The Most Dangerous Idea in Mental Health

Pacific Standard Magazine By: Ed Cara

The belief that hidden memories can be "recovered" in therapy should have been exorcised years ago, when a rash of false memories dominated the airwaves, tore families apart, and put people on the stand for crimes they didn't commit. But the mental health establishment does not always learn from its mistakes—and families are still paying the price.

It has been two years since *Tom Mitchell last saw his 20-year-old daughter, Anna. “She was planning to come stay with us right after she came back,” he says, gesturing toward her bedroom in his Craftsman style home in New York on a recent afternoon. “We’ve kept everything the same, except for the boy-band posters.”

Nearly four years ago, Tom and his ex-wife sent their daughter to an eating-disorder clinic called the Castlewood Treatment Center, outside St. Louis. In her five months there, Anna grew to believe she had recovered memories of a deeply abusive childhood that she had previously banished from her conscious mind. Since then, Mitchell has lived in the shadow of a horrific accusation: that he sexually abused Anna for more than a decade.

Child sexual abuse is, of course, a serious and widespread issue in America. Researchers agree that it occurs far more often than official statistics indicate, because children so often decline to report their abuse out of embarrassment, a desire to protect members of their family, or in an attempt to avoid the memory altogether. But the idea that people can immediately banish abuse from their own consciousness, lock those memories away for years, and then recover them through therapy is one with far shakier empirical grounding, and a deeply problematic history. The therapeutic vogue for memory recovery in the early 1990s fueled a nationwide moral panic over ritual sex abuse, satanic cults, and other supposedly repressed traumas. Today, for most of us, the fad seems like a strange, self-contained, and very much closed chapter in recent cultural history.

But for Tom Mitchell, who denies his daughter’s accusations, the controversy is very much alive. He believes his family has suffered from the fact that the mental health establishment has never really purged itself of a thoroughly discredited idea—and arguably lacks the basic mechanisms necessary to self-correct.

Like his daughter’s room, Tom’s life is marooned in the past. Though he continues to manage the business he owns, his head is often elsewhere. “My wife will be talking to me for a few minutes and I won’t hear a word she says because my mind is off on this horrible subject,” he says. “It’s affected him profoundly,” says Tom’s second wife, Jenny. He finds it hard to handle empty time, filling his idle hours fixing an old Ford Falcon that sits in his garage. And he is consumed by a personal mission to expose the institution he believes destroyed his daughter’s sense of reality.

TOM REMEMBERS HIS DAUGHTER as a child who found few things she couldn’t excel at. “She was a gregarious, happy, sensitive girl,” Tom says. (The names of all family members in this story, and some identifying details, have been changed.) Though he and her mother divorced when Anna was seven, Tom insists that his bond with his daughter never wavered. Every other weekend, he drove many miles to bring her to his home, talking and playing games the whole way. Of his ex-wife, he says, “We never stopped being a team.”

When Tom remarried, Anna grew close to one of her two stepsisters, Suzy; the two often disappeared into corners of the house to plan practical jokes on family members. “They were inseparable,” he says. “She was Suzy’s protector.”

But as she approached 15, Anna began to suffer from bouts of anxiety, and started losing a lot of weight. She was caught drinking and cutting school, and typical teenage fights with her mother grew intense. Although Tom and Anna rarely argued, he says, he could see his daughter changing. She had been a good student, but now she declared she wanted to quit school. Near the end of 2010, during a holiday visit, Tom discovered self-inflicted cuts on her arms and legs. She was soon diagnosed with an eating disorder by a therapist.

On that therapist’s recommendation, the family contacted Castlewood, a high-end residential center near St. Louis. Though the center advertised a wide variety of treatment approaches, it especially touted a practice called the Internal Family Systems model, which claims that people’s inner selves are comprised of sub-personalities called “parts” that, in healthy individuals, work together to create an ideal self. An Internal Family Systems therapist’s job is both to heal individual parts and to repair dysfunctional relationships between them.

Early in 2011, Anna entered the 10-bed facility; her stepmother’s insurance covered a near $1,000-a-day rate for inpatient care. Though he didn’t like sending Anna so far from home, Tom was reassured by Castlewood’s credentials. He had researched the clinic online. “Nothing came out that was bad,” he says.

