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

Part One:

THE REDISCOVERY OF TRAUMA

Chapter Three

Looking into the Brain: The Neuroscience Revolution

With the advancements in brain imaging technology in the early 1990’s such as the positron emission tomography (PET) and functional magnetic resonance imaging (fMRI) scanners, the field of neuroscience was delving deeper into the mysteries of the mind. These sophisticated pieces of equipment can watch brain activity in live time as it reacts to stimuli.

Kolk had just finished a study on how trauma is remembered when the first director of the Massachusetts General Hospital Neuroimaging Lab, Scott Rauch, proposed the question of what happens to the brains of people who have flashbacks.

8 participants volunteered to have their brains scanned as a script designed to be a re-creation of their trauma, constructed from isolated fragments of memories such as sounds, images, and feelings was read to them. The scanner detects areas of the brain that are metabolically active as they breathe in the radioactive oxygen, while other physiological signs like blood pressure and heart rate were monitored to correlate with brain activity. A second script was created that described a scene where they felt safe and in control as a baseline

As one could guess, the participants’ brains and physiological responses were activated as if the trauma was taking place at that moment, although the event happened many years in the past. The brain scans unsurprisingly revealed heightened activity in the limbic (emotional) area of the brain, specifically the amygdala, which is responsible for activating stress hormones and response to threat.

Speechless Horror

There is a phenomenon of trauma that causes the speech center of the brain to become less active. A traumatized person will not be capable of articulating the experience into a coherent story from beginning to end. They can become frozen, mute, and unable to find the words.

Interestingly, this was revealed in the brain scans. Kolk found that the Broca’s area, a speech center in the brain often affected by stroke patients, had significantly decreased in activity during the experiment.

“When words fail, haunting images capture the experience and return as nightmares and flashbacks. In contrast to the deactivation of the Broca’s area, another region, Brodmann’s area 19 lit up in our participants. This is a region in the visual cortex that registers images when they first enter the brain. We were surprised to see brain activation in this area so long after the original experience of the trauma. Under ordinary conditions raw images registered in area 19 are rapidly diffused to other brain areas that interpret the meaning of what has been seen. Once again, we were witnessing a brain region rekindled as if the trauma were actually occurring.”

Shifting to One Side of the Brain

The differences between the left and right hemispheres of the brain are well known these days. Left-brain activity regulates logical thinking, rationality, linguistics, analytics and linear sequential thought. The much earlier developed right-brain communicates with images, sounds, feelings; it is intuitive and spatial in its function of thinking. In memory, the left brain is all about facts and statistics while the right brain stores memories of sound, touch, smell and associated feelings.

We need both hemispheres of our brain to work together, but people tend to be dominated by one side or the other. In the brain scan research of trauma patients, it clearly reveals that the left hemisphere is deactivated, and the right hemisphere is lit up.

“When something reminds traumatized people of the past, their right brain reacts as if the traumatic event were happening in the present. But because their left brain is not working very well, they may not be aware that they are reexperiencing and reenacting the past.”

Stuck in Fight or Flight

Sensations of trauma are stored in memories that can easily be brought to the surface and activate the alarm system of cascading stress hormone responses. This chronic elevation of biochemical imbalances can be extremely detrimental to a person’s health and longevity. It disrupts sleep, causes irritability, hinders memory and ability to focus.

“Our scans revealed how their dread persisted and could be triggered by multiple aspects of daily experience. They had not integrated their experience into the ongoing stream of their life. They continued to be ‘there’ and did not know how to be ‘here’- fully alive in the present.”

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.

What sensations (sound, image, smell) bring to the surface reenactments of trauma?
When have you been speechless or frozen without words to articulate?
How would you describe your ability to be in the present moment?