PTSD POLITICS
PTSD & Politics - Engulfed by the Gulf
PTSD FACTSHEET
http://ivaw.org/ptsdfactsheet
When the War Comes Home: Chaos, Flashbacks & Dark Futures “Peace for veterans is not an ‘absence of war’ but its living ghost in the bedroom, at the lunch counter, on the highway. The trauma is not ‘post’ but acutely present, and the ‘syndrome’ is not in the veteran but in the dictionary, in the amnesiac’s idea of peace that colludes with an unlivable life.” “The return from the killing fields is more than a debriefing; it is a slow ascent from hell. …The veteran needs a rite de sortie that belongs to every initiation as its normal conclusion, making possible an intact return.” --James Hillman
What happens when stressed-out vets return from the war theatre and try to resume their lives with business-as-usual? Many, if not most, find that to be impossible, because they are not the same as they were prior to deployment. In fact, many contend with sleepless nights, inability to focus, depression and Post Traumatic Stress Syndrome.
SUICIDE EPIDEMIC: Studies show at least 35% of the Iraq War vets have PTSD, many to the point of being suicidal. Suicide is at a record high: 20.2 per 100,000 soldiers. As there is an average of 10 failed suicide attempts for each actual loss of life, the figures suggest that more than 1,600 serving army and marine personnel tried to kill themselves last year. An estimated 30 percent of soldiers who took their own lives in 2008 did so while on deployment. Another 35 percent committed suicide after returning from a tour of duty.
Two-thirds screened positive for PTSD are not receiving treatment. Those who do are often just medicated without talk therapy. Even so, many still experience attacks seemingly out of nowhere, mimicing their Iraq experiences. Twenty percent of female soldiers report "military sexual trauma." The boundaries between friend and foe collapse.
When PTSD was first discovered in combat veterans in WWI, it was known as SHELLSHOCK, and studies of these vets by Britain's Tavistock Institute led to new discoveries about the breaking points of personalities and how lives could be shattered by the faultlines of unseen wounds lacerating the soft connective tissues of the personality and self-image.
The big question is what happens when today's vet becomes a danger to him or herself or others? How can we detect and avert potential tragedy in this growing population?
How can we best help our friends, families, and fellow citizens who now feel lost and alienated?
Veteran's PTSD is a multidimensional issue involving disabilities, traumatic brain injury, psychophysical regulation, stress-management, depression, grief, dissociation, and perhaps ADHD, T-type behavior, chronic pain management, alcohol and drug use, and compulsive disorders. Soldiers in the 101st Airborne claim most use alchol and drugs in excess, including Valium and marijuana. That is the short list, as each unique individual will have particular adjustment issues depending on their life and combat histories. Some also have service-related chronic health issues from vaccines, Gulf War Syndrome, DU, etc.
Regardless of which war or conflict you look at, high rates of PTSD in veterans have been found. Throughout history, people have recognized that exposure to combat situations can negatively impact the mental health of those involved in these situations. In fact, the diagnosis of PTSD historically originates from observations of the effect of combat on soldiers. The grouping of symptoms that we now refer to as PTSD has been described in the past as "combat fatigue," "shell shock," or "war neurosis."
Regardless of the war, soldiers involved in a war consistently show high rates of PTSD. If you are a veteran, the National Center for PTSD provides some excellent information on coping with the effects of war. If you are returning from Iraq, information about VA Transition Centers and additional resources are also provided. And, if you are a family member of a veteran, important information is also available pertaining to living with and caring for someone with PTSD.
It's Not Your Fault Traditionally, those in military and intelligence duty find it difficult to frame their difficulties as a mental health issue. There are associated taboos and shame surrounding perceived 'weakness' or inability to "be all you can be." While PTSD distorts and unravels personality, it is not a character defect, nor the fault of anyone who finds themselves plagued with its symptoms and consequences. In returning vets, as elsewhere, PTSD is a societal probelm, reflected in the sick society that creates a "dual reality" incongruent with our real needs.
Treatment for PTSD is varied but it usually consists of some form of talk therapy and group therapy plus medication, typically antidepressants or anti anxiety medications. The Army is experimenting with exposing veterans with PTSD to training video games in order to desensitize soldiers to their experiences. The Army also is funding research on Propranolol to treat PTSD. Propranolol is a blood pressure medication that may be useful in treating PTSD. It appears to reduce symptoms of emotional distress associated with traumatic memories. It doesn't wipe out the memory, just limits the emotional response.
THE WAR WITHIN
Time Does Not Heal All Wounds "More than 120 veterans of the wars in Afghanistan and Iraq commit suicide every week while the government stalls in granting returning troops the mental health treatment and benefits to which they are entitled… veterans are committing suicide at the rate of 18 a day - a number acknowledged by a VA official in a Dec. 15 (SF Chronicle – Bob Egelko)
SYMPTOMS - Re-experiencing traumatic events (obsessive recollections, flashbacks or intrusive thoughts, nightmares), avoidant symptoms (fear of being with people), signs of hyper arousal (easily startled, irritable), avoiding experiences or people that trigger memories of such event(s), increased arousal, to include nervousness, over-reaction to sudden noises, difficulty sleeping (night sweats), and nightmares, bouts of rage and/or depression, difficulty relating emotionally to others, feelings of extreme alienation and meaninglessness, isolation from others, in extreme cases, persistent thoughts of murder and-or suicide. Symptoms can take months or even years to develop.
The development of a chronic trauma-based disorder is qualitatively different from simple exaggeration of the normal stress response. In those affected, a cascade of biobehavioral changes leads far beyond simple conditioning. Symptoms are intrusive and lead to hyperarousal and/or avoidant behavior. Frightening and vivid flashbacks are the most striking phenomenon. Prime victimization comes from memories of the event, rather than simply the event itself. Development of PTSD depends on personality and genetic make up, and on whether or not the trauma was expected. Prolonged exposure to severe trauma may cause permanent psychological scars.
Dissociation at the moment of the trauma has been shown to be an important factor in developing full-blown PTSD. Therefore, adults with a predisposition from childhood in chaotic, threatening, sexually abusive or violent families are at greater risk. Dissociation is characterized by feelings of detachment, estrangement, depersonalization, an unusual sense of one’s own reality, being an outside observer of one’s own actions and body, feeling like an automaton, or as if in a dream. Ability to feel emotions of any type, (especially those associated with intimacy, tenderness, sexuality), is markedly decreased, as is ability to express angry feelings. Attacks appear like a psychological seige, therefore “bunkering” mentality prevails.
Treatment Options: To Medicate or Not to Medicate The conventional view is that hyperarousal, sleep disturbances, and embeddedness of the trauma makes effective pharmacological treatment essential. However, innovative physicians, such as Marshall F. Gilula, M.D. strongly recommend consideration of complementary treatments such as Alpha Stim, brainwave resonance CDs,meditation and other means of self-care and self-regulation. Such alternatives can be used alone or in conjunction with medication, or weaning from medication.
Whether antidepressant, antianxiety, or sleeping medications are prescribed or not, dealing with traumatized people requires a staged process of treatment that is responsive to how much the victim can tolerate. Here again, the specific nature of the therapeutic relationship is a critical variable in outcome.
PTSD plays a role in the dysregulation of neurohormones and their roles in the stress response. Intense stress is accompanied by the release of endogenous, stress-responsive neurohormones, such as the catecholamines (including epinephrine and norepinephrine), serotonin, hormones of the hypothalamic-pituitary-adrenal (HPA) axis (including cortisol and other glucocorticoids, vasopressin, oxytocin), and endogenos opioids. These stress hormones help us mobilize energy required to deal with emergency stress by increasing glucose release for quick energy and enhancing immune function. Chronic stress inhibits their effectively and induces desensitization.
Drug therapy for PTSD is based on several biological models and has a few different purposes, (which also can be met with CRP’s intregrative approach). (1). Noradrenergic dysregulation is treated with MAO inhibitors, tricyclic antidepressants, beta-adrenergic blockers and benzodiazepines to calm the body’s alarm center. (2). Serotonergic dysfunction is treated with antidepressant SSRIs to regulate stress resilience, sleep, and for impulse control. (3). Anti-kindling drugs, such as carbamazepine, allegedly regulate an excitability threshold that has been lowered. (4). Anxiolytic drugs, such as clonazepam and buspirone are given in an attempt to reduce the startle response, which is one of the most persistent symptoms of PTSD.
The principle goals of using medication in PTSD are as follows:
1. Reduction of frequency and/or severity of intrusive symptoms.
2. Reduction in the tendency to interpret incoming stimuli as recurrences of the trauma.
3. Reduction in conditioned hyperarousal to stimuli reminiscent of the trauma, as well as in generalized hyperarousal.
4. Reduction in avoidant behavior.
5. Improvement in depressed mood and numbing.
6. Reduction in psychotic or dissociative symptoms.
7. Reduction of impulsive aggression against self and others. (Davidson, van der Kolk).
Intrusion is the active force creating anxiety. Psychiatrist Mardi Horowitz catalogued these intrusions, and Goleman lists them in Vital Lies, Simple Truths (1985). They refer to unbidden ideas and pangs of feeling which are difficult to dispel, and of direct or symbiotic behavioral reinactments of the stress event. They are unbidden thoughts and feelings impinging on awareness. Every variety of intrusion is some aspect of the stress response taken to an extreme. They include the following:
* Pangs of emotion, waves of feeling that well up and subside rather than being a prevailing mood;
* Preoccupation and rumination, a continued awareness of the stressful event that
recurs uncontrollably, beyond the bounds of ordinary thinking through of a problem;
* Intrusive ideas, sudden, unbidden thoughts that have nothing to do with the mental task at hand;
* Persistent thoughts and feelings, emotions or ideas which the person cannot stop once they start;
* Hypervigilance, excessive alertness, scanning and searching with a tense expectancy;
* Insomnia, intrusive ideas and images that disturb sleep;
* Bad dreams, including nightmares and anxious awakening, as well as any upsetting dream. The bad dream does not necessarily have any overt content related to a real event.
* Unbidden sensations, the sudden, unwanted entry into awareness of sensations that are unusually intense or are unrelated to the situation at the moment.
* Startle reactions, flinching or blanching in response to stimuli that typically do not warrant such reactions.
Anxiety swamps attention; denial can erase anxiety. The forms of denial include:
* Avoided associations, short-circuiting expected, obvious connections to the event that would follow from the implications of what is said or thought.
* Numbness, the sense of not having feelings, appropriate emotions that go unfelt.
* Flattened response, a constriction of expectable emotional reactions.
* Dimming of attention, vagueness or avoidance of focusing clearly on information, including thoughts, feelings, and physical sensations.
* Daze, defocused attention that clouds alertness and avoids the significance of events.
* Constricted thought, the failure to explore likely avenues of meaning other than the obvious one at hand; an abbreviated range of flexibility.
* Memory failure, an inability to recall events or their details, a selective amnesia for telling facts.
* Disavowal, saying or thinking that obvious meanings are not so.
* Blocking through fantasy, avoiding reality or its implications by fanciful thoughts of might have been or could be.
What Is PTSD?
Healing Power of Art - http://aras.org/docs/00036OGrady.pdf
Post-traumatic stress is a disorder, that automatically implies a chaotic state of being. The experiences that tend to induce PTSD include combat trauma, crimes, rape, grief, kidnapping, natural disasters, accidents, torture, and imprisonment. Predisposition to dissociation can arise in violent family environments.
Those with PTSD become hypervigilant and hyperreactive to environmental threat, real or imagined. The frozen traumatic syndrome is ever present and unchanging. Emotionally, it is as if it keeps on happenING. State-related learning and memory encoding help maintain the trance-like steady state. Depression, shame, anxiety, substance abuse, over-medication and survivor guilt are complications.
The nucleus of the disorder is a physioneurosis, somatization, depersonalization, and dissociation. Psychosomatic symptoms are expressions of the dissociation. Therapy proceeds by facilitating information transduction between them. Sufferers exhibit poor impulse control and explosive aggressive reactions. There are persistent and profound alterations in stress hormone secretions and immune function.
Therefore, PTSD is a toxic biochemical cascade that prevents homeostasis or recalibration of the whole person. They cannot “stand down.” Integration of traumatic memories proceeds by verbal and nonverbal means in therapy. However, time does not heal all wounds.
Different treatments are needed at different stages of posttraumatic adaptation. Consciousness restructuring offers a way of restructuring the frozen structure of this disorder at the most fundamental level, in the sensory terms in which it is encoded. The healing processing and imagery must come from within the individual, not be imposed or mandated from without.
PTSD FACTSHEET
http://ivaw.org/ptsdfactsheet
When the War Comes Home: Chaos, Flashbacks & Dark Futures “Peace for veterans is not an ‘absence of war’ but its living ghost in the bedroom, at the lunch counter, on the highway. The trauma is not ‘post’ but acutely present, and the ‘syndrome’ is not in the veteran but in the dictionary, in the amnesiac’s idea of peace that colludes with an unlivable life.” “The return from the killing fields is more than a debriefing; it is a slow ascent from hell. …The veteran needs a rite de sortie that belongs to every initiation as its normal conclusion, making possible an intact return.” --James Hillman
What happens when stressed-out vets return from the war theatre and try to resume their lives with business-as-usual? Many, if not most, find that to be impossible, because they are not the same as they were prior to deployment. In fact, many contend with sleepless nights, inability to focus, depression and Post Traumatic Stress Syndrome.
SUICIDE EPIDEMIC: Studies show at least 35% of the Iraq War vets have PTSD, many to the point of being suicidal. Suicide is at a record high: 20.2 per 100,000 soldiers. As there is an average of 10 failed suicide attempts for each actual loss of life, the figures suggest that more than 1,600 serving army and marine personnel tried to kill themselves last year. An estimated 30 percent of soldiers who took their own lives in 2008 did so while on deployment. Another 35 percent committed suicide after returning from a tour of duty.
Two-thirds screened positive for PTSD are not receiving treatment. Those who do are often just medicated without talk therapy. Even so, many still experience attacks seemingly out of nowhere, mimicing their Iraq experiences. Twenty percent of female soldiers report "military sexual trauma." The boundaries between friend and foe collapse.
When PTSD was first discovered in combat veterans in WWI, it was known as SHELLSHOCK, and studies of these vets by Britain's Tavistock Institute led to new discoveries about the breaking points of personalities and how lives could be shattered by the faultlines of unseen wounds lacerating the soft connective tissues of the personality and self-image.
The big question is what happens when today's vet becomes a danger to him or herself or others? How can we detect and avert potential tragedy in this growing population?
How can we best help our friends, families, and fellow citizens who now feel lost and alienated?
Veteran's PTSD is a multidimensional issue involving disabilities, traumatic brain injury, psychophysical regulation, stress-management, depression, grief, dissociation, and perhaps ADHD, T-type behavior, chronic pain management, alcohol and drug use, and compulsive disorders. Soldiers in the 101st Airborne claim most use alchol and drugs in excess, including Valium and marijuana. That is the short list, as each unique individual will have particular adjustment issues depending on their life and combat histories. Some also have service-related chronic health issues from vaccines, Gulf War Syndrome, DU, etc.
Regardless of which war or conflict you look at, high rates of PTSD in veterans have been found. Throughout history, people have recognized that exposure to combat situations can negatively impact the mental health of those involved in these situations. In fact, the diagnosis of PTSD historically originates from observations of the effect of combat on soldiers. The grouping of symptoms that we now refer to as PTSD has been described in the past as "combat fatigue," "shell shock," or "war neurosis."
Regardless of the war, soldiers involved in a war consistently show high rates of PTSD. If you are a veteran, the National Center for PTSD provides some excellent information on coping with the effects of war. If you are returning from Iraq, information about VA Transition Centers and additional resources are also provided. And, if you are a family member of a veteran, important information is also available pertaining to living with and caring for someone with PTSD.
It's Not Your Fault Traditionally, those in military and intelligence duty find it difficult to frame their difficulties as a mental health issue. There are associated taboos and shame surrounding perceived 'weakness' or inability to "be all you can be." While PTSD distorts and unravels personality, it is not a character defect, nor the fault of anyone who finds themselves plagued with its symptoms and consequences. In returning vets, as elsewhere, PTSD is a societal probelm, reflected in the sick society that creates a "dual reality" incongruent with our real needs.
Treatment for PTSD is varied but it usually consists of some form of talk therapy and group therapy plus medication, typically antidepressants or anti anxiety medications. The Army is experimenting with exposing veterans with PTSD to training video games in order to desensitize soldiers to their experiences. The Army also is funding research on Propranolol to treat PTSD. Propranolol is a blood pressure medication that may be useful in treating PTSD. It appears to reduce symptoms of emotional distress associated with traumatic memories. It doesn't wipe out the memory, just limits the emotional response.
THE WAR WITHIN
Time Does Not Heal All Wounds "More than 120 veterans of the wars in Afghanistan and Iraq commit suicide every week while the government stalls in granting returning troops the mental health treatment and benefits to which they are entitled… veterans are committing suicide at the rate of 18 a day - a number acknowledged by a VA official in a Dec. 15 (SF Chronicle – Bob Egelko)
SYMPTOMS - Re-experiencing traumatic events (obsessive recollections, flashbacks or intrusive thoughts, nightmares), avoidant symptoms (fear of being with people), signs of hyper arousal (easily startled, irritable), avoiding experiences or people that trigger memories of such event(s), increased arousal, to include nervousness, over-reaction to sudden noises, difficulty sleeping (night sweats), and nightmares, bouts of rage and/or depression, difficulty relating emotionally to others, feelings of extreme alienation and meaninglessness, isolation from others, in extreme cases, persistent thoughts of murder and-or suicide. Symptoms can take months or even years to develop.
The development of a chronic trauma-based disorder is qualitatively different from simple exaggeration of the normal stress response. In those affected, a cascade of biobehavioral changes leads far beyond simple conditioning. Symptoms are intrusive and lead to hyperarousal and/or avoidant behavior. Frightening and vivid flashbacks are the most striking phenomenon. Prime victimization comes from memories of the event, rather than simply the event itself. Development of PTSD depends on personality and genetic make up, and on whether or not the trauma was expected. Prolonged exposure to severe trauma may cause permanent psychological scars.
Dissociation at the moment of the trauma has been shown to be an important factor in developing full-blown PTSD. Therefore, adults with a predisposition from childhood in chaotic, threatening, sexually abusive or violent families are at greater risk. Dissociation is characterized by feelings of detachment, estrangement, depersonalization, an unusual sense of one’s own reality, being an outside observer of one’s own actions and body, feeling like an automaton, or as if in a dream. Ability to feel emotions of any type, (especially those associated with intimacy, tenderness, sexuality), is markedly decreased, as is ability to express angry feelings. Attacks appear like a psychological seige, therefore “bunkering” mentality prevails.
Treatment Options: To Medicate or Not to Medicate The conventional view is that hyperarousal, sleep disturbances, and embeddedness of the trauma makes effective pharmacological treatment essential. However, innovative physicians, such as Marshall F. Gilula, M.D. strongly recommend consideration of complementary treatments such as Alpha Stim, brainwave resonance CDs,meditation and other means of self-care and self-regulation. Such alternatives can be used alone or in conjunction with medication, or weaning from medication.
Whether antidepressant, antianxiety, or sleeping medications are prescribed or not, dealing with traumatized people requires a staged process of treatment that is responsive to how much the victim can tolerate. Here again, the specific nature of the therapeutic relationship is a critical variable in outcome.
PTSD plays a role in the dysregulation of neurohormones and their roles in the stress response. Intense stress is accompanied by the release of endogenous, stress-responsive neurohormones, such as the catecholamines (including epinephrine and norepinephrine), serotonin, hormones of the hypothalamic-pituitary-adrenal (HPA) axis (including cortisol and other glucocorticoids, vasopressin, oxytocin), and endogenos opioids. These stress hormones help us mobilize energy required to deal with emergency stress by increasing glucose release for quick energy and enhancing immune function. Chronic stress inhibits their effectively and induces desensitization.
Drug therapy for PTSD is based on several biological models and has a few different purposes, (which also can be met with CRP’s intregrative approach). (1). Noradrenergic dysregulation is treated with MAO inhibitors, tricyclic antidepressants, beta-adrenergic blockers and benzodiazepines to calm the body’s alarm center. (2). Serotonergic dysfunction is treated with antidepressant SSRIs to regulate stress resilience, sleep, and for impulse control. (3). Anti-kindling drugs, such as carbamazepine, allegedly regulate an excitability threshold that has been lowered. (4). Anxiolytic drugs, such as clonazepam and buspirone are given in an attempt to reduce the startle response, which is one of the most persistent symptoms of PTSD.
The principle goals of using medication in PTSD are as follows:
1. Reduction of frequency and/or severity of intrusive symptoms.
2. Reduction in the tendency to interpret incoming stimuli as recurrences of the trauma.
3. Reduction in conditioned hyperarousal to stimuli reminiscent of the trauma, as well as in generalized hyperarousal.
4. Reduction in avoidant behavior.
5. Improvement in depressed mood and numbing.
6. Reduction in psychotic or dissociative symptoms.
7. Reduction of impulsive aggression against self and others. (Davidson, van der Kolk).
Intrusion is the active force creating anxiety. Psychiatrist Mardi Horowitz catalogued these intrusions, and Goleman lists them in Vital Lies, Simple Truths (1985). They refer to unbidden ideas and pangs of feeling which are difficult to dispel, and of direct or symbiotic behavioral reinactments of the stress event. They are unbidden thoughts and feelings impinging on awareness. Every variety of intrusion is some aspect of the stress response taken to an extreme. They include the following:
* Pangs of emotion, waves of feeling that well up and subside rather than being a prevailing mood;
* Preoccupation and rumination, a continued awareness of the stressful event that
recurs uncontrollably, beyond the bounds of ordinary thinking through of a problem;
* Intrusive ideas, sudden, unbidden thoughts that have nothing to do with the mental task at hand;
* Persistent thoughts and feelings, emotions or ideas which the person cannot stop once they start;
* Hypervigilance, excessive alertness, scanning and searching with a tense expectancy;
* Insomnia, intrusive ideas and images that disturb sleep;
* Bad dreams, including nightmares and anxious awakening, as well as any upsetting dream. The bad dream does not necessarily have any overt content related to a real event.
* Unbidden sensations, the sudden, unwanted entry into awareness of sensations that are unusually intense or are unrelated to the situation at the moment.
* Startle reactions, flinching or blanching in response to stimuli that typically do not warrant such reactions.
Anxiety swamps attention; denial can erase anxiety. The forms of denial include:
* Avoided associations, short-circuiting expected, obvious connections to the event that would follow from the implications of what is said or thought.
* Numbness, the sense of not having feelings, appropriate emotions that go unfelt.
* Flattened response, a constriction of expectable emotional reactions.
* Dimming of attention, vagueness or avoidance of focusing clearly on information, including thoughts, feelings, and physical sensations.
* Daze, defocused attention that clouds alertness and avoids the significance of events.
* Constricted thought, the failure to explore likely avenues of meaning other than the obvious one at hand; an abbreviated range of flexibility.
* Memory failure, an inability to recall events or their details, a selective amnesia for telling facts.
* Disavowal, saying or thinking that obvious meanings are not so.
* Blocking through fantasy, avoiding reality or its implications by fanciful thoughts of might have been or could be.
What Is PTSD?
Healing Power of Art - http://aras.org/docs/00036OGrady.pdf
Post-traumatic stress is a disorder, that automatically implies a chaotic state of being. The experiences that tend to induce PTSD include combat trauma, crimes, rape, grief, kidnapping, natural disasters, accidents, torture, and imprisonment. Predisposition to dissociation can arise in violent family environments.
Those with PTSD become hypervigilant and hyperreactive to environmental threat, real or imagined. The frozen traumatic syndrome is ever present and unchanging. Emotionally, it is as if it keeps on happenING. State-related learning and memory encoding help maintain the trance-like steady state. Depression, shame, anxiety, substance abuse, over-medication and survivor guilt are complications.
The nucleus of the disorder is a physioneurosis, somatization, depersonalization, and dissociation. Psychosomatic symptoms are expressions of the dissociation. Therapy proceeds by facilitating information transduction between them. Sufferers exhibit poor impulse control and explosive aggressive reactions. There are persistent and profound alterations in stress hormone secretions and immune function.
Therefore, PTSD is a toxic biochemical cascade that prevents homeostasis or recalibration of the whole person. They cannot “stand down.” Integration of traumatic memories proceeds by verbal and nonverbal means in therapy. However, time does not heal all wounds.
Different treatments are needed at different stages of posttraumatic adaptation. Consciousness restructuring offers a way of restructuring the frozen structure of this disorder at the most fundamental level, in the sensory terms in which it is encoded. The healing processing and imagery must come from within the individual, not be imposed or mandated from without.
A PERFECT DESERT STORM
Can We Continue Playing Politics with PTSD Vets
Who Are a Clear & Present Danger to Themselves & Others?
By Iona Miller, CHT, 11/2009
Toxic Vaccines, Toxic Environments, Toxic Treatment
PTSD * Shame * Grief * Anxiety * Depression * Talk Therapy and Medication
“We have men and women walking around here like zombies--medicated to the gills. Personally, I've been diagnosed with "Adjustment Disorder," which is incorrect. I'm still fighting. I attend group counseling sessions three times a week with men and women who are burned out--some suicidal, some homicidal, and some both. Many are afraid.”-Anon
Threats From Vets
A "perfect storm" is an expression that describes an event where a rare combination of circumstances can aggravate a situation drastically. There is growing awareness surrounding the issue of dangerous vets returning from combat. Highly trained in military mayhem, stealth and special ops, many of these vets declare themselves to be ticking time bombs. Who knows where or when they will “go off”?
A Penn State University training video depicts faculty dealing with stereotypical “crazy, paranoid, and overly aggressive” veterans. Penn State University's Office of Student Affairs, in partnership with President Graham Spanier, produced this vignette.
http://www.youtube.com/watch?v=vhLq9NPLv0M
Have returning vets become “Dangerous Minds” aimed at society, without a mission but with an omnidirectional target? Are they just another symptom or casualty of our “sick” society? Perhaps we all need a remedy for our emotional pain.
We are all in it together. The troops who defend us are not “the enemy.” But we need a new vision, a new paradigm for our society. We can empower ourselves to resist status quo politics and shape ourselves a better destiny - a 21st century Manifest Destiny that fulfills our positive spiritual potential. We need creative repatterning.
If we don't want a dark future for humanity, we must reinvent ourselves and our culture from the foundation upwards. Even if that is fantastically radical, it can still happen, one inspired person at a time and cascade toward a visionary approach to large-scale societal transformation that heals personal and global socio-economical scars.
We live in a POST-TRAUMATIC CULTURE: PTSD is a chaotic, hyper-reactive state of being. Our cultural crisis is characterized by symptomatic numbing, dissociation, impulsive aggression, depression, denial, shame and anxiety. We are haunted by a sense of injury -- victimization. "Victim speech" is used for economic and military gain. First- and second-hand trauma shapes our central narratives of overwhelming personal and collective change.
Mission Mental Health
Our returning Vets are broken, but who will fix them? How can they overcome the societal taboos and personal shame that go along with mental illness to get the help they need upon re-entry to the US? Who can treat those vets when several factors cmbine to disrupt the homeostatic relationship of each one, resulting in breakdown that can be likened to a "perfect storm" scenario. Multi-spectrum treatments are not available through the VA.
The Veterans Administration is utterly overwhelmed by the problem. They have no recourse but to medicate military troops both going into and returning from hotzone combat. But drugs do not solve the problem and may exacerbate the problems at every point in their service arc, from pre-deployment vaccinations to societal re-entry to discharge.
Studies in depression have shown that pills alone are not enough. They not only don’t produce any better results than talk therapies, they come with a plethora of sideffects from zombification to physiological problems. Much the same can be said for isolated medication of Post Traumatic Stress Disorder (PTSD), once known as “Shellshock” in combat veterans. Psychiatry has made itself the authority on authority and to question its protocols is considered “crazy.” Yet in this arena, it has failed utterly, putting lives in a holding pattern, rather than providing true relief, much less rehabilitation.
The main characteristic of PTSD is that the trauma doesn’t recede into the past, but is perceived as perpetually happenING. When does this internal torture end? What do we do when normal counseling and talk therapies fail? How do we help rebuild shattered personalities? We need to listen, as one Vet says to the blunt fact that, “there are many more crippling mental conditions that exist that should be addressed other than just PTSD. We're just scratching the proverbial "tip of the iceberg.”
Playing Politics with Soldiers’ Lives
Many vets suffer unknowingly from PTSD and other combat-induced disorders far more severe than civilian forms of personality disorders. According to a Truthout report, Chuck Luther, served 12 years in the military and is a veteran of two deployments to Iraq, where he was a reconnaissance scout in the 1st Cavalry Division. The former sergeant was based at Fort Hood, Texas, where he lives today.
"I see the ugly, I see soldiers beating their wives and trying to kill themselves all the time, and most folks don't want to look at this, including the military."
Luther, who founded and directs "The Soldier's Advocacy Group of Disposable Warriors," knows about these types of internal problems in the military because he has been through it himself. Other symptoms include sleepless nights/nightmares, headaches, bouts of anger, lack of focus, weight loss, depression, high stress and extreme exhaustion.
Anti-depressants may compound the situation: "in EVERY walk-in, shoot up an office/school/hiway full of people case, I've looked at the attacker(s) has
1) been on meds -- most often anti depressants.
2) somewhere has had a military background/training- even ‘Columbine.’" (M. Fox)
A Torturous Existence
As if the horrors of combat aren’t enough, there is no let-up when troops return to the US. In the words of JB, an Intelligence Officer and Tactical Operations Manager:
“Dear Everybody,
The treatment received by quiet patriots that put their hearts, minds ,ears ,eyes on the line is appalling and hurts me in a deep way. We are taught to be tough, we are trained to the level of not being able to un train without the proper understanding of
WHAT IS TO COME FOR THE VETERAN WHEN THEY GET HOME , AND FOR SOME, WHILE THEY ARE STILL DEPLOYED. IT IS LIKE GOING FROM THE MOST HIGH SPEED ENVIRONMENT, AND THEN (RETURNING HOME) TO cold molasses. Everything is way to slow for their "not to be something up."
Then you hear from everybody in the US how many programs their are now to help "you guys" followed by, "So , what did you do?" *(who are 'us guys' and when did we become different than the rest of Americans?)
I learned not to answer that second question. I broke a glass of coke in the middle of a party because of a memory, while trying to answer that second question. Then there are those Servicemen that are specop trained , trained to the point of secrecy , wounded in the critical moment that determines a successful mission , but keep their mouth shut because they KNOW how important tomorrows mission is and WHO it is we are going after. Now remember, I was on the 15th MEU in Australia when 9/11 happened. My unit was the first in to the theater of operations, the so called "tip of the spear" as Marines Mike. Here is so information on the Marine Expeditionary Unit (SOC)” http://www.15thmeu.net/
What about NOW?
Yet another vet says:
"Everybody talks about how many programs their are for the OEF/OIF, or Veterans in general"
Programs may exist , but how many of you know of them, how many commercials are shown of these programs, who is limiting the SHARING OF THEM?
Here are two:
https://www.veteransadvantage.com/alt/Register.jsp?va30=true&partner=linkshare
http://www.woundedwarriorproject.org/
These are just two, there are more projects, and some including the WW project having ties with the DNI and IC.
You go and speak to these people at the VA trying to hold back tears from memories you witnessed because of the same government that is showing you its back now, but of course, on the battlefield giving you certificate of commendations.
YOU RETURN HAVING NO IDEA WHAT YOU WILL BE FACING when you get back to the so-called civilian world.
Everything seems chaotic, different, unstructured, and it makes you want to go back to your comfort WAR zone, it just doesn't make sense that our Military servicemen who are treated like complaining kids seek help in foxholes , , , again,,,,,who in the hell really runs this country????
You feel in your heart fear that is confusing
Your mind tells you can't do this and their is no way possible for you "to get out of this one."
Your eyes begin to show the disproportionate chances of success through smoke and doubt.
Your ears hear everybody laughing at the dinner table and hopefully praying for your safety, and then a shell brings you back to reality.
You miss what you bleed for.
And then you go home, noticing the empty seats on the helicopters with one M16A2 service rifle and helmet. How can one mistake a persons willingness to put his life down for another as fulfilling just a contract or enlistment?.
TAKES A BIT MORE THAN INK TO SUSTAIN.
I am sorry if feathers ruffled but glad that maybe one or two eyes were open to the reality of our Wounded Warriors, and their mistreatment.
Therapist’s View: Addicted to War?
This is a big story and one I've been following for some time, as insider therapeutic 'shop talk' among my counselor friends and medical colleagues. A psychiatric nurse practitioner [male] friend is the sole practitioner dealing with PTSD vets at a VA Domiciliary, and the only treatment is medication. It is not working. This person says many of them -- most actually -- remain suicidal. He deals with this all day long, everyday, working as fast as he can go.
When I tell this expert, "drugs won't do it," he just says "don't tell me that," and hangs his head knowing it is true and he cannot do more, being already slammed for time everyday. He is taking on all this negativity of the vast volume of returnees needing this treatment. Realize in PTSD, the trauma did not occur, but is perceived to continue to be OCCURRING. It comes at them from every angle including replaying 'tapes' inside their heads, with 'coulda, shoulda, woulda' about incidents where people were let down or died.
Another counselor friend turned over his business space to someone with this specialty who says the vast numbers of PTSD and other disorders in vets pose a serious threat to the country -- in other words they are societal wild cards, who can go ‘postal.’ There is no time limit on that because the re-adjustment is not occurring.
Hark back to the Vietnam era vets and their lifelong dysfunctionalities and you get the idea. Suicide rates in the military have not been so since that era. Naturally, this is not all vets, but in this war the proportions are as high or higher than other wars. In WWI, it was called Shellshock. This human breaking point was studied at Tavistock Institute, who then turned their psychological warfare on the public in a 60 year propaganda, psyops, media blitz and psychiatric warfare campaign we can call “the Long Crisis,” much of which is socially engineered.It is the thinktank of the global War Machine.
It is a very deep issue. It is like all these vets went through the breaking down portion of brainwashing and are still unglued. The complication is that only those of similar experience can be trusted, so 'talk therapy' is limited and useless done by those who don't know the blunt experience or war, firsthand. You see how our friend reacted when asked to talk about his experiences. It is like saying 'have a hypnotic regression NOW' and they are back 'in it', immersed in toxic traumatic memories. They don't want to think about or discuss it, yet are compelled to do so internally -- physiologically always on Red Alert.
I have some therapeutic processes that do NOT use the historical or realtime dimension, but work through metaphor. It helps clients move from the 'storm' to a calmer place, but without regressing them BACK into the situation. I think you've seen enough colleagues in this state to realize what I am saying and why normal 'adjustment' therapies and talk are just too mild. One has to help them rebuild and mend their personality from the ground up.
Further, there is tremendous shame associated by themselves and the military for being in this state. Also, this extends to their collective, and their relationship with society. No one likes to think that 'something is profoundly wrong with me.' And asking for help is taboo and compounds the shame professionally, at home and at large.
These are just a few of the immediate challenges. Halfway houses may compound the sense of separation and isolation, most wanting to return home. The former are usually used for addiction behavior, so there is the implication. Shall we call it "Addicted to War"?
We take our best and brightest and impose this on them instead of finding other solutions to our cultural greed to consume a disproportionate amount of the global resources. The least we can do is commit to healing them once we've assured the rest of their lives will be disrupted. You know I have personally dealt with those of Vietnam era in extreme cases where only their high character has saved them -- from headhunter assassins to 'normal' troops.
If someone in our group has a viable treatment option, I would sure like to hear it, because as usual I am skeptical of half measures. Further, who is supposed to PAY for this treatment, which is not brief and likely will not come to any form of therapeutic 'closure.'
Where are the clinical directors and large numbers of available suicide prevention experts for such a program, which is tough duty in itself. Much more that halfway houses and halfway measures are required. Who among us has any expertise in the treatment end? And what are they thinking regarding actual treatment? What is the method of changing the toxic internal dialogue? How can we translate what we know about ‘ordinary’ PTSD to the extreme and recurrent issue of the battle arena? What can we do when soliders bring the battle home?
When You Can’t Just Stop
What happens when you can’t help yourself, can’t stop the racing thoughts and psychphysical symptoms of fight/flight that accompany them? What happens when there is no “escape” from compulsive thoughts and alienation? What happens when suicide seems the only possible release? What is the remedy for such a Dark Night of the Soul, not just behaviorally but spiritually? PTSD is a disorder of the soul as well as of the mind. What happens when the life-giving magic is sucked out of a person by harsh realities too overwhelming to deal with? What could possibly be a creative solution to such misery?
The concept of the internal dialogue is only of use to us by stopping it. The issue isn't whether violence is caused by the internal dialogue, but the fact that we are mesmerized by the internal dialogue. Stilling the internal dialogue leads us into a separate reality.
Stopping the internal dialogue is much more powerful than a mantra, which is a lame way of doing the same thing which can become a mesmerizing distraction. The way of the hunter is to focus silently on the second attention without the distraction of the internal dialogue leading us back into the merry-go-round of uncontrolled folly.
PTSD Culture - We are All shellshocked by Shock Doctrine What is Shellshock?
Post-traumatic stress is a disorder, that automatically implies a chaotic state of being. The experiences that tend to induce PTSD include combat trauma, crimes, rape, grief, kidnapping, natural disasters, accidents, torture, and imprisonment. Predisposition to dissociation can arise in violent family environments.
Those with PTSD become hypervigilant and hyperreactive to environmental threat, real or imagined. The frozen traumatic syndrome is ever present and unchanging. Emotionally, it is as if it keeps on happenING. State-related learning and memory encoding help maintain the trance-like steady state. Depression, shame, anxiety, substance abuse, over-medication and survivor guilt are complications.
The nucleus of the disorder is a physioneurosis, somatization, depersonalization, and dissociation. Psychosomatic symptoms are expressions of the dissociation. Therapy proceeds by facilitating information transduction between them. Sufferers exhibit poor impulse control and explosive aggressive reactions. There are persistent and profound alterations in stress hormone secretions and immune function.
