I want to share with you a recent review I did of the classic book on trauma therapy, The Body Keeps the Score: Brain, Mind and Body in the Healing of Trauma (TBKTS), by Bessel van der Kolk M.D. It is my hope that it might help you or someone you love who might be suffering from any of the debilitating, yet often insidious effects of mental and emotional trauma that are surprisingly common in life.
The Body Keeps the Score (TBKTS) is truly a classic in the field of trauma therapy, somatic release and mind-body treatment. Bessel van der Kolk, M.D. is the founder and medical director of the Trauma Center in Brookline, Massachusetts (my home state!). He is also the professor of psychiatry at B.U. School of Medicine, Director of the National Complex Trauma Treatment Network and teaches all over the world.
I was first introduced to this book years ago in my own trauma healing efforts by several people, but it wasn’t until recently, when I was undergoing a certification to teach online Non-Linear Movement Method classes (NLMM), that because it was required reading for the instructor certification that I really dug in. Like they say, timing is everything…!
When I first started reading it I couldn’t put it down and soon my book had more sections highlighted than non-highlighted! Perhaps one of the biggest benefits I received was that it helped me understand myself better – which if you follow my work, or listen to my podcast, is a big theme of everything I do! Also, like me, Van der Kolk’s main objective is to help people integrate all parts of themselves, and become whole, highly functional and with sovereignty over themselves.
Unlike conventional talk therapy techniques and pop psychology, this book explained a lot of things that others didn’t have answers for. One of it’s main premises is that our most painful experiences and memories are stored in the body – not just the mind – and therefore to heal them, we need to get into the body. This is why talk therapy alone often doesn’t work for many people as it didn’t work for me, despite many attempts.
Although there where times that it was emotionally very hard for me to keep reading, I realized that this was because it was triggering a lot of the old, buried, deep subconscious “stuff” inside me and I found by the end of learning all I did, I had anew sense of compassion for myself and therefore LOVE- what a blessing!
I feel this book should be a must-read for any therapist, trauma survivor, or loved one of a trauma survivor to facilitate understanding and help not only heal, but deal. Every page is full of fascinating and educational insights and anecdotes. I thought it was very interesting how the author shares that one of the hardest things for traumatized people is dealing with the shame they feel about how they behaved during the episode/event. Meaning they often feel that they took a lack of “appropriate” action, as in fighting or fleeing, but rather they often submitted to the abuse, which is otherwise known as “freezing”. Van der Kolk explains that freezing is a common psychological response to extreme stress and trauma and one which is only now becoming more studied and understood.
The book is divided into 20 chapters and 5 parts:
Part 1: The Rediscovery of Trauma
- Lessons from Vietnam Veterans
- Revolutions in Understanding Mind and Brain
- Looking into the Brain: The Neuroscience Revolution
Part 2: This is Your Brain on Trauma
- Running for Your Life: The Anatomy of Survival
- Body-Brain Connections
- Losing Your Body, Losing Your Self
Part 3: The Minds of Children
- Getting on the Same Wavelength: Attachment and Attunement
- Trapped in Relationships: The Cost of Abuse and Neglect
- What’s Love Got to Do with It?
- Developmental Trauma: The Hidden Epidemic
Part 4: The Imprint of Trauma
- Uncovering Secrets: The Problem of Traumatic Memory
- The Unbearable Heaviness of Remembering
Part 5: Paths to Recovery
- Healing from Trauma: Owning Yourself
- Language: Miracle and Tyranny
- Letting Go of the Past: EMDR
- Learning to Inhabit Your Body: Yoga
- Putting the Pieces Together: Self-Leadership
- Filling the Holes: Creating Structures
- Applied Neuroscience: Rewiring the Fear-Driven Mind with Brain/Computer Interface Technology
- Finding Your Voice: Communal Rhythms and Theater
- 1 in 5 Americans was sexually molested as a child
- 25% of us grew up with alcoholic relatives
- 1 in 8 witnessed their mother being hit
- Painkillers now kill more people each year in the United States then guns or car accidents.
