Reversing the Trauma of War - Book Review by Nick Brink, PhD

Review – Reversing the Trauma of War: A PTSD Imagery Handbook for Veterans, Active-Duty Personnel, and Their Families

by Phyllis Kahaney, M.S.W., Ph.D. and Rachel Epstein, L.Ac., J.D., New York, NY: ACMI Press, 2020.

     I was awarded the opportunity to review the prepublication manuscript of Reversing the Trauma of War by its author Rachel Epstein.  With our lifetime experience of endless wars combat posttraumatic stress has become a major issue in a practice of psychotherapy.  In my 50 years as a private practicing psychologist I have seen innumerable military veterans who have suffered with posttraumatic stress.  Central to my practice have been the use of guided imagery, dreamwork and hypnotherapy, tools that are most effective and indispensible in therapy for PTSD.  I wish I would have had this imagery handbook, Reversing the Trauma of War, at my fingertips over these years with its extensive repertoire of mental imagery exercises, exercises for the wide range of symptoms or problems experienced by the veterans of Viet Nam and the war-torn lands of the Near East.

     Mental Imagery is visualization from beyond that which we experience through our five senses of sight, sound, smell, taste and touch, from beyond our logical or rational consciousness.  When these mental images are positive they become effective avenues for coping with stressful situations. These visualizations that being from beyond our rational mind, are quickly embedded within our unconscious, thus change us at a deeper unconscious level.  The mental imagery exercises described in this book can create new neural connections within the pliable and malleable neurons of the brain.  They can provide us with new ways to look at what have learned as habitual responses to war trauma, the continued false emergency state of a flight or fight response of the sympathetic nervous system.  Learning these new mental imagery exercises is a pleasant experience that costs nothing.  One’s sensitivity to the learned responses to war trauma is not logical, and these responses to past events do not dictate the future when one recognizes that new healing responses can be learned.

     To practice the mental imagery exercises, sit with a straight spine in a comfortable chair used specifically for the use of mental imagery.  Exhale slowly through the mouth and inhale through the nose. Focusing on the exhale that rids the body of waste products brings a sense of relaxation in preparation for the imagery exercise.  An imagery exercise is generally practiced three times a day for 21 days, takes only a couple of minutes, and is directed to only one symptom at a time.  Some people are more verbal than visual in experiencing the exercises, i.e. they put the experiences into words rather than visualizations.

     Each of thirteen chapters is about one symptom of PTSD as a result of war trauma.  These include hypervigilance, anxiety and fear, anger, triggers, isolation, depression, guilt, insomnia and nightmares, loss and grief, physical pain, concussions and mild traumatic brain injury, addictions, and sexual trauma.  Each chapter begins by addressing the considered issue to provide an understanding of the issue using examples from combat veterans.  This is followed by several imagery exercises for overcoming the particular symptom.  Three of the chapters will be reviewed to provide a flavor of the importance of this well organized book: hypervigilance, insomnia and nightmares, and sexual trauma.

Hypervigilance

     I chose to review this chapter because of a relatively recent case I had of a Navy vet whose job aboard the ship was to sit by himself and watch gages in a small room deep in the bowels of the ship with a number of sealed doors above him that separated him from the rest of the crew.  He sat in this room with nothing else to do but to watch the gages for hours at a time with his mind imagining the worst, of being attacked with each jerk and sounds of the ship.  His feeling of being trapped was traumatic.

     This hypervigilance chapter begins with the narrative of Dustin, the team leader of three men who went from house to house in each village looking for insurgents.  Upon returning to California he could not sleep and was continually looking out the windows and over his shoulder feeling threatened by everything around him.  This was especially a problem while driving when other cars would pass or when he would go under a bridge.  He was always watching, expecting to see someone with a gun pointed at him.  Like the above Navy vet, Dustin felt traumatically trapped, in this case in his car. 

     Dustin’s narrative/story offered many examples of his hypervigilance that were legitimate for self-protection while serving in Iraq, but back in the states this need was no longer legitimate but a learned habit that could be changed by practicing mental imagery.  This chapter offers seven mental imagery exercises for such hypervigilance.  In addressing the feeling of being trapped, the first exercise was to imagine the exodus story of God parting the waters of the Red Sea for the Israelites to escape from Egypt, an imagery experience that provides feelings of strength and confidence while hurrying between the two towering walls of water.  Upon returning to California Dustin also attempted to take a college course but was unable to deal with being in a crowd of people.  For learning to feel safe and calm in a crowd the imagery exercise of imagining surfing a diminishing tidal wave to the safety of the beach was offered, to be practiced three times a day for 21 days.

