Hypnosis and the Iatrogenic Creation of Memory
Cultic Studies Journal, Volume 14, Number 2, 1997, pages 172-206
Hypnosis and the Iatrogenic Creation of Memory: On the Need for a Per Se Exclusion of Testimony Based on Hypnotically Influenced Recall
Robert A. Karlin, Ph.D.
Rutgers University
Martin T. Orne, M.D., Ph. D.
University of Pennsylvania
Abstract
An overview of Karlin and Orne (1996) and related research shows why hypnotically influenced testimony is more unreliable and misleading than testimony based on ordinary recall. McConkey and Sheehan’s (1995) report on a recent series of forensic hypnosis cases is then used to illustrate the need for a per se exclusion. Next, several points raised by Scheflin (1996) are discussed. First, as in Amytal interviews -- whose per se exclusion most scholars accept -- testimony influenced by hypnosis tends to be believable, vivid, and misleading. Second, Scheflin’s (1994, 1996) challenge to per se exclusion based on the case of an abused child is answered. Third, the time course of Ms. Borawick’s hypnotically influenced retrieval of putative abuse memories is examined. Fourth, consideration is given to the inherent incredibility of Ms. Borawick’s claims and the costs of debating the admissibility of such testimony on a case-by-case basis. Combining clinical hypnosis and psychotherapy will not result in objectively reliable memories, since each procedure encourages recall that may be subjectively important, but is often historically inaccurate. In the therapeutic context a lack of understanding of iatrogenic effects is hazardous, and hypnotically influenced testimony, with rare and easily specifiable exceptions, should be automatically excluded at trial.
In this paper, we will first review some of the points we made in our original paper (Karlin & Orne, 1996). Then, we will comment directly on points Scheflin (1996) made and answer the challenge he laid down in that paper. We will pay special attention to the notion that safeguards for forensic hypnosis will protect the fact-finding process from the distortions inherent in admitting hypnotically influenced testimony.1 Finally, we will briefly review the evidence for the contention that memories emerging from hypnotic procedures during psychotherapy are somehow more likely to be historically factual than hypnotically based memories recovered in other contexts.
An Overview of Our Original Paper
Hypnotic procedures produce testimony that, for a number of reasons, is less reliable than ordinary recall (cf. Dinges et al., 1992; Orne, Soskis, Dinges, & Carota Orne, 1984). First, a standard hypnotic induction asks people to relax, close their eyes, and experience, for example, a motor movement that “happens by itself.” Response to such suggestions requires one to lower critical judgment temporarily (e.g., ignore the absurdity of the idea that one’s hands can move by themselves) and blur the boundary between fantasy and reality. Second, when hypnosis is used to “refresh recollection” the participation of authorities (from the police to an expert hypnotist) and expenditure of time and effort suggest strongly that memory change through hypnosis is possible and expected. Any subsequent change is also legitimized by hypnosis.
Further, given the demand characteristics inherent in hypnosis (cf. Orne, 1959, 1970), it is unsurprising that hypnotic suggestions for increased memory result in heightened production of information. However, it is also unsurprising that much of the new material gained in hypnosis is incorrect (cf. Carota Orne, Whitehouse, Dinges, & Orne, 1996; Whitehouse, Dinges, Carota Orne, & Orne, 1988). Hypnosis also often produces an overall increase in confidence about both correct and incorrect memories; this increased confidence weakens the usual correlation between certainty and accuracy, and “confident errors” result (cf. Sheehan, 1988). Consequently, a jury may be presented with a factually incorrect witness who provides vivid detail with more confidence than is warranted. And juries are swayed by witness confidence and detail, both of which hypnosis promotes. Finally, subjects are generally unable to discriminate accurately what they remembered of the original events before hypnosis, what material they learned subsequently from other sources, and what additional material they remembered during hypnosis (Whitehouse, Carota Orne, Orne, & Dinges, 1991).
When we take together the decreased critical judgment, the blurring of the boundary between fantasy and memory, the increase in certainty unrelated to accuracy, the misattribution of whether information was learned during hypnosis or before it, and the fact that hypnosis makes a major change in memory credible, we find a formidable basis for automatically keeping hypnotically influenced testimony out of court.2
It is noteworthy that all the effects just indicated are part of the social psychology of the hypnotic context; they are not dependent on the hypnotizability of the specific subject. For example, research in the second author’s laboratory has shown a greater increase in memory errors among low hypnotizable subjects in a hypnotic condition than in a nonhypnotic condition during repeated recall trials. Further, lows who underwent waking and hypnotic recall trials displayed more source misattribution than their counterparts whose recall trials were both nonhypnotic. Moreover, all groups of subjects tended to misattribute their memories to nonhypnotic rather than hypnotic recall trials (Carota Orne et al., 1996; see also Dinges et al., 1992; Whitehouse et al., 1991). Thus, contrary to Scheflin’s (1996) assertions, these and other recent findings have supported the early 1980s appellate court decisions that automatically excluded hypnotically influenced testimony (e.g., People v. Shirley, 1982) and the American Medical Association’s (1985, 1994) repeated calls for such restrictions. Further, contrary to Scheflin’s (1996) views, these studies clearly distinguish hypnotizability as a stable individual difference dimension, measured by overt response to standardized hypnotic suggestions, from the effects of hypnosis as a social psychological context and an invitation to a particular cognitive style.3
Additionally, if a subject is relatively highly hypnotizable, the suggestions to relive events that routinely follow hypnotic induction in the forensic context may have additional effects. First, the frequent inclusion of confabulated, vivid detail in the new material makes hypnotically influenced memories more credible (Dywan, 1995). Also, fantasies entirely unrelated to what actually occurred may also be suggested during hypnosis and remembered as veridical (Laurence, Nadon, Nogrady, & Perry, 1986; Laurence & Perry, 1983). This is especially the case when there are no clear original memories to overlay (cf. Orne, 1979; see also Karlin, 1983) or when, as in civil cases, the hypnotized party has a strong interest in “remembering” one version of events (cf. Karlin, 1997; State v. Hurd, 1981). Finally, more highly hypnotizable subjects may subjectively relive events and vividly experience a version of the past. Unfortunately, vividness has no relation to historical accuracy, but again increases confidence inappropriately (cf. Frankel, 1994).
The use of hypnosis to increase memory is often justified by the notion that it allows people to overcome the effects of traumatically induced psychogenic amnesia (cf. Kanovitz, 1992). In our original paper, we noted that psychogenic amnesia (as distinguished, for example, from unwillingness to remember, ordinary forgetting, and failure to originally encode information) is a very rare phenomenon. Combined, the two authors of this paper have more than 50 years of clinical experience in this area; we have seen a total of three such cases.4
Moreover, while psychogenic amnesia is very rare, psychogenic fugues are rarer still. Multiple personality disorder (MPD), now called dissociative identity disorder (DID), is a combination of quickly shifting fugues and highly specific amnesias. At present, the disorder is rarely diagnosed outside of North America and Holland; the limited geographic nature of this disorder is an indication that it occurs only when viewed as a legitimate social role (cf. Orne & BauerManley, 1991; Spanos, 1996). In this way it is unlike other forms of severe psychopathology, such as major depression, schizophrenia, and bipolar disorder, whose incidence is relatively the same cross-culturally (Davison & Neale, 1996). Further, the mental mechanisms DID requires contradict a good deal of what is scientifically known about memory. Moreover, DID has a very high rate of comorbidity with borderline personality disorder (BPD); BPD patients tend to welcome melodramatic roles irrespective of their content. Additional factors are described by Karlin & Orne (1996) and by Spanos (1996); all lead to the view that the present form of DID is largely, if not entirely, iatrogenic.
