Book Review: The Body Keeps the Score

The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma by Bessel van der Kolk

My rating: 5 of 5 stars


This should be required reading for anyone majoring in psych. Associate’s. Hell, standard grade school curriculum, if that weren’t such a joke. We all need to know this. This book isn’t just going to change your treatment approach, or the way you think about trauma. It’s going to change your life.

The first thing you need to know about trauma in general and PTSD in particular is also the last thing, and they’re both the title of the book. The body keeps the score. Every time you experience a traumatic event, especially of the kind that are so severe that your brain goes offline, your body, like a sketchy 3rd party emulator, takes a save state. There’s an evolutionary reason for this. Every cell you’ve got is convinced you’re facing annihilation – whether this is brought about by physical abuse, incest, or getting royally and publicly dunked on in gym class is only relevant in terms of depth of response – and the system that is You agrees that if you make it out of this alive, whatever you did to survive is obviously the plan you’ll need to stick to the next time something like this happens.

It’s adaptation, and our capacity for it brought us from being tall, gregarious monkeys to owning the world. In PTSD, the triggering event to implement that survival script can get a little overeager. Better safe than sorry, after all, even if the safety save state is blackout violence, a dissociative episode, or full catatonia.

And that, my beauties, is the process a veteran undergoes when he returns from the atrocities he witnessed and, in many cases, committed, and tries to integrate back into society. The fireworks go off, and they sound like gunshots. The save state is quickloaded, and you have to understand, it’s not remembering what happens last time. It’s a complete neurochemical and hormonal overhaul to match the conditions of “the last time this happened”. His brain replicates the circumstances of the war, his endocrine system double-times the adrenaline and cortisol he needs to do whatever it was he did the first time to survive. Obviously, the neighbor kid playing with firecrackers in the suburbs is not the same as his 12th straight day of being shelled in Fallujah, but it doesn’t matter. His body can’t tell the difference, and neither can his brain.

Same is true of an abuse survivor. (Tap out here if you think this might trigger you).

Someone who lived through being molested in their early childhood, when they were dependent on the adults in their lives to literally keep them alive, they internalize the necessity of cooperation, often to the point where they identify with their abuser and condemn their victimized self, because it’s easier to hate yourself than to be without the anchor points of your childhood world. The desire to escape or to fight will necessarily give way to the freeze response, and that “compliance” will go on to fuse with the frustration, the trustlessness, the self-loathing to form a melange of cognitive dissonance that the victim internalizes and eventually spills over onto their adult relationships.

The thing to remember is, should a panic attack and dissociative episode emerge at a triggering point (most likely when the victim is having regular, consensual sex with a significant other who cares about them), it’s not that they’re being reminded of their assault, or drawing similarities or associations. They are quickloaded into their childhood bodies. A flashback is time travel. They are reliving it, and they need to follow the script that let them survive it the first time. It’s not a mind over matter situation, and it’s not a decision they’re making. As far as the whole system of their selfhood is concerned, it’s their only way they’re going to live through what’s happening.

Heavy, right? The whole book is like that. When I say it’ll change your life, I mean it. No matter how self-possessed you are, you’re not going to walk through this particular thicket without getting some scars.

Van der Kolk is the last word in trauma treatment. He’s a psychiatrist (boo hiss) but he rails against overuse of psychopharmaceutical interventions (wooooo yea), especially the widely overprescribed antipsychotics that blunt the physiological responses causing most of the problems. In PTSD therapy, as in most things, the only way out is through.

Van der Kolk suggests that it’s an issue of integration. A good way to think about it is corrupted data. Once upon a time, saving things on a computer took more than a microsecond. If you turned off the power before the file was saved, the data would be corrupted and unusable, and every time you tried to open that file, something bad would happen. Maybe it would just be computer code gibberish, or crash the program, or short out the whole computer. Maybe it would fry your entire motherboard.

That’s trauma. We encode memories on the fly, integrating episodic information into the personal narrative that comprises our life, and from this narrative we extract the information of who we are. Our concept of self comes from our ideas about identity, which we draw from the stories about ourselves, and the only place we can source those are from our memory.

During episodes of extreme trauma, the encoding process shuts off. Huge chunks of the brain shut off. You can’t be running all that extra hardware right now, you’re fighting for your life. We go into shock. So we save bits and pieces of the information coming through – impressions, sensory data, feelings – but not a comprehensive understanding of what happened, because at the time of the trauma, it’s too horrible for us to comprehend, and our thinking brain simply refuses to the task.

But the brain is continually referring to previous experiences for reference, especially in what it deems similar situations. So the brain tries to load that corrupted data, and the whole system crashes, and there’s the sudden onset of explosive PTSD symptoms, dissociation, panic attacks, numbing, crushing depression, and whatever might naturally follow from these experiences (risky behavior as self-soothing, self-harm, suicidality, etc.)

Van der Kolk’s answer is surprisingly direct and intuitive. Integrate the trauma. The flashbacks offer a doorway directly to the trauma, and if we can descalate the physiological response sufficiently to reintegrate the data into our story, we can accept the trauma as “something that happened in the past” and move on, rather than an ongoing experience we continually live and relive.

