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The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma
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“Every once in a while, a book comes along that fundamentally changes the way we look at the world” (Stephen Cope). Trauma has emerged as one of the great public health challenges of our time, not only because of its well-documented effects on combat veterans and on victims of accidents and crimes, but because of the hidden toll of sexual and family violence, addiction, and of entire communities devastated by abuse and neglect. “Breathtaking in its scope and breadth, The Body Keeps the Score is a seminal work by one of the preeminent pioneers in trauma research and treatment” (Peter Levine).

“Seamlessly weaving keen clinical observation, neuroscience, historical analysis, the arts, and personal narrative” (Rachel Yehuda ), Bessel van der Kolk MD shows how terror and emotional isolation literally reshape both brain and body. New developments in neuroscience explain why traumatized people experience incomprehensible anxiety, inexplicable numbing and intolerable rage, and how trauma impacts concentration, memory, and the ability to form trusting relationships. Not feeling in control of themselves and frustrated by failed therapies, they often fear that they are damaged beyond repair.

“ With the compelling writing of a good novelist” (Richard Schwartz) The Body Keeps the Score is the inspiring story of how he - and his colleagues from around the world— have defined how trauma affects the minds brains and bodies of children and adults. With the help of their courageous, memorable patients they have integrated recent advances in brain science, attachment research, and body awareness into treatments that can free trauma survivors from the tyranny of the past. These new paths to recovery activate the brain’s natural neuroplasticity to rewire disturbed functioning and rebuild, step by step, the ability to “know what you know and feel what you feel”. This book offers an array of reparative experiences that directly contradict the terror, helplessness and invisibility of trauma to enable survivors to reclaim ownership of their bodies and their lives.

Bessel van der Kolk, M.D. is the founder and medical director of the Trauma Center in Brookline, Massachusetts. He is also Professor of Psychiatry at Boston University School of Medicine and Director of the National Complex Trauma Treatment Network. When he is not teaching around the world, Dr. van der Kolk works and lives Boston, Massachusetts.

Advanced Praise from some of the world's leading experts on trauma

Dr. van der Kolk's masterpiece combines the boundless curiosity of the scientist, the erudition of the scholar, and the passion of the truth teller.

- Judith L Herman, MD,
Clinical Professor of Psychiatry, Harvard Medical School,
Author of Trauma and Recovery.

Every once in a while, a book comes along that fundamentally changes the way we look at the world. Bessel VanderKolk has written such a book. Having read “The Body Keeps the Score”, it will be impossible for us any longer to deny the profound extent of trauma and its impact on our lives. VanderKolk writes in the humanitarian tradition of his great Harvard mentor, Elvin Semrad, and his book is a worthy testament to the tutelage of this great man, and the beautiful maturation of his pupil. The arc of VanderKolk’s story is vast and comprehensive—but Vanderkolk is such a skillful storyteller that he keeps us riveted to the page. I simply could not put this book down. It is, simply put, a great work.

- Stephen Cope, Founder and Director, Kripalu Institute for Extraordinary Living,
Author of Yoga and the Quest for the True Self.

In this inspirational work which seamlessly weaves keen clinical observation, neuroscience, historical analysis, the arts, and personal narrative, Dr. van der Kolk has created an authoritative guide to the effects of trauma, and a revolutionary approach to its treatment, including pathways to recovery.  The book is full of wisdom, humanity, compassion and scientific insight, gleaned from a lifetime of clinical service, research and scholarship in the field of traumatic stress.   A must read for mental health and other health care professionals, trauma survivors, their loved ones, and those who seek clinical, social, or political solutions to the cycle of trauma and violence in our society.

- Rachel Yehuda, PhD, Professor of Psychiatry and Neuroscience, Director of the Traumatic Stress Studies Division at the Mount Sinai School of Medicine New York NY.

This is an absolutely fascinating and clearly written book by one of the nation’s most experienced physicians in the field of emotional trauma. Equally suitable for primary care doctors and psychotherapists wishing to broaden their range of helpfulness, or for those trapped in their memories, “The Body Keeps the Score” helps us understand how life experiences play out in the function and the malfunction of our bodies, years later.

