Category Archives: post-traumatic stress

April 23, 2009 · 2:17 pm

Backgammon (Bear Off)


While both backgammon and chess are war-games, the former is way older [3000 B.C. vs. 600 A.D.] and–in Geneva Conventions terms–way more soldier-friendly. In chess you can sacrifice all your troops, except the King, in the name of victory; whereas in backgammon you cannot win until you rescue all your troops from their captivity [on the Bar], and bear off every last one of them to safety.

Without getting too name-droppy about it, I was lucky enough to meet [separately] with two of Freud’s analysands [his patients], who went on to become noted psychoanalysts [both now dead–this was in the 70s]; and one of them [can’t remember which] told me that Freud preferred the metaphor of backgammon to chess, for the Game of Life. As we slog through the vicissitudes [Freud’s oh-so-prissy translator, Lytton Strachey, chose this term, instead of ups & downs, or snakes & ladders, or swings & roundabouts] of life, we get stuck in some boggy patches. [If A.A. Milne had been Freud’s translator, more people would have gotten the benefit of the useful bits.] These have to do with tricky dilemmas discussed in previous posts [such as “To be smothered with attention, or to be left utterly alone?” and “To be a Goody-Two-Shoes, or to be a Black Sheep?”]. In our earliest struggles, grown-ups represent the opposing side [the Giants, Freud said, because these battles took place When We Were Very Young, therefore, small].

In each of these skirmishes, we lose a few soldiers; but we carry on with our remaining troops, to face the next dust-up. For some people, these encounters are not so bad, and only a few soldiers are lost. For others, it’s a hard-knocks life; and the Bar is crowded with their captive troops. Freud thought of troop strength as the Vital Force [or psychic energy] needed to confront life’s challenges. Let us think of it as blood to the hippocampus, shall we? Not enough of it, and the hippocampus shrivels up, leaving us unable to remember important stuff or to problem-solve. We lose traction. We are in danger of being gammoned or even backgammoned [losing the Game of Life very badly].

So we need to make like the Red Cross [Crescent, whatever], and negotiate for the release of these PoWs. In backgammon, it’s a roll of the dice–if a useful number comes up, a soldier can be liberated and head for home. In real life, we need to go back–to revisit the hard-knock event–and see if we can reframe it in such a way that we get the captive soldier back. The most current treatment for Post-Traumatic Stress Disorder encourages the individual to recollect the traumatic event: to write about it, or to talk about it into a taperecorder and listen to it repeatedly, until it loses its power to arouse the amygdala. Then the “wolf-work” can begin. “What got up your nose, about the event?” “Are you bummed because you lost a buddy, or do you blame yourself for his/her loss?”

As in all real wars, we may never recover all the fallen or captive soldiers, but it is vitally important that we try. Those who say that we should simply “Move on,” from traumatic events, without any attempt to understand what really happened–what we were thinking, what got up our nose–are ignoring human nature and brain physiology. What we have not acknowledged and understood, we are likely to act out–against ourselves and others. Before we can truly move on, we need to look back.

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Filed under Freud meant..., gets right up my nose, limbic system, post-traumatic stress

October 18, 2009 · 6:08 pm

One-Trial Learning


The American philosopher-turned-behavioral-psychologist, Elwin R. Guthrie (1886-1959), challenged other Behaviorists of his time, by declaring: “A combination of stimuli which has accompanied a movement will on its recurrence tend to be followed by that movement.” BFD? You’re missing the “heaviosity” of his premise. Unlike Pavlov [Big Daddy of Classical Conditioning] or Skinner [BD of Operant Conditioning], Guthrie was the BD of Associative Learning. No reward need be given, said he, for a movement to become “cued” by a stimulus. Forget the all the use of High-Value-Treats to reward the desired response, advocated by dog trainers, or the symbolic reward, the clicker [which betokens to the dog that a treat has been earned, redeemable at a later time]. According to Guthrie, it only takes one coincidence of stimulus and movement, for the two things to become forever paired. Boom! Done! [Pavlov’s dogs had to have many pairings of sub-lingual meat powder with a bell, before the bell alone elicited drooling.]

