Nobody can “treat” a war, or abuse, rape, molestation, or any other horrendous event, for that matter; what has happened cannot be undone. But what can be dealt with are the imprints of the trauma on body, mind, and soul: the crushing sensations in your chest that you may label as anxiety or depression; the fear of losing control; always being on alert for danger or rejection; the self-loathing; the nightmares and flashbacks; the fog that keeps you from staying on task and from engaging fully in what you are doing; being unable to fully open your heart to another human being. – Bessel van der Kolk
In our previous notes, namely Becoming Supernatural, The Healing Code, The Emotion Code, we have learned that the body has a mind of its own. A mind that remembers everything. Now, in this book, we explore this body-mind further.
“The Body Keeps the Score,” don’t you find that intriguing? I did. It sounded fascinating to me, but boy did this book shake my core.
While I (you, too probably) am keenly aware of the common forms of sickness that plague the world, such as cancer, heart diseases, diabetes, this book just opened up my awareness to what could be a more insidious form of suffering inflicted on the lives of many people – trauma.
Dr. Bessel says it’s a hidden epidemic. And I often found myself shaking my head, almost teary-eyed, as I turn the pages learning about the traumatic experiences of people, especially the young children. I mean, how could you make them see the world differently when they have been molested and abused by the very same people from whom they expected love and care?
Ah, this expanding awareness is two-fold. You get to see the extremities of the duality of this human experience.
In this masterful work, which I’d like to call “The Bible of Trauma Studies,” Dr. Bessel does just that. On one hand, he shows us a world of suffering. On the other, he offers us a world of hope.
We have learned that trauma is not just an event that took place sometime in the past; it is also the imprint left by that experience on mind, brain, and body. This imprint has ongoing consequences for how the human organism manages to survive in the present.
Trauma results in a fundamental reorganization of the way mind and brain manage perceptions. It changes not only how we think and what we think about, but also our very capacity to think.
Dr. Bassel compares the effect of trauma to a condition known as “inescapable shock,” which is based on the experiment conducted by Steven Maier and Martin Seligman. It’s about learned helplessness in animals.
In it, electric shock was administered to a group of control dogs inside a cage. The researchers then opened the doors of the cage and shocked the dogs again. Another group of dogs who had never been shocked before immediately ran away. But the shocked dogs? They made no attempt to flee, even with the doors open.
Dr. Bassel says that the shock to dogs has similar effects of trauma to people. They have learned becoming helpless to escape the experience that traumatized them.
It was also found that traumatized people keep secreting large amounts of stress hormones and do not return to baseline level after the threat has passed.
Left Brain Dead
Deactivation of the left hemisphere has a direct impact on the capacity to organize experience into logical sequences and to translate our shifting feelings and perceptions into words. (Broca’s area, which blacks out during flashbacks, is on the left side.) Without sequencing we can’t identify cause and effect, grasp the long-term effects of our actions, or create coherent plans for the future. People who are very upset sometimes say they are “losing their minds.” In technical terms they are experiencing the loss of executive functioning.
Brain scan results show that when a traumatic memory is triggered and therefore trauma is re-experienced, the left hemisphere shuts down. As you may know, this is the linguistic, sequential, and analytical side of the brain.
Included there is a region called Broca’s area, one of the speech centers of the brain (the part often affected in stroke patients. When it’s not functioning, we cannot put our thoughts and feelings into words. It’s the reason why traumatized people find it difficult to talk about what happened in a linear narrative way.
Instead of a coherent story having logical sequences, what they have are just isolated fragments.
And when their memory is triggered, the right brain of traumatized people reacts as if the event were happening in the present. Because their left brain is dead, they’re not fully aware that they’re re-experiencing the past – they are just terrified, enraged, or frozen.
Top Down or Bottom Up
Effectively dealing with stress depends upon achieving a balance between the smoke detector and the watchtower. If you want to manage your emotions better, your brain gives you two options: You can learn to regulate them from the top down or from the bottom up.
We have covered the major parts of the brain in our notes on Essential Living (see Switch on the PC). Dr. Bessel provides another detailed presentation in the book and focuses on the two that are mainly involved in trauma. They are the amygdala (the “smoke detector”) and the prefrontal cortex (the “watchtower”).
In traumatized people, the balance between the amygdala and the prefrontal cortex goes out of whack. And so they have a faulty alarm system, so to speak. They react immediately to every false alarm. That is, anything that reminds them of their traumatic experience.
