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THE TREATMENT OF EXTREME TRAUMATISATION (PTSD)
A Method developed by Dr. Carlos Chan
A HISTORICAL NOTE
A review of treatment methods over the last 20 years by Dr. Terence M. Keane (Director, National Centre for PTSD, Boston,
Massachusetts) shows that most therapies currently used in PTSD are of two types a) Anxiety Management. b) Exposure Therapies.
The most recent advances conclude that a combined approach of Anxiety Management and Exposure Therapy is the most effective
treatment method. How can we explain this? Why may talking therapy not be enough?
Man in effect has inherited three brains, the reptilian (brain stem which regulates the physiology of the body), the limbic
system (emotional brain) and the neocortex (the intellect). This model of therapy works with all three brains.
Verbal therapy works with the neocortex and explicit memory. i.e. the Where, When, How, What, Why that journalists use.
Explicit memory is stored in the hippocampus but it only matures in the infant between 2 -3yrs. This is one explanation of
infantile amnesia.
Implicit memories are stored in the amygdala. i.e. the emotional and body sensations. During extreme traumatisation explicit
memories stop being recorded in the hippocampus but the emotions and body sensations continue to be recorded in the amygdala.
Antonio Damasio points out that a somatic marker is left after the trauma. This explains the phenomenon of flashbacks in PTSD.
As Daniel Goleman points out extreme trauma often alters the emotional brain permanently causing emotional highjacking.
Fear conditioning has occurred. In normal people natural relearning by pairing calm and fear extinguishes the fear. In PTSD
spontaneous relearning fails to occur. The amygdala alarm response occurs every time something vaguely reminds you of the
original trauma (flashbacks). Appropriate therapy involves the extinction of the fear by an active learning process whereby
the neocortex is taught how to inhibit the amygdala alarm response in the emotional brain. In Damasios theory what is needed
is a new healthy somatic marker to replace and extinguish the old traumatic marker.
More recent research shows that PTSD often reactivates some of the primitive reptilian brain reflexes that normally are
integrated in infants from 0-2yrs 6 months. Svetlana Masgutova points out that when these reflexes are active, they short-circuit
at a primitive behavioural level explaining unreasonable outbursts of terror, panic, rage and sadness in PTSD victims. The
good news is that there is a developing body of knowledge of how to diagnose the presence of these reflexes and how to re-integrate
them.
That is why talking therapy may not be enough. But most therapists nowadays admit that it may be important to work with
the body but they dont know how to do it. In short they find themselves trapped in a therapeutic model where they received
no training for body work.
But if it is the body that remembers (implicit memories in the amygdala) and not the mind (explicit memories in the hippocampus)
how do we help a sexual abuse victim or a torture victim recover body parts anaesthetised by the trauma? The answer is in
transferential bodywork. A method well documented by Dr. Alexander Lowen, founder of Bioenergetic Therapy.
AN INTEGRATED MODEL OF BIONERGETICS, PSYCHODRAMA AND GROUP THERAPY.
The Therapeutic Process
Dr. Judith Lewis Hermans outline of the recovery process is followed.
A) Attaining a sense of safety.
B) Remembering the details of the trauma and mourning the loss it has brought.
C) Re-establishing a normal life.
The group therapy contributes the creation of a microcosm of society where there is a therapeutic contract of confidentiality,
respect, equality, and emotional support. It is the structure or container that allows the rest of the therapy to develop.
In it people learn to feel safe and respected again. And later, when the group starts to focus on the here and now behaviour
of the group members, it becomes a living learning laboratory where unhelpful patterns of behaviour are confronted thus helping
the members re-establish a normal life in the society outside. Members learn democratic behaviours. They also recover some
sense of law and order, trust in society and spiritual values.
The psychodrama enables members to tell their stories through an art form. The emotional brain is more easily accessed
by the primary process inherent in the messages of metaphor. If appropriate and in the right timing, members may go back and
replay their traumatic scenes. Shocking memories are hard to confront and trauma victims are skilled at avoiding the very
feelings they need to work through. The therapist has to strike a delicate balance between not pushing hard enough and going
to far.
The bioenergetic bodywork re-educates the emotional brain and body to respond to old fears in a different way. Thus instead
of going into a panic attack, the person learns to ground himself and centre his breathing in his lower belly. Members systematically
learn relaxation and breathing exercises. These act as kinaesthetic anchors. They move from body constriction and muscle armour
to personal mastery of their bodies, self-awareness and relaxation. Their bodies need to learn to let go and experience pleasure
and love. They move from merely surviving to quality of life. New somatic markers are established.
A final word of warning. Most therapists lack the emotional courage and training to work deeply with PTSD. The clinical
settings in which they work also disapprove of patients showing too much feeling. The possibilities of vicarious traumatisation
from clients is high. Therapists need skill and courage and should have worked through their own traumatic experiences. They
should also be contained by colleagues, friends and family.
The theory and practice of this model can be taught. There is no doubt that a training centre in Säter has to be established
where Carlos Chan and his Swedish colleagues can demonstrate, teach and supervise this method. This method is not in conflict
with other methods, it is a contribution to existing methods. People come to Sweden with different kinds of traumas and some
of the traumas can be connected to experiences as; war, torture, catastrophes, sexual abuse and tsunamis. People need help
so they can be integrated in the different contexts of the Swedish society.
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