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A major approach to the treatment of posttraumatic stress disorder (PTSD) involves narrative processing of the traumatic memory. This is designed to undo the distressing continued effect of the traumatic experience that intrudes into the patient’s present life as PTSD symptoms, depression, and dissociation. The narrative processing collects and organizes the fragmented images and perceptions of the trauma into a coherent verbal structure with beginning, middle, and end. Now the person can assimilate the gathered fragments into verbal memory as personal history. The shock of the trauma is no longer stunning in present time and no longer felt as unfinished threat. The experience finally can be examined in the light of present consciousness as a remembered past event.
It is exceedingly difficult to simply recite a traumatic experience. Outside of verbal consciousness memory fragments fester like “memory shrapnel” and prevent narrative closure. Enlisting the help of the “mind’s eye” and the imagery of the right brain can facilitate the assimilation of these nonverbal images into verbal memory. It is not just what the mind’s eye sees but how it beholds and reports. When the mind’s eye serves narration it is observing and describing through the perspective of a hidden observer. It is helping to protect the person from reliving the experience.
The methods to recruit the mind’s eye to the work of narrative processing depend on visual imagery even though many of the memory fragments may not be visual. They may consist of bodily sensations such as pain or pressure or feelings of terror. Whatever the content, their presence can be detected by the mind’s eye and reported by the hidden observer. It is the duty of the hidden observer to give an objective narration while resisting the subjective pull of unfinished experience and avoiding reliving of the experience. Once narrative closure is achieved there is no more pull into the traumatic experience.
The Hidden Observer
In the 1970’s the research psychologist Ernest Hilgard experimented with the hypnotic induction of analgesia and discovered that a hidden observer could be elicited in those subjects claiming to feel no pain. He asked for a report by a part of the subject that did feel the pain and could rate the severity. Some subjects responded from a part of themselves that was aware of the pain and could rate it on a scale of ten during the time the subject had claimed analgesia. These elicited parts were very much alike from subject to subject. The part was normally hidden from the subject’s awareness although the part claimed to have always been there. The part was aware of the experimentally induced pain (produced by ischemia of the arm deprived of circulation by the tourniquet effect of a blood pressure cuff inflated to a pressure above the systolic pressure) but the part denied suffering. Dr. Hilgard designated these parts “Hidden Observers.” The Hidden Observers claimed to be onlookers of the person’s experiences at all times, whether the subject was hypnotized or not. They played no role in executing action and did not participate in the emotional experience of the subject.
More than 90% of the patients undergoing hypnosis in an intensive trauma therapy clinic were able to liberate a Hidden Observer. Following hypnotic induction by progressive relaxation the patient visualizes an imaginary scene and executes the imaginary action of stepping out of the body and observing the body from the outside. The therapist refers to the onlooker as the Hidden Observer and points out the capacity for emotional distance from the patient. The Hidden Observer then temporarily leaves the patient in the imagined scene and goes to the time of the trauma to observe the traumatic event as it unfolds. The Hidden Observer narrates the event impassively, referring to the self in the trauma in the third person – as “him” or “her” – and telling the story from beginning to end. The narration is recorded by videotape for subsequent review by the patient in a normal waking state. The hypnotic session ends after the Hidden Observer returns to the self left in the imagined scene.
Reviewing the videotaped narrative in the waking state completes the hypnotic narrative processing. The patient and the therapist watch the replayed videotape together. Now the patient no longer has the emotional distance of the Hidden Observer. The patient may only dimly remember much of the narrative and there is a risk of being triggered into a re-experiencing of the trauma. If this happens the therapist will stop the tape and help the patient become grounded.
Usually there is little or no triggering or abreaction with review of the tape. This is positive because abreaction interferes with verbal narrative assimilation. There may be an element of desensitizing in the review. Emotional desensitization can also diminish assimilation because the patient might escape full avowal or owning of the experience and feel instead as if it happened to someone else. If this failure is not corrected, the entire narrative processing must be repeated.
Usually when the narrative processing is repeated the second narration is more detailed and complete and makes it possible to fill in gaps that were not detected during the first. When this still does not relieve the intrusive symptoms of PTSD the cause might be that the symptoms arise from earlier traumas. The patient may have to search for unremembered traumas, such as preverbal ones or overlooked traumas due to medical or surgical procedures, for example.
Processing traumatic memories with the mind’s eye and the Hidden Observer makes it possible to do trauma therapy rapidly and safely without re-traumatizing the patient.