Concerned About Unconventional Mental Health Interventions?

Concerned About Unconventional Mental Health Interventions?
Alternative Psychotherapies: Evaluating Unconventional Mental Health Treatments

Tuesday, June 3, 2014

Bessel van der Kolk is an Old-Fashioned Guy

The Sunday New York Times Magazine ran a worshipful story a few weeks ago about Bessel van der Kolk and his beliefs about the treatment of post-traumatic disorders (www.nytimes.com/2014/05/25/magazine/a-revolutionary-approach-to-treating-ptsd.html?r=0). The article stressed van der Kolk’s claims about the role of physical contact, tapping, massage, movement, and dance in lessening the impact of traumatic experiences. I know a lot of infuriated people have already responded to this story, and I’m trailing along in the rear--  but I do have a few things to say.

Van der Kolk’s views were described as “revolutionary” in the article, but in fact they go back at least 150 years. Jean Strouse, in her biography of Alice James (sister of Henry and William), tells of the use of massage for Alice’s depression and mental turmoil in the 1870s. Van der Kolk’s claims are very little different from those made off and on in the intervening years, and are no better substantiated by empirical evidence than the earlier ones.

I’m going to give a brief summary of van der Kolk’s unsung predecessors.

  1. Chiropractic treatment (sorry, I can’t bring myself to noun this adjective as its practitioners do):
From the 1920s until about 1960, there were chiropractic mental hospitals where spinal adjustments were used to treat mental illness. One Dr. Quigley reported that it was ”a deeply rewarding experience to watch an extremely agitated delusional patient  respond to chiropractic adjustments … well enough to go home in a month to six weeks.” The adjustments were considered to remove blockages in the Innate or Life-Force and to allow the vis mediatrix naturae  to circulate and heal the patient’s problems.
  1. Georg Groddeck:
Groddeck (1866-1934) was a considerable influence on Sigmund Freud, and an even stronger influence on Sandor Ferenczi and other “wild psychoanalysts” (Freud’s term for them). Groddeck published Das Buch vom Es (The Book of the It) in 1923. (The Book of the It was re-issued in 1947 with a forward by the novelist Lawrence Durrell.) Groddeck’s view was that both mind and body are “lived by” a life-force he called “It”, which existed before an individual brain and even caused that brain to be created. Groddeck attributed accidents and illness to patients’ beliefs and wishes, and considered early deaths to be forms of suicide. He illustrated this belief system with various anecdotes, including his treatment of a pregnant woman approaching full term with the baby presenting in the breech position; Groddeck explained to her how childbirth was very pleasant, even sexually gratifying, and lo and behold the baby turned head-down. Groddeck presented a paper on massage at a conference and considered physical treatment to be a major factor in managing mental illness. He also discussed recovery from untreatable illness following a “talking cure”.
  1. Wilhelm Reich:
Reich (1897-1957) is best known for his invention of the “orgone box”, a device that was supposed to collect life-energy and use it to treat cancer and other diseases, and for his death in prison after he was convicted of fraud for continuing to sell the boxes. However, his place in the intellectual ancestry of Bessel van der Kolk has more to do with his belief in “character armor”, muscle tension caused by early traumatic events,  that interfered with genuine human emotion and made sufferers unable to have real relationships, sorrows, or pleasures. Character armor was treated by prodding and poking the patient under the arms while forcing eye contact; patients had to be naked or nearly so, to allow the practitioner to detect areas of muscle tension. (If this seems to you unlikely to be convincing to anyone, let me point out that it was described in a textbook I used in college [White, The abnormal personality]). Reich considered the effects of trauma to be stored through muscle tension in specific body parts, and to be removed when the tension relaxed. Incidentally, Reich claimed to have “cured” his infant son of the Moro reflex in about the same amount of time it normally takes for this reflex of newborns to disappear.
  1. Gurdjieff, Steiner, Chestnut Lodge:
I’ll put together several related phenomena that all have connections to van der Kolk’s beliefs. The first was the invention of dance rituals that were supposed to give spiritual benefit by G.I.Gurdjieff (1855-1949), a Russian mystic and guru who had a philosophical institute near Paris. Gurdjieff passed on these dance rituals to Mme. Ouspensky, a former member with her husband of the Theosophical Society, who took them to England. Another former Theosophist, Rudolf Steiner (1861-1925), founder of the Waldorf Schools, was at about the same time developing his practice of Eurhythmy, a dance form that represented speech sounds and that was supposed to be the work of one’s “etheric body”.  In the 1930s and ‘40s, Frieda Fromm-Reichmann (lightly fictionalized as a central character of I never promised you a rose garden), working at the Chestnut Lodge mental health foundation in Maryland, invited two dance therapists to work with patients, in the belief that spontaneous movement conveys meaning that can be interpreted or responded to with other movements for therapeutic purposes.

  1. Alice Miller:
I don’t really want to get into Alice Miller as background to van der Kolk, but does the title The body never lies suggest anything?

So, I think you will see what I mean. There is nothing revolutionary about van der Kolk’s methods--  on the contrary, they are quite old-fashioned. Far from getting credit for being new and innovative and not having had time to develop an evidentiary foundation, they have been around for years and years without developing one. This just might be because they are not effective, much as was the case with the Recovered Memory Therapy he once supported. Instead, they seem to be results of what Freud called the furor sanandi—the frenzy for healing.

{Incidentally, thinking about evidence, I note in the Times article that there has been some objection to the statement that some techniques were not scientifically investigated.  The page has added a statement that the evaluations for those techniques were done by “blinded” evaluators. That’s great, but there are quite a few other criteria that such studies would need to meet—including  randomization to treatment groups, intervention fidelity, and certainly a big issue: what happens to the comparison group?}





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