Final Thoughts on the Book

You have to do the thing or else like three hundred people are gonna say it in our comments. What? Let the bodies keep the score. Let the bodies keep the score. the bodies keep the score. The other one that somebody pointed out was, you know, the Abasong winner takes it all. No, I do not. You can also do the body keeps the score which has been stuck in my head for like three weeks. Sound off in the comments. Are there any other songs? What other songs match this book? Well, what do you have? Oh, I was just gonna do that. Oh wait, you actually were? Yeah, of course. What else is there How can you even do that though? You can't just chant until the music kicks in. Yes, I can. Wait, come come up with a better one. I can't believe I have to come up with a thing about trauma, a thing I don't understand at all. It was a great thing to announce right off the bat. Trauma never looked into it myself. Could you do something score like a soccer, like at donon't try to make me do sports. I don't know. Dance for me monkey. Do a sports joke Well, you got to do something else, have one All right Peter. Michael What do you know about the body keeps the score? All I know is that I've been told the score my body keeps is a six point five at best So the full title of the book is The Body Keeps the score, Con, Brain, Mind and Body in the Healing of Trauma by Bessel Vander Koke. What do you know about this book, Peter? Very little. I don't know a lot about trauma. This will be embarrassing for me because I feel like you're going send me excerpts and be like, canan you believe you said this about trauma? And I'll be like, what you what did you get wrong I don't know. The author is a psychiatrist. Oh, even though I constantly mess up and say psychologist, he runs a trauma center where he works with individual patients. He's an an actual guy in the space. Yeah he's like an actual expert. He's like, very well known in the field. He's published widely about this. This isn't a book by just like a guy. Okay. It comes out in twenty fourteen, esssentially noobbody notices it and then it just starts sllowly kind of rising up bestestseller charts, eventually around twenty eighteen, twenty twenty, it appears entirely through word of mouth This ends up on the New York Times bestestseller list and then stays on the bestseller list for two hundred and forty eight weeks.. One of the reasons I'm doing this is because if you check the kind of random Amazon charts of like nonfiction books, this will oftentimes be in the top five, desespite now being twelve years old. you know eventually it gets endorsed by Oprah and there's like various high prominent people that recommend this book. But at first, it was just like, I read this book and you tell your friend about it kind of thing. Right. I think for this reason, I want to give like a big disclaimer at the beginning of this episode. I think people are probably very clenched for us to talk about this episode because I'm sure you know people like this. I know a lot of people who read this book and liked it and got something really beautiful out of it. This book is the kind of thing Pe you like and respect will tell you to read it. So I don't want to like take that away from somebody. The most important thing about this book, I think is really just the premise and especially the title. Yeah. So for this episode, I talked to four different psychologists, all of whom either specialize in trauma or see a lot of patients who've experienced trauma, and all of them said that this was an important kind of corrective to the field and an important way of broadcasting to the more general public The idea that when you are traumatized, that has physical symptoms, right? It shows up in your sleep, it shows up in your immune system. It shows up in all of these ways that don't necessarily feel like trauma to you, right? It doesn't feel like a trauma response. That was like really healing for people too be like, oh, it's not that I'm broken, it's that I'm affected by the thing that happened to me as a child The other thing that I think was really important about this book is the idea of complex PTSD, the previous old school understanding of PTSD was that you had to experience a major single event. You experienced a sexual assault or you were in combat or you were in a car accident. But it turns out you don't have to experience one discrete event. You can experience like more lower level events over a long period of time. Okay And I also think that's like a really important Reframing both within psychology and also among the public. Because that goes contrra what the Spranos said about Tony having anxiety attacks whenever he saw me because he traced it to his father's criminal activity when he was young. That's almost like too specific. You're like, give it to me in Sopranos. I'm gonna figure this all out based on a series of prestige television shows I think the third thing that is important about this book and is one of the reasons why people like it, is that the author of this book and the book itself have extremely good politics. So one of the critiques that you always hear of books like this that are kind of individually focused efforts to help you deal with your trauma or self help books in general, is that they don't talk about structural forces, right The entire epilogue of this book is dedicated to talking about structural drivers of trauma So here is an excerpt. In many ways, we seem to be regressing, with measures like the callous congressional elimination of food stamps for kids whose parents are unemployed or in jail, with the stubborn opposition to universal healthcare in some quarters, with psychiatry's obtuse refusal to make connection between psychic suffering and social conditions, with the refusal to prohibit the sale or possession of weapons whose only purpose is to kill large numbers of human beings And with our tolerance for incarcerating a huge segment of our population, wasting their lives as well as our resources. When I give presentations on trauma and trauma treatment, participants sometimes ask me to leave out the politics and confine myself to talking about neuroscience and therapy I wish I could separate trauma from politics, but as long as we continue to live in denial and treat only trauma While ignoring its origins, we are bound to fail. In today's world, your zip code even more than your genetic code determines whether you will lead a safe and healthy life. Cooking. He's cooking. Absolutely cooking here. So as opposed to many of the other books we talk about on the show, we won't really be criticizing him for things he leaves out of this book. It is a book focused on individual therapies, but I kind of think that's somewhat defensible.ike, he's a psychologist He treats individual patients tellelling the patient like, well, you should solve racism isn't really useful as a therapeutic mode. It's also it's not what he's an expert at exactly, R? So I think that's defensible. Yeah. However Sing all of that I also was very struck while I was reading this book. By the sheer size of the gap between the book that people describe to me and the effect that this book has had on them versus the text of the actual book itself. So we're gonna walk Roughly chronologically through the book, we start with chapter one. This is Bessel Vanderkoke talking about his upbringing, how he ended up as a trauma therapist He is born in nineteen forty three in the Netherlands. In nineteen sixty two, he moves to Hawaii for college. He gets a summer job in a psychiatric asylum, essentially Given how many of the patients there are suffering from trauma or have been through like really horrible things, this inspires him to become a psychologist and work specifically on Rama So the opening scene of the book is in nineteen seventy eight when he is dealing with a Vietnam veteran. this guy watched all of his patriots killed in front of him. There was some sort of ambush when they were in Vietnam. He had a really close friend who he basically watched murdered like three feet away from him. He's super fucked up from that And then Eessel Vander Koke continues. Maybe even worse for Tom than the recurrent flashbacks of the ambush was the memory of what happened afterward. I could easily imagine how Tom's rage about his friend's death had led to the calamity that followed It took him months of dealing with his paralyzing shame before he could tell me about it The day after the ambush, Tom went into a frenzy to a neighboring village, killing children, shooting an innocent farmer, and raping a Vietnamese woman After that, it became truly impossible for him to go home again in any meaningful way. And then he continues At the end of his tour of duty, Tom was honorably discharged and all he wanted was to put Vietnam behind him. Outwardly, that's exactly what he did. He attended college on the GI bill, graduated from law school married his high school sweetheart and had two sons Tom was upset by how difficult it was to feel any real affection for his wife, even though her letters had kept him alive in the madness of the jungle Tom went through the emotions of living a normal life hoping that by faking it, he would learn to become his old self again He now had a thriving law practice and a picture perfect family, but he sensed he wasn't normal. He felt dead inside. So a lot going on in these paragraphs. Can we get Tom in prison, folks? This is like a very complicated sequence of the book. One of the things that's interesting if you ever look up this book on Reddit is like every three months, somebody will go on Reddit and be like, My friend recommended. The body keeps its core to me. And then I read it and the first anecdote is a sympathetic portrayal of someone who raped and murdered a bunch of people in Vietnam like as a surviv of sexual assault this feels really fucking weird. On the other hand, I do want to say that all of the trauma psychologists I spoke to said that if you're a trauma therapist, you are dealing with people who have done horrible things. L a lot of people's trauma is based on what's happened to them, but also how they react to it. L people who were traumatized beat their spouses, they Yeah, Mbe they killed somebody in a driving accident. I mean, this is just part of like being a trauma therapist. And mayaybe you murder a bunch of children and this is just No No, I here's the thing. I get it. E as I was reading it, I sort of get it, right? whereere there's this chain of events that starts with this horrible trauma and leads to more horrible things. Yeah. It is weird though that the solution it feels like we're working toward is like comfort and peace for Tom. Exactly. And I think what people are really responding to is not just that this anecdote appears in the book, but the way that it appears in the book. because at no point does Bessel Vander Koke give a single statement of sympathy to this poor woman in Vietnam who had her children killed and was brutally raped for no fucking reason, right? To me, this story is a story of like the cycle of trauma, right? that when you get fucked up, you do something even more fucked up to innocent people. is Yeah That is what this story is, right? And I also think fundamentally this is a story about racism, right? He wants to impose collective punishment on this woman because she's Vietnamese and he considers Vietnamese people to be like such a distinct species that if one of them does something bad to you, then you can just enact revenge on others of them. Like He could have also said, like,, when I first started out as a trauma therapist, it turns out people have done really fucked up shit and it might seem difficult from far away to talk about this, but also I wan to prevent Tom ing these these violent fantasies out in his life now. That was my purpose as a therapist. There are ways to present this that keep the same basic facts of the story, but kind of like put it in context of like, yes, Tom should be in fucking prison. But given that that's not really in my power as a therapist, I'm gonna try to work with Tom to make sure that this doesn't happen again. Yeah,'s like he felt that inside. was like, whoa Yeah. Yeah, because you made other people dead outside. You actually killed children, dude? Yeah. I don't know, this like, it's hard not to read this and be like, wow, this man sure went unpunished for his horrific crimes. Right. But what he's actually saying is just like, Tom is sad. So after Tom, we then meet another Vietnam veteran named Bill. Oh boy, who is a participant in a study about Night. Just a series of war crimes, and they're like, Bill sad too So I mean, basically, here's this. Phill or the Napalm king, as they call him. As part of that study, we gave our participants a Warschack test Unlike tests that require answers to straightforward questions, responses at the Rorschach are almost impossible to fake. The Rorschach provides us with a unique way to observe how people construct a mental image from what is basically a meaningless stimulus, a blot of ink Because humans are meaning making creatures, we have a tendency to create some sort of image or story out of those ink blots. What people make out of these blots can tell us a lot about how their minds work On seeing the second card on the Rorsack test, Bhill exclaimed in horror, That is that child I saw being blown up in Vietnam in the middle You see the charred flesh, the wounds and the blood is spurting out all over. Panting and with sweat beating on his forehead, he was in a panic similar to the one that had initially brought him to the VA clinic I gotta say that's the most straightforward Worschach example I've ever heard in my life. Dude, yeah, I look this up. The Rorschach test, you know, it's ink bllot tests. Everyone has kind of seen these like canonical ink blot symmetrical ink blot things. They always use the same ten. So it's always the same ones. Right. And like, yeah, there's something kind of weird about the way that he describes it here Because like when I look at them, I see like a bat or like a mask. I'm just like butterfly. That's a butterfly. You got another butterfly there? I'm not like it's my dad emotionally neglecting me. L it's really weird. I don't know what it's like to have this level of like trauma, right? So I'm not gonna I don't wan to be too flippant. but if you like put that in front of someone And they're seeing shit like that I don't it just doesn't comport with my understanding of how that would actually play out, but what He then has a long sequence where he talks about all the other veterans that they brought in to use the Roschach test. He says, The veterans interpreted the cards with descriptions like, These are the bowels of my friend Jim after a mortar shell ripped him open And This is the neck of my friend Danny after his head was blown off by a shell whileile we were eating lunch. You just showing them to Elon Musk, and he's like, that's someone online being mean to me. That's someone online being mean to me. That is a helicopter shot of white genocide. So like we're eight pages into the book. I'm like, is this really how the Rorschach test