Integrating Approaches in the Treatment of PTSD
We have not advanced much from the old days of Descartes when the scientists started thinking in terms of either the material world or the non-material world. We still think in terms of “either-or.” We are still stuck to picking either the drug or talking cure.
There is a prevailing tendency to believe that talk-therapy it is too slow to work or it is ineffective. We cannot prove that it works through a double blind control study to prove its efficacy. Yet in clinical experience we have come across cases where the right kind of listening and talking can achieve wonders. For example, when the diagnosis of DID is correctly identified, effective remedy is instituted, and patient’s useless medication is discontinued, the patient achieved rapid improvement.
However, such cases are dismissively labeled “anecdotal.” They cannot be reproduced in a laboratory. Without double-blind studies paralleling pharmaceutical research, it is claimed that they do not validate any particular approach. This disparages the history of psychiatry from its inception until the advent of pharmaceutical industry control over psychiatric training programs, insurance reimbursement, and the consequent denial of the impact of the many schools of psycho-therapy from Freud, Jung, Frankl and others.
An Integrated Approach to Treating PTSD
[1] In PTSD, we identify the “hyper-aroused nervous system.” In that hyper-arousal, the individual is also robbed of his confidence. Why? It is because he is not in control of his own body, which suddenly and without warning transitions into a hyper-kinetic state.
The first goal in treatment is for the body to relearn the experience of remaining in the here and now, appropriate to the reality in which it finds itself. Putting it simply, if you are running, your pulse rate should be high. If you are resting for a few minutes, you pulse rate should reflect a resting state of the body. In the PTSD experience, the pulse rate skyrockets even when the body is not running. In fact, the body starts to move in response to the messages it is being bombarded with – message of danger. These messages come all the time, when there is no danger, when the individual is simply sitting at home.
Several of my earlier blog posts discuss grounding exercises to aid the individual to achieve this goal. Surely yoga and meditation make sense as a fundamental exercise to get in touch with the here and now body. Many experienced therapists advise their clients to do these exercises of yoga and mindfulness. The “scientific” therapists, perhaps more accurately the pharmaceutically trained therapists, shy away from such advice. Why? According to conversations I have had, it is for fear of being ridiculed since there is little peer-reviewed literature to support yoga and meditation as an adjunct in the treatment of PTSD.
[2] We need to open our eyes and listen with deep empathy. We should be openly waiting for our clients to tell us what their concern in life really is.
I had a patient who was given ECT and kept in hospital for months. Her diagnosis was depression, accompanied by self-mutilating behaviour. No one seemed interested or inclined to listen to her story. It was as if her life of being abused by family and neighbors was irrelevant to her mental health.
Her children were taken away to be adopted out by relatives. She was trying hard to leave her abusive husband while her church insisted that she should try to reconcile with him. No wonder her depression never got remitted despite being seen by numerous doctors. No therapist ever came close to the Complex PTSD issue, not to mention the DID diagnosis. No one seemed to show any inclination to listen for the patient to communicate these problems in her life.
In short, we need to go back to square one. Therapists need to make sure they have a firm therapeutic alliance with the survivor, before they even begin to try to understand each and every case. There is no short cut. Making a diagnosis of depression and prescribing an antidepressant is a far cry from thoroughly assessing and understanding the individual. The ability to write a prescription has little to do with learning about the nature of the trauma that is causing the disability.
The right direction
The National Institute for the Clinical Application of Behavioral Medicine [NICABM ] offers a good program in training therapists to do trauma therapy. The works of Colin Ross, Judith Herman, B, Van de Kolk and others are very important. There are several self-help groups of DID survivors that have organized themselves that have a lot of good information and some training programs.
But, in short, the therapist who only offers pills will not get to the heart of the issue. Medication can be an important adjunct to psychotherapy, particularly in an immediate crisis. It is never a substitute. Complex PTSD can be healed through the efforts of the survivor and the support of competent therapists.
