Notebook
for
The Body
Keeps the Score: Mind, Brain and Body in the Transformation of Trauma
Kolk,
Bessel van der
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experiences
. It’s hard enough to face the suffering that has been inflicted by others ,
but deep down many traumatized people are even more haunted by the shame they
feel about what they themselves did or did not do under the circumstances .
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He felt
emotionally distant from everybody , as though his heart were frozen and he
were living behind a glass wall . That numbness extended to himself , as well .
He could not really feel anything except for his momentary rages and his shame
.
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trauma
changes people’s perceptions and imagination .
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You never
know when you will be assaulted by them again and you have no way of telling
when they will stop .
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Imagination
gives us the opportunity to envision new possibilities —
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It fires
our creativity , relieves our boredom , alleviates our pain , enhances our
pleasure , and enriches our most intimate relationships .
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Without
imagination there is no hope , no chance to envision a better future , no place
to go , no goal to reach .
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You were
either in or out — you either belonged to the unit or you were nobody .
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People
who have not shared the traumatic experience cannot be trusted , because they
can’t understand it .
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Somehow
the very event that caused them so much pain had also become their sole source
of meaning . They felt fully alive only when they were revisiting their
traumatic past .
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it is
very difficult for growing children to recover when the source of terror and
pain is not enemy combatants but their own caretakers .
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helping
victims of trauma find the words to describe what has happened to them is
profoundly meaningful ,
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enough .
The act of telling the story doesn’t necessarily alter the automatic physical
and hormonal responses of bodies that remain hypervigilant , prepared to be
assaulted or violated at any time . For real change to take place , the body needs
to learn that the danger has passed and to live in the reality of the present .
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people
who’ve been abused as children often feel sensations ( such as abdominal pain )
that have no obvious physical cause ; they hear voices warning of danger or
accusing them of heinous crimes .
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I
gradually realized how much of our professional training was geared to helping
us stay in control in the face of terrifying and confusing realities .
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“ The
greatest sources of our suffering are the lies we tell ourselves , ”
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You can
be fully in charge of your life only if you can acknowledge the reality of your
body , in all its visceral dimensions .
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(
Ironically , the hospital was started as an “ asylum , ” a word meaning “
sanctuary ” that gradually took on a sinister connotation .
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Neurotransmitters
are chemical messengers that carry information from neuron to neuron ,
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The
foreword to the landmark 1980 DSM - III was appropriately modest and
acknowledged that this diagnostic system was imprecise — so imprecise that it
never should be used for forensic or insurance purposes .
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In PTSD
patients , however , the stress hormone system fails at this balancing act .
Fight / flight / freeze signals continue after the danger is over , and , as in
the case of the dogs , do not return to normal . Instead , the continued
secretion of stress hormones is expressed as agitation and panic and , in the
long term , wreaks havoc with their health .
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Scared
animals return home , regardless of whether home is safe or frightening .
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reenactments
were an unconscious attempt to get control over a painful situation and that
they eventually could lead to mastery and resolution .
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amygdala
, a cluster of brain cells that determines whether a sound , image , or body
sensation is perceived as a threat .
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the
sensitivity of the amygdala depended , at least in part , on the amount of the
neurotransmitter serotonin in that part of the brain .
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higher
levels of serotonin dampened their fear system ,
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But maybe
the mother’s kisses that soothe her child’s scrapes are “ just ” a placebo as
well .
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If they
were indeed as effective as we have been led to believe , depression should by
now have become a minor issue in our society .
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These
medications often are used to make abused and neglected children more tractable
.
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All
trauma is preverbal .
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Under
extreme conditions people may scream obscenities , call for their mothers ,
howl in terror , or simply shut down . Victims of assaults and accidents sit
mute and frozen in emergency rooms ; traumatized children “ lose their tongues
”
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most
survivors , like the veterans in chapter 1 , come up with what many of them
call their “ cover story ” that offers some explanation for their symptoms and
behavior for public consumption .
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When
words fail , haunting images capture the experience and return as nightmares
and flashbacks .
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Brodmann’s
area 19 , lit up in our participants . This is a region in the visual cortex
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sense
fragments of trauma , like sounds and smells and physical sensations , are also
registered separately from the story itself .
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The right
is intuitive , emotional , visual , spatial , and tactual , and the left is
linguistic , sequential , and analytical .
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The left
and right sides of the brain also process the imprints of the past in
dramatically different ways . 2 The left brain remembers facts , statistics ,
and the vocabulary of events . We call on it to explain our experiences and put
them in order . The right brain stores memories of sound , touch , smell , and
the emotions they evoke .