Even though these numbers are disturbing, Van Der Kolk talks about how resilient we are as a species – (which is encouraging), yet how unfortunately, if we are exposed to violence or family violence as a child it can make it difficult to enjoy stable and trusting relationships as an adult.
According to van der Kolk, trauma as: “unbearable and intolerable” events that end up producing actual physiological changes in the brain including a recalibration of the brain’s alarm system, an increase in stress hormone activity and alterations in the system that filters relevant information from irrelevant. This really helped me understand why often traumatized people can be so hyper-vigilant, have such difficultly “going with the flow” or truly relaxing on a visceral level. And I really appreciate the way the author describes trauma as not as much an “event”, but rather something that physically changes brain and body and the way the person sees and processes things.
The author explains how the “fight” stress response actually gives you ENERGY. I feel that that can be part of why many people can be unwittingly addicted to the high adrenal stress lifestyle. It’s almost as if it’s their default mode and automatic way of being and living – because it gives you energy. I know I’ve always been an “over-doer”, high-achiever, high-energy and ambitious person. This was a possible explanation for some of that that I hadn’t previously considered. As the author states:
“It takes tremendous energy to keep functioning while carrying the memory of terror and the shame of utter weakness and vulnerability.”
Further, van der Kolk explains how trauma survivors can be triggered and reactivated at the slightest associated thing, and this can set off a cascade of intense, disturbing emotions and/or intense physical sensations which leave them to feel out of control and even “damaged to the core” or “beyond redemption”.
Until reading this book, I had only thought about someone as being the victim of, and on the receiving end, of trauma. Yet the author states that trauma can possibly be both the result of something done to you or the result of something you have done . He makes the point that regardless of which end the person is on (victim or perpetrator), the resulting dysfunction and disruption is the same.
A major premise, and one that is consistent with all trauma therapy models, is that feeling, and feeling safe in particular, are required for healing. Ultimately, we cannot access and feel our feelings unless it’s safe to feel; thus, establishing a safe environment is step one of healing and recovery.
I found it fascinating how van der Kolk explains that humans are ‘meaning-making creatures’ and it is because of this that the story we tell ourselves about the event is so critical to address. He goes into great detail about the physiological process and function of “memory”, and how it is not only highly subjective but also almost always different than reality (at least in some regard). It is our unique recall of the events that then shape the development of the personal meaning or interpretation that we attach to an event.
van der Kolk describes how research done using the Rorschach test revealed that traumatized people have a tendency to superimpose their trauma on everything around them and have trouble accurately deciphering what is going on around them, showing how trauma not only affects:
- The imagination
- The ability to let our minds play
- The ability to be mental flexible (which is the hallmark of imagination)
All of these faculties are disrupted. Instead of these normal processes, the mind rather simply replays an old reel. This is a big problem because imagination is absolutely critical to the quality of our lives. As is stated:
“Imagination enables us to go beyond the everyday routine of life by allowing us to fantasize about different things, which includes the ability to imagine new possibilities”.
Therefore, having a properly functioning imagination is an essential launch pad for making our hopes come true – for it is what “fires our creativity, relieves our pain and enlivens are boredom. As well as opening up our capacity for pleasure.” Trauma survivors can be compulsively and constantly pulled back into the past, to the last time they felt an intense involvement and deep emotions, they suffer from a failure of imagination, a loss of mental flexibility and how “Without imagination there’s no hope for a better future.” Ouch.
The origins of the term, “Post Traumatic Stress Disorder” (PTSD) are explained as well as its cluster of symptoms, which include, at its core, the feeling of profound hopelessness and helplessness. van der Kolk explains how for trauma survivors, the world can be divided into two groups of people: between those who “know” and those who “don’t know”. You’re either in or you’re out. You either can or you cannot be trusted. And he talked about how trauma is not only something that had occurred in the past but is also something that has left an imprint on the person’s mind, brain and body with consequences on how the person manages to survive and her/his worldview in the present and in addition, how “trauma changes not only what we think and what we think about, but also our very capacity to think.”