works? Beause like, you know, we've all seen them in movies or. Yeah, yeah. The Rorschach test is completely debunked pseudos science. That's kind of what I thought, but I didn't want to say it out loud. I was like, is this real? This isn't the way that it work Right, That is a photore realalistic image of exactly of my exact trauma. So there's an open letter by a bunch of psychologists called Call for a moratorium on the use of the Rorschach Inkblot test in cllinical and forensic setettings from nineteen ninety nine This is not a test that is like given all that much credibility. It still is used in court sometimes in America, but that's really fucking embarrassing. And it's so weird for him to talk about this in twenty fourteen as if it's just like a cool method that we have for finding out the truth about things. That's not how like anyone credible in the field talks about it anymore. You're allowed to use fake science inortin America, and that's part of what makes this country great. I started looking into this and the history of the Rorschach test, it was often used to diagnose homosexuality. That's the one thing I think it works for. they're just like butt hole, butt hole.. Peter Peter Peter. I'ming. I'm sitting something. I'm like not even fucking exaggerated. heres this hang. At that time, the five signs most often interpreted as diagnostic of homosexuality One, buttocks and anuses, two, famemine clothing. Three male or female sex organs. Four, human figures without male or female features and five human figures with both male and female features. I am someone who like knows my way around an anus. I do not look at these fucking things and be like, oh my Godd, it's a butthole. Yet again, a butthole.ike Mike, if you think you can say I am someone who knows my way around an anus on this podcast, And just move forward. Do you need a minute, Peter to collect yourself Actually, this is such a sign to me of like, this is not real science. A gay person is not just gonna be like, this is a butthole. don they don't look like buttholes objectively. Secondly, I don't think people are just blurting out. Like you have this random businessman, he's like a closeted homosexual. and he's like, yet again, it's buttocks. L there's no fucking word. That's a little boy who's just begging for it have to cut that. I't mean I didn't mean an underage boy. I I imagine of age little twink, all? You were spelling it BOI. It's fine. It'son problematic. That's a beautiful twenty year old boy presenting himself to me. So we then get into the next section of the book, which talks about how trauma affects the brain after he works with Vietnam veterans branches out into people who've experienced child abuse, sexual abuse. They oftimes have the same types of symptoms as the Vietnam veterans. So he starts to explore this and here is him describing what he sees as the mechanism beind this Whether the trauma had occurred ten years in the past or more than forty, my patients could not bridge the gap between their wartime experiences and their current lives Somehow the very event that caused them so much pain had also become their sole source of meaning They felt fully alive only when they were revisiting their traumatic past. He then has a section called Addicted to Tuma, The Pain and Pleasure and the Pleasure of Pain. Okay. Oh here's more. Oh, I should also say like this is a really rough description of somebody. This episode is going to include a lot of like very detailed descriptions of sexual assault because that's what the book contains. So if that sucks, feel free to tap out. Many traumatized people seem to seek out experiences that would repel most of us, and patients often complain about a vague sense emptiness and boredom when they are not angry, under duress, or involved in some dangerous activity My patient, Julia was brutally raped at gunpoint in a hotel room at age sixteen. Shortly thereafter, she got involved with a violent pimp who prostituted her He regularly beat her up. She was repeatedly jailed for prostitution, but she always went back to her pimp Finally, her grandparents intervened and paid for an intense rehab program. After she successfully completed inpatient treatment, she started working as a receptionist and taking courses at a local college. In her sociology class, she wrote a term paper about the liberating possibilities of prostitution, for which she read the memoirs of several famous prostitutes. She gradually dropped all her other courses. A brief relationship with a classmate quickly went sour. He bored her to teearars, she said and she was repelled by his boxer shorts She then picked up an addict on the subway who first beat her up and then started to stalk her She finally became motivated to return to treatment when she was once again severely beaten. The mechanism that he's describing is that you're kind of addicted to the neurotransmitters that are firing when you're under duress. And so whether you realize it or not, you're sort of in a way thrill seeking, or you're seeking out experiences that trigger these kinds of responses because when you're in you more functioning relationships, you're bored by them It's not triggering the same kind of pleasure responses that you're getting from these traumatic experiences Mm. Okay. What do you think, Peter? I feel likere I'm way out of my depth here. This sounds like it could have like some broad element of truth to me people who experience trauma tend to find themselves in these scenarios more frequently I like I have genuinely no knowledge about this as like a causal mechanism, right? So this phenomenon is real. peopleeople who experienence child abuse or child sexual abuse are more likely to be abused as adults. And this is a phenomenon that is very well established, but there's tons of work investigating why this phenomenon is real. And essentially nobody subscribes to the idea that they are addicted to trauma. So I read a really interesting paper that sort of goes through the history of this concept, how it's been interpreted over the years A lot of really interesting qualitative work where they ask people like why did you return to this person who was abusive? whichich again is a very common phenomenon. It's kind of part of the process of leaving an abusive relationship. offtentimes it' going back to that person a couple times. People who experienced child abuse, child sexual abuse are more likely to go back to an abusive partner. That again is like an actual phenomenon. However the cause of this is much more kind of obvious and direct. So one of them is just poverty. People in poverty are more likely to be abused and people in poverty are more likely to be abused as adults simply because it's harder to leave an abusive relationship if you don't have money. Yeah. That is one aspect. An aspect that they think might explain some of it is that people who have experienced abuse and grew in like really chaotic homes can't spot the red flags of an abusive relationship as well, right? They have a sort of higher tolerance for like mid level toxic behavior, right? They might not see it as something that is like going to become much worse. Yeah I mean, you lack a framework for what a healthy dynamics areight. So obviously you're going to be bad at spotting unhealthy dynamics. Yes. And what's really interesting is there's all these qualitative surveys where they ask people like, why did you go back to this abusive partner The most common response is I loved him One of the theories is that people who've experienced abuse as children because the cycle of abuse is you get abused and then the abuser apologizes, I'll never do it again They are more likely to accept the apology. You also think about things like, you know, child abuse can cause low self esteem anxious attachment, these other kinds of like personality drivers that would make you more likely to go back to somebody who is treating you terribly. It's not that you're addicted to it or you like it or you're seeking it out. What was that thing about hating that guy's boxer shorts? I don't know where. Was he trying to sort of like hint at the idea that she's coming up excuses but was actually just bored I don't know I was Googling around I found like a domestic violence research center. And like the first line of their frequently asked questions, it says, it is important to note that victims do not stay in abusive relationships because they enjoy being abused This idea that like, oh, they're addicted to it, they like it. They're bored if they're not getting it. This is like an old trope about peoplee who are abused, right? It's sort of blaming them for the abuse like, oh, they w to be there. And like that just isn't fucking true. It's not something that people say in the field at all. Like this addicted to trauma framework that he's proposing here has not been the academic consensus about sexual assault, interpersonal violence for like decades. Interesting. Yeah, I This is the part of the episode where I'm just listening and learning. I'm like You're like, wowobs Tell him, Bobs. Tell him. After he's established this like addicted to trauma model, He then tells us the brain mechanisms behind it. So he walks us through something called the Triune brain model. The brain is built from the bottom up It develops level by level within every child in the womb just as it did in the course of evolution. The most primitive part, the part that is already online when we are born, is the ancient animal brain, often called the Rptilian brain. The Reptilian brain is responsible for all the things that newborn babies can do Sleep, wake, cry, breathe, feel temperature, hunger, wetness and pain An effective treatment for trauma has to address these basic housekeeping functions of the body. So now he contrasts the retilian system with the more advanced parts of the brain. Right above the reptilian brain is the limbic system. It's also known as the mammalian brain because all animals that live in groups and nurture their young possess one Development of this part of the brain truly takes off after a baby is born. It is the seat of the emotions, the monitor of danger, the judge of what is pleasurable or scary, the arbiter of what is or is not important for survival purposes It is also a central command post for coping with the challenges of living within our complex social networks. And then he gets to the most sophisticated part of the brain. The frontal lobes are responsible for the qualities that make us unique within the animal kingdom They enable us to use language and abstract thought The frontal lobes allow us to plan and reflect imagine and play out future scenarios, they make choice possible and underlie our astonishing creativity. So this is the derver behind the addicted to trauma model, right? Because your trauma is embedded in all three parts of the brain, including these sort of reptile instinctive parts. And so the challenge with trauma is that if you're only addressing it in the prefrontal cortex, like the sort of logical part of your brain, you're basically leaving the trauma in those deeper parts of your brain intact. It feels like we're building towards the inadequac of talk therapy or something, right? whereere it's likeope you can't talk out your trauma because You're using the top layer of your brain, but it goes deeper. We are also building toward the total debunking of this entire concept, this lizard Reptilian triune brain model thing It was invented in the nineteen sixties based on extremely thin data from the early nineteen hundreds It was already controversial by the nineteen seventies And it was essentially discarded by the field by the nineteen nineties.. Humans, first of all, did not evolve from reptiles. It's not like there was a reptile brain and then there's like an extra layer on top of it. Essentially, every animal has like the same parts. L lizards also have a prefrontal cortex.. There's different parts of the brain, it adapts, it does different things. It just is not the case that like they have a qualitatively different brain than us. There's also not really this like step by step evolution. like first there's your ancient brain, and then there's like the more modern mammalian brain. That just isn't how evolution works. And even beyond the anatomical stuff, one of the core theses of this book is that there's a clean separation between your emotional brain and your rational brain. And that also just isn't true. So there's a really good article about this called The Brain is adaptive not Triune that says modern neuroscience research demonstrates that the Tune brain theory does not accurately explain how the brain functions in everyday life or during the stress response Specifically, emotion and cognition are interdependent and work together. The limbic system is not a purely emotional center, nor are there purely emotional circuits in the brain, and the cortex is not a purely cognitive center, nor are there purely cognitive circuits in the brain. I sort of intuitively understand that like we don't know an enormous amount about brains. Yeah. And so a lot of the ways in which We talk about it colloquially, sort of metaphorical or you know, very very oversimplified. Truly, whenever he does this in the book, he like gets it wrong. There are huge sections of this book. that are just like absolutely incorrect. He has a whole thing about the polyvagal system, which is like a spinal cord thing. You have your sympathetic system and your parasympathetic system. It's a similar thing. It's like one system ramps you up and another system kind of cools you down and then trauma affects it in a specific way. That's also been completely debunked. That was debunked way before this book was ever published. There was never any good evidence behind it. And it was like a bunch of like rat studies and monkey studies and shit Like he just includes it in the book What's going on with this guy? I thought he was u Well, we'll get to read her. why why is this well respected guy who is sort of legitimately an expert doing this? If the only thing in the book was misinformation of this type, like, we fucked up the reptile brain thing I don't think I'd be doing epode it. I'd be like whatever. Lve the rest your life thinking we have a reptile brain. fine. But this starts to get get worse when we get into the Tuma in the body section. So after we talk about how trauma affects the brain, we talk about how trauma affects the body. I'm going to send you the vignette. Sherry had graduated from college, but now she worked in a joyless clerical job lived alone with her cats and had no close friends. When I asked her about men, she told me that her only relationship had been with a man who'd kidnapped her while she was on a college vacation in Florida. He'd held her captive and raped her repeatedly for five consecutive days She remembered having been curled up, terrified, and frozen for most of that time until she realized she could try to get away. She escaped by simply walking out while he was in the bathroom. When she called her mother Collect for help Her mother refused to take the call. Cherry finally managed to get home with assistance