Treating trauma

The DO Book Club, July 2020: The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma

Traumatic stress expert Bessel A. van der Kolk, MD, discusses his lifelong research on psychosocial trauma. His insights have surprising parallels to osteopathic medicine.

Welcome back to The DO Book Club! For July, I read The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma by Bessel A. van der Kolk, MD. If you’ve read this one, please share your thoughts in the comments below. And if you’d like to write a book review for a future month, please email Andy Brown at abrown@osteopathic.org.

On a sub-internship at Georgetown University this past year, I saw that several students, residents and faculty members were very interested in trauma psychiatry. During some teaching moments, I saw that many were particularly curious about the somatic and body-oriented treatment approach in trauma therapy, though they may not have had much experience with it.

After I matched as a psychiatry resident there this spring, I decided to read this book with my osteopathic glasses. I was looking for materials that resonated with my training and, at the same time, trying to think of some concrete ways that I could apply my unique strengths to my dream residency program as the only DO in my incoming class. If you are an osteopathic medical student going into psychiatry, I urge you to pick up this book.

Plot summary

Dr. van der Kolk begins the book by remembering that one of his earliest patient encounters with veterans of the Vietnam War challenged the prevailing brain-disease model of psychiatric illness at the time. He suggests that the brain-disease model, which reduces the complex experience of trauma and subsequent mental illness to a dysfunction of an individual brain, overlooks the pivotal importance of the self-healing and self-regulating capacity of our body, which sounds much like the osteopathic tenet.

He then explains the nature of trauma as an extreme stress response—with a high allostatic load—that overwhelms our innate system to cope. He states, “all trauma is pre-verbal (p. 43),” meaning that our usual cognitive process may not be able to process the stressful event or situation, but our “body continues to keep the score (p. 46).” Dr. van der Kolk advocates for treatment options that focus on “recalibrating the autonomic nervous system … [which can be accessed through] breath, movement, or touch. (pp. 63-64).”

Simply put, the book was a phenomenal read. It is an accumulation of Dr. van der Kolk’s lifelong efforts to study psychosocial trauma as a psychiatrist and a clinical researcher. He cites sources from a wide range of disciplines, including but not limited to cognitive science, clinical neuroscience, developmental psychology and attachment theory, mind-body medicine, to art therapy.

Interesting tidbits for DOs

Although this book would resonate with health care professionals across the board, there are several aspects of his work that are particularly worthwhile to the DO reader.

All three of the basic human needs mentioned above (breath, movement, and touch) are similar to our osteopathic medical education through the experiential and tactile learning of osteopathic manipulative treatment (OMT). In particular, the aspect of touch is an avenue that DO psychiatrists have the first-hand advantage of understanding deeply and personally.

Osteopathic psychiatrists, versed in both OMT as well as primary psychiatric and neuroscientific literatures, are ideal candidates to become the bridge in understanding the interplay between the tactile practice of bodywork and the underlying psychosocial processes that lead to healing.

We may not be able to perform the therapeutic touch on our psychiatric patients due to logistical or legal reasons. We, however, have the responsibility to maintain our fluency in both fields, given that mental health professionals and therapeutic touch providers may not always communicate or refer between one another.

Notable quotes

Regarding the potential for using touch to treat trauma, Dr. van der Kolk refers to anecdotal evidence that some of his patients continued to improve emotionally with massage therapy. Touch, being the “most elementary tool we have to calm down [through evolution as mammals and social creatures] (p. 218),” is essential to his approach to trauma therapy.

After observing the improvement of his patients’ psychological states through touch-based intervention, he now encourages all his patients to “engage in some sort of bodywork, be it therapeutic massage, the Feldenkrais Method [exercises], or craniosacral therapy (p.218).”

In addition to the solely mechanical benefit of relieving bodily tensions, he also states that “being able to feel safe with other people is probably the single most important aspect of mental health (p.81).” As DOs, we know firsthand that having our patient feel safe with our touch and presence during OMT is critical; and when done right, profoundly therapeutic.

Takeaways

Overall, I was particularly impressed with Dr. van der Kolk’s synthesis of knowledge from modern neuroscience and traditional healing modalities that emphasize the mind-body bidirectionality. Although he does not explicitly mention the potential for osteopathic physicians to contribute to this field, his book has left me with a sense of hope, excitement and responsibility.

I anticipate that the future holds several discoveries about the body, mind and brain, and that there is a place for DOs to bring their unique contributions and perspectives into the evolving and ever-expanding field of psychiatry.

August’s book

For August, The DO Book Club will be reading The Immortal Life of Henrietta Lacks by Rebecca Skloot. We encourage all who are interested to read along! If you are unable to get out to a local library or bookstore due to COVID-19, we recommend checking out eBook options for rent or purchase.

As a reminder, if you read The Body Keeps the Score or any previous Book Club selection and want your reflections to be shared in future posts, or want to write your own book review for a future month, please leave a comment below or email abrown@osteopathic.org.

Happy reading!

Related reading:

The DO Book Club, June 2020: The Ghost Map: The Story of London’s Most Terrifying Epidemic

The DO Book Club, May 2020: This is Going to Hurt: Secret Diaries of a Medical Resident

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