The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma

Chapter 8 addresses how childhood trauma can affect the rest of a person’s life, even if they have blocked out the actual events. Van der Kolk illustrates this concept through the story of one of his patients, Marilyn. Marilyn has a violent reaction to a romantic encounter with a man, which prompts her to seek help. She does not recall any abuse and thinks that she “must have had a happy childhood” (126). Eventually, through group therapy and hearing of another woman’s experiences, Marilyn realizes she was abused as a child. She and van der Kolk eventually learn that her father and brother repeatedly raped and beat her, and that she dissociated as a way of protecting herself.

Van der Kolk explains how dissociation as a form of coping can lead to fully blocking out bad experiences mentally, but that doing so can cause physical problems as the body searches for an outlet. He runs a study in which he learns that patients with histories of incest have a greater likelihood of developing autoimmune diseases, nothing that “the immune system [is] oversensitive to threat, so that it is prone to mount a defense when none in needed, even when this means attacking the body’s own cells” (129).

Van der Kolk also observes that children tend to remain attached to their caretakers, even when the caretakers are the source of pain. Most children, no matter how badly treated, will generally want to stay with their caregivers, and the prospect of telling someone about what’s happening at home comes with the threat of being hurt further if the caretaker finds out. 

Chapters 9 and 10 address the disconnect between the field of psychiatry and the treatment of traumatized children. Critiquing the “bible” of psychiatry, the Diagnostic and Statistical Manual of Mental Disorders (or DSM), van der Kolk notes that although psychiatry is not as precise a science as other areas of medicine, the DSM treats it as if it were. He adds, “All too often diagnoses are mere tallies of symptoms, leaving patients […] likely to be viewed as out-of-control women who need to be straightened out” (139).

Van der Kolk illustrates modern medicine’s resistance to trauma diagnoses through two studies. Researching the connection between borderline personality disorder (BPD) and trauma, Van der Kolk’s team finds overwhelming data connecting the two, and are asked to do a field study for the next edition of the DSM. Despite their evidence, the new diagnosis they create—“Disorders of Extreme Stress, Not Otherwise Specified” (145)—does not appear in the new DSM edition because it will impede insurance reimbursement because of how the insurance system in the United States works. Without a diagnosis, doctors cannot submit their work to insurance companies, making them unable to adequately help their patients.

The second study van der Kolk mentions is the Adverse Childhood Experiences (ACE) study, which finds overwhelming evidence both for the prevalence of child abuse and neglect in the United States and for the lasting effects that this trauma causes. Van der Kolk points out, “As the children matured, they didn’t ‘outgrow’ the effects of their early experiences” (148). Child abuse and neglect can cause behavioral problems, inclination to self-harm, addiction, and higher incidences of life-threatening diseases from stress on the body. The ACE study finds that child abuse is “the gravest and most costly public health issue in the United States” (150), and yet it has had no effect on classification or treatment systems.

Chapter 10 more closely examines how the psychiatric industry has failed children with traumatic home environments. Multiple studies of both primates and humans have shown that nature and nurture are almost equally important in determining the likelihood of someone developing a mental illness, and that those with genetic problems can still lead normal lives if raised in a safe environment: “Safe and protective early relationships are critical to protect children from long-term problems” (156).

Van der Kolk chronicles his complicated experiences when attempting to get better diagnoses and treatment for abused and neglected children. Through van der Kolk’s efforts in conjunction with other researchers, in 2001, the U.S. Congress established the National Child Traumatic Stress Network, which has since run studies on traumatized children that corroborate data from the ACE study. Van der Kolk points out that PTSD is different from the trauma children experience, noting: “Eighty two percent of the traumatized children seen in the national Child Traumatic Stress Network do not meet diagnostic criteria for PTSD” (159).

Van der Kolk and his colleagues developed a new diagnosis category specifically for traumatized children: Developmental Trauma Disorder. Despite providing research as well as supporting letters from mental health commissioners to the APA, the DSM-V refused to include DTD. Van der Kolk explains two of the supporting studies his team submitted, including one studying child/mother relationships and the other, the effects of incest on young girls. In van der Kolk’s assessment, the DSM-V “largely lacks what in the world of science is known as ‘reliability’—the ability to produce consistent, replicable results” (166).

The new DSM ignores social causes of abnormal behavior, instead focusing on trying to pin down biological causes in an attempt to align psychological illness with physical disorders. He concludes that improper diagnosis accounts for a huge burden on taxpayers, as the public ends up paying more for rehabilitation and incarceration of troubled youth than would be spent on preventative measures.