The lifelong cost of burying our traumatic experiences

© Image: Stanley Greene/Noor/eyevine

Past trauma can mean not feeling fully alive in the present.

The Body Keeps the Score

WHAT has killed more Americans since 2001 than the Afghanistan and Iraq wars? And which serious health issue is twice as likely to affect US women as breast cancer?

The answer, claims psychiatrist Bessel van der Kolk, lies in what we now understand about trauma and its effects. In his disturbing book, , he explains how trauma and its resulting stress harms us through physiological changes to body and brain, and that those harms can persist throughout life. Excess stress can predispose us to everything from diabetes to heart disease, maybe even cancer.

Take his two examples. The number of Americans killed by family members exceeds the number that country lost in both wars. But it doesn't stop there. Imagine the fallout for all who witnessed the murder or likely violence in the years preceding it. And women have double the risk of domestic violence - with the health consequences that brings - as they do of breast cancer.

Van der Kolk draws on 30 years of experience to argue powerfully that trauma is one of the West's most urgent public health issues. The list of its effects is long: on mental and physical health, employment, education, crime, relationships, domestic or family abuse, alcoholism, drug addiction. "We all want to live in a world that is safe, manageable... predictable, and victims remind us that this is not always the case," says van der Kolk. When no one wants to hear about a person's trauma, it finds a way to manifest in their body.

And it is not only extreme experiences that linger. Family disturbance or generalised neglect can wire children to be on high alert, their stressed bodies tuned to fight or flight. Or they may be so "numbed out" by keeping demons at bay they can't engage with life's pleasures or protect themselves from future trauma. Even parents who don't attune with their children can do untold damage, van der Kolk argues.

He makes it clear why it's so important: help parents with their problems, deprivation or social isolation, and you help their kids. "If your parents' faces never lit up when they looked at you, it's hard to know what it feels like to be loved and cherished," he says. Neglect creates mental maps used by children, and their adult selves, to survive. These maps skew their view of themselves and the world.

The book has gut-wrenching stories: about Vietnam veterans who committed war atrocities, incest survivors, broken adults that were terrorised as children or shunted between foster homes. Van der Kolk draws on hundreds of studies to back up his claim that "the body keeps the score".

We meet a woman who had suppressed the memory of being raped at age 8 by her father, but when she ferociously attacked a new partner for no reason, she signed up for therapy with van der Kolk. Soon after, her eyesight started to fail: an autoimmune disease was eroding her retina. In a study, his team found that female incest survivors had abnormalities in the ratios of immune cells, compared with untraumatised women, exposing them to autoimmune diseases.

In terms of treatments, van der Kolk argues that "integrating" trauma by turning it into a bad memory, rather than reliving it, in therapy, may be key to recovering from trauma. And he criticises dealing with symptoms rather than causes. He has scary stats: half a million US children and teens take antipsychotic drugs, while privately insured 2 to 5-year-olds on antipsychotics have doubled between 2000 and 2007.

Packed with science and human stories, the book is an intense read that can get technical. Stay with it, though: van der Kolk has a lot to say, and the struggle and resilience of his patients is very moving.