Dawn of the Trauma Ghouls

Have you noticed the recent up-trend of trauma as pop culture?

Quickly, I can point to two examples on television: "Rescue Me" is a Fox Network show about a NYC firefighter who lost his brother in the WTC disaster. It stars Denis Leary and is, while relatively inconsistent, one of the better series on tv. One of its main plot arcs is the ptsd symptoms of Leary's character (and of other characters, most of whom are either fellow firefighters or their family members). I think it does it well.

The other one is a new series called "The Nine," which, based on its trailers, follows the fate of 9 survivors of a bank robbery gone wrong. Based only on the trailers, which have been airing regularly, the cast seems to be running through the typical ptsd reactions - guilt, fear, etc.

A contradiction in my own therapy (as a witness/survivor of 9/11) that I cant get past is when the docs tell me that what I'm feeling is "normal." My reaction is: if what I'm feeling is normal, why am I in therapy?

I think the analogy of swimming and splashing is a good one. To add to it, I think we have to consider that, prior to being thrown into the water of some traumatic event, each person is already carrying (well, what did you expect?) baggage on their person. This can weigh them down, or sometimes provide floatation devices. It depends on what baggage they had at the dock and how familiar they are with that which they carry with them into the water. In this regard, doctors can help not only with teaching patients how to swim, but how to use what they have, how to understand what they have, to both understand why they are unable to swim and how to take everything they have around them - the good and the bad - to make it to the next step.

This is an interesting debate, about how soon therapy can be effective or if therapy in and of itself is counterproductive to recovery. In either case, I think it's important for patients and potential patients to work with a highly skilled doctor. Applied to real-world situations, the victim of trauma is in some ways the last person who can comment on the kind of help they need, or whether they need help at all. Here, it's a skilled practioner who may bear the responsibility of advising people as well as tending to their care.

A current trend in post trauma treatment is to prevent consolidation of memories of the event. If the patient is completely sedated immediately after the trauma, some retrograde and anterograde amnesia can be induced. The idea is that the patient will be able to discuss the event intellectually in a therapy session, but the emotional details will be permanently missing. In that case, the ghouls will not have power. This is a controversial treatment because of a common belief that reliving the event in the psychotherapist's office leads to a healing catharsis.

I think there's research to show that Freud got this "catharsis" thing all wrong. Getting people to re-live and rehearse the trauma simply drives the pain home, deeper, so it becomes almost impossible to dislodge. Let nature take its course. Above all do no harm.

Unfortunately, managed health care sets limits to psychotherapy in terms of number of sessions and TX method. In fact, part of the ethics of practice requires the psychotherapist to warn the client that the insurance company may stop paying even though there is more work to be done. This may promote the fast "cookie cutter" approach.