Although there was a rapid decline in the use of memory recovery therapies and in the diagnoses of multiple personality disorder, the mental health profession arguably never really came to terms with the fad that so many of its clinicians participated in and promoted.

However, Tom says, within a month he started getting worried calls and emails from Anna’s mother. She told him that Anna was becoming more despondent and angry. His ex-wife, he says, told him that she had found the center to be emotionally toxic. The staff seemed to assume that it was the families that were to blame for the patients’ issues, she reported.

Anna’s calls to her father became fewer and farther between. Then, two months into her stay, Anna sent a text message to Suzy: She asked her stepsister if Tom had ever touched her in a sexual way.

“We both knew he’d kick the crap out of anyone who so much as looked at us that way,” Suzy says. “To get those kind of messages from her did feel strange.” She texted Anna back, answering no. Suzy then showed the message to Tom. He was shocked, but even more disturbed by Anna’s growing silence. He began planning to bring her home.

Toward the end of April, Tom says, Mark Schwartz, the co-founder and then clinical co-director of Castlewood, called to tell him that it would be unwise to take Anna away; Schwartz, Tom remembers, said that his daughter was now making direct claims of abuse against him. “In that instant, I felt shattered,” Tom says. Schwartz told him that the staff needed time to clarify her memories. A silver-haired, Johns Hopkins-trained psychologist, certified in sex therapy and hypnosis by the American Association of Sexuality Educators, Counselors, and Therapists, Schwartz had a long history in the Missouri area, where he had run other trauma clinics with his spouse, Lori Galperin, a social worker and the then clinical co-director of Castlewood. “I knew nothing about psychiatry back then,” Tom says. The staff at Castlewood—and Schwartz, he adds—“told me that we’d figure out what was going on together, and I actually believed them.” (Calls and emails to Schwartz have not been answered.)

Unbeknownst to Tom, in accordance with mandatory reporting laws, the facility had reported Anna’s accusations to Child Protective Services—including a long list of abuses that he allegedly committed against his daughter. Among Anna’s claims, Tom says, was that from a very young age, her father molested her on trips they took, and eventually at their home—while the rest of the family slept. Upon learning of Anna’s letter, her mother obtained an emergency order of protection, barring Tom from having any contact with his daughter. According to Tom, Anna claimed her terrifying encounters remained hidden in her unconscious until she got to Castlewood, where grisly recountings of trauma by other patients, and sessions with her primary therapist, brought them bubbling to the surface.

In June 2011, Anna left Castlewood because of an insurance issue, and went to stay with relatives. The same month, Suzy, Jenny, and Tom arrived at a New York office of Child Protective Services to be interviewed. Suzy told the investigators what she had told her sister: that she had neither witnessed nor been subject to abuse. Jenny said the same about the two girls. When officers asked Tom when he had stopped having sex with Anna, he forcefully replied, “I never would do that to my daughter. Never.”

Protective Services wasn’t convinced. In September, investigators filed a report accusing Tom of sexual abuse. Though no criminal charges followed, the report meant Tom would be placed on New York’s Statewide Central Register of Child Abuse and Maltreatment, and identified as a potential danger to children. Tom contested the finding, and a hearing was scheduled—for the following year. “It felt like having all the air sucked out of the room,” Tom says of receiving the report.

With nothing to do but wait, Tom began searching for any lead that could help him figure out what may have happened to his daughter in the months when she was supposed to be getting help.

ONE DAY IN NOVEMBER, as Tom was researching online, he came across a news article. A 42-year-old former Castlewood patient named Lisa Nasseff had filed a civil suit against the center and Schwartz on four counts of malpractice, including negligence and misconduct that exacerbated her emotional distress. Three months later a second woman, Leslie Thompson, also filed a lawsuit against Castlewood and Schwartz, making similar allegations. (Two more women would file their own lawsuits against Castlewood, with some of the same claims, in 2012. All four of these women’s cases were being tried by the attorney Ken Vuylsteke, who in 2003 and 2004 served on then governor of Missouri Bob Holden’s Commission on Patient Safety, and is currently the president of the Missouri Association of Trial Lawyers.)

