The Psychophysiology of Trauma and Trauma Treatment
by Babette Rothschild
New York, Norton & Company, 2000.
Babette Rothschild, who is a social worker and psychotherapist working with trauma victims since 1976, composed a book about the physiology of trauma and trauma treatment with the clarifying title ’the Body Remembers’. According to the introduction, she did this to bridge the gap between the neuroscience of traumatology and clinical practice, and the gap between verbal psychotherapies and body-oriented psychotherapy. As a body-psychotherapist she will be heavily interested in the psychophysiology of traumatisation, and the book is a reflexion of that.
The first half of the book is about the theory, and the second half about the practice. In the theoretic part the writer gives an overview of mostly neurobiologic findings about the posttraumatic stress disorder. Epidemiology is not mentioned. Features of the disorder are scarcely mentioned, in two pages, but are to be read between the lines in the rest of the book.
Less stress put on the symptomatology makes it understandable that the example given of PTSD is a case of simple phobia, as I see it: this is a case of fear for a dog, which in the DSM-IV is described as specific phobia, animal type (300.29). Essential features of PTSD such as nightmares, flashbacks and numbing are lacking in these cases.
The author thinks also that dissociation is not mentioned as a symptom of PTSD. However, in cluster C several symptoms of dissociative nature, such as inability to recall an important aspect of the trauma, and feelings of detachment or estrangement from others are described.
It is also not done to classify classical and operant conditioning as a class of implicit memory, as the author does. Conditioning is seen as from another field of science as the science of memory and recall.
Apart from these small comments, the author could be gratulated with the overview of the neurobiology of trauma and traumatisation she offers in the first half of the book. It reads easily, and she succeeds in making difficult things easier for the reader. There are other books in which the neurobiology of PTSD is described, but this description is very accessible.
The second half of the book, about the practice of treatment, disappointed me somewhat. From the first part you could expect that the second half would offer extensive descriptions of bodily oriented work with traumatised patients, but it did not. The author describes mostly her own work with her patients: and this is mostly talking. She does not describe psychomotor therapies, and does not write a word about indication and contra-indication for group treatment in traumatised persons. There are some descriptions of bodily oriented techniques, for instance muscle tensing, which are interesting. Muscle relaxation is described as anxiety provoking: this can be true for some patients but not for all. In our clinic (for traumatised refugees) we tend to use anger control techniques before relaxation is used: our experience with that is promising. In the book there are long word-by-word descriptions of sessions of the therapist with clients, which are revealing. But I would like to read more about experiment with nonverbal techniques. A book about these techniques has to be written yet, maybe by the same author.
Any form of scientific proof of the effectivity of the practical exercises is lacking, nor are evaluations of patients given. In this field there is not much scientific literature. It would be good to perform more studies in the future about the outcome of bodily oriented psychotherapies in traumatised persons. A lot of patients cannot talk about their experiences, and well studied and good performed nonverbal therapy would be a great offer for them.
Hans Rohlof, M.D. psychiatrist, Centrum ’45 – de Vonk – Centre for the Treatment of Traumatised Refugees. Westeinde 94, 2211 XS the Netherlands.