TRAUMA IS ALL AROUND US

BOOK REVIEW:

Bessel van der Kolk:  The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. 2015. Penguin Books. 464 pages. ISBN: 978-0143127741

by Hanri Mostert

1     Introduction

The final shot in the South African real-life drama film Ellen: The Ellen Pakkies Story[1] is a high-angle shot of the protagonist’s house. The shot slowly zooms out to become an aerial view of the street, the neighbourhood, the district. It is supposed to be the last full-stop behind the harrowing tale of a mother who buckled under the multiple afflictions of gender-based violence, poverty, life in a crime-ridden area, and ultimately the abuse she suffered at the hands of her Meth-addicted son, once the apple of her eye, when she tied him to his bed, coiled a rope around his neck, and suffocated him.

The drama narrates the life of Ellen Pakkies, her relationship with her son and the rest of her family, and the legal process that followed after she had handed herself over to the police. She was ultimately given a suspended sentence, motivated largely by the psychological assessment of the effects that a life liven in trauma had on her. That last shot of the movie silently makes the chilling point that what had happened to Ellen Pakkies, could have just as well happened to any of the millions of other people living under the same conditions, and who are being harassed by the same problems.  It’s not a full stop. It’s an ellipses…

I was reminded again of this story as I read Bessel van der Kolk’s definitive book on trauma, “The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma”. Whether you’re a coach, a reflective practitioner, or someone curious about how trauma shapes our lives and societies, this book offers insights that are both personally resonant and professionally valuable.

2     Premise, findings and insights:

Van der Kolk, who dedicated his life studying the effects of trauma, first on war veterans, and later on the survivors of domestic abuse and neglect, opens with a powerful assertion: trauma isn’t only confined to the undeniably severe experiences in war zones or refugee camps, but is woven into everyday life wherever there is violence, abuse, neglect, poverty, or chronic stress. Trauma fundamentally alters brain wiring and body physiology, disrupting sleep, mood, memory, and self-regulation.[2]  PTSD can produce nightmares, flashbacks, risk-taking behaviors, addiction, and more subtle but pervasive states of anxiety and depression. Trauma severs the connection to the embodied sense of aliveness (p 3). Ultimately, Van der Kolk shows, trauma has a collective impact: it warps relationships, communities, and societies. His central message is stark and crucial — trauma is all around us, and its effects run deep into the structures of our brains and our social fabric.

The book is divided into five parts:

Part one, “The Rediscovery of Trauma” contains three chapters introducing the subject matter of PTSD and its effects on the brain, while also telling Van der Kolk’s own story as a researcher.

Part two, “This is Your Brain on Trauma” contains three chapters focused on what happens to the body and the brain pursuant to a traumatic experience.

Part three, “The Minds of Children” turns the attention to childhood trauma and its long-term effects on victims’ health, relationships and lives. These four chapters were particularly harrowing to work through, given the case studies discussed.

Part Four, “The Imprint of Trauma” deals with traumatic memory in two chapters.

Part Five, “Paths to Recovery” contains eight chapters looking at different treatment modalities. These are a treasure trove for the Integral® Coach. I will focus my discussion of learnings and takeaways on this part.

3     Learnings / Key Takeaways

“The Body Keeps the Score” is not a self-help book.  Rather, it reads like a textbook or handbook for students of trauma therapy — but one that remains remarkably accessible to readers outside the clinical field, including reflective practitioners and coaches drawn to neuroscience and psychology. The subject matter is heavy, though, and the case studies hard going for someone who is sensitive to the pain of others.

3.1    Own Insights

Van der Kolk writes (p 2) about the tremendous energy it takes for a person to keep on functioning after a traumatic experience, while the memory of the terror and the shame of utter weakness and vulnerability continue their relentless plaguing of the body that have already suffered the actual harm. He explains that, as much as one would want to put such an experience behind you, your brain – the part that ensures your survival, to be specific – won’t let you ignore or deny what has happened. Even if you are pretty good at trying to forget what happened to you, even if you can suppress it for a long time, the brain circuits that were disturbed due to the trauma will reactivate the trauma response at even a slight hint of danger. This is because of physiological changes brought on by the trauma.

The insight that hit home hardest, when I read this book back in 2018 for the first time, was a thought from the epilogue: 

“In today’s world your ZIP code, even more than your genetic code, determines whether you will lead a safe and healthy life. People’s income, family structure, housing, employment and educational opportunities affect not only their risk of developing traumatic stress, but also their access to effective help to address it. Poverty, unemployment, inferior schools, social isolation, widespread availability of guns, and substandard housing are all breeding grounds for trauma.”

Van der Kolk follows up this profound insight with a commentary on the South African Truth and Reconciliation Commission’s work, and on the guiding light of Ubuntu, the African value that expresses our inextricability from one another. Ellen Pakkies’ heart-breaking story - a lifetime of suffering abuse at the hands of a series of men, and her inability to protect her son from a ruthless cycle of poverty, hopelessness and crime, and herself from his violence - casts a critical light on our ability to live that value of Ubuntu. And on the broken system in which we have to keep on trying to live that value. Indeed, as Van der Kolk also asserts, trauma is political. I’d add: the political is traumatic.

