onsdag 13 november 2013

Acupuncture as aid-work to treat PTSD: treating refugees, aid-workers, and helping to heal trauma

Darkness is falling outside the windows. There is a big city outside; at a distance, I can see cars travelling by like glowing lines of light. Straight-backed street-lights are proud guardians who spread light in their lives. If I opened the windows, I would smell the scent of the rain that fell before: it has created canvases of light and shining asphalt. But I stand here and look out, because the chairs are in place, and I am waiting. Waiting for them to come.
There is a proverb that was very popular during WWII: those also serve who stand and wait.
I am here to treat refugees in a free treatment-program. I have done it for several years, here and in other places. The acupuncture from Chinese medicine and the ear acupuncture helps them when they are in situations that few Swedish people will ever understand, and it helps them after they have been in situations most Swedish people would see as nightmares. Things that can only happen in the most feverish sleep one can imagine, but never in real life. Never in real life.
  Few Swedish people can imagine what refugees have fled from. Thankfully. Most of us have had the luxury of growing up in one of the richest and most peaceful countries on the planet, and part of that luxury is to take it for granted. We live in a society where corruption does exist, but it´s a whisper in the background; few of us can imagine what it´s like to live in a society where there is barely a judicial system, where every civil servant demands bribes from you, and where the police just laugh or even threaten you or rape you again if you try to report anything to them.
If we are lucky – because it shows that we have the ability to understand what humanity is – we have empathy enough to understand what might have happened to another human being. If we are even luckier than that, we have the ability for sympathy that forces us to act, that forces us to stand straight and help out.
I stand and wait. This is the time before, the bated breath before the song, the silence that makes the music exist. The room is full of emptiness, and the promise of people coming in search of becoming more whole.
  Then they come, one by one.
First a refugee who has problems sleeping. He is only 17. ”Problems sleeping” is a laughable description of reality; as soon as he closes his eyes, he sees armed soldiers beat his father and threaten to rape his mother and sisters. But those images he is used to.
  What really disturbs his sleep is that he is lying on full alert, the smallest sound makes his arms and legs twitch in readiness, adrenaline kickstarts his kidneys and his heart suddenly beat fast and hard, like it was a bird caught inside his chest. What really bothers his sleep at one in the morning, just when he begins to slumber, is being torn awake by fear, because he sees the images of the bomb on the block next door back home: the pieces of bodies everywhere, the blood that looks so fake compared to the movies, just lying there in sheeths and clumps coagulating everywhere, and he remembers the faces of some of the pieces lying there, and it´s those images he is trying to avoid looking at and sleep instead. But he can´t. So he lies awake. Because he never wants to see them again.
The acupuncture in Chinese medicine and the ear acupuncture has begun to help him heal. He sleeps, after treatments, sleeps quite alright for several nights in a row, and he is beginning to relax more with sleep now, because he knows he can actually sleep again. He has learned that now. The acupuncture has also started to heal his internal organs and nervous system from the constant stress he has lived with most of his life. He is only 17, and at the same time, the acupuncture helps him calm down to learn more easily in school.
   People who are traumatized often get learning problems. It is rare that people like him get any help from psychiatrists in Sweden. Mostly, they just adapt, especially if they come from an environment where everybody has been through the same thing. But they must not only get used to that, they must also get used to carrying these memories while trying to live a new life in a peaceful, but very different, country.
   And sometimes, with peace, memories catch up.

A second refugee comes in together with a volunteer from the organisation helping them. His leg hurts. Why? A knife-stab. Right. When? When he was fleeing. In Italy. And sleeping problems. He is just entering the asylum process and is deeply worried about the outcome. Before this, life was uncertain, but now he can get a ”no”. I don´t ask anything more, I just begin to take his diagnosis in Chinese medicine and then to treat him.

The volunteer with him also sleeps badly. She is tough, and she knows what she is doing, but she has done it for a year. She has heard too much and worried too much. She has seen several refugees live in panic up close, and the stress is simply catching up now.

As I begin to palpate meridians and acupuncture points, before gently putting in the needles to heal his leg and the rest of his health, I ask her to sit down at the back of the room, where I put those who need ear acupuncture. Just sit down over there and land, and I will come over.

I go and manipulate the needles to help the first refugee. He looks so young. Thin, skinny. That clarity in the face that sometimes comes with too much pain. He is already sitting half a sleep on his chair, a weak smile on his lips, as I turn up. He knows he will sleep tonight. Sleep, for real.

I walk over to the volunteer. She is also young, 23. She is part of that small group of Swedish people who actively work to improve society. I have a lot of compassion for those who invest back in society, for those who want to help out. It is us who know that when people stop doing that, the fall slowly begins, those first steps of the slow fall that leads to us becoming a country to flee from, instead of to.
   She is tense, with dark circles under her eyes.

