By Our Wounds We Are Healed

The Body Keeps the Score: 
Brain, Mind, and Body in the Healing of Trauma
by bessel van der kolk
penguin, 464 pages, $19

Before #MeToo, before Black Lives Matter, Bessel van der Kolk argued for the centrality of trauma to human experience. President of the Trauma Research Foundation in Brookline, Massachusetts, van der Kolk is author of The Body Keeps the Score, a book that has been a perennial best-seller since its publication seven years ago. (As of this writing, it sits atop the New York Times’s paperback nonfiction list; it has held the top spot since February and has been on the list for 147 consecutive weeks.) Van der Kolk invokes his clinical experience and the prestige of neurology to make an increasingly familiar argument: There can be no progress until we reckon with the traumas inflicted on ourselves, on those around us, and on human collectivities—traumas that are inscribed on our flesh. When Ta-­Nehisi Coates speaks of traumas to the “black body” as central to black experience, he echoes the words of this soft-spoken Dutchman.

Van der Kolk’s theory has gone “pop” because it appeals to twenty-­first-century Americans who aspire to be “in touch”—with their psyches, with their bodies, and with moral and ethical realities. In the process, it has accelerated a comprehensive twenty-first-­century project: the re-founding of self and society on the basis of injury and betrayal.

The Diagnostic and Statistical Manual of Mental Disorders presents post-traumatic stress disorder as above all a disorder of memory. PTSD sufferers are stuck in the past. They recur constantly to their traumas, often suffering intrusive memories and flashbacks, during which they lose all sense of temporal distance from the event. They experience ­dissociative symptoms—emotional detachment, a sense of people and things as ­remote and unreal—and so cannot be present in the present, cannot be alive to current relationships and events.

Van der Kolk follows the DSM in many respects. He departs from the manual, however, in his claims that traumatic memory is often repressed entirely and that even when it is available to consciousness it resists composition into a coherent narrative: “The different sensations that entered the brain at the time of the trauma are not properly assembled into a story, a piece of autobiography.” They exist instead as sensory fragments—images, sounds, smells—which assert themselves in flashbacks, during which the sufferer “literally relives” the event he cannot begin to describe.

The body, likewise, fails to consign the trauma to the past. The body of the PTSD sufferer remains on high alert, constantly responding as though to a present threat. Trauma “produces actual physiological changes, including a recalibration of the brain’s alarm system, an increase in stress hormone activity, and alterations in the system that filters relevant information from irrelevant.” Constantly assailed by “visceral warning signs,” the traumatized learn to ignore their feelings (bodily sensations as well as emotions). Once they “lose touch” in this way, their distress asserts itself in the form of physical maladies: “Instead of feeling angry or sad, they experience muscle pain, bowel irregularities, or other symptoms for which no cause can be found.” Van der Kolk’s fuller list includes chronic back and neck pain, fibromyalgia, chronic fatigue, asthma, and migraines. Symptoms of this sort, common enough in the broader population, “are ubiquitous in traumatized children and adults.” At times, van der Kolk comes close to suggesting that the bodily traces of trauma are directly symbolic: “One of the ways the memory of ­helplessness is stored is as muscle tension or feelings of disintegration in the affected body areas: head, back, and limbs in accident victims,” the pelvic region in victims of sexual assault. He makes much of the fact that many of his patients who are rape victims cannot abide the “happy baby” yoga pose; learning to do so is, he says, essential to their recovery.

In their experience of these symptoms, PTSD sufferers are constantly retraumatized. The horror is especially acute for those whose memories of trauma are repressed. They are “constantly assaulted by, but consciously cut off from, the origin of [their] bodily sensations.” Unable to recall or describe what afflicts them, they suffer from an acute form of the mind-body split.

Van der Kolk prescribes yoga and meditation to overcome the divide: “Only by getting in touch with your body, by connecting viscerally with your self, can you regain a sense of who you are, your priorities and values.” The treatment continues with the repair of the “self-others connection,” by means of collaborative exercises such as dance and theater. Once the victim again feels “in touch with” his body and society, he may revisit his trauma. His memory of it, which exists as sensory fragments and physiological reactions, can be recovered in full and composed as a story. Once integrated into narrative consciousness, it will be accorded its proper place—as one, not defining, element of autobiographical ­memory—and moved on from.

The allure of this theory is miscellaneous. A clinician of many years’ experience, van der Kolk has a fund of moving anecdotes at his disposal. A research psychiatrist, he invokes science impressively. (Few lay readers can resist the beguiling simplicity of a brain scan that purports to depict the physiological corollary of some psychic reality.) His emphasis on the mind-body connection partakes of the holistic charm of yoga and mindfulness. His insistence that the fragments of memory must be integrated into autobiographical memory resonates with the idea of the healing power of story. And as trauma is increasingly politicized, van der Kolk both affirms the centrality of historical trauma and offers a relatively individualized and depoliticized means of reckoning with past wrong.

