The Body Bears the Burden: Trauma, Dissociation and Disease
I have focused my attentions, during the last year of reading, on the neurobiology of trauma. Robert Scaer's remarkable treatise has particularly grabbed my attention for its innocence, its profundity, its empiricism, its clear-headed medical suggestion that pain-and long-term response to sudden physical trauma-may be linked to earlier, emotional trauma. A simple example: the length of time whiplash symptoms persist after a motor vehicle accident may have less to do with the particulars of the accident itself than with whether or not the victim had been-even decades before-abused.
We have intuited many of the things that Dr. Scaer demonstrates, from empirical research, in his book. But what an experience it is to sit with this now-retired physician and pain specialist-initially naive to the psychology of accidents-and have him teach us about the physiology of being harmed when we were very little. He proposes, for example, that "... adults with a history of child abuse typically experience a greater tendency to freeze at the moment of subsequent trauma and to develop dissociative symptoms." (p. 108). But he goes on to teach us about the vulnerability that such early victims of abuse may then have to seemingly unrelated events: It is this very tendency to freeze, to dissociate (born in our earlier struggle to cope with abuse, for example), that sets us up to respond to a minor car accident not merely by being angry, or having a sore muscle for a few days, but by developing PTSD symptoms-including difficulty in focusing, difficulty in remembering, headaches, irritability, sexual dysfunction, pain in a variety of regions (orofacial, bladder, pelvic, low back), fibromyalgia, and irritable bowel syndrome. And we may well make a connection, in our bodies, between the earlier emotional hurt and the present physical hurt: a childhood sexual abuse victim, for example, may not only have a delayed recovery to a vehicle accident, but have specific, abuse-related symptoms that persist for years after the accident-such as low back and pelvic pain, or piriformis syndrome (a form of sciatica due to spasm of one of the deep muscles of the buttock).
Dr. Scaer even takes the huge risk, as a physician, of mentioning birth traumas-and their possible relationship to dissociation and increased morbidity in an adult experiencing whiplash syndrome after a motor vehicle accident. For example: "Intrauterine needling of the fetus has been shown to elicit a full-blown stress-related increase in plasma cortisol and B-endorphin level ...." (p. 152). Does this suggest that an unborn child may be set up for increased reactivity to later events that seem (to an organism intent on surviving) to be similarly threatening? He concludes, "The risks of induction of traumatic stress in the medical management of the premature newborn and as-yet unborn fetus cannot be underestimated" (p. 152), and then, "Exposing the newborn to traumatic stress through thoughtless invasive and painful medical procedures is senseless and dangerous" (p. 153). In his courageous section on pediatric medical trauma, he takes note of studies suggesting the predictive link between birth complications-along with maternal separation-and the likelihood of commission of violent crimes, later in life. And he spreads out before us one of the more elegantly simple arguments extant about circumcision: the simple connection between circumcision and increased severity of the emotional responses of boys to vaccinations at age four and six months.
This surprising book includes a section on trauma therapies (counseling, desensitization, somatically-based models, EMDR, Levine's Somatic Experiencing, the "power therapies", pharmacotherapy). And the case history section-where he discusses somatic representations of trauma, medical retraumatization, and specific responses to trauma (piriformis syndrome, disorders of speech, torticollis, and reflex sympathetic dystrophy)-will fascinate the reader with a preexisting interest in prenatal and perinatal issues.
But it is in his Postscript that Scaer gives himself permission to wander, and to wonder, as a meto-physician. People who have unusual or, especially, morbid responses to normal life stressors, or to accidents, may, he says, be reexperiencing and dissociating. They are driven by internal arousal cues that have "... thrust the victim into a perceptual state locked in the past, incapable of experiencing the present, and blind to the future .... [T]he ongoing cues of the present continue to trigger indiscriminate arousal and fear. The present, therefore, serves only to thrust the victim back into instinctual and conditioned modes of self-preservation ... ." (p. 205).
His clarion call for the future is profoundly ringing, not only uniting physiology and psychology forever, but demanding whole new ways of looking at health: "If we are able to conclude that many of the chronic, unexplained diseases that we treat so ineffectively may be based on a variation of autonomic dysregulation based on ... cumulative life trauma, a whole new paradigm for prevention and management of these diseases may be developed" (p. 207).
Perhaps it is strange to be enraptured by a book on pain and trauma. This one did it for me, however.