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

In the pursuit of understanding trauma and what treatment is most effective, modern science and medicine have reduced the human being to a materialistic explanation of biochemical processes in the brain and nervous system.

Synthetic drugs are capable of altering the balance of brain chemistry, but they are limited in their scope of treatment in that they cannot reach the root of the trauma in order for true healing to take place.

Part One:

THE REDISCOVERY OF TRAUMA

Chapter Two

Revolutions in Understanding Mind and Brain

Kolk spent some time as an attendant at a research facility that was studying young adults who had suffered their first mental breakdown diagnosed as schizophrenia. Part of the goal of the study on his ward was to determine if psychoanalysis or medication was the best treatment. He was in charge of organizing recreational activities that reflected normal college student’s lives.

Trauma Before Dawn

During the night when patients could not sleep, they would wander into the nursing station and open up in conversation unlike anything the doctors would see during a normal day time visit. Kolk listened to their horrific stories of abuse in the home.

“I was often surprised by the dispassionate way patients’ symptoms were discussed and by how much time was spent on trying to manage their suicidal thoughts and self-destructive behaviors, rather than on understanding the possible causes of their despair and helplessness. I was also struck by how little attention was paid to their accomplishments and aspirations; whom they cared for, loved, or hated; what motivated and engaged them, what kept them stuck, and what made them feel at peace- the ecology of their lives.”
Kolk

After reading Eugen Bleuler’s 1911 textbook Dementia Praecox, Kolk asks a question that is perhaps unanswered to this day.

Could it be that hallucinations and hearing voices are fragmented memories of real experiences?

Other notable observations Kolk made during his time working with the patients is that as a group they were physically uncoordinated and clumsy. In relaxed conversation with friends, they did not show a natural flow of communication, gestures, and facial expressions.

Making Sense of Suffering

After finishing medical school, Kolk returned to MMHC to train as a psychiatrist. He speaks fondly of his teacher Elvin Semrad who always discouraged a textbook forward approach.

“Semrad taught us that most human suffering is related to love and loss and that the job of therapists is to help people acknowledge, experience, and bear the reality of life- with all its pleasures and heartbreak.”
Kolk

Semrad emphasized that healing in its simplest form is recognizing basic human needs and acknowledging the reality of your body.

In 1968 the study from the research ward where he spent some time as an attendant published the results and it changed the way medicine and psychiatry approached psychological problems. It showed that schizophrenics who received medication had better outcomes than those who talked with a therapist 3 days a week.

Freud and Jung were pushed to the wayside and mental illness was now considered a chemical imbalance in the brain. In these early days, Kolk embraced the pharmacological revolution. Between 1955 and 1996 the number of people living in mental institutions was reduced by nearly 90% due to the onset of antipsychotic drugs. Research in the pharmacology lab revealed how drugs could affect mental symptoms.

Inescapable Shock

With still more unanswered questions about traumatic stress, Kolk began attending meetings of the American College of Neuropsychopharmacology (ACNP). He listened to a presentation about a condition called “inescapable shock” where the scientists would repeatedly administer painful electric shocks to dogs trapped in a cage. The cruelty to animals being tested on in a lab is not something myself or Kolk condone, but the result of the experiment is relevant information to consider.

After all the pain from being shocked, the cage doors were left open and none of the dogs were inclined to get out of the cage to escape. They just laid there whimpering and defecating. These results are similar to what is found with traumatized humans who experience being immobilized or trapped. They tend to stay stuck in the fear they know rather than risk new options. Just because an option is available to be free, doesn’t mean they will take it.

This research led to the discovery that animals and people who are traumatized will secrete abnormal levels of stress hormones long after the real danger has passed. When stress hormones do not balance themselves out, the signals to fight or flee remain pumping through the blood. This condition is expressed with agitation, panic, and can lead to long term health issues.

