In the prologue and Part One of the book, van der Kolk explains how trauma is far more prevalent than previously believed. Understanding how trauma physically alters the brain and body should inform therapeutic approaches. As a psychiatrist at the Boston Veterans Administration Clinic beginning in 1978, van der Kolk encountered numerous veterans suffering from posttraumatic stress disorder (PTSD). PTSD also afflicts people who survive childhood sexual abuse and violence. Very early on in his career, van der Kolk wondered about the possible link between early abuse and current psychiatric disorders. He describes the different innovative technologies that have revolutionized our understanding of cognitive processing. The Western medicinal approach to human suffering has gone through many evolutions, and currently relies mostly on psychotherapy and medication.
The second section in The Body Keeps the Score explores the cognitive repercussions of trauma. Van der Kolk cites immobilization as the root of most traumas. This means that treatment to restore homeostasis will require effective action in the face of a threat that triggers the fight-or-flight response. Otherwise, the brain continues to secrete stress chemicals. In addition to fight-or-flight, trauma responses can manifest as fawning or freezing. Van der Kolk describes neuroanatomy using the triune brain theory, which suggests that the human brain evolved in three layers: the reptilian brainstem, the limbic system, and the neocortex (each with distinct functions). Van der Kolk highlights how trauma can impair the prefrontal cortex, responsible for rational thought, while overstimulating the amygdala, which governs fear responses. These changes lead to symptoms like flashbacks, hypervigilance, and emotional dysregulation. He highlights the importance of feeling safe and loved from a neural perspective. One essential aspect of healing from trauma is learning how to discern what is happening inside one's own body (physically and emotionally).
Part Three focuses on children who experience trauma and abuse. Van der Kolk recalls working with traumatized children at the Children's Clinic at the Massachusetts Mental Health Center. He and his colleagues found that abused children are conditioned to give up in the face of later life challenges. Van der Kolk advocates for supporting parents in learning how to attune to their children. Since officially recognized diagnoses published in the Diagnostic and Statistical Manual of Mental Disorders (DSM) inform a patient's possible treatment, van der Kolk and his colleagues attempted to add a diagnosis called developmental trauma disorder. However, it ended up being excluded from the revised manual.
In Part Four, van der Kolk provides an overview of how trauma imprints on an individual's memory. This introduces the ongoing debate of whether traumas such as childhood sexual abuse can be genuinely forgotten and later recovered. Van der Kolk was given the controversial task of evaluating whether a young man's resurfaced memories of rape were credible. This underscores the challenges associated with psychological evaluations in court proceedings. Although humans are wired to remember insults and injuries clearly, this does not always apply to traumatic experiences because they overwhelm and fracture memories.
Part Five is an exploration of holistic healing modalities that can help traumatized individuals recover. While self-management protocols and having a solid social support network help, there is no specific universal therapeutic approach. Psychotropic medications, according to van der Kolk, cannot "cure" trauma, but he prescribes them in cases he deems appropriate. MDMA is another potential treatment. Cultures around the world rely on art, music, and dance to treat trauma. Van der Kolk writes about eye movement desensitization and reprocessing (EMDR) as an evidence-based treatment for PTSD and other psychological conditions. Yoga allows patients to safely get in touch with their bodies. Internal Family Systems Therapy (IFS) is used to treat a wide range of mental health conditions, and it promotes understanding, compassion, and self-management. Pesso Boyden System Psychomotor (PBSP) therapy is used in many trauma centers to create new, positive memories that address past unmet needs. Neurofeedback holds immense promise as a therapeutic treatment for trauma by training the brain to regulate itself. Theater can be a powerful tool for addressing trauma since it provides a safe space to consider different emotions, have embodied experiences, and practice interpersonal skills. Overall, van der Kolk urges clinicians to be open to trying different approaches, even if they seem unconventional.
Ultimately, The Body Keeps the Score serves as both a scientific guide and a call to action, offering hope and practical strategies for those seeking to heal from trauma.
