[Full Audiobook] The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma | Part 3-5

0:00 part four the imprint of trauma chapter 11 uncovering Secrets the problem of traumatic memory it is a strange thing that all the memories have these two qualities they are always full of quietness that is the most striking thing about them and even when things weren't like that in reality they still seem to have that quality they are soundless apparitions which speak to me by looks and gestures wordless and silent and their silence is precisely what disturbs me Eric Maria remark All Quiet on the Western Front in the spring of 2002 I was asked to examine a young man who claimed to have been sexually abused while he was growing up by Paul Shanley Catholic priest who had served in his Parish in Newton Massachusetts

0:46 now 25 years old he had apparently forgotten the abuse until he heard that the priest was currently under investigation for molesting young boys the question posed to me was even though he had seemingly repressed the abuse for well over a decade after it ended were his memories credible and was I prepared to testify to that fact before a judge I will share what this man whom I'll call Julian told me drawing on my original case notes even though his real name is in the public record I'm using a pseudonym because I hope that he has regained some privacy and peace with the passage of time point1 his experiences illustrate the complexities of traumatic memory the controversies over the case against father Shanley are also typical of the passions that have swirled around

1:32 this issue since psychiatrists first described the unusual nature of traumatic memories in the final Decades of the 19th century flooded by Sensations and images on February 11th 2001 Julian was serving as a military policeman at an Air Force Base during his daily phone conversation with his girlfriend Rachel she mentioned a lead article she'd read that morning in the Boston Globe a priest named Shanley was Under Suspicion for molesting children hadn't Julian once told her about a father Shanley who had been his Parish priest back in Newton did he ever do anything to you she asked Julian initially recalled father Shanley as a kind man who'd been very supportive after his parents got divorced but as

2:18 the conversation went on he started to go into a panic he suddenly saw Shanley silhouetted in a door frame his hands stretched out at 45° staring at Julian as he urinated overwhelmed by emotion he told Rachel I've got to go he called his flight Chief who came over accompanied by the first sergeant after he met with the two of them they took him to the base chaplain Julian recalls telling him do you know what is going on in Boston it happened to me too the moment he heard himself say those words he knew for certain that Shanley had molested him even though he did not remember the details Julian felt extremely embarrassed about being so emotional he

3:03 had always been a strong kid who kept things to himself that night he sat on the corner of his bed hunched over thinking he was losing his mind and terrified that he would be locked up over the subsequent weak images kept flooding into his mind and he was afraid of breaking down completely he thought about taking a knife and plunging it into his leg just to stop the mental pictures then the panic attacks started to be accompanied by seizures which he called epileptic fits he scratched his body until he bled he constantly felt hot sweaty and agitated between panic attacks he felt like a zombie he was observing himself from a distance as if what he was experiencing were actually happening to somebody else in April he

3:49 received an administrative discharge just 10 days short of being eligible to receive full benefits When Julian entered my office almost a year later I saw a hand handsome muscular guy who looked depressed and defeated he told me immediately that he felt terrible about having left the Air Force he had wanted to make it his career and he'd always received excellent evaluations he loved the challenges and the teamwork and he missed the structure of the military lifestyle Julian was born in a Boston suburb the second oldest of five children his father left the family when Julian was about six because he could not tolerate living with Julian 's emotionally label mother Julian and his father get along quite well but he

4:34 sometimes reproaches his father for having worked too hard to support his family and for abandoning him to the care of his unbalanced mother neither his parents nor any of his siblings has ever received psychiatric care or been involved with drugs Julian was a popular athlete in high school although he had many friends he felt pretty bad about himself and covered up for being a poor student by drinking and partying he feels ashamed that he took advantage of his popularity and good looks by having sex with many girls he mentioned wanting to call several of them to apologize for how badly he treated them he remembered always hating his body in high school he took steroids to pump himself up and smoked marijuana almost every day he did not go to college and after graduating from high school he was virtually

5:21 homeless for almost a year because he could no longer stand living with his mother he enlisted to try to get his life back on track Julian met father Shan at age six when he was taking a CCD catechism class at the Parish church he remembered father Shanley taking him out of the class for confession father Shanley rarely wore a cassic and Julian remembered the priest's dark blue corduroy pants they would go to a big room with one chair facing another and a bench to kneel on the chairs were covered with red and there was a red velvet cushion on the bench they played cards a game of war that turned into strip poker then he remembered standing in front of a mirror in that room father Shanley made him bend over he remembered

6:06 father Shanley putting a finger into his anus he does not think Shanley ever penetrated him with his penis but he believes that the priest fingered him on numerous occasions other than that his memories were quite incoherent and fragmentary he had flashes of images of shanley's face and of isolated incidents Shanley standing in the door of the bathroom the priest going down on his knees and moving it around with his tongue he could not say how old he was when that happened he remembered the priest telling him how to perform oral sex but he did not remember actually doing it he remembered passing out pamphlets in church and then father Shanley sitting next to him in a Pew fondling him with one hand and holding Julian's hand on himself with the other

6:52 he remembered that as he Grew Older father Shanley would pass close to him and caress his penis Paul did not like it but did not know what to do to stop it after all he told me Father Shanley was the closest thing to God in my neighborhood in addition to these memory fragments traces of his sexual abuse were clearly being activated and replayed sometimes when he was having sex with his girlfriend the priest's image popped into his head and as he said he would lose it a week before I interviewed him his girlfriend had pushed a finger into his mouth and playfully said you give good head Julian jumped up and screamed if you ever say that again I'll kill you then terrified they both started to cry this

7:38 was followed by one of Julian's epileptic fits in which he curled up in a fetal position shaking and whimpering like a baby while telling me this Julian looked very small and very frightened Julian alternated between feeling sorry for the old man that father Shanley had become and simply wanting to take him into a room somewhere and kill him he also spoke repeatedly of how ashamed he felt how hard it was to admit that he could not protect himself nobody with me and now I have to tell you this his self-image was of a big tough Julian how do we make sense of a story like Julian's years of apparent forgetting followed by fragmented disturbing images dramatic physical symptoms and sudden

