perhaps bigger…

Posted on Monday 17 February 2014

Ever since Richard Noll, a psychologist scholar at DeSales University, wrote an article called When Psychiatry Battled the Devil [online full text on Gary Greenberg’s site] for the Psychiatric Times about the epidemic of interest in fictive reports of ritualized abuse by satanic cults in the late 1980s, the story continues to get as bizarre as his topic itself.  After being published online for a week, the article disappeared [see the unforgotten unremembered…, the twilight zone…, learning from mistakes…]. Apparently some of the psychiatrists who were in the thick of things back in the day objected to having the topic brought back up and threatened legal action. After some waffling, Psychiatric Times decided not to repost the article. Now something I wouldn’t have guessed. Ivan Oransky’s Retraction Watch  is a fascinating blog that usually catalogs the retractions from Scientific journals of articles that are found to be fraudulent, and there are plenty of them. But this time, Retraction Watch is focusing on an article that has been retracted for telling the truth. You guessed it, it’s Richard Noll’s When Psychiatry Battled the Devil:
Retraction Watch
by Ivan Oransky
February 13, 2014

Some Retraction Watch readers may recall this episode, recounted in a recent op-ed by Lew Powell:
    During the 1980s and early ’90s a wave of nonexistent “satanic ritual abuse” claims shut down scores of day cares such as Little Rascals, McMartin in California and Fells Acres in Massachusetts. In virtually every instance the charges lacked any basis in fact. Today no reputable psychologist or other social scientist will argue otherwise. The defendants were innocent victims of a “moral panic” that bore striking similarities to the Salem witch hunts 300 years earlier.
Psychologist Richard Noll found the charges troubling too, so he wrote a piece last year for Psychiatric Times because:
    Despite the discomfort it brings, we owe it to the current generation of clinicians to remember that an elite minority within the American psychiatric profession played a small but ultimately decisive role in the cultural validation, and then reduction, of the Satanism moral panic between 1988 and 1994. Indeed, what can we all learn from American psychiatry’s involvement in the moral panic?
The Psychiatric Times editor said the staff thought the essay was “terrific” and might even be a cover story for their January issue. It was posted on December 6. But you won’t find that article — available here — at Psychiatric Times anymore. As Gary Greenberg relates:
    The editor made some suggestions for the print version and asked for Noll to finish them by Dec. 16. But then on Dec. 14, Noll discovered that his article  had vanished from the website. He made gentle inquiries and determined that it wasn’t a glitch, but that PT had intentionally taken down the article. The reasons were vague–something about how they didn’t like the title (which they had chosen), and how they didn’t like the fact that he had named names. But whatever the reason, the article was gone.
Here’s what the editors told Noll when he pushed for an explanation:
    Dear Dr. Noll,

    I don’t blame you for being miffed at the inexplicable disappearance of your article, and the long delay in getting back to you with an explanation. I’d like to offer a sincere apology for the delay, and to explain what happened. It hasn’t helped that our offices were closed most of last week and that communications between editorial board members and staff have been generally slow because of vacations.

    As you know, Professor [redacted] is the final arbiter of History of Psychiatry columns, so our staff enthusiastically went ahead and posted your article. I read it the weekend it was posted, however, and grew immediately concerned that it raised potential liability issues—possibly for you and, by extension, for Psychiatric Times. I therefore thought it prudent to hide the piece from public view until I could get some guidance from our editorial board. The board did support these concerns, and it was suggested that I consider obtaining corporate legal advice. There was also the suggestion that Drs. Kluft and Braun and some others discussed in your essay needed to be given the opportunity to respond to claims made in the piece. However, there was also general consensus that the piece “may be of some historical interest, but not particularly relevant to the problems facing psychiatry today.” Ultimately, it was the board’s recommendation that we not publish the piece.

    We respect your expertise and previous contributions to Psychiatric Times. The scenario is a first for us. I’m so sorry it happened this way. We will return your copyright form and hope that you find another venue for the piece…
Powell, we should note, has also been urging the Journal of Child and Youth Care (now called Relational Child & Youth Care Practice) to retract a 1990 issue devoted to In the Shadow of Satan: The Ritual Abuse of Children.
I would particularly urge you to read this last brief piece, In the Shadow of Satan: The Ritual Abuse of Children. It gives the flavor of the whole period. There’s much in this story to respond to, but this is the part that catches my attention today:
"However, there was also general consensus that the piece ‘may be of some historical interest, but not particularly relevant to the problems facing psychiatry today.’ ”
It’s hard to imagine how one might go about defending that statement in any context, but particularly this one. When is it ever true that retracting history is a particularly good idea? Because of the subjectivity of matters mental, we rarely have the kind of solid anchors [those elusive biosignatures we love to talk about] that hold us in the road. While that’s a source of major criticism and derision, it’s also a simple fact of life in the subjective world of mental illness. If anything, it is a central feature of all of the mental health disciplines. Our histories are littered with paradigms that became "the answer" and were elevated to a centrality that look pretty foolish in retrospect – vilified for their failings. The reforms of moral treatment lead to hospitals that were later known as snake pits. Deinstitutionalization started as liberation from those snake pits but became abandonment of the mentally ill. The miracle drugs of the 1950s became chemical straight jackets.

