What causes people to continually relive what they most want to forget, and what treatments could help restore them to a life with purpose and joy? Here, Dr. Bessel van der Kolk offers a new paradigm for effectively treating traumatic stress.
Neither talking nor drug therapies have proven entirely satisfactory. With stories of his own work and those of specialists around the globe, The Body Keeps the Score sheds new light on the routes away from trauma - which lie in the regulation and syncing of body and mind, using sport, drama, yoga, mindfulness, meditation and other routes to equilibrium.
Bessel van der Kolk MD spends his career studying how children and adults adapt to traumatic experiences, and has translated emerging findings from neuroscience and attachment research to develop and study a range of treatments for traumatic stress in children and adults.
In 1984, he set up one of the first clinical/research centers in the US dedicated to study and treatment of traumatic stress in civilian populations, which has trained numerous researchers and clinicians specializing in the study and treatment of traumatic stress, and which has been continually funded to research the impact of traumatic stress and effective treatment interventions. He did the first studies on the effects of SSRIs on PTSD; was a member of the first neuroimaging team to investigate how trauma changes brain processes, and did the first research linking BPD and deliberate self-injury to trauma and neglect in early childhood.
The Body Keeps Score is my jam. It's better than that. It's like my slammajam. This is my fave book of the year so far, by a bunch.
It's a rich treasure trove of information from the frontiers of trauma research, etiology, diagnosis and treatment. It's changing the way I do therapy and it's changing the way a interpret human behavior.
And to think. I almost didn't read it.
When I entered the mental health field I had intended to specialize in Somatic Experiencing (SE) trauma therapy. But I quickly rejected the model when I realized it was way outside the mainstream and lacked randomized control trials (RCT) that demonstrated its effectiveness compared to other "first line" treatments such as Cognitive Behavioral Therapy (CBT) and Prolonged Exposure Therapy (PE).
I saw the author Dr. Bessel Van Der Kolk lecture at the Evolution of Psychotherapy conference in 2013. He was awesome, and he really reinvigorated my interest in doing somatically oriented trauma work. But something about the experience as a whole left me feeling woozy.
Perhaps my experience was negativity impacted by the mass, prolonged exposure to the unwashed throngs of other psychotherapists (never a good thing), some of whom were from the San Francisco Bay Area (a deadly combination).
Don't get me wrong. There are lots of mental health professionals (even ones from the Bay Area) that are highly functional, sober, top notch folks.
But there are also a bunch of kooky, crazy as fuck people in the field (Particularly in the Bay Area), and there were a bunch in the crowd, and I think I was feeling a bit (or perhaps a lot) of shame for my profession. A pathological shame that was clearly a sequallia of my own dark hippy shadow.
I myself lived in the Bay Area for around a decade. I came to therapy from an unconventional "hippyish" background. I went to art school as an undergraduate. I have practiced yoga and meditation for over 30 years. Plus I have a couple of crappy tattoos. When I entered the field I was dreadfully afraid no one would take me seriously.
So I somewhat consciously but mostly unconsciously tried to distance myself from my own freaky roots.
I was probably still up in my head about all that when I was listening to Dr. Van Der Kolk. I was loving what he was saying, the parts I could understand any way (he speaks in a thick Dutch accent), but I also remember looking around the room and thinking "I have to distinguish myself from these nutty hippies".
Perhaps it was at that point I unconsciously gripped up and rejected somatic trauma work (again) in favor of the more "masculine" "serious" "evidence based", behaviorally oriented, here and now stuff that I currently practice.
Which, by the way, is Acceptance Comment Therapy (ACT). A mindfulness based variant of CBT which is incidentally a "hippy as fuck" therapeutic modality by many standards.
When I first saw that the book was released, I was like "hey, that looks pretty good" but then I had a flash back from the psychotherapy conference.
It was an intrusive mental image of a patchouli smelling, chubby middle aged hippy chick in a mauve knit poncho sweater and dream catcher earrings saying "your fifth level is emitting too much teal energy" and I reflexively withdrew my enthusiasm for the whole somatically oriented trauma treatment program.
Anyway. I did eventually get over myself (and my hippy phobia) and got the book and man is it good. It's extremely, extremely triple extremely good. It's like, organically, cosmically, spin your chakras at a dead show good.
And despite Dr. Van Der Kolk's activist agenda, he's actually a pretty reputable (Harvard affiliated) scientist and clinician and widely regarded as one the the worlds foremost authorities on trauma and trauma sequelae (yes I used the term seguelae twice in the same review, actually three times if you count the time I just used sequallia in this parentheses, oops, better make that four).
And, yes, Dr. Van Der Kolk also apparently does yoga and meditation and has probably smoked tons of weed and hung out at Eslen. But I am willing to forgive the man for that because I too have been guilty of similar behavior in my woolly headed, not so distant past.
Before I became a therapist, I was on my own journey to recovery from addiction, trauma, depression, anxiety etc.
BTW: when I hear other therapist start talking about their recovery, I cringe. Please forgive me if you're feeling cringy. But sometimes we all have to go there in order to communicate certain important points.
The foundation of my recovery was self-care. For me, self-care was (and still is) founded on basics such as: healthy sleep, exercise and nutrition. It also included good therapy and a little 12-step. But the rocket fuel of my recovery was yoga, loving kindness meditation and mindfulness meditation.
Now, one of my primary intentions as a therapist is to assist my clients in developing self compassion and embodied mindfulness skills for utilization in their recovery.
While the secular mindfulness revolution thing that has been happening over the past two decades has normalized mindfulness and provided ample scientific evidence for the clinical use value of mindfulness training e.g. Mindfulness Based Stress Reduction (MBSR).
And mindfulness-based psychotherapeutic modalities such as Dialectical Behavioral Therapy (DBT) and Acceptance Commitment Therapy (ACT) have provided evidence-based mindfulness integrated psychotherapeutic frameworks.
The evidence for somatically oriented (embodied) therapeutic modalities has lagged. Dr. Van Der Kolk's work is providing this evidence and is blazing the trail for mainstream acceptance of somatically oriented practices.