8:24 reenactments as a therapist treating people with a legacy of trauma my primary concern is not to determine exactly what happened to them but to help them tolerate the sensations emotions and reactions they experience without being constantly hijacked by them when the subject of blame arises the central issue that needs to be addressed is usually self-blame accepting that the trauma was not their fault that it was not caused by some defect in themselves and that no one could ever have deserved what happened to them once a legal case is involved however determination of culpability becomes primary and with it the admissibility of evidence I had previously examined 12 people who had been sadistically abused as children in a Catholic orphanage in Burlington Vermont they had come forward with many other claimants more than four decades

9:10 later and although none had had any contact with the others until the first claim was filed their abuse memories were astonishingly similar they all named the same names and the particular abuses that each nun or priest had committed in the same rooms with the same furniture and as part of the same daily routines most of them subsequently accepted an outof Court settlement from the Vermont dicese before a case goes to trial the judge holds a so-called dobert hearing to set the standards for expert testimony to be presented to the jury in a 1996 case I had convinced a federal circuit court judge in Boston that it was common for traumatized people to lose all memories of the event in question only to regain access to them in bits and pieces at a much later date the same standards would apply in

9:55 Julian's case while my report to his lawyer remains confidential it was based on Decades of clinical experience and research on traumatic memory including the work of some of the great pioneers of modern Psychiatry normal versus traumatic memory we all know how fickle memory is our stories change and are constantly revised and updated when my brothers sisters and I talk about events in our childhood we always end up feeling that we grew up in different families so many of our memories simply do not match such autobiographical memories are not precise reflections of reality they are Stories We Tell to convey our personal take on our experience the extraordinary capacity of the human mind to rewrite memory is Illustrated in the grand study of adult development which has

10:41 systematically followed the psychological and physical health of more than 200 Harvard men from their sophomore years of 1939 to 44 to the present Point 2 of course the designers of the study could not have anticipated that most of the participants would go off to fight in World War II but we can now track the evolution of their War Memories the men were interviewed in detail about their War experiences in 1945 1946 and again in 1989/1990 4 and a half decades later the majority gave very different accounts from the narratives recorded in their immediate post-war interviews with the passage of time events had been bleached of their intense Horror in contrast those who had been traumatized and subsequently developed PTSD did not modify their accounts their memories

11:28 were preserved essentially intact 45 years after the war ended whether we remember a particular event at all and how accurate our memories of it are largely depends on how personally meaningful it was and how emotional we felt about it at the time the key factor is our level of arousal we all have memories associated with particular People songs smells and places that stay with us for a long time most of us still have precise memories of where we were and what we saw on Tuesday September 11th 2001 but but only a fraction of us recall anything in particular about September 10th most day-to-day experience passes immediately into Oblivion on ordinary days we don't have much to report when we come home in the evening the mind works according to

12:14 schemes or maps and incidents that fall outside the established pattern are most likely to capture our attention if we get a raise or a friend tells us some exciting news we will retain the details of the moment at least for a while we remember insults and injuries best the adrenaline that we secrete to defend against potential threats helps to engrave those incidents into our minds even if the content of the remark Fades our dislike for the person who made it usually persists when something terrifying happens like seeing a child or a friend get hurt in an accident we will retain an intense and largely accurate memory of the event for a long time as James mcgau and colleagues have shown the more adrenaline you secrete the more precise your memory will be three but that is true only up to a

12:59 certain point confronted with horror especially the horror of inescapable shock this system becomes overwhelmed and breaks down of course we cannot monitor what happens during a traumatic experience but we can reactivate the trauma in the laboratory as was done for the brain scans in chapters 3 and 4 when memory traces of the original sounds images and Sensations are reactivated the frontal lobe shuts down including as we've seen the region necessary to put feelings into words for the region that creates our sense of location in time and the thalamus which integrates the raw data of incoming Sensations at this point the emotional brain which is not under conscious control and cannot communicate in words takes over the emotional brain the lyic area and the

13:45 brain stem expresses its altered activation through changes in emotional arousal body physiology and muscular action under ordinary conditions these two memory systems rational and emotional collaborate to produce an integrated response but High arousal not only changes the balance between them but also disconnects other brain areas necessary for the proper storage and integration of incoming information such as the hippocampus and the thalamus point5 as a result the imprints of traumatic experiences are organized not as coherent logical narratives but in fragmented sensory and emotional traces images sounds and physical Sensations point 6 Julian saw a man with outstretched arms a pew a staircase a strip poker game he felt a

14:33 sensation in his penis a panicked sense of dread but there was little or no Story uncovering the secrets of trauma in the late 19th century when medicine first began the systematic study of mental problems the nature of traumatic memory was one of the central topics under discussion in France and England a prodigious number of Articles were published on a syndrome known as Railway spine a psychological aftermath of railroad accidents that included loss of memory the greatest advances however came in the study of Hysteria a mental disorder characterized by emotional outbursts susceptibility to suggestion and contractions and paralyses of the muscles that could not be explained by simple anatomy. 7 once considered an Affliction of unstable or malingering

15:20 women the name comes from the Greek word for womb hysteria now became a window into the mysteries of Mind and Body the names of some of the greatest Pioneers in neurology and Psychiatry such as Gene Martin Sho Pierre Janet and Sigman Freud are associated with the discovery that trauma is at the root of Hysteria particularly the trauma of childhood sexual abuse point8 these early researchers referred to traumatic memories as pathogenic Secrets nine or mental parasites 10 because as much as the sufferers wanted to forget whatever had happened their memories kept forcing themselves into Consciousness trapping them in an Ever renewing present of existential horror the interest in hysteria was particularly strong in France and as so often happens its roots lay in the

