Postmortem on case history - Letter to the Editor

In "Who Abused Jane Doe?" (Conclusion, July/August 2002) the authors perform a detailed review of previous work and expose what appears to be poor workmanship in a case history. It should be no surprise that clinical psychologists and psychiatrists make mistakes. Mistakes are made in every profession.

A critical factor in improving the quality of work done in a profession is being able to locate mistakes. Only when mistakes can be identified can the quality of work be improved.

When a patient dies, a detailed autopsy performed by an independent doctor may discover that an incorrect diagnosis or procedure harmed the patient. From this knowledge the practice of medicine is improved. What Loftus and Guyer have done is similar to performing a postmortem. From a detailed and independent audit of a case history mistakes and poor practices are identified.

Quality is not likely to advance quickly when a profession makes it very hard for poor work to be detected and corrected. To an outsider it seems obvious that clinical psychologists, in the interests of performing quality work, should have independent professionals audit a random sampling of their past cases. Without this, improvements in quality will be slow.

Steve Sullivan

Beaverton, Oregon

Loftus and Guyer offer a case study to assail the issue of memory repression and recovery, ostensibly revealing the weakness of case studies. I do not dispute their research, but wish to point our that readers are no more able to assess the accuracy, balance, and validity of their work than were readers of Corwin's work.

Unfortunately the memory issue was addressed in our adversarial legal system, which polarizes debate and is ill-suited to arriving at moderate or reasonable conclusions, and became inflamed, with first one witch-hunt against sexual abusers, then another in retaliation.

SKEPTICAL INQUIRER's readers may be surprised to learn that "repression" and "memory recovery" have not been discredited. SI's focus otherwise does a disservice to the people involved and to the skeptical community. Repeated investigation has reached conclusions that should surprise no one: Memory of trauma is sometimes forgotten, sometimes not. Memories which have been forgotten are sometimes recovered, sometimes not. Recovered memories are sometimes accurate and reliable, sometimes not. (Check out www.apa.org/pubinfo/mem.html.)

Invalid methods to ascertain memory reliability are unfortunately widespread. I suggest we move discussion to more useful focus. How might reliable best be distinguished from unreliable? What corroborations constitute sufficiency? What indicators suggest presence or absence of reliability? With this focus, we could meaningfully inform clinical, legal, and lay communities regarding an important subject and truly demonstrate the value of skepticism and rational thought.

Kenneth L. Salzman

Licensed Clinical Psychologist

Lansing, Michigan

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