Dr. Van Der Kolk's work is also foundational for changing the way the field conceptualizes and diagnoses trauma.
Additionally Dr. Van Der Kolk is lending legitimacy to some cutting-edge and very exciting trauma treatments such as Neural Feedback and Eye Movement Desensitization and Reprocessing (EMDR).
I, like millions of other people, have suffered from Post-Traumatic Stress Disorder (PTSD) symptoms. In early recovery I received lots of good therapy for trauma and I'm happy to report that I am no longer impaired by PTSD symptoms.
Out of all of the therapy I received, anecdotally speaking, I have to say, some of the most effective was EMDR. I had phenomenal results from an equally phenomenally brief treatment time (two, one hour sessions).
This is standard EMDR testimonial. People very commonly report that it works and it works fast.
Again, as a nascent therapist in training, I had intended to train in EMDR. But EMDR is like the dirty redheaded stepchild of psychotherapy. Despite ample evidence of its efficacy, nobody can figure out why it works, so the model has been widely rejected by the mainstream mental health community.
I sort of drank the Kool-Aid and jumped on the anti EMDR bandwagon. But after reading this book, I'm feeling very enthusiastic about treating trauma with EMDR.
I could go on and on, but I'd rather just urge you to do yourself a big favor and read this book.
As a survivor of sexual abuse and trauma, I found this book triggering and lacking the enlightenment I expected, given the reviews. I felt the author showed more compassion for the soldiers who raped and murdered than the rape victims, and the ways in which he discussed the two left me feeling the women weren't as well humanized. Speaking about this with another trauma survivor, she shared that the author was removed from his own trauma center for creating a hostile work environment for women employees. There are articles to confirm it. I rarely—if ever—don't finish a book, but I'm shelving this one.
This book represents everything that is groundbreakingly wonderful and and pseudoscientifically horrendous about trauma research. Individuals who suffer trauma are in need of actual help. This book contains some of the best, latest, and most effective cures for trauma sufferers, which can steer patients toward the help they need. However, van der Kolk seems wholly unable to engage in critical thinking when it comes to various treatments.
When attending courses in cognitive neuroscience and psychology at the University of Pennsylvania, my favorite professors were those who ripped apart each treatment to examine it for efficacy. The profs held out hope that cures were attainable but put them under the microscope to make damn sure the "cure" would not actually retraumatize and individual or make matters worse. In order to trust a mental health care provider, that provider should demonstrate not only a knowledge of the literature (as van der Kolk does as he repeatedly throws around his MD and Harvard alma marter to assure his reader of his credentials) but also an ability to sort out fact from fiction. van der Kolk seems entirely enamored with outdated findings (that have since been shown to be incorrect) and therapies that have failed to be backed up by empirical support. Most concerning, he seems completely in denial about how easily false memories form and the damage they can do.
On a more positive note, he does a great job championing individuals who are often rejected by the field of psychiatry. Since false memories are real, and they have wreaked havoc on an already traumatized person's fragile life, many aspects that lead to remembering repressed memories have come under fire. This has served to invalidate the real and true experiences suffered by many people during their childhoods and beyond. Under particular scrutiny is dissociation, something that can be particularly difficult for survivors to deal with, is treated as if it doesn't exist. This is certainly a problem and I do not know how to find a middle ground between dissociation deniers and false memory/ personality creating therapists, but I would venture to say that van der Kolk's approach is not it. There has got to be a better way to validate the real, and sometimes repressed traumas while, at the same time, not creating new ones by promoting fictitious experiences that do not exist.
Additionally, there is a lot of study involving a person's perception that never made it into this book. I understand that, again, it is difficult to take on the effects of perception while simultaneously trying to validate what really happened to people. But, perception can really affect mental health and subsequent behavior. Not only that, there is a very real phenomenon in which excused behavior can cause the trauma sufferer to continue to delve out trauma to others. While van der Kolk mildly touched on this at times, he did not do so in any in depth of concrete manner.
This book could have been half as long and, if van der Kolk had stuck to only empirically sound findings and treatments, could have been a great book. Associating words with Harvard and MD doesn't make them true. It just makes people believe them more. Sometimes that is more harmful than helpful.
Despite the foregoing criticisms, this book, with its many chapters on various treatments, might help trauma sufferers seek a treatment that seems right for them.
A compassionate, intelligent, and transformative book about trauma. As an aspiring clinical psychologist and writer, I look up to Bessel van der Kolk a lot. In The Body Keeps the Score, he infuses empirical, innovative research with hands-on clinical experience to explain trauma in a clear, authentic way. I loved his emphasis on incorporating both biology and social relationships into our understanding of trauma, as awful events affect both the body as well as the actual life of a struggling individual. He clarifies many misconceptions by stressing how many victims of child abuse often go ignored when compared to war veterans, and he argues with much logic that we cannot just use drugs to treat Post-Traumatic Stress Disorder (PTSD) and other mental illnesses. We must treat the whole person.
Dr. van der Kolk steers this book in a hopeful direction by discussing many treatment strategies for PTSD. He includes descriptions and research studies to support a gamut of methodologies, ranging from Cognitive Behavioral Therapy (CBT) to Eye Movement Desensitization Therapy (EMDR) to Neurofeedback, and more. In particular I enjoyed reading about the Internal Family System approach (IFS), a mode of psychotherapy I had never heard of, which I found enlightening and holistic. Dr. van der Kolk emphasizes the importance of getting back in touch with our emotions and our bodies after trauma, and he gives many practical ways to do so, like talk therapy and yoga, just to name a few.
Dr. van der Kolk's genuine heart elevates this book above others. His vulnerability with his own story models a message for all of us to live by: only by confronting and accepting the past can we learn to live in the present. He writes about the importance of de-stigmatizing PTSD and mental illness, and he relates the issue of trauma to several societal factors, like the prolific amount of gun violence in the United States and the lack of socioemotional education given to our kids. Dr. van der Kolk, with great humility and insight, details his admiration for each of his clients - because they have overcome such devastating hardship, and they have had the courage to share their stories with him, and in some cases, others as well.