Therefore, PTSD is a toxic biochemical cascade that prevents homeostasis or recalibration of the whole person. They cannot “stand down.” Integration of traumatic memories proceeds by verbal and nonverbal means in therapy. However, time does not heal all wounds.
Different treatments are needed at different stages of posttraumatic adaptation. Consciousness restructuring offers a way of restructuring the frozen structure of this disorder at the most fundamental level, in the sensory terms in which it is encoded. The healing processing and imagery must come from within the individual, not be imposed or mandated from without.
PART II: WHAT IS POSTTRAUMATIC STRESS DISORDER?
The development of a chronic trauma-based disorder is qualitatively different from simple exaggeration of the normal stress response. In those affected, a cascade of biobehavioral changes leads far beyond simple conditioning. Symptoms are intrusive and lead to hyperarousal and/or avoidant behavior. Frightening and vivid flashbacks are the most striking phenomenon. Prime victimization comes from memories of the event, rather than simply the event itself. Development of PTSD depends on personality and genetic make up, and on whether or not the trauma was expected. Prolonged exposure to severe trauma may cause permanent psychological scars.
Dissociation at the moment of the trauma has been shown to be an important factor in developing full-blown PTSD. Therefore, adults with a predisposition from childhood in chaotic, threatening, sexually abusive or violent families are at greater risk. Dissociation is characterized by feelings of detachment, estrangement, depersonalization, an unusual sense of one’s own reality, being an outside observer of one’s own actions and body, feeling like an automaton, or as if in a dream. Ability to feel emotions of any type, (especially those associated with intimacy, tenderness, sexuality), is markedly decreased, as is ability to express angry feelings. Attacks appear like a psychological seige, therefore “bunkering” mentality prevails.
Flashbacks can be triggered by overreactions to sounds, smells, feelings, or images. During the flashback, the person relives the traumatic event and may completely lose touch with reality, suffering through the trauma for minutes or hours at a time, believing that it is actually happening all over again. There is activation of sensory areas of the brain during flashbacks, right-hemispheric activation, and limbic-system activation.
The psychological function of emotions is to alert us to pay attention to what is happening, so that we can take adaptive action. Generally, we stop having an emotional response when we have realigned our expectations of what is supposed to happen with what is actually happening. We either take action that adjusts the given situation to our expectations, or change our expectations to fit better with what is actually going on.
But in PTSD, emotional arousal and goal-directed action are disconnected from one another because of emotional numbing. Arousal is no longer a cue to pay attention to incoming information. There is no gap between stimulus and response with fight-flight reactions. They either freeze or overreact. The emotions of fear, terror, and helplessness characterize any traumatic event, and avoidance of these feelings would seem to be the result, but chronic reenactment of the damaging event is compulsive.
Those with PTSD are more sensitive to sound intensities than average. They are “reducers” in whom inhibitory feedback loops are activated to dampen a tonic state of hyperarousal. They have difficulty neutralizing stimuli in the environment in order to attend to relevant tasks. To compensate, they tend to shut down, which of course means decreased involvement in ordinary, everyday life. Rather than reacting to the daily environment flexibly, they react to internal stimuli that are irrelevant to current demands.
Trauma effects the hormones of both brain and body creating more psychophysical stress.
Intense distress is accompanied by release of stress-responsive neurohormones which seek to mobilize the energy required to deal with the stress. Chronic and persistent stress inhibits the effectiveness of the stress response and produces desensitization and sleep disturbances combined with hypervigilance.
Time does not heal all wounds. Therapy allows an inner search for healing alternatives within the “deeper” state-dependent psychobiological levels until the sought-for structure is transduced into the verbal level and emerges as a new psychophysical form. The recursive process which manifests in flashbacks and immersive rumination is facilitated, unblocked, and allowed to flow to its healing conclusion. This creates a shift in recurrent intrusive recollections and in recurrent distressing dreams and nightmares.
CRP helps probe into the state-dependent patterns of physiology, memory, and learning that have been encoded during circumstances of stress-released epinephrine by the autonomic nervous system and related responses by the endocrine and neuropeptide systems, and their related existential meanings and sensory images. It provides a healthier means of dissociation and reiteration leading to creative self-organization.
DIAGNOSIS OF POSTTRAUMATIC STRESS DISORDER
The diagnostic criteria for PTSD are listed in the DSM IV:
A. The person has been exposed to a traumatic event in which both of the following were present:
(1) The person experienced, witnessed, or was confronted with an event or events that involved actual or threatened with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others.
(2) The person’s response involved intense fear, helplessness, or horror. Note: In children, this may be expressed instead by disorganized or agitated behavior.
B. The traumatic event is persistently reexperienced in one or more of these ways:
(1) Recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Note: in children, repetitive play may occur in which themes or aspects of the trauma are expressed.
(2) Recurrent distressing dreams of the event. Note: in children, there may be frightening dreams without recognizable content.
(3) Acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated). Note: in children trauma-specific reenactment may occur.
(4) Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
(5) Physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspects of the traumatic event.
C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following:
(1) Efforts to avoid thoughts, feelings, or conversations associated with the trauma.
(2) Efforts to avoid activities, places, or people that arouse recollections of the trauma.
(3) Inability to recall an important aspect of the trauma.
(4) Markedly diminished interest or participation in significant activities.
(5) Feeling of detachment or estrangement from others.
(6) Restricted range of affect (e.g. unable to have loving feelings).
(7) Sense of foreshortened future (e.g. does not expect to have a career, marriage, children, or normal life span).
D. Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following:
(1) Difficulty falling or staying asleep.
(2) Irritability or outbursts of anger.
(3) Difficulty concentrating.
(4) Hypervigilance.
(5) Exaggerated startle response.
WHAT CAUSES POSTTRAUMATIC STRESS DISORDER?
Any overwhelmingly stressful life situation (surgery, war, natural disaster, robbery, traumatic bereavement, torture, physical battery, accident, rape, malnutrition, etc.) that stimulates excessive arousal by the autonomic and endocrine systems can lead to the symptomology of post-traumatic stress. State-dependent memory, learning, and behavior (SDMLB) is the essential feature of posttraumatic stress syndrome, and the many more subtle dysfunctions associated with it. Fear-conditioning and parasynaptic cellular modulation mediates SDMLB, (Rossi, 1986).
PTSD seems to be the basic process underlying Freud’s original concept of the “traumatic neurosis” as the organic basis of psychopathology. Therefore, the entire history of depth psychology and psychotherapy can now be understood as a prolonged clinical observation of how dissociated or state-dependent memories remain active at unconscious levels, giving rise to “complexes.” These complexes are the source of psychological and psychosomatic problems.
Trauma affects our capacity to regulate bodily homeostatsis. Even years after the trauma has ceased, memories continue to dominate people’s perceptions, and affect capacity to think and make sense out of current experience. Psychological interventions can only effect the degree of reversal of a disorder with such strong biological underpinnings.
Healing those who develop PTSD in the aftermath of overwhelming experience is a complex process, whose dynamics cannot be described like a cookbook recipe--it requires tremendous sensitivity and intuition. Reestablishing a sense of personal safety and equilibrium is a primary goal of all treatment, and this happens within the therapeutic alliance.
Recognition of each person’s unique situation and reactions is paramount. It is critical that the therapist continue to take stock of the safety of the relationship and progress in achieving therapeutic goals. Participants are encouraged to make meaning of their life experiences when they feel personally supported by their therapists. A primary goal is to not retraumatize the person with therapies that force them to relive the original trauma in historical, rather than metaphorical or sensory terms, or compound the episodes with fallacious material.
Because traumatic memories are stored in state-dependent fashion, they are often rendered inaccessible to verbal recall for prolonged periods of time. Because memories are dissociated, they are stored outside of ordinary awareness, and expressed in incomprehensible symptoms as physical ailments, behavioral reenactments, and vivid sensory reliving experiences. Reenactment of the trauma in personal and social relationships is a major source of shame for the victims and is a source of ongoing tragedy.
Constricted ego functioning is a feature of all traumatized individuals. It is even more complex when traumatization comes in childhood, because trauma early in the life cycle fundamentally affects maturation of systems in charge of regulating psychological and biological processes. It can result in lack of emotional control, destructuve behavior against self and others (or animals), brutality (victim/victimizer), learning disabilities, somatization, dissociative problems, and distortions in concepts about self and others.
Reaction to trauma is a process of adaptation over time. In Chaos Theory, attractors describe the characteristic behavior of a dynamical system changing over time. Traumatic events, especially chronic events, act as “strange attractors” in consciousness which keep everything in their orbit, cycling wildly, unpredictably, but within the parameters of the attractor, reiterating the same cues over and over. Memories are embedded in all layers of psychophysical self in, what is known in Chaos Theory, as infinite nesting.
Psychological siege describes the dominance of trauma in memory and its crucial maintenance over time. The feeling of being constantly beseiged or barraged leads to a bunkering mentality which may be acted out, particularly in combat veterans. Over time some people’s PTSD may become subclinical, and yet it may continue to influence their level of functioning.
PTSD is the result of complex interrelationships among psychological, biological, and social processes--one that varies depending on the maturational level of the victim, as well as the length of time for which the person was exposed to the trauma, and the source of the trauma. Central to understanding these processes is awareness of the nature of traumatic memory and its biological substrates that lead to the dominance of the trauma in memory and to its maintenance over time.
Social cues are important for recovery -- whether people are encouraged to attend to their pain and learn from the past or cultivate a “stiff upper lip,” suppressing the profound meaning of their experience. There is often resistance to acknowledging the trauma or depth of its impact. Reality can profoundly and permanently alter people’s psychology and biology. Individuals make a choice whether to examine their reactions to the trauma in order to overcome it, or ignore it and try to go on with their lives. There is a range of reactions from acute trauma to long-term outcome.
The inner structure of the disorder overlaps catagories of dissociative disorder and stress responses. Adjustment disorder, grief reactions, and a variety of characterological adaptations are germaine. The interaction between external events and subjective response can vary widely, even among victims of the same trauma, based on internal processing and approach to life in general.
Predisposition and vulnerability reflect on recovery from acute symptomology and long-term resilience. Critical issues include the emergence of chronic patterns of adaptation, in which lack of involvement in current reality, rather than preoccupation with the past are the most pathological features.
The ways people view themselves and their world can be compounded by a host of self-destructive behaviors (e.g. suicide attempts, self-multilation, and eating disorders). Complexity of adaptation includes both hormonal and autonomic nervous system dimensions. This includes unusual patterns of cortisol, norepinepherine, and dopamine metabolite excretion; the role of serotonergic and opioid systems (arousal and numbing); receptor modification by processes such as kindling; and involvement of central pathways involved in the integration of perception, memory and arousal.
Traumatic memories are qualitatively different from memories of ordinary events, in that amnesia co-exists with vivid recollections. Information processing and dissociation affect a person’s ability to perceive and integrate overwhelming experiences. Dissociative fragmentation of the self is common, leading to shattered psyches and lives.
Trauma is particularly devastating in childhood, including traumatic bereavement. Because of their dependence on caregivers, their incomplete biological development, and immature self-concepts and concepts of surroundings, children have unique patterns of reaction and needs for intervention. Although they may suffer from subclinical PTSD in middle age, memories recur and come to dominate their lives as seniors. There is generally greater lack of flexibility or capacity to repair damage with increasing age.
CONVENTIONAL TREATMENT OF PTSD
In actual practice, most clinicians use an eclectic approach, in which we must constantly reevaluate what is being accomplished. The core symptoms of PTSD (including paranoia, intrusions, numbing, and hyperarousal), occupational disabilities, dissociative phenomena, and interpersonal problems and alienation may all need widely different approaches. Treatment, therefore, depends in large part on clinical judgement.
In order to respond to current life and reach their fullest potential, people need to regain control over their emotional responses. It helps to place the trauma in the larger perspective of their lives--as a historical event (or series of events), that occurred at a particular time in a particular place, and that can be expected not to recur if the traumatized individuals take charge of their lives.
The key element is integration of the alien, the unacceptable, the terrifying, and the incomprehensible; the trauma must come to be “personalized” as an integrated aspect of one’s personal history. The therapeutic relationship is the cornerstone of effective treatment.
Critical incident stress debriefing has been proposed as a way of modifying the stress reactions of emergency service workers. Acute stress reactions, with the absence of stable symptom patterns and extreme degrees of physiological hyperarousal at this stage mean that there are unique problems in the treatment of this group.
Traumatized people with high levels of avoidance are often most reluctant to expose themselves to their traumatic memories, even when they seek help. Systematic desensitization and Eye Movement Desensitization and Reprocessing (EMDR) have been applied with limited results. Any positive results with EMDR probably come from mimicing the REM state.
Representations of trauma are more complex than roles like “perpetrator,” and “victim”. They are embedded in numerous affect states, defenses, object relations, and deep meaning configurations. Pertinent to these are subjective decision points in which critical self-judgements are embedded.
They include insufficient anticipation of danger, naive trust, impossible choices, guilt and shame, and terror at revealing the content of the traumatic experience to someone new. Other elements include temporally continguous ego states, such as splitting, denial, and dissociation, coupled with temporally contiguous fantasy states, such as murderous vengeance and wishes to die. Intrusions can also remind the person of moments of fantasied safety within the trauma.
The conventional view is that hyperarousal, sleep disturbances, and embeddedness of the trauma makes effective pharmacological treatment essential. Whether antidepressant, antianxiety, or sleeping medications are prescribed or not, dealing with traumatized people requires a staged process of treatment that is responsive to how much the victim can tolerate. Here again, the specific nature of the therapeutic relationship is a critical variable in outcome.
PTSD plays a role in the dysregulation of neurohormones and their roles in the stress response. Intense stress is accompanied by the release of endogenous, stress-responsive neurohormones, such as the catecholamines (including epinephrine and norepinephrine), serotonin, hormones of the hypothalamic-pituitary-adrenal (HPA) axis (including cortisol and other glucocorticoids, vasopressin, oxytocin), and endogenos opioids. These stress hormones help us mobilize energy required to deal with emergency stress by increasing glucose release for quick energy and enhancing immune function. Chronic stress inhibits their effectively and induces desensitization.
Drug therapy for PTSD is based on several biological models and has a few different purposes, (which also can be met with CRP’s intregrative approach). (1). Noradrenergic dysregulation is treated with MAO inhibitors, tricyclic antidepressants, beta-adrenergic blockers and benzodiazepines to calm the body’s alarm center. (2). Serotonergic dysfunction is treated with antidepressant SSRIs to regulate stress resilience, sleep, and for impulse control. (3). Anti-kindling drugs, such as carbamazepine, allegedly regulate an excitability threshold that has been lowered. (4). Anxiolytic drugs, such as clonazepam and buspirone are given in an attempt to reduce the startle response, which is one of the most persistent symptoms of PTSD.
The principle goals of using medication in PTSD are as follows:
1. Reduction of frequency and/or severity of intrusive symptoms.
2. Reduction in the tendency to interpret incoming stimuli as recurrences of the trauma.
3. Reduction in conditioned hyperarousal to stimuli reminiscent of the trauma, as well as in generalized hyperarousal.
4. Reduction in avoidant behavior.
5. Improvement in depressed mood and numbing.
6. Reduction in psychotic or dissociative symptoms.
7. Reduction of impulsive aggression against self and others. (Davidson, van der Kolk).
Intrusion is the active force creating anxiety.
Psychiatrist Mardi Horowitz catalogued these intrusions, and Goleman lists them in Vital Lies, Simple Truths (1985). They refer to unbidden ideas and pangs of feeling which are difficult to dispel, and of direct or symbiotic behavioral reinactments of the stress event. They are unbidden thoughts and feelings impinging on awareness. Every variety of intrusion is some aspect of the stress response taken to an extreme. They include the following:
* Pangs of emotion, waves of feeling that well up and subside rather than being a prevailing mood;
* Preoccupation and rumination, a continued awareness of the stressful event that
recurs uncontrollably, beyond the bounds of ordinary thinking through of a problem;
* Intrusive ideas, sudden, unbidden thoughts that have nothing to do with the mental task at hand;
* Persistent thoughts and feelings, emotions or ideas which the person cannot stop once they start;
* Hypervigilance, excessive alertness, scanning and searching with a tense expectancy;
* Insomnia, intrusive ideas and images that disturb sleep;
* Bad dreams, including nightmares and anxious awakening, as well as any upsetting dream. The bad dream does not necessarily have any overt content related to a real event.
* Unbidden sensations, the sudden, unwanted entry into awareness of sensations that are unusually intense or are unrelated to the situation at the moment.
* Startle reactions, flinching or blanching in response to stimuli that typically do not warrant such reactions.
Anxiety swamps attention; denial can erase anxiety. The forms of denial include:
* Avoided associations, short-circuiting expected, obvious connections to the event that would follow from the implications of what is said or thought.
* Numbness, the sense of not having feelings, appropriate emotions that go unfelt.
* Flattened response, a constriction of expectable emotional reactions.
* Dimming of attention, vagueness or avoidance of focusing clearly on information, including thoughts, feelings, and physical sensations.
* Daze, defocused attention that clouds alertness and avoids the significance of events.
* Constricted thought, the failure to explore likely avenues of meaning other than the obvious one at hand; an abbreviated range of flexibility.
* Memory failure, an inability to recall events or their details, a selective amnesia for telling facts.
* Disavowal, saying or thinking that obvious meanings are not so.
* Blocking through fantasy, avoiding reality or its implications by fanciful thoughts of might have been or could be.
The operative principle that unites these forms of denial is that they are all ways of blanking from awareness a troubling fact. These tactics are countermoves to the intrusions listed previously. Denial and intrusion are two sides of attention, the one an avoidance, the other an invasion.
Self-deception involves forgetting and forgetting we have forgotten. Repression creates no trace when it is in progress--it is the sound of a thought evaporating.
There are secrets we keep even from ourselves. They are retrievable only under the most extraordinary circumstances, since the essence of repression lies simply in the function of rejecting and keeping something out of consciousness. It suppresses the single class of items which evoke psychological pain. This fear-based pain can be of many varieties: trauma, “intolerable ideas,” unbearable feeling, anxiety, guilt, shame, etc.
Repression lessens mental pain by creating a blind spot as does its cousin denial. It protects a core of forbidden information. The nearer to that core one probes the greater the resistance. The deepest schemas encode the most painful memories, and are the hardest to activate.
Defensive postures include:
* Repression. Forgetting and forgetting one has forgotten.
* Denial and Reversal. What is so is not the case; the opposite is the case.
* Projection. What is inside is cast outside.
* Isolation. Events without feelings.
* Rationalization. I give myself a cover story.
* Sublimation. Replacing the threatening with the safe.
* Selective inattention. I don’t see what I don’t like.
* Automatism. I don’t notice what I do.
REFERENCES
American Psychological Assn., DSM IV
Blackmore, Susan, The Meme Machine, Oxford Univ. Press, 1999.
Brodie, Richard, Virus of the Mind, Integral Press, 1995.
Goleman, Daniel, Vital Lies, Simple Truths: The Psychology of Self Deception, Simon and Schuster, New York, 1985.
Lynch, Aaron, Thought Contagion, Basic Books, 1996.
Rossi, Ernest, Psychobiology of Mind-Body Healing, W.W. Norton & Co., Inc., New York, 1986.
Rossi, Ernest and Cheek, David B., Mind-Body Therapy, W.W. Norton & Co., Inc. New York, 1988.
Swinney, Graywolf, Holographic Healing, Asklepia Pub., 1997.
Vallee, Jacque, Dimensions, Contemporary Books, Chicago, 1988.
van der Kolk, Bessel; McFarlane, Alexander; Weisaeth, Lars, Editors;Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body, and Society, Guilford Press, New York, 1996.
Wilson, John P. and Keane, Terence M., Editors, Assessing Psychological Trauma and PTSD, GuilfordNew York, 1997. Press
Jamail, Dahr, "Iraq War Veteran on a Mental-Health Mission" Truthout, Saturday 21 November 2009
Can We Continue Playing Politics with PTSD Vets
Who Are a Clear & Present Danger to Themselves & Others?
By Iona Miller, CHT, 11/2009
Toxic Vaccines, Toxic Environments, Toxic Treatment
PTSD * Shame * Grief * Anxiety * Depression * Talk Therapy and Medication
“We have men and women walking around here like zombies--medicated to the gills. Personally, I've been diagnosed with "Adjustment Disorder," which is incorrect. I'm still fighting. I attend group counseling sessions three times a week with men and women who are burned out--some suicidal, some homicidal, and some both. Many are afraid.”-Anon
Threats From Vets
A "perfect storm" is an expression that describes an event where a rare combination of circumstances can aggravate a situation drastically. There is growing awareness surrounding the issue of dangerous vets returning from combat. Highly trained in military mayhem, stealth and special ops, many of these vets declare themselves to be ticking time bombs. Who knows where or when they will “go off”?
A Penn State University training video depicts faculty dealing with stereotypical “crazy, paranoid, and overly aggressive” veterans. Penn State University's Office of Student Affairs, in partnership with President Graham Spanier, produced this vignette.
http://www.youtube.com/watch?v=vhLq9NPLv0M
Have returning vets become “Dangerous Minds” aimed at society, without a mission but with an omnidirectional target? Are they just another symptom or casualty of our “sick” society? Perhaps we all need a remedy for our emotional pain.
We are all in it together. The troops who defend us are not “the enemy.” But we need a new vision, a new paradigm for our society. We can empower ourselves to resist status quo politics and shape ourselves a better destiny - a 21st century Manifest Destiny that fulfills our positive spiritual potential. We need creative repatterning.
If we don't want a dark future for humanity, we must reinvent ourselves and our culture from the foundation upwards. Even if that is fantastically radical, it can still happen, one inspired person at a time and cascade toward a visionary approach to large-scale societal transformation that heals personal and global socio-economical scars.
We live in a POST-TRAUMATIC CULTURE: PTSD is a chaotic, hyper-reactive state of being. Our cultural crisis is characterized by symptomatic numbing, dissociation, impulsive aggression, depression, denial, shame and anxiety. We are haunted by a sense of injury -- victimization. "Victim speech" is used for economic and military gain. First- and second-hand trauma shapes our central narratives of overwhelming personal and collective change.
Mission Mental Health
Our returning Vets are broken, but who will fix them? How can they overcome the societal taboos and personal shame that go along with mental illness to get the help they need upon re-entry to the US? Who can treat those vets when several factors cmbine to disrupt the homeostatic relationship of each one, resulting in breakdown that can be likened to a "perfect storm" scenario. Multi-spectrum treatments are not available through the VA.
The Veterans Administration is utterly overwhelmed by the problem. They have no recourse but to medicate military troops both going into and returning from hotzone combat. But drugs do not solve the problem and may exacerbate the problems at every point in their service arc, from pre-deployment vaccinations to societal re-entry to discharge.
Studies in depression have shown that pills alone are not enough. They not only don’t produce any better results than talk therapies, they come with a plethora of sideffects from zombification to physiological problems. Much the same can be said for isolated medication of Post Traumatic Stress Disorder (PTSD), once known as “Shellshock” in combat veterans. Psychiatry has made itself the authority on authority and to question its protocols is considered “crazy.” Yet in this arena, it has failed utterly, putting lives in a holding pattern, rather than providing true relief, much less rehabilitation.
The main characteristic of PTSD is that the trauma doesn’t recede into the past, but is perceived as perpetually happenING. When does this internal torture end? What do we do when normal counseling and talk therapies fail? How do we help rebuild shattered personalities? We need to listen, as one Vet says to the blunt fact that, “there are many more crippling mental conditions that exist that should be addressed other than just PTSD. We're just scratching the proverbial "tip of the iceberg.”
Playing Politics with Soldiers’ Lives
Many vets suffer unknowingly from PTSD and other combat-induced disorders far more severe than civilian forms of personality disorders. According to a Truthout report, Chuck Luther, served 12 years in the military and is a veteran of two deployments to Iraq, where he was a reconnaissance scout in the 1st Cavalry Division. The former sergeant was based at Fort Hood, Texas, where he lives today.
"I see the ugly, I see soldiers beating their wives and trying to kill themselves all the time, and most folks don't want to look at this, including the military."
Luther, who founded and directs "The Soldier's Advocacy Group of Disposable Warriors," knows about these types of internal problems in the military because he has been through it himself. Other symptoms include sleepless nights/nightmares, headaches, bouts of anger, lack of focus, weight loss, depression, high stress and extreme exhaustion.
Anti-depressants may compound the situation: "in EVERY walk-in, shoot up an office/school/hiway full of people case, I've looked at the attacker(s) has
1) been on meds -- most often anti depressants.
2) somewhere has had a military background/training- even ‘Columbine.’" (M. Fox)
A Torturous Existence
As if the horrors of combat aren’t enough, there is no let-up when troops return to the US. In the words of JB, an Intelligence Officer and Tactical Operations Manager:
“Dear Everybody,
The treatment received by quiet patriots that put their hearts, minds ,ears ,eyes on the line is appalling and hurts me in a deep way. We are taught to be tough, we are trained to the level of not being able to un train without the proper understanding of
WHAT IS TO COME FOR THE VETERAN WHEN THEY GET HOME , AND FOR SOME, WHILE THEY ARE STILL DEPLOYED. IT IS LIKE GOING FROM THE MOST HIGH SPEED ENVIRONMENT, AND THEN (RETURNING HOME) TO cold molasses. Everything is way to slow for their "not to be something up."
Then you hear from everybody in the US how many programs their are now to help "you guys" followed by, "So , what did you do?" *(who are 'us guys' and when did we become different than the rest of Americans?)
I learned not to answer that second question. I broke a glass of coke in the middle of a party because of a memory, while trying to answer that second question. Then there are those Servicemen that are specop trained , trained to the point of secrecy , wounded in the critical moment that determines a successful mission , but keep their mouth shut because they KNOW how important tomorrows mission is and WHO it is we are going after. Now remember, I was on the 15th MEU in Australia when 9/11 happened. My unit was the first in to the theater of operations, the so called "tip of the spear" as Marines Mike. Here is so information on the Marine Expeditionary Unit (SOC)” http://www.15thmeu.net/
What about NOW?
Yet another vet says:
"Everybody talks about how many programs their are for the OEF/OIF, or Veterans in general"
Programs may exist , but how many of you know of them, how many commercials are shown of these programs, who is limiting the SHARING OF THEM?
Here are two:
https://www.veteransadvantage.com/alt/Register.jsp?va30=true&partner=linkshare
http://www.woundedwarriorproject.org/
These are just two, there are more projects, and some including the WW project having ties with the DNI and IC.
You go and speak to these people at the VA trying to hold back tears from memories you witnessed because of the same government that is showing you its back now, but of course, on the battlefield giving you certificate of commendations.
YOU RETURN HAVING NO IDEA WHAT YOU WILL BE FACING when you get back to the so-called civilian world.
Everything seems chaotic, different, unstructured, and it makes you want to go back to your comfort WAR zone, it just doesn't make sense that our Military servicemen who are treated like complaining kids seek help in foxholes , , , again,,,,,who in the hell really runs this country????
You feel in your heart fear that is confusing
Your mind tells you can't do this and their is no way possible for you "to get out of this one."
Your eyes begin to show the disproportionate chances of success through smoke and doubt.
Your ears hear everybody laughing at the dinner table and hopefully praying for your safety, and then a shell brings you back to reality.
You miss what you bleed for.
And then you go home, noticing the empty seats on the helicopters with one M16A2 service rifle and helmet. How can one mistake a persons willingness to put his life down for another as fulfilling just a contract or enlistment?.
TAKES A BIT MORE THAN INK TO SUSTAIN.
I am sorry if feathers ruffled but glad that maybe one or two eyes were open to the reality of our Wounded Warriors, and their mistreatment.
Therapist’s View: Addicted to War?
This is a big story and one I've been following for some time, as insider therapeutic 'shop talk' among my counselor friends and medical colleagues. A psychiatric nurse practitioner [male] friend is the sole practitioner dealing with PTSD vets at a VA Domiciliary, and the only treatment is medication. It is not working. This person says many of them -- most actually -- remain suicidal. He deals with this all day long, everyday, working as fast as he can go.
When I tell this expert, "drugs won't do it," he just says "don't tell me that," and hangs his head knowing it is true and he cannot do more, being already slammed for time everyday. He is taking on all this negativity of the vast volume of returnees needing this treatment. Realize in PTSD, the trauma did not occur, but is perceived to continue to be OCCURRING. It comes at them from every angle including replaying 'tapes' inside their heads, with 'coulda, shoulda, woulda' about incidents where people were let down or died.
Another counselor friend turned over his business space to someone with this specialty who says the vast numbers of PTSD and other disorders in vets pose a serious threat to the country -- in other words they are societal wild cards, who can go ‘postal.’ There is no time limit on that because the re-adjustment is not occurring.
Hark back to the Vietnam era vets and their lifelong dysfunctionalities and you get the idea. Suicide rates in the military have not been so since that era. Naturally, this is not all vets, but in this war the proportions are as high or higher than other wars. In WWI, it was called Shellshock. This human breaking point was studied at Tavistock Institute, who then turned their psychological warfare on the public in a 60 year propaganda, psyops, media blitz and psychiatric warfare campaign we can call “the Long Crisis,” much of which is socially engineered.It is the thinktank of the global War Machine.
It is a very deep issue. It is like all these vets went through the breaking down portion of brainwashing and are still unglued. The complication is that only those of similar experience can be trusted, so 'talk therapy' is limited and useless done by those who don't know the blunt experience or war, firsthand. You see how our friend reacted when asked to talk about his experiences. It is like saying 'have a hypnotic regression NOW' and they are back 'in it', immersed in toxic traumatic memories. They don't want to think about or discuss it, yet are compelled to do so internally -- physiologically always on Red Alert.
I have some therapeutic processes that do NOT use the historical or realtime dimension, but work through metaphor. It helps clients move from the 'storm' to a calmer place, but without regressing them BACK into the situation. I think you've seen enough colleagues in this state to realize what I am saying and why normal 'adjustment' therapies and talk are just too mild. One has to help them rebuild and mend their personality from the ground up.
Further, there is tremendous shame associated by themselves and the military for being in this state. Also, this extends to their collective, and their relationship with society. No one likes to think that 'something is profoundly wrong with me.' And asking for help is taboo and compounds the shame professionally, at home and at large.
These are just a few of the immediate challenges. Halfway houses may compound the sense of separation and isolation, most wanting to return home. The former are usually used for addiction behavior, so there is the implication. Shall we call it "Addicted to War"?
We take our best and brightest and impose this on them instead of finding other solutions to our cultural greed to consume a disproportionate amount of the global resources. The least we can do is commit to healing them once we've assured the rest of their lives will be disrupted. You know I have personally dealt with those of Vietnam era in extreme cases where only their high character has saved them -- from headhunter assassins to 'normal' troops.
If someone in our group has a viable treatment option, I would sure like to hear it, because as usual I am skeptical of half measures. Further, who is supposed to PAY for this treatment, which is not brief and likely will not come to any form of therapeutic 'closure.'
Where are the clinical directors and large numbers of available suicide prevention experts for such a program, which is tough duty in itself. Much more that halfway houses and halfway measures are required. Who among us has any expertise in the treatment end? And what are they thinking regarding actual treatment? What is the method of changing the toxic internal dialogue? How can we translate what we know about ‘ordinary’ PTSD to the extreme and recurrent issue of the battle arena? What can we do when soliders bring the battle home?
When You Can’t Just Stop
What happens when you can’t help yourself, can’t stop the racing thoughts and psychphysical symptoms of fight/flight that accompany them? What happens when there is no “escape” from compulsive thoughts and alienation? What happens when suicide seems the only possible release? What is the remedy for such a Dark Night of the Soul, not just behaviorally but spiritually? PTSD is a disorder of the soul as well as of the mind. What happens when the life-giving magic is sucked out of a person by harsh realities too overwhelming to deal with? What could possibly be a creative solution to such misery?
The concept of the internal dialogue is only of use to us by stopping it. The issue isn't whether violence is caused by the internal dialogue, but the fact that we are mesmerized by the internal dialogue. Stilling the internal dialogue leads us into a separate reality.
Stopping the internal dialogue is much more powerful than a mantra, which is a lame way of doing the same thing which can become a mesmerizing distraction. The way of the hunter is to focus silently on the second attention without the distraction of the internal dialogue leading us back into the merry-go-round of uncontrolled folly.
PTSD Culture - We are All shellshocked by Shock Doctrine What is Shellshock?
Post-traumatic stress is a disorder, that automatically implies a chaotic state of being. The experiences that tend to induce PTSD include combat trauma, crimes, rape, grief, kidnapping, natural disasters, accidents, torture, and imprisonment. Predisposition to dissociation can arise in violent family environments.
Those with PTSD become hypervigilant and hyperreactive to environmental threat, real or imagined. The frozen traumatic syndrome is ever present and unchanging. Emotionally, it is as if it keeps on happenING. State-related learning and memory encoding help maintain the trance-like steady state. Depression, shame, anxiety, substance abuse, over-medication and survivor guilt are complications.
The nucleus of the disorder is a physioneurosis, somatization, depersonalization, and dissociation. Psychosomatic symptoms are expressions of the dissociation. Therapy proceeds by facilitating information transduction between them. Sufferers exhibit poor impulse control and explosive aggressive reactions. There are persistent and profound alterations in stress hormone secretions and immune function.
Therefore, PTSD is a toxic biochemical cascade that prevents homeostasis or recalibration of the whole person. They cannot “stand down.” Integration of traumatic memories proceeds by verbal and nonverbal means in therapy. However, time does not heal all wounds.
Different treatments are needed at different stages of posttraumatic adaptation. Consciousness restructuring offers a way of restructuring the frozen structure of this disorder at the most fundamental level, in the sensory terms in which it is encoded. The healing processing and imagery must come from within the individual, not be imposed or mandated from without.
PART II: WHAT IS POSTTRAUMATIC STRESS DISORDER?
The development of a chronic trauma-based disorder is qualitatively different from simple exaggeration of the normal stress response. In those affected, a cascade of biobehavioral changes leads far beyond simple conditioning. Symptoms are intrusive and lead to hyperarousal and/or avoidant behavior. Frightening and vivid flashbacks are the most striking phenomenon. Prime victimization comes from memories of the event, rather than simply the event itself. Development of PTSD depends on personality and genetic make up, and on whether or not the trauma was expected. Prolonged exposure to severe trauma may cause permanent psychological scars.
Dissociation at the moment of the trauma has been shown to be an important factor in developing full-blown PTSD. Therefore, adults with a predisposition from childhood in chaotic, threatening, sexually abusive or violent families are at greater risk. Dissociation is characterized by feelings of detachment, estrangement, depersonalization, an unusual sense of one’s own reality, being an outside observer of one’s own actions and body, feeling like an automaton, or as if in a dream. Ability to feel emotions of any type, (especially those associated with intimacy, tenderness, sexuality), is markedly decreased, as is ability to express angry feelings. Attacks appear like a psychological seige, therefore “bunkering” mentality prevails.
Flashbacks can be triggered by overreactions to sounds, smells, feelings, or images. During the flashback, the person relives the traumatic event and may completely lose touch with reality, suffering through the trauma for minutes or hours at a time, believing that it is actually happening all over again. There is activation of sensory areas of the brain during flashbacks, right-hemispheric activation, and limbic-system activation.
The psychological function of emotions is to alert us to pay attention to what is happening, so that we can take adaptive action. Generally, we stop having an emotional response when we have realigned our expectations of what is supposed to happen with what is actually happening. We either take action that adjusts the given situation to our expectations, or change our expectations to fit better with what is actually going on.
But in PTSD, emotional arousal and goal-directed action are disconnected from one another because of emotional numbing. Arousal is no longer a cue to pay attention to incoming information. There is no gap between stimulus and response with fight-flight reactions. They either freeze or overreact. The emotions of fear, terror, and helplessness characterize any traumatic event, and avoidance of these feelings would seem to be the result, but chronic reenactment of the damaging event is compulsive.
Those with PTSD are more sensitive to sound intensities than average. They are “reducers” in whom inhibitory feedback loops are activated to dampen a tonic state of hyperarousal. They have difficulty neutralizing stimuli in the environment in order to attend to relevant tasks. To compensate, they tend to shut down, which of course means decreased involvement in ordinary, everyday life. Rather than reacting to the daily environment flexibly, they react to internal stimuli that are irrelevant to current demands.
Trauma effects the hormones of both brain and body creating more psychophysical stress.
Intense distress is accompanied by release of stress-responsive neurohormones which seek to mobilize the energy required to deal with the stress. Chronic and persistent stress inhibits the effectiveness of the stress response and produces desensitization and sleep disturbances combined with hypervigilance.
Time does not heal all wounds. Therapy allows an inner search for healing alternatives within the “deeper” state-dependent psychobiological levels until the sought-for structure is transduced into the verbal level and emerges as a new psychophysical form. The recursive process which manifests in flashbacks and immersive rumination is facilitated, unblocked, and allowed to flow to its healing conclusion. This creates a shift in recurrent intrusive recollections and in recurrent distressing dreams and nightmares.
CRP helps probe into the state-dependent patterns of physiology, memory, and learning that have been encoded during circumstances of stress-released epinephrine by the autonomic nervous system and related responses by the endocrine and neuropeptide systems, and their related existential meanings and sensory images. It provides a healthier means of dissociation and reiteration leading to creative self-organization.
DIAGNOSIS OF POSTTRAUMATIC STRESS DISORDER
The diagnostic criteria for PTSD are listed in the DSM IV:
A. The person has been exposed to a traumatic event in which both of the following were present:
(1) The person experienced, witnessed, or was confronted with an event or events that involved actual or threatened with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others.
(2) The person’s response involved intense fear, helplessness, or horror. Note: In children, this may be expressed instead by disorganized or agitated behavior.
B. The traumatic event is persistently reexperienced in one or more of these ways:
(1) Recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Note: in children, repetitive play may occur in which themes or aspects of the trauma are expressed.
(2) Recurrent distressing dreams of the event. Note: in children, there may be frightening dreams without recognizable content.
(3) Acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated). Note: in children trauma-specific reenactment may occur.
(4) Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
(5) Physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspects of the traumatic event.