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People
who are very upset sometimes say they are “ losing their minds . ” In technical
terms they are experiencing the loss of executive functioning .
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The
stress hormones of traumatized people , in contrast , take much longer to
return to baseline and spike quickly and disproportionately in response to
mildly stressful stimuli . The insidious effects of constantly elevated stress
hormones include memory and attention problems , irritability , and sleep
disorders .
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Marsha is
hypersensitized to her memories of the past and that the best treatment would
be some form of desensitization .
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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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I am
continually impressed by how difficult it is for people who have gone through
the unspeakable to convey the essence of their experience . It is so much
easier for them to talk about what has been done to them — to tell a story of
victimization and revenge — than to notice , feel , and put into words the
reality of their internal experience .
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They had
not integrated their experience into the ongoing stream of their life .
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basic to
human survival . At the time the disaster occurred , he was able to take an
active role by running away from it , thus becoming an agent in his own rescue
.
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traumatized
people become stuck , stopped in their growth because they can’t integrate new
experiences into their lives .
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The
survivor’s 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 .
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If for
some reason the normal response is blocked — for example , when people are held
down , trapped , or otherwise prevented from taking effective action , be it in
a war zone , a car accident , domestic violence , or a rape — the brain keeps
secreting stress chemicals , and the brain’s electrical circuits continue to
fire in vain .
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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 .
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Immobilization
keeps the body in a state of inescapable shock and learned helplessness .
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The most
important job of the brain is to ensure our survival , even under the most
miserable conditions . Everything else is secondary .
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( 1 )
generate internal signals that register what our bodies need , such as food ,
rest , protection , sex , and shelter ; ( 2 ) create a map of the world to
point us where to go to satisfy those needs ; ( 3 ) generate the necessary
energy and actions to get us there ; ( 4 ) warn us of dangers and opportunities
along the way ; and ( 5 ) adjust our actions based on the requirements of the
moment .
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Our
rational , cognitive brain is actually the youngest part of the brain and
occupies only about 30 percent of the area inside our skull .
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Beneath
the rational brain lie two evolutionarily older , and to some degree separate ,
brains , which are in charge of everything else : the moment - by - moment
registration and management of our body’s physiology and the identification of
comfort , safety , threat , hunger , fatigue , desire , longing , excitement ,
pleasure , and pain .
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the
ancient animal brain , often called the reptilian brain . It is located in the
brain stem , just above the place where our spinal cord enters the skull .
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reptilian
brain is responsible for all the things that newborn babies can do : eat ,
sleep , wake , cry , breathe ; feel temperature , hunger ,
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The brain
stem and the hypothalamus ( which sits directly above it ) together control the
energy levels of the body . They coordinate the functioning of the heart and
lungs and also the endocrine and immune systems , ensuring that these basic
life - sustaining systems are maintained within the relatively stable internal
balance known as homeostasis .
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Any
effective treatment for trauma has to address these basic housekeeping
functions of the body .
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Right
above the reptilian brain is the limbic system . It’s also known as the
mammalian brain ,
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It is the
seat of the emotions , the monitor of danger , the judge of what is pleasurable
or scary , the arbiter of what is or is not important for survival purposes .
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The
limbic system is shaped in response to experience ,
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that
neurons that “ fire together , wire together . ”
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If it
detects danger or a special opportunity — such as a promising partner — it
alerts you by releasing a squirt of hormones .
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The
emotional brain’s cellular organization and biochemistry are simpler than those
of the neocortex , our rational brain , and it assesses incoming information in
a more global way . As a result , it jumps to conclusions based on rough
similarities , in contrast with the rational brain , which is organized to sort
through a complex set of options . ( The
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The
frontal lobes allow us to plan and reflect , to imagine and play out future
scenarios .
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mirror
neurons explained many previously unexplainable aspects of the mind , such as
empathy , imitation , synchrony ,
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But our
mirror neurons also make us vulnerable to others ’ negativity , so that we
respond to their anger with fury or are dragged down by their depression .
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The more
intense the visceral , sensory input from the emotional brain , the less
capacity the rational brain has to put a damper on it .
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However ,
processing by the thalamus can break down . Sights , sounds , smells , and
touch are encoded as isolated , dissociated fragments , and normal memory
processing disintegrates . Time freezes , so that the present danger feels like
it will last forever .
