Abstract
Bessel van der Kolk is a medical doctor and psychiatrist. He attended medical school at the University of Chicago and completed his psychiatric training at Massachusetts Mental Health Center at Harvard University. He held academic positions at Harvard University. Dr. van der Kolk began treating Vietnam veterans suffering post-traumatic stress disorder (PTSD) in 1978. He has also worked with rape, childhood abuse, and domestic violence victims, as well as persons experiencing other types of violence or catastrophic events. In 1984 he set up one of the first centers in the United States, in Brookline, MA, to both treat and study traumatic stress. This center became a leading research, training, and clinical institution for PTSD. Additional author information is available at his website https://www.besselvanderkolk.com/. His book, The Body Keeps the Score, was on the New York Times bestseller list for over 245 weeks, including 27 weeks at Number 1, and has sold over 2 million copies. The book has been published in 36 languages.
In his book, Dr. van der Kolk explores trauma, PTSD, recovery, and the brain body connection. Dr. van der Kolk posits that traumatic experiences leave lasting effects on the person, their body, their families and larger communities. He states that “trauma, by definition, is unbearable and intolerable” (p. 1). Trauma is damaging and can be reactivated years or decades after it was experienced, impacting a person’s well-being. The American Psychiatric Association (n.d.) defines PTSD as, A psychiatric disorder that may occur in people who have experienced or witnessed a traumatic event, series of events, or set of circumstances. An individual may experience this as emotionally or physically harmful or life-threatening and it may affect mental, physical, social, and/or spiritual well-being.
Triggering events may produce flashbacks and physical symptoms. Dr. van der Kolk emphasizes that the brain may suppress trauma, but the body does not. He notes that one must love themselves in order to love others, and that positive relationships are necessary for recovery.
It is difficult to pinpoint exact numbers of people worldwide suffering from PTSD; however, the incidence has increased globally over the past 20 years (Bryant, 2019). Prevalence is specific to individual studies, meta-analyses, specific research methods, and sample characteristics. The National Center for PTSD, a program of the U.S. Department of Veterans Affairs, estimates, in the United States, that 6% of people will experience PTSD in their lives, with women more likely to experience PTSD (Schnurr, 2023). In a 2017 systematic review and meta-analysis, Pelin et al. (2017) found the incidence of PTSD in pregnant and postpartum women to be around 4%. Trauma occurred prior to, during, or in the postpartum period. I was not able to locate more current prevalence rates for childbearing women.
The first four parts of The Body Keeps the Score focus on trauma while Part Five focuses on recovery. Incorporating specific patient exemplars, Parts One and Two of this book provide a thorough presentation of how trauma manifests in the body and how trauma is manifested in the brain. The author presents a comprehensive review of brain development and function, and brain–body connections. The drawings and diagrams provide visual representation of the text. Part Three explores childhood trauma. Chapter 7, in Part Three, reviews attachment with a grounding in John Bowlby’s seminal works. Part Four examines traumatic memory. Part Five presents non-pharmacologic treatment modalities such as yoga, mindfulness, dance, and Eye Movement Desensitization and Reprocessing (EMDR). Each chapter is well referenced; 51 pages of references in total. References include scientific studies. There are three pages of resources as well as four pages of further reading.
This book is informative for those caring for families. Given that PTSD occurs more often in women and is expressed in both mind and body symptoms, it is important for lactation consultants to understand trauma and how it is expressed. The content of this book can help us better understand the families with whom we work. The information on attachment and relationships is particularly important given our work with dyads and families. I am not suggesting that lactation support providers, including International Board Certified Lactation Consultants, use the knowledge gleaned from this book to provide mental health treatment; however, recognizing trauma requires the lactation support provider to give patients resources and referrals to qualified care providers for those suffering from trauma and PTSD.
As with any book, there are readers, including health care providers, who do not agree with some of the information that Dr. van der Kolk shares. In the United States and many Western countries, cognitive behavioral therapy (CBT), other talk therapies, and medications are first line therapies for those diagnosed with PTSD. While Dr. van der Kolk does not dispute that, in some cases, there is a need for these therapies, he offers alternative treatment modalities. Additionally, Dr. van der Kolk calls for better diagnostic criteria and additional diagnoses, in the Diagnostic and Statistical Manual of Mental disorders (DSM), to more accurately characterize childhood mental health conditions. Dr. van der Kolk pushed for changes to the DSM which were not incorporated.
This book was difficult for me to read. I read the book over several months, needing to read a chapter, put the book down for several days, then read more. While well written, the stories of trauma and suffering were hard to integrate. Some readers have noted that reading this book has brought their own trauma to the surface. Despite the tough read I highly recommend this book. It provides extremely valuable information which can inform the care and support that we provide to breastfeeding families.
Footnotes
Disclosures and Conflicts of Interest
The author declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: SG was an Associate Editor for JHL at the time this article was written.
Funding
The author received no financial support for the research, authorship, and/or publication of this article.
