PSYCHODRAMA AND NEUROSCIENCE
The other day, one of my colleagues of “GEM” – Moreno’s study group – said something very curious about round tables in congresses. She said that no matter what the table theme is, the debaters always talk about what they like, i.e., they take the opportunity to make public the points of their own interest, not necessarily the ones proposed by the organizers.
I normally follow rules, but when I considered this table theme – Foundations of Psychodrama – it soon came to my mind two ways of approaching it: in the first, I would interpret the word ‘foundation’ as a solid basis that legitimates and authorizes the psychodramatic practice; in the second, I would seek what seems to me to be fundamental, essential and indispensable to Psychodrama.
I confess that I was more attracted by the second possibility, as for Moreno (1999:33) Psychodrama is just one of the methods of sociatry, one of the three components of socionomy: sociodynamics, sociometry and sociatry. (figure 1)
FIGURE 1 – SOCIONOMY
Searching for the foundations of Psychodrama would involve establishing the basis for the whole of socionomy, i.e., describing the foundations of all of Moreno’s work. At least, I would have to mention the Morenean vision of the spontaneous man, his philosophy of the moment, as well as his Role Theory and Action Theory. Honestly, I would not be able to do that in 15 minutes.
Therefore, I chose the second possibility, i.e., to understand the word ‘foundation’ as what I consider to be the basic, essential and indispensable attribute to Psychodrama .
Moreno describes Psychodrama in many ways. In one of them he defines Psychodrama as the treatment of an individual or group through dramatic action (1992:183).
Personally, I consider the dramatic action one of the fundamental characteristics of Psychodrama and its absence concerns me, especially in relation to the bipersonal status. Many colleagues, who are teachers-supervisors, say that they do not like and do not dramatize in the absence of an auxiliary-ego or supplied with objects and cushions. I must point out that I do not doubt the efficiency of psychodrama without drama, as I know that the success of a treatment does not lie in one factor only.
What amazes me is that some colleagues do not consider such a fantastic technical tool as dramatization, which therapeutic value has been more and more experimentally proven. Therefore, in the next 15 minutes, I would like to comment on three therapeutic aspects of the dramatic action that seem fundamental to me:
1- IT PROVIDES A MUSCULAR ENERGETIC DISCHARGE, NECESSARY FOR PATIENTS TRAUMATIZED BY VARIOUS CHILD ABUSES OR CARRYING TRAUMA
SEQUELAE OF ACCIDENTS (POST-TRAUMATIC STRESS DISORDERS).
Studies on trauma and its long-lasting effects in people’s lives have proved that Moreno (1959, p.239) was right to say that “act hunger” is a human physiological need just like eating, drinking and breathing.
The immediate response to a stressing situation** releases mechanics of the sympathetic nervous system reaction, known as “alert reaction”. When the animal organism gets ready to fight or escape, its breathing becomes deeper, the blood flows from the stomach and intestines to the heart and to the muscles; the ongoing processes in the alimentary canal cease, sugar is released from the liver’s reserves, the spleen shrinks and releases its contents, the hypothesis stimulates the adrenal glands and the body is flooded with hormones, like adrenaline. That’s an efficient preparation for activity and combat, as Walter Cannon had described, in 1939, and Paul MacLean reaffirmed, in 1952.
Studies developed on the animal kingdom (Levine, 1999) show that when an animal is hindered from reacting, archaic brain mechanics start operating, i.e., the reptilian brain, provoking freezing of the vital functions, thus simulating death. Through this trickery, the animal succeeds to be left by the predator or at least, to gain time to think of another escape strategy.
The same occurs, with some differences, to the human animal. In 1952, the American neurologist Paul MacLean described the triune theory of the human brain, a result of our phylogenetic evolution (See figure 2).
FIGURE 2. PAUL MACLEAN “THE VISCERAL BRAIN” (1952)
The brain stem is the primitive, reptilian brain, a remnant of our prehistoric past.
