For generations, our society has questioned the best way to heal people who have experienced terrible things in their childhood.
Do these memories need to be exhumed so that their destructive power can disappear? Should they be gently molded into something less painful? Or should they remain untouched?
Researchers from King’s College London and the City University of New York explored this conundrum by conducting an unusual experiment.
Researchers repeatedly interviewed a group of 1,196 American adults over 15 years about their levels of anxiety and depression. Unbeknownst to the subjects, 665 of them had been selected because court records showed they had been subjected to maltreatment, such as physical abuse, sexual abuse, or neglect, before the age of 12.
However, not all of them told investigators that they had been abused — and that related to a big difference.
The 492 adults who reported being abused and had court records substantiating the abuse had significantly higher levels of depression and anxiety than a control group with no documented history of abuse, according to the study, published last week in JAMA Psychiatry. The 252 subjects who reported being abused with no court documents reflecting this also had higher levels.
But the 173 subjects who did not report being abused, despite court records showing that it happened, suffered no more than the general population.
The findings suggest how people shape and interpret events in their early childhood and powerfully shape their mental health as adults, said Dr. Andrea Danese, a professor of child and adolescent psychiatry at King’s College London and one of the study’s joint authors.
“It goes back to almost the stoic message, that it’s what you make of the experience,” he said. “If you can change how you interpret the experience, if you have more control in the moment, that’s something that can improve mental health in the longer term.”
In a meta-analysis of 16 child abuse studies published in 2019, Dr. Danese and colleagues found that 52 percent of people with a history of child abuse did not report it in interviews with researchers, and 56 percent of those who reported it had no documented history of abuse.
This discrepancy may be due in part to measurement issues — court records may not include all history of abuse — and may also reflect that self-reporting of abuse is influenced by a person’s levels of anxiety and depression, said Dr. Danish.
“There are many reasons why people somehow forget those experiences, and other reasons why others misinterpret some experiences as neglect or abuse,” he said.
But even considering these caveats, he said, it was remarkable that adults who had a documented history of abuse but failed to report it — because they had no memory of the events, interpreted them differently or chose not to share those memories with interviewers. sharing – seemed healthier.
“If the meaning you give to these experiences isn’t central to how you remember your childhood so you don’t feel like you have to report it, you’re more likely to have better mental health over time ,” he said.
Traumatic childhood experiences have been the subject of some of the fiercest battles in psychiatry. Early in his career, Sigmund Freud hypothesized that much of his patients’ behavior indicated a history of childhood sexual abuse, but later relapsed and attributed them to subconscious desires.
In the 1980s and 1990s, therapists used techniques such as hypnosis and age regression to help clients uncover memories of childhood abuse. Those methods subsided under a barrage of criticism from mainstream psychiatry.
Recently, many Americans have embraced therapies designed to manage traumatic memories, which have been shown to be effective in treating post-traumatic stress disorder. Experts are increasingly advocating screening patients for adverse childhood experiences as an important step in the management of physical and mental health.
The new findings in JAMA Psychiatry suggest that therapy that attempts to alleviate depression and anxiety by attempting to unearth repressed memories is ineffective, said Dr. Danese, who works at the Institute of Psychiatry, Psychology & Neuroscience at King’s College.
But he cautioned that the study’s results should not be interpreted as confirming avoidance of disturbing memories, which could make them “scarier” in the long run. Instead, they point to the promise of therapies that attempt to “reorganize” and moderate memories.
“It’s not about erasing the memory, it’s about having the memory and having more control over it so that the memory feels less scary,” he said.
Memory has always been a challenge in child protection, as many abuse cases involve children under the age of 3, when lasting memories begin to form, said David Finkelhor, the director of the Crimes Against Children Research Center at the University of New Hampshire, who was not involved in the investigation.
When treating people with a history of abuse, he said, clinicians must rely on vague, incomplete and mixed records. “All we have are their memories, so it’s not like we have a choice,” he said.
He warned against the conclusion that forgotten abuse has no lasting effect. Early abuse can arise from what he described as “residuals” — difficulty modulating emotions, feelings of worthlessness, or, in the case of sexual abuse victims, the urge to provide sexual gratification to others.
Elizabeth Loftus, a psychologist at the University of California, Irvine, and a prominent skeptic of the reliability of memories of abuse, noted that the study ends with another conclusion that the data might support: forgetting abuse can be a be a healthy response.
“They could have said, people who somehow don’t remember are better off, and maybe you don’t want to mess with them,” she said. “They don’t say that, and that’s very important to me.”
