Psychiatrist challenges 3 'fashions'


November 24, 1992|By Jonathan Bor | Jonathan Bor,Staff Writer

After three decades in the field, Dr. Paul R. McHugh believes several trends that have swept American psychiatry since the 1960s are wrong-headed outgrowths of popular culture.

In a recent magazine article, "Psychiatric Misadventures," Dr. McHugh outlines his distaste for three "fashions" -- the anti-psychiatry movement, sex-change surgery and the theory of multiple-personality disorder. None, in his view, addresses what really ails patients; the result has been prolonged treatment with dubious results.

The most conspicuous case, he says, is the anti-psychiatry movement, the view that psychiatrists have imposed labels like "schizophrenic" on people who are simply different. That movement, he says, is partly responsible for the deinstitutionalization of thousands of desperately ill patients onto the streets of America.

Dr. McHugh's article appears in the autumn issue of the American Scholar, a quarterly published by Phi Beta Kappa. He is chairman of psychiatry at the Johns Hopkins School of Medicine and a professor of mental hygiene at the Johns Hopkins School of Hygiene and Public Health -- positions he has held since 1975.

QUESTION: Your article says that every 10 years or so a new fashion sweeps over psychiatry, "proving how all too often the discipline has been held captive to culture." What is the current fad?

ANSWER: This whole idea of hidden child abuse, that somehow or another there are all kinds of victims who are not remembering their "victimhood."

Q.: Do you disagree with the idea that children who are sexually or physically abused can so thoroughly suppress the memory that it remains buried until emerging years later in adulthood?

A.: All I can tell you is that every time I come across such a case, the testimony is remarkably dubious. The mind can do all kinds of things. But one of the things that the mind can do more than anything else is take up a suggestion and run with it.

It's a contemporary view that many of us are victims. I don't think there's any malice involved in this. It's just an idea that's come to many therapists who have forgotten true abuse, and it's a total re-creation of just what Sigmund Freud ran into at the turn of the century.

Freud began his important work and suddenly came across a whole slew of claims about sexual abuse. And eventually, after going public and saying there was all this abuse going on, he came to realize that in the interactions between him and the patients, the ideas had been generated not out of historical reality as he said but out of psychic reality.

Q: But some patients are making specific statements about who abused them, what happened, and when. These aren't vague memories. How do such specific memories get formed if the events never really happened?

A.: When I had an opportunity to follow [these cases], they took the course of a person in distress going to a therapist who concluded quite early that sexual abuse had occurred.

Together, the patient and the therapist discuss the possibility. The patient says things like, "Well, you know, there are things in my background I can't quite remember, I feel uneasy about."

And after weeks and weeks of focusing on that, something quite concrete emerges.

Q.: It would seem a huge leap of faith for most people to accuse a father, uncle or brother of abuse. Wouldn't most people be loath to accuse a parent of sexual abuse unless they remembered specific abuse?

A.: Indeed, and the people who have recanted these things and have changed their mind, speak about how long it took for them to both come to that opinion and then change that opinion. The power of psychotherapy and the power of the therapist's even-unconscious suggestions are not to be underestimated.

Q.: What do you think is really going on with these patients?

A.: There's no one thing. I think these are people in a variety of forms of distress. They need to be understood for the nature of their distress, and we shouldn't pour them all into a category of post-traumatic stress sex abuse.

Don't get me wrong. I believe there's sex abuse of children. We know a lot more about sex abuse than we used to, and sex abuse has long-term effects on people. But they don't forget it. They don't forget it.

Q.: You've also debunked the theory of multiple-personality disorder, an idea popularized by such movies as "Sybil." The theory is that victims of sexual abuse invent alter egos to shelter RTC themselves from the trauma. The disorder is now recognized as an official diagnosis, and thousands of victims are being diagnosed every year. Is this a fad, too?

A.: Only in the sense that it's a hysterical symptom. The word "hysteria" is a professional one: an individual has developed a physical or a psychological state that is derived from conflict and suggestion.

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