Repression, Dissociation, and Sex-Abuse Accusations

Richard A. Gardner, M.D.*

ABSTRACT: The concept of repression has been given a bad press because it has been used by therapists to justify their induction of sex-abuse delusions in non-abused patients.  Denying the existence of repression, however is not the best way to deal with these therapists.  Repression does exist, but must be put into perspective with related phenomena including forgetting, suppression, denial, dissociation, and depersonalization.  The controversy over the existence of repression is a distraction from the widespread problem of recovered memory therapists who induce false memories of childhood sexual abuse.
  

The Basic Issues in the Repression Debate

Among the many conflicts raging in the field of sex-abuse accusations is the one centering on repression, especially regarding whether or not it exists.  But we are not dealing here simply with some kind of an intellectual discussion on a theoretical issue.  Rather, the debate has become heated because of its relevance to the question of whether certain sex-abuse accusations are true or false.  This is especially the case when an adult woman belatedly accuses her father (and/or other relatives) of having sexually abused her in childhood.  Memories of such abuses are said to have been repressed and then uncovered in treatment many years later.  The accusing woman, her therapist, and others claim that her failure to recall anything at all about the abuses over many years was the result of repression.

Critics of such claims say that there is no such thing as repression or, even if there is, people subjected to abuses are not likely to repress them, at least to the degree described by many of these women.  Supporters cite four studies to bolster their claim that sexual abuse can be repressed or dissociated (Briere & Conte, 1989, 1993; Herman & Schatzow, 1987; Loftus, Polonsky, & Fullilove; Williams, 1994).  The best of these, by Williams (1994), suggests that a significant percentage of adult women with verified medical records of sexual abuse in childhood will not describe their abuses in the course of interviews many years later.  The supporters maintain that these studies not only prove the existence of the repression phenomenon, but also confirm that memories of sexual abuse can be repressed for many years.  Critics reply that none of these studies assesses repression nor provides any credible scientific evidence to support the assumptions of recovered memories.

My own position regarding this particular conflict is this: Concerns about whether or not repression exists are irrelevant to the question of whether there are people being induced by their therapists to believe that they were sexually abused when they weren't.  It matters not whether 10% repressed or 99% repressed or any number in between.  The existence (or nonexistence) of repression does not preclude the parallel track of false accusations being induced in suggestible women by overzealous and even fanatical therapists.  If what I have said is valid, we are still left with the question of whether or not repression exists.  Accordingly, the question of whether repression exists is still an important one, not simply for our understanding of memories of sex abuse, but for other mental disorders in which the repression theory is used.

One of the problems confronting those who are arguing about repression is that those who believe it exists cannot point to any specific part of the brain (at least at this stage of our knowledge) and say, "That's where it's taking place."  They have to rely on patients' statements of their thoughts and feelings, much of which is subjective.  Such phenomena do not lend themselves well to verification by traditional scientific methods.  Accordingly, it is very difficult for proponents of the regression theory to "prove" that repression exists.  Those who claim that it does not exist also have difficulty providing "proof" because it is just about impossible to prove that something does not exist, i.e., one cannot prove a null hypothesis.  We are left, then, with appeals to "common sense" and what seems more or less likely.

I personally believe that there is such a phenomenon as repression.  It is the purpose of this article to not only describe why I believe in its existence, but to put it into perspective with other related phenomena, especially dissociation.  There are some who say that they do not believe in repression, but do believe in dissociation.  This may appear somewhat paradoxical because both involve relegation of cognitive material out of conscious awareness.  Clearly, definition of terms is warranted.  The definitions presented here are derived from traditional concepts; however, I have provided clarifications that should prove useful to those involved in this debate.
  

Preliminary Considerations

Most would agree that we cannot keep in ongoing conscious awareness all cognitive material.  The vast majority of such material must be stored.  Not to do so would probably drive us insane as we would be continually confronted with all the thoughts and memories of our lives.  In addition, it would make it difficult to select the specific material that would be most important to focus on in a particular situation, especially situations involving survival.  To say that long-term memory is stored in places like the hippocampus is perfectly acceptable to most people today and does not evoke much controversy.

To say, however, that certain material is relegated to the "unconscious" is likely to raise eyebrows in some circles and even antagonism in others.  Where material that is not in conscious awareness is stored (and the name one gives to the Site[s] where it is stored) is not particularly relevant to what I will be saying here.  (Of course, this issue is very relevant to such people as neuropsychologists and those who are studying memory.)  For my purposes here, I am only stating that there must be sites (for lack of a better term) where cognitive material that is not immediately available to conscious awareness is stored.  Nor does it matter to me whether one calls such areas "the unconscious" or something else.  I will refer to these sites as storage areas.

