Cultic Studies Journal, Vol. 13, No. 1, 1996, page 40
patient recollections of abuse from the therapeutic context to interactions with persons
meaningfully involved with the patient outside therapy. Given the fictive nature of the
narrative developed in psychotherapy (Spence, 1982), this is simplistic, naïve, and
unfortunate.
Psychotherapy is an influence process. Whether we talk of that influence process in terms of
transference or the social psychology of persuasion and attitude change, it remains an
intense dialogue in which a doctor seeks to influence the patient, and frequently succeeds.
In what Perls (1965) called the “safe emergency” of the therapeutic encounter, the patient
often seeks to please the doctor. An obvious way to please doctors is to adopt their view of
one‟s problems. The pressure on patients to do so is ordinarily far more long-lasting and
often more intense than that found in investigative contexts. After all, the patient and
therapist will be back together next week and the patient has to confront the doctor then as
well as now. So demand characteristics and expectancy effects play major parts in
determining what information the patient will provide (Orne, 1970). It is an old therapy
adage that Freudian patients dream Freudian dreams, Jungian patients dream Jungian
dreams, and behavior therapy patients don‟t dream. Similarly, patients of recovered
memory therapists dream about and/or remember ICA.
Satanic Ritual Abuse and Early Incestuous Child Abuse: Iatrogenic Fantasies?
Recently, Harvey and Herman (1994) distinguished three prototypical groups of patients.
Patients in the first group report “largely intact and continuous remembrance of their abuse
experiences.... and a lifting, not of amnesia, but of the veil of denial and minimization that
enabled them to preserve secrecy and illusion.” The second type of patient has spotty
memories of abuse. The onset of abuse, its escalation, and the entire period of early
childhood are likely targets of amnesia. Finally, the third type of patient begins therapy with
no memories of abuse. When memory is “recovered,” such patients report “severe and
repeated sexual and physical abuse, beginning in early childhood and continuing into early
adolescence.... Most reported witnessing family violence as well and many reported abuse
by more than one perpetrator” (Harvey &Herman, 1994, pp. 302B303).
While this nosology remains unproven and is certainly incomplete (cf. Pezdek, 1994),
problems with the interpretation of data from each group can be identified if the nosology is
momentarily accepted as a heuristic device. For example, the reinterpretation required by
the first group raises the question of how such interpretation shall be accomplished and by
whom. Similarly, when the second group tries to fill in critical gaps in memory, the
possibility that hypnosis and similar techniques will produce confabulation is high and the
situation becomes rife with the possibility of iatrogenic memory creation based on
suggestion, demand, and expectancy effects. That is, in both cases the credible extension of
memories into detailed events is likely to result in pseudoconfirmation of ambiguous
thoughts and ambivalent feelings as memories of ICA.
Joan Borawick belongs in the third group, apparently reporting both a history of total
amnesia and bizarre memories of satanic ritual abuse (SRA), multiple perpetrators, and
early incestuous abuse. Recent, clear memories may constrain fantasies to some degree,
but as an event becomes more remote and memory more vague and/or spotty, there is
more room for confabulation. Lack of any memory for an event provides a blank screen on
which one can project anything (Loftus &Ketcham, 1994). Thus, if the amnesia is more
pervasive, more questions are raised by those concerned with false memories (cf. Dawes,
1992 Frankel, 1993 Loftus, 1993 Tavris, 1993). This is not to say that patients reporting
more spotty amnesia are not confabulating and fantasizing. Many certainly are. But when
hypnosis has been used to elicit memories for which the patient was originally totally
amnesic, even greater concern arises about iatrogenic factors. Borderline personality,
multiple personality disorder (MPD), multiple perpetrators, SRA, and memories of very early

Cultic Studies Journal, Vol. 13, No. 1, 1996, page 41
abuse by incestuous fathers are most common among this totally amnesic group. The most
troubling aspects are MPD and early incestuous abuse. We will discuss MPD later. For now
let us turn to the question of the incestuous abuse of young children.
While SRA would seem to be obvious fantasy, the early incestuous abuse reported as
common in the totally amnesic patients and seen as likely to be concealed by the spotty
amnesia of the second group (Harvey &Herman, 1994) raises questions. The literature
suggests that father-daughter incest is most likely to take place after a child begins to show
secondary sexual characteristics, that is, age 9 or 10 at the earliest (Gebhard, Gagnon,
Pomeroy, &Christenson, 1965). Pedophilia, on the other hand, may involve children as
young as 2 or 3, but the data suggest that parents seldom engage in sexual relations with
their own children at an early age. Pedophilia tends to be perpetrated by adults who are
familiar to the child, but not by the young child‟s parents (Davison &Neale, 1974, 1994).
Recent research supports this view. For example, Marshall, Barabee, and Christophe (1986)
used a penile plethysmograph to measure erectile responses among nonfamilial molesters
and incestuous males exposed to photographs of both nude children and adult heterosexual
behavior. The incestuous molesters were aroused by the adult heterosexual stimuli, while
the nonfamilial molesters were more aroused by the photographs of nude children.
A second rationale employed to make early ICA by parents believable, the popular notion
that those persons who have been sexually abused as children become pedophiles in their
turn, has little support from relevant research (Freund, Watson, &Dickey, 1990 Hindman,
1988). So the notion that abused parents will in turn abuse their children seems
inconsistent with the literature. The sexual abuse of children has negative consequences for
many victims, but not a one-to-one simplistic relationship with pedophilia. Taken together,
if early sexual abuse does not tend to involve parents, and abused parents are not likely to
be exceptions to this rule, the evidence would suggest that early father-daughter incest is
extremely rare and such memories are likely to be an iatrogenic fantasy.
Diagnosing Relatively Rare Conditions with Fuzzy Boundaries: The Problem of
False Positives
As noted above, even Herman and her colleagues now view total amnesia as the least
frequent type of response to childhood abuse. This view is consistent with the work of
Femina, Yeager, and Lewis (1990), who found little evidence for total amnesia among abuse
survivors. Additionally, Williams (1994) interviewed 129 women 17 years after an episode in
which they had been reported to be victims of child sexual abuse. In a 3-hour interview, 49
of the 129 victims (39%) did not report the abuse, and 15 victims (12%) denied ever
having been sexually abused during childhood. While there are a number of ways to
interpret these data (e.g., second interviews are frequently able to elicit reports of abuse
consciously withheld at an initial interview), the fact that only 12% of these women denied
any sexual abuse at a first interview suggests that total amnesia for ICA is not common,
although specific instances may be forgotten.
As Lindsay and Read (1994) note, much of what is identified as psychogenic amnesia is
ordinary infantile and childhood amnesia, the loss of detail for a single event when similar
instances recur, and simple forgetting. All of these instances are normal, not pathognomic.
In the present authors‟ experience, the remainder of what at first appears to be psychogenic
amnesia almost always involves one of three factors: (1) alcohol or other intoxicating drugs,
(2) trauma to the brain based on accidental injury, and (3) a conscious choice to refuse to
think about ego-dystonic or otherwise extremely unpleasant memories. In fact, the major
problem with traumatic memories in general is not that they are repressed and forgotten.
More often they are remembered all too well (Christianson, 1992). This is not to say that
psychogenic amnesia never occurs. However, it well may be more limited and far less
frequent than most ICA-related reports have suggested.