Living in a society littered with trigger warnings and inundated with therapy culture, talk about trauma can make many of us skeptical. In his book, The Body Keeps the Score, however, Bessel van der Kolk argues that trauma is more common than we think and causes more issues than we could imagine. I hope you will take his words to heart before dismissing the stories of troubled individuals. It is a lengthy, dense book; I hope my reading notes can help you digest what Kolk has to say.
The body keeps the score
The book’s title tries to teach us something fundamental about trauma: it is stored in our memory but manifests in our body. Trauma can cause all sorts of physical ailments. Oftentimes patients are misdiagnosed and trauma goes untreated.As we all know, stressful experiences - divorce, loss, final exams, loneliness, trauma - negatively affects our immune system and makes us vulnerable to sickness, both mental and physical. (240-241) More intense stress can also affect our mind and body, such as loss of emotional (88) or physical feeling (89, 89); loss of self-awareness, purpose, or direction (92); and loss of agency. (95)
The author writes, “Over the years our research team has repeatedly found that chronic emotional abuse and neglect can be just as devastating as physical abuse and sexual molestation.” (88) Furthermore, "when people are chronically angry or scared, constant muscle tension ultimately leads to spasms, back pain, migraine headaches, fibromyalgia, and other forms of chronic pain." (266) Suppressing our thoughts can manifest in our body. Many trauma patients develop migraines or asthma attacks. (97) PTSD patients claim to feel pain in their body that mimics trauma from the past, as if the memory is in their body and not just their brain. (25).
Kolk stumbled into his career in trauma therapy through a study helping people with nightmares. He noticed that most of his patients were veterans dealing with PTSD, not just civilians experiencing nightmares.
Symptoms of trauma
Bessel is convinced that much of the mental illness and emotional insecurity we see manifested throughout society stems from trauma. He and his colleagues “have learned that trauma is not just an event that took place sometimes in the past; it is also the imprint left by that existence on the mind, brain, and body.” (21)The imprint of trauma can cause a variety of symptoms:
Self-loathing
Many trauma victims feel “haunted by shame about what they themselves did or did not do under the circumstances. They despise themselves for how terrified, dependent, excited, or enraged they felt.” (13) They are confused about whether they are a victim or willing participant in what happened. (14)Self-loathing starts at a young age for abused children. For children, it is safer to hate themselves than to risk running away or getting angry at their caregiver. They believe they are fundamentally unlovable - it's the only way their young minds can explain why they are treated so badly and not loved. "They survive by denying, ignoring, and splitting off large chunks of reality: They forget the abuse; they suppress their rage or despair; they numb their physical sensations." (279)
Chronic problems in childhood cause defects into adulthood. An ignored child may lack self-respect. A child not allowed to assert himself will not do so into adulthood. An abused child may carry smoldering rage into adulthood. When children suffer pain from those close to them, they interpret the actions of others with less understanding, and react so they are not hurt or disappointed again. (304)
Why don’t children find help when they have a terrible home life? Why won’t they tell other adults what is happening at home? “Children are also programmed to be fundamentally loyal to their caregivers,” Kolk writes, “even if they are abused by them. Terror increases the need for attachment, even if the source of comfort is also the source of terror.” (133)
“Initiation, intimidation, stigmatization, isolation, helplessness, and self blame depend on a terrifying reality of child sexual abuse. Any attempts by the child to divulge the secret will be countered by an adult conspiracy of silence and disbelief. Don’t worry about things like that; that could never happen in our family. How could you ever think of such a terrible thing? Don’t let me ever hear you say anything like that again! The average child never asks and never tells.” (131)
Adults, reminiscing about their demoralizing childhood, will insist they must have made these experiences up, or are exaggerating. Surely these terrible things didn’t really happen to them. “They firmly believe that these terrible things were done to them because they are terrible people.” (132)
The truth is, no one outgrows the effects of early experiences. “Traumatic experiences are often lost in time and concealed by shame, secrecy, and social taboo.“ (146) Martin Teicher tells us that “our brains are sculpted by our early experiences. Maltreatment is a chisel that shapes the brain…” (149). Bessel insists that “safe and protective early relationships are critical to protect children from long-term problems.“ (154)
Those with early life problems may experience physical problems like sleep disturbances, headaches, unexplained pain, over-sensitivity to touch or sound, chronic masturbation, or rocking. They lack resilience, which is important to form a profitable life. The author defines resiliency as “the capacity to bounce back from adversity.” One's parents determine how resilient they become. Studies show that “resilience in adulthood could be predicted by how lovable mothers rated their kids at age 2.” (161)
