Book reviews on stress and trauma – “When the body says No” (Gabor Mate) and “The body keeps the score” (Dr Bessel Van der Kolk)

Many therapy clients are surprised to learn that their issues relate to chronic stress and also to trauma (even if it occurred during their childhood). A useful counselling tool is psychoeducation – helping clients learn more about their mental health, what they are experiencing and both the causes and remedies. Both of these books show the strong link between mental health and physical health – the mind-body connection (psychoneuroimmunology is a new discipline in the science of the interactions between mind and body). I reviewed these books originally when studying complex PTSD (cPTSD) as part of a research project. Book reviews on stress and trauma – “When the body says No” (Gabor Mate) and “The body keeps the score” (Dr Bessel Van der Kolk).

When the body says No – The cost of hidden stress by Gabor Mate (2019)

This book explores the hidden connections between mental health and physical illness.

Biologically, the stress response exists to warn us of potential danger and to keep us safe. Many people are familiar with the fight, flight, fawn and freeze response. So stress itself isn’t a problem – and we need some stress in order to perform well (see Creativity and good and bad stress – Kim Tasso.

However, when stress becomes regular, prolonged or chronic it can cause serious mental and physical health issues. Stress in children – perhaps from early emotional or physical neglect or abuse – can create patterns of feeling, thinking and coping mechanisms which make them more vulnerable to the damage of stress in later life.

The author, Addiction Recovery Resources: Dr. Gabor Maté Author & Speaker ( is highly sought after for his expertise on addiction, stress and childhood development. Dr. Maté weaves together scientific research, case histories and his own insights and experience to present a broad perspective that enlightens and empowers people to promote their own healing and that of those around them. After 20 years of family practice and palliative care experience, Dr. Maté worked for over a decade in Vancouver with patients challenged by drug addiction and mental illness. He is also a survivor and child of the Nazi genocide.

At 280 pages, with substantial scientific material and evidence, the book is a long and tough read: “My other purpose was to hold up a mirror to our stress-driven society so that we may recognise how, in myriad unconscious ways, we help generate the illnesses that plague us”. But it’s also an illuminating and worthwhile read. Contents include:

  • The Bermuda Triangle (the story of how abuse and repression led to a fatal autoimmune disease for one patient, setting the scene for how stress is transmuted into illness)
  • The little girl too good to be true
  • Stress and emotional competence
  • Buried alive
  • Never good enough
  • You are part of this too, Mom
  • Stress, hormones, repression and cancer
  • Something good comes out of this
  • Is there a “cancer personality”?
  • The 55 per cent solution
  • It’s all in her head
  • I shall die first from the top
  • Self or non-self: the immune system confused
  • A fine balance: the biology of relationships
  • The biology of loss
  • The dance of generations
  • The biology of belief
  • The power of negative thinking
  • The Seven As of Healing

The information about particular personalities (e.g. those who repress their emotions – especially anger – and those who are unable to say “no”) and the link to serious illnesses such as cancer, Multiple Sclerosis (MS) and auto-immune diseases such as Rheumatoid Arthritis, Crohn’s Disease and Alzheimer’s is alarming. Particularly as I had a late diagnosis of Rheumatoid Arthritis: Disabled and down but definitely not out – A story of hope after a year (,

The book demonstrates the powerful impact of helping people to express their emotions (especially anger) to reduce the risk of serious psychological and physical illnesses.

Some interesting references in the book:

  • In 1892 the Canadian William Osler, one of the greatest physicians of all time, suspected RA -a condition related to scleroderma – to be a stress-related disorder
  • In another study, four of the women (of eight with MS), had been abused physically or psychologically by their partners sometime before the onset of the illness
  • Selye’s analogies illustrate an important point: excessive stress occurs when the demands made on an organism exceed that organism’s reasonable capacities to fulfil them
  • The research literature has identified three factors that universally lead to stress: uncertainty, the lack of information and the loss of control
  • “Extreme suppression of anger” was the most commonly identified characteristic of breast cancer patients in a 1974 British study
  • Cancer, ALS, MS and RA and all these other conditions, it seems to me, happen to people who have a poor sense of themselves as independent persons
  • Characteristics of many persons with rheumatoid diseases is a stoicism carried to an extreme degree and a deeply ingrained reticence about seeking help. The non-complaining stoicism exhibited by rheumatoid patients is a coping style acquired early in life…one common characteristic was a pseudo-independence, described by author as a compensating hyper-independence.
    • Other traits identified in the psychological investigations of people with rheumatoid disease include perfectionism, a fear of one’s own angry impulses, denial of hostility and strong feelings of inadequacy
    • The repression of anger is a form of dissociation, a psychological process originating in childhood. Bowlby calls this phenomenon “defensive exclusion”. Not infrequently anger is directed away from an attachment figure who aroused it and aimed instead at the self. Bowlby suggests “inappropriate self-criticism results”.
  • The other way of protecting oneself from the stress of threatening relationship is emotional shutdown. To feel safe, the vulnerable person withdraws from others and closes against intimacy
  • Dr. Lipton calls the process the biology of belief e.g. I have to be strong, It’s not right for me to be angry, I’m responsible for the whole world, I can handle anything
  • The overwhelming need of the child to avoid pain and conflict is responsible for the personality trait or coping style that later predisposes the adult to disease

