A Book Review by Tim Brunson, PhD
One of the most refreshing things about When the Past is Always Present: Emotional Traumatization, Causes, and Cures by Ronald A. Ruden, MD, PhD, is that is a trauma book written by someone who is both a medical doctor and has a doctorate in neurochemistry. By explaining this often debilitating issue in terms of the chemical communication between the different substrates of the brain, his non-psychotherapeutic perspective presents a fresh approach. His unique treatment protocol is referred to as "havening," which is a mixture of energy tapping, guided imagery, and reassuring touch.
Ruden sees trauma as a situation in which the patient has experienced an event, which is permanently stored in his or her short-term working memory (i.e. encoded in the hippocampus and amygdala). This triggering event is a disturbing one for which there is no perceived escape. He clearly explains the neurochemistry of trauma, which he says involves working memory activating glutamate receptors in the amygdala thus precipitating a strong emotional response – which then can be disrupted and resulting in a long-term resolution.
While recognizing the psychotherapy and pharmacological alternatives, which he refers to as the two original treatment pillars, he proposes a third. He calls this a psychosensory approach. Essentially, it involves triggering the patient's working memory of the initiating event – or a traumatic state as in the case of panic attacks – and depotentiating the response prior to the amygdala creating a strong emotional reaction. The specific technique involves a TFT-like tapping technique, an eye movement exercise that tends to replicate EMDR-like results, visual-spatial imagery, a phonological component, and a specific method of touching the patient. The purpose of the last step is to stimulate serotonin production by creating a nurturing, calm-producing effect. Havening is designed to counteract the role of glutamate by encouraging a serotonin/GABA interruption. He says that he has used this with numerous patients who claim long-term positive results.
The wealth of clearly and logically explained information makes this a credible contribution to the mental health field. Ruden progresses from general concepts and then clearly explains the neurochemical basis of trauma before expounding upon the specific havening protocol. Although he claims that the book is not meant as a scholarly or academic work, it is very well documented with appropriate research citations. Furthermore, the appendices and notes at the end of the book were very much appreciated. I found the information added substantially to the value of this book.
Although Ruden's detailed description from the neurochemical perspective as to how mental trauma is created and can be treated is by far his book's strongest feature, I did have a few misgivings. Starting very early in the book he attempted to compare and contrast other treatment approaches such as Reiki, which he would apparently likewise consider as coming under the psychosensory umbrella. However, his conclusions seemed to be rather premature and reflected a lack of familiarity with those topics. Also, although citing another resource, the comment in which he explained away the relevance of Buddhism as a "one with everything" phenomenon, I found to be a rather trite cliché. Buddhist contributions, especially when one considers the tremendous depth of the energy-related transformational concepts within Buddhist tantric practices, warrant more credit. I would have preferred that his rather inappropriate reference been left out. When Ruden stayed within his core competencies, he clearly displayed his brilliance. On the other hand, when he gave unfounded opinions in other areas I am afraid he may have lead otherwise informed readers to unjustly question his credibility. When the Past is Always Present will appeal to the energy medicine and psychology crowd, as well as other psychotherapists who don't mind digging into some of the more technical neurological aspects of trauma. For those who want to increase their understanding of trauma at that level, this book is excellent.