Story help: Calling all therapists
October 30, 2018 12:49 PM Subscribe
I need help getting past a bump in my story and I don‘t know enough about the traumatised brain.
As I am still at the world building stage and also there is a small amount of magic involved I have some leeway to accommodate the plot. But I would like this part not to sound like a bad tv plot to a therapist. Please also. feel free to question the basic premise for those reasons.
The Good Guys need to recover some information that only the patient knows. They’re kind of in a hurry, they don’t have several months or years. But this information is part of a huge block of memory that he can‘t access. Basically, he can‘t remember a significant part of his life because of a traumatic series of incidents at the time.
The patient wants to recover this memory because he feels like a big part of himself is missing and the memory gap leaves him unmoored (and for other, plot related reasons). But he doesn‘t know what it is or why it’s gone. Because every time anyone gets close to talking about the Stuff That Happened, he gets a panic attack, blacks out and has other symptoms that take him out of the picture for a day or two. It‘s obvious a larger part of him definitely doesn‘t want to revisit this time.
Assuming no access to drugs, is there anything a therapist could do to speed this along?
I feel like I’ve written myself into a corner. Again, I have some leeway, but it should make sense from a „this is how human brains function“ point of view.
As I am still at the world building stage and also there is a small amount of magic involved I have some leeway to accommodate the plot. But I would like this part not to sound like a bad tv plot to a therapist. Please also. feel free to question the basic premise for those reasons.
The Good Guys need to recover some information that only the patient knows. They’re kind of in a hurry, they don’t have several months or years. But this information is part of a huge block of memory that he can‘t access. Basically, he can‘t remember a significant part of his life because of a traumatic series of incidents at the time.
The patient wants to recover this memory because he feels like a big part of himself is missing and the memory gap leaves him unmoored (and for other, plot related reasons). But he doesn‘t know what it is or why it’s gone. Because every time anyone gets close to talking about the Stuff That Happened, he gets a panic attack, blacks out and has other symptoms that take him out of the picture for a day or two. It‘s obvious a larger part of him definitely doesn‘t want to revisit this time.
Assuming no access to drugs, is there anything a therapist could do to speed this along?
I feel like I’ve written myself into a corner. Again, I have some leeway, but it should make sense from a „this is how human brains function“ point of view.
Perhaps they have Dissociative Disorder in which case it is possible that another part holding the trauma may surface in session, unbenownst to the primary character.
Google Theory of Structural Dissociation if you like this angle.
posted by crunchy potato at 1:11 PM on October 30, 2018
Google Theory of Structural Dissociation if you like this angle.
posted by crunchy potato at 1:11 PM on October 30, 2018
My impression is that there is a lot of controversy over whether any specific technique can bring back repressed memories — and, among those who think it's possible, even more controversy over what the right technique is.
One thing I've gotten the impression is relatively uncontroversial is that sometimes, when a person gets into a safe situation, develops some coping skills, and starts to improve their mental health, memories start coming back "on their own." The metaphor I've heard used is that you can repress memories because remembering them feels unsafe — and then, if the rest of your situation changes, remembering them can start to feel safer again. Apparently this can really freak people out, because they expect recovery to mean "I'm in less distress now," and then it turns out that making progress in recovery brings all these distressing memories back.
I'm not a therapist, just a patient with a history of trauma and an annoying habit of asking therapists "What's the evidence for this?"
posted by nebulawindphone at 1:12 PM on October 30, 2018 [5 favorites]
One thing I've gotten the impression is relatively uncontroversial is that sometimes, when a person gets into a safe situation, develops some coping skills, and starts to improve their mental health, memories start coming back "on their own." The metaphor I've heard used is that you can repress memories because remembering them feels unsafe — and then, if the rest of your situation changes, remembering them can start to feel safer again. Apparently this can really freak people out, because they expect recovery to mean "I'm in less distress now," and then it turns out that making progress in recovery brings all these distressing memories back.
I'm not a therapist, just a patient with a history of trauma and an annoying habit of asking therapists "What's the evidence for this?"
posted by nebulawindphone at 1:12 PM on October 30, 2018 [5 favorites]
I would also suggest hypnotherapy and art therapy as methods that show some promise in breaking down those kinds of barriers.
