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.

In this blog, we will review a book by Bessel van der Kolk, a (Dutch-born) psychiatrist, researcher and author of the book, among others, ‘The Body Keeps the Score’. Since having been published in 2014, the book has become a best-seller and is one of the most prominent books about the effects of trauma on the biopsychosocial level, both for the person and for the society as a whole. He is also the founder of the National Child Traumatic Stress Network (NCTSN), which is a network of organisations and professionals in many different sectors of society that specialise in treating traumatised children and their families all over the US.
Although the introduction of his book feels like a curriculum vitae, it is very relevant to understand Van der Kolk’s work and the way he chose to present his ideas and arguments. He uses many real-life examples (fully anonymously of course to protect the identities of the families). He advocates multidisciplinary cooperation within communities, the same way he works with different professionals from around the world and at the NCTSN.
Per part of the book, we will give an overview of the main aspects dealt with.

Part 1
Part 1 is an account of how Bessel van der Kolk started researching traumas and it is almost an account of how the field of trauma studies and trauma research evolved to what it is today. He started his career working with Vietnam war veterans who experienced symptoms of PTSD. However, in the 1970s in America, PTSD was not yet an official diagnosis. Van der Kolk observed many veterans walking into the clinic with complaints about nightmares, panic attacks, rage, aggression, urge to drink or use substances and finding little support because of the lack of resources. As a way to offer them a form of support, he organised an informal group meeting where the veterans who felt unable to talk about their experiences (because of numbing or loss of words) started to share their stories within this social group. People felt supported, came back for a next session and continued coming to the meeting for weeks.
In 1980, he started working with another group of patients: child abuse survivors. He noticed that this area of study was just as understudied as the PTSD in veterans, and that there were similarities with regard to the symptoms that the war veterans were exhibiting. In the 1990s, brain-imaging technology helped scientists to see the effects of trauma in the brain and brought about a new understanding of trauma. Van der Kolk describes this as:
“Trauma results in a fundamental reorganization of the way mind and brain manage perceptions. It changes not only how we think and what we think about, but also our very capacity to think. We have discovered that helping victims of trauma find the words to describe what has happened to them is profoundly meaningful, but usually it is not enough. The act of telling the story doesn’t necessarily alter the automatic physical and hormonal responses of bodies that remain hypervigilant, prepared to be assaulted or violated at any time. For real change to take place, the body needs to learn that the danger has passed and to live in the reality of the present.” 

Part 2
Part 2 delves even deeper into neuroscience and the ways the brain and the body respond to toxic stress and trauma and how people do or do not make sense of their traumatic experiences. Two pictures and their accompanying stories are showing this quite strikingly, as explained below.

First, little Noam witnessed the World Trade Center attack on 9/11. He witnessed the first airplane crushing on the Twin Towers and the people falling to their death. The following day he made this drawing of what he had witnessed; in his drawing, however, the people weren’t falling to their death but on a trampoline (the black circle just to the right of the door). Van der Kolk explains that Noah was growing up in a loving family; his caregivers were calm and responsive. Probably, while the initial event created a flight response in Noam, in the safety and security of his home, he was able to make sense of the whole incident he had witnessed.

Second, Stan and Ute, a couple, had a horrible accident in 1999. Three months later, they were both suffering from flashbacks; they were tense, hypersensitive and irritable. They asked Van der Kolk’s team to have a brain scan. Stan’s brain showed that he was reliving the trauma over and over again, causing him to sweat, tremble and feel his heart racing. Ute’s scan was different; it showed that she froze everytime she was reminded of the event, which led Van der Kolk to believe that this came from some unresolved previous trauma that had conditioned her to dissociate.
Van der Kolk explains that traumatised people’s brains have a difficult time processing internal and external stimuli and tend to interpret some signals as threatening although the danger has already passed.

In order to point out the connection between mind and body, Van der Kolk mentions two famous scientists: Charles Darwin and, our contemporary, Stephen Porges.
Darwin documented the responses many animals have in the face of threat and he observed that when an organism is stuck in survival mode, they have no room for nurture or love. He explains this beautifully in this quote:
“If an organism is stuck in survival mode, its energies are focused on fighting off unseen enemies, which leaves no room for nurture, care, and love. For us humans, it means that as long as the mind is defending itself against invisible assaults, our closest bonds are threatened, along with our ability to imagine, plan, play, learn, and pay attention to other people’s needs.”
He then goes on to outline Stephen Porges’ polyvagal theory, as a theory that unifies the body with the mind and that can explain the body’s response to toxic stress and trauma.

