📚 Finished reading The Body Keeps the Score by Bessel A Van der Kolk.

This reads like an very comprehensive book about the grim impact that experiencing trauma can have on many aspects of subsequent life as a human, and what we can do about it.

It gets into the science a fair bit, explaining the impact that trauma has on the functioning on one’s brain, mind and of course the titular body. For whilst those impacted might find ways to push what they went through out of their mind most of the time, whether through continuously effortful mental work, chemical escapism or other risky and numbing behaviours, their bodies may remain in a state of constant stress.

This ever-present fight-or-flight response dramatically lowers one’s ability to fully engage in everyday life. So survivors sometimes find themselves alone, keeping secrets from others and indeed themselves, struggling to form quality connections and relationships or do much of anything beyond the minimum necessary to simply get through the day. They may feel entirely numb, unable to interpret, trust or control their inner physical and mental experience, or exhibit seemingly inexplicable violent outbursts. Continual output of stress hormones also cause problems with memory, attention, mood, sleep, learning and many other health issues.

This doesn’t need to be the case though. The author is at pains to say we do know a lot about the causes of trauma now, as well as some effective solutions. However classic mainstream psychiatry does not embrace many of them, preferring to restrict itself to the use of pharmaceuticals and talking therapy.

He regards both these conventional approaches as having their use, but not as close to being the be-all and end-all of what treatments should be offered. Drugs might successfully help a patient get through the day whilst they’re taking them, but fail to address the underlying cause of their condition or allow for full engagement in life. Talking therapies may not even be possible for patients who in truth presently unable to communicate their experience to others.

And many patients never even get a trauma diagnosis, instead receiving a set of disparate individual mental and physical diagnoses. The former are often a hodge-podge taken from whatever the latest DSM categories of mental disorder are. It’s a approach of diagnosis and treatment by symptoms rather than cause, which has long been discredited in other fields.

A more wide-ranging and effective response would be to combine those approaches with others. Some of his suggestions sounded a little incredible to me at first, but apparently all have increasing amounts of experiential and scientific evidence as to their effectiveness. And it’s not like for the most part we can definitively explain the mechanisms for why conventional pharmaceuticals or talking therapies work.

His recommendations include yoga, communal activities such as singing breathing and chanting, mindfulness, experiencing touch, Eye Movement Desensitization and Reprocessing, writing, Internal Family Systems therapy, psychomotor therapy, neurofeedback, taking part in a theatrical production and more. One of the commonalities across many of those is the aim to teach the body and mind that it’s safe, particularly in the presence of other humans. They also offer the possibility of integrating, rather than concealing, one’s traumatic memories from others and yourself. If all goes well, then strategies that subconsciously you may be using to hide the unbearable pain from yourself will one day no longer be required, allowing you to go ahead and flourish in everyday life.

Despite not being a particularly new book, it has famously hit the best-seller list a whole lot in recent times - 150 weeks on the New York Times' list! - selling millions of copies to an audience far wider than one might naively expect to be interested in a book that’s edging towards a more academic way of writing at times. It’s even the basis for at least at least a couple of semi-viral tweets .

Part of this may be due to the unfortunate fact that trauma should not be thought of as solely the preserve of soldiers returning from combat and refugees fleeing genocide.

The book presents some truly harrowing statistics of how common events with potentially similar health effects are; 20% of Americans apparently being sexually molested as a child, 25% beaten as a child, a third of couples experiencing physical violence and so it goes on. The feminist movement has also helped the world understand that up to half of it’s population may feel varying degrees of threat and endangerment in their lives on the basis of their gender alone.

One perhaps related thing to note is that the book does contain descriptions of traumatic events. I’ve noticed several discussions online whereby people have noted that they find themselves triggered by these, here for instance. Perhaps some caution is to be advised if that’s something that might affect you. But other people feel seen and affirmed by its contents even if it was tremendously difficult reading for them, so YMMV for sure.

Another contributor to its recent popularity would likely be the Covid-19 pandemic, although interestingly the author doesn’t consider the general experience of the pandemic a collective trauma in the sense he’s writing about. I guess this may be because it’s something that we don’t intuit as shameful, as something we must hide from ourselves and others, in the same way as other traumatising incidents manifest. Everyone has “experienced” the pandemic, albeit in different ways, with vastly different levels of comfort and safety. Many people have been lucky enough to have been able to maintain many of their most significant social connections, as frightening, isolating and limiting as the experience has has been.

Although surely the aspect of continuously feeling under threat must have been, and still be, some people’s experience. And it’s perfectly plausible to me that it’s been more “conventionally” traumatic for those either on the frontlines of it - for example medical professionals making life or death decisions, witnessing hundreds of people experiencing unpleasant deaths that they cannot realistically to do anything about - or those already in vulnerable situations for which the simultaneous isolation and closure of a lot of the world may have been too much to bear.

My full notes are here.