Turning to horrific memories for the remote past, supposedly lost for decades and recovered in relatively pristine, highly accurate form, we seem to be encountering another largely iatrogenic phenomenon. Interestingly, such recovered memories have frequently included stories of satanic ritual abuse, as for example, Ms. Borawick’s story did. In fact, the Witches’ Sabots routinely described in such stories are quite similar to descriptions of Sabots current during the Middle Ages. However, careful scholarship has established that such tales were fantasies in the Middle Ages as well as now (Mulhern, 1994). Moreover, law enforcement efforts to track down any satanic cults in question have led to the conclusion that they do not exist (Lanning, 1991). This, among other reasons, would lead us to believe that fantasy often plays a major part in the creation of recovered memory narratives.
Based on these and other factors, both the United States District Court, District of Connecticut and the U.S. Court of Appeals for the Second Circuit refused to admit Ms. Borawick’s recovered memories of incest and satanic ritual abuse (Borawick v. Shay, 1995). In this regard, the Borawick courts acted similarly to the vast majority of courts asked to admit accounts of memories recovered after long periods of amnesia. With rare exceptions, our courts have deemed such testimony more likely to lead us away from the truth than towards it, and therefore inadmissible.
Note that the present authors do not believe that all recovered memories, even all those elicited with hypnosis, are false. But examining the data with a Bayesian analysis, whose assumptions lowered the proportion of false positives below realistic expectations, we computed that of 40 cases of carefully diagnosed recovered memories of sexual child abuse, between 29 and 35 out of 40 diagnoses would be false positives. This proportion was consistent with those found in the similarly conservative analyses of Lindsay and Read (1994) and of Kihlstrom (in press).
We also pointed out that therapy is usually a powerful, but benign process, with effect sizes ranging from about .8 to 1.1 or 1.2. [In comparison, a 9month reading program causes a change of about 0.6 standard deviations in children’s reading skills (Lindsay & Read, 1994).] However, diagnoses of DID and of recovered memories of sexual abuse often lead to lengthy treatments that for the most part seem to often do more harm than good. For example, in the State of Washington a fund designated for the victims of crime was used to pay for recovered memory therapy. However, payment was discontinued recently when a follow-up showed patients getting worse, not better, with intensive, lengthy recovered memory therapy.
Similarly, the particular method of treatment of dissociative identity disorder in which aspects of the self are reified, interacted with, and legitimized as separate entities, is not only lengthy, intensive, and unimpressive in outcome, but also detrimental to a cohesive view of self. On the other hand, both of the present authors have had clinical success treating patients with similar disorders of self using less intensive traditional psychotherapy and/or cognitive behavior therapy. The core strategy in these less melodramatic successes involves both overtly and subtly helping the patient assume full responsibility for conflicting impulses and emotions (Orne & BauerManley, 1991).
Looking at the recent history of psychotherapy, one of the few other ways that therapy has been harmful occurs when a third party not involved in the therapy is blamed for the patient’s problems. Parents have been the consistent target of such accusations, and until quite recently, mothers were seen as centrally at fault. For example, starting in the late 1940s and continuing into the 1970s, some therapists blamed schizophrenia on mothers confusing their children with “double bind” communication (cf. Bateson, Jackson, Haley, & Weakland, 1956). More recently, careful investigation has shown “double binds” to be entirely unrelated to the etiology of schizophrenia (cf. Davison & Neale, 1996). But picture the pain created by this kind of accusation. Schizophrenia is a terrible, crippling disorder. It has about a 10% mortality rate and badly maims the lives of most of those left alive. Blaming parents for the disorder would be analogous to having family physicians telling close relatives they are responsible for a patient’s Alzheimer’s disease!
Likewise, in the 1960s and 1970s, psychiatrists and psychologists accused mothers of causing their children’s disorders with a variety of other “errors” ranging from overprotectiveness to failure to breast-feed (cf. Cheek, 1975). Again, these accusations proved largely or entirely baseless. What was seemingly occurring in all these cases is that, for some therapists, the creation of a coherent narrative routinely requires finding someone to blame. Mothers and fathers were vulnerable to such accusations as parents were both salient and not part of the therapeutic dyad involved in narrative creation. We now understand that the narrative created in therapy is fictive, a subjective history, not an objective one (cf. Spence, 1994). Unfortunately, if therapists support this particular form of narrative creation as accurately reflecting real world events, a patient’s chance of family life usually is destroyed, cutting him or her off from a major source of emotional and economic support.
One would think we would have learned from these mistakes; seemingly, many have not. Today’s victimology largely blames male relatives, usually fathers, for severe psychological conditions, such as BPD, DID, and posttraumatic stress disorder (PTSD). These are serious afflictions, and the crimes said to cause them are malignant, most often involving sexual abuse during childhood. We acknowledge that childhood sexual abuse is a far larger and worse problem than are false memories of childhood sexual abuse, but we consider the latter, as well as the former, tragic.
Along with perceiving epidemic levels of childhood sexual abuse, some therapists see their patients as routinely forgetting traumatic events that these therapists believe must have occurred. However, studies of memory have shown that the central events in highly emotionally charged situations are remembered better, not worse, than other memories (Christianson, 1992; Lindsay & Read, 1994). For example, in the vast majority of cases in which verifiable, lengthy exposure to severe combat stress results in PTSD, one bothersome symptom is the intrusion of unwanted memories into both waking and sleeping. In these cases, it is the inability to forget, not the inability to remember, that is problematic.
Since postulating widespread traumatic amnesia contradicts what we know about the way memory works, a variety of theories have evolved to describe the unique circumstances that make memories of abuse unlike memories of all other kinds. These range from the seemingly absurd view that if abuse happens once you will remember it; if it happens many times you will forget it (cf. Terr, 1991), to the highly speculative and entirely unsupported notion that betrayal is so awful that children must forget it (cf. J. Freyd, 1996). Again, this is not to say that cases of traumatic amnesia do not occur; we have seen them. They are simply very rare.
Unfortunately, those arguing that psychogenic amnesia is common often fail to distinguish between the inability to remember, consciously deciding to avoid thinking about unpleasant experiences, ordinary amnesia for childhood events, unwillingness to discuss embarrassing events, and simple forgetting (Lindsay & Read, 1994). For example Terr’s (1991) view is more parsimoniously explained by the fact that when multiple similar events occur, we remember what happened in general, but forget many of the details of specific instances (Hudson & Nelson, 1986; Linton, 1975). Recent work on children’s memories about Voiding Cystourethrogram Fluoroscopy, a medical procedure involving painful, forced contact with the genitals (i.e., catheterization through the urethra and liquid infusion into the bladder that may be repeated a number of times) failed to reveal Terr’s (1991) hypothesized multiple incident forgetting effect (Goodman, Quas, BattermanFaunce, Riddlesberger, & Kuhn, 1996).