Van der Kolk’s influence can be measured not just by his sales figures but by the ideological variousness of his admirers. Activists have cited The Body Keeps the Score in support of various causes: transgender rights, slavery reparations, the dismantling of systemic white supremacy. And Christian campus ministries have employed it to “foster a trauma-­informed pastoral dialogue.”

Van der Kolk’s illumination of trauma may in fact be more compelling spiritually than scientifically. Aaron Kheriaty, professor of ­psychiatry at the University of California–Irvine and director of the Medical Ethics Program at UCI Health, writes in an email that The Body Keeps the Score is “not a perfect book from a scientific perspective.” He most values it as an affirmation of the embodied soul: “Perhaps the most important contribution of the book is the way it pushes back against what Walker Percy called ‘the San Andreas fault in the modern mind,’ i.e. the Cartesian mind-body split.”

Of the several difficulties that emerge in van der Kolk’s handling of the science of trauma, one is elementary: Nowhere in The Body Keeps the Score does van der Kolk define “trauma,” a term hotly contested in the recent history of psychiatry. Having once referred strictly to physical injury, it was appropriated in the 1960s by psychologists for what had been called “shell shock” or “combat fatigue.” Since the 1980s, it has undergone extensive conceptual bracket creep, whereby it comprehends ever more kinds of injury (horizontal creep) and ever less grave injuries (vertical creep, all the way down to off-color jokes in the workplace). Naturally, the expansion of the category has had much to do with the creation of a professional class that ministers therapeutically to trauma victims. The Harvard psychologist Richard J. McNally was to observe that peace and prosperity have the odd effect of generating new forms of trauma.

What counts as trauma? has been an urgent and difficult question since the formulation of PTSD. “Trauma” might denote simply exposure to a “traumatic stressor,” an abnormal and intensely negative experience. This definition yields very high rates of traumatization. For instance, in the 1995 National Comorbidity Survey, 60.7 percent of randomly sampled American adults reported some exposure to the traumatic stressors enumerated in the DSM. ­Alternatively, “trauma” might denote exposure to a stressor only when that exposure is followed by chronic stress symptoms. This definition yields much lower rates of traumatization. Of the trauma-­exposed respondents to the National Comorbidity Survey, 8.2 percent of the men and 20.4 percent of the women reported ever having suffered such symptoms.

Van der Kolk is perhaps wise to stay out of these weeds in a popular work. His reticence as to what counts as trauma may even be seen as fitting. He presents trauma as unspeakable, almost indefinable: “Trauma, by definition, is unbearable and intolerable”; “Trauma by nature drives us to the edge of comprehension, cutting us off from language based on common experience or an imaginable past.” He enlists literary precedents, quoting ­Macbeth: “O horror! horror! horror! Tongue nor heart cannot conceive nor name thee! . . . Confusion now hath made his masterpiece!” More concise is Lear’s “Howl, howl, howl, howl!,” and most pertinent would have been Lavinia’s last words in ­Titus Andronicus—but let it pass.

Van der Kolk handles the science of trauma more deftly than he handles the poetry; yet fault may be found. The fact that traumatic stress has physiological effects is not van der Kolk’s discovery, nor is it controversial. The thesis that traumatic memory resists entering narrative consciousness and resides instead in the body, where it determines actions and sensations, certainly is controversial, though it, too, is not original to van der Kolk. Pierre Janet, van der Kolk’s acknowledged hero, pion­eered it around the turn of the twentieth century. Van der Kolk’s contribution is the ­enlistment of neurological research in support of Janet’s ideas. His article “Dissociation and the fragmentary nature of traumatic memories” (Journal of Traumatic Stress, 1995) reported on an experiment conducted by his research team involving PET scans and trauma scripts. Years later, the experiment reappears, methodological flaws and all, in The Body Keeps the Score.

Eight PTSD sufferers undergo PET scans while listening to narrative accounts of their traumas. Upon exiting the scanner, each subject avows that hearing the trauma script triggered a flashback—an extremely vivid “reliving” ­experience, complete with physical sensations related to the trauma. Their brain scans reveal that during their flashbacks, Broca’s area—“one of the speech centers in the brain, which is often affected in stroke patients”—went “offline.” “Without a functioning Broca’s area,” explains van der Kolk, “you cannot put your thoughts and feelings into words.” The deactivation of Broca’s area during flashbacks therefore demonstrates that traumatic memory is inaccessible to narrative and ­declarative consciousness. As van der Kolk wrote in 1995, “[traumatic] memory may be entirely organized on an implicit or perceptual level, without an accompanying narrative about what happened.”

