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Commentary on Borawick V Shay - Karlin


Cultic Studies Journal, 1996, Volume 13, Number 1, pages 42-94

Commentary on Borawick v. Shay:  Hypnosis, Social Influence, Incestuous Child Abuse, and Satanic Ritual Abuse:  The Iatrogenic Creation of Horrific Memories for the Remote Past

Robert A. Karlin, Ph.D.

Rutgers University

Martin T. Orne, M.D., Ph.D.

University of Pennsylvania

Abstract

Borawick v. Shay involved several issues of broad concern. These are (1) the admissibility of hypnotically influenced memory, (2) iatrogenic contributions to memories of satanic ritual abuse and early incestuous child abuse, (3) the problematic diagnosis of hidden, incestuous child abuse as a causative factor in adult psychopathology, and (4) whether multiple personality disorder, recently renamed dissociative identity disorder, is a defense mechanism of overwhelmed children seeking escape or whether it is, in many cases, a dramatic, adult social role legitimized by certain therapists.

With rare and easily identified exceptions, the authors suggest that hypnotically influenced testimony be excluded per se (i.e., automatically). They also suggest that decade-delayed memo-ries of satanic rituals and of very early incestuous abuse recovered in therapy, hypnosis, or with hypnosis-like pro-cedures are usually iatrogenic fantasies and/or based on postevent information. Next, the authors present a Bayesian statistical analysis indicating that, at a minimum, more than 70% of diagnoses of hidden incestuous abuse are likely to be false positives. Finally, they point out several factors indicating a largely iatrogenic origin to the current epidemic of diagnoses of dissociative identity disorder.

In a recent decision the United States Court of Appeals for the Second District sitting on a three-judge panel unanimously affirmed the U.S. District Ruling (Borawick v. Shay, 1995) that excluded the hypnotically influenced testimony of Joan Borawick, a plaintiff seeking damages for incestuous childhood abuse. Because Ms. Borawick also alleged abuse by a satanic cult, her case raised a series of issues. Some of these issues involved the multifold dangers of allowing hypnotically influenced memories to be presented as testimony in civil cases. Broader concerns raised by Borawick v. Shay involved (1) iatrogenic contributions to memories of satanic ritual abuse and early incestuous child abuse, (2) the problematic diagnosis of hidden, incestuous child abuse as a causative factor in adult psychopathology based on recent adult memories, and (3) whether multiple personality disorder is a defense mechanism of over-whelmed children seeking escape or whether it is a dramatic adult social role legitimized by certain therapists. Often using the available facts in Borawick v. Shay as illustrations, this article will examine these issues.

When memories of childhood sexual abuse are recovered in therapy and regarded as veridical, the results can be devastating. For example, in late 1994 the world learned that Chicago’s Archbishop Joseph Cardinal Bernadin had been accused of sexually abusing Steven Cook when Steven was a teenager. Cook’s “memories” were recovered as an adult in therapy during hypnotic age regression. Although Cardinal Bernadin is now exonerated by Cook’s retraction, much of the harm cannot be undone (Grossman & Pressley, 1994). Similarly, during the past decade there is substantial evidence that a number of parents and other family members have been falsely accused of incestuous childhood abuse after decade-delayed “memories” are recovered, with disastrous consequences for the entire family, including the family member who made the accusation (Nelson & Simpson, 1994).

It is a terrible fact that childhood sexual abuse does occur. Everyone wants its perpetrators punished and its incidence and prevalence decreased. It used to be all too commonplace for instances of childhood abuse, especially incestuous childhood abuse (ICA), to be “hushed up” or ignored by families. Thus, it is understandable why patients and therapists alike may wish to unearth any possible hidden memories of abuse that might be lurking. Further, if one’s therapeutic bent is to believe that psychogenic amnesia is a common response to traumatic stress, helping patients remember childhood abuse may be seen as a necessary prerequisite to healing (Summit, 1983). However, this view raises a number of scientific and professional questions (cf. Loftus & Ketcham, 1994; Ofshe & Watters, 1994; Spence, 1994; Tavris, 1993).

For example, the view that psychogenic amnesia is commonplace among trauma survivors has little scientific support, despite its popularity with the media and some professional therapists (Lindsay & Read, 1994). Further, memory is a reconstructive process (Bartlett, 1932). Even under ideal circumstances, where alert, attentive, adult observers report what has just occurred, memories can be altered by the way questions are phrased (Loftus, 1979). As for memories of remote events, we are all aware that memory fades over time, and we become less certain of our memories as they age. When accurate recall is required, we seek alternate sources of information, if they are available. When they are not available, memory for remote events can be inaccurate. Although there are recent claims that memories of traumatic events are stored differently from other strongly emotionally valenced memories and may emerge unscathed through the mists of time (see van der Kolk, 1994), there is little or no evidence of this to date (Lindsay & Read, 1994).

Iatrogenically Created Remote Memory: An Overview

The emergence over the past 15 years of what has been called by its opponents “recovered memory” psychotherapy (Ofshe & Watters, 1994), as well as books and media events on the topic, has generated both greatly increased reports of incest with young children and serious debate in the scientific and therapeutic communities about the incidence and prevalence of ICA and of iatrogenic, false memories of ICA. While these debates are not resolved, we will discuss evidence supporting the idea that many memories of abuse recovered after lengthy amnesia are created, not remembered, during therapy, and it is highly likely that the “recovered” incestuous abuse episodes did not occur as historical events. This is not surprising, as scholars of psychotherapy believe remote memories obtained during therapy are symbolically accurate, not historically accurate. Such memories primarily tell us about a patient’s inner, subjective world, and may mislead us about the outer, objective one (Spence, 1982, 1994).

Is it really possible for any form of psychotherapy to create detailed memories of childhood sexual abuse that never occurred? Do other iatrogenic consequences frequently follow? Unfortunately, the answer to both questions is yes. The following description of recovered memory therapy may indicate how and why.

In recovered memory therapy, an individual, more frequently a woman, comes to a therapist with a relatively common complaint (e.g., depression and low self-esteem). Associating the presenting symptoms with a possible history of childhood sexual abuse, the therapist seeks to explore whether or not forgotten sexual abuse is a causative factor. The exploration often involves hypnotic age regression and what has been called “disguised hypnosis” (Perry, 1995) in the form of relaxation instructions combined with guided imagery and “regression work.” Patients are also asked to look at photographs from their childhood and read the book The Courage to Heal (Bass & Davis, 1988), or another like it, as bibliotherapy. These forms of exploration constitute a strongly suggestive environment in which the patient’s recovery is seen as dependent on her remembering childhood sexual abuse, usually at the hands of her father.

When images or memories start to emerge, as they often may with vulnerable patients, they are hailed as confirmation of the therapist’s hypotheses and the beginning of the patient’s recovery. Given this reinforcement, more memories soon emerge and the patient becomes convinced she is an incest survivor. The therapist may then suggest a meeting at which the angry patient denounces her parents. At such meetings it is usual for parents to be forbidden to respond to their daughter’s accusations; instead, their only participation is to listen. Unless the parents agree to confess their guilt and even support public pronouncements about the now-remembered incestuous abuse, their daughter will almost always sever her ties to them. Siblings are also contacted, and if they deny abuse, relationships with them may also be severed. Thus, the rest of the family is forced to choose a side or walk a tightrope between accusing and accused family members.

At this point, memory has been altered. For many patients the new “memories” are as real (and more vivid) as other remote memories. Further, having alienated herself from her family, the patient is increasingly dependent on support from the therapist and self-help or therapy groups comprising other people who also have learned they are incest survivors. Given their shared beliefs, both the therapist and fellow survivors will treat any remaining doubts about the historical reality of the memories as a pathological retreat into “denial.” The combination of isolation from previous support, rewriting the meaning of one’s entire past life, and participation in a belief system which many view skeptically and which alienates participants from their families is reminiscent of cult indoctrination. An additional way to gain allies and affirm the reality of the new memories is to contact a prosecutor and/or begin a civil suit.

 

At this point a future-oriented therapist may try to help the patient organize his or her life in the present and encourage looking forward rather than backward (Dolan, 1994). If not, therapy will focus on additional exploration of traumatic memories. In this case, the situation may go from bad to worse. The painful nature of this process and the loss of familial support often increases the patient’s depression and other symptoms, despite the best efforts of the therapist and support group members. This may be taken as proof by the patient or therapist that the most horrific memories have yet to be unearthed, and further exploration with hypnosis and hypnosis-like procedures is required. Not surprisingly, even more horrific memories emerge.

By this point the therapist and patient may have discovered that the patient has multiple personality disorder[1] (although the Borawick case did not involve this). The theory is that multiple personality disorder (MPD) reflects the patient’s inability to withstand awful experiences. Confronted with the horrors of ICA, in desperation, the patient dissociated and created alternative personalities, or alters, who protect her from her worst memories by keeping them “walled off” (Kanovitz, 1992). Patients who entered therapy with more serious problems, especially those with borderline personality disorder, may enjoy the drama and reach this point with far less therapeutic encouragement. Depending in part on the therapist’s views, additional searching may take place that leads to the discovery of satanic ritual abuse. Here again, those with borderline personality disorder are more likely to find they have been ritually abused in childhood.

The patient’s continued deterioration or failure to improve at each stage indicates that still worse memories lie ahead, and that further hypnosis and related techniques are required to probe deeper. As Loftus and Ketcham (1994) have suggested, the question can become, What can be worse? What can be worse than incestuous pedophilic abuse? Incestuous abuse involving multiple perpetrators, not only the father but also other adults, such as the mother and the father’s friends, may be “remembered” as sexually abusing the patient. The patient may come to see ordinary memories of childhood as a lie, with monsters hiding behind all the masks of caring faces. What could be worse? Being sexually abused during satanic rituals and forced to drink the blood of dead animals. (As we will see below, this is one of the events reported by Joan Borawick.) By this time the patient has learned that she had to develop a series of alters during childhood to protect herself from being overwhelmed by the horrors inflicted on her.

Unbelievably, it continues. What could be worse? The patient learns that her family is part of a multigenerational satanic cult; her grandparents and great-grandparents were members of the cult, and each generation was subsequently abused. It is now the patient’s turn. Additionally, the patient may learn that the cult programs some alters to be self-mutilating and/or suicidal; when that alter takes charge, the results can be injurious or fatal. What scenario could be worse? The patient may remember being made into a breeder, forced to bear babies who became slaves to the cult or, alternatively, were aborted, after which the patient was forced to eat her own babies. By this time, members of the patient’s family may be remembered as high authorities in the cult, and one of the patient’s own alters may also be the high priestess. This alter must eat bits and pieces of thousands of people each year (see Ofshe & Watters, 1994).