     The last of the seven exercises is one for feeling self-renewal, for feel the way you were before combat; to again be the self you want to be.  I have frequently used this exercise: “See yourself in a mirror as you are now.  Looking into the mirror, go backward in time.  Keep going back until you get to the time… before the trauma that changed you.  See, sense, and feel yourself as you were then. Retrieve this image of yourself and become one with this self.  Now go forward in time as this renewed self to the present.  See yourself as” this renewed self.

     This story of Dustin makes clear that the imagery narrative is in response to the narrative told by him in the therapy session.  Mental imagery is a clear example of what Theodore Sarbin (1986), Stanley Krippner, et al (2007, 2007) and Lewis Mehl-Medrona (2007, 2010) have described as Narrative Therapy, of listening to narratives offered by the client/patient and offering counter narratives or images, the topic of my unpublished manuscript, Loki’s Children: Using Hypnotic and Shamanic Imagery in Narrative Psychotherapy.

Insomnia and Nightmares

     The inability to fall asleep and of waking in the night without being able to get back to sleep are common experiences of PTSD.  These experiences are legitimate when in a war situation where hypervigilance is important for self-protection, but they are a severe problem in normal life when responsibilities of living require sufficient sleep.  Without sufficient sleep many of the other symptoms of PTSD are exacerbated.  Creating the feeling of peace and safety is the first intent of the mental imagery exercise.  Imagining lying in a comfortable spot to watch the sun set as it descend below the horizon just before going to bed can bring about this sense of peace for falling asleep.  Of the seven mental imagery exercises another for promoting a feeling safety is to imagine yourself surrounded by some protective barrier until the danger passes, e.g. a high steel wall or a ring of fire.  Again, it is generally suggested that each of the exercises should be practiced three times a day for 21 days, and if more time is needed, after a seven day rest it can be repeated for another 21 days.

     With regard to nightmares, one exercise entitled Strong Box, is to put your nightmare in a heavy box with a strong lid, seal it in a vault and bury it deep in the earth.  Another, entitled Conquering the Dragon of Fear, calls upon any strength or supernatural power to defeat the beast, thus becoming your own hero.  This is basically the imagery exercise I have frequently used for nightmares, using the imagery rehearsal technique suggested by Barry Krakow (Rosner et al, 2004).  He suggests begin with just one nightmare and during waking hours imagine a new positive outcome to the nightmare.  Imagine this new dream frequently throughout the day for several days before going on to another nightmare, following the same procedure.  Changing the outcome of the nightmare can be created in any way imaginable, e.g. by becoming some superhero or using some supernatural strength.  From my experience with combat veterans it does not take long for the nightmares to diminish and disappear, which in turn lessens the other symptoms of PTSD.

     The seven mental imagery exercises for treating insomnia and the four for treating nightmares provide a wealth of ways to treat these problems, as do the many other mental imagery exercises provided throughout the book in treating the other symptoms of war trauma.

Sexual Trauma

     One trauma rarely spoken of by military veterans is a sexual trauma, the trauma of being molested or raped.  Sexual trauma has come more out in the open with more women enlisting in the military, still when the trauma is inflicted by an officer of senior rank, because of the officer’s authority and ability to prevent advancement, the traumatized victim is very hesitant to report it.  In addition, because of the need for complete trust and close comradery with others in the unit, understanding that others are ready to possibly die for you, such personal assault is contrary to this trust.  These factors make treatment for sexual trauma especially difficult.

     The ten mental imagery exercises offered by Kahaney and Epstein for sexual trauma are thus especially important.   These exercises begin with imagining 10,000 stick of light being raised against the darkness, knowing that the light has caused the demons to flee.  Many of the exercises are of rising above the trauma to find beauty and peace in life such as climbing a rainbow staircase, descending into the Garden of Eden, being transformed in a lake of tears, or walking in a new pair of diamond studded shoes.  Only one exercise is for addressing the abuser, the Golden Lasso for restraining the image of the abuser, forcing him to listen to your pain.  I have some concern with two of the imagery experiences, the Cloak that makes you invisible for eliminating the feelings of danger, and Challenger Deep used to bury your deepest secrets.  Both these experiences seem to me to facilitate dissociation, to ignore the pain.  When someone is ready to come to therapy they are generally ready to face the issue as painful as it may be, and helping them rise above the pain rather than dissociating from it seems more appropriate.