Also, as nebulawindphone suggests, safety increases recall. So, for example, if it was a parent that perpetrated abuse maybe they suddenly die.
posted by crunchy potato at 1:23 PM on October 30, 2018
Also, as nebulawindphone suggests, safety increases recall. So, for example, if it was a parent that perpetrated abuse maybe they suddenly die.
posted by crunchy potato at 1:23 PM on October 30, 2018
Also, as nebulawindphone suggests, safety increases recall. So, for example, if it was a parent that perpetrated abuse maybe they suddenly die.
Yikes, no, the death of an abuser brings up all sorts of new trauma.
As a therapist who trained in and worked in trauma, generally with adults who experienced trauma as children, the big thing that tended to work to create the type of safety nebulawindphone talks about was a longstanding relationship with a trustworthy person. Basically, the relationship between the therapist and the client is, in and of itself, the major intervention. I've also seen healthy romantic relationships serve this function, especially if the trauma was due to sexual abuse or assault.
If the Good Guys are previously unknown to the patient, and they're unable to invest the time in an unhurried way to create a strong, trusting relationship with the patient, I don't see them able to accomplish this on their own in a way that wouldn't make therapist-me roll my eyes.
What you're basically talking about is extreme anxiety (black outs, panic attacks, inability to remember, etc.). What helps treat extreme anxiety is learning coping skills to calm the anxiety, and while they're not generally very complicated -- it mostly comes down to breathing exercises, really -- they take a lot of time for the client to learn to trust that they'll work.
Can the Good Guys (magically or not) locate someone trustworthy in the patient's life from the time of the missing memories? I was taught that abused/traumatized children who have a trusted adult in their lives who can be steady and responsive to the child can help mitigate some of the otherwise-expected lasting effects of trauma (e.g., a child who has a caring and empathetic teacher may not suffer as many long-term trust issues due to their abusive parent; I'm explaining badly but I hope you get the point). Maybe you can short-circuit the time required to build a trusting relationship with the Good Guys by bringing in a loving figure from the past who could create that sense of safety as well as be a bit of a memory-trigger?
posted by lazuli at 1:36 PM on October 30, 2018 [3 favorites]
Yikes, no, the death of an abuser brings up all sorts of new trauma.
As a therapist who trained in and worked in trauma, generally with adults who experienced trauma as children, the big thing that tended to work to create the type of safety nebulawindphone talks about was a longstanding relationship with a trustworthy person. Basically, the relationship between the therapist and the client is, in and of itself, the major intervention. I've also seen healthy romantic relationships serve this function, especially if the trauma was due to sexual abuse or assault.
If the Good Guys are previously unknown to the patient, and they're unable to invest the time in an unhurried way to create a strong, trusting relationship with the patient, I don't see them able to accomplish this on their own in a way that wouldn't make therapist-me roll my eyes.
What you're basically talking about is extreme anxiety (black outs, panic attacks, inability to remember, etc.). What helps treat extreme anxiety is learning coping skills to calm the anxiety, and while they're not generally very complicated -- it mostly comes down to breathing exercises, really -- they take a lot of time for the client to learn to trust that they'll work.
Can the Good Guys (magically or not) locate someone trustworthy in the patient's life from the time of the missing memories? I was taught that abused/traumatized children who have a trusted adult in their lives who can be steady and responsive to the child can help mitigate some of the otherwise-expected lasting effects of trauma (e.g., a child who has a caring and empathetic teacher may not suffer as many long-term trust issues due to their abusive parent; I'm explaining badly but I hope you get the point). Maybe you can short-circuit the time required to build a trusting relationship with the Good Guys by bringing in a loving figure from the past who could create that sense of safety as well as be a bit of a memory-trigger?
posted by lazuli at 1:36 PM on October 30, 2018 [3 favorites]
I should clarify the question was about unlocking memories behind a wall of dissociative anxiety. These tend to get triggered (become conscious) when the original threat is perceived as neutralized, just as they do when there are trauma reminders or situational avoidance. That doesn't mean the person feels safe, but that it is safe to process the content behind the wall, because the threat is gone, the impulse to maintain amnesia subsides.