In vulnerable patients this process of escalating horrific fantasy induction reaches the point of an enduring, confidently-held delusion. The delusion usually lasts at least so long as the therapist, an attorney, or someone else significant to the patient is there to support it. Remember, most forms of therapy are beneficent; but all too often therapy that centers on recovering memories of childhood abuse is not. Instead it is destructive of both patients and those who otherwise would have been closest to them.

Moreover, although this depiction of recovered memory therapy includes extremes, it is by no means a caricature. Some therapists who treat adult victims of recently recalled ICA do not create an environment of escalating suggestions, but it happens often enough to be frightening (cf. Loftus & Ketcham, 1994; Ofshe & Watters, 1994; Perry, 1995; Yapko, 1994). For example, a recent case received notoriety when a well-known psychotherapist and authority on MPD was sued by a patient who no longer believed she was a satanic high priestess. She claimed years of belief in satanic cults during psychiatric hospitalization were due to suggestions in hypnosis that escalated unduly (Ofshe & Watters, 1994). This is not an isolated case. Both of the present authors know psychologists and psychiatrists whose practice includes a number of patients who have “learned” or are convinced that their multiple personality disorder occurred as one result of satanic ritual abuse. Rather than treating such fantasies with benign neglect, their diagnosis and ensuing suggestive treatment serves to consolidate the fantasies into believed-in memories.

Borawick v. Shay

One approach to better understanding the problems we are discussing is to examine how our courts are dealing with these issues. In a recent decision, the United States Court of Appeals for the Second District sitting on a three-judge panel unanimously affirmed the U.S. District Court ruling (Borawick v. Shay, 1995) to exclude the testimony of Joan Borawick, a plaintiff seeking damages for incestuous childhood abuse allegedly inflicted by her aunt and uncle, Christine and Morrie Shay. The plaintiff, who was herself a California attorney, claimed that her aunt inserted a cap pistol and a broomstick in the plaintiff’s vagina on two separate occasions during family visits when she was 4 and 7 years old. In addition, the aunt allegedly involved Ms. Borawick in some type of ritual dancing while both the aunt and child were naked. On another occasion, during these visits, the plaintiff claimed that her uncle placed a dog collar around her neck and committed anal rape. The court’s decision states that Ms. Borawick also Aleveled fanciful accusations of sexual abuse against numerous persons other than the defendants.... For example, Borawick allegedly recalls being raped and sexually abused at the age of 3 during rituals by men whom she believed to be members of the Masons. She also reports recollecting several incidents in which she was drugged by injection as well as an incident in which she was forced to drink blood at a ritual involving a dead pig, incense, chanting, and people dressed in black gowns” (Borawick v. Shay, 1995, Slip opinion, p. 10).[2]

Ms. Borawick stated that she had no memory of these events for more than 20 years. While seeking treatment in 1987 for various physical and psychological ills, Ms. Borawick’s physician referred her to a lay hypnotist, Valerian St. Regis. Her physician seemingly believed that “’problems in childhood’ sometimes cause chronic illness and are susceptible to recall through hypnosis” (Borawick v. Shay, 1995, Slip opinion, p. 2). St. Regis was known to help patients recover such memories.

During a course of 12 to 14 unrecorded hypnotic sessions in 1988, St. Regis aided Ms. Borawick in recovering memories of childhood rape, incest, and ritual abuse involving her aunt and uncle, among others. St. Regis seemingly allowed or suggested that Ms. Borawick remain amnesic for these events when not in hypnosis, because he believed the memories recovered in hypnosis would be “’devastating’ and would probably surface in time” (Borawick v. Shay, 1995, Slip opinion, p. 2). Ms. Borawick reports that it was several months after the end of hypnotic treatment before she began to remember in “bits and pieces” a lengthy and involved history of satanic ritual abuse (SRA). More memories emerged over the ensuing months.

In January 1992 Ms. Borawick initiated suit against her aunt and uncle for their “alleged willful, wanton, and malicious sexual exploitation of her in 1961 and 1964,” when she was 4 and 7 years old, respectively (Borawick v. Shay, 1995, Slip opinion, p. 5). The defendants claimed that Ms. Borawick’s memory was rendered unreliable by hypnosis and asked that her entire testimony be excluded at trial. When the District Court agreed, the defendants asked for and were granted summary judgment. Ms. Borawick appealed to the U.S. Court of Appeals for the Second District, which affirmed the District Court’s suppression of Ms. Borawick’s hypnotically influenced recall.

As part of its decision, the Court of Appeals noted the following five concerns with hypnotically influenced recall: (1) the subject becomes hypersuggestible, (2) the subject may fill in gaps in memory with fantasy [i.e., confabulate], (3) the subject may develop unwarranted confidence in the version of the story that emerged during or through hypnosis [memory hardening], (4) the subject may become less able to distinguish between accurate and inaccurate memory, and (5) the subject may incorporate postevent information into the narrative. Quoting Diamond (1980), the court held that “hypnotically recalled memory is apt to be a mosaic of (1) appropriate accurate events, (2) entirely irrelevant actual events, (3) pure fantasy, and (4) fantasized details to make a logical whole.” The present authors agree with the five concerns expressed by the court and the conclusions quoted from Diamond.

The court then considered decisions by other courts about the admissibility of hypnotically influenced testimony. These other courts made four types of rulings: (1) that hypnosis went to the credibility but not the admissibility of the evidence, (2) that hypnotically influenced testimony be excluded per se (i.e., automatically), (3) that adherence to some form of the Hurd safeguards determines admissibility, and (4) that the “totality of the circumstances,” as determined by the trial court, shall govern the admissibility of the hypnotically influenced testimony. The last ruling, number 4 above, was the choice of the Borawick court. It calls for a case-by-case evidentiary hearing at which the probative and prejudicial value of the testimony is assessed. While on the surface this ruling seems reasonable, especially if the number of cases were few, in the long run similar rulings may require a large expenditure of judicial and expert resources to little advantage. The American Medical Association Council on Scientific Affairs (AMA) recently reaffirmed its 1985 statement (AMA, 1994) calling for a per se exclusion of testimony influenced by hypnosis. Based on considerable scientific evidence and experience with forensic hypnosis, the AMA view should not be dismissed lightly.

Finally, the court noted that in previous cases hypnosis was used to refresh recollection, while in the case of Borawick v. Shay (1995), hypnosis was used therapeutically. However, in its decision, the court was “not willing to assume that the risks of suggestibility, confabulation, and memory hardening are significantly reduced when the hypnosis that triggers the testimony is used for therapeutic purposes.” This segment of the court’s decision will be supported in this paper. When hypnotically influenced recall emanates from a clinical setting, it may often pose as great or even greater risks to the fact-finding process than if it originates during an investigation.

In summary, the court’s decision excluded Ms. Borawick’s testimony on the formal grounds of the unreliability of hypnotically influenced testimony and the somewhat more informal rationale of the “fanciful” nature of her accusations about devil-worshiping Masons. Beginning with hypnosis, these two factors will be discussed.

Notes on the History of Forensic Hypnosis

Joan Borawick’s memories of childhood abuse originally emerged during hypnosis. The District and Circuit Courts disallowed Ms. Borawick’s testimony because her recall had been hypnotically influenced. The hypermnesia techniques used by recovered memory therapists involve either formal hypnosis or what Perry (1995) has called hidden hypnosis: guided imagery and “regression work.” So the effects of hypnosis on memory play a central role in this matter.

Problems with hypnosis and the testimony resulting from it formed the basis for judicial decisions in France as early as the 1850s. By the 1880s, the problems of confabulation, simulation, and the possibility of lay hypnotists harming their subjects were debated regularly in French courts (Laurence & Perry, 1988). Around the same time, a number of psychiatrists became aware of the possible pathogenic consequences of memories from early traumatic events recounted during hypnosis (Ellenberger, 1970). For example, Janet (1889, 1894) worked with hypnosis as a means of tapping into such memories and altering the idée fixe. At about the same time, Freud was producing abreactions during hypnosis (Freud & Breuer, 1895). After hypnosis, the patients of both psychiatrists obtained relief from their symptoms. It should be noted that Janet’s work depended on the ability to alter memory with hypnosis, whereas Freud’s work led to a recognition that the early childhood events his patients recounted in hypnosis were partially or entirely fantasy. Thus, both Janet and Freud knew that hypnotic memories were both mutable and historically inaccurate. Interestingly, Freud’s realization of the inaccuracy of hypnotic recall led to his conception of the Oedipal fantasy (Ellenberger, 1970).

Despite the experience of European psychiatry around the turn of the 20th century, investigations about whether hypnotic age regression involved a true reliving of earlier events continued through the 1950s. Studies of age-regressed adults found physiological and cognitive patterns believed possible only in young children or infants (e.g., Gidro-Frank & Bowersbuch, 1948; Reiff & Scheerer, 1959; True, 1949). These results were considered seriously until necessary methodological advances and careful controls showed such findings artifactual (cf. O’Connell, Shor, & Orne, 1970; Orne, 1951).[3] Age-regressed adults are adults who act as if they were children. The fact that well-respected psychiatrists and psychologists continued research on whether literal childhood responses could be temporarily reinstituted during hypnotic age regression illustrates the convincing nature of memories recounted during hypnosis.

During the past 15 years, considerable research has been done on the effects of hypnosis on memory. A number of such studies appeared in the 1980s and 1990s (e.g., Dywan & Bowers, 1983; Spanos, Quigley, Gwynn, Glatt, & Perlini, 1991). Books, chapters, and review articles appeared subsequently (e.g., Laurence & Perry, 1988; McConkey & Sheehan, 1995; Orne, Whitehouse, Dinges, & Carota Orne, 1988; Scheflin & Shapiro, 1989). This research found that hypnosis causes heightened production of information. Much of the new material gained in hypnosis, however, is incorrect. Hypnosis also produces an overall increase in confidence about both correct and incorrect memories (cf. Sheehan, 1988). Subjects are ordinarily more confident about their memory for correct rather than incorrect information (for a recent review, see Sporer, Penrod, Read, & Cutler, 1995).