A stellar book I would recommend to anyone interested in trauma, mental health, or science in general. I noted so many well-written passages and cannot wait to reference this book in the future. I hope more people read The Body Keeps the Score - it would improve our society a lot.
As someone who suffers from chronic pain I’ve found it difficult to find resources about the connection between trauma + physical pain. This is because the mind-body connection are (I think intentionally) underdeveloped in Western medicine which so often rehearses the body outside of context.
Van der Kolk shows how trauma can shape every aspect of our psychology + physiology: making us attracted to dangerous/painful situations, affecting our perception of time + space, dispossessing us of the ability to describe our discomfort, causing chronic muscle pain, headaches, + autoimmune disorders. We live in a world that constantly underemphasizes the emotional trauma even though the same parts of the brain are impacted by emotional pain as by physical violence. Heartbreak, betrayal, neglect, depression physically hurt. This continual undervaluation of emotional stress means that it accumulates, depletes significant energy + attacks our most vulnerable organs.Van der Kolk describes chronic pain as when your brain gets trapped in a pre-programmed escape route, stuck in perpetual fear. For him, the goal is about how to develop coping strategies for trauma that don’t retraumatize us: reintegration, not repression. Healing is possible when we commit to this reintegration. Talk therapy isn’t enough: we can’t just describe the problem, we have to experience “immobilization without fear.”
As a doctor, his book has a clinical bent + outlines various strategies like EMDR + biofeedback which help break trauma cycles. I wish that there had been more discussion of people who have complex trauma where there is no “before” or “after” to the traumatic event. I’m thinking here about how racism + transphobia are continual forms of trauma that we can’t move out of. There was so much important info in the book, but I was kind of turned off by the clinical language where complex people became case studies and cultural rituals became Western mindfulness practices without appreciation for context.
As a survivor of abuse this book can be difficult to get through, so serious content warning.
Am I supposed to feel bad for Tom? I don't. He reports that he murdered a farmer, children, and raped a woman in a village in Vietnam to "cope" with the loss of his platoon. I don't understand why he was never criminally charged for this? Being traumatized doesn't give you free reign to do whatever you want. The author even seems to blow it off by saying something like, "I understand why this happened. Men have been getting revenge like this since Homer's time".
Now, Tom is actually parading around as a lawyer in the United States. I guess if you kill and rape in another country it gets forgiven? Are their lives worth less than American lives?
The author even brings up a certain case Tom got very excited about being involved in; finally "felt alive". He was defending a murderer, and he won. I'm not sure how the author missed the fact that in Tom's brain he was actually defending himself in a desperate attempt to justify his actions in Vietnam. I'm also not sure how the author seems to miss the fact that he seems to be empathizing with a very problematic, asshole, rapist, homicidal combat veteran in an attempt to become closer to his own father's memory.
Hardly a mention of Tom's wife, who is seemingly unawares that she is married to a man who committed these atrocities. There is not a serious consideration for the safety of her or their children, despite the fact that Tom is "prone to violent outbursts".
I'm quite upset over this portion of the book and the lack of empathy shown by the author towards Tom's victims. He even mentions Tom and his friend chasing around "Vietnamese bar girls" in a weird "boys will be boys" way, blatantly ignoring the trauma that led those women to that situation to begin with. Oh, and again the fact that Tom had a significant other at home during that "good fun".
This isn't worth my time to finish. It borders on misogyny and is very tone deaf. I'm actually pretty disgusted by it. People like Tom are the main cause of all of this bullshit in the first place.
This is a remarkable book. There are a lot of people I would recommend this book to, but it is about trauma and so the author discusses trauma and describes traumatic events – and the more I thought about who I might recommend it to, the less I felt able to. I’m not sure I really can ‘recommend’ you read this – but then, I might be more squeamish than other people are with books on these topics. And dear god, there are people out there who do the most awful things to one another.
In one of Steven Pinker’s books I read years ago – either the Blank Slate or How the Mind Works – he says that father-daughter incest is incredibly rare, in fact, virtually unheard of – like most things he says, he said this with utter conviction and, like most things he seems to say outside of linguistics, he was completely and even dangerously wrong.
Like I’ve said, a lot of this book makes for unbearable reading. That said, I would still encourage you to read it if you can bring yourself to. Now, I’m not saying that for the normal bullshit reason people say such things – you know, because it gives you an insight into the dark side of the human condition (if you want that, you could just turn on the news), or that it is so inspiring to see people overcome near infinite aversity (I guess it must be, but there are better ways to be inspired), but I would suggest reading it because I think our world is becoming an increasingly traumatic place. I’m certainly not saying that modern life is the same as being raped by your drunken father while you are still in primary school, but I do think that modern life presents us with a sense of powerlessness, of disassociation, of an overwhelming sense of loathing for what we are forced to do in our day-after-day jobs and that all this can be (no, actually, IS) a source of mental trauma to far too many of us. If the trauma discussed here often happens with a bang, I think the slow drip, drip, drip of horror of a lot of modern life can have much the same accumulative impact. Couple that with the abject precariousness with which we hold our jobs, even while they cripple our sense of self-worth, and really, you get one of those perfect storms people seem to like to talk about – you know, lots of bad things and all of them happening at the same time.
I am a very strong believer in the power of narrative – we are not just ‘pattern making creatures’ but rather we are ‘story making creatures’. All the same, this isn’t always a good thing. The story Hitler told of German humiliation after WWI, of the power of world Jewry to cripple the German nation out of spite, of the Jewish link to Bolshevisms, and this and so much more, left us with a decade drowned in blood. My belief in the power of stories has always made me fond of the psychological ‘talking cure’ – well, fond for other people, if not so much for myself. I’ve always believed that if we can find ways to ‘rewrite’ our stories we gain power over our life. This book makes it clear that in cases of real and deep trauma this isn’t always possible, in fact, it is counter-productive at best.
