Review: The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma

The Body Keeps the Score: Brain, Mind, and Body in the Healing of TraumaThe Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma by Bessel A. van der Kolk
My rating: 5 of 5 stars

I bought this book after reading Lost Connections. I discussed Lost Connections with my therapist and he recommended this book to me. I have to say this book is emotionally difficult to read. The author does everything he can to make the book easy to consume. I think just about anyone would be able to read this book, but there are some difficult medical terms and you need to remember some acronyms, but beyond that, it’s fairly easy.

This book focuses more exclusively on trauma and recovering from trauma, while Lost Connections is about depression. So if you’ve read that book, then think of this as a book on the trauma section in that book.

If you’ve experienced trauma in your life this book will likely cause you to feel anxiety as you read it. However, I think it’s more important for you to read this book than anyone else, because it provides you with tools to discuss with a therapist. I would suggest pairing this book with some meditation and to read it over the span of several weeks rather than sitting down and plowing through the book. I also suggest that you plan some time after you read to decompress and think about what’s happened. Meditation will certainly help with that.

On to the book itself. It provides a great history of psychology and psychiatry from the start (with fewer details) and in great detail from the late ’70’s to 2014 (when the book was published). The author goes into great detail about the history of PTSD for soldiers and how he was able to successfully apply the same treatments that were effective (or more effective) with soldiers to children that have had traumatic experiences.

He goes into great detail explaining that the body is essentially trapped in the moment that the traumatic event happens. That people who are having flashbacks or are triggered are physiologically going back to the moment of the event. This means their brains are literally shut down in some ways. That their heart rate, blood pressure, and adrenaline are all acting as if they are currently in the traumatic experience. The brain that shuts down always includes the part that is capable of telling the difference between past and present. This is a key part of treating PTSD, you need to get the person grounded back in reality for them to process the trauma at all.

In terms of Triggers and micro-triggers, he doesn’t directly deal with them in a way that would support a conversation with a tumblr that is aggressively anti-triggering. However, he does talk about how to deal with being triggered. First, if events do trigger something, you need to get treatment for it. You need to find someone that you can trust. Then together you can come up with a treatment plan.

Many of those techniques do not include medicine. They include meditation, Yoga (in many cases it works best if you do therapeutic Yoga – since some positions in Yoga can trigger people that have been raped), a therapy that uses rapid eye movement while talking about the event in a safe environment, and many others. The author went from being a strong advocate of better living through chemistry, but has moved into spaces that help people manage it.

The reason the book is called The Body Keeps the Score, is that you need to heal the body and mind to heal the person. It requires a holistic approach.

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Talking About Depression: On Being Defined by Trauma

I saw a tweet last night that went something along the lines of “People with trauma are afraid to get help because they’re afraid of who they would be if they weren’t defined by their trauma.” At first, I thought that this was an interesting thing to say. Yea, people need to get help and people are afraid of who they’ll be without their trauma. However, I think, for most people, they are terrified for their trauma and don’t want to be controlled by it. They have no real way of effectively dealing with their trauma. I’m going to use Shawshank Redemption as a way to talk about Trauma, it’s probably going to offend some people, but I think it will help people that don’t understand trauma how much it controls your life. I’m not even someone that has PTSD, but I understand how small trauma adds up through growing up in an unhealthy environment.

When you have trauma, you’re like Andy from the Shawshank Redemption. You were wronged in someway that takes your freedom away. You are basically imprisoned by that event. You aren’t able to mature or grow as a whole person. Like Andy, you do change. You learn new skills, you progress in your job and craft. In his case he learns how to break the law for the Warden, while you or I, might get a bachelor’s degree or become successful in our chosen profession. However, like Andy, you relive your traumatic event on a regular basis. In the movie, this can be represented by his rapes in the laundry room or his hopes being dashed when the Warden kills a man that could have vindicated Andy.

For a person, you’re stopped in physiologically, in such a way that when you are triggered, your mind and body returns to that point of trauma. There’s no light switch to get past it. You don’t want to be reminded of your trauma, but you have to deal with the fact that the trauma existed. In cases where people have defined their life by their trauma, it’s not a badge of pride it’s a coping mechanism. You’re trying to find a set of people that allows you to talk about your trauma and actually listen. For people with depression and trauma, you don’t want to feel like a burden on your friends and family. In cases of extreme trauma, people don’t want to hear about how nasty and horrific the events were.

Confronting these events in an attempt to heal from them and put the trauma behind you is terrifying. Therapy may look very clean and clinical, but that’s because that’s the physical location. It’s designed to provide a very safe space for you to work through your trauma and root cause of your depression. Psychologically it’s closer to “crawling through 500 yards of shit and stank” to get to freedom. But those 500 yards could take years to move through. You could get stuck in there. You have no idea where the end of the pipe is, if you’ll make it the whole way through, if what’s on the other end is really worth it.

