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About Bessel Van der Kolk
Van der Kolk is a qualified psychiatrist. He specializes in the area of post-traumatic stress. This has led to him writing over 150 peer-reviewed scientific articles, with the majority being about post-traumatic stress. Van der Kolk has also served as a past president for the International Society for Traumatic Stress Studies. He is currently a professor of psychiatry at Boston University School of Medicine.
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 individuals. Trauma can impact the way people perceive themselves and the world around them. Psychological trauma can also 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 of this topic. Van der Kolk also presents ways neuroscience allows us to produce new, effective treatments for psychological trauma survivors. Examples of these approaches are eye movement desensitization and reprocessing, yoga, and limbic system therapy. Van der Kolk guides us to these modern therapies by recalling his career and the patients he has seen. So, this book also acts as a history of the mental health field of the last 30 years.
This summary will have a similar structure to the book: five parts. After reading this summary, 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 recover.
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. This means that the following things have sadly been removed from mental health support:
- The belief that we can heal each other in the same way we can destroy each other.
- Language is critical in providing us with the power to change circumstances.
- Our physiology is not only regulated by medication. We can control our physiology by using breathing, moving, and touching techniques.
- We can 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. During this time, he 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. Rorschach tests found that trauma can distort the brain’s reality (trauma-distorted perceptions). These tests were integral to how Van der Kolk then approached his therapy sessions with survivors of incest. He was now treating his patients through what a ‘trauma lens.’ Working with veterans allowed him to understand the remarkable courage that it takes for trauma victims to remember their trauma.
Van der Kolk also applied this trauma lens to a broader range of individuals. Based on this, he noted 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 those around the survivor. Traumatized individuals often have Post-Traumatic Stress Disorder (PTSD), leading to depression and substance abuse. Traumatized individuals can also 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 by talking about a group therapy session he provided for war veterans. The group also helped veterans find friends to share their experiences. That said, those who weren’t traumatized were considered outsiders by those who were. This prejudice also meant Van der Kolk was an outsider in the traumatized group’s eyes. 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 the traumatized before we can expect any trust. Often trauma is caused by trusted people. So, it is essential to understand that 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 to produce action. Think of the fight or flight responses. Both require an action to end the stress. Issues arise when stress is overwhelming, such as with a traumatic event. This can overwhelm the body’s adaptive response and prevent the required action. So, eye movement desensitization and reprocessing (EMDR) is vital. This therapy helps the traumatized to adaptively process information.
StoryShot #5: Brain Scanning Suggests You Should Take Action
Treating this hopelessness or lack of action is extremely important. Hopelessness 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 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 as they limit the activity of a brain 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 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 want to 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 regulation are:
- Mindfulness meditation
Ways to recalibrate bottom-up regulation are:
StoryShot #6: How Therapists Should Approach Treating Trauma
Therapy for traumatized individuals needs to utilize all of the bullet points above. Here is a summary of how 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. Mindfulness helps to do exactly that.
- 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 imagination. This means imagination is fundamental to helping the traumatized heal.
StoryShot #7: Early Trauma Changes Neuroanatomy
Self-regulation is learned from early caregivers through mirror neurons, empathy, and imitation. Early trauma changes how the brain is wired, and neither drugs nor conventional therapy can change the brain. Van der Kolk cites his research to show that the vast majority of children’s mental health issues 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. He wanted it included as a replacement for the majority of childhood diagnoses. Van der Kolk puts this down to the substantial monetary value of the DSM.
Diagnoses should lead us to interventions. Van der Kolk asserts that our current child diagnoses describe behavioral and emotional symptoms resulting from trauma.
StoryShot #8: Traumatic Memories Are Disorganized
Healthy and traumatic brains both store perceptions of experience in neural networks. That said, the critical difference between them is their levels 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.
Van der Kolk explains that 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 as images, physical sensations, and intense emotions.
The American psychologist, Shapiro, believes that unprocessed memories are the basis of pathologies. These memories prevent our brain from adaptively updating our neural pathways. But 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.
StoryShot #9: Restore the Balance Between Your Emotional and Rational Brain
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 by 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. Remaining truthful includes how you managed to survive the trauma.
In summary, overcoming trauma is about restoring the balance between the 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 to help you 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
One of the most impactful therapies for trauma is yoga. Van der Kolk explains that your body and mind have a close relationship. So, a balanced life relies on understanding how your emotions work and how these emotions impact your body. Trauma can make this relationship between your body and mind particularly hard to understand. For example, traumatized individuals have a hypersensitive alarm system.
To tackle this disconnect between body and mind, traumatic people will turn to things that will numb their feelings. But this tends to do more harm than good. An alternative that aims to help you get in touch with your emotions is yoga. Van der Kolk explains that he has had many patients successfully encourage signals about their emotional state by using yoga. Yoga allows traumatized individuals to adopt stereotypically vulnerable positions within a safe environment.
Mindfulness has a similar potential for allowing traumatized individuals to get in touch with their emotions. Mindfulness’ primary goal is to help people maintain a conscious awareness of their bodies and emotions rather than deny them. Trauma is often associated with denial of emotions as a way of repressing difficult memories. This denial prevents traumatized individuals from starting the healing process.
Mindfulness has consistently been able to alleviate some of the psychological and physiological effects of trauma. Research also suggests that mindfulness can also improve immune responses and activate the brain regions that regulate emotions.
StoryShot #10: Try to Process Traumatic Experiences Like Other Experiences
There are clear differences between the way we remember traumatic memories and non-traumatic memories. Traumatic memories are heavily reliant on sensory and emotional fragments. This is because our brains are overwhelmed by the shock of traumatic events and struggle to process all the information. A vital part of overcoming trauma is trying to remember the details of these experiences. If you can process this information you will be better equipped to put the structures in place to start overcoming trauma.
Final Review and Analysis
The Body Keeps the Score is an overview of the relationship between our bodies and minds. Van Der Kolk uses his years of experience researching, diagnosing and treating PTSD to offer guidance on the strong relationship between trauma and our bodies. He challenges the common view that drugs are the cure for traumatic experiences. The alternative is better understanding how trauma affects our mind and body, and how we can change the way we process this information.
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