The author explains that when we experience deeply traumatic events our brains ‘cope’ by shutting down those parts of the brain that are not immediately necessary for us to come out the other end of the event alive. The part of the brain that gets shut down that is most interesting in relation to post-traumatic stress is the bit that locates the event in time. (That part of the brain has a name, I’m never interested enough to remember those names – the book gives you all those names and maybe even more). I guess the brain figures that all times are one time if you it isn’t clear you are going to live through an event. The problem is that this means that the event then isn’t really connected to any specific time – and so it can never be ‘over’ – it is ‘ever-present’. That is, any trigger that brings the event back to mind doesn’t just remind you of the event – it puts you back into the immediacy of the event. You don’t just ‘remember’ the event – you are back living it. And this is why talking cures don’t work so well with trauma – if memory is like groves implanted on our brain, reliving events in all of their immediacy over and over again, as if these events are constantly in the present, turns those groves into canyons.
A lot of post-modern theory is interested in how our bodies embody who we are. A case in point is gender – what it means to become male and female is highly dependent on the culture you are brought up in. In pre-revolutionary China certain women had their feet bound since this was considered the height of feminine beauty – but you don’t need to physically bound parts of people’s bodies to embody social attitudes within them. The wearing of high heels comes to mind, of course, but I’m also thinking of the ‘man spread’ people complain about on trains – and yet, you never hear the same complaint about women. And why? Because women are taught to make themselves small throughout their lives in our culture and this eventually becomes so embodied within their identity as to be unnoticed by them or anyone else – well, unless they break the rule, take up more space than is allocated to them, and then everyone notices.
A large part of the point of this book is to show how trauma marks our bodies in ways we may not notice as being related to the trauma and that these marks, these embodied scars, while designed to ‘protect’ us, can often have the effect of prolonging and accentuating the scars the trauma has left.
As such, a lot of this book, at least the bits that consider at how to overcome trauma, look much less at what drugs you should take to make the symptoms disappear, but rather what can you do physically to control the effects of your trauma. The author practices EMDR – Eye Movement Desensitisation and Reprocessing – which, is something my daughter has been doing, and something I would have dismissed a few years ago as nonsense. As I said above, the point of much of trauma therapy is to convince your brain that the traumatic event is now in the past. It is pretty difficult to rewrite your story if the story seems to be happening right now and you are about to die. So, finding a way to think about that story and to also feel safe is pretty important. The author suggests that EMDR is one of the ways to achieve that – well, and patience too. He also has an entire chapter on yoga. He stresses the importance of becoming aware of one’s own body, and not just in the sense of noticing when you are hyperventilating or your heart is jumping out of your chest – although, these are good things to notice too – but also where memories feel like they are stored in your body. You know, where it is uncomfortable to be touched or, in yoga, which positions make you feel vulnerable and why that might be.
He also talks about the power of writing – I really do believe in this, like I’ve said already, I believe in stories. I really think that most of us miss the point of writing, that it is a way for us to see what we think, quite literally, and that we do not use this power nearly often enough. But, again, this comes back to my belief in the power of narrative, and perhaps it is just me.
Like I said at the beginning – it is hard to know if I can recommend this book, but it is fascinating stuff.
And Benjamin Rogers – thanks for recommending this to me, I’m very grateful.
Gave up. The author's description of his (psychiatric, traumatized) women patients as "slender" and "gorgeous" is so annoying. (ETA: Especially considering that he is writing in the same breath about rape and incest survivors.)
I'm not a psychologist, psychiatrist, doctor, social worker or otherwise involved in treatment or research of mental conditions or disorders. What I am is a guy in his mid-twenties who experienced multiple instances of severe medical trauma as a child, in my case open-heart surgeries at the ages of three months, six years and eleven years.
I've spent the majority of my life (read: all of it) doing my best to repress and resist the terror, anger and sadness I felt as a result of having gone through these procedures. And I was able to get by, mostly, though my life always seemed to be a highly fragile construct, where I worked tirelessly to maintain control.
I lost control this year, or maybe part of myself decided it was time to let go of my controlling behaviors and coping mechanisms, which no longer serve to help me, but instead negatively affect the quality of my life. This was a very tough realization, and my default response was to beat up myself for behaving 'wrong' or otherwise being 'a failure' for the way I had been just trying to get by.
That's why this book has been so important for me, because I now realize that the way I've been living isn't bad or wrong--I've been trying to survive, to get to a place where I can truly feel safe, validated and connected to others. But my body doesn't know how to let down, to let go. Much as Dr. van der Kolk points out throughout this book, I'm stuck in these moments of past horror, faced with autonomic imbalances that keep me on the defensive 24/7. And I don't know how to stop.
This book has already proven to be a crucial resource, as it sheds light on much of what I've been struggling with my whole life, showing that there are people out there who really understand. Just as important, it shows me that there is help available. It took me over three months to read this book, because part of me hated that I could identify with so much of what the author describes when discussing the nature of trauma. Oftentimes it just made me profoundly sad. Some of the experiences shared within are also quite harrowing. Usually I couldn't get through a chapter without breaking down. But I kept coming back to it, because I knew it was within my power to help and educate myself.
Thank you, Dr. van der Kolk, for helping me take this step towards healing myself, past and present. I hope to look back on this period one day and recognize how much reading this book helped me to start down the path to recovery, presence of mind and body, and fully engaging with life.
This book was super okay. I think the title should be changed to, "PTSD for Treatment Professionals: An academic and anecdotal exploration of trauma treatments." So, that was not what I signed up for. I'll say, if you have PTSD, probably don't read this book because it has these very graphic descriptions of patient trauma experiences. I think therapists are the target audience for this book, and it provides an interesting overview of the treatment modalities available for PTSD and the research about them.
One thing I will say about all of the PTSD books I've read lately is that people HATE the DSM. I kind of get it, and I can see how it fucks everything up, especially with kids, but also I kind of think the rage should be turned more to the insurance industry than the DSM. Like the DSM seems more like a symptom of the overall problem where we are more into classifying people than helping them.
