The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma

View in Browser   Key insights from The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma By Bessel van der Kolk

What you’ll learn We humans may be resilient creatures, but many have experienced traumatic events that can live on in brain and body and bar us from a sense of belonging and enjoyment of the present.   Read on for key insights from The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma.

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1. Trauma is a state of being stuck and running for your life well after the original threat is over. Noam Saul was five-years-old when he saw a commercial airliner slam into a skyscraper 500 yards from his school. It was just after nine in the morning on September 11, 2001 in New York City. His teacher guided him and his classmates to the ground floor; the students, upon finding parents who had just dropped them off moments before, ran as fast as they could from the source of smoke and chaos. The next day, Noam drew a picture depicting the previous day’s pandemonium: the tail end of a jet protruding from a tower, fire, and people hurling themselves out of windows in a last ditch effort to survive. There was also a black circle at street-level next to the building. Noam explained that it was a trampoline, “so next time, when people have to jump, they’ll be safe.” This was remarkable: a young boy was already using his imagination to create a new alternative for future events and starting to move forward with his life in spite of the destruction he witnessed just a day earlier. Not everyone bounces back with the same alacrity. There were, however, several elements in Noam’s favor. For one thing, his parents had been calm and soothing throughout the event. As kids take their cues from their parents, they tend to rebound without serious emotional damage if they sense that their caregivers aren’t excessively distressed. It also helped that Noam was an agent of his own survival. He himself ran from the disaster, and he was able to return to the safety of a home that hadn’t been marred by the incident. For those who are living with trauma, however, life is organized around a traumatic incident that continues into the present. The survivors expend massive amounts of energy simply managing the internal chaos and “keeping it together.” Curiosity, imagination, and wholehearted engagement with life become impossible because survivors live in a perpetual mode of self-preservation. The goal of trauma is not for the survivor to cope with the past better, but to return to the present and inhabit it fully. When you don’t feel alive in the present, you return to times and places—even horrendous ones—where you did. Desensitization accomplishes a short term good by alleviating the intensity of horrible feelings and the body undergoing the same shock and terror, but it also dampens simple joys of everyday existence like taking a hike, cooking a meal, or spending time with your family—things that make life meaningful.

2. Post-traumatic stress disorder was not a recognized theory until 1980. When the author began working for the VA in 1978, there was a wide array of diagnoses for returning soldiers: alcoholism, depression, mood disorder, anxiety, and schizophrenia. Treatments were built around these diagnoses, which were more like misdiagnoses until 1980 when several psychologists from New York began to lobby the American Psychological Association for a new diagnosis—post-traumatic stress disorder, or PTSD. PTSD effectively collected these disparate issues of substance abuse and violent mood swings and allowed people to interpret them more accurately—as symptoms of a root issue of trauma. It was often after episodes of utter helplessness and terror that veterans would abuse drugs and family, or spiral downward into depression. This paradigm shift opened up new opportunities to research more effective methods of healing trauma. To show how much things have changed, consider that the VA rejected the author’s grant proposal to investigate the physical effects of trauma on the body. The letter of response stated plainly that, “It has never been shown that PTSD is relevant to the mission of the Veteran’s Administration.” It might sound laughable now, but that was a different time. Things have changed considerably in the decades that followed this rejection, and the care of veterans is now centered on assisting veterans to move past trauma into the present. Among the biggest breakthroughs in our understanding of trauma is that trauma does produce changes in the body beyond conscious control (the rewiring of the brain’s alarm system, the production of stress hormones, the brain’s systems that sort significant and insignificant material, and so on). It’s clear that what would have been written off as moral deficiency or lack of self-control is actually the result of fundamental changes in the brain that result in an inability to think rationally or make decisions on any basis other than fight or flight. Still another significant finding that has changed the way we see trauma is that trauma affects the portion of the brain that interacts with the physical, embodied sense of “aliveness.”

3. For every traumatized soldier returning home, there are ten children for whom home is a warzone.  hung-over Vietnam veteran named Tom came into Boston’s VA clinic in 1978. It was the day after the Fourth of July. Tom had spent the holiday in his office drinking himself into a stupor so as to avoid his wife and young sons witnessing his violently erratic reactions to the fireworks and to numb the shame he felt over not being with them. The traumatic experience that Tom continued to inhabit occurred while he was a platoon leader in Vietnam. He was leading his men through a rice paddy when Vietcong soldiers ambushed and gunned down his entire crew, his best friend Alex among them. All were dead or injured in a matter of seconds. For millennia, warriors have reacted to the deaths of fellow soldiers in shocking ways. The day after the attack that decimated his platoon, Tom went into a nearby village, killed several small children, an elderly farmer, and raped a Vietnamese woman. Tom was keeping his platoon alive by staying in that hellish moment in the past. At the same time, Alex, the one good and best friend he’d known, was gone. Tom’s loyalty to the dead was preventing him from joining the living. One moment was nullifying everything that came after. Tom believed that the best parts of himself had died in Vietnam with his comrade and best friend, Alex. His vicious outburst in response to the loss barred his emotional reentry into civilian life. How do you tenderly take your wife to bed after you ferociously violated a woman or cherish your kids after you killed several children yourself? Trauma makes it challenging to participate in intimate relationships. The traumatized often have a difficult time accepting how they acted during and in response to the traumatic incident. The shame is overwhelming. They agonize over what they did or didn’t do, and it keeps them from the present. It’s easier for veterans to talk about shanking a German or immolating the Vietcong than about their relationships now or how they find meaning in their work—whether the war was 10 or 50 years ago. When we think of PTSD, we often think of soldiers returning from war, but trauma is a far more prevalent experience than most realize. 20 percent of Americans were sexually molested as a child. 25 percent were beaten to the point that it left a mark. There’s physical abuse in 33 percent of couples. One in eight Americans saw mom get hit or beaten. One in four has a relative who abuses alcohol. For every one soldier returning from war, there are 10 children for whom home itself is the warzone.  History bears out the fact that human beings are astonishingly resilient, but there are still secret wounds that many carry and pass on to the next generation. Trauma, in its essence, is an unbearable condition, but, over the past 50 years, our understanding of trauma and ability to assist survivors has improved exponentially, so there is hope for soldiers and civilians alike.

