47 pages • 1 hour read
Bessel van der KolkThe Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma
Nonfiction | Book | Adult | Published in 2014A modern alternative to SparkNotes and CliffsNotes, SuperSummary offers high-quality Study Guides with detailed chapter summaries and analysis of major themes, characters, and more.
Themes
The Body Keeps the Score
More than just the title, “the body keeps the score” is van der Kolk’s central premise, and a phrase that he repeats verbatim around half a dozen times over the course of the text. Over the course of history, trauma has been poorly understood, misdiagnosed, ignored, and discounted as an area of legitimate study. However, trauma affects a considerable number of people, whether through terrible experiences in adulthood like rape or violent combat, or through abuse or molestation in childhood. Van der Kolk has devoted his entire career to understanding what causes trauma, how trauma affects the brain and body, and how to treat a condition that literally rewrites a person’s ability to interface with themselves and the world around them.
Van der Kolk provides abundant scientific evidence from personal research and interactions with patients and from other scientists who have studied neuroscience and the human condition. He supports his thesis with anecdotes about specific patients, illustrations of brain scans, and anatomical diagrams that demonstrate how the brain reacts to trauma and how that subsequently can affect the rest of the body. Van der Kolk builds a strong case in support of his assertion that the brain and body retain a “memory” of traumatic experiences even if someone is not conscious of it. In some cases, a person may have physical symptoms relating to trauma when the actual trauma has been blocked from their conscious mind, causing habits, tensions, or diseases that seem on the surface to have no underlying cause.
For van de Kolk, treating trauma means treating the body not with medications that numb the senses and target outward symptoms, but with a combination of therapies designed to reprogram the body’s “memory” by rewiring the brain’s circuitry (bottom-up regulation) or altering the brain’s processing to ease the rest of the body (top-down regulation).
Childhood Trauma Is a Lifelong Problem
Though van der Kolk has worked with and advocated for a variety of types of patients, he is most passionate about treating those with a history of childhood abuse and neglect. He devotes an entire section of The Body Keeps the Score to the origins and effects of childhood trauma, and argues fervently for changes in how the psychiatric community addresses childhood trauma. While “the body keeps the score” in all trauma patients, this is worse in children, who often dissociate from their trauma. This makes them harder to treat, as their difficulties cannot easily be linked to a particular event or set of events. In some cases, as with van der Kolk’s patient, Marilyn, adults abused as children may not even have any memory of their abuse, with their trauma only coming out in strange and erratic behavior later in their lives. As van der Kolk points out in Chapter 9, children who grow up with abusive or neglectful caretakers have much higher rates of addiction, behavioral issues, self-harm, autoimmune diseases, and other physical ailments as adults.
Medicine’s refusal to acknowledge child abuse and neglect as a genuine disorder compounds the issues that many traumatized children experience. As van der Kolk notes, “You cannot develop a treatment for a condition that does not exist” (145). He adds:
How do we treat people who are coping with the fall-out of abuse, betrayal and abandonment when we are forced to diagnose them with depression, panic disorder, bipolar illness, or borderline personality, which do not really address what they are coping with? (145).
While the medical community and wider society also marginalizes those with combat PTSD or trauma from rape, PTSD at least exists as an “official” diagnosis in the DSM. What makes treating child abuse so troubling is not only that children are being traumatized, with lasting effects for the rest of their lives, but also that their plight is completely glossed over or outright denied by the medical community.
Contemporary Medicine’s Dismissal of Trauma
Despite abundant scientific evidence demonstrating the existence of trauma and treatments that work best in treating it, the scientific community and public at large still frequently deny the evidence, as they have done since scientists first started studying “hysteria” in the late 19th century. Having worked on trauma for decades, van der Kolk has personally conducted numerous studies concerning different kinds of trauma, and has attempted to get new trauma classifications and better treatments. He provides examples throughout The Body Keeps the Score of rejections and denials: the American Psychiatric Association claims child abuse is a “niche” interest that does not deserve its own diagnosis category; journalists interview him about repressed memory, but ignore everything he has said when they publish their articles. Van der Kolk observes, “Nobody wants to remember trauma. In that regard society is no different from the victims themselves” (196).
More than just personally frustrating for van der Kolk, modern medicine’s refusal to fully acknowledge trauma in all its forms has a lasting impact on victims and the public alike. For victims, this denial means lack of access to proper treatment, which in turn means lifetimes spent medicated into numbness, wrestling with self-harm, battling addiction, and being in and out of hospitals and rehabilitation centers. Children in particular are assigned diagnoses based on surface symptoms and labeled “difficult” by parents, teachers, and peers, rather than being given the chance to resolve or improve their underlying trauma issues and lead fuller lives. As van der Kolk illustrates in Chapter 12, widespread denial of trauma has serious impact for a society—for example, categorizing shell shock as “weakness” helped support the rise of fascism in Germany.