Traumatized children also lack experimentation later in life. They are reluctant to try new options. Trapped in fear, isolation, and scarcity, they fear failure above all else. Anticipating rejection, ridicule, and deprivation, they have a hard time welcoming new experiences. They are stuck with a fixed mindset. (305)
Attachment Disorder
Children are conditioned based on how they attach as infants and children. “Children with his histories of abuse and neglect,” Kolk writes, “are being conditioned to give up when they face challenges later in life.“ (113).As children, whatever our caregivers say about us, we believe to be true. “If you conclude that you must be a terrible person, you start expecting other people to treat you horribly. You probably deserve it, and anyway, there is nothing you can do about it. When disorganized people carry self perceptions like these, they are set up to be traumatized by subsequent experiences.“ (119). Self-worth is learned as a young child. (127)
“If your caregivers ignore your needs, or resent your very existence, you learn to anticipate rejection and withdrawal. You cope, as well as you can by blocking out your mother’s hostility or neglect and act, as if it doesn’t matter, but your body is likely to remain in a state of high alert, prepared toward blows, deprivation, or abandonment.” (121)
“We are profoundly social creatures,” Kolk writes. We scream as we enter the world, and we find our place within a community. (110) Those from healthy upbringings enjoy growing into a secure attachment (113), while others develop insecure, avoidant, anxious, or disorganized attachment. (117) Unfortunately, this affects entire generations; disorganized mothers raise disorganized children and the cycle continues. (120)
Lack of agency
Trauma also diminishes one’s agency. Agency is the feeling that you are in charge of your life. You know what you believe, where you stand, and have the ability to shape the circumstances around you. (95)We hold ourselves together in public. We have a "social editor" who becomes alert and doesn't allow us to lose our cool, to subordinate our feelings to the task at hand, to keep us alert and guarded. (238)
Traumatized people may experiment with self-harming activities like biting, cutting, burning, pulling their hair out, picking their skin. They want to feel something. They want to be in charge of something. (158) When a veteran plows his fist through a wall, he is trying to assert agency the only way he knows how. (95) Victims practice “switching,” acting differently in different environments. She may seem ok one moment, and then not ok the next. (241)
Another way of describing agency is self-leadership. "Trauma robs you of the feeling that you are in charge of yourself." This is how Kolk describes self-leadership. (203)
We have several "selves" within us - a confident self, a traumatized self, a healthy self, a scared self, etc. Our inner person must manage all those parts. (283) “Managers” are the parts of the self that control our emotions and actions. (286) “Firefighters” are the pieces of one’s personality that will do anything to make the emotional pain stop. (288) “Exiles” cause crushing physical sensations or numbing, offending the reasonable managers of the brain or the firefighters. (289)
He shares a fascinating story of the self through Helen Keller. Before Helen was able to interact with other humans, she had no awareness of self; it was a language-less existence. Looking back, she called her pre-aware self "Phantom" as she describes in her book, The Story of my Life. (234-235)
Dissociation and Depersonalization
Dissociation is feeling lost, overwhelmed, abandoned, disconnected, unloved, empty, helpless, trapped, or weighed down. (121) When terrible things happen to us, our minds have a hard time reconciling those memories. Traumatic memory is disassociated; it is isolated from our mind and we don’t know what to do with it. (180)Pierre Janet coined "Dissociation" in the early 1900's to describe isolated and split memories. "Janet discovered that, while it is normal to change and distort one's memories, people with PTSD are unable to put the actual event, the source of those memories, behind them." (180) Normal memories are organized with a beginning, middle, and end. Traumatic memories are disorganized. (193)
Dissociation is explained vividly by a little girl, plagued by her father’s lust. When molested, which happened frequently, she pictured herself in the clouds looking down at her body, as if it was someone else. “When her father started to touch her, she made herself disappear; she floated up to the ceiling, looking down on some other little girl in the bed. She was glad that it was not really her. It was some other girl who was being molested.“ (132)
A similar term for this phenomenon is called “depersonalization.” (71, 99) Victims of abuse often see themselves from above, as if they are floating overhead and watching from a distance. “The self can be detached from the body and live in a phantom existence on its own." (100)
Another victim said "I was afraid all the time. I didn't like to be touched. I was always jumpy and nervous. I couldn't close my eyes if another person was around… That makes you feel crazy." It is a state of inescapable shock. (317) Sadly, as late as 1974, it was believed that molestation had little effect on kids as they grew up (189).
