Summary
Chapter 4—Running For Your Life: The Anatomy of Survival
Van der Kolk states that children whose caregivers remain calm and attentive to their needs can more easily adapt to and recover from adversity. Moreover, effective action in response to the perceived threat (and the body's subsequent state of fight or flight) restores homeostasis. If this response is blocked by circumstances such as war, domestic violence, or rape, then the brain continues to secrete stress chemicals. The brain's primary role is to ensure our survival. Van der Kolk distinguishes between three main brain levels: the ancient animal or reptilian brain, the mammalian brain or limbic system, and the rational brain or neocortex. The reptilian brain is responsible for basic survival functions like breathing, heart rate, and body temperature regulation. The mammalian brain regulates emotions, monitors danger, and processes sensory information. The neocortex sets us apart in the animal kingdom.
Van der Kolk explains the way the brain learns and adapts through experience. He quotes the work of Donald Hebb when he says, "neurons that fire together, wire together." This applies to feeling safe and loved as much as it does to feeling fear and abandonment. Van der Kolk also explains empathy in cognitive terms: mirror neurons guide our responses to other people's emotional states, movements, and perceived intentions. One hallmark experience of trauma is dissociation: the fragmentation of a person's thoughts, memories, feelings, actions, or sense of identity. This causes people with PTSD to relive parts of their past trauma in the present day. Apart from the fight or flight response, another possibility is the biological freeze response. The medical term is depersonalization, and it is one symptom of the massive dissociation stemming from trauma.
Chapter 5—Body-Brain Connections
Van der Kolk draws on Charles Darwin's book about emotions, titled The Expression of the Emotions in Man and Animals. According to Darwin, emotions are primarily expressed through the muscles of the face and body, which are then used to communicate our mental state and intention to others. Being stuck in survival mode can threaten one's capacity for imagination, planning, playing, learning, and tuning in to other people's needs. Van der Kolk proceeds to break down the autonomic nervous system (which controls involuntary bodily functions) into its two main parts: the sympathetic and parasympathetic branches. The first primes the body for action (fight or flight) by increasing heart rate, respiration, and blood pressure. The latter promotes energy conservation (rest and digest) by slowing heart rate, aiding digestion, and promoting wound healing. In the face of threat, we first turn to social engagement. If no one comes to our aid, the fight or flight response is triggered. If all else fails, we may experience a state of freeze or collapse. Van der Kolk writes that "immobilization is at the root of most traumas."
Chapter 6—Losing Your Body, Losing Your Self
One of van der Kolk's patients over the years was a young woman named Sherry who, as a response to chronic emotional abuse and neglect, resorted to picking at her skin to combat numbness. Unable to establish a connection with her, van der kolk referred her to a massage therapist. Sherry's traumatic experiences had led to a profound disconnection from her body. According to the neuroscientist Antonio Damasio, the core of our self-awareness rests on the physical sensations that convey the inner states of the body. Trauma can impair people's ability to discern what is going on inside their bodies. This can manifest in various ways. One is alexithymia, a psychological phenomenon in which an individual cannot identify, understand, or express his or her emotions. Another is depersonalization: losing your sense of self. A third (and pervasive feeling in traumatized individuals) is shame. Van der Kolk noticed a pattern in how many of his patients avoided eye contact because they "[felt] disgusting and...[couldn't] stand having [him] see how despicable they [were]."
In van der Kolk's own practice, he helps his patients notice and describe physical sensations and feelings in their bodies. From there, he helps them identify the sensations associated with relaxation and pleasure. Gradually learning how to feel safe in one's body is a key step in healing from trauma.
Analysis
Van der Kolk cites action and agency as primary factors that determine whether a terrible incident will linger as a traumatic experience in one's life. This partly accounts for why experiencing the same incident may traumatize one person but not another. Part of the book's premise is to explain the physiological impacts of trauma, but van der Kolk acknowledges that this is not enough to fully address it. In Chapter 4, he writes that "very few psychological problems are the result of defects in understanding...when the alarm bell of the emotional brain keeps signaling that you are in danger, no amount of insight will silence it." This lays the groundwork for future sections of the book, which delve into van der Kolk's perspectives on treatment.
In his explanation of the various layers of the brain and their functions, van der Kolk distinguishes between the reptilian brain, the limbic or mammalian brain, and the rational brain. This explanation expresses the triune brain theory, which was developed by American physician and neuroscientist Paul MacLean in the 1960s. However, many neuroscientists now consider this theory to be outdated, inaccurate, and oversimplified. The current understanding of the brain is that these different regions are interconnected and influence each other.
In Chapter 5, van der Kolk characterizes humans as relational beings. He points out that despite Western culture's focus on personal uniqueness and individualism, humans evolved to function as members of a tribe. Even when someone engages in more solitary activities, such as listening to music on one's own, van der Kolk argues that "most of our energy is devoted to connecting with others." This highlights the crucial significance of reciprocity: feeling authentically heard, seen, and held. Although van der Kolk does not discuss cultural specificities in great deal, he does touch on the potential harms of ardent individualism in relation to trauma. This chapter also suggests that striving to heal oneself can also heal others because we have visceral impacts on each other's physiology.
Van der Kolk also posits activities such as play as essential for restoring a sense of physical safety and promoting social engagement. He argues that schools should prioritize programs and schedule for chorus, physical education, recess, and "anything else involving movement, play, and joyful engagement." Research and therapeutic assumptions concerning trauma are increasingly acknowledging this, but several factors make it challenging to apply in practice. These include shifts in federal education priorities, funding decisions, and changes in state and local responses.
According to van der Kolk, traumatized children and adults experience somatic symptoms with unclear (if any) physical origins. This is because when people are unable to heed their inner warning signs, different body systems may break down as a result of stress. The physician and world-renowned expert on addiction and trauma Gabor Maté has also written extensively on this topic. According to Dr. Maté, "when we have been prevented from learning how to say no, our bodies may end up saying it for us."
