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Anna Keeps the Score (joyfully)

A Commentary on The Body Keeps the Score

by Gaetjens of Chicago with Claude

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 your fellow survivors 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.

Annotation

Part One: The Rediscovery of Trauma

Chapter 1. Lessons from Vietnam Veterans

PTSD narrative 1: an origin narrative

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.

Annotation

The rule he breaks. Van der Kolk knows that unannounced trauma detail does harm. In this same chapter he admits that pressing veterans for the precise details of their trauma often set off full flashbacks. In chapter 8 he names “Auden’s rule” and deliberately declines to push a patient to remember, and in chapter 13 he advises revisiting trauma only once a person feels safe. Yet he opens the book with a dead friend face down in a rice paddy and then, in one flat sentence, children killed, a farmer shot, and a woman raped, with no warning and no stated purpose. Tom needed months before he could tell the story to one trusted doctor. The reader receives it from a stranger in the book’s first pages.

What the story does for its author. The account serves four ends, none of them the reader’s:

1. It is his origin story. The chapter turns on his own conversion, the morning he realized he would spend his professional life on trauma.
2. It enlists the reader’s body as evidence. The reader’s shock stands in for argument, so the thesis is felt before it is tested.
3. It sets up his critique of medication, since Tom refused the pills to stay loyal to his dead friends.
4. It admits the author’s father and uncle, whose rages he links to Tom’s, so the patient’s story frames the author’s own.

What it does to the victims. The Vietnamese woman, the children, and the farmer appear only as the cause of Tom’s shame. The rape exists in the text to wound its perpetrator, and the woman is never mentioned again. The author of this commentary felt assaulted by the passage, and the word fits: the passage uses the reader as it uses the woman, as material for someone else’s story.

Origin myths. The idea is old. The anthropologist Bronisław Malinowski argued in the 1920s that a myth works as a charter: a story of how things began licenses an arrangement in the present, such as who holds the land or who leads the rite. Mircea Eliade added that knowing how a thing began confers power over it, so the healer who recites a disease’s origin claims the authority to cure it. Joseph Campbell’s The Hero with a Thousand Faces (1949) supplied the plot: a call, an ordeal, and a return bearing a gift.

Chapter 1 fits all three. Tom bursts through the door on the first day, which is the call. The refused pills and the empty VA library are the ordeal. The author emerges vowing a lifetime to trauma, and the book is the gift. The charter it grants is his authority over the subject.

Two modern origin myths. An origin myth names a first cause, gives it a will, and lets the story serve someone now.

HIV spilled over from a chimpanzee virus in central Africa early in the twentieth century. Three conspiracy theories grew around it:

1. In 1983 the KGB planted a story in an Indian newspaper claiming the Pentagon had built AIDS at Fort Detrick. The East German biophysicist Jakob Segal later lent it scientific cover, and the campaign, now known as Operation INFEKTION, spread it worldwide. Soviet officials admitted it in the early 1990s.
2. The dermatologist Alan Cantwell argued in AIDS and the Doctors of Death (1988) that government scientists seeded HIV into gay men through the hepatitis B vaccine trials run in New York and San Francisco from 1978 to 1981. The trials were real and recruited gay men, which gave the story its grip, but the vaccine lots were later shown to be free of HIV.
3. Many Black Americans came to believe HIV was made to kill Black people. Tuskegee made that distrust earned rather than paranoid.

The Reagan administration’s long silence gave all three soil to grow in. When a government visibly does not care whether you die, the belief that it wants you dead is a short step.

The origin of COVID-19 remains disputed between natural spillover and a laboratory accident. The laboratory hypothesis becomes a myth only when it acquires villains with motives, such as scientists who meant harm, because no evidence about a virus can confirm or refute an intention.

A test. A claim about how something works can turn out to be wrong; a myth can only be believed or doubted. Van der Kolk’s origin narrative is a myth in this sense. Nothing in the book could show that his calling was mistaken; the reader is simply asked to feel it.

Part Five: Paths to Recovery

Chapter 16. Learning to Inhabit Your Body: Yoga

PTSD narrative 2: a seduction narrative

Incorporated by reference: van der Kolk, The Body Keeps the Score, chapter 16, the sections “Finding Our Way to Yoga” and “Exploring Yoga,” with their four heart rate variability figures and notes 2, 9, and 11; and chapter 5, the section “A Window into the Nervous System,” where heart rate variability is first defined.

Annotation

Force and seduction. Chapter 1 takes the reader by force. The heart rate variability material takes the reader by seduction, which is harder to name because it works through what the reader wants rather than against it. It needs no atrocity and leaves no visible wound.

