The Body Keeps the Score is an innovative book released by psychiatrist and trauma expert Van der Kolk. We all understand the effect that psychological trauma can have on an individual, impacting the way they perceive themselves and the world around them. Plus, psychological trauma can have a lasting impact on the individual’s loved ones. In this book, Van der Kolk covers the intricacies of how trauma produces these effects by considering the neuroscience related to this topic. More importantly, though, Van der Kolk also presents the novel ways in which neuroscience is allowing us to produce new, effective treatments for survivors of psychological trauma. Examples of these approaches are eye movement desensitization and reprocessing, yoga, and limbic system therapy. Van der Kolk guides us to these modern therapies through the history of his career and the patients he has seen; therefore, this book also acts as a history of the mental health field of the last 30 years.
Broken down into the five parts of Van der Kolk’s book, this book summary will help you better understand how our brain reacts to and deals with psychological trauma. Plus, what Van der Kolk recommends is needed to help survivors of psychological trauma recover.
“I discovered that my professional training, with its focus on understanding and insight, had largely ignored the relevance of the living, breathing body, the foundation of ourselves.”
One of the fundamental points made by Van der Kolk is that despite the excitement he and other researchers/therapists in the field had when antidepressants were first introduced, he believes that our overuse of these medications has led us to purely treat mental illness as a disease. This means that the following things have sadly been removed from mental health support:
- The belief that we have the capacity to heal each other in the same way we have the capacity to destroy each other
- Language is extremely important in providing us with the power to change circumstances
- Our physiology is not only regulated by medication. We can control our own physiology through using breathing, moving and touching techniques
- It is possible for us to change social conditions so that people feel safer and are then able to thrive
Rediscovery of Trauma
“It takes tremendous energy to keep functioning while carrying the memory of terror, and the shame of utter weakness and vulnerability.
The first section of this book provides an outline of how trauma, as a psychological issue, was first identified. Plus, how Van der Kolk’s early research played a huge part in reigniting ideas surrounding trauma.
Trauma and its association with mental health were supposedly first discovered by Pierre Janet in the late 1800s. One of the founding fathers of psychology, Janet was one of the first to identify how previous events in a person’s life can lead to present-day trauma for the individual. During this time, he first defined the terms dissociation and subconscious, both of which are still used today within the conversation surrounding trauma.
Van der Kolk speaks about his early research on veterans, particularly how the use of the Rorschach tests found that trauma can distort the brain’s reality. This is called trauma-distorted perceptions. These tests were integral to the way Van der Kolk then approached his therapy sessions with survivors of incest, as he was now treating his patients through what he called a ‘trauma lens’. This time working with veterans allowed him to understand the remarkable courage that it takes for trauma victims to remember their trauma.
Van der Kolk also points out how he applied this trauma lens to a wider range of individuals and noted that trauma was far more widespread than veterans and survivors of sexual abuse. Trauma can result from any experience of extreme stress or pain that leaves the individual with feelings of helplessness. Van der Kolk also began to acknowledge that trauma also has a huge impact on those around the survivor. Traumatized individuals often suffer from Post-Traumatic Stress Disorder (PTSD), which can then lead to depression and substance abuse. On top of this, traumatized individuals can struggle to trust others, as they assume nobody can understand what happened to them and why they keep reliving it.
Van der Kolk gave an example of this by talking about a group therapy session he provided for war veterans. The group also helped veterans to find friends to share their experiences with, but those who weren’t traumatized were considered outsiders by those who were. This also meant Van der Kolk was an outsider in the traumatized group’s eyes and, in order to overcome this, Van der Kolk had to provide weeks of listening, empathizing, and building trust. This shows that we must build a rapport with those who are traumatized before we can expect any level of trust. Often trauma is caused by people the traumatized trusted, so being empathetic and understanding that trust is difficult for the traumatized is extremely important.
This is Your Brain on Trauma
“The great challenge is finding ways to reset their physiology so that their survival mechanisms stop working against them.”
This section of the book delved deep into the relationship between our brain and trauma. This includes how our brain reacts to traumatic events and how years later it continues to deal with traumatic events of the past.
Van der Kolk described how the brain’s health and adaptive responses to stressors is to produce action. Think of the fight or flight responses. Both require an action to end the stress. The issue is that when stress is overwhelming, such as with a traumatic event, this can overwhelm this adaptive response and prevent the required action. This is why eye movement desensitization and reprocessing (EMDR) is so important, as it helps the traumatized to adaptively process information again.
