Book and film reviews - 2015

 

The alchemy of wolves and sheep : a relational approach to internalized perpetration in complex trauma survivors

By Harvey L. Schwartz

 

Book reviewed by Robert Grant

From ESTD Newsletter Volume 4, Number 4, December 2015

It is a rather daunting and humbling task to review a book that has been written on a subject that the reviewer specializes in but which the author takes to a whole new level. My hope is that I can come close to doing justice to the intricacy, complexity and sensitivity of this important work.

Most readers will find The Alchemy of Wolves and Sheep: A relational approach to internalized perpetration in complex trauma survivors (Routledge, 2013), especially the small minority who specialize in treating victims of complex trauma, dissociative disorders, and organized child abuse, to be simultaneously inspiring and intimidating. This is as it should be when readers are fortunate enough to come across a book that goes beyond the limits of contemporary thinking on a number of important matters.

This book offers hope and guidance to any that walk into and try to understand the profound forms of chaos and darkness that are inevitably encountered whenever helping other human beings to undo and rework the most insidious and damaging effects of severe child abuse, multiple perpetrator abuse, group violence, trauma bonding, mental programming and “soul murder.” Everything that  Dr. Schwartz describes must be known from the inside and out, if a therapist is going to lead afflicted an individual out of a shattered identity and worldview, and back into the human community.

This book displays an uncanny ability to explore the darkest dimensions of human relatedness, i.e., systematic forms of torture, mind control and spirit killing, as well as many, if not all, of trauma’s most complicated effects, e.g., dissociation, identity fragmentation, loss of innocence and identification with and/or internalization of a perpetrator, as well as, the destruction of any sense of personal identity and belief in any form of collective or archetypal goodness. Judith Herman opened up the notion of Complex PTSD and Harvey Schwartz takes it to another level altogether, while showing how to successfully work with its most complex aspects.

The author explores territories that most mental health professionals and contemporary citizens would hesitate to enter. Dr. Schwartz is willing to proceed into a variety of moral wastelands where the people he treats have been deposited by their tormentors. He records the geography and dangers that are endemic to this kind of terrain, in a way that no other book has previously accomplished in the field of psychological trauma. Almost all contemporary forms of clinical thinking are unwilling and unable to address or work with the darkest aspects of human nature and evert human society. The work of documenting and analyzing the methods, madness and social complicity involved in the Holocaust presents an ongoing challenge to the human capacity to face horrors that transcend the human capacity to comprehend. Yet, being able to properly address this side of human existence is essential for the evolution of a society to develop an ethics of understanding and care. In the same spirit, The Alchemy of Wolves and Sheep enters the terrain of unspeakable atrocities and emerges with knowledge that applies to every form of intentional and/or large-scale violence.

This reviewer knows from professional experience that those who have been intentionally fragmented by a sophisticated perpetrator(s) is typically not able to gain access to or work through the complexity of his/her internal systems without the skills, courage and care of an unusually knowledgeable therapist. How to language and work with the complexity of what is involved in coerced forms of perpetration trauma and the restructuring of a personality that has been nearly destroyed by intentional human cruelty is a task of monumental proportion. Restoring and healing of a personality structure that has become riddled with self-hatred, self-doubt, psychic sabotage, perpetual evasiveness and almost total mistrust of other human beings is something that most therapists and theoreticians are not well equipped to approach, handle or resolve.

Like his first book, Dialogues With Forgotten Voices: Relational perspectives on child abuse trauma and treatment of dissociative disorders (Basic Books, 2000), Dr. Schwartz’s second book, The Alchemy of Wolves and Sheep, takes the trauma field for a quantum leap. It should be of great help a number of clinicians, theorists, and lay people that work in the trauma field and/or have been seriously affected by complex forms of trauma.  The book will likely expand the reader’s capacity to understand, work with and respect anyone who has survived coerced perpetration trauma. In other words, those whose capacities for perpetration were activated and developed by disturbed family members, criminal groups, cults, cartels, and charismatic leaders, and corrupt and para-military personnel (as in the case of child soldiers).

The chapter, Perpetrators and Perpetrator States, is the highlight of the book. It integrates essential psychoanalytic concepts with the literature from the fields of trauma and dissociation. By exposing a previously hidden, poorly understand and universal form of trauma (coerced perpetration trauma), The Alchemy of Wolves and Sheep provides the courageous therapist with a new perspective to potentiate his/her capacity to effectively witness and heal a large number of trauma survivors whose suffering has gone unrecognized and untreated for far too long.

In his first book, Dialogues with Forgotten Voices, Dr. Schwartz probed deeply into the complexities surrounding organized child abuse, intergenerational forms of familial abuse, severe dissociative disorders and relational approaches to psychotherapeutic treatment. In that book, he detailed how predatory individuals disrupt, fragment, empty and annihilate the identities of their prey. He also examined patterns of individual and social complicity, and created a map for patterns of perpetration. While attempting to unlock many of the key problems associated with posttraumatic forms of psychological adaptation, Dr. Schwartz’s earlier book also took a very serious look at the complex and interdependent relationship between psychosocial complicity and a survivor’s internalization of complicit and collusion patterns, along with the long-standing effects of doing so.

In The Alchemy of Wolves and Sheep, Schwartz dives much deeper into the analysis that was started in his first book. In his current book, he goes deeper into how perpetrators break and control their victims through a sophisticated induction of intolerable pain, terror, and isolation; the slaughtering innocence; alternating between rescuing and torturing; fomenting traumatic attachments; engineering dissociative splits in the self structure; implanting fail-safe mechanisms; and utterly destroying any hope that one will be rescued, forgiven or redeemed. The book meticulously dissects how perpetrators bind victims to their own wounded psyches, to a malevolent family, cult, criminal system, pedophile network and para-military unit. The book catalogues a blueprint of interpersonal and intrapsychic dynamics, which contains the mindsets and methodologies used by perpetrators to transform a vulnerable individual (typically a childr) into a psychological container for the damaged, dead and toxic aspects of their personalities, while exploiting the victim’s constant fear of identity loss, engulfment and psychic annihilation.

