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If you have doubts, reach out. Here to listen.
- Jul 15, 2024
- 440
26/08/2024 - 02/09/2024
The Body Keeps The Score by Bessel van der Kolk
The Body Keeps The Score by Bessel van der Kolk
Wow, this is one long and dense book. It's nowhere near as dense as some of the textbooks on combinatorial set theory that I've had to slog through - if you know, you know, and I'm sorry - but it's up there. I somehow managed to finish the book in about a week. At some points I could not bring myself to read, so I also made use of this awesome playlist on YouTube for some parts - this gal wears goofy hats, which I assume she made on her own judging from the backdrop scene. She is extremely cool in my book. I hope she proudly wears them in public as a display of superior fashion sense.
I actually further recommend you also read two other books about the impact of trauma from different perspectives:
- Trauma and Recovery by Judith Hermann - she goes in depth about C-PTSD in this book
- The End of Trauma by George A. Bonanno - this guy researched resilience and the role it plays in PTSD
Before we start, I'd like to dedicate some words towards a disclaimer and to address some things about the book. There is some controversy (and allegations) about the author as well, related to his recent work ethics and treatment of his peers - I will not pass judgement about these specifically, because frankly I don't know what happened, and I think I can still review the book based solely on the merits of its content. You can look into the allegations yourself online.
I found writing this review to be quite difficult, because I am not an expert in mental health, not used to writing in depth about topics in mental health, and admittedly, rarely read books on mental health. Therefore, I lack an efficient ontological view on such topics in general. The "correct organisation and presentation" of such topics elude me for now. This review won't be me venting about how much I relate or agree/disagree with xyz. I'll keep it objective, focusing on what the book says, only rarely giving my opinions on certain topics.
Initially I was going to post it as an update in one of my status posts, as part of an ongoing task to read a crap ton of books you guys recommend me.
Disclaimer
My sense of humour might not be for everyone. I am neither a doctor nor mental health professional, rather, I am a professional dumbass. I am not formally diagnosed with PTSD and have never sought the diagnosis. With that being said, I've had several traumatic events happen to me as a child of varying kinds, some where my life was threatened, some over prolonged periods of time. This review touches on themes that are possible triggers for certain people due to the nature of the book and PTSD. If I make reference to some person's work, that does not mean I endorse the person, rather, I just happen to think that the specific work could be helpful for people with PTSD.
I wrote this review while using the dark (pink) theme, so some colors might render text illegible on other themes. I only use dark themes, you see, since I'm not a fucking moron heathen. Also, there's no rhyme or reason for when I use colours. I'm just built like that. Colours are pretty. If I link to something, it will be in the default red. Maybe I have the book review and text colour autism (link). I'm very used to looking at rainbow vomit on my screen for several hours a day. My apologies if you're severely colourblind - in the case of this review, that's probably a blessing.
There could also be minor mistakes here and there.
There could also be minor mistakes here and there.
Controversy and Criticism
The book can be especially hard to get through for women (in general) and survivors of abuse in particular, not just because of the fact that the topic of abuse is central, but also because of the writing style the author uses. Some parts (especially Part 1) describe accounts of PTSD suffered by abusers of innocent people, the victims sometimes being women. In this sense, the author is strictly looking at PTSD as 'the condition', and you should not be expecting any hints of empathy or moral judgement passed by the author reflected in this book. In some instances it could seem as if the author is sympathising with abusers who suffered from PTSD as a result of abusing others, due to the omission of judgement or lack of opinion in the text. I personally made the decision to understand such passages from the lens of a psychiatrist trying to rationalise why an abuser was suffering from PTSD, rather than the psychiatrist dismissing the horrors of abuse.
I also noticed that the author has an interesting way of describing the women mentioned in the book, touching on details that are irrelevant to the topic at hand, sometimes focusing briefly on how attractive or seductive they were. The book does not really have long lasting characters, so introducing characters for the sake of filling one or two pages and dedicating a small portion in that space to focus on such details does strike as incongruent with the topics at hand.
