The Body Keeps the Score.

I’ve been open about my own mental health issues, such as this piece I wrote on being anxious throughout my childhood, but am fortunate in one respect in that my childhood was also relatively free of trauma. I grew up in a loving family, didn’t lose any close family members until I was a teenager – both of my grandmothers lived to their 100th birthdays – and never had to deal with the effects of divorce or abuse, to pick just two possible traumas that affect kids. Events I might recall as “traumatic” pale in comparison to what others grew up with.

I’ve only come to learn about trauma and PTSD (post-traumatic stress disorder) in the last handful of years, due to several close friends who suffer from it and how its effects can often include problems I’ve dealt with, including anxiety, panic, depression. Somewhere along the way I heard about Dr. Bessel van der Kolk’s seminal 2015 book The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma, which I have since learned is an incredibly influential and important book in the world of mental health professionals. Dr. van der Kolk has spent decades working with trauma victims and was one of the leading proponents of the hypothesis, later supported by fMRI and similar evidence, that trauma actually alters the brain in a physical sense rather than just a mental one, and that even minor events can still have traumatic effects on our brains, especially when they happen while we’re young.

Dr. van der Kolk spends the first part of The Body Keeps the Score discussing his own history in working with trauma victims and the difficulty he and other colleagues had in even gaining acceptance for the idea of the aftermath of trauma as a distinct medical disorder. PTSD was only recognized by the American Psychiatric Association as a formal diagnosis in 1980, when it was included in the Diagnostic and Statistical Manual of Mental Disorders‘s third edition (DSM-III), thanks to a surge in sufferers among soldiers who returned from fighting in Vietnam. Awareness of the condition dates back to ancient Greece, and is well-documented in medical and popular literature from the 1800s forward under terms like “shell shock” (whence our word “shell-shocked” derives), but people with PTSD prior to 1980 were treated as if they had a panoply of other, seemingly unrelated mental health disorders, which led to problems like overmedication and a lack of any progress back towards a normal life.

From there, the author discusses new evidence from the world of neuroscience to support his and others’ hypotheses that the brain of a trauma victim works differently than the brain of someone without PTSD. Different parts of the brain are activated in similar situations, although among trauma victims there can be varying responses, from panic to dissociation to shutdown. He also discusses the various ways we develop PTSD, often in excruciating details of childhood abuse or wartime atrocities, tying these underlying conditions to changes in methylation of genes that can even be passed on to offspring, a process known as “epigenetics,” that also explains how the brains of trauma victims end up operating on a different BIOS than those of others.

The prose here can feel a bit academic, perhaps the result of van der Kolk’s background but also that he’s a native Dutch speaker and writing in his second language. In part five, which constitutes nearly half of the book, the writing livens up as he delves into various methods of attacking trauma and retraining the brain not to panic, dissociate, or just peace out when the person is presented with a trigger. Some suggestions are obvious or well-known, like using yoga or EMDR therapy (Eye Movement Desensitization and Reprocessing, which sounds like it shouldn’t work, but does help trauma victims), while others are novel and surprising, including participation in theater or similar role-playing activities, or using a computer program to try to ‘reprogram’ the brain not just in its fear response but all of the time. He includes EEG graphs that show patterns of attention in the brains of study participants where the trauma victims’ brain waves are less tightly connected and even diverge in the milliseconds after the subject was presented with information for the brain to process. Neurofeedback, which allows the user to regulate his/her own brain function with the help of software that displays EEG results, has shown promise for trauma victims and people with other mental health disorders to reestablish control over their brains’ betrayals. Dr. van der Kolk also goes into heart-rate variability training, self-leadership of the different parts of our personality (not quite dissociative identity disorder, but leaning that way), and the pros and cons of cognitive behavioral therapy or medication for PTSD sufferers.

If you or someone close to you is a trauma victim of any sort, even if it seems like a ‘minor’ trauma, The Body Keeps a Score will be an illuminating read that could help alter the course of your/your intimate’s treatment. Even just the final section, where he points out why things like CBT aren’t effective (discussing the trauma over and over doesn’t actually change the way the brain responds to it or other triggers) and gives numerous suggestions for other remedies, would be useful. If you can get through some of the more technical language earlier in the book, though, the entire read is worthwhile, especially as van der Kolk explains his own journey of understanding through decades of working with veterans, children, and other trauma victims to get to this comprehensive theory of how best to treat these people – often people who were considered untreatable by previous generations of psychiatrists.