The Body Keeps the Score

I absolutely loved this book. I'm sure it is going to be a reference for me for the rest of my life. One thing I didn't realize going into it was that it is such a polemical book. I thought it was mainly just educational about trauma; but no, it is a book that wants to argue with the establishment and the ideas we take for granted in mental health. It is a book of deconstruction and, hopefully, reconstruction. Or rather, more accurately, reclamation of older (and at times pre-scientific) ways of thinking about mental health and treatment. Just as one brief example, I've become accustomed to Freud being appreciated for who he was at his time, but that he has little to no bearing on our understanding of humans or treating their difficulties today. But this book gave me renewed respect and insight into Freud and how he thought about things.

It is really hard to distill all of my thoughts from such a big book that goes in so many different directions. I already had a decent understanding of trauma-informed care, adverse childhood experiences, and the role of the body in processing trauma. So, going into this book, I mainly thought I would just enjoy how he goes about explaining it to lay people in a way that captured the mainstream consciousness when it was published. I thought I would hear about some research studies and stories about trauma I had never heard, but I wouldn't necessarily learn much that was revolutionary or earth-shattering to me. Boy was I wrong.

Pretty much no aspect of mental health and treatment today is left untouched by Van der Kolk's analysis. Yet at the same time, he's not just gleefully bashing the establishments and throwing the baby out with the bath water. He really is seeking a comprehensive, nuanced, and balanced approach to treatment that is truly helpful to people, no matter what that means or where it takes him.

Van der Kolk gives voice to a lot of things a lot of us intuitively wonder or question about mental health treatment today but just shrug off because “the experts” say otherwise. Psych meds are amazing, and have changed lives, but have they really changed society? Or made us happier overall? Is it truly the case that all these other holistic, older, bodily, pre-scientific approaches have little to no merit or place in “real” psychotherapy? Does non-medication mental health treatment deserve its status as lesser and less-substantive than psychiatric care? Etc. Etc.

I walked away with a lot of takeaways, thoughts, and experiences—too much to put here in this paper. I really want to get trained in a number of the treatment modalities described, especially Internal Family Systems Therapy and EMDR. I will surely explore referring future clients to yoga and theater/improv activities. I would really love to undergo neurofeedback treatment myself. I like yoga a lot and have gone through fits and starts of doing it occasionally in my life. As I was reading this book, I even tried a long yoga session geared for PTSD. It was interesting. It was slower and gentler but still a pretty standard yoga session. I think the benefit is probably more in regularity and not one-off sessions. I also signed up through PESI for a 9-hour webinar with Van der Kolk with more up-to-date research than in the book, and was focused more on the complexities of this in treatment (i.e. very few people are only struggling with some pure form of PTSD). (By the way, I had it on in the background while at work, and it was mainly going through stuff in the book, so I didn't count more than a few hours of it for these internship hours.)

I also appreciated his critiques of policy through history and today, making it very relevant for social workers in our task of discerning what systems and policies to advocate for change in. The lack of research funding and insurance reimbursement for neurofeedback is a scandal, and just how little attention we give to ACEs in our society is a tragedy. As far as return on investment goes, challenging the systems and structures and social policies that foster ACEs seem to be one of the clearest, most efficient ways we could fundamentally reshape the spirit and health of our country.

I loved this book, but it was still a lot all at once, and I don't know that he really brings it all together at the end in a way I had hoped. I leave the book pretty overwhelmed with all these blind spots in psychotherapy and a huge number of possible, less-mainstream treatments that may be even more effective than current treatments. But once I have a client in front of me, how do I choose between EMDR, Spatial Psychomotor Therapy, Yoga, Theater, or Internal Family Systems Therapy? I was hoping for some final chapter about how we therapists shouldn't stress about all of this too much, and the specific intervention doesn't matter so much as accomplishing such-and-such specific tasks, however that most effectively can be done with a given patient.

But he did not give us that. So I'm left with both too much and not enough information and ideas, which I fear will end up meaning I just default to the way things usually go instead of staying open to the spirit of creativity and tenacity that animates this book. That's why I said in the beginning that I'll likely treat the book more as a very helpful reference or refresher book, even as I try to get more into the nitty-gritty elsewhere.

But still, this book was life-affirming and changing on several levels, and will benefit clients (and myself) for years to come.