This insight, for me, was all the more heart-wrenching because I didn’t expect it. I hung on every word of the book, especially Part Five, because of how it helped me personally. Several of the modalities expounded had come in very handy in my own life, and the lives of my loved ones. But Van der Kolk’s epilogue had the same effect on me as that disappearing aerial shot at the end of The Ellen Pakkies Story: it broadened my awareness of how urgently we – South Africans – need to grasp that we live in a highly traumatized society. We cannot expect so-called “normal” behaviour from our people: our brains have been altered by our traumatic experiences of life in this country, and those of our ancestors.

3.2    Applications

Van der Kolk makes it clear (p 243) that trauma cannot be “treated”, it can only be metabolized: Terrible events that happened can’t be undone. The best that can be done is to deal with the “imprints of the trauma on the body, mind and the soul”: anxiety, depression, hyper-alertness, brain-fog, insomnia, self-loathing, fear of rejection, to name but a few. A big part of such an approach is to re-establish “self-leadership”. Van der Kolk explains this as “ownership of your body and your mind – of your very self.”

Self-leadership is, of course, also the essential goal of Integral® Coaching. Hence the modalities discussed in Part Five of the book are so well transferable to the coaching domain. In the subsections below, I highlight only some of those modalities and the ways in which they could be transformed into therapeutic experiences for one’s clients, even ones who wouldn’t regard themselves as having suffered major trauma. My focus here is not on medical or psychotherapeutic treatments for trauma, which fall outside my professional scope, but rather on the practices and insights from the book that can be meaningfully translated into the coaching and community development space.

3.2.1     Practices

The Body Keeps the Score offers several ideas that can be converted into coaching practices. Of the most obviously transferable, is Yoga (p 319ff). Van der Kolk and his researchers were drawn to this modality when they began realizing the effect trauma could have on the body. Van der Kolk writes (p 398) that “our sense of agency, how much we feel in control, is defined by our relationship with our bodies and its rhythms: Our waking and sleeping and how we eat, sit, and walk define the contours of our days. In order to find our voice, we have to be in our bodies – able to breathe fully and able to access our inner sensations.” This makes a compelling case to focus on the body in coaching as the portal into the world of emotions and thoughts. Van der Kolk and his researchers noticed that the age-old practice of Yoga combines three extremely useful practices of breathing (pranayama), stretching / postures (asana) and meditation. These are excellent practices to cultivate self-regulation and interoception: self-awareness, for short. From these can grow a feeling of being safely embodied, which is crucial for self-leadership.

Yoga is a practice that can be done individually, but which also is very effective when done in a communal context. I have always experienced yoga studios as welcoming and non-judgmental spaces, supportive of all people, no matter their level of competency or aspiration. I’m aware, also of studies in criminology being done on offering Yoga group classes in prisons for female inmates.

Another practice is built around words and language. As Van der Kolk explains, painful experiences sometimes run so deep emotionally, that there are no words to express them. Helping clients to articulate their emotions and experiences with what words they do have available, is a very effective way of facilitating self-leadership. The chapter on Language (ch 14, from p 275) offers several options, but the one that caught my attention is “Writing to Yourself” as a way to access your inner emotional world. I have come to appreciate writing as a profoundly healing practice in my own life. It is probably more important to me than taking a daily dose of vitamins. It is a way of organizing the thoughts that run amok with you when you are stressed, traumatized or overwhelmed. It helps you to release what is too unbearable to hold. The page can hold it for you.[3]

3.2.2     Self-observations

Van der Kolk also mentions the work of Richard Schwartz (ch 17, p 357ff) with Internal Family Systems (IFS). This is a therapy / practice based on the premise that the human mind is multiplicitous and social: that we all have within us “parts” that are either managerial, protective, or hurt/weak. Van der Kolk’s interest in IFS arises from what happens in the internal systems of traumatized people, where the “parts” might disassociate and/or turn on one another in an attempt to protect the core Self.

IFS is a fascinating model. Since being led to it by Van der Kolk’s account thereof, I have read several of its standard texts[4] with interest. I mention it here under “self-observation” rather than “practice” or “exercise” because I think it could have immense value as a non-judgmental mindfulness tool for getting to know and understand oneself in all one’s glorious multiplicity. As in Integral® Coaching, the ultimate aim of IFS is to facilitate self-leadership. IFS theory provides deep insight into a process called “unblending” that assists individuals to access their true Selves, and lead from their core being.

3.2.3     Exercises

Van der Kolk dedicates a whole chapter to Eye Movement Desensitisation and Reprocessing (EMDR), explaining it as a modality to assist people to process and integrate traumatic memories effectively and to allow the mind/brain to assign them an appropriate place in the subconscious, from where they do not have to overwhelm their host. Even just a few sessions can help someone to feel calmer and more self-directed. I have seen EMDR help someone close to me manage anxiety about flying effectively, and will often recommend it to clients struggling with persistent anxiety, intrusive thoughts, or overwhelm.

