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

by Bessel van der Kolk

alexithymia, the technical term for not being able to identify what is going on inside oneself.16 People who suffer from alexithymia tend to feel physically uncomfortable but cannot describe exactly what the problem is. As a result they often have multiple vague and distressing physical complaints that doctors can’t diagnose. In addition, they can’t figure out for themselves what they’re really feeling about any given situation or what makes them feel better or worse. This is the result of numbing, which keeps them from anticipating and responding to the ordinary demands of their bodies in quiet, mindful ways. At the same time, it muffles the everyday sensory delights of experiences like music, touch, and light, which imbue life with value. Yoga turned out to be a terrific way to (re)gain a relationship with the interior world and with it a caring, loving, sensual relationship to the self. If you are not aware of what your body needs, you can’t take care of it. If you don’t feel hunger, you can’t nourish yourself. If you mistake anxiety for hunger, you may eat too much. And if you can’t feel when you’re satiated, you’ll keep eating. This is why cultivating sensory awareness is such a critical aspect of trauma recovery.

Body awareness also changes your sense of time. Trauma makes you feel as if you are stuck forever in a helpless state of horror.

People who feel safe in their bodies can begin to translate the memories that previously overwhelmed them into language.

Every major school of psychology recognizes that people have subpersonalities and gives them different names.2 In 1890 William James wrote: “[I]t must be admitted that . . . the total possible consciousness may be split into parts which coexist, but mutually ignore each other, and share the objects of knowledge between them.”3 Carl Jung wrote: “The psyche is a self-regulating system that maintains its equilibrium just as the body does,”4 “The natural state of the human psyche consists in a jostling together of its components and in their contradictory behavior,”5 and “The reconciliation of these opposites is a major problem. Thus, the adversary is none other than ‘the other in me.’”

“But what of the idea that the self is not a unified being, and there may exist within us several realms of consciousness? . . . From our [split-brain] studies the new idea emerges that there are literally several selves, and they do not necessarily ‘converse’ with each other internally.”8 MIT scientist Marvin Minsky, a pioneer of artificial intelligence, declared: “The legend of the single Self can only divert us from the target of that inquiry.9 . . . [I]t can make sense to think there exists, inside your brain, a society of different minds. Like members of a family, the different minds can work together to help each other, each still having its own mental experiences that the others never know about.”

Children who act out their pain rather than locking it down are often diagnosed with “oppositional defiant behavior,” “attachment disorder,” or “conduct disorder.” But these labels ignore the fact that rage and withdrawal are only facets of a whole range of desperate attempts at survival. Trying to control a child’s behavior while failing to address the underlying issue—the abuse—leads to treatments that are ineffective at best and harmful at worst. As they grow up, their parts do not spontaneously integrate into a coherent personality but continue to lead a relatively autonomous existence.

As Schwartz states: “If one accepts the basic idea that people have an innate drive toward nurturing their own health, this implies that, when people have chronic problems, something gets in the way of accessing inner resources. Recognizing this, the role of therapists is to collaborate rather than to teach, confront, or fill holes in your psyche.”14 The first step in this collaboration is to assure the internal system that all parts are welcome and that all of them—even those that are suicidal or destructive—were formed in an attempt to protect the self-system, no matter how much they now seem to threaten it.

The internal system of an abuse victim differs from the non-abuse system with regard to the consistent absence of effective leadership, the extreme rules under which the parts function, and the absence of any consistent balance or harmony. Typically, the parts operate around outdated assumptions and beliefs derived from the childhood abuse, believing, for example, that it is still extremely dangerous to reveal secrets about childhood experiences which were endured.

Schwartz makes two assertions that extend the concept of mindfulness into the realm of active leadership. The first is that this Self does not need to be cultivated or developed. 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. The second assumption is that, rather than being a passive observer, this mindful Self can help reorganize the inner system and communicate with the parts in ways that help those parts trust that there is someone inside who can handle things. Again neuroscience research shows that this is not just a metaphor. 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.

The greatest discovery of my generation is that human beings can alter their lives by altering their attitudes of mind.

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.

