A Different Approach to Trauma Healing: The Body Keeps the Score {Book Review: Part 1}

This is Part 1 in a series of three articles that will discuss themes from the book, The Body Keeps the Score — a resource for trauma healing and recovery from PTSD.

* Names have been changed in this article

I worked with a man named Robert and his family many years ago, but I remember them well because they were such a classic case.  Robert* was a combat soldier who’d returned home after a tour of duty in Afghanistan.

Professionals at his son’s school began to grow concerned, reported family issues to the Department for Health Services (DSHS), and because of his service, CPS provided a counselor even though there wasn’t any real evidence of childhood safety issues.

I was sent to provide family counseling, and to assess for DSHS whatever safety concerns I stumbled upon. Within a few meetings with the family – Robert, his wife, and Robert’s teenage son – I knew that there wasn’t going to be any sitting down with the whole family.

Instead, I met with Robert’s wife alone. She needed help coping with Robert’s shocking new and unwanted behaviors. I noted right away that Robert wasn’t just unwilling, but unable to sit and participate in conversations.

The longest he managed to participate in counseling was a few seconds before he’d see a certain expression of concern on my face, and especially on his wife’s. On the two occasions when he tried to join us, he jumped out of his chair and fled from the room. It was as if sniper fire was whizzing over his head and he had to make a break.  He cupped his ears as if words, words his wife hadn’t even said yet, threatened his eardrums, like the blast of a grenade.

Robert wasn’t much better alone. I was able to talk with him for about five minutes, just making idle chat, before the anticipation of probing questions drove him away from me.  Robert couldn’t handle even the slightest hint of pressure, certainly no criticism, and feedback from his family seemed unbearable.

His wife explained in an individual session that what I observed actually was the problem she had with him; she had no real criticisms of her husband to speak of. She only wanted to get back to marriage, having arguments, and resolving differences like before.

Robert’s sensitivity, outbursts, and his inability to connect or be intimate had become unworkable for her. While Robert’s wife assured me he hadn’t become violent at home as school professionals suspected, she was prepared to divorce him. I could tell her decision was already made, and Robert’s issues surpassed the time frame I was allowed to work with them.

Robert couldn’t take the regular pressures of relationships like he could before seeing combat. It seemed as if family life had become combat for him, and Robert had nothing left, no mental reserves with which to fight that battle. He was unable to sit down, explore feelings, even manage his thoughts and impulses.

Robert had seemingly been irreversibly damaged on the actual battlefield that left him with a Traumatic Brain Injury, physical disabilities, but most debilitating to his interactions to his family, a severe case of Post-Traumatic Stress Disorder, also known as PTSD.

Robert’s son told me his father went to war and never came back.  Some other man returned and took his father’s place. The teen shared how he and his father used to wrestle, go hunting, play basketball, or just spend time talking about life.

He seemed far more resolved about the loss of Robert than his mother was. He’d been clearly raised by a loving father up until that point. He did what well-adjusted kids do: relied on his mother, talked to caring coaches and teachers at school, and spent time with good, reliable friends his age. He said his father was just too confused, too flighty; his brain just didn’t work.

On a trip to Nashville, I had the chance to talk to a homeless man named Daryl* who also reported having a problem with his brain.  My husband and I were checking out the music scene, and I met Daryl standing outside of one of the bars holding a sign that read, “Army Veteran. Anything helps.”

I asked him if he was really an Army Vet, and prepared to lecture him on drug and alcohol issues like I tend to do with homeless individuals who’ve succumbed to their habit. In the course of our conversation, Daryl proved he was in fact a veteran, detailing his experiences overseas, not unlike Robert’s.

When I asked him why he wasn’t utilizing programs available to vets, he just shook his head. He said those programs didn’t work. He shared that combat had rendered him unable to think.

Like many veterans with untreated trauma, Daryl burned his bridges and turned to drugs. He’d decided, finally, his family was better off without him. Against my better judgment, I began to dig in my purse for my wallet, at which point Daryl stopped me and said, “Don’t worry about it.” He opened his arms and gave me an awkward hug.

In the book, The Body Keeps the Score, Bessel Van Der Kolk, M.D., describes common symptoms of PTSD that he researched and studied while treating clients who had experienced war. These symptoms included a loss of self, numbing, reorganization of perception, and being “stuck” in trauma.

In short, Kolk writes:

“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 capacity to think. We have discovered that helping victims of trauma find the words to describe what has happened to them is profoundly meaningful, but usually it is not enough. 

The act of telling the story doesn’t necessarily alter the automatic physical and hormonal responses of bodies that remain hyper-vigilant, prepared to be assaulted or violated at any time. 

For real change to take place, the body needs to learn that the danger has passed and to live in the reality of the present. Our search to understand trauma has led us to think differently not only about the structure of the mind, but also about the processes by which it heals.”

The idea that the body, not only the mind, needs to learn that danger has passed is a profound realization for those of us who treat individuals with past trauma. Every therapist has been confronted with a Robert or Daryl, who seem so far gone.

Countless times in therapy, I’ve been confronted with traumatized clients trying to “will” themselves into a different emotional state, feeling intense shame for not being able to control their thought life.  Experts are warned about the profound effects of trauma, but still outdated literature would have us teach clients they can usually think themselves into a better mood.

Therapeutic models like Cognitive Behavioral Therapy (CBT) promote the true assertion that thoughts do impact emotions. Self-talk can be a powerful mechanism to relieve clinical anxiety and depression. CBT walks clients through a process of recognizing habitual and negative thoughts, replacing those thoughts with better adapted, rational ones, and noting the impact thinking can have on debilitating emotional states.

But in therapy, severe PTSD pushes back in a way that leaves the best professionals resigned that they’ve reached the glass ceiling of what they can do. At this point, we usually recommend medical treatment, and like medical doctors, we succumb to the idea of “brain-disease,” and we all know some diseases cannot be cured.

In The Body Keeps the Score, Kolk presents his research from practice and teaching psychiatry that challenges the common belief that severe trauma is an incurable disease.

He writes:

“The brain-disease model overlooks four fundamental truths:

“(1) our capacity to destroy one another is matched by our capacity to heal one another. Restoring relationships and community is central to restoring well-being;

“(2) language gives us the power to change ourselves and others by communicating our experiences, helping us to define what we know, and finding a common sense of meaning;

“(3) we have the ability to regulate our own physiology, including some of the so-called involuntary functions of the body and brain through such basic activities as breathing, moving, and touching; and

“(4) we can change social conditions to create environments in which children and adults can feel safe and where they can thrive.

“When we ignore these quintessential dimensions of humanity, we deprive people of ways to heal from trauma and restore their autonomy. Being a patient, rather than a participant in one’s healing process, separates suffering people from their community and alienates them from an inner sense of self. Given the limitations of drugs, I started to wonder if we could find more natural ways to help people deal with their post-traumatic responses.”

This series of essays explores Kolk’s book, The Body Keeps the Score in order to better understand what an individual needs in the way of treatment to address severe symptoms, but also what they and their families can do to get better.