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Traumatized people chronically feel unsafe inside their bodies: The past is alive in the form of gnawing interior discomfort. Their bodies are constantly bombarded by visceral warning signs, and, in an attempt to control these processes, they often become expert at ignoring their gut feelings and in numbing awareness of what is played out inside. They learn to hide from their selves. (p.97)
Bessel A. van der Kolk,
The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma
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As long as you keep secrets and suppress information, you are fundamentally at war with yourselfThe critical issue is allowing yourself to know what you know. That takes an enormous amount of courage.
Bessel A. van der Kolk,
The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma
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Being able to feel safe with other people is probably the single most important aspect of mental health; safe connections are fundamental to meaningful and satisfying lives.
Bessel A. van der Kolk,
The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma
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BEFRIENDING THE BODY Trauma victims cannot recover until they become familiar with and befriend the sensations in their bodies. Being frightened means that you live in a body that is always on guard. Angry people live in angry bodies. The bodies of child-abuse victims are tense and defensive until they find a way to relax and feel safe. In order to change, people need to become aware of their sensations and the way that their bodies interact with the world around them. Physical self-awareness is the first step in releasing the tyranny of the past.In my practice I begin the process by helping my patients to first notice and then describe the feelings in their bodiesnot emotions such as anger or anxiety or fear but the physical sensations beneath the emotions: pressure, heat, muscular tension, tingling, caving in, feeling hollow, and so on. I also work on identifying the sensations associated with relaxation or pleasure. I help them become aware of their breath, their gestures and movements.All too often, however, drugs such as Abilify, Zyprexa, and Seroquel, are prescribed instead of teaching people the skills to deal with such distressing physical reactions. Of course, medications only blunt sensations and do nothing to resolve them or transform them from toxic agents into allies. 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. Individuals who lack emotional awareness are able, with practice, to connect their physical sensations to psychological events. Then they can slowly reconnect with themselves.
Bessel A. van der Kolk,
The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma
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As I often tell my students, the two most important phrases in therapy, as in yoga, are Notice that and What happens next? Once you start approaching your body with curiosity rather than with fear, everything shifts.
Bessel A. van der Kolk,
The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma
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The brain-disease model overlooks four fundamental truths: (1) 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; (2) language gives us the power to change ourselves and others by communicating our experiences, helping us to define what we know, and finding a common sense of meaning; (3) 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; and (4) we can change social conditions to create environments in which children and adults can feel safe and where they can thrive.When we ignore these quintessential dimensions of humanity, we deprive people of ways to heal from trauma and restore their autonomy. Being a patient, rather than a participant in ones healing process, separates suffering people from their community and alienates them from an inner sense of self.
Bessel A. van der Kolk,
The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma
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We have learned that trauma is not just an event that took place sometime in the past; it is also the imprint left by that experience on mind, brain, and body. This imprint has ongoing consequences for how the human organism manages to survive in the present. Trauma results in a fundamental reorganization of the way mind and brain manage perceptions. It changes not only how we think and what we think about, but also our very capacity to think.
Bessel A. van der Kolk,
The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma
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Neuroscience research shows that the only way we can change the way we feel is by becoming aware of our inner experience and learning to befriend what is going inside ourselves.
Bessel A. van der Kolk,
The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma
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Beneath the surface of the protective parts of trauma survivors there exists an undamaged essence, a Self that is confident, curious, and calm, a Self that has been sheltered from destruction by the various protectors that have emerged in their efforts to ensure survival. Once those protectors trust that it is safe to separate, the Self will spontaneously emerge, and the parts can be enlisted in the healing process.
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Being traumatized means continuing to organize your life as if the trauma were still going onunchanged and immutableas every new encounter or event is contaminated by the past.
Bessel A. van der Kolk,
The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma
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It takes enormous trust and courage to allow yourself to remember.
Bessel A. van der Kolk,
The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma
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If your parents faces never lit up when they looked at you, its hard to know what it feels like to be loved and cherished. If you come from an incomprehensible world filled with secrecy and fear, its almost impossible to find the words to express what you have endured. If you grew up unwanted and ignored, it is a major challenge to develop a visceral sense of agency and self-worth.