To the extent that Guthrie’s theory is true, it is not altogether good news. In college I was riding shotgun in my roommate’s car, when a motorist failed to observe the Stop sign at an intersection, and plowed into the side of the car. Having caught a glimpse of his not-slowing-down car in my peripheral vision [the cue], I crouched into the fetal position recommended for airplane crashes [the movement]. Nevermind that my addled hippocampus had applied the wrong transport safety tip [and I consequently suffered gory-looking but superficial facial abrasions that I would have avoided, had I remained sitting upright]. To this day, 4 decades later, when a I see a car approaching an intersection “too fast to stop,” I have to fight the reflex to cringe. It doesn’t happen when I am driving, mind you, just when I am riding shotgun; but this One-Trial Habit [as Guthrie called it] annoys the hell out of whoever is driving “Miss Crazy.”

Let’s do the wolf-work. It is humiliating to them, that I appear not to trust their driving skills. Further, my sudden movement is both intrusive (sometimes blocking their view of the other car) and frightening (since it betokens a “clear & present danger,” rather than a remembered danger from long ago).

Guthrie’s own recommendation, to diminish the power of a problematic cue/movement connection, was called Sidetracking. One must endeavor to discover the initial cue, and then deliberately associate a different [incompatible] movement with it. Alrighty, then. What’s incompatible with cringing? Why, sitting upright (as I should have done in the first instance), with my forearms resting on my thighs (rather than covering my face). Unfortunately, whenever I abruptly assume this crash-test-dummy position, it is almost as alarming [therefore, annoying] as the cringe. At least it doesn’t obstruct the driver’s view. In recent years, I’ve taken to wearing sunglasses while being driven [avoiding harmful UV rays, you know], behind whose dark lenses I close my eyes when a car rushes up to the Stop sign. I also contrive to sit in the back seat whenever possible, where I am blissfully oblivious to the threat of reckless drivers. I am unflappable in taxis, even in Manhattan.

Not all instances of One-Trial habit formation are as trivial as my intersection cringe, however. The cue/movement nexus might account for the intractability of various substance addictions. Today’s New York Times has an article speculating that Adam Goldstein [aka DJ AM], may have relapsed into drug abuse because of filming a documentary in which a young woman injected herself with heroin. An individual’s first use of an addictive substance is likely to occur in the presence of others who are using the substance. According to Guthrie’s model, the cue [of others shooting/lighting/drinking up] will be forever associated with the movements one made, in connection with the first use of that substance.

Nor need the cue be visual. Even in 1960s Britain, the sound of an air-raid siren sent survivors of the Blitz diving for cover under a table or bed. The whiff of that certain food you ate just before you got sick can, years later, activate your gag reflex. The song you were listening to when that false love in high school broke up with you can still make you cry, a lifetime later.

Yesterday, while making his weekend rounds at two DC hospitals, my husband discovered that his car had [at least temporarily] “died,” and he came home in a rental car. Lili, who was awaiting the return of her beloved master, saw the intrusion of a strange white vehicle in the driveway [the cue], which set up a barrage of histrionic barkitude [the movement]. Even when her master emerged from the rental car, she could not stop herself from barking at it. Just now, his arrival in the cue vehicle again sent her into a reflexive barkfest, despite my commands to her to assume a position [presumably] incompatible with barking [“Foo-say!” Lie down!]. When the UPS truck cues Lili to bark, she has learned the incompatible movement of sending herself down to the basement [where she can’t see the offending vehicle]; but apparently this weekend’s “combination of stimuli” [strange car, beloved master] presents a more difficult cue to Sidetrack.

It was Guthrie’s contention that “excitement facilitates associative learning,” making the cue/movement connection even stronger. Lili is very excited whenever her master comes home.

To be continued.

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Filed under gets right up my nose, limbic system, post-traumatic stress

October 20, 2009 · 6:49 pm

Virtual Backgammon


Yes, I admit it. I am a Luddite, but not a Troglodyte. Until last Sunday I regarded computer games [especially the one which spends electricity, merely to spare the player the Therbligs it would take to shuffle and lay out an actual deck of cards] as a waste of time and resources. Not any more.

