The Courage to Heal

The Courage to Heal: A Guide for Women Survivors of Child Sexual Abuse  (first published in 1988) is a popular book written by Ellen Bass and Laura Davis that discusses the impact of child sexual abuse and how to address it. The primary thrust of the book is that individuals (mainly women) with a vague set of symptoms have been abused. The book also states that in some cases the memories of the abuse have been forgotten but are responsible for the individual's current problems. A variety of techniques are proposed to help these individuals heal, involving confronting their alleged abusers, adopting an identity as a "survivor", overcoming the associated trauma and in cases where there is no memory of any abuse, recovering the memories.

The book has been criticized for creating false memories of abuse, its authors being unqualified and for creating an industry which has isolated and separated family members despite having no positive proof the abuse occurred. Bass and Davis have also been criticized for leaping to unwarranted, implausible conclusions with significant consequences and for scientific errors found in the first edition that were not corrected in subsequent reprintings.

Authors
The Courage to Heal is written by feminist activists Ellen Bass, a poet and creative writing teacher, and Laura Davis, an incest survivor. Bass and Davis attributed efforts to confront incest and child sexual abuse to the Women's liberation movement. While working with students, Bass and Davis came to believe that the stories of some students were trying to convey painful memories of incest. From this idea, the two developed methods to assist students in recovering memories of abuse in childhood.

Neither Bass nor Davis have any training in psychotherapy or science, and they state that nothing in the book is based on any psychological theories. They have defended their lack of training with the claim that a PhD is not necessary "to listen carefully and compassionately to another human being"; neither author has ever acknowledged the errors they have made in their descriptions of memory and trauma. Despite their complete lack of knowledge about the workings of memories, the scientific approach or information and lack of qualifications, Bass and Davis stil define themselves as healers and experts in the area of child sexual abuse, due to leading workshops with vicitms.

Overview
The philosophy of the authors is: Forgetting is one of the most effective ways children deal with sexual abuse. The human mind has tremendous powers of repression. Many children are able to forget about the abuse, even as it is happening to them... You may think you don't have memories but often as you begin to talk you do remember, there emerges a constellation of feelings, reactions, and recollections which add up... To say 'I was abused' you don't need the kind of recall that would stand up in a court of law... Often the knowledge that you were abused starts with a tiny feeling, an intuition. It's important to trust that inner voice and work from there. Assume your feelings are valid... So far no-one we've talked to thought she might be abused and then later discovered she hadn't been. The progression always goes the other way, from suspicion to confirmation. If you think you were abused, and your life shows the symptoms, then you were.

The 2008 edition is divided into the following sections:
 * 1) Taking Stock
 * 2) The Healing Process
 * 3) Changing Patterns
 * 4) For Supporters of Survivors
 * 5) Courageous Women
 * 6) Resource Guide

The third edition featured an afterword called "Honoring the Truth: A Response to the Backlash", which was added to respond to and rebut negative reactions to the book. The section has been characterized as an effort to dismiss all research contradicting the book as being part of a backlash against victims of incest.

The book was written as a response to the authors' frequent encounters with women who were the victims of sexual abuse during their childhood and adolescence, and is predicated on the belief that extreme childhood trauma, of which sexual abuse is one, is spontaneously repressed. The authors suggest that people experiencing dysfunction in their lives (including a wide-ranging set of problems such as depression, anxiety, alcoholism, drug addiction, dysfunctional relationships, dissociative identity disorder, self-injury and suicidal thoughts) or feel there was something traumatic in their childhood should investigate these feelings; Bass and Davis also present what they believe is a path to healing from the trauma of alleged childhood abuse. The latest edition features language more inclusive of male sexual abuse victims.

The original edition of the book contained an influential chapter discussing satanic ritual abuse (though satanic ritual abuse is now considered a moral panic, the case specifically discussed in The Courage to Heal is that of Judith Spencer, which has since been discredited ) and the discredited autobiography Michelle Remembers - citing the latter approvingly along with other alleged survivor stories of satanic ritual abuse. Subsequent editions renamed the phenomenon "sadistic ritual abuse". The Courage to Heal was part of the vision that childhood sexual abuse could be discovered with no corroborating evidence beyond a vague set of symptoms.

The basic errors regarding the science of memory have never been corrected between editions; in the third edition, the book stated that for a small number of women their symptoms may have originated in emotional rather than sexual abuse.

Reception
A large number of therapists, between a quarter and a third, adopted the approach advocated in the book. Lacking training in research and awareness of the confirmation bias, these therapists lacked appreciation of the risks of seeing incest behind any symptom, or even a lack of symptoms and did not consider that other factors besides incest may have caused sexual problems in their clients. The book was a bestseller in North America and Europe.

Criticisms
Bass and Davis have no formal training in psychiatry, psychology or any form of treatment for mental illness, with critics stating that as a result they are not qualified to write such a book. This lack of training may have resulted in Bass, Davis and others who adopted their approach leaping to conclusions that caused considerable harm, irrespective of their good intentions. Bass and Davis also never acknowledged that their basic claims of how memory works were flawed or outright wrong. Paul R. McHugh, professor of psychiatry at Johns Hopkins University and award-winning researcher in the field of memory describes the book as the "bible of incompetent therapists". A report for the Australian branch of the False Memory Syndrome Foundation (FMSF) found the book was linked to nearly 50% of the cases in which a false allegation of child sexual abuse was made based on recovered memories and a 2005 report by the Health Services Commissioner to the Minister for Health of Australia stated that some respondents from families where there were accusations of child sexual abuse called for the book to be banned, believing the book promotes the practice of recovered memory therapy. Frederick C. Crews has criticized the book for appealing not to women who have always remembered abuse, but rather being aimed at those who struggle to convince themselves they were abused as children in the absence of previously-existing memories, and that the author's claim to promote self-esteem are actually based "on a shattering of their readers' prior sense of identity and trust".

Elizabeth Loftus, an award-winning researcher on memory, stated that the book was certainly very comforting to individuals living with memories of abuse, but questioned the effect it would have on people who do not have such memories, and suggested The Courage to Heal may be one of many sources of false memories for some individuals. Loftus also stated that "All roads on the search for popular writings inevitably lead to [the book]". The Courage to Heal encourages the use of strategies such as guided imagery to access and attempting to elaborate details and emotions and discouraging individuals from questioning the memories recovered.

Relationship to the False Memory Syndrome Foundation
A 2009 newsletter from the American branch of the FMSF criticizes the 20th anniversary edition, claiming "No book did more to spread false memory syndrome" (though the existence of false memory syndrome, a belief that memories can be created through inappropriate therapy techniques, is itself debated). The book was described as vicious, and filled with factual errors about the FMSF and the nature of memory, though the anniversary edition is described as better, without the outrageous features of earlier publications and that in the new edition, the FMSF is not mentioned in the book's index. The book is still dedicated to recovering memories, and does not warn the reader of the doubts scientists have about its premises. The book still contains a section on satanic ritual abuse, without noting the FBI's report that concluded there was no evidence for the phenomenon.

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. The FMSF criticized the chapter about their organization as filled with factual errors and written by a man who had no known credentials and no scientific publications in the relevant fields; the discussion of the FMSF was removed from the 20th anniversary edition.