Dr. Uri Bergmann has heard some horrific stories lately. Several of his therapy patients had worked for the Port Authority, on the 69th floor of World Trade Center 1, and their memories of Sept. 11 are gruesome.
"They saw bodies flying out of the building, and the second airplane hit the south tower," Bergmann says. "By the time they got down those 60 flights of stairs and walked into the plaza, they had walked into a living hell. Several people remember someone who was standing there in the lobby, directing people to exits; they saw something, a piece of glass, fall from the ceiling and cut him in half. They saw bodies and body parts, and remember the smell of burning flesh. When they got out of the building, the second tower came down and the debris -- steel and glass -- was flying for blocks at 300 miles an hour. They had to run, because people were being decapitated."
These survivors became zombies. They didn't sleep; they drank alcohol and swallowed tranquilizers. They were afraid to come back into the city. By the time they contacted Bergmann, seeking help, they were barely functioning at all.
On Monday, three weeks after the attack, Bergmann cured his first patient. He says it took him three 90-minute sessions -- thanks to a therapy protocol called EMDR.
EMDR -- or "Eye Movement Desensitization and Reprocessing" -- has a certain hocus-pocus ring to it, particularly when suggested as the "cure" for a psychic bludgeoning; but in the decade since its discovery, EMDR has proven to be astonishingly effective at helping victims of severe trauma. A process that combines principles of neruoscience with elements of therapy, it is meant to facilitate the healthy processing of grief by using visual and audio stimulation to help patients talk about terrifying memories.
It looks quite simple, even simplistic, to the observer: A patient recalls memories of a traumatic event -- over and over -- while watching a doctor's fingers move back and forth, or while listening to repetitive sounds in a headset. That's it -- a drill that looks a bit like a nightclub hypnotism. Yet after just a few sessions, this methodology has helped the survivors of hugely traumatic events, including the Columbine school shootings, the Oklahoma City bombing, the Bosnian war and floods in Bangladesh.
In the months to come, it also could prove to be the most effective method of dealing with the psychological fallout of the Sept. 11 attacks.
"We are facing a year's worth of work, as wave after wave of people recognize their debilitation and look for help," says Francine Shapiro, a senior research fellow at the Mental Research Institute in Palo Alto, Calif., and the psychologist who discovered EMDR. "The grief you feel after someone's death is devastating initially, and should lessen over time. But many people will find that that isn't happening, and will find later in the year that they need help. We want to make sure we're available to help anyone who needs it."
In the weeks since the attacks, Bergmann has already had sessions with more than 20 survivors; some who escaped the World Trade Center buildings, others who witnessed the event from close range. In his sessions, Bergmann asks his patients to tell him their worst memories of the disaster as they watch his fingers move back and forth or listen to sounds. They also are told to focus on how they feel in their bodies.
"You take them through snapshot by snapshot," says Bergmann. "You tell them you want them to begin with a ho-hum day and walk through it, processing all the disturbances, until they are out in the street after the event and it's over."
The patient then describes the day again, this time with their eyes closed. Finally, they are asked to repeat the events, but to focus on the more positive outcome -- say, that they survived, or saved a co-worker. After 90 minutes, the less traumatized clients will leave feeling relatively symptom-free; for more severe causes, it will take three or more sessions.
Three 90-minute sessions is a blip compared to the years of psychotherapy that traumatized survivors have typically undergone seeking recovery. Practitioners of EMDR say this is because their methodology turns the process on its head. "Traditional psychotherapy is to take something that hurts and think about it -- top down processing," says Bergmann. "EMDR is bottom up -- it's not important to talk about it, but to notice what you are feeling, what you feel in your body. What you think about it isn't important."
Francine Shapiro says she discovered EMDR entirely by accident in 1985, when she realized that certain kinds of eye movements alleviated her own disturbing thoughts. She began working with trauma victims -- including Vietnam vets and sexual abuse victims -- and in 1989 produced her first study. A subsequent study, by researchers in Honolulu, indicated that after 12 EMDR sessions, many Vietnam vets had no remaining post-traumatic stress symptoms. Ten years later, eight more studies by various researchers have shown that EMDR is effective with 80 to 100 percent of civilian trauma victims -- in just one to five sessions.
