One way this emotional healing seems to occur spontaneously—at least in children—is through such games as Purdy. These games, played over and over again, let children relive a trauma safely, as play. This allows two avenues for healing: on the one hand, the memory repeats in a context of low anxiety, desensitizing it and allowing a nontraumatized set of responses to become associated with it. Another route to healing is that, in their minds, children can magically give the tragedy another, better outcome: sometimes in playing Purdy, the children kill him, boosting their sense of mastery over that traumatic moment of helplessness.
Games like Purdy are predictable in younger children who have been through such overwhelming violence. These macabre games in traumatized children were first noted by Dr. Lenore Terr, a child psychiatrist in San Francisco.17 She found such games among children in Chowchilla, California—just a little over an hour down the Central Valley from Stockton, where Purdy wreaked such havoc—who in 1973 had been kidnapped as they rode a bus home from a summer day camp. The kidnappers buried the bus, children and all, in an ordeal that lasted twenty-seven hours.
Five years later Terr found the kidnapping still being reenacted in the victims' games. Girls, for example, played symbolic kidnapping games with their Barbie dolls. One girl, who had hated the feeling of other children's urine on her skin as they lay huddled together in terror, washed her Barbie over and over again. Another played Traveling Barbie, in which Barbie travels somewhere—it doesn't matter where—and returns safely, which is the point of the game. A third girl's favorite was a scenario in which the doll is stuck in a hole and suffocates.
While adults who have been through overwhelming trauma can suffer a psychic numbing, blocking out memory of or feeling about the catastrophe, children's psyches often handle it differently. They less often become numb to the trauma, Terr believes, because they use fantasy, play, and daydreams to recall and rethink their ordeals. Such voluntary replays of trauma seem to head off the need for damming them up in potent memories that can later burst through as flashbacks. If the trauma is minor, such as going to the dentist for a filling, just once or twice may be enough. But if it's overwhelming, a child needs endless repetitions, replaying the trauma over and over again in a grim, monotonous ritual.
One way to get at the picture frozen in the amygdala is through art, which itself is a medium of the unconscious. The emotional brain is highly attuned to symbolic meanings and to the mode Freud called the "primary process": the messages of metaphor, story, myth, the arts. This avenue is often used in treating traumatized children. Sometimes art can open the way for children to talk about a moment of horror that they would not dare speak of otherwise.
Spencer Eth, the Los Angeles child psychiatrist who specializes in treating such children, tells of a five-year-old boy who had been kidnapped with his mother by her ex-lover. The man brought them to a motel room, where he ordered the boy to hide under a blanket while he beat the mother to death. The boy was, understandably, reluctant to talk with Eth about the mayhem he had heard and seen while underneath the blanket. So Eth asked him to draw a picture—any picture.
The drawing was of a race-car driver who had a strikingly large pair of eyes, Eth recalls. The huge eyes Eth took to refer to the boy's own daring in peeking at the killer. Such hidden references to the traumatic scene almost always appear in the artwork of traumatized children; Eth has made having such children draw a picture the opening gambit in therapy. The potent memories that preoccupy them intrude in their art just as in their thoughts. Beyond that, the act of drawing is itself therapeutic, beginning the process of mastering the trauma.
EMOTIONAL RELEARNING AND RECOVERY FROM TRAUMA
Irene had gone on a date that ended in attempted rape. Though she had fought off the attacker, he continued to plague her: harassing her with obscene phone calls, making threats of violence, calling in the middle of the night, stalking her and watching her every move. Once, when she tried to get the police to help, they dismissed her problem as trivial, since "nothing had really happened." By the time she came for therapy Irene had symptoms of PTSD, had given up socializing at all, and felt a prisoner in her own house.
Irene's case is cited by Dr. Judith Lewis Herman, a Harvard psychiatrist whose groundbreaking work outlines the steps to recovery from trauma. Herman sees three stages: attaining a sense of safety, remembering the details of the trauma and mourning the loss it has brought, and finally reestablishing a normal life. There is a biological logic to the ordering of these steps, as we shall see: this sequence seems to reflect how the emotional brain learns once again that life need not be regarded as an emergency about to happen.
The first step, regaining a sense of safety, presumably translates to finding ways to calm the too-fearful, too easily triggered emotional circuits enough to allow relearning.18 Often this begins with helping patients understand that their jumpiness and nightmares, hypervigilance and panics, are part of the symptoms of PTSD. This understanding makes the symptoms themselves less frightening.
Another early step is to help patients regain some sense of control over what is happening to them, a direct unlearning of the lesson of helplessness that the trauma itself imparted. Irene, for example, mobilized her friends and family to form a buffer between her and her stalker, and was able to get the police to intervene.
The sense in which PTSD patients feel "unsafe" goes beyond fears that dangers lurk around them; their insecurity begins more intimately, in the feeling that they have no control over what is happening in their body and to their emotions. This is understandable, given the hair trigger for emotional hijacking that PTSD creates by hypersensitizing the amygdala circuitry.
Medication offers one way to restore patients' sense that they need not be so at the mercy of the emotional alarms that flood them with inexplicable anxiety, keep them sleepless, or pepper their sleep with nightmares. Pharmacologists are hoping one day to tailor medications that will target precisely the effects of PTSD on the amygdala and connected neurotransmitter circuits. For now, though, there are medications that counter only some of these changes, notably the antidepressants that act on the serotonin system, and beta-blockers like propranolol, which block the activation of the sympathetic nervous system. Patients also may learn relaxation techniques that give them the ability to counter their edginess and nervousness. A physiological calm opens a window for helping the brutalized emotional circuitry rediscover that life is not a threat and for giving back to patients some of the sense of security they had in their lives before the trauma happened.
Another step in healing involves retelling and reconstructing the story of the trauma in the harbor of that safety, allowing the emotional circuitry to acquire a new, more realistic understanding of and response to the traumatic memory and its triggers. As patients retell the horrific details of the trauma, the memory starts to be transformed, both in its emotional meaning and in its effects on the emotional brain. The pace of this retelling is delicate; ideally it mimics the pace that occurs naturally in those people who are able to recover from trauma without suffering PTSD. In these cases there often seems to be an inner clock that "doses" people with intrusive memories that relive the trauma, intercut with weeks or months when they remember hardly anything of the horrible events.19