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The growth in the USA of ‘recovered memory therapy’ for past sexual abuse has caused great public and professional concern. It became apparent that the polarisation of views and fierce controversy within the American psychiatric community was in danger of bringing psychotherapy into disrepute and it seemed important to examine objectively the scientific evidence before such polarisation developed in the UK.
A small working group reviewed their own experience, visited meetings and centres with expertise in this field, interviewed ‘retractors' and accused parents, and then began a comprehensive review of the literature.
There is a vast literature but little acceptable research. Opinions are expressed with great conviction but often unsupported by evidence.
The issue of false or recovered memories should not be allowed to confuse the recognition and treatment of sexually abused children. We concluded that when memories are ‘recovered’ after long periods of amnesia, particularly when extraordinary means were used to secure the recovery of memory, there is a high probability that the memories are false, i.e. of incidents that had not occurred. Some guidelines which should enable practitioners to avoid the pitfalls of memory recovery are offered.
A recent working party report published by the Nuffield Provincial Hospitals Trust (1996) made a series of recommendations for the improvement and better coordination of existing services. This comes at a time when new and expensive counselling services are springing up everywhere, the most ambitious being the British Medical Association's 24-hour counselling service for doctors and their relatives.
The APA is concerned about its declining membership. Only 16 700 psychiatrists were able to attend this year's meeting in New York and many of them came mainly to consult the job bureau in search of employment. For the first time unemployment is a real issue for psychiatrists as health care providers restrict services and seek alternative and cheaper patterns of care. Most health care organisations have lists of approved psychiatrists and anyone not on that list is not able to claim reimbursement for their services. Exclusion may be because of unreported and unchallenged complaints about care or conduct or a penchant for expensive drugs or high risk therapies. In this context a high risk therapy is one which exposes the insurers to a high risk of litigation, such as ‘recovered memory therapy’. The buzz in the corridors, which used to be of art collections, the new home by the lake or the costs of putting the kids through college, is now of managed care. These dread words reduce the most ebullient colleagues to anger or tears. Some time ago I reported in amazement the discussions at an earlier meeting on alien abduction, ritual abuse, multiple personality disorder (110 different individuals in one body was then the record) and the false memory syndrome.
The annual meeting of the American Psychiatric Association is always something of a jamboree but this year its Sesquicentennial Celebration (1844–1994), held in its birthplace Philadelphia PA, was especially splendid with a birthday gala held in the elegant and richly endowed Art Gallery. However, attendance at the Philadelphia meeting was disappointing with only 15,000 delegates.
During Phase II of the Cross-National Panic Study, descriptions of the patient's last severe panic attack were collected for 1168 patients. Statistical analysis indicated that patients could be divided into two groups, characterised by the presence or absence of prominent respiratory symptoms. The two groups did not differ on demographic variables or coexisting diagnoses, but they did differ on psychopathology on entry to the study and treatment outcome. The group with prominent respiratory symptoms suffered more spontaneous panic attacks and responded to imipramine, whereas the group without prominent respiratory symptoms suffered more situational panic attacks and responded more to alprazolam. It is important to distinguish spontaneous and situational panic attacks, to aid choice of treatment.
Ernest (Ernie) Gruenberg was born in New York City on 2 December 1915 and died in Washington on 2 July 1991. He was the second son of Ben, an educator, and Sidonie, founder of the Child Study Association of America, who together produced one of the earliest books for the sex education of children.