Monday, January 12, 2009

Tetris + Ecstasy = no PTSD

illustration: The Economist

In Medical News Today, I read an article that triggered a lot of thinking. It's about how playing Tetris reduces PTSD flashbacks:

Playing 'Tetris' after traumatic events could reduce the flashbacks experienced in post-traumatic stress disorder (PTSD), preliminary research by Oxford University psychologists suggests.

If this early-stage work continues to show promise, it could inform new clinical interventions for use immediately after trauma to prevent or lessen the flashbacks that are the hallmark symptom of PTSD. Existing treatments can only be provided once PTSD has become established.

The researchers report in the online, peer-reviewed journal PLoS ONE that for healthy volunteers, playing 'Tetris' soon after viewing traumatic material in the laboratory can reduce the number of flashbacks to those scenes in the following week. They believe that the computer game may disrupt the memories that are retained of the sights and sounds witnessed at the time, and which are later re-experienced through involuntary, distressing flashbacks of that moment.

This is a brilliant idea: no drugs, no re-traumatising talk therapy by well-meaning fools, just moving coloured blocks around. How does it work? Well, you should read the article, but I know most of you won't. So. The Tetris approach relies on three elements:

First, the mind is considered to have two separate channels of thought: one is sensory and deals with our direct perceptual experience of the world, the other is conceptual and draws meaning and narrative from our experiences to give them context. For example, we would use one channel to see and hear someone talk and the other to comprehend the meaning of what they were saying.

Second, there appear to be limits to our abilities in each stream: it is difficult to hold a conversation while doing maths problems, for example.

And third, there is a short time after an event in which it is possible to interfere with the way our memories are retained in the brain.

The Oxford team reasoned that recognising the shapes and moving the coloured building blocks around in 'Tetris' soon after seeing traumatic events should compete with the visions of trauma to be retained in the sensory part of the brain. The narrative and meaning of the events should be unaffected.

The big snag is, it only works if you play the game immediately after the trauma (within six hours) before the memory can be laid down in all it's multi-mode glory/gory. However, a recent Economist article shows that after that time, drugs can be very useful:

Gail Westerfield, a writer who lives in South Carolina, was sexually abused by a neighbour when she was a child, and later raped by an acquaintance when a university student. She suffered a range of symptoms including memory problems, bouts of depression, crying fits and tremors.
vShe was diagnosed with PTSD a decade ago when she was in her 30s. But she found this knowledge cold comfort. “I was probably on half a dozen different kinds of antidepressants over the years”, she says, “and they never worked for me. I’ve had this my whole life, pretty much.”

So the results of a clinical trial recently announced by Michael Mithoefer, a psychiatrist in Charleston, South Carolina, are encouraging. Twenty patients with PTSD who had resisted standard treatments—including both Ms Westerfield and the security contractor—were given an experimental drug in combination with psychotherapy. After just two sessions all of them reported dramatic improvement. The compound, methylenedioxymethamphetamine, or MDMA, is not new. Known as Ecstasy, it is illegal nearly everywhere.

This made me think about the time, in the early 80s, that I got beaten to shit in a gay club in the early '80s, and how magic mushrooms kept me sane. I wrote about it in And Now We Are Going to Have a Party. Here's the relevant excerpt. It begins with a diary entry. (Warning: the spelling is crap and it's writerly and self-conscious; talking about 'weakness'--even to myself--was embarrassing at that age, plus I had just started writing fiction and, urgh, poetry, and was practising my nascent craft.)

Monday 16th June 1986

Long time no entry & all that...Much has happened, too much really:
1. I had a nervous breakdown [...]

2. I joined the proto-LL [Lesbian Line] & helped it burst into flower on Sept. 30th (my birthday, too) 1985. We're still going but internal strife between various collective members has cost me much in terms of upset, trust and raw hurting

3. I now teach women's S-D at ₤8.52 per hour, courtesy of Adult Ed.

4. Me and Katherine (and, later, Mindy & Rachael) organised a Northern Writing Dykes w/end which went v. well

5. have written four short stories all of which I like (tho' some more than others) & have almost finished the first draft of another novel

So...after that quick resume, how do I feel? Hard to say, really.

