Psychiatry Must Stop Ignoring Trauma, with Dr. Bessel van der Kolk
Acclaimed psychiatrist Bessel van der Kolk explores his field's long, complex, and stubborn history with traumatic experiences.
Bessel van der Kolk is a psychiatrist noted for his research in the area of post-traumatic stress since the 1970s. His work focuses on the interaction of attachment, neurobiology, and developmental aspects of trauma’s effects on people. His major publication, Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body, and Society, talks about how the role of trauma in psychiatric illness has changed over the past 20 years.
Dr. van der Kolk is past President of the International Society for Traumatic Stress Studies, Professor of Psychiatry at Boston University Medical School, and Medical Director of the Trauma Center at JRI in Brookline, Massachusetts. He has taught at universities and hospitals across the United States and around the world, including Europe, Africa, Russia, Australia, Israel, and China.
His most recent book is The Body Keeps the Score: Brain, Mind, and Body in the Treatment of Trauma.
Bessel van der Kolk: Psychiatry has always had a complex relationship to trauma. It first started off as a discipline that looked at the bizarre symptoms that people have and then they uncovered way back in the late 1800s at the Salpêtrière in Paris particularly that people have very bizarre reactions to trauma and so that defines hysteria 150 years ago. So there was some interest in it. And then they put a kibosh on it; people are no longer allowed to study hysteria. The first World War breaks out; a huge number of traumatized guys have the same symptoms as these women. People come home from the first war, have a terrible experience. They're all being accused of malingering; very traumatized people; probably had a lot to do with the rise of Nazism.
And eventually the second World War, a lot effort the second World War. And then in 1947, the last book about war trauma gets published and there's nothing till 1982 or something. So it takes a long time. And even when I was a student my textbook said that incest is extremely rare and it is really good for people and it doesn't really cause any major damage because it gives women and girls permission to do something that is really forbidden, but eventually protects their mental health. And so there has been a long-term, complex relationship where psychiatry really doesn't want to see trauma and in occurrence DSM, what people call the Bible of Psychiatry, where my colleagues and I, at the National Child Traumatic Stress Network, worked very hard to get a diagnosis in to make room for the hundreds of thousands, if not millions, of kids who get abused and neglected, whose parents go off to jail, whose parents are drug addicts, whose parents are not there for them and them being grown up. We try to get a diagnosis called Developmental Trauma Disorder and the response was after submitting data on 20,000 children with this problem, they said, "Oh we don't really have enough evidence for this niche diagnosis." And in fact vast numbers of people who seek psychiatric care are in fact traumatized human beings.
So now we live with weird diagnosis like Oppositional Defiant Disorder where people don't ask why did these kids become defiant; or cold and dark disorder where these kids behave strangely; Bipolar Disorder; kids being mentally unstable; going up and down on their emotions. And people don't really—psychiatry doesn't really want to look at what's behind there. And as a consequence, instead of looking at social conditions as being at the origin of these disorders, these kids get drugged up. Last year in the U.S., kids got $18.1 billion worth of psychotropic drugs and these drugs actually do calm people down, but they also work on the reward system in the brain and decrease curiosity, openness, experimentation, engagement with people. And I am extremely concerned that all these medicated children in America are likely to grow up having a deficit in the capacity to engage, a deficit in the capacity to learn, to be original, to be engaged, to be a useful member of the workforce. So the neglect of the issue of trauma in the U.S., in particular, is a very serious public health issue.
Directed/Produced by Jonathan Fowler, Elizabeth Rodd, and Dillon Fitton
Acclaimed psychiatrist Bessel van der Kolk explores his field's long, complex, and stubborn history with traumatic experiences. Dr. van der Kolk explains how, for the better part of a century, psychiatry avoided progress by relying on outdated misdiagnoses. The results of trauma were deemed "hysteria" or, in the case of shell-shocked soldiers, "malingering." The experiences of abused women and children were more or less ignored, and they're still being ignored in the way diagnoses are given today. Psychiatry is still not cognizant enough of the traumatic experiences that lead to diagnoses. In a way, we're simply treating the symptoms, not the problem.
Van der Kolk's latest book is titled "The Body Keeps the Score."
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Northwell Health is using insights from website traffic to forecast COVID-19 hospitalizations two weeks in the future.
- The machine-learning algorithm works by analyzing the online behavior of visitors to the Northwell Health website and comparing that data to future COVID-19 hospitalizations.