My other takeaway is that Bessel A. van der Kolk is super badass. He is one of the early researchers on PTSD, and he describes working in the old mental hospitals and seeing people sprayed down with hoses to clean them. So, that's an example of the type of story he tells that made this book a slow read for me. I will say, I listen to people's trauma stories all day long, but the stories he told in this book were really heavy to me. I had to take a lot of breaks.
In the chapter on EMDR, he talks about his EMDR training. He was in a group training class and was partnered with a person who did not want to talk about his trauma experience during the EMDR. (In EMDR, the way van der Kolk did it, you basically wave your fingers in front of someone's face as they re-experience a trauma memory, and the eye movements process the trauma memory into the regular stream of memory in the brain. It's super magic and also evidence-based.) Van der Kolk was mad that the person didn't want to talk and complained to the instructor. The instructor told him to question whether there was a voyeuristic element to why he became a therapist.
So, that seemed like an insightful perspective, and I thought it made sense with this book. A lot of the stories he told had a voyeuristic element to them in my view. I don't really feel critical about that, but I did not enjoy that aspect of the book.
I appreciated the overview of trauma treatments, though. So far, from everything I've read somatic experiencing and EMDR are the ones I'm most impressed with.
I got to page 13 after a Vietnam war vet disclosed horrific crimes he had committed with seemingly no author acknowledgement towards the victims and the individual seeming to never have to face any consequences for his actions (still a practicing lawyer??!??!) despite disclosing this.
Other commenters note this and add that there are many voyeuristic description of female victim survivors experiences
I am done with non fiction male narrators taking an "objective neutral stance" in situations like this
This book has received much praise and also disappointed many readers. I now understand why. If you plan to read this book, you need to understand it's two basic characteristics: 1) it's POP-SCIENCE and 2) it's TRAUMATIZING.
Let's tackle the first point. Pop-science is not science. People who write pop-science are rock stars with a degree. Most of them are administrators who spend most of their time on the lecture circuit, writing books, attending conferences, and managing a host of grant writers, practitioners, medical staff, public relations experts, middle managers, and financial officers. Their days of actually practicing their art has long gone, but they still will occasionally see the odd patient here and there to keep their feet wet, their privileges relevant, and to demonstrate their medical genius.
How do I know this? I've been practicing psychiatry for two decades and have worked with and met my share of famous pop-practitioners in my various roles as a medical provider, chief medical officer, State government policy-maker, public speaker, and chief executive officer. Dr. van der Kolk is one of those rockstars and thought leaders.
And it is thanks to people like him that we have a society that has been moving at all to trauma-informed care, and to understanding the neurology behind anxiety and disorders impacted by or caused by trauma. And it is thanks to books like this that the known science is explained in a way that is accessible to people who have not lived their whole lives speaking the lingo. This book was designed to turn on light bulbs, to inspire, and to reduce stigma. One of the greatest things I can ever do for a patient is to DEMYSTIFY their experience. When people realize that their experiences are not due to moral failings, or to being weak-willed, or because they are "crazy," when it all ceases to be magic and now they can define it and hold it in their hands, then they have a challenge with solutions rather than a stigma to hide from others and themselves.
But this then leads to the weaknesses of books like this. Pop-science has to balance rigorous academic standards with making a product that is easily understandable and sensational enough to sell to a wide audience. So the science will not all be fully explained or referenced. And what science there is may be flawed by the basic issue that there just aren't the same standards applied to a self-help book as to a scientific journal article. So Dr. van der Kolk can ramble on about how what a mensch he is, and tell sensational details about his experiences with patients, and take some liberties with the verifiability and consistency of his outcomes.
Therefore, do NOT think this is the book that will change your life with secrets no one but the chosen few have known till now. And do NOT read this book with the idea that you will be able to debunk scientifically everything the author is saying and prove he is a fraud. And do NOT read this book if you are easily triggered.
Regarding my later warning, know that this book goes into some explicit details regarding traumatic events. Some may hit a little too close to home. And this leads to my main criticism of van der Kolk's work--I don't think he takes into account enough the potential to RE-TRAUMATIZE.
I think an important take-away should be that your brain is designed to protect you from danger, and one of the ways it does this is by erring on the side of being hyper-alert. All humans are designed this way. If you were to hear a rustle in the bushes, it's best to assume it's a lion and not a rabbit. Because what if it is a rabbit? No harm is done if you run from a noise when it was only caused by a little bunny. But if you were to make the opposite error and assume the rustle is something harmless and it's really a hungry carnivore, well you may just get removed from the gene pool. So we are all primed this way. But what if at some point in your life everything proves to be a lion? And no matter what you know to do to avoid the danger, nothing works to protect you or someone next to you?
Now that is when your brain essentially short circuits the traumatic memory. Merciful to say the least. But your brain is also responsible for keeping you from getting hurt again. If you burn your hand on a hot stove, you will rightfully feel anxiety near a hot stove. This is protective. But with PTSD, now you have a situation where your anxiety isn't necessarily paired with a conscious cognition. Fear, panic, defensiveness, aggression, may seem to come out of nowhere.
So where this book fails to tread lightly is in the emphasis on verbalizing the traumatic event, the idea being that making those cognitive connections gives the traumatized person more control and the therapist more access to working through cognitive distortions that are no longer helpful in protecting the person. This overemphasis tends to lead to some gratuitous sharing by patients, which then gets gratuitously shared in this book, and then we get to vicariously read about these experiences.
And here's the clincher--the book didn't need to go there. People can and do get better without having to wallow in their story by telling it over and over again. Sometimes there is no way to even know if the story you get from this practice is accurate, because our minds naturally confabulate and fill in gaps of memory. This book should have discussed the danger of therapists accidentally contributing to false memories and retraumatizing someone. It should have focused more on grasping the here and now, no matter what the past story. In Chapter 6, he does mention the importance of physical self-awareness as essential for fully experiencing the present, and my own clinical experience finds this to be absolutely spot on. It is not avoidance. Accepting that something awful has happened and then helping that person develop more effective ways of interacting with a world that is, in fact, not completely filled with nothing but hot stoves and lions--that's what this book is ultimately all about. Therefore, all the patient anecdotes were unnecessary in my opinion.