There is a continuum regarding the depth and degree of implantation of cognitive material in the memory storage areas.  The range is from material that is only superficially implanted and is easily forgotten to material that is deeply embedded in storage area circuitry so deeply embedded that it will always exist in the person's brain.  The comparison here is between writing with a stick in the sand (writing that inevitably blows away) and writing deeply in cement.

In addition, there is a continuum from stored material with which the individual is comfortable and that with which the individual is extremely uncomfortable.  Retrieval of material in the former category does not produce significant anxiety, guilt, or revulsion.  In contrast, retrieval of material at the other end of the continuum is likely to produce such reactions.  Under such circumstances there is a lack of receptivity for such information to be given access to conscious awareness.  In this article I will define a series of mental mechanisms that relate to the phenomena of storage and ease of retrieval.  These phenomena also fall on a continuum, roughly from that material which is readily and easily retrieved to that which, although deeply embedded in the storage site, is very difficult to retrieve — especially because of significant degrees of guilt, fear, and/or revulsion.

It would be an error for the reader to oversimplify my comments by referring to them simply as "Freudian," with the implication that they are passť and thereby not to be taken seriously.  Furthermore, that does me a disservice in that, although psychoanalytically trained, I believe there are things Freud said that are worthy of our serious consideration and other things that are best forgotten, and all points in between.  Those who dismiss Freud entirely are throwing out the baby with the bath water.

There are different mechanisms that lie on the continuum related to the relegation of conscious material into storage: forgetting, suppression, denial, repression, dissociation, and depersonalization.  Roughly, these represent processes that involve the most superficial degree of relegation to storage (forgetting) to the most deep seated and dramatic example of that process (depersonalization).  These are not "pure" in that there is some overlap.  However, viewing these processes as being on a continuum can he useful for understanding cognitive material that may not be immediately accessible to conscious awareness.
  

Forgetting

All of us forget, and children more than adults. I speak on the phone with my three-year-old granddaughter, Anna Lauren. This is the conversation:

Gardner: Hi, Anna Lauren. How are you?
Anna: I'm fine, Grandpa.
Gardner: What did you do today?
Anna: (after a pause) Mommie, what did I do today?

Children must be reminded to put on their coats and hats, take their books and lunch, and remember not to lose their gloves.  There is no school worthy of the name that does not have a "lost and found department," the primary purpose of which is to facilitate the retrieval of the numerous articles that will inevitably be lost in any school.  It is a rare mother who has not been summoned to the school to bring a forgotten book, homework assignment, or lunch.

A high-school student studies for a French test.  She gets 23 out of 25 words right on her French vocabulary test.  No one would claim that this child has "a problem."  We go to our 25th anniversary alumni meeting.  A typical interchange involves people arguing about whether X event did or did not happen.  They may even do this somewhat humorously.  Each may swear by everything that is holy to him or her that his or her rendition is the accurate one.  But all agree that both cannot be right, so diametrically opposed are their recollections.  The interchanges, however, do result in a gradual recovery (I hesitate to use that word) of memories that were not previously recalled.  This process is referred to as accretion.  It may very well be that such memories would never have been recalled had the individuals not attended the meeting.  They were stored somewhere and not immediately available to conscious awareness.  Certain external cues, however, brought about retrieval that might not have otherwise occurred.  This, too, is all normal.  No one would say that these people have "a problem."

But the storage system is also affected by motivation.  Two boys meet a girl and both ask for her telephone number.  Boy A's testosterone levels soared the very minute he set eyes on her and it is highly likely that he will remember the telephone number.  Boy B, with a sexual inhibition problem, has a conflict.  His testosterone is mobilizing him to ask for her number.  However, his adrenaline levels (mobilizing him for flight), also become elevated and this results in his forgetting the girl's telephone number.  (The reader will forgive me for my oversimplification here, but I do believe it helps make the point.)  I believe that in the second boy's situation there were processes, not in direct conscious awareness (I am trying to avoid the use of the word unconscious here), that were operative in bringing about the memory failure.  Perhaps in therapy or in a discussion with a friend he would have been able to delineate the psychological factors operative in his having forgotten the number.
  