16:06 politics of the day Gene Martin sharo who is widely regarded as the father of Neurology and whose pupils such as Gillis de la tette lent their names to numerous neurological diseases was also active in politics after Emperor Napoleon theii abdicated in 1870 there was a struggle between the monarchists the old order backed by the clergy and The Advocates of the fledgling French Republic repu who believed in science and in secular democracy sharo believed that women would be a critical factor in this struggle and his investigation of Hysteria offered a scientific explanation for phenomena such as demonic possession States witchcraft exorcism and religious ecstasy 12 shko conducted meticulous studies of the physiological and neurological correlates of Hysteria in

16:52 both men and women all of which emphasized embodied memory and a lack of language for example in 1889 he published the case of a patient named log who developed paralysis of the legs after being involved in a traffic accident with a horron cart although leog fell to the ground and lost Consciousness his legs appeared un hurt and there were no neurological signs that would indicate a physical cause for his paralysis shko discovered that just before leog passed out he saw the wheels of the cart approaching him and strongly believed he would be run over he noted that the patient does not preserve any recollection questions addressed to him upon this point are attended with no result he knows nothing or almost

17:39 nothing 13 like many other patients at the salpeter log expressed his experience physically instead of remembering the accident he developed paralysis of his legs point4 painting by Andre bruet Gene Martin Sho presents the case of a patient with hysteria Sho transformed Lo Al patrier an ancient Asylum for the poor of Paris which he transformed into a modern hospital notice the patient dramatic posture but for me the real hero of the story is Pierre Janet who helped Sho establish a research laboratory devoted to the study of Hysteria at the salpeter in 1889 the same year that the Eiffel Tower was built Janet published the first book-length scientific account of traumatic stress lism psychology point5

18:26 Janet proposed that at the root of what we now call PTSD was the experience of vehement emotions or intense emotional arousal this tretis explained that after having been traumatized people automatically keep repeating certain actions emotions and Sensations related to the trauma and unlike Sho who was primarily interested in measuring and documenting patients physical symptoms Janet spent Untold hours talking with them trying to discover what was going on in their minds also in contrast to sharco whose research focused on understanding the phenomenon of Hysteria Janet was first and foremost a clinician whose goal was to treat his patients that is why I studied his case reports in detail and why he became one of my

19:11 most important teachers 16 Amnesia dissociation and reenactment Janet was the first to point out the difference between narrative memory the stories people tell about trauma and traumatic memory itself one of his case histories was the story of irin a young woman who was hospitalized following her mother's death from tuberculosis Point 17 irin had nursed her mother for many months while continuing to work outside the home to support her alcoholic father and pay for her mother's medical care when her mother finally died irin exhausted from stress and lack of sleep tried for several hours to revive the corpse calling out to her mother and trying to force medicine down her throat at one point the lifeless body dropped off the

19:57 bed while ain's drunken father lay passed out nearby even after an aunt arrived and started preparing for the burial irin's denial persisted she had to be persuaded to attend the funeral and she laughed throughout the service a few weeks later she was brought to the salpetriere where Janet took over her case in addition to amnesia for her mother's death irin suffered from another symptom several times a week she would stare trans-like at an empty bed ignore whatever was going on around around her and begin to care for an imaginary person she meticulously reproduced rather than remembered the details of her mother's death traumatized people simultaneously remember too little and too much on the

20:42 one hand irin had no conscious memory of her mother's death she could not tell the story of what had happened on the other she was compelled to physically act out the events of her mother's death Janet's term automatism conveys the involuntary unconscious nature of her actions Janet treated Arin for several months mainly with hypnosis at the end he asked her again about her mother's death Arin started to cry and said don't remind me of those terrible things my mother was dead and my father was a complete drunk as always I had to take care of her dead body all night long I did a lot of silly things in order to revive her in the morning I lost my mind Not only was a ren able tell the story

21:28 but she had also recovered her emotions I feel very sad and abandoned Janet now called her memory Complete because it now was accompanied by the appropriate feelings Janet noted significant differences between ordinary and traumatic memory traumatic memories are precipitated by specific triggers in Julian's case the trigger was his girlfriend's seductive comments in ains it was a bed when one element of a traumatic experience is triggered other elements are likely to automatically follow traumatic memory is not condensed it took a Rin 3 to 4 hours to reenact her story but when she was finally able to tell what had happened it took less than a minute the traumatic enactment serves no function in contrast ordinary

22:16 memory is adaptive our stories are flexible and can be modified to fit the circumstances ordinary memory is essentially social it's a story that we tell for a purpose in ain's case to enlist her doctor's help and comfort in Julian's case to recruit me to join his search for justice and revenge but there is nothing social about traumatic memory Julian's rage at his girlfriend's remark served no useful purpose reenactments are Frozen in Time unchanging and they are always lonely humiliating and alienating experiences Janet coined the term dissociation to describe the splitting off and isolation of memory imprints that he saw in his patients he was also preent about the heavy cost of

23:02 keeping these traumatic memories at Bay he later wrote that when patients dissociate their traumatic experience they become attached to an insurmountable obstacle 18 you enable to integrate their traumatic memories they seem to lose their capacity to assimilate new experiences as well it is as if their personality has definitely stopped at a certain point and cannot enlarge any more by the addition or aimilar of new elements 19 he predicted that unless they became aware of the split-off elements and integrated them into a story that had happened in the past but was now over they would experience a slow decline in their personal and professional functioning this phenomenon has now been well documented in contemporary research Point 20 Janet discovered that while it