Bessel A. van der Kolk,
The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma
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Psychologists usually try to help people use insight and understanding to manage their behavior. However, 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.
Bessel A. van der Kolk,
The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma
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As the ACE study has shown, child abuse and neglect is the single most preventable cause of mental illness, the single most common cause of drug and alcohol abuse, and a significant contributor to leading causes of death such as diabetes, heart disease, cancer, stroke, and suicide.
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In our studies we keep seeing how difficult it is for traumatized people to feel completely relaxed and physically safe in their bodies. We measure our subjects HRV by placing tiny monitors on their arms during shavasana, the pose at the end of most classes during which practitioners lie face up, palms up, arms and legs relaxed. Instead of relaxation we picked up too much muscle activity to get a clear signal. Rather than going into a state of quiet repose, our students muscles often continue to prepare them to fight unseen enemies. A major challenge in recovering from trauma remains being able to achieve a state of total relaxation and safe surrender.
Bessel A. van der Kolk,
The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma
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The contrast with the scans of the eighteen chronic PTSD patients with severe early-life trauma was startling. There was almost no activation of any of the self-sensing areas of the brain: The MPFC, the anterior cingulate, the parietal cortex, and the insula did not light up at all; the only area that showed a slight activation was the posterior cingulate, which is responsible for basic orientation in space. There could be only one explanation for such results: In response to the trauma itself, and in coping with the dread that persisted long afterward, these patients had learned to shut down the brain areas that transmit the visceral feelings and emotions that accompany and define terror. Yet in everyday life, those same brain areas are responsible for registering the entire range of emotions and sensations that form the foundation of our self-awareness, our sense of who we are. What we witnessed here was a tragic adaptation: In an effort to shut off terrifying sensations, they also deadened their capacity to feel fully alive.
Bessel A. van der Kolk,
The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma
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Imagination is absolutely critical to the quality of our lives. Our imagination enables us to leave our routine everyday existence by fantasizing about travel, food, sex, falling in love, or having the last wordall the things that make life interesting. Imagination gives us the opportunity to envision new possibilitiesit is an essential launchpad for making our hopes come true. It fires our creativity, relieves our boredom, alleviates our pain, enhances our pleasure, and enriches our most intimate relationships.
Bessel A. van der Kolk,
The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma
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In order to change, people need to become aware of their sensations and the way that their bodies interact with the world around them. Physical self-awareness is the first step in releasing the tyranny of the past.
Bessel A. van der Kolk,
The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma
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The essence of trauma is that it is overwhelming, unbelievable, and unbearable. Each patient demands that we suspend our sense of what is normal and accept that we are dealing with a dual reality: the reality of a relatively secure and predictable present that lives side by side with a ruinous, ever-present past.
Bessel A. van der Kolk,
The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma
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As long as we feel safely held in the hearts and minds of the people who love us, we will climb mountains and cross deserts and stay up all night to finish projects.
Bessel A. van der Kolk,
The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma
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One thing is certain: Yelling at someone who is already out of control can only lead to further dysregulation. Just as your dog cowers if you shout and wags his tail when you speak in a high singsong, we humans respond to harsh voices with fear, anger, or shutdown and to playful tones by opening up and relaxing. We simply cannot help but respond to these indicators of safety or danger.
Bessel A. van der Kolk,
The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma
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Mindfulness not only makes it possible to survey our internal landscape with compassion and curiosity but can also actively steer us in the right direction for self-care.
Bessel A. van der Kolk,
The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma
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One day he told me that hed spent his adulthood trying to let go of his past, and he remarked how ironic it was that he had to get closer to it in order to let it go.
Bessel A. van der Kolk,
The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma
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Long after a traumatic experience is over, it may be reactivated at the slightest hint of danger and mobilize disturbed brain circuits and secrete massive amounts of stress hormones. This precipitates unpleasant emotions intense physical sensations, and impulsive and aggressive actions. These posttraumatic reactions feel incomprehensible and overwhelming. Feeling out of control, survivors of trauma often begin to fear that they are damaged to the core and beyond redemption.