The lack of distinction among these very different reasons for not reporting an event may be seen throughout the literature in this area (e.g., Harvey & Herman, 1996). For example, in the often cited study by Williams (1994), a large majority of those did not mention the specific abuse incident remembered abuse on other occasions than the one that precipitated their inclusion in the study. As for unwillingness to report embarrassing events, Williams (1994) interviewed her subjects at length, but on only one occasion. Other research (Femina, Yaeger, & Lewis, 1990) has clearly shown that multiple interviews often result in information being revealed that subjects were unwilling or unable to share during an initial session.
Additionally, as Dawes (1997) has recently pointed out, those who support the veridical nature of reports based on previously repressed memories universally seem to misunderstand what can be concluded from correlational research. Almost all the nonanecdotal research in this area compares allegedly traumatized subjects to controls. In such studies, the differences among subjects were there prior to the study (not created during the study); these studies are correlational research, comparing participants differing in history and physiology. Any such preexisting differences, measurable and unmeasurable (literally an infinite number), may be responsible for the relationship between the studied variables. As an illustration, consider the fact that early morning awakening and suicide are related, but waking early does not cause people to become suicidal. Rather, both the circadian phase advance signaled by early wakening and suicidal dysphoria are caused by the (still elusive) biochemical lesion underlying major depressive disorder (Davison & Neale, 1996).
Few would mistake causality in the case of suicide and early awakening, but the limitations of correlational research that studies the effects of trauma are sometimes not so obvious. For example, van der Kolk (1996) frequently views differences in brain function between patients with PTSD diagnoses and their controls as caused by trauma and its consequences. However, there are multitudinous differences between the PTSD and control groups, and any one of these unobserved and/or unimagined differences may be responsible for the relationship he, in our view mistakenly, reports as causal.5
Finally, we described recovered memory therapy. In a typical scenario, a therapist sees a patient with a common problem, such as physical symptoms of unclear etiology. Associating the problem with the possibility of a history of childhood sexual abuse, the therapist asks the patient to explore the possibility of sexual abuse, using hypnotic age regression or forms of “disguised hypnosis” (Perry, 1995) such as guided imagery and regression work. In some dyads, a strongly suggestive environment is created, in which the therapist assumes that the patient must remember childhood sexual abuse in order to get better (cf. Lindsay & Read, 1994). Failure to remember is seen as resistance to facing the awful truths of the past. Once “memory” has been created, the patient is often encouraged to have little or no contact with her parents, or even with siblings who do not support her view of the past. Years of alienation routinely follow. As social support, the patient is encouraged to join “survivors’ groups,” with inclusion dependent on support for the belief that oneself and all the other group members have been sexually abused as children. The similarity to the familial alienation typical of cults is unmistakable.
Does Hypnotically Influenced Testimony, Elicited Under Optimal Conditions, Routinely Aid or Injure the Fact-finding Process?
Although claims for the accuracy of testimony based on hypnotically influenced recall have been made (cf. Reiser, 1980), they remain unsubstantiated. With published exceptions so rare that they may be considered historic oddities, we do not know of cases in which hypnotically influenced testimony in court clearly has aided the cause of justice. In the famous Chowchilla kidnapping (Kroger & Doucé, 1979), where hypnosis seemingly helped a witness remember enough of a license plate to facilitate solving the crime, the witness was never needed to testify at trial. Rather, hypnosis was used as we and the AMA task force suggest it be used: to generate leads, but not testimony in court. (Analogously, you can use a medium to generate leads; but you do not put the medium on the witness stand.) Even in Rock v. Arkansas (1987) in which the U.S. Supreme Court decided that a defendant had a constitutional right to tell her story though it had been elicited through hypnosis, the role of hypnosis in the service of fact finding was questionable. The Rock case finally ended in a plea bargain, and many found Rock’s hypnotically influenced memory that the shooting was accidental both selfserving and improbable.
On the other hand, hypnotically altered memory has often proved misleading (e.g., People v. Shirley, 1982) or simply incorrect (e.g., People v. Kempinski, 1980) whether that memory is a change from previous recall, or entirely de novo (see also Karlin, 1983, 1997). Our own experience is negative enough for us to favor a per se exclusion of hypnotically influenced testimony (cf. Orne et al., 1984).
In considering the question of the frequency with which hypnosis has a greater probative than prejudicial value, it seems reasonable to examine the series of cases recently reported by McConkey and Sheehan (1995) in a monograph Scheflin (1996) recognized as authoritative. This small series of cases is important, as McConkey and Sheehan have been among the foremost researchers in the field of memory and hypnosis, and their forensic work was done in accord with an intricate and relatively comprehensive set of safeguards for the use of forensic hypnosis. So their work is Aas good as it gets.”
There are nine case histories in McConkey and Sheehan’s (1995) text. The first three, in which hypnosis was done by lay hypnotists, are used as examples of how not to perform forensic hypnosis. The authors then suggest safeguards to avoid the types of egregious errors found in such cases. Following their safeguards, the authors report hypnotizing witnesses in three murder cases. All three cases remained unsolved, with forensic hypnosis merely providing an inefficient venue for aid with the witnesses’ emotional reactions to the murders.
The two other cases in which the authors induced hypnosis involved sexual assaults. In the first case, a young woman (AP) was unable to remember what had happened before she awakened naked in a public park. A subsequent medical examination revealed semen in her vagina. Hypnosis was used to help her recall what had happened, and the full set of safeguards suggested by McConkey and Sheehan (1995) were employed. AP seemingly experienced an abreaction during hypnosis. Several weeks later, on the basis of her abreaction, she reported being abducted and sexually assaulted by her former employers. Hypnosis seemed to have led to an increased ability to remember and recount important information about the incident. About 2 years later, on the morning that the trial of AP’s former employers was to begin, the prosecutor discovered that AP had reported dreaming of being abducted and sexually assaulted by her employers as part of a sexual harassment claim made 2 weeks before she was found in the park. The account of the abduction and assault experienced in a dream was essentially identical to the crime alleged to have occurred 2 weeks later, the crime she reported “remembering” during hypnosis. Because it seemed unlikely that a crime identical to a previously reported dream had actually occurred, the judge dismissed the charges just as the trial was scheduled to begin. If the prosecutor had not accidentally discovered the dream and reported it to the judge and the defense, the defendants might well have been convicted. In that case, hypnotically influenced and legitimized testimony, elicited by experts on hypnosis and memory using intricate safeguards, might have played a part in a major miscarriage of justice.
In the second sexual assault case, CK awoke in her bed to find evidence she had been involved in sexual intercourse after allowing a taxi driver (LG) into her home. The taxi driver, a man more than 30 years CK’s senior, was reportedly a skilled lay hypnotist. Hypnosis helped CK recall the hypnotic seduction and her sense of helplessness and muscular inhibition -- responses quite similar to those reported in an earlier Australian case, that of Mr. Magic (Perry, 1979). During the subsequent investigation, a policewoman posed as a potential victim; LG attempted to use hypnotic procedures to seduce her. Although ruled inadmissible at trial, the results of this investigation corroborated CK’s hypnotically aided recall. However, LG was subsequently acquitted. Interestingly, this case involved alleged abuse during hypnosis, one of the two widely accepted exceptions to the per se rule (see n. 2).
