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Introducing “Writing/Fighting to Survive: The Rhetorical Strategies of Trauma Bloggers”

As I reconstruct my dissertation–rewriting, revising, conducting a new research study–I’ve been considering many of the questions that reappear in my personal research journal. Since my research isn’t just my research, I can’t really make my research reflections fully public. Some of the things that I reflected on were concerns for specific participants (I include this here because I am conducting a new research study to complete my dissertation and have an entirely different set of research participants) or feelings that were at the time too personal to share with my blogging audience. I’m beginning to test out these boundaries now for several reasons. First, blogging is good for me. Seriously, it’s like vitamin C (and not the sunshine and vitamin C that I joke about being in clove cigarettes) and warm chamomile tea followed by a slug of peppermint oil to wake up your brain. As Father Ong (That’s Walter J. Ong, S.J. to all of you non-Purdue, non-rhet/comp geeks like me) so aptly put it “the writer’s audience is always a fiction.” So, while writing in my research journal, I am writing to a fictional audience just as you, my dear blog reader, are a fiction in your own way, writing in my blog makes the audience less fictional. Sure, I imagine you when I write and until I hit the “post” button that’s all you are–imagined readers. But the great thing about blogging is that in the moment that my post changes status from “draft” to “published,” you emerge from the ether along with my pixelated thoughts and voila–real readers who write back. And this brings me to…

Here’s a piece of my dissertation introduction for your edification. Feedback is appreciated.

When I wrote my master’s thesis, I began with a story of my own pain, relating it to the purpose and context of my subject matter. I did this because stories matter. They are how we construct ourselves within the world, how we determine self worth, how we deal with the vicissitudes of living, and most importantly for me, they provide insight into our motivations. Just as motive is important to understanding our life decisions in a broader context, it is important for the scholar in understanding what she chooses to research, to the writer in understanding what she chooses to write about and how. My research deals explicitly with these motivations that compel the trauma blogger to write about their experiences. It seems only fitting that I do the same.

I was first diagnosed with primary PTSD and chronic depression at the age of nineteen. These two diagnoses did not define me but rather put into words what I was experiencing. After a lifetime of painful medical conditions and procedures as well as emotional and physical abuse, my psyche was damaged, so much so that I feared it might never heal. Luckily, I was fortunate enough to meet an amazing therapist who guided me in understanding and working through the traumas that had so disrupted my ability to live fully in this world. In addition, I had a caring psychiatrist who carefully worked with me to find a drug regimen to balance out the neurochemical problems that contributed to my disorders. Many people with PTSD and depression are not as lucky as I have been and/or need to supplement the professional help by engaging in therapeutic techniques that they develop in response to who they are. The people discussed in my research have chosen writing as the vehicle for their therapy, more specifically they have chosen blogging.

Like the bloggers that I discuss, I needed to develop my own techniques for dealing with my trauma. Unsurprisingly these techniques were rooted in my previous experiences of dealing with problems. First, I researched; I read everything I could find on PTSD. I read clinical studies, psychological theories, research into the causes and effects of PTSD, narratives, and literary theory. I became consumed with learning about trauma, convinced that if I could only understand it, I could defeat it. Since then I have written about and researched trauma extensively; I have posed theories about trauma and language; I have analyzed works of literary fiction and nonfiction; and after I became a blogger, I began studying the writing of trauma bloggers. My academic and scholarly nature lead me to deal with my trauma in concert with my professional development. However, throughout all of this I discovered that what helped most was not the research and reading but the writing about it. Like these trauma bloggers, writing became my therapeutic outlet. Yet my writing did not fall into the traditional rubric of therapeutic writing; it was and is primarily academic in nature and doesn’t fall into the genre of therapeutic journalling. In spite of this, I have found it to be more rewarding than writing about the specific experiences and perhaps more importantly, it feels safer. Those feelings of safety are often what allow victims to write about feelings and experiences that they cannot speak of.

