Getting Past Your Past is about trauma, PTSD and an exciting (if controversial) treatment modality (Eye Movement Desensitization Reprocessing) that reportedly gets very rapid, very dramatically effective results where other trauma treatments fail.
I have mixed feelings about this book. It's such an important subject. I have a very positive personal experience with Eye Movement Desensitization Reprocessing (EMDR). But it's not (in my humble opinion) very well written. So I didn't find it to be a very pleasurable read. But what ever. It's still a very useful book. Particularly if it gets people who need it into treatment.
WARNING:
This review is going to be ridiculously long. I'm going to start from way back and take it all the way home. So consider your self informed and continue at your own risk.
The real subject of the book is psychological trauma. But what (exactly) is trauma, why do we have it, what causes it, when is it a problem and how do we treat it.
Those are all questions I will try to address (because I'm not so sure the book really addressed these issues so well). But first let's strip the issue down to the roots.
Trauma is largely an issue of emotional dysregulation. In order to understand trauma, we need to understand emotions.
What Are Emotions and What Are They For?
It's a strange question that doesn't get asked nearly enough. I teach an undergraduate affective psychology course. I ask that same question before every lecture.
I have a three word answer that I make my students repeat every single class. They roll their eyes after week 12, but you'd be surprised how many of them don't get it right, even after 16 weeks of repetition, personalization, elaboration and systematic recall.
The answer is:
Emotions are for Survival and Reproduction.
Maybe not exclusively, at least not for humans, but primarily, yes, even for humans.
Allow me to explain.
The Evolution of Emotion Research:
Not many people know this but Charles Darwin was fascinated by emotions. He applied the theory of evolution via natural selection to the study of emotions in his aptly titled 1872 work, The Expression of the Emotions in Man and Animals.
He proposed that much like other traits found in animals (including humans), emotions evolved to serve adaptive functions.
Just like (almost) every other evolved trait (excluding evolutionary spandrels like belly buttons etc.) emotions were evolutionarily conditioned and conserved based on the adaptive advantages they bestowed i.e. based on their use value in the survival and reproduction game.
According to modern evolutionary theory, different emotions evolved at different times.
Primal emotions, such as fear and anger are associated with ancient parts of the brain (e.g. the amygda and associated limbic processes) and almost certainly (like 99.9% certainly) evolved in our pre-mammal ancestors.
Feelings (and/or instincts) of fear and anger elicit safety seeking behavior e.g. the startle response, running in terror and becoming enraged and aggressive in response to a threat (to your parking spot).
Pretty much all animals are equipped with some sort of safety seeking and threat response action patterns.
That doesn't mean that all animals "consciously experience" what we refer to as emotions. We don't really know if the do or not (there's still a debate going about that). But even lizards and stuff have these types of hard wired acton patterns.
Bonding emotions, such as a mother's love for her offspring, and the drive to pair bond (i.e. keep it together boyf and grilf style) seem to have evolved among early mammals.
Lizards and reptiles don't really bond with each other and they don't bond with their offspring. Not like mammals do anyway. They don't need to. Their babies survive either way.
Mammal babies need nurturing loving care in order to survive in their early developmental period.
Particularly human babies, who, let's face it, are pretty fucking incapable of taking care of themselves for their first 47 years of development (if one were to use myself as an example).
One theory posits that mammals (particularly humans) evolved such powerful bonding emotions (out of sheer necessity), that we can even bond with animals outside of our species.
Everyone has seen the YouTubes of the duck that raised a kitten. Nonhuman interspecies bonding happens. But no where near like it does between humans and their pets.
My wife and I literally refer to our dog as "the baby". That's not normal outside of humans (and frankly, it's pretty lame even amongst humans, but that's how we do).
Social emotions, such as guilt and pride, evolved among social primates (particularly humans).
WARNING:
Don't make the mistake that a lot of people do and think that the evolutionarily older emotions and the brain structures that produce them dominate the evolutionarily newer ones.
They don't.
If you're prone to mechanical analogies.
Think about an engine. If you want to rent somebody a truck, but you don't want them to go over the speed limit, you can put a governor on the engine that limits the maximum speed.
So, The engine comes first (It's older), the governor is added on second (it's newer or more recent) but the governor dictates the maximum speed of the vehicle.
Even the bossest 450 hp 5.7 Hemi will top out at 55mph if the governor is set there.
Analogously, sometimes, a more recently evolved part of the brain moderates an older part of the brain, such as when the evolutionarily recent prefrontal cortex (associated with prosocial emotions and flexible behavior) moderates the amygdala's fear response (associated with aggressive affect and inflexible behavior).
Evolutionary psychologists consider human emotions to be best adapted to the life our ancestors led in nomadic foraging bands.
It was more important for human survival to cooperate than anything else.
So sometimes love actually does win.
Or, if you're a fiscal conservative, rational self interest is sometimes best served by nonzero sum strategies.
So, to reiterate:
Emotions are for......
SURVIVAL and REPRODUCTION
Or in other (maybe nicer) words, emotions are there to keep us SAFE and CLOSE
Emotional Conditioning:
So, we talked about how emotional traits were selected and conserved evolutionarily for their adaptive benefit to the species overall survival and reproduction.