The book does in general allude to the idea that the body keeps the score at several points throughout. This is, apparently, a somewhat controversial claim within the medical community - although from my digging, the controversy seems to be largely rooted on splitting hairs and arguing semantics. Again, I am not a medical professional so I might have missed certain details that such people would pick up. There are key parts of the book where the effects of PTSD are reframed within the context of a certain physiologically-rooted theory that will be discussed later, and it does come across as the author suggesting or even ascertaining that the theory explains PTSD despite the general consensus being that the theory is untenable, debunked, or needs improvement. From my layman's perspective, I do not consider this book to be very technical or clinical, so I think some of the criticism is overblown. Perhaps if I were better educated on biology, I would agree with them more.
A seemingly more accurate and perhaps more widely acceptable claim would be to say:
"Your brain keeps score and your body is the scorecard"
Quote attributed to Lisa Feldman Barrett. PhD
Quote attributed to Lisa Feldman Barrett. PhD
This does not roll off the tongue as well. As far as my pea-sized brain is aware, there is no physiological mechanism** for "remembering" trauma anywhere in the entire human body except for the brain, although I suppose this is laced with nuance, because the impacts of prolonged stress can absolutely have changes down to the epigenetic level - roughly, the way your genes are expressed. I will discuss what the book mentions about this later, as well as point towards some papers on this topic.
**Please correct me if I'm wrong.
There is also mentions of the idea of 'lost memories of traumatic events' which are repressed and yet have long lasting effects on how the brain reacts to the present. This to me makes a little sense and strikes me as certainly possible. I think memory is fallible, but the physiological effects of our lived experience on the brain can have long lasting and marginal changes, even if we forget the memories that caused them. Some people in the medical community seem to think it does not - often stating that certainly, victims of traumatic events would remember their trauma. I personally believe that I remember all of my traumatic experiences - it's hard not to when you think about them so often.
One of the questions found on the PCL-5, a self-assessment tool for PTSD, is:
"In the past month, have you experienced repeated, disturbing, and unwanted memories of the stressful experience?"
What is PTSD?
"I think this man is suffering from memories"
Sigmund Freud, dumbass
"I think this man is suffering from memories"
Sigmund Freud, dumbass
Post-Traumatic Stress Disorder (PTSD) is a chronic mental health condition that can develop after experiencing or witnessing a potentially traumatic event (PTE), such as war, natural disasters, accidents, violent assaults, etc etc. It is characterized by symptoms that persist for an extended period of time and significantly impact daily life.
Key symptoms of PTSD include:
- Re-experiencing: Reliving the traumatic event through flashbacks, nightmares, or intrusive thoughts.
- Avoidance: Steering clear of reminders of the trauma, such as places, people, or associated activities.
- Negative changes in thinking and mood: Persistent negative thoughts, guilt, shame, detachment.
- Hyperarousal: Being constantly on edge, easily startled, or having difficulty sleeping and concentrating.
- Everybody faces some PTEs - it's part of life. However, we do not always have the luxury to be prepared for when they come. Not everyone will have the inner resilience, right upbringing, and conducive living conditions to overcome their trauma the moment it happens. In such a case, a PTE can become a traumatic event whose effects are chronic.
- The easiest ways to cope with prolonged stress in life are often not good for you in the long run. Coping ugly should serve as a transient period of your life while you seek help and transition to more effective, healthy ways to cope and recover. I will go into how maladaptive coping mechanisms can end up creating more problems on top of the already existing ones, without actually fixing anything, later.
- The phsyiological reaction to trauma is not an Olympic sport. We should never tell someone suffering from PTSD that other people have had it "worse but somehow managed", and that therefore they should simply try harder. I assure you they've already heard that before, and they've already said it to themselves before. This only reinforces the idea that they are defective and do not deserve to recover, something they probably already believe, and only serves to exacerbate their hopelessness and unwillingness to open up. Instead, I believe we need to guide them towards the appropriate kinds of behaviour that build resilience and self-leadership, help them obtain faith in themselves and possibly encourage lifestyle changes that directly contradict the negative self-image of themselves cultivated over the years of coping ugly with their traumatic past.
Introduction
The author of the book is a psychiatrist who has extensive history in the study and treatment of PTSD patients, technically since before the inception of the PTSD diagnosis in the 1980s. Simply put, the book is about:
- The general history of PTSD and its treatment.
- The typical presentation of PTSD in clients
- with anecdotal examples from the author's clinical experience.
- How PTSD rewires the brain, as well as how it affects child development.
- Avenues for recovery from trauma.
