In the United States the fate of veterans was also fraught with problems. In 1918, when they returned home from the battlefields of France and Flanders, they had been welcomed as national heroes, just as the soldiers returning from Iraq and Afghanistan are today. In 1924 Congress voted to award them a bonus of $1.25 for each day they had served overseas, but disbursement was postponed until 1945.
By 1932 the nation was in the middle of the Great Depression, and in May of that year about fifteen thousand unemployed and penniless veterans camped on the Mall in Washington DC to petition for immediate payment of their bonuses. The Senate defeated the bill to move up disbursement by a vote of sixty-two to eighteen. A month later President Hoover ordered the army to clear out the veterans’ encampment. Army chief of staff General Douglas MacArthur commanded the troops, supported by six tanks. Major Dwight D. Eisenhower was the liaison with the Washington police, and Major George Patton was in charge of the cavalry. Soldiers with fixed bayonets charged, hurling tear gas into the crowd of veterans. The next morning the Mall was deserted and the camp was in flames.7 The veterans never received their pensions.
While politics and medicine turned their backs on the returning soldiers, the horrors of the war were memorialized in literature and art. In All Quiet on the Western Front,8 a novel about the war experiences of frontline soldiers by the German writer Erich Maria Remarque, the book’s protagonist, Paul Bäumer, spoke for an entire generation: “I am aware that I, without realizing it, have lost my feelings—I don’t belong here anymore, I live in an alien world. I prefer to be left alone, not disturbed by anybody. They talk too much—I can’t relate to them—they are only busy with superficial things.”9 Published in 1929, the novel instantly became an international best seller, with translations in twenty-five languages. The 1930 Hollywood film version won the Academy Award for Best Picture.
But when Hitler came to power a few years later, All Quiet on the Western Front was one of the first “degenerate” books the Nazis burned in the public square in front of Humboldt University in Berlin.10 Apparently awareness of the devastating effects of war on soldiers’ minds would have constituted a threat to the Nazis’ plunge into another round of insanity.
Denial of the consequences of trauma can wreak havoc with the social fabric of society. The refusal to face the damage caused by the war and the intolerance of “weakness” played an important role in the rise of fascism and militarism around the world in the 1930s. The extortionate war reparations of the Treaty of Versailles further humiliated an already disgraced Germany. German society, in turn, dealt ruthlessly with its own traumatized war veterans, who were treated as inferior creatures. This cascade of humiliations of the powerless set the stage for the ultimate debasement of human rights under the Nazi regime: the moral justification for the strong to vanquish the inferior—the rationale for the ensuing war.
THE NEW FACE OF TRAUMA
The outbreak of World War II prompted Charles Samuel Myers and the American psychiatrist Abram Kardiner to publish the accounts of their work with World War I soldiers and veterans. Shell Shock in France 1914–1918 (1940)11 and The Traumatic Neuroses of War (1941)12 served as the principal guides for psychiatrists who were treating soldiers in the new conflict who had “war neuroses.” The U.S. war effort was prodigious, and the advances in frontline psychiatry reflected that commitment. Again, YouTube offers a direct window on the past: Hollywood director John Huston’s documentary Let There Be Light (1946) shows the predominant treatment for war neuroses at that time: hypnosis.13
In Huston’s film, made while he was serving in the Army Signal Corps, the doctors are still patriarchal and the patients are still terrified young men. But they manifest their trauma differently: While the World War I soldiers flail, have facial tics, and collapse with paralyzed bodies, the following generation talks and cringes. Their bodies still keep the score: Their stomachs are upset, their hearts race, and they are overwhelmed by panic. But the trauma did not just affect their bodies. The trance state induced by hypnosis allowed them to find words for the things they had been too afraid to remember: their terror, their survivor’s guilt, and their conflicting loyalties. It also struck me that these soldiers seemed to keep a much tighter lid on their anger and hostility than the younger veterans I’d worked with. Culture shapes the expression of traumatic stress.