In the last of the nine cases, the authors were able to show that a murder suspect, who had made exculpatory statements while seemingly under hypnosis, was simulating hypnosis. McConkey and Sheehan (1996) saw their testimony as an important factor in his subsequent conviction.
In summary, when extensive safeguards were employed, and forensic hypnosis was induced by internationally known experts, hypnosis had a confusing, misleading, or time-wasting effect in four of the five cases. One of the four cases avoided becoming a major miscarriage of justice only through a fortuitous accident that occurred after 2 years of pretrial effort by both the prosecution and the defense. The fifth case was one in which sexual abuse seemingly occurred during hypnosis, in circumstances where most authorities would urge the admission of hypnotically influenced testimony (but whose admission did no good in this case). As McConkey and Sheehan note in their own summary, “It is dispiriting to realize that the most conclusive instance in our analyses of investigative hypnosis was a case in which the court accepted expert testimony that hypnosis was not involved” (1995, p. 216). We add that the case of AP shows that even the most extensive safeguards will not protect the fact finding process from hypnotically based fantasies, nor can experts detect the occurrence of such events.
Why Hypnotically Influenced Testimony Should Be Excluded When Unreliable Testimony -- Such As That Given by the
Accused and His Accomplice’s Admissible
One of Scheflin’s (1996) arguments for admission of hypnotically influenced testimony is that other forms of testimony are admissible despite their questionable nature (e.g., accomplice testimony). Over the past 15 years or so, the trend clearly has been to admit more marginal testimony and let the trier of fact -- the jury -- decide what weight to give it.
As Scheflin argues, all eyewitness testimony may be seen as questionable to some degree. For example, in Rock v. Arkansas (1987), the U.S. Supreme Court reviewed the evolution of the right to testify in one’s own defense. Originally, our judicial system excluded such testimony per se, on the basis of self-interest. Later, defendants were not allowed to give exculpatory evidence under oath. Obviously, the temptations to give false testimony in one’s own defense may be overwhelming. How can we exclude hypnotically influenced testimony while leaving the testimony of the accused and his accomplice?
The answer lies in the jury’s ability to weigh testimony appropriately. Self-interest in its various forms is part of each adult’s everyday experience. On the basis of this experience, juries may be expected to appraise realistically the testimony of someone accused of a crime or of an accomplice who has been given immunity or a plea bargain in return for his testimony. On the other hand, the change in certainty and the creation of memory in forensic hypnosis or hypnotically facilitated psychotherapy lie outside the range of experience of most jurors. Nor do juries know of the demand characteristics inherent in forensic hypnosis (cf. Orne, 1959, 1979). This is why expert testimony on the probative value of such evidence is required, if there is any question of admitting the testimony. However, the issues are so complex that psychiatrists, psychologists, and law professors are sincerely troubled by them. Do we want to depend on the most convincing expert to carry the day? As noted above, supposed experts in this area often fail to distinguish between knowledge based on correlational research and that based on experimentation. As McConkey and Sheehan (1995) and Southwick et al. (1997, see n. 5) have shown, both correlation and hypnosis will fool.
Moreover, unlike the case in accomplice or defendant testimony, jurors’ everyday experience leads them away from giving appropriate weight to hypnotically influenced testimony, not toward it. While the jury is aware of human fallibility, testimony is now being given by victims of or witnesses to crimes, not accomplices who have made plea bargains or defendants facing prison and/or disgrace. Note that previously hypnotized witnesses’ or victims’ manner will convey that they are telling the truth as they know it. When such testimony is presented in court in vivid detail, with heightened certainty (as hypnotically influenced or created memory often is), juries tend to believe it. Jurors’ everyday experience tells them that detailed, vivid memories, conveyed by someone without a strong interest in deception, are likely to be true. And they usually are. But in this case, the effects of hypnosis lend only the patina of fact rather than clear, accurate memories of historical events.
Experts can argue about the effects of hypnosis in a specific case, but their differences are easily obscured by a witness whose memory has been “refreshed” by hypnosis. The problem in civil cases is similar; hypnosis legitimizes memory changes and results in believable testimony when memory has been created, rather than simply refreshed (cf. Karlin, 1997; Karlin & Orne, 1996).
In fact, hypnotically influenced testimony is not similar to accomplice or defendant testimony. It is analogous to testimony based on an Amytal (“truth serum”) interview. Amytal does not always result in historically inaccurate testimony. But, like hypnosis, it provides legitimacy, certainty, and vividness disconnected from accuracy. As a result very few scholars would argue (as Scheflin, 1996, does for hypnosis) that since Amytal interviews do not always result in error, they should be considered on a case-by-case basis. Instead, the limitations of the technique and per se exclusion are generally accepted.
Professor Scheflin’s Challenge
In a paper published in the Australian Journal of Clinical and Experimental Hypnosis, Scheflin (1994) challenged defenders of the per se exclusion of hypnotic testimony to respond to an actual case illustration of the problems with the per se rule. He raises these problems again in his initial article in this series:
For example, Scheflin (1994) has challenged defenders of the per se rule to respond to the following actual case illustration. No defender of the rule has yet met the challenge. In a New York case described to Scheflin by a district attorney, a 4yearold girl told her mother that her father had, in effect, been molesting her. The mother had a serious breakdown and required complete institutionalization. The girl was raised by her father and the sexual abuse continued for several years. The girl, however, would no longer talk about the abuse. A year of therapy could not persuade her to talk even though there was solid medical evidence clearly supporting the abuse. Finally, after hypnosis was used for relaxation, the girl told the sad and sordid tale of her father’s repeated abuses of her [italics added]. Because New York excludes posthypnotic testimony, the girl was unable to tell her story in court, and, therefore, could not identify her father as the perpetrator. Despite the medical evidence corroborating the abuse, she remained in her father’s custody [italics added]. How is justice served in this case? (Scheflin, 1996, p. 29)
There are several problems with this challenge. The first involves the question of independent corroboration. If the medical evidence was entirely convincing, we cannot fathom why the child was left in the home. Certainly, any evidence of abuse accumulated over years would have led to the conclusion that whoever had custody of the child was an inappropriate caretaker; “solid” medical evidence would more than suffice in this regard for any official child welfare agency. Whether the father or some other perpetrator committed the abuse would seem irrelevant; the fact of continuing abuse would be sufficient for removing the child from the father’s care. Thus, one wonders whether the medical evidence was as “solid” as Professor Scheflin’s informant would have us believe.
The problem of what does and does not constitute independent corroboration of hypnotically created memory is a far-reaching one. For example, in his earlier article Scheflin (1996) viewed Ms. Borawick as “able to present independent corroborative evidence of the truth of the memories” (p. 32). In fact, this evidence comprised two letters from Ms. Borawick’s hospitalized schizophrenic sister, who, knowing the charges that Ms. Borawick had brought, wrote her to say essentially, “me too.” Viewing the letters as independent of Ms. Borawick’s accusations is problematic, and the Court appropriately ignored them. (Incidentally, the sister had recanted her charges well before the courts ruled on the matter.)