Neurofeedback (ch 19, p 371ff) – a treatment that works on the neural circuits of the brain – is another modality mentioned that could offer particular clients useful exercises on their path to living their best lives. It is expensive, and so will not be accessible to the larger part of our society. But for those who can afford it, an exercise in rewiring the brain can help with managing anxiety, creating calm focus, and improving concentration. All of the support it offers can assist in living self-directed lives. Neurofeedback is an excellent support for PTSD and addiction management, learning disabilities and distractibility.

3.2.4     Self-remembering

Van der Kolk tells the moving story (ch 20, 398ff) of his ill, isolated and oversensitive son, who gained new pathways into his identity through improvisations classes and later theatre and acting. He then elaborates how his Trauma Centre had researched and experimented with treatment of trauma through theater. The job of a director, Van der Kolk says (p 405), is to “slow things down so that the actors can establish a relationship with themselves, with their bodies.”

He also offers the thought that communities and groups may benefit from the collective movement and music that gives their lives meaning beyond their individual fates. A good example of such is the documentary “Amandla!: A Revolution in Four-Part Harmony”[5] that narrates the role that song and dance played in the struggle against Apartheid. A more recent example is the remarkable rise of the Ndlovu Youth Choir, whose vibrant performances blend traditional South African music with contemporary styles. Their story shows how collaborative music-making can nurture confidence, hope, and belonging, offering young people from impoverished backgrounds a way to transform personal and communal hardship into collective pride and joy.

Recently, I had the immense privilege of collaborating on a coaching programme that included community theatre techniques, helping a group explore limiting beliefs around money, earning, and financial responsibility. It was powerful to witness participants reclaim their sense of financial agency through this process.

4     What other titles relate to this book?

The Body Keeps the Score is a definitive work. Nick Haslam describes it in his review on The Conversation[6] as  a “publishing phenomenon” that, contrary to all expectations, “spent more than 150 weeks on the New York Times best seller list for paperback nonfiction, including over half a year in the coveted #1 spot during 2021.” Haslam speculates about the reasons for the popularity of this “long, dense, and demanding book on the psychology and neurobiology of trauma”, but I think Van der Kolk himself offers the explanation (p 417): we are hovering on the brink of becoming “a trauma-conscious society”, and as such will be able to assimilate breakthrough insights on the handling and prevention of trauma. Van der Kolk welcomes his own forecast.

In the years that passed since this book first hit the shelves in 2014, with an intervening health pandemic and all, Van der Kolk’s forecast has probably realized itself. In a more recent publication, Gabor Maté’s life work, “The Myth of Normal”, points to the watershed scholarship contained in The Body Keeps the Score. Other trauma counsellors recommend titles such as Jon Kabat-Zinn’s “Wherever you go, there you are”, Jamie Marich’s “Dissociation made Simple”, the Arielle Schwartz’ “Complex PTSD Workbook,” or Laura Koudari’s “Lifting Heavy Things.” Even so, Van der Kolk’s book is comprehensive in its coverage and empathic in the sharing of its core message.

5     Personal reflection, recommendations, and rating

While some reviewers may raise the concern that broadening trauma’s scope might risk diluting the suffering of severe trauma survivors, I believe that trauma, however it originates, is profoundly personal — one person’s experience does not negate another’s. Rather, this broader understanding that Van der Kolk offers invites us into a more humane solidarity, where we can truly say to one another: ‘I see you.’

Although the case studies may trigger or retraumatize readers who are the survivors of the kind of traumatic experiences reported in those case studies, the book is still high on my list of recommendations. Definitely five stars for content, scope and reach, as well as for presentation and accessibility.

Note: Any references to client or family experiences are shared with respect for confidentiality. Identifying details have been changed or omitted to protect privacy.

Disclaimer: Links in this post are provided for convenience. I do not receive any commission or benefit from purchases made through these links.

Endnotes

[1] 2018. Director: Daryne Joshua. Available on Showmax.

[2] Ho JMC, Chan ASW, Luk CY, Tang PMK. Book Review: The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. Front Psychol. 2021 Aug 18;12:704974. doi: 10.3389/fpsyg.2021.704974. PMCID: PMC8418154.

[3] At first, I was so self-conscious of the thoughts and feelings that might find their way onto the pages of my journal, that I wrote in pencil. To erase if needed. Gradually something shifted, and I transitioned to pen, and later to a high-end fountain pen and good ink. I think this was a shift from thinking that what comes out of my mind do not matter and cannot be seen, towards a greater respect for what I have to offer myself, and the world.

[4] Richard Schwartz, No bad parts (2021); Richard C. Schwartz and Martha Sweezy Internal Family Systems Therapy, 2nd Edition (2019); Susan McConnell Somatic Internal Family Systems Therapy: Awareness, Breath, Resonance, Movement, and Touch in Practice (2020)

[5] 2002. Director: Lee Hirsch.

[6] Nick Haslam “The Body Keeps the Score: how a bestselling book helps us understand trauma – but inflates the definition of it” The Conversation, 8 August 2022.