from a domestic violence shelter While Sherry Dutifully came to every appointment and answered my questions with great sincerity, I did not feel we were making this sort of vital connection that is necessary for therapy to work Struck by how frozen and uptight she was, I suggested she see Liz, a massage therapist I had worked with previously. She gets massages. This is what I was talking about, right Tuck therapy is like too shallow. you're not digging deep enough into the brain. You must first get a massage. I also think frozen and uptight is a choice of the way to describe someone who's like brutally raped. Right, A little bit judgy. It's like a little like uptight is just like a rude judgment of a person. Is weird Okay, and then at the end of the chapter, he comes back to her and talks about the results. It was fascinating to see how much Sherry benefited from her massage therapy She felt more relaxed and adventurous in her day to day life and was also more relaxed and open with me. She became truly involved in her therapy and was genuinely curious about her behavior, thoughts, and feelings She stopped picking out her skin and when summer camp came, she started to spend evenings sitting outside on her stoop chatting with her neighbors She even joined a church choir, a wonderful experience of group synchrony. So if you've been raped, get a massage. I can't tell if this is like weirdly shallow and insensitive or just like totally fine and like things that physically relax you might actually chill you out a little bit. I honestly don't know. So for this, I spoke to Emmy Neatfield, who is the author of a memoir about trauma called accceptance and wrote like one of the first pieces to publicly criticize this book from Mother Jones. It's excellent. I'll include it in the show notes of the research for that article, she contacted Bessel Vander Koke to ask him about another problematic anecdote and he told her O than Bill Every anecdote in this book is a composite. Oh, meananing they are made up. Wait other than the guy who looked at the Rorschach and was like, that's a video of my Vietnam experience. According to him, that is the only real anecdote in the book. There's one other that's kind of like a news story. so that's like available publicly. But other than that, apparently he told her These are all composites. And I reach out to him to like double check this. like, are these really composites? He didn't get back to me. Once you If think about it this way, you notice a lot of just like weird fake sounding details in these anecdotes. The fact that this woman lives alone with her cats is like a little on the nose. And also, he says she told me her only relationship had been with a man who'd kidnapped her. Yeah. I don't know that somebody would describe that as a relationship. If you're a rape victim, have you ever been a relationship? Oh, yeah, there's the guy that like raped me repeatedly. Yeah, I was kidnapped. Yeah, exactly. also it feels very weird do composite characters with trauma Like what parts of this are one person is like a really important question here. Yeah. And like this is a book about trauma. so you're going to change the names of some people. You're gonna to change some details so that like people aren't identifiable. That sort of stuff is totally fine. I have done this in magazine articles when I've had sources that I didn't want to identify. but first of all, he didn't disclose anywhere in the book that he's doing this or describe like the extent of that. Secondly, if he's compositing characters, that means he's taking different pieces From different people's stories, this book depends heavily on these miraculous cures for trauma. Yeah, right? was the person who benefited from massage therapy, the person who was kidnapped? He also made up the thing that she was uptight, potentially. That's also kind of a weird move. What if the only composite aspect is the three cash, you know He threw that in it's like, Oh, you got to make it believable. Right. So we're not gonna to talk all that much about the rest of this section about how trauma affects the body. Again, this book, the basic premise is true, this basic mechanism is true. The most notable thing though, is that this is the section where I started to notice a weird sloppiness when it comes to So a lot of the section is about this work by Frank Putnam, who is examining the effect that trauma has on young girls. He has two groups, a group of abused girls and a group of non abused girls, and he follows them for twenty years and he gets like their're biomarkers. And so here is Bessel Vanderkoke describing that study By the time girls get to middle school, most have begun to master a whole set of social skills, including being able to identify what they feel, negotiating relationships with others, and pretending to like people they don't, and so on The sexually abused girls have an entirely different developmental pathway don't have friends of either gender because they can't trust They hate themselves and their biology is against them leading them either to overreact or numb out They can't keep up in the normal envy driven inclusion exclusion games in which players have to stay cool under stress Other kids usually don't want anything to do with them. They simply are too weird. But that's only the beginning of the trouble. The abused, isolated girls with incest histories matures sexually a year and a half earlier than the non abused girls Sexual abuse speeds up their biological clocks and a secretion of sex hormones. Early in puberty, the abused girls had three to five times the levels of testosterone and Androsinidone the hormones that fuel sexual desire as the girls in the control group. So the first thing that stuck out to me was this finding about friendship. He says, they don't have friends of either gender. They can't trust. They hate themselves. O kids don't want anything to do with them. I was like, is this really what the studies show they don't have any friends? He does this a lot through the book where he talks about people who've experienced trauma and he's like really totalizing terms of like they can't experience pleasures. At one point, he says they're disconnected from their soul. So anyway, I went to his citation for this The citation includes five publications One of them does not appear to exist The rest of them don't include anything about Num of friends happappiness with friends, social, ostracism, etcetera. Oh my God. One of them includes a citation to a two thousand paper that does look at the number of peers that abused and non abused girls have when they are young. Peers is defined though as like the number of people around you, like classmates if you're in school.'s not friendship Yeah. So this finding that like the girls hate themselves and everybody else hates them too That just is not supported by the literature at all. Right. The other result that stuck out to me was this result that when you're abused, you hit puberty earlier. This is actually true. Yeah, yeah, I've heard that before. This is one of the big pieces of evidence for like, yeah, there are physiological effects of trauma Vander Coke says it's one point five years. The study that he's citing says it's seven point five months or six months earlier, depending on which stage of puberty you're talking about. But that one, I mean, I'm kind of willing to forgive that one. It's like a sort of a detail error. There's also the finding that abused girls have three to five times the testosterone and androstenidion levels of non abused girls This also does not appear in any of the sources that Bessel Vander Koch cites. Goddamn it. I reached out to Frank Putnam about this. He said results like this have never been published. I started Googling around and I found that Bessel Vander Koke has been saying this for more than a decade. I found a presentation that he gave to Congress in twenty ten where he just like says that abused girls have five times the testosterone of non abused girls. This is as far as I can tell, a super preliminary result that was never published, never made it through peer review And he has just been Galivanting around saying that. for fifteen years. This is interesting because sometimes when I'm Do an episode for the podcast or writing an article or whatever re you're trying to present What is like a relatively small point? If you're trying to be detail oriented, it can actually take you a while to pin it down and you go down a rabbit hole and maybe you decide it's not worth it at the end of the day. Yeah yeah. But if you want to be good at this shit, if you want to be a releliable author then you have to do it. like before you present a fact as a fact, you have to actually track it down and like see You know, just check the veracity and sometimes that's a lot of work And so when someone does this sort of like, you know, I heard this somewhere. Yeah Yeah And like they pop it into their book, like it's as much of a fact as something that's been The subject of peer review. Yeah. that to me is just a like an indicator that someone maybe shouldn't be writing a book about this shit. The thing is I don't want to throw too many stones because like I do fuck up details like this on the podcast. Like this is an unscripted show. Well every everyone fucks up a detail. There's a difference between fucking up a detail and going to Congress and presenting something you heard your friends say without peer review And again, I wouldn't be harping on this stuff if this was the only factual error in the book, but like everywhere throughout this book, there's just a weird sloppiness. The opening paragraph of the book includes two factual errors, places where his own citations do not agree with him. He also says that this landmark study showed that women who had an early history of abuse and neglect were seven times more likely to be raped in adulthood He cites a study that doesn't include rape. But that very much feeds into his narrative that they are consciously seeking it out in exact way, right. He also says at one point, traumatized children have fifty times the rate of asthma versus their non traumatized peers. fifty five zero. five zero. That is crazy. Emy Neatfield looked into this one. This is not in his cited study. and like the testosterone one, it isn't something you find in the broader literature It would be a huge deal if it was true. Yeah. So I have no idea where this came from, but it appears to be something that he pulled out of thin air. It must have pulled that out of extremely thin air. amm I right?? asthma joke. I'm cooking. So we then get to the section that he has about trauma and childhood, so how childhood trauma affects you as an adult. going send you. There are hundreds of thousands of children like the ones I'm about to describe, and they absorb enormous resources often without appreciable benefit They end up filling our jails, our welfare rollles, and our medical clinics. Most of the public knows them only as statistics. Tens of thousands of school teachers, probation officers, welfare workers, judges, and mental health professionals spend their days trying to help them, and the taxpayer pays the bills the American taxpay. I love it when when people frame these sort of like social ills as like a taxpayer problem at the end of the day. It's like and even worse, you're paying Yeah. I love saying the word welfare rolls in a book like this. That feels great to me. So then he get us a bunch of vignettes of children who've experienced abuse. Then there's Maria, a fifteen year old Latina One of the more than half a million kids in the United States who grew up in foster care and residential treatment programs Maria is obese and aggressive She has a history of sexual, physical, and emotional abuse and has lived in more than twenty out of home placements since age eight. The pile of medical charts that arrived with her described her as mute Vengeful, impulsive, reckless and self harming with extreme mood swings and an explosive temper She describes herself as garbage, worthless, rejected. After multiple suicide attempts, Maria was placed in one of our residential treatment centers Initially, she was mute and withdrawn and became violent when people got too close to her after other approaches fail to work She was placed in an equine therapy program where she groomed her horse daily and learned simple dressage. Two years later, I spoke with Maria. At her high school graduation, she had been accepted by a four year college. When I asked her what helped her the most, she answered, the horse I took care of. Another person who healed her trauma, not through talking about it, but through something separate. Yeah, Dressage, should that The simple key folks. horses. Yeah, this is just a great example of why how How sick it is to be rich. No, you know you know what helps is a horse if you guys can just get get a hold of one of this. And then okay, then he has one more, Peter. Th he has one more Virginia is a thirteen year old adopted white girl She was taken away from her biological mother because of the mother's drug abuse. After her first adoptive mother fell ill and died, she moved from foster home to foster home before being adopted again Virginia was seductive with any male who crossed her path And she reported sexual and physical abuse by various babysitters and temporary caregivers. Personally, I constantly describe thirteen year old girls as actually aggressive. Yeah.. They're seductive with any male. That's what I say about thirteen year olds. She came to our residential treatment program after thirteen crisis hospitalizations for suicide attempts. The staff described her as isolated, controlling exosive sexualized, intrusive, victive and narcissistic. He described herself as disgusting and said she wished she were dead. Remember again, the way that he described the Vietnam veterans? Oh, he did these horrible things, but he felt really bad about it. He's struggling. So many of the vignettes of men describe horrible behavior, but also are like, well, he couldn't help it, it's really hard for him. But a lot of the vignettes of women are just like She's uptight, she's vindictive, like they're just like a tone. It's difficult to put my finger on, but it's the way that he describes victims of abuse make me really uncomfortable throughout the book. The single sentence Maria is obese and aggressive. Why would you mention how she looks? Maria is obese and aggressive. So he then gets into this adverse childhood experiences study, which is where a lot of the data on like how trauma affects the body comes from. He gives a little intro to the guy who He's writing the study. In nineteen eighty five, Vincent Filidi was chief of Kaiser Permanente's Department of Preventative Medicine in San Diego, which at the time was the largest medical screening program in the world He was also running an obesity clinic that use a technique called supplemented absolute fasting to bring about dramatic weight loss without surgery. This is a technique called supplemented abbsolute fast. Absolute fasting. Is that sort of a direct translation? Supplemented absolute fasting sounds