Summary and Takeaways from The Body Keeps the Score by Bessel van der Kolk

Hi, everyone.  This is Lara Hammock from the Marble Jar channel and in today's video, I will give a summary and my takeaways from the seminal book on trauma, The Body Keeps the Score, by Bessel Van der Kolk.

The scope of this book is so huge and so impactful that I'm really going to struggle to do a single video on it.  Based on the enormous impact of trauma, particularly childhood trauma, on our society and our communities -- this book really needs to be required reading for everyone -- whether you have personal experience with it or not.  Bessel Van der Kolk, along with Judith Herman, are pioneers in the field of trauma research.  Both of them have specific experience with victims of childhood incest and have advocated for a new diagnostic category called complex trauma, which looks slightly different from, and can be harder to recover from, than standard Post-Traumatic Stress Disorder or PTSD.  This book is chock full of information and it's presented in a way that is accessible and easy to understand for anyone. 

I'm a mental health therapist in training and, once I started seeing clients, I quickly determined that this is the one area I really needed to have more knowledge.  Like medical doctors, a mental health professional's first principle is to do no harm.   With clients who have experienced trauma, you can easily stumble into material while in therapy that provokes a flashback or panic attack and just not know how to handle it.  This is one of the books that I needed to read just to get a foundational understanding of trauma and the paths to healing.

Van der Kolk covers, not just the neurobiological underpinnings of trauma, research findings, case studies, and best practices, but also provides a bit of a memoir and history of trauma from his perspective.  He is a psychiatrist that came of age before trauma was a diagnosable condition, so he had not only a front seat view, but was able to help steer the bus to where we are now in our understanding of trauma.  He started out by treating Vietnam Veterans at the VA Hospital.  But he quickly determined that trauma not only impacts veterans and survivors of disasters, but also victims of childhood trauma.  There are insane numbers of people impacted: 1/4 of all war veterans develop PTSD, 1 out of every 6 women has experienced rape or attempted rape -- 1/2 of those occurred before the age of 15.  3 million reports are made of child abuse each year -- and those are only the ones that are reported.  You get the picture and it's horrifying.   Many times those people are haunted not only by what happened to them, but also by what they may have done to survive -- whether it's a war veteran or a child raped by her father. 

Van der Kolk goes into all of the neurobiology behind trauma including the nervous system, brain, and the role of stress hormones -- all pretty fascinating stuff.  He talks about the issues around the medical model, which is based on the question -- what is wrong with you?  Trauma-sensitive institutions are now beginning to ask the question “what happened to you?” instead.  Throwing prescription drugs at this problem is also not particularly helpful.  And it ignores these four fundamental truths:

• Humans CAN hurt each other -- but we can also heal each other
• We heal in community by feeling safe enough to interact and talk together
• We can use our body's natural systems to help calm us down, and
• We need to change the policies and social conditions that perpetuate trauma.

Van der Kolk tells us that traumatic memories are not stored the same way that regular memories are stored. Normal memories are stored like a ribbon with a beginning, a middle, and an end.  Traumatic memories are stored like shards of glass -- each shard is an emotional or sensory experience -- like scents, visions, and sounds.  People who have been traumatized can have flashback or triggers out of the blue -- these will make them feel like the trauma is happening right now -- not in the past.  Even when they are not experiencing that terror, they are like a house with the smoke detectors constantly going off.  They are stressed out, irritable, jumpy, and always on high alert and they can get stuck in that place of hyper vigilance.  Conversely, some people, in an effort to make the constant alarms less terrifying, shut down many of their senses so that their experience is distant, hazy, and flat -- but that coping strategy also serves to deaden their ability to experience positive emotions like joy, love, and connection.

Healing in Community

He then talks about how we heal naturally in connection with other people -- by feeling safe and being able to engage.  Our social engagement systems shut down when we are in a crisis, so folks who have experienced trauma can feel chronically out of sync with other people -- and being with others is one of our main sources of healing.  So, how can we feel more in sync?  By participating in activities that involve rhythm and quite literally syncing up with others -- activities like music, dance, and sports.  These activities are crucial to traumatized youth and are, unfortunately, the first things to be cut from a school's curriculum when funds are an issue.  