This is why trauma can seem repressed or forgotten. Traumatic memory is reenacted, sometimes in hysterical episodes or by blowing up in anger when triggered. (179). Traumatic memories can be forgotten and return years later, oftentimes in bits and pieces. (175)
Lacking verbal memory often results in acting out. Freud stated "He reproduces it not as a memory but as an action; he repeated it, without knowing, or course, that he is repeating, and in the end, we understand that this is his way of remembering." (181) "People fully recall their traumas, they 'have' the experience: They are engulfed by the sensory or emotional elements of the past." (219)
If dissociation is the problem, association is the answer. (181) Later in the book, Bessel explains therapeutic methods that help those with PTSD associate their memories in constructive ways.
What trauma does to our mind
In chapters four and thirteen, the author explains how our brains work through trauma. We all have what scientists call a “reptilian brain“ and a “mammalian brain", both part of the limbic system. (56) The sympathetic nervous system controls arousal; our fight or flight response. The parasympathetic nervous system, which promotes self preservation, breaking our arousal, slowing the heart down, relaxing muscles, and returning breathing to normal. (77)When someone is in survival mode, their energies are totally focused on “fighting off, unseen enemies, which leaves no room for nurture, care, and love.“ They can’t enjoy things, make friends, learn, play, or imagine. (76)
Kolk names these two brains the Rational Brain and the Emotional Brain. (205) The rational brain cannot control the emotional brain, but therapy can restore balance. "That wasn't your fault… you are safe now…" We understand this rationally, but our body and heart do not operate rationally. For example, in AA teachers will speak out against "White knuckle sobriety," pretending you are making out ok, while you are actually uptight and unraveling. (205)
Trauma messes with our memories. Those with PTSD “are not preoccupied with specific memories of their abuse, but they continue to behave as if they were still in danger. They go from one extreme to the other; they have trouble staying on task, and they continually lash out against themselves and others.” (142).
Trauma messes with our memories. Those with PTSD “are not preoccupied with specific memories of their abuse, but they continue to behave as if they were still in danger. They go from one extreme to the other; they have trouble staying on task, and they continually lash out against themselves and others.” (142).
Memory is fickle, and we rewrite it often. (175). "As long as a memory is inaccessible, the mind is unable to change it. But as soon as a story starts being told, particularly if it is told repeatedly, it changes - the act of telling itself changes the tale." (191) Memories can easily be implanted, of events that never took place. (Like the "lost in a mall" experiment). (191) There’s even a line of research regarding "the unreliability of eyewitness testimony." (192)
Perhaps you have heard the term "shell shock," a diagnostic label that emerged during World War I to describe what we now understand as Post-Traumatic Stress Disorder (PTSD). British soldiers suffering from the intense psychological impact of trench warfare were frequently diagnosed with shell shock, a diagnosis that entitled them to medical care and a military pension. However, the sheer number of soldiers affected led to a significant shift. Concerned about the depletion of troops, a general issued an order during the war: instead of "shell shock," soldiers presenting with similar symptoms were to be classified as "Not Yet Diagnosed, Nervous" (NYDN). This change aimed to keep soldiers at their posts, highlighting the immense pressure to maintain troop numbers despite the widespread psychological toll of the conflict. (184-185).