23:49 is normal to change and distort ones memories people with PTSD are unable to put the actual event the source of those memories behind behind them dissociation prevents the trauma from becoming integrated within the conglomerate ever shifting stores of autobiographical memory in essence creating a dual memory system normal memory integrates the elements of each experience into the continuous flow of self-experience by a complex process of Association think of a dense but flexible Network where each element exerts a subtle influence on many others but in Julian's case the sensations thoughts and emotions of the trauma were stored separately as Frozen barely comprehensible fragments if the problem with PTSD is dissociation the

24:35 goal of treatment would be Association integrating the cutoff elements of the trauma into the ongoing Narrative of life so that the brain can recognize that that was then and this is now the origins of the talking cure psychoanalysis was born on the wards of the salpeter in 1885 Freud went to Paris to work with Sho and he later named his firstborn son Jee Martin in SHO honor in 1893 Freud and his viene mentor Joseph Brewer cited both shco and Janet in a brilliant paper on the cause of Hysteria hysterics suffer mainly from reminiscences they Proclaim and go on to note that these memories are not subject to the wearing away process of normal memories but persist for a long time with astonishing freshness nor can

25:20 traumatized people control when they will emerge we must mention another remarkable fact namely that these memories unlike other memories of their past lives are not at the patient disposal on the contrary these experiences are completely absent from the patient memory when they are in a normal psychical state or are only present in a highly summary form 21 all italics in the quoted passages are Brewer and freuds Brewer and Freud believed that traumatic memories were lost to ordinary Consciousness either because circumstances made a reaction impossible or because they started during severely paralyzing affects such as fright in 1896 Freud boldly claimed that the ultimate cause of Hysteria is

26:06 always the seduction of the child by an adult 22 then faced with his own evidence of an epidemic of abuse in the best families of Vienna one he noted that would implicate his own father he quickly began to retreat psychoanalysis shifted to an emphasis on unconscious wishes and Fantasies though Freud occasionally kept acknowledging the reality of sexual abuse 23 after the horrors of World War I confronted him with the reality of combat Neurosis Freud reaffirmed that lack of verbal memory is Central in trauma and that if a person does not remember he is likely to act out H reproduces it not as a memory but as an action he repeats it without knowing of course that he is repeating and in the end we understand that this is his way of remembering 24

26:51 the lasting Legacy of Brewer and Freud's 1893 paper is what we now call the talking cure W found to our great surprise at first that each individual hysterical symptom immediately and permanently disappeared when we had succeeded in bringing clearly to light the memory of the event by which it was provoked and in arousing its accompanying effect and when the patient had described that event in the greatest possible detail and had put the effect into words all italics in original recollection without effect almost invariably produces no result they explained that unless there is an energetic reaction to the traumatic event the effect remains attached to the memory and cannot be discharged the reaction can be discharged by an action from tears to acts of Revenge but

27:38 language serves as a substitute for Action by its help an affect can be AB reacted almost as effectively it will now be understood they conclude how it is that the psychotherapeutic procedure which we have described in these Pages has a Curative effect it brings to an end the operative Force which was not abreact in the first instance I.E at the time of the trauma by allowing its strangulated effect to find a way out through speech and it subjects it to associative correction by introducing it into normal Consciousness even though psychoanalysis is today in Eclipse the talking cure has lived on and psychologists have generally assumed that telling the trauma story in great detail will help people to leave it behind that is also a basic premise of cognitive behavioral therapy CBT which

28:26 today is taught in graduate psychology courses around the world although the diagnostic labels have changed we continue to see patients similar to those described by shco Janet and Freud in 1986 my colleagues and I wrote up the case of a woman who had been a cigarette girl at Boston's Coconut Grove nightclub when it burned down in 1942. 25 during the 1970s and 1980s she annually reenacted her escape on Newberry Street a few blocks from the original location which resulted in her being hospitalized with diagnosis like schizophrenia and bipolar disorder in 1989 I reported on a Vietnam veteran who yearly staged an armed robbery on the exact anniversary of a buddy's death point 26 he would put a finger in his pants pocket claim that

29:12 it was a pistol and tell a shopkeeper to empty his cash register giving him plenty of time to alert the Police this unconscious attempt to commit suicide by cop came to an end after a judge referred the veteran to me for treatment once we had dealt with his guilt about his friend's death there were no further reenactments such incidents raise a critical question how can doctors police officers or social workers recognize that someone is suffering from traumatic stress as long as he reenacts rather than remember how can patients themselves identify the source of their behavior if their history is not known they are likely to be labeled as crazy or punished as criminals rather than help to integrate the past traumatic memory on trial at least two dozen men

29:59 had claimed they were molested by Paul Shanley and many of them reached civil settlements with the Boston Arch dasis Julian was the only victim who was called to testify in shanley's trial in February 2005 the former priest was found guilty on two counts of raping a child and two counts of assault and battery on a child he was sentenced to 12 to 15 years in prison in 2007 shanley's attorney Robert F Shaw Jr filed motion for a new trial challenging shanley's convictions as a miscarriage of Justice Shaw tried to make the case that repressed memories were not generally accepted in the scientific community that the convictions were based on junk science and that there had been insufficient testimony about the scientific status of repressed memories

30:45 before the trial the appeal was rejected by the original trial judge but 2 years later was taken up by the Supreme Judicial Court of Massachusetts almost 100 leading psychiatrists and psychologists from around the United States and eight foreign countries signed an amicus curi brief stating that repressed memory has never been shown to exist and that it should not have been admitted as evidence however on January 10th 2010 the court unanimously upheld shanley's conviction with this statement in some the judges finding that the lack of scientific testing did not make unreliable the theory that an individual may experience dissociative Amnesia was supported in the record there was no abuse of discretion in in the admission of expert testimony on the subject of

