In 1994, Boston-based psychiatrist Bessel van der Kolk recruited eight individuals for an unprecedented study. Each patient was asked to lie inside a brain scanner while listening to a recorded narration of the most traumatic moment of their life. “You are six years old and getting ready for bed,” a typical recording might start, “You hear your mother and your father yelling at each other… You look over the banister and see your father holding your mother’s arms while she struggles to free herself.” As the patients listened, the scanner monitored which parts of their brains became more or less active, while van der Kolk simultaneously recorded their blood pressure and heart rate.
The brain-imaging revolution of the early ’90s allowed van der Kolk to see something he’d long since suspected: when traumatised people think about their traumas, they do not simply remember them – they relive them. Heart, blood, and brain all respond as though the events were actually occurring all over again. In short, as van der Kolk would later title his 464-page book on the subject: the body keeps the score.
Not much has remained constant over the last 142 weeks. We’ve had a turbulent two-and-a-bit years of devastating wildfires, shock impeachments, will-they-won’t-they Brexit negotiations, and a catastrophic global pandemic. And yet one thing has stayed the same since October 2018: Bessel van der Kolk’s The Body Keeps the Score has remained steadfastly on The New York Times Best Seller list.
First published in 2014, the book – in van der Kolk’s own words – “is the fruit of thirty years of trying to understand how people deal with, survive, and heal from traumatic experiences.” While it was positively reviewed by academics upon its release, over the last couple of years the book has become a pop culture phenomenon. It has been endorsed by everyone from indie rock singer Phoebe Bridgers to food writer Nigella Lawson. Fans have used it to analyse TV shows like superhero soap WandaVision and thriller Mr Robot. At least one actress has read it to better understand her character. Roughly once an hour, every hour, someone new tweets about the book.
Why is a seven-year-old psychology book an object of cult fascination today? While it’s tempting to argue that we’re currently experiencing more trauma than ever – van der Kolk has been offering discounted online training to therapists who are treating distressed NHS workers during the pandemic – the trauma the psychiatrist deals in is not the colloquial kind. At times, The Body Keeps the Score is a disturbing book that details the turmoil of everyone from rape victims to the rapists themselves. But van der Kolk’s work does stress that anyone can be traumatised: “For every soldier who serves in a war zone abroad, there are ten children who are endangered in their own homes.”
The Body Keeps the Score begins in 1978 – two years before post-traumatic stress disorder (PTSD) was listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM) – when van der Kolk was a staff psychiatrist at the Boston Veterans Administration Clinic. When administering a Rorschach test to veterans, he saw how many interpreted the inkblots as bloody scenes and realised that traumatised people perceive the world differently. Decades later, his brain scans showed that traumatised people’s amygdala (which van der Kolk nicknames the “brain’s smoke detector”) misinterpreted the dangers around them, flooding the body with stress hormones in safe situations.
Stress hormones are one thing, but van der Kolk documents a host of ways trauma can affect the body, from patients with incest histories developing autoimmune disorders to the fact that traumatised children have almost 50 times the rate of asthma than their non-traumatised peers. “It is amazing how many psychological problems involve difficulties with sleep, appetite, touch, digestion, and arousal,” he writes.
But the crux of van der Kolk’s argument is that if the symptoms of trauma involve the body, so too must the cure. If you can show via brain scans that people relive their trauma when they remember it, how can you help people confront their past without damaging their present?
“What Bessel did, in a very open minded way, was to begin examining new approaches to trauma that were outside the mainstream,” says Norman Doidge, a Canadian psychiatrist who has published and taught on trauma for decades, and the author of The Brain That Changes Itself. This included revolutionising attitudes to Eye Movement Desensitization and Reprocessing (EMDR) – a type of therapy which involves recalling disturbing experiences while engaging in a series of rapid eye movements. Though van der Kolk first thought the therapy was a fad, he was amazed when he saw how the treatment stopped his patients being “hijacked” by their memories (scientists still debate exactly how EMDR works).
“There are psychiatrists, myself included, who were moving in a parallel track with Bessel, or, more often, following him, who now can practice these techniques more easily because of his synthesis,” Doidge says. Today, celebrities from Prince Harry to Jameela Jamil swear by EMDR. Doidge says that by emphasising the neuroscience, van der Kolk gave treatments like EMDR “legitimacy”: “Without a doubt his work transformed what’s happening on the ground amongst those who treat trauma.”
But why look for a new treatment at all? While van der Kolk doesn’t dismiss the power of talk therapy, he argues it isn’t always suitable for trauma patients. During his scans of the eight traumatised individuals, he found that the Broca’s area of the brain – one of the speech centres which allows people to put their feelings into words – “went offline” when a flashback was triggered. “Trauma by nature drives us to the edge of comprehension,” van der Kolk wrote. Perhaps his book especially appeals in an era dominated by mental health slogans such as “It’s okay to talk”. It might be okay; it might not always be possible.
In 2004, van der Kolk’s colleague Ruth Lanius scanned the brains of trauma victims when they were idling, i.e. they weren’t thinking about their trauma. What she found was shocking: compared to “normal” subjects, PTSD patients had very little activation in the self-sensing areas of the brain, those that work together to give us a physical sense of where we are, register sensations from our body, and coordinate emotions and thinking. In short, patients had responded to trauma by shutting down parts of their brain.
Van der Kolk believes interventions that involve the body and touch can reactivate the self-sensing system and restore a patient’s sense of self: he advocates for both massage therapy and yoga, as well as theatre (“Acting is an experience of using your body to take your place in life”). Later, he discusses the power of neurofeedback – allowing patients to see their real-time brain activity – as a tool to rewire the brain.
Today, Lanius says the brain scans printed in van der Kolk’s book have drastically helped to validate people’s experiences. “Often what I find is that when people have a lot of trauma-related symptoms, they think they’re crazy,” says the director of the PTSD unit at the University of Western Ontario, who has been working in trauma since the late ’90s. “Trauma survivors are so hard on themselves often, and they think they’re broken… Having that brain-body perspective and actually being able to visualise changes in the brain is so validating.” Lanius says she gets regular emails from people who’ve read the book: “I think it really is making an impact.”
It is clear that The Body Keeps the Score appeals to both patients who sing its all-caps praises on mental health forums and to psychologists who believe it has revolutionised the ways we talk about – and treat – trauma. Amazingly, the book largely seems to have spread through word of mouth. Though it is the culmination of decades of work, it arguably arrived at the right time: between 2009 and 2016, a “Time to Change” campaign run by charities in England demonstrably weakened the stigma around mental illness. Half a decade later, it’s hardly surprising it’s become an essential mental health text; van der Kolk’s work brought the body back into psychiatry.
Early in The Body Keeps the Score, the author recalls how the “pharmacological revolution” led to the swimming pool and basketball court being removed in the Harvard teaching hospital where he worked in the 1990s. No longer could patients and doctors share “the pleasures of splashing in the pool” to “restore a sense of physical wellbeing” – instead, those areas of the hospital were used to dispense drugs. In a way, The Body Keeps the Score is van der Kolk’s own swimming pool and basketball court: a place where readers can “become familiar with and befriend the sensations in their bodies” in order to heal.
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Image: Ryan MacEachern / Penguin
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