The Body Keeps the Score by Bessel van der Kolk

Dr. Bessel van der Kolk, the founder and director of the Trauma Center in Brookline, Massachusetts, began practicing psychiatry in 1978 at the Boston VA Clinic. On his very first day on the job he ran into an extremely troubled Vietnam veteran. That former Marine became “the first veteran I had ever encountered on a professional basis,” van der Kolk writes in The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma (Viking, 464 pp., $27.95), his best-selling blend of memoir, clinical observations, and recommended treatments.

It won’t surprise any Vietnam veteran to learn that Dr. van der Kolk—who today is one of the most renowned experts on post-traumatic stress—ran into nothing but roadblocks at the VA in 1978 as he attempted to work with the former Marine and other Vietnam veterans with what we now call post-traumatic stress disorder.

van der Kolk was not trained to deal with war-related post-traumatic stress. So after he began working with his first Vietnam veteran patient, he decided to read up on the subject at the VA’s medial library. van der Kolk  was looking for “books on war neurosis, shell shock, battle fatigue, or any other term or diagnosis I could think of that might shed light on my patients,” he writes.

Back in 1978, van der Kolk didn’t find one book “about any of those conditions” at the VA, he says. “Five years after the last American soldier left Vietnam, the issue of wartime trauma was not on anyone’s agenda.”

Bessel van der Kolk

After a breakthrough in 1980—when a group of Vietnam veterans working with pyschoanalysts Chaim Shatan and Robert J. Lifton convinced the American Psychiatric Association to recognize PTSD–van der Kolk wrote a proposal for a study that would look at traumatic memories and PTSD.

The VA rejected his proposal, saying: “It has never been shown that PTSD is relevant to the mission of the Veterans Administration.”

Nor surprisingly, van der Kolk soon left the VA, and went to work at Harvard University’s Massachusetts Mental Health Center. As frustrating as it was, van der Kolk’s experience at the VA proved to be good training. His experiences treating Vietnam veterans, he writes, “had so senstized me to the impact of trauma that I now listened with a very different ear when depressed or anxious patients told me stories of molestation and family violence.”

In many ways, he says, “these patients were not so different from the veterans I had just left behind at the VA. They also had nightmares and flashbacks. They also alternated between the occasional bouts of explosive rage and long periods of being emotionally shut down. Most of them had great difficulty getting along with other people and had trouble maintaining meaningful relationships.”

van der Kolk has spent more than three decades doing innovative work with veterans, their families, rape victims, and other survivors of trauma. In this well-written and readable book he explains how trauma rearranges the brain’s wiring and offers ways to treat PTSD. That includes neurofeedback, group role-playing, mindfulness techniques, and yoga.

You can make a case that one of the biggest influences on van der Kolk’s pioneering work has been the time he spent working with Vietnam veterans at the uncooperative VA back in the late seventies.

–Marc Leepson

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