C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following:
(1) Efforts to avoid thoughts, feelings, or conversations associated with the trauma.
(2) Efforts to avoid activities, places, or people that arouse recollections of the trauma.
(3) Inability to recall an important aspect of the trauma.
(4) Markedly diminished interest or participation in significant activities.
(5) Feeling of detachment or estrangement from others.
(6) Restricted range of affect (e.g. unable to have loving feelings).
(7) Sense of foreshortened future (e.g. does not expect to have a career, marriage, children, or normal life span).
D. Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following:
(1) Difficulty falling or staying asleep.
(2) Irritability or outbursts of anger.
(3) Difficulty concentrating.
(4) Hypervigilance.
(5) Exaggerated startle response.
WHAT CAUSES POSTTRAUMATIC STRESS DISORDER?
Any overwhelmingly stressful life situation (surgery, war, natural disaster, robbery, traumatic bereavement, torture, physical battery, accident, rape, malnutrition, etc.) that stimulates excessive arousal by the autonomic and endocrine systems can lead to the symptomology of post-traumatic stress. State-dependent memory, learning, and behavior (SDMLB) is the essential feature of posttraumatic stress syndrome, and the many more subtle dysfunctions associated with it. Fear-conditioning and parasynaptic cellular modulation mediates SDMLB, (Rossi, 1986).
PTSD seems to be the basic process underlying Freud’s original concept of the “traumatic neurosis” as the organic basis of psychopathology. Therefore, the entire history of depth psychology and psychotherapy can now be understood as a prolonged clinical observation of how dissociated or state-dependent memories remain active at unconscious levels, giving rise to “complexes.” These complexes are the source of psychological and psychosomatic problems.
Trauma affects our capacity to regulate bodily homeostatsis. Even years after the trauma has ceased, memories continue to dominate people’s perceptions, and affect capacity to think and make sense out of current experience. Psychological interventions can only effect the degree of reversal of a disorder with such strong biological underpinnings.
Healing those who develop PTSD in the aftermath of overwhelming experience is a complex process, whose dynamics cannot be described like a cookbook recipe--it requires tremendous sensitivity and intuition. Reestablishing a sense of personal safety and equilibrium is a primary goal of all treatment, and this happens within the therapeutic alliance.
Recognition of each person’s unique situation and reactions is paramount. It is critical that the therapist continue to take stock of the safety of the relationship and progress in achieving therapeutic goals. Participants are encouraged to make meaning of their life experiences when they feel personally supported by their therapists. A primary goal is to not retraumatize the person with therapies that force them to relive the original trauma in historical, rather than metaphorical or sensory terms, or compound the episodes with fallacious material.
Because traumatic memories are stored in state-dependent fashion, they are often rendered inaccessible to verbal recall for prolonged periods of time. Because memories are dissociated, they are stored outside of ordinary awareness, and expressed in incomprehensible symptoms as physical ailments, behavioral reenactments, and vivid sensory reliving experiences. Reenactment of the trauma in personal and social relationships is a major source of shame for the victims and is a source of ongoing tragedy.
Constricted ego functioning is a feature of all traumatized individuals. It is even more complex when traumatization comes in childhood, because trauma early in the life cycle fundamentally affects maturation of systems in charge of regulating psychological and biological processes. It can result in lack of emotional control, destructuve behavior against self and others (or animals), brutality (victim/victimizer), learning disabilities, somatization, dissociative problems, and distortions in concepts about self and others.
Reaction to trauma is a process of adaptation over time. In Chaos Theory, attractors describe the characteristic behavior of a dynamical system changing over time. Traumatic events, especially chronic events, act as “strange attractors” in consciousness which keep everything in their orbit, cycling wildly, unpredictably, but within the parameters of the attractor, reiterating the same cues over and over. Memories are embedded in all layers of psychophysical self in, what is known in Chaos Theory, as infinite nesting.
Psychological siege describes the dominance of trauma in memory and its crucial maintenance over time. The feeling of being constantly beseiged or barraged leads to a bunkering mentality which may be acted out, particularly in combat veterans. Over time some people’s PTSD may become subclinical, and yet it may continue to influence their level of functioning.
PTSD is the result of complex interrelationships among psychological, biological, and social processes--one that varies depending on the maturational level of the victim, as well as the length of time for which the person was exposed to the trauma, and the source of the trauma. Central to understanding these processes is awareness of the nature of traumatic memory and its biological substrates that lead to the dominance of the trauma in memory and to its maintenance over time.
Social cues are important for recovery -- whether people are encouraged to attend to their pain and learn from the past or cultivate a “stiff upper lip,” suppressing the profound meaning of their experience. There is often resistance to acknowledging the trauma or depth of its impact. Reality can profoundly and permanently alter people’s psychology and biology. Individuals make a choice whether to examine their reactions to the trauma in order to overcome it, or ignore it and try to go on with their lives. There is a range of reactions from acute trauma to long-term outcome.
The inner structure of the disorder overlaps catagories of dissociative disorder and stress responses. Adjustment disorder, grief reactions, and a variety of characterological adaptations are germaine. The interaction between external events and subjective response can vary widely, even among victims of the same trauma, based on internal processing and approach to life in general.
Predisposition and vulnerability reflect on recovery from acute symptomology and long-term resilience. Critical issues include the emergence of chronic patterns of adaptation, in which lack of involvement in current reality, rather than preoccupation with the past are the most pathological features.
The ways people view themselves and their world can be compounded by a host of self-destructive behaviors (e.g. suicide attempts, self-multilation, and eating disorders). Complexity of adaptation includes both hormonal and autonomic nervous system dimensions. This includes unusual patterns of cortisol, norepinepherine, and dopamine metabolite excretion; the role of serotonergic and opioid systems (arousal and numbing); receptor modification by processes such as kindling; and involvement of central pathways involved in the integration of perception, memory and arousal.
Traumatic memories are qualitatively different from memories of ordinary events, in that amnesia co-exists with vivid recollections. Information processing and dissociation affect a person’s ability to perceive and integrate overwhelming experiences. Dissociative fragmentation of the self is common, leading to shattered psyches and lives.
Trauma is particularly devastating in childhood, including traumatic bereavement. Because of their dependence on caregivers, their incomplete biological development, and immature self-concepts and concepts of surroundings, children have unique patterns of reaction and needs for intervention. Although they may suffer from subclinical PTSD in middle age, memories recur and come to dominate their lives as seniors. There is generally greater lack of flexibility or capacity to repair damage with increasing age.
CONVENTIONAL TREATMENT OF PTSD
In actual practice, most clinicians use an eclectic approach, in which we must constantly reevaluate what is being accomplished. The core symptoms of PTSD (including paranoia, intrusions, numbing, and hyperarousal), occupational disabilities, dissociative phenomena, and interpersonal problems and alienation may all need widely different approaches. Treatment, therefore, depends in large part on clinical judgement.
In order to respond to current life and reach their fullest potential, people need to regain control over their emotional responses. It helps to place the trauma in the larger perspective of their lives--as a historical event (or series of events), that occurred at a particular time in a particular place, and that can be expected not to recur if the traumatized individuals take charge of their lives.
The key element is integration of the alien, the unacceptable, the terrifying, and the incomprehensible; the trauma must come to be “personalized” as an integrated aspect of one’s personal history. The therapeutic relationship is the cornerstone of effective treatment.
Critical incident stress debriefing has been proposed as a way of modifying the stress reactions of emergency service workers. Acute stress reactions, with the absence of stable symptom patterns and extreme degrees of physiological hyperarousal at this stage mean that there are unique problems in the treatment of this group.
Traumatized people with high levels of avoidance are often most reluctant to expose themselves to their traumatic memories, even when they seek help. Systematic desensitization and Eye Movement Desensitization and Reprocessing (EMDR) have been applied with limited results. Any positive results with EMDR probably come from mimicing the REM state.
Representations of trauma are more complex than roles like “perpetrator,” and “victim”. They are embedded in numerous affect states, defenses, object relations, and deep meaning configurations. Pertinent to these are subjective decision points in which critical self-judgements are embedded.
They include insufficient anticipation of danger, naive trust, impossible choices, guilt and shame, and terror at revealing the content of the traumatic experience to someone new. Other elements include temporally continguous ego states, such as splitting, denial, and dissociation, coupled with temporally contiguous fantasy states, such as murderous vengeance and wishes to die. Intrusions can also remind the person of moments of fantasied safety within the trauma.
The conventional view is that hyperarousal, sleep disturbances, and embeddedness of the trauma makes effective pharmacological treatment essential. Whether antidepressant, antianxiety, or sleeping medications are prescribed or not, dealing with traumatized people requires a staged process of treatment that is responsive to how much the victim can tolerate. Here again, the specific nature of the therapeutic relationship is a critical variable in outcome.
PTSD plays a role in the dysregulation of neurohormones and their roles in the stress response. Intense stress is accompanied by the release of endogenous, stress-responsive neurohormones, such as the catecholamines (including epinephrine and norepinephrine), serotonin, hormones of the hypothalamic-pituitary-adrenal (HPA) axis (including cortisol and other glucocorticoids, vasopressin, oxytocin), and endogenos opioids. These stress hormones help us mobilize energy required to deal with emergency stress by increasing glucose release for quick energy and enhancing immune function. Chronic stress inhibits their effectively and induces desensitization.
Drug therapy for PTSD is based on several biological models and has a few different purposes, (which also can be met with CRP’s intregrative approach). (1). Noradrenergic dysregulation is treated with MAO inhibitors, tricyclic antidepressants, beta-adrenergic blockers and benzodiazepines to calm the body’s alarm center. (2). Serotonergic dysfunction is treated with antidepressant SSRIs to regulate stress resilience, sleep, and for impulse control. (3). Anti-kindling drugs, such as carbamazepine, allegedly regulate an excitability threshold that has been lowered. (4). Anxiolytic drugs, such as clonazepam and buspirone are given in an attempt to reduce the startle response, which is one of the most persistent symptoms of PTSD.
The principle goals of using medication in PTSD are as follows:
1. Reduction of frequency and/or severity of intrusive symptoms.
2. Reduction in the tendency to interpret incoming stimuli as recurrences of the trauma.
3. Reduction in conditioned hyperarousal to stimuli reminiscent of the trauma, as well as in generalized hyperarousal.
4. Reduction in avoidant behavior.
5. Improvement in depressed mood and numbing.
6. Reduction in psychotic or dissociative symptoms.
7. Reduction of impulsive aggression against self and others. (Davidson, van der Kolk).
Intrusion is the active force creating anxiety.
Psychiatrist Mardi Horowitz catalogued these intrusions, and Goleman lists them in Vital Lies, Simple Truths (1985). They refer to unbidden ideas and pangs of feeling which are difficult to dispel, and of direct or symbiotic behavioral reinactments of the stress event. They are unbidden thoughts and feelings impinging on awareness. Every variety of intrusion is some aspect of the stress response taken to an extreme. They include the following:
* Pangs of emotion, waves of feeling that well up and subside rather than being a prevailing mood;
* Preoccupation and rumination, a continued awareness of the stressful event that
recurs uncontrollably, beyond the bounds of ordinary thinking through of a problem;
* Intrusive ideas, sudden, unbidden thoughts that have nothing to do with the mental task at hand;
* Persistent thoughts and feelings, emotions or ideas which the person cannot stop once they start;
* Hypervigilance, excessive alertness, scanning and searching with a tense expectancy;
* Insomnia, intrusive ideas and images that disturb sleep;
* Bad dreams, including nightmares and anxious awakening, as well as any upsetting dream. The bad dream does not necessarily have any overt content related to a real event.
* Unbidden sensations, the sudden, unwanted entry into awareness of sensations that are unusually intense or are unrelated to the situation at the moment.
* Startle reactions, flinching or blanching in response to stimuli that typically do not warrant such reactions.
Anxiety swamps attention; denial can erase anxiety. The forms of denial include:
* Avoided associations, short-circuiting expected, obvious connections to the event that would follow from the implications of what is said or thought.
* Numbness, the sense of not having feelings, appropriate emotions that go unfelt.
* Flattened response, a constriction of expectable emotional reactions.
* Dimming of attention, vagueness or avoidance of focusing clearly on information, including thoughts, feelings, and physical sensations.
* Daze, defocused attention that clouds alertness and avoids the significance of events.
* Constricted thought, the failure to explore likely avenues of meaning other than the obvious one at hand; an abbreviated range of flexibility.
* Memory failure, an inability to recall events or their details, a selective amnesia for telling facts.
* Disavowal, saying or thinking that obvious meanings are not so.
* Blocking through fantasy, avoiding reality or its implications by fanciful thoughts of might have been or could be.
The operative principle that unites these forms of denial is that they are all ways of blanking from awareness a troubling fact. These tactics are countermoves to the intrusions listed previously. Denial and intrusion are two sides of attention, the one an avoidance, the other an invasion.
Self-deception involves forgetting and forgetting we have forgotten. Repression creates no trace when it is in progress--it is the sound of a thought evaporating.
There are secrets we keep even from ourselves. They are retrievable only under the most extraordinary circumstances, since the essence of repression lies simply in the function of rejecting and keeping something out of consciousness. It suppresses the single class of items which evoke psychological pain. This fear-based pain can be of many varieties: trauma, “intolerable ideas,” unbearable feeling, anxiety, guilt, shame, etc.
Repression lessens mental pain by creating a blind spot as does its cousin denial. It protects a core of forbidden information. The nearer to that core one probes the greater the resistance. The deepest schemas encode the most painful memories, and are the hardest to activate.
Defensive postures include:
* Repression. Forgetting and forgetting one has forgotten.
* Denial and Reversal. What is so is not the case; the opposite is the case.
* Projection. What is inside is cast outside.
* Isolation. Events without feelings.
* Rationalization. I give myself a cover story.
* Sublimation. Replacing the threatening with the safe.
* Selective inattention. I don’t see what I don’t like.
* Automatism. I don’t notice what I do.
REFERENCES
American Psychological Assn., DSM IV
Blackmore, Susan, The Meme Machine, Oxford Univ. Press, 1999.
Brodie, Richard, Virus of the Mind, Integral Press, 1995.
Goleman, Daniel, Vital Lies, Simple Truths: The Psychology of Self Deception, Simon and Schuster, New York, 1985.
Lynch, Aaron, Thought Contagion, Basic Books, 1996.
Rossi, Ernest, Psychobiology of Mind-Body Healing, W.W. Norton & Co., Inc., New York, 1986.
Rossi, Ernest and Cheek, David B., Mind-Body Therapy, W.W. Norton & Co., Inc. New York, 1988.
Swinney, Graywolf, Holographic Healing, Asklepia Pub., 1997.
Vallee, Jacque, Dimensions, Contemporary Books, Chicago, 1988.
van der Kolk, Bessel; McFarlane, Alexander; Weisaeth, Lars, Editors;Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body, and Society, Guilford Press, New York, 1996.
Wilson, John P. and Keane, Terence M., Editors, Assessing Psychological Trauma and PTSD, GuilfordNew York, 1997. Press
Jamail, Dahr, "Iraq War Veteran on a Mental-Health Mission" Truthout, Saturday 21 November 2009
Treatment Options
PTSD Full-Spectrum Treatment by Iona Miller, Asklepia Foundation, c2000
ABSTRACT: Posttraumatic stress is a disorder, and that implies automatically a chaotic state of being. The sorts of trauma that tend to induce PTSD include combat trauma, crimes, rape, grief, kidnapping, natural disasters, accidents, torture, and imprisonment. Predisposition to dissociation can arise in violent family environments. Those with PTSD become hypervigilant and hyperreactive to environmental threat. The traumatic syndrome is ever present and unchanged. Emotionally, it is as if it keeps on happening. State-related learning and memory encoding help maintain the trance-like steady state. Depression, shame, anxiety, substance abuse, and survivor guilt are complications.
The nucleus of the disorder is a physioneurosis, somatization, depersonalization, and dissociation. Psychosomatic symptoms are expressions of the dissociation. Therapy proceeds by facilitating information transduction between them. There is poor impulse control and explosive aggressive reactions. There are persistent and profound alterations in stress hormone secretions and immune function. Integration of traumatic memories proceeds by verbal and nonverbal means in therapy. Time does not heal all wounds. Different treatments are needed at different stages of posttraumatic adaptation. CRP offers a way of restructuring the frozen structure of this disorder at the most fundamental level, in the sensory terms in which it is encoded.
KEYWORDS: PTDS, consciousness, creativity, psychotherapy, mind/body healing, integrative therapy, dreams, dreamwork, flashbacks, dissociation, trauma, state-dependent learning and memory, hypervigilance, sleep disorders, Freud, chaos theory, adjustment disorder, hormones, neurotransmitters, paranoia, EMDR, SSRIs, antidepressants, intrusion, intruders, anxiety, self-deception, ufo abduction, abductees, memes, placebo effect, REM, Consciousness Restructuring Process.
WHAT IS POST-TRAUMATIC STRESS DISORDER?
The development of a chronic trauma-based disorder is qualitatively different from simple exaggeration of the normal stress response. In those affected, a cascade of biobehavioral changes leads far beyond simple conditioning. Symptoms are intrusive and lead to hyperarousal and/or avoidant behavior. Frightening and vivid flashbacks are the most striking phenomenon. Prime victimization comes from memories of the event, rather than simply the event itself. Development of PTSD depends on personality and genetic make up, and on whether or not the trauma was expected. Prolonged exposure to severe trauma may cause permanent psychological scars.
Dissociation at the moment of the trauma has been shown to be an important factor in developing full-blown PTSD. Therefore, adults with a predisposition from childhood in chaotic, threatening, sexually abusive or violent families are at greater risk. Dissociation is characterized by feelings of detachment, estrangement, depersonalization, an unusual sense of one’s own reality, being an outside observer of one’s own actions and body, feeling like an automaton, or as if in a dream.
Ability to feel emotions of any type, (especially those associated with intimacy, tenderness, sexuality), is markedly decreased, as is ability to express angry feelings. Attacks appear like a psychological seige, therefore “bunkering” mentality prevails. Flashbacks can be triggered by overreactions to sounds, smells, feelings, or images. During the flashback, the person relives the traumatic event and may completely lose touch with reality, suffering through the trauma for minutes or hours at a time, believing that it is actually happening all over again. There is activation of sensory areas of the brain during flashbacks, right-hemispheric activation, and limbic-system activation.
The psychological function of emotions is to alert us to pay attention to what is happening, so that we can take adaptive action. Generally, we stop having an emotional response when we have realigned our expectations of what is supposed to happen with what is actually happening. We either take action that adjusts the given situation to our expectations, or change our expectations to fit better with what is actually going on.
But in PTSD, emotional arousal and goal-directed action are disconnected from one another because of emotional numbing. Arousal is no longer a cue to pay attention to incoming information. There is no gap between stimulus and response with fight-flight reactions. They either freeze or overreact. The emotions of fear, terror, and helplessness characterize any traumatic event, and avoidance of these feelings would seem to be the result, but chronic reenactment of the damaging event is compulsive.
Those with PTSD are more sensitive to sound intensities than average. They are “reducers” in whom inhibitory feedback loops are activated to dampen a tonic state of hyperarousal. They have difficulty neutralizing stimuli in the environment in order to attend to relevant tasks. To compensate, they tend to shut down, which of course means decreased involvement in ordinary, everyday life. Rather than reacting to the daily environment flexibly, they react to internal stimuli that are irrelevant to current demands.
Trauma effects the hormones of both brain and body creating more psychophysical stress. Intense distress is accompanied by release of stress-responsive neurohormones which seek to mobilize the energy required to deal with the stress. Chronic and persistent stress inhibits the effectiveness of the stress response and produces desensitization and sleep disturbances combined with hypervigilance.
Time does not heal all wounds. Therapy allows an inner search for healing alternatives within the “deeper” state-dependent psychobiological levels until the sought-for structure is transduced into the verbal level and emerges as a new psychophysical form. The recursive process which manifests in flashbacks and immersive rumination is facilitated, unblocked, and allowed to flow to its healing conclusion. This creates a shift in recurrent intrusive recollections and in recurrent distressing dreams and nightmares.
CRP helps probe into the state-dependent patterns of physiology, memory, and learning that have been encoded during circumstances of stress-released epinephrine by the autonomic nervous system and related responses by the endocrine and neuropeptide systems, and their related existential meanings and sensory images. It provides a healthier means of dissociation and reiteration leading to creative self-organization.
DIAGNOSIS OF POSTTRAUMATIC STRESS DISORDER
The diagnostic criteria for PTSD are listed in the DSM IV: A. The person has been exposed to a traumatic event in which both of the following were present:
(1) The person experienced, witnessed, or was confronted with an event or events that involved actual or threatened with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others. (2) The person’s response involved intense fear, helplessness, or horror. Note: In children, this may be expressed instead by disorganized or agitated behavior. B. The traumatic event is persistently re-experienced in one or more of these ways:
(1) Recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Note: in children, repetitive play may occur in which themes or aspects of the trauma are expressed.
(2) Recurrent distressing dreams of the event. Note: in children, there may be frightening dreams without recognizable content.
(3) Acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated). Note: in children trauma-specific reenactment may occur.
(4) Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
(5) Physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspects of the traumatic event.
C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following:
(1) Efforts to avoid thoughts, feelings, or conversations associated with the trauma.
(2) Efforts to avoid activities, places, or people that arouse recollections of the trauma.
(3) Inability to recall an important aspect of the trauma.
(4) Markedly diminished interest or participation in significant activities.
(5) Feeling of detachment or estrangement from others.
(6) Restricted range of affect (e.g. unable to have loving feelings).
(7) Sense of foreshortened future (e.g. does not expect to have a career, marriage, children, or normal life span).
D. Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following:
(1) Difficulty falling or staying asleep.
(2) Irritability or outbursts of anger.
(3) Difficulty concentrating.
(4) Hypervigilance.
(5) Exaggerated startle response.
WHAT CAUSES POSTTRAUMATIC STRESS DISORDER?
Any overwhelmingly stressful life situation (surgery, war, natural disaster, robbery, traumatic bereavement, torture, physical battery, accident, rape, malnutrition, etc.) that stimulates excessive arousal by the autonomic and endocrine systems can lead to the symptomology of post-traumatic stress. State-dependent memory, learning, and behavior (SDMLB) is the essential feature of post-traumatic stress syndrome, and the many more subtle dysfunctions associated with it. Fear-conditioning and parasynaptic cellular modulation mediates SDMLB, (Rossi, 1986).
PTSD seems to be the basic process underlying Freud’s original concept of the “traumatic neurosis” as the organic basis of psychopathology. Therefore, the entire history of depth psychology and psychotherapy can now be understood as a prolonged clinical observation of how dissociated or state-dependent memories remain active at unconscious levels, giving rise to “complexes.” These complexes are the source of psychological and psychosomatic problems.
Trauma affects our capacity to regulate bodily homeostatsis. Even years after the trauma has ceased, memories continue to dominate people’s perceptions, and affect capacity to think and make sense out of current experience. Psychological interventions can only effect the degree of reversal of a disorder with such strong biological underpinnings.
Healing those who develop PTSD in the aftermath of overwhelming experience is a complex process, whose dynamics cannot be described like a cookbook recipe--it requires tremendous sensitivity and intuition. Reestablishing a sense of personal safety and equilibrium is a primary goal of all treatment, and this happens within the therapeutic alliance.
Recognition of each person’s unique situation and reactions is paramount. It is critical that the therapist continue to take stock of the safety of the relationship and progress in achieving therapeutic goals. Participants are encouraged to make meaning of their life experiences when they feel personally supported by their therapists. A primary goal is to not retraumatize the person with therapies that force them to relive the original trauma in historical, rather than metaphorical or sensory terms, or compound the episodes with fallacious material.
Because traumatic memories are stored in state-dependent fashion, they are often rendered inaccessible to verbal recall for prolonged periods of time. Because memories are dissociated, they are stored outside of ordinary awareness, and expressed in incomprehensible symptoms as physical ailments, behavioral reenactments, and vivid sensory reliving experiences. Reenactment of the trauma in personal and social relationships is a major source of shame for the victims and is a source of ongoing tragedy.
Constricted ego functioning is a feature of all traumatized individuals. It is even more complex when traumatization comes in childhood, because trauma early in the life cycle fundamentally affects maturation of systems in charge of regulating psychological and biological processes. It can result in lack of emotional control, destructuve behavior against self and others (or animals), brutality (victim/victimizer), learning disabilities, somatization, dissociative problems, and distortions in concepts about self and others.
Reaction to trauma is a process of adaptation over time. In Chaos Theory, attractors describe the characteristic behavior of a dynamical system changing over time. Traumatic events, especially chronic events, act as “strange attractors” in consciousness which keep everything in their orbit, cycling wildly, unpredictably, but within the parameters of the attractor, reiterating the same cues over and over. Memories are embedded in all layers of psychophysical self in, what is known in Chaos Theory, as infinite nesting.
Psychological siege describes the dominance of trauma in memory and its crucial maintenance over time. The feeling of being constantly beseiged or barraged leads to a bunkering mentality which may be acted out, particularly in combat veterans. Over time some people’s PTSD may become subclinical, and yet it may continue to influence their level of functioning.
PTSD is the result of complex interrelationships among psychological, biological, and social processes--one that varies depending on the maturational level of the victim, as well as the length of time for which the person was exposed to the trauma, and the source of the trauma. Central to understanding these processes is awareness of the nature of traumatic memory and its biological substrates that lead to the dominance of the trauma in memory and to its maintenance over time.
Social cues are important for recovery -- whether people are encouraged to attend to their pain and learn from the past or cultivate a “stiff upper lip,” suppressing the profound meaning of their experience. There is often resistance to acknowledging the trauma or depth of its impact. Reality can profoundly and permanently alter people’s psychology and biology. Individuals make a choice whether to examine their reactions to the trauma in order to overcome it, or ignore it and try to go on with their lives. There is a range of reactions from acute trauma to long-term outcome.
The inner structure of the disorder overlaps catagories of dissociative disorder and stress responses. Adjustment disorder, grief reactions, and a variety of characterological adaptations are germane. The interaction between external events and subjective response can vary widely, even among victims of the same trauma, based on internal processing and approach to life in general. Predisposition and vulnerability reflect on recovery from acute symptomology and long-term resilience. Critical issues include the emergence of chronic patterns of adaptation, in which lack of involvement in current reality, rather than preoccupation with the past are the most pathological features.
The ways people view themselves and their world can be compounded by a host of self-destructive behaviors (e.g. suicide attempts, self-mutilation, and eating disorders). Complexity of adaptation includes both hormonal and autonomic nervous system dimensions. This includes unusual patterns of cortisol, norepinepherine, and dopamine metabolite excretion; the role of serotonergic and opioid systems (arousal and numbing); receptor modification by processes such as kindling; and involvement of central pathways involved in the integration of perception, memory and arousal.
Traumatic memories are qualitatively different from memories of ordinary events, in that amnesia co-exists with vivid recollections. Information processing and dissociation affect a person’s ability to perceive and integrate overwhelming experiences. Dissociative fragmentation of the self is common, leading to shattered psyches and lives.
Trauma is particularly devastating in childhood, including traumatic bereavement. Because of their dependence on caregivers, their incomplete biological development, and immature self-concepts and concepts of surroundings, children have unique patterns of reaction and needs for intervention. Although they may suffer from subclinical PTSD in middle age, memories recur and come to dominate their lives as seniors. There is generally greater lack of flexibility or capacity to repair damage with increasing age.
CONVENTIONAL TREATMENT OF PTSD
In actual practice, most clinicians use an eclectic approach, in which we must constantly reevaluate what is being accomplished. The core symptoms of PTSD (including paranoia, intrusions, numbing, and hyperarousal), occupational disabilities, dissociative phenomena, and interpersonal problems and alienation may all need widely different approaches. Treatment, therefore, depends in large part on clinical judgement.
In order to respond to current life and reach their fullest potential, people need to regain control over their emotional responses. It helps to place the trauma in the larger perspective of their lives--as a historical event (or series of events), that occurred at a particular time in a particular place, and that can be expected not to recur if the traumatized individuals take charge of their lives.
The key element is integration of the alien, the unacceptable, the terrifying, and the incomprehensible; the trauma must come to be “personalized” as an integrated aspect of one’s personal history. The therapeutic relationship is the cornerstone of effective treatment.
Critical incident stress debriefing has been proposed as a way of modifying the stress reactions of emergency service workers. Acute stress reactions, with the absence of stable symptom patterns and extreme degrees of physiological hyperarousal at this stage mean that there are unique problems in the treatment of this group.
Traumatized people with high levels of avoidance are often most reluctant to expose themselves to their traumatic memories, even when they seek help. Systematic desensitization and Eye Movement Desensitization and Reprocessing (EMDR) have been applied with limited results. Any positive results with EMDR probably come from mimicing the REM state.
Representations of trauma are more complex than roles like “perpetrator,” and “victim”. They are embedded in numerous affect states, defenses, object relations, and deep meaning configurations. Pertinent to these are subjective decision points in which critical self-judgements are embedded. They include insufficient anticipation of danger, naive trust, impossible choices, guilt and shame, and terror at revealing the content of the traumatic experience to someone new. Other elements include temporally contiguous ego states, such as splitting, denial, and dissociation, coupled with temporally contiguous fantasy states, such as murderous vengeance and wishes to die. Intrusions can also remind the person of moments of fantasied safety within the trauma.
The conventional view is that hyperarousal, sleep disturbances, and embeddedness of the trauma makes effective pharmacological treatment essential. Whether antidepressant, antianxiety, or sleeping medications are prescribed or not, dealing with traumatized people requires a staged process of treatment that is responsive to how much the victim can tolerate. Here again, the specific nature of the therapeutic relationship is a critical variable in outcome.
PTSD plays a role in the dysregulation of neurohormones and their roles in the stress response. Intense stress is accompanied by the release of endogenous, stress-responsive neurohormones, such as the catecholamines (including epinephrine and norepinephrine), serotonin, hormones of the hypothalamic-pituitary-adrenal (HPA) axis (including cortisol and other glucocorticoids, vasopressin, oxytocin), and endogenous opioids. These stress hormones help us mobilize energy required to deal with emergency stress by increasing glucose release for quick energy and enhancing immune function. Chronic stress inhibits their effectively and induces desensitization.
Drug therapy for PTSD is based on several biological models and has a few different purposes, (which also can be met with CRP’s intregrative approach).
(1). Noradrenergic dysregulation is treated with MAO inhibitors, tricyclic antidepressants, beta-adrenergic blockers and benzodiazepines to calm the body’s alarm center.
(2). Serotonergic dysfunction is treated with antidepressant SSRIs to regulate stress resilience, sleep, and for impulse control.
(3). Anti-kindling drugs, such as carbamazepine, allegedly regulate an excitability threshold that has been lowered.
(4). Anxiolytic drugs, such as clonazepam and buspirone are given in an attempt to reduce the startle response, which is one of the most persistent symptoms of PTSD.
The principle goals of using medication in PTSD are as follows:
1. Reduction of frequency and/or severity of intrusive symptoms.
2. Reduction in the tendency to interpret incoming stimuli as recurrences of the trauma.
3. Reduction in conditioned hyperarousal to stimuli reminiscent of the trauma, as well as in generalized hyperarousal.
4. Reduction in avoidant behavior.
5. Improvement in depressed mood and numbing.
6. Reduction in psychotic or dissociative symptoms.
7. Reduction of impulsive aggression against self and others. (Davidson, van der Kolk). Intrusion is the active force creating anxiety. Psychiatrist Mardi Horowitz catalogued these intrusions, and Goleman lists them in Vital Lies, Simple Truths (1985). They refer to unbidden ideas and pangs of feeling which are difficult to dispel, and of direct or symbiotic behavioral reenactments of the stress event. They are unbidden thoughts and feelings impinging on awareness. Every variety of intrusion is some aspect of the stress response taken to an extreme. They include the following: * Pangs of emotion, waves of feeling that well up and subside rather than being a prevailing mood;
* Preoccupation and rumination, a continued awareness of the stressful event that
recurs uncontrollably, beyond the bounds of ordinary thinking through of a problem;
* Intrusive ideas, sudden, unbidden thoughts that have nothing to do with the mental task at hand;
* Persistent thoughts and feelings, emotions or ideas which the person cannot stop once they start;
* Hypervigilance, excessive alertness, scanning and searching with a tense expectancy;
* Insomnia, intrusive ideas and images that disturb sleep;
* Bad dreams, including nightmares and anxious awakening, as well as any upsetting dream. The bad dream does not necessarily have any overt content related to a real event.
* Unbidden sensations, the sudden, unwanted entry into awareness of sensations that are unusually intense or are unrelated to the situation at the moment.
* Startle reactions, flinching or blanching in response to stimuli that typically do not warrant such reactions.
Anxiety swamps attention; denial can erase anxiety. The forms of denial include:
* Avoided associations, short-circuiting expected, obvious connections to the event that would follow from the implications of what is said or thought.
* Numbness, the sense of not having feelings, appropriate emotions that go unfelt.
* Flattened response, a constriction of expectable emotional reactions.
* Dimming of attention, vagueness or avoidance of focusing clearly on information, including thoughts, feelings, and physical sensations.
* Daze, defocused attention that clouds alertness and avoids the significance of events.
* Constricted thought, the failure to explore likely avenues of meaning other than the obvious one at hand; an abbreviated range of flexibility.
* Memory failure, an inability to recall events or their details, a selective amnesia for telling facts.
* Disavowal, saying or thinking that obvious meanings are not so.
* Blocking through fantasy, avoiding reality or its implications by fanciful thoughts of might have been or could be. The operative principle that unites these forms of denial is that they are all ways of blanking from awareness a troubling fact. These tactics are countermoves to the intrusions listed previously. Denial and intrusion are two sides of attention, the one an avoidance, the other an invasion.
Self-deception involves forgetting and forgetting we have forgotten. Repression creates no trace when it is in progress--it is the sound of a thought evaporating. There are secrets we keep even from ourselves. They are retrievable only under the most extraordinary circumstances, since the essence of repression lies simply in the function of rejecting and keeping something out of consciousness. It suppresses the single class of items which evoke psychological pain. This fear-based pain can be of many varieties: trauma, “intolerable ideas,” unbearable feeling, anxiety, guilt, shame, etc.
Repression lessens mental pain by creating a blind spot as does its cousin denial. It protects a core of forbidden information. The nearer to that core one probes the greater the resistance. The deepest schemas encode the most painful memories, and are the hardest to activate.
Defensive postures include:
* Repression. Forgetting and forgetting one has forgotten.
* Denial and Reversal. What is so is not the case; the opposite is the case.
* Projection. What is inside is cast outside.
* Isolation. Events without feelings.
* Rationalization. I give myself a cover story.
* Sublimation. Replacing the threatening with the safe.
* Selective inattention. I don’t see what I don’t like.
* Automatism. I don’t notice what I do.
“ALIENATION”
PTSD AND CONSCIOUSNESS RESTRUCTURING
PTSD has turned out to be a very common disorder, since exposure to extreme stress is widespread and a large proportion of those exposed become symptomatic. A factor there may be predisposition from homelife in violent or sexually abusive families, or earlier experiences. Over 1 million U.S. teenagers suffer from PTSD; 76 percent of American adults report exposure to extreme stress, and perhaps 10% suffer from PTSD; over 15% of Vietnam veterans continue to suffer PTSD for more than 20 years after the war.
Repeated replaying of upsetting memories serves the function of modifying the emotions associated with the trauma, and in most cases creates a tolerance for the content of the memories. However, those with PTSD begin organizing their lives around the trauma. The meaning they attach to the experience of extraordinary events is as fundamental as the trauma itself. PTSD is an emotional, behavioral, interpersonal, and spiritual disorder. But, the core issue in PTSD is that the primary symptoms are not symbolic, defensive, or driven by secondary gains. The core issue is the inability to integrate the reality of particular experiences, and the resulting repetitive replaying of the trauma in images, behaviors, feeling, physiological states, and interpersonal relationships. It is, therefore, critical to examine where they have become “stuck” (fixation on the trauma) and around which traumatic events they have built their psychic elaborations.
One way or another, the passage of time modifies how the brain processes trauma-related information. New organization of experiences is the result of iterative learning patterns, in which trauma-related memories become kindled, etching them more deeply and powerfully into the brain. These emotional memories are programmed to last forever. Experiences are initially imprinted as sensations or feeling states, and are not collated and transcribed into personal narratives. Traumatic memories come back as emotional and sensory states with little verbal representation. There is texture to the response.
Time does not positively modify memories in PTSD; the full brunt does not fade with time, as in normal transformation. Adaptation is more complex; the body keeps the score. Stress-induced serotonin dysfunction may lead to impaired functioning of the behavioral inhibition system, leading to behavioral problems including impulsivity, aggression and brutality, compulsive reenactment, and inability to learn from past mistakes.
Traumatic experiences change the way the brain and body work; and so can each therapeutic session which can be just as powerful in the healing direction, creating immediate, discrete changes in psychophysiology. Much depends on whether clients want to know “what happened” or “to heal.” Knowing, or reliving what happened is often unessential and many times would be retraumatizing and terrifying.
If we view trauma as a dimensional continuum over time, the splitting occurs at the point of “T minus 1,” leading to dissociation of part of consciousness just prior to the worst part of the event. This split off, or frozen, or stuck consciousness needs to find a way to move forward through the event with the assurance that it survived and is now all right, so it can rejoin the holistic flow of consciousness.
This integrative therapy is most successfully done in a dimension other than historical time, such as metaphor or imagery originating with the client, rather than imported metaphors from the therapist. It can also be done in sensory channels. As the story progresses, things get “worse” before they get better and then healing resolution comes and new resources and adjustments come along with it.
Because of the severity of their wounding, PTSD clients are vulnerable to therapeutic exploitation by either unscrupulous or poorly-trained therapists. Because they are shut-down and intimacy is a primary issue, the safety of the therapeutic relationship, and the broader nature of that relationship are crucial if any healing is to take place.
Prospective participants may have to struggle with their need for help, acknowledging dependence, grief, humiliation, and helplessness, as well as overcoming fears of confronting their shame and pain. Shame-based behavior may be amplified by substance abuse and survivor guilt. Other syndromes like major depressive syndrome, personality disorders, paranoid ideation and dissociative disorder can compound the situation.