It seems to me that our real failing is that when we go through the oscillations in science known as paradigm shifts, there are two things that are unique to our mental health specialties. Our highs and lows tend to swing way higher and way lower, often into the realm of absurdity as in this case. And we tend to reject whole paradigms lock stock and barrel as rapidly as we were too quick to embrace them earlier [lock stock and barrel]. I would surmise that the wide swings are in the nature of anything subjective. But I’m not sure I altogether understand the waves of naive acceptance and outright rejection. In other scientific endeavors, the phase of paradigm exhaustion leaves a growing residue of what was useful that leads to a gradual upward movement in the discipline.

Freud rejected his earlier trauma theory in favor of one based on fantasy, leaving the actually traumatized behind. The revival of trauma theory left those with powerful fantasies behind. In the midst of that rediscovery of traumatic mental illness, the episode Richard wants us to remember emerged. And it’s important to know that the therapists that got caught up in this story weren’t all crazy themselves, nor charlatans. The clarity offered by the victim/persecutor paradigm is a compelling human experience – extending well beyond the borders of the formally paranoid among us. And it came at a time when there were other paradigm shifts around every bend – including the medicalization of psychiatry.

There are other places where our history has unmentioned lacunae – prefrontal lobotomies, insulin coma wards, over-use of convulsive therapy or neuroleptics, etc – breakthroughs gone viral. We’re in the afterglow of some now – the DSM revolution, evidence-based medicine and clinical trials, translational science, clinical neuroscience, psychopharmacology. These are all useful concepts in moderation, but moderation has never been our forte. Are we going to suddenly disappear all of them just as we sought to disappear psychotherapy thirty years ago? or, to return to the point, as we continue to disappear the days when psychiatry battled the devil?

Dr. Noll ends his article with:
Are we ready now to reopen a discussion on this moral panic? Will both clinicians and historians of psychiatry be willing to be on record? Shall we continue to silence memory, or allow it to speak?
The editor’s comment "not particularly relevant to the problems facing psychiatry today" is way off the mark. How will we ever learn to have appropriate restraint and to avoid the pifalls of polarization if we continue to erase the very examples that might help us grow in a less tumultuous fashion in this strange subjective world we inhabit with our patients? This is an unexpected but useful function of Retraction Watch – pointing out things retracted in error. In my mind, Richard is bringing up the most important of lessons – learning by experience, and I see this article as deserving a place in our literature and collective memory perhaps bigger than Psychiatric Times
    February 17, 2014 | 3:41 PM

    Psychiatry is subject to fads? Can’t be true.

    February 17, 2014 | 6:54 PM

    As one who remembers this panic (and the highly profitable “dissociative disorder units” it spawned at prestige medical centers like Rush Chicago) I think there is one very relevant lesson for today: When patients consistently get worse under a given form of “care”, be suspicious. When their “care providers” tell you they are not causing the pathology but only “unmasking” it, be VERY suspicious.

    Although on the surface they look very different, I think the late-80’s epidemic of Multiple Personality Disorder and the modern-day epidemic of Bipolar Disorder have a lot in common. In both cases people (mostly women) entered treatment in some level of emotional distress but still able to carry on. After a year or two of treatment, many were in severe, chronic distress and almost completely nonfunctional. (OK, this may not happen quite as often with “bipolar” treatment as it did with “recovered-memory” therapy, but it does happen way too often.)

    In both cases the patient is expected to be grateful to the doctor who discovered just how terribly ill she was beneath the surface. And sometimes, sadly, the patient is grateful. And completely dependent on an ever-expanding “treatment” regimen that trumps everything else in her life. And terrified of trying to resume life without it.

    A few years ago a California feminist journalist named Meredith Maran wrote a book called My Lie — a memoir of the eight years she spent convinced she was an “incest survivor” and struggling to “recover” memories of sexual abuse by her dad. Years after she finally realized there was no incest and no memories to recover, she set about trying to reconstruct how she, a smart, skeptical and very sane person, came to drink the Kool-Aid. It’s one of the few honest reappraisals of the whole sad story I’ve seen. I’m sorry, but not surprised, that it got so little attention.

