The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma

by Bessel van der Kolk

You may also alternate between being inhibited and being uptight or reactive and explosive—all without knowing why. As long as you keep secrets and suppress information, you are fundamentally at war with yourself.

Discovering your Self in language is always an epiphany, even if finding the words to describe your inner reality can be an agonizing process.

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I could either focus on reliving old scenes in my mind’s eye and let myself feel what I had felt back then, or I could tell my analyst logically and coherently what had transpired.

Since then neuroscience research has shown that we possess two distinct forms of self-awareness: one that keeps track of the self across time and one that registers the self in the present moment. The first, our autobiographical self, creates connections among experiences and assembles them into a coherent story. This system is rooted in language. Our narratives change with the telling, as our perspective changes and as we incorporate new input.

Not autists!

Then she shifted again and proudly told me about her accomplishments—how much she’d achieved despite that lack of support. Public story and inner experience finally met.

Most of us have poured out our hearts in angry, accusatory, plaintive, or sad letters after people have betrayed or abandoned us.

In the practice called free writing, you can use any object as your own personal Rorschach test for entering a stream of associations. Simply write the first thing that comes to your mind as you look at the object in front of you and then keep going without stopping, rereading, or crossing out.

Writing experiments from around the world, with grade school students, nursing home residents, medical students, maximum-security prisoners, arthritis sufferers, new mothers, and rape victims, consistently show that writing about upsetting events improves physical and mental health.

The real reason [that soldiers fall silent] is that soldiers have discovered that no one is very interested in the bad news they have to report. What listener wants to be torn and shaken when he doesn’t have to be? We have made unspeakable mean indescribable: it really means nasty.

trauma victims often withdraw and why their stories become rote narratives, edited into a form least likely to provoke rejection.

“the psychical trauma—or more precisely the memory of the trauma—acts like a foreign body which long after its entry must continue to be regarded as an agent that still is at work.”

you really need to know the difference between your desire to hear stories and your patient’s internal process of healing.”

People may be able to heal from trauma without talking about

EMDR can help even if the patient and the therapist do not have a trusting relationship.

This is typical of most studies of drugs for PTSD: Simply showing up brings about a 30 percent to 42 percent improvement; when drugs work, they add an additional 5 percent to 15 percent.

After eight EMDR sessions one in four were completely cured (their PTSD scores had dropped to negligible levels), compared with one in ten of the Prozac group. But the real difference occurred over time: When we interviewed our subjects eight months later, 60 percent of those who had received EMDR scored as being completely cured. As the great psychiatrist Milton Erickson said, once you kick the log, the river will start flowing. Once people started to integrate their traumatic memories, they spontaneously continued to improve. In contrast, all those who had taken Prozac relapsed when they went off the drug.

if patients take Prozac or related drugs like Celexa, Paxil, and Zoloft, their PTSD symptoms often improve, but only as long as they keep taking them.

Chronic childhood abuse causes very different mental and biological adaptations than discrete traumatic events in adulthood. EMDR is a powerful treatment for stuck traumatic memories, but it doesn’t necessarily resolve the effects of the betrayal and abandonment that accompany physical or sexual abuse in childhood. Eight weeks of therapy of any kind is rarely sufficient to resolve the legacy of long-standing trauma.

When the process is complete, the experience is integrated with other life events and stops having a life of its own.

Kathy told me that her father had used her for many years for child prostitution, which would normally have made me think of using EMDR only as an adjunctive therapy. However, she turned out to be an EMDR virtuoso and recovered completely after eight sessions, the shortest time thus far in my experience for someone with a history of severe childhood abuse. Those sessions took place fifteen years ago, and I recently met with her to discuss the pros and cons of her adopting a third child. She was a delight: smart, funny, and joyfully engaged with her family and her work as an assistant professor of child development.

the eyes move rapidly back and forth in REM sleep, just as they do in EMDR.

Wakened from REM sleep, they make less conventional connections, such as thief/wrong.15 They also solve simple anagrams more easily after REM sleep. This shift toward activation of distant associations could explain why dreams are so bizarre.

drugs can blunt the images and sensations of terror, but they remain embedded in the mind and body.

When people are chronically angry or scared, constant muscle tension ultimately leads to spasms, back pain, migraine headaches, fibromyalgia, and other forms of chronic pain.

