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The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma - Part 3, The Minds of Children – Chapter 9 Summary & Analysis

The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma by Bessel van der Kolk M.D.

“What’s Love Got to Do with It?” begins with a quote outlining the many reasons a sexually abused child might stay silent. Author van der Kolk then prologues the chapter with consideration of how trauma sufferers tend to be treated by the medical profession, often going through a series of different diagnoses before a treatment professional arrives at the idea of trauma at the root of everything. He also refers to the number of medications that are often prescribed during that process, and how the development of a manual of psychiatric disorders (developed by the American Psychiatric Association) became foundational for the consideration and treatment for such disorders – even though, as the author says, the Association warned against doing so. This, he adds, also relates to issues like access to medical insurance which, he says, tends to need...

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Book Summary The Body Keeps the Score , by Bessel van der Kolk

Trauma can stem from abuse to a severe car accident to wartime combat—and cause a lifetime of flashbacks, nightmares, isolation, insomnia, hypervigilance, and rage. In The Body Keeps the Score, the author explores how diagnosing and treating trauma has evolved as new technologies, research, and fields of science emerged.

Trauma’s impact is not only mental, emotional, and neurological, but also physiological: Trauma rewires the brain to put people in a constant state of stress or numbness, leading to a host of physical problems.

In this summary, you’ll learn:

  • Why trauma survivors feel like their trauma is never-ending
  • How flashbacks make parts of the brain shut down and others to go into overdrive
  • Why some trauma survivors can’t recognize themselves in the mirror
  • How activities like choral singing, yoga, and theater can be therapeutic

The Body Keeps the Score

1-Page Summary 1-Page Book Summary of The Body Keeps the Score

Trauma has become one of those broad psychological terms that is often thrown around but seldom truly understood; even in the field of psychiatry, trauma has historically been a nebulous term with a wide range of symptoms and treatments. In The Body Keeps the Score, the author explores how the understanding and treatment of trauma has evolved as new technologies, research, and fields of science emerged.

Trauma can stem from a one-time event or an ongoing experience—from abuse to a severe car accident to wartime combat—and can cause a lifetime of flashbacks, nightmares, isolation, insomnia, hypervigilance, and rage. Until just a few decades ago, there was no umbrella diagnosis for trauma; instead, patients were wrongly diagnosed with depression, mood disorders, substance abuse, even schizophrenia. Incorrect diagnoses led to ineffective treatments and patients’ continued suffering.

The effects of trauma live on not only in the emotional mind and the chemical makeup and circuitry of the brain, but also in the body’s physiology. Traumatic experiences rewire the brain to cause people to be hypervigilant to threats: The slightest hint of a threat sends trauma sufferers into a fight-or-flight response, triggering stress hormones to flood their bodies and keep them in a state of hyperarousal long after the perceived threat is gone. Over time, hypervigilance and hyperarousal cause physical ailments and hamper trauma sufferers’ ability to function emotionally and socially.

Trauma’s Impact on the Mind

Mentally and emotionally, trauma affects how survivors interact with people and the world around them.

  • Trauma survivors experience isolation, unable to trust anyone after suffering pain and abuse at the hands of another person. Additionally, sufferers don’t believe anyone could understand how they feel. Furthermore, they struggle to read people’s emotions and intentions through their physical expressions because they’re so consumed by their hypervigilance that they can’t connect with other people; they see most people as threats, and they don’t give off an open, welcoming vibe to invite others to approach them.
  • Trauma survivors are often more haunted by shame at what they did or didn’t do during the traumatic event— whether or not they could’ve rationally acted any differently— than by the atrocity of their abusers’ actions.
  • Trauma survivors typically develop learned helplessness—a sense of powerlessness and resignation to their circumstances—after experiencing an inescapable trauma, such as a car accident, combat zone, or physical assault.
  • Flashbacks keep survivors stuck in their traumatic event, so that they’re never able to be fully engaged in the present. As a result, they typically go through life feeling numb.

Trauma’s Impact on the Brain

Traumatic experiences are so overwhelming that parts of the brain go offline while others go into overdrive, and as a result, your brain fails to process the traumatic event and integrate it into the timeline of your life, as it would any other experience. Consequently, the trauma never becomes part of the past; it’s ever-present (as evidenced by the pervasive flashbacks and near-constant state of fight or flight).

Brain scans reveal that when trauma survivors experience flashbacks, their brains react as if the actual trauma were happening in that moment .

Your brain has three parts:

  • The reptilian brain, which manages your most primitive functions such as breathing, eating, sleeping, and expelling waste.
  • The limbic system—the mammalian brain—which manages emotions, looks out for danger, and helps you navigate social networks.
  • The neocortex—the rational brain—which operates logic, language, creativity, empathy, and the ability to plan for the future and reflect on the past.

Together, the reptilian brain and the limbic system (the two most primitive parts of your brain) make up the emotional brain. The emotional brain alerts you to danger and, if necessary, jump-starts your pre-programmed reactions, like the fight-or-flight response, before your rational brain weighs in to determine if the threat is really a threat (e.g. you might jump back at the sight of a snake, only to realize it’s just a rope). However, trauma hinders the brain from accurately and effectively perceiving threats, so trauma survivors go through life constantly jumping in response to non-threats.

Trauma’s Impact on the Body

Your mind and body are inextricably connected: Emotions give you physical sensations (e.g. butterflies in your stomach) and are revealed in your facial expressions and body language. By the same token, physical sensations impact your mood and emotions—a soft, warm breeze puts you at ease, while loud, clanging noises put you on edge.

Trauma and flashbacks cause intense emotions and physical sensations that are so overwhelming that survivors cope by suppressing both their emotions and physical sensations. As a result, they become disconnected from their bodies—unable to identify and interpret their physical sensations—which makes it impossible to feel fully alive, take care of their bodies and minds, and effectively engage with other people.

When you suppress or can’t understand what your physical sensations are telling you, the body finds other ways to demand your attention: Many trauma survivors develop psychosomatic issues (physical ailments that have no physical cause) such as migraines, neck and back pain, fibromyalgia, asthma, digestive issues, irritable bowel syndrome, and chronic fatigue.

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The Body Keeps the Score Summary Prologue: Trauma Haunts Many People for Life

We tend to think of trauma in its most extreme forms, such as PTSD in veterans, rape victims, and survivors of tragedies like 9/11. But nearly everyone is likely to either suffer from trauma or know someone who does—whether from a tragedy or accident, domestic violence, childhood abuse, or witnessing violence as a child.

Regardless of how many years or decades have passed since the traumatic event(s), your brain and body continue to feel the effects. Trauma rewires the brain to cause people to be hypervigilant to threats and repeat the same mistakes, seemingly compulsively.

In this summary,...

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The Body Keeps the Score Summary Chapter 1: Developing a Definition of Trauma and PTSD

Trauma can stem from a one-time event or an ongoing experience. And each person who experiences trauma deals with it differently; two people who experience the same traumatic event may cope with it in entirely different ways—some people become irritable and have explosive rage, while others shut down emotionally or repress it entirely.

The range of symptoms, lack of uniformity, and occasionally the repression or denial of the traumatic event itself can make trauma difficult to identify and diagnose. As a result, there was no single diagnosis of the collective symptoms of trauma until just a few decades ago.

Despite the range of causes, symptoms, and severity, all trauma sufferers have common neurological and physiological effects that last until effective treatment can heal both the mind and the body.

(Shortform note: Trauma is the umbrella term for the mental, emotional, neurological, and physical response to an intensely distressing or disturbing traumatic event. Posttraumatic stress disorder (PTSD) is the diagnosis most commonly associated with trauma, but as we’ll discuss, not every trauma survivor fits the definition of PTSD; other disorders that can result from...

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The Body Keeps the Score Summary Chapter 2: The Mental and Emotional Scars of Trauma

The effects of trauma are three-pronged: the mind (mental and emotional), the brain (brain wave frequencies and neurological reactions), and the body. First, we’ll explore how trauma impacts the mind.

Isolation and Shame

One of the lasting impacts of trauma is an inability to develop intimate relationships with others: After experiencing such suffering at the hands of another person, how can you trust anyone again?

Additionally, how can anyone possibly understand how you feel, with the exception of other trauma survivors? These two questions cause many trauma survivors to be extremely isolated.

What’s more, many trauma survivors feel paralyzing shame about their own behavior during a traumatic episode. In some cases, the survivor may have lashed out in response to the trauma and subsequently feels shame about it; for instance, the day after Tom’s platoon was ambushed in Vietnam, he killed children and raped women in a nearby village in a vengeful rage. The shame of his actions later haunted him mercilessly.

In other cases, trauma survivors feel shame about their behavior—regardless of any rational reality of whether they could’ve acted any differently. This is...

The Body Keeps the Score Summary Chapter 3: Your Brain on Trauma: Flashbacks and Memories

The advent of brain-imaging technology in the early 1990s gave scientists new insight into the way brains process information, memories, sensations, and emotions. With these tools, researchers learned that trauma leaves an imprint on the mind, brain, and body that has long-term effects on how you survive in the present. Trauma not only changes how and what you think but also your capacity to think.

Flashbacks Alter Brain Functions

In the face of trauma, part of your brain shuts down and causes you to lose your ability to articulate your feelings, your sense of time, your ability to make sense of your body’s sensations, and your ability to store that information. The emotional brain takes over, kicking up your emotional arousal, physiological reaction, and muscle activity. All this causes the trauma to be stored as fragments of sensory information—sounds, smells, sensations, and images—instead of a coherent narrative. This is the basis for flashbacks.

In one study, eight trauma survivors recreated scenes of their traumas—essentially triggering flashbacks—as they had their brains scanned to see the reactions. The researchers found that participants’ amygdalas (the...

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the body keeps the score chapter 9 summary

The Body Keeps the Score Summary Chapter 4: Understanding Trauma Through Brain Anatomy

Your brain’s primary function is to ensure your survival. This entails:

  • Signaling when your body needs essentials such as food, water, rest, shelter, safety, and sex.
  • Interpreting the world around you to point you in the right direction to find and satisfy those essential needs.
  • Creating the energy and initiating the actions to achieve those tasks.
  • Warning you of dangers and opportunities you may encounter as you pursue those tasks.
  • Adapting to act and respond to changing circumstances along the way.

Your brain has three parts that work together to achieve its primary functions.

  • The reptilian brain
  • The limbic system, or the mammalian brain
  • The neocortex

Trauma alters the balance between these three parts, ramping up activity in some areas and weakening others. As we’ll see, trauma causes the more primitive parts of your brain to be overactive, while hindering the parts responsible for empathy, creativity, and abstract thought—which are critical to thriving in a community and in everyday life.

The Reptilian Brain

The reptilian brain is the most primitive part of your brain and develops while you’re in the womb. It’s responsible...

The Body Keeps the Score Summary Chapter 5: Your Mind Impacts Your Body and Vice Versa

Your mental and physical states are inextricably connected. Both positive and negative emotions can give you physical sensations—like when the hair on the back of your neck stands up in the face of a threat, or you feel butterflies in your stomach when you’re excited.

Other people pick up on your mental and emotional state through your facial expressions and body language, and likewise, you read other people’s emotions and intentions through their physical expressions. However, if your mind and emotions are hijacked by a hypervigilance to danger—as is the case with trauma sufferers—it prevents you from relaxing enough to connect with other people ; they don’t read an open, welcoming state in your posture, and you mistakenly see them as threatening.

Researcher Stephen Porges’s Polyvagal Theory explains how our social interactions with others, and the way we read each others’ body language, impacts our emotions—for instance, why hearing a soothing voice can calm you, and why feeling ostracized by other people can make you angry or cause you to shut down. Your mirror neurons (which help you pick up on other people’s actions, emotions, and intentions and are responsible for...

Shortform Exercise: Nonverbal Communication in Social Interactions

As a baby, your interactions with your caregivers help you develop the ability to read people’s moods and emotions through their nonverbal cues, including body posture, tone of voice, and eye contact. Your ability to do this is critical in social interactions throughout your life.

Think of a recent conversation you had with someone who you knew was upset simply by reading their body language. What could you discern through their facial expressions, tone of voice, posture, and other nonverbal clues?

The Body Keeps the Score Summary Chapter 6: Traumatized People Disconnect From Their Physical Sensations

Recognizing the physical sensations in your body—as basic as feeling cold or hungry—is at the core of your sense of self: How can you know what you enjoy, need, or want if you don’t understand how you feel on the most basic level?

Before you develop language or consciousness, your physical awareness begins in the womb—feeling your mother’s movements and hearing the whooshing of fluids flowing around you. As you get older, physical sensations continue to provide information about your internal condition and your environment. Effectively reading sensory cues is essential to staying safe and healthy.

Many trauma survivors suffer major disconnection from their bodies, which makes it impossible for them to feel fully alive, take care of their bodies and minds, and effectively engage with other people.

Some survivors lose feeling in whole areas of their bodies, and can’t even determine what kind of object they’re holding in their palm by touch alone. Some survivors of chronic childhood trauma are so disconnected from their bodies that they can’t even recognize themselves in the mirror.

Sensory Unawareness in the Brain

Researchers asked people to think about...

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Shortform Exercise: Recognizing Your Own Body Awareness

Recognizing the physical sensations in your body—as basic as feeling cold or hungry—is at the core of your sense of self, but for most people it’s so natural that you probably don’t even think about it. Use this exercise to notice your body awareness.

Take a moment and focus on your body. Write all the sensations you notice—the feel of the chair against your back, your empty stomach growling, the smell of the room, the tension in your shoulders.

The Body Keeps the Score Summary Chapter 7: Resilience Builds From Birth

From the moment you’re born, every interaction with your caregivers helps form your understanding of the world and teaches you how to have relationships with others; this comes through your attachment and attunement to your caregiver, which we’ll describe below. In fact, the biggest predictor of your ability to cope with challenges in life is the security you feel with your primary caregiver during the first two years of your life.

As a baby, since you’re unable to care for yourself, you must rely on your caregivers to meet your most basic needs, from food and clothing to safety and comfort. Your attachment—how well your caregivers meet your needs—determines how well you’ll take care of these needs for yourself later in life. Furthermore, the more responsive your caregivers are to you, the more responsive you’ll be to others .

Babies are programmed to form an attachment no matter what, so the quality of that attachment depends upon the kind of caregiver they have.

Caregivers’ own traumas and mental health issues can impede their ability to care for and provide secure attachment. Children without a healthy attachment tend to dissociate and shut...

The Body Keeps the Score Summary Chapter 8: Treatments to Heal the Mind, Brain, and Body

As the fields of science and psychology have evolved, so have the understanding and treatment of trauma. There are three general approaches to treatment.

  • Top-down: Talking, connecting with other people, opening up about your traumatic memories and their present-day effects.
  • Medication: Using prescription drugs that inhibit trauma survivors’ overactive internal alarm systems, or affect the brain’s chemistry in some other way to alleviate the symptoms of trauma.
  • Bottom-up: Seeking physical experiences that connect the body and mind to counteract feelings of helplessness, rage, and emotional collapse that plague trauma survivors.

The goal of treatment is to regain control of yourself and your thoughts, feelings, and body. Generally, this involves four steps:

  • Learn how to be calm and focused.
  • Find a way to stay calm in the face of sensations (images, sounds, smells) associated with your trauma.
  • Learn how to be present and engage with the people around you.
  • Don’t hide things from yourself, such as the ways you adapted in order to survive during and after your trauma.

First we’ll explore top-down trauma treatments and discuss their benefits and drawbacks....

The Body Keeps the Score Summary Chapter 9: Medication Revolutionized Mental Disorders

Throughout history, available technology dictated the understanding and treatment of mental and emotional issues. Before the Enlightenment, mental illness and emotional issues were attributed to God, demons, sin, magic, and witchcraft. In the 19th Century, scientists began viewing behavior as a result of people’s adaptation to the complex world around them.

In the early 1950s, French scientists discovered a chemical compound that could make psychiatric patients less agitated and delusional. This introduced the brain-disease model of viewing mental problems as “disorders” that could be treated with drugs to adjust brain chemistry.

The brain-disease model and growth of pharmacology changed the field of psychiatry in several ways.

  • Mental problems were not approached as a nebulous issue in the emotional mind, but as a measurable abnormality in brain chemicals that could be corrected with drugs.
  • Doctors had another tool besides talk therapy.
  • Drug sales created income for doctors and profits for pharmaceutical companies.
  • Grants from pharmaceutical companies funded studies and laboratories.

However, **the availability of drugs has become a substitution...

The Body Keeps the Score Summary Chapter 10: Bottom-Up: Engaging the Body in Healing

The bottom-up approach to treatment uses physical experiences that connect the body and mind. This empowers patients to inhabit their bodies, be present, and learn how they can affect their emotions—all of which help them to counteract feelings of helplessness, rage, and emotional collapse.

Eye Movement Desensitization and Reprocessing (EMDR)

Eye movement desensitization and reprocessing (EMDR) is a treatment in which patients revisit their trauma while focusing on a therapist’s finger moving side-to-side. In contrast to exposure therapy, which aims to desensitize patients through repeatedly revisiting the traumatic memory, EMDR uses the trauma as merely a starting point leading to other, seemingly unrelated thoughts and memories.

While researchers don’t know exactly how EMDR works, the treatment helps people get in touch with loosely connected memories and images and then integrate their traumatic experience into a broader context. After EMDR treatment, patients are able to look at the traumatic event as they would another memory—something that’s in the past, that doesn’t have power over them in the present. Furthermore, one study showed that not only was EMDR more...

The Body Keeps the Score Summary Epilogue: Invest in Prevention

Awareness of trauma and its effects is steadily increasing, as more research is published and more treatments become available. However, there is much room for change in the way our society addresses and prevents trauma.

Unemployment, poverty, struggling schools, inadequate housing, social isolation, and relatively easy access to firearms all create fertile grounds for trauma— and still, we see cuts to food stamps, opposition to universal healthcare and stricter gun laws, high rates of incarceration, and an overdependence on...

Table of Contents

Sam Thomas Davies

The Body Keeps the Score by Bessel van der Kolk

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The Body Keeps the Score Summary

Rating: 4/5

What Is The Body Keeps the Score About?

The Body Keeps the Score  is about the profound impact of trauma on the mind and body, exploring innovative healing methods through the lens of neuroscience and psychology.

