What Counts as Trauma?
In 1987, Dutch psychiatrist Bessel van der Kolk argued that “psychological trauma affects the entire human organism—body, mind, and brain,” even though he and his colleagues presented “reports that are anecdotal [and] there are almost no controlled studies” in their support for this hypothesis in Psychological Trauma.1Bessel A. van der Kolk, ed., Psychological Trauma (Washington, DC: American Psychiatric Press, 1987), 78. Van der Kolk is a clinician, researcher, and teacher in the area of posttraumatic stress. His work integrates developmental, neurobiological, psychodynamic, and interpersonal aspects of the impact of trauma and its treatment. He is considered one of the leading voices on this topic with over 150 peer-reviewed journal articles as well as the author of Psychological Trauma, Traumatic Stress, and The Body Keeps the Score. He is the founder and medical director of the Trauma Center in Brookline, Massachusetts. He is also a professor of psychiatry at Boston University School of Medicine and director of the National Complex Trauma Treatment Network and the past President of the International Society for Traumatic Stress Studies. In his recent best-seller The Body Keeps the Score, he continues to promote this same hypothesis that “the memory of trauma is encoded in the viscera, in heart-breaking and gut-wrenching emotions, in autoimmune disorders and skeletal/muscular problems” using three new branches of science: neuroscience, developmental psychopathology, and interpersonal neurobiology.2Bessel A. van der Kolk, The Body Keeps the Score: Brain, Mind and Body in the Healing of Trauma (New York, NY: Penguin Books, 2015), 88. No evidence was discussed to support the mechanism of this claim and van der Kolk proceeds to expose the non-scientific basis of his claim, when he says, “Somatic symptoms for which no clear physical basis can be found in traumatized children and adults” (99). However, his hypothesis 36 years ago is still just that—a hypothesis.
Van der Kolk describes trauma as something “unbearable and intolerable,” and it includes both direct experiences of traumatic events and an incommunicable inner chaos in an individual’s mental state.3Ibid., 1. Van der Kolk does not provide a definition of trauma, he describes it in terms of signs and symptoms, but there is no clear definition of what it is. This book has been referenced nearly six thousand times within trauma literature as well as clinicians, non-profit organizations, advocacy groups, policy makers and so on nationwide. It has become the Grand Unifying Theory that trauma is the root of all behavioral, interpersonal, health, and social problems. The language of trauma permeates everyday speech and is present in everything from educational systems to public health policies.4The notion of trauma is expanded from the catastrophic events of adulthood to the everyday interactions and has essentially become the “lingua franca of suffering,” but the supposed prevalence and severity of individuals being diagnosed with PTSD are questionable. For example, by September 11, 2001, posttraumatic stress disorder (PTSD) became a widely accepted cultural phenomenon that almost immediately after the towers fell, an estimated nine thousand trauma counselors flooded lower Manhattan in order to address what was expected to be a tidal wave of post-traumatic stress. The Federal Emergency Management Agency spent 155 million dollars to make psychological counseling available for the quarter of a million people who would need help dealing with their trauma, but to the shock of many, a mere three hundred people turned up. See Figure 1 in Appendix and David J. Morris, The Evil Hours: A Biography of Post-Traumatic Stress Disorder (Boston, MA: Houghton Mifflin Harcourt, 2015). According to the Oxford English Dictionary, the word “trauma” was first used to describe an acute physical wound in the field of medicine in the 17th century before the emergence of the effects of accidents (railway spine) and war trauma (soldier’s heart) in Anglo-Saxon literature in the mid-19th century.5When the industrial revolution was well under way and serious industrial accidents were becoming more frequent, that references to physical trauma started to appear in the middle of the 19th century. Physicians treating the survivors of those accidents occasionally noted odd behaviors or mysterious, unexplainable symptoms, but it was believed that such symptoms were due to an underlying physical cause, even if the physical cause had not yet been detected. A Danish physician, John Eric Erichsen called it “railway spine,” because rail travelers who had experienced even minor accidents were reporting to their doctors strange and oddly psychological symptoms, including memory difficulties, lack of appetite, nightmares, and anxiety. Erichsen explained that these patients were suffering from microlesions of the spine, which was causing emotional havoc in their lives, and it could be a striking coincidence, but liability insurance was created during the same period. Some of these survivors of “railway spine” made their way to neurologist Hermann Oppenheim’s office in Berlin. Oppenheim came to believe that these strange symptoms were due to more than physical trauma, and that they are attributed to an underlying psychological