Eric Smith remembers the crack of gunfire clearly now, how the fusillade startled him from light sleep sometime after midnight. This was Vietnam, north of Saigon, 1968. Dug in following heavy fighting, his squad had orders to guard a prisoner until morning. They had lost a lot of men. They were angry. Some pretended to fall asleep knowing the prisoner would try to escape.
"I woke up as they gunned him down," he says in a voice quieted by the memory. "It was sort of a get-even. It was cold-blooded murder."
For more than two decades since a booby-trapped grenade ended his tour of duty, Smith tried desperately to dismiss a half-dozen such incidents as part of a bad Vietnam experience. He struggled with the time the soldier who replaced him as the squad's point man was killed while he was mistakenly sent on R & R. He tried to forget an air strike he radioed in that destroyed a village.
Instead of forgetting, though, he agonized. At times the guilt, the anger and angst welled up into depression so severe he couldn't leave his house for days. Recurring nightmares tormented him. He'd awaken from nearly sleepless nights troubled and anxious. He became an alcoholic; he smoked pot, snorted cocaine. His marriage ended in divorce. The phantoms of Vietnam ambushed him day after day as he teetered on the edge of suicide.
"It just ate at me and ate at me," says Smith, 45. "I would spend 20 hours a day thinking about it." Three years of counseling, including a 90-day in-patient stint at a Veterans Administration (VA) hospital in 1987, helped him accept that Vietnam was ruling and ruining his life. But nothing pried loose its stranglehold.
Then, attending a veterans' outreach program in 1988, Smith heard of a California psychologist who needed veterans willing to test a new and unusual therapeutic procedure. Apparently she was getting remarkable results treating post-traumatic stress disorder (PTSD), a long-term psychological reaction to trauma characterized by anxiety, depression, sleep disorders, difficulty in concentration, inappropriate guilt, fear and anger. PTSD most commonly has been diagnosed in war veterans who have had difficulty reassimilating into normal life. Survivors of other severe traumas -- natural catastrophes, violent crimes, incest and rape -- also can suffer PTSD symptoms. Smith fit the profile. He volunteered.
A week later, having reviewed his case, Francine Shapiro began using on Smith the experimental technique that she had developed over the previous year. Called Eye Movement Desensitization and Reprocessing (EMDR), it's a finger-waving therapy that appears futuristic -- a biopsychological method that seems more suited to Spock aboard the Starship Enterprise than to 20th-century psychology.
The eye-movement technique itself is relatively simple, though its therapeutic context and effects can be rife with complications. To start, Shapiro asks the client to visualize a distressing image and "gather" his feelings. That done, she instructs him to keep his head steady while tracking with his eyes the movements of two fingers she holds directly in front of his face. She then rapidly moves her fingers 20 to 30 times laterally across his line of vision. His eyes race back and forth and stop when she stops.
After each set of eye movements, the client closes his eyes to "get a reading" on any new feelings, insights or forgotten memories that come to mind; the therapist prods or questions minimally. Depending on how the client responds, that basic procedure typically is repeated a dozen or more times over a 90-minute session.
In his case, Eric Smith says EMDR accomplished more in one hour than conventional counseling had accomplished in years. And, he says, after nine weeks of EMDR treatments, he was liberated emotionally, once and for all, of the horrors of Vietnam. "It's gone," he says, "and I've never had a problem with it again."
Smith has regained control of his life as well. A computer systems engineer, he now runs his own research and development company in Santa Clara; he is remarried, has children. "I thought for so many years that was just my life," he says of the daily torment. "I never had any hope of being how I am now."
Before Your Very Eyes
Francine Shapiro doesn't know exactly why EMDR does what it does. The discovery was happenstance, not the result of focused research. While strolling through a park in Los Gatos in 1987, the 38-year-old graduate student in clinical psychology -- then eight years removed from New York and life as an English teacher, divorcee and cancer patient -- was pondering a disturbing thought when she realized it had vanished. Paying attention, she recognized the disappearing act was accompanied by a spontaneous rapid movement of her eyes.
"It was something automatic," says Shapiro. "The thought left consciousness. When I brought it back, it didn't have the same charge."
Trying the eye movements deliberately, she got consistently similar results. Experimenting with the process, she determined that people lacked muscle control to sustain repeated sets of eye movements, so she began guiding their eyes with her finger.