The Five Big Ideas

  • The Prevalence and Impact of Trauma : Trauma is a widespread issue that profoundly affects individuals’ mental and physical health, altering the brain’s structure and potentially leading to conditions like PTSD.
  • The Body-Mind Connection : Trauma is stored not just in the mind but also in the body, manifesting through physical symptoms and sensations, underscoring the need for integrated treatment approaches.
  • The Limitations of Talk Therapy : Traditional talk therapy may not be sufficient for healing trauma because the brain often stores traumatic memories in non-verbal parts of the brain; therefore, therapies that engage the body and mind are often more effective.
  • The Role of Neuroplasticity in Healing : The brain’s ability to change and adapt (neuroplasticity) is central to recovering from trauma, and we can facilitate healing through therapies that promote positive neural changes.
  • Innovative Therapies for Trauma : The book highlights various innovative therapies, such as Eye Movement Desensitization and Reprocessing (EMDR), which have shown promise in helping individuals process and recover from traumatic experiences.

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The body keeps the score summary.

Note:  While this summary provides an overview of the key themes and ideas presented in The Body Keeps the Score , the book is rich with case studies, personal narratives, and scientific research that offer a deeper understanding of trauma and its effects.

Part One: The Rediscovery of Trauma

In the first part of the book, Bessel van der Kolk sets the stage by discussing his early experiences with trauma patients during the Vietnam War era. He introduces the concept of Post-Traumatic Stress Disorder (PTSD) and how it was initially observed in war veterans but is also prevalent in survivors of other forms of trauma, such as abuse and accidents. He explains how trauma affects the brain, particularly the areas responsible for processing fear, emotion, and memory. Traumatic experiences can lead to changes in the brain that make individuals more susceptible to fear, anxiety, and memory distortions.

Part Two: This is Your Brain on Trauma

Here, van der Kolk delves deeper into the neuroscience of trauma. He explains how traumatic experiences can alter the brain’s structure and function, particularly in the areas involved in processing threat and safety, such as the amygdala, prefrontal cortex, and hippocampus. These changes can result in a heightened state of alertness, making it difficult for trauma survivors to distinguish between past and present threats. Van der Kolk also discusses the role of neuroplasticity in trauma recovery, emphasizing that the brain can rewire itself, which is a cornerstone of healing.

Part Three: The Minds of Children

In this section, van der Kolk focuses on the impact of trauma on children. He explains how early experiences, particularly those involving neglect or abuse, can profoundly shape a child’s brain development and affect their ability to regulate emotions and form healthy relationships. He also discusses the importance of a supportive environment for children who have experienced trauma and the role of attachment in healing.

Part Four: The Imprint of Trauma

Part four delves into the ways trauma can leave lasting marks on individuals. Van der Kolk discusses how trauma survivors often relive their experiences through flashbacks and intrusive memories. He also explores the concept of “body memory,” explaining how traumatic experiences can manifest physically, leading to symptoms like chronic pain, gastrointestinal issues, and other somatic complaints. The body’s physical response to trauma is a key theme, highlighting the importance of addressing both the mind and body in treatment.

Part Five: Paths to Recovery

Van der Kolk dedicates the book’s final part to treatment and recovery, outlining various therapeutic approaches beyond traditional talk therapy. He emphasizes the importance of therapies that engage the body, such as Eye Movement Desensitization and Reprocessing (EMDR), yoga, and mindfulness practices. He also discusses the role of art, theater, and communal experiences in healing trauma. The book concludes with a message of hope, emphasizing that recovery is possible and individuals can reclaim their lives from trauma.

Recommended Reading

If you like The Body Keeps the Score , you might also like:

  • Tuesdays with Morrie by Mitch Albom
  • Atomic Habits: Tiny Habits, Remarkable Results by James Clear
  • Building a Second Brain: A Proven Method to Organize Your Digital Life and Unlock Your Creative Potential by Tiago Forte

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The Body Keeps The Score Summary

1-Sentence-Summary: The Body Keeps The Score teaches you how to get through the difficulties that arise from your traumatic past by revealing the psychology behind them and revealing some of the techniques therapists use to help victims recover.

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The Body Keeps The Score Summary

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The body keeps the score review, audio summary, who would i recommend the body keeps the score summary to.

It’s easy to see the trauma that war causes. Too many veterans come home with PTSD and suffer from a range of difficulties because of it. But more and more people are experiencing their own ordeals that leave scars on their minds that are tough to heal. 

Chances are you’ve had a traumatic event or two in your own life. Whether you realize it or not these do affect you, and in some cases a lot. You’re probably wondering about the impact that these tragic memories have on your mind and body. And why is it so difficult to get free of the pain they cause?

Finding relief from trauma is what Bessel van der Kolk’s The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma is all about. This will help you see the effects of it on your life. But more importantly, you’ll discover a few techniques that can free you of it’s torment. 

Here are the 3 most helpful lessons this book teaches about trauma and recovery:

  • EMDR is a slightly mysterious technique that the author uses to help trauma patients recover, and with wonderfully positive results.
  • You can connect your body and mind through yoga to help you deal with your troubling past.
  • Having a network of supportive people and practicing mindfulness are two more ways that bring healing.

Ready to find out how to recover from your most difficult experiences that still haunt you? Let’s dive right in!

If you want to save this summary for later, download the free PDF and read it whenever you want.

Lesson 1: Trauma patients who go through the EMDR technique have seen incredible results in recovery.

Difficult events can have a long-lasting negative effect. Just remembering them can raise blood pressure and deactivate rational thinking parts of a victim’s brain. Many of these experiences came from childhood and have been around for a long time. But there is hope for even the nastiest of demons you face. 

One technique is as simple as moving a finger across a patient’s vision. As they follow the finger with their eyes, audio cues from the medical professional help them make new associations. EMDR, or eye movement desensitization and reprocessing might sound crazy, but it’s wildly effective at helping people recover from trauma. 

The reason it’s so helpful is because of the way it allows victims to integrate their traumatic memories. Part of the problem with these events is that their memory can play out as if it’s happening in the present. Integration allows for them to simply add these events to a memory bank instead of thinking they’re real. 

The author used this technique to help a woman named Kathy who had just attempted suicide for the third time. At a young age, she’d been raped, assaulted, and abused by her father. 

Using EMDR, van der Kolk helped Kathy re-imagine these memories in a helpful way. She imagined a bulldozer destroying her childhood home and the memories that came with it. Another visualization had her thinking about locking her dad out of a cafe. She progressed well and 15 years later the author reconnected with her to discover she was happy and healthy.

Lesson 2: Dealing with your troubling past is easier when you practice yoga to help you connect your mind and body.

Your body and mind are more connected than you might think. Figuring out how your emotions work and impact your body is essential for balance and stability in life. 

Trauma makes this really hard because of the way it puts a sort of alarm system in our bodies. A child who was sexually abused, for example, might feel panic when doing something as simple as cuddling with their significant other. 

People usually try to numb these feelings with drug or alcohol abuse, or by overworking themselves. But these temporary fixes only put a bandage on rather than getting to the root of the issue. That’s where unifying the body and mind with yoga comes in handy. 

Yoga allows trauma victims a way to understand emotions and how their body handles them. The author had a patient named Annie who had been raped and suffered from PTSD that decided to give it a try. It was tough at first because just a simple pat on the back triggered her alarm system. 

But refusing to give up, Annie persevered and began to notice how her body was giving her information about her emotional state. Some of the positions made her feel sadness, pain, and vulnerability. Instead of pushing them away, she began to explore and accept them. This let Annie come to terms with these difficult feelings and deal with them instead of trying to bury them.

Lesson 3: Mindfulness and a support network of friends and family who care are also great ways to experience healing.

The aim of mindfulness is to mentally connect with and become aware of your body and emotions instead of just denying them. It’s difficult to do this after adversity because we don’t like to deal with painful emotions like sadness or anger. But suppressing them, as many victims do, just leads to more problems. 

Only by confronting your demons can you begin to heal from them. Meditation techniques help you reconnect with the way you really feel so that you can start this process. 

This unique tool can calm the impacts of trauma on the mind and body. Whether it’s depression or chronic pain, mindfulness can help. It’s also known to strengthen your immune system, help you regulate emotions, and get your hormones in better balance.

Relationships are another vital component of the recovery process. Your network of family, friends, and medical professionals can help you always have someone to turn to for help. You can connect with other helpful people through local AA meetings, religious groups, and veterans’ organizations.

The Body Keeps The Score is a powerful book especially at a time when too many have to deal with trauma. I’ve got family members who have been through some pretty difficult things that I know the techniques in this book could help. If you’ve been through traumatic events this book will give you hope to recover.

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The 33-year-old who was abused by her father as a child and is now dealing with mental illness because of it, the 56-year-old who has chronic pain and wants to find ways to deal with it, and anyone who has been through trauma or suffers from depression or anxiety.

Last Updated on August 30, 2022

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Luke Rowley

With over 450 summaries that he contributed to Four Minute Books, first as a part-time writer, then as our full-time Managing Editor until late 2021, Luke is our second-most prolific writer. He's also a professional, licensed engineer, working in the solar industry. Next to his day job, he also runs Goal Engineering, a website dedicated to achieving your goals with a unique, 4-4-4 system. Luke is also a husband, father, 75 Hard finisher, and lover of the outdoors. He lives in Utah with his wife and 3 kids.

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The Body Keeps The Score

BRAIN, MIND, AND BODY IN THE HEALING OF TRAUMA

The Body Keeps the Score is the inspiring story of how a group of therapists and scientists— together with their courageous and memorable patients—has struggled to integrate recent advances in brain science, attachment research, and body awareness into treatments that can free trauma survivors from the tyranny of the past. These new paths to recovery activate the brain’s natural neuroplasticity to rewire disturbed functioning and rebuild step by step the ability to “know what you know and feel what you feel.” They also offer experiences that directly counteract the helplessness and invisibility associated with trauma, enabling both adults and children to reclaim ownership of their bodies and their lives. Drawing on more than thirty years at the forefront of research and clinical practice, Bessel van der Kolk shows that the terror and isolation at the core of trauma literally reshape both brain and body. New insights into our survival instincts explain why traumatized people experience incomprehensible anxiety and numbing and intolerable rage, and how trauma affects their capacity to concentrate, to remember, to form trusting relationships, and even to feel at home in their own bodies. Having lost the sense of control of themselves and frustrated by failed therapies, they often fear that they are damaged beyond repair. What distinguishes THE BODY KEEPS THE SCORE is that the author is both a scientific researcher with a long history of measuring the effect of trauma on brain function, memory, and treatment outcomes, and an active therapist who keeps learning from his patients what benefits them most. This makes for deeply personal, analytic, and highly readable (not to mention incredibly moving) approach to the topic of trauma recovery. The title underscores the book’s central idea: Exposure the abuse and violence fosters the development of a hyperactive alarm system and molds a body that gets stuck in fight/flight, and freeze. Trauma interferes with the brain circuits that involve focusing, flexibility, and being able to stay in emotional control. A constant sense of danger and helplessness promotes the continuous secretion of stress hormones, which wreaks havoc with the immune system and the functioning of the body’s organs. Only making it safe for trauma victims to inhabit their bodies, and to tolerate feeling what they feel, and knowing what they know, can lead to lasting healing. This may involve a range of therapeutic interventions (one size never fits all), including various forms of trauma processing, neurofeedback, theater, meditation, play, and yoga. Readers will come away from this book with awe at human resilience and at the power of our relationships—whether in the intimacy of home or in our wider communities—to both hurt and heal.

Published in 43 languages with...

Penguin Books Ltd. (UK) Al Karma Publishers (Arabic) Attakween Publishing House (Arabic) Iztok-Zapad Ltd. Publishing House (Bulgarian) Editorial Eleftheria SL (Catalan) China Machine Press/Beijing Huazhang Graphics &(Chinese Simplified) Common Master Press(Chinese Complex) Geromar d.o.o. (Croatian) Jan Melvil Publishing, s.r.o. (Czech) Forlaget Klim / Klim Publishers (Danish) Uitgeverij Mens! (Dutch) Tanapaev (Estonian) Viisas Elama Ltd. (Finnish) Editions Albin Michel (French) Klidarithmos Publications EPE (Greek) Ullstein Buchverlage GmbH (German) G.P. PROBST VERLAG GMBH (German) Pardes Publishing (Hebrew) Ursus Libris Kiado (Hungarian) Forlagid (Icelandic) PT Elex Media Komputindo (Indonesian) Raffaello Cortina Editore Srl. (Italian) Kinokuniya Shoten (Japanese) Eulyoo Publishing Co., Ltd. (Korean) UAB Liutai ne avys (Lithuanian) Tri Publishing Centre (Macedonian) Injinash Publishing LLC (Mongolian)

Flux Forlag AS (Norwegian) Wydawnictwo Czarna Owca, Sp. z.o.o. (Polish) Edicoes ASA II S.A. (Portuguese in Portugal) Editora Schwarcz S.A.(Portuguese in Brazil) GMT Editores Ltda (Portuguese in Brazil) SC ADEVAR DIVIN SRL (Romanian) Eksmo Publishing House Ltd (Russian) Psiholosko savetovaliste Mozaik (Serbian) Tatran Publishers (Slovakian) Editorial Eleftheria SL (Spanish) Akademius Forlag (Swedish) Suan Nguen Mee Ma Publishing House (Thai) Nobel Akademik Yay. Eg. Dan. Tic. Ltd.Sti. (Turkish) Vivat Publishing Ltd (Ukranian) Saigon Books Cultural JSC (Vietnamese)

A Conversation with Bessel van der Kolk

Q. You’ve been working with traumatized children and adults for many years and have seen significant changes in how mental illness and trauma are treated. What have you learned from neuroscience, attachment research, and interpersonal neurobiology about how to help children and adults recover from toxic stress?

A. Trauma is ubiquitous in our society. Over 500,000 children are reported for abuse and neglect each year. One out of four Americans reports having been left with bruises after having been hit as a child, one out of five was sexually molested, one out of eight has witnessed severe domestic violence, and a a quarter grew up with alcoholism or drug addiction. Almost every inmate in our prison system, by far the largest in the world, has a serious history of prior trauma. Half a million women are raped each year, half of them before they are adolescents.

These experiences leave traces on people’s biology and identity and have devastating social consequences–medical illnesses, problems with school and work performance, drug addiction and a variety of psychiatric illness. In fact, the Centers for Disease Control and Prevention calculate that childhood trauma is our single largest public health issue—more costly than cancer or heart disease—and one that is largely preventable by early prevention and intervention.

In order to overcome trauma people need to feel safe enough to open up their hearts and minds to others and become engaged with new possibilities. This can only be done if trauma survivors, and their communities, are helped to confront and confess the reality of what has happened and are helped to feel safe again. In many non-Western cultures this involves communal rhythmical activities, such as dancing, athletics, and collective prayer. Communal rituals of acknowledgment, support, and repentance can play a substantial role in healing from trauma.

Treatments that focus solely on decreasing a few PTSD symptoms, or on drugs to obliterate feelings, ignore the importance of integrating the traumatic experience in the overall arc of one’s life, and they fail to help survivors reconnect with their communities. The scientific evidence for the efficacy of these therapies, while widely promulgated and practiced, is, in fact, quite disappointing.

Probably the most important challenge in recovering from trauma is learning to regulate oneself. We can activate this innate capacity by utilizing breath, touch, movement, and rhythmical engagement with one’s fellow human beings, such as yoga, tai chi, and dancing, methods that are not widely utilized in medical settings or in school systems.

Q. In your book you talk about the effect of trauma on the brain. What changes occur in the brain in response to trauma? What happens when someone experiences a flashback?

A. Neuroscience research has shown that traumatized individuals are prone to activate brain areas involved in fear perception, and to have deficits in the areas involved in filtering out relevant from irrelevant information, as well as in the perception of bodily sensations. These changes do not occur in the rational part of the brain, and do not really seem to benefit merely from being aware of the error of one’s ways.

The impact of trauma is located in the survival part of the brain, which does not return to baseline after the threat is over. This part of the brain is by definition unreasonable—you do not stop being hungry by reminding yourself how fat you are, and it’s pretty difficult to talk yourself out of being angry, shut down, or in love.

One of the most devastating effects of trauma is that people’s biology changes into a biology of threat; this is expressed on multiple levels, in stress hormones, immunology and what the brain selects to pay attention to. The intrinsic reward system changes, as do “attractors”—what turns you on or leaves you cold. As a consequence, traumatized people stay on hyper alert; they feel chronically unsafe and in danger, and they have problems feeling calm and enjoying the moment and they are out of touch with their surroundings. Trauma can make it difficult to have comfortable reciprocal relationships with one’s children, partners, and coworkers.

Through brain imaging technology, we can visualize how traumatized people even have problems processing ordinary, nonthreatening information, which makes it difficult to fully engage in daily life and to learn from experience. As a result, they are frazzled, unfocused, and tend to repeat the same nonproductive behavior patterns, with the same miserable results.

Trauma affects the entire human organism–thinking, feeling, relationships, and the housekeeping of one’s body. Trauma survivors are vulnerable to a host of medical illnesses and chronic pain syndromes, insomnia, drug and alcohol addiction, depression, obesity, and other issues related to optimal functioning of the entire organism, and the capacity for self regulation and self-care.

Q. What do you wish more people understood about trauma?

A. First of all, is important to understand is how ubiquitous trauma is in our society, what devastating effects it has on family life, workplace productivity, the facility to learn and take initiative, the ability to stay calm and focused, and the capacity to be compassionate with one’s fellow man.

As a society we cannot afford to ignore trauma and keep our heads in the sand. There are, in fact, countries where governments have taken the science of trauma (and its prevention and treatment) seriously, with results to prove how well that works. For example, Norway has fifty-one citizens per hundred thousand in jail; the US, 951. Their students also have higher test scores and higher graduation rates from high school and college, and their society has a fraction of our crime rate.

I think that the general public tends to associate trauma with the military and terrorism, but the vast majority of traumas occur within families, schools, and neighborhoods, the very people whom they depend on for safety and security. Most traumatized women and children, for example, are traumatized by their intimates. Another important issue is that trauma has a different impact, depending on the age and relative maturity of the affected individual. The brains of traumatized kids develop in a “use-dependent” manner—they become experts in dealing with threat, and have problems with self-regulation, play, and the sort of imaginative creativity that is necessary to become productive members of society.

Trauma is a deeply communal problem: we are fundamentally social animals, and trauma profoundly affects people’s capacity to get along with others and be a cooperative and enjoyable member of the tribe.

Q. You have worked with war veterans and at the beginning of your career worked with Vietnam vets before PTSD was an official diagnosis. What do you think of the current prescribed treatment by the Veteran Affairs office for trauma?

A. I currently treat only a few veterans and I am not intimately familiar with what is happening at the Veterans Administration. The VA is a pretty closed system—people who work at the VA rarely attend my workshops or lectures, or those of my close colleagues.