So that is why I give this book a middling review. I do recommend it, but proceed with caution.
I won't give a rating to The Body Keeps the Score since I'm setting it aside with no intention of picking it back up. My expectation was that it would provide insightful tools to help deal with my own chronic neck and back pain, but it reads like a psychology textbook. As I fortunately have not suffered the severe PTSD-causing trauma of focus in the book, not much is applicable in that regard. Even viewing it from the lens of a psychology memoir, it didn't hold my interest. There I'd refer readers to the superb and superior Good Morning, Monster by Catherine Gildiner.
AND I really did not enjoy reading about the various trauma/abuse tests done on animals... including dogs!!!
Nearly finished. Couldn’t deal with his voyeuristic description of specific traumatic events. It came across as self-inflating. It’s almost as though it gave him pleasure to share how others confided their traumas to him. Not a great book if you’re easily triggered by descriptions of sexual abuse (sometimes unnecessary graphic).
A lot of women and non-binary folks read this book, so I want to say this:
This book was written by a white man who hurt women (and who knows who else) and is simply regurgitating the wisdom of Black women and women of color who have not only been through the trauma he speaks of, but who also have been saying these things and operating in trauma healing far before this yahoo put his stolen thoughts down.
Knowing the reason folks are most likely reading this book and how he made people feel violated in chauvinistic ways is more disturbing than the heavy contents itself.
UPDATE: in replacement, I HIGHLY SUGGEST “What My Bone’s Know” by Stephanie Foo, The Body Is Not and Apology by Sonya Renee Taylor plus the accompanying work book, and Who is Wellness For by Fariha Róisín (I also have a shelf that I am constantly adding books to in case you need more!)
Audiobook.... read by the author: Dr. Bessel van der Kolk.
Kolk is one of the world’s experts on trauma. He spent three decades working with survivors.
This book is packed filled with science, research, experience, and human stories that are phenomenally informative and intense!!!!
Kolk exposes how trauma physically affects changes in the brain and body causing anxiety, rage, depression, the inability to concentrate, problems remembering, flashbacks, trusting, and forming relationships.
He examines trauma caused by childhood neglect, abandonment, sexual or domestic abuse, and war.
....We learn lessons from Vietnam veterans. ....We get a better understanding how the brain works. How PTSD plays out. ....He explains the body-mind connections: losing your body: losing yourself. ....He takes us into the minds of children, and adults - showing how trauma develops over time -turning into PTSD.
We get a grand overview of the ‘historical development’ -academically & intimately - associated with understanding mental health science. I found this book literally fascinating, important, engaging, and helpful.
We get a wide glimpse of how doctors have been educated. (with real life examples of doctor/patient connections),
The stories were incredibly gripping and compelling..... integrating medical and psychological practices.... ....mixing traditional talk therapy, medications ( many different ones were explore of their effectiveness), new treatments, and alternative therapies such as mindfulness, meditation, breathing exercises, yoga, boxing, tai chi, walking, kick boxing, etc. were also explored.
Towards the end of the book Dr. Kolk outlines healing paths to recovery - letting go of the past and rewiring the brain. How to choose a doctor - etc.
I can’t express enough how informative and gripping/informative these real life stories exposes. And how sadly PTSD is passed on to our children.
Dr. Kolk shared with us patients trauma....( he’s an amazing advocate for finding solutions) > real healing treatments, beyond medications, ....and ongoing life healing. We see why it’s vital to get help!!! Old traumas get stuck in the brain - it takes gentle safe work to unlock them... in order to experience real joy in the present.
I came away with a ‘deeper’ and ‘expanded’ understanding of the body/mind connection in relationship to trauma.
I also came away with remarkable compassion/admiration - respect - and dignity for people who have dedicated their lives in the field of mental health... and for all those who suffer.
This is an extremely comprehensive book exploring PTSD...(havoc on the brain and body).
Highly recommended to educators, parents, and the rest of us! Paul & I both found this book exceptional! One of the most valuable Audiobooks I’ve ever bought!
This book is...okay. My problems with it: Way too long, van der Kolk is long-winded and draws attention to himself, his insights, his compassion, his associations with too much regularity. The book would be a third shorter without his ego included. Could be an academic text but not really. van der Kolk can't seem to make up his mind if he wants to provide us with the most up-to-date trauma research or a folksy case study journal. Made for tedious writing. He describes some rape and incest victims as "gorgeous". Gag me. Being a trauma victim does not excuse inflicting trauma on others. In the first PTSD case he describes (a Vietnam Vet whose unit was killed in a rice paddy), "Tom", he positions Tom as someone haunted by his friends' deaths. After the rice paddy incident, Tom goes out and kills a child, rapes a woman, you know war crimes, and what van der Kolk offers is, "maybe the worst of Tom's symptoms was that he felt emotionally numb." Well, no. That is not the worst of his symptoms. Well, maybe getting away with rape and murder is the worst of his symptoms. But van der Kolk continues to somehow excuse the traumatized by saying that they feel shame "about the way they behaved during a traumatic episode, whether it is objectively warranted or not." EXCUSE ME? Shame over the commission of atrocities is not objectively warranted???? They feel shame? Enough shame to present yourself to an International War Crimes Tribunal? Guess not. Again, gag me.
Having said all of that, it is, overall, a necessary and important subject highlighting how trauma alters us physiologically and that treatment has to include a re-mapping of the brain and body. That seems like a pretty straight-forward case to be made. Unfortunately, Bessel van der Kolk somehow seems to muddy the waters here. This book shows up as an over-wrought, an over-long, missed opportunity.
