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
One of the primary symptoms of 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.
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 is associated with our logical and analytical thinking, and the right side is associated with our emotions and memories. Research from brain scans show that during flashbacks, only the right side of the brain (the emotional side that stores memories) is activated. The left side the (logical, analytical 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.
Social Support as a Biological Necessity
From my own experience treating PTSD, one of the things I hear repeatedly is, “I’ve never spoken about this before.” Trauma is extremely distressing and often associated with strong feelings of fear, grief, shame and guilt. Nobody likes to experience these emotions and so a common way to try and 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, what we know to be important in moving past a traumatic experience, and PTSD, is the very act of talking about it. In Cognitive Behavioural Therapy for PTSD, the treatment involves telling the story in order to process the trauma and enable the traumatic experience to be stored as a regular memory of something that has passed and ended. We see that through going through this process, the intrusive memories stop. This is done in a very structured and supported way, with the expertise of a therapist to ensure that any activated sense of threat or distress can be managed.
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 and in PTSD, this 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.”
The Mind-Body Connection
Throughout the book, The Body Keeps The Score, 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 by showing up as symptoms that demand our attention. He references somatic symptoms with no clear physical cause, often referred to as medically unexplained, which 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 appraisals made during the trauma event (such as the belief that one was going to die) and bringing the updated knowledge that this was untrue (that one survived) into the trauma narrative. This often involves the use of physical actions and gestures as a way of making the mind-body connection to accept and acknowledge this as the truth and current reality.
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. I wouldn’t necessarily advise against reading this book but before choosing to read this, I would encourage some consideration of whether you would feel emotionally ready and able to deal with such accounts. Perhaps unsurprising given the topic, it does make for quite heavy read.