It is incredibly common for people who grow up with abuse to have a deluge of traumatic memories surface when the abuser dies.
posted by crunchy potato at 1:45 PM on October 30, 2018
It is incredibly common for people who grow up with abuse to have a deluge of traumatic memories surface when the abuser dies.
posted by crunchy potato at 1:45 PM on October 30, 2018
EMDR can work miracles on a person's ability to interact with traumatic memories in a short number of sessions. "Repressed memories" are a whole 'nother can of worms, though.
posted by opossumnus at 2:15 PM on October 30, 2018 [1 favorite]
posted by opossumnus at 2:15 PM on October 30, 2018 [1 favorite]
I'm a trauma researcher. Repressed memories are generally not considered to be a thing. But inability to remember some important part of what happened is a symptom of PTSD. This is considered to be a memory that was successfully encoded (i.e., the patient wasn't dissociating at the time of the trauma) but cannot be retrieved. Because most people with PTSD avoid memories of the trauma and push away intrusive thoughts, it becomes more difficult to retrieve these memories. So once patients engage with the trauma memory, some of these memories sometimes come back. There is no evidence that eye movements or tapping (as in EMDR) has a direct effect on trauma memories. Actively engaging with the trauma memory by repeating the story over and over, either aloud or in written form, with attention to detail, often results in patients recalling parts they forgot.
posted by quiet coyote at 2:44 PM on October 30, 2018 [9 favorites]
posted by quiet coyote at 2:44 PM on October 30, 2018 [9 favorites]
If I might chime in from a patient point of view... I am not a therapist, but I had Something Traumatic (tm) happen last spring, and I have a diagnosis of Adjustment Disorder (the only reason it's not PTSD is because, apparently, one must be having trouble functioning, to the point of being non-functional, for a PTSD diagnosis. I boggled at my therapist and was like, okay, so am I supposed to wait until this gets WORSE to get some help? And she chuckled and kind of agreed, but she has to go by the book with the DSM because she's in training, so adjustment disorder is what's in the records, but I check most of the boxes on PTSD).
Anyhow, I'm missing large portions of that night/that morning. I am literally missing time, as I told a friend after the fact; the only reason I have a fair idea of what went down is because of my habit of texting people I'm in the same room with. I do not remember sending those text messages, and I don't expect to ever do so, and I'm totally okay with that. Parts have come back, however, because I've started to feel safe enough, either in therapy or with my friends, to talk about it - in other words, just as Quiet Coyote says. However, it's not linear - it's a stupid comment here or there, a brief whiff of what the people around that night looked like, stuff like that. I doubt that I'm ever going to be linearly recount exactly what went down that evening/morning, and I'm okay with that. I have the gist of it, and I no longer melt down talking about it even though though I run across reminders of it all the time. But it took 6 months to get here AND getting sober, and I had something fairly low-key happen in the greater scheme of trauma.
I guess this is my long winded way of saying, from my N=1 point of view, that you may have written yourself into a corner if you want to resolve this in a realistic fashion (and I hate to say that, but). You may have to decide how much you're willing to hand wave the realities (and I don't want to say that, because I appreciate that you're trying to get this right).
posted by joycehealy at 3:47 PM on October 30, 2018 [2 favorites]
Anyhow, I'm missing large portions of that night/that morning. I am literally missing time, as I told a friend after the fact; the only reason I have a fair idea of what went down is because of my habit of texting people I'm in the same room with. I do not remember sending those text messages, and I don't expect to ever do so, and I'm totally okay with that. Parts have come back, however, because I've started to feel safe enough, either in therapy or with my friends, to talk about it - in other words, just as Quiet Coyote says. However, it's not linear - it's a stupid comment here or there, a brief whiff of what the people around that night looked like, stuff like that. I doubt that I'm ever going to be linearly recount exactly what went down that evening/morning, and I'm okay with that. I have the gist of it, and I no longer melt down talking about it even though though I run across reminders of it all the time. But it took 6 months to get here AND getting sober, and I had something fairly low-key happen in the greater scheme of trauma.