Therapists, on the other hand, must cope with the horrendous experiences that can befall people and the inescapable truth that reality can damage their fundamental existential sense of safety and trust. The therapists must walk a fine line, intuitively determining when to help the client integrate and recall the traumatic memories, and when to help the person create distance from them and promote functionality. We cannot assume that the primary trauma we are aware of is the only one that affects current symptoms.
Therefore, different therapeutic procedures are helpful at different stages of treatment. These protocols are not only not standardized, they are virtually non-existent, leaving these people at the mercy of practitioners who want to experiment on them with practices that may or may not be germaine to their healing and adaptation.
In terms of information processing, there are six issues which effect those exhibiting PTSD: (1) persistent intrusions of memories related to the trauma interfering with other incoming information; (2) compulsive exposure to situations reminiscent of the trauma; (3) active avoidance of specific triggers of trauma-related emotions, and generalized numbing; (4) loss of modulation of physiological responses to stress in general and capacity to use body signals as guides for action; (5) generalized problems with attention, distractability, and stimulus discrimination; and (6) alteration in psychological defense mechanism and in personal identity. All these factors filter what new information is selected as relevant. One particular event can activate other, long-forgotten memories of previous traumas, creating a “domino effect.”
Based on criterion formulated for drug treatment of PTSD, we can assume that psychotherapy would have the complementary goals of (1) reduction of intrusive reexperiencing; (2) reduction in the tendency to interpret incoming stimuli as recurrences of the trauma; (3) reduction in conditioned and generalized hyperarousal; (4) reduction in avoidance behavior; (5) improvement in depression and numbing, (6) reduction in dissociative or psychotic symptoms, and (7) reduction of impulsive aggression against self and others.
Effective treatment needs to resolve the spectrum of symptoms, including intrusions, compulsive reexposure, avoidance and numbing, hyperarousal, problems with attention, distractability, stimulus discrimination, altered perceptions of self and others, dissociation and somatization.
We cannot assume that a traumatic situation is amenable to interpretive reconstructive or insight-promoting work at the time we may feel ready to dispense it. However, keeping a watchful eye out for the complex ways in which the trauma may be repeating itself in the present, both in the transference and in the countertransference, may be useful.
The primary presenting imagery is of disintegration, confusion, alienation, and despair. Fixation on the event(s) feels like being pulled into a Black Hole of trauma. People may experience sensory elements of the trauma without being able to make sense out of what they are feeling or seeing. CRP facilitates the direction of their own self-healing call. Verbalizing plays a critical role in reestablishing physical and psychological health.
Exploring the personal meaning of the trauma is critical, since no one can undo their past. Personal attributions, and feelings of guilt in causing (or at least not preventing) the incidents affect whether they see themselves as capable or worthy of having restorative experiences, and whether they consider themselves capable of being entrusted with responsibility, intimacy, and care.
CRP allows them to move further into dark gloomy voids, to go ahead and disintegrate and see what happens when they let those compelling images play out in the therapeutic setting. The call to heal and the call to death are the same call to formlessness and creative restructuring, but the process has gotten stuck at the point of fragmentation. The self is shattered. Shame is the emotion related to having let oneself down.
It would be an error to think of detachment and withdrawl in PTSD as merely a psychodynamic phenomenon, or as a deficit of certain neurotransmitter supplements. Chronic hyperarousal depletes both the biological and psychological resources needed to experience a wide variety of emotions. Over time there are changes in the CNS which are similar to the effects of prolonged sensory deprivation.
“Healing” does not necessarily mean a cure nor total elimination of all symptoms. It has to do with a subjective process, difficult to describe because it is non-linear, reflects a multi-leveled psychic disorder which carries and stores meaning in biological forms. Yet this syndrome is linked to a timeless and universal experience of healing, in which recurrent dreams and nightmares play a fundamental role.
What are symptoms, dreams, and chronic reliving of the event trying to tell the person who is affected? The meaning of those overwhelming experiences -- their total significance -- is contained and expressed in psychobiological forms which have outlived their adaptive usefulness. The structures can dissolve as they transform from corporeal to verbal form. Traumatic memory gradually becomes narrative memory.
Inchoate sensations and dysphoric affect, complete with the emergency defenses used at the time (e.g. dissociation, splitting, or disavowal), come to be personal stories of tragedy, trauma, and loss. These stories embody tremendous significance for the past, present, and future. Therapy helps the survivor find words to express nuances of subjective meaning in an empathic context, reorganizing everyday experience for traumatized individuals.
Most participants have created a personal myth or framework about their experience, but this story generally is not encompassing enough to initiate healing. The story needs amplification, and the healing comes in filling in the blanks and in the telling and re-telling of the personal tragedy. The task of the therapist is to instill confidence and create an intimacy with the client so the person can begin to believe that they will improve.
The placebo effect is the therapist’s greatest tool in this regard. It is a gift of nature, and our nature, that this phenomenon exists, and it is neither purposeless nor a coincidence that it crops up in all healing attempts and modalities. It can be purposefully deployed, rather than being viewed as a troublesome interloper in treatment.
“The power of the placebo effect is one of the ironies that have to be dealt with in the desire to prove the effectiveness of new treatments. In drug studies, up to 40% of subjects may be placebo responders. This means that there has to be a powerful therepeutic effect before a treatment is of proven benefit, and that the placebo effect is actually one of the most powerful treatments in the therapeutic arsenal. It is important not to scoff at the placebo response, but rather to maximize its potential and usefulness. It is possible that the strength of the placebo response accounts for the power of some of the less conventional forms of psychotherapy. The conviction with which these forms are practiced may maximize people’s natural capacity for healing.” (Turner, McFarlane, van der Kolk, 1996).
So, the therapist should invoke the placebo response. But just as importantly, retraumatizing the participant with historical reliving of the trauma is to be absolutely avoided. Incorporation of missing time or memories through regression is contra-indicated. This can lead to avoidance and alienation, and reinforces the sense of threat. New explorations can be done in less-harmful dimensions which lead to a greater sense of self, rather than withdrawl into self or away from therapeutic interaction.
The incorporation can take place through metaphorical and sensory channels, rather than in the time dimension of historical regression, and this allows the frozen, stuck or traumatized energy to dissolve and flow into the whole, becoming part of the holistic consciousness restructuring. In this process dissociated and repressed material is automatically included. Interpretations should be avoided, although re-framing of experiences may be helpful if a prospective outlook is fostered. Helping the person find their own internal funding and resources is the most helpful approach.
Inappropriate cues and guided imagery for reliving trauma may create false memories through suggestion. The “change history” process and hypnotic “re-frame” of Neuro-linguistic Programming (NLP) work on the principle of imagining things differently. However, these techniques don’t restructure at the deepest psychophysiological level.
Change history is actually an invitation to use imagination and confabulation to fantasize a different reality. Unfortunately, PTSD victims know their body is telling them history hasn’t changed. For them, its still happening. False memories are often created by combining actual memories with suggestions received from others. They can be induced when a person is encouraged to imagine experiencing specific events without worrying about whether they really happened or not.
Suggestion and imagination can create “memories” of events that did not actually occur. Needless to say, this is a diservice to the participant, rather than a therapeutic step forward, and may be construed later as yet another form of victimization. Research has shown that corroboration of an event by another person can be a powerful technique for instilling a false memory. In fact, merely claiming to have seen a person do something can lead that person to make a false confession of wrongdoing.
“Research has helped us understand how false memories of complete, emotional and self-participatory experiences are created in adults. First, there are social and therapeutic demands on individuals to remember, to come up with memories. Second, memory construction by imagining events can be explicitly encouraged when people are having trouble remembering.
And, finally, individuals can be encouraged not to think about whether their constructions are real or not. Creation of false memories is most likely to occur when these external factors are present, whether in an experimental setting, in a therapeutic setting, or during everyday activities. False memories are constructed by combining actual memories with content of suggestions received from others. This is a classical example of source confusion, in which the content and the source become dissociated.” (Loftus, 1977).
It is important to heed the cautionary tale in this data: mental health professionals and others must be aware of how greatly they can influence the recollection of events and of the urgent need for maintaining restraint in situations in which imagination is used as an aid in recovering presumably lost memories.
CRP restructuring changes the physiological responses which affects the psyche, and the new psychic outlook feeds back new signals to the body. These are all parts of “completing the story” with its intrinsic meaning, and facilitating its healing goal. The therapist needs to respect the need to keep traumatic details of memories away from consciousness, remembering that these memories are state-bound. He or she must help the survivor differentiate them while providing hope and meaning that the goals are worth the pain of pursuing them.
There are a few technical principles established in conventional PTSD therapy which can act as guidelines for the practitioner:
1. Trauma reconstruction should occur when intrusive rather than numbing aspects of the PTSD are present.
2. Under ideal circumstances, the alliance should be strong and the general transference positive; the intrusion should be limited and should be occurring in the context of a generally improving clinical condition.
3. However, when the therapist is faced with a rapidly deteriorating clinical situation in which there is a significant negative component to the transference, reconstruction of trauma can provide a new temporary structure around which ego functions can be consolidated rather than fragmented and an alliance has the opportunity to develop. (Lindy, 1996).
There are some central points in the question of how to reconstruct trauma:
1. It is the therapist’s task to keep as empathically in contact with the patient in the here and now as possible, including strong feelings directed toward the place or person of the therapist.
2. The therapist, through introspection, should use words to describe feelings in the here and now that can also be applied to the there and then of the trauma. However, it is the patient who should make the reconstruction of the memory, not the therapist.
3. Repetitions in the present, in which the therapist has struggled internally to find words that express anguished meaning, provide an open door for the survivor to find better words to describe his or her uniquely traumatizing events of the past. (Lindy, 1996).
Co-consciousness in the journey process creates an intimate non-verbal bond with the other person. Co-consciousness is an originally shamanic technique which has been incorporated into hypnotherapeutic practice. Shamanic techniques have proven particularly valuable in the treatment of PTSD, particularly with combat veterans. Group work is helpful because original traumas may have been group experiences. Drum-journeys, sweats, vision quest, and even sun-dancing have produced healing and spiritual connection. The nature of shared consciousness dynamics is complex.
One needs to learn by direct experience how to enter and maintain it. Milton Erickson, for example, noted that when he was in this co-consciousness state the information and stories just came to him intuitively from opening to the whole situation. He maintained this increased his therapeutic impact greatly. Abraham Maslow also identified this state, labeling it “trans-human.”
It is our contention that the placebo effect and spontaneous remission operate at the deepest level of enfoldment, before energy differentiates into psychic and somatic. Because it targets this deeper state of primal restructuring of energy, the CRP process offers several advantages over the placebo effect and some of the other healing practices. They include the following:
* A higher frequency of connection with mind/body dynamics than the placebo effect offers;
* The elimination of the dogma and superstition that permeate many shamanic, spiritual (and scientific/medical) approaches;
* The awareness and consciousness expansion for the client in directly experiencing these consciousness dynamics and processes;
* Development of, and familiarity with an inner creative process for problem solving and crisis resolution, and resultant lifestyle changes;
* The client is empowered by the process and experiences the healing dynamics as self and internally generated rather than other-generated and externally imposed, (such as imported metaphors and imagery, or psychoactive medication).
In the journey process, REM seems to be the ideal consciousness to explain the body’s natural healing process as realized in the placebo effect. The CRP journeys seem to trigger natural healing and operate with the same consciousness dynamics as the placebo effect. The chaotic, unstructured or complex consciousness is the dynamics required for consciousness restructuring. This restructuring of the primal existential sensory self-image, in turn, affects neural patterns (the existential hologram).
In the dynamics of REM, it is possible to change the neural firing patterns in the brain by dissolving an old pattern and establishing a new one. When the functioning of the brain is changed, the existential perceptions of the entire person are altered. These precipitate as greater and lesser changes in attitude and behavior. We perceive and sense ourselves differently. Changes in the firing patterns also affect the entire body’s chemistry.
It is necessary to be at the initial conditions of the system for this restructuring to have maximum effect, and REM consciousness seems to be necessary to these processes. This information implies a plausible mechanism by which dreams do their healing and regenerative work, helping us adapt to the exigencies of daily life.
REFERENCES
American Psychological Assn., DSM IV
Blackmore, Susan, The Meme Machine, Oxford Univ. Press, 1999.
Brodie, Richard, Virus of the Mind, Integral Press, 1995.
Goleman, Daniel, Vital Lies, Simple Truths: The Psychology of Self Deception, Simon and Schuster, New York, 1985.
Lynch, Aaron, Thought Contagion, Basic Books, 1996.
Rossi, Ernest, Psychobiology of Mind-Body Healing, W.W. Norton & Co., Inc., New York, 1986.
Rossi, Ernest and Cheek, David B., Mind-Body Therapy, W.W. Norton & Co., Inc. New York, 1988.
Swinney, Graywolf, Holographic Healing, Asklepia Pub., 1997.
van der Kolk, Bessel; McFarlane, Alexander; Weisaeth, Lars, Editors;Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body, and Society, Guilford Press, New York, 1996.
Wilson, John P. and Keane, Terence M., Editors, Assessing Psychological Trauma and PTSD, Guilford Press, New York, 1997.
ABSTRACT: Posttraumatic stress is a disorder, and that implies automatically a chaotic state of being. The sorts of trauma that tend to induce PTSD include combat trauma, crimes, rape, grief, kidnapping, natural disasters, accidents, torture, and imprisonment. Predisposition to dissociation can arise in violent family environments. Those with PTSD become hypervigilant and hyperreactive to environmental threat. The traumatic syndrome is ever present and unchanged. Emotionally, it is as if it keeps on happening. State-related learning and memory encoding help maintain the trance-like steady state. Depression, shame, anxiety, substance abuse, and survivor guilt are complications.
The nucleus of the disorder is a physioneurosis, somatization, depersonalization, and dissociation. Psychosomatic symptoms are expressions of the dissociation. Therapy proceeds by facilitating information transduction between them. There is poor impulse control and explosive aggressive reactions. There are persistent and profound alterations in stress hormone secretions and immune function. Integration of traumatic memories proceeds by verbal and nonverbal means in therapy. Time does not heal all wounds. Different treatments are needed at different stages of posttraumatic adaptation. CRP offers a way of restructuring the frozen structure of this disorder at the most fundamental level, in the sensory terms in which it is encoded.
KEYWORDS: PTDS, consciousness, creativity, psychotherapy, mind/body healing, integrative therapy, dreams, dreamwork, flashbacks, dissociation, trauma, state-dependent learning and memory, hypervigilance, sleep disorders, Freud, chaos theory, adjustment disorder, hormones, neurotransmitters, paranoia, EMDR, SSRIs, antidepressants, intrusion, intruders, anxiety, self-deception, ufo abduction, abductees, memes, placebo effect, REM, Consciousness Restructuring Process.
WHAT IS POST-TRAUMATIC STRESS DISORDER?
The development of a chronic trauma-based disorder is qualitatively different from simple exaggeration of the normal stress response. In those affected, a cascade of biobehavioral changes leads far beyond simple conditioning. Symptoms are intrusive and lead to hyperarousal and/or avoidant behavior. Frightening and vivid flashbacks are the most striking phenomenon. Prime victimization comes from memories of the event, rather than simply the event itself. Development of PTSD depends on personality and genetic make up, and on whether or not the trauma was expected. Prolonged exposure to severe trauma may cause permanent psychological scars.
Dissociation at the moment of the trauma has been shown to be an important factor in developing full-blown PTSD. Therefore, adults with a predisposition from childhood in chaotic, threatening, sexually abusive or violent families are at greater risk. Dissociation is characterized by feelings of detachment, estrangement, depersonalization, an unusual sense of one’s own reality, being an outside observer of one’s own actions and body, feeling like an automaton, or as if in a dream.
Ability to feel emotions of any type, (especially those associated with intimacy, tenderness, sexuality), is markedly decreased, as is ability to express angry feelings. Attacks appear like a psychological seige, therefore “bunkering” mentality prevails. Flashbacks can be triggered by overreactions to sounds, smells, feelings, or images. During the flashback, the person relives the traumatic event and may completely lose touch with reality, suffering through the trauma for minutes or hours at a time, believing that it is actually happening all over again. There is activation of sensory areas of the brain during flashbacks, right-hemispheric activation, and limbic-system activation.
The psychological function of emotions is to alert us to pay attention to what is happening, so that we can take adaptive action. Generally, we stop having an emotional response when we have realigned our expectations of what is supposed to happen with what is actually happening. We either take action that adjusts the given situation to our expectations, or change our expectations to fit better with what is actually going on.
But in PTSD, emotional arousal and goal-directed action are disconnected from one another because of emotional numbing. Arousal is no longer a cue to pay attention to incoming information. There is no gap between stimulus and response with fight-flight reactions. They either freeze or overreact. The emotions of fear, terror, and helplessness characterize any traumatic event, and avoidance of these feelings would seem to be the result, but chronic reenactment of the damaging event is compulsive.
Those with PTSD are more sensitive to sound intensities than average. They are “reducers” in whom inhibitory feedback loops are activated to dampen a tonic state of hyperarousal. They have difficulty neutralizing stimuli in the environment in order to attend to relevant tasks. To compensate, they tend to shut down, which of course means decreased involvement in ordinary, everyday life. Rather than reacting to the daily environment flexibly, they react to internal stimuli that are irrelevant to current demands.
Trauma effects the hormones of both brain and body creating more psychophysical stress. Intense distress is accompanied by release of stress-responsive neurohormones which seek to mobilize the energy required to deal with the stress. Chronic and persistent stress inhibits the effectiveness of the stress response and produces desensitization and sleep disturbances combined with hypervigilance.
Time does not heal all wounds. Therapy allows an inner search for healing alternatives within the “deeper” state-dependent psychobiological levels until the sought-for structure is transduced into the verbal level and emerges as a new psychophysical form. The recursive process which manifests in flashbacks and immersive rumination is facilitated, unblocked, and allowed to flow to its healing conclusion. This creates a shift in recurrent intrusive recollections and in recurrent distressing dreams and nightmares.
CRP helps probe into the state-dependent patterns of physiology, memory, and learning that have been encoded during circumstances of stress-released epinephrine by the autonomic nervous system and related responses by the endocrine and neuropeptide systems, and their related existential meanings and sensory images. It provides a healthier means of dissociation and reiteration leading to creative self-organization.
DIAGNOSIS OF POSTTRAUMATIC STRESS DISORDER
The diagnostic criteria for PTSD are listed in the DSM IV: A. The person has been exposed to a traumatic event in which both of the following were present:
(1) The person experienced, witnessed, or was confronted with an event or events that involved actual or threatened with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others. (2) The person’s response involved intense fear, helplessness, or horror. Note: In children, this may be expressed instead by disorganized or agitated behavior. B. The traumatic event is persistently re-experienced in one or more of these ways:
(1) Recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Note: in children, repetitive play may occur in which themes or aspects of the trauma are expressed.
(2) Recurrent distressing dreams of the event. Note: in children, there may be frightening dreams without recognizable content.
(3) Acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated). Note: in children trauma-specific reenactment may occur.
(4) Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
(5) Physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspects of the traumatic event.
C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following:
(1) Efforts to avoid thoughts, feelings, or conversations associated with the trauma.
(2) Efforts to avoid activities, places, or people that arouse recollections of the trauma.
(3) Inability to recall an important aspect of the trauma.
(4) Markedly diminished interest or participation in significant activities.
(5) Feeling of detachment or estrangement from others.
(6) Restricted range of affect (e.g. unable to have loving feelings).
(7) Sense of foreshortened future (e.g. does not expect to have a career, marriage, children, or normal life span).
D. Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following:
(1) Difficulty falling or staying asleep.
(2) Irritability or outbursts of anger.
(3) Difficulty concentrating.
(4) Hypervigilance.
(5) Exaggerated startle response.
WHAT CAUSES POSTTRAUMATIC STRESS DISORDER?
Any overwhelmingly stressful life situation (surgery, war, natural disaster, robbery, traumatic bereavement, torture, physical battery, accident, rape, malnutrition, etc.) that stimulates excessive arousal by the autonomic and endocrine systems can lead to the symptomology of post-traumatic stress. State-dependent memory, learning, and behavior (SDMLB) is the essential feature of post-traumatic stress syndrome, and the many more subtle dysfunctions associated with it. Fear-conditioning and parasynaptic cellular modulation mediates SDMLB, (Rossi, 1986).
PTSD seems to be the basic process underlying Freud’s original concept of the “traumatic neurosis” as the organic basis of psychopathology. Therefore, the entire history of depth psychology and psychotherapy can now be understood as a prolonged clinical observation of how dissociated or state-dependent memories remain active at unconscious levels, giving rise to “complexes.” These complexes are the source of psychological and psychosomatic problems.
Trauma affects our capacity to regulate bodily homeostatsis. Even years after the trauma has ceased, memories continue to dominate people’s perceptions, and affect capacity to think and make sense out of current experience. Psychological interventions can only effect the degree of reversal of a disorder with such strong biological underpinnings.
Healing those who develop PTSD in the aftermath of overwhelming experience is a complex process, whose dynamics cannot be described like a cookbook recipe--it requires tremendous sensitivity and intuition. Reestablishing a sense of personal safety and equilibrium is a primary goal of all treatment, and this happens within the therapeutic alliance.
Recognition of each person’s unique situation and reactions is paramount. It is critical that the therapist continue to take stock of the safety of the relationship and progress in achieving therapeutic goals. Participants are encouraged to make meaning of their life experiences when they feel personally supported by their therapists. A primary goal is to not retraumatize the person with therapies that force them to relive the original trauma in historical, rather than metaphorical or sensory terms, or compound the episodes with fallacious material.
Because traumatic memories are stored in state-dependent fashion, they are often rendered inaccessible to verbal recall for prolonged periods of time. Because memories are dissociated, they are stored outside of ordinary awareness, and expressed in incomprehensible symptoms as physical ailments, behavioral reenactments, and vivid sensory reliving experiences. Reenactment of the trauma in personal and social relationships is a major source of shame for the victims and is a source of ongoing tragedy.
Constricted ego functioning is a feature of all traumatized individuals. It is even more complex when traumatization comes in childhood, because trauma early in the life cycle fundamentally affects maturation of systems in charge of regulating psychological and biological processes. It can result in lack of emotional control, destructuve behavior against self and others (or animals), brutality (victim/victimizer), learning disabilities, somatization, dissociative problems, and distortions in concepts about self and others.
Reaction to trauma is a process of adaptation over time. In Chaos Theory, attractors describe the characteristic behavior of a dynamical system changing over time. Traumatic events, especially chronic events, act as “strange attractors” in consciousness which keep everything in their orbit, cycling wildly, unpredictably, but within the parameters of the attractor, reiterating the same cues over and over. Memories are embedded in all layers of psychophysical self in, what is known in Chaos Theory, as infinite nesting.
Psychological siege describes the dominance of trauma in memory and its crucial maintenance over time. The feeling of being constantly beseiged or barraged leads to a bunkering mentality which may be acted out, particularly in combat veterans. Over time some people’s PTSD may become subclinical, and yet it may continue to influence their level of functioning.
PTSD is the result of complex interrelationships among psychological, biological, and social processes--one that varies depending on the maturational level of the victim, as well as the length of time for which the person was exposed to the trauma, and the source of the trauma. Central to understanding these processes is awareness of the nature of traumatic memory and its biological substrates that lead to the dominance of the trauma in memory and to its maintenance over time.
Social cues are important for recovery -- whether people are encouraged to attend to their pain and learn from the past or cultivate a “stiff upper lip,” suppressing the profound meaning of their experience. There is often resistance to acknowledging the trauma or depth of its impact. Reality can profoundly and permanently alter people’s psychology and biology. Individuals make a choice whether to examine their reactions to the trauma in order to overcome it, or ignore it and try to go on with their lives. There is a range of reactions from acute trauma to long-term outcome.
The inner structure of the disorder overlaps catagories of dissociative disorder and stress responses. Adjustment disorder, grief reactions, and a variety of characterological adaptations are germane. The interaction between external events and subjective response can vary widely, even among victims of the same trauma, based on internal processing and approach to life in general. Predisposition and vulnerability reflect on recovery from acute symptomology and long-term resilience. Critical issues include the emergence of chronic patterns of adaptation, in which lack of involvement in current reality, rather than preoccupation with the past are the most pathological features.
The ways people view themselves and their world can be compounded by a host of self-destructive behaviors (e.g. suicide attempts, self-mutilation, and eating disorders). Complexity of adaptation includes both hormonal and autonomic nervous system dimensions. This includes unusual patterns of cortisol, norepinepherine, and dopamine metabolite excretion; the role of serotonergic and opioid systems (arousal and numbing); receptor modification by processes such as kindling; and involvement of central pathways involved in the integration of perception, memory and arousal.
Traumatic memories are qualitatively different from memories of ordinary events, in that amnesia co-exists with vivid recollections. Information processing and dissociation affect a person’s ability to perceive and integrate overwhelming experiences. Dissociative fragmentation of the self is common, leading to shattered psyches and lives.
Trauma is particularly devastating in childhood, including traumatic bereavement. Because of their dependence on caregivers, their incomplete biological development, and immature self-concepts and concepts of surroundings, children have unique patterns of reaction and needs for intervention. Although they may suffer from subclinical PTSD in middle age, memories recur and come to dominate their lives as seniors. There is generally greater lack of flexibility or capacity to repair damage with increasing age.
CONVENTIONAL TREATMENT OF PTSD
In actual practice, most clinicians use an eclectic approach, in which we must constantly reevaluate what is being accomplished. The core symptoms of PTSD (including paranoia, intrusions, numbing, and hyperarousal), occupational disabilities, dissociative phenomena, and interpersonal problems and alienation may all need widely different approaches. Treatment, therefore, depends in large part on clinical judgement.
In order to respond to current life and reach their fullest potential, people need to regain control over their emotional responses. It helps to place the trauma in the larger perspective of their lives--as a historical event (or series of events), that occurred at a particular time in a particular place, and that can be expected not to recur if the traumatized individuals take charge of their lives.
The key element is integration of the alien, the unacceptable, the terrifying, and the incomprehensible; the trauma must come to be “personalized” as an integrated aspect of one’s personal history. The therapeutic relationship is the cornerstone of effective treatment.
Critical incident stress debriefing has been proposed as a way of modifying the stress reactions of emergency service workers. Acute stress reactions, with the absence of stable symptom patterns and extreme degrees of physiological hyperarousal at this stage mean that there are unique problems in the treatment of this group.
Traumatized people with high levels of avoidance are often most reluctant to expose themselves to their traumatic memories, even when they seek help. Systematic desensitization and Eye Movement Desensitization and Reprocessing (EMDR) have been applied with limited results. Any positive results with EMDR probably come from mimicing the REM state.
Representations of trauma are more complex than roles like “perpetrator,” and “victim”. They are embedded in numerous affect states, defenses, object relations, and deep meaning configurations. Pertinent to these are subjective decision points in which critical self-judgements are embedded. They include insufficient anticipation of danger, naive trust, impossible choices, guilt and shame, and terror at revealing the content of the traumatic experience to someone new. Other elements include temporally contiguous ego states, such as splitting, denial, and dissociation, coupled with temporally contiguous fantasy states, such as murderous vengeance and wishes to die. Intrusions can also remind the person of moments of fantasied safety within the trauma.
The conventional view is that hyperarousal, sleep disturbances, and embeddedness of the trauma makes effective pharmacological treatment essential. Whether antidepressant, antianxiety, or sleeping medications are prescribed or not, dealing with traumatized people requires a staged process of treatment that is responsive to how much the victim can tolerate. Here again, the specific nature of the therapeutic relationship is a critical variable in outcome.
PTSD plays a role in the dysregulation of neurohormones and their roles in the stress response. Intense stress is accompanied by the release of endogenous, stress-responsive neurohormones, such as the catecholamines (including epinephrine and norepinephrine), serotonin, hormones of the hypothalamic-pituitary-adrenal (HPA) axis (including cortisol and other glucocorticoids, vasopressin, oxytocin), and endogenous opioids. These stress hormones help us mobilize energy required to deal with emergency stress by increasing glucose release for quick energy and enhancing immune function. Chronic stress inhibits their effectively and induces desensitization.
Drug therapy for PTSD is based on several biological models and has a few different purposes, (which also can be met with CRP’s intregrative approach).
(1). Noradrenergic dysregulation is treated with MAO inhibitors, tricyclic antidepressants, beta-adrenergic blockers and benzodiazepines to calm the body’s alarm center.
(2). Serotonergic dysfunction is treated with antidepressant SSRIs to regulate stress resilience, sleep, and for impulse control.
(3). Anti-kindling drugs, such as carbamazepine, allegedly regulate an excitability threshold that has been lowered.
(4). Anxiolytic drugs, such as clonazepam and buspirone are given in an attempt to reduce the startle response, which is one of the most persistent symptoms of PTSD.
The principle goals of using medication in PTSD are as follows:
1. Reduction of frequency and/or severity of intrusive symptoms.
2. Reduction in the tendency to interpret incoming stimuli as recurrences of the trauma.
3. Reduction in conditioned hyperarousal to stimuli reminiscent of the trauma, as well as in generalized hyperarousal.
4. Reduction in avoidant behavior.
5. Improvement in depressed mood and numbing.
6. Reduction in psychotic or dissociative symptoms.
7. Reduction of impulsive aggression against self and others. (Davidson, van der Kolk). Intrusion is the active force creating anxiety. Psychiatrist Mardi Horowitz catalogued these intrusions, and Goleman lists them in Vital Lies, Simple Truths (1985). They refer to unbidden ideas and pangs of feeling which are difficult to dispel, and of direct or symbiotic behavioral reenactments of the stress event. They are unbidden thoughts and feelings impinging on awareness. Every variety of intrusion is some aspect of the stress response taken to an extreme. They include the following: * Pangs of emotion, waves of feeling that well up and subside rather than being a prevailing mood;
* Preoccupation and rumination, a continued awareness of the stressful event that
recurs uncontrollably, beyond the bounds of ordinary thinking through of a problem;
* Intrusive ideas, sudden, unbidden thoughts that have nothing to do with the mental task at hand;
* Persistent thoughts and feelings, emotions or ideas which the person cannot stop once they start;
* Hypervigilance, excessive alertness, scanning and searching with a tense expectancy;
* Insomnia, intrusive ideas and images that disturb sleep;
* Bad dreams, including nightmares and anxious awakening, as well as any upsetting dream. The bad dream does not necessarily have any overt content related to a real event.
* Unbidden sensations, the sudden, unwanted entry into awareness of sensations that are unusually intense or are unrelated to the situation at the moment.
* Startle reactions, flinching or blanching in response to stimuli that typically do not warrant such reactions.
Anxiety swamps attention; denial can erase anxiety. The forms of denial include:
* Avoided associations, short-circuiting expected, obvious connections to the event that would follow from the implications of what is said or thought.
* Numbness, the sense of not having feelings, appropriate emotions that go unfelt.
* Flattened response, a constriction of expectable emotional reactions.
* Dimming of attention, vagueness or avoidance of focusing clearly on information, including thoughts, feelings, and physical sensations.
* Daze, defocused attention that clouds alertness and avoids the significance of events.
* Constricted thought, the failure to explore likely avenues of meaning other than the obvious one at hand; an abbreviated range of flexibility.
* Memory failure, an inability to recall events or their details, a selective amnesia for telling facts.
* Disavowal, saying or thinking that obvious meanings are not so.
* Blocking through fantasy, avoiding reality or its implications by fanciful thoughts of might have been or could be. The operative principle that unites these forms of denial is that they are all ways of blanking from awareness a troubling fact. These tactics are countermoves to the intrusions listed previously. Denial and intrusion are two sides of attention, the one an avoidance, the other an invasion.
Self-deception involves forgetting and forgetting we have forgotten. Repression creates no trace when it is in progress--it is the sound of a thought evaporating. There are secrets we keep even from ourselves. They are retrievable only under the most extraordinary circumstances, since the essence of repression lies simply in the function of rejecting and keeping something out of consciousness. It suppresses the single class of items which evoke psychological pain. This fear-based pain can be of many varieties: trauma, “intolerable ideas,” unbearable feeling, anxiety, guilt, shame, etc.
Repression lessens mental pain by creating a blind spot as does its cousin denial. It protects a core of forbidden information. The nearer to that core one probes the greater the resistance. The deepest schemas encode the most painful memories, and are the hardest to activate.
Defensive postures include:
* Repression. Forgetting and forgetting one has forgotten.
* Denial and Reversal. What is so is not the case; the opposite is the case.
* Projection. What is inside is cast outside.
* Isolation. Events without feelings.
* Rationalization. I give myself a cover story.
* Sublimation. Replacing the threatening with the safe.
* Selective inattention. I don’t see what I don’t like.
* Automatism. I don’t notice what I do.
“ALIENATION”
PTSD AND CONSCIOUSNESS RESTRUCTURING
PTSD has turned out to be a very common disorder, since exposure to extreme stress is widespread and a large proportion of those exposed become symptomatic. A factor there may be predisposition from homelife in violent or sexually abusive families, or earlier experiences. Over 1 million U.S. teenagers suffer from PTSD; 76 percent of American adults report exposure to extreme stress, and perhaps 10% suffer from PTSD; over 15% of Vietnam veterans continue to suffer PTSD for more than 20 years after the war.
Repeated replaying of upsetting memories serves the function of modifying the emotions associated with the trauma, and in most cases creates a tolerance for the content of the memories. However, those with PTSD begin organizing their lives around the trauma. The meaning they attach to the experience of extraordinary events is as fundamental as the trauma itself. PTSD is an emotional, behavioral, interpersonal, and spiritual disorder. But, the core issue in PTSD is that the primary symptoms are not symbolic, defensive, or driven by secondary gains. The core issue is the inability to integrate the reality of particular experiences, and the resulting repetitive replaying of the trauma in images, behaviors, feeling, physiological states, and interpersonal relationships. It is, therefore, critical to examine where they have become “stuck” (fixation on the trauma) and around which traumatic events they have built their psychic elaborations.
One way or another, the passage of time modifies how the brain processes trauma-related information. New organization of experiences is the result of iterative learning patterns, in which trauma-related memories become kindled, etching them more deeply and powerfully into the brain. These emotional memories are programmed to last forever. Experiences are initially imprinted as sensations or feeling states, and are not collated and transcribed into personal narratives. Traumatic memories come back as emotional and sensory states with little verbal representation. There is texture to the response.
Time does not positively modify memories in PTSD; the full brunt does not fade with time, as in normal transformation. Adaptation is more complex; the body keeps the score. Stress-induced serotonin dysfunction may lead to impaired functioning of the behavioral inhibition system, leading to behavioral problems including impulsivity, aggression and brutality, compulsive reenactment, and inability to learn from past mistakes.
Traumatic experiences change the way the brain and body work; and so can each therapeutic session which can be just as powerful in the healing direction, creating immediate, discrete changes in psychophysiology. Much depends on whether clients want to know “what happened” or “to heal.” Knowing, or reliving what happened is often unessential and many times would be retraumatizing and terrifying.
If we view trauma as a dimensional continuum over time, the splitting occurs at the point of “T minus 1,” leading to dissociation of part of consciousness just prior to the worst part of the event. This split off, or frozen, or stuck consciousness needs to find a way to move forward through the event with the assurance that it survived and is now all right, so it can rejoin the holistic flow of consciousness.
This integrative therapy is most successfully done in a dimension other than historical time, such as metaphor or imagery originating with the client, rather than imported metaphors from the therapist. It can also be done in sensory channels. As the story progresses, things get “worse” before they get better and then healing resolution comes and new resources and adjustments come along with it.
Because of the severity of their wounding, PTSD clients are vulnerable to therapeutic exploitation by either unscrupulous or poorly-trained therapists. Because they are shut-down and intimacy is a primary issue, the safety of the therapeutic relationship, and the broader nature of that relationship are crucial if any healing is to take place.
Prospective participants may have to struggle with their need for help, acknowledging dependence, grief, humiliation, and helplessness, as well as overcoming fears of confronting their shame and pain. Shame-based behavior may be amplified by substance abuse and survivor guilt. Other syndromes like major depressive syndrome, personality disorders, paranoid ideation and dissociative disorder can compound the situation.
Therapists, on the other hand, must cope with the horrendous experiences that can befall people and the inescapable truth that reality can damage their fundamental existential sense of safety and trust. The therapists must walk a fine line, intuitively determining when to help the client integrate and recall the traumatic memories, and when to help the person create distance from them and promote functionality. We cannot assume that the primary trauma we are aware of is the only one that affects current symptoms.
Therefore, different therapeutic procedures are helpful at different stages of treatment. These protocols are not only not standardized, they are virtually non-existent, leaving these people at the mercy of practitioners who want to experiment on them with practices that may or may not be germaine to their healing and adaptation.
In terms of information processing, there are six issues which effect those exhibiting PTSD: (1) persistent intrusions of memories related to the trauma interfering with other incoming information; (2) compulsive exposure to situations reminiscent of the trauma; (3) active avoidance of specific triggers of trauma-related emotions, and generalized numbing; (4) loss of modulation of physiological responses to stress in general and capacity to use body signals as guides for action; (5) generalized problems with attention, distractability, and stimulus discrimination; and (6) alteration in psychological defense mechanism and in personal identity. All these factors filter what new information is selected as relevant. One particular event can activate other, long-forgotten memories of previous traumas, creating a “domino effect.”
Based on criterion formulated for drug treatment of PTSD, we can assume that psychotherapy would have the complementary goals of (1) reduction of intrusive reexperiencing; (2) reduction in the tendency to interpret incoming stimuli as recurrences of the trauma; (3) reduction in conditioned and generalized hyperarousal; (4) reduction in avoidance behavior; (5) improvement in depression and numbing, (6) reduction in dissociative or psychotic symptoms, and (7) reduction of impulsive aggression against self and others.
Effective treatment needs to resolve the spectrum of symptoms, including intrusions, compulsive reexposure, avoidance and numbing, hyperarousal, problems with attention, distractability, stimulus discrimination, altered perceptions of self and others, dissociation and somatization.