like they give you vitamins and you don't eat food. This is a diet on which you subsist on four hundred twenty calories a day I found like a little manifesto where he like lays out this diet. He says, during a year of supplemented absolute fasting, a weight loss of approximately three hundred pounds will occur Well, yeah Yeah, You'rehing to like not have your period, all your hair is going to fall out. You might have a heart attack, but like, yeah, you'll lose so much of your weight. Why not just go down to zero at that point? There's something funny, like a lot of people who defend the body keeps the score will be like, this is a product of its time. Like someome of it's a little outdated. This is twenty fourteen. You sort of said that he's going chronologically through his own career Here we are decades later and a lot of that shit' been debunked, but he's sort of writing about it like it hasn't been. Yeah, exactly. And at no point does they say, like, oh, we've now updated these methods or something like that. But this guy Fhilidi at the time is famous for exploring this link between trauma and obesity. And in one of his papers, he talks about The need to recognize the what he calls the benefits of obesity. So now we're back to Vander Koke. Here's Vander Koke describing this. One day a twenty eight year old nurse's aide showed up in his office. Falidi accepted her claim that obesity was her principal problem and enrolled her in the program Over the next fifty one weeks, her weight dropped from four hundred and eight pounds to one hundred and thirty two pounds. Again, this is just fairly impossible. Can this be is this real? How is that? I mean, even on bariatic surgery, you don't see results like this. Losing essentially three quarters of your body weight. However, when Philidiix saw her a few months later, she had regained more weight than he thought was biologically possible in such a short time It turned out that her newly felt body had attracted a male coworer who started to flirt with her and then suggested sex. She went home and began to eat You've gained more weight than I biologically thought was possible, reallyally because you're Bending the boundaries of biology. No exactly. Yeah three hundred pounds in a year. As he and his team started to inquire more closely, they were shocked to discover that most of their morbidly obese patients had been sexually abused as children They also uncovered a host of other family problems Twelve years after he originally treated her, Felidia again saw the woman whose dramatic weight loss and gain had started him on his quest. She told him that she'd subsequently had bariatric surgery, but that after she'd lost ninety six pounds, she'd become suicidal It had taken five psychiatric hospitalizations and three courses of electroshock to control her suicidality Paliti points out that obesity, which is considered a major public health problem may in fact be a personal solution for many. Oh my God, dude. This was my like, I'm the fucking joker moment with this book. This is sort of a common trope that obesity is like a trauma response to sexual abuse. And for some people, it is, right? That is the experience of some people. However, saying most of theirre patients had been sexually abused as children, insane. R The idea that it's sort of like You are obese, therefore this must be a trauma response of some kind. You're reacting to something. And if you did not have this trauma, you would be normal sizeed. And this gets to a huge problem with this book. He attributes to trauma things that have much more proximate causes.. Anyone who loses three hundred pounds on a fucking diet, ninety nine point nine percent of those people are going to gain some of the weight back, most of the weight back, right? The overwhelming experience people who lose huge amounts of weight is that they gain it back. That is very common. That doesn't mean that they have trauma or that they haven't dealt with their trauma or that something is fucked up with them mentally. That is a biological response to not having enough food, right? Your body is screaming at you to put the weight back on. Yeah. And like he can hide behind like, oh well, I'm noting Most fat people in general were sexually abused. I'm just saying this one clinic, right? Oh, he founded this one clinic. At no point does Bessel Vander Koke say like, oh, well, we've done follow up studies and it turns out like at the population level, that's not true. There's also other drivers. He just fucking leaves this there and then gives the explanation of ah, it may in fact be a personal solution for many R N numerous times throughout the book, he attributes things like autoimmune disorders, various like at one point a woman cures her asthma by curing her trauma. It seems like he's taking this idea that like trauma can manifest in these physiological symptoms and starting to invert it So he sees a physiological problem and he's like, that must be trauma. Peter, I have led you perfectly to what really bugs me about the book and what I want to get into. I think I found my way there myself This is what again is so interesting to me about like what people have taken away from the book versus what the book actually says. What people have taken away is like, yeah, trauma has physical effects, trauma is stored in the body. Yeah. Again, I find that lovely and true and accurate, and I think it's great that there's a much broader understanding of that. However, the actual book itself says over and over again that trauma is only stored in the body And the only way to deal with trauma is to do physiological interventions like take care of a horse do yoga, get a massage. It is a mistake to work on it in a logical way. You should be working on it in these instinctual ways. Do we get to that point where he's sort of like talk therapy is not the correct starting point for most people. Yes, the next two chapters of the book are dedicated to the idea that the standard medical model cannot address trauma because it doesn't get to the root causes of people's symptoms. This is why he hates talk therapy, and this is why he hates medications I want one doctor to be like, you know, every now and then pop a razapam and have half a glass of wine. You will feel unreal So here's this Because drugs have become so profitable, major medical journals rarely publish studies on non drug treatments of mental health problems Practitioners who explore treatments are typically marginalized as alternative. Studies of non drug treatments are rarely funded unless they involve so called manualized protocols where patients and therapists go through narrowly prescribed sequences that allow little fine tuning to individual patients needs Mainstream medicine is firmly committed to a better life through chemistry, and the fact that we can actually change our own physiology and inner equilibrium by other means than drugs is rarely considered. Nobody wants to look into non drug treatments for mental health conditions. This sounds like RFK Sometimes my mother. This is very maha coded, especially this thing that because drugs are profitable They never look into anything else. Not true, but whatever. Bessel Vanderkoke hosts seminars where he charges tw thousand two hundred dollars hundred a person. People who give yoga and massages and fucking equwine therapy also charge money. Also profitable. like Yeah, selling bullshit ass supplements is profitable. Wellness retreats cost like tens of thousands of dollars sometimes. There's sort of like this underlying grain of truth here, which is how this stuff always works Yes, there is money in pharmaceuticals, which means you get a ton of research about the efficacy of pharmaceuticals, and it's probably disproportionate The way this always gets used is like You'll find like someone who's like eating horse hair. You're like, that doesn't work, man. You can't eat horsehir to make yourself taller. There's never been research showing that. And they're like, that's because they won't fund it, dudes. And also he mentions here, therapists have to go through narrowly prescribed sequences that allow little fine tuning to individual patients's needs. That's called a study That's called a randomized controlled trial where you test something against a placebo to see if it actually has an effect You can't just say like, oh, you can't test these medicines. This is something you always fucking hear from these people. It's like, oh, alternative medicines, you can't even really test them. Why You can fuck cont test them against other things. Peter, I want you right now to go to Google scholar and type into the search bar yoga depression.s This is interesting because almost all of our listeners have yoga depression. I am getting A mirr three hundred thirty nine thousand results. Of course, it's not all gonna be studies and RCTs and shit, but yeah, yeah. three hundred thirty nine thousand results. Yeah, Yoga for depression, a systematic review and a meta analysis, Yoga for depression, the research evidence There's a ton. All the top ones are like meta analyses.. entntire medical system is not just like, let's do drugs forever A lot of people, just like he is, are pretty uncomfortable with the amount of drugs that the American population is taking, right? Your doctor will oftentimes have you go through a number of non drug treatments before he will give you a drug, right? It's not like every single person who goes for any kind of mental illness just like gets fucking drugs on the way out. It took me like three months to get diagnosed with ADHD before they gave me anything And what you get Anything good? Well, they gave me a much devotion and nothing worked. I'm still like this, Peter. I have to say like there were just two unmedicated ADHDs on a podcast. They were like, is it affecting your functioning at all? And I was like, I actually need it to function. I actually need to be a wired little weirdo. I'm actually just seeing things so clearly. Please don't give me medicine. I actually need to be upsetting as a person to keep my job so' medicate. I actually need to work in waves of productivity and complete collapse. So this issue of not addressing the root causes is his reason why medications don't work. It's also his reason why therapy doesn't work. Nice. He talks about this throughout the book that like talking won't get at it, talking won't touch the amygdala, talking doesn't do it. He always wants to push you to these body based things either as a replacement for talk therapy or as a prerequisite for talk therapy.. So here is another place where he talks about that. I think this is like a good articulation of it. Steve Gross used to run the play program at the trarauma Center Steve often walked around the clinic with a brightly colored beach ball, and when he saw angry or frozen kids in the waiting room, he would flash them a big smile The kids rarely responded then a little later, he would return and accidentally drop his ball close to where a kid was sitting As Steve leaned over to pick it up, he'd nudge it gently toward the kid who would usually give a half hearted push in return Gradually Steve got a back and forth going, and before long you'd see smiles on both faces from simple Rhythmically attuned to movements, Steve had created a small, safe place where the social engagement system could begin to re emerge. In the same way, severely traumatized people may get more out of simply helping to arrange chairs before a meeting or joining others in tapping out a musical rhythm on the chair seats than they would from sitting in those same chairs and discussing the failures in their life. Discussing the failures in your life is a wild way to described therapy. Discussing the failures now life He's just talking about like victims of abuse? There are sections in the book where he says like talking about a trauma is really important for people. but he does it in the way Barry Weiss says like, I'm a liberal. This sort of like talk therapy works But like it's always followed by a butt or a however. And also keep in mind, right? he told the story of that rape victim who like she did massages. and like it was amazing how much better she felt, right? The other rape victims, like, oh, she took care of horses and I started high school graduation. She like the most important thing for me was taking care of the horse, this immediate permanent turnaround due to these kind of like body based non talk therapy interventions This book contains probably fifty case studies like little vignettes of various like victims of trauma. There's not a single person in this entire book that benefits from talk therapy. He infers from this little story about like getting a kid to play with a ball, that someone who's severely traumatized might get more helping to arrange chairs can talk therapy? I don't I understand the beach ball story and what and like the mechanism he's talking about broadly, but I don't understand how he's like Similarly, arranging chairs is better than hook therapy sometimes I don't get. Well, luckily, luckily, Peter, he spends the entire second half of the book articulating this exact concept why it helps to do body stuff rather than talking stuff. Okay. But before we talk about his prescription to treat all of this bodily trauma We have to go on a little interlude, mostly because this book goes on an interlude. So Peter, are you aware of the recovered memories panic? Recovered memories panic? No. This started in the nineteen eighties. Hold on. I'm gonna guess. Oh yeah, go go. Do it. Let's do this for like thirty minutes. Just speculate. go. I feel like this sounds familiar, so I'm sort of picking at something. but The idea that due to trauma memories get buried and then you can sort of do certain things to trigger those memories to resurface. This is one of the most embarrassing episodes in the history of modern psychology. And that's saying something folks. fake science But so the entire thing started essentially in the seventies and eighties when yeah, there started to be data about the way that trauma was affecting various health systems in your body, all of the stuff that we've already talked about But people would go to their therapist and say, oh, I have insomnia, I'm having panic attacks. I'm having these symptoms But I don't have any trauma. Like I had a happy childhood, right A lot of therapists took this idea way too far and the therapists were then like, o, well what if you have trauma, but you don't remember it? You've blocked it out And so oftentimes they were using hypnosis or other techniques to kind of soften people up a little bit. And then they would eventually get them to quote remember abuse that they had suffered. Okay. So the starting pistol for this entire panic was the nineteen eighty book Michelle Rembers, which means Sarah did a whole series on, where this woman under hypnosis recovers memories of like years long satanic rituals. where there's like hundreds of people in a basement in Victoria, BC in Right, right. a suburban neighborhood People are cutting off their fingers as part of the ritual. They're murdering like ten to twenty white kittens like