Leading Article: Remembering sexual abuse in childhood

SEXUAL ABUSE is something that perpetrators, and often their victims, would prefer to forget. Those not involved may also feel uncomfortable with the subject, which has been discussed openly only in recent years. So it may seem surprising that some people recall sexual abuse which never happened to them: they are said to be suffering 'false memory syndrome'.

The consequences of this phenomenon are deeply distressing. Parents may be wrongly accused of abusing their children and may be socially ostracised. Conversely, those who have really experienced abuse may encounter great scepticism when they pluck up courage to reveal the truth. 'False memory syndrome' could become a shield behind which abusers hide. So it is an area in which to tread cautiously.

Psychiatry has long acknowledged that patients can have imaginary memories of incidents which never occurred. Freud also wrote about nachtraglich, or 'deferred' action. This relates to occasions when real childhood experiences, impressions and memory traces are revived at a later date and reinterpreted. Originally innocuous incidents may years later be seen in a sinister light. Well-trained therapists will be aware of these possibilities. They will recognise additionally that people may reveal psychological distress in culturally acceptable ways. So as sexual abuse is talked about more, there may be a few patients who portray themselves as abuse victims as a way to express other problems.

Unfortunately, a minority of psychotherapists have only rudimentary knowledge of these issues and few skills to deal with them: the profession still does not have a register and it lacks control over training. Sometimes therapists become too involved with clients, breaking boundaries that are the very basis of the psychotherapeutic relationship. They may, even unwittingly, indicate to highly suggestible and vulnerable clients that sexual abuse in childhood is the cause of their problems. Such unprofessional practice is fertile ground for encouraging and confirming false memories. So a client may be led not to self- knowledge but down a dead end of self- delusion by an inexperienced therapist.

There is a great danger in such poor practice both to the client and those close to him or her. More generally, it threatens the credibility of adults who only in later life detail their childhood experiences. Often it is abuse that was not forgotten, but simply never spoken about. And it is possible to uncover memories that have been completely repressed because they are so painful. After such disclosure, siblings and perhaps a parent may confirm the truth of what has been revealed. Equally, medical evidence often supports children and even adults who allege sexual abuse.

Despite all the evidence that sexual abuse of children is real and surprisingly common, there are many people who will exaggerate the prevalence of 'false memory syndrome' to back up their belief that it is largely a myth. Unless those treating the abused maintain their credibility through high standards of practice, they and their clients may be unjustly dismissed as cranks.