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 Six

Losing your body, losing your self

All of this professional research and insight into understanding the brain’s response to trauma was leaving out the quintessential foundation to existence, the living and breathing body.

The human instinctual response to distress is to reach out to somebody known and trusted for support, and to give care and nurturing to the self by engaging in calming physical activities. When a person has never learned from their parents or mentors what proper regulation of emotions looks like, then they are more likely to find other ways to self soothe that is actually self-harming such as with drugs, alcohol, eating disorders, and cutting or picking on the body.

Losing your body

People with a history of trauma and neglect will often describe a condition of extreme disconnection from their body. Some patients expressed that they could not feel entire areas of their body. Sensory input becomes so muffled that they cannot identify a simple common object put into their hands if they were blindfolded. William James (1884 American psychologist) describes this phenomenon as “sensory insensibility” in an article he wrote called “What is an Emotion?”

“This response to trauma raises an important question: How can traumatized people learn to integrate ordinary sensory experiences so that they can live with the natural flow of feeling and feel secure and complete in their bodies?”
Dr. Kolk

How do we know we’re alive?

Ruth Lanius, a colleague of Dr. Kolk, conducted studies on the brain scans of chronically traumatized persons to determine what happens when they think of nothing, or what is known as the “default state network”.

It turns out that when you turn down the noise of the thinking mind, the activity becomes directed towards self-awareness. Dr. Kolk describes this midline structure of the brain as the “Mohawk of Self-Awareness”. Sensations are integrated within this region of the brain to process information about spacial relatedness, emotional input, and self-consciousness.

The neuroimaging studies of traumatized people revealed that the self-sensing areas of the brain were hardly activated at all. The explanation for this is that the brain shuts down this area of activity as a coping response to the traumatic event and the persistence of post traumatic sensations of terror. With the closure of the self-sensing pathways also comes the numbing and deadening of the feeling of being fully alive.

Without a foundation of knowing “Self” (inner reality), there is little to draw upon for knowing what next steps to take in life. The dissociation can be so extreme that they may not recognize themselves in a mirror.

“The implications are clear: to feel present you have to know where you are and be aware of what is going on with you. If the self-sensing system breaks down we need to find ways to reactivate it.”
Dr. Kolk

The self-sensing system

It is primarily through our sensory perceptions that the self is experienced. From gestation to birth, through adolescence and adulthood, through the end of life phase, we are assimilating sensory inputs and responses.

Antonio Damasio, author of the book “The Feeling of What Happens”, describes the divide between self-awareness and sensory life as a screen that veils the inner states of the body. The primary relationship between the self and the body becomes impaired overtime when these communication pathways are not open. Sensation primes our thoughts, actions and behavior.

The self under threat

When intense and unpleasant emotions are recalled, nerve signals cause visceral sensations in the body. For people who are reliving their trauma, this puts them in a state of overwhelming physiological arousal. The ability to come back into inner equilibrium is impaired when the limbic system is overly activated.

“How do people regain control when their animal brains are stuck in fight or flight for survival? If what goes on deep inside our animal brains dictates how we feel, and if our body sensations are orchestrated by subcortical (subconscious) brain structures, how much control over them can we actually have?”
Dr. Kolk

Agency: Owning your life

Interoceptive awareness is a collective of sensory inputs that relay information about the inner states of the body to the brain. Awareness of our own sensations and feelings brings power to own ourselves and to understand not only what we feel, but why we feel what we feel, which in turn strengthens our ability to mobilize appropriate action. This inner to outer world regulation is a key to recovering from trauma.

“The price for ignoring or distorting the body’s messages is being unable to detect what is truly dangerous or harmful for you and, just as bad, what is safe or nourishing.”
Dr. Kolk

When sensory awareness is suppressed, stress hormones are still continuing to mobilize. The distortions manifest within the body through various symptoms such as headaches, asthma, digestive issues and chronic fatigue.

Alexithymia: No words for feelings

Alexithymia is a condition in which a person does not register or express inner states of emotions. There is a disconnection between feelings and the brain’s response. For example, tears of sadness may be dissociated and blamed on the wind. Being out of touch with the body contributes to a lack of self-protection and brings challenges with feeling pleasure.

Depersonalization

Taken to the extreme, trauma can cause a loss of one’s sense of self. Clinically known as depersonalization, the description for this experience is very similar to what is described as an out of body experience. The fear part of the brain shuts off and the person becomes detached in a sort of altered state of observation.

Befriending the body

The body is the home we live in. Recovery from trauma involves reconnecting with the language of our sensorial experience within the body. Self-awareness through embodiment is noticing physical sensations beneath the emotion. How does the body feel when emotions arise and flow? Often the body will contort itself back into the position held at the original trauma. In this case, a skilled therapist can assist with soothing the terror response and bringing the patient back into a feeling of safety.

“The most natural way for human beings to calm themselves when they are upset is by clinging to another person…The mind needs to be reeducated to feel physical sensations, and the body needs to be helped to tolerate and enjoy the comforts of touch.”
Dr. Kolk

Connecting with yourself, connecting with others

Aversion to making eye contact is something that can occur with traumatized persons. It is critical to engage with making eye contact in building relationships, defining self and to sense other people’s intentions.

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.