The war neuroses of World War II (WWII) provide ample evidence that repression does indeed occur, and that the recovery of these traumatic memories and their related affects led to remission of symptoms. Moreover, these recovered memories were of events that had occured. An illustrative case history from WWII is described. This well-documented body of data, well-known at the time, seems to have been forgotten in current discussions concerning repressed memories.

Managed care was intended to save money by eliminating unnecessary services. However, for both physical medicine and mental health care, it is easier to save money by simply cutting needed services. This is what is happening in managed care in the United States today. However, data exist for arriving at reasonable procedures to provide real help and still be cost-conscious, a fact that is being ignored by managed care companies. The German national health system covers up to 300 sessions of psychotherapy if needed, but only 3% of their outpatient medical costs are used for such psychotherapy. Unfortunately, the American managed care systems aim at short-term cost savings, even if it means higher costs in the long run (or making patients go outside the managed care health plan for help or forgo getting psychological help at all). J. G. BENEDICT served as action editor for this article. BERTRAM P. KARON received his PhD from Princeton University in 1957. He is currently professor of psychology at Michigan State University and president of the Michigan Psychoanalytic Council. I GRATEFULLY ACKNOWLEDGE the editorial assistance of Anmarie J.

Describes a study in which 2 forms of psychoanalytic psychotherapy, one not using medication and one using medication adjunctively, were contrasted with treatment by medication only. Ss were 36 16-49 yr. old schizophrenics who were randomly assigned to 3 treatment groups. Treatment was available to Ss for 20 mo. and an average of approximately 70 sessions. Ss were examined before treatment, and after 6, 12, and 20 mo. of treatment with the Rorschach, TAT, a clinical status interview, and a battery of intellectual tests, e.g., the Thorndike-Gallup Vocabulary Test, Porteus Mazes, WAIS, and the Feldman-Drasgow Visual-Verbal Test. Measures of psychotherapy effectiveness were divided into 4 groups: length of hospitalization, clinical evaluation of functioning, direct measures of the thought disorder, and projective tests. Findings, including a 2-yr follow-up, reveal that psychotherapy produces significantly greater S change than medication, and is particularly effective in changing the thought disorder. Immediate change in the thought disorder was found to be more closely related to the long run ability to function outside of a hospital than are short term behavioral criteria usually related to hospital discharge. (25 ref.)

Loftus (1998), andM. Pendergrast (1998) deny the existence of repression. But every psychodynamic therapist regularly observes the phenomenon. Experimental as well as clinical evidence for repression clearly exists; these critics ignore or misrepresent both sources of data. More detailed case history material that shows the phenomena is readily available from current cases. The case in the authors' previous article (B. P. Karon & A. J. Widener, 1997) illustrated the hundreds of cases of WWII veterans who experienced battlefield trauma, repressed the trauma and displayed neurotic symptoms, and experienced alleviation of the symptoms when the trauma was remembered in therapy.In January of 1998, a rape victim whose initial treatment had not been helpful was seen for consultation and referral (to more helpful treatment, it was hoped). She reported having been raped by a man she admired and trusted. She reported initially remembering all the events that occurred the day of the rape, both before and after the rape, but not the rape itself. Rather, for a week after the rape, although she did have symptoms of distress, she did not remember being raped and got angry at anyone who made negative statements about the perpetrator. When she finally remembered the rape, she reported it, and the perpetrator later admitted the crime. Would any serious clinician tell her she is lying because there is no such thing as repression?Our previous article (Karon & Widener, 1997) related to only one fact: Repression obviously exists. Every psychodynamic therapist sees it. The only way he or she could not see it is by assuming that what patients say are lies. However, this farfetched assumption of lies is raised by Piper (1998), Lilienfeld and Loftus (1998), Giglio (1998), andPendergrast (1998). They suggest that the WWII patients who suffered trauma and repression were all malingerers. It would make as much sense to say all of Loftus's experimental participants were liarspossible, but improbable. Even in our illustrative case (Karon & Widener, 1997), one would have to explain why the patient would malinger for years after the war was over when he was seeing neurologists (whose possible interventions can be quite drastic), but 6 months after talking to a psychologist would decide to make up details and tell these details to the therapist BERTRAM P. KARON received his PhD from Princeton University. He is a professor of clinical psychology at Michigan State University, where he has taught since 1962. He is past president of the Division of Psychoanalysis of the American Psychological Association and past president of the Michigan Psychoanalytic Council.

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