One of the basic concepts of Freudian psychoanalysis is that people tend to repress unpleasant memories and that this repression can lead to negative consequences. Bad memories were thought of as if they were a psychological toxin in the brain that had to be expelled by bringing them to the surface and confronting them. Although psychiatry has moved far from Freud, this basic concept still holds popular appeal and influences some current psychotherapies – most infamously repressed memory therapy.

It turns out that the ability to repress emotionally negative memories is likely a normal and adaptive behavior (at least for some, if not most people). Now neuroscientists have been able to catch the brain in the act with functional MRI scanning and show that the far frontal lobes are engaged in suppressing negative emotional memories.

But back to therapy for a moment. This is one of those situations where what makes intuitive sense may turn out to be completely wrong. The notion that repressing bad memories is unhealthy and expelling them therapeutic is commonplace. Although I admit I do not know if this belief is widespread because it is intuitive, or because it was popularized by Freud, or perhaps some combination of the two.

Repressed memory syndrome is the ultimate expression of this idea – people present to a therapist with a psychological problem and it is “discovered” through a therapeutic process designed to find such things that the person’s symptoms result from repressed memory of a horrendously traumatic event in their childhood. The goal of such therapy is to recover the memories and then work through them. It turns out repressed memory syndrome is actually false memory syndrome – the trauma never existed, the memories were fabricated by therapy, and the client who may have presented with a little anxiety or an eating disorder has their life and their family destroyed.

Another example of this basic concept is crisis intervention. After a major crisis, like the 9/11 terrorist attacks or a college mass murder, crisis counselors come in to meet with victims who are traumatized. The goal of such intervention is to force victims to face the event and work through the trauma.

However, this approach also does not work and in fact may worsen the effects of trauma. (See this meta-analysis and this systematic review.)

My reading of existing evidence is that the ability to suppress painful or negative emotional memories is actually an adaptive and healthy trait. Disorders such as post-traumatic stress disorder, anxiety, and depression may result from a decreased ability to repress negative memories – therefore leading to dwelling on such emotions, or when a person with an average ability to suppress such memories is overwhelmed by extreme mental trauma.

The suppression may also be temporary, as if our brains put the bad memories in a box and then let them out little by little so that we can deal with them over time without being overwhelmed. This concords well with the stages of grief; we start with denial and then finally work our way over time through to acceptance.

The cautionary tale for therapists (and for healthcare providers in general) is not to be too quick to institute interventions based upon the latest fad theory. Such interventions, even if they make sense and seem benign, can be harmful. The mind, just like the body as a whole, has evolved mechanisms for dealing with the traumas of life and we should not be quick to short-circuit these protective instincts. This is not to say that the instincts we evolved in the wild are always best adapted to modern civilization – some are not – but rather that a thoughtful and evidence-based approach should be taken toward any intervention, especially those that seek to supercede our natural defenses.

Another lesson in this story is that individual coping mechanisms may vary greatly, and this needs to be respected as well. Applying a single method to everyone, without assessing them individually or monitoring their response to the intervention, is not likely to be a successful strategy.

Despite popular belief rooted in Freudian theory and perhaps our intuitive assumptions, forcing people to experience and confront emotionally negative memories is not always a good thing, and suppressing these memories is not always a bad thing. It seems that a healthy balance between the two extremes (and what that balance is will vary from person to person) is probably the optimal approach. The neuroscience has helped to provide a solid theoretical basis for this, and good clinical psychological research is ongoing. We still need more evidence, however, and in many cases the clinical practice needs to catch up to the evidence.