Dr. Bessel says there are two ways to fix this:
- Top-down regulation: for strengthening the capacity of the watchtower to monitor your body’s sensations. This involves mindfulness meditation and yoga; and
- Bottom-up regulation: for recalibrating the autonomic nervous system (If you can recall the car analogy from The Healing Code, it consists of the sympathetic nervous system that acts as the gas, and the parasympathetic nervous system as the brakes). This can be regulated through breath, movement, or touch.
The Essence of Trauma
Dissociation is the essence of trauma. The overwhelming experience is split off and fragmented, so that the emotions, sounds, images, thoughts, and physical sensations related to the trauma take on a life of their own. The sensory fragments of memory intrude into the present, where they are literally relived.
As long as the trauma is not resolved, the stress hormones that the body secretes to protect itself keep circulating, and the defensive movements and emotional responses keep getting replayed.
Experiencing the illusion of separation, which is the root of human suffering, is painful enough for a normal person. Imagine how much worse it is for traumatized people. They go through what’s known as “dissociation.” Their perception of reality is shattered. They keep reliving their traumatic past in the present.
Dr. Bessel adds that flashbacks can even be more burdensome than the trauma itself because they can occur at any time. That’s why traumatized people organize their lives around protecting themselves against them. They don’t feel safe in the world they live in.
Traumatized people keep reliving the past, which prevents them from being fully alive in the present. The long-term effect of which, according to Dr. Bessel, is that they no longer feel real. So they tend to resort to extreme and often dangerous activities, including hurting themselves, just to feel something.
But there is hope. As Dr. Bessel writes:
The challenge is not so much learning to accept the terrible things that have happened but learning how to gain mastery over one’s internal sensations and emotions. Sensing, naming, and identifying what is going on inside is the first step to recovery.
Children have a biological instinct to attach—they have no choice. Whether their parents or caregivers are loving and caring or distant, insensitive, rejecting, or abusive, children will develop a coping style based on their attempt to get at least some of their needs met.
The critical issue turned out to be that the caregivers themselves were a source of distress or terror to the children.
Children in this situation have no one to turn to, and they are faced with an unsolvable dilemma; their mothers are simultaneously necessary for survival and a source of fear.
This confirms what was before an unfounded assumption I have – that the quality of our childhood has a direct correlation to how we will interact with the world as we grow up.
In this book, Dr. Bessel gives particular attention to the child-parent relationship. He says it’s a biological instinct of children to attach to their primary caregiver.
Now, imagine what it’s like for children who grow up with an abusive parent. Since they are in their formative years, they will learn to associate “care” and “love” with terror and rejection. That would be confusing! This conflict leads to a relationship pattern called Disorganized Attachment, based on the work of scientists Mary Ainsworth and Mary Main.
Parental abuse and parents who are traumatized themselves are causes of disorganized attachment. In this situation, the child and the parent become out-of-tune, which has detrimental long-term effects on both. They become disorganized within, setting them up to be traumatized even more.
Limbic System Therapy
The fundamental issue in resolving traumatic stress is to restore the proper balance between the rational and emotional brains, so that you can feel in charge of how you respond and how you conduct your life.
Recovery from trauma involves the restoration of executive functioning and, with it, self-confidence and the capacity for playfulness and creativity.
Dr. Bessel asserts that if we want to change post-traumatic reactions so people won’t keep reliving the trauma, we have to access the limbic brain (the emotional brain) and do Limbic System Therapy, which is basically “repairing the faulty alarm systems.”
How? Dr. Bessel shares the neuroscientific findings of Joseph LeDoux and his colleagues – that the only way we can consciously access the emotional brain is through self-awareness.
Let me stress that: the only way is through self-awareness.
The technical term is Interoception, a Latin word for “looking inside.” It’s activating the prefrontal cortex so we can notice what’s going on inside us and feel what we’re feeling, and befriending that inner experience.
For the majority of the rest of the book, Dr. Bessel then discusses thoroughly various proven ways on how to befriend the emotional brain, and thus ultimately heal trauma.
A Mutual Exploration
Traumatized human beings recover in the context of relationships. The role of those relationships is to provide physical and emotional safety, including safety from feeling shamed, admonished, or judged, and to bolster the courage to tolerate, face, and process the reality of what has happened.
You have to find someone you can trust enough to accompany you, someone who can safely hold your feelings and help you listen to the painful messages from your emotional brain. You need a guide who is not afraid of your terror and who can contain your darkest rage, someone who can safeguard the wholeness of you while you explore the fragmented experiences that you had to keep secret from yourself for so long. Most traumatized individuals need an anchor and a great deal of coaching to do this work.
When Dr. Bessel was training as a psychiatrist, he once asked his mentor about a certain patient, “What would you call this patient—schizophrenic or schizoaffective?” To which his mentor replied, “I think I’d call him Michael…”
That taught him one great lesson: that every patient is a human being, not just some a host of symptoms or whatever diagnosis we put a label on. He writes, “Recovery from trauma involves (re)connecting with our fellow human beings.”
