February 23, 2003 By LAUREN SLATER
You've been in therapy for years.You've time-traveled back to your childhood home, to your mother's makeup mirror with its ring of pearl lights. You've uncovered, or recovered, the bad baby sitter, his hands on you, and yet still, you're no better. You feel foggy and low; you flinch at intimate touch; you startle at even the slightest sounds, and you are impaired. Hundreds of sessions of talk have led you here, back to the place you started, even though you've followed all advice. You have self-soothed and dredged up; you have cried and curled up; you have aimed for integration in your fractured, broken brain.
This is common, the fractured, broken brain and the uselessness of talk therapy to make it better. A study done by H.J. Eysenck in 1952, a study that still causes some embarrassment to the field, found that psychotherapy in general helped no more, no less, than the slow passing of time. As for insight, no one has yet demonstrably proved that it is linked to recovery. What actually does help is anyone's best guess -- probably some sort of fire, directly under your behind -- and what leads to relief? Maybe love and work, maybe medicine. Maybe repression. Repression? Isn't that the thing that makes you sick, that splits you off, so demons come dancing back? Doesn't that cause holes in the stomach and chancres in the colon and a general impoverishment of spirit? Maybe not. New research shows that some traumatized people may be better off repressing the experience than illuminating it in therapy. If you're stuck and scared, perhaps you should not remember but forget. Avoid. That's right. Tamp it down. Up you go.
The new research is rooted in part in the experience of Sept. 11, when swarms of therapists descended on New York City after the twin towers fell. There were, by some estimates, three shrinks for every victim, which is itself an image you might want to repress, the bearded, the beatnik, the softly empathic all gathered round the survivors urging talk talk talk. ''And what happened,'' says Richard Gist, a community psychologist and trauma researcher who, along with a growing number of colleagues, has become highly critical of these debriefing procedures, ''is some people got worse. They were either unhelped or retraumatized by our interventions.'' Gist, who is an associate professor at the University of Missouri and who has been on hand to help with disasters from the collapse of the Hyatt Regency pedestrian skywalks in Kansas City, Mo., in 1981 to the United Airlines crash in Sioux City, Iowa, in 1989, has had time to develop his thoughts regarding how, or how not, to help in times of terror. ''Basically, all these therapists run down to the scene, and there's a lot of grunting and groaning and encouraging people to review what they saw, and then the survivors get worse. I've been saying for years, 'Is it any surprise that if you keep leading people to the edge of a cliff they eventually fall over?'''
Based in part on the findings that encouraging people to talk immediately after a trauma can actually emblazon fear more deeply into the brain, researchers began to question the accepted tenets of trauma treatment, which have at their center the healing power of story. In Tel Aviv, three researchers, Karni Ginzburg, Zahava Solomon and Avi Bleich, studied heart-attack victims in an effort to determine whether those who repressed the event fared better in the long run. ''Repression'' is a word that radiates far beyond its small syllabic self; it connotes images of hysterical amnesiacs on magic mountains or mist-swaddled Viennese streets. But in experimental psychology, as opposed to psychoanalysis, repression has far more mundane meanings; it is used to describe those who minimize, distract, deny. Is it possible that folks who employ these techniques cope better than the rest of us ramblers? In order to address this question, Ginzburg and her collaborators followed 116 heart-attack patients at three hospitals in Israel with the aim of assessing who developed post-traumatic stress disorder and who went home whistling. Ginzburg's team was particularly interested in exploring the long-term effects of a repressive coping style; some earlier research demonstrated that those who deny are, in fact, better off in the short term. But there remained the larger questions: What happens to these stern stoics over time? Do they break down? Do memories and symptoms push through? Ginzburg's team assessed its subjects within one week of their heart attacks and then seven months later. During the first assessment, the team evaluated, among other things, the patient's general coping style using a series of scales that reflect the tendency to avoid and to deny. The researchers defined repressors as those who exhibited ''a specific combination of anxiety and defensiveness'' as measured on the self-reported scales.
They found that those patients who had high anxiety and low defensiveness -- in other words, those patients who had a lift-the-lid approach to their experience, thinking about it, worrying about it, processing it -- had a far poorer outcome than their stiff-lipped counterparts. Specifically, of the stiff-lipped stylers, only 7 percent developed post-traumatic stress disorder seven months after the infarction, compared with 19 percent of the voluble ones. <...> <http://www.nytimes.com/2003/02/23/magazine/23REPRESSION.html?ei=1&en=739bbad2e455f1af&ex=1047089975&pagewanted=print&position=top>