Being able to make the plans to escape is terrifying. I haven’t had the trauma that a lot of people have had out there. I know how difficult it was for me to start therapy. For someone with a history of rape, molestation, child abuse, or survived a war it must surely seem insurmountable. You have to find someone you can trust. You have to feel safe. You have to be helped through a flashback when the trauma is too much to handle. You have to be able to afford it.

Defining your life by trauma is a coping mechanism. It’s driven by fear in a lot of ways, but saying that the person is afraid of not being defined by that trauma shows that they don’t truly understand trauma and the amount of effort that a person goes through to survive the trauma, let alone to address the trauma.

I definitely recommend, when you are experiencing an overwhelming flashback, to pull out an app like Headspace and do the one minute SOS meditation. Then, two minutes, and finally three minutes. By the time you finish with those 6 minutes, you’ll have centered yourself on your breathing and helped yourself to comeback to the present and out of the past. Physiologically, it’ll help get your blood pressure and hearth rate under control. As well as giving you a sense of control of your mind and body.

This advice is going to be nearly impossible to follow if you’re not already building the practice into your life already. So, start with doing daily meditation before you beat yourself up when you don’t do it. It’ll take time to get to the point where you even think about something like that. Don’t feel embarrassed about needing to that take minute for yourself (or longer), you’re going to take it anyway. This will help that minute be much more meaningful in dealing with your trauma and anxiety.

Talking about Depression: You aren’t “Broken”

I’ve wanted to write this one for a while now. It’s a common theme in books, songs, and movies that if you have depression or PTSD that you’re a broken person. A shell of who you used to be. Yes, you’re different than you were before the trauma or the start of your depression. You aren’t broken though. I think about this every time I hear lovelytheband’s song broken. Which talks about how a couple gets together because they were both depressed in a similar way. This is the basis of starting a relationship together.

I find this problematic, because it implies that a very natural reaction to stressful situations leads us to be broken that everything is our fault and that there’s no systemic problem at play here. For example, calling a solider with PTSD, broken may make it harder for them to get help because it puts the burden on them. The fact that they have PTSD is solely their fault when it certainly wasn’t their fault. There were a whole slew of reasons that lead them to enlisting in the first place. They were not the person making the decision to go to war. They weren’t the one making the decision to lead them into the battle that caused them to experience the traumatic event. Even if they were in charge, it’s impossible to know a priori what sort of event would trigger PTSD for a given person or themselves.

When it comes to more general depression due to the general factors controlling your life, think of that friend you know that never seems to have luck and ends up working at some shitty gas station. The one that was super smart that everyone thought would do really well for themselves. But then one thing went sideways, maybe they got sick, then their future collapsed into a single point where there’s no way out. Their going to be depressed. They aren’t broken, even though they have been beat up. They are reacting in an emotional way and a natural way. That person isn’t in that position because they wanted to be there. Their life isn’t what they wanted it to be. That doesn’t mean they are a broken failure of a person. Lucky always plays a role in anything that happens in our lives. For some people, it’s a case of bad luck that leads you to where you are. Other people they get a lucky break a different way and end up with a very different life.

I bring up the job example, because I watched a really interested video on YouTube, by a channel I enjoy watching, WiseCrack. They looked at the psychology and physiology of being depressed and what can cause a person to feel depressed. They typically explore themes in pop culture using philosophy and they’ve explored the Philosophy of One Punchman before. This time they use the same character to investigate depression related to not being properly challenged in your life. In this context “properly” can mean the amount of stress you’ve experienced across your life, it could be too much or too little. Each resulting in differing negative consequence when you’re stressed in the future. The other context for properly challenged means that even if you had been stressed in a healthy manner growing up, that in your current job you could be insufficiently challenged leaving you without a meaningful life.

Neither case means that you’re broken. You are reacting to what your body has been trained to respond to its entire life. Which isn’t being broken. Society is broken though. There are so many things that don’t align with our intrinsic values or needs, that we can’t help but look broken if we’re doing something that runs counter to that societal norm.

Anyway, I plan to revisit this topic again in the future. In the interim, check out some of the science of depression due to missing meaning in life.

Talking about Depression: Explaining to a pair of Friends

Last night, while having a few drinks, I followed my own advice and talked about my depression with two good friends visiting from Austin. The conversation started because my wife is considering starting a business around helping people deal with their depression. Which naturally result in a conversation about my depression, since she, ultimately, wants to help me and people like me. Which is just about the sweetest reason to start a business.