The research that Judy Herman, Chris Perry, and I had done (see chapter 9) showed that people who felt unwanted as children, and those who did not remember feeling safe with anyone while growing up, did not fully benefit from conventional psychotherapy, presumably because they could not activate old traces of feeling cared for.

How can we help people become viscerally acquainted with feelings that were lacking early in their lives?

People process spatial relations with the right hemisphere of the brain, and our neuroimaging research had shown that the imprint of trauma is principally on the right hemisphere as well

According to recent research, up to 90 percent of human communication occurs in the nonverbal, right-hemisphere realm,

A neuroimaging study has shown that when people hear a statement that mirrors their inner state, the right amygdala momentarily lights up, as if to underline the accuracy of the reflection.

Our relationships will suffer as well. The more early pain and deprivation we have experienced, the more likely we are to interpret other people’s actions as being directed against us and the less understanding we will be of their struggles, insecurities, and concerns. If we cannot appreciate the complexity of their lives, we may see anything they do as a confirmation that we are going to get hurt and disappointed.

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.

In order to change, people need to become viscerally familiar with realities that directly contradict the static feelings of the frozen or panicked self of trauma, replacing them with sensations rooted in safety, mastery, delight, and connection.

“Traumatic stress is an illness of not being able to be fully alive in the present.”

As Sebern explained, feedback provides the brain with a mirror of its own function: the oscillations and rhythms that underpin the currents and crosscurrents of the mind. 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.

Approximately one-third to one-half of severely traumatized people develop substance abuse problems.

There is a circular relationship between PTSD and substance abuse: While drugs and alcohol may provide temporary relief from trauma symptoms, withdrawing from them increases hyperarousal, thereby intensifying nightmares, flashbacks, and irritability.

Between 75 percent and 80 percent of patients who are admitted for detox and alcohol and drug abuse treatment will relapse.

Acting is not about putting on a character but discovering the character within you: you are the character, you just have to find it within yourself—albeit a very expanded version of yourself.

In order to find our voice, we have to be in our bodies—able to breathe fully and able to access our inner sensations.

Every single eighth grader in these typical American inner-city schools had witnessed serious violence. Two-thirds had observed five or more incidents, including stabbings, gunfights, killings, and domestic assaults. Our data showed that eighth graders with such high levels of exposure to violence were significantly more aggressive than students without these histories and that the program made no significant difference in their behavior.

“Therapy and theater are intuition at work. They are the opposite of research, where one strives to step outside of one’s own personal experience, even outside your patients’ experience, to test the objective validity of assumptions. What makes therapy effective is deep, subjective resonance and that deep sense of truth and veracity that lives in the body.”

We are on the verge of becoming a trauma-conscious society. Almost every day one of my colleagues publishes another report on how trauma disrupts the workings of mind, brain, and body. The ACE study showed how early abuse devastates health and social functioning, while James Heckman won a Nobel Prize for demonstrating the vast savings produced by early intervention in the lives of children from poor and troubled families: more high school graduations, less criminality, increased employment, and decreased family and community violence. All over the world I meet people who take these data seriously and who work tirelessly to develop and apply more effective interventions, whether devoted teachers, social workers, doctors, therapists, nurses, philanthropists, theater directors, prison guards, police officers, or meditation coaches. If you have come this far with me in The Body Keeps the Score, you have also become part of this community.

throughout life, experiences change the structure and function of the brain—and even affect the genes we pass on to our children.

American women are twice as likely to suffer domestic violence as breast cancer. The American Academy of Pediatrics estimates that firearms kill twice as many children as cancer does.

Trauma breeds further trauma; hurt people hurt other people.

We are fundamentally social creatures—our brains are wired to foster working and playing together. Trauma devastates the social-engagement system and interferes with cooperation, nurturing, and the ability to function as a productive member of the clan.

People can learn to control and change their behavior, but only if they feel safe enough to experiment with new solutions. The body keeps the score: If trauma is encoded in heartbreaking and gut-wrenching sensations, then our first priority is to help people move out of fight-or-flight states, reorganize their perception of danger, and manage relationships.

Emotional intelligence starts with labeling your own feelings and attuning to the emotions of the people around you.