every night that they're doing this. Things that if it was happening, like you would notice. You'd be like,, why are we delivering three hundred white kittens to Victoria BC every week? But this was I mean, this was a really popular kind of understanding of memory, right? So you know, of course it's promoted on Oprah It's on Donghue There's aillion like TV shows about it. There's of other kind of popular books and self help books, essentially saying like, if you think you had a happy childhood, there's a chance that you were systematically abused for years and you don't remember it. Yeah. So for this, I spoke to Richard McNally, who is a Harvard researcher and the author of Remembering Trauma, which is one of the definitive that debunks this trend, the other one is by Elizabeth Loftis According to him and in his book Bessel Vander Koke was a major promoter of this theory. Okay. Now we're cooking. So starting the nineteen eighties, he starts doing these studies that show that memory is stored kind of in this fragmentary way and that people oftentimes don't really know that they're storing it And then in nineteen ninety four He publishes an article laying out this entire like repressed memory theory The paper is called drumroll, Peter the body keeps the score So the original proposal of this concept was about repressed memories. And it predates the disturbed song. He lays out in this paper and various other things that he writes during the nineteen nineties his core thesis that trauma is not stored the way that other memories are stored. So in this paper he says Trauma interferes with declarative memory, i. e. conscious recall of experience, but does not inhibit implicit or non declarative memory. So that's essentially thesis of like the first half of the book, right that your memories of trauma are being encoded in your body and they can't be accessed like other memories, right? That you're getting these fragmentary glimpses You're getting pieces of a story, but you're not Incoding like first this happened, then this happened, then this happened. To his credit, Bessel Vaner Koke is not like a satanic panic guy. I read one of his papers from nineteen ninety eight where he like explicitly decries the satanic stuff. He's like, well, some of that stuff's implausible. But he's very focused on this idea that traumatic memories are not the same as ordinary memories And so in this book, The Body Kes the score Chapter eleven and chapter twelve are basically recapitulations of this theory So I'm going to send you this. When people remember an ordinary event, they do not also relive the physical sensations, emotions, images, smells, or sounds associated with that event In contrast, when people fully recall their traumas, they have the experience They are engulfed by the sensory or emotional elements of the past. The brain scans of Stan and Oot, Lawrence, the accident victims in chapter four, show how this happens when Stan was remembering his horrendous accident T key areas in his brain went blank the area that provides a sense of time and perspective, which makes it possible to know was then, but I am safe now and another area that integrates the images, sounds, and sensations of trauma into a coherent story When those parts of the brain are knocked out, you experience something not as an event with a beginning, a middle, and then end, but in fragments of sensations, images, and emotions. So this is why these bodily based treatments are so important is because it's embedded in you as these like fragments and you have to put them together and you can only do that by accessing these kindind of lower order ancient reptile systems, basically. Here, what do you think about about the excerpt? I don't know, what am I a fucking brain scientist? What's a fucking old show, Padar. I mean say a joke so I can move on. That was my joke. All right, let me take it for the show. Oh, I think he's missing something. He doesn't It doesn't seem like he's accounting accounting for some cortex or another. He essentially relitigates the memory wars throughout the course of this book, so Here is him talking about the fact that repressed memories are proven science. This issue is not particularly controversial. As early as nineteen eighty, the DSM three recognized the existence of memory loss for traumatic events in the diagnostic criteria for dissociateative amnesia An inability to recall important personal information, usually of a traumatic or stressful nature, that is too extensive to be explained by normal forgetfulness Memory loss has been part of the criteria for PTSD since that diagnosis was first introduced There have, in fact been hundreds of scientific publications spanning well over a century documenting how the memory of trauma can be repressed only to resurface years or decades later Memory loss has been reported in people who have experienced natural disasters, accidents, war trauma, kidnapping, torture concentration camps and physical and sexual abuse. Total memory loss is most common in childhood sexual abuse with incidents ranging from nineteen percent to thirty eight percent They're as early as nineteen eighty thing kind of stood out to me as. Maybe he's cherry picking a time when this actually was more when the scientific consensus was on his side and now it's not. now it's shifted away Is that what's happening? There is still dissociative amnesia in the DSM, like that continues to be there. However, it's like really controversial and a lot of people think that it shouldn't be in there. And it also has really strict criteria. It says that it's amnesia that is defined over and above ordinary forgetting. and that is really The distinction that he refuses to draw and is the important distinction here that because you forget something doesn't mean that you repressed it. Like know your sibling or somebody be like rememember that camping trip we went on when we kids and you're like, oh shit, we did go on a camping trip.. I repressed the memory of a camping trip. I forgot about it. You forget most things that happen in your childhood. Yeah. The fact that there is memory loss in PTSD is not the same as saying that people are repressing the memory of their traumas. I always thought that I went to Maine. when I was young, and then when I went to Portland a few years back Which I've talked about on the show.erous times at this point. Because slurs hit me. But when I was going, I went to my mom and I was like, ye, we're going to Maine. Remember when we went to Maine when we were kids and she was like, we never went to Maine. Oh really? you totally fabricated it? I was like, No, remember the paddle boats. She was like, that was the Pokon was I remember driven your whiny ass to Maine at that age. Dude, I had a super vivid memory of going up the Chrysler building, my first trip to New York on my own, like as an adult traveling by myself. So indelible that I took a friend there last time I was in New York. and like I didn't even check the website first. I was like, well, obviously I remember doing this. We show up, there's like the security guard guy and he's like, we don't have a viewing platform. We close it in World War two. And I was so sure of my memory that I was like, How long have you worked here? I was like gaslighting the guy that fucking worked there. 'use I was like one hundred percent sure that I'd gone up the Chryser buildill like, No. But yeah, that's the thing. Mmory is very malleable Right But I really want to zoom in on this claim He says total memory loss is most common in child sexual abuse, with incidents ranging from nineteen percent to thirty eight percent. forty percent of people repressing the memory of their child abuse. is a fucking law. Yeah. So I'm like, okay, what is this thirty eight percent figure This is based on a study where basically they have a bunch of hospital records. From nineteen seventy three to nineteen seventy five, where people were brought in, children were brought in with signs of sexual abuse. So they reported to the hospital with like physical symptoms of child sexual abuse So we have these patient records, we know the names of the patients twentywenty years later, a researcher contacts around one hundred and fifty of these people who we know we were admitted to the hospital for child sexual abuse and says, Hey, we're doing a study on people who went to this hospital at this time. They don't mention anything about sexual abuse ike can we interview you kind of like almost like a customer satisfaction thing? Like can we interview you about your experience at this hospital? And what she finds is that of those people who were admitted to the hospital for sexual assault as children, thirty eight percent of them did not mention The sexual abuse. Okay. Oh yeah. I went there because of the sexual abuse. Yeah, to a stranger who shows up my home. Right, okay. So the researcher who does the study says for some women, having no recall of the abuse is based on more than just ordinary forgetting associated with the passage of time. So she's immediately going from like, they forgot about this to like something else is happening, right? The memories are being deliberately repressed. So this study is so bad that there's like an entire study debunking it. It's called forgetting seexual trauma. What does it mean when thirty eight percent forget? This is by Elizabeth Loftis, who's one of the people who sort of litigated the memory Wars on the this is fake side of the debate So the most important thing that she says about this is that this is not a study of repressed memories. this is a study of forgetting. Right. Right. And that's a really, really, really important distinction So here is the paper. For full appreciation of the drama of forgetting, it must be kept in mind that people can forget all kinds of things that might at first thought seem surprising For example, people Over one quarter of those interviewed have failed to recall automobile accidents nine to twelve months after their occurrence, although someone else in the car had been injured People over twenty percent who when they were four years old had a family member Die have failed to recall a single detail about the death People, over fifteen percent, have failed to recall a hospitalization approximately nine months after discharge Patients have failed to recall visits to a doctor that they made within the previous year for something that was serious or even very serious. So it's actually kind of shocking how much we forget Youd think that something really traumatic, you would absolutely encode it in your memory, but like kind of big things can happen to you and you can forget about them relatively quickly. Yeah. I mean, one of the most important things about getting in a car accident is just moving on Just don't think about what happened and what you did wrong or who else you injured in the car. Get a massage. You doing some yoga, you're fine. Clear your mind, you know. The other reason this study is a little bit sketchy is because I hate talking about this shit, but the abuse took place when the participants were between zero and eighteen years old. Okay. Some of the people were abused when they were like one year old Right. And then they't remember because you don't remember anything that happened to you at that age. Yeah. The biggest issue, of course, is that like it might just be that they're not telling a random person, like, oh yeah, there's the time I was sexually assaulted by my uncle. like let's talk about this within five minutes of meeting a stranger, right? Right. This is like a much more plausible explanation for this finding, but in the study They say the same people who didn't remember this admission to the hospital, they did remember other child sexual abuse. Okay. But then it's like, well, wait a minute, they do remember the child sexual abuse. Right. They just don't remember this specific hospitalization. Yeah, was I was gonna say, I have memories of being in medical facilities when I was young and for nothing serious just for like checkups. L I was on a medication when I was young and I would somewhat frequently go to to doctors just to make sure that there were no adverse reactions And I have like vague memories of that, but I couldn't possibly tell you where I was. Or like dates and months of. No. A abbsolutely not. I can tell you that this it happened anytime between the age of five and eleven. have like And if you told me I was wrong about that, I'd be like, well, that was a good shot. And again, referring to Vander Coke, total memory loss is most common in child sexual abuse incidents ranging from nineteen percent to thirty eight percent. This is not total memory loss. They remember that they were abused. Right. They just don't remember a specific event. These poor fucking kids might have been admitted to the hospital numerous times. Yeah yeah. If you have an abusive parent or family member Getting admitted to the hospital might have been something that happened once a fucking year. So like you're not going to remember any single hospitalization. That's totally plausible. Right. So it's just a total misrepresentation of the study. He also has never really admitted that the Rressed memories panic was false. Like at no point in this book Does he say like, oh, some psychologist took it like a little too far? Like there were some implausible claims of satanic panic abuse. He never gives any context for this. All he says is like it's not controversial to say that memories can be repressed A, it is very controversial. B, you should at least give some overview of like, yeah, this is considered in the field to be a huge fucking scandal. R. So for this, I also read a book called Trauma A Genealogy by Ruth Lays. She quotes him as saying The quote false memory movement claims that thousands of unsuspecting white middle class women go to therapists who implant false memories of abuse in their minds. However, current research shows that there is no evidence that traumatic memories can be simply implanted in people's minds But there's tons of evidence that false memories can be planted. Right. How else you explain the Satanic panic? Those are traumatic memories being planted by Satan. This has now been done like a million times. There's studies where they're like, do you remember that ear infection that you had when your kid? You had to be hospitalized overnight? ten percent of people say yes. There's one where ten percent of kids remember getting a rectal enema in a doctor's office. L again, you'd think that you would know whether or not that happened to you, but people are falsely remembering this shockingly and like disturbingly easy to implant memories in people. Your brain just like takes little bits of memories and then like fills out the remainder the information that may or may not be accurate. That's why I thought I was in Maine when I was in in central Pennsylvania. What's so frustrating is that he has this idea that traumatic memories are completely different from ordinary memories, but there's tons of evidence at this point that that's not true So this is from Rue Lis's book. Contrary to Vander Koch's theory, trauma does not