False Memory Syndrome was a diagnosis doctors would give people who they believed were making up sex abuse stories later in life. (189) As it turns out, those stories were grotesquely true: "The memory of trauma can be repressed, only to resurface years or decades later…. Total memory loss is most common in childhood sexual abuse…. An inability to recall important personal information, usually of a traumatic or stressful nature, that is too extensive to be explained by normal forgetfulness." (190)
Why do victim stories change over time? "Memories evolve and change. Immediately after a memory is laid down, it undergoes a lengthy process of integration and reinterpretation… When the process is complete, the experience is integrated with other life events and stops having a life of its own." In PTSD, the memory gets stuck - "undigested and raw." (255)
PTSD not only traps memory, it also traps imagination. “Imagination is absolutely critical to the quality of our lives.” It gives us hope for the future, makes our routine existence interesting, relieves our boredom, makes us creative, allows us pleasure, and enriches our relationships… “When people are compulsively and constantly pulled back into the past… they suffer from a failure of imagination.” Lack of imagination cripples agency and self-leadership: there is no hope, no vision for a better future, and no goal to reach. (17)
The author was able to work with Henry Murray, the creator of the Thematic Apperception Test (TAT). In this test, children were shown pictures of families spending time together. Some of the children were from nice, loving homes, and other children were from poverty-stricken, depressed homes who regularly witnessed shocking violence. The kids from nice homes had nice things to say about the photos - such as explaining how a little girl is helping her dad fix a car. Kids from unstable homes assumed the worst, suggesting that the same little girl in the photo was about to smash her father’s head in with a hammer. (106-107) Kolk writes, “We could only conclude that for abused children, the whole world is filled with triggers. As long as they can imagine, only disastrous outcomes to relatively benign situations, anybody walking into a room, any stranger, any image, on a screen or a billboard might be perceived as a harbinger of catastrophe.” (108)
It wasn’t until the 1980’s that PTSD became a diagnosis (19). Before then, especially in the 70’s and 80’s, doctors used disturbing psychiatric practices to diagnose and help their patients. Suffice it to say, they did not take into account “the ecology of their [patients’] lives.” Doctors were trying to treat the symptoms without trying to understand where the suicidal thoughts and self-destructive behaviors came from, or the patient’s accomplishments and aspirations, or who they cared about in life, or what motivated them or made them feel at peace. (24) We must realize that “people can never get better without knowing what they know and feeling what they feel.” (27)
In a disturbing experiment, animals were traumatized and then given the chance to escape. Surprisingly, the animals did not try to escape when shocked. “Rather than risk experimenting with new options, they stay stuck in the fear they know.” In another study, “scared animals return home, regardless of whether home is safe or frightening.” (29-31).
This experiment explains “the Pleasure of Pain.” Trauma victims often return to their abusers - prostitutes to their pimps, adults to their childhood abusers. Why? Perhaps the pain brings a high, like running a marathon or parachute jumping. “For many traumatized people, re-exposure to stress might provide a similar relief from anxiety.” (31- 33, 83).
Trauma also causes self-destructive behavior. The author has treated many people who practice self harm. When someone is cutting and picking themselves, they are “seldom suicidal, but are trying to make themselves feel better and the only way they know.“ When nobody cares about you, you have to discover other ways of taking care of yourself and people experiment with drugs, alcohol, binge eating, cutting, etc. (88) “Why do some people deal with being upset by playing three sets of tennis or drinking a stiff martini, while others carved their arms with razor blades?“ he asks. It is a desperate attempt to gain some sense of control; i.e. agency. (141, 88).