Bessel A. van der Kolk,
The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma
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Sadly, our educational system, as well as many of the methods that profess to treat trauma, tend to bypass this emotional-engagement system and focus instead on recruiting the cognitive capacities of the mind. Despite the well-documented effects of anger, fear, and anxiety on the ability to reason, many programs continue to ignore the need to engage the safety system of the brain before trying to promote new ways of thinking. The last things that should be cut from school schedules are chorus, physical education, recess, and anything else involving movement, play, and joyful engagement.
Bessel A. van der Kolk,
The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma
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After trauma the world is experienced with a different nervous system. The survivors energy now becomes focused on suppressing inner chaos, at the expense of spontaneous involvement in their lives. These attempts to maintain control over unbearable physiological reactions can result in a whole range of physical symptoms, including fibromyalgia, chronic fatigue, and other autoimmune diseases. This explains why it is critical for trauma treatment to engage the entire organism, body, mind, and brain.
Bessel A. van der Kolk,
The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma
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For a hundred years or more, every textbook of psychology and psychotherapy has advised that some method of talking about distressing feelings can resolve them. However, as we've seen, the experience of trauma itself gets in the way of being able to do that. I am continually impressed by how difficult it is for people who have gone through the unspeakable to convey the essence of their experience.
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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? If Darwin was right, the solution requires finding ways to help people alter the inner sensory landscape of their bodies. Until recently, this bidirectional communication between body and mind was largely ignored by Western science, even as it had long been central to traditional healing practices in many other parts of the world, notably in India and China. Today it is transforming our understanding of trauma and recovery.
Bessel A. van der Kolk,
The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma
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Eighty two percent of the traumatized children seen in the National Child Traumatic Stress Network do not meet diagnostic criteria for PTSD.15 Because they often are shut down, suspicious, or aggressive they now receive pseudoscientific diagnoses such as oppositional defiant disorder, meaning This kid hates my guts and wont do anything I tell him to do, or disruptive mood dysregulation disorder, meaning he has temper tantrums. Having as many problems as they do, these kids accumulate numerous diagnoses over time. Before they reach their twenties, many patients have been given four, five, six, or more of these impressive but meaningless labels. If they receive treatment at all, they get whatever is being promulgated as the method of management du jour: medications, behavioral modification, or exposure therapy. These rarely work and often cause more damage.
Bessel A. van der Kolk,
The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma
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If youre still in it, its hard to talk about it. I wasnt able to attach in the way that you need to attach and open up in the way that you need to open up in order to have any type of relationship with a therapist. This was a stunning revelation: So many patients are in and out of treatment, unable to meaningfully connect because they are still in it. Of course, when people dont know who they are, they cant possibly see the reality of the people around them.
Bessel A. van der Kolk,
The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma
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Because traumatized people often have trouble sensing what is going on in their bodies, they lack a nuanced response to frustration. They either react to stress by becoming spaced out or with excessive anger. Whatever their response, they often cant tell what is upsetting them. This failure to be in touch with their bodies contributes to their well-documented lack of self-protection and high rates of revictimization23 and also to their remarkable difficulties feeling pleasure, sensuality, and having a sense of meaning. People with alexithymia can get better only by learning to recognize the relationship between their physical sensations and their emotions, much as colorblind people can only enter the world of color by learning to distinguish and appreciate shades of gray.
Bessel A. van der Kolk,
The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma
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Self-regulation can be taught to many kids who cycle between frantic activity and immobility. In addition to reading, writing, and arithmetic, all kids need to learn self-awareness, self-regulation, and communication as part of their core curriculum. Just as we teach history and geography, we need to teach children how their brains and bodies work. For adults and children alike, being in control of ourselves requires becoming familiar with our inner world and accurately identifying what scares, upsets, or delights us.
Bessel A. van der Kolk,
The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma
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Generally the rational brain can override the emotional brain, as long as our fears dont hijack us. (For example, your fear at being flagged down by the police can turn instantly to gratitude when the cop warns you that theres an accident ahead.) But the moment we feel trapped, enraged, or rejected, we are vulnerable to activating old maps and to follow their directions. Change begins when we learn to "own" our emotional brains. That means learning to observe and tolerate the heartbreaking and gut-wrenching sensations that register misery and humiliation. Only after learning to bear what is going on inside can we start to befriend, rather than obliterate, the emotions that keep our maps fixed and immutable.
