The Body Keeps the Score Essay Questions

Give an overview of how the field of psychiatry changed over time.

Prior to the Enlightenment period of the 17th and 18th centuries, the origins of behavioral anomalies were thought to be divine, magical, or evil. A new paradigm emerged in the 19th century when French and German scientists began investigating behaviors as "an adaptation to the complexities of the world" (Chapter 2). Modern psychopharmacology burgeoned in the 1940s and 1950s with the introduction of certain breakthrough medications used to treat conditions such as schizophrenia and bipolar disorder. This shifted the field of psychiatry to include biological and chemical interventions instead of purely psychoanalytic talk therapy. In the decades that followed, psychopharmacology became the central modality.

Describe how Dr. van der Kolk's treatment approach evolved over the course of his career.

In the 1970s, van der Kolk eagerly took the position that mental disorders, illnesses, and symptoms could be fixed by the administration of appropriate chemicals. In 1973, he became the first chief resident in psychopharmacology at the Massachusetts Mental Health Center, and took a teaching position at the same institution in 1982. At this time, he saw psychopharmacology as the pinnacle of treatment. However, his research and clinical practice over the years expanded his understanding of trauma as something that required root-cause and integrative treatment. He also shares his suspicions about financial corruption in pharmaceutical companies (Chapter 2). While he still prescribes medications in certain circumstances, he also embraces innovative and sometimes unconventional treatments.

What does van der Kolk say about how trauma affects and is affected by relationships?

Van der Kolk cites "trouble in creating workable and satisfying relationships" as one of the main sources of mental suffering (Chapter 5). This is because humans evolved as social beings, which has implications for our survival, cognition, and cultures. Anything that threatens or disrupts one's sense of belonging has biological and psychological consequences. Particularly for children, trauma reduces or harms the capacity for connection later in life. While other people might be the greatest source of potential harm to a human being, they also can be the greatest source of healing. Van der Kolk writes about the power of healing in social contexts, whether it be through different relationships or in group settings. This provides "physical and emotional safety, including safety from feeling shamed, admonished, or judged, and to bolster the courage to tolerate, face, and process the reality of what has happened" (Chapter 13).

How does trauma impact a person's brain and memory?

Brain scans and imaging technology have shed light on the nature of traumatic memory. Van der Kolk describes this in detail in Part Two of the book. While researchers of course cannot always monitor a person's brain in the immediacy of a traumatic experience, they have reactivated the trauma in a laboratory setting to see which parts of the brain activate and which shut down. One region that shuts down is the frontal lobe, which has a variety of implications. The frontal lobe allows for language, abstract thought, the integration of raw sensory data, meaning-making, planning, reflection, and imagining future scenarios, among other things (Chapter 4). Trauma triggers the brain's alarm response by way of the amygdala. This initiates a physiological cascade of stress hormones that prepare the body for fight or flight. People with PTSD often have an overactive amygdala, which can potentially override rational thinking.

There is no universal blueprint response to trauma. This is demonstrated when van der Kolk compares the brain scans of a couple that survived a mass automobile accident. While specific parts of the husband's prefrontal cortex and his thalamus deactivated, nearly every area of the wife's brain showed markedly decreased activity (Chapter 4). She demonstrated depersonalization, one manifestation of the biological freeze reaction. This shows the need for personalized treatment.

Give an overview of one treatment approach presented in this book.

In the final chapter, van der Kolk describes the healing potential of theater, prayer, song, and dance. He begins with a personal anecdote. When his own son Nick suffered from chronic fatigue syndrome, van der Kolk and his wife strove to alleviate the boy's isolation and sense of self-hatred. They enrolled him in an improvisational theater class so that he could interact with kids his own age. This had deep, life-long reverberations: van der Kolk credits theater with guiding Nick toward becoming a creative and loving adult.

According to van der Kolk, having embodied, communal, and rhythmic experiences can be an immense source of healing for traumatized individuals. This is an age-old truth, though "little research exists on how collective ceremonies affect the mind and brain and how they might prevent or alleviate trauma" (Chapter 20). For van der Kolk, the lack of empirical data does not detract from the healing potential. One incredible example that van der Kolk witnessed was when Archbishop Desmond Tutu utilized collective singing and dancing as he conducted public hearings for the Truth and Reconciliation Commission in South Africa in 1996. He "fully [credits] Tutu and the other members of the commission with averting what might have been an orgy of revenge" (Chapter 20).

Van der Kolk observed and studied three different programs for treating trauma through theater: Urban Improv in Boston, the Possibility Project in New York City, and Shakespeare & Company in Lennox. Overall, theater helps people confront painful realities and symbolically transform them through communal action.