Because the hypnotic subject experiences increased confidence in both accurate and inaccurate memories, the usual correlation between certainty and accuracy is abrogated, making cross-examination more difficult (Sheehan, 1988). Further, the frequent inclusion of confabulated, vivid detail in the new material makes hypnotically influenced memories more credible (Dywan, 1995). Fantasies entirely unrelated to historical events may also be suggested during hypnosis and remembered as veridical (Laurence, Nadon, Nogrady, & Perry, 1986; Laurence & Perry, 1983). Finally, subjects are often unable to discriminate accurately what they remembered of the original events before hypnosis, what material they learned subsequently from other sources, and what additional material they remembered during hypnosis (Orne, Whitehouse, Carota Orne, & Dinges, 1996).[4]

To some degree, these effects are independent of individual differences in response to hypnosis. Hypnotizability, as measured by response to standardized inductions and suggestions, is a stable personality trait. The test-retest reliability of the Stanford Scale of Hypnotic Susceptibility, Form A, is approximately .70 when individuals, originally measured when undergraduates at Stanford University, were measured again between 10 and 25 years later (Morgan, Johnson, & Hilgard, 1974; Piccione, Hilgard, & Zimbardo, 1989). These results compare favorably with the test-retest reliability of other personality dimensions, and are exceeded only by the full-scale stability of multitask measures of intelligence. However, even those relatively insusceptible to hypnosis show increased productivity, error, and confidence when hypnosis is used to influence memory (Carota Orne, Whitehouse, Dinges, & Orne, 1996). The amount of change, however, is usually somewhat greater for highly hypnotizable subjects than less hypnotizable subjects.

Examples of Modern Forensic Cases Leading to the Per Se Exclusion of Hypnotically Influenced Testimony

The problems related to hypnosis are not limited to the laboratory. In numerous modern cases, the problems attendant to hypnotically influenced recall have endangered the cause of justice in both the criminal and civil arenas. As a result, many state courts have excluded such testimony on a per se basis, either in its entirety or with specific exceptions. The following brief review of three early cases may illustrate the reasons underlying the per se exclusion rule.

People v. Kempinski (1980). An eyewitness identification of Michael Kempinski was made by a man present at a stabbing death. Prior to hypnosis, the witness was unable to identify either of the two assailants because he was sitting in a truck approximately 250 feet away, it was night, and the lighting was poor. During hypnosis, the hypnotist told the witness he could remember what he saw as if he were watching a videotape of the event on a mental screen. He could increase or decrease its speed, reverse, stop, or zoom in on any part of his videotape. After hypnosis, the witness indicated he recognized the assailant as a person he knew, and identified Michael Kempinski from a photograph in a book of mug shots.

Despite a lack of evidence placing Kempinski at the scene of the crime or other proof that he was one of the perpetrators, he was indicted and brought to trial. The second author of this paper was consulted on this case and suggested that an ophthalmologist determine if it was possible for the witness to make a facial identification of the assailant at night in poor light at the distance of about 270 feet. By studying the weather charts and the available light at the appropriate time of the evening, the ophthalmologist found that only relatively inefficient vision registered by the rods of the retina was possible. Located toward the periphery of the retina, the rods provide less ability than the cones to resolve visual detail and are insensitive to color; however, the rods retain some function under low light conditions. Given the poor lighting conditions, the ophthalmologist stated that it would have been impossible to resolve facial features at a distance of more than 30 feet. The witness and assailant, however, were more than eight times that far away from each other.

Hypnosis created the witness’s recollection of Kempinski long after the original event. Note that the witness was not aware he was testifying about a hypnotic creation rather than real memory. The certainty of his recall was absolute. This case illustrates why (1) hypnotically influenced testimony should not be admitted in court, especially without independent corroboration, and (2) a subject’s posthypnotic assertions about the prehypnotic origin of a memory are valueless unless accompanied by a written or videotape record made before hypnosis.

State v. Mack (1980). David Mack met a young woman, whom we will call Carol, at a bar, danced and drank with her, and took her to a local motel on his motorcycle. Later in the evening Carol found herself bleeding from her vagina. Mack called for an ambulance, told the drivers the couple had been engaged in sexual intercourse when Carol started bleeding, and expressed concern about her. In the ambulance Carol, who was described as “quite drunk,” insisted that the bleeding was not Mack’s fault. At the emergency room Carol told an intern she had been “engaged in sexual activity with fingers placed in her vagina.” A second intern told Carol the injury could neither have occurred during intercourse nor been caused by a human fingernail. She understood the second intern to say her vagina must have been cut with a knife. Carol reported her experience to the police 2 days later, telling them she could only remember waking in a pool of blood on the bed in the motel.

About 6 weeks after the alleged assault, the police made an appointment for Carol with a self-taught, lay hypnotist. During hypnosis Carol remembered being forced to remove her clothes and lie on the bed, after which she recalled Mack repeatedly sticking a knife into her vagina as she screamed. However, the physical examination in the emergency room 6 weeks earlier revealed only a single, internal cut. If the events occurred as they were remembered during hypnosis, multiple external and internal lesions would have resulted. Other details of her posthypnotic description memory were also factually incorrect. Based on these facts, the Minnesota Supreme Court denied admission of Carol’s testimony and ruled that a per se exclusion of hypnotically influenced testimony was required.

People v. Shirley (1982). Catherine was drinking in a bar near the Camp Pendleton Marine base. Donald Shirley, a Marine who lived in a building near Catherine’s apartment, was also drinking in the same bar. A Marine sergeant with whom Catherine once cohabited drove her home, but she passed out immediately and the sergeant left. Catherine claimed her next memory was of waking to find Shirley standing naked near her holding a butcher knife or a screwdriver. Catherine claimed Shirley then took her into the bedroom, bound and gagged her, and had nonconsensual sexual intercourse with her. After about 30 minutes, Shirley untied her, removed the gag, and took her back into the living room where he turned on the lights. With both still naked, she sat in his lap on the couch and they chatted for about 30 minutes. Shirley then asked her if she liked beer; she said she did. He put on his clothes and left her apartment building to get the beer. Catherine made no effort to call for help or leave her apartment while Shirley was gone. When Shirley returned, he again removed his clothes. Catherine reported she got back on his lap, and they resumed their conversation.

A short time later, one of Catherine’s girlfriends called to say she was coming to visit. Catherine told this to Shirley and asked him to return at another time when she would cook dinner. According to Catherine, Shirley put on his clothes again, wrapped the weapon in a T-shirt, concealed it in the front of his pants, and, after being introduced to Catherine’s girlfriend, left the apartment. Catherine and her girlfriend discussed what had happened. After her girlfriend left, Catherine called the police and reported that she had been raped.

Catherine’s story changed repeatedly during subsequent retelling. One of the changing elements was her description of Shirley’s weapon. More than 3 months after the events in question, Catherine was hypnotized by a deputy district attorney. At that point, her story changed one more time. She did not waver from her final version, which she told in court with considerable certainty.

Shirley claimed Catherine invited him to her apartment and engaged in consensual intercourse with him. He said he did not tie her up and did not carry a knife or other sharp instrument. No weapon of any description was ever found. A number of Marine officers testified in his behalf, and unanimously expressed their high personal regard for the defendant’s “truthfulness and honesty.” His first sergeant testified that he knew of no altercations involving the defendant and that Shirley had no history of aggressive or violent behavior. Shirley was convicted of rape at trial.

On appeal, the California Supreme Court stated that Catherine’s hypnosis created an “artificial but impenetrable aura of certainty” around her entire testimony and that, given her constantly changing prehypnotic story, her unwarranted certainty was prejudicial. Referring to Diamond’s (1980) warnings, that years later were also noted by the Borawick court, the California Supreme Court excluded hypnotically influenced testimony per se, concluding that “the game isn’t worth the candle.” Subsequently, the State Legislature changed the law to allow the admission of hypnotically influenced testimony when the Hurd safeguards were observed.[5]

Summary. These three cases illustrate some of the problems that the research on hypnosis and memory suggests will occur. Hypnosis can serve as a catalyst not only to revise earlier memory reports, but also to create memories de novo in which the individual is confident. People become certain of one version of their story, where previously their testimony was either nonexistent or quite variable. The source of a memory is often attributed to viewing the original event, even when a record shows it was not the case, and so on. In criminal cases, hypnosis has occasioned little new useful material but a great deal of highly suspect testimony. With the exceptions of a defendant’s right to testify in his own defense (Rock v. Arkansas, 1987) and a plaintiff’s right to testify about abuse that allegedly occurred during hypnosis (McConkey & Sheehan, 1995), the per se exclusion seems warranted.

An Illustration of One Problem with Hypnotically Influenced

Testimony from Borawick v. Shay

Are the problems with hypnotically influenced recall pertinent to the Borawick case? Interestingly, the court’s decision in Borawick v. Shay (1995) has implications for most of the important areas of debate in forensic hypnosis. Let us begin with the Borawick court’s quotation from Harker v. Maryland (1986): “In the worst case, someone who has under-gone hypnosis might inaccurately reconstruct the memory...and...then become convinced of the absolute accuracy of the [re]construction through memory hardening.”

A person unfamiliar with the results of hypnotic age-regression procedures may have difficulty believing the frequency with which this “worst case” occurs. A good example may be seen in the following accusations Ms. Borawick made about her aunt’s behavior:

 

And I believe this was in 1961 in the summer and that we had been brought up to the attic to play dress-up. And that we were in the attic and there were several boxes of clothes in cardboard boxes that were old clothes that belonged to my cousins and that there were other boxes up there. The walls I remember were not finished and there was some exposed house insulation that was a pinkish salmon color. There was a very, very large house fan built into the wall of the attic and there were two wooden chairs.

Many of us spent time in such an attic room when we were children. If not, movies and television shows make the scene easy to visualize. Ms. Borawick continues:

And th[en] she had my little sister and I take off our pants and our underpants and th[en] she tied--she put the chairs facing each other and she had my sister and I sit in the chairs and we were going to play some other game. And she tied us to the chairs with what looked like pieces of cloth or like small scarves that were I think like a pink color and some were white. And th[en] at some point in time she untied me and had me lie prone on the attic floor in the center of the attic. And then she inserted--tried to push this broomstick into me. And I remember that in the course of this she held up, I think, a stuffed animal, I think it was like a stuffed rabbit, told me that if I ever told anybody what happened, and I think she squeezed the neck of the rabbit and said that’s what was going to happen to me and that this was just our little secret. And that was the conclusion. That’s all I’ve remembered of that episode in the attic with the chairs and the broomstick. (Plaintiff’s deposition transcript from July 29, 1992, labeled as Exhibit D [a part of the record not under seal] and included as part of the Plaintiff’s Submission Re: Ruling on Defendant’s Motion in Limine submitted to the U.S. District Court, District of Connecticut)

Given the richness of detail, certainty of memory, Matisse-like coloration, and normative biases against the public disclosure of such information, a jury member might be hard-pressed to disbelieve Ms. Borawick’s account. It is only when the above passage is placed in the context of devil-worshiping rituals conducted by Masons in black robes that the nature of Ms. Borawick’s deposition emerges as seeming fantasy, not historically accurate memory. It is sobering to imagine what would have happened in this case without the satanic rituals, especially when one recognizes that not all apparent fantasies include such bizarre elements.

