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: Breath

Breath: The New Science of a Lost Art by James Nestor

My rating: 4 of 5 stars


I have a favorite class of book, which I refer to lovingly as “my ungabunga bullshit” that usually consists of nutritional or fitness claims drawing on shaky evolutionary science to advance an agenda that, ultimately and disappointingly, leads to pawning supplement placebos. Despite how insulting to the intelligence these tactics are, I can’t help but love the paleo quasi-science they’re pushing. Pull virtually anything from the Joe Rogan recommended reading list and you’ve got a 1 in 3 chance of stumbling on the kind of literature I’m talking about.

These books usually lean heavily on anecdotal evidence (like the entire Carnivore diet), or what we believe may have been how primitive man lived based on the fossil record and modern hunter-gatherer societies (like the Primal Blueprint or the Awakened Ape), and they universally reference our man Weston Price, peregrine dentist, and his discoveries on the miraculous effects of not eating carbohydrates (Good Calories, Bad Calories, the Obesity Code, anything keto or paleo related, et cetera ad nauseum).

I might sound dismissive, but it comes from a place of love. I like what they’re pushing, but I know the limitations of the science and I resent them trying to sucker me into buying “Primal Calm” sugar pills, especially with them saying, in the same breath, that sugar is the Great Western Devil.

In the same breath, bringing us back to the topic at hand. James Nestor is a journalist with disastrous dentition and a mouthbreathing habit that has left him, to hear him tell it, physically deformed. He looked like a normal dude to me, but maybe that’s the problem. Breath takes the same tone and theme as the rest of my ungabunga bullshit books, but rather than suggesting that the answer is “shit in a squatting position and deny the Demon Wheat”, Breath suggests that all of our problems, as highlighted by Price’s hundred year old tribal dentistry journals, are caused by the fact that we breathe through our mouths (and, to a lesser extent, don’t chew enough).

The science is young, but the few studies he referenced seemed legit. A lot of the book was more of a memoir of him serving as guinea pigs in these breathing experiments alongside crazed foreigners who were likewise convinced that proper breathing was the key to immortality, with the craziest and most foreign being Wim Hof, just for context.

I was especially intrigued by the perfect sociopath with the damaged amygdala experiencing fear for the first time in her life when forced to breath carbon dioxide at greater concentrations than usual, which is an effect mimicked in the body by “overbreathing” or not fully pushing the air from your diaphragm on the exhale. The exercise studies suggesting greater athletic capacity when breathing properly (that is, through the nose and emptying the lungs) were interesting, but highly anecdotal, and relied too much on the emotional language of the participants for my own comfort.

There’s also the whole Mewing thing, the glue that holds this collection of yoga techniques and self-report questionnaires together, and that isn’t empirically tested either.

End of the day, there’s not much in Breath that qualifies as actual science. On the same token, “breathe deeply and close your mouth, you stupid animal” isn’t bad advice. It’s like that folk wisdom you hear so much about.



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Yea, I’m into BDSM: Beatitude, Dharma, Stupas, and Moderation

October 8, 2017. Sedona, Arizona.

What the hell is a Buddhist Stupa, you may ask?

I suspect you may, because I certainly was, and by all accounts I should have known. In the five lost years I spent between high school and college doing sketchy blue collar work, abusing substances, and reading, I cleared entire shelves on Zen (and astrology but like, I’m not as proud of that one). I know more paradoxical riddles and methods of sitting real still than you could shake a shit-stick at. I also grifted my way through a grad course for my philosophy minor called “Special Topics: American Buddhism”, but that was chiefly just reading monotonous Alan Watts excerpts and arguing with communists.

Why they always gotta make it about the state, anyway? I’m just tryna talk about buddhanature and have a good time, it doesn’t always need to be civic responsibility and the plight of the proletariat. Besides, Buddha straight up said “the most important thing is to do good work”! Even Buddha’s telling you to get a job!

Sorry. I digress.

Two miles off the highway, through a residential area with street names like “Moondrop Ave” and “Allegra Drive” and the equally thematic “Splendor Court”, I found the dirt pull off for a ‘tranquility park’ that I am, quite frankly, too Western to remember the name of. I parked the car and shuffled up the path to the park proper, passing a shoeless nine-year-old girl who was discernibly closer to enlightenment than I have ever been.

The Stupa itself was a 36-foot tall pink monument with an alcove near the top housing, you guessed it, Buddha. A path was worn into the ground around it designating the meditative circle you were supposed to take while contemplating that good loving-kindness. Stupas function as compassion batteries, absorbing all the good vibes from decent, outwardly-projecting Buddhists, amplifying them, and broadcasting them across the world in an effort to cleanse the karma of all living beings. Only a Buddhist can say “#all lives matter” and really mean it, but they wouldn’t because of the douche factor.

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In a little pavilion next to the stupa was a man and three generations of women, all sitting cross-legged and listening to him tell a story in a gentle, nonthreatening voice. He was definitely moving in on the cute daughter, and she was definitely into it. Next to their gathering was some Vegan chow, a plastic baggy full of graham crackers that someone had covered in birdseed.

“Not very compassionate,” I chided to myself, realizing my internal monologue was being, well, a bastard. “This karma needs cleanin’.”

I did three laps of the Stupa and touched it, got my cosmic tally reset, then spun a couple of prayer wheels. As I understand, prayer wheels do the same thing the stupa does, but in a little burst when you spin it. Think of it like an automatic car. You press the pedal and the rpms gradually go up. Stomp the pedal and for a second your rpms’ll jump to 6k and your engine will scream. It’s like that, but with understanding and kindness.

prayerwheels

Prayer flags hung from the trees all around the walking meditation trail, and little shrines to Buddha were decorated with colored stones and flat, stacked rocks. These little cairns serve the same purpose as the greater and better organized stupa, but more localized; each stone functions as a prayer to impart blessings on the stacker and their loved ones, with the implication that the balance of the stones mirrors the desired harmony of the stacker’s life.

It was a nice place. Very peaceful. The boundaries were ill-defined, so at one point I accidentally wandered outside of the park and a quarter mile into the desert. Luckily, somebody in the peace park lit a joint and I followed the smell back. I walked in on a cadre of young ladies with an older woman, howling like wolves in the center of a mandala. It was some sort of prayer for friendship. It made sense. Wolves make good friends.

The Girl was blowing up my phone, insisting that the Buddhist would close the parking gate and lock us in the stupa if we weren’t out by 6. I hit the Buddha with one of the mudras I remembered from my Zen days, then followed the Friend Wolf Sisterhood out to the parking lot, escaped before they sealed us in, and made a b-line for Phoenix.

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haha gottem

We attempted to order a pizza from a place next to the hotel called Mellow Mushroom. Just one. The girl on the phone didn’t know any part of her job, so I’m hopeful that she was new.

“Hello, Mellow Mushroom, I don’t know what’s on our menu or how much anything costs, how can I realistically help you?”

Eventually I mined her for enough data to conclude that they had a “house special” which is what any other pizza joint would call a supreme. They clotted it with every available meat, which struck even an unrepentant carnivore like me as excessive. I had them remove the ground beef. The total for one supreme pizza was $30, or which translates to 120 chicken nuggets or 10 parking spaces on Vortex Hill, so I cancelled the order and found a Little Caesars attached to a beer store. Dinner was a pepperoni Hot ‘n’ Ready and a six-pack of PBR. Bone apple teeth.