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

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1-Page Summary of The Body Keeps the Score

Overview

We often think of trauma in war or refugee camps, but it actually happens all around us. According to the Centers for Disease Control and Prevention (CDC), about 20% of people living in the United States were sexually abused as children, and a quarter were physically beaten.

Because people are resilient, they can survive traumatic events. However, these events could have a lasting impact on their mental and emotional wellbeing. They also affect the interpersonal relationships of those who’ve gone through them.

The first two parts of this summary discuss the latest research on how stress affects our brains and bodies. The third part further explores the effects that early childhood trauma has on developing brains. Next, it looks at how traumatic memories affect us over time. Finally, it examines some of the most thoroughly researched treatments for trauma.

The Rediscovery of Trauma

Tom was a war veteran who worked as an accountant. He fought in the Vietnam War and had recurring nightmares about it. On July 5, 1978, Tom went to see a psychiatrist because of his problems with flashbacks and nightmares.

When the psychiatrist suggested taking pills to help Tom go away from Vietnam, he refused because he wanted to remember his dead friends. He had been home for almost a decade and was still committed to reliving his experience there.

Revolutions in understanding mind and brain

At the time, there was not much knowledge about how to treat Tom’s condition. Now we know it as PTSD, which can manifest in many ways such as flashbacks, nightmares and substance abuse. Since then we have gained a lot of knowledge thanks to psychological research and technological advancements in brain imaging.

In the 1980s, Steve Maier and Martin Seligman conducted research about animals that had been exposed to electric shocks. They found that after experiencing repeated shocks, the animals’ responses became diminished.

The neuroscience revolution

Research has shown that people who have experienced trauma continue to secrete high levels of stress hormones, which leads them to be constantly on edge. Because they don’t know what is safe and dangerous, it’s difficult for them to tell the difference between the two. PTSD symptoms are a result of this clouded reality. However, brain imaging technology has given scientists an opportunity to see which parts of the brain are activated by various stimuli or memories associated with past traumas.

This imaging has helped us understand PTSD by verifying the different functions of the left and right hemispheres of the brain. For example, when someone with PTSD is having a flashback, parts of their left hemisphere shut down. Meanwhile, right-brain areas that deal with strong emotions take over. This distorted sense of reality often leads people to lose foresight about potential consequences for their actions.

This Is Your Brain on Trauma

Noam was 5 years old when he saw the first plane hit the World Trade Center from his classroom. The whole family survived, and Noam never suffered any post-traumatic stress disorder as a result of that experience.

Noam’s ability to survive the 9/11 attacks was helped by his fight-or-flight response, as well as support from family and friends. He also drew pictures of what he saw that day. In one drawing, Noam depicted the collapsing twin towers surrounded by trampolines so people could jump down safely.

It’s important to feel in control of a dangerous situation, especially if you can’t escape it. If you’re unable to leave the situation, your brain will continue looking for ways out even when there isn’t one.

Body–brain connections

It is also important to have a set of coping mechanisms for dealing with stressful experiences. These can include talking, moving your body, and making art. Noam’s favorite tool is “making art” because it helps him deal with stress. He learned about this from his study of Darwin’s book The Expression of Emotions in Man and Animals.

Darwin believed that emotions evolved to keep us safe. For example, fear keeps you safe from danger. It also makes your heart beat faster and slows down digestion so that you have more energy for running away from the danger. When people feel too much anxiety or sadness, they often try to numb themselves with drugs or alcohol because it’s hard to deal with those feelings when they start affecting their physical health.

Darwin argued that if we could understand what causes these negative emotional states in ourselves and others, we might be able to develop new treatments for mental illness and drug addiction.

Darwin’s ideas about the importance of empathy were expanded upon by Stephen Porges. He found that humans’ sense of safety depends on sensing others’ emotions, and hearing supportive words from familiar people can help us feel more at ease in stressful situations.

Losing your body, losing yourself

The importance of keeping balance in one’s internal and interpersonal health cannot be overstated. Almost all forms of mental illness can be traced back to difficulty regulating emotional states and maintaining stable relationships. Before Sherry had even spoken a word to her new therapist, he could tell that she was afraid because she was slouched with her head down and turned inward. She explained that the scabs on her arms were from picking at them too much, which is a sign of an unstable relationship between herself and others.