- Vincent J. Felitti, MD
Chief of Preventative Medicine Emeritus, Kaiser Permanente San Diego;
Co-Principal Investigator, ACE study

Breathtaking in its scope and breadth, The Body Keeps the Score is a seminal work by one of the preeminent pioneers in trauma research and treatment. This essential book unites the evolving neuroscience of trauma research with an emergent wave of body-oriented therapies and traditional mind/body practices. These new approaches and ancient disciplines build resilience and enhance the capacity to have new empowered bodily (interoceptive) experiences that contradict the previous traumatic ones of fear, overwhelm and helplessness. They go beyond symptom relief, and connect us with our vital energy and here-and-now presence. A must read for all therapists and for those interested in a scholarly, thoughtful, tome about the powerful forces that affect us as human beings in meeting the many challenges of life including accidents, loss and abuse.

- Peter A. Levine, PhD, Author,
In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness.

This book is a tour de force. Its deeply empathic, insightful, and compassionate perspective promises to further humanize the treatment of trauma victims, dramatically expand their repertoire of self-regulatory healing practices and therapeutic options, and also stimulate greater creative thinking and research on trauma and its effective treatment. The body does keep the score, and Van der Kolk’s ability to demonstrate this through compelling descriptions of the work of others, his own pioneering trajectory and experience as the field evolved and him along with it, and above all, his discovery of ways to work skillfully with people by bringing mindfulness to the body (as well as to their thoughts and emotions) through yoga, movement, and theater are a wonderful and welcome breath of fresh air and possibility in the therapy world.

- Jon Kabat-Zinn, Professor of Medicine emeritus, UMass Medical School,
Author of Full Catastrophe Living.

In The Body Keeps the Score we share the author's courageous journey into the parallel dissociative worlds of trauma victims and the medical and psychological disciplines that are meant to provide relief. In this compelling book we learn that as our minds desperately try to leave trauma behind, our bodies keep us trapped in the past with wordless emotions and feelings. These inner disconnections cascade into ruptures in social relationships with disastrous effects on marriages, families, and friendships. Van der Kolk offers hope by describing treatments and strategies that have successfully helped his patients reconnect their thoughts with their bodies. We leave this shared journey understanding that only through fostering self-awareness and gaining an inner sense of safety will we, as a species, fully experience the richness of life.

- Stephen W. Porges, PhD
Professor Department of Psychiatry University of North Carolina at Chapel Hill,
Author of The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-Regulation.

This is an amazing accomplishment from the neuroscientist most responsible for the contemporary revolution in mental health toward the recognition that so many mental problems are the product of trauma.  With the compelling writing of a good novelist, van der Kolk revisits his fascinating journey of discovery that has challenged established wisdom in psychiatry.  Interspersed with that narrative are clear and understandable:  descriptions of the neurobiology of trauma; explanations of the ineffectiveness of traditional approaches to treating trauma; and introductions to the approaches that take patients beneath their cognitive minds to heal the parts of them that remained frozen in the past.  All this is illustrated vividly with dramatic case histories and substantiated with convincing research.  This is a watershed book that will  be remembered as tipping the scales within psychiatry and the culture at large toward the recognition of the toll traumatic events and our attempts to deny their impact take on us all.

- Richard Schwartz PhD Originator, Internal Family Systems Therapy

This exceptional book will be a classic of modern psychiatric thought. The impact of overwhelming experience can only be truly understood when many disparate domains of knowledge, such as neuroscience, developmental psychopathology, and interpersonal neurobiology are integrated, as this work uniquely does.  There is no other volume in the field of traumatic stress that has distilled these domains of science with such rich historical and clinical perspectives, and arrived at such innovative treatment approaches.  The clarity of vision and breadth of wisdom of this unique but highly accessible work is remarkable.  This book is essential reading for anyone interested in understanding and treating traumatic stress and the scope of its impact on society.

- Alexander McFarlane AO, MB BS (Hons) MD FRANZCP.
Director of the Centre for Traumatic Stress Studies,
The University of Adelaide, South Australia

This is masterpiece of powerful understanding and brave heartedness, one of the most intelligent and helpful works on trauma I have ever read.  Dr. Van der Kolk offer a brilliant synthesis of clinical cases, neuroscience, powerful tools and caring humanity, offering a whole new level of healing for the traumas carried by so many.

