TRAUMA, Part One

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23

I recall leaving the Frankenstein monster lumbering around my laboratory and my poor puppy trying to take a chunk out of his leg, with the barest, wryest hint of how this all might resolve.  What a drama!  Then, I told myself, “Let’s get serious.”  So, here it is...

Let’s look in all the directions that one mind, in this case my own, can work simultaneously.  I am concerned about a monster destroying my lab, my dog who wants my attention and to be fed something meaty, how the mechanism of a humanoid made from parts might work, whether the door to the lab is stout enough to control what I have unleashed, what might happen when the villagers find out about it, whether the tale is readable, funny, and instructive, what I want for dinner, etc. etc.  All this is going on at once.

While I am shaken, if not traumatized, by cognitive overload, I would like to contrast this with the psychological models of extinction used to treat trauma, based on theories described in Wikipedia, as follows [http://en.wikipedia.org/wiki/Extinction_(psychology)]: 

The dominant account of extinction involves associative models. However, there is debate over whether extinction involves simply "unlearning" the US–CS association (e.g., the Rescorla–Wagner account) or, alternatively, a "new learning" of an inhibitory association that masks the original excitatory association (e.g., Konorski, Pearce and Hall account). A third account concerns non-associative mechanisms such as habituation, modulation and response fatigue. Myers and Davis laboratory work with fear extinction in rodents has suggested that multiple mechanisms may be at work depending on the timing and circumstances in which the extinction occurs.[2]

Further, the article states, to resolve some of these sticky, unresolved issues “researchers have turned to investigations at the cellular level (most often in rodents) to tease apart the specific brain mechanisms of extinction…”

This raises the question, “How many of us are feeling like rodents today?”  Remember, some of us may not be sure whether our dogs, with even more complicated brains than mice, even like us or just rely on us for a food source.  Then, there is our own brain which is lumbering around the laboratory with Boris Karloff, while still wondering what we will have for dinner.

The stage is set for a new theory, which I would call the Frankenstein model.  In consideration of all that a human brain can do at once is it right to reduce a Conditioned Response (CR) to a cell or cells or even to a learned response set while the brain (thinking most people are more like me than a mouse) can multi-task and may very well multi-task even when we are not aware of it?

Let’s start out by saying that the Frankenstein model is a more holistic approach.  It does not look at a response set as such, but at how the brain busies itself until such time as the CS (Conditioned Stimulus) reintroduces itself either in the environment, association, or even in memory.  Yes, our large brains can have holistic memories for events (and trauma victims often do have such memories) that may be highly traumatic and that are re-introduced because that rascal brain, which might still be bumbling around in a laboratory, may for some reason think it’s time to once again come to our attention.  But, why would these memories come back?  For what purpose?  These questions do not arise in a vacuum.  They exist in a therapy session whether a client actually asks them or not.  Why else would they come to therapy except to try to find out what is happening to them and to get some relief?

And what do we have to provide that relief?  The current treatments of choice are exposure therapy—which may work through the mechanisms of unlearning prior responses, new learning of inhibitory response sets or habituation-modulation-response fatigue—and chemistry.  It should be clear at this point that these treatments are based on reductionistic theories and models.  Our dogs and our monsters are more complex than that.  This disconnect may be why some cases of PTSD appear intractable and why symptoms may come back or even become worse with treatment.

The fact that poor treatment response is all too prevalent would explain why the people with the greatest and longest periods of trauma are quick to run out of the room before treatment is even started and why they often avoid treatment entirely.  Unless they are brain-dead, experience often tells them that the best that modern science can offer them is sometimes useless or can make their symptoms worse (an unanticipated CS-CR). That, however, cannot be said of the Frankenstein model of treatment which is durable and impish enough to find another way outside of accepted theories.