Suppression

Suppression is a more active process than simple forgetting.  Forgetting often occurs without any willful intent to forget. In contrast, in suppression, the individual may make a determined effort to remove the material from conscious awareness.  Girl jilts boy.  Boy is deeply pained.  His consoling parents tell him: "Try to forget about her.  There are other fish in the sea."  He agrees that he is going to try to forget about her.  They suggest he watch television, play ball, or do something else to try to distract himself.  He agrees that that is a good idea and watches a videotape of great interest to him.  The parents studiously avoid mentioning the girl's name in the hope that they will thereby facilitate their son's forgetting process.  The boy's decision not to think about it is an active process and protects him from psychological pain.

Another example of suppression would be the adult who wants to forget about some embarrassing situation that occurred previously.  The mechanism lessens the likelihood that the material will become deeply entrenched in the brain circuitry and, in some cases, blow away like the name imprinted in the superficial layers of the sand.  Whereas suppression is a conscious deliberate process, repression (see below) is a more automatic process — less likely to be directed by the individual's will.  The aforementioned sexually inhibited boy who forgot the girl's telephone number exhibited repression.  He did not consciously say to himself, "I want to forget her number."  Rather, he consciously said to himself, "I want to remember her number."  However, other forces within him, not operating at conscious awareness, dictated otherwise.

An old Laurel and Hardy movie (VHS Tape) is relevant here not only with regard to what it tells us about forgetting, but techniques used in so-called "recovered memory therapy."  Oliver Hardy has fallen deeply and madly in love with Georgette, the woman of his dreams.  She will have no part of him and he becomes despondent.  The two men decide to join the French Foreign Legion in the hope that service in the distant Sahara Desert will help Oliver forget Georgette.  So off they go to North Africa.  Intermittently, Stan asks Oliver, "Did you forget her yet?"  Oliver, justifiably irritated, implores Stan to please stop reminding him of Georgette because his reminders are interfering with the forgetting process.  Stan (predictably) keeps asking Oliver the same question and Oliver (predictably) responds with increasingly zany fits.  The forgetting process is further complicated by the fact that Georgette turns out to be the wife of the commanding officer of their unit!  The vignette not only says something about the forgetting process, but the techniques used by the so-called recovered memory therapist.
  

Denial

Denial may be similar to suppression in that it often involves a conscious decision: "I don't want to think about it" or "I don't want to know about it."  Denial, however, is a much more powerful mechanism than suppression and is often automatically (and unconsciously) used.  Denial lies between suppression and repression on the continuum.  Denial is a much more powerful mechanism and its ability to keep material out of conscious awareness is far stronger than the mental mechanisms involved in suppression.  A foot soldier goes into battle denying the likelihood that he will be killed.  An indiscriminate lover has sex with a stranger, denying the possibility of contracting a sexually transmitted disease.  People living in earthquake areas return to build their homes on the same site, denying that it can happen again.  The person with an incurable disease denies the death sentences of a series of competent doctors and believes the quack who tells him that he has the cure.  James Boswell attributed to Samuel Johnson the observation that "Remarriage represents the triumph of hope over experience."

One can say that denial represents the triumph of hope over reality, or the triumph of hope over the laws of probability.  It is the most powerful and widespread of the psychological defense mechanisms.  It has the power to entrench itself deeply into the brain circuitry.  Unlike suppression, it is most often an automatic process, and not something that people most often deliberately do by making a conscious decision.  The boy who tries to forget about the girl who jilted him is doing something constructive.  People who deny are often doing something self-destructive and do not wish to recognize that they are acting injudiciously.  Accordingly, the denial mechanisms operate at unconscious levels to protect people from the recognition that they are often being injudicious and even foolish.  An old anecdote that demonstrates this principle well: A middle-aged single woman (well into middle age) spends a weekend at a resort in the hope of meeting a husband.  One day she notices a newcomer sitting alone on the porch.  It isn't long before she is sitting next to him.  The following conversation ensues:

Woman: Are you new here?
Man: I just came up this morning.
Woman: You know, I hope you don't mind my saying this, but you look very pale. Is something wrong?
Man: No, I don't mind talking about it. You see, I just got out of jail.  I was in jail for a total of 25 years.
Woman: That's terrible. What happened?
Man: Well, I got into a big fight with my wife and I ended up murdering her.  They gave me 10 years in jail.
Woman: That's too bad.  But that's only 10 years.  What happened then?
Man: Well, soon after I got out, I got married again.  And then soon after that, I had a fight with my second wife and I killed her too.  So they gave me another 15 years, and I just got out.
Woman: (excitedly) Oh, so you're single!
  