My own experience inspired the questions that I explore here. What has motivated these bloggers to write? More specifically, why did they choose blogging rather than private journals? Why have they chosen personal blogs as opposed to the support forums that are plentiful? And when they sit down to write a blog entry, why do they do it? What experiences motivate them to take the time to sit and write and publish their thoughts? And I don’t mean the traumas that are the origin of their PTSD; I mean the experiences that directly precede the act of writing the entry. How do they respond to the experience in content and form? Do they write about the experience, the emotions that the experience engenders, or do they externalize like me and write about what they learn through the media and reading? I want to know what the writing means to them and if it helps. I want to know the answers to all of these questions, but to answer them I need to start at the beginning—the motivation.

As Kenneth Burke has noted “motives are shorthand terms for situations” (p. 30, Permanence & Change). In making this claim, he is explaining that motives are more complex than we usually perceive them to be. Motives are situations that we recognize through a pattern of stimuli and response that have occurred with enough frequency that we have generated a word for them. For example, my motivation in writing this is what I would describe as a desire to help myself and others. My “desire to help” is actually my response to a situation in which I see a pattern. Specifically, there are people who are hurting and who deserve to have their voices heard; I want to have my voice heard; I want to do my part in helping these people; and I am best equipped to help through my training as a rhetorician and scholar. So, there is a situation that involves both stimulus and response that I have translated into the words “a desire to help.” The motivations of the bloggers that I am discussing are no less complicated. Understanding the situational context of their writing helps me to understand what interactions constitute their defined motives which then helps me understand their writing. To clarify, the writing in this context is the response, and I am trying to identify the stimuli and understand the response and by making connections between stimuli and response understand motive.

So, the reader may have a question here: why do motives matter? An excellent question deserving of an explanation. I refer back to Burke to answer this. In examining motive I am actually looking at three linked concepts: orientation, motivation, and communication. Trauma victims’ orientation has been disrupted by their response to trauma. It’s really not dissimilar to being lost. The structures or landmarks that you use to determine your position are no longer there; you are disoriented and to find your way you must find those structures. “Orientation is a bundle of judgments as to how things were, how they are, and how they may be.” (14) Orientation is a means of understanding the world, when it is lost or disrupted, so is the individual sense of self and well being. Motivation is directly related to one’s orientation. The stimuli and response to a given situation (and the naming of it) are understood through prior experience. For the traumatized their orientation, influenced by trauma, results in response to stimuli that can be harmful in a multitude of ways. Because their response doesn’t always make sense in the way that we might normally understand it, they can’t attribute a word for it. They can’t give the situation a name. Thus, they cannot communicate their experience and that is what makes traumatic experiences traumatic—the disabling effect that they have on our ability to communicate. Communication is how we make connections to others. Ultimately these three concepts are circular. Communication helps us to reestablish orientation. Being able to communicate the trauma and experiences returns the ability to situate that bundle of judgments that is our orientation. Since my argument here is that writing allows us to process information differently and in some ways more effectively than other forms of communication, I need to understand the motive for writing as opposed to talking and the efficacy of blogging as the means of communicating these experiences. I also am trying to determine how blogging may move the blogger toward more stable orientation.

coming out of the closet … for World Mental Health Day

Okay, so I’m over a week late on this, since WMH Day was on the 11th, but better late than never, right? Actually, I’ve been thinking about posting this for a while now. I’ve posted some things about my disorders but feel most comfortable posting about my physical health. It seems that my physical health has always been fodder for public consumption. If nothing else, having physical problems seems so ordinary to me because I’ve always had them. When you’re born with cancer, doctors, nurses, hospitals, needles, and the like are normal parts of everyday life. Growing up, I had more “friends” who were health care professionals than I did kids my own age. When you’re a child with a compromised immune system, play dates are out of the question. Hell, even my own sister had to stay with my grandparents from time to time just in case she brought some germy germs home from school with her. Physical health problems were just a part of my life, like bedtime and CareBears. And (at least when you’re a child) physical health problems don’t carry the same stigma that I’ve found to be true as an adult woman. Sure there were some kids who were afraid they might “catch” my cancer or who made mean jokes, but adults mostly felt sorry for me and, not knowing that there was anything wrong with this, I accepted it along with the spinal taps, months of hospital incarcerations (as I now think of them, though at the time I was the beloved daughter of the pediatric oncology wing), blood draws, IVs, surgeries, and so on. Also, as a child with cancer you’re encouraged to talk about your illness and how you feel physically at any given moment. Doctors need that information and so do primary caregivers. When I was six and got the chicken pox, I just laid down without telling anyone and I was then hospitalized for over a week. So, saying “I don’t feel good” when you’re a recovering cancer patient generally means that you’re coming down with more than just the sniffles. Let’s just say that once you’ve had multiple spinal taps, you revise the meaning of pain.