I think--no, I believe, a different word altogether--I believe the tumbling train of events stem from New Year. That's how I alway say it now: NEW YEAR. Not 'that New Year' or 'the New Year before last' or 'that time eighteen months ago when I had my face re-arranged b[y] a bunch of fucking maniacs.' No. Now, it's simply: New Year.

The physical hurts may have healed quickly but the emotional scars have taken much, much longer--they're only just beginning to get better now. Now that I am acknowledging the real impact it has made on me.

Getting beaten up tore my world apart. It would have been enormously damaging at any time but, coming as it did less than ten days after hearing both publishers had rejected a ms. I had worked on for over a year, it was disastrous. It reached right down to an emotional core I never even knew existed and wrenched it awry. I remember feeling it go. Lying on that trolley bed in Accident & Emergency watching the blood dribble out of my nose. I'll never forget it--I'm not sure if I want to forget it. It taught me something. I don't know exactly what, but something.

I remember lying there and wanting to weep or scream or something and simply not being able to. Some part of my automatic system had taken over, even after the shock reaction, and I was polite and reasonable.

I desparately [sic] wanted--no, needed--Carol and I knew she was somewhere, somewhere, but that I just couldn't manage to go find her on my own. I asked two nurses (oh! so nicely I asked them!) & they said: wait. Wait. It's an ugly word.

Then they came & wheeled me backwards to somewhere. Why do they always push you backwards? It's terrifying, especially if you have a head injury: all the time you think 'God, I might crash into something, I wish I could see where I was going.' And the bumps as the trolley went over...what? Maybe there weren't really any bumps but my head felt them, and my arms, and my stomach, and my blood.

I remember being very scared then but with that fear that beyond panic, that strange stillness that seizes every muscle and gloats while your soul writhes. They took all my clothes off--put me in a white tiled room and dressed me a white gown and cap.

Alien. I felt so alien--to myself, the world, my body.

I don't really remember much after that clearly--I suppose the concussion was beginning to take its toll.

I remember Carol pretending to be calm and my relief at seeing that she was still Carol: still there, steady, rocklike, when so much had inexplicably changed.

I remember Linda's face--concerned with practicalities because she couldn't turn to look at the greater, more hideous realities. Then being home.

Five o'clock in the morning. And the panic beginning to catch up with the fear. And people coming to visit me saying 'terrible, terrible' and going away with that look on their faces that says: 'thank god it wasn't me. What did she do for that to happen to her?'

Already, women were thinking: in some way, this was her fault.

The inability to really move my head and face was the worst: pain, fear of pain, fearing of damaging the broken bones even more.

Tension built up because I couldn't MOVE, and constant surges of fear boosted adrenalin I couldn't get rid of. On top of that was the rage. Rage such as I have never--no, not never, twice before I've felt it. Rage that couldn't be released but was real and huge: frozen like the photo of a mad and rabid dog, mouth agape, fangs bared and indiscriminate.

Worse than all that, worse than knowing that every morning when I woke up, a slightly different face would look at m[e] from a mirror, worse than the rage and the pain and the frustration, worse than those things was the fear and the sickness in my stomach at feeling betrayed.

I felt betrayed by everyone. Every single last goddamn woman on earth, except Carol. Sometimes it's impossible for me to say how much I love that woman. She will give and she will take and all at the right times.

The meeting we held here several days later--four days I think--was packed with indignant women--'something should be done' but none of them cared. Except perhaps Linda. All of them thought--& some of them said, right out loud before me, with no shame--that it might 'not have happened to someone...well...less aggressive.' A politer way of putting it than 'you asked for it' but it's not any easier to hear.

And yet...I buried it all. Oh, I said I was angry and scared, I said I felt betrayed but I never really tried to convince anyone of it. I even tried to pretend to myself that I wasn't. And so the bruises and breaks and cuts healed and gradually my fear lessened enough for me to force myself to go out alone, sometimes. But the emotions were never dealt with, the vulnerability I felt was never truly acknowledged to exist. After all, wasn't I a strong and powerful woman whose look could quell an invading army, whose assertive and authoritative voice could silence a football crowd? Of course I was, so I was left--& I left myself--to it.

