So many things eventually catch up to us, and the body is no different. How many times have you ignored what your body is telling you, and how many times have you eventually realized that what it’s saying isn’t going to go away?
The Body Keeps the Score, examines the need to address trauma in order to move towards the present. Van der Kolk uncovers the true cost of stress, anxiety, and trauma, and shows how the body is literally keeping score of how we're treating it. With a better idea of self-care and healing, we can avoid numerous life-threatening diseases.
Bessel van der Kolk is a psychiatrist who has published a whopping 150 peer-reviewed articles, and written numerous books around the subject of trauma. He’s also a highly acclaimed professor of psychiatry, and president of the Trauma Research Foundation. In short, when it comes to understanding trauma, you’d be hard-pressed to find someone with more expertise in the field.
For over thirty years, his clients, who include war veterans, survivors of adult and childhood trauma, and victims of sexual abuse, kept giving him an unequivocal message. That message was, while we may think that trauma belongs in the past, the reality is that the body remembers what the mind is trying to block out. Trauma shows no respect for our typical timeline of past, present, and future. Instead, it persuades the brain and body that the trauma will happen repeatedly and that the only way to cope is to be on constant high alert. The threat is unavoidable and overwhelming, and there’s no escape. This has devastating consequences, not only for trauma survivors, but also for people close to them. So, put simply, the body keeps the score.
Most of us will experience some form of trauma in our lifetime, and this summary will briefly guide us through how to deal with it more effectively. Trauma and stress are the norms, rather than the exceptions, so it's vital to explore them. Van der Kolk provides insights into his client's experiences, as well as explanations as to how trauma wires the brain, changes our capacity to think, and controls our bodies. Furthermore, by examining new neuroscientific research, the aim is to change how we think about trauma and how we go about treating it. Most importantly, this book gives us hope. Hope in the form of treatments that can help people reconnect to themselves and others, and the normal rhythm of everyday life.
How We Use the Word "Traumatic"
The words trauma and traumatic, are used very loosely in everyday conversation. Even in psychology, they're used to describe a broad range of causes and symptoms. In fact, people don't have to be the victims of trauma, just witnessing or being indirectly involved in such events, can trigger Post Traumatic Stress Disorder, or PTSD. However, this doesn't mean that everyone who experiences trauma, will necessarily develop PTSD.
Work on PTSD, gained traction when doctors realized how veterans struggled to adjust to normal life after the Vietnam War. This led to PTSD being included as a diagnosis in the DSM (the Diagnostic and Statistical Manual), which is a worldwide tool used by psychiatrists and psychologists. It describes trauma as a complex combination of symptoms, that occur in response to a real or threatened injury or assault.
The first thing is that we often keep reliving the experience of the trauma. This means we struggle with unpleasant physical sensations, and strong negative thoughts or moods. We can feel detached from ourselves and the world around us. We then tend to avoid anything that reminds us of the event. So, while DSM describes the symptoms, it doesn't give us an understanding of the root causes of trauma.
This can be illustrated by Tom, a client whose experiences during the Vietnam war, ten years previously, were still causing havoc in his life. One small example was Tom's refusal to take his sleep medication, and eventually admitting that he actually needed to hold onto his traumatic experiences, so that he could be a living memorial to his fallen comrades. To heal would mean letting them down. He was reckless, drank too much, and isolated himself from his family. He was trapped in this vicious cycle of being unwilling, and unable to escape from what had happened during combat. Tom's difficulties highlight how complex and debilitating trauma can be.
This lack of deep understanding of trauma, has meant that over the years, it's been very difficult to treat. So how can we treat trauma more effectively?
The Effects of Trauma
The brain doesn't return to normal after a traumatic event, and trauma disconnects us from ourselves and others.
If we look at brain imaging techniques, it shows us what trauma actually looks like. Trauma overwhelms our bodies and our brains. Those who suffer from trauma, often find intrusive sights, sounds, smells, and other physical sensations overwhelming. Our brain's threat system detects this, and responds by flooding our bodies with stress hormones and neurochemicals. As a result, we experience intense emotions, that can leave us feeling helpless, disconnected, and immobilized.
Key areas of the brain are affected during any traumatic experiences.
Language and logic centers in the brain shut down during trauma. This means we can't access the words to describe what happened. Nor can we logically make sense of the trauma. As a result, these sensory and emotional experiences become trapped in the body. What's more, our memory is also affected. Memory helps us to capture our minute-by-minute experiences of life, and puts everything in a sequential story form. How we remember trauma however, is different. Traumatic memories remain fragmented in our minds, and we experience them as flashbacks. These are vivid sensory experiences of the trauma, that make us feel as if the event is happening in the here and now. This makes the part of the brain that detects threats, work to keep the brain and body on high alert, while also making us feel that nothing and no-one can be trusted.
