Brain, Mind, and Body in the Healing of Trauma
by Bessel van der Kolk, M.D.
1. Stress Disorders, Post-Traumatic—physiopathology. 2. Stress Disorders, Post-Traumatic—therapy.
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Book Details
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4.00 |
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Pages
| 464 p |
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8,229 KB |
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PDF format |
ISBN
| 978-1-10160830-2 (ebook) |
Copyright©
| 2014 by Bessel van der Kolk Penguin supports copyright |
“This book is a tour de force. Its deeply empathic, insightful, and compassionate
perspective promises to further humanize the treatment of trauma victims,
dramatically expand their repertoire of self-regulatory healing practices and
therapeutic options, and also stimulate greater creative thinking and research on
trauma and its effective treatment. The body does keep the score, and Van der
Kolk’s ability to demonstrate this through compelling descriptions of the work of
others, his own pioneering trajectory and experience as the field evolved and
him along with it, and above all, his discovery of ways to work skillfully with
people by bringing mindfulness to the body (as well as to their thoughts and
emotions) through yoga, movement, and theater are a wonderful and welcome
breath of fresh air and possibility in the therapy world.”
—Jon Kabat-Zinn, professor of medicine emeritus, UMass Medical School; author of
Full Catastrophe Living
“This exceptional book will be a classic of modern psychiatric thought. The
impact of overwhelming experience can only be truly understood when many
disparate domains of knowledge, such as neuroscience, developmental
psychopathology, and interpersonal neurobiology are integrated, as this work
uniquely does. There is no other volume in the field of traumatic stress that has
distilled these domains of science with such rich historical and clinical
perspectives, and arrived at such innovative treatment approaches. The clarity of
vision and breadth of wisdom of this unique but highly accessible work is
remarkable. This book is essential reading for anyone interested in
understanding and treating traumatic stress and the scope of its impact on
society.”
—Alexander McFarlane AO, MB BS (Hons) MD FRANZCP, director of the Centre
for Traumatic Stress Studies, The University of Adelaide, South Australia.
“This is an amazing accomplishment from the neuroscientist most responsible
for the contemporary revolution in mental health toward the recognition that so
many mental problems are the product of trauma. With the compelling writing of
a good novelist, van der Kolk revisits his fascinating journey of discovery that
has challenged established wisdom in psychiatry. Interspersed with that narrative
are clear and understandable descriptions of the neurobiology of trauma;
explanations of the ineffectiveness of traditional approaches to treating trauma;
and introductions to the approaches that take patients beneath their cognitive
minds to heal the parts of them that remained frozen in the past. All this is
illustrated vividly with dramatic case histories and substantiated with convincing
research. This is a watershed book that will be remembered as tipping the scales
within psychiatry and the culture at large toward the recognition of the toll
traumatic events and our attempts to deny their impact take on us all.”
—Richard Schwartz, originator, Internal Family Systems Therapy
“The Body Keeps the Score is clear, fascinating, hard to put down, and filled with
powerful case histories. Van der Kolk, the eminent impresario of trauma
treatment, who has spent a career bringing together diverse trauma scientists and
clinicians and their ideas, while making his own pivotal contributions, describes
what is arguably the most important series of breakthroughs in mental health in
the last thirty years. We’ve known that psychological trauma fragments the
mind. Here we see not only how psychological trauma also breaks connections
within the brain, but also between mind and body, and learn about the exciting
new approaches that allow people with the severest forms of trauma to put all the
parts back together again.”
—Norman Doidge, author of The Brain That Changes Itself
“In The Body Keeps the Score we share the author’s courageous journey into the
parallel dissociative worlds of trauma victims and the medical and psychological
disciplines that are meant to provide relief. In this compelling book we learn that
as our minds desperately try to leave trauma behind, our bodies keep us trapped
in the past with wordless emotions and feelings. These inner disconnections
cascade into ruptures in social relationships with disastrous effects on marriages,
families, and friendships. Van der Kolk offers hope by describing treatments and
strategies that have successfully helped his patients reconnect their thoughts with
their bodies. We leave this shared journey understanding that only through
fostering self-awareness and gaining an inner sense of safety will we, as a
species, fully experience the richness of life.
—Stephen W. Porges, PhD, professor of psychiatry, University of North Carolina at
Chapel Hill; author of The Polyvagal Theory: Neurophysiological Foundations of
Emotions, Attachment, Communication, and Self-Regulation
“Bessel van der Kolk is unequaled in his ability to synthesize the stunning
developments in the field of psychological trauma over the past few decades.
