Notebook for The Body Keeps the Score: Mind, Brain and Body in the Transformation of Trauma Kolk, Bessel van der

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 .