I hear that their main focus is on cognitive behavioral treatments, and on desensitizing people to their memories. These treatments, research shows, are not particularly effective. That is not surprising, given that being traumatized is not an issue of faulty cognition—the problems emanate from parts of the brain that have little to do with cognition.

The biggest problem for veterans is to fully engage in their current lives. The Body Keeps the Score provides a number of ways to reengage — some are ancient, like yoga, theater, and martial arts, while others, like neurofeedback, are based on the latest advances in neuroscience.

Doctors at the VA and the DoD prescribe vast amounts of drugs, even though there is scant evidence that drugs significantly help traumatic stress. Drugs can obscure posttraumatic symptoms but not resolve them.

This issue is even more concerning in the treatment of traumatized children. The poorer you are the more likely it is that you will be given psychiatric drugs to control your behavior. These drugs can have devastating effects on children’s capacity to learn, engage and feel good in their bodies.

Q. What benefits does yoga offer patients in treatment? Are they universal?

A. Yoga is just one of many time-honored ways to help people experience ownership of their bodies and to feel safe and in control. Our most recent research study on this subject showed that yoga had better results than any drug studies so far for PTSD. That is not to say that everybody should practice yoga—one size never fits all—but every trauma survivor would do well to engage in practices that increases their inner bodily sense of control, safety, and flexibility.

In order to overcome trauma we have to befriend and be in touch with ourselves—our sensations and our emotions. Neuroscience research has shown that the only way we can consciously access that disturbed survival brain is through our interoceptive pathways — through the part of the brain that helps us to feel what is going on deep inside of ourselves.

Q. What do you hope to accomplish with The Body Keeps the Score? What do you want readers to take away from it?

A. I hope that all traumatized individuals, and their loved ones, will find this book helpful for comfort, understanding, and guidance. That politicians and policy makers will read this book to help them understand the devastating effects of early deprivation and punitive school systems on the health and welfare of our country, as well as the predictable consequences of putting our young men and women in harm’s way.

That parents of adopted kids will understand what their children are dealing with, and serve as a guide to solutions.

That educators and school systems will implement trauma-based interventions for children who come from abuse and neglect, and thereby become agents of change to help all children become productive members of society. My greatest hope is that all school systems will teach the four R’s: reading, writing, rhythmatic, and self-regulation. That from K to 12 all kids will be taught to experience how they can regulate themselves though their breath, movements, and synchronized interactions with others, and learn how their bodies, brains, and minds react to overwhelming stress with recognizable patterns that can be managed through self-regulation practices, more than with drugs or alcohol.

That it will inspire our armed forces to become as expert in helping returning warriors to once again become peaceful and productive civilians, as they are in transforming adolescents into members of magnificent fighting units.

That physicians will appreciate the role of trauma in the disintegration of bodily systems, and learn what they can do about it.

That mental health professionals will acknowledge the relationship between trauma, drug addiction, and numerous psychiatric “disorders” and incorporate effective trauma treatments in their practice.

That law enforcement and criminal justice personnel will read it to understand their own responses, and that of the people they are dealing with.

That psychiatrists will integrate the scientific knowledge that our brains are meant to help us cooperate and thrive in a community, and realize that their job is to help patients deal with the devastating effects of trauma on mind, brain, and body.

I hope that this book will help us all acknowledge the fact that our zip code has a more profound effect on health and well-being then our genetic code. In short, the goal of this book is to help us to become a trauma-informed society that will confront and deal with our largest public health issue: psychological trauma.

Every once in a while, a book comes along that fundamentally changes the way we look at the world. Bessel VanderKolk has written such a book. Having read “The Body Keeps the Score”, it will be impossible for us any longer to deny the profound extent of trauma and its impact on our lives. VanderKolk writes in the humanitarian tradition of his great Harvard mentor, Elvin Semrad, and his book is a worthy testament to the tutelage of this great man, and the beautiful maturation of his pupil. The arc of VanderKolk’s story is vast and comprehensive—but Vanderkolk is such a skillful storyteller that he keeps us riveted to the page. I simply could not put this book down. It is, simply put, a great work. - Stephen Cope , Founder and Director, Kripalu Institute for Extraordinary Living; Author, Yoga and the Quest for the True Self.

In this magnificent book, Bessel van der Kolk takes the reader on a captivating journey that is chock full of riveting stories of patients and their struggles interpreted through history, research, and neuroscience made accessible in the words of a gifted storyteller. We are privy to the author’s own courageous efforts to understand and treat trauma over the past 40 years, the results of which have broken new ground and challenged the status quo of psychiatry and psychotherapy. The Body Keeps the Score leaves us with both a profound appreciation for and a felt sense of, the debilitating effects of trauma, along with hope for the future through fascinating descriptions of novel approaches to treatment. This outstanding volume is absolutely essential reading not only for therapists but for all who seek to understand, prevent, or treat the immense suffering caused by trauma. - Pat Ogden PhD , Founder/Educational Director of the Sensorimotor Psychotherapy Institute; Author, Sensorimotor Psychotherapy: Interventions for Trauma and Attachment

This is masterpiece of powerful understanding and brave heartedness, one of the most intelligent and helpful works on trauma I have ever read. Dr. Van der Kolk offer a brilliant synthesis of clinical cases, neuroscience, powerful tools and caring humanity, offering a whole new level of healing for the traumas carried by so many. - Jack Kornfield Author, A Path work Heart

The Body Keeps the Score articulates new and better therapies for toxic stress based on a deep understanding of the effects of trauma on brain development and attachment systems. This volume provides a moving summary of what is currently known about the effects of trauma on individuals and societies, and introduces the healing potential of both age-old and novel approaches to help traumatized children and adults fully engage in the present. - Jessica Stern , Policy consultant on terrorism; Author, Denial: A Memoir of Terror

This is an amazing accomplishment from the neuroscientist most responsible for the contemporary revolution in mental health toward the recognition that so many mental problems are the product of trauma. With the compelling writing of a good novelist, van der Kolk revisits his fascinating journey of discovery that has challenged established wisdom in psychiatry. Interspersed with that narrative are clear and understandable: descriptions of the neurobiology of trauma; explanations of the ineffectiveness of traditional approaches to treating trauma; and introductions to the approaches that take patients beneath their cognitive minds to heal the parts of them that remained frozen in the past. All this is illustrated vividly with dramatic case histories and substantiated with convincing research. This is a watershed book that will be remembered as tipping the scales within psychiatry and the culture at large toward the recognition of the toll traumatic events and our attempts to deny their impact take on us all. - Richard Schwartz PhD Originator, Internal Family Systems Therapy

Breathtaking in its scope and breadth, The Body Keeps the Score is a seminal work by one of the preeminent pioneers in trauma research and treatment. This essential book unites the evolving neuroscience of trauma research with an emergent wave of body-oriented therapies and traditional mind/body practices. These new approaches and ancient disciplines build resilience and enhance the capacity to have new empowered bodily (interoceptive) experiences that contradict the previous traumatic ones of fear, overwhelm and helplessness. They go beyond symptom relief, and connect us with our vital energy and here-and-now presence. A must read for all therapists and for those interested in a scholarly, thoughtful, tome about the powerful forces that affect us as human beings in meeting the many challenges of life including accidents, loss and abuse. - Peter A. Levine, PhD , Author, In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness

The body keeps the score is masterful in bringing together science and humanism to clearly explain how trauma affects the whole person. Bessel van der Kolk brings deep understanding to the pain and chaos of the trauma experience. The treatment approaches he recommends heal the body and the mind, restoring hope and the possibility of joy. One reads this book with profound gratitude for its wisdom. - Alicia F. Lieberman, Ph.D., Irving B. Harris Endowed Chair in Infant Mental Health; Vice Chair, Academic Affairs, UCSF Department; Director, Child Trauma Research Program, SF General Hospital

This book is a tour de force. Its deeply empathic, insightful, and compassionate perspective promises to further humanize the treatment of trauma victims, dramatically expand their repertoire of self-regulatory healing practices and therapeutic options, and also stimulate greater creative thinking and research on trauma and its effective treatment. The body does keep the score, and Van der Kolk’s ability to demonstrate this through compelling descriptions of the work of others, his own pioneering trajectory and experience as the field evolved and him along with it, and above all, his discovery of ways to work skillfully with people by bringing mindfulness to the body (as well as to their thoughts and emotions) through yoga, movement, and theater are a wonderful and welcome breath of fresh air and possibility in the therapy world.

- Jon Kabat-Zinn , Professor of Medicine emeritus; UMass Medical School; Author, Full Catastrophe Living

Clear, fascinating, hard to put down, filled with powerful case histories, Van der Kolk, the eminent impresario of trauma treatment who has spent a career bringing together diverse trauma scientists and clinicians, and their ideas, while making his own pivotal contributions, describes what is arguably the most important series of breakthroughs in mental health in the last thirty years. We’ve known that psychological trauma fragments the mind. Here we see not only how psychological trauma also breaks connections within the brain, and between mind and body, and learn about the exciting new approaches that allow people with the severest forms of trauma to put all the parts back together again. - Norman Doidge, M.D. , Author, The Brain That Changes Itself

This exceptional book will be a classic of modern psychiatric thought. The impact of overwhelming experience can only be truly understood when many disparate domains of knowledge, such as neuroscience, developmental psychopathology, and interpersonal neurobiology are integrated, as this work uniquely does. There is no other volume in the field of traumatic stress that has distilled these domains of science with such rich historical and clinical perspectives, and arrived at such innovative treatment approaches. The clarity of vision and breadth of wisdom of this unique but highly accessible work is remarkable. This book is essential reading for anyone interested in understanding and treating traumatic stress and the scope of its impact on society. - Alexander McFarlane AO, MB BS (Hons) MD FRANZCP Director of the Centre for Traumatic Stress Studies; The University of Adelaide, South Australia

In The Body Keeps the Score we share the author's courageous journey into the parallel dissociative worlds of trauma victims and the medical and psychological disciplines that are meant to provide relief. In this compelling book we learn that as our minds desperately try to leave trauma behind, our bodies keep us trapped in the past with wordless emotions and feelings. These inner disconnections cascade into ruptures in social relationships with disastrous effects on marriages, families, and friendships. Van der Kolk offers hope by describing treatments and strategies that have successfully helped his patients reconnect their thoughts with their bodies. We leave this shared journey understanding that only through fostering self-awareness and gaining an inner sense of safety will we, as a species, fully experience the richness of life. - Stephen W. Porges, PhD Professor Department of Psychiatry University of North Carolina at Chapel Hill; Author, The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-Regulation

The Body Keeps the Score” eloquently articulates how overwhelming experiences affect the development of brain, mind, and body awareness, all of which are closely intertwined. The resulting derailments have a profound impact on the capacity for love and work. This rich integration of clinical case examples with ground breaking scientific studies provides us with a new understanding of trauma, which inevitably leads to the exploration of novel therapeutic approaches that allow the brain to 'rewire' itself, and help traumatized people to (re)-engage in the present. This book will provide traumatized individuals with a guide to healing and permanently change how psychologists and psychiatrists think about trauma and recovery. - Ruth A. Lanius, M.D., Ph.D. , Harris-Woodman Chair in Psyche and Soma; Professor of Psychiatry, and director PTSD research at the University of Western Ontario; Author, The Impact of Early Life Trauma on Health and Disease​

In this inspirational work which seamlessly weaves keen clinical observation, neuroscience, historical analysis, the arts, and personal narrative, Dr. van der Kolk has created an authoritative guide to the effects of trauma, and a revolutionary approach to its treatment, including pathways to recovery. The book is full of wisdom, humanity, compassion and scientific insight, gleaned from a lifetime of clinical service, research and scholarship in the field of traumatic stress. A must read for mental health and other health care professionals, trauma survivors, their loved ones, and those who seek clinical, social, or political solutions to the cycle of trauma and violence in our society. - Rachel Yehuda, PhD , Professor of Psychiatry and Neuroscience; Director of the Traumatic Stress Studies Division at the Mount Sinai School of Medicine New York NY

With his comprehensive knowledge, clinical courage, and creative strategies Bessel van der Kolk leads the way in understanding the impact of trauma and helping people heal from overwhelming life experiences. The Body Keeps the Score is a cutting-edge offering for the general reader to comprehend the complex effects of trauma, and a guide to a wide array of scientifically informed approaches to not only reduce suffering, but to move beyond mere survival-- and to thrive. - Daniel J. Siegel, M.D. , Clinical Professor, UCLA School of Medicine; Author, Brainstorm: The Power and Purpose of the Teenage Brain; Mindsight: The New Science of Personal Transformation

This is an absolutely fascinating and clearly written book by one of the nation’s most experienced physicians in the field of emotional trauma. Equally suitable for primary care doctors and psychotherapists wishing to broaden their range of helpfulness, or for those trapped in their memories, “The Body Keeps the Score” helps us understand how life experiences play out in the function and the malfunction of our bodies, years later. - Vincent J. Felitti, MD Chief of Preventative Medicine Emeritus, Kaiser Permanente San Diego; Co-Principal Investigator, ACE study

Quotes from The Body Keeps the Score

​“As long as you keep secrets and suppress information, you are fundamentally at war with yourself…The critical issue is allowing yourself to know what you know. That takes an enormous amount of courage.” ​

"Traumatized people chronically feel unsafe inside their bodies: The past is alive in the form of gnawing interior discomfort. Their bodies are constantly bombarded by visceral warning signs, and, in an attempt to control these processes, they often become expert at ignoring their gut feelings and in numbing awareness of what is played out inside. They learn to hide from their selves." ​

“Eighty two percent of the traumatized children seen in the National Child Traumatic Stress Network do not meet diagnostic criteria for PTSD. Because they often are shut down, suspicious, or aggressive they now receive pseudoscientific diagnoses such as “oppositional defiant disorder,” meaning: “This kid hates my guts” or “disruptive mood dysregulation disorder,” meaning he has temper tantrums. These kids accumulate numerous diagnoses over time. Before they reach their twenties, many patients have been given four, five, six, or more of these impressive but meaningless labels. If they receive treatment at all, they get whatever is being promulgated as the method of management du jour: medications, behavioral modification, or exposure therapy. These rarely work and often cause more damage.”

“Neuroscience research shows that the only way we can change the way we feel is by becoming aware of our inner experience and learning to befriend what is going inside ourselves.” ​

“Mindfulness not only makes it possible to survey our internal landscape with compassion and curiosity but can also actively steer us in the right direction for self-care.”

“As the ACE study has shown, child abuse and neglect is the single most preventable cause of mental illness, the single most common cause of drug and alcohol abuse, and a significant contributor to leading causes of death such as diabetes, heart disease, cancer, stroke, and suicide.” ​

“Imagination is absolutely critical to the quality of our lives. Our imagination enables us to leave our routine everyday existence by fantasizing about travel, food, sex, falling in love, or having the last word—all the things that make life interesting. Imagination gives us the opportunity to envision new possibilities—it is an essential launchpad for making our hopes come true. It fires our creativity, relieves our boredom, alleviates our pain, enhances our pleasure, and enriches our most intimate relationships.”

​“Being able to feel safe with other people is probably the single most important aspect of mental health; ​safe connections are fundamental to meaningful and satisfying lives."

“How many mental health problems, from drug addiction to self-injurious behavior, start as attempts to cope with the unbearable physical pain of our emotions? If Darwin was right, the solution requires finding ways to help people alter the inner sensory landscape of their bodies. Until recently, this bidirectional communication between body and mind was largely ignored by Western science, even as it had long been central to traditional healing practices in many other parts of the world, notably in India and China. Today it is transforming our understanding of trauma and recovery.”

​“The prevailing brain-disease model overlooks four fundamental truths: (1) our capacity to destroy one another is matched by our capacity to heal one another. Restoring relationships and community is central to restoring well-being; (2) language gives us the power to change ourselves and others by communicating our experiences, helping us to define what we know, and finding a common sense of meaning; (3) we have the ability to regulate our own physiology, including some of the so-called involuntary functions of the body and brain, through such basic activities as breathing, moving, and touching; and (4) we can change social conditions to create environments in which children and adults can feel safe and where they can thrive.” ​

“Psychologists usually try to help people use insight and understanding to manage their behavior. However, neuroscience research shows that very few psychological problems are the result of defects in understanding; most originate in pressures from deeper regions in the brain that drive our perception and attention. When the alarm bell of the emotional brain keeps signaling that you are in danger, no amount of insight will silence it.”

“Self-regulation can be taught to many kids who cycle between frantic activity and immobility. In addition to reading, writing, and arithmetic, all kids need to learn self-awareness, self-regulation, and communication as part of their core curriculum. Just as we teach history and geography, we need to teach children how their brains and bodies work. For adults and children alike, being in control of ourselves requires becoming familiar with our inner world and accurately identifying what scares, upsets, or delights us.”

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The Body Keeps the Score Book Summary, Review, Notes

Dr. Bessel van der Kolk’s book, The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma, makes use of the most recent discoveries in the field of science to demonstrate how trauma can literally reshape both the body and the brain, impairing the sufferer’s capacity for pleasure, engagement, self-control, and trust. 

Dr. Bessel van der Kolk is widely recognized as one of the world’s preeminent trauma experts due to his extensive, three-decade-long work with trauma survivors. 

He investigates new methods of healing that engage the brain’s inherent neuroplasticity, including neurofeedback and meditation as well as sports, drama, and yoga.

Book Title— The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma Author—  Bessel van der Kolk Date of Reading—  August 2022 Rating—   10/10

Table of Contents

What is being said in detail, lessons from vietnam veterans.

The author makes it clear in this first chapter that, based on his work with a wide range of patients, he does not believe that trauma can be remedied with pills alone . 

The author notes that most hearers experience horror when hearing about someone else’s second-hand trauma. 

Because hearing about a slaying or rape is upsetting, many people would rather ignore the possibility of such atrocities occurring altogether, or at least believe that they occur only in remote areas of the world. 

It’s understandable that survivors of such horrific acts would want to put them behind them. But a talking cure, in which they learn to talk about what they’ve been through, is rarely enough. 

A healthy response to trauma involves the body accepting the reality that the threat is no longer present.

REVOLUTIONS IN UNDERSTANDING MIND AND BRAIN

The author while working at the Massachusetts Mental Health Center between his first and second years of medical school.   

He thought patients’ hallucinations came from suppressed memories. 

After becoming a psychiatrist, the author became interested in neuroscience to comprehend traumatic stress better.  

The author later explored the possible connection between PTSD and serotonin. Once Prozac was available in 1988, he began prescribing it with effectiveness. 

Prozac helped many trauma patients, but not combat veterans. The author has never been able to explain this, but says it indicates pharmacology’s limitations in treating trauma. 

