Book Rex: The Body Keeps the Score

Bessel van der Kolk's manual on overcoming trauma is a game changer.

Look: I can’t say I’d recommend depression. It’s not a particularly fun time. In terms of enjoyability, I’d put it at zero out of five stars. BUT, it has been a weirdly fascinating experience? Without fetishizing it, it has taught me an enormous amount about the world and myself, to the point where I can’t imagine myself without having experienced it, and am skeptical that I would want to.

If you are one of my paid subscribers, you’ll know that last week I couldn’t manage to churn out a Book Rex due to the lack of focus that was a side effect of my antidepressant. I’m good now, for the record: I went off the offending antidepressant and switched to a new one, which has yet to fuck me up with side-effects (fingers crossed!). In the intervening week and a half, I’ve finished about half as many books as I did in the previous four months. So. Things are on the right track.

But drugs are just the latest chapter in this work — I’ve been in therapy for the better part of a decade, unpacking all of the reasons that I got to a point where everything was just so adrift. And unpacking has been painful: it’s revealed some hard truths about my family and my upbringing and my place in this society that have been hard for me to swallow. It seems to me that every time I peel a layer off the Depression Onion, there’s just another, more tender layer waiting there to get picked at. It is a bummer.

Easily the most fascinating book I’ve read on this subject is Bessel van der Kolk’s The Body Keeps the Score, which came out in 2014 and, as of this writing in 2023, remains on the New York Times nonfiction bestseller list, currently in second place.

I only finished the book this weekend, but it has already had an impact on my life. Van der Kolk has spent decades as a psychiatrist focusing on the issue of post-traumatic stress, dating back to the days in the 70’s when there was not, as yet, a term for PTSD, even though it was clearly affecting thousands of Vietnam War veterans.

The book takes us through the development of this field, through psychoanalysis to talk therapy to the psychiatric drug revolution, the neural imaging revolution, and through today, with promising innovative (and as of yet, not widely accepted) therapies that seem to help different people in different circumstances.

The reality is that every human, to some extent, experiences trauma in their life, but for some, it can be crippling. There are many different reasons for this — violence, neglect, emotional abuse, sexual abuse, traumatic accidents or disasters, etc. — but they affect the brain in such a way that it has difficulty moving on and adapting to changing circumstances.

Van der Kolk summarizes what scientists currently believe cause these behavioral issues in the brain, and suggests that the solution lies not entirely in treating the rational brain, but in treating the emotional brain and the body as well.

The first part of the book examines the evolution of this field and also discoveries about the effects of trauma on the body, and the second half of the book examines various treatments that have been useful. These include yoga (particularly useful for people who have undergone any sort of physical trauma), neurofeedback (particularly useful in treating ADHD, anxiety, depression, insomnia, and even epilepsy), Eye Movement Desensitization and Reprocessing (EMDR, a controversial therapy that nonetheless has produced impressive results in many patients), Internal Family Systems Therapy (which involves imagining the different aspects of your personality as individuals whom you can speak to and work with) and even confidence building exercises like working in local theater or joining local choirs.

Van der Kolk’s approach is a curious one, which is to say he’s not particularly dogmatic about which therapies are “right” or “wrong,” he’s more interested in the results they show, and in researching why they work when they do.

What he’s most strident about is the fact that we’re currently facing a massive public health crisis when it comes to trauma (and keep in mind this was written 6 years before COVID), as trauma tends to play out in all sorts of unwanted behavior, from violence to suicide to abuse to drug addiction to criminality. By treating this core affliction, he suggests, we’d go a long way towards fixing many of our society’s problems, many of which stem from bodily autonomy (which, incidentally, is the topic of my Wednesday column, so stay tuned).