book review of the body keeps the score

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Inside the Best-Seller List

Does a Writer Ever Get Cozy on the Best-Seller List? Bessel van der Kolk Says No.

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By Elisabeth Egan

July 8, 2021

MEET A REGULAR If you spend enough time scrutinizing the best-seller list , you may notice that it has a lot in common with a party. There are guests who drop in, pop a bottle of champagne and exit promptly. Others arrive with a companion, or occasionally an entourage. (These authors have more than one book on the list at the same time: Madeline Miller, Leigh Bardugo, James Patterson, Jason Reynolds and Ibram X. Kendi, to name a few.) Finally, there are guests who amble in, make themselves comfortable and stay for weeks.

Bessel van der Kolk is of the fixture variety. His guide to healing trauma, “The Body Keeps Score,” has been on the paperback nonfiction list for 141 weeks — 27 of them in the No. 1 slot. The book has also appeared on the audio nonfiction list, the health and science monthly lists (now discontinued), and the combined print and e-book list, where it is currently No. 2. Not to belabor the soiree analogy, but this Boston-based psychiatrist and co-founder of the Trauma Research Foundation is a serious party animal.

Does van der Kolk keep track of where “The Body Keeps Score” falls on the list each week? “How could you not?” he asked in a phone interview. “I have friends who say, ‘Bessel, are you always checking your phone to see how your book is doing?’ I say, ‘Wouldn’t you?’”

You might wonder whether the pandemic has been partially responsible for readers’ interest in the ways the body metabolizes trauma. “I am not so sure about that,” van der Kolk said, admitting that he has been inundated with inquiries like this one. “My answer is, no, the pandemic is not a trauma. The pandemic is a challenging event which for some people might turn into a trauma. It has really shown the enormous issue of inequality and how different groups of the population were very differently affected.”

In addition to members of the media seeking his expertise, van der Kolk hears from readers who recognize their struggles in “The Body Keeps Score.” He recently learned that Oliver Sacks answered all his mail, which would be impossible for him to do: “My life would come to a complete end.” But van der Kolk keeps a close eye on his Amazon reviews, which number 32,046 at the time of this writing. (“HEAVY,” said a recent one. “Great read, but HEAVY.”) There are new reviews every day and, like the best reveler, this author pays attention to them all.

Elisabeth Egan is an editor at the Book Review and the author of “A Window Opens.”

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

Jacqueline mei chi ho.

1 School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China

Alex Siu Wing Chan

2 Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong, China

Ching Yu Luk

3 Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Hospital Authority, Hong Kong, China

Patrick Ming Kuen Tang

4 State Key Laboratory of Translational Oncology, Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong, China

Bessel van der Kolk, editor. The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. 2015. Penguin Books. 464 p. ISBN: 978-0143127741.

Posttraumatic stress disorder (PTSD) is defined as a psychiatric disorder in an individual who has experienced or witnessed a devastatingly traumatic event (Bufka et al., 2020 ). These patients persistently experience overwhelming stress responses beyond the traumatic period. Fear and stress are triggered predominantly in response to a dangerous event followed by a series of bodily changes, including increased blood pressure, heart rate, and breathing due to the release of adrenaline. This biochemical reaction is termed as the “fight-or-flight” mechanism, which temporarily protects people against danger (Kozlowska et al., 2015 ). It has been well-recognized that PTSD significantly impacts social functioning, physical well-being, and occupational ability (Watkins et al., 2018 ).

Bessel revisits his clinical experience and reconfirms the impact of PTSD on his patients. People with PTSD experience various symptoms, including personality changes, depression, social disconnection, poor sleep hygiene, flashbacks, and nightmares. Facing recurrent episodes of disturbing symptoms, PTSD patients are prone to develop risky behaviors, including alcoholism, substance abuse, or self-injury. PTSD has many negative impacts on patients' quality of life (QoL), and poses a potential health burden to society if no prompt assessment and support is guaranteed (Lewis et al., 2019 ).

In his work “The body keeps the score,” Bessel highlights that traumatic stress is at the root of neuroscience. Traumatic stress is associated with functional and chemical changes in the emotional part of the brain—the limbic area and brain stem. Knowing the functions of the amygdala, hippocampus, and prefrontal cortex, as the primary stress responders in the brain, can provide a new therapeutic direction for PTSD management. The hyperactive status of the amygdala triggers the release of stress hormones (Badura-Brack et al., 2018 ) and impairs the functioning of the hippocampus, causing traumatic memories to remain vivid. In addition, the deactivation of the prefrontal cortex function and the failure to maintain a balanced stress hormone system, causes panic, agitation, and hypervigilance responses in PTSD patients (Koenigs and Grafman, 2009 ). This hyperactive aroused emotional status can be evidenced by hyperactive brain waves over the fear center of the right temporal lobe of the brain, with suppression of electric activity over the frontal area.

Pharmacotherapy is the first-line of treatment for PTSD. Antipsychotics, anticonvulsants, and tranquilizers have been widely used to improve the QoL of PTSD patients over the past few decades. As some patients developed morbid obesity and diabetes from the medication as well as experienced drug overdoses, it alarmed the book author and pushed him to consider a much safer and natural approach to assist PTSD patients in dealing with their symptoms and responses using a self-regulation strategy. Bessel further suggests that medication cannot 'cure' trauma; it can only mediate the disruptive behavior of the sufferers.

This revolutionary treatment was enlightened by one of Bessel's patients, who could not get rid of his traumatic memory as a minister for many years after returning home from Vietnam. This memory was subconsciously imprinted in his life. Bessel continued working with this patient and explored that yoga can help him regain his sense of control and bodily pleasure. A subsequent experimental study showed that mindfulness yoga significantly reduced PTSD symptomatology and restore the homeostasis of the autonomic nervous system. With the aid of the mindfulness approach, we can raise awareness of bodily sensations, which can improve control over the flow of emotions by decreasing activity over the amygdala. Hence, individuals can have a reasonable degree of control over themselves, both physically and psychologically (Streeter et al., 2012 ).

To restore the emotional part of the brain and repair the limbic system, Bessel explains various psychotherapies related to the brain, mind, and body of PTSD patients. He emphasized on the human body as the means of communicating with oneself and others. Expressive therapies, through language, art, music, and dance, can motivate people orientate themselves and find their own identity and a meaningful purpose in life (Baker et al., 2018 ). Most importantly, the reconnection of attachment bonding with family and friends can help individuals feel secure in fighting against the threat (Chan et al., 2021a , b ).

“The body keeps the score” attempts to address how PTSD patients experience trauma over the years following a traumatic exposure. From the stories of different victims introduced by the author, Bessel used both scientific and philosophical approaches to explain the complex neurobiology and connection of the human brain-mind-body, and provided useful guides for specialists and the public. An abstract or summary of each chapter can aid readers in capturing the essence of the message. As various approaches that can help people with PTSD are suggested by the author, the book would be more comprehensive if further empirical findings are provided to demonstrate their effectiveness and how readers can integrate them into practice.

Author Contributions

JH is mainly writing this book review. CL, AC, and PT gave comment and suggestion in this manuscript. All authors contributed to the article and approved the submitted version.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher's Note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

Funding. The preparation of this manuscript was partially supported by funding's from School of Nursing and the Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong.

Badura-Brack A., McDermott T. J., Heinrichs-Graham E., Ryan T. J., Khanna M. M., Pine D. S., et al.. (2018). Veterans with PTSD demonstrate amygdala hyperactivity while viewing threatening faces: a MEG study . Biol. Psychol. 132 , 228–232. 10.1016/j.biopsycho.2018.01.005 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
Baker F. A., Metcalf O., Varker T., O'Donnell M. (2018). A systematic review of the efficacy of creative arts therapies in the treatment of adults with PTSD . Psychol. Trauma Theory Res. Pract. Policy 10 , 643–651. 10.1037/tra0000353 [ PubMed ] [ CrossRef ] [ Google Scholar ]
Bufka L. F., Wright C. V., Halfond R. W. (Eds.). (2020). Casebook to the APA Clinical Practice Guideline for the Treatment of PTSD. Washington, DC: American Psychological Association. [ Google Scholar ]
Chan A. S. W, Ho J. M. C., Tam H. L., Tang P. M. K. (2021a) Book review: successful aging: a neuroscientist explores the power potential of our lives. Front. Psychol. 12 :705368. 10.3389/fpsyg.2021.705368 [ CrossRef ] [ Google Scholar ]
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Lewis S. J., Arseneault L., Caspi A., Fisher H. L., Matthews T., Moffitt T. E., et al.. (2019). The epidemiology of trauma and posttraumatic stress disorder in a representative cohort of young people in England and Wales . Lancet Psychiatry 6 , 247–256. 10.1016/S2215-0366(19)30031-8 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
Streeter C. C., Gerbarg P. L., Saper R. B., Ciraulo D. A., Brown R. P. (2012). Effects of yoga on the autonomic nervous system, gamma-aminobutyric-acid, and allostasis in epilepsy, depression, and post-traumatic stress disorder . Med. Hypotheses 78 , 571–579. 10.1016/j.mehy.2012.01.021 [ PubMed ] [ CrossRef ] [ Google Scholar ]
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Bessel van der Kolk … ‘The number of kids who get abused and abandoned is just staggering.’

Trauma, trust and triumph: psychiatrist Bessel van der Kolk on how to recover from our deepest pain

His 2014 book, The Body Keeps the Score, has become a huge pandemic hit, topping bestseller lists this summer and becoming a meme on social media. What does it tell us about the world we live in?

W hen Dr Bessel van der Kolk published The Body Keeps the Score in 2014, it was a huge hit with yoga people. That is not a euphemism for “rich, underoccupied people”, it is just people who do yoga. Certain physical activities do something weird to your brain: ancient memories resurface, often with new feelings or perspectives attached; you start treating yourself with more compassion. It doesn’t make sense until you read Van der Kolk . After that, nothing has ever made more sense.

His thesis centres on trauma: the urgent work of the brain after a traumatic event is to suppress it, through forgetting or self-blame, to avoid being ostracised. But the body does not forget; physiological changes result, a “recalibration of the brain’s alarm system, an increase in stress hormones, an alteration in the system that filters relevant information from irrelevant”, as he says in his book. The stress is stored in the muscles and does not dissipate. This has profound ramifications for talking therapies and their limits: the rational mind cannot do the repair work on its own, since that part of you is pretending it has already been repaired.

The Body Keeps the Score is engagingly written and plainly not a textbook. Nevertheless, it is a searching, complex account of trauma and post-traumatic stress disorder (PTSD), not pop-psychology for the general reader seeking to live their best life through Bikram. So, how do you account for its incredible popularity ? In the seven years since its publication, it has spent 147 weeks on the New York Times bestseller list and sold more than half a million copies in the UK alone, and nearly 2m worldwide; amid the shared trauma of the pandemic, it has become more popular than ever, spending the whole of July this year at No 1 on the nonfiction bestseller list in the US. On social media, it is ubiquitous, a psychiatric meme, the source of inspirational get-you-out-of-bed quotes and self-deprecating jokes. (If your body does keep the score, is that why you look so rough?) Is trauma really so widespread? And are people feeling particularly traumatised now?

Van der Kolk speaks to me on a video call from Boston, Massachusetts, where he has lived for the past 50 years. He still has the pronounced, reassuringly psychoanalytical western European accent of his birthplace – the Netherlands – even though he took his first degree in the 60s at the University of Hawaii and has practised in the US since. “We define ‘trauma’ as an event outside the normal human veins of experience,” he says. “At least one-third of couples, globally, engage in physical violence. The number of kids who get abused and abandoned is just staggering. Domestic violence, staggering. Rapes, staggering. Psychiatry is completely out to lunch and just doesn’t see this.”

His work with people who had PTSD began at around the time the term was defined, in 1978, at a veterans’ clinic in Boston, working with men who had fought in Vietnam. He picked up patterns in their symptoms and presentation: either a tendency to superimpose their traumatic experience on to everything around them or an inability to decipher what was going on around them and “very little in between”. Another pattern he picked up was in his own profession. Psychiatrists would diagnose these patients with everything from alcoholism to schizophrenia and miss – almost resist noticing – the trauma.

A US Soldier in Vietnam … Van der Kolk began his professional career working with men who had fought there.

This became his life’s work, learning in the first instance from his own patients. “I have had regular experiences, to this day, when a patient makes me realise something. I think: ‘I’ll pay you for this session, because that’s an important lesson. You shouldn’t be paying me.’” He explored, too, the lost or discredited work on trauma from the earliest days of psychoanalysis: Pierre Janet, writing insightfully in the 1880s, and the British psychiatric reactions to the first world war. “There’s very good literature [on shellshock] from 1919 and 1920. But then there was pushback, people saying: ‘You’re just a bunch of cowards.’ The assault on people who had been traumatised has been relentless – to this day, almost. You’re not allowed to tell the truth about the horrible things that people do to each other.”

He is a huge fan of John Bowlby, the inventor of attachment theory . “I knew him slightly, actually. He didn’t love me – he thought I was too impulsive. But I thought he was fantastic. Most of my colleagues haven’t read Bowlby. In psychiatry, people don’t talk a lot about attachment.” In Van der Kolk’s account, he has always been an outsider in his profession, which masks the pedigree of his credentials. He was a research assistant on the 1980 edition of the prestigious Diagnostic and Statistical Manual of Mental Disorders.

At the start of his career, he was driven by curiosity and a practical urge to find out what worked. The further he delved, the more important he realised the work was, in terms of the incidence and impact of trauma, on society and the self. “The reality, of course, is that being traumatised does make you a difficult person to get along with. Because you suddenly get angry, you suddenly shut down or you space out. But more difficult is to live that life: not being able to trust yourself. And there’s always this internal pressure to step up to the plate and keep functioning. So the next piece is a profound feeling of shame about yourself and your reactions.”

It would be much too simple to say that PTSD quashes any potential for creativity or success. “It is striking how many times people carve out a piece of exceptional intelligence – exceptional creativity – that allows them to go on. Isaac Newton was one of the most abused, abandoned children ever … And then he invented mathematics.” The question, I suppose, is what else he might have invented, had his trauma been addressed. Van der Kolk is adamant; people shouldn’t be left as walking wounded. No one should have to keep hurling themselves at the same brick wall of therapy and antidepressants if they are not working.

European and American psychiatry have an obsession with analysis and pharmaceuticals, which is partly – especially in the US – about monetisation, with research grants flowing to the most profitable and established fields. Van der Kolk is keenly aware of inequality as a factor in untreated PTSD, and no great fan of capitalism generally. “I’m not sure that the fall of the Berlin Wall was the best thing that ever happened to us,” he says, gnomically, but I get the drift. Part of the commercial imperative in psychiatry has been the drive to find one thing that works for everyone: a Fordist factory-line approach to the brain that has seen millions spent on figuring out, for instance, what works best between pharmaceuticals and talking therapies, or between one therapy and another.

Van der Kolk’s insistence that no single treatment is likely to work alone, and no combination will be exactly the same for every patient, is iconoclastic enough on its own. Yet it is his engagement with what you could loosely classify as “hippy stuff” – eye-movement desensitisation and reprocessing, yoga, bodywork (Feldenkrais, craniosacral therapy) and touch – that shows how unperturbed he is in going beyond the realm of classic psychiatry. His thinking on the body is so succinct and simple: if the body is storing trauma in its musculature, in its hormonal pathways, then it is the body that needs “experiences that deeply and viscerally contradict the helplessness, rage or collapse that result from trauma”, as he writes in his book.

This is not to say he is totally against pharmaceuticals, which can play a useful role in shutting down inappropriate alarm reactions. But he is much more interested in psychedelics, which are gaining widespread interest in the treatment of PTSD and depression, as well as the fear of death . Van der Kolk has yet to nail down how MDMA differs from ketamine, psychiatrically speaking, but he has tried both a number of times.

‘You’re not allowed to tell the truth about the horrible things that people do to each other.’

“Something has always really puzzled me. I was born in 1943 in the Netherlands. A very large number of kids of my generation died of starvation, and I was a very sickly child, but I’ve felt no trace of that sickly child,” he says. “The last time I took MDMA, I experienced what that child went through back then. It was very painful, actually. But the main effect was a very deep sense of self-compassion. I felt so much love for that child who I once was, who had to go through all that sickness, who had a hard time breathing, who was hungry.”

The next day, in 2017, he had a calamity in his professional life. He had set up the Trauma Center, in Brookline, Massachusetts, in 1982, while he was still a junior faculty member at Harvard medical school, and had built it into a leading research, training and clinical institution for PTSD. In the mid-2010s, while he was writing The Body Keeps the Score, he took a step back – during which time, the executive director, Joseph Spinazzola, was accused of mistreating female employees and was removed from his post. The head of the Justice Resource Institute, its parent organisation, fired Van der Kolk . “It was a purely cynical move,” he says; one designed to shift blame. “He was trying to pin the tail of that donkey on me.”

It was resolved to Van der Kolk’s satisfaction: his key staff left with him, in protest, and they have set up a new foundation. Because it happened in the middle of his MDMA study, though, he was “in this very open, compassionate mode. So the guy said: ‘You’ve created a toxic environment and you’re fired.’ And I said: ‘You know, that’s really not a good idea. It’s going to hurt you too much if you do this, and in the end it may hurt you more than it’ll hurt me.’” Separately, he mentions in passing that it is much easier to have compassion for your spouse if you have compassion for yourself. In Van der Kolk’s telling, the idea that self-love is a precondition for loving others – so popular in motivational statements on Instagram – has very credible and practical examples. That said, he did sue the guy from the Justice Resource Institute.

Collective trauma is complicated. Taboo is a core component of PTSD. The brain buries feelings only if they can’t be spoken about, because of the risk of alienation, from a family (this is particularly relevant to abused children) or from society (this is what silences veterans). Large, shared events – 9/11, for instance – which are not suppressed, which in fact bring those affected together, do not leave the same scars.

What about the pandemic? He shrugs: “I get a lot of questions about this, people talking about our collective trauma, and my answer is: for me and most of my colleagues, the pandemic has not been traumatic. Our friendships, our careers; they’re all fine. If you’re a single mother who’s 18 years old with no income, oh God. If you’re a nurse who has dealt with people for a year, who are choking to death, then you’re traumatised.” Part of taking trauma seriously is not seeing it where it is not present.

When The Body Keeps the Score was published, his editor said, perhaps because of the yoga, the drugs or the very trenchant way in which he describes trauma’s primacy and psychiatry’s myopia around it: “Wait until the blowback hits.” He is still waiting. “I’ve had very little blowback. I find it strange. Because I know how the academic world functions and, in every academic institution I’ve been involved in, my approach has been pooh-poohed by my colleagues.”

Maybe it is not so strange. In the end, psychiatry is simply society in a white coat, the medical end of the norm-enforcement and denial of reality that drives individuals to suppress their trauma in the first place. Van der Kolk’s life in practice has been to treat traumatised patients, but his life as an author is as an emissary from the world of PTSD, confronting his profession – and the world that created it – with what is actually happening. Ultimately, psychiatry and the world that created it can cope.

The Body Keeps the Score: Mind, Brain and Body in the Transformation of Trauma by Bessel van der Kolk (Penguin, £10.99) is out now. To support the Guardian and the Observer, order your copy at guardianbookshop.com . Delivery charges may apply.

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Post-traumatic stress disorder

The Self-Help That No One Needs Right Now

The pandemic has boosted interest in trauma books full of advice that isn’t particularly relevant to what most Americans are going through.

An image of a book with an arm coming out of it

Nothing about The Body Keeps the Score screams “best seller.” Written by the psychiatrist Bessel van der Kolk, the book is a graphic account of his decades-long career treating survivors of traumatic experiences such as rape, incest, and war. Page after page, readers are asked to wrestle with van der Kolk’s theory that trauma can sever the connection between the mind, which wants to forget what happened, and the body, which can’t. The book isn’t academic, exactly, but it’s dense and difficult material written with psychology students in mind. Here’s one line: “The elementary self system in the brainstem and limbic system is massively activated when people are faced with the threat of annihilation, which results in an overwhelming sense of fear and terror accompanied by intense physiological arousal.”

And yet, since its debut in 2014, The Body Keeps the Score has spent 150 weeks—nearly three years—and counting at the top of the New York Times best-seller list and has sold almost 2 million copies globally. During the pandemic, it seems more in demand than ever : This year, van der Kolk has appeared as a guest on The Ezra Klein Show , been profiled in The Guardian , and watched his book become a meme . (“Kindly asking my body to stop keeping the score,” goes one viral tweet .)

After all the anxiety and social isolation of pandemic life, and now the lingering uncertainty about what comes next, many people are turning to a growing genre of trauma self-help books for relief. The Body Keeps the Score is now joined on the best-seller list by What Happened to You? , a compilation of letters and dialogue between Oprah Winfrey and the psychiatrist Bruce D. Perry. Barnes & Noble, meanwhile, sells about 1,350 other books under the “Anxiety, Stress & Trauma-Related Disorders” tab, including clinical workbooks and mainstream releases. Sometimes, new installments in the genre seem to position themselves as a cheat code to a better life: Fill out the test at the back of the book; try these exercises; narrativize your life. One blurb I read, on the cover of James S. Gordon’s Transforming Trauma , basically said as much: “This book could give you back your life in unimaginable ways, whether you think of yourself as a trauma victim or not.”

“You can kind of understand why the sales of these books are going up in this stressful, pressurized situation,” Edgar Jones, a historian of medicine and psychiatry at King’s College London, told me. In a moment of personal and collective crisis, the siren song of a self-help book is strong.

There’s just one problem. In spite of their popularity, trauma books may not be all that helpful for the type of suffering that most people are experiencing right now. “The word trauma is very popular these days,” van der Kolk told me. It’s also uselessly vague—a swirl of psychiatric diagnoses, folk wisdom, and popular misconceptions. The pandemic has led to very real suffering, but while these books have one idea of trauma in mind, most readers may have another.

What happens when Americans can finally exhale

The Greek term for “wound,” trauma was initially used to refer to physical wounds. Although today’s best sellers seem to provide all the answers, psychiatrists began to widely embrace the notion of purely psychological trauma only around World War I. But the disorder has evolved since the days of shell shock. The current diagnosis of PTSD dates back to only 1980, applied to the flashbacks experienced by some soldiers who had served in the Vietnam War.

In the decades since, trauma has come to signify a range of injuries so broad that the term verges on meaninglessness. The American Psychological Association, for example, describes trauma as “an emotional response to a terrible event like an accident, rape or natural disaster”— like , but not only . “Like weeds that spread through a space and invasively take over semantic territory from others,” trauma can be used to describe any misfortune, big or small, Nicholas Haslam, a psychology professor at the University of Melbourne, told me. That concept creep is evident on TikTok, where creators use “trauma response” to explain away all kinds of behavior , including doomscrolling and perfectionist tendencies.

In the pandemic, trauma has become a catchall in the U.S. for many varied, and even competing, realities. Some people certainly are experiencing PTSD , especially health-care workers who have dealt with the carnage firsthand. For most people, however, a better description of the past 19 months might be “chronic stressor,” or even “extreme adversity,” experts told me —in other words, a source of immense distress, but not necessarily with severe long-term consequences. The whole of human suffering is a lot of ground for one word to cover, and for trauma best sellers to heal.

Read: On top of everything else, the pandemic messed with our morals

Today, a comprehensive shelf of trauma self-help includes the biophysicist Peter Levine’s Waking the Tiger , which argues that a lack of trauma in wild animals can offer insight into how humans might overcome their seemingly unique susceptibility to it; The Deepest Well , by the surgeon general of California, Nadine Burke Harris, who uses personal experience to draw a direct line from childhood stress to a host of physical and social ills; and It Didn’t Start With You , in which the author, Mark Wolynn, makes the controversial claim that trauma can be inherited from distant ancestors.

These books tend to follow a reliable arc, using the stories of trauma survivors to advance a central thesis, and then concluding with a few chapters of actionable advice for individual readers. In The Body Keeps the Score , van der Kolk writes about people he refers to as Sherry, a woman who was neglected in childhood and kidnapped and repeatedly raped for five days in college, and Tom, a heavy drinker whose goal was to become “a living memorial” to his friends who had died in Vietnam. For patients like these, van der Kolk eventually turned to yoga, massage therapy, and an intervention called eye-movement desensitization and reprocessing , or EMDR, which specifically treats the traumatic memories that pull people with PTSD back into the past.

Those experiences are remarkably different from what most Americans have endured in the pandemic. Although almost everyone has struggled with the risk of contracting a deadly virus and the resulting isolation and potential loneliness, a remote worker’s depressive episode, or an unemployed restaurant worker’s inability to pay their bills, has little in common with stories like Tom’s and Sherry’s. They are no less important—no less deserving of attention—but we need better words to describe them, and other remedies to treat them.

Even van der Kolk himself is wary of some of the ways in which trauma is used today. When I asked him whether he thinks The Body Keeps the Score is useful for all the readers turning to it during the pandemic, he objected to the premise of my question: The readers he hears from most, he said, are those who grew up in abusive households, not those who feel traumatized by COVID-19. “When people say the pandemic has been a collective trauma,” van der Kolk said, “I say, absolutely not.”

Read: When PTSD is contagious

Still, the trauma books keep selling. Some lessons they contain are universally applicable, if a little trite. In What Happened to You? Oprah and her co-author dedicate a chapter to their spin on the idea of “ post-traumatic growth ,” a concept popular again in the pandemic, as people search for a silver lining to what they’ve been through. But sometimes, there is no wisdom to glean or personal growth to uncover—what happened happened, and people move forward anyway. Other recommendations, as with van der Kolk’s emphasis on EMDR, are specific to people with more typical symptoms of PTSD. Most people just don’t need those kinds of interventions, says George Bonanno, a clinical-psychology professor at Columbia University and the author of The End of Trauma . In the aftermath of disasters such as 9/11, Bonanno has found remarkable resilience, despite the odds. Yet people “don’t seem to want to let go of the idea that everybody’s traumatized,” he told me.

Surely some people find solace in these books, whatever their reason for reading. And not all trauma books have these pitfalls. In My Grandmother’s Hands , the therapist Resmaa Menakem examines the physical and emotional toll of racism and white supremacy, and his advice charts a different course. When people feel they have experienced a collective trauma, Menakem writes, “our approaches for mending must be collective and communal as well.” When it comes to the challenges Americans now face—as varied as responding to the pandemic and acting on climate change—that’s advice worth taking.

Ultimately, talking about trauma isn’t just a semantic matter. “Having a tight, limited idea of what mental illness looks like is a recipe for stigma; it’s a recipe for not seeking help for oneself [and for] not offering help to others,” Haslam said. The desire to validate other people’s suffering “is a good corrective,” he added. “It just happens to be a pretty blunt object in this concept of trauma.” And that is the major lesson you’ll learn if you can make it to the end of this grueling syllabus: We still have so much to understand about trauma. If we want a shot at addressing the real consequences of the pandemic, we will need not only more research but a new language—one that expresses terrible experiences that aren’t strictly traumatic and leads to solutions that are bigger than any one of us in isolation. Until then, trauma books will just keep flying off the shelves.

The Body Keeps the Score: how a bestselling book helps us understand trauma – but inflates the definition of it

Professor of Psychology, The University of Melbourne

Disclosure statement

Nick Haslam receives funding from the Australian Research Council.

University of Melbourne provides funding as a founding partner of The Conversation AU.

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In a new series, we look at books that have become cultural touchstones.

If new books are lucky they enjoy a brief honeymoon of attention before ebbing away into oblivion. Not so The Body Keeps the Score , a publishing phenomenon that has kept selling long after it first hit the shelves in 2014. The book has spent more than 150 weeks on the New York Times best seller list for paperback nonfiction, including over half a year in the coveted #1 spot during 2021. It has reportedly sold almost 2 million copies.

Why a long, dense, and demanding book on the psychology and neurobiology of trauma should occupy so bright a spotlight for so long is not immediately obvious. Post-traumatic stress disorder is old news, a staple of psychological chatter for over four decades, and the book doesn’t offer any quick fix solutions for self-helpers.

Clues to what has driven The Body Keeps the Score’s success can be found in its sales trajectory. On bookriot.com , writer Gina Nicoll notes that sales began to liven up around 2018 and then grew in spurts, reaching a peak in 2021. The pandemic may have contributed to this surge by bringing collective trauma to our doorsteps, she speculates, but the pre-pandemic upswing suggests other factors are also at play.

Reckonings with sexual and racial trauma in the wake of #MeToo and Black Lives Matter have combined to raise the cultural profile of trauma, Nicoll suggests.

But alongside this increase in cultural attention, there has been a broadening of what we take trauma to be.

People are seeing trauma everywhere and re-conceptualising their own experiences of misery and misadventure in its terms. They are doing so, at least in part, because the concept’s meaning has been stretched. More on that later.

Read more: Six psychiatric concepts that have mutated: for better or worse

The book explained

So what is all the fuss about? Bessel van der Kolk , a Dutch-born psychiatrist who has been a successful researcher and clinician in the Boston area since the late 1970s, wrote The Body Keeps the Score as a guide to the understanding and treatment of trauma.

The book adopts several standard features of the popular psychology genre: case studies from the author’s clinical practice, autobiographical reflections, and sharp critiques of mainstream views to assure readers the author is not merely doing good but slaying dragons in the process.

However, its presentation of the science of trauma is unusually compelling, setting it above most works of popularisation. Van der Kolk has substantial legitimacy as a researcher, and his interleaving of the personal and the scientific makes for an engaging read.

Van der Kolk begins his blockbuster with a discussion of the neuroscience of trauma, complete with explorations of brain anatomy and function and how they underpin reactions to extreme threat.

He presents traumatic reactions not simply as disturbances of fear and anxiety – how the amygdala becomes an over-sensitive “smoke detector” that triggers traumatised people into fight or flight reactions – but also as disruptors of interpersonal relationships and a stable sense of self.

Trauma’s somatic signature extends beyond the brain. Van der Kolk explains at length how hormonal influences and the vagus nerve, which runs from brain to abdomen and regulates several internal organ functions, reverberate its effects throughout the body.

In trauma, he argues, people may lose a sense of body ownership to accompany their loss of self, felt connection to others, and even their sense of being fully alive. Recovering a sense of personal agency and of bodily ownership – what he refers to as befriending the body – is a key to recovery.

Childhood trauma

Trauma in childhood becomes the second major focus of the book. Whereas early investigations of post-traumatic reactions focused on adult combatants in war, van de Kolk directs much of his attention to impacts of trauma and hardship earlier in life. Once again, his focus is expansive, extending beyond traumatised individuals in isolation to the disruptions trauma creates in their intimate attachments.

Abusive family environments produce children who lack a secure sense of connection to others and suffer elevated risks of illness and re-traumatisation. They are more likely than their peers to experience and perpetrate violence as adults, to engage in self-damaging behaviour, and to experience cancer, heart disease, obesity and a range of psychiatric conditions.

Van der Kolk presents childhood trauma as a “hidden epidemic”, swept under the carpet by society at large and by psychiatry in particular. He advocates for policy responses that combat the economic and societal drivers of childhood adversity, and for better recognition by organised psychiatry of the mental health impacts of trauma.

In this second quest he has had limited success. His proposal of new diagnoses that recognise the outcomes of repeated childhood trauma – “complex PTSD” and “developmental trauma disorder” – were rebuffed by the developers of American psychiatry’s classification of mental disorders, the DSM.

The DSM’s third edition, published in 1980, recognised PTSD for the first time. But the fourth and fifth editions, DSM-IV (1994) and DSM-5 (2013), would have none of these new proposals.

Van der Kolk’s outrage at this rejection, and his jaundiced, if sometimes straw-mannish view of the psychiatry profession, seasons his book with anti-establishment saltiness. The alternative view – that the DSM’s guardians were wary of adding new disorders that overlapped substantially with existing conditions, privileging trauma as the single, dominant cause of a diffuse and multi-determined set of symptoms – does not get a hearing.

The Body Keeps the Score closes with an extended exploration of alternative forms of treatment. Despite his neuro-biological leanings, van der Kolk does not see medication as the best line of intervention. He contends that effective therapies must target meaning rather than chemistry and allow traumatic memories to be processed rather than blunted.

Among his diverse collection of preferred treatments are neurofeedback, in which people learn to alter brain waves via real-time encephalographic feedback, somatic psychotherapies, yoga, theatre, and eye movement desensitisation and reprocessing ( EMDR , in which people recall traumatic experiences while performing rhythmic, therapist-guided eye movements).

His enthusiasm for these interventions, some of which veer towards the fringe and the faddish, sometimes outstrips the evidence for their efficacy, but has contributed to their growing popularity.

Understanding the book’s appeal

The Body Keeps the Score has been remarkably popular for reasons beyond its alignment with our current cultural preoccupations. For one, it is a hopeful book. Although it underscores the sweeping extent of traumatic experiences and the severity and range of their impacts, it also argues that therapy works and post-traumatic distress need not be a life sentence.