So how do you teach a traumatized dog to get out of the cage of pain? They eventually had to physically drag them out to show them how to experience getting away. Kolk correlated this experiment with his patients and asked some important questions.

“Did my patients need to have physical experiences to restore a visceral sense of control? What if they could be taught to physically move to escape a potentially threatening situation that was similar to the trauma in which they had been trapped and immobilized?”
Kolk

Addicted to Trauma: The Pain of Pleasure and the Pleasure of Pain

A noted condition with traumatized individuals is that despite the absolute horror of the event, they seem to come to life when talking about it and are attracted to experiences that most people would be repulsed by.

Freud termed this behavior as “the compulsion to repeat” traumatic reenactments. They are unconsciously trying to get control over a situation that may eventually lead to resolution. Kolk states that this method is not necessarily proven and may be perpetuating more pain through preoccupation and fixation.

Attractors are things that motivate and lead to feeling better; they stimulate the feeling of being alive. Kolk asks, “why are so many people attracted to dangerous or painful situations”?

After digging into some research studies, he finds that activities that initially may cause discomfort or terror may eventually lead to pleasure. There is a sense of exhilaration when the body is pushed to the limit and the activity is craved just like an addiction. He proposes that this may have something to do with why people are attracted to seeking out pain.

“Fear and aversion, in some perverse way, can be transformed into pleasure.”
Kolk

The hypothesis is that endorphins, morphine like chemicals the brain secretes in response to stress, are somehow related to addictions. Essentially, strong emotions can block pain, and this may explain why reexposure to stress may provide relief from anxiety.

Soothing the Brain

The amygdala part of the brain determines and perceives threats from sounds, images and body sensations. In another meeting Kolk attended at the ACNP, one of the presentations showed that low serotonin levels in animals caused a hyperactive amygdala response to stimuli, and high levels reduced the fear response.

Kolk then goes on to explain how selective serotonin reuptake inhibitors such as Prozac, Zoloft, Celexa, Cymbalta, and Paxil have made a significant contribution to the treatment of trauma related disorders and how they have helped patients to no longer be debilitated by their overly stimulated emotional reactions and impulses.

The Triumph of Pharmacology

With the evolution of drugs as a treatment tool that created major profits, psychotherapy was pushed to the wayside. Unfortunately, the drug revolution may have brought more harm than good. By reducing mental illness to chemical imbalances in the brain, it enabled patients to further suppress their problems by deflecting attention away from underlying issues.

“The brain-disease model takes control over people’s fate out of their own hands and puts doctors and insurance companies in charge of fixing their problems.”
Kolk

With 1 in 10 Americans taking antidepressants, why are so many people still struggling with depression? Why does Medicaid spend more money on antipsychotic drugs than any other? Why are half a million children in the United States prescribed antipsychotic drugs?

These drugs may make children “more manageable and less aggressive” but they interfere with natural behaviors such as motivation, play and curiosity, that are essential for maturing into a well-functioning individual within society.

Non-drug treatments of mental disorders are often sidelined into the category of “alternative”, and research studies are rarely funded. The institutions of modern medicine are committed to the brain chemistry model and do not consider the fact that people can change their own physiology without the use of prescribed drugs.

Adaptation or Disease?

Four fundamental truths of the quintessential dimensions of humanity

Our capacity to destroy one another is matched by our capacity to heal one another. Restoring relationships and community is central to restoring well-being.
Language gives us power to change ourselves and others by communicating our experiences, helping us to define what we know, and finding a common sense of meaning.
We have the ability to regulate our own physiology, including some of the so-called involuntary functions of the body and brain, through such basic activities as breathing, moving and touching.
We can change social conditions to create environments in which children and adults can feel safe and where they can thrive.

Restoring autonomy involves participation in one’s healing process rather than being the patient who goes to the doctor to get fixed. By the end of this chapter Kolk is questioning the limitation of drugs and begins to wonder about other natural ways to help traumatized people restore inner equilibrium and sense of self.

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.