This is why doctors should look not just at the patient, but at the environment and the household. Generally, if someone grew up with a brother in prison and everything else is great, that’s a flag. (145) Rather than asking “Were you abused as a child?” one can ask the following questions: How often did you move growing up? Who was your primary care giver? Who in your family was affectionate to you? Was there anyone you felt safe with? Who made the rules at home, who enforced discipline? Were you kept in line with talking, scolding, spanking, hitting, locking you up? How did your parents handle disagreements? (139)
PTSD can be treated rather effectively. But when someone is misdiagnosed they get meaningless labels, harmful medicine, behavior modification, exposure therapy, etc. (157) Bessel developed a new diagnosis, which has not yet been admitted into the DSM: Developmental Trauma Disorder. (158) He believes this diagnosis will help many misdiagnosed individuals. (166)
Why do victims return to their abusers? “Activating fight or flight at least makes them feel energized. That is why so many abused and traumatized people feel fully alive in the face of actual danger, while they go numb in situations that are more complex, but objectively safe, like birthday parties or family dinners.” (83). Immobilization, by contrast, is at the root of most traumas. You dissociate, faint, become zombie-like. (84)
People who feel safe and connected with others have no need to squander their lives with drugs, numb themselves with television, be tempted by the allure of pills, find community in extreme religious leaders, or become intoxicated. (351) Likewise, a good support network is "the single most powerful protection against becoming traumatized. Safety and terror are incompatible." (210)
The pharmacology industry has boomed in recent years, making big money selling LSD, MDMA (ecstacy), SSRI's (Prozac, Zoloft, Effexor, Paxil), tranquilizing drugs (Klonopin, Valium, Xanax, Ativan), mood stabilizers (Lithium, Valproate), and antipsychotic medication (Risperdal, Abilify, Seroquel). The discovery of serotonin and the invention of Prozac were key moments in this movement. (34) Besell warns, passionately, against assuming all problems are “chemical imbalances.” He challenges doctors who quickly turn to medicine in order to suppress real problems, thereby preventing patients from dealing with root issues. (36-38, 101) Many patients lose hope of ever getting better, so they turn to medicine dependency. (279)
Below are some alternatives:
Believe it or not, group rhythmic exercises—like chanting, martial arts, drumming, singing, and dancing—offer profound healing. As the author explains, "Collective movement and music create a larger context for our lives, a meaning beyond our individual fate." This explains why practices such as rocking at the Wailing Wall, gesturing religious symbols, moving in unison during a mass, or rhythmically reciting prayers are so restorative. These shared experiences of dancing, marching, drumming, and singing together forge a powerful sense of unity, instilling hope and courage.
Actively engaging with challenges also plays a crucial role in recovery; as the author notes, "People who actively do something to deal with a disaster… utilize their stress hormones for their proper purpose and therefore are at much lower risk of becoming traumatized." (217) This kind of agency can also be fostered through caring for animals, like a horse. (213),
Perhaps you have heard the term "shell shock," a diagnostic label that emerged during World War I to describe what we now understand as Post-Traumatic Stress Disorder (PTSD). British soldiers suffering from the intense psychological impact of trench warfare were frequently diagnosed with shell shock, a diagnosis that entitled them to medical care and a military pension. However, the sheer number of soldiers affected led to a significant shift. Concerned about the depletion of troops, a general issued an order during the war: instead of "shell shock," soldiers presenting with similar symptoms were to be classified as "Not Yet Diagnosed, Nervous" (NYDN). This change aimed to keep soldiers at their posts, highlighting the immense pressure to maintain troop numbers despite the widespread psychological toll of the conflict. (184-185).