Bessel A. van der Kolk,
The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma
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The more you stay focused on your breathing, the more you will benefit, particularly if you pay attention until the very end of the out breath and then wait a moment before you inhale again. As you continue to breathe and notice the air moving in and out of your lungs you may think about the role that oxygen plays in nourishing your body and bathing your tissues with the energy you need to feel alive and engaged.
Bessel A. van der Kolk,
The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma
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A few years ago I heard Jerome Kagan, a distinguished emeritus professor of child psychology at Harvard, say to the Dalai Lama that for every act of cruelty in this world there are hundreds of small acts of kindness and connection. His conclusion: "To be benevolent rather than malevolent is probably a true feature of our species." Being able to feel safe with other people is probably the single most important aspect of mental health; safe connections are fundamental to meaningful and satisfying lives. 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.Social support is not the same as merely being in the presence of others. The critical issue is reciprocity: being truly heard and seen by the people around us, feeling that we are held in someone else's mind and heart. For our physiology to calm down, heal, and grow we need a visceral feeling of safety. No doctor can write a prescription for friendship and love: These are complex and hard-earned capacities. You don't need a history of trauma to feel self-conscious and even panicked at a party with strangers - but trauma can turn the whole world into a gathering of aliens.
Bessel A. van der Kolk,
The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma
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Over the years our research team has repeatedly found that chronic emotional abuse and neglect can be just as devastating as physical abuse and sexual molestation.
Bessel A. van der Kolk,
The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma
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Healing, he told us, depends on experiential knowledge: You can be fully in charge of your life only if you can acknowledge the reality of your body, in all its visceral dimensions.
Bessel A. van der Kolk,
The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma
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We can hardly bear to look. The shadow may carry the best of the life we have not lived. Go into the basement, the attic, the refuse bin. Find gold there. Find an animal who has not been fed or watered. It is you!! This neglected, exiled animal, hungry for attention, is a part of your self.
Bessel A. van der Kolk,
The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma
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Because drugs have become so profitable, major medical journals rarely publish studies on nondrug treatments of mental health problems.31 Practitioners who explore treatments are typically marginalized as alternative. Studies of nondrug treatments are rarely funded unless they involve so-called manualized protocols, where patients and therapists go through narrowly prescribed sequences that allow little fine-tuning to individual patients needs. Mainstream medicine is firmly committed to a better life through chemistry, and the fact that we can actually change our own physiology and inner equilibrium by means other than drugs is rarely considered.
Bessel A. van der Kolk,
The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma
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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.
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I have met countless patients who told me that they are bipolar or borderline or that they have PTSD, as if they had been sentenced to remain in an underground dungeon for the rest of their lives, like the Count of Monte Cristo. None of these diagnoses takes into account the unusual talents that many of our patients develop or the creative energies they have mustered to survive.
Bessel A. van der Kolk,
The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma
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Feeling out of control, survivors of trauma often begin to fear that they are damaged to the core and beyond redemption.
Bessel A. van der Kolk,
The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma
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Economists have calculated that every dollar invested in high-quality home visitation, day care, and preschool programs results in seven dollars of savings on welfare payments, health-care costs, substance-abuse treatment, and incarceration, plus higher tax revenues due to better-paying jobs.
Bessel A. van der Kolk,
The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma
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Scared animals return home, regardless of whether home is safe or frightening.
Bessel A. van der Kolk,
The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma
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Children who dont feel safe in infancy have trouble regulating their moods and emotional responses as they grow older. By kindergarten, many disorganized infants are either aggressive or spaced out and disengaged, and they go on to develop a range of psychiatric problems.23 They also show more physiological stress, as expressed in heart rate, heart rate variability,24 stress hormone responses, and lowered immune factors.25 Does this kind of biological dysregulation automatically reset to normal as a child matures or is moved to a safe environment? So far as we know, it does not.
Bessel A. van der Kolk,
The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma
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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 lifewith all its pleasures and heartbreak. The greatest sources of our suffering are the lies we tell ourselves, hed say, urging us to be honest with ourselves about every facet of our experience. He often said that people can never get better without knowing what they know and feeling what they feel.