It does not make a lot of references to other academic books, and it did not strike me as some sort of medical textbook or reference book. While there are references, I think they are relatively few and far between, when compared to the frequency of assertions made in the book. There are sections of the book that go into what I consider to be mild detail on anatomy and the physiological processes that are impacted by prolonged response to stress. The latter parts of the book are dedicated to recovery strategies, some more emerging and novel than others, as well as accounts of clients who managed to improve their symptoms and how they did it.
The effects of PTSD on people
Trauma and Imagination
Trauma and Imagination
The book goes into some anecdotal detail of how PTSD sufferers perform when given tests that rely on their imagination, such as the Rorschach and Thematic Apperception Tests**. In the former, the subjects are presented with vague and undetailed ink blots and are asked to describe what they see. In the latter, subjects are presented with ambiguous scenes, such as a family at dinner, and asked to describe what has led up to the event shown, what is happening at the moment, what the characters are feeling and thinking, and what the outcome of the story was. According to the book, both of these tests can help the clinician understand how the subject's brain fills in missing bits and pieces of information - and whether their imagination is working for or against the subject.
**It should be noted that these tests, as far as I know, are not considered psychometrically valid (that they measure what they claim to measure), or reliable (that they give consistent results over time). You are not likely to find clinical psychologists that use these anymore.
Imagination is a powerful force that fuels our drive for continuous improvement in life. It allows us to envision a better future, to dream up new possibilities, and to push the boundaries of what we believe is possible. Through imagination, we pursue meaning and set goals that give our lives direction and purpose, guiding us toward the person we aspire to become. However, when trauma strikes, it can distort our self-perception, casting a shadow over our dreams and dulling the bright spark of imagination. Instead of seeing possibilities, we may become trapped in negative loops, where fear and self-doubt dominate our thoughts. The positive aspects of imagination - our ability to hope, to create, and to see beyond the present - can be dampened significantly, making it harder to envision a path forward where "life gets better". But even in the face of trauma, nurturing our imagination can help us reclaim our sense of self, rebuild our dreams, and find new ways to heal and grow.
The Brain on PTSD
Throughout the book, and especially in Chapter 3, the book discusses studies that were done to investigate whether people suffering from PTSD have any measurable difference in how their brain operates.
- Amygdala: Brain imaging studies have shown hyperactivity and dysregulation in the amygdala ([1], [2] referenced in the book amongst others), the brain's fear center, in individuals with PTSD. This overactivation is linked to heightened fear responses and difficulty regulating emotions, especially in the presence of stimuli reminiscent of trauma. The book further mentions (in Chapter 5) the impact trauma can have on reading facial expressions, microexpressions, and inferring other people's intent and emotional state.
- Prefrontal Cortex: Responsible for rational thought, decision-making, and emotion regulation, the prefrontal cortex tends to be underactive. This underactivity can lead to difficulty in controlling emotional responses and a reduced ability to distinguish between safe and dangerous situations. One of the studies above highlights diminished activity in the mPFC in PTSD subjects.
- "The contrast with the scans of the eighteen chronic PTSD patients with
severe early-life trauma was startling. There was almost no activation of any of
the self-sensing areas of the brain: The MPFC, the anterior cingulate, the parietal
cortex, and the insula did not light up at all; the only area that showed a slight
activation was the posterior cingulate, which is responsible for basic orientation
in space. There could be only one explanation for such results: In response to the
trauma itself, and in coping with the dread that persisted long afterward, these
patients had learned to shut down the brain areas that transmit the visceral
feelings and emotions that accompany and define terror. Yet in everyday life,
those same brain areas are responsible for registering the entire range of
emotions and sensations that form the foundation of our self-awareness, our
sense of who we are. What we witnessed here was a tragic adaptation: In an
effort to shut off terrifying sensations, they also deadened their capacity to feel
fully alive. The disappearance of medial prefrontal activation could explain why so
many traumatized people lose their sense of purpose and direction. I used to be
surprised by how often my patients asked me for advice about the most ordinary
things, and then by how rarely they followed it."
- "The contrast with the scans of the eighteen chronic PTSD patients with
- Hippocampus: The book also casually refers to a study which highlights that brain imaging has revealed a reduction in the size of the hippocampus, a region critical for memory and learning. This shrinkage is associated with the fragmented and disorganized memories.
