By Dr Marcel de Roos, Psychologist PhD, the Netherlands
The book “The body keeps the score” by Prof. dr. Bessel van der Kolk MD is an eyeopener for everyone who is interested in the etiology, context and treatment of traumas, be it professional or otherwise. Van der Kolk is a Dutch-American psychiatrist, researcher and educator based in Boston, United States.
He is one of the founders of the concept (complex) Post Traumatic Stress Disorder and he combines his expertise in clinical practice with brain research. Nowadays, traumas frequently are still not recognised as such by mental health professionals and they are labelled (often out of ignorance) with some arbitrary DSM diagnosis. As a consequence, clients don’t get the correct treatment and after some time they will be labelled with another DSM “disorder” or even get institutionalised which makes it worse.
The medical term comorbidities, having two or more conditions at the same time, is in a psychological sense not very practical. The personal history explains the present idiosyncratic symptoms and situation of the client. Van der Kolk is very critical regarding the present DSM focused practice which works with about 300 labels (“disorders”) instead of an explanatory problem analysis and therefore misses the underlying history and often the damaging childhood experiences.
As a consequence, the “disorder” is perceived as situated within the individual and presented as a “disease” without a social and historical context. But you can’t compare for example borderline personality disorder (BPD) with cancer or covid-19, BPD is just handful of symptoms (with a huge variability!) with no biomarkers (like lab tests, scans, blood pressure, etc.) to substantiate it. And BPD (or ADHD, bipolar depression, or any other “disorder”-label) is just a definition; there exists for example no “subtle signs” of it. Only if you change the definition into a broader sense then more people will be included.
Any psychological disorder is a combination of biological, psychological and social vulnerabilities. The behaviour of a traumatised client is a reaction and an adjustment to the trauma. Van der Kolk propagates attempts to integrate the past in the present without experiencing the anxiety and panic out of fear for the past.
The author presents a thorough scientific basis in neurological research combined with numerous case studies. It’s a 400+ page handbook about trauma. A substantial part of the book is focused on different ways to recover from trauma. He gives mental health professionals practical tips. Van der Kolk rejects the medical model and the idea that PTSD can be compared with a broken arm that can be cured in a standardised and protocolled manner in six weeks’ time. He recommends not one method but is a proponent of self-management. The author describes different methods such as EMDR, yoga, internal family systems therapy (a form of psychotherapy), neurofeedback and theatre.
This book emphasises that trauma deeply affects our body and mind. But mental health professionals still don’t know much about trauma and clients are often not given the proper treatment which can cause serious damage. Van der Kolk is right to make a clear case with PTSD for replacing the medical model for an integrated biological – social – psychological model.