When med school students and interns are brought into your exam room on a regular basis so they can see the physical manifestations of one or more of your rare disorders, you kinda lose your shyness and to be frank, your physical problems seem to be part of the panopticon. Private and public get really blurry once you’ve had your ass hanging out of a dressing gown while twelve interns take turns looking at your eyes through a scope to see “this truly rare manifestation of Horner’s syndrome.” However, mental illness was a thing of silence and whispers. It was self-medicating relatives and suicides discussed as gun “accidents.” It was a little girl who would stay awake for three days straight before collapsing from exhaustion. I was nine years old and though it’s rare for children to exhibit signs of bipolar disorder at such a young age, my doctor and I determined that this was likely my first manic “episode.” It was my ninth birthday. Yes, that’s right; I have bipolar disorder.

Now here’s the laugh riot: I’m fine disclosing the details of my physical health (we’ve been over that), and I’m even okay talking about my primary PTSD and chronic depression diagnoses, though I shy away from the details. I’m not as strong as the bloggers who are participating in my dissertation research, though they are helping me get stronger. So, back to the point: admitting that I’m bipolar is harder. I don’t even like telling healthcare professionals about it. I feel such a strong stigma surrounds it that I am quick to qualify that I have Bipolar-II and not Bipolar-I. In other words, I have hypomanic episodes rather than manic and since my diagnosis is Bipolar-I with melancholic features, I have more pronounced depressive episodes. I don’t get psychotic. I don’t go on crazy shopping or gambling binges. My mania is not dangerous; my depression is. When I’m in manic phase, I’m super-productive and while I might speak a little faster than usual and seem overly energetic, I am for the most part indistinguishable from the “average” person. My depression on the other hand tends towards anhedonia. Sometimes I just feel “down” but the bad times are when nothing makes me happy. And yes, I become suicidal. This is why I am on (and probably always will be on) medication. Even typing this scares me. I fear the stigma. I’m afraid that potential employers will read about this and my physical health problems and decide not to hire me. Maybe even decide not to interview me. In spite of the fact that there are laws against it, it still happens.

Stigma happens. And I’m afraid of the stigma associated with mental illness. I don’t want to be defined by any of my illnesses. I want to be known as me not as some diagnostic code on a doctor’s office form. And that would be all well and good if I was the only one. But I’m not and coming out of the psychiatric closet is the first line of defense against stigma. I encourage you to come out of the closet like I have. Like my research participants have. Read Seaneen / The Secret Life of a Manic Depressive — Stigma of the Self and revolt against the stigma of the self.

apparently I am researching a myth

According to a recent book by Susan Clancy, The Trauma Myth, childhood sexual abuse is not traumatizing. In fact, according to Clancy, children may even enjoy it. Let me begin with this caveat: I have not actually read Clancy’s book. I read the Salon.com interview discussing her book. While Clancy is clear to point out that sex with children is a crime, her primary argument is that it does not result in trauma or PTSD. This is the “myth” she is referring to. According to Clancy

Most victims do not understand they are being victimized, because they are too young to understand sex, the perpetrators are almost always people they know and trust, and violence or penetration rarely occurs.

My first response to this is: of course they don’t understand that they are being victimized, they’re children and since, as Clancy notes, the abuse is usually perpetrated by people (and I would add “adults”) that they trust, they may very well think that it’s normal. Not consciously knowing that one is being victimized is quite distinct from the reality of being victimized. Many children who experience physical abuse at the hands of parents are also frequently unaware that they are being victimized. Quite simply, if it is the norm in their household, they assume that it is the norm in all households. Does this make the abuse less “wrong” or traumatizing? Furthermore, I wonder how Clancy defines “violence.” I would argue that all acts of sexual abuse are violent by nature. Perhaps these children aren’t being beaten, but they are certainly being coerced and forced to do something that they cannot freely consent to.