Repression

The next step on the continuum is repression.  This mechanism is more automatic than denial and more likely to be triggered by unconscious processes that may be more complex.  In denial the dangers are well circumscribed and easily defined, e.g., death by incurable disease, a highly probable future earthquake, and lifelong spinsterhood.  In repression, as is true for denial, there is relegation of data to storage out of conscious awareness.  Whereas in denial the material being avoided is well circumscribed and generally external, in repression the danger is internal, i.e., stored material, which, if brought into conscious awareness would cause psychological pain.  Such relegation to storage often relates to the guilt, shame, embarrassment, self-loathing, etc. that individuals would experience if they were to recognize that such impulses existed within themselves.  The wife beater represses memories of all the unconscionable things he did in the course of his rage outbursts.  I have enough experiences with these individuals to say that they are not all simply lying when they deny the extent of their depravity (although lying is certainly operative).  Many of them genuinely do not recall many of the more odious things they do.

Slips of the tongue often provide good examples of the repression mechanism.  Many years ago a mother described to me extremely harsh punitive measures for disciplining her children.  These included beating them with a strap, punishing them with meals consisting only of bread and water, and locking them in closets.  After describing these in great detail, the mother said to me: "Don't get me wrong, Doctor.  I love my killdren, I mean my children."  It was obvious to me that this woman could not allow herself to appreciate the extent of her murderous rage toward her own children.  This would have evoked enormous guilt.  Her hostility revealed itself however, with her slip.  Sigmund Freud would have called this "return of the repressed."  I am in full agreement with him on this point and this vignette is an excellent example of the phenomenon.

Another example: I recall well seeing on television a TV interview of Richard Nixon on the White House steps.  He was asked about his reactions to Jack Ruby's murder of Lee Harvey Oswald, soon after Oswald had murdered John F. Kennedy.  Nixon's statement (and I swear I remember it this way): "Two rights don't make a wrong; I mean two wrongs don't make a right."

Dreams provide a good example of the process of repression.  Freud erred when he considered the primary purpose of dreams to be wish fulfillment.  Certainly, there are dreams that do provide wish fulfillment and overtly sexual dreams (not necessarily the so-called symbolic ones with phallic and vaginal symbols) are good examples of this.  Freud did not, however, describe the more important and common function of dreams, namely, an alerting mechanism designed to bring to the dreamer's attention dangers that he or she might not have consciously been aware of.  Because of guilt and shame, the data were relegated out of conscious awareness, but press for expression because the information is of vital importance to the individual, possibly even of survival value.  For example, a middle-aged woman, still single (I'm not talking here about the woman described previously at the resort), tells me that she's met a new man and she's "deeply in love."  By the time of the session she's already had three dates and they're talking about marriage.  She describes herself as "walking on a cloud."  In the course of our discussion she tells me that the man had been married twice previously.  (I know that this vignette has an uncanny similarity to the story above about the woman at the resort, but believe me, it has nothing to do with it.)  I asked her what she knew about his two previous marriages and the reasons. for the divorces.  Her answer: "I never asked him about that.  I don't believe that's any of my business."  In response, I told her that I thought it was very much her business and that it was also my business.  She disagreed with me and the session ended.

That night she had a dream in which a man, who looked uncannily similar to her new boyfriend, was married to another woman, a woman whom she could not recognize.  In the dream the woman was very upset because her husband was cheating on her.  It was not simply a case of an occasional one night stand.  Rather, it was a situation of compulsive infidelity.  In the next session, she presented the dream and, with some difficulty, came to appreciate that the dream reflected deep concerns on her part about her new boyfriend's potential for marital infidelity.  She agreed with me, then, that it was her business to find out about the causes of his previous divorces.

In the following session she told me that she had indeed confronted her boyfriend and learned what she had feared, namely, that his previous marriages broke up because of his infidelities.  We both agreed that, although he had never said anything specific about his philandering, she must have been picking up certain messages from him that suggested danger for her marriage.  She did, then, describe how he boasted about his sexual conquests and sexy women with whom he had gone to bed.  The dream and our ensuing discussions helped her appreciate that there was a high likelihood that such behavior would be repeated in this new marriage, so deeply were such patterns embedded in his brain circuitry.

