The Body Keeps the Score

Brain, Mind, and Body in the Healing of Trauma

Bessel Van Der Kolk, M.D.

Founder and medical director of the Trauma Center in Brookline Massachusetts.

Professor of psychiatry at Boston University School of Medicine

Director of the National Complex Trauma Treatment Network

Published in 2014

Opening Commentary

The topic of trauma is going straight to the heart of healing. Opening the book club with such a brutally honest subject wasn’t my plan. In fact, this blog series is nearly unplanned and unfolding in its own natural way. The Body Keeps the Score just happens to be one of the books I am currently reading. I had been putting off reading it and decided to pick it up during a rather moody phase I was experiencing the other day.

Everyone is affected as a result of trauma being passed on through generations of families, culturally, and historically. In fact, ancestral trauma is real. Reading about the life changing effects of trauma helps to see the whole picture when thinking about humanity and our evolution as a species. Facing our trauma is crucial in being able to move forward and have a meaningful life.

Prologue: Facing Trauma

With the help and support from colleagues and students at the Trauma Center, Bessel Van Der Kolk has treated thousands of people spanning from adult to child who are the victims of abuse, disaster and wars. Over 30 years of research has been conducted in the exploration of the effects of traumatic stress. It has been his life’s work.

Bessel Van Der Kolk wrote this book as an “invitation to dedicate ourselves to facing the reality of trauma, to explore how best to treat it, and to commit ourselves, as a society, to using every means we have to prevent it.”

He asks a challenging question:

“How can people gain control over the residues of past trauma and return to being masters of their own ship?”

CDC Research

1 in 5 Americans was molested as a child

1 in 4 was beaten by a parent to the point of marks being left on their body

1 in 3 couples engage in physical violence

A quarter grew up with alcoholic relatives

1 in 8 witnessed their mother being beaten or hit

War, disaster, violence and betrayal are in the lives of most people. Traces are found historically, culturally, and within our families. They are passed down through generations, leaving traces in the mind, emotions, biology and immune system. It alters our capacity for joy and intimacy, and ability to be in a healthy relationship.

“It takes tremendous energy to keep functioning while carrying the memory of terror, and the shame of utter weakness and vulnerability. While we all want to move beyond trauma, the part of our brain that is devoted to ensuring our survival (deep below our rational brain) is not very good at denial. Long after a traumatic experience is over, it may be reactivated at the slightest hint of danger and mobilize disturbed brain circuits and secrete emotions, intense physical sensations, and impulsive and aggressive actions. These posttraumatic reactions feel incomprehensible and overwhelming. Feeling out of control, survivors of trauma often begin to fear that they are damaged to the core and beyond redemption.”

Traumatized individuals become hypervigilant to threat, keeping them from engaging in everyday life. They often repeat the same problems throughout life and have trouble learning from experience. These behaviors are caused by actual changes in the brain.

He outlines three avenues to helping people feel fully alive in the present and move on with their lives. Most people require a combination of the three.

1. Top down, by talking

2. Taking medicines that shut down inappropriate alarm reactions, or by utilizing other technologies that change the way the brain organizes information.

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

Chapter One

Lessons from Vietnam Veterans

Bessel Van Der Kolk was a staff psychologist at the Boston Veterans Administration Clinic, and it is here where he first realized that nothing in his psychiatric training had prepared him for the challenges that the veterans presented.

The veterans were ordinary men before going into the battlefield. They enjoyed life, had many interests and pleasures, and were devoted husbands and fathers. In one moment of war driven trauma, everything changed for them. When they returned home, ordinary life was no longer experienced in the same way.

They were prone to fits of rage, hair trigger tempers, and often fell into addictions of drugs and alcohol to subdue their extreme outbursts of behavior. Nightmares, flashbacks and disconnection from their loved ones prevented them from experiencing any real pleasure in their lives. One expressed that he felt dead inside. These conditions are more than just a bad memory, damaged brain chemistry, or altered fear circuits in the brain.

In his search for understanding the trauma of war, Van Der Kolk discovered a book by a psychiatrist named Abram Kardiner called The Traumatic Neuroses of War (1941). The findings in this book corroborated his own observations, noting that

“sufferers from traumatic neuroses develop a chronic vigilance for and sensitivity to threat.”
Abram Kardiner

They become withdrawn, detached and overwhelmed with a sense of futility. What the author describes as traumatic neurosis is what we now call posttraumatic stress disorder (PTSD).

“The nucleus of the neurosis is a physioneurosis.”
Abram Kardiner

With this statement he emphasizes that PTSD is not only in the head, but symptoms have their origin in the entire body’s response to the original trauma.

One of Kolk’s favorite teachers, Elvin Semrad, taught him to be skeptical of textbooks and that the greatest teachers are the patients and your own experiences. He warned this process can be most difficult due to the nature of human beings to be self-deceptive and obscure the truth.

