Friday, June 5, 2009

PTSD Symptom Word of the Day: Alexithymia

I'm in Boston at the 20th Annual Trauma Conference. I spent yesterday in a seminar with Bessel van der Kolk, Alexander McFarlane, Jim Hopper, Ruth Lanius and Rachel Yehuda on the topic of 'Reorganizing the Disorganized Brain', all about the neuroanatomy of trauma. I learned some interesting things about primary, secondary and tertiary dissociation, failed cortical inhibition, neural networks, the default state, the important roles of the prefrontal medial cortex and posterior cingulate cortex, self dysregulation, the positive healing effects of neurofeedback, and the anti-healing effect of alexithymia (the difficulty of identifying and labeling emotional states).

I admit, the science got a little unwieldy by the end of the day. Nevertheless, I came out of the seminar with some new ideas about trauma, PTSD, how and why we respond the way we do, and what all of this means in terms of healing.

One of the big questions all these bigwigs had is still one of the questions all we survivors have: How do we heal PTSD? And when someone does heal, how do they? Meaning, for this crowd, what are the neuroanatomical changes that take place?

The men and women gathered here are clinicians, trained psychiatrists and scientists. They like empirical evidence and strive to compose studies, research and publishable papers to quantify, qualify and certify the PTSD experience. But as a survivor - and in light of the question that still lingers despite all of this compiled data - I'm wondering: Do we need to know exactly why or how the fear vs. reward circuitry, amygdala vs. hippocampus activity changes the neuroanatomy of healing?

I know that perspective is the focus of the conference, but after looking at the problem through it all day yesterday, I'm not sure we do. Given the fact that each survivor is different; each healing path is individual; what works for and happens in me isn't necessarily your experience, I'm not sure we can empirically decide and/or define a healing method that will work exactly the same neuroanatomically speaking, for everyone. I'm not sure we can generalize healing down to that extremely specific scientific level. I'm not sure that's where our time and money should be spent.

I think each survivor still reserves the right to be unique in his journey and to defy science at any point. So I don't think the question should be how or why or what happens in the brain so much as the question should be who is this survivor in his soul? And then, how many methods can we devise, scientifically or otherwise, to try to woo that soul back to health. At one point everyone agreed yesterday that trauma is the murder of the soul. If that's true, is science the way to resusitate it?

When we get lost in the science it's easy to lose the humanity. Everyone becomes a statistic.

Everything becomes a computer generated model. By the end of the day I hadn't heard anything about how we are to deal with, accept, make peace with and reconceptualize memories. I heard a lot about PET scans, MRIs and brain mapping. I heard a lot about how we can determine what areas of the brain are functioning at too high or too low levels. I heard a lot about how to exercise and stimulate the brain to function differently, but I heard nothing about how to quell the tsunami of trauma's subconscious imprint - or how any of this science collaborates with that activity.

When I asked a noted neuroscientist about how to bridge the gap between science and the subconscious, she confessed she didn't know and that I should throw this question out to the entire seminar. When I asked the question to one of the speakers, she answered, "This afternoon we'll be talking about neurofeedback." Not really a satisfactory answer.

During a break I asked the questions to a miscellaneous woman standing near me. She replied,

"Oh, none of this stuff is meant to do any of that. It's just supposed to help survivors manage symptoms."

"So, these scientific ideas are meant to function like medication: to help survivors cope so that they have the strength and focus to do the rest of the therapeutic work."

"Exactly!" she said, and ran off to look at the vast trauma book display set up in the lobby of the World Trade Center.

I'm not sure she was entirely right. I'm not sure the professionals presenting about neurofeedback, the star of this year's conference, are seeing it in the same vein as medication. They are promoting it as the next big breakthrough in the science of healing PTSD. With caveats: "If neurofeedback doesn't help in 20 sessions at our center we keep treating for free until it does work." That doesn't sound very scientific to me. Which brings me back to the idea that science is a nice wing, but it's not really the leg that healing trauma stands on.