It’s very interesting how he stated that the act of telling the story and talking about it and applying meaning to what happened is not enough for healing, but rather that in order to resolve the person’s constant hypervigilance and their constant state of preparedness to be assaulted, or violated at any time, the body needs to learn that the danger has passed and how to live in the reality of the present. This is essential for real change to take place,
Van der Kolk states that more than half the people who seek psychiatric care have been either abandoned, assaulted neglected or even raped as children, or have witnessed violence in their families.
And he shares how he had formulated a rule as a result of all his training:
“If you do something to a patient that you would not do to a friend, or children, consider whether you are unwittingly replicating the trauma from a patient’s past.”
Again, keep in mind, trauma is “held” in the body, in the very cells from head to toe, not just in the brain or mind. Thus, van der Kolk states:
“People “cannot get better without knowing what they know and feeling what they feel”.
One of the author’s mentors and professors at Harvard University puts it another way:
“Failure to attend to our basic human needs result in a stunt of our basic existence. You can be fully in charge of your life only if you acknowledge the reality of your body, in all its visceral dimensions.”
I found it fascinating how research shows that people suffering from PTSD had low cortisol levels. The reason for this was theorized that this was because cortisol puts an end to the stress response by signaling an “all is safe” signal to the body. In short, basically the stress hormones of people with PTSD do not return to baseline after the event has passed. Instead they continue to secrete. Also of note was that low serotonin in the brain was associated with hyper-reactivity – again, that hypervigilant state so common in those who have experienced trauma. .
van der Kolk then discusses how the conventional The Brain Disease Model is faulty, in that it basically takes the control over people’s fate out of their own hands and into that of doctors and insurance companies to instead fix their problems. He postulates that based on the astronomical level of annual drug prescriptions, “if the drug model worked and actually was as effective as we have been led to believe, then depression, for example should no longer be an issue”. He shares that even as prescriptions have increased, it has not made even a dent in hospital admissions for depression and how one in 10 Americans now take antidepressants. (Back at the time of writing this book however I’m sure it’s significantly even higher now)
He shares how part of the popularity of the high prescription rate in an attempt to treat trauma survivors, is due to that sad fact that antipsychotic medications make children more “manageable” and less aggressive. Yet unfortunately they also interfere with children’s motivation, sense of curiosity and play and are associated with morbid obesity and diabetes.
The brain research presented as fascinating as well as enlightening.
I found it very interesting how the author shares evidence that when trauma patients had flashbacks, the right side of their brain would light up (was activated) on brain scans and deactivated on the left and how his research showed that images of past trauma clearly affect the right area of the brain. (Of note, the right brain is the first to develop in the womb and carries the non-verbal communication between the mother and the infant.)
The brain develops from the reptilian base area first, followed by the mammalian and the neo-cortex. The popular saying: “Neurons that fire together, wire together” basically means how the brain develops on an as required basis.
A pervasive theme in the book was: The number one requirement for mental health is feeling safe. For the physiology to be able to calm down, there must be a visceral sense of safety and relationships need to be reciprocal in order to be nurturing and therefore effective. Trauma almost invariably involves “not being seen, not being mirrored and not being taken into account”, thus treatment needs to reactivated the capacity to safely mirror and be mirrored by others, yet also resist being hijacked by others negative emotions.
I was also so happy to see the section on the work of Stephen Porges, his research on the vagus nerve and how the Polyvagal Theory is related to trauma with fight, freeze or flee responses in particular. And I also love how the author explains how the origin of the word “sympathetic’, in the sympathetic nervous system is based on the root word for “emotion” and therefore indicative of its connection to our emotions. So cool!
van der Kolk goes on to explain how the brain is a “cultural organ” and thus how our experience “shapes” our brain. He basically makes a strong argument for the nature v. nurture theory – which is consistent with the current epigenome research and what we know about the direct and powerful influence our environment, lifestyle, diet, thoughts and every day choices makes on our genes and their expression.
The case is made that immobilization is at the root of most traumas, which involves the nervous system slowing down to such a degree that the person becomes numb, stops “feeling”, and often collapses and disassociates from the situation. This is consistent with how we see many traumatized people are either too vigilant ( or what’s known as “hypervigilant”), or they’re numbed out. This is truly a tragedy because in order to truly connect with ourselves as well as others, we need to be able to relax, surrender, trust, and perceive we are safe.
