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
THIS IS YOUR BRAIN ON TRAUMA
Human beings can instinctively read mental and emotional signals through body language and facial expressions. A lesser-known book by Charles Darwin titled The Expression of the Emotions, is an exploration into the purpose of emotions in the life of mammals including human beings. He notes how humans and other mammals share physical emotional expressions and that the primary role of emotions is to initiate movement that will restore the organism to safety and physical equilibrium.
“For Darwin mammalian emotions are fundamentally rooted in biology: They are the indispensable source of motivation to initiate action. Emotions (from Latin emovere– to move out) give shape and direction to whatever we do, and their primary expression is through the muscles of the face and body.”Kolk
Darwin comments that although it is normal mammalian behavior to avoid and escape from danger for survival purposes, there is a clear disadvantage when these emotional responses are sustained and unnecessarily prolonged. When stuck in survival mode, there is little room for nurturing, care, feeding, shelter and love. All the emotions that facilitate healthy reproductivity.
The connection between mind and body through the vagus nerve (pneumogastric) is explored in Darwin’s book and is still being researched today. When we experience intense emotions, the mind instantly affects the visceral bodily functions. We can feel gut wrenching sensations, heavy pressure on the chest and weakness in the knees.
“How many mental health problems, from drug addiction to self-injurious behavior, start as attempts to cope with the unbearable physical pain of our emotions?”Kolk
Ivan Pavlov and the instinct of purpose
Well known for his research with dogs and the “conditioned response, Ivan Pavlov also made an important discovery about trauma after a sudden ice-cold flooding event left Pavlov’s dogs trapped in their cages of his basement laboratory. The dogs survived the ordeal but continued exhibiting symptoms of stress long after the environment returned to normal.
“Pavlov showed that after exposure to extreme stress, animals find a new internal equilibrium different from the previous organization of their internal housekeeping.”Kolk
When there is a struggle between two opposing impulses, there is a breakdown of equilibrium. A phenomenon defined as inescapable shock. This is when there is a “collision between two contrary processes: one of excitation and the other of inhibition.”
The observations of Pavlov’s traumatized dogs led him to discover what he considers to be the most important factor of life and that is the “Reflex of Purpose”.
“All creatures need a purpose- they need to organize themselves to make their way in the world, like preparing a shelter for the coming winter, arranging for a mate, building a nest or home, and learning skills to make a living. One of the most devastating effects of trauma is that it often damages that Reflex of Purpose.”Kolk
Kolk asks the reader an important question…
“How do we help people to regain the energy to engage with life and develop themselves to the fullest?”
Both Pavlov and Darwin would agree that developing a sense of purpose involves the management of emotions and movement. The energy of positive and negative emotions propels us into actions ranging from pleasure to defense.
A window into the nervous system
The autonomic nervous system and its two branches, the sympathetic and parasympathetic, work in synchrony. They are reciprocals of each other and manage the body’s energy flow.
Deep inhalation activates the sympathetic nervous system. It is excitatory and with the help of adrenaline moves blood to muscles quickly in response to the fight or flight signal.
Deep long exhalation activates the parasympathetic nervous system and triggers acetylcholine which assists with relaxation, slowing the heart rate down, easing the process of digestion and healing.
The neural love code 9
Stephen Porges Ph. D wrote a book titled A Neural Love Code: The Body’s Need to Engage and Bond where he outlines the Polyvagal Theory which puts social relationships in the forefront of understanding trauma.
“The Polyvagal Theory provided us with a more sophisticated understanding of the biology of safety and danger, one based on the subtle interplay between the visceral experiences of our own bodies and the voices and faces of the people around us. It explained why a kind face or a soothing tone of voice can dramatically alter the way we feel. It clarified why knowing that we are seen and heard by the important people in our lives can make us feel calm and safe, and why being ignored or dismissed can precipitate rage reactions or mental collapse. It helped us understand why focused attunement with another person can shift us out of disorganized and fearful states.”Kolk
Human beings are very sensitive to the subtle changes in facial expressions, body language, tone of voice, and can easily detect how a person is feeling without ever exchanging words. Mirror neurons register the experiences of each other, and our body makes adjustments. Alone as we may feel in the world, most of our energy is devoted to connecting with others. Regulating our reactions of arousal and trouble with creating meaningful relationships are at the root of all mental suffering. The standard medical treatment of musing drugs for mental disorders fails to address the issue of how to function as a member of the human tribe.