The feminist theorist Germaine Greer wrote about the treatment of her father’s PTSD after World War II: “When [the medical officers] examined men exhibiting severe disturbances they almost invariably found the root cause in pre-war experience: the sick men were not first-grade fighting material. . . . The military proposition is [that it is] not war which makes men sick, but that sick men can not fight wars.”14 It seems unlikely the doctors did her father any good, but Greer’s efforts to come to grips with his suffering undoubtedly helped fuel her exploration of sexual domination in all its ugly manifestations of rape, incest, and domestic violence.
When I worked at the VA, I was puzzled that the vast majority of the patients we saw on the psychiatry service were young, recently discharged Vietnam veterans, while the corridors and elevators that led to the medical departments were filled by old men. Curious about this disparity, I conducted a survey of the World War II veterans in the medical clinics in 1983. The vast majority of them scored positive for PTSD on the rating scales that I administered, but their treatment focused on medical rather than psychiatric complaints. These vets communicated their distress via stomach cramps and chest pains rather than with nightmares and rage, from which, my research showed, they also suffered. Doctors shape how their patients communicate their distress: When a patient complains about terrifying nightmares and his doctor orders a chest X-ray, the patient realizes that he’ll get better care if he focuses on his physical problems. Like my relatives who fought in or were captured during World War II, most of these men were extremely reluctant to share their experiences. My sense was that neither the doctors nor their patients wanted to revisit the war.
However, military and civilian leaders came away from World War II with important lessons that the previous generation had failed to grasp. After the defeat of Nazi Germany and imperial Japan, the United States helped rebuild Europe by means of the Marshall Plan, which formed the economic foundation of the next fifty years of relative peace. At home, the GI Bill provided millions of veterans with educations and home mortgages, which promoted general economic well-being and created a broad-based, well-educated middle class. The armed forces led the nation in racial integration and opportunity. The Veterans Administration built facilities nationwide to help combat veterans with their health care. Still, with all this thoughtful attention to the returning veterans, the psychological scars of war went unrecognized, and traumatic neuroses disappeared entirely from official psychiatric nomenclature. The last scientific writing on combat trauma after World War II appeared in 1947.15
TRAUMA REDISCOVERED
As I noted earlier, when I started to work with Vietnam veterans, there was not a single book on war trauma in the library of the VA, but the Vietnam War inspired numerous studies, the formation of scholarly organizations, and the inclusion of a trauma diagnosis, PTSD, in the professional literature. At the same time, interest in trauma was exploding in the general public.
In 1974 Freedman and Kaplan’s Comprehensive Textbook of Psychiatry stated that “incest is extremely rare, and does not occur in more than 1 out of 1.1 million people.”16 As we have seen in chapter 2 this authoritative textbook then went on to extol the possible benefits of incest: “Such incestuous activity diminishes the subject’s chance of psychosis and allows for a better adjustment to the external world. . . . The vast majority of them were none the worse for the experience.”
How misguided those statements were became obvious when the ascendant feminist movement, combined with awareness of trauma in returning combat veterans, emboldened tens of thousands of survivors of childhood sexual abuse, domest
ic abuse, and rape to come forward. Consciousness-raising groups and survivor groups were formed, and numerous popular books, including The Courage to Heal (1988), a best-selling self-help book for survivors of incest, and Judith Herman’s book Trauma and Recovery (1992), discussed the stages of treatment and recovery in great detail.
Cautioned by history, I began to wonder if we were headed toward another backlash like those of 1895, 1917, and 1947 against acknowledging the reality of trauma. That proved to be the case, for by the early 1990s articles had started to appear in many leading newspapers and magazines in United States and in Europe about a so-called False Memory Syndrome in which psychiatric patients supposedly manufactured elaborate false memories of sexual abuse, which they then claimed had lain dormant for many years before being recovered.