The book ends by describing the Seven As of healing

    • Acceptance
    • Awareness
    • Anger
    • Autonomy
    • Attachment
    • Assertion
    • Affirmation

The Body keeps the score – mind, brain and body in the transformation of trauma by Dr Bessel Van der Kolk (2014)

This book summarizes several decades of research into the nature of trauma. The central idea is that if we do not resolve a trauma, the stress hormones that the body secretes to protect itself from danger keep circulating. So the defensive movements and emotional responses that belong to the past traumatic event keep getting replayed in the present.

Author Bessel van der Kolk MD spends his career studying how children and adults adapt to traumatic experiences. He has translated emerging findings from neuroscience and attachment research to develop and study a range of treatments for traumatic stress in children and adults. In 1984, he set up one of the first clinical/research centres in the US dedicated to study and treatment of traumatic stress in civilian populations. He did the first studies on the effects of SSRIs on PTSD; was a member of the first neuroimaging team to investigate how trauma changes brain processes and did the first research linking BPD and deliberate self-injury to trauma and neglect in early childhood.

Much of his research has focused on how trauma has a different impact at different stages of development and disruptions in care-giving systems. He has focused on studying treatments that stabilize physiology, increase executive functioning and help traumatized individuals to feel fully alert to the present.

The book explores the ways trauma can cause changes to brain functioning, elevate nervous system arousal and cause long-term pain and chronic illness. It directs people to pay attention to physical sensations in their bodies as a way of detecting how their emotional state may be having an impact.

It has 350 pages of detailed information and a further 100 pages of references and indices. The first 200 pages set the scene with information and evidence about trauma and then 150 pages discuss remedies and treatments.

Key points of interest: 

  • Long after a traumatic experience is over, it may be reactivated at the slightest hint of danger and mobilise disturbed brain circuits and secrete massive amounts of stress hormones
  • Three new branches of science have led to an explosion of knowledge about the effect of psychological trauma, abuse and neglect – neuroscience, developmental psychopathology and interpersonal neurobiology
  • Trauma produces physiological changes including recalibration of the brain’s alarm systems (resulting in hypervigilance towards potential threats)
  • There are three avenues of treatment:
  1. top down by talking (therapy)
  2. medication to shut down inappropriate physical alarms
  3. bottom up by allowing the body to have experiences that deeply and viscerally contradict the helplessness, rage or collapse that result from trauma

Part One – The rediscovery of trauma

There’s much material about Vietnam veterans and the impact of trauma and loss. Trauma, whether it is the result of something done to you or something you yourself have done, almost always makes it difficult to engage in intimate relationships.

One of the hardest things for traumatised people is to confront their shame about the way they behaved during a traumatic episode. Trauma results in a fundamental reorganization of the way mind and brain manage perceptions. For real change to take place, the body needs to learn that the danger has passed and to live in the reality of the present.

There’s a chapter devoted to revolutions in understanding mind and brain. In PTSD the body’s stress hormones do not return to baseline after the threat has passed. Freud had a term for such traumatic re-enactments: “the compulsion to repeat”. The number of people treated for depression has tripled over the past two decades – and 1 in 10 Americans now take antidepressants. The neuroscience revolution is examined and how it has helped understand the physical response to trauma.

Part Two – Your brain on trauma

The anatomy of survival shows that as long as their caregivers remain calm and responsive to their needs, children often survive terrible incidents without serious psychological scars. Traumatised people become stuck, stopped in their growth because they can’t integrate new experiences into their lives. Survivors’ energy then becomes focused on suppressing inner chaos.

The physical mechanisms (amygdala, prefrontal cortex etc) of the stress response are explored.

The Autonomous Nervous System (ANS) regulates involuntary physiological processes such as heart rate, blood pressure, breathing, digestion and sexual arousal. Two of the critical sub-systems are the Sympathetic Nervous System (SNS) – which when activated leads to elevated activity and attention – the fight or flight response. The Parasympathetic Nervous system (PNS) promotes the “rest and digest” processes.

The author notes that dissociation is the essence of trauma – if trauma is replayed the stress hormones engrave those memories ever more deeply. Depersonalization – where people split off from the self (outward freeze reaction) – can result.

Many traumatised people find themselves chronically out of sync with the people around them. There’s reference to Porge’s grand theory the VVC (Ventral Vagus Complex) – how it evolved in mammals to support an increasingly complex social life.