- Jack Kornfied. Author A Path work Heart

“The Body Keeps the Score” eloquently articulates how overwhelming experiences affect the development of brain, mind, and body awareness, all of which are closely intertwined. The resulting derailments have a profound impact on the capacity for love and work. This rich integration of clinical case examples with ground breaking scientific studies provides us with a new understanding of trauma, which inevitably leads to the exploration of novel therapeutic approaches that allow the brain to 'rewire' itself, and help traumatized people to (re)-engage in the present. This book will provide traumatized individuals with a guide to healing and permanently change how psychologists and psychiatrists think about trauma and recovery.

- Ruth A. Lanius, M.D., Ph.D., Harris-Woodman Chair in Psyche and Soma.
Professor of Psychiatry, and director PTSD research at the University of Western Ontario. Author, The Impact of Early Life Trauma on Health and Disease

In this magnificent book, Bessel van der Kolk takes the reader on a captivating journey that is chock full of riveting stories of patients and their struggles interpreted through history, research, and neuroscience made accessible in the words of a gifted storyteller. We are privy to the author’s own courageous efforts to understand and treat trauma over the past 40 years, the results of which have broken new ground and challenged the status quo of psychiatry and psychotherapy. The Body Keeps the Score leaves us with both a profound appreciation for and a felt sense of, the debilitating effects of trauma, along with hope for the future through fascinating descriptions of novel approaches to treatment. This outstanding volume is absolutely essential reading not only for therapists but for all who seek to understand, prevent, or treat the immense suffering caused by trauma.

- Pat Ogden PhD, Founder/Educational Director of the Sensorimotor Psychotherapy Institute, Author, Sensorimotor Psychotherapy: Interventions for Trauma and Attachment

With his comprehensive knowledge, clinical courage, and creative strategies Bessel van der Kolk leads the way in understanding the impact of trauma and helping people heal from overwhelming life experiences. The Body Keeps the Score is a cutting-edge offering for the general reader to comprehend the complex effects of trauma, and a guide to a wide array of scientifically informed approaches to not only reduce suffering, but to move beyond mere survival-- and to thrive.

- Daniel J. Siegel, M.D., Clinical Professor, UCLA School of Medicine, Author, Brainstorm: The Power and Purpose of the Teenage Brain; Mindsight: The New Science of Personal Transformation

Clear, fascinating, hard to put down, filled with powerful case histories, Van der Kolk, the eminent impresario of trauma treatment who has spent a career bringing together diverse trauma scientists and clinicians, and their ideas, while making his own pivotal contributions, describes what is arguably the most important series of breakthroughs in mental health in the last thirty years. We’ve known that psychological trauma fragments the mind. Here we see not only how psychological trauma also breaks connections within the brain, and between mind and body, and learn about the exciting new approaches that allow people with the severest forms of trauma to put all the parts back together again.

- Norman Doidge, M.D., Author, The Brain That Changes Itself

The body keeps the score is masterful in bringing together science and humanism to clearly explain how trauma affects the whole person. Bessel van der Kolk brings deep understanding to the pain and chaos of the trauma experience. The treatment approaches he recommends heal the body and the mind, restoring hope and the possibility of joy. One reads this book with profound gratitude for its wisdom.

- Alicia F. Lieberman, Ph.D.
Irving B. Harris Endowed Chair in Infant Mental Health; Vice Chair, Academic Affairs, UCSF Department; Director, Child Trauma Research Program, SF General Hospital

The Body Keeps the Score articulates new and better therapies for toxic stress based on a deep understanding of the effects of trauma on brain development and attachment systems. This volume provides a moving summary of what is currently known about the effects of trauma on individuals and societies, and introduces the healing potential of both age-old and novel approaches to help traumatized children and adults fully engage in the present.