Nasseff and Thompson claimed that they were repeatedly encouraged by Castlewood therapists to believe that their problems were connected to hidden memories of past abuse. To recover these memories, they claimed, they were subjected to the use of hypnosis and psychiatric drugs. Nasseff and Thompson said they grew to believe they had suffered—and forgotten—multiple acts of physical and sexual abuse, often perpetrated by family members. The two had been patients at the clinic intermittently from 2007 to 2010, and during that time had become convinced that they had once been members of cults and, in Thompson’s case, had witnessed sacrificial murders. They also claimed they were led to believe they possessed multiple personalities—in Nasseff’s case, as many as 20. All of these memories, they both later said, were false.

In an ABC News report on the Nasseff lawsuit, Schwartz responded, “We don't use hypnosis” at Castlewood, and said that he hadn’t discussed satanic cults with Nasseff. In March 2013, a response on the Castlewood website stated that the lawsuits “contains numerous false, absurd and bizarre allegations that we patently reject.” (In an email to this publication, current Castlewood CEO Nancy Albus added, “In the past, a former administrator was trained in hypnotism, but it was not an approach used by primary therapists.”)

As Tom began to make connections between the experiences of the women suing Castlewood and his daughter’s treatment, he became increasingly troubled by a new thought: The therapy allegedly used at Castlewood bore an uncanny resemblance to discredited techniques used throughout the 1980s and early ’90s, when uncovering supposed repressed memories of abuse was a mainstay of many therapy practices.

THOUGH THERAPEUTIC ACCOUNTS OF repressed memories appear as far back as the days of Freud, it was during the mid-20th century that they garnered popular attention. In 1957, The Three Faces of Eve, a pseudobiographical novel written by two psychiatrists, presented the case study of a woman with severe gaps in her memory as a result of a traumatic childhood experience. Later, Flora Schreiber’s Sybil retold psychiatrist Cornelia Wilbur’s journey with the then anonymous patient Shirley Mason, and the uncovering of Mason’s suppressed history of abuse by her mother. With an Emmy-winning television adaptation coming shortly after the book’s publication in 1973, Sybil captivated the public’s imagination. Before long, the belief that memories of abuse could disappear from consciousness right after the abuse happened, and stay hidden for decades—only to be retrieved intact during therapy—became accepted wisdom both with the general public and many in the mental health community. This new theory of how the mind reacted to trauma gained momentum from the growing cultural acceptance that sexual abuse had long been underestimated and ignored.

IN ADDITION TO THE vast array of symptoms ascribed to early repressed trauma—depression, anorexia, lingering sensations of pain—some psychologists believed it was able to spawn independent personalities. These personalities, or alters, which could instantly take over the patient’s consciousness and wall off memories from each other, were the manifestation of what was then called multiple personality disorder, a psychiatric condition that had been listed in the third edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM) in 1980.

A significant portion of the mental health community—by one estimate, in the mid-1990s, more than 50,000 U.S. therapists—appeared to accept repressed memories uncritically. A subset of them also promoted the notion that murderous satanic cults were common, and responsible for their clients’ forgotten pasts. Seminars in which practicing therapists offered advice on how best to retrieve memories of cult abuse from their clients were held around the country. (A typical example of the memories that therapists said they were uncovering could be seen in the 1980 autobiography Michelle Remembers, written by Lawrence Pazder, a Canadian psychiatrist, and his patient—and eventual wife—Michelle Smith. Smith described a satanic organization that, she claimed, tortured her for months, feeding her soup laced with worms and forcing her to witness animal sacrifices.) Even when they did not extend to the demonic, the sessions of now-specialized trauma experts almost always centered on recollections of incest and sexual abuse.

America was captivated by the phenomenon, weaving it into popular culture: Daytime talk shows like Geraldo held regular interviews with victims who claimed to have recovered memories, and celebrities like Roseanne Barr disclosed their own experiences of repressed trauma. Books like The Courage to Heal: A Guide for Women Survivors of Child Sexual Abuse and Secret Survivor: Uncovering Incest and Its Aftereffects in Women, which listed hundreds of symptoms that were supposed proof of having repressed memories, became bestsellers. “If you think you were abused and your life shows the symptoms, then you were,” wrote the authors in the first edition of The Courage to Heal. Activists like Gloria Steinem championed the tales emerging from therapy offices through their publications (a Ms. magazine cover proclaimed, “Believe It! Cult Ritual Abuse Exists”). As the panic peaked, many states changed their statutes of limitation to allow for newly discovered memories to become the basis of civil lawsuits and, sometimes, criminal prosecution.

