By Lucien Greaves
This interview was originally posted on Greaves’ Patreon.
While the newest edition of the American Psychiatry Association’s diagnostic “bible”, the Diagnostic & Statistical Manual edition 5 (DSM-V) was still in deliberation, I interviewed Dr. Harrison Pope, author of Psychology astray: fallacies in studies of “repressed memory” and childhood trauma and professor of Psychiatry at Harvard Medical School. Dr. Pope serves as Director of the Biological Psychiatry Laboratory at McLean Hospital, a Harvard Medical School affiliate in Boston, MA. According to his profile on the McLean website, Dr. Pope,
has conducted research in a wide range of areas in psychiatry and has authored more than 300 peer-reviewed papers. This work includes many publications on the diagnosis and treatment of psychotic disorders and major mood disorders, together with extensive research on eating disorders and related issues of body image in both women and men. More recently, Dr. Pope has also focused on substance abuse disorders, with emphasis on drugs such as cannabis, hallucinogens, ecstasy, and anabolic-androgenic steroids.
I was interested in speaking to Dr. Pope about “recovered memories” and multiple personalities, areas in which he has offered critical insights and expert testimony. The following interview gives a very basic elaboration of his opinions and experiences related to recovered memories and multiple personalities. (I feel I should point out that while I ask about quantitative measures of Multiple Personality Disorder, such as fMRI correlates, such measures do nothing to resolve the issue of how the disorder establishes itself — that is to say, it says nothing at all regarding iatrogenic causes, trauma, or anything to establish causation of any kind. We would certainly expect correlates to be established in the fMRIs of the demonically “possessed” as they seek exorcisms, believing themselves to be in the throes of an evil spirit take-over, but such fMRI results would give us no reason whatever to credit claims that the mental state is a result of literal demonic spiritual incursions into a corporeal body rather than a mental state cultivated by that belief. MPD, some [like myself] argue, is a culture-bound disorder the same as demonic possession, and the expectations of how it manifests lays the blueprint for how individuals who believe, or are made to believe they harbor the condition, express their malaise. It’s surely not an act, but it’s a learned and often therapeutically-cultivated condition.)
You’ve treated some thousand-odd patients, many of whom experienced extreme trauma, from what I understand –
And you didn’t see evidence of DID (Dissociative Identity Disorder, otherwise known as Multiple Personality Disorder) in any of them?
I have seen a number of people who were diagnosed with DID, or where the patients themselves felt that they had DID, so it depends on what you mean by the question. In other words, there are certainly people that I’ve seen that were quite convinced that they did have different personalities that had amnesia for one another. But, even though it was “real” in the sense that the patients believed that they had it, I’m not convinced that it was real in the sense that it was a naturally occurring phenomenon, as opposed to something that had occurred through the power of suggestion.
We should move back a step into the issue of repressed memories of trauma. You have not observed such repression in patients who were not introduced to the idea of Dissociative Identity Disorder?
Well, it is virtually impossible to be living in our Western culture today without being introduced to the idea. Even if you’ve had no contact with the psychiatric community, or with the mental health profession as a whole, you still are very likely to have heard about repressed memories. You see people recovering repressed memories in Hollywood movies, or in TV dramas. So the notion of repressed memory is something you probably would have heard about even as you’re growing up.
That’s true – but as for people who have experienced extreme trauma that is known to have occurred, for which there is corroborating evidence – you didn’t find evidence of dissociative amnesia in them?
No. I have never seen anybody who had experienced a severe trauma where I believed that they were literally unable to remember it. People that I typically see who fall into the so-called repressed memory category fall into two categories: Type one being people who had an incident such as being sexually touched, or sexually assaulted in some way as a child – but the incident at that time, from their vantage point as a small child, was not particularly memorable. A characteristic story would be somebody who was groped on several occasions by a priest, or by some other adult, and who was around eight or nine years old, and at the time felt that the event was bizarre or weird or gross, but did not find it to be particularly traumatic, but simply bizarre. As a result, [the event] was simply forgotten about for a long period of time because it was not particularly important on the scale of all of the numerous other things happening to a kid who is growing up through those years. What would happen in these types of cases is that, a couple of decades later, something reminds the individual of it, and from the vantage point of modern times, the individual would say, “Good heavens! That was sexual abuse that was happening to me.” Looking at it from the adult vantage point [the individual] would be quite horrified at what had happened to him or her. They might think that they had repressed the memory when, in fact, it was not that they were unable to remember it, but simply that they had forgotten about it for quite a long time. Now, when they remember it again with modern eyes – with adult eyes – they often are quite traumatized at that point. They recognize it as a traumatic event, even though it was not perceived as traumatic at the time that it happened as children.
