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Criticisms of “The Body Keeps the Score”

(josepheverettwil.substack.com)
263 points adityaathalye | 1 comments | | HN request time: 0s | source
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softwaredoug ◴[] No.45674571[source]
This article (and author) seems to be something of a trauma-skeptic, which doesn't seem to agree with mainstream science (setting aside Body Keeps the Score)

> That is, trauma doesn’t lead to dysfunction or abnormal brain function, physiology or hormonal regulation. Rather, an unhealthy person may be more susceptible to trauma.

What has been documented about Adverse Childhood Experiences doesn’t agree with this. There is copious evidence that the presence of ACEs, independent of other factors, leads to poor health outcomes [1]

It's also well known that past trauma predisposes you to future trauma [2]

There's also data indicating CPTSD, PTSD, and Borderline are distinct disorders [3]

1 - https://pmc.ncbi.nlm.nih.gov/articles/PMC8882933/ https://bmcpublichealth.biomedcentral.com/articles/10.1186/s...

2 - https://pmc.ncbi.nlm.nih.gov/articles/PMC5858954/

3 - https://www.psychiatrypodcast.com/psychiatry-psychotherapy-p...

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taeric ◴[] No.45674663[source]
I think there is a bit of a crowd that is pushing the idea that you can make events worse by telling people that they are forever scarred from them? That is, yes, some trauma sticks with you. History shows people are also very resilient at moving on from trauma. Kind of have to be, so that we aren't devastated when we ultimately do lose some family.

Would be like saying you should hammer people on how much grieve they must be feeling because they lost a dog. Now, nor should you also scold people for feeling said grief. It is very personal and hard to really know what experience someone will have until they have it.

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crazygringo ◴[] No.45675257[source]
> History shows people are also very resilient at moving on from trauma.

That's the "classical" mindset that modern empirical studies are refuting.

Actually, no, people are often not very resilient at all in moving on from trauma. They suffer greatly, they traumatize others, and it affects their health.

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taeric ◴[] No.45675703{4}[source]
On this, then, I would generally have a hard time agreeing. I'd be comfortable with the idea that not everyone is very resilient. I'd expect that. If the claim, then, is that there is an absurdly high variance there, I'd agree.

But I'm also growingly sympathetic to the idea that telling people they are, in fact, traumatized, is not healthy. People are, as a rule, susceptible to what they are told. Especially from authority.

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Schmerika ◴[] No.45675756{5}[source]
> People are, as a rule, susceptible to what they are told.

Research shows that suggestibility is actually moderately correlated with trauma.

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Jensson ◴[] No.45676683{6}[source]
If so then its true, telling traumatized people that they are traumatized makes it worse for them.
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paulryanrogers ◴[] No.45676782{7}[source]
Correlation is ~not~ [actually] causation?
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Jensson ◴[] No.45677234{8}[source]
Doesn't matter, suggestibility was correlated with trauma, which means they are likely to be suggestible to becoming miserable if you tell them they are.
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Retric ◴[] No.45677299{9}[source]
That requires someone to tell them they are miserable rather than observing them to be miserable.

There’s a lot of historic terms to describe people suffering from traumatic experiences like shell shocked (WWI), soldier’s hart (US civil war), lost/bewildered (US Revolutionary War), etc going back literally thousands of years.

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strken ◴[] No.45677906{10}[source]
You need to separate physical trauma from psychological trauma. There's no debate that getting hit in the head or having explosives go off nearby can cause physical brain damage. That's empirically proven (at least in animal models) and so obvious that it's hard to argue against.

What I'm unclear on is the details: is physical trauma a necessary factor in shell shock as it was understood a century or more ago? Is that shell shock the same thing as the combat stress reaction and/or post-traumatic stress disorder? Is PTSD an amalgamation of two different things that aren't the same? To what extent does suggestion worsen the physical vs psychological sides of PTSD? Is suggestion the only thing that causes shell shock, the CSR, and/or PTSD in the absence of physical damage? Etc.

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motorest ◴[] No.45678318{11}[source]
> Is suggestion the only thing that causes shell shock, the CSR, and/or PTSD in the absence of physical damage? Etc.

I think you're venturing into denialism territory. There is a mountain of evidence supporting the fact that traumatic experiences have a negative impact on health. See for example the impact of stress on, say, cardiac issues, and even growing grey hair and/or going bald altogether.

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1. strken ◴[] No.45678844{12}[source]
I'm less saying "it definitely isn't" and more trying to show the complexity of understanding this and the paucity of evidence. Is long-term stress different from a one-off traumatic incident? How much stress does trauma cause? Is therapy effective at preventing stress caused by trauma? What part of therapy is effective: can you stick someone in a room with a nice doctor and no therapeutic plan and achieve a result? Does therapy make things worse for some patients? Which patients are those, and how do you tell?

My personal opinion is that trauma probably has an effect, it's a lot worse in sustained cases, many of the symptoms are mixed up with other conditions, treatment for it is effective (in that it hits statistical significance) but not particularly effective (in that the effect size is small), treating healthy people can make them worse, some traumatised patients probably also get worse after treatment, and the symptoms of e.g. ASR/CSR are so vague that some of them apply to most of the people who read them.