At the turn of the 16th century, a monumental shift was about to occur in scientific medicine.

Not so quietly, a call to intellectual arms was on the move. In 1527, Paracelsus, a Swiss physician and alchemist, would help ignite a medical revolution by publicly burning the works of Galen and Avicenna, throwing the much accepted medical theories and practices of the classical masters, such as Hippocrates and Aristotle, into doubt. The world was changing. By the end of the 1500’s much of the occultist influence of the previous principles would be dumped. With the old skin shed, the 17th century would come in with a roar. Throughout the 1600’s two of the most significant advances in all of medical science, inoculation and blood transfusion, would take their first teetering steps. Marcello Malpighi, a lecturer in theoretical medicine at the university of Bologna, using the light of the setting sun, would be the first human being to observe the capillaries through the lens of a microscope. The circulatory system, in all its glory, was being revealed. Yet such monumental revelations, riveting and inconceivable at the time, would be small potatoes compared to what was coming on the wing of the 18th century. The Age of Enlightenment rocked the world, and struck a chord in the western medical sciences. Students flocked to lecture halls, experimentation abounded. What was not known was now known; what was invisible could now be seen. Huge developments were breaking out, huge discoveries being made. And, during this cataclysmic time, small and unnoticingly at the end of the 17th century from an Ancient Greek word meaning “wound”, the term trauma slipperingly entered the medical Latin. The pin drop of this moment, a mere pebble deposited in already rolling waters, would not be truly realized until centuries later.

Though the Greeks used the term only for physical injuries, it would evolve, and around the late 19th century trauma would come to encompass the description of both physical and psychic harm. It is this latter, evolved meaning, psychic, that so often predominates the modern day relationship with trauma. In Bessel Van der Kolk’s illuminating work, The Body Keeps The Score: Brain, Mind, and Body in the Healing of Trauma, Van der Kolk plunges headlong into this most tumultuous, eluding of maladies, and gives a studious, heartfelt attempt at bringing integration and clarity into this often misunderstood condition and field.

How to even begin to tackle such a hulking shadow? For those of us who have experienced it, lived with it, trauma is a hydra that pursues its vessel without tire. Van der Kolk, M. D. has spent the greater majority of his life aiding, studying, and observing the individuals hounded by this miraculously persistent of beasts. From car accident victims to rape survivors, from children who have been molested to war veterans, Van der Kolk’s breadth of interaction with the wounded is revealed potently in his book’s pages. Much like the Swiss physician nearly 500 years before him, the Dutch born Van der Kolk is seeking a revisioning of ingrained practice and theory; however, unlike Paracelsus, he has chosen to write books instead of burn them. (A less flashy, though better way I would think.)

In the prologue, Van der Kolk is quick to the point: Trauma affects all of us, our brothers, sisters, parents, cousins, friends, daughters, sons, neighbors, ourselves. Trauma can occur at any moment, happen at any time. In what is often designated into the realm of “other people”, Van der Kolk moves the needle, and advises an awareness that human beings have tendency to let slide. “Trauma […],” he places tenderly, “is unbearable and intolerable. Most […] victims […] 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.” In these words, it is very easy to forget how fast one can lose control of one’s own life. Yet it happens; in terrible frequency it happens. To the young and old, weak and strong alike. Trauma, like cancer, can rise from the dead. Dormant in the body, it can sudden, fling, and burst sundering through as a tsunami. The brain, for all its faults, is very good at what it does: Storing and maintaining information. But what of horrors? What of profound grief? The brain keeps them, the body suffers them, and the mind, in the grip, writhes.

cover_van der kolk“[…]traumatized people become stuck, stopped in their growth because they can’t integrate new experiences into their lives.[…] Being traumatized means continuing to organize your life as if the trauma were still going on—unchanged and immutable—as every new encounter or event is contaminated by the past.’

“After trauma the world is experienced with a different nervous system. The survivor’s energy now becomes focused on suppressing inner chaos, at the expense of spontaneous involvement in their life. These attempts to maintain control over unbearable physiological reactions can result in a whole range of symptoms […] . This explains why it is critical for trauma treatment to engage the entire organism, body, mind, and brain.”

