A conference entitled Healing the Wounds — Dealing with Trauma took place in Gloucester on October 8th. It was organized by the local branch of the charity Survivors of Bereavement by Suicide (SOBS), a self-help organization for people who have been bereaved by the suicide of family members or others close to them. I was able to obtain a place at the conference through Gloucestershire LINk.
The word ‘survivors’ in this context seems slightly strange to me, as it seems to imply a shared threat that resulted in the death of one family member while all the others escaped. That seems to deny the reality of a suicide victim’s isolation and pain, somehow. And I thought that at the conference there was a feeling always in the background, only occasionally surfacing, of family members being victims of failure by services like the NHS or police, resulting in lingering and unresolved anger.
Also unresolved was the question of how the medical diagnosis of the mental illness post-traumatic stress disorder (PTSD) differs from grief after someone has died. One presenter even introduced a third category, unresolved grief, implying that it is a separate mental illness. It seems to me that there has to be some acknowledgement of normal grief in all this, and some way to differentiate between normal adjustment processes and mental illness, but the conference did not consider these things.
What are the signs of PTSD?
After some introductions by representatives of the 2gether NHS Foundation Trust (Gloucestershire’s mental health trust) and of SOBS, the conference immediately split into discussion groups to consider the question, “What are the signs of PTSD?”
The group I found myself in quickly filled a page with possible symptoms. It seemed that every symptom of every conceivable mental illness could instead be caused by PTSD, making a nonsense of diagnosis. This weird, to my mind, labelling of every distressing mental state in exactly the same way was echoed by the first presenter.
Dr Claudia Herbert
Dr Claudia Herbert gave a presentation on the treatments for PTSD provided by her private psychology practice, the Oxford Development Centre, at its Oxford Stress and Trauma Centre branches in Witney and Stroud. It was unfortunate that the presentation overran leaving hardly any time for questions.
Her centres employ a very complicated four-phase treatment process, tailored to each individual patient, and a bewildering array of treatment approaches. The latest treatment approach is one she has invented herself, called Positive Growth Therapy. I cannot find any information about it to link to.
The NICE guidelines for treatment of PTSD, she explained, only apply to a limited number of very simple cases. Many cases are complex and can take a very long time to treat.
Much of the presentation’s content seemed fairly trivial, and it was delivered in a soporific monotone that made it easy to nod along. Among the trivia, though, she would slip in assertions that are perhaps questionable, such as that survivors of suicide may not seek help because they do not understand PTSD. It may be true that they do not always seek help, and it may be true that they do not always understand PTSD, but slipping ‘because’ in there makes it a different proposition altogether.
At one point, Dr Herbert confirmed her belief in the idea that most mental illnesses are really PTSD in disguise. She did not explain, though, how using one label for all would actually help anyone, and I thought there was some irony in the quotation (from The Zen of Seeing by Frederick Franck) that she ended with:
By these labels we recognize everything but no longer see anything.
He seemed to be attempting to make the workshop into some kind of humanistic group therapy session, but whatever it was he was attempting, he completely failed in addressing the question in the workshop’s title. He led a rambling discussion that never really got going because he constantly interrupted. At one point he even stood up and declared, “I’m not getting where I think we need to go.”
He appeared to have two axes to grind. One was that SOBS should set up its own counselling service. A SOBS member tried to explain that SOBS’ whole ethos is based on survivors helping each other, not on their receiving counselling from professionals who have not themselves suffered bereavement by suicide, but the message did not seem to get through.
The other was that some counsellors are just ‘jokers’, whatever that means. Again verbatim from a discussion about referral, “You don’t want them going to any old joker.” Jokers were a recurring theme. At one point he seemed to think that training and registration with a professional body would ensure that a counsellor is not a joker, but then he changed his mind and remarked that some trained and registered counsellors are jokers too.
It was disappointing to see someone attempt to lead a discussion with such poor skill in understanding or reflecting what people said to him. His judgemental remarks and abrupt changes of subject showed little respect for his audience of professionals, experienced volunteers and survivors. His defensive body language and extraordinary reluctance to share his own views in the discussion made it seem that he was trying to be something he was not.
