Body Bears the Burden: Trauma, Dissociation, and Disease, The

American Journal of Clinical Hypnosis, Jan 2003 by Hammond, D Corydon

The Body Bears the Burden: Trauma, Dissociation, and Disease. Robert C. Scaer. New York: Haworth Medical Press (2001). 250 pp. ($59.95). Reviewed by D. Corydon Hammond, Ph.D., ABPH; University of Utah School of Medicine

The author of this book is a neurologist who practiced in a rehabilitation medicine setting and in pain management for many years. The book has a forward by Bessel van der Kolk and a very positive endorsement by Allan Schore, both very respected authors in their own right.

The central focus of the book relates to the author's work with motor vehicle accident victims suffering with whiplash and post-concussion syndrome. Thus, this volume may be of more interest to individuals working in a rehabilitation setting and with accident victims than to trauma therapists. However, as background to the topic, the author devotes a great deal of time to reviewing literature on trauma and the response of the brain and body to traumatic events. This review is familiar ground for many therapists who have studied literature on trauma and PTSD, and is reviewed more thoroughly and with greater precision in several other books that are available. Scaer does provide a fascinating review of literature on whiplash which is quite unique, some of it dating back a hundred years. He describes the symptomatology of whiplash syndrome: neck stiffness, fatigue, headaches, problems concentrating and with short-- term memory, depression, anxiety, blurred vision, and problems with balance. Next, he reviews the physical forces at work and the theories about structural injury, but then he proceeds to present his primary premise upon which the majority of the book is built. He attributes the symptoms just mentioned, as well as the resulting myofascial pain, thoracic outlet syndrome, piriformis syndrome, fibromyalgia, and TMJ to posttraumatic stress disorder stemming from the accident. In the process, the author did not mention a model that is supportive of many of his ideas, the High Risk Model of Threat Perception (Wickramasekera, 1995). Scaer concludes:

I would like to discard the concept of physical and structural injuries to the spine, jaw, and brain as the model for whiplash-based injury. Instead, I would like to explore the concept of the whiplash experience as a model of traumatization, with long-standing and at times permanent neurophysiological and neurochemical changes in the brain that are experience-based, rather than injury-based (p.33).

Although this reviewer has a clinical background of considerable trauma work, the central thesis of the Scaer book seems to me to be an extreme and unsupportable position. I believe that what Scaer theorizes undoubtedly accurately describes some motor vehicle accident victims with whiplash. Several cases that he cites have a history of prior traumatic experiences which undoubtedly sensitized them to more readily experiencing PTSD symptoms. The author indicates that he routinely asks all of his car accident patients in detail about past traumatic life experiences, which can identify important predisposing vulnerabilities, but if not done carefully can also result in contaminating influences which then someone might uncritically accept. I think that the possibility of whiplash symptoms stemming from PTSD may very well be a possible etiologic factor in low velocity accidents (e.g., 5 mph).

However. I believe it is a mistake to engage in dichotomous reasoning, taking an either/or position on the etiology of whiplash symptoms. I strongly prefer a multifactor, multi-causal model where psychological trauma is simply one definate variable to be considered. In terms of legal standards, I seriously question whether the speculative, single-factor theory that Scaer presents has the peer-reviewed research support to meet Daubert standards of validity and reliability for admissibility in court, particularly given the absence of discussion of objective measures of PTSD. I can agree with him that in some cases PTSD may in fact be the primary variable causing the whiplash symptoms. In other cases, PTSD may only be a mild contributor or contribute nothing at all to the equation, with the whiplash symptoms stemming from neurological trauma. It is my experience that most neurologists and physicians evaluating whiplash symptoms rely on structural neuroimaging such as CAT scans and MRI's, or visual inspection of raw EEG, which seldom reveal physiological damage. In contrast, when functional evaluations such as quantitative EEG (qEEG) or SPECT are used, in many cases a physiological reason for the symptomatology is discovered. Furthermore, individuals who have a history of previous mild head injuries may be more vulnerable to effects from cumulative physiological damage when they suffer another, even mild whiplash.

As part of these more sophisticated assessment techniques available now, mild traumatic brain injury (TBI) discriminant functions have also been developed. As an example of support for the validity of a position counter to Scaer's, peer reviewed scientific publications of 608 mild TBI patients who were compared with 103 age matched normal subjects demonstrated, in independent cross-validations, an average false positive rate of only about 5% and an average false negative rate of approximately 9% (Thatcher et al., 1989). Similar levels of sensitivity and specificity were reported in a series of independent and replicated qEEG studies of TBI in which sensitivity was 95.45% and specificity was 97.44% (Thatcher et al., 2001 b).