- Broca's Area: In the beginning of Chapter 3, about 5 pages in, is a section on "Speechless Horror". Have you ever been in a prolonged situation where you wanted to utter anything that could describe what you're feeling, but physically could not? At a loss for words - except you might even have the words but you physically cannot speak. As it turns out, the book discusses, when the brain is overwhelmed with a response to trauma, activity in the Broca's Area, one of the regions in the brain responsible for the motor functions that produce speech, was shown (granted, small sample) to have diminshed activity. The "good" news is that there's ways to bypass this - instead of verbalisation, one can communicate via text, art, or other media.
- Right-brain Dominance: The right hemisphere is intuitive, emotional, visual, spatial, and tactile, and holds sensory memories and emotional reactions, while the left is linguistic, sequential, and analytical and stores facts and organizes experiences. The author notes that the subjects reliving trauma during the previously linked study were observed to activate the right hemisphere and deactivate the left, impacting the ability to verbalize and logically sequence experiences. Normally, both brain hemispheres work together, but trauma can disrupt this balance. Deactivation of the left brain during trauma leads to difficulty in organizing thoughts, understanding cause and effect, and verbalizing experiences. Individuals with PTSD often react emotionally as if the trauma is happening again, but without the left brain's input, they may not realize that they are re-experiencing the past and are not in actual danger. This disconnection can lead to misplaced blame, confusion, and difficulty in recognizing the true source of their emotional responses.
The impact of PTSD on the Body and Polyvagal Theory
From Chapter 5 onwards, the book also goes through some significant detail about Polyvagal Theory (PVT). PVT was developed by Dr. Stephen Porges, and it focuses on how the vagus nerve, a key part of the parasympathetic nervous system, regulates our physiological state in response to stress and social interactions in mammals.
Some claims of PVT are actually contested within the medical community, and I am not qualified to go into it. Current consensus seems to be that some parts of Polyvagal Theory are decisively debunked or untenable. Several studies seem to support this and are easy to find. However, we should consider the fact that PVT has been cooking for a long time in the oven, and some aspects of it are still considered useful by clinical psychologists. PVT seems to be one of those theories that seem so elegant and make so much sense prima facie, offering efficient explanations of complex phenomena, which might explain its popularity.
As I kept reading on, it became clearer to me that the book was suggesting that most of the superficial (personality, behaviour) symptoms of PTSD could be better understood from the lens of PVT. Specifically, that these personality changes are often rooted in the brain's altered processing of stress and safety, and that PVT could help explain that. I kept a list of some of these traits that were mentioned in the book. Not all necessarily manifest in a single subject, and not all are uniquely characteristic of PTSD.
- Heightened alertness, exaggerated startle responses, sensitivity to stimuli that remind them of traumatic events.
- Emotional detachment or numbness as a protective mechanism, or alternatively, excessive fawning, overapologising, constantly bartering for security - whether it be physical or emotional.
- General conflict between internal emotional state and outward expression, alexithymia.
- A confrontational or aggressive personality as a way to cope with feelings of vulnerability or powerlessness.
- Traditionally depressive symptoms, such as difficulty feeling pleasure or joy, loss of interest in activities, social withdrawal due to lack of hobbies and unwillingness to engage in said hobbies due to trauma.
- Disproportionate irritability, short-temper, outbursts of anger, misplaced blame.
- Internalised feelings of guilt and shame, especially in victims of abuse. Accompanied with tendencies to be self-critical or self-deprecating - always comparing oneself to absolute standards of "what should have been".
- The negative feelings associated with minor mistakes (that most people forget within days) linger for significantly longer, possibly years, contributing to an ever increasing list of reasons for why the subject is irredeemable and undeserving of feeling better. In this sense, people with PTSD are more likely to turn acute stressors into chronic stressors. Many trauma survivors feel irrevocably changed by their experiences, leading to the belief that they are broken or fundamentally different from others.
- Because their imagination is compromised, they are more prone to negative or catastrophic thinking.
- PTSD can make it difficult to trust others or feel safe in relationships, which may result in a more guarded, defensive, or withdrawn posturing when such behaviour is not warranted (touch dilemma).
- Difficulty concentrating and memory problems, particularly in relation to recalling details about everyday life or the trauma itself.