The problem of misidentifying quite marginal data as corroboration seems widespread. Recent articles by putatively competent professionals have reported independent confirmation for the accuracy of “birth” memories (Chamberlain, 1986) and memories for past lives (Tarazi, 1990). Similarly, claims of confirmation of childhood sexual abuse have been made after decadedelayed recovery of repressed memories. However, these claims often have been based on questionable grounds, such as the presence of “body memories” (Bass & Davis, 1988), flashback experiences (Terr, 1994), or the “survivor’s” interpretation of post hoc discussions with relatives (Herman & Schatzow, 1987; see also Harvey & Herman, 1996). Thus, a good deal of what is said to be independent confirmation proves ephemeral when considered seriously.
Alternatively, if we assume for a moment that the medical evidence in the abuse case cited by Scheflin (1996) was “solid,” then we know that the abuse did occur. Verification of sexual abuse is not necessarily difficult to obtain. For example, if vaginal penetration were part of the molestation, well over 90% of children so assaulted can be identified with a simple, unaided physical examination (Muram, 1989). Assuming such evidence existed, the central issue, whether the child had been and continued to be abused, was a settled one. The identity of the perpetrator and the details of the abuse may have been similarly clear. Then we return to the question of why any child welfare agency would allow the child to remain in the care of someone who allowed continuing abuse to occur. It is not the case that children are removed from a home only when they can detail their mistreatment; rather, they are routinely removed for less reason than solid medical evidence of continuing sexual abuse.
But let’s go one more step. Let’s postulate both that such nonfeasance by a child welfare agency is possible in a case known to the District Attorney’s Office and that the problem of getting the child to talk about the abuse is somehow critical to her removal from the home. Under such circumstances, it seems inconceivable that only hypnosis could have relaxed the young child sufficiently to allow her story to be told. While we do not know what techniques were tried to no avail, any competent child psychologist or psychiatrist could suggest several possibilities other than hypnosis for inducing relaxation, including the use of a mild tranquilizer.
Finally, as Scheflin’s own work on informed consent for forensic hypnosis suggests, all involved should have been made aware of the very real possibility that hypnosis was not a reasonable alternative under the circumstances; that the child’s hypnotically influenced testimony would be excluded and she would therefore remain in the home. New York courts have been ruling against hypnotically influenced testimony since 1904 (Austin v. Barker, 1904, 1906). Modern rulings have called for a per se exclusion (e.g., People v. Hughes, 1983). Given the possibility that the child would be returned to the father’s custody, how could this legal history not have been taken into account? In summary, we would suggest that this “challenge” reflects a biased view of the medical evidence, extraordinary incompetence on the part of the professionals attempting to protect the child, or is simply unbelievable as presented.
The Relationship of Recall During Hypnosis with the Emergence of Memory Several Months Later in the Borawick Case
Scheflin suggests that “the fact pattern in Borawick is not particularly unique thereby making the case all the more important” (1996, p. 30). We generally agree, although there are some unusual facts in the case. One of the more unusual aspects is the fact that several months elapsed between Ms. Borawick’s original, detailed recall of abuse during hypnosis and the subsequent recall of these memories outside hypnosis. For Professor Scheflin, this raises the question of whether memories retrieved posthypnosis were influenced by or independent of it.
The fact that something follows in time does not mean that it was caused by what preceded it. Suppose Ms. Borawick’s memories did not return until 1 year, 5 years, or 10 years after the hypnosis sessions. Did the hypnosis “refresh” those memories simply because it preceded them? The Second Circuit fails to analyze this issue, and no American court appears to have addressed the problem. (1996, p. 31)
Obviously, when one event precedes another, most often the two will not be related at all, never mind causally related. The question is whether it is reasonable to conclude that in this particular case, there was a causal link. Although the evidence is circumstantial, we believe it clear enough to make such a link apparent.
Much of the time, age regression or hypermnesia instructions given to suitable subjects will result in alterations in posthypnotic recall; but ordinarily, only relatively brief periods of posthypnotic amnesia are suggested. In forensic contexts, the hypnotist typically suggests that the subject’s memory will continue to improve after hypnosis ends. Unfortunately, these typical instructions can lead to confusion about the source of memories and additional confabulation, while legitimizing further memory alteration.
In this case, Joan Borawick experienced 12 to 14 hypnotic sessions in 1988 conducted over several months by Valerian St. Regis, a lay hypnotist. Her recall during hypnosis involved a revivification of sexual abuse that was vivid and detailed, as best one can tell from the available records. St. Regis either allowed or suggested that Ms. Borawick remain amnesic for these events when not in hypnosis, because he believed the memories recovered in hypnosis would be “devastating” and would probably surface in time (Borawick v. Shay, 1995, Slip opinion, p. 2).
Several months later, Ms. Borawick recovered very similar memories. Given the similarity, the court’s assumption that the two were related seems reasonable to us. However, the evidence in favor of this assumption is stronger than the common sense grounds on which the Borawick court presumably based its decision.
According to St. Regis, Ms. Borawick had already demonstrated her ability to manifest profound and lengthy posthypnotic amnesia in response to his expectations and/or suggestions; she had remained amnesic outside hypnosis over the several months that she had been treated by him. Seemingly, memories of abuse would emerge during hypnotic sessions only to be forgotten again until the next time Ms. Borawick was hypnotized and age-regressed. Thus, during treatment, Ms. Borawick had already demonstrated lengthy, recoverable posthypnotic amnesia for a time comparable to that between the end of treatment and final “recovery” of her memories.
Given that the memories recovered months later were essentially identical to those obtained in hypnosis, we’re not sure what time frame should create uncertainty about the relationship between the two sets of memories. However, in our view that period should be longer than the 5 months or so that in fact separated the hypnosis sessions from much of Ms. Borawick’s later recall, as Ms. Borawick had already demonstrated recoverable posthypnotic amnesia for a similar length of time.
