The Body Keeps The Score Summary | Bessel van der Kolk

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Summary and Analysis of The Body Keeps The Score: Brain, Mind, and Body in the Healing of Trauma

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Bessel Van der Kolk’s Perspective

Bessell Van der Kolk, MD, is a qualified psychiatrist. He specializes in the field of post-traumatic stress, which led him to write over 150 peer-reviewed scientific articles, the majority of them about post-traumatic stress. Van der Kolk, originally from the Netherlands, has also served as president of the International Society for Traumatic Stress Studies. He is currently a professor of psychiatry at Boston University School of Medicine. 

Introduction

The Body Keeps the Score is an innovative book by psychiatrist and trauma expert Van der Kolk. We all understand the effect that psychological trauma can have on individuals. Trauma can impact the way people perceive themselves and the world around them. Psychological trauma can have a lasting impact on the individual’s loved ones as well. In this book, Van der Kolk covers the intricacies of how trauma produces these effects by considering the neuroscience involved. Van der Kolk also presents ways neuroscience allows us to produce new, effective treatments for psychological trauma survivors. Examples of these approaches include eye movement desensitization and reprocessing, yoga, and limbic system therapy. Van der Kolk guides us through these modern therapies by recalling his career and the patients he has seen. So this book also serves as a history of the mental health field of the last 30 years. 

After learning these storyshots, you will better understand how our brains react to and deal with psychological trauma. What Van der Kolk recommends is helping survivors of psychological trauma to recover.

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StoryShot #1: Antidepressants Ruined Mental Health Support 

Van der Kolk describes how he and other researchers/therapists were so excited when antidepressants were first introduced. He now believes that our overuse of these medications has led us to treat mental illness as a disease. Unfortunately, this approach means that the following things have been removed from mental health support:

1. The belief that we can heal each other in the same way we can destroy each other
2. Language that is critical to providing us with the power to change circumstances
3. Controlling our physiology by using breathing, moving, and touching techniques, rather than by resorting to medication
4. An inclination to change social conditions so that people feel safer and are then able to thrive

StoryShot #2: The Development of Our Understanding of Trauma

Van der Kolk’s early research played a massive part in reigniting ideas surrounding trauma. 

Trauma and its association with mental health were supposedly first discovered by Pierre Janet in the late 1800s. Janet is one of the founding fathers of psychology. He was also one of the first to identify how previous events in a person’s life can lead to present-day trauma. He defined the terms dissociation and subconscious, both of which are still used today in conversations surrounding trauma. 

Van der Kolk describes his early research on veterans. Rorschach tests found that trauma can distort the brain’s perceptions of reality. These tests were integral to the way Van der Kolk later approached his therapy sessions with survivors of incest. That’s when he began treating patients through a ‘trauma lens.’ Working with veterans allowed him to understand the remarkable courage that it takes for trauma victims to recall their trauma. 

Van der Kolk also applied this trauma lens to a broader range of individuals, revealing that trauma was far more widespread. Trauma can result from any experience of extreme stress or pain that leaves the individual with feelings of helplessness. 

StoryShot #3: Trauma Influences Relationships

Van der Kolk also acknowledged that trauma has a significant impact on the people around the survivor. Traumatized individuals often have Post-Traumatic Stress Disorder (PTSD), leading to depression and substance abuse. Traumatized individuals can struggle to trust others. They assume nobody can understand what happened to them and why they keep reliving it. 

Van der Kolk gave an example of this phenomenon by writing about a group therapy session he provided for war veterans. The group also helped veterans find new friends to share their experiences with. That said, those who weren’t traumatized were considered outsiders by those who were. This prejudice meant Van der Kolk was also an outsider in the traumatized group’s eyes. To overcome this hurdle, Van der Kolk had to provide weeks of listening, empathizing, and building trust. This story shows that we must build rapport with the traumatized before we can expect any trust from them. Often trauma is caused by trusted people in the first place. So it is essential to understand that regaining trust is difficult for traumatized people.

StoryShot #4: Therapy Can Treat Trauma

Van der Kolk described how the brain’s health and adaptive responses to stressors are key to producing action. Think of the “fight or flight” responses. Both require action to end the stress. Issues arise when stress is overwhelming, such as with a traumatic event that can block the body’s adaptive response and prevent the required action. This suggests why eye movement desensitization and reprocessing (EMDR) is vital. This therapy helps the traumatized person to process information adaptively.  

StoryShot #5: Brain Scanning Suggests You Should Take Action

Treating hopelessness or inertia is extremely important. Hopelessness has been described as the most impactful feature of trauma. Action is key to healing because it shuts down the fight or flight survival mechanism, signaling safety. As this survival response can be blocked by trauma, our brain continues to secrete stress hormones. Van der Kolk likens this to a smoke detector always going off. So, even when you are not currently experiencing this stressor, your body is still reacting as if you are. Stress hormones are particularly impactful because they limit the activity of the brain in an area called the prefrontal cortex. The prefrontal cortex is arguably the most crucial part of the brain, as it is involved in all decision making. While reliving the trauma, the amygdala and the limbic system run at maximum speed. This overdrive means the part of the brain and the system associated with emotions are always overactivated. 

This reaction can be described as ‘bottom-up’ processing. Van der Kolk explains that we should develop therapies that encourage the recalibration of both ‘top-down’ and ‘bottom-up’ processing. The brain’s watchtower (prefrontal cortex) should then be better able to monitor our body’s reactions. 

Ways to strengthen top-down mental regulation are:

1. Mindfulness meditation
2. Yoga

Ways to recalibrate bottom-up mental regulation are:

1. Breathing
2. Movement
3. Touch

The Body Keeps The Score PDF, Free Audiobook, and Animation

This was the tip of the iceberg. To dive into the details and support the author, order the book here or get the audiobook for free on Amazon.

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Editor’s Note

First published in March 2021. Updated in March 2022.

Disclaimer

This is an unofficial summary and analysis.

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