The Body Bears the Burden: Trauma, Dissociation and Disease

Abstract

The Body Bears the Burden: Trauma, Dissociation and Disease by Robert C. Scaer, MD. (2001). Binghamton, New York: The Haworth Medical Press. 250 pp. ISBN: 0-7890-1245-6. 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? …