Dying to survive

In this chapter we describe elements of the trauma treatment service within one of the high-security hospitals in the UK. This service has been evolving over several decades based on the significant increase in knowledge about the processes that underlie trauma, which has offered new potential to palliate the damage of trauma using psychological principles. We acknowledge the challenge of working closely with clinicians who take a pharmacological approach and the widespread use of medicines that suppress alarm reactions and/or the way the brain is managing traumatic impact. We share case material that illustrates the value of Eye Movement Desensitisation and Reprocessing (EMDR) treatment within the context of other talking therapy options for the processing of memories of trauma and the body-based experiences that can reverse the helplessness, rage and/or collapse that occur during (repeated) traumatic incidents. We illustrate the importance of working cautiously with those who have (unconsciously) converted victimisation experiences into perpetration, as is so often the narrative in forensic services. We highlight the fragility inherent in this journey and the need to watch carefully for signs that survival is not always possible, nor even always the intention for those whose circumstances have taken them to desperate places that are not affirming of life. Equally, we reference the long-term gains that become more viable when trauma histories are witnessed and addressed in therapy.