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 Two:

THIS IS YOUR BRAIN ON TRAUMA

Chapter Four

opening comments

As I read about how the brain processes sensory information to differentiate levels of threat and appropriate response, I am tuning in to these functions within myself. It is fascinating to understand how the body will respond to stress and danger before the logical functions of the brain can weigh in on the situation. Knowing this is helpful because I can observe the initial sensory information, take a breath and bring myself into the present moment, therefore bringing context and meaning to the experience.

A brief personal story

I went for a walk out in the woods with my dog as I normally do every day. I get out of my car and see a rather large set of deer bones with flesh and ligaments still intact. Clearly a mountain lion recently passed through here and left behind the remnants of its last meal. I immediately feel my senses become heightened and on alert. I am taking in more sensory information with my eyes, ears and body. I continue on my walk. A little way further down the path, my dog has picked up the lower leg bone of a small deer, fur and hoof still intact. More alarm signals go off, but I keep walking. My senses are so heightened at this point that I become startled at the slightest snap of a twig coming from the woods. I see something in my peripheral vision and jump, feeling a flush of adrenaline pulse through my body. A few seconds later, I realize it’s only a tree stump. My body responded way before my brain registered what I was seeing. I keep walking and begin to rationalize why there is not an immediate threat to my life. The lion has obviously just eaten a large meal and is likely happily sleeping with a full belly, or it has continued on its path and is long gone from the area. I continue on my walk and take full breaths as I consciously calm my nervous system with the words “I am safe”.

Running for your life: The anatomy of survival

“During disasters young children usually take their cues from their parents. As long as their caregivers remain calm and responsive to their needs, they often survive terrible incidents without serious psychological scars.”
Kolk

A five-year-old who had witnessed airplanes fly into the World Trade Center on 9/11 from his school window drew a picture of what he witnessed on the following morning. It showed the towers in flames and people falling from high above. On the ground level he added a trampoline for the people to land safely.

The adaptive stress response in this child was partly because he was able to get away from the immediate threat of danger and return home to safety, but also because he was able to use creative imagination as an alternative to what he had seen.

A traumatized person may become stuck and frozen in their growth because they are unable to integrate new experiences into their lives. All their energy is focused on an attempt to control the physiological responses that flood the body, signaled from the brain.

There is a difference in the way trauma is processed, depending upon whether the person was able to use effective action to get away from the event or if they were immobilized and trapped. When a person’s normal response to get away has been blocked, the fight or flight electrical circuits continue to fire long after the threat has passed.

“Being able to move and do something to protect oneself is a critical factor in determining whether or not a horrible experience will leave long-lasting scars.”
Kolk

The brain from bottom to top

Trauma can interfere with the essential functions of the brain and can cause psychological problems when these signals and needs are not attended to appropriately.

Signal and register the needs of the body
Create a map of the world to know where to go to satisfy those needs
Generate energy and actions to get there
Warn of dangers and opportunities
Adjust actions required of the moment

The older part of the brain known as the reptilian brain, is responsible for maintaining and regulating the energy functions of the body. When this internal balance is thrown into disequilibrium, there will be difficulty with the fundamental activities of daily human needs such as appetite, digestion, sleep, touch and arousal.

The limbic system, known as the mammalian brain, is where the experience of emotions and complex social networks develop. It is shaped uniquely to each individual as they grow from womb to adult through genetics and environmental experiences of the world. Neurons become programmed into a default setting based upon responses most likely to occur. The brain will specialize in managing the feelings of whatever is repeating. Early exploratory experiences as infants and toddlers shape the limbic structures devoted to emotions and memory. As we grow into adulthood, these later experiences such as friendship and love or violence and neglect can also alter the limbic structure.

Kolk refers to the reptilian and limbic part of the brain together as the “emotional brain”, the heart of the central nervous system and is essentially responsible for detecting what is dangerous or beneficial to your welfare. This function of the brain is a first responder on the scene when there is a threat. We are preprogrammed to have an escape plan and the body reacts before your neocortex, rational brain, has anything to say about it.

The frontal lobes, or neocortex, develop rapidly from age two to seven. Using words and symbols, emotional impulse control, planning futures scenarios, and integrating information with meaning are part of the frontal lobes function.

“…only human beings command the words and symbols necessary to create the communal, spiritual, and historical contexts that shape our lives. (The frontal lobes) make choice possible and underlie our astonishing creativity.”
Kolk

Mirroring each other: Interpersonal Neurobiology

In 1994 a group of Italian scientists discovered by accident what is now known as mirror neurons. They are a group of specialized cells in the cortex that pick up on other people’s movement, facial expressions, emotions, and intentions. This is how we become in sympathetic resonance with others and express empathy. Kolk touches on how trauma “treatment needs to reactivate the capacity to safely mirror, and be mirrored, by others, but also to resist being hijacked by others’ negative emotions.” He’ll have more to say on this later in the book.

Active and well-functioning frontal lobes are key to creating relationships that are harmonious. It is essential to learn how to adapt safely within a group that has differing perspectives and values, something all toddlers experience as part of their development. The frontal lobes can also keep us from acting impulsively, although this function is diminished when sensory input from the emotional brain dominates.