Safety and reciprocity
Having safe connections with other people is a fundamental aspect of creating healthy minds.
“Numerous studies of disaster response around the globe have shown that social support is the most powerful protection against becoming overwhelmed by stress and trauma.”Kolk
Experiencing true social support involves more than just being in the same room with others.
“For our physiology to calm down, heal, and grow we need a visceral feeling of safety.”Kolk
This means that we experience reciprocity with another through deep listening and presence, through friendship and love. With traumatized people, it can be challenging to learn these capacities because they feel out of sync with others around them. Sometimes groups can be helpful in finding ways to relate to others and alleviate a sense of isolation. They can also be limited in that they narrow a person to conformity within such groups.
When the traumatized person is too closed off to find comfort and safety from other humans, other mammals such as dogs and horses can offer a less complicated companionship.
Three levels of safety
Neuroception is a word coined by the author Stephen Porges to describe “the capacity to evaluate relative danger and safety in one’s environment.” In working with trauma, there is a challenge in resetting the physiological response so that the survival mode is not operating in counterproductivity to safety and relaxation.
There is a spectrum of responses when a person is experiencing a traumatic event. Some people will remain calm and be able to help others during a disaster, while others will immediately panic and remain in that state long after the event, while others will completely shut down and freeze.
- FOCUSED The Social Engagement System: Through the ventral vagal complex, alarm signals are sent to the throat, heart and lungs to show distress. Vocalizing for help, increased breathing.
- FRANTIC Fight or Flight: Activation of limbic brain and sympathetic nervous system prepare the body for action to get away from danger or fight for survival. Increased heart rate, expressions of rage or terror, sweat gland excretion.
- COLLAPSED The Ultimate Emergency System: Activation of the dorsal vagal complex that reaches down into the digestive system. Metabolism and heart rate drastically reduce, emptying of the guts and bowels, the body disengages, freezes and collapses.
Fight or flight versus collapse
The mammalian brain is in charge of the fight or flight response and is thought to be protective in the face of danger. On the other hand, the freeze and collapse response is governed by the reptilian brain. It is common that a traumatized person will feel very energized and alive during intense moments but go numb during more complex social situations.
“Once this system (dorsal vagal complex) takes over, other people, and we ourselves, cease to matter. Awareness is shut down, and we may no longer even register physical pain.”Kolk
How we become human
The social evolution of mammals, including humans, involves the ventral vagus complex and its ability to synchronize the two branches of the autonomic nervous system, therefore facilitating better attunement with the group.
“Being in tune with other members of our species via the ventral vagal complex is enormously rewarding. What begins as the attuned play of mother and child continues with the rhythmicity of a good basketball game, the synchrony of tango dancing, and the harmony of choral singing or playing a piece of jazz or chamber music- all of which foster a deep sense of pleasure and connection.”Kolk
Defend or relax?
Mammals and humans have the instinct to protect and defend but also can relax those signals and be playful, intimate and nurturing. In some cases of trauma, a person may be hyper-attuned to their surroundings, always looking for danger or they may be completely tuned out and numb to what’s going on around them.
“…achieving any sort of deep intimacy- a close embrace, sleeping with a mate, and sex- requires allowing oneself to experience immobilization without fear. It is especially challenging for traumatized people to discern when they are actually safe and to be able to activate their defenses when they are in danger.”Kolk
New approaches to treatment
How do we deactivate these defensive maneuvers?
By creating safe spaces where the social-engagement system reflects open playful tones that facilitate relaxation rather than fear, anger and collapse.
“If the memory of trauma is encoded in the viscera, in heartbreaking and gut-wrenching emotions, in autoimmune disorders and skeletal/muscular problems, and if mind/brain/visceral communication is the royal road to emotion regulation, this demands a radical shift in our therapeutic assumptions.”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.
- What is your most visceral memory?
- How are you more likely to respond in a dangerous event? Calm, panicked, collapsed?
- What activities help you to feel safely connected with others in a group?
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