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.
Part 1Chapter Summaries & Analyses
Part 1: “The Rediscovery of Trauma”
Part 1, Chapter 1 Summary: “Lessons from Vietnam Veterans”
As “a staff psychiatrist at the Boston Veteran Administration Clinic” (7), van der Kolk meets Tom, a Vietnam veteran suffering from rage episodes and nightmares. Van der Kolk prescribes Tom medication for his nightmares, which Tom does not take, explaining that he fears if the nightmares go away, his friends’ “deaths will have been in vain” (10). Prompted by Tom’s statement, van de Kolk tries to research war neuroses, only to find that “the VA didn’t have a single book about any of these conditions” (11).
Driven to understand Tom and other veterans, van der Kolk conducts studies of Vietnam veterans. He compares their experiences to those of victims of child abuse, noting that both groups often become entirely numb to emotions and unable to engage effectively with the world around them. Through a study asking Vietnam veterans to describe Rorschach blots, van der Kolk discovers that trauma also shuts down perception and imagination.
During group therapy studies separately involving Vietnam and World War II veterans, van der Kolk finds that many of the veterans can only talk about the war. The groups of men come alive when describing their battle experiences, but fail to engage with anyone who isn’t part of the “in” group. He notes, “After trauma the world becomes sharply divided between those who know and those who don’t” (18).
Two years after van der Kolk joins the VA, posttraumatic stress disorder (PTSD) becomes an official diagnosis with the
American Psychiatric Association. Van der Kolk leaves the VA for a new job at a mental health center, where he finds similar symptoms among victims of child abuse as he has seen in combat veterans. He also finds a frustrating lack of information and research on childhood trauma just as he did with combat trauma.
Part 1, Chapter 2 Summary: “Revolutions in Understanding Mind and Brain”
Chapter 2 covers the rise of antipsychotic drugs in treating mental illness. While Van der Kolk is between his first and second years of medical school, tranquilizing drugs first come on the market. Van der Kolk works “on a research ward at the Massachusetts Mental Health Center” (22) where he sees firsthand how doctors treated patients with mental and behavioral disorders like problems to be solved as opposed to people with feelings, fears, and accomplishments.
While van der Kolk’s mentor pushes for focusing on patients, not textbooks, the psychiatric profession heads in a different direction, “from infinitely variable expressions of intolerable feelings and relationships to a brain-disease model of discrete ‘disorders’” (27). When Prozac comes out, it causes a huge shift in psychiatry due to its effectiveness as a treatment for a wide range of mental “disorders.” Van der Kolk notes the growth of the psychopharmacology industry and cites statistics that suggest many disorders are probably erroneously treated with medications.
Van der Kolk weaves anecdotes about lectures he attended and people he interacted with throughout his facts about the history of psychiatry. These personal details explore how he conceived of possible explanations for trauma, including the concept of “inescapable shock” and the idea that “strong emotions can block pain” (33), which suggest reasons why traumatized people stay in bad environments and/or return to or generate anxiety-inducing situations.
Part 1, Chapter 3 Summary: “Looking into the Brain: The Neuroscience Revolution”
In the early ‘90s, brain imaging technology gives neuroscientists the ability to “see inside the engine” (40) for the first time. Van der Kolk and his fellow researchers neuroimage traumatized patients’ brains while inducing traumatic flashbacks. They discover several key elements of trauma that were previously unknown.
Van der Kolk’s study finds three key areas of the brain that activate during traumatic flashbacks. The first is the amygdala, which controls the body’s “fight or flight” responses, and whose activation floods the body with stress hormones. Second is the visual cortex, and third is Broca’s area, which regulates speech. Essentially, trauma causes people to be in a constant state of anxiety and diminishes the ability to speak about what has happened, or, as van der Kolk puts it, “All trauma is preverbal” (43).
All of the areas that “light up” in the brain during a flashback are in the right hemisphere, the “intuitive, emotional, visual, spatial, and tactual” (44) part of the brain. By contrast the left hemisphere—“linguistic, sequential, and analytical” (44)—stays more or less offline. Brains react to trauma “as if the traumatic event were happening in the present” (45).
Van der Kolk notes two key observations stemming from the understanding of a traumatized brain provided by neuroimaging. First, talk therapy, long suggested as treatment for trauma, does not work very well if the patient is unable to activate their language center when experiencing traumatic flashbacks. Second, long-term elevation of stress hormones eventually wears the body down, causing a host of physical ailments and diseases unrelated to the original trauma.
Part 1 Analysis
In Part 1, van der Kolk provides personal anecdotes that give context to his history of psychiatry and explains what compelled him to study the things he has and to approach them the ways he has. Even as a medical student, van der Kolk could see that typical methods of diagnosing and treating those with mental illness were not working. Teams of doctors and nurses wrestling unruly patients to the ground, forcing them to behave, or tranquilizing patients with powerful sedatives couldn’t take the human behind the behavior into account. Van der Kolk’s natural desire to learn about people and listen to what they have to say leads him to discoveries about the patients, in particular that many of those with behavioral or mental “disorders” experienced some form of trauma in their past that may be driving their problems later in life.
Van der Kolk’s relationship with modern medical science is a double-edged sword. On one hand, he sees that advances in psychopharmacology and neuroscience give researchers and doctors insights they’ve never had before and new tools to use to treat patients who are suffering. On the other hand, pharmaceutical and insurance companies have undermined psychiatry by focusing too much on the “diseases” themselves as opposed to the people. Treating the disorder has created a multi-billion dollar industry that isn’t actually helping the patients and ignores underlying causes.
While the monetization of trauma features most heavily in this section, van der Kolk touches on the two other primary themes of the text as well. In Chapter 1, he introduces the idea that childhood trauma has similar, if not worse, effects to combat trauma—an idea that he will expand upon in Part 3. In Chapter 3, van der Kolk cites the title of his text—“But the body continues to keep the score” (46)—for the first of many times, introducing the idea that emotional and mental trauma takes a serious and lasting physical toll.
