Prince Harry's therapy on Apple TV+ gets right a vital truth about trauma

A fear of flying is common, but that is not what was affecting Prince Harry, a military-trained helicopter pilot.

Instead, the 36-year-old monarch’s airplane anxiety stems from a childhood fear associated with returning to the United Kingdom from trips abroad. They were experiences linked with being hounded by Britain’s tabloid press in the wake of the death of his mother, Princess Diana, in 1997.

Harry was 12 at the time, but his adult mind still relives this fear, despite more than two decades separating him from the experience.

But as we see Harry experience therapy in The Me You Can’t See, a new Apple TV+ documentary series, we realize that vital truth about trauma: There is no quick fix for it. But there are ways to live with it, and even to thrive.

The Me You Can’t See is a six-episode series co-created by Prince Harry and Oprah Winfrey. Celebrities like Lady Gaga, actress Glenn Close, and NBA player DeMar Rozan all appear. We also meet private citizens like Jen, a first responder struggling with isolation and trauma during the Covid-19 pandemic, and Fawzi, a young Syrian refugee.

“Anyone is vulnerable to trauma.”

The series shows anyone is vulnerable to trauma, and money cannot fully insulate a person from it. The series also succeeds in its presentation of a roadmap for how to recognize trauma and how to begin to deal with it.

The timing couldn’t be better. A deeper understanding of how trauma and post-traumatic stress disorder, a related condition, affect the brain is urgently needed after the last year. Experts say the stress of the Covid-19 pandemic is likely to create unprecedented mental health issues for years to come. (After all, there are literally hundreds of memes that illustrate the mental toll Covid-19 has taken.)

David Reiss, a psychiatrist and trauma expert, puts it plainly to Inverse “Anyone and everyone is vulnerable to trauma.” You, me, Prince Harry, Lady Gaga, Jen the first-responder.

How does trauma change the brain?

In the wake of the January 6 Capitol Riot, Congresswoman Alexandria Ocasio-Cortez shared this definition of trauma:

“I once heard trauma described as ‘too much, too fast, too soon,’” the New York member of Congress says in an Instagram video.

During a traumatic event, the brain and the body go into fight-or-flight mode. This response is governed by the brain’s fear center, the amygdala, which plays an outsized role in emotional perception and experience.

“You move from an adaptation into pathology.”

In this mode, the amygdala can interfere with another part of the brain, the hippocampus, which is critical for long-term memory. This relationship is part of why people who experience trauma can become emotional when recalling their experiences — even when it’s something as basic as flying on an airplane, like Prince Harry. It’s also why someone’s memory of the event is often fragmented.

Charles Nelson, a professor of pediatrics at Harvard Medical School, tells Inverse that our brains adapt to our environments.

“If you think about PTSD, these are adaptations you’ve made to an adverse environment,” he says. “In a war zone, these adaptations keep us safe.” The problems arise, of course, when someone is still making those adaptations outside a war zone.

Consider the classic example of a war veteran who ducks when a car backfires. It’s the brain’s executive function taking control because it’s used to a constantly dangerous environment.

“When the context changes, when you’re no longer in a war zone, suddenly the adaptations affect your functioning. And that’s when you move from an adaptation into pathology.”

In Episode 3 of The Me You Can’t See, trauma specialist and Harry’s own therapist Sanja Oakley explains that potentially adverse childhood experiences occur when the brain is still developing, so they become deeply ingrained in one’s neural networks, and are especially challenging to treat.

As Oakley says in the episode:

“You are treating a child even when you have a 50-year-old in the room.”

It’s something that’s under-discussed to a baffling degree. Adverse childhood experiences are strongly linked to later mental health conditions, including depression, anxiety, PTSD, substance use disorder, and even attention deficit hyperactivity disorder. Only look to the condescending phrase “who hurt you?” to see how the idea of personal trauma is quickly used against a person.

Stress hormones can become neurotoxic to the brain.

“If you're exposed to high levels of stress, your body starts creating high levels of stress hormones. And some of those can become neurotoxic to the brain,” Nelson says. Brain areas having to do with memory are often the most affected, he says. But critically, not every child who experiences trauma will later develop PTSD or other conditions.

Adverse physical consequences can stem from these early traumas, according to research, and those health problems can manifest as ischemic heart disease, stroke, and cancer. Trauma is often thought of as mental, but it also changes the body.

“Your cellular integrity starts to get compromised if you’re experiencing adversity...that can be a pathway to physical ailments,” Nelson says.