Hypnosis and the Creation of Unreliable Memories

Why does hypnosis produce such unreliable memories, even in subjects not particularly responsive to the procedure (Carota Orne et al., 1996)? Several reasons have been suggested, including (1) a lowering of critical judgment and reality orientation combined with heightened suggestibility, and an attendant lowered criterion for calling a guess or image a memory (Orne, Soskis, Dinges, & Carota Orne, 1984; Whitehouse, Dinges, Carota Orne, & Orne, 1988); (2) increased vividness of recall and a resultant false sense of familiarity (Dywan, 1995); (3) the belief of many hypnotists and subjects that hypnosis allows one to transcend one’s ordinary ability to remember (O’Connell et al., 1970; Reiser, 1980); and (4) increased openness to fantasy and primary process thinking (Fromm, 1978B79). With the possible exception of vividness of recall and increased openness to fantasy, these factors are not strongly related to response to hypnotizability. Therefore, relatively unhypnotizable subjects continue to display major cognitive distortions in recall after hypnosis (Carota Orne et al., 1996). We shall examine these factors, starting with the lowering of critical judgment, the factor that may underlie the others.

The lowering of critical judgment is central to hypnosis. Even the simplest and easiest hypnotic suggestions require the subject to accept the logically absurd as possible. Hypnotic induction usually involves the suggestion that some part of the body, often the eyelids, will move without conscious volition and close “by themselves.” After completing the formal induction, the subject is usually asked to make some gross motor movement, that, once again, will occur “by itself.” For example, it may be suggested that one’s arms and hands, held out at shoulder height, will feel a force pulling them together and “they will move together.”

Obviously, the only way for the subject’s arms to make a major movement without the nonexistent external force is for the subject to move them. Even attempting to comply with this suggestion necessitates testing whether one’s arms will move without volition, thus putting one’s critical judgment on temporary hold so as to ignore the logical absurdity of the suggestion. A large majority of cooperative subjects will accept the absurdity, respond to such suggestions, and feel the force and their hands moving without experiencing volition. More difficult hypnotic suggestions require acceptance of even more logically absurd instructions, again requiring lowered critical judgment.

The second factor noted above is the false sense of familiarity with the remembered material provided by increased vividness of recall (Dywan, 1995). Vivid memories tend to convince everyone of historical accuracy, especially the person remembering them. This is one reason why flashbacks are frequently viewed as veridical representations of past events, when, in fact, often they are not (Frankel, 1994). If a subject experiences a vivid revivification of the past during age regression or confabulates details after direct suggestions for hypermnesia, he or she is not unlike someone who is able to view his or her own very personal videotape. Previous memory of the event will be contaminated or usurped by this experience. Of course, the vivid mental videotape contains all the problems of memory creation and distortion noted above. However, it is understandable that the subject accepts the hypnotically influenced vivid images as playbacks of events as they actually occurred earlier, especially if the social environment supports this view.

The belief that hypnosis allows the subject to transcend the ability to remember is endemic to our cultural view of hypnosis. There is no reason to induce hypnosis and give hyperamnesia suggestions unless the hypnotist expects hypnosis to allow greater access to memory. Even if the subject is not explicitly told that hypnosis will increase recall, the message is inherent in the use of the procedure.

Finally, agreeing to be hypnotized is accepting an invitation to engage in fantasy. To the degree a “neutral” form of hypnosis can be induced, it involves greater openness to fantasy and primary process (idiosyncratic) thinking (Fromm, 1978B79; Fromm & Kahn, 1990). Such thinking is less reality oriented and subject to social constraint than ordinary, secondary process thought.

Each factor contributes to the unreliability of hypnotically influenced testimony. Their cumulative effect makes it clear why hypnotically influenced recall is less reliable, but often presented more credibly than ordinary recall.

Civil Suits and Hypnosis

Until recently, landmark cases involving forensic hypnosis have been criminal prosecutions. If one grants that hypnosis has largely proved detrimental to the cause of justice when influencing testimony in criminal cases, what will be its effects in civil litigation? As Scheflin and Shapiro (1989) predicted, the civil arena is becoming the setting for more litigation involving hypnotically influenced testimony. The present authors have encountered two types of civil cases: (1) those involving the attribution of blame and liability in automobile accidents, and (2) those involving recovered memories of incestuous child abuse (ICA). Given the issues raised by Borawick v. Shay, most of the rest of this article will discuss ICA. To highlight some general problems with hypnotically influenced recall in civil litigation, however, we will begin with litigation involving hypnosis and automobile accidents.

In the typical automobile accident involving hypnosis, an accident occurs and a victim is either amnesic for critical events or has recalled and reported events that do not support his lawsuit. Hypnosis is employed to “refresh” recall of the events. The hypnotist, who sometimes observes the Hurd safeguards and sometimes does not, induces hypnosis, and the subject remembers the disputed facts. In all the cases with which we are familiar, the hypnotically influenced memory strongly favored the subject’s position in the lawsuit. In these cases, the difficulty of detecting simulation, the ability to lie during hypnosis, and secondary gain attendant to a particular story contribute to the unreliability and self-serving nature of posthypnotic testimony. Even if the subject is entirely honest, after hypnosis he is likely to remember only what he wants to remember and will later testify to those memories with great conviction. The key is that hypnosis justifies or at least legitimizes a change in memory. Whether the subject is amnesic for critical details (Karlin, in press) or has previously asserted an alternative, less self-serving story (e.g., Sprynczynatyk v. General Motors, 1985), the old version of events is replaced with the new.

For example, in the two cases reported by Karlin (in press), both victims suffered anterograde and retrograde amnesia for their automobile accident. In the first case, a woman driving a three-wheel “all-terrain” vehicle lost control and went off the road. Because the woman suffered moderate to severe brain damage, remained in a coma for days, and lost a good deal of procedural and semantic memory along with autobiographical information, it was clear that she did not permanently store any memories of the accident. Several years later, a psychologist hypnotized and age regressed her. Not surprisingly, the woman remembered her vehicle as uncontrollable through no fault of her own. The accident was the fault of the vehicle, not the fault of her driving. As state law required the psychologist to adhere to the Hurd safeguards, which he did not, her testimony was excluded and summary judgment was granted to the defendant.

In the second case, an internationally reputed authority on forensic hypnosis was consulted and the Hurd safeguards were employed in their entirety. Before hypnosis Mr. A. knew that it would be to his financial advantage to remember that Mr. B.’s car had entered an intersection on a green light and stalled. In fact, Mr. A., who was a passenger in the back seat of Mr. B.’s car, would not have been able to see the green light if he were sitting up. During hypnosis, Mr. A., who had been amnesic for the entire accident, recalled bending forward to give something to Mr. B. and seeing the green light just as the car was about to enter the intersection. Within days after the judge ruled that Mr. A.’s testimony would be admissible at trial, the case was settled and Mr. A. received a six-figure sum.

In a final example, Sprynczynatyk v. General Motors (1985), Rodney Sprynczynatyk, a 14-year-old boy with a learner’s permit, was driving his mother’s car home when the car ran off the road into a ditch. The mother, who was a passenger, became quadriplegic. At two depositions taken by the insurance company, the boy stated that he did not try to apply the brakes. The Sprynczynatyk family subsequently sued General Motors, claiming Rodney did try to apply the brakes, which locked, and the car spun and went off the road. Therefore, the brakes, not the boy, were to blame.

Before trial, Rodney was hypnotized by a psychologist, who videotaped the session. While hypnotized, Rodney relived the accident and remembered that he applied the brakes, but they had locked. The car then went out of control and spun off the road. The jurors saw the videotaped hypnotic revivification of Rodney’s experience and awarded the Sprynczynatyks more than five million dollars. The case was overturned on appeal to the U.S. Circuit Court for the Eighth District, which mandated evidentiary hearings at the District Court level on the admissibility of hypnotically influenced testimony.

In each case, a self-serving memory emerged during hypnosis. The results varied, at least in part, because of adherence, or lack of it, to the Hurd safeguards. The Hurd safeguards are directed toward establishing a record of the extent of suggestion present in the hypnotist’s technique and the specific hypnotic context. Even if such safeguards are followed, they cannot protect against self-suggestion when the hypnotized subject knows precisely what he wants to remember in hypnosis. Forensic hypnotists are being used when they agree to use hypnosis to refresh recollection and thereby promote wishes into highly remunerative memories. In more general terms, the auto accident cases show that suspicions and feelings may be turned into memories and the change legitimized by the hypnotic procedure. This bears directly on the use of hypnosis in incestuous child abuse cases.

Incestuous Child Abuse

Compared to the relatively straightforward situation in automobile accidents, suits about recovered memories of incestuous child abuse (ICA) are loaded with complex and subtle issues. Many states altered their statutes, so that victims of alleged sexual abuse can sue long after time has lapsed for ordinary torts. These statutes were usually passed without any attempt to determine the prevalence of mistaken memories of abuse, many of which may have been caused inadvertently by well-meaning therapists.

Psychotherapy, ICA, and False Memories

The major increase in reported ICA in recent years is especially problematic for psychotherapists; as a profession, we have played a critical role in the increased reports of ICA. For some therapists, this role is a source of pride, but for the authors, it is a grave concern. It is important here to remember that, with rare exceptions, psychotherapy has been a beneficent force during the past 100 years. Meta-analytic studies of the outcome of psychotherapy have shown that the average psychotherapy patient shows more improvement across a variety of measures of well-being than approximately 80% of untreated controls (Smith, Glass, & Miller, 1980).

Newer treatments ordinarily produce even better results. For example, meta-analytic research has shown that psychotherapy patients show an improvement of about .85 standard deviations as compared to controls. In the first 3 or 4 years a new treatment is available, the effect size rises to approximately 1.1 to 1.2 standard deviations. Thus, the average patient in a new form of therapy does better than almost 90% of untreated controls. In comparison, a 9-month reading program causes a change of about 0.61 standard deviations in children’s reading skills (Lindsay & Read, 1994). Ranging from .85 to 1.2 standard deviations, the effects of psychotherapy are far from trivial.

Rare exceptions to this rule of generally beneficent effects for “talk therapy” have occurred when psychotherapy focused blame on specific types of individuals outside the therapeutic alliance. The profession’s castigation of so-called “schizophrenogenic” mothers and of the intellectual and rigid parents of autistic children for their children’s largely biochemically-based, devastating disorders has produced untold misery. As a profession, we were wrong in those cases and blamed the innocent; we must be aware of and avoid repeating such harmful errors.