What he claims. Across the two chapters van der Kolk makes these assertions:

1. A deep breath activates the sympathetic system, and a burst of adrenaline speeds the heart; exhaling activates the parasympathetic system and slows it (ch. 5).
2. Heart rate variability tests the flexibility of this system, and more fluctuation is better, a sign that brake and accelerator are in balance (ch. 5).
3. Good heart rate variability is a measure of basic well-being (ch. 16).
4. Poor coherence between breathing and heart rate leaves people vulnerable to heart disease, cancer, depression, and PTSD. Note 2 cites four papers, all on PTSD.
5. His team measured about sixty people with chest bands and earlobe pulse monitors and found unusually low heart rate variability in PTSD, which he reads as the two branches of the autonomic nervous system being out of sync.
6. Yoga can change heart rate variability. The citation is note 11, his own 2006 review, not a trial.
7. Handheld devices and phone apps can train cardiac coherence. Note 9 concedes that nobody has tested whether they reduce PTSD symptoms and calls it “very likely.”

What the story offers. The seduction consists of four gifts:

1. It gives invisible pain a number. Suffering that no scan or laboratory test shows suddenly has a graph, and a graph promises legitimacy.
2. It exculpates. If trauma has knocked out a brake in the nervous system, the trouble lies in machinery, not in character.
3. It hands the reader a lever. Breathe at six breaths a minute, watch the screen, and a jagged line becomes a smooth wave within minutes.
4. It supplies a map with three rooms. Polyvagal theory’s safe, mobilized, and shut-down states give every experience an address. A racing heart and a slow heart both confirm it, which is why the map never fails.

The hook. The third gift is also the con. At about six breaths a minute, breathing and heart rate fall into resonance, and the smooth wave follows mechanically from the breathing itself. The device displays a coherence that the procedure manufactured, and the reader takes it as evidence that something inside has healed. Nothing in the graph can say whether anything has.

The theory under it. The psychophysiologist Paul Grossman has argued that each of polyvagal theory’s five basic premises is contradicted by existing evidence, including the claim that respiratory sinus arrhythmia is a distinctly mammalian social system, since fish and reptiles show it too (Grossman, Biological Psychology, 2023). Defenders of the theory have replied, and the dispute continues. The book presents none of it.

One reader’s craving. In the author’s voice: I grabbed hold of this theory the way a hungover drinker grabs the bottle at an eight a.m. liquor store. It soothed me to have a theory. In my trauma group I said that my attempts to avoid the pain nearly cost me my soul, and that I carry a craving for a cure, or for proof of safety. The heart rate variability chapter is written to that craving. It offers a number that certifies I am safe now, and a device that produces the number on demand. Van der Kolk says elsewhere that safety comes from people and presence; here he sells a measurement of it. The search for proof did not heal me. It occupied the place where living should have been.

A test. A rigorous heart rate variability claim names its metric, recording conditions, breathing rate, and the outcome it predicts, and it can then be wrong. Van der Kolk’s version names none of these, so it cannot be wrong, and a claim that cannot be wrong can only soothe.

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.

Bogart, Laura M., and Sheryl Thorburn. “Are HIV/AIDS Conspiracy Beliefs a Barrier to HIV Prevention among African Americans?” Journal of Acquired Immune Deficiency Syndromes 38, no. 2 (2005): 213–18.

Boghardt, Thomas. “Soviet Bloc Intelligence and Its AIDS Disinformation Campaign.” Studies in Intelligence 53, no. 4 (2009): 1–24.

Campbell, Joseph. The Hero with a Thousand Faces. New York: Pantheon Books, 1949.

Cantwell, Alan, Jr. AIDS and the Doctors of Death: An Inquiry into the Origin of the AIDS Epidemic. Los Angeles: Aries Rising Press, 1988.

Centers for Disease Control. “Hepatitis B Vaccine: Evidence Confirming Lack of AIDS Transmission.” Morbidity and Mortality Weekly Report 33, no. 49 (1984): 685.

Eliade, Mircea. Myth and Reality. Translated by Willard R. Trask. New York: Harper & Row, 1963.

Faria, Nuno R., et al. “The Early Spread and Epidemic Ignition of HIV-1 in Human Populations.” Science 346, no. 6205 (2014): 56–61.

Grossman, Paul. “Fundamental Challenges and Likely Refutations of the Five Basic Premises of the Polyvagal Theory.” Biological Psychology 180 (2023): 108589.

Malinowski, Bronisław. Myth in Primitive Psychology. London: Kegan Paul, Trench, Trubner, 1926.

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.

van der Kolk, Bessel A. “Clinical Implications of Neuroscience Research in PTSD.” Annals of the New York Academy of Sciences 1071 (2006): 277–93.

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