The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma

As a Behavioral Health Pharmacist, I work with many patients dealing with PTSD and other trauma-related mental health issues. I wanted to read The Body Keeps the Score to better understand how trauma affects the brain and body, and to be able to explain to my patients why sticking with their prescribed medications can be an important part of their healing process.This book is packed with information. Dr. van der Kolk does a wonderful job of explaining how trauma changes brain chemistry, often leaving people stuck in a cycle of stress and emotional distress. I found the discussions on fight, flight, or freeze especially interesting, as they really helped connect the dots between mental health symptoms and physical reactions. The book also explores different treatment approaches, including traditional therapies and alternative methods like yoga, drama, and neurofeedback, which I found useful.That said, this book isn’t the easiest to read. It’s dense, and at times, I felt like it could have been more concise. Some of the detailed trauma accounts were difficult to get through and might be triggering for some readers. I also think it could have done a better job acknowledging resilience—many people do recover from trauma without extensive therapy, and that wasn’t really addressed.Overall, I’m glad I read it. It gave me valuable insights that will help me guide my patients and explain why managing trauma often requires a combination of medication, therapy, and lifestyle changes. While it may not be for everyone, it’s a powerful book for those wanting a deep dive into the science of trauma and recovery.

Psychiatrist, professor, world-class researcher, and traumatologist Bessel van der Kolk MD requires no introduction to trauma psychotherapists. My enduring impressions of him over many years is one of relevance, cogency, frankness, and accessibility - served up with a subtle dash of impishness. He tends to be a bit disruptive - something of a provocateur - and everything of his I have ever read has taught me something, confirmed something important, or pushed my thinking in a new direction. When he has something to say, I want to hear it.However, I almost didn't buy this book: I was put off by the title. Familiar with major reviews of PTSD psychotherapy outcomes research, I know that research support for body-oriented approaches to treating psychological trauma psychopathology is thin at best, and such treatment models simply do not have the research validation of either EMDR (Eye Movement Desensitization and Reprocessing) and PE (Prolonged Exposure), neither of which are especially body-focused.J. Interlandi's excellent article anticipating publication of this book - "A Revolutionary Approach to Treating PTSD" (New York Times Magazine, 2014.05.22 - available online) - initially supported my fears that for some inexplicable reason van der Kolk was now promoting some treatment model for which we have little confirming research. "Psychomotor therapy is neither widely practiced nor supported by clinical studies," Interlandi informs us. Provocateur he may be, but I'm strongly biased in favor of paying attention to therapies for which we do have solid empirical validation. Our clients do not deserve to be experimental subjects - maybe not even if they agree to this, as I'm not sure they can ever know enough to make a truly informed consent. Knowledge that PTSD and related disorders are usually highly curable, when using the right treatment protocols, sadly remains the possession of a minority of people, even in the professional psychotherapy world.Yet the account of van der Kolk's therapy work in Interlandi's article is gripping. Becoming completely absorbed in the account, I was convinced. (I've been here before, reading van der Kolk's own accounts of his work.) And so the disruption begins! Deeper into the article, he has me. Van der Kolk's critique of CBT (cognitive behavioral therapy - a general class of therapies) and PE (E. Foa's exposure therapy model) is withering and correct: neither really work. "Trauma has nothing whatsoever to do with cognition...It has to do with your body being reset to interpret the world as a dangerous place....It's not something you can talk yourself out of." Interlandi reports that "That view places him on the fringes of the psychiatric mainstream."But he's right, and I can't stress this enough. Why? Because as a trauma treatment professional I'm well aware of what the trauma treatment outcomes research actually says. The best current summary of this research well may be chapter 2 of Ecker, et al.'s (2012) "Unlocking the emotional brain". (Buy this book, too!) Ecker et al. brilliantly presents a synthetic summary that encompasses 11 existing therapy models which actually DO cure trauma psychopathology, if done right. In this context, what van der Kolk is doing makes perfect sense. Finally, it appears, the trauma psychotherapy field is moving toward a consensus which has strong credibility.Van der Kolk's new book has many virtues. Parts One and Two (102 pp) provide a substantial review of the