The same optimism shines through in the book’s dialectical account of the history of the mental health disciplines. A period of “brain-less” psychoanalytic interest in the meaning of psychological distress – carried out with no eye for biological processes – gave way to an era of “mind-less” psychopharmacology. We have now arrived at a stage in which neurobiology and a deep appreciation of human psychology can go hand in hand.

The book also contributes to an ongoing de-masculinising of trauma studies. Psychiatric thinking about trauma was long dominated by investigations of combat reactions in soldiers, described variously as shell shock or battle fatigue. The flood of psychological casualties among Vietnam veterans spurred the official recognition of PTSD in 1980.

Van der Kolk pays much more attention to sexual abuse and violence as sources of trauma. These disproportionately affect women and girls and account at least partially for women’s higher rates of PTSD diagnoses.

Read more: What is complex PTSD and how does it relate to past abuse and trauma?

The same feminising of trauma can be seen more symbolically in van der Kolk’s emphasis on the bodily and relational dimensions of trauma. Historically, the gender binary has been overlaid on the mind/body distinction, and on the distinction between stereotypically masculine independence and stereotypically feminine relatedness.

By paying heed to somatic impacts and treatments of trauma, and the ways in which it disrupts attachments and relationships, van der Kolk is making the psychology of trauma more inclusive of the experiences of female trauma survivors.

Inflating trauma

The Body Keeps the Score offers a vision of trauma that is inclusive in some respects. But is it over-inclusive in others? Van der Kolk’s understanding of trauma is expansionary, offering a broad view of its impacts and implications.

He recognises a wide range of manifestations of trauma, promotes new trauma-related diagnoses, affirms a broad definition of what counts as a traumatic event, and recommends diverse modes of treatment.

For example, conventional descriptions of PTSD point to a restricted set of symptoms, such as flashbacks, nightmares, and hyper-vigilance. Van der Kolk connects trauma to a much wider web of phenomena. It is examined as a primary source of relationship problems, emotional disturbances, and forms of acting out such as rebellious, defiant, impulsive, and inattentive behaviour.

Most significantly of all, Van der Kolk sees trauma lurking beneath an array of somatic complaints. Trauma is embodied and manifested in such concerns as irritable bowel, auto-immune conditions, fibromyalgia, headaches, and a range of diffuse physical symptoms.

Similarly, Van der Kolk’s work expands the range of events that are considered traumas. When PTSD was first defined in DSM-III, the condition could only be diagnosed if the event that precipitated it was life-threatening and outside the range of normal human experience.

Later editions of the diagnostic manual loosened the definition to include unpleasant events witnessed indirectly, which are not physically endangering.

Van der Kolk uses the term “trauma” more freely still, often employing it to refer to almost any form of life adversity, including enduring circumstances rather than only discrete incidents. Trauma can easily be stretched to encompass minor illnesses, normal romantic breakups and disappointing exam results.

On this broadened definition, all but the most cosseted among us have been traumatised and can view our struggles and sufferings through the potentially magnifying lens of trauma.

This expansion of the meaning of trauma has taken place in parallel with a steep rise in the cultural prominence of the concept. Research shows that the word “trauma” appears in everyday discourse much more frequently now than it did even two decades ago.

That rise has been even more dizzying within the mental health professions, a recent study finding that “trauma” appeared at an almost 20 times higher rate in psychology journal articles in the 2010s as it did in the 1970s.

Read more: More than half of Australians will experience trauma, most before they turn 17. We need to talk about it

It should not be surprising to learn that this sharply spiking interest in trauma has generated some push-back. In 2021, Eleanor Cummins observed in The Atlantic that the concept of trauma has become “uselessly vague – a swirl of psychiatric diagnoses, folk wisdom, and popular misconceptions”. In the same year, writer Will Self criticised “how everything became trauma” and Parul Sehgal decried how trauma-driven plots flatten fictional narratives and hollow out characters in The New Yorker.

In 2022, in the New York Times, Jessica Bennett asked “if everything is trauma, is anything?” and denounced “post-traumatic hyperbole”. Lexi Pandell , writing for Vox, argued this “word of the decade” has become close to meaningless.

Like Bennett and Pandell, several writers have queried whether trauma is now being used too promiscuously. Some have distinguished big “T” trauma from less severe little “t” trauma to resist this concept creep .

Others worry that the growing popularity of trauma narratives represents an encroachment of medical language into the realm of ordinary adversity, reducing unjust social arrangements to individual pathologies, or promoting personal fragility. Still others have voiced concerns that the concept of trauma has become politicised .

The argument that broad concepts of trauma produce fragility rests on the belief that defining moderate life challenges as mind-shattering traumas might undermine our resilience.

Understanding an adversity as a trauma implies that it overwhelms our capacity to cope and is likely to have lasting effects. In the popular mind, trauma still carries a connotation of indelibility.

Of course, many adversities do take people beyond their breaking points and have enduring consequences. The question is whether perceiving less severe experiences as traumas makes them loom larger and longer than they need to. Emerging research evidence suggests that it might.

Van der Kolk can’t be held entirely responsible for the runaway success of his book or for the runaway semantic inflation and popularity of its central concept. The Body Keeps the Score has been successful because it resonates with its cultural moment, and it has helped to mould that moment for millions of readers.

The recent elevation of trauma attests to a time in which people are keenly attuned to their individual and collective suffering, increasingly attribute it to causes beyond their control, and look to a therapeutic mindset to resolve it. Van der Kolk’s book is a lucid guide to this new reality.

Book reviews
Cultural touchstones

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BOOK REVIEW article

Book review: the body keeps the score: brain, mind, and body in the healing of trauma.

$\nJacqueline Mei Chi Ho$

1 School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
2 Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong, China
3 Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Hospital Authority, Hong Kong, China
4 State Key Laboratory of Translational Oncology, Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong, China

A Book Review on The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma

Bessel van der Kolk (Penguin Books), 2015, 464 pages, ISBN: 978-0143127741.

Posttraumatic stress disorder (PTSD) is defined as a psychiatric disorder in an individual who has experienced or witnessed a devastatingly traumatic event ( Bufka et al., 2020 ). These patients persistently experience overwhelming stress responses beyond the traumatic period. Fear and stress are triggered predominantly in response to a dangerous event followed by a series of bodily changes, including increased blood pressure, heart rate, and breathing due to the release of adrenaline. This biochemical reaction is termed as the “fight-or-flight” mechanism, which temporarily protects people against danger ( Kozlowska et al., 2015 ). It has been well-recognized that PTSD significantly impacts social functioning, physical well-being, and occupational ability ( Watkins et al., 2018 ).

In his work “The body keeps the score,” Bessel highlights that traumatic stress is at the root of neuroscience. Traumatic stress is associated with functional and chemical changes in the emotional part of the brain—the limbic area and brain stem. Knowing the functions of the amygdala, hippocampus, and prefrontal cortex, as the primary stress responders in the brain, can provide a new therapeutic direction for PTSD management. The hyperactive status of the amygdala triggers the release of stress hormones ( Badura-Brack et al., 2018 ) and impairs the functioning of the hippocampus, causing traumatic memories to remain vivid. In addition, the deactivation of the prefrontal cortex function and the failure to maintain a balanced stress hormone system, causes panic, agitation, and hypervigilance responses in PTSD patients ( Koenigs and Grafman, 2009 ). This hyperactive aroused emotional status can be evidenced by hyperactive brain waves over the fear center of the right temporal lobe of the brain, with suppression of electric activity over the frontal area.

To restore the emotional part of the brain and repair the limbic system, Bessel explains various psychotherapies related to the brain, mind, and body of PTSD patients. He emphasized on the human body as the means of communicating with oneself and others. Expressive therapies, through language, art, music, and dance, can motivate people orientate themselves and find their own identity and a meaningful purpose in life ( Baker et al., 2018 ). Most importantly, the reconnection of attachment bonding with family and friends can help individuals feel secure in fighting against the threat ( Chan et al., 2021a , b ).

Author Contributions

JH is mainly writing this book review. CL, AC, and PT gave comment and suggestion in this manuscript. All authors contributed to the article and approved the submitted version.

The preparation of this manuscript was partially supported by funding's from School of Nursing and the Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher's Note

Badura-Brack, A., McDermott, T. J., Heinrichs-Graham, E., Ryan, T. J., Khanna, M. M., Pine, D. S., et al. (2018). Veterans with PTSD demonstrate amygdala hyperactivity while viewing threatening faces: a MEG study. Biol. Psychol. 132, 228–232. doi: 10.1016/j.biopsycho.2018.01.005

PubMed Abstract | CrossRef Full Text | Google Scholar

Baker, F. A., Metcalf, O., Varker, T., and O'Donnell, M. (2018). A systematic review of the efficacy of creative arts therapies in the treatment of adults with PTSD. Psychol. Trauma Theory Res. Pract. Policy 10, 643–651. doi: 10.1037/tra0000353

Bufka, L. F., Wright, C. V., and Halfond, R. W. (Eds.). (2020). Casebook to the APA Clinical Practice Guideline for the Treatment of PTSD. Washington, DC: American Psychological Association.

Google Scholar

Chan, A. S. W, Ho, J. M. C., Tam, H. L., and Tang, P. M. K. (2021a) Book review: successful aging: a neuroscientist explores the power potential of our lives. Front. Psychol. 12:705368. doi: 10.3389/fpsyg.2021.705368

CrossRef Full Text | Google Scholar

Chan, A. S. W., Ho, J. M. C., Li, J. S. F., Tam, H. L., and Tang, P. M. K. (2021b) Impacts of COVID-19 pandemic on psychological well-being of older chronic kidney disease patients. Front. Med. 8:666973. doi: 10.3389/fmed.2021.666973

Koenigs, M., and Grafman, J. (2009). Posttraumatic stress disorder: the role of medial prefrontal cortex and amygdala. Neuroscientist 15, 540–548. doi: 10.1177/1073858409333072

Kozlowska, K., Walker, P.l., McLean, L., and Carrive, P. (2015). Fear and defense cascade: clinical implications and management. Harv. Rev. Psychiatry 23, 263–287. doi: 10.1097/HRP.0000000000000065

Lewis, S. J., Arseneault, L., Caspi, A., Fisher, H. L., Matthews, T., Moffitt, T. E., et al. (2019). The epidemiology of trauma and posttraumatic stress disorder in a representative cohort of young people in England and Wales. Lancet Psychiatry 6, 247–256. doi: 10.1016/S2215-0366(19)30031-8

Streeter, C. C., Gerbarg, P. L., Saper, R. B., Ciraulo, D. A., and Brown, R. P. (2012). Effects of yoga on the autonomic nervous system, gamma-aminobutyric-acid, and allostasis in epilepsy, depression, and post-traumatic stress disorder. Med. Hypotheses 78, 571–579. doi: 10.1016/j.mehy.2012.01.021

Watkins, L. E., Sprang, K. R., and Rothbaum, B. O. (2018). Treating PTSD: a review of evidence-based psychotherapy interventions. Front. Behav. Neurosci. 12:258. doi: 10.3389/fnbeh.2018.00258

Keywords: posttraumatic stress disorder, physical well-being, psychological well-being, health care, quality of life

Citation: Ho JMC, Chan ASW, Luk CY and Tang PMK (2021) Book Review: The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. Front. Psychol. 12:704974. doi: 10.3389/fpsyg.2021.704974

Received: 04 May 2021; Accepted: 25 May 2021; Published: 18 August 2021.

Edited and reviewed by: Hyemin Han , University of Alabama, United States

Copyright © 2021 Ho, Chan, Luk and Tang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Jacqueline Mei Chi Ho, mc-jacq.ho@polyu.edu.hk ; Alex Siu Wing Chan, chansw.alex@gmail.com

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

The Body Keeps the Score

Bessel Van Der Kolk is a leading trauma specialist and The Body Keeps The Score is his latest brilliant synthesis of contemporary thinking about the impact of trauma on the body and mind - drawing research and experience from his own clinic, neuroscience, psychiatry, history, and thinking from the fields of psychotherapy and psychology. He makes a powerful case for re-considering many diagnostic labels that dominate the US psychiatric field (and to a lesser extent over here), arguing that the root of many people's distress is actually one of trauma, rather than a ‘disorder’ preferred by psychiatric manuals. This could be trauma from parental abuse, neglect or extreme poverty and conflict - or trauma from war, accidents or loss.

Clinically, trauma causes immense suffering and needs a profound treatment. If you feel like you can re-live a horrid experience from the past, with all that that entails in mind and body - this is unresolved trauma: 'The essence of trauma is that it is overwhelming, unbelievable and unbearable...people live with a dual reality: of a relatively secure and predictable present that lives side by side with a ruinous, ever present past.' Trauma presents in every therapist’s practice, and treatment is more hopeful than perhaps some had imagined. Van de Kolk believes it is possible to thrive after extreme traumas - a heartening conclusion.

While the virtue of talking therapies for trauma are discussed in the book, Van Der Kolk presents a watertight case for every therapist working with trauma to work with the body too. It’s worth considering this if you are seeking treatment. The body stores trauma even more reliably than the mind - as the title of the book suggests. While memories can get broken up and confused, the body records the threat or threats it originally experienced, replaying it again and again until healing is achieved: the fight or flight response is re-engaged and can be completely flooding for some - accounting for panic attacks, numbness, racing hearts, sweating, or even out of body experiences. The suggested pathways to recovery in the book are varied, but suggestive of anything that includes more than talking alone: theatre work, EMDR, yoga and biofeedback included. Many of his clinical vignettes are very inspiring in their depth of healing.

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The Body Keeps the Score by Bessel van der Kolk

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Rating: 4/5

What Is The Body Keeps the Score About?

The Body Keeps the Score is about the profound impact of trauma on the mind and body, exploring innovative healing methods through the lens of neuroscience and psychology.

The Five Big Ideas

The Prevalence and Impact of Trauma : Trauma is a widespread issue that profoundly affects individuals’ mental and physical health, altering the brain’s structure and potentially leading to conditions like PTSD.
The Body-Mind Connection : Trauma is stored not just in the mind but also in the body, manifesting through physical symptoms and sensations, underscoring the need for integrated treatment approaches.
The Limitations of Talk Therapy : Traditional talk therapy may not be sufficient for healing trauma because the brain often stores traumatic memories in non-verbal parts of the brain; therefore, therapies that engage the body and mind are often more effective.
The Role of Neuroplasticity in Healing : The brain’s ability to change and adapt (neuroplasticity) is central to recovering from trauma, and we can facilitate healing through therapies that promote positive neural changes.
Innovative Therapies for Trauma : The book highlights various innovative therapies, such as Eye Movement Desensitization and Reprocessing (EMDR), which have shown promise in helping individuals process and recover from traumatic experiences.

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The body keeps the score summary.

Note: While this summary provides an overview of the key themes and ideas presented in The Body Keeps the Score , the book is rich with case studies, personal narratives, and scientific research that offer a deeper understanding of trauma and its effects.

Part One: The Rediscovery of Trauma

In the first part of the book, Bessel van der Kolk sets the stage by discussing his early experiences with trauma patients during the Vietnam War era. He introduces the concept of Post-Traumatic Stress Disorder (PTSD) and how it was initially observed in war veterans but is also prevalent in survivors of other forms of trauma, such as abuse and accidents. He explains how trauma affects the brain, particularly the areas responsible for processing fear, emotion, and memory. Traumatic experiences can lead to changes in the brain that make individuals more susceptible to fear, anxiety, and memory distortions.

Part Two: This is Your Brain on Trauma

Here, van der Kolk delves deeper into the neuroscience of trauma. He explains how traumatic experiences can alter the brain’s structure and function, particularly in the areas involved in processing threat and safety, such as the amygdala, prefrontal cortex, and hippocampus. These changes can result in a heightened state of alertness, making it difficult for trauma survivors to distinguish between past and present threats. Van der Kolk also discusses the role of neuroplasticity in trauma recovery, emphasizing that the brain can rewire itself, which is a cornerstone of healing.

Part Three: The Minds of Children

In this section, van der Kolk focuses on the impact of trauma on children. He explains how early experiences, particularly those involving neglect or abuse, can profoundly shape a child’s brain development and affect their ability to regulate emotions and form healthy relationships. He also discusses the importance of a supportive environment for children who have experienced trauma and the role of attachment in healing.

Part Four: The Imprint of Trauma

Part four delves into the ways trauma can leave lasting marks on individuals. Van der Kolk discusses how trauma survivors often relive their experiences through flashbacks and intrusive memories. He also explores the concept of “body memory,” explaining how traumatic experiences can manifest physically, leading to symptoms like chronic pain, gastrointestinal issues, and other somatic complaints. The body’s physical response to trauma is a key theme, highlighting the importance of addressing both the mind and body in treatment.

Part Five: Paths to Recovery

Van der Kolk dedicates the book’s final part to treatment and recovery, outlining various therapeutic approaches beyond traditional talk therapy. He emphasizes the importance of therapies that engage the body, such as Eye Movement Desensitization and Reprocessing (EMDR), yoga, and mindfulness practices. He also discusses the role of art, theater, and communal experiences in healing trauma. The book concludes with a message of hope, emphasizing that recovery is possible and individuals can reclaim their lives from trauma.

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The body keeps the score book review

The Body Keeps the Score is a book you would read to learn about the physiology and science of trauma, people’s experience of trauma and ways that a person might recover from it. It is written by Bessel Van Der Kolk a Dutch born psychiatrist, educator and author with over thirty years of experience working with people who have experienced trauma.

What i liked about the book?

The Body Keeps the Score is written from thirty years of real-life experience and research giving it a solid grounding. This book paints a comprehensive picture of the different types of trauma as well as how it might affect the mind, brain and body. Examples include attachment trauma, abuse and big T trauma.

What I like about it is that the order and thread of the book takes the reader on the journey of trauma. Essentially our experience of it and how it affects us, to remembering trauma and what we can do to help ourselves recover from it.

If you have experienced trauma or therapy to help you process the trauma this book will have a wealth of information to help you. What is great about the book is that in my experience one of the difficulties people have when trying to get over trauma is questioning their response to the trauma or their role within it. Gaining insight from this book in relation to the commonalities of how people respond to trauma helps the reader feel normal. As a practitioner who works everyday with trauma another difficulty people might experience after trauma is their perceived inability to ‘get over it’ even many years later. This book explains why this is again normalising a person’s experience of trauma.

The book takes you on a trauma journey from the eyes of people who have experienced trauma or helped with it. What is helpful about the book is that each section or chapter of information can be read and understood as a stand alone piece making it a book that you can dip in and out of without having to begin at the beginning each time. The case studies illustrating a person’s experience help provide the relevant context needed for understanding each chapter in its own right.

The book is well indexed and each section of the book is clearly labelled maintaining the transformation of trauma thread all the way through the book. Some of the sections and chapters have a clever play on words, for example: ‘What’s love got to do with it?’ which makes the chapter memorable and keeps trauma amateur sleuth interested.

The main reason why I love this book is that it makes some complicated insights and observations and insights accessible to trauma survivors, clinicians and anyone who is interested in the subject.

In keeping with tradition and to present a balanced book review I have included a section on what I don’t like about the book. There is very little I dislike about the book however the only point I would raise is the format of the book. This could be deemed a negative or a positive depending on your viewpoint. The book is in a novel paperback format which is not necessarily the best format for such a rich abundance of informative information. A text book which was in colour with larger print would make the book more accessible for some readers. The positives of this format is that it keeps the cost down and can be read on the move.

In conclusion this book is a comprehensive guide to trauma for general interest or for a therapist working with traumatised clients. The way it is written is accessible to all readers because of the simple way it is written and practical examples used. The book takes you on an informative journey about trauma; which includes the mind and body as well as ways to heal from it. I would thoroughly recommend this book.

Notable Quotes about The Body Keeps the Score

‘Van der Kolk draws on thirty years of experience to argue powerfully that trauma is one of the West’s most urgent public health issues… Packed with science and human stories’ NEW SCIENTIST

‘Breath-taking in its scope and breadth, a seminal work by one of the preeminent pioneers in trauma research and treatment’ PETER A. LEVINE. AUTHOR OF WAKING THE TIGER

‘Dr can der Kolk’s masterpiece combines the boundless curiosity of the scientist, the erudition of the scholar, and the passion of the truth teller’ JUDITH HERMAN, AUTHOR OD TRAUMA AND RECOVERY

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‘The Body Keeps the Score’ offers uncertain science in the name of self-help. It’s not alone.

On the first page of “ The Grieving Brain ,” the neuroscientist and psychologist Mary-Frances O’Connor writes: “Poets, writers, and artists have given us moving renderings of the almost indescribable nature of loss. … As human beings, we seem compelled to try to communicate what our grief is like, to describe carrying this burden.” In her book, published by the imprint Harper One (tagline: “Books that transform and inspire”), O’Connor seeks to tell us what all those poets, writers and artists couldn’t about grief: why we feel it, from the standpoint of neuroscience.

O’Connor, who directs the Grief, Loss and Social Stress (GLASS) lab at the University of Arizona, was among the first to use functional magnetic resonance imaging (fMRI) brain scans to study grief. When her first study on the neuroanatomy of grief was published in the early 2000s, fMRI technology was only about a decade old and was seen as a revolutionary breakthrough in modern neuroscience — itself only a few decades older. The giant magnets of an fMRI machine detect the iron in oxygenated red blood cells; the resulting scans depict the changes in oxygenated blood flow that coincide with brain activity. This technology promised to show which parts of the brain “lit up” when a patient was performing a particular task, seemingly giving neuroscientists the ability to map the brain and chart where each particular emotion, thought or action originates.

“The Grieving Brain” represents O’Connor’s attempt to translate her fMRI-based research for a general audience. In this, it joins a genre that psychiatrist Bessel van der Kolk popularized with “ The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma ” (2014). In recent years, van der Kolk’s book, with its Matisse-bedecked cover, invaded social media, rendering it both a meme and a sleeper bestseller — it has stayed near the top of the New York Times paperback nonfiction list for 248 weeks, more than 4½ years. “The Body Keeps the Score” found an eager and sizable audience because it boiled down complex ideas about the physiological and behavioral effects of trauma — the visceral ways we feel mental pain, the lasting role of early adversity in the patterns we fall into as adults — into explanations that feel intuitively true. We have all felt our guts clench and pulses quicken in moments of fear or anguish; we have all questioned why we can’t control our emotional reactions.

I first picked up “The Grieving Brain” for the same reason that I read “The Body Keeps the Score” the year before: I wanted to understand how a series of firing neurons can suddenly leave me in tears when I get an unexpected reminder of my parents, who both died of cancer about 20 years ago, when I was a young teen. More than that, I wanted the objectivity and rationality of science to impose order on my grief.

Reading “The Body Keeps the Score,” I realized that my experience of losing my parents — while devastating and life-altering — wasn’t traumatic, exactly; at least not by van der Kolk’s definition, making me wonder why so many readers had slogged through its dense descriptions of brain activity. As science journalist Eleanor Cummins argued in the Atlantic , when researchers like van der Kolk talk about “trauma,” they mean something quite different than the everyday discomfort imposed by, say, the first year of the coronavirus pandemic. In the psychiatric world, ruled by the Diagnostic and Statistical Manual of Mental Disorders, trauma manifests in physical and emotional wounds from experiences like combat, or surviving horrific accidents or acts of violence.

My feelings around my parents’ deaths may not result from trauma, but they are definitely grief. As I read “The Grieving Brain,” I encountered descriptions that mirrored some of my emotions back to me: my anguish over not being able to locate my parents on this earthly plane, my yearning to be close to them. But I questioned why I had sought an “objective,” neurobiological stamp of approval on what I had already known about how and why humans suffer when we are bereaved: We long for our dead, we face the need to adapt to a world without them in it, we dwell on what our lives would be like if our dead had instead lived. Even O’Connor acknowledges early on that she does “not believe that a neuroscientific perspective on grief is any better than a sociological, a religious, or an anthropological one,” but she feels that “neuroscience is part of the conversation of our times.”

Our interest in talking about what’s going on inside our brains isn’t new, but received neuroscientific wisdom is now recirculating in new mediums, calcifying into consensus that we can’t stop parroting. Most Americans have poor scientific literacy — as the pandemic attests — and yet we cannot get enough of using the language of neuroscience to talk about our brains and seeking self-help solutions to what we think ails us neurologically.

Beyond “The Grieving Brain” and “The Body Keeps the Score,” publishing has cashed in on these desires in recent years with bestsellers such as psychiatrist Bruce D. Perry and Oprah Winfrey’s “ What Happened to You? Conversations on Trauma, Resilience, and Healing ,” biologist and neurologist Robert M. Sapolsky’s “ Behave: The Biology of Humans at Our Best and Worst ,” and clinical psychologist Lisa Feldman Barrett’s “ How Emotions Are Made: The Secret Life of the Brain .” More such books are forthcoming: “Brain performance coach” Nicole Vignola — who has a bachelor’s degree in neuroscience and more than 300,000 people following her advice on Instagram — recently sold “Rewire: The Neuroscience of a Good Life” to Harper One and 12 other publishers worldwide. The book, pitched as a “toolkit for shifting deeply ingrained brain behavioral patterns,” is due out next spring.

The more I learned about how much some of these books overplay what neuroscience can currently tell us about the brain and human behavior, the more I thought that the self-helpification of a relatively young and incredibly complex field of scientific study is not so helpful after all. We keep consulting neuroscience — even when its findings are disproven or overblown — to explain the human condition, and often to validate what we want to believe or what we already know. Tracing all of our messy emotions, reactions and habits to the workings of electrical currents and neurochemicals lets us off the hook.

Humans have been trying to understand the brain since the time of Hippocrates; neuroscience is still in its toddlerhood. Western physicians didn’t even know what the brain looked like until the mid-16th century, when the Belgian anatomist Andreas Vesalius illustrated what he observed via autopsies and dissections in “De Humani Corporis Fabrica.” Vesalius’s empirical drawings finally unseated theories put forward in the second century that the brain was composed of four fluid-filled ventricles through which the “pneuma physicon,” or animal spirit, flowed.

It wasn’t until 1848, when a railroad construction foreman named Phineas Gage survived an accident in which an iron rod was driven through his head, that it was proved that different areas of the brain are responsible for different functions. That breakthrough initially seemed to back up some of the tenets of phrenology , a pseudoscience that studied bumps on the skull and offered “evidence” for racist ideas — namely, that characteristics such as benevolence were controlled by “organs,” or areas, of the brain.

As recently as the mid-20th century, doctors performed lobotomies on people deemed mentally ill, severing the connection between the thalamus and the frontal lobe. Neuroscientists like Walter Freeman, the biggest evangelist for the lobotomy in the United States, believed that psychosis was caused by endlessly circling thoughts and that cutting off the prefrontal cortex would break the circuit.

It’s worth remembering that as we advance in our understanding, what we know about the brain — such a key part of what makes us human — will inevitably be revised, refined and sometimes proved wrong. The imaging revolution, starting with the invention of the positron emission tomography (PET) scanner and the MRI in the 1970s, seemed to bring neuroscience out of the dark ages. But the fMRI scan, which is just over 30 years old, has already had episodes of comeuppance. In 2009, a neuroscientist put a dead salmon through an fMRI and detected activity in its dead brain, showing how easy it is to produce a false positive when sorting through the statistical noise of these scans. Beyond statistical dangers, there’s an even more fundamental problem of interpreting what fMRI scans depict. A scan can correctly identify the areas of a person’s brain that are receiving blood flow at a particular moment, but we can’t definitively say that activation of a brain region equals a particular emotional or cognitive state. An activated amygdala can be pointed to as proof of negative emotions like fear, stress or anxiety, but also positive ones, like happiness.

More recent reevaluation of fMRI scans taken while subjects are triggered to feel certain emotions — the kind that O’Connor and van der Kolk have deployed in their research and write about in their books — has further revealed their limitations. In 2020, Ahmad Hariri, a Duke University professor of psychology and neuroscience, led a team that conducted a reanalysis of 56 published academic studies based on fMRI analysis, and found that when an individual has their brain scanned in an fMRI, the results are not replicable on a second scan. You can have the same person conduct the same task while in an fMRI scanner a few months later and get a different readout of brain activation. While bad fMRI data will probably not lead to the same horrors as phrenology and lobotomies, it’s not hard to imagine how these scans could be manipulated to diagnose people with psychiatric illnesses they may not have, or to deny insurance coverage for treatments they need.

And yet books that tout the results of fMRI studies are still being marketed to everyday readers who aren’t up to date on issues of psychological science. These books propose that the findings of fMRI studies provide groundbreaking insight into human emotions and behaviors. These claims play into the motivations of everyone involved in the intersection of neuroscience and self-help, like the scientists who get to promote the real-world applicability of their work outside of the academy (and thus gain notoriety within it) and the publishers who are willing to shell out hefty advances for books that promise to meet readers’ endless appetite to understand why they feel bad — and promise solutions. At best, these books oversimplify and overstate the takeaways of neuroscientific research; at worst, they rehash neuroscientific ideas that are already outmoded.

In “The Grieving Brain,” O’Connor constantly hedges when writing about the status of knowledge in the field. Here she is on mirror neurons, brain cells that TikTok users can’t get enough of. She’s using them to explain how “neural machinery” helps us feel close to others, and later how our brains struggle when we cannot be close to our dead: “If you show a monkey that you are doing something with your hand — grasping a banana, for example — some of his same neurons will fire when he watches you grasp the banana as when he grasps the banana himself.” Immediately following this clunky explanation, she inserts a caveat that I had never seen issued in discussions of mirror neurons, which come up frequently to explain empathy: “Despite the widespread interest in mirror neurons, human neuroimaging does not have sufficiently high definition to detect individual mirror neurons in humans.”

In “The Body Keeps the Score,” van der Kolk writes about those same monkey experiments on mirror neurons, calling them “one of the truly sensational discoveries of modern neuroscience.” He obscures the distinction between monkeys and humans, though: “Numerous other experiments followed around the world, and it soon became clear that mirror neurons explained many previously unexplainable aspects of the mind, such as empathy, imitation, synchrony, and even the development of language.” This makes it sound like experiments on humans followed. Yes, we are closely related to the macaque monkeys used in these studies, but the connection between our evolutionary lines diverged 25 million years ago. Our brains are capable of more than monkey brains, and not just because they are bigger.

Beyond the hyperbole common when neuroscience crosses over into self-help is the popularization of theories that have already been disproved. “The Body Keeps the Score” takes the prize in this realm. Van der Kolk is totally credulous when it comes to researcher Stephen Porges’s ideas about the vagus nerve, a central component of the parasympathetic nervous system that controls basic bodily functions such as digestion and resting heart rate.

As van der Kolk sees it, Porges’s polyvagal theory explains why, when faced with danger, people respond in different ways. When we collapse or disengage in a dangerous situation, van der Kolk says, we’ve been taken over by the dorsal vagal complex, “an evolutionarily ancient part of the parasympathetic nervous system.” Except the dorsal vagal complex hasn’t actually been proved to exist in humans. Some of van der Kolk’s readers spread this theory further on Instagram carousels about trauma-informed parenting and breathing and stretching exercises to help you move from “freeze + disassociation states to calm and connection states.”

Perhaps unsurprisingly, van der Kolk also buys into the triune brain model, as do many therapists on social media. Maybe you’ve heard of it as your “lizard brain” or “reptilian brain” — the idea that humans have a primitive brain center that acts on instinct. The triune brain model, developed in the mid-20th century by neuroscientist Paul MacLean, has long been considered nonsense by most neuroscientists; the theory was first disproved back in the 1970s. Van der Kolk proposes that when we are pulled back into trauma, we behave like lizards. People still love this explanation — like mirror neurons, it’s all over TikTok.

Van der Kolk must be aware that his peers have long discredited the idea of the “reptilian brain,” but he continues to give it the sheen of scientific credibility in his work, perhaps because it speaks to something a large audience wants to hear: If some of our worst reactions stem from a primitive, animalistic part of our brains, we are not really responsible for them.

Neuroscientific self-help books scratch the same itch as labeling everything a trauma response , self-diagnosing ADHD and treating mental health diagnosis like a giant BuzzFeed quiz . They superimpose order on the messiness of emotions, telling us that looking inside the brain can explain why we feel so out of control. With neat answers come neat solutions, as though we can life-hack some of the hardest parts of being a person — grieving our loved ones, grappling with the long effects of trauma. But there is no remedy for the human condition, and implying that it’s all in our heads makes our pain seem like a glitch instead of a feature.

Kristen Martin is a cultural critic based in Philadelphia. Her debut narrative nonfiction book on American orphanhood is forthcoming from Bold Type Books.

‘The Body Keeps the Score’ offers uncertain science in the name of self-help. It’s not alone.

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Book Review: The Body Keeps The Score

The Body Keeps The Score is a book about post-traumatic stress disorder.

