Trauma can be treated, but not erased

I am often wary of attempts to use
mice as a way of predicting human
responses (whether biological or
psychological), but this time I was
drawn in. "The Real Eternal Sunshine
of the Spotless Mind," squealed the
headline. "Gene discovery paves the
way for a pill to erase your most
painful memories." This ostensibly
silly story actually contained
important research: scientists at MIT
have identified (in mice) the gene
responsible for memory extinction,
which could eventually lead to
important developments in the
treatment of post-traumatic stress
disorder – a condition that, according
to the NHS, affects 5% of men and
10% of women over the course of
their lives.
I am one of those women. In
September 2010 I was subjected to a
random attack, during which I was
cornered by three men, one of whom
strangled me. I was lucky to get away
alive, but I was left profoundly
affected by what happened. But it
isn't just me – traumatised people
walk among us, unseen. There's a
feeling that friends, family, members
of the public, or even the system at
large can never truly understand.
Whether you're a veteran, a victim of
abuse, or a refugee, the condition
itself is profoundly isolating.
While science is not quite at the stage
where it can erase memories of our
ex-partners, the story did make me
wonder how I would respond if faced
with a pill or a procedure that could
make the memory of the bad thing
that happened go away for ever.
Would I do it?
As recent speculation as to whether
Aaron Alexis, the Washington navy
yard gunman, was suffering from
PTSD illustrates, the effects of trauma
are little understood. Studies have
shown how difficult it is to link the
disorder and extreme violence
without resorting to the anecdotal, as
many studies rely on war veterans
responding to questionnaires. There
is little doubt that PTSD increases
feelings of anger and aggression
(veterans with the disorder are two to
three times more likely to be violent
towards wives or girlfriends), but the
jump to murder is a big one to make
without further research.
As far as my own condition, yes,
there were times when I felt like
killing people, but there were many,
many more times where I felt like
people were trying to kill me. One
person had tried, but in my confused
and traumatised brain, there were
more where he came from. Like
many trauma victims, I was
constantly on high alert but,
naturally, other people just thought I
was mad.
Fury, paranoia, hypervigilance,
overreaction to a perceived threat –
all are common in a traumatised
person. The psychologist who helped
me to get better characterised the
condition thus: imagine your
memories are a conveyor belt of
cardboard boxes heading towards a
final point, where they are processed.
But if something life-threatening
disrupts that process, the box
memories get stuck, trapped in the
amygdala, that bit of the brain that
triggers your fight or flight survival
impulse. The amygdala knows no
sense of past or present, and so, when
faced with a perceived threat, it
responds how it sees fit, unbeholden
to logic, in the form of blind panic.
This is, of course, a very basic way of
explaining an extremely complicated
condition, but it certainly helped me.
When faced with irrational outbursts
of anger, flashbacks, paranoia,
sleeplessness, knowing this was a
source of comfort. For months I was
terrified that the tube was crawling
with terrorists intent on blowing me
up. "What's the worst that can
happen?" my therapist would ask,
appealing to my rational self.
"What's the worst?"
I was treated using trauma-focused
cognitive behavioural therapy,
provided by the NHS. I was fortunate
that there wasn't too long a waiting
list; others aren't so lucky. A survey
by the We Need To Talk coalition
found that one in five of those with
mental health problems were waiting
more than a year for referral, but
studies have shown that those with
PTSD should be given therapy within
three months.
Part of the treatment involves
reliving – an emotional and arduous
process where every moment of the
event is recounted and expanded
upon. I was surprised by the things I
remembered, how the patchwork quilt
of that evening became increasingly
more detailed. It made me wonder
about those legal cases involving
victims, fleeing conflict zones and
seeking asylum, that hang on the
consistency of their evidence. What
if, instead of sanctuary, a guilty
verdict, and someone saying "I
believe you", I had been told that my
fractured, confused story didn't add
up? If you'd been through an
experience like that, wouldn't you
take the magic pill?
I don't know how many people there
are in this country walking the streets
addled by trauma, but I know that
they need to be better looked after.
And I wonder if the research will
ever come to anything. Just how
much horror, after all, can a mouse