The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma

Van der Kolk offers some exploration of language’s relationship to trauma. Trauma is difficult to put into words, especially since it’s experienced as sensory fragments rather than as a cohesive narrative. However, van der Kolk points out that, “If you’ve been hurt, you need to acknowledge and name what happened to you […] As long as you keep secrets and suppress information, you are fundamentally at war with yourself” (235). Words allow us to share our deepest pain with others.

Van der Kolk describes some of the science of self-awareness, observing that we essentially have two “languages”: actual language and physical awareness, or body language. Part of recovering from trauma means reconnecting physical sensations with the ability to describe them in words. Writing to oneself can be a useful way of connecting feelings and language for those who struggle, providing a safe place to communicate. While communication can help in the right circumstance, van der Kolk admits that sometimes communication can actually hinder a person’s healing by inadvertently pushing away people who do not want to hear uncomfortable things.

Van der Kolk covers the first of the many treatments he describes in Part 5—eye movement desensitization and reprocessing, or EMDR. EMDR involves a therapist moving their fingers in front of a patient’s eyes while asking patients to focus on certain thoughts and notice sensations and thoughts they have as they focus. While scientists at this point are unsure of why EMDR works, some have hypothesized that the process effectively recreates REM sleep, the state in which dreaming occurs. Van der Kolk notes, “The basic EMDR instruction, ‘Hold that image in your mind and just watch my fingers moving back and forth,’ may very well reproduce what happens in the dreaming brain” (263).

Alongside his discussion of the science of EMDR, van der Kolk includes anecdotes about patient experiences, his own interest in EMDR, and a brief historical overview of EMDR. Van der Kolk finds it compelling that in EMDR, a therapist does not need to know anything about the patient’s trauma for the process to work—van der Kolk has worked with patients with whom he did not share a common language, and still found success. Van der Kolk does acknowledge that EMDR seems to work best for adults who have had acute traumatic incidents and does not have the same efficacy for children with a history of ongoing abuse and neglect. 

Van der Kolk begins with an anecdote about a specific patient who experienced strong physical reactions in response to things that made her uncomfortable. Van der Kolk observes, “One of the ways the memory of helplessness is stored is as muscle tension or feelings of disintegration in the affected body areas” (267). Chronic muscle tension can lead to a host of other physical ailments.

Finding a patient’s Heart Rate Variability (HRV)—the measurement of the ratio of inhalation and exhalation—a useful diagnostic tool, van der Kolk looks for treatments that can stabilize HRV in patients. He stumbles on Eastern practices like yoga and qi gong that train practitioners to focus on regulating breathing, which “can improve problems with anger, depression, and anxiety” (271). Yoga is a bottom-up form of regulation that allows patients to integrate with their bodies in a meaningful way.

Van der Kolk holds experimental yoga classes at the Trauma Center, conducting a study of yoga’s effect on PTSD. Following very positive results, van der Kolk and his team integrate yoga classes into their regular offerings at the Trauma Center, and van der Kolk becomes a yoga teacher. 

This chapter covers the treatment method called Internal Family Systems Therapy or IFS. IFS address the idea that people are composed of subpersonalities, parts of themselves that are “not just feelings but distinct ways of being, with their own beliefs, agendas, and roles in the overall ecology of our lives” (282). Those parts act like an internal family consisting of exiles (the traumatized parts), managers (protectors), and firefighters (emergency responders). Van der Kolk notes, “Mangers are all about staying in control, while firefighters will destroy the house in order to extinguish the flame” (290). When traumatized, a person’s subpersonalities fight each other. In order to help someone heal, “IFS focuses on cultivating an inner relationship between the Self and the various protective parts” (286), trying to bring all the parts back into a cohesive whole.

Van der Kolk includes supporting information about how he first learned about this type of therapy and an in-depth explanation of how IFS works to heal trauma. For IFS in particular, van der Kolk provides several very detailed anecdotes about specific patients to illustrate how the process works, where he ran into difficulties in treatment, and how patients eventually got better. He also mentions that IFS can be useful in helping rheumatoid arthritis sufferers learn to accept and handle their pain better. 

This chapter covers psychomotor therapy, a group process in which a patient, called a “protagonist,” creates a three-dimensional “structure” with guidance from a therapist acting as a “witness” and others in the group participating in roles from their internal lives. Van der Kolk describes the process as protagonists becoming “the directors of their own plays, creating around them the past they never had” (300). The witness acts as an observer whose seeing and hearing the protagonist’s emotional state and context gives them validation and therefore safety.

Van der Kolk frames psychomotor therapy as particularly helpful for victims of childhood abuse and neglect, since it creates a new memory alongside old ones and doesn’t rely on tapping into prior feelings of safety that an abused child wouldn’t have. He notes: “Structures do not erase bad memories […] Instead, a structure offers fresh options—an alternative memory in which your basic human needs are met and your longing for love and protection are fulfilled” (302). While the science may be imprecise, the process seems to tap into the spatial brain where both creativity and trauma sit, giving the protagonist a chance to connect with real people in a real space.

Along with describing the technique itself, van der Kolk explains how he was introduced to it, his own experiences going through psychomotor therapy as a protagonist, and specific examples of patients he has worked with for whom psychomotor therapy was helpful. 

Chapter 19 explores neurofeedback, a treatment method that involves using electrical impulses and tones to retrain brain waves to behave differently than usual. Along with historical context and anecdotes, van der Kolk explains the science behind neurofeedback. He provides information about electroencephalograms (EEGs) that measure brain wave activity and shows how brain waves in traumatized peopled differ from neurotypical brains.

The historical context for neurofeedback is longer than that of most of the other treatments van der Kolk outlines, as the technology has been around for much longer. Van der Kolk explains that when psychiatric drugs became popular in the 1970s, “Psychiatry and brain science adopted a chemical model of mind and brain, and other treatment approaches were relegated to the back burner” (317). He adds that since there are five different competing systems of neurofeedback and few large-scale studies, neurofeedback has not been widely adopted as a treatment practice.

Along with an explanation about how he was introduced to neurofeedback and came to provide it at the Trauma Clinic, van der Kolk notes that neurofeedback is used for more than just trauma treatment: “Neurofeedback has probably been studied more thoroughly for performance enhancement than for psychiatric problems” (324). Neurofeedback can help athletes and musicians perform better, and may help treating learning disabilities and addiction. 

Chapter 20 addresses the final treatment method covered in this section—theater. Van der Kolk reiterates the idea that communal movement, music, and rhythm help people connect to each other and form a sense of community. Theater has roots in Ancient Greece, where most theater addressed veterans returning from wars and the aftermath of their return. Van der Kolk mentions several historical events where music or rhythm had a positive effect, adding, “It is surprising how little research exists on how collective ceremonies affect the mind and brain and how they might prevent or alleviate trauma” (336).

Van der Kolk mentions three specific theater programs with which he has had personal contact and that help traumatized individuals: Urban Improv, the Possibility Project, and Shakespeare in the Courts. He notes that “theater is about embodying emotions, giving voice to them, becoming rhythmically engaged, taking on and embodying different roles” (337). Urban Improv performs skits for kids in which the kids are able to substitute in at “choice points” to make decisions about situation that resemble what they encounter in real life. The Possibility Project gives kids a chance to write and present their own full-length musical through a devising process, and has a special program for foster care youth. Shakespeare in the Courts sends kids and veterans to theater training in place of jail, having them learn and perform condensed Shakespeare plays.

All of the programs van der Kolk mentions help troubled youth and adults engage safely with their own feelings and bodies, and connect with those around them. Van der Kolk includes anecdotes about specific patients, in this case including his own son among them.