PTSD: Chapter Summaries and Reflection

Chapter Summaries and Reflection

Summary of Chapter 1

Chapter one of The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma authored by Bessel Van der Kolk draws on the personal and professional experiences of the author to illustrate a vivid mapping of the development, symptomology, and the mechanisms of post-traumatic stress disorder (PTSD). At the beginning of the chapter, Kolk narrates his experiences as a mental health practitioner working with the Veterans Administration (VA). Kolk’s encounters with mental health patients lead him to an exploration of “the mysteries of trauma” and the quest for answers to the question, “How do horrific experiences cause people to become hopelessly stuck in the past?” (p. 21). Accordingly, the remainder of chapter 1 presents the preliminary findings of the author’s exploration along the lines of inquiry mentioned above. It identifies four primary themes which can be understood as the mechanisms of PTSD in traumatized people. Firstly, Kolk asserts that one cause of the difficulties faced by victims of trauma in moving beyond painful events stems from the fact that trauma leads to a loss of the self (p.23). The substantial injury inflicted by trauma among its victims is the experience or constant feeling that a part of the person’s self- the part that is good and honorable- is forever destroyed.

Secondly, the author asserts that another difficulty associated with trauma derives from the fact that it causes substantial emotional numbing among victims. Trauma increases the emotional distance between the victim and their immediate environment, thereby eliminating an individual’s ability to evoke any feeling for those who are supposed to function as the person’s support system, including family. Lastly, Kolk demonstrates that trauma creates a “fundamental reorganization of the way the mind and brain manage perceptions” (p.33) by not only altering thought processes but also impairing intellectual capacity. The overarching takeaway from chapter 1 is, therefore, that healing PTSD requires an in-depth understanding of how the mind heals.

Summary of Chapter 2

Chapter 2 of The Body Keeps the Score is devoted to understanding the phenomenon of human suffering and its relation to trauma. Kolk proposes that a significant dimension of PTSD is unraveled through an elaborate comprehension of the ‘addiction to trauma,’ which he describes as “The Pain of Pleasure and the Pleasure of Pain” (p.44). The author evidences his proposition above through the observation that while working at the VA, many of his PTSD patients -despite their feelings of horror and grief- seemed to be enlivened when they narrated stories about the very traumatic events that plagued them, such as helicopter crashes and their dying companions. The empirical observation highlighted above, in addition to the findings of several other scientific studies, convinces Kolk that many victims of trauma are addicted to, and tend to seek out experiences which would repel most “normal” people; and that traumatized people “often complain about a vague sense of emptiness and boredom when they are not angry, under duress, or involved in some dangerous activity” (p.44).

Accordingly, the bulk of chapter 2 revolves around the construction of a conceptual framework to explain why traumatized people often seem to perpetuate the pain of their trauma.  The author describes the phenomenon as ‘addiction to traumatic reenactments,’ whereby traumatized people experience an unconscious compulsion to reenact a painful situation in the attempt to gain control over the pain, and in the belief that such reenactment could eventually lead to mastery and resolution of the past trauma. However, although exposure to the pain may provide temporary relief from the anxiety associated with PTSD, the author finds no evidence that such reenactment could be therapeutic in the long run and the chapter concludes that it does not lead to mastery and resolution of trauma. On the contrary, even in the setting of therapy, the reenactment often worsens the perpetual preoccupation and fixation with trauma among patients.


In my reading of chapters 1 and 2, I encountered one interesting question as I reflected on the book’s contents, namely: why do some victims of trauma break down as a result of the horrific experiences to which they are exposed while others are able to go on with their lives? Or more specifically, why does PTSD only affect specific people and not others even amongst a group exposed to the same traumatic experience such as the same wartime military service? Based on the reading of the chapters summarized above, my perspective is that three primary factors determine and differentiate the impact of trauma among people. First is the combination of the severity of the traumatic event and pre-exposure vulnerabilities. The more severe the exposure to trauma the more likely the onset of PTSD especially among individuals with pre-exposure vulnerabilities such as childhood experiences of physical abuse.

Secondly, physiological differences, especially differences in the brain’s resilience to structural and chemical changes can predict the differences in individuals’ predisposition to PTSD. Neurobiological resilience is a critical factor that comes to play when determining how an individual reacts to the exposure to trauma because, as mentioned earlier, trauma affects not only the brain structure but also chemistry, which in turn influences differences in perception and intellectual capacities. Therefore, neurological resilience determines whether the effects of exposure to trauma are long-lasting or temporary. Lastly, differences in the predisposition and onset of PTSD are also linked to individuals’ interpretations and emotional reactions to traumatic events. For example, individuals who react to the aftermath of trauma with shame, guilt, and helplessness are more likely to develop severe PTSD compared to traumatized people who choose to deal with their trauma by seeking help, joining support groups, and devising other helpful coping strategies.



Van der Kolk, B. (2014). The body keeps the score: Mind, brain, and body in the transformation of trauma. New York, NY: Penguin Group.

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