Anyway, I started the conversation with points from Lost Connections. Which helped them understand that there are multiple types of depression and that most of these are very natural reactions to problems that we face in every day life. I explained how I would feel and how that sensation wouldn’t go away. There were definitely points where I was on a bit of a diatribe, but they asked some good questions. Specifically about how I felt and if it was easy for me to identify the root cause of my depression. At that point I explained how meditation had helped me figure out some of that. Because it allowed me to sit with my emotions and sift through them. To hold a thought, feeling, or memory then to let it go through returning to focusing on my breathing. It allows me, as my therapist puts it, to chew on those things, digest them, and then shit them out. Which is a lot better than just “burying” the emotions and things that had happened to me.

All in all, the experience was a really positive one for me. I’ve unconsciously (and in some cases intentionally) pushed people away my whole life. Much of that is related to my depression and the pain and hurt I experienced while growing up with a household where fighting was the norm. So, this was a big step really letting two of my friends understand what I’ve gone through and how I’ve been working through addressing it. Explaining that it’s a long journey and I’m a year into it and I know I have more things to work through and more time to take to fully heal.

Having this conversation was both easier and harder than I thought it would be. First, it was certainly easier because I’ve been writing this blog for a while now and because I had been drinking for a bit at that point. Second, it was harder because, even though I’ve been writing this blog, it’s still hard to talk about some topics. So I ended up glossing over them or skirting past them. Similarly to what I do about some harder topics with this blog. However, I felt good this morning for having talked with them. I wasn’t judged (I didn’t expect them to judge me) and my friends cared about my wellbeing and want to see me be healthy. They really didn’t know what was happening or understand it. They attributed some of my behavior before to being drunk or something immediate going on. So, I think they appreciated a deeper understanding of me.

I hope that you take the time to talk with a friend or loved one about your depression. If you think that’s too big of a step, writing about what you would say, even if you delete it immediately afterwards, can help a lot. Write it by hand as well, so that way you don’t have to worry about the internet machine gobbling it up and saving it somewhere. According to “The Body Keeps the Score” writing can really help processing trauma. So, give that a try. Write it down, throw it out, do it again tomorrow.

Talking about Depression: Starting Somewhere

I was tweeting earlier with @WoytekNives about my blogs. First, I really appreciate the feedback, second, he mentioned that he was feeling better about starting somewhere because he’d seen so many other people talking about depression. This is great. It’s fantastic that people are talking about it. That’s why I started writing about this topic. I knew I needed an outlet for it and I had hoped to help other people.

I want to talk about the steps that I’ve taken again. I started with Therapy. I know I’m really fortunate to be in a position where I can afford it. However, I didn’t take advantage of it for a really long time and that was a mistake. It had some negative consequences with my marriage because of how depressed I had gotten.

So it’s important to start somewhere. You won’t be perfect when you first start. I recommend starting with meditation. It’s tough, so I don’t recommend doing it alone. I suggest using an app like Headspace, because it’s a simple guided meditation. There are these little animated videos to help you understand the point of the exercises you’re doing. I’ll be honest, at first I just wanted to skip them. I know I’m not alone in that. They can feel a bit off putting, because you’re there waiting to get started to meditate and THEN this damn animation starts. However, it can help provide an image to help you center your meditation on. Especially when you start doing the Blue Sky meditation, the animation provides great context and images to help you imagine the blue sky more clearly.

You won’t be perfect, you’ll miss days. I still miss days fairly often. However, the important thing is that you start. Because as Jake the Dog says “Sucking at something is the first step to being sorta good at something.” Going in knowing that it’s there for you when you need it and won’t judge you if you miss it, is great too.

If you’re feeling down, start with something simple. Then move on to the harder stuff. Because the simple stuff is hard. Doing something is hard. It’s hard because while you’re depressed, your time horizons collapse around you. Planning more than a few days out is tough. Thinking about a trip is overwhelming. Even when that trip is to something like, PAX, where you hope to meet up with some of your friends. It can both be the life preserver you’re wearing as you’re muddling through the days and weeks up to it. Otherwise, you’re so overwhelmed by life that you can’t see beyond getting enough food for today or tomorrow. Thinking about yesterday is hard too. You don’t want to.

So starting with something that doesn’t require you to think about tomorrow or yesterday. Just to think about how your body is moving while you’re breathing. It can be liberating. If you give something a try today, let me know. I’d love to hear what you did to start you on your journey to feeling better.

Talking about Depression: Otherness

Talking about Otherness is an odd topic when it comes to depression. At least for people that don’t really suffer from chronic form of depression. However, this is something that I think a lot of people can relate to that suffer on a regular basis. Otherness in this context means that there are time where you feel like you’re watching someone go through the motions of your life for you. Where you look at things you’ve written in the past and don’t even recognize who that person was. That when you read that, you can’t even imagine that person could possibly have the depression that you have. That person is capable and competent. That they certainly couldn’t be the same person as you.