Whenever psychotherapists occasion a patient’s recovery of a forgotten memory of ICA, a perpetrator takes the blame for the patient’s misery. The patient and the people who believe her may punish the remembered perpetrators without remorse. If the recovered memories of ICA were correct, it would be difficult to fault this position. But all too often, the “recovered memories” are destructive fantasies, shaped and elicited by a therapist who believes that ICA is at the root of the disorder and memories of it await uncovering by hypnosis. Exploring this hypothesis often devastates the accused, the accuser, and other family members (cf. McElroy & Keck, 1995). This harm is occasioned by the transfer of patient recollections of abuse from the therapeutic context to interactions with persons meaningfully involved with the patient outside therapy. Given the fictive nature of the narrative developed in psychotherapy (Spence, 1982), this is simplistic, naïve, and unfortunate.

Psychotherapy is an influence process. Whether we talk of that influence process in terms of transference or the social psychology of persuasion and attitude change, it remains an intense dialogue in which a doctor seeks to influence the patient, and frequently succeeds. In what Perls (1965) called the “safe emergency” of the therapeutic encounter, the patient often seeks to please the doctor. An obvious way to please doctors is to adopt their view of one’s problems. The pressure on patients to do so is ordinarily far more long-lasting and often more intense than that found in investigative contexts. After all, the patient and therapist will be back together next week and the patient has to confront the doctor then as well as now. So demand characteristics and expectancy effects play major parts in determining what information the patient will provide (Orne, 1970). It is an old therapy adage that Freudian patients dream Freudian dreams, Jungian patients dream Jungian dreams, and behavior therapy patients don’t dream. Similarly, patients of recovered memory therapists dream about and/or remember ICA.

Satanic Ritual Abuse and Early Incestuous Child Abuse:

Iatrogenic Fantasies?

Recently, Harvey and Herman (1994) distinguished three prototypical groups of patients. Patients in the first group report “largely intact and continuous remembrance of their abuse experiences.... and a lifting, not of amnesia, but of the veil of denial and minimization that enabled them to preserve secrecy and illusion.” The second type of patient has spotty memories of abuse. The onset of abuse, its escalation, and the entire period of early childhood are likely targets of amnesia. Finally, the third type of patient begins therapy with no memories of abuse. When memory is “recovered,” such patients report “severe and repeated sexual and physical abuse, beginning in early childhood and continuing into early adolescence.... Most reported witnessing family violence as well and many reported abuse by more than one perpetrator” (Harvey & Herman, 1994, pp. 302B303).

While this nosology remains unproven and is certainly incomplete (cf. Pezdek, 1994), problems with the interpretation of data from each group can be identified if the nosology is momentarily accepted as a heuristic device. For example, the reinterpretation required by the first group raises the question of how such interpretation shall be accomplished and by whom. Similarly, when the second group tries to fill in critical gaps in memory, the possibility that hypnosis and similar techniques will produce confabulation is high and the situation becomes rife with the possibility of iatrogenic memory creation based on suggestion, demand, and expectancy effects. That is, in both cases the credible extension of memories into detailed events is likely to result in pseudoconfirmation of ambiguous thoughts and ambivalent feelings as memories of ICA.

Joan Borawick belongs in the third group, apparently reporting both a history of total amnesia and bizarre memories of satanic ritual abuse (SRA), multiple perpetrators, and early incestuous abuse. Recent, clear memories may constrain fantasies to some degree, but as an event becomes more remote and memory more vague and/or spotty, there is more room for confabulation. Lack of any memory for an event provides a blank screen on which one can project anything (Loftus & Ketcham, 1994). Thus, if the amnesia is more pervasive, more questions are raised by those concerned with false memories (cf. Dawes, 1992; Frankel, 1993; Loftus, 1993; Tavris, 1993). This is not to say that patients reporting more spotty amnesia are not confabulating and fantasizing. Many certainly are. But when hypnosis has been used to elicit memories for which the patient was originally totally amnesic, even greater concern arises about iatrogenic factors. Borderline personality, multiple personality disorder (MPD), multiple perpetrators, SRA, and memories of very early abuse by incestuous fathers are most common among this totally amnesic group. The most troubling aspects are MPD and early incestuous abuse. We will discuss MPD later. For now let us turn to the question of the incestuous abuse of young children.

While SRA would seem to be obvious fantasy, the early incestuous abuse reported as common in the totally amnesic patients and seen as likely to be concealed by the spotty amnesia of the second group (Harvey & Herman, 1994) raises questions. The literature suggests that father-daughter incest is most likely to take place after a child begins to show secondary sexual characteristics, that is, age 9 or 10 at the earliest (Gebhard, Gagnon, Pomeroy, & Christenson, 1965). Pedophilia, on the other hand, may involve children as young as 2 or 3, but the data suggest that parents seldom engage in sexual relations with their own children at an early age. Pedophilia tends to be perpetrated by adults who are familiar to the child, but not by the young child’s parents (Davison & Neale, 1974, 1994).

Recent research supports this view. For example, Marshall, Barabee, and Christophe (1986) used a penile plethysmograph to measure erectile responses among nonfamilial molesters and incestuous males exposed to photographs of both nude children and adult heterosexual behavior. The incestuous molesters were aroused by the adult heterosexual stimuli, while the nonfamilial molesters were more aroused by the photographs of nude children.

A second rationale employed to make early ICA by parents believable, the popular notion that those persons who have been sexually abused as children become pedophiles in their turn, has little support from relevant research (Freund, Watson, & Dickey, 1990; Hindman, 1988). So the notion that abused parents will in turn abuse their children seems inconsistent with the literature. The sexual abuse of children has negative consequences for many victims, but not a one-to-one simplistic relationship with pedophilia. Taken together, if early sexual abuse does not tend to involve parents, and abused parents are not likely to be exceptions to this rule, the evidence would suggest that early father-daughter incest is extremely rare and such memories are likely to be an iatrogenic fantasy.

Diagnosing Relatively Rare Conditions with Fuzzy Boundaries:

The Problem of False Positives

As noted above, even Herman and her colleagues now view total amnesia as the least frequent type of response to childhood abuse. This view is consistent with the work of Femina, Yeager, and  Lewis (1990), who found little evidence for total amnesia among abuse survivors. Additionally, Williams (1994) interviewed 129 women 17 years after an episode in which they had been reported to be victims of child sexual abuse. In a 3-hour interview, 49 of the 129 victims (39%) did not report the abuse, and 15 victims (12%) denied ever having been sexually  abused during childhood. While there are a number of ways to interpret these data (e.g., second interviews are frequently able to elicit reports of abuse consciously withheld at an initial interview), the fact that only 12% of these women denied any sexual abuse at a first interview suggests that total amnesia for ICA is not common, although specific instances may be forgotten.

As Lindsay and Read (1994) note, much of what is identified as psychogenic amnesia is ordinary infantile and childhood amnesia, the loss of detail for a single event when similar instances recur, and simple forgetting. All of these instances are normal, not pathognomic. In the present authors’ experience, the remainder of what at first appears to be psychogenic amnesia almost always involves one of three factors: (1) alcohol or other intoxicating drugs, (2) trauma to the brain based on accidental injury, and (3) a conscious choice to refuse to think about ego-dystonic or otherwise extremely unpleasant memories. In fact, the major problem with traumatic memories in general is not that they are repressed and forgotten. More often they are remembered all too well (Christianson, 1992). This is not to say that psychogenic amnesia never occurs. However, it well may be more limited and far less frequent than most ICA-related reports have suggested.

The notion that ICA is commonly hidden by total amnesia for the abuse (Gelinas, 1983) has frightening implications for those concerned with the iatrogenic creation of false memories of ICA. The problem is that literally anyone can be suspected of being an ICA victim. This enormously increases the number of patients who may be caught up in the highly suggestive exploration for hidden ICA discussed at the beginning of this article. For example, Ganaway (1995) reports a communication from Chris Sizemore, the actual patient described in Thigpen and Cleckley’s (1957) The Three Faces of Eve: “Sizemore reports being openly confronted at speaking engagements with accusations that despite her claims of having been successfully treated for multiple personality disorder, she must still be in denial about her sexual abuse (Sizemore, personal communication, 1994)” (p. 131, fn. 4).

How will the presence or absence of ICA as an etiologic factor be diagnosed among patients who may be amnesic for its presence? In the popular literature (e.g., Fredrickson, 1992), lists of allegedly telltale symptoms are long and contain common enough problems to create a “Barnum effect”--a description that fits one and all (Ofshe & Watters, 1994). Less inclusive, professional guides to the diagnosis of hidden ICA often suggest superficially plausible relationships between specific symptoms and ICA (e.g., bulimia).

However, the early research supporting this view is methodologically flawed and the relationships between ICA and various forms of adult psychopathology may reflect nonspecific effects (cf. Pope & Hudson, 1992). For example, two careful, methodologically-sophisticated studies of the relationship between bulimia and ICA failed to find any relationship between the two (Kinzl, Traweger, Guenther, & Biebl, 1994; Rorty, Yager, & Rossoto, 1994), though many clinicians mistakenly continue to see conditions such as bulimia as strong indicators of “hidden” ICA. As an example, the psychologist Ms. Borawick consulted before seeing Valerian St. Regis espoused such views (Affidavit of Anthony E. Reading, Ph.D., labeled as Exhibit F [a part of the record not under seal] and included as part of the Plaintiff’s Submission Re: Ruling on Defendant’s Motion in Limine submitted to the U.S. District Court, District of Connecticut).

Some therapists feel that experiences such as dreams or memories of Aodd feelings” can be used as a guide to the diagnosis of hidden ICA. More vivid experiences, such as flashbacks or revivification of memories during hypnosis, with or without an abreaction, are usually seen as confirmation of ICA both by the patient and therapist. However, like hypnotically influenced memories, flashbacks quite often have little or no relationship to objective, historical reality (Frankel, 1994). As is the case for most events that occur in psychotherapy, appropriate interpretation has to do with the patient’s inner world, not the external one (Spence, 1994). Similarly, many clinicians feel that poor memory for childhood, especially early childhood, is diagnostic of a history of sexual abuse. However, people can generally remember only scattered moments before age 5 or 6 and have almost no retrievable memories before age 2 or 3. If they were under 4 years old at the time, for example, most people remember very little, if anything, about the birth of a younger sibling (Usher & Neisser, 1993). Little memory of early childhood is normal, not a sign of pathology (Lindsay & Read, 1994).

Without reliable pathognomic signs, the identification of patients who endured, but do not remember, childhood sexual abuse involves a complex series of decisions. It is too easy to make mistakes. ICA is a hidden etiologic problem which can only be inferred, not observed. From the “Research Diagnostic Criteria” that preceded DSM-III (Spitzer, Endicott, & Robins, 1977) through the ongoing process of revising DSM-IV (American Psychiatric Association, 1994), attempts to create reliable diagnostic categories have eschewed such supposed etiologic factors in favor of overt, verifiable symptoms because experts will routinely disagree about hidden causes.

