Trauma undermines the very foundation stone of all clinical practice.

Until this FACT about trauma makes its impact, clinically in general – we’re flailing.

[Another post from the Critical Psychiatry Network]

The part played by trauma in all clinical settings is crucial — it actively prevents the sufferer from VERBALISING. They cannot tell you (or themselves) about the worst thing that has ever happened to them — so they need help in explaining themselves to themselves — and until this potent clinical, and provable FACT is widely acknowledged — we’re all in deep, deep trouble, and how. “SPEECHLESS TERROR”is very real, very potent, and 100% curable.

In 1996 Dr Bessel van der Kolk wrote, page 193 –

“These findings may account for the observation that trauma may lead to "speechless terror," which in some individuals interferes with the ability to put feelings into words,” see below.

Since words are all we clinicians have to go on, the FACT that some troubled individuals cannot tell you about their trauma, in full, pollutes the supply of INVALUABLE data on which the entire fabric of clinical practice is built, and on which both doctors and their patients rely. All of them, without exception. And that includes you.

Without words, we have no history, no symptoms, no reliable means of arriving at any sort of realistic diagnosis.  If what is really going on, is hidden behind an inability to “put feelings into words”, you can either say that feelings don’t matter, or you're worried you're missing something of vital clinical significance. And if you're not the second, you darn well should be.

I attach the video clip in which Bessel repeats this devastating fact. Brainscans provide objective scientific evidence that certain traumas disable frontal lobes and speech centre.

What you get from the most troubled patients is secondary verbiage – which entirely misses the central clinical point. And – wouldn't you know – the worst traumas incur the deepest speechlessness.

Now of course, you don’t have to give this a second thought – it does not occur in the psychiatrist’s bible, or anywhere in peer–reviewed clinical journals. It features not a whisper in medical schools. So does it exist, or not? Your choice. But until you grasp this nettle, you are going to be floundering in all severely traumagenic cases. Worse, if you try and communicate the problem more widely, expect more put-downs than plaudits.

Does this mark a turning point in how we deliver mental healthcare? It all turns on whether Bessel’s findings signify or not. If they do, then the onus travels from me to you – my challenge has been to find a way of communicating what I found – yours is now rather different. I can’t unknow this clinical finding, nor do I want to. What about you?

Bessel proposed a counter-cultural medical fact. He has objective brainscan evidence to back him up. I don’t. Through serendipity, I uncovered a workaround, almost 40 years ago, and have applied it to the full gamut of psychiatric morbidity since, with gratifying results. I’ve also encountered more medical calumny than is good for me – which side are you on?

Ho Hum,

Bob

Dr Bessel van der Kolk : Traumatic Stress: the effects of overwhelming experience on mind, body, and society. edited by Bessel van der Kolk, Alexander McFarlane, and Lars Weisaeth, published by Guilford Press, 1996.

Chapter 9 : The Complexity of Adaptation to Trauma •        page 193

 ALEXITHYMIA AND SOMATIZATION: LOSS OF WORDS AND SYMBOLS TO COMMUNICATE WITH SELF AND OTHERS

Henry Krystal (1978) was the first to suggest that trauma results in a "de-differentiation of affect"—that is, a loss of ability to identify specific emotions as a guide for taking appropriate actions. He noted that this inability to create semantic constructs to identify somatic states is related to the development of psychosomatic reactions and to aggression against self and others. Our recent positron emission tomography (PET) scan study of people with PTSD (Rauch et al., in press) showed that when people with PTSD are exposed to stimuli reminiscent of their trauma, there is an increase in perfusion of the areas in the right hemisphere associated with emotional states and autonomic arousal. Moreover, there is a simultaneous decrease in oxygen utilization in Broca’s area—the region in the left inferior frontal cortex responsible for generating words to attach to internal experience. These findings may account for the observation that trauma may lead to "speechless terror," which in some individuals interferes with the ability to put feelings into words, leaving emotions to be mutely expressed by dysfunction of the body.

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