Incidentally, posthypnotic amnesia of this duration, even if directly suggested, is quite rare. On the other hand, St. Regis clearly expected Ms. Borawick to be capable of it; and, if we credit his deposition, she was. Given the rarity of such amnesia, these data would suggest that Ms. Borawick’s memory was unusually responsive to hypnotic influence and that St. Regis’s expectations, overtly stated or not, were capable of powerful effects. Ms. Borawick was referred to St. Regis by his employer/supervisor, a physician who believed that patients with chronic illnesses, like Ms. Borawick, might well have histories of childhood sexual abuse (Borawick v. Shay, 1995, Slip Opinion, p. 10). Patients referred to St. Regis by this physician seemingly recovered such memories quite often (St. Regis, 1993, p. 66). We can surmise St. Regis held the expectation that this would occur in Ms. Borawick’s case. When the “memories” appeared, St. Regis instructed Ms. Borawick to experience lengthy amnesia, but expected Ms. Borawick to eventually recover them. We should not be surprised when she did.6
Inherent Incredibility
Another objection to the Second Circuit’s decision raised by Scheflin (1996) involves the rationale for excluding Ms. Borawick’s posthypnotic testimony without an evidentiary hearing. Professor Scheflin suggests that neither St. Regis’s lack of academic credentials nor the absence of minimal safeguards such as the maintenance of records of the hypnotic sessions should have been “fatal,” especially as Ms. Borawick had evidence that could “[verify her testimony] by other means” (i.e., the schizophrenic sister’s letters, noted above). Additionally, Scheflin (1996) notes that the court considered a “second factor”:
The second factor influencing the Second Circuit to deny Ms. Borawick her pretrial hearing is the court’s opinion about: “the inherent incredibility of Borawick’s allegations” including rape, ritual abuse, blood drinking, satanic activities, and other events involving relatives and strangers. The court acknowledges that Ms. Borawick was denied an opportunity to substantiate her claims with proof, and then denies her that opportunity. In short, because the court felt the claims were “incredible,” it denied Ms. Borawick the right to prove they were true. Once again, this violates the spirit and the purpose of the totalityofthecircumstances test, as well as common sense. Even if some of the claims are incredible, others might well be true. Let Ms. Borawick have her hearing to see what she can prove. (p. 33)
Intense law enforcement interest has failed to find any evidence of a multi generational satanic cult (cf. Lanning, 1991). As Scheflin notes, common sense is useful here. If blood-drinking, black-robed Masons engaged in satanic worship featuring ritual child abuse are not inherently incredible, what is? Do the ritual events have to take place on a flying saucer (cf. Mack, 1994), or in a past life (cf. Tarazi, 1990), before we can term them absurd? And while it is logically possible that other aspects of Ms. Borawick’s account did occur, it makes sense to us, as it did to the United States District and Circuit Courts, that an account backed by no physical evidence that includes absurd charges should be given no credence. The Borawick court noted in this regard that the Shays had some right to be free of the need to respond to inherently incredible accusations. While we do not know the history of this legal reasoning, the Court’s view certainly makes sense.
However, it is disappointing to us that in the future people accused on the basis of hypnotically created recall will have to endure lengthy pretrial hearings on the basis of obviously incredible claims. Under the Atotalityofthecircumstances” standard adopted by the Second Circuit Court, trial courts will have to review each set of hypnotically influenced memories on a case-by-case basis. The Court made an exception in this case only because they felt sure that the District Court would decide against admitting Ms. Borawick’s testimony when all the circumstances were considered.
Remember that the “treatment” in this case was conducted by a lay hypnotist, who kept no records of what occurred before, during, or after hypnosis. Additionally, independent corroboration comprised two Ametoo” letters from a hospitalized, schizophrenic relative who later recanted her accusations. This illustrates the kind of testimony about which decisions will have to be reached, case by case. In the future, the admissibility of hypnotically influenced or created memories about blood-drinking, devil-worshiping, child-abusing Masons will be debated in Federal Courts by expensive experts. Thus, a “totalityofthecircumstances” approach can result only in a costly cottage industry of forensic hypnosis experts, while increasing the likelihood of major miscarriages of justice.7
Will Hypnosis Used in Psychotherapy Result in More Veridical Memories than Hypnosis Used in the Forensic Context?
As we noted above and in our original paper, traditional psychotherapy involves, among other things, the creation of a fictive narrative that provides a coherent framework for therapist and patient to conceptualize a plausible etiology and treatment for psychological distress (cf. Spence, 1994; Woolfolk, Sass, & Messer, 1988). The created narrative represents a subjective version of history, not the objective one sought in legal proceedings. Whether a conversation with Uncle John happened on one’s fourth birthday, at Christmas when one was seven, with someone else altogether, or not at all, makes little difference to the therapeutic value of working through the memory. It is the emotional tone and cognitive orientations revealed by such memories that make them important therapeutically. To believe we obtain objective records with such reminiscences is worse than naive.
As we have also noted, hypnosis increases productivity and openness to fantasy; decreases critical judgment; and can create believable, vivid, coherent memories of the past de novo. If these memories are taken as literal renderings of the past, the results can be destructive. Remember that hypnosis can also create believable “memories” of past lives, and of future lives as well.
Does combining these two methods of creating subjective history -- psychotherapy and hypnosis -- lead to memories that can be relied on in court? Of course not! But cannot careful hypnotherapists avoid such problems? Unfortunately, even internationally respected experts cannot do so, as we saw in the AP case of McConkey and Sheehan (1995). While reviewing the scientific literature on hypnosis and memory, we have been struck, as was Spanos (1996), by the absurdity of questioning whether hypnotic age regression can create bizarre, deeply believed memories of impossible events. It has a well-known history of doing so.
For example, David Cheek (1975), an internationally known obstetrician and hypnotist, reported a series of more than 2,000 cases in which he traced a variety of psychosomatic and physical illnesses to negative events during and immediately after birth that were remembered during hypnotic trance. Of course, such “memories” were not hidden somewhere in the brain; they did not exist until Cheek helped create them. Working with Leslie LeCron, another noted figure in clinical hypnosis in the 1950s and 1960s, Cheek (1975) reported finding that a whole variety of disorders were related to untoward events “remembered” as occurring immediately after birth. And, as in current recovered memory therapy, adult figures were often “remembered” as being to blame for later illness. For example, Cheek (1975) found that those adult women who were hypnotically age-regressed to birth and remembered hearing someone stating preferences for a boy at their births often suffered from a variety of genital complaints. Other well-meaning therapists have produced similar incredible reports during therapeutic hypnosis, even claiming to have found independent confirmation of them (cf. Chamberlain, 1986). David Cheek was no fool, but the notion that hypnosis in therapeutic contexts produces historically accurate memories is foolish.
Final Thoughts
Crews et al. (1995) have documented at length the blindness of traditional psychotherapists when asked to see how they contribute to the symptoms they find. An extraordinary incident, illustrative of this blindness, occurred about 20 years ago, when one of our esteemed colleagues, a former president of the American Psychiatric Association, was seriously discussing diagnosis in psychotherapy. He noted that he was frequently making inferences, analogous to those of an internist, who, on feeling a particular type of distention in the abdomen, infers a swollen liver. Getting to know the patient better, the internist gathers more evidence for his view. During surgery or on autopsy, the inference can be conclusively confirmed. Using this metaphor, our colleague argued that he, as a psychiatrist, did the same thing. At first, he made a number of inferences about his patients’ pathologies. Getting to know them better, he usually found these inferences confirmed.
It is possible that this colleague was an extraordinary diagnostician. However, his view has severe problems for most of us. Put simply, thoughts, feelings, and behavior are not concrete objects. A liver viewed at autopsy will not be swollen because one expected it to be. Thus, internists get real feedback; pathology is at the heart of medicine’s feedback loop. Psychiatrists and psychologists do not usually have access to ground truth.
On the other hand, people frequently interact in a manner that creates selffulfilling prophecies (cf. Snyder, Tanke, & Berscheid, 1977). Patients are no exception; their cognitions, emotions, and behavior change, drastically, when the doctor thinks she or he knows what is wrong. If anything, the influence effects in psychotherapy should be stronger than during ordinary interaction. Psychotherapy is by definition a situation in which one person, the healer, attempts to influence another, the patient, and therapists often view therapy as successful when the patient comes to agree with their views (cf. Frank, 1973).
