Why People Still Misunderstand Trauma

Dr. Bessel van der Kolk has spent 30 years figuring out why people behave so strangely. His specialty is treating those who have endured traumas so horrific—war, carnage, incredible pain that they couldn’t stop—that their brains have not been able to fully process them, and their bodies have reacted to their brain’s precarious state in ways they could not explain or control. But many human behaviors still puzzle van der Kolk, 82. He doesn’t understand why the medical community doesn’t take childhood trauma more seriously. He doesn’t understand why leaders still send citizens to war without factoring in how it will deplete their capacity to live normally for decades. And he’s not quite sure why a woman recently came up to him on the street and kissed his feet.

“I said, ‘What are you doing?’” says van der Kolk via video call from his home in the Berkshires. Van der Kolk’s is a specific type of fame. Most people haven’t heard of him, but for those who began to understand why they—or someone they loved—behaved the way they did via his 2014 book, The Body Keeps the Score, he’s a miracle worker. Hence the feet-kissing. 

In the book, the psychiatrist, who was born to Holocaust survivors in the Netherlands, makes the case that trauma is more present and more powerful than people realize. He argues that while trauma injures the brain, its effects go much deeper. “Trauma victims cannot recover,” he writes, “until they become familiar with and befriend the sensations in their bodies.” The Body Keeps the Score is not a self-help book; it is a summary of the scientific advances in understanding and treating trauma in the past century and why van der Kolk believes medicine is still not grappling with it effectively. But for many readers, it was an epiphany. As the book has lingered atop best-seller lists for the past five years, trauma has been elevated from a subject discussed mostly in the medical and military communities to a feature of the national conversation.

In fact, many people—including the book’s author—have begun to caution that trauma is being redefined in unhelpful ways. “People are inflating the whole trauma notion and now apply it to everything,” says van der Kolk. “When somebody breaks up with you in a love relationship, that’s part of life, but that is not a trauma. What’s happening in Gaza, that’s a trauma.” He also dismisses the notion that his book became popular five years after it was published because of the trauma of the pandemic. “My take on this is that I owe a lot of it to President Trump,” he says. “When we saw brutality enter our political arena, a lot of people got triggered and [felt] like, ‘Oh, that’s what my upbringing was about; somebody treated me very badly and hurt me.’”

As the book climbed the charts, van der Kolk—who has also run the Trauma Research Foundation in Massachusetts since 2018—has noticed that he’s invited to more speaking engagements, but fewer hospitals or universities. “Institutions, by and large, have not embraced the book,” he says. Clinicians, however, have. Laurie Marcellin, a therapist in Colorado, says it’s one of the four top books she recommends as a supervisor for new therapists. “It’s amazing, given the amount of years it’s been out, that the book is still considered foundational,” Marcellin says. She’s more cautious about recommending it to clients because it can be triggering in its specificity. “I once heard someone say, ‘It’s like someone opened my mail,’” she says.

Van der Kolk parts company with established medical tradition on several key issues. Some of the treatments he recommends are unconventional. He’s a proponent of using MDMA—also known as the street drugs ecstasy or Molly—to help people debilitated by trauma. (He currently uses ketamine instead, because unlike MDMA, it’s legal to prescribe.) “When you get traumatized, you live in a very narrowed reality, and your fear and your rage really determine your reaction to everything,” he says. “Psychedelics have the capacity to open up people’s minds to live in a much larger reality.”

In his most recent study, published in January, van der Kolk treated 46 traumatized people with psychotherapy and MDMA and 44 with psychotherapy and a placebo. He says he was shocked by the results. “After the MDMA, people were much better able to both articulate their own point of view and understand other people’s point of view, and to not get into fights but find the ability to compromise,” he says. Best-seller influence can get you only so far, however. While Australia and the Netherlands have announced MDMA programs, the experts at the U.S. Food and Drug Administration are advising against recommending it.

Other less-than-orthodox treatments he recommends include activities that can help people feel in step with others, including dancing, drumming, and choir, as well as in step with themselves, such as yoga and breath work. The current system, he says, “where you talk about how bad you feel or you take drugs, needs to be vastly expanded [to be like] the way we raise small kids, which is to have the experiences of discovery and pleasure and connection, not talking about your trauma, just to be in sync with other people.” He’s a big fan of drama therapy. “It is really good for people to inhabit different creatures than who they usually are,” he says.

For some clinicians, the book’s out-of-the-box thinking is what makes it appealing. “I think that we’re pretty stuck in psychiatry for some things,” says Dr. Chuck Weber, co-founder and chief medical officer of Family Care Center, a national chain of mental-health providers that treats a lot of ex-military PTSD (posttraumatic stress disorder) sufferers. One of the book’s techniques he has seen used is therapeutic massage for people whose trauma means they can’t bear to be touched. The hope is that it can retrain the brain to associate touch with different memories.

While the health industry has yet to fully embrace many of these treatments, van der Kolk is seeing progress on the front line, including in schools and prisons; San Quentin has a program based loosely on the practices encouraged by The Body Keeps the Score. “It’s an astounding thing to see the criminal-justice system actually having a trauma model,” says van der Kolk. “It made me very optimistic.”

It’s entirely plausible that van der Kolk’s views of health care institutions have been colored by events in his own history. In 2018, he was dismissed from the first trauma center he founded, amid allegations of bullying, which he strongly denied. He also bristles at the mention of the highly influential Diagnostic and Statistical Manual of Mental Disorders. The DSM describes and encodes all known psychiatric disorders. It’s often key to getting health insurers to pay for a treatment. Despite what van der Kolk believes is overwhelming evidence that children who suffer from persistent trauma because of an absent, abusive, or unwell parent need particular help, the only trauma in the DSM is PTSD. “I have spent too much time in my life trying to change the DSM,” he says, ruefully. “Innumerable research papers—I’m not doing it anymore.” Instead, he is writing a workbook based on his theories. 

He’s also hoping his work has an impact on an institution close to children: schools. His recommendations for how to make up for pandemic losses are, unsurprisingly, mildly heretical. Most school systems are leaning into extra instruction time and tests to catch kids up in reading and math. Van der Kolk says that’s all wrong. “The main thing you learn in school is to be a member of a group, to collaborate, to have fun and to create things together,” he says. “So I would focus on theater groups, I would focus on athletics, because the pandemic really made people physically very isolated and alienated from each other.”

It’s hard to imagine a world in which such activities might be prescribed and paid for by health insurers, or educational systems for that matter. There are no double-blind peer-reviewed studies to establish that they make people feel better. Van der Kolk is not at all put off by this. People surprise him all the time.

Correction, 7/19

The original version of this story misstated Dr. Chuck Weber's techniques. He has seen therapeutic massage used on PTSD sufferers. He does not use it in his clinic.

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