The Alchemy of Wolves and Sheep takes readers into the deep end of the trauma pool. The book dives into the daunting clinical challenge of trying to remain compassionate and effective in the face of an individual’s obliterated sense of self and spirit. Schwartz describes, with a level of insight and precision rarely seen in an academic book, how victims of malevolent perpetration attempt to hold onto their humanity and essential spirituality through a sophisticated usage of  splitting, dissociation, internalization, identification and archetypical imagery. This material is presented in a way that helps the practitioner navigate through a labyrinth of dissociative obstacles, while providing hope to both client and therapist. Instilling a sense of hope, through a regular demonstration of compassion and understanding, is essential especially when working with populations that identify with being beyond hope, repair or redemption.

Because the psychological, interpersonal and spiritual damage sustained by those described in the book was done in and through several distorted forms of human relatedness, Schwartz posits that authentic healing must be accomplished through a transformational form of human relatedness. Describing the process of relational return in an intricate, nuanced and compassionate manner, Schwartz clarifies how the persistent, non-judgmental, committed and knowledgeable care of a single human being can light a path that leads out of a nightmarish maze that was created by scripted forms of programming, torture and abuse, and complex forms of traumatic bonding - all of which were employed to shatter, destroy and ultimately control every aspect of an individual’s being.

Working at the extreme end of the interpersonal continuum, i.e., in terms of dissociated and polyfragmented self structures, radical instances of subterfuge, and the internalization of and/or identification with evil, requires that Dr. Schwartz’s methodologies and understandings be multifaceted and capable of grappling with the myriad of malevolent forces that were enacted upon the bodies, psyches, and spirits of his clients. The last chapter of the book takes a profound look at the kinds of transpersonal and archetypal issues that typically emerge in the wake of having been repetitively and systematically traumatized (deconstructed) by another human being. When evil is a major part of perpetration, i.e., the desire to obliterate another’s sense of psychic integrity, goodness and divinity, then matters of the spirit must inevitably become a part of any authentic process of  healing.

By adopting the best aspects and practices of relational psychoanalysis and expanding beyond them, Schwartz provides readers with a template of interpersonal and intrapsychic dynamics that is so complex and convoluted that only a highly experienced trauma specialist could put them into words, let alone articulate how to work with these dynamics in an effective and therapeutic manner. What is described in this book involves a level of knowledge that only a true Sifu could acquire through years of having done combat with a range of violent and malevolent forces. The way he has bridged relational and archetypal perspectives on trauma and treatment has enabled the author to transcend much of the unnecessary polarization and fragmentation that plagues the mental health field, while offering an integrative clinical approach that has not been previously conceived or developed. This book advocates that clinicians move beyond limited ideologies and constrictive understandings of treatment, while discovering new forms of creativity and courage that can effectively meet the suffering, unique clinical challenges and confusing patterns of presentations that are presented by those that have been savagely abused by other human beings.

There are several aspects of this book that are of particular interest and which deserve special recognition:

  • The archetypal journey of a child soldier as therapeutic model for transformation
  • Mutations and restorations of innocence
  • The therapist as a transitional objects for trauma survivor that provides linking and an integration of functions across a range of dissociated ego and affective states
  • A therapist’s multi-relational approach for working with multiplicity of client subjectivities
  • Reparative tactics for damaged responses to pain and pleasure
  • The technological intricacies of intentionally fragmenting another human being’s identity
  • Traumatic attachments and a handing over of subjectivity and identity to another person
  • Primitive envy and its role in the eradication of another person’s psychic vitality and personal spirit
  • Deprogramming methods for survivors of mind control and coercive forms of violence that are used against others
  • Treating the internalization of a perpetrators’ malevolent values as a survival response
  • The importance of self-forgiveness for perpetrating and/or colluding with or against a third party
  • The role of transpersonal and archetypal energies in the processes of healing and transformation

This book is a must-read for anyone who wants to better understand and treat those who experienced and been exposed to the most malevolent forms of human exploitation. It is also valuable for anyone who wants to better appreciate the many paradoxical forms of courage that are manifested by the most psychologically wounded members of the human race. It should be a requisite field manual that is forever placed in the rucksack of any spiritual warrior and/or clinician who dares to enter a psychic war zone, triage those the broken and displaced, and eventually bring someone back home to his/her home and the human community. Unfortunately, as now very few in the field of trauma are willing to enter such dangerous territories, let alone dare to succeed or fail in assisting another to come back to an “ordinary” life.

The Alchemy of Wolves and Sheep is an intense read. It is densely packed and almost every line has been carefully honed to convey maximum understanding of what is involved when working with the traumatically afflicted that carries the consequences of internalized perpetration. There is little room to breathe in this book. As a result, the reader needs to proceed slowly. S/he should allow him/herself to be affected and digest material that will take him/her beyond the parameters of mainstream awareness. The Alchemy of Wolves and Sheep provides a breakthrough perspective that allows better access to and understanding of many of the intractable conditions that plague the human spirit. Readers that work with such traumatized populations will most likely find that their own worldviews and practices have been transformed. If clinicians are able to comprehend and work with the populations that mentioned throughout this book then working with other types of traumatized clients should be a piece of cake. For this reason alone, The Alchemy of Wolves and Sheep is worth its weight in gold.

 

The Disintegrating Self: Psychotherapy of Adult ADHD, Autistic Spectrum, and Somato-psychic Disorders

By Patricia DeYoung

April 2015 London: Karnac

 

Book reviewed by Henry Strick van Linschoten

From ESTD Newsletter Volume 4, Number 4, December 2015

Phil Mollon wrote The Disintegrating Self as a response to his growing realisation that many clients he and others have worked with, have been, and continue to be, misunderstood by mental health professionals. Like colleagues, he 'may have placed too much faith in the dynamics of the psyche alone – as opposed to the psyche in relation to the brain and body.' This is perhaps unsurprising for a psychoanalyst who has tirelessly expanded his psychoanalytic theorising with an integration of body-led fields of inquiry. Indeed, most recently he has pioneered the development of Psychoanalytic Energy Psychotherapy which focuses on the subtle and nuanced energy systems of our bodies that many of us know little about (or may even feel sceptical about). His work, and this book, impressively integrates neurobiological, cognitive and energy thinking into his Freudian and Kohutian frame.

