Try to Remember
Psychiatry's Clash Over Meaning, Memory, and Mind


In the 1990s patients in psychotherapy began accusing parents and other relatives of sexually abusing them in childhood. Most of the accusations were false “recovered memories” implanted by therapists pursuing a new theory of mental illness. Paul R. McHugh saw it all and feared that his profession had done itself in, once and for all.

The public, in losing confidence in psychotherapy and turning solely to medications for psychiatric treatment, abandoned an important healing method just as several psychiatrists, including McHugh, were teaching what had gone wrong in psychotherapy and putting it right. Everyone—the public and professionals—should appreciate how psychiatry lost its way on this occasion so as to guarantee that discredited ways of searching memory for sources of disorder do not reappear in some new garb.

The recent uptick in popular interest, for example, HBO’s "In Treatment," suggests that Americans may be ready to give psychotherapy another chance. McHugh wants them and their therapists to get it right this time. In Try to Remember, he describes his battles against “recovered memories,” multiple personality and the excessive diagnosis of PTSD to explain the difference between good treatment and bad and to draw urgent lessons for therapists and patients alike.

 Acknowledgments

Introduction

Chapter 1: Meeting the Issue

Chapter 2: The Path Less Traveled

Chapter 3: Appraising the Problem

Chapter 4: Joining the Contest

Chapter 5: Fighting for Danny Smith

Chapter 6: The Scope of Suspicion

Chapter 7: Moving from Defense to Offense

Chapter 8: Getting to Know Patients

Chapter 9: Making Sense of DSM

Chapter 10: What Is Meant by Hysteria?

Chapter 11: Words, Words, Mere Words

Chapter 12: The Move to Post-Traumatic Stress Disorder

Chapter 13: Making Sense of Psychotherapy

Chapter 14: The “Conflict” and the “Deficit” Psychotherapies

Epilogue

Notes

Suggested Reading

Endorsements

Advance praise for Try to Remember:

"This is the absorbing, never-before-told story of how a cult of Freudian psychiatrists, believers in such dingbat doctrines as "multiple personality disorder," "disassociative identity disorder," "recovered memory," and "post-traumatic stress syndrome," went on a witch-hunting rampage across America that dwarfs the Salem and medieval European witch hunts of yore, prodding patients, most of them young women, into fantasies of childhood sexual abuse that sent their parents off to prison for stretches as long as 20 years---before a small band of scientists risked their reputations and livelihoods to expose the cult for what it was: a wacky pack-a quacks."

—Tom Wolfe

"America's premier pioneering biological psychiatrist Paul McHugh blows the whistle on sloppy and trendy thinking in psychiatry… A must read."

—Michael S. Gazzaniga, Ph.D., author of Human: The Science Behind What Makes Us Unique

Try to Remember is a riveting account of his battle against the repressed memory movement. It is also a passionate plea for psychiatry as a humane science, grounded in evidence, and focused on helping people in the here and now."

—Michael J. Sandel, author of The Case against Perfection: Ethics in the Age of Genetic Engineering 

 

"… Readers of this splendid book will not forget its central lesson: If psychotherapists do not learn from their colossal mistakes, they will surely repeat them."

—Carol Tavris, Ph.D., co-author of Mistakes Were Made (But Not by Me)

 

 

“Of all the mad ideas that have swept through the practice of psychiatry since Freud first undertook to map the unconscious, probably none has resulted in more cruelty to patients and their loved ones than those that led to the Recovered Memory Movement and its adjunct disease, Multiple Personality Disorder…. Paul McHugh is a healer.”

—Midge Decter, author of An Old Wife’s Tale

 

“…Engagingly written and accessible to a wide audience…a gold mine of fresh insights and constructive suggestions concerning how we can improve our system of psychiatric diagnosis.”

—Richard J. McNally, Ph.D., author of Remembering Trauma

 

"…Never has psychiatry been so simultaneously inundated with real science and with so much pseudoscience…..McHugh explains to uninitiated readers how he learned to tell the difference and where many of his colleagues went wrong."

— Alan Stone, M.D. Professor of Law and Psychiatry, Harvard University

 

 

“…Paul McHugh documents some of the absurd concepts introduced in to psychiatry…his book is of equal interest to those outside the healing professions as it is to those within them.”

 — Sir David Goldberg, Institute of Psychiatry, London, UK

 

 

 

Excerpts

FROM THE INTRODUCTION

What’s wrong with psychiatry? For the better part of my career I have been asking myself and others this question about the profession that has been my life’s work.