Part 3
In Part 3, Van der Kolk closely examines early life experiences and the importance for children to form secure attachments with caregivers. If they do not succeed in doing so, a form of insecure attachment may develop. Generally, three types of insecure attachment are distinguished:

• avoidant attachment: when parents/caregivers are largely emotionally unavailable or unresponsive most of the time and the child feels emotionally distant and distrusting;
• anxious attachment: when the parents/caregivers are overconcerned, inconsistent, or unpredictable and the child can have strong mood swings;
• disorganized attachment: when parents/caregivers are a source of both comfort and fear and the child has a lack of confidence in self and others and feels very confused.

In the rest of Part 3, Van der Kolk discusses the Diagnostic and Statistical Manual of Mental Disorders (DSM) used to diagnose disorders by mental health professionals. He points out the problems with giving people a diagnosis of trauma (sometimes resulting in PTSD), without paying attention to the root causes of their health issues. He also mentions the slow progress the medical community has been making in recognising issues as a sign or symptom of trauma and then translating them into trauma-related diagnoses. He also discusses the results of the ACEs studies and how these are proof of a larger, hidden epidemic of developmental trauma, which, despite its prevalence, remains unclassified as a health risk, and has no formal treatments.

Next week, we will look at Part 4 and 5 and provide a short analysis of the book as a whole.

Today, we share with you a children’s story, written in a beautiful book, which turns out to be much more than that.

‘The Little Iceberg’ is connected baby’s first children’s book, carefully written by Nicky Murray and stunningly illustrated by Sylvia Lynch. Since it has come out, the book has seen unexpected success within the UK and other English-speaking countries, and has been picked up by parents, professionals and schools alike.

Nicky has been a primary and head teacher in Scotland for many years. During his teaching experience, he was struck by the amount of stress and fear that children often carry, and which adults often overlook. He decided to write this story as one way to help in regaining that lost connection for children who experienced various forms of emotional trauma. Sylvia is a lifetime artist who won the competition for illustrating the book, and we absolutely love the visual world she created, embedding the story in our imaginations so vividly.

‘The Little Iceberg’ is a powerful and creative story of an iceberg and a little bird set in the middle of the Arctic ocean.

• The floating iceberg is a metaphor for a lonely and scared child, disconnected from the (social) world it belongs to, building a protective layer of thick ice to cope with the cold and hostile surroundings, and carrying a much larger burden underneath the visible surface. No one pays attention to the iceberg as it is just one of so many others, and everyone is scared of hitting its sharp edges and thick coat of coldness, although everyone maintaining so much distance is the last thing the iceberg wants.
• The bird is a snow bunting, characteristic of the Arctic pole by relentlessly perching on ice shelves and burrowing itself in deep snow to stay warm, communicating through the most beautiful tunes. It represents the one who reaches out, who is not scared of being rejected, who finds the courage to show fierce compassion day after day, who eventually shows the iceberg that the world is not such a lonely place, that connecting to others helps in sharing the burden, that opening up and healing are possible, that freedom and happiness are also part of this world. We do not learn about her name, nor does the iceberg, for it does not matter who the bird is; it could be anyone – true kindness knows no demographics.
• The Arctic sets the scene in a natural world of distant and unfamiliar land of ice, of an endless, deep and cold ocean, of storms and winds, representing the harsh and hostile world that trauma-loaded children who dissociated from their social world experience on a daily basis.

Importantly, the book comes with a companion guide written by the author, Nicky Murray, and our dear friend dr. Suzanne Zeedyk, entitled ‘Making sense of trauma’. Besides explaining the scene of the story, the guide takes the reader by the hand in understanding the themes that are implied in the story, how to make the best of it in recognizing the clues and reaching out to children, how to help them cope with stress, loss and loneliness, and how to use this story as a story of healing. All the themes implied in the story (such as loneliness, horizon scanning, sensory experiences, emotional storms, breathing, trust and hope) are elaborated in the companion guide and adults are provided with small action steps that can help children in coping with trauma.

This call and motivation to learn how to listen more closely to our little ones that ‘The Little Iceberg’ puts forward is embedded in a problematic context of what we have coined as ‘adult supremacy’, a power position in which adult interests consciously or unconsciously trump child wellbeing. As adults, we are constantly making decisions for our children. This is, of course, often inevitable in raising children and guiding them in their development. Is it possible, however, that, inadvertently, we take too much advantage of this power position we have? Is it possible that we often find it truly difficult to observe and listen to what they are trying to tell us? Is it possible that they are capable of clearly knowing their needs and understanding themselves much sooner than we think as a society? Is it possible that, regularly, we are not taking them seriously when we should, underestimate them when we shouldn’t? The scientific evidence points to a complex process of interdependency between the child and the adult, where children know how to listen to us and do so extensively, and it is us who are still learning how to listen to them.

