Book Review of ‘The Body Keeps the Score’ by Bessel van der Kolk, Part 2

Last week, we dealt with Parts 1, 2, and 3 of the book ‘The Body Keeps the Score’. In these parts of the book, Van der Kolk discusses how science started including trauma in medical diagnoses, how neuroimaging allowed us to see the effects of trauma on the nervous system, and the impact of trauma and attachment styles on the way we develop into adulthood.
This week we will dive in deeper on memory formation after exposure to adversity or trauma  and ways of healing from trauma, especially in relation to Van der Kolk’s subtitle of the book: ‘Mind, Brain and Body in the Transformation of Trauma’.

Part 4
Part 4 is all about remembering the trauma. Here, Van der Kolk provides a detailed illustration of how society perceived narrative versus traumatic memory from the 19th century onwards. He explains the difference between the two forms of memory. On the one hand, people might be telling about the traumatic events they went through (which can be hard, but also allows for reshaping what happened depending on who is listening). On the other hand, people might be reliving the traumatic event (repeatedly and while feeling trapped in that moment or situation). In the traumatic memory, people might dissociate (understood as a process of mentally escaping or detaching from an experience or a memory), or form a second self (understood as losing the connection with your authentic self). In essence, the difference between the two is that the narrative memory gives one a sense of control over the story’s unfolding, whereas the traumatic memory focuses on the embodiment aspects of the experience.
Together with the analysis of these concepts, the author touches upon the problem of misdiagnosis, using as an example the diagnosis for ‘hysteria’ in women during the 19th century. These women were, in hindsight, clearly suffering from trauma-related disorders. He repeatedly mentions the theme of the reluctance of society at large to talk about trauma, and more importantly, to listen to the survivors.

These two topics, memory (narrative and traumatic) and society’s reluctance to talk about trauma, are interconnected. On the one hand, victims strive to forget trauma, because it’s too painful to realise that other people can be so violent or inhumane as to inflict trauma, or that the world can be so chaotic, scary, and cruel. It can make you doubt the foundation under your existence or it could make you create multiple selves or realities in order to cope with this loss of security and Sense of Coherence (SoC). On the other hand, society at large prefers to view trauma as being the exception and the rest of the world being safe and orderly, because acknowledging the trauma is somehow proof of sociocultural practices being problematic. It can mean that something in the status quo has to change, which is uncomfortable, because systems tend to strive for continuity and stability, not so much for change. Both keep one another captured: the individual has a hard time telling their story because society has difficulty hearing it, and society has a hard time acknowledging the trauma because the system has difficulty adjusting to a new approach or a new paradigm altogether. To the end of this part, we find this quote that both summarises how these two are connected and how we can move on to healing, which is dealt with in Part 5 of the book.

“Nobody wants to remember trauma. In that regard society is no different from the victims themselves. We all want to live in a world that is safe, manageable, and predictable, and victims remind us that this is not always the case. In order to understand trauma, we have to overcome our natural reluctance to confront that reality and cultivate the courage to listen to the testimonies of survivors.”

Rembrandt van Rijn: Christ healing the sick. Gestures of comfort are universally recognisable and reflect the healing power of attuned touch.

Part 5
This is one of the most powerful and optimistic parts of the book. In these last eight chapters, Bessel van der Kolk shares decades of research and his experience in working with professionals from all over the world in research settings, community centers and school environments. He describes the mindset shifts, the strategies and the methods he has found useful in treating trauma. He acknowledges the fact that your body, your mind, and your soul store the sensations you experienced during certain events. That means that the past cannot simply be erased, because there is an embodied memory of what happened. That, however, does not mean that no progress in healing can be made; you really can reduce the sense of fear, alertness or fog in order to not constantly remind you of the trauma or make you dissociate. He discusses a few goals one can set on the journey to healing, such as using calming practices and learning to be present in the here and now. Loving, secure, and attuned touch can play an important role in this process, as it helps co-regulate each other’s nervous systems.

The chapters in Part 5 are full of ideas for a person to face or help face their trauma, help express it in words, integrate their body in all the mental work they might be doing to resolve the trauma, and ultimately to rise stronger and more resilient.

Bessel van der Kolk

More detailed analysis
One of the biggest strengths of this book is that it manages to describe the path to healing without sounding cheesy or being full of cliches. Bessel van der Kolk’s writing is full of compassion, yet fresh with insights from his research and experience, that are brought to life by the real-life stories and speech fragments from his patients. This makes the material relatable, shocking at the layers of trauma a person can face; it is both humbling and empowering.
Another strength surfaces in Chapter 17 where Van der Kolk explains that the mind is the sum of the experiences and sensations the person feels. If one wants to heal their trauma, or help other people heal theirs, one has to be able to see the mind as a puzzle, with many layers of complex trauma. He has a fascinating story of Jane, who would have uncontrolled temper tantrums and feel guilty for her affairs with other people. Page after page after page, he documents their sessions using internal family systems therapy (IFS). By doing so, there are two things that we feel are perfectly illustrated. One, he shows how healing needs to happen in the context of a system and not just in people on their own (which would be a reductionist approach); and two, he indicates the complex face of trauma which involves shame and guilt, criticism and self doubt. This goes against the often still held perception that trauma is a one-time event leading to a single, defined personal issue that needs to be solved by the person alone, a sort of ‘you have to deal with it’ narrative. It is not always known how pervasive the effects of trauma are on the person as a whole, on behaviours and practices, on worldviews and social functioning. Such a multifaceted issue therefore requires  a multidisciplinary and open-minded attitude.

To sum it all up, The Body Keeps the Score is one of the most influential books in trauma studies and psychology, and rightly so. Van der Kolk explains the neuroendocrinology of trauma from different perspectives and the effects of trauma not only on the individual, but on society as a whole. He takes a critical view of the research and common medical practices and sheds light on the misdiagnosis or the lack of trauma diagnosis that exists (to this day) in different aspects of trauma. In line with discussing the role of society in trauma, he provides strategies and therapies to prevent and to heal trauma when and if it happens.
What he makes a plea for is really something we see advocated by many experts on the topic: for humans, being wired for connection, secure relationships with others are key in order to come to a healing process. It takes courage and compassionate curiosity on the side of both the one who lived through the experience and the one who creates holding space to truly heal as a community. This book greatly contributes to that goal.

Posted in Boek- en filmbesprekingen.