Book Review: Why We Sleep – Matthew Walker

Title:Why We Sleep: The New Science of Sleep and Dreams
Author:Matthew Walker

This is undoubtedly another book that everyone should read. Walker puts across a strong, evidence-based case for every adult to get their 7-9 hours’ sleep, every single night.

Blowing myths out of the water, such as the notion of being able to repay ‘sleep debts’ and allowing ourselves weekend lay-ins, this book makes us totally rethink our relationship with that other halves of our lives: sleep.

And it makes it impossible to ignore the case for getting enough sleep. The problems associated with not getting enough are truly tragic. If scientists could package up the positive benefits of 8 hours’ natural sleep per night and sell it in a pill, it would be the most miraculous drug ever sold. But it’s right there for the taking, every night, and still we deprive ourselves of it.

Whilst a must-read for everyone, this is especially fascinating if you struggle with sleep issues related to complex trauma. It might give you some reasons into your struggles, insights you never knew, and facts to discuss with your family & friends to help them prioritise their sleep, too.

It also makes you think about wider mental health issues: with insomnia producing symptoms similar to those diagnosed as schizophrenia, could curing trauma-related sleep issues also be at the bottom of many other mental health ‘illnesses’ professionals say we have? A controversial thought for some – let’s see how my brain processes that further whilst I sleep tonight!

Have you read this book too? Share your thoughts in the comments below.

Book Review: Trauma and Recovery, J. Herman

Title:Trauma and Recovery: The Aftermath of Violence – From Domestic Abuse to Political Terror
Author:Judith Herman

Herman’s seminal book on psychological trauma and recovery from its grip was a hard read. It uses more academic language than Pete Walker’s easily accessible book, but turning every page was pretty much a lightbulb moment as I came to learn the neurological underpinnings to the struggles I’ve always had with my head.

Trauma is never a standalone issue, and to conquer it we will have to work together as society. Herman gives a great overview of psychodrama throughout history which helps us understand why trauma is still badly supported within mental health services.

If you can make it through to the end, Herman instead offers hope for a trauma-informed society with this very compassionate take on this often painful subject.

I would highly recommend this as one of the key reads about trauma, which is often referenced elsewhere, but it won’t be for everybody.

Have you read this book too? Share your thoughts in the comments below.

Book Review: Complex PTSD – Pete Walker

A must-read book about Complex PTSD, very accessible, and with practical advice. ?✨

Title:Complex PTSD: From Surviving To Thriving
Author:Pete Walker

This was the first book I ever read which talked about complex PTSD and emotional flashbacks in such accessible and easy-to-understand terms. It changed my life. Everyone who has any interest or relationship with complex trauma should read this book. And if you can only read one book to start with, this is also a good one to go for.

There is a lot of scientifically validated information and research here. Walker, also with lived-experience of CPTSD, has presented and explained everything in a way which will finally give you some answers after a lifetime of searching.

The Americanism and sometimes under-par formatting lets it down a little, it’s no literary masterpiece and ‘which trauma type are you?’ style quiz can take the tone down a little, but the accessible context and delivery is life-changing.

In fact, this book inspired me to create the emotional flashback cards you can now download for free here. I asked Pete for his approval and he is very happy to support my work here. Thanks Pete! ??

Have you read this book too? Share your thoughts in the comments below.

Research analysis

Reduced anterior cingulate and orbitofrontal volumes in child abuse-related complex PTSD.

Thomaes K, Dorrepaal E, Draijer N, de Ruiter MB, van Balkom AJ, Smit JH, Veltman DJ. Journal of clinical psychiatry
2010; 71(12):1636-1644

OBJECTIVE: Classic posttraumatic stress disorder (PTSD) is associated with smaller hippocampus, amygdala, and anterior cingulate cortex (ACC) volumes. We investigated whether child abuse-related complex PTSD–a severe form of PTSD with affect dysregulation and high comorbidity–showed similar brain volume reductions.

METHOD: Measuring gray matter concentrations in referred outpatients with child abuse-related complex PTSD (n = 31) compared to matched healthy nontraumatized controls (n = 28).

RESULTS: As was hypothesized, patients with child abuse-related complex PTSD showed reductions in gray matter concentration in right hippocampus (P(SVC corrected) = .04) and right dorsal ACC (P(SVC corrected) = .02) compared to controls. In addition, a reduction in gray matter concentration in the right orbitofrontal cortex (OFC) was found. Impulsivity correlated negatively with hippocampus volume, and anger, with hippocampus and OFC volume. Comorbidity of borderline personality disorder–compared to comorbid cluster C personality disorder–accounted for more extensive reductions in the ACC and OFC volume.

CONCLUSIONS: In complex PTSD, not only the hippocampus and the ACC but also the OFC seem to be affected, even in the absence of comorbid borderline personality disorder. These results suggest that neural correlates of complex PTSD are more severe than those of classic PTSD.

What does this research study show us?

Important conclusions:

  • Individuals with child-abuse related complex PTSD show reductions in grey matter concentration in brain in these areas:
    • Right hippocampus,
    • Right dorsal ACC and
    • Right orbitofrontal cortex (OFC)
  • Impulsivity correlates negatively with hippocampus volume
  • Anger correlates negatively with hippocampus and OFC volume
  • Comorbidity of borderline personality disorder meant more extensive correlations with ACC and OFC volume
  • Complex PTSD affects the hippocampus, ACC and OFC
  • This neural impact of Complex PTSD is more severe than classic PTSD
  • These effects are seen even without comorbid borderline personality disorder diagnosis

So, the effects are worse if individuals were also diagnosed with comorbid borderline personality disorder. But the effects were otherwise present (and still more so than classic PTSD) in individuals without this diagnosis.