False Memory Syndrome was a diagnosis doctors would give people who they believed were making up sex abuse stories later in life. (189) As it turns out, those stories were grotesquely true: "The memory of trauma can be repressed, only to resurface years or decades later…. Total memory loss is most common in childhood sexual abuse…. An inability to recall important personal information, usually of a traumatic or stressful nature, that is too extensive to be explained by normal forgetfulness." (190)
Why do victim stories change over time? "Memories evolve and change. Immediately after a memory is laid down, it undergoes a lengthy process of integration and reinterpretation… When the process is complete, the experience is integrated with other life events and stops having a life of its own." In PTSD, the memory gets stuck - "undigested and raw." (255)
PTSD not only traps memory, it also traps imagination. “Imagination is absolutely critical to the quality of our lives.” It gives us hope for the future, makes our routine existence interesting, relieves our boredom, makes us creative, allows us pleasure, and enriches our relationships… “When people are compulsively and constantly pulled back into the past… they suffer from a failure of imagination.” Lack of imagination cripples agency and self-leadership: there is no hope, no vision for a better future, and no goal to reach. (17)
Trauma makes people act strangely
Those suffering from PTSD think, say, and do the strangest things. They hallucinate, seemingly stuck in “fragmented memories of real experiences.” (25) They lack self-awareness, having shut down their minds for self-protection. “In an effort to shut off terrifying sensations, they also deaden their capacity to feel fully alive.“ Sometimes “they cannot recognize themselves in a mirror." (92)The author was able to work with Henry Murray, the creator of the Thematic Apperception Test (TAT). In this test, children were shown pictures of families spending time together. Some of the children were from nice, loving homes, and other children were from poverty-stricken, depressed homes who regularly witnessed shocking violence. The kids from nice homes had nice things to say about the photos - such as explaining how a little girl is helping her dad fix a car. Kids from unstable homes assumed the worst, suggesting that the same little girl in the photo was about to smash her father’s head in with a hammer. (106-107) Kolk writes, “We could only conclude that for abused children, the whole world is filled with triggers. As long as they can imagine, only disastrous outcomes to relatively benign situations, anybody walking into a room, any stranger, any image, on a screen or a billboard might be perceived as a harbinger of catastrophe.” (108)
It wasn’t until the 1980’s that PTSD became a diagnosis (19). Before then, especially in the 70’s and 80’s, doctors used disturbing psychiatric practices to diagnose and help their patients. Suffice it to say, they did not take into account “the ecology of their [patients’] lives.” Doctors were trying to treat the symptoms without trying to understand where the suicidal thoughts and self-destructive behaviors came from, or the patient’s accomplishments and aspirations, or who they cared about in life, or what motivated them or made them feel at peace. (24) We must realize that “people can never get better without knowing what they know and feeling what they feel.” (27)
In a disturbing experiment, animals were traumatized and then given the chance to escape. Surprisingly, the animals did not try to escape when shocked. “Rather than risk experimenting with new options, they stay stuck in the fear they know.” In another study, “scared animals return home, regardless of whether home is safe or frightening.” (29-31).
This experiment explains “the Pleasure of Pain.” Trauma victims often return to their abusers - prostitutes to their pimps, adults to their childhood abusers. Why? Perhaps the pain brings a high, like running a marathon or parachute jumping. “For many traumatized people, re-exposure to stress might provide a similar relief from anxiety.” (31- 33, 83).
Trauma also causes self-destructive behavior. The author has treated many people who practice self harm. When someone is cutting and picking themselves, they are “seldom suicidal, but are trying to make themselves feel better and the only way they know.“ When nobody cares about you, you have to discover other ways of taking care of yourself and people experiment with drugs, alcohol, binge eating, cutting, etc. (88) “Why do some people deal with being upset by playing three sets of tennis or drinking a stiff martini, while others carved their arms with razor blades?“ he asks. It is a desperate attempt to gain some sense of control; i.e. agency. (141, 88).
