The Psychiatrist Who Thinks We’re All Wrong About Trauma
Sitting With Hannah Spier
I found her by accident.
YouTube’s algorithm — which has been studying me longer than my therapist has — surfaced a long-form lecture by a woman in glasses with a slight Norwegian accent talking calmly into a camera about why the borderline patient in front of her almost certainly wasn’t traumatized in the way the chart said she was. I clicked because I was annoyed. I kept watching because she was good.
Her name is Hannah Spier. She is a psychiatrist trained in Norway and Switzerland, currently practicing in Zürich, with a Substack called Psychobabble and a YouTube channel that has been growing fast over the last two years. She writes for Mad in America, Commentary, the Federalist, the American Spectator, Evie. Iain McGilchrist has endorsed her work. She hit the Substack Bestseller list in August 2025. And her central argument is that mainstream psychiatry — including most of the trauma-informed framework I have spent years building this entire ministry on — is wrong in load-bearing ways.
I want to talk about her honestly, because I think she is the strongest disagreement Nervous System Theology has to answer. And I do not believe the answer is to ignore her.
What She Is Actually Saying
Spier’s thesis, condensed to one sentence: modern psychiatry has overcorrected toward trauma-as-master-explanation, and this overcorrection is hurting the people it claims to help.
That sentence sounds inflammatory. She means it carefully. The specific moves underneath it are these:
On BPD: Trauma is neither necessary nor sufficient for borderline personality disorder. Many people meet BPD criteria without identifiable abuse histories. Many people with severe abuse never develop BPD patterns. The “high rates of childhood trauma in BPD” statistics you see in popular trauma books rest almost entirely on retrospective self-report — adult patients telling clinicians what they remember — and retrospective self-report is one of the weakest forms of evidence in clinical research. Memory is reconstructive. The trauma-informed paradigm rewards identifying as having been hurt. The numbers are inflated, and the field knows it.
On Linehan’s biosocial model: Marsha Linehan’s framing — sensitive temperament plus invalidating environment equals BPD — has become the polite consensus. Spier argues it is incomplete. What it omits is the role of reinforcement: behavior that gets attention persists. A nervous system that learns dysregulation reliably draws care will continue to dysregulate. This is not a moral failing in the patient. It is operant conditioning, and ignoring it doesn’t make it not real.
On DBT: Dialectical Behavior Therapy is the most-prescribed BPD intervention and has the strongest marketing apparatus around it. Spier argues the actual outcome data is weaker than the marketing suggests, and that the therapy’s success often comes from the structured human contact and high expectations rather than from the specific skills modules.
On CPTSD: She does not treat Complex PTSD as a legitimate construct distinct from PTSD. She sees the DSM-5’s expansion of trauma criteria from objective events to subjective interpretation as a category-error expansion that opens the door to identity-by-victimhood. Pete Walker and Judith Herman, on her account, gave us a vocabulary that comforts more than it heals.
On ADHD: Calls it “a social construct” — not in the dismissive sense that nothing real is happening, but in the technical sense that the diagnostic line between “ADHD” and “ordinary low conscientiousness paired with high impulsivity” is drawn culturally, not biologically. Inattention aligns with low conscientiousness. Impulsivity with low agreeableness. Personality, not brain disease.
On neuroticism: This is where she is sharpest. She uses Neuroticism in the Big Five / Five-Factor sense — the classical personality psychology trait measuring tendency toward negative emotion under stress. And she argues that many DSM diagnoses (anxiety disorders, parts of BPD, much of what gets called “trauma response”) are actually high-neuroticism temperament being repackaged as pathology and then medicated. The dial isn’t a disease.
You can already feel why this matters. If she is right about even half of this, the trauma-informed cathedral has structural problems.
Where She Is Sharp Enough That I Had To Sit Down
I am going to steelman her, because I think she deserves it.
The retrospective-self-report problem is real. If you go through the actual research base on “BPD patients have very high rates of childhood trauma,” what you find is that most of the high numbers come from adults reporting backward, often inside therapy structures that frame trauma identification as a step toward healing. The studies that restrict to verified abuse (court records, CPS files, contemporaneous medical documentation) consistently produce lower rates. Not zero. Not low. Lower. Spier is right that the field does not talk about this enough, and that the gap between the headline statistics and the verified-only statistics is exactly the kind of gap that should make a methodologist uncomfortable.
The Big Five framing of neuroticism is also right. Neuroticism is a temperamental trait. It is heritable in the 40-50% range across twin studies. It predicts negative-emotion experience across the lifespan with more consistency than almost any other personality measure. And a substantial portion of what gets labeled “anxiety disorder” in primary care is high-neuroticism temperament colliding with modern life, not a disease state distinct from the person who carries it. This does not mean those people don’t suffer. It means the framing matters: you have a high-reactivity nervous system in an environment that punishes high reactivity is a different sentence than you have a disorder. The first invites accommodation and skill-building. The second invites medication.
The diagnostic-inflation critique is the strongest of all. Allen Frances, who chaired the DSM-IV task force, has said publicly that he believes the DSM-5 went too far in lowering diagnostic thresholds. Sally Satel has written on the same theme. The point isn’t that mental illness is fake. The point is that broad diagnostic categories, applied liberally, become identity containers — and identity containers, once installed, are very hard to leave.
If you have spent any time inside the trauma-informed paradigm and you have not yet encountered the version of yourself that started using “I’m in dorsal” the way previous generations used “I’m just tired” — as a stop-thinking shortcut — you will, eventually. Spier is naming that risk, and the risk is real.
Where She Misses Something That Cannot Be Skipped
Here is where the argument cracks.
