Shock, confidence and triumph: Psychiatrist Bisel van der Kolk on how to recover from our deepest pain | Psychiatry

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When Dr. Bissell van der Kolk published The Body Keeps the Score in 2014, it was a huge hit with yoga. This is not a euphemism for “busy rich people,” just people who do yoga. Certain physical activities do something strange to your brain: Old memories resurface, often associated with new feelings or perspectives; You begin to treat yourself with more compassion. It doesn’t make sense until you read Van der Kolk. After that, nothing made more sense than ever.

His thesis focuses on trauma: the urgent action of the brain after a traumatic event is to suppress it, through forgetfulness or self-blame, to avoid being ostracized. But the body does not forget. It results in physiological changes, “a recalibration of the brain’s alarm system, an increase in stress hormones, and a change in the system that filters relevant information from irrelevant information,” he says in his book. The pressure is stored in the muscles and is not dissipated. This has profound implications for speech therapies and their limitations: The rational mind cannot do the work of repair on its own, because that part of you is pretending to be already fixed.

The truth, of course, is that being traumatized makes you a difficult person to live with

The Body Keeps the Score is attractively written and not clearly a textbook. However, it is a researched and complex narrative of trauma and post-traumatic stress disorder (PTSD), not the popular psychology of the general reader seeking to live their best life through Bikram. So, how do you explain its amazing popularity? In the seven years since its publication, it has spent 147 weeks on the New York Times bestseller list and has sold over half a million copies in the UK alone, and nearly two million copies worldwide; Amid the combined shock of the pandemic, it’s more common than ever, spending the entire month of July of this year at number one on the US bestseller list. On social media, it’s ubiquitous, a psychopathic meme, the source of inspirational quotes to get you out of bed and self-deprecating jokes. (If your body retains the score, is that why you look so stiff?) Is the shock really so widespread? And are people feeling particularly shocked now?

Van der Kolk spoke to me via video call from Boston, Massachusetts, where he has lived for the past 50 years. He still has the clear and reassuring Western European accent of psychoanalysis from his birthplace – the Netherlands – even though he earned his first degree in the 1960s at the University of Hawaii and has worked in the United States ever since. “We define ‘trauma’ as an event outside the veins of normal human experience,” he says. “At least a third of couples, globally, engage in physical violence. The number of abused and abandoned children is staggering. Domestic violence, zap. Shocking rape. Psychiatry is totally ready for lunch and doesn’t quite see this.”

He began his work with people with PTSD around the time the term was defined, in 1978, at a Boston veterans clinic, working with men who fought in Vietnam. He picked up patterns in symptoms and presentation: either a tendency to impose their traumatic experience on everything around them or an inability to decipher what was going on around them and “too little in between.” Another pattern he picked up was in his own career. Psychiatrists will diagnose these patients with everything from alcoholism to schizophrenia and miss—almost resist noticing—the trauma.

An American soldier in Vietnam… Van der Kolk began his career working with men who fought there. Photo: Bettmann / Bettmann Archive

This became his life’s work, as he learned primarily from his patients. “I have had regular experiences, to this day, when a patient makes me realize something. I think: ‘I will pay you for this session, because that is an important lesson. You shouldn’t have paid me. There is very good literature [on shellshock] From 1919 to 1920. But then there was a backlash, where people said, “You’re just a bunch of cowards.” The abuse of traumatized people has been relentless – to this day, almost. You are not allowed to tell the truth about the terrible things that people do to each other.”

He is a big fan of John Bowlby, the inventor of attachment theory. “I knew him a little, actually. He didn’t like me—he thought I was too impulsive. But I thought it was cool. Most of my classmates haven’t read Bowlby. In psychiatry, people don’t talk much about attachment.” In Van der Kolk’s account, he has always been an outsider in his profession, which conceals the pedigree of his credentials. He was a research assistant in the 1980 edition of the prestigious Diagnostic and Statistical Manual of Mental Disorders.

Early in his career, he was driven by curiosity and a practical desire to know what works. The deeper I went, the more important the work was, in terms of the occurrence and impact of the trauma, on society and the psyche. “The truth, of course, is that being traumatized makes you a difficult person to live with. Because you get angry all of a sudden, you suddenly shut out or empty. But what’s even harder is living that life: not being able to trust yourself. And there’s always that inner pressure to rise to the plate and keep going. .so the next piece is a deep sense of shame about yourself and your reactions.”

It would be all too easy to say that PTSD eliminates any possibility of creativity or success. “It is astonishing how often people make a piece of extraordinary intelligence – extraordinary creativity – that allows them to go on. Isaac Newton was one of the most abused and abandoned children of all time…and then he invented mathematics.” The question, I suppose, is what Which he could have invented, had his trauma been handled. Van der Kolk is stubborn. Wounded people should not be left walking. No one should have to keep throwing themselves at the same wall of treatment and antidepressants if they don’t work.

