Book Summary (1 of 2): The Body Keeps the Score by Bessel Van der Kolk
by Jerry Wu
The summary of the book is divided into two parts: Part 1 discusses trauma and how it affects our physical brain and cognitive functioning, and you can jump to Part 2 to check out a list of healing methods.
"The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma" by psychiatrist Dr. Bessel van der Kolk. It goes into meticulous detail about psychological trauma and its lasting effects, and most importantly, the healing approaches.
In this summary of the book, I will try to stick with the author's original concepts but also add some personal commentary and perspective. I try to keep it short, but it is a very comprehensive book, so I can’t help but cover as many insights as possible.
This book explores trauma in its various forms—distressing, frightening, or stressful incidents that are difficult to cope with or out of one's control—including childhood abuse, rape, severe car accidents, or war zones. We might consider trauma in extreme circumstances. However, in a broader sense, any event or condition that negatively affects our thinking and behavior probably has some degree of traumatic impact. A child who is not physically abused but being completely neglected by the caregiver would be considered experiencing trauma as well since it causes tremendous pain that is no worse than abuse.
We might dismiss certain incidents as trivial, perhaps because they happened decades ago, or we believe we have let them go. Maybe an incident of your parents mocking you when you were a kid. When you recall the memory of a particular event, if it triggers a strong emotional response or discomfort, then it could be considered a trauma. The pain is dismissed by the mind but likely buried deep in the body somewhere and has long-lasting negative effects on our behavior and thinking unconsciously.
Why is it so challenging to move on from Trauma?
Starting with some factual statistics, a study on adverse childhood experiences revealed that women who were abused or neglected early in life are seven times more likely to be raped as adults. Women who witnessed their mothers being attacked by partners are also much more likely to become victims of domestic violence.
Worse, from a genetic perspective, abusers and victims often pass on their trauma to the next generation, creating a cycle of recurring issues within the families. This raises the question: why can’t victims simply leave bad relationships and move on?
The complexity of trauma makes the matter exceedingly difficult. As van der Kolk suggested:
Trauma results in a fundamental reorganization of the way mind and brain manage perceptions. It changes not only how we think and what we think about, but also our very capacity to think. We have discovered that helping victims of trauma find the words to describe what has happened to them is profoundly meaningful, but usually it is not enough. The act of telling the story doesn’t necessarily alter the automatic physical and hormonal responses of bodies that remain hypervigilant, prepared to be assaulted or violated at any time. For real change to take place, the body needs to learn that the danger has passed and to live in the reality of the present.
These behaviors may appear irrational, but they are often not due to a lack of understanding, willpower, or character flaws. Rather, they are the result of altered and distorted brain systems. Traumatized individuals carry a tremendous burden, which takes immense courage to bear. The relentless pain and weight gradually grind a person down, leading to a sense of helplessness and vulnerability.
Trauma can be large or small, from the brutality of a battlefield to the incessant criticism of parents. People do not wish to suffer, yet they are trapped in past memories and conditioning, unable to shake them off. Trauma exhausts people’s energy as they deal with internal chaos. This is similar to a software glitch in the brain, which can manifest as physical ailments and diminish the spontaneity of life.
“Trauma causes people to remain stuck in interpreting the present in light of an unchanging past.” Our past shapes our thinking framework and inner reality. Trauma, whether severe like growing up in an abusive family or more passive like being neglected as a child, has enormous impacts on shaping our inner reality. The neglect or absence of support can also traumatize children in a passive format.
Reality becomes distorted, and defensive mechanisms developed to protect oneself. These mechanisms can be destructive: dampening emotional responses, distrusting others, appearing tough and independent, or severing connections, which further isolates individuals. Thus, healing is to untwist and unveil the wholeness of being, and to reestablish the view of the world from a fresh standpoint.
Malfunctioning Alarm System and Hormone
Psychologists usually try to help people use insight and understanding to manage their behavior. However, neuroscience research shows that very few psychological problems are the result of defects in understanding; most originate in pressures from deeper regions in the brain that drive our perception and attention. When the alarm bell of the emotional brain keeps signaling that you are in danger, no amount of insight will silence it.
