It Takes a Community - Page 5

Our biologically based TRM skills are compatible with communal populations because they can be taught to large numbers of people at one time by nonclinicians who are just like them. This enables many people to receive stabilization skills that they can practice independently and teach to others in the family, platoon, school, or village.

As an alternative to reliance on a small contingent of professionals, peer-to-peer interventions offer the possibility of reaching far larger populations and fostering resilience throughout a community. We've seen proof of it in Haiti, where the nearly 100 community "animators" we've trained in TRM-C have now taught hundreds of others. If individuals need clinical or medical care, they can be referred to a mental health professional or physician, in areas where one is available. We're learning, however, that sometimes TRM-C's biologically based stabilization skills can be enough to set someone on a path of hope and resiliency. While there haven't yet been any formal studies that have measured the effectiveness of the TRM-C approach, no other trauma treatment—CBT, EMDR, or any other—has demonstrated its effectiveness with the cohort of troops who've gone through the intense stresses and repeated deployments experienced by our military in Iraq and Afghanistan.

We currently have two research studies under way (one in the U.S., the other in Haiti) that systematically assess TRM-C's impact at the individual and community levels. Preliminary evidence suggests that TRM skills can be taught to large groups, learned by people with low literacy levels, and used in ways that reduce symptoms, even after only one or two sessions.

Military Culture and War Trauma

All work with our troops needs to be "culturally appropriate," taking into account the special context of the military culture and combat setting. Not only does the military have its own language, filled with formal and informal acronyms, but its own organizational structure, values, and expectations, along with rigorous training designed to override our natural biological programming to avoid danger and seek safety at all costs. The life-saving skills warriors learn impart focus, competence, self-confidence, and inner strength that can keep them and their comrades alive in a combat zone.

What makes it even harder for those with war-related trauma and other emotional disorders to get the help they need is that therapists often don't understand the unique, confounding, and anomalous situation of the war zone. As in no other potentially traumatizing situation, troops are predator and prey and witness, sometimes all three at once. We call this role complex the Predator-Prey-Witness triangle (PPW). For example, Joan, who was sent into Afghan villages to ferret out the Taliban, had the job of searching Muslim women suspected of carrying explosives. Armed and ready to engage with the Taliban, she was in the predator role, but she was simultaneously frightened prey, because if one of the explosives she was looking for actually detonated, she'd die instantly or be horribly wounded. She might also be shot from behind by a sniper. While she herself never discovered explosives, she did, tragically, become a direct witness to a traumatizing event—seeing one of her closest buddies blown up.

Under other trauma circumstances, no matter how stressful, the roles and troubling emotional responses called forth by each segment of the PPW triangle are far more distinguishable, because different people are involved or the same person at different life stages. A woman is "prey" when raped, while her rapist is the "predator," though someone abused as a child ("prey") may grow up and perpetuate abuse ("predator"). A witness to such abuse—for instance, a spouse—may or may not intervene, or may also be prey. In combat zones, however, these three roles often are experienced simultaneously, with the corresponding physiological arousal: as prey, the biological impulse may be to flee; as predator, to fight—often with great ferocity and rage (if a buddy has been killed, for example)—and as witness, to freeze while terrible events unfold before one's eyes. Since the battlefields in Iraq and Afghanistan have neither boundaries nor any predictable let-up to the violence, a soldier can be experiencing these states serially or simultaneously much of the time. Add multiple deployments with little chance to decompress in between them, and we can begin to appreciate the difficulties so many of our troops experience when they attempt to reintegrate back home.

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