We cannot assume that a traumatic situation is amenable to interpretive reconstructive or insight-promoting work at the time we may feel ready to dispense it. However, keeping a watchful eye out for the complex ways in which the trauma may be repeating itself in the present, both in the transference and in the countertransference, may be useful.
The primary presenting imagery is of disintegration, confusion, alienation, and despair. Fixation on the event(s) feels like being pulled into a Black Hole of trauma. People may experience sensory elements of the trauma without being able to make sense out of what they are feeling or seeing. CRP facilitates the direction of their own self-healing call. Verbalizing plays a critical role in reestablishing physical and psychological health.
Exploring the personal meaning of the trauma is critical, since no one can undo their past. Personal attributions, and feelings of guilt in causing (or at least not preventing) the incidents affect whether they see themselves as capable or worthy of having restorative experiences, and whether they consider themselves capable of being entrusted with responsibility, intimacy, and care.
CRP allows them to move further into dark gloomy voids, to go ahead and disintegrate and see what happens when they let those compelling images play out in the therapeutic setting. The call to heal and the call to death are the same call to formlessness and creative restructuring, but the process has gotten stuck at the point of fragmentation. The self is shattered. Shame is the emotion related to having let oneself down.
It would be an error to think of detachment and withdrawl in PTSD as merely a psychodynamic phenomenon, or as a deficit of certain neurotransmitter supplements. Chronic hyperarousal depletes both the biological and psychological resources needed to experience a wide variety of emotions. Over time there are changes in the CNS which are similar to the effects of prolonged sensory deprivation.
“Healing” does not necessarily mean a cure nor total elimination of all symptoms. It has to do with a subjective process, difficult to describe because it is non-linear, reflects a multi-leveled psychic disorder which carries and stores meaning in biological forms. Yet this syndrome is linked to a timeless and universal experience of healing, in which recurrent dreams and nightmares play a fundamental role.
What are symptoms, dreams, and chronic reliving of the event trying to tell the person who is affected? The meaning of those overwhelming experiences -- their total significance -- is contained and expressed in psychobiological forms which have outlived their adaptive usefulness. The structures can dissolve as they transform from corporeal to verbal form. Traumatic memory gradually becomes narrative memory.
Inchoate sensations and dysphoric affect, complete with the emergency defenses used at the time (e.g. dissociation, splitting, or disavowal), come to be personal stories of tragedy, trauma, and loss. These stories embody tremendous significance for the past, present, and future. Therapy helps the survivor find words to express nuances of subjective meaning in an empathic context, reorganizing everyday experience for traumatized individuals.
Most participants have created a personal myth or framework about their experience, but this story generally is not encompassing enough to initiate healing. The story needs amplification, and the healing comes in filling in the blanks and in the telling and re-telling of the personal tragedy. The task of the therapist is to instill confidence and create an intimacy with the client so the person can begin to believe that they will improve.
The placebo effect is the therapist’s greatest tool in this regard. It is a gift of nature, and our nature, that this phenomenon exists, and it is neither purposeless nor a coincidence that it crops up in all healing attempts and modalities. It can be purposefully deployed, rather than being viewed as a troublesome interloper in treatment.
“The power of the placebo effect is one of the ironies that have to be dealt with in the desire to prove the effectiveness of new treatments. In drug studies, up to 40% of subjects may be placebo responders. This means that there has to be a powerful therepeutic effect before a treatment is of proven benefit, and that the placebo effect is actually one of the most powerful treatments in the therapeutic arsenal. It is important not to scoff at the placebo response, but rather to maximize its potential and usefulness. It is possible that the strength of the placebo response accounts for the power of some of the less conventional forms of psychotherapy. The conviction with which these forms are practiced may maximize people’s natural capacity for healing.” (Turner, McFarlane, van der Kolk, 1996).
So, the therapist should invoke the placebo response. But just as importantly, retraumatizing the participant with historical reliving of the trauma is to be absolutely avoided. Incorporation of missing time or memories through regression is contra-indicated. This can lead to avoidance and alienation, and reinforces the sense of threat. New explorations can be done in less-harmful dimensions which lead to a greater sense of self, rather than withdrawl into self or away from therapeutic interaction.
The incorporation can take place through metaphorical and sensory channels, rather than in the time dimension of historical regression, and this allows the frozen, stuck or traumatized energy to dissolve and flow into the whole, becoming part of the holistic consciousness restructuring. In this process dissociated and repressed material is automatically included. Interpretations should be avoided, although re-framing of experiences may be helpful if a prospective outlook is fostered. Helping the person find their own internal funding and resources is the most helpful approach.
Inappropriate cues and guided imagery for reliving trauma may create false memories through suggestion. The “change history” process and hypnotic “re-frame” of Neuro-linguistic Programming (NLP) work on the principle of imagining things differently. However, these techniques don’t restructure at the deepest psychophysiological level.
Change history is actually an invitation to use imagination and confabulation to fantasize a different reality. Unfortunately, PTSD victims know their body is telling them history hasn’t changed. For them, its still happening. False memories are often created by combining actual memories with suggestions received from others. They can be induced when a person is encouraged to imagine experiencing specific events without worrying about whether they really happened or not.
Suggestion and imagination can create “memories” of events that did not actually occur. Needless to say, this is a diservice to the participant, rather than a therapeutic step forward, and may be construed later as yet another form of victimization. Research has shown that corroboration of an event by another person can be a powerful technique for instilling a false memory. In fact, merely claiming to have seen a person do something can lead that person to make a false confession of wrongdoing.
“Research has helped us understand how false memories of complete, emotional and self-participatory experiences are created in adults. First, there are social and therapeutic demands on individuals to remember, to come up with memories. Second, memory construction by imagining events can be explicitly encouraged when people are having trouble remembering.
And, finally, individuals can be encouraged not to think about whether their constructions are real or not. Creation of false memories is most likely to occur when these external factors are present, whether in an experimental setting, in a therapeutic setting, or during everyday activities. False memories are constructed by combining actual memories with content of suggestions received from others. This is a classical example of source confusion, in which the content and the source become dissociated.” (Loftus, 1977).
It is important to heed the cautionary tale in this data: mental health professionals and others must be aware of how greatly they can influence the recollection of events and of the urgent need for maintaining restraint in situations in which imagination is used as an aid in recovering presumably lost memories.
CRP restructuring changes the physiological responses which affects the psyche, and the new psychic outlook feeds back new signals to the body. These are all parts of “completing the story” with its intrinsic meaning, and facilitating its healing goal. The therapist needs to respect the need to keep traumatic details of memories away from consciousness, remembering that these memories are state-bound. He or she must help the survivor differentiate them while providing hope and meaning that the goals are worth the pain of pursuing them.
There are a few technical principles established in conventional PTSD therapy which can act as guidelines for the practitioner:
1. Trauma reconstruction should occur when intrusive rather than numbing aspects of the PTSD are present.
2. Under ideal circumstances, the alliance should be strong and the general transference positive; the intrusion should be limited and should be occurring in the context of a generally improving clinical condition.
3. However, when the therapist is faced with a rapidly deteriorating clinical situation in which there is a significant negative component to the transference, reconstruction of trauma can provide a new temporary structure around which ego functions can be consolidated rather than fragmented and an alliance has the opportunity to develop. (Lindy, 1996).
There are some central points in the question of how to reconstruct trauma:
1. It is the therapist’s task to keep as empathically in contact with the patient in the here and now as possible, including strong feelings directed toward the place or person of the therapist.
2. The therapist, through introspection, should use words to describe feelings in the here and now that can also be applied to the there and then of the trauma. However, it is the patient who should make the reconstruction of the memory, not the therapist.
3. Repetitions in the present, in which the therapist has struggled internally to find words that express anguished meaning, provide an open door for the survivor to find better words to describe his or her uniquely traumatizing events of the past. (Lindy, 1996).
Co-consciousness in the journey process creates an intimate non-verbal bond with the other person. Co-consciousness is an originally shamanic technique which has been incorporated into hypnotherapeutic practice. Shamanic techniques have proven particularly valuable in the treatment of PTSD, particularly with combat veterans. Group work is helpful because original traumas may have been group experiences. Drum-journeys, sweats, vision quest, and even sun-dancing have produced healing and spiritual connection. The nature of shared consciousness dynamics is complex.
One needs to learn by direct experience how to enter and maintain it. Milton Erickson, for example, noted that when he was in this co-consciousness state the information and stories just came to him intuitively from opening to the whole situation. He maintained this increased his therapeutic impact greatly. Abraham Maslow also identified this state, labeling it “trans-human.”
It is our contention that the placebo effect and spontaneous remission operate at the deepest level of enfoldment, before energy differentiates into psychic and somatic. Because it targets this deeper state of primal restructuring of energy, the CRP process offers several advantages over the placebo effect and some of the other healing practices. They include the following:
* A higher frequency of connection with mind/body dynamics than the placebo effect offers;
* The elimination of the dogma and superstition that permeate many shamanic, spiritual (and scientific/medical) approaches;
* The awareness and consciousness expansion for the client in directly experiencing these consciousness dynamics and processes;
* Development of, and familiarity with an inner creative process for problem solving and crisis resolution, and resultant lifestyle changes;
* The client is empowered by the process and experiences the healing dynamics as self and internally generated rather than other-generated and externally imposed, (such as imported metaphors and imagery, or psychoactive medication).
In the journey process, REM seems to be the ideal consciousness to explain the body’s natural healing process as realized in the placebo effect. The CRP journeys seem to trigger natural healing and operate with the same consciousness dynamics as the placebo effect. The chaotic, unstructured or complex consciousness is the dynamics required for consciousness restructuring. This restructuring of the primal existential sensory self-image, in turn, affects neural patterns (the existential hologram).
In the dynamics of REM, it is possible to change the neural firing patterns in the brain by dissolving an old pattern and establishing a new one. When the functioning of the brain is changed, the existential perceptions of the entire person are altered. These precipitate as greater and lesser changes in attitude and behavior. We perceive and sense ourselves differently. Changes in the firing patterns also affect the entire body’s chemistry.
It is necessary to be at the initial conditions of the system for this restructuring to have maximum effect, and REM consciousness seems to be necessary to these processes. This information implies a plausible mechanism by which dreams do their healing and regenerative work, helping us adapt to the exigencies of daily life.
REFERENCES
American Psychological Assn., DSM IV
Blackmore, Susan, The Meme Machine, Oxford Univ. Press, 1999.
Brodie, Richard, Virus of the Mind, Integral Press, 1995.
Goleman, Daniel, Vital Lies, Simple Truths: The Psychology of Self Deception, Simon and Schuster, New York, 1985.
Lynch, Aaron, Thought Contagion, Basic Books, 1996.
Rossi, Ernest, Psychobiology of Mind-Body Healing, W.W. Norton & Co., Inc., New York, 1986.
Rossi, Ernest and Cheek, David B., Mind-Body Therapy, W.W. Norton & Co., Inc. New York, 1988.
Swinney, Graywolf, Holographic Healing, Asklepia Pub., 1997.
van der Kolk, Bessel; McFarlane, Alexander; Weisaeth, Lars, Editors;Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body, and Society, Guilford Press, New York, 1996.
Wilson, John P. and Keane, Terence M., Editors, Assessing Psychological Trauma and PTSD, Guilford Press, New York, 1997.
Depression & Grief
ABSTRACT: There are three main types of depressive disorders: major depressive disorder, dysthymia, and the depressive lows of bipolar disorder. While conventional treatment has been to freely dispense antidepressants (SSRIs), an integrative approach would include psychosocial therapy to focus on the personal, interpersonal, and transpersonal issues behind depression. For many individuals, SSRIs are contra-indicated due to a wide range of side effects, some quite severe. CRP offers a comprehensive psychoimmunotherapy, which can alter mood in a positive direction, restore interest or pleasure in daily activities, promote healthy sleep patterns, restore energy reserves, transform feelings of worthlessness or guilt, foster pro-active decisions, calm restlessness, and ameliorate recurrent thoughts of death or morbidity. In CRP, the value of the depressive state and/or grief is acknowledged and honored. Rather than medicating it away, CRP facilitates the depressive process and allows it to fully cycle through. Biological disturbances lead to a complex, dynamic interlocking group of psychophysical changes which depress the well-being and functionality of the individual until the call to restructure consciousness is heeded. By going deeper into the process and allowing imagery of death, for example, to play out to its natural conclusion in rebirth, CRP fosters restructuring at the genetic, cellular, biochemical, and psychoneuroimmunological levels.
KEYWORDS: Creative Consciousness Process, dreams, depression, creativity, healing, psychotherapy, SSRIs, complex dynamics, chaos theory, neurotransmitters, restructuring consciousness, psychosomatics, grief, flow, psychoneuroimmunology, depressive disorders, major depression, treatment protocols, dysthymic disorder, double depression, bipolar disorder, cyclothymia, seroton in, Prozac, Zoloft, Paxil, antidepressants, sexual dysfunction, St. John's Wort, Asklepios, David Bohm.
WHAT IS DEPRESSION?
Chronic depression is characterized by a profound and persistent feeling of sadness or despair and a loss of interest in things that were once pleasurable. The causes behind depression are complex and dynamic and not yet fully understood. The “initial conditions” that lead to either a major depressive episode or chronic dysthymia are generally situational rather than biologically-induced.
Therefore, practitioners treating all depressions with SSRIs may neglect to address and heal the psychological and emotional wounds that led to the maladaptive changes in biochemistry. While an imbalance of certain neurotransmitters, the chemicals in the brain that transmit messages between nerve cells, is believed to be the key to depression, external factors, such as upbringing (more so in dysthymia than major depression) may be as important.
For example, if an individual is abused and neglected throughout childhood and adolescence, a pattern of low self-esteem and negative thinking may emerge, initiating a lifelong pattern of depression. Or, perhaps, the death of a parent during childhood creates patterns of unresolved loss, grief, sadness, and guilt. Whenever emotions are deadened, we tend to identify with that state exclusively.
Heredity does seem to play a role in who develops depressive disorders. Individuals with major depression in their immediate family are up to three times more likely to have the disorder themselves. It is modeled by their caregivers. It has been theorized that biological and genetic factors may make certain individuals pre-disposed or prone to depressive disorders, but environmental circumstances may often trigger the disorder. Transactional Analysis describes the Life Scripts which we adopt as children.
It postulates that depression is a “No Love” script. According to Steiner, (1974): “Large numbers of people in this country are in a constant unsuccessful quest for a successful, loving relationship. This is a difficulty that seems to affect women more often than men, probably because women are more sensitized to their needs for love and less capable of adapting to Lovelessness. Lack of adequate stroking, which leads to chronic stroke-hunger and various degrees of depression, culminating in either suicide or in the most extreme form of depression--catatonia--is one large strand of human suffering.
The Lovelessness script is based on the Stroke Economy, a set of early childhood injunctions addressed to the stroking capacities of children. Those injunctions very effectively cripple the growing child’s normal tendencies and skills for getting strokes. The result is various degrees of depression with feelings of being unloved and/or unlovable.” External stressors and significant life changes, such as chronic medical problems, death of a loved one, divorce or estrangement, miscarriage, or loss of a job can also result in a form of depression known as adjustment disorder with its lowered expectations. Although periods of adjustment disorder usually resolve themselves, occasionally they may evolve into a major depressive disorder. In ancient times, depression was a recognized temperament, known as Melancholia.
Depression was also seen as a characteristic part of the universal process of transformation. It was viewed as the starting point of the journey, recognition of the emptiness and sterility of the experience of those who are frustrated, isolated, and discontent. It was discovered to be the root of the spiritual quest for personal and universal meaning. That transformative process necessarily begins in a forced breakdown which demands the time for introversion and recovery of energy reserves. In alchemy this melancholic state was known as the nigredo, a deep blackness of spirit, a dry empty void.
In mythology and astrology, it was kindled by Father Time, Saturn (Roman) or Cronos (Greek), hence its inherently “chronic” nature. In depression, our fundamental psychobiological rhythms are disturbed--sleeping, eating, thinking, and activity. These biological disturbances lead to a complex interlocking group of psychophysical changes which depress the well-being and functionality of the individual until the call to restructure consciousness is heeded. There is time-honored value and meaning in many types of depression, which can only be experienced by letting the process unfold, rather than chemically blocking or subverting it. It was always considered the beginning of a descent into darkness, a metaphorical trip to hell, or in modern terms, the unconscious.
Psychologically, one experiences a chaotic state of conflict between hostile psychic elements. These complex dynamics need time to resolve and allow recovery from the intolerable strain of the environment. Then the characteristic melancholia, sleeplessness, and restless volatility begin to resolve. Rather than a state to be overcome, the disorder is a call to adventure from the spirit to the soul, a call from dry literalism into the imagistically rich inner world. This allows one to break through into a fresh mode of perception.
Typical manifestations of this stage of the mystery process include long dreams, confusions, numbing, and a drained or depressed mental attitude. Missing the point, we may keep looking for what is “wrong,” in organic or neurological problems. Then we get gross--rather than subtle--treatments, consisting of pills, body work, or dance therapy. But it is the soul which is sick unto death, and ruminates on it morbidly. The cure will not come through vitamin therapy, or rejuvinating exercise, or prescription drugs. Life as you have known it is is falling apart. You are prematurely grieving the death of your old self, and may not yet even know it.
The élan vital, or life energy has been pulled into the unconscious, leaving the ego frustrated and discontent. It is the syndrome of a soul cut off from the well-springs of life. The feeling of being drained, or over-extended may become so powerful that it forces a breakdown. Life becomes a metaphorical journey through a wasteland. It brings skepticism, bitterness, sarcasm, the feeling of being damned. The depression and restlessness that result may lead to drugs or alcohol abuse. Conversely, substance abuse aggravates depression in a viscious cycle. The ability to see through to a value in depression and experience the meaningfulness of the feeling of meaninglessness has a prognosticative purpose. Attaching meaning to depression allows an emotional participation which unblocks the flow of psychic energy.
Depression is not a loss of meaning, but the feeling of loss of a sense of meaning. This is actually the beginning point of the quest, as illustrated by such stories as Dante’s Inferno, Rider Haggard’s SHE!, Fowles’ The Magus, and Melville’s Moby Dick. If one can see that the world is beautiful, but has lost the ability to feel that beauty, mood swings can range from sullen inertia to active despair.
There is a sense of fragmentation and alienation from one’s self. You may find yourself devoid of emotional response, except perhaps self-judgement and volcanic outbursts. Compassion fatigue and anhedonia are the result of “not caring anymore.” There may be a persistent belief that oneself or others would be better off dead. Suicidal ideation may occur with or without a specific plan or suicide attempts.
Commonly associated features include tearfulness, anxiety, irritability, brooding or obsessive rumination, excessive concern with physical health, panic attacks and phobias. A common delusion is that one is being persecuted. There may be nihilistic delusions of world or personal destruction, somatic delusions of cancer or other serious illness, or delusions of poverty. Depressed children may develop Separation Anxiety Disorder, Overanxious Disorder and Avoidant Disorder, as well as sulkiness, inattentiveness, reluctance to cooperate, and inattention to personal appearance and hygiene.
Those adults who are extremely depressed become unable to function socially or occupationally, or even to feed, bathe, and clothe himself or herself. Seniors are particularly vulnerable. The smallest task seems difficult or impossible to accomplish. This is a major reason individuals seek psychotherapy, or a spiritual path of renewal. Participants find a new sense of inner unity and renewal, a glimpse of deeper values, of the Self, and self-reconciliation, spiritual connection, renewed zest.
The wilderness is no longer barren and life blossoms and bears fruit. One meaning of the experiences of depression is that our wholeness, or individuation, the Self, can no longer wait while we follow egotistic ways or even seek legitimate ego fulfillment. When current ego attitudes are outdated and lack adaptability, we feel stuck. The subconscious begins to revolt, seeking a psychological revolution in attitudes. If we listen to the voice within our depression, we come to realize that we must willingly subject ourselves to change. Conscious and unconscious drives, what was previously rejected and suppressed, need to realign (Miller and Miller, 1994).
The Self brings us, drives us, into the wilderness of depression and from there we can attend to the vision within. This decision to subject ourselves to change may be considered a spiritual awakening, a willingness to look at our own unlived potential for both good and evil. Classically, the nigredo is a time of disappointment, divorce, soul-searching, and reorientation, and responsibility to self to fulfill unlived potential. Your destiny begins to take form, or reform. You may be pressured into it even if you resist, and this is the black mood’s positive intent. The promise reported by the ancient alchemists, is that following this state of darkness, the light begins to dawn.
Insights gained through paying attention to the unconscious, to dreams and so on, throw a light on our inner condition, and we regain relatedness through feeling. The blackness is accepted and taken to oneself, instead of being blamed on outside situations and other people. We begin to see it is our own withdrawl and loss of feeling and contact with our shadow that is the true cause of the darkness. We can recognize we are not just suffering a personal ill, but participating in a universal process of creativity. It is a natural part of human development, when the ego can no longer pursue only its selfish concerns and addictive demands Depression shakes up the stagnant order of things with its burning awareness of personal shortcomings and inadequacies. Old traumas, limiting core beliefs, and self-indulgent tendencies that severely limit one must be given a way to transform and free up energy for personal fulfillment.
Feeling and compassion return as light begins to shine in the darkness. The experience of restriction begins to transform into one of liberation as you re-own the lost part of yourself, and digest your new experiences. Psychosomatic symptoms may suddenly vanish. True, you will have to withstand a chaotic state of conflict among hostile psychic forces. But, in reconnecting with the well-spring of being, chaotic consciousness, we restructure our primal existential self-image.
Psychopharmacology rests on a “disease model” of psychiatric symptoms. This is the application of an extreme medical or biological model to psychological syndromes. Perhaps a few severe psychiatric conditions such as schizophrenia, bipolar, or psychotic depression have a strong biological componenet. But to treat all psychiatric symptoms as though they were exclusively biological is unacceptable reductionism.
Symptoms in and of themselves do not necessarily indicate a disease. All psychiatric diagnoses are merely syndromes, clusters of symptoms presumed to be related, disorders not diseases. There is no proof either of the cause or physiology for any psychiatric diagnosis. WHAT CAUSES DEPRESSION? Depression affects an estimated 17 million people. The size of the subgenual prefrontal cortex of the brain (located behind the bridge of the nose) may be a determining factor in hereditary depressive disorders. Positron emission tomography (PET) scans reveals widespread changes in brain functioning for those clinically depressed.
The hereditary and biochemical imbalance theories are still unproven and controversial models. Researchers admit that they have many elegant models, but don’t really know the exact mechanism by which antidepressants work because they aren’t sure of the origin of depression itself. “Eventually, scientists may discover real proof that a small percentage of patients have genetically determined, biological symptoms. But we are a long way from any such knowledge. When patients are told otherwise, they are being seriously misled.” (Glenmullen, 2000).
The average age for a first depressive episode occurs in the mid-20s, although it can strike all age groups indiscriminately, from children to the elderly. Even infants can experience a major depressive episode, and certainly they are affected by the depressions of their caregivers. Depression is more likely in first-degree relations of the depressed. One in four women is likely to experience a severe episode, with a 10-20% lifetime prevalence, compared to 5-10% for men.
Disturbances in sleep, appetite, and mental processes are a common accompaniment. Major depressive disorder is a moderate or severe episode of depression lasting two or more weeks, and may include a preoccupation with death or suicide. In children, the major depression may appear as irritability. The person may deny feeling depressed, or try to mask or self-medicate the problem. Major markers of onset include the following: * Significant change in weight. * Insomnia or hypersomnia (excessive sleep) nearly every day. *
Psychomotor agitation or retardation. * Fatigue or loss of energy. * Feelings of worthlessness or inappropriate guilt. * Diminished ability to think or to concentrate, or indecisiveness. * Recurrent thoughts of death or suicidal and/or suicide attempts. * Excessive crying. * Unexplained, chronic aches and pains that don’t respond to treatment.
Dysthymic Disorder (or Depressive Neurosis) is an ongoing, chronic depression that lasts two or more years (one or more years in children) and has an average duration of 16 years. Predisposing factors include an inadequate, disorganized, rejecting, and chaotic environment. The mild to moderate symptoms may rise and fall in intensity, with some periods of normal, non-depressed mood of up to two months in length. Its onset is gradual, and may not be pinpointed. Often there is coexisting personality disturbance, such as Borderline, Histrionic, Narcissistic, Avoidant, or Dependent Personality Disorders. Dysthymia often occurs with other psychiatric and physical conditions. Up to 70% of patients have both dysthymic disorder and major depressive disorder, which is known as “double depression.” Substance abuse, panic disorders, personality disorders, and social phobias may compound the problem.
Dysthymia is common in certain medical conditions, such as multiple sclerosis, AIDS, hypothyroidism, chronic fatigue syndrome, Parkinson’s disease, diabetes, and post-cardiac transplantation. It is possible that other pharmacological treatment affects neurotransmitters, and the depression may complicate recovery. Two or more of the following symptoms are experienced daily: * Under or overeating. * Insomnia or hypersomnia. * Low energy or fatigue. * Poor concentration or trouble making decisions. * Feelings of hopelessness. Bipolar disorder is an affective mental illness that causes radical emotional changes and alternating mood swings from manic highs to depressive lows. Cyclothymia is a mild form of Bipolar Disorder. Another temporary and little understood source of depression is post-partum depression, with its radical hormone shifts.
CONVENTIONAL TREATMENT PROTOCOLS AND HAZARDS
Untreated or improperly treated depression is the number one cause of suicide in the United States. Proper treatment relieves symptoms in 80-90%.
After each major depressive episode, the risk of recurrence climbs significantly--50% after one episode, 70% after two episodes, and 90% after three episodes. For this reason, patients need to be aware of the symptoms of recurring depression and may require long-term maintenance treatment of antidepressants and/or therapy. Early intervention with children with depression is effective in arresting development of more severe problems. Patient education in the form of therapy or self-help groups is crucial for taking an active part in the treatment program.
Numerous independent studies have found that drugs are not significantly more effective than “talking cures” and process work at treating the most common adjustments of depression and grief. Diagnosis includes interviews and several clinical inventories to assess mental status. Among them are the Hamilton Depression Scale, Beck Depression Inventory, Child Depression Inventory, Geriatric Depression Inventory, and the Zung Self-Rating Scale for Depression. Most scales reflect the biochemical imbalance theory, and reflect the problems inherent in subjective evaluation.
Typical conventional treatment begins with finding a compatible antidepressant, such as fluoxetine (Prozac), sertraline (Zoloft), or Paxil, or Luvox. One class of drugs, SSRIs, increases levels of serotonin but have many unfortunate side effects, including allergic reaction, anxiety, diarrhea, drowsiness, headache, poor sexual functioning, sweating, nausea, and insomnia. There is emotional blunting, even apathy and indifference. An average dose of Zoloft, for example, is 50-100 milligrams; 200 milligrams is the maximal dose. Patients are frequently taken from 50-100-150 mgs. in quick succession.
Serotonin reuptake inhibitors, or serotonin boosters have been implicated as catalysts for suicidal and violent impulses. Neurological disorders including disfiguring facial and whole body tics (TD, irreversible tardive-dyskinesia), indicating potential brain damage, are an increasing concern for those on the drugs. Calling these drugs “antidepressants” is seriously misleading and virtually meaningless. They function like the stimulants amphetamine and cocaine and users develop a tolerance for the dosage and often psychological or chemical dependencies.
These drugs are stimulants for people who would otherwise be fatigued, distracted by negative thoughts, or have difficulty concentrating. With their energizing, attention-focusing, mood-elevating, and calming effects, serotonin boosters would make almost anyone feel better so long as they did not experience distressing side effects. There can be debilitating withdrawl symptoms for as many as half of all patients. Withdrawl symptoms include suicidality, rebound irritability, increased vulnerability to depressive relapse, weight gain, etc.
Withdrawl mimics return to depressive symptoms with feelings of dread, dizzyness, sleeplessness, and inability to concentrate. Side effects raise concern that patients may sustain silent brain damage that cannot be assessed. Withdrawl from Prozac-type drugs sometimes happens spontaneously when the drug “wears off” probably from having damaged its target axons beyond any ability to respond to the drug (permanent chemical lobotomy). This has led to dependency and patients increasing their own doses. When doctors prescribe up to and beyond the maximal doses there is nowhere left to go. Related to dependence is a phenomenon called “supersensitivity” or sensitization of brain cells by psychiatric drugs, which implies that the drugs can actually worsen the progression of the illness which they are supposed to treat.
After being treated for three years patients do poorly and show an inability to withdraw. The core physical effects of withdrawl are outlined in the DSM-IV: 1. disequilibrium (e.g. dizzyness, spinning sensations, swaying, or difficulty walking) 2. gastrointestinal symptoms (e.g. nausea, vomiting) 3. flu-like symptoms (e.g. fatigue, lethargy, muscle pains, chills) 4. sensory disturbances (e.g. tingling, electric shock sensations) 5. sleep disturbances (e.g. insomnia, vivid dreams) Recent research on serotonin antidepressants has shown the adaptations of brain cells involve changes in the instructions given by the DNA of the cells--the master code regulating cellular function.
The Director of the National Institute of Mental Health reports that chronic drug administration drives the production of adaptations, including regulation of neural gene [brain cell DNA] expression. Perhaps as many as 75% of patients are needlessly on these drugs for mild, even trivial, conditions. When the immediate cause of their distress is gone, doctors often don’t check to see if prescription renewal is essential. Patients often fear to “rock the boat,” and fear the return of their distress if unmedicated.
If a person is going to relapse into depression after meds are withdrawn, this typically does not occur until weeks or months after the drug is stopped. Doctors rarely offer alternatives. By combining drugs with psychotherapy and other alternatives, one can usually minimize exposure to the drugs, keeping the dosage low and weaning off the medication within six months to a year. Reassessment should be done at least once a year. It is not an established scientific fact that those with mild to even severe depression have serotonin-deficiencies to begin with. The drugs are all-purpose psychoanalgesics, and would make virtually anyone feel better initially.
Managed care providers don’t want to pay for safer, more effective treatment. Big business discourages alternatives, and sales of Prozac, Zoloft, and Paxil now exceed $4 billion a year. Virtually no studies have been done on long-term effect of the drugs on depressed children and their developing nervous systems, even though they are a specific target market, as are seniors. There is an unusually high incidence of three or more minor malformations in newborns exposed to Prozac in the first trimester, indicating it has a negative effect on embryonic development. To promote psychopharmaceuticals, the marketing of psychiatric diagnoses is often redefined to include much milder forms to include many more people. This has been especially true for depression, obsessive-compulsive disorder, and social phobia and anxiety.
Psychotherapy produces just as effective results, though antidepressants may jump-start those with moderate to severe depression on the road to recovery. While antidepressants take a month or so to become effective, conventional psychotherapy generally takes six to eight weeks for noticeable effects.
The TCAs (Tricyclic antidepressants, such as Elavil) have more severe side effects, which can include persistent dry mouth, sedation, dizziness, and cardiac arrhythmias. They are contraindicated for patients with suicidal tendencies since they can be lethal in even small overdoses. Other drug classes used for depression include monoamine oxidase inhibitors (MAOIs), which block the action of an enzyme in the central nervous system. Heterocyclics, (which cannot be given to those with a seizure disorder), include bupropion (Wellbutrin/Zyban)) and trazodone (Desyrel), Serzone, Effexor, and Remeron.
Side effects include agitation, anxiety, confusion, tremor, dry mouth, fast and irregular heartbeat, headache, low blood pressure, gastrointestinal distress and insomnia. Sexual dysfunction affects 60% of those on antidepressants. Curiously, many of the drug treatments’ side effects seem to actually amplify or highlight the original symptoms of the distress and depression. Men report impotence, inability to ejaculate, or retrograde ejaculation. Many complain most vociferously about the loss of sexual interest, claiming that they were depressed before, but since they now feel like eunuchs, they are really depressed.
Women report an inability to orgasm, inhibited sexual arousal, loss of libido. Many would rather cope with their well-known symptoms again. 70% of all antidepressants are prescribed by primary-care physicians, rather than mental health specialists. There is duress from managed care insurers to treat quickly with this cheaper option, and physicians are paid or debited according to their quotas and compliance. There is little or no incentive to refer patients for psychotherapy. In conventional treatment, psychotherapy is usually limited to weak options such as cognitive-behavioral therapy which simply don’t go deep enough to restructure the psychobiological sources of distress.
Superficial therapies assume that faulty thinking is causing the current depression and focuses on changing the thought patterns and perceptions. The therapist helps the patient identify negative or distorted thought patterns and the emotions or behavior that accompany them, and then retrains the depressed individual to recognize the thinking and react differently to it. The cornerstones of psychotherapy are insight and emotional growth.
Becoming aware of previously unconscious emotions and finding patterns in one’s behavior effect recovery from acute depression and make one less vulnerable to depression in the future. The healing comes from inside not outside, adding to a sense of personal empowerment, rather than reliance or dependence on a pill. Lifestyle--caffeine, alcohol, diet and exercise also need to be considered as amplifiers of depressive disorder. Sadness is a clarifying and relieving emotion that helps us move on after losses.
On the other hand, depression is a paralyzing short-circuit of self-doubt and self-recrimination. Sometimes people become depressed because they are not appropriately angry or sad over the situation. Good psychiatric care doesn’t stop when symptoms abate. Longer-term goals address the individual’s underlying vulnerability to depression--persistent negative views of self, the world, and the future. Cognitive-behavioral therapy is popular with managed care administrators, and is often the only modality offered, because it is easily standardized and can be done with groups, also.
ECT (electroconvulsive therapy) may be administered in extreme cases, when oral medication is refused, or psychotic and suicidal tendencies are present. Though now done under general anesthesia with a muscle relaxant to prevent convulsions, this therapy still sounds downright medieval and produces mixed results. Memory loss, headaches, muscle soreness, nausea and persistent confusion may result. Integrative treatments include homeopathic treatment, good nutrition, exercise, and herbal treatments.
St. John’s wort (Hypericum perforatum) is often tried, but effectiveness of nonregulated suppliments depends on the strength and freshness of the crops used to distill the effective ingredients. A 900 mgs. daily dose is roughly equivalent in action to 5-10 mgs daily of Prozac. Many off-the-shelf products do not contain fresh enough active ingredients or the dosage is irregular. This herb can also negate the biological action of birth-control pills, resulting in unanticipated or unwanted pregnancies, which can lead to further depression and coping failure.
Other side effects include high blood pressure, headaches, stiff neck, nausea, and vomiting. St. John’s wort increases the risk of transplant rejection, and has been implicated in immune suppression. St. John’s wort is available in 300-milligram doses, which are taken three times a day, for a total daily dose of 900 mgs. It takes one or two months to achieve full effects. 64% respond to St. John’s wort while 59% respond to synthetic antidepressants.
TRANSACTIONAL ANALYSIS AND DEPRESSION
Transactional Analysis is a grammar of the internal dynamics of the personality, which is structured through pre- and post-natal imprinting, scripts, games, and rackets. Some individuals are structured around a depressive life script which has the following characteristics: (1) The person has decided upon a position of I’m not OK -- You’re OK. (2) The person occupies the Victim role in the drama triangle, but switches periodically into the Persecutor role, or through magical means into the Rescuer role. (3) The timing of the script is “Wait.” (4) The “wait” is for a magical occurrence that transforms the world without requiring the person to take an active part in causing changes to occur. (Cox, 1980).
The script injunctions are numerous and include “Don’t Succeed,” “Don’t Think,” “Don’t Be Close,” “Don’t Have Fun,” and “Don’t Judge Others.” The last is particularly devastating because they prevent the person from acknowledging that he is being set up. It is a reworded way of saying a “not OK” person shouldn’t pass judgement on persons who are “OK” (everybody else). Actually the person may be very accurately judging and selecting, based on that judgement, persons who will deceive him. Depressive life scripts appear in American literature.
Typical examples include Rip Van Winkle, Charlie Brown, and Rudolph, the Red-Nosed Reindeer. These are stories of those unfortunate souls who are defective from birth, don’t grow up, don’t succeed, get persecuted, and don’t have fun. The fear of individuation and the fear of attachment have both been found to be associated with depression. Depressed individuals fear to get involved with others and differentiating themselves from others, suggesting that they prefer to remain dependently involved with familiar figures.
People in the detached/deindividuated position are the most depressed. Primal fears are fear of getting involved and fear of establishing a clear identity. This implies they favor dependence, even over-dependence, or familiar figures, or an infantile pattern of attachment. Stroke-starved infants grow up to become depressed adults. Because of a tendency toward isolation and blocking, they become stroke-deficient, lacking in allowable stimulation.
Infant depression results from lack of stimulation coupled with the absence (emotional or physical) of the child’s mother during the first year of life, and can be responsible for nearly irremedial damage. Non-verbal and verbal stroking is a vital component in the alleviation of reactive depression in adults. Self-reported distress includes the experience of headaches, faintness, loss of sexual appetite, trouble remembering things, uncontrolled temper outbursts, blaming oneself, pains in the lower back, feeling of inferiority to others, feeling hopeless and nausea.
Many people who come for therapy lead a relatively stroke-less existence (alienation) which has an influence of their experience of “dis-ease” and distress. They don’t know how to ask for strokes in a positive way without discounting or rejecting (“shielding”) their meaning. Positive strokes are defined as expressions of affection, closeness, and appreciation, as well as acknowledgement of one’s competence, skill, and resources from others.
Positive strokes are units of emotional nourishment communicated at the interpersonal level. Emotional anemia comes from scarcity of acceptance and acknowledgement of affection and closeness from others. Whether one accepts or discounts contact is a significant factor associated with the degree of experienced symptom distress. As people are educated to recognize that they have a part in creating “illness” through limiting thoughts, beliefs, and actions, they can become active and responsible participants in their healing process instead of passive victims of the disease process or drug treatment.
DEPRESSIVE DISORDERS AND CRP
In complex dynamic systems (CDS) the whole process unfolds with a “sensitivity to initial conditions.”