Thanks in part to his work, psychological trauma—ranging from chronic child
abuse and neglect, to war trauma and natural disasters—is now generally
recognized as a major cause of individual, social, and cultural breakdown. In this
masterfully lucid and engaging tour de force, Van der Kolk takes us—both
specialists and the general public— on his personal journey and shows what he
has learned from his research, from his colleagues and students, and, most
important, from his patients. The Body Keeps the Score is, simply put, brilliant.”
—Onno van der Hart, PhD, Utrecht University, The Netherlands; senior author, The
Haunted Self: Structural Dissociation and the Treatment of Chronic Traumatization
“The Body Keeps the Score articulates new and better therapies for toxic stress
based on a deep understanding of the effects of trauma on brain development and
attachment systems. This volume provides a moving summary of what is
currently known about the effects of trauma on individuals and societies, and
introduces the healing potential of both age-old and novel approaches to help
traumatized children and adults fully engage in the present.”
—Jessica Stern, policy consultant on terrorism; author of Denial: A Memoir of Terror
“A book about understanding the impact of trauma by one of the true pioneers in
the field. It is a rare book that integrates cutting edge neuroscience with wisdom
and understanding about the experience and meaning of trauma, for people who
have suffered from it. Like its author, this book is wise and compassionate,
occasionally quite provocative, and always interesting.”
—Glenn N. Saxe, MD, Arnold Simon Professor and chairman, Department of Child
and Adolescent Psychiatry; director, NYU Child Study Center, New York University
School of Medicine.
“A fascinating exploration of a wide range of therapeutic treatments shows
readers how to take charge of the healing process, gain a sense of safety, and find
their way out of the morass of suffering.”
—Francine Shapiro, PhD, originator of EMDR therapy; senior research fellow,
Emeritus Mental Research Institute; author of Getting Past Your Past
“As an attachment researcher I know that infants are psychobiological beings.
They are as much of the body as they are of the brain. Without language or
symbols infants use every one of their biological systems to make meaning of
their self in relation to the world of things and people. Van der Kolk shows that
those very same systems continue to operate at every age, and that traumatic
experiences, especially chronic toxic experience during early development,
produce psychic devastation. With this understanding he provides insight and
guidance for survivors, researchers, and clinicians alike. Bessel van der Kolk
may focus on the body and trauma, but what a mind he must have to have
written this book.”
—Ed Tronick, distinguished professor, University of Massachusetts, Boston; author of
Neurobehavior and Social Emotional Development of Infants and Young Children
“The Body Keeps the Score eloquently articulates how overwhelming
experiences affect the development of brain, mind, and body awareness, all of
which are closely intertwined. The resulting derailments have a profound impact
on the capacity for love and work. This rich integration of clinical case examples
with ground breaking scientific studies provides us with a new understanding of
trauma, which inevitably leads to the exploration of novel therapeutic
approaches that ‘rewire’ the brain, and help traumatized people to reengage in
the present. This book will provide traumatized individuals with a guide to
healing and permanently change how psychologists and psychiatrists think about
trauma and recovery.”
—Ruth A. Lanius, MD, PhD, Harris-Woodman chair in Psyche and Soma, professor
of psychiatry, and director PTSD research at the University of Western Ontario; author
of The Impact of Early Life Trauma on Health and Disease
“When it comes to understanding the impact of trauma and being able to
continue to grow despite overwhelming life experiences, Bessel van der Kolk
leads the way in his comprehensive knowledge, clinical courage, and creative
strategies to help us heal. The Body Keeps the Score is a cutting-edge offering
for the general reader to comprehend the complex effects of trauma, and a guide
to a wide array of scientifically informed approaches to not only reduce
suffering, but to move beyond mere survival— and to thrive.”
—Daniel J. Siegel, MD, clinical professor, UCLA School of Medicine, author of
Brainstorm: The Power and Purpose of the Teenage Brain; Mindsight: The New
Science of Personal Transformation; and The Developing Mind: How Relationships
and the Brain Interact to Shape Who We Are
“In this magnificent book, Bessel van der Kolk takes the reader on a captivating
journey that is chock-full of riveting stories of patients and their struggles
interpreted through history, research, and neuroscience made accessible in the
words of a gifted storyteller. We are privy to the author’s own courageous efforts
to understand and treat trauma over the past forty years, the results of which
have broken new ground and challenged the status quo of psychiatry and
psychotherapy. The Body Keeps the Score leaves us with both a profound
appreciation for and a felt sense of the debilitating effects of trauma, along with
hope for the future through fascinating descriptions of novel approaches to
treatment. This outstanding volume is absolutely essential reading not only for
therapists but for all who seek to understand, prevent, or treat the immense
suffering caused by trauma.”