problem. In 1889, his book titled “The Traumatic Neuroses” became the first medical use of the term “trauma” to describe a purely psychological response. The literature on the development of trauma has always been a search to answer the question—is trauma physical or non-physical? Does trauma affect the brain or the mind or both? For an overview of the historical development of trauma, see Table 1 in Appendix (p. 57-58), which demonstrates the parallel threads that influence contemporary traumatology. Cf. George A. Bonanno, The End of Trauma: How the New Science of Resilience Is Changing How We Think about PTSD, First edition (New York: Basic Books, 2021); Carlos Blanco, “Epidemiology of PTSD,” in Post-Traumatic Stress Disorder, ed. Dan J. Stein, Matthew J. Friedman, and Carlos Blanco (Chichester, UK: John Wiley & Sons, Ltd, 2011), 49–74, https://doi.org/10.1002/9781119998471.ch2; Patrick Bracken, Celia Petty, and Save the Children Fund, eds., Rethinking the Trauma of War (London New York: Free Association Books, 1998); Roy R. Grinker and John P. Spiegel, War Neuroses, American Military Experience (New York: Arno Press, 1979); Allan V. Horwitz, PTSD: A Short History, Johns Hopkins Biographies of Disease (Baltimore, MD: Johns Hopkins University Press, 2018). Today, trauma is simultaneously believed to be a universal disorder based on neurobiological evidence as well as an amorphous and immeasurable diagnosis that is based on an individual’s subjective experience, perception, and feelings.6For more on the changing definitions of trauma, see the Diagnostic Statistic Manual— Posttraumatic Stress Disorder (PTSD) is first defined in the third edition of the Diagnostic Statistic Manual (DSM-III) in 1980 as “a person who has experienced an event outside the range of usual human experiences” that results in intrusive memories, avoidance, negative changes in thinking and mood, and changes in physical and emotional reactions. In the span of three DSM editions from 1980 to 1994, the definition of PTSD went from direct experiences of a traumatic event to only having to hear about a severe misfortune befalling another person. As a result, the expanded definition of PTSD now includes vicarious traumatization, as demonstrated by Isaac Galatzer-Levy and Richard Bryant who used a binomial equation to elucidate possible symptom combinations in the DSM-V and concluded that there are 636,120 ways to be diagnosed with PTSD. In addition to DSM’s official changing definitions, complex PTSD (C-PTSD) was proposed by psychiatrist Judith Herman in 1992 to include psychological trauma that is defined as “an affiliation of the powerless whereby the victim is rendered helpless by an overwhelming force,” and this “overwhelming force” includes problems in emotional regulation, self-image, and interpersonal conflicts. Although Herman and her supporters lobbied the DSM committee to formally recognize C-PTSD, the effort was rejected for lack of evidence. About fifteen years passed, and as the fifth edition of the DSM was being assembled, supporters repackaged CPTSD as a childhood disorder, and once again, this effort was rejected for lack of evidence. Even though it has no scientific validity, C-PTSD has now become one of the most influential notions in the field to the extent that the majority of practicing clinicians and relevant national organizations recognize that C-PTSD is a real disorder. In Judith Herman’s admission, “despite [her] best efforts and those of her colleagues in the trauma field, the American Psychiatric Association chose not to designate C-PTSD as a distinct entity because the committee did not like the fact that the description of the condition includes symptoms that overlap with other diagnostic categories without its own diagnostic criterion.” See American Psychiatric Association, ed., Diagnostic and Statistical Manual of Mental Disorders: DSM-IV ; Includes ICD-9-CM Codes Effective 1. Oct. 96, 4. ed., 7. print (Washington, DC, 1998); American Psychiatric Association and American Psychiatric Association, eds., Diagnostic and Statistical Manual of Mental Disorders: DSM-5, 5th ed (Washington, D.C: American Psychiatric Association, 2013); Michael S. Scheeringa, The Trouble with Trauma: The Search to Discover How Beliefs Become Facts (Las Vegas, NV: Central Recovery Press, 2021); Judith Lewis Herman, Trauma and Recovery, 2015 edition (New York: Basic Books, 2015), 386. By using the validity of a truly traumatic experience for rape victims, prisoners of war, holocaust survivors and the like, this expansion of a catch-all definition of trauma actually minimizes and negates the suffering of such individuals.7According to the Oxford English Dictionary, the word “trauma” was first used in the 17th century to describe an acute physical wound in the field of medicine. Even references to physical trauma did not appear with any frequency until the mid-19th century, and by that time, the industrial revolution was in full swing, and with it a marked increase in the frequency of industrial accidents causing serious injury. Physicians treating the survivors of those accidents occasionally noted odd behaviors or mysterious, unexplainable symptoms, but it was believed that such symptoms were due to an underlying physical cause, even if the physical cause had not yet been detected. A Danish