Thus, particularly treating chronic, “hereditary” depression, we can expect that CRP journeys will need to return participants to those conditions and events which gave form to their dis-ease, prior to birth, and prior to conception. Painful feelings often resurface when people have less structure in their lives, fewer activities to distract them. Psychiatric syndromes have two parts: a psychological core and superficial physical symptoms. Unaware of the true source of our upsets, we may develop symptoms, becoming distressed and tearful. This is a kind of code or flag raised over the distress.
Psychotherapy helps decipher the code and brings the flag, or symptoms, down in the process. By contrast, medications only suppress symptoms. By themselves, they are never a cure. As such, they should be used only as adjuncts to the real healing process. “Healing” does not necessarily mean a cure nor total elimination of all symptoms. It has to do with a subjective process, difficult to describe because, by its very nature, it is irrational, totally individual, and yet linked to a timeless and universal experience. The therapist helps a person to understand what his unconscious is saying, and gives helpful encouragement to integrate this knowledge, or relate to the unintegratable, and accept it. This promotes growth according to that particular person’s own inner laws, allowing the unfolding of the total individual.
Many CRP participants know, confusedly, from the start, that there is something they are looking for. They don’t know what it is, but they do know that their discontent stems from within themselves and that they are yearning for an inner journey for which they need a guide. “Healing is a dynamic happening related to a deep understanding of the role of suffering; an acceptance of what one is, totally: whole, rather than striving toward an image of perfection; an awareness of, and a relatedness to, a power greater than ourselves.
In other words, healing is discovering the meaning of our own life, and our place in the universe, not as a philosophical concept, but as an existential experience of inestimable value--the pearl of great price, hidden in the dunghill of unconsciousness, and pride.” (Tuby, 1976). Jung thought that no therapist could lead his patients further than he had gone himself. No therapist can help a participant on the inner journey unless he himself is continuously grappling with his own unconscious material. The theme of the wounded healer is universal, and eternally valid. It is archetypal. From the most primitive shaman, to the Greek god Asklepios, it is through some divine injury that healing takes place.
In the Asklepian healing temples, only those summoned by the god Asklepios were allowed to take part in the initiation rites. When the inner voice cannot be heard, a neurosis develops, forcing the individual to change course and be true to himself, true to his vocation. Healing begins through the call of the symptom. In ancient Greece, a sign such as a dream, or a vision, had to indicate to the sick person that he was called by the god of healing. Those who dedicated their lives to the cult of the god were called therapeutea, and it is they who performed the preparatory ritual. Sacrifices were offered, and the therapeutea would bathe and purify the incubant, who would then be left to sleep, alone, in the sacred precinct of the temple.
If Asklepios appeared to him, either in a dream or in ‘the waking state’, i.e. in a vision, he was cured. These dreams were never interpreted, either by the priests or the physicians. They just happened. The right dream was the cure, and the role of the therapeutea was to assist, to help the dreamer be in the best possible situation to receive the healing dream...in other words to draw upon his or her own inner healing power. The dynamic imagery of consciousness is a self-representation of the energic processes of the psyche. It is the vehicle by which one form of energy is transformed into another, and makes possible the transmutation, or true change, of psychological conditions--a means of recreating the original whole.
David Bohm has proposed a notion which supersedes the term psychosomatic. Soma-significance emphasizes the unity of body and significance or meaning. “The notion of soma-significance implies that soma (or the physical) and its signficance (which is mental) are not separate in the sense that soma and psyche are generally considered to be; rather they are two aspects of one overall indivisible reality. By such an aspect, we mean a kind of view or a way of looking. That is to say, it is a form in which the whole of reality appears (i.e., displays or unfolds), either in our perception or in our thinking.
Clearly, each aspect reflects and implies the other (so that the other shows in it). Although we describe these aspects by using different words, we imply that they are both revealing one unbroken whole of reality, as it were from different sides.” (Bohm, “Soma-Significance”). This description is reminiscent of the nature of fractals (self-similar forms) in Chaos Theory--”a form in which the whole of reality appears.” It is commonly known in psychotherapy that, for example, a dream (especially the first dream presented) often contains the whole image of the client’s problem and its eventual cure. In this way our nightly dreams reiterate our existential situation over and over. The problem, distress, or disease is neither physical nor mental/emotional--it is indivisibly both.
Soma-significance regards the field of reality as a whole, as an unbroken flow: “To bring out how soma and signficance are related, we first note that each particular kind of significance is carried by some somatic order, arrangement, connection, or organization of distinguishable elements...meanings are carried somatically by further physical, chemical, and electrical processes into the brain and the rest of the nervous system, where they are apprehended at higher and higher intellectual and emotional levels of meaning.” “As this process takes place these meanings, along with their somatic concomitants, become ever more subtle. . .The meaning is rarefied, delicate, highly refined, elusive, indefinable, intangible.
The subtle may be contrasted with the manifest. The next proposal is then that reality has two further key aspects, the subtle and the manifest, which are closely related to soma and significance. Thus, as has already been pointed out, each somatic form carries a meaning. This meaning is clearly more subtle than the form itself. But in turn, such a meaning can be grasped in yet another somatic form; electrical-chemical and other activity in the brain and the rest of the nervous system - which is evidently more subtle than the original somatic form that gave rise to it. This distinction of subtle and manifest is clearly only relative, since what is manifest in one level may be subtle on another.”
This is reflected in Chaos Theory as the notion of fractal reiteration, infinite nesting. In CRP, no matter at what level we perceive the dis-ease the form is self-similar and embedded in deeper or more subtle levels, each level holographically encoding the whole form with less detail (Swinney and Miller, 1992).
“This sort of action may in principle go on to indefinitely deep and subtle levels of significance. Meanings are thus seen to be capable of being organized into ever more subtle and comprehensive overall structures that imply, contain, and enfold each other, in ways that are capable of indefinite extension. In this whole process...a certain content is first met in a given level and later in a different level. The relationship between these levels is then seen to be part of the essential content of yet another level...this structure continues indefinitely...no ultimate reduction is possible. ...A level that is mainly somatic may have a significance, which is carried into the next more subtle level of soma, which has a further significance.” (Bohm).
“We have thus far emphasized the significance of soma, i.e. that each somatic configuration has a meaning, and that it is such a meaning that is grasped at more subtle levels of soma. This may be called the soma-significant relationship.” (Bohm). Bohm makes it clear that it is necessary for both somatic and significant poles to be present in each concrete instance of experience. It is impossible, for example, to have all the content on the side of soma (or on that of signficance). In the inverse signa-somatic relationship, every meaning at a given level is seen actively to affect the soma at a more manifest level. The signa-somatic relationship is to be distinguished from the psychosomatic in that the latter is commonly regarded as between separate entities or substances.
Soma-significance only implies abstracted aspects or poles of one whole flow in a field. Bohm goes on to point out that “a similar approach may be made for diseases and disorders in the soma-significant flow,” and he speaks of runaway feedback loops between the soma-significant and the signa-somatic as being deeply involved in a wide range of neurotic disorders. It is the over-all structure of meaning that is grasped in every experience. “As a given meaning is carried into the somatic side, whether in healthy or in disordered process, one can see that it still continues to be a kind of development of the original significance. . .One can regard this whole process as a further unfoldment of the original significance into forms that are suitable for instructing the body to carry out the implications of what is meant.” Even relationships with Nature and with the Cosmos are evidently deeply affected by what these mean to us. Such meanings fundamentally affect our actions toward them, and thus indirectly their actions back on us are influenced in a similar way.
Once we begin listening to the nature within us--our nature--and experience journeys through the inner cosmos, we can never feel truly lonely, disconnected, and hopeless again. We can directly experience ourself as an intrinsic part of one subtle webwork of being. Meaning indicates not only the significance of something to us, but also, our intention toward it. Our choices thus depend on the total significance of the moment. It is this whole signficance that gives rise to the over-all intention, which we sense as a feeling of being ready to respond in a certain way. All the factors of a given total situation, both external and internal, contribute to the determination of intention.
In the process of somasignficance it is not possible to form and sustain intentions that do not grow out of this totality of significance, but most of the meaning in this process is implicit. Recalling that meaning is an intrinsic part of reality, we see that perception of new meaning constitutes a creative act. As their implications are unfolded when people take them up, work with them, etc., the new meanings that have thus been created make their corresponding contributions to this reality. These contributions are not only in the aspect of significance, but also in the aspect of soma. Each perception of a new meaning by a human being actually changes the over-all reality in which they live and have their existence, sometimes in a far-reaching way.
Psychopharmacology rests on a “disease model” of psychiatric symptoms. This is the application of an extreme medical or biological model to psychological syndromes. Symptoms in and of themselves do not necessarily indicate a disease. All psychiatric diagnoses are merely syndromes, clusters of symptoms presumed to be related, disorders not diseases. There is no proof either of the cause or physiology for any psychiatric diagnosis.
This is a compelling argument for fostering and allowing the self-healing capacity to adjust biological parameters in an internally directed self-organizing way that is not separate from the psychological situation. Psychological processes can be modeled as chaotic attractors, some on the edge of chaos, poised between chaotic and predictable regimens depending on small changes in their control parameters. The stability of patterns arises from the tendency to self-organize. For example, Allan Combs (1996) gives an example, “An ordinary episode of depression is usually accompanied by behaviors that actively feed that state of mind, or at least don’t rally against it. In the mean time, cognitive processes such as thought, perception, and memory become tilted toward discouraging outcomes.
Research suggests, for example, that when we are depressed we tend to recall unpleasant episodes from our past (Bower, 1981). These recollections in turn feed the mood of depression, and so perpetuate a continuous cycle of memory and mood. To disrupt such a self-perpetuating circuit one needs to engage in activities that can up-end the dominant depressive attractor.” “The essential notion is that the whole cloth of consciousness is woven of a tightly knit patchwork of subprocess, each made possible and supported on all sides by the totality of the cloth itself, while at the same time contributing its part to the creation of that totality.
To take another example, consider two discrete states of consciousness, the ordinary waking state and dream sleep. Each is an entire world of experience. Each carries its own intrinsic styles of thinking, its own forms of memory, feelings, thought and perceptions--its own possibilities.” “Now, dream thought arises from the total experience of the dream and cannot be sensibly separated from it. At the same time, it contributes its unique quality to the dream. Finally, what is possible to know in the dream may not make sense in waking life, and what is reasonable in waking life may not be sensible in a dream. Thus, knowledge is state specific (Tart,1985), as is the entire experienced world of each form of consciousness.”
Ben Goertzel describes the process of transformation of consciousness in a complex dynamical system--the mind: “Psychological structures make no sense considered statically; they have to be considered dynamically, as “attractors” of systems that change over time. There are three kinds of attractors. There are fixed-point attractors, i.e. equilibrium system behaviors, in which a system does not change over time. There are periodic attractors, i.e. cyclic system behaviors. And there are strange attractors -- a grab-bag category covering everything that is neither unchanging nor periodic.
Strange attractors are often chaotic, in that, once a system is locked into a strange attractor, its behavior cannot be predicted in any detail. But, nevertheless, strange attractors need not be “random,” they can be intricately structured.” “In chaos theory terms, the transition between one state of consciousness and another is represented as a jolt which knocks the system out of its attractor, and leads it along a trajectory toward another attractor.
This model predicts that transition between states of consciousness should be a sudden and dramatic process -- very much a discrete shift rather than a continuous gradation.” In Persuasion and Healing, psychiatrist Jerome D. Frank argues that the theoretical framework within which therapists work has little or nothing to do with their ability to “heal” patients. That power stems, rather, from the therapist’s ability to make patients believe they will improve. Frank gives credit to the placebo effect as the primary active ingredient underlying all psychotherapies and even most drug treatments.
Science, of course, cannot pinpoint or measure the qualities that enable a particular therapist to induce the placebo effect in a given individual. Frank attributes it to more than creating a positive expectation: “People have been attacking Freud because he wasn’t a scientist, but that misses the point. He was a great mythmaker.” He carried the power of the archetypal healer and embodied it in himself and others. Studies of antidepressants over the past 30 years show that two thirds of the patients placed on medication either showed no improvement or responded equally well to a placebo as to the antidepressant.
Drugs only produce significantly different outcomes in one third of patients, but they never learn to solve their depression problems internally. Walter A. Brown, a psychiatrist at Brown University and an authority on the placebo effect, has supported the assertion that the placebo effect might explain much of the effectiveness of medications for emotional disorders (SciAmer, Dec’96, p. 110).
For the majority of patients there is little or no significant difference between any of the treatments, including the placebo-plus-clinical management approach. Patients self-report that they do as well with psychotherapy alone, as with therapy in conjunction with drugs. Research has shown that traumatic experiences can change the way the brain works, as can talk therapy, and even more so, process-oriented therapy which creates flow experiences. The brain undergoes changes similar to those induced by medication. The new biological explanations of mental disorders make “good stories” but still lack empirical substantiation.
CRP AND GRIEF WORK
“Melancholy is at the bottom of everything, just as at the end of all rivers is the sea...Can it be otherwise in a world where nothing lasts, where all we have loved or shall love must die? Is death, then, the secret of life? The gloom of an eternal mourning enwraps, more or less closely, every serious and thoughtful soul, as night enwraps the universe.” (Amiel, 1893). In grief, we are pulled down into the world of the dead. We continue to live, but with a foot in both worlds. However, there is no sweetness or savor in life.
We mimic death, and exist in a dead world. We feel miserable and ill, moving through a world of ghosts, feeling like the shadow of a dream. In our isolation we are cut off from others, the world, and God. We seem to be in perpetual fog and darkness, plagued by indecision, inefficiency, and confusion. Most of us have felt depressed in greater or lesser degree. Since everything changes as time flows, and change entails loss, this is not surprising. It is a truism that we grow sad and depressed when a person we love dies; it is a truism because grief is universal and normal. In fact, failure to grieve is evidence of psychological abnormality.
Mourning is characteristically a state of mind, but it is accompanied by a host of painful somatic sensations that are remarkably uniform. The following are commonly shown during acute grief: sensations of somatic distress occurring in waves lasting from twenty minutes to an hour at a time, a feeling of tightness in the throat, choking with shortness of breath, need for sighing, and an empty feeling in the abdomen, lack of muscular power, and intense subjective distress described as tension or mental pain. Traumatic bereavements are a special case of mourning (see “PTSD and CRP”). They results from shocking deaths which are sudden and perhaps horrific. They occur in a variety of settings including personal and community violence or catastrophe.
Traumatic bereavement stands in contrast to experiences of quiet death at home, without mutilation, bodily distortion, shock, threat, horror, and helplessness. Reactions to the traumatic circumstances are different and predict more adverse health outcomes for bereaved spouses. There is interference in the grieving process from traumatic stress. The striking features point up that the emotional aspect of grief is quite as painful as the somatic. Inner anguish, loss of interest in a dreary, empty world, isolation from other people, loneliness and feelings of inner emptiness. In this way grief mimics clinical depression. The call to heal and the call to death are ultimately the same call to formlessness.
Many disorders display symptoms and imagery which represent stalled stages in the natural consciousness restructuring process -- the organism’s attempt to heal itself gets stuck. According to Freud, mourning is work and requires mental effort. That work consists of the courage extended over a period of time to face the pain of grieving and to combat the tendency of the living attachment to the lost person to persist. The fabric of memories and associations and feelings that permeate the image of the deceased in the mind of the bereaved survivor does not automatically disappear when the loved person dies.
In the process of grieving each of the memories and associations must be revived in the mind’s eye; as each is thought of, a fresh wave of grief occurs, which gradually fades. As each separate strand of the fabric of associations is thus worked over, it loses its power to evoke the pain of loss, and the loving attachment to the dead one gradually diminishes until the process is complete and the ghost is laid to rest. The mourner is once again free to live and love in the world of the living.
There are times, however, when grief does not flow so smoothly; it becomes blocked or distorted in ways that have to be considered pathological. These abnormal forms of mourning differ from major depression in one way: grief does not include the feelings of guilt nor the self-accusatory attitudes that characterize the depressed person. This holds true, unless, there were unresolved issues, and conflicts about choices in the caregiving process. Then the internal litany becomes one of, “Coulda, shoulda, woulda...” A certain degree of self-criticism is understandable as a consequence of the failure to live up to ideals set for one’s behavior. This can be felt as a lowering of self-esteem. Unresolved grief can function within like a “strange attractor” through the process of identification.
For example: “Barbara” accepts the fact of her mother’s death. She knows she ‘can’t bring her back.’; there is no denial. She is aware of no feelings or conviction that her mother is still alive. And yet she does, in a way, ‘bring her back’ by psychologically making a part of her mother a part of herself. The image of her beloved mother at the time of her death was that of a person sick with heart disease. She does not relinquish this image nor allow it to die. She keeps it alive, but not as the image of a person external to herself; it become internalized and alters her own image of herself.
She no longer conceives of herself as a healthy person, able to be active. Rather, she thinks of herself as a person who is sick and in danger of dying of heart disease. She develops symptoms which are for her consistent with this diagnosis, and has to be admitted to the hospital for her illness. The image of herself is the image of her mother, which has entered the fabric of her ego and has radically altered that portion of the self-organization that constitutes her self-image.
She has identified with her mother; she has made certain behavioral and personality attributes of her mother a part of herself. In this way she keeps her mother alive. Her attention and mental energies are not directed toward the real fact of her mother’s death; she does not experience the pain of this loss. On the contrary, she concentrates on the image of her mother now living within her. She is preoccupied with her concern over having heart disease.
The grief work is blocked, neurotic symptoms replace mourning, and she cannot free herself of her mother. We do not yet fully understand the psychological process involved in the mechanism of identification, but it is as if it were “attractor-centered.” Faced with a loss, a person adopts certain behavioral and characterological traits of the lost one. This represents a change in self-organization, an internalization, but how this modification in the ego is brought about is not yet apparent. The sense of identity as a person, the feeling of oneness and unity is disturbed.
SUMMARY:
THE EXPERIENCE OF HEALING AS FLOW
Whether we speak of normal experience, chronic depression or grief, it is a fact that frustration is deeply woven into the fabric of life. We are riddled with desires and programmed by ideals. Should some of our real or imagined needs be temporarily met, we immediately begin wishing for more. This chronic dissatisfaction stands in the way of our contentment. Depression has its roots in failure to adjust to lowered expectations of self, others, and world. Faust was given power by the Devil on condition that he would never be satisfied with what he has. Happiness and satisfaction with life depend on how small a gap one perceives between what one wishes for what one possesses.
Traditional social shields such as religion, ethnic traditions, patriotism, etc. no longer are effective for many who feel exposed to the harsh winds of chaos. One of the main forces that affects consciousness adversely is psychic disorder--that is, information that conflicts with our existing intensions, or distracts us from carrying them out. We give this condition many names, depending on how we experience it: pain, fear, rage, anxiety, depression, ennui, anomie, or jealousy. All these varieties of disorder force attention to be diverted in undesirable directions--toward other attractors. Fear of chaos manifests as ontological anxiety or existential dread, a fear of being, a feeling there is no meaning in life; since nothing makes sense, why go on?
Overcoming the anxiety and depressions of contemporary life requires a drastic change in attitude about what is important and what is not. We can learn to enjoy and find meaning in the ongoing stream of experience, in the process of living itself. Experience depends on the way we invest psychic energy--on the structure of attention. This, in turn is related to goals and intentions. These processes are connected to each other by the self, or the dynamic mental representation we have of the entire system of our goals. This process is complex, and the notion of complexity is related to the same concept as used by some evolutionary biologists and also described with poetic insights. Its essence in terms of the psychology of the self is that a complex person is one whose behavior and ideas cannot be easily explained, and whose development is not predictable, but is autopoetic, that is self-organizing emergent order. Order in consciousness is experienced as flow, optimal experience, healing experience. Following a flow experience, the organization of the self is more complex than it had been before. It is by becoming increasingly complex that the self might be said to grow. The flow state facilitates both differentiation and integration.
The old alchemists used to say, “Only that which has been properly separated can be rightfully joined.” Complexity also facilitates the integration of autonomous parts. After each episode of flow a person becomes more of a unique individual, less predictable, possessed of rarer skills. The complex self is more likely to avoid both selfishness and conformity. “The self becomes complex as a result of experiencing flow. Paradoxically, it is when we act freely, for the sake of the action itself rather than for ulterior motives, that we learn to become more than what we were. . .Flow is important both because it makes the present instant more enjoyable, and because it builds the self-confidence that allows us to develop skills and make significant contributions to humankind.” (Csikszentmihalyi, 1990). Flow helps us to integrate the self because in that state of deep concentration consciousness is unusually well ordered. Thoughts, intentions, feelings, and all senses are focused on the same goal. Experience is in harmony. And when the flow episode is over, one feels more “together” than before, not only internally but also with respect to other people and the world and cosmos in general. As a youth, the healer Asklepios received a special gift from Athena, Goddess of Wisdom. She gave him the blood of the terrible serpent-haired Medusa. The blood that flowed from the left side of Medusa brought death, and the blood that flowed from the right side brought healing. The paradoxical quality of this blood reflects the closeness between illness and health, and points to the equally paradoxical quality of the unconscious that both wounds and heals. This metaphor of the mystically-charged flowing life-blood --the archetypal placebo-- is all part of the mysteries of illness and death, healing and life. As the archetype of the wounded healer shows, the healing power flows, not through those who have known only health, but through those who have been ill, who have been drawn near the dark land of death, and have then been healed. Only through illness or a journey to the underworld can the Wounded Healer come alive in a human being, either as “healer” or one who heals from within. Ultimately, it matters little what complex mechanisms help us mobilize our own inner capacity for healing. The fact that we enter the healing process with commitment and intentionality is far more important. Taking the journey toward healing means we recreate the archetypal journey of the hero or heroine, who is neither helpless nor hopeless, but approaches fate with determinism and courage. When we willingly submit to the universal process of death and renewal we activate transpersonal resources that transcend our own limited capacities for restructuring our consciousness and self-healing. Ultimately all healing is self-healing, and implies profound self-acceptance, and can lead to loving acceptance of others and the world as it is, rather than as we would like it to be. It is impossible to feel isolated, lonely, and “dead” when one feels a sense of vivifying identification which stems from direct experience of the dynamic whole of reality. It restores our sense of personal wholeness. We are an indivisible part of a flow in the whole field of consciousness. The entire cosmos is contained holographically within us. When we become “superconductors” of consciousness, we draw from the spiritual wellsprings of life and health, that which eternally makes the world bloom anew. The “dam” of depression which has blocked the dynamic flow of life and love cannot forever withstand this immense healing force. It breaks through the “dead void” and one is no longer bereft of the power of the dynamic ground-state of existence, or cosmic unity. Restoration of the flow-state through process-oriented experiential therapy is the serpentine process of healing. It changes us at the quantum and psychobiological levels. Immersion in this healing state has the power to restructure our consciousness at the most fundamental level, and is an endless source of creativity, spiritual sustanance, and pleasure. REFERENCES Bloomfield, M.D., Harold, Nordfors and McWilliams, HYPERICUM & DEPRESSION, Prelude Press, Los Angeles, 1996. Bohm, David, “Soma-Significance: A New Notion of the Relationship Between the Physical and the Mental,” online from DynaPsych and Ben Goertzel. Cartmel, Gerald, “Cognitive dysfunction and psychosomatic disease,” Transactional Analysis Journal, Vol. 22, No. 3, July 1992, pp.174-181. Combs, Allan, “Consciousness as a System Near the Edge of Chaos,” online from DynaPsych, 1996. Cox,, Mary Osborne, “Depressive life scripts in American folk literature,” TA Journal, Vol. 10, No. 3, July 1980. Csikszentmihalyi, Mihaly, FLOW: THE PSYCHOLOGY OF OPTIMAL EXPERIENCE, Harper & Row, New York, 1990. Glenmullen, Joseph, M.D., PROZAC BACKLASH, Overcoming the dangers of Prozac, Zoloft, Paxil, and other antidepressants with safe, effective alternatives. Simon & Schuster, New York, 2000. Harding, M. Esther, “The Value and Meaning of Depression, “ Bulletin for the A.P.C. of N.Y. (Analytical Psychology Club of New York, Inc.), 1970. Horgan, John, “Why Freud Isn’t Dead,” SciAmer, December 1996, p.106-111. Miller, Iona and Richard, THE MODERN ALCHEMIST: A Guide to Personal Transformation, Phanes Press: Grand Rapids, Michigan: 1994. Steiner, Claude, SCRIPTS PEOPLE LIVE, Grove Press, New York, 1974. Swinney, Graywolf, HOLOGRAPHIC HEALING, Asklepia Foundation, 1997. Swinney, Graywolf and Iona Miller, DREAMHEALING: Chaos & the Creative Consciousness Process, Asklepia Pub., 1992. Tart, Charles T., 1985. “Consciousness, altered states, and worlds of experience,” The Journal of Transpersonal Psychology, 18: 159-170.
KEYWORDS: Creative Consciousness Process, dreams, depression, creativity, healing, psychotherapy, SSRIs, complex dynamics, chaos theory, neurotransmitters, restructuring consciousness, psychosomatics, grief, flow, psychoneuroimmunology, depressive disorders, major depression, treatment protocols, dysthymic disorder, double depression, bipolar disorder, cyclothymia, seroton in, Prozac, Zoloft, Paxil, antidepressants, sexual dysfunction, St. John's Wort, Asklepios, David Bohm.
WHAT IS DEPRESSION?
Chronic depression is characterized by a profound and persistent feeling of sadness or despair and a loss of interest in things that were once pleasurable. The causes behind depression are complex and dynamic and not yet fully understood. The “initial conditions” that lead to either a major depressive episode or chronic dysthymia are generally situational rather than biologically-induced.
Therefore, practitioners treating all depressions with SSRIs may neglect to address and heal the psychological and emotional wounds that led to the maladaptive changes in biochemistry. While an imbalance of certain neurotransmitters, the chemicals in the brain that transmit messages between nerve cells, is believed to be the key to depression, external factors, such as upbringing (more so in dysthymia than major depression) may be as important.
For example, if an individual is abused and neglected throughout childhood and adolescence, a pattern of low self-esteem and negative thinking may emerge, initiating a lifelong pattern of depression. Or, perhaps, the death of a parent during childhood creates patterns of unresolved loss, grief, sadness, and guilt. Whenever emotions are deadened, we tend to identify with that state exclusively.
Heredity does seem to play a role in who develops depressive disorders. Individuals with major depression in their immediate family are up to three times more likely to have the disorder themselves. It is modeled by their caregivers. It has been theorized that biological and genetic factors may make certain individuals pre-disposed or prone to depressive disorders, but environmental circumstances may often trigger the disorder. Transactional Analysis describes the Life Scripts which we adopt as children.
It postulates that depression is a “No Love” script. According to Steiner, (1974): “Large numbers of people in this country are in a constant unsuccessful quest for a successful, loving relationship. This is a difficulty that seems to affect women more often than men, probably because women are more sensitized to their needs for love and less capable of adapting to Lovelessness. Lack of adequate stroking, which leads to chronic stroke-hunger and various degrees of depression, culminating in either suicide or in the most extreme form of depression--catatonia--is one large strand of human suffering.
The Lovelessness script is based on the Stroke Economy, a set of early childhood injunctions addressed to the stroking capacities of children. Those injunctions very effectively cripple the growing child’s normal tendencies and skills for getting strokes. The result is various degrees of depression with feelings of being unloved and/or unlovable.” External stressors and significant life changes, such as chronic medical problems, death of a loved one, divorce or estrangement, miscarriage, or loss of a job can also result in a form of depression known as adjustment disorder with its lowered expectations. Although periods of adjustment disorder usually resolve themselves, occasionally they may evolve into a major depressive disorder. In ancient times, depression was a recognized temperament, known as Melancholia.
Depression was also seen as a characteristic part of the universal process of transformation. It was viewed as the starting point of the journey, recognition of the emptiness and sterility of the experience of those who are frustrated, isolated, and discontent. It was discovered to be the root of the spiritual quest for personal and universal meaning. That transformative process necessarily begins in a forced breakdown which demands the time for introversion and recovery of energy reserves. In alchemy this melancholic state was known as the nigredo, a deep blackness of spirit, a dry empty void.
In mythology and astrology, it was kindled by Father Time, Saturn (Roman) or Cronos (Greek), hence its inherently “chronic” nature. In depression, our fundamental psychobiological rhythms are disturbed--sleeping, eating, thinking, and activity. These biological disturbances lead to a complex interlocking group of psychophysical changes which depress the well-being and functionality of the individual until the call to restructure consciousness is heeded. There is time-honored value and meaning in many types of depression, which can only be experienced by letting the process unfold, rather than chemically blocking or subverting it. It was always considered the beginning of a descent into darkness, a metaphorical trip to hell, or in modern terms, the unconscious.
Psychologically, one experiences a chaotic state of conflict between hostile psychic elements. These complex dynamics need time to resolve and allow recovery from the intolerable strain of the environment. Then the characteristic melancholia, sleeplessness, and restless volatility begin to resolve. Rather than a state to be overcome, the disorder is a call to adventure from the spirit to the soul, a call from dry literalism into the imagistically rich inner world. This allows one to break through into a fresh mode of perception.
Typical manifestations of this stage of the mystery process include long dreams, confusions, numbing, and a drained or depressed mental attitude. Missing the point, we may keep looking for what is “wrong,” in organic or neurological problems. Then we get gross--rather than subtle--treatments, consisting of pills, body work, or dance therapy. But it is the soul which is sick unto death, and ruminates on it morbidly. The cure will not come through vitamin therapy, or rejuvinating exercise, or prescription drugs. Life as you have known it is is falling apart. You are prematurely grieving the death of your old self, and may not yet even know it.
The élan vital, or life energy has been pulled into the unconscious, leaving the ego frustrated and discontent. It is the syndrome of a soul cut off from the well-springs of life. The feeling of being drained, or over-extended may become so powerful that it forces a breakdown. Life becomes a metaphorical journey through a wasteland. It brings skepticism, bitterness, sarcasm, the feeling of being damned. The depression and restlessness that result may lead to drugs or alcohol abuse. Conversely, substance abuse aggravates depression in a viscious cycle. The ability to see through to a value in depression and experience the meaningfulness of the feeling of meaninglessness has a prognosticative purpose. Attaching meaning to depression allows an emotional participation which unblocks the flow of psychic energy.
Depression is not a loss of meaning, but the feeling of loss of a sense of meaning. This is actually the beginning point of the quest, as illustrated by such stories as Dante’s Inferno, Rider Haggard’s SHE!, Fowles’ The Magus, and Melville’s Moby Dick. If one can see that the world is beautiful, but has lost the ability to feel that beauty, mood swings can range from sullen inertia to active despair.
There is a sense of fragmentation and alienation from one’s self. You may find yourself devoid of emotional response, except perhaps self-judgement and volcanic outbursts. Compassion fatigue and anhedonia are the result of “not caring anymore.” There may be a persistent belief that oneself or others would be better off dead. Suicidal ideation may occur with or without a specific plan or suicide attempts.
Commonly associated features include tearfulness, anxiety, irritability, brooding or obsessive rumination, excessive concern with physical health, panic attacks and phobias. A common delusion is that one is being persecuted. There may be nihilistic delusions of world or personal destruction, somatic delusions of cancer or other serious illness, or delusions of poverty. Depressed children may develop Separation Anxiety Disorder, Overanxious Disorder and Avoidant Disorder, as well as sulkiness, inattentiveness, reluctance to cooperate, and inattention to personal appearance and hygiene.
Those adults who are extremely depressed become unable to function socially or occupationally, or even to feed, bathe, and clothe himself or herself. Seniors are particularly vulnerable. The smallest task seems difficult or impossible to accomplish. This is a major reason individuals seek psychotherapy, or a spiritual path of renewal. Participants find a new sense of inner unity and renewal, a glimpse of deeper values, of the Self, and self-reconciliation, spiritual connection, renewed zest.
The wilderness is no longer barren and life blossoms and bears fruit. One meaning of the experiences of depression is that our wholeness, or individuation, the Self, can no longer wait while we follow egotistic ways or even seek legitimate ego fulfillment. When current ego attitudes are outdated and lack adaptability, we feel stuck. The subconscious begins to revolt, seeking a psychological revolution in attitudes. If we listen to the voice within our depression, we come to realize that we must willingly subject ourselves to change. Conscious and unconscious drives, what was previously rejected and suppressed, need to realign (Miller and Miller, 1994).
The Self brings us, drives us, into the wilderness of depression and from there we can attend to the vision within. This decision to subject ourselves to change may be considered a spiritual awakening, a willingness to look at our own unlived potential for both good and evil. Classically, the nigredo is a time of disappointment, divorce, soul-searching, and reorientation, and responsibility to self to fulfill unlived potential. Your destiny begins to take form, or reform. You may be pressured into it even if you resist, and this is the black mood’s positive intent. The promise reported by the ancient alchemists, is that following this state of darkness, the light begins to dawn.
Insights gained through paying attention to the unconscious, to dreams and so on, throw a light on our inner condition, and we regain relatedness through feeling. The blackness is accepted and taken to oneself, instead of being blamed on outside situations and other people. We begin to see it is our own withdrawl and loss of feeling and contact with our shadow that is the true cause of the darkness. We can recognize we are not just suffering a personal ill, but participating in a universal process of creativity. It is a natural part of human development, when the ego can no longer pursue only its selfish concerns and addictive demands Depression shakes up the stagnant order of things with its burning awareness of personal shortcomings and inadequacies. Old traumas, limiting core beliefs, and self-indulgent tendencies that severely limit one must be given a way to transform and free up energy for personal fulfillment.
Feeling and compassion return as light begins to shine in the darkness. The experience of restriction begins to transform into one of liberation as you re-own the lost part of yourself, and digest your new experiences. Psychosomatic symptoms may suddenly vanish. True, you will have to withstand a chaotic state of conflict among hostile psychic forces. But, in reconnecting with the well-spring of being, chaotic consciousness, we restructure our primal existential self-image.
Psychopharmacology rests on a “disease model” of psychiatric symptoms. This is the application of an extreme medical or biological model to psychological syndromes. Perhaps a few severe psychiatric conditions such as schizophrenia, bipolar, or psychotic depression have a strong biological componenet. But to treat all psychiatric symptoms as though they were exclusively biological is unacceptable reductionism.
Symptoms in and of themselves do not necessarily indicate a disease. All psychiatric diagnoses are merely syndromes, clusters of symptoms presumed to be related, disorders not diseases. There is no proof either of the cause or physiology for any psychiatric diagnosis. WHAT CAUSES DEPRESSION? Depression affects an estimated 17 million people. The size of the subgenual prefrontal cortex of the brain (located behind the bridge of the nose) may be a determining factor in hereditary depressive disorders. Positron emission tomography (PET) scans reveals widespread changes in brain functioning for those clinically depressed.
The hereditary and biochemical imbalance theories are still unproven and controversial models. Researchers admit that they have many elegant models, but don’t really know the exact mechanism by which antidepressants work because they aren’t sure of the origin of depression itself. “Eventually, scientists may discover real proof that a small percentage of patients have genetically determined, biological symptoms. But we are a long way from any such knowledge. When patients are told otherwise, they are being seriously misled.” (Glenmullen, 2000).
The average age for a first depressive episode occurs in the mid-20s, although it can strike all age groups indiscriminately, from children to the elderly. Even infants can experience a major depressive episode, and certainly they are affected by the depressions of their caregivers. Depression is more likely in first-degree relations of the depressed. One in four women is likely to experience a severe episode, with a 10-20% lifetime prevalence, compared to 5-10% for men.
Disturbances in sleep, appetite, and mental processes are a common accompaniment. Major depressive disorder is a moderate or severe episode of depression lasting two or more weeks, and may include a preoccupation with death or suicide. In children, the major depression may appear as irritability. The person may deny feeling depressed, or try to mask or self-medicate the problem. Major markers of onset include the following: * Significant change in weight. * Insomnia or hypersomnia (excessive sleep) nearly every day. *
Psychomotor agitation or retardation. * Fatigue or loss of energy. * Feelings of worthlessness or inappropriate guilt. * Diminished ability to think or to concentrate, or indecisiveness. * Recurrent thoughts of death or suicidal and/or suicide attempts. * Excessive crying. * Unexplained, chronic aches and pains that don’t respond to treatment.
Dysthymic Disorder (or Depressive Neurosis) is an ongoing, chronic depression that lasts two or more years (one or more years in children) and has an average duration of 16 years. Predisposing factors include an inadequate, disorganized, rejecting, and chaotic environment. The mild to moderate symptoms may rise and fall in intensity, with some periods of normal, non-depressed mood of up to two months in length. Its onset is gradual, and may not be pinpointed. Often there is coexisting personality disturbance, such as Borderline, Histrionic, Narcissistic, Avoidant, or Dependent Personality Disorders. Dysthymia often occurs with other psychiatric and physical conditions. Up to 70% of patients have both dysthymic disorder and major depressive disorder, which is known as “double depression.” Substance abuse, panic disorders, personality disorders, and social phobias may compound the problem.
Dysthymia is common in certain medical conditions, such as multiple sclerosis, AIDS, hypothyroidism, chronic fatigue syndrome, Parkinson’s disease, diabetes, and post-cardiac transplantation. It is possible that other pharmacological treatment affects neurotransmitters, and the depression may complicate recovery. Two or more of the following symptoms are experienced daily: * Under or overeating. * Insomnia or hypersomnia. * Low energy or fatigue. * Poor concentration or trouble making decisions. * Feelings of hopelessness. Bipolar disorder is an affective mental illness that causes radical emotional changes and alternating mood swings from manic highs to depressive lows. Cyclothymia is a mild form of Bipolar Disorder. Another temporary and little understood source of depression is post-partum depression, with its radical hormone shifts.
CONVENTIONAL TREATMENT PROTOCOLS AND HAZARDS
Untreated or improperly treated depression is the number one cause of suicide in the United States. Proper treatment relieves symptoms in 80-90%.
After each major depressive episode, the risk of recurrence climbs significantly--50% after one episode, 70% after two episodes, and 90% after three episodes. For this reason, patients need to be aware of the symptoms of recurring depression and may require long-term maintenance treatment of antidepressants and/or therapy. Early intervention with children with depression is effective in arresting development of more severe problems. Patient education in the form of therapy or self-help groups is crucial for taking an active part in the treatment program.
