EVIDENCE-BASED HELP FOR TRAUMATIC DISTRESS

Every time I find a new “school of thought” about psychology, I think I’ve found the Grail at last and this time the world will be healed.  That lasts a day or so.  Then I begin to research and discover what’s really useful and what is just dreck.  This time around it is “Evidence-Based” treatment, which applies to both medical and psychological cases.  It arises out of several forces, one being the amazing brain function research of the NIneties and the other coming from the “best practices” movement.  

Brain function research is something that can be demonstrated, quantified, replicated in a scientific manner, and researched further.  “Best practices” is measured by results.  Whatever works, regardless of theory schemes.  The motivation for driving towards better goals with better results in counseling comes in large part from the need to address complex traumatic stress disorders arising from war, from poverty, from substance abuse, and from confused families.  Not only do the trauma-causers seem to be increasing, we are much more aware of them than in the past.  PTSD and child abuse seem to be everywhere.

The historical sequence of waves of psych theory --  Freudian forces of sex and death grappling in the darkness; Jungian Celtic figures producing universal narratives; Skinner’s cogs and levers; the Third Force thinkers offering peak experiences, and New Age notions of imports from other cultures -- mixed with a host of people wanting to be healers -- have created a Great Chaos that sometimes has deadly consequences and certainly discredits the whole weaving of moonbeams that psych counseling can seem to be.

What got me excited about “evidence-based” practice in the first place was brain research.  The main thing is the disproving of the idea that brain cells are never renewed and that after age 37, it’s all downhill.  QUITE to the contrary, brains are living, changing, processing complexes of organs that adapt to whatever happens to the whole body.  A person who is blinded re-allocates the brain space to hearing.  A person who takes up golf or piano playing, will “grow” a whole new area of the cortex for storing the new skill.  No one knew this, because it was undetectable with the instruments of the past, though people demonstrated it all the time.

In fact, specialized CELLS -- not just organelles or complexes of connections or processing centers -- but one-by-one specialized brain cells are being found (spindle cells, pyramidal cells, mirror cells), features only found otherwise in elephants, toothed whales, and some apes.  The cells seem to endow empathy, social cooperation, and the like, which the scientists speculate are due to evolution -- not to the benefit of the individual so much as related to the survival of the species which is the real location of evolution.  Not every human has these cells, though there have not been surveys of large numbers of people since it’s so expensive to find individual cells.  It’s not hard to think of people who seem to have no empathy.

Which brings us to the next revelation: that there are certain periods on the time-line of human development that are crucial to the brain.  Most of us by now realize that a baby must have basic physical safety and care to survive, but few have really absorbed “attachment theory.”  Attachment to one human who is dependable, attentive, and responsive is the foundation of everything else in life.  Combined with the genomic potential that it helps to unfold, being able to form an attachment gives the baby the power and motivation to explore the world.

Some reseach suggests and can show on an fMRI, that there are two “modes” in which the young brain operates:  the “learning” mode is when curiosity and exploration are the main motivators.  If the baby is hurt, scared, traumatized, it goes into a second mode: “defensive.”  All energies convert over to watching for danger and taking self-protective measures like fight, flight, freeze, or hide.  The way the person sets these up in his or her brain will govern relationships for the rest of that person’s life.  Even being able to see oneself convert back and forth -- one writer compares this conversion to the sea anemone opening up and closing down -- or learning late in life to be more trusting, will always be in terms of the background of those first early lessons.

There are two more well-described periods of brain growth and elaboration, one at adolescence and one between 17 and maybe 24, the years of college or military service.  What keeps stumping me is why the period they label “adrenarche” -- 6 to 9 -- when long bones grow, adult teeth come in, and sexual organs begin to grow into their functions (though they aren’t operational yet), is not considered a time of brain development.  Freud called it latency.  But those are the years of accumulating identity and reaching the age of reason in terms of legal standing.  I suspect that this is the time of life that the specialized cells are developing rather than more easily perceived organs and connections.

I’m drawing on a book called “Treating Complex Traumatic Stress Disorders: An Evidence-Based Guide.”  Googling brought up a rebellion on the committee that is supposed to be rewriting the DMSO-IV which guides psych people and the insurance industry.  It’s the book that says what is and what is not a psychological problem.  It has to be rewritten all the time because ideas change so much.  You’d be shocked to look at an historic overview.  Anyway, all the European shrinks on the committee felt unheard and disrespected, so they left.  I’m not surprised.  The earlier counseling theory empires are hugely powerful and make a LOT of money, much of it in the US.

This book includes essays by people I would avoid, but Christine Courtois is a person whose thinking I value.  She’s worth searching on YouTube.  I’ve got this book, which she co-edited, on Interlibrary Loan from the Veteran’s Administration Center in Seattle.  The pocket card shows one borrower per year for the last two years.  Maybe counselors can afford to buy their own copies.  It is a compilation of essays by practicing psychologists.

There is nothing about criminality.  The word they use is “forensic,” though traumatic stress disorders are very much entwined with prisons and phenomena like mass murder, to say nothing of domestic abuse.  There is nothing about physical safety when people are after you with bad intentions, though safe houses for abused persons are crucial.  There is nothing about substance abuse, though one writer notes that “self-treatment with drugs and alcohol” can work to the point of being life-saving.  Nothing about sexwork at any age or at any social level from street to penthouse.   Nothing about therapy for those who impose trauma.  One of the most intriguing chapters is that about “vicarious trauma,” which is like second-hand smoke -- trauma to the witnessing healer.  Wasn’t that an HBO series?  “In Treatment”?  I”m just about to the end of “Oz.”  If I survive it, maybe I should try “The Sopranos” to see what that therapist does.