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The emotional
brain has first dibs on interpreting incoming information . Sensory Information
about the environment and body state received by the eyes , ears , touch ,
kinesthetic sense , etc . , converges on the thalamus , where it is processed ,
and then passed on to the amygdala to interpret its emotional significance .
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When that
system breaks down , we become like conditioned animals : The moment we detect
danger we automatically go into fight - or - flight mode .
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that
intense fear , sadness , and anger all increase the activation of subcortical
brain regions involved in emotions and significantly reduce the activity in
various areas in the frontal lobe , particularly the MPFC .
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the
inhibitory capacities of the frontal lobe break down , and people “ take leave
of their senses ” : They may startle in response to any loud sound , become
enraged by small frustrations , or freeze when somebody touches them .
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Top -
down regulation involves strengthening the capacity of the watchtower to
monitor your body’s sensations .
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Bottom -
up regulation involves recalibrating the autonomic nervous system ,
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We can
access the ANS through breath , movement , or touch . Breathing is one of the
few body functions under both conscious and autonomic control .
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emotions
assign value to experiences and thus are the foundation of reason .
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unexpected
sounds or threats from other animals can make the horse bolt ,
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when
people feel that their survival is at stake or they are seized by rages , longings
, fear , or sexual desires , they stop listening to the voice of reason , and
it makes little sense to argue with them .
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When the
alarm bell of the emotional brain keeps signaling that you are in danger , no
amount of insight will silence it .
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When our
emotional and rational brains are in conflict
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lead to
both physical discomfort and psychological misery .
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Dissociation
is the essence of trauma .
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or try to
cultivate an illusory sense of control in highly dangerous situations
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Not being
fully alive in the present keeps them more firmly imprisoned in the past .
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Feeling
numb during birthday parties for your kids or in response to the death of loved
ones makes people feel like monsters .
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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 .
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When those
areas are deactivated , people lose their sense of time and become trapped in
the moment , without a sense of past , present , or future .
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loss .
Trauma is the ultimate experience of “ this will last forever . ”
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trauma is
primarily remembered not as a story , a narrative with a beginning middle and
end , but as isolated sensory imprints : images , sounds , and physical
sensations that are accompanied by intense emotions , usually terror and
helplessness . 17
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Depersonalization
is one symptom of the massive dissociation created by trauma .
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This is
where a bottom - up approach to therapy becomes essential . The aim is actually
to change the patient’s physiology , his or her relationship to bodily
sensations .
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Many
untreated trauma survivors start out like Stan , with explosive flashbacks ,
then numb out later in life .
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acting -
out kids tend to get attention ; the blanked - out ones don’t bother anybody
and are left to lose their future bit by bit .
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The
challenge of trauma treatment is not only dealing with the past but , even more
, enhancing the quality of day - to - day experience .
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others :
Angry expressions and threatening postures caution them to back off . Sadness
attracts care and attention . Fear signals helplessness or alerts us to danger .
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Darwin
goes on to observe that the fundamental purpose of emotions is to initiate
movement that will restore the organism to safety and physical equilibrium .
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If an
organism is stuck in survival mode , its energies are focused on fighting off
unseen enemies , which leaves no room for nurture , care , and love .
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“ Heart ,
guts , and brain communicate intimately via the ‘ pneumogastric ’ nerve ,
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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 ?
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Porges ,
who was a researcher at the University of Maryland at the time we started our
investigation of HRV , and who is now at the University of North Carolina ,
introduced the Polyvagal Theory ,
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( Polyvagal
refers to the many branches of the vagus nerve — Darwin’s “ pneumogastric nerve
” — which connects numerous organs , including the brain , lungs , heart ,
stomach , and intestines . )
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the
subtle interplay between the visceral experiences of our own bodies and the
voices and faces of the people around us .
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Slight
changes in the tension of the brow , wrinkles around the eyes , curvature of
the lips , and angle of the neck quickly signal to us how comfortable ,
suspicious , relaxed , or frightened someone is . 9 Our mirror neurons register
their inner experience , and our own bodies make internal adjustments to
whatever we notice .
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Our
brains are built to help us function as members of a tribe . We are part of
that tribe even when we are by ourselves , whether listening to music ( that
other people created ) , watching a basketball game on television ( our own
muscles tensing as the players run and jump ) , or preparing a spreadsheet for
a sales meeting ( anticipating the boss’s reactions ) .
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we find
that almost all mental suffering involves either trouble in creating workable
and satisfying relationships or difficulties in regulating arousal ( as in the
case of habitually becoming enraged , shut down , overexcited , or disorganized
) .