Since the brain is slackin’ ass, which is the entire problem, and trauma is stored in the body, the body is how treatment is approached. Trauma survivors usually have terrible relationships with their bodies. Eating disorders, obesity, dysmorphia, self-harm, chronic pain, alexithymia, you name it, all born of a disconnect from the body’s wants and needs, originally developing as a mechanism to survive the trauma. “If thine eye offend thee,” and all that. The first step is reconnecting the survivor with their body. Any physical modality will get them there, so long as there’s an element of interpersonal connection to it – martial arts, dance, gymnastics, theater, most forms of structured group exercise. In theory, crossfit would do the job, although weight training alone might be too isolationist, and can worsen things like body dysmorphia and eating disorders. Van der Kolk himself is absolutely horny for yoga. I’ve never heard anyone pop off about yoga with such fanatical adoration. Like, I’ve known a lot of yoga practitioners and teachers, and they tend to be like, “yeah, it’s pretty nice”. Van der Kolk is straight up yoga street-teaming.

It makes sense. The point of yoga is reintegration with the needs of the body, releasing the energy from the muscles, being kind to yourself and compassionate to others. Those are exactly the issues of PTSD. It’s an ideal counterbalance.

Once the body is grounded, the trauma work itself can begin. Van der Kolk is dismissive of “just talk therapy” to the point of contempt, which is not normally what you want to see from a guy who prescribes psychotropic drugs, but he acknowledges it’s a necessary component of childhood trauma processing. The trauma is stirred up, brought to the surface, then “experienced” and processed along with the new arsenal of improved bodily awareness, often “dipping the toe in” a little at a time until the whole of the traumatic experience can be mapped out and integrated into the memory. The reflexive responses that the body needed at the moment are manifested, allowed, and released. The system’s job queue is cleared, and the trauma can be accepted as something that happened, not something that’s happening. The physiological responses to it die off, and the PTSD just… disappears. It goes away. The spirits are exorcised.

Van der Kolk also talks about fringier approaches like EMDR, IFS, and biofeedback, all of which have seen fantastic results in certain populations of PTSD sufferers, and all of which are pooh-poohed by establishment shrinks and researchers because they’re expensive and difficult to understand empirically (beyond the demonstrable improvements in patients), and everybody in the field just wants to rave about how great CBT is, rather than gamble with their tenure.

It’s an incredible book, and everyone should read it. Not just every clinician, not just everyone who’s been traumatized. Every living person. If we all knew this information and we all applied it, it would be a much, much better world.



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Berlin: Ich Bin Ein

December 4, 2017. Berlin, Germany.

The first thing I learned was my normal strategy of walking everywhere is of no use here. Berlin is too big. It’s because there used to be too many Berlins, and once Reagan hulk-punched that wall down it became a single, titanic Berlin.

Hostels were in short supply, but I managed to get my hands on a nice $13 a night dealie right off of the Landwehr canal, called the Grand Hostel Berlin. Their delusions of grandeur didn’t stop at the name. They were under the mistaken impression they were a party hostel, and wanted this party to center around what they called the Gin Library.

Now, ordinarily, those would be great things better together, right? Peanut butter and jelly. Peanut butter and chocolate. Peanut butter and whatever arbitrary nutritional asceticism I’m inflicting on myself at present.

No such luck, beautiful reader. It was most assuredly a library a la Ron Burgundy, leatherbound books and rich mahogany, but it also had bar no one ever wanted to tend, obnoxious techno music that kind of disrupted the whole “library” mystique, and a fucking disco ball.

Do you know why most libraries don’t have disco balls? It’s because you need light to read.

When I entered the Gin Library, there were four people sitting around a coffee table, talking over the bad music in various accents about what their favorite types of alcohol are. Pretty standard cultured frat-boy hostel fare. The girls were middling attractive, the boys were “traveler chic” with whiteboy dreadlocks and dated facial piercings.

Laboring under the mistaken impression I could get some reading done in the library, I stood at the bar and tried to order a beer during happy hour. It didn’t work for a few minutes. I went to reception and said, “Hey, think I could get a beer?” The receptionist smiled, nodded, and shouted rapid German at no one in particular.

I went back to the bar and waited for another couple minutes, then decided the hell with it, I didn’t need one that bad, and started back to the corner seat to chip away at a reread of Stephen King’s It.

It wasn’t until then that one of the girls at the table, still squawking something about how Oh she LUVES tequila, deigned to stand up, approach the bar, and say, “Did you want a beer?”

“You work here?” I asked.

“Yeah.”

I narrowed my eyes. “Are you sure?”

She smiled, thinking I was flirting. I corrected this misconception by deliberately stiffing a service worker on a tip for the first time in my life.

Sorry baby. West Berlin’s always been a capitalism.

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I started at the Brandenburg gate, one of Germany’s most famous monuments despite its relative youth, at least by European standards. Berlin had been a defensible fort with a sequence of unpronounceable names since Germany was Prussia, but the Brandenburg gate didn’t show up until around 1790. For America, that’s all of relevant history, but for countries like Italy or England, that’s basically yesterday.

