
This, prominent Boston-based Dutch psychiatrist deals predominantly with PTSD, and childhood trauma of various types.
In the first part there is far too much neuroscience and neuroanatomy for the nonscientist reader, (I also got lost), with generalizations about the limited dichotomy of the rational vs the emotional brain.
The author expresses ambivalence about newer pharmaceuticals for a variety of psychoses, PTSD and depression vs talk therapy, with the inevitable side effects of the latter including obesity and diabetes, but he also shows the limited benefits of cognitive behavioral therapy as compared with a placebo. But he does document positive lasting effects of talk about PTSD therapy on the blood pressure and the immune function. And there seems to be positive effects on symptoms of rheumatoid arthritis by something called internal family systems therapy. His scepticism includes the prospect of finding genetic factors contributing to various mental illnesses, although he is cautiously positive about epigenetics.
The DSM-5, the “Bible of psychiatry” receives appropriate scorn as being complex and imprecise. Desensitization therapy is seen as of limited use.
Art, theatre, dance, and music therapy is praised but these are only evaluated in historical and uncontrolled anecdotes.
Both psychedelics and yoga practices with meditation are touted as very helpful in treating PTSD, with some limited convincing evidence presented. His greatest praise, however, is for something called EMDR, eye movement desensitizing and reprocessing, and for neurofeedback based on continuous monitoring of an electroencephalogram with very good controlled trials of both modalities.
In later chapters the author waxes eloquent about generalizations of the determinants of childhood abuse, and the social determinants of mental health generally, almost entirely confined to those in the U.S.
I may have sustained some mild form of PTSD, but never received any prolonged professional psychotherapy of any kind so I cannot easily relate to much of this discussion. Others who have been been less fortunate may well benefit more from reading this now somewhat dated and wordy book.
There is more than a whiff of self-congratulatory smugness with a distinct overabundance of quoting the results of his own research and experience, both in proper controlled studies and many anecdotes. The anecdotes include many patient names that would seem to violate usual doctor-patient confidentiality rules. And I wonder how applicable the findings are for those who cannot afford or access the best psychiatric help at Harvard.
3.5/5


