If those both with and without this BPD diagnosis have the same neurological symptoms, then the common correlate is trauma, not the BPD diagnosis.

This is evidence that the borderline personality disorder diagnosis is a meaningless social construct which further serves to re-traumatise survivors of complex childhood trauma.

To explain the fact that those with a BPD diagnosis have markedly more volume differences than those without, we could consider the fact that these individuals’ trauma experiences (perhaps they were more severe; perhaps they were women more likely to be diagnosed with BPD than PTSD; or simply lived in an area with better access to services) led them to try and access help from the mental health system, which gave them their diagnosis of BPD.

Given what we know about the stigma attached to this diagnosis and the lack of a trauma-informed approach within the mental health system, it’s a likely theory that the individuals diagnosed with BPD have higher correlates because they have been diagnosed with BPD. This diagnosis has caused them more trauma to add to their complex trauma.

Radio 4 Program – ‘D for Diagnosis’

On the Friday 12th July 2019 I was listening to Radio 4 in the morning, whilst making coffee at my friend’s apartment, about to leave and cycle to my boat in the boatyard in Brighton Marina to work on her.

And then the program ‘D for Diagnosis’ came on the air, and I had to stay and listen to it. Presenter Claudia Hammond investigates the constantly shifting nature of diagnostic labels in mental health, exactly what Eyes On Trauma is campaigning around.

You can listen back to this ‘D for Diagnosis’ Radio 4 program via BBC Sounds here.

BBC Radio 4 ‘D for Diagnosis’ 12/07/2019

Diagnoses Are Of Their Time

What becomes clear is that mental health diagnoses are often based around assumptions about how people should be expected to behave.

Diagnoses are products of their time, either expressing society’s intolerance of indifference, or using them as overt tools of oppression.

Looking at the History of Psychiatry

At the Wellcome Library in London, historian of psychiatry Dr Jen Wallis illustrates this with a few examples from the deep depths of psychiatry’s past.

In the days of slave trading, Dr Wallis explains that it was believed that “black slaves are pre-ordained and naturally should be submissive, and so for them to decide to run away clearly meant that they were mad.”

This is a view we would now find abhorrent within today’s society, as we have instead moved towards greater human rights, multiculturalism and freedom of speech & movement.

Women Particularly Oppressed

As another example, Dr Wallis goes on to say that a lot of text books written by psychiatrists, especially in relation to female behaviour, illustrate the expectations of the ways different groups of people were expected to behave. (Listen back at 09:46.)

These expectations and assumptions around women’s behaviour continue today, and still remain a big part of the problem with having our trauma recognised, validated and healed compassionately.

Maudsley & Hysterical Women

Dr Wallis goes on to introduce Henry Maudsley, whom the NHS named their top UK psychiatry training hospital after. But what kind of views did Maudsley inform his psychiatry with?

Well, Maudsley happened to be a proponent of degeneration & de-evolution theory. He believed in evolution, but also believed there must be a counterbalance, a de-evolution. In his 1870 book ‘Body and Mind’, Maudsley talks about hysterical insanity – again, referring to women in particular. The diagnosis of hysteria isn’t just about physical signs, e.g. convulsions, but it also talks about moral issues, conversation that tends to be erotic or the obscene. Maudsley believed that these hysterical women would fall foul to moral perversion if they are not put under the control of a psychiatrist.

So this is a top psychiatrist, who believes in de-evolution, and is obviously using hysterical women as his target here. His description of what we would now see as traumatised women would today be abhorrent. (And by the way, those convulsions and moral issues are probably emotional flashbacks.)

Dr Wallis explains that a lot of diagnoses aren’t around today, with social and cultural factors continuing to have an influence on diagnosis now.


Shellshock was also mentioned as an example of this – now known as PTSD, and the symptoms having changed as well.

This shows us how trauma presentations can differ hugely with time, given society’s assumptions and expectations towards it.

Time To Move On

Whilst we’re taking steps in the right direction and have already moved away from the label of hysteria, the modern equivalent of borderline personality disorder (or even emotionally unstable personality disorder… or explosive anger disorder… or any of these other horrific labels) treats patients – mostly women – in exactly the same individual-blaming trauma-invalidating ways.

And no wonder, with Maudsley’s name still hanging above the NHS’s top psychiatry training hospital’s door. It’s time we challenged these un-trauma informed, abusive stalwarts of psychiatry and psychology.

Summing up her views on diagnosis, Dr Wallis thinks we’ll look back on some of our current diagnoses in 100 years and be appalled by them. (Listen back at 12:14.) Yes! Bingo! But come on – we don’t need to wait 100 years. It’s called complex trauma and it’s all around us and we can do something about it now.

Time To Validate Trauma

It’s brilliant that these topics are getting so much attention in the media at the moment, and we are finally able to have these much-needed discussions.

But it’s really disappointing that people still aren’t validating the bigger picture of trauma, abolishing modern-day hysteria ‘personality disorder’ labels, talking about complex trauma & emotional flashbacks, and calling for wider trauma-informed practice and care.