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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Book Review: The Cancer Code

The Cancer Code by Jason Fung

My rating: 5 of 5 stars


Nobody loves codes as much as iconoclast physician Jason Fung. This is his third code so far. Though it’s easy to suppose they’d be spiritual successors the Robert Langdon trilogy of shitty mystery novels, Doc Fung instead focuses his energy on street-teaming for intermittent fasting and pushing low-carb paleo living without ever saying the word “paleo”, for which we’re all grateful.

Now, full disclosure, I haven’t read the Diabetes Code, but my high IQ and longtime Rick and Morty enjoyment makes me pretty good at recognizing patterns, so I’m still going to take a stab at cracking all three codes for you, right now, to save you the thousand or so pages it would take to assemble the whole picture of “the Wellness Code”, which apparently contains the cancer code, but neither the diabetes nor obesity code. Fung moves in mysterious ways. Coded ways.

Here’s the Konami code to health: Insulin is the devil. Minimize insulin exposure, maximize everything else from disease resilience to longevity to looking sleek and sexual at the beach.

Fung’s money is where his mouth is. I googled him, and he looks pretty ripped, especially for a doctor. He’s not massive or anything, not like that one doctor on Instagram who keeps trying to sell you special rubber bands to use in place of weights. All other things constant, I could beat up Dr. Fung, but I would never, as he inspires me.

The Cancer Code details the sordid history of attempting to treat cancer and its repeated, catastrophic failures. It’s implied that cancer is a disease of civilization, as outside of agrarian societies it’s rare to the point of mythical. Immunotherapy seems to be the most effective, if the least profitable, treatment option, but Jason Fung gently suggests (as most of my favorite practicing scientists, psychologists, and medical professionals tend to) that we don’t know shit about dick and consequently fall back on tried-and-true Hail Marys like radio- and chemotherapy, which poisons everything in hopes of killing the cancer.

Cancer is a disease of irregular cell growth. Normally, cell growth is a pretty good thing, but only if the cells cooperate with what is expected of them within the confines of the tissue they comprise. Cancer is the wires getting crossed and the cells in, say, the liver deciding that cooperation is too chancy and they’ll go it alone from here. The cells revert from eukaryotic function to a more primitive, prokaryotic function, remembered in the DNA from back in the days when each cell was fighting for its own life. And that’s what cancer is. These cells grow and propagate individually as fast as they can, sabotaging and consuming the surrounding cells (who are still being team players). The meme of cellular primeval psychopathy bounces all over the body, setting up satellite colonies, and that’s metastasis. Since these cells only care about individual survival now, the health of the organism isn’t taken into account, and it typically dies, taking the newly expanded cancer empire with it.

So how do we protect against cellular mutiny? As in most nutrition books, the message refines to Michael Pollan’s dietary dictum: Eat food, not too much, mostly plants.

Doc Fung is always pushing intermittent fasting, so that’s step one. After that, low carb. Step 2. Get some exercise, the human body needs to move. Step 3. Voila. You’re… not quite cancerproof, but you just improved your chances enormously.

Here’s the why.

He repeatedly likens cancer to a sort of weed that grows in the garden of your body. The thing is, it needs specific soil conditions and nutrients to take root and strangle out the rest of the garden. The most important of these conditions, these specialized weed-foods, is IGF-1, or insulin-like growth factor, released whenever we have an insulin response. The more insulin circulating in our system, the more IGF-1 comes with it. Insulin is pivotal for growth and development, especially for things like protein synthesis, testosterone production, and building muscle. We need some insulin, but we need it to serve its purpose.

Keeping the body perpetually inundated with insulin causes all sorts of stupid, avoidable problems, and it turns out cancer is a major one of them. A nonstop stream of IGF-1 keeps cells growing, and growing, and growing, and as soon as one flips the switch and decides it would do better on its own, baby, you a got a tumor goin’.

Caloric restriction, weight loss, and increased insulin sensitivity all help to shrink tumors, sometimes pushing them into full remission. Cancer needs insulin to grow. Burn the granaries and starve the empire.

