Reforming Mental Health Care: How Ending “Recovered Memory” Treatments Brought Informed Consent to Psychotherapy

Jun 05, 2014

How the Repressed-Recovered Memory–Multiple Personality Disorder iatrogenic epidemic-surely one of the most tragic chapters in the history of psychiatry, psychology, and psychotherapy-ended, and how psychotherapy patients came to be protected by informed consent.

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R. Christopher Barden, PhD, JD
R. C. Barden & Associates


I recently reviewed Dr Richard Noll’s article “Speak, Memory” (as posted on Psychiatrictimes.com, March 19, 2014 at http://www.psychiatrictimes.com/history-psychiatry/speak-memory), including the attached commentaries from Drs David Spiegel, Richard Kluft, and Bennett Braun. I agree with Dr Noll’s suggestion that “now is the time for everyone to share their memories” of the “Repressed-Recovered Memory–Multiple Personality Disorder” (RRM-MPD) iatrogenic epidemic-surely one of the most tragic chapters in the history of psychiatry, psychology, and psychotherapy.

Unfortunately, historians reviewing Dr Noll’s comments and the ensuing online debate would learn little about the prodigious efforts that put a stop to the RRM-MPD misadventure and brought important, lasting reforms to the US mental health system. As one who was very involved in the creation and prosecution of these national efforts, I am grateful for this opportunity to share some memories-documented with media and journal citations.

Dr Noll’s brief history began with a description of the RRM-MPD craze of the late 1980s and 1990s. He accurately noted, “members of the American Psychiatric Association (APA) were making it worse.” Dr Noll then veered off course by asserting, “eventually, just like the last wave of the influenza pandemic, after 1994 it ended as suddenly and incomprehensibly as it had started.” Amazingly, this last statement failed to acknowledge, much less accurately report, the well-documented history of coordinated legal-science-policy-education-licensing-media actions that rapidly ended the RRM-MPD debacle.

Truncated histories such as Dr Noll’s increase the risk that psychiatry could fail to remember the errors and abuses of the RRM-MPD movement and therefore tragically repeat them. In sum, Dr Noll’s account lacked an informed discussion of how the “Memory Wars” were won.

The end of the RRM-MPD epidemic was not “incomprehensible” but rather the predictable-and predicted-result of carefully planned and executed, multidisciplinary efforts to protect the fundamental human rights of vulnerable patients and families. These integrated efforts included model legislation, litigation (malpractice suits in dozens of states), regulation (multi-state licensing prosecutions), public education via international media, continuing medical-professional education, a wave of scientific research publications, Daubert-Kumho legal hearings to exclude RRM-MPD notions from courtrooms,1 and criminal prosecutions of therapists.

Our multidisciplinary, legal-policy-media reform strategy was aided and enhanced by the collective efforts of some of the world’s leading psychiatric and psychological scientists and reviewers, including Richard McNally,2 Harrison Pope,3 James Hudson, Elizabeth Loftus,4 Paul McHugh, Richard Ofshe, William Grove, Paul Meehl, Stephen Ceci, Maggie Bruck, Michael Lamb, Margaret Singer, August Piper, and many others. Our national science allies investigated, published, reviewed, and testified about the science of memory and false memory, thus providing the valid and reliable science we needed to effectively educate juries, licensing boards, and the public.

Our national wave of successful (financially viable) reform litigation began in August 1995. Following a nearly 2-month trial, a St Paul jury awarded $2.5 million to Vynette Hamanne for damages inflicted by RRM-MPD “therapy.”5 Dramatic reports of this extraordinary verdict echoed throughout the international media, including the CBS Evening News, the BBC, NPR, the Associated Press Newswire, and other major media sources worldwide. The long-standing legal myths that psychotherapy negligence lawsuits were “impossible” and “not financially viable” were crushed.

In January 1996, following another lengthy, science-intensive trial, another Minnesota jury awarded $2.4 million to Elizabeth Carlson in a similar malpractice lawsuit exposing abusive, experimental RRM-MPD “therapy.”6 These international record-setting verdicts proved once and for all that citizen juries could fully comprehend-and would aggressively punish-experimental (unsupported by competent science) RRM-MPD “treatments.” Jurors reported they found such therapy methods-methods clearly documented in the patient’s medical records and carefully articulated in the training materials offered by RRM-MPD proponents-to be reckless, abusive, and a violation of the patients’ fundamental human right to control treatment by informed consent.