Sherry grew up in a household with many foster children. Her mother would often tell her that she didn’t belong in the family, and Sherry was tasked with caring for most of these kids.

Sherry felt numb and started picking at her skin. To get her to feel the connection with her body, Sherry’s therapist recommended a massage therapist. When the massage therapist started working on Sherry’s feet, she yelled out because she wasn’t able to feel it in that part of her body.

One example of how trauma affects people is Sherry’s case. Trauma can cause a person to be unable to trust their senses, which prevents them from feeling safe. When someone doesn’t feel safe, they have trouble sleeping and eating normally.

The Minds of Children

You may have heard of the Rorschach test, or inkblot test. In this type of psychological evaluation, people are shown abstract shapes and asked to interpret what they see. Similarly, researchers used a similar approach to study trauma in children by showing them pictures of everyday scenes that could be interpreted in different ways. One card showed a man fixing his car while two kids watched him smilingly from afar. Children who had not experienced trauma told stories about how the man would get his car fixed and then take the kids out for McDonald’s afterwards. However, those who had been traumatized told stories that were much more negative than those without trauma—for example, how the kids might hurt the man with tools or kick out his jack so he would get crushed by his own car.

Adverse childhood experiences

Bowlby’s attachment theory shows us that we are born with the instinct to connect deeply with caregivers. These relationships, called primary bonds, are key to our survival as children. If these primary bonds are reliable and nurturing, then a child can expect others to be trustworthy and have trouble forming relationships later in life if those expectations aren’t met. In 1995-1997 Vincent Felitti surveyed 17000 patients at the Kaiser Department of Preventive Medicine about adversity in their childhoods. The findings were shocking: two thirds of them reported experiencing at least one type of childhood trauma.

For example, more than one in four respondents reported being physically abused during their childhood. And if someone had one adverse experience growing up (physical abuse), they were likely to have more (87% of them did).

The case for diagnosis

The ACE study was revolutionary because it studied the correlation between childhood trauma and adult health. Adults who experienced six or more traumatic events were twice as likely to get cancer, four times as likely to develop emphysema, seven times more likely to become an alcoholic and had a higher risk of many other diseases. Those who have been through chronic trauma need a lot of support. People with developmental trauma disorder (DTD) are at high risk for developing various problems in adulthood.

A new category of mental illness is needed because the majority of children who are abused and neglected do not have PTSD. As a result, they’re diagnosed with other disorders that don’t address their problems.

The symptoms of DTD are as follows: trouble concentrating, emotional dysregulation and social interactions. It is a combination of these symptoms that would be diagnosed as DTD if there was a known history of trauma.

Trauma experts presented their case to the APA (American Psychiatric Association) in 2009, arguing that they should be able to diagnose a new condition called DTD – developmental trauma disorder. However, the APA claimed that it was too niche and rejected it even though an estimated 1 million children are abused or neglected every year in America.

The Imprint of Trauma

Julian was on the phone with his girlfriend, Rachel, when she mentioned a story in that morning’s edition of The Boston Globe. It said that Father Shanley was being investigated for child molestation. Julian had worked with him as a child and told her about it.

Julian had a positive relationship with Shanley in the past, but he started to remember that he was one of his victims. He realized this when Rachel told him what Shanley did to her. Julian began having panic attacks and other problems after their conversation.

The importance of remembering

Traumatic memories are different from regular ones because our brains become overwhelmed during moments of shock and can’t save coherent versions of events. Instead, we remember only sensory and emotional fragments. As a result, it’s difficult for our brains to process traumatic experiences as we do other experiences. Erich Maria Remarque’s 1929 novel “All Quiet on the Western Front” describes the impact of World War I on soldiers who experienced mental health issues after returning home from war. This work was one of the first attempts to characterize traumatized veterans as something other than weak or cowardly.

Remarque’s message was not well received in its time. It took decades for it to be taken seriously, even by the medical community. At that time, veterans were only treated for physical manifestations of PTSD, such as stomach cramps and chest pains. The causes behind these symptoms weren’t addressed at all.

