and a half years ago, FMSF didn't exist. A group of 50 or so people found each other and today more than 18,000 have reported similar experiences . . . . Our stories are true and as the saying goes "truth is stranger than fiction." (FMSF, 1997b)
QUESTIONS ABOUT INFORMED CONSENT
The question of informed consent is an important one if those who were diagnosed as afflicted with the supposed FMS were clinically assessed or involved in human participants research validating the diagnosis. If both Kihlstrom in his original work and FMSF in its research documenting the frequency of occurrence of the syndrome had used a methodology such as de Rivera's (1994; i.e., the person alleged to have FMS is not interviewed or examined; the diagnosis is made primarily on the basis of a report from one or both parents who claim to have been falsely accused of incest), then the informed consent of those afflicted with the syndrome might not have been a factor. Here is the discussion of this issue in my article:
Research involving human participants usually involves the informed consent of the participants. For those independently evaluating or attempting to replicate studies seeming to validate the existence and widespread occurrence of false memory syndrome, it would be useful if the procedures for obtaining informed consent if consent was obtained from people who were diagnosed as suffering from false memory syndrome were disclosed. It appears possible, on the basis of a reading of materials generated by the FMSF, that some might not consider interviewing or clinically assessing people supposedly afflicted by false memory syndrome to be an essential component of a study of the validity and occurrence of the syndrome.
If, for this reason, the informed consent of or even direct contact with people diagnosed with false memory syndrome has been considered unnecessary in documenting specific cases or the extent of the phenomenon, it would be useful for FMSF and its Scientific and Professional Advisory Board to report any available scientific data about the ability to diagnose false memory syndrome without meeting the person alleged to have the disorder. If the person reporting the so-called memory does not participate in the research, how do researchers conclude that the memory is objectively false (rather than simply subjectively judged to be false by those who have been accused)? How do researchers determine that the center of a person's identity and interpersonal relationships is a particular false memory without even meeting the person? How do they examine all aspects of personality without interviewing, evaluating, or even knowing the person? (Pope, 1996, p. 962)
QUESTIONS ABOUT WHETHER DISAGREEMENT IS LEGITIMATE
The Columbia Journalism Review recently published an examination (Stanton, 1997; see also Bowman & Mertz, 1996a, 1996b) of the problems that the news media have encountered when questioning FMSF claims and factors making it difficult for them to publish material that is unacceptable to FMSF. Similarly, as I described in my article (Pope, 1996), FMSF set forth a discussion of the rejection of suggestions that a more balanced program at a psychological association convention might result from supplementing members of the FMSF board who had been invited as speakers with scientists who might present alternatives to FMSF's view. That discussion included the following statement:
A memory researcher told us that research academics "don't even know what this memory debate is about. They see the evidence and to them the science of memory is obvious." He is right. The "science" of the "memory" is established . . . . How could a scientific program about memory be "balanced?" The notion makes no more sense than trying to balance a program in astronomy by including astrologers. ("Social Political Movement," 1996)
It should be permissible to ask the FMSF board about this position, about whether the issues as presented by FMSF are sufficiently established that to question or disagree is no more scientifically legitimate than endorsing a belief in astrology.
QUESTIONS ABOUT RESEARCH SUPPOSEDLY DEMONSTRATING THE EASE OF THERAPY IMPLANTING FALSE MEMORIES OF ABUSE
As yet another example, FMSF amicus briefs stated, "The available data indicate the relative ease with which psychotherapy can mistakenly persuade clients that they were sexually abused as children" (e.g., FMSF, 1995b, pp. 33-34; 1997a, p.41). When, as noted in my article (Pope, 1996), the names and affiliations of the FMSF board members appear listed as an appendix to such amicus briefs, it can produce a significant impact. To evaluate the empirical evidence, if any, that establishes the validity of this claim, it is a legitimate and responsible scientific task to ask for the evidence.