Because of the focus on eye motion, EMDR has the appearance of hypnotism, but it's not the same; the patient is fully awake and alert during the process. It's also a lot more complicated than simple eye motion -- instead, EMDR mixes certain principles of neuroscience with aspects of therapy, combining elements of all kinds of psychotherapy (psychodynamic, cognitive, experiental and behavioral) with visual and audio stimulation. The process, in the form created by Shapiro, stimulates the natural thinking and grieving processes that have become "stuck" in the victim of a traumatic event.
Researchers believe that an unhealed traumatic memory is primarily stored in the right side of the brain. Additionally, research shows that when recalling severe trauma, the left side of the brain -- which primarily controls verbal skills, logic, and optimism -- essentially shuts down. Therefore, the victim of trauma often is unable to process memories and get them out of their head -- instead, they relive moments over and over in their thoughts. EMDR triggers voluntary eye movements, which some researchers believe results in "accelerated information processing" by activating both brain hemispheres, says Bergmann. (There are a number of variations on EMDR therapy -- some EMDR clinicians use a point of light instead of their fingers, others ask their clients to listen to sounds through a headset, others tap on their client's palm. All are designed to stimulate both the left and right sides of the brain.)
EMDR, though a logical process in many ways, remains somewhat mysterious, even to the therapist who invented it: "The 'why' of EMDR is not known, because there's not enough known in the area of brain physiology to know what the underpinnings of any form of psychotherapy are," says Shapiro. One popular theory is that EMDR forces the same kind of rapid eye movements (or REM) that occur when you sleep; and the function of REM is to process emotion. Others believe that the constant sensory stimulation basically bombards the brain, and activates the frontal areas that have shut down.
The fact is, however, that EMDR appears to work -- quickly, effectively and dramatically.
"EMDR is phenomenal," says Bergmann. "It has sped up everything. After 11 years of practicing it, I'm still amazed."
Bergmann isn't the only therapist in New York who is currently performing EMDR. According to the EMDR Humanitarian Assistance Program, which offers EMDR therapy and training to people in disaster zones, 500 EMDR clinicians have volunteered to treat the survivors of the September attacks for free; and more are calling every day. They've even set up a hotline (917-626-9117 for those in New York City; 800-531-3640 elsewhere).
The EMDR Humanitarian Assistance Program has plenty of experience with disasters -- they've visited disaster sites all over the world, beginning with the tragedy in Oklahoma City. "We got a call about a week after the bombing from an FBI agent who had had EMDR therapy," says Shapiro. "People had already started going into the mental health professionals. He said, 'Can you do something? The mental health professionals are dropping like flies.' ... We trained 200 clinicians there."
Although EMDR clinicians such as Bergmann have already begun coping with the immediate aftermath of the events in New York, the greatest need for EMDR is usually in the year following a tragedy. It often takes survivors several months to realize that they need help. This was the case in Sarajevo, where EMDR-trained clinicians worked with children who were severely traumatized by years of proximity to war and death.
"There is an immediate application of EMDR that can be done strategically, but the primary emphasis is in the following weeks and months," says Barbara Korzun, the executive director of the EMDR Humanitarian Assistance Program. "We see the most need for it in post-conflict cultures, like Sarajevo and Bangladesh, and cultures where conflict is ongoing like Northern Ireland. And the inner cities of the U.S."
Korzun's most recent project in the United States was in Littleton, Colo., where she worked to train local therapists in EMDR techniques to help both children and adults who were still upset months after the attack at Columbine High School. Says Kurzon, "In Columbine, they were seeing severe post-traumatic stress throughout the whole community -- they found EMDR incredibly helpful."
According to Kurzon, child survivors are often the best candidates for EMDR. "Children show more symptoms of stress than adults," she says. "But EMDR works very fast with children because they don't have layering of memories that adults have. Even severe trauma can be resolved quite rapidly. We're just readying to do a training for those working with children in New York City."
The aftershocks of the World Trade Center will resonate in the minds and hearts of its survivors for months or even years; and this, say EMDR researchers, is why EMDR will play a key role in their recovery -- now and later.
"In the aftermath of a tragedy such as this, with unresolved grief and pain, reactions can be uncontrollable anger; or numbing, withdrawal and depression," says Shapiro. "You can imagine parents who have lost a loved one manifesting these symptoms, and see what devastating effects it would have on their children. You set up problems which will be ongoing for many years. The bottom line is pain begets pain, suffering begets suffering."