For generations, our society has wondered about how best to heal people who have experienced terrible things in childhood.
Should these memories be unearthed, allowing their destructive power to disappear? Should they be gently molded into something less painful? Or should they be left untouched?
Researchers from King’s College London and City University of New York examined this conundrum by conducting an unusual experiment.
Researchers interviewed a group of 1,196 American adults repeatedly over a 15-year period about their levels of anxiety and depression. Unbeknownst to the subjects, 665 of them were selected because court records showed they had suffered maltreatment such as physical abuse, sexual abuse or neglect before the age of 12.
Not all of them told researchers they had been abused, though — and that accounts for a big difference.
492 adults who reported maltreatment and had court records confirming the abuse had higher levels of depression and anxiety than a control group with no documented history of abuse, according to study, which is published last week in JAMA Psychiatry. The 252 subjects who reported being abused without court records reflecting this also had higher rates.
But the 173 subjects who didn’t report being abused, despite court records showing it had happened, had no more anxiety than the general population.
The findings suggest how people frame and interpret events in their early childhood strongly 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 comes back to the almost constant message, that this is what you make of the experience,” he said. “If you can change how you interpret the experience, if you feel more in control of the present, that’s something that can improve mental health in the long term.”
In a meta-analysis in 16 studies of childhood maltreatment published in 2019, Dr. Danese and colleagues found that 52 percent of people with records of childhood abuse did not report it in interviews with researchers, and 56 percent of those who reported it had no documented history of abuse.
This difference may be partly due to measurement problems – court records may not contain all histories of abuse – and may also reflect that self-reporting of abuse is influenced by levels of of a person’s anxiety and depression, said Dr. Danish.
“There are many reasons why people may forget, in some ways, those experiences, and other reasons why others may misinterpret some of the experiences as neglect or abuse,” she said.
But even considering these caveats, he said, it’s notable that adults who have a documented history of abuse but don’t report it — because they have no memory of the events, differ their interpretation or chose not to share those memories with the interviewers. – seems healthier.
“If the meaning you give to these experiences is not so central to how you remember your childhood that you don’t feel the need to report it, you’re more likely to have better mental health over time,” he says.
Traumatic childhood experiences have been the subject of some of psychiatry’s fiercest battles. Sigmund Freud postulated early in his career that many of his patients’ behaviors indicated a history of childhood sexual abuse but later retracted, attributing them to subconscious desire
In the 1980s and 1990s, therapists used techniques such as hypnosis and age regression to help clients uncover memories of childhood abuse. Those methods retreated under a barrage of criticism from mainstream psychiatry.
Recently, many Americans have received therapies designed to manage traumatic memories, which have proven effective in the treatment of post-traumatic stress disorder. Experts are increasingly advocating screening patients for adverse childhood experiences as an important step in providing physical and mental health treatment.
New findings in JAMA Psychiatry suggest therapy aimed at alleviating depression and anxiety by trying 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 an endorsement of avoiding distressing memories, which could make them “scarier” in the long run. Instead, they point to the promise of therapies that aim to “reorganize” and moderate memories.
“It’s not about erasing the memory, but having the memory and being more in control of that so that the memory is less scary,” he said.
Memory always poses a challenge in the field of child protection because many abuse cases involve children under 3, when long-term memories begin to form, said David Finkelhor, the director of Crimes Against Children Research. Center at the University of New Hampshire, who was not involved in the study.
In treating people with histories of abuse, he said, clinicians must rely on incomplete, incomplete and shifting accounts. “All we have are their memories, so we don’t have a choice,” he said.
He cautions against concluding that forgotten mistreatment has no lasting effects. Early abuse can appear through what he describes as “residues” — difficulty modulating emotions, feelings of worthlessness or, in the case of victims of sexual abuse, the urge to give of sexual pleasure to others.
Elizabeth Loftus, a psychologist at the University of California, Irvine, and a noted skeptic of the reliability of abuse memories, said the study jumps to another conclusion that the data may support: Forgetting the abuse can be a healthy response.
“They might have said, people who don’t remember in some ways are better, and maybe you don’t want to mess with them,” he said. “They don’t say that, and that, to me, is of great interest.”