Similarly, it is an important scientific responsibility of those making this claim to provide their evidence so that it can be subject to independent examination. Does Poole et al's (1995) or any other scientific study actually establish that therapy can easily persuade adults that they were sexually abused as children when such abuse never occurred? To contend that such claims are "obvious," "settled," and therefore beyond customary scientific questioning is, as my original article discussed, not useful.
QUESTIONS ABOUT THE FALSE MEMORY SYNDROME FOUNDATION'S CLAIMS CONCERNING INDIVIDUALS
Similarly, if FMSF or one of its officers or board members makes a public or published claim about any family or individual family member, should it not be permissible to ask for the evidence supporting that claim? My award address (Pope, 1995a) contains examples of but a few claims that I believe deserve careful evaluation in light of the supporting evidence, if any. Evaluation in light of the empirical evidence seems preferable to reflexive acceptance and institutionalization of such claims.
To request supporting evidence seems particularly salient when a board member makes public statements about a special relationship to a specific family that might provide him or her with information, access, or perspective. For example, one FMSF board member wrote in an American Psychological Association (APA) divisional newsletter:
At the time that Pam and Peter Freyd came to see me, I had not been Pamela Freyd's psychiatrist for over ten years. Although they came to see me as "patients," I stopped any therapeutic connection with them within a month after the FMS Foundation was formed and I was asked to be a member of the Advisory Board. (Lief, 1994. p. 8)
QUESTIONS ABOUT FORCING PATIENTS TO CROSS PICKET LINES TO OBTAIN SERVICES FROM THOSE WHO DISAGREE WITH THE FALSE MEMORY SYNDROME FOUNDATION
And as a final example of the legitimacy of questioning FMSF's statements, forcing the patients of those who disagree with FMSF to pass through picket lines to obtain legal mental health services was a topic of my award address (Pope, 1995a) and my article (Pope, 1996). As early as 1992 in a False Memory Syndrome Foundation Newsletter article entitled "What Can Families Do?" the first activity mentioned after the rhetorical title's question was picketing (FMSF, 1992b). In his order granting summary judgment in favor of defendant trauma therapist Charles Whitfield, MD, whom Pamela Freyd and Peter Freyd had sued for alleged defamation, U.S. Judge Benson Legg mentioned many aspects of FMSF activities, including picketing. He wrote:
In response, the Freyds mounted a public campaign, challenging the validity of such recovered memories. In 1992, they formed the False Memory Syndrome Foundation ("FMSF"), aggressively contesting the existence of traumatic amnesia and repressed memories. (Resp. at 12). Plaintiffs relied on various fora to publicize their foundation and "to debunk this preposterous theory," including . . . the picketing of therapists' homes. [At the time this article went to press, it was unclear whether this decision would be appealed.] (Pamela Freyd et al. v. Charles L. Whitfield, 1997, pp. 1-2)
It should be permissible to ask FMSF and its board, whose prestige lends credibility to FMSF's positions and may cause a real impact, about the consequences of such a tactic.
CAN CHILD ABUSE PERPETRATORS AND VICTIMS FALSELY REMEMBER THAT NO ABUSE OCCURRED?
The remaining five comments underscore, deepen, and extend the basic themes of my article (Pope, 1996). Although space requirements permit only a brief mention of an aspect of each, this should not reflect on their importance.
Spiegel (1997) highlights a characteristic of much literature supporting claims about the supposed FMS epidemic: The malleability of memory is discussed only in terms of why therapy patients (or people who have been exposed to certain books, movies, or other influences) are claiming to be abused when such claims do or may represent FMS. There is no examination of the possibility that therapists (or exposure to books, etc.) might cause abuse victims to begin falsely remembering that they were not abused, perpetrators to falsely remember that they are innocent, and other family members who might have been aware of the abuse to falsely remember events or information supposedly proving that the abuse never happened. Similarly, surveys and experimental studies may be constructed to gather data about and discuss suggestibility or false memories only as they pertain to those who claim to have been abused. For example, Olio (1996) discussed ways in which research may be constructed so that it may unintentionally shape findings to confirm the beliefs of FMS proponents. Part of the process of careful, informed questioning that was the fundamental theme of my article (Pope, 1996) is that all research methodology and reports, no matter what their purported conclusions, must be rigorously examined for potential bias.