She found the technique didn't always release symptoms effortlessly: Sometimes it opened a Pandora's Box of other repressed problems requiring repeated sessions over months -- one reason she is adamant that only credentialed therapists who are formally trained in EMDR use it.
In the case of 38-year-old Molly Fisk, who had been sexually molested throughout her childhood and was terrorized by flashbacks, her first of many EMDR sessions resulted in "a tremendous headache" and an outburst of anger and crying. "I was simply having emotions that I felt had been stuck," says the business consultant who lives north of San Francisco. "But I'm working again and I'm out in the world because of this process. The memories are not paralyzing me."
In about 40 percent of the cases, Shapiro says, "it looks simple and it is simple." Of more than 70 of her earliest cases, EMDR defused the potency of traumatic stress symptoms with such ease and speed that it flew in the face of existing therapeutic standards and expectations. After a single session, one fellow counselor who had never gotten over unloading body bags in Vietnam declared the war finally was over for him. A rape victim reported her lingering anxiety dropped substantially following one EMDR treatment.
In the first controlled study of EMDR Shapiro conducted in 1988, all 22 PTSD subjects -- war veterans and victims of rape and childhood sexual abuse who endured symptoms an average of 23 years -- reported significant relief after one 50-minutes session. "It doesn't work for everybody, and it doesn't work all the time," says Shapiro, whose EMDR Institute is in Pacific Grove, Calif. "But it has a good consistency rate."
Seeing Is Believing
In a 1992 study, for instance, more than 100 people who were traumatized two months earlier when Hurricane Andrew devastated their homes in South Florida reported that, on a 10-to-0 scale, their stress levels dropped from an 8 to a 2 after an EMDR session lasting one to two hours. A second and more formal Hurricane Andrew study conducted a year later, and to be presented this August at the American Psychological Association convention, showed nearly an identical outcome.
"Those were amazing results," says psychologist Clifford Levin, senior research fellow at the Mental Research Institute (MRI) in Palo Alto, who organized those studies. He also is director of the EMDR Research Center of Palo Alto. "One session is really remarkably little treatment, given the trauma they experienced."
Levin is one of a growing cadre of "true believers" in EMDR, their testimonials enthusiastic about the positive changes they witness in treating PTSD. Of more than 100 clients he has treated with the technique, Levin estimates 90 percent have shown dramatic improvement. "What we are looking at," he explains, "is a different way of producing change in human beings. It is a powerful tool."
Ronald Doctor attests to similar EMDR success. A professor of psychology at California State University at Northridge, he has used it for three years -- recently with clients traumatized by the Los Angeles earthquake who feared returning to their homes or going to sleep.
"Something is going on here that isn't going on in a traditional sense of therapy," says Doctor, who underwent EMDR treatment himself to relieve post-earthquake anxiety. "Somehow EMDR taps into a connection between the mind, the memory, the physiology, the feelings and attitudes. ... It doesn't mean the person is made over into a new person. It just means that that trauma isn't going to drive his behavior anymore."
In Seattle, police psychologist Roger Soloman concurs from his experience using EMDR in "high-impact trauma incidents" such as police shootings, multiple-fatality fires and railroad-crossing accidents. Initially skeptical, he reluctantly took the training; his first EMDR case -- a driver who accidentally hit and killed a child -- erased his doubts. One session resolved the symptoms, says Soloman. "Seeing it with one's own eyes is definitely a convincer."
Two years ago, a survey of 1,295 clinicians who studied EMDR at least six months earlier asked for feedback. Of those responding, 76 percent said they found EMDR to be more effective than the other psychotherapeutic procedures they used and 20 percent said it was as effective. "I hadn't seen any therapeutic work like this in my years of practice," says Howard Lipke, who conducted the survey.
Since 1990, Lipke, a clinical psychologist at the VA Medical Center in North Chicago and former director of its PTSD unit, has used EMDR primarily with PTSD-diagnosed Vietnam vets. The technique, he says, has found a following among many VA psychologists who had grown increasingly frustrated by the ineffectiveness of traditional therapies. Already it is standard treatment in more than a dozen VA medical centers.
Steven Silver, director of the in-patient PTSD program at the VA Medical Center in Coatesville, Pa., says he has seen newly trained VA clinicians take to EMDR "like fish to water." A Vietnam veteran, Silver has worked with trauma cases for 20 years and says, "EMDR is producing greater effects in the treatment of PTSD than any other treatment we have used or seen used," providing a positive effect in about 80 percent of his patients in the center's 90-day treatment program. "And," he says, "I fully expected it to be one of those fuzzy-thinking New Age things that come out of California with every new moon."
