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AR 28:37 - How trauma became "America's favorite diagnosis"

In this issue:

MEMORY - "traumatic memory": the body (allegedly) keeps the score

Apologia Report 28:37 (1,634)
October 19, 2023

MEMORY

The topic of memory in Apologia Report <www.tinyurl.com/5n6p8ry6> represents a broad area of conflict with many applications related to apologetics. In "Tell Me Why It Hurts," Danielle Carr <www.tinyurl.com/55cx2r72> explains "How Trauma Became America's Favorite Diagnosis" (cover story, New Yorker, Jul 31 '23) -- a profile of former Harvard Medical School trauma researcher Bessel van der Kolk <besselvanderkolk.com> and the disputed memory of trama, specifically those of "people who claimed to have had experiences the scientists couldn't definitively verify." (Oh, how this categoric uncertainty applies to ever wider areas of modern debate.) 

   "Traumatic memory, van der Kolk argued, is not so much a narrative about the past; it is a literal state of the body, one that can bypass conscious recall only to resurface years later. ...

   "Traumatic memories are not ordinary memories. ... van der Kolkian theories of traumatic dissociation had transmogrified into the 'recovered memory' movement [and how] distinct memories of abuse could surface wholesale many years later;" specifically in regard to "childhood sexual abuse," "multiple personality disorder," and "gender radicalism."

   "Nearly three decades after leaving Harvard, van der Kolk is currently the world's most famous living psychiatrist and the author of The Body Keeps the Score, which has spent 248 weeks on the New York Times paperback-nonfiction best-seller list and counting. <www.tinyurl.com/5basd2m8> To date, it's sold 3 million copies and been translated into 37 languages. Published by Penguin in 2014, The Body Keeps the Score is van der Kolk's manifesto. It argues that trauma constitutes a special type of memory.... the body can register what happened in a way the person might catch up to only years later. ...

   "After a respectable performance following its publication, The Body Keeps the Score began a steady climb in the publishers' charts, and its prominence - dating to roughly 2018....

   "In his ascent, van der Kolk has done for trauma what Carl Sagan did for the galaxy. Today, the prevalent trauma concept is fundamentally van der Kolkian: trauma as a state of the body, rather than a way of interpreting the past. ...

   "van der Kolk's renown - built on translating neuroscience into language accessible to people searching for a cure for their pain - has placed him in a position straddling scientific celebrity and guru." His supporters, people in "trauma-informed care," are said to think "he's like a god." ...

   "When van der Kolk was beginning his research career, working with patients at the Boston VA outpatient clinic a ... controversy [erupted that] centered on whether post-traumatic stress disorder would become a psychiatric diagnosis" to be recognized in the latest Diagnostic and Statistical Manual of Mental Disorders (DSM-III).

   "Ultimately, the strength of the grassroots campaign for PTSD, coupled with the undeniable symptoms psychiatrists were seeing in veterans, forced the skeptics to cave. PTSD became an official diagnosis in the DSM-III. <www.tinyurl.com/ydswc52vz> ...

   "'In the '80s and '90s,' van der Kolk told me, repeating a line he's fond of, 'Boston was for trauma studies what Vienna was for music.' ...

   "In Cambridge, Massachusetts, van der Kolk was the ringleader of this network. For more than ten years, the Harvard Trauma Study Group met every month, forming the first stronghold of what its enemies would later call 'the traumatologists.'

   "In 1984, van der Kolk published his first trauma paper; it contained the seed from which all his future work would develop. In it, he argued that the nightmares veterans were having weren't like normal nightmares: They came earlier in the sleep cycle and 'were repetitive dreams that were usually exact replicas of actual combat events.' ... At a biological level, van der Kolk would soon argue, this implied that trauma is physically seared into the nervous system, more like a scar than a story. This was a big claim. If it was true, it meant trauma could act as a kind of objective proof that something had happened. A person can lie, but the body cannot.

   "Van der Kolk set out to determine what kind of physiological system could account for this type of 'body memory.' In an extraordinary paper from 1985, <www.tinyurl.com/pyma9b36> he proposed the first neurobiological model for PTSD, one that could explain why trauma victims so often return to situations in which the traumatic experience will likely repeat. ...

   "This 1985 paper contained all the signature features of van der Kolkian trauma. Most notably, it synthesized the two factions that had clashed over the PTSD diagnosis. ...

   "By the late '80s, van der Kolk was collaborating with Harvard psychiatrist Judith Herman, another founding member of the Harvard Trauma Study Group. Herman was one of the first people to research father-daughter incest, and her findings indicated that a vast conspiracy of silence was hiding the extent of domestic abuse nationwide. ...

   "A 1980 memoir, Michelle Remembers, co-written by a Canadian psychiatrist and his patient (and, subsequently, wife) Michelle Smith, detailed tales of grotesque satanic ritual child abuse. (The book was later thoroughly debunked.)