It is important to note the possibility that some people who abuse children may deny that they abuse children in the absence of false memories of innocence. That is to say, some perpetrators may make statements they know to be untrue. For research concerning this phenomenon among perpetrators of childhood sexual abuse, see Salter (1995, 1997).
THERAPISTS' BEHAVIORS, CONSEQUENCES, AND MALPRACTICE
Gold (1997) discusses the treatment decisions that clinicians face and emphasizes the need for an empirical approach, placing this concern within the context of the relative scarcity of well-designed research to find out what clinicians actually do with their patients and the consequences of those interventions. The randomized-trial research sponsored by the National Institute of Mental Health that Spiegel (1997) mentions provides an example of one approach that is likely to be useful.
Well-designed research is also needed to explore how clinicians arrive at their decisions about patients who claim to have been abused. In my article (Pope, 1996), I suggested some specific questions about clinicians' decision making that research could address, such as "to what degree if at all might therapists refrain from pursuing diagnostic leads based on presenting symptoms because of the threat of malpractice suits?" (p. 967). False memory proponents' statements relevant to malpractice and the standard of care, as documented in my award address (Pope, 1995a) and my article (Pope, 1996, pp. 966-968), may have significantly influenced therapists who provided services to those claiming to have been abused. In presenting the results of an APA task force study, former APA president Ron Fox noted that the research showed that "state licensure and grievance procedures have been used to harass and make unfounded charges against psychologists who provide psychotherapy to abuse victims" (Seppa, 1996, p. 12). As reported in the APA Monitor, 'There are some groups that have taken [recovered] memories as prima facie evidence of poor therapeutic practice,' Fox said. Some groups have mailed out newsletters instructing people how to make complaints to ethics boards to harass therapists, he said" (Seppa, 1996, p. 12). Fox noted that some clinicians have consequently altered their practice in response to this risk and others have discontinued serving this population.
Saakvitne et al. (1997) address the issue of graduate education in this area. Graduate schools must provide comprehensive training based on the most recent, still evolving scientific research. Graduate schools also must teach, model, and foster skills in critical thinking. Rather than being taught that some particular group's view of a topic (such as memory with regard to childhood sexual abuse) is established, final, and beyond serious question or disagreement, students can be encouraged to avoid passive acceptance of authoritative claims, no matter how prestigious or powerful the group, organization, or board members endorsing them, in favor of active, careful, informed questioning (Pope & Brown, 1996). They can be encouraged to seek information about the underlying methodology and empirical data from those who make claims. They can be invited to replicate the empirical research on which such claims are based, to reanalyze the raw data from the original study, and to create new models for studying the phenomenon at issue.
This process of requesting methodology and raw data can have surprising results. One of the researchers to request the raw data set from the Feldman-Summers and Pope (1994) study was J. J. Freyd. She reanalyzed the data by using a creative approach that tested specific hypotheses relevant to her theory. Consequently, she found significant statistical patterns that the original authors had simply never thought to look for (J. J. Freyd, 1996). It is through a collaborative approach, in which methodology and data supporting claims are freely disclosed to others, that the process of scientific questioning can flourish.