A Statistical Approach to the Incidence and Prevalence

of False Positives

Lindsay and Read (1994) used Bayesian statistical methods to predict the rate of false positives and false negatives in the diagnosis of ICA. If a patient is suspected of a hidden presentation of ICA (Gelinas, 1983), false positives occur when a history of ICA is diagnosed, but, in fact, ICA never occurred. Deliberately using unrealistic assumptions intended to minimize the prediction of false positives, Lindsay and Read (1994) estimated that a minimum of 30% of the patients diagnosed as having repressed memories of ICA would be false positives.

Extending the unrealistic assumptions of Lindsay and Read (1994) still further, Pezdek (1994) was able to reduce the predicted false positive rate to 18%. This figure does not assume incompetent diagnosticians--quite the contrary. Both the Lindsay and Read (1994) prediction and the predictions made in the two tables below assume the ability to diagnose the hidden presence of an etiologic factor (ICA) with as much accuracy as experts can diagnose many overt conditions.

While the Lindsay and Read (1994) predictions provide a good starting place, their assumptions were deliberately unrealistic, perhaps in part to avoid the appearance of making overly pessimistic predictions about the proportion of false positives. In order to establish a range for the incidence of incorrect diagnoses of hidden ICA, we will use two sets of somewhat more realistic assumptions. One set of assumptions will be more realistic than that of Lindsay and Read, but still strongly minimize false positives. The second set of assumptions will be more middle of the road. Comparing these predictions may provide a conservative range for the proportion of incorrect diagnoses of hidden ICA.

The authors’ first set of assumptions--and computation of resulting false positive rate--follows. Presuming that interested clinicians will be very careful not to miss a case of repressed ICA memories, we assign a sensitivity of .95 to the diagnostic process: 1 patient in 20 with a hidden presentation of ICA will be overlooked. Given the human tendency to interpret data in light of our ideas (i.e., confirmation bias), let us assume a specificity of .85, which is as good as or better than that for overt DSM-IV diagnoses. A specificity of .85 means that 85% of patients wrongly suspected of ICA will be correctly identified as unabused. Assuming a specificity of .85 is unrealistically optimistic, but it provides a lower limit on the proportion of false positives.

In this first computation, we will use a 33% prevalence estimate for ICA, similar to that suggested by Bass and Davis (1988). However, we will make it more realistic by using the 33% figure as an estimate of prevalence in the population of women seeking psychotherapy, and not the population as a whole. Given a sample of 1,000 women seeking therapy, 330 would have suffered from ICA and 670 would not. Again, we use this figure not because we think it correct, but because it establishes a lower limit on the proportion of false positives.

The best study of the incidence of amnesia for ICA to date was done by Williams (1994), who found that 12% of the abused women were entirely amnesic for ICA. If we assume 12% of the 330 women are amnesic for the ICA they really experienced, 40 women (.12 x 330) would have been abused and become totally amnesic for it, and there would be 290 women who were abused and remembered the abuse. These last 290 women raise no diagnostic questions in the context of finding patients entirely amnesic for ICA and will be excluded from further analysis. Given .95 sensitivity and .85 specificity, the following table results:

Table 1. True State

Diagnosis

Experienced ICA and is amnesic

Did not experience ICA

Repressed memory of ICA

        38

        100

No repressed memory of ICA

         2

        570

As you can see from the table, all but two of the women who experienced ICA and are amnesic for it will be identified. However, 100 patients (.15 x 670) will be incorrectly identified as suffering from ICA even though they were not abused as children. Thus, given these assumptions, 100 of 138 patients (73%) diagnosed as having repressed memories of ICA will be false positives. To put it another way, using these assumptions, of 40 patients diagnosed as hidden presentations of ICA, 29 will be false positives.

To create a range for the proportion of false positives, we will do a second analysis using more moderate assumptions about diagnostic specificity and prevalence rates. Studies of childhood sexual abuse indicate that a significant minority of children show few or no ill effects 18 months after the abuse (see Levitt & Pinnell, 1995, for a recent review). We will assume that 20% of women coming for therapy have experienced ICA serious enough to create long-term disturbances. Again assuming that 12% are amnesic for the experience (Williams, 1994), this would result in a prevalence of 24 abused amnesic women per thousand. We will continue to use a sensitivity estimate of .95, but decrease our specificity estimate to .80, which is still good for any psychological or psychiatric diagnosis, never mind a hidden, etiologic factor.

Table 2. True State

Diagnosis

Experienced ICA and is amnesic

Did not experience ICA

Repressed memory of ICA

        23

        160

No repressed memory of ICA

          1

        640

This time only one patient suffering ICA was missed. But Table 2 yields 160 false positives of 183 patients diagnosed as having a hidden presentation of ICA, a rate of 87.4%, or 35 false positives out of 40 typical patients who might have experienced ICA. Thus, of 40 patients diagnosed as having repressed memories of ICA, our two estimates suggest that between 29 and 35 of the 40 patients will be false positives. Using different assumptions, a recent analysis by Kihlstrom (in press) resulted in an estimate of the proportion of false positives in the same range.

To repeat, in the case of the hidden presentation of ICA, we seek an etiologic factor above and beyond that which is overt. This makes the diagnostic task far more difficult, but we have assumed this hidden aspect of women’s experience can be diagnosed with accuracy similar to that for overt presentations. Even so, the results indicate a very high rate of false positives. As when using any unreliable and questionably valid assessment protocol, the problem lies in the practitioner’s belief in and use of the procedure.

Further, the major problem is not even the proportion of false positives; it is with their implications. If a therapist errs and initially identifies dysthymic disorder as generalized anxiety disorder or thinks someone is suffering from an obsessive/compulsive disorder when they are not, time may be wasted and unnecessary suffering allowed. This is unfortunate, but rarely tragic as long as therapists correctly identify and respond to life-threatening situations. The process of psychotherapy is, as noted above, generally beneficent.

Further, when diagnosis is based on DSM-IV criteria, overt symptoms should be continually assessed and, despite confirmation bias, self- correction is possible. However, when a patient is misdiagnosed as a hidden ICA victim, the disastrous sequence discussed at the beginning of this paper may unfold. At the least, basic familial relationships will be brought into question and may often be severely disrupted (Esman, 1994; McElroy & Keck, 1995).

Multiple Personality Disorder (MPD):

Childhood Defense or Adult Role?

For those studying ICA and related phenomena, SRA cases such as that of Joan Borawick are interesting because they seemingly contain high levels of fantasy. There is no evidence for the existence of a multigenerational satanic cult that performs ritual murders and abortions while it programs young women with multiple personalities. Despite enormous effort by law enforcement officials to track down such a cult, no trace has ever been found. The witches’ sabbaths regularly described by alleged victims are similar to those that were described in the Middle Ages. Conversely, careful historians and anthropologists have established that such orgiastic festivals of evil didn’t happen in the Middle Ages either (Mulhern, 1994). They were the product of vivid imagination then as well as now. As Lanning, the agent in charge of the FBI’s investigation of this putative cult, wrote “this is not a law enforcement problem” (Lanning, 1991).

One of the intriguing aspects of fantasies of satanic ritual abuse is that, almost universally, those expressing this fantasy are diagnosed as having multiple personality disorder (MPD). Patients who recall SRA constitute a significant minority of those currently diagnosed as multiple personalities (Braun, 1992; Hammond, 1992; Ofshe & Singer, 1994). In the view held by mental health professionals who routinely diagnose MPD, the disorder results when a child is overwhelmed by the horror of a traumatic situation, escapes by dissociating, but leaves a part of herself to deal with the horror. This part then becomes autonomous, an alter, and the original self becomes amnesic for the traumatic events. The alter reemerges in later instances where the child has to cope with similar traumas. If new traumas occur with which neither the original self nor its alter can cope, another alter will be “born” (Kluft, 1991, Putnam, 1989).

Like hypnosis, MPD has a checkered history with periods of strong interest and excessive claims followed by barren periods in which the phenomenon is ignored. Multiple personality disorder also resembles hypnosis in that it seems to take on the characteristics expected by the patient and therapist. Prior to 1970, an MPD diagnosis did not necessarily imply a severe and disabling condition. If one examines classic cases, such as Morton Prince’s case of Miss Beauchamp, multiple personalities included only two or three alters who were not seriously harmful. For example, Miss Beauchamp’s Devil alter, Sally, is described as a mischievous imp, not an immoral devil. Prince also notes, AFor although the characters of the personalities widely differ, the variations are along the lines of mood, temperament, and tastes. Each personality is incapable of doing evil to others” (Prince, 1908, 1957, as cited in Orne & Bates, 1992). Prince’s other cases were similar with all the alters being relatively beneficent, although one might be morose and the other flamboyant.

With one exception, the cases cited by Ellenberger (1970) resembled those of Prince. In the late 1930s and early 1940s, Milton Erickson reported two cases with beneficent alters whose help and strengths he engaged to aid in the patient’s recovery (Richeport, 1994). In none of these cases was there any implication that the development of multiple personality disorder routinely involved incestuous child abuse, nor did anyone find the extremely hostile self-mutilating, suicidal, and downright nasty alters of today’s dissociative identity disorder patients.

The milder version of MPD was still seen as recently as the 1950s. The Three Faces of Eve (Thigpen & Cleckley, 1957) portrayed a patient whose disorder was traceable to her parents’ well-meaning demand that she kiss her dead grandmother goodbye, hardly a case of incestuous abuse. Similarly, Eve’s alter, Eve Black, was flamboyant and sexually provocative, but overall was no more evil than Miss Beauchamp’s alter, Sally. It was not until Sybil (Schrieber, 1973), the story of Cornelia Wilbur’s patient, was published that we began to see the multilayered, numerous alters that are common today. For the first time we also had a media-disseminated view of MPD that included a truly dangerous and destructive alter whose “birth” was occasioned by incestuous and sadistic anal and vaginal rape. Unfortunately, since the book’s publication and the subsequent television presentation, Sybil seems to have become the prototype for MPD  (Ganaway, 1995).

At present, multiple personality disorder is a severe and malignant syndrome. Orne and Bates (1992) note that since Bliss (1984) reported that 21% of MPD patients had self-mutilating alters, the proportion of such patients has been increasing. Coons, Bowman, and Milstein re-ported a 34% rate in 1988, while Coons and Milstein (1990) reported that 48% of the patients in their sample had self-mutilating alters. It has also become increasingly rare to find patients with just two or three personalities. More than 10 alters has become modal, and more than 100 have been discovered in several patients.

