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

by Bessel van der Kolk

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.

You begin to experiment with changing the way you feel. Will taking a deep breath relieve that tension in your shoulder? Will focusing on your exhalations produce a sense of calm?18

Simply noticing what you feel fosters emotional regulation, and it helps you to stop trying to ignore what is going on inside you. As I often tell my students, the two most important phrases in therapy, as in yoga, are “Notice that” and “What happens next?” Once you start approaching your body with curiosity rather than with fear, everything shifts.

As a result, abused children are likely to grow up believing that they are fundamentally unlovable; that was the only way their young minds could explain why they were treated so badly. They survive by denying, ignoring, and splitting off large chunks of reality: They forget the abuse; they suppress their rage or despair; they numb their physical sensations. If you were abused as a child, you are likely to have a childlike part living inside you that is frozen in time, still holding fast to this kind of self-loathing and denial.

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.

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.

Patients are asked to identify the part involved in the current problem, like feeling worthless, abandoned, or obsessed with vengeful thoughts. As they ask themselves, “What inside me feels that way?” an image may come to mind.16 Maybe the depressed part looks like an abandoned child, or an aging man, or an overwhelmed nurse taking care of the wounded; a vengeful part might appear as a combat marine or a member of a street gang.

Next the therapist asks, “How do you feel toward that (sad, vengeful, terrified) part of you?” This sets the stage for mindful self-observation by separating the “you” from the part in question. If the patient has an extreme response like “I hate it,” the therapist knows that there is another protective part blended with Self. He or she might then ask, “See if the part that hates it would step back.” Then the protective part is often thanked for its vigilance and assured that it can return anytime that it is needed. If the protective part is willing, the follow-up question is: “How do you feel toward the (previously rejected) part now?” The patient is likely to say something like “I wonder why it is so (sad, vengeful etc.).” This sets the stage for getting to know the part better—for example, by inquiring how old it is and how it came to feel the way it does.

Asked how they were feeling, they almost always replied, “I’m fine.” Their stoic parts clearly helped them cope, but these managers also kept them in a state of denial. Some shut out their bodily sensations and emotions to the extent that they could not collaborate effectively with their doctors.

He expressed contempt for people who blamed their parents or society for their problems. Even though he had had his own share of misery as a child, he was determined never to think of himself as a victim.

Peter’s wife joined us for the next meeting. She described how he criticized her incessantly—her taste in clothes, her child-rearing practices, her reading habits, her intelligence, her friends.

He was silent for perhaps a minute before he whispered: “I would get hurt.” I urged him to ask the critic what that meant. Still with his eyes closed, 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, and as he became silent again, I could see his shoulders relax and his breathing become slower and deeper.

Peter watched this scene for several minutes, weeping silently through much of it. I asked him if the boy had told him everything he wanted him to know. No, there were other scenes, like running to embrace his father at the door and getting slapped for having disobeyed his mother. From time to time he would interrupt the process by explaining why his parents couldn’t have done any better than they had, their being Holocaust survivors and all that implied. Again I suggested he find the protective parts that were interrupting the witnessing of the boy’s pain and request that they move temporarily to another room. And each time he was able to return to his grief.

Peter imagined himself confronting his dad as a grown man, telling him: “If you ever mess with that boy again, I’ll come and kill you.” He then, in his imagination, took the child to a beautiful campground he knew, where the boy could play and frolic with ponies while he watched over him.

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.

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 your parents’ faces never lit up when they looked at you, it’s hard to know what it feels like to be loved and cherished. If you come from an incomprehensible world filled with secrecy and fear, it’s almost impossible to find the words to express what you have endured. If you grew up unwanted and ignored, it is a major challenge to develop a visceral sense of agency and self-worth.

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.

I could see this even in some of my most committed and articulate patients. Despite their hard work in therapy and their share of personal and professional accomplishments, they could not erase the devastating imprints of a mother who was too depressed to notice them or a father who treated them like he wished they’d never been born. It was clear that their lives would change fundamentally only if they could reconstruct those implicit maps....

“A witness can see how crestfallen you are when you talk about your father deserting the family.” I was impressed by how carefully he tracked subtle shifts in body posture, facial expression, tone of voice, and eye gaze, the nonverbal expressions of emotion. (This is called “microtracking” in psychomotor therapy). Each time Pesso made a “witness statement,” Nancy’s face and body relaxed a bit, as if she felt comforted by being seen and validated. His quiet comments seemed to bolster her courage to continue and go deeper. When Nancy started to cry, he observed that nobody should have to bear so much pain all by herself, and he asked if she would like to choose someone to sit next to her. (He called this a “contact person.”) Nancy nodded and, after carefully scanning the room, pointed to a kind-looking middle-aged woman. Pesso asked Nancy where she would like her contact person to sit. “Right here,” Nancy said decisively, indicating a pillow immediately to her right.

was fascinated. 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 (see chapter 3). Caring