“We can’t know why we feel, until we know what we feel.”
I loved the section in the book on attachment. As we’ve learned in research on infant development, imitation is our most important social skill. It was fascinating to learn how 6-hour old babies will imitate facial expressions of researchers as well as their mothers and care-takers and behave differently depending on the care-taker’s disposition and attention.
The author goes on to explain how often dissociation can manifest as feeling lost, overwhelmed , abandoned and disconnected from the world as well as feeling unloved, empty, helpless, trapped or weighed down. He explains how infants who are not truly seen and known by their mothers grow into adults with trauma symptoms and their bodies basically learn to stay in a state of high alert to ward off the abandonment pending. As explained:
“If you cannot tolerate knowing what you know, and feeling what you feel, the only option is disassociation, or denial.”
You might want to read that again…
The main goal of recovery from any type of trauma is ownership of our own sensations and body. Further, van der Kolk shares that he learned (the hard way) as a therapist, to “never try to tell someone they shouldn’t feel the way they do.” Good advice that I think we can all try to make a special note to remember!:)
TBKTS goes into extensive detail about the popular Adverse Childhood Trauma, (A.C.E.) Test and the strong correlation between high A.C.E. scores and mental disorders, depression, suicide attempts, further abusive relationships and rape etc.
One of my favorite quotes from the book is:
“If you mistake someone’s solution for a problem in need of being eliminated , not only are they likely to fail treatment, but then other problems may emerge.”
An example of this type of phenomenon is with of patients who overeat and as a result become obese as a way of coping or protecting themselves from unmanageable feelings. If a well-meaning therapist or friend tries to treat the obesity and overeating as the root of the problem, rather than the symptom of an underlying problem for which the person has utilized this method as a coping mechanism, they will inevitably have poor results.
I was very impressed to learn that van der Kolk was instrumental in spearheading a new diagnosis called Developmental Trauma Disorder and was also very involved with trying to influence public and political policy in an effort to really make some significant and lasting inroads. I also appreciate and admire his philosophy on taking a holistic approach to treatment and in particular, his encouragement of the importance of including non-drug based treatments. As he states:
“If you focus only on faulty biology and defective genes as the cause of mental discourses and ignore abandonment, abuse and deprivation, you run the risk of running into dead ends – as most generations did – and blaming it all on defective mothers.”
Further, he does a wonderful job of explaining how “humans are ‘social animals’, and thus, often mental problems involve not being able to get along with other people, not fitting in, not belonging and in general not being able to get on the same wavelength. As he states, one of our most powerful survival strategies is how everything about us, our brains, our bodies, our survival systems, are geared towards social survival systems.
Thus another favorite and powerful quote:
“Social support is a biological necessity not an option. “
I found particularly helpful that the author explains the underlying mechanisms as to why trauma and abuse patients often can’t seem to consciously recall detailed memories of the abuse. Reiterating how in these circumstances, the traumatic event exceeds the person’s resources to process or cope with the event. Our “memories” are directly related to the meaning(s) we assign to the situation as well as the emotions we feel in relation to these events, plus memory is intimately related to arousal states, such as the amount of adrenaline that is circulating in the body at the time. So emotion is is key factor in memory as well as recall. In a nutshell, memories are largely dependent on how personally meaningful the situation was and how emotional the we felt about the situation at the time.
To explain this further, trauma produces feelings of overwhelm, which shuts down the frontal lobe in the brain (the higher cognition, executive area), which is why we often can’t put feelings into words. I’ve often wondered this – why it’s super hard sometimes to articulate how we’re feeling at a core level. The author explains how the emotional brain, which is not under conscious control, is the limbic area in the brain stem and how there are two different types of memory: our narrative memory and the trauma memory itself, and how unfortunately, many therapists are not aware of the difference and hence have negative ramifications for their patients.
