Tonight I am planning to watch another episode of the TV drama ‘Broken’ starring Sean Bean as the central character. He plays Fr Michael who was sexually abused as a child by a priest and had a destructive late adolescence/early adulthood. Fr Michael has uncued flashbacks of the abuse, at times like consecrating the Eucharist. In the last episode he angrily confronted his abuser. But since becoming a priest Fr Michael has nobly served the severely disadvantaged. It was filmed at St Vincent’s, Church, Liverpool directly opposite where I work. Should I nip across and offer EMDR /CBT?
This fictional example echoes a real life conundrum for clinicians – a colleague of mine recently brought to my attention the case of a lady who had intrusive flashbacks of the aftermath of ECT and wondered whether she needed EMDR. By coincidence I had assessed the lady and knew that she was suffering neither from depression or PTSD and had functioned well for many years. She came to my colleagues attention because of some inherently stressful life events. My response was in the words of Allen Frances’ seminal work ‘Saving Normal’ published in 2013 by William Morrow we must not pathologise every uncomfortable memory, the acid test is whether it is directly causing significant functional impairment now.
In a similar vein I remember seeing a lady some time ago who had undergone prolonged sexual abuse as a child, she had been referred to a number of therapists over the years and they had all wanted to focus on the abuse. She protested that the abuse did not get in the way she was simply anxious about everything. When I saw her I found she was just suffering from generalised anxiety disorder, nothing more nothing less. I treated her with a standard protocol for GAD and she recovered.
I think the answer to all of this is “If it is not ‘Broken’ don’t fix it”, I’m off to watch the TV.
Dr Mike Scott