Thursday, July 18, 2024

Psychiatrist Bessel van der Kolk: ‘When trauma becomes your identity, that’s a dangerous thing’ -Dlight News

The sound of piano music floats among the white-linened tables of the Red Lion Inn’s dining room as Bessel van der Kolk declares the end of humanity.

“We are doomed as a species!” says the 80-year-old psychiatrist, perhaps the most influential of the 21st century, leaning towards me across a half-empty glass of Sauvignon Blanc.

“We can’t do it! We can’t use our rational brains,” he continues, with the vigour of a much younger man. “Climate change. It’s very serious stuff! . . . Are you still flying?”

He jabs a finger in my direction. I confess that I am.

“You know you shouldn’t!” he says in a thick Dutch accent, his bearded face creasing with affable frustration.

Over the past few hours in this corner of rural Massachusetts, I’ve learnt that the energetic octogenarian is not short on strong views. We have already touched on the militant group Hamas (“What the hell were you doing?”), and will later get on to Sigmund Freud (“a bit of an egomaniac”) and Brexit (“You guys fucked that one up!”).

But van der Kolk has built a storied career on stubbornly staking out contentious positions. One of the first researchers to study post-traumatic stress disorder in Vietnam war veterans in the 1980s, he spent the ensuing decades fighting a tide of indifference in the academic community over the psychological impact of the worst horrors that can befall human beings.

In recent years, his 2014 masterwork The Body Keeps the Score has become an improbable sensation. Buoyed by a groundswell of popular interest in trauma and psychology in the wake of the pandemic, the dense, scientifically rigorous text has become a latent, runaway success, spending nearly 300 weeks on the New York Times bestseller list.

“It feels odd,” he says of his elevation to the internet’s favourite therapist. “Because it’s a sort of external persona that you become, but of course I am unchanged. I’m still the same old flawed creature I’ve always been.”

The 18th-century Red Lion Inn is a curiously tranquil place to be meeting this archaeologist of nightmares. As I await van der Kolk’s arrival earlier that afternoon, the faint smell of potpourri wafts from among chintz armchairs in the lobby beyond. Above my head, I notice absent-mindedly, the ceiling beams host an impressive collection of antique teapots.

“You flew all the way here from London?” he says a few minutes later, settling into his chair and scrutinising me through wire-rimmed glasses. “This had better be a good lunch!”

The thesis of van der Kolk’s book, and indeed much of his life’s work, is that horrifying experiences leave an imprint on the mind and body that prevents them from being properly consigned to the past. As a result, traumatised people become stuck, like mosquitoes in amber, frozen in the moment of catastrophe.

“You and I, what will we remember of this lunch a year from now?” he says as we each order a glass of white wine and look out over the thick forest carpeting the surrounding Berkshire mountains. “Maybe what we ate. Maybe something else. But we won’t have nightmares about it.

“But if something terrible were to happen from now on, sitting at a table like this may become a trigger for me,” he continues. “Somebody who looks like you. The sensation becomes the trigger for the emotional experience.”

The book describes case studies of unthinkable horrors. A woman wakes up during surgery to feel a scalpel lacerating her abdominal organs; a married couple miraculously survive an 87-car pile-up on a Canadian highway.

But while these extraordinary events are edge cases, van der Kolk argues that it is “extremely common” to experience trauma. “I’m about as privileged as you get, and my life is still hard,” he says, in a whispery intonation that frequently reminds me of David Attenborough. “We all have people die on us, people disappear on us. It’s challenging.”

A waiter arrives with a goat’s cheese salad for me, adorned with candied walnuts. Van der Kolk, who has declined a starter, sips his wine contentedly as I chomp hastily through pear and radicchio. 


The Old Red Lion
30 Main Street, Stockbridge MA 01262

Glass Sauvignon Blanc x4 $56
Goat’s cheese salad $15
Steak frites $40
New England lobster roll $36
Total (incl tax and tip) $177.66

We turn to his childhood in the Netherlands in the aftermath of the second world war. Van der Kolk says his father, despite being jailed by the Nazis for his pacifism, was an authoritarian at home. “I said, ‘Dad, you were in a Nazi concentration camp, and here you are running a house like a concentration camp!’” he says.

The impact of “adverse childhood experiences” is a major thread of van der Kolk’s work, and explains why so many people bear the hallmarks of traumatic stress, from depression to addiction. The Body Keeps the Score argues that child abuse constitutes the “gravest and most costly public health issue in the United States”.

In a landmark 1998 US study cited in the book, more than a quarter of respondents said they had been physically abused as children. It also found that people who had four types of negative early-life experience — such as abuse, neglect or family dysfunction — were seven times more likely to become alcoholics than those who had none.

“Everybody who gets hurt at home tries to pretend it’s normal to everybody else,” says van der Kolk gravely of the child’s evolutionary impulse to protect the bond with their caregiver, even if that person is causing them harm. “You’re not going to tell your classmates that something [bad] happens to you.”

A waitress deposits a Subway-sized lobster roll in front of van der Kolk and hands me a plate of steak so large that its accompanying frites are spilling on to the table.

A few weeks before our meeting, the social psychologist Jonathan Haidt published the much-discussed The Anxious Generation, which links the recent rise in adolescent mental-health problems to the increased use of smartphones among young people.

“Very important book I think,” says van der Kolk, attacking his lobster with his knife and fork. “This huge flag that he’s raising, I don’t know what the hell we’re going to do about it.”

