TRAUMA-Part Three Narrative in Therapy

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It seems to be the hallmark of our culture that we should get what we want whenever we want it.  It is a standard against which all our efforts are compared.  This is conveniently illustrated by a bumper-sticker from a couple of decades ago that openly stated the rules, “Whoever has the most toys at the end wins.”  This was written at a time when our economy was in overdrive and a lot of people were making a lot of money with very little effort, that is, until people were convinced that we were so rich we didn’t need to pay taxes or pay for anything at the same time that we got into two wars that were politically unwinnable and that sapped all our resources.  American hubris.

But there is a psychological, even a medical correlate here that most people tend to overlook.  It is implicit in our media, in our worship, in our expectations of ourselves and others.  It is that the only true goal is perfection, perfect cures for our ills and perfect satisfaction of all our desires.  It is the end to which most people in our society aspire, but from others we expect little because we have it all.  I am describing a mass delusion of American exceptionalism that has us in a constant state of convincing ourselves that we are better than everybody else.

A lot of the false data from testing new drugs and new therapies comes out of our endless quest to offer people the perfect lives they wish for and think they deserve.  They are told, “No pain, no gain,” so that people can tell themselves pain is good and, when they hurt, nothing is wrong with them and they are even more perfect in suffering.  If Pat Robertson tells 80 year olds from his flock to pray to God for guidance about how to get more money to both support themselves and to continue tithing, he is doing it to provide guidance on the road to perfection that is applicable even to the geriatric.  If you have no evidence to convince yourself that you are perfect, you can at least convince yourself you are on the road to perfection, even if all your instincts says otherwise.

In psychology, you can find this in the development of new therapies that are dedicated to relieving symptoms and restoring lives that might have been perfect except for uncomfortable and sometimes very challenging parts of ourselves that appear like a well-spring.  And to help people, we want solutions that can be administered simply and consistently so that there is no error in application with no dosage problem.  Therapists want therapies that are easy to use.  Where this concerns PTSD treatments, such as EMDR, there is the hope that a specific procedure, if consistently administered, will eliminate symptoms of trauma.

My problem with all of this is that I don’t see life or the events of our lives, whether good or bad, as a set of symptoms that need to be treated and that together form a mental disorder that should also be treated to restore normalcy.  Rather, I approach my work as if I am entering a narrative, a person’s story, that, when fully elaborated can reveal what, beyond the recognition of symptoms, might cause a person to be that way.  Strangely enough, this investigation can also show unrevealed resources in a person that can enable them to better deal with the stress.  Symptoms do need to be addressed through available means, including through medications and behavioral techniques, but, in my view, the narrative is always at the core of treatment because when taken as a whole, this is the content of our lives, what we are doing here.  To me, therapy is not separate from life, but a part of it.  And me, I am just another guy with a broader focus, training, and with a sense for personal narrative.

Some examples:

When a treatment like EMDR is developed, indeed even with exposure therapy before it, the hope is that the therapy will eliminate PTSD symptoms or at least make them better, restoring a normal life.  Getting away from the idea that any life is a normal life, because so few people have one, let’s consider how these treatments are handled scientifically.  With the creation of the treatment, there is a sudden rush to research it.  “What do we do? What do we do?”  (Even I’m getting excited as I write about this.)  First, you get people with PTSD.  “How do we do that?”  You have to get people with known traumas that are diagnosed with PTSD by their doctors.  “Good idea!  Let’s go.”

Here is a guy or gal who was in a bad car wreck.  Thanks to modern safety devices, they survived with only minor injuries.   Except for PTSD symptoms from the wreck, their lives have been almost perfect without trauma.  Maybe that person smoked pot a few times while a teen, might have a couple of glasses of alcohol at the end of the day for their heart, but otherwise that person is perfect.  Subject that person to a prescribed system of eye-movements and-Voilà!-a fully controlled study of an individual with an identifiable set of symptoms coming from a specific event is relieved.  That is good.  It is good treatment and gives us good evidence that a treatment works in specific cases.

Contrast this with combat veterans, many of whom have lived through trauma frequently, sometimes almost daily, who were sent off to war for reasons that may have been incomprehensible  to them, but with faith in the purposes of the country that sent them there.  Perhaps they entered the military to obtain citizenship, perhaps they came from poverty, gang-warfare at home, and perhaps they simply did it by conviction with no circumstances that might make them want to enlist other than service to their country.  The point is that each of these scenarios describes a narrative that precedes the events of war and can have significant impact on their perception of their war experience or subsequent PTSD.  I give you narrative!  This is stuff that alters perceptions before the first bullet is stopped by the soldier’s body armor, stuff that elaborates what that bullet means and how that person will handle the experience.  With this, the veteran returns and is given the latest research-based therapies that have proven successful for people with problems like yours, i.e. people with PTSD.  It doesn’t matter where you come from or what you’ve been through.  The research shows that it works (and besides it’s all we’ve got, so we’re giving you the best treatment available.)

For a final example, consider the woman who was brutally raped and the rapist was never caught or else was caught, but has threatened to come back and kill her or else the rape was so wanton that she would believe he would return to finish the job anyway, even without threat.  What do we say?  That you should rapidly move your eyes back and forth until you think of something else?  That the possibility of the rapist returning is extremely low (besides he’s locked up for ten years)?  Or that you repeatedly visualize an experience over which you never had any control, but this time stop it whenever you like?  You could also try an anti-anxiety medication while you are doing that?

My point, of course, is that, when a new treatment is developed, to adequately test it, thorough personal histories must be taken so that researchers can know if they are really comparing apples and orange.  And, if the treatment does not work for them, we can investigate further why it does not.  We can’t simple line up a bunch of PTSD patients the way we do cancer patients and expect that we are researching the same phenomenon.  I would expect that one size does not fit all whether with cancer or PTSD.  Both have their narratives and both need to be explored.  Leading one to appropriately conclude, there is good research and bad research, but we each have our own narrative that needs to be more fully addressed, a physical and mental narrative that must marry up somewhere to make a life.  Include that in scientific research and the concept of research-based will have something useful for individuals with real problems.