The Eyes Have It

The most talked-about treatment in Texas these days for trauma-related anxiety and depression sounds incredible, but seeing is believing.

By the time that vietnam veteran Jerry Smith (not his real name) found his way to psychologist John Black at the Veterans Administration North Texas Health Care System in Dallas in the fall of 1995, he was an absolute mess. In and out of the V.A. system since 1976 suffering from depression, anxiety, alcoholism, and post-traumatic stress disorder (PTSD), he had tried various medications and sat through hours of conventional therapy to no avail. He was an unemployable shut-in: Driving anywhere or visiting the mall—being in any crowd, in fact—made him anxious. He was tormented by sleep terrors, meaning he would wake up in the middle of the night in a cold sweat. And he was so morose that in the previous year he had checked into the V.A. center ten times, five for attempting or considering suicide.

The V.A. first tackled 53-year-old Smith’s drinking problem in the center’s substance-abuse unit, then eased him into occupational therapy. And then, after a few months, Black set about treating Smith’s underlying pathology, combat-related PTSD, with eye-movement desensitization and reprocessing (EMDR), a voguish treatment whose guiding principle is that rapid eye movements similar to those that occur involuntarily during deep sleep can help heal the psychological wounds inflicted by traumatic experiences.

Like many doctors who treat PTSD, Black had initially been skeptical of EMDR’s value when it became the talk of his profession in the late eighties. The brainchild of California psychologist Francine Shapiro in 1987, EMDR sounded implausible, but it gained credibility after she published the results of experiments on 22 trauma victims in 1989: Study after study showed that something about repeated left-right brain activity prompted the psyche to desensitize and reprocess traumatic memories. As word spread, other therapists—particularly those with patients suffering from PTSD—gave EMDR a try, and they too had great success. By the mid-nineties it had become one of the most debated treatment protocols in modern clinical psychiatry. And though some skeptics held firm, there was no denying EMDR’s success rate: 80 percent to 90 percent, compared with only 55 percent for conventional PTSD treatments. No wonder, then, that EMDR was the choice of many doctors treating survivors of the 1995 Oklahoma City bombing. “It can work faster than other techniques, and patients seem to like it better,” says Black, who tried out EMDR in 1991 and has used it in hundreds of sessions since.

In Jerry’s case, Black first took a thorough personal and psychiatric history, emphasizing the traumatic events Jerry had experienced in Vietnam. He then had Jerry rate the level of distress that the memories caused him on the Subjective Units of Disturbance Scale, from zero (no distress) to ten (extreme distress). One incident in particular seemed profoundly troubling—what Jerry called the shoot-don’t-shoot episode. During the war, he and his platoon were ambushed after a patrol and pinned down by a sniper. As they ran for cover, they realized that one of their group had been shot and was down in a clearing directly in the sniper’s line of sight. “Every time we fired on the sniper, he would fire at the wounded man,” Jerry recalled. “But if we didn’t fire, then he was just stuck there.”

Such “double binds,” Black says, are common among sufferers of PTSD. “Many traumas are formed around a damned-if-you-do-damned-if-you-don’t situation,” he says. “There’s the impact of the event itself but also guilt about not having done enough and a sense of helplessness. It can be all the more acute when a life is involved.” To counteract those feelings, Black had Jerry envision the incident in his mind and supplement the memory with smells, sounds, and other sensory components. Then he began moving his hand back and forth, and he asked Jerry to follow it with his eyes. After a minute or two of rapid eye movement, Black told Jerry to take a break and tell him what else had come to mind. “Frequently with EMDR you’re not only processing the traumatic memory,” he explains. “The eye movement will unearth other aspects of the memory or other traumatic memories entirely. When those things come up, we address them with more eye movement. It’s like you’re tracking pathological memories.” The results of Jerry’s first EMDR sessions were startling: The shoot-don’t-shoot memory, which he’d initially given a rating of ten, dropped to zero. “There was immediate relief,” Black recalls, “and that made all the difference.”

Of course, even EMDR has its limits. By the time Jerry returned to see Black the next week, the nightmares and disturbing thoughts had returned, so he went through the treatment again and again, eventually stepping up his regimen to two visits a week. Over time, his distress over his war memories steadily abated to the point that his ratings were consistently down to two or three. Meanwhile, Black eased him back into a normal life, persuading him to buy a car and shop at the mall. “It wasn’t the easiest thing in the world, but I could do it,” Jerry says. He still has an anxiety disorder, and he still has the occasional nightmare, but eye-movement therapy has gotten his PTSD under control. “This is a good outcome,” Black says. “He’s had no drinking, no suicide attempts, and no hospitalizations since he started EMDR. Conventional techniques might have produced the same result, but they would have been much rougher on him.”

So how does it work? Even Shapiro admits that she is at a loss to explain what causes such dramatic psychological healing, but she and other researchers have a few theories. We know, for instance, that the human brain has an intricate system for processing traumatic life experiences. This processing system, which involves memory, learning, and regulating emotions, records the traumatic events in the memory and then sorts through them, absorbing the valuable lessons they can teach (don’t touch the stove top until you’ve checked to see if it’s turned on) and discarding the negative ones. This filtering takes place during our waking hours, when

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