The Body Bears the Burden: Trauma, Dissociation, and Disease

246 Pages·2014·1.29 MB·English

by  Robert Scaer

The Body Bears the Burden
When The Body Bears the Burden made its debut in 2001, it changed the way p eople
thought about trauma, PTSD, and the treatment of chronic stress disorders. Now
in its third edition, this revered text offers a fully updated and revised analysis of the
relationship between mind, body, and the processing of trauma. Here, clinicians
will fi nd detailed, thorough explorations of some of neurobiology’s fundamental
tenets, the connections between mind, brain, and body, and the many and varied
ways that symptoms of traumatic stress become visible to those who know to look
for them.
Robert Scaer, MD, has practiced neurology and rehabilitation for 36 years. His
three books, The Body Bears the Burden, The Trauma Spectrum, and 8 Keys to
Brain–Body Balance, address the intimate relationship between life trauma and
chronic disease, the ubiquitous association of modern society with intrinsic
sources of trauma, and the role of somatic techniques for healing trauma.
This page intentionally left blank
The Body Bears the Burden
Trauma, Dissociation, and Disease
Third Edition
ROBERT SCAER
Third edition published 2014
by Routledge
711 Third Avenue, New York, NY 10017
and by Routledge
27 Church Road, Hove, East Sussex BN3 2FA
© 2014 Robert Scaer
Routledge is an imprint of the Taylor & Francis Group, an informa business
The right of Robert Scaer to be identified as author of this work has been asserted by him
in accordance with sections 77 and 78 of the Copyright, Designs and Patents Act 1988.
All rights reserved. No part of this book may be reprinted or reproduced or utilized in any
form or by any electronic, mechanical, or other means, now known or hereafter invented,
including photocopying and recording, or in any information storage or retrieval system,
without permission in writing from the publishers.
Trademark Notice:P roduct or corporate names may be trademarks or registered
trademarks, and are used only for identification and explanation without intent to
infringe.
First edition published by The Haworth Press, Inc. 2001
Second edition published by The Haworth Press, Inc. 2007
Library of Congress Cataloging-in-Publication Data
Scaer, Robert C.
The body bears the burden : trauma, dissociation, and disease / Robert Scaer.—3rd
edition.
pages cm
Includes bibliographical references and index.
1. Post-traumatic stress disorder—Treatment. 2. Bioenergetic psychotherapy.
3. Mind and body therapies. 4. Somatoform disorders—Treatment. I. Title.
RC552.P67S2236 2014
616.85′21—dc23
2013024486
ISBN: 978-0-415-64151-7 (hbk)
ISBN: 978-0-415-64152-4 (pbk)
ISBN: 978-0-203-08182-2 (ebk)
Typeset in Minion
by Apex CoVantage, LLC
Contents
Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ix
Bessel A. van der Kolk
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xiii
Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xxi
CHAPTER 1—Concepts of Traumatization: The Role of Boundaries . . . . . . . . . . . . . . 1
The Concept of Boundaries 3
The Role of Boundaries in Trauma 3
Boundaries and Childhood 4
Conclusion 6
CHAPTER 2—Trauma, Instinct, and the Brain: The Fight/Flight/Freeze
Response . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
The Neurophysiology of Trauma 7
Brain Responses to Stress 10
Fighting, Fleeing, or Freezing 13
The Animal Model 13
The Freeze Discharge 15
The Human Anomaly 16
Conclusion 18
CHAPTER 3—The Whiplash Syndrome I: Symptoms in Search of a Meaning . . . . . 21
The History of Whiplash 21
The Clinical Syndrome 22
vi Contents
Physical Forces and Structural Injury 23
The Pathophysiology of Whiplash 24
Myofascial Pain 24
Thoracic Outlet Syndrome (TOS) 25
Piriformis Syndrome 26
Temporomandibular Joint Syndrome (TMJ) 27
Minor Traumatic Brain Injury (MTBI) 27
Neurological Symptoms 28
Emotional Symptoms 29
Conclusion 29
CHAPTER 4—The Whiplash Syndrome II: A Model of the Brain in Trauma . . . . . . . . 33
Memory Mechanisms in Trauma 33
Declarative Versus Nondeclarative Memory 34
Somatic Responses to Stress 35
The Meaning of Speed 36
Vehicular Transport and Society 36
The Automobile as a Threat 38
The Neurophysiology of Trauma in Whiplash 38
Kindling and Trauma 39
Cognitive Deficits in Trauma 42
Trauma and Post-Concussion Syndrome 43
Binocular Dysfunction 43
Vestibular and Autonomic Dysfunction 44
Neuromuscular Dysfunction and Myofascial Pain 45
Head and Neck Myofascial Pain 47
Conclusion 48
CHAPTER 5—Bonding, Attunement, and Concepts of Homeostasis . . . . . . . . . . . . . 51
The Neurophysiology of Attunement and the Developing Brain 51
The Development of Character 53
The Polyvagal Theory 54
The Dorsal Vagal Complex 54
The Ventral Vagal Complex 56
Conclusion 58
