Nadav Liam Modlin is the Psychology & Psychotherapy Lead in Psychedelics and researcher at the Institute of Psychiatry, Psychology & Neuroscience, King’s College London, and a therapist and therapist trainer on our COMPASS studies of COMP360 psilocybin therapy. He has a particular interest and clinical expertise in caring for people with psychological trauma. Here he tells us what drew him to help people suffering from trauma, and discusses some of the myths and misconceptions surrounding PTSD.
Tell us about your background. What led you to become a psychological therapist specialising in PTSD?
It is not uncommon for researchers and clinicians to be interested in a field due to the personal circumstances that have shaped their sense of identity and purpose. This is the case for me; I grew up in South Africa and Israel-Palestine. Trauma, both on an individual and societal scale, was very often present. What became apparent to me was not just how prevalent trauma was, but also how prevalent our attempts to deny or reject its existence. What also became evident was the resilience and human potential I observed in people; courageous acts of compassion, understanding, and hope took place alongside, and perhaps as a response to, terrible violence.
And so, I became interested in people’s innate wisdom, resourcefulness, and capacity for healing, especially when confronted with life-threatening experiences. Training as a psychological therapist and researcher seemed to be one way to personally make sense and meaning of suffering by helping people discover and create new ways of thinking and of feeling, of being in the world. I wanted to contribute towards a discourse concerned with understanding what brings us together as individuals and communities by directly addressing what sets us apart. Psychotherapy encourages a different kind of conversation where this is made possible and where compassion, patience and respect are deemed as powerful, if not more, than fear and hatred.
In your experience, how does PTSD impact people’s lives?
Trauma disrupts, it rapidly changes the lives of individuals, families, and communities. Some people describe the experience of trauma as if a part of them was “lost to the fire”. And so part of the struggle people with PTSD might face is to do with intense feelings of vulnerability; therefore, regaining feelings of agency and security after trauma is part of the therapeutic process. An additional struggle concerns the question of how to move on from what happened or what to do about that which was lost; how to find and create hope after despair, how to find and create feelings of safety after betrayal.
Trauma happens when adverse external circumstances overwhelm a person’s ability to cope with experiences that often evoke intense feelings of fear, helplessness, and shock, for example actual or threatened death, serious injury, or sexual violence. Not everyone exposed to adversity develops symptoms of trauma or PTSD; our reactions to single or repeated traumatic experiences are dependent on multiple interdependent factors, and important research into this is ongoing.
PTSD is a condition unique to the individual: for some PTSD patients, symptoms start in the immediate aftermath of exposure to a traumatic event, while others may not develop symptoms for months or years after the trauma. Symptoms may last for weeks and months, or years and even decades.
People with PTSD are more likely to organise their lives around the trauma by attempting to manage their symptoms (eg avoidance of thoughts and situations) or have their lives severely impacted by intrusive thoughts and emotions (eg upsetting memories and high emotional arousal). These symptoms are a person’s attempts to protect themselves from further harm and distress, but they are often pathologised. As a consequence, people with PTSD may also become preoccupied with overly negative thoughts and beliefs about themselves or the world.
On top of this, irritability, hypervigilance and startle reactions are also reported in PTSD patients, potentially making it difficult to secure employment and form and sustain relationships. Taken together, PTSD can have a debilitating impact on quality of life, which may result in a range of issues, including diminished cognitive and psychosocial functioning, substance abuse, and self-harm, including suicide. On a societal level, PTSD carries a high cost to healthcare systems.
What misconceptions have you observed around PTSD?
Most people who experience a traumatic event will not qualify for a PTSD diagnosis, and this may lead to a distorted negative view of self or others who do develop PTSD symptoms; people might view it as a sign of weakness. However, there are many contributing factors to how we respond and process traumatic events. From neurobiological predispositions to developmental circumstances and sociocultural factors, to the nature, duration, and severity of the trauma; these all play an important role in how we react to extremely painful and distressing life events.
Further, perhaps due to our individual and collective tendency to distance ourselves from disturbing realities, people experiencing PTSD may sometimes feel objectified or gaslighted. An example of objectification could include the notion that people with PTSD are somehow aggressive or unstable. Conversely, at times, people might deny the existence of PTSD due to the trauma “not being severe enough”. For example, the notion that it is mainly military personnel rather than civilians who develop PTSD. Despite higher rates of PTSD in combat military personnel, frontline workers and people who have experienced childhood abuse, neglect, domestic and racial violence are at elevated risk of PTSD.
Finally, some myths surrounding PTSD involve the idea that it is a final, “life-sentence” diagnosis. While it is true that current treatments are not effective for many people, with the right treatment team and social support, individuals with PTSD are able to restore feelings of agency, safety, and enhance their quality of life. Hope and trust are essential ingredients for healing and growth, and so for PTSD patients failed by current treatments, it is our responsibility to develop novel, safe and effective therapies.
Our vision is a world of mental wellbeing. What does that mean to you?
As a psychological therapist, I subscribe to the notion that our sense of self and wellbeing is largely determined by the quality and nature of our relational experience; the interpersonal relationships and socio-cultural context that shaped us in childhood and continues to impact us in adulthood. And so “a world of mental wellbeing” in my view is largely to do with promoting ways of relating to and being with oneself and others that respect our common humanity and value the healing potential of relationships.