Dr. Bessel van der Kolk’s new book, The Body Keeps the Score, is filled with wisdom, compassion, brilliance, and profound understanding. PTSD (Post-traumatic Stress Disorder) has never been made SO clear. PTSD has never been presented as passionately and humanely. Read one, two, or all of the quotes below that I’ve chosen to showcase this amazing work. Why is each quote so long? Because Van der Kolk’s ideas are so fresh and brilliant, I couldn’t stop once I started! I’ve only read half the book or there would have been more!
“We now know that trauma compromises the brain area that communicates the physical, embodied feeling of being alive. These changes explain why traumatized individuals become hypervigilant to threat at the expense of spontaneously engaging in their day-to-day lives. They also help us understand why traumatized people so often keep repeating the same problems and have such trouble learning from experience. We now know that their behaviors are not the result of moral failings or signs of lack of willpower or bad character–they are caused by actual changes in the brain” (3).
“After conducting numerous studies of medications for PTSD, I have come to realize that psychiatric medications have a serious downside, as they may deflect attention from dealing with the underlying issues. The brain-disease model takes control over people’s fate out of their own hands and puts doctors and insurance companies in charge of fixing their problems. Over the past three decades, psychiatric medications have become a mainstay in our culture, with dubious consequences. Consider the case of antidepressants. If they were indeed as effective as we have been led to believe, depression should by now have become a minor issue in our society. Instead, even as antidepressant use continues to increase, it has not made a dent in hospital admissions for depression. The number of people treated for depression has tripled over the past two decades, and one in ten Americans now take antidepressants” (37).
“People who suffer from flashbacks often organize their lives around trying to protect against them. They may compulsively go to the gym to pump iron (but finding they are never strong enough), numb themselves with drugs, or try to cultivate an illusory sense of control in highly dangerous situations (like motorcycle racing, bungee jumping, or working as an ambulance driver). Constantly fighting unseen dangers is exhausting and leaves them fatigued, depressed, and weary” (67).
“In order to change, people need to become aware of their sensations and the way that their bodies interact with the world around them. Physical self-awareness is the first step in releasing the tyranny of the past. How can people open up to and explore their internal world of sensation and emotions? In my practice I begin the process by helping my patients to first notice and then describe the feelings in their bodies–not emotions such as anger or anxiety or fear but the physical sensations beneath the emotions: pressure, heat, muscular tension, tingling, caving in, feeling hollow, and so on. I also work on identifying the sensations associated with relaxation or pleasure. I help them become aware of their breath, their gestures and movements. . . . Noticing sensations for the first time can be quite distressing . . . All too often . . . drugs such as Abilify, Zyprexa, and Seroquel are prescribed instead of teaching people the skills to deal with such distressing physical reactions” (101).
“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” (101).
“Nobody can ‘treat’ a war, or abuse, rape, molestation, or any other horrendous event, for that matter; what has happened cannot be undone. But what can be dealt with are the imprints of the trauma on body, mind, and soul: the crushing sensations in your chest that you may label as anxiety or depression; the fear of losing control; always being on alert for danger or rejection; the self-loathing; the nightmares and flashbacks; the fog that keeps you from staying on task and from engaging fully in what you are doing; being unable to fully open your heart to another human being” (203).
As yet, Dr. van der Kolk has not mentioned PTSD due to infant surgery with or without anesthesia or invasive medical procedures on children and infants. This omission disappoints me as I’m a survivor of pyloric stenosis (stomach blockage) surgery without anesthesia as an infant and suffer from PTSD as a result. I haven’t though given up hope. Moreover, I feel seen despite. In any case, relish collecting your own quotes as you read Van der Kolk’s magnificent book The Body Keeps the Score.
Thank you Wendy for your continuing series of posts about Dr Bessel van der Kolk and your excitement about his latest book.
I want to underline the quotation you have included above about the limited benefits of medication in treating trauma and depression (as opposed to organically-based mental illnesses). I remember mentioning to you (and perhaps here online also) that a psychiatrist acquaintance of mine had said the same thing. Even more strongly: that many people with trauma or depression can be as well helped by a sensitive and aware friend as by a professional. And I can vouch for that: this psychiatrist (one of the top ones in our State) is managing the “issues” of somebody else I know very effectively, thank you, really just by being “a good friend”.