Numerous independent studies have found that drugs are not significantly more effective than “talking cures” and process work at treating the most common adjustments of depression and grief. Diagnosis includes interviews and several clinical inventories to assess mental status. Among them are the Hamilton Depression Scale, Beck Depression Inventory, Child Depression Inventory, Geriatric Depression Inventory, and the Zung Self-Rating Scale for Depression. Most scales reflect the biochemical imbalance theory, and reflect the problems inherent in subjective evaluation.
Typical conventional treatment begins with finding a compatible antidepressant, such as fluoxetine (Prozac), sertraline (Zoloft), or Paxil, or Luvox. One class of drugs, SSRIs, increases levels of serotonin but have many unfortunate side effects, including allergic reaction, anxiety, diarrhea, drowsiness, headache, poor sexual functioning, sweating, nausea, and insomnia. There is emotional blunting, even apathy and indifference. An average dose of Zoloft, for example, is 50-100 milligrams; 200 milligrams is the maximal dose. Patients are frequently taken from 50-100-150 mgs. in quick succession.
Serotonin reuptake inhibitors, or serotonin boosters have been implicated as catalysts for suicidal and violent impulses. Neurological disorders including disfiguring facial and whole body tics (TD, irreversible tardive-dyskinesia), indicating potential brain damage, are an increasing concern for those on the drugs. Calling these drugs “antidepressants” is seriously misleading and virtually meaningless. They function like the stimulants amphetamine and cocaine and users develop a tolerance for the dosage and often psychological or chemical dependencies.
These drugs are stimulants for people who would otherwise be fatigued, distracted by negative thoughts, or have difficulty concentrating. With their energizing, attention-focusing, mood-elevating, and calming effects, serotonin boosters would make almost anyone feel better so long as they did not experience distressing side effects. There can be debilitating withdrawl symptoms for as many as half of all patients. Withdrawl symptoms include suicidality, rebound irritability, increased vulnerability to depressive relapse, weight gain, etc.
Withdrawl mimics return to depressive symptoms with feelings of dread, dizzyness, sleeplessness, and inability to concentrate. Side effects raise concern that patients may sustain silent brain damage that cannot be assessed. Withdrawl from Prozac-type drugs sometimes happens spontaneously when the drug “wears off” probably from having damaged its target axons beyond any ability to respond to the drug (permanent chemical lobotomy). This has led to dependency and patients increasing their own doses. When doctors prescribe up to and beyond the maximal doses there is nowhere left to go. Related to dependence is a phenomenon called “supersensitivity” or sensitization of brain cells by psychiatric drugs, which implies that the drugs can actually worsen the progression of the illness which they are supposed to treat.
After being treated for three years patients do poorly and show an inability to withdraw. The core physical effects of withdrawl are outlined in the DSM-IV: 1. disequilibrium (e.g. dizzyness, spinning sensations, swaying, or difficulty walking) 2. gastrointestinal symptoms (e.g. nausea, vomiting) 3. flu-like symptoms (e.g. fatigue, lethargy, muscle pains, chills) 4. sensory disturbances (e.g. tingling, electric shock sensations) 5. sleep disturbances (e.g. insomnia, vivid dreams) Recent research on serotonin antidepressants has shown the adaptations of brain cells involve changes in the instructions given by the DNA of the cells--the master code regulating cellular function.
The Director of the National Institute of Mental Health reports that chronic drug administration drives the production of adaptations, including regulation of neural gene [brain cell DNA] expression. Perhaps as many as 75% of patients are needlessly on these drugs for mild, even trivial, conditions. When the immediate cause of their distress is gone, doctors often don’t check to see if prescription renewal is essential. Patients often fear to “rock the boat,” and fear the return of their distress if unmedicated.
If a person is going to relapse into depression after meds are withdrawn, this typically does not occur until weeks or months after the drug is stopped. Doctors rarely offer alternatives. By combining drugs with psychotherapy and other alternatives, one can usually minimize exposure to the drugs, keeping the dosage low and weaning off the medication within six months to a year. Reassessment should be done at least once a year. It is not an established scientific fact that those with mild to even severe depression have serotonin-deficiencies to begin with. The drugs are all-purpose psychoanalgesics, and would make virtually anyone feel better initially.
Managed care providers don’t want to pay for safer, more effective treatment. Big business discourages alternatives, and sales of Prozac, Zoloft, and Paxil now exceed $4 billion a year. Virtually no studies have been done on long-term effect of the drugs on depressed children and their developing nervous systems, even though they are a specific target market, as are seniors. There is an unusually high incidence of three or more minor malformations in newborns exposed to Prozac in the first trimester, indicating it has a negative effect on embryonic development. To promote psychopharmaceuticals, the marketing of psychiatric diagnoses is often redefined to include much milder forms to include many more people. This has been especially true for depression, obsessive-compulsive disorder, and social phobia and anxiety.
Psychotherapy produces just as effective results, though antidepressants may jump-start those with moderate to severe depression on the road to recovery. While antidepressants take a month or so to become effective, conventional psychotherapy generally takes six to eight weeks for noticeable effects.
The TCAs (Tricyclic antidepressants, such as Elavil) have more severe side effects, which can include persistent dry mouth, sedation, dizziness, and cardiac arrhythmias. They are contraindicated for patients with suicidal tendencies since they can be lethal in even small overdoses. Other drug classes used for depression include monoamine oxidase inhibitors (MAOIs), which block the action of an enzyme in the central nervous system. Heterocyclics, (which cannot be given to those with a seizure disorder), include bupropion (Wellbutrin/Zyban)) and trazodone (Desyrel), Serzone, Effexor, and Remeron.
Side effects include agitation, anxiety, confusion, tremor, dry mouth, fast and irregular heartbeat, headache, low blood pressure, gastrointestinal distress and insomnia. Sexual dysfunction affects 60% of those on antidepressants. Curiously, many of the drug treatments’ side effects seem to actually amplify or highlight the original symptoms of the distress and depression. Men report impotence, inability to ejaculate, or retrograde ejaculation. Many complain most vociferously about the loss of sexual interest, claiming that they were depressed before, but since they now feel like eunuchs, they are really depressed.
Women report an inability to orgasm, inhibited sexual arousal, loss of libido. Many would rather cope with their well-known symptoms again. 70% of all antidepressants are prescribed by primary-care physicians, rather than mental health specialists. There is duress from managed care insurers to treat quickly with this cheaper option, and physicians are paid or debited according to their quotas and compliance. There is little or no incentive to refer patients for psychotherapy. In conventional treatment, psychotherapy is usually limited to weak options such as cognitive-behavioral therapy which simply don’t go deep enough to restructure the psychobiological sources of distress.
Superficial therapies assume that faulty thinking is causing the current depression and focuses on changing the thought patterns and perceptions. The therapist helps the patient identify negative or distorted thought patterns and the emotions or behavior that accompany them, and then retrains the depressed individual to recognize the thinking and react differently to it. The cornerstones of psychotherapy are insight and emotional growth.
Becoming aware of previously unconscious emotions and finding patterns in one’s behavior effect recovery from acute depression and make one less vulnerable to depression in the future. The healing comes from inside not outside, adding to a sense of personal empowerment, rather than reliance or dependence on a pill. Lifestyle--caffeine, alcohol, diet and exercise also need to be considered as amplifiers of depressive disorder. Sadness is a clarifying and relieving emotion that helps us move on after losses.
On the other hand, depression is a paralyzing short-circuit of self-doubt and self-recrimination. Sometimes people become depressed because they are not appropriately angry or sad over the situation. Good psychiatric care doesn’t stop when symptoms abate. Longer-term goals address the individual’s underlying vulnerability to depression--persistent negative views of self, the world, and the future. Cognitive-behavioral therapy is popular with managed care administrators, and is often the only modality offered, because it is easily standardized and can be done with groups, also.
ECT (electroconvulsive therapy) may be administered in extreme cases, when oral medication is refused, or psychotic and suicidal tendencies are present. Though now done under general anesthesia with a muscle relaxant to prevent convulsions, this therapy still sounds downright medieval and produces mixed results. Memory loss, headaches, muscle soreness, nausea and persistent confusion may result. Integrative treatments include homeopathic treatment, good nutrition, exercise, and herbal treatments.
St. John’s wort (Hypericum perforatum) is often tried, but effectiveness of nonregulated suppliments depends on the strength and freshness of the crops used to distill the effective ingredients. A 900 mgs. daily dose is roughly equivalent in action to 5-10 mgs daily of Prozac. Many off-the-shelf products do not contain fresh enough active ingredients or the dosage is irregular. This herb can also negate the biological action of birth-control pills, resulting in unanticipated or unwanted pregnancies, which can lead to further depression and coping failure.
Other side effects include high blood pressure, headaches, stiff neck, nausea, and vomiting. St. John’s wort increases the risk of transplant rejection, and has been implicated in immune suppression. St. John’s wort is available in 300-milligram doses, which are taken three times a day, for a total daily dose of 900 mgs. It takes one or two months to achieve full effects. 64% respond to St. John’s wort while 59% respond to synthetic antidepressants.
TRANSACTIONAL ANALYSIS AND DEPRESSION
Transactional Analysis is a grammar of the internal dynamics of the personality, which is structured through pre- and post-natal imprinting, scripts, games, and rackets. Some individuals are structured around a depressive life script which has the following characteristics: (1) The person has decided upon a position of I’m not OK -- You’re OK. (2) The person occupies the Victim role in the drama triangle, but switches periodically into the Persecutor role, or through magical means into the Rescuer role. (3) The timing of the script is “Wait.” (4) The “wait” is for a magical occurrence that transforms the world without requiring the person to take an active part in causing changes to occur. (Cox, 1980).
The script injunctions are numerous and include “Don’t Succeed,” “Don’t Think,” “Don’t Be Close,” “Don’t Have Fun,” and “Don’t Judge Others.” The last is particularly devastating because they prevent the person from acknowledging that he is being set up. It is a reworded way of saying a “not OK” person shouldn’t pass judgement on persons who are “OK” (everybody else). Actually the person may be very accurately judging and selecting, based on that judgement, persons who will deceive him. Depressive life scripts appear in American literature.
Typical examples include Rip Van Winkle, Charlie Brown, and Rudolph, the Red-Nosed Reindeer. These are stories of those unfortunate souls who are defective from birth, don’t grow up, don’t succeed, get persecuted, and don’t have fun. The fear of individuation and the fear of attachment have both been found to be associated with depression. Depressed individuals fear to get involved with others and differentiating themselves from others, suggesting that they prefer to remain dependently involved with familiar figures.
People in the detached/deindividuated position are the most depressed. Primal fears are fear of getting involved and fear of establishing a clear identity. This implies they favor dependence, even over-dependence, or familiar figures, or an infantile pattern of attachment. Stroke-starved infants grow up to become depressed adults. Because of a tendency toward isolation and blocking, they become stroke-deficient, lacking in allowable stimulation.
Infant depression results from lack of stimulation coupled with the absence (emotional or physical) of the child’s mother during the first year of life, and can be responsible for nearly irremedial damage. Non-verbal and verbal stroking is a vital component in the alleviation of reactive depression in adults. Self-reported distress includes the experience of headaches, faintness, loss of sexual appetite, trouble remembering things, uncontrolled temper outbursts, blaming oneself, pains in the lower back, feeling of inferiority to others, feeling hopeless and nausea.
Many people who come for therapy lead a relatively stroke-less existence (alienation) which has an influence of their experience of “dis-ease” and distress. They don’t know how to ask for strokes in a positive way without discounting or rejecting (“shielding”) their meaning. Positive strokes are defined as expressions of affection, closeness, and appreciation, as well as acknowledgement of one’s competence, skill, and resources from others.
Positive strokes are units of emotional nourishment communicated at the interpersonal level. Emotional anemia comes from scarcity of acceptance and acknowledgement of affection and closeness from others. Whether one accepts or discounts contact is a significant factor associated with the degree of experienced symptom distress. As people are educated to recognize that they have a part in creating “illness” through limiting thoughts, beliefs, and actions, they can become active and responsible participants in their healing process instead of passive victims of the disease process or drug treatment.
DEPRESSIVE DISORDERS AND CRP
In complex dynamic systems (CDS) the whole process unfolds with a “sensitivity to initial conditions.”
Thus, particularly treating chronic, “hereditary” depression, we can expect that CRP journeys will need to return participants to those conditions and events which gave form to their dis-ease, prior to birth, and prior to conception. Painful feelings often resurface when people have less structure in their lives, fewer activities to distract them. Psychiatric syndromes have two parts: a psychological core and superficial physical symptoms. Unaware of the true source of our upsets, we may develop symptoms, becoming distressed and tearful. This is a kind of code or flag raised over the distress.
Psychotherapy helps decipher the code and brings the flag, or symptoms, down in the process. By contrast, medications only suppress symptoms. By themselves, they are never a cure. As such, they should be used only as adjuncts to the real healing process. “Healing” does not necessarily mean a cure nor total elimination of all symptoms. It has to do with a subjective process, difficult to describe because, by its very nature, it is irrational, totally individual, and yet linked to a timeless and universal experience. The therapist helps a person to understand what his unconscious is saying, and gives helpful encouragement to integrate this knowledge, or relate to the unintegratable, and accept it. This promotes growth according to that particular person’s own inner laws, allowing the unfolding of the total individual.
Many CRP participants know, confusedly, from the start, that there is something they are looking for. They don’t know what it is, but they do know that their discontent stems from within themselves and that they are yearning for an inner journey for which they need a guide. “Healing is a dynamic happening related to a deep understanding of the role of suffering; an acceptance of what one is, totally: whole, rather than striving toward an image of perfection; an awareness of, and a relatedness to, a power greater than ourselves.
In other words, healing is discovering the meaning of our own life, and our place in the universe, not as a philosophical concept, but as an existential experience of inestimable value--the pearl of great price, hidden in the dunghill of unconsciousness, and pride.” (Tuby, 1976). Jung thought that no therapist could lead his patients further than he had gone himself. No therapist can help a participant on the inner journey unless he himself is continuously grappling with his own unconscious material. The theme of the wounded healer is universal, and eternally valid. It is archetypal. From the most primitive shaman, to the Greek god Asklepios, it is through some divine injury that healing takes place.
In the Asklepian healing temples, only those summoned by the god Asklepios were allowed to take part in the initiation rites. When the inner voice cannot be heard, a neurosis develops, forcing the individual to change course and be true to himself, true to his vocation. Healing begins through the call of the symptom. In ancient Greece, a sign such as a dream, or a vision, had to indicate to the sick person that he was called by the god of healing. Those who dedicated their lives to the cult of the god were called therapeutea, and it is they who performed the preparatory ritual. Sacrifices were offered, and the therapeutea would bathe and purify the incubant, who would then be left to sleep, alone, in the sacred precinct of the temple.
If Asklepios appeared to him, either in a dream or in ‘the waking state’, i.e. in a vision, he was cured. These dreams were never interpreted, either by the priests or the physicians. They just happened. The right dream was the cure, and the role of the therapeutea was to assist, to help the dreamer be in the best possible situation to receive the healing dream...in other words to draw upon his or her own inner healing power. The dynamic imagery of consciousness is a self-representation of the energic processes of the psyche. It is the vehicle by which one form of energy is transformed into another, and makes possible the transmutation, or true change, of psychological conditions--a means of recreating the original whole.
David Bohm has proposed a notion which supersedes the term psychosomatic. Soma-significance emphasizes the unity of body and significance or meaning. “The notion of soma-significance implies that soma (or the physical) and its signficance (which is mental) are not separate in the sense that soma and psyche are generally considered to be; rather they are two aspects of one overall indivisible reality. By such an aspect, we mean a kind of view or a way of looking. That is to say, it is a form in which the whole of reality appears (i.e., displays or unfolds), either in our perception or in our thinking.
Clearly, each aspect reflects and implies the other (so that the other shows in it). Although we describe these aspects by using different words, we imply that they are both revealing one unbroken whole of reality, as it were from different sides.” (Bohm, “Soma-Significance”). This description is reminiscent of the nature of fractals (self-similar forms) in Chaos Theory--”a form in which the whole of reality appears.” It is commonly known in psychotherapy that, for example, a dream (especially the first dream presented) often contains the whole image of the client’s problem and its eventual cure. In this way our nightly dreams reiterate our existential situation over and over. The problem, distress, or disease is neither physical nor mental/emotional--it is indivisibly both.
Soma-significance regards the field of reality as a whole, as an unbroken flow: “To bring out how soma and signficance are related, we first note that each particular kind of significance is carried by some somatic order, arrangement, connection, or organization of distinguishable elements...meanings are carried somatically by further physical, chemical, and electrical processes into the brain and the rest of the nervous system, where they are apprehended at higher and higher intellectual and emotional levels of meaning.” “As this process takes place these meanings, along with their somatic concomitants, become ever more subtle. . .The meaning is rarefied, delicate, highly refined, elusive, indefinable, intangible.
The subtle may be contrasted with the manifest. The next proposal is then that reality has two further key aspects, the subtle and the manifest, which are closely related to soma and significance. Thus, as has already been pointed out, each somatic form carries a meaning. This meaning is clearly more subtle than the form itself. But in turn, such a meaning can be grasped in yet another somatic form; electrical-chemical and other activity in the brain and the rest of the nervous system - which is evidently more subtle than the original somatic form that gave rise to it. This distinction of subtle and manifest is clearly only relative, since what is manifest in one level may be subtle on another.”
This is reflected in Chaos Theory as the notion of fractal reiteration, infinite nesting. In CRP, no matter at what level we perceive the dis-ease the form is self-similar and embedded in deeper or more subtle levels, each level holographically encoding the whole form with less detail (Swinney and Miller, 1992).
“This sort of action may in principle go on to indefinitely deep and subtle levels of significance. Meanings are thus seen to be capable of being organized into ever more subtle and comprehensive overall structures that imply, contain, and enfold each other, in ways that are capable of indefinite extension. In this whole process...a certain content is first met in a given level and later in a different level. The relationship between these levels is then seen to be part of the essential content of yet another level...this structure continues indefinitely...no ultimate reduction is possible. ...A level that is mainly somatic may have a significance, which is carried into the next more subtle level of soma, which has a further significance.” (Bohm).
“We have thus far emphasized the significance of soma, i.e. that each somatic configuration has a meaning, and that it is such a meaning that is grasped at more subtle levels of soma. This may be called the soma-significant relationship.” (Bohm). Bohm makes it clear that it is necessary for both somatic and significant poles to be present in each concrete instance of experience. It is impossible, for example, to have all the content on the side of soma (or on that of signficance). In the inverse signa-somatic relationship, every meaning at a given level is seen actively to affect the soma at a more manifest level. The signa-somatic relationship is to be distinguished from the psychosomatic in that the latter is commonly regarded as between separate entities or substances.
Soma-significance only implies abstracted aspects or poles of one whole flow in a field. Bohm goes on to point out that “a similar approach may be made for diseases and disorders in the soma-significant flow,” and he speaks of runaway feedback loops between the soma-significant and the signa-somatic as being deeply involved in a wide range of neurotic disorders. It is the over-all structure of meaning that is grasped in every experience. “As a given meaning is carried into the somatic side, whether in healthy or in disordered process, one can see that it still continues to be a kind of development of the original significance. . .One can regard this whole process as a further unfoldment of the original significance into forms that are suitable for instructing the body to carry out the implications of what is meant.” Even relationships with Nature and with the Cosmos are evidently deeply affected by what these mean to us. Such meanings fundamentally affect our actions toward them, and thus indirectly their actions back on us are influenced in a similar way.
Once we begin listening to the nature within us--our nature--and experience journeys through the inner cosmos, we can never feel truly lonely, disconnected, and hopeless again. We can directly experience ourself as an intrinsic part of one subtle webwork of being. Meaning indicates not only the significance of something to us, but also, our intention toward it. Our choices thus depend on the total significance of the moment. It is this whole signficance that gives rise to the over-all intention, which we sense as a feeling of being ready to respond in a certain way. All the factors of a given total situation, both external and internal, contribute to the determination of intention.
In the process of somasignficance it is not possible to form and sustain intentions that do not grow out of this totality of significance, but most of the meaning in this process is implicit. Recalling that meaning is an intrinsic part of reality, we see that perception of new meaning constitutes a creative act. As their implications are unfolded when people take them up, work with them, etc., the new meanings that have thus been created make their corresponding contributions to this reality. These contributions are not only in the aspect of significance, but also in the aspect of soma. Each perception of a new meaning by a human being actually changes the over-all reality in which they live and have their existence, sometimes in a far-reaching way.
Psychopharmacology rests on a “disease model” of psychiatric symptoms. This is the application of an extreme medical or biological model to psychological syndromes. Symptoms in and of themselves do not necessarily indicate a disease. All psychiatric diagnoses are merely syndromes, clusters of symptoms presumed to be related, disorders not diseases. There is no proof either of the cause or physiology for any psychiatric diagnosis.
This is a compelling argument for fostering and allowing the self-healing capacity to adjust biological parameters in an internally directed self-organizing way that is not separate from the psychological situation. Psychological processes can be modeled as chaotic attractors, some on the edge of chaos, poised between chaotic and predictable regimens depending on small changes in their control parameters. The stability of patterns arises from the tendency to self-organize. For example, Allan Combs (1996) gives an example, “An ordinary episode of depression is usually accompanied by behaviors that actively feed that state of mind, or at least don’t rally against it. In the mean time, cognitive processes such as thought, perception, and memory become tilted toward discouraging outcomes.
Research suggests, for example, that when we are depressed we tend to recall unpleasant episodes from our past (Bower, 1981). These recollections in turn feed the mood of depression, and so perpetuate a continuous cycle of memory and mood. To disrupt such a self-perpetuating circuit one needs to engage in activities that can up-end the dominant depressive attractor.” “The essential notion is that the whole cloth of consciousness is woven of a tightly knit patchwork of subprocess, each made possible and supported on all sides by the totality of the cloth itself, while at the same time contributing its part to the creation of that totality.
To take another example, consider two discrete states of consciousness, the ordinary waking state and dream sleep. Each is an entire world of experience. Each carries its own intrinsic styles of thinking, its own forms of memory, feelings, thought and perceptions--its own possibilities.” “Now, dream thought arises from the total experience of the dream and cannot be sensibly separated from it. At the same time, it contributes its unique quality to the dream. Finally, what is possible to know in the dream may not make sense in waking life, and what is reasonable in waking life may not be sensible in a dream. Thus, knowledge is state specific (Tart,1985), as is the entire experienced world of each form of consciousness.”
Ben Goertzel describes the process of transformation of consciousness in a complex dynamical system--the mind: “Psychological structures make no sense considered statically; they have to be considered dynamically, as “attractors” of systems that change over time. There are three kinds of attractors. There are fixed-point attractors, i.e. equilibrium system behaviors, in which a system does not change over time. There are periodic attractors, i.e. cyclic system behaviors. And there are strange attractors -- a grab-bag category covering everything that is neither unchanging nor periodic.
Strange attractors are often chaotic, in that, once a system is locked into a strange attractor, its behavior cannot be predicted in any detail. But, nevertheless, strange attractors need not be “random,” they can be intricately structured.” “In chaos theory terms, the transition between one state of consciousness and another is represented as a jolt which knocks the system out of its attractor, and leads it along a trajectory toward another attractor.
This model predicts that transition between states of consciousness should be a sudden and dramatic process -- very much a discrete shift rather than a continuous gradation.” In Persuasion and Healing, psychiatrist Jerome D. Frank argues that the theoretical framework within which therapists work has little or nothing to do with their ability to “heal” patients. That power stems, rather, from the therapist’s ability to make patients believe they will improve. Frank gives credit to the placebo effect as the primary active ingredient underlying all psychotherapies and even most drug treatments.
Science, of course, cannot pinpoint or measure the qualities that enable a particular therapist to induce the placebo effect in a given individual. Frank attributes it to more than creating a positive expectation: “People have been attacking Freud because he wasn’t a scientist, but that misses the point. He was a great mythmaker.” He carried the power of the archetypal healer and embodied it in himself and others. Studies of antidepressants over the past 30 years show that two thirds of the patients placed on medication either showed no improvement or responded equally well to a placebo as to the antidepressant.
Drugs only produce significantly different outcomes in one third of patients, but they never learn to solve their depression problems internally. Walter A. Brown, a psychiatrist at Brown University and an authority on the placebo effect, has supported the assertion that the placebo effect might explain much of the effectiveness of medications for emotional disorders (SciAmer, Dec’96, p. 110).
For the majority of patients there is little or no significant difference between any of the treatments, including the placebo-plus-clinical management approach. Patients self-report that they do as well with psychotherapy alone, as with therapy in conjunction with drugs. Research has shown that traumatic experiences can change the way the brain works, as can talk therapy, and even more so, process-oriented therapy which creates flow experiences. The brain undergoes changes similar to those induced by medication. The new biological explanations of mental disorders make “good stories” but still lack empirical substantiation.
CRP AND GRIEF WORK
“Melancholy is at the bottom of everything, just as at the end of all rivers is the sea...Can it be otherwise in a world where nothing lasts, where all we have loved or shall love must die? Is death, then, the secret of life? The gloom of an eternal mourning enwraps, more or less closely, every serious and thoughtful soul, as night enwraps the universe.” (Amiel, 1893). In grief, we are pulled down into the world of the dead. We continue to live, but with a foot in both worlds. However, there is no sweetness or savor in life.
We mimic death, and exist in a dead world. We feel miserable and ill, moving through a world of ghosts, feeling like the shadow of a dream. In our isolation we are cut off from others, the world, and God. We seem to be in perpetual fog and darkness, plagued by indecision, inefficiency, and confusion. Most of us have felt depressed in greater or lesser degree. Since everything changes as time flows, and change entails loss, this is not surprising. It is a truism that we grow sad and depressed when a person we love dies; it is a truism because grief is universal and normal. In fact, failure to grieve is evidence of psychological abnormality.
Mourning is characteristically a state of mind, but it is accompanied by a host of painful somatic sensations that are remarkably uniform. The following are commonly shown during acute grief: sensations of somatic distress occurring in waves lasting from twenty minutes to an hour at a time, a feeling of tightness in the throat, choking with shortness of breath, need for sighing, and an empty feeling in the abdomen, lack of muscular power, and intense subjective distress described as tension or mental pain. Traumatic bereavements are a special case of mourning (see “PTSD and CRP”). They results from shocking deaths which are sudden and perhaps horrific. They occur in a variety of settings including personal and community violence or catastrophe.
Traumatic bereavement stands in contrast to experiences of quiet death at home, without mutilation, bodily distortion, shock, threat, horror, and helplessness. Reactions to the traumatic circumstances are different and predict more adverse health outcomes for bereaved spouses. There is interference in the grieving process from traumatic stress. The striking features point up that the emotional aspect of grief is quite as painful as the somatic. Inner anguish, loss of interest in a dreary, empty world, isolation from other people, loneliness and feelings of inner emptiness. In this way grief mimics clinical depression. The call to heal and the call to death are ultimately the same call to formlessness.
Many disorders display symptoms and imagery which represent stalled stages in the natural consciousness restructuring process -- the organism’s attempt to heal itself gets stuck. According to Freud, mourning is work and requires mental effort. That work consists of the courage extended over a period of time to face the pain of grieving and to combat the tendency of the living attachment to the lost person to persist. The fabric of memories and associations and feelings that permeate the image of the deceased in the mind of the bereaved survivor does not automatically disappear when the loved person dies.
In the process of grieving each of the memories and associations must be revived in the mind’s eye; as each is thought of, a fresh wave of grief occurs, which gradually fades. As each separate strand of the fabric of associations is thus worked over, it loses its power to evoke the pain of loss, and the loving attachment to the dead one gradually diminishes until the process is complete and the ghost is laid to rest. The mourner is once again free to live and love in the world of the living.
There are times, however, when grief does not flow so smoothly; it becomes blocked or distorted in ways that have to be considered pathological. These abnormal forms of mourning differ from major depression in one way: grief does not include the feelings of guilt nor the self-accusatory attitudes that characterize the depressed person. This holds true, unless, there were unresolved issues, and conflicts about choices in the caregiving process. Then the internal litany becomes one of, “Coulda, shoulda, woulda...” A certain degree of self-criticism is understandable as a consequence of the failure to live up to ideals set for one’s behavior. This can be felt as a lowering of self-esteem. Unresolved grief can function within like a “strange attractor” through the process of identification.
For example: “Barbara” accepts the fact of her mother’s death. She knows she ‘can’t bring her back.’; there is no denial. She is aware of no feelings or conviction that her mother is still alive. And yet she does, in a way, ‘bring her back’ by psychologically making a part of her mother a part of herself. The image of her beloved mother at the time of her death was that of a person sick with heart disease. She does not relinquish this image nor allow it to die. She keeps it alive, but not as the image of a person external to herself; it become internalized and alters her own image of herself.
She no longer conceives of herself as a healthy person, able to be active. Rather, she thinks of herself as a person who is sick and in danger of dying of heart disease. She develops symptoms which are for her consistent with this diagnosis, and has to be admitted to the hospital for her illness. The image of herself is the image of her mother, which has entered the fabric of her ego and has radically altered that portion of the self-organization that constitutes her self-image.
She has identified with her mother; she has made certain behavioral and personality attributes of her mother a part of herself. In this way she keeps her mother alive. Her attention and mental energies are not directed toward the real fact of her mother’s death; she does not experience the pain of this loss. On the contrary, she concentrates on the image of her mother now living within her. She is preoccupied with her concern over having heart disease.
The grief work is blocked, neurotic symptoms replace mourning, and she cannot free herself of her mother. We do not yet fully understand the psychological process involved in the mechanism of identification, but it is as if it were “attractor-centered.” Faced with a loss, a person adopts certain behavioral and characterological traits of the lost one. This represents a change in self-organization, an internalization, but how this modification in the ego is brought about is not yet apparent. The sense of identity as a person, the feeling of oneness and unity is disturbed.
SUMMARY:
THE EXPERIENCE OF HEALING AS FLOW
Whether we speak of normal experience, chronic depression or grief, it is a fact that frustration is deeply woven into the fabric of life. We are riddled with desires and programmed by ideals. Should some of our real or imagined needs be temporarily met, we immediately begin wishing for more. This chronic dissatisfaction stands in the way of our contentment. Depression has its roots in failure to adjust to lowered expectations of self, others, and world. Faust was given power by the Devil on condition that he would never be satisfied with what he has. Happiness and satisfaction with life depend on how small a gap one perceives between what one wishes for what one possesses.
Traditional social shields such as religion, ethnic traditions, patriotism, etc. no longer are effective for many who feel exposed to the harsh winds of chaos. One of the main forces that affects consciousness adversely is psychic disorder--that is, information that conflicts with our existing intensions, or distracts us from carrying them out. We give this condition many names, depending on how we experience it: pain, fear, rage, anxiety, depression, ennui, anomie, or jealousy. All these varieties of disorder force attention to be diverted in undesirable directions--toward other attractors. Fear of chaos manifests as ontological anxiety or existential dread, a fear of being, a feeling there is no meaning in life; since nothing makes sense, why go on?
Overcoming the anxiety and depressions of contemporary life requires a drastic change in attitude about what is important and what is not. We can learn to enjoy and find meaning in the ongoing stream of experience, in the process of living itself. Experience depends on the way we invest psychic energy--on the structure of attention. This, in turn is related to goals and intentions. These processes are connected to each other by the self, or the dynamic mental representation we have of the entire system of our goals. This process is complex, and the notion of complexity is related to the same concept as used by some evolutionary biologists and also described with poetic insights. Its essence in terms of the psychology of the self is that a complex person is one whose behavior and ideas cannot be easily explained, and whose development is not predictable, but is autopoetic, that is self-organizing emergent order. Order in consciousness is experienced as flow, optimal experience, healing experience. Following a flow experience, the organization of the self is more complex than it had been before. It is by becoming increasingly complex that the self might be said to grow. The flow state facilitates both differentiation and integration.
The old alchemists used to say, “Only that which has been properly separated can be rightfully joined.” Complexity also facilitates the integration of autonomous parts. After each episode of flow a person becomes more of a unique individual, less predictable, possessed of rarer skills. The complex self is more likely to avoid both selfishness and conformity. “The self becomes complex as a result of experiencing flow. Paradoxically, it is when we act freely, for the sake of the action itself rather than for ulterior motives, that we learn to become more than what we were. . .Flow is important both because it makes the present instant more enjoyable, and because it builds the self-confidence that allows us to develop skills and make significant contributions to humankind.” (Csikszentmihalyi, 1990). Flow helps us to integrate the self because in that state of deep concentration consciousness is unusually well ordered. Thoughts, intentions, feelings, and all senses are focused on the same goal. Experience is in harmony. And when the flow episode is over, one feels more “together” than before, not only internally but also with respect to other people and the world and cosmos in general. As a youth, the healer Asklepios received a special gift from Athena, Goddess of Wisdom. She gave him the blood of the terrible serpent-haired Medusa. The blood that flowed from the left side of Medusa brought death, and the blood that flowed from the right side brought healing. The paradoxical quality of this blood reflects the closeness between illness and health, and points to the equally paradoxical quality of the unconscious that both wounds and heals. This metaphor of the mystically-charged flowing life-blood --the archetypal placebo-- is all part of the mysteries of illness and death, healing and life. As the archetype of the wounded healer shows, the healing power flows, not through those who have known only health, but through those who have been ill, who have been drawn near the dark land of death, and have then been healed. Only through illness or a journey to the underworld can the Wounded Healer come alive in a human being, either as “healer” or one who heals from within. Ultimately, it matters little what complex mechanisms help us mobilize our own inner capacity for healing. The fact that we enter the healing process with commitment and intentionality is far more important. Taking the journey toward healing means we recreate the archetypal journey of the hero or heroine, who is neither helpless nor hopeless, but approaches fate with determinism and courage. When we willingly submit to the universal process of death and renewal we activate transpersonal resources that transcend our own limited capacities for restructuring our consciousness and self-healing. Ultimately all healing is self-healing, and implies profound self-acceptance, and can lead to loving acceptance of others and the world as it is, rather than as we would like it to be. It is impossible to feel isolated, lonely, and “dead” when one feels a sense of vivifying identification which stems from direct experience of the dynamic whole of reality. It restores our sense of personal wholeness. We are an indivisible part of a flow in the whole field of consciousness. The entire cosmos is contained holographically within us. When we become “superconductors” of consciousness, we draw from the spiritual wellsprings of life and health, that which eternally makes the world bloom anew. The “dam” of depression which has blocked the dynamic flow of life and love cannot forever withstand this immense healing force. It breaks through the “dead void” and one is no longer bereft of the power of the dynamic ground-state of existence, or cosmic unity. Restoration of the flow-state through process-oriented experiential therapy is the serpentine process of healing. It changes us at the quantum and psychobiological levels. Immersion in this healing state has the power to restructure our consciousness at the most fundamental level, and is an endless source of creativity, spiritual sustanance, and pleasure. REFERENCES Bloomfield, M.D., Harold, Nordfors and McWilliams, HYPERICUM & DEPRESSION, Prelude Press, Los Angeles, 1996. Bohm, David, “Soma-Significance: A New Notion of the Relationship Between the Physical and the Mental,” online from DynaPsych and Ben Goertzel. Cartmel, Gerald, “Cognitive dysfunction and psychosomatic disease,” Transactional Analysis Journal, Vol. 22, No. 3, July 1992, pp.174-181. Combs, Allan, “Consciousness as a System Near the Edge of Chaos,” online from DynaPsych, 1996. Cox,, Mary Osborne, “Depressive life scripts in American folk literature,” TA Journal, Vol. 10, No. 3, July 1980. Csikszentmihalyi, Mihaly, FLOW: THE PSYCHOLOGY OF OPTIMAL EXPERIENCE, Harper & Row, New York, 1990. Glenmullen, Joseph, M.D., PROZAC BACKLASH, Overcoming the dangers of Prozac, Zoloft, Paxil, and other antidepressants with safe, effective alternatives. Simon & Schuster, New York, 2000. Harding, M. Esther, “The Value and Meaning of Depression, “ Bulletin for the A.P.C. of N.Y. (Analytical Psychology Club of New York, Inc.), 1970. Horgan, John, “Why Freud Isn’t Dead,” SciAmer, December 1996, p.106-111. Miller, Iona and Richard, THE MODERN ALCHEMIST: A Guide to Personal Transformation, Phanes Press: Grand Rapids, Michigan: 1994. Steiner, Claude, SCRIPTS PEOPLE LIVE, Grove Press, New York, 1974. Swinney, Graywolf, HOLOGRAPHIC HEALING, Asklepia Foundation, 1997. Swinney, Graywolf and Iona Miller, DREAMHEALING: Chaos & the Creative Consciousness Process, Asklepia Pub., 1992. Tart, Charles T., 1985. “Consciousness, altered states, and worlds of experience,” The Journal of Transpersonal Psychology, 18: 159-170.
http://ncptsd.va.gov/ncmain/ncdocs/manuals/nc_manual_iwcguide.html
The Iraq War Clinician Guide, 2nd Edition For Mental Health Care Providers The Iraq War Clinician Guide was developed by members of the National Center for PTSD and the Department of Defense. It was developed specifically for clinicians and addresses the unique needs of veterans of the Iraq war.
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Download individual chapters by clicking on the chapter names below. If you would like to download the large complete file: Iraq War Clinician Guide, 2nd Edition with Appendices (PDF) (8.9 mb), use the link at the top of the table.
The Iraq War Clinician Guide, 2nd Edition, Contents Complete Guide Iraq War Clinician Guide, 2nd Edition (PDF) (8.9 mb)
Or download individual chapters by clicking on the chapter names below. Table of Contents Table of Contents and Cover Page (PDF) Chapter 1 Executive Summary (PDF) Key Topics Chapter 2 Topics Specific to the Psychiatric Treatment of Military Personnel (PDF) Chapter 3 The Returning Veteran of the Iraq War: Background Issues and Assessment Guidelines (PDF) Chapter 4 Treatment of the Returning Iraq War Veteran (PDF) Special Topics Chapter 5 Treatment of Medical Casualty Evacuees (PDF) Chapter 6 Treating the Traumatized Amputee (PDF) Chapter 7 PTSD in Iraq War Veterans: Implications for Primary Care (PDF) Chapter 8 Caring for the Clinicians Who Care for Traumatically Injured Patients (PDF) Chapter 9 Military Sexual Trauma: Issues in Caring for Veterans (PDF) Chapter 10 Assessment and Treatment of Anger in Combat-Related PTSD (PDF) Chapter 11 Traumatic Grief: Symptomatology and Treatment for the Iraq War Veteran (PDF) Chapter 12 Substance Abuse in the Deployment Environment (PDF) Chapter 13 The Impact of Deployment on the Military Family (PDF) Appendices There are three Sections of appendices for the Iraq War Clinician Guide.
