The Courage to Heal

"The Courage to Heal: A Guide for Women Survivors of Child Sexual Abuse " (first published in 1988) is a book written by Ellen Bass and Laura Davis, aimed at a female audience who have suffered child sexual abuse and who seek to overcome the associated trauma generated by it. Many websites discuss "The Courage to Heal".

Overview

The book has been issued in several editions, and has sold more than a million copies. The most recent edition, as of 2007, has the book divided into the following sections:

# Taking Stock
# The Healing Process
# Changing Patterns
# For Supporters of Survivors
# Courageous Women
# Honoring the Truth: A Response to the Backlash. (This sixth section was added to respond to negative reactions to previous editions, notably the claim that the book promotes false memory.)

The book was written as a response to the author's frequent encounters with women who were the victims of sexual abuse during their childhood and adolescence. The authors present a path to healing from the trauma of childhood abuse. They additionally suggest that people experiencing dysfunction in their lives, who feel that something traumatic happened in their childhood that they do not currently remember, should investigate these feelings. They say that extreme childhood trauma, of which sexual abuse is one, is often spontaneously repressed to allow the child to continue growing up. The authors outline how the damaging effects of child sexual abuse can be wide-ranging: depression, anxiety, alcoholism, drug addiction, dysfunctional relationships, dissociative identity disorder, [http://ajp.psychiatryonline.org/cgi/reprint/154/12/1703.pdf "American Journal of Psychiatry", December 1997: Objective Documentation of Child Abuse and Dissociation in 12 Murderers with Dissociative Identity Disorder] (PDF)] self-mutilation, suicidal thoughts and others. The latest edition features language more inclusive of male sexual abuse victims.

Since writing "The Courage to Heal" Laura Davis has written books and produced tapes ("I Thought we’d never Speak Again" and "The Last Frontier: Is Reconciliation Possible After Sexual Abuse?") that deal with reconciliation of families, many of which have been torn apart due to allegations of abuse. [http://www.lauradavis.net/ The Official Laura Davis Website] ]

upporters' view

The book tells abuse survivors that they are not alone, but that one in four girls and one in seven boys have been similarly victimised. It gives specific and detailed steps about how other survivors have healed from abuse.

The book encourages men and women to trust their feelings; if they know or suspect that something traumatic happened to them as young children, they should not ignore it. By going back to deal with the childhood trauma of sexual abuse, the victim may be able to unravel the many physical and emotional symptoms that continue to plague their adult lives, and thereby overcome often lifelong obstacles to functionality.

Just as some mental health practitioners encourage patients to use the book, the book also recommends that survivors seek out a therapist or support group.

In the book’s defense, supporters also point out that many survivors who recover abuse memories do so without the aid of therapy. Because of extreme anxiety and fear instilled at the time of the abuse, many victims remain silent for years and never report it to police or confront the perpetrator. However, in such cases, there is debate over whether such memories were in fact consciously repressed and not thought about by the victim - or whether they were not retrievable (as in amnesia) even if the victim had tried to recall them.

Critics' view

Though critics recognize that child sexual abuse is common, and that there are confirmed cases of amnesia regarding sexual abuse, whether these are cases of "repressed memory" is still inconclusive.

Critics contend that because Bass and Davis have no formal training in psychiatry or psychology, they are not qualified to write such a book [ [http://www.skeptics.com.au/journal/1997/2.pdf The Skeptic Vol 17, No 2, Page 26 "Authors of The Courage to Heal report no formal psychological qualifications"] ] . Bass has a background in creative writing, Davis' background is in journalism.

In Australia a 1998 study by psychologist Merle Elson showed that "The Courage to Heal" was associated with 47 percent of cases in which it was alleged false accusations of sexual abuse were made. [http://www.afma.asn.au/ELSONREP1.html Australian False Memory Association: Accusations of Childhood Sexual Abuse Based on Recovered Memories: A Family Survey] ]