neuropsychology of trauma's impact on a person. It's fun, interesting, informative reading, for professional and layperson alike. Part Three (64 pp) surveys childhood development, attachment experience, and "the hidden epidemic of developmental trauma". Van der Kolk has for years been a leading champion of the idea that there is a type of PTSD which substantially differs from all the rest. It develops in response to chronic child abuse and/or neglect. I completely share his belief that the diagnosis of Developmental Trauma Disorder (sometimes called C-PTSD, with "C" meaning "Complex") is overdue for formal recognition. I find his review of the struggle to legitimize DTD as gripping and distressing as anything else in the book. It is anguishing to know that a major problem exists, AND that the psychiatric establishment simply refuses to acknowledge it. DTD/C-PTSD is no fantasy. We see and treat these people, as children and adults. They exist, and they are nothing like "ordinary" PTSD treatment clients.Part Four (29 pp) focuses on memory. I've long thought that much writing on treating psychological trauma seems to miss the point: trauma memory is what causes the problem. Deal with that and the symptoms vanish. Why is this so hard to understand? Yet, it is not a common understanding at all. Explaining how trauma memory works is invariably enlightening to my clients. And experiencing what happens when we change the nature of trauma memory is revelatory to someone who's lived with it for years, if not decades. As he does throughout the book, van der Kolk offers fine stories about clients who have experienced exactly what I've seen happen in my clients, making excellent use of what cognitive research tells us: people understand things best through narratives. Offer a good narrative and you convince.Psychological trauma therapy is complex, but we are now well prepared to launch into the book's core content - Part Five (154 pp), "Paths to Recovery". He gets right to it: we cannot undo the trauma, but we CAN undo its effect on us, and so get our "self" back. Ch. 13 reviews existing therapies. His approach is to repair "Descartes' Error" (see Damásio's 1994 book of that title) by viewing mind and body as a single coherent functional unit. His topical coverage is complete and his critique of current therapies acute - not to be missed.He then writes of the importance of language (Ch. 14). We construct our narrative mainly in words, and the words we choose are critical. But language is not enough (this anticipates his next two chapters). Our senses encompass a larger world, and it's center is our body, where all our sensory receptors are located. Then he introduces the treatment model he's long advocated: EMDR (Eye Movement Desensitization and Reprocessing). I'm trained in EMDR, and in fact van der Kolk and I had the same instructor for our advanced training: Gerald Puk PhD. Van der Kolk tells an amusing and self-deprecating story about his advanced training experience, in which Puk was able to provide a strong corrective to his approach to clients. This is typical van der Kolk - he's a truth-teller, even when it may put him in a poor light! And,after all, at this point he has nothing to prove to anyone.Finding an EMDR therapist is not hard (see his "Resources" section). Nor is it hard to find a yoga instructor, and yoga is what he advises for helping a trauma victim get back into their body. Yoga is a wise choice, because it is available, already widely known, and adaptable to a wide range of individuals and capabilities.There is much more in Part Five, and the focus is on self-empowerment. "Victim no more!" as they say. Most trauma therapists have a keen interest in seeing their clients leave therapy charged up and ready to fully embrace their life - that certainly is my own emphasis. Van der Kolk's thoughts on self-empowerment for those in recovery from psychological trauma will be invaluable to any trauma psychotherapy client.For psychotherapy professionals, this book will be both delightful and confirming. For everyone else, it will be a readable, gripping, highly educational tour of topics all of which are critical to a successful transition back from the impact of psychological trauma. That he gives prominent though not dominating emphasis to developmental trauma disorders is entirely appropriate. Our society has yet to grasp that child abuse and neglect is a more often chronic than not, and that its impact is largely ignored and poorly treated, if at all. This does not have to be. Get educated (this book will do that), then commit to being an advocate for children as well as for adults impacted by trauma. They all deserve the chance to be healed, and we can now do that. Van der Kolk shows us how.The physical book: Jacket design is pleasant and interesting. Binding is less so: color of spine wrapping is semi-florescent, and of paper, not cloth. The book feels substantial and pleasant to hold and look at.Organization -* 6 pp: prefatory praise by peers and related luminaries (interesting comments from some important people in the field);* 2 pp: Table of Contents;* 356 pp: actual text;* 4 pp: Appendix: Consensus proposed criteria for developmental trauma disorder* 3 pp: Resources* 4 pp: Further reading* 51 pp: Notes* 21 pp: Index