Although there is no full tally, University of California-Berkeley professor Frederick Crews, who wrote about recovered memory therapy, suggested (conservatively, he says) that one million patients may have been convinced they had recovered repressed memories. Of course, as Crews notes, the number of those affected was far greater; the accusations from each of these patients almost always radiated through families and communities, leading to bewildering and painful estrangements for fathers, mothers, teachers, and others.

AS THE PRACTICE OF memory recovery therapy rose to prominence, skeptics began to step forward. Researchers, journalists, and law enforcement officers started asking certain basic questions: Was there any empirical evidence that the mind had the ability to immediately hide memories of trauma? Where had the dramatic symptoms of multiple personality disorder been before the sudden rise of the diagnosis in the 1980s? Was there any forensic evidence of the murderous satanic cults that were supposedly hiding in our midst?

Psychologist and memory expert Elizabeth Loftus, then at the University of Washington, was already an expert in how memory—particularly in the context of eyewitness testimony—was malleable to suggestion and social influence. Her studies suggested that people could be guided toward unequivocally false recollections. In 1994 she published a book, The Myth of Repressed Memories: False Memories and Allegations of Sexual Abuse, challenging the fundamental tenets of recovered memory therapy. People don’t recall the past, she argued, but reconstruct it, molding it to the demands and beliefs of the present moment. Therapists’ assumptions that their clients held hidden memories of abuse, she asserted, could be a key factor in creating those very “memories.” Other researchers found that, contrary to the proponents’ theory of traumatic repression, people who had survived various atrocities like the Holocaust, torture, and natural disasters did not appear to have the ability to seal away a memory after a traumatic experience, keep it locked away, then recall it with clarity.

In 1992, Harold Merskey, a professor of psychiatry from the University of Western Ontario, published a paper in the British Journal of Psychiatry in which he examined all cases of multiple personality disorder-like symptoms in the historical record—and couldn’t find one that wasn’t contaminated by suggestions from clinicians or other forms of social encouragement. “It is likely that MPD never occurs as a spontaneous persistent natural event in adults,” he concluded. “Suggestion, social encouragement, preparation by expectation, and the reward of attention can produce and sustain a second personality. Enthusiasm for the phenomenon is a means of increasing it.”

Troublingly, 43 percent of practicing clinical psychologists still think it is possible to retrieve repressed memories. Those therapists are profoundly out of step with the thinking among research psychologists.

Across the country, many law enforcement agencies conducted investigations, and sometimes excavations, looking for evidence of satanic cults engaged in murder, cannibalism, and torture. FBI special agent Ken Lanning, then a member of the bureau’s behavioral science unit, examined hundreds of satanic ritual abuse claims and found no compelling evidence that such cults existed. He wrote in a 1992 report, “Now it is up to the mental health professionals ... to explain why victims are alleging things that don’t seem to have happened.”

Parents and others who had been accused of abuse based on false recovered memories also became a force in the growing public debate. In 1992, Pamela Freyd and her husband, Peter Freyd—who had been accused by his daughter of abuse—founded the non-profit False Memory Syndrome Foundation, which publicized the work of Loftus and other scholars who were skeptical of recovered memory therapy. The group listed many prominent researchers and clinicians as advisory board members.

But the tide really began to turn when former patients started to doubt their own recovered memories. In dozens of lawsuits, patients described coercive therapeutic techniques including hypnosis, guided visualization, and dream analysis, and the pressure of group therapy, often used on them when they were at their most vulnerable. Some former patients related terrifying experiences of being confined in mental health wards stocked with people who believed they had dozens of personalities. Therapists, some of the lawsuits claimed, both encouraged these beliefs and accused patients who expressed doubt of succumbing to programming they received from a cult. Some settlements from the lawsuits reached into the millions.

By the end of the 1990s, many of the trauma clinics that had specialized in recovered memory therapy had shut down. The daytime talk shows about satanic abuse and multiple personalities became less frequent, and the courts became wary of testimony based on recovered memories. Richard McNally, the director of clinical training in the Department of Psychology at Harvard and author of the book Remembering Trauma, put it bluntly in a friend-of-court brief: “The notion that traumatic events can be repressed and later recovered is the most pernicious bit of folklore ever to infect psychology and psychiatry.”