I myself had a dream, about a patient, that serves as an excellent example of the dreams value as an alerting mechanism.  Many years ago a man of 25 requested treatment for homosexual difficulties.  He considered his homosexuality to be psychogenic and hoped that therapy would help him achieve a heterosexual life pattern.  This treatment took place in the mid-1960s at a time when a psychotherapeutic (psychoanalytic) approach to homosexuality was accepted practice.  Today, I would be far less receptive to trying to "cure" this man's homosexuality.

The patient was born and raised in New England and had attended a prestigious boarding school and Ivy League college.  His father had died when he was three and he had absolutely no recollection of him.  He was raised with his mother and three older sisters, all of whom doted over him.  His mother often undressed in front of him, even into the teen period.  He first began having homosexual experiences in high school, but did describe some successful heterosexual experiences as well.  However, his homosexual experiences were much more gratifying to him.

In his early twenties he married in the hope that this might bring about a heterosexual orientation.  He had not told his wife about his homosexuality at the time of the marriage.  After about a year she became aware of his activities and at first hoped that she might be able to salvage the marriage.  When I saw him, she had decided upon divorce and he went into therapy, hoping that he could avoid future similar consequences of his homosexuality.  At the time he entered treatment, he was also in difficulty in the firm where he worked.  He was employed by an investment banking firm, and it was becoming increasingly clear to him that he was being passed over for promotions because of suspicions of his homosexual lifestyle.

During the first two months of treatment, the patient appeared to be involving himself well in therapy.  He was a mild mannered man who was quite polite and formal.  His relationships, however, were invariably tempestuous, especially his homosexual relationships, especially because of jealous rivalry.  In association with the stresses of these relationships, he would often drink heavily and sometimes become quite depressed.

Consciously, I did not consider the patient to be significantly different from other patients I was seeing with regard to any particular thoughts and/or emotional reactions that I might be having about them.  One night, however, after about two months of treatment, I had a dream in which the patient was pursuing me with a knife in an attempt to murder me.  Although I fled in terror, he was gaining on me.  The pursuit seemed endless.  Finally, I awakened just at the point where he was about to stab me.  When I awakened, it was with a sigh of relief when I appreciated that it was only a dream.  I was in analytic training at the time and so I began to think seriously about what the possible meaning(s) of the dream could be.  I had to consider the most obvious explanation, namely, that my dream was a reflection of unconscious homosexual desires that I presumably harbored toward my patient (his putting a knife=penis into me).  Because I have never had any particular inclinations in this directions, I found it difficult to accept this as a possible explanation.  However, I also had to accept reluctantly the latent homosexual explanation because of the way unconscious processes operate.  I was also taught in analytic training that when a therapist has a dream about a patient, it invariably indicates inappropriate countertransferential reactions.  I was not too comfortable with this unflattering explanation either.  I could not recall having had any dreams previously about my patients (nor have I had any since), but I did, on occasion, exhibit what I had to accept were inappropriate countertransferential reactions.  Accordingly, I was left with the feeling that the dream was important but without any particular explanation for its meaning.  (At that time, I was not appreciative of the alerting value of dreams.)

About two weeks after the dream, the patient entered the session in an agitated state.  Although I do not have verbatim notes on the interchange that ensued during that session, the following is essentially what took place:

Patient: (quite tense) I'm very upset. I can't take it any longer. I can't continue this way.
Gardner: Tell me.
Patient: This is very difficult to talk about.
Gardner: I suspect it will be, but I know you appreciate that it's important for you to discuss those things here that you are hesitant to speak about.
Patient: Yes, I know I have to tell you but it's difficult.
Gardner: I'm listening.
Patient: I can't stand it any longer.  I've got to tell you.  I'm in love with you.  And I've been in love with you since the first session.  I can't stand it any longer.  While I'm talking to you about my problems, I keep thinking about how much I love you.
Gardner: You know, the word love can mean many things.  It would be helpful to us if you could tell me the exact kinds of thoughts and feeling you've been having when you say that you love me.
Patient: That's even harder.
Gardner: I can appreciate that; however, if we're to fully understand what's happening, it's important that you try to tell me.
Patient: If you really want to know, I want to have sex with you.
Gardner: Even there, having sex with someone is a statement that covers a lot of ground.  I'd like you to try to be more specific about the particular kinds of thoughts and feelings you're having when you say that you want to have sex with me.
Patient: (hesitantly) Well, I just wouldn't want to start having sex right away.  I'd want there to be some overtures on your part, some advances by you.
Gardner: I'm starting to get the picture.  Now what specifically would you want me to say and do.
Patient: Well, I just wouldn't want you to simply ask me.  I'd want you to plead.
Gardner: What would you want me to say specifically?
Patient: I'd want you to beg me.  I'd want you to get down on your knees and beg me to have sex with you.  (Patient now becoming agitated.)  I'd want you to be extremely frustrated, to be very horny.  I'd want you to be on the floor kissing my feet, begging me over and over again to have sex with you.
Gardner: What then?
Patient: Well, I wouldn't just have sex with you then.  I'd want you to beg more.  I'd want you to kiss my feet.  I'd want you to promise to do anything at all to get me to have sex with you.  You'd be on the floor crying and pleading.  But I still wouldn't gratify you.  I'd let you squirm.  I'd let you plead.  (Patient now becoming enraged.)
Gardner: What then?
Patient: Finally, when I felt you had enough punishment, I'd make you get undressed and then I'd make you lie down on the ground on your belly.  Then I'd fuck you in the asshole and reduce you to my level.  I'd humiliate you and gratify you at the same time.
Gardner: Is that the end of the fantasy or is there more?
Patient: Oh, there's more; I just wouldn't stop at that.  First, I'd call your wife.  I know you're married; you have that ring on your finger.  And I saw those pictures on your desk; I assume those are your kids.  Anyway, what I'd do then would be to call your wife.  I'd tell her that you're a fag.  And I'd tell her that you have sex with your patients.
Gardner: What do you think would happen then?
Patient: Then she'd divorce you.  What woman would want to live with a fag?
Gardner: Anything else?
Patient: Yeah, I wouldn't stop there.  I'd call the people who are in charge at the Columbia Medical School, the dean or whoever it is.  I'd tell him that they have someone on the faculty who fucks his patients.  I'd also tell them you're gay.  And I'd tell them that you had sex with me.  Then they'd kick you off the faculty.
Gardner: Anything else?
Patient: Yeah, one more thing.  I'd call the medical society and tell them what you really are, a fag, a gay doctor who fucks his patients.   And they'd take away your license.
Gardner: Anything else?
Patient: No, that's it.
Gardner: You know, you started this session by telling me that you '~love" me. Is this your concept of love?
Patient: Well, maybe it's not love, but it's the way I feel.  Maybe it's the way I feel because I know that you don't love me the way I love you.
Gardner: Here you tell me that you love me and then you tell me how you want to humiliate me, expose me as a doctor who has sex with patients.  Then you tell me that you would like to have my wife divorce me and then I'd be kicked off the faculty at the medical school and then lose my medical license.  It sounds to me like you want to destroy me.  It doesn't sound very much like love to me.  It sounds to me like the opposite, like hate.

In the ensuing discussion, the patient was too upset to be able to gain any insight into what was going on.  His treatment did not last much longer.  He left about two weeks later, claiming that I really did not have very much affection for him.  If I genuinely wanted to show my affection, I would have sex with him.

Although the vignette demonstrates well an important psychodynamic mechanism operative in some patients with male homosexuality, namely, the use of love as a reaction formation to hate, it is not presented here for that purpose.  Rather, the vignette is presented as an example of an alerting dream.  It is reasonable to speculate that at the time of the dream I was already receiving subtle signals of the patient's hostility.  I was not aware of these consciously and may have been threatened by them.  This resulted in my repressing these thoughts and feelings.  However, it was important for me to ultimately appreciate the implications of the patient's hostility, especially because the implementation of his wishes would have been catastrophic for me.  Accordingly, my pent-up thoughts and feelings finally erupted into conscious awareness via the alerting dream.  This dream, like many dreams, served as a compromise between full repression without any conscious awareness of the repressed material and full conscious appreciation.  The symbolic portrayal allowed for release of the repressed material and, at the same time, lessened the unpleasant emotions (such as shame, guilt, and fear) that I would have experienced had this material been allowed to enter conscious awareness without any disguise.

Had the man continued in therapy, I would have used the dream to help me make decisions regarding hospitalization.  The dream suggested that this was indeed a dangerous man.  Of course, one would not and should not use one's own dream as an important criterion for deciding whether or not to hospitalize a patient.  The clinical behavior must be paramount; however, the dream should not be ignored either.  As I hope the reader agrees, the dream can be a powerful source of information about dimly sensed but not overtly recognized dangers.