Healing from Trauma
“The way we define their problems, our diagnosis, will determine how we approach their care.” (136) The author claims that many who suffer from PTSD are misdiagnosed with ODD, depression, anxiety, ADHD, DMDD, attachment disorder, oppositional defiant disorder, or conduct disorder; all because doctors often are unable to find the root problem and solve it. (150, 157, 282) “A psychiatric diagnosis has serious consequences,” he writes. (137) The diagnosis becomes how they define themselves, how we treat them, and their access to help.This is why doctors should look not just at the patient, but at the environment and the household. Generally, if someone grew up with a brother in prison and everything else is great, that’s a flag. (145) Rather than asking “Were you abused as a child?” one can ask the following questions: How often did you move growing up? Who was your primary care giver? Who in your family was affectionate to you? Was there anyone you felt safe with? Who made the rules at home, who enforced discipline? Were you kept in line with talking, scolding, spanking, hitting, locking you up? How did your parents handle disagreements? (139)
PTSD can be treated rather effectively. But when someone is misdiagnosed they get meaningless labels, harmful medicine, behavior modification, exposure therapy, etc. (157) Bessel developed a new diagnosis, which has not yet been admitted into the DSM: Developmental Trauma Disorder. (158) He believes this diagnosis will help many misdiagnosed individuals. (166)
Healing requires safety
“Being able to feel safe with other people is probably the single most important aspect of mental health; safe connections are fundamental to meaningful and satisfying lives.” (79) There are three levels of safety: social engagement, fight or flight response, and freeze / collapse. (80)Why do victims return to their abusers? “Activating fight or flight at least makes them feel energized. That is why so many abused and traumatized people feel fully alive in the face of actual danger, while they go numb in situations that are more complex, but objectively safe, like birthday parties or family dinners.” (83). Immobilization, by contrast, is at the root of most traumas. You dissociate, faint, become zombie-like. (84)
People who feel safe and connected with others have no need to squander their lives with drugs, numb themselves with television, be tempted by the allure of pills, find community in extreme religious leaders, or become intoxicated. (351) Likewise, a good support network is "the single most powerful protection against becoming traumatized. Safety and terror are incompatible." (210)
Drugs are not always the answer
Kolk is not opposed to the use of drugs, but he does signal warning. (see pgs. 36, 101, 223) "Drugs cannot cure trauma,” he writes, “they can only dampen the expressions of a disturbed physiology. And they do not teach the lasting lessons of self-regulation." (224)The pharmacology industry has boomed in recent years, making big money selling LSD, MDMA (ecstacy), SSRI's (Prozac, Zoloft, Effexor, Paxil), tranquilizing drugs (Klonopin, Valium, Xanax, Ativan), mood stabilizers (Lithium, Valproate), and antipsychotic medication (Risperdal, Abilify, Seroquel). The discovery of serotonin and the invention of Prozac were key moments in this movement. (34) Besell warns, passionately, against assuming all problems are “chemical imbalances.” He challenges doctors who quickly turn to medicine in order to suppress real problems, thereby preventing patients from dealing with root issues. (36-38, 101) Many patients lose hope of ever getting better, so they turn to medicine dependency. (279)
Surprising treatments
The author suggests a large variety of treatment options for those suffering PTSD. Talking about trauma is helpful, but does not solve the problems of flashbacks, concentration, hypersensitivity, etc. (194) And sometimes it makes matters worse. (222) There are limits to language. It is difficult to feel deeply and articulate those feelings to someone else. (235)Below are some alternatives:
Group Activities
A therapist at a trauma center found a unique way to engage with angry or withdrawn children: he'd "accidentally" drop a brightly colored beach ball near them. When the children offered even a half-hearted push back, he'd initiate a playful back-and-forth, giving them a sense of agency and rhythm that often brought smiles. This highlights how physical and rhythmic activities can aid emotional regulation, especially for those whose bodies hold the memory of trauma.Believe it or not, group rhythmic exercises—like chanting, martial arts, drumming, singing, and dancing—offer profound healing. As the author explains, "Collective movement and music create a larger context for our lives, a meaning beyond our individual fate." This explains why practices such as rocking at the Wailing Wall, gesturing religious symbols, moving in unison during a mass, or rhythmically reciting prayers are so restorative. These shared experiences of dancing, marching, drumming, and singing together forge a powerful sense of unity, instilling hope and courage.
Touch
Healing from trauma often hinges on feeling safe in one's own skin. (216) Techniques like bodywork, therapeutic massage, Feldenkrais, acupuncture, yoga, and craniosacral therapy can be vital in this process. "Just like you can thirst for water, you can thirst for touch."Actively engaging with challenges also plays a crucial role in recovery; as the author notes, "People who actively do something to deal with a disaster… utilize their stress hormones for their proper purpose and therefore are at much lower risk of becoming traumatized." (217) This kind of agency can also be fostered through caring for animals, like a horse. (213),
Multiple times, the author expresses the importance of befriending one's body. Bessell shares the story of a patient who, despite a neurological illness likely unrelated to trauma, learned to embrace distressing sensations in his body. "Now befriending his body was keeping him from organizing his life around the loss of physical control… He copes with his physical limitations as an inconvenience… these episodes do not dominate his existence." (228-9) This allowed him to manage his physical limitations as mere inconveniences rather than letting them dominate his life. In another example, a woman was experiencing extreme bodily disconnection; she could not feel part of her body at all. Dr. Kolk suggested massage therapy which, over time, helped.