But there's much more to the story than that.
Emotional traits can also become conditioned by an individual's culture, environment and life experiences.
In other words. Part of our emotional experience is hard wired, the rest of it is learned. That's right, learned.
Learning Theory:
Pavlovian (classical) Conditioning:
Refers to the way a neutral stimuli can become associated (paired) with hard wired responses.
For Example:
We don't come out of the baby factory being afraid of guns. We do come out of the baby factory afraid of (a) loud noises (b) people in anguish (c) hostile facial expressions and vocalizations (d) things other people are afraid of and don't forget (e) death and violence.
So when, as young people, we are exposed to the otherwise neutral stimuli of a gun, we're not afraid, but over time, being exposed to experiences and/or media images of hostile people shooting other people and seeing them die, you develop a fear response to guns, sometimes even when there not loaded or pointed at you.
Operant Conditioning:
Refers to the way our behavior is selected and conserved based on rewarding or punishing consequences.
I remember when my daughter didn't understand what money was. I would give her a dollar and she would loose it, or color on it. It just wasn't a reward for her yet.
Later in life, she learned what that stuff could do for a person and pow. Money became very associated with reward.
After that, she would do chores and stuff for small monetary rewards. She would also avoid breaking rules in order to avoid the punishment of having her allowance docked.
In this way, her behavior was shaped by these rewarding and aversive experiences. Her behavior was selected based on its consequences.
My point is, some of our emotional responses are innate, and some are shaped by our life experiences.
Nature provides the rough draft, nurture (in the form of experiences and consequences) finishes the book.
But back to the the subject of trauma. Almost all species of animal learn via classical and operant conditioning.
But not all animals get PTSD or anything like it. Pretty much only people do. Other kinds of animals experience a near death attack from a predator, and just bounce back shortly after the episode. They literally shake it off.
People can get stuck if the state of trauma. They can be haunted by intrusive memories of the event. They can be triggered to relive the traumatic experiences by seemingly unrelated stimuli.
What gives?
Relational Frame Theory (RFT):
RFT is a theory of learning that asserts that language adapted animals (humans) display a qualitatively different type of learning than other animals.
RFT argues that the building block of human language and higher cognition is 'relating', i.e. the human ability to create links between things.
Check this out:
Roses are red, violets are _________
Mary had a little_________
Go______ your self you ________mother_____er
If you grew up in the USA, I didn't need to finish these sentences. You finished them for me. It happened automatically.
People fill in the blanks.
We take take that for granted. But it turns out to be a fundamental feature of how people think and feel.
We also make cognitive and emotional connections.
When I say milk, what comes to mind?
Probably a large network of words, mental images and memories and emotions like:
MILK - chocolate - sweet
|
cow - farm - farmer - tractor
|
white - creamy - ice cream
|
cereal - coco puffs - breakfast
Each of these nodes are linked and associated.
In this network there is a not so distant connection between chocolate and tractor.
It seems kind of random, but it's not.
Chocolate and Tractor are related.
Many on the nodes are connected to other networks of association.
TRACTOR - my dads tractor - my dads farm
|
big tires - monster trucks - rednecks
|
combine - farm accident - the time I saw __
So now we have tractor associated with my dads farm, rednecks and the time I saw ______, maybe someone get injured in a farming accident.
So, in this particular network, milk and a memory of a terrible farming accident are linked.
Let's say the terrible farming accident was really disturbing. You were a child when you saw it. And you never had a chance to fully make sense out of the experience.
Maybe, even as an adult, years later, every time you sit down for breakfast, you run the risk of triggering the unprocessed memory of the accident. And now, instead of sitting down for a morning meal with your children, at least part of your attention is consumed by the haunting memory.
That could be a problem no?
As I mentioned previously. Emotions are for keeping us CLOSE and SAFE. But sometimes our conditioned responses to extremely distressing life experiences can keep us alive in one context, but become problematic and even dangerous in other contexts.
For instance:
Becoming conditioned to be "hyper-vigilant" (very fearful and alert to any sign of danger) may keep you alive in a combat situation. But staying stuck in that hyper-vigilant state may become problematic when you return home to safety.
Fight or Flight, Rest and Digest:
The Autonomic Nervous System (ANS) is a division of the peripheral nervous system (the nervous system outside your brain) that acts largely unconsciously and automatically to regulate bodily functions such as heart rate, digestion and respiratory rate.
The autonomic nervous system has two branches (1) the Sympathetic Nervous System and (2) the Para Sympathetic Nervous System. They essentially function like the gas and breaks on your car to rev you up or slow you down.
More technically, the (1) the Sympathetic Nervous System "up-regulates" your body and the (2) Para Sympathetic Nervous System "down-regulates" your body, and the two systems work together to keep you at an appropriate level of tension for the situation at hand.
The Gas Peddle:
The (1) Sympathetic Nervous System (SNS) is the primary mechanism in control of the fight-or-flight response and the freeze-and-dissociate response.
This is your bodies emergency threat response system. When there is a real or perceived threat, the body garners its resources to either attack, run away or freeze up like a dear in the headlights, or (if it's really bad) pass out i.e. play dead like a possum.
