Does the Body Really Keep the Score?

Dare I say, I have not rushed out to buy a copy of the best selling book on trauma medicine-- that would be Dr. Bessel van der Kolk’s book, The Body Keeps the Score. 

The book feels like a bunch of recycled New Age nostrums and bromides, ranging from yoga exercises to psychedelic drugs. It’s thesis, that the body remembers traumas when the mind forgets them, is intriguing, but it also feels like recycled Freud. 

The good doctor, not a very impressive thinker, suggests that certain yogic exercises and massages can revive repressed memories, leading to-- it is not very clear what. We will grant, for the sake of argument, that exercises can bring back memories, but then, what about it?

In fairness, I have still not read the book and have no intention to do so. But I did find a largely sympathetic interview with Van der Kolk in the Guardian. Since it will not require too much time to assess the value of the book from the Guardian story I will make that my lodestone. At the risk of being churlish I would say that the picture of the doctor that accompanies the article does not inspire confidence. I will leave it at that.

Before offering something of a critique of his approach, I would make one point. The first involves resilience. As psychiatry has been researching of late, most people recover from trauma and abuse without undergoing any specialized treatment. The implication, not quite explicit, that people can only recover from trauma if they do some yoga, have a massage and take some psychedelic mushrooms seems superseded by the simple fact that the normal way of dealing with trauma seems largely to work.

As for New Age approach favored by Van der Kolk, yoga can certainly be beneficial, so can massage. And yet, the experience of reliving a trauma that had been stored in your musculature does not necessarily provide anything more than a cathartic experience. When it’s over you still have the problems you had before you underwent it. And you still need to learn how to function in daily life. Taking magic mushrooms tells you nothing about any of this.

Be careful before you start imagining that miracle cures can bring back traumas and make you whole again. 

According to the Guardian, the end result of the exercises is that you treat yourself with  more compassion. In truth, we did not need to go on any magical mystery tour to learn this. And we can question whether an obvious call to self-absorption is really what trauma victims need:

When Dr Bessel van der Kolk published The Body Keeps the Score in 2014, it was a huge hit with yoga people. That is not a euphemism for “rich, underoccupied people”, it is just people who do yoga. Certain physical activities do something weird to your brain: ancient memories resurface, often with new feelings or perspectives attached; you start treating yourself with more compassion.

Dr. Van der Kolk recognizes the reasons why people do not try to recall traumas, do not want to have traumas define them and try to forget trauma. If the mind wants to forget trauma, perhaps it has good reason to do so. Obviously, this does not make sense to someone who worships the goddess of truth, but still:

His thesis centres on trauma: the urgent work of the brain after a traumatic event is to suppress it, through forgetting or self-blame, to avoid being ostracised. But the body does not forget; physiological changes result, a “recalibration of the brain’s alarm system, an increase in stress hormones, an alteration in the system that filters relevant information from irrelevant”, as he says in his book. The stress is stored in the muscles and does not dissipate. This has profound ramifications for talking therapies and their limits: the rational mind cannot do the repair work on its own, since that part of you is pretending it has already been repaired.

Why the stress? Perhaps it’s because the victim fears, as the doctor suggests, that other people find out about the trauma. In more succinct terms, there are two issues with trauma: what happened and who knows.

In short, if it is only you who know about your trauma-- though normally another person, your tormentor, also knows-- it is easier to deal with than if the world knows. We sympathize with the gymnasts who were sexually abused by one Dr. Larry Nasser, but aren’t they suffering mightily from the fact that everyone knows what happened to them, and that everyone who knows is looking at them in a certain, pitying way? Once the world knows you have been traumatized and once people look at you as a victim, the trauma will come to define you. And most people, especially victims of sexual abuse, do not want to be defined by their traumas.

Apparently, Dr. Van der Kolk thinks he is the only psychiatrist who knows how much sexual abuse and violence there is in the world. This means that he is completely full of himself. The psychiatric profession talks of nothing but abuse and harassment. We have had giant cultural movements where people have defiantly chosen to share the stories of their abuse with the public. To say that this is being hidden is a bit much. If anything, we are exposing too much and defining people by their traumas-- thus producing victimhood cults.