CHAPTER 6—Negative Neuroplasticity: Does Trauma Damage the Brain? . . . . . . . 61
The History of Post-Traumatic Stress Disorder in Psychiatry 62
Brain Plasticity in Trauma 64
Objective Measurements of Brain Change in Trauma 65
The Permanence of Post-Traumatic Stress Disorder 66
Conclusion 68
CHAPTER 7—Somatic Dissociation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
Examples of Dissociation 72
Memory in Dissociation 73
Contents vii
Cognitive and Emotional Features 75
Dissociative Physical Symptoms 76
Conversion Hysteria and Dissociation 78
The Autonomic Nervous System in Post-Traumatic Stress Disorder 82
The Concept of Boundaries 87
The Spectrum of Somatic Dissociation 90
The Dissociative Capsule 91
Conclusion 94
CHAPTER 8—Diseases of Traumatic Stress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98
The Pathophysiology of Stress 99
Stress Versus Trauma 100
The Hypothalamic/Pituitary/Adrenal Axis 101
Stress, Post-Traumatic Stress Disorder, and Immune Function 102
The Diseases of Trauma 103
Chronic Pain 103
Somatic Dissociation and Disease 105
Reflex Sympathetic Dystrophy 106
Fibromyalgia/Chronic Fatigue Syndrome 108
Somatization Disorders 110
Morbidity and Mortality 111
Conclusion 112
CHAPTER 9—Trauma Reenactment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
Introduction 119
The Roots of Reenactment 120
Clinical Features 121
Gender Differences 123
The Anniversary Syndrome 125
Reenactment Through Risk Taking 126
Conclusion 127
CHAPTER 10—Sources of Trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130
Introduction 131
The Definition of Traumatic Stress 133
Exposure to Combat 135
Child Abuse 137
Societal Trauma 140
Medical Trauma 143
Anesthesia, Surgery, and Critical Medical Illness 143
The Role of Past Trauma 147
Awareness During Anesthesia 147
Pediatric Medical Trauma 149
Fetal and Neonatal Trauma 149
Birth Trauma 151
Circumcision 151
viii Contents
Childhood Medical Trauma 152
Conclusion 153
CHAPTER 11—Trauma Therapy: Essential Ingredients . . . . . . . . . . . . . . . . . . . . . . 160
Cognitive/Verbal Therapy 161
Exposure and Desensitization Techniques 164
Somatically Based Therapies 166
Eye Movement Desensitization and Reprocessing (EMDR) 168
Somatic Experiencing (SE) 170
Energy Psychology 172
Brainspotting (BST) 175
Neurofeedback 176
The Search for the Essential Ingredient 179
Pharmacotherapy of Post-Traumatic Stress Disorder 181
Conclusion 185
CHAPTER 12—Case Histories: The Somatic Spectrum of Trauma . . . . . . . . . . . . . 191
A State of Vulnerability 191
Somatic Representations of Prior Trauma 193
Medical and Forensic Trauma 194
Multiple Chemical Sensitivities 196
The Mysterious Piriformis 197
Disorders of Speech in Trauma 198
Spasmodic Torticollis: An Aberration of the Orienting Reflex 200
Dissociation and Reflex Sympathetic Dystrophy 202
Comments 203
Epilogue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211
Foreword
A bout a century ago, scientists became aware of the existence of memories that
are different from the memories of everyday experience. Ordinarily, events are
remembered as stories that change over time and that do not evoke intense emo-
tions and sensations. However, since time immemorial there have been records of
people being tormented by memories that fill them with feelings of irreparable
loss, and sensations of fright and horror. The neurologists and psychiatrists at the
end of the nineteenth century elucidated the nature of posttraumatic conditions
and showed that elements of the past were relived with an immediate sensory
and emotional intensity that makes victims feel as if it were occurring all over
again. While trauma related emotions and sensations endured, however, conscious
knowledge of the event itself was sometimes absent. They discovered that, para-
doxically, even though vivid elements of the trauma intrude insistently in the form
of flashbacks and nightmares, many traumatized people have a great deal of dif-
ficulty relating precisely what has happened.
They often experience sensory elements of the trauma without being able to
make sense out of what they are feeling or seeing. These mysterious combina-
tions of remembering emotions and sensations, while forgetting the origin and the
content, were called “repression” and “dissociation.” These early scientists hypoth-
esized that these amnesias and intrusive reexperiences were the result of severely
paralyzing fears in response to terrifying life events. For example: the “father of
neurology,” Jean-Martin Charcot, noted that: “The patient . . . does not preserve any
recollection, or he preserves it in a vague manner. Questions addressed to him upon
this point are attended with no result. He knows nothing or almost nothing.” These
early students of the effects of fear-related trauma noted that the loss of memory