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

by Bessel van der Kolk

distrust and self-hatred make collaboration difficult.

But the moment we feel trapped, enraged, or rejected, we are vulnerable to activating old maps and to follow their directions.

Only after learning to bear what is going on inside can we start to befriend, rather than obliterate, the emotions that keep our maps fixed and immutable.

could parents inflict such torture and terror on their own child? Part of them continues to insist that they must have made the experience up or that they are exaggerating.

The manual has become a virtual industry that has earned the American Psychiatric Association well over $100 million.1 The question is: Has it provided comparable benefits for the patients it is meant to serve?

How do you turn a newborn baby with all its promise and infinite capacities into a thirty-year-old homeless drunk?

we may be treating today experiences that happened fifty years ago—at ever-increasing cost.

The ongoing stress on the body keeps taking its toll.

But when the ACE study data started to appear on his computer screen, he realized that they had stumbled upon the gravest and most costly public health issue in the United States: child abuse. He had calculated that its overall costs exceeded those of cancer or heart disease and that eradicating child abuse in America would reduce the overall rate of depression by more than half, alcoholism by two-thirds, and suicide, IV drug use, and domestic violence by three-quarters.20 It would also have a dramatic effect on workplace performance and vastly decrease the need for incarceration.

Only now they receive high doses of psychotropic agents, which makes them more tractable but which also impairs their ability to feel pleasure and curiosity, to grow and develop emotionally and intellectually, and to become contributing members of society.

The challenge is to find ways to help them lead productive lives and, in so doing, save hundreds of millions of dollars of taxpayers’ money.

Suomi identified two personality types that consistently ran into trouble: uptight, anxious monkeys, who become fearful, withdrawn, and depressed even in situations where other monkeys will play and explore; and highly aggressive monkeys, who make so much trouble that they are often shunned, beaten up, or killed.

This leads to the conclusion that, at least in monkeys, early experience has at least as much impact on biology as heredity does.

Because they often are shut down, suspicious, or aggressive they now receive pseudoscientific diagnoses such as “oppositional defiant disorder,” meaning “This kid hates my guts and won’t do anything I tell him to do,” or “disruptive mood dysregulation disorder,” meaning he has temper tantrums.

stayed out of jail, and to be working in well-paying jobs. Economists have calculated that every dollar invested in high-quality home visitation, day care, and preschool programs results in seven dollars of savings on welfare payments, health-care costs, substance-abuse treatment, and incarceration, plus higher tax revenues due to better-paying jobs.

Janet now called her memory “complete” because it now was accompanied by the appropriate feelings.

If the problem with PTSD is dissociation, the goal of treatment would be association: integrating the cut-off elements of the trauma into the ongoing narrative of life, so that the brain can recognize that “that was then, and this is now.”

The reaction can be discharged by an action—“from tears to acts of revenge.” “But language serves as a substitute for action; by its help, an affect can be ‘abreacted’ almost as effectively.”

However, what doctors encounter in emergency rooms, on psychiatric wards, and on the battlefield is necessarily quite different from what scientists observe in their safe and well-organized laboratories.

Langer hauntingly concludes, “Who can find a proper grave for such damaged mosaics of the mind, where they may rest in pieces?

Through Pilates, I found a stronger physical core, as well as a community of women who willingly gave acceptance and social support that had been distant in my life since the trauma. This combination of core strengthening—psychological, social, and physical—created a sense of personal safety and mastery, relegating my memories to the distant past, allowing the present and future to emerge.”

The neuroscientist Joseph LeDoux and his colleagues have shown that the only way we can consciously access the emotional brain is through self-awareness, i.e. by activating the medial prefrontal cortex, the part of the brain that notices what is going on inside us and thus allows us to feel what we’re feeling.5 (The technical term for this is “interoception”—Latin for “looking inside.”)

If you cannot tolerate what you are feeling right now, opening up the past will only compound the misery and retraumatize you further.

Prolonged exposure or “flooding” has been studied more thoroughly than any other PTSD treatment.

Research has shown that up to one hundred minutes of flooding (in which anxiety-provoking triggers are presented in an intense, sustained form) are required before decreases in anxiety are reported.

However, drugs cannot “cure” trauma; they can only dampen the expressions of a disturbed physiology.

Communicating fully is the opposite of being traumatized.

“Notice that,” the key EMDR instruction.

As the great psychiatrist Milton Erickson said, once you kick the log, the river will start flowing.

Their diagnosis will come to define their reality without ever being identified as a symptom of their attempt to cope with trauma.

may never realize that a traumatized part is triggered by passivity and that another part, an angry manager, is stepping in to protect that vulnerable part.

leads to treatments that are ineffective at best and harmful at worst.

The Self is like an orchestra conductor who helps all the parts to function harmoniously as a symphony rather than a cacophony.

One day he told me that he’d spent his adulthood trying to let go of his past, and he remarked how ironic it was that he had to get closer to it in order to let it go.

It is not that something different is seen, but that one sees differently. It is as though the spatial act of seeing were changed by a new dimension. —Carl Jung

Children who have not been allowed to assert themselves will probably have difficulty standing up for themselves as adults, and most grown-ups who were brutalized as children carry a smoldering rage that will take a great deal of energy to contain.

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.

The faculty of voluntarily bringing back a wandering attention, over and over again, is the very root of the judgment, character, and will. —William James

Pierre Janet had said back in 1889: “Traumatic stress is an illness of not being able to be fully alive in the present.”

After all, stress is not an inherent property of events themselves—it is a function of how we label and react to them.

Once the brain has been trained to produce different patterns of electrical communication, no further treatment is necessary, in contrast to drugs, which do not change fundamental brain activity and work only as long as the patient keeps taking them.

Since the time of Homer, soldiers have used alcohol to numb their pain, irritability, and depression.

Music binds together people who might individually be terrified but who collectively become powerful advocates for themselves and others.

Still in his early twenties, he had recently completed his schooling in Latin, which enabled him to read 1,500-year-old Roman manuals on military tactics.

As we’ve seen, the essence of trauma is feeling godforsaken, cut off from the human race.

Competence is the best defense against the helplessness of trauma.

Trauma breeds further trauma; hurt people hurt other people.

Commission, which was based on the central guiding principle of Ubuntu, a Xhosa word that denotes sharing what you have, as in “My humanity is inextricably bound up in yours.”

What are these patients trying to cope with? What are their internal or external resources? How do they calm themselves down? Do they have caring relationships with their bodies, and what do they do to cultivate a physical sense of power, vitality, and relaxation? Do they have dynamic interactions with other people? Who really knows them, loves them, and cares about them? Whom can they count on when they’re scared, when their babies are ill, or when they are sick themselves? Are they members of a community, and do they play vital roles in the lives of the people around them? What specific skills do they need to focus, pay attention, and make choices? Do they have a sense of purpose? What are they good at? How can we help them feel in charge of their lives?

“This is what I believe in; this is what I stand for; this is what I will devote myself to.”