On EMDR (Part 3/4)

Kolk states that If you are stuck in old memories you can't have new behavior. True, but new behavior is not something one superimposes onto a patient. New behavior emerges dialectically out of the reliving of the past, for one simple reason: the agony portion of the past imprint has not yet been lived. It has led an underground life manufacturing ulcers, migraines and high blood pressure. When I say agony, I believe that until one sees it or feels it there is no concept of the depth of that pain; something that can elevate brainwave amplitude by hundreds of percent. (Hoffman, Eric. Long-term Effects of Psychotherapy on the EEG of Neurotic Patients. Res. Comm. Psychol. Psychiat. Behavior. Vol. 8, 1983 pages 171-185. See also, “Hoffman, E., Goldstein, L. “Hemispheric Quatitative EEG Changes Following Emotional Reactions in Neurotic Patients. Acta Psych. Scand. Vol 63. 1981 pages 153-164)

Reliving anoxia or hypoxia at birth, the patient turns red and struggles for breath as if it were a life-and-death matter, which it was and is. An imaginary ending would be to feed the patient oxygen at a critical moment, which would inter alia, abort the memory and stop the healing process. The patient is beginning a dying sequence, as dramatic as that may sound, and needs to complete it; she did not die originally, and she will not die in the reliving. But with a thermister, an electronic thermometer, attached rectally we see the temperature drop by many degrees as the patient approaches “ground zero”. Why is this necessary? Because the trauma and the ensemble of physiologic reactions form a template for survival—a prototype which guides future behavior. To change the prototype one must descend to its origins. Out of the original trauma evolve numerous ramifications, directing diverse behavior and diverse symptoms, from colitis to heart problems such as frequent palpitations. Until the prototype is relived the best we can do is treat deep problems symptomatically. Generally, the deeper in the body the symptom the earlier the trauma, not always, but often.

Feeling the terror in the birth canal reduces and eventually eliminates phobias of elevators, for example. No one has to take the hand of the patient and help her enter an elevator. That is Behavior Therapy and makes the mistake of taking the ostensible problem as the real one; taking the symptom and making “it” well instead of the person. The deeper one feels and integrates the terror the less there is to deal with.

Retrieval of early memory activates the right hemisphere more than the left. When our patients are deep into reliving early trauma the limbic system is fully activated, and we believe the information is then transferred to the left hemisphere for final integration. In our brain research there is a shift of power from right to left hemisphere. Kolk: “Traumatic memories are often stored in the limbic system, which is responsible for attention, arousal, and attachment, but are usually stored as somatic (body sensations) memories. Traditional therapy does not even begin to approach the limbic system to resolve the trauma, so a therapy that accesses body memories (like attachment therapy does) is much more effective. EMDR is useful for resolving many traumatic memories, although it is not at all clear why it works.” Dr. Van der Kolk suspects that it works because doing the eye movements distracts the person from the traumatic memories and allows the brain to be changed.

There is a basic contradiction here. If eye movement therapy distracts the person from memory it defeats the ability to fully access that memory; it then cannot be integrated. He is right. Eye movement is a distraction that aids in the process of repression, which is exactly why the person feels better. Prayer can do it, “om” can do, thinking other thoughts can do it, directive daydreaming can do it by offering other images instead of the real one, etc. The fastest way is a good dose of Paxil.

Let us discuss what integration means. First let us see what disintegration means. Feelings stored on lower brain level, and this is where pre-birth,` birth and post-birth traumas reside, due to their valence of pain cannot rise to the prefrontal cortex for connection and integration. They are inhibited by various neurotransmitters and kept below the level of conscious-awareness. This is disintegration; the higher levels do not know what is going on in the various lower levels even while they are being driven by it. Paranoid ideation can help be quelled by tranquilizers that work on deeper brain levels, indicating the provenance of the higher level ideas. The person is not aware of the deep-level imprint but is driven to develop strange ideas by it. He does not need to feel a little bit of it, say being abandoned in infancy, or living in an institution for the first year of life, and then told to change his ideas or his behavior. He needs to relive the early traumas bit by bit over many, many months or years until the ideas driven by them evaporate. And they do. Solutions provided by a therapist are his solutions, not the patients’; therefore not real. Reality lies in the reality, as banal as that may seem. Reality lies in the truth of the memory and only there; certainly not in someone else’s brain.

We can only heal where we are wounded. The seeds of cure lie in the problem. We do not teach people how to live or how to manage in the future. Once free of their past they can figure it out themselves.