I thoroughly enjoyed reading "DAMAGED: Childhood Trauma, Adult Illness, and the Need for a Health Care Revolution," (UTP, University of Toronto Press, 2021) a new book by two traditional academic psychiatrists from Canada, Dr. Robert Maunder and Jonathan Hunter.

I found the book to be a good read on many levels: It has a clear introduction to ACEs, child maltreatment, child abuse trauma and its lifelong impact and what trauma informed care is. It is a relaxed insight into good, dedicated, treating docs' thoughts, feelings, concerns and experiences. The authors go outside the clinic to contemplate many (often idealistic) levels of recommended intervention on the individual, professional, cultural, and political levels needed to make a preventive difference.  Even with its heavy topic the book is a 'sweet' book - conveying a patient, kindly, supportive, empathetic tone. Thus, all in all, it is an excellent introduction to the subject.

In my mind I contrast it with books written by people who experienced abuse and recounted the travails that followed them through their lives. I am certain at the core these writings have a therapeutic as well as educational and inspirational function. These writings convey more raw emotions and passion (positive and negative), steep learning curves, barriers and often failures, as well as inept interactions with the medical profession.

I think that many readers on PACESConnection may be put off by these doctors' patient kindness and the lack of resolution of their patient's condition. After all, the book recounts ongoing psychotherapy for over 20 years and never mentions more effective behavioral treatments. There is good evidence that certain behavior mod techniques could have done better in weeks or months. As a person and a family doc, if I wanted to understand a person or illness I think the psychodynamic frame is important. Nonetheless I am convinced that with regard to treatment of child abuse trauma the "behavioral" approach is far more effective.

These authors do very well to 'break the wall' to get past the white coat barrier, but their humanitarian caring is limited by the traditional psychiatric model. In that they join most of their psychiatric colleagues in refusing to recognize the core importance of child abuse and neglect trauma to many standard psychiatric diagnostic categories.