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: Go Wild

Go Wild: Free Your Body and Mind from the Afflictions of Civilization by John J. Ratey

My rating: 5 of 5 stars


One of the best nonfiction books I’ve ever read. The idea is that humans are wild animals, and for all the trappings of civilization we wrap ourselves in, we’re still running the old jungle OS. We’re primitive creatures with primitive drives trying to force ourselves into the shape demanded by a modern world, and it’s making us fat, sick, and crazy.

The concept is a sort of natural expansion of Freud’s suggestion from Civilization and its Discontents, but less pseudoscientific and quacky. Freud said we’re animals. So did the Bloodhound Gang, in their seminal 1999 treatise “Bad Touch”. According to Siggy, the root of all neurosis is our superego trying to cram our id into the acceptable conduct box, so We might continue to Live In A Society.

Ratey says the same thing in more modern and empirical terms. Evolution programmed us over the last couple million years to exercise constantly, socialize constantly, eat huge quantities of fats, and maintain a state of mindfulness (which is just awareness of our surroundings so we don’t get eaten by bears). Our stress was immediate, and faded as soon as the danger was gone.

Flash forward to the present day. The most physically fit among us exercise seven or eight hours a week. We live in privacy boxes with immediate family or a couple roommates, who we tend to avoid because of how stressful talking to people at work or school is. Most of what we eat is corn and sugar. We don’t have time to be aware of our surroundings due to the constant hyperstimulus beaming a stream of shining blue data from the attention-hog computer we keep in our pockets, directly into our frontal lobes. We are mad at our computers because someone said something WRONG about VIDEO GAMES on the INTERNET, and we maintain a constant high-boil of cortisol because the tried and true tactic of “sprint until you escape” doesn’t work on student loan debt.

The answer? Knock it off.

The first book I read by Ratey was Spark, which changed the way I looked at exercise. I’ve always been obsessive about it (I tend to be hyperactive to a point just south of mania, Jackie Chan snap-kicking out of bed a few seconds before my alarm goes off), but I didn’t realize the effect it has on mental health and hormone profile. Most of what ails you, regular exercise will cure. Present research suggests that in trials for treatment of depression, anxiety, and ADHD, daily cardio worked as well or better than medication in terms of treatment. So naturally, that’s what they lead with in Go Wild: get off your ass and get your heart pumping, remind your body it’s alive.

Then comes groundbreaking life advice like “Zebra Cakes aren’t dinner”, “Sleep regularly”, and “Talk to people you like, in real life”.

I’m doing it a disservice with the pithy summary, but it’s an amazing book, and one I took my time reading because I didn’t want it to be over.

SECOND READ:
Read it again. I was right the first time, although now that I’m older and wiser I can recognize some of the reaching Ratey did in the last few chapters. A lot of the evidence was anecdotal there and instead of providing sources or studies he was like, “Try it! You’ll like it!”

I also found myself getting a little defensive when he talked about his other psychiatrist friend who insisted that PTSD therapy didn’t work and qualified it as “yakking”. So how do you resolve a lifetime of the collected, complex trauma from childhood physical and sexual abuse? Just go ahead and dance it right out. Join a Zumba and all those scars will evaporate. Oh, and slam down a handful of these super special drugs every day, of course.

I was going to write “get fucked, van der Kolk”, but in googling what the hell his name actually is I found out that he initially formulated the PTSD diagnosis and has been researching it for 50 years. He’s an authority, and pretending I know better based on my own anecdotal treatment experiences would be disingenuous, especially considering how often I push physically active coping skills on my clients.

The bleedover is van der Kolk tends to focus on ritualized movement methods within cultures like dancing, shamanic and wildly boolin’ religious practices (Shaker/Quaker style), and ancient Greek theater. A lot of these things included elements of psychotherapy right in them. Catholic confession is the most on-the-nose example, but exercises like shamanic soul retrieval have persisted largely unchanged into modern psychotherapeutic practice, so maybe our man has a point. I’ll give you this round, van der Kolk, and I’ll read The Body Keeps the Score someday.




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