Intermittent fasting becomes a magic bullet in this situation because not only does your insulin sensitivity improve when you phase out snacking, 16+ hours of fasting promotes increased autophagy, which is sort of like defragmenting your hard drive, if your hard drive was your body. Autophagy means “eating your own damn self” and it’s like a concerted effort within your body of looking for dying, damaged, or junk cells, then catabolizing them into component proteins and energy, potentially stopping fledgling cancer before it has a chance to foment rebellion.

It was a truly fascinating book, and a talisman against the 21st century’s answer to the Grim Reaper. Now that I think about it, it’s kind of ironic that he carried a wheat scythe.




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Book Review: Human Sexual Response

Human Sexual ResponseHuman Sexual Response by William H. Masters

My rating: 4 of 5 stars

My elderly next-door neighbor gave me this book after recovering it from a box of thrift shop books that someone put out for garbage day. I think she thinks I’m a doctor.

Human Sexual Response is an extensively researched collection of intriguing experiments that consisted almost entirely of having prostitutes fuck in a lab. It was published in 1966, ten years before MRIs and a year before CT scans, so when they say “clinical observation”, they mean exactly that. Clinicians brought in 118 female prostitutes and 27 male prostitutes, selected, as in all science, by availability, and gathered their sexy, sexy histories. Then they picked the best 11, judged on intelligence, diversity of prostitution experience, communication ability, and general availability and agreeableness. These eight women and three men, these Right Stuff philianauts, had their anatomies studied exhaustively, by both literal and figurative definitions of the word.

Those of you with a background in science might be saying “wait, a participant pool of eleven? To generalize the entire human sexual response? That’s outrageous!” To which I say: shut up, nerd. This was the only game in town.

I’ve got to reiterate that this was before resonance imaging was available to the game. Masters brought in a team of grad students and put their noses right to the grindstone, around where the lenses would be on pornography camcorders, and had them scribbling medical jargon on clipboards while these prostitutes that science found absolutely went to town on each other.

It made for some interesting reading. For its design flaws, it seemed painstakingly controlled, and the literature always specified the differences that the anatomies would register dependent on whether a woman was nulliparous, which I learned means “has not made a baby”. Breast tissue swells during what Masters operantly defined as the “plateau” stage of sexual arousal, so you’re not imagining that, they do get bigger. There’s also a sort of mood-ring effect to the labia minora approaching and during orgasm, so if you bust out a Mag-Lite real quick you can check if she’s faking.

What? They do that?

The section on males was less fleshed out (a-ha-ha), partly because of the pitiful sample size, partly because I doubt that was Williams et al.’s priority with this sequence of studies. It talked about penile size change averages pre and post-arousal, but in centimeters, so that’s anyone’s guess. Allegedly, the oldest sexually active participant was 89, so that’s heartening.

To speak in good faith, the prostitute voyeurism was only the first part of the study. A lot of the literature was drawn up by self-report questionnaires and interviews conducted with hundreds of other participants. That 89 year old guy was probably not one of the three male prostitutes whose wieners they studied.

Above board, it was a fascinating read, if you can keep in mind the constraints of design, the prevailing science at the time, and the weird sex hangups of the 50s and their subsequent 60s reaction formation.

Also, I pounded through it in an hour, so it must be written accessibly. Four stars. It would’ve been five stars if Masters had given into the temptation to make a dick joke, like a real intellectual, like fucking Shakespeare, but he remained haughtily professional and academic the whole time. Which is a real mood-killer, unless you’re into that sort of thing.

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Book Review: Your Brain on Nature

Your Brain On Nature: The Science of Nature's Influence on Your Health, Happiness and VitalityYour Brain On Nature: The Science of Nature’s Influence on Your Health, Happiness and Vitality by Eva M. Selhub

My rating: 3 of 5 stars

From beginning to end, this book was an exercise in cognitive dissonance for me.