I think increasing and decreasing brain musculature is a great thing, but I'm still wondering, where's the person in any of this? I haven't yet heard anyone speak about how to integrate traumatic memories or personal perceptions or narrative or identity. I haven't heard anyone speak about how these scientific theories coallesce into a healing model that incorporates the less scientifically quantifiable areas of how we emotionally hold and handle trauma beyond the cognitive affective data in brain regions. There's been a lot of grouching about the DSM V and how important it is to get neuroscience into it. But as someone remarked today, the more neuroscience they put into the DSM, the more of the patient they take out of it.

Science and yesterday's intriguing seminar aside, I remain much more interested in the work that happens on the perceptual, subconscious level. We all agree there are changes in the brain. But since the changes came about through emotional reactions, can they be reverted by purely scientific actions? I don't know.... Science seems too black and white, too absolute. Healing is full of variables and a greyness that comes with the undulating planes of experience and perception.

Do you agree, or disagree? Anyone willing to offer a hypothesis on which is more important to healing - science or the soul?

The usual BRIDGE THE GAP healing workshop posts are suspended for the duration of the conference and will resume next week.

(Photo: Entity 6)


Anonymous said...

Knowing how memories are laid down and how the Amygdala (sp?) works with that has been very helpful for me.

It's allowed me to structure a program that works directly with that knowledge to consciously reprogram it.

Things like exposure therapy, rewriting emotions and other bits n bobs.

Knowing the science allowed me to realize that the work would take a long time and be slow and painful.

Knowing the science allowed me to depersonalise some things and to realize that some memories and emotions had been burned very deep into my mind and it was because in part my brain had perhaps due to nothing more than genetic variance worked too well doing what it normally does.

Most important of all it allowed me to turn round to people who would tell me to "Get over it" or "Let it go" and tell them (sometimes politely) that they were talking nonsense.

It also helped me to accept that my brain was now overworking things and needed to be retrained.

Jaliya said...

I think that science and soul both matter ... Lately, I am focused more and more on basic bodily functions like sleep, appetite, and movement ... I've had to go to that basic level because those basic functions are so out of whack ... and my work right now is to regulate / moderate them as best I can ... The science helps me to understand these basic processes and what happens to all of me (including my soul) when they are short-circuited ... The soul-work goes on, every day ...

Lucky you, Michele -- getting to listen to Bessel van der Kolk. He's surely a pioneer in the field ...

An excellent book I'm reading right now was written by a physician who writes with *lots* of soul -- The book is *Healing Invisible Wounds: Paths to Hope and Recovery in a Violent World*, by Richard F. Mollica.

Michele Rosenthal said...

Thank you both for your insight! Just what I needed in order to reframe my experience here. During my own healing it never occurred to me to consider the science of it all. I was hellbent on process, not evidence based findings. I can see that the two go together and would be a symbiotic partnership. Thanks for pointing that out!

tanya said...

This may be very un-PC for a mental health professional to say but I'm going to say it anyway: I think a lot of what is discussed in conferences is more for the professional to learn a theory to help them develop a distance from the pain of their clients and thus, be able to do the work without a personal sense of overwhelm. The brain technology which I find useful to a point, but not a replacement for the real healing vehicle, which is a healing relationship, can be so dazzling and interesting that it can lead the therapist and client away from the larger goal which you bring back: how can I heal?

Michele Rosenthal said...

@Tanya - I love unPC! That's when we really get down and dirty with the truth. I would add to your assessment (which I can totally understand) that for some in the trauma crowd PTSD becomes a vehicle to make, break, jumpstart, progress a career. So.... the survivor becomes less important than the theory and what it can do in terms of money and prestige.

That makes me sound so cynical! I don't mean to be, but there were enough people at the conference who made me feel they're not in it for the survivors. Sad. UnPC to say. True.

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