Talk:Traumatic memories

I do take this article to be a wholly good-faith effort on the part of its author(s), but I am troubled by its mere existence, apart from several already existing articles. Also, it contains plain errors of scholarship - both incorrect summary and incomplete representations of the literature. This has the potential to mislead and confuse, and to cause poor decision making in persons afflicted with enduring traumatic memory. Errors aside, this article has no obvious justification, to my mind, for being outside the PTSD article (and several others).

While I am critical of a number of things about this article, let me first say that it evidences significant research, thought, and attention to careful writing. I am delighted by the quality of references it cites, for in the citations one can find any number of very fine reports, articles, and such. Excellent work...!

Now, my first and largest concern is that this material is either already covered elsewhere, or else should be. Please consider that the topic of traumatic memory simply did not enter into psychology outside of a concern for the pathological effects of such memory. Classical neurology certain didn't take it up on its own, nor did cognitive psychology. These fields got involved in studying traumatic memory after disorders caused by such memory were finally formally recognized in psychiatry. So, why is it taken up as a separate topic, here?

Trauma memory disorders lead naturally to curiosity about the nature and dynamics of traumatic memory, to be sure. I do think that trauma memory is an entirely legitimate subject in research psychology and neurology, but it is difficult to address the matter at any length without touching upon psychopathology. Indeed, from the very beginning (see the first 2 sentences of the lede), this article does not even try. The psychology/neurology of traumatic memory is already addressed in articles about acute stress disorder (ASD), posttraumatic stress disorder, and dissociative identity disorder (DID), and probably several others. What does this article hope to add? What CAN it add? Why would we even want to split off this material from those topical articles? To me, as a clinician who treats PTSD specifically, this seem distinctly ill-advised. Put it in context and it has real value. Otherwise, one is apt to wonder why we should care (unless you'e a memory researcher...and they didn't, historically, as I said).

At a number of points, statements about traumatic memory are overdrawn. For examples, in the lede: "Traumatic memories...emotionally overwhelm people's existing coping mechanisms.[2]" Well, this CAN happen, but many victims of traumatic memory DO cope with their memories. They dissociate, they drug themselves, they distract themselves, they avoid stimuli that activate memories, etc. The problem here isn't lack of coping but the cost of the coping, as well as its ultimate effectiveness.

The statement in the lede that "Several psychotherapies have been developed that change, weaken, or prevent the formation of traumatic memories..." has at least two problem.

First, there is NO mention in the lede of the two well-validated psychotherapies which can completely resolve traumatic memory problems - E. Foa's brand of CBT (not mentioned in the article at all), and Shapiro's EMDR (which is mentioned, but mischaracterized). That these therapies exist and are completely effective much of the time is FAR more important than mention of the bogus notion of memory erasure.

Second, please tell me what psychotherapy "prevent[s] the formation of traumatic memories"? Critical incident stress management was touted as having this effect, but recent research has completely failed to support this claim. In short, this statement is simply wrong.

Finally...of the 3 sentences in the last paragraph of the lede, 2 are devoted to drugs. This makes no sense, for as I explain below, while there ARE proven treatments for traumatic memory disorders, they are psychotherapeutic ones, not pharmacological ones. The emphasis in the lede suggests something quite different.

The reader needs this to be clarified, because it is critical to understanding several matters. A "trauma memory" is just a story, a narrative. A "traumatic memory" is that plus an emotional response elicited at the time of memory activation. Only the latter will ever be a problem.

With that distinction clearly in mind, I can say that the goal of good trauma memory disorder treatment is to turn traumatic memories into trauma memories. This is NEVER made clear in the article, and thus a common misperception is fostered yet again: once you have a traumatic memory, you will always have it, until we find a way to "erase" it. This is simply grossly wrong. Trauma memory is in no way impaired memory. It just doesn't hurt and disrupt, as does traumatic memory.

With that made clear, I have also resolved the alleged "ethical dilemma" taken up in the article. I am greatly bothered that this topic is even addressed. Is there an ethical dilemma involved with setting a broken leg? With giving morphine for the pain? If not, then why would there be one relative to removing the pain of a memory? This only comes up if one accepts the entirely incorrect idea that resolving traumatic memory involves memory reduction, elimination, or destruction. I can tell you, from years of clinical work (and my own psychotherapy) that such memory pain resolution leaves intact all the narrative memory of the traumatic event that was there before treatment.

So, this "ethical dilemma" business simply needs to excised. It is a false dilemma, based on false understanding of the process and effect of psychotherapy. Which leads us to...