- "Disconnection" between their past selves, resulting in an acute but chronic identity crisis and loss of purpose.
- Some trauma survivors may engage in risky or self-destructive behaviors (such as substance abuse, reckless driving, allowing themselves to be in proximity to danger) as a way to numb pain, cope with overwhelming emotions, or feed a self-fulfilling prophecy - again, coping ugly.
- There is also an anecdotal case in the later parts of the book where a CSA victim was sympathising with their abuser, minimising the abuse, and reframing the abuse as their (victim) fault. Victims reframing their traumatic past as their fault is sadly (from experience) a common way people seek to justify what happened to them.
- The famous ACE (Adverse Childhood Experience) study, which is quoted pretty much everywhere when the topic of PTSD and child develpment comes up.
- My ACE score is 9, although I will say that I believe the questionnaire is flawed, and omits a lot of possible modalities of abuse.
- PTSD in children and self-leadership paralysis in adulthood.
- It is mentioned that children with a traumatic past can grow up lacking a sense of agency, willingness to face the world out of fear, and learned helplessness.
- Studies done on painkillers administered in burn victims and PTSD onset.
- "Similarly, the reactions of children to painful events are largely determined
by how calm or stressed their parents are. My former student Glenn Saxe, now
chairman of the Department of Child and Adolescent Psychiatry at NYU,
showed that when children were hospitalized for treatment of severe burns, the
development of PTSD could be predicted by how safe they felt with their
mothers. The security of their attachment to their mothers predicted the
amount of morphine that was required to control their pain—the more secure the
attachment, the less painkiller was needed."
- "Similarly, the reactions of children to painful events are largely determined
- Somatic sensations such as chronic back and neck pain, fibromyalgia, migraines, digestive problems, spastic colon/irritable bowel syndrome, chronic fatigue, and some forms of asthma were mentioned in earlier parts of the book as common comorbidities in traumatised people, including children.
- In Chapter 10, the impact of PTSD on epigenetics is loosely mentioned - and alludes to how it could impact a child's overall development. I think this stuff is particularly fascinating, so I did some digging and found some concrete studies about this, because the book did not go into any depth. I'm no geneticist, so I cannot even begin to penetrate the studies I'm listing below. If anyone is even moderately equipped to guide me into the appropriate literature, please do so - I would be very grateful, even if I have to do prep reading. These studies seem to suggest that epigenetic changes as a result of PTSD not only change the gene expression of the host, but also of future generations.
- A review of epigenetic contributions to post-traumatic stress disorder
- "While epigenetics does not change the sequence of the DNA code, it does alter the expression of genes and may contribute to long-lasting - in some cases intergenerational - phenotypic effects".
- Parental olfactory experience influences behavior and neural structure in subsequent generations
- "Using olfactory molecular specificity, we examined the inheritance of parental traumatic exposure, a phenomenon that has been frequently observed, but not understood."
- "Our findings provide a framework for addressing how environmental information may be inherited transgenerationally at behavioral, neuroanatomical and epigenetic levels."
- In particular, there is some evidence that suggests that, although most epigenetic marks are wiped from the paternal side when fertilisation occurs in mammals, rare cases exist for when this is not the case.
- Identification, Characterization, and Heritability of Murine Metastable Epialleles: Implications for Non- genetic Inheritance
- I find it incredible (as in, so fascinating that I find it not credible) that scientists are finding specific epigenetic markers that predict the successful outcome of certain therapuetic modalities in resolving PTSD.
- A review of epigenetic contributions to post-traumatic stress disorder
The Touch Dilemma
"The most natural way for human beings to calm themselves when they are upset is by clinging to another person.
This means that patients who have been physically or sexually violated face a dilemma:
They desperately crave touch while simultaneously being terrified of body contact."
"The most natural way for human beings to calm themselves when they are upset is by clinging to another person.
This means that patients who have been physically or sexually violated face a dilemma:
They desperately crave touch while simultaneously being terrified of body contact."
