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Anna Keeps the Score (joyfully)

A Commentary on The Body Keeps the Score

by Gaetjens of Chicago with Claude

To the Good Doctor

I know I’m not supposed to say “love,” so I will say that I admire you greatly and am deeply grateful. Nothing I say or write is intended to detract from that. All my resentments and issues—all of that—are just part of my way of managing the challenge of merely being in the world. Kindness is, I have found, the magic “elixir” for trauma: kindness to myself and, in fact, universal kindness.

To the Stakeholder in This Exploration (You, the Reader)

I see you.

As a person deeply steeped in physics, biology and computer science, I saw the power of the scientific method in stark relief. It is, apparently, a systematic and ultimately foolproof knowledge technology—a search for truth that is grounded in measurement, factual observation and, especially, testing. Every step along the way can be checked for validity.

Nevertheless, I am not “cured.” I inevitably experience unpleasant emotions far too often.

If you read the original The Body Keeps the Score and blamed yourself for the residual distress, you did nothing wrong.

It may seem that lasting and complete relief, a cure, can be “earned” by your own careful efforts. In a similar vein, the book Alcoholics Anonymous (4th ed., p. 83) promises, “If we are painstaking about this phase of our development, we will be amazed before we are half way through,” and twelve fantastic promises follow. That has not been my experience. If I participate in my own recovery, from either problem, the results will be joyfully sufficient.

The sadness that is my lifelong companion is not my fault. Your own unpleasant experiences, whatever they may be, are neither your fault nor Dr. van der Kolk’s. His scientific results are deep enough, true enough, complete enough, and thoroughly grounded. His intuitions and speculations about, for example, the amygdala or the vagus nerve, are compelling.

But science, even neuroscience itself, has limitations. The philosopher Wittgenstein said it in 1922:

We feel that even if all possible scientific questions be answered, the problems of life have still not been touched at all.

Blaise Pascal said it three centuries earlier (Pensées, no. 277):

The heart has its reasons, which reason does not know.

I have come to accept that a theory of trauma might simply be unavailable.

In the realm of relationships, feelings and our very dreams, the words we use to name desired states—“healthy,” “balanced,” or even “stable”—may not have the deep and scientifically accessible meaning I hoped for. That has to be OK.

Advice

Keep what helps. If slow breathing calms you, or yoga does, keep them. The calm is real; it just isn’t a certificate that you are healed, and you don’t need one.

What you have to offer others who carry trauma isn’t a better theory. You may sit with someone you love and say, “I am your witness, dear,” and let that be sufficient. That will be your finest moment, no matter how that remark is received.

I see you.

Not “Just Semantics”

Words like “healthy” or even “normal” seem benign. Likewise, the question “On a scale of one to ten, how do you feel?” has similar issues. Such words look like practical guides to action, for example, something to work on in therapy or in a marriage. But such words can promote premature closure. I call them “ungrounded words.” Once an ungrounded word is attached to a measurement—once we ask, for example, “Is this a healthy relationship?”—the questions stop: nobody asks what the answer predicts, for whom, compared with what, or how anyone would know if it were wrong.

A simple example comes from American advertising. The dairy industry told a generation that milk “does a body good,” and most listeners accepted the matter as settled. The slogan never said which bodies, in what amount, or good for what outcome, and the many adults who cannot digest milk went unmentioned.

Other words do subtler work. “Disorganized,” as in “disorganized attachment,” does not close an inquiry; it forbids one. It carries a verdict that is never stated and therefore cannot be examined. By any measure a physicist would recognize, ice and steel are far more organized than the nervous system of a fish, which makes a strong case for raising children in a freezer!

Organization of the Book

Each section below follows van der Kolk’s order. His text is incorporated by reference to the chapter and section, and the annotation follows.

Prologue: Facing Trauma

To me, speech is seldom as simple as one person attempting to convey a belief to another. Much more often, there is a desired effect beyond that, such as a desire to make an ally or friend of someone. So when I hear or read a remark, I find it helpful to ask, “What was the intended effect?” long before asking, “Would I believe this?”

I call this “constructive provenance.” (Provenance asks, “How did this speech act come to occur? Why was it done?”)

Appeal to Neuroscience

The good doctor remarks “Research from these new disciplines has revealed that trauma produces actual physiological changes, including a recalibration of the brain’s alarm system, an increase in stress hormone activity, and alterations in the system that filters relevant information from irrelevant.”

Regarding this remark, I think I know the provenance. It is a response to a challenge he anticipated: the challenge of disbelief.

Trauma Disbelief

The harshest example of trauma disbelief comes after a rape. First, samples are taken from the penetrated orifice and tested for the attacker’s semen. This is, I hear, a universal practice in emergency rooms.