Why treat it at all? One doesn't treat something unless it's a problem, and if it's a problem, then it's a clinical or subclinical disorder, and we take such disorders in detail in several articles, three of which I've already mentioned. The matter does not need to be taken up here. Such redundancy is of no value. To take up the treatment subtopic in an academic paper, a stand-alone document, is fine. But Wikipedia is a community of articles. Nothing stands alone here.

In the PTSD article, when I completely rewrote the pharmacological intervention section, I quoted a leading authority from Columbia University - to closely paraphrase: "There is no drug treatment for PTSD". But we do prescribe a number of medication for the disorder (which I take up in considerable detail). The distinction is this: we can treat various of the symptoms, with varying success, but no drug successfully treats the disorder as a whole. The same is true for Acute Stress Disorder and DID.

So, why in heaven's name is drug treatment taken up in this article BEFORE psychotherapy? It clearly should be subordinate, in any discussion of treatment. We really do NOT have to be the vassals of the drug industry, do we?

But, it gets worse.

In the discussion I wrote for the PTSD article, I outlined 10 CLASSES of medication used to treat PTSD symptoms, not including the "miscellaneous" class. In each class there are a number of individual pharmaceuticals, all research validated for use in clinical settings.

The present article discusses 5 substances, of which I only recognize ONE as an accepted drug intervention for symptoms of traumatic memory disorders. The article completely misrepresents the place of pharmaceuticals. In particular, the discussion of substances under experimental investigation (the other 4 of the 5) does not belong in a discussion of clinical interventions ("treatments"). Research looks into many strange things, in the hope of finding a miracle. Clinical intervention uses proven tactics to lesson or resolve human suffering. To confound the two activities is in no way helpful.

Briefly, this section, at best duplicates what has been addressed well elsewhere. Why are we repeating the topic here? This makes no sense, for the article is about memory, not clinical disorders.

Within the section itself, there are serious problems:

• Exposure therapy is NOT known as "flooding". Rather, the latter is one kind of the former. "...gradually exposing individuals to a stimuli they find disturbing..." is clearly NOT flooding, though it IS a type of progressive desensitization involving exposure.
• Use of "virtual reality" is NOT a well validated treatment. It is an experimental procedure which may prove effective, but has not yet been so proven. (This is another example of this article's repeated mixing of research interventions with accepted clinical interventions, which is completely confusing to lay readers, and appears nonsensical to informed ones.)
• Cognitive behavioral therapies are not correctly characterized. There is no mention at all of the fact that one carefully described CBT (that of E. Foa) has received excellent clinical validation. Well done, it doesn't reduce symptoms, it eliminates them.
• Ditto for EMDR. I am exhausted from continually reading about how "controversial" EMDR is supposed to be. It is, rather, one of only two treatments which have been proven to completely cure PTSD (and, in my experience, all other traumatic memory disorders except DID). WHAT controversy? Over a hundred validation studies exist for EMDR. There is dispute only about WHY it's effective. That's a research question, not a clinical question.

And then we come to video gaming. This section is at least 30% longer than the section on EMDR, not to mention that on CBT. It is not a clinical intervention at all. It is the subject of a few research studies. Nothing more. This section simply needs to disappear. Video gaming is not yet worthy of discussion in the very limited space we have for a Wikipedia article.

In the "Biological impact" section, we find "...there is some neuroimaging (fMRI) evidence that those who are susceptible to PTSD have a hippocampus with a reduced size.[4] Oh, no. This is exactly backward. The reference cited, as well as a large body of other literature, support the idea that PTSD causes reduced hippocampal volumne, not the reverse.

In the "Psycho-social impact" section, the reference to contant reliving (of traumatic events) through nightmares and/or flashbacks is overdrawn. That would require something akin to constant dissociation, which if present, moves us into the realm of dissociative disorders. The upcoming DSM V is very likely to separate dissociation-imbued PTSD from all other kinds, for several reasons. But, even then, the dissociative response to active traumatic memory is not described as "constant". I have only even seen THAT in someone with dissociative identity disorder. There, the constancy is not due to traumatic memory but rather to a long term adaptation to trauma involving fragmentation of the personality. Outside of this context, "reliving" is intermittent at worst. The final sentence of this section is addressing "management", not effects, and so is out of place.