The Touch Dilemma is briefly mentioned in the beginnings of Chapter 6. It is a profound challenge rooted in the complex relationship between trauma, the body, and human connection. For many trauma survivors, particularly those who have experienced physical or sexual abuse, touch - normally a source of comfort and safety - can become deeply associated with danger, pain, or violation. As a result, even well-intentioned, non-threatening physical contact can trigger feelings of fear, hypervigilance, or dissociation. The body reacts to touch as if it were still in the traumatic event, leading to physiological responses like increased heart rate, muscle tension, or even flashbacks. For individuals with PTSD, this creates a dilemma: touch, for most of us, is biologically essential for healing, social bonding, and emotional regulation, yet it can also be the source of overwhelming distress.
This causes challenges in therapeutic contexts, where trauma survivors may need to rebuild a sense of safety and trust in their bodies. Therapeutic touch - such as gentle, consensual physical connection in practices like massage therapy, yoga, or even trauma-informed physical therapies - has the potential to help trauma survivors reconnect with their bodies in a safe and positive way. Understanding the individual's triggers, pacing the introduction of touch, and ensuring that the person maintains full control over their boundaries are crucial in helping them relearn that touch can be safe and restorative.
When problems become solutions
One part of the book that really stuck with me is Chapter 9, specifically 3 little paragraphs on coping ugly. Here, the book mentions anecdotal accounts of patients with Eating Disorders (ED) who were either sexually or physically abused.
- "Overweight is overlooked, and that's the way I need to be."
- "It wasn't that I ate because I was hungry and all of that. It was just a place for me to feel safe. All the way from kindergarten I used to get beat up all the time. When I got the weight on it didn't happen anymore."
"The global figures of prevalence of CSA are mind-boggling. In 2002, the WHO estimated that worldwide 150 million females and 73 million males under the age of 18 years suffered CSA. A meta-analysis of 65 studies from 22 nations revealed that CSA occurred in 19.7% of girls and 7.9% of boys. The prevalence of CSA in Africa, Asia, America, and Europe was 34.4%, 23.9%, 10.1%, and 9.2%, respectively. South Africa had the highest prevalence of CSA for both men (60.9%) and women (43.7%). For men, the second highest prevalence of CSA was found in Jordan (27%), followed by Tanzania (25%), Israel (15.7%), Spain (13.4%), Australia (13%), and Costa Rica (12.8%). The prevalence rates of CSA for men in the remaining countries were <10%. For women, the second highest prevalence of CSA was seen in Australia (37.8%), followed by Costa Rica (32.2%), Tanzania (31.0%), Israel (30.7%), Sweden (28.1%), the United States (25.3%), and Switzerland (24.2%). The authors also mentioned that the lower rate for males may not reflect the reality; there may be underreporting of male CSA due to intense shame and fear of being labeled a sissy (if the perpetrator was a female) or homosexual (if the perpetrator was male) or weak."
Substance abuse and addictive behaviour is highly prevalent among individuals with PTSD. Many trauma survivors use alcohol or drugs as a way to cope with the overwhelming emotions, anxiety, and distress associated with their traumatic experiences. The relationship between PTSD and substance abuse is well-documented, with research showing that almost half of individuals with PTSD also struggle with substance abuse disorders at some point in their lives.
Many individuals with PTSD use alcohol or drugs to "numb" themselves from flashbacks, intrusive thoughts, hyperarousal, or feelings of fear and sadness. In addition, some seek substances to combat the insomnia and nightmares that come with PTSD. Trauma survivors often feel disconnected from others, and substances can become a social lubricant of sorts. While substances may provide temporary relief, they tend to worsen the symptoms of PTSD over time, leading to a cycle of dependence and escalating symptoms. This makes treatment for both PTSD and substance use critical for recovery.
Eating disorders are not uncommon either - in particular, the references section of this study is littered with further studies on this topic that show positive correlation between ED and victims of sexual and physical abuse. One study in particular is a gold mine for finding references to other studies that focused on CSA and different types of ED. Men and women with PTSD also exhibit patterns of behaviour related to muscle dysmorphia.
Cost of child-abuse in the US
The book also dedicates a section to discuss just how much money child abuse costs the United States. Since the book is a bit old, I'd like to point towards newer data:
- The CDC breaks down costs due to general injuries and violence here.
- In particular, ACEs account for a total expenditure which is three orders of magnitude (x10^3) higher than the second most expensive category.