I direct your attention to a BBC on-line [see, I do use my MacBook for more than word processing] article, posted on 18 Oct 09: Virtual Reality Tackles “Shell Shock.” In it, the Beeb’s medical correspondent, Fergus Walsh, describes the successful treatment of 30 [out of a group of 40] US military personnel diagnosed with Post-traumatic Stress Disorder, following several tours of duty in Iraq. Alas, the 30 who responded well to the treatment were thereafter sent back to Iraq, or on to Afghanistan. But I digress…

The [non-radioactive, non-pharmaceutical] treatment was developed by Albert Rizzo, of the Institute for Creative Technologies at the University of Southern California, and is based on the X-Box game, Full Spectrum Warrior. We’ll get to the [literally] whiz-bang features of the current treatment soon, but first, back to Vienna.

If you recall my original “Backgammon” post, Freud used that game metaphor to describe the capture and imprisonment of one’s “soldiers” at the scene(s) of particularly harrowing “battles” in the course of one’s life. Lose too many troops [which he conceptualized as psychic energy], and you become unable to “soldier on.” His therapeutic model encouraged the traumatized individual to revisit the distressing events, recalling them in as much detail as s/he could manage, with the goal of “liberating the hostage soldiers” [regaining psychic energy]. In the actual game of backgammon, one has to throw a specific dice score, to move a “soldier” off the bar, and allow him to complete his journey home to safety [“bearing off”]. Why did this psychotherapeutic treatment take so long [or not work at all]? Resistance. Having survived [sometimes, just barely] a traumatic event, who would want to “go there” again? The Jack Nicholson censor in the mind tells the would-be recollector of a trauma, “You can’t handle the truth! I’m not going to let you remember what really happened back there.”

Let’s use the wolf [up-your-nose] model to explain the same thing. By definition, the traumatic event was frightening. If a major injury was sustained, there was pain & suffering. Often, the trauma involved the sudden intrusion of hostile individuals or their devices of destruction. Less obviously, but saliently, there may have been humiliating circumstances [such as a momentary loss of nerve, or loss of continence]. When the amygdala is thus aroused, the hippocampus is deprived of blood. Therefore, the brain’s most direct information-processing site is “off-line” during the traumatic event. Victims of violent crime are notoriously bad at picking their assailant out of a line-up. Back in college, I was a very weak witness during my deposition for my roommate’s totalled car lawsuit: unable to remember the make of the car that hit us, or even the make of the car we were in! [Luckily, the guy settled out of court, just as our case was called.]

Guthrie’s One-Trial Learning model is also relevant here. The complex stimuli of a traumatic event [the cue] may be followed by an evasive movement [as is my case], or by an aggressive movement, or by a catatonic freeze. When I was a VA Psychology Trainee in 1973, working with veterans “fresh out of the jungle” [of Vietnam], the most commonly cued movement in our clientele was aggression. Assaulting a stranger who accidentally brushed up against you from behind would get you arrested in a New York minute, back in the day. The best explanation the assailant could offer the judge was the non-specific, “All-of-a-sudden, I was back in Nam.” [Just like, all-of-a-sudden, in that shotgun seat, I am back in Durham.]

In 1999, Rothbaum et al. modified an X-Box wargame to treat a 50-year-old Vietnam vet, who had been suffering flashbacks and other PTSD symptoms since that war. Their hope was that Virtual Reality Exposure Therapy would overcome the patient’s resistance [or limbically-induced amnesia], allowing him to re-experience, in a safe and controlled setting, the traumatic events that had held him hostage for 3 decades. Once the memories were recovered, the conventional therapeutic work of processing the information and assisting the patient to “handle the truth” could begin.

As the lead clinician in the current San Diego study says, “Our different senses are very powerful cues to our memory.” Therefore, as well as tailoring the sights and sounds to re-enact the individual soldier’s traumatic event(s), the Virtual Reality program adds realistic motion [such as vibrations and sudden impacts] and smells: burning rubber, cordite, garbage, smoke, diesel fuel, Iraqui spices and what is euphemized as “body odor” [but was more likely ordure]. The subject’s heart rate and galvanic skin response [both measures of anxiety] are constantly monitored during the 30-minute VR sessions, to “keep it real,” but not so real that the original [fight/flight/freeze] movement is triggered. Then an hour of debriefing and talk-therapy ensues. The entire treatment consists of only 4 once-weekly sessions.

Just think of all the Therbligs such a treatment method could save the government! More importantly, just think of all the “hostage soldiers” it could “liberate” from their traumatic war experiences.