According to her interview, Clancy does believe that childhood sexual abuse is harmful but that the resulting psychological state is not traumatic. She cites the fact that few people seek treatment for the abuse in adulthood and that most of them first describe the experience as “confusing,” which she says is “a far cry from trauma.” She also notes that shame is part of the reason people don’t come forward about their sexual abuse. This is one of the few points that we agree on. However, Clancy argues that the shame isn’t so much a result of the abuse but rather that victims don’t see their responses as consistent with what they see portrayed in the media and pop culture. In other words, their response to the abuse isn’t identical to cinematic representations, etc. I disagree. The shame does not come from the fact that their responses may be different from those of others (although that may be a factor; I can’t say since I’ve seen no research on this) but is instead the result of feeling as though they are somehow to blame for the abuse.

I’m trying to not have a knee-jerk reaction to her argument, but knowing what I know makes that difficult. I’m sure that this is something I share with other researchers and survivors. Unfortunately, many of the comments posted on the Salon site reflect agreement with her argument. Certainly there are those who disagree and they have posted their refutations, but I am saddened by the number of people who dismiss the traumatizing effects of childhood sexual abuse.

In all honestly, I will probably not read Clancy’s book. I have neither the time nor inclination. This is a song that, sadly, I have heard before.

why I fight

And when I say fight, I mean research and write. For me, fighting (in the sense of working to accomplish something) is particular to who I am–a scholar, a writer, a teacher. As many of you know (or will discover from reading my blog), my research deals with psychological trauma. I research trauma because I believe that the people who have experienced trauma matter. That they deserve to have their voices heard. That their experiences have not been in vain.

While watching a rerun of one of my favorite television shows, Criminal Minds, something important occurred to me. My research focuses on those who experience what I call “personal” traumas. All trauma is personal, so when I say “personal trauma” I mean people who have experienced trauma as a result of individual acts of violence like sexual assault, childhood abuse, and domestic violence. One of the reasons that I focus on them is because of the stigma that is still associated with these traumas. For a long time all traumas and their aftermath, PTSD, were stigmatizing. Soldiers returning from war were seen as malingerers rather than as victims of the trauma of war. Since Vietnam PTSD has become a recognized psychological disorder and since the wars in Afghanistan and Iraq, there is greater public awareness of psychological trauma and with that awareness comes less stigma. However, it is important to note that the lessening of stigma does not alleviate the pain of trauma. The pain is real; it remains a living memory that haunts the individual who has experienced it. People who experience trauma during “public” acts of violence, like war and terrorist events such as 9/11, are more accepted as “real” sufferers. Their stories are less taboo, and their experiences tend to be validated more. Validation certainly helps. In fact, validation and awareness help to alleviate some of the sense of alienation felt by those who have experienced trauma. In spite of that, the reality of the trauma and the suffering that it engenders does not go away.

The fact that I focus on personal traumas and thus do not focus on the trauma of war compels me to write this post. While I am not researching and writing about soldiers and veterans who blog about trauma, their experiences are not unimportant to me. In fact, one of the reasons that my dissertation deals with blogging about trauma is due to reading the blogs of soldiers and talking to them. My original dissertation idea actually focused on veterans. I wanted to study narrative ability in people who’ve experienced trauma, and I hoped to conduct my study through the VA. Unfortunately, my qualifications do not include a PhD in Psychology, and the IRB isn’t keen on letting rhetoricians study protected populations. As a result, I returned to an earlier research idea conceived when I began stumbling on trauma blogs. I was researching blogging and continuing my research on trauma when the two somehow converged. I became interested in this counterpublic (to use Michael Warner‘s term) who were loosely connected through their strategic use of blogging. The subgenre of the trauma blog became the research topic for my dissertation, yet I chose to exclude the blogs of those traumatized as a result of war or terrorist attacks. Partly this was practical, I needed to limit the number of blogs that I used in my analysis. The other reason for this choice was more ideological in nature. Drawing attention to those who speak out about traumas that are still highly stigmatized will hopefully lessen the stigma or, at the very least, draw attention to these survivors brave enough to speak out.