Mollon recognises that many clients with ADHD and autistic spectrum disorders often present in therapy practices as they may struggle terribly with their internal worlds. Yet sadly many have not been helped or at worst, misdiagnosed –ADHD is often, he thinks, a hidden core within the clinical picture seen as borderline personality disorder, or indeed seen to be the result of extreme early trauma. Mental health professionals therefore need to better understand the interplay of both neurobiological and psychological perspectives – each informs the other and neither are understood well enough. This book aims to help us here, and is structured in discrete chapters that can be read alone and out of sequence – there is some overlap and repetition, particularly in the early chapters on ADHD, although each has a particular theme.

Typical ADHD traits are explored in great detail, and the book pays more attention to ADHD than autism. These traits tend to include those that may also cluster in a borderline or anti-social personality disorder presentation -  such as hyperactivity, impulsivity, a propensity to rage, a narcissistic vulnerability, rigid thinking and a low self-esteem combined with grandiosity. Tragically, if a child suspected with ADHD is seen in a family context, Mollon has seen a 'misguided tendency' to view his or her problematic behaviours and feeling states as a result of inadequate boundary setting and structure – ie family dynamics - rather than anything else. This can, of course, be a shaming experience for loving families struggling hard to cope with inevitable disruption brought by a child in distress.

Given that all mental health states and processes have a neurobiological basis, and we work psychologically with these to alter them, it follows that we can work psychologically with these non 'neurotypical' clients too. Mollon urges us to deepen our understanding of these brain states, and apply much of what we know therapeutically already. Pharmacotherapy – often used in the US and UK - is therefore not the only feasible option, although Mollon concedes that psychotherapy with these clients can be slow and difficult. I imagine I'm not the only one wondering how the NHS provision of psychotherapy can work effectively with such clients when short-term interventions are the norm.

Mollon's thesis is that ADHD and related autistic spectrum conditions are to do with an impaired self-regulation and an associated enhanced need for others to help regulate an emotional world. Kohut's thinking is particularly helpful here for him here (as it has for much of Mollon's thinking over the years), as others are experienced as 'self-objects' – ie the other person forms a part of the regulatory system of the self. To defend against such an overwhelming and continual fear of disintegration, these clients particularly rely upon the organising, stimulating and regulating empathic responsiveness of other people – therapists included of course. Their mental world is a fragile one that readily falls apart, compromising thinking, planning and focus.

Without these helpful responses from others, which may be very difficult to elicit from someone who can't understand what's really going on in the other's mind, rage, shame and a search for stimulation may result (along with other tricky behaviours). If autistic traits are present too, this may also result in a withdrawal from other people and a desire to seek comfort in repetitive activities or with inanimate objects.

The important point to re-iterate is that these conditions Mollon explores aren't a result of any 'environmental deficiency' from early care-givers or traumatic experiences, but they have a neurobiological underpinning that creates unusual and particular needs for 'environmental ego support' – these are 'self-object disorders' in Kohutian terms. Not only is this de-shaming for families, but for those who suffer too and Mollon writes movingly of the relief of some clients when they understand their struggles are not their 'fault'. He also writes about the positive aspects of ADHD and the successes of those who are able to harness their unusual minds and energies in fulfilling ways and with self-worth.

The early chapters explore in great depth the features, experiencing and neurobiology of ADHD before moving on to principles of psychotherapy with this client group – here's where Mollon's vast authority on psychoanalytic and more recent neurobiology applies itself best. He offers detailed clinical examples too, which bring some of the denser material to light. As with much of his work, Mollon pays deference to Freudian thinking, looking at drive theory and the predominance of aggression, the functioning of the ego and its need for support, the dominance of the pleasure principle over the reality principle, and superego deficits. Honing in of aspects of the therapy relationship and process that support development of these deficits forms the interesting part for clinicians – in particular, interventions that facilitate ego functioning.

CBT has a 'passing glance', while energy psychologies get more of a look than a glance. A handful of exercises Mollon finds particularly useful are found in some detail in an appendix, but it may be that readers who have some experience, understanding and even training in energy psychology approaches (TFT, EFT, AIT, TAT and PEP included) will find these interventions more appealing than those who haven't. Although Mollon has great faith in their worth, he accepts that many still regard these as 'experimental' stage. For those that do, the chapter on 'subtle energetic aspects of ADHD: reversed and scrambled energy fields and yin-yang imbalance' may find the territory too unfamiliar – acupressure meridians and chakras are a given here. Mollon uses the idea that the agitated emotional state of a person with ADHD will have a disturbed subtle energetic field (or 'reversed' in Mollon's view), which will also be experienced negatively by others. Simple exercises may be very fruitful to re-balance the brain and energetic states, along with suggestions for commercial brain-training programmes.

I found the chapter on 'somato-psychic fragility syndromes' particularly interesting, with its focus on Ehlers-Danlos syndrome (EDS) – a condition I have met in my own consulting room a few times. A constellation of diverse symptoms can make it difficult to diagnose, but Mollon sees that a sufferer will feel continually in danger of physical and psychological disintegration too. Again, the point he urges upon his readers is to take on board that the workings of the mind in front of you are determined in part by the substrate of a compromised brain or body. This is a valuable and robustly

 

Borderline personality disorders and EMDR therapy

By Dolores Mosquera and Annabel Gonzalez

Ediciones Pléyades (Spanish) CREATESPACE (English)

 

Book reviewed by Paola Castelli Gattinara and Antonio Onofri

From ESTD Newsletter Volume 4, Number 3, September 2015

According to the most recent literature, Borderline Personality Disorder is a severe pathology that emerges from the intertwining between biological vulnerability and a history of chronic early neglect and trauma. Anabel Gonzalez and Dolores Mosquera offer in this book a unique contribution to the treatment of patients suffering from Borderline Personality Disorder (BPD) by integrating the EMDR approach within the theory of structural dissociation of the personality.