Like Haidt, van der Kolk argues that the rise of screen-based communication, propelled by the pandemic lockdowns, has degraded the experience of human interaction. “On a screen, you don’t work for it, you get a reward without reciprocity,” he says. “That’s huge. You don’t have the sense you’ve done anything, any sense of accomplishment. You get cheap rewards for minor actions, and it’s meaningless.”

The pandemic also accelerated a shift in the way people think about themselves, as a social-media-driven focus on identity fused with concerns about our collective mental health. The result has been a growing cultural preoccupation with trauma — a word that is invoked everywhere from university campuses to TikTok.

“Did you ever take a history course?” says van der Kolk of the popular argument that we are living in an unusually traumatic era. “Read about the French Revolution?”

For van der Kolk, there is a strange irony that the concept he worked so hard to inscribe into the academic canon has become a mainstay of online culture.

“The moment I saw trauma, it grabbed me,” he says, remembering the day in 1978 when he first encountered a Vietnam veteran with PTSD. But as he pursued the subject further, he says, “My colleagues would say, ‘What’s this trauma bullshit? After you croak, no one will ever talk about trauma again.’”

Despite the popularity of The Body Keeps the Score today, he says that the academic community remains fractured in its understanding of the mechanisms and treatment of trauma. (It has also battled institutional dysfunction: in 2018, van der Kolk was fired as medical director of the Trauma Center in Massachusetts over what was characterised as an allegation of bullying, which he denies, saying he was removed to “mitigate . . . legal liability” over the actions of another employee.)

“Maybe from the outside, you see people have adopted [the concept of trauma] . . . I don’t see it in the major academic institutions,” he says. “It’s curious how widely the book is read.”

We are meeting as the conflict between Israel and Hamas has killed more than 30,000 people, and is threatening to spill over into a broader regional war.

I ask if he views such events through the lens of trauma — of each side reacting not just to the immediate demands of warfare but also to years, even generations, of pain.

“I get both stories,” he says, referring to the fraught histories of Israel and Palestine, “and they’re both horrible trauma stories . . . [But] we all come from generations of trauma. It’s no excuse. When trauma becomes your identity, that’s really quite a dangerous thing.”

“What’s appalling to me is that ideology is trumping facts,” he says, noting that he has faced accusations of antisemitism for making public reference to the Palestinian death toll without mentioning the Israelis killed on October 7.

“It’s tearing America apart,” he says. “This may just have a disastrous result on our election.”

Van der Kolk, who emigrated to the US in 1962 and now lives with his wife in the nearby Berkshire Hills, appears to retain a fondness for his home continent. He calls the European Union “the greatest miracle of our time”. The American healthcare system, by contrast, he describes as “a disaster”.

“There is something about this high-risk living in America that really brings out the best and the worst in people,” he says thoughtfully. “If I’d stayed in Holland, I would’ve become chronically depressed.

“In America,” he adds with a chuckle, “I’m chronically anxious.”

The dining room has thinned out and the chattering of lunchtime guests has dwindled to a low hum. A waitress removes my long-finished plate and asks if we’d like a second glass of wine as van der Kolk picks at the last of his lobster.

“I’ll get another,” he says brightly, after some consideration.

If the first half of van der Kolk’s book is concerned with the damage that our existence can inflict on us, the second proposes solutions for how we might be healed. Contentiously in this golden age of talk therapy, he is sceptical of the power of language to treat psychological injuries.

“These are habitual, visceral reactions,” he says. “Understanding why doesn’t rewrite the experience . . . Talking about why my tennis game was off is not always useful. I need to go back on the court and practise again.”

He is similarly lukewarm on mainstream pharmaceutical interventions for depression and anxiety, such as Prozac and other selective serotonin reuptake inhibitors, or SSRIs. “It’s: let me give you a pill, and stop being a pain in the ass!” he says of psychiatrists’ tendency to prescribe drugs that simply block out psychological pain.

Instead, he believes that the brain can be more durably rewired to properly integrate traumatic experiences into memory, using more experimental treatments such as MDMA-assisted therapy.

“In psychedelics, it’s as magical an exploration of the world as you can have,” he says, with evident enthusiasm. “It’s entering a territory you don’t know anything about, and stuff comes up that you didn’t know was living inside of you.

“You go there and part of you experiences it,” he continues, “and part of you observes yourself experiencing it, and the experience is very much like, ‘Oh my God, that’s what I went through.’”

He argues that the clue to healing may lie as much in the body as the mind. Yoga can produce “quite dramatic” results in traumatised people, he says, noting that he recently visited a prison that had implemented a programme for inmates based on his book.

“A goddamn healing environment in a maximum-security prison?” he says. “That’s stunning.”

Van der Kolk’s book contains frequent admissions that the mechanisms behind many trauma treatments, some of which border on the bizarre, are not fully understood. (He is particularly enthusiastic about eye movement desensitisation and reprocessing, or EMDR, in which patients move their eyes from side to side while remembering traumatic events.)

I ask if we will look back on such methods as laughably rudimentary in years to come, in the same way that we see bloodletting and lobotomies today. “I hope so! . . . It’s the nature of the beast, we always cling to stuff that to other people sounds ridiculous,” he says. “But I hope that 50 years from now we’ll be laughing at ourselves.”

As we finish the dregs of our wine, I note that van der Kolk’s continued enthusiasm for his field is impressive at an age when most people would be enjoying a quiet retirement. “What do I do?” he says incredulously. “Learn how to play golf?”

He suddenly grabs his phone in alarm. “Oh my gosh, it’s almost three o’clock. Oh boy! Who did I stand up?”

He tells me he has a patient to see. I call for the bill. We shake hands, say our goodbyes, and he’s off into the forest.

India Ross is the FT’s deputy news editor

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