The author worries that medications have become the default technique of addressing mental health concerns. He’s interested in natural techniques to treat trauma.

LOOKING INTO THE BRAIN: THE NEUROSCIENCE REVOLUTION

In the 1990s, brain-imaging techniques were very popular. This new technology was used by the author to conduct an investigation of brain function during flashbacks. 

He found increased activity in the limbic area of the brain, especially the amygdala, which triggers stress. There was less activity in the parts of the brain that process speech. 

The author explains this by saying that trauma is hard to put into words and cuts the patient off from language.

Activity shifted from the logical, analytical left hemisphere to the creative, intuitive right hemisphere, as revealed by the MRI scans. 

The left hemisphere of the brain stores factual information, while the right hemisphere stores emotional recollections.   

When the left side of the brain fails to function during trauma memory, it prevents the patient from viewing the action analytically as something that happened long ago.

RUNNING FOR YOUR LIFE: THE ANATOMY OF SURVIVAL

In chapter 4, the author states the ability to move and act in the face of a threat is crucial for preventing long-term trauma. 

Immobilized or trapped victims’ brains repeat survival strategies long after the threat has passed. 

The right side of the brain (emotional) responds first to danger, but the left side can analyze the situation soon after. 

When the body is unable to respond, the delicate equilibrium between the right and left hemispheres of the brain is disturbed, and the analytical, logical left hemisphere is unable to function in a proper manner.

The author concludes the chapter by saying that dissociation is the essence of trauma. 

Flashbacks and memories of the traumatic event , accompanied by the stress hormones that marked the event itself, cut the patient off from the rest of the world. 

Trauma patients’ brain scans show that they can’t distinguish past from present. The author believes that desensitizing patients to the past isn’t enough; they must learn to live in the present.

BODY-BRAIN CONNECTIONS

In Chapter 5, Charles Darwin’s findings are examined, in which he discovered that humans and animals express the same emotions in the same way. 

Emotions are biologically based and serve the same purpose: to motivate self-preservation.

Darwin noted that strong emotions affect the body and brain.

All emotional signs are produced by the autonomic nervous system (ANS). In this case, the sympathetic nervous system (SNS) responds to sudden danger, while the parasympathetic nervous system (PNS) heals wounds and digests food.

Bessel van der Kolk: “Being able to feel safe with other people is probably the single most important aspect of mental health; safe connections are fundamental to meaningful and satisfying lives.”

Stephen Porges developed Polyvagal theory based on Darwin’s observations in 1994. 

The Polyvagal theory argues that social relationships are key to understanding and treating trauma. Mammals’ complex social interactions led to the development of a system called the ventral vagal complex (VVC), which fosters feelings of empathy among members of the same species. 

In trauma victims, the VVC shuts down for survival, even though this survival response is no longer needed. According to the author, one of the most important aspects of trauma therapy is helping patients move out of survival mode and back into social interaction.

LOSING YOUR BODY, LOSING YOUR SELF

In chapter 6, the findings of some colleagues of van der Kolk Drs. Lanius are discussed. Drs. Lanius discovered trauma patients’ self-sensing systems were severely damaged. 

They had lower self-awareness and self-recognition and felt “less alive.” Another doctor called  Antonio Damasio found that negative memories change how the brain regulates bodily functions. 

The patient has trouble sleeping, no longer enjoys food, and is always anxious.

The author also says traumatized people experience depersonalization. As a result, their bodies are always tense and on guard, and they experience a disconnection from their own bodies. 

To help them re-connect with others and engage in society, they must first make this connection within themselves.

GETTING ON THE SAME WAVELENGTH: ATTACHMENT AND ATTUNEMENT

Chapter 7 explains child trauma’s effects. Children learn to care for themselves by being cared for by their parents. 

John Bowlby describes attachment as a child’s secure base. Babies become attuned to their mothers’ movements and speech when they’re cared for.

Children without secure parent bonds develop coping strategies, such as pretending not to care or crying and screaming constantly. 

Disorganized attachment is a pattern seen in children who have been abused or traumatized and whose caregivers are a source of further distress for the child. 

These children may become physically static, seek affection with strangers, or trust no one. As adults, these children continue to have emotional issues.

TRAPPED IN RELATIONSHIPS: THE COST OF ABUSE AND NEGLECT

In chapter 8, the author elaborates on her earlier points about the effects of trauma on children in their adult lives. 

Self-worth is formed in childhood. Children internalize the positive messages from their parents about how beautiful, special, and valued they are. 

Those who later have abusive partners react with anger and indignation, knowing they don’t deserve it. 

However, those who have experienced trauma and abuse as children are more likely to internalize the belief that they deserve to be abused as adults. 

When people’s feelings run so deep, telling them they shouldn’t feel that way isn’t going to help (despite the fact that this is what many therapists do).

WHAT’S LOVE GOT TO DO WITH IT?

Chapter 9 examines the complexity of trauma and its treatment. 

Many times, trauma patients will be given a variety of different diagnoses and medications by different doctors, all of which will be chosen based on whatever the individual physician considers to be the most important factor in the patient’s case. 

These diagnoses won’t be wrong, but they won’t solve the problem. Mental illnesses and their patients are more complex than labels like “depression” or “PTSD,” and psychiatric diagnoses can’t match physical ones.

A psychiatric disorder diagnosis can have serious consequences, but it’s often arbitrary. Even taking a patient’s history is a difficult and variable process. 

The author notes that childhood traumas are often linked. Childhood trauma often causes obesity, drug abuse, and self-harm. 

Those who resort to self-harming behaviors like cutting or drug use are more likely to have experienced childhood abuse than those who deal with stress through healthy activities like sports or talking to friends.

DEVELOPMENTAL TRAUMA: THE HIDDEN EPIDEMIC

In Chapter 10, the effects of the United States’s failure to provide adequate care for children and other trauma survivors are assessed.

Childhood abuse is the root cause of developmental trauma, which manifests in a person’s inability to form healthy relationships at any point during their life. 

Without strong attachments to their primary caregivers, children are much less likely to be able to successfully navigate the social dynamics of school. 

When they reach puberty without a solid social foundation, they may struggle to form meaningful bonds with others.

The high rates of social dysfunction and incarceration in the United States can be traced back to the country’s failure to recognize the impact of developmental trauma on children. 

The author draws a contrast between the United States and Western European countries, which recognize the problem of developmental trauma and spend more money on diagnosis and treatment while allocating significantly less money to prisons, where many trauma victims end up.

UNCOVERING SECRETS: THE PROBLEM OF TRAUMATIC MEMORY

Chapter 11 analyzes hidden traumas. 

The author makes use of the work of nineteenth-century pioneer Pierre Janet, who differentiated between what he called “narrative memory,” the process by which people recount their traumatic experiences and actual traumatic memories. 

When a traumatic memory is triggered, the victim may reenact it for hours, even though telling the story takes a minute. 

Janet coined the term “dissociation” to describe how his patients separated traumatic memories from their lives.

Bessel van der Kolk Quote: “Neuroscience research shows that the only way we can change the way we feel is by becoming aware of our inner experience and learning to befriend what is going inside ourselves.”

Sigmund Freud developed the “talking cure” at the same time as Janet. 

Even though Freud’s psychoanalytic ideas aren’t popular anymore, the talking cure is still one of the most common treatments for trauma victims. 

Janet observed that many patients reenact their trauma instead of recounting it. The author notes that those without psychiatric training may treat trauma victims as lunatics or criminals.

THE UNBEARABLE HEAVINESS OF REMEMBERING

In chapter 12, the author emphasizes trauma’s long-term effects. He cites soldiers in battle. Their bodies continue to keep score: they’re nauseous, their hearts are racing, and they’re paralyzed with fear.

Survivors of multiple wars experienced similar patterns of repression despite a wide variety of symptoms. War’s extraordinary nature left returning soldiers with a secure present and an unbearable past. 

War creates duality in many subjects, but other trauma patients share the same pattern. The author mentions Nancy, who received insufficient anesthesia during surgery and remained awake. 

She dreamed about this memory first. She had daily flashbacks of the surgical team laughing and gossiping while hurting her.

Healing was a slow process for Nancy, and it didn’t begin until she was able to put her memories in the past and focus on developing a physically strong foundation through Pilates.

HEALING FROM TRAUMA: OWNING YOUR SELF

Chapter 13 examines “taking ownership of oneself” as a way to heal trauma. After a traumatic event, one must regain control of one’s body and mind in order to heal from the experience. 

The author suggests four ways to achieve this: becoming focused and relaxed maintaining that calm in the face of distressing memories and other trigger events, living in the moment and interacting with others, and not keeping secrets from oneself.

Accepting what has happened and developing coping mechanisms are essential first steps on the road to recovery. 

First, comprehend the trauma. An individual’s feelings cannot be altered through understanding, but it may help them fight off the temptation to give in to their emotions. 

The author then discusses ways to keep calm. Yoga can help a patient feel relaxed mentally and physically even when experiencing horrible memories. 

Mindfulness techniques help people notice how thoughts affect physical sensations. Having a strong community and support system in the background is also important for the healing process.

Different therapies work for different people, but the goal is always to reintegrate the traumatic event into the patient’s life so that the mind treats it as a normal memory rather than a constant threat.

LANGUAGE: MIRACLE AND TYRANNY

In chapter 14, van der Kolk shares his views on “language therapy” treating a traumatic event. 

He notes that there is a limit to what can be accomplished by words alone in the process of recovering from traumatic experiences. 

One is that, rather than bringing people together , discussing traumatic experiences might isolate them. In addition, when the language center of the brain shuts down, trauma victims might become completely mute. 

Those with PTSD frequently have a lot harder time expressing themselves than the average person does, and this is true even when the symptoms of trauma are mild.

Too much emphasis on language also increases the risk of approaching therapy as though it were an argument. 

The author argues that restoring the patient’s mental and physical sense of self is more important than disputing with a patient who makes nonsensical assertions.

LETTING GO OF THE PAST: EMDR

In Chapter 15, van der Kolk examines a technique for dealing with traumatic experiences called, EDMR.

Psychotherapist Francine Shapiro discovered the beneficial effects of rapid eye movement on her own distressing memories, which led to the development of EMDR. 

As soon as the author realized how effective it was, he incorporated it into his own therapeutic toolkit; he found that it was especially useful when dealing with patients who did not speak English.

According to the author, eye movement desensitization and reprocessing (EMDR) is a powerful but poorly understood technique for processing traumatic memories, which can help bring previously repressed memories to the surface and establish associations with other memories. 

He explains it as a strategy for reorganizing previously collected data. Although EMDR does spend some time recalling the traumatic event, it serves primarily as a jumping-off point for a more open-ended process of free association. 

Similarly to the mystery surrounding EMDR’s mechanism of action, the same cannot be said of many pharmaceuticals, including the antidepressant Prozac. 

Antibiotic properties of penicillin were discovered in 1928, but the author notes that its mechanism of action wasn’t fully elucidated discovered until 1965. 

This gives him faith that EMDR can eventually be formally recognized as a scientific method.

LEARNING TO INHABIT YOUR BODY: YOGA

Chapter 16 focuses on the positive effects the author has seen yoga have on his patients.

Those with PTSD who have shut down emotionally will have a slower heart rate despite their rapid and shallow breathing. 

As a form of relaxation exercise, hatha yoga can help patients improve their HRV and breathing while also reducing their physical stress.

Asana (Yoga posture) encourages paying attention to one’s breathing and one’s present bodily sensations. 

Some patients reported an improvement in their ability to identify and verbalize their emotions, as well as an increase in their level of physical comfort and confidence.

PUTTING THE PIECES TOGETHER: SELF-LEADERSHIP

In chapter 17, van der Kolk analyzes the way responses to trauma can present.

Mental health issues frequently begin as coping mechanisms. When people are feeling down and ashamed, they often turn to fantasy as a means of coping. 

These survival mechanisms tend to fade into the background fairly quickly in most people, but in trauma patients, they are more likely to stick around for good. Furthermore, each person’s personality consists of different facets. 

Many people’s internal splits are merely temporary states of mind and not distinct identities. 

Nonetheless, traumatic experiences amplify preexisting dissociation and pit the mind’s fragments against one another as if they were entirely distinct individuals.

The author suggests that self-leadership can help with this type of traumatic dissociation. 

In the same way that the person in charge of an organization is responsible for all aspects of that organization, a person needs to have an internal leader who looks out for all aspects of themselves.

FILLING IN THE HOLES: CREATING STRUCTURES

In chapter 18, the author describes other methods to deal with trauma.  

Even if they had otherwise made significant strides in their therapy, many of his patients were still unable to fill the void within themselves. 

The author outlines a technique pioneered by Albert Pesso to build tableaux or “structures” of the past. 

In this therapy model, the patient plays the lead role in a drama while the other participants play supporting roles as significant others in their lives. 

The protagonists direct their own plays, recounting what happened and how they wish the other characters had acted. 

The development of these tableaux enables the protagonist to both reveal the truth and come up with a solution that is more satisfying.

REWIRING THE BRAIN: NEUROFEEDBACK

In chapter 19, the author describes his findings on “neurofeedback” and its impacts on trauma. 

Electroencephalogram (EEG) readings can reveal the specific patterns of brain waves produced by a variety of mental processes (EEG). In 2000, researchers discovered that traumatized people’s brain waves behave differently when viewing both traumatic and non-traumatic imagery. 

This group has trouble forming meaningful patterns and ignoring irrelevant data. 

After considering these findings for seven years, the author finally realized that neurofeedback could be able to help alter these brain wave patterns. 

Through the use of neurofeedback, the brain can be trained to produce more of certain frequencies while suppressing others, thereby generating novel patterns that boost both its inherent complexity and its inclination toward self-regulation.

Bessel van der Kolk: “The greatest sources of our suffering are the lies we tell ourselves.”

The parameters of neurofeedback can be changed to promote and reward some mental characteristics, such as calm, relaxation, and focus, while discouraging others. 

The author has had some success with neurofeedback; patients have reported feeling calmer, more focused, and less anxious after sessions, despite the technique’s youth and the fact that most of its present uses do not entail trauma.

FINDING YOUR VOICE: COMMUNAL RHYTHMS AND THEATER

In chapter 20, van der Kolk shares the advantages that theatre can have on patients dealing with trauma.

Several benefits of theater-based trauma therapy are often overlooked. First of all, many of the most powerful dramas are about traumatic events and serve as catharsis for the audience. 

Putting on a play is a great way to let your guard down and work toward a common goal as part of a team. 

The author describes a foster child who played Ophelia in a production of Hamlet as part of a Shakespeare program. 

She was extremely anxious about the program, but she stuck it out because she knew the play couldn’t go on without her. 

People who have participated in similar theater programs have remarked on the sense of accomplishment they gained from producing something meaningful and feeling “more in the world” than they had before.

Most Important Keywords, Sentences, Quotes

Chapter 1 . lessons from vietnam veterans.

“We have learned that trauma is not just an event that took place sometime in the past; it is also the imprint left by that experience on mind, brain, and body. 

This imprint has ongoing consequences for how the human organism manages to survive in the present. 

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.”

“The greatest sources of our suffering are the lies we tell ourselves.”

CHAPTER 2 – REVOLUTIONS IN UNDERSTANDING MIND AND BRAIN

Chapter 3 – looking into the brain: the neuroscience revolution, chapter 4 –  running for your life: the anatomy of survival.

“Psychologists usually try to help people use insight and understanding to manage their behavior. 

However, neuroscience research shows that very few psychological problems are the result of defects in understanding; most originate in pressures from deeper regions in the brain that drive our perception and attention. 

When the alarm bell of the emotional brain keeps signaling that you are in danger, no amount of insight will silence it.”

CHAPTER 5 – BODY-BRAIN CONNECTIONS

“Being able to feel safe with other people is probably the single most important aspect of mental health; safe connections are fundamental to meaningful and satisfying lives.”

CHAPTER 6 – LOSING YOUR BODY, LOSING YOUR SELF

“Traumatized people chronically feel unsafe inside their bodies: The past is alive in the form of gnawing interior discomfort. 

Their bodies are constantly bombarded by visceral warning signs, and, in an attempt to control these processes, they often become expert at ignoring their gut feelings and of what is played out inside. 

They learn to hide from their selves.”

CHAPTER 7 – GETTING ON THE SAME WAVELENGTH: ATTACHMENT AND ATTUNEMENT

Chapter 8 – trapped in relationships: the cost of abuse and neglect, chapter 9 – what’s love got to do with it.

“As the ACE study has shown, child abuse and neglect is the single most preventable cause of mental illness, the single most common cause of drug and alcohol abuse, and a significant contributor to leading causes of death such as diabetes, heart disease, cancer, stroke, and suicide.”

CHAPTER 10 – DEVELOPMENTAL TRAUMA: THE HIDDEN EPIDEMIC

Chapter 11 – uncovering secrets: the problem of traumatic memory, chapter 12 – the unbearable heaviness of remembering..

“The essence of trauma is that it is overwhelming, unbelievable, and unbearable. 

Each patient demands that we suspend our sense of what is normal and accept that we are dealing with a dual reality: the reality of a relatively secure and predictable present that lives side by side with a ruinous, ever-present past.”

CHAPTER 13 – HEALING FROM TRAUMA: OWNING YOUR SELF

“Neuroscience research shows that the only way we can change the way we feel is by becoming aware of our inner experience and learning to befriend what is going inside ourselves.”

CHAPTER 14 – LANGUAGE: MIRACLE AND TYRANNY

“As long as you keep secrets and suppress information, you are fundamentally at war with yourself […]The critical issue is allowing yourself to know what you know. That takes an enormous amount of courage.”

CHAPTER 15 – LETTING GO OF THE PAST: EMDR

Chapter 16 – learning to inhabit your body: yoga, chapter 17 – putting the pieces together: self-leadership.

“Beneath the surface of the protective parts of trauma survivors there exists an undamaged essence, a Self that is confident, curious, and calm, a Self that has been sheltered from destruction by the various protectors that have emerged in their efforts to ensure survival. 

Once those protectors trust that it is safe to separate, the Self will spontaneously emerge, and the parts can be enlisted in the healing process.”

CHAPTER 18 – FILLING IN THE HOLES: CREATING STRUCTURES

Chapter 19 – rewiring the brain: neurofeedback, chapter 20 – finding your voice: communal rhythms and theater, book review (personal opinion):.

The book “The Body Keeps the Score” breaks out the ways in which traumatic experiences can have an effect on our minds, brains, and bodies. 

The author examines a variety of therapeutic approaches, highlighting both their benefits and their drawbacks. 