The author, Bessel van der Kolk, helped discover the condition and lobby for its inclusion in the DSM, and the brief forays into that history are the best part of the book. Like so many things, PTSD feels self-evident once you know about it. But this took decades of conceptual work by people like van der Kolk, crystallizing some ideas and hacking away at others until they ended up with something legible to the Establishment. Before that there was nothing. It was absolutely shocking how much nothing there was. As soon as the APA officialy recognized PTSD as a diagnosis in 1980, Bessel and his friends applied for a grant from the VA to study it. The grant was rejected on the grounds that (actual quote from the rejection letter) “it has never been shown that PTSD is relevant to the mission of the Veterans Administration”. So the first step in raising awareness of PTSD was – amazingly – convincing the US military that some people might get PTSD from combat.

After the military relented, the next step was convincing everyone else. PTSD was temporarily pigeonholed as “the thing veterans get when they come back from a war”. The next push was convincing people that civilian trauma could have similar effects. It was simple to extend the theory to sudden disasters like fires or violent crimes. But van der Kolk and his colleagues started noticing that a history of child abuse, and especially childhood sexual abuse, correlated with a lot of psychiatric problems later on.

Again, “child abuse is bad” sounds self-evident once you know it. But van der Kolk insists this is the result of hard work by a coalition of psychiatrists, psychologists, activists, and victims. When he first started raising awareness of the problem, nobody believed him. His grant proposal to study whether childhood trauma was associated with personality disorders got rejected too. He recalls that:

I was particularly struck by how many female patients spoke of being sexually abused as children. The standard textbook of psychiatry at the time stated that incest was extremely rare in the United States, cocurring about once in every million women. Given that there were then only about one hundred million women in the United States, I wondered how forty-seven, almost half of them, had found their way to my office in the basement of the hospital. Furthermore, the textbook said, “There is little agreement about the role of father-daughter incest as a source of serious subsequent psychopathology”…the textbook went on to practically endorse incest, explaining that “such incestuous activity diminishes the subject’s chance of psychosis, and allows for a better adjustment to the external world.”

Van der Kolk found that child abuse (sexual and otherwise) was both far more common and far more destructive than anybody else thought. He also found that it worked differently than regular PTSD. A soldier traumatized during war has already developed a sense of self, and has a concept of a safe homeland to return to if he makes it out alive; a child has neither, and has to deal with trauma again and again absent any trustworthy external support system. This is the same insight some researchers call “complex PTSD”; van der Kolk uses the terms “developmental trauma disorder” and argues it is the real culprit behind many people currently diagnosed with ADHD, bipolar, intermittent explosive disorder, oppositional defiant disorder, etc. He rejects at least some of these diagnoses as “pseudoscience…impressive but meaningless labels”.

A group including Van der Kolk tried to get developmental trauma disorder added to the DSM; the APA decided against it. He denounces this decision, which he thinks ignored several great studies that prove developmental trauma (ie child abuse) is much more important than anyone else thinks. I have a lot of opinions about this section.

First, I think van der Kolk downplays the importance of the APA’s philosophical commitment to categorizing by symptoms rather than cause. Consider four patients, Alice, Bob, Carol, and Dan. Alice has poor concentration caused by child abuse. Bob has poor concentration caused by bad genes. Carol throws tantrums because child abuse. Dan throws tantrums because bad genes. The current DSM would categorize Alice and Bob as ADHD, and Carol and Dan as intermittent explosive disorder. Van der Kolk would like to classify Alice and Carol as having Developmental Trauma Disorder, and Bob and Dan as…I don’t know. Bad Gene Disorder? Seems sketchy. When the APA decides not to do that, they’re not necessarily rejecting the seriousness of child abuse, only saying it’s not the kind of thing they build their categories around.

Second, van der Kolk really does not come across as a great source about the effects of development. He does not mention the possibility that links between parent behavior and child pathology might be genetic (ie a disordered parent is more likely to abuse their child, and to pass on genes for disordered behavior). In fact, he is weirdly and vocally ignorant about genetics in general, dismissing the entire field because “after thirty years and millions upon millions of dollars worth of research, we have failed to find consistent genetic patterns for schizophrenia – or for any psychiatric illness, for that matter”. When TBKtS was published in 2014, we already know with certainty that schizophrenia was about 80% genetic, and at least 15 genes had been identified as especially likely to be involved; today we know hundreds and can even make primitive polygenic predictors. The only gene he considers sympathetically is good old 5-HTTLPR, which he says proves that genes have different effects in children with vs. without abuse histories (like everything else about 5-HTTLPR , this has since been proven false). He shows total lack of interest in behavioral genetics and the challenge it raises to his hypothesis.

This is a very pre-replication crisis book. I don’t hold this against the author, I don’t think anyone’s really proud of what they believed pre-replication crisis, but it’s undoubtedly a product of its time. Mirror neurons, candidate genes, left- vs right-brained people, etc all make dramatic appearances. Nothing (except the genetics parts) are inexcusable or even certainly wrong, but all of them together concern me. And several of the book’s key studies are contradicted by later, larger studies. Van der Kolk talks about how childhood trauma decreases IQ, but some pretty good studies say it doesn’t . Even the studies that have passed the test of time look a little weird. The Adverse Childhood Experiences study found that obesity and other seemingly nonpsychiatric diseases were linked to child abuse, and recent studies confirm this – but the controls for socioeconomic status are always insufficient, and there’s surprisingly little shared environmental component . I’m biased about this, everyone’s biased, but part of the book was meant to prove that child abuse mattered shockingly more than you thought it possibly could, and that part was wasted on me.

Fine, okay, drop that hobby horse, what does this book have to say about PTSD?

The book stressed the variety of responses to PTSD. Some people get anxious. Some people get angry. But a lot of people, whatever their other symptoms, also go completely numb. They are probably still “having” “emotions” “under” “the” “surface”, but they have no perception of them. Sometimes this mental deficit is accompanied by equally surprising bodily deficits. Van der Kolk describes a study on stereoagnosia in PTSD patients: if blindfolded and given a small object (like a key), they are unable to recognize it by feel, even though this task is easy for healthy people. Sometimes this gets even more extreme, like the case of a massage therapy patient who did not realize they were being massaged until the therapist verbally acknowledged she had started.

The book is called The Body Keeps The Score , and it returns again and again to the idea of PTSD patients as disconnected from their bodies. The body sends a rich flow of information to the brain, which is part of what we mean when we say we “feel alive” or “feel like I’m in my body”. In PTSD, this flow gets interrupted. People feel “like nothing”. For example:

I don’t know what I feel, it’s like my head and body aren’t connected. I’m living in a tunnel, a fog, no matter what happens it’s the same reaction – numbness, nothing. Having a bubble bath and being burned or raped is the same feeling.

Or, borrowed from one of William James’ patients:

I have no human sensations. I am surrounded by all that can render life happy and agreeable, still to me the faculty of enjoyment and of feeling is wanting. Each of my senses, each part of my proper self, is as it were separated from me and can no longer afford me any feeling; this impossibility seems to depend upon a void which I feel in the front of my head, and to be due to the diminuition of the sensibility over the whole surface of my body, for it seems to me that I never actually reach the objects that I touch. All this would be a small matter enough, but for its frightful result, which is that of the impossibility of any other kind of feeling and of any sort of enjoyment, although I experience a need and desire of them that render my life an incomprehensible torture.

One other new thing I learned about PTSD is the importance of immobilization. Van der Kolk thinks that traumas are much more likely to cause PTSD when the victim is somehow unable to respond to them. Enemy soldiers shooting at you and you are running away = less likelihood of trauma. Enemy soldiers shooting at you and you are hiding motionless behind a tree = more likelihood of trauma. Speculatively, your body feels like its going into trauma mode hasn’t gotten you to take the right actions, and so the trauma mode cannot end.

There’s some discussion of the neurobiology of all this, but it never really connects with the vividness of the anecdotes. A lot of stuff about how trauma causes the lizard brain to inappropriately activate in ways the rational brain can’t control, how your “smoke detector” can be set to overdrive, all backed up with the proper set of big words like “dorsolateral prefrontal cortex” – but none of it seemed to reach the point where I felt like I was making progress to a gears-level explanation. I felt like the level on which I wanted an explanation of PTSD, and the level at which van der Kolk was explaining PTSD, never really connected; I can’t put it any better than that.

Why does PTSD exist? “The brain isn’t prepared to feel emotions as intense as…” Yes it is! Trauma is as old as living creatures; war, disaster, bullying, and rape far predate homo sapiens . Even if child abuse is rare in hunter-gatherer tribes (as some optimistic anthropologists claim) killing all the adults in a tribe and enslaving their children is pretty common, which cashes out to kids getting abused. Our evolutionary history should have prepared us incredibly well for all of this; the brain “getting stuck” in fear mode after a particularly bad trauma should be no more likely than the legs “getting stuck” in running mode after a particularly long chase.

And why would the body be so confused by the right action being “hide” or “accept the pain and abuse” rather than “run” or “fight”? The safest action has been “hide” or “accept the pain and the abuse” in a pretty good fraction of traumatic events since humanity came down from the trees.

And why should the consequences of this be the body going numb? Why not other things that seem more like the consequences of garden-variety acute or chronic stress?

I missed any answers that TBKtS might have contained to questions like these, and so a lot of its neurobiology ended up feeling more like a random collection of simplified facts than like real enlightenment.

But all of this would be excusable if TBKtS had answered the most important question: how do you treat PTSD? There are a wide variety of proposed methods, and I was looking forward to having an authority like van der Kolk sort through the evidence for and against each.

Instead, I felt like he rejected every conventional treatment on the grounds that they didn’t treat the root problem, then waxed rhapsodic about every single weird alternative treatment and how it was a perfect miracle cure that truly gave patients their lives back. I understand that he may just be presenting the alternative treatments that he found most effective, but something about the style here really turned me off.

There are a lot of alternative treatments for PTSD. Neurofeedback, where you attach yourself to a machine that reads your brain waves and try to explore the effect your thoughts have on brain wave production until you are consciously able to manipulate your neural states. Internal family systems, where a therapist guides you through discovering “parts” of yourself (think a weak version of multiple personalities), and you talk to them, and figure out what they want, and make bargains with them where they get what they want and so stop causing mental illness. Eye movement directed reprocessing (alternative when the book was written, now basically establishment) where you move your eyes back and forth while talking about your trauma, and this seems to somehow help you process it better. Acupuncture. Massage. Yoga.

There was a thing called “PBSP psychomotor therapy”, where the therapist would create “tableaus” representing people’s traumas. They would enlist an actor to play the victim’s abusive father, then another actor to play an idealized version of their father who didn’t abuse them and was always there when they needed them, then have them recite formulaic lines that “played their part” in the remembered (or alternative hypothetical) versions of the patient’s trauma. Gradually they would progress from the real trauma to a version where things had worked out better, with the therapist discussing the patient’s reaction the whole time.

There was a chapter on community theater, where troubled youth who would otherwise be sent to jail were instead asked to put on a Shakespeare production. This encountered some early hitches:

We were shocked to discover that, in scenes where someone was in physical danger, the students always sided with the aggressors. Because they could not tolerate any sign of weakness in themselves, they could not accept it in others. They showed nothing but contempt for potential victims, yelling things like “Kill the bitch, she deserves it,” during a skit about dating violence. At first some of the actors wanted to give up – it was simply too painful to see how mean these kids were – but they stuck it out, and I was amazed to see how they gradually got the students to experiment, however reluctantly, with new roles. Toward the end of the program, a few students were even volunteering for parts that involved showing vulnerability or fear.

The traumatic incidents in Shakespeare’s work helped them come to terms with their own difficult history:

As we’ve seen, the essence of trauma is feeling godforsaken, cut off from the human race. Theater involves a collective confrontation with the realities of the human condition. As Paul Griffin, discussing his theater program for foster care children, told me: “The stuff of tragedy in theater revolves around coping with betrayal, assault, and destruction. These kids have no trouble understanding what Lear, Othello, Macbeth, or Hamlet is all about.” In Tina Packer’s words: “Everything is about using the whole body and having other bodies resonate with your feelings, emotions, and thoughts.” Theater gives trauma survivors a chance to connect with one another by deeply experiencing their common humanity.”

Each of these stories about an alternative therapy was, on its own, inspiring. But after chapter after chapter on these, plus other even weirder things, you start to wish there was at least one alternative therapy that Bessel van der Kolk didn’t like, or one conventional therapy that he did.

This is a very pre-replication-crisis book. In these more cynical days, we know that the first few studies on any technique – usually done in an atmosphere of frothy excitement, by the technique’s most fervent early adapters – are always highly positive. And later studies – done in an atmosphere of boredom, by large multi-center consortia – are almost always disappointing. Half the time van der Kolk is so excited about the miraculous life-changing potential of the latest alternative therapy that he doesn’t list studies at all. The other half of the time, the studies are there to support his enthusiasm. But can they be trusted?

Overall, so many bizarre methods seemed to work so well (with no examples of anything that didn’t work) that it was hard for me to figure out how this book should affect my treatment decisions. Find the closest person in a robe and wizard hat and send all of my trauma patients to them, because every alternative therapy works equally well as long as it’s weird? This might actually be a good lesson, there are a lot of things in psychiatry where as long as people feel drawn in and “validated” the treatment works. But I’m annoyed I have to ponder this kind of thing on my own rather than have the book take a step back and wonder about these kinds of questions.

[Update, written a few weeks after the rest of this post: maybe it is all wizardry. I recommended this book to a severely traumatized patient of mine, who had not benefited from years of conventional treatment, and who wanted to know more about their condition. The next week the patient came in, claiming to be completely cured, and displaying behaviors consistent with this. They did not use any of the techniques in this book, but said that reading the book helped them figure out an indescribable mental motion they could take to resolve their trauma, and that after taking this mental motion their problems were gone. I’m not sure what to think of this or how much I should revise the negative opinion of this book which I formed before this event.]

Maybe the most consistent lesson from this book’s tour of successful alternative therapies – keeping with the theme of the title – is that it’s important for PTSD patients to get back in touch with their bodies. Massage therapy, yoga, and acupuncture addressed this directly, usually creating gentle, comfortable sensations that patients could take note of to gradually relax the absolute firewall between bodily sensation and conscious processing. Some of the other methods – the community theater, maybe even the internal family systems – seemed like tricks to get people afraid of emotions back in touch with their emotions anyway: “Oh, you’re not going to be feeling your emotions, just emotions from Macbeth or Hamlet or this other personality living in your mind”. I don’t know how plausible this interpretation is.

Overall, I was not too impressed with this book. The highlight was van der Kolk’s personal reminisces from the fight to get PTSD recognized as a real disease – but some of them were so over-the-top that I would have liked to triangulate them with a more objective history. The sections with the symptomatology and neurobiology of PTSD were helpful in exploring the boundaries of the syndrome, but didn’t make me feel like I really understood what was going on. The sections on the dangers of child abuse were a good knock-down of some hypothetical “child abuse isn’t really that bad” position, but I don’t know anyone who holds that position, and some of the research seemed questionable. And the section on treatment was so glowing about everything that it was hard to draw any specific conclusions.

Maybe a broader concern is that I seem to inhabit a different world than van der Kolk. All of his patients showed bizarre and florid sequelae from serious trauma. My patients seem to discuss their trauma with comparative equanimity, have only the usual psychiatric symptoms (depression, anxiety, etc) and not experience much benefit from the weirder alternative therapies they try. Some of this might be van der Kolk being a better doctor than I am, or having sicker patients. But I’m concerned about this because van der Kolk seems pretty good at doing what he does, and I would like to be able to inhabit his world insofar as he’s able to get good results in it. But insofar as my goal is to become more like Bessel van der Kolk, I was surprised how little this book helped guide me along that journey.

I think my actual takeaway is to screen for trauma more carefully, especially in patients who seem anhedonic or numb, and to recommend they go to a trauma clinic. There are a lot of places like this (I sometimes send patients to this one in Berkeley), and they practice a lot of the weirder alternative therapies that van der Kolk mentions (in fact, van der Kolk seems to work at/lead a very similar type of institution in Massachussetts). Whether or not these work for everybody, I think everybody deserves a chance at them, and I should take them more seriously at least until I get a better sense of the terrain here myself.

221 Responses to Book Review: The Body Keeps The Score

I recall that George Carlin had a monologue about PTSD being a mere neologism for the more direct phrase “shell shock” used in the First World War. Now I don’t typically take my psychology from comedians but is it really true that the military was reluctant to accept the reality of severe psychological trauma from combat given the well-documented extreme cases we can all watch on grainy recordings from the second decade of the twentieth century? The language of the grant rejection quoted in the text doesn’t clearly question the reality of the condition, and in fact could arguably read to presuppose its veracity.

I wonder about that too. Authorities during WW1 had little respect for human life, but a condition that prevented soldiers to return to the fight and made them completely useless in the field, regardless of threats or incentives, had to be extensively studied. How is it possible that PTSD took so long to be recognised, when there was already so much research done on “male hysteria” or “shell shock”? One can question the quality of the research conducted in those days and under such conditions, but I don’t see how one would question the existence of the condition.

@RC-cola-and-a-moon-pie

The military has historically been very concerned about desertion and/or not rewarding cowardice.

Furthermore, WW 1 was the war that changed the view on war significantly, from a very heroic endeavor that turns boys into men, to something that can be a meat grinder that turns boys into corpses and invalids.

I think that it is hard for modern people to understand the mindset of the day.

Another Carlin (Dan) gives a pretty good account of this in his six(!)-part series about WWI. He paints the view of war as a glorious adventure, where anyone could find fortune and renown in daring charges, gallant last stands, and inspiring personal combat. All of this was because of how bespoke war was. The Industrial Revolution hadn’t made its impact felt yet – the only harbinger of things to come was the Russo-Japanese war. Then came the Great War, with its machine guns and trenches and artillery and thousands lost in a single day with no ground gained. Nations had industrial bases now. It took a lot more to knock one out of a fight.

Which is a bit weird to me – Europe had experienced long wars before. But there it is. Maybe the camera and broadcast media played a key role in bringing it all home.

I was going to recommend Dan Carlin’s Blueprint for Armageddon as well. It’s an incredible explanation about the history and legacy of WWI and gives a great account of how soldiers were affected at the time, and how military institutions responded and reacted to the newly seen condition of “Shell Shock”, which we now know as PTSD.

Specifically, this quote in this post jumped out:

One other new thing I learned about PTSD is the importance of immobilization. Van der Kolk thinks that traumas are much more likely to cause PTSD when the victim is somehow unable to respond to them… Speculatively, your body feels like its going into trauma mode hasn’t gotten you to take the right actions, and so the trauma mode cannot end.

Dan Carlin discusses this type of feeling in detail and gives a WWI veteran’s description of what it was like to have gigantic, modern artillery shells constantly exploding all around you. The soldier said it was like being tied to an iron stake and having an executioner repeatedly swing a giant battle ax right at your head, only he misses each time, and hits the solid metal pole an inch above your scalp.

This was a new form of torture that soldiers hadn’t experienced before. For all of human history, nearly every battle ever fought happened over the span of hours or maybe days, and occurred in an easily identifiable location like “Thermopylae” or “Bunker Hill”. WWI was the first war where battles lasted months , and the battlefield spanned a continent. Soldiers were subjected to incomprehensibly hellish conditions for extended periods of time. They were trapped in a combination trench/sewer/mass grave, unable to affect their surroundings, and all just to gain a few hundred yards of territory, which would be lost to the enemy within a month.

At the time, military culture held the gallantry of soldierly virtues and heroic self-sacrifice in the highest regard. When the high-ranking military officers saw huge numbers of soldiers fleeing or refusing orders, they considered it a bizarre and egregious form of cowardice, and well-deserving of a firing squad. Eventually, doctors saw it as a traumatic injury, and some suspected it was a physiological response to the huge pressure waves of exploding shells (hence the term “shell shock”). Over time, people recognized the obvious psychological damage of modern warfare and the devastating effects it had.

Anyways, I highly recommend the podcast series, both for the history lesson and the relevant discussion of the psychological effects of extreme trauma.

@Paul Brinkley

I think that there is a big difference between a long, fairly low intensity war vs the extreme experience of WW I. Even Napoleon’s campaign in Russia, which was very extreme for the time, had only a tenth of the casualties of WW I & far fewer battles.

Also, something that is probably very important: most casualties of Napoleon’s campaign and other pre-modern battles/wars happened during a rout, while WW I ‘punished’ the attacker to an extreme degree. This probably shattered a sense of justice, which is probably more important than the bare number of casualties, when it comes to having or losing a sense of rightness in the world.

Anyway, Theodore Roosevelt is a good example of someone who saw war as a glorious adventure. Yet when his son died in WW I, it devastated him…

Dunno about WWI, but the Patton slapping incidents (or rather, the ensuing scandal) seem to show that by WWII the US military establishment believed “shell shock” was a real medical condition.

Not to mention the 1946 documentary “ Let There be Light ” on the topic of shell shock among returning WWII veterans. It was produced by the Army but then suppressed (also by the Army) for fear of reducing enlistment.

Here’s the George Carlin bit: https://www.youtube.com/watch?v=hSp8IyaKCs0

“Shell Shock” was generally presumed to be a physiological rather than psychological condition, the result of traumatic brain injuries due to the blast effect of nearby exploding shells. Which, to confuse matters, is actually a thing – just not a thing that could explain most of what WWI-era doctors were attributing to “shell shock”.

Given the general stigma towards mental illness that leads to it being seen as a moral failing, it was “helpful” to have a purely physiological cause to pin everything on, and please to ignore all the “shell-shocked” soldiers who were never actually near an exploding shell. If we say it’s psychological, then we’re saying it’s a moral failing, which in this context is at least adjacent to cowardice. Cowardice in battle has to be extremely discouraged, but nobody wants to shoot or imprison all these sympathetic victims, so just diagnose traumatic brain injuries all around.

From “shell shock” we get to IIRC “battle fatigue”, which again seems plausibly physiological and not cowardice-adjacent, but doesn’t need the exploding shells. By the time we’re calling it “PTSD”, we(*) are at least somewhat willing to entertain the concept of a mental illness that isn’t a moral failing. Now we can start looking for effective treatments.

* Meaning the general public, and military decision-makers in particular, rather than mental-health professionals.

Before that we had “soldier’s heart” — also called DaCosta syndrome, after the doctor who figured out that it wasn’t damage to the heart.

Indeed, there does appear to be a strong physical component to soldier’s ptsd and in general anyone who works with loud machinery.

There were a couple of guests on a Joe Rogan podcast a while back who talk about this. They said one of the biggest issues is a lack of ability to produce hormones after brain damage which lead to a lot of these depression and PTSD symptoms. They have an interesting treatment protocol which overlaps these sorts of mental illnesses with traumatic brain injury in general. Even a simple car accident or banging of the head can do it.

You can check out the Warrior Angels Foundation as well, where this doctor works with many vets.

I’ve found some of these protocols to be personally helpful, but I’m not being regularly tested or getting direct testosterone injections as the protocol sometimes calls for. Still it fits in well with the theme of this article and Scott’s general preference for physiological/biological explanations – though it doesn’t address all causes, such as childhood trauma with happens without brain injury.

http://jrefan.com/the-joe-rogan-experience-episode-1056-with-dr-mark-gordon-and-andrew-marr/

those are 3 different conditions but apparently public discourse can only contain a single combat related mental issue at a time

With respect to shell-shock, I guess it’s interesting that trench warfare is exactly the kind of conflict that should generate PTSD on van der Kolk’s view. Being held static for months at a time with shells raining down on you, only to be massed into a sudden assault with high probability of mortality is nightmarish in prospect, let alone for real.

Given that being drafted (WWI, Vietnam) is itself a form of being held immobile, I wonder if here is higher PTSD in draftees over volunteer soldiers?

I think that contemporary (post-1900) warfare is more likely to cause PTSD than earlier warfare (even if “months at a time” is an exaggeration — armies in WW1 tended to rotate their units out of the front line after a week or so). In earlier conflicts, you’d have maybe one or two big battles per campaigning season, and each battle would usually be over and done with in a single day; even earlier, before gunpowder weapons became dominant, most people would be fighting hand-to-hand, where they had an opportunity to defend themselves, rather than hiding and hoping that none of the enemy shells happens to land in your position.

I wonder if the experience of being in a formation with many other people also tends to help protect against PTSD? It certainly helped armies get soldiers to not run away in the face of danger.

I can’t seem to find it, but I remember reading something fascinating about PTSD-like symptoms in ancient armies – specifically, traumatised Roman soldiers were supposedly said to be haunted by the ghosts of those who died around them.

A great deal of ancient poetry puts a surprising amount of emphasis on the horrors and evils of war, but my suspicion would be that it’s a lot easier to talk about glory and nobility in battle when it’s a question of who puts a spear through whom first than when it’s a question of how many people inhale chlorine and drown in their own blood.

I’ve always heard that attributed to Assyrians. . . it was probably common, the question is whose records survived.

It was in the comments of this blog, IIRC.

Also I think WWI was one of the first times when a load of literate people were conscripted to fight. It’s possible that pre-moder folks got PTSD, but nobody literate cared about them enough for it to enter the historical record.

The American Civil War was fought between two very literate sides, although the North was more literate at the time.

Most European countries had conscription during the second half of the 19th century, and literacy levels were pretty high by that time. It’s not like the period was short of wars, either: you had the Franco-Austrian War, the Schlesvig-Holstein War, the Austro-Prussian War, the Franco-Prussian War, the Russo-Turkish War, the Balkan Wars…

What today we call “PTSD” was called “Soldier’s heart” after the American Civil War, and “nostalgia” back to the Revolutionary War era. That was about as early as you can go, and get anything even approximating science and systematic data collection in medicine. This is not a new discovery to society.

One problem today is that, in veterans, it is often a co-morbidity with traumatic brain injury– even 20 years ago we didn’t understand how micro-trauma can cause major problems with things like working memory, impulsiveness, judgment, etc.

This is something I’ve also wondered about. Even a long career in a pre-1850 military was probably fewer days of actual combat than a single tour in Iraq or Afghanistan. But I also remember reading somewhere (On Killing or Acts of War, I think) that it might be partially due to the way we use troops nowdays. During WWII, you usually came home via ship with your unit, or at least with other men who had seen combat. You could talk about it before you had to return to civilian life. Starting in Vietnam, you could be stepping on American soil 24 hours after you got out of the jungle. Vietnam also had the problem of stupid rotation policies, where you got separated from your unit on return.

Ancient city-states often fought wars quite close to the home city (according to Google Maps, for example, you could walk from Athens to Marathon in under eight hours), although I suppose in those societies the army tended to be a citizen militia, so even in civilian life you’d be interacting with many of the same people whom you’d fought alongside (ETA and hence could talk with them about what had happened). Lots of cultures apparently also had ritual cleansing ceremonies for soldiers returning from battle, which I suppose would also help to mark a clear transition to civilian life (and hence no need for continued vigilance and the like).

Those rituals were actually mentioned in the book as another example of the same process. And even if you were an Athenian who fought at Marathon, you probably weren’t spit out back to civilian life the next day. Time spent theoretically still on duty after the battle would still probably count for decompression.

I think it would depend on the exact situation. Most city-states had very small territory — less than a day’s walk in each direction, in many cases — and if you were called out to, say, drive off a raiding party from the next city, you could well march out, fight, and return to the city within a day. And in the case of Marathon specifically, the Athenian army hurried back immediately to stop the Persian fleet reaching Athens while they were away. So in such societies, I think that specific end-of-battle or end-of-campaigning rituals, and the general militarisation of society, would be more important in preventing PTSD.

Probably On Killing . I remember the argument, and I’ve read that but haven’t read Acts of War .

I’ve gotten pretty skeptical of Grossman since then, though.

Me, too. I read them within a few months of each other, so I can’t say for certain which it came from.

This is also discussed in Shay’s books about PTSD Achilles in Vietnam , whose patient testimonials emphasizes the way in which US command deployed soldiers and officers by a method which seemed to maximize the amount of trauma they would experience and diminish their ability to psychologically recover from battlefield situations.

Specifically, extended times in the field, constant rotations of soldiers and commanders in platoons and companies weakening comradery, the M-16, unfair practices by officers when on patrol putting the same guy on point multiple times in a row, requesting and being denied air support or artillery support in a hot zone (pretty rare though, I think).

The Germans didn’t rotate as much, tended to mostly use their troops up, so when they sent people to the trenches they were all fresh and motivated.

It’s also exactly the kind of conflict that should generate traumatic brain injury, since World War I saw the first wide scale use of high explosive artillery shells. George Carlin’s bit was about how political correctness obscures the true nature of things via euphemism, and he might have been more right than he knew. Research into PTSD during the wars in Iraq and Afghanistan showed almost no correlation between the horribleness of the wartime experience (in terms of injuries suffered, gore observed, friends dead, subjective perception of danger, etc) and the rate of PTSD. There was a great deal of correlation between proximity to explosions and PTSD. The term “Shell Shock” actually contained a really important clue as to the cause of the condition, and that clue was lost as we kept changing the condition’s name.

Learning all this has made me extremely skeptical that the condition suffered by soldiers in war has anything to do with the condition suffered by victims of childhood sexual abuse. I’m sure both are equally real and equally serious, but trying to apply the same treatment to both may be a misstep.

C-PTSD is completely different from PTSD. PTSD is what the war vets get, C-PTSD is what a child who is abused daily with no escape gets. PTSD can be treated with EMDR and exposure therapy, C-PTSD is interwoven into the person’s psyche, because the trauma with no escape was there throughout a significant part of their formative years, and so there are zillions of different traumatic events memories of which the child suppressed in order to survive. EMDR, exposure therapy and other kinds of trauma therapy destabilize the walled compartments and overwhelm the delicate balance, often leading to retraumatizing, lasting depression, suicidality and general decrease in the quality of life. Yet the therapists tend to use PTSD techniques on C-PTSD survivors, with predictably ill results. There are some promising pharmacological treatments, like the current MDMA trials, and therapies, like healing a wounded inner child, or, more recently, working on Internal Family Systems. Also, consider having a look at Pete Walker’s book Complex PTSD: From Surviving to Thriving . Maybe you can review it at some point.

This matches with my intuitions/experiences. I’d be interested in that review.

In line with Van der Kolk’s efforts. C-PTSD is not a recognized diagnosis unlike PTSD. We can’t get approved therapies for C-PTSD because we can’t get research grants for diagnoses that don’t exist. Thus people use the treatments that do get funded and label the outer treatments as “woo” because the system won’t recognize C-PTSD as a legitimate thing.

I have training in IFS and like it a lot. I think it helps people feel safe and in control when exploring their past traumas.

Well, now I feel like I’ve dodged a bullet by not yet starting EMDR. Your comment prompted me to see in a new light the rapid and serious decline my quality of life took when I started conventional PTSD treatment for my C-PTSD. (Concrete example: I was able to brush my teeth at least once or twice a week before treatment. Now it’s barely once a year, even using every trick in the book.)

I had been considering EMDR for what I believe are C-PTSD symptoms; I will not be seeking that out now, so thank you.

I tried MDMA for the first time in 2015 and it was essentially the beginning of my “real” life. Up until that time, I was so emotionally over-regulated that I didn’t even realize I needed help.

This also matches my experiences. I think C-PTSD is probably worth recognizing as different than PTSD because the symptoms and treatment are significantly different. I can respect that there might not yet be sufficient evidence to add it to the DSM, but I don’t think the “bad gene disorder” analogy in this review is fair.

I second the recommendation for Pete Walker’s book for what it is worth.

Those interested in an accessible yet academic-level discussion of C-PTSD, I warmly recommend this blog . The author has since focused on sex blogging with emphasis on mental health, so not linking it here, but a search for “deviant succubus” will get you there.

I think Betrayal Trauma: The Logic of Forgetting Childhood Abuse would be worth reviewing– it’s based on the theory that people are more likely to forget abuse if acknowledging it would risk losing needed support. And the forgetting can work more strongly than I would have thought– it’s possible tor children to be abused nightly and forget during the day.

The book has a deep dive into how memory works and evidence about remembering and forgetting traumatic events.

There was a recent This Ameican Life episode about CPT: cognitive behavioral therapy for PTSD ( https://www.thisamericanlife.org/682/ten-sessions ). Does anyone have an informed view about CPT?

The VA has a specific CBT protocol for treating PTSD. Many people see it as re-traumatizing and most veterans who undergo the treatment dislike it and prefer something else. Is that protocol CPT? I don’t know. CBT has expanded in so many ways that you can classify a lot of stuff as CBT without being CBT.

Trauma is a focus of my work and I use CPT a lot in my psychotherapy practice.

I really believe the research showing that most all therapy techniques are more or less equal in the context of a trusting, therapeutic relationship where the common therapeutic factors are in place. Having said that, all techniques are not equally effective for all people, so part of the challenge is finding the way in for each individual person.

CPT is good for folks who are fairly articulate and can access their cognitive functions easily, even when somewhat distressed.

