The Body Keeps the Score Study Guide PDF

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The The Body Body Keeps Keeps the the Score Score Study Guide © 2022 eNotes.com, Inc. or its Licensors. ALL RIGHTS RESERVED. No part of this work covered by the copyright hereon may be reproduced or used in any form or by any means graphic, electronic, or mechanical, including photocopying, recording, taping, Web distribution or information storage retrieval systems without the written permission of the publisher.

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eNotes | TABLE OF CONTENTS THE BODY KEEPS THE SCORE STUDY GUIDE

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SUMMARY

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Summary CHAPTER SUMMARIES

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Chapter Summaries: Prologue–Chapter 3 Summary and Analysis

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Chapter Summaries: Chapters 4–6 Summary and Analysis

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Chapter Summaries: Chapters 7–8 Summary and Analysis

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Chapter Summaries: Chapters 9–10 Summary and Analysis

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Chapter Summaries: Chapters 11–12 Summary and Analysis

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Chapter Summaries: Chapters 13–14 Summary and Analysis

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Chapter Summaries: Chapters 15–16 Summary and Analysis

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Chapter Summaries: Chapters 17–18 Summary and Analysis

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Chapter Summaries: Chapter 19–Epilogue Summary and Analysis

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THEMES

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Themes

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CHARACTERS

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Characters

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ANALYSIS

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Analysis

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Summary Summary In The Body Keeps the Score, Bessel van der Kolk uses his own experience and research as a psychiatrist to describe and evaluate the effectiveness of some of the principal developments in the treatment of trauma patients over the course of his career. He begins by discussing such innovations as the widespread prescription of drugs to treat mental illness and the use of brain-imaging techniques by neuroscientists to understand the effects of trauma on the brain. Van der Kolk admits the importance of such innovations, which have assisted him in his work, but cautions against relying on them too heavily. In chapter 4, van der Kolk begins to develop his central thesis that “dissociation is the essence of trauma,” particularly dissociation between the body and the brain. He uses case studies in each chapter to illustrate how trauma severs the usual connections between brain and body which allow most people to retain a clear distinction between past and present. He describes how trauma victims physically relive the past, as the emotional responses which would allow them to feel love and trust, or to be creative, shut down in repeated attempts to survive a threat which no longer exists in the present. This dissociation often begins in early childhood, when abused and neglected children are prevented from forming bonds with their primary caregivers. These early experiences of dissociation lay the foundations for dysfunctional relationships in the future, exacerbating the trauma and preventing victims from forming support networks. In chapter 9, the author stresses the complexity of psychiatric diagnosis and hence the vagueness with which patients are labeled. A diagnosis of depression will have important consequences for the patient but will never be as certain or meaningful as a diagnosis of pancreatic cancer, for instance. This complexity arises in part because everyone’s minds and formative experiences are different, but also because childhood trauma in particular often has a myriad of causes, since dysfunctional families seldom suffer only from a single problem. The author describes child abuse and childhood trauma as a “hidden epidemic” in America. This hidden epidemic causes misery to the victims of trauma but also inflicts social and economic damage on the country as a whole, particularly in the size of the United States prison population. Chapters 11 and 12 have a historical focus, with the former covering the development of psychology in the late nineteenth century and the introduction of the Freudian “talking cure,” which is still used today. Chapter 12 looks at the symptoms of trauma exhibited by soldiers returning from the First and Second World Wars and examines how they were treated. Although war seems like an exceptional experience, far removed from the lives of noncombatants, the author shows that the symptoms of trauma in soldiers are similar to those experienced by civilians. He uses the words of a patient who was traumatized by remaining awake during an operation to illustrate this point while also showing the importance of learning directly from what patients say about their own experiences. The final and longest section of the book, including chapters 13–20, addresses the ways in which patients can recover from trauma. The author points out that many psychiatrists are focused on the traditional talking cure, first developed by Freud in 1893, and on Cognitive Behavioral Therapy (CBT), which arose in the 1960s. He does not dismiss either method but points out the limitations of both as “top-down” solutions, which rely too heavily on the therapist and deprive the patient of agency. He also notes that, while it is vital for trauma victims to express what

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they have suffered and put it into context, it is impossible for them to accomplish this using language alone. The author discusses physical therapies, including eye movement desensitization and reprogramming (EMDR) and yoga, as an alternative to more traditional methods. Different therapies work for different patients, but more important than the technique is the patient’s ownership of and investment in it. Van der Kolk favors the use of theater in therapy, both as a means of allowing patients to rescript and direct their own lives and as a way of participating in a healthy group dynamic with a shared purpose and a positive role for patients, who claim a sense of agency and creativity as part of the process. The sign that any therapy works is an increase in the patient’s physical well-being, which it is impossible to simulate. The author ends with an epilogue in which he calls for more general recognition of and response to trauma as an urgent public health issue.