The Authors show how the specific impairments of BPD clients can be addressed with tools from EMDR. In this book, as in their previous book, EMDR and Dissociation: a progressive approach, they expand and modify the EMDR procedures, offering a clear and exhaustive view on how to work through every issue that may influence the outcome, like psychological defenses and dissociative phobias.

Through the description of several clinical cases, the book explains howbilateral stimulation can be used and dosed according to multiple modes and at different times during the therapeutic process, to address a wide variety of clinical conditions, symptoms and somatic problems. EMDR is able to provide malleable and flexible answers at all stages of the phase-oriented treatment, which is recognized worldwide as the most effective approach in these clinical conditions. Many EMDR procedures enhance the stabilisation of the patient, and strengthen the already existing resources. Furthermore, the use of bilateral stimulation not only facilitates the processing of traumatic memories, but increases the patient's ability to take care of him or herself, to access, tolerate and process their experiences.

The book is divided into 4 sections: in the first, the authors describe the theoretical foundation of this pathology, in the second and third sections they illustrate, phase by phase, the EMDR treatment. Many of the complex situations that the therapist might meet during the therapeutic process are examined; among them, self-harm and suicide are two aspects that constitute the greatest relational challenge for a therapist. For this reason, particular attention is given to the therapeutic relationship. Mosquera and Gonzalez repeatedly underline the importance of monitoring reactions, enabling the therapist to understand the relational experiences the client has had or is still having. The last part of the book is entirely dedicated to the interpersonal context of the BDP client, focusing on families and partners of individuals who present a borderline disorder. Clients with this pathology tend to be trapped in problematic relationships and managing these dynamics is crucial to the success of the treatment.

The reader will find in this book practical guidelines and clinical vignettes that reflect in a simply, but accurate way the great amount of experience the two scholars have of the borderline inner world. The two Authors demonstrate the usefulness of the EMDR approach not only in reprocessing traumatic memories, but also in encouraging the post-traumatic growth that can lead to a healthier functioning.

 

The Decent One

Director:  Vanessa Lapa, 2014

 

Film reviewed by Orit Badouk Epstein

From ESTD Newsletter Volume 4, Number 3, September 2015

‘In life one must always be decent, outrageous and kind-hearted’ Heinrich Himmler, 1935

Some weeks ago on the morning news of BBC Radio 4, (UK), there was an item about a YouTube video that caused a world outcry. In the video, we watch a practice from Russia, known as ‘baby yoga’, where a woman swings, tosses, and spins an infant of only a few weeks old, eventually throwing the baby into a bucket of water. This kind of practice was developed by Dr. Igor Charkovsky, who also believes that waterboarding the newborn will help them have better blood flow and muscular growth, thus maximising their full potential and supposedly allowing them to become early readers, musicians, talkers, and high achievers such as Olympic champions. How this horrifying item links to the review of this documentary will soon be revealed.

‘The Decent Man’ is a biographical documentary about Heinrich Himmler, one of the chief architects of Hitler’s Final Solution and the founder of the SS. The film is based on archive footage using voice actors to read through dozens of letters and diary entries presented chronologically. Lapa, the granddaughter of Holocaust survivors, worked on this documentary for 8 years. Her father had purchased in an auction the 350 letters, 50 diaries and memos mostly written by Himmler himself. This is a rare collection, and aside from Goebbels, we do not know of any other senior Nazi officers who left behind so many personal documents.

To a layman the film does not appear to reveal much about Himmler’s psyche; from his diaries we learn a small amount about the young and oppressed  Heinrich who felt that nobody liked him and who suffered from recurrent stomach pains. The letters that he sent to his wife Marga, daughter Gudrun, and his mistress contain monotonous chit-chat about the lack of time he has for his family, his lack of sleep, and his duty to his country: ‘I am off to Auschwitz. Kisses, Yours Heini.’ To the more psychologically aware observer, the letters reveal  a man with an impoverished internal landscape, devoid of reflective functioning, filled with hatred, who is eager to show a heroic side of himself whilst remaining fully convinced that he was doing what was best for his country till the bitter end.

 As the founder of the SS, Himmler believed his organisation to be composed of ‘decent men more moral than Jews’ who ‘will be remembered for their decency’. Himmler repeatedly uses the terms ‘decent’ and ‘decency’ in his private journals and correspondence. Decency was the term Hitler’s top henchman admired and aspired to appear to the world.

In presenting  us with plain facts, Lapa takes an unopinionated approach to other Holocaust commentators such as the philosopher Hannah Arendt who coined the term ‘the banality of evil’ in order to describe the tendency for ordinary people such as Eichmann to follow orders and who saw it merely as a failure to think. Lapa on the other hand claims to be more interested in the story than the character. The film juxtaposes moving pictures of Himmler running Nazi party rallies and later supervising killing squads. Some of these letters reveal Himmler as a colourless figure and others, as virulently anti-Semitic and sexually perverse. Although the film presents the documents and footage in a slightly dull manner, the film works best when it’s at its most austere since its potency lies in the evidence presented, thus showing Himmler as a person who was fully aware of what he was doing and not just following orders. Notably, the film doesn’t show Himmler’s darker crimes, nor do the letters reveal the extent of his darkest activities. In an interview, Lapa said she did not own such a document. ‘I am presenting Himmler to the audience in the most authentic way. I am leaving it to them to come away with their own conclusions and to judge him as they see fit’ (The Israel Times, November, 2014).

Since all the footage in the film is itself propaganda made by Himmler’s men, the film mainly releases images about the Nazis’ methods of controlling humanity. One image in particular, of a man stretching an agitated a baby of a few months old and then tossing him backwards and forwards, is reminiscent of the aforementioned ‘baby yoga’ clip and has been haunting me ever since.

