The ‘T’ Word:

The Body keeps the Score by Van Der Kolk is one of the most famous books in the mental health field. It’s one of the first ones we’re told to read when we’re training, it’s one we are always recommending to our clients. You’d be surprised then by how reluctant we are to actually delve into it’s details. Well, I did. And it was as painful as you’d expect a treatise to trauma to be. But it has forced me to open my eyes to the realities of trauma in a way that will change myself, and my work, forever. So here, I want to share some of the profound and painful lessons Van Der Kullk has taught me.

First of all - trauma isn’t what you think it is. We are taught so often according to the categories and definitions that the DSM gives us. But Van Der Kolk explains comprehensively how unreliable the diagnostic approach can be. He explains that in the third edition of the DSM it was written not to use the book for insurance or persecution purposes as it is too unreliable. Van Der Kolk argues that the DSM guides us into applying labels and treatments that often fail to meet the needs of our clients. Because of capitalism, or avoidance, or perhaps a need for control, I’m not sure, we have continued to use this resource like it is the utmost authority. So I want to use this opportunity to ask you to consider, what if it’s not? 

What if the definition we’ve been given for ‘trauma’ fails to reflect the actual lived experience of it? What if we’ve been telling each other, and ourselves, for decades not to use the ‘t’ word, when it could have the piece that was missing all along? What if we really can rely on our experience and instincts just as much as we rely on the research or our supervisors? What if there are answers and pathways available to us to the questions that we have learned implicitly not to ask? What if trauma is a big part of the reason behind so much avoidance and anxiety? That is what it has become for me, but perhaps the answer is different for you.

Types of Trauma

So what is trauma? Trauma is everywhere. PTSD is one of three types of trauma that Van Der Kolk writes about: the acute traumatic events we experience as adults that leave us dysregulated and suffering nightmares and flashbacks. Leaves us unable to connect or move forward. PTSD was the thing that tipped us off to more universal experiences of trauma. It is the only trauma disorder listed in the DSM. Despite how obviously terrible it is, in some ways, it is the easiest to understand and the easiest to treat. 

CPTSD was at least mentioned in my training and is sometimes diagnosed unofficially. But until I read this book, I did not really know what it was. Van Der Kolk also calls it Interpersonal Trauma. And this was my first great revelation. That trauma is often not acute, and not singular, and not obvious. That trauma is social. That the majority of trauma we experience happens in our relationships, in minute moments of interaction, again and again and again. It is a scolding, a moment of physical aggression, a sense of exclusion or rejection. Trauma, if it happens once, is easier to overcome. Trauma, when it happens constantly, is easy to minimize and brush off - this is also when it evolves into some of its worst manifestations.

The third kind of trauma Van Der Kolk mentioned is Developmental Trauma. Simply put, trauma that happens when we’re kids or teenagers. As kids or teenagers we are vulnerable, and prone to internalization. When we’re young we are in need of attention: unconditional care and validation. But trauma often replaces these things - moments that should have been loving become moments of cruelty. People that we should have been able to trust become the source of our fears. Childhood trauma isn’t just trauma, it’s the sabotage of that which should have protected us from trauma in the first place. 

In general, Trauma is a moment of hurt with lasting effects. It is a moment of intolerable suffering in the absence of another’s comfort or recognition. Trauma is invalidated pain. Which means, trauma is cultural - because how likely we are to feel validated has everything to do with the cultural-emotional atmosphere we are immersed in. And in our current culture trauma, even just little bits of it, is everywhere.

Working With Trauma

“In order to understand trauma, we have to overcome our natural reluctance to confront that reality and cultivate the courage to listen to the testimonies of survivors.” pg. 196-197

“Nobody can “treat” a war, or abuse, rape, molestation, or any other horrendous event, for that matter; what has happened cannot be undone.” pg. 205

I think we’re scared of trauma - deeply, viscerally. I think we are intimidated, and uncertain, and, well, traumatized. And so when we hear the word or sense it in a person we shy away. We avoid and suppress. We freeze or we fight. We become defensive or aggressive. More than anything, we don’t want to know how common true traumatic events are. (Very, as it turns out.) But there’s a serious consequence to the avoidance of our deepest hurts: these consequences can be seen now everywhere in our culture, our politics, our economies. In how our avoidance has allowed a dark undercurrent of cruelty and exploitation to take root in our societies. The most obvious example in The Body Keeps the Score, however, was us. The mental health field which is meant to treat the very thing we’re avoiding. Our determination not to take it seriously, not to include it in the DSM, not to diagnose it if another word works, not to fund or research treatments that work better and don’t rely on medication use, not to implement interventions that research shows are more effective and less costly. We are cutting ourselves off at the knees - setting ourselves and our clients up for failure. And until we admit to, and face, our own taboo-fear, we will continue to do so.

So here’s what we could do instead: we strip trauma of all its scary connotations and focus instead on what working with trauma is really, actually like. We don't need to know what the trauma was, we don't need to know the details. Sometimes, we don’t need to talk about trauma at all. We only need to know that there was some. That there is a reason people are how they are, and that that reason is valid. That trauma can heal. We can take our wars and our suffering and make peace with them. And maybe the flashbacks never stop, the intrusive thoughts, the moments that feel out of our control. Maybe we'll never be rid of the panic and turmoil. But we can learn how to sit with it. We must own our traumas, take responsibility for them. Otherwise they will do so to us.

To the therapists reading this: you’re already treating trauma successfully. You have been your whole career. It’s scary, yes, but it is not impossible. And to everyone else: You’re already living with your traumas. You already survived and made something of yourself. You have already achieved the impossible. Putting a word to it cannot make the pain worse than it already is. What it can do is give you the autonomy to label and define your experiences. To give yourself credit for your successes. Van Der Kolk says it again and again: language is crucial because it is the opposite of shut down avoidance. Language requires us to find and utilize a voice - this is the antithesis to being stuck in the past or stuck in our insecurities.

Trauma is also the first book to a series of amazing revelations. Trauma has the potential to teach us so much about ourselves and the world. Resilience learned in trauma is incredibly powerful, and the wisdom that comes from it is akin to that of our greatest or most spiritual leaders. In his epilogue Van Der Kolk mentions Oprah Winfrey and Nelson Mandela, the abolition of slavery and many other significant moments of human experience in which traumatic experiences gave way to history-defining transitions. Trauma happens, yes, but when we overcome it we transform ourselves.

“The challenge of recovery is to reestablish ownership of your body and your mind –  of yourself. This means feeling free to know what you know and to feel what you feel.” Pg. 205