I guess this is my long winded way of saying, from my N=1 point of view, that you may have written yourself into a corner if you want to resolve this in a realistic fashion (and I hate to say that, but). You may have to decide how much you're willing to hand wave the realities (and I don't want to say that, because I appreciate that you're trying to get this right).
posted by joycehealy at 3:47 PM on October 30, 2018 [2 favorites]
Response by poster: Just chiming in to say I appreciate the feedback from many angles and it‘s fine if the feedback is „you may need to change the plot“.
Thank you.
posted by Omnomnom at 4:25 PM on October 30, 2018 [1 favorite]
Thank you.
posted by Omnomnom at 4:25 PM on October 30, 2018 [1 favorite]
Put your character in a situation similar to one they cannot remember, to trigger recovering fragments (at first) of the big block.
(This happened to me, wholly inadvertently; I'm now in EMDR therapy to retrieve and move past the remainder.)
I'm not sure what a legitimate therapist in your story could do to deliberately simulate the original trauma. Meeting the patient-character at a pool, and throwing them a faulty life preserver, because one of the original incidents involved a near-drowning, sounds... unethical, to put it mildly.
Therapeutic, tandem skydiving, and the adrenaline rush is so reminiscent of _____ that it makes memories surface? Therapist and patient, each running late to the appointment, have a fender bender? Perhaps the therapist doesn't deliberately do anything; the character has the triggering experience on their own, unexpectedly, and then talks with the therapist. (The therapist is then positioned to elicit more detail, because the patient is able to start the conversation.)
posted by Iris Gambol at 6:40 PM on October 30, 2018 [3 favorites]
(This happened to me, wholly inadvertently; I'm now in EMDR therapy to retrieve and move past the remainder.)
I'm not sure what a legitimate therapist in your story could do to deliberately simulate the original trauma. Meeting the patient-character at a pool, and throwing them a faulty life preserver, because one of the original incidents involved a near-drowning, sounds... unethical, to put it mildly.
Therapeutic, tandem skydiving, and the adrenaline rush is so reminiscent of _____ that it makes memories surface? Therapist and patient, each running late to the appointment, have a fender bender? Perhaps the therapist doesn't deliberately do anything; the character has the triggering experience on their own, unexpectedly, and then talks with the therapist. (The therapist is then positioned to elicit more detail, because the patient is able to start the conversation.)
posted by Iris Gambol at 6:40 PM on October 30, 2018 [3 favorites]
Thinking about this more, and coming at it from a "how do stories work" perspective instead of a "how do brains work" perspective, does your story require that the therapist succeed by skill? Or would it work just as well if it went like this:
posted by nebulawindphone at 7:03 PM on October 30, 2018 [1 favorite]
- Therapist has some theory of how to "recover" repressed memories — which might well be something that makes sense in their world-internal culture but seems bizarre to us.
- Therapist does a bunch of stuff based on their theory.
- Meanwhile, the patient has some idiosyncratic, can't-be-planned-for experience which starts to bring some of the memories back.
- (Optionally: Therapist takes credit anyway.)
posted by nebulawindphone at 7:03 PM on October 30, 2018 [1 favorite]
EMDR, alpha-theta neurofeedback, hypnotherapy, MDMA treatment, all work to reduce panic responses brought about by recollection of trauma so that memory reconsolidation and integration can happen. Echoing the others who said that the issue is not repressed memories but overwhelming panic.
posted by namesarehard at 9:23 PM on October 30, 2018 [3 favorites]
posted by namesarehard at 9:23 PM on October 30, 2018 [3 favorites]
I actually have been diagnosed with DID, although my diagnosis was at a time when the language was a bit different. I pretty much don’t believe there is a non-magical way to go searching for memories and my own therapy never did that exactly. To use the language and identity I find most accurate and respectful, what different people in my head (parts/alters/etc) remembered were different, but no one really forgot per se. (However, I did lose swathes of time. And yes that is somewhat paradoxical but...not, via my lived experience.)
