Book Review: The Body Keeps the Score

Understanding trauma and healing

The Body Keeps the Score by Bessel van der Kolk is perhaps one of the best-known books about trauma, and in particular early life trauma. It’s been on my to-be-read list for quite a while, and I’ve finally managed to get around to it.

This is a hefty book. The epub version that I was reading weighed in at 488 pages including a lengthy reference section. It’s very in-depth, giving plenty of detail, but it’s not unnecessarily complicated. There’s some technical terminology used, particularly with respect to the functioning of the brain, but I thought this was explained well.

Van der Kolk is a psychiatrist who initially began working with trauma while treating war veterans. There was a lot that wasn’t known about trauma at that point, but he’s been an active researcher through his career, often at the forefront of new trauma-related knowledge.

In the book, he repeatedly stresses the importance of recognizing the changes that occur in the brains and nervous systems of people who’ve been through trauma, and targeting treatment accordingly to get back the functioning they lost. He writes:

“Trauma results in a fundamental reorganization of the way mind and brain manage perceptions. It changes not only how we think and what we think about, but also our very capacity to think.”

He explains what imaging studies have uncovered about flashbacks. There’s activation of the right brain along with a drop in activity in the brain structure called the thalamus, which prevents the events from being remembered as a coherent narrative, as would be the case with other kinds of memories.

Brain scans have also showed impaired self-awareness, and van der Kolk explains that this is why it’s important to work on breathing, mindfulness, and recognizing the link between physical sensations and emotions. He writes:

“The body keeps the score: If the memory of trauma is encoded in the viscera, in heartbreaking and gut-wrenching emotions, in autoimmune disorders and skeletal/muscular problems, and if mind/brain/visceral communication is the royal road to emotion regulation, this demands a radical shift in our therapeutic assumptions.”

The book pays a lot of attention to early life trauma, including issues like attachment and attunement. The author explains that trauma increases the need for attachment, even when the only attachment figure available to the child is the abuser.

Van der Kolk has long argued that complex PTSD should be a separate diagnosis from PTSD. He was part of the working group that proposed C-PTSD for inclusion in the DSM-IV, and the group that proposed developmental trauma disorder for inclusion in the DSM-5. Neither of those diagnoses were approved by the American Psychiatric Association.

There’s a section of the book devoted to several different therapeutic approaches that he’s seen patients have success with. While chapters in the earlier sections of the book tend to build on the information presented in earlier chapters, the chapters in this section are more stand-alone.

One chapter is focused on yoga, and how it can be helpful in settling down the hyperaroused nervous system and getting in touch with the body. There’s a chapter on internal family systems therapy, and the different internal parts and their roles. There are also chapters on psychomotor therapies, EMDR (eye movement desensitization and reprocessing), neurofeedback, and expressive arts like theatre. The author expresses concerns that medications and cognitive behavioural therapy-based interventions aren’t actually as helpful as people tend to think they are.

As the book draws to an end, the author returns to the message in the title:

“The body keeps the score: If trauma is encoded in heartbreaking and gut-wrenching sensations, then our first priority is to help people move out of fight-or-flight states, reorganize their perception of danger, and manage relationships.”

He argues that the best way to help children who’ve been abused or neglected is to give them a good school environment that allows them to be seen, learn to self-regulate, and develop agency around their own lives.

This is a valuable read for anyone looking to more deeply understand trauma’s effects on mind and body. It’s by no means a quick and easy read, but it’s not unnecessarily wordy. It’s just jam-packed with information. While the subject matter isn’t exactly light, there’s a lot of hope for recovery and stories of tremendous healing.

Originally published at https://mentalhealthathome.org on July 22, 2020.