While numbing (or compensatory sensation seeking) may make life tolerable, the price you pay is that you lose awareness of what is going on inside your body and, with that, the sense of being fully, sensually alive.

If you don’t feel hunger, you can’t nourish yourself.

Any posture that involved the pelvis could precipitate intense panic or even flashbacks to sexual assaults. Intense physical sensations unleashed the demons from the past that had been so carefully kept in check by numbing and inattention.

if we notice our breath we are in the present because we can’t breathe in the future or the past.

Some of the poses can be triggering for me. Two of them were today, one where your legs are up frog like and one where you are doing really deep breathing into your pelvis. I felt the beginning of panic, especially in the breathing pose, like oh no that’s not a part of my body I want to feel. But then I was able to stop myself and just say, notice that this part of your body is holding experiences and then just let it go.

We all know what happens when we feel humiliated: We put all our energy into protecting ourselves, developing whatever survival strategies we can. We may repress our feelings; we may get furious and plot revenge. We may decide to become so powerful and successful that nobody can ever hurt us again.

Parts are not just feelings but distinct ways of being, with their own beliefs, agendas, and roles in the overall ecology of our lives. How well we get along with ourselves depends largely on our internal leadership skills—how well we listen to our different parts, make sure they feel taken care of, and keep them from sabotaging one another.

When we are abused, these are the parts that are hurt the most, and they become frozen, carrying the pain, terror, and betrayal of abuse. This burden makes them toxic—parts of ourselves that we need to deny at all costs. Because they are locked away inside, IFS calls them the exiles.

I asked her how she felt toward that critic. This key question allowed her to begin to separate from that part and to access her Self. Joan responded that she hated the critic, because it reminded her of her mother.

but it was trying to preempt her mother’s criticism.

Internal managers also control how much access we have to emotions, so that the self-system doesn’t get overwhelmed. It requires an enormous amount of energy to keep the system under control.

I’ve met firefighters who shop, drink, play computer games addictively, have impulsive affairs, or exercise compulsively.

He described himself as brutally honest, a real scientist, someone who just looked at the facts and—with a meaningful glance in my direction—did not suffer fools gladly. He had high standards, but no higher than he had for himself,

that internal managers who are obsessed with power are usually created as a bulwark against feeling helpless.

Because he had so many important obligations, and because he was so explosive, his family always tiptoed around him.

what it was afraid would happen if he stopped his ruthless judging.

Peter replied: “If you criticize others, they don’t dare to hurt you.” Then: “If you are perfect, nobody can criticize you.” I asked him to thank his critic for protecting him against hurt and humiliation,

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It is one thing to process memories of trauma, but it is an entirely different matter to confront the inner void—the holes in the soul that result from not having been wanted, not having been seen, and not having been allowed to speak the truth.

If you grew up unwanted and ignored, it is a major challenge to develop a visceral sense of agency and self-worth.

I’m impressed by how precise the outward projections of the right hemisphere are. Protagonists always know exactly where the various characters in their structures should be located. It also surprises me, again and again, how the placeholders representing the significant people in the protagonist’s past almost immediately assume a virtual reality:

cradled.” Acquiring a sensory experience of feeling treasured and protected as a three-year-old in the trancelike container of a structure allows people to rescript their inner experience,

Most people are hesitant to go into past pain and disappointment—it only promises to bring back the intolerable. But as they are mirrored and witnessed, a new reality begins to take shape. Accurate mirroring feels completely different from being ignored, criticized, and put down. It gives you permission to feel what you feel and know what you know—one of the essential foundations of recovery.

we can never undo what happened, but we can create new emotional scenarios intense and real enough to defuse and counter some of those old ones. The healing tableaus of structures offer an experience that many participants have never believed was possible for them: to be welcomed into a world where people delight in them, protect them, meet their needs, and make you feel at home.

the experiences of soldiers in Iraq, I immediately recalled Sandy’s study: As long as they were coping with extreme stress, these men performed with pinpoint focus; but back in civilian life they were overwhelmed having to make simple choices in a supermarket.

Neurofeedback nudges the brain to make more of some frequencies and less of others, creating new patterns that enhance its natural complexity and its bias toward self-regulation.

Homeostasis

If you see smiles or slight nods, you’re rewarded, and you go on telling your story or making your point.

Autism and social skills not-learning