It’s good that more people are able to get help for their mental health issues, because they need it. Therapists provide a safe place where people can talk about what happened to them and work through the trauma. They can also connect patients with other forms of treatment such as body work or medication.

Paths to Recovery

People who have experienced trauma can heal through various means. One of the most important things to do is to build four capacities: calm focus, staying calm and focused despite external circumstances, being fully present in your body, and keeping an inner awareness and honesty with yourself. Two strategies you can try on your own are meditation and mindfulness because they help you stay present in your body by focusing on breathing. Reaching out for relationships when facing a difficult past or even now is crucial to have social support that provides safety which allows the body to return back into equilibrium after stress or trauma. Confronting trauma alone is a great start but professional help may be needed as well. Talk therapy helps people make sense of traumatic experiences by opening up about them so it’s not kept inside where it takes a huge amount of energy; therapists lend a trustworthy ear and help steer conversations in productive directions together creating cohesiveness among fragmented memories; eye movement desensitization reprocessing (EMDR) allows for subconscious reprocessing of traumatic memories giving the brain more capacity to process information while re-enacting structures from group therapy addresses issues related to hurtful relationships allowing one to gain control over those relationships instead of feeling powerless over them; yoga helps relieve muscle tension as well as rebuild connections with physical senses helping one feel at ease within themselves again which gives rise self-leadership skills where different parts need attention like the inner child protective parent goofy friend etc all this leads us towards having better coping mechanisms for dealing with problems without letting our minds get away from us preventing ourselves from getting lost within ourselves

Conclusion

The research of the past few decades has helped mental health workers and researchers greatly expand their understanding of trauma. However, our society’s collective mental health is worsening because we have underfunded safety nets like public housing, we have a huge problem with mass incarceration in black communities, and we don’t provide universal access to quality healthcare.

The fact is that the treatment and prevention of trauma cannot be separated from politics. If we expect people to live in a healthy environment, then our government needs to prioritize services for all Americans. As long as this isn’t done, public health crises will remain relevant.

We can help people who are suffering from the effects of trauma by forming relationships with them. We should also help one another when we need it, and advocate for social services. Above all, we should remember that experiencing trauma isn’t a death sentence. People like Maya Angelou and Nelson Mandela have dealt with adversity in their lives to become great leaders who contribute positively to society. There is always hope for healing ourselves and our world even if there’s been personal devastation.

Full Summary of The Body Keeps the Score

Overall Summary

The Body Keeps the Score is a 2014 nonfiction work by Bessel van der Kolk, M.D., who specializes in treating trauma victims. He has published numerous scientific studies about his work and contributed to many more. The book was well-received by critics and consumers alike, becoming a New York Times Bestseller as well as winning praise from fellow doctors who specialize in trauma therapy.

The author uses his own experiences, stories about patients he’s treated, scholarly citations and general information to explain trauma. He also charts the history of scientific interest in trauma as well as his personal experience trying to get the best treatment for those who suffer from it.

Part 1 of the book covers van der Kolk’s background and how he became interested in helping people with trauma. He describes what he noticed about soldiers, victims of child abuse, and other patients who suffer from PTSD. He explains brain anatomy through neuroscience to describe how trauma affects the human body. He also criticizes doctors for focusing too much on treating symptoms with antipsychotic drugs instead of trying to treat their patients’ underlying problems.

Part 2 of this book discusses the physiology and anatomy of trauma. It explains how different parts of the brain are affected by trauma, and how that affects other parts of the body.

Chapter 3 goes into more detail about child abuse and neglect. It separates these traumas from other forms of trauma, as they affect the brain and body differently than ongoing childhood traumas. He explains how this happens to children, how it affects them in the long run, and why medical systems fail victims of child abuse.

In Part 4, van der Kolk lays out historical context for the scientific study of trauma. He discusses in depth some of the primary objections to trauma as a diagnosis throughout history and even today. Van der Kolk also notes that it’s difficult to get others to see trauma as a valid area of study since it cannot be authentically reproduced in a laboratory setting.

Part 5 discusses treatment methods that can help with trauma. It focuses on EMDR, yoga, IFS psychomotor therapy, neurofeedback and theater.

In the epilogue, the author tells us that traumatized people need more attention from scientists and doctors so they can get the help they need to lead full lives.

