Bessel van der Kolk
THE BODY KEEPS THE SCORE: Brain, Mind, and Body in the Healing of Trauma
Reviewed by Barry Blackwell
Van der Kolk’s fourth book was first published in 2014 but has been republished several times by various publishers and is available in 32 languages. In America the volume of sales started to climb in 2018 and has increased continuously; it reached the New York Times Best Seller List in October 2021 and has remained in the top 3 positions since. Like the body the book seems to be keeping the score on both the publics and our profession’s interest in trauma, its treatment and the implications.
This book is the product of a lifetime’s dedication to understanding trauma and its treatment disseminated worldwide by a scientist who is now aged 79 (https://en.wikipedia.org/wiki/Bessel_van_der_Kolk).
Structure & Content
Van der Kolk dedicates his book “To my patients, who kept the score and were the textbook.”
After the cover and before this quotation are 28 reviews by experts in the fields of neuroscience, psychiatry and leading scientific journals. They are compelling and I will quote briefly from 10 of them.
“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 Herman, Harvard Medical School).
“This exceptional book will be a classic of modern psychiatric thought. The impact of overwhelming experience can only be understood when many domains of knowledge, such as neuroscience, developmental psychopathology, and interpersonal neurobiology are integrated, as this work uniquely does.” (Alexander McFarlane, University of Adelaide, Australia).
‘With the compelling writing of a good novelist, Van der Kolk revisits his fascinating journey of discovery that has challenged established wisdom in psychiatry.” (Richard Schwartz, Internal Family Systems Therapy).
“The most important series of breakthroughs in mental health in the last thirty years.” (Norman Doidge, author, The Brain that Changes Itself).
“The Body Keeps the Score is, simply put, brilliant.” (Onno, van der Hart, Utrecht University).
“Every once in a while, a book comes along that fundamentally changes the way we look at the world. I could not put this book down.” (Stephen Cope, Founder and Director of the Kripalu Institute for extraordinary living).
“This book is wise and compassionate, occasionally quite provocative and always interesting.” (Glenn Saxe NYU University of Medicine.)
“One reads this book with profound gratitude for its wisdom.” (Alice Lieberman, Director, Child, Trauma Research Project, San Francisco General Hospital.)
“This is a masterpiece of powerful understanding and Brave heartedness, one of the most intelligent and helpful works on trauma I have ever read.” (Jack Kornfied, author, Path with Heart.)
CONTENTS OF THE BOOK
This book is in five Parts with a Prologue, Epilogue, 20 Chapters and seven Appendices for a total of 455 pages of text.
Prologue: Facing Trauma
PART ONE: THE REDISCOVERY OF TRAUMA
Lessons From Vietnam
Revolutions in Understanding the Mind & Brain
Looking into the Brain: The Neuroscience Revolution
PART TWO: THIS IS YOUR BRAIN ON TRAUMA
4. Running for your Life; The Anatomy of Survival
5. Body-Brain Connections
6. Losing your Body, Losing Yourself.
PART THREE: THE MINDS OF CHILDREN
7. Getting on the same Wavelength
8. Trapped in Relationships: The Cost of Abuse and Neglect
9. What’s Love to do with it?
10. Developmental Trauma: Owning your Self
PART FOUR: THE IMPRINT OF TRAUMA
12. The Unbearable Heaviness of Remembering
PART FIVE: PATHS TO RECOVERY
13. Healing from Trauma: Owning Yourself
14. Language & Tyranny
15.Letting go of the Past: EMDR
16. Learning to Inhabit your Body: Yoga
17. Putting the Pieces Together: Self Leadership
18. Filling in the Holes: Creating Structures
19. Applied Neuroscience: Rewiring the Fear-Driven Mind
20.Finding Your Voice: Communal Rhythms & Theatre
EPILOGUE: Choices to be made
APPENDIX: CONCENSUS PROPOSED CRITERIA FOR DEVELOPMENTAL TRAUMA DISORDER RESOURCES (Trauma &Treatment Strategies)
NOTES (Footnotes and References for each Chapter)
INDEX (20 pages of alphabetized topics)
A REVIEWER‘S FANTASY
The task of reviewing this thought-provoking volume and its unusual evolution as a greatly admired best seller has triggered a fantasy that more and even better may yet to come based on the switch from a chemical to an electrical formulation. With trauma, both in diagnosis and treatment, electricity trumps chemistry. Of course, as the author acknowledges, both systems are involved but for most of the 20th Century into the present neurochemistry and medications have dominated the practice of psychiatry, the management of mental illness and the diagnoses derived from a flawed DSM system.