In "Consolidation", it is not at all made clear that traumatic memories do not always become consolidated. It is probably more the rule than not that within a brief period, they are resolved, and become mere trauma memories, just as most scratches that draw blood scab over rather quickly, then heal in a very few days. Consolidation must happen for a traumatic memory to become problematic, but consolidation is by no means a forgone conclusion.

If the article is to be kept in any form at all, it should discuss memory and nothing more. When the focus starts to leave the nature and dynamics of traumatic memory, and get into effects, and, Lord help us, treatment, a link should be provided to the articles which take up these topics appropriately.

The material in the effects section on memory reconstruction is a delight to read. This has not been taken up (I think???) in {{PTSD]] at all, and I doubt that it appears in the other clinical articles, yet it's been known for about a decade, and it is significant. Because of the construction > recall > reconstruction cycle, traumatic memory is dynamic. Because of that, we can make more sense of some traumatic memory disorder treatments which work, and hypothesize about others not yet being tried. This is an important topic, but should, in the main, be in an article about clinical disorders.

So, I propose this: Let's dismantle this article and put the pieces of it which have value in articles which take up traumatic memory disorders. Lets NOT duplicate material taken up in those articles HERE. Discussion of the dynamics of traumatic memory, never of real interest to the pure scientists, needs to be taken up in articles discussing psychopathology and the science-based interventions employed in clinical practice. The people invested in this article would be a decidedly valuable contribution to the communities associated with the psychopathology articles. Their contributions would have more meaning there, and they would likely enjoy the richer environment of those articles.

I hope for discussion here of this recommendation, and have no plan to take any immediate action with this article until time has passed sufficient to allow that discussion to occur. I am likely, however, to correct some of the more glaring problems I have pointed out - the minor ones, anyway.

Sorry for the length of this. I didn't want to throw stones without attempting also to make some sense.

Tom Cloyd (talk) 08:47, 4 July 2011 (UTC)[reply]

Thanks, Tom, for this thorough review. The article was written as part of a student project. I suggest being bold and going ahead with the changes you suggest. MartinPoulter (talk) 18:22, 4 July 2011 (UTC)[reply]

Martin, I err sometimes in assuming that others can handle a frank critique as I do, and I was afraid, after working (for hours, in truth) on my critique last night, that I might be making the same mistake, again - i.e., that I being too bold. I wanted to speak plainly, but also not to offend. That can be a difficult charge.

I find your non-defensive response refreshing and encouraging. I truly do find much to like about the article, and I also must be frank in reacting to it as a professional who deals daily with traumatic memory. I got involved in the first place at Wikipedia because I was concerned that my clients were being misled by the errors and misrepresentations in the PTSD article. While much work remains on that article, at least I have engaged the issue, and invited (and received) critical comment for my ideas. I do think the article is improved, and improving, but much work remains. Writing a truly good article is hard work, frankly. Also good work, which is why I stay with it.

Your invitation to me to go ahead with my proposals surely commends you, to my mind. Nevertheless, I think it most reasonable to move forward slowly, so that any other comments which may appear have a chance to do so. Wikipedia is a community effort, and I learned to have considerable respect for the community.

I will confidently say that I am glad you have joined us, and I hope you will remain and continue to contribute. I'd love to have you work on PTSD with me and the others who have a concern for it, or wherever you find it worth your while to contribute. You're here now; please stay.

I must also comment that the major reason why I have been slow to follow up on my initial promise to return with my full critique 'in a few hours' is that I have been extremely busy preparing to go to Boston this Wednesday to participate in a planning conference with about 110 other people, all of whom are committed to fostering the inclusion of Wikipedia editing in university classes. This project, now referred to as the Global University Program (GUP) is an outgrowth of a privately funded pilot project which occurred this spring in the USA. This fall, it is anticipated that the GUP will be expanding in the USA and also to Great Britain, Germany, Brazil, and India. For many, many reasons, this program is critically important, to my mind, so I'm grateful to be invited to be a part of it.

That said, it occurs to me that perhaps you might find the GUP worth your attention as well. If so, get back to me and I can give you more information. This is a wonderful time to get involved, and your passions for scholarship would have an excellent playing field.

In any case, thanks for your response. I will wait for the comments of others, probably about 10 days or so, then outline specifics of what I suggest we might do. I'm more than willing to see this through, and I hope you will join in as well. I do appreciate your effort and contributions. I was speaking to someone just today about my excitement in encountering the section on memory reconsolidation, and commenting to them about the potential usefulness of including this material any of several other articles.

Tom Cloyd (talk) 00:43, 5 July 2011 (UTC)[reply]