My good therapist never really focused on the past unless/until something came up like “being outside at night around the scent of roses makes me feel weird” (not a real example) in which case we might talk about roses and nights at the time roses bloom, or times I felt weird, until information presented itself. I cannot speak for all or most people who experience dissociation but I feel a bit like anyone trying to force a memory would have had to use really manipulative techniques and a sheer amount of “luck” and that would have caused a double-down on the dissociation. (This actually did happen to me with a bad therapist, once, with the result that our merry band in my head both tossed forward the person *least* likely to share anything and walked out and left a voicemail quitting.)
I agree that if your protagonist is natively in a time where approaching self-knowledge causes *days* of dysfunction, there’s no quick access. (Incidentally is this necessary? By which I mean if it is providing a heart/mind/soul dilemma core to this character and the struggle is interesting great...if not, this would bother me more than a hokey retrieval scene.)
Soooo...basically unless your system of magic prohibits it, I think it might actually be best to approach this via magic.
posted by warriorqueen at 4:31 AM on October 31, 2018 [6 favorites]
My good therapist never really focused on the past unless/until something came up like “being outside at night around the scent of roses makes me feel weird” (not a real example) in which case we might talk about roses and nights at the time roses bloom, or times I felt weird, until information presented itself. I cannot speak for all or most people who experience dissociation but I feel a bit like anyone trying to force a memory would have had to use really manipulative techniques and a sheer amount of “luck” and that would have caused a double-down on the dissociation. (This actually did happen to me with a bad therapist, once, with the result that our merry band in my head both tossed forward the person *least* likely to share anything and walked out and left a voicemail quitting.)
I agree that if your protagonist is natively in a time where approaching self-knowledge causes *days* of dysfunction, there’s no quick access. (Incidentally is this necessary? By which I mean if it is providing a heart/mind/soul dilemma core to this character and the struggle is interesting great...if not, this would bother me more than a hokey retrieval scene.)
Soooo...basically unless your system of magic prohibits it, I think it might actually be best to approach this via magic.
posted by warriorqueen at 4:31 AM on October 31, 2018 [6 favorites]
Also, please ignore this if it is not helpful but it's been on my mind. I have a human brain that has functioned that way, and have been involved with many humans with similar brains.
If your concern is not having a bad TV plot please do be careful about this: "But he doesn‘t know what it is or why it’s gone. Because every time anyone gets close to talking about the Stuff That Happened, he gets a panic attack, blacks out and has other symptoms that take him out of the picture for a day or two. It‘s obvious a larger part of him definitely doesn‘t want to revisit this time."
How to phrase this...if this is a magical/world/fantasy/alien thing then I guess it is fine.
But if it's a PTSD/dissociative thing...it's not exactly how things work in my experience, and in my experience having been involved in support communities for a long time. Certainly people with PTSD experience dissociative episodes, flashbacks and intrusive thoughts and panic and triggers, and some of those are probably predictable in a lot of ways like if you were in a fire then the smell of smoke is probably going to inherently raise your fight or flight response. However you might start throwing bonfires obsessively every weekend and make your friends dance around them, it doesn't always mean that you will avoid them.
It's by no means a 1:1 ratio like "every time I try to think about my past I throw up and have to take a 3-hour nap." That kind of thing will make me roll my eyes.
It's more like...let's say I was attacked by a mall Santa as a child. Every time people start talking about Elf on the Shelf, I might decide to go organize my spice rack (ANGRILY because GOD, the SPICE RACK IS A MESS), or I get into an argument about how religion is pablum for the masses and Christmas is just a consumer nightmare, and then two days later I dream about being chased by Rudolph the Red-Nosed Reindeer.
I might develop an aversion to malls, either at Christmas or during the entire year, but it's doubtful that I would throw up at the thought of them, because that's kind of ineffective. It's more likely that I would have road rage in the parking lots of malls.
Or, on the more extreme end, like full-bore DID, *I* would not remember freaking out about Santa at all, but my friends might report that I acted weirdly cold/aggressive/whatever in that conversation. Or started rambling about 80s pop or something. *I* might get up the next morning feeling a bit hung over and assume that my cold medication made me spacey the day before. If my friends brought this conversation up with me, the likelihood that I would believe them is low, because that sort of removes the dissociative barrier already (and is indeed how this gradually worked.) I would either crack a joke or have a fight about it.