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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
.
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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 .
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Many
traumatized people find themselves chronically out of sync with the people
around them . Some find comfort in groups where they can replay their combat
experiences , rape , or torture with others who have similar backgrounds or experiences
.
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Isolating
oneself into a narrowly defined victim group promotes a view of others as
irrelevant at best and dangerous at worst , which eventually only leads to
further alienation .
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In the
past two decades it has become widely recognized that when adults or children
are too skittish or shut down to derive comfort from human beings ,
relationships with other mammals can help .
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so that
their survival mechanisms stop working against them . This means helping them
to respond appropriately to danger but , even more , to recover the capacity to
experience safety , relaxation ,
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states .
The level of safety determines which one of these is activated at any
particular time . Whenever we feel threatened , we instinctively turn to the
first level , social engagement . We call out for help , support , and comfort
from the people around us . But if no one comes to our aid , or we’re in
immediate danger , the organism reverts to a more primitive way to survive :
fight or flight . We fight off our attacker , or we run to a safe place .
However , if this fails — we can’t get away , we’re held down or trapped — the
organism tries to preserve itself by shutting down and expending as little
energy as possible . We are then in a state of freeze or collapse .
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When the
VVC is engaged , it also sends signals down to our heart and lungs , slowing
down our heart rate and increasing the depth of breathing . As a result , we
feel calm and relaxed , centered , or pleasurably aroused .
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Any
threat to our safety or social connections triggers changes in the areas
innervated by the VVC .
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Finally ,
if there’s no way out , and there’s nothing we can do to stave off the
inevitable , we will activate the ultimate emergency system : the dorsal vagal
complex ( DVC ) . This system reaches down below the diaphragm to the stomach ,
kidneys , and intestines and drastically reduces metabolism throughout the body
. Heart rate plunges ( we feel our heart “ drop ” ) , we can’t breathe , and
our gut stops working or empties ( literally “ scaring the shit out of ” us ) .
This is the point at which we disengage , collapse , and freeze .
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immobilization
, generated by the reptilian brain , characterizes many chronically traumatized
people ,
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Danger turns
off our social - engagement system , decreases our responsiveness to the human
voice , and increases our sensitivity to threatening sounds .
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Activating
flight / flight at least makes them feel energized .
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many
abused and traumatized people feel fully alive in the face of actual danger ,
while they go numb in situations that are more complex but objectively safe ,
like birthday parties or family dinners .
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Collapse
and disengagement are controlled by the DVC ,
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as we coo
and smile and cluck at them , we stimulate the growth of synchronicity in the
developing VVC .
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The VVC
controls sucking , swallowing , facial expression , and the sounds produced by
the larynx .
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harmony
of choral singing or playing a piece of jazz or chamber music — all of which
foster a deep sense of pleasure and connection .
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We can
speak of trauma when that system fails : when you beg for your life , but the
assailant ignores your pleas ;
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Immobilization
is at the root of most traumas .
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the DVC
is likely to take over : Your heart slows down , your breathing becomes shallow
, and , zombielike , you lose touch with
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In order
to play , mate , and nurture our young , the brain needs to turn off its
natural vigilance .
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Many
traumatized individuals are too hypervigilant to enjoy the ordinary pleasures
that life has to offer , while others are too numb to absorb new experiences —
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Women who
, as children , had witnessed their mothers being assaulted by their partners
had a vastly increased chance to fall victim to domestic violence .
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deep
intimacy — a close embrace , sleeping with a mate , and sex — requires allowing
oneself to experience immobilization without fear .
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traumatized
children and adults get stuck in fight / flight or in chronic shut - down ,
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humans
respond to harsh voices with fear , anger , or shutdown and to playful tones by
opening up and relaxing .
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combining
top - down approaches ( to activate social engagement ) with bottom - up
methods ( to calm the physical tensions in the body ) .
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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
,
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chronic
emotional abuse and neglect can be just as devastating as physical abuse and
sexual molestation .
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Not being
seen , not being known , and having nowhere to turn to feel safe is devastating
at any age , but it is particularly destructive for young children , who are
still trying to find their place in the world .
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started
to pick at her skin because it gave her some relief from feeling numb .
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physical
sensations made her feel more alive but also deeply ashamed —
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the most
common response to distress is to seek out people we like and trust to help us
and give us the courage to go on . We may also calm down by engaging in a
physical activity like biking or going to the gym .
