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Book Review: The Body Keeps the Score

by rayalez on 11/13/19, 10:17 AM with 68 comments

by imgabe on 11/13/19, 12:42 PM
> First, I think van der Kolk downplays the importance of the APA’s philosophical commitment to categorizing by symptoms rather than cause. Consider four patients, Alice, Bob, Carol, and Dan. Alice has poor concentration caused by child abuse. Bob has poor concentration caused by bad genes. Carol throws tantrums because child abuse. Dan throws tantrums because bad genes. The current DSM would categorize Alice and Bob as ADHD, and Carol and Dan as intermittent explosive disorder. Van der Kolk would like to classify Alice and Carol as having Developmental Trauma Disorder, and Bob and Dan as…I don’t know. Bad Gene Disorder? Seems sketchy. When the APA decides not to do that, they’re not necessarily rejecting the seriousness of child abuse, only saying it’s not the kind of thing they build their categories around.
This seems like a problem with the APA. Why would they categorize around symptoms? The same symptoms can have different root causes and would then require different treatments. So doesn't it make sense to categorize around root causes?
The rest of medicine seems to be more concerned with causes. A sore throat might be a cold, or it might be cancer. Obviously they require different treatments, so they don't lump them all into "sore throat" and do the same thing every time there's a sore throat.
Likewise if someone exhibits the symptom of ADHD and the cause is "Bad Genes" but you're trying to treat them for non-existent trauma, it doesn't seem like it's going to be effective.
by jacek on 11/13/19, 12:32 PM
Another summary of the book that was discussed on HN three weeks ago: https://praxis.fortelabs.co/the-body-keeps-the-score-summary...
Discussion: https://news.ycombinator.com/item?id=21340636
by keeptrying on 11/13/19, 12:18 PM
This might be one of the only books that I would classify as a “must read”.
The perspective of being able to debug your own brain is invaluable and understanding other methods to do the same are worth the price of the book.
Buy an electronic and paperback. Great book.
by michael_j_ward on 11/13/19, 4:19 PM
Interesting bit burried in section IV that I'm posting here in the likely event that most people don't read that far.
TL/DR- he's mostly critical of the book, but provides this update:
>[Update, written a few weeks after the rest of this post: maybe it is all wizardry. I recommended this book to a severely traumatized patient of mine, who had not benefited from years of conventional treatment, and who wanted to know more about their condition. The next week the patient came in, claiming to be completely cured, and displaying behaviors consistent with this. They did not use any of the techniques in this book, but said that reading the book helped them figure out an indescribable mental motion they could take to resolve their trauma, and that after taking this mental motion their problems were gone. I’m not sure what to think of this or how much I should revise the negative opinion of this book which I formed before this event.]
by foobar_ on 11/13/19, 11:16 AM
On a minor pedantic note, its more like the amygdala keeps the score. There is no difference between physical abuse and emotional abuse when it comes to the final end result on the brain.
by docdeek on 11/13/19, 10:54 AM
>> The standard textbook of psychiatry at the time stated that incest was extremely rare in the United States, cocurring about once in every million women.
This would seem incredibly low, even for a non-expert. At the time, as the article notes, there were 100 million women in the US - for incest to only impact 100 women in the country and yet be something that there is a word (noun) for, laws against, and historical records of stretching back millenia stretches credibility, surely.
by fellow_human on 11/13/19, 5:08 PM
> Even the studies that have passed the test of time look a little weird. The Adverse Childhood Experiences study found that obesity and other seemingly nonpsychiatric diseases were linked to child abuse, and recent studies confirm this – but the controls for socioeconomic status are always insufficient, and there’s surprisingly little shared environmental component.
I'm not sure of the author is purposefully ignorant about this, but the original ACE study was done on middle class households, 75% white. https://www.npr.org/sections/health-shots/2018/09/17/6487108...
by patrec on 11/13/19, 12:51 PM
> Like so many things, PTSD feels self-evident once you know about it.
Only from the myopic perspective of people only used to a life of luxury and ease.
Throughout most of history several of the people most close to you would have made an early and often quite unpleasant exit before you reached adulthood -- most of your siblings and children would probably not make it into adulthood and women had a double digit chance of dying from child birth[1]. And that held true even if you were an affluent member of a relatively stable and successful society.
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1139114/pdf/med...
So a priori it seems extremely unlikely to me that severely unpleasant experiences have psychologically crippling effects on a majority of people. Because that would seem to be extremely maladaptive for almost all of the last few millenia.
by afpx on 11/13/19, 12:08 PM
The reviewer shows lack of critical thinking and lack of understanding of how genes work when he goes on a political rant at the end of the first section. Armchair scientists have got to go.