block the formation of narrative memory Memory for trauma can be expressed as physiologic reactivity to traumatic reminders, but that does not preclude it being expressed in narrative as well As Lawrence Langer has thoroughly documented, survivors of the Nazi Holocaust readily provide detailed narrative accounts of their horrific experiences. So like it just isn't true that you're encoding traumatic memories in these glimpses and it has to be unlocked by your body. Like people who've experienced insanely bad shit can put it into narrative. his entire theory that like you can't possibly access memories of trauma because they're not stored narratively is just false. And as for sort of repression in general, the therapist that I talked to said that when you speak to people who are struggling with PTSD, the issue isn't forgetting. The issue is intrusive remembering. A lot of people want to forget the traumas that happen to them, but it like pops out, right? You get these flashbacks, or you like hear a sound or you have a conversation or something, and then all of a sudden, you're remembering when you don't want to I don't know if you're going to include this in your book, then surely you'd have to go through this narrative of like in the eighties, we thought this and then it seems like maybe not. but here are the aspects of it that I still think are true based on the evidence right? Instead, he's just like Look, it's not controversial. It's not controversial. Right? He's just like, yeah, this is just a fact. So that was our repressed memory interlude. We are now going get back to the book. The second half of the book is about how to treat trauma. Okay. So every chapter is about one of these sort of woo woo treatments and they all involve someomebody miraculously getting better. So he brings back Bill, the Vietnam veteran that he told us about in the intro to the book. Bill recovers through becoming a yoga instructor He also introduces us to a five year old girl who was rescued from an orphanage in China And she's mute. she cannot speak And then she starts doing sensory motor therapy. He says, The staff bathed her in the tub with plastic balls. That helped her feel sensations on her skin. They helped her sway on swings and crawl under weighted blankets. After six weeks, something shifted and she started to talk. What? He tells us about a woman who has asthma so bad that she's like constantly going to the ER Put her in the ball pit. Put her in the ballpit He says, herer therapy focus on identifying the link between her physical sensations and her emotions, and I also encourageed her to enroll in a kickboxing program. She had no emergency room visits during the three years she was my patient. This almost feels like like anti intellectual I know. whereere someone's like, I have this severe trauma and you're like, get a fucking hobby Just get a hobby,. Have you tried volunteering How about this? Get a job. So we're gonna dive a little bit more into this one because he has a whole chapter about it. Are you familiar with neurofeedback, Peter? Neuro feeedback? No, that sounds like it's part of like a supplement ad or something. So it's basically this thing where they attach a bunch of electrodes on your head and then in real time, they can see your like little brain waves, and then oftentimes they will be linked to like a sound. Yeah. So if your brain waves get too big, it'll be like b And so they're training you to like talk about your trauma or go through therapy without getting the beeps. Yeah,reag you're managing your brain waves. Exactly So then he has this anecdote, Peter. The first patient I treated with neurofeedback was a professional man in his early fifties who defined himself as heterosexual, but he compulsively sought homosexual contact with strangers whenever he felt abandoned and misunderstood His marriage had broken up around this issue and he had become HIV positive. He was desperate to gain control over his behavior During a pre During I like how it's treating gay horniness like a a disease of some kind.'s gotta cure it. He's overwhelmed by gay horny. But brain waves can fix it. What about his brain waves During a previous therapy, he had talked extensively about his sexual abuse by an uncle at around the age of eight. We assumed that his compulsion was related to that abuse, but making that connection had made no difference in his behavior After more than a year of regular psychotherapy with a competent therapist, nothing had changed A week after I started to train his brain to produce slower waves in his right temporal lobe, he had aistressing argument with a new girlfriend and instead of going to his habitual cruising spot to find sex, he decided to go fishing. Tramp. It's a trampph. Even gayer, dude. I attributed that response a chance However, over the next ten weeks, in the midst of his tumultuous relationship, he continued to find solace in fishing and began to renovate a lakeside cabin. I like he's doing the straightest things imaginable. He's like, I'm okay. He's going full broke back, dude. One highot cowboy shows up and this experiment is over. He's like ripping the electrodes off of his head and he's like fuck Whenen when we skipped three weeks of neuro feeedback because of our vacation schedules, his compulsion suddenly returned, suggesting that his brain had not yet stabilized its new pattern. Its new straight pattern. That's stight pattern. We trained for six more months and now four years later, I see him about every six months for a checkup. He has felt no further impulse to engage in his dangerous sexual activities How did his brain come to derive comfort from fishing rather than from compulsive sexual behavior At this point, we simply don't know. Neuro feeedback changes brain connectivity patterns. The mind follows by creating new patterns of engagement. How I learned to stop being gay through electrodes? We fixed them, folks This is fucking hilarious. He's like, I have found the cure for homosexual rally. We're not gonna discuss, like maybe there's something more complicated going on with this guy. J justust a triumph fishing over restest opops. I can take your gay horniness and turn it into the straightest shit in the world, I can make a catch of the day out of it. This man is a lumberjack now. It's not like homophobic or whatever, but it's just the fucking weird framing of the story. It might be homophobic. like it's a good thing he's no longer like attracted to men, I guess. It's just fucking weird. You know what talk therapy could have gotten? Talk therapy, the therapist could have been like, are you gay? Yeah? And you would' have been like, no, And the therapist would have been like, actually, let's stay with this. So I mean, obviously I had you read this because it's fucking berserk. But then also the thing that really suuck out to me is after more than a year of regular psychotherapy with a competent therapist, nothing had changed A week after I started to train his brain. It's like a year of therapy, nothing, a week of fucking head This guy's cured of his homosexuality. It's like This is such a fucking insane claim to make. I do feel like if this shit work this well We would all know about it. Oh I know, dude. If you can cure being gay using the power of nodes, then God knows what else you can do. you can prevent if you can just cause the horniest man on earth to go fishing, if you can overcome the power of horny. This is like the greatest scientific miracle in history. So I did look into neurofeedback. He has a whole chapter about well it works. He has numerous other stores be like turning around their entire lives after one session. Again, this isn't like shocking you with electricity or anything. It's just reading your brain waves. So like you kind of have to train yourself to do it. But anyway, as all these anecdotes, I finally looked into it. Essentially there's a bunch of studies showing that it works, but as soon as you test it against a placebo, the effect goes away'sessentially There's a guy in a lab coat and he's putting all these electrodes on you and you're talking through your trauma. someome of the studies are like, we did this with people one hour a day for like twenty eight days. And then they had an effect. It's like, Well yeah if you're in therapy for twenty eight fucking days in a row, you'd also probably have an effect, right? Damn This guy just got placebo into fishing instead of nightly orgies This guy's listening to this episode. Like, what am I fishing for? It wasn't even real. He's got his airpods in's just floating in solitude in a boat in the middle of a lake. Listening to if books could kill. An sign that you're gay. I don't want tona stack the deck. He has this chapter on neurofeedback, which is quite bad, but a lot of the second half of the book is just these kind of woo woo treatments, some of which are actually fine Like he has a whole chapter on yoga, which has been shown to be effective in like a wide range of mental health conditions like him appears to be very effective for depression. That's how if you really want to cure the gay. Gaay West Hollywood Yoga studio. Yeah. He also has a whole chapter on MDMA. I talked a researcher who said that it's actually fairly promising and people in the field are pretty excited about MDMA as a treatment for PTSD. Yeah. That's something that's kind of like evidence based But then he also he talks a lot about acupuncture and acupressure. He has a whole chapter about Amunity theater There's like some program where foster kids perform and prepare a musical. Like they write a musical and they perform it. There's a fucking buuck Wild program in Massachusetts where you can get court ordered So instead of going to juvenile detention the judge can sentence you to putting on a Shakespeare playank Which I'm like, this is obviously bullshit, but also it's so much better than sending kids a Juvie that I'm like, yeah, fine. Like expand it, make it like makeake it nationwide. I don't give a shit. No, this is too woke. This is like a nineties movie to like turning some kids around. like Hey Hamlet's actually really cool. It rarapping is just like poetry. Yeah. Yeah. Shakespeare was the first MC So those things are sort of harmless He But also, I mean, I looked up like RCT for community theater interventions and like there's no studies of this. I don't dispute that like I'm sure some people get something out of this. Like being a kid and like writing a play, performing Shakespeare is probably good for your self esteem. you make some friends. I mean, it's there like any other like kind of summer camp experience? It's probably great for the kids. I don't think it's a treatment for fucking PTSD. L you need to rigorous studies before you're gonna put them in your book. But some of the stuff that he promotes is like really out there. So here's this. One of my favorite body oriented ways to build effective fight flight responses is our local Impact Center's model mugging program, Mel mugging in which women and increasingly men are taught to actively fight off a simulated attack The program started in Oakland, California in nineteen seventy one after a woman with a fifth degree black belelt in karate was in karate was raped. Wondering how this could have happened to someone who supposedly could kill with her bare hands, her friends concluded that she had become deskaled by fear In the terms of this book, her executive functions, her frontal lobes, went offline and she froze The model mugging program teaches women to recondition the freeze response through many repetitions of being placed in the zero hour, a military term for the precise moment of an attack and learning to transform fear into positive fighting energy. Maybe you should fight back. learearn to fight back next time. Yeah. Great message for victims of sexual assault. One of my patients, a college student with a history of unrelenting child abuse, took the course. When I first met her, she was collapsed, depressed, and overly compliant. Three months later During her graduation ceremony, she successfully fought off a gigantic male attacker who ended up lying Finging on the floor shielded from her blows by a thick protective suit. So That's like a skit that they did, apparently. Not long afterward She was walking home from the library after midnight when three men jumped out of some bushes yelling, bitch, give us your money. She later told me that she took that same karate stance and yelled, okay guys I've been looking forward to this moment who wants to take me on first. They ran away. If you are hunched over and too afraid to look around, you are easy prey to other people's sadism. But when you walk around projecting the message, donon't mess with me You're not likely to be bothered. Maybe you had bad vibes. Maybe you were raped because you had bad vibes. I think that's a great message to have in this book a book about trauma. I think that's great. So first of all, this is obviously a fake story. Obviously fake The benefit taking a self defense class like this is like ninety nine point nine percent psychological. Yeah. The idea that someone would be like, a victim and then take the class and then like immediately be mugged, like theoretically possible, but come on. He really liked this roleplay thing. He has a thing where you do like family role playay where somebody Somebody plays like your mom, like your mean mom, and then somebody plays like the mom you wish you had. And then you get into a karate stance. Like literally, he has a scenario where this guy's like, you fucking bitch, you left me and he's like screaming this like basically, I don't know if this would really work. I couldn't find any like good studies of this. It doesn't seem very kind of like widely used. You don't need the to pap Heay to take like a skit class. Just scream at your real mom. And also, when I talked to Emmy Neatfield for this, the way that she got interested in this book was because she was sexually assaulted on a trip through Europe. She then had this therapist that was like really into this body Keeps S score stuff who prescribed a bunch of like frank shit to her, one of which was onene of these like role play scenarios where they wanted to act out. the time when she was sexually assaulted and like this time you can fight back And she's like this feels like you're saying that if I had fought back in the first place, I wouldn't have been raped, which is precisely the wrong fucking message. Right right too give to people who've experienced trauma. Like it happened because you did something wrong. E exactly you're delivering that message Also, it just feels like very situational, like I don't wantan to say that you should never fight back. I also wouldn't say that you should always fight back It's like this very situational thing Yeah trying to like diagnose the problem as like no peopleople aren't fighting back enough. That feels like really dangerous. He also has this fucking anecdote, which I might cut this, but I can't help myself, Peter, here's this It was early in my career and I'd been seeing Mary a shy, lonely and physically collapsed young woman. Again, the way it's just a