Following the success of the “Minnesota Twins” multi-million dollar jury verdicts, settlements across the country began to reflect the new “market value” for such cases. In just a little over 2 years, by November 1997, the RRM-MPD therapy industry had collapsed under mounting pressure from our coordinated cluster of internationally reported legal actions. In 1996, former RRM-MPD patients received a $1.57 million settlement in Oregon and a $1 million settlement in Missouri.7 On March 4, 1997, a Wisconsin RRM-MPD case followed the “Minnesota Twins” template by settling for $2.4 million.8 In August 1997, a Texas jury upped the ante by awarding $5.8 million for damages from abusive RRM-MPD therapy.9 In October 1997, a federal grand jury in Houston returned criminal indictments against several RRM-MPD therapists who were already facing a swarm of malpractice suits.10

The most devastating blow of all came in November 1997, when the Burgus family accepted a $10.6 million settlement for damages suffered during years of RRM-MPD treatment with Bennett Braun, MD. The Burgus v Braun settlement was widely reported, including a page 1, column 1 story in The New York Times; a full-hour NBC Dateline investigation watched by millions of viewers; and intensive international print, radio, and television media coverage.11 This dramatic, world-record settlement saved the defendants from further exposure at trial, further investigation for criminal prosecution, and the very real potential of imprisonment. Dr Braun, like several other prominent RRM-MPD therapists, subsequently surrendered his medical license.12 Following this tsunami of legal victories, hundreds of smaller cases were quickly and confidentially settled across the US. By the end of 1997, the RRM-MPD industry had collapsed.

The Burgus settlement, resulting international media firestorm, and subsequent wave of licensing prosecutions were indeed the death knells for the RRM-MPD industry. As Pope, Barry, Bodkin, and Hudson13 have documented, as the clinics and hospital units closed, RRM-MPD research and review publications also collapsed at the end of 1997.

It is essential for historians to note that in contrast to the tragic damages of the RRM-MPD epidemic, the cleansing wave of successful reform lawsuits and licensing actions resulted in historic, lasting reforms in the US mental health system. Such reforms included a new focus on empirically supported therapies,14 a treasure trove of new research on the nature of human memory, model applications of Daubert-Kumho legal hearings that excluded unreliable notions such as “repressed-recovered memories,”15 and the long overdue enforcement of informed consent protections for psychotherapy patients.

Before our wave of RRM-MPD reform lawsuits, the fundamental right of patients to the protection of informed consent in psychotherapy was widely ignored. By making “failure to properly obtain informed consent” one of the key allegations in our wave of lawsuits and licensing prosecutions, we forced the mental health system to recognize, honor, and protect this fundamental human right of all health care patients. I have previously documented many of the key elements of this important history and hope that we may all remember and be grateful for these lasting and important reforms.16

Disclosures:

Dr Barden is a scientist-clinician-attorney-policy expert specializing in multidisciplinary analysis and reform. He is a licensed clinical psychologist and research scientist trained at the University of Minnesota; University of California, Berkeley; and the USVA/Stanford Medical Center. Dr Barden is also a licensed attorney trained at Harvard Law School (cum laude). He served as the President of the National Association for Consumer Protection in Mental Health Practices (1995-2005). As a practicing trial lawyer, Dr Barden has litigated cases in dozens of states and several countries and has obtained record verdicts and settlements. As an expert witness in psychology, he has testified or consulted in civil, criminal, and licensing cases in dozens of jurisdictions. Dr Barden’s research efforts have been funded by grants from the National Science Foundation, the National Institute of Mental Health, the W. T. Grant Foundation, the Foundation for Child Development, and other sources. He is the recipient of two national science awards in child psychology and has published in peer-reviewed journals and texts in law, clinical psychology, developmental psychology, psychiatry, pediatrics, surgery, public policy, and legislation.

