On EMDR (Part 2/4)

Van der Kolk says that the child never made the proper psychologic assessment of the trauma and therefore never prepared for the future. I submit that the assessment is inherent in the trauma itself. Reliving never being touched as a child makes immediately clear the reason for one’s nymphomania. It puts the need for touch in the past so that it is no longer acted-out in the present. If there was insufficient skin to skin contact very early on, we can be sure she will get it later on in her sexual act-out.
The patient does not need to be told how to appreciate the trauma; everything is understood within the feeling, provided it is a full reliving. We seem to think that nymphomania is some kind of sick symptom, rather than seeing it as a survival mechanism; trying to be touched to make up for a terrible early lack. Almost every symptom may be considered a compensatory mechanism that should not be altered without regard to roots. Symptoms are anchored in those roots.

When I mention a “total reliving” it can mean the reappearance of the original bruises from an early beating or the forceps marks from the birth procedure. We have photographed these marks. The whole system must be involved in reliving, because it was originally. That is why, it is being recognized more and more, that simply discussing the past trauma will not get the job done. That is, by and large, a cortical operation that remains in the area of thought. It is the inordinate pain portion that is limbically (and brainstem) stored and held away from conscious-awareness. And that is what constitutes the unconscious. It is that portion of pain that must be relived. Waving a wand in front of the eyes is most certainly never going to help a girl get over being raped by one’s father over and over again for four years at the age of ten. In my mind that is not science. It is magical thinking to believe that being abused by an alcoholic mother for ten years of one’s childhood can be eradicated by waving a few fingers in front of the eyes of the patient. If the reader could see the amount of pain this engenders he would understand right away how impossible this is. The caveat here is that it is not possible to understand the depths of feeling until a therapist has seen it. It then becomes clear.
Another point by Kolk: As I pointed out, he describes the PTSD sufferer as someone who cannot integrate memories of earlier trauma and instead gets mired in, “a continuously reliving of the past.” He states that those PTSD individuals suffer from persistant activation of the biological stress response. Part of this reaction is decreased serotonin levels, or a deficit in inhibition. This translates into an inability to modulate general arousal; hence impulsivity, irritability and hyper-excitability. Good neurologists who lack clinical experience do not have enough patient information to get it right.
What he says is true. The early trauma is obviously imprinted into the neurophysiologic system and produces repetitive or “neurotic” behavior. There is often a decreased serotonin response and therefore faulty inhibition. The imprinted trauma “uses up” serotonin supplies and produces lifelong deficiencies. I call it a faulty serotonin pump. There is just so much repression the system can produce. He suggests that serotonin uptake inhibitors which keep higher levels of serotonin in the brain, help keep the past in the past, allowing the person to function in the present. This is not entirely true. Drugs help normalize the system artificially and, above all, temporarily, but the imprint is implacable and immutable, and does intrude into everyday life; hence migraines, high blood pressure, phobias, etc. These are the sequelae of the early trauma. They are part of the memory.
But suppose we could raise serotonin levels by purely natural means. Would not that be preferable? We do. We have done a double blind imipramine binding study on our patients and have found that levels normalize after one year of our therapy. Our rationale for the imipramine study is that we can consider it an analogue of serotonin; that is, what happens in the blood platelets would be mirrored in the brain. It is not only imipramine binding that we have studied but also salivary cortisol (stress hormones). Cortisol levels normalize after one year of therapy. (See research on imipramine platelet binding, done in conjunction with Open University, Milton Keynes, England).
Van der Kolk believes that we need a high level of arousal to heal a patient. He is right; not any level of arousal but the same as inherent in the original trauma; and we must remember that one of the greatest traumas of all is not being held enough during infancy. Further, when any situation including sex, reaches the arousal level of the original trauma, it sets off the prototypic reaction of survival. For example, total shut off or repression in response to being strangled on the cord. This is the “freeze” reaction that Kolk describes. It continues on into sex, and the frigidity will not be cured until that original trauma with the whole panoply of physiologic responses are reawakened in context. But Van der Kolk has a conflicting message; he states that we must relive with the same intensity as originally, yet using EMDR will tend to block a full reaction, hence cutting off the healing process.
Again, no one has to help a patient integrate; the neurologic system does that all on is own. The lower level stamped-in feelings move to frontal cortex for connection and integration when that feeling is not such as to inundate the cortex. That is why integration takes place over months or years as the neocortex allows more and more pain to connect to conscious-awareness.
There is a point where all of the EMDR theorists merge. They believe that after moving the wand or hands the patient needs a different solution to the trauma. Kolk stated that, “If you are stuck in old memories, you can't have new behavior. Only changing the outcome of past events can result in new behavior in the future because the purpose of memory is to prepare you to deal with future events. There are a few problems with this: it is basically non-dialectic. Instead of having a patient relive totally an event as it happened, they provide a different solution, not recognizing that the solution lies in the imprint itself, not a different ending, which when we think about it, can only be imaginary, a false ending, because it never happened. The deeper one plunges into the agony of the imprint, the less pain there is to repress. The person is then free to deal in the present. The deeper one feels one’s very early hopelessness (someone who did not have a nourishing mother right after birth), the more hope there is. One way we verify this, is that the vital signs move from very low to normal after a reliving—the physiologic sign of the resolution of hopelessness. The patient reports feeling more hopeful, at the same time. We have treated thousands of patients over the decades and have seen beneficial outcomes through the five year follow-up studies we undertook. (see Primal Man. Janov, a. Holden, M. for results) The symptoms do seem to remain resolved.