For people who lack insight into their emotional turbulence, who are very well defended, who dissociate under stress, or who are not big verbal processors, there may be better options.

All the different flavors of trauma treatment are different roads into “trauma processing” — which is really just a way for a person to sit down with and face the horror of their experience and its impact on them in the presence of a safe witness/guide. Which approach a therapist takes should depend mostly on the learning/processing style of the client, but often depends instead on the latest fad in psychotherapy or what that therapist feels most comfortable doing.

Trauma has a way of freezing people’s development in various ways and so trauma processing is not always the end of it (sometimes it is), and the person needs help bringing along underdeveloped parts of themselves. Chronic neglect or abuse in childhood tend to produce adults who chronically neglect and abuse themselves, to put it simplistically.

I have a personal anecdote about use of CBT. I have found it a helpful way of classifying and deconstructing my neuroses. I had had an extended traumatic experience which, I think, would be classified as PTSD, although it was not diagnosed. Psychologist described to me CBT especially the book Schema Therapy which he allowed me to borrow. After about two months, I was able to quickly recognize when I was actualizing the cycle of spiralling thoughts and take a step back to stop from that downward slope.

I have to say though, that there is, of course, more to full flourishing than control over one’s thoughts. My environment changed too. The people around me were more well-adjusted, positive, and supportive. That also released a lot of the psychological tension and diminished the likelihood of these wild psychological reactions.

The current DSM would categorize Alice and Bob as ADHD, and Carol and Dan as intermittent explosive disorder. Van der Kolk would like to classify Alice and Carol as having Developmental Trauma Disorder, and Bob and Dan as…I don’t know. Bad Gene Disorder?

This is exactly how successful medicine works. Understanding what causes a disease is very often necessary to successfully treat it.

Imagine four people who have headaches. The “current DSM” method would classify all of them as having the “headache” disease. An actual medical investigation would find that one has the flu, one was over-stressed at work, one just had a stroke, and one is dehydrated. Knowing this, each of them could then get the treatment which works for them.

Van der Kolk is proposing one explanation of the causes. Is it right? Who knows, but we can think of ways to test it. If it turns out to be right, we are that much closer to a treatment. If not, we can try a different explanation.

Indeed. This insistence on categorizing crude symptoms may be why psychiatry progresses so slowly and appears incapable of handling more complex things like autism.

What is the evidence that any causal explanation is correct? What is the evidence that any treatment works?

I’m probably way to uncharitable towards psychology as a field, but with a few exceptions, it seems riddled with completely ad hoc hypotheses and argued by deference to authority, and diagnoses appear to rise and fall based on factors like societal acceptance, reward, opportunity, and downright fashion.

Where is the rationalist approach to all of this?

Psychology =/= psychiatry. Psychology is more like this than psychiatry, although psychiatry is more like this than, say, internal medicine. Partly this is due to systemic failures, partly because the more abstract the subject matter, the harder it is to study empirically.

All right, so I went and did my own homework, viz. Googled the literature. Trauma-focused therapy is what works, including Prolonged Exposure (PE), Cognitive Processing Therapy (CPT) and trauma-focused Cognitive Behavioral Therapy (CBT). From a cursory glance, it means you keep going over the traumatic experience more (CPT) or less (PE) analytically, to basically put it behind you and to desensitize your emotional response.

I find this credible.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6224348/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5126802/ https://www.sciencedirect.com/science/article/pii/S027858461830143X

That’s not really true in psychiatry. We don’t really have good causitive biological models of, well, basically most of the common psychiatric entities.

When we do, we might be able to group and treat via cause. Although, equally, we might not given there’s probably a neurodevelopmental component to a lot of them.

As it currently stands, I really can’t see how anyone can advocate not grouping by symptoms. It’s the best system we’ve got and it categorises people who respond to different treatments well.

I think this is complicated and depends on (among other things) to what degree our current treatments are symptomatic vs. disease-modifying.

Suppose you have pain in your arm due to a bacterial infection. A symptomatic treatment would be Advil (reduces pain regardless of what the cause is). A disease-modifying treatment would be antibiotics (kills bacteria regardless of what symptoms they are causing).

I don’t think there’s an official position about which of these categories psych treatments fall into. I suspect the drugs are mostly symptomatic – for example, antidepressants will reduce depressed feelings around the death of a loved one. This maybe bleeds into disease-modification – I think stress reinforces depression, so if the antidepressant is just making you less stressed, that in itself can help the depression go away at the root – but all of this is wild speculation.

Antipsychotics are close to disease-modifying (there’s some evidence they can arrest the progression of schizophrenia or prevent prodromes from turning into full schizophrenia), but they’re also clearly symptomatic on some level (e.g. they work both on bipolar psychosis and schizophrenic psychosis, and they even seem to work a little for dementia psychosis).

If you mostly have symptomatic treatments, you should probably use symptomatic categories; if you mostly have disease-modifying treatments, you should probably use disease-modifying categories. This is just my opinion and I’ve never heard any official APA or DSM people talk about things at this level before (though I’m sure it’s happening somewhere).

If you mostly have symptomatic treatments, you should probably use symptomatic categories; if you mostly have disease-modifying treatments, you should probably use disease-modifying categories.

And if you have both, you might need both kinds of categories, instead of dogmatically choosing one.

But imagine that medical science were still in its earliest stages, and the best treatment it had for any type of headache, regardless of underlying causation, was to prescribe aspirin to treat the symptoms.

In that case, classifying all those headaches together makes a lot more sense.

Psychology and psychiatry are still maturing, and treating symptoms for lack of a better option is still very common. This is also complicated by the fact that many conditions get moved from psychology to medicine once we understand the root biological cause and have a standard medical treatment for it.

I agree with this view.

The DSM is structured the way it is because we don’t understand causes in mental illness. There are some pretty big areas of non-psychiatric medicine that are also this way — all kinds of chronic conditions, gut illness, back pains, neuropathies, and so on. Even with something like diabetes or hypertension or hearing loss, we are treating symptoms and we have some ideas about risk factors. But it’s not like, X bug causes Y infection, and so we apply Z medicine which kills X bug. Infections and mechanical problems where causes are readily apparent are a big part of medicine, but by no means all of it.

PTSD is one of a very few psychiatric conditions that is definitionally anchored to a cause — ie, a traumatic experience.

Even with knowledge of that cause, though, it’s a cause that happened in the past and cannot be undone, so we can’t go “fix” the cause.

Even with PTSD, we don’t understand why some people who experience trauma don’t develop PTSD and others do. We can say some things about risk factors, but that’s all.

In 2013, new head of the NIMH Tom Insel launched a big effort to re-write our psychiatric nosology around biological causes for mental illness (called RDoC or Research Domain Criteria). Insel left two years later and I think this effort has only limped along because we simply don’t have the science yet.

I have some experience in running personal-growth retreats for young adults (completely volunteer-run, within the Scout organization in my country). Some of the people I worked with had psychological/psychotherapeutical education and spoke a lot about “connecting with your body”, “understanding your emotions through your body” or “being IN your body” and similar stuff broadly in-line with what I understand the book to be about. And for what it’s worth, I’ve found this framework to be quite useful in designing activities and experiences that the participants mostly enjoyed and in retrospect rated as positive, helpful, sometimes even life-transforming.

I don’t claim it is true, just that it helped me – as someone who tends to be quite rational and has relatively shallow emotions – think about psychological processes in others and design activities that help them grow as persons.

Speaking as someone who has felt like an advanced consciousness trapped in a primitive meat vessel for most of my life, I agree with your retreat participants. Mindless physical activity often creates a state of “flow” that is liberating and pleasurable.

I mostly go out in light clothing even in winter and this year, even should there be snow and ice this year. A because I can B because it feels exhilarating Nothing better for getting in your body, than having all those normally equilibrated-and-bored-out-of-their-skull thermal receptors all start screaming at the same time.

And I really need that. Shallow emotions and if I don’t pay attention, dull apathy.

This comment isn’t related to the main theme of Scott’s post, but is in regards to the “APA’s philosophical commitment to categorizing by symptoms rather than cause.” I think this approach might be counterproductive and inaccurate in some cases. For example, there is significant overlap or comorbidity among anxiety disorders. As a pre-teen I was diagnosed with OCD, GAD, *and* panic disorder with agoraphobia, based on having symptoms that met the criteria for each. Believing that I had three separate and unrelated disorders was devastating. On the other hand, there was a 19th/early-20th century concept of “neurasthenia” that basically grouped all of the anxiety disorders together based on the proposed common cause of an “over-reactive” nervous system. Patients often shifted between various symptoms, and benefited from a common treatment for all. Believing that I had a neurasthenic phenotype that could cause various symptoms of anxiety didn’t seem as bad/unusual/isolating as having three disorders. If there is a genetic basis for an anxious temperament, then categorizing the disorders based on a common cause would seem to be an appropriate model.

Your experience seems pretty typical, but I’m not sure this is a failure of grouping by symptoms rather than cause – all the symptoms you describe tend to run together, so a good symptomatic grouping system should classify them as one condition!

I think the problem here is just that the categories are too fuzzy – if people with depressed mood are 80% likely to have low energy, 50% likely to have anxiety, and 20% likely to have obsessions/compulsions, at some point you need to arbitrarily group (mood, energy) together as “one disease”, and (mood, energy)(anxiety) separately as two highly comorbid diseases. This is naturally going to be an unprincipled or barely-principled distinction. Borsboom et al’s idea of symptom networks rather than diseases tries to address this problem, but it’s a lot harder to understand and work with than the traditional system.

If it were easier to find the common cause, I suspect our diagnostic methods would change dramatically. As it stands, professionals like to work with that which they can observe, so symptom-based criteria is the standard.

I don’t know this for sure, but I suspect that “cause” when it comes to anxiety is like “cause” when it comes to cancer, which is to say it’s a mix of genetics and environment. Same perhaps with autism or autoimmune disorders.

The DSM always asks “is this presentation of symptoms better accounted for by a medical condition?” and so it’s important to test for hyper or hypo thyroid, anemia, drug-induced anxiety or agitation, etc.

Some people’s anxiety is almost entirely stress-induced — which is to say, they have no history of anxiety but it came on when their sick, elderly mother moved in with them or when their daughter developed a heroin habit.

So for now, the DSM is just a way to corral symptoms and says nothing about causes or treatment. It just gives us a shared language — but mainly, a way to bill for insurance. It’s not a very impressive book at the end of the day, but we also don’t have something better.

This is so well said, both about the big overlap between anxiety “disorders” and the impact from a patient’s point of view of being overly-labeled and inadequately understood.

It’s particularly odd when our treatments — whether medication or talk therapy — are not specific enough to differentiate between treatments for one or the other type of anxiety.

This doesn’t counter anything you say here. I would only add that as a clinician who mainly treats anxiety and PTSD that having names for the different flavors or manifestations of these conditions and having research and writing that speaks about these different flavors is helpful.

There is writing about anxiety research and treatment that proposes different causes for these different flavors but my impression is that this is more speculative or impressionistic based on lots of clinical experience rather than being actual science.

I’m confused by the image on that book cover. It looks like this person has two legs, one naked boob, and… four arms? Two arms and two bunny ears, perhaps? And her head is weirdly bulbous.

What is this image trying to convey?

— I mean, I assume it’s trying to convey “people who have trauma tend to have a strange connection to their bodies and this twisted deformed image of a body represents that strange connection”. I just don’t get that very well from this image of a person with a naked boob and bunny ears.

Not that it answers your question, but it’s one of the Matisse cut outs. “Blue Nude with Hair in the Wind” http://www.matissepaintings.org/blue-nude/

That actually does help a lot. Thanks!

Huh, I would have guessed it was a scarf.

I thought it was a bipedal rabbit 🙁

Isn’t this called a Rorschach test?

”…the textbook went on to practically endorse incest, explaining that “such incestuous activity diminishes the subject’s chance of psychosis, and allows for a better adjustment to the external world.”

Yes, yes of course. As Nietzsche said: “What doesn’t kill you, makes you stronger.”

More seriously I’d want to see that standard textbook, before I just believe that claim. It sounds on the surface preposterous. Sure, it’s medicine and of that psychiatry….. but that sounds extraordinarily stupid and downright perverse by pretty much any cultural standard in human history. And if it was a standard textbook, were there other textbooks as well with wildly different ideas? Is this some Freud fetish or Lancan fetish rearing its ugly head? Did anyone ever take that claim seriously? Did psychiatrists ever tell their patients to diddle their daughter or encourage pedophiles?

I don’t mean to say that van der Kolk is making this up or that this is even wrong, just that it would be nice to know a little more about this. Could you or someone else expand on this? I have trouble believing it or at least don’t know what to make of it.

Not a direct answer to your question, but FWIW, I once went to an estate sale where the decedant was, judging from the items for sale, a professional psychotherapist of some sort. I purchased a few books and one of them was a pop-level book written by an apparently serious and credentialed psychologist, who in one of the chapters advocated for incestuous interest from parents to pubescent children as a normal and healthy part of development… basically the exact same answer he gave for masturbation or homosexuality: “no big deal, get over silly taboos”.

I think his ideology was something like: as long as everyone treated sexuality as a completely normal, guilt free thing, then nobody would end up with any neurotic troubles from it. The 60’s were a weird time.

My ability to recall further details (e.g. author, title) is hampered by the fact that I didn’t want that book on my shelf, and also didn’t want to give it away to anyone, so I threw it in the garbage.

I suppose so. I’m unaware of the history of the field. What does credentialed and standard mean in the sixties? Standard textbook implies that this was consensus, but I’d have trouble believing that. And if that was consensus among psychiatrist, I’d expect psychiatry itself to be this fringe thing, that noone took all too seriously. Though when watching “Annie Hall” I get the impression that psychiatry was mostly an odd Jewish cultural practice, rather than a field of medicine. The German title of this movie is “der Stadtneurotiker” (the city neurotic) being more true to what the film is about.

As I implied, my memories of the book are rather fuzzy now, but IIRC he had “Dr.” in front of his name and saw patients…

I’m just providing one data point, not making a claim about what was “mainstream” then in the sense of consensus. I was born in 1984; I wasn’t there. But I’m guessing that things would go very differently if a clinician tried to advocate for parental incest in print today…

I mean, I heared there where those people that argued stuff like that. But were they ever the mainstream?

But were they ever the mainstream?

Talk psychotherapy itself was not “mainstream” then. People knew it existed, because it was portrayed in fiction, mostly as something that “rich people from New York did” or “something that anxious parents sent their sullen teenager to to talk to someone with a diploma”, but what the actors lines were likely barely related to what the advanced textbooks said or what was spoken in sessions.

I’m pretty sure I read a copy of that book, or one substantially like it.

It was a library book, so I couldn’t throw it in the trash.

The 60s and 70s were a weird and more than a little bit disgusting time.

There was a fairly well-known educator where I grew up who wrote a lot like this, saying things like “the teacher should appear to the pupil as a sexual being” and trying to “liberate” people from old-fashioned taboos about sexuality. He also was very supportive of “progressive” education and a lot of his theories sort of became dogma in the local teacher training institute.

It turned out recently that he was also a serial child abuser.

> but that sounds extraordinarily stupid and downright perverse by pretty much any cultural standard in human history.

Not quite. Some native tribes let their babies cry on purpose for a while, because it would make more ferocious warriors. [citation needed]

Googling for the quote, I found another reference with more details. The book was Freedman and Kaplan’s Comprehensive Textbook of Psychiatry . With regard to father-daughter incest, it asserts that “the vast majority of them were none the worse for the experience.”

Like Scott’s patient, I experienced tremendous breakthroughs with respect to my mental health after reading this book. I already knew I had anhedonia and the related difficulties in motivating myself, and thought I was on the way to fixing this because therapy had helped me come to a conceptual understanding of the childhood experiences behind the numbness. But I didn’t know what I didn’t know… this book evoked the frozen and lifeless quality of trauma in a way that resonated so strongly I could no longer deny that there was trauma involved with my problems. It made me realise that there was a whole series of internal sensations and processes that I was actively missing. As a result I then read In An Unspoken Voice by Peter Levine, and by following the exercises in that book I’ve made inroads into resolving that trauma and becoming a happier and more effective creature. While I was also annoyed by the breathless sections on whatever fad treatment had popped up, I’m nevertheless tremendously grateful for this book.

If people want a summary, this paper by Levine and chums goes over the method and the proposed pathways by which it might work. I haven’t really interrogated the sources but I’d be interested to hear thoughts from people with subject expertise: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4316402

adding Levine to my reading list; thank you!

This is so cool to hear.

I’m interested in this phenomenon more broadly. There are lots of folks who say their back (or other mystery) pain resolved after reading John Sarno’s books.

For pain that is psychogenic in nature, whether the pain is emotional or physical, it seems a receptive mind is a good thing, and in that way, reading a book is not so different from talking to a therapist.

I’ve had clients come see me for just a couple of sessions because they noticed a huge improvement in their presenting problem after they called to schedule an appointment and before showing up to meet me (there’s research about this, btw). We just have a couple of sessions to make sure that result sticks.

re: ADHD I thought that ADHD was fairly well understood on a neurological level these days? Does the author discuss the proposed 30% reduced “executive age” in children affected with ADHD? https://www.youtube.com/watch?v=BzhbAK1pdPM&list=PLzBixSjmbc8eFl6UX5_wWGP8i0mAs-cvY

From what I understand, Dr. Russel Barkley is a leading ADHD researcher and this is the latest understanding of ADHD and that anyone that doesn’t discuss in 2015, what was known in 2014 already has no standing to discuss ADHD at all? Perhaps van der Kolk does discuss it and you just haven’t quoted that passage.

Were the misspellings in the excerpt about the Shakespeare production in the original or transcription errors?

I have done training at The Trauma Center which is Van der Kolk’s organization. I think, Scott, you have some misunderstandings.

But first, I’m not all that impressed by genetic studies. Every genetic study carries with it the family lineage of abuse, so a person who inherits from their abusive parent, who inherits from their abusive parent, is a trend that goes back forever. Our not so distant past was sufficiently difficult and traumatizing that it’s not too far a stretch to understand way more people are dealing with traumatic effects than we admit. (I work with people who literally say everything is trauma. I don’t believe this, but I think it’s relevant to expand our concept of trauma even further than what ACEs might imply) So, to say that genetics disproves the trauma theory, to me, seems suspect. As you asked about the book “how do you treat PTSD?” I ask as well, “how do you treat genetics?”. With trauma, there’s a path of change that I think I see working, with genetics, I’m hopeless. As you said in the symptoms section “bad gene disorder?” If you think bad gene disorder is a sketchy response to classifying disorders why is bad gene disorder not a sketchy explanation for why this stuff happens?

Second, I think you’re completely wrong about the APA’s philosophical commitment to categorizing by symptom vs cause. Thomas Insel and NIMH have hammered the APA on this point many times. It’s bad science. Many diseases have similar symptoms and yet need treated differently. Treating symptoms never leads to cures, just coping with the underlying disease.

On to specific misconceptions. I think you’re missing something about immobilization because the way you wrote about it seemed off. Immobilization isn’t a choice in the moment, it’s a part of the environment in that moment. A person who is trapped in a car crash and watches a person die with no chance of action, will be more traumatized than a person who had the option to try to help that person when they still died. Your example of hiding behind a tree, isn’t exactly the same because the choice to hide as the best option is there. In children, their worldview is so shaped by their parents, that options like “run away” seem impossible and thus they feel trapped by their abuser. The immobilization is about the feeling of trapped and powerless.

How this connects to the body. We often say that trauma is memories that the mind hasn’t accurately placed in the past, always present. Specific symptoms of PTSD like hyper vigilance, intrusive memories, night terrors, flashbacks, etc. We see all of these as memories appearing in the present context and being removed of their appropriate time stamp. By getting people to reprocess the memory in it’s appropriate temporal context, we “cure” the PTSD. This is the basis of the VA’s CBT Protocol. It’s the theory behind EMDR. And so on. The body part is that these memories aren’t stored in our explicit memories that most people think of, but our implicit memories that are body sense related. Neurologically, things like the hippo-campus for explicit and amygdala for implicit. ( Brain Based Therapy is a good book on this) In traumatic events, the senses that are associated with the trauma get tied to the stuck memories, so that the sensation re-triggers the traumatic memory and we relive it. Firecrackers setting off veterans kind of thing. Or a particular smell of cologne that matched the abusive uncle.

Treating this kind of trauma requires understanding more senses in the brain. We have 8 senses. The typical 5 plus vestibular, proprioception, and interoception. Vestibular, sense of balance located in the inner ear. Proprioception is the sense of where your body is in relation to itself. Close your eyes and have someone move your foot up or down. Proprioception is your ability to know which direction your foot is facing. Interoception is your internal senses of how your body is feeling; temperature, hunger, emotions. Treating trauma often involves reteaching how to sense Proprioception and interoception without getting retriggered. It’s separating the sensations from the memories. Yoga is a good tool for this because it’s focuses so heavily on the body sensations while giving enough distraction that the mind doesn’t think too hard about the memories. The other weird stuff that Van der Kolk introduces is about reprocessing the memories from present to past. There’s probably lots of ways that works and his specific examples are just the ones he encountered.

Finally, we have to deal with the reality of vulnerability. As an emotion, it kind of sucks. People with traumatic histories, even mildly traumatic as described in some of the ACEs material, can be really sensitive to the emotion of vulnerability. Being intolerant of vulnerability, makes it really hard to have good emotional connection with other people. Situations that produce this kind of intolerance don’t have to be all that bad but I would still classify them as trauma-like. A person who was never beat as child, but was always punished (extra chores) when they made a mistake (as children do), learns as an adult that making mistakes is unacceptable. Therefore, they will deny any wrong doing ever thus creating fights with their spouse. (I have a client with this exact situation) This isn’t TRAUMA, but it’s trauma like. We’re working on picking out the sensations and emotions that happen in that moment and learning to attach the sensations to the past instead of the present moment so they can respond differently in the present.

That’s an overview of things I think you’re missing. It’s been a while since I read The Body Keeps the Score. Some of this information may not be in that book and stuff I picked up elsewhere. I still don’t think the APA takes trauma seriously enough and that a lot of the diagnoses we have are just manifestations of the same thing. I think it’s a real disservice and harm to patients, that this is so.

But first, I’m not all that impressed by genetic studies. Every genetic study carries with it the family lineage of abuse, so a person who inherits from their abusive parent, who inherits from their abusive parent, is a trend that goes back forever.

This is not an issue with bullying, yet genetic factors are still significantly correlated .

I don’t understand what you mean by this not being an issue with bullying. Family transmission has long been an issue with bullying.

First, with respect to victimization, Allison et al. (2014) showed that a parents’ past history of victimization is associated with an increased risk of their offspring being victimized. Whereas only 25% of the parents without a past history of being bullied reported that their offspring was victimized, in the case of parents, who had been victimized themselves, this proportion was 55%. Second, with respect to perpetration, Farrington (1993) observed a comparable inter-generational continuity. Whereas only 5.5% of the fathers who did not bully had children who bullied, 16% of the fathers who were bullies reported that their children were bullies as well. Together, these family-risk studies show that perpetration and victimization are familial, but not whether this familial transmission is genetic or environmental in nature.

Furthermore, the twin study did not exclude being raised by the same parents, thus the twins were raised by the same parent that was bullied/perpetrated. The appropriate study would be to study twins that were adopted instead of raised by biological parents. They did not appropriately isolate the home environment from the test variables. I don’t see the study proving much.

Well someone who is bullied as a kid, how are they going to transmit that environmentally to their kid so that the kid is also bullied? Fathers who beat children who beat their children is plausible, but how would it work for people who were bullied? I’m sure you an make up some kind of story, but given the extremely small effects of shared environment they would seem implausible.

I’m not 100% on board with this, but I would think it would go something like: father who was bullied still carries the behaviors/social cues and/or values that lead to being a target of bullying. The child picks up some of these things from being around/learning from/mimicking the father and becomes a target themselves. Same for bullies with bully type behavior.

“But first, I’m not all that impressed by genetic studies. Every genetic study carries with it the family lineage of abuse, so a person who inherits from their abusive parent, who inherits from their abusive parent, is a trend that goes back forever.”

I’m a little confused what you mean. My stab at interpreting this is something like “Genetics is confounded by abuse, because you don’t just inherit genes from your parents but also whatever abuse they inflict on you”. But the studies are designed to compare monozygotic vs. dizygotic twins to avoid exactly this possibility. You mention the division by ACE later in your comment, so it sounds like you’re aware of this – what am I missing here?

“Second, I think you’re completely wrong about the APA’s philosophical commitment to categorizing by symptom vs cause. Thomas Insel and NIMH have hammered the APA on this point many times. It’s bad science. Many diseases have similar symptoms and yet need treated differently. Treating symptoms never leads to cures, just coping with the underlying disease.”

Wrong that this is in fact the APA’s current commitment? Or wrong that the commitment is a good idea, which I didn’t assert and am not sure I want to defend (though see my response here )?

My impression is that Insel has given the world a giant promissory note marked “IOU a good ontology based on causes of psychiatric conditions”, then mostly failed to deliver. I agree it is a good idea for a research program, but you can’t actually use it until the research program has born fruit, which so far it hasn’t.

I really appreciated the rest of your comment; thanks for sharing your expertise on this issue.

On the genetics, I’m not sure you’re missing much. I’m just expressing skepticism. I understand the studies being done but something just doesn’t seem right to me and when people try to use genetics to confound trauma explanations, I think we’re heading down the wrong path. And I guess I see that here. Your comments were criticizing van der Kolk about ignoring genetics but so often I see genetics explanations ignoring trauma.

Related to the second point on APA, there seems to be a really strong effort to ignore childhood abuse as a cause of disorders. It’s the battle over the medical model of mental health and maybe more specifically the biological model of mental health, and the nature v nurture debate as well. It really does feel like the APA wants everything to be biological and nature based with no room for nurture and trauma to play a role. In a simplistic example, a person who was raised by terrible parents and was told they were unlovable all the time for the first 18 years of their life (I’ve known clients who have had this kind of life). The APA and DSM say said person has bipolar disorder which is biologically based, maybe genetically caused and the only thing that will help is some medication to alter brain states. But, I also think there’s a lot of benefit to help that person grieve the pain they suffered, and retrain some deep beliefs about themselves and how the world works. A lot of those people don’t believe they’re lovable because the very beginning of their existence was saturated in messages that they’re not lovable and therapy is sometimes just the long slog into believing something different. The biological and genetic model doesn’t seem to have room for this so that even genetics studies that somehow prove something, I’m still skeptical of.

Murray Bowen did an experiment in the 80s where he “cured” a child of schizophrenia by helping the family improve their behavior towards each other. This bleeds into the next argument, we need to understand causes for doing correct diagnosis. Was the child actually cured? Was the child given the correct diagnosis? I tend to explain Bowen’s findings as bad diagnosis, but this also assumes that schizophrenia is genetic. Meaning, child didn’t have schizophrenia but simply behaved as if they did because family was so messed up. But with the symptoms based approach, how could we even tell?

To clarify my statement, you said van der Kolk downplayed the importance of the symptoms based approach, and I think that importance is wrong. I guess that sentence reads to me like you endorse the APA’s stance and I find that stance really problematic. Like above, I definitely believe that multiple causes can create similar symptoms and we end up treating the wrong thing if we rely on symptoms only approaches, which is what the DSM is.

I agree that Insel made promises that never got followed up on, but I don’t think that undermines the original complaints about the system not being rigorous enough.

APA seems to be shifting to blaming culture as well .

A person who was never beat as child, but was always punished (extra chores) when they made a mistake (as children do), learns as an adult that making mistakes is unacceptable. Therefore, they will deny any wrong doing ever thus creating fights with their spouse.

This smacks to me of a just-so story, like a lot of pop evolutionary psychology.

> Why does PTSD exist? “The brain isn’t prepared to feel emotions as intense as…” Yes, it is! Trauma is as old as living creatures; war, disaster, bullying, and rape far predate homo sapiens. Even if child abuse is rare in hunter-gatherer tribes (as some optimistic anthropologists claim) killing all the adults in a tribe and enslaving their children is pretty common, which cashes out to kids getting abused. Our evolutionary history should have prepared us incredibly well for all of this; the brain “getting stuck” in fear mode after a particularly bad trauma should be no more likely than the legs “getting stuck” in running mode after a particularly long chase.

I’m no expert, but doesn’t it make sense in a context of a situation where a danger exists for a long time? When someone gets stuck in a terrible situation (constant abuse, etc.), the desensitization might help to cope and not to be flooded with emotions that do not help to get out of situation anymore. If so, then the PTSD works as an ultimate “freeze” response as opposed to “fight or flight”, where a person turns off their emotions until the situation gets better. And then they are not able to get out of this state even when everything is over, the war has ended, the child grew up and does not need to freeze to stop hearing their parents’ argument anymore, insert any other cause of the disorder.

I think it aligns with the symptoms of PTSD well enough?

The brain could be stuck in any of the three. Stuck in fight would be constant anger and explosive outbursts. Flight mode would be agoraphobia and hyper vigilance. Freeze mode is catatonia and dissociation.

I’m no expert, but doesn’t it make sense in a context of a situation where a danger exists for a long time?

I think that might be it, and it might also be relevant that a lot of the traumas our ancestral environment involved would have been relatively short-lived. Getting chased by a lion isn’t very fun, but it’s going to be over quite quickly, one way or the other; I don’t think stone-age man had to deal with something like being on the front line of WW1 getting continuously shelled for a week, and it’s plausible that our psyches would be poorly-adapted to deal with the latter kind of trauma as opposed to the former.

Maybe? What about slowly starving to death, your children slowly starving to death, outsiders driving you off your territory into marginal land, being enslaved, your kids dying repeatedly, your wife being stolen from you?

I’m not convinced that stone-age man is actually the relevant ancestral environment. We’ve been congregating in cities for a long time. And when I look at history, I see a lot of cities being besieged for long lengths of time. Now, that’s admittedly the sort of thing history likes to focus on, so maybe it’s not actually that common.

But ancestors in China had to endure Mongol sieges that boiled their captives and then used the fat to hurl fire at the besieged. Eastern Europe also had to endure Mongol invasions (which killed about a quarter of the population of Hungary). The Israelites were beseiged and exiled from their lands multiple times, and I’m sure every city around the world has several such similar stories. All of that sounds really traumatic to me, and not at all short-lived.

I feel Scott’s paragraph on evolution here is too hopeful of the abilities of evolution to make us into perfect machines, verging into magical thinking.

There is a kilometer long list of things that evolution should reasonably have fixed yet we still are stuck with, and the brain is so complex that I am actually surprised the brain does not have _more_ weird failure modes. Particularly as the brain helped us escape a little from evolutionary pressures from other big predators, it stands to reason that it’d be the one where evolution would have less sway over.

And why would the body be so confused by the right action being “hide” or “accept the pain and abuse” rather than “run” or “fight”? The safest action has been “hide” or “accept the pain and the abuse” in a pretty good fraction of traumatic events since humanity came down from the trees.

That makes perfect sense to me. How is that confusing? People would rather die fighting than be constantly humiliated. Have you never experienced homicidal rage? It’s very difficult to deal with, without homicide as a realistic option.

“Why would evolution leave us with a brain that would rather fight or run than hide or accept abuse, if the latter is commonly a beneficial tactic?”

“Because people would rather fight and die than hide or accept abuse!”

That’s just restating the question, man.

There may be a useful distinction here between “doing X is in your interest” and “having characteristics that make you do X is in your interest,” the difference being the response of other people to knowing you have those characteristics.

Consider bullying. It may well be the case that, in a particular situation, you are better off letting someone bigger than you hit you than trying to fight back. But the knowledge that you will fight back if attacked may be a reason not to attack you.

Alright Scott, I want to suggest a different frame for this, that aligns with another SSC hobbyhorse: let’s take a Fristonian view of PTSD.

What is “trauma”, in a Fristonian sense (working off their REBUS paper )? Trauma writes a new set of priors at some level along the predictive hierarchy. This results in downstream effects. If you develop a new prior that hiding behind a tree and ignoring all sensory stimuli is the only way to guarantee survival, and then you take this “bad prior” out of the context of war, you’ll continue ignoring all sensory stimuli even if the experiences that caused the development of this prior disappear. This has been known for decades in the psychoanalytic literature as Neurosis (at least, according to some psychoanalytic thinkers).

So if we make the assumption that Friston is correct about the etiology, let’s address some complaints:

the first few studies on any technique – usually done in an atmosphere of frothy excitement, by the technique’s most fervent early adapters – are always highly positive. And later studies – done in an atmosphere of boredom, by large multi-center consortia – are almost always disappointing.

If the goal of any treatment is to shift one’s priors , then of course treatment performed in a more exciting atmosphere will lead to more dramatic results. Excitement and novelty mean an atmosphere of (sacred?) significance, which has the best chance of allowing the patient to form a new set of priors. If the therapy is routine, then it’s unlikely to “push” the patient out of their trauma-induced, undesirable predictive position. How could we test this, though? How do you repeatedly generate an atmosphere of excitement, to permit the action of Science? These are interesting and difficult epistemological concerns, and I’d be interested in thoughts.