Van der Kolk interweaves autobiographical and biographical stories throughout the technical components of the book.

These stories enable the reader to gain a better understanding of what has happened in the field of psychiatry and psychology in relation to trauma, as well as what has not happened. 

The stories aid to firmly establish both the imagination and the capacity to comprehend what it is that he is trying to say.

The book is written in a somewhat technical manner, covering topics such as neuroscience, brain studies, physiology, and several professional acronyms. 

However, the author makes an effort to disclose all relevant information to readers. This book has excellent writing and offers both insight and knowledge on the subject of traumatic experiences.

Rating : 10/10

This Book Is For:

• Anybody who wants to know about his or her traumatic experiences in a researched manner • Students or psychologists who want to get deeper into trauma and its effects • People who want to understand how a loved one may feel after a traumatic experience.

If You Want To Learn More

Here is the presentation of Bessel van der Kolk’s book “The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma”

How I’ve Implemented The Ideas From The Book

.When it comes to traumatic experiences, I came to the realization that the connection between the bodily and the psychological aspects is really significant. 

I became aware that I was, as many people do, bottling up a lot of feelings inside of my body. That’s why I’m starting to practice mindfulness on a daily basis.

One Small Actionable Step You Can Do

One of the first steps to getting over trauma is to understand what happened and why we can’t feel peace and joy. 

The mind turns off its emotional ability to survive through horrifying despair, but in doing so, it also shuts down the positive emotions. 

If you suffer from chronic pain, fatigue, anxiety, or depression, those symptoms are your body’s way of letting you know that it needs to let out something. 

When that happens, the emotional mind comes back to life, and after a lot of grief, anger, sadness, and fear, there is room for peace and joy.

The-Body-Keeps-the-Score-Bessel-van-der-Kolk-Book-Summary-Infographic

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The Body Keeps The Score Summary and Infographic | Bessel van der Kolk

posted on March 25, 2022

Brain, Mind, and Body in the Healing of Trauma

The Body Keeps The Score summary by chapter cliff notes

Life gets busy. Has The Body Keeps The Score been on your reading list? Learn the key insights now.

We’re scratching the surface in The Body Keeps The Score summary. If you don’t already have the book, order it here or get the audiobook for free to learn the juicy details.

Bessel Van der Kolk’s Perspective

Bessell Van der Kolk , MD, is a qualified psychiatrist. He specializes in the field of post-traumatic stress, which led him to write over 150 peer-reviewed scientific articles, the majority of them about post-traumatic stress. Van der Kolk, originally from the Netherlands, has also served as president of the International Society for Traumatic Stress Studies. He is currently a professor of psychiatry at Boston University School of Medicine. 

Listen to the Audiobook Summary of The Body Keeps The Score

Introduction.

The Body Keeps the Score is an innovative book by psychiatrist and trauma expert Van der Kolk. We all understand the effect that psychological trauma can have on individuals. Trauma can impact the way people perceive themselves and the world around them. Psychological trauma can have a lasting impact on the individual’s loved ones as well. In this book, Van der Kolk covers the intricacies of how trauma produces these effects by considering the neuroscience involved. Van der Kolk also presents ways neuroscience allows us to produce new, effective treatments for psychological trauma survivors. Examples of these approaches include eye movement desensitization and reprocessing, yoga, and limbic system therapy. Van der Kolk guides us through these modern therapies by recalling his career and the patients he has seen. So this book also serves as a history of the mental health field of the last 30 years. 

After learning these storyshots, you will better understand how our brains react to and deal with psychological trauma. What Van der Kolk recommends is helping survivors of psychological trauma to recover.

StoryShot #1: Antidepressants Ruined Mental Health Support 

Van der Kolk describes how he and other researchers/therapists were so excited when antidepressants were first introduced. He now believes that our overuse of these medications has led us to treat mental illness as a disease. Unfortunately, this approach means that the following things have been removed from mental health support:

  • The belief that we can heal each other in the same way we can destroy each other
  • Language that is critical to providing us with the power to change circumstances
  • Controlling our physiology by using breathing, moving, and touching techniques, rather than by resorting to medication
  • An inclination to change social conditions so that people feel safer and are then able to thrive

StoryShot #2: The Development of Our Understanding of Trauma

Van der Kolk’s early research played a massive part in reigniting ideas surrounding trauma. 

Trauma and its association with mental health were supposedly first discovered by Pierre Janet in the late 1800s. Janet is one of the founding fathers of psychology. He was also one of the first to identify how previous events in a person’s life can lead to present-day trauma. He defined the terms dissociation and subconscious , both of which are still used today in conversations surrounding trauma. 

Van der Kolk describes his early research on veterans. Rorschach tests found that trauma can distort the brain’s perceptions of reality. These tests were integral to the way Van der Kolk later approached his therapy sessions with survivors of incest. That’s when he began treating patients through a ‘trauma lens.’ Working with veterans allowed him to understand the remarkable courage that it takes for trauma victims to recall their trauma. 

Van der Kolk also applied this trauma lens to a broader range of individuals, revealing that trauma was far more widespread. Trauma can result from any experience of extreme stress or pain that leaves the individual with feelings of helplessness. 

StoryShot #3: Trauma Influences Relationships

Van der Kolk also acknowledged that trauma has a significant impact on the people around the survivor. Traumatized individuals often have Post-Traumatic Stress Disorder (PTSD), leading to depression and substance abuse. Traumatized individuals can struggle to trust others. They assume nobody can understand what happened to them and why they keep reliving it. 

Van der Kolk gave an example of this phenomenon by writing about a group therapy session he provided for war veterans. The group also helped veterans find new friends to share their experiences with. That said, those who weren’t traumatized were considered outsiders by those who were. This prejudice meant Van der Kolk was also an outsider in the traumatized group’s eyes. To overcome this hurdle, Van der Kolk had to provide weeks of listening, empathizing, and building trust. This story shows that we must build rapport with the traumatized before we can expect any trust from them. Often trauma is caused by trusted people in the first place. So it is essential to understand that regaining trust is difficult for traumatized people.

StoryShot #4: Therapy Can Treat Trauma

Van der Kolk described how the brain’s health and adaptive responses to stressors are key to producing action. Think of the “fight or flight” responses. Both require action to end the stress. Issues arise when stress is overwhelming, such as with a traumatic event that can block the body’s adaptive response and prevent the required action. This suggests why eye movement desensitization and reprocessing (EMDR) is vital. This therapy helps the traumatized person to process information adaptively.  

StoryShot #5: Brain Scanning Suggests You Should Take Action

Treating hopelessness or inertia is extremely important. Hopelessness has been described as the most impactful feature of trauma. Action is key to healing because it shuts down the fight or flight survival mechanism, signaling safety. As this survival response can be blocked by trauma, our brain continues to secrete stress hormones. Van der Kolk likens this to a smoke detector always going off. So, even when you are not currently experiencing this stressor, your body is still reacting as if you are. Stress hormones are particularly impactful because they limit the activity of the brain in an area called the prefrontal cortex . The prefrontal cortex is arguably the most crucial part of the brain, as it is involved in all decision making. While reliving the trauma, the amygdala and the limbic system run at maximum speed. This overdrive means the part of the brain and the system associated with emotions are always overactivated. 

This reaction can be described as ‘bottom-up’ processing. Van der Kolk explains that we should develop therapies that encourage the recalibration of both ‘top-down’ and ‘bottom-up’ processing. The brain’s watchtower (prefrontal cortex) should then be better able to monitor our body’s reactions. 

Ways to strengthen top-down mental regulation are:

  • Mindfulness meditation

Ways to recalibrate bottom-up mental regulation are:

StoryShot #6: How Therapists Should Approach Treating Trauma

Therapy for traumatized individuals needs to leverage both top-down and bottom-up mental regulation techniques, including mindfulness, yoga, breathing, movement and touch. . Dissociation is the essence of trauma, as adverse experiences fragment our everyday lives. Here is a summary of how therapists should approach treating trauma:

  • Help clients to reactivate a sense of self in the physical body. Mindfulness helps to do exactly that.
  • Draw out blocked sensory information and help the client to befriend, not suppress, bodily responses.
  • Complete the self-preserving physical actions that were thwarted when the survivor was restrained or immobilized by terror.
  • Assist clients through imagination . Our brain does not know the difference between real life and imagination, as evidenced by dreams. This means imagination is fundamental to helping the traumatized heal.

StoryShot #7: Early Trauma Changes Neuroanatomy

Self-regulation is learned from early caregivers through mirror neurons, empathy, and imitation. Early trauma changes how the brain is wired, and neither drugs nor conventional therapy can erase those changes in the brain. Van der Kolk cites his research to show that the vast majority of children’s mental health issues are due to trauma.  

Sadly, despite this fact, Van der Kolk has lost his battle to have the diagnosis of child Developmental Trauma Disorder added to the DSM-5 (Diagnostic Statistical Manual of Mental Disorders). He wanted it included as a replacement for the majority of childhood diagnoses. Van der Kolk attributes the rejection to the substantial monetary value derived from the DSM.

Diagnoses should lead us to interventions. Van der Kolk asserts that our current child diagnoses describe behavioral and emotional symptoms resulting from trauma. 

StoryShot #8: Traumatic Memories Are Disorganized

Healthy and traumatic brains both store perceptions of experience in neural networks. That said, the critical difference between them is their level of arousal. Charcot and Pierre Janet were the first to talk about PTSD as being characterized by intense emotional arousal. Freud also provided talking cures that focused on an energetic reaction being connected to the memory, and the resolution is to release or sever this connection. Van der Kolk explained that this dissociation involves isolating oneself with this memory and its emotional connection.

Van der Kolk explains that research shows that positive and traumatic memories differ in structure. Positive memories have a beginning, a middle, and an end. Traumatic memories are disorganized, fragmented, and appear as images, physical sensations, and intense emotions. 

The American psychologist, Francine Shapiro, believed that unprocessed memories are the basis of pathologies. These memories prevent our brain from adaptively updating our neural pathways. But our brains are neuroplastic, so developments in neuroscience and knowledge of how our brains can be changed provide great hope for our ability to assist others toward mental health and well-being. 

StoryShot #9: Restore the Balance Between Your Emotional and Rational Brain

Van der Kolk’s directive to effective trauma therapy includes the following tips:

  • Find a way to be calm in all moments. Learn to maintain your calmness and focus even when triggered by past thoughts or emotions.
  • Learn to be fully alive in the present. Remain engaged with others and with the present moment.
  • Try to remain truthful to yourself. Remaining truthful includes how you managed to survive the trauma.

In summary, overcoming trauma is about restoring the balance between the rational (prefrontal cortex) and emotional (amygdala) parts of the brain. You should use breathing techniques (also known as breathwork) to manage hyperarousal, mindfulness to strengthen your self-awareness, and strong relationships and support networks developed to help you move towards recovery. 

Beyond this basic foundation, Van der Kolk provides many suggestions for therapy options, including:

  • Schwartz’s Internal Family Systems
  • Pesso PBSP psychomotor therapy
  • Neurofeedback
  • Movement 

One of the most effective therapies for trauma is yoga. Van der Kolk explains that your body and mind have a close relationship. So a balanced life depends on understanding how your emotions work and how these emotions impact your body. Trauma can make this relationship between your body and mind particularly hard to understand. For example, traumatized individuals have a hypersensitive alarm system.

To tackle this disconnect between body and mind, post-traumatic people will turn to things that will numb their feelings. But this tends to do more harm than good. An alternative that aims to help you get in touch with your emotions is yoga. Van der Kolk explains that he has had many patients successfully encourage signals about their emotional state by using yoga. Yoga allows traumatized individuals to adopt stereotypically vulnerable positions within a safe environment. 

Mindfulness

Mindfulness has a similar potential for allowing traumatized individuals to get in touch with their emotions. Mindfulness’ primary goal is to help people maintain a conscious awareness of their bodies and emotions rather than denying them. Trauma is often associated with denial of emotions as a way of repressing difficult memories. This denial prevents traumatized individuals from starting the healing process. 

Mindfulness has consistently been able to alleviate some of the psychological and physiological effects of trauma. Research also suggests that mindfulness can improve biological immune responses and activate the regions of the brain that regulate emotions.

StoryShot #10: Try to Process Traumatic Experiences Like Other Experiences

There are clear differences between the ways we remember traumatic memories and non-traumatic memories. Traumatic memories are heavily reliant on sensory and emotional fragments. This is because our brains are overwhelmed by the shock of traumatic events and so we struggle to process all the information. A vital part of overcoming trauma is trying to remember the details of these experiences. If a person can process this information, they will be better equipped to put the structures in place to start overcoming trauma.

Final Summary and Review of The Body Keeps The Score

The Body Keeps the Score is an overview of the relationship between our bodies and minds. Van Der Kolk uses his years of experience researching, diagnosing and treating PTSD to offer guidance on the strong relationship between trauma and our bodies. He challenges the common view that drugs are the cure for traumatic experiences. The alternative is to better understand how trauma affects our mind and body, and how we can change the way we process this information. 

We rate The Body Keeps the Score 4.6/5.

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Editor’s Note

First published in March 2021. Updated in March 2022.

This is an unofficial summary and analysis.

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The Body Keeps the Score

47 pages • 1 hour read

The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma

A modern alternative to SparkNotes and CliffsNotes, SuperSummary offers high-quality Study Guides with detailed chapter summaries and analysis of major themes, characters, and more.

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Prologue Summary: “Facing Trauma”

The Body Keeps the Score opens with an overview of the text to come. Van der Kolk introduces all of the various threads that he will cover, stating: “I wrote this book to serve as both a guide and an invitation” (4). He provides a brief explanation of his own interest in psychiatry and mentions that he has been working in the field of trauma for over 30 years, often with support from a variety of major medical and granting organizations.

Van der Kolk includes a brief clinical explanation of what trauma is, how it affects the mind and body, and which areas of research address it: neuroscience, developmental psychopathology, and interpersonal neurobiology. He offers the suggestion that “Research from these new disciplines has revealed that trauma produces actual physiological changes” (2). Van der Kolk notes several avenues by which people commonly become traumatized—combat, abuse, and sexual abuse in particular—and mentions some of what he will cover in the rest of the text, including the treatment methods that he will cover in Part 5. 

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  • The body keeps the score :

The body keeps the score : brain, mind, and body in the healing of trauma /

The body keeps the score : brain, mind, and body in the healing of trauma /

An expert on traumatic stress outlines an approach to healing, explaining how traumatic stress affects brain processes and how to use innovative treatments to reactivate the mind's abilities to trust, engage others, and experience pleasure--

  • Description
  • Table of Contents

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  • Prologue : Facing trauma
  • Part I. The rediscovery of trauma. Lessons from Vietnam veterans ; Revolutions in understanding mind and brain ; Looking into the brain: the neuroscience revolution
  • Part II. This is your brain on trauma. Running for your life: the anatomy of survival ; Body-brain connections ; Losing your body, losing your self
  • Part III. The minds of children. Getting on the same wavelength: attachment and attunement ; Trapped in relationships: the cost of abuse and neglect ; What's love got to do with it? ; Developmental trauma: the hidden epidemic
  • Part IV. The imprint of trauma. Uncovering secrets: the problem of traumatic memory ; The unbearable heaviness of remembering
  • Part V. Paths to recovery. Healing from trauma: owning your self ; Language: miracle and tyranny ; Letting go of the past: EMDR ; Learning to inhabit your body: yoga ; Putting the pieces together: self-leadership ; Filling in the holes: creating structures ; Applied neuroscience: rewiring the fear-driven mind with brain/computer interface technology ; Finding your voice: communal rhythms and theater
  • Epilogue : Choices to be made
  • Appendix : Consensus proposed criteria for developmental trauma disorder.
  • Principles of trauma therapy : a guide to symptoms, evaluation, and treatment / by: Briere, John Published: (2006)
  • The Oxford handbook of traumatic stress disorders / Published: (2012)
  • Optimization of research and clinical applications for combat-related posttraumatic stress disorder (PTSD) : progress through modern translational methodologies / by: Norrholm, Seth D. Published: (2010)
  • The Oxford handbook of traumatic stress disorders / Published: (2020)
  • Trauma sequelae / Published: (2022)

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Summary of The Body Keeps the Score by Bessel van der Kolk

  • Post published: December 25, 2023
  • Post category: Summaries
  • Post last modified: December 25, 2023

112a

Summary : 45 min

Book reading time: 10h40

Score: 9/10

Book published in: 2014

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  • Trauma changes the structure of the brain by keeping the victim in an abnormal emotional state.
  • Being traumatized means continuing your life as if the trauma was still going on.
  • Some victims’ bodies shut down and feel numb as a result of trauma. Others feel constantly stressed and on the edge. Others have their trauma reactivated due to environmental cues. Others strive to maintain extreme control which leads to fatigue or autoimmune diseases.
  • As long as the trauma is not resolved, the stress hormones remain in the body as the defensive movement that responded to the threat keeps getting replayed. The more the trauma is replayed, the more engrained into the mind it becomes.
  • Traumatized don’t relate well with others because they feel disgusting and shameful.
  • Solving traumas means retraining the body to recognize that the danger has passed and that it can relax. This means becoming familiar with and befriending the sensations in their bodies.
  • Traumas are solved through integration, not desensitization. The purpose is to put the trauma “in the past” so that its consequences have no effects on the present.

Social support is the most powerful protection against being overwhelmed by stress and trauma.

  • EMDR is an effective technique for people who were traumatized as adults.
  • Yoga is effective for people who were physically traumatized and whose bodies shut down. It helps them reinhabit and feel good in their bodies.
  • IFS and PBSB are effective for people who were badly treated as kids and developed unhealthy relationships as adults as a result.
  • Neurofeedback also helps people who were particularly traumatized as kids.
  • Theater and communal rhythms help those ashamed of their bodies and their emotions. It helps them relax and reconnect with themselves. Choral singing, aikido, tango dancing, improvisation, or kickboxing also work.
  • CBT is advised only when there’s a need to desensitize to fear and phobias. Talking about traumas rarely solves them, and often reinforces them instead.
  • Therapeutic massage, Feldenkrais, acupuncture, or craniosacral therapy help people feel food in their bodies.
  • Sensorimotor psychotherapy and somatic experiencing are great for those stuck in learned helplessness.
  • Writing to yourself about what happened helps you move forward.

Table of Contents

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What The Body Keeps the Score Talks About

The Body Keeps the Score is a book written by the psychiatrist and trauma specialist Dr. Bessel van der Kolk. It explains the effects of trauma on the body and discusses several methods (EMDR, yoga, IFS, PBSB, neurofeedback, theater) for their resolution.