Have you ever felt something that you know “logically” doesn’t make sense or is “irrational” yet still felt it anyway in spite of yourself?
van der Kolk explains this occurrence by means of how our rational brain expresses and manifests itself in “thoughts”, while our emotional (limbic) brain manifests itself in “physical reactions”, bodily sensations such as heart rate, butterflies, sweating, tight voice, breathing, etc.…Thus, understanding logically why you feel a certain way cannot keep you from feeling how you feel. In a nutshell, with trauma, the emotional brain hijacks the body. This is why a traumatized person feels so hopelessly out of control and overwhelmed and powerless to stop what’s happening. van der Kolk shares the vital importance of social support and our social networks as part of the essentials for recovery and healing and how safety and terror are incompatible.
Further, in regards to healing and treatment, I thought it was both interesting and encouraging that both adults and children respond the same way to the effectiveness of receiving comfort by means of gentle holding and rocking, and the “assurance that somebody bigger and stronger is taking care of things” as well as the powerful effect of being around familiar loved ones, feeling safe at a visceral level and provided with physical shelter, food care as well as time for ample sleep and rest to help best heal. Thus, reinforcing his theory that our attachment bonds are our greatest protection against threat, whereas “managing your terror all by yourself gives rise to another set of problems: disassociation, despair, addictions, and a chronic sense of panic in relationships that are marked by alienation, disconnection and explosions.”
TBKTS provides strong evidence the power of physically moving our bodies in rhythmic ways, as well chanting and humming as very effective methods for healing trauma and the relationship between rhythm, movement and healing. Examples of these are things like dancing, tango, kickboxing as well as theater as a means of self-expression, embodiment of feelings, and building confidence and self-esteem.
As van der Kolk states: “You can’t fully recover unless you feel safe in your skin” and that’s why, in addition, he recommends some sort of regular bodywork like massage, cranial sacral therapy, etc. He shares that his patients with the poorest outcomes are those who suffer from feelings of mental defeat. Trauma is just not the problem with being stuck in the past, it’s a problem with the stimulating and processing feelings in the present moment fully and effectively.
He also states that:
“Feeling listened to and understood create physiological changes in reaction, whereas and NOT telling your story is death to the soul.”
The effectiveness of EMDR therapy is shared as well as its relationship with getting adequate REM sleep, having a strong, well-functioning memory and preventing depression and how they are all related.
Another one of my my favorite quotes, which is another shout out to the importance of embodiment:
“We don’t truly know ourselves until we can feel and regulate certain sensations.”
One thing that really stood out for me was that I never knew there was an actual word for the ability to not be able to identify and articulate what you feel. There’s actually a term for that. It’s called Alexithymia. Apparently it’s so common there is a name for it. Alexithymia can be the result of numbing. It muffles the person’s everyday senses to world. A textbook trauma response.
Also interesting and thought-provoking was how van der Kolk shares how yoga and psychotherapy share in common two most important phrases:
1. “Noticed that…”
2. “What happens next?”
And I love how he shares Rumi’s famous poem: The Guest House, which is an often referenced classic and a personal favorite of mine (and a copy of which I was given by a elderly Chinese acupuncturist and energy medicine healer that I had worked with years ago in an effort to help my father and his cancer treatment (as well as some of my own issues).
As I’ve stated, I love how van der Kolk’s main objective is to integrate all parts of the self as it is my personal and professional goal as well. We now know that in order for this to happen, the person needs to feel safe. As he states, “the price of not doing so is the absence of a loving relationship with one’s own body and soul.”
I found it very encouraging and inspiring that van der Kolk shares that the majority of visionaries and social change agents in the world where all were people who had experienced some sort of deep trauma in their past. For example, Sir Issac Newton…if you just look into his childhood…
As far as treatment and recovery: Since trauma de-synchronizes the person from their environment, the whole point of therapy is to reestablish synchronicity with the environment. Somatic therapy and EMDR work because they rewire brain circuits. The trauma/memory is in the body, therefore by moving the body you can change it, which is why drugs and just talk therapy are almost always not enough. The memories are stored in the body. “The goal is to teach the body to sequester the event as just ‘a memory that occurred in the past’ rather than continuing to relive it as if it was still happening in the present.”
