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: What Makes Your Brain Happy and Why You Should Do the Opposite

What Makes Your Brain Happy and Why You Should Do the Opposite by David DiSalvo

My rating: 2 of 5 stars

Fisher-Price My First Neuroscience book. Somebody should have stopped him from publishing the introduction, it was so awkward that I almost stopped reading the book.

If you make it through that, it’s a primer on neuroscience and cognitive psych, citing the usual bunch of studies you would have learned about in a Psych 101 gen ed. The gorilla basketball experiment, the marshmallow one, monkeys creating a token economy, you know the drill.

The science was sturdy and the takeaway is that our brains are organized to prefer short-term benefits over the long-term promise of benefits due to an innate understanding of uncertainty, which served us fine living in the caves, but doesn’t fly as well trading crypto.

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Book Review: Pathways of Bliss

Pathways to Bliss: Mythology and Personal Transformation by Joseph Campbell

My rating: 4 of 5 stars

Joseph Campbell’s work is always best consumed through audiobook. He’s a dry writer. Unfortunately, he’s an even drier speaker, as career academics usually are, so you’ve really gotta hunt for the audiobooks where they hired professional narrators to read it, instead of the recordings of his university lectures that they try to pass off as books.

The ideas contained in the work are gold, especially if you’re a Jungian or some other kind of witch. Human beings think in terms of the mythological. These archetypes help us understand aspects of ourselves, and we call on them the way that voodoo practitioners let the loa ride them, or how ancient Greeks invoked the protection of situational gods, color-coded for easy reference

The main idea of pathway to bliss is We Live in a Society and we lost the plot, which is why we have such a hard time figuring out what makes us happy. The first step is initiation, the transformation from the comfort and protection of childhood to suddenly having all the responsibility of adulthood thrust on us. In many cultures, this is a highly ritualized process. In American culture, it’s not, which is why there are so many cringy “adulting” jokes. Women get menstruation, which serves as a pretty undeniable threshold, but men just kind of stumble along and eventually segue into what their interpretation of proper adulthood and conduct is.

The other function of initiation is to unite the mentalities of the tribe with regard to what the values of the tribe are, and to provide a clear, concise set of rules for the aspiring initiated to follow and uphold. A code. We don’t have a code anymore. Instead, we have a selection of half-ass codes that we spend all our time arguing about, because as mythologically-minded creatures, we want the meaning and purpose provided by a unanimous code.

There’s a vague blueprint, though. You graduate. You get a job. You marry. You produce 2.3 offspring. You provide for them. You keep all those plates spinning until the kids grow up and launch along their own ill-defined trajectories, and then you retire, and then…

And then?

Campbell talks about how it’s at that point you’re free to pursue your bliss, even though time has almost run out. You spend your whole life working toward the golden years where you’ll finally be able to fish in peace, and once you’ve squared away the rest of your requirements and you have your lifetime boxed up nice and tidy, you get in your little boat and row out. And sometimes, after a week, you realize that fishing is boring, and holy shit, I wasted my entire life.

There is no formalized initiation. There is no clearly defined rule set. We have interpretations of the expectations foisted on us, but interpretations are all they are, since our culture is without a true moral compass. The main message of the book is that we don’t need to put our bliss off until we’re almost dead. In fact, it’s the worst move we can make. Our lives belong to us foremost, and we contain all the archetypes, and maybe some would resonate with us better than others if we gave ourselves the chance to explore those sides of ourselves.

Maybe you weren’t meant to be a fisherman. You thought you were, but you waited and scrimped and saved for 50 years, and now you’re out there, and fishing is boring. Maybe your true passion is base jumping. Well, you’re 70, so you’re not going to go base jumping. Not more than once, anyway. It’s tragic to deny yourself the best life you could have had, and the best you that you could have been, because instead of pursuing some ridiculous bliss dream off the beaten path, you followed what you thought was expected of you — but which was never really expected of you in the first place!

Go on out there, chase your bliss. The Gonzo kids would say “Let your freak flag fly”. Do that, if it makes you feel better. It’s your life. You’re the protagonist of the story, and I think that the real and deep-down origin of neuroticism is the cognitive dissonance that comes from knowing yourself to be the hero of your personal mythology while observing yourself constantly acting unheroic.

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Book Review: Waking the Tiger: Healing Trauma

Waking the Tiger: Healing Trauma by Peter A. Levine

My rating: 5 of 5 stars

It’s an excellent and insightful book on the topic of trauma therapy. The gold standard of current PTSD treatment is the acknowledgement that the body keeps the score. That’s why PTSD flashbacks are so visceral. The refrain is, “It’s like I’m back there, in that moment”, and as far as the body is concerned, you are. The evolutionary perspective justifies this both in the understanding that we are animals operating on primitive mammalian hardware, and in the body’s reasoning that whatever it was we did the first time we were in that traumatic (read: perceived as life-threatening) situation, we survived it, or we wouldn’t be here to have the flashback. It becomes maladaptive when falling back on whatever that response was damages the way we live our lives.