The book is among one of the highest rated on Amazon with 4.8.

Is it that good? Well, it’s not bad. But it’s in no way revolutionary. One thing I learned was that CBT doesn’t work as well as often claimed as traumas must be solved by taking the body into account along with the mind.

So, how do you know which method is good for you?

You try. EMDR, IFS, and neurofeedback will be quick to show results. PBSB will take a bit more time. Yoga and theater are long-term methods, but they can’t do you any wrong.

Should you read the book?

Unless you really want to know what happens inside a traumatized brain, no.

Just read this summary.

Get the book here.

Summary of The Body Keeps the Score Written by Bessel van der Kolk

Prologue: facing trauma.

Traumatized people struggle to regulate their emotions or/and fail to bond emotionally with others. Trauma affects everyone, both the victim and their entourage.

Long after the trauma, any minor cues can reactivate it, inflicting a great deal of suffering onto the survivors who feel like they’re damaged to the core.

While we all want to move beyond trauma, the part of our brain that is devoted to ensuring our survival is not very good at denial.

Trauma isn’t purely “psychological”; it produces physiological changes, including a recalibration of the brain’s alarm system, an increase in stress hormone activity, and the alterations in the system that filter relevant from irrelevant information.

Trauma compromises the brain area that communicates the physical, embodied feeling of being alive. These changes explain why traumatized individuals become hypervigilant to threat at the expense of spontaneously engaging in their day-to-day lives.

Thankfully, we have developed methods enabling individuals to fully come back to the present moment. There are three different kinds:

  • Top-down : talking and reconnecting with others.
  • Taking medicines .
  • Bottom-up : by allowing the body to have experiences that deeply and viscerally contradict the helplessness, rage, or collapse that result from trauma.

These methods can be combined.

Part One: The Rediscovery of Trauma

Chapter 1: lessons from vietnam veterans.

Many Vietnam veterans came back traumatized from the war, drowning their feelings into addictions or going on violent tantrums at the slightest cue reminding them of their experiences.

At the time, there was little literature about the topic.

Trauma, whether it is the result of something done to you or something you yourself have done, almost always makes it difficult to engage in intimate relationships.

The worst symptom for soldiers was that they felt emotionally numb.

He desperately wanted to love his family, but he just couldn’t evoke any deep feelings for them. (…) He could not really feel anything except for his momentary rages and his shame.

Traumatized people superimpose their trauma on everything around them and struggle to understand what’s going on around them.

They can’t bridge the gap between their traumatized experiences and their current lives. The very event that caused them so much pain becomes their sole source of meaning. They only feel fully alive when they’re revisiting their traumatic past.

Traumas manifest themselves as memories that the victim cannot leave in the past.

While talking about it provides relief, it’s not enough. The bodies remain hypervigilant, prepared for defense.

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.

Chapter 2: Revolutions in Understanding Mind and Brain

Traumatized patients in the ward where the author worked had no coordination and often could not cooperate with others – at all.

Most human suffering is related to love and loss; the job of therapists is to help people “acknowledge, experience, and bear” the reality of life.

The greatest sources of our suffering are the lies we tell ourselves.

Healing depends on experiential knowledge: You can be fully in charge of your life only if you can acknowledge the reality of your body.

Many traumatized people get into a state of learned helplessness, described as the inability to escape abuse even when you have the chance to -> traumatized people give up.

Rather than risk experimenting with new options they stay stuck in the fear they know.

The fight/flight response is thwarted. The stress hormone remains at high levels even after the danger has passed.

Experiments have shown that scared animals return home in case of more fear, even if the home was scary and painful.

Addicted to Trauma: The Pain of Pleasure and the Pleasure of Pain

Many traumatized people feel bored when not in an extreme mood (anger, fear, etc). Many others get addicted to being in a situation that gave them their initial trauma -> they often have to enroll in a rehab program to get better.

Freud named this “the compulsion to repeat”. He believed that reenactments were an unconscious attempt to get control over a painful situation and that it could lead to mastery and resolution. There is no proof of this theory .

In fact, reliving a trauma many times in therapy can reinforce it.

New emotions create new chemical balances in the body. People can even get addicted to the pleasure they feel after pain (eg: running) which compels them to keep going.

This may be why traumatized people reenact their trauma.

In the brain, the amygdala is tasked to judge whether a sound, image, or sensation is perceived as a threat or not. The sensitivity of the amygdala depends partly on how much serotonin is present in that part of the brain.

High-status monkeys had high levels of serotonin; low-status monkeys did not. Low-status monkeys given high levels of serotonin became high-status monkeys.

That’s what Prozac does, but it doesn’t work for everyone and we don’t know why.

While drugs helped many, they also caused harm by propagating the idea that trauma was a consequence of a chemical imbalance in the brain. This has led doctors and insurance companies to take over people’s fate based on the brain-disease model.

Furthermore, despite abundant antidepressant prescriptions, depression has not decreased.

The brain-disease model overlooks four fundamental truths:

  • We can destroy one another as much as we can heal one another. Restoring relationships and community is central to restoring well-being.
  • Language gives us the power to change ourselves and others by communicating our experiences, helping us to define what we know, and finding a common sense of meaning.
  • We have the ability to regulate our own physiology, including some of the so-called involuntary functions of the body and brain, through such basic activities as breathing, moving, and touching.
  • We can change social conditions to create environments in which children and adults can feel safe and where they can thrive.

When we ignore these principles, we deprive people of the way of healing from trauma.

Being a patient rather than a participant alienates people from an inner sense of self (control).

Chapter 3: Looking Into the Brain: The Neuroscience Revolution

When the scanning technology was invented (PET and fMRI), doctors observed that when traumatized patients thought about trauma, the amygdala was bright (it’s the center of emotions, among other things) while the Broca’s area underwent a decrease in activity preventing the person from expressing their feelings.

Even years later traumatized people often have enormous difficulty telling other people what has happened to them. Their bodies reexperience terror, rage, and helplessness, as well as the impulse to fight or flee, but these feelings are almost impossible to articulate.

Brodmann’s area 19 also lit up. This is a region that registers images when they’re seen for the first time.

When something reminds traumatized people of the past, the right part of the brain reacts as if the traumatic event was happening in the present.

But because their left brain is not working very well, they may not be aware that they are reexperiencing and reenacting the past—they become just furious, terrified, enraged, ashamed, or frozen.

Traumatized people relive the memory of the trauma as if it was happening to them for the first time, so the stress level goes disproportionally high and slows to come back down.

In some other people, the mind denies what happened but the body still shows the signs.

This is why sometimes, talking about the event is not enough as the trauma gets in the way of its own resolution.

No matter how much insight and understanding we develop, the rational brain is basically impotent to talk the emotional brain out of its own reality.
They continued to be “there” and did not know how to be “here”—fully alive in the present.

Part Two: This Is Your Brain on Trauma

Chapter 4: running for your life: the anatomy of survival.

During disasters young children usually take their cues from their parents. As long as their caregivers remain calm and responsive to their needs, they often survive terrible incidents without serious psychological scars.

Traumatized people become stuck. They stop growing because they can’t integrate new experiences into their lives.

Being traumatized means continuing your life as if the trauma was still going on. Every new encounter or event is contaminated by the past as the world is experienced with a different nervous system.

The victim focuses their energy on suppressing inner chaos at the expense of spontaneity.

Attempting to maintain control over these physiological reactions can lead to lots of different physical symptoms including fibromyalgia, chronic fatigue, and other autoimmune diseases.

This is why you need to engage your body and mind when treating traumas.

When we flee, the old brain takes over and shuts down the higher brain which contains our conscious mind, etc.

When the fight/flight option isn’t available, the brain keeps on secreting stress hormones long after the actual events have passed.

This intervenes and changes the parts of the brain that deal with survival.

The most important job of the brain is to ensure our survival, even under the most miserable conditions. Everything else is secondary.

To do that, the brain:

  • Generate signals about needs that our body acts on (food, rest, protection, sex, and shelter)
  • Create a map of the world to point us to where to go to satisfy those needs.
  • Generate the necessary energy and actions to get us there.
  • Warn us of dangers and opportunities along the way.
  • Adjust our actions based on the requirements of the moment.

Psychological problems occur when our internal signals don’t work (we can’t get where we need to go, our actions don’t correspond to our needs, and our relationships break down).

Let’s look at the structure of the brain. The brain is built from the bottom up.

  • The reptilian brain is the most primitive part. It’s responsible for basic life-sustaining activities.
  • The limbic system is tasked with the identification and expression of emotions. Its development starts after birth.

image 1

The brain develops according to how it is used: neurons that fire together, wire together. After a while, a specific circuit becomes default.

If you feel safe and loved, your brain becomes specialized in exploration, play, and cooperation; if you are frightened and unwanted, it specializes in managing feelings of fear and abandonment.

Taken together the reptilian brain and limbic system make up the “emotional brain”.

The emotional brain is at the heart of the nervous system; its key task is to look out for your welfare . When it sees an opportunity (for food, mating, etc), it tells you to move to get it.

The emotional brain’s organization is simpler than the one of the rational brain. As a result, it jumps to conclusions faster than the rational brain.

The emotional brain initiates preprogrammed escape plans, like the fight-or-flight responses.

image

Threats are processed in two ways.

The fast one : the thalamus sends a message to the amygdala (some sort of smoke detector). If it estimates the threat is worth fleeing, it sends a message to the hypothalamus which secretes stress hormones.

If not, it sends a message to the prefrontal cortex, which takes longer to decide. People with PTSD tend to use their amygdala even in situations that don’t warrant it.

Once the danger has passed, the body recovers to its normal state. But when recovery is blocked, the body remains agitated.

Trauma leads to misinterpreting whether a situation is dangerous or safe. One can get along with others only if they can accurately decide if they’re “safe” or not.

If the amygdala is a smoke detector, the medial prefrontal cortex (MPFC) is a watchtower. When it breaks down like under PTSD, we constantly remain in a fight or flight mode.

Effectively dealing with stress depends upon achieving a balance between the amygdala and the MPFC .

You can learn to do that top-down, or bottom-up.

  • Top-down : strengthen the capacity of the watchtower to monitor your body’s sensations. Mindfulness meditation and yoga can help with this.
  • Bottom-up : recalibrate the autonomic nervous system through breath, movement, or touch.
Emotion is not opposed to reason; our emotions assign value to experiences and thus are the foundation of reason. Our self-experience is the product of the balance between our rational and our emotional brains.

When the rational and the emotional are in balance, we feel like being ourselves. But when survival is at stake, they can work independently.

Whenever the limbic system decides that something is a question of life or death, the pathways between the frontal lobes and the limbic system become extremely tenuous.
Dissociation is the essence of trauma. The overwhelming experience is split off and fragmented, so that the emotions, sounds, images, thoughts, and physical sensations related to the trauma take on a life of their own.

As long as the trauma is not resolved, the stress hormones remain in the body as the emotional response from the defensive movement keeps getting replayed. The more the trauma is replayed, the more engrained into the mind it becomes.

The flashbacks can be even worse than the trauma itself; people suffering from flashbacks often organize their lives to protect themselves against them which is exhausting. Being stuck in the past prevents them from being in the present and feeling fully alive.

This is where therapy comes in: it helps sense, name, and identify what is going on inside.

It’s important to have an efficient smoke detector (…) you need to detect whether somebody is getting upset with you, but if your amygdala goes into overdrive, you may become chronically scared that people hate you, or you may feel like they are out to get you.

Two brain systems are relevant for the mental processing of trauma:

  • Amygdala and medial prefrontal cortex : deal with emotional intensity.
  • Dorsolateral prefrontal cortex (DLPFC) and the hippocampus : context and meaning of an experience.

The DLPFC tells us how our present experience relates to the past and how it may affect the future. It signals that whatever begins will eventually end. This is why people should feel calm and secure when talking about traumas in therapy – so that they can activate these parts of the brain that shut down when the trauma happened.

Trauma is the ultimate experience of “this will last forever.”
Being anchored in the present while revisiting the trauma opens the possibility of deeply knowing that the terrible events belong to the past. For that to happen, the brain’s watchtower, cook, and timekeeper need to be online. Therapy won’t work as long as people keep being pulled back into the past.
People with PTSD have their floodgates wide open. Lacking a filter, they are on constant sensory overload. In order to cope, they try to shut themselves down and develop tunnel vision and hyperfocus. The tragedy is that the price of closing down includes filtering out sources of pleasure and joy, as well.

The other way to deal with trauma is going blank, also called “depersonalization”.

Anyone who deals with traumatized men, women, or children is sooner or later confronted with blank stares and absent minds, the outward manifestation of the biological freeze reaction.

People who experiment with depersonalization become lifeless which makes it hard for the therapist to focus. This is where a bottom-up approach is necessary.

Many people start out with flashbacks, then move on to numbing.

The challenge of trauma treatment is not only dealing with the past but, even more, enhancing the quality of day-to-day experience.

One reason why traumatic memories become dominant in PTSD is that it’s so difficult to feel truly alive right now, so you go back to a moment when you felt truly alive – during the trauma.

Many treatments focus on desensitizing patients to their past, but the real purpose should be to help them live in the present.

To do that, we need to bring back the areas of the brain that went numb during the trauma.

If you cannot feel satisfaction in ordinary everyday things like taking a walk, cooking a meal, or playing with your kids, life will pass you by.

Chapter 5: Body-Brain Connections

In The Expression of the Emotions in Man and Animals , Charles Darwin noticed that humans shared their emotions with animals which led him to deduce that they likely had a biological basis and origin.

Emotions are conveyed by the muscles of the body and face and are instinctively read by other people. For Darwin, emotions are the indispensable source of motivation to initiate action, but serve also to restore the organism to safety and physical equilibrium.

He also wrote that being in a constant fight or flight mode was detrimental since the animal could not ensure its own survival by reproducing, sheltering, or feeding (activities that demand one to be relaxed).

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.

Emotions are also felt in the gut and heart (chest).

The signs about our and others’ bodies are linked by the two branches of the autonomic nervous system:

  • The sympathetic nervous system acts as the body’s accelerator (responsible for arousal, including the fight-or-flight response). Activates with deep breaths.
  • The parasympathetic serves as its brake (promotes self-preservative functions like digestion and wound healing). Activates with deep exhalations.

Human beings are sensitive to subtle emotional shifts in people. Slight changes (tension of the brow, wrinkles around the eyes, curvature of the lips) inform about how comfortable, suspicious, relaxed, or frightened someone is.

Our mirror neurons register other people’s inner experiences and our own bodies make internal adjustments to whatever we notice. When the message we receive from others is that they’re safe to be with, we relax.

If we’re lucky in our relationships, we also feel nourished, supported, and restored as we look into the face and eyes of the other.
Our culture teaches us to focus on personal uniqueness, but at a deeper level we barely exist as individual organisms. Our brains are built to help us function as members of a tribe. Most of our energy is devoted to connecting with others.
Almost all mental suffering involves either trouble in creating workable and satisfying relationships or difficulties in regulating arousal (becoming enraged, shut down, overexcited, or disorganized).
Being able to feel safe with other people is probably the single most important aspect of mental health; safe connections are fundamental to meaningful and satisfying lives.

Social support ≠ being with other people. Social support means having a relationship (being heard and validated.)

Many traumatized people find themselves chronically out of sync with the people around them.

They find friends in other traumatized people. They can hardly bond with those who haven’t been traumatized.

Isolating oneself into a narrowly defined victim group promotes a view of others as irrelevant at best and dangerous at worst, which eventually only leads to further alienation.

Traumatized people experience the world differently after the trauma, usually in three different ways:

There are three physiological states we get in, regulated by the nervous system and based on how safe we feel.

Being social depends on nerves located in the vagus, linking to nerves that activate the muscles of the face, throat, middle ear, and voice box or larynx.

When the “ventral vagal complex” (VVC) runs the show, we have calm and normal social reactions (smile when others smile at us, etc).

Any threat to our safety or social connections triggers changes in the areas innervated by the VVC.

When a traumatic event happens, we signal our distress through the facial muscles (calling on someone); if it doesn’t work, we move on to the limbic brain ( fight or flight ); if this fails, we activate the dorsal vagal complex (DVC) which slows down the metabolism ( disengage, collapse, freeze ).

For many people, panic and rage are better than shutting down.

That is why many traumatized people feel fully alive in the face of actual danger, while they go numb in situations that are more complex but objectively safe, like birthday parties or family dinners.

The more efficiently the VVC synchronizes the activity of the sympathetic and parasympathetic nervous systems, the better the physiology of each individual will be attuned to that of other members of the tribe.

Being in tune with other members of our species via the VVC is enormously rewarding (dancing, playing sports, music).

Trauma happens when that synchronicity fails. Eg: you beg for your life but the person ignores your plea.

Immobilization is at the root of most traumas. When that occurs the DVC is likely to take over: Your heart slows down, your breathing becomes shallow, and, zombielike, you lose touch with yourself and your surroundings. You dissociate, faint and collapse.

The natural state of mammals is to be on guard; but to feel close to someone, you have to put your guard down.

Many traumatized individuals are too hypervigilant to enjoy the ordinary pleasures that life has to offer, while others are too numb to absorb new experiences or recognize signs of danger.

Consequence: women who had an early history of abuse and neglect were seven times more likely to be raped in adulthood.

The only way to get traumatized people out of these modes is through cooperation.

Getting people to play, sing, build, etc together helps them relax, deactivate the fight/flight mode so they are open to new information.

When children are oppositional, defensive, numbed out, or enraged, it’s also important to recognize that such “bad behavior” may repeat action patterns that were established to survive serious threats, even if they are intensely upsetting or off-putting.

Dancing, playing, singing, and cooperating help shift people out of fight/flight states, reorganize their perception of danger, and increase their capacity to manage relationships.

Chapter 6: Losing Your Body, Losing Your Self

If no one has ever looked at you with loving eyes or broken out in a smile when she sees you; if no one has rushed to help you, but instead said, “Stop crying, or I’ll give you something to cry about”, then you need to discover other ways of taking care of yourself.

These ways are drugs, alcohol, cutting yourself… anything that can make you feel something.

Many people with trauma get completely disconnected from their bodies. Some of them cannot even feel whole parts of it.

While trauma-free people think about themselves when not doing anything in particular, traumatized people cannot because they shut down their relationship with themselves due to the terror.

In an effort to shut off terrifying sensations, they also deadened their capacity to feel fully alive.
The disappearance of medial prefrontal activation could explain why so many traumatized people lose their sense of purpose and direction.
The lack of self-awareness in victims of chronic childhood trauma is sometimes so profound that they cannot recognize themselves in a mirror.

To feel present, you need to know what is going on with you. You can’t do that if the self-sensing system breaks down.

Massage is a good way to learn to reconnect to one’s body.

When we remember an emotion from the past, we reexperience what we experienced then. Traumatized people remain stuck in their life-or-death situation.

Agency, the feeling of being in charge of your life, helps you regain control and unstuck your brain from this state of constant arousal.

Agency means that you know:

  • Where you stand.
  • That you have a say in what happens to you.
  • That you have some ability to shape your circumstances.

Agency begins with self-awareness. The bigger the awareness of your self, the greater the potential to control your life. Mindfulness is a great tool to strengthen the MPFC and increase awareness of your gut feeling. Once you trust it, you feel in charge of your body.

Traumatized people feel unsafe inside their bodies as the past is constantly replaying in their brains, bombarding them with warning signs. In an attempt to control these, they split and numb themselves by hiding their selves.

People who cannot comfortably notice what is going on inside become vulnerable to respond to any sensory shift either by shutting down or by going into a panic—they develop a fear of fear itself.

Panic symptoms are maintained largely because the individual develops a fear of panic attacks.

On the flip side, people become unable to detect real dangers when they numb themselves.

Suppressing our inner cries for help does not stop our stress hormones from mobilizing the body.

Furthermore, numbing doesn’t mean that the consequences of a feeling disappear. Rather, they manifest as chronic back and neck pain, fibromyalgia, migraines, digestive problems, spastic colon/irritable bowel syndrome, chronic fatigue, and some forms of asthma.

Many people will feel emotions but won’t be able to name them. This is called alexithymic.

They substitute feelings for actions. If you ask them how they’d feel if a crazy truck ran toward them, they’d say “I would move” instead of saying “I’d be terrified”.

Instead of feeling angry or sad, they experience muscle pain, bowel irregularities, or other symptoms for which no cause can be found.

One step further is depersonalization— losing your sense of yourself.

Trauma victims cannot recover until they become familiar with and befriend the sensations in their bodies.

Being frightened means that you live in a body that is always on guard. Angry people live in angry bodies.

Physical self-awareness is the first step in releasing the tyranny of the past.

Traumatized people often cannot look at others because they feel disgusting and shameful.

Part Three: The Minds of Children

Chapter 7: getting on the same wavelength: attachment and attunement.

Most research is me-search. Beatrice Beebe
We are profoundly social creatures; our lives consist of finding our place within the community of human beings.

At the beginning of our lives, we are incapable of taking care of ourselves and remain at the mercy of our parents and family. As a result, we get our first lesson in self-care from the way our parents cared for us.

Mastering the skill of self-regulation depends to a large degree on how harmonious our early interactions with our caregivers are. Children whose parents are reliable sources of comfort and strength have a lifetime advantage—a kind of buffer against the worst that fate can hand them.

Children choose one adult (whoever takes care of them the most) with whom they develop an attachment bond. The attachment should be secure and to do so, must include emotional attunement (sync). When the child is in sync with his caretaker, he’s happy.

The more responsive the adult is with the child -> the deeper the attachment -> the better the child can respond to people around him.

When infants and young children notice that their mothers are not fully engaged with them, they become nervous. When their mothers disappear from sight, they may cry and become inconsolable, but as soon as their mothers return, they quiet down and resume their play.

Attachment is a secure base from which the child explores the world.

Growing up in a safe environment helps the child develop self-reliance and feel sympathetic and helpful to people in distress. They learn how to become social and the difference between situations they can control, and those they cannot.

But children who didn’t grow up in a safe environment learned that no amount of crying registered with their caregivers.

This is the case of babies whose needs aren’t met by the mother. Since the mother does not adapt to the baby, the baby adapts to the mother.

Abused kids tend to be very focused on angry faces or voices, but they interpret them as threats rather than cues.

The need for attachment never lessens. Most human beings simply cannot tolerate being disengaged from others for any length of time.
People who cannot connect through work, friendships, or family usually find other ways of bonding, as through illnesses, lawsuits, or family feuds. Anything is preferable to that godforsaken sense of irrelevance and alienation.

Children whose main caregiver is unresponsive deal with anxiety in two ways:

  • Being upset (anxious).
  • Being passive and withdrawn (avoidant).

These children don’t become happy again when the mother comes back.

Attachment researchers think that there are three “organized” attachment strategies:

Avoidant/anxious kids tend to become avoidant/anxious adults. As long as the attachment style remains constant, the child can cope even though it is not ideal.

Then there is another category of children whose caregivers are a source of terror and distress (called disorganized attachment, solely caused by parental abuse). Eg: parents (source of joy) who molest their children (source of distress).

Children in this situation have no one to turn to, and they are faced with an unsolvable dilemma; their mothers are simultaneously necessary for survival and a source of fear.
Children who don’t feel safe in infancy have trouble regulating their moods and emotional responses as they grow older.

When a traumatic event happens in a family, the impact on children is largely determined by how calm or stressed their parents are -> mimesis at play .

When children were hospitalized for treatment of severe burns, the development of PTSD could be predicted by how safe they felt with their mothers.

When you have no sense of security, you can’t distinguish between safety and danger. If you feel numb, you may seek potentially dangerous experiences. When you think you are a terrible person, you expect others to treat you badly.

Among the different types of abuse, emotional distance and role reversal (kids look after their parents) are specifically linked to aggressive behavior against themselves and others in young adults.

Let’s talk about dissociation. Dissociation is feeling lost, overwhelmed, abandoned, and disconnected from the world. These people see themselves as unloved, empty, helpless, trapped, and weighed down.

There is a relationship between maternal disengagement and misattunement during the first two years of life and dissociative symptoms in early adulthood.

Infants who are not truly seen and known by their mothers are at high risk to grow into adolescents who are unable to know and to see.

If your parents ignore your needs, or resent your very existence, you learn to anticipate rejection and withdrawal. You may pretend it doesn’t matter, but your body feels otherwise.

When you don’t feel, nothing matters, so you can’t protect yourself well. Lack of safety leads to an impaired sense of inner reality, excessive clinging, and self-damaging behavior -> the quality of early caregiving is critically important in preventing mental health.

Chapter 8: Trapped in Relationships: The Cost of Abuse and Neglect

People who have been victims of incest are prone to auto-immune diseases because the body has used a considerable amount of RA cells, memory cells part of the immune system that helps it defend against known threats. The body becomes incapable of distinguishing between danger and safety.

The imprint of past trauma does not consist only of distorted perceptions of information coming from the outside; the organism itself also has a problem knowing how to feel safe.

We become how we were treated. If we were well-treated, we like ourselves. If we weren’t, we don’t.

It’s important NOT to tell people they should not feel the way they feel when they blame everything on themselves or when they say they don’t like themselves. It makes them feel even lonelier and more frustrated.

To change the map of our world, we need to reorganize our nervous system where it’s located.

The first thing to do is to observe and tolerate the bad feelings (mindfulness). Once we do, we can befriend them instead of trying to numb and suppress them.

Trauma is not stored as a narrative. It can be expressed as flashbacks that contain fragments of the experience, isolated images, sounds, and body sensations that initially have no context other than fear and panic.

Lots of people don’t even remember their trauma.

Chapter 9: What’s Love Got to Do With It?

The diagnosis of a traumatized patient will depend on what the healthcare provider focuses on. Traumatized people can be described as having ADHD, PSTD, depression, or bipolar disorder.

It’s never entirely wrong, but it’s never entirely right either.

The vast majority of patients with psychiatric problems were traumatized as kids.

When children feel pervasively angry or guilty or are chronically frightened about being abandoned, they have come by such feelings honestly; that is because of experience. People typically don’t grow up in a household where one brother is in prison but everything else is fine.

The impact of trauma doesn’t vanish in time but remains.

Many of the patients’ treatments today are for problems from many years ago.

The more isolated and unprotected a person feels, the more death will feel like the only escape.

How traumatized someone was can be measured by the ACE , a test of ten questions.

In the case of obesity, it may as well be the solution for many people (prison guards want to be big to feel safe and women who have been raped don’t want to be looked at).

Other kids ate because as they got fat, they didn’t get beaten.

When these people lose weight, many struggle with depression, suicidal thoughts, or even panic.

What one sees, the presenting problem, is often only the marker for the real problem, which lies buried in time, concealed by patient shame, secrecy and sometimes amnesia—and frequently clinician discomfort.

Obesity isn’t the worst problem; child abuse is.

Chapter 10: Developmental Trauma: The Hidden Epidemic

Many are tempted to describe the problems of difficult children with genetic determinism. After millions of dollars and years of research, no one found the “gene” responsible for misbehavior.

It turns out that many genes work together to influence a single outcome. Even more important, genes are not fixed; life events can trigger biochemical messages that turn them on or off.

One of the most widely cited studies in epigenetics showed that rats whose mother licked them and took care of them 12 hours after birth permanently affected the brain chemicals that respond to stress—and modified the configuration of over a thousand genes.

They recovered better when hurt, too.

Of course, stressful experiences affect gene expression in humans, as well.

In rhesus monkeys, two personalities run often into social problems:

  • Uptight, anxious monkeys, who become fearful, withdrawn, and depressed.
  • Highly aggressive monkeys, who end up beaten up, or killed.

It’s been observed that early experiences of young monkeys had as much impact on their biology as heredity does through the level of cortisol that they have.

In 1975, a study tracked 180 children for 30 years to find out what best predicted their outcome in life.

Neither the mother’s personality, nor the infant’s neurological anomalies at birth, nor its IQ, nor its temperament predicted whether a child would develop serious behavioral problems in adolescence. The key issue, rather, was (…) how parents felt about and interacted with their kids.
As with Suomi’s monkeys, the combination of vulnerable infants and inflexible caregivers made for clingy, uptight kids. Insensitive, pushy, and intrusive behavior on the part of the parents at six months predicted hyperactivity and attention problems in kindergarten and beyond.
The children who received consistent caregiving became well-regulated kids, while erratic caregiving produced kids who were chronically physiologically aroused.

They were also much more resilient.

In 1986, Putnam and Trickett ran the first study on the impact of sexual abuse on female development.

They found out that sexually abused girls suffer from a large range of profoundly negative effects, including cognitive deficits, depression, dissociative symptoms, troubled sexual development, high rates of obesity, and self-mutilation.

Despite that, the APA still does not recognize traumatic relationships as a cause for traumas.

Part Four: The Imprint of Trauma

Chapter 11: uncovering secrets: the problem of traumatic memory.

We don’t remember things exactly as they happened, and we don’t remember everything either.

Pierre Janet was the find out about the difference between “narrative memory”—the stories people tell about trauma—and traumatic memory itself.

Traumatized people remember both too little because they can’t have a defined memory of the experience, and too much because their body remembers. But they never remember the trauma as a story.

Traumatic memories are precipitated by specific triggers. In contrast, ordinary memory is adaptive; our stories are flexible and can be modified to fit the circumstances.

Ordinary memory is social; it’s a story that we tell for a purpose. But there is nothing social about traumatic memory.

Chapter 12: The Unbearable Heaviness of Remembering

Memory loss is frequent in the case of trauma, but it took a long time before it was recognized by the medical community.

Normal memories are remembered as stories, with a beginning, middle, and end.

Traumatic memories are remembered in a disorganized way. Victims remember details but cannot explain how the events unfolded.

Traumatic memories are fundamentally different from the stories we tell about the past. They are dissociated: The different sensations that entered the brain at the time of the trauma are not properly assembled into a story, a piece of autobiography.

Furthermore, remembering the trauma does not necessarily resolve it.

Finding words to describe what has happened to you can be transformative, but it does not always abolish flashbacks or improve concentration, stimulate vital involvement in your life or reduce hypersensitivity to disappointments and perceived injuries.

The truth is that nobody wants to remember trauma.

The essence of trauma is that it is overwhelming, unbelievable, and unbearable. Each patient demands that we suspend our sense of what is normal and accept that we are dealing with a dual reality: the reality of a relatively secure and predictable present that lives side by side with a ruinous, ever-present past.

Part Five: Paths to Recovery

Chapter 13: healing from trauma: owning your self.

Whatever trauma happened to you cannot be undone. What you need to deal with isn’t the trauma, but its consequences.

  • The crushing sensations in your chest that may look like anxiety or depression.
  • The fear of losing control.
  • Always being on alert for danger or rejection.
  • The self-loathing; the nightmares and flashbacks.
  • The fog that keeps you from staying on task and from engaging fully in what you are doing.
  • Being unable to fully open your heart to another human being.
Trauma robs you of the feeling that you are in charge of yourself.
The challenge of recovery is to reestablish ownership of your body and your mind—of your self. This means feeling free to know what you know and to feel what you feel without becoming overwhelmed, enraged, ashamed, or collapsed.

This means:

  • Finding a way to be calm and focused.
  • Learning to maintain that calm in the face of images, thoughts, sounds, or physical sensations from the past (or that remind you of it)
  • Finding a way to be alive and engaged in the present and with the people around you,
  • Not having to keep secrets from yourself, including secrets about the ways that you have managed to survive.

These don’t necessarily have to be achieved in this order. They can also be achieved at the same time.

Posttraumatic reactions come from the emotional brain and manifest themselves in physical reactions: (heart pounding, fast breathing, speaking with an uptight and reedy voice).

Unfortunately, the rational brain cannot abolish those feelings.

Understanding why you feel a certain way does not change how you feel.
The fundamental issue in resolving traumatic stress is to restore the proper balance between the rational and emotional brains, so that you can feel in charge of how you respond and how you conduct your life.

When we are triggered into states of hyper- or hypoarousal, we get outside of our “window of tolerance”.

We become reactive and disorganized and we panic or fly into rages; or we shut down, feel numb, and have low energy.

Either way, we can’t learn from experience in these states.

Even if we keep control, we become so uptight that we are inflexible, stubborn, and depressed.

Recovery from trauma involves the restoration of executive functioning and, with it, self-confidence and the capacity for playfulness and creativity.

If we want to change posttraumatic reactions, we have to access the emotional brain and do “limbic system therapy”: repairing faulty alarm systems and restoring the emotional brain to its ordinary job of being a quiet background presence that takes care of the housekeeping of the body, ensuring that you eat, sleep, connect with intimate partners, protect your children, and defend against danger.

The rational (analyzing) brain does not have direct connections with the emotional brain, but the self-awareness brain does. It’s the only way to access the emotional brain.

Neuroscience research shows that the only way we can change the way we feel is by becoming aware of our inner experience and learning to befriend what is going inside ourselves.

Befriending the Emotional Brain

1. Dealing with Hyperarousal

80% of the fibers of the vagus nerve run from the body into the brain. This means we can retrain the brain from the body.

Eg: 10 weeks of yoga can reduce PTSD syndrome where everything else failed.

Learning how to breathe calmly and remaining in a state of relative physical relaxation, even while accessing painful and horrifying memories, is an essential tool for recovery.

Taking a few deep breaths will already make you more relaxed. The more you focus on the breathing, the better it is.

2. No Mind Without Mindfulness

At the core of recovery is self-awareness. The most important phrases in trauma therapy are “Notice that” and “What happens next?”

Traumatized people live with unbearable sensations (tightness in the chest, etc). Ignoring them increases our vulnerability to being overwhelmed by them.

Body awareness puts us in touch with our inner world, the landscape of our organism. Simply noticing our annoyance, nervousness, or anxiety immediately helps us shift our perspective and opens up new options other than our automatic, habitual reactions.

Traumatized people are often afraid of feelings because they felt some that were really painful.

It’s not surprising that so many trauma survivors are compulsive eaters and drinkers, fear making love, and avoid many social activities: Their sensory world is largely off limits.

If you want to change though, you have to open up to your inner experience.

Here’s how.

  • Focus on your sensations and notice how they’re transient and respond to slight shifts in body position, changes in breathing, and shifts in thinking.
  • Label them. Eg: “When I feel anxious, I feel X in my chest.”

Mindfulness calms down the sympathetic nervous system.

If you cannot tolerate what you are feeling right now, opening up the past will only compound the misery and retraumatize you further.

3. Relationships

A solid network of people constitutes the best way to avoid being traumatized.

The British children sent to the countryside during the war were more traumatized than the children who remained with their parents during the bombings.

Recovery from trauma involves (re)connecting with our fellow human beings.

This is why the traumas that happen within relationships are harder to solve. When the solution is the cause of the problem, people shut down,

If your heart is still broken because you were assaulted by someone you loved, you are likely to be preoccupied with not getting hurt again and fear opening up to someone new. In fact, you may unwittingly try to hurt them before they have a chance to hurt you.

4. Communal Rhythms and Synchrony

Trauma breaks synchronicity with other people. A community can fix that, particularly through music and rhythms, choral singing, aikido, tango dancing, improvisation, or kickboxing.

5. Getting in Touch

You can’t recover if you don’t feel safe in your skin.

People should engage in some sort of bodywork, be it therapeutic massage, Feldenkrais, or craniosacral therapy.

6. Taking Action

When the body secretes stress hormones, these help the person get moving. If you remain immobile, your body will work against you.

Sensorimotor psychotherapy and somatic experiencing were developed to deal with these issues where the purpose is to deal with the parts of the body where the trauma was imprinted rather than dealing with the story.

Feeling the pleasure of taking effective action restores a sense of agency and a sense of being able to actively defend and protect themselves.

When people are forced to submit to a stronger power, they survive with “resigned compliance”.

The best way to overcome ingrained patterns of submission is to restore a physical capacity to engage and defend.
People cannot put traumatic events behind until they are able to acknowledge what has happened and start to recognize the invisible demons they’re struggling with.

The purpose of CBT is to desensitize patients to their irrational fears so they become less upset.

Exposure sometimes helps to deal with fear and anxiety, but it has not been proven to help with guilt or other complex emotions.

Furthermore, remembering traumas may reinforce them rather than solve them.

In contrast to its effectiveness for irrational fears such as spiders, CBT has not done so well for traumatized individuals, particularly those with histories of childhood abuse. Only about one in three participants with PTSD who finish research studies show some improvement.
Being traumatized is not just an issue of being stuck in the past; it is just as much a problem of not being fully alive in the present.

Veterans traumatized by war were given virtual-reality therapy where they relieved the battle. They performed well in the same environment but remained traumatized outside of it.

Desensitization

Most medical students learn that the purpose of therapy is to desensitize the patient to his trauma, but this is incorrect.

The real purpose is to help them integrate it.

Drugs to Safely Access Trauma?

MDMA + internal family system (IFS) therapy has given good results on veterans and firefighters with PTSD.

When it comes to medicines like Prozac, EMDR had better results. Some types of traumas respond better to drugs than others (combat veterans don’t respond well).

Chapter 14: Language: Miracle and Tyranny

After 9/11, the survivors were offered two methods to deal with their trauma: psychoanalysis, and CBT.

Nobody showed up to either of them. After a year, people were asked which method they had used to deal with the stress since they hadn’t gone to their CBT/psychoanalysis appointments.

The answer was: acupuncture, massage, yoga, and EMDR.

The lack of interest in talking therapies led specialists to wonder why anyone would talk about their traumas in the first place.

Therapists have had full faith in talking therapies since Freud and Breuer wrote that talking about them made them disappear instantly. As we said above, this isn’t true. On the other hand, being silent isn’t good either.

Recovery begins when one manages to say out loud: “I was beaten/r*ped/etc”.

You need to name and acknowledge what happened to you.

If you hide from yourself the fact that an uncle molested you when you were young, you are vulnerable to react to triggers like an animal in a thunderstorm.
As long as you keep secrets and suppress information, you are fundamentally at war with yourself.

Hiding your core feelings leaves you tired, decreases your motivation, and leaves you bored and shut down. It eats your identity, sense of self, and purpose.

The stress hormones keep flooding your body, leading to headaches, muscle aches, bowel and sexual problems, etc.

Naming what happened to you is crucial. It’s the first step of recovery.

Knowing Yourself or Telling Your Story? Our Dual Awareness System

We possess two distinct forms of self-awareness:

  • The intellectual one : keeps track of the self across time, creating one coherent story.
  • The “feeling-based” one : registers the self in the now (self-awareness), based primarily in physical sensations.

Only the second one can change the emotional brain.

It’s possible to observe these two systems working simultaneously, when people tell a “happy story” while being slumped, or a sad story while standing straight.

The Body Is the Bridge

Trauma stories lessen the isolation of trauma, and they provide an explanation for why people suffer the way they do.

But trauma also transforms people, and people can’t quite phrase how they were transformed by the trauma, which makes, in many cases, talking therapy useless.

Writing to Yourself

Writing about your traumas and what happened has been shown to help people move forward, but we don’t know if it’s due to the writing or to something else.

The purpose of writing is to talk to yourself – to tell yourself what you have been trying to avoid.

Art, Music, and Dance

A lot of therapists use these but we know little about how they work.

The Limits of Language

Talking about trauma is overwhelming for both listeners and speakers and doesn’t help people bond with one another.

People don’t want to hang out with those depressed by their traumas, which is why trauma victims withdrawn and ruminate over the same stories again and again.

That doesn’t mean you shouldn’t tell your story. Rather, you should tell it in an acceptable setting, like group therapies.

Other people are so overwhelmed by the emotion that they’re incapable of speaking.

Dealing With Reality

Dealing with traumatic memories, however, is only the beginning.

People with PTSD also struggle often with focused attention and learning new information.

A trauma is inside the brain what a splinter would be inside the hand. It constantly sends your body annoying sensations you have to deal with during the day.

Being constantly assaulted by, but consciously cut off from, the origin of bodily sensations produces alexithymia: not being able to sense and communicate what is going on with you.

To overcome trauma, you need to get back in touch with your body, that is, with your self.

Chapter 15: Letting Go of the Past: EMDR

EMDR means Eye Movement Desensitization and Reprocessing . The patient recalls a traumatic story then quickly follows with his eyes the finger of the therapist moving left and right. Another variant of it uses taps on the hands.

Doing so, the trauma is often released and the patient may even remember other traumatic incidents to talk about.

  • EMDR seems to give people access to memories and images from their past which seems to contextualize the trauma differently.
  • Talking isn’t needed for people to solve their trauma.
  • EMDR can help even if the patient and the therapist do not have a trusting relationship.

Studying EMDR

After only three EMDR sessions, most patients had a different brain scan than they did prior (sharp increase in prefrontal lobe activation).

However, EMDR seems to work mostly on people traumatized as adults rather than those traumatized as children.

We’re not sure how EMDR works exactly, but it seems to help integrate a traumatic memory.

Chapter 16: Learning to Inhabit Your Body: Yoga

The memory of helplessness is stored as muscle tension or feelings of disintegration in the affected body parts: head, back, and limbs in accident victims, vagina, and rectum in victims of sexual abuse.

The lives of many trauma survivors revolve around fighting against unwanted sensory experiences which they do with self-numbing (with addictions, mostly).

The other side to self-numbing is sensation seeking (high-risk activities, prostitution, gambling, etc).

When people are chronically angry or scared, constant muscle tension ultimately leads to spasms, back pain, migraine headaches, fibromyalgia, and other forms of chronic pain.

The biological marker “heart rate variability” (HRV, fluctuation in heart rate in response to breathing) is a reliable indicator of how well the autonomic nervous system is going (with its two branches, the sympathetic nervous system and the parasympathetic nervous system).

When these two systems work closely together (when the autonomic nervous system is modulated), we feel at our best and we have reasonable control over minor frustrations (feeling insulted or left out).

Individuals whose ANS isn’t well modulated are easily out of balance because there is no coherence between breathing and heart rate.

It makes people likelier to contract heart disease, cancer, depression and PTSD.

In people with PTSD, the two systems are out of sync.

Luckily, yoga can help recover a proper HRV and help people to “re-inhabit” and take care of their bodies; it puts people “back in touch” with their bodies.

Chapter 17: Putting the Pieces Together: Self-Leadership (IFS)

Every traumatized person copes in their own way. Traumatized children often choose to hate themselves rather than being angry at their caretakers, or running away.

As a result, abused children are likely to grow up believing that they are fundamentally unlovable.

It’s the only way they can explain why so much harm was done to them.

If you were abused as a child, you are likely to have a childlike part living inside you that is frozen in time, still holding fast to this kind of self-loathing and denial.

While resolving your trauma is important, you’ll also need to resolve the part of yourself you developed to cope with it.

IFS (internal family system) effectively deals with this problem.

IFS was built on the idea that the mind works like a family. Any change to one part will affect the other parts.

image 3

In trauma the self-system breaks down, and parts of the self become polarized and go to war with one another.

Self-loathing co-exists with grandiosity, loving care with hatred and numbing, and passivity with rage and aggression.

IFS considers each part as a distinct mental system. Trauma injects into these parts some beliefs and emotions that hijack them. They become toxic and must be denied; IFS calls these parts exile.

Then there is the part called manager whose task is to manage the individual’s life around the trauma so that they never get hurt again; then there’s the firefighter which awakens when the exile becomes conscious or attempts to come back. The firefighter often expresses itself through binge drinking, risky behavior, self-harm, etc. It’s an attempt at suppressing the emotion associated with the exile.

Each part holds a memory or an emotion. The purpose of IFS is to bring all of these parts together and get them to collaborate especially the exiles.

IFS recognizes that the cultivation of mindful self-leadership is the foundation for healing from trauma.

When the Self is no longer in charge, it identifies with one of its parts. It is further assumed that the Self remains untouched in the person, protected by the parts, and that once the parts trust they can separate, the Self emerges.

image 4

Furthermore, the mindful Self can help reorganize the inner system and communicate with the parts in ways that help those parts trust that there is someone inside who can handle things.

In fact, mindfulness increases activation of the medial prefrontal cortex and decreases activation of structures like the amygdala that trigger our emotional responses.

IFS builds a relationship between the Self and the various parts -> the Self has an active leadership role.

The role of the IFS therapist is to separate the parts so that the patient can objectively look at his parts rather than identify with them.

image 5

The patient must then ask his parts to “stand back”. After a while, the Self emerges.

After, the therapist asks the patient how they feel about a certain part. If the patient says “I hate it”, the therapist knows he stumbled onto another part and asks “can that part that hates it, step back?”

Once the Self begins to emerge, it spontaneously talks to the parts.

Internal managers who are obsessed with power are usually created as a bulwark against feeling helpless.

Chapter 18: Filling in the Holes: Creating Structures (PBSB)

People who felt unwanted as children, and those who did not remember feeling safe with anyone while growing up, did not fully benefit from conventional psychotherapy, presumably because they could not activate old traces of feeling cared for.

PBSB (Pesso Boyden System Psychomotor) is a form of therapy that asks the patient to represent in real life the most important people in their lives, either using real individuals, or symbols (furniture).

Projecting your inner world into the three-dimensional space of a structure enables you to see what’s happening in the theater of your mind and gives you a much clearer perspective on your reactions to people and events in the past.

It feels as if you were going back to the past and rewrote the scenes that stuck with you; it brings closure.

Chapter 19: Rewiring the Brain: Neurofeedback

In 2000, a study showed that key parts of the brain worked together in non-traumatized individuals, while the brain waves of traumatized subjects failed to come together.

Changing this pattern is made with neurofeedback.

Neurofeedback intervenes in the brain circuits that promote fearfulness, shame, and rage.

Electrodes are placed on the patient’s head.

They can observe their brain’s waves in real-time and are rewarded when they emit the “right” brain waves.

Neurofeedback has helped with ADHD, PTSD, and addictions.

Neurofeedback nudges the brain to make more of some frequencies and less of others, creating new patterns that enhance its natural complexity and its bias toward self-regulation.

Chapter 20 Finding Your Voice: Communal Rhythms and Theater

Our sense of agency, how much we feel in control, is defined by our relationship with our bodies and its rhythms.

To function properly, we have to be in our bodies. Depression, dissociation, etc is the opposite.

Acting helps you put yourself back in your body.

The fact that you do it with other people helps establish relationships and empathy. Furthermore, many plays portray what happens to traumatized people which has a healing effect.

…confrontation of the painful realities of life and symbolic transformation through communal action.
Traumatized people are terrified to feel deeply. They are afraid to experience their emotions, because emotions lead to loss of control. In contrast, theater is about embodying emotions, giving voice to them, becoming rhythmically engaged, taking on and embodying different roles.
Theater gives trauma survivors a chance to connect with one another by deeply experiencing their common humanity.

Epilogue: Choices to Be Made

As long as we feel safely held in the hearts and minds of the people who love us, we will climb mountains and cross deserts and stay up all night to finish projects. Children and adults will do anything for people they trust and whose opinion they value. But if we feel abandoned, worthless, or invisible, nothing seems to matter. Fear destroys curiosity and playfulness.
It is standard practice in many schools to punish children for tantrums, spacing out, or aggressive outbursts—all of which are often symptoms of traumatic stress. When that happens, the school, instead of offering a safe haven, becomes yet another traumatic trigger.
One of the prime reasons for habitual drug use in teens is that they cannot stand the physical sensations that signal fear, rage, and helplessness.
In addition to reading, writing, and arithmetic, all kids need to learn self-awareness, self-regulation, and communication as part of their core curriculum.
Children and adults alike need to experience how rewarding it is to work at the edge of their abilities. Resilience is the product of agency: knowing that what you do can make a difference.

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IMAGES

  1. The Body Keeps the Score

    the body keeps the score chapter 9 summary

  2. The Body Keeps the Score by Bessel van der Kolk [Actionable Summary]

    the body keeps the score chapter 9 summary

  3. The Body Keeps The Score

    the body keeps the score chapter 9 summary

  4. The Body Keeps the Score Book Summary by Bessel van der Kolk

    the body keeps the score chapter 9 summary

  5. The Body Keeps The Score

    the body keeps the score chapter 9 summary

  6. Summary of The Body Keeps The Score: Brain, Mind, and Body in the Healing of Trauma: A Quick

    the body keeps the score chapter 9 summary

VIDEO

  1. 5 Minutes Book Summary

  2. RDV #92

  3. How does trauma become stored in the body? #spinalenergetics

  4. [Full Audiobook] The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma

  5. Your body keeps score when unconscious?

  6. The body keeps the score

COMMENTS

  1. The Body Keeps the Score Chapters 9-10 Summary and Analysis

    Analysis Chapters 9-10 Summary and Analysis PDF Chapter 9 The author begins by saying that trauma patients will often receive five or six unrelated diagnoses and prescriptions during the...

  2. The Body Keeps the Score Chapter Summaries

    There are now three fundamental options: talking, forming human connections, and "processing the memories of the trauma"; using medicines which control the brain's responses; and creating positive...

  3. The Body Keeps the Score: Brain, Mind, and Body in the Healing of

    The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma - Part 3, The Minds of Children - Chapter 9 Summary & Analysis Bessel van der Kolk M.D. View the Study Pack View the Lesson Plans Study Guide Show Section Navigation Print Word PDF This section contains 1,447 words (approx. 4 pages at 400 words per page) View a FREE sample

  4. Book Summary The Body Keeps the Score , by Bessel van der Kolk

    The Body Keeps the Score Book Summary by Bessel van der Kolk Book Summary The Body Keeps the Score, by Bessel van der Kolk Book Rating by Shortform Readers: 4.7 ( 93 reviews) Trauma can stem from abuse to a severe car accident to wartime combat—and cause a lifetime of flashbacks, nightmares, isolation, insomnia, hypervigilance, and rage.

  5. The Body Keeps the Score Summary and Study Guide

    The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma Nonfiction | Book | Adult | Published in 2014 A modern alternative to SparkNotes and CliffsNotes, SuperSummary offers high-quality Study Guides with detailed chapter summaries and analysis of major themes, characters, and more. Download PDF Access Full Guide Study Guide

  6. PDF Trauma Book Club Study Guide: The Body Keeps the Score

    1. Lessons from Vietnam Veterans • 1. Soldiers' reactions to traumatic experiences following the war demonstrate the undeniable connection between mind and body. • 2. In order to overcome trauma, one must move past the physiological impact of trauma on the body and train the brain to recognize when it is safe. • 3.

  7. The Body Keeps the Score Summary

    In Chapter 9, the author stresses the complexity of psychiatric diagnosis and hence the vagueness with which patients are labeled. A diagnosis of depression will have important consequences for...

  8. The Body Keeps the Score Study Guide

    The fifth edition of the American Psychiatric Association's The author describes his son's recovery from chronic fatigue syndrome, which was assisted by his participation in an evening class in improvisational theater. He started playing powerful, confident roles, such as Fonzie in

  9. Book Summary: The Body Keeps the Score by Bessel van der Kolk

    Rating: 4/5 What Is The Body Keeps the Score About? The Body Keeps the Score is about the profound impact of trauma on the mind and body, exploring innovative healing methods through the lens of neuroscience and psychology. The Five Big Ideas

  10. The Body Keeps The Score Summary

    1-Sentence-Summary: The Body Keeps The Score teaches you how to get through the difficulties that arise from your traumatic past by revealing the psychology behind them and revealing some of the techniques therapists use to help victims recover. Read in: 4 minutes Favorite quote from the author: Table of Contents Video Summary

  11. BOOK SUMMARY: THE BODY KEEPS THE SCORE

    We had a wonderful and relaxing time with the few who attended and plan to continue in future with book reviews. Bessel Van der Kolk, MD's "The Body Keeps the Score" remains one of the best books out there for both clinicians and clients. This book is a primer on trauma and the body and is invaluable to any of us in trauma focused work.

  12. The Body Keeps the Score Epilogue Summary & Analysis

    Epilogue Summary: "Choices to Be Made". Van der Kolk summarizes the text, noting that trauma therapy is still an active field. He finds himself "close to despair" (350) since even with advances in neuroscience, in some ways, trauma therapy seems to be regressing. Reiterating his assessment of modern psychiatry, van der Kolk adds ...

  13. The Body Keeps The Score

    The Body Keeps the Score is the inspiring story of how a group of therapists and scientists— together with their courageous and memorable patients—has struggled to integrate recent advances in brain science, attachment research, and body awareness into treatments that can free trauma survivors from the tyranny of the past.

  14. The Body Keeps the Score Book Summary, Review, Notes

    He investigates new methods of healing that engage the brain's inherent neuroplasticity, including neurofeedback and meditation as well as sports, drama, and yoga. Book Title— The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. Author— Bessel van der Kolk. Date of Reading— August 2022. Rating— 10/10.

  15. The Body Keeps The Score Summary and Infographic

    The Body Keeps the Score is an innovative book by psychiatrist and trauma expert Van der Kolk. We all understand the effect that psychological trauma can have on individuals. Trauma can impact the way people perceive themselves and the world around them. Psychological trauma can have a lasting impact on the individual's loved ones as well.

  16. The Body Keeps the Score

    RC552.P67 V358 2014. The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma is a 2014 book by Bessel van der Kolk about the effects of psychological trauma, also known as traumatic stress. [1] [2] The book describes van der Kolk's research and experiences on how individuals are affected by traumatic stress, and its effects on ...

  17. Book Summary for Bessel van der Kolk's "The Body Keeps the Score"

    Claim your FREE copy of "The Body Keeps the Score" here Chapter 2: This Is Your Brain on Trauma. Van der Kolk examines the neural foundations of trauma in this chapter. He describes how ...

  18. The Body Keeps the Score Prologue Summary & Analysis

    The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma Nonfiction | Book | Adult | Published in 2014 A modern alternative to SparkNotes and CliffsNotes, SuperSummary offers high-quality Study Guides with detailed chapter summaries and analysis of major themes, characters, and more. Download PDF Access Full Guide Study Guide

  19. The Body Keeps the Score Chapters 13-14 Summary and Analysis

    The author cites Helen Keller's discovery of language as a "birth into selfhood," an experience which allowed her to feel and be part of the world around her, despite the formidable obstacles of...

  20. Table of Contents: The body keeps the score : :: Library Catalog Search

    The body keeps the score : brain, mind, and body in the healing of trauma /. An expert on traumatic stress outlines an approach to healing, explaining how traumatic stress affects brain processes and how to use innovative treatments to reactivate the mind's abilities to trust, engage others, and experience pleasure--. New York, New York ...

  21. The Body Keeps the Score: Brain, Mind, and Body in the Healing of

    The Body Keeps the Score is, simply put, brilliant." —Onno van der Hart, Ph.D., Utrecht University, The Netherlands; senior author, The Haunted Self: Structural Dissociation and the Treatment of Chronic Traumatization "The Body Keeps the Score articulates new and better therapies for toxic stress based on a deep understanding of the ...

  22. The Body Keeps the Score Chapter 19-Epilogue Summary and Analysis

    by Bessel van der Kolk Start Free Trial Questions & Answers Themes Characters Analysis Chapter 19-Epilogue Summary and Analysis PDF Chapter 19 Different mental activities produce different...

  23. Summary of The Body Keeps the Score by Bessel van der Kolk

    The Body Keeps the Score is a book written by the psychiatrist and trauma specialist Dr. Bessel van der Kolk. It explains the effects of trauma on the body and discusses several methods (EMDR, yoga, IFS, PBSB, neurofeedback, theater) for their resolution. The book is among one of the highest rated on Amazon with 4.8.