When the brain’s alarm system goes off, it automatically triggers preprogrammed emotional or physical responses in the primitive part of the brain, reverting to human ancestor’s instincts of fight-or-flight, which partially shuts off the department of logical reasoning and overpowers the ability of rational thinking.
In cases of severe trauma, the brain doesn't fully recover from the shocking event. As a result, the brain and body continue secreting stress chemicals long after the event has ended. Essentially, the brain (or the person) remains stuck in a heightened state of stress and "survival" mode, unable to fully return to a relaxed state.
To people who are reliving a trauma, nothing makes sense; they are trapped in a life-or-death situation, a state of paralyzing fear or blind rage. Mind and body are constantly aroused, as if they are in imminent danger. They startle in response to the slightest noises and are frustrated by small irritations. Their sleep is chronically disturbed, and food often loses its sensual pleasures. This in turn can trigger desperate attempts to shut those feelings down by freezing and dissociation.
In other words, the alarm never truly turns off and can be easily reactivated by subtle triggers. Trauma-induced physiological changes cause the brain's alarm system to malfunction, leading to an increase in stress hormones and making individuals overly vigilant to ordinary events. Early childhood abuse, in particular, has long-term negative effects on brain development. Consequently, individuals become hypersensitive and overreact to stimuli, similar to an allergic response. This can result in full-blown panic or a paralyzed state, throwing off the equilibrium.
In PTSD the critical balance between the amygdala (smoke detector) and the MPFC (watchtower) shifts radically, which makes it much harder to control emotions and impulses. Neuroimaging studies of human beings in highly emotional states reveal that intense fear, sadness, and anger all increase the activation of subcortical brain regions involved in emotions and significantly reduce the activity in various areas in the frontal lobe, particularly the MPFC. When that occurs, the inhibitory capacities of the frontal lobe break down, and people “take leave of their senses”.
If the brain continues to secrete stress hormones even after a traumatic event has ended, keeping neural circuits hyperactive and overwhelming the individual with emotions. Chronic secretion of stress hormones can be detrimental to long-term health. A study shown, different hormones are linked to various disorders: abnormal adrenaline levels are associated with depression, while dopamine imbalances are linked to schizophrenia. Low serotonin levels can cause animals to overreact to stress, whereas high serotonin levels can suppress the fear system, making animals less likely to respond aggressively to danger.
Shutdown, Alexithymia, and Dissociation
Shutdown, alexithymia, and dissociation are common symptoms of severe trauma. The brain may attempt to avoid emotional overload or may become so overwhelmed that it effectively crashes. Consequently, individuals might unintentionally close themselves off to fend off negative emotions or, in more severe cases, shut down, freeze, or trigger a panic attack.
As stressful emotions persist, many people learn to repress their feelings, cutting off emotional and bodily sensations, which can result in alexithymia. This condition makes it difficult for individuals to sense and communicate their own feelings.
Suppressing their feelings had made it possible to attend to the business of the world, but at a price. They learned to shut down their once overwhelming emotions, and, as a result, they no longer recognized what they were feeling. Few of them had any interest in therapy.
A patient with alexithymia described her sensation:
I don’t know what I feel, it’s like my head and body aren’t connected. I’m living in a tunnel, a fog, no matter what happens it’s the same reaction—numbness, nothing. Having a bubble bath and being burned or raped is the same feeling. My brain doesn’t feel.
The brain employs another strategy to prevent emotional overload by dialing down sensitivity and withdrawing from overwhelming pain, which leads to many issues, including dissociation, which is the essence of trauma, along with flashbacks and reliving traumatic events, re-experiencing images, sounds, and emotions. As well as losing the sense of time, thus individuals become trapped in the moment without a clear sense of past, present, or future.
Flashbacks and reliving are in some ways worse than the trauma itself. A traumatic event has a beginning and an end—at some point it is over. But for people with PTSD a flashback can occur at any time, whether they are awake or asleep. There is no way of knowing when it’s going to occur again or how long it will last.
As suffering prolongs, reliving trauma becomes increasingly painful and potentially self-destructive. To prevent constantly tripping the circuit, the brain employs a self-protective mechanism—dissociation. This process reduces activity in various brain regions to prevent further damage from hyperactivity or hypersensitivity. However, this results in emotional detachment and a numbing of overall feelings, both negative and positive, leading to a sense of numbness—feeling emotionless during joyful events like birthday parties or sorrowful occasions such as the death of loved ones.
