New York: The Haworth Medical Press, 2001.
ISBN: 0789012464. Paperback: 250 pages. $39.95
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Robert
C Scaer, MD, trained as a psychologist and a neurologist, has for
the major part of his professional life been engaged in the challenges
located at the interface between neurology and psychiatry. In the
present book, he addresses chronic somatic symptoms in the aftermath
of trauma that do not lend themselves to ordinary medical understanding
and that frequently resist usual therapeutic approaches. He has
chosen to elicit the nature--and perhaps logic--of persisting disability
resulting from whiplash injuries. His professional familiarity with
this particular medical problem seems comprehensive.
In
the Preface, Dr Scaer presents a blueprint of the entire book:
a patient's story, the diagnosis of whiplash due to accident,
a pattern of chronic and disabling complaints, different types
of victimization prior to the actual trauma, and bodily inscriptions
that literally "mirror" how this patient previously
has been abused or maltreated.
The
author states: "I have found that the severity of a person's
whiplash-related symptoms strongly correlates with his or her
cumulative load of traumatic life experiences before the accident
occurred."1:xx His observations are condensed
in two salient clues: first, "... the meaning of the
event during which the injury occurs," and second, "...
the life history of specific traumatic events, especially those
experienced in childhood."1:xx Dr Scaer proposes
that the meaning of the present and the resonance of the past
are the main keys to understand the resulting incapacitation.
He addresses this interlinked process of "making pain out
of meaning" and "making meaning out of pain" as
follows: "The consistency of these findings among patients,
and their startling correlations with concepts of altered autonomic
physiology, has led me to the inescapable conclusion that clinical
syndromes previously categorized as 'nonphysiological,' 'psychosomatic,'
or 'functional' may be based on demonstrable dynamic neurophysiological
changes in the brain."1:xxii
Central
in Dr Scaer's exploration are the HPA-axis and the Amygdala. Using
observations of the freeze-flee-fight response to threat found
in wild animals, the author concentrates upon the freeze response.
After having survived threat by appearing as if dead in a frozen
state, wild animals are documented as subsequently trembling,
which even may extend to grand mal seizures. This trembling or
shaking seems to accomplish the unfulfilled intention of fleeing,
thus reestablishing the animal's balance of functions.
Dr
Scaer hypothesizes that humans represent an anomaly: they are
not, when having been in a complete and passive state of freezing,
relieved of their stored hormonal load. Defensive patterns of
tension and nonaction remain unresolved and continue to act or
be reenacted by every new trauma experience. Consequently, the
observable, permanent, neurophysiological and neurochemical changes
are experience-based rather than injury-based.
However,
given the author's strong emphasis on the meaning of experience,
there is a risk in his thesis. If it is personal meaning that
is decisive for individual trauma impact, one must be careful
not to lose the details of personal and individual situations
in the search for relevant activity in the central nerve system.
Amygdala and hormones are means and mechanisms in the process
of personal medical appraisal, not their causes.
The
risk of mistaking means for cause exemplifies the very challenge
this book represents. Both the author and his physician readers
are trained in applying biological models and biomedical language
that is deeply informed by the mind-body split of modern biomedicine.
The personal appraisal of experiences cannot be addressed in the
biomedical terms and models of brain and body. This book bespeaks
the unity of human beings and their experiences; it calls for
a joint effort. Author and reader must increase their awareness
of the principal shortcomings in the framework, the concepts,
and the language of biomedicine.
The
Body Bears the Burden is a good tool for an exercise that
is urgently warranted in medicine: thinking about human bodies
as mindful. It may render the apparently "meaningless"
highly meaningful.
Reference
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Scaer RC. The body bears the burden: trauma, dissociation, and
disease. New York: The Haworth Medical Press; 2001.
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