A bit ago, I blogged on David Morris’ new book, “The Evil Hours: A Biography of Post-Traumatic Stress Disorder” and his NPR interview. [You can read my previous post here.] Having just finished reading the text, I want to highlight a few more insights about the book.
Morris does an excellent job describing his experience of trauma and then expanding to the history of PTSD and its impact, both on those going to war and those who have experienced civilian traumas. For those who wonder why Vietnam vets struggle more than WWII vets, Morris helps reveal the falseness of that belief in the beginning of chapter 5.
But the most important chapters of the book are chapters 6 through 9 where he examines therapies designed for PTSD, how research protocols designed to help us know which treatments work best may harm, how drugs and alternative interventions (e.g., yoga) may help and how to think about posttraumatic growth.
Though these chapters are his experience, I would highly recommend every MHP to read these chapters. Skip the first chapters if you must (you should not!) but these are paramount if you are going to work with traumatized individuals. Here are just a few reasons why:
- Following protocol for therapy can harm a patient. Don’t get me wrong, research IS necessary. But when a protocol is harming a patient, it is important to make sure that research goals do not become primary over the needs of the one who is in need.
- Prolonged Exposure, the gold standard treatment, has a HUGE drop-out rate. Somewhere around 54%. That should give us great pause. Surgery hurts. PE is like surgery but repeated opening of a wound. The dropout rate should tell us that imaginal work can re-traumatize. There are other methods that may work just a well but do less damage in the process. I think about the changes in the last 10 years for breast cancer. We are discovering that not everyone needs bilateral breast removal to survive. Not everyone needs 30 days of radiation as radiation at the time of lumpectomy may work just as well for some patients. So, we must be less fixed in our minds on treatment protocols and be considering if the patient can improve with less radical treatment options.
- Cognitive therapies are good but over-emphasize think right = feel right. Such work could ignore the moral complexity of life, especially for those who have moral injuries.
- The person of the therapist is more important than the treatment modality. This is not to say that the modality is of no consequence. Rather, that good interventions live or die on the capacity of the therapist to be truly human with clients.
- Recovery must be done in community. Gutting it out alone does not work.
- Alternatives, like yoga, works for some far better than talking, but shouldn’t be sold as a cure-all.
…yoga stands out as a uniquely effective treatment, precisely because it insists that people shut up and start listening to their bodies. Yoga works to correct the central lie of Western philosophy, which goes all the way back to Descartes, who said that the body and the mind are distinct entities that exist independent of each other. (237)
However, Morris acknowledges that yoga is, “ridiculous”, even “moronic.” Though he is also quick to say, “In the Marine Corps, we had a saying: ‘If it’s stupid but it works, then it isn’t stupid.” (238). “Placebo, wishful thinking, whatever. I’ll take the help where I can get it.” (246, discussing the mixed evidence for EMDR). Yet, be wary of proponents of any one treatment as a cure. They prey on desperate people.
The bottom line is that there is no ‘magic bullet’ for PTSD, and claims to the contrary should be taken with more than a grain of sand. (240)
- Growth happens but not apart from ongoing trauma symptoms and changes. Too often we expect recovery to mean the removal of symptoms. But, there is no going back. Identity changes, just as it would if you lost your spouse and then got remarried. Growth needs to be observed and underlined, but not assumed to eliminate strong, continuing reminders of trauma.