Books like those of people like Dr van der Kolk can do great things to make people like us aware and able to be excellent people-helpers.
I also share your sadness that despite what has been researched, written and done in recent decades, there is still so little recognition of the possible long-term damage done by infant surgery and the underlying attitudes and mantras which so often held sway in times not so long ago – even into the 1990s.
You are I will continue to write publicly about this, and our efforts will continue to inform and encourage others affected to speak up and join our little band of “survivor advocates”.
Thank you, Fred, for understanding the importance of Bessel van der Kolk’s voice. His perspective is priceless. I appreciate your affirmation of the quote about medication. There was another quote about the unscientific foundation of the DSM-VR, the diagnostic manual that psychologists and psychiatrists use to label people and get insurance reimbursement. Another time. You, above all, understand my disappointment about the infant surgery omission thus far in his book. I looked in the index but no mention of infant surgery and lack of anesthesia and pain control in infant surgery. (As I said in the post, I’m only half-way through the book.) There was, however, a page or so about a woman’s insufficient anesthesia experience, which served me well in imagining what our experience under the knife must have been like. In reading her account, I easily put myself in her shoes. Terrifying. I felt so much compassion for myself and for all babies operated on without anesthesia. The story of her life afterward was also shocking, for this experience threw her into serious PTSD, deeply disrupting her life. Another connection for me there. Yes, you and I will keep broadcasting the message about the consequences of infant surgery without anesthesia. I’m so glad and honored to be in the “survivor advocates” boat with you all these years! Paddle on!
As always, I greatly appreciate your taking the time to share this valuable material. Like you and Fred, I lament the ongoing lack of widespread awareness about the impact of infant surgery without anesthesia on so many people in the twentieth century and even in recent times. One reason for this, I believe, is that there are so few people like us who have managed to become aware of the experiential source of our own responses to such surgery, so our symptoms are treated as medical rather than experiential issues.
I recently sent a copy of a long paper about my discovery of circumcision trauma during regressive therapy to the psychiatrist I saw every week for ten years in the 1960s and he responded with the following email message: “Sorry, I can’t relate to this.” I was very upset and told him so in a response to which he just replied “Sorry!” Unfortunately, words on paper–even eloquent words–are not understandable to people who are themselves deeply repressed. In the case of infant circumcision, it is staggering to think how may people suffer from this trauma without any awareness of its profound traumatic effects.
I want you to know that I’ve been tentatively invited to present on this topic at an APPPAH meeting in San Francisco next May, just before a meeting of an Obstetrician Congress. Marilyn Milos will be presenting in the same hour-long session. I plan to link my topic to Terry Monell’s research on infant surgical trauma, largely because only certain people even at APPPAH quite “get it” about this topic. Are you, Fred, or anyone else tuning in here members of APPPAH?
Thanks again, Wendy, for the helpful Bessel van der Kolk quotations! Our connection is very important to me!
So great to hear from you, Robert! So happy to be in the “survivor advocates” (as Fred calls it) boat with you. And very honored. I am not a member of APPPAH. As I think I emailed you months ago, I submitted a proposal a few years ago to speak and was turned down. I also asked for a slight scholarship to attend the conference two years ago but APPPAH lost track of my application. Right now, APPPAH is not in the cards for me, but I’d love to attend your panel discussion. Perhaps I’ll inquire about attending, not the whole conference, but the morning or afternoon that you’ll present. I’m glad you liked the van der Kolk material. Our connection is very important to me as well. Perhaps one day down the road, we’ll be on a panel together. I’m ⅔ finished with The Body Keeps the Score and still no mention of infant surgery without anesthesia. I plan to write to him about the omission if it persists. It’s unlikely he’ll get the message, but I’ll try. Looking forward to our continued connecting in the new year! Congrats, btw, on the invitation to present at APPPAH. Very exciting!