The Body Keeps the Score, Bessel van der Kolk. Penguin Books (ISBN: 9780143127741) 2015.

Summary: An account of the growing understanding of the effects of trauma on the brain and the body and promising treatments.

Since its initial publication in 2014, The Body Keeps the Score has prompted a widespread conversation about the effects of trauma on the brain and body. Particularly, in recent years the focus on #MeToo and on race-based trauma have extended the conversation.

For Bessel van der Kolk, his awareness of trauma began with some of the Vietnam war veterans he was seeing. They suffered from nightmares, waking flashbacks, hair-trigger anger responses, alcoholism, depression and suicidal ideation. They also often felt detached from their lives. This book traces the growing understanding of the effects of trauma that didn’t fit existing clinical diagnoses or treatments. Often, efforts to treat symptoms brought little relief.

This book chronicles the learning journey of van der Kolk and other clinicians to understand trauma. A key to all of this was the growing field of neuroscience. They found that the brains of the traumatized were not like others. Either they were in an amygdala-triggered hyper-vigilant state that bypassed the pre-frontal cortex, or they were shut down. Not only this, effects of trauma were also evident in the body from auto-immune issues, headaches, and a number of other somatic complaints. They discovered genes that turned on under stress. Hence the book’s title: the body does keep score.

While his work began with soldiers, van der Kolk began to realize the ongoing marks on mind and body of childhood traumas. These include physical and sexual as well as emotionally abusive situations. They learned to take trauma histories. But they also learned that people were not always consciously aware, or could only remember bits and pieces. And these memories were not integrated parts of one’s life story.

The final part of the book describes a variety of therapeutic approaches. In one sense, trauma cannot be undone. But people can learn to manage the feelings, the triggers that bring up the past. They can learn to be present to others. And they can stop keeping secrets from the self. The author describes the use of neurofeedback, mindfulness, and cognitive behavioral therapy. He devotes a chapter to finding the language to name one’s experience. Eye movement desensitization and reprocessing (EMDR) is another approach he describes in processing trauma. Because mind and body often detach in trauma, he also addresses approaches like yoga, theater, choral singing and others that re-establish that connection, often in the context of community.

The book combines explanation of neuroscience and physiology with case studies. Another aspect of the book is how the author describes his own learning journey. He considers patients his first teachers. But he also learns from other clinical approaches and allows himself to be the subject of those approaches, sharing how he changes through them. While not ruling out using medications, he prefers other approaches. This makes sense if the goal is for a person to be able to integrate traumatic memories, self-manage, and be present.

Two things I wonder about. One is the “grabbag” of therapeutic approaches. It seems important over time to develop standards of care, identifying the most effective therapies where possible. It also seems like we are in a pendulum swing from not recognizing trauma to possibly applying the label overly freely. I hear people describing listening to the news as traumatizing. Distressing, yes. But traumatizing? It doesn’t seem to be the same thing as childhood sexual abuse or rape. I wonder if clinicians will develop greater precision in what is labelled as and treated as trauma.

Still, I found this a fascinating book and can understand its path-breaking nature. Van der Kolk describes his own journey to understanding trauma’s effects on brain and body when there wasn’t a category for this. And he offers hope that, while we can’t undo trauma, what we’ve learned about neuroscience and therapy can help people get their lives back and understand and not just react to trauma. There is hope.