So that’s type one.
Type Two is what is called “false memories.” It is where someone thinks back to an incident and gradually constructs – usually quite unconsciously – constructs a memory of an event that did not actually happen. As you know, that has been documented in laboratory studies where scientists have intentionally caused study participants to develop false memories by convincing them that they had been lost in a shopping mall (in the case of Beth Loftus’s study), or that they knocked over a punch bowl at a wedding when they were five years old, or something of that nature. In actual treatment of patients with psychiatric disorders the power of these false memories can be much greater, because: number one, the individual is not just coming to the laboratory for one session, but is seeing a therapist for potentially months or years of time, so the potential duration for influence is far greater. Secondly, because the individual is suffering from some psychiatric symptoms and is trying to find an explanation as to why those symptoms are recurring, it is only natural and human that one try to construct some type of explanation for why one is feeling depressed or feeling anxiety. This phenomenon has a name. It is known as “Effort After Meaning.” If you have someone who has psychiatric symptoms, is not getting better, is in therapy for a period of time, and is engaging in this very natural Effort After Meaning, the ingredients for forming a false memory are obviously much more powerful than they would be in an artificial laboratory session where the experimenter is simply trying to convince the subject that they were lost in a shopping mall. So these Type Two phenomena are cases where the individual were genuinely not able to remember the event in the past because the event did not in fact occur.
What you often see in people is a hybrid of Type One and Type Two – where my best guess is that it is a hybrid of Type One and Type Two – where the individual really did have something happen, they were sexually groped by an adult, or some inappropriate act was perpetrated, where they then add new details or new memories on top of them. So you have a foundation of several real memories, and then on top of that a structure of additional false memories that have evolved over the course of time.
I’m interested in what kind of work you may have done with individuals already convinced that they had DID. Have you entered into treatment with them?
I don’t treat very many patients in that category. The vast majority of patients that I treat personally, over the years, have been patients with very severe psychiatric disorders, such as Bipolar Disorder, Schizophrenia, severe depression, many who are patients for psycho-pharmacological interventions, so my experience with patients reporting repressed memories has happened either because of seeing them in forensic settings incidentally in the course of research studies, or interviews where we were looking at something else. I have not personally sought to treat that population of people, but I have seen them in the course of my other work.
I believe [Dr.] Paul McHugh found that if one separates a DID patient from a therapeutic process that encourages a belief in the condition, it tends to go away – the alternate personalities dissipate, and the patient begins acting as one person again.
Yes. Yes, I’ve heard McHugh say that, but I haven’t had any experience one way or the other because it’s outside my field of people I see in treatment or in research settings.
Arguably you wouldn’t have a whole lot of DID patients because you don’t subscribe to a belief in the diagnosis, and if DID is indeed a clinical creation we should expect that your own patients wouldn’t exhibit it.
That’s largely true for DID, although repressed memory – I see people who believe they have recovered repressed memories rather often. There is no doubt that there really are such people who walk in the door of the office and are quite convinced that they’ve recovered a repressed memory. There’s no doubt that these people exist. The question is whether they are demonstrating something that is a true naturally occurring psychological phenomenon in the brain, or whether it is a product of Western culture, as you know I’ve argued the latter point-of-view in my papers.
You’ve acted as an expert witness, and very successfully [in cases using recovered memories as evidence]. I feel that an obvious, but little used argument against the validity of recovered memories is just how outrageous many of [these so-called memories] are. Satanic Ritual Abuse, Alien Abduction, I don’t often hear these recovered memory scenarios invoked to shake the foundation of this misguided faith in inerrant repressed memory recall.
But often in the forensic cases in which I have been involved, occasionally the claims are quite bizarre, and just on the face of them they seem implausible. But it is not at all uncommon in forensic cases that an individual claims to have recovered repressed memories of, say, sexual abuse by a priest, where it is a matter of known fact, virtually beyond dispute, that the priest has molested numerous other kids, or has a well-documented history of it. So in many of the forensic cases where I’ve been involved, the memory is not – on the face of it – particularly bizarre. It often is something that is quite plausible, and in many cases they may represent what I call hybrid cases where there was an element of truth about something that had happened, and then added on to it an additional structure of elaborations that probably did not happen.