I also found it comforting to learn that the responses that you developed as a result of the trauma were actually your body’s intelligent and loving way to try to protect you and allow you to survive, rather than being something that is a shameful problem or annoyance. That now rather than being angry at and fighting yourself, you can now have a sense of compassion and gratitude and that now it’s safe for you to give them up because you can incorporate other methods to process and deal with the feelings more effectively. Realizing that at the time, you coped (and survived) by either becoming hyper-vigilant or shutting yourself down, but unfortunately that doesn’t allow for intimacy and connection in the present so you can know find another way.
van der Kolk shares that promising new trauma recovery treatments are in the works with MDMA/Ecstasy and so far, the research is very promising – with a special note that set and setting are key – providing a safe container – with these modalities. They have shown to allow people to go deep into their trauma and help them ultimately learn to love themselves (which is something that just cognitive “talk therapy” can’t achieve as previously stated, because the logical/adult brain “understands” that the person was not at fault, yet the body still holds the memory/sensation, it so they keep the traumatic behavior by means of hyper-vigilance or shut down). MDMA treatment has proven to be very effective therapy, particularly in helping the person come to the conclusion that it wasn’t their fault. A key point to remember in regards to using psychedelic medicine in treatment therapy, is that the objective is not to help people maintain or “tolerate” bad things, but rather to help create a new mindset, a new frame of reference from which they can now live and operate. As the author states, there’s nothing necessarily wrong with medications, the question is if they’re working for you – Is your life is better with them?
If you have experienced trauma and are still here, congratulations, you are a Survivor!
In fact, people who have undergone trauma are the ultimate “definition” of a Survivor. Additionally, the author shares that in his (vast) experience, they usually have a tremendous amount of life force which has enabled them to keep going in spite of the horrific things that happened to them. Plus they are often the ones that significantly change the world and are responsible for great advances in humanity because, as the author states, “If you’re not traumatized, there’s no need to change anything.” (Back to our Sir Issac Newton example, who was the inventor of physics and mathematics, he had a horrific childhood.)
“We’ve learned that the way we move, the way we breath, the way we touch, and are being touched all have dramatic effects on self-regulation.”
Want to heal? …FEEL!
With phenomenal contributions to the fields of mental health and healing, such as the life’s work of Dr. Bessel van der Kolk, we now understand why traumatized people often become emotionally disengaged,
sensitive to sound and lights, and withdraw in response to the slightest
provocation, and most importantly, how to help heal them.
Not only a mental, emotional issue, trauma changes the very physical structure and function of the brain. It has been said that feeling physically and emotionally safe is the definition of “mental health”. Feeling known and seen, with a sense of predictability and above all safety, are vital for healing and for us to have a sense of agency and control over the self. Thus, having some predictably and clarity of expectations are critical for healing to occur. Additionally, consistency and agency are essential. Things like engaging in athletics, playing music, dancing, and theatrical performances all promote agency and community and therefore help the person heal.
On a personal note
After reading this book, I finally understood some of why I am the way I am. I had no idea what “dissociation” was or that it was something that I do at times and I finally appreciated that I have not done anything “wrong” or I am not necessarily broken or defective, but rather, some of my mysterious behavior was simply my body’s natural defense mechanism to protect me, and thus rather than berating myself, perhaps I can develop a new sense of compassion and appreciation for my self and the wisdom of my body, and a reverence for it’s superior and creative intelligence!
So now I am considering that it would be like to finally “tend and befriend” my body rather than thinking of it as something that had betrayed me, or that would hijack me for no “good reason”, or that I need to otherwise override or disconnect from in order to function in society. Instead, I know realize it is quite the opposite, and that my body had in fact cared about my well being and survival so much that it was actually protecting me and it was smart/doing the right thing! This is truly an example of how our bodies have wisdom far in advance and magnitude of our conscious minds.
The book, The Body Keeps The Score; Brain, Mind and Body in the Healing of Trauma, and Dr. Bessel van der Kolk’s work is aligned with mine: The key to healing our minds, bodies, spirits and souls involves understanding how the bodymind works, both in the conscious and unconscious Self, with the aim ultimately at obtaining self-knowledge, mastery and agency.
I hope this has helped you. Please feel free to share it with someone you think it might help.
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