   "The traumatologists tried to establish distance between their research and the voyeuristic excesses of its popularization. ... But by the early '90s, the idea of repressed memories had escaped its theoretical origins and was running wild through the culture.

   "This was the period in which van der Kolk came under academic scrutiny. If you ask him, he says his push out of Harvard was orchestrated by [Massachusetts General Hospital's] chief of psychiatry, a Jesuit priest who had consulted with the Boston archdiocese on sex-abuse cases. But by the mid-'90s, the recovered-memory movement was on the back foot. In 1994, anthropologist Jean La Fontaine demonstrated that American 'specialists' were contributing to the rise in satanic-abuse allegations internationally. That same year, Harvard Medical School undertook an investigation into the work on recovered memories done by van der Kolk's research assistant; the data was later revealed to have been faked."

   In 1994, "the Trauma Center's work wasn't fringe so much as a niche psychiatric specialty. This changed after 9/11, which transformed trauma into a national public-health crisis. During the Vietnam War, the U.S. government had fought the introduction of the PTSD diagnosis, but the War on Terror found it eager to invoke trauma. ... Between 2004 and 2012, Department of Defense funding for PTSD skyrocketed from $30 million to $300 million, placing trauma science on the cutting edge of respectable mainstream psychiatric research.

   "The War on Terror affected a pivot in the type of trauma research that was funded, toward the neurobiology of PTSD. This came as a vindication to van der Kolk and gave him a chance to shake off the dead weight of the recovered-memory wars. ... What united this arsenal of 'somatic therapies' [like 'non-pharmaceutical treatments' such as 'eye-movement desensitization and reprocessing,' [EMDR] and 'neurofeedback'] was that they targeted the body, rather than cognition (like cognitive behavioral therapy) or language (like talk therapy). ...

   "For the group of practitioners long dismissed as New Age flakes, van der Kolk's enthusiasm came as a godsend. ...

   "Van der Kolk's biggest collaboration was with the National Child Traumatic Stress Network, a group of clinicians, researchers, and families that had been created by Congress to improve treatment for abused children. Starting in 2005, van der Kolk and his allies began a campaign to get a diagnosis they called 'developmental trauma disorder' into the fifth edition of the DSM.... Psychiatry, he claimed, needed to understand that a vast array of diagnoses - from bipolar disorder to substance-use disorders to personality disorders - are not so much discrete diseases as, at root, all caused by trauma.

   "The fight over 'developmental trauma disorder' was fieldwide and acrimonious. If accepted into the DSM-5, critics argued, DTD would become a kind of diagnostic blob absorbing an enormous range of diagnoses with little concern for what skeptics believed were crucial differences. Van der Kolk threw his energy into the campaign. When DTD wasn't included in the DSM-5, it came as a bitter disappointment.

   "Still, the campaign was a victory in another sense. In the world of therapists, psychiatrists, and researchers, the fight over DTD mainstreamed an expansion of trauma from 'acute stressors' (like a bomb explosion or sexual assault) to 'developmental traumas,' or all the ways a caregiver's failure to provide safety can change a child's development. The connective tissue here, between big-T trauma (acute) and little-t trauma (chronic, developmental) was attachment theory, a framework developed by John Bowlby, a researcher who had influenced van der Kolk during the Harvard Trauma Study Group years. ...

   "In 1994, he had published a paper in The Harvard Review of Psychiatry titled 'The Body Keeps the Score.' <www.tinyurl.com/pyma9b36> It was his first stab at the unified theoretical model the trauma-tologists had long craved. Trauma, the paper argued, is stored as changes in the body's biological stress response.... In the book, van der Kolk laid out [his] arguments and added his thesis on developmental trauma. ...

   "Widening trauma to include both acute and developmental stressors transformed it from a 'you have it or you don't' binary into a spectrum. The result is if everyone's body is keeping the score, what that score actually adds up to starts to get less clear. ...

   "Our 2023 trauma moment has blossomed out of the scientific foundation of van der Kolk's theories, though what seems to be germinating often appears to be less his specific neurobiological model than what we might call 'traumatic literalism.'"

   Carr notes that "the appeal of traumatic literalism is not so much its scientific rigor as its scientific sheen [and, that] the battle lines of the '80s and '90s trauma culture wars were staked out along clear lines. If you were a feminist or an antiwar activist, you invoked trauma; if you were a conservative, you didn't. But today's literalization of trauma is politically promiscuous. In fact, rather than treating trauma as an ideological weapon of the left, now the right wants in on it too." She uses the example of "the 2016 memoir Hillbilly Elegy, by new-right icon J.D. Vance...." <www.tinyurl.com/2pdx32af>

   We conclude with Carr's reflection: "van der Kolk's ascent has landed him squarely back in the problem that defined his position in the memory wars: If he were to disavow the excesses of how his work is being popularized in order to preserve its scientific bona fides, it would mean taming its viral uptake." Stay tuned. <www.tinyurl.com/45h5k9wd>

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