Chapter Summaries Chapter Summaries: Prologue–Chapter 3 Summary and Analysis PROLOGUE The author begins by pointing out that trauma is a common experience. Many Americans were sexually molested or beaten as children or have seen other family members abused. Trauma is often passed on, meaning that the husbands, wives, and children of those with PTSD or depression are themselves affected by psychological insecurity and anxiety. This makes it difficult for them to build stable relationships. The brain is not well adapted for moving beyond trauma. People who have survived the trauma itself often find memories of the trauma, and the psychological reactions triggered by these memories, to be intolerable. However, recent research has revealed new ways in which trauma can be treated. There are now three fundamental options: talking, forming human connections, and “processing the memories of the trauma”; using medicines which control the brain’s responses; and creating positive experiences for the body which contradict feelings of rage and helplessness. The author has found that individual patients require different approaches, and most require a combination of the above methods. However, he is particularly interested in the third method, which is the newest and which he believes has not yet received enough attention. His aim in this book is to explore how best to treat trauma, allowing those who have experienced it to regain control over their lives.

CHAPTER 1 The author describes the first patient he treated when he worked as a psychiatrist at the Boston Veterans Administration Clinic in 1978. This was a man called Tom, who was now a successful lawyer, and a husband and

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father, but was deeply troubled by his memories of combat in Vietnam. The author gave him pills to stop him from having nightmares but discovered, when Tom came for his second appointment, that he had not taken the pills. Tom explained that to do so would have been to abandon his friends who had died in Vietnam. This showed the author that Tom’s experience of trauma was more complex than he had thought and was not something which could be cured by chemicals. When the author attempted to research Tom’s condition, he was surprised to find very little medical literature on the subject. However, he did read The Traumatic Neuroses of War by Abram Kardiner, which suggested a physiological basis for post-traumatic stress. Aside from this, his main sources of information were what his patients told him and the symptoms they showed. Another patient, named Bill, was about to be diagnosed with paranoid schizophrenia after describing the way in which his mind was flooded with images of dying children. The author, however, realized that Bill was suffering from his memories of Vietnam. The author points out that most listeners react to secondhand trauma with horror. It is difficult to hear an account of a murder or a rape, and most people would prefer to think that such things do not happen, or at least that they only happen far away from the comfortable society they themselves inhabit. In such circumstances, it is not surprising that the people who actually experienced these horrors try to forget them. However, a talking cure, in which they gain the ability to articulate what they have experienced, is seldom enough. The body needs to come to terms with trauma and recognize that the danger has passed.

CHAPTER 2 Between his first and second years of medical school, in the late 1960s, the author worked as an attendant at the Massachusetts Mental Health Center. Because he was there all the time, he was able to observe patterns of behavior and listen to patients’ stories at length in a way that was not possible for the doctors, who visited only briefly. He speculated that the hallucinations patients often described might come from suppressed memories. The author also found some of the methods of treatment counterproductive, particularly when they involved the use of violence, as with the force-feeding of a young woman named Sylvia. Sylvia had been sexually abused by her brother and uncle, and holding her down for force-feeding replicated this trauma. Later in his career, after qualifying as a psychiatrist, the author developed an interest in neuroscience, which he thought might contribute to his understanding of traumatic stress. He describes a presentation by Steven Maier of the University of Colorado, who had administered electric shocks to caged dogs. When he opened the doors of the cages, the dogs did not attempt to escape, whereas a group of control dogs, which had not been shocked in cages, ran away immediately. This reminded the author of the way in which his human patients were psychologically frozen and unable to escape from trauma. The author also became interested in the role serotonin might play in PTSD. As soon as Prozac was released in 1988, he began to prescribe it for his patients, often with successful results. However, while Prozac worked well for many trauma patients, it had no effect on combat veterans. The author has never been able to explain this but maintains that it shows the limitations of pharmacology in treating trauma. The author is concerned that, because drugs are so profitable, they have become the default method of treating mental health problems. He remains interested in exploring other, more natural ways of treating trauma.

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CHAPTER 3 In the 1990s, sophisticated brain-imaging techniques made neuroscience a popular field for research. The author used this new technology to conduct a study of brain activity during flashbacks. He found increased activity in the limbic area of the brain, particularly the amygdala, which activates the body’s response to stress. There was decreased activity in the parts of the brain that process speech, and the author explains this with the observation that trauma is impossible to express in words and cuts the patient off from language. The brain scans also showed a shift in activity from the left to the right side of the brain, the part that is more emotional and visual. Whereas the left side of the brain recalls the facts about what happened, the right side remembers how it felt. Most of the time, the two sides of the brain work together fairly smoothly, and to have one side shut down is disabling. When the left side of the brain fails to function during the memory of trauma, this prevents the patient from viewing the action analytically, in context, as an experience that happened long ago. Although brain scans have been very helpful in providing images for the effects of trauma, these images still have to be interpreted. Moreover, certain states of mind, such as denial, cannot be measured by brain scans. These scans are best adapted to show when and how trauma can be triggered.