Levine breaks up sympathetic nervous response into fight, flight, or freeze, and the main thrust of his argument is people who deal with PTSD are trapped in the freeze response. Animals who survive life-threatening encounters tend to take minute to literally shake it off before going about their days, but these same animals tend not to have enough cortical folding to develop an obsessive fixation on the traumatic event (and future avoidance thereof). They don’t have the brain power to get stuck in the trauma, and they probably don’t have the computing power to have flashbacks, because flashbacks require memory and imagination.

His recommendation is trying to create some form of meaning aside from “I was a helpless victim”, not because it wasn’t necessarily true, but because for therapeutic purposes it’s not helpful in the long term. Sympathizing with your own victimhood is the willing lamb-on-the-altar sacrifice of your personal power and autonomy, deliberately sabotaging any efforts you (and to a lesser extent, your therapist) make to help you process the trauma and better understand the effect it has had on your perspective, your emotional response cycles, and the person you have become. You need that understanding to effect changes, and you need those changes to keep the PTSD from dominating your life. This is pragmatically indistinguishable from Levine’s “shaking it off”.

He wrote it for the layman and for survivors, so the language is accessible. It draws heavily on evolutionary biology and psychology which is usually conjecture cross-referenced with the fossil record, as you obviously can’t naturalistically observe human evolution, or replicate it in a lab.

That said, I am utterly baffled by some of the other reviews this book is getting, calling Levine condescending or unscientific. Blood from a stone here, fellas. If you want footnotes, we can tack a few APA citations from modern psychodynamic practitioners here, and although that technically qualifies as empirical, a real scientist would understand it’s about as scientific as reading tea leaves.

Psychologists are a bunch of bone shakers. All of the evidence we have comes from self-report, which can take a 180 degree turn based on whether the participant ate breakfast that day, and brain imaging, which is dudes in labcoats looking at a grainy photo and saying “that part seems to be… activated.” It’s the least scientific of all scientific disciplines, so to deride an active practitioner, a dude in the trenches of trauma therapy, putting his ass on the line every session and risking his own secondhand traumatization, for being unscientific… it’s like standing up at the “Speak now or forever hold your peace” part of a wedding and going: “This marriage is a sham, for God cannot be proven!”

Yeah, maybe. But you don’t gotta be such an asshole.

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Book Review: The Zen Path Through Depression

The Zen Path Through DepressionThe Zen Path Through Depression by Philip Martin

My rating: 3 of 5 stars

Since zen is basically stoicism but further East, and CBT is essentially a cut-and-paste job of stoicism, it tracks that you can use zen to get through depression, too. Less journaling and self-critique, more listening to birds, roughly the same amount of meditation, but all roads lead to Rome. Or to China, in this case.

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Book Review: The Confidence Gap

The Confidence GapThe Confidence Gap by Russ Harris

My rating: 5 of 5 stars

Acceptance and Commitment Therapy (ACT) differs from the gold standard Coggy-B Therapy (CBT) by picking Albert Ellis’s pockets for the best parts of Rational/Emotive Behavior Therapy (REBT), which have fallen to the wayside in the rising tide of stuffy clinical automatons desperate to crowbar psychology into the hard science category by attaching everything to a chart, regardless as to whether that chart shows anything. God willing, I won’t bring any more acronyms into this book review.

ACT, like CBT and every other therapeutic method we’ve established since slam-dunking Freud’s body into the earth, focuses on coping skills and relaxation strategies that can then be used to descalate the client (which, in the case of a self-help book, is you) when the work begins, poking around at exposed psychological nerves, irrational thought patterns and behavioral schema. The difference is modern CBT leans heavy on mindfulness and positive psychology, and as a result comes flush with meaningless platitudes about positive thinking snatched directly from the bottom of those office motivator posters.

ACT brings with it a degree of humanity. It takes standard-issue CBT and grafts on the more empowering parts of REBT, like unconditional self-acceptance, humor, and irony. The treatment becomes less of a script and more of an opportunity for growth.

In ACT, the intrusive and anxious thoughts aren’t something to be banished and ignored, or drowned under an endless self-inflicted torrent of positive affirmations. Fear is there for a reason, and the more you pretend it’s not, the more powerful it becomes. It’s like someone sneaking around your factory and screwing with the machinery, so you try to make them go away by averting your eyes, which allows them to grow bolder in their sabotage since they don’t need to be as sneaky.

