Bessel Van Der Kolk (2014) The Body Keeps the Score. Mind, brain and body in the transformation of trauma.

For many readers the term The Body Keeps the Score has become a truism. Something that sounds kinda true, but you don’t really know why or who said it. It’s routinely rolled out in debates and conversations about mental health and in particular PTSD. But really it applies to those lives that have been struck by tragedy and trauma. Unfortunately this includes a large group of children. Those hundreds of thousands of children in Palestine, for example, whose parents cannot keep themselves or them safe from the effect of genocide. Bessel Van Derk Kolk keeps the score because he knows the score. This book is the type that you want to give to others and urge them to read it. Because it makes sense. Perfect sense.

In Van Der Kouk’s epilogue, over ten years ago, he noted  in ‘Choices to be made’ it was pretty much a done deal.

‘We are on the verge of becoming a trauma conscious society.’

Demonstrable facts about how trauma disrupts the workings of mind, brain and body had shown how abuse works not just in the short but longer term, over a lifetime if untreated.

‘James Heckman won a Nobel Prize for demonstrating the vast savings by early intervention in the lives of children from poor and troubled families.’

Yet the opposite has happened.

Congress eliminating Food Stamps for Kids. Shutting down Homestart. Opposing and rolling back the idea of Universal Health Care.

In Britain, David Cameron’s Tory Government shutting down Sure Start.

https://www.bbc.co.uk/news/articles/cz977nxww1jo

Reform creating headlines by promising to save a vast sum of money, in the same way that Van Der Kolk charted how ‘shellshock’ was cured by elimination of the term in reports. A refusal to believe that the shell-shocked soldier was at it. He (and it usually was a he) wasn’t made of the right stuff. They lacked moral fibre. At the stroke of a pen they were made outcast and could not claim for injury or benefits.

Most of us no longer believe that. In one study of Australian troops deployed to Afghanistan (before giving the county back to the Taliban) using EEG the experimenters noted how trauma changed the structure of their brains. Their brain patterns—hypervigilance but also a loss of mental clarity in everyday life—was consistent with children diagnosed with ADHD. A stepping stone to PTSD. Soldiers’ lives are only valued when they’re dead or have a physical injury.

A refusal some psychiatrists make between mental-health problems and a patient’s social conditions. Those on the front-line of chaos and trauma and abuse are the wrong kind of children, adolescents and then adults. They are the wrong stuff.

Reform promises to cure them by being tougher. And make vast savings in the same way climate-change deniers promise vast savings. If you firmly believe that please don’t read this book. Van Der Kolk’s measure arguments and possible solutions will be no solution to the dictatorial and fascist state of mind that produces brain rot.

I feel angry. My body is keeping the score. I’ve began slowing my breathing. Talking myself down. This too will pass.

Notes.

  Core idea: Trauma is not the event — it’s the lasting imprint on the mind, brain, and body when an individual’s capacity to cope is overwhelmed.

Trauma is:

                a body based memory that persists even when the mind wants to move on

                a disruption of the nervous system’s ability to regulate fear, emotion, and bodily states

                a fragmentation of experience: the past intrudes into the present

                a condition where survival mechanisms override normal functioning

He emphasises that trauma is stored physiologically:

                heart rate

                muscle tension(s)

                hormonal systems

                sensory memories

                dissociation

                hypervigilance

This is why “talking about it” often isn’t enough.

 (Non-Tory, populations affected

Van der Kolk’s research spans decades, and he identifies several groups with high trauma prevalence:

1. Combat veterans

                PTSD from life threatening events

                intrusive memories, hyperarousal, emotional numbing (cf booze and drugs)

                higher rates of suicide

2. Survivors of childhood abuse

This is the largest trauma population.

                physical, sexual, emotional abuse

                neglect

                attachment disruption

                developmental trauma shapes the brain (and body)

3. Domestic violence survivors

                chronic fear

                loss of autonomy

                dissociation

                somatic symptoms

4. Refugees and displaced populations

                war

                persecution

                loss of home and identity

                ongoing instability

5. Prison populations

Van der Kolk is explicit: prisons are full of traumatised people, especially those with childhood trauma.

                high rates of early abuse, neglect, and household dysfunction

                trauma leads to impulsivity, aggression, emotional dysregulation

                incarceration often re-traumatises

                punitive environments worsen symptoms (powder-keg environments produce blow-ups)

                untreated trauma contributes to recidivism

He argues prisons should be trauma informed environments — but they are the opposite with America building more and more prisons and incarcerating more of its citizens than the rest of the world’s prison population combined.

Treatments that often FAIL

1. Pure talk therapy (limited success)

                Trauma is stored in non-verbal brain regions

                Talking can activate trauma without resolving it at great cost.

                Insight into trauma does not mean cure.

2. Medication alone

                SSRIs help some symptoms

                They don’t address traumatic memory

                Over reliance leads to numbing (and possible addiction) rather than integration

3. Exposure therapy (when done poorly)

                Can re- traumatise

                Doesn’t work for people with severe dissociation

                Requires careful regulation

Treatments that show SUCCESS

Van der Kolk emphasises bottom-up approaches that restore bodily regulation. Autonomy over time and self-control.

1. EMDR (Eye Movement Desensitisation and Reprocessing)

                bilateral stimulation

                helps integrate traumatic memories (he’s not sure how or why)

                impressive empirically based success rate (eg Fergal Keane OBE)

2. Yoga

                reconnects body awareness

                regulates autonomic nervous system

                reduces dissociation

3. Neurofeedback

                trains brainwave patterns

                improves emotional regulation

                promising for complex trauma

4. Internal Family Systems (IFS)

                works with dissociate parts of the self

                helps integrate fragmented identity

                effective for childhood trauma

5. Theatre, movement, and expressive arts

                rebuild agency

                restore connection (to self and others)

                allow safe embodiment

6. Safe relationships/Safe space

                Attachment and repair (brain plasticity)

                Co-regulation

                community healing