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Book Review, John Marzillier, Psychiatry, Psychological Therapies, Psychology, Psychotherapy, PTSD, To Hell and Back, Trauma
A wise, thoughtful, compassionate and skillful book about PTSD revealed through the words of those who have experienced this.
It’s funny how synchronicity works. Because I read Noel Hawley’s highly recommended Before The Fall, which I highly recommend, and which features a small boy who suffers a profound traumatic event, and clearly would be diagnosed with PTSD, and because I have a professional interest in the subject, I was reminded that John Marzillier, a British clinical psychologist and later, psychotherapist had written a book on the subject.
I had been moved and beautifully taught much in another book by him, The Gossamer Thread, where he explored his wide journey of development as a practitioner, and the deep exploration, refining, and ambiguity in human relationships that happen throughout all our lives, within and without any kind of formal therapeutic setting, simply because human beings are complex, and so each and every encounter between self and other is fraught with – an endless possibility.
Duke and Duchess of Cambridge and Prince Harry: Promoting the charity Heads Together to open up discussion of mental health issues
So, I started to read the in some ways, more geared towards the practitioner, slightly more left brain, slightly less poetical/metaphorical To Hell and Back: Personal Experiences of Trauma and How We Recover and Move on. And during my reading and reflecting period, mental health, particularly linked to the experience of dealing with psychological trauma, suddenly became positive news, due to Prince Harry, and also Prince William, speaking openly about the deep, hidden effects caused by their mother’s death. Public figures speaking out in such a way, honestly, – particularly public figures who are, not being rude, part of the Establishment rather than famous for flashier, sex-and-drugs-and-rock-and-roll lifestyles, not to mention ‘reality TV’ famous only for being famous ‘stars’, will be listened to more seriously.
Expression of emotion is more common, and I would say, generally a good thing, with the exception of the artificial stimulation of emotion in reality TV shows!
But, he also cautions against those who assume it always IS the right approach to bare the suffering soul:
Is avoiding talking about feelings always wrong? I do not think that one can or should make such a categorical statement. So much depends on the context and the person, not to mention their relationships with family and close friends and on timing
Focusing on a wide range of traumatic single events – Marzillier in this book is exploring the kind of ‘out of a moderately clear blue sky’ unexpected and traumatic event, rather than, say the trauma of repeated brutal events from early childhood – the author looks both at the unpredictable horrors caused by acts of deliberate chosen malevolence, and the impersonal ‘being in the wrong place at the wrong time’ of major accidents like train crashes due to mechanical failures. Marzillier was, for many years, employed by Thames Valley Police, working with those who have to deal with traumatic events, which arise out of the nature of their work – police, firefighters, army personnel, ambulance personnel. The professionals have to maintain a distance from their own natural ‘alert! Danger! I am under threat! autonomic nervous system response of flight, fight, freeze or dissociation which is our physiological survival response. The fact that they are trained to do this, and have techniques to use, cannot ever completely over-ride that ancient animal response, and this kind of ‘trauma is my 9-5, day in-day out worker’ may well find health problems which arise out of the continual overriding of the normal response to danger – get out of here!
How people feel and behave once they are out of danger and the traumatic event is over is a product of the intensity of the experience itself, the nature of the person and the context – that is, what their life is after the event
As in his previous book, what most blazes out, necessarily and importantly, is Marzillier’s artistry, his compassion, his flexibility and his open-ness to meet each individual he interviews for this book, making space for a joint exploration of their stories. Time and again he cautions against the single fix-it approach to PTSD – and, indeed, to the single, fashionable diagnosis of the condition. There may be other mental and emotional health issues experienced by someone who has been in a ‘traumatic’ situation, and other approaches, other diagnoses may need to be made. Don’t jump to a PTSD conclusion, he cautions.
It is a mistake to sweep all post-trauma psychological reactions into one simple category, or to assume that if someone shows PTSD symptoms then nothing needs to be done but treat the person’s PTSD
At the heart of this book, is the often stated central idea that whatever ‘the diagnosis’ says, that it is a unique individual with all their individual personality, history, belief systems and social networks who is receiving the diagnosis, and there CAN be no ‘one way’ of treatment. As in Gossamer Thread, Marzillier stresses it is the relationship between practitioner/clinician and patient/client which actually matters MORE than any ‘specific’ method. Sure, the practitioner must have relevant skills which can work in this field, and preferably, the flexibility and skill to acknowledge that ‘their’ skillset may not be the right one for THIS client at this point. Marzillier even acknowledges that treatment approaches which lie outside his particular belief system and training, DO work for some people, – with the right practitioner. He is extremely open-minded, whilst being at the same time, a scientist by training.
This book has a lot, highly relevant, to say to both the clinical psychologist and the ‘energy worker’ working in this field.
It is a marvellous book, serious, analytical, warm, open minded and hearted – and, always important, beautifully written, and authentic – he has allowed the individual voices of the many people he interviewed in this book – those who had experienced events, and been diagnosed with PTSD – to recount their stories, and the different treatments and outcomes. These are not, in the main, ‘his clients or former clients’ . They are people who chose to respond to a general request made ‘public’ when he was planning on writing a book on this subject.
Lady Fancifull 
This is such a difficult topic, one that has touched my life. I have a brother who was a firefighter/paramedic. He’s put several of his friends into body bags. He’s also has several traumatic brain injuries from ceilings falling in on him or falling into pits while fighting fires. And he’s not one to talk about any of his feelings. So, I’ve often wondered how some kind of treatment would have changed how he currently deals with the world. But that’s all I can do—wonder. Thank you for reviewing this book.
I’ve got another school fundraiser literary dinner coming up with Shanthi Sekaran, author of Lucky Boy. I think you’ll like the book. Will be reviewing it sometime in May. Cheers!
It’s always a pleasure when you drop by or appear in my reader, Jilanne. I am aware that there are a lot of people whose work involves daily encounters with the stuff most of us hope never to encounter. And i have huge admiration for them, without being able to understand how a purely animal response – survive, escape from danger – can get chosen and overridden. I can’t see how people can do these jobs without damage to themselves. One thing I suppose must happen (as a plus) is the knowledge that you really HAVE made positive, meaningful difference in the world. Without your presence and your actions, individuals would have died. Absolutely heroic.
When a traumatic event affects a whole community (such as the severe earthquakes my city experienced some years ago), then among those affected are children (who may also be living in disrupted homes with stressed parents). This turns teachers into wellbeing practitioners first and educators second (and some days, friends told me, they didn’t get much past supporting wellbeing). I absolutely agree about the individual pathways and needs that individuals have, even in the face of a common disaster. In my work, I noticed that some individuals who may have had some mental health vulnerability, but who were managing their lives well, in the face of these traumatic events, had their coping overloaded and needed to seek assistance. The seriousness of the events seemed to allow some other previously vulnerable people to reach depths of resilience they didn’t know they had.
Very perceptive, underrunner – it’s also something Marzillier touches upon, that some people do find ‘depths of resilience’ though he is of course careful not to make value judgements on those who are overloaded. One of the reasons he eschews one size fits all treatment protocols is precisely because the method a therapist may prefer may not work with THIS person, with their specific personality and prior history
That makes complete sense, that the ‘everyday, repetitive trauma’ and having to overcome it and be resilient might work for some of us for a while, but in the long run can prove very destructive. I also like what he says about there being no single fix-it approach.
Yes, to me that is the hallmark of a truly wise and skilled practitioner, to NOT think ‘my method, MY approach, ME’ will work for everyone, even if it is treating the same presentation – the presentation is always afftecting THIS unique individual