The review of this film can more or less end here, but the parallels between the testimonies of some of my severely traumatised clients and the treatment of these babies is remarkable, and I felt compelled to investigate this bizarre practice further.

Obsessed with racial cleansing while increasing the Nordic race, Himmler’s grand plan was to build a breeding centre (much like the chicken farm he grew up on), for pure German babies with blonde hair and blue eyes. In 1935, he founded such homes: Lebensborn, ‘spring of life’. Himmler had encouraged SS soldiers to impregnate Aryan-looking women, thus young girls who were deemed ‘racially pure’ from all over Europe were ordered to hand over their illegitimate offspring to SS-backed organisations. In some of these propaganda films, one can see dozens of babies lying tightly next to each other, crying and bottle-feeding themselves. The programme eventually failed, many of the children were sent to concentration camps; others stayed with their adoptive SS families, never to find out their real backgrounds; some were sent back and reunited with their original families; some, in countries like Norway, became the ‘shame children’ and were further institutionalised and continued to receive abuse. Today, in their 70s, many of these survivors are still struggling with depression, addiction, self-harm, and suicide.

We are still learning about the extent to which extreme methods of conditioning, namely abuse, and control of infants affects mental health later in life. My clients’ narratives and body memories, combined with the alarming images seen in the film and YouTube, provide us with an added insight on the traumatic roots of dissociation at its preverbal stage. In writing this review, I am well aware that I may have detoured from convention. Nevertheless, as clinicians working in the field of trauma and bearing witness to our clients’ dissociated bodies, the film’s non-intrusive style, has given me the opportunity to explore outside its subject matter and find out this invaluable information, and for that, I am grateful to the director’s exhaustive efforts in producing this film.

 

The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma

By Bessel Van der Kolk

2014, New York: Viking.

 

Book reviewed by Henry Strick van Linschoten

From ESTD Newsletter Volume 4, Number 2, June 2015

This is a wonderful new book (September 2014) that everyone involved with trauma ought to read and have available. It is the latest book about the consequences of trauma by Professor Bessel van der Kolk, the Dutch psychiatrist based in Boston, Massachusetts who has devoted his life to studying PTSD and finding ways of treating it more effectively.

The book is so special as it manages to effectively reach three groups, practitioners of various forms of treatment, people with PTSD, and researchers. It is written simply and straightforwardly, with many examples, without sacrificing rigour. It does not make easy reading, as books about trauma rarely do…

The book is divided into five parts, a historical perspective, a summary of new knowledge about brain and body, a section on children and attachment, a discussion of memory, and a long final part on different treatment methods.

Van der Kolk is an indefatigable learner and researcher. He has continued from his days in medical school to look everywhere for ways of treating trauma more effectively, humanely and quickly. The book stands out as he gently mixes his own life development and seminal experiences into the narrative. He is and remains a psychiatrist, but he has kept a very open mind about all and any ways of working that have some promise. And when he finds a new approach that he takes seriously, he is usually the first to request it being tested on himself.

Some people may be a bit disturbed by the breadth of the approaches he confidently recommends. Of course as a psychiatrist he prescribes drugs - but he has a healthy skepticism about their limitations. He is fully trained psychotherapeutically, but he carefully points out that many forms of psychotherapy make no impact, and integrates in his vignettes the frequency with which people arrive after years of ineffective psychotherapy. However, in these two key areas of possible treatment, he remains open too, and shows that he continues to prescribe drugs and refer clients (he uses "patients" throughout the book) to psychotherapy, if he believes this may help, support or give relief.

What is more exceptional is the range of non-traditional approaches he has tried out at the Trauma Center he founded. Main methods that he strongly recommends for their effectiveness are EMDR; yoga; Richard Schwartz's Internal Family Systems therapy (IFS); the body psychotherapy approaches of Pesso, Ogden (sensorimotor psychotherapy) and Levine; neurofeedback; and theatre including improvisation. In between these major recommendations he also shows partiality towards EFT (or other "tapping" systems), acupuncture, and mindfulness methods. While he explains and quotes how many research studies he has initiated, and points out how important research evidence is for him, he freely admits that many of his ideas have neither extensive nor even sometimes partial formal research evidence for their effectiveness.

In his understanding of the sequelae of trauma Van der Kolk is of course enormously experienced. In addition he is familiar with all the literature and perspectives. In particular he describes dissociation well and from different angles; in the chapter on Internal Family Systems therapy, he describes how IFS is designed to address Dissociative Identity Disorder.

Van der Kolk is a practitioner, and writes for practitioners. For him the careful practical evidence ("practice-based evidence" perhaps, though he doesn't use the expression) of having seen a number of clients who did not improve with other methods get better from using some unusual or even esoteric practices is enough to put such a practice on his list of "things to try". Van der Kolk, and clearly the Trauma Center, surely are rigorous in documenting and reviewing what they do for each individual client, and why they do it. But the variation seems endless compared with most other places.

Van der Kolk is well aware that no practitioner is going to be sufficiently trained in all of his favoured approaches to be able to use them themselves, apart from the question of whether this would always work. But he assumes that it is always possible to maintain contact after referring someone to go and try something else that he believes might work, such as a psychotherapist or psychiatrist referring a client to yoga or neurofeedback. He also assumes that many people will need several approaches simultaneously, e.g. drugs, psychotherapy, yoga, and perhaps dancing - but it's also possible that for practical reasons a "normal" approach with assessment and full programmatic treatment will not be available, such as for the students in the many schools that the Trauma Center has supported in setting up student programmes, sometimes based around dance and nothing else.

As he says in the Prologue, "I have no preferred treatment modality, as no single approach fits everybody". The implication of his view on trauma is that ideally one single practitioner (perhaps an assessor?) will know enough about a very wide range of treatment methods to be able to follow and recommend what a particular person may need, and what they could try simultaneously or in succession.This is a challenging way of seeing things, and clearly not practical in many settings, especially not in private insurance-funded ones, or state systems such as Medicaid / Obamacare or the NHS. At least this book gives a grand vision of how it could be, and perhaps should be. And in the context of a private practitioner working in the UK, it can be a true inspiration to think "out of the box", and consider if some "strange" alternative treatment could be tried that might lead to a breakthrough whether they make progress with their problems.

