The Body Keeps the Score Book Summary

Many Vietnam war veterans continued to be haunted by their traumatic combat experiences years or decades later, unable to move on with their lives. Their trauma infiltrated every aspect of their lives, making it difficult to maintain relationships, find satisfaction in work, and control intense emotions like rage. Trauma leaves an imprint on mind, brain, and body that persists long after the original event. Healing requires finding ways to come fully alive in the present rather than remaining stuck in the past.

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"The greatest sources of our suffering are the lies we tell ourselves" - Elvin Semrad

Van der Kolk's teacher Elvin Semrad taught that the biggest obstacles to healing are the denial, lies and self-deceptions trauma survivors tell themselves to avoid the painful truth of their past. Being honest with oneself about one's experience and feelings is an essential first step in recovery.

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The brain develops sequentially "from the bottom up", starting with the brainstem that controls basic survival functions, then the emotional brain or limbic system, and finally the rational brain or neocortex. Emotional and relational patterns learned in childhood become deeply ingrained in the limbic system and shape our expectations and behaviors in relationships throughout life. When early attachment relationships are disrupted by abuse or neglect, the emotional brain becomes hyperreactive to threat and the rational brain loses its ability to effectively regulate emotions and impulses. This sets the stage for psychological problems later in life.

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Conventional talk therapy relies on the rational brain to try to control the emotional brain through insight and understanding. But when people are triggered into trauma responses, the rational brain goes "offline" and loses its ability to override the emotional brain.

• Therapists must help patients learn to regulate their physiological arousal and feel safe and grounded in their bodies, not just understand their issues intellectually. Mindfulness practices, yoga, and other body-based techniques can be valuable tools for this.
• Medication can help dampen hyperreactivity in the emotional brain, but is not enough for full recovery. Therapy must engage the whole organism and promote actual experiences of safety and mastery.

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Brain scans of trauma survivors in the throes of a flashback show that the amygdala, the brain's "smoke detector" for threat, remains highly activated as if the trauma were happening in the present. This occurs even decades after the original event. At the same time, Broca's area, the part of the brain responsible for putting feelings into words, goes "offline," making it difficult for trauma survivors to articulate what they are experiencing. Trauma also appears to affect the brain in a highly lateralized fashion, shutting down the left hemisphere responsible for language and sequential ordering, while the right hemisphere responsible for emotional and sensory experience goes into overdrive. This results in the fragmentation of traumatic memories into sensory "splinter skills" without a coherent narrative.

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Faced with overwhelming threat, the brain triggers preprogrammed physical escape plans: fight, flight, or freeze. This happens automatically, before the thinking brain has time to process what's happening.

When these survival responses succeed in getting a person out of danger, the nervous system is able to return to baseline once the threat has passed. But if escape is thwarted, the brain and body keep sounding the alarm, leading to chronic hyperarousal and vigilance.

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According to pioneer Charles Darwin, emotions are fundamentally rooted in the body and give shape and direction to behavior:

• The autonomic nervous system (ANS) is key in regulating emotions and arousal through the sympathetic (accelerator) and parasympathetic (brake) branches
• Trauma upsets the balance between the sympathetic and parasympathetic nervous systems, leading to issues like hyperarousal, numbing, and dissociation
• The body continues to react as if the trauma is ongoing, even after the threat has passed

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Children who grow up with abuse and neglect lack a stable, cohesive sense of self. Traumatized children have trouble sensing what is going on inside their bodies and cannot describe their feelings. This impairs their ability to know what they want or to protect themselves from danger

Abused children often blame themselves and feel defective, developing a deep sense of inner badness. In adulthood, child abuse survivors continue to struggle with self-loathing, emptiness and feeling unreal

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Infants learn to regulate their arousal and emotions through attunement with caregiversWhen a caregiver is responsive and attuned, the child feels soothed and connected. Misattunement, as when a caregiver doesn't respond, is overwhelming for babies. Repeated attunement builds secure attachment, allowing optimal child development. Disrupted attunement, as in abuse and neglect, leads to emotional dysregulation

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Sexual abuse has profound negative impacts on child development. Sexually abused girls show cognitive deficits, depression, dissociation, eating issues, self-harm, substance abuse and sexual problems. They have difficulty forming healthy peer relationships, especially in adolescence. Abuse speeds up biological development, with early puberty and sexual development.