Disappointing. I so looked forward to this book from Goodreads. I found it to be disconnected and disorganized, covering so many different aspects of trauma that it dealt with none of them well. The disjunctive aspect of placing Vietnam vet PTSD along with survivors of childhood abuse was confusing. Language used was at times that of a professor, at times that of a thesis, and at others of a non professional. van der Kolk's debate with DSM V was also unnecessary to the book. A great deal of footnotes were listed, however in many areas footnotes were necessary to support statements and were not there. Case studies, neuropsychology experiments on rats are not valid supporting evidence of corresponding brain function in humans nor of the "curative " aspects of EMDR. I find it difficult to recommend this book to any particular "audience" or reader
This book took me more than a year to work through, and I’m glad I took my time with it. The sheer number of flags on these pages will tell you how meaningful this one was for me... as a rape and sexual abuse survivor who is still battling the long term effects of PTSD, this one hit home so hard.
It gave me hope, it helped me understand deeper levels to what I’ve lived/am living through, it taught me so much about how the body holds pain and past experiences, it broke my heart as I read of stories similar and different to mine, it reminded me again and again how important therapy and EMDR and psychiatry are for healing...
(also hear me say: I am a Christian who fully believes in the power of prayer, and I also see a psychiatrist and take a daily antidepressant and have additional anxiety meds for when triggers cause panic attacks, I see a Christian counselor every single week, I have gone through EMDR, I have trusted friends and loved ones supporting me daily, and ALL of these things are helpful tools in my arsenal as I work to heal and be healthy.)
This powerful book is not for the faint of heart, and it’s not really an easy read, but wow, I am so incredibly thankful for all of the research and wisdom and stories that went into this important and needed work.
I feel seen, heard, understood, known, and most beautifully, hopeful.
Dr. van der Kolk's study of trauma treatment is the most respected book lately published on the subject of post-traumatic stress disorder.
Following in the footsteps of Babette Rothschild and Peter Levine, van der Kolk takes as his focus the physical aspects of psychological injury - suggesting that work with the body is the clearest and most effective approach to healing. He is not a fan of the pharmacological. Drugs, while useful in tamping down the flood of fearsome emotional response, do little more than re-establish a basic level of functioning. In his view, medications cannot be considered treatment as they do not lead to a resolution of the condition. Over thirty years of research and clinical practice have led him to alternative methods of care that have shown to produce real results in the lives of those too often relegated to prescriptive numbing and symptom management.
After a bit of a muddled start (that will trigger the vulnerable reader), the doctor locates his footing and begins a guided tour through a series of body-based programs designed to address the fundamental conflict underlying PTSD. Those familiar with trauma are well aware of the sense of being caught in the maelstrom of a past catastrophe and unable to break free. The surreptitious assault of flashback, the tactile immediacy of phantom danger, and the brutal jolt into a fight/flight/freeze posture leaves the psyche in a constant state of high alert as energy levels drop to depletion. Dr. van der Kolk traces the body-brain connection and walks the injury through several alternative treatments - among them EMDR (eye movement desensitization and reprocessing), yoga, IFS (internal family systems therapy - which has nothing to do with families and everything to do with creating a whole of the many different internal parts of a person), psychomotor therapy, neurofeedback, and even theater work. These are the money chapters, and where a substantial amount of hope resides. Merely becoming familiar with the methods may, in fact, set some wheels to turn...and that is helpful.
Dr. van der Kolk is not a writer, but then few in this field throw their skills in a literary direction. What is important to them is what will help you. This book holds that aim as its sole preoccupation. And all I have to say about that is...bravo.
What fascinates me about trauma is what it does to you. It helps you survive whatever has tried to hurt you. It’s a survival instinct.
When you experience trauma your brain protects you, it literally creates a new personality on top of the one you were born with and transforms you. It increases your senses, it makes you more intelligent, but it changes your brain chemistry and that's the big problem. If your chemistry changes then you're not going to benefit in normal everyday situations because your flight, fight and freeze part of your brain is now on over drive, your hypothalamus is now stuck in hyper drive and your prefrontal cortex becomes neglected and undeveloped and in a contradicting to making you more intelligent now makes you less able to learn by constantly injecting stress hormones into your blood stream.
A lot is crammed into this book, over 30 years of research into trauma and I agree with the author, trauma is so important and so relevant in our society. Most people experience some form of trauma throughout their lives, but it seems the younger and more undeveloped you are the more profound the effect is later on in life. It literally passes down from generation to generation and we still don't discuss or treat trauma as a norm. If everyone was more knowledgeable about trauma and how it affects us then I think our medical advice and how we treat people would be far different from what it is today. I find it easy to notice when someone has experienced trauma. It affects their persona, but there are visual and acoustic clues as well. It helps to know if someone has trauma because you have to adapt to their reasoning and thinking which can often be off kilter.
This book is brilliant for psychologists and people who want to learn more about themselves and trauma. It has a diverse knowledge or different applications which are proven to work. Obviously CBT is the most common, but two more I find very interesting and fascinating for trauma treatment is EMDR and Yoga. Both I think are brilliant and I was aware of before the book, but this book shows just what impact it has on masses.
I genuinely feel like when it comes to psychology and nutritional sciences, the USA is years ahead of everyone else especially the UK. I really hope a lot of this work makes it over here sooner rather than later.
Knowing more about trauma means we can help heal our society, prevent abuse and even enrich ourselves.
The Body Keeps the Score is a non-fiction book about how the body stores trauma and what you can do about it.
My most distressing take-away from this book was how common trauma is. Author Bessel van der Kolk discusses how people from all walks of life suffer from trauma.
People suffering from these kinds of afflictions believe they're the only ones. They try to numb the pain with drugs or alcohol and are easily triggered which brings back the pain of the traumatic events again and again.
This affects their lives, relationships and ability to trust others.
Kolk details how traumatic memories can be triggered by smells, touch and taste. He explains how powerful emotions remain behind, even after the logical mind has processed the event.
He suggests you can't think your way out of strong emotions.
What do we do about this?
Form a strong community around yourself with supportive relationships. Practice mindfulness and yoga- exercises that explore the mind and body connection.
Also, find a therapist who practices eye movement desensitization and reprocessing (EMDR). The author records amazing recoveries by sufferers who utilized this therapy.
Personally, I've practiced EMDR with a therapist and the results were astounding. I left the session feeling lighter than I have in years, having released trauma I didn't realize I was carrying.