Is the book perfect then? On its own terms it may be - it is so beautifully, compellingly and sweepingly written in its grand vision of integrating medical, psychological and mixed or alternative approaches, based on a careful reading of the client and a holistic mind-body view. Single-school-practitioners wouldn't like it, as it does not privilege any single method. Scientific purists might dislike Van der Kolk's preparedness to recommend and use methods that have not been fully "signed off" with Randomised Controlled Trials. But given how much high-quality research Van der Kolk personally has done and initiated, more than most practitioners would ever consider, this would seem almost ironic. The choices made amongst neuroscience findings are comprehensive but perhaps remain a bit traditional (e.g. left-right brain; MacLean's triune brain; mirror neurons; attachment theory), but they are state-of-the-art as far as integration with practical work is concerned.

Early in the book Van der Kolk refers to the late Elvin Semrad, one of Harvard's great teachers, as an enormous inspiration for him. He uses Semrad as the authority for approaching the client with an as much as possible open mind, without theoretical preconceptions, and listen and observe to the wisdom that they as client have about their own life. The book clearly is as a whole a tribute to this way of seeing things.

In the Epilogue Van der Kolk goes even further than in the main body of the book. He points out the importance of the sociopolitical context, and that there is much wrong with today's society. He also emphasises the enormous importance of protecting children, and of education and what could ideally be improved there to give all children equal chances, and protection against abuse. This is a dignified and fully appropriate ending.

After a lifetime of working with people bearing the scars of the trauma they have experienced, this is Van der Kolk's grand synthesis of a lifetime of dedication. I believe we can only admire the book, and use if for ourselves, and in some cases directly for our clients, as a source of wisdom and practical ideas. There are very few practitioners who could not learn from this book and become more effective, as well as inspired, by reading and studying it.

 

Not My Secret To Keep: A Memoir of Healing From Childhood Sexual Abuse

By Digene Farrar with Cynthia Hurn

Portage Bay Press

 

Book reviewed by Julia Bueno

From ESTD Newsletter Volume 4, Number 2, June 2015

In Not My Secret to Keep, we first meet Digene Farrar in her early 40s, at the cusp of realising her professional dream. Nursing and running a business had been an occupation over the years, but modelling was a career she had really wanted to pursue. Against stiff competition, she wins a magazine contest that takes her to New York with a year’s contract. Life had never seemed so good.But not long after settling into her Manhatten apartment, a jet crashes into the North Tower of the World Trade Center. Her nursing training kicks in, and she runs to the scene to offer help, only to become a part of the trail of destruction. In the wake of this indescribable tragedy, Digene begins to fall apart –processing not only the horrors of that day, but those of sustained sexual and physical abuse she’d experienced growing up.

Digene tells her powerful story through a series of diary extracts, bringing us close to her mind as she fell apart and put herself back together again. She begins in May of 2001 and chronicles events over the best part of a decade, which include the agonising processing of early trauma she experienced as a young child and infant. We learn very little about her adult life prior to her early 40s, only references to how her defences got her through her years up until then: those of self-reliance, avoidance of intimacy, denial and self-recrimination. The trauma of 9/11 seemed to puncture these well honed survival tactics, and we journey with her through the painstaking process of making sense of all that she was defending against.

Trapped in New York City after the Towers fell, and unable to return to her possessions in her apartment, Digene desperately tries to find a secure base. It is hard to find and she walks for hours around the chaos, disoriented and not knowing quite who to turn to –just as she felt when young. Her husband Jack is miles away in their marital home in Seattle and when eventually she makes it back she notes ‘Now that I’m home, I know I’m safe, but nothing seems real anymore’. As the literal dust settles in New York, and the collective mourning begins, Digene begins to experience flashbacks, nightmares and high anxiety, and understandably sinks deeper and deeper into a depression. When Jack begins to despair, she realises she needs help.

So Digene seeks therapy –unfortunately her first therapist she meets isn’t a good fit. ‘Her awkward questions prompt my retelling the story of that painful day, but my emotions have flatlined like the heart monitor of someone whose pulse has stopped. I feel as if part of me is sealed in a cocoon, and the result is total numbness. I may as well be talking about someone on another planet; I’m so devoid of feelings.’Unfortunately, this therapist fails to see the dissociation in front of her and inaccurately reflects, ‘You seem to be doing remarkably well.’

Fortunately, Digene is swiftly re-allocated to a more experienced therapist, Janet, who clearly attunes to Digene’s level of trauma far better. We meet other therapists later on, although her relationship with Janet is particularly important and longest lasting, and obviously the one that contains the greatest psychological work and contributes to healing her severe attachment trauma. We learn about their long journey to make the unthinkable thinkable –not just the horrors of the terrorism, but the horrors of her repeated sexual and physical abuse.

This isn’t swift work, as we know. After nearly five years with Janet, in a chapter ‘Facing Reality’ Digene notes ‘I understand I need to talk and feel in order to heal; I just can’t seem to tolerate the feelings’. This leads into a year of ‘exposure therapy’ where although ‘tedious, excruciatingly painful and exhausting’, Digene concludes that ‘I truly believe exposure therapy is what saved me....providing me with a tool to ‘relanguage’ the experiences at my core and to connect the memories with the disassociated feelings. I’m now able to face them instead of running away from them or numbing myself.’

I wondered about Digene’s relationship with her body during all of this –her work with Janet seemed to be processing through talking rather than bodywork, although Janet did encourage Digene to write her feelings down when things became too intense. But while often dissociating from her sense of self and embodiment, Digene meanwhile maintains and builds upon a successful professional persona as a fashion model –her functioning part gains contracts through her innate good looks, but also her confidence and some sense of ‘I am beautiful’. The irony is another part of her feels so deeply ‘I am not beautiful’ that it has, at times, become annhiliatory.

