There are only a handful of books that I can recall that totally blew my mind as I read them. Usually they are chocked full of layers of revelations that keep getting more and more fascinating with each chapter. This book was all of that, and then some.
Content warnings: murder, sexual assault, self harm, torture, child abuse.
I’ve been going through some tough times in my personal life, and I think I was in an emotionally primed state for this book on trauma to really hit me in the feels. I listened to it on audiobook while taking really long walks and there were several times where I started sobbing and hyperventilating at the same time while walking through the empty streets of Singapore.
As the title suggests, the book is about how trauma works, how it takes root in our body, and the ways in which it can be treated and overcome. Van der Kolk is a very esteemed psychiatrist who has worked on the topic of trauma for decades. He’s both a clinician and a researcher and was one of the people who originally came up with the diagnosis of Post Traumatic Stress Disorder (PTSD) while working with American veterans of the Vietnam war.
There are many retellings of his patients’ experiences from his decades of work as a clinician that really makes this book a non-stop cascade of the most gut wrenching and human stories. Many are horrific and reading all the ways in which people can inflict the worst atrocities on one another really felt like a series of gut punches. From soldiers who had their friends killed who then in turn committed their own atrocities having ceaseless flashbacks of mutilated bodies and dead children, to the dozens of accounts of survivors of childhood sexual abuse who go through cycles of self destructive behaviour, it’s all quite overwhelming.
The book is not just about anecdotes though. All these human stories form the backbone of a narrative that tells the story of the development of psychiatry as a science with all its follies and setbacks (the author has been waging a relentless campaign within his own profession to take a more complex, embodied approach to understanding trauma), and explanations of the biological and neurological underpinnings of how trauma affects and stays in the body in a very literal way.
The word “visceral” comes up over and over again, and he talks about how it is literally in our viscera that the trauma is imprinted. He explains that “being traumatized means continuing to organize your life as if the trauma were still going on – unchanged and immutable – as every new encounter or event is contaminated by the past” (p62). Your traumatized brain will keep sending signals to your body to escape a threat that has happened long ago, as if it literally is still happening to you. How the body deals with this is frightening: from feeling like everything around you can be a threat, to being triggered by things that have the smallest connection to the traumatic event, to entirely not being able to feel certain body parts, to completely blocking out the memories of the events. This one story made my jaw drop: a patient of his, when asked to draw a picture of her childhood, drew a horrific drawing of herself as a child trapped in a cage surrounded by menacing dark figures with no eyes and a giant erect penis pointed towards her, nevertheless kept insisting that she “must have had” a happy childhood.
As much as the stories of abuse and violent encounters were gut wrenching, the second half of the book deals with different types of treatments that were at the forefront of research and really gave a hopeful counterweight to the horrors described. Van der Kolk is convinced that trauma is the most important public health crisis that we face, and that especially for those trauma victims who faced abuse as a child from their own caregivers, they have to work through a great deal of damage as they grow into adulthood.
I’ve always thought (in my ignorance) that this kind of deep trauma really stays with you forever and you just have to cope with a certain stoicism but the pathways to recovery that he describes were really fascinating. He is adamant that the way trauma is treated with medication is inadequate and does not undo the root causes of the damage – patients relapse once they are off their meds. Eye Movement Desensitisation and Reprocessing (ESMR) uses a very simple technique of recreating the rapid eye movements experienced during REM while someone is fully conscious to reconstruct and recontextualise fragmented traumatic memories. Internal Family Systems therapy gets patients to isolate different “selves” inside them, for example: the aggressive child throwing tantrums, the promiscuous adolescent, the critic who is always passing judgment, and the manager obsessively keeping things orderly. Yoga and mindfulness are other ways to restore ownership of one’s body, letting your body tell its story, and its truth to your mind.
Some parts of this sounded almost new agey, and if it wasn’t for the author repeatedly citing empirical research published in top scientific journals showing the treatments’ effectiveness I would have been skeptical. None of this is new. Every culture on earth has ways of getting in touch with one’s own body to heal, from yoga to chi gong to drum circles and communal singing. I am reminded of my own personal experience of the one time I went on a vipassana meditation retreat where the only thing we had to do was to be mindful of the sensations in each part of our body in as minute detail as we can. After reading this book it really struck me how much that wasn’t so much a spiritual journey but a completely pragmatic one, which comes from the awareness of healing from trauma in my own Burmese culture.
My culture is also one that is really averse to mental health awareness. I feel we are too stoic and too eager to dismiss mental health issues as not just unimportant but even non existent – the stigma of being “crazy” or overly emotional cocoons us from expressing things as we really feel them. One thing that changed in recent years following the coup is that I definitely find that admitting that we all went through trauma is now quite normal, and that seeking help for mental health is no longer a taboo topic of discussion. On a personal level, I’ve really come to appreciate the importance of all this, after seeing the people I love experiencing their own cycles of trauma and slowly realizing how much of my own trauma I have to work through. This book gave me hope that there is a whole world of things I need to learn about, and unlike other nerdy topics that I like to peruse, this one can put me and the people I care about the most in my life on a journey of healing.