Trauma

Trauma is no longer a subject discussed only by experts. Books about trauma have now become number-one bestsellers. In recent years, Dr Gabor Maté became world famous

with his In the Realm of Hungry Ghosts, about the link between drug use and trauma, and When the Body Says No, about the connection between trauma and physical health.

When the Body Says No presents research into the physiological connection between life's stresses and emotions and the body’s systems governing nerves, the immune system, and hormones.

In the Realm of Hungry Ghosts recounts stories of treating drug addicts in Vancouver's notorious Downtown Eastside, with legislative reform in mind. The book is a call-to-arms for the decriminalisation of drugs and for a more informed view of addiction. "Those whom we

dismiss as 'junkies' are not creatures from a different world, only men and women mired at the end of a continuum on which, here or there, all of us might well locate ourselves." In the Realm of Hungry Ghosts begins by introducing many of Maté's patients. They steal, cheat, sell sex, and otherwise harm themselves for their next hit. He looks to the root causes of addiction and trauma, applying a clinical and psychological view to the physical manifestation and offering some answers to why people inflict such catastrophe on themselves.

Similarly, The Body Keeps the Score, by Bessel van der Kolk, contains case studies of trauma from the author’s clinical practice, autobiographical reflections, and sharp critiques of mainstream practices. The book begins with a discussion of the neuroscience of trauma, explaining brain anatomy and function and how they underpin reactions to threats. Traumatic reactions, van der Kolk, explains, are not simply disturbances of fear and anxiety: the amygdala in the traumatised brain triggers people into fight-or-flight reactions. This severely disrupts interpersonal relationships. Van der Kolk explains how hormonal influences and

the vagus nerve result in trauma having significant effects throughout the body. Traumatised people may lose a sense of bodily ownership, connection to others, and even of being alive. Recovering a sense of personal agency and bodily ownership – what he refers to as ‘befriending the body’ – is key to recovery. He then explores childhood trauma. His focus is on violent family environments that produce children who lack a secure sense of connection to others and suffer a heightened risk of illness and re-traumatisation. These children are more likely than their peers to experience and perpetrate violence when they get older, to engage in self-damaging behaviour, and to experience a range of mental health conditions.

He advocates for policy responses that address disadvantage and vulnerability and for better recognition and understanding by the medical profession of the impacts of trauma. He proposes diagnoses that recognise the outcomes of repeated childhood trauma, such as

Complex PTSD and Developmental Trauma Disorder, to be included in the DSM. However, these efforts were rebutted by the DSM-IV (1994) and DSM-5 (2013).

The Body Keeps the Score ends with an exploration of forms of treatment other than medication. It advocates for using neurofeedback, somatic psychotherapies, yoga, theatre, and eye movement desensitisation and reprocessing (EMDR). The book is a hopeful one. Although it acknowledges the enormous impact of traumatic experiences, it argues that post-traumatic distress can be healed. Van der Kolk pays attention to sexual abuse and

violence as sources of trauma that affect women and girls. In doing so, he is making the psychology of trauma, once focussed on soldiers coming home from combat, more

inclusive of the experiences of female trauma survivors. PTSD is not only described as the traditional set of symptoms, such as flashbacks, nightmares, and hypervigilance, but also as the cause of relationship problems,emotional disturbances, and forms of acting out, such as

rebellious, defiant, impulsive, and inattentive behaviour. The range of events that lead to trauma is considerably widened in this book to include unpleasant events witnessed indirectly (vicarious trauma).

Closer to home, Australia’s National Research Organisation for Women’s Safety developed the emerging theory that a high percentage of Aboriginal women incarcerated for violent crime may have a diagnosis of complex trauma. It found that these women had experienced multiple life stressors, many of which involved abuse beginning in early childhood, which may contribute to the women’s victimisation and offending, but also to the incredible resilience the women display. The study identified common complex trauma enabler that the women experience, such as broken mother-child, family and community relationships; communication disconnect; impacts of the legal and policy environments; and barriers to health, housing and support services; and systemic failures.