4. Trauma is not something that just lives on “in your head”: it’s deeply embedded in your body. Charles Darwin observed similarities between the physical signs of emotion that humans and animals alike exhibit. When a person sneers, for example, he exposes his canines, much like a snarling dog. When a person feels threatened, the hair on the back of the neck stands up, just like other mammals. Humans and mammals naturally have a defensive posture, and Darwin attributed such similarities to a shared evolutionary history. In survival mode, humans—like animals—will devote their emotional energies to fending off enemies, real or imagined. This mindset, of course, leaves no room for love (nor creativity, play, nor learning), which is why war veterans, for example, have a difficult time connecting to the love and emotion that their wives and children show. Darwin saw clear links between brain and body, and that deep emotions were not just “in the head” but a conversation between brain, heart, and gut. Even in the mid-1800s, he wrote of a “pneumogastric nerve,” which was central to the regulation and expression of emotion, and interacted with the body’s viscera, or intestines. At a “gut level,” Darwin’s intuition resonates. How often does deep grief or the pain of betrayal feel like your heart is actually breaking or that you’ve been gut punched? Those feelings are unbearable, and we are willing to do just about anything to make them stop. We frantically cling to other people, numb ourselves with drugs and alcohol, or cut ourselves open—all to distract ourselves from the intense physical pain that the emotions bring.  Modern science is now confirming Darwin’s insight that the brain and body are intimately connected, and this discovery has tremendous implications for working with the traumatized. In 1994, scientist Stephen Porges built on Darwin’s idea of the pneumogastric nerve when he presented the idea of Polyvagal Theory.  The polyvagal nerve connects a variety of organs: the brain, intestines, lungs, stomach, and heart. You can’t talk about the anatomy of safety and danger without talking about the polyvagal nerve. Social engagement is a sign that the ventral vagal complex, or VVC, is in control: we smile when we see others smiling; we nod to indicate we are tracking with our fellow interlocutor, and our facial muscles convey concern when we hear sad news. When the VVC is running the show, the heart rate slows, and breathing becomes deeper. We feel safe and relaxed, open to intimacy. All is calm, all is bright. BUT whenever there’s a threat to safety or social ties, the organs attached to the ventral vagal complex begin to change: facial musculature shifts, vocal cords tighten, breathing becomes labored, the tone of voice alters. If there’s no assistance, the sympathetic nervous system takes over for the ventral vagal complex, which strengthens muscles, heart, and lungs to fight or flee. If a dog is in the room, it will usually start barking and snarling in response to smelling people’s activated sweat glands. If there’s no apparent escape, the dorsal vagal complex (DVC) is engaged. This branches down into the diaphragm, stomach, and intestines. Heart rate and metabolism slow. The gut shuts down or expels—which is why people get “scared shitless.” Once the DVC kicks in, the old reptilian brain is in control, and a person no longer cares for others. Awareness, reason, and sometimes even sensitivity to physical pain completely desert. When we are in touch with one another through the VVC, all is right with the world. We are attuned to each other and the natural rhythms of life and community. This is hard to restore for people who have experienced trauma. Immobilization lies at the bottom of almost all traumatic experiences. Once your trauma is activated, the DVC takes over and you collapse. You cannot encounter true intimacy and belonging unless you can allow yourself to be immobilized and feel safe in that immobilized state. Without it, intimate embrace, sleeping with a partner, or enjoying sex will be impossible. The traumatized have a difficult time figuring out when to have defenses up and when they can let them down. This is why Cognitive Behavioral Therapy, which places an emphasis on realigning beliefs with reality, is a superficial solution. It engages the issues at a cognitive, conscious level, one that is impossible for a survivor to access when the delicate equilibrium has been disrupted, and biology has hijacked the reasoning parts of the brain in order to survive a perceived threat. The implications of the body’s ties to trauma are profound: it changes the way we think about trauma and the way we treat it. Chinese and Indian understandings of the human person historically have been more holistic. The West is coming around to appreciating the communication between body and mind.