In 2020 I published a book, Treating the Brain: An Odyssey. It was based on a compilation of essays published on the International History of Neuropsychopharmacology website (INHN.org) that was founded by Tom Ban in 2013. The book contrasted two epochs, beginning with a “Pioneer Period” (1949-1980) when all the first drugs were discovered for each of the major mental health disorders, (aided by serendipity), leading to the emptying of asylums and initiating care in the community, thus creating an optimistic, proud and highly productive profession, supported by Government funding and an NIMH drug testing program staffed by physicians from the Veterans Administration Hospitals, Academic Medical Schools and State Hospitals, the Early Clinical Drug Evaluation Units (ECDEU).
This was followed by the decades from 1981 to the present (“The Modern Era”) during which Government support dwindled, the ECDEU Program was terminated and the development of new drugs was taken over by Industry. Testing and marketing were supported by paid academics and clinicians known as Key Opinion Leaders (KOLs). This epoch was characterized by dwindling innovation, vast corporate profits and corruption of both testing and marketing with professional and academic complicity coupled with their organizations and leading journals that turned a blind eye to “conflicts of interest” and suborned scientific integrity (Blackwell 2020).
The last paragraph of my book is A FINAL WORD. It states: “The scientific zeitgeist at the beginning of the 21st Century appears to be impervious to change and will require discoveries in neuroscience that would create the foundation for a new generation of psychotropic drug research.”
At the beginning the 20th century both the chemical and electrical theories of brain function were intact. The onset of a successful chemical period was marked right at the beginning by modern psychopharmacology; the discoveries of lithium, chlorpromazine, meprobamate, the MAOI inhibitors, tricyclic antidepressants and benzodiazepines, often aided by serendipity (Ayd and Blackwell 1970). Electrical theories were close behind, pioneered by Bob Heath at Tulane University and Jose Delgado at Yale both working on electrical stimulation of parts of the brain. Delgado believed electrical stimulation was superior to oral administration of drugs because their effects were mitigated by liver metabolism, the blood brain barrier and distribution at multiple sites with variable effects. The collapse of the electrical viewpoint occurred in 1972 led by a libertarian psychiatrist and Scientologists combined with public concern over CIA “mind control” experiments that resulted in Congress withdrawing government support of electrical brain stimulation research (Blackwell 2013)
In Chapter 19 of his book Van der Kolk notes, “before the advent of the pharmacological revolution, it was widely understood that brain activity depends on both chemical and electrical signals. The subsequent dominance of pharmacology almost obliterated interest in the electrophysiology of the brain for several decades.”
I have nothing but admiration for this author and his book which is an astonishing mélange of clinical wisdom and neuroscience fact finding. It spells out a wide range of traditional, novel, electric and clinical strategies for calming and healing a troubled mind.
The fantasy I pray will be fulfilled by Bessel van der Kock’s elegant and definitive research is that focusing on the electrical functions of the brain will moderate the wildly inflated, costly and corrupt chemical considerations, rampant in the late Modern Era, to restore a balanced (biopsychosocial) view of the brain’s functions and their treatments. Bessel’s work is the kind to capture public and professional imagination, capable of changing the spirit of our times. Amen.
Ayd FJ, Blackwell B. Discoveries in Biological Psychiatry. Philadelphia/Toronto, JB Lippincott Company; 1970.
Blackwell B. A Distinguished but Controversial Career: Jose Manuel Delgado. inhn.org/inhn-projects/biographies/. May 30, 2013.
Blackwell B. Treating the Brain: An Odyssey. INHN Publisher, Cordoba; 2020.
September 29, 2022