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Book Forum: Posttraumatic Stress   |    
The Trauma Model: A Solution to the Problem of Comorbidity in Psychiatry
Am J Psychiatry 2002;159:687-688. doi:10.1176/appi.ajp.159.4.687-a
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New York, N.Y.

By Colin A. Ross, M.D. Richardson, Tex., Manitou Communications, 2000, 404 pp., $27.95 (paper).

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Dr. Ross, who was trained in psychiatry at the University of Manitoba and who directs trauma treatment programs in Texas, Michigan, and California, has written a book that, among other things, attempts to turn DSM-IV on its ear. According to Dr. Ross, most psychiatric conditions are comorbid with one another, thus losing their right to be categorized as separate and distinct disorders. For example, he believes the division between simple phobia, social phobia, panic disorder, and generalized anxiety disorder to be arbitrary and that the signs and symptoms of each overlap. Almost every diagnostic category has this fatal nosological flaw. Dr. Ross uses the term “polydiagnostic comorbidity” to refer to this phenomenon. At times he can sound like Thomas Szasz, the legendary psychiatric iconoclast, as in the following:

Why out of all the behaviors carried out by human beings are fire starting, hair pulling, shoplifting and gambling given status as separate Impulse Control Disorders in DSM-IV-TR? Why doesn’t DSM-IV-TR have categories for self-mutilation disorders, credit card overutilization disorders and migratory game bird excessive killing disorder?

As suggested in the title of the book, great emphasis is placed on trauma to explain the development of mental illness. In Dr. Ross’s view, traumatic experience has a profound effect on the structure and function of the brain that can be undone with his version of trauma therapy—an eclectic mix of cognitive, behavioral, experiential, and dynamic approaches.

Dr. Ross has a long-standing interest in dissociative states—he has written four books on the subject—and he relies on that defense mechanism to explain not only multiple personality disorder but also anxiety, depression, and substance abuse, among others. He covers a wide territory with discussions on schizophrenia and personality, sleep, eating, sexual, and childhood disorders, continually emphasizing the role of physical, sexual, and emotional trauma acting on the individual’s genetic vulnerability. There is an interesting chapter on false memory syndrome from which one can infer Dr. Ross’s disapproval of so-called memory retrieval specialists and the harm they do by invoking false memories of childhood sexual abuse.

Dr. Ross writes with enthusiasm and zeal. At times he is too strident, but that may be a reaction to the critics be appears to have picked up along the way. Indeed, the book has an appendix in which he defends himself against charges of “scholarly errors,” many of which seem to have been committed by a person identified only as Piper. The more I read, the more I began to like Dr. Ross, who comes across as an ethical and skilled psychotherapist; unfortunately, however, I liked him more than I liked the book. In spite of that, I recommend The Trauma Model for its interesting observations about psychiatry and for its ability to provoke the reader into new ways of thinking.




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