Bessel A. van der Kolk,
The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma
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Many of our patients are barely aware of their breath, so learning to focus on the in and out breath, to notice whether the breath was fast or slow, and to count breaths in some poses can be a significant accomplishment.13
Bessel A. van der Kolk,
The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma
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For our physiology to calm down, heal, and grow we need a visceral feeling of safety. No doctor can write a prescription for friendship and love: These are complex and hard-earned capacities. You don't need a history of trauma to feel self-conscious and even panicked at a party with strangers but trauma can turn the whole world into a gathering of aliens.
Bessel A. van der Kolk,
The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma
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Psychiatry, as a subspecialty of medicine, aspires to define mental illness as precisely as, lets say, cancer of the pancreas, or streptococcal infection of the lungs. However, given the complexity of mind, brain, and human attachment systems, we have not come even close to achieving that sort of precision. Understanding what is wrong with people currently is more a question of the mind-set of the practitioner (and of what insurance companies will pay for) than of verifiable, objective facts.
Bessel A. van der Kolk,
The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma
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The challenge of recovery is to reestablish ownership of your body and your mind of your self. This means feeling free to know what you know and to feel what you feel without becoming overwhelmed, enraged, ashamed, or collapsed. For most people this involves (1) finding a way to become calm and focused, (2) learning to maintain that calm in response to images, thoughts, sounds, or physical sensations that remind you of the past, (3) finding a way to be fully alive in the present and engaged with the people around you, (4) not having to keep secrets from yourself, including secrets about the ways that you have managed to survive.
Bessel A. van der Kolk,
The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma
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Mindfulness increases activation of the medial prefrontal cortex and decreases activation of structures like the amygdala that trigger our emotional responses. This increases our control over the emotional brain.
Bessel A. van der Kolk,
The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma
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when children were hospitalized for treatment of severe burns, the development of PTSD could be predicted by how safe they felt with their mothers.31 The security of their attachment to their mothers predicted the amount of morphine that was required to control their painthe more secure the attachment, the less painkiller was needed.
Bessel A. van der Kolk,
The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma
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In contrast, EMDR, as well as the treatments discussed in subsequent chaptersinternal family systems, yoga, neurofeedback, psychomotor therapy, and theaterfocus not only on regulating the intense memories activated by trauma but also on restoring a sense of agency, engagement, and commitment through ownership of body and mind.
Bessel A. van der Kolk,
The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma
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Trauma causes people to remain stuck in interpreting the present in light of an unchanging past. The scene you re-create in a structure may or may not be precisely what happened, but it represents the structure of your inner world: your internal map and the hidden rules that you have been living by.
Bessel A. van der Kolk,
The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma
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Managing your terror all by yourself gives rise to another set of problems: dissociation, despair, addictions, a chronic sense of panic, and relationships that are marked by alienation, disconnections, and explosions. Patients with these histories rarely make the connection between what has happened to them a long time ago and how they currently feel and behave. Everything just seems unmanageable.
Bessel A. van der Kolk,
The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma
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Our increasing use of drugs to treat these conditions doesnt address the real issues: What are these patients trying to cope with? What are their internal or external resources? How do they calm themselves down? Do they have caring relationships with their bodies, and what do they do to cultivate a physical sense of power, vitality, and relaxation? Do they have dynamic interactions with other people? Who really knows them, loves them, and cares about them? Whom can they count on when theyre scared, when their babies are ill, or when they are sick themselves? Are they members of a community, and do they play vital roles in the lives of the people around them? What specific skills do they need to focus, pay attention, and make choices? Do they have a sense of purpose? What are they good at? How can we help them feel in charge of their lives?
Bessel A. van der Kolk,
The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma
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No matter how much insight and understanding we develop, the rational brain is basically impotent to talk the emotional brain out of its own reality.
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In contrast, children with histories of abuse and neglect learn that their terror, pleading, and crying do not register with their caregiver. Nothing they can do or say stops the beating or brings attention and help. In effect theyre being conditioned to give up when they face challenges later in life. BECOMING
Bessel A. van der Kolk,
The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma
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