Book Matters

The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma

By Bessel Van Der Kolk, M.D.

This is an important book, not only for the problem it identifies and the experimental therapies it recommends but for its overview of what it takes to be a human being.

A word about my own vantage point.  In A Good Look at Evil, I argued that a good life is one that lives its own nonfiction story — conscious of what one’s aim was at particular points on one’s timeline, keeping in mind what happened first and what happened next, what went wrong and how it was (or still needed to be) self-corrected.  Such, I held, would be the human norm.  The evil-doer I took to be an agent who sees the victim’s story and does what that mischief-maker can do to spoil it.

But there is another way a person’s story can be lost, which I did not consider in my book; it’s the way of trauma.  Although, as the author finds, beneath the symptoms of trauma “there exists an undamaged essence, a Self,” trauma blocks the sufferer’s view of it.  

How does trauma do that?  It does it by interfering with the tenses of the person’s story.  The traumatic memory refuses to take its chronological place in the past.  Instead, it gets in front of experiences that are occurring right now.  This skewing of the tenses has its physiological counterpart in the disorienting of the area of the brain that normally integrates experience, providing “a sense of time and perspective, which makes it possible to know that ‘that was then but I am safe now,’” and “another area that integrates the images, sounds and sensations of trauma into a coherent story.”

What’s the cure?  A number of promising, experimental therapies are described.  All offer ways of getting sufferers to feel sufficiently safe in their bodies and emotional states to be able, by degrees, to visit buried memories.  Methods that work with one patient might not work with another.   Effective therapies give the adult self the time and leeway to reassemble its own narrative chronology.  No “transference” to the therapist of early angers or authority is required in every case, nor is recourse to some favored psychological theory.  What is needed is for the terrible event – whether battlefield horror, car accident, or childhood abuse – to be recollected in full and then safely restored by the adult to its place in the past. 

A talking cure alone — begun without these preliminaries designed to restore a sense of present-day safety — won’t deliver that restoration of the “exiled” fragments of memory to the adult whose entire story this still is.  Nor can drugs, which are currently prescribed for a multitude of symptoms – each one still mislabeled as a distinct dysfunction — do more than mask the trauma underneath the symptoms.  

The story has heroes, chief among them our self-effacing, persistent, and courageous author, Van der Kolk who, with his colleagues, undertook a long struggle to gather the probative studies and treatments chronicled here, along with the evidence, both clinical and coming from brain studies.

The tale has villains too: among them psychiatric associations that repeatedly refused to simplify their current smorgasbord of separate illness categories and instead consider which of these might be trackable to traumatic occurrences in their patients’ histories.

One such eminent professional mislabeler is mentioned in passing whom I’d like to single out for special attention.  “In 1896 Freud boldly claimed that ‘the ultimate cause of hysteria is always the seduction of the child by an adult.’  Then, faced with his own evidence of abuse in the best families of Vienna – one, he noted, that would implicate his own father—he quickly began to retreat.”  

And thus, ladies and gentlemen, by a slight sleight of hand, was born the so-called Oedipus Complex!  Good grief!  Whole phases of culture — distorting otherwise wholesome parent/child relationships, skewing the self-assessment of persons — were bent out of shape by Freud’s cover story!  

When I wrote “The Filial Art,” really written in tribute to my mother, it would be returned unread by editors of American philosophy journals who explained, in their rejection letters, that thanks, but they’d already done their piece on child abuse!  Finally, I submitted it in England and got it published — but not without first ascertaining (from an English philosopher friend) that the editor of that journal actually did love his mother!

Look how consequential one small lie can be!