“…part of you is pretending it has already been repaired.”

Zoe Williams interviewed Bessel van der Kolk for The Guardian of 20.9.21:

“When Dr Bessel van der Kolk published The Body Keeps the Score in 2014, it was a huge hit with yoga people…

His thesis centres on trauma: the urgent work of the brain after a traumatic event is to suppress it, through forgetting or self-blame, to avoid being ostracised. But the body does not forget; physiological changes result, a “recalibration of the brain’s alarm system, an increase in stress hormones, an alteration in the system that filters relevant information from irrelevant”, as he says in his book. The stress is stored in the muscles and does not dissipate. This has profound ramifications for talking therapies and their limits: the rational mind cannot do the repair work on its own, since that part of you is pretending it has already been repaired.

…He explored, too, the lost or discredited work on trauma from the earliest days of psychoanalysis: Pierre Janet, writing insightfully in the 1880s, and the British psychiatric reactions to the first world war. “There’s very good literature [on shellshock] from 1919 and 1920. But then there was pushback, people saying: ‘You’re just a bunch of cowards.’ The assault on people who had been traumatised has been relentless – to this day, almost. You’re not allowed to tell the truth about the horrible things that people do to each other.”

He is a huge fan of John Bowlby, the inventor of attachment theory. “I knew him slightly, actually. He didn’t love me – he thought I was too impulsive. But I thought he was fantastic. Most of my colleagues haven’t read Bowlby. In psychiatry, people don’t talk a lot about attachment.” In Van der Kolk’s account, he has always been an outsider in his profession, which masks the pedigree of his credentials. He was a research assistant on the 1980 edition of the prestigious Diagnostic and Statistical Manual of Mental Disorders.

At the start of his career, he was driven by curiosity and a practical urge to find out what worked. The further he delved, the more important he realised the work was, in terms of the incidence and impact of trauma, on society and the self. “The reality, of course, is that being traumatised does make you a difficult person to get along with. Because you suddenly get angry, you suddenly shut down or you space out. But more difficult is to live that life: not being able to trust yourself. And there’s always this internal pressure to step up to the plate and keep functioning. So the next piece is a profound feeling of shame about yourself and your reactions.”

…This is not to say he is totally against pharmaceuticals, which can play a useful role in shutting down inappropriate alarm reactions. But he is much more interested in psychedelics, which are gaining widespread interest in the treatment of PTSD and depression, as well as the fear of death. Van der Kolk has yet to nail down how MDMA differs from ketamine, psychiatrically speaking, but he has tried both a number of times.

…Separately, he mentions in passing that it is much easier to have compassion for your spouse if you have compassion for yourself…

When The Body Keeps the Score was published, his editor said, perhaps because of the yoga, the drugs or the very trenchant way in which he describes trauma’s primacy and psychiatry’s myopia around it: “Wait until the blowback hits.” He is still waiting. “I’ve had very little blowback. I find it strange. Because I know how the academic world functions and, in every academic institution I’ve been involved in, my approach has been pooh-poohed by my colleagues.”

Maybe it is not so strange. In the end, psychiatry is simply society in a white coat, the medical end of the norm-enforcement and denial of reality that drives individuals to suppress their trauma in the first place. Van der Kolk’s life in practice has been to treat traumatised patients, but his life as an author is as an emissary from the world of PTSD, confronting his profession – and the world that created it – with what is actually happening. Ultimately, psychiatry and the world that created it can cope.”

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