What was striking about these articles was the certainty with which they stated that there was no evidence that people remember trauma any differently than they do ordinary events. I vividly recall a phone call from a well-known newsweekly in London, telling me that they planned to publish an article about traumatic memory in their next issue and asking me whether I had any comments on the subject. I was quite enthusiastic about their question and told them that memory loss for traumatic events had first been studied in England well over a century earlier. I mentioned John Eric Erichsen and Frederic Myers’s work on railway accidents in the 1860s and 1870s and Charles Samuel Myers’s and W. H. R. Rivers’s extensive studies of memory problems in combat soldiers of World War I. I also suggested they look at an article published in The Lancet in 1944, which described the aftermath of the rescue of the entire British army from the beaches of Dunkirk in 1940. More than 10 percent of the soldiers who were studied had suffered from major memory loss after the evacuation.17 The following week, the magazine told its readers that there was no evidence whatsoever that people sometimes lose some or all memory for traumatic events.
The issue of delayed recall of trauma was not particularly controversial when Myers and Kardiner first described this phenomenon in their books on combat neuroses in World War I; when major memory loss was observed after the evacuation from Dunkirk; or when I wrote about Vietnam veterans and the survivor of the Cocoanut Grove nightclub fire. However, during the 1980s and early 1990s, as similar memory problems began to be documented in women and children in the context of domestic abuse, the efforts of abuse victims to seek justice against their alleged perpetrators moved the issue from science into politics and law. This, in turn, became the context for the pedophile scandals in the Catholic Church, in which memory experts were pitted against one another in courtrooms across the United States and later in Europe and Australia.
Experts testifying on behalf of the Church claimed that memories of childhood sexual abuse were unreliable at best and that the claims being made by alleged victims more likely resulted from false memories implanted in their minds by therapists who were oversympathetic, credulous, or driven by their own agendas. During this period I examined more than fifty adults who, like Julian, remembered having been abused by priests. Their claims were denied in about half the cases.
THE SCIENCE OF REPRESSED MEMORY
There have in fact been hundreds of scientific publications spanning well over a century documenting how the memory of trauma can be repressed, only to resurface years or decades later.18 Memory loss has been reported in people who have experienced natural disasters, accidents, war trauma, kidnapping, torture, concentration camps, and physical and sexual abuse. Total memory loss is most common in childhood sexual abuse, with incidence ranging from 19 percent to 38 percent.19 This issue is not particularly controversial: As early as 1980 the DSM-III recognized the existence of memory loss for traumatic events in the diagnostic criteria for dissociative amnesia: “an inability to recall important personal information, usually of a traumatic or stressful nature, that is too extensive to be explained by normal forgetfulness.” Memory loss has been part of the criteria for PTSD since that diagnosis was first introduced.
One of the most interesting studies of repressed memory was conducted by Dr. Linda Meyer Williams, which began when she was a graduate student in sociology at the University of Pennsylvania in the early 1970s. Williams interviewed 206 girls between the ages of ten and twelve who had been admitted to a hospital emergency room following sexual abuse. Their laboratory tests, as well as the interviews with the children and their parents, were kept in the hospital’s medical records. Seventeen years later Williams was able to track down 136 of the children, now adults, with whom she conducted extensive follow-up interviews.20 More than a third of the women (38 percent) did not recall the abuse that was documented in their medical records, while only fifteen women (12 percent) said that they had never been abused as children. More than two-thirds (68 percent) reported other incidents of childhood sexual abuse. Women who were younger at the time of the incident and those who were molested by someone they knew were more likely to have forgotten their abuse.
