The Body Keeps The Score – Book Review

One of my favorite things to do is reading good books.  I finished reading Bessel van der Kolk’s The Body Keeps the Score some months ago, but it has taken me a while to report on it.  Besides having gleaned 25 pages of quotes, I’m feeling the need to go back and re-read the whole thing.  This was a book of serious ahas.  Van der Kolk is himself a survivor of early relational trauma – a fact of which he was unaware until well into his professional career.  Currently the Medical Director of the Trauma Center in Boston, he is also a Professor of Psychiatry at Boston University Medical School and serves as the Co-Director of the National Center for Child Traumatic Stress Complex Trauma Network.  You can read more about him here.

“Trauma,” says van der Kolk, “drives us to the edge of comprehension, cutting us off from language based on common experience or an imaginable past.”  Its effects are profound and lasting when it occurs before we have language to describe it or even hope to get the help we need.  But, “like a splinter that causes an infection, it is the body’s response to the foreign object that becomes the problem more than the object itself.”

I love this book because Van der Kolk gives me words for things I had no idea how to talk about before.  And he validates suspicions that have nagged at me for decades.  For instance, when I was 24 and had already ditched my first husband and abandoned my three-year-old son, I was puzzled by the lack of pain I felt.  What was wrong with me, anyway?  I had many explanations, some of which had to do with depression, being clueless about what I was going to do with my life, and feeling incapable of caring well for a small child while trying to do all those things that I had been taught that a husband was supposed to do.  Van der Kolk calls this “Numbing.”  In describing what one survivor of developmental trauma experienced, he says, “He desperately wanted to love his family, but he just couldn’t evoke any deep feelings for them.”

Numbing may keep us from suffering in the short-term, but long-term is another matter.  “…though the mind may learn to ignore the messages from the emotional brain, the alarm signals don’t stop.  The emotional brain keeps working, and stress hormones keep sending signals to the muscles to tense for action or immobilize in collapse.  The physical effects on the organs go on unabated until they demand notice when they are expressed as illness.  Medications, drugs, and alcohol can also temporarily dull or obliterate unbearable sensations and feelings.  But the body continues to keep the score.”

“After trauma the world is experienced with a different nervous system.  The survivor’s energy now becomes focused on suppressing inner chaos, at the expense of spontaneous involvement in their life.”

The seemingly endless path of breadcrumbs leading me back to my own trauma included my status as “stimulus seeker.”  Though I am most likely on the mild end of this spectrum, survivors of trauma don’t feel quite alive if they aren’t in the middle of some kind of chaos.  Says van der Kolk, “Somehow the very event that caused them so much pain had also become their sole source of meaning.  They felt fully alive only when they were revisiting their traumatic past.”

“That is why so many abused and traumatized people feel fully alive in the face of actual danger, while they go numb in situations that are more complex but objectively safe, like birthday parties or family dinners.”

All of this is determined at a very physical level.  “If an organism is stuck in survival mode, its energies are focused on fighting off unseen enemies, which leaves no room for nurture, care, and love.  For us humans, it means that as long as the mind is defending itself against invisible assaults, our closest bonds are threatened, along with our ability to imagine, plan, play, learn, and pay attention to other people’s needs.”

Among van der Kolk’s research-based conclusions (and things to think about as you consider this idea he’s calling developmental trauma):

  • Exposure to stress relieves anxiety.
  • Addiction to trauma may be characterized by the pain of pleasure and the pleasure of pain.
  • Immobilization is at the root of most traumas (your heart slows down, your breathing becomes shallow, and, zombielike, you lose touch with yourself and your surroundings).
  • It is especially challenging for traumatized people to discern when they are actually safe and to be able to activate their defenses when they are in danger.
  • All too often, drugs such as Abilify, Zyprexa, and Seroquel, are prescribed instead of teaching people the skills to deal with distressing physical reactions associated with repressed emotion.

Real healing, he says, has to do with experiential knowledge: “You can be fully in charge of your life only if you can acknowledge the reality of your body, in all its visceral dimensions.”  Here, EXPERIENCE, not UNDERSTANDING is what we need.

“…neuroscience research shows that very few psychological problems are the result of defects in understanding; most originate in pressures from deeper regions in the brain that drive our perception and attention.  When the alarm bell of the emotional brain keeps signaling that you are in danger, no amount of insight will silence it.”

Treatment

“Treatment needs to reactivate the capacity to safely mirror, and be mirrored, by others, but also to resist being hijacked by others’ negative emotions.”

“…the great challenge is finding ways to reset their physiology, so that their survival mechanisms stop working against them.  This means helping them to respond appropriately to danger but, even more, to recover the capacity to experience safety, relaxation, and true reciprocity.”