Prologue: “Facing Trauma”

The Body Keeps the Score by Bessel van der Kolk is an introduction to the book. Van der Kolk explains that he wrote this book as a guide and invitation for people interested in trauma treatment. He mentions his own interest in psychiatry and says that he has worked on trauma research for over 30 years, often with support from major medical organizations.

Van der Kolk offers a brief explanation of what trauma is and how it affects the mind and body. He also mentions some areas that are researching this topic, including neuroscience, developmental psychopathology, and interpersonal neurobiology. Van der Kolk then suggests that research shows that trauma has actual physiological changes.

Part 1, Chapter 1: “Lessons from Vietnam Veterans”

As a psychiatrist, Dr. van der Kolk met with Tom, a Vietnam veteran who suffered from rage episodes and nightmares. The doctor prescribed medication for the nightmares, but Tom refused to take it because he feared that if his nightmares ended, so would the memory of his friends’ deaths.

Driven to understand veterans and other people who are traumatized, van der Kolk studies their experiences. He compares them to victims of child abuse, as both groups have trouble engaging with the world around them. In a study asking veterans to describe Rorschach blots (inkblot tests), he finds that trauma also shuts down perception and imagination.

During therapy sessions with Vietnam and World War II veterans, it was found that they could only talk about their war experiences. In these groups, the men were alive when discussing battle stories but did not engage in conversation with anyone who wasn’t part of the group.

Two years after van der Kolk joins the VA, PTSD becomes an official diagnosis.

Dr. Van der Kolk leaves the VA to work at a mental health center where he finds similar symptoms in victims of child abuse as he has seen in combat veterans. He also finds a lack of information and research on childhood trauma, just like with combat trauma.

Part 1, Chapter 2: “Revolutions in Understanding Mind and Brain”

Chapter 2 talks about how antipsychotic drugs came into use. Van der Kolk was in medical school when they first became available. He saw firsthand the way doctors treated patients with mental and behavioral disorders as if they were objects to be solved, not people with feelings, fears, and accomplishments.

While van der Kolk’s mentor encourages him to focus on his patients rather than textbooks, the psychiatric profession does just the opposite. It focuses on treating individual disorders by using medications like Prozac, which has a huge impact in psychiatry due to its effectiveness at treating many different mental “disorders.” Van der Kolk also notes that there are statistics suggesting that many disorders aren’t actually treated with medication and may be misdiagnosed.

Van der Kolk uses personal anecdotes to explain his theories on trauma, including why people who have been traumatized may stay in bad environments or return to them. He also discusses the idea that strong emotions can block pain and other similar concepts.

Part 1, Chapter 3: “Looking into the Brain: The Neuroscience Revolution”

In the early 1990s, brain imaging technology allowed neuroscientists to see inside the brains of traumatized patients for the first time. They discovered several key elements of trauma that were previously unknown.

A study by van der Kolk found that the amygdala, visual cortex, and Broca’s area are activated during flashbacks. The amygdala controls fight or flight responses and floods the body with stress hormones. The visual cortex is also activated as well as Broca’s area which regulates speech. Trauma essentially creates a constant state of anxiety while diminishing people’s ability to speak about what happened to them.

The right side of the brain, which is responsible for visual and spatial recognition, is active when someone has a flashback. The left side of the brain, which is responsible for language and analysis, remains inactive during flashbacks.

The author notes two key observations about the effects of trauma on the brain. First, talk therapy does not work very well if a patient is unable to activate their language center when experiencing traumatic flashbacks. Second, elevated stress hormones eventually wear down the body and cause physical ailments unrelated to the original trauma.

Part 2, Chapter 4: “Running for Your Life: The Anatomy of Survival”

Dr. van der Kolk explains more about the brain and how it responds to trauma. He says that if we can run away from a threatening situation, we have a better chance of not being traumatized by it. If we feel safe after running away, our fight-or-flight response can turn off and the traumatic event won’t affect us as much later on in life.

The brain has three parts: the reptilian brain, which handles basic functioning; the limbic system, which controls emotions and allows us to navigate social networks; and the neocortex, or “rational” brain, which handles higher executive functions. The emotional and rational brains are in constant interaction with each other. Additionally, our brains contain “mirror neurons” that allow us to empathize with others.