It all began to creep to the surface at the end of June. Suddenly, I could no longer continue with karate, despite getting a blue belt: my courage simply began to evaporate, I was scared every time I donned my gi, made the ritual bow. Then Carol went away for a few days, taking with her the borrowed foundations of my hastily re-erected confidence. I began to crumble, saying and doing irrational things because I didn't know what else to do. I hurt Linda, who retaliated with ten times the--calculated--ferocity. And still Carol hadn't come home. I had to beg her in the end: she cut her holiday short and came home three days early. I convinced myself that, really, there was nothing the matter except that, perhaps, I was just a teeny weeny bit too emotionally dependent upon Carol.

I struggled on for about three weeks, pretending the panic attacks I kept having were allergic reactions. I even went to the doctor who said I was working too hard and here's some valium to take when things get too bad. Needless to say, I thought he was an idiot and, apart from carrying them with me everywhere, I never touched them.

Then I went, with Mindy & Katherine, down to Leicester for the national women's writing conference. After half an hour on the coach, I knew it was a mistake. Away from Carol, I was crumbling again.

But again, I refused to really see what was happening. The nausea was travel sickness, wasn't it? With maybe just a touch of claustrophobia?

For the first evening and the next day I shook and trembled, felt sick, couldn't think or cope, could barely eat, didn't sleep...and pretended all was well.

By this time I had the disquieting feeling that something really was wrong--but I didn't know how to say so, or how to ask for help or even simple comfort. I was still the amazing, powerful, strong woman.

Sunday came with an even stronger rush of nausea than before. I couldn't even stomach tea. At the venue, I finally fell to pieces.

I rushed from the building, refusing to go back inside, and I sat on the grass--the sun was shining--and cried. I sat outside all day, eating valium like smarties until it was time to go home.

Then I really fell to pieces. As soon as I saw Carol, it all came gushing out: fear, fear, fear. I couldn't cope with anything. For weeks I refused to set foot outside the house, at least not on my own. Carol had to come with me to sign on, I couldn't shop. Anyone who wanted to go out for a drink with me had to come and collect me from the flat. And then, the pubs were hell.

The worst part was the crying: all the time and always unpredictably. I'd wake up in the morning, feel okay, start doing something fairly enjoyable then...for no reason that I could discern, I'd just dissolve into great wracking sobs.

Gradually, I began to think again, to cope. Now & then, I get agoraphobic again for a day or two and travelling anywhere (even on a bus or to Beverley) on my own is virtually impossible. But not totally impossible. I'm improving but it's so slow. So very, very slow.

Everything is still a bit raw around the edges--I can take far less pressure than I used to and, unfortunately, there's a lot more pressure that must be taken. But, at last, I am learning how to say: 'stop' and 'help' and 'I don't think so, no.' It's like learning a new alphabet--strange and rewarding.

One thing I don't say here is that for a few months in 1985, every day before I left the flat I would swallow a handful of magic mushrooms. The most I ever took at one time was thirty or so. It might sound counterintuitive, but I remain convinced that those mushrooms kept me sane and out of the kind of depression that led to all of my sisters (except Anne) making very serious suicide attempts.

When the mushrooms ran out, though, that was that. No more illegal drugs. I was watching Helena dance with death every day, and Carolyn flirting with it through alcohol (and razors, and prescription drugs) and I knew it was time to stop...

Unlike half my family (dead, now), I wasn't the least bit interested in making myself a victim. Nor did I want to arrest my emotional development. So I took the drugs for a while, then I stopped. Stopped everything cold turkey--amphetamine sulphate, hash, mushrooms, even smoking--except alcohol, because that was the one drug I felt I could control. I still feel that way. I love drinking, love my beer and wine (though I loathe being drunk).

So, oof, that's what happens when you read an interesting article in The Economist and stop to think about it: trips (no pun intended) down memory lane.

I'm pleased that my self-medication and self-soothing strategies worked. Mostly. I still see the broken nose every morning in the mirror but I no longer notice; it's just my nose. And these days I'm much, much better at asking for help. These days I understand that being strong doesn't mean being unbreakable, it means putting yourself back together. It means understanding that Leonard Cohen line (from 'Anthem') that it's the cracks that let the light in.

Oh, and ANWAGTHAP has just gone on sale for the bare bones price of $50. (We're finally profitable, yay! So now it doesn't have to cost so much.)


Coming later today: final voting results for Ozymandias, our publishing co-op.

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