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Though often invisible in our society, studies have shown that more than seven out of 10 people experience trauma at some point in their lives, whether it's physical, sexual, or emotional abuse or a life-threatening accident or illness.
In this episode, Henry Bair and Tyler Johnson, MD, speak with Bessel van der Kolk, MD, a psychiatrist and pioneering researcher on post-traumatic stress. His 2014 book, The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma, spent 27 weeks at the top of the New York Times bestseller list. He's also the past president of the International Society for Traumatic Stress Studies.
Over the course of their conversation, they discuss why van der Kolk began studying trauma, the role of non-pharmaceutical methods in treating post-traumatic stress, how healthcare providers can overcome the psychological and emotional burden of encountering stressful situations in their practice, and how we can get back in touch with the irreducible human dimensions of love, belonging, and meaning through creativity, fellowship, self-expression, and imagination.
In this episode, you will hear about:
- 2:16 Why van der Kolk finds trauma a fascinating area of study
- 3:47 How van der Kolk views the emotional burden he carries from helping patients
- 7:53 A discussion of empathy and sympathy, and how they impact physicians dealing with patient suffering on a daily basis
- 14:10 Self-compassion: what does it look like and how do you cultivate it?
- 19:22 A discussion of how trauma manifests physically and mentally
- 29:31 The difference between the "top-down" and "bottom-up" paradigms of coping with trauma and stress
- 32:06 How the complexities of trauma have been oversimplified repeatedly throughout history
- 41:36 Advice on cultivating a compassionate and sympathetic mindset for new physicians
- 47:38 How medical practitioners can safely process the trauma of medical training
The following is a partial transcript (note errors are possible):
Bair: To start us off and you start your book this way, too, can you tell us what compelled you to a career in medicine and studying trauma?
van der Kolk: My book was very much about learning medicine. And I said, I'm on the residency admissions committees at various Harvard hospitals and Boston University. And I always asked the applicants, what books have you read that makes you want to become a psychiatrist? And for the last 10 years, nobody came up with a book that they had read that had inspired them.
I was very inspired as an undergraduate by many books, and I thought, I'll write this book about how everything we learned about neuroscience is relevant. Everything we learned about political science is important. Sociology is important, human development is important, culture is important. If you really want to do something that engages all of your faculties, the work had to -- trauma is the place to work. It's the human condition, happens everywhere all the time.
So I've had a great chance to travel a great deal, work quite a bit in South Africa, Egypt, many, many other parts of the world. And so you get to see how people in different cultures have different solutions, different models of medicine, different models of pathology, different models of the community. And so this just happens to be the most interesting topic in the world.
Johnson: You know, one of the things, though, that I have to say that really strikes me, you know, so I'm a medical oncologist, right? And I will often have people who come to me and they say, oh my gosh, how can you possibly do that? Right? How can you work with cancer patients every day and chemotherapy? And they have all these terrible symptoms and many of them end up dying of their disease. And, you know, and I have my own personal set of answers to those questions.
But I have to say that when I speak to people who are in psychiatry, let alone somebody who is a psychiatrist, who has spent his life basically thinking about how people process trauma and working with people as they attempt to process their trauma, I have to admit that my reaction to what you do is similar to a lot of laypeople's reactions to what I do. ... And this comes out in many parts of your book, too, right? That when I read some of the parts of your book, I have to put the book down and go over and do something else for a while because it's so heavy. So ... as you were thinking about going into psychiatry, how did you think about the burden that would come with sharing the burdens, such heavy burdens, from so many patients?
van der Kolk: Well, you know, to some degree, this work is always the same whether you are an intern, an internist, an ob/gyn person or oncologist. Facing death is very much part of what we do as physicians. So, to some degree, we are trained for that. It's interesting that my field is largely run by psychologists and social workers, and they don't really have that life cycle idea that you so very much get with the medical training that, you know, that life begin, they get fought, and they come to an end.
And that's what medicine is all about. And to some degree, what I do with trauma fits in there in that you see people struggle with horrendously difficult issues, but it also puts you in touch with human resiliency and with the life force. I'm sure you see this as an oncologist, that it is incredible drive that we have to make things happen, like oncology patients being traumatized. You carry all this pain and this hurt.
And I think to some degree, our professions are professions of hope. And that despite enormous suffering, sometimes it can bring relief. So that's really a very important part of it. On the other hand, an interesting take on this also, because people had asked me this question many times and I tend to underestimate it.
And then we started to do psychedelic therapies. And as part of my psychedelic therapies as the PI [principal investigator], I had to have a psychedelic experience also. And so I went through our MDMA protocol. And as I was lying there in that altered state of consciousness, all of the patients that I had treated came to visit me and I lied there for 8 hours going, oh sh*t, oh sh*t. Are you sure this is a party drug? Do people take this for fun?
Because I was confronted with all the horror that I had carried and I had become much more vulnerable since that time and much more protective because I feel more open. So part of medicine, of course, medical training is very much about helping you to face horrendous stuff and walling off your emotions to some degree. And I think we get pretty good at that. But in the last few years, I can't wall off my emotions very well anymore. And I feel what people go through much more deeply.
For the full transcript, visit The Doctor's Art.
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