Warren Fournier's Reviews > The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma

This book has received much praise and also disappointed many readers. I now understand why. If you plan to read this book, you need to understand it's two basic characteristics: 1) it's POP-SCIENCE and 2) it's TRAUMATIZING.

Let's tackle the first point. Pop-science is not science. People who write pop-science are rock stars with a degree. Most of them are administrators who spend most of their time on the lecture circuit, writing books, attending conferences, and managing a host of grant writers, practitioners, medical staff, public relations experts, middle managers, and financial officers. Their days of actually practicing their art has long gone, but they still will occasionally see the odd patient here and there to keep their feet wet, their privileges relevant, and to demonstrate their medical genius.

How do I know this? I've been practicing psychiatry for two decades and have worked with and met my share of famous pop-practitioners in my various roles as a medical provider, chief medical officer, State government policy-maker, public speaker, and chief executive officer. Dr. van der Kolk is one of those rockstars and thought leaders.

And it is thanks to people like him that we have a society that has been moving at all to trauma-informed care, and to understanding the neurology behind anxiety and disorders impacted by or caused by trauma. And it is thanks to books like this that the known science is explained in a way that is accessible to people who have not lived their whole lives speaking the lingo. This book was designed to turn on light bulbs, to inspire, and to reduce stigma. One of the greatest things I can ever do for a patient is to DEMYSTIFY their experience. When people realize that their experiences are not due to moral failings, or to being weak-willed, or because they are "crazy," when it all ceases to be magic and now they can define it and hold it in their hands, then they have a challenge with solutions rather than a stigma to hide from others and themselves.

But this then leads to the weaknesses of books like this. Pop-science has to balance rigorous academic standards with making a product that is easily understandable and sensational enough to sell to a wide audience. So the science will not all be fully explained or referenced. And what science there is may be flawed by the basic issue that there just aren't the same standards applied to a self-help book as to a scientific journal article. So Dr. van der Kolk can ramble on about how what a mensch he is, and tell sensational details about his experiences with patients, and take some liberties with the verifiability and consistency of his outcomes.

Therefore, do NOT think this is the book that will change your life with secrets no one but the chosen few have known till now. And do NOT read this book with the idea that you will be able to debunk scientifically everything the author is saying and prove he is a fraud. And do NOT read this book if you are easily triggered.

Regarding my later warning, know that this book goes into some explicit details regarding traumatic events. Some may hit a little too close to home. And this leads to my main criticism of van der Kolk's work--I don't think he takes into account enough the potential to RE-TRAUMATIZE.

I think an important take-away should be that your brain is designed to protect you from danger, and one of the ways it does this is by erring on the side of being hyper-alert. All humans are designed this way. If you were to hear a rustle in the bushes, it's best to assume it's a lion and not a rabbit. Because what if it is a rabbit? No harm is done if you run from a noise when it was only caused by a little bunny. But if you were to make the opposite error and assume the rustle is something harmless and it's really a hungry carnivore, well you may just get removed from the gene pool. So we are all primed this way. But what if at some point in your life everything proves to be a lion? And no matter what you know to do to avoid the danger, nothing works to protect you or someone next to you?

Now that is when your brain essentially short circuits the traumatic memory. Merciful to say the least. But your brain is also responsible for keeping you from getting hurt again. If you burn your hand on a hot stove, you will rightfully feel anxiety near a hot stove. This is protective. But with PTSD, now you have a situation where your anxiety isn't necessarily paired with a conscious cognition. Fear, panic, defensiveness, aggression, may seem to come out of nowhere.

So where this book fails to tread lightly is in the emphasis on verbalizing the traumatic event, the idea being that making those cognitive connections gives the traumatized person more control and the therapist more access to working through cognitive distortions that are no longer helpful in protecting the person. This overemphasis tends to lead to some gratuitous sharing by patients, which then gets gratuitously shared in this book, and then we get to vicariously read about these experiences.

And here's the clincher--the book didn't need to go there. People can and do get better without having to wallow in their story by telling it over and over again. Sometimes there is no way to even know if the story you get from this practice is accurate, because our minds naturally confabulate and fill in gaps of memory. This book should have discussed the danger of therapists accidentally contributing to false memories and retraumatizing someone. It should have focused more on grasping the here and now, no matter what the past story. In Chapter 6, he does mention the importance of physical self-awareness as essential for fully experiencing the present, and my own clinical experience finds this to be absolutely spot on. It is not avoidance. Accepting that something awful has happened and then helping that person develop more effective ways of interacting with a world that is, in fact, not completely filled with nothing but hot stoves and lions--that's what this book is ultimately all about. Therefore, all the patient anecdotes were unnecessary in my opinion.

So that is why I give this book a middling review. I do recommend it, but proceed with caution.