A surprisingly good article on the social function of Bessel van der Kolk’s The Body Keeps the Score: We’re all victims now

“Tell Me Why It Hurts: How Bessel van der Kolk’s Once-Controversial Theory of Trauma Became the Dominant Way We Make Sense of Our Lives,” is a strikingly good article on the appeal of The Body Keeps the Score (New York Magazine, July 31, 2023).    It’s not long, and you can read it for yourself (the web address is given in the references).  The article, and my comments, are not about whether van der Kolk (vdK) is right or wrong, but why his book has become so extraordinarily popular, spending 248 weeks on the New York Times paperback-nonfiction best-seller list and still counting. It’s sold 3 million copies and has been translated into 37 languages.  It’s made vdK the world’s best-known psychiatrist. 

The book’s thesis is that post-traumatic stress disorder (PTSD) is not just something that happens on the battlefield.  It happens in childhood, and for many of us throughout our lives.  PTSD is the intrusion of experiences that cannot be emotionally or cognitively assimilated, in many cases because we are too young or overwhelmed to make sense of them.  Instead, these experiences are stored in a special type of memory he calls somatic memory that is based in the body, not the mind.  Because these memories are stored in the body, they can’t be reached by talk therapy or reflection.  Body work is necessary, by which vdK means virtually any therapy that involves the body and its movements.  Yoga and massage are exemplary, but dance, play therapy, and psychodrama, in which people replay traumatic experiences with others, also count.  Indeed, almost any therapy counts that isn’t just talk, but involves the body (I’m not quite sure why vdK includes psychodrama; it’s almost all talk). 

But why did the book become so popular?

The book has been so influential because it says that you are emotionally ill not because of something in you, or about you.  You are in a state of anxiety, depression, and despair because of what was done to you by others, frequently parents who paid insufficient attention to your needs, or responded inappropriately. 

There’s a parallel here between the original diagnosis of PTSD, which took its place in the Diagnostic and Statistical Manual of Mental Disorders in 1980 (DSM III) as a result of pressure from Vietnam veterans and their psychiatrists, who claimed that veterans’ symptoms, such as anxiety, depression, and hyper-arousal, were the result of being placed in unbearable combat situations for which they were unprepared.

Developmental Trauma Disorder (DTD), as vdK prefers to call it, is similar to PTSD in that its origin is external to the individual, residing in environmental failure, not psychological weakness or illness, such as borderline personality disorder.  It’s not your fault, it’s the fault of your environment, be it parent or society.  This is not just an excuse made by the liberal left.  Hillbilly Elegy by J. D. Vance, “invokes the neurobiological impact of the chronic stress he endured in Appalachian poverty to show how rural white voters have been abandoned by liberal elites.”

You don’t know what you don’t know

There are really two questions here.  First, does DTD exist, or does it just turn ordinary difficult experiences into a psychiatric disorder?*  Second, is the thesis tenable that DTD resides in a special type of memory, inaccessible to ordinary talk therapy and reflection? 

The answer to the first question depends not only on clinical judgment but an assessment of the state of the culture.  The answer to the second question, in my opinion, is that vdK makes too sharp a distinction between two types of memory.  Particularly problematic is his claim that one can have been traumatized and not know it, so embedded is the experience in somatic (body) memory. 

No doubt something like somatic memory exists, but fragments of these bodily experiences are almost always present in consciousness, even if they cannot be healed by talking alone.  There’s a big difference between saying that some traumas are so deeply embedded in the body that talk alone won’t restore the sufferer, and saying that these traumas are completely inaccessible to memory.  Surely many of these memories are fragmentary and incomplete, some may even be false, but mind and body are not completely divided. 

            Recovered memory moment

How do I know this for sure?  It’s hard to disprove a negative but consider one of the consequences of assuming that some somatic memories leave no trace in consciousness.  The most dramatic is the recovered memory movement. Children with no memory of abuse were convinced by  therapists and others that they had been ritually and satanically abused by their preschool teachers.  Devil worship, cannibalism, and secret tunnels figured prominently (McMartin preschool trial).  VdK claims no responsibility for this misuse of his theory, and probably he’s right.  But since he testified for the prosecution in several similar cases, Harvard University closed his trauma clinic and put his papers under review.  He walked, setting up his own trauma research center in Brookline, a suburb of Boston. 

Conclusion

Even if one agrees with vdK on the somatic status of trauma, one should be concerned that research on trauma has become a study of the body rather than a way of interpreting the influence of the past on the present.  Trauma is no longer an experience we seek to know and understand.  People no longer experience trauma so much as have it inscribed upon their bodies.  The possibility that trauma, treated with talk therapy, might be an experience, no matter how painful, from which we can grow and learn has disappeared.  We are making sense of our lives with a theory that makes some of our most important experiences senseless.

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* DTD is not yet recognized by the DSM of the American Psychiatric Association.  The concern of the editors is that it is overbroad, subsuming categories such as borderline personality disorder.  In addition, it risks transforming difficult everyday life experiences into psychiatric disorders.

References

Danielle Carr, Tell me why It hurts: How Bessel van der Kolk’s once-controversial theory of trauma became the dominant way we make sense of our lives.  New York, July 31, 2023.  https://apple.news/Aoz3HIaM6QBSxiGSh3UQQqA

American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision.  2002.  [DSM}

Bessel van der Kolk, The Body Keeps the Score.  Penguin, 2015.

 

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