This study also examined the reliability of recovered memories. One in ten women (16 percent of those who recalled the abuse) reported that they had forgotten it at some time in the past but later remembered that it had happened. In comparison with the women who had always remembered their molestation, those with a prior period of forgetting were younger at the time of their abuse and were less likely to have received support from their mothers. Williams also determined that the recovered memories were approximately as accurate as those that had never been lost: All the women’s memories were accurate for the central facts of the incident, but none of their stories precisely matched every detail documented in their charts.21
Williams’s findings are supported by recent neuroscience research that shows that memories that are retrieved tend to return to the memory bank with modifications.22 As long as a memory is inaccessible, the mind is unable to change it. But as soon as a story starts being told, particularly if it is told repeatedly, it changes—the act of telling itself changes the tale. The mind cannot help but make meaning out of what it knows, and the meaning we make of our lives changes how and what we remember.
Given the wealth of evidence that trauma can be forgotten and resurface years later, why did nearly one hundred reputable memory scientists from several different countries throw the weight of their reputations behind the appeal to overturn Father Shanley’s conviction, claiming that “repressed memories” were based on “junk science”? Because memory loss and delayed recall of traumatic experiences had never been documented in the laboratory, some cognitive scientists adamantly denied that these phenomena existed23 or that retrieved traumatic memories could be accurate.24 However, what doctors encounter in emergency rooms, on psychiatric wards, and on the battlefield is necessarily quite different from what scientists observe in their safe and well-organized laboratories.
Consider what is known as the “lost in the mall” experiment, for example. Academic researchers have shown that it is relatively easy to implant memories of events that never took place, such as having been lost in a shopping mall as a child.25 About 25 percent of subjects in these studies later “recall” that they were frightened and even fill in missing details. But such recollections involve none of the visceral terror that a lost child would actually experience.
Another line of research documented the unreliability of eyewitness testimony. Subjects might be shown a video of a car driving down a street and asked afterward if they saw a stop sign or a traffic light; children might be asked to recall what a male visitor to their classroom had been wearing. Other eyewitness experiments demonstrated that the questions witnesses were asked could alter what they claimed to remember. These studies were valuable in bringing many police and courtroom practices into question, but they have little relevance to traumatic memory.
The fundamental problem is this: Events that take place in the laboratory cannot be considered equivalent to the conditions under which traumatic memories are created. The terror and
helplessness associated with PTSD simply can’t be induced de novo in such a setting. We can study the effects of existing traumas in the lab, as in our script-driven imaging studies of flashbacks, but the original imprint of trauma cannot be laid down there. Dr. Roger Pitman conducted a study at Harvard in which he showed college students a film called Faces of Death, which contained newsreel footage of violent deaths and executions. This movie, now widely banned, is as extreme as any institutional review board would allow, but it did not cause Pitman’s normal volunteers to develop symptoms of PTSD. If you want to study traumatic memory, you have to study the memories of people who have actually been traumatized.
Interestingly, once the excitement and profitability of courtroom testimony diminished, the “scientific” controversy disappeared as well, and clinicians were left to deal with the wreckage of traumatic memory.
NORMAL VERSUS TRAUMATIC MEMORY
In 1994 I and my colleagues at Massachusetts General Hospital decided to undertake a systematic study comparing how people recall benign experiences and horrific ones. We placed advertisements in local newspapers, in laundromats, and on student union bulletin boards that said: “Has something terrible happened to you that you cannot get out of your mind? Call 727-5500; we will pay you $10.00 for participating in this study.” In response to our first ad seventy-six volunteers showed up.26
After we introduced ourselves, we started off by asking each participant: “Can you tell us about an event in your life that you think you will always remember but that is not traumatic?” One participant lit up and said, “The day that my daughter was born”; others mentioned their wedding day, playing on a winning sports team, or being valedictorian at their high school graduation. Then we asked them to focus on specific sensory details of those events, such as: “Are you ever somewhere and suddenly have a vivid image of what your husband looked like on your wedding day?” The answers were always negative. “How about what your husband’s body felt like on your wedding night?” (We got some odd looks on that one.) We continued: “Do you ever have a vivid, precise recollection of the speech you gave as a valedictorian?” “Do you ever have intense sensations recalling the birth of your first child?” The replies were all in the negative.
The Body Keeps the Score Page 24