This is a fantastic book about psychiatry, trauma, PTSD, Complex-PTSD, and recovery.
It is rare that a book written for such a wide audience manages to be both accessible and hugely informative. It references (seemingly) all of the relevant and up-to-date research, brings in case studies for more concrete examples and understanding, and keeps the language clear with no unnecessary jargon.
Bessel van der Kolk is a psychiatrist who specialises in trauma and how the environment impacts the body’s physiology. He mounts a very persuasive argument against any kind of mind-body dualism and shows that the things we go through leave marks on our biology, and influence how we approach things in the future.
I really appreciate his double-focus, on both the lives people lead and the actual situations that cause the psychological problems (essentially he takes people’s trauma seriously), and how this impacts their biology. He shows that we would be foolish to ignore either the environmental factors (a term which is far too broad and vague, anyway) and the biological ones. But the direction that his argument goes in (environment influences biology) also suggests that the focus of treatment should be on creating a new safe environments (so: relationships) for the person to heal in; rather than aiming only to fix the biology, which would be treating the consequences and not the cause…
He argues for a participatory approach in the healing process, against the notion of passive ‘patients’ who must be cured by experts, acknowledging that the role individuals take in their recovery has significant impacts on how the recovery goes. This person-centred and identity focus I think is a useful counter to the standardising and universalising biomedical trend, which gives everyone drugs and expects that to be enough to heal them. Drugs are particularly ineffective for curing PTSD and C-PTSD, so I think his expertise in this area is particularly useful and hopefully could be applied to other forms of psychological distress.
Another of the interesting arguments that his book put forward is that to help someone recover from trauma, it sometimes isn’t right (or enough) to simply to get them to open up about it in language first. If their body is still stuck in the ‘fight, flight or freeze’ mode, and gets either excessively stressed or dissociated when remembering the event, it will do no good to keep getting the person to talk about it. The biology will overpower the talk-therapy, and they won’t be able to process it in a calm and reflective manner, and won’t be able to acknowledge that it is now in the past and no longer a threat. This is why he is such a strong advocate for trauma-informed yoga, because he finds that it can be hugely successful in calming down the body (learning to breathe deeply, feel the sensations of your body in the present…) which is the necessary first step before then talking about the traumatic event.
But, he does also believe that it is absolutely necessary to then find words for feelings and events once the individual is in a safe enough feeling-state to do so. Then they can gain some distance and perspective on the event which will help them process it more ‘rationally’, with the more developed and less instinctive parts of the brain.
Here are some quotes from the conclusion that I found particularly interesting:
‘We are fundamentally social creatures – our brains are wired to foster working and playing together. Trauma devastates the social-engagement system and interferes with cooperation, nurturing, and the ability to function as a productive member of the clan. In this book we have seen how many mental health problems, from drug addiction to self-injurious behaviour, start off as attempts to cope with emotions that became unbearable because of a lack of adequate human contact and support.’
‘Our increasing use of drugs to treat these conditions doesn’t address the real issues: What are these patients trying to cope with? What are their internal or external resources? How do they calm themselves down? Do they have caring relationships with their bodies, and what do they do to cultivate a physical sense of power, vitality, and relaxation? … Do they have a sense of purpose? What are they good at? How can we help them feel in charge of their lives?’ (349-350).
‘As long as we feel safely held in the hearts and minds of the people who love us, we will climb mountains and cross deserts and stay up all night to finish projects … But if we feel abandoned, worthless, or invisible, nothing seems to matter. Fear destroys curiosity and playfulness.’ (350)
As someone who wrote their BSc Psychology dissertation on attachment theory, I am very strongly inclined to think that so many of our psychological problems and mental health issues stem from poor attachment system functioning. The reasons can be many (societal, financial, psychological, biological), but if an individual doesn’t feel that they have a ‘secure base’ of loving relationships from which to explore, I think it’s incredibly likely that life will feel a bit too much and not something they can adequately cope with, and any kind of mental health issue might develop…