—Pat Ogden PhD, founder/educational director of the Sensorimotor Psychotherapy
Institute; author of Sensorimotor Psychotherapy: Interventions for Trauma and Attachment
“This is masterpiece of powerful understanding and brave heartedness, one of
the most intelligent and helpful works on trauma I have ever read. Dr. Van der
Kolk offer a brilliant synthesis of clinical cases, neuroscience, powerful tools
and caring humanity, offering a whole new level of healing for thtraumas
carried by so many.”
—Jack Kornfield, author of A Path with Heart
....
PROLOGUE
FACING TRAUMA
One does not have be a combat soldier, or visit a refugee camp in Syria or the
Congo to encounter trauma. Trauma happens to us, our friends, our
families, and our neighbors. Research by the Centers for Disease Control and
Prevention has shown that one in five Americans was sexually molested as a
child; one in four was beaten by a parent to the point of a mark being left on
their body; and one in three couples engages in physical violence. A quarter of
us grew up with alcoholic relatives, and one out of eight witnessed their mother
being beaten or hit.1
As human beings we belong to an extremely resilient species. Since time
immemorial we have rebounded from our relentless wars, countless disasters
(both natural and man-made), and the violence and betrayal in our own lives.
But traumatic experiences do leave traces, whether on a large scale (on our
histories and cultures) or close to home, on our families, with dark secrets being
imperceptibly passed down through generations. They also leave traces on our
minds and emotions, on our capacity for joy and intimacy, and even on our
biology and immune systems.
Trauma affects not only those who are directly exposed to it, but also those
around them. Soldiers returning home from combat may frighten their families
with their rages and emotional absence. The wives of men who suffer from
PTSD tend to become depressed, and the children of depressed mothers are at
risk of growing up insecure and anxious. Having been exposed to family
violence as a child often makes it difficult to establish stable, trusting
relationships as an adult.
Trauma, by definition, is unbearable and intolerable. Most rape victims,
combat soldiers, and children who have been molested become so upset when
they think about what they experienced that they try to push it out of their minds,
trying to act as if nothing happened, and move on. It takes tremendous energy to
keep functioning while carrying the memory of terror, and the shame of utter
weakness and vulnerability.
While we all want to move beyond trauma, the part of our brain that is
devoted to ensuring our survival (deep below our rational brain) is not very good
at denial. Long after a traumatic experience is over, it may be reactivated at the
slightest hint of danger and mobilize disturbed brain circuits and secrete massive
amounts of stress hormones. This precipitates unpleasant emotions intense
physical sensations, and impulsive and aggressive actions. These posttraumatic
reactions feel incomprehensible and overwhelming. Feeling out of control,
survivors of trauma often begin to fear that they are damaged to the core and
beyond redemption.
• • •
The first time I remember being drawn to study medicine was at a summer camp
when I was about fourteen years old. My cousin Michael kept me up all night
explaining the intricacies of how kidneys work, how they secrete the body’s
waste materials and then reabsorb the chemicals that keep the system in balance.
I was riveted by his account of the miraculous way the body functions. Later,
during every stage of my medical training, whether I was studying surgery,
cardiology, or pediatrics, it was obvious to me that the key to healing was
understanding how the human organism works. When I began my psychiatry
rotation, however, I was struck by the contrast between the incredible
complexity of the mind and the ways that we human beings are connected and
attached to one another, and how little psychiatrists knew about the origins of the
problems they were treating. Would it be possible one day to know as much
about brains, minds, and love as we do about the other systems that make up our
organism?
We are obviously still years from attaining that sort of detailed
understanding, but the birth of three new branches of science has led to an
explosion of knowledge about the effects of psychological trauma, abuse, and
neglect. Those new disciplines are neuroscience, the study of how the brain
supports mental processes; developmental psychopathology, the study of the
impact of adverse experiences on the development of mind and brain; and
interpersonal neurobiology, the study of how our behavior influences the
emotions, biology, and mind-sets of those around us.
Research from these new disciplines has revealed that trauma produces
actual physiological changes, including a recalibration of the brain’s alarm
system, an increase in stress hormone activity, and alterations in the system that
filters relevant information from irrelevant. We now know that trauma
compromises the brain area that communicates the physical, embodied feeling of
being alive. These changes explain why traumatized individuals become
hypervigilant to threat at the expense of spontaneously engaging in their day-today
lives. They also help us understand why traumatized people so often keep
repeating the same problems and have such trouble learning from experience.