vibe, it's a tone, the way that he talks about female victims is crazy. If Books could Kill Listener Bumble profile. I'd been seeing Mary, a shy, lonely and physically collapsed young woman for about Th months in weekly psychotherapy, dealing with the ravages of her terrible history of early abuse One day I opened the door to my waiting room and saw her standing there provocatively, dressed in a mini skirt, Her hair dyed flaming red with a cup of coffee in one hand and a snarl on her face You must be Dr. Vander Koke, she said. My name is Jane and I came to warn you not to believe any of the lies that Mary has been telling you Can I come in and tell you about her I was stunned but fortunately kept myself from confronting Jane and instead heard her out. Over the course of our session, I met not only Jane, but also a hurt little girl and an angry male adolescent This is the beginning of a long and productive treatment. So this is fake for so many reasons. The detail I'm stuck on is the fact that she dyed her hair to be one of her like alter egos. L sureurely she's gonna switch back to Mary in some way Does she then have to dye her hair again? Yeah, do you dye her hair before or after you mentally switch? You mentally switch to the other person and then you're like u this is landishly fake. This is like a completely debunked thing where you'd have a bunch of different alhars. There's a million academic articles about this. that it was basically sort of approval seeking or attention seeking by patients They thought their doctors wanted this and would get subtly rewarded for it. And so they would create these altars. This is a phenomenon that essentially only ever existed in the United States. I read a super interesting article about this that they've looked at the patterns of know people's different altars and people would constantly say, like, I have a four year old. like that's one of my altars. And they would look at the linguistic patterns and it's like this is not The language patterns of a child this is the language of an adult pretending to be a child. It's like really easy to identify. And then they also said over time, people at first would say like, oh, I have four altars. but then by the end of the trend, people were saying like, I have two hundred fifty altars. Right, right,. It's like a tolerance builds up. You're like, I gotta get my therapist's attention somehow. That's like that brief period in Tumblr history when people were just like, I'm a wolf. Yeah. they don't actually know anything about wolves. Yeah. They're just like they're just like doing a little bit of howling. I love that like Jane still went to therapy. She's like, Ohh, I' like stay away from Mary. She's the worst, but alsos it's Tuesday at four. I gott to make my appointment. She wakes up As Jane, she's like, I hate this hair. Time to put on my hot ass skirt, which I also have. She looked at the calendar and she's like doctor appointment, huh? So I do want to talk a little bit about the research For all of these, they're classified as mind body interventions. I also really want to be sensitive to people who have tried this stuff and who like this stuff and who got a positive impact out of it. A lot of people Trauma affects people in very different ways. For somebody to be able to get a massage, like to be touched in a safe environment, that could be like really healing for people, right? And things like yoga can be really healing. There's a self esteem aspect, a community aspect. All this stuff feels like it's real in some sense. just like It's not just like this magical cure in the way that he presents it, right Now I was joking about it, but like getting a hobby is actually a good idea. Yeah. If you have anxiety, if you're if you have depression like this As far as I know, the research is pretty clear that that sort of stuff can help. It's so important to me to not take anything away from people. and like if youve benefited from dance therapy or ecoine therapy or whatever, like that is a real effect. I don't really feel the need to like debunk that. If you have multiple personalities and one's very prumpy and one's very sexy, that's cool. There's also a lot of research on this and a ton of research shows Interventions are effective, Like I looked up dance therapy. and there's actually a lot of studies on dance therapy and most of them find a positive effect. Like they're small, they're early, you can quibble with the methodology stuff, but it' like it's not remotely implausible that a lot of these interventions would in fact work. I do just want to talk about that. I also, however, want to talk about the academic consensus for what works for PTSD, like the most strongly evidence based approaches. Before this, I talked to Keith Cox, who is a PTSD researcher and the author of an entire academic paper about how this book is incorrect. So here is the intro. Most individuals with PTSD do not receive science based treatment This is a massive problem and the systems and individuals best able to address it misunderstand key components of the problem Advocates of research supported treatments have substantial influence and authority in federal agencies, university settings and medical centers and limited influence authority with the public at large and with many providers, especially those in private practice settings Figures such as Bessel Vander Kok and Peter Levine, who are not consistently science based, have limited influence in government and research settings and enormous influence with the public and many individual providers. We see such figures as a main contributor to the problem. So this is like a huge problem for the field that like academic research is not speaking to in practice therapy all that much. And a lot of therapists are really bought into these frameworks, which are not evidence based. A lot of them don't know that they are not evidence based or don't care. But researchers, like he has a whole section about how academic researchers do not refer to Bastel Vaner Koch's book. He's not considered influential in like PTSD studies and he hasn't been for decades. He estimated only around ten percent of people with PTSD get like effective treatments. It's mostly this like wild west shit. That is like a huge problem in society. L a lot of people have PTSD or these other symptoms of traum that they experienced when they were growing up and like they're not getting effective treatments. Right. So he walked me through the official guidance from all of the major institutions. So the American Psychological Association says the most effective treatment is CBT which is cognitive behavioral therapy, specifically something called cognitive processing therapy and something called prolonged exposure therapy, where you basically you sit there and you talk about your trauma, you describe what happened to you. Typically, you're getting like these physiological symptoms when you talk about it, right? Your heart rate goes up, your're sweating is really stressful. and over time, it becomes less and less stressful Processing it with a professional therapist who can say things like you know it's not your fault and like put it into context of like how to think about it and how to integrate it into your life. This works astonishingly well. This is the most evidence based treatment. I also checked the guidelines for the VA, they also recommend this, the British institution that does this nice Also recommended cognitive behavioral therapy.ight. Bessel Vaner Koke does address CVT in his book He has an entire chapter about how it's bad. So we are going to spend a little bit of time on this chapter. Here's this. In september two thousand one, several organizations, including the National Institutes of Health, Pfizer Pharmaceuticals, and the New York Times Company Foundation Organize expert panels to recommend the best treatments for people traumatized by the attacks on the World Trade Center Because many widely used trauma interventions had never been carefully evaluated in random communities as opposed to patients who seek psychiatric help I thought this presented an extraordinary opportunity to compare how well a variety of different approaches would work My colleagues were more conservative and after lengthy deliberations, the committees recommended only two forms of treatment, psychoanalytically oriented therapy and cognitive behavioral therapy. Why analytic talk therapy? Since Manhattan is one of the last basashions of Freudity and psychoanalysis, it would have been bad politics to exclude a substantial proportion of local mental health practitioners YCBT because behavioral treatment can be broken down into concrete steps and manualized into uniform protocols It is the favorite treatment of academic researchers, another group that could not be ignored. So the recommendations of this committee were Freidian theraapy and CBT, basically for political reasons. After the recommendations were approved, we sat back and waited for New Yorkers to find their way to therapists' offices Almost nobody showed up Dr. Spencer F, who ran the psychiatry department at the now defunct St. Vinscent's Hospital in Greenwich Village, was curious where survivors had turned for help And early in two thousand two, together with some medical students, he conducted a survey of two hundred and twenty five people who had escaped from the twwin towers asked what had been most helpful in overcoming the effects of their experience The survivors credited acupuncture, Massageed, yoga and EMDR in that order F's survey suggests that the most helpful interventions focused on relieving the physical burdens generated by trauma Physical burdens don't talk about it. Let's do physical first. Itesn't really suggest that's what's most helpful right, It's just that people didn't go to the therapy. Also, this is not true. I couldn't find the committee that he was talking about, but there is a FEMA supported program in New York City after nine eleven to get mental health counseling to people and it was used by I've seen different numbers But somewhere between one hundred thousand and seven hundred fifty thousand people. Right. It just factually is not true that like nobody wanted therapy after nine hundred eleven. There's also this survey by Dr. Spencer F, who talked to two hundred twenty five S sururvivors from the twwin Twers, and then it turns out like, oh, we don't want therapy. we actually want acupuncture. Yeah. So the citation for this in Bessel Vaner Kochke's book justust says Dr. Spencer F to Vessel Vander Coke, march two thousand two. So this is something that a personal conversation from two thousand two. From like twelve years ago, my buddy told me this thing. It's first of all, just really fucking weird to not point to like a real study. Yeah, it's a survey, right? I reached out to Spencer F. I was like, Hey, this is the passage from the book. Can you send me anything on this study? He wrote me back He sent me a bunch of background documents. He sent me One document that was like a study, like a before and after study of acupuncture in his clinic, which had nothing to do with nine hundred and eleven And then the second The thing that he sent me was essentially just an advertisement for the clinic and the kinds of things that they were doing. He also sent me a JpeG of a woman giving acupuncture. Here's the Wikipedia for acupuncture. It's just a walk in clinic. Some of the people that they were treating, I'm sure were nine hundred eleven victims but they weren they weren't reaching out to people who were there in the Twin towers. And like they were just providing a bunch of services and the only thing he has as far as like a survey of what people liked This document that just quotes a bunch of like patient satisfaction survey results. So it says, I felt so cared for and cradled. I experienced great healing here. This provides a sense of tranquility. So like great, but this is not a survey of two hundred twenty five nine hundred eleven survivors. No What survey does not appear to exist? I'm just surprised that people whose job is to some degree science I know are' so like Dinterested in like the precision of the statements being made. Also, he's doing this in service of a conclusion that is not true. Bessel Vanerkoke is including this one survey of two hundred and twenty five people. hundredundreds of thousands of people got counseling after nine eleven, there's numerous evaluations. So I found one evaluation that found eighty nine percent of people who got this counseling service were happy with it. So it isn't the case that nobody showed up. It isn't the case that I benefited from acupuncture way more than therapy. None of this is true He specifically talks about CBT, and these forms of prolonged exposure therapy, cognitive processing therapy, he says, in contrast to its effectiveness for irrational fears, such as spiders, CBT has not done so well for traumatized individuals, particularly those with histories of childhood abuse. Only about one in three participants with PTSD who finish research studies show some improvement. Those who complete CBT treatment sually have fewer PTSD symptoms, but they rarely recover completely. Most continue to have substantial problems with their health, work or mental wellbeing. Wow. He's explicitly saying it doesn't work for PTSD, right? Yeah. Emy Neatfield in her Mother Jones article tracks down the author of some of these studies that he's citing, so I'm just going to send you an excerpt from her paper Mand claim Only about one in three participants with PTSD who finished CBT research studies show some improvement, citing a paper by Julian Ford, a professor of psychiatry at the University of Connecticut School of Medicine, and several other papers including a meta analysis The meta analysis, in fact concluded that sixty seven percent of people who completed treatment benefited, and Ford disagrees with Vander Koolch's interpretation of what the numbers imply As a front line treatment, I don't think there is anything better for the treatment of PTSD than CBT. he tells me. One study by the Department of Veterans Affairs and academic Rsearchers that Vander Koolch cites, the largest of its kind when it was published in two thousand seven, found that after just ten weeks of CBT, seventy five percent of patients improved significantly and forty seven percent no longer had PTSD at all We used to think that PTSD was chronic and that we had to help people live with their symptoms. says Paishchner, co author of that study and executive director of the VA's National Center for PTSD. We now know that PTSD is treatable. I also looked into his citations for this. He has the sentence only one in three participants with PTSD who finished studies show some improvement. You then go to his citation and it says in the abstract The majority of patients, treated with psychotherapy for PTSD, recover or improve, rendering these approaches some of the most effective psychoocial treatments devised to date. And they do compare these against you yoga, equine therapy, all of these other things. And they basically say like the evidence is very strong for CBT, The effects are very