31:31 dissociative Amnesia in the following chapter I'll talk more about memory and forgetting and about how the debate over repressed memory which started with Freud continues to be played out today chapter 12 the unbearable heaviness of remembering our bodies are the texts that carry the memories and therefore remembering is no less than reincarnation Katy conon scientific interest in trauma has fluctuated wildly during the past 150 years sho's death in 1893 and Freud's shift in emphasis to Inner conflicts defenses and instincts at the root of mental suffering were just part of mainstream medicine's overall loss of interest in the subject psychoanalysis rapidly gained in popularity in 1911 the Boston

32:17 psychiatrist Morton prince who had studied with William James and Pierre Janet complained that those interested in the effects of trauma were like clams swamped by the rising tide in Boston Harbor this neglect lasted for only a few years though because the outbreak of World War in 1914 once again confronted medicine and psychology with hundreds of thousands of men with bizarre psychological symptoms unexplained medical conditions and memory loss the new technology of Motion Pictures made it possible to film these soldiers and today on YouTube we can observe their bizarre physical postures strange verbal utterances terrified facial expressions and ticks the physical embodied expression of trauma a memory that is inscribed simultaneously in the mind as interior images and words and on the

33:03 body one early in the War the British created the diagnosis of shell shock which entitled combat veterans to treatment and a Disability Pension the alternative similar diagnosis was neurasthenia for which they received neither treatment nor pension it was up to the orientation of the treating physician which diagnosis a soldier received point to more than a million British soldiers served on the Western Front at any one time in the first few hours of July 1st 1916 alone in the battle of the P the British army suffered 57,4 se0 casualties including 19,24 dead the bloodiest day in its history the historian John Keegan says of their Commander field Marshall

33:50 Douglas ha whose statue today dominates White Hall in London once the center of the British Empire in his public Manner and private Diaries no concern for human suffering was or is discernible at the psalm he had sent the flower of British youth to death or mutilation three as the war war on shell shock increasingly compromised the efficiency of the fighting forces caught between taking the suffering of their soldiers seriously and pursuing victory over the Germans the British general staff issued General routine order number 2384 in June of 1917 which stated in no circumstances whatever will the expression shell shock be used verbally or be recorded in any regimental or other casualty report or any hospital or other medical document all Soldiers with

34:37 psychiatric problems were to be given a single diagnosis of nydn not yet diagnosed nervous point4 in November 1917 the general staff denied Charles Samuel Myers who ran four field hospitals for wounded soldiers permission to submit a paper on shell shock to the British medical journal the Germans were even more punitive and treated shell shock as a character defect which they managed with a variety of painful treatments including electroshock in 1922 the British government issued the Southboro report whose goal was to prevent the diagnosis of shell shock in any future Wars and to undermine any more claims for compensation it suggested the elimination of shell shock from all official nomenclature and insisted that these cases should no more be classified as a battle casualty than sickness or

35:23 disease is so regarded five the official view was that well-trained troops properly LED would not suffer from Shell Shock and that the servicemen who had succumbed to the disorder were undisciplined and unwilling soldiers while the political storm about the legitimacy of shell shock continued to rage for several more years reports on how to best treat these cases disappeared from the scientific literature point 6 in the United States the fate of veterans was also fraught with problems in 1918 when they returned home from the battlefields of France and Flanders they had been welcomed as National Heroes just as the soldiers returning from Iraq and Afghanistan are today in 1924 Congress voted to award them a bonus of $125 for each day they had served

36:09 overseas but dispersement was postponed until 1945 by 1932 the nation was in the middle of the Great Depression and in May of that year about 15,000 unemployed and penniless veterans camped on the mall in Washington DC to petition for immediate payment of their bonuses the Senate defeated the bill to move up dispersement by a vote of 62 to8 a month later President Hoover ordered the Army to clear out the veteran encampment Army Chief of Staff general Douglas MacArthur commanded the troops supported by six tanks Major Dwight D Eisenhower was the liaison with the Washington police and major George Patton was in charge of the Cavalry Soldiers with fixed bayonets charged hurling tear gas into the crowd

36:55 of veterans the next morning the mall was deserted and the camp was in Flames 7 the veterans never received their pensions while politics and Medicine turned their backs on the returning Soldiers the horrors of the war were memorialized in literature and Art In All Quiet on the Western Front a a novel about the war experiences of Frontline Soldiers by the German writer Eric Maria remark the book's protagonist Paul bomber spoke for an entire generation I am aware that I without realizing it have lost my feeling ings I don't belong here anymore I live in an alien world I prefer to be left alone not disturbed by anybody they talk too much I can't relate to them they are only busy with superficial things nine published in

37:42 1929 the novel instantly became an international bestseller with translations in 25 languages the 1930 Hollywood film version won the Academy Award for best picture but when Hitler came to power a few years later all Quiet on the Western Front was one of the first degenerate books the Nazis burned in the Public Square in front of Humbolt University in berlin10 apparently awareness of the devastating effects of War on soldiers Minds would have constituted a threat to the Nazis plunge into another round of insanity denial of the consequences of trauma can wreak havoc with the social fabric of society the refusal to face the damage caused by the war and the intolerance of weakness played an important role in the rise of fascism and militarism around the world in the 1930s the extortionate

38:30 war reparations of the Treaty of Versailles further humiliated and already disgraced Germany German Society in turn dealt ruthlessly with its own traumatized War veterans who were treated as inferior creatures this Cascade of humiliations of the powerless set the stage for the ultimate debasement of human rights under the Nazi regime the moral justification for the strong to Vanquish the inferior the rationale for the ensuing War the new face of of trauma the outbreak of World War II prompted Charles Samuel Myers and the American psychiatrist Abram cardner to publish the accounts of their work with World War I soldiers and Veterans shell shock in France 1914 to 1918 1940 11 and the traumatic Neurosis of War