In a dangerous (or perceived to be dangerous) situation, the SNS "up-regulates" your body by:
• increasing heart rate and blood pressure
- heart pounding
• increasing respiratory rate
- shallow rapid breathing and even hyperventilating
• decreasing digestive processes
- that stomach in a knot, pants shitting feeling
-you don't need to digest lunch if you're about to be somethings lunch
• withdrawing blood from extremities
- cold hands and feet
• reduce immune function
- stress can make you sick
All of these effects should be commonly recognizable to anyone who has ever been in danger or felt anxiety.
In extreme cases like life threatening emergencies or panic attacks, the Fight, Flight or Freeze effects can get so rad i.e. the body can becomes so up-regulated, that people can experience:
• tunnel vision
• loss of hearing
• inability to verbally communicate
• slow motion time perception
• paralysis
• involuntary defecation and urination
The Break Peddle:
The (2) Parasympathetic Nervous System (PNS) is the primary mechanism in control of the rest and digest response and the tend and befriend response.
This is like your bodies rest and repair mode. When there is no real or perceived threat, the body garners its resources to repair muscle tissue, fight off disease, digest food and tend to relationships.
In a safe situation the PNS "down-regulates" your body by:
• decreasing heart rate and blood pressure
• decreasing respiratory rate
• increasing digestive processes
• increasing circulation in extremities
• increase immune function
Again, these two branches of the Autonomic Nervous System work together to maintain appropriate levels of action readiness (tension) for the situation at hand. Much like the gas and breaks on your car work together to keep you at the right speed for the road conditions (ideally).
All of these SNS and PNS reflexes helped keep your ancestors alive in their natural environment, what modern evolutionary theorist referred to as the Environment of Evolutionary Adaptation (EEA)
But problems occur when (a) contemporary stressors (email, traffic, taxes) chronically activate the stress response, or (b) highly traumatic experiences condition our threat response to be overly active.
Psychological Trauma:
Refers to a particularly high intensity threat response to a real or perceived danger, that floods the nervous system with so much energy, that the person experiences residual effects e.g. flashbacks, intrusive disturbing memories or thoughts, emotional dysregulation etc. even after the stressor has diminished.
Vulnerability to psychological trauma is influenced by a wide variety of biological, psychological and social factors.
Trauma is most frequently caused by experiences that involve being, or seeing someone else being intentionally harmed by another person.
Examples include: harassment, sexual abuse, being the victim of child abuse or witnessing domestic violence as a child and of course, prolonged exposure to active combat situations.
Long-term exposure to situations such as extreme poverty or milder forms of abuse, such as verbal abuse may also lead to psychological trauma.
Post Traumatic Stress Disorder (PTSD):
The Diagnostic and Statistical Manual 5 (DSM 5) Cite a list of diagnostic criteria for PTSD. It's way too huge to list here. Google it if your curious or if you suspect you or a loved one may have PTSD.
EMDR is a trauma and PTSD treatment developed by Francine Shapiro.
EMDR focuses on processing unresolved traumatic experiences.
If your traumatic past is emerging into the present due to triggering circumstances and you are "re-living" or "re-experiencing" the event in the sense that your body is having a threat or stress response that is disproportionate to the actual situation at hand, than EMDR considers that memory "unprocessed".
If the unprocessed traumatic memory is causing impairment at home, work, school, in relationship or in some other domain such as substance dependence, than it is clinically significant than you may wish to consider getting treatment.
If, after treatment, the same memory does not significantly dysregulate your emotions and no longer represents a source of impairment in your life, than EMDR considers that memory processed.
According to Shapiro, "when a traumatic or distressing experience occurs, it may overwhelm normal coping mechanisms. The memory and associated stimuli are inadequately processed and stored in an isolated memory network".
The goal of EMDR therapy is to process these distressing memories, reducing their long lasting effects and allowing the person to develop more adaptive coping mechanisms.
The process of EMDR essentially involves having the client recall traumatic memories and then subjecting the client to "bilateral stimulation" which can be accomplished in a number of ways, but is essentially any brief stimuli that alternates between left and right. e.g. alternating clicking noises in a stereo audio, or tracking a target with eye movements left and right.
The the client reports the next image or memory or association that come to mind (see RFT above). If there is an unprocessed traumatic memory in the network of associations, EMDR attempts to bring it up, and utilize the biomechanics of dreaming (REM sleep) to encode the memory into longterm memory, so that it is "just a memory" rather that a repeatedly relived experience".
I know it sounds kinda crack head. But if administered by a trained clinician, it can produce some pretty dramatic results.
It's very common for people to report dramatic reductions in PTSD symptoms after one or two sessions.
My personal experience with EMDR was very positive. But that's different than proof. It's just an anecdote.
As I mentioned, EMDR is controversial, but the good news is EMDR has been found to be effective in numerous randomized placebo controlled trials (RCT).
Anyway. Get the book I guess. It's pretty good. But get the treatment if you need it. That's the really good really important thing.
Don't suffer needlessly.
3.75 stars for the book.
5 stars for EMDR