When asked about traumatic events, some individuals may go blank and seem absent-minded, or recount horrendous stories without any emotional response. Dissociated, or emotionally detached, where individuals feel nothing, is a symptom caused by trauma, known as depersonalization.
To the depersonalized individual the world appears strange, peculiar, foreign, dream-like. Objects appear at times strangely diminished in size, at times flat. Sounds appear to come from a distance. . . . The emotions likewise undergo marked alteration. Patients complain that they are capable of experiencing neither pain nor pleasure. . . . They have become strangers to themselves.
Consequently, people cut themselves with sharp objects or get into a fistfight to make the numbing go away to embody the feeling of being alive.
Hyperactive of Alpha Waves and Hyperarousal
A study examining the effects of combat exposure on previously normal brains highlights this phenomenon. By measuring the mental and biological functioning, including brain-wave patterns, of soldiers deployed to combat duty in Iraq and Afghanistan, researchers found significant changes. The persistence of excessive alpha wave activity suggests a chronic state of agitation and struggle to relax, underscoring the profound impact of combat on brain function.
They found that the total number of months in combat over a three-year period was associated with progressive decreases in alpha power at the back of the brain. This area, which monitors the state of the body and regulates such elementary processes as sleep and hunger, ordinarily has the highest level of alpha waves of any region in the brain, particularly when people close their eyes. As we have seen, alpha is associated with relaxation. The decrease in alpha power in these soldiers reflects a state of persistent agitation…The net effect is that arousal, which is supposed to provide us with the energy needed to engage in day-to-day tasks, no longer helps these soldiers to focus on ordinary tasks. It simply makes them agitated and restless.
At the same time, too much slow-wave at the waking state could also cause problems.
If people have too much slow-wave activity while they’re awake, their thinking is foggy and they exhibit poor judgment and poor impulse control. 80 percent of children with ADHD and many individuals diagnosed with PTSD have excessive slow waves in their frontal lobes.
Reprogramming and Deconditioning
Trauma, especially in early childhood, inflicts deep wounds and lasting scars that are challenging to heal. Recurring traumatic circumstances reinforce specific ways of thinking and behaving, solidifying these patterns over time. The phrase "fire together, wire together" describes how neural circuits that frequently activate together form strong connections, becoming default routes or habitual responses. If you experience safety and love, you learn to be calm; conversely, repeated exposure to fearful or harmful conditions cause the brain to be highly alert and ready to protect itself at any moment.
These conditioned responses often operate unconsciously, meaning you react in specific ways without your volition. Your emotional brain, comprising the reptilian brain and limbic system, automatically handles these emotional or physical responses. However, this does not mean you don’t have the ability to override these emotional or behavioral patterns. Through various healing techniques, it is possible to deprogram or reprogram certain undesirable responses.
Mindfulness meditation teaches us to observe our thoughts, feelings, and emotions objectively. They allow us to pause and perform cognitive calculations, finding appropriate responses to situations rather than reacting automatically based on preprogrammed emotional responses. Essentially, these practices enable us to use the rational brain to override the reactive responses of the emotional brain, recalibrating the autonomic nervous system.
In recent years, previously controlled psychedelic substances like MDMA have come into the realm of psychotherapy with proven effectiveness. “Two months later 83 percent of the patients who received MDMA plus psychotherapy were considered completely cured, compared with 25 percent of the placebo group.” When administered safely, psychedelic is an effective way to put the brain into a deep state of altered state of consciousness.
Meditation, hypnosis, and altered states of consciousness share a commonality—they place us in a unique state of consciousness with therapeutic effects. This state allows us to decondition certain patterns and reprogram the brain’s "software," offering a pathway to healing and personal growth.
Trance states, during which theta activity dominates, can help to loosen the conditioned connections between particular stimuli and responses, such as loud cracks signaling gunfire, a harbinger of death. A new association can be created in which that same crack can come to be linked to Fourth of July fireworks at the end of a day at the beach with loved ones.
By engaging in these practices, we can develop a greater sense of control over our reactions and foster a more balanced and mindful approach to life.