Treating this hopelessness or lack of action is extremely important, as it has been described as the most impactful feature of trauma. Action is key to healing, as 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 describes this as a smoke detector going off constantly). So, even when you are not currently experiencing this stressor, your body is still reacting as if you are. Stress hormones are particularly impactful as they limit the activity of a brain area called the prefrontal cortex. This is arguably the most important part of the brain, as it is involved in all decision making. During the time, a brain area called the amygdala and the limbic system are both running at maximum speed; this means that the part of the brain and the system associated with emotions are being constantly overactivated.
This can be described as ‘bottom-up’ processing. Van der Kolk explains that we want to develop therapies that encourage recalibration of both ‘top-down’ and ‘bottom-up’ processing, so that the brain’s watchtower, as Van der Kolk describes the prefrontal cortex, can better monitor our body’s reactions.
Ways to strengthen top-down regulation are:
- Mindfulness meditation
Ways to recalibrate bottom-up regulation are:
Therapy for traumatized individuals needs to utilize all of the bullet points above. Here is a summary of the ways in which therapy should approach treating trauma:
- Dissociation is the essence of trauma, as adverse experiences fragment our everyday experiences. So, treatment must help clients to reactivate a sense of self or our physical body. This is why mindfulness is so helpful
- Draw out blocked sensory information and help the client to befriend, not suppress, bodily responses
- Complete the self-preserving physical actions that were thwarted when the survivor was restrained or immobilized by terror
- Assist our clients through imagining. Our brain does not know the difference between real life and imagining, so imagination is fundamental to helping the traumatized to heal
The Minds of Children
“During disasters, young children usually take their cues from their parents. As long as their caregivers remain calm and responsive to their needs, they often survive terrible incidents without serious psychological scars.”
As expected, this section focuses purely on children and their potential to heal from trauma. Specifically, Van der Kolk focuses on the impact of child abuse and neglect on their developing brain.
Self-regulation is learned from early caregivers through mirror neurons, empathy, and imitation. Early trauma changes the way the brain is wired and ‘neither drugs nor conventional therapy’ has shown the necessary ability to change the brain. Van der Kolk cites his own research to show that the vast majority of mental health issues in children are due to trauma.
Sadly, despite this, Van der Kolk has lost his battle to have the diagnosis of child Developmental Trauma Disorder added to the DSM V as a replacement for the majority of childhood diagnoses. Van der Kolk puts this down to the huge monetary value of the DSM.
Diagnoses should lead us to interventions, and he asserts that our current child diagnoses describe behavioral and emotional symptoms that are the result of trauma.
The Imprint of Trauma
“The traumatic event itself, however horrendous, had a beginning, a middle, and an end, but I now saw that flashbacks could be even worse. You never know when you will be assaulted by them again and you have no way of telling when they will stop.”
Delving into the history of trauma, in this section, Van der Kolk talks about how a normal and traumatic brain both stored perceptions of experience in neural networks, but the key difference is in the level of arousal. Charcot and Pierre Janet were the first to talk about PTSD as being characterized by intense emotional arousal. Freud also provided talking cures that focused on an energetic reaction being connected to the memory, and the resolution is to release this connection. Van der Kolk explained that this dissociation involves isolating yourself with this memory and its emotional connection, meaning you are stuck in trauma time.
Finally, Van der Kolk explained how research shows that positive memories and traumatic memories differ. Positive memories have a beginning, a middle, and an end. Traumatic memories are disorganized, fragmented, and present themselves as images, physical sensations, and intense emotions.
The American psychologist, Shapiro, believes that unprocessed memories are the basis of pathologies as it prevents our brain from adaptively updating our neural pathways. However, developments in neuroscience and knowledge of how our brains can be changed (they are neuroplastic), provides great hope for our ability to assist and health others.
Paths to Recovery
“Healing, he told us, depends on experiential knowledge: You can be fully in charge of your life only if you can acknowledge the reality of your body, in all its visceral dimensions.”
Van der Kolk’s directive to effective trauma therapy involves the following tips:
- Find a way to be calm in all moments. Learn to maintain your calmness and focus even when triggered with past thoughts or emotions
- Learn to be fully alive in the present. Remain engaged with others and with the present moment
- Try to remain truthful to yourself. This includes the way in which you managed to survive the trauma
In summary, overcoming trauma is about restoring the balance between your rational (prefrontal cortex) and emotional (amygdala) parts of the brain. You should use breathing for hyper-arousal, mindfulness to strengthen your self-awareness, and develop strong relationships and support networks so you can help move towards recovery.
As well as this, Van der Kolk provides many suggestions for therapy options. These therapy options include:
- Schwartz’s Internal Family Systems
- Pesso’ PBSP psychomotor therapy