Barbara Martino, a private psychotherapist in Stratford-upon-Avon, gave two presentations in her session, which was entitled “Suicidality and self-harm”. The first was about the treatment she provides for PTSD, and the second was a standard presentation on suicide prevention. Suicidality was barely mentioned, and self-harm not at all.
In her psychotherapy practice she mostly deals with childhood trauma and chronic pain. The two are related because chronic pain can be caused, she believes, by a ‘body memory’ of trauma, even when the patient has no actual (‘narrative’) memory of the trauma. She revealed that some of her patients have taken their own lives recently.
She seems to know a lot about the way the brain and the body work, and she spent some time describing brain scans showing how trauma increases activity in certain areas of the brain, with effective treatment reducing the activity. Trauma also has effects on the body, which she is able to identify in clients’ posture and movements.
She uses a variety of treatment methods with her clients. They include EMDR (a technique based on eye movements) to allow the client to tell their story, sensory-motor therapy to address body memories of the trauma, and mindfulness to change the client’s thinking habits.
Her presentation on suicide prevention was part of a standard presentation from the American Foundation for Suicide Prevention. While this is a good presentation, and she delivered it well, I wondered whether her audience of professionals, experienced volunteers, and people who have already been bereaved by suicide, gained much from it.
Overall, she seemed a relaxed and well-informed presenter who enlivened the session with many anecdotes, and who responded to questions and comments with empathy and warmth. It would have been good if half the session had been set aside for us to talk with her.
John Peters is a suicidologist — that is, a person who knows a lot about suicide. His great strength is that he knows a lot about suicide. His great weakness is that he knows a lot about suicide. He gave a fairly tedious presentation in a stuffy room that was just too small for the size of the group.
He seems to be very involved with the SOBS helpline, although he never made it clear exactly what his involvement is. The helpline is run by volunteers, on 0844 561 6855 every day from 9 a.m. to 9 p.m. He is also an author, having written several booklets and a new book, to be published soon.
The impression he gave was that he has a dogmatic fact-obsessed approach to everything related to suicide. For example, a delegate remarked that religious people may believe suicide is a sin, but he countered this with statistics about suicides in the Bible, and a short rant about the Pope, completely missing the point, it seemed to me, about having to deal sensitively with people’s beliefs.
I would not like to be on the receiving end of that kind of treatment if I telephoned a helpline in distress. Perhaps, though, he was unnerved by having to give a presentation, and is quite different on the telephone. His presentation was far too long, and it had to be cut short when time ran out.
Various organizations had exhibition stands or displays of leaflets at the conference. The ones I noted were:
- Age UK
- beat (eating disorders)
- Cheltenham Trauma Clinic (private psychotherapy)
- Gloucester Rape Crisis Centre
- Oxford Stress & Trauma Centre (private psychotherapy)
- Rethink (mental illness support)
- Samaritans (emotional support and suicide prevention)
- Winston’s Wish (childhood bereavement)
Strangely absent was the organization that had obtained a place for me at the conference, Gloucestershire LINk. A couple of people read my name badge and asked me what LINk is, as they had never heard of it. This all gave me the impression that LINk’s publicity is half-hearted.
This was a very interesting conference with several strange features. Though run in collaboration with an NHS Trust, all the presenters were from the private sector (except for the last, who was from SOBS but nevertheless advertised his book).
NHS services were hardly mentioned by presenters, except right at the start when they were criticised, and again right at the end when someone asked a question about them and received only an evasive answer.
The presenters never got to present to the whole conference in the main hall. Their so-called workshops were just lecture presentations with a few questions, except for the one on counselling, which tried to be a workshop and failed.
The LINk was not formally represented, and SOBS took on the LINk’s role, in effect, by inviting delegates to submit comments, both good and bad, about our experience of support services.
There was an amazing mix of delegates — NHS, police, army, private sector, voluntary organizations, and SOBS members. It was intense and engaging, and I had a great time, but I really don’t know what benefit there is in giving a few providers of private sector services such an advertising opportunity.