Although there was a rapid decline in the use of memory recovery therapy and the diagnoses of multiple personality disorder, the mental health profession in the United States arguably never really came to terms with the fad that so many of its clinicians participated in—and promoted. Multiple personality disorder received a superficial facelift in the fourth edition of the DSM, released in 1994; the new moniker was “dissociative identity disorder,” but there were few changes in the diagnostic guidelines concerning the emergence of wholly separate identities in one person. In 1993, the American Psychiatric Association did issue a cautionary note about the difficulty in distinguishing true memories from false; the next year, the American Medical Association declared recovered memories to be “fraught with problems of potential misapplication.” In 1997, the Royal College of Psychiatrists in Britain, by contrast, explicitly advised against the use of techniques designed to elicit recovered memories of abuse. No such advice was given by either the American Psychological Association or the American Psychiatric Association. The mental health professional organizations, by and large, did not appear interested in calling recovered memory therapists to account.

Because of this, recovered memory therapy—with its attendant theories of multiple personalities and ritual abuse—faded from public view, but never really went away.

IN 2012, OVER THE course of six months and many hearings, Tom Mitchell argued to overturn the charges leveled at him by Child Protective Services. These sessions also marked the first time Tom had seen his daughter in more than a year. Anna sat opposite him in the large room, unwilling to meet his eyes. “She was unrecognizable,” he says.

Up until then, he hadn’t heard the full record of her claims. At the end of the first day, he was allowed to read the progress notes from the investigation. When he left the room, Tom says, he went to his car and threw up. “I stayed there for hours, unable to move or drive,” he adds.

On the last day of the hearing, Anna took the stand. For many hours, Tom says, she described a litany of traumatic events she claimed to have experienced. But now, she told the room that she had been abused not only by Tom, but by tutors, coaches, babysitters, even policemen. She described, Tom says, being a call girl by the time she left middle school. The memories of it all, she believed, had been hidden inside her alternate personalities. Tom’s lawyer asked her how many of these personalities she possessed. According to Tom, Anna started to list them, but lost count. With each disjointed description of her past, Tom says he increasingly felt like he was staring at a stranger wearing his daughter’s face. He couldn’t stop crying. “My little girl was so sick and so easily and completely dismantled,” he says. After the hearing, Tom says he tallied nearly 100 people whom Anna named as complicit in abusing her throughout her childhood.

The judge concluded that Anna’s testimony was too inconsistent, too contradictory with the other evidence presented, to be credible. Nearly 16 months since the text message that turned his life upside down, Tom was cleared of wrongdoing, his name removed from the state registry. But it was a bittersweet victory; though the judge vacated an order of protection that had been filed on behalf of Anna, Tom respected her wish: She didn’t want any contact with him. His only knowledge of his daughter’s whereabouts is the address where he sends support payments.

TOM MAY NEVER KNOW what exactly happened during Anna’s time at the center. He is left only with the accounts of other former Castlewood patients.

“It was as if someone had reached into my head, pulled out my brain, and replaced it with craziness,” began Amy Fedor in an email to me. Suffering a protracted battle with bulimia, Amy was admitted to Castlewood in 2004, a year after giving birth to twins. Amy told her therapist at the center that she had been sexually assaulted by a classmate in high school. She felt the incident explained much of her struggle. However, she told me, the center seemed intent to set that event aside.

According to Amy, Castlewood peeled away her sense of what was and wasn’t true. The therapy focused on what the therapists felt were her other “parts” or personalities. “I was naming parts, mapping out parts on paper, drawing parts.” As she sat in a dark room with her therapist, disoriented by a litany of anti-depressants and under hypnosis, Amy began to visualize scenes of brutal, sexual torture by her father and others; she says she saw herself becoming pregnant at the age of 14; being naked on an upside-down cross while a crown of thorns was placed on her head at her grandmother’s house. Therapists assigned Amy readings of recovered memory autobiographies along the lines of Michelle Remembers, she told me. Group sessions featured testimonials by other Castlewood patients about the satanic abuse they suffered. The groups also spent time, she says, “watching movies on cults and in our over-medicated minds developing more false memories.” Amy claims these sessions were led by Schwartz.