These neurological reactions mean that we never feel safe after trauma. To cope, we might try to numb the pain, through alcohol and other addictions. But none of this frees us from the trauma. The emotional and physical experiences remain trapped, and the body continues to release a cascade of stress hormones, which seriously compromises our health.
The effect on our daily life is also devastating: we fall into a vicious cycle of panic - fear, and helplessness. These powerful emotions trigger intense physical reactions, causing us to feel disconnected. This deeply affects relationships. If we can't connect to ourselves, then it's impossible to connect meaningfully with others.
Children are More Vulnerable to the Lasting Effects of Trauma
It's important to note that children, more so than adults, are particularly susceptible to the lasting effects of trauma. Childhood trauma is different from adult trauma, because children are more vulnerable. They haven't yet had the opportunity to develop a healthy understanding of their place in the world, and how to relate to others. Furthermore, healthy development rests upon a parent being able to meet a child's needs, especially during the early years of life. Psychologists call this, healthy attachment.
Let's explore this further, by looking at the spectrum of attachment. On the one end of the spectrum, is secure attachment, and on the other, is disorganized attachment. A healthy secure attachment is where a parent's responses are attuned with their child's needs. Disorganized attachment is when there's neglect or abuse. The terrible conundrum regarding disorganized attachment, is that a child is in a constant mode of threat, with feelings of dependency, but also distrust towards their parent.
Chronic trauma creates extreme anxiety, to the extent that children disconnect from their bodies and shut down emotionally. The irony is these children might appear outwardly calm, but inwardly they're extremely overwhelmed. This can have long-term consequences. A study conducted in 1990, indicated that childhood trauma is highly correlated with mental, emotional, and physical problems later in life.
So what can we do to break free from trauma?
Key Interventions to Effectively Treat Trauma
Treating trauma is complex, however, there are some key interventions that have proved effective in treating trauma.
Firstly, we need to address the physical, psychological, and social roots of it, and we also need to be aware that there's no preferred treatment, or a single therapy that can "fix" trauma. A combination of treatments may include traditional talk therapies and medication. However, it's crucial to incorporate therapies that work with the body, because the body has to learn to manage its response to overwhelming triggers.
Therapy that connects body and brain, and does so in a social context, using group activities, is helpful. The author believes that effective therapies release the tight hold trauma has on our bodies. The rational mind needs to re-connect to what's happening in the body. What's more, if people can identify what their bodies are telling them, and work out how to respond calmly to these physical sensations, they can start to feel safe again.
People often only tell the cover story of their trauma. We need to resolve the deeper embodied experiences of trauma, so that we can find our place in the world again. This means that we have to look beyond traditional psycho-therapeutic interventions. Talk-therapy is one that has its place, particularly if the trauma holds secrets that have never been spoken about. However, this type of therapy doesn't necessarily unlock the trauma stored in the body. Medication does reduce the unpleasant symptoms of the trauma, but papers over its root causes.
So what are some other ways that we can deal with treating trauma?
Less Traditional, Promising Therapeutic Techniques
There are other options that have proved to be very promising when it comes to treating people who have suffered from traumatic experiences. Options here include things such as, EMDR (eye-movement desensitization, and reprocessing). EDMR is interesting because no-one can explain exactly how it works, but the premise is that patients visually track a trained therapist's finger movements. This helps them non-verbally resolve the memories of the trauma.
Then there's sensorimotor psychotherapy, which links body experiences to thoughts and emotions, so that clients can manage the triggers of trauma. Neurofeedback can also be a helpful modality because it relies on machines tracking brainwaves. Clients see their brain's activity on a screen, which helps them to recognize and control their physical responses to triggers. Heart Rate Variability is a form of neurofeedback that helps clients to control their heart rate, in order to calm them down. Mindfulness also has good research backing, and improves emotional regulation, calms the emotional system, and strengthens the immune system.
Finally, activities that involve movement and interaction with other people are also helpful. For example, yoga helps because it allows people to be more aware of their bodies, and to link emotion to certain physical sensations. Music, as well as, dancing, drumming, and art, help because they combine group support with physical ways of getting in sync with the body. Theatre can be useful for people to express themselves in creative ways. And journaling can help people re-write their stories. Lastly, the power of deep touch like getting a regular body massage, can help release trapped emotions.
Trauma is a public health issue that needs to be taken very seriously. Nearly 700 thousand cases of child abuse, are reported each year in the United States. One in four women in America, have admitted to some form of violent physical abuse at the hands of an intimate partner. And, according to an extensive study, 60 thousand war veterans who served in Iraq and Afghanistan, tested positive for PTSD.
The real takeaway of this book, is that the body does not let go of trauma, which can cause serious long-term health issues. We remain trapped in trauma and we're forced to re-experience it, in frightening and fragmented ways. Van der Kolk gives us a clearer understanding of trauma and what we can do about it. When our bodies and minds can work together to resolve trauma, we feel safe enough to enjoy the fullness of our lives.