Archives for : Bessel van der Kolk

PTSD is Torture

PTSD is torture.  

The most obvious thing to say about the relationship between torture and severe psychic trauma is that psychic trauma is often the result of being tortured.  That’s true, but the relationship is closer than that.  Severe psychic trauma is torture.   PTSD has many of the same features as the pain intentionally inflicted by torture.  (PTSD is a narrower category than severe trauma.  I use PTSD only for convenience, not as a diagnostic category.)   In other words, the relationship between torture and PTSD is not simply sequential.  In many respects, PTSD is torture. 

My authority for the pain of torture is the well known work by Elaine Scarry, The Body in Pain: The Making and Unmaking of a World.  All page references are to this work unless otherwise noted.  Others have written thoughtful works on torture, including Jean Améry, who was himself tortured.  I have written about Améry elsewhere (Trauma and Forgiveness), but Scarry’s description of the experience of torture seems more relevant.

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What if Bessel van der Kolk is right about trauma?

B0000757Bessel van der Kolk (vdK) is probably the world’s most well known trauma theorist. I reviewed his recent book, The Body Keeps the Score, in an earlier post. Since then I’ve read more of his work and listened to him speak for hours (he is all over youtube). The best way I’ve figured out to think seriously about his work is to ask what difference it would make if he were right.

What he says

Asked about how he treats the victims of acute trauma, vdK says

Holding them, rocking them, giving them massages, calming their bodies down is a critical issue. I am probably the minority among my colleagues in that I am much more focused on bodily state than on articulating what’s going on. I think that words are not really the core issue here. It is the state of being, of tenseness, of arousal, and of numbing, and that people need to learn again to be safely in their bodies. (http://www.medscape.com/viewarticle/408691)

Think about this for a minute. One might expect a trauma therapist to say something like “I try to create a safe environment in which my patients can put words to unspeakable experiences. I try to help them remember an experience so they don’t have to constantly relive it.” This makes sense, for trauma is a disorder of time, in which the past is never past but is constantly intruding upon the present.

VdK would have no difficulty with the last sentence, and yet his treatment program (or rather programs) has little to do with the past, and everything to do with the present. Trauma is when the past colonizes the present. Its treatment depends on reappropriating the present, and one does that not through understanding the past, but coming to live in the present, and the best way to do this is to bring the body into the present.

Behind vdK’s approach is his view that PTSD and related traumatic disorders, particularly developmental trauma (childhood abuse and neglect), are disorders of the limbic system, one of the oldest parts of the brain, the one we share with all mammals. In the limbic system, threat is experienced as sensation, and the impulse to fight or flee. Threat turns into trauma when we can neither fight nor flee, when we are trapped, and the stress is turned against the self. Trauma is embedded in the body-mind, a single entity.

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