European and American psychiatry has an obsession with analysis and pharmacology, which is partly related – especially in the United States – to the transfer of funds, with research grants flowing into more profitable and more established fields. Van der Kolk is well aware of inequality as a factor in untreated PTSD, and is not a big fan of capitalism in general. “I’m not sure that the fall of the Berlin Wall was the best thing that ever happened to us,” he says, in a customary fashion, but I realized the drift. Part of the commercial necessity in psychiatry has been the impulse to find one thing fits all: The Forde Brain Factory’s approach has seen millions spent figuring out, for example, what is best between drugs and dialogic therapies, or between one treatment and another.

Van der Kolk’s insistence that no treatment alone is likely to work, and no combination will be exactly the same for every patient, is shattering enough on its own. However, his involvement with what you might loosely classify as “hippy stuff” – eye movement desensitization and reprocessing, yoga, body (Feldenkrais, craniosacral therapy) and touch – is what shows how unconcerned he is in going beyond the field of classical psychiatry. . His reasoning about the body is very brief and simple: if the body stores trauma in its muscles, in its hormonal pathways, it is the body that needs to “experience deeply and profoundly incompatible with the helplessness, anger, or breakdown of trauma,” as he writes in his book.

This does not mean that it is completely against drugs, which can play a useful role in stopping inappropriate alarm reactions. But he is more interested in drugs that are gaining wide interest in the treatment of PTSD and depression, as well as the fear of death. Van der Kolk has yet to determine how MDMA differs from ketamine, psychologically, but he has tried both several times.

“You are not allowed to tell the truth about the terrible things that people do to each other.” Photograph: M Scott Brawer/The Guardian

“There has always been something that has really puzzled me. I was born in 1943 in the Netherlands. So many children of my generation died of starvation, and I was a very sick child, but I did not feel any trace of that sick child,” he says. “The last time I took MDMA, I experienced what that child was going through at the time. It was actually very painful. But the main effect was a deep feeling of self-compassion. I felt so much love for that child that I was the same. Once, who had to go through all this sickness, who had trouble breathing, who was hungry. ”

The next day, 2017, he had a misfortune in his career. He established the Trauma Center, in Brooklyn, Massachusetts, in 1982, while still a junior faculty member at Harvard Medical School, and built it into a leading research, training, and clinical institution for PTSD. In mid-2010, while writing The Body Keeps the Score, he took a step back — during which time its CEO, Joseph Spinazzola, was accused of abusing female employees and removed from his position. The head of the Justice Resources Institute, his parent organization, fired van der Kolk. “It was a purely sarcastic move,” he says. One designed to shift blame. “He was trying to hang that donkey’s tail on me.”

It was resolved to the satisfaction of Van der Kolk: with him he left his main team, in protest, and created a new enterprise. And because that happened in the middle of his MDMA studies, he was “in this very open and emotional situation. So the guy said, ‘You created a toxic environment and you’re fired.'” And I said, ‘You know, that’s not a really good idea. It’s going to hurt you a lot if you do that,’ And in the end it may hurt you more than it will hurt me. Compassion for yourself. In van der Kolk’s novel, the idea that self-love is a prerequisite for loving others – so popular in motivational statements on Instagram – has very reliable and practical examples. The man from the Justice Resources Institute sued.

Mass trauma is complex. Taboo is a key component of PTSD. The brain buries feelings only if they cannot be talked about, due to the risk of alienation, from the family (this is especially important for abused children) or from society (this is what silences veterans). Large, common events – 9/11, for example – that have not been quelled, and that actually bring those affected together, do not leave the same scars.

What about the epidemic? He shrugs: “I have a lot of questions about this, people talk about our collective trauma, and my answer is: For me and most of my colleagues, the pandemic hasn’t been painful. Our friendships, our jobs; they’re all fine. If you’re an 18-year-old single mom with no income, oh My God. If you were a nurse who dealt with people for a year who choked to death, you are traumatized.” Part of taking trauma seriously is not seeing it where it doesn’t exist.

In every academic institution I attended, my style was deceived by my peers

When The Body Keeps the Score was published, its editor said, perhaps because of yoga, drugs, or the very sharp way he describes the primacy of trauma and psychiatry’s shortsightedness around it: “Wait until the setback hits.” Still waiting. “I have had quite a few setbacks. I find it strange. Because I know how the academic world works, and in every academic institution I have been involved in, my style has been scattered by my peers.”

Maybe not so strange. In the end, psychiatry is simply the white-coat society, the medical end to enforcing standards and denying reality that drives individuals to repress their traumas in the first place. Van der Kolk’s life was practically one of treating trauma patients, but his life as an author is as an emissary from the realm of PTSD, confronting his profession – and the world he created – with what is really going on. Ultimately, psychiatry and the world it created can cope.

The Body Keeps Score: Mind, Brain and Body in Trauma Transformation by Bisel van der Kolk (Penguin, £10.99) is out now. To support Guardian and Watcher, order your copy at guardianbookshop.com. Delivery charges may apply.

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