Next complaint:

Trauma is as old as living creatures; war, disaster, bullying, and rape far predate homo sapiens. Even if child abuse is rare in hunter-gatherer tribes (as some optimistic anthropologists claim) killing all the adults in a tribe and enslaving their children is pretty common, which cashes out to kids getting abused. Our evolutionary history should have prepared us incredibly well for all of this; the brain “getting stuck” in fear mode after a particularly bad trauma should be no more likely than the legs “getting stuck” in running mode after a particularly long chase.

These events were potentially cyclical: a tribesman might experience war repeatedly throughout their lives. However, the current state of modern war leaves veterans returning, psychologically prepared for another go at war at any time, but without any real likelihood that they’ll be sent back out in the field. The result is that the developed priors become useless, rather than necessary preparation for the next conflict.

We can also consider how ancient tribes may have handled “bad” prior formation by considering ritual experience . The sacred, the psychologically powerful, as a means of restoring a more “normal” psychic equilibrium. But I don’t want to get too much into pure speculative territory here without any real anthropological knowledge of how the tribes actually operated.

My final critique was going to involve the idea of symptomatic vs etiological treatment, but I think that’s been addressed thoroughly in the other comments here. But I would like to hop on my personal hobbyhorse and comment that if we restrict etiology to a purely neurobiological realm, then we may lose out on significant opportunities to help people. It feels like the equivalent of only relying on genetics to diagnose physiological illnesses: you may well predict heart disease, but you’ll have no chance of diagnosing a viral infection. This is where having a deeper, systematic theory of mind comes in handy, and this is also where psychoanalytic theorizing is useful, because it operates at a layer above the neurobiological. Hopefully Friston and future research can unify the psychoanalytic sphere with the neurological sphere (the REBUS paper above already starts tackling some of Freud’s concepts of ego), producing a seamless hierarchy of mental reality as we have with body reality, but this is probably a few decades off.

This review is a month or so old – I’ve since come around to some of what you’re saying after reading https://www.lesswrong.com/posts/i9xyZBS3qzA8nFXNQ/book-summary-unlocking-the-emotional-brain . Review of that impending.

Word — a brief look at this LW post makes me suspect it’s the sort of synthesis I’ve been seeking; I should give it a read and note/write up whatever psychoanalytic parallels I can find. Looking forward to your review of it!

Thank you for linking that post; it was quite illuminating. I’m inclined to agree with this explanation of the schema updating process. It tracks with what I’ve learned through logical, rational methods *and* with what I’ve learned through intuitive, emotional methods.

I’m looking forward to your review, especially since I find the premise of the book plausible but I feel somewhat emotionally swamped trying to read it.

The first time I tried reading it, the print seemed too small to be comfortable. On the second whack, the print seemed smaller than average and with less space between the lines than usual, but it wasn’t a problem to read. This is the first time I’ve had that sort of problem with a book.

A thought on this part: “If the goal of any treatment is to shift one’s priors, then of course treatment performed in a more exciting atmosphere will lead to more dramatic results…”

There is a theory of family therapy that uses what it calls “ordeals” to produce change — ie, onerous, time-or-energy consuming tasks they have to undertake in service of change. Another family therapy method is to “prescribe the symptom” in which clients are asked to re-enact the problem sometimes in more dramatic fashion. Almost every therapy modality has some element of drama or excitement that disrupts the client’s default mode of responding. Koan’s are said to be used in Zen for similar purpose.

Anyway, this is just to say that a lot of therapy technique is focused on shifting people’s priors, as you would say, and they use many varied and dramatic techniques to accomplish that. All of EMDR could be seen than way, as could IFS, much of Gestalt, a lot of expressive arts therapy, and so on.

In treating people with PTSD, one has to be pretty careful about “exciting” — people often have multiple dysregulated rhythms and so need more quiet, more routine, more predictability so their nervous system can stand down a little.

But I think your larger point here stands, which is that the therapist needs to bring energy, confidence, optimism to their work because the client arrives usually in a frustrated and dispirited state. And oftentimes it’s the therapist’s fresh hope in what feels like an old, stuck, tired situation that helps get things going. The therapist’s positive outlook can’t carry the whole process, but it makes for a good starting place. And just the experience of showing up for a new experience, whether talk therapy or medication, is a kind of ordeal that can lead someone to update their priors.

I would absolutely believe that the brain is “Wired” to completely numb its body or do other “weird” things when severe mental/physical trauma happens. For example – it is well documented that the body is perfectly willing to “sacrifice” external parts (arms, legs, noses, etc) to survive… So if a person going cold and numb or “sort of crazy” results in being able to push 200% harder to achieve survival – then it makes sense…

For example – kids who become “numb to abuse” can take incredible beatings and literally not feel it…. BUT – when those kids fight others – they often inflict far more serious damage on others (and their own bodies) because they don’t feel things like their own hands or feet breaking when they fight… They lose the internal sense of restraint that says “No, stop… Those are his ribs crunching…” All the normal personal restraint channels are shut off and they just go as hard as their bodies can possibly go with zero pain response…. And that is CONSIDERABLY harder than it can when it feels pain or emotion….

So then…. It seems like the BIGGER question is “How do we get the brain to reactivate ‘Normal mode’ with feelings, emotions, and sensations?” …. Presumably – if the brain can turn it off – the brain can turn it back on given the correct signals that it should do so…. It’s just that somehow – it gets stuck in “Experience Trauma” mode….

An interesting aside for Scott… The Jewish priesthood was forbidden to participate in war… Makes me wonder if this was partially to reduce the incidence of those men losing their emotions and sensation feeling like warriors would…

re: your lost-arm theory of those fight-happy kids I don’t think the people you describe are in “Experience Trauma”-mode at all. It’s just that having experienced trauma (and hopefully not too much head trauma, too), the brain adapted in some improvisational ways. If you’re not afraid of fighting hard anymore, then how could fighting still be trauma? Not sure if going back to “normal mode” is desirable or possible. Not possible, because how could neurological changes just revert to the default blueprint? The brain is firing and growing everywhere at once and doesn’t really stop. Not desirable, because punching and fighting hard is pretty great if you still need to defend yourself. Don’t think of them as broken, think of them as merely a little different (and a lot more dangerous). It’s more that they’ve got to learn restraint, peace and probably purpose. The internal mechanisms that they had before don’t work anymore, because they’re mismatched now. Trying to make them just like well-adjusted, carefree, happy people doesn’t sound too promising. Trying to make sure that they don’t get themselves or someone else killed, teaching them to put their aggression and fearlessness to productive use seems better. As a succesful (though fictional) example: Amos Burton in “The Expanse” Ur xabjf ur qbrfa’g ernyyl trg gur zbeny pbzcnff/rzcngul guvat, fb ur whfg bhgfbheprf gung gb Anbzv naq Ubyqra. Naq jura va qbhog ur whfg hfrf n pbhcyr unzsvfgrq urhevfgvpf yvxr: “Gur jnl V frr vg, gurer ner guerr xvaqf bs crbcyr va gur jbeyq: onq barf, barf lbh sbyybj, naq barf lbh arrq gb cebgrpg.”

Talking of weird things, one of the family legends is that one of my ‘great great’ relatives returned from WW1 with “shell shock” and was never the same again. The legend says that he took all the family money and buried it in the nearby New Forest, never to be seen again.

Co-incidentally a recent visit to a museum in the same are revealed that a significant number of Roman Coin Hoards have also been discovered in the New Forest. I’m not saying that the Romans suffered from ‘chariot shock’ but perhaps the nature of landscape lends itself…

Or perhaps your family had invested their savings in Roman coins.

Regarding “patients’ different reactions to trauma” and “how much child abuse is there?” and “is PTSD a thing?” and “hasn’t trauma been around for eons?” and “what if we just don’t call it ‘child abuse’?”, is it possible that social/cultural factors/expectations play a really big role? (Maybe this is a naive/banal insight that everyone is already aware of, sorry, if so call me an idiot and ignore me!). I just remember some study (possibly debunked!) that people tend to have the reaction to alcohol (i.e. affect on inhibitions, etc…) that the culture around them expects alcohol to have. If we can modulate our behavioral reaction to the same chemical in such different ways, wouldn’t we also be able to do so with trauma, particularly since “how we respond to trauma” would be very important factor in our success in the small groups of likely-prone-to-frequent-trauma humans we evolved in? And even more, wouldn’t it also heavily affect how the wider society describes (or chooses not to) the effect of that trauma on individuals? I don’t mean to diminish the impact of PTSD or anything else in any way (not only just because “even if society just told me I should be scarred by X” is still a real and valid reason you might be traumatized by something!) but it does seem like it would be part of the explanation for a lot of this, including the “I read this book and it totally helped!” situations.

I think that you are exaggerating the effect of social/cultural factors. In WW I it was societally not acceptable to have shell shock, but people got it anyway.

Before I respond in more detail, I’d like to be sure I understand you. Is the question you’re asking “if all children were abused and everyone thought it was normal, would the children still be traumatized?”

Maybe, “were catamites in ancient times traumatized?”

You are referencing the Red Bull Vodka experiment where two groups of French young men were served Red Bull Vodkas, but one group did not actually have Red Bull in their Vodka. Thus demonstrating the psychological expectation of getting drunk can lead to drunk behavior.

I don’t think there is a good way to extend this experiment’s results to PTSD. They don’t seem to map on right. But I take NovaByblos’ concern to be something similar to Sebastian Junger’s… We’ve recognized trauma for a few millenia now, but is our society somehow worse than previous ones at caring for the traumatized. Perhaps because a lower proportion of us have been traumatized the social sphere has changed, making the symptoms after trauma more pronounced/obvious?

On the subject of why people didn’t have PTSD in the past, I think it is a mistake to assume they didn’t. The unusual feature of the modern world is not that you can be exposed to trauma, it’s that you can be removed from it. In the modern world, a victim of rape may have trouble returning to normal life. In the ancient world if you are taken as a slave, then rape is a part of your “normal” life from now on. Anything that helps you navigate that is helpful, and in that sense it is not hard to see some aspects of PTSD as adaptive.

Genetically, I feel this fits in with a lot of what’s being discussed today in terms of genetic predispositions that are triggered by outside events: Grow up in a peaceful village, run the peacetime program. Village is sacked and burnt, run the life is violence program. The only difference is that in our modern age violence.exe doesn’t work as well as a default mindset as it would have been in the past, so we want to find a way to turn off those behaviors as soon as they are triggered.

The unusual feature of the modern world is not that you can be exposed to trauma, it’s that you can be removed from it.

I mean this sincerely: what a lovely thought! Makes me appreciate existing here and now.

Unless the other commenter is right and we are forcing some people into trauma in ways that didn’t happen in the past (hello schools).

The truth is probably in the middle.

I’m speculating a bit here, but I believe the range (not necessarily the intensity) of possibly-traumatic experiences is narrower for neurotypical people than it is for neurodivergent people. There is a growing body of evidence that suggests *most* autistic people have c-PTSD as a result of:

a) repeated negative social/emotional interactions b) behavioral therapy/modification c) being forced to endure painful/damaging stimuli d) being deprived of sufficient pleasurable/helpful stimuli e) any combination of the above

While I do not claim to be autistic myself, I do vividly recall being held down at the age of 5, having a large cold silver spoon forced into my mouth, and being made to swallow liquid medicine, weeping and thrashing all the while. I did not eat with a spoon for 20 years afterwards, because the feeling of its shape in my mouth would cause me to have a panic attack.

Was it objectively “abusive” for my caretakers to medicate me when I was ill? No. Did I subjectively experience this incident as traumatic? Clearly yes.

Yes to what both you LeeBird and Aapje say here.

The DSM criteria for PTSD focuses on direct exposure to death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence.

And yet I have a lot of clinical experience with people who have stories like yours about the spoon or other bad/scary/adverse experiences of childhood that were profoundly affecting a decade or more later. As well as people who describe a whole host of soul-crushing horrors happening in a school setting that don’t meet any of the above criteria but nonetheless are producing behavioral changes years later that get in the way of a person’s daily living. I suspect there is a portion of social anxiety that is really subclinical PTSD for having been treated pretty badly at one or more points in childhood.

The other thing I see is clients who seem to have inherited multi-generational family histories of trauma. We could say it’s genetic, but without the science, we could also say grandmother’s terrifying immigration experience led her to raise her daughter in an environment of fear and hyper-vigilance and that daughter went on to raise another daughter who has no lived immigration adversity experience but grew up with her mother’s hypervigilance and continues to re-enact it in situations that, while stressful, are not life-threatening.

Mark Epstein has written a book called The Trauma of Everyday Life that’s worth mentioning in this context.

I think that a ‘sense of safety’ is very important, yet not very well understood. It probably depends heavily on specific needs being satisfied and the mental model of the person, where those needs and that mental model can differ substantially per person. For some people, force feeding with a spoon was or would have been no big deal, while for others, it violates something essential.

Note that we also seem to see that rape affects some people greatly, causing PTSD, while for others, it has no significant emotional impact (and for many, it has significant impact, but is not devastating).

Note that there are all kinds of ‘life hacks’ that people employ to produce a sense of safety in children, although often merely because they notice that it makes children happy, not because they understand why. For example, pacifiers probably induce a sense of being with the mother and a feeling of food security. Swaddling produces a sensation of being held. Sleeping with a bear or other anthropomorphic toy produces a sense of being guarded and/or not alone. Etc.

It probably works in part like a ledger, where things that positively produce a sense of safety, allow people to endure things that harm their sense of safety with much less or no ill effects (and this is why people who have a big lack of a sense of safety, are easily traumatized by things that seem like trifles to others).

The DSM seems to miss the point in a variety of ways. They ignore the resilience that safety-inducing experiences can bring, that the impact of safety-reducing experiences depends on the resilience that people have and not merely on the extent to which the experience is (typically) safety-reducing, nor the differences between people’s needs.

The DSM’s definition of PTSD seems tailored to reasonably well-calibrated people who experience a major safety-reducing event, treating the latter like a gunshot wound, even though so much evidence suggests that this is a bad way to think about it.

A good metaphor may be a pugil joust , where life is like standing on a platform trying not to fall off, as you are getting hit by negative life experiences and trying to enjoy the positive parts of the experience. Excessive anxiety is then being unsure of or underestimating the size of the platform you are standing on. Even though stronger hits are more likely to knock you off, even a small push can knock you off, if you are already poorly balanced. A very well-balanced person can endure a very strong push and/or can deflect most of the hit. An apathetic/avoidant person has given up on trying to play the game. Etc.

In this model, you can see how certain intervention can or can’t work. For example, encouraging an apathetic/avoidant person to climb back on the platform only works by itself if that person misjudges the risks of being on the platform and will have has sufficient confidence when being on that platform. If they do have life skills, but are afraid to use them, they need to be taught to trust their skills more. Yet if they lack those life skills, then teaching them to trust their skills will merely get them hurt due to unfounded confidence, so they need to be taught those skills.

I shared the spoon story because it was the least dark example I had, and because I’ve been able to move past it. My actual reasons for having (suspected) clinical c-PTSD are not nearly so trivial…but those are stories for my therapist, haha!

The other thing I see is clients who seem to have inherited multi-generational family histories of trauma.

Anecdotally, this tracks. Part of my decision not to have children is that I simply don’t have enough hubris. Could an unbroken, centuries-long chain of complicated mother-daughter relationships by broken by ME? Doubtful.

There is also the thought that in the days when being eaten by tigers was common, someone who had narrowly escaped being eaten would easily find someone else with a similar experience to talk to about it. It would be a lot harder to do that now.

Why would that even be traumatizing? That sounds like an adventure. When I picture that (assuming I didn’t take crippling injuries), I assume I’d start laughing manically, fall into the grass and sigh happily.

Because you nearly got killed. This is extremely traumatic to most people

Haven’t you ever nearly been killed while driving? It’s traumatic for like five seconds and energizing after that.

Anonymous: No, I get a bit freaked out by the thought of some of my near misses on the road, even years later. It’s not traumatic per se – it doesn’t interfere with my life, or even my driving – but it’s not even close to “energizing”.

If I may be forgiven for making a couple of assumptions, I think this kind of speaks to what I’m saying about the different worlds of now and the past. The short version is you can picture yourself as removed from the danger once it’s over, where in the past the danger will never really be over.

When you pictured almost being eaten by a tiger, you pictured the event: A furious action, terrifying in every degree in sight and sound-even smell, where your threadbare escape only serves to highlight your extreme good fortune. But in this you picture the event, not the context, and the context is what makes it truly damaging.

Let me supply it: In the night, you were walking a few steps from your home to go to the bathroom. And importantly, this isn’t a freak event where a tiger got loose from the zoo, in your life there are tigers are out there every night. For our ancestors this kind of event isn’t a unique opportunity to look mortality in the face and walk away, as it might be for us; it is yet another demonstration of vulnerability, a mocking dress rehearsal of the final night when your luck runs out.

Peter Levine talks about discovering that wild animals deal with trauma by going off and shaking.

I’m not and he isn’t saying it’s a complete cure for everything, but not having a chance to do it fairly soon could make trauma worse.

@Nancy Lebovitz

That seems to just be the after-effect of adrenaline. I doubt that it has psychological benefits.

You explained this concept very well, and I think it likely plays a role. A lot of this is social–the fact that you can be removed from it means that you are likelier to experience being an outlier, on top of it being a non-workable strategy in your new environment. On top of that, modern society is very focused on a certain type of efficiency/stability/presentation and I think requires a larger degree of conformity in certain neurological senses even if it seems to allow more freedom. It constantly confronts people who have experienced these shifts with an obligation to be “normal” and happy, or to “fix” the problem of being otherwise. Even if people today are technically more “sensitive” about the issue, they’re also more likely to focus on it. Basically, modern society is focused on certain emotions and certain experiences in a way that ties them to identity and can make them defining. And we have few outlets for the aggressive, as you pointed out. This likely increases the awareness, suffering, and visibility of the issue. But it is so consistently present throughout human history in the last few hundred years that I assume it is built-in human reaction to trauma that has the potential to activate in a large number of people.

This is really well said:

“modern society is very focused on a certain type of efficiency/stability/presentation and I think requires a larger degree of conformity in certain neurological senses even if it seems to allow more freedom. It constantly confronts people who have experienced these shifts with an obligation to be “normal” and happy, or to “fix” the problem of being otherwise. Even if people today are technically more “sensitive” about the issue, they’re also more likely to focus on it. Basically, modern society is focused on certain emotions and certain experiences in a way that ties them to identity and can make them defining.”

I feel like a lot of therapy is helping to build up people’s immunity to these social forces by helping them clarify who they are and giving them permission to feel less apologetic for the people they seem to be.

…reading the book helped them figure out an indescribable mental motion they could take to resolve their trauma, and that after taking this mental motion their problems were gone.

I’ve had a similar experience – years ago I used to have fairly frequent, intense bursts of guilt. For example, I could be walking along and then suddenly for no particular reason I would feel like I was the worst person in the world. It would come out of nowhere, almost like accidentally walking into a wall. And the guilt was always completely abstract, not connected to anything specific that I did or did not do.

One day, I was thinking about my life and I realized that the guilt was because I was alive and my mother (who died when I was a child) was not. I would be eager to die in her place if I could. (Of course time travel appears to be impossible and the concept of “a life for a life” is from fairy tales and not how that sort of thing works in the real world, but the eagerness is genuine.) And with that, the guilt never came back. I still have issues, but I don’t have that issue anymore.

Longtime lurker here, first-time comment here. FWIW.

Scott’s discussion re immobilization triggered (pun intended) a question I never found a handle for in discussions with counselors of divers modalities: the potential difference when trauma or developmental disturbance is linked to what might be called a nothing rather than a something. That is, to an absence of something that “normally” or “typically” (or, more likely, “ideally” in our current way of express or implied judgment/expectation) would be something present.

To put a finer point on it, while anger can be a useful and fruitful summoner of our energies to move through a developmental obstacle, anger seems harder to summon when it’s about “nothing” or an “absence” than when it’s about “something”. In the latter case, there’s a potentially clear object for anger (albeit not always accurate). In the former, the nebulous black hole yields either immobilization or finds a default substitute object – with the self being the most obvious alternative object. And then…tada!…the cluster of depressive/dysthymic possibilities.

Decades of life have taught me that deeper understanding is not necessarily fruitful in good ways, but still over those years I’ve found others who’ve encountered what I’ve described above and I wonder if there are more fruitful ways of describing it to them. (I use fruitfulness rather than more utilitarian terms because in my experience it can resonate in broader/deeper ways than utilitarian terms typically do.)

Interestingly, this can also explain why people tend to scapegoat. It’s hard to get truly angry about a lack, unless you can blame someone or something for taking something from you.

Yes, that’s also true. The potential limiting factor for toggling that might be what would implicate the “superego” in Freudian terminology: whether or not the subject has deeply absorbed a sense of duty not to impose unjustly on others.

Beyond, there are people who are quite aware that no *particular* other person necessarily “owes” them what is “normal/typical/ideal” (other than basic duties of nurture to a child as means and circumstance allow), and have a strong sense of boundaries about imposing any such expectation on others. As opposed to people who have a highly developed sense of personal entitlement.

there are people who are quite aware that no *particular* other person necessarily “owes” them what is “normal/typical/ideal”

True, but a lack of this kind of ‘entitlement’ may be very unhealthy, just like an excess. The former probably makes for good abusees, causes loneliness and atomization, etc.

Note that entitlement of being treated a certain way seems fairly orthogonal (or even negatively causally linked) to entitlement to impose on others, so you can have the seemingly contradictory situation where a person expects little from others, yet feels entitled to impose on others.

In my society, there seems to be a substantial increase in anti-social behavior at the very same time where people seem to expect less from others and fear being assertive to people who impose on them. I don’t think that this fits a model with a single type of entitlement, but rather, that different kinds of entitlement exist, where people can be very entitled in some ways, but anti-entitled in other ways. The average can then be a moderate level of overall entitlement, although this is highly pathological, because it is an average of a pathologically low level of some kind(s) of entitlement and a pathologically high level of other kind(s) of entitlement.

Note that entitlement of being treated a certain way seems fairly orthogonal (or even negatively causally linked) to entitlement to impose on others

At a slight tangent …

Consider someone with a dietary restriction, self-imposed, medically imposed, or whatever. When attending a dinner provided by someone else, one possibility is to unobtrusively avoid whatever parts are not to be eaten and perhaps have a second meal when he gets home if that means missing large parts of the dinner. An alternative is to make a point of telling the host about the restrictions, with the clear implication that the host is supposed to either structure the meal accordingly or provide suitable alternatives for the guest.

My impression is that, over the past fifty years, the latter has become much more common. That looks like a feeling of entitlement to being treated a certain way leading to imposition on others.

one possibility is to unobtrusively avoid whatever parts are not to be eaten

This is only possible when “what is not to be eaten” is obvious, e.g. vegetarians. Not possible for e.g. gluten intolerant people — almost any food could contain flour, not necessarily visible.

A pathological lack of self-interest makes one VERY popular, but at what cost?

I actually think that most people dislike it, even if they feel drawn to take advantage of it.

Although I guess I might be debating your definition of ‘popular.’

By this “when trauma or developmental disturbance is linked to what might be called a nothing rather than a something” — do you mean the experience of neglect by one’s caregivers or are you speaking of something else?

I can’t tell if you’re saying it’s easier to find anger when a parent actively abused us, but when we simply failed to get what we need, what is there to be angry at? Is that it or something else?

Apologies if I’m being obvious: children need active care and attention to adjust well and feel safe in the world. As humans, our needs go well beyond food and shelter. It’s the grownups who teach us emotional regulation. They can’t teach us that if they aren’t showing up in a genuine way for the relationship.

I haven’t checked in on this in awhile, but my memory is that the research on childhood adversity shows that emotional neglect can be as devastating or more than physical abuse.

That’s how I see it. It is much easier to blame someone for doing harm to you, than blaming them for not being good to you, especially since the latter is often a lot more diffused and more demanding.

Take sexuality. It’s much more obvious that someone harmed you by raping you, than that someone harmed you by not sleeping with you, even if we recognize that many people have immense sexual needs. If you are raped, you can easily blame the rapist; especially as the modern Western norm is that people never ‘ask for it.’ But if no one wants to sleep with you, who is to blame? Are they being unfair to you or are they fairly refusing a poor quid-pro-quo, where the burden is on you to improve your offer or to accept that you ask too much of others?

To what extent do people have a duty to accept a poor quid-pro-quo to compensate for imbalances (like parents have a greater duty to children, because the latter are still more helpless), poor luck, etc vs people having to accept that they don’t get their needs met.

Of course, parents are typically seen as having a fairly strong duty to actively provide positive experiences, yet that is typically insufficient, where people/kids also require positive experiences from their peers and others.

my memory is that the research on childhood adversity shows that emotional neglect can be as devastating or more than physical abuse.

This also explains why people, in particular children, can induce abuse by others to stop being neglected, when they have no ability to induce positive attention.

I was not given adequate medical care and suffered from undiagnosed & untreated neurological issues for approximately 15 years. I am somewhat angry and resentful about the situation, but then again, I’m not sure that my parents had the knowledge or access to do any better.

The best way I’ve found to handle it is 1) name and acknowledge these emotions when they come to me, 2) listen to them/recognize them as valid and rooted in lived experience, 3) allow them to be without feeling ashamed of them or trying to make them go away, 4) gently ask them if there is anything I can DO *here and now* to help them. 5) The answer to that question is always “no.” The emotions leave of their own accord after that.

The thing is, the hunter-gatherer environment was not likely one where people were coerced into staying in trauma-inducing situations once their flight instincts had been activated. A hunter-gatherer warrior is surrounded by loud and dangerous exploding things? She runs off and lives alone gathering nuts on the other side of the mountain. A hunter-gatherer child is being abused by tribal elders? He runs off and lives alone gathering nuts on the other side of the mountain. They didn’t have the coercive institutions that modern humans deal with that force them to stay in abusive environments. They didn’t get executed as deserters if they ran away from a war; they didn’t get picked up by child protection if they ran away from an abusive home.

It’s just that everything changed when human population became dense enough that there wasn’t anywhere else to safely run away to, and human societies became complex and wealthy enough that self-sufficiency wasn’t a desirable option anymore anyway. So I don’t think it’s too surprising that the brain has failure modes that arise in these specific conditions that wouldn’t have come up in the hunter-gatherer environment.

A hunter-gatherer warrior would be male. And anyone of any sex running away from the tribe would become vulnerable to almost any man they came across. And real hunter-gatherers have to cook what they hunt and gather, which typically means some woman cooking while some man hunts. Either would be hungry without the other. So no one is that free to run away from anyone else.

Why does anyone think that the lives of hunter-gatherer humans beings was any more peaceful than that of hunter-gatherer animals?

You can always run off to join the French Foreign Legion. (Not saying that will help with your trauma, just saying.)

I sometimes wonder what kind of PTSD traumas could be caused by clumsy NSA surveillance and how such traumas could be counteracted. For example, say that you are a genius social scientist being spied upon by your government, which finds a way to hide cameras all over your house. Of course, being a government, they’re dumber than shit so you quickly realize what they’re up to. You say to the cameras “Hey, I don’t approve of this violation of my privacy. If you have something to say to me, come out and say it.” But of course they say nothing and try to gaslight you because admitting their espionage would not only reveal their own incompetence but also make them legally liable for violating your privacy. So there you are, with your government spying on your every move – in the bathroom, in the bedroom, EVERYWHERE. From a legal perspective, they’ve essentially turned you into a sex slave and are making non-consensual porn of you.

Based on what Scott has written, this is the kind of thing that would cause severe PTSD, because you are being attacked and have no way of fighting back. But since fighting back and asserting control through personal agency and self-determination have been proven to mitigate the effects of PTSD, I wonder if it might be possible to mitigate the effects of such PTSD somewhat by fighting back in unconventional ways. For example, you could spread info-hazards by speaking directly to the hidden cameras and revealing very simple and elegant ways to conduct terrorist attacks that could kill millions of people in the U.S. Since you know that hostile governments doubtless have spies embedded in the NSA, these info-hazards will replicate very quickly, as it is in their best interests to spread that information to other enemies of the United States. In other words, once hostile governments realize the value of the information that you are giving the NSA, they will prioritize you in their espionage. Best of all, from a legal perspective you’re completely innocent of any culpability, since you’re entirely justified in speaking out loud to yourself in a situation where you have the reasonable expectation of privacy. In fact, if anybody carries the blame for those terrorist attacks occurring it is the NSA, since it is their own organization that is inadvertently spreading the info-hazards. If they weren’t watching you against your will, then this dangerous information wouldn’t be spreading. That would be a very interesting way to punish the NSA for their arrogance. And since dangerous secrets spread the most rapidly, the NSAs unlawful espionage and harassment campaign against you would eventually be discovered and become public. You could probably bring a very expensive lawsuit against them when your lawyer pointed out how they “basically turned you into a sex slave for over a year against your will.”

It’s an interesting conceptual exercise in how to weaponize the Dark Arts of Rationality – a sort of modern-day vengeance parable. I might one day write a short story about it.

The Prisoner (1967) is a bit like your surveillance situation. Very interesting series all around.

However, your idea of rationalist powers allowing you to escape seems a bit fanciful and full of hubris. The typical issue with terror plots seems less the ability to generate ideas, but more execution (and recruiting capable terrorists).

The Prisoner is a fantastic TV show. Too few watch it.

I wanted to thank you both for bringing this show to my attention. I’ve started watching it today and really enjoyed the first episode. I imagine it will stay interesting!

Relevant, from Greg Cochran: https://westhunt.wordpress.com/2018/08/18/ptsd/

I’m pretty skeptical of this hypothesis. Even ignoring the cPTSD stuff (which seems genuinely different), military PTSD seems really similar to “trapped in a burning building” PTSD or “family killed in a home invasion” PTSD. If you attribute military PTSD to shell shock, what happens to all those other things? Fake? A different disease which mysteriously shares the same triggers and symptoms?

I happened to listen to Jocko Podcast 10 this morning, wherein a SEAL officer discusses a book from the perspective of a WWW II Marine grunt. One of the points he made was that the modern military PTSD belief is that it’s related to not just danger, but danger combined with a lack of control in not being able to do anything about it.

So the same level of danger, but being able to move, maneuver, shoot back, etc… is under your control and doesn’t produce PTSD, but the equivalent level of danger while stuck unable to move in a hole in the ground waiting for a random piece of shrapnel from an artillery shell to kill you does produce PTSD.

It’s easy for me to see the parallels between that and the “trapped in a burning building” PTSD or “family killed in a home invasion” PTSD, in that those seem to also imply a lack of control/inability to influence the result.

This is a comment on the replication crisis. What makes it so frustrating is that, in all of the silly studies (like this Harvard one ), there are almost certainly true things that are just hard to measure, or in which the studies neglect large societal patterns. The studies have very coarse outcome measures, like using mortality to evaluate a medical treatment or a medical system. Or studies that might be neglecting a large big-picture shift in the population, like students who might otherwise be good at math tasks not understanding the paragraph-long word problems. (Example from my childhood: an algebra state test asked a problem about “how many tickets does the club need to break even”. I didn’t know what “break even” meant, but figured it out from context…. but what if I hadn’t? It wasn’t a hard problem, but the test should not have been reading comprehension – just algebra.)

Unfortunately, while studies and meta-analyses can help determine the truth, they don’t excuse us from thinking and trying to use intuition and common sense….. (Note: please don’t interpret this as an accusation that our host isn’t using common sense or something.) Which of course is still subject to biases and such. I don’t know of a solution to this problem.

in all of the silly studies (like this Harvard one), there are almost certainly true things that are just hard to measure, or in which the studies neglect large societal patterns

Almost certainly?

I seem to inhabit a different world than van der Kolk. All of his patients showed bizarre and florid sequelae

Given how many other famous psychology stories and books from the past century have collapsed under even gentle investigative journalism, maybe the reason is …

… he made them up?

I’m going to give the guy the benefit of the doubt just because he’s been in the field working almost entirely on trauma for over 40 years and often in residential settings where the level of severity is much greater.

I’ve been in private practice for much less than that time and have no experience in residential facilities and a small but significant number of the clients I’ve met present with what I’d call “bizarre and florid sequelae” even though they are functioning marginally okay in their lives. I could see if I added more years to my career and put myself among a more severely-impacted population that that’s what I’d see.

Of course, also possible he’s making stuff up.

People have got to start treating that as the default/null hypothesis.

Consider four patients, Alice, Bob, Carol, and Dan. Alice has poor concentration caused by child abuse. Bob has poor concentration caused by bad genes. Carol throws tantrums because child abuse. Dan throws tantrums because bad genes. The current DSM would categorize Alice and Bob as ADHD, and Carol and Dan as intermittent explosive disorder. Van der Kolk would like to classify Alice and Carol as having Developmental Trauma Disorder, and Bob and Dan as…I don’t know. Bad Gene Disorder?