After being struck by trauma – combat, auto accident, assault, abuse – why do the dreams come and come and come? From where does the anxiety, distractedness, or outburst originate? Are there reasons for the gut balling up into a knot and the chest squeezing tight and feeling like it will implode when unwanted memories of the distress invade? Why does the recall come in pieces, chunks, or flashes? And then there’s the inability to communicate, the mental shut-down, the emotional-frigidity; what is that all about? Is there any way to move from the trauma and its aftermath to some sense of genuine wellbeing? All of these subjects, and more, are covered by Bessel van der Kolk, founder and medical director of the Trauma Center in Brookline, Massachusetts, professor of psychiatry at Boston University School of Medicine, and director of the National Complex Trauma Treatment Network, in his 464 page paperback, “The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma”. This volume is written for both the helping-professions technician and therapist, as well as for the traumatized and their families. With thousands of book reviews already posted and published, I’ll make this review brief.“The Body Keeps the Score” unpacks the way trauma affects us, mind, brain, and body. The author looks at multiple forms of therapy, showing their strengths and limits. He recognizes that there are “fundamentally three avenues [of therapy]: 1) top down, by talking, (re-) connecting with others, and allowing ourselves to know and understand what is going on with us, while processing the memories of the trauma; 2) by taking medicines that shut down inappropriate alarm reactions, or by utilizing other technologies that change the way the brain organizes information, and 3) bottom up: by allowing the body to have experiences that deeply and viscerally contradict the helplessness, rage, or collapse that results from trauma” (3). Van der Kolk addresses each of these approaches while explaining in detail what harrowing ordeals do to people.The author’s proposition through the pages is that the anguish of assault and abuse “changes brain development, self-regulation, and the capacity to stay focused and in tune with others…experiences change the structure and function of the brain – and even affect the genes we pass on to our children…devastates the social-engagement system and interferes with cooperation, nurturing, and the ability to function as a productive member of the clan” (349, 351). One of the aspects that surprised me was how the “ventral vagal complex” – the vagus nerve that interfaces with other nervous systems – takes what my brain is experiencing (even re-experiencing through PTSD, etc.) and mobilizes muscles, heart, lungs and other body parts, so that I feel the alarm – or helplessness – or grief in my brain all the way down into my chest and stomach! Which means my body begins to take on muscle-memory (as we put it in martial arts)! Therefore, if “the memory of trauma is encoded in the viscera, in heartbreaking and gut-wrenching emotions, in autoimmune disorders and skeletal/muscular problems, and if mind/brain/visceral communication is the royal road to emotion regulation, this demands a radical shift in our therapeutic assumptions (88). It’s this “radical shift in therapeutic assumptions” that dominates the authors final eight chapters, where he methodically explains different “paths to recovery”. This is truly a captivating read!Van der Kolk weaves into the technical aspects of the book biographical and autobiographical tales that help the reader to see what has gone on, and not gone on, in the world of psychiatry and psychology regarding trauma. The stories also help to cement into the imagination and comprehension what he is trying to communicate. The book is reasonably technical with neuroscience, brain studies, physiology, professional acronyms and so forth. But the author is careful to not leave anyone in the dark. It is a fascinating read that treats the audience as mature enough to handle the subject and grasp the material. I disagreed with the evolutionary explanations of how the brain develops and found the little political rant in the epilogue disappointing. But beyond these, I was almost mesmerized by the book!“The Body Keeps the Score” is a whole textbook on physiology, brain studies and neuroscience, as well as therapeutic theories. It is not a self-help book, but readers who are looking for help will likely find it beneficial. Helping professionals may also find it advantageous as the author has a plethora of notes on various studies and articles. But I think that the biggest value will be for those who have family members, friends, and parishioners that have been through violent experiences. It gives a bigger and better perspective on what s going on, and they will be able to draw from the various paths to recovery approaches they can take as they seek to be part of the remedy and not the trauma. I highly recommend the book.