STIMULUS ANALOGY AND ECOLOGICAL VALIDITY
Alpert (1997) emphasizes the all-too-often overlooked requirement of "ecological validity," a concept also discussed by Gleaves and Freyd (1997, this issue), who provide examples. The concept may be relatively easy, taught to beginning graduate students, but it is one that may be forgotten in practice. Imagine, for example, that someone, as part of an experimental study, demonstrates that people sometimes forget some mildly traumatic matter (e.g., either an upcoming or a recent doctor's appointment for minor surgery) and then later remember it. It is unlikely that this would be accepted as the existence of proof that people lose access to memories of repeated acts of incest and then later remember them. Even if it were presented as a demonstration that delayed recall of repeated sexual abuse is possible because it demonstrates the mechanism by which such blocked memory access and subsequent recall occur, it would be unlikely to convince serious and unbiased scientists. The study would lack ecological validity, and the traumatic stimulus in the study would seem to differ in significant ways from repeated acts of incest. However, it is worth asking, as Gleaves and Freyd do, whether the experimental studies of implanting false memories and obtaining false confessions possess even minimal ecological validity. For example, is confessing to actually typing the wrong key in an experiment, an unintentional act that takes a fraction of a second, sufficiently similar to confessing that one has repeatedly raped one's children over a period of years, a hardly unintentional felony, the confession to which can result in years of imprisonment? Or is the stimulus memory of being briefly lost in a mall when one was a child sufficiently similar to the memory of being repeatedly raped when one was a child?
SCIENCE AS CAREFUL QUESTIONING
P. Freyd (1997) quotes a significant passage from my award address: "I'd like to encourage each of you to obtain the primary data, the articles and books that I will read from, and to read them cover-to-cover" (p. 997). I renew that recommendation now, in the hope that reading the primary data, articles, books, and other documents that I cited in my address (Pope, 1995a) and my article (Pope, 1996) will enable the kind of careful, informed, and comprehensive questioning that was my fundamental theme.
In conclusion, I would like to place these diverse individual issues back into the context of my original article (Pope, 1996). Because I cannot think of a better way to express it, what follows is the conclusion of my original article.
Claims about a new diagnostic category (false memory syndrome) reaching epidemic proportions, the ease with which extensive autobiographical memories about trauma can be implanted, and the large number of therapists engaging in behaviors likely to cause false memories of trauma in their patients deserve careful consideration.
It is important to examine carefully the evidence and logic of the claims and to ask, what if these claims are valid? The profound implications for individual lives, public policy, the standard of care, clinical work, and education and training have been compellingly set forth in books by Crews (1995), Dawes (1994), Goldstein and Farmer (1993, 1994), Loftus and Ketcham (1994), Ofshe and Watters (1994), Underwager and Wakefield (1994), and Wassil-Grimm (1995).
An open, fair, and independent analysis must also allow for the possibility that the evidence and logic do not convincingly establish the validity of some or perhaps any such claims. Psychologists must be prepared to examine the profound implications for individual lives. . . . [social] policy, the standard of care, clinical work, and education and training if these widely accepted and institutionalized claims are invalid. What if, for example, tens of thousands of individuals have been wrongly diagnosed with a label lacking adequate scientific validation?
It is equally important to examine the process by which these claims are evaluated and institutionalized, including tactics used to promote them. Psychologists must be as attentive to factors that, however unintentionally, may confound the process of consideration and discussion as they are to factors that may confound an individual experiment. If disagreement with certain claims is . . . [diagnosed as reflecting] impaired functioning or serious psychopathology, the scientific process may be subverted. If those who question, doubt, or disagree are authoritatively characterized by professionals as hate-filled True Believers, paranoid cultists, [unethical witch-hunters,] or Hitler-like zealots, the process of free and independent analysis of FMSF claims may be affected. If patients currently seeking legal health care services from those who question or disagree with FMSF are forced to cross picket lines to obtain those services, . . . the privacy of their therapy is invaded . . . . If they are diagnosed without their participation as suffering a false memory syndrome, then their freedom of choice may . . . [become illusory].
Claims grounded most firmly in the scientific tradition are those emerging from hypotheses that are falsifiable. Scientists bear an essential responsibility to examine primary data, research methodology, assumptions, and inferences. Science works best when claims and hypotheses can be continually questioned.
Each scientific claim should prevail or fall on its research validation and logic. That which tends to disallow doubt and discredit anyone who disagrees is unlikely to foster the scientific venture or promote public policies and clinical practices based on scientific principles. (Pope, 1996, p. 971)
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