The Guardian continues:

“We define ‘trauma’ as an event outside the normal human veins of experience,” he says. “At least one-third of couples, globally, engage in physical violence. The number of kids who get abused and abandoned is just staggering. Domestic violence, staggering. Rapes, staggering. Psychiatry is completely out to lunch and just doesn’t see this.”

It adds:

There’s very good literature [on shellshock] from 1919 and 1920. But then there was pushback, people saying: ‘You’re just a bunch of cowards.’ The assault on people who had been traumatised has been relentless – to this day, almost. You’re not allowed to tell the truth about the horrible things that people do to each other.”

Where is he living? We talk about nothing but the horrible things that people do to each other. Unfortunately, the more we talk about it, the more it feels like a norm. And, the more we give people bad ideas about doing bad things to other people.

Dr. Van der Kolk believes that there is only one way to deal with trauma-- badly. Again, his simple minded thinking fails to see differences and nuances.  In truth, different people deal with trauma differently. Resilience studies show us that most people recover well on their own, without taking magic mushrooms.

The further he delved, the more important he realised the work was, in terms of the incidence and impact of trauma, on society and the self. “The reality, of course, is that being traumatised does make you a difficult person to get along with. Because you suddenly get angry, you suddenly shut down or you space out. But more difficult is to live that life: not being able to trust yourself. And there’s always this internal pressure to step up to the plate and keep functioning. So the next piece is a profound feeling of shame about yourself and your reactions.”

The good doctor reflects on one Isaac Newton, a man who suffered unconscionable abuse but who achieved greatness in science-- without receiving the right kinds of massages. 

It would be much too simple to say that PTSD quashes any potential for creativity or success. “It is striking how many times people carve out a piece of exceptional intelligence – exceptional creativity – that allows them to go on. Isaac Newton was one of the most abused, abandoned children ever … And then he invented mathematics.” The question, I suppose, is what else he might have invented, had his trauma been addressed. Van der Kolk is adamant; people shouldn’t be left as walking wounded. No one should have to keep hurling themselves at the same brick wall of therapy and antidepressants if they are not working.

This kind of reasoning signals fanaticism. Yes, Newton could always have done better. He could also have done worse. This form of logic is not science; it traffics in a fiction. It’s like saying that tens of millions of people died during the Chinese famine of five decades ago, but, without Mao’s Great Leap Forward, more people might have died. It’s flatulent reasoning, like saying that Newton might have invented relativity theory if he had been treated by the right psychiatrist. It’s fatuous cant.

The enticing part of the van der Kolk approach is that the victim need not do anything to overcome his trauma. The massages and the mushrooms will do it all. This provides you with no sense of what happened to you and it gives you no way to conduct your life more productively in the future. It makes you perfectly passive-- which is the way trauma victims feel.

His thinking on the body is so succinct and simple: if the body is storing trauma in its musculature, in its hormonal pathways, then it is the body that needs “experiences that deeply and viscerally contradict the helplessness, rage or collapse that result from trauma”, as he writes in his book.

As for the mambo jumbo and the psychobabble, he has plenty of it.

Separately, he mentions in passing that it is much easier to have compassion for your spouse if you have compassion for yourself. In Van der Kolk’s telling, the idea that self-love is a precondition for loving others – so popular in motivational statements on Instagram – has very credible and practical examples.

So, if you love yourself, if you have compassion for yourself, you will naturally love others. This is silly, worthy of an adolescent. It suggests that the book is popular because it is unrelentingly simple minded. 

He is obviously at war with psychiatry, but he is also a shameless self-promoter. To say that psychiatry has no sense of trauma, that the issue has been swept aside, is patent nonsense. To say that we should overcome social norms and overcome our denial of reality is psychobabble. For some, especially those of simple mind, it might be comforting. It has no real use beyond that.

In the end, psychiatry is simply society in a white coat, the medical end of the norm-enforcement and denial of reality that drives individuals to suppress their trauma in the first place.