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Section 2 (Appendices F to I) PDFs of relevant published articles.
Section 3 (Appendix J) Educational Handouts for Iraq War Veterans and their Families.
Section 1 Appendix A Case Examples from Operation Iraqi Freedom (PDF) Appendix B1 VA/DoD PTSD Practice Guideline Table of Contents (PDF) Appendix B2 VA/DoD PTSD Practice Guideline (2.8mb PDF) Appendix C VA Documents on Service Provision (PDF) Appendix D Assessment of Iraq War Veterans: Selecting Assessment Instruments and Interpreting Results (PDF) Appendix E Program Evaluation (PDF) Section 2 Appendix F Litz, B. T., Gray, M. J., Bryant, R. A., & Adler, A. B. (2002). Early interventions for trauma: Current status and future directions. Clinical Psychology: Science and Practice, 9, 112-134. (PDF) Appendix G Keane, T. M., Street, A. E., & Orcutt, H. K. (2000). Posttraumatic stress disorder. In M. Hersen & M. Biaggio (Eds.), Effective brief therapies: A clinician's guide (pp. 140-155). New York: Academic Press. (PDF) Appendix H Friedman, M. J., Donnelly, C. L., & Mellman, T. A. (2003). Pharmacotherapy for PTSD. Psychiatric Annals, 33, 57-62. (PDF) Appendix I Friedman, M. J., Schnurr, P. P., & McDonagh-Coyle, A. (1994). Post-traumatic stress disorder in the military veteran. Psychiatric Clinics of North America, 17, 265-277. (PDF) Section 3 Educational Handouts for Iraq War Veterans and Their Families Appendix J Transition Assistance Information for Enduring Freedom and Iraqi Freedom Veterans Warzone-Related Stress Reactions: What Veterans Need to Know Depression Stress, Trauma, and Alcohol and Drug Use What If I Have Sleep Problems? Coping with Traumatic Stress Reaction Warzone-Related Stress Reactions: What Families Need to Know Families in the Military Homecoming: Dealing with Changes and Expectations Homecoming: Tips for Reunion
The Iraq War Clinician Guide, 2nd Edition For Mental Health Care Providers The Iraq War Clinician Guide was developed by members of the National Center for PTSD and the Department of Defense. It was developed specifically for clinicians and addresses the unique needs of veterans of the Iraq war.
NOTE: This guide is ONLY available online and is not available in hard copy. Please make sure you have the latest version of Adobe Acrobat Reader to download these files. Not having the latest version (8) of this reader may cause error messages saying that the PDF file is "damaged".
Download individual chapters by clicking on the chapter names below. If you would like to download the large complete file: Iraq War Clinician Guide, 2nd Edition with Appendices (PDF) (8.9 mb), use the link at the top of the table.
The Iraq War Clinician Guide, 2nd Edition, Contents Complete Guide Iraq War Clinician Guide, 2nd Edition (PDF) (8.9 mb)
Or download individual chapters by clicking on the chapter names below. Table of Contents Table of Contents and Cover Page (PDF) Chapter 1 Executive Summary (PDF) Key Topics Chapter 2 Topics Specific to the Psychiatric Treatment of Military Personnel (PDF) Chapter 3 The Returning Veteran of the Iraq War: Background Issues and Assessment Guidelines (PDF) Chapter 4 Treatment of the Returning Iraq War Veteran (PDF) Special Topics Chapter 5 Treatment of Medical Casualty Evacuees (PDF) Chapter 6 Treating the Traumatized Amputee (PDF) Chapter 7 PTSD in Iraq War Veterans: Implications for Primary Care (PDF) Chapter 8 Caring for the Clinicians Who Care for Traumatically Injured Patients (PDF) Chapter 9 Military Sexual Trauma: Issues in Caring for Veterans (PDF) Chapter 10 Assessment and Treatment of Anger in Combat-Related PTSD (PDF) Chapter 11 Traumatic Grief: Symptomatology and Treatment for the Iraq War Veteran (PDF) Chapter 12 Substance Abuse in the Deployment Environment (PDF) Chapter 13 The Impact of Deployment on the Military Family (PDF) Appendices There are three Sections of appendices for the Iraq War Clinician Guide.
Section 1 (Appendices A to E) Additional PDFs on assessment, treatment & program evaluation.
Section 2 (Appendices F to I) PDFs of relevant published articles.
Section 3 (Appendix J) Educational Handouts for Iraq War Veterans and their Families.
Section 1 Appendix A Case Examples from Operation Iraqi Freedom (PDF) Appendix B1 VA/DoD PTSD Practice Guideline Table of Contents (PDF) Appendix B2 VA/DoD PTSD Practice Guideline (2.8mb PDF) Appendix C VA Documents on Service Provision (PDF) Appendix D Assessment of Iraq War Veterans: Selecting Assessment Instruments and Interpreting Results (PDF) Appendix E Program Evaluation (PDF) Section 2 Appendix F Litz, B. T., Gray, M. J., Bryant, R. A., & Adler, A. B. (2002). Early interventions for trauma: Current status and future directions. Clinical Psychology: Science and Practice, 9, 112-134. (PDF) Appendix G Keane, T. M., Street, A. E., & Orcutt, H. K. (2000). Posttraumatic stress disorder. In M. Hersen & M. Biaggio (Eds.), Effective brief therapies: A clinician's guide (pp. 140-155). New York: Academic Press. (PDF) Appendix H Friedman, M. J., Donnelly, C. L., & Mellman, T. A. (2003). Pharmacotherapy for PTSD. Psychiatric Annals, 33, 57-62. (PDF) Appendix I Friedman, M. J., Schnurr, P. P., & McDonagh-Coyle, A. (1994). Post-traumatic stress disorder in the military veteran. Psychiatric Clinics of North America, 17, 265-277. (PDF) Section 3 Educational Handouts for Iraq War Veterans and Their Families Appendix J Transition Assistance Information for Enduring Freedom and Iraqi Freedom Veterans Warzone-Related Stress Reactions: What Veterans Need to Know Depression Stress, Trauma, and Alcohol and Drug Use What If I Have Sleep Problems? Coping with Traumatic Stress Reaction Warzone-Related Stress Reactions: What Families Need to Know Families in the Military Homecoming: Dealing with Changes and Expectations Homecoming: Tips for Reunion
Manifest Destiny Manifesto
Manifest Destiny Manifesto by Iona Miller, 2008 SUMMARY: We can create an evolutionary politics to build a more creative future. Calculated cycles of commodification and scarcity, business and war have driven the military/industrial complex and the multinational corporate climate. Cover Ups and confusion have paralyzed us into apathy where nothing significant can be trusted, believed or known. One percent of humanity controls 40% of global wealth.
But we can empower ourselves to resist status quo politics and shape ourselves a better destiny - a 21st century Manifest Destiny that fulfills our positive spiritual potential. If we don't want a dark future for humanity, we must reinvent ourselves and our culture from the foundation upwards. Even if that is fantastically radical, it can still happen, one inspired person at a time and cascade toward a visionay approach to large-scale societal transformation that heals personal and global socioeconomical scars.
Competent citizenry can learn to impliment constructive visions for our collective planetary future. Deep and broad visions can stimulate reflection and lively discussion of contemporary solutions that can become the scaffolding for action plans from the community level upwards. A courageous and truly integrated vision would include a detailed strategy for a vibrant and life-sustaining future. Individually and collectively we have to redefine what it means to thrive with more compassion for others, not just survive. The paradigm needs to switch from "dog eat dog" to "we're all in it together."
SOUL OF AMERICA: A spectre is haunting America -- the dark shadow of her domestic and international covert activities, cover ups and arguably poor choices. America is dysfunctional; she has a sickness of the soul. Maybe she has lost her soul. Soul loss is a spiritual illness. We are an addictive nation and our government is an addictive organization, as demonstrated by its leaders. Individuals reflect the addictive nature of the system. The system demands you are consistent with the system. CONSENSUS CULTURE: We are always in a trance state. We conspire with one another to create or confabulate consensus reality. Cultures and subcultures share tacit understandings which together are Cultural Trance States, an unconscious cohesion. All cultures are trance states with their own modified programming content - family, community, religion, nation. We have been programmed by repeated suggestion since birth. We don't question or doubt this deep trance. Nations and organizations also create lived trance states. We are surrounded by and absorbed in their powerful reality in the social cradle.
SHAME & BLAME: Addictive organizations and their false images (PR, spin, false fronts, false flags) are the infrastructure of an addictive society. Addiction leads to compulsiveness. Thus, we have become a shame-based society. Symptoms include grandiosity, confusion, self-centeredness, dishonesty, perfectionism, scapegoating, self-righteousness, paranoia, projection, defensiveness, fear and ethical deterioration.
TOXIC SHAME, the fuel of addiction, divides us from ourselves and others. In toxic shame, we disown ourselves and cover-up with a false self. Toxic shame has many disguises; it loves darkness and secretiveness. It stays in hiding and covers itself up with a myriad of behavioral cover-ups. Toxic shame is spiritual bankruptcy. Healthy shame is honest. It lets us know our healthy limitations and provides meaning. It is the basis of humility and spirituality.
DEPRESSION is the number one mental health problem. Stress is the number one killer. Often depression lurks behind compensatory manic activity. Our boom-bust economics, the irrationally optimistic housing bubble and over-extended credit reflect the same syndrome. We react to an illusion of scarcity with the illusion of control that blocks what we fear we can't handle. Personal or collective disaster leaves us dispossessed. Shock, disaster and economic downturn is a formula that can be manipulatively exploited to eliminate resistance.
GOD CULT: What we worship is what we give our attention to. We worship GOD: Gold, Oil and Drugs. They are what makes the world go 'round. They fuel the social control systems and fund the elite controllers. This GOD is the tangible source of our freedoms and our slavery, the buffers between ourselves and our awareness and feelings. The cult of GOD has taken over our lives and we are more and more powerless. *We rely on the elusive promise of a hoped-for reward to pull us into the future, toward our destiny. This is the the Catch-22 in the American Dream, which was the 20th century prime directive. It promises you will get ahead with power, money or influence. Despite our lip-service to democracy, we are far from a classless society.* We are seduced by the promise of the good life, with benefits that is the payoff for the Protestant work(aholic) ethic. We deny this is the core of the sick system by working out and eating well so we can work even more without burnout. We are lured by the promise of the addictive system to take us out of the here and now.* Economics and politics have taught us that greatness lies in expansion and accumulation. Yet even though we work harder, the US has lost its manufacturing base and pre-eminence as the world's greatest economic power to the EU. The Greenback is slipping. Markets have been appropriated by transnational corporations. Only empathy can heal this entropy -- the global acceleration crisis and destructive wastefulness. Economic development has failed to create and maintain social welfare.
For America to recover, she has to see through deep denial, acknowledge the realities of her shadow self, hold the tension of the opposites, and let go to the transformative process of self-actualization that promises rebirth at a higher level of integration, stabilization and functionality. We can become more conscious participants in our own self-unfolding and in course-correcting the ship of state toward positive directionality. We can understand, adapt and respond to our world better.
POST-TRAUMATIC CULTURE: PTSD is a chaotic, hyper-reactive state of being. Our cultural crisis is characterized by symptomatic numbing, dissociation, impulsive aggression, depression, denial, shame and anxiety. We are haunted by a sense of injury -- victimization. "Victim speech" is used for economic and military gain. First- and second-hand trauma shapes our central narratives of overwhelming personal and collective change.
COUNTERMEASURES: Mediated images of war and catastrophe can produce PTSD symptoms much like directly witnessing traumatic events, especially if one identifies with the victims. Providing a means of processing information and feelings, Internet may provide an antidote to toxic media images that induce panic. When we see history repeating itself, we flashback to similar unresolved events. Hampered by persistent high-level denial, time does not heal these collective wounds. Disclosure would be a start.
CREATIVE RE-PATTERNING: We need to eliminate the blocks to our maturation process as a nation, even if no nation can realistically survive being totally transparent. A nation can oversight itself internally just like an individual can do a "reality check." We've been stuck in pointless paranoia with a Draconian government, corporate feudalism and an unwinable war that has sucked us dry. Dynamic change and flux means finding our own way to an authentic relationship with self, others and world.
SELF-IMAGE: We need to make a quantum leap beyond our delusions in all these domains. Currently, we are getting "shock treatment." The Shock Doctrine (Klein) and "disaster capitalism" have been imposed abroad and domestically to reengineer societies reeling from disasters. This corporate warfare and economic policy are rooted in CIA electroshock experiments in torture. Ideally, we need breakthrough not breakdown. But our self-image, our national esteem has been damaged. Self image is linked to feelings of destiny, meaningfulness, significance, uniqueness and reason for being.
TRANSFORMATION: Without meaning we are cut off from our spiritual source that is our motivation, soul, spirit or destiny. The essence of tragedy is the realization of a destiny that escapes the human will, even if some have been able to predict the end. With insight and a new orientation we could effect a dramatic and positive self-transformation of our national character. It is our potential for eminence and the exceptional -- a clearer perception of and response to reality. OWNING THE SHADOW: The Shadow is the first challenge on the way to clarity. With 1/20th of the world's population, we consume over 50% of the energy. We have to integrate our dark side, face our negative qualities, what we have attempted to hide or deny, our secret shame. Our national shadow is embodied in our clandestine history, the dirty tricks conducted in our name. We have to know ourselves fully. We also discover our own buried potential there. It brings hidden powers into the light. To heal our denial and learn discernment, we need trustworthy disclosure.
I’ve seen the future, brother: it is murder
Thing’s are going to slide, slide in all directions
Won’t be nothing
Nothing you can measure any more
The blizzard of the world
Has crossed the threshold
And it has overturned
The order of the soul (Cohen 1992)
SOUL RETRIEVAL is the process of recovering what we've cut off, left or lost somewhere, or that was stolen or appropriated by someone else. Refuge is found in the human heart. Soul retrieval relieves trauma and fragmentation by mending the past and healing the future. The object of healing is to become whole...to embody soul. Wholeness is a process of reconciliation. Imagine what a more soulful nation might be like.
VISION: Each step in our history has been marked by a quantum leap in our Manifest Destiny driven by our expansive spirit and zeitgeist. If it is so that we "create our own destiny," it is time for America to manifest a better destiny in harmony with global values that support true democracy and our Constitutional freedoms. A more meaningful manifestation of our national spirit would prioritize universally spiritual ideals, like respect and compassion, over domestic and international power trips. To grow our citizenry and government need vision, communication and trust. We are the only species capable of long-term systematic planning, but we willingly sabotague ourselves for short-term gratification. We need to heal our relationship to self, others, and world.
CRISIS DRIVEN: The fact is, we live in a sick system and it impacts our quality of life from the inside out. If the USA was a person, that individual would be a toxic, narcissistic, territorial, workaholic control freak with boundary issues. Our violent nation is manipulative, dramatic, paranoid, compulsive and soon may become literally depressive. The housing market is in a depression, and that is symbolic of our condition. You have to wonder what all our irrational exhuberance and manic activity is hiding in the depths of America's soul. Just what is our collective "heart's desire?"
COMMITMENT TO TRUTH: What is our shared vision today? Shared visions arise from those truly committed to their personal visions. What is the true nature of this "reality" we are creating? Are we on purpose and achieving our collective destiny or has our country been hijacked by special interests? Why do we obsessively overwork, overspend, cover up, get aggressive and perpetuate sick organizations? How can we let go of our old national identity, pass through the 'neutral zone' and experience transforming rebirth? We need a paradigm that superimposes the new on the old. First comes a change in attitudes or worldview that embodies a different set of values in cultural rebirth.
CREATIVE STRATEGIES: How can we raise the bar? Shared vision uplifts our aspirations, gives us courage and ignites our spirit. It pulls us toward an overarching goal. It creates room for risk taking and experimentation by fostering long term commitment. We can extend principles and insights from personal mastery into the world of discipline, collective aspiration and shared commitment. The vision may come before its time is ripe, but we have to try, even to fail. We need a transition plan or crisis and confusion will arise. We can look to the past to get to the root of the problem.
*
MANIFEST DESTINY is the philosophy that created the USA in her westward expansion. But it didn't stop there; our penetration has gone global. America has lost her boundaries but Manifest Destiny is still a driving ideal of virtually endless expansion. This ideology is still creating America's history, powering our culture. But in our egotistical zeal we have spread ourselves too thin, like the Alexanders, Napoleans and Hitlers of bygone eras.
But does the rightful destiny of the American people include unlimited imperialistic expansion? We're running out of places and cultures to invade. As a restless territorial culture bent on acquisition and conquest, we have boundary issues. We are the dominators, but the only frontiers left are within ourselves. It is high-time we manifest a new vision of our collective destiny, beyond the materialistic, religious, utopian design.
If the buzzword "Intentionality" is to be properly applied, we have to move beyond the ego gratification and wish fulfilment of THE SECRET and apply it in a global context. We can choose to consciously engage in self and social transformation. In a strongly networked society, a bottom-up approach to order is the counterpoint to the old hierarchal dominator model that has permeated history -- participatory consciousness.
We are enmeshed in denial. We either don't know or don't want to know the details of global exploitation that undergird our consumer lifestyles. We don't have the rationalized right to destroy anything or anyone who gets in the way of our so-called freedom and independence. We aren't independent; all of humanity and life is interdependent. We aren't free; we have traded freedom for so-called security. Far from demonstrating our superiority, the immortal doctrine of international Manifest Destiny reveals the spiritual faultline in the Soul of America.
FOR "WE THE PEOPLE" TO HEAL...
We have already mortgaged our progeny's future and must address that debt with more ethical economics. We need to find out what lies beyond the artificial constraints of corporate media, unregulated covert action, self-serving officials, greed-ridden American imperialism, the decline of civil liberties, environmental atrocities, egregious war, nuclear proliferation, lying leaders, global tyranny, the military industrial complex, the prison industrial complex, commodification of healthcare, and transnational crime.
ECONOMIC SYNERGY
We need to reinstitute safety nets and social justice. We need a pro-evolutionary environment, social innovation and economic synergy -- socio-cultural negentropy. Our nation needs to make a strong commitment to the health and well-being of all people and stop being an entropy sink. To successfully meet the challenge, we need our Constitutional Rights restored.
*
We can begin by admitting our addiction to our false GOD -- Gold, Oil & Drugs.
*
MANIFEST DESTINY: How can we manifest the common destiny of a peaceful and prosperous future for all of mankind? We can create an evolutionary politics to build a more creative future. Calculated cycles of commodification and scarcity, business and war have driven the military-industrial complex and the manipulative/exploitative multinational corporate climate. Cover Ups, media distortion, disinformation and confusion have paralyzed us with apathy and cynicism so nothing significant can be trusted, believed or known. But we do know this: 1% of humanity controls 40% of global wealth.
FROM GREEDY TO NEEDY: But we can empower ourselves to resist propaganda, consumerism, fear factors, status quo politics and meta-control to shape ourselves a better destiny - a 21st century MANIFEST DESTINY that fulfills our positive spiritual potential. Spiritual bankruptcy, the failure to consider our effects on the whole system, is a symptom of our collective ethical and economic failures.
ETHICAL ECONOMICS: If we don't want a dark future for humanity, we must reinvent ourselves, our ethical economics and our culture from the foundation upwards. Even if that is fantastically radical, it can still happen any moment, one inspired person or community at a time, cascading toward a visionay approach to large-scale societal transformation that heals personal and global socioeconomical scars. Active reconciliation must replace passive resignation to our fate. We have to "check it before we wreck it," that is, check our overweening narcissism, self-indulgence and gluttony as a nation-state.
COMPASSIONATE CONSUMPTION: Competent citizenry can learn to impliment constructive visions for our collective planetary future. We can wrestle our future from the grip of sociopathic control freaks, fiscal irresponsibility and deluded mental processes. Deep and broad visions can stimulate reflection and lively discussion of contemporary solutions that can become the scaffolding for action plans from the community level upwards. A courageous and truly integrated vision would include a detailed strategy for a vibrant and life-sustaining future.
SURVIVAL STRATEGIES: Individually and collectively we have to redefine what it means 'to thrive' not just survive with more compassion for others and life in general. The paradigm needs to switch from materialistic "dog eat dog" to universalist "we're all in it together." We must remain self-reflectively vigilant for mass stupidity, cultural bigotry and racial intolerance. We have to develop an active courage to change and to impliment more intelligent choices.
CONSCIOUS EVOLUTION: Evolution has made us self-aware and self-conscious. But those terms are not states but a spectrum of states, which can be up-regulated with simple techniques, such as concentration, self-reflection and meditation. Even biological evolution is now under the direction of human Conscious Evolution. Hard technolgies and spiritual tech are expanding our ideas of what it means to be human, and our inherited potential for realization and self-expression. Conscious Evolution is a worldview that supercedes the Manifest Destiny philosophy, a higher octave of the comprehension that "our reality is what we make it."
ENLIGHTENMENT: Many are pro-actively implementing their personal and collective vision of social potential and an emergent worldview that is negentropic and integrative, personally and culturally. Greed is unenlightened self-interest, myopic selfishness. Enlightened Self Interest is a good place to begin. It is an ethical philosophy demonstrating when we act in the interest of others, we promote our own well-being. An illumined state is not the goal, but the platform for creative interaction within the authentic Self, or essence, in a collective context. Conscious Evolution links discipline, practice and service. Our culture can be enriched by our present actions.
EMERGENT PARADIGM: The new paradigm embraces chaos, complexity, emergent creativity and self-organization. We all participate in the evolution of consciousness, whether our transformations are conscious or unconscious. Conscious Evolution is the ethical, philosophical, intentional governance of human change and cultural engineering.
We can each conduct ourselves compassionately with spiritual responsibility for the health and unfolding of human progress.Thinking and behaving with creative intent, we form a graceful society, approaching our ideal, incorporating loving, harmonious methods also in harmony with nature. The post-metaphysical desire is to contribute to the spiritual fulfillment of all people. The needs of the many resonate with the needs of the one.
But we can empower ourselves to resist status quo politics and shape ourselves a better destiny - a 21st century Manifest Destiny that fulfills our positive spiritual potential. If we don't want a dark future for humanity, we must reinvent ourselves and our culture from the foundation upwards. Even if that is fantastically radical, it can still happen, one inspired person at a time and cascade toward a visionay approach to large-scale societal transformation that heals personal and global socioeconomical scars.
Competent citizenry can learn to impliment constructive visions for our collective planetary future. Deep and broad visions can stimulate reflection and lively discussion of contemporary solutions that can become the scaffolding for action plans from the community level upwards. A courageous and truly integrated vision would include a detailed strategy for a vibrant and life-sustaining future. Individually and collectively we have to redefine what it means to thrive with more compassion for others, not just survive. The paradigm needs to switch from "dog eat dog" to "we're all in it together."
SOUL OF AMERICA: A spectre is haunting America -- the dark shadow of her domestic and international covert activities, cover ups and arguably poor choices. America is dysfunctional; she has a sickness of the soul. Maybe she has lost her soul. Soul loss is a spiritual illness. We are an addictive nation and our government is an addictive organization, as demonstrated by its leaders. Individuals reflect the addictive nature of the system. The system demands you are consistent with the system. CONSENSUS CULTURE: We are always in a trance state. We conspire with one another to create or confabulate consensus reality. Cultures and subcultures share tacit understandings which together are Cultural Trance States, an unconscious cohesion. All cultures are trance states with their own modified programming content - family, community, religion, nation. We have been programmed by repeated suggestion since birth. We don't question or doubt this deep trance. Nations and organizations also create lived trance states. We are surrounded by and absorbed in their powerful reality in the social cradle.
SHAME & BLAME: Addictive organizations and their false images (PR, spin, false fronts, false flags) are the infrastructure of an addictive society. Addiction leads to compulsiveness. Thus, we have become a shame-based society. Symptoms include grandiosity, confusion, self-centeredness, dishonesty, perfectionism, scapegoating, self-righteousness, paranoia, projection, defensiveness, fear and ethical deterioration.
TOXIC SHAME, the fuel of addiction, divides us from ourselves and others. In toxic shame, we disown ourselves and cover-up with a false self. Toxic shame has many disguises; it loves darkness and secretiveness. It stays in hiding and covers itself up with a myriad of behavioral cover-ups. Toxic shame is spiritual bankruptcy. Healthy shame is honest. It lets us know our healthy limitations and provides meaning. It is the basis of humility and spirituality.
DEPRESSION is the number one mental health problem. Stress is the number one killer. Often depression lurks behind compensatory manic activity. Our boom-bust economics, the irrationally optimistic housing bubble and over-extended credit reflect the same syndrome. We react to an illusion of scarcity with the illusion of control that blocks what we fear we can't handle. Personal or collective disaster leaves us dispossessed. Shock, disaster and economic downturn is a formula that can be manipulatively exploited to eliminate resistance.
GOD CULT: What we worship is what we give our attention to. We worship GOD: Gold, Oil and Drugs. They are what makes the world go 'round. They fuel the social control systems and fund the elite controllers. This GOD is the tangible source of our freedoms and our slavery, the buffers between ourselves and our awareness and feelings. The cult of GOD has taken over our lives and we are more and more powerless. *We rely on the elusive promise of a hoped-for reward to pull us into the future, toward our destiny. This is the the Catch-22 in the American Dream, which was the 20th century prime directive. It promises you will get ahead with power, money or influence. Despite our lip-service to democracy, we are far from a classless society.* We are seduced by the promise of the good life, with benefits that is the payoff for the Protestant work(aholic) ethic. We deny this is the core of the sick system by working out and eating well so we can work even more without burnout. We are lured by the promise of the addictive system to take us out of the here and now.* Economics and politics have taught us that greatness lies in expansion and accumulation. Yet even though we work harder, the US has lost its manufacturing base and pre-eminence as the world's greatest economic power to the EU. The Greenback is slipping. Markets have been appropriated by transnational corporations. Only empathy can heal this entropy -- the global acceleration crisis and destructive wastefulness. Economic development has failed to create and maintain social welfare.
For America to recover, she has to see through deep denial, acknowledge the realities of her shadow self, hold the tension of the opposites, and let go to the transformative process of self-actualization that promises rebirth at a higher level of integration, stabilization and functionality. We can become more conscious participants in our own self-unfolding and in course-correcting the ship of state toward positive directionality. We can understand, adapt and respond to our world better.
POST-TRAUMATIC CULTURE: PTSD is a chaotic, hyper-reactive state of being. Our cultural crisis is characterized by symptomatic numbing, dissociation, impulsive aggression, depression, denial, shame and anxiety. We are haunted by a sense of injury -- victimization. "Victim speech" is used for economic and military gain. First- and second-hand trauma shapes our central narratives of overwhelming personal and collective change.
COUNTERMEASURES: Mediated images of war and catastrophe can produce PTSD symptoms much like directly witnessing traumatic events, especially if one identifies with the victims. Providing a means of processing information and feelings, Internet may provide an antidote to toxic media images that induce panic. When we see history repeating itself, we flashback to similar unresolved events. Hampered by persistent high-level denial, time does not heal these collective wounds. Disclosure would be a start.
CREATIVE RE-PATTERNING: We need to eliminate the blocks to our maturation process as a nation, even if no nation can realistically survive being totally transparent. A nation can oversight itself internally just like an individual can do a "reality check." We've been stuck in pointless paranoia with a Draconian government, corporate feudalism and an unwinable war that has sucked us dry. Dynamic change and flux means finding our own way to an authentic relationship with self, others and world.
SELF-IMAGE: We need to make a quantum leap beyond our delusions in all these domains. Currently, we are getting "shock treatment." The Shock Doctrine (Klein) and "disaster capitalism" have been imposed abroad and domestically to reengineer societies reeling from disasters. This corporate warfare and economic policy are rooted in CIA electroshock experiments in torture. Ideally, we need breakthrough not breakdown. But our self-image, our national esteem has been damaged. Self image is linked to feelings of destiny, meaningfulness, significance, uniqueness and reason for being.
TRANSFORMATION: Without meaning we are cut off from our spiritual source that is our motivation, soul, spirit or destiny. The essence of tragedy is the realization of a destiny that escapes the human will, even if some have been able to predict the end. With insight and a new orientation we could effect a dramatic and positive self-transformation of our national character. It is our potential for eminence and the exceptional -- a clearer perception of and response to reality. OWNING THE SHADOW: The Shadow is the first challenge on the way to clarity. With 1/20th of the world's population, we consume over 50% of the energy. We have to integrate our dark side, face our negative qualities, what we have attempted to hide or deny, our secret shame. Our national shadow is embodied in our clandestine history, the dirty tricks conducted in our name. We have to know ourselves fully. We also discover our own buried potential there. It brings hidden powers into the light. To heal our denial and learn discernment, we need trustworthy disclosure.
I’ve seen the future, brother: it is murder
Thing’s are going to slide, slide in all directions
Won’t be nothing
Nothing you can measure any more
The blizzard of the world
Has crossed the threshold
And it has overturned
The order of the soul (Cohen 1992)
SOUL RETRIEVAL is the process of recovering what we've cut off, left or lost somewhere, or that was stolen or appropriated by someone else. Refuge is found in the human heart. Soul retrieval relieves trauma and fragmentation by mending the past and healing the future. The object of healing is to become whole...to embody soul. Wholeness is a process of reconciliation. Imagine what a more soulful nation might be like.
VISION: Each step in our history has been marked by a quantum leap in our Manifest Destiny driven by our expansive spirit and zeitgeist. If it is so that we "create our own destiny," it is time for America to manifest a better destiny in harmony with global values that support true democracy and our Constitutional freedoms. A more meaningful manifestation of our national spirit would prioritize universally spiritual ideals, like respect and compassion, over domestic and international power trips. To grow our citizenry and government need vision, communication and trust. We are the only species capable of long-term systematic planning, but we willingly sabotague ourselves for short-term gratification. We need to heal our relationship to self, others, and world.
CRISIS DRIVEN: The fact is, we live in a sick system and it impacts our quality of life from the inside out. If the USA was a person, that individual would be a toxic, narcissistic, territorial, workaholic control freak with boundary issues. Our violent nation is manipulative, dramatic, paranoid, compulsive and soon may become literally depressive. The housing market is in a depression, and that is symbolic of our condition. You have to wonder what all our irrational exhuberance and manic activity is hiding in the depths of America's soul. Just what is our collective "heart's desire?"
COMMITMENT TO TRUTH: What is our shared vision today? Shared visions arise from those truly committed to their personal visions. What is the true nature of this "reality" we are creating? Are we on purpose and achieving our collective destiny or has our country been hijacked by special interests? Why do we obsessively overwork, overspend, cover up, get aggressive and perpetuate sick organizations? How can we let go of our old national identity, pass through the 'neutral zone' and experience transforming rebirth? We need a paradigm that superimposes the new on the old. First comes a change in attitudes or worldview that embodies a different set of values in cultural rebirth.
CREATIVE STRATEGIES: How can we raise the bar? Shared vision uplifts our aspirations, gives us courage and ignites our spirit. It pulls us toward an overarching goal. It creates room for risk taking and experimentation by fostering long term commitment. We can extend principles and insights from personal mastery into the world of discipline, collective aspiration and shared commitment. The vision may come before its time is ripe, but we have to try, even to fail. We need a transition plan or crisis and confusion will arise. We can look to the past to get to the root of the problem.
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MANIFEST DESTINY is the philosophy that created the USA in her westward expansion. But it didn't stop there; our penetration has gone global. America has lost her boundaries but Manifest Destiny is still a driving ideal of virtually endless expansion. This ideology is still creating America's history, powering our culture. But in our egotistical zeal we have spread ourselves too thin, like the Alexanders, Napoleans and Hitlers of bygone eras.
But does the rightful destiny of the American people include unlimited imperialistic expansion? We're running out of places and cultures to invade. As a restless territorial culture bent on acquisition and conquest, we have boundary issues. We are the dominators, but the only frontiers left are within ourselves. It is high-time we manifest a new vision of our collective destiny, beyond the materialistic, religious, utopian design.
If the buzzword "Intentionality" is to be properly applied, we have to move beyond the ego gratification and wish fulfilment of THE SECRET and apply it in a global context. We can choose to consciously engage in self and social transformation. In a strongly networked society, a bottom-up approach to order is the counterpoint to the old hierarchal dominator model that has permeated history -- participatory consciousness.
We are enmeshed in denial. We either don't know or don't want to know the details of global exploitation that undergird our consumer lifestyles. We don't have the rationalized right to destroy anything or anyone who gets in the way of our so-called freedom and independence. We aren't independent; all of humanity and life is interdependent. We aren't free; we have traded freedom for so-called security. Far from demonstrating our superiority, the immortal doctrine of international Manifest Destiny reveals the spiritual faultline in the Soul of America.
FOR "WE THE PEOPLE" TO HEAL...
- We have to Know the truth about cover ups and clandestine activity.
- We have to mobilize collective Will to change ourselves and culture.
- We have to care enough to Dare to see through the manipulation of our beliefs and attitudes about what is important to collective well-being.
- We have to find our collective voice to overcome the public Silence that has kept us in denial to the point of moral and economic bankruptcy.
- We have to work toward restoration of our Constitutional Rights.
We have already mortgaged our progeny's future and must address that debt with more ethical economics. We need to find out what lies beyond the artificial constraints of corporate media, unregulated covert action, self-serving officials, greed-ridden American imperialism, the decline of civil liberties, environmental atrocities, egregious war, nuclear proliferation, lying leaders, global tyranny, the military industrial complex, the prison industrial complex, commodification of healthcare, and transnational crime.
ECONOMIC SYNERGY
We need to reinstitute safety nets and social justice. We need a pro-evolutionary environment, social innovation and economic synergy -- socio-cultural negentropy. Our nation needs to make a strong commitment to the health and well-being of all people and stop being an entropy sink. To successfully meet the challenge, we need our Constitutional Rights restored.
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We can begin by admitting our addiction to our false GOD -- Gold, Oil & Drugs.
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MANIFEST DESTINY: How can we manifest the common destiny of a peaceful and prosperous future for all of mankind? We can create an evolutionary politics to build a more creative future. Calculated cycles of commodification and scarcity, business and war have driven the military-industrial complex and the manipulative/exploitative multinational corporate climate. Cover Ups, media distortion, disinformation and confusion have paralyzed us with apathy and cynicism so nothing significant can be trusted, believed or known. But we do know this: 1% of humanity controls 40% of global wealth.
FROM GREEDY TO NEEDY: But we can empower ourselves to resist propaganda, consumerism, fear factors, status quo politics and meta-control to shape ourselves a better destiny - a 21st century MANIFEST DESTINY that fulfills our positive spiritual potential. Spiritual bankruptcy, the failure to consider our effects on the whole system, is a symptom of our collective ethical and economic failures.
ETHICAL ECONOMICS: If we don't want a dark future for humanity, we must reinvent ourselves, our ethical economics and our culture from the foundation upwards. Even if that is fantastically radical, it can still happen any moment, one inspired person or community at a time, cascading toward a visionay approach to large-scale societal transformation that heals personal and global socioeconomical scars. Active reconciliation must replace passive resignation to our fate. We have to "check it before we wreck it," that is, check our overweening narcissism, self-indulgence and gluttony as a nation-state.
COMPASSIONATE CONSUMPTION: Competent citizenry can learn to impliment constructive visions for our collective planetary future. We can wrestle our future from the grip of sociopathic control freaks, fiscal irresponsibility and deluded mental processes. Deep and broad visions can stimulate reflection and lively discussion of contemporary solutions that can become the scaffolding for action plans from the community level upwards. A courageous and truly integrated vision would include a detailed strategy for a vibrant and life-sustaining future.
SURVIVAL STRATEGIES: Individually and collectively we have to redefine what it means 'to thrive' not just survive with more compassion for others and life in general. The paradigm needs to switch from materialistic "dog eat dog" to universalist "we're all in it together." We must remain self-reflectively vigilant for mass stupidity, cultural bigotry and racial intolerance. We have to develop an active courage to change and to impliment more intelligent choices.
CONSCIOUS EVOLUTION: Evolution has made us self-aware and self-conscious. But those terms are not states but a spectrum of states, which can be up-regulated with simple techniques, such as concentration, self-reflection and meditation. Even biological evolution is now under the direction of human Conscious Evolution. Hard technolgies and spiritual tech are expanding our ideas of what it means to be human, and our inherited potential for realization and self-expression. Conscious Evolution is a worldview that supercedes the Manifest Destiny philosophy, a higher octave of the comprehension that "our reality is what we make it."
ENLIGHTENMENT: Many are pro-actively implementing their personal and collective vision of social potential and an emergent worldview that is negentropic and integrative, personally and culturally. Greed is unenlightened self-interest, myopic selfishness. Enlightened Self Interest is a good place to begin. It is an ethical philosophy demonstrating when we act in the interest of others, we promote our own well-being. An illumined state is not the goal, but the platform for creative interaction within the authentic Self, or essence, in a collective context. Conscious Evolution links discipline, practice and service. Our culture can be enriched by our present actions.
EMERGENT PARADIGM: The new paradigm embraces chaos, complexity, emergent creativity and self-organization. We all participate in the evolution of consciousness, whether our transformations are conscious or unconscious. Conscious Evolution is the ethical, philosophical, intentional governance of human change and cultural engineering.
We can each conduct ourselves compassionately with spiritual responsibility for the health and unfolding of human progress.Thinking and behaving with creative intent, we form a graceful society, approaching our ideal, incorporating loving, harmonious methods also in harmony with nature. The post-metaphysical desire is to contribute to the spiritual fulfillment of all people. The needs of the many resonate with the needs of the one.