Connecting with the Body

Obviously, one of the main themes in the book is how trauma is stored in our bodies — thus the title.  In some cases, our body's physical reaction to fear is so triggering that just trying to avoid those body sensations can cause panic attacks.  People can also shut down the ability to feel parts of their bodies in response to trauma.  Think about it — if you’ve been subjected to repeated trauma, like rape, wouldn’t it be better just to not feel those areas of your body?  As a result, some survivors can't feel whole areas of their bodies -- or, like I mentioned before, those physical sensations are deadened so that everything -- even positive feelings -- feel remote, hazy, and distant. 

If you can't receive feelings from your body, then it's almost impossible to make good decisions for yourself.  After all, our bodies let us know when a stove is too hot, when we are standing in water, and when an exercise makes our knees hurt.  Not getting those signals, shuts down our ability to react well to our environments.  In order to heal from trauma, you have to reconnect with your body and all of its negative and positive sensations -- and then you can actively direct what happens to your body yourself.

Childhood Trauma

Van der Kolk has a whole section on children and trauma, which includes a discussion of attachment theory and, in particular, disorganized attachment, which is a result of being scared of your primary caregiver.  He discusses the tragic impact of incest and how dramatically underestimated the incidents of that were for so long.  And finally, he talks about what trauma looks in children, all of the mis-diagnoses those children receive, and the DSM committee's ultimate rejection of a diagnostic category for this type of complex childhood trauma -- which he and his colleagues named Developmental Trauma.  The stories are absolutely horrifying, but are shockingly commonplace.  He talks about the epidemic of high ACE scores (this is essentially a measurement of childhood trauma) and the impact of this, not just on mental health, but also on physical health, and the health of our communities.

Healing Trauma

Finally, he talks about how to heal trauma.  Many of the issues that plague trauma survivors started out as coping strategies that they used to survive.  But they usually involve shutting out people and shutting down physical and emotional feelings -- all things which are necessary for overall wellbeing.  Most therapists are partial to the healing powers of talk therapy -- and truly, the relationship built between client and therapist can be incredibly healing.  But as Van der Kolk points out, trauma is sometimes hard to remember, hard to talk about, and hard to put words to, so talk therapy doesn't always resolve it.  He gives lots of other evidence-based options that have been shown to help to heal from trauma -- all of which involve regaining ownership of your mind and body -- and in the end -- yourself.  There are four ways to do this -- get calm, maintain calm, be present and engage, and no secrets.  Let's go through each one:

• Get Calm - we need to find ways to get calm and focused.  This could involve breath, yoga, tai chi, meditation, and other forms of mindfulness and soothing.
• Maintain Calm - we need to be able to stay calm even in the midst of big emotions.  So, find ways to summon the parasympathetic nervous system to bring us into balance even when we are stressed, angry, or scared.
• Be Present and Engage - we need to find ways to be fully alive in the present moment and engage with others.  This usually involves participating in synchronous or rhythmic activities like singing, playing an instrument, dancing, chanting, sports, working, or playing with others.  And finally,
• No Secrets - Secrets are corrosive.  Try not to keep secrets from yourself or others.  Even things you may feel ashamed about -  like what you needed to do in order to survive.  This could involve journaling or talk therapy in many forms: EMDR, CBT, desensitization, psychodelic drugs, etc.

Van der Kolk then discusses some of the more promising evidence-based treatments: EMDR (or rapid eyemovement therapy), Yoga (which can offer trauma-sensitive ways to reconnect with your body), Self-leadership as a way to address dissociative identity disorder (what used to be known as multiple personality disorder), Psychomotor Therapy (which helps to create new memories to replace or live alongside the traumatic ones), Neurofeedback, and Theater Therapy.

Van der Kolk ends with a plea to recognize the impact of trauma in our lives and our communities.  We need to treat trauma differently than we have been.  We need to train anyone dealing with children about trauma. And we need to recognize that right now, childhood trauma is our most urgent public health issue and needs to be funded and focused on accordingly.  Again, this book is so densely packed with information that I can’t possibly do it justice in a 10 minute video.  So, if you have experienced trauma, love someone who has, or work with children or traumatized adults -- you won't regret reading this book.  The more of us who have access to this information -- the better!  Let me know what you think.  Comments are always appreciated and thanks for watching.