The changing and malleable nature of this disorder suggests that we are seeing underlying pathology expressed in a manner shaped by the expectations and demand characteristics of the clinical setting. The geographic distribution of this disorder, which is observed largely among North American women, also suggests that this latest form of possession (Spanos, Burgess, & Burgess, 1994) is not inherent in the patient, but is shaped by cultural expectations and the availability of a role model. Finally, the infrequency of childhood cases of MPD (Kluft, 1984b) suggests that the disorder is an adult expression of psychopathology, not a defense employed by overwhelmed children.

Multiple personality disorder has been conceptualized as a lesion in memory (Orne & Bates, 1992; Orne & Dinges, 1989). Patients cannot or will not remember and “own” ego-dystonic behavior. They suggest appropriate therapy involves gentle exploration in order to allow patients to accept and control behavior and impulses that otherwise might be dissociated. McHugh (1993, 1995) proposes a more dismissive approach in which manifestations of dissociative behavior are simply ignored and thus extinguished. Both approaches assume a major feature of appropriate therapy is the therapist’s assignment of and patient’s acceptance of responsibility for all their feelings, thoughts, and behaviors.

Orne and Bauer-Manley (1991) suggest that the normal self is a complex mixture of information, impulses, and feelings, and that the unidimensional alters of multiple personality disorder reflect the concept of a unitary self, not the reality of a multifaceted one. In another similar view, Ganaway (1995) sees multiple personality disorder as an expression of underlying dissociative pathology that is iatrogenically shaped into its malignant form by well-meaning therapists. Like Orne and Bates (1992), Ganaway sees the shaping as a product of therapist expectancy and demand. Spanos et al. (1994) take a similar position, seeing multiple personality as one of a series of role enactments, such as being possessed or remembering an abduction by space aliens, in response to the availability of the social role and an environment that provides acceptance for such behavior. Similarly, Sarbin (1995) sees multiple personality as role enactment involving believed-in imaginings and self-deception.

It is difficult to conceptualize MPD without accepting the common elements of the positions noted above. Certainly, standard models of autobiographical memory are entirely inconsistent with more simplistic models of MPD that involve a series of traumatized selves and quickly alternating fugues. As noted above, true psychogenic amnesia remains a rare condition; lengthy fugue states are still rarer. In MPD, we supposedly have quickly alternating fugue states that come and go on request, as well as a variety of different psychogenic amnesias, such that A knows what B knows but not what C knows, while D is unknown to A, B, and C, but knows all about them. It is as if we were being told of people who routinely run 3-minute miles and jump 15 vertical feet. The human organism is not built that way. Consider the mutable nature of the disorder, its geographic distribution, the difficulty of finding the syndrome among children, and the way it contradicts our understanding of memory. In light of these factors, the belief that MPD symptoms are purely the product of defensive dissociative states, rather than a social role legitimized by the media and therapists, seems naïve.

Another factor should be considered. Most MPD patients also satisfy the diagnostic criteria for borderline personality disorder. Although it is clear that some multiples are not borderlines, estimates of comorbidity have ranged from over 60% (Horevitz & Braun, 1984) to over 90% (Putnam, 1989). Clinically, patients with borderline personality disorder may be expected to enthusiastically embrace any role that is sufficiently melodramatic and provides enough attention and activity for them to avoid feeling the chronic emptiness endemic to the condition.[6]

Narrative Truth, Historical Truth, and Therapeutic Hypnosis

We have focused on the hidden presentation of ICA (Gelinas, 1983) because it demonstrates the dangers present when therapeutic hypnosis is considered a source of veridical information (and because it was Ms. Borawick’s claim). Information obtained in psychotherapy is often true in a symbolic sense, not a literal one. The person who is age regressed to his or her 4-year-old birthday party may vividly reexperience a conversation with Aunt Jane. The conversation may have occurred at another birthday party, with another relative, or not at all. In psychotherapy, it does not matter. The content and nature of the interaction are the critical factors because they may provide insight into how the patient thinks and feels. However, they do not tell us what happened historically or legally on the patient’s fourth birthday.[7]

In recent years, scholars of psychotherapy have increasingly described historical reconstruction during psychotherapy in terms of the creation of a fictive narrative (Spence, 1982, 1994). This view gave rise to hermeneutic interpretation of autobiographical information obtained in psychotherapy. The narrative is treated as you would treat a literary text in which you wish to discover meaning (cf. Woolfolk, Sass, & Messer, 1988). The notion that any procedure used in psychotherapy will routinely elicit reliable history is contradicted by the work of both early pioneers and modern investigators. Adding hypnosis to psychotherapy inevitably has the same effects that occur when hypnosis is used to influence memory retrieval in any other context. Hypnosis increases productivity, certainty, and believability without a corresponding increment in historically correct information.

There are rare instances in which hypnosis may stimulate the return of historically accurate memory that has been blocked for emotional reasons (cf. Raginsky, 1969). Given what we know about memory for stressful events, true psychogenic amnesia can be expected to be very rare. In more than 20 years of practice and research, the first author has encountered one case that seems to involve true psychogenic amnesia. In more than 30 years of practice and research, the second author has encountered two; clearly, other cases exist (cf. Raginsky, 1969). However, the possibility of created memory is so high that the rare cases should not be allowed to justify the admission of highly unreliable testimony produced by the combination of hypnosis and psychotherapy. Hypnosis is an excellent tool for obtaining useful clinical data, but we have known for more than 100 years that the data are largely historically inaccurate. They pertain to a subjective universe, not an objective, historical one.

Like correlation, hypnosis will fool. Hypnotic phenomena represent a complex interface of cognitive variables, social-psychological factors, genetic propensities, psychopathology, stable individual differences, and cultural artifacts. Understanding the role of these factors is a lifetime work for numerous behavioral scientists. However, we do know something about when not to use hypnosis. In the forensic context, it should not be used to influence the memory of anyone called upon to testify about information recalled during hypnosis (AMA, 1985, 1994).

There are exceptions to this rule. As the Supreme Court ruled in Rock v. Arkansas, the defendant in a criminal trial has the constitutional right to testify in her own behalf whether or not she has been hypnotized. Similarly, if patients believe that they were abused during hypnosis, the fact that they were hypnotized should not prevent them from testifying about the alleged abuse (cf. McConkey & Sheehan, 1995). However, these are exceptions to a general rule. Per se exclusion of testimony influenced by the use of hypnosis in psychotherapy seems the best response to this situation, with specific provision being made for the obvious exceptions just noted. Per se exclusion has costs, but they would seem lower than those attendant to any other solution.

Conclusion

Hypnotically influenced testimony constitutes an unusual threat to the fact-finding process: memory is often irreversibly altered without awareness by either subject or hypnotist that anything untoward has occurred. The resulting testimony is less reliable but more certain, vivid, and detailed than that resulting from ordinary recall. The admission of hypnotically influenced testimony has led to potential and actual miscarriages of justice in the criminal arena. In civil cases, where the burden of proof is lower, the prejudicial effects of hypnosis may be even more extreme.

So far, we know of two kinds of civil cases: those involving automobile accidents and those involving memories of child sexual abuse. In the automobile cases, memories retrieved during hypnosis have been universally self-serving. Since simulation and lying, as well as honest fantasy and confabulation, are possible, we can expect further examples of such memories to be far more prejudicial than probative. Unfortunately, given its effects on the resolution of auto accident cases, extension of hypnosis into areas such as child custody suits is both foreseeable and potentially tragic.

In cases involving recovered memories of ICA, testimony based on psychopathology and the demand characteristics of the clinical setting will be routine. Our computation of the range of false positives in the diagnosis of ICA errs, if anything, on the side of underestimating the incidence of misdiagnosis, and we have estimated that well over half the cases will be false positives.

Admitting hypnotically based recall will encourage an enormous waste of judicial resources and professional time. Also, it will inevitably result in what Laurence and Perry (1988) have called “trial by fantasy.” Excluding hypnotically influenced recall per se (with rare and easily specifiable exceptions) will have some costs. Compared to the costs attendant on other alternatives, however, these costs are minimal. While a totality-of-the-circumstances test is the only reasonable alternative to a per se exclusion, to paraphrase the Shirley court, the game is really not worth the candle.

If it is not possible to exclude hypnotic testimony per se, the totality-of- the-circumstances test ordered by the Borawick court is the next best alternative, although it is costly in judicial and psychological resources. If this latter view is adopted, we would strongly prefer that the party advocating admission bear the burden of “clear and convincing” evidence of the probative value of hypnotic testimony. Given the rarity with which hypnosis to refresh memory will be helpful and the frequency with which it will be prejudicial, this burden is reasonable.

Satanic ritual abuse and multiple personality disorder, two of the three broader issues, can be treated with relative certainty. Since there is no multigenerational, baby-killing, sex-enslaving, satanic cult, reports of SRA are inherently unbelievable and place any report of ICA at risk of being dismissed. While it is logically possible that a report of SRA may coincide with or act as a screen memory for a historically accurate report of ICA, reports of SRA generally provide easy recognition that fantasy, not history, underlies an accusation.

Given that psychogenic amnesia is rare, fugue states even rarer, and reports of MPD during childhood, when the alters are said to form, hard to obtain, we strongly suggest that MPD is almost universally if not entirely formed in adulthood in response to the availability of a legitimate, dramatic social role in which psychopathology can be expressed and responsibility for one’s actions and feelings avoided.

The most appropriate treatment seems to be to encourage patients to accept and come to terms with all their impulses, thoughts, and feelings. This is a classic task for psychotherapy, and can be accomplished without calling forth and integrating ever-growing groups of alters. Unless outcome data demonstrate that the alter-integration approach is preferable, the time and expense required and the potential harm to the patient dictate the careful therapist both question a diagnosis of MPD when a case is referred and proceed with undramatic psychotherapy, emphasizing acceptance of and responsibility for all one’s needs, thoughts, feelings, and behavior. Both the present authors have used this approach to treat such cases successfully.

In understanding SRA and MPD, another issue must be considered: the role of patients with borderline personality disorder. Such patients may well be eager to enact the roles of incest survivor, victim of cult abuse, and the alters of a multiple personality. They are all dramatic, attention-getting symptoms that allow the patient to avoid responsibility for destructive and antisocial impulses and to experience relief from chronic feelings of emptiness. Thus, the causal direction ordinarily may be the reverse of that usually suggested: borderline personality disorder may lead to reports of ICA, rather than childhood sexual abuse causing borderline personality disorder.