- Jessica Stern, policy consultant on terrorism
Author of Denial: A Memoir of Terror

Renowned trauma researcher van der Kolk's book is comprehensive in scope. The author explains in clear terms the physical causes and manifestations of post-traumatic stress disorder (PTSD), how vast the population of sufferers is, and the devastating repercussions to society in general as a result of inadequate treatment. Anecdotes of patients from all walks of life are used to illustrate how trauma rewires the brain to create dissociated memories. Sufferers do not merely "remember" the event or events but actually relive it, complete with a cascade of excruciating physical and emotional pain. Organizing their lives to avoid triggers can lead to behaviors such as substance abuse that often compound the destructiveness of the original trauma. Inadequate conventional treatments such as talk therapy and pharmaceuticals are being replaced with neurofeedback, mindfulness training, yoga, Internal Family Systems, and Eye Movement Desensitization and Reprocessing therapies, helping victims reclaim their minds and bodies and regain self-regulation and personal resilience. VERDICT This valuable work for psychologists, therapists, and public health professionals walks the line between academic medical text and popular nonfiction. More important, it offers hope for the millions of sufferers and their families seeking meaningful treatment and relief from the ongoing pain of trauma.

- Janet Tapper, University of Western States Lib., Portland, OR

Buy this book!
Format: Kindle Edition Verified Purchase

The physical book:
* Jacket design is pleasant and interesting. Binding is less so: color of spine wrapping is semi-florescent, and paper, not cloth. Feels substantial and pleasant to hold and look at (spine excepted). [ + ] [ - ]

** 6 pp: prefatory praise by peers and related luminaries (interesting comments);
** 2 pp: Table of Contents;
** 356 pp: actual text;
** 4 pp: Appendix: Consensus proposed criteria for developmental trauma disorder
** 3 pp: Resources
** 4 pp: Further reading
** 51 pp: Notes
** 21 pp: Index

Psychiatrist, professor, world-class researcher, and traumatologist Bessel van der Kolk, MD (VDK) requires no introduction to those in the professional world of psychological trauma. As a member of that world, my enduring impressions of him, over many years, is one of relevance, cogency, frankness, accessibility - served up with three dashes of impishness. VDK tends to be a bit disruptive - a bit of a provocateur. Everything of his I have ever read has taught me something, confirmed something important, or pushed my thinking up to the next level. When he has something to say, I want to hear it.

However, I almost didn't buy this book: I was put off by the title. Familiar with major reviews of PTSD psychotherapy outcomes research, I know that research support for body-oriented approaches to treating psychological trauma psychopathology is thin at best, and such treatment models simply cannot compete with the two best validated models: EMDR (Eye Movement Desensitization and Reprocessing) and PE (Prolonged Exposure), when it comes to level of validation coming from research.

J. Interlandi's long, interesting, wholly excellent article "A Revolutionary Approach to Treating PTSD" (New York Times Magazine, 2014.05.22 - available online) on VDK, anticipating publication of this book, initially supported my fears that for some inexplicable reason he'd has gone over the edge was now promoting some approach for which we have little confirming research.

"Psychomotor therapy is neither widely practiced nor supported by clinical studies," Interlandi informs us. Provocateur he may be, but I'm strongly biased in favor of paying attention to therapies for which we do have research validation. Our clients do not deserve to be experimental subjects - maybe not even if they agree to this, as I'm not sure they can know enough to make an informed consent. Knowledge of the reality that PTSD and related disorders is usually highly curable (if we use the right protocols) sadly remains the possession of a chosen few, even in the professional world, in my experience.

Yet the account of VDK's therapy work in the article is gripping and convincing. I became completely absorbed in the account. It was convincing. (I've been here before, reading VDK's own accounts of his work.) And so the disruption begins! Deeper into the article, he has me. VDK's critique of CBT (cognitive behavioral therapy - a general class of therapies) and PE (E. Foa's exposure therapy model) is withering and correct: neither really work. ""Trauma has nothing whatsoever to do with cognition...It has to do with your body being reset to interpret the world as a dangerous place....It's not something you can talk yourself out of." Interlandi reports that "That view places him on the fringes of the psychiatric mainstream."

But he's right, and I can't stress this enough. Why? Because I'm a research fanatic, and I'm aware of what the trauma outcomes research actually says. The best current summary of this is probably ch. 2 of Ecker, et al.'s (2012) Unlocking the emotional brain. (Buy this book, too!) Ecker et al. brilliantly presents a synoptic model which encompasses 11 existing therapy models which really DO cure trauma psychopathology, if done right. In this context, what VDK is doing, in Interlandi's article, makes perfect sense. Finally, it appears, the trauma psychotherapy field is moving toward a consensus which has strong credibility (though we are NOT there yet).