It is useful for quick decisions that do not demand much thinking. The reptilian brain focuses on survival; it is fear-driven and takes over whenever we are in danger and do not have time to think. In a world where the fittest survive, the reptilian brain is concerned with getting food and not with becoming food.
The central part of the brain is the limbic part or mammalian brain, the root of emotions, humor and feelings. The neocortex is the most evolutionary advanced part of the brain. It controls our ability to speak, think and solve problems. The neocortex affects creativity and the ability to learn, comprising approximately 80 per cent of the brain.
As we can see, the human brain is more specific. However, as Le Doux and Van Der Kolk (1996) demonstrated, the brain is not fully functional in traumatic situations, as the neocortex undergoes functional alterations releasing hormones that make it numb. (figure 3).
The memories filed at this moment do not need to be verbalized, they are formed by sensations, visual images and motor patterns, as language is a neocortical function.
FIGURE 3- BRAIN FUNCTIONING IN POST-TRAUMATIC STRESS
Like the animal, the human being when prevented from reacting, functions with the reptilian brain. Freezing of vital functions is shown through superficial breathing and stiff muscles, simulating “rigor mortis” and anesthetized mind, as in an ethereal state. But contrary to the animal, which after the danger is past defrosts through a noticeable body shivering, the human being mingles these physical functions with thoughts, feelings, emotions, invisible loyalties, etc¾ which are results from the other two parts of the brain.
Many times, a person who was raped, for example, conceals his/her horror, refrains from crying, shaking and feeling ashamed to pretend that nothing’s happened. As a result of this non-action, his/her body will not recover from the trauma and the helplessness feelings experienced at the moment he/she was attacked. The individual lacks an offensive action and control recovery, which often are only attained many years later, through the active repetition of violence or abuse, this time taking the role of the abuser or of someone who holds control (many addictions are disastrous attempts to simulate control).
Dramatization allows this missing action to come about, enabling muscles to produce a safe discharge of the body’s need for control recovery. I would like to remind you that psychodrama was one of the first body therapies; Moreno said that the body remembers what the mind forgets, especially events that take place in early childhood, even before language acquisition. The best way to recover the memory of actions is through expressive methods, which address the whole person (body and mind) in the action.
2- IT PROVIDES ACTIVE AND RESPONSIBLE RESEARCH OF THE PATIENT IN RELATION TO HIS PROBLEM
As I described above, hindering of an offensive reaction creates a lethargic and helpless attitude before reality. Needless to say that most of our patients feel like this towards their own lives. They feel that something must be changed, but they don’t feel capable of undertaking this change.
In many talk therapies, especially when interpretation is utilized, the key to the symbolic puzzle, to the meaning of feelings and thoughts, to how they relate to the past, present and future seems to be in the therapist’s hand. The patient is just the patient ¾ he/she expects the therapist to do his job. This only reinforces his/her already known fragility and helplessness.
Bustos has a small picture in his office that says: “what they say about me that was not disclosed by me does not fit me”; Milton Erickson (1983, pp. 45), the innovative American psychotherapist, father of modern hypnotherapy and whose methods inspired the systemic, strategic, familiar therapies, etc ¾ also thought that the direct interpretation of the therapist represents raping to the unconscious of the patient, who releases a host of defenses to dissociate, deny, i.e., to defend himself as much as he can. We penetrate indirectly into the patient’s unconscious, through the back door, with much warming-up, and never ahead of the patient himself.
Moreover, all patients have a sound and combative portion and I particularly make my patients aware of this from day one. I always ask them what they feel like working with in that specific session and I have them play the situations they choose to work. They are active researchers like me. Decoding their material, their emotions, decisions, etc, is our joint task, often their task more than mine.
3- IT OFFERS THE SURPRISE ELEMENT TO A PATIENT ACCUSTOMED TO FUNCTIONING WITH DEFENSIVE MECHANISMS ONLY.
Dramatization has no predetermined script. I never know what is going to happen, much less does my client. I am often amazed at what comes up and I love to see my patients’ surprised look. I surprise them too, playing roles and counter-roles unexpectedly, seeking an interpolation of resistances very useful to stimulate spontaneous-creative answers, i.e., new answers to old situations.