There hasn´t been one big thing, nothing dramatic has happened, just a long stretch of small disasters, small lessons most never have to learn, small shards of pain borrowed from someone else´s life.
Gently I put in the needles for the ear acupuncture. Five in each ear, and one hand on the shoulder at the same time to help her relax. Once all are in place, she closes her eyes, and just sits there as relaxation spreads through her body and mind again.
I know that if I open the window, the rain-scent of the city will come in, and the car-sounds from people having a safe existence and a pass-port in their drawers, one that can be renewed at the police office without being afraid to go through the doors.
Stress comes in many versions. All the way from what has become ”every day stress” in Sweden, a society with way too high speed, and up to what is termed traumatic stress. In a common diagnostic handbook in psychiatry – DSM, Diagnostic and Statistical Manual of Psychiatry – now on its fifth version, traumatic stress is usually seen as something that should mostly dissolve within seven days. If it continues to bother the person´s every day life after that, it is called posttraumatic stress disorder, or PTSD. If it persists after thirty days, it is called chronic PTSD.
  Traumatic stress used to be defined as ”seeing things that we are not expected to see as part of a normal life”, a definition that has been changed a lot since then. It can be to have a traumatic event happen to you, but also see it happen to someone else. The most common reasons for PTSD is violence, rape, natural disasters, or seeing someone else get attacked or in injured. But it might also be getting the diagnosis of a severe illness, maybe cancer, and then living with that. It can be being a family-member to someone who has had traumatic events happen to them – this is called secondary PTSD.
  To listen a few times too many to people telling you about traumas they have had, can give what is called tertiary PTSD.
Of those who have had traumatic events happen to them, only a very small group go on to developing PTSD. It is a completely natural reaction to seeing very bad things happen. But if they get it, it can often dominate every day and every night with traumatic memories.
I turn back into the room, away from the dark of Autumn and the pearl necklace of lights outside, and look at the three sitting in the first treatment-session. The first one is done now, and I gently take out his needles. He smiles, almost sunnily, and thanks me, still a bit half asleep as he leaves.

I adjust the needles to help out with the pain in the leg of the other refugee. It is a deep scar, into the knee. He has some on his arms too, long, deep ones. I am used to seeing them in the refugees I treat. And these are just the visible ones. Visible scars are always easier to see. I have added needles to help him sleep better too. Just goin through the asylum process can be really hard, caught in the hope of safe haven and the fear of having to go back.
I look at the young woman sitting at the back. She sits there, quiet and relaxed, with eyes closed. I don´t bother her, just let her sit. She will also sleep a lot better tonight.

If memories of traumatic events stay too long and begin to affect us every day, this is usually called posttraumatic stress disorder. If someone has this, symptoms include (but are not limited to) nightmares, flashbacks (quick or longer sequences of memory of the event, intruding during the day), and thoughts and ways of thinking that one can´t get out of, negative thoughts often linked to the trauma and what happened.
Symptoms include a heightened sensitivity to sounds, to lights; a sensitivity to other people´s movements that makes us want to jump out of the way even though they didn´t try anything threatening. It also includes a severely lowered ability to trust others, and a lack of seeing any hope in the future. 
Some only get some of these, others get all of them. Some get milder versions, some get severe ones, so severe that they can no longer work.
Some become afraid of crowds, or open spaces. PTSD is just memories that have become stuck, memories from events that were too strong for us to deal with them at the time. Now we are stronger, more adult and older; now it is easier to see what we have learned from them and then let them rest where they are in the past, so that we can live and walk freer into the future.
PTSD can catch up one or two years after traumatic events too. Something might have been lying dormant under the surface, and then something happens again, something small, and everything breaks. This is why the calm before the storm, or all the time you have in peace-time, paradoxically can make people worse as there´s finally time for the memories to catch up.
There are two general kinds of PTSD: the first one is the obvious one, the film version, where something big happens and we re-live it for a while before we slowly heal and it goes away.
  The other one is called PDSD – Prolonged Duress Stress Disorder. This is where there has been not one big thing, but a long stretch of small traumas for a very long time, until things finally snap. PDSD is more common in social welfare work, for police, and people who live with violence or threat for a long time at home or in the workplace. Swedish psychiatry can usually recognize the first one, but is rarely trained to see the second.
In jobs like that – and within different kinds of aid-work – one needs to have a continual check on the stress levels in life and just gently take care of them, like keeping an eye on a garden or a beautiful flower-box outside the window. You need to look at them every now and then, water, add fertilizer, and check so that weeds are not spreading among the flowers.

PTSD can be treated and allowed to heal again. Western medicine most often uses psychopharmaceuticals, and, in best case, talk therapy together with CBT, Cognitive Behavioural Therapy. Sometimes people are unfortunately just put on psychopharmaceuticals and more or less permanently left to fend for themselves.
PTSD is very treatable with acupuncture in Chinese medicine, if the practitioner is trained how to do it. Same thing with NADA ear acupuncture. There are also techniques in communication-training that I work with that are very effective. I have treated many with them. Seen, again and again, the freedom people can have from memories who used to feel like chains for them.
I withdraw the needles from the ear acupuncture and smile as I see how much more relaxed the young woman is. While she sits there and gently wakes up, I withdraw the needles from the man with the old stab wound. As he gets up, and tries the leg, it is a lot stronger, the hip doesn´t hurt anymore, nor does the knee. They both look relieved, happier, as they leave.
If we are lucky – because it shows that we have the ability to understand what humanity is – we have empathy enough to understand what might have happened to another human being. If we are even luckier than that, we have the ability for sympathy that forces us to act, that forces us to stand straight and help out.

Daniel Skyle © 2013