But, like others, I still struggle with powerful emotions stored in my body. It is a process, not a cure. And I've learned to take life one day at a time.
Highly recommended for readers looking for scientifically-proven ways to handle trauma.
This is one of the most important books I’ve ever read. Don’t let the word “trauma” keep you away from this one, we’ve all had emotional and physical pain that has affected our bodies more than we realize, and I took so much from reading about how these things could manifest over time.
Vernachlässigung schafft mentale karten, die von kindern und ihren erwachsenen verwendet werden, um zu überleben. Diese Karten verzerren ihre Sicht auf sich selbst und die Welt. Das Buch enthält spannende Geschichten: über Vietnam-Veteranen, die Kriegsgräueltaten begangen haben, Inzestüberlebende, gebrochene Erwachsene, Kinder terrorisiert oder zwischen Pflegeheimen umgeleitet wurden.
Herr Van der Kolk stützt sich auf Hunderte von Studien, um seine Behauptung zu untermauern, dass der Körper die Punktzahl hält“.Wir treffen eine Frau, die Erinnerung daran unterdrückt hatte, im Alter von 8 Jahren von ihrem Vater vergewaltigt worden zu sein, aber als sie einen neuen Partner ohne Grund heftig angriff, meldete sie sich für eine Therapie bei van der Kolk an. Bald darauf versagte ihr Sehvermögen: Eine Autoimmunerkrankung erodierte ihre Netzhaut.
"Die Frontallappen ermöglichen es uns zu planen und zu reflektieren ... Sie ermöglichen die Auswahl und liegen unserer erstaunlichen Kreativität zugrunde. Generationen von Frontallappen ... haben Kultur geschaffen ... haben uns aus ausgegrabenen Kanus, Pferdekutschen und Briefen geholt zu Düsenflugzeugen, Hybridautos und E-Mail." ---Bessel A. van der Kolk, MD
In einer studie stellte sein Team fest, dass weibliche Inzestüberlebende im Vergleich zu nicht traumatisierten Frauen Anomalien im Verhältnis der Immunzellen aufwiesen und sie Autoimmunerkrankungen aussetzten.In Bezug auf die behandlungen argumentiert van der Kolk, dass die „Integration“ des Traumas durch Umwandlung in ein schlechtes Gedächtnis, anstatt es in der Therapie erneut zu erleben, der Schlüssel zur Genesung von einem Trauma sein kann.
Und er kritisiert eher den Umgang mit Symptomen als mit Ursachen. Er hat beängstigende Statistiken: Eine halbe Million US-Kinder und Jugendliche nehmen Antipsychotika ein, während sich privat versicherte 2- bis 5-Jährige mit Antipsychotika zwischen 2000-2007 verdoppelt haben. Du kann gelesen un find das weg die leute haben viel stress und krankenheit von PTSD. Kaufen und gendanken dein problem drinnen, immer aus mit worden und bewegung hilfen. Aus ist immer besser mit bewegung.
This book mentions many important points about trauma and healing (specifically in kids/adults who experienced abuse during childhood), in passages I sometimes really liked, but I am unable to recommend this without critical reservations. For instance, one cannot help but notice the homogeneity of white male Eurocentrism reflected in source after outdated source. Are we really to laud an exploration of trauma, in a 440+ page work, that still manages to exclude almost all but one type of academic voice — that which looks and sounds like the author’s own? I’m not impressed.
More alarmingly for a title of this scope, van der Kolk repeatedly fails to address systemic issues of the overwhelmingly male-identified assailants who inflict violence and cause trauma to his patients, even when they come to him as the patient. In several examples of treatment that he himself administered and included in this book, the cloud of abusive patriarchal reproductions in his male AND female patients left undiscussed — and therefore normalized via complicity — unnerved me.
I caution fellow survivors of male abusers that the ways the author chooses to talk about some accounts can be extremely triggering/uncomfortable (eg, NOT talking about any relevant rehabilitation for male patients who raped and murdered women and children. Then going on to exclaim over the high percentage of people, predominately women, who experience debilitating trauma for the rest of their lives specifically due to sexual violence/childhood abuse — and leaving it at that). You get the sense that his professional/research capacity tops out at being a sympathetic buddy to war vets and a collector of traumatic stories from willing patients (in a later chapter, he openly admits his "voyeuristic" therapy tendency). I have no confidence in van der Kolk's ability or willingness to use his research to help prevent the epidemics of violence that cause the trauma he studies. These are just a few of my qualms.
Bessel seems like the problematic archetype of “a good man.” I appreciate his 30+ years of advocacy within the trauma counseling and research community; he has championed trauma-informed care for PTSD patients and established multiple trauma research foundations. His legacy is certain — and that makes the narrowness of his vision all the more disappointing.
If you read this book, consider being additionally mindful of the ways it cannot adequately (or at all) serve the traumas carried by Black, brown and Indigenous bodies, let alone trans bodies and bodies physically disabled due to their trauma. This book may inform you, but I doubt it will impress you.
I thought this book was interesting (though sometimes repetitive) and was fascinated to learn about bodily manifestations of trauma. Though some things I am less convinced of (some of the methods seemed questionable/pseudoscientific/new agey), other methods seemed to be paths worth exploring. Hopefully trauma research will head in a positive direction.
However, I have to give my political theorist's critique which is that sometimes, van der Kolk rightly notes the political connotations what he is talking about has (e.g. the school to prison pipeline). Other times, however, he doesn't. In discussing US soldiers in Vietnam and Iraq, the acknowledgment of a very political element here is left out. That is, it takes place within an imperialist american imaginary where Americans are always victims of a foreign enemy or territory, even when they are the ones perpetuating terror. Not that a medical book is *required* to do otherwise, but it's always disappointing to me when discussions of war-induced trauma centre the aggressors. Reminds me of that comedian who said "Not only will America come to your country and kill all your people: but they will come back and make a movie about how killing your people made them feel sad." Because lots of the praise for this book involves van der Kolk's "sympathy" and "compassion", I just felt like I had to nitpick that part. Medicine and cultural commentary surrounding it is never divorced from the political!