Over 55 years ago, I graduated from the then almost new University of Texas Southwestern Medical School in Dallas and went off to Boston and the Brigham to be a straight medical intern. I had been married for 2 years, and my wife was pregnant with our first child-neither of us knew a soul in Boston. I was on duty for 36 of each 48 hours (except for 1 weekend a month) and was of little help to my wife, who was alone in a strange city and was facing the imminent birth of our first child.
Over 55 years ago, I graduated from the then almost new University of Texas Southwestern Medical School in Dallas and went off to Boston and the Brigham to be a straight medical intern. I had been married for 2 years, and my wife was pregnant with our first child-neither of us knew a soul in Boston. I was on duty for 36 of each 48 hours (except for 1 weekend a month) and was of little help to my wife, who was alone in a strange city and was facing the imminent birth of our first child. It was, in short, not an easy year. However, we made friends, and I was encouraged to stay on at the Brigham. We not only survived but, in a sense, flourished. Although from a developmental perspective, survival and growth are important markers of outcome, there is more to the ways in which those experiences changed us than those markers suggest.
One change concerned what was to become my career in psychiatry. In the Dallas of the early 1950s, psychiatry was overwhelmingly biologic. There were no helpful psychotropic drugs, and the prevalent treatment paradigms involved electroshock, insulin coma, and, for some, sleep therapy. In Boston, psychoanalysis was the clearly dominant ideology, and whether stated explicitly or accepted implicitly, it was based, in part, on the biblical injunction that knowing the truth shall set you free. As a psychoanalytic premise, however, the biblical injunction was understood as meaning that knowing the truth about oneself led to freedom from maladaptive behavioral patterns learned in childhood. This emphasis on truth and the search for insight attracted some of the very brightest of my fellow house officers in Boston and had a major impact on my evolving ideas about human psychology.
How much things have changed since those early days! My reading of the current understanding of what one discovers about oneself in many forms of psychotherapy is not necessarily the truth but rather a more useful reconceptualization of one’s personal past. The emphasis on truth has been replaced by that of utility. What, it is now asked, is the most helpful way of understanding one’s personal past?
This movement away from the search for truth as a guiding principle of many psychotherapeutic schools has been influenced during the past 50 years by multiple factors. In this essay I will discuss only 3: longitudinal studies, narrative theory, and neuroscientific advances, particularly those regarding memory.
Longitudinal studies suggest that many adults’ recollections of their pasts-especially childhood and family experiences-undergo changes throughout life. One “truth” is replaced by another. For some, the parents of childhood are recalled more sympathetically. For others, the recollections are much more critical. Some believe that the difference between those who are more sympathetic and those who are more critical is to be found in the present circumstances of those who are doing the recollecting.
We found support for this premise in a longitudinal study of young couples before and after the birth of their first child.1,2 In the findings relevant to this topic, the participants’ reports of their childhood relationships with each parent and the nature of their parents’ marriage were relatively stable from the prenatal period to 4 years after the birth of their first child. Having a child and parenting that child for 4 years did not appear to induce systematic changes in the recollections of their own childhoods. There was, however, one intriguing exception to this picture of relative continuity. A number of the female participants changed their recollections of their fathers from positive to negative. After 4 years of parenting, they no longer recalled their fathers as being as affectionate and supportive during their childhoods as they had been before the birth of their child. In searching to understand the correlates of these changed memories, we found a clear pattern, and it had to do not with the female participants but their husbands. The women who changed their recollections had husbands who were depressed, who helped little with parenting, and who were observed to be less sensitive to their children than other fathers.
Why, then, would the women with less available and helpful husbands change their recollections of their fathers in a negative way? One possible answer to this question was found in the marital satisfaction data. The women with depressed, unhelpful husbands did not report lower levels of marital satisfaction; rather they were maintained at high levels. One interpretation of our data was that the women’s more negative memories of their fathers served the function of minimizing (or denying) their husbands’ failure to be as helpful as needed. If this is all that can be expected of men, then I can no longer recall my father so positively!
Although there are other interpretations of these data, the central issue is that they show that reconstructions of the past may be in the service of adapting to present circumstances.
The second factor impacting the diminished emphasis on the truth is the growth of narrative theory and its extension into the study of the self. There is a vast literature on these topics and, for reasons of space, I will refer only to the work of McAdams, whose theoretical writing and empirical research on the narrative self has been particularly illuminating for me.3 McAdams suggests that personality can be conceptualized as a 3-level entity. Personality traits occupy the first level, and these partially inherited characteristics are relatively unchanging during adult life. The second level, personal concerns, includes a wide array of important characteristics (eg, values, defense mechanisms) that often change during adult development. The third level is the autobiographical self, the story one tells oneself and important others about one’s life-the past, present, and anticipated future. This narrative is believed to undergo subtle but constant revision, usually outside the person’s awareness. Indeed, if confronted with clear evidence of revisions, most persons become distressed.
The major revisionary process is altering the memories of the past to better fit the present. Many students of the narrative self believe that these reconstructions are in the service of coherence. In order to maintain a coherent sense of self in an often unpredictable world, one modifies the past. Here, again, as in the longitudinal study reviewed above, it is the present that changes the past.
The third influence on the lessened emphasis on the truth consists of the views of some memory researchers. Gilbert reviews this research and describes the picture that comes together of how memory actually works.4 We are unable to store all that we experience over time; there is simply too much to handle, even for our complex brains. Rather, experiences are compressed for storage by being reduced to a few key elements. When we want to recall a particular experience “our brains quickly reweave the tapestry by fabricating-not by actually retrieving-the bulk of the information that we experience as a memory.”4(p87) This happens so quickly that we believe the information was all in our heads all the time.
The laboratory research that documents this process is voluminous and establishes that information obtained after an event may alter the memory of the event. (Here, again, the impact of present on past.) Gilbert suggests that most scientists have become convinced that remembering involves “filling in” details that were not actually stored, and this process occurs outside of the awareness of the remembering person.
In this essay I have suggested some of the factors that have altered the romantic paradigm of my early psychiatric experiences-that the truth can set one free. In its place has crept the paradigm of utility. The objective of some forms of psychotherapy is to assist patients in rewriting their narrative selves into a form that provides both a greater understanding and relief from pain. Almost immediately, however, it is important to point out that not just any revision of the patient’s life narrative will do. The revision must include all that is “known” to have happened to the patient, it should emphasize the importance of the patient’s decisions on one’s life course, and it should represent a collaborative process shared by patient and therapist.
I suspect that some readers will disagree with my formulation of these changes, and, in truth, I hope so. Such would reassure me that these issues are still alive in a field that often seems dominated by diagnoses and prescriptions.
Lewis JM, Owen, MT, Cox MJ. Family of origin. In: Lewis JM.
The Birth of the Family:
An Empirical Inquiry.
New York: Brunner/Mazel; 1989:89-99.
Lewis JM, Owen MT. Stability and change in family-of-origin recollections over the first four years of parenthood.
Mc Adams DP.
Power, Intimacy, and the Life Story: Personological Inquiries Into Identity.
New York: Guilford Press; 1988.
Stumbling on Happiness.
New York: Alfred A. Knopf; 2006.