Bessel Van Der Kolk is a leading trauma specialist and his latest book, The Body Keeps The Score is a brilliant synthesis of contemporary thinking about the impact of trauma on the body and mind – drawing research and experience from neuroscience, psychiatry, history, his own clinical experience and the fields of psychotherapy and psychology. He makes a powerful case for re-considering many diagnostic labels that dominate the US psychiatric field (and to a lesser extent over here). At root of many people’s distress – described by the DSM manuals as ‘disordered’ and managed by drugs – is an experience of trauma, Van Der Kolk argues. Trauma from parental abuse, neglect or extreme poverty and conflict – or trauma from war, accidents or loss.
Evidence suggests that a significant minority of children in the US suffer some trauma that is serious enough for them to end up unwell in childhood or beyond – making the real numbers in psychiatric clinics eye wateringly high. Clinically, trauma causes immense suffering and needs a profound treatment: ‘The essence of trauma is that it is overwhelming, unbelievable and unbearable…people live with a dual reality: of a relatively secure and predictable present that lives side by side with a ruinous, ever present past.’ Van Der Kolk sees that trauma is trans-diagnostic, and introduces a framework for a more appropriate Developmental Trauma Disorder to capture the reality of these many clinical presentations.
Treatment is more hopeful than perhaps some had imagined – he believes it is possible to thrive after extreme traumas. While talking therapies are discussed, Van Der Kolk presents a watertight case for every trauma therapist (I’d suggest that means most therapists), to incorporate work that uses and heals the body too. As the title of his book suggests, we can’t experience trauma without it having a negative impact on the body – the fight or flight response is an embodied one after all. His suggested pathways to recovery include theatre work, EMDR, yoga and biofeedback, and many of his clinical vignettes are very inspiring in their depth of healing. You don’t have to be a therapist to get a huge amount out of this book.