We Must Stop Ignoring Trauma

Acclaimed psychiatrist Bessel van der Kolk explores his field's long, complex, and stubborn history with trauma. Dr. van der Kolk explains how psychiatry as a whole avoided progress, often misdiagnosing trauma as hysteria or, in the case of shell-shocked soldiers, malingering. The experiences of abused women and children were more or less ignored for a century. They're still being ignored in ways, he says. Psychiatry is still too focused on abstract diagnoses and not cognizant enough of the traumatic experiences that lead to them. His latest book "The Body Keeps the Score" was written to draw attention to how traumatic disorders can be avoided.

Transcript

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 Salpetriere 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 text book 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.