Van der Kolk explains that traumatized brains have a hard time finding the balance between rational and irrational ways of thinking. The thalamus is where sensory information goes, and it’s connected to the amygdala (the “smoke detector”) and the frontal lobes (the “watchtower”). Traumatized brains overuse the smoke detector at the expense of rational thinking.

Van der Kolk concludes the lecture with an example of two trauma victims who were in the same car accident. One patient responds to his memory trigger as if it is happening in the present, while another goes completely numb and feels nothing at all. Treatment for trauma takes a top-down or bottom-up approach, depending on how the traumatized brain behaves.

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Part 2, Chapter 5: “Body-Brain Connections”

In order to prove the connection between mind and body, van der Kolk cites two famous scientists: Charles Darwin and Ivan Pavlov. Both men believed in equilibrium within the body. If an organism is stuck in survival mode, its energies are focused on fighting off unseen enemies. This leaves no room for nurture, care or love. The same goes for animals that have been exposed to extreme stress; they find a new internal equilibrium different from their previous organization of housekeeping.

The author uses Charles Darwin and Ivan Pavlov’s findings as a foundation for his explanation of how the human body reacts to stress. The autonomic nervous system governs reactions to stressful situations, with an equilibrium between the sympathetic and parasympathetic systems. When humans encounter threatening situations, they go through three levels of “safety” triggered by the vagus nerve that runs from the brain to intestines.

When faced with danger, people first turn to their friends and family for help. If this is not possible or they’re in immediate danger, they have two options: fight back or run away. If neither of these are available to them, then the person will shut down by freezing up or collapsing.

According to Van der Kolk, humans work as members of a tribe. In order to do that well, we need support from others. Babies learn how to synchronize with others when they’re born and trauma makes it difficult for people to connect with each other afterwards. Trauma can also cause alienation because traumatized people have trouble connecting with one another.

Part 2, Chapter 6: “Losing Your Body, Losing Your Self”

Van der Kolk goes on to talk about how trauma affects the body. He cites a study that shows that people with trauma do not take stock of their own bodies when they’re in a clear state of mind, while normal people do this. Trauma causes people to lose their sense of self, which is why they have trouble connecting with others.

Van der Kolk notes that some patients with extreme trauma cannot recognize their own reflection in the mirror or identify sensations from entire areas of their bodies. Essentially, humans need to register physical sensations of themselves and the world around them in order to feel safe. When those sensations are overwhelmed and/or dulled, people exist in a constant state of threat, distrusting their own feelings and the feelings of others.

Trauma can also affect a person’s ability to feel and understand their own body. This is called alexithymia, or the inability to describe one’s feelings. Traumatized people are more likely to be victimized again because they don’t know what they’re feeling, so they don’t protect themselves from potential harm. Van der Kolk has concluded that trauma treatment must start with helping patients become aware of their bodily sensations even if it makes them uncomfortable; numbing these feelings only furthers the problem.

Part 3, Chapter 7: “Getting on the Same Wavelength: Attachment and Attunement”

Part 3 of the book addresses trauma as it relates specifically to children. Van der Kolk explains that even young children can experience trauma if they and their caregivers are out of sync. He also says that doctors label these children with developmental disorders and medicate them heavily, but this doesn’t address the underlying causes of their problems.

Van der Kolk explains the concept of attachment theory, which helps explain how early experiences shape a person’s life. The ideal is to have secure attachments with caregivers so that children can learn how to deal with adversity and be part of society as a whole.

The relationship between a child and their caregiver is critical. However, sometimes it can be difficult. There are three types of attachment: avoidant attachment (where the child deals with their emotions but not in an ideal way), anxious attachment (where the child feels emotion but doesn’t deal with it well), and disorganized attachment (where there’s no solution to feeling frightened). Van der Kolk notes that children who don’t feel safe as babies have trouble regulating their moods later on in life.

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Part 3, Chapter 8: “Trapped in Relationships: The Cost of Abuse and Neglect”

Chapter 8 of this book focuses on how people who have endured traumatic childhood events can still experience effects from those events, even if they don’t remember the actual incidents. The author illustrates this concept with the story of one patient named Marilyn. She did not recall being abused as a child and believed that she had a happy childhood, but eventually learned that her father and brother repeatedly raped and beat her. This led to dissociation as a way for her to protect herself from these traumatic experiences.