In the future I hope to apply the same research strategies to the blogs written by veterans.

struggling with ethical dilemnas

I find myself in an interesting situation this morning: considering the ethics of what I do.  Much of the time my work is with vulnerable populations.  However, the majority of my research participants self-disclose online, which means that they have already agreed to divulge information about their personal experiences.  That being said, I find rich information, regarding experiences of people involved in traumatic situations, in my face-to-face life as well.  The challenge is: how much of their information can I disclose?  Obviously, I would leave out identifying information unless I had their explicit permission to do so.  However, is it ethical for me to quote them without permission?  My conclusion, influenced by the advice of a colleague, is to hold off on sharing information privately disclosed prior to gaining permission.  The challenge, then, is how do you ask someone who is maybe not as familiar with blogging, if you can quote them on your blog.  This, I feel, is relevant to my research because my particpant bloggers are divulging sensitive information and should they divulge information regarding others in their blog without permission, am I being unethical including it in my research?

arguing for the strength of the traumatized mind

I have found, that living under circumstances of chronic traumatization, of sustained abuse, has made me a better critical thinker and has increased my ability to understand the needs, emotions and motives of other.  But this could be a mythos created by me to make sense of my disorder and pain.  Still, I think that those who suffer chronic traumatization as children, and thus during crucial brain development, experience a different development of mental capacity.  Forced to live in a mode of hypervigilance and to consider at all moments the thoughts and motives of those perpetrating the abuse, abused children learn a sort of “double consciousness,” W.E.B. Dubois’ name for the state of mind possessed by oppressed groups:

It is a peculiar sensation, this double-consciousness, this sense of always looking at one’s self through the eyes of  others, of measuring one’s soul by the tape of a world that looks on in amused contempt and pity. One ever feels his twoness,–an American, a Negro; two warring souls, two thoughts, two unreconciled strivings; two warring ideals in     one dark body, whose dogged strength alone keeps it from being torn asunder (The Souls of Black Folks)

Often I have felt as though those around me were seeing the world with a different set of lenses, ones which are blurry and leave images soft along the edges, whereas in my world all of the edges are hard and unyielding.  Speaking with other survivors has lead me to believe that I am not alone in this feeling.  Many of us feel that we see what others cannot.  Whether or not this is a deeper truth or a figment of the traumatized mind remains to be seen.

Judith Herman refers to a similar thought process in Trauma and Recovery, though she likens her version to George Orwell’s “doublethink” and the psychologist’s use of the word “dissociation”  According to Herman, “the dialectic of trauma gives rise to complicated, sometimes uncanny alterations of consciousness” (1).

“To speak publicly about one’s knowledge of atrocitites is to invite the stigma that attaches to victims” (2) I have plenty of friends from high school (middle and elementary) who do not believe that I was abused. I worked long and hard to create the appearance of a normal family, not because I wanted to be like everyone else, but because I didn’t want my abuse to be the thing that distinguished me from the crowd.  I wanted to stand out, but because of who I was not what was done to me.

Let’s take something horrible and make something good out of it.  I want to show the horror; give voice to the voiceless; but I also want to make what we have, take what we have suffered and transform it into something that gives the former meaning.  So that our sacrifices will not have been in vain.

