In his recent book The Body Keeps the Score, Dutch-born psychiatrist Besselvan der Kolk presents a comprehensive overview of Post Traumatic Stress Disorder (PTSD). It also describes the often-troubling history of modern psychiatry.
Dr. van der Kolk is well equipped to understand trauma. He spent his early career treating veterans at a hospital in Boston. He also spent a considerable time as psychiatrist to another group subject to considerable trauma: female victims of rape and other forms of sexual assault.
The premise behind the his book is that violence done to a person takes a considerable toll in every aspect of that victim’s being. Even if he or she attempts to suppress or minimize the incident, the trauma will surface through the body or parts of the victim’s personality. Such suppression causes the victim to become profoundly ill mentally or physically.
Post Traumatic Stress Disorder, only officially recognized in the past few decades, is a condition suffered by persons who have been exposed, either directly or as witnesses, to imminent risk of death or serious injury. As humans, we are a violent species. The number of persons who have been exposed to such trauma is considerable. And unfortunately, a large portion of these people are still untreated.
Dr. van der Kolk goes through the diagnosis and treatment for PTSD. Studies were made during and after World War I of soldiers who suffered from what was then described as shell shock. When the U.S. was about to enter the Second World War, psychiatrists began to again study these World War I cases. Many psychiatrists understood that a new generation of soldiers was to suffer from the same shell shock symptoms.
Despite the subsequent psychological damage done to Korean and Viet Nam soldiers, most often their symptoms were ignored or misdiagnosed. It was not until the 1980’s that PTSD was formally recognized by the psychiatric profession. And too often in the subsequent decades funding for research on PTSD was cut with other mental health programs.
This books looks at the often troubling history of the psychiatric profession, going back to Charcot’s studies of hysteria in the 1880’s. Much attention is given the so-called pharmacological revolution of the 1970’s and 80’s. Rapid advances in psychotropic drugs led droves of psychiatrists to consider these medications as cure-alls for every sort of psychiatric maladies. They abandoned older forms of therapy, often and disregarded the theories of such earlier psychologists as William James and Carl Jung.
Concurrent with this attitude has been an alarming trend in medical practice. The ancient Greek physician Hippocrates said that the physician must not study the disease but the rather patient. Yet with the recent push of medical organizations to achieve maximum profits, many doctors have spent minimal time seeing their patients. They have prescribed medications without understanding individual patients. The result has been the opioid epidemic that is now a major public health concern.
While Dr. van der Kolk does not entirely condemn the use of medication in psychological cases, he argues that alternative treatments will have long term effects. He devotes considerable space to discussing such group therapy practices as role playing. By acting out their issues, patients come to better understand themselves, and often to identify the sources, repressed traumatic events, of their psychological issues.
Much of the latter part of the book is devoted to looking at alternative therapies. One treatment, neurofeedback, seems to be cutting edge, but the technology it uses goes back a near century. The electrocephalogram (EEG) was invented in the 1920’s. In neurofeedback the patient is hooked up to an EEG machine. Brain waves are electrically monitored as the patient is exposed, often by the mere mention of words, to potential stressors. Based on these brain waves, the troublesome stressors are identified. As with role playing, the patient comes to see the roots of his or her physical or mental illness.
Other therapies praised here are much more traditional, and may not seem therapeutic at first glance. Such eastern practices as chanting and meditation have a calming effect, and are of help much to persons afflicted with PTSD. Choral singing also is beneficial to a person’s mental and physical health, for it heals a person to breathe in sync with others.
Perhaps the most surprising therapy described in The Body Keeps the Score is theatre. Yet a movement has started called Theatre of War in which veterans perform or watch classical tragedies by Aeschylus and Sophocles. Through the ancient texts, these veterans come to see the universality of their suffering. By addressing, by re-experiencing, they are better able to cope in their everyday lives.
Certainly much of the psychiatric profession is subject to much criticism in this book. Yet not all is not dark. Dr. van der Kolk has much praise for the large numbers of social workers who treat their patients with sympathy and understanding.
I heard some time ago of a young woman who was a New York schoolgirl in 2001. She was in school less than two blocks from the World Trade Center when 9/11 occurred. In the following years she developed significant psychological symptoms. She was seen by numerous physicians and therapists, and was prescribed several successive medicines.
She did not improve, for she had been misdiagnosed. It was only in the relatively recent past that she was correctly diagnosed as having PTSD.
This is not a mistake that should have occurred in the hands of competent professionals. One of my main hopes as an attorney is for psychological healthcare to become part of the legal system. Many persons who frequent the legal system, often charged with crimes, have serious psychological issues.
But such a step would also require psychological healthcare to enter medicine’s mainstream. The mental health field needs to catch up with the better developments in healthcare.
Dr. van der Kolk’s book is a step in the right direction.