Bessel van der Kolk is a trauma specialist. He began his medical career in 1978 treating Vietnam vets. These soldiers suffered from nightmares and flashbacks, fits of rage, substance abuse, and emotional shutdown. Their condition lasted for years, in some cases, decades. Some would eventually commit suicide. The American medical profession will not recognize the term post-traumatic stress disorder or PTSD until 1980.
Today, we know that PTSD afflicts more than combat veterans. Van der Kolk cites some horrifying statistics in his prologue to The Body Keeps the Score.
Research by the [US] Centers for Disease Control and Prevention has shown that one in five Americans was sexually molested as a child; one in four was beaten by a parent to the point of a mark being left on their body; and one in three couples engage in physical violence. A quarter of us grew up with alcoholic relatives, and one out of eight witnessed their mother being beaten or hit.Bessel van der Kolk, The Body Keeps the Score: Mind, brain and body in the transformation of trauma (Penguin 2014)
For a book published in 2014, Van der Kolk has managed an astonishing run. His book entered The New York Times bestseller list soon after publication and has stayed there ever since. As of the date of this review, The Body Keeps the Score is at #5. So what keeps this book top of mind?
Van der Kolk offers an unorthodox approach to PTSD. Adherents call it revolutionary; detractors call Van der Kolk nuts. His central premise is that trauma affects both mind and body. A veteran of the wars in Vietnam or Iraq or Afghanistan is on constant alert for incoming fire. A battered child is ever vigilant for the warnings of the next beating. For sufferers of PTSD,
Fight/flight/freeze signals continue after the danger is over, and … do not return to normal. Instead, the continued secretion of stress hormones is expressed as agitation and panic and, in the long term, wreaks havoc with their health.
The standard treatment in the US for PTSD is psychotherapy and/or medication. Psychotherapy, also known as “talk therapy”, focuses on exposure therapy and cognitive reconstruction therapy. Similar to systematic desensitization, talk therapy presumes that having the patient revisit their trauma will eventually help them understand it. Van der Kolk disagrees. A trauma patient cannot remember their trauma; they can only relive it.
Van der Kolk believes that medication renders the patient more tractable for caregivers and loved ones. It may alleviate certain symptoms. It does not address the underlying ailment.
Talk therapy and pharmaceuticals ignore the role of the body. Trauma over-excites certain parts of the brain and suppresses others. The reptilian brain, in charge of security, takes over. The limbic brain, where the executive function resides, goes to sleep.
Yoga, dance, and theater are some of the therapies Van der Kolk applies to address the mind-body connection. Yoga and meditation use breath as a means to calm the mind. Dance can help a patient feel safe inside their own body, something that many victims of physical or sexual abuse have lost. Van der Kolk believes that the ancient Greeks used theater as a form of ritual reintegration of their combat veterans.
The playwright, David Mamet, created Sketches of War at the instigation of homeless veterans. Al Pacino, Donald Sutherland, Michael J. Fox, and others appeared alongside these veterans in its first stage production.
Standing on a stage with professional actors, speaking about their memories of the war, and reading their poetry was clearly a more transformative experience than any therapy could have offered them.
Not every therapy will work with every patient. Van der Kolk writes movingly of his patient Annie who had suffered horrible abuse from both her parents.
One of the hardest positions for Annie to tolerate was one that’s often called Happy Baby, in which you lie on your back with your knees deeply bent and the soles of your feet pointing to the ceiling, while holding your toes with your hands. This rotates the pelvis into a wide-open position. It’s easy to understand why this would make a rape victim feel extremely vulnerable.
My Sensitivity Reader
I came to Van der Kolk’s book with an ulterior motive. In my novel-in-progress, two of my characters suffer from PTSD. Jin is the victim of an attack by her husband, Kang. Li witnesses the attack. I needed to know whether my representation of their reactions was accurate.
A sensitivity reader was my first thought. Someone who could tell me from their own personal experience whether I’m on the right track. But it also seemed like a grossly insensitive thing to ask for exactly the same reasons that talk therapy does not work. I could be triggering someone into reliving their trauma, merely for the sake of a little novelistic accuracy.
Van der Kolk is the next best thing. Through his case studies and his empathetic account of his patients’ journeys, I’ve come to understand a little more about PTSD. Compare the adult traumatized by a natural disaster to a battered child. The former can, with the aid of a sensitive therapist, reach back to happier times to bolster their journey to recovery. The traumatized child literally cannot know any better.
I’ve dogeared my copy of The Body Keeps Count and littered the margins with notes. What is the physical expression of their present-day reactions? What would it cost to evolve in the future? My synapses fire as I take in Van der Kolk’s words. Here’s one example:
Somehow the very event that caused them so much pain had also become their sole source of meaning. They felt fully alive only when they were revisiting their traumatic past.
28 May 2022 | Karen Kao