39:15 1941 12 served as the principal guides for psychiatrists who were treating soldiers in the new conflict who had War Neurosis the US war effort was prodigious and the advances in Frontline psychiatry reflected that commitment Again YouTube offers a direct window on the past Hollywood director John Houston's documentary let there be light 1946 shows the predominant treatment for war Neurosis at that time hypnosis 13 in Houston's film made while he was serving in the Army signal Corps the doctors are still patriarchal and the patients are still terrified young men but they manifest their trauma differently while the World War I soldiers flail have facial picks and collapse with paralyzed bodies the following generation talks

40:01 and cringes their bodies still keep the score their stomachs are upset their hearts race and they are overwhelmed by Panic but the trauma did not just affect their bodies the Trans State induced by hypnosis allowed them to find words for the things they had been too afraid to remember their Terror their survivors guilt and their conflicting loyalties it also struck me that these soldiers seem to keep a much tighter lid on their anger and hostility than the younger veterans I'd worked with culture shapes the expression of traumatic stress the feminist theorist Germaine Greer wrote about the treatment of her father's PTSD after World War II when the medical officers examined men exhibiting severe disturbances they almost invariably found the root cause in pre-war

40:47 experience the sick men were not first grade fighting material the military proposition is that it is not war which makes men sick but that sick men cannot fight Wars 14 it seems unlikely the doctors did her father any good but Greer's efforts to come to grips with his suffering undoubtedly helped fuel her exploration of sexual domination in all its ugly manifestations of rape incest and domestic violence when I worked at the VA I was puzzled that the vast majority of the patients we saw on the Psychiatry service were young recently discharged Vietnam veterans while the corridors and elevators that led to the medical departments were filled by old men curious about this disparity I conducted a survey of the World War II veterans in

41:32 the medical clinics in 1983 the vast majority of them scored positive for PTSD on the rating scales that I administered but their treatment focused on medical rather than psychiatric complaints these vets communicated their distress Via stomach cramps and chest pains rather than with nightmares and rage from which my research showed they also suffered doctors shape how their patients communicate their distress when a a patient complains about terrifying nightmares and his doctor orders a chest x-ray the patient realizes that he'll get better care if he focuses on his physical problems like my relatives who fought in or were captured during World War II most of these men were extremely reluctant to share their experiences my sense was that neither the doctors nor their patients wanted to revisit the war

42:19 however military and civilian leaders came away from World War II with important lessons that the previous generation had failed to grasp after the defeat of Nazi Germany and Imperial Japan the United States helped rebuild Europe by means of the Marshall Plan which formed the economic foundation of the next 50 years of relative peace at home the GI Bill provided millions of veterans with educations and home mortgages which promoted General economic well-being and created a broad-based well-educated middle class the Armed Forces led the nation in racial integration and opportunity the Veterans Administration built facilities Nationwide to help combat veterans with their health care still with all this thoughtful attention to the returning veterans the psychological scars of War went unrecognized and traumatic Neurosis

43:07 disappeared entirely from official psychiatric nomenclature the last scientific writing on combat trauma after World War II appeared in 19471 15 trauma rediscovered as I noted earlier when I started to work with Vietnam veterans there was not a single book on war trauma in the library of the VA but the Vietnam War inspired numerous studies the formation of scholarly organizations and the inclusion of a trauma diagnosis PTSD in the professional literature at the same time interest in trauma was exploding in the general public in 1974 fredman and kaplan's comprehensive textbook of Psychiatry stated that incest is extremely rare and does not occur in more than one out of 1.1 million people 16 as we have seen in Chapter 2 this

43:54 authoritative textbook then went on to exall the POS benefits of incest such incestous activity diminishes the subject's chance of psychosis and allows for a better adjustment to the external world the vast majority of them were none the worse for the experience how misguided those statements were became obvious when the ascendant feminist movement combined with awareness of trauma in returning combat veterans emboldened tens of thousands of survivors of childhood sexual abuse domestic abuse and rape to come forward Consciousness raising groups and Survivor groups were formed and numerous popular books including the courage to heal 1988 a bestselling self-help book for survivors of incest and Judith Herman's book trauma and Recovery 1992 discussed the stages of treatment

44:41 and Recovery in great detail cautioned by history I began to wonder if we were headed toward another backlash like those of 1895 1917 and 1947 against acknowledging the reality of trauma that proved to be the case for by the early 199 '90s articles had started to appear in many leading newspapers and magazines in United States and in Europe about a so-called false memory syndrome in which psychiatric patients supposedly manufactured elaborate false memories of sexual abuse which they then claimed had Lain dormant for many years before being recovered what was striking about these articles was the certainty with which they stated that there was no evidence that people remember trauma any differently than they do ordinary events I vividly recall a phone call from a well-known newsweekly in London telling

45:26 me that they planed to publish an article about traumatic memory in their next issue and asking me whether I had any comments on the subject I was quite enthusiastic about their question and told them that memory loss for traumatic events had first been studied in England well over a century earlier I mentioned John Eric Ericson and Frederick Myers's work on Railway accidents in the 1860s and 1870s and Charles Samuel Myers's in w r Rivers's extensive studies of memory problems in combat soldiers of World War I I Al suggested they look at an article published in the Lancet in 1944 which described the aftermath of the rescue of the entire British Army from the beaches of dunker in 1940 more than 10% of the soldiers who were studied had suffered from major memory

46:12 loss after the evacuation Point 17 the following week the magazine told its readers that there was no evidence whatsoever that people sometimes lose some or all memory for traumatic events the issue of delayed recall of trauma was not particularly controversial when Myers and cardner first described this phenomenon in their books on combat Neurosis in World War I when major memory loss was observed after the evacuation from Dunkirk or when I wrote about Vietnam veterans and the Survivor of the Coconut Grove nightclub fire however during the 1980s and early 1990s as similar memory problems began to be documented in women and children in the context of domestic abuse the efforts of abuse victims to seek Justice against their alleged perpetrators mov the issue from science into politics and law this in turn became the context for the