physician, John Eric Erichsen called it “railway spine,” because rail travelers who had experienced even minor accidents were reporting to their doctors strange and oddly psychological symptoms, including memory difficulties, lack of appetite, nightmares, and anxiety. Erichsen explained that these patients were suffering from microlesions of the spine, which was causing emotional havoc in their lives, and it could be a striking coincidence, but liability insurance was created during the same period. Some of these survivors of “railway spine” made their way to neurologist Hermann Oppenheim’s office in Berlin. Oppenheim came to believe that these strange symptoms were due to more than physical trauma, and that they are attributed to an underlying psychological problem. In 1889, his book titled “The Traumatic Neuroses” became the first medical use of the term “trauma” to describe a purely psychological response. In short, this begins the search for the question—is trauma physical or non-physical? Does trauma affect the brain or the mind or both? For more, see George A. Bonanno, The End of Trauma: How the New Science of Resilience Is Changing How We Think about PTSD, First edition (New York: Basic Books, 2021); Carlos Blanco, “Epidemiology of PTSD,” in PostTraumatic Stress Disorder, ed. Dan J. Stein, Matthew J. Friedman, and Carlos Blanco (Chichester, UK: John Wiley & Sons, Ltd, 2011), 49–74, https://doi.org/10.1002/9781119998471.ch2; Patrick Bracken, Celia Petty, and Save the Children Fund, eds., Rethinking the Trauma of War (London New York: Free Association Books, 1998); Roy R. Grinker and John P. Spiegel, War Neuroses, American Military Experience (New York: Arno Press, 1979); Allan V. Horwitz, PTSD: A Short History, Johns Hopkins Biographies of Disease (Baltimore, MD: Johns Hopkins University Press, 2018). While this is partly due to the everexpanding definition of trauma and a culture of ubiquitous pathology that venerates personal narrative over objective truth, the natural man will always exchange the truth of God for the wisdom of the age that gives explanatory power to the experience of human suffering and sin (1 Corinthians 1:18-31).8Unless otherwise specified, all Bible references in this paper are to the New American Standard Bible, 1995 (NASB) (LaHabra, CA: The Lockman Foundation, 1995).
For this reason, a critical evaluation of van der Kolk’s hypothesis that the body keeps the score (hereinafter referred to as, “BKS”) will help the present-day reader to understand the philosophical presuppositions for his non-scientific theory.9Van der Kolk claimed that Pierre Janet is the “real hero [and his] most important teacher.” Van der Kolk, The Body Keeps the Score, 180–81. There is a myriad of approaches in traumainformed care (TIC), but the researcher will be examining the first order presuppositions of van der Kolk’s theory (ontological arguments) in this paper, because the ontological incompatibility of a secular worldview with a biblical worldview will subsequently inform the incompatibility of integrating secular methodology in biblical counseling. See “Word of God and Counseling” by Doug Bookman in Heath Lambert, Sufficiency: Historical Essays on the Sufficiency of Scripture (Association of Certified Biblical Counselors, 2016). “Contemporary science has, with modern tools and in current language, discovered many of the central topics first spelled out for psychiatry by Janet,” he concedes, adding the neuroscience research to the theoretical foundation of 19th century French psychiatrist Pierre Janet.10“Pierre Janet and the Breakdown of Adaptation in Psychological Trauma,” American Journal of Psychiatry 146, 12 (December 1989): 1533, https://doi.org/10.1176/ajp.146.12.1530. Van der Kolk acknowledges that the goal of he and his colleagues’ work (Judith Herman and Herbert Rosenfeld) is to demonstrate the theoretical validity of early psychiatrists who understand psychological trauma to be the ultimate source of psychopathology. While Herman revived Freud’s original, self-repudiated seduction theory, arguing that repressed memories of sexual abuse, often incestuous abuse, caused traumatic symptoms, van der Kolk utilized more of Janet’s writings and clinical practice because Janet did not focus on sexual traumas, but instead often described sickness, accidents, and other common experiences as the origin of dissociated states. More specifically, Janet’s theory that the natural psychological defense against traumas was for the mind to protect itself by blocking memories of the trauma while retaining them in a hidden part of the psyche that can be recovered through techniques such as hypnosis. See Van der Kolk, Psychological Trauma, 1; Herman, Trauma and Recovery; Onno Van Der Hart and Rutger Horst, “The Dissociation Theory of Pierre Janet,” Journal of Traumatic Stress 2, 4 (1989). So the aim of this essay is to demonstrate that Bessel van der Kolk’s theory that trauma is encoded in the brain and body is based upon the theories of traumatic stress and dissociation developed by the Janet rather than verified scientific findings; therefore, pastors ought to expose this particular folly of scientism with the superiority and sufficiency of the Word of God.
To keep reading this essay by Francine Tan in the Journal of Biblical Soul Care Fall Edition 2023 click here.