Spier’s entire model treats the body as the behavioral output of personality traits and reinforcement contingencies. Her clinical lens is CBT-trained, behavioral, cognitive. She does not engage Stephen Porges’ polyvagal theory. She does not engage Bessel van der Kolk on somatic memory. She does not engage Peter Levine on the discharge of incomplete sympathetic mobilization. She does not engage Pat Ogden or Sensorimotor Psychotherapy. She does not engage the heart-rate-variability literature that has accumulated since Porges started publishing on the vagal brake.
When you ask Spier’s framework what does the body do under chronic relational threat, the framework does not have a mechanism-level answer. It has a behavioral answer: the body produces behaviors that get reinforced or not, and personality predicts which behaviors are likely. The autonomic nervous system, as such, does not appear in the model. The body is a black box that emits outputs.
This is not a small omission. This is the load-bearing part of the trauma-informed framework that her critique walks past. Because once you take seriously that the autonomic nervous system records threat history physiologically — measurable in heart rate variability, in startle response, in cortisol awakening response, in vagal tone — the question is no longer did this person have enough Big-T trauma to justify the symptoms. The question is what is this body doing right now, and what does it need to come back online. The mechanism is real whether or not the diagnosis is.
And here is the other thing Spier’s model cannot account for: the somatic intervention data. Why does Somatic Experiencing produce symptom remission in patients who never developed full insight into their trauma narrative? Why does EMDR work when the patient cannot verbally articulate what happened? Why do trauma-informed yoga programs produce measurable reductions in PTSD symptoms in populations where talk therapy stalled? If trauma is just behavior plus temperament plus identity-by-victimhood, none of this should work. It does work. The body is in the room whether the framework includes it or not.
So my honest read: Spier is correct that the field has overcorrected toward trauma as a master narrative, and she is correct that retrospective self-report is doing too much methodological lifting, and she is correct that neuroticism as a Big Five trait is being repackaged as pathology in ways that hurt people. And she is missing the autonomic mechanism that is the actual reason trauma-informed care exists in the first place.
Both can be true. They are.
The Political Register
I have to address this directly because I would lose your trust if I didn’t.
Spier self-brands as “the antifeminist psychiatrist.” She publishes in the Federalist and Commentary. She has written that “feminism is the ideology of resentment” and that “feminist ideologies are the pathogen we must eradicate.” She has framed angry female political protestors as displaying borderline psychopathology. She is in the lane that includes Jordan Peterson, the heterodox-psychiatry voices around Mad in America’s right flank, and a media ecosystem that I would not call my home.
You are allowed to find this disqualifying. A lot of people will, and I understand why.
What I would ask you to hold, separately: a person’s politics and a person’s clinical observations are not the same evidence base. Spier’s BPD trauma critique stands or falls on the methodology of retrospective self-report studies, not on her position on feminism. Her neuroticism reframing stands or falls on the Big Five literature, not on her byline in the Federalist. The temptation, when someone is politically uncomfortable, is to dismiss the whole argument. The discipline is to evaluate the argument on its own terms and then say what you think about the politics separately.
I disagree with her politically on most of what she has written outside the clinical lane. I think her framing of female political behavior as cluster-B pathology is the kind of move that, if a male psychiatrist did it to men, would be flagged as exactly the diagnostic overreach she critiques elsewhere. I think her “feminism as pathogen” rhetoric is the inverse error of the trauma-craze rhetoric she opposes — replacing complex social analysis with a single villain frame.
And I think her clinical critique is sharp enough that I keep watching her videos anyway.
What This Means For This Ministry
Nervous System Theology is not changing its frame. Trauma is real. The autonomic nervous system records relational threat. Polyvagal theory is the substrate. Somatic and parts-based interventions reach what cognitive therapies alone do not. CPTSD is a useful construct because the body of a person who survived chronic relational threat does not behave like the body of a person who survived a single event — and that difference is observable in the measuring equipment, not just the self-report.
But Spier’s critique is going to make the writing on this site more honest. Specifically:
- I will be more careful about which trauma statistics I cite, and whether they rest on retrospective self-report or verified records.
- I will name temperament as a real input alongside experience, rather than treating it as the optional rounding error in the equation.
- I will distinguish more clearly between trauma the event, trauma the autonomic memory, and trauma the identity — and resist the third when it shows up.
- I will not pretend that the trauma-informed paradigm is incapable of being weaponized for avoidance or identity entrenchment. It can be. The risk is in the room.
You can read the updated F10 BPD 101 chapter for the clinical version of this engagement. The new section is titled Alternative Framings — The Spier Critique and sits inside the chapter as a steelman, not a footnote.
I am not interested in being the kind of trauma writer whose framework cannot be questioned. The body keeps the score, and the score is not the whole song. Hannah Spier is one of the people sharpening that distinction for me. Take what is useful. Notice what is not. Stay in the question.
Sources
- Psychobabble Substack
- The Trauma Myth of Borderline Personality Disorder
- How Borderline Traits Develop and Why They’re Increasing Now (Ep 66)
- The False Promises of Dialectical Behavioural Therapy
- ADHD: The Disorder That Never Was
- The Trauma Craze (Mad in America, Nov 2024)
- Why I Am the Antifeminist Psychiatrist
- YouTube — Hannah Spier, MD
Gentle disclaimer: Normal Like Peter and Church of NORMAL publish trauma-informed educational and creative content. Nothing on this site is medical, mental-health, legal, or crisis advice. If you are in immediate danger or emotional crisis, seek local emergency services. In the U.S., you can call or text 988.
Church of NORMAL — Normal Like Peter
“Nothing is lost. Only recompiled.”