46:58 pedophile scandals in the Catholic church in which memory experts were pitted against one another in courtrooms across the United States and later in Europe and Australia experts testifying on behalf of the church claimed that memories of childhood sexual abuse were unreliable at best and that the claims being made by alleged victims more likely resulted from false memories implanted in their minds by therapists who were overs sympathetic credulous or driven by their own agendas during this period I examined more than 50 adults who like Julian remembered having been abused by priests their claims were denied in about half the cases the science of repressed memory there have in fact been hundreds of scientific Publications spanning well over a century documenting how the memory of trauma can be repressed only to resurface years or decades later 18

47:44 memory loss has been reported in people who have experienced natural disasters accidents War trauma kidnapping torture concentration camps and physical and sexual abuse total memory loss is most common in childhood sexual abuse with incidents ranging from 19% to 38% point9 this issue is not particularly controversial as early as 1980 the dsm3 recognized the existence of memory loss for traumatic events in the diagnostic criteria for dissociative Amnesia an inability to recall important personal information usually of a traumatic or stressful nature that is too extensive to be explained by normal forgetfulness memory loss has been part of the criteria for PTSD since that diagnosis was first introduced one of the most

48:31 interesting studies of repressed memory was conducted by Dr Linda Meer Williams which began when she was a graduate student in sociology at the University of Pennsylvania in the early 1970s Williams interviewed 206 girls between the ages of 10 and 12 who had been admitted to a hospital emergency room following sexual abuse their laboratory tests as well as the interviews with the children and their parents were kept in the hospitals Medical records 17 years later Williams was able to track down 136 of the children now adults with whom she conducted extensive follow-up interviews 20 more than a third of the women 38% did not recall the abuse that was documented in their medical records while only 15 women 12% said that they had never been abused as children more

49:17 than 2/3 68% reported other incidents of childhood sexual abuse women who were younger at the time of the incident and those who who were molested by someone they knew were more likely to have forgotten their abuse this study also examined the reliability of recovered Memories One in 10 women 16% of those who recalled the abuse reported that they had forgotten it at some time in the past but later remembered that it had happened in comparison with the women who had always remembered their molestation those with a prior period of forgetting were younger at the time of their abuse and were less likely to have received support from their mothers Williams also determined that the recovered memories were approximately as accurate as those that had never been lost all the women's memories were accurate for the central facts of the

50:03 incident but none of their stories precisely matched every detail documented in their charts Point 21 Williams's findings are supported by recent Neuroscience research that shows that memories that are retrieved tend to return to the memory bank with modifications 22 as long as a memory is inaccessible the mind is unable to change it but as soon as a story starts being told particularly if it is told repeatedly it changes the act of telling itself changes the tale the Mind cannot help but make meaning out of what it knows and the meaning we make of our lives changes how and what we remember given the wealth of evidence that trauma can be forgotten and resurface years later why did nearly 100 reputable memory scientists from several different countries throw the weight of their reputations behind the appeal to

50:49 overturn father shanley's conviction claiming that repressed memories were based on junk science because because memory loss and delayed recall of traumatic experiences had never been documented in the laboratory some cognitive scientists adamant denied that these phenomena existed 23 or that retrieved traumatic memories could be accurate Point 24 however what doctors encounter in emergency rooms on psychiatric Wards and on the battlefield is necessarily quite different from what scientists observe in their safe and well organized Laboratories consider what is known as the Lost in the mall experiment for example academic researchers have shown that it is relatively easy to implant memories of events that never took place such as having been lost in a shopping mall as a child Point 25 about 25% of subjects in

51:36 these studies later recall that they were frightened and even fill in missing details but such Recollections involve none of the visceral Terror that a Lost Child would actually experience another line of research documented the unreliability of eyewitness testimony subjects might be shown a video of a car driving down a street and ask asked afterward if they saw a stop sign or a traffic light children might be asked to recall what a male visitor to their classroom had been wearing other eyewitness experiments demonstrated that the questions Witnesses were asked could alter what they claimed to remember these studies were valuable in bringing many police and courtroom practices into question but they have little relevance to traumatic memory the fundamental problem is this events that take place

52:22 in the laboratory cannot be considered equivalent to the conditions under which traumatic memories are created the terror and helplessness associated with PTSD simply can't be induced to noo in such a setting we can study the effects of existing traumas in the lab as in our script driven Imaging studies of flashbacks but the original imprint of trauma cannot be laid down there Dr Roger Pitman conducted a study at Harvard in which he showed college students a film called faces of death which contained newsreal footage of violent deaths and executions this movie now widely banned is as Extreme as any institutional review board would allow but it did not cause pitman's normal volunteers to develop symptoms of PTSD if you want to study traumatic memory you have to study the memories of people

53:09 who have actually been traumatized interestingly once the excitement and profitability of courtroom testimony diminished the scientific controversy disappeared as well and clinicians were left to deal with the wreckage of traumatic memory normal versus traumatic memory in 199 before I and my colleagues at Massachusetts General Hospital decided to undertake a systematic study comparing how people recall benign experiences and horrific ones we placed advertisements in local newspapers in laundromats and on student union bulletin boards that said has something terrible happened to you that you cannot get out of your mind call 72755 we will pay you $10 for participating in this study in response to our first ad 76 volunteers showed up

53:57 26 after we introduced ourselves we started off by asking each participant can you tell us about an event in your life that you think you will always remember but that is not traumatic one participant lit up and said the day that my daughter was born others mention their wedding day playing on a winning sports team or being valedictorian at their High School graduation then we ask them to focus on specific sensory details of those events such as are you ever somewhere and suddenly have a vivid image of what your husband looked like on your wedding day the answers were always negative how about what your husband's body felt like on your wedding night we got some odd looks on that one we continued do you ever have a vivid precise recollection of the speech you