I’m a major proponent of the back-to-nature mentality, which I refer to as my “unga bunga bullshit” and inflict on my friends at every opportunity. So are this book’s authors, and they provided chapter after chapter of studies confirming my every bias. Even biases I didn’t know I had!

Shinrin-yoku, Japanese for “btfo in the woods”, improves your mental health on every conceivable level, including what aspects of it extend to the physical. Being around dogs, cats, fish, and hamsters do, too. Eating fewer Tastykakes and more fish reduces brain inflammation, linked to improvement in mood, lower depression symptom presentation, and increased cognitive functioning.

Wow! Turns out I was right about everything forever. To ameliorate any potential flagging in well-being, I self-prescribe a friendship dog and a big ol’ joint of roasted meat like in Conan. Join me in the shrub, my brethren.

“That’s not what cognitive dissonance means,” you may be saying. “Everything is great for you rn! Why you so stingy with those stars?”

Let me tell you, beloved reader. Although I’m functionally paleo, and I do consider hitting a tire with a sledgehammer to be cardio, I’m also a practician clinician who reads this shit recreationally and spent the last decade arguing with people on the internet. I know a thing or two about sourcing references.

Red Flag #1:
The writing wasn’t very good. This is excusable, but must be considered. Writing is hard, academic writing is agony, and you can’t expect a dry, scientific tome of this length to be an emotional roller-coaster the whole way through. What stuck out for me were word repetitions, slips in grammar, and clunky sentence construction. A good solid edit could have fixed all of this, but didn’t. Disconcerting.

Red Flag #2:
“For a chapter-by-chapter list of references used in this book, go to yourbrainonnature.com”.
What? Why?
I get that you used a lot of references, but removing your scientific backing and proof from your argument by additional degrees is incredibly suspicious.

I did track the references down, and they seem to be a pretty even divide between respectable sounding psych or anthropology(???) journals, and ambiguous horticultural journals no one’s ever heard of. Considering the authors, that makes sense, which brings us to our next red flag.

Red Flag #3:
Eva Selhub, MD, and Alan Logan, ND. What the hell is an ND, you may ask? I certainly did. It means “naturopathic doctor”, which is to say, not any kind of actual doctor. I tried to find more information on naturopathy thereafter and there were only two sources of information:
a) Naturopathic.org, which paints all NDs as physicians who became frustrated with the pharmaceutical industry and injecting children with autism vaccines so they went rogue, quit “conventional medicine”, and started prescribing essential oils
b) Wikipedia.org, which was essentially a 3000-word rendition of holding up a foghorn and yelling “QUAAAAAAAAAAACKS”

Red Flag #4:
Eva Selhub is very well-credentialed. She’s a for-real doctor of internal medicine, taught at Harvard Medical School for around 20 years, and served as Medical Director at Benson Henry Institute for Mind-Body Medicine at the Massachusetts General Hospital for 6 years. She publishes often in medical journals and shows up on Dr. Oz. Despite being nearly 50, she still lookin’ kinda fresh doe. Nowadays she identifies as a “resiliency expert and executive coach” and is her own LLC, which is probably much more lucrative. The issue with lucrative is, most pyramid schemes tend to be, for the executive coach.

Red Flag #5:
An alarming number of medical quotes and excerpts throughout the book come from the 1700s to the early 1900s. This is intended to instill the “forgotten wisdom” motif, but we just stopped leeching people in the early 1900s.

None of these attempts to poison my own well necessarily detract from the suggestions made by the research, which boil down to “hanging out in the woods is better for your mental and physical health than playing Candy Crush 15 hours a day”. That’s a reasonable supposition. I’ve gotten through some more recent and less suspect books recently with data that points the same way — Digital Minimalism is a good one.

It’s an “I want to believe” situation. Everything seems to check out, but there’s a fishy smell under all this patchouli.

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Rome: Slowin’ it Down

November 4, 2017. Rome, Italy.