By taking our children more seriously when they are trying to tell us something or when we feel that they are hiding something, we all stand a lot to gain. By finding a way to empathically reach out to our children and to learn what is going on in their lives, we can show our love for them and make them feel safe and secure, valued and connected. By gently addressing their sadness, we validate the often impressive experience of loss. This moving story underlines once more the value of quiet presence and active listening, of knowing what to look for and how to react. A genuine interest and non-judgemental understanding of our children’s emotional life, expressed through compassion and kindness, will go a long way to make them aware of how precious they are as a human being and to support their self-confidence. This story paves a way of how to do just that.

In short, it is a book about supporting society to understand and respond to difficult emotions, about teaching children to understand their feelings and reach out to others, about helping adults recognize behavioral signs of emotional disturbances and trauma in children either as parents or as teachers, about showing a way to rebuild lost connection through compassion and kindness. We really think that this book is for everyone, for every child, parent, teacher, professional out there. Therefore, we have made it part of our mission to translate the book and bring it to the Netherlands, share it in schools, in nursery homes, in general practitioner centers, all across the relevant fields. We will keep you posted on that process.

Here is the link to more information and purchasing of ‘The Little Iceberg’.

Here are two examples of users reviewing the book:  

“What a lovely book! Illustrations are beautiful. Wonderful way of helping children through a traumatic experience and particularly loss, helping them to understand that people who care for them are there to help them through it and how they can do this. Helping them to open themselves up to receiving help. Beautifully written and produced.” 

“Thank you for this book! It spoke to me as a person who lost someone close to me without a goodbye, and also as a practitioner and a book lover. I think it will be a very valuable tool when supporting families and the children that I teach. Simply beautiful.”

In her latest book, ‘Sabre Tooth Tigers & Teddy Bears: The connected baby guide to attachment’, dr. Suzanne Zeedyk shares the science of connection and universal importance of early life in a remarkably sober and humane voice. First published in Great Britain in 2013 and seeing the second edition in 2020, the 80 pages represent a concise and compassionate tour de force that literally everyone ought to get their hands on.

After working for nearly 20 years as a developmental psychologist at the University of Dundee in UK, dr. Zeedyk stepped away from her academic path in 2011 to share the importance of attachment, relationships, and love from the first moments of life with the larger public. Ever since, she has been collaborating with national and international partners towards raising awareness and engagement around the science of connection and has co-organized one of the biggest series of public events on the topic, in Scotland.

In familiar and playful language, the book describes human attachment – ‘the process through which relationships shape our biology’ by giving an overview of the evolutionary, neurobiological, and psychosocial perspectives at work that make attachment an absolutely vital component of every life. Through scientific evidence, Suzanne showcases that our interactions and relationships are literally crafting the anatomy and physiology of our brains from conception until death, and especially so in the first years of life. This crafting, on a platform of genetic background and environmental factors, will dictate how we develop and function using a fine-tuned balance of hormones and neurotransmitters (those little chemicals that keep our bodies and brains in balance). When the connection is not developed or lost and attachment becomes disturbed, when a child learns that the world is not a safe and warm space where emotional states are understood and responded to, this balance and the healthy development that comes with it are in danger.

The metaphor of a ‘sabre tooth tiger’ is brought forward to make the ‘childish’ and ‘unreasonable’ fear perceived by the baby when left alone more vivid and relatable to us, adults. When we understand that, way back in time, being abandoned meant being vulnerable and under threat of survival for a child, we begin to understand the meaning behind the crying for help and the importance of giving our baby a hug when we return after having left. At the same time, the notion of a ‘teddy bear’ is used to represent the concept of resilience, a feeling of internal comfort and safety that every child needs and deserves. When we understand that resilience only becomes embodied with enough repetition of happy, non-judgmental experiences in relationships with trusted others, we begin to understand that being there not only physically, but also emotionally, matters more than we could ever imagine.

Through the concept of Adverse Childhood Experiences, or ACEs, professionals and scientists have begun to understand the unprecedented importance of early life experiences on later life. Communities around the world have started to share and apply the science around ACEs. When the lack or loss of connection mentioned earlier is left unattended for long enough, it can turn into trauma. When trauma is left unattended for long enough, it can turn into a lifelong series of health problems and risky behavioral patterns. Besides sharing this evidence, Suzanne witfully shares real stories of real people whose lives have been changed by these insights. These stories, from the personal change of parents and survivors, to the professional change of teachers, nursery owners, lawyers, and policemen, speak louder than any scientific article.

If there is one tip to take away from this book and use at all times, it would be that the laughter flowing from positive and secure relationships has the power to build resilience, or as Suzanne puts it: ‘Sabre Tooth tigers are scared off by the sound of giggling’!