References:

1. Grove WM, Barden RC. Protecting the integrity of the legal system: the admissibility of testimony from mental health experts under Daubert/Kumho analyses. Psychology Public Policy Law. 1999;5(1):224-242.

2. McNally RJ. Remembering Trauma. Cambridge, MA: Harvard University Press; 2003.

3. Pope HG Jr, Oliva PS, Hudson JI. Repressed memories: the scientific status of research on repressed memories. In: Faigman DL, Kaye DH, Saks MJ, Sanders J, eds. Science in the Law: Social and Behavioral Science Issues. St Paul: West Group; 2012:807-913.

4. Loftus EF, Davis D. Recovered memories. Ann Rev Clin Psychol. 2006;2:469-498.

5. Gustafson P. Jury awards patient $2.6 million: verdict finds therapist Humenansky liable in repressed memory trial. Minneapolis St Paul Tribune. August 1, 1995:1B. See also: Repressed Memory. USA Today. August 1, 1995:A1.

6. Guthrey M, Kaplan T. 2nd patient wins against psychiatrist: accusation of planting memories brings multi-million dollar verdict. St Paul Pioneer Press. January 25, 1996:4B.

7.Fultz v Carr, Cir Ct, Multnomah County, Oregon, No. 9506-04080 (1996); Rutherford v Strand, Cir Ct, Greene County, Missouri, No. 1960C2745; Associated Press. Springfield, MO. Family torn by false repressed memories settles for $1 million. 1996.

8. Tribune News Services. $2.4 million settlement reached over multi-personality diagnosis. Chicago Tribune News Services. March 4, 1997. http://articles.chicagotribune.com/1997-03-04/news/9703040177_1_cool-multiple-personality-disorder-malpractice.

9. Smith M. Jury awards $5.8 million in satanic memories case. Houston Chronicle. August 15, 1997.

10. US v Peterson, 71 F Supp 2d 695 (SD Tex 1999).

11. Belluck P. Memory therapy leads to a lawsuit and big settlement [$10.6 million]. New York Times. November 6, 1997:1. http://www.nytimes.com/1997/11/06/us/memory-therapy-leads-to-a-lawsuit-and-big-settlement.html. Accessed April 24, 2014.

12. Psychiatrist [B. Braun] loses license over satanic allegations. Chicago: AP News Wire; October 8, 1999.

13. Pope HG Jr, Barry S, Bodkin A, Hudson JI. Tracking scientific interest in the dissociative disorders: a study of scientific publication output 1984-2003. Psychother Psychosom. 2006;75:19-24.

14. Chambless DL, Hollon SD. Defining empirically supported therapies. J Consult Clin Psychol. 1998;66:7-18.

15.Kumho Tire Co v Carmichael, 119 S Ct 1167 (1999); See, eg, Hamanne v Humenansky, Ramsey County Minnesota, No. C4-94-203 (1995), Judge Betrand Poritsky; Carlson v Humenansky, Minnesota, No. CX-93-7260, (1996), Judge Betrand Poritsky; Engstrom v Engstrom, Cal App, 2nd App Dist, Div 2, (Cal 1997); State of New Hampshire v Hungerford and State of New Hampshire v Morahan, 698 A2d 1244 (1997); State of New Hampshire v Walters, 697 A2d 916 (NH 1997); Franklin v Stevenson, 987 P2d 22 (Utah 1999); State of Rhode Island v Quattrocchi, CA No. P92-3759 (RI 1999); New Hampshire v Bourgelais, Docket No. 02-S-2834 (2005); Rivers v Father Flanagan’s Boys Town, Doc 1024 No. 743 (Neb 2005); John Doe (Keenan) v Archdiocese of St Paul, 817 NW2d 150 (Minn 2012); See, Affidavits of Harrison Pope, MD, Richard McNally, PhD, and R. Chris Barden, PhD, JD, regarding the testimony of Daniel Brown, PhD, in Anonymous v Vella, US District Court of Nebraska, No. 8:04CV-269 (2007).

16. Barden RC. Commentary: informed consent in psychotherapy-a multidisciplinary perspective. J Am Acad Psychiatry Law. 2001;29:160-166.