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: 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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Political division is nothing new. Throughout American history there have been numerous flare ups in which the political arena was more than just tense but incideniary. In a letter addressed to William Hamilton in 1800, Thomas Jefferson once lamented about how an emotional fervor had swept over the populace in regards to a certain political issue at the time. It disturbed him greatly to see how these political issues seemed to seep into every area of life and even affect people's interpersonal relationships. At one point in the letter he states:

"I never considered a difference of opinion in politics, in religion, in philosophy, as cause for withdrawing from a friend."

Today, we Americans find ourselves in a similar situation, with our political environment even more splintered due to a number of factors. The advent of mass digital media, siloed identity-driven political groups, and a societal lack of understanding of basic discursive fundamentals all contribute to the problem.

Civil discourse has fallen to an all time low.

The question that the American populace needs to ask itself now is: how do we fix it?


Discursive fundamentals need to be taught to preserve free expression

In a 2017 Free Speech and Tolerance Survey by Cato, it was found that 71% of Americans believe that political correctness had silenced important discussions necessary to our society. Many have pointed to draconian university policies regarding political correctness as a contributing factor to this phenomenon.

It's a great irony that, colleges, once true bastions of free-speech, counterculture and progressiveness, have now devolved into reactionary tribal politics.

Many years ago, one could count on the fact that universities would be the first places where you could espouse and debate any controversial idea without consequence. The decline of staple subjects that deal with the wisdom of the ancients, historical reference points, and civic discourse could be to blame for this exaggerated partisanship boiling on campuses.

Young people seeking an education are given a disservice when fed biased ideology, even if such ideology is presented with the best of intentions. Politics are but one small sliver for society and the human condition at large. Universities would do well to instead teach the principles of healthy discourse and engagement across the ideological spectrum.

The fundamentals of logic, debate and the rich artistic heritage of western civilization need to be the central focus of an education. They help to create a well-rounded citizen that can deal with controversial political issues.

It has been found that in the abstract, college students generally support and endorse the first amendment, but there's a catch when it comes to actually practicing it. This was explored in a Gallup survey titled: Free Expression on Campus: What college students think about First amendment issues.

In their findings the authors state:

"The vast majority say free speech is important to democracy and favor an open learning environment that promotes the airing of a wide variety of ideas. However, the actions of some students in recent years — from milder actions such as claiming to be threatened by messages written in chalk promoting Trump's candidacy to the most extreme acts of engaging in violence to stop attempted speeches — raise issues of just how committed college students are to
upholding First Amendment ideals.

Most college students do not condone more aggressive actions to squelch speech, like violence and shouting down speakers, although there are some who do. However, students do support many policies or actions that place limits on speech, including free speech zones, speech codes and campus prohibitions on hate speech, suggesting that their commitment to free speech has limits. As one example, barely a majority think handing out literature on controversial issues is "always acceptable."

With this in mind, the problems seen on college campuses are also being seen on a whole through other pockets of society and regular everyday civic discourse. Look no further than the dreaded and cliche prospect of political discussion at Thanksgiving dinner.

Talking politics at Thanksgiving dinner

As a result of this increased tribalization of views, it's becoming increasingly more difficult to engage in polite conversation with people possessing opposing viewpoints. The authors of a recent Hidden Tribes study broke down the political "tribes" in which many find themselves in:

  • Progressive Activists: younger, highly engaged, secular, cosmopolitan, angry.
  • Traditional Liberals: older, retired, open to compromise, rational, cautious.
  • Passive Liberals: unhappy, insecure, distrustful, disillusioned.
  • Politically Disengaged: young, low income, distrustful, detached, patriotic, conspiratorial
  • Moderates: engaged, civic-minded, middle-of-the-road, pessimistic, Protestant.
  • Traditional Conservatives: religious, middle class, patriotic, moralistic.
  • Devoted Conservatives: white, retired, highly engaged, uncompromising,
    Patriotic.

Understanding these different viewpoints and the hidden tribes we may belong to will be essential in having conversations with those we disagree with. This might just come to a head when it's Thanksgiving and you have a mix of many different personalities, ages, and viewpoints.

It's interesting to note the authors found that:

"Tribe membership shows strong reliability in predicting views across different political topics."

You'll find that depending on what group you identify with, that nearly 100 percent of the time you'll believe in the same way the rest of your group constituents do.

Here are some statistics on differing viewpoints according to political party:

  • 51% of staunch liberals say it's "morally acceptable" to punch Nazis.
  • 53% of Republicans favor stripping U.S. citizenship from people who burn the American flag.
  • 51% of Democrats support a law that requires Americans use transgender people's preferred gender pronouns.
  • 65% of Republicans say NFL players should be fired if they refuse to stand for the anthem.
  • 58% of Democrats say employers should punish employees for offensive Facebook posts.
  • 47% of Republicans favor bans on building new mosques.

Understanding the fact that tribal membership indicates what you believe, can help you return to the fundamentals for proper political engagement

Here are some guidelines for civic discourse that might come in handy:

  • Avoid logical fallacies. Essentially at the core, a logical fallacy is anything that detracts from the debate and seeks to attack the person rather than the idea and stray from the topic at hand.
  • Practice inclusion and listen to who you're speaking to.
  • Have the idea that there is nothing out of bounds for inquiry or conversation once you get down to an even stronger or new perspective of whatever you were discussing.
  • Keep in mind the maxim of : Do not listen with the intent to reply. But with the intent to understand.
  • We're not trying to proselytize nor shout others down with our rhetoric, but come to understand one another again.
  • If we're tied too closely to some in-group we no longer become an individual but a clone of someone else's ideology.

Civic discourse in the divisive age

Debate and civic discourse is inherently messy. Add into the mix an ignorance of history, rabid politicization and debased political discourse, you can see that it will be very difficult in mending this discursive staple of a functional civilization.

There is still hope that this great divide can be mended, because it has to be. The Hidden Tribes authors at one point state:

"In the era of social media and partisan news outlets, America's differences have become
dangerously tribal, fueled by a culture of outrage and taking offense. For the combatants,
the other side can no longer be tolerated, and no price is too high to defeat them.
These tensions are poisoning personal relationships, consuming our politics and
putting our democracy in peril.


Once a country has become tribalized, debates about contested issues from
immigration and trade to economic management, climate change and national security,
become shaped by larger tribal identities. Policy debate gives way to tribal conflicts.
Polarization and tribalism are self-reinforcing and will likely continue to accelerate.
The work of rebuilding our fragmented society needs to start now. It extends from
re-connecting people across the lines of division in local communities all the way to
building a renewed sense of national identity: a bigger story of us."

We need to start teaching people how to approach subjects from less of an emotional or baseless educational bias or identity, especially in the event that the subject matter could be construed to be controversial or uncomfortable.

This will be the beginning of a new era of understanding, inclusion and the defeat of regressive philosophies that threaten the core of our nation and civilization.