Van der Kolk talks about how when people dissociate from bad experiences, it can lead to physical problems. He mentions a study that found that patients with histories of incest have a greater chance of developing autoimmune diseases. The immune system is oversensitive because the body searches for an outlet for all the pain and suffering.

Van der Kolk also observes that children have a hard time telling someone about their pain and suffering. If they do tell, the person who’s supposed to help them will only hurt them even more.

Part 3, Chapter 9: “What’s Love Got to Do with It?”

Chapters 9 and 10 address the disconnect between psychiatry and treatment of traumatized children. The Diagnostic and Statistical Manual of Mental Disorders, or DSM, is criticized for not being as precise as other areas of medicine. It also treats psychiatry like it were a science when it’s not. This results in people with PTSD being viewed as out-of-control women who need to be straightened out.

Van der Kolk illustrates how the medical community has been slow to accept trauma diagnoses by telling two stories. First, he tells of a study that shows a connection between borderline personality disorder and trauma. Despite the results, this new diagnosis is not included in the next edition of DSM because it will make insurance companies less willing to pay for treatment because they won’t be able to submit their work as easily. Second, he tells another story about an entirely different issue where doctors are unable to help patients with PTSD due to similar reasons as above.

The second study, the Adverse Childhood Experiences (ACE) study, shows that child abuse is very prevalent in America. The ACE study also found that childhood trauma can cause behavioral problems and self-harming tendencies. Additionally, it causes addiction and diseases caused by stress on the body later in life. However, despite its prevalence, this type of trauma has had no effect on classification or treatment systems.

Part 3, Chapter 10: “Developmental Trauma: the Hidden Epidemic”

Chapter 10 discusses the psychiatric industry and how they have failed children with traumatic home environments. Studies show that nature and nurture are both important in determining whether someone will develop a mental illness, but if they do, it’s not a death sentence: safe early relationships can protect them from long-term problems.

Van der Kolk discusses his efforts to get better diagnoses and treatment for abused children. Through van der Kolk’s efforts, the U.S. Congress established the National Child Traumatic Stress Network in 2001, which has since run studies on traumatized children that corroborate data from the ACE study (Adverse Childhood Experiences Study). Van der Kolk points out that PTSD is different from trauma experienced by children; 82 percent of traumatized children do not meet diagnostic criteria for PTSD.

Van der Kolk and his colleagues developed a new diagnosis category for children with trauma. They provided research as well as letters of support from mental health commissioners to the APA, but it was rejected. The DSM-V stated that it lacked reliability, which is important in science. Van der Kolk explains two studies he submitted demonstrating this lack of reliability.

The new DSM (Diagnostic and Statistical Manual of Mental Disorders) ignores social causes of abnormal behavior in favor of biological causes. This is an attempt to make psychological illness align with physical disorders, but it’s a flawed approach because it doesn’t take into account the fact that many people who are diagnosed with mental illnesses may not have any biological defects. The author concludes that this has led to misdiagnosis and a huge burden on taxpayers for rehabilitation and incarceration, which would be better spent on prevention.

Part 4, Chapter 11: “Uncovering Secrets: The Problem of Traumatic Memory”

Van der Kolk goes on to explain how traumatic memories are different from regular ones. Although adrenaline can help memory become clearer, too much of it shuts down the rational mind. As a result, traumatic imprints are fragmented and disorganized. He also notes that while treating repressed memories is difficult, explaining them in court presents its own challenge because people tend to have difficulty understanding trauma-related evidence.

Van der Kolk provides some historical context for the psychiatric study of traumatic memory. He acknowledges that he learned most from Pierre Janet, who was a clinician and wanted to help his patients. Van der Kolk also points out that Janet was the first person to make a distinction between “narrative memory” and traumatic memories themselves.

Part 4, Chapter 12: “The Unbearable Heaviness of Remembering”

Van der Kolk continues his exploration of the differences between normal memory and traumatic memory. He also tracks historical attitudes towards trauma, noting that interest in it has risen during wartime, but soon after, people have dismissed the idea as “weakness”.

