Üsküdar Üniversitesi Founding Rector Prof. Dr. Nevzat Tarhan's opening speech delivered at the Trauma Psychology Congress organized by Üsküdar Üniversitesi on March 7-8, 2020:
First of all, I thank the proponents for bringing the topic of trauma psychology to the forefront as a congress. It is indeed an important subject. Congresses are the best venues for the optimal analysis of this topic and the development of new treatment methods. Congresses are platforms where science advances and thought evolves. Let this congress be the beginning of that. It is beneficial to hold this congress every year. Trauma is a very important field that can influence politics.
Traumas even influence strategic and political decisions. The reason for the US withdrawal from Iraq was the high incidence of post-traumatic stress disorder among American soldiers.
In the US, there are special hospitals for retired soldiers. Many soldiers develop alcohol dependence due to trauma. Patients cannot cope with post-traumatic stress disorder. They try to soothe the symptoms with alcohol. This, in turn, transforms into a different pathology as a continuation of post-traumatic stress disorder. As such situations have increased, there is now public resistance and reaction. Even US soldiers do not want to fight. If there is no comfort where they go, they become restless and do not want to work. This situation influences the strategic and political decisions of the US. For this reason, studies related to trauma have become an important area, especially in psychiatry.
I see that many colleagues do not sufficiently prioritize the field of trauma. When we analyze a disease, we now routinely apply the childhood trauma scale in the clinic. This is because, even in a patient presenting with obsessive-compulsive disorder or anxiety symptoms, high trauma scores can be found in many areas such as sexual abuse, physical abuse, violence, or emotional neglect. Symptoms of post-traumatic stress disorder can be observed in these individuals.
Let me give an example from one of my patients. My patient weighed 130 kilograms. They had all material and spiritual resources. They wanted to lose weight but couldn't succeed. When we conducted an analysis related to their childhood, we learned that they had been subjected to incest as a child. Unconsciously, to avoid experiencing this again, they held the belief: “I must be ugly, I must not be beautiful.” They unconsciously ensured this behaviorally by overeating. While consciously wanting to lose weight, they unconsciously did not. Eating had become an avoidance mechanism for them, a pathological defense. For this reason, traumas are a very important etiological factor in the emergence of mental and physical illnesses.
Furthermore, there are hidden traumas in childhood. Childhood neglect falls into this group. For example, emotional neglect. You might ask how childhood neglect becomes a trauma. Particularly, 'abandonment without distance' is not well known. During childhood, parents can be very busy. They are in the same house, but the mother dedicates herself to cleaning and other chores. The father dedicates all his energy and attention to work. In such cases, even if all the child's basic needs are met, they are still abandoned without distance. When this happens, the child believes that no one loves them. The problem is not that they are unloved, but rather that parents do not spend time or express affection. In such situations, the child feels excluded. Even a conflictual relationship is better than a lack of communication. You might yell and shout, but the child perceives that they are being treated as a person. Otherwise, if you don't even say 'how are you,' don't show any interest, and don't make eye contact with the child, they experience emotional neglect. Children who experience emotional neglect are also exposed to trauma. In such a situation, they say, 'Nobody loves me.' Their self-confidence drops. They start avoiding people and experience a traumatic shock.
Resolving and treating traumas is very difficult and time-consuming, but there are also very effective treatments. For instance, treatments like EMDR. We have seen the benefits of this method extensively in our practical applications. Some therapists are against EMDR, but as a physician and therapist, I do not share that view at all. In traumas, the person may have forgotten the live trauma residing in their brain, but it remains in the unconscious like an extinguished volcano. It emerges occasionally, then subsides again, negatively affecting the person's daily life and increasing their stress. When applying the EMDR technique, forgotten traumas come from implicit memory to explicit memory, and we can resolve them.
I had seen a case of headache that lasted for twenty years. Painkillers, etc., were not effective. When our psychologist colleagues performed EMDR on that person, the twenty-year-long headache resolved in a short time. It was understood that they had experienced trauma twenty years ago, which exacerbated the headache.
I encountered another case when I was working in Erzincan. A married male patient, married for nine years, came to me. He had no sexual relations with his wife. The man couldn't express or experience sexuality. At that time, EMDR did not exist. There was a treatment method called narcohypnosis. We administered a hypnotic drug intravenously, and the person entered a state between sleep and wakefulness. We performed narcohypnosis on the person. We had planned 10 sessions, but after approximately 5-6 sessions, the person said, 'I've recovered.' When we asked how he recovered, he said that his father was not alive when he got married, but he had an older brother whom he considered a father figure. His brother didn't approve of the relationship and therefore didn't attend his wedding. When his brother didn't come to the wedding, the patient felt such a degree of responsibility that it created a traumatic effect. He suddenly became depressed during sexual intercourse with his wife, unable to have sexual relations, thinking, 'How could I do something my brother didn't approve of and didn't attend?' Normally, you'd say, 'What's the big deal!' but for that person, it was significant.
For example, there are people traumatized because their cat died. For them, the cat is an object of affection. It is an important value where they invested their love. Since it is an area where they invested their love, it should not be underestimated. Trauma can be experienced with its loss.
There are many common mistakes made in trauma. Some people, when a loved one passes away, mummify the trauma. They carry a sense of responsibility towards it. They don't change the room, they preserve it as it is. When trauma is mummified, secondary and tertiary traumas can emerge, making the person dysfunctional and depressed. Ignoring trauma can also lead to pathology. Because the person suppresses it, problems arise in other areas. For example, in physiological, psychological, and social areas. Trauma cannot be forgotten, but it should not be brought into today as if it just happened. If you bring a trauma that occurred ten years ago into today with the same vividness, it means you have developed a pathological defense. It is also possible to keep the object of affection alive and avoid guilt by preserving a small memory of it.
Working with trauma requires special effort and skill. Traumas can be overlooked in general psychotherapy practices. It is very important to be able to look at cases with that perspective. For this reason, I thank the congress organizing team for bringing this issue to the agenda.
Questions
Does expressing emotions resolve traumas?
Prof. Dr. Nevzat Tarhan:
Studies on the therapeutic effect of emotional expression have found that expressing emotions has a trauma-resolving effect. However, regulating emotion treats trauma better. When a person merely expresses their emotions, there is temporary relief. But if they cannot balance the emotion in subsequent reactions, more problematic secondary traumas emerge. Therefore, emotion regulation studies, which involve managing emotions directly, are currently considered more rational than just emotional expression. Teaching emotional regulation to an individual enables them to manage their relationships with their environment better.
When emotional regulation is performed, the anterior cingulate cortex becomes active. In 2014, we conducted a Sufi meditation study with our master's students, which was published. In both Sufi and Buddhist meditation, the cingulate cortex is regulated and becomes active. The cingulate cortex is also referred to as the brain's gearbox or rumination box. If a person cannot regulate their emotions, they experience constant repetitions. If you confront them with that emotion without resolution, the person can experience guilt. If you merely bring out the emotion and confront them with it, it leaves the wound open. This is a dangerous situation for the individual. Bringing out the emotion might be done with good intentions, but the consequences can be negative. The person might become hostile towards their mother, father, or anyone they had problems with in the past. They might argue, saying, 'Why did you do this to me?' These, in turn, lead to new traumas. In trauma treatment, it is necessary to bring that past trauma to the present, resolve it, and then put it back on its old shelf. The regulation of emotion, cognition, and behavior must be performed. In this regulation process, action is also taken according to the person's IQ level. If there is a low IQ level, cognitive work is not undertaken. Work should be done directly with behavior. These points should be considered.