A book so stuffed with information one has to wonder how Van der Kolk fit it all in, I was very moved and learned a lot from The Body Keeps The Score. A work of relentless devotion, Van der Kolk maintains and promotes the highest of medical ethics clearly: “First, do no harm.” Though many of his patients have histories of horrible aggression and violence towards other human beings, Van der Kolk has only one objective on his mind: Healing. This might make him seem naive, or at worst, enabling to certain readers. But Van der Kolk has not chosen a profession in justice, or law, or philosophy; he has chosen a profession in medicine. And medicine is about treatment and recovery. He doesn’t much seem to care if he comes across gullible and sentimental. What he does care about, to his bones, is results. Open and driven, the writing speaks to these qualities. Crisp, empathic, and full of study, The Body Keeps The Score is a book foremost about medical science. Trauma, and all its terrors, is secondary.

Sectioned down into five parts, Van der Kolk uses the first four chapters to thoroughly discuss the origins and varied symptoms of trauma. In the fifth, and final chapter, Van der Kolk refocuses the energy into what he believes matters most: Recovery.

In the briefest of briefs and oversimplified, trauma stems from “immobility”. When the instinctual fight or flight responses to terror are denied, the human body continues to create hormones and continues to fire off nerves that instruct the individual to either fend off the attack, or flee. When the panicked pumping of these faculties produces no result, the brain and body, in a way, begins to implode. This implosion, internal and frightening and powerful, can hijack the mind, and from this commandeering, thrown completely out of whack, an individual can become ostracized from their body. They are, essentially, tossed off their own ship. What follows is an endless treading of water and desperation not to drown. Adrift, and wounded, without any navigation tools, the person begins to develop symptoms both physical and psychological from what is nothing short of total exhaustion.

To say that Van der Kolk presents a well researched documentation of trauma and its many expressions is an understatement. So much has gone into The Body Keeps The Score that it can make a reader dizzy. Eager to fit all his arguments and observations in, I will say that if the book has any fault at all, it is that Van der Kolk jumps from point to point to point so frequently, that the ability for the reader (and writer for that matter) to mull and chew upon what’s been laid out is squished.

anatomical drawing
Anatomical illustration by Arnauld-Eloi Gautier-Dagoty (1741-1771); Provided by rawpixel

But this is a small matter, and one that did not dissuade this reader from being impressed by the astonishing workload Van der Kolk has taken upon himself and convinced by the enlightening though troubling facts dispensed in rapid fire formation. Chiefly in the beginning chapters, Van der Kolk makes it clear that mental illness—in its ever growing bouquet of variation—is not birthed out of chemical imbalances spur-of-the-moment. Mental illness, overwhelmingly, is the result of trauma, either formed from a singular catastrophic event (such as a car crash, or a rape) or from repeated punishment and exposure to violence (such as an abusive childhood, or a long war). Van der Kolk, as clearly and kindly as he can, provides a thorough mapping of what happens to the human brain when such circumstances occur, and how these changes then create rippling effects throughout the body. Presenting studies, PEW supported statistics, using images, telling his own stories and the stories of his patients, Van der Kolk dissects the arguments for the belief and trust in purely pill-form medicine. The root cause of such painful and often confusing conditions are not addressed, he argues, and therefore modern medicine continues to fall short for the elephant in the room continues to be ignored: Trauma. How can we prevent mental illness in the brain and body if we do not acknowledge the inception of these diseases? Van der Kolk is not just asking for better, more talk-based healing. What Van der Kolk is pushing for is a cultural awakening.

In a illuminating surprise, there is a hidden, tertiary plot inside Van der Kolk’s information laden volume. One that he has slipped in effectively and, perhaps, quite unconsciously. It is a story of denialism and silence.