large. and like the evidence for all of these other things is pretty weak Yeah. Right. A lot of them aren't controlled. A lot of them are just before and after studies. A lot of them are like fifteen people. We have good evidence on CBT. We have some slightly maybe preliminary evidence and a lot of anecdotes about the other things. Well, it's hard to scale equine therapy. You can't give everyone in New York after nine eleven a horse, you know So the other thing that he says about CBT is that it has really high dropout rates. so it's kind of a moot point whether it works or not 'cause like nobody can stick with it for long enough. so here's this. A twenty ten report on forty nine thousand four hundred twenty five veterans with newly diagnosed PTSD from the Iraq and Afghanistan wars who sought care from the VA showed that fewer than one out of ten actually completed the recommended treatment As in Pitman's Vietnam veterans, exposure treatment as currently practiced, rarely works for them. We can only process horrendous experiences if they do not overwhelm us. and that means that other approaches are necessary. It rarely works is what he's saying. We're getting into like actually harmful territory, right? Oh because there's a high level view of this book that's just like trauma can manifest in different ways and can be treated in different ways and there are like alternative treatments that have shown have been shown to have some efficacy. And that's like this perfectly defensible the is in fact like correct. But then He just goes that extra step where he's like, actually like this is the treatment that is best and should be focused on. Yep and appears to be recommending it over the most effective known treatments for severe PTSD. Exactly. And the problem in PTSD in our medical system is that not enough people are getting access to effective treatments.. And he's saying, oh, well they don't work anyway. Make sure you get a massage. Right In this passage, he says there's this report on a bunch of veterans and ninety percent of them dropped out of CBT before they finished the program I've never heard of a fucking ninety percent dropout rate before in a study. likeike you would just not publish the study if you had a dropout rate that high. that would be a major part of the study. You're like, oh, everyone fucking hated this So I go to the study, this is not a dropout rate. This is the percentage of people who went to a primary care provider, said, I think I have PTSD, got a referral to therapy and either didn't follow up on the referral or didn't go to ten sessions.. That's not a drop out rate. A dropout rate is like you sign up a study like you're gonna do yoga for ten weeks. Yeah. and you can't hack it for whatever reason or another This is just people who didn't follow a referral.. I did this last year. I got a referral from my hands and I just like never called the place to schedule the physical therapy. I'm skipping fifty percent of referrals at a minimum. o? You have to keep them guessing. CBD does actually have relatively high dropout rates. It's like between twenty percent and thirty percent Mostly because like it's really painful to talk about your trauma over and over again for like week after week after week. It does work, but for a lot of people, it's extremely painful. And so there's meta analyses of the various dropout rates, like some of it's higher, some of it's lower, but this is an identified issue that is actually really difficult to solve. And like there is consternation in the medical field about this. It's not fucking ninety percent Right?. He also in his own section cites numerous studies of like yoga and dance therapy and also with huge dropout rates. Like I found one study of equine therapy with twenty three participants and ten of them dropped out. Any therapeutic treatment is going to have like dropout being a problem. This is also why it's very important to me to stress it's really malpractice to say that CBT doesn't work. I think it's also just a fucking huge dick move To be like, have you tried CBT? What about CBT? Yeah It's the most effective treatment that we have, but it's like forty seven percent, right? Meaning fifty percent of people don't have their PTSD cured. Maybe there's something more complex going on. Like I've heard from trauma victims. shhut the fuck up about CBT. Like I've tried it and it didn't work, right?ike it's not right for me. You also don't wantan to be this asshole who's like,, the studies say that you should do this. Like individuals are very diverse Tuma is so different for different people. You also don't want to write a book saying it doesn't work. Yes, exactly You have to find a middle ground. I think it would be defensible to say like CBT is the most effective treatment, however, it can be really expensive. It can be really difficult to access for people. For some people, it doesn't work, but he's just openly saying it doesn't work. Right, R. evidence based is, do you know what EMDR is, Peter? I am familiar with the acronym in that I believe it was in one of the excerpts you sent me and I skipped over it. I was like, please don't ask me about it because we're going gonna talk about it later. This stands for eye movement desensitization and reprocessing. Okay. So this is basically a procedure by which You talk about your trauma, you talk about what happened to you while moving your eyes back and forth So sometimes it's kind of like rapid eye movements. sometometimes it's like your therapist like hold a pen. Oh, okay, okay. so're You're speaking and you're purposefully looking back and forth with ees. Exactly. Okay. And so this is one of those things that started out as like a woo woo intervention. like, o, move your eyes back and forth. But like over and over again, it's been shown to be incredibly effective. So in like the APA guidelines in the VA guidelines, everybody says like E MDR is the other thing that people should probably think about doing. Honestly, even though it's real and worked, I'm still mad at how stupid that is. Do I know I remember the first time I heard about it I was like,h, we're gonna do a fucking mainance phase on this aren't we? Like this is such traash. This is like having a revelation while you're like cooking eggs, and then you're like, I have an idea This is one of the woo woo things that he recommends that's actually very evidence based. So like that's good. Okay. However, over the course of time, as more and more studies have come out about this The consensus in the field seems to be tilting toward. the reason it works is not the eye movement. The reason is that it's basically exposure there, but you're talking about your trauma and you're processing your trauma with somebody else, right? So he has an entire chapter about EMDR, And here is what he says about it. People may be able to heal from trauma without talking about it. EMDR enables them to observe their experiences in a new way without verbal give and take with another person EMDR can help even if the patient and the therapist do not have a trusting relationship This is particularly intriguing because trauma understandably rarely leaves people with an open, trusting heart In the years since, I have done EMDR with patients who spoke swahili, Mandarin, and Breiton All languages in which I can say only notice that The key EMDR instruction. I always had a translator available, but primarily to explain the steps of the process Because EMDR doesn't require patients to speak about the intolerable explain to a therapist why they feel so upset It allows them to stay fully focused on their internal experience with sometimes extraordinary results How does he know when to say notice that? So what's amazing to me here Even when he's referring to an evidence based practice, he recommends the non evidence based part of it. He says I shouldn't be talking about your trauma as you're doing the eye movements. I can do this with people who speak any language. It's not about the talking, it's about the eye movements. When all of the evidence indicates that it's mostly about the fucking talking. He stumbled on the one thing that's like, okay, you're dovetailing with the actual like meta analyses here. but he's like, no, no, don't do it in the way that the meta analyses say to do it. Right. Becauseuse why the fuck would just moving your eyes back and forth do anything? To be fair, why does it help at all? I don't know. It sounds fake as shit. I can't believe it. I can't believe this shit works.'s the book to give a couple of ing thoughts. Okay When I was talking to Emmy Neatfield, she told me about the story of her therapist that she went to the therapist and was like, I want to talk about this horrific trauma that happened to me in Europe And she says she started telling the story and she sort of got to the buildup of it. and then eventually they ran out of time in the session and they werere like, okay, we'll pick this up next week. And theny went next week and she started telling, Okaykay, well'll pickking up where we left off. And therapist iss like, Ah, let's talk about your childhood. Like let's go And she says this went on for like many weeks. She's like,, I'm ready to talk about this, but you don't seem to want me to talk about this. And her therapist basically said, you're too traumatized to talk about it. It will make you relive your trauma if you talk about it. and then recommended pressure. This is a story that I've heard from many people that These ideas have gotten really entrenched in the field of psychology, like the individual experience often does Fus on these body based treatments over and above talking about your trauma, and that is very, very bad. Suppress the memory and go get on a horse. Another one of the therapists that I talked to, I can't say what city it is, but it's like a major hospital in a major city. He had to attend a mandatory twelve hour training on somatic treatments, like mind body stuff. He says he went to his boss And I was like, sorry, there's no evidence for this st. Why are we doing it? And his boss is like, Ohh yeah, it's bushit, but like take what you can from it. You know, there might be something in there that's useful The field is actually like kind of falling for this stuff and like making it a big part of practice. And again, some of the stuff may work under certain conditions. But this is fundamentally a nineteen fifties understanding of trauma, right? Do not talk about it. Do something else. It's being repackaged as like woo woo, new age hippie stuff But fundamentally, he is telling you that talking about your trauma is totally pointless may be harmful All of the evidence shows the exact opposite. And we're talking about actively suppressing things that we know are effective, right It's like exactly. Ooh, don't talk about it. insane. Just go to yoga. So even as it's very important to me to acknowledge that this book has like a good premise. And like the core insight of the book is absolutely true. I'm so glad that people took that away from the book. A lot of people seem to have taken away from the book that you should talk about your trauma, which I think is great There are better vessels for this message, then fucking Bessel Vander Koke and this book. Yeah. So there is a New York magazine profile of him and this kind of this new understanding of trauma where the author just keeps talking about like how much of a dick he is. so here's this. In conversation, he sometimes radiates impatience and is prone to interrupting to give the dialogue the shape he thinks it should take When I mentioned that I was not convinced by a claim he made in a lecture that a nationwide program of early childhood attachment intervention could end mass incarceration, he told me a matter of factly that I was not qualified to have an opinion. great time. Lll do. Al also know he does have that chapter where he talks about like the structural forces, So like, okay, good for him, you know, universal health carere, Trump sucks, et cetera. But the word racism does not appear in this book. The word homophobia, transphobia does not appear in this book. He never talks about any of his patients Experencing discrimination in any way? Well, it's not about what you experience, It's about what type of massage to get after. What kind of horse you have to be riding It's just is like, it's really weird that this has been taken up So strongly, I think by like progressive, very well meaning people who I align with politically when like the book itself is not particularly progressive, right? I think it's terrible on gender. You didn't like the part where he was like Mary showed up, but this time she was hot But then there's also I don't know you know about this, Peter, but in twenty seventeen, he was pushed out of his own treatment center buying Moo casualty. The guy that was running the like sort of day to day running the center got meed and got pushed out. and then like a couple days later, he got pushed out and the center like announced that it was for It says he created a hostile work environment, his behavior could be characterized as bullying and making employees feel deniggrated and uncomfortable. I should say Bessel Vaner Coke denies the allegations. He puts a statement on Facebook that says, As far as I know, none of you have ever confronted me with such misbehavior If I have inadvertently denigrated or bullied any of you, I would like to know about it, apologize and make amends. I think I've talked about this on the show before, but there's certain ty like at hedge funds, hedge funds are like built around the investment strategies of one person. And so like they are like untouchable. Like you canot fire that. Exactly. This is like one step down from that, right?ly This center is built around your ideas. Yes. And they fire you. You know out of our way to like be nice in these things and not sort of Yes. I do know how I do that. Thankk you. Honestly, I think people should not be recommending this book. People should not be using this book in curricula for academic courses. Sometimes we're sort of a corrective, right? Everyone has been very nice to this book already. So if we're too mean, that's just us bringing balance into the universe That's how I view the fact that I'm always too mean. This book is bad. Like the text of the book is bad. Even if at a civilian level I don't think that the effect of this book is harmful. I think the effect within the field has been very harmful.. And I think the book itself is fucking bad and there are other books written by people who are like Basically promoting the same ideas, but are not reactionary who are like bing people at work and lying to you about like basic scientific discoveries. There's a little bit of maha to it, right? where it's like Oh, you very much so. The primary voices in the field are focusing on the wrong thing and they're doing it potentially for profit, right? I mean what they need to be focusing on is making an EEG that makes people gay. If you just reverse the circuitry. Look, lookook, I don't w want to throw the baby out with the bath water. He did cure homosexual ra in the course of this book. He buried the lead