What of the more concrete quantitative measurements? I saw there was a study claiming that amygdalar and hippocampal differences could be discerned in DID patients. There have been fMRI comparisons of multiple personality patients against people who were not, apparently showing a difference. Are you aware of those studies?
I haven’t followed that literature closely. There was a study that came out several years ago where they taught word lists to patients with multiple personalities, or patients diagnosed with multiple personalities. One personality would remember a word list, and another personality would remember a different word list, or something like that. I can’t quote this exactly – you’d have to get the original paper – but the words that were forgotten by the personalities, the pattern of forgetting was such that it was clear that the personalities did in fact have memory for each other, because otherwise the person would not have forgotten so precisely. Something to that effect.
I understand that [Dr.] Merskey initiated a letter to the DSM-V Task Force to urge a reconsideration of Dissociative Disorders. Are you involved in that?
I helped work with that group of people to draft an editorial – but it was not accepted for publication – looking at Dissociative Disorders as a whole, as opposed to just Dissociative Identity Disorder.
Your feeling is that Dissociative Disorders as a whole should be reconsidered?
Well, the problem is that the very word “dissociation” does not define a specific entity that you could get ten different independent psychiatrists to agree upon. Sometimes the word dissociation is used to refer to the fact that you’re driving down the street, and you’re very intent on what it is you are going to do when you reach your destination, so as a result you have very little awareness of the trees and houses that you are passing by. That’s sometimes used as “dissociation.” Sometimes the word refers to when you have a panic attack and everything around you seems unreal, or you feel that you are walking around in a movie or in a dream. Other times dissociation is used to refer to multiple personality disorder where it is alleged that there are personalities with amnesia for one another. Because of the fact that dissociation is used to describe these very different phenomena it’s very misleading to begin by assuming that it does define a specific entity. You’ve already begun to mislead the listener just from that initial assumption before you get any further down the line. I think it would be better if dissociation were replaced with more precise words to describe these various phenomena rather than used as general term which starts to confound the issue right from the start.
Speaking of definitional problems, isn’t part of the reason Multiple Personality Disorder was relabeled as Dissociative Identity Disorder due to a lack of definition as to what constitutes “personality”?
I’m not sure what the literature is on what’s the definition of personality, but the problem is if you have a global term like “dissociation” that actually describes a number of mental states that may not even be related to one another – we all agree that there are people who felt disconnected from reality when they get a panic attack. We all agree that there are situations where you can be focused on one thing and become unconscious of other things going on around you because your mind is focused on one thing. Scientists all agree that there are a number of these phenomena that truly exist – but then the logical fallacy is to assume that just because these phenomena occur that therefore there is an entity, a single entity: Dissociation, and that this entity could account for repressed memory or multiple personalities. It’s a little bit analogous to saying that because scientists agree on the existence of hoofed mammals that scientists also therefore agree on the existence of unicorns. It’s an analogous logical fallacy.
Do you think that MPD is poised for a come-back? Do you think it will ever be as popular as it was in the eighties?
I doubt that it will be. And, in fact, we have data suggesting that. I wrote an article back in 2006 pointing out that the number of articles that had been published in each year on DID and on dissociative amnesia rose from a very low number up to a high peak in the late nineties, and fell back again to a much lower number, suggesting that it was what some people have termed a scientific fad that lasted for a little while, then gradually faded from the radar, so to speak. People have criticized my study saying maybe [the decline in DID literature] is just because the questions have now been answered and scientists now agree on MPD, and therefore they don’t need to write articles. That argument is clearly fallacious, because if you look at other well-established diagnostic entities, such as anorexia nervosa, schizoprenia, alcohol dependence – the number of articles that have come out each year has been steady, or even rising in passing years. Having a number of scientific articles rise to a sharp peak, and then fall back again, strongly suggests that this is an idea that enjoyed a brief period of popularity or scientific interest, but has already gone well past its peak.
Do you have high hopes that the new DSM will be a better manual than the one before it?
I don’t know. I have virtually no knowledge as to what’s going on with the dissociative identity disorder/dissociative amnesia diagnoses. I fear that these may continue into DSM-V. I’m a bad person to ask that question to because I am not very politically connected and don’t have much contact with the workings that have gone on in the production of DSM-V. I’ve been peripherally involved in the diagnoses of anxiety disorders, but not at all in the evolution of dissociative disorders diagnoses.
Are you involved with the False Memory Syndrome Foundation?
I’m on their board of scientific advisors. But that’s just the board of advisors. I don’t physically do anything for the False Memory Syndrome Foundation, or have any other interaction with them. It’s more of a title, if you will.