There are times where you feel like you’re watching someone put on your face and getting in front of a crowd of people doing something with such conviction and confidence that you’re floored. That person is supposed to be you, but you don’t feel like it. This has certainly happened to me. I look back at my blog posts from years ago or even within the same year and I hardly remember writing them. I’m impressed that I was able to put together that coherent of an argument. That I had that sort of passion for a topic, even if it was only while I was writing.

When I was a regular instructor for Lean Six Sigma in my various roles in my career I’ve often felt as someone riding and watching myself give those presentations. Where I would be able, without much or any preparation, to give a full week of training courses (granted there were some slide decks where this showed more than others). I would be asked questions and I’d feel like I was watching someone else answer. That I was just along for the ride while this other “Ryan” was giving the presentation. This person didn’t feel like me.

At the end of the day, I’d be completely exhausted and so worn out. In a lot of ways I was also energized, because I had a community. I was with a group of like minded people. I wasn’t alone, which felt great. But, I also often felt like a fraud and was depressed because I felt like I was selling something that my bosses didn’t really support. That enough though we offered to our students a great remedy for what was ailing these organizations, the leadership didn’t support it. This caused a great deal of internal turmoil because the values of the organization didn’t fully align with what I was teaching.

Recognizing this otherness is important to do though. We need to be able to sit and look at this otherness and try to identify the source of it. In the case of teaching Lean, the root of the otherness was a misalignment of values. This exasperated my existing depression, I had already felt alone. I then struggled to find new meaningful work, when I didn’t trust other companies to have a value that really aligned with what I wanted to teach.

It’s also important to recognize the otherness because we don’t like it in ourselves. This means we’re less tolerant of otherness in other people, because it reminds us of our own otherness. However, sitting with our otherness can allow us to see why we’re feeling that way. This otherness, hiding from ourselves, putting a mask on, or burying our true feelings, is a coping mechanism and is completely natural. Everyone does it. So, meditating after you feel like an Other will allow you, as you scan down your body, to experience a wholeness. It’ll make you aware of the anxiety or fear you’d been hiding from yourself. It removes the otherness and centers you back in your body. It makes you feel again.

I strongly recommend meditation when you feel like this. Your thoughts will drift, you’ll feel lighter, eventually, but you’ll feel. Which is important for your and my recovery.

Talking about Depression: Your Depression

As I stated in my last blog post, one of the most difficult things to do is understand your depression. This is because you have to actually sit and try to understand why you’re feeling the way you are. Which means you must be still in a manner of speaking. To sit with your emotions, means you cannot turn on a show, be it TV, Twitch, YouTube, Netflix or whatever else. It means  you cannot just idly scroll through a social media account. This is a double no, because when you look at a site like Facebook or Instagram, you’re likely increasing your feelings of depression even though you’re probably, even if you’re not aware of it, trying to run away from your emotions.

I’d do this by looking, first, at articles on Reddit, then pictures, and then anything else that I could look at to avoid how I was feeling. What I’ve been doing instead is stopping. When I notice that I’m feeling down, I’ll stop. I’ll take a moment to look at how I’m feeling. This isn’t easy. I’ll look at the moments leading up how I’m feeling and try to understand what happened. I acknowledge that I’m feeling however I’m feeling. This means that I try to describe how I’m feeling.

Putting into words some of these sensations isn’t easy at all. One way to help with this is to pull up an emotion sheet like this, below. It’s not going to be perfect, but it’s a way to stop and investigate how you’re feeling rather than just trying to move away from your emotions. It’s further complicated by the fact that you’re probably feeling a number of emotions at once. Or in my case, I often felt completely flat, or a feeling of emptiness. For me, this happened a lot. It didn’t matter how good of a day I was having, I’d eventually end up feeling flat or empty as the day wore on. It was crushing over time.

It’s something that’s difficult to explain to a loved one. If you can’t really explain why you feel that way to yourself, what hope do you have to explain it to someone that cares about you? For me, this was made even more difficult since my family didn’t really talk much about feelings, so I had a stunted vocabulary when it came to how I felt, but I could, through reading and other media, articulate how and why I thought other people were feeling. I “simply” had to start using that same sort of analysis to look internally.

As I reflected, I would certainly feel anxious. It was very uncomfortable for me to investigate my emotions. Furthermore, I knew that just being able to explain what was happening to me to myself wasn’t enough. I had to start explaining how the actions of people around me started to impact how I was feeling. This primarily revolved around my relationship with my wife, where I haven’t been able to explain why I react to things the way that I do. I still don’t always understand why I react the way that I do.

If you decide to give this a try, feel free to leave a comment or ask me how I’ve been doing it. I’d love to offer some tips.

Emotion sheet