It is my hope that these vignettes demonstrate well the repression mechanism.  It is a powerful force.  I believe that there probably are some women who do indeed repress memories of sexual abuse.  In some cases it was repressed because it was a painful, embarrassing, and humiliating experience that would only produce personal denigration if recalled.  For others, there may have been enjoyment of the experience and recognition of such pleasure would be too guilt-evoking to allow such memories into conscious awareness.  I do believe, however, that such repression is relatively uncommon and does not approach the traditional one-third figure frequently floating about these days.  But even if I am incorrect here and it is indeed true that the one-third (or even greater) figure of repressed memories of sexual abuse is valid, this does not preclude the parallel track of suggestible and/or gullible women being programmed to believe that they were sexually abused in childhood when there was no good reason to believe that they were.
  

Dissociation

At the time of abuse, especially when it is severely traumatic, a small percentage of children will dissociate.  This is a phenomenon which is most often seen in situations of severe trauma, such as military combat, earthquakes, tornadoes, floods, rape, and attempted murder.  There is a massive flooding of stimuli into the brain circuitry.  The unity of consciousness is disrupted.  There is a disintegration of consciousness and certain segments of the personality may operate autonomously.  Continuity and consistency of thoughts are disconnected from one another.  Identity confusion and identity alteration may occur.  There is a loss of sense of the passage of time.  The person may experience perceptual distortions, illusions, or feelings that the surrounding world is strange or unreal (derealization).  Sometimes there is complete amnesia for the event (psychogenic or dissociative amnesia) or the individual enters into an altered state of consciousness in the context of which complex behaviors are exhibited that are unknown to the patient (psychogenic or dissociative fugue).  Dissociation is well compared to the overloaded computer that stops functioning because it cannot deal with the massive amount of information being poured in.  This phenomenon may be associated with psychic numbing, which also serves to protect the individual from full appreciation of the trauma.

In chronic abuse this pattern may become deeply entrenched to the point where the process becomes automatic: each time the person is abused, he or she automatically dissociates and thereby protects himself or herself from the pain of the experience.  The result may be (in a small percentage of cases) no conscious recall of the traumatic events.

Such dissociative episodes may then occur in situations in which the person is reminded of the abuse by cues that are similar to those that existed at the time of the original abuse.  For example, a Vietnam veteran walks past a movie house with advertisements showing battle scenes from the movie playing therein.  These, because of their similarities to the battlefield conditions in Vietnam, trigger a dissociative reaction in which his brain is flooded with flashbacks of the combat situation as well as the disorganization of thinking typical of dissociation.  Under such circumstances, there are likely to be other manifestations of dissociation in which the person may be amnesic for certain time blocks during which events that transpired are totally obliterated from the person's memory, but have been clearly observed by others.  This is not simply a matter of forgetting certain events, which all people do, but there is total obliteration of memory of such events and confusion when confronted by observers of the person's involvement in such events.

People who have not been traumatized and/or abused are not likely to manifest or experience bona fide dissociative phenomena.  Overzealous examiners often frivolously apply the concept of dissociation to even the most transient episodes of inattentiveness and "spacing out."  This may be done in circumstances when there was absolutely no evidence for bona fide dissociation at the time of the original alleged abuse.

An article on the subject of dissociative states would not be complete without some mention of the so-called Multiple Personality Disorder, a diagnosis which is very much in vogue at this time.  Although DSM-IV (American Psychiatric Association, 1994) lists Dissociative Identity Disorder (Multiple Personality Disorder), I have not yet personally seen such a case and am extremely dubious about its existence, although I cannot be certain that it does not exist.  As mentioned, one cannot prove a null hypothesis.  I can, however, express my skepticism.

Many years ago, while serving as a psychiatrist in the military service, I interviewed in jail a man who had murdered another soldier in the course of a fight.  Specifically, he had fired 23 rounds to the head and chest of this man.  When I saw him he was clearly in an altered state of consciousness and this is basically what he had to say to me:

Patient: I don't remember killing him.  I have absolutely no memory of killing him.  They say I killed him. ...  I must have because the bullets match my gun, which they found in the bushes.  I don't remember throwing it in the bushes, but it must have been my gun because my fingerprints were on it. ...

 I do not think this man was lying.  He was clearly in an altered state of consciousness and I do believe he was suffering with psychogenic amnesia.  The information was dissociated because he did not want to view himself as the murderer that he actually was.