To me this sounds like we need more classifications, not less, right? I mean having a cough because of pneumoconiosis, or because of an chronic infection, should be treated differently, also.

To me this sounds like we need more classifications, not less, right?

Why? How would it change therapy for Alice and Carol in contrast to the treatment for Bob and Dan? I get that it is convenient for Carol to blame her bad behavior on an external factor, but I don’t think it helps straightening her out. Maybe if I get a psychoanalyst to plant false memories of child abuse in Dan, the cure would then work for him too?

Because both Alice and Carol reacted differently to the child abuse, which suggest to me that both of them have diffrent conditions. Just as both Bob and Dan probably have different sets of “bad genes”.

Furthermore, the textbook said, “There is little agreement about the role of father-daughter incest as a source of serious subsequent psychopathology”…the textbook went on to practically endorse incest, explaining that “such incestuous activity diminishes the subject’s chance of psychosis, and allows for a better adjustment to the external world.”

I can’t help but wonder about the authors and reviewers and readers and professors of those textbooks.

And how they treated their daughters.

This is closely related to “Freud discovered that a lot of his upper middle class Jewish Viennese women patients had been molested by their fathers and uncles. When he announced this, he was told this was unthinkable, unspeakable, and unprintable. So he caved in for the sake of reputation and money, and instead faked up a fake theory that all these women actually secretly wished that they had been molested, and faked up stories that they had been.”

A colorful typo: “colunteering for prats” in the Shakespeare section. (Intended to be “volunteering for parts”)

The sections on the dangers of child abuse were a good knock-down of some hypothetical “child abuse isn’t really that bad” position, but I don’t know anyone who holds that position …

I know of more than a few. I once had a really bitter argument with such a person. He attacked someone on Twitter for opening up about their trauma and its effect on their life. His stance boiled down to: “Practically everyone was ‘abused’ as a child. I was ‘abused’ and I turned out fine. Just shut up about it and stop being such an attention whore.” I tried to explain to him why his approach was harmful and why “everyone” was suddenly “hating on” him. I didn’t manage to get through to him at all, and got badly retraumatized in the process of trying. Fun stuff. (I’ve seen that exact dynamic play out probably half a dozen times, even though I normally shun social media. This time I only tried to engage because I knew the person.)

His behavior demonstrates that he did not turn out just fine, though he will likely never accept that. :/

I agree. It was one of those cases where a serious problem is obvious to everyone except its sufferer.

His mentally labeling of himself as fine, thus justifying the abuse, is almost certainly his coping mechanism. Challenging that was always going to be extremely threatening to him.

I’d be interested to know what people think about this blog post, which argues that PTSD is “ A very modern trauma “. Unfortunately, the papers he cites are locked behind paywalls, and I don’t have access to them.

A study just published in the Journal of Anxiety Disorders looked at the extensive medical records for soldiers in the American Civil War, whose mortality rate was about 50-80 greater than modern soldiers fighting in Iraq and Afghanistan. In other words, there would have been many more having terrifying experiences but despite the higher rates of trauma and mentions of other mental problems, there is virtually no mention of anything like the intrusive thoughts or flashbacks of PTSD.

I read a lot of historical documents from this time, and it doesn’t come up as much as I’d expect, but they also weren’t usually asked directly about it. Crucially, that mortality statistic means that way fewer people survived combat at that time! Most of them weren’t around to have flashbacks. On top of that, not all veterans are affected–it isn’t a number thing, or something that directly correlates with the amount of death going on. Virtually everyone saw death on a regular basis, given the state of medicine at that time, so that alone was not shocking. Most soldiers died of disease or infection, not from direct combat, and the nature of warfare is such that the terror may not have been more intense or frequent in most situations. I’m sure it was plenty terrifying enough in some–“Worst Seat in the House,” about Col. Henry Rathbone, who survived the Battle of the Crater (particularly traumatic) and witnessed the shooting of Lincoln from a few feet away, argues he had PTSD.

Whether or not the author is correct, the book provides a lot of context that is useful to this debate. Rathbone became increasingly disturbed and eventually murdered his wife. A lot of witnesses to the assassination, including combat veterans, described intrusive thoughts and nightmares related to it–something about that event seemed to be destabilizing in a way that battle had not been for them. It occurred at the time lilacs bloom, as Whitman noted in his famous poem. Charles Sabin Taft was a *surgeon* who witnessed the shooting and the aftermath, and his sister later wrote, “as long as Charlie Taft lived the scent of lilacs would turn him sick and faint, as it brought back the black horror of that dreadful night.” He’d spent the last few years hacking limbs off without anesthesia, but that made him sick! From that description, we don’t know if it reached the level of a flashback or intrusive thought–it could be a dramatic touch, but that was the sort of thing they were generally euphemistic about. A young military doctor who was unable to stop thinking about it was told by his superiors to block all of it out of his mind, and he focused on doing so for decades before speaking out. That advice seems to have been prevalent, so they may have been primed to block out intrusive thoughts instead of process them. If you cope by shutting down or refusing to talk, and society decides it wants to focus on glorifying the war instead of dealing with it, no one will know about your intrusive thoughts, but that may well be what is causing a noticeable mental decline. We’re trained to talk things out more, and talk therapy means you have a lot more of a record to work with.

I wish I could see the locked paper, but I have a feeling the guy is taking the absence of data for the absence of trauma. It was easy to lose track of people back then. It does seem like actual flashbacks came up less–but are those super prevalent now, or are they just the stereotype people have of what it is “like” to have PTSD–for me, the first thing that comes to mind is hypervigilance, which I assume is more common. I also wonder if living in a televisual age makes full flashbacks more prevalent–we’re used to inhabiting multiple realities at once, in some sense, and to experiencing things vividly and vicariously.

I tried to edit this and missed the window, so I lost my post. This book looks interesting. If I understand this correctly, between 1980 and the last decade, the way the DSM defines PTSD has shifted in favor of emphasizing the memory part of it, along with emotional outbursts and depression, over the hyper-vigilance and numbing aspects. I think this reflects cultural preoccupations that will mean less of a match up over time.

I think the thing you’re forgetting is that we evolved under group selection and we came down pretty hard on the cooperative, pro-social strategy. So maybe the mechanism by which we became good at cooperating is that we’re born with hard-wired fictions like “you are a valuable part of your community” and “you can trust people”. And, since there is also an evolutionary advantage to free-riding on your community’s resources (in a way that no one notices), maybe PTSD is the mechanism by which abuse victims were able to maintain community cohesion and keep quiet about their abuse, while internally not being able to reconcile the pre-wired fictions they were born with?

FWIW, I’m aware of 6-13 year old sexual child abuse by biological fathers (thankfully none related to me) in 1 of 50 white families I’ve known reasonably well. The general rate could be 10x higher or lower but I doubt it.

Consider four patients, Alice, Bob, Carol, and Dan. Alice has poor concentration caused by child abuse. Bob has poor concentration caused by bad genes. Carol throws tantrums because child abuse. Dan throws tantrums because bad genes. The current DSM would categorize Alice and Bob as ADHD, and Carol and Dan as intermittent explosive disorder. Van der Kolk would like to classify Alice and Carol as having Developmental Trauma Disorder, and Bob and Dan as…I don’t know. Bad Gene Disorder? Seems sketchy.

Isn’t this how medicine works outside psychiatry? Alice and Bob both have respiratory problems, Alice has been infected by mycobacterium tuberculosis, Bob has a mutation of the CFTR gene. You diagnose Alice with Tuberculosis and Bob with Cystic fibrosis, you don’t diagnose both with Respiratory Disorder.

Why does PTSD exist? “The brain isn’t prepared to feel emotions as intense as…” Yes it is! Trauma is as old as living creatures; war, disaster, bullying, and rape far predate homo sapiens. Even if child abuse is rare in hunter-gatherer tribes (as some optimistic anthropologists claim) killing all the adults in a tribe and enslaving their children is pretty common, which cashes out to kids getting abused. Our evolutionary history should have prepared us incredibly well for all of this; the brain “getting stuck” in fear mode after a particularly bad trauma should be no more likely than the legs “getting stuck” in running mode after a particularly long chase.

I suppose that the typical traumas you get in modern conflicts are different than those a hunter-gatherer would experience. If you are being chased by lions or enemy spearmen, the best responses in most cases is either fight back or run away. Indeed the “ fight-or-flight ” response to acute stress is common to many mammals, especially predators and large preys. Some small prey animals tend to freeze and play dead instead, but this typically doesn’t occur to humans.

Now, imagine you are in the middle of a WW1-to-Vietman era battle, bullets whizzing past your ears, shells landing around you, smoke and dust everywhere, the adrenaline flowing in your veins is telling you to either charge gung-ho or turn back and run for your life, but you know that both options would get you instakilled, so you have to suppress your instincts, take cover, move slowly and cautiously, infer the enemy position and movements from the scarce sensory information you have and game-theoretical reasoning about their strategy, and so on. And yet you realize that even if you play according to the perfect soldier training manual, you still have a good chance of getting killed, who lives and who dies will mostly depend on a combination of strategic factors you have no control over and dumb luck. Probably the automatic fight-or-flight response suppresses the helplessness: the cornered mouse lashes back at the cat, if instead you start to think rationally about how likely you are to die if you do X, Y or Z, then you can’t help but notice how powerless you actually are.

I conjecture that the voluntary suppression of the fight-or-flight response and realization of helplessness can knock the weights of your neural network into a sub-optimal local minimum (to use a deep learning analogy), where your emotions are suppressed and you underestimate your ability to control the situations you are in.

There’s an interesting nexus between the buddhist path and the takeaway that healing trauma is often aided by getting in touch with one’s body. Breath meditation and body scan meditations are sort of the foundational tools that buddhism uses to get you in touch with what’s happening in your head – “wisdom” follows later, after you’ve learned to calm down.

Pet theories follow:

TBKtS left me thinking that trauma is both adaptive and ubiquitous – for victims of e.g. human trafficking, stuff like extreme dissociation seems plausibly beneficial. It’s also my guess that trauma is “nothing special”, in the sense that the anxiety that keeps you from mentioning politics when Uncle Ricky is over at thanksgiving is the same mechanism at play in catatonic PTSD, except it’s turned up to 11 in the latter case.

The “problem” with trauma responses is that the triggers summon an overwhelmingly intense context that drives you towards one pattern, e.g. shutting down, or shouting at Uncle Ricky for being a murderist. Turning up the rheostat on your physical bodily experience you entertain the triggering stimuli while maintaining a safer context, namely a physical reality where there’s no threat present. Alternatively, EMDR and ART function to “break” the context that gets brought up. As far as I can tell with ART, you’re essentially implanting false memories. Voila, context obliterated, trauma response ameliorated.

So then, grounded in the idea of grounding yourself in physical experience, the primary value prop for mediation that I see is giving people tools for dealing with moderate amounts of trauma. If we’re in the business of reducing suffering, I suspect the rest of it (what is enlightenment? is meditation unique?) is kind of a sideshow.

It requires a whole toolkit to repair one’s trauma, in my experience. The process is something like inheriting a grand ruin of a house from your parents, which you must renovate almost entirely on your own, because you cannot live elsewhere.

Just dropping in here to say I’ve really enjoyed your way with words in this discussion, LeeBird.

The sections with the symptomatology and neurobiology of PTSD were helpful in exploring the boundaries of the syndrome, but didn’t make me feel like I really understood what was going on.

Many who work with trauma, professionals and survivors, found Stephen Porges’ Polyvagal Theory helpful in wrapping their heads around a neurobiological cause. Polyvagal Theory also describes cures, the power of human connection to release badly charged memories which lock people into a Fight, Flight, or Freeze response. Sometimes people fall into the Freeze response (low engagement) simply to conserve energy after their sympathetic nervous system spent too much time set at Fight or Fligh t. I say all this as a survivor. But I’d love to hear the SSC communities take on Polyvagal therapies.

Several good comments on this post. A few thoughts:

As Scott mentions in his reference to his “Different Worlds” post it seem many of Scott’s patients are very intellectualized. In the Different Worlds post Scott mentions that he tends to attract patients who are very much “in their head” and not the more emotional, creative, primary process/fantasy types (i.e. people who would be drawn to books like Body Knows the Score.)

On to genetics.

When TBKtS was published in 2014, we already know with certainty that schizophrenia was about 80% genetic, and at least 15 genes had been identified as especially likely to be involved; today we know hundreds and can even make primitive polygenic predictors

While I do not view Wikipedia as a definitive source, if you read the section in the Causes of Schizophrenia page just because schizophrenia is 80 % genetic does not mean people who appear to carry “schizophrenia genes”become schizophrenic. There is a gene x environment interaction. Also, recently I have been reading Dante Ciccheti’s Developmental Psychopathology volumes and I recall in the volume on Developmental Neuroscience the genetic component of schizophrenia was closer to 50%. Also, they refer to twin studies showing a significant environmental component in schizophrenia.

That being said, I agree that Van Der Kolk did not give enough focus on genetic influences. But not everything can be reduced to genes. Another very popular book that seems similar to TBKTS is Eugene Gendlin’s work on focusing and the felt sense.

Lastly, when I have tried to check out the Body Knows the Score from my local library it is usually checked out which tells me that it is very popular and the books themes resonate with people. On Amazon the book has 89% five star ratings which I rarely see on Amazon.

IMO, overall I think Scott is being too focused on the book’s shortcomings in regards to PTSD and it’s lack of attention to genetics. As the “Different World’s” post mentions Scott’s leanings tend to be the more rationalistic views. However, it was nice to see the Update with Scott being a bit more open minded. The overall message of the book for me was being aware of the “somatic’ experiencing of people’s trauma, feelings, etc. Many people deny or repress their traumas/abuse but certain parts of their body may “hold” the trauma.

Interesting. Yeah, I could see psychiatrists specializing by patient type–seems like it would benefit everyone. A ‘geek psychiatrist’ would be more able to provide coping strategies dealing with things like social anxiety, and possibly autism-adjacent sensory issues, and so on.

“So the first step in raising awareness of PTSD was – amazingly – convincing the US military that some people might get PTSD from combat.”

What term did the military use before? A WW1 airman might be diagnosed with Flying Sickness D, rather than PTSD, but does that mean anything except the RFC in 1918 used a different acronym to the one he was trying to sell a few decades later?

(Winged Victory, for example, is a novel almost entirely about a pilot with what would now be PTSD, but was written by a veteran in the 1920s. No other character thinks the central character in any way odd or unusual.)

As I noted above: there were a string of terms to describe this same basic phenomenon, as far back as we have records. “PTSD” today; in Vietnam “Gross Stress Disorder” and “Adjustment Disorder”; in Korea and WWII “Combat Stress” or “Combat Fatigue” or “Battle Fatigue”; in WWI “Shell Shock”; in the Civil War, “Soldier’s Heart” or “DaCosta Syndrome”; and before that, “Nostalgia”.

One issue with the VA, specifically, is, that it is required to use a Code of Federal Regulations to evaluate medical conditions; this is subject to federal laws, court cases, administrative requirements, and more, and it takes years and years to make any change at all. So, many of their decisions are known, by everyone concerned, to be nonsensical– but they can’t take a sensible approach under the law or regulation. (They also hire some, shall we say, less-than-they-ought-to-be personnel… but that’s a separate issue, don’t get me started.) And nobody is particularly interested in getting something that will cost money, added to the CFR. The bias is always going to be against expanding the definition of disability; these usually have to be done directly with legislation from Congress (as, e.g. Agent Orange exposure).

My own theory on this is, previously, our society was a much simpler place, and so somebody who was knocked off their “peak” but was still mostly functional, could still get a job, a house, etc. and was just expected to get on with their lives. Veterans would get together with other veterans, such as with the VFW or American Legion, for an understanding group of friends (and an equivalent group for their wives) to talk to. Such as my father in law, who pretty much came home from Korea and moved on with his life– although he developed an alcohol problem, had a variety of physical impairments, and would wake up crying periodically until the day he died. Or the man my husband always called, “Poor Mr. Brauner”, who made it through Bataan and the Japanese POW camps, but lived by himself in a shack just off the highway, never married or held a job beyond an unskilled laborer, had a very limited tolerance for being around people, hard drinker (maybe alcoholic), died in his 50s… but was already an old man by then.

Today, though, there’s few (if any) decent jobs for a guy who will periodically show up exhausted and maybe hung over at work, or get unreasonably angry and co-workers for no apparent reason sometimes. Nobody to keep a general eye on Poor Mr. Brauner, make sure he’s at least got a landscaping job during the week and is up and around on the weekends. So we try to fill the gap with a check from Uncle Sam, and a disability rating… and it’s worse by a long shot, but that’s what we’re doing.

I’d like to see some evidence that shipyards, mines, textile mills and so on really are so much more welcoming environments for someone suffering from a traumatic stress disorder. It doesn’t seem like the sort of thing you should expect. Yet those are the kinds of workplaces that have become rarer.

I don’t think they have to be more welcoming overall environments for this to hold true. They could even be more likely to trigger strong reactions on occasion–like from loud noises that sound like gunfire. The key thing is that workplaces today have virtually no tolerance for “difficult” people—it reminds me of Scott writing about the patient who randomly shouted “grahh” at times but was totally capable of doing the work required by many jobs. However, no one would hire him, because that disturbs other people, and they can easily get someone who does not do that. Most positions nowadays are somewhat “customer-facing” and very focused on presentation, even if they are simple and low-paying. And, people move around a lot–when everyone worked at the same company for decades, doing manual work without much interaction with the general public, a man like the patient described could get a job at his brother’s factory, where his quirks were known and everyone had gotten used to it. Even someone who is just cranky and awkward may alienate his co-workers quickly enough to cause problems in an office environment–it only takes occasional instability to cause a problem. A low-level guy who is moving things around at a shipyard can to some extent have whatever attitude he wants as long as he moves the items correctly. Maybe eventually he has an outburst and is fired, but he doesn’t have to emotionally regulate himself and look good in front of his co-workers every second of the day, or pass an interview based on soft skills.

I think this is an important point. Not that society is so much more complex, but that the tolerance for alcoholics is so much less today. The three martini lunch used to not be a big deal but would get almost anyone fired today. For blue collar people it would be very common on paydays for wives to wait for their husbands at the factory gate so they could some money for groceries before it was all spent at the bar.

Alcohol used to be the go to treatment for PTSD and it was just accepted.

I’m not sure what to think of this or how much I should revise the negative opinion of this book which I formed before this event.

How much of the value that these and other similar books provide is simply by providing people a language or frame of reference to communicate their expression to others? Internal emotional states are frequently hard to describe (praise be the poets who can do so!) and having any shared language or experience is a way to connect and share that experience. Perhaps the trauma experienced is further worsened or complicated by feeling alone and/or an inability to communicate their experience to others.

That is certainly at least some of its value. I believed that no one thought or felt the way I did, until I read what other folks with C-PTSD said about their thoughts and feelings. The details of trauma/abuse differ from one person to the next, but the strategies for coping/healing have broad application.

I found the descriptions of PTSD numbness really striking because they’re the complete opposite of my recent experience.

I don’t have PTSD but I do practice detachment, I think because I experienced a lot of social disappointment as a child. But over the past few weeks, I’ve been practicing getting more in-touch with my senses. Now, as I get more attuned to how I feel and what’s going on around me, I feel more alive but also more content and confident.

The practice of being more attuned with my senses is coupled with ascribing more meaning to my life. Like I have to justify the increased sensitivity because it has a cost in psychic discomfort. So it’s usually very unpleasant in and of itself but has the secondary effect of elevating how good I feel about myself.

“Trauma is as old as living creatures; war, disaster, bullying, and rape far predate homo sapiens. Even if child abuse is rare in hunter-gatherer tribes (as some optimistic anthropologists claim) killing all the adults in a tribe and enslaving their children is pretty common, which cashes out to kids getting abused. Our evolutionary history should have prepared us incredibly well for all of this”

Any reason to think it hasn’t?

PTSD is subjectively unpleasant, but do people with PTSD have fewer successful offspring? In hunter-gatherer tribes?

In these more cynical days, we know that the first few studies on any technique – usually done in an atmosphere of frothy excitement, by the technique’s most fervent early adapters – are always highly positive. And later studies – done in an atmosphere of boredom, by large multi-center consortia – are almost always disappointing.

What if having an excited therapist is more important than the treatment methodology they’re using? Maybe what matters is that you’re treated by an individual that really cares about you and really wants you to get better (if only so they can get the result they want for their study) instead of a dreary, uninspired medical bureaucracy.

According to the research I’ve read, EMDR appears to work regardless of how competent or engaging the therapist is, and I would hazard a guess that many other physical/mechanical therapies would be the same.

However, talk-based therapy is very much about the relationship. My former therapist (who I only stopped seeing because I moved away) is a woman in her late 20’s, immersed in the same sort of sociocultural environment I myself exist in, and it was delightful to work with her because there were so many things I didn’t have to explain. I could say “I haven’t posted a selfie in six months” and she understood what that signified instantly. She knew the difference between ironic, memetic suicidal ideation vs. a genuine intent to self-harm. Most importantly, she was down with the LGBTQ community, didn’t lecture me about my recreational drug use, and asked precisely one question about my ethically non-monogamous relationship structure (“Does everyone know about each other and is everyone cool with this?” “Yes.” “Good.”) A therapist like that is worth their weight in gold.

Two points.

First, there’s a fine distinction between “child sexual abuse committed by a legal parent/guardian” and “incest” that might look very significant based on the statistics for the incidence of child sexual abuse as committed by stepparents vs. biological parents.

Second, as for combat PTSD in particular, there is a lot about modern combat that differs from the kind of stress that would be experienced in the premodern era that we are still genetically adapted for. Ancient combat wasn’t filled with loud gunfire and explosives at the very least, and it’s likely that ancient warriors also got better sleep.

Perhaps most importantly, many warriors today are specifically trained to overcome the natural human inhibition against killing. Compared to the World Wars where surprisingly few men in combat actually fired their weapons at the enemy, let alone made an honest and deliberate attempt to kill them outside of the most desperate of circumstances, modern ground forces are thoroughly trained to kill and hence are more likely to have the traumatic experience of having knowingly killed people. (This theory also seemingly tracks backwards into history: in the era of bayonet charges, for instance, there were surprisingly few combat deaths by bayonet.)

There’s an essay by David Drake about how war has gotten worse for soldiers. More continuous (low tech meant stopping for night, and also for planting and harvest seasons), louder, and more random.

More continuous (low tech meant stopping for night, and also for planting and harvest seasons),

Reminds me of the theory that the ancient Roman practice of fortifying their camps each night was as much about psychology as practical defence. Knowing that there was a defensive barrier between them and the enemy, even something as simple as a ditch and row of pales, made it easier for soldiers to “switch off” when they weren’t on duty.

That’s so interesting, Mr. X! Might you happen to have a citation for that bit of Roman history/theory?

It makes a potentially wonderful metaphor for wondering what set of even symbolic practices one can employ that enable the nervous system to “switch off” when the world feels like a scary place.

Unfortunately, it was so long ago that I can’t really remember. It might have been Goldsworthy’s Complete Roman Army , but I couldn’t swear to it.

Going beyond escape vs no-escape, PTSD (my impression) follows an “extinction burst” and it can take quite a while for that to emerge. Learned helplessness was another term that I’ve seen. That can happen with grief and loss, e.g. Bonnie Green (2000), Traumatic Loss: Conceptual and Empirical Links Between Trauma and Bereavement, Journal of Personal and Interpersonal Loss: International Perspectives on Stress & Coping, 5:1, 1-17, http://www.tandfonline.com/loi/upil19

“Actually, data gathered in a number of studies indicate that people who have experienced one traumatic event are likely to have experienced multiple events, making it difficult to link symptoms with a particular incident” (from above article). That fits in with predisposition to PTSD having a genetic component ( https://health.ucsd.edu/news/releases/Pages/2019-10-08-study-reveals-ptsd-has-strong-genetic-component.aspx )

I’ve been wanting to read Allan Schore’s book “The Science of the Art of Psychotherapy” (2012) Schore has written a lot about disorders of affect regulation, which would possibly encompass PTSD. “Affect Regulation and the Origin of the Self: The Neurobiology of Emotional Development” (1994; Routledge reprint 2015) is a famous book of his that I also would like to read someday.

He has an article collection “The Allan Schore Reader” (Eva Rass, ed.) which looks interesting. Scott A, you might want to look at his stuff since I think his approach might be what you were looking for in van der Kolk’s book.

“Fear of predators causes PTSD-like changes in brains of wild animals” talks about PTSD in the brain: https://www.sciencedaily.com/releases/2019/08/190807112939.htm

Military PTSD is in fact often caused by blast injuries: https://www.nytimes.com/2016/06/12/magazine/what-if-ptsd-is-more-physical-than-psychological.html

One of the markers of PTSD is supposed to be nightmares. Has anyone monitored stress hormones (cortisol in saliva or whatever) of a PTSD sufferer during the person’s REM sleep, and compared the level to that of non-sufferers?

I wonder if the blast injuries thing is actually misdiagnosed CTE. Some of CTE and PTSD’s symptoms can be similar:

* Confusion.

* Personality changes (including depression and suicidal thoughts).

* Erratic behavior (including aggression).

* Difficulty sleeping

CTE doesn’t involve flashbacks whereas PTSD does, but I could see someone who suffers from many of those symptoms being misdiagnosed.

Two quick notes

– see your reading history backwards post. The fact that it’s obvious abuse is bad now does not mean that it always was obvious.

– this book may not be aimed at you. I got the impression that this book was aimed at people with ptsd and was meant to be read by people who had the condition, not people treating it. And it’s worth noting that your one anecdote of giving the book to someone with the condition was highly successful.

“Railway spine” was a disorder that started appearing in victims of train wrecks in the early 1800s–the first mass casualty incidents to occur with regularity, pretty much. It sounds just like PTSD, and that is now what it is believed to have been. Doctors thought that whiplash from the accident deranged the molecules in the spine…it wasn’t a *bad* guess, all things considered. Then they noticed its prevalence during the Civil War, among people who hadn’t been in railway accidents but had seen combat.

Van der Kolk describes a study on stereoagnosia in PTSD patients: if blindfolded and given a small object (like a key), they are unable to recognize it by feel, even though this task is easy for healthy people.

While I’ve been unable to trace it to any event or trauma, I’ve for the last few years had symptoms that seem to correlate well with PTSD. One of them, though I had not been able to connect it to a larger theory, was that suddenly I was unable to rummage around in my purse to find items without looking. Like, my hand just does not perceive what I am feeling, and it causes this bizarre sense of panic and impossibility, even if the item should be pretty easy to recognize and obtain. I have no idea how to explain the phenomenon, but this was interesting to read.

the absolute firewall between bodily sensation and conscious processing.

This is an accurate description of what I experience. If I attempt to think about my situation and get on track, it seems to immediately shut down my sense of “being,” and therefore the thoughts don’t “take.” They don’t internalize. Because of this, it feels like no progress is made, like I’m trying to write but there’s no sensation of making an indent on the paper. It is bizarre. The “mental motion” or interrupted motion therapy idea has always appealed to me, because that is what it feels like–missing the off-ramp, even if you are aware there is one. It’s like the reaction process doesn’t complete. But I know it also sounds mystical and may well be totally wrong.

I’m pretty sure people noticed the similarities in psychological issues between some veterans and some sexual abuse victims early on–I thought I read that Freud pointed that out at one point, but sort of dodged the issue? I was reading letters from the 1860s or 1870s in which a woman noted that she had a friend who was eccentric and emotionally hardened, and she commented that the friends seemed “demoralized” like many of the Civil War veterans. I don’t find it hard to believe that there is a certain reaction caused by that sort of trauma (somewhat prolonged vulnerability in a situation where fleeing isn’t an option, possibly combined with complex social factors or a confused feeling in hindsight that you *should* have somehow done something different) that can look similar to symptoms caused by “bad genes” or a number of other problems, but still have a different underlying dynamic that would be beneficial to recognize and treat specifically. Of course, it it may also just be an false explanation that sounds good, and it is important to figure that out. But I don’t see why it wouldn’t be a possible way to categorize. Also, some people could genetically have issues with some of the emotional regulation that becomes dysfunctional after trauma–it can be relevant without being exclusive.

There was a huge drama in the Freud scholarship world about [Freud’s seduction theory]( https://en.wikipedia.org/wiki/Freud%27s_seduction_theory ) a few decades ago. Jeffrey Moussasief Masson was the director of the Freud Archive, found and published some evidence about it, and had an incredibly acrimonious split with the Archive, and with Sigmund Freud’s granddaughter Anna Freud who had first appointed Masson to the gig. I didn’t pay much attention to the details but it got some news coverage while it was going on.

Whole bunch of “Just So” stories.

As for military rotations, mentioned above, I am told that it is a statisticalmatter. Bringing in an entirely new unit means that a bunch of people are now in an environment where they don’t know who among the “locals” is friendly and what things or places are dangerous. Brining in individuals allows for some “on the job” training although there are personal stresses since the FNG [F___ing New Guy] is mostly likely to be killed or to do something that gets his fellows killed.

I am very sympathetic to the APA as to diagnosing symptoms and “disorders” rather than “causes”. It is next to impossible to disentangle genetics and interpersonal relationships for a particular patient. The patient may say, “I was abused”, while the parents may say, “No, He/She was always weird, just like his/her cousins”.

Well, the therapist has the lay of the land, beyond that is the game of divorce court; “He said, She said”. The therapist has becomes effectively burdened with a badge and handcuffs which may make both the family and patient defensive and uncommunicative. If the parents are proved to be abusive, then the patient gets the burder of “betrayal”. Alternatively, the patient’s mental state provides “evidence” of criminal behavior by innocent parents.

The focus on the sexual aspect of “abuse” is a traditional fantasy. The most severe “abuse” that I am aware of included erratic and, in my view, “brutal” punishment that included isolation in dark rooms or basements. I suspect that there would have been no sex/incest involved but I sure would expect some emotional or behavioral consequences in the “survivors”.

The potential contributions to maladaptive behavior is a concern in therapy. Weird families have weird children and such folks may respond differently to various forms of therapy. That real consideration is easily lost in the current non-therapeutic confrontation of ideologies and politics. Did the patient’s mal-adaptive behavior come from a childhood in the “ghetto” or did “their” common mal-adaptive behavior cause the “ghetto”? I think that it is likely that a child that grew up in South Chicago or in a village in Syria or the Central African Republic during the “unrest” will have some “unusual” behavioral characteristics. That gets the therapist into “divorce court” scenario of He/she said vs. he/she said but with automatic weapons.

A therapist probably has to be aware of lthe potential contribution of both the genetic and environmental factors without being too infatuated by the details or the current social ideology. It isn’t always “sex”. The patient/client isn’t always a “victim”. Some clear “victims” are quite functional and “well adjusted”. I think it is notable that there are media reports of individuals diagnosed with PTSD who have never been in a combat environment. Apparently, the highly regimented but open ended (What’s next?) military environment is highly stressful for some individuals (genetics?).

I can’t speak to the estimate that 80% of schizophrenia is genetic, but even so, I agree that the therapist is more important than the theory. We are very adaptable critters.

If anyone cares there is a hacker news thread about this book review:

https://news.ycombinator.com/item?id=21522600

That’s how I found my way here, should have mentioned earlier.

The story about troubled youths performing Shakespeare is almost exactly the plot of HBO’s Barry, where a Iraq war vet / hit man (Bill Hader) with PTSD like issues joins a local acting class. It’s actually a great show and that description doesn’t do it justice – it’s funny and has some great twists. Recommend.

I am not a psychologist, but I research AI and I can see some similarities here. For those with more knowledge about psychology, how good does this description of PTSD sound?

Trauma sets a new reference level for the type of experiences you should expect. PTSD is when the brain overreacts while doing this.

Most of the treatment options listed in this article help with resetting the reference level: They force repeated exposure to more normal stimuli levels, while also keeping the patient in a mental state where they are receptive to adapting their reference level.

A way to test this hypothesis: Check if PTSD happens more often to people who otherwise lived sheltered lives than to people who are exposed to varying levels of horror throughout their lives up to the time of the trauma. This hypothesis would predict this to be true. It would also predict that fixing childhood trauma is both different and harder than adult trauma, because the child had fewer non-traumatic experiences against which the traumatic experiences stand in contrast.

Rather than a new reference level it’s more like a closed loop of subconscious processing that stays with the person for potentially decades because it stays out of contact with the outside world. There’s a description in a Yeats poem about a cycle repeating over and over that in retrospect describes that.

Here is a very powerful illustrated depiction:

http://nautil.us/issue/23/dominoes/ptsd-the-wound-that-never-heals

I believe the research we have shows that for soldiers in any case that childhood trauma/adversity makes them more likely to develop PTSD from combat trauma. So prior traumatic exposure is a risk factor for developing PTSD from later trauma.