Moreno (1923, p. 54) already mentioned the surprise function in the activation of spontaneous-creative processes. In turn, Milton Erickson (1983, p. 50) used the confusion technique to induce to hypnosis. For example, he would ask a person to imagine him/herself climbing into an airplane flying to the USA and at the end of the trip, after various commands, he would ask the person to find him/herself landing in India. He knew that the surprise tactic unbalances the intrapsychic defenses, compelling the mind to produce a different responsive energy.
The surprise element is also present in childhood traumatic situations or even in accidental traumatic situations, compelling the patient to create a defense that will give him back a feeling of control. Healing provided by dramatization is somehow driven by the homeopathic principle of prescribing the same factor that caused the disease, with the objective to heal it.
I can’t think of anything more anti-morenean than a therapist listening and interpreting his/her patient verbally. It would at least require triggering an internal action in the patient according to internal psychodrama or Fonseca’s relation therapy, doing reverse roles sat down or symbolically favoring his/her amazement and surprise, although without the benefit of muscular associations provided by body movements.
Finally, I would like to say that I believe the lack of dramatization in many psychodrama sessions is due to the unawareness of how and why to dramatize rather than to the difficulty of doing it without auxiliary egos or a group.
Supervising my students, I came to the following list of more frequent questions regarding dramatization:
- How to handle issues related to therapeutic relationship: contract (timetable, location, fee, repositions); patients who do not wish to undergo dramatization, etc.
- What is the objective of dramatization? Is the objective exploratory (like a social atom), experimental (training of roles), or does it aim to repair narcissistic damages? (dramatization of childhood scenes)
- How to choose a scene to be dramatized? How to choose a scene when the patient is too talkative? Who should choose the scene: the therapist or the patient?
- How to establish time in dramatization, i.e., present, past and future? How to go from the present complaint of the patient to the past (regressive scene), or to the future (feared and desired scenes) and then come back to the here and now in the relationship with the therapist?
- How to warm up the patient and keep this warming up throughout the dramatization?
- How to decide which technique to use, among the classical ones?
- Which is best: an open scene psychodrama or an internal psychodrama?
- How not to get lost in the middle of a dramatization session?
- What to do when session’s time is over in the middle of a dramatization session?
- How to finish a dramatization?
As you may conclude, my colleague, the one who says that no matter what the table theme is the debater always talks about what he likes, was right.
I really believe dramatization to be one of the most important tools for psychodrama and I think that better prepared students regarding these topics have less fear to use dramatization and may realize the advantages of using action techniques to help their patients.
Thank you very much.
Rosa Cukier
BIBLIOGRAPHIC NOTES
- Cukier, Rosa (1992) – Bipersonal Psychodrama, its technique, its patient and its therapist, Editora Àgora, S.Paulo.
- Cannon Walter (1939) – The Wisdom of the Body, Nova York, Norton, Quoted by Anne Ancelin Schutzenberger – “Querer Sarar”, Editora Vozes, Rio de Janeiro, 1995.
- Lê Doux, Joseph.(1996) –The Emotional Brain, Editora Objetiva, Rio de Janeiro
- Levine P.A. (1999) – Waking the Tiger – Healing Trauma – Editora Summus, S. Paulo.
- Moreno, J. L (1923). – The Theater of Spontaneity. São Paulo: Summus Editorial, Ltda, 1973
- Moreno, J. L. (1959) – Group Psychotherapy and Psychodrama, Editora-Livro Pleno Ltda., Campinas,1999.
- Van der Kolk, B. Mc. Farlane A. Weisaeth L. (eds.). Traumatic Stress: the effects of overwhelming experience on mind body and society. New York, Guilford Press. 1996
- Zeig, K. J. (1983)- Didactic Seminars on Psychoanalysis by Milton H. Erickson, Editora Imago, Rio de Janeiro
- ** Stressing situation means any situation leading the individual to a state of despair, either for striving to preserve his/her life or the life of a significant other.