     The last four chapters take you beyond the symptoms of PTSD to follow your dreams and your creative intentions as you move into the future.  The mental imagery exercise is to first confront a disturbing trait and convert it into its opposite, a trait that opens you to the new world of future possibilities, e.g. ending the feeling of anxiety, an addiction to alcohol or cigarettes, or angry outbursts.  Imagine yourself with one unwanted trait, then stop it and replace it with a new positive image, again repeating this three times a day for 21 days.  The replacement trait necessarily needs to be positive.  Simply stopping the negative trait leaves a void of not knowing what to do otherwise.  As you eliminate your disturbing traits, one at a time, you become open to the exercises of the last chapter, Choosing to Live Well, of Cleansing the Heart and Reimagining Yourself to become what you want to be as you move into the future.

     Suggestions for creating your own imagery exercises, and imagery exercises for the families of the veterans for dealing with the stress caused by the veteran’s symptoms, for providing support, and for improving communication are also offered.  One of my favorites is the Breathing as One exercise: “See and sense yourself standing at the base of a large, tall tree, facing the tree.  Your partner is standing on the other side of the tree, facing the tree as well.  Sense and feel yourself firmly grounded on the earth, drawing energy from it.  Sense yourself breathing deeply and rhythmically, feeling the tree breathing in harmony with you.  Sense your partner’s breathing, coming into rhythm with yours so that you both are breathing as one with the tree.  Now see both your and your partner’s arms and legs growing longer, extending to embrace one another while growing taller and taller until your heads reach above the crown of the tree.  Know that you are growing as one.  Keep this feeling of oneness” as you breathe out and open your eyes.

     I strongly believe that in order to save the Earth from the global climate crisis we need to become one with all that is of the Earth.  This exercise also brings you to being one with the tree as well as with your partner, an exercise especially important to me.

     The powerful tool of mental imagery needs to be central in the treatment of Post Traumatic Stress.  Reversing the Trauma of War brings mental imagery to this center.  This well organized book with Kahaney and Epstein’s many examples brings alive the treatment of this disorder.  It is an easy read and an exceptionally important book for those who treat the sufferers of the trauma of war, for the sufferer, and for the families of the sufferer. The wealth of imagery exercises for each of the thirteen symptoms or problems (chapters) caused by the trauma is an indispensable resource. It is a must read for both the professional and for self-help.

REFERENCES

Krippner, Stanley; Bova, M.; and Gray, L. (Eds.), (2007).  Healing Stories: The Use of Narrative in Counseling and Psychotherapy,  Charlottesville, VA: Puente Publications.

Krippner, Stanley;  Bova, M.; Gray, L.; and Kay, A (Eds), (2007).  Healing Tales: The Narrative Arts in  Spiritual Traditions Charlottesville, VA: Puente Publications,

Mehl-Medrona, Lewis, (2007). Narrative Medicine: The Use of History and Story in the Healing Process.  Rochester, VT: Bear & Co.

_____ (2010).  Healing the Mind Through the Power of Story: The Promise of Narrative Psychiatry, Rochester, VT: Bear & Co.

Krakow, B. (2004).  Imagery rehearsal therapy for chronic posttraumatic nightmares: a mind’s eye view.  In Rosner, R. I., Lyddon, W.J. and Freeman, A.  Cognitive Therapy and Dreams. New York, NY: Springer Publishing, 89-109.

Sarbin, Theodore, (1986).  Introduction and Overview. In Narrative Psychology: The Storied Nature of Human Conduct, edited by Theodore R. Sarbin.  Westport, CT: Praeger.

 

About Nick Brink

Nicholas E. Brink, Ph.D., is a psychologist and a certified teacher of ecstatic trance with the Cuyamungue Institute. Board certified by the American Board of Professional Psychology, and past president of the American Association for the Study of Mental Imagery. He is the author of many articles and books including The Power of Ecstatic Trance, Ecstatic Soul Retrieval, and his forthcoming book, Loki's Children: A Healing Story of Antiquity Shamanism and Psychotherapy .

He lives in Coburn, Pennsylvania and can be reached at brinknick9@gmail.com, or www.imaginalmind.net

Dr. Nicholas E. Brink on 11:11 Talk Radio