Wednesday, April 10, 2013

The King's Speech

The King's Speech might be the best movie about trauma therapy to come out in the past 10 years. The video quality is poor, but this scene is rather well done.

Other, similiar films that give reasonable depiction of trauma therapy that come to mind immediately are Good Will Hunting, The Prince of Tides, and Ordinary People. (Caution: Those three are not recommended for a single weekend's viewing.) (David Cronenburg's A Dangerous Method, while excellent, focuses more on the therapists than the therapy.) The first season of HBO's In Session with Gabriel Byrne also does a good job of portraying, to a certain extent, what psychotherapy is like. You always have to recall what F. Scott Fitzgerald said about the danger of making screenplays too realistic -- if you portray life as it really is, you will only elicit two emotions: boredom and disgust.

Frederick Woolverton, Ph.D., director of The Village Institute for Psychotherapy in Manhattan, wrote this nice piece on The King's Speech for Psychology Today. Without saying so directly, it's a brilliant slam against the commonly used cognitive-behavioral treatments.

[Begin Excerpt]

The King's True Trauma

It's nice to see trauma therapy depicted well on the big screen.
"Hollywood isn't always kind to my profession, so as a Manhattan psychotherapist it was with trepidation that I saw The King's Speech, a movie depicting the therapeutic relationship that helped King George VI overcome a crippling speech impediment. The winner of four Academy Awards, including best picture, generated good will among critics and viewers of all ages. I too came away delighted, yet I was curious. How could a gentle, feel-good film get something so right that so many of my colleagues get so wrong?

The movie is, indeed, enormously controversial- not for its depiction of the sympathies of Winston Churchill (another stutterer, by the way), or whether the speech therapist, played by Geoffrey Rush, really insisted on calling the future King of England by his family nickname, Bertie. Without realizing it, the movie takes a bold, saber-rattling stand on a topic the recalcitrant medical community barely acknowledges: that most speech defects are actually outward manifestations of childhood trauma.

In The King's Speech, Bertie (at that time the Duke of York, second in line to the throne after a brother who later abdicated), played by Colin Firth, tries every remedy of the day to cope with his debilitating affliction. The future Queen Elizabeth (Helena Bonham Carter) drags her husband to one last resource: Lionel Logue (Rush), an Australian actor and self-styled speech therapist. Logue has no medical credentials - relying instead on empathy, intuition, and his work with traumatized and speechless victims of WWI. He sees that his royal patient's stammer is not rooted in mechanical breakdown, and proves it by having Bertie read aloud from Shakespeare while headphones blast music into his ears. When the future king finally listens to the resulting recording, he hears only the sound of his own voice mellifluously reciting from the Bard.
Logue is more of a psychotherapist than a speech therapist, which is how he knows the future King has more than a speech defect.

It did not surprise me to learn that the screenwriter, David Seidler, also stuttered in childhood. In interviews, Seidler ascribes his early condition to the trauma he experienced as a toddler during WWII, including his family's displacement. Through Seidler's own childhood trauma, he has managed to articulate treatment details for stuttering that few in the psychology and psychiatry field understand.

I, too, suffered from a "speech defect" that began in childhood. When I was called upon to speak in class, all I managed were unintelligible, grunted syllables-or nothing at all, just as we see in The King's Speech. Years later, I learned to teach, speak and lecture with fluency. I didn't get there by trying Demosthenes' marbles in the mouth. Nor did King George VI, for a reason the movie makes clear: It's pointless to work on the symptom when the underlying cause goes unrecognized.
In the case of King George VI and many patients with speech impediments worldwide, the problem is Developmental Trauma Disorder. The traumatic triggers refer to an experience that is emotionally painful, distressing or shocking, and often results in lasting mental and physical effects. We usually think of trauma as a single, explosive isolated event such as 9/11, but it can also be a series of related events, such as being on the frontlines in wartime, or - in my case - growing up with an abusive, alcoholic parent.

Unfortunately Developmental Trauma Disorder isn't in the forthcoming edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Dr. Bessel A. van der Kolk, M.D., of the Trauma Center at the Justice Resource Institute in Boston, petitioned last year for inclusion of this new diagnostic terminology, based on his research into the neurology of trauma, and was rejected.
But if you want to know more about this prevalent problem, it's right there in The King's Speech. People with this kind of trauma are controlled by their own tortured psychology. They feel unsafe, bad, defective, wrong and inadequate. It strikes regardless of vocation, social standing, education, success, race or gender and might inflict a screenwriter, a psychotherapist, or a future King of England.

Traditionally, the theory behind trauma treatment is that you relieve the pressure of haunting memories when the individual talks about it. Yet research shows that Developmental Trauma Disorder affects a part of the brain words can't reach-the limbic system, specifically the amygdala and hypothalamus, all lower in the brain and far from the cortex, the seat of thinking, logic and reason. This is why the understanding and insight produced by "talk" and behavioral therapy doesn't fix trauma. The patient doesn't hear it. The traumatized brain cannot process the words.

Consider Logue's methods: singsong, guttural utterances and curse words, physical movements such as rolling on the floor. The patient's intellectual grasp of his condition is irrelevant. Although Bertie eventually opens up about the childhood abuses he endured: humiliation and criticism, harsh disapproval of his father, King George V, the leg braces he was forced to wear and sexual abuse by a nanny. Yet healing is the product of the developing trust between him and his therapist. Since trauma involves a psychological injury resulting from multiple, chronic, prolonged, developmentally adverse events, treatment requires the establishment of intimacy. Logue knows he has to create a "safe place" for his patient: "I will call you Bertie, and you will call me Lionel."

Many therapists today have difficulty endorsing a strategy of healing intimacy. Yet there is a revolution in the works, and The King's Speech fires the first salvo: You cannot treat trauma with words alone."

[End Excerpt]


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