Psychologist professor Elizabeth Loftus has written many articles/books on the subject of recovered memories(see references below). She is skeptical about the authenticity of supposed memories of trauma recovered after decades of apparent repression. Some of Loftus' work, however, has been critiqued in terms of the applicability of its conclusions [cite journal |last=Crook |first=L. |year=1999 |title=Lost in a Shopping Mall--A Breach of Professional Ethics. |journal=Ethics & Behavior. |volume=9 |issue=1 |pages=39–50 |url=http://www.questia.com/PM.qst?a=o&d=95748793 |accessdate= 2008-01-18 |quote=Although the mall study has been cited to support claims that psychotherapists can implant memories of false autobiographical information of childhood trauma in their patients, the therapeutic implications of the study appear to be limited to a narrowly defined and perhaps even unlikely situation....Notably, a similar study (Pezdek, 1995) found that although 3 (15%) of 20 participants recalled a plausible false memory of getting lost in a shopping mall, none of the participants accepted an implausible false memory that they had received a painful enema as a child from their parent. |doi=10.1207/s15327019eb0901_3] [http://users.owt.com/crook/memory/] [cite journal |last=Pope |first=K. |year=1996 |title=Memory, Abuse, and Science: Questioning Claims About the False Memory Syndrome Epidemic |journal=American Psychologist |volume=51 |url=http://www.questia.com/googleScholar.qst;jsessionid=HvMJ8y7hTLwzJKhQcXtBzn5T7hD51pStTy7SkQkzTNz51hB3Shgg!1063769811?docId=96531378 |accessdate= 2008-01 -31 |quote=Does the trauma specified in the lost-in-the-mall experiment seem comparable to the trauma forming the basis of false memory syndrome?....Does this seem, for example, a reasonable analogy for a five-year-old girl being repeatedly raped by her father?....Is it possible that the findings are an artifact of this particular design, for example, that the older family member claims to have been present when the event occurred and to have witnessed it, a claim the therapist can never make? To date, replications and extensions of this study have tended to use a similar methodology... |doi=10.1037/0003-066X.51.9.957] [http://kspope.com/memory/memory.php] and for not having been subjected to rigorous scientific scrutiny. [http://users.owt.com/crook/memory/]

In a 2005 report by the Health Services Commissioner to the Minister for Health of Australia, some respondents from families where there were accusations of child sexual abuse called for the book to be banned. The critics of recovered memory in the report stated that the book had been used by therapists to help patients recover memories of child sexual abuse. The majority of patients in the study that reported recovering memories of abuse reported they had recovered fragments of their memories before seeking therapy. Only one patient stated they had recovered their first memories of child sexual abuse in therapy. Patients mentioned that they didn't encounter therapists that suggested memories of child sexual abuse. In contrast, therapists were described as not likely to encourage their recovered memories. Patients in the study described this type of treatment as damaging. [http://www.health.vic.gov.au/hsc/downloads/final_rmt_inquiry.pdf Victoria, Australia Health Services Commissioner: Inquiry into the Practice of Recovered Memory Therapy] (PDF)]