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Patients with histories of abuse and neglect often receive many different psychiatric diagnoses over time, like depression, bipolar disorder, ADHD, borderline personality, etc.

• However, none of these diagnoses adequately capture what these patients are truly suffering from or point to effective treatments
• The current diagnostic system fails to recognize the profound impact of abuse, neglect and abandonment in childhood
• As a result, treatment ends up focusing narrowly on managing symptoms with drugs rather than addressing the underlying trauma and attachment disruptions

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• Traumatic memories are often stored as fragmented sensations, images and emotions rather than as a coherent narrative. They persist with "astonishing freshness" and can be triggered involuntarily
• This is in contrast to ordinary memories which evolve and change over time
• Traumatized individuals simultaneously remember "too little and too much" - explicit memory may be impaired while implicit trauma memories intrude. Recovery involves putting the trauma in the past and regaining ownership of body and mind

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While language is crucial for processing traumatic experiences, it also has constraints:

• Traumatized individuals often struggle to put their experiences into words - the default is speechless terror
• Trauma is registered in the body and right brain, while language is the province of the left brain
• Focusing exclusively on creating a narrative can keep one stuck in trauma - it needs to be balanced with accessing sensations and emotions
• Therapists must be able to tolerate patients' intense affects and sensory experiences without fleeing into intellectualization

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Van der Kolk presents the Internal Family Systems (IFS) model as a paradigm for restoring inner harmony after trauma. In IFS, the psyche is viewed as a system of interacting "parts" with different roles and agendas. Trauma disrupts this inner ecology, causing parts to become polarized and disconnected from the core Self.

The goal of IFS therapy is to reestablish the Self's innate leadership and compassion. The Self is the seat of clarity, confidence and curiosity - it is not identified with any one part but can create space for all. From this empowered center, the individual can open a dialogue with the protective parts that carry trauma burdens.

Exiles are the wounded parts that become frozen in time, bearing the pain, terror and shame of trauma. Managers are the preemptively controlling parts that try to safeguard against further wounding. Firefighters are the impulsive, self-destructive parts that try to extinguish overwhelming emotions.

IFS teaches people to embrace all their parts with understanding and empathy. As the Self grows more robust, it can help exiles to heal, managers to relax, and firefighters to discover new roles. By honoring each part's positive intention and releasing it from extremes, the system moves toward balance and wholeness.

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Many traumatized children grow up with an aching void - the absence of feeling loved, seen, soothed or safe. These deficits in early nurturance create "holes in the soul" that continue to undermine adult functioning, even after considerable therapeutic work.

Van der Kolk poses the question: How can we help people acquire an embodied sense of security when it was missing from the start? How can the brain and nervous system belatedly experience the warmth, resonance and regulation that are essential for healthy development?

While therapists can provide a reparative attachment experience to some degree, van der Kolk suggests that somatic practices may offer a more direct route to filling developmental gaps. By engaging in powerful physical experiences of attunement and protection, patients can viscerally encode new possibilities of comfort and connection.

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Neurofeedback is a technology that allows individuals to directly reshape their brain wave patterns through real-time feedback. By targeting areas of dysregulation associated with trauma, such as the fear center in the temporal lobe, neurofeedback can help restore neural integration and flexibility. As patients learn to consciously shift their brain activity, they develop a greater capacity for self-regulation and emotional balance. Neurofeedback capitalizes on the brain's neuroplasticity to gradually rewire the patterns that keep traumatized people stuck in cycles of hyperarousal and dissociation.

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Communal rhythmic activities and theater can serve as powerful tools for trauma recovery. Moving together to a shared beat fosters a sense of attunement, connection, and empowerment - experiences often shattered by trauma. Theater allows survivors to safely express and transform their stories through embodied role-play and collective creation. By physically experimenting with new possibilities, they can reclaim a sense of agency and spontaneity. These expressive arts tap into the emotional brain and invite the whole self into a space of witnessed authenticity. They remind trauma survivors of their capacity to create beauty and meaning from the fragments of pain.

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