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The Making of a Psychotherapy Eye Movement Desensitization And Reprocessing (EMDR): The Making of a Psychotherapy Steven Cohen Department of Anthropology Social Shciies of Medicine McGü1 University, Montreal A thesis submitted to the Facdty of Graduate Studies and Research in partial mentof the rewements for the degree of Masters of Arts Bbüoaiéque nationale du Canada Acquisitions and Acquisitions et Bibliographii Services services bibliographiques The author has granted a non- L'auteur a accordé une licence non exciusive licence ailowiug the exclusive pennethnt à la National Li'brary of Canada to Bibliothèque nationale du Canada de reproduce, loan, distrr'bute or sel reproduire, prêter, distri'buer ou copies of this thesis in microfom, vendre des copies de cette thèse sous paper or electronic formats. la forne de microfichelfiim, de reproduction sut papier ou sur format électronique. The author retains ownership of the L'auteur conserve la propriété du copyright in this thesis. Neither the droit d'auteur qui protège cette thèse. thesis nor substantial extracts fiom it Ni la thèse ni des extraits substantiels may be printed or otherwise de ceiie-ci ne doivent être miprimés reproduced without the author's ou autrement reproduits sans son permission. autorisation. Acknowledgements I thank my thesis supervisors, Man Young, Laurence Kirmayer, and Alberto Cambrosio, for their support throughout the writing of this thesis. in particular, I want to express my great appreciation toward Allan Young for both introducing me to medical anthropology seven years ago, and sharing throughout these years his passion and philosophical rigour in approaching the social sciences of medicine. Allan has provided me with advice and inspiration that have opened up many options, which is the most generous gift. He has patiently walked me through numerous outliues and drafh of this thesis. Laurence Kirrnayer has brought the nuances of psychiatry to Me for me. I thank him for the office space, access to his library, technical support, scholastic advice, and most notably for his humou and sense of cosmic irony. André Leblanc, Yasir Khan, Alana Hirsh, and Adam Hacking carefully read over clrafts of this thesis and provided saiient tips and corrections. I am grateful for their time, energy, and expertise. The energy with which André approaches his academic leanings has provided much inspiration for me. I thank McGill University for providing support in teaching assistantships and research assistant work for two years. 1 especially appreciated the Anthropology department's Administrative Assistant, Rosemary Stano, who seemed to have a calming ansver for al1 of my questions and concerns. Finally, i thank my farnily for their continued support throughout my studies. It has aiways meant very much to me. Table of Contents -1. Introduction 1.1 Background 1.2 Francine Shapiro's EMDR: An Intemal Accounr 2.3 .4pplicariom and Variations 7.4 EMDR as a Style of Reasoning -2. The Aistorical Construction of Madness 7 1 Railway-Spine and Psychogenic Trauma 2.2 Instincts and Organic Memory 2.3 Dissociation and Pathogenic Secrets 2.3 Fretid and Fanrasy 2.5 Suggestion, Hypnosis and Rapport 2.6 Neuroses and Nosologies 3. Sociolonv, Science, and EMDR Therapv - 0 3.1 Revolrrtions and the Botindaiy Object 3.2 Psydogenic Trauma and the Universal Bo4v 3.3 Objectiviiy, Standardkation, and Mechanical Infmnce 3.4 Eye Movements and Reliability 3.5 Suggestion, Hypnosis, and Rapport Revisited -4. Conclusion 4.1 Implications for a Moral Economy 3.2 Implicationsfor a Political Economy 4.3 Implicationsfor Psydotherapy Works Cited Eye Movement Desensitization Reprocessing (ENDR) therapy has burst upon the psychotherapeutic scene as a tirne-limited, cost-contained, and efficacious treatrnent for anxiety, stress, and psychological trauma. Although this therapy has been pronounced as revolutionary by its inventor, Franche Shapiro, it has distinct historicd precedents. The explanatory models of pathogenic memory and dissociation îheory, and the reiiance on mechanical inference for objectivity rnake EMDR therapy famiIiar and salieut. Notions of suggestion and hypnosis, aud the eye-movement component of therapy are presented as discontinuous with clinical and theoreticai practice, in order to fiee them hmthe tainting associations of pseudo-science and quackery. By co~ectingthe curent EMDR movement with the conceptual and practical history of traumatic memory, dissociation, and suggestion, 1argue that EMDR is not revolutionary. It is a powerful technotogy of the self, nomaking and valourking certain ways of behaving and thinking. Shapiro's implicit assurnptions that psychological suffering is pathological, and that early traumatic events are indelibly encoded, stored and dissociated in the brain are