It’s also the core lesson that Saki Santorelli wants to impart in his book, Heal Thy Self (the first ever book I’ve picked-up that led me to this healing journey) – healing the patient-practitioner relationship.
This reflects Dr. Bessel’s message: “Therapy is a collaborative process—a mutual exploration of your self.”
Reminds me also of an insight from The Art of Connection: “Conjungere ad Solvendum,” which translates as “Connect before solving.” We need to establish connection first before we can offer a solution.
Because traumatized people are helpless by themselves, and there is more to healing trauma than merely addressing its physical manifestations, the help they require is more than professional experience. They need someone who’s going to do the inner work with them – someone, preferably, who has healed themselves first.
Healed people, heal people.
Get in Touch
However, the most natural way that we humans calm down our distress is by being touched, hugged, and rocked. This helps with excessive arousal and makes us feel intact, safe, protected, and in charge.
Touch, according to Dr. Bessel, is the most elementary tool that we have to calm down. Yet, it is what’s missing in conventional therapies. He argues that you can’t fully recover if you don’t feel safe in your skin. So he encourages all his patients to engage in any form of bodywork.
As we’ve learned earlier, traumatized people experience dissociation. It’s like having a head that is dissociated from the body.
So if the problem is dissociation, then the goal of treatment is association. Integration. That implies getting back in the body.
Bodywork entails body awareness, which means noticing what you feel and feeling it. Dr. Bessel found out (via Heart Rate Variability results) that yoga does just that. He says that it helps regain a relationship with the inner world and with it, a nurturing, loving, sensual relationship to yourself.
For complementary, I also recommend the work of Suzanne Scurlock-Durana: Reclaiming Your Body.
How well we get along with ourselves depends largely on our internal leadership skills—how well we listen to our different parts, make sure they feel taken care of, and keep them from sabotaging one another.
Therapists who are trained to see people as complex human beings with multiple characteristics and potentialities can help them explore their system of inner parts and take care of the wounded facets of themselves.
In the book, Dr. Bessel explores a number of therapeutic approaches he has proven and tested to help people recover from trauma.
They include journaling (to access the inner world of feelings and allow for their expression), EMDR (or Eye Movement Desensitization and Reprocessing, read more here), and Neurofeedback (a computer-based program that helps retrain brainwave signals).
There’s also what I’ve found to be intriguing: IFS (Internal Family Systems), developed by Richard Schwartz. The idea is it views the mind (through mindfulness) like a family composed of members that have different levels of maturity, wisdom, and pain, wherein a change in any part will affect all the others.
With IFS, there’s the Self who leads all the family members. Dr. Bessel refers to this as “Self-leadership.” He says that only the parts can be traumatized, but beneath their surface is the Self that always remains unharmed. And it is this Self that can lead all parts to healing.
Check out a similar approach, “Big You / Little You,” on The Abandonment Recovery Workbook.
The Greatest Hope
The greatest hope for traumatized, abused, and neglected children is to receive a good education in schools where they are seen and known, where they learn to regulate themselves, and where they can develop a sense of agency.
More than anything else, being able to feel safe with other people defines mental health; safe connections are fundamental to meaningful and satisfying lives. The critical challenge in a classroom setting is to foster reciprocity: truly hearing and being heard; really seeing and being seen by other people.
The children, most especially those helpless ones who experience trauma in their own homes, need another place they can consider their second home – the school. Even better is when the teachers take not only the role of educators, but also act as second parents.
Speaking of act, Dr. Bessel was in fact surprised to find that theater (yup, Shakespeare!) turns out to be an effective therapeutic outlet. Indirectly, theater can help in reprocessing trauma-like experiences because it gives voice to emotions and allows people to have a different character, someone they like to embody. This is just one of the many avenues the school can provide to foster healing in a community.
Dr. Bessel urges that self-awareness and self-regulation, which both lead to self-leadership, be included in the school’s core curriculum. More so, educators, facilitators, and coaches should be there to believe in the children’s potential and teach them that they can be anything they want to become.
As the lines in the song The Greatest Love of All go, I also believe that the children are our future. But we, their caretakers, hold that future in our hands.
ABOUT THE AUTHOR
BESSEL VAN DER KOLK M.D. is a Boston-based psychiatrist noted for his research in the area of post-traumatic stress since the 1970s. His work focuses on the interaction of attachment, neurobiology, and developmental aspects of trauma’s effects on people.
Visit him at besselvanderkolk.net