    Jenefer Curtis
    February 17, 2014 | 7:58 PM

    Back at the height of the “recovered memories” fad, the associate pastor of our Presbyterian church “remembered” her dad abusing her during therapy with a therapist. Suddenly, she was a victim and not an effective pastor. The whole congregation suffered.

    Jen in San Jose

    Peter Parry
    February 17, 2014 | 11:29 PM

    A very good and balanced article Micky.
    Both false memories and occasionally recovered memories do seem to exist.
    Dissociation does occur and I’ve seen the occasional case of DID.
    The moral panic was very harmful to many people but it was also fascinating in how a moral panic or idea can get so much widespread traction.
    I agree with Joanna that bipolar disorder fuelled by Pharma money in an era of dominant biomedical paradigm – has similarities with the SRA phenomenon. Particularly the young children so diagnosed.

    Steve Lucas
    February 18, 2014 | 6:57 AM

    Back in the day we separated marketing and sales. Marketing is; what is my product and who am I going to sell it too? Sales is; feet on the ground, how do I convince people to buy the product.

    In this case the product is repressed memories and the product is treatment. Bipolar receives a similar product cycle in that we create a storm of vague symptoms and then sell medical treatment. It becomes very important in the whole marketing/sales system to have satisfied customers so as to increase sales and maximize the life of the product.

    You will notice how medical treatments become less important when the drug associated with that malady goes off patent. Statins have become less important now that there are a large number of generics.

    People want to believe they are special and in the rush, rush world we live in stress takes its toll and a medical condition becomes a refuge from failure. Mental health also provides a stumbling block for employers in removing an underperforming employee and people will seek shelter in this designation.

    The Presbyterian Church seems to attract a large number of ministers who have professionally diagnosed mental health issues. I have dealt with a number, and wonder if the San Jose minister’s first name is Debbie?

    Steve Lucas

    February 18, 2014 | 4:48 PM

    My impression is that what we try to obscure are the difficulties inherent in the doctor patient relationship and not any particular moment in time or technique. And when I say we I do mean we. Once upon a time someone in pain took their pain to a doctor and became a patient…

    February 18, 2014 | 7:52 PM

    If child psychologists had told parents in the early 21st Century that their field had made a mistake telling parents that the word “no” would crush their children’s creativity instead of rolling their eyes at parents who did not firmly and consistently tell their child “no”, I might feel a bit more respect for the field.

    A solution to this kind of convenient forgetfulness and blindness is to require every degree and licensing program to include the historiography of that field. It should be absolutely required for people entering field to learn about its history and to be encouraged to examine themselves in such a light.

    February 18, 2014 | 7:57 PM

    thank you, Wiley, “Convenient forgetfulness” That’s a useful term.

    February 18, 2014 | 8:06 PM

    Clinicians whose stock in trade is judgment of the moral and social fitness of others should be particularly aware of the errors of their profession.

    February 19, 2014 | 2:41 PM

    Thank you for continuing to follow the Psychiatric Times affair — a suitably bizarre coda to the moral panic itself.
    I blog about the Little Rascals Day Care case and similar episodes at in hopes of persuading the State of North Carolina to grant the Edenton Seven a “statement of innocence.”

    February 20, 2014 | 8:57 PM

    An update on Richard Noll and Psychiatric Times:

    March 1, 2014 | 10:27 AM

    For 18 years, I have been a volunteer moderator in social networking websites focused on chronic face pain. In this role, I see a flip side of the satanic ritual abuse picture: the non-benign neglect or abuse of patients with rare or complex medical disorders, aided by psychiatrists and psychologists.

    I have corresponded with hundreds if not thousands of chronic pain and rare disorder patients who have been dismissed as head cases. I believe there is plausible evidence that the simple assignment of a psychosomatic diagnosis in the medical records of a pain patient may be directly responsible for a 250% increase in suicide risk. My conviction is based on a very large-sample study of suicide rates associated with seven documented non-cancer pain conditions, in a population of 4.5 million US veterans of military service. My published paper on the issue is titled “Psychogenic Pain and Iatrogenic Suicide” [].

    As an informed layman, I cannot claim with authority that there is no such thing as “dissociative disorders”. What I can confidently suggest from protracted search of the medical literature is that medical evidence for such disorders is fragmentary, subjective, judgmental on the part of practitioners and ill-supported in field trials. If it were up to me, the entire field of psychosomatic medicine would be legally abolished and its practitioners barred. The harms done to medical patients by misapplications of this field, are legion. Evidence for positive outcomes among those treated for “somatoform” issues is missing or very weak. It is time and past time that psychiatric professionals owned this debacle and took steps to put their own houses in order.


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