- "Adverse childhood experiences (ACEs) are preventable, potentially traumatic events that occur in childhood. Examples of ACEs include neglect, experiencing or witnessing violence, or growing up in a household with substance use problems, mental health problems, or instability due to parental separation or incarceration. A CDC study published in 2023 indicates that nearly 63% of U.S. adults had an ACE, associated with an annual economic burden of $14.1 trillion—$183 billion in medical spending and $13.9 trillion in lost healthy life years. This is $88,000 per affected adult annually and $2.4 million over their lifetime."
Recovery - and my opinions
"I don't go to therapy to find out if I'm a freak
I go and I find the one and only answer every week
And when I talk about therapy, I know what people think
That it only makes you selfish and in love with your shrink
But, oh how I loved everybody else
When I finally got to talk so much about myself"
Dar Williams, What Do You Hear in These Sounds
There are several avenues of recovery mentioned in the book that sufferers of PTSD should consider trying. Not all have to be used, but if one avenue fails, there is always a chance that something else might work. I will simply list whatever I took note of here - but I won't go into details of what I think about each option, because this post is already 6k+ words at this point, and I believe the road to recovery can be quite personal. This is certainly not a comprehensive account of the options available."I don't go to therapy to find out if I'm a freak
I go and I find the one and only answer every week
And when I talk about therapy, I know what people think
That it only makes you selfish and in love with your shrink
But, oh how I loved everybody else
When I finally got to talk so much about myself"
Dar Williams, What Do You Hear in These Sounds
- Regaining ownership of the body
- Yoga, consistent meditation, massage therapy with someone you can trust
- Rythmic movement, such as dance, Tai Chi, and traditional martial arts
- Pilates, resistance training, and cardiovascular exercise
- Interoception techniques, taking your time to sense, cultivating mindfulness, self-awareness
- Self leadership, self worth
- Volunteering, helping others
- Gradual lifestyle changes that contradict negative self-image
- Seeking more fulfilling job
- Community
- Volunteering (again)
- Support Networks
- Finding an anchor
- Quoting below, for the author, it seems that an anchor is some other person.
- "This poses a real challenge for recovery. Once you recognize that
posttraumatic reactions started off as efforts to save your life, you may gather the
courage to face your inner music (or cacophony), but you will need help to do
so. You have to find someone you can trust enough to accompany you, someone
who can safely hold your feelings and help you listen to the painful messages
from your emotional brain. You need a guide who is not afraid of your terror and
who can contain your darkest rage, someone who can safeguard the wholeness
of you while you explore the fragmented experiences that you had to keep secret
from yourself for so long. Most traumatized individuals need an anchor and a
great deal of coaching to do this work."
- Resolving trauma through therapy (do your own research)
- IFS and sub-personality therapy
- Integrative therapy
- Structure-based therapy
- Can help with overcoming specific traumatic scenarios and win over them.
- This one's interesting, and a bit weird, I suggest you look it up if you have never heard of it.
- EMDR therapy
- CBT (high dropout rate for people with PTSD - actually, not as high as I expected compared to other modalities)
- Medication (do your own research)
- SSRIs
- Psychedelics
- ECT
The book mentions how dealing with trauma should be gradual and not overwhelming. Many people attempt white knuckling to recover from PTSD and their maladaptive coping strategies. Simply put, white knuckling is about recovering through sheer willpower, without external help of any kind, without substituting bad coping strategies with better ones. I believe that this almost never works, and everytime you fail, it gets harder. Your brain will learn to make you fail more effectively.
Final thoughts
It is likely that I have made several mistakes here and there - for that, I apologise and hope that most of it is at least coherent and legible. This review / summary is posted as an update to my Book Suggestions thread. Unless I find the content of the upcoming books to be super relatable, there will not be another post of this size.
I hope that this post caused minimal to no discomfort for the people reading it. Going through this book and related topics helped me understand my situation a bit better, so I hope that it will help others too. Should you have suggestions for improving this post, do not hesitate to contact me either as a reply here or via a private conversation.
Now, do I actually recommend the book?
I would be careful recommending this book to others unless I know for a fact that they have the resilience to go through it without the content affecting them too badly. There is nothing particularly graphic or grotesque in the book. However, it can still be difficult to digest for someone who has gone through significant trauma in their life. It is by far not the most disturbing book I've ever read - I think the book can be safely read by most people that are in a sound state of mind.
If you somehow read all of this, thank you.
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