Mindfulness, or the ability to hover calmly and objectively over our thoughts, feelings, and emotions, is one of the primary tools van der Kolk teaches his patients.  This ability allows us to then take our time to respond,” he says, which “allows the executive brain to inhibit, organize, and modulate the hardwired automatic reactions preprogrammed into the emotional brain.  This capacity is crucial for preserving our relationships with our fellow human beings.”

Increasing “interoception,” or self-awareness, is another important feature of recovery, van der Kolk says.  “Because traumatized people often have trouble sensing what is going on in their bodies, they lack a nuanced response to frustration.  They either react to stress by becoming ‘spaced out’ or with excessive anger.  Whatever their response, they often can’t tell what is upsetting them.  This failure to be in touch with their bodies contributes to their well-documented lack of self-protection and high rates of revictimization.  And also to their remarkable difficulties feeling pleasure, sensuality, and having a sense of meaning.”

Noticing and then describing what they are feeling is a process van der Kolk helps his patients learn.  He begins the process by helping them talk about what is happening in their bodies, “not emotions such as anger or anxiety or fear but the physical sensations beneath the emotions: pressure, heat, muscular tension, tingling, caving in, feeling hollow, and so on.”  He also works on “identifying the sensations associated with relaxation or pleasure…their breath, their gestures and movements.”  He asks them to “pay attention to subtle shifts in their bodies, such as tightness in their chests or gnawing in their bellies, when they talk about negative events that they claim did not bother them.”

“…many programs (that try to help traumatized people) continue to ignore the need to engage the safety system of the brain before trying to promote new ways of thinking,” van der Kolk says.  He provides some ways to engage this part of the brain in his book.  Among them are:

  • Yoga
  • Theater Programs
  • Breath Exercises (Pranayama)
  • Chanting
  • Martial Arts
  • Qigong
  • Drumming
  • Group Singing
  • Dancing

“Our culture teaches us to focus on personal uniqueness, but at a deeper level we barely exist as individual organisms.  Our brains are built to help us function as members of a tribe….Most of our energy is devoted to connecting with others.”

 

A few more nuggets I thought you might appreciate:

  • While you need to be able to stand up for yourself, you also need to recognize that other people have their own agendas. Trauma can make all that hazy and gray.
  • (As infants) our most intimate sense of self is created in our minute-to-minute exchanges with our caregivers.
  • Children’s disturbed behavior is a response to actual life experiences – to neglect, brutality, and separation – rather than the product of infantile sexual fantasies.
  • Our lives consist of finding our place within the community of human beings.
  • Babies can’t regulate their own emotional states, much less the changes in heart rate, hormone levels, and nervous-system activity that accompany emotions.
  • Learning how to manage arousal is a key life skill, and parents must do it for babies before babies can do it for themselves.
  • Securely attached kids learn the difference between situations they can control and situations where they need help.
  • Kids will go to almost any length to feel seen and connected.
  • Traumatized parents, in particular, need help to be attuned to their children’s needs.
  • Dissociation means simultaneously knowing and not knowing.
  • Early attachment patterns create the inner maps that chart our relationships throughout life, not only in terms of what we expect from others, but also in terms of how much comfort and pleasure we can experience in their presence.
  • It’s not important for me to know every detail of a patient’s trauma. What is critical is that the patients themselves learn to tolerate feeling what they feel and knowing what they know.
  • Rage that has nowhere to go is redirected against the self, in the form of depression, self-hatred, and self-destructive actions.
  • Eradicating child abuse in America would reduce the overall rate of depression by more than half, alcoholism by two-thirds, and suicide, IV drug use, and domestic violence by three-quarters.
  • Social support is a biological necessity, not an option, and this reality should be the backbone of all prevention and treatment.
  • As long as people are either hyperaroused or shut down, they cannot learn from experience. Even if they manage to stay in control, they become so uptight that they are inflexible, stubborn, and depressed.  Recovery from trauma involves the restoration of executive functioning and, with it, self-confidence and the capacity for playfulness and creativity.
  • In order to recover, mind, body, and brain need to be convinced that it is safe to let go. That happens only when you feel safe at a visceral level and allow yourself to connect that sense of safety with memories of past helplessness.
  • Being traumatized is not just an issue of being stuck in the past; it is just as much a problem of not being fully alive in the present.
  • Antipsychotic medications such as Risperdal, Abilify, or Seroquel can significantly dampen the emotional brain and this makes patients less skittish or enraged, but they also may interfere with being able to appreciate subtle signals of pleasure, danger, or satisfaction.
  • As long as you keep secrets and suppress information, you are fundamentally at war with yourself. Hiding your core feelings takes an enormous amount of energy, it saps your motivation to pursue worthwhile goals, and it leaves you feeling bored and shut down.

I highly recommend this book.

Van der Kolk, Bessel. The Body Keeps the Score: Brain, Mind, and Body In the Healing of Trauma. New York: Penguin Books, 2014.

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