Psychotherapy, Religion, and Brain Effects of Trauma

People deeply involved in any way of looking at the human world tend to take that worldview with them wherever they go. So it is both with those committed to a religious tradition as well as those committed to evidence-based psychology and psychotherapy. Each of us will tend look at serious human problems from our respective viewpoints. This can get confusing. An excellent example of this came up recently with a question posted to Google+ for general comment by HealthyPlace.com:

Is forgiveness an important component of healing from trauma?

I suspect that individuals committed to both worldviews reacted to this question in fairly predictable ways. I know I did. My reaction was immediate: "Important? Absolutely not. Useful? It can be, but not in the way religious people tend to think." As I discussed the matter with a thoughtful and articulate individual, a richer picture emerged which is worth bringing to this venue, and elaborating on, for many reasons.

A Quick Definition of Healing

Healing seems to mean many things to many people, but I will propose a simple, easy to grasp, and defensible definition. To do that, we must first look at the diagnostic criteria for posttraumatic stress disorder (PTSD) given in the Diagnostic and Statistical Manual of Mental Illness (DSM-5) (APA, 2013, p. 271). Diagnostic criteria, by definition, are simply the qualities a person must have to justify giving them a diagnosis. They are not a complete description of a disorder. Still, fail to meet the criteria and you don't get the diagnosis, if you're being assessed.

That gives us, at the outset, a handy definition of healing: It doesn't necessarily mean a full return to your original condition. It means that you no longer qualify for a diagnosis. While this is not a perfectly satisfying definition for everyone, it is good enough in real life, clinical practice. The diagnostic criteria, the symptoms of PTSD, are 8 in number, with the last several being constraining criteria specified to avoid over-diagnosis. The critical ones are the first 5, and in summary require the presence of:

A. Exposure to a traumatizing event.

B. Presence of intrusive symptoms relating to the event.

C. Attempts to avoid triggers for these intrusive symptoms.

D. Negative alterations in thought and mood, associated with the traumatizing event.

E. Significant alterations (increases or decreases) in physiological reactivity, after the traumatic event.

Brain Effects of Trauma

I could discuss many such effects - and the DSM-5 does, but in truth we need focus on only one. I can make this point easily enough.

Here's the big idea (and too few people see this!): the event referred to initially in the diagnostic criteria by itself is nothing. It must be "traumatizing." How do we know it was, IF it was? By the presence of one or more of the symptoms detailed in "B" - triggered memories, disturbing dreams, dissociative reactions, psychological or physiological distress, or reactions upon exposure to reminders of the event.

If these intrusive symptoms are not present, you just will NOT see the symptoms in "C", "D", or "E." When in treatment we focus on removing the group "B" symptom(s), we are striking at the heart of the issue, because the "B" symptoms cause all the others. Removing these alone will resolve the PTSD. That tells us that these symptoms are the essential brain effects of trauma which lie at the heart of PTSD.

Psychology and Religion - the worlds to which they refer

Regrettably, this essential difference is not frequently enough considered and articulated in ordinary conversation. Why do it? Because it prevents or resolves many disputes right at the beginning.

Let's approach this from the point of view of common sense. We need to consider two highly relevant terms in common use in our society: "the natural world" and "the supernatural world." As advised by the Oxford Companion to Philosophy (p. 607), the world of "nature" is the "physical world of experience" - the world to which we have access with our 5 senses. It is contrasted with "the supernatural world" (Gove, 1966, p. 1507), described as ". . . belonging to . . . the physical universe that is observable, and capable of being experienced by ordinary means . . ." (Gove, 1966, p. 2295).

Surely it is obvious that psychology, and its application in clinical (treatment and healing) settings, is a science based practice and body knowledge. All "applied" knowledge employs and embodies a degree of "craft knowledge" as well - this would be the "art" of psychotherapy. But at its base, it is a science.

What precisely does that mean? Like many common terms, it doesn't have just one meaning. Typically we refer to psychology as a "behavioral" or "cognitive" or "natural" science. Let's look just at that last characterization, since it encompasses the other two. It tells us that the focus is on the world as we can know with our 5 senses. How we accomplish that "knowing" is the topic of "scientific methodology." The Oxford Dictionary of Philosophy (Blackburn, 1994, p. 242) advises us that in modern times discussion of this topic tends to focus on what people in science actually DO - it is descriptive rather than prescriptive. Before graduating from high school in the U.S., we are all told what this is: scientists propose and test hypotheses.

Psychology and Religion - the essential difference

It is that last part - the testing - which poses a problem for religion. If religion is about the domain of the supernatural (to which we do not have access with our senses), then we are unable to propose and scientifically test religious hypotheses.

And, indeed, there is no religious science, no peer-reviewed journals of scientific, religious research - addressing such questions as the nature of deity, the question of the existence of God or gods, etc. Religion is forever consigned to the realm of hypothesis, simply by its subject matter: the supernatural world.

Since "forgiveness" is an idea that springs from religious tradition, how can anything having to do with forgiveness be related to psychological trauma, its treatment and healing from its effects? I will take this and related matters up in my next blog post. As you will see, this question is more complex and interesting than you might suppose. [continue to Part II of this series]

References

American Psychiatric Association, & DSM-5 Task Force. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Arlington, Va.: American Psychiatric Association.

Blackburn, S. (1994). The Oxford dictionary of philosophy. Oxford; New York: Oxford University Press.

Gove, P. B. (Ed.). (1966). Webster’s Third New International Dictionary (3 Volumes) (3rd ed., Vols. 1-3). Chicago: William Benton, Encyclopaedia Britannica.

Honderich, T. (1995). The Oxford companion to philosophy. Oxford; New York: Oxford University Press.

Connect with Tom Cloyd also at Google+, LinkedIn, Facebook, Twitter, his Sleight of Mind blog, his Trauma Psych blog, or his professional website.

Image credit: Sean MacEntee /license