Tag Archives: Trauma

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.

Surviving my dissertation

After my original dissertation idea was determined to be unfeasible (by myself and my dissertation chair), I found myself struggling to find a topic that still fit the spirit of my work.  Ideally, I would use the dissertation to create a theoretical base for my future study into narrative and trauma.  This, however, is much easier said than done.  The truth is that I don’t know how to write a theory without the use of real world applications.  I imagine this has something to do with the way that I value theory as praxis and vice-versa, and, while I am by no means rejecting that belief, it’s making this dissertation thing kind of difficult.  So, I’m trying to determine how, given the resources readily available to me, I can make a significant contribution to the field of trauma studies. (It’s times like these that make me think that I should have gone into psychology.) Here’s what I’m getting so far:

Thought #1: In the struggle to use writing as a way of healing, trauma survivors use unique rhetorical strategies for approaching their trauma.  My sample set would be blogs, discussion forums, and memoirs, which I would examine using a combination of Burkean theories of identification and feminist content analysis.  Using Jeanne Perrault’s idea of feminist autography, I would loosely categorize my samples as such, perhaps even going so far as to include theory within the scope of my research into autography.  Perreault defines autography as “a writing whose effect is to bring into being a ‘self’ that the writer names ‘I,’ but whose parameters and boundaries resist the nomadic” (2)*  While Perreault examines exclusively female-authored texts that have been published in print, I will be exploring mostly self-published blogs.  Also, my focus will be on how the writing brings into being a self that has been formed in response to and in spite of trauma.  I would also be looking into the Burkeian concepts of identification and consubstantiality as strategies for repairing the rift between self and other that is characteristic of trauma.

Thought#2: Focus on traumatic autography as a way of fighting back.  Writing as a way of healing seems too optimistic, as though writing can make the trauma all better, which I do not think is true.  Titles tend to help me focus, so I’d tentatively title this: “Writing/Fighting to Stay Alive: Rhetorical Strategies for Survival” or “Writing/Fighting to Survive: A Rhetorical Theory of Trauma”

Thought#3: [The most ambitious of these and the most difficult to put into concrete terms.]

My dissertation will serve as a basis for future research into memory, trauma, and narration.  By first establishing a methodology based on a synthesis of feminist, psychological, and narrative theory,  I will lay the groundwork for future study of the significance of language in identity formation and the effects of trauma on that process.  For the purposes of this dissertation, I will be taking a small sampling of writing by those who have experienced traumas.  These samples include: single-authored blogs, discussion forums, and memoir.

I want to create a theoretical basis for the argument that trauma is inherently a linguistic issue and that the loss of language is more than a symptom of the trauma; it is the trauma itself.

Okay.  Here’s a start.  Any feedback is appreciated.

*Perreault, Jeanne.  Writing Selves: Contemporary Feminist Autography. Minneapolis: U of Minnesota Press, 1995.

An Articulation of Trauma

The framework for understanding trauma that I am using in my dissertation defines trauma as the emotional/psychological impact to a person’s psyche as the result of an event, experience or set of experiences that overwhelm those individuals who experience it. This results in an inability to integrate the experience into their narrative memory, and it is this inability to integrate the traumatic experience(s) that results in a psychological state of being that impairs the trauma victim’s ability to live completely within the world of the present.  Instead of current actions and feelings, the trauma victim lives with both the horrific memories of the past and the fear that they engender.  Because traumatic memory is not integrated into the narrative memory, it cannot be controlled and recalled at will; rather, it is often elicited without the individual having a conscious choice and unlike memories subject to recall and control, these feel as though they are temporally present.  In addition to the ability of these memories to intrude upon the present, they are also responsible for the state of fear and hyper-vigilance that characterizes the life of the traumatized.  Thus, the memories themselves not only interfere with the ability of the traumatized to live in a current reality by intruding upon that reality; they also impair the individual’s ability to negotiate within the world around them because of the state of fear that they have engendered, both a fear of the traumatic event and a fear of the memory’s ability to surface and disrupt beyond their ability to control it.  Posttraumatic stress disorder (PTSD) is the clinical term encompassing the development of these traits “following exposure to an extreme traumatic stressor” (DSM-IV 424).

To further clarify, when we use the term “memory,” we are usually referring to either “working memory” or “narrative memory.”  Working memory “holds short term information for the purposes of performing a current process” (Field 326).  On the other hand, narrative memory is a form of long-term memory in which past experiences have been integrated and are available for conscious recall and reflection.  Since trauma occurs “[u]nder extreme conditions, existing meaning schemes may be entirely unable to accommodate frightening experiences, which causes the memory of these experiences to be stored differently and not available for retrieval under ordinary conditions” (van der Kolk 160)*. This loss of meaning schema makes trauma narratives disjointed and fragmented.

*van der Kolk, B. (1996). Trauma and memory. In B. A. van der Kolk, A. C. McFarlane,
& L. Weisuth (Eds.) Traumatic stress : the effects of overwhelming experience on mind, body, and society. New York: Guilford Press.

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