November 2007 issue
In 1974, Sam (not his real name)
joined the Royal Ulster Constabulary, now known as the Police Service of Northern Ireland. The death toll exacted by The Troubles was being ratcheted up daily, topping 1,000 in April of that year. It would double and then triple over the course of Sam’s service, as the country was convulsed by sectarian violence. Corpses, bombings and assault became part of Sam’s routine. “It was like a normal event,” he says, “explosions, killings, being attacked, seeing my friends attacked and even killed.”
He suffered from severe anxiety, flashbacks, nausea and sleeplessness as his mind replayed his most traumatic experiences with shocking immediacy. He never sought help for his problems because in Sam’s world at the time, post-traumatic stress disorder (PTSD), a condition in which victims of a psychological trauma experience severe and ongoing emotional reactions, simply didn’t exist. “You were told to just get on with it.”
Five years ago, when Sam was told he and his family were being targeted in their home by Republican terrorists, something snapped. “It was horrendous. I felt anxious, vulnerable and constantly unsure who to trust. Whenever I was at home, I was terrified for my own life. Whenever I wasn’t at home, I was terrified for my family.”
Even when his wife and four children were safely relocated, Sam couldn’t escape this state of near-panic. He became a total insomniac, relying on sleeping pills for rest, obsessively vigilant against threats and increasingly quick to anger. Living this way was intolerable. “I had been carrying so much pain for so long,” he says, “I finally felt I had to do something about it.”
Sam’s doctor referred him to a Belfast psychologist whose treatment made all the difference. After 13 sessions, he was able to put to rest 30 years of ongoing psychological pain. “Now it just seems like a memory,” he says.
Since his treatment, Sam has never discussed his trauma or the therapy that helped to heal him with anyone but his doctor. Speaking now, he seems amazed at how well he truly is. “I’m not breaking into a cold sweat talking about it. I’m not sick. It happened. It’s a memory. I can move on.”
The therapy that helped sam was eye movement desensitization and reprocessing (EMDR), a treatment that involves the patient following the therapist’s fingers moving from left to right before his eyes. As the patient attends to the eye movement, or to other bilateral stimuli such as knee-tapping or audio tones, the therapist acts as a guide back through the memory of the trauma, helping him reorder and reprocess damaging thoughts and emotions.
Not that EMDR is a quick fix. “So much attention has gone to the eye movement,” says its founder, California psychologist Francine Shapiro, “some people think it is a matter of ‘follow my finger.’” It’s not. EMDR is an eight-stage treatment in which the therapist is highly involved. Some patients who have been treated with EMDR recall intense reactions to the therapy—nausea, sweating, even vomiting and, like Sam, physical pain. Almost all emphasize the need for a trusting relationship with a therapist, who helps prepare patients to participate, actively assists them in reprocessing thoughts and feelings that surface during a session and is on hand to help with closure and aftercare.
Ever-increasing numbers of therapists, psychologists and other practitioners are stepping forward to fill that role. Worldwide, more than 80,000 are now trained in the treatment, according to the EMDR Institute in Watsonville, California. EMDR is increasingly used to treat a range of anxiety-related disorders, from acute PTSD to phobias and addictions.
The treatment seems to have a startlingly high success rate. One study published in the Journal of Consulting and Clinical Psychology reported that 84 percent of patients suffering from a single-incident trauma—such as an assault, natural disaster or accident—no longer suffered from PTSD after only three treatments. In 2004, The American Psychiatric Association gave EMDR the highest level of recommendation for use in the treatment of trauma. The following year, Britain’s National Institute for Clinical Excellence endorsed the therapy as an empirically supported treatment for PTSD.
Shapiro began the development of EMDR in 1987. The oft-repeated story of her eureka moment has become almost a legend, an integral—if somewhat apocryphal—part of the therapy’s history. Coming up with EMDR was, if the stories are to be believed, quite literally a walk in the park, or the forest, or along the lakeside. For the record, Shapiro says, it was a park.
“As I walked, I started to notice that some troubling thoughts I had been having were disappearing,” she explains, “and when I started paying attention to what was happening I noticed that whenever negative thoughts came up, my eyes spontaneously moved from side to side.” At that point, Shapiro started to move her eyes back and forth deliberately and found that as she did so, the negative thoughts she had been suffering from became less pressing, “less charged” than they had been.
There is a great deal of disagreement about the precise role that the eye movements and other bilateral stimuli play in EMDR. When Shapiro made her discovery, she found that her eyes moved spontaneously as she processed some disturbing thoughts. Today practitioners of EMDR initiate this physical state in others in the expectation that this will, somehow, evoke a similar mental state conducive to psychological healing.
To date, studies have indicated that the eye movements may decrease the vividness of mental imagery, which might help a trauma victim facing painful experiences like Sam, and that they can also facilitate increased access to memories. Other studies have concluded that the eye movements contribute nothing to the therapy.
Yet we still know little about exactly why EMDR proves so effective. Shapiro explains that the theory behind the therapy is based on an “information-processing model.” When something happens to us in ordinary life, our brains link the event to a memory network of past events. It also processes our experience. What is useful is brought into the network and assimilated. The rest is let go, forgotten.
When a trauma occurs, however, this process is interrupted. Rather than being digested into a memory network, the experience lingers in our minds in its unprocessed form. So a rape victim may continue to feel her assault as a present experience long after the event is over. Every hand that touches her can bring back the grip of her assailant with terrifying immediacy in much the same way that an amputee will continue to experience live sensation in a missing limb.
Robert Stickgold, associate professor of psychiatry at Harvard Medical School, has theorized that the eye movement employed in EMDR is somehow related to rapid eye movement (REM) sleep, which takes place for roughly 20 percent of an average adult’s time asleep and is qualitatively distinct from the other dozing we do. The exact function of REM sleep is not precisely understood, but it is widely believed that during this time, our brains consolidate memories. EMDR might be helping trauma victims access this state directly rather than accidentally, as most of us do, and activate the mental healing process.
“When someone suffers from post-traumatic stress disorder, one of the systems that is disturbed is REM sleep,” says Shapiro. “With EMDR, you may be able to take someone further into processing than they could go naturally. You help them to access those troubling thoughts and activate the information-processing system.”
Still, what is most important for Sam and thousands of other trauma victims is not how the therapy works, but that it does.
Shapiro has high hopes for EMDR’s global application. The therapy has already been used to assist victims of the Indian Ocean tsunami, September 11th and the 2002 Milan skyscraper crash. On any given day, a quick glance at the front page of the papers—chronicling crisis in Darfur, Afghanistan, Iraq—provides a daunting idea of how much healing is needed.
“Trauma begets violence,” says Shapiro, “and people are limited by the pain they are carrying with them no matter where they are. Alleviating that offers a chance, at least, for peace.”
Lillian Kennett is a freelance journalist.