This tension between liking/not liking her body and her struggle to integrate the past and present manifests strikingly around the years of efforts Digene makes to replace a false tooth with an implant. Knocked out as a child by an abuser, she is determined to have the smile she (sometimes feels she) deserves, but the implant doesn’t take and she ends up having repeated painful, expensive and unsuccessful procedures. Getting there in the end ties up with her integration –as if the implanted tooth couldn’t settle until she got there.

Digene’s relationship with her body is attended to in a different way at the Miravel Resort in Arizona, where she signs up for five days of personal challenges –including leaping off a high platform and spending time with a much feared horse. Her brief but powerful retreat ends with a moving letter to her younger self, conveying the unconditional love, acceptance and self-compassion she so needed during her early years.

In the chapter ‘Hands On’, towards the end of the book, we learn about Digene’s year of massage therapy –all the successful psychological work she had made eventually allowed for her to open herself to touch -something she had struggled with over the years. ‘I wasn’t sure what it would feel like to allow someone to touch me or hug me and remain present with the feeling’. Unsurprisingly, one massage triggers flashbacks –’it’s like my body’s key unlocked the doors to stored memories at a cellular level, one after another.’ However, trust in the skilled massage therapist and a stock of new resources allow Digene to experience the flashback with greater ease.

The book is not just a courageous and inspiring memoir. The shorter second section explores the unhappy reality that childhood sexual abuse is far from unique to Digene. Just as Van Der Kolk flags this up as an issue of (US) national importance, so does Digene, and she shares suggestions to survivors and those supporting survivors around seeking support and healing. And as her memoir testifies, the journey can be long, arduous, and may involve different ways of working at different times as the healing unfolds. I imagine this book to a tremendous resource to clients and therapists alike.

Becoming Yourself: Overcoming Mind Control and Ritual Abuse

By Alison Miller

2014, Karnac

The Enslaved Queen: A Memoir about Electricity and Mind Control

By Wendy Hoffman

2014, Karnac

Books reviewed by  Sue Richardson

From ESTD Newsletter Volume 4, Number 1, March 2015

These two books share several aims: to break the silence surrounding ritual abuse and mind control; to expose the perpetrator’s techniques; to empower survivors to reclaim their minds; to convey hope for healing.  Both authors are motivated by a search for truth and belief in the right to mental freedom.   Alison Miller’s book is a survivor-friendly version of her clinical book Healing the Unimaginable (2012, see review by Orit Badouk Epstein).  It addresses the same content directly to survivor with key questions designed for exploration.  It bridges the gap in the self-help literature for complex post-traumatic dissociative conditions left by the lack of consideration of ritual abuse and mind control.  Wendy Hoffman’s book is a first-hand account of the deliberate division  of her mind by Nazi doctors in the US. Each author acknowledges and expresses gratitude to the other. Alison includes illustrative material from Wendy. In turn, Wendy acknowledges  Alison’s clinical help in helping her to be free of pervasive mind control.

Neither book is an easy read. Each one validates what is often held to be unbelievable: the deliberate structural division of the personality by the most horrific methods.  Both books lay bare the techniques used to the install internal personalities for the purpose not only of ritualistic ceremonies but also child trafficking, prostitution, drug and arms running and military use such as espionage. Both authors set out the methods of torture, mind control and manipulation of attachment needs on which installed structural dissociation is based. 

Each book is a very different experience for the reader. Wendy’s testimony is consistent  with survivor accounts throughout the world: the destruction of attachment bonds and sense of self to ensure total submission to the perpetrators. The comment on the cover,  that the book is ‘not for the faint hearted ‘ is an understatement.   It is likely to be profoundly disturbing for even the most experienced practitioner. A singularly shocking feature is that the subjects of the mind control experiments Wendy describes were Jewish children, abused with the active collusion of their families, something which highlights the poison of anti-semitic hatred.  Care is needed if the reader is to avoid secondary traumatisation. I found it easy to be transfixed by the harrowing nature of the content which can make the book hard to put down.  I know of colleagues who have been equally transfixed and have read the book in one sitting. I was aware of my pulse & respiration rate going up and decided to take it slowly to avoid  dysegulation.   Since I am familiar with similar narratives without experiencing the same reactions, I wondered about the cause. On reflection, I think the context in which the narrative of extreme trauma emerges influences  its impact.  In my experience, traumatic content can be better held and coped with in the relational context  of a therapeutic relationship.  At the same time, one value of encountering the author’s narrative in stark print is that it is likely to resonate with the fragmented memories of other survivors of mind control. In this respect it is validating of what is heard in the therapy room.  It exposes a whole range of tricks and techniques which therapists need to know about when working with victims of highly organised cults and government mind control experiments.    

Wendy was a master programmer’s grandchild and a designated Iluminati Queen so her experience is at the extreme end of an extreme spectrum.  Some of the specifics may not apply to all clients with installed structural dissociation but the principles are the same. A lot of torture takes place in an ordinary domestic setting. For example, Wendy says that  ‘the majority of one’s time is spent in ordinary life’.  She ‘had ballet twice a week; speech, piano and mind control once a week’.  Every aspect of programming targets the attachment system in order to inculcate a sense of helplessness, bondage to the abusers and the impossibility of escape.  One vivid illustration of the assault on attachment is how Wendy’s  mother was made to walk past her crying baby repeatedly without responding or making eye contact until the child gave up .  Yet the saving and protective power of attachment is there too in a relationship with an older child, despite the tragic consequences which ensue.   

If you are to read Wendy’s book, I recommend you do so alongside Alison’s.  If we are to open our minds to what Wendy describes, it is essential to know how to help.  Like the  clinical version ( Miller, 2012), ‘Becoming Yourself’ is an exceptional contribution to the field by this author.  With the help of survivors like Wendy who reviewed the material, the book’s design fulfils its aims of accessibility and conceptual clarity.  Practitioners will find the way in which the material is set out helpful. For example, the itemised questions put forward for survivors to ask themselves can also be used by therapists to frame exploratory  remarks to  help the client to access what would otherwise remain hidden.  Addressing the survivor directly in the way the book does has a great deal of power.  I have used to good therapeutic effect  a passage in which the author asserts that it is possible to take back your own mind no matter what others might have dictated.  I am less sure about how the book and its exercises will work for survivors who are not in therapy.  While it is a superb resource for survivors of ritual abuse and mind control who are able to research and manage their own healing journey , the ideal might be for the book to be used alongside therapeutic help. 