Later trauma is very commonly layered on top of earlier trauma so in that sense it’s harder to “fix” childhood trauma in an adult because usually more bad stuff has happened to them since, while it’s usually easier to “fix” childhood trauma in childhood, though it doesn’t happen nearly enough.

Re: APA categorizations by symptoms rather than cause I don’t think this is true. For example part of the ADHD diagnostic criteria under DSM 5 ” Symptoms do not occur exclusively during the course of schizophrenia or another psychotic disorder, and are not better explained by another mental disorder (eg, mood disorder, anxiety disorder, dissociative disorder, personality disorder, substance intoxication, or withdrawal). ” What the APA does is have a bunch of idiopathic syndromes, like depression, schizophrenia etc. Whenever any case can be explained by factors that can’t be the cause of the majority of cases of the syndrome, then it is immediately excluded. So if trauma is not the cause of the majority of e.g. ADHD, but say 30%, by the APA philosophy trauma caused ADHD should be excluded from being called ADHD and should be grouped under trauma.

This is called differential diagnosis and isn’t really speaking to causes; it’s more just a way of distinguishing between diagnoses that have overlapping symptoms.

I once read a book about the Argentinian Dirty War and some of the accounts of torture victims really stuck with me and IMO explain why dissociation occurs and its role as a very beneficial defense mechanism. Many of the victims’ accounts described how they experienced extreme pain during torture, but it was much worse during the first few sessions. Over time they managed to adapt to an extent, because by feeling disconnected from their bodies the torture was a little bit more tolerable. For many of them it helped them survive to the end of the war, though of course it made it difficult for them to reintegrate into society.

Has anyone looked for PTSD in today’s limited-contact primitive tribes? Scott’s observation that PTSD-inducing events appear to have been ubiquitous in our evolutionary environment, yet we don’t seem to have an adapted response to it, is thought-provoking.

Maybe there’s a qualitative difference in how people in, say hunter-gatherer tribes experienced those events, and how people experience traumatic events today?

This is kind of a sloppy and crude observation, but our ancestors had no access to bach, literature, history, or really any of the networked culture/knowledge that define who we are today. Maybe back then being eaten by a lion (or watching someone get eaten) was just an assault against your body, whereas today such a trauma is also an assault against Civilization. ?

There are a few theories discussed in this thread, but one idea is that it may well *be* the adapted response to certain types of trauma, allowing the person to navigate the new dangerous reality he or she must live in, such as constant warfare, enslavement, or risk of sexual assault. This is where hyper-vigilance and emotional numbing would be helpful. The person is ill-adapted for a life where everything is going well, and the issue today is that there is often the potential to leave the traumatic situation and return to a very safe life. Additionally, there is the idea that it is a failure mode for a normally helpful adaptation, when someone is stuck in the traumatic situation and unable to react normally to defend themselves. Back then, things tended to be over pretty quickly–you got away from the predator, or you didn’t. Our very organized civilization makes it very easy for people to be trapped in situations in which they can’t effectively fight back and in which the right reaction is not clear. I think being so networked definitely has an effect–the trauma is infused with a lot of meaning is probably something talked about when it happens to other people. And our society sort of operates on the idea you should be trusting, emotionally forthcoming, and feel generally safe, which would be a lot less tenable in previous times, even if they had very trusting bonds within their communities. A certain amount of vigilance and uncertainty was just part of daily life.

I’m not questioning the trapped-reality theory (you’re in a long-term bad situation you can’t escape, make the best of it); rather, I’m curious about the experiential difference, post-attack, between two hypothetical lion victims, our primitive survivalist living in the ancestral Savanah, and say a mall-shopper in present-day Scottsdale, AZ, both of whom survive a lion encounter.

Both attacks are over quickly enough so that neither victim ends up in a TR scenario. After the news interviews, I imagine our mall survivor in bed, in her room (assuming she’s not in the hospital), with the curtains drawn, maybe looking at texts from friends and family, or maybe just ruminating about the attack and *what it means*.

Meanwhile PS in contrast is back in motion, maybe digging up grubs or climbing a tree to get at some half-ripe fruit or heck maybe back on the run because there’s another lion out there.

I don’t know how to conceptualize PS’s thought stream (does she even think in “thoughts”?) but I bet it doesn’t involve a monologue about being betrayed by people, institutions, or Reality. Did PS ever think she was safe in the first place? She can’t even count on eating tomorrow!

PS’s response to the attack is going to be inherently kinesthetic whereas MS’s is inherently cerebral. MS feels disembodied in a way, perhaps, that PS never can.

These ideas are interesting to me. Thanks for the response!

The ideas are definitely interesting, and I agree with your assessment of the thought process–I think it is easier for us to feel “disembodied” for a lot of reasons, and that this has more effects that we would acknowledge.

Intrusive thoughts are part of the diagnostic criteria for PTSD, but it’s not the only disorder with them. I’ve read that there’s a relatively high incidence of co-morbidity between OCD and PTSD, which is interesting, but also might imply that maybe some of these things are different symptoms of some of the same underlying frailties, for lack of a better term, manifesting in different ways – someone with OCD is going to feel like their hands are dirty and they need to wash them, while someone with PTSD might freak out and feel like they’re in a combat zone again and start acting like that.

It makes me wonder sometimes if perhaps PTSD is really just triggering pre-existing psychological issues and making them far worse, rather than actually being a thing that is generated unto itself, so you either will develop issues or you won’t, based on preexisting factors. This could explain why we see weird patterns in people suffering from it – if you screen against these things heavily in people who are most directly exposed to trying situations, you could well see your badass commandos who drop in behind enemy lines and slit people’s throats in their sleep have a lower rate of PTSD than the guys who sit in base camp all day listening to guns go off in the distance, because the former group selects against people who are psychologically frail (or, alternatively, the training is sufficiently traumatic that most people who would develop psychological disorders, do so before they’re actually deployed).

For instance, Navy SEALS seem to stand up a lot better to stress than “normal” troops do, which is the source of some study. People are hoping this can be learned, but I suspect it is actually a result of screening out people who have potential underlying issues.

Here’s an interesting video: “Battle fatigue — did it affect soldiers in the ancient world?” The speaker basically endorses the theory that ancient warfare was less intense than modern warfare, and so cases of PTSD were less common (although not entirely unknown).

I read this book and didn’t like it at all, it was very long and hard to read.

Does van der Kolk provide a citation for “standard textbook of psychiatry at the time” with the shocking quotes about the alleged benefits of incest? If not, does anyone know which textbook this was? Some quick searching on my part was not turning up anything besides TBKtS for the quoted material (“such incestuous activity diminishes the subject’s chance of psychosis, and allows for a better adjustment to the external world.”) . . .

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

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The Body Keeps the Score: Mind, Brain and Body in the Transformation of Trauma Paperback – January 1, 2015

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Print length 454 pages
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Publication date January 1, 2015
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Publisher ‏ : ‎ Penguin Books Ltd; 17st edition (January 1, 2015)
Language ‏ : ‎ English
Paperback ‏ : ‎ 454 pages
ISBN-10 ‏ : ‎ 0141978619
ISBN-13 ‏ : ‎ 978-0141978611
Item Weight ‏ : ‎ 6.3 ounces
Dimensions ‏ : ‎ 7.76 x 5.08 x 1.09 inches
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About the authors

Bessel van der kolk.

Bessel van der Kolk (born 1943) is a Boston based psychiatrist noted for his research in the area of post-traumatic stress since the 1970s. His work focuses on the interaction of attachment, neurobiology, and developmental aspects of trauma’s effects on people. His major publication, the New York Times bestseller, 'The Body keeps the Score', talks about how the role of trauma in psychiatric illness has changed over the past 20 years; what we have learned about the ways the brain is shaped by traumatic experiences; how traumatic stress is a response of the entire organism and how that knowledge needs be integrated into healing practices.

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Bessel van der Kolk M.D.

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The Body Keeps The Score

BRAIN, MIND, AND BODY IN THE HEALING OF TRAUMA

The Body Keeps the Score is the inspiring story of how a group of therapists and scientists— together with their courageous and memorable patients—has struggled to integrate recent advances in brain science, attachment research, and body awareness into treatments that can free trauma survivors from the tyranny of the past. These new paths to recovery activate the brain’s natural neuroplasticity to rewire disturbed functioning and rebuild step by step the ability to “know what you know and feel what you feel.” They also offer experiences that directly counteract the helplessness and invisibility associated with trauma, enabling both adults and children to reclaim ownership of their bodies and their lives. Drawing on more than thirty years at the forefront of research and clinical practice, Bessel van der Kolk shows that the terror and isolation at the core of trauma literally reshape both brain and body. New insights into our survival instincts explain why traumatized people experience incomprehensible anxiety and numbing and intolerable rage, and how trauma affects their capacity to concentrate, to remember, to form trusting relationships, and even to feel at home in their own bodies. Having lost the sense of control of themselves and frustrated by failed therapies, they often fear that they are damaged beyond repair. What distinguishes THE BODY KEEPS THE SCORE is that the author is both a scientific researcher with a long history of measuring the effect of trauma on brain function, memory, and treatment outcomes, and an active therapist who keeps learning from his patients what benefits them most. This makes for deeply personal, analytic, and highly readable (not to mention incredibly moving) approach to the topic of trauma recovery. The title underscores the book’s central idea: Exposure the abuse and violence fosters the development of a hyperactive alarm system and molds a body that gets stuck in fight/flight, and freeze. Trauma interferes with the brain circuits that involve focusing, flexibility, and being able to stay in emotional control. A constant sense of danger and helplessness promotes the continuous secretion of stress hormones, which wreaks havoc with the immune system and the functioning of the body’s organs. Only making it safe for trauma victims to inhabit their bodies, and to tolerate feeling what they feel, and knowing what they know, can lead to lasting healing. This may involve a range of therapeutic interventions (one size never fits all), including various forms of trauma processing, neurofeedback, theater, meditation, play, and yoga. Readers will come away from this book with awe at human resilience and at the power of our relationships—whether in the intimacy of home or in our wider communities—to both hurt and heal.

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A Conversation with Bessel van der Kolk

Q. You’ve been working with traumatized children and adults for many years and have seen significant changes in how mental illness and trauma are treated. What have you learned from neuroscience, attachment research, and interpersonal neurobiology about how to help children and adults recover from toxic stress?

A. Trauma is ubiquitous in our society. Over 500,000 children are reported for abuse and neglect each year. One out of four Americans reports having been left with bruises after having been hit as a child, one out of five was sexually molested, one out of eight has witnessed severe domestic violence, and a a quarter grew up with alcoholism or drug addiction. Almost every inmate in our prison system, by far the largest in the world, has a serious history of prior trauma. Half a million women are raped each year, half of them before they are adolescents.

These experiences leave traces on people’s biology and identity and have devastating social consequences–medical illnesses, problems with school and work performance, drug addiction and a variety of psychiatric illness. In fact, the Centers for Disease Control and Prevention calculate that childhood trauma is our single largest public health issue—more costly than cancer or heart disease—and one that is largely preventable by early prevention and intervention.

In order to overcome trauma people need to feel safe enough to open up their hearts and minds to others and become engaged with new possibilities. This can only be done if trauma survivors, and their communities, are helped to confront and confess the reality of what has happened and are helped to feel safe again. In many non-Western cultures this involves communal rhythmical activities, such as dancing, athletics, and collective prayer. Communal rituals of acknowledgment, support, and repentance can play a substantial role in healing from trauma.

Treatments that focus solely on decreasing a few PTSD symptoms, or on drugs to obliterate feelings, ignore the importance of integrating the traumatic experience in the overall arc of one’s life, and they fail to help survivors reconnect with their communities. The scientific evidence for the efficacy of these therapies, while widely promulgated and practiced, is, in fact, quite disappointing.

Probably the most important challenge in recovering from trauma is learning to regulate oneself. We can activate this innate capacity by utilizing breath, touch, movement, and rhythmical engagement with one’s fellow human beings, such as yoga, tai chi, and dancing, methods that are not widely utilized in medical settings or in school systems.

Q. In your book you talk about the effect of trauma on the brain. What changes occur in the brain in response to trauma? What happens when someone experiences a flashback?

A. Neuroscience research has shown that traumatized individuals are prone to activate brain areas involved in fear perception, and to have deficits in the areas involved in filtering out relevant from irrelevant information, as well as in the perception of bodily sensations. These changes do not occur in the rational part of the brain, and do not really seem to benefit merely from being aware of the error of one’s ways.

The impact of trauma is located in the survival part of the brain, which does not return to baseline after the threat is over. This part of the brain is by definition unreasonable—you do not stop being hungry by reminding yourself how fat you are, and it’s pretty difficult to talk yourself out of being angry, shut down, or in love.

One of the most devastating effects of trauma is that people’s biology changes into a biology of threat; this is expressed on multiple levels, in stress hormones, immunology and what the brain selects to pay attention to. The intrinsic reward system changes, as do “attractors”—what turns you on or leaves you cold. As a consequence, traumatized people stay on hyper alert; they feel chronically unsafe and in danger, and they have problems feeling calm and enjoying the moment and they are out of touch with their surroundings. Trauma can make it difficult to have comfortable reciprocal relationships with one’s children, partners, and coworkers.

Through brain imaging technology, we can visualize how traumatized people even have problems processing ordinary, nonthreatening information, which makes it difficult to fully engage in daily life and to learn from experience. As a result, they are frazzled, unfocused, and tend to repeat the same nonproductive behavior patterns, with the same miserable results.

Trauma affects the entire human organism–thinking, feeling, relationships, and the housekeeping of one’s body. Trauma survivors are vulnerable to a host of medical illnesses and chronic pain syndromes, insomnia, drug and alcohol addiction, depression, obesity, and other issues related to optimal functioning of the entire organism, and the capacity for self regulation and self-care.

Q. What do you wish more people understood about trauma?

A. First of all, is important to understand is how ubiquitous trauma is in our society, what devastating effects it has on family life, workplace productivity, the facility to learn and take initiative, the ability to stay calm and focused, and the capacity to be compassionate with one’s fellow man.

As a society we cannot afford to ignore trauma and keep our heads in the sand. There are, in fact, countries where governments have taken the science of trauma (and its prevention and treatment) seriously, with results to prove how well that works. For example, Norway has fifty-one citizens per hundred thousand in jail; the US, 951. Their students also have higher test scores and higher graduation rates from high school and college, and their society has a fraction of our crime rate.

I think that the general public tends to associate trauma with the military and terrorism, but the vast majority of traumas occur within families, schools, and neighborhoods, the very people whom they depend on for safety and security. Most traumatized women and children, for example, are traumatized by their intimates. Another important issue is that trauma has a different impact, depending on the age and relative maturity of the affected individual. The brains of traumatized kids develop in a “use-dependent” manner—they become experts in dealing with threat, and have problems with self-regulation, play, and the sort of imaginative creativity that is necessary to become productive members of society.

Trauma is a deeply communal problem: we are fundamentally social animals, and trauma profoundly affects people’s capacity to get along with others and be a cooperative and enjoyable member of the tribe.

Q. You have worked with war veterans and at the beginning of your career worked with Vietnam vets before PTSD was an official diagnosis. What do you think of the current prescribed treatment by the Veteran Affairs office for trauma?

A. I currently treat only a few veterans and I am not intimately familiar with what is happening at the Veterans Administration. The VA is a pretty closed system—people who work at the VA rarely attend my workshops or lectures, or those of my close colleagues.

I hear that their main focus is on cognitive behavioral treatments, and on desensitizing people to their memories. These treatments, research shows, are not particularly effective. That is not surprising, given that being traumatized is not an issue of faulty cognition—the problems emanate from parts of the brain that have little to do with cognition.

The biggest problem for veterans is to fully engage in their current lives. The Body Keeps the Score provides a number of ways to reengage — some are ancient, like yoga, theater, and martial arts, while others, like neurofeedback, are based on the latest advances in neuroscience.

Doctors at the VA and the DoD prescribe vast amounts of drugs, even though there is scant evidence that drugs significantly help traumatic stress. Drugs can obscure posttraumatic symptoms but not resolve them.

This issue is even more concerning in the treatment of traumatized children. The poorer you are the more likely it is that you will be given psychiatric drugs to control your behavior. These drugs can have devastating effects on children’s capacity to learn, engage and feel good in their bodies.

Q. What benefits does yoga offer patients in treatment? Are they universal?

A. Yoga is just one of many time-honored ways to help people experience ownership of their bodies and to feel safe and in control. Our most recent research study on this subject showed that yoga had better results than any drug studies so far for PTSD. That is not to say that everybody should practice yoga—one size never fits all—but every trauma survivor would do well to engage in practices that increases their inner bodily sense of control, safety, and flexibility.

In order to overcome trauma we have to befriend and be in touch with ourselves—our sensations and our emotions. Neuroscience research has shown that the only way we can consciously access that disturbed survival brain is through our interoceptive pathways — through the part of the brain that helps us to feel what is going on deep inside of ourselves.

Q. What do you hope to accomplish with The Body Keeps the Score? What do you want readers to take away from it?

A. I hope that all traumatized individuals, and their loved ones, will find this book helpful for comfort, understanding, and guidance. That politicians and policy makers will read this book to help them understand the devastating effects of early deprivation and punitive school systems on the health and welfare of our country, as well as the predictable consequences of putting our young men and women in harm’s way.

That parents of adopted kids will understand what their children are dealing with, and serve as a guide to solutions.

That educators and school systems will implement trauma-based interventions for children who come from abuse and neglect, and thereby become agents of change to help all children become productive members of society. My greatest hope is that all school systems will teach the four R’s: reading, writing, rhythmatic, and self-regulation. That from K to 12 all kids will be taught to experience how they can regulate themselves though their breath, movements, and synchronized interactions with others, and learn how their bodies, brains, and minds react to overwhelming stress with recognizable patterns that can be managed through self-regulation practices, more than with drugs or alcohol.

That it will inspire our armed forces to become as expert in helping returning warriors to once again become peaceful and productive civilians, as they are in transforming adolescents into members of magnificent fighting units.

That physicians will appreciate the role of trauma in the disintegration of bodily systems, and learn what they can do about it.

That mental health professionals will acknowledge the relationship between trauma, drug addiction, and numerous psychiatric “disorders” and incorporate effective trauma treatments in their practice.

That law enforcement and criminal justice personnel will read it to understand their own responses, and that of the people they are dealing with.

That psychiatrists will integrate the scientific knowledge that our brains are meant to help us cooperate and thrive in a community, and realize that their job is to help patients deal with the devastating effects of trauma on mind, brain, and body.

I hope that this book will help us all acknowledge the fact that our zip code has a more profound effect on health and well-being then our genetic code. In short, the goal of this book is to help us to become a trauma-informed society that will confront and deal with our largest public health issue: psychological trauma.

Every once in a while, a book comes along that fundamentally changes the way we look at the world. Bessel VanderKolk has written such a book. Having read “The Body Keeps the Score”, it will be impossible for us any longer to deny the profound extent of trauma and its impact on our lives. VanderKolk writes in the humanitarian tradition of his great Harvard mentor, Elvin Semrad, and his book is a worthy testament to the tutelage of this great man, and the beautiful maturation of his pupil. The arc of VanderKolk’s story is vast and comprehensive—but Vanderkolk is such a skillful storyteller that he keeps us riveted to the page. I simply could not put this book down. It is, simply put, a great work. - Stephen Cope , Founder and Director, Kripalu Institute for Extraordinary Living; Author, Yoga and the Quest for the True Self.

In this magnificent book, Bessel van der Kolk takes the reader on a captivating journey that is chock full of riveting stories of patients and their struggles interpreted through history, research, and neuroscience made accessible in the words of a gifted storyteller. We are privy to the author’s own courageous efforts to understand and treat trauma over the past 40 years, the results of which have broken new ground and challenged the status quo of psychiatry and psychotherapy. The Body Keeps the Score leaves us with both a profound appreciation for and a felt sense of, the debilitating effects of trauma, along with hope for the future through fascinating descriptions of novel approaches to treatment. This outstanding volume is absolutely essential reading not only for therapists but for all who seek to understand, prevent, or treat the immense suffering caused by trauma. - Pat Ogden PhD , Founder/Educational Director of the Sensorimotor Psychotherapy Institute; Author, Sensorimotor Psychotherapy: Interventions for Trauma and Attachment

This is masterpiece of powerful understanding and brave heartedness, one of the most intelligent and helpful works on trauma I have ever read. Dr. Van der Kolk offer a brilliant synthesis of clinical cases, neuroscience, powerful tools and caring humanity, offering a whole new level of healing for the traumas carried by so many. - Jack Kornfield Author, A Path work Heart

The Body Keeps the Score articulates new and better therapies for toxic stress based on a deep understanding of the effects of trauma on brain development and attachment systems. This volume provides a moving summary of what is currently known about the effects of trauma on individuals and societies, and introduces the healing potential of both age-old and novel approaches to help traumatized children and adults fully engage in the present. - Jessica Stern , Policy consultant on terrorism; Author, Denial: A Memoir of Terror

This is an amazing accomplishment from the neuroscientist most responsible for the contemporary revolution in mental health toward the recognition that so many mental problems are the product of trauma. With the compelling writing of a good novelist, van der Kolk revisits his fascinating journey of discovery that has challenged established wisdom in psychiatry. Interspersed with that narrative are clear and understandable: descriptions of the neurobiology of trauma; explanations of the ineffectiveness of traditional approaches to treating trauma; and introductions to the approaches that take patients beneath their cognitive minds to heal the parts of them that remained frozen in the past. All this is illustrated vividly with dramatic case histories and substantiated with convincing research. This is a watershed book that will be remembered as tipping the scales within psychiatry and the culture at large toward the recognition of the toll traumatic events and our attempts to deny their impact take on us all. - Richard Schwartz PhD Originator, Internal Family Systems Therapy

Breathtaking in its scope and breadth, The Body Keeps the Score is a seminal work by one of the preeminent pioneers in trauma research and treatment. This essential book unites the evolving neuroscience of trauma research with an emergent wave of body-oriented therapies and traditional mind/body practices. These new approaches and ancient disciplines build resilience and enhance the capacity to have new empowered bodily (interoceptive) experiences that contradict the previous traumatic ones of fear, overwhelm and helplessness. They go beyond symptom relief, and connect us with our vital energy and here-and-now presence. A must read for all therapists and for those interested in a scholarly, thoughtful, tome about the powerful forces that affect us as human beings in meeting the many challenges of life including accidents, loss and abuse. - Peter A. Levine, PhD , Author, In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness

The body keeps the score is masterful in bringing together science and humanism to clearly explain how trauma affects the whole person. Bessel van der Kolk brings deep understanding to the pain and chaos of the trauma experience. The treatment approaches he recommends heal the body and the mind, restoring hope and the possibility of joy. One reads this book with profound gratitude for its wisdom. - Alicia F. Lieberman, Ph.D., Irving B. Harris Endowed Chair in Infant Mental Health; Vice Chair, Academic Affairs, UCSF Department; Director, Child Trauma Research Program, SF General Hospital

This book is a tour de force. Its deeply empathic, insightful, and compassionate perspective promises to further humanize the treatment of trauma victims, dramatically expand their repertoire of self-regulatory healing practices and therapeutic options, and also stimulate greater creative thinking and research on trauma and its effective treatment. The body does keep the score, and Van der Kolk’s ability to demonstrate this through compelling descriptions of the work of others, his own pioneering trajectory and experience as the field evolved and him along with it, and above all, his discovery of ways to work skillfully with people by bringing mindfulness to the body (as well as to their thoughts and emotions) through yoga, movement, and theater are a wonderful and welcome breath of fresh air and possibility in the therapy world.

- Jon Kabat-Zinn , Professor of Medicine emeritus; UMass Medical School; Author, Full Catastrophe Living

Clear, fascinating, hard to put down, filled with powerful case histories, Van der Kolk, the eminent impresario of trauma treatment who has spent a career bringing together diverse trauma scientists and clinicians, and their ideas, while making his own pivotal contributions, describes what is arguably the most important series of breakthroughs in mental health in the last thirty years. We’ve known that psychological trauma fragments the mind. Here we see not only how psychological trauma also breaks connections within the brain, and between mind and body, and learn about the exciting new approaches that allow people with the severest forms of trauma to put all the parts back together again. - Norman Doidge, M.D. , Author, The Brain That Changes Itself

This exceptional book will be a classic of modern psychiatric thought. The impact of overwhelming experience can only be truly understood when many disparate domains of knowledge, such as neuroscience, developmental psychopathology, and interpersonal neurobiology are integrated, as this work uniquely does. There is no other volume in the field of traumatic stress that has distilled these domains of science with such rich historical and clinical perspectives, and arrived at such innovative treatment approaches. The clarity of vision and breadth of wisdom of this unique but highly accessible work is remarkable. This book is essential reading for anyone interested in understanding and treating traumatic stress and the scope of its impact on society. - Alexander McFarlane AO, MB BS (Hons) MD FRANZCP Director of the Centre for Traumatic Stress Studies; The University of Adelaide, South Australia

In The Body Keeps the Score we share the author's courageous journey into the parallel dissociative worlds of trauma victims and the medical and psychological disciplines that are meant to provide relief. In this compelling book we learn that as our minds desperately try to leave trauma behind, our bodies keep us trapped in the past with wordless emotions and feelings. These inner disconnections cascade into ruptures in social relationships with disastrous effects on marriages, families, and friendships. Van der Kolk offers hope by describing treatments and strategies that have successfully helped his patients reconnect their thoughts with their bodies. We leave this shared journey understanding that only through fostering self-awareness and gaining an inner sense of safety will we, as a species, fully experience the richness of life. - Stephen W. Porges, PhD Professor Department of Psychiatry University of North Carolina at Chapel Hill; Author, The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-Regulation

The Body Keeps the Score” eloquently articulates how overwhelming experiences affect the development of brain, mind, and body awareness, all of which are closely intertwined. The resulting derailments have a profound impact on the capacity for love and work. This rich integration of clinical case examples with ground breaking scientific studies provides us with a new understanding of trauma, which inevitably leads to the exploration of novel therapeutic approaches that allow the brain to 'rewire' itself, and help traumatized people to (re)-engage in the present. This book will provide traumatized individuals with a guide to healing and permanently change how psychologists and psychiatrists think about trauma and recovery. - Ruth A. Lanius, M.D., Ph.D. , Harris-Woodman Chair in Psyche and Soma; Professor of Psychiatry, and director PTSD research at the University of Western Ontario; Author, The Impact of Early Life Trauma on Health and Disease

In this inspirational work which seamlessly weaves keen clinical observation, neuroscience, historical analysis, the arts, and personal narrative, Dr. van der Kolk has created an authoritative guide to the effects of trauma, and a revolutionary approach to its treatment, including pathways to recovery. The book is full of wisdom, humanity, compassion and scientific insight, gleaned from a lifetime of clinical service, research and scholarship in the field of traumatic stress. A must read for mental health and other health care professionals, trauma survivors, their loved ones, and those who seek clinical, social, or political solutions to the cycle of trauma and violence in our society. - Rachel Yehuda, PhD , Professor of Psychiatry and Neuroscience; Director of the Traumatic Stress Studies Division at the Mount Sinai School of Medicine New York NY

With his comprehensive knowledge, clinical courage, and creative strategies Bessel van der Kolk leads the way in understanding the impact of trauma and helping people heal from overwhelming life experiences. The Body Keeps the Score is a cutting-edge offering for the general reader to comprehend the complex effects of trauma, and a guide to a wide array of scientifically informed approaches to not only reduce suffering, but to move beyond mere survival-- and to thrive. - Daniel J. Siegel, M.D. , Clinical Professor, UCLA School of Medicine; Author, Brainstorm: The Power and Purpose of the Teenage Brain; Mindsight: The New Science of Personal Transformation

This is an absolutely fascinating and clearly written book by one of the nation’s most experienced physicians in the field of emotional trauma. Equally suitable for primary care doctors and psychotherapists wishing to broaden their range of helpfulness, or for those trapped in their memories, “The Body Keeps the Score” helps us understand how life experiences play out in the function and the malfunction of our bodies, years later. - Vincent J. Felitti, MD Chief of Preventative Medicine Emeritus, Kaiser Permanente San Diego; Co-Principal Investigator, ACE study

Quotes from The Body Keeps the Score

“As long as you keep secrets and suppress information, you are fundamentally at war with yourself…The critical issue is allowing yourself to know what you know. That takes an enormous amount of courage.”

"Traumatized people chronically feel unsafe inside their bodies: The past is alive in the form of gnawing interior discomfort. Their bodies are constantly bombarded by visceral warning signs, and, in an attempt to control these processes, they often become expert at ignoring their gut feelings and in numbing awareness of what is played out inside. They learn to hide from their selves."

“Eighty two percent of the traumatized children seen in the National Child Traumatic Stress Network do not meet diagnostic criteria for PTSD. Because they often are shut down, suspicious, or aggressive they now receive pseudoscientific diagnoses such as “oppositional defiant disorder,” meaning: “This kid hates my guts” or “disruptive mood dysregulation disorder,” meaning he has temper tantrums. These kids accumulate numerous diagnoses over time. Before they reach their twenties, many patients have been given four, five, six, or more of these impressive but meaningless labels. If they receive treatment at all, they get whatever is being promulgated as the method of management du jour: medications, behavioral modification, or exposure therapy. These rarely work and often cause more damage.”

“Neuroscience research shows that the only way we can change the way we feel is by becoming aware of our inner experience and learning to befriend what is going inside ourselves.”

“Mindfulness not only makes it possible to survey our internal landscape with compassion and curiosity but can also actively steer us in the right direction for self-care.”

“As the ACE study has shown, child abuse and neglect is the single most preventable cause of mental illness, the single most common cause of drug and alcohol abuse, and a significant contributor to leading causes of death such as diabetes, heart disease, cancer, stroke, and suicide.”

“Imagination is absolutely critical to the quality of our lives. Our imagination enables us to leave our routine everyday existence by fantasizing about travel, food, sex, falling in love, or having the last word—all the things that make life interesting. Imagination gives us the opportunity to envision new possibilities—it is an essential launchpad for making our hopes come true. It fires our creativity, relieves our boredom, alleviates our pain, enhances our pleasure, and enriches our most intimate relationships.”

“Being able to feel safe with other people is probably the single most important aspect of mental health; safe connections are fundamental to meaningful and satisfying lives."

“How many mental health problems, from drug addiction to self-injurious behavior, start as attempts to cope with the unbearable physical pain of our emotions? If Darwin was right, the solution requires finding ways to help people alter the inner sensory landscape of their bodies. Until recently, this bidirectional communication between body and mind was largely ignored by Western science, even as it had long been central to traditional healing practices in many other parts of the world, notably in India and China. Today it is transforming our understanding of trauma and recovery.”

“The prevailing brain-disease model overlooks four fundamental truths: (1) our capacity to destroy one another is matched by our capacity to heal one another. Restoring relationships and community is central to restoring well-being; (2) language gives us the power to change ourselves and others by communicating our experiences, helping us to define what we know, and finding a common sense of meaning; (3) we have the ability to regulate our own physiology, including some of the so-called involuntary functions of the body and brain, through such basic activities as breathing, moving, and touching; and (4) we can change social conditions to create environments in which children and adults can feel safe and where they can thrive.”

“Psychologists usually try to help people use insight and understanding to manage their behavior. However, 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.”

“Self-regulation can be taught to many kids who cycle between frantic activity and immobility. In addition to reading, writing, and arithmetic, all kids need to learn self-awareness, self-regulation, and communication as part of their core curriculum. Just as we teach history and geography, we need to teach children how their brains and bodies work. For adults and children alike, being in control of ourselves requires becoming familiar with our inner world and accurately identifying what scares, upsets, or delights us.”

More Quotes @ Good Reads

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 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:

Theater Programs
Breath Exercises (Pranayama)
Martial Arts
Group Singing

“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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The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma Hardcover – Illustrated, Sept. 25 2014

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Print length 464 pages
Language English
Publisher Viking
Publication date Sept. 25 2014
Dimensions 15.98 x 3.96 x 23.57 cm
ISBN-10 0670785938
ISBN-13 978-0670785933
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“This is an absolutely fascinating and clearly written book by one of the nation’s most experienced physicians in the field of emotional trauma. The Body Keeps the Score helps us understand how life experiences play out in the function and the malfunction of our bodies, years later.”

—Vincent J. Felitti, M.D., chief of preventative medicine, emeritus, Kaiser Permanente San Diego; co-principal investigator, ACE study

“Every once in a while, a book comes along that fundamentally changes the way we look at the world. Bessel van der Kolk has written such a book. The arc of Van der Kolk’s story is vast and comprehensive, but he is such a skillful storyteller that he keeps us riveted to the page. I could not put this book down. It is, simply put, a great work.” —Stephen Cope, founder and director, Kripalu Institute for Extraordinary Living; author of Yoga and the Quest for the True Self

“Breathtaking in its scope and breadth, The Body Keeps the Score is a seminal work by one of the preeminent pioneers in trauma research and treatment. This essential book unites the evolving neuroscience of trauma research with an emergent wave of body-oriented therapies and traditional mind/body practices that go beyond symptom relief and connect us with our vital energy and here-and-now presence.”