I believe that adult women who are raped might, under certain circumstances, dissociate.  But this is rare.  It is probable that some children dissociate in the course of sexual encounters with adults but this is also rare.  Overzealous evaluators, however, are interpreting every distraction and every mild example of "spacing out" as a manifestation of dissociation.  This is most commonly seen in situations where the child has not been sexually abused and the dissociation phenomenon is being brought in to give medical credibility to the evaluator's belief that the child was abused, a belief which has absolutely no basis in reality.

Dissociation, then, can be considered a stronger form of repression.  Repression probably does not use up as much brain energy or as much brain-cell circuitry.  When dissociation is occurring, the brain is really buzzing.  Therefore, it should be differentiated from repression and placed further along the continuum of mental mechanisms that induce storage of cognitive material.
  

Depersonalization

Depersonalization is commonly seen in association with dissociation.  Again, it is primarily confined to situations in which the individual is subjected to extremely severe trauma.  Depersonalization is best viewed as a phenomenon in which the mind appears to have split away from the body.  It is as if the person's mental apparatus hovers above the body and observes it.  This is an adaptive mechanism in life-threatening situations that helps protect the individual from full appreciation of the impact of what is going on.  Sometimes the individual feels that his or her body is dead, like a zombie or a mummy.  This is often referred to as derealization and is also seen in association with dissociation.  When, however, the mind appears to be looking down upon the dead (derealized) body, the term depersonalization is warranted.  People on the brink of death, while being tended to by emergency caretakers, may look upon what is going on, as if from above, in a dispassionate, but nevertheless interested way.  Again, it is important to note that depersonalization only occurs in situations of severe trauma.  On occasion, a woman, in the course of being raped, will depersonalize.

Some children, while being abused, will depersonalize the whole event by making believe (usually consciously at first) that they are someone else.  The child may believe that the abuse is occurring to someone else or that he or she is invisible and observing the abuse from above.  This lessens psychic pain.  The child may feel like he or she is living in a dream state.  Such children may also have experiences in which they believe they are someone else.  In contrast, children who have not been abused are not likely to describe depersonalization phenomena.  The only one exception to this would be psychotic children, especially older ones, for whom the depersonalization phenomenon may be part of a schizophrenic process.
  

Conclusions

Repression has been given a bad press because it has been resorted to by overzealous, incompetent, and fanatic therapists who use the "repressed memory" theory to justify their induction of sex-abuse delusions in their gullible patients.  They have borrowed a psychological mechanism in the service of giving medical (psychiatric) credibility to their programming maneuvers.

Denying the existence of repression is not the best way to deal with these therapists.  First, it is very difficult to "prove" that something does not exist.  Second, even if one were to be able to prove that repression does not exist, overzealous therapists would merely focus on other justifications for their maneuvers.  Disputes over what percentage of sexually abused women forget (repress) their memories of abuse are irrelevant to the question of whether gullible and/or suggestible women are being programmed to believe they were abused when they weren't.  Accordingly, the repressed memory arguments are in the wrong arena.  Whatever the degree of repression and forgetting there is in the track of those who were abused, there is a parallel track of those who are being convinced that they were abused when they were not.  The repression controversy is a distraction from this phenomenon and thereby does not serve well the goal of those who are trying to bring attention to the national scandal of the induction of false sex-abuse accusations in gullible and suggestible people.
  

References

American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) (Hardcover)(Paperback). Washington, DC: Author.

Briere, J., & Conte, J. (1989, August). Amnesia in adults molested as children: Testing theories of repression. Paper presented at the 97th Annual Convention of the American Psychological Association, New Orleans, IA.

Briere, J., & Conte, J. (1993). Self-reported amnesia for abuse in adults molested as children. Journal of Traumatic Stress, 6(1), 21-31.

Herman, J. L., & Schatzow, E. (1987). Recovery and verification of memories of childhood sexual trauma. Psychoanalytic Psychology, 4(1), 1-14.

Loftus, E. F., Polonsky, S., & Fullilove, M. T. (1994). Memories of childhood sexual abuse: Remembering and repressing. Psychology of Women Quarterly, 18, 67-84.

Williams, L. M. (1994). Recall of childhood trauma: A prospective study of women's memories of child sexual abuse. Journal of Consulting and Clinical Psychology, 62(6), 1167-1176.

* Richard A. Gardner, M.D. is Clinical Professor of Child Psychiatry, Columbia University, College of Physicians and Surgeons.  His most recent book is Protocols for the Sex-Abuse Evaluation (Paperback) (Cresskill, New Jersey: Creative Therapeutics, 1994).  [Back]

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