I hadn’t done a lot of Nazi-centric sightseeing because the weather is depressing enough and I like to have fun, but considering the Germanic bent my recent journeys have taken, it’s not avoidable. The Memorial to the Murdered Jews in Europe is about a block from the Brandenburg gate, rising from a concrete lot like a time-lapse cemetery. Catchy name too, huh? It’s got a beat and you can dance to it.

Concrete slabs of varying heights shoot haphazardly from the ground with no inscription, pattern, or real rhyme or reason. Some look like tombstones, some like coffins, some like tiny Brutalist skyscrapers. The architect, a dude named Eisenman, claims that the blocks are supposed to create a confusing atmosphere indicative of a highly ordered system gone wrong, then in the same breath says that the memorial has no symbolic significance. Sounds like your confusing atmosphere worked better than planned.

The designer’s contradictory Zen-koan babbling doesn’t stop visitors from their interpretations, though. Popular opinion is that entering the monument proper was isolating. The concrete absorbed the sounds of traffic and life coming from Berlin, leaving you in this cold, spooky hallway. The alienation, the echoes, and the imposing bleakness of the corridors reminded me of a slaughterhouse, but I’m not the best central tendency metric for this kind of thing.

Some people call that vague feeling of visceral unease the heebie-jeebies, or something comparably cute. I call it draggin’ ghosts, and I felt them like a physical weight on my shoulders as I walked out of that bleak little grid. At the same time, I was reining in an almost irresistible urge to jump from block to block. That was something I liked to do in graveyards when I was young, until someone saw me. Never met anyone who was thrilled about that.

I turned the corner and a giant brain-blimp shone down from a wall.

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“Oh, good,” I said aloud. Berlin’s got a reputation for art, and a lot of what I saw was pretty cool, but we’ll save that for its own post.

I turned another corner.

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agreed

I doubled back to the hostel and sat down for a while since I’d somehow managed to walk four or five miles, thanks to Berlin’s comical immensity. Der Hunger was setting in. I asked a spindly blonde receptionist where I could get some food, and she helpfully said she’d tell me in ten minutes.

She didn’t get the chance. A dude who sounded Ukrainian was scribbling a sort of city-overview to the stoner kid I mentioned yesterday and a middle-aged Japanese couple, and I eavesdropped on that until he circled the areas where “all the best restaurants are”. I leaned in, snapped a picture, and disappeared into Germany’s perpetual freezing rain.

What he meant by “all the best restaurants” was “places you could conceivably locate food”. This walk was only a mile, though, so that was… better? The street was called Bergmannstraße, it was itself about a mile long, and it had nothing but Asian food, one italian restaurant, one Mexican restaurant, and a kebab shop. I didn’t come to Germany for any of those things, but my choices rapidly became branch out or starve. I ate Indian two days in a row, from two different restaurants right next to each other. The first, called India, was bad. The second was incredible. I don’t remember the name.

There were a smattering of tourist shops along Bergmann, and one of them stopped me dead.

Now, my German is not what you would call spectacular. Any doubt about that, ask any of the Austrians or Germans I’ve befriended in my travels; they invariably mock my awful accent and I demand they answer for “feuerzeug“.

I delight in the German language because of the kindergarten way they just staple short, existing words into monstrous yet inexplicably precise Frankenwords.

You’re sick? Du bist krank. Welp, if you’re sick enough, we gotta get you to the hospital. That’s the krankhaus. How we gonna get you there? We’re gonna load you into the krankenwagen.

Absolute poetry.

In my Duolingings, I ran across the suffix –zeug, which essentially just means “stuff”. Your toy? That’s spieltzeug, literally play-stuff. How about a tool? Werkzeug. You can noodle that one out.

Then you got Fahrenzeug which means “driving stuff” and refers to a car. Uh, okay, I guess. But Feuerzeug is exactly what it sounds like, fire-stuff, and it means “a lighter”, and that makes me absolutely furious. You go TOO FAR.

German grammar is a disaster rivaled only by English grammar and their idioms are, as one would expect, deeply nonsensical and often sausage-themed. Every German I’ve encountered has argued they don’t have that many sausage-themed idioms, forcing me to point it out to them when they invariably use one within the following two hours.

These magnets, for those of you who didn’t quite catch up with the bus somehow, are word-for-word English translations of German turns of phrase. I reveled in them, grinning like an idiot in the rain for five minutes, then made the first and last legitimate souvenir purchase of my trip.

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I also encountered this gem.

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Trump halts maul. Well, it didn’t sound complimentary, but it did sound like home. The last I’d heard of the German opinion on Donnie was when the Morgenpost referred to him as… well, as thus:

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“please not the Horror-Clown!”

Well, I had to wait until I got back to the rad library party hostel to solve this particular mystery, but I giggled when I did.

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It reminded me of one’a my favorite twitter threads.

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Although, in fairness, the t-shirt’s not wrong.

That’s all I can do for today, if I type for too long WordPress’s busted-ass text editor starts flinching away from me every time I hit the enter key like a beaten puppy. Talk to you tomorrow, boys and girls.

Love,

The Bastard