martes, 6 de mayo de 2008

Niños con abusos sexuales

From mquiroga@...
Adjunto archivo que trata sobre los problemas de memoria en los niños víctimas de abuso sexual. Lo encuentro interesante por lo reciente de su publicación, su amplio contenido y la fuente de la que procede.

The Royal College of Psychiatrists 17 Belgrave Square, London Press Release - Embargoed until Wednesday 1st April 1998

Doubts Cast on Validity of Recovered Memory Therapy

A comprehensive review of the literature on recovered memories of childhood sexual abuse has concluded that when 'memories' are recovered after long periods of amnesia, particularly when questionable techniques were used to recover them, there is a high probability that the memories are false.

Published in the April 1998 issue of the British Journal of Psychiatry, the review article by Professor Sydney Brandon and colleagues presents the conclusions of an overview of recovered memories and the techniques used to elicit them. This follows last year's publication of consensus recommendations for good practice (Royal College of Psychiatrists Working Group on Reported Recovered Memories of Child Sexual Abuse, 1997).

A recovered memory, in the context of this paper, is the emergence of an apparent recollection of childhood sexual abuse of which the individual had no previous knowledge. A false memory is the recollection of an event which did not occur, but which the individual subsequently strongly believes.

The paper distinguishes different types of memory, namely episodic, autobiographical and implicit. Numerous studies in children and adults have found that psychologically traumatic events often result in an inability to forget, rather than a complete expulsion from awareness. Amnesia for prolonged recurrent abuse is rare. Adult patients suffering from amnesia are well aware of the gap in their memory. It has not been possible to demonstrate any clear link between clinical accounts of trauma and the neurobiology of memory.

Memory changes overtime and is subject to error and distortion

A growing body of research indicates that memory is fallible and vulnerable to suggestion; and that suggestibility and confabulation increase with the length of time between the events and later attempts to recall it.

The authors conclude that individual autobiographical memory is unreliable, and that people are often unable to remember considerable parts of their past experiences. Expectations and beliefs can colour people's recollections, and gaps in memory will be filled to create a "life story" which they find satisfying.

Confidence in one's memory does not correlate with the accuracy of the memory. No autobiographical memory can be relied on without some external corroboration, but the frequent denial, even by proven abusers, and the secrecy surrounding child abuse often make such corroboration difficult to obtain.

Memory enhancement techniques questioned

Therapists may use a number of techniques, some of which are regularly employed in orthodox therapy but are questionable when used as 'memory recovery' procedures. These include:

Check Lists: there is no evidence that any check lists, syndromes, symptoms or signs indicate with any degree of reliability that an individual has been sexually abused in the remote past.

Drug-induced abreaction: it is inappropriate to use repeated abreaction to 'trawl' for traumatic events. There is considerable anecdotal clinical evidence that in repeated session patients will eventually generate material which is a product of fantasy. Even in a single session of abreaction great caution is required.

Hypnosis: this technique has been shown to be unreliable as a means of eliciting memories of past events, and such 'memories' are no longer admitted as legal testimony.

Age regression: there is no evidence for the efficacy of this technique, nor can it be shown that the subject's 'memories' actually do regress to the target age.

Dream interpretation: there is no evidence that dreams are a 'royal road' to historical accuracy; and interpretations usually reflect the training and personal convictions of the therapist.

Imagistic and 'feelings' work and art therapy: although many of these techniques are applications of accepted clinical practice, they can be powerfully suggestive and induce trance-like states. The beliefs of the therapist are the determining factor in how a patient's production are shaped.

Survivors' groups: whilst these can be supportive, the practice of mixing those who clearly remember abuse with those who are suspected by the therapist of having repressed their memories has been strongly criticised because of the risk of suggestion and contagion among group members.

The authors conclude that memory enhancement techniques do not actually enhance memory, and that there is evidence that they can be powerful and dangerous methods of persuasion. Many of the memories 'recovered' by these measures refer to events in the early months and years of life, which fall within the period of infantile amnesia, and must be regarded as implausible for that reason. The evidence suggests that all the techniques outlined above can create entirely new and false memories, not only experimentally but also in clinical practice.

Can repeated, severe childhood abuse be forgotten?

There is no evidence that memories can be 'blocked out' by the mind, either by repression or by dissociation. Given the prevalence of childhood sexual abuse, even if only a small proportion of memories are repressed and only some of them subsequently recovered, there should be a significant number of corroborated cases recovered through psychotherapy in the literature. In fact, there is none.

Distortion of memory may occur in any therapeutic situation, and psychiatrists need to be aware of the techniques employed by other members of their teams, such as community psychiatric nurses, psychologists and social workers.

The review paper ends with a series of guidelines to help psychiatrists to avoid the pitfalls of memory recovery. The issue of false or recovered memories should not, the authors emphasize, be allowed to confuse the recognition and treatment of sexually abused children. However, it is also essential to minimise the risk of creating false memories of abuse which will cause the patient and family further suffering.

More research is needed into the reported associations between childhood sexual abuse and later adult psychopathology. The authors conclude that at present there is no specific post-sexual abuse syndrome.


For press copies of the paper or further information contact Deborah Hart or Vanessa Harries Tel: 00 44 171 235 2351 ext 127 or 154 E-mail: dhart@rcpsych.ac.uk or vharries@rcpsych.ac.uk Fax: 0171 245 1231