I read that it was Madrid’s night life that really shines, and since I had to catch a bus to the airport by 5 AM I opted not to book a hostel and spend the night homelessly bar-hopping. I spent an hour in Museo Chicote, Hemingway’s “best bar in Spain, certainly” and had his recommended daiquiri. I imagine when he was there the lighting was less fish-tank neon and they played fewer techno remixes of Sweet Dreams, but I could be wrong. Maybe that’s why he liked it.

I walked down a street grabbing tapas and beer at each place until I felt full for the first time that week, then chased it with a coffee to make sure I’d catch the bus. This proved to be unnecessary, since the entirety of Madrid closed by 2 AM. I don’t know where all these travel writers are getting the idea of “Madrid goes hard until at least 4 AM”, but I imagine probably the on-season. There were, however, so many insistent prostitutes who literally chased me up the Gran Via, trying as hard as they could across several language barriers that I had just happened to discover a stone-sober, sexually liberated young woman who found me irresistibly attractive, and that in this part of the world “how about a blow job?” is a common icebreaker.

“I just feel like it’s too early in our relationship,” I told the first.

“Only one night! One night relationship,” she clarified.

“Tell me, sweetheart, this relationship. Does it cost money?”

“Not even that much! Not even much money!”

I caught the 2:30 bus and slept on the airport floor and a sequence of planes until I arrived in Rome, where they tried very hard to convince me that the only way I would get to my hostel was by $50 taxi.

I explained to them that I could easily just take a $6 bus to center city and walk the half mile to my hostel, but they insisted that it was impossibly far, and my only chance of survival in the unnavigable maze of Rome was to take a taxi. I told them thanks, and took the bus, settled into my hostel, showered, shaved, took a nap, then went down and had free pasta dinner cooked by an immensely outgoing receptionist named Doniella. At dinner, I got drunk off $2 wine with a German med student and a 700-year-old American named Herbie, who extended me this sage advice:

“You gotta slow down. You’re taking this too fast. It’ll all be there, you’re not gonna die next month.”

“You don’t know that,” I said, because I’ve never been able to project myself more than 2 days into the future.

“That’s true, but you’re probably not. You can’t keep rushing around like this or you won’t enjoy anything. Take a week. Really see Florence. You should take at least two if you want to see everything in the countryside, but maybe that’s another trip. You have time.”

I fought him every step of the way during the conversation because my pastiche of personal philosophies draws heavily from zen and existentialism, both of which are really specific about “This day will not come again.”

“You didn’t come all the way across the world to not spend the money,” he chided, which was weird because we hadn’t talked about money. “Slow down, take your time. There’ll always be more time and money. Learn the Greek alphabet. Go to Istanbul!”

His advice became a little meandering from that point on, but it was the thought that counts.

“You don’t have to rush. Just go out, see everything. Then you can die.”

“Hear, hear,” I said, and we clonked (it wasn’t a clink) our plastic cups of grocery store wine.

Then, after a moment, “Welp, the wine’s gone. I’m going to bed. See you all tomorrow.” And off he went.

I was good and drunk and still tired because it turns out sleeping on planes in 1 hour increments is not the same thing as a night’s rest, so I stumbled upstairs and went dead to the world for 10 hours. But as I did, I internalized what Herbie said. I fundamentally disagree. I don’t have time. None of us have time, life is too short to not Go For It, whatever the present It happens to be, but I think he’s right in that I’ll enjoy myself more if I slow my roll a little. You can Go For It strategically. It can be a plan.

I’m going to reread the Stoics while I’m here, I think. Marcus Aurelius was always my favorite, and seeing his colossal, melon-shaped head in a marble bust at the Prada brought his Meditations screaming back to me. I’ll wrap this up with what seems like an unrelated Epictetus quote, but just replace “books” with “travel”, or “making money”, or anything else people collect like Pokemon cards as though the collection is enough.

“Don’t just say you have read books. Show that through them you have learned to think better, to be a more discriminating and reflective person. Books are the training weights of the mind. They are very helpful, but it would be a bad mistake to suppose that one has made progress simply by having internalized their contents.” 
 Epictetus, The Art of Living 
Love,
The Bastard