The Body Keeps the Score will surely be considered a classic among the texts on human trauma, and human nature more generally. Although van der Kolk is writing about Post-Traumatic Stress Disorder (PTSD) broadly, he gives (justifiably) a significant emphasis to developmental (in-utero, infant and early childhood) trauma, as this is perhaps the primary source of trauma for many.
Van der Kolk essentially argues that developmental trauma can be understood in the context of a PTSD-like state which arises from chronic child abuse, neglect or lack of a consistent warm, nurturing relationship with an adult. This is an exceptional, though at times harrowing text which explores not only case for understanding childhood through this lens, but then presents a well-constructed and plausible case for a range of treatments and approaches for regaining the self and recovery from childhood and other trauma.
It is difficult, in a short review, to simply summarise this text, or to capture the depth and quality of information that van der Kolk offers in this book. His main aim is to explain to practitioners and lay-people alike, exactly how far-reaching and devastating an infiltration trauma has made into our homes, neighbourhoods, schools, workplaces, and society.
One does not have be a combat soldier, or visit a refugee camp in Syria or the Congo to encounter trauma. Trauma happens to us, our friends, our families, and our neighbors. Research by the Centers for Disease Control and Prevention has shown that one in five Americans was sexually molested as a child; one in four was beaten by a parent to the point of a mark being left on their body; and one in three couples engages in physical violence. A quarter of us grew up with alcoholic relatives, and one out of eight witnessed their mother being beaten or hit.[…]It takes tremendous energy to keep functioning while carrying the memory of terror, and the shame of utter weakness and vulnerability.
Van der Kolk presents a compelling case for healing. He explains how traumatic memory works (as distinct from ordinary recall memory that most of us are familiar with) and how this memory becomes embedded within the body. The is experienced in a range of bodily sensations which, ultimately must be detached from to survive.
In other words, the distinction between the mind and the body is a false one. Any form of post-traumatic stress is characterised by the return of those sensations, causing a person to re-live the trauma, rather than simply remember it. The key to unlocking a pathway to healing, van der Kolk argues, is to re-engage with awareness of those bodily sensations to be able to make the shift from re-living the trauma to simply being able to recall it as a bad memory in past. Talking therapies, he argues, are not enough. Body-based therapies – particularly those that connect the mind and the body together – are essential.
Van der Kolk presents all of this with what can only be described as an exquisite understanding of evidence, and a phenomenal ability to explain it in a way that can be grasped, understood and actioned.
From an infant mental health promotion perspective, one of the most important elements of this text, is his exploration of the role of social connection and, particularly, the significance of touch.
…being able to feel safe with other people is probably the single most important aspect of mental health; safe connections are fundamental to meaningful and satisfying lives. Social support is not the same as merely being in the presence of others. The critical issue is reciprocity: being truly heard and seen by the people around us, feeling that we are held in someone else’s mind and heart. For our physiology to calm down, heal, and grow we need a visceral feeling of safety. No doctor can write a prescription for friendship and love: These are complex and hard-earned capacities. You don’t need a history of trauma to feel self-conscious and even panicked at a party with strangers — but trauma can turn the whole world into a gathering of aliens.
This discussion goes to the very heart of our work here at Baby in Mind: which is to ensure the development of the capacity for our wholeness as humans.
To lay this foundation, a baby must not only be seen, heard, and held in the heart and mind of at least one adult: but they must also feel seen, heard, and held. To not feel seen, heard and held by at least one, consistent adult in infancy and early childhood is to lay the groundwork and open the door for developmental trauma.
This also helps explain some of the research demonstrating that some of us have not only survived – but utterly transcend – exceptional and unimaginable childhood trauma. Studies exploring why some children seem “untouched” by childhood trauma invariably show that in a life characterised by pain and fear, that these children had at least one adult – a teacher, a neighbour, a relative – who enabled their access to protective factors and consistently held them in mind, and ensured they felt heard and seen.
Importantly, Van der Kolk acknowledges the central role of touch in the causes, prevention, and recovery of trauma.
Many people feel safe as long as they can limit their social contact to superficial conversations, but actual physical contact can trigger intense reactions. However … achieving any sort of deep intimacy — a close embrace, sleeping with a mate, and sex — requires allowing oneself to experience immobilization without fear. It is especially challenging for traumatized people to discern when they are actually safe and to be able to activate their defenses when they are in danger. This requires having experiences that can restore the sense of physical safety.
The most natural way for human beings to calm themselves when they are upset is by clinging to another person. This means that patients who have been physically or sexually violated face a dilemma: They desperately crave touch while simultaneously being terrified of body contact. The mind needs to be reeducated to feel physical sensations, and the body needs to be helped to tolerate and enjoy the comforts of touch. Individuals who lack emotional awareness are able, with practice, to connect their physical sensations to psychological events. Then they can slowly reconnect with themselves.
This understanding underpins why so much of our work at Baby in Mind involves the use of infant massage, touch and physical interaction between parents and babies.
And for those of us working with parents who feel a sense of struggle to connect with their babies, this “trauma-informed” understanding of the experience of touch is crucial. Van der Kolk is not necessarily suggesting that all parents who feel dread, disconnect or other feelings of discomfort about interacting with their baby have necessarily been sexually abused.
Another wonderful author, Naomi Stadlen, captures the essence of this when she notes how often women come to motherhood after a life-time – not necessarily of abuse – but simply of having learned to ignore, downplay and minimise their bodily sensations (hunger, thirst, the need to use the bathroom) to accommodate the needs and timetables of others.
Is it surely not surprising that (along with all the other stresses and pressures of new parenthood) that the immediacy of the physical demands of caring for a new baby are overwhelming, anxiety-evoking and even foreign to some new parents? Both Stadlen and Van der Kolk are making the point that it is perhaps (?) impossible to ensure a baby can experience a sense of being seen, heard, and held, unless the parent has a sense that they too have been seen, heard, and felt in the same way. Facilitating a slow, gentle, and even piecemeal pathway for parents to regain a sense of “Ok-ness” with their sensations is therefore a core part of our work.
Ultimately, though this is a book not only of healing, but one which also offers hope of prevention:
All of us, but especially children, need … confidence that others will know, affirm, and cherish us. Without that we can’t develop a sense of agency that will enable us to assert: “This is what I believe in; this is what I stand for; this is what I will devote myself to.” As long as we feel safely held in the hearts and minds of the people who love us, we will climb mountains and cross deserts and stay up all night to finish projects. Children and adults will do anything for people they trust and whose opinion they value. But if we feel abandoned, worthless, or invisible, nothing seems to matter. Fear destroys curiosity and playfulness. In order to have a healthy society we must raise children who can safely play and learn. There can be no growth without curiosity and no adaptability without being able to explore, through trial and error, who you are and what matters to you.