Two flaws plague van der Kolk’s experiment. First, no control subjects were tested; as a result, we cannot know that the PET scans show the effects of traumatic memory. Perhaps a subject listening to a vivid narrative of fictional horror would exhibit the same patterns of brain activation and deactivation. Second, the trauma narratives read to the subjects had been composed by the subjects themselves. It is difficult to see how subjects whose brain scans reveal the deactivation of narrative consciousness in respect of traumatic memory can have provided narrative accounts of the very traumas whose memory causes this deactivation. McNally flagged both these flaws in 2003, when discussing van der Kolk’s 1995 article in his magisterial Remembering Trauma. Perhaps in response, van der Kolk concedes in The Body Keeps the Score that most trauma survivors will eventually piece together narratives of their traumas—but these ­narratives will be mere “cover ­stories,” which ­never come close to capturing the real experience of trauma. (Likewise, even the greatest poetry never comes close to capturing the real ­experience of romantic love, or of bereavement, or of religious ­ecstasy . . .)

Van der Kolk does not address research that calls into question his claim that PTSD sufferers lack narrative memory for trauma. For instance, studies in 1998 and 2001 evaluated rape narratives supplied by fourteen female victims of sexual assault. Though narrative complexity was found to decrease as the severity of PTSD symptoms increased, this inverse relation disappeared when the researchers ­controlled statistically for the effects of verbal intelligence. Traumatic memory is no more “fragmentary,” as a rule, than any other kind of memory.

The success of The Body Keeps the Score is one, and far from the only, sign that we are witnessing a return of recovered memory. Many had regarded the recovered-memory movement as permanently discredited by infamous cases such as that of the McMartin Preschool (1983–90), in which teachers were falsely accused by children of heinous, ludicrous, and often physically impossible acts. But in van der Kolk’s book the central tenets of recovered-memory theory—that traumatic memories are repressed and fragmentary, that they can be retrieved and reassembled in therapy—are revived.

Van der Kolk defends recovered memory, and in The Body Keeps the Score he purports to establish its psychobiological basis. He also boasts of his participation in the prosecutions of Boston-area priests accused of sexual abuse. Foremost among these was the “street priest” Paul Shanley. Only one of ­Shanley’s three accusers, “Julian” (real name Paul Busa), offered testimony that was deemed admissible. Busa’s story, like those of the other accusers, consisted entirely of recovered memories. Van der Kolk describes Busa’s testimony as “incoherent and fragmentary.” Other writers, discussing Busa’s claims in more detail, present a damning picture of almost certain perjury and prosecutorial malfeasance. Van der Kolk disclaims any duty to arbitrate the truth or falsity of this or any other trauma story: “My primary concern is not to determine exactly what happened to [alleged victims] but to help them tolerate the sensations, emotions, and reactions they experience.” Nonetheless, as he proudly recounts, he attested to the credibility of Busa’s memories.

“Nobody wants to remember trauma,” writes van der Kolk in The Body Keeps the Score. But Paul McHugh, reflecting on his years as chief of psychiatry at Johns Hopkins Hospital, recalls many painful encounters with women who appeared in his office requesting that he supply them with memories of sexual abuse, which they could not produce on their own. In The Courage To Heal(1988), another best-seller promoting recovered memory, Ellen Bass and Laura Davis inadvertently disclose why some people do want to remember trauma: “When you first remember your abuse or acknowledge its effects, you may feel tremendous relief. Finally there is a reason for your problems. There is someone, and something to blame.” The Body Keeps the Score shares with The Courage To Heal certain formal and practical similarities, including a spinoff “workbook.” But perhaps the most important similarity is that both books popularize the pernicious—ostensibly generous—notion that trauma is more or less everywhere, but characteristically invisible, forgotten.

This idea may be van der Kolk’s true inheritance from his “great teacher,” Elvin Semrad, a teaching psychiatrist at Massachusetts Mental Health Center from 1956 to 1976. Van der Kolk recounts a typical exchange with his teacher: “I remember asking him once: ‘What would you call this patient—schizophrenic or schizoaffective?’ He paused and stroked his chin, apparently deep in thought. ‘I think I’d call him ­Michael McIntyre.’” Van der Kolk takes this incident as a lesson in never losing sight of the humanity of patients. It might also be ­understood to reveal ­Semrad’s ­limitations as a clinician. He had little to offer the schizophrenic patients at Mass Mental, especially as he refused on principle to prescribe ­antipsychotic medications. Semrad was more an analyst than a ­psychiatrist, and as much an antipsychiatrist as an ­analyst.