Exploring fluctuations in attitudes to trauma leads van der Kolk back to repressed memories. He notes that after interest in trauma went up again in the late 1980s and early 1990s, there were articles that claimed people could make up false memories of being abused. Although hundreds of scientific publications had documented how memory can be repressed, society still denied the possibility.

Van der Kolk explains how traumatic memories are formed and why they’re difficult to accept. He says that the scientific community finds it hard to believe because traumatic memory cannot be reproduced in a lab setting, and also mentions the story of a patient who experienced trauma from waking up during surgery but eventually found healing through treatments like those he recommends in this book.

Part 5, Chapter 13: “Healing from Trauma: Owning Your Self”

Van der Kolk reviews what he has covered in the preceding sections and tells us what’s to come. He emphasizes that treating trauma requires balancing the rational brain with the emotional one, pointing out that “understanding why you feel a certain way doesn’t change how you feel.” Van der Kolk also compares Western medicine’s reliance on drugs to other traditions that rely on movement, breathing, and mindfulness.

The rest of this chapter discusses several treatments for trauma that van der Kolk covers in more detail later. He breaks those down into categories based on the steps he thinks are most important: managing hyperarousal, gaining self-awareness, creating a support network, engaging with community, participating in some form of bodywork and learning to take action. Van der Kolk also adds that part of having a support network means choosing the right therapist and offers advice for doing so by asking if they’re just using diagnostic checklists or if they actually get to know you as a person?

Van der Kolk covers a range of treatments for trauma, including many that are effective and some that are not. He is particularly critical of Cognitive Behavioral Therapy (CBT) and desensitization as ineffective methods to treat trauma. Van der Kolk also criticizes the over-prescription of psychotropic drugs, saying “drugs cannot cure trauma; they can only dampen its symptoms.”

Part 5, Chapter 14: “Language: Miracle and Tyranny”

Van der Kolk discusses the role of language in trauma. Trauma is difficult to put into words because it’s experienced as sensory fragments rather than a cohesive narrative. He points out that, “If you’ve been hurt, you need to acknowledge and name what happened to you.” If we don’t share our pain with others, we are at war with ourselves.

Van der Kolk explains that we have two languages: actual language and body language. It’s important to be aware of our own body language, because it can help us communicate better with others. Writing in a journal is one way of expressing feelings and connecting physical sensations with the ability to describe them in words. However, sometimes writing can push people away if they don’t want to hear uncomfortable things.

Part 5, Chapter 15: “Letting Go of the Past: EMDR”

Van der Kolk goes on to discuss EMDR, a type of treatment that involves having patients focus on certain thoughts and notice sensations and thoughts they have as they focus. Scientists are unsure why this process works, but some hypothesize that it recreates REM sleep, the state in which dreaming occurs. The basic instruction for EMDR is ‘Hold that image in your mind and just watch my fingers moving back and forth’. This may very well reproduce what happens during dreaming.

Along with discussing the science behind EMDR, van der Kolk also includes anecdotes from people who have used EMDR and his own experience with it. He mentions that he’s worked with patients whom he does not share a language with, and still found success in helping them. Van der Kolk acknowledges that EMDR is most effective for adults who experienced acute trauma but has less efficacy for children who were abused over an extended period of time.

Part 5, Chapter 16: “Learning to Inhabit Your Body: Yoga”

Van der Kolk starts with a story about one of his patients who was physically uncomfortable when she experienced something that made her feel helpless. She felt like her body was disintegrating and couldn’t do anything about it, which led to chronic muscle tension.

Van der Kolk found that Heart Rate Variability (HRV)—the measurement of the ratio of inhalation and exhalation—is a useful diagnostic tool for patients. He discovered that he could regulate HRV by using Eastern practices like yoga, which trains practitioners to focus on regulating breathing. Yoga is a bottom-up form of regulation, meaning it allows patients to integrate with their bodies in a meaningful way.

Dr. van der Kolk is conducting an experiment at the Trauma Center, where he teaches yoga and evaluates its effectiveness on PTSD patients. The results are very positive, so his team integrates yoga classes into their regular offerings at the center. Dr. van der Kolk becomes a certified yoga instructor.

