Book Review: The Body Keeps the Score by Bissel Van Der Kolk

As I stated in my Review of Nadine Harris’s The Deepest Well, every mental health professional should know that adverse (traumatic) childhood experiences (ACE’s) - especially with parents who are abusive, neglectful, are perpetrators or victims of domestic violence, have multiple partners, or have substance abuse issues - are a major risk factor for children developing many different psychiatric disorders, as well as being a risk factor for a variety of physical illnesses. Yet therapists and psychiatrists often ignore this issue in favor of theories about some sort of genetically-caused, pre-existing brain disorder.

 

In this fascinating book, the author also makes the case for the importance of ACE’s, especially in the case of pediatric psychiatric conditions, by examining the physiological effects of trauma on brain development. There is an extensive literature on this, although most of it neglects the fact that a continued relationship with an abusive or formerly abusive parent is usually continuing in some form throughout much of these patients’ adult life. 

In any event, the author points out that organized psychiatry in 2011 refused to acknowledge that “…childhood adverse experiences lead to substantial developmental disruptions” and added that the idea that it is is “more clinical intuition than research-based fact.” They then added, “There is no known evidence of developmental disruptions that were preceded in time in a causal fashion by any type of trauma syndrome.” (From the American Psychiatric Association rejection of a Developmental Trauma Disorder diagnosis, as quoted in the book).

 

That last part is misleading if not an outright lie. We don’t have high caliber causal evidence on the causes of just about any diagnosis in the DSM. Van Der Kolk has a list of references from an extensive literature on the enduring negative effects of early maltreatment. ACE’s are a major contributor to a variety of psychiatric symptoms that are part and parcel of the genesis of many different psychiatric disorders. Especially the childhood ones like ADHD, conduct disorder, and oppositional defiant disorder, as well as many of the mood and anxiety disorders.

 

This blindness by the psychiatric community has led to what is called “malignant polypharmacy”  – the tendency of some psychiatrists and psychiatric nurse practitioners to confuse symptoms that appear in different forms within a variety of different psychiatric diagnosis as instead being co-morbid (co-occurring) conditions. When I was in practice, I would find new patients who were on several different psych medications – sometimes including both uppers and downers simultaneously – because new drugs were added whenever the practitioner noticed additional, seemingly untreated symptoms. 

Clinicians had misinterpreted these symptoms as being due to their being indicative of other psychiatric disorders that were not being addressed by the existing drug regimen. As the author points out, what was really not being addressed is the underlying issue – the history of abuse.

 

As mentioned, and as with the Deepest Well, this book unfortunately ignores the question of whether brain changes caused by ACE’s are at least partially reversible - were it not for continuing reinforcement of the trauma throughout the lives of the subjects of this literature. This question lurks in many of the book’s case examples and within the literature that the author quotes. 

For example, he talks about a case where a woman continued to blame herself for her father molesting her despite her rational mind knowing full well that this was nonsense. He describes traumatized firefighters who were “desperately trying to protect the system.” As part of a suggestion for criteria for a proposed diagnosis of developmental trauma disorder, he included,  “Intense preoccupation with the safety of the caretaker or other loved ones.” He even describes himself as mistakenly thinking that his own parents no longer had a major influence on him!

 

In the numerous, highly interesting case examples, Van Der Kolk omits mention of whether or not the patient still maintained contact with abusive parents. The closest he comes is a statement on page 210 about a perpetrator "hopefully" not still being around to hurt a traumatized individual.

 

Nonetheless, this well-written and almost entertaining book is a good introduction to the consequences of ACE’s on psychological and brain development, as well as introducing some possible therapeutic ways to treat traumatized patients. Van der Kolk is a master story teller.