54:44 gave as a valedictorian do you ever have intense Sensations recalling the birth of your first child the replies were all in the negative then we asked them about the traumas that had brought them into the study many of them rapes do you ever suddenly remember how your rapist smelled we asked and do you ever experience the same physical Sensations you had when you were raped such questions precipitated powerful emotional responses that is why I cannot go to parties anymore because the smell of alcohol on somebody's breath makes me feel like I am being raped all over again or I can no longer make love to my husband because when he touches me in a particular way I feel like I am being raped again there were two major differences between how people talked

55:29 about memories of positive versus traumatic experiences one how the memories were organized and two their physical reactions to them weddings births and graduations were recalled as events from the past stories with a beginning a middle and an end nobody said that there were periods when they'd completely forgotten any of these events in contrast the traumatic memories were disorganized our subject remembered some details all too clearly the smell of the rapist the gash and the forehead of a dead child but could not recall the sequence of events or other vital details the first person who arrived to help whether an ambulance or a police car took them to the hospital we also asked the participants how they recalled their trauma at three points in

56:15 time right after it happened when they were most troubled by their symptoms and during the week before the study all of our traumatized participants said that they had not been able to tell any body precisely what had happened immediately following the event this will not surprise anyone who has worked in an emergency room or Ambulance Service people brought in after a car accident in which a child or a friend has been killed sit in stunned silence dumbfounded by Terror almost all had repeated flashbacks they felt overwhelmed by images sounds Sensations and emotions as time went on even more sensory details and feelings were activated but most particip ANS also started to be able to make some sense out of them they began to know what had

57:00 happened and to be able to tell the story to other people a story that we call the memory of the trauma gradually the images and flashbacks decreased in frequency but the greatest Improvement was in the participants ability to piece together the details and sequence of the event by the time of our study 85% of them were able to tell a coherent story with a beginning a middle and an end only a few were missing significant details we noted that the five who said they had been abused as children had the most fragmented narratives their memor still arrived as images physical Sensations and intense emotions in essence our study confirmed the Dual memory system that Janet and his colleagues at the salpeter had described more than 100 years earlier traumatic memories are fundamentally different

57:47 from the stories we tell about the past they are dissociated the different Sensations that entered the brain at the time of the trauma are not properly assembled into a story a piece of autobiography perhaps the most important finding in our study was that remembering the trauma with all its Associated effects does not as Brewer and Freud claimed back in 1893 necessarily resolve it our research did not support the idea that language can substitute for Action most of our study participants could tell a coherent story and also experience the pain associated with those stories but they kept being haunted by unbearable images and physical Sensations research in contemporary exposure treatment a staple of cognitive behavioral therapy has similarly disappointing results the

58:33 majority of patients treated with that method continue to have serious PTSD symptoms 3 months after the end of treatment Point 27 as we will see finding words to describe what has happened to you can be transformative but it does not always abolish flashbacks or improve concentration stimulate vital involvement in your life or reduce hypers sensitivity to disappointments and perceived injuries listen listening to survivors nobody wants to remember trauma in that regard Society is no different from the victims themselves we all want to live in a world that is safe manageable and predictable and victims remind us that this is not always the case in order to understand trauma we have to overcome our natural reluctance to confront that reality and cultivate the courage to

59:19 listen to the testimonies of survivors in his book Holocaust testimonies the ruins of memory 199 1 Lawrence Langer writes about his work in the fortunoff video archive at Yale University listening to accounts of Holocaust experience we unearth a mosaic of evidence that constantly vanishes into bottomless layers of incompletion Point 28 we wrestle with the beginnings of a permanently unfinished Tale full of incomplete intervals faced by the spectacle of a faltering witness often reduced to a distressed Silence by the overwhelming solicitations of deep memory as one of his Witnesses says if you were not there it's difficult to describe and say how it was how men function under such stress is one thing and then how you communicate and express

1:00:06 that to somebody who never knew that such a degree of brutality exists seems like a fantasy another Survivor Charlotte delbo describes her dual existence after aitz to he self who was in the camp isn't me isn't the person who is here opposite you no it's too unbelievable and everything that happened to this other self the one from aitz doesn't touch me now me doesn't concern me so distinct our deep memory and common memory without this split I wouldn't have been able to come back to life 29 she comments that even words have a dual meaning otherwise someone in the camps who has been tormented by thirst for weeks would never again be able to say I'm thirsty let's make a cup of tea thirst after the war has once

1:00:53 more become a currently used term on the other hand if I dream of The Thirst I felt in birkenau the extermination facilities in awit I see myself as I was then Haggard bft of Reason tottering 30 Langer hauntingly concludes who can find a proper grave for such damaged mosaics of the Mind where they may Rest In Pieces life goes on but in two temporal directions at once the future unable to escape the grip of a memory Laden with grief 31 the essence of trauma is that it is overwhelming unbelievable and unbearable each patient demands that we suspend our sense of what is normal and accept that we are dealing with a dual reality the reality of a relatively

1:01:38 secure and predictable present that lives side by side with a ruinous everpresent past Nancy's story few patients have put that Duality into words as vividly as Nancy the director of nursing in a Midwestern Hospital who came to Boston several times to consult with me shortly after the birth of her third child Nancy underwent what is usually routine outpatient surgery a laparoscopic tubal liation in which the Fallopian tubes are cauterized to prevent future pregnancies however because she was given insufficient anesthesia she awakened after the operation began and remained aware nearly to the end at times falling into what she called a light sleep or dream at times experiencing the full horror of her situation she was unable to alert the your team by moving or crying out

1:02:25 because she had been given a standard muscle relaxant to prevent muscle contractions during surgery some degree of anesthesia awareness is now estimated to occur in approximately 30,000 surgical patients in the United States every year 32 and I had previously testified on behalf of several people who were traumatized by The Experience

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