Part 5, Chapter 17: “Putting the Pieces Together: Self-Leadership”

In this chapter, the author discusses Internal Family Systems Therapy (IFS). IFS is a treatment method that addresses the idea of people being composed of subpersonalities. These parts are like an internal family made up of exiles (the traumatized parts), managers (protectors), and firefighters (emergency responders). Managers are all about staying in control, while firefighters will destroy the house in order to extinguish the flame. When someone has been traumatized, their subpersonalities fight each other. In order to help them heal, IFS focuses on cultivating an inner relationship between a person’s Self and their various protective parts.

Van der Kolk explains how he first learned about this type of therapy, as well as an in-depth explanation of the process and its effectiveness. He also provides several anecdotes to illustrate how it works, where he ran into difficulties during treatment and how patients eventually got better. Van der Kolk mentions that IFS is useful in helping rheumatoid arthritis sufferers learn to accept their pain better.

Part 5, Chapter 18: “Filling in the Holes: Creating Structures”

This chapter describes psychomotor therapy, which is a group process in which one person acts as the protagonist and creates an emotional structure with guidance from a therapist acting as the witness. The witness validates the protagonist’s feelings by offering insight into his or her past experiences.

Van der Kolk frames psychomotor therapy as particularly helpful for victims of childhood abuse and neglect, since it creates a new memory alongside old ones. He also notes that structures don’t erase bad memories; instead they offer an alternative memory where basic human needs are met and longings for love and protection are fulfilled. The protagonist in the book is able to connect with real people in the real space.

Van der Kolk talks about a technique he learned, psychomotor therapy. He explains how he got interested in it and describes his own experiences with the technique as well as how helpful it was for some of his patients.

Part 5, Chapter 19: “Applied Neuroscience: Rewiring the Fear-Driven Mind with Brain/Computer Interface Technology”

Chapter 19 explores a treatment method called neurofeedback. This involves using electric impulses and tones to train the brain to have different reactions than it normally would. Additionally, historical context and anecdotes are used to explain that subject matter. Details about electroencephalograms (EEGs), which measure brain wave activity, provide science behind how this works in people with trauma-related stress issues as opposed to those without their condition; he discusses differences based on typical individuals’ patterns as well.

Neurofeedback has been around for a long time. It was used before the 1970s, but it wasn’t widely adopted because of its competition with psychiatric drugs at that time. Van der Kolk says that there are five different neurofeedback systems and few large-scale studies to prove their effectiveness.

The author states that he was introduced to neurofeedback through a friend, and then learned about its use in treating trauma at the Trauma Clinic. He also mentions that it may be used for more than just psychiatric problems. Neurofeedback can help athletes and musicians perform better as well as treat learning disabilities and addiction.

Part 5, Chapter 20: “Finding Your Voice: Communal Rhythms and Theater”

Chapter 20 covers the final method of treatment, theater. Van der Kolk reiterates that communal movement and rhythm help people form a sense of community. He mentions several historical events where music or rhythm had a positive effect on people, adding “It’s surprising how little research exists on how collective ceremonies affect the mind and brain and how they might prevent or alleviate trauma.”

Van der Kolk mentions three theater programs that he has had personal contact with and that help people who have experienced trauma. Urban Improv helps kids by giving them the opportunity to make decisions in skits, which is a safe way for them to experience what they might encounter in real life. The Possibility Project allows kids to write their own musicals and perform them on stage, and it also works with foster care youth. Shakespeare in the Courts gives veterans an alternative to jail time by having them learn condensed versions of Shakespeare’s plays.

Van der Kolk mentions several programs that help troubled youth and adults connect with their feelings, bodies, and those around them. He uses his son as an example of someone who has benefited from the programs.

Epilogue: “Choices to Be Made”

The author summarizes the text by saying that trauma therapy is still very much an active field. He notes that while neuroscience has advanced, in some ways it seems like we’re regressing because many psychiatrists are doling out pills to patients without knowing them well.

Trauma is a serious epidemic in today’s society. Although there are programs that try to help those who have been traumatized, they fail because of the current system. The author suggests ways to improve it and ends with a call for action before trauma becomes too much for society to handle.

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