Rhetorical Strategies of Trauma Bloggers and What Counts as Evidence

As I struggle to find the sample set (representative trauma blogs) for my dissertation, I have been able to separate the bloggers into three categories based on their rhetorical strategies for dealing with trauma. One set of trauma bloggers discuss the intimate details of their traumas, clearly focusing on the internal struggles of PTSD.  The other set of bloggers seem to externalize their trauma by focusing on the political aspects of post traumatic stress disorder without revealing a large amount of personal information. There is a third set of bloggers that I situate between the other two.  These bloggers have situated themselves as therapeutic experts in the sense that they provide a healing plan based on their own process of healing.  Most of them are careful to note that they are not trained professionals and that their advice should not be taken in lieu of seeking professional help.  Still, their strategy is an interesting one because it positions them as expert, helper, and survivor/victim.  To some extent these are the most complex.  They implicitly argue for the value of personal experience by positioning themselves as a form of expert.  This, of course, is not unusual in the blogosphere.  Bloggers typically position themselves as authorities based on their experience.  This is necessary to establish an ethos with their audience.  Productivity blogs are particularly focused on this, because, like trauma bloggers, they are presenting a kind of self-help regimine based on the strategies that have worked for them.

The rhetorical strategies of these bloggers raise interesting questions regarding standards of evidence.  In academia, personal experience, while not entirely eschewed, is not valued as highly as other forms of research.  Experience is not considered rigorous in the ways that quantitative and other forms of qualitative data are.  Thus, while situating one’s research within a personal context is acceptable, using personal experience as theory or evidence is not.  Rather than increasing one’s ethos, the academic who focuses on personal experience will most likely have their research regarded as spurious at best.  I realize that we are talking about very different genres with distinctly different audiences and that these are not necessarily comprable.  However, I’m interested in exploring this further.  Given that there are many academic blogs that contain a mixture of experience and theoretical discussion, might there be an opportunity for a hybridization of scholarly genres?  Could this provide inroads into increasing the valuation of experiential evidence?

why I write

This may come as a surprise to some,  but I like deflecting attention away from myself.  At least, I like deflecting attention away from certain aspects of my self. [spacing deliberate] At this point in my life I am completely comfortable with putting my physical health on display.  It’s something that can’t easily be hidden, though many of my disabilities are “invisible.”  Still, when you have a tendency to jerk and twitch, convulse into seizures, have debilitating migraines, etc., it’s difficult to play normal.  It’s also marginally acceptable.  At least those who know me well aren’t usually made uncomfortable by my mention of physical illness.  It’s the mental illness that makes people squirmy.  The life experiences that don’t fall gently on the ears.

I’m thinking about this now because, as I read “trauma blogs” to select for my dissertation research sample, I cannot help but compare them to my own.  Many of the blogs that I find discuss their trauma in detail, bare their souls so-to-speak.  Not only in blog entries themselves, but in their profiles they identify themselves as survivors of a myriad of abuses.  My blog doesn’t do that.  My blog positions me as an academic and a feminist, someone interested in politics and trauma, but not the raw meat of the trauma victim.  Their blogs are personal to the point of being uncomfortable and I’m still afraid of putting some people off.  You see, I’m not sure who all reads my blog and there are people, people in my family, who, if they read some of the stories that I have to tell, would no longer speak to me.  I realize that this is a chance I am not yet willing to take.  I could, of course, start an anonymous blog, like many of the bloggers who I follow.  Yet something prevents me from doing so.  Perhaps it is that I would feel hypocritical.  In my research, I boldly proclaim the importance of breaking silences; I advocate for the removal of stigma from those traumatized by rape, sexual and child abuse.  Because they have no reason to feel shame; they didn’t do anything wrong; the shame should fall on the shoulders of the perpetrator not the victim.  But it doesn’t.  Mostly this is because perpetrators don’t tell the stories of the abuse that they have rendered.  They want silence.  And silence is what the public wants as well.

Tonight, I had dinner at the bar of a local restaurant.  I had been reading blogs all day, selecting ones for my research sample.  The bartender asked me about my dissertation work and I told her the topic.  Her response was: “yeah, that’s something that no one wants to hear about” tacking on “except in theory,” which was, I assume, her attempt to be polite given that “hearing those things” is part of my chosen line of work.  But I recognized truth in what she said.  When people ask me my dissertation topic and I tell them “trauma and narrative,” they want to hear more.  In the past when I’ve explained the work that I’d like to do with veterans, they want to hear more.  As soon as they hear the words “rape” or “sexual abuse” they no longer want to hear about my dissertation.  Ultimately, there are dining table traumas and kitchen table traumas and one doesn’t talk about kitchen table traumas in polite company.  In fact, kitchen table traumas don’t really get talked about at all.  It’s more like there are three tiers of where the food of experience is served: dining table, kitchen table, and yard scraps.  If anything, intimate traumas are yard scraps–thrown in the dirt and eaten by only the mangy and starving.  Eaten by those who’ve also had their lives turned into yard scraps. [Reminder: this is some of my exploratory writing and I’ve yet to really perfect the metaphors.]