I would suggest as a (very biased on this topic) editorial view that you are having trouble with the revelation plot point because the mechanism that you're using to hide the information is itself too two-dimensional to support the degree of realism (?) you're going for, and if you fix that then the solution will present itself.
posted by warriorqueen at 8:39 AM on October 31, 2018 [7 favorites]
If your concern is not having a bad TV plot please do be careful about this: "But he doesn‘t know what it is or why it’s gone. Because every time anyone gets close to talking about the Stuff That Happened, he gets a panic attack, blacks out and has other symptoms that take him out of the picture for a day or two. It‘s obvious a larger part of him definitely doesn‘t want to revisit this time."
How to phrase this...if this is a magical/world/fantasy/alien thing then I guess it is fine.
But if it's a PTSD/dissociative thing...it's not exactly how things work in my experience, and in my experience having been involved in support communities for a long time. Certainly people with PTSD experience dissociative episodes, flashbacks and intrusive thoughts and panic and triggers, and some of those are probably predictable in a lot of ways like if you were in a fire then the smell of smoke is probably going to inherently raise your fight or flight response. However you might start throwing bonfires obsessively every weekend and make your friends dance around them, it doesn't always mean that you will avoid them.
It's by no means a 1:1 ratio like "every time I try to think about my past I throw up and have to take a 3-hour nap." That kind of thing will make me roll my eyes.
It's more like...let's say I was attacked by a mall Santa as a child. Every time people start talking about Elf on the Shelf, I might decide to go organize my spice rack (ANGRILY because GOD, the SPICE RACK IS A MESS), or I get into an argument about how religion is pablum for the masses and Christmas is just a consumer nightmare, and then two days later I dream about being chased by Rudolph the Red-Nosed Reindeer.
I might develop an aversion to malls, either at Christmas or during the entire year, but it's doubtful that I would throw up at the thought of them, because that's kind of ineffective. It's more likely that I would have road rage in the parking lots of malls.
Or, on the more extreme end, like full-bore DID, *I* would not remember freaking out about Santa at all, but my friends might report that I acted weirdly cold/aggressive/whatever in that conversation. Or started rambling about 80s pop or something. *I* might get up the next morning feeling a bit hung over and assume that my cold medication made me spacey the day before. If my friends brought this conversation up with me, the likelihood that I would believe them is low, because that sort of removes the dissociative barrier already (and is indeed how this gradually worked.) I would either crack a joke or have a fight about it.
I would suggest as a (very biased on this topic) editorial view that you are having trouble with the revelation plot point because the mechanism that you're using to hide the information is itself too two-dimensional to support the degree of realism (?) you're going for, and if you fix that then the solution will present itself.
posted by warriorqueen at 8:39 AM on October 31, 2018 [7 favorites]
Because every time anyone gets close to talking about the Stuff That Happened, he gets a panic attack, blacks out and has other symptoms that take him out of the picture for a day or two.
I think this is the part that needs to change if you want to get usable information from this character in a relatively quick period. Someone can not want to get into something without it being debilitating in the sense of completely being unable to function for days. A brief period of dissociation would be more plausible while still having genuine emotional weight. If I smash your hand with a hammer, it does hurt as much as if I went full tilt with torture devices, but it would still hurt and you’d rather I didn’t do that at all.
posted by RainyJay at 2:22 PM on October 31, 2018 [1 favorite]
I think this is the part that needs to change if you want to get usable information from this character in a relatively quick period. Someone can not want to get into something without it being debilitating in the sense of completely being unable to function for days. A brief period of dissociation would be more plausible while still having genuine emotional weight. If I smash your hand with a hammer, it does hurt as much as if I went full tilt with torture devices, but it would still hurt and you’d rather I didn’t do that at all.
posted by RainyJay at 2:22 PM on October 31, 2018 [1 favorite]
This thread is closed to new comments.
The memory part, no idea.
posted by Smearcase at 1:07 PM on October 30, 2018 [1 favorite]