Last night the BBC broadcast the experiences of its’ intrepid reporter, Fergal Keane, in battling with PTSD and alcohol. He has performed an invaluable service in normalising responses to extreme trauma. In the program he described being sometimes wiped out for days after a session of EMDR. Fergal showed great fortitude in continuing with such treatment. But it raises the question the question of how many others would persist? Particularly if they were not attending an exalted Private Hospital.
Unfortunately the treatment that he had had is predicated on the assumption that he needs to confront all the horrors that he experienced in different lands. Fergal returns to Rwanda and relives the smells and sights of extreme traumas. He feels guilty that he left Rwanda in the first place. Fergal is annoyed with himself that he left a hotspot in Ukraine at the beginning of the current conflict. In the program he is reunited with an adult from Rwanda who as an older child escaped under a blanket hidden by younger children. He is amazed that she has not suffered his debility. De facto she has not seen her traumatic memory as relevant to her day-to-day functioning in the UK, but works in mental health. The key point I make in ‘Personalising Trauma Treatment: Reframing and Reimagining’ Routledge 2022 is that traumas only need to be confronted in the sense of addressing their relevance for today. Thus this lady might well write to Priti Patel about the obscenity of routing refugees to Rwanda, whilst not letting the traumatic memory be her central window through which she views the world.
In the programme the EMDR therapist is seen trying to replace Fergal’s thought ‘I am going to die’ whilst under a mortar attack in Lebanon, with the installation of a positive thought ‘I survived’. But this replacement is unnecessary, more parsimoniously it could have been pointed out that he made a negative prediction and was wrong and may have developed a penchant for making negative predictions that turn out to be wrong. He would be advised to have second thoughts when he makes negative predictions or damns himself. Fergal appears to believe that he has to be successful in his endeavours encountering horrors rather than just do what he can. He berates himself for returning to war zones but I think he’s simply trying to ensure that horrors don’t have the last word – a noble task if ever there was one!
The programme featured groups for survivors and whilst they are useful, groups to resolve PTSD appear not to be effective. Interestingly one group member highlighted the problem with a sequential approach to PTSD treatment, an insistence that drink problems is sorted 1st before PTSD. People want treatment for all their conditions now.
Dr Mike Scott