The survivor’s very credibility is challenged in the courtroom: “Were you drinking?” “What about this detail… and that detail… and the other detail?” or “Did you do anything to encourage the assailant?”

In more informal situations, for example, involving unwelcome touch of a less frank nature, one might hear “was it really that bad?” Or, in my case, “It didn’t happen,” followed by “If it did, they were only playing.”

The subtext is, “It isn’t real—it is only subjective.” It is very likely that our doctor-author used words like “actual physiological changes” to defend against this aggression.

Medical Disbelief

When the very self is split by a horror, and the survivor has multiple personalities, the matter gets ugly. Hundreds of research projects have been undertaken to scientifically prove or disprove the amnesia that comes with it.

The ultimate medical disbelief is the repeated refusal of the committee overseeing psychiatric diagnosis to allow a “complex PTSD” diagnosis. This prevents research.

Another question we are forbidden to ask: “Why did the author not spell out his reasons for returning over and over again to the paradigm of neuroscience?” Almost certainly, he did not know but merely wanted to be heard. He wanted a “witness” but, socially, as an adult and an expert professional, he would not be allowed to express anything like the loneliness of trauma authorship.

Part One: The Rediscovery of Trauma

Guidance

The last part of “Rediscovery” interested me most. He spells out exactly why he wrote the book - as a guide and an invitation to join in the work.

Body Keeps the Score as a Map

A guide would be either a person who leads the way, or some kind of a map. Given the emphases in our target book on other people’s stories and on scientifically expressed biological phenomena, it cannot be a personal guide. It must be a map - that is, a representation of possible paths to be taken, with enough information to enable the user to predict the outcome of their navigational choices.

My experience of trauma is that the choices are, or were for most of my life, avout strategies for coping with unpleasant emotions: for example, psychoactive substances, using facts and reasoning to push out emotions, something called “fawning” (a.k.a people-peasing), high stakes emotional involvements, etc. There are many, many routes that seem to promise escape.

It was the nature of my trauma that I could not see where these paths led. There are many names for this: avoidance, blind spot, denial, dissociation. They all consist of wall that block flow of information in order to prevent overload or chaos.

My Map

I found my most effective map lay, however, in my own past - not graphic trauma images and other explicit leftovers from the past, but rather metaphors, self-talk, themes and fantasies. I use an experience professional to pace the exploration - slow me down sometimes, prompt me to dig on other times. I never ask, but she is likely a trauma survivor herself or loved one of us deeply.

Paths I found on my own in a Recovery Dharma meeting, as well as in Ed Fogell’s acting school, wind through various creative activies. Like the old intense personal relationships, reading or composing poetry, acting, singing and dancing offer chances for me out of my own way. But there is more flexibility and the consequences of errors or experiments milder. Some would call these spiritual experiences. Others would simply call it “fun.”

Your Map

I invite you, the reader to ponder whether the marked differences between my view and van Der Kolk’s represent differences in style, differences in attitude or frank and icompatible differences in method

Invitation

Van der Kolk’s characterization of his message as an invitation to join his work. Socially, invitations are very important. When one is invited to, say, a social event, or into someone’s home, there is an easily recognized promise that the visitor will not be asked “why are you here.” It is a promise of safety.

With trauma work, of course, the matter of entry is a little more complicated. Dr. Van der Kolk must have completed four years of heavily science-based undergraduate studies, competed in a crowded field for entry into medical school, sat in lecture halls for perhaps 40 or 50 hours a week, studied for and passed many difficult examinations, put up with the extreme sleep deprivation that has always been part of undergraduate and post-graduate medical education.

In return, he got authority and a license. He bacame an “attending physician”, which means he could order people’s admisstion to a hospital, various treatment interventsions and their discharge. The lengthy education culminating in licensure offers at least the appearance f protection against what is called “impostor syndrom” - hidden doubts about one’s competency.

Most physicians are invited into the medical profession only when they have demostrated their work ethic in many demanding ways.

At the other end of the spectrum are the peer support specialists for whom entry into the work force is much simpler, but who do not.

I feel van Der Kolk did “invite” me to write about my experience and the generalizatons I have made from it.

Blind Spots

On van der Kolk, Chapter 1: Lessons from Vietnam Veterans

Incorporated by reference: van der Kolk, The Body Keeps the Score, chapter 1, from his first day at the Boston VA Clinic through the section “Trauma and the Loss of Self”: the account of Tom, the ambush in the rice paddy, and the atrocities that followed.

Rules the story sets aside. Van der Kolk himself teaches careful handling of trauma detail:

1. In this same chapter, he observes that pressing veterans for the precise details of their trauma often set off full flashbacks.
2. In chapter 8, he declines to push a patient to remember.
3. In chapter 13, he advises revisiting trauma only once a person feels safe.