“The greatest sources of our suffering are the lies we tell ourselves.”
Elvin Semrad

It is difficult to observe trauma. We don’t really want to know about what happens in the battlefield during combat, or about the tragic abuse of children or violence within the home of families. Traumatized individuals themselves cannot even tolerate remembering it and that is what leads to destructive behaviors to try and block the pain.

Trauma and the Loss of Self

It is difficult to engage in intimate relationships after trauma occurs. Whether it was done to an individual or inflicted upon somebody else by the individual, the feelings of trust and surrender that are required for deep relationships are compromised after violation.

“It is hard enough to face the suffering that has been inflicted by others, but deep down many traumatized people are even more haunted by the shame they feel about what they themselves did or did not do under the circumstances. They despise themselves for how terrified, dependent, excited, or enraged they felt.”
Kolk

Numbing

The feeling of emotional numbness is a symptom of PTSD. Even though the desire to be present and connected on this level is there, the feelings cannot be evoked. One patient that Kolk referred to as Tom describes the feeling as if his heart were frozen and he was living behind a glass wall. He was emotionally distant and felt as if he were floating in space, lacking any sense of purpose or direction. The only time he felt anything was during momentary fits of rage and shame or when he was riding his motorcycle at high speeds. He describes how he would “do anything to avoid confronting his demons.”

The Reorganization of Perception

During a nightmare study at the VA, Kolk explored how trauma changes people’s perception and imagination. Traumatized people see the world very differently than other people. What may seem like an ordinary scenario is obscured by the perception of somebody who has experienced a traumatic life changing event.

Part of the study was giving participants a Rorschach test. This is a test that observes how people construct mental images from a meaningless stimulus, an inkblot. Humans, as meaning creating beings, will try to construct a story from the inkblot image. What they report seeing can reveal a lot about how their minds work.

“We learned from these Rorschach tests that traumatized people have a tendency to superimpose their trauma on everything around them and have trouble deciphering whatever is going on around them….In viewing scenes from the past in those blots they were not displaying the mental flexibility that is the hallmark of imagination. They simply kept replaying an old reel.”
Kolk

Imagination is critical to being able to develop mental flexibility. We need this function in order to discover new ways of seeing reality and envision new opportunities. It is our creativity that brings relief to pain, and enhances our ability to experience pleasure and enrich our relationships. Failure to imagine ensures the loss of hope for a better future.

Stuck in Trauma

During his discussion groups with veterans, Kolk discovered that although the wartime trauma was over ten years ago these men could not bridge the gap between the past and present. They were open to retelling the violent stories of the war but could not speak about the issues of their everyday lives and relationships. They were stuck in trauma and had identified meaning in life with the painful trauma of war.

“They felt fully alive only when they were revisiting their traumatic past.”
Kolk

Diagnosing Posttraumatic Stress

The diagnosis of war veterans changed in 1980 when the American Psychiatric Association created a new diagnosis known today as PTSD. Before this change, veterans were all over the board when it came to diagnosis. They were alcoholics, schizophrenics, substance abusers, and had mood disorders, but none of these gave name to the disorder that these people were suffering from. This change in definitions gave rise to expansive research in trying to find effective treatments.

Kolk was inspired with this new diagnosis and proposed a study on the biology of traumatic memories to the VA. They rejected his request and so he resigned and took a job at the Massachusetts Mental Health Center where he went into the study of psychopharmacology.

He realized that the experience he had with veterans sensitized him to the impact of trauma, and he was able to listen to the patients with a specialized type of hearing. The patients he was working with were revealing stories of sexual abuse and family violence. They were not so different from the veterans in that they experienced rage, emotional distancing, depression, confusion, self-harmful behaviors and had extreme difficulty in maintaining meaningful relationships.

Trauma is not only experienced by victims of war crimes, but it is also found in the home. Most people have or will experience a violent crime during their lives. 12 million women have been the victims of rape, and half of all rapes occur in girls below the age of 15. Every year, 3 million children are reported to have been victims of child abuse or neglect.

“This is particularly tragic, since it is very difficult for growing children to recover when the source of terror and pain is not enemy combatants but their own caretakers.”
Kolk

A New Understanding

Since the 1990’s, brain imaging tools help to reveal what is going on within the brains of traumatized people which helps to understand how to create new ways to repair the damage. As research continues, the realization is that trauma is not just an event of the past. It leaves an imprint on the mind, brain and body that has ongoing consequences for living life in the present. It changes the way people perceive reality, how and what they think about and even their capacity to think.

“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.”
Kolk

QUESTIONS PROMPT FOR THE READER

These questions are for you to ponder and write answers to in your journal. If you are inclined to share, please leave your answers in the comments section below.