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Prologue

In the Prologue, van der Kolk first proposes the idea that trauma impacts the lives of everyone in society, whether directly or indirectly. Statistics show that a not insignificant percentage of Americans have survived trauma, such as child abuse, sexual assault, or combat experience. Those not directly impacted still feel the effects of trauma in their lives as they interact with, live with, and love survivors in their family and community. The brain does not easily let trauma go, as it is devoted to ensuring survival and thus hardwired to remember these traumatic experiences in order to protect itself in the future. As research has continued over the years, showing not only the deep physiological and mental havoc that trauma can wreak, it has also revealed different treatments that may be used to effectively manage trauma. The key to begin dealing with trauma in everyday life is to first begin the discussing it, learning about it, and working with others to heal it.

Chapter 1: Lessons from Vietnam Veterans

The first chapter details van der Kolk’s experience working at the Boston Veterans Administration Clinic (VA) in 1978, where his research on post-traumatic stress disorder (PTSD) began. On his first day, he met Tom, a Vietnam veteran troubled by flashbacks and nightmares that drove him to bouts of rage, alcoholism, and high-risk activities. At the time, PTSD was not an official diagnosis, but van der Kolk found guidance in Abram Kardiner’s The Traumatic Neuroses of War (1941), which detailed Kardiner’s observations of World War I soldiers suffering from what was then known as “shell-shock.” However, Kardiner had little idea on how to treat this condition, and so van der Kolk set about studying for himself how best to help his patients at the VA. He found that many had the same symptoms as Tom, and the same experiences: losing comrades and close friends in battle, and dealing with the shame of their behavior during traumatic episodes following these losses.

Veterans increasingly experienced emotional numbing as well and were not feeling present in their lives. During a study a study involving Rorschach tests, some veterans responded to the Rorschach ink blots with flashbacks and descriptions of traumatic memories, but for others, there was no response at all. Either veterans were stuck in the past, or simply could interpret nothing at all from the indistinct shapes. The former response led to many veterans forming their lives around the traumatic events that had shaped them and having difficulty talking about current issues in their lives.  After Van der Kolk failed secure a grant to study the effects of PTSD on these veterans, he resigned and began working at the Massachusetts Mental Health Center in 1982, and noticed similar patterns of behavior and symptoms in traumatized patients who had never seen combat. This led van der Kolk to the understanding that trauma, no matter the kind, fundamentally changes the function of the mind and physiology of a patient.

Chapter 2: Revolutions in Understanding Mind and Brain

Chapter 2 discusses the history of changing mental health treatment in the 1960s and 70s. As a young student working at the Massachusetts Mental Health Center in the late 1960s, van der Kolk noticed the cold way that patients were treated by staff, with little interest in the personal histories of trauma that brought them to the hospital in the first place. In 1968, medicine became a mainstay in treatment, often to the point of overreliance and with a similar disregard to a patient’s traumatic history, seeking only to treat the symptoms. Van der Kolk also learned of inescapable shock and learned helplessness from a presentation given by Steven Maier, detailing an experiment in which dogs who had never been shocked would leave an open cage when shocked, but dogs who had been previously shocked would not leave.

Chapter 3: Looking Into the Brain: The Neuroscience Revolution

The concluding chapter in Prat 1 continues the history of developments in neuroscience and mental health treatment, beginning in the 1990s. New types of brain scans, such as PET and fMRI, were allowing scientists in-depth looks at the brain’s activity for the first time. Van der Kolk and his research assistant, Rita Fisler, used this technology to map brain activity in a study that involved scanning patient’s brains while reading two scripts: one recreating a traumatic memory, and the other recreating a scene of comfort and safety. One such patient was Marsha, who had lost her daughter in a car accident 13 years prior. During the reading of the traumatic memory, Marsha showed physical signs of distress, as well as activation in the amygdala, which activates the stress response. All participants only showed activation in the right hemisphere of the brain during their traumatic scripts. The right hemisphere is responsible for processing emotions and sensations, as opposed to facts or timelines. This left patients unable to process the narrative of their traumatic experiences, and thus at the mercy of reliving emotions and stressed responses still associated with the event.

Next section Part 2: This Is Your Brain on Trauma (Chs 4-6)

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