Other physical activities, such as yoga, tai chi, qigong, drumming, martial arts, aikido, judo, tae kwon do, kendo, jujitsu, capoeira, humming, singing, moving, dancing, choral singing, aikido, tango dancing, and kickboxing have proven to reconnect the mind with the body. (208, 214) Body awareness is related to mindfulness: "Simply noticing our annoyance, nervousness, or anxiety immediately helps us shift our perspective." (208) Learning to breathe calmly and obtain physical relaxation while accessing painful memories is "an essential tool for recovery." (207)
While the exact process of EMDR is complicated (outlined on pgs. 257-259), it has been effective for some. Kolk encourages readers to be less concerned with how it works and more interested in if it works. (262)
Other physical activities, such as yoga, tai chi, qigong, drumming, martial arts, aikido, judo, tae kwon do, kendo, jujitsu, capoeira, humming, singing, moving, dancing, choral singing, aikido, tango dancing, and kickboxing have proven to reconnect the mind with the body. (208, 214) Body awareness is related to mindfulness: "Simply noticing our annoyance, nervousness, or anxiety immediately helps us shift our perspective." (208) Learning to breathe calmly and obtain physical relaxation while accessing painful memories is "an essential tool for recovery." (207)
Free writing
Free writing (238) offers a powerful avenue for healing, allowing individuals to process difficult experiences. Studies with university students have shown that writing about personal traumas not only leads to fewer visits to health centers but also correlates with improved immune function. Across various writing experiments worldwide, the act of putting upsetting events on paper has consistently demonstrated benefits for both physical and mental well-being. (241)EMDR
Eye Movement Desensitization and Reprocessing (EMDR) is a therapeutic approach that, similar to a form of hypnosis, helps to integrate dissociated memories. (248) It effectively "loosens up something in the mind/brain that gives people rapid access to loosely associated memories and images from their past" without requiring individuals to verbalize intolerable experiences. (253)While the exact process of EMDR is complicated (outlined on pgs. 257-259), it has been effective for some. Kolk encourages readers to be less concerned with how it works and more interested in if it works. (262)
Yoga
Yoga, a combination of breathing practices and stretching, is a powerful tool for self-regulation. (270) By holding challenging poses and calmly breathing through discomfort, one learns to manage difficult sensations. Mindful breathing on its own is beneficial. "The way one breathes can improve problems with anger, depression, and anxiety” the author writes. “Yoga can positively affect… high blood pressure, elevated stress hormone secretion, asthma, and low back pain." (269)PBSP
Psychomotor Bodywork and Systems Psychotherapy (PBSP) uses representations, such as people or objects, to symbolize individuals who have caused harm. This method helps patients to process their experiences objectively. (298) This might involve creating an imaginary "container" (300) for distressing feelings or physically confronting "structures"—actual objects or people—as if they were past abusers.Theatre
Finally, theatre provides a unique space for healing. Perhaps we really can fake it till you make it! The author shares an story about his son, who, cast as "The Fonz" from Happy Days, gradually embodied the character's confidence, which in turn made him more confident. (330) Actors must train themselves to feel deeply. Traumatized people are terrified of feeling anything deeply. Acting forces them to feel again. (335)In conclusion, I was impressed with Bessel Kolk’s knowledge, experience, and ability to articulate deep problems and practical solutions. Abuse and mistreatment, especially of women and children, is known to be a major problem in our world. Practically speaking, helping cure trauma can result in more high school graduations, less criminality, increased employment, and decreased family and community violence. (347) Helping those plagued by PTSD in tangible ways can lead to a better world for all of us, and future generations.