Trauma is everywhere, in our siblings, our cousins, our parents, our friends, our neighbors. Then so, The Body Keeps The Score strategically tells us by simple deduction that abuse is everywhere, rape is everywhere, violence is everywhere, domination and hate is everywhere. The hardest lesson of the world, the most uncomfortable of truths, Van der Kolk tells in strict and factual form. Strangers, foreign invaders, monsters of the dark do not arrive in the form immaculate conception. Therefore mental illness—be it PTSD, depression, a behavioral disorder, insomnia—does not arrive by way of spontaneous combustion or generation. No, mental illness is foisted. Those who do our loved ones harm are us. An uncle, a father, a mother, a friend, a fellow employee, a sibling; trauma arrives more often than not on the wings of an intimate than on the heels of a catastrophe. It is this hidden lesson, poignantly slid between the lines of Van der Kolk’s compelling volume, that I found held the most weight. The silencing of abuse and trauma victims, Van der Kolk reminds us, comes at a high price: Skyrocketing medical expenses, homelessness, drug addiction, mental disorders, autoimmune sickness, and more. The question Van der Kolk most wants asked is this: Not what is wrong with a patient (this is often evident), but what has happened to them.

Though great advances have been made in all the medical fields, and the composition of our bodies has never been diagrammed more pristinely, puzzlingly, perhaps predictably, we still remain largely in the dark about the interactions and operations of our inner components. This statement will no doubt cause dispute; however, the likelihood of agreement on the conflicting reports of the scientific media and misinterpretation of discovery, is high. It is evident that, even if a small pocket of heavily uptodate individuals exists, and are inching ever closer to a totality of medical anatomy, biology, neurology, et al., it remains so that the vast majority of individuals are constantly bombarded with opposing results about what is good for them and what is bad, what will harm them and what will not, what is so and what is not so. An avalanche of unreplicatable results continues to plague psychology and much of modern medicine. So, unavoidably, The Body Keeps The Score is a book of subject information to be argued over and disagreed. For his part, Van der Kolk understands and sympathizes with his fellow physicians in the “finding a needle in a mountain of needles” problem. But this does not stop him. Van der Kolk has done his homework, put in his hours, and has chosen to listen to his patients, and, what is perhaps most revealing, Van der Kolk has chosen to believe their stories. And their stories are violence, their stories are sexual abuse, their stories are guilt and shame and above all, suffering. In the epilogue, Van der Kolk writes, “We are on the verge of becoming a trauma-conscious society.” This is, by all means, Van der Kolk’s ultimate goal. To take the ugly thing from the shadow, and bring it into the light.

If you remember, I opened this preposterously long review with a short history lesson. History, by all means, is a great way to reveal the world. To understand where a thing comes from, we must first understand the events that led up to it, the foundation and components that birthed it, the environment and circumstances that hindered, or nurtured it. From a time of great revolution of thought the word trauma emerged. From there, it has traveled hills and valleys, and will continue to move and change and perhaps rebirth and die despite what future awaits. But, its genesis, its life, is planted firm. Though trauma is from the Greeks, *trau, an extended form of root *tere (or *terə) is a Proto-Indo-European word meaning to “cross over, pass through, overcome.”

I do not know if we will ever become a trauma-conscious society in the way Bessel Van der Kolk hopes us to be. I do not know if suffering has purpose, or greater meaning, or if there is a magic bullet out there, waiting for medical science to uncover and wield. But I do know that human beings are strong, stronger then we will ever know, and of the stuff of stars. The cover of The Body Keeps The Score is what initially drew me; a wonderful portrait of human body surrounded by what could be perceived as hands or birds or sound blasts or stars… I saw them as stars. And my first thought upon viewing the picture was how it felt like a transformation.

On the blotted shape, with no characteristics other than legs, torso, arms, and head, there is the heart. Just a heart. A small red dot in a rising shadow.

The heart keeps the score.

body keeps score cover art
Photo of The Body Keeps The Score cover art by French artist Henri Matisse.

Four out of Five Stars for The Body Keeps The Score: Brain, Mind, and Body in the Healing of Trauma

The featured image is an antique lithograph of an anatomy chart of a human body showcasing its internal system by Korpers Des Menschen (1898). Provided by rawpixel – Thank You.

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