We now know that their behaviors are not the result of moral failings or signs of
lack of willpower or bad character—they are caused by actual changes in the
brain. This vast increase in our knowledge about the basic processes that underlie
trauma has also opened up new possibilities to palliate or even reverse the
damage. We can now develop methods and experiences that utilize the brain’s
own natural neuroplasticity to help survivors feel fully alive in the present and
move on with their lives. There are fundamentally three avenues: 1) top down,
by talking, (re-) connecting with others, and allowing ourselves to know and
understand what is going on with us, while processing the memories of the
trauma; 2) by taking medicines that shut down inappropriate alarm reactions, or
by utilizing other technologies that change the way the brain organizes
information, and 3) bottom up: by allowing the body to have experiences that
deeply and viscerally contradict the helplessness, rage, or collapse that result
from trauma. Which one of these is best for any particular survivor is an
empirical question. Most people I have worked with require a combination.
This has been my life’s work. In this effort I have been supported by my
colleagues and students at the Trauma Center, which I founded thirty years ago.
Together we have treated thousands of traumatized children and adults: victims
of child abuse, natural disasters, wars, accidents, and human trafficking; people
who have suffered assaults by intimates and strangers. We have a long tradition
of discussing all our patients in great depth at weekly treatment team meetings
and carefully tracking how well different forms of treatment work for particular
individuals.
Our principal mission has always been to take care of the children and adults
who have come to us for treatment, but from the very beginning we also have
dedicated ourselves to conducting research to explore the effects of traumatic
stress on different populations and to determine what treatments work for whom.
We have been supported by research grants from the National Institute of Mental
Health, the National Center for Complementary and Alternative Medicine, the
Centers for Disease Control, and a number of private foundations to study the
efficacy of many different forms of treatment, from medications to talking, yoga,
EMDR, theater, and neurofeedback.
The challenge is: How can people gain control over the residues of past
trauma and return to being masters of their own ship? Talking, understanding,
and human connections help, and drugs can dampen hyperactive alarm systems.
But we will also see that the imprints from the past can be transformed by
having physical experiences that directly contradict the helplessness, rage, and
collapse that are part of trauma, and thereby regaining self-mastery. I have no
preferred treatment modality, as no single approach fits everybody, but I practice
all the forms of treatment that I discuss in this book. Each one of them can
produce profound changes, depending on the nature of the particular problem
and the makeup of the individual person.
I wrote this book to serve as both a guide and an invitation—an invitation to
dedicate ourselves to facing the reality of trauma, to explore how best to treat it,
and to commit ourselves, as a society, to using every means we have to prevent
it.
....
Table of Contents
Praise for The Body Keeps the Score
Title Page
Copyright
Dedication
PROLOGUE: FACING TRAUMA
PART ONE:
THE REDISCOVERY OF TRAUMA
1. LESSONS FROM VIETNAM VETERANS
2. REVOLUTIONS IN UNDERSTANDING MIND AND BRAIN
3. LOOKING INTO THE BRAIN: THE NEUROSCIENCE REVOLUTION
PART TWO:
THIS IS YOUR BRAIN ON TRAUMA
4. RUNNING FOR YOUR LIFE: THE ANATOMY OF SURVIVAL
5. BODY-BRAIN CONNECTIONS
6. LOSING YOUR BODY, LOSING YOUR SELF
PART THREE:
THE MINDS OF CHILDREN
7. GETTING ON THE SAME WAVELENGTH: ATTACHMENT AND ATTUNEMENT
8. TRAPPED IN RELATIONSHIPS: THE COST OF ABUSE AND NEGLECT
9. WHAT’S LOVE GOT TO DO WITH IT?
10. DEVELOPMENTAL TRAUMA: THE HIDDEN EPIDEMIC
PART FOUR:
THE IMPRINT OF TRAUMA
11. UNCOVERING SECRETS: THE PROBLEM OF TRAUMATIC MEMORY
12. THE UNBEARABLE HEAVINESS OF REMEMBERING
PART FIVE:
PATHS TO RECOVERY
13. HEALING FROM TRAUMA: OWNING YOUR SELF
14. LANGUAGE: MIRACLE AND TYRANNY
15. LETTING GO OF THE PAST: EMDR
16. LEARNING TO INHABIT YOUR BODY: YOGA
17. PUTTING THE PIECES TOGETHER: SELF-LEADERSHIP
18. FILLING IN THE HOLES: CREATING STRUCTURES
19. REWIRING THE BRAIN: NEUROFEEDBACK
20. FINDING YOUR VOICE: COMMUNAL RHYTHMS AND THEATER
EPILOGUE: CHOICES TO BE MADE
ACKNOWLEDGMENTS
APPENDIX: CONSENSUS PROPOSED CRITERIA FOR DEVELOPMENTAL TRAUMA
DISORDER
RESOURCES
FURTHER READING
NOTES
INDEX
Screenbook
....
VIKING
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A Penguin Random House Company First published by Viking Penguin, a member of Penguin Group
(USA) LLC, 2014