This is Bessel van der Kolk’s treatise on the physical manifestations of trauma, and the enormous implications of trauma on our society. The Body Keeps the Score is for a mainstream audience, not a scientific one, but van der Kolk (a psychiatrist) does take the time to teach neuroanatomy and brain function – to a greater extent than this reader needed, so that I let some of it flow by, but no criticism there.
Van der Kolk also maintains a narrative voice throughout that I appreciate: he is always a character in the story of (re)discovering and studying trauma and seeking treatments for it. He begins with veterans returning from Vietnam, when he began work as a psychiatrist at the Boston VA in 1978. He then introduces us to the children he’s worked with who live with trauma of many kinds, and the adult survivors of childhood trauma; these adults, he shows, suffer differently than those who encounter trauma in adulthood (car crashes, violence, natural disasters) (and are different again from military vets). Throughout the book, he outlines what we know about how each of these groups’ brains operate, including the different between the rational and emotional parts of the brain. He moves us through time, outlining research studies and how we’ve learned what we know about trauma and its manifestations in mind and body. He points out that the words ‘heartbreaking’ and ‘gut-wrenching’ are not entirely metaphoric. Emotions, and reactions to trauma, play out physically. He also makes clear that traumatized people actually reexperience their traumas: that until the brain can integrate these events as memory, they remain present, and can take over the individuals’ present. Those suffering from these flashbacks are truly living their trauma again.
Van der Kolk feels strongly that developmental trauma, which takes place in childhood, is a “hidden epidemic” that exacts enormous costs on society, even just purely in the monetary sense (sufferers “end up filling our jails, our welfare rolls, and our medical clinics”). When he gives presentations on trauma and treatment, he writes, “participants sometimes ask me to leave out the politics and confine myself to talking about neuroscience and therapy. I wish I could separate trauma from politics, but as long as we continue to live in denial and treat only trauma while ignoring its origins, we are bound to fail.” I didn’t find the book very political at all, in fact, but maybe I just don’t think it’s radical to suggest we devote public resources to universal health care – including mental health care – and extend a little compassion and shared responsibility to others, especially kids, who are essentially defenseless. He notes that the trendier discussions of trauma tend to focus on military vets and survivors of splashy, violent single events, while the more everyday (child abuse, intimate partner violence, rape) don’t get as much attention, although they affect many more people.
He also devotes a healthy chunk of the book to treatment options, written (he says) both for trauma survivors and for their therapists. These include talk therapy, EMDR (eye movement desensitization and reprocessing), yoga, rhythmic movement and theatre, neurofeedback (as from Bewilderment, in fact!), and more. “Communicating fully is the opposite of being traumatized.” Van der Kolk stresses the importance of language throughout. (And I love the idea of Shakespeare in the Courts!) He does not love medication for trauma survivors; drugs can mask or deaden symptoms, but don’t address the root of the problem or begin to help the patient integrate trauma into memory, so as soon as they go off the meds, they’ll be in just the same position again. He also does not love the DSM (Diagnostic and Statistical Manual of Mental Disorders), which persists in excluding a diagnosis for Developmental Trauma Disorder despite decades of research and statistics and the support of expert practitioners. He includes as an appendix “Consensus Proposed Criteria for Developmental Trauma Disorder,” the inclusion of which in DSM would enable clearer diagnoses, better funding for research, insurance coverage, and more.
I find The Body Keeps the Score to be a very thorough explanation of extreme trauma, how it works on its sufferers, and what we might be doing about it – as individuals and as a society. It is coherent, credible, compassionate and evidence-based, and accessible to a regular sort of reader, like me. (Again, I let some of the hard science go by.) I think this is a book for everyone, especially the traumatized among us and those who love them – in other words, considering the prevalence of trauma in our world, everyone. I found it interesting reading, if sometimes dense, and sometimes difficult to read – I took this one a little slower than usual, but it was worth all my time. Recommended.
For a much more in-depth summary and review, check out this excellent article from Brain Pickings.
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