There have been cases where people conceded that apparent recovered memories were false, and that the recovery of these false memories were not only traumatic, but also caused long term harm socially, emotionally and economically. [http://www.stopbadtherapy.com/courage/retract.shtml StopBadTherapy.com: Quotes About "The Courage to Heal" From Retractors] ] Some researchers believe that while some retractions may be accurate, the number of reported retractions is small when compared to the large number of actual child sexual abuse cases.cite book | last = Whitfield M.D. | first = Charles L.| title = Memory and Abuse - Remembering and Healing the Effects of Trauma | publisher = Health Communications, Inc | date = 1995 | location = Deerfield Beach, FL |pages = 375 | url =http://books.google.com/books?id=z1LW3u1e04YC&dq=whitfield+memory+and+abuse&pg=PP1&ots=Q_GZ1Yy1iE&sig=ivzKYWTrLhVa3HODty7kwIuJp0Y&hl=en&prev=http://www.google.com/search?hl=en&ie=ISO-8859-1&q=Whitfield+Memory+and+Abuse&sa=X&oi=print&ct=title&cad=one-book-with-thumbnail | isbn = 1-55874-320-0 | quote=...while some of the retractions are likely to be accurate, they are small in number compared with the vast number of actual case of child sexual abuse, and it is likely that some of the retractors were actually sexually abused and that many were abused in other ways and have re-activated their traumatic forgetting.] Some have suggested that a child may retract their story of abuse due to guilt and a feeling of obligation to protect their family.cite journal |last= Summit |first= R. |year= 1983 |month= |title= The child sexual abuse accommodation syndrome. |journal= Child Abuse & Neglect |volume=7 |issue= |pages=177–193 |quote=Whatever a child says about sexual abuse, she is likely to reverse it. Beneath the anger of impulsive disclosure remains the ambivalence of guilt and the martyred obligation to preserve the family.|doi= 10.1016/0145-2134(83)90070-4] It is also argued that people who retract previous allegations of incest made against family members may be reacting to the familial stress brought on by their allegations.. cite journal |last= Summit |first= R. |year= 1983 |month= |title= The child sexual abuse accommodation syndrome. |journal= Child Abuse & Neglect |volume=7 |pages=177–193 |quote=Whatever a child says about sexual abuse, she is likely to reverse it. Beneath the anger of impulsive disclosure remains the ambivalence of guilt and the martyred obligation to preserve the family.|doi= 10.1016/0145-2134(83)90070-4] Even when patients who have had therapy to recover 'memories' come to decide that their memories are in fact false (and so retract their claims), they can still suffer a kind of post traumatic stress. This is due to what some therapists call "brain stain". [Kelly Lambert and Scott O. Lilienfeld, [http://www.sciam.com/article.cfm?chanID=sa006&articleID=4338D296-E7F2-99DF-3D7F5370B4FB5D10] , 'Scientific American Mind', Oct 2007.] The article “Brain stains” has been called a “onesided, misleading and unscientific account” of the dissociative disorders. [cite article |author = Executive Council, International Society for the Study of Trauma and Dissociation: Boon, S.; Butler, L.; Cardena, E.; Carlton, T.; Classen, C.; Laddis, A.; Rhoades, G.; Potgieter, R.; Steele, K.; Twombly, J.; Yehuda, N. |year=2007 |month=November 30 |title=Letter to Scientific American, Inc. Editor and Chief | accessdate= 2008-01-08 |url=http://www.isst-d.org/education/sciamerican-ltr.pdf |quote=Regrettably the authors of the article ““Brain stains: Traumatic therapies can have longlasting effects on mental health,”” Kelly Lambert and Scott O. Lilienfeld chose to provide a onesided, misleading and unscientific account of the dissociative disorders (DD), including dissociative identity disorder (DID).]

Some critics claim that to date there has been no scientific (as opposed to hearsay/clinical) evidence that memories can be completely repressed (as in amnesia) for decades and then later reliably recovered. [http://www.fmsfonline.org/Popetbl1.html False Memory Syndrome Foundation: Studies of Psychological Symptoms in Trauma Survivors] ] However, child abuse, especially chronic abuse starting at early ages, has been found to be related to the development of high levels of dissociative symptoms, which includes amnesia for abuse memories. cite journal |last=Chu |first=J |coauthors= Frey L, Ganzel B, Matthews J |year=1999 |month=May |title=Memories of childhood abuse: dissociation, amnesia, and corroboration. |journal=American Journal of Psychiatry |volume=156 |issue=5 |pages=749–55 |url=http://www.ncbi.nlm.nih.gov/pubmed/10327909?dopt=abstractplus |accessdate= 2008-01-16] This same study suggests that psychotherapy is not usually connected with memory recovery. The level of dissociation has been found to be related to reported overwhelming sexual and physical abuse.cite journal |last=Draijer |first=N |coauthors=Langeland W |year=1999 |month=March |title=Childhood trauma and perceived parental dysfunction in the etiology of dissociative symptoms in psychiatric inpatients |journal=Am J Psychiatry |volume=156 |issue=3 |pages=379–85 |url=http://www.ncbi.nlm.nih.gov/pubmed/10080552?dopt=abstractplus |accessdate= 2008-01-16] When severe sexual abuse (penetration, several perpetrators, lasting more than one year) had occurred, dissociative symptoms were even more prominent.

The Third Edition of the book, published in 1994, offers a whole chapter titled “Honoring the Truth,” in which the authors respond to the book’s critics.

References

External links

* [http://www.division42.org/MembersArea/Nws_Views/articles/Reviews_Books/courage_to_heal.html Courage to Heal - Positive Book Review]
* [http://www.debunker.com/texts/courage_to_heal.html Negative book review]
* [http://faculty.washington.edu/eloftus/Articles/lof93.htm 1993 Recovered Memories article by Elizabeth Loftus]

ee also

*Amnesia
*Birth trauma
*Child abuse
*Dissociation
*False memory
*Memory inhibition
*Post-traumatic stress disorder
*Recovered memory therapy
*Repressed memory