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Filed under catharsis, gets right up my nose, limbic system, post-traumatic stress

October 25, 2009 · 7:40 pm

Lumbered


In 1961 our family [and just about everyone else in the UK] went to see Anthony Newley’s WestEnd musical, Stop the World, I Want to Get Off, which was thrillingly cynical [especially to us Young Ones], about what is euphemized in the US as “a shotgun wedding.” Newley wrote & sang the phrase, “I’ve been lumbered.” It sounded like another example of Cockney slang [the meaning evident from the context]; but it’s actually ever so old, dating from the 1500s in England, and the 1300s in Continental Europe. It refers to an Italian ethnic group, the Lombardi, who were pawn-brokers and money-lenders. Lombard Street in London was so named for its plethora of pawnshops. [Incidentally, did you know, “Pop goes the weasel” is a euphemism for pawning a fur garment?] The Oxford Concise Dictionary (1911 ed.) defines “to be lumbered” as “to be burdened with something unpleasant” [which pawn-brokers were: namely, the “popped” weasels, used furniture, and other old tat that their clients had exchanged, for enough money to buy more rice & treacle]. Nar’mean?

Last week’s exploration of Guthrie’s One-Trial Learning theory was prompted by an event in the forest, during Lili’s & my morning walk. It had been raining for days, and then it got windy. The beaten path was like a waterslide in the downhill parts, to avoid which, I was detouring right through the trees, for better footing. As I came to the next downhill bit, I heard a tremendous crack, like the detonation of a shotgun, directly in front of me. First, I froze. Then I looked behind me, to see if a deer had been shot [since I, happily, had not]. Then I looked directly ahead, to see if I could spot a hunter and tell him to cease fire. Lili, meanwhile, looked straight up. Following her gaze, I saw a huge branch break off a tree, and fall right on the spot where I had planned to walk. Amazingly, I did not utter my trademark Hitchcock-victim scream, but just calmly followed Lili [my Pack Leader pro tem] along the slippery path, away from the newly fallen lumber.

We used to think Lili was silly, to look up warily at every looming object she passed [such as playing field lampposts, the water tower, and even our ceiling fan, when it first turns on or off]. Now I get her point. I was looking everywhere but up, in the woods; and without Lili’s vigilance I would have been well and truly lumbered.

Then I wondered if the next day I would shy away from that specific part of the woods, or if I would be more amygdally aroused in general, especially by any “gunshot” noises. In fact, I was able to cognitively reframe the falling branch as “a lucky escape,” rather than a “trauma”; and we have had remarkably serene walks. Today was the first time my husband has been able to come with us in two weeks, and it had been bucketing rain last night, so I remarked, “I hope all the branches have done their falling, by the time we pass through.” Several 100 yards past the site of last week’s fallen branch, he pointed to an 8-inch-in-diameter, newly fallen tree, lying directly across our path, and said, “Well, there you go.” [It’s not the one pictured here. No camera today.] Lili glanced up warily at an adjacent, precariously-balanced tree, decided it posed no immediate hazard, and jumped over the fallen lumber.

So, even without a tailor-made X-Box game [Timber!], I have been able to do my own limbic debriefing, and avoid being lumbered with a fear habit about our beloved walks on the wild side. In the thick of the forest, I will trust Lili’s big ears and big eyes, to warn me of impending danger from above. Still, I will be the judge of whether the people and animals we encounter on the ground are friends or foes.

Meanwhile, since last week, I have not flinched once while riding shotgun with my husband. See, we can learn to tame our Wild Things [aka howling limbic wolves], of which, more next time.

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Filed under limbic system, post-traumatic stress, semiotics

November 4, 2009 · 9:36 pm

Tame Thing


My parents may have been avant garde, in using Ying Tong [the Wild Thing] as a “therapy pet,” to break my cycle of paroxysmal coughing; but earlier still [in 1956] they got Alfred [the Tame Thing], to gently awaken me from my frequent nightmares.

