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January 20 - August 2, 2025
1) top down, by talking, (re-) connecting with others, and allowing ourselves to know and understand what is going on with us, while processing the memories of the trauma; 2) by taking medicines that shut down inappropriate alarm reactions, or by utilizing other technologies that change the way the brain organizes information, and 3) bottom up: by allowing the body to have experiences that deeply and viscerally contradict the helplessness, rage, or collapse that result from trauma.
“The nucleus of the neurosis is a physioneurosis.”
“The greatest sources of our suffering are the lies we tell ourselves.”
Without imagination there is no hope, no chance to envision a better future, no place to go, no goal to reach.
After trauma the world becomes sharply divided between those who know and those who don’t. People who have not shared the traumatic experience cannot be trusted, because they can’t understand it.
As we now know, war is not the only calamity that leaves human lives in ruins.
Some of them wondered if they really still needed electroshock after having gotten so much off their chests. I always felt sad at the end of these meetings, knowing that the treatments that would be administered the following morning would erase all memory of our conversation. I did not last long in that job.
help people “acknowledge, experience, and bear” the reality of life—with all its pleasures and heartbreak.
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.8 As we will see, that modesty was tragically short-lived.
patients often complain about a vague sense of emptiness and boredom when they are not angry, under duress, or involved in some dangerous activity.
This suggested that for many traumatized people, reexposure to stress might provide a similar relief from anxiety.
our capacity to destroy one another is matched by our capacity to heal one another.
language gives us the power to change ourselves
many of them expressing their hope that what we learned from their suffering could help other people.
Without sequencing we can’t identify cause and effect, grasp the long-term effects of our actions, or create coherent plans for the future.
After the emotional storm passes, they may look for something or somebody to blame for it. They behaved the way they did because you were ten minutes late, or because you burned the potatoes, or because you “never listen to me.”
The survivor’s energy now becomes focused on suppressing inner chaos, at the expense of spontaneous involvement in their life.
mirror neurons explained many previously unexplainable aspects of the mind, such as empathy, imitation, synchrony, and even the development of language.
As anybody who has worked with brain-damaged people or taken care of demented parents has learned the hard way, well-functioning frontal lobes are crucial for harmonious relationships with our fellow humans.
For now I want to emphasize that emotion is not opposed to reason; our emotions assign value to experiences and thus are the foundation of reason.
a flashback can occur at any time, whether they are awake or asleep.
Most of us know from sad personal experience that terrible grief is typically accompanied by the sense that this wretched state will last forever, and that we will never get over our loss. Trauma is the ultimate experience of “this will last forever.”
Breakdown of the thalamus explains why trauma is primarily remembered not as a story, a narrative with a beginning, middle, and end, but as isolated sensory imprints:
Lacking a filter, they are on constant sensory overload. In order to cope, they try to shut themselves down and develop tunnel vision and hyperfocus.
I see depersonalization regularly in my office when patients tell me horrendous stories without any feeling. All the energy drains out of the room, and I have to make a valiant effort to keep paying attention. A lifeless patient forces you to work much harder to keep the therapy alive, and I often used to pray for the hour to be over quickly.
The 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.
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?
Most of our energy is devoted to connecting with others.
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.
Gangs, extremist political parties, and religious cults may provide solace, but they rarely foster the mental flexibility needed to be fully open to what life has to offer and as such cannot liberate their members from their traumas.
Steve had created a small, safe place where the social-engagement system could begin to reemerge.
One thing is certain: Yelling at someone who is already out of control can only lead to further dysregulation.
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, this demands a radical shift in our therapeutic assumptions.
Be patient toward all that is unsolved in your heart and try to love the questions themselves. . . . Live the questions now. Perhaps you will gradually, without noticing it, live along some distant day into the answer.
if no one has rushed to help you (but instead said, “Stop crying, or I’ll give you something to cry about”), then you need to discover other ways of taking care of yourself. You are likely to experiment with anything—drugs, alcohol, binge eating, or cutting—that offers some kind of relief.
The disappearance of medial prefrontal activation could explain why so many traumatized people lose their sense of purpose and direction. I used to be surprised by how often my patients asked me for advice about the most ordinary things, and then by how rarely they followed it. Now I understood that their relationship with their own inner reality was impaired. How could they make decisions, or put any plan into action, if they couldn’t define what they wanted or, to be more precise, what the sensations in their bodies, the basis of all emotions, were trying to tell them?
The implications are clear: to feel present you have to know where you are and be aware of what is going on with you. If the self-sensing system breaks down we need to find ways to reactivate it.
All feelings of emotion are complex musical variations on primordial feelings.
interoception, our awareness of our subtle sensory, body-based feelings:
People who cannot comfortably notice what is going on inside become vulnerable to respond to any sensory shift either by shutting down or by going into a panic—they develop a fear of fear itself.
Self-regulation depends on having a friendly relationship with your body. Without it you have to rely on external regulation—from medication, drugs like alcohol, constant reassurance, or compulsive compliance with the wishes of others.
When asked, “How would you feel if you saw a truck coming at you at eighty miles per hour?” most people would say, “I’d be terrified” or “I’d be frozen with fear.” An alexithymic might reply, “How would I feel? I don’t know. . . . I’d get out of the way.”
One step further down on the ladder to self-oblivion is depersonalization—losing
I ask them to pay attention to subtle shifts in their bodies, such as tightness in their chests or gnawing in their bellies, when they talk about negative events that they claim did not bother them.
to prevent them from becoming retraumatized by accessing the past.
These images were not selected because they had some hidden meaning that sensitive people could uncover; they were ordinary images of everyday life. We could only conclude that for abused children, the whole world is filled with triggers.
Instead, their medical records were filled with diagnostic labels: “conduct disorder” or “oppositional defiant disorder” for the angry and rebellious kids; or “bipolar disorder.” ADHD was a “comorbid” diagnosis for almost all. Was the underlying trauma being obscured by this blizzard of diagnoses?
(Or, as the attachment researcher Beatrice Beebe once told me, “most research is me-search.”)
Nothing they can do or say stops the beating or brings attention and help.
Attachment researchers think that the three “organized” attachment strategies (secure, avoidant, and anxious) work because they elicit the best care a particular caregiver is capable of providing.