ANALYSIS After the brief prologue, the first three chapters form part 1 of the book, titled “The Rediscovery of Trauma.” In this first part, van der Kolk emphasizes the mysterious nature of human psychology and responses to trauma in particular. He focuses on three approaches to trauma—the traditional talking cure which derives from Freudian analysis, and two which have developed during the course of his career: drug therapy and brain imaging. Drugs are used for treatment and brain imaging primarily for diagnosis and research, but the author treats them in similar ways, first pointing out where they have been helpful, then discussing their limitations. This section, therefore, barely touches on the main subject of the book and is essentially a preamble in which the author provides the background to his own approach. He does, however, introduce case studies to which he later returns, briefly explaining the origins of each patient’s trauma. These case studies make harrowing reading and emphasize the seriousness of the author’s research, and the work of others, on which he relies. Van der Kolk makes the point that much of this research comes at a high cost. His own experiments involve patients reliving their trauma and being seriously upset by the process. He obtains informed consent for these processes but states that he would not have been able to participate in Steven Maier’s experiments, which involved administering painful electric shocks to dogs. However, he still had to rely on the results of these inhumane experiments in his own work.

Chapter Summaries: Chapters 4–6 Summary and Analysis CHAPTER 4 The author begins with the story of a boy called Noam, who witnessed the attack on the World Trade Center in New

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York City on September 11, 2001. Noam’s school was close to the World Trade Center, but he and his classmates and teachers were able to run away and escape unharmed. The next day, Noam drew a picture of what happened, in which he included a trampoline at the bottom of the Twin Towers, his idea for saving anyone who had to jump out of the windows in any future attack. Noam’s agency in running away and his optimism in planning for the future are a stark contrast to the paralysis experienced by victims of trauma. The ability to move and do something in the face of a threat is critically important in the prevention of long-term trauma. When the victim is immobilized or trapped, the brain’s strategies for survival are frustrated and continue to repeat themselves long after the threat has passed. The emotional part of the brain (the right-hand side) responds first to danger, but when the brain is operating normally, the left-hand side is able to process and analyze the situation soon afterward. When the body is prevented from reacting, the balance between the two sides of the brain is destroyed, and the rational left-hand side is unable to perform this function. The author concludes the chapter with the idea that “dissociation is the essence of trauma.” The traumatic experience is cut off from the rest of the patient’s life, continually revisited in the form of flashbacks and memories, which are accompanied by the stress hormones which marked the experience itself. Brain scans show an inability to distinguish between past and present in the reactions of trauma patients. The author is therefore convinced that it is not enough to desensitize patients to the past: they must learn “to live fully and securely in the present.”

CHAPTER 5 Charles Darwin observed that humans and animals express the same emotions in the same way. This is because emotions have their origins in biology and serve the same essential purpose: that of moving those who feel them to take action for self-preservation. However, when people or animals are focused on survival, they have no emotional capacity for love or creativity. Darwin also noted that strong emotions are felt in the body as well as the brain. The author believes that trauma victims often depend on drugs or alcohol primarily to make physical sensations go away. He observes that “if Darwin was right, the solution requires finding ways to help people alter the inner sensory landscape of their bodies.” All the signs of emotion people feel and observe in others are produced by the synchrony of the two branches of the autonomic nervous system (ANS). These are the sympathetic nervous system (SNS), which is responsible for responses to sudden danger, and the parasympathetic nervous system (PNS), which relaxes these responses and promotes such functions as healing wounds and digesting food. The SNS is activated by inhaling, the PNS by exhaling. In 1994, a researcher called Stephen Porges developed the Polyvagal theory based on Darwin’s observations. The Polyvagal theory explains emotional reactions in social terms, arguing that relationships with others are central to understanding and treating trauma. This is because one of the worst effects of trauma is often to cut victims off from those around them. The ventral vagal complex (VVC) creates sympathy between members of the same group and evolved in mammals as their social interactions became more complex. In trauma victims, the VVC shuts down for the purposes of survival, even though this survival response is no longer required. The author sees one of the main aims of trauma treatment as reversing this process, allowing the patient to form meaningful connections with others again, rather than being stuck in “survival mode.”

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CHAPTER 6 The author discusses his experience with patients whose sensory perception has been damaged by abuse or neglect. He sent a woman named Sherry, who was self-harming, to a massage therapist, and Sherry was unable to feel the therapist’s hands when they were on her feet. Other patients who had objects placed in their hands were unable to describe the size and shape of the objects by relying on their sense of touch alone. Dr. Ruth Lanius, the author’s colleague, conducted neuroimaging studies of trauma patients alongside people who had not suffered trauma to determine their respective patterns of brain activity when they allowed their minds to go blank. Dr. Lanius found that the self-sensing systems of the trauma patients were severely impaired. They had less self-awareness and self-recognition, and felt less fully alive. Another researcher, Antonio Damasio, discovered that strong negative memories change the way the brain regulates basic bodily functions. Sleep is often disturbed, food is no longer a source of pleasure, and the patient is constantly nervous. The author adds to these findings his own observation that trauma victims often feel unsafe inside their own bodies, with no sense of agency in life. Depersonalization is a common feeling among traumatized people. They feel disconnected from their bodies, which are constantly tense and defensive. The author asks his patients to notice and describe the feelings in their bodies, a process which can be distressing at first. However, establishing this connection within themselves is a vital step in ...