The 1960s vogue for anti­psychiatry, led by such luminaries as Thomas Szasz, R. D. Laing, ­Erving Goffman, and Michel ­Foucault, held that we are all mad in our own ways—indeed, that the maddest of us are the sanest of us. In this heroic ideal, indebted to literary ­Romanticism, madness is a shattering originality of vision. The outward symptoms of psychological disturbance are artifacts of originality’s encounter with a world that madly insists on uniformity and conformity. (Van der Kolk reports that Semrad considered disturbed behavior “an adaptation to the complexities of the world.”)

With trauma swapped in for madness, this paradigm seems Semrad’s true bequest to van der Kolk, and antipsychiatry’s true bequest to the twenty-first century. In the precepts that trauma is ubiquitous and trivialities can traumatize, we find trauma characterized as an artifact of the psyche’s encounter with an unjust world. Trauma becomes a signal aspect of interiority, perhaps the perfection of it. The tragic heroes of Shakespeare become through their suffering the perfection of human interiority; in van der Kolk’s telling, they are at their greatest when they confess that they cannot speak their suffering. Van der Kolk’s rhetoric of “getting in touch” draws on a schema of ­personal cultivation, comporting with the bourgeois pursuits of cultivated people—yoga, mindfulness, dance, theater—and s­­uggesting that when we are conscious of our trauma, then we are most fully ­realized. The contemporary prestige of trauma arises not just from the cult of the victim and the nobility of the survivor, but from the attribution of self-awareness and psychic depth.

Van der Kolk ran into trouble in 2017, during the first season of #MeToo. The Justice Resource Institute, parent company of the Trauma Center he had founded in 1982, fired him due to allegations that he had ­created a “toxic work environment.” The episode was experienced as traumatic by his acolytes, including Laurie Kahn, a therapist who writes for Psych Central: “I’ve seen the inner workings of the impact of betrayal trauma in hundreds of patients and now I am seeing them in myself. . . . When I first read the news report in The Boston Globe, I was filled with dread. I had nightmares. I experienced an emotional whiplash.” Shortly after, almost the entire executive staff of the Trauma Center resigned in protest and ­reconstituted itself as a new 501(c)3 with van der Kolk at its head.

In The Body Keeps the Score, van der Kolk wrote hopefully, “We are on the verge of becoming a trauma-conscious society.” He got his wish in #MeToo, the thesis of which is that trauma is more or less everywhere in American society, even where it is not visible. “Trauma remains . . . arguably the greatest threat to our national well-being,” writes van der Kolk, and he enumerates among our national traumas gun violence, domestic violence, and the “developmental trauma” of growing up in poverty. He sees “denial of the consequences of trauma” as a main cause of every bad and nearly every momentous thing, including the Holocaust and the wars that led to it and followed upon it.

In the Treaty of Versailles, America and her allies humiliated “an already disgraced Germany,” which in turn “dealt ruthlessly with its own traumatized veterans,” whose abjection led to the rise of Nazism. Back at home, veterans of the Great War were treated poorly by the American state, their shell shock untreated, their pensions often denied. Veterans of World War II would fare better, thanks to the GI Bill and the Veterans Administration. But combat trauma continued to be scanted by American psychiatry, and wars continued. The pax Americana was born of trauma and inflicts further traumas in order to perpetuate itself: Vietnam, Afghanistan, Iraq. To the extent that violence and inequity are ineradicable, trauma may be judged constitutive of the regnant order, the radically negative foundation of American society.

The thesis of Black Lives Matter is that America was and is ­founded on the traumatization of black bodies. The 1619 Project accordingly dates our founding to the arrival in Virginia of the first African slaves. Van der Kolk promises that “getting in touch” and “moving on” mean reconciling with one’s body, one’s history, and other people. Yet if we become “trauma-conscious” as he desires, injury and betrayal seem likely to appear at the heart of society, in the place once reserved for love and trust.

The Body Keeps the Score exhibits one other curious tension. It devotes much energy to defining psychological trauma and its effects in medical terms. The medical model suggests that our ­profoundest problems are fixable and do not implicate character; we are comforted to learn that our wounds are not in our souls. Yet van der Kolk understands that what the ­trauma-­conscious finally desire is a ­spiritual cure. Observe it in his subtitle, in the phrase “the Healing of Trauma”: Whereas “trauma,” borrowed from Greek, has always been a medical term in English, the Anglo-Saxon “healing” is holistic. Souls admit of healing. Van der Kolk understands that the trauma-conscious want to be not just healthy, but happy and whole.

A spirituality is therefore called for, and in yoga, theater, and dance it has its bourgeois liturgies. Doctrinally, van der Kolk’s therapeutic creed both resembles Christianity and inverts it. His first tenet is that we cannot heal our trauma without meditating on it. Christians have for centuries meditated on the wounds (Greek: trauma) of Christ, for it is by his wounds that we are healed. In van der Kolk’s faith, the survivor replaces the savior, and healing flows not from Christ’s wounds, but from our own.

Julia Yost is senior editor of First Things.