My father’s name was Alfred, but his family called him Red, and his Naval Academy moniker was Rosie [by which he was known for the rest of his life]. Bestowing his unused name on our new puppy, he joked that Alfred-the-dog “could sign checks while (Rosie) was at sea”; and thereby hangs a tale. During the Korean War, my father’s ship [a Destroyer] was catastrophically damaged [either mined or torpedoed], and the initial news reports listed Rosie among the dead. We found out the next day, via cryptic telegram, that he was alive. In fact, he had been instrumental in saving the ship [he couldn’t swim]; and was then given a command of his own [a Destroyer Escort, which, years later, “starred” as the USS Kornblatt in the film Don’t Give Up the Ship]. Meanwhile, when Rosie finally got some shore leave in California, between deployments, we went to visit family friends in Hollywood, just in time for an earthquake! Not a huge one, mind you; but it made a lasting impression on my young [3 or 4-year old] psyche.

From then on, I was prone to nightmares [especially when my father was about to deploy] in which earthquakes and explosions at sea were combined to harrowing effect; and I developed a nifty knack for the Hitchcock-victim-scream, thereby waking up the whole household. When I was turning 8, an Academy classmate of Rosie’s, stationed with us in Newport, had a purebred Cocker Spaniel who had just had 3 puppies; and we got Alfred, whose job it was to keep watch over me by night, so that the rest of them could get some sleep.

Some years later, when both our family and Alfred’s dam’s family had moved to Annapolis, we took him to see his mother, who barked with disdain and chased him into the Bay. By then it had become clear that Alfred’s sire was not her usual purebred Spaniel mate, but Dusty [a mix of Chow, Spitz, and Husky, who could apparently scale a 6-foot fence]. What a sweet-tempered dog he turned out to be, though. More significantly, he served as a Transitional Object for me [a living teddy], to stand in loco paternis, when his namesake was away at sea. He had hybrid vigor and lived to be 18, spending many of those years interacting with the bellicose Ying Tong, whom he never stopped trying to befriend.

So, this is a second answer to Sendak’s question, “How do children survive?” When their parents are physically, emotionally, or otherwise unavailable to protect them, children rely on the comforting presence of animals [imaginary, stuffed, or real] to help them through the rough stuff.

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Filed under object relations theory, post-traumatic stress, transitional objects

May 1, 2011 · 6:15 pm

"(Venez) M’Aider!"


In 1923 Frederick Mockford, the senior radio operator @ Croydon Airport, near London, was asked to come up with “the international radiotelephone signal for help, [to be] used by ships and aircraft in distress.” [Webster’s 1988 ed.] Since much of Croydon’s air traffic plied the route to and from LeBourget airfield in France, Mockford thought of the French phrase, “Venez m’aider!” [“Come help me!”], which was shortened to “Mayday,” then lengthened to “Mayday, Mayday, Mayday!” [since the redundancy makes it clear that you really mean “Help!” and are not just talking about the 1st of May].

In this April’s issue of AOPA Pilot magazine [the official publication of the Aircraft Owners & Pilots Association], an article called “High Anxiety” recounts the consequences of a Panic Attack, suffered by a private pilot “with 20 years of flying experience” while he was flying solo and practicing an Instrument [as opposed to Visual] approach into Oceanside Municipal Airport [near San Diego, CA}. “Shortly after I entered the clouds, a wave of incredible panic and terror came over me. I believed I was completely out of control of the situation. I was afraid of losing control of the airplane, as well as the repercussions of [Air Traffic Control] if I got on the radio and told them I was losing control of the airplane.” [In other words, he feared that if he called a “Mayday,” he might lose his pilot’s license.]

Well, since this is a nonfiction article [not an episode of Lost], we can assume that he managed to overpower his “howling wolf” [fear-fueled amygdala, which was freezing up his hippocampus] and get it together for long enough to land, yah? Here’s what he recalls of that process: “I started talking to myself out loud, telling myself that there was nothing that needed to be done that I hadn’t done many times before. I got the needles centered where they were supposed to be and completed the approach successfully.”

Thereafter, though, he developed the symptoms of Post-traumatic Stress, becoming unable even to fly as a passenger in a commercial airplane, and sought psychotherapy [of which more, later]. Meanwhile, what may have saved his life during the event was talking out loud to himself. If he had burst forth into song [maybe “I believe I can fly,” or “Off we go into the wild blue yonder”], he might have gotten a good result, as well, since his vocalizations short-circuited the unhelpful shallow breathing which fuels Panic. Speaking, singing, and whistling a happy tune really do work as anti-anxiety strategies, just as Rogers & Hammerstein told us.