There’s evidence that those who suffered ACE (Adverse Childhood Experiences) have a higher likelihood of trauma in adulthood. There’s mention of therapeutic yoga programmes to help people calm down and get in touch with their dissociated bodies. These are often combined with top-down approaches to activate social engagement.

In “Losing your body, losing your mind” the author explains that traumatised people need to learn to integrate ordinary sensory experiences with the natural flow of feeling and to feel secure within their bodies. He notes that traumatised people often cannot describe what they are feeling because they cannot identify what their physical sensations mean. Practitioners start the process of helping patients by asking them to notice and describe the feelings in their bodies.

Part Three – The minds of children

The importance of attachment and attunement between children and their care givers is explored.

Bowlby’s work on attachment suggests that 62% have secure attachment, 15% avoidant, 9% anxious (ambivalent) and 15% disorganized (similar to those who have experienced trauma).

The author suggests there is a hidden epidemic of developmental trauma. He notes that those with Borderline Personality Disorder (BPD) may start their challenging behaviours as way of dealing with overwhelming emotions and inescapable brutality (81% of patients with BPD reported severe child abuse or neglect). He observes that if you lack a deep memory of feeling loved and safe, the receptors in the brain that respond to human kindness may simply fail to develop.

Ultimately, the evidence suggests that early maltreatment has enduring negative effects on brain development.

Part Four – The imprint of trauma

Various problems of traumatic memory are explored including amnesia, dissociation and reenactment. The author notes that talking therapy can be ineffective unless there is an energetic reaction to the traumatic event (the affect remains attached to the memory). False memory syndrome is also explored as well as studies relating to repressed memories.

Part Five – Paths to recovery

The author observes that trauma robs you of the feeling you are in charge of yourself. He outlines the steps to recover from trauma:

  1. Find a way to feel calm and focused
  2. Learn to maintain calm in response to images and sensations that remind you of the past
  3. Find a way to feel fully alive in the present and engaged with people around you
  4. Avoid keeping secrets from yourself

The emotions and sensations imprinted during trauma are experienced not as memories but as disruptive physical reactions in the present. Understanding why you feel a certain way does not change how you feel.  And telling the story does not guarantee the traumatic memories will be laid to rest. He suggests:

  • Restore the proper balance between rational and emotional brains (through self-awareness)
  • Befriend the emotional brain – deal with hyperarousal by learning to breathe calmly and techniques for emotional regulation. (e.g. mindfulness)
  • Develop a good support network. Attachment bonds are our greatest protection against threat
  • Managing terror gives rise to dissociation, despair, addictions, panic and relationships marked by alienation, disconnection and explosions. You need a guide who is not afraid of your terror and who can contain your darkest rage
  • Therapists can: stabilise/clam patients, lay traumatic memories to rest and reconnect patients with others (There is no one “treatment of choice” for trauma)
  • Feeling safe is a necessary condition for you to confront your fears and anxieties
  • You can use communal rhythms and synchrony to calm yourself (e.g. join a singing group)
  • Allow yourself to be touched, hugged and rocked
  • Pat Ogden and Peter Levine developed sensorimotor psychotherapy and somatic experiencing. This is where they allow patients to physically experience what it would have felt like to fight back or run away. Or they recondition the freeze response through many repetitions of being placed in zero hour (precise moment of attack) and learning to transform fear into positive fighting energy

Therapeutic solutions include:

  • EMDR allows patients to access memories without being overwhelmed by them
  • Hypnosis can induce a state of relative calm from which to observe traumatic experiences
  • Cognitive Behaviour Therapy (CBT) can desensitise irrational fears (up to 100 minutes of flooding are needed before decreases in anxiety are reported).
  • Internal Family Systems (IFS) therapy enables patients to observe trauma from a calm, mindful state that IFS calls Self
  • Medications to make feelings less intense or to block adrenaline

In a section called “Language – miracle and tyranny” the author explores the impact of some of these therapies with a focus on the importance of the words used.

After the World Trade Centre disaster, patients reported the most helpful treatments were: acupuncture, massage, yoga and EMDR in that order. It helps to give a name to things – and feeling listened to and understood changes our physiology

Writing to yourself can help you access your inner world of feelings. In a study of 200 participants, 65 wrote about a childhood trauma. Those who wrote about both facts and emotions benefitted the most – a 50% drop in doctor visits.

Expressive therapies (art, music and dance) were found to be helpful. A “zone of silence” can be created by trauma so finding a responsive community to which to tell your truth makes recovery possible.

There’s also an exploration of how Eye Movement Desensitisation and Reprocessing (EMDR) helps those suffering from trauma to integrate their memories. The author shares some compelling evidence: After just three EMDR sessions 8 of 12 shown significant decrease in PTSD scores. After 8 EMDR sessions 1 in 4 were completely cured.


If you would like further information on counselling and therapy services, please contact me or for a confidential chat. Or take a look at my therapy web site

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