Freud, who if he did not invent the “talking cure” was at the least its greatest publicist, insisted on the scientific nature of his enterprise by distinguishing his procedures from mere suggestion. Yet, it has become obvious that Freud engaged in highly suggestive practices, a notion he assiduously denied (Crews et al., 1995). Similarly, it has become absurd to believe that psychotherapists are either entirely objective or fail to influence their patients in ways consistent with their beliefs.
While it is difficult to blame someone like Freud, whose intellectual foundations rested in 19th-century neurology, the movement that he engendered and its offspring have all too frequently denied the role of many social-psychological variables in psychotherapy, including the role of suggestion and the influence of the therapist in creating the narrative that emerges (cf. Spence, 1994). In this light, it seems long past time to recognize the role of influence and suggestion in creating false memories of incestuous child abuse. In the present case, Ms. Borawick’s memories included satanic ritual abuse. We cannot, however, hold patients such as Ms. Borawick responsible for the generation of such beliefs. Patients do not have the responsibility of delineating the scientific from the ridiculous in this context. Rather, therapists are responsible for misunderstanding the largely literary, not historical, memories that emerge in psychotherapy.
There is no question but that, of the two tragedies -- child abuse and iatrogenic false memories of child abuse -- the former is by far the greater, more widespread, more devastating in its effects, and more to be abhorred. But the amount we can do, as therapists and as scholars of therapy, to prevent child abuse is relatively small, even if we try at every opportunity.
On the other hand, therapists have been deeply involved in, and in our view, largely responsible for, the creation of false memories of incestuous child abuse and satanic ritual abuse and the creation of a particularly destructive version of multiple personality disorder. We hope that this can be stopped before it irretrievably, deeply, and properly damages the public view of the psychotherapy enterprise.
Over the past 35 years or so, psychology and psychiatry have developed specific treatments for specific disorders and the beginnings of an integration of psychopharmacological approaches with talk therapy. These are real advances. Further, as a profession, we have begun to condemn some of the more egregious examples of quackery (e.g., past-lives therapy).
In regard to hypnosis, we have begun to think about and use hypnosis clinically in light of what we have learned experimentally (cf. Lynn, Kirsch, & Rhue, 1996). We have learned that hypnosis is a powerful tool, in and out of forensic settings. As a therapeutic technique, it has demonstrable specific effects (cf. Bowers & Kelly, 1979). It also has a capacity to create believable illusions. More than that, if people have illusions to begin with, hypnosis is very likely to give them form and substance, to make them more believable, vivid, detailed, and firmly remembered. The vulnerable patients seeking help who have developed false memories of incestuous child abuse are all too often participants in a folie à deux that requires therapist ignorance about the way the human organism functions and therapist credulity when provided with simple, plausible explanations. We feel that in order to preserve good psychotherapy, the practice of creating memories of childhood abuse via hypnosis and/or psychotherapy must stop. However, this will be an all-too-slow process unless the relevant professional societies specifically denounce such practices in their ethical codes.
In conclusion, there are costs to every solution to the question of admitting hypnotically influenced testimony. Certainly, we consider a case-by-case review of the “totalityofthecircumstances” -- the approach that the Borawick court approved -- the second best choice: far better than admission of such testimony automatically or admission determined solely by adherence to inherently inadequate safeguards. But under this “totalityofthecircumstances” rule, experts would have debated whether Ms. Borawick’s testimony about blooddrinking, black-robed Masons engaged in ritual child abuse should be admitted at trial. Under the “totalityofthecircumstances” standard, all such arguments would have to be considered on a case-by-case basis. If a myriad of such cases are to be tried, both the costs, in time, effort, and expense, and the risks of major miscarriages of justice, will be considerable.
When the Shirley (1982) court reflected on the case-by-case consideration of the effects of hypnosis, they concluded that “the game isn’t worth the candle” and held for a per se exclusion. We concur; case-by-case evaluation of hypnotically influenced testimony is not worth the extensive judicial and psychological resources it requires nor the risks it incurs.
Notes
These safeguards were originally proposed by the second author in an amicus brief in California v. Quaglino (1978). After over a decade of experience, he and his colleagues arrived at a consensus that such safeguards are inadequate to protect the fact-finding process (cf. Orne et al., 1984). This consensus was reflected by the American Medical Association’s statements on this issue (AMA, 1985, 1994).
Of course there are times when an exception must be made. The criminal defendant who has been hypnotized has a constitutional right to tell his story (Rock v. Arkansas, 1987). Moreover, we agree that anyone who claims to have been abused during hypnosis is entitled to case by case consideration under a totality of the circumstances standard. But such exceptions are relatively rare.
A full discussion of the scientific literature on memory and hypnosis over the past two decades is beyond the scope of this paper. We note here that an appropriate review must examine the literature in light of the specific research paradigms employed; the presence or absence of a clear, coherent memory prior to hypnosis; the circumstances of original encoding; controls for productivity; how hypnotizability was measured; the demand effects in specific studies; and so on. If such distinctions are not made, reviews can be quite misleading.
For example, Spanos, Gwynn, Comer, Baltruweit, and de Groh (1989) conducted two experiments examining the impact of varied crossexamination conditions on mistakes and misidentifications after misleading interrogation. In Experiment 1, high and low hypnotizables in hypnosis, imagery, or control conditions were shown a film depicting the robbery of a candy store by a Caucasian male in his late teens. The offender was seen for 30 seconds of a 3-minute, color video in which subjects saw both full body shots and closeups of the offender’s face and upper body. After viewing the film, subjects were asked to relate everything they would have felt and done had they been in the store. They were then asked to describe what happened in the film, what the offender looked like, was wearing, and what he said and did. Several days later, subjects witnessed a second videotape in which they saw a suspect arrested and fingerprinted. The suspect, however, was not the perpetrator in film one, differing from him in a number of ways, including eight distinctions about which misleading questions were asked.
Subjects who made at least one misattribution in line with leading questions, or who misidentified the perpetrator in a photo lineup from a display that contained a foil but not the original perpetrator, were exposed to a crossexamination session approximately a week later. Before cross-examination, they all took an oath that they would tell the truth. All crossexamination in Experiment 1 was rigorous, designed to break down the subjects and convince them the person in the second film was not the offender (as in fact, he was not). Subjects who admitted uncertainty were considered to have broken down in response to crossexamination.
The results of the first experiment indicated that subjects in all conditions showed a major decrement in mistakes during cross-examination, with the subjects in the leading question condition without either hypnosis or imagery showing the smallest degree of breakdown under cross-examination. Similar patterns were seen on the mug shots with more of the highly hypnotizable subjects in the hypnosis and imagery conditions breaking down. Thus, neither hypnosis, high hypnotizability, nor their interaction seemingly helped subjects maintain their testimony in the face of stringent crossexamination.