Finally, the most difficult issue is the proportion of true and illusory memories of incestuous childhood abuse. There will be no ultimate answer to this question until and unless we obtain relatively accurate and objective incidence and prevalence data for ICA. If we knew the frequency of such abuse, we could hope for less debate in this field. We do not have such data (Gardner, 1992; Ludwig, 1992) and, unfortunately, it is not apparent how appropriate data can be obtained. We are talking about secret acts that, if discovered, will result in abhorrence for the perpetrator even among institutionalized felons. Further, the definition of incestuous child abuse remains debatable. Are casually naked families engaged in child abuse? When a father washes the itchy anus and genitals of his 4- or 5-year-old, how should the act be interpreted? If a mother similarly washes the same area of the same child in the same way, is the meaning different? Does it matter if the child is a boy or a girl? When the bottom is washed, who is to decide whether it was incestuous child abuse: the mother, the father, the child, or the same child, now an adult, and a therapist two or three decades later? There are no ready answers to these and other similar questions.

Given the lack of incidence and prevalence data and the problem of obtaining good estimates in the immediate future, we are forced to view the problem from an alternative angle. To date, there are no published studies indicating the success of therapy oriented to recovery from ICA as compared to alternative treatment strategies. Thus, we have no clear data supporting the notion that therapy focusing on these issues is helpful (cf. Levitt & Pinnell, 1995; McElroy & Keck, 1995).

On the other hand, it is obvious that the discovery of and focus on decade or more delayed reports of  ICA uncovered in therapy emotionally devastates families and isolates children from parents. It also results in bizarre, cultlike formulations (e.g., SRA) among a sizable minority of patients. The medical rule is “First, do no harm.” A psychological parallel might be “First, do not increase error.” If these are considered first principles, the search for evidence of ICA in psychotherapy would seem to serve neither of them.

Notes

1Although the new terminology of dissociative identity disorder avoids some excess meaning, the older, more descriptive term, multiple personality disorder (MPD), reflects the way this disorder is still conceptualized by both the lay public and a large number of professionals. Since such conceptions may govern a good deal of expressed symptomology, we prefer to use it here.

2 We see Ms. Borawick as a victim of inappropriate suggestions in hypnotic treatment. Further, we see actual and documented ICA as more widespread and horrific than the creation of false memories of ICA. Nevertheless, the creation of false memories in therapy results in tragedy for both the accuser and the accused in many families. Therapists should be aware of the factors that inculcate false memories in order to assiduously avoid contributing to their creation.

3Hypnosis research has been at the leading edge in developing research methods in the social sciences since the 1950s (cf. Orne, 1970). Hypnosis researchers study a robust, complex, and somewhat spectacular set of phenomena easily produced and examined under controlled laboratory conditions. Perhaps any set of robust and interesting phenomena that isn’t easily explained by current paradigms will attract increasingly rigorous investigators. Since Hull’s (1933) work, we have had the good fortune to have this occur in hypnosis research (cf. Hilgard, 1975; Kihlstrom, 1985).

4A number of studies appeared in the late 1980s by Spanos and his colleagues (cf. Spanos et al., 1991) and others that seemed to show that similar effects on recall to those found with hypnosis could be obtained without hypnotic induction when sufficiently motivating instructions were given. There are, however, a number of problems with these studies. First, instructions like Barber’s task-motivating instructions usually increase compliance beyond that obtained with hypnosis, but fail to provide equivalent subjective experiences. Second, only hypnosis provides the ingrained cultural expectation that legitimizes memory change. Imagine the automobile accident victim who publicly blames himself for the crash, but, after talking to his lawyer and learning precisely what he must say to win a lawsuit, thinks hard about what happened and remembers that it was really the other party’s fault. Now imagine the same situation, but now he is hypnotized, age regressed, relives the accident, and discovers that it was the other party’s fault. Most people, including the hypnotic subject, find this latter situation more believable; being hypnotized provides a rationale for the memory alteration where an instructional set would not.

5The Hurd safeguards are so named because they were adopted by the New Jersey Supreme Court in State v. Hurd (1981). Since elaborated, they require that a qualified professional, independent of the police, interview the witness prior to hypnosis, then hypnotize the witness and allow for a period of free recall. Finally, the witness may be asked specific questions while hypnotized. Except under specific, unusual circumstances the hypnotist and subject are to be alone in the room. The entire contact between hypnotist and subject is video-taped. Any communication between the hypnotist and interested parties is also recorded and, if necessary, written notes suggesting questions can be given to the hypnotist during the last parts of the hypnotic interview. The entire record is then made available to outside experts who can examine it for undue suggestiveness. The idea is to prevent the subject from being unwittingly influenced by what occurs during the hypnotic session.

Unfortunately, the Hurd safeguards do not prevent the subject from being influenced by other postevent information and turning such information into “memory” during hypnosis. Nor do they protect the process from the creation of confident errors nor from the effects of self-serving motivation, simulation, or lying. Thus, the Hurd safeguards are now deemed useful only when hypnosis is used in a purely investigative context (AMA, 1985, 1994; Orne, Soskis, Dinges, & Carota Orne, 1984). In our view the hypnotized subject, like a medium consulted by police at a loss for leads, can help generate hypotheses. However, the hypnotized subject is thereafter excluded from testifying about anything discussed during hypnosis. You put neither the medium nor the previously hypnotized witness on the stand.

6The role of contagion effects must also be considered. Patients coming into therapy seem increasingly readied by trade books and the media to seek and accept ICA and MPD as rationales for their concerns. The fact that each provides a means to avoid responsibility for those concerns may make them especially agreeable to some patients, especially those with borderline personality disorder.

7A moderately or highly susceptible hypnotic subject may also be age regressed to age 4 in his last life or progressed to his next life. Convincing “memories” can then be obtained.

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Acknowledgments

The substantive research upon which these views were based was supported in part by grant no. MH44193 from the National Institute of Mental Health, U.S. Public Health Service, by grant no. 87-IJ-CX-0052 from the National Institute of Justice, and by a grant from the Institute for Experimental Psychiatry

Correspondence concerning this article should be addressed to Robert A. Karlin, Ph.D., Associate Professor, Psychology Department, Tillett Hall, Livingston Campus, Rutgers University, New Brunswick, NJ 08903.

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Robert A. Karlin, Ph.D., is Associate Professor of Psychology at Rutgers University. A former member of the Executive Board of Division 30 (Psychological Hypnosis) of the American Psychological Association, he has been actively involved in research on hypnosis and related phenomena since 1976.

Martin T. Orne, M.D., Ph.D., is Professor Emeritus of Psychiatry at the University of Pennsylvania. He is Executive Director of the Institute for Experimental Psychiatry Research Foundation, Inc., and past president of the International Society of Hypnosis and the Society for Clinical and Experimental Hypnosis. Orne served as editor-in-chief of the International Journal of Clinical and Experimental Hypnosis from 1963 through 1992.

Cultic Studies Journal,  Volume 13 Number 1 1996

Cultic Studies Journal, Vol. 13, No. 1, 1996, page


[1]1Although the new terminology of dissociative identity disorder avoids some excess meaning, the older, more descriptive term, multiple personality disorder (MPD), reflects the way this disorder is still conceptualized by both the lay public and a large number of professionals. Since such conceptions may govern a good deal of expressed symptomology, we prefer to use it here.

[2]2 We see Ms. Borawick as a victim of inappropriate suggestions in hypnotic treatment. Further, we see actual and documented ICA as more widespread and horrific than the creation of false memories of ICA. Nevertheless, the creation of false memories in therapy results in tragedy for both the accuser and the accused in many families. Therapists should be aware of the factors that inculcate false memories in order to assiduously avoid contributing to their creation.

[3]3Hypnosis research has been at the leading edge in developing research methods in the social sciences since the 1950s (cf. Orne, 1970). Hypnosis researchers study a robust, complex, and somewhat spectacular set of phenomena easily produced and examined under controlled laboratory conditions. Perhaps any set of robust and interesting phenomena that isn’t easily explained by current paradigms will attract increasingly rigorous investigators. Since Hull’s (1933) work, we have had the good fortune to have this occur in hypnosis research (cf. Hilgard, 1975; Kihlstrom, 1985).

[4]4A number of studies appeared in the late 1980s by Spanos and his colleagues (cf. Spanos et al., 1991) and others that seemed to show that similar effects on recall to those found with hypnosis could be obtained without hypnotic induction when sufficiently motivating instructions were given. There are, however, a number of problems with these studies. First, instructions like Barber’s task-motivating instructions usually increase compliance beyond that obtained with hypnosis, but fail to provide equivalent subjective experiences. Second, only hypnosis provides the ingrained cultural expectation that legitimizes memory change. Imagine the automobile accident victim who publicly blames himself for the crash, but, after talking to his lawyer and learning precisely what he must say to win a lawsuit, thinks hard about what happened and remembers that it was really the other party’s fault. Now imagine the same situation, but now he is hypnotized, age regressed, relives the accident, and discovers that it was the other party’s fault. Most people, including the hypnotic subject, find this latter situation more believable; being hypnotized provides a rationale for the memory alteration where an instructional set would not.

[5]5The Hurd safeguards are so named because they were adopted by the New Jersey Supreme Court in State v. Hurd (1981). Since elaborated, they require that a qualified professional, independent of the police, interview the witness prior to hypnosis, then hypnotize the witness and allow for a period of free recall. Finally, the witness may be asked specific questions while hypnotized. Except under specific, unusual circumstances the hypnotist and subject are to be alone in the room. The entire contact between hypnotist and subject is video-taped. Any communication between the hypnotist and interested parties is also recorded and, if necessary, written notes suggesting questions can be given to the hypnotist during the last parts of the hypnotic interview. The entire record is then made available to outside experts who can examine it for undue suggestiveness. The idea is to prevent the subject from being unwittingly influenced by what occurs during the hypnotic session.

Unfortunately, the Hurd safeguards do not prevent the subject from being influenced by other postevent information and turning such information into “memory” during hypnosis. Nor do they protect the process from the creation of confident errors nor from the effects of self-serving motivation, simulation, or lying. Thus, the Hurd safeguards are now deemed useful only when hypnosis is used in a purely investigative context (AMA, 1985, 1994; Orne, Soskis, Dinges, & Carota Orne, 1984). In our view the hypnotized subject, like a medium consulted by police at a loss for leads, can help generate hypotheses. However, the hypnotized subject is thereafter excluded from testifying about anything discussed during hypnosis. You put neither the medium nor the previously hypnotized witness on the stand.

[6]6The role of contagion effects must also be considered. Patients coming into therapy seem increasingly readied by trade books and the media to seek and accept ICA and MPD as rationales for their concerns. The fact that each provides a means to avoid responsibility for those concerns may make them especially agreeable to some patients, especially those with borderline personality disorder.

[7]7A moderately or highly susceptible hypnotic subject may also be age regressed to age 4 in his last life or progressed to his next life. Convincing “memories” can then be obtained.