His psychotherapist used 2 non-pharmaceutical techniques with our grounded pilot. He suggested a bit of in vivo desensitization [taking aerobatic gliding lessons with a seasoned instructor as his co-pilot], and cognitive challenging of any feelings of anxiety he experienced while flying, with reality-testing. If he began to feel anxious, he would quickly realize that he “was in complete control of the airplane and there was no reason to feel that way.” [And even if he “lost it,” the co-pilot could take over the controls at any time, if necessary.]

It is unclear, whether our pilot also took medications to control his anxiety. At the end of the article there is a message from the AOPA Medical Services Program, setting out the regulations for becoming recertified as a private pilot, after taking SSRIs or benzodiazepines. We do know that he has currently chosen to fly ultralight aircraft, for which no pilot’s license is required.

Be that as it may, the article offers insight into the onset, course, and successful treatment of a first-time Panic Attack, when a seasoned pilot who always thought he had “the right stuff,” got “tangled up in blue,” lived through it, and found the courage to take aother leap of faith “into the wild blue yonder.” Once again, he believes he can fly.

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Filed under limbic system, post-traumatic stress

April 16, 2013 · 4:05 pm

My Ducks Are All in a Row

IMG_7102When I began this post, around 2 pm on 15 April 13, I was going to reminisce about this ironic lyric from James Taylor’s 1992 song, “Sun on the Moon,” which I used to play on repeat as I drove to work @ the “Laughing Academy” [Irish slang for Mental Health treatment center] in the early 2000s, as an actor’s preparation for an Improv scene, in which one’s Intention is so robust that it can withstand the onslaught of the opposing Intentions of all the other players in the scene. Sometimes I would also hum “Clowns to the left of me, jokers to the right…” as I mounted the stairs to my belfry office. Alas, rarely did my Intention prevail; but my belief that I might someday get [and keep] my ducks all in a row for an entire [typically, 10-hour] day never wavered…until the morning of 9/11/01. I did not entirely abandon my striving for Internal Locus of Control; but, like every other sentient being on that day, I reluctantly acknowledged that I was not the Director of my own Improv Scene. Further, I joined the ranks of those who gave up believing that the Director [if present at all] was a Mensch. Nemesis might not be in charge, but his cousin Chaos seemed to be.

I also gave up playing James Taylor’s song, even ironically. Instead, I embraced the [mostly humorless] philosophy of the Stoics, who opined that You are not in charge of your fate, only of your reaction to it. As lamented in “Sun on the Moon,” your pets, your children, and your mortal enemies have Intentions of their own, even though they sometimes impersonate biddable “ducks in a row,” just to lull you into a false sense of command & control.

Around 3 pm my Boston [actually, Cambridge] daughter called, to say that she was “okay, but very freaked out” about the “one-two punch” of explosions near the finish line of the Boston Marathon. She reported that the city was on “virtual lockdown.” All the bridges across the Charles were closed, and public transport had stopped running. She was most concerned about her aunt [Chris’ sister] who had probably gone into work, and whose office was the site of the first blast. As Chaos would have it, there was no reaching her by cellphone to check her status. To spare you the suspense that our family endured all afternoon, we learned that evening that she happened to be in the bathroom during the blast, after which all the occupants of the building were fiercely herded outside [with no opportunity to grab purses, laptops, or cellphones] and ordered to “Clear the area! Go home!” So, without funds or means of communication, she walked the many miles back to her home in suburban Boston, found her “just-in-case” hidden house key, and emailed her most cyber-linked-in brother, who passed the word to the rest of us.

Rather than succumbing to Post-Traumatic Stress, she opted to take her Vizsla dog for a romp in the woods, during which he found a “disgusting smelling” dead creature to roll on, and had to be bustled home for a bath, thus fulfilling his function of providing much-needed Comic Relief. Indeed, that may be one of the most important functions of unbiddable pets & children:  to provide moments of Comic Relief when we are facing the intentional cruelty of our mortal enemies.

Sometimes [often, in my case], a good laugh is as cathartic as a good cry.

 

 

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Filed under catharsis, comic relief, locus of control, post-traumatic stress, Uncategorized