Perhaps I’ve chosen the trauma blogs because they are yard scraps rather than in spite of them being yard scraps. Someone has to dust them off and show them to be, not refuse, but sustenance for readers who are desperate to find someone, anyone, who will speak and listen.

Why do I write?  Because I want them to be heard, and, someday, I’ll be ready to be heard too.

a pill for PTSD?

In my research on PTSD blogs and due to my own tendency to keep up with PTSD-related news, I keep coming across articles regarding a “pill” for treating PTSD.  It’s not a new idea; a bit of research into it reveals articles as far back as 2004.  So, why is it suddenly popping up everywhere now? Because the US Department of Veteran Affairs is currently recruiting for a clinical trial continuing the research into a pill that, as the popular press has put it, “erases bad memories.” The drug in question is propranolol, a beta-blocker used to control blood pressure.  I was a bit shocked when I read the name of the medication, having been previously prescribed it as a migraine prophylactic. If I knew more about neurophysiology, I could probably explain how a beta-blocker could also function as a preventative for migraines and a treatment for PTSD.  But I don’t.  What I can do is explain the process and assumptions behind this clinical trial.

Designed based on two previous studies, this trial will examine the effect of a 24-hour oral dose of propranolol as opposed to that of a placebo.  The participants, comprised of male and female combat veterans previously stationed in Iraq and Afghanistan, all meet DSM-IV criteria for Post Traumatic Stress Disorder.  The basic protocol of the study is thus: during each of six “memory reactivation sessions,” participants will be asked to spend ten minutes relating the traumatic memory of the event that they believe “caused” their PTSD to a trained psychiatrist, who will then continue to provoke the “reactivation” of the memory by asking questions, “keeping the participant focused on the traumatic event and encouraging him/her to identify aspects of the traumatic event that continue to provoke emotional distress“.  Immediately following the “memory reactivation sessions.” participants will be administered either propranalol or its placebo.  Following the treatment sessions, the protocol efficacy will be determined by measuring the physiological response that particpants have in response to recollections of the traumatic event.  They will also measure the presenting symptoms by using the Clinician Administered PTSD Scale (CAPS), which was previously used to diagnose participants.  The effects of the treatment will be determined based on the physiological response and a comparison between the two CAPS.

The treatment protocol relies on the reconsolidation hypothesis, which states that “a consolidated memory could again become unstable and susceptible to facilitation or impairment for a discrete period of time after a reminder presentation.”  In other words, for the purposes of this study, immediately following the memory reactivation the memory is susceptible to alteration.  Alterations of fear responses have already been accomplished in studies on animals.

So, what’s my problem?  My first response is that I don’t want anyone monkeying around with my memories.  Removal of the memory or even the fear-related response doesn’t necessarily include healing from the traumatic event nor does the erasure of symptoms necessarily include successful treatment of the underlying condition.  My other issue concerns the exclusion criteria for the study, one of which is:

Current participation in any psychotherapy (other than supportive). Subjects will be asked not to initiate psychotherapy during the course of the proposed study except in clinically urgent circumstances; if this becomes necessary, a decision will be made on a case-by-case basis whether to retain the subject in the study or terminate participation.

I understand the need to eliminate variables in research studies, but I’m also a firm believer in “do no harm.” In my opinion, restricting access to health care constitutes harm.  Of course, this is just my layperson’s opinion.  I’m not trained in medicine or psychology, though I do know a fair amount about the psychology of trauma.  Still, there are certainly nuances that I am missing due to a lack of training in the aforementioned areas. If anyone can explain it in a more satisfactory way, please post a comment here.

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