Identifying danger: The cook and the smoke detector

In this analogy, Kolk describes the way danger is processed in the brain. Sensory information such as sight, smell, sound and skin sensations converge in the thalamus, acting as “the cook”. The thalamus blends all this input into an integrated experience that defines what is happening at that moment. From here the sensations are then passed in two directions known as the low road and the high road. The low road is a lightning-fast pathway to the amygdala, “the smoke detector”. This is where the significance of the emotional experience is processed to detect if a message needs to be sent to the hypothalamus to release stress hormones in defense against a threat. The high road is a much slower pathway leading to the prefrontal cortex where the experience can be processed rationally and consciously. Basically, your body is aware of what is happening to you before your conscious mind does. This can be an issue with people who have PTSD because they can lose control over automatic emergency responses when the amygdala is too intense, and the frontal lobes are impaired.

“You can get along with other people only if you can accurately gauge whether their intentions are benign or dangerous. Even a slight misreading can lead to painful misunderstandings in relationships at home and at work. Functioning effectively…requires the ability to quickly assess how people are feeling and continuously adjusting your behavior accordingly. Faulty alarm systems lead to blowups or shutdowns in response to innocuous comments or facial expressions.”
Kolk

Controlling the stress response: The watchtower

The medial prefrontal cortex (MPFC) is located directly above the eyes and is what Kolk refers to as the watchtower. When your amygdala (smoke detector) senses danger, it doesn’t discern or make a judgment about the threat, it only gets you ready to fight or flee. It is the executive function of the MPFC to objectively observe and conjugate what may be the result of potential actions. The watchtower functions as a breath between emotionally impulsive reactionary behavior. This capacity to mindfully respond to the automatic responses that are preprogrammed in our emotional brain is crucial in our relations with other people.

Managing your emotions and effectively dealing with stress depends upon achieving balance between the smoke detector and the watchtower, the amygdala and medial prefrontal cortex. Regulation can be achieved from the top down or the bottom up.

Top-down regulation is all about developing strength in the ability of the watchtower to monitor sensory input coming from the body. Activities such as mindfulness meditation and yoga are helpful. Bottom-up regulation is recalibrating the autonomic nervous system through breath, movement and touch.

The rider and the horse

It is not that emotions need to be overridden by logic; they are essential in assigning value and meaning. Rather, there is a need for balance to be achieved between the rational and emotional brain. Kolk uses a metaphor to describe the way this relationship works. Your rational brain is a competent rider, and the emotional brain is a powerful unruly horse. All is well and you are in control so long as nothing spooks the horse.

“…neuroscience research shows that very few psychological problems are the result of defects in understanding; most originate in pressures from deeper regions in the brain that drive our perception and attention. When the alarm bell of the emotional brain keeps signaling that you are in danger, no amount of insight will silence it.”
Kolk

Dissociation and reliving

When trauma happens, the memories that contain sensory information about the experience can split off and fragment. This can lead to an intrusion from the past, known as flashbacks. This reliving of the trauma long after it is gone can make living a normal life nearly impossible. There is an intensity of control that goes into the numbing of emotions and sensations that leads to exhaustion, fatigue, and depression. If that wasn’t enough, there is also shame that comes from not engaging a natural emotional response to life.

“Not being fully alive in the present keeps them more firmly imprisoned in the past.”

“The trauma that started ‘out there’ is now played out on the battlefield of their own bodies, usually without conscious connection between what happened back then and what is going on right now inside. 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.”
Kolk

The timekeeper collapses

While the amygdala and medial prefrontal cortex (MPFC) determine emotional intensity, the dorsolateral prefrontal cortex (DLPFC) and the hippocampus determine context and meaning. Interestingly, “the structures along the midline of the brain are devoted to your inner experience of yourself, those on the side are more concerned with your relationship with your surroundings.” That being said, the DLPFC is known as the timekeeper because it relates the present experience with the past and future. Knowing when something is going to end is helpful and tolerable rather than experiencing something that is interminable.

“Trauma is the ultimate experience of ‘this will last forever’.”

For therapy and healing to work, a person needs to be firmly grounded in the present. The brain cannot organize the experience of trauma in proper context and meaning without a fully embodied sense of being in the present moment.

The thalamus shuts down

A normal functioning thalamus is able to filter sensory information and determine if it is relevant or something you can safely ignore. In this way it acts as a gatekeeper and assists with the ability to focus, give attention and learn new things. A person with PTSD experiences sensory overload and will try to manage this effect by shutting down the thalamus through hyper focused tunnel vision. This may also lead to drug and alcohol use as a means to diminish the sensory input that overwhelms them. Unfortunately, shutting down the thalamus will also filter out the sensory information relating to joy and pleasure.

Depersonalization: Split off from the self

The medical term that is used to describe the symptom of massive dissociation created by trauma is depersonalization.

“Anyone who deals with traumatized men, women, or children is sooner or later confronted with blank stares and absent minds, the outward manifestation of the biological freeze action.”
Kolk

The challenge in this case is to become alert and engaged. This is where physiological exercises that involve bodily movements are helpful in recovery.

Learning to live in the present

“While reliving trauma is dramatic, frightening and potentially self-destructive, over time a lack of presence can be even more damaging…Desensitization may make you less reactive, but if you cannot feel satisfaction in ordinary everyday things like taking a walk, cooking a meal, or playing with your kids, life will pass you by.”
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.

How would you describe your adaptive stress response in challenging situations?
What strategies will you use to engage the frontal lobes when the emotional brain sends alarm signals?
Where in your life are you most capable of feeling joy, pleasure and playfulness?