Bessel Van Der Kolk
The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. New York, New York: Viking, 2014; 464 pages
Reviewed by Barry Blackwell
This book is in five Parts with a Prologue, 20 Chapters, Epilogue and seven Appendices.
Prologue: Facing Trauma
Part 1. The Rediscovery of Trauma
1. Lessons from Vietnam Veterans
2. Revolutions in Understanding Mind and Brain
3. Looking into the Brain: The Neuroscience Revolution
Part 2. This is Your Brain on Trauma
4. Running for Your Life: The Anatomy of Survival
5. Body-Brain Connections
6. Losing Your Body, Losing Your Self
Part 3. The Minds of Children
7. Getting on the Same Wavelength: Attachment and Attunement
8. Trapped in Relationships: The Cost of Abuse and Neglect
9. What's Love Got to Do With It?
10. Developmental Trauma: The Hidden Epidemic
Part 4. The Imprint of Trauma
11. Uncovering Secrets: The Problem of Traumatic Memory
12. The Unbearable Heaviness of Remembering
Part 5. Paths to Recovery
13. Healing From Trauma: Owning Your Self
14. Language: Miracle and 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. Rewiring the Brain: Neurofeedback
20. Finding Your Voice: Communal Rhythms and Theater
Epilogue: Choices to Be Made
Appendix: Consensus Proposed Criteria for Developmental Trauma Disorder
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 Network for the History of Neuropsychopharmacology website (INHN.org) that was founded by Tom Ban in 2013. The book contrasted two epochs; 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, and the Early Clinical Drug Evaluation Units (ECDEU).
This contrasted with 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 in my book, A FINAL WORD, 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.
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
Blackwell B. A Distinguished but Controversial Career: Jose Manuel Rodriguez Delgado. inhn.org.biographies. May 30, 2013.
Blackwell B. Treating the Brain: An Odyssey. INHN Publisher Cordoba; 2020.
December 1, 2022