Mind-Body Connection
Van der Kolk discusses how traumatic experiences and memories affect both the body and mind. When the amygdala detects a threat, it initiates the body's stress response. Van der Kolk calls the amygdala the "brain's smoke detector" for this reason (Chapter 4). Many traumatized individuals have a hyperactive amygdala, which can cause them to exhibit emotional dysregulation. If the mind is constantly defending itself against invisible assaults, then this has measurable physiological impacts on one's brain structure, neurochemical systems, cardiovascular health, immune system, musculoskeletal system, and gastrointestinal tract. Chapter 5 in particular shows how intricately linked the brain, mind, and body are by way of the nervous system. According to van der Kolk, psychiatrists have long ignored the body while assessing the effects of trauma on the brain. This is why he advocates for integrative approaches that engage both the mind and body.
The Limits of Psychopharmacology
At the beginning of van der Kolk's career, he saw psychopharmacology as the pinnacle of treatment. A 1968 study published in the American Journal of Psychiatry showed that schizophrenic patients who received medication alone (rather than talk therapy three times per week) had better outcomes. Psychiatry entered a new paradigm, one in which mental disorders were aberrations of the brain that "could be fixed by the administration of appropriate chemicals" (Chapter 2). At the time, van der Kolk was riveted and jumped fully on board, becoming the first chief resident in psychopharmacology at the Massachusetts Mental Health Center. However, upon witnessing a 1984 lecture presented by Steven Maier on learned helplessness, van der Kolk began to wonder if his patients needed to have physical experience to address the thwarted fight/flight response. He opened his mind to other potential therapeutic avenues. While drugs like Zoloft, Celexa, Cymbalta, and Paxil have significantly improved outcomes for individuals with trauma-related disorders, van der Kolk also stresses that they do not address the underlying issues of trauma. For this reason, he argues that they are not a be-all and end-all solution.
The Ubiquity of Trauma
In the prologue, van der Kolk casts trauma as a hidden epidemic due to its pervasive presence in American society. This has been well-documented through research such as the Adverse Childhood Experience (ACE) study, which "revealed that traumatic life experiences during childhood and adolescence are far more common than expected" (Chapter 9). The magnitude of effects are devastating: exposure to adverse childhood experiences are linked to physical and mental health issues, risky behaviors, relational challenges, and an overall reduced life expectancy. At the end of the book, van der Kolk expresses his belief that we are on the verge of becoming a trauma-conscious society (Epilogue).
The Power and Limits of Language
Bessel van der Kolk discusses the power and limits of language in relation to trauma in his book The Body Keeps the Score. Language allows us to articulate and understand experiences, but several factors inhibit its healing capabilities for traumatized individuals. Van der Kolk first introduces the speechless horror associated with trauma in Chapter 3. Imaging scans revealed decreased activity in one of the brain's speech centers (Broca's area). This shows how the preverbal nature of trauma cuts people off from language, which van der Kolk describes as having "no way of giving voice to the unspeakable" (Chapter 8). A 1994 study that van der Kolk conducted with his colleagues "did not support the idea that language can substitute for action" (Chapter 12). While "sensing, naming, and identifying what is going on inside is the first step to recovery," van der Kolk also stresses the importance of engaging the body directly (Chapter 4).
Shame
Shame is a negative self-evaluation, stemming from a perceived fault or failing in oneself. Van der Kolk writes about how trauma fosters and entrenches shame in people, particularly if the trauma occurs in childhood. Dr. Vincent J. Felitti—the co-principal investigator of the Adverse Childhood Experiences (ACE) Study—notes that "traumatic experiences are often lost in time and concealed by shame, secrecy, and social taboo" (Chapter 9). Follow-up studies have confirmed that high ACE scores increase shame proneness (Sullins and Weaver). According to van der Kolk, shame can arise in various situations. One example that he gives in Chapter 4 is when victims of sexual abuse are "excited by sensations of images that recall their molestation, even when those sensations are the natural pleasures associated" with intimate relations. This example demonstrates how trauma and accompanying shame can impair one's engagement with meaningful life experiences.
The Dual Need for Flexible Care Plans and Diagnostic Reliability
Throughout the book (and particularly in Part 5), van der Kolk champions personalized and flexible pathways when it comes to treating trauma. He advises mental health professionals to maintain an open mind and consider innovative or unconventional treatments. At the same time, he hopes to "combine the rigor of scientific methods with the power of embodied intuition" (Chapter 20). What works for one patient may not work for another. That being said, the path toward treatment must begin on the common ground of diagnostic reliability. According to van der Kolk, "If doctors can’t agree on what ails their patients, there is no way they can provide proper treatment. When there’s no relationship between diagnosis and cure, a mislabeled patient is bound to be a mistreated patient" (Chapter 10).
Humans As Social Beings
Humans evolved as social beings, which was a key to our species' survival. Van der Kolk cites "trouble in creating workable and satisfying relationships" as one of the two main causes of mental suffering (Chapter 5). In a later chapter, he goes on to say that "mental problems involve not being able to get along with other people, not fitting in, not belonging, and in general not being able to get on the same wavelength" (Chapter 10). The physical and psychological costs create a vicious cycle because many people socially withdraw or externalize maladaptive behaviors, which then compounds suffering when interpersonal conflicts arise. While mental health professionals should understand human suffering in part through neural connections in the brain and body, van der Kolk also emphasizes our interdependence and relationality. This can be seen in the way that "most of our energy is devoted to connecting with others" (Chapter 5).
