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

For the large number of people who are still suffering from the effects of trauma, despite the tremendous advances in the treatment of posttraumatic stress disorder (PTSD) made in the last 20 years, this book offers new insights into psychopathology and recovery. Part scholarly review, part case series, part history, part philosophy, and part memoirs, Dr van der Kolk uses anecdotes elegantly to illustrate evidence based concepts in a way that patients can grasp yet experts will not find simplistic. Providers, patients, and families will inevitably find that the science and stories resonate with their own experiences. Like all great innovations, this book builds on past innovations. Seemingly unrelated neuroimaging, neurochemistry, endocrinology, animal studies, attachment, interpersonal, psychodynamic, cognitive, and behavioral concepts are woven together, creating an intricate but coherent, unifying tapestry that helps reveal how trauma can change survivors. Freud and Pavlov are referenced alongside films, novels, Galen, and Yogi Berra. Contradictions that have long mystified observers simultaneously not wanting but needing to talk about trauma, coming alive in the present only when recounting the past, repetition compulsions, maintaining connections with abusers, recklessness resulting in calmness, finding pain in pleasure and pleasure in pain, avoiding treatment for fear recovery will result in forgetting dead comrades, reacting to minor irritations as if life threatening yet having little apparent reaction to further assaults suddenly become clearer. Just as he explains how trauma can disturb circuits, hormones, sensorimotor systems, and "how we think and what we think about," van der Kolk describes how these can be recalibrated. He defines 3 avenues for recovery: "top down" through the medial prefrontal cortex (ie, talking, processing, reconnecting) medicine changing the way the brain organizes and reacts to stimuli, and "bottom up" through the "reptilian brain" (ie, the body having experiences that contradict the physical and emotional impacts of trauma) Not everyone will respond to the same treatments, and most will require a combination to recover. He laments how clinicians often spend more time managing problem behaviors than trying to understand their causes. For some, medications can "deflect attention from dealing with underlying issues" and from relationships, and only talking about trauma can sometimes be counterproductive due to reinforcing a focus on the past instead of the present, or is thwarted by triggering dissociation (his neuroimaging studies found that the brain's speech centers deactivate in some when trying to recall trauma, making it nearly impossible for this subset of traumatized patients to talk about the trauma) The book pays particular attention to those for whom typical treatments may not be effective: those who freeze, dissociate, have personality disorders, suffer physical collapse, and who have persistent heartbreaking and gut wrenching sensations as "the body continues to defend against a threat that belongs in the past." For them, "the body needs to learn that the danger has passed and to live in the reality of the present." In addition to typical Marcia L. Verduin, MD,