I ask it having repeatedly witnessed how faddish misdirections of thought and therapeutic practice sweep across the field to dominate opinion and action for years, only to sink from favor and fade away, leaving wounded patients and public scorn in their wake. One must wonder why psychiatrists learn so little from these misdirections, because they all follow the same pattern: seeing in human mental disorders things that do not exist, building treatment programs that are doomed, and then unapologetically retreating from these claims and therapies to await some other apparition to recapture the profession’s loyalty and attention.

As an appalling example, in the early 1980s, a group of prominent psychiatrists claimed that certain mental symptoms indicated a past history of childhood sexual abuse in patients who insisted they had no memory of such experiences, and they alleged that these symptoms could be relieved if, and only if, the patients “recovered” their memories and dealt with them. Within the decade, this idea gained broad support not only from individual psychotherapists but also from such citadels of authority as academic psychiatric hospitals, psychiatry teaching departments, and even the National Institute of Mental Health in Bethesda. And yet the idea rested on claims unsupported by evidence, on speculation unrestrained by caution, and on the trust in authority that leads patients to accept suggestion. It vividly displayed the foundational vulnerabilities to mischief and misdirection that abides in psychiatric thought and practice.

I write about this episode now because it represents in almost pure form the kind of error that psychiatrists regularly fall into and thus has a clear message to teach. I was someone with a front-row seat in American academic psychiatry, who witnessed the injuries to people it exacted, and who, in protesting against it, came upon—as I had before—the power of this discipline to protect itself from criticism. I can tell the story from start to finish and believe that by describing it fully I can accomplish several useful objectives. Not only may I help prevent its repetition and mitigate the willingness of the public to accept such incoherence from psychotherapists, but I can explain just how proper psychiatric practice is carried out and what patients should expect from doctors and therapists as they strive to bring them the best treatments.

In this book, I will describe the calamitous course of the recovered memory movement in psychiatric practice and how the theories on which it was based proved invalid and pernicious. Eventually the public, to its amazement, came to realize that, with the procedures promoted by psychiatric “experts,” a craze reminiscent of the Salem witch hunts had emerged from the psychiatric clinics. Several components, each of interest in itself, make up the story I plan to tell.

The first component describes some of the clinical incidents I encountered. They reveal what I learned from patients and their families as the idea of repressed memory emerged, promoted by a group of zealots so confident of their mission that they never questioned the dangerous and crude therapeutic practices they employed. I describe my part in the history, when—to the mortification of psychiatrists with any pride in their discipline—reform had to come not from the profession itself but from the civil government, which intervened to preserve social justice in the face of vicious abuse of authority and license.

The second component considers the long-term implications of this calamity for the psychiatric discipline. The most obvious effect is the general public’s current distrust in the judgment and even the integrity of psychotherapists. This is not a trivial matter, given that people fearful of mistreatment may resist turning to the help they need. What constitutes proper and safe psychotherapeutic practices must be made clear again.

A subtle but momentous implication is the repressed memory movement’s discrediting of Freudian psychoanalysis. A cozy niche for psychoanalysis was disrupted by the movement’s disastrous misdirection, but as I shall strive to make clear, Freudianism regrouped, somewhat chastened, but just as determined to legitimize equally fallacious if not so crudely injurious views about mental disorders and their causes.

The third and final component of the story deals with the practical questions that dawn on people after any disaster. These include questions of an immediate kind, such as where they or relatives can find services worthy of their trust and how they might protect themselves if another fad or mistreatment emerges in the future...

FROM CHAPTER ONE

A parable familiar to doctors speaks of a man rescuing people from a river—pulling them to safety as they splash helplessly past. He keeps at it: saving some, losing others, fighting the current, suffering the cold. At last he grasps what should have been obvious to him earlier and scrambles upstream to find out who’s throwing these people in. There he discovers a tough gang and faces a new, more difficult challenge.

The parable fits my story. Over the course of eight months in 1990, I tussled with three incidents that I never fully grasped until I looked “upriver.” There I found a group of psychiatrists producing my “downstream” experiences. Their practices and ideas—throwbacks, I thought, to discredited ways of the past—were gathering authority, taking on recruits, and dominating the rounds and conferences of many psychiatric educational programs. They were beginning to move into the public realms of civil and criminal law, where, like witch-hunters of old, they were threatening the defenseless and would ultimately shake public trust in psychiatry.

This discovery drew me into what was the biggest professional battle than I’d ever encountered over matters that were fraught with human meaning and supported by zealous and vocal advocates with whom I would have to quarrel. The quarrels would spill out of the hospital and my office, propelling me into courtrooms for testimony and distant legal offices for depositions, into surly confrontations in auditoriums and ugly professional exchanges in journals, into public attention and private miseries...