problematized. A briefcornmentary on the mord, politicai, and psychotherapeutic implications of EMDR therapy is provided. Résumé La nouvelle thérapie Eye Movement Desensitization and Reprocessing (EMDR) se passe pour me thérapeutique peu coiiteuse. courte et efficace dans le traitement de l'anxiété, le stress at le trauma psychologique. Bien qu'elle soit présentée comme étant révolutionnaire par son inventeur, Francine Shapiro, cette thérapie connaît d'importants précédents historiques. Par l'usage qu'elle fait de modèles explicatifs tels que la dissociation et la mémoire pathogénique et par son dépendance sur une mode inductive méchanique d'objectivité, I'EMDR et du déjà vu, Les concepts de suggestion et d'hypnose, et I'éIément thérapeutique des mouvements oculaires sont présentés comme étant dissocie de Ia prahque clinique et théoretique afin de les nettoyer de toutes taches de pseudo-science et de charlatanisme. En lient le mouvement EMDR contemporain avec l'histoire pratique et conceptuel de la mémoire traumatique, avec la dissociation at la suggestion, j7afFirmeque I'EMDR n'est nullement révolutionnaire. Elle est une puissante technologie du sujet qui normalise et valorise certains façon d'agir et de penser pIutÔt que d'autres. Les suppositions que la soufhce psychoiogique est pathologique et que les événements traumatiques sont dissociés, codés at enregistrés de façon indélébile dans te cerveau sont problematisées. Un bref commentaire sur les implications morales, politiques et psychothérapeutiques est donné a Ia fui. "How do we srand ru ihe rivai projectr of clar$cation and expianation in general? We must avoid two complenenrary emon. thal of seeking ro remive by refledon whar cm ooiy be raoived &yUivestigaîim. anàthat of seeking explanation when ewn i&successf;I consummariun could not give us whar we anticipatefiom i~ " -Frank Cioffi (1998: 301) 1. Introduction In the Iate 1980's a new psychotherapy, called Eye Movement Desensitization and Reprocessing (EMDR) therapy was presented as a treatment of post-traumatic stress disorder (PTSD). This psychotherapy has situated itself within, as well as generated, much debate on the genesis and nature of traumatic rnemories, matment straiegies, and the production, reproduction, validation, and reliability of scientific knowledge in the mental heaith discipiines. It is a usefiil starting point to speak ofpsychotherapy by its relation to suffering. The relief and easing of suffering, whether physical or existentiaI, is most oflen the implicit motive driving the production and engagement of myriad psychotherapeutic interventions. Suffering has no inthsic, timeless rneaning. It is provided rneaning by systems and institutions, most prominently biomedicine. The common explanation provides us with an etiological event, leading to alterations in brain chemistry, which the scientific community is slowly unraveiing in its attempts to end this scourge ofpain. It is a moral argument in which suffering is the evii against which cm dlyour resources together in opposition, Less often, however, are the historical, poütical, Iegal, economic, and philosophical dimensions brought into this discourse. In this thesis, 1plan to situate EMDR therapy in the debates through which a particuIar type of experience of suiTering is circumscribed and given rneaning. 1 rely upon an ethnographie stance in characterizing psychology and the scientific principles it purports to uphold. My goal is not to speak toward the tnith and Falsity of claims made by one group or another, on whether mernories are falliile and cultivateci by therapirts or not, whether EMDR therapy work or not 1 a will instead sp& on the way h which the very idea of cause, proof, and conviction are formed. As Ian Hacking (1986) observes when coaside~gthe manifoId ways in which science and technology "make up" people, the very diversity of human life means that a genei-al theory bent on explanations and predictions will make Little headway, Consequently, historians, philosophers, sociologists and anthropologists aiiie must attend carefiilly to the origin of our ideas and their evolution. In ttiis introduction, 1 will provide a brief intemal account of EMDR therapy, using laquage consistent with the prescribed treatrnent theory and practice, quoting heavily to rninimize interpretive distortion. t wilI Merouthne the implications for such a genealogy. 1.1 Background a in 1979, Francine Shapiro was undertaking a PhD programme in English literahtre at New York University when she was diagnosed with cancer. Unsatisfied with biomedicd approaches to matment, she feft New York "in search of workshops and seminars on mind, body, and psychological methods to enhance physical and mental well being" (1995:vi). Shapiro's new-age investigative odyssey eventually
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