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An important approach to the treatment of post-traumatic stress disorder (PTSD) involves narrative processing of traumatic memory. This is designed to undo the ongoing distressing effect of the traumatic experience intruding on the patient’s current life as PTSD symptoms, depression, and dissociation. Narrative processing collects and organizes the fragmented images and perceptions of the trauma into a coherent verbal structure with a beginning, middle, and end. Now the person can assimilate the fragments collected in verbal memory as personal history. The impact of the trauma is no longer stunning in the present tense and no longer feels like an unending threat. The experience can finally be examined in the light of present awareness as a remembered past event.
It is extremely difficult to simply recite a traumatic experience. Outside of verbal awareness, memory fragments rot like “memory shrapnel” and prevent narrative closure. Enlisting the help of the “mind’s eye” and right brain imagery 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 the narrative it is observing and describing through the perspective of a hidden observer. It is helping to protect the person from reliving the experience.
Methods for recruiting the mind’s eye for narrative processing work rely on visual imagery, although many of the memory fragments may not be visual. They can consist of bodily sensations such as pain or pressure or feelings of terror. Whatever the content, its 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 narrative while resisting the subjective pull of the unfinished experience and avoiding reliving the experience. Once narrative closure is achieved, there is no longer any attraction to the traumatic experience.
the hidden observer
In the 1970s, research psychologist Ernest Hilgard experimented with hypnotic induction of analgesia and found that a hidden observer could be elicited from subjects who claimed to feel no pain. He asked for a report from a part of the subject that felt the pain and could rate the severity. Some subjects responded from a part of themselves that they were aware of the pain and could rate it on a scale of ten for as long as the subject had claimed analgesia. These elicited parts were very similar from subject to subject. The part was normally hidden from the subject’s consciousness, although the part claimed to have always been there. The dispatcher was aware of the experimentally induced pain (produced by ischemia of the arm deprived of circulation due to the tourniquet effect of a sphygmomanometer inflated to a pressure greater than systolic) but the dispatcher denied suffering. Dr. Hilgard designated these parts as “Hidden Observers”. The Hidden Observers claimed to be spectators to the person’s experiences at all times, whether the subject was hypnotized or not. They played no role in the execution of the action and did not participate in the subject’s emotional experience.
Over 90% of patients undergoing hypnosis in a trauma intensive care clinic were able to release a Hidden Watcher. After hypnotic induction by progressive relaxation, the patient visualizes an imaginary scene and performs the imaginary action of leaving the body and observing the body from the outside. The therapist refers to the viewer as the Hidden Observer and points to the patient’s capacity for emotional detachment. The hidden observer then temporarily leaves the patient in the imagined scene and goes to the moment of 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 “he” or “she”—and telling the story from beginning to end. The narrative is recorded on videotape for later review by the patient in a normal waking state. The hypnotic session ends after the Hidden Observer returns to the self left behind in the imagined scene.
Reviewing the videotaped narrative in the waking state completes the hypnotic narrative processing. The patient and therapist watch the played videotape together. Now the patient no longer has the emotional distance of the Hidden Observer. The patient may only vaguely remember much of the narrative, and there is a risk that a new experience of the trauma will be provoked. If this happens, the therapist will stop the tape and help the patient ground himself.
There is usually little or no activation or abreaction with the tape review. This is positive because the abreaction interferes with verbal narrative assimilation. There may be an element of desensitization in the review. Emotional desensitization can also decrease assimilation because the patient may escape full confession or appropriation of the experience and instead feel as if it happened to someone else. If this fault is not corrected, all narrative processing must be repeated.
Generally, when processing is repeated, the second narrative is more detailed and complete, allowing to fill in the gaps that were not detected during the first. When this still does not relieve the intrusive symptoms of PTSD, the cause may be that the symptoms stem from prior trauma. The patient may have to search for unremembered traumas, such as preverbal ones or missed 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 perform trauma therapy quickly and safely without retraumatizing the patient.