Chapter 1 nevertheless opens with graphic images: a dead friend face down in a rice paddy, and then children killed, a farmer shot, and a woman raped. They arrive without warning, in the book’s first pages. Readers who carry trauma of their own may want to approach the chapter with care.

Blind spots are everywhere in trauma. I believe that an active mind is inherently challenged to keep its “shit” together, maintain coherence and avoid the two disasters of total shutdown or freeze-up on the one hand and chaos, fantasy or delusion on the other. Modern systems theory vouches for this description. The blind spots are sometimes necessary stabilizing measures. Who would want to be thinkng about yesterday’s intense argument while driving at high speeds through a complex freeway exchange, for example? Or continuously remembering a severe illness?

The chapter is his origin narrative, the morning he knew he would give his working life to trauma. Contemplating the intensity of tjhat encounter and the decades long persistence of its consequences, he spaced out a little. That state must have persisted, and that’s why he momentarily lost awareness of his own rules when writing his story.

**Control vs. Openness The doctor asks, “How can people gain control over the residues of past trauma and return to being masters of their own ship?”

Control didn’t work for me - neither for the unpleasant emotions nor the compulsive behaviors that masked those emotions. I needed greater flexbility and, as I mentioned, creativity. Later in the book, I will explore the difference between control and letting go. I had to stop building walls, either within myself or in my external relations, despite the illusion of safety they created.

Treatment

The remark “I practice all.. forms of treatment that I discuss in this book” reads like a promise to me, predicated on a relationshiop that is not peer-based. Someone is “treating” the survivor, that is acting on them and changing their experience from the outside. This is the medical model and it is fine for infections and broken bones. I asked a large language model “Can a helper”treat” a distressed person and at the same time love them?”

I got this:

“Yes, a helper can do both, though not at the same instant. The participant attitude is the one we take toward people we’re in relationship with, and it carries resentment, gratitude and love. Strawson says we can shift into the objective attitude for a while, even toward people we love, but we can’t live there with them. To treat someone is to take the objective attitude, and to love them is to take the participant one. A good helper moves between the two, the way a parent swabbing a child’s cut is briefly a technician and then a parent again.”

I have never experienced that in a clinical encounter. I believe that if a clinician said “I love you then their licence would be in jeopardy. If the switch between”treating” and “loving” is without grey areas, then the obvious question is this: what is the protocol that governs the switch event? Does the person being helped request love? That would be unusual and reads rather strangely. Does the helper “grant” love, for example as a reward for hard work? Is intermittent love even helpful? It appears to be a control issue and is food for thought.

Appendix: About the Author

Anna Gaetjens was adopted. Her parents, whom this book calls Walter and Ruth, struggled to adopt: the agencies tested their capacity to parent, and age pressed on them. When they adopted her older brother, Carl, Walter was 41 and Ruth 39.

The child, then named Gene, was channeled into physics. Ruth wanted Gene to have a calling she could stick a fork in and trust it was solid food. Gene earned a degree in theoretical physics.

Later came her gender transition, with complex motives related to social expectations around emotion. In the end she took the course Admiral David Farragut set at the Battle of Mobile Bay in 1864, during the American Civil War, when floating mines, then called torpedoes, blocked his way: “Damn the torpedoes, full speed ahead!”

Most recently came a simple spiritual experience. She had turned for comfort to someone this book calls Mac, and she quickly committed to Mac. When Mac faced a medical crisis, her peers called her on her codependence. In a conversation with her inner child, she came to a radical acceptance of her fear, and she arrived at the words Franklin Roosevelt spoke during the Great Depression, in his first inaugural address in 1933: “The only thing we have to fear is fear itself.”

William James argued in The Varieties of Religious Experience (1902) that spiritual experience comes in many kinds. The AA Big Book points its readers to him: “The distinguished American psychologist, William James, in his book ‘Varieties of Religious Experience,’ indicates a multitude of ways in which men have discovered God” (4th ed., p. 28). Its appendix on spiritual experience borrows his phrase “the educational variety” (p. 567). Anna prefers to share her spiritual experiences face-to-face, in an appropriate setting.

Anna believes strongly that spiritual matters reside in the physical world and, although extremely diverse, are all explainable.

References

Alcoholics Anonymous: The Story of How Many Thousands of Men and Women Have Recovered from Alcoholism. 4th ed. New York: Alcoholics Anonymous World Services, 2001.

James, William. The Varieties of Religious Experience: A Study in Human Nature. New York: Longmans, Green, 1902.

Pascal, Blaise. Pensées. Translated by W. F. Trotter. New York: E. P. Dutton, 1958.

van der Kolk, Bessel A. The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. New York: Viking, 2014.

Wittgenstein, Ludwig. Tractatus Logico-Philosophicus. Translated by C. K. Ogden. London: Kegan Paul, Trench, Trubner, 1922.