By Reporter staff

Terence M. Keane will lead the virtual discussion about the Greater Binghamton Jewish Film Fest documentary “The Narrow Bridge” on Sunday, January 7, at 6 pm. For more information about the film and how to register, see "Film Fest to hold virtual showing of 'The Narrow Bridge' in January".

Although Terence M. Keane now works in the Boston area, he has several connections to the Binghamton area. A 1978 graduate of Binghamton University’s Clinical Psychology Training Program, he later completed a clianical residency at the University of Mississippi Medical Center. His doctoral training, though, continued with Stephen A. Lisman, Ph.D., who is now a distinguished teaching professor emeritus at Binghamton University and a member of the Greater Binghamton Jewish Film Fest Committee. Although the focus of the two men’s work was substance abuse, in particular alcohol abuse, it is Keane’s later work with the Veteran’s Administration, which focuses on Post-Traumatic Stress Disorder, that made Lisman recommend Keane as the moderator for the documentary “The Narrow Bridge.” 

Keane noted that he was pleased to be asked to lead the discussion. “I am forever grateful to Steve Lisman for the background and training he provided me some 50 years ago; the perspectives he provided me allowed me to successfully apply my graduate training to cultivate a new area in the field of mental health (i.e., PTSD),” Keane said in a e-mail interview. “It’s a pleasure for me to work again with him in January to promote an understanding of the complex topic explored here in ‘The Narrow Bridge.’ I look forward to the discussion and to adding whatever I might from my background and experience. The tragedies and betrayals associated with October 7 loom large as we try to elucidate what are the possible next steps on this narrow bridge, and how healing might emerge.”

Keane brings a great deal of experience to the discussion: he has been the director of the Behavioral Science Division of the National Center for PTSD (located at VA Boston Healthcare System) for nearly 35 years and a professor at the Boston University School of Medicine since 1985, where he is also an assistant dean of research. His first experience with PTSD occurred after he completed a clinical residency at the University of Mississippi Medical Center and joined the faculty at the VA in Jackson, MS, in 1978. As a result to his doctoral work, he was assigned to the Substance Abuse Treatment Unit at the VA. He notes that it was there that he “began to provide clinical care to dozens, if not hundreds of veterans, most of whom were Vietnam veterans. Emerging from those experiences was an appreciation of the impact of the war on their long-term mental health. We established one of the first treatment programs specifically for people suffering the impact of war trauma. The disorder eventually became known as Post-Traumatic Stress Disorder in 1980.”

After moving to the VA in Boston in 1985, he helped establish a treatment program for PTSD for male and female veterans that in 1989 became known as the National Center for PTSD. “In 1998, we collaborated with a group of physicians at Boston University School of Medicine to establish the Boston Center for Refugee Health and Human Rights, a program designed to provide comprehensive care for refugees of war-torn countries,” Keane said. “Largely women survivors, this program continues to this day providing mental health and physical health care programming as well as social and legal services for refugees. Over my career, I’ve provided consultation to governments and nongovernmental organizations (NGOs),” including the United Nations, Ireland (North and the Republic), Israel, Jordan, the United Kingdom, Norway, Sweden, Iraq, Kuwait, South Africa, Taiwan and China.

Keane noted that soldiers and civilians experience PTSD differently. “Conceptually, the disorder is the same (the diagnostic criteria are actually identical), yet the manifestations and concurrent conditions are different,” he said. “Combatants often have strong reactions to what they are asked to do (violence), as well as what they themselves experience (high risk exposure), whereas civilians are often unarmed and untrained, and are therefore unable to protect themselves and their loved ones. Civilians are typically all ages, including children and the elderly.”

Therapists must take these different variables into consideration when treating those with PTSD. “Psychotherapy takes into account many of these concurrent variables in an effort to promote recovery and rehabilitate survivors,” Keane said. “Cognitive features such as uncontrollability and helplessness figure prominently among soldiers and civilians alike. Assumptions about safety and key appraisals of the malevolence/beneficence of others in the world are often damaged, and alternatives need to be considered in an effort to move people to a position of security in their lives moving forward.”

Keane mentioned that PTSD is a complex diagnosis and the condition has a large number of triggers. “PTSD is a disorder that possesses features of both anxiety and depression,” he added. “It also encompasses symptoms such as reliving of the traumatic experiences (e.g., nightmares, dissociative flashbacks, ruminative thinking, preoccupation with things one might have or should have done to mitigate the events), avoidance of cues of the trauma (e.g., sights, sounds, cues of the index experience) and negative alterations of cognitions and mood and withdrawal from key interpersonal relationships are key factors. In addition, symptoms of hyperarousal and hypervigilance represent ongoing components of the condition. These symptoms collectively lead to disability and impairment in functioning across many if not all domains of life (e.g., work, marriage, family, friends, etc.). PTSD is often associated with depression, substance abuse, traumatic brain injury and other psychological conditions that add to the complexity of the clinical presentation.”

According to Keane, there are currently six different types of therapy: Exposure Therapy (which includes Written Exposure Therapy, Prolonged Exposure and Direct Therapeutic Exposure); Cognitive Processing Therapy and Cognitive Therapies; Eye Movement Desensitization; and Reprocessing and Interpersonal Therapy. “Due to the high rates of PTSD worldwide, many experts feel that public health approaches are essential to the dissemination of these therapies, and that the Internet and World Wide Web must play an essential role in the distribution of therapies to those in need,” he noted. 

His hope is that the discussion on January 7 will leave attendees with a better understanding of the complexities of PTSD and those who suffer from the disorder.