​The Body keeps the Score – Brain, Mind and Body in the Healing of Trauma by Bessel van der Kolk, M.D      £21
 
What a wonderful book – authoritative, erudite, compassionate and beautifully written.

Dr Bessel van der Kolk combines the curiosity and analytical mind of the scientist with what Judith Herman calls, “the passion of the truth teller”, and the refreshingly humble outlook of a man in awe of his patients.

But a word of caution, this book is a challenge. Think twice if you are easily shocked, offended, or likely to wallow in guilt for doing what you believed to be best practice at the time. All we can ever do is our best and our best changes all the time, as van der Kolk himself has also had to acknowledge in his 30-year career.
 
To summarise the content I’m going to start in the middle of the book because it is here that van der Kolk makes the bold statement that developmental trauma is “the hidden epidemic” in society. As a trainer I talk to parents and teachers about attachment and trauma, many of whom think trauma is a fringe topic affecting a minority of children.  Van der Kolk would argue otherwise. He compares the (US) public health budget devoted to both heart health education and smoking cessation with the barely mentioned topic of childhood abuse, the cost of which exceeds cancer and heart disease in the USA.  To halve the rate of depression, drastically reduce alcoholism, IV drug use, domestic violence, suicide, prison admissions and improve workplace performance he believes we need to eradicate child abuse.
 
Even obesity comes in for a radical rethink. Diets, bariatric surgery even a sugar tax may look like a solution to a major health crisis, but for the trauma survivor society’s problem may actually be their solution, eg, being big may be a health risk in the long term, but for now being the biggest boy in class may be a way to feel safe from bullies, or being an overweight girl may stop unwanted sexual attention. Brace yourself for the research from one chief of medicine that most of his morbidly obese patients were survivors of child sexual abuse. Van der Kolk wants to get this “hidden epidemic” out in the open. When he asks, “how do you turn a newborn baby with all its promise and infinite capacities into a thirty-year-old homeless drunk?  He gets us to acknowledge how much relationship rather than genetics shapes development. So, while there may be a gene for alcoholism, for example, stressful experiences impact on genetic expression both in the womb and after birth.
 
Throughout the text van der Kolk gives us a glimpse of his own childhood and family traumas. He also tours the many dubious practices of the psychiatry profession over the course of his career, from the brutal to the inspired, focusing frequently on the profession’s more recent obsession with pharmaceuticals. Drugs such as Prozac transformed the lives of many depressed patients from the late 1980s onward, but in van der Kolk’s experience they did not work for war veterans with PTSD. The difficulty arose when medication was seen as the go to “fix it” for mental health problems rather than being part of a holistic treatment package. Drug benefits lay in their ability to dampen reactions not heal the illness. In the case of the half a million US children on antipsychotic drugs, medication has improved things for adults by making the children easier to control! Van der Kolk reports huge over prescribing in the children of low-income families and children in foster care. Shockingly, even thousands of under fives have been prescribed antipsychotics, reducing their aggression but also their motivation, playfulness, curiosity, general functioning and socialization.
 
Thankfully, amid the horror stories are accounts of the author’s inspirational teachers, such as the psychiatrist Elvin Semrad who discouraged him from relying too heavily on psychiatry text books and diagnostic labels which obscured his perceptions of real patients. Instead, he urged getting to know and respect the person while acknowledging that, “most human suffering is related to love and loss”. Teachers have also appeared in the form of patients such as Marilyn who told him his reassuring platitudes only made her more lonely and isolated because, “it confirms that nobody in the whole world will ever understand what it feels like to be me.”
 
Through his experience of working with patients Van der Kolk has  concluded that “all trauma is preverbal” whether it happens in infancy or adulthood. This doesn’t mean that it can’t be talked about but that talking rarely gets to the truth because it reactivates the experience of trauma in the body. Experiments with fMRI scans show that trauma activation stops the brain’s speech centre (Broca’s area in the cortex) from functioning. Consequently, the traumatised continue to live in isolated “speechless horror”. He questions accepted therapeutic practices in the light of what we now know from brain scans, research and experience and advocates alternatives such as yoga, EMDR, mindfulness and others that put trauma survivors back in touch with themselves.
  
There is so much in this book that cannot be summarised. I have only selected morsels to tempt and tantalise. In doing so, I feel that I have done it an injustice by missing out so much of the content on attachment, traumatic memory, the anatomy of survival, neuroscience and the numerous and varied paths to recovery. There is a huge focus on relationship and connectedness and our innate drive to be part of a tribe, which goes against the cultural norm of being an individual, competitive and self made. You have to read it to begin to grasp the breadth and depth of its reach but I’ll leave you with this summary by the author himself, “Trauma results in a fundamental reorganisation of the way the mind and brain manage perceptions… 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. [We need] to think differently not only about the structure of the mind but also the processes by which it heals.”
 
Happy reading!
 
Reviewed by Sheila Lavery

THESE REVIEWS ORIGINALLY APPEARED ON THE SCOTTISH ADOPTION WEBSITE AND ARE REPRODUCED WITH PERMISSION

The Huge Bag of Worries tells the story of Jenny and her struggles with her increasing number of worries. Big worries, small worries, worries about all manner of things. No matter what Jenny tries to do, the worries just won’t go away and worse still, they keep growing...

Thankfully, help is at hand, in the shape of a kindly neighbour, who knows a thing or two about tackling a worry. Her words of wisdom and range of strategies soon help Jenny to lighten her load and finish up with a smile on her face!

This is a lovely children’s book, which would appeal particularly to those in the early years of primary school. It is enhanced by lively and witty illustrations, which help bring the story to life. The depiction of worries as furry creatures living in a bag also offers great creative options for working with children in a similar vein, to conceptualise and manage their own personal worries. The story has a reassuring message and the strategies offered by the neighbour are widely transferable and could be used by children again and again.

As a story, it stands alone as enjoyable read. For children struggling with worries on a range of levels, it is a terrific resource for supporting them to understand and manage these.

This months review comes from Naomi Head, a Senior Practitioner in the Placement Team.