Gary Fulcher hesitates to report the EMDR success he's seen in his practice. "It's worked in 99 percent of my PTSD cases," says the director of the department of psychology at Concord Hospital in Sidney, Australia, and the past president of the Australian Psychological Association. "There's only been one person in my work that it hasn't done anything for. But I don't like to say that because it sounds like miracle work."
'The Science Just Isn't There'
Shapiro takes great pains to emphasize that EMDR is no miracle. She believes it is a physiological trigger that releases psychological damage done by trauma that is stuck in the nervous system and never normally processed by the mind. She associates it with the rapid eye movements (REM) during some stages of dream sleep, a time when scientists have evidence that the mind normally works through troubling information and resolves it.
"We think it might be kicking in a mechanism similar to that," Shapiro told several hundred curious therapists last month at the 17th Annual Family Therapy Network Symposium here in Washington.
"There seems to be inherent in all of us an information system that naturally adapts to mental health. When a trauma occurs, there appears to be a disruption of that process and all the perceptions are locked in. When we do an EMDR session, the eye movement may be a catalyst to stimulate the information processing system."
But as good as EMDR seems to be, Shapiro doesn't want it seen as too good to be true. Yet some critics in psychology believe that is precisely what EMDR is.
"The first law of the Hippocratic Oath is 'Do no harm,' and there certainly is no evidence that this is toxic," says psychiatrist Matthew Friedman, executive director of the VA National Center for PTSD, in White River Junction, Vt. "But there's a lot of maybes. The science just isn't there."
Psychiatrist Roger Pitman describes himself as "less than enthusiastic" but "not negative" about EMDR. An associate professor of psychiatry at Harvard Medical School who coordinates research and development at the VA Medical Center in Manchester, N.H., Pitman conducted a controlled EMDR study in 1993 on 17 Vietnam combat veterans.
His findings: Only modest improvement, about on the order of what other PTSD treatments achieve; though the eye movements seemed inconsequential. "This is only one study," he cautions. "There need to be more studies."
James Herbert couldn't agree more. Probably the most vociferous of EMDR's critics, the assistant professor of psychology at Hahnemann University in Philadelphia, who researches outcomes of treatments, charges that Shapiro and her EMDR advocates are "almost cult-like" and have created an atmosphere around the technique that is "anti-intellectual, anti-scientific and anti-professional."
Foremost of his criticisms is that the studies attesting to EMDR's efficacy used flawed methodology; the only two that aren't flawed are snubbed because they don't support the incredible anecdotal claims for EMDR. "Those kinds of things are important as kind of case-history stuff," he says, "but they do not replace real science."
Herbert says he has never attended formal EMDR training but he has met Francine Shapiro and says he is convinced of her sincerity. "I could be completely wrong, and I would be the first person to eat crow and say this is the greatest thing since sliced bread," he says, "but the data right now doesn't prove it."
So why are patients and therapists alike saying EMDR really works? "I have no doubt they believe it is really working, but so do people who believe in UFOs believe UFOs are really here. ... My opinion is anything that involves bells and whistles and is flashy, that doesn't involve plain old-fashioned hard work but has a mysterious quality, has a very strong placebo effect."
Shapiro rejects outright the placebo argument. She says placebo effects fall apart generally within six months and EMDR cases that were resolved six years ago have not relapsed.
As for critics who contend that the complex nature of PTSD defies easy or quick recovery, she says, "If time heals all wounds, there wouldn't be a field of psychotherapy. But if time isn't sufficient to heal wounds, is it necessary? As a therapist, if your model excludes rapid change, you have to reject EMDR."
Meanwhile, EMDR's supporters and critics await the promise of new research. "Controlled research is beginning to come up now," says Shapiro, who will have overseen the training of 7,000 therapists in EMDR by mid-1994, during what she has referred to as its awkward experimental limbo state. "The problem is because the results are so dramatic, there is a tendency to say it can't be so -- and we have to keep on proving it."
Last month, at its annual convention, the California Psychological Association presented Francine Shapiro with its 1994 Distinguished Scientific Achievement in Psychology Award.
The EMDR Network at 1-408-372-3900 provides more information on EMDR and referrals to therapists trained in the procedure.