- The tool, which uses anonymized data, has so far predicted hospitalizations with an accuracy rate of 80 percent.
- Machine-learning tools are helping health-care professionals worldwide better constrain and treat COVID-19.
The value of forecasting<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNTA0Njk2OC9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYyMzM2NDQzOH0.rid9regiDaKczCCKBsu7wrHkNQ64Vz_XcOEZIzAhzgM/img.jpg?width=980" id="2bb93" class="rm-shortcode" data-rm-shortcode-id="31345afbdf2bd408fd3e9f31520c445a" data-rm-shortcode-name="rebelmouse-image" data-width="1546" data-height="1056" />
Northwell emergency departments use the dashboard to monitor in real time.
Credit: Northwell Health<p>One unique benefit of forecasting COVID-19 hospitalizations is that it allows health systems to better prepare, manage and allocate resources. For example, if the tool forecasted a surge in COVID-19 hospitalizations in two weeks, Northwell Health could begin:</p><ul><li>Making space for an influx of patients</li><li>Moving personal protective equipment to where it's most needed</li><li>Strategically allocating staff during the predicted surge</li><li>Increasing the number of tests offered to asymptomatic patients</li></ul><p>The health-care field is increasingly using machine learning. It's already helping doctors develop <a href="https://care.diabetesjournals.org/content/early/2020/06/09/dc19-1870" target="_blank">personalized care plans for diabetes patients</a>, improving cancer screening techniques, and enabling mental health professionals to better predict which patients are at <a href="https://healthitanalytics.com/news/ehr-data-fuels-accurate-predictive-analytics-for-suicide-risk" target="_blank" rel="noopener noreferrer">elevated risk of suicide</a>, to name a few applications.</p><p>Health systems around the world have already begun exploring how <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7315944/" target="_blank" rel="noopener noreferrer">machine learning can help battle the pandemic</a>, including better COVID-19 screening, diagnosis, contact tracing, and drug and vaccine development.</p><p>Cruzen said these kinds of tools represent a shift in how health systems can tackle a wide variety of problems.</p><p>"Health care has always used the past to predict the future, but not in this mathematical way," Cruzen said. "I think [Northwell Health's new predictive tool] really is a great first example of how we should be attacking a lot of things as we go forward."</p>
Making machine-learning tools openly accessible<p>Northwell Health has made its predictive tool <a href="https://github.com/northwell-health/covid-web-data-predictor" target="_blank">available for free</a> to any health system that wishes to utilize it.</p><p>"COVID is everybody's problem, and I think developing tools that can be used to help others is sort of why people go into health care," Dr. Cruzen said. "It was really consistent with our mission."</p><p>Open collaboration is something the world's governments and health systems should be striving for during the pandemic, said Michael Dowling, Northwell Health's president and CEO.</p><p>"Whenever you develop anything and somebody else gets it, they improve it and they continue to make it better," Dowling said. "As a country, we lack data. I believe very, very strongly that we should have been and should be now working with other countries, including China, including the European Union, including England and others to figure out how to develop a health surveillance system so you can anticipate way in advance when these things are going to occur."</p><p>In all, Northwell Health has treated more than 112,000 COVID patients. During the pandemic, Dowling said he's seen an outpouring of goodwill, collaboration, and sacrifice from the community and the tens of thousands of staff who work across Northwell.</p><p>"COVID has changed our perspective on everything—and not just those of us in health care, because it has disrupted everybody's life," Dowling said. "It has demonstrated the value of community, how we help one another."</p>
Archaeologists discover a cave painting of a wild pig that is now the world's oldest dated work of representational art.
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- The painting is the earliest known work of representational art.
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The Persian polymath and philosopher of the Islamic Golden Age teaches us about self-awareness.
A leading British space scientist thinks there is life under the ice sheets of Europa.
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- The moon is one of Jupiter's 79.
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Can computers do calculations in multiple universes? Scientists are working on it. Step into the world of quantum computing.
- While today's computers—referred to as classical computers—continue to become more and more powerful, there is a ceiling to their advancement due to the physical limits of the materials used to make them. Quantum computing allows physicists and researchers to exponentially increase computation power, harnessing potential parallel realities to do so.
- Quantum computer chips are astoundingly small, about the size of a fingernail. Scientists have to not only build the computer itself but also the ultra-protected environment in which they operate. Total isolation is required to eliminate vibrations and other external influences on synchronized atoms; if the atoms become 'decoherent' the quantum computer cannot function.
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