In Experiment 2, only highly hypnotizable subjects were used, but along with the stringent interrogation seen in Experiment 1, two other forms of crossexamination were used: a benign crossexamination, in which it was not necessarily implied that subjects had been previously incorrect, and a hidden observer condition, in which subjects were told that a hidden part of them “remains uninfluenced by suggestion. The hidden part can always distinguish between suggestions and reality.” In this second experiment, the stringent crossexamination was nowhere near as successful as it seemingly had been during the first study. In fact, the decrease in the number of mistaken characteristics, while significant for all three conditions, showed a smaller decrease in the stringent cross-examination condition (the one studied in Experiment 1) than in either the benign cross-examination or the hidden observer condition, with the difference being significant for the hidden observer condition. Similarly, confidence in mug shot misidentifications decreased only slightly (and nonsignificantly) for those in the stringent and benign cross-examination conditions and decreased about three times as much (and significantly) in the hidden observer condition. Thus, contrary to Experiment 1, in Experiment 2, the misidentification of mug shots -- probably the most important single problem in terms of witness misidentification -- did not show a significant decrement despite stringent crossexamination of these highly hypnotizable subjects.
Why does the effect of stringent cross examination fail to replicate? Perhaps because we are looking at the wrong variable. The stringent cross-examination after hypnosis condition is the active treatment in the first experiment, while the hidden observer condition is the active treatment in Experiment 2. One way to view this is that, taken together, the two experiments show that the active treatment, whatever it is, yields the results Spanos and his colleagues anticipated. An alternative way of stating this view is to note that Spanos et al. (1989) found that stringent cross-examination causes decrements in mistaken hypnotically influenced testimony only when expected to do so, when it is the active condition on which the experiment focuses, not when it is one of the control conditions. While this interpretation is post hoc, it is consistent with effects seen in a variety of experimental contexts, effects that must be most carefully considered when hypnosis is used and ecological validity is a central consideration (cf. Orne, 1970).
In regard to ecological validity, the oath and stringent cross-examination were used by Spanos et al. (1989) in an attempt to parallel real-world courtrooms. However, in real-world courtrooms, witnesses have been prepared and are called by one side and their social role suggests maintaining their testimony as best they can during cross-examination. Therefore, real courtrooms would seem to provide an a fortiori version of the demand effects operating during stringent cross-examination in Experiment 2, not those of Experiment 1. Thus, contrary to the conclusions of Spanos et al. (1989), their study suggests that rigorous cross-examination will be largely ineffective in countering misidentifications influenced by hypnosis in real- world courtrooms, as it was in Experiment 2. This study also illustrates how important it is to consider the details of experimental contexts in reviewing the hypnosis and memory literature.
We are referring here to spontaneously occurring cases outside the forensic arena.
Moreover, in correlational research the direction of causality may, in reality, be the reverse of that originally deemed plausible; that is B can cause A, rather than A causing B. For example, combat veterans who report PTSD also report more severe exposure to combat. The usual conclusion is that severe combat exposure causes PTSD. This view is supported, for example, by studies of our Vietnam soldiers who volunteered to explore tunnels occupied by the enemy, a particularly dangerous and frightening duty. Almost universally, our tunnel soldiers developed PTSD. However, while no one doubts the reality of PTSD in many such cases, the length and severity of stress necessary for a diagnosis of PTSD has decreased over time. For example, studies of PTSD have been conducted with Gulf War veterans, few of whom underwent combat as severe as that seen by the average Vietnam combat infantry soldier. Southwick and his colleagues recently reported a prospective study (as opposed to the usual retrospective study) of memory for exposure to severe combat and the development of PTSD among Gulf War veterans. They obtained memories of whether or not soldiers had endured any or all of 19 combatrelated traumatic events at 1 month and 2 years after combat ended. Those who developed PTSD symptomology amplified their memories of combat stress, changing their responses from “no” at 1 month to Ayes” at 2 years more often than did those with fewer symptoms (Southwick, Morgan, Nicolaou, & Charney, 1997). They concluded:
These findings do not support the position that traumatic memories are fixed or indelible. Further, the data suggest that as PTSD symptoms increase, so does amplification of memory for traumatic events. This study raises questions about the accuracy of recall for traumatic events, as well as about the wellestablished, but retrospectively determined relationship between level of exposure to trauma and degree of PTSD symptoms. (p. 173.)
In other words, PTSD symptoms caused memories of heightened combat trauma instead of exposure to trauma causing symptoms. These findings are not surprising from a methodological point of view. But correlation fools us into believing we know things when we don’t and these findings surprised many clinicians. In response to the Southwick et al. (1997) study, the American Journal of Psychiatry published an editorial which read, in part:
If the findings of Southwick et al. are replicated and it is verified that patients with greater PTSD symptoms amplify or distort memories of traumatic stressors, our most basic assumptions about the relationship between trauma and PTSD will be challenged. Commonly, a central focus in the clinical evaluation of patients is the linking of current symptoms to traumatic events that occurred months or years before treatment and an exploration of those events. In light of these new findings, our approach to assessing and treating the disorder requires reexamination. Because the recollections of past trauma may be distorted, findings by Southwick et al. encourage us to shift our attention to the assessment of current symptoms and their impact on current functioning and quality of life. (Hales & Zatzick, 1997, p. 144)
In our view this would be an appropriate way to focus both assessment and treatment in the vast majority of PTSD and other trauma-related cases.
It would be a rare professionally trained hypnotist in this half of the 20th century who could support such expectations. Since Charcot’s work was discredited as artifactual and the Nancy School triumphed at the end of the 19th century (cf. Ellenberger, 1970), professionals have been usually trained to believe that lengthy and unsuggested posthypnotic amnesias are unlikely. When we do suggest amnesia in clinical situations, it is to provide a subjective psychological distancing and permission for the patient to recover memory slowly or to act temporarily Aas if” she or he can’t remember. Alternatively, we may suggest direct alterations in memories, as did Janet in the early part of this century, and Erickson and Ericksonians more recently (e.g., Lamb, 1985; Rossi, 1980). But we do not expect to ablate the original memory this way. For example, we would not expect hypnotic instructions for memory alteration or the amnesia produced by direct suggestion to prevent proactive or retroactive inhibition of memory for recently learned material (Hilgard, 1977).
We think that the debate would have probably required experts not merely on hypnosis and memory, but in other areas as well. For example, since corroboration was offered and then recanted by Ms. Borawick’s sister, who had originally written while hospitalized for schizophrenia, experts on the meaning of recantation and on the effects of schizophrenia in such a case would also have been needed by both sides.
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Acknowledgments
The substantive research upon which these views were based was supported in part by grant no. MN44193 from the National Institute of Mental Health, U.S. Public Health Service, by grant no. 87-IJ-CX-0052 from the National Institute of Justice, and by a grant from the Institute for Experimental Psychiartry.
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Robert A. Karlin, Ph.D., is Associate Professor of Psychology at Rutgers University. A former member of the Executive Board of Division 30 (Psychological Hypnosis) of the American Psychological Association, he has been actively involved in research on hypnosis and related phenomena since 1976.
Martin T. Orne, M.D., Ph.D., is Professor Emeritus of Psychiatry at the University of Pennsylvania. He is Executive Director of the Institute for Experimental Psychiatry Research Foundation, Inc., and past president of the International Society of Hypnosis and the Society for Clinical and Experimental Hypnosis. Orne served as editor-in-chief of the International Journal of Clinical and Experimental Hypnosis from 1963 through 1992.