—Peter A. Levine, Ph.D., author of In An Unspoken Voice: How the Body Releases Trauma and Restores Goodness

“Dr. van der Kolk's masterpiece combines the boundless curiosity of the scientist, the erudition of the scholar, and the passion of the truth teller.”

—Judith Herman, M.D., clinical professor of psychiatry, Harvard Medical School; author of Trauma and Recovery

“ The Body Keeps the Score is clear, fascinating, hard to put down, and filled with powerful case histories. Van der Kolk, the eminent impresario of trauma treatment, who has spent a career bringing together diverse trauma scientists and clinicians and their ideas, while making his own pivotal contributions, describes what is arguably the most important series of breakthroughs in mental health in the last thirty years. We’ve known that psychological trauma fragments the mind. Here we see not only how psychological trauma also breaks connections within the brain, but also between mind and body, and learn about the exciting new approaches that allow people with the severest forms of trauma to put all the parts back together again.” —Norman Doidge, author of The Brain That Changes Itself “This exceptional book will be a classic of modern psychiatric thought. The impact of overwhelming experience can only be truly understood when many disparate domains of knowledge, such as neuroscience, developmental psychopathology, and interpersonal neurobiology are integrated, as this work uniquely does. There is no other volume in the field of traumatic stress that has distilled these domains of science with such rich historical and clinical perspectives, and arrived at such innovative treatment approaches. The clarity of vision and breadth of wisdom of this unique but highly accessible work is remarkable. This book is essential reading for anyone interested in understanding and treating traumatic stress and the scope of its impact on society.”

—Alexander McFarlane AO, MB BS (Hons) MD FRANZCP, director of the Centre for Traumatic Stress Studies, The University of Adelaide, South Australia

“ The Body Keeps the Score articulates new and better therapies for toxic stress based on a deep understanding of the effects of trauma on brain development and attachment systems. This volume provides a moving summary of what is currently known about the effects of trauma on individuals and societies, and introduces the healing potential of both age-old and novel approaches to help traumatized children and adults fully engage in the present.”

—Jessica Stern, policy consultant on terrorism; author of Denial: A Memoir of Terror

“As an attachment researcher I know that infants are psychobiological beings. They are as much the body as they are of the brain. Without language or symbols infants use every one of their biological systems to make meaning of their self in relation to the world of things and people. Van der Kolk shows that those very same systems continue to operate at every age, and that traumatic experiences, especially chronic toxic experience during early development, produce psychic devastation. With this understanding he provides insight and guidance for survivors, researchers, and clinicians alike. Bessel van der Kolk may focus on the body and trauma, but what a mind he must have to have written this book.”

—Ed Tronick, distinguished professor, University of Massachusetts, Boston; author of Neurobehavior and Social Emotional Development of Infants and Young Children

“This book is a tour de force. Its deeply empathic, insightful, and compassionate perspective promises to further humanize the treatment of trauma victims, dramatically expand their repertoire of self-regulatory healing practices and therapeutic options, and also stimulate greater creative thinking and research on trauma and its effective treatment. The body does keep the score, and Van der Kolk’s ability to demonstrate this through compelling descriptions of the work of others, his own pioneering trajectory and experience as the field evolved and him along with it, and above all, his discovery of ways to work skillfully with people by bringing mindfulness to the body (as well as to their thoughts and emotions) through yoga, movement, and theater are a wonderful and welcome breath of fresh air and possibility in the therapy world.”

—Jon Kabat-Zinn, professor of medicine emeritus, UMass Medical School; author of Full Catastrophe Living

“In The Body Keeps the Score we share the author’s courageous journey into the parallel dissociative worlds of trauma victims and the medical and psychological disciplines that are meant to provide relief. In this compelling book we learn that as our minds desperately try to leave trauma behind, our bodies keep us trapped in the past with wordless emotions and feelings. These inner disconnections cascade into ruptures in social relationships with disastrous effects on marriages, families, and friendships. Van der Kolk offers hope by describing treatments and strategies that have successfully helped his patients reconnect their thoughts with their bodies. We leave this shared journey understanding that only through fostering self-awareness and gaining an inner sense of safety will we, as a species, fully experience the richness of life.”

—Stephen W. Porges, PhD, professor of psychiatry, University of North Carolina at Chapel Hill; author of The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-Regulation

“Bessel van der Kolk is unequaled in his ability to synthesize the stunning developments in the field of psychological trauma over the past few decades. Thanks in part to his work, psychological trauma—ranging from chronic child abuse and neglect, to war trauma and natural disasters—is now generally recognized as a major cause of individual, social, and cultural breakdown. In this masterfully lucid and engaging tour de force, Van der Kolk takes us—both specialists and the general public— on his personal journey and shows what he has learned from his research, from his colleagues and students, and, most important, from his patients. The Body Keeps the Score is, simply put, brilliant.”

—Onno van der Hart, PhD, Utrecht University, The Netherlands; senior author, T he Haunted Self: Structural Dissociation and the Treatment of Chronic Traumatization

“A fascinating exploration of a wide range of therapeutic treatments shows readers how to take charge of the healing process, gain a sense of safety, and find their way out of the morass of suffering.”

—Francine Shapiro, PhD, originator of EMDR therapy; senior research fellow, Emeritus Mental Research Institute; author of Getting Past Your Past

“In this magnificent book, Bessel van der Kolk takes the reader on a captivating journey that is chock-full of riveting stories of patients and their struggles interpreted through history, research, and neuroscience made accessible in the words of a gifted storyteller. We are privy to the author’s own courageous efforts to understand and treat trauma over the past forty years, the results of which have broken new ground and challenged the status quo of psychiatry and psychotherapy. The Body Keeps the Score leaves us with both a profound appreciation for and a felt sense of the debilitating effects of trauma, along with hope for the future through fascinating descriptions of novel approaches to treatment. This outstanding volume is absolutely essential reading not only for therapists but for all who seek to understand, prevent, or treat the immense suffering caused by trauma.”

—Pat Ogden PhD, founder/educational director of the Sensorimotor Psychotherapy Institute; author of Sensorimotor Psychotherapy: Interventions for Trauma and Attachment

“A book about understanding the impact of trauma by one of the true pioneers in the field. It is a rare book that integrates cutting edge neuroscience with wisdom and understanding about the experience and meaning of trauma, for people who have suffered from it. Like its author, this book is wise and compassionate, occasionally quite provocative, and always interesting.”

—Glenn N. Saxe, MD, Arnold Simon Professor and chairman, Department of Child and Adolescent Psychiatry; director, NYU Child Study Center, New York University School of Medicine

“ The Body Keeps the Score eloquently articulates how overwhelming experiences affect the development of brain, mind, and body awareness, all of which are closely intertwined. The resulting derailments have a profound impact on the capacity for love and work. This rich integration of clinical case examples with ground breaking scientific studies provides us with a new understanding of trauma, which inevitably leads to the exploration of novel therapeutic approaches that ‘rewire’ the brain, and help traumatized people to reengage in the present. This book will provide traumatized individuals with a guide to healing and permanently change how psychologists and psychiatrists think about trauma and recovery.”

—Ruth A. Lanius, MD, PhD, Harris-Woodman chair in Psyche and Soma, professor of psychiatry, and director PTSD research at the University of Western Ontario; author of The Impact of Early Life Trauma on Health and Disease

“This is an amazing accomplishment from the neuroscientist most responsible for the contemporary revolution in mental health toward the recognition that so many mental problems are the product of trauma. With the compelling writing of a good novelist, van der Kolk revisits his fascinating journey of discovery that has challenged established wisdom in psychiatry. Interspersed with that narrative are clear and understandable descriptions of the neurobiology of trauma; explanations of the ineffectiveness of traditional approaches to treating trauma; and introductions to the approaches that take patients beneath their cognitive minds to heal the parts of them that remained frozen in the past. All this is illustrated vividly with dramatic case histories and substantiated with convincing research. This is a watershed book that will be remembered as tipping the scales within psychiatry and the culture at large toward the recognition of the toll traumatic events and our attempts to deny their impact take on us all.”

—Richard Schwartz, originator, Internal Family Systems Therapy

“When it comes to understanding the impact of trauma and being able to continue to grow despite overwhelming life experiences, Bessel van der Kolk leads the way in his comprehensive knowledge, clinical courage, and creative strategies to help us heal. The Body Keeps the Score is a cutting-edge offering for the general reader to comprehend the complex effects of trauma, and a guide to a wide array of scientifically informed approaches to not only reduce suffering, but to move beyond mere survival— and to thrive.”

—Daniel J. Siegel, MD, clinical professor, UCLA School of Medicine, author of Brainstorm: The Power and Purpose of the Teenage Brain ; Mindsight: The New Science of Personal Transformation ; and The Developing Mind: How Relationships and the Brain Interact to Shape Who We Are

“This is masterpiece of powerful understanding and brave heartedness, one of the most intelligent and helpful works on trauma I have ever read. Dr. Van der Kolk offer a brilliant synthesis of clinical cases, neuroscience, powerful tools and caring humanity, offering a whole new level of healing for the traumas carried by so many.”

—Jack Kornfied, author of A Path With Heart

About the Author

FACING TRAUMA

One does not have be a combat soldier, or visit a refugee camp in Syria or the Congo to encounter trauma. Trauma happens to us, our friends, our families, and our neighbors. Research by the Centers for Disease Control and Prevention has shown that one in five Americans was sexually molested as a child; one in four was beaten by a parent to the point of a mark being left on their body; and one in three couples engages in physical violence. A quarter of us grew up with alcoholic relatives, and one out of eight witnessed their mother being beaten or hit.1

As human beings we belong to an extremely resilient species. Since time immemorial we have rebounded from our relentless wars, countless disasters (both natural and man-made), and the violence and betrayal in our own lives. But traumatic experiences do leave traces, whether on a large scale (on our histories and cultures) or close to home, on our families, with dark secrets being imperceptibly passed down through generations. They also leave traces on our minds and emotions, on our capacity for joy and intimacy, and even on our biology and immune systems.

Trauma affects not only those who are directly exposed to it, but also those around them. Soldiers returning home from combat may frighten their families with their rages and emotional absence. The wives of men who suffer from PTSD tend to become depressed, and the children of depressed mothers are at risk of growing up insecure and anxious. Having been exposed to family violence as a child often makes it difficult to establish stable, trusting relationships as an adult.

Trauma, by definition, is unbearable and intolerable. Most rape victims, combat soldiers, and children who have been molested become so upset when they think about what they experienced that they try to push it out of their minds, trying to act as if nothing happened, and move on. It takes tremendous energy to keep functioning while carrying the memory of terror, and the shame of utter weakness and vulnerability.

While we all want to move beyond trauma, the part of our brain that is devoted to ensuring our survival (deep below our rational brain) is not very good at denial. Long after a traumatic experience is over, it may be reactivated at the slightest hint of danger and mobilize disturbed brain circuits and secrete massive amounts of stress hormones. This precipitates unpleasant emotions intense physical sensations, and impulsive and aggressive actions. These posttraumatic reactions feel incomprehensible and overwhelming. Feeling out of control, survivors of trauma often begin to fear that they are damaged to the core and beyond redemption.

The first time I remember being drawn to study medicine was at a summer camp when I was about fourteen years old. My cousin Michael kept me up all night explaining the intricacies of how kidneys work, how they secrete the body’s waste materials and then reabsorb the chemicals that keep the system in balance. I was riveted by his account of the miraculous way the body functions. Later, during every stage of my medical training, whether I was studying surgery, cardiology, or pediatrics, it was obvious to me that the key to healing was understanding how the human organism works. When I began my psychiatry rotation, however, I was struck by the contrast between the incredible complexity of the mind and the ways that we human beings are connected and attached to one another, and how little psychiatrists knew about the origins of the problems they were treating. Would it be possible one day to know as much about brains, minds, and love as we do about the other systems that make up our organism?

We are obviously still years from attaining that sort of detailed understanding, but the birth of three new branches of science has led to an explosion of knowledge about the effects of psychological trauma, abuse, and neglect. Those new disciplines are neuroscience, the study of how the brain supports mental processes; developmental psychopathology, the study of the impact of adverse experiences on the development of mind and brain; and interpersonal neurobiology, the study of how our behavior influences the emotions, biology, and mind-sets of those around us.

Research from these new disciplines has revealed that trauma produces actual physiological changes, 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. We now know that trauma compromises the brain area that communicates the physical, embodied feeling of being alive. These changes explain why traumatized individuals become hypervigilant to threat at the expense of spontaneously engaging in their day-to-day lives. They also help us understand why traumatized people so often keep repeating the same problems and have such trouble learning from experience. We now know that their behaviors are not the result of moral failings or signs of lack of willpower or bad character—they are caused by actual changes in the brain.

This vast increase in our knowledge about the basic processes that underlie trauma has also opened up new possibilities to palliate or even reverse the damage. We can now develop methods and experiences that utilize the brain’s own natural neuroplasticity to help survivors feel fully alive in the present and move on with their lives. There are fundamentally three avenues: 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 result from trauma. Which one of these is best for any particular survivor is an empirical question. Most people I have worked with require a combination.

This has been my life’s work. In this effort I have been supported by my colleagues and students at the Trauma Center, which I founded thirty years ago. Together we have treated thousands of traumatized children and adults: victims of child abuse, natural disasters, wars, accidents, and human trafficking; people who have suffered assaults by intimates and strangers. We have a long tradition of discussing all our patients in great depth at weekly treatment team meetings and carefully tracking how well different forms of treatment work for particular individuals.

Our principal mission has always been to take care of the children and adults who have come to us for treatment, but from the very beginning we also have dedicated ourselves to conducting research to explore the effects of traumatic stress on different populations and to determine what treatments work for whom. We have been supported by research grants from the National Institute of Mental Health, the National Center for Complementary and Alternative Medicine, the Centers for Disease Control, and a number of private foundations to study the efficacy of many different forms of treatment, from medications to talking, yoga, EMDR, theater, and neurofeedback.

The challenge is: How can people gain control over the residues of past trauma and return to being masters of their own ship? Talking, understanding, and human connections help, and drugs can dampen hyperactive alarm systems. But we will also see that the imprints from the past can be transformed by having physical experiences that directly contradict the helplessness, rage, and collapse that are part of trauma, and thereby regaining self-mastery. I have no preferred treatment modality, as no single approach fits everybody, but I practice all the forms of treatment that I discuss in this book. Each one of them can produce profound changes, depending on the nature of the particular problem and the makeup of the individual person.

I wrote this book to serve as both a guide and an invitation—an invitation to dedicate ourselves to facing the reality of trauma, to explore how best to treat it, and to commit ourselves, as a society, to using every means we have to prevent it.

THE REDISCOVERY OF TRAUMA

LESSONS FROM VIETNAM VETERANS

I became what I am today at the age of twelve, on a frigid overcast day in the winter of 1975. . . . That was a long time ago, but it’s wrong what they say about the past. . . . Looking back now, I realize I have been peeking into that deserted alley for the last twenty-six years.

—Khaled Hosseini, The Kite Runner

Some people’s lives seem to flow in a narrative; mine had many stops and starts. That’s what trauma does. It interrupts the plot. . . . It just happens, and then life goes on. No one prepares you for it.

—Jessica Stern, Denial: A Memoir of Terror

The Tuesday after the Fourth of July weekend, 1978, was my first day as a staff psychiatrist at the Boston Veterans Administration Clinic. As I was hanging a reproduction of my favorite Breughel painting, “The Blind Leading the Blind,” on the wall of my new office, I heard a commotion in the reception area down the hall. A moment later a large, disheveled man in a stained three-piece suit, carrying a copy of Soldier of Fortune magazine under his arm, burst through my door. He was so agitated and so clearly hungover that I wondered how I could possibly help this hulking man. I asked him to take a seat, and tell me what I could do for him.

His name was Tom. Ten years earlier he had been in the Marines, doing his service in Vietnam. He had spent the holiday weekend holed up in his downtown-Boston law office, drinking and looking at old photographs, rather than with his family. He knew from previous years’ experience that the noise, the fireworks, the heat, and the picnic in his sister’s backyard against the backdrop of dense early-summer foliage, all of which reminded him of Vietnam, would drive him crazy. When he got upset he was afraid to be around his family because he behaved like a monster with his wife and two young boys. The noise of his kids made him so agitated that he would storm out of the house to keep himself from hurting them. Only drinking himself into oblivion or riding his Harley-Davidson at dangerously high speeds helped him to calm down.

Nighttime offered no relief—his sleep was constantly interrupted by nightmares about an ambush in a rice paddy back in ’Nam, in which all the members of his platoon were killed or wounded. He also had terrifying flashbacks in which he saw dead Vietnamese children. The nightmares were so horrible that he dreaded falling asleep and he often stayed up for most of the night, drinking. In the morning his wife would find him passed out on the living room couch, and she and the boys had to tiptoe around him while she made them breakfast before taking them to school.

Filling me in on his background, Tom said that he had graduated from high school in 1965, the valedictorian of his class. In line with his family tradition of military service he enlisted in the Marine Corps immediately after graduation. His father had served in World War II in General Patton’s army, and Tom never questioned his father’s expectations. Athletic, intelligent, and an obvious leader, Tom felt powerful and effective after finishing basic training, a member of a team that was prepared for just about anything. In Vietnam he quickly became a platoon leader, in charge of eight other Marines. Surviving slogging through the mud while being strafed by machine-gun fire can leave people feeling pretty good about themselves—and their comrades.

At the end of his tour of duty Tom was honorably discharged, and all he wanted was to put Vietnam behind him. Outwardly that’s exactly what he did. He attended college on the GI Bill, graduated from law school, married his high school sweetheart, and had two sons. Tom was upset by how difficult it was to feel any real affection for his wife, even though her letters had kept him alive in the madness of the jungle. Tom went through the motions of living a normal life, hoping that by faking it he would learn to become his old self again. He now had a thriving law practice and a picture-perfect family, but he sensed he wasn’t normal; he felt dead inside.

Although Tom was the first veteran I had ever encountered on a professional basis, many aspects of his story were familiar to me. I grew up in postwar Holland, playing in bombed-out buildings, the son of a man who had been such an outspoken opponent of the Nazis that he had been sent to an internment camp. My father never talked about his war experiences, but he was given to outbursts of explosive rage that stunned me as a little boy. How could the man I heard quietly going down the stairs every morning to pray and read the Bible while the rest of the family slept have such a terrifying temper? How could someone whose life was devoted to the pursuit of social justice be so filled with anger? I witnessed the same puzzling behavior in my uncle, who had been captured by the Japanese in the Dutch East Indies (now Indonesia) and sent as a slave laborer to Burma, where he worked on the famous bridge over the river Kwai. He also rarely mentioned the war, and he, too, often erupted into uncontrollable rages.

As I listened to Tom, I wondered if my uncle and my father had had nightmares and flashbacks—if they, too, had felt disconnected from their loved ones and unable to find any real pleasure in their lives. Somewhere in the back of my mind there must also have been my memories of my frightened—and often frightening—mother, whose own childhood trauma was sometimes alluded to and, I now believe, was frequently reenacted. She had the unnerving habit of fainting when I asked her what her life was like as a little girl and then blaming me for making her so upset.

Reassured by my obvious interest, Tom settled down to tell me just how scared and confused he was. He was afraid that he was becoming just like his father, who was always angry and rarely talked with his children—except to compare them unfavorably with his comrades who had lost their lives around Christmas 1944, during the Battle of the Bulge.

As the session was drawing to a close, I did what doctors typically do: I focused on the one part of Tom’s story that I thought I understood—his nightmares. As a medical student I had worked in a sleep laboratory, observing people’s sleep/dream cycles, and had assisted in writing some articles about nightmares. I had also participated in some early research on the beneficial effects of the psychoactive drugs that were just coming into use in the 1970s. So, while I lacked a true grasp of the scope of Tom’s problems, the nightmares were something I could relate to, and as an enthusiastic believer in better living through chemistry, I prescribed a drug that we had found to be effective in reducing the incidence and severity of nightmares. I scheduled Tom for a follow-up visit two weeks later.

When he returned for his appointment, I eagerly asked Tom how the medicines had worked. He told me he hadn’t taken any of the pills. Trying to conceal my irritation, I asked him why. “I realized that if I take the pills and the nightmares go away,” he replied, “I will have abandoned my friends, and their deaths will have been in vain. I need to be a living memorial to my friends who died in Vietnam.”

I was stunned: Tom’s loyalty to the dead was keeping him from living his own life, just as his father’s devotion to his friends had kept him from living. Both father’s and son’s experiences on the battlefield had rendered the rest of their lives irrelevant. How had that happened, and what could we do about it? That morning I realized I would probably spend the rest of my professional life trying to unravel the mysteries of trauma. How do horrific experiences cause people to become hopelessly stuck in the past? What happens in people’s minds and brains that keeps them frozen, trapped in a place they desperately wish to escape? Why did this man’s war not come to an end in February 1969, when his parents embraced him at Boston’s Logan International Airport after his long flight back from Da Nang?

Tom’s need to live out his life as a memorial to his comrades taught me that he was suffering from a condition much more complex than simply having bad memories or damaged brain chemistry—or altered fear circuits in the brain. Before the ambush in the rice paddy, Tom had been a devoted and loyal friend, someone who enjoyed life, with many interests and pleasures. In one terrifying moment, trauma had transformed everything.

Product details

Publisher ‏ : ‎ Viking; Illustrated edition (Sept. 25 2014)
Language ‏ : ‎ English
Hardcover ‏ : ‎ 464 pages
ISBN-10 ‏ : ‎ 0670785938
ISBN-13 ‏ : ‎ 978-0670785933
Item weight ‏ : ‎ 680 g
Dimensions ‏ : ‎ 15.98 x 3.96 x 23.57 cm
#28 in Emergency Medicine (Books)
#69 in Psychiatry Books
#80 in Psychopathologies (Books)

About the authors

Bessel van der kolk.

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Bessel van der Kolk M.D.

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Book Review: The Body Keeps The Score – Healing of Trauma

This month, our book review covers: The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma by Bessel van der Kolk, M.D.

From the book’s prologue, the author writes: “While we all want to move beyond trauma, the part of our brain that is devoted to ensuring our survival (deep below our rational brain) is not very good at denial. Long after a traumatic experience is over, it may be reactivated at the slightest hint of danger and mobilize disturbed brain circuits and secrete massive amounts of stress hormones.” According to Dr. van der Kolk, this can trigger unpleasant emotions, intense physical sensations, and impulsive and aggressive actions. He says, this can leave survivors of trauma feeling out of control and they can begin to fear that they are damaged to the core and beyond redemption.

Trauma is a fact of life, says Bessel van der Kolk, M.D. Drawing on 30 plus years of working with trauma survivors, he offers insight into how the body changes in response to trauma and a roadmap of paths to navigate how to move beyond it.

Book Review: The Body Keeps the Score

This is not light reading for anyone wanting to work through trauma, but it does offer hope. Backed by science, Dr. van der Kolk shows just how trauma changes the brain and nervous system and can keep both children and adults in a never-ending cycle of fight or flight.

Speaking of adrenalin, the author talks about how “The stress hormones of traumatized people take much longer to return to baseline and spike quickly and disproportionately in response to mildly stressful stimuli.” These hormones also contribute to many long-term health issues, depending on which body system is most vulnerable, and contribute to memory and attention problems, irritability, and sleep disorders.

Kendy Anderson reviews the book “The Body Keeps the Score: Brain, Mind and Body in the Healing of Trauma.”

Restoring Proper Balance in the Brain

The fundamental issue in resolving traumatic stress is to restore the proper balance between the rational and emotional brains so that you can feel in charge of how you respond and how you conduct your life.

He says we can directly train our arousal system by the way we breathe, chant and move.

10 weeks of yoga practice markedly reduced PTSD symptoms of patients who had failed to respond to any medication or other treatments.

Methods to Help You Move, Breathe, and Relax

Learning how to breathe calmly and remaining in a state of relative physical relaxation, even while accessing painful memories is an essential tool for recovery.

Aikido, Judo, Tae Kwon Do, Kendo, and Jiujitsu are examples of techniques that involve movement, breathing, and meditation, the three things the author states are your way out of being stuck in trauma.

Mindfulness Has Benefits Too

Mindfulness, another tool, puts you in touch with your feelings and perceptions and has shown to have a positive effect on numerous psychiatric, psychosomatic and stress-related symptoms, including depression and chronic pain.

A survey was conducted on 225 survivors of the twin towers and they rated acupuncture, massage, yoga, and eye movement desensitization and reprocessing (EMDR), in that order, as most helpful in overcoming that trauma.

Alternative Methods To Explore

Other methods the author explores include writing, cognitive behavioral therapy (CBT), desensitization, art, music, dance, EDMR, yoga, neurofeedback as well as others.

This is a well-documented book on navigating through trauma if you are ready to begin that journey. Not an easy book by any means but ready when you are. I’ll let the author conclude with his words, “The choice is ours to act on what we know.”

Conclusion of our book review: The Body Keeps the Score

Thank you for reading our book review: The Body Keeps the Score. Get your copy of The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma by Bessel van der Kolk, M.D .

Ready for more? Read Kendy’s book review: 4 Building Blocks of Motivational Interviewing .

Are you a certified health and wellness coach? Join our monthly book club and earn 2 continuing education (CE) credits per month, National Board for Health and Wellness Coaching (NBHWC) approved.

About the Author: Kendy Anderson

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COMMENTS

Does a Writer Ever Get Cozy on the Best-Seller List? Bessel van der
The author of "The Body Keeps Score" awaits news of his standing each week — and pays close attention to what his readers have to say. ... Elisabeth Egan is an editor at the Book Review and ...
Book Review: The Body Keeps the Score: Brain, Mind, and Body in the
In his work "The body keeps the score," Bessel highlights that traumatic stress is at the root of neuroscience. Traumatic stress is associated with functional and chemical changes in the emotional part of the brain—the limbic area and brain stem. Knowing the functions of the amygdala, hippocampus, and prefrontal cortex, as the primary ...
The Body Keeps the Score: Brain, Mind, and Body in the
The Body Keeps the Score is a non-fiction book about how the body stores trauma and what you can do about it. ... I finished this book and am writing this review 3 weeks after an article appeared in the Boston Globe reporting that Bessel van der Kolk has been fired from his own Trauma Center allegedly for "bullying" staff. This book was ...
Trauma, trust and triumph: psychiatrist Bessel van der Kolk on how to
The Body Keeps the Score: Mind, Brain and Body in the Transformation of Trauma by Bessel van der Kolk (Penguin, £10.99) is out now. To support the Guardian and the Observer, order your copy at ...
'The Body Keeps the Score': Are Trauma Books Helpful During the
Matt Chase. October 18, 2021. Nothing about The Body Keeps the Score screams "best seller.". Written by the psychiatrist Bessel van der Kolk, the book is a graphic account of his decades-long ...
The Body Keeps the Score: how a bestselling book helps us understand
Clues to what has driven The Body Keeps the Score's success can be found in its sales trajectory. On bookriot.com , writer Gina Nicoll notes that sales began to liven up around 2018 and then ...
Frontiers
A Book Review on. The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. Bessel van der Kolk (Penguin Books), 2015, 464 pages, ISBN: 978-0143127741. Posttraumatic stress disorder (PTSD) is defined as a psychiatric disorder in an individual who has experienced or witnessed a devastatingly traumatic event ( Bufka et al., 2020 ...
The Body Keeps the Score book review
The body stores trauma even more reliably than the mind - as the title of the book suggests. While memories can get broken up and confused, the body records the threat or threats it originally experienced, replaying it again and again until healing is achieved: the fight or flight response is re-engaged and can be completely flooding for some ...
Book Summary: The Body Keeps the Score by Bessel van der Kolk
The Body Keeps the Score Summary. Note: While this summary provides an overview of the key themes and ideas presented in The Body Keeps the Score, the book is rich with case studies, personal narratives, and scientific research that offer a deeper understanding of trauma and its effects. Part One: The Rediscovery of Trauma. In the first part of the book, Bessel van der Kolk sets the stage by ...
The Body Keeps the Score: Brain, Mind, and Body in the Healing of
The Body Keeps the Score is a cutting-edge offering for the general reader to comprehend the complex effects of trauma, and a guide to a wide array of scientifically informed approaches to not only reduce suffering, but to move beyond mere survival—and to thrive." —Daniel J. Siegel, M.D., clinical professor, UCLA School of Medicine ...
The body keeps the score book review
The Body Keeps the Score is written from thirty years of real-life experience and research giving it a solid grounding. This book paints a comprehensive picture of the different types of trauma as well as how it might affect the mind, brain and body. Examples include attachment trauma, abuse and big T trauma.
The Body Keeps the Score
Dr. Bessel van der Kolk, one of the world's foremost experts on trauma, has spent over three decades working with survivors. In The Body Keeps the Score, he uses recent scientific advances to show how trauma literally reshapes both body and brain, compromising sufferers' capacities for pleasure, engagement, self-control, and trust.
'The Body Keeps the Score' offers uncertain science in the ...
Reading "The Body Keeps the Score," I realized that my experience of losing my parents — while devastating and life-altering — wasn't traumatic, exactly; at least not by van der Kolk's ...
Book Review: The Body Keeps The Score
The Body Keeps The Score is a book about post-traumatic stress disorder. The author, Bessel van der Kolk, helped discover the condition and lobby for its inclusion in the DSM, and the brief forays into that history are the best part of the book. Like so many things, PTSD feels self-evident once you know about it.
THE BODY KEEPS THE SCORE: How Trauma Lodges Itself in o…
The Body Keeps the Score reveals the enormous potential of our connections to harm and heal—and gives new hope for recovering lives—based on research from Dr. van der Kolk and other top experts. 82 pages, Kindle Edition
The Body Keeps the Score
The book describes van der Kolk's research and experiences on how individuals are affected by traumatic stress, and its effects on the mind and body. It is based on his 1994 Harvard Review of Psychiatry article "The body keeps the score: memory and the evolving psychobiology of posttraumatic stress".
The Body Keeps the Score: Mind, Brain and Body in the Transformation of
Essential reading for anyone interested in understanding and treating traumatic stress and the scope of its impact on society." —Alexander McFarlane, Director of the Centre for Traumatic Stress Studies A pioneering researcher transforms our understanding of trauma and offers a bold new paradigm for healing in this New York Times Science bestseller Trauma is a fact of life.
The Body Keeps The Score
The body keeps the score is masterful in bringing together science and humanism to clearly explain how trauma affects the whole person. Bessel van der Kolk brings deep understanding to the pain and chaos of the trauma experience. The treatment approaches he recommends heal the body and the mind, restoring hope and the possibility of joy.
The Body Keeps The Score
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 ...
Mindsplain Book Review: "The Body Keeps the Score"
In this article, we review New York Times' best-selling book on healing trauma, The Body Keeps the Score by Bessel Van Der Kolk, MD.
The Body Keeps the Score: Brain, Mind, and Body in the Healing of
Praise for The Body Keeps the Score "In this inspirational work which seamlessly weaves keen clinical observation, neuroscience, historical analysis, the arts, and personal narrative, Dr. van der Kolk has created an authoritative guide to the effects of trauma, and pathways to recovery. The book is full of wisdom, humanity, compassion and scientific insight, gleaned from a lifetime of ...
The Body Keeps the Score, Bessel van der Kolk. Book Review
What are the books' key messages? Trauma is not just the event(s) that took place sometime in the past. It is also the imprint left on mind, brain, and body. This imprint has on-going consequences for how the human organism manages to survive in the present. Trauma results in a fundamental reorganisation of the way mind and brain manage ...
Book Review: The Body Keeps The Score
This month, our book review covers: The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma by Bessel van der Kolk, M.D. From the book's prologue, the author writes: "While we all want to move beyond trauma, the part of our brain that is devoted to ensuring our survival (deep below our rational brain) is not very good at denial.

Does a Writer Ever Get Cozy on the Best-Seller List? Bessel van der Kolk Says No.

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

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Trauma, trust and triumph: psychiatrist Bessel van der Kolk on how to recover from our deepest pain

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The Body Keeps the Score: how a bestselling book helps us understand trauma – but inflates the definition of it

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The Body Keeps the Score by Bessel van der Kolk

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Part One: The Rediscovery of Trauma

Part Two: This is Your Brain on Trauma

Part Three: The Minds of Children

Part Four: The Imprint of Trauma

Part Five: Paths to Recovery

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The Body Keeps the Score: Mind, Brain and Body in the Transformation of Trauma Paperback – January 1, 2015

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The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma Hardcover – Illustrated, Sept. 25 2014

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