Essentially, the brain adapts very quickly under duress, but it’s much slower to adapt to a new, safe situation. Very often, people with PTSD need treatment to help their brain and body unlearn the adaptations their brain made while under extreme stress.

An adaptation that helped one survive in a chaotic environment isn’t going to quickly disappear by itself. To understand how this works, let’s go back to Harry and his anxieties in the air.

What is EMDR therapy?

Later in Episode 3 of The Me You Can’t See, we see Harry at his home in California, where he video conferences with Oakley, his therapist. He talks about a trip he took to Botswana after his mother died.

In Botswana, he was free from the press that hounded his mother to her death. Returning to the UK after this getaway trip filled the then 12-year-old Harry with dread. The moment the wheels of the plane touched down, the press would be back.

Prince Harry tells Oakley that he feels the same acute dread any time he flies to London. To help Harry deal with this trigger in the air, Oakley walks him through an eye-movement and desensitization and reprocessing exercise, also known by the acronym EMDR.

The theory behind EMDR treatment is that traumatic memories get stuck in an emotional, reactive part of the brain. EMDR helps the brain move the memory from that emotional place to areas of the brain more associated with information processing.

“Whoosh, we’re done with that.”

Here’s what happens during a session of EMDR:

• The person chooses a traumatic memory that has specific triggers — like descending over London does for Harry.
• The person describes the traumatic memory in as much detail as possible to the therapist while following a process called bilateral stimuli. An example of bilateral stimuli might be focusing your gaze on a light moving back and forth across your vision. It could also involve playing tones in each ear one after the other, tapping alternate hands, or any combination of the above.
• The bilateral stimuli help to tamp down the emotions around the memory and, ultimately, desensitize the patient to their trauma’s triggers.
• EMDR therapy is usually delivered one to two times per week, and people can do as many as 12 sessions in a treatment block.

It’s clear EMDR helps Harry immensely. The prince says that after EMDR, when he thinks about the triggering event, he feels a sensation of relief: “whoosh, we’re done with that.”

Reiss, the psychiatrist, tells Inverse that the best therapy for PTSD is one that “treats the individual person, not just specific symptomatology, and not just the effects of selected events in the person’s past.”

“The type of therapy indicated depends more upon understanding the totality of the person who suffered the trauma rather than the specific nature of the traumatic event,” he adds.

What are effective therapies for PTSD?

Most of the therapies for PTSD share common goals. They’re designed to limit the emotional charge around a traumatic event and help develop new, more constructive coping mechanisms.

In addition to EMDR, here are a few other common and effective therapies for PTSD:

• Cognitive-behavioral therapy: CBT is a kind of talk therapy; one that you’re likely using if you’re currently in therapy. The goal of CBT is to identify and modify thought destructive thought patterns and behaviors.
• Cognitive processing therapy: CPT is similar to CBT in its goal — change the disruptive thoughts that resulted from the trauma. However, it’s more focused and intensive. It’s the type of therapy that veteran, mental health advocate, and politician Jason Kander used to help address his PTSD from his tour in Afghanistan.
• Exposure therapy: Ginny, a boxer featured in The Me You Can’t See, uses exposure therapy to help address her obsessive-compulsive disorder. The therapy involves frequently retelling or thinking about the story of your trauma, or, under the supervision and direction of a therapist, exposing oneself to triggers. Sometimes this is done through a subset of exposure therapy called virtual reality exposure therapy, in which a person virtually revisits the scene of the trauma, and ultimately the traumatic incident itself.

Medication can also be a useful tool, too, either alone or combined with other treatments.

Trauma is treatable

Trauma is an incredibly complex experience that will affect different people in many different ways. It can be stubborn and debilitating. But there’s good news: there are extremely effective treatments for trauma and it is something that can be reduced and even completely relieved.

“PTSD is the diagnosis of a condition,” Reiss says. “It is a clinical description of a certain syndrome, the presence of a significant ‘composite’ of symptomatology that has resulted from the experience of a traumatic event.”

“All PTSD, by definition, relates to having experienced a traumatic event. But not every traumatic event results in post-traumatic symptomatology,” he adds

People like Prince Harry, refugee Fawzi, or Germanotta who have experienced trauma in early life all trace their PTSD to these seminal moments.

But Reiss is careful to note that, “PTSD is only one possible result.”

Unfortunately, the stigma around mental health issues like trauma and PTSD can stop people from seeking help. That’s what makes The Me You Can’t See such an important docuseries.

No one is immune from mental health challenges. But help is out there and healing is possible.

The Me You Can’t See is streaming now on Apple TV.