From their  different perspectives, these two authors shed light on the capacity for surviving the unimaginable and give hope for healing.  They underline that the features of installed structural dissociation need to be addressed specifically in clinical practice ( Richardson, 2013).  Work with dissociation will enhanced if we can be brave enough to learn from what  these authors share.

 

References

Badouk Epstein, O. ( 2012) ESTD Newsletter , Vol 2, No.3, June 2012, p.12. 

Miller, A. ( 2012) Healing the Unimaginable: Treating Ritual Abuse and Mind Control. London: Karnac. 

Richardson. S. ( 2013) Installed structural dissociation: Cool thinking about a hot debate

ESTD Newsletter , Vol 3, No. 3, June 2013, 6-8. 

 

Ex-Machina

Director Alex Garland, 2014

 

Film reviewed by Orit Badouk Epstein

From ESTD Newsletter Volume 4, Number 1, March 2015

When, fifty years ago Ray Kurzweil futurist & inventor first started talking about ‘singularity’ a concept borrowed from the science fiction writer Vernor Vinge, he was dismissed as a fantasist. He believed that the moment at which computers would exhibit human like intelligence and become conscious would happen in 2029. This will be the point that a robot will pass the Turing Test, a concept developed by Alan Turing where a human converses with an individual in another room and does not know whether they are talking with another human or a computer robot.

Ex-Machina is an elegant sci-fi thriller that attempts to demonstrate exactly that. Ava is a sexy, female android (a riveting performance by Alicia Vikander) created by a genius, company owner, Nathan who has meticulously gathered thought processes from his company “Blue”, the world’s biggest search engine. He selects Caleb a young and vulnerable male employee to join him for a week in his secluded and sleek villa to determine Ava’s capacity for emotional intelligence and whether or not she can pass for a human being with consciousness.

What is a self? What is consciousness? What is a mind? These are big questions that have been playing on our minds and those of the great philosophers for centuries. In trying to provoke a debate between those of us who believe that robot of the future will have enough AI (artificial intelligence) to surpass us and those who dismiss it ex-Machina had the potential to act as a lesson about the hazard of data tracking which is rapidly carving up our life and its impact on human relationship. With its magnificent special effects, the film exposes us to some of the latest ideas about technology but dismally fails to deliver much beyond that. The film had a promising start but ends up with a muddled and familiar story line that we already know from Pygmalion, the Golem and Frankenstein. Garland’s deliberate portrait of Nathan as a misogynistic alpha male whose narcissism is his primary flaw is particularly impressive. We are increasingly exposed to this kind of chauvinism in films (like in Spike Jones film ‘Her’) about the giants of Silicon Valley, whose sexuality only comes alive at the prospect of a submissive female android but then proves more sophisticated than these men could ever have imagined.

The relationship between the two men and the female robots is hollow, equally presenting man and woman as an object of use and exploitation. Nathan chooses Caleb to be his special protégé because he has the data about Caleb’s childhood and his emotional mapping. The relationship between the Guru and his disciple is based on idealised dynamics that we can predict will end up like a car crash. There is a point in the film where the two men briefly disagree about who said what and how exactly it was said. It is at this moment where the whole narrative could have taken a deeper path and explore the real meaning of AI vs EI (Emotional Intelligence). Instead we are left with so many unanswered questions mainly: can a robot with the best of its AI fully comprehend the extent to which our right brain to right brain communications and intentions function?

Kurzweil is confident that by 2045 ‘Computers will be billions times more powerful of all the human brain on earth’ ‘Google will know the answers to your questions before you have asked it. It will have read every email you’ve written, every document, every idea, every thought you’ve tapped into a search engine box. It will know you better than your intimate partner does. Better, perhaps than even yourself. At the moment computers are on the threshold of reading and understanding the semantic content of a language but not quite at human levels. But since a computer can read material a million time more quickly than humans, they can make up for that with quantity’. (Guardian, 22nd February 2014)

But dare I ask Mr. Kurzweil if mimicking our minds will really outstrip us as human beings? In his book ‘Present moments’ Daniel Stern writes ‘two minds create intersubjectivity but equally intersubjectivity shapes the two minds’ (p.78). As psychotherapists, being in the room with our clients, means that by resonating with them, we may have to be unconsciously in synch with that person; watching every move, observing every breath or sigh and mirroring back what was often so absent from their life in the first place. We know that thanks to these micro-present moments where we authentically connect, we help them regulate their affects, empathise with their pain and make them feel understood. ‘The desire for intersubjectivity is one of the major motivations that drive psychotherapy forward. Patients want to be known and to share what it feels like to be them…This desire to be known and the ongoing regulation of the intersubjective space are also features of any intimate friendship’ (Stern p.97).Only with affect attunement and implicit knowing can we make sure that the activation of mirror neurons does not spill over to trigger corresponding motor neurons with the result of automatic or reflexive imitation potentially seen in individuals with echo-praxia or “imitative behaviour” (Stern p.82) and like we see in the androids in the film.

In working with survivors of mind control and systemic abuse the phenomenon of the self is even more complex and controversial. The abusers who robbed and programmed the survivors’ minds have successfully caused a profound fragmentation of the self and to some extent some survivors present us with challenges similar to the utopic nature of Kurzweil’s controlling androids.

Whether we can reach a place of intersubjectivity with clients whom from birth have been subjected to mind control and torture is still a work in progress and perhaps Garland was merely trying to convey that by talking about AI we are actually talking about ourselves and the issues of the self, self-awareness, consciousness, our feeling mind vs our thinking mind and whatever it is that we believe is meant to constitute a sense of selfhood.

 

References:

Stern, D.N (2004), The present moment, Norton, USA.