VDK's new book has many virtues. Parts One and Two (102 pp) provide a substantial review of the neuropsychology of trauma's impact on a person. It's fun, interesting, informative reading, for professional and layperson alike. Part Three (64 pp) surveys childhood development, attachment experience, and "the hidden epidemic of developmental trauma". VDK has for years been a leading champion of the idea that there is a type of PTSD which substantially differs from all the rest. It develops in response to chronic child abuse and/or neglect. I completely share his belief that the diagnosis of Developmental Trauma Disorder (sometimes called C-PTSD, with "C" meaning "Complex") is overdue for formal recognition. His review of the struggle to legitimize DTD is, for me as a professional, as gripping and distressing as anything else in the book. It is anguishing to know that a major problem exists, AND that the psychiatric establishment simply refuses to acknowledge it. DTD/C-PTSD is no fantasy. We see and treat these people, as children and adults. They exist, and they are nothing like "ordinary" PTSD treatment clients.

Part Four (29 pp) focuses on memory. I'm particularly glad to see this. Much writing about psychological trauma seems to miss the point: trauma memory is what causes the problem. Deal with that and the symptoms vanish. Why is this so hard to understand? Yet, it is not a common understanding at all. Explaining how trauma memory works is invariably enlightening to my clients. Experiencing what happens when we change the nature of trauma memory is revelatory. As he does throughout the book, VDK offers fine stories about clients who have experienced exactly what I've seen happen in my clients, making excellent use of of what cognitive research tells us: people understand things through narratives. Offer a good narrative and you convince.

Psychological trauma therpy is complex, but we are now prepared to launch into Part Five (154 pp) - "Paths to Recovery", the book's core content. He gets right to it: we cannot undo the trauma, but we CAN undo its effect on us, and so get our "self" back. Ch. 13 reviews existing therapies. His approach is to repair "Descarte's Error" (see Damásio's 1994 book of that title) by viewing mind and body as a single coherent functional unit. His topical coverage is complete and his critique of current therapies acute - not to be missed. At the same time, what he writes is clearly accessible to the non-professional.

He then writes of the importance of language (Ch. 14), something I've long embraced. We construct our narrative mainly in words, and the words we choose are critical. But language is not enough (this anticipates his next two chapters). Our senses encompass a larger world, and it's center is our body, where all our sensory receptors are located. Then he introduces the treatment model he's long advocated: EMDR (Eye Movement Desensitization and Reprocessing). I'm trained in EMDR, and in fact VDK and I had the same instructor for our advanced training: Gerald Puk PhD. VDK tell an amusing and self-deprecating story about his advanced training experience, and how Puk was able to provide a strong corrective to his approach to clients. This is typical VDK - he's a truth-teller, even when it may put him in a poor light! He also has nothing to prove to anyone.

Finding an EMDR therapist is not hard (see his Resources section). Nor is it hard to find a yoga instructor, and yoga is what he advises for helping a trauma victim get back into their body. Yoga is a wise choice, because it is available, an approach already widely known, and adaptable to a wide range of individuals and initial capabilities. There is much more in Part Five, and the focus is on self-empowerment. "Victim no more!" as they say. I could not be more approving of this. Most trauma therapists have a keen interest in seeing their clients leave therapy charged up and ready to fully embrace their life - that certainly is my own emphasis. VDK's thoughts on self-empowerment for those in recovery from psychological trauma would be invaluable to any therapy client.

For professionals, this book will be both informative and confirming (depending on how well informed they are). For everyone else, it will be a readable, gripping, highly educational tour of topics all of which are critical to a successful transition back from the impact of psychological trauma. That he gives prominent but not dominating emphasis to developmental trauma disorders is entirely appropriate.

Our society has yet to grasp that child abuse and neglect is a more often chronic than not, and that its impact is largely ignored and poorly treated, if at all. This does not have to be. Get educated (this book will do that), then commit to being an advocate for children as well as for adults impacted by trauma. They all deserve the chance to be healed, and we now do that. VDK show us how.

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- Tom Cloyd on September 27, 2014