Few circumstances confront the psychiatrist with more complex, painful, and potentially problematic clinical dilemmas and challenges than the treatment of the incest victim. When evaluating a patient, attention must be paid to evidence of dissociation in the patient’s history and to the patient’s overall symptoms. Here are factors that may lead to memory of a trauma becoming inaccessible or being reported as inaccessible for long periods. For more on this topic, see "Ramifications of Incest," a 2011 Psychiatric Times article by Richard P. Kluft, MD, PhD, from which this Tipsheet is adapted.
TIPSHEET: WHY MEMORIES OF INCEST TRAUMA MAY BE INACCESSIBLE (OR WITHHELD) BY A PATIENT
■ Familiar mechanisms of defense
■ Dissociated storage processes and structures
■ Conscious coping mechanisms
■ Guilt and shame
■ Loyalty to/protection of the abuser
■ Protection of family members and of the family
■ Perceived moral or religious imperative to withhold
■ Confusion about the reality of events and their meanings
■ Confusion about the source and nature of and misunderstanding of the meanings of available mental contents; obsessing over the reality of mental material
■ Consequences of obfuscation or gaslightinga or promoted reinterpretations of events
■ Obsessing over the meanings of terms
■ Deliberate or inadvertent discouragement of reporting by others
■ Encouragement to doubt or dismiss memories
■ Strategic withholding with goals and objectives in mind
■ Driven withholding, motivated by higher priorities (personal or cultural, including defending loved ones)
a Gaslighting involves providing a person with false information in order to bring that person to doubt his or her perceptions and memories. The term comes from a play and movies about a husband’s attempt to drive his wife insane by raising and lowering the illumination in their home and denying that any changes had occurred.
b Contamination is information that is not autobiographic but to which one was exposed; it influences memory or may become the basis for a memory with no basis in autobiographic fact.