I’ve only just learned about this book and have not read it but didn’t want to wait for whenever, if ever, that might happen to pass it on to readers here.
Many adoptees and foster children have some degree of trauma. It is said that this is one of the best-known books about trauma, and in particular early life trauma (which especially applies to the topics I cover in this blog).
It is not light weight reading, has almost 500 pages that includes a significant reference section. Someone who did read this (link at bottom of this essay) says – “It’s very in-depth, giving plenty of detail, but it’s not unnecessarily complicated. There’s some technical terminology used, particularly with respect to the functioning of the brain, but I thought this was explained well.”
Van der Kolk is a psychiatrist who initially began working with trauma while treating war veterans. There was a lot that wasn’t known about trauma then. He’s been an active researcher throughout his career and often considered at the forefront of new trauma-related knowledge.
In this book, he repeatedly stresses the importance of recognizing the changes that occur in the brains and nervous systems of people who’ve been through trauma, and targeting treatment accordingly with the goal of getting back the functioning they have lost. He is quoted as saying, “Trauma results in a fundamental reorganization of the way mind and brain manage perceptions. It changes not only how we think and what we think about, but also our very capacity to think.”
Imaging studies have produced some new understandings about flashbacks. There’s activation of the right brain along with a drop in activity in the brain structure called the thalamus, which prevents the events from being remembered as a coherent narrative, as would be the case with other kinds of memories.
Brain scans have also shown an impaired self-awareness. Van der Kolk explains that this is why it’s important to work on breathing, mindfulness, and recognizing the link between physical sensations and emotions. He writes further: “The body keeps the score: If the memory of trauma is encoded in the viscera, in heartbreaking and gut-wrenching emotions, in autoimmune disorders and skeletal/muscular problems, and if mind/brain/visceral communication is the royal road to emotion regulation, this demands a radical shift in our therapeutic assumptions.”
The book pays a lot of attention to early life trauma, including issues like attachment and attunement. The author explains that trauma increases the need for attachment, even when the only attachment figure available to the child is the abuser.
Van der Kolk championed adding complex PTSD as a separate diagnosis from PTSD. He was part of the working group that proposed C-PTSD for inclusion in the DSM-IV, and the group that proposed developmental trauma disorder for inclusion in the DSM-5. American Psychiatric Association did not approve any of these suggestions as new diagnoses.
I am indebted to Ashley of The Mental Health @ Home blog for her review which is the basis of my own blog today. You can read more about this book in her article.