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The Long Shadow of Trauma: One-on-One with Bessel van der Kolk

 

Today’s conversation between Bessel van der Kolk and Rich Simon, regarding van der Kolk’s thoughts on trauma, was a really interesting follow-up to Mary Sykes Wylie’s article, “The Long Shadow of Trauma” in the March/April issue. See her article here.

Van der Kolk continued to make his case that people who suffer from trauma are not being well-served by the therapy community. He thinks that right now, we have no language or terms that justly describe people enduring trauma.  Van der Kolk described those suffering from trauma as having difficulties with affect regulation, that they have extreme anger and anxiety, trouble concentrating, paying attention, and staying organized.

“The most important thing is to use methods that help people stabilize, to keep going, and to get them even keel,” he recommended, “There are many different ways of doing that and almost none of them have been systematically studied.”

It’s so shocking to me to hear that he thinks that America’s number one public health issue is child abuse. If someone had offhandedly asked me my opinion on the most serious public health issue countrywide, child abuse would not necessarily be the first thing I might think of. Van der Kolk explained that each year, 3 million children are reported to Child Protective Services for abuse or neglect.

Part of the reason that child abuse is such an issue in America, he said, is that we just don’t have a clear understanding of how to help those suffering from trauma.

As van der Kolk is quoted in Wylie’s article: “We don't seem ready to acknowledge that the largest danger to our women and children isn't Al-Qaeda, but the people who are supposed to love and take care of them."
04.13.2010   Posted In: NETWORKER EXCHANGE   By Psychotherapy Networker
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    • 0 avatar John Schureman 04.14.2010 08:36
      I just participate in the excellent webcast with Bessel van der Kolk on Complex Trauma and was moved and enlightened. His presentation of Complex Trauma was among the finest I have heard. I found his sharing insights into the machinations of DSM-V politics to be true and demoralizing. I am engaged in a similar battle with the DSM-V Committee over ADHD and have encountered to same cultural orthodoxy and ideological rigidity.
      Missing for me in the mornings (PST) discussion was the neuroscience of self-regulation. The ambiguous symptoms of dysregulation Bessel was referring, are impairments in high-order executive functioning. The neuroscientific operational definition for human volitional consciousness is our frontal lobe system of executive self-direction. The VM-PFC mediates amygdala imputes into self-efficacious agency control of the inhibitory processes. Psychotherapist need to understand that self-regulation is a genet Universal deep structure and not the exclusive result of ma maternal bond.
      I identify with Bessel van der Kolk’s frustration with the DSM-V process. Just as ADHD is no longer understood to be a Disruptive Behavioral Disorder by the NIMH and NIH, the DSM-V Committee insisted on continuing to use the phrase “Disruptive Behavioral Disorder and ADHD,” flatly contradicting their own policy and science. In 2008, NIMH and NIH clarified that the symptom cluster previously termed ADHD, was in scientific actuality, and neurodevelopmental disorder of self-regulation resulting from down regulation of DA/NE tonic modulation. They insist on referring to “impulsive decision making,” when the morphology of dysfunctional cognition is well documented with great specificity. ADHD is distinctive in non self-efficacious temporally mediated decision-making; with separate the symptoms from Complex Trauma, Depression, Anxiety, Personality Disorders, and other mood disorders.
      I will follow his suggesting of with the DSM-V site and submit today, his imputes on adjusting Complex Trauma, being conscious of the April 20th deadline. I am already signed in on the DSM-V web site because of my interest in ADHD. The larger problem for psychotherapist in the country is their scientific ignorance reguarding self-regulation neurology.
      If clinicians had knowledge of high-order executive functions, they would be more equipped to characterize accurately, maladaptive symptom presentation. The PFC serves to mediate amygdala into adaptive self-regulation. If the clinician is lacking in awareness of 21st century neuroscience of volitional agency, than the default of personality attributions made to define disruptive, inattentive, non self-efficacious behavior is mistakenly used to diagnose and treat the problem.
      There seems to be a lag in clinical understanding of the paradigmatic shifts over the past thirty- years of neuroscientific achievements, which allow for coherently conceptualizing affect, social, self-care, and anomalistic symptomatic presentations. The risks of not understanding the science of human volition self-directedness has psychotherapists relying upon heuristic attachment theory, which misses the neurology of the impairment. The proponents of attachment theory have inadvertently bamboozled California psychotherapist in believing Self-regulation is acquired through acculturation. The three universal genetic endowments that our species benefit from possessing, are “deep structure” for formal language acquisition, social attribution (ToM), and executive agency top-down control. Self-regulation, except in extreme cases of early abuse, neglect, or institutionalization, is a Universal epigenetic endowment exactly like formal language acquisition.
      The differential diagnoses of various executive functional impairments require knowledge of Universal Linguist Grammar and Universal Ethical Grammar, the evolutionary consequence high-order executive functioning. Neurofeedback, EMDR, cognotropic medications, and empathically attuned, cognitively resonant, psychotherapeutic relationships, all are top-down interventions that build upon agency control of affect, cognition, interpersonal sensitivity, and behavioral comportment.
      I fear American psychotherapists will remain unaware of the significant transformation, presented by the 21st century neuroscience, and our profession is doomed to becoming marginalized because of basic scientific ignorance.
      John Schureman

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