Harris never directly references the Ironic Process Theory, but I’ve found it a recurrent annoyance in my own practice that CBT never addresses. When you tell someone “just don’t think about your anger” or “Kyle, instead of punching holes in the wall, why don’t you go for a walk?”, you’re asking them to do the impossible.

Don’t think of a pink elephant. There, you did. Now don’t think of how nervous you are.

In ACT, you drag these demons into the light with near-weaponized mindfulness. Fear shows up, quietly wrecking your shelves. You point at it and say, “Hey, that’s fear! Fear, come here, buddy. Take a seat. What the hell are you screeching about?”

Fear shuffles its feet and, given your full attention, quietly announces that you are not good enough, she will reject you, and your screenplay is garbage.

You nod sagely and say, “Thanks for your contribution. I appreciate it. You want a soda?”

Fear does not want a soda. Fear wants you to stop whatever it is you’re planning on doing. You shrug and say you can’t right now, because it’s incompatible with your values and/or goals.

Fear is treated this way every time it shows up until it stops making such a ruckus and wrecking your production (or stops monopolizing your life, outside the metaphor).

Values and goals are ACT’s method of self-esteem building. Goals are what you want to get done. Values are how you want to do it. A goal would be getting a promotion, writing a novel, buying a new car. Values are things like courage, empathy, loyalty to family, and other happy little adjectives like that.

We get purpose from living our values in pursuit of our goals. It’s okay to fall off your goal-seeking sometimes, everybody needs the occasional break. If you fall off your values, you’re living inauthentically, and your sense of purpose will dissipate. You’ll become self-critical, demotivated, and mopey. It’ll be a real drag to be around you, causing you to further isolate and creating a feedback loop that will drive you further from your goals and, likely, values.

We choose our values. We get to decide which traits are important to us, and how to live authentically through them. Sort of like a chivalric code, but instead of the reward being eternal knightly bliss in heaven or whatever, it’s being content with ourselves and our decisions. A big part of the therapy is reminding ourselves (or having our shrinks remind us) of our values or goals. For example, your goal is to be good at soccer, but you’re too tired after work to go to soccer practice and you just wanna lay around watching TV. Your motivation to lay around watching TV is stronger than your motivation to go to soccer, no matter how you excuse it. You’re not working toward a goal, and if your values are “teamwork”, “dependability”, or “physical fitness”, you’re blowing it. It makes sense that you’d feel shitty about this.

There are a couple of solutions. The most obvious would be to
(1) get off your ass and go to soccer practice.

If that’s not feasible, or continues to make you miserable, than either your values or goals are in misalignment. You don’t want to be good at soccer as much as you want to relax. That’s fine. Relaxation and self-care can be a value. Maybe
(2) don’t sign yourself up for obligations you won’t attend.

You’re damaging your reputation and your self-worth by repeatedly putting yourself in a situation where you don’t live up to your own values. The third option is goal adjustment; rather than “be a good soccer player”, your goal becomes, “I want to play soccer sometimes”. That’s okay, but then you shouldn’t be on a team.
(3) quit the team and play occasional pick-up games, so soccer stays fun and engaging.

If that doesn’t sound good, or if you fail to make it to those pick-up games, then you’re not tired, you’re avoidant, and that calls for self-reflection. Which of those values is scaring you? Where’s the block?

ACT, much like REBT, can feel brutal. That’s an inevitable consequence of seeing where your values and behaviors don’t match up. You’ve internalized “I want to be good at soccer”, but then you’re confronted with the realization that you’re doing nothing to be good at soccer, and that can make you feel defensive. It carries the implication that you’re lying. This is where the acceptance part comes in.

It’s totally fine if you’re not good at soccer! Or not as good as you want to be, anyway. You’re the only one who cares how good you are at soccer. This is your goal, and if it’s not a goal you find that important, go ahead and change it. It’s your life. You’re responsible for it. If you’re not living authentically, then it’s time to reexamine your values and goals, and make sure these are things you truly want to do and be, and not just things you think you SHOULD want to do and be.

After I finished the book I went online to see if I could get certified in ACT. Our boy Harris never developed a cert for it, because he didn’t want the methods behind a paywall. There’s an $80 fee to become an “ACT Teacher”, but they teach to therapists.

So it’s like, joining the gym is free. ACT Teachers are like personal trainers. You’ve got to pay to become a personal trainer, because personal trainers can charge you for their knowledge in the same way ACT teachers charge you for CEU credits. But you can also just go online and learn how to work out. You don’t need a trainer to use the free gym, and you don’t need an ACT teacher to use ACT, both in your personal or professional lives.

The book is dense, and there’s a lot of stuff I didn’t touch on. If any of this sounded interesting, I highly recommend it.

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