The Body Keeps The Score by Vessel Van der Kolk is a book about Post-Traumatic Stress Disorder (PTSD) that has rather impressively been on Amazon’s ‘Bestseller’ list for over three years. While this book is supposedly aimed at both clinicians and those suffering with PTSD, my view is that this book is pitched more so towards clinicians. It focuses a lot on the history and research behind the illness and treatment approaches over time, and covers detailed accounts of traumas that even trauma therapists would find naturally distressing to read. It is a valuable book on an important and largely misunderstood subject, however, it is certainly not bedtime reading! 

Having read this as part of the Brighter Minds Book Club, I found myself enthusiastically scribbling pages of notes and quotes. From all of these insights captured, I have found there are three key areas that stand out to me as important and valuable for us all to have a greater understanding of. These themes cover the nature of memory, the role of social support and the mind-body connection. This blog will cover a summary of these three themes.  

 

The Anatomy of a Trauma Memory

Trauma memories are different to any other memories we have. They are formed, stormed and recalled differently to other memories.

Intrusive Memories

One of the primary symptoms of Post-Traumatic Stress Disorder (PTSD) are intrusive memories that take the form of nightmares and flashbacks. They are described as intrusive because they are unlike memories that we actively recall, but are memories that impose themselves without invitation and feel like a real and current experience rather than like a memory. In PTSD, a trauma is characterised as an experience that involves threat to life. The emotional response to this is understandably far more intense that the emotions we experience day to day. 

Memory Formation and Storage

Van der Kolk highlights that, “the essence of trauma is that it is overwhelming, unbelievable, and unbearable.” These characteristics and the intensity of the emotions felt at the time interfere with the way that the brain processes the information about the experience. It is therefore not stored as a ‘normal’ memory. It is often fragmented, with missing parts, and rather than being ‘stored’ away as a memory, it ‘misfires’ in the form of intrusive memories that evoke the same level of threat and distress experienced during the trauma.   

We know from neuroscience that our brain operates in two halves. The left side of the brain is associated with our logical and analytical thinking. The right side of the brain is associated with our emotions and memories. Research from brain scans show that during flashbacks, only the right side of the brain is activated. The left side is shown to be deactivated. Usually, both sides of our brain work together. This deactivation of the left side impacts on the ability to logically sequence experiences and express them in words.

This can help explain why a person having a flashback believes they are re-experiencing the trauma. When a person is reminded of their trauma, the right side of the brain reacts as if the trauma is happening in the present. With the left size under-activated, they are unable to recognise this and so can struggle to explain why they have felt or responded a certain way.

body keeps the score

Social Support as a Biological Necessity 

As social beings, we have an innate need to belong and be accepted by others. Being part of a social group had an evolutionary function and was necessary for our survival as hunter-gatherers. We are brought together by commonalities and we can be isolated by our differences. When our inner world doesn’t make sense to us, it can feel hard to connect with others. Many people who struggle with their mental health will withdraw from their friends and family. We know, however, that social support, is an important part of recovery. For those with PTSD, the intense emotions attached to the trauma play an especially big part in isolating oneself.

Telling the Trauma Story

Clients with Post-Traumatic Stress Disorder often say to me, “I’ve never spoken about this before.” Trauma is extremely distressing and often associated with strong emotions. Fear, grief, shame and guilt and big players here. Nobody likes to experience these emotions. A common way to cope with them is to try and ‘numb’ them, suppress them, and avoid them. This often involves trying not to think or talk about the trauma. 

However, we know that talking about trauma is an important part of processing and moving on from it. In Cognitive Behavioural Therapy for PTSD, the treatment involves telling the story. This helps the brain process the trauma and store traumatic experience as a regular memory. It enables the brain to recognise it as an event from the past that is now over. We see that by going through this process, the intrusive memories stop. This is done in a very structured and supported way. The expertise of a skilled therapist ensures that any activated sense of threat or distress can be managed. 

Therapeutic and Social Support

Therapy is one aspect of social support – working a therapist who can tolerate hearing about the trauma, remain non-judgemental, and focus on moving a person with PTSD towards their goals can be extremely validating. However, there is also a world outside of therapy where social support is important. For those with PTSD, this social support can often be absent. Due to the distress from the trauma, it is not unusual for those with PTSD to withdraw from their usual activities. The unpredictability and fear of having a flashback can become so intense that everything becomes a potential threat and so a person’s world can become smaller and smaller as a way to try and shut out these threats. 

A key aspect of PTSD treatment is to help a person with ‘reclaiming their life.’ This involves rebuilding social connections and meaningful relationships. Van der Kolk writes that “social support is a biological necessity, not an option, and this reality should be the backbone of all prevention and treatment.”

telling the story

The Mind-Body Connection

Throughout the book, there is a focus on the mind-body connection and the role that this plays in both our physical and mental health. The clue here may be in the book’s title! Van der Kolk presents research into the use of movement and yoga to help those with PTSD find ways to reconnect with their body again after abuse, violence or injury. He also highlights the role that our emotions have on us, not only psychologically but physically too. 

We can all fall into patterns of avoidance at times, and this can include attempts to avoid our emotions. Van der Kolk highlights that when we ignore our emotions, they tend to find another way to grab our attention. They may show up as symptoms that demand our attention. He references somatic symptoms with no clear physical cause, often referred to as medically unexplained. These can include chronic pain, IBS, fibromyalgia, chronic fatigue and some forms of asthma. He stresses that for recovery from PTSD, both the mind and body need to recognise that the danger has passed and that it is safe to live in the present reality. 

Within CBT, we do this by using a process known as ‘updating.’ This involves acknowledging the beliefs held at the time of the trauma event, such as, “I’m going to die.” We then bring in the updated knowledge, such as, “I survived” into the trauma narrative. This often involves the use of physical actions and gestures to support the mind-body connection in accepting this as the truth and current reality. Through updating, it is possible to shift out of reliving the past and into living in the present. 

suppressing emotions

A Gentle Word of Caution

I found The Body Keeps The Score to provide a thorough and insightful account into PTSD. As a clinician with a particular passion for this area of my work, it was an interesting read. However, I would highlight that there are very graphic accounts of violence, sexual abuse, and child abuse throughout the book. This is naturally distressing. As trauma therapists, we receive a lot of clinical support to look after our own wellbeing working with PTSD. Before choosing to read this, I would encourage some consideration of whether you feel emotionally able to deal with such accounts. Perhaps unsurprising given the topic, it does make for quite heavy read. 

 

 

 

Updated, June 2024.