Earlier this week, Dr. Bessel van der Kolk was featured on Big Think in a video discussion on the history of the PTSD diagnosis. Dr. van der Kolk is one of the world's foremost psychiatrists specializing in trauma and the author of several books, including his latest The Body Keeps the Score: Brain, Mind, and Body in the Treatment of Trauma. You can watch the interview below:
Early in the video he explains how the PTSD diagnosis was developed "in order to remind the VA to take care of veterans and to really say to the VA 'these guys are messed up because of Vietnam.'" Even from the beginning, the plight of war veterans has been at the core of the PTSD diagnosis. Today, recent veterans commit suicide at an alarming rate much higher than that of the general public. The effects of trauma are major contributing factors.
Dr. van der Kolk explains that the flashbacks and bad memories commonly associated with PTSD are only one aspect of the issue:
"The issue that people came in with was that they had a very hard time getting along with other people, not blowing up at people, becoming scared and frozen, having no feelings for their kids, feeling numb with their girlfriends and general problems with engagement with other human beings and getting triggered and becoming very angry and very upset and very out of sort."
Common portrayals of PTSD in film and television feature scenes of war vets waking up in a cold sweat after having a nightmare about battle. Van der Kolk doesn't downplay that aspect of the disorder but emphasizes that the crippling effects of trauma are much worse than flashbacks -- they suck all the joy out of life:
"It really is about having difficulty feeling alive in the present, feeling engaged, feeling a sense of pleasure, of joy, of even exuberance at the right moment of just feeling like boy it's good to be alive. And in the years since that time we have understood a lot about what happens in the brain that interferes with the capacity to feel alive in the present."
Of course, it's not just war veterans who experience trauma and have to deal with its consequences Van der Kolk speaks at length about childhood trauma and how it can leave victims feeling useless and ashamed. The key to treatment is to sift past this powerlessness to the happiness that still exists beneath the veneer. To restore a patient's joie de vivre, the doctor or mentor must remind them what joy felt like before the pain began:
"It becomes very important to help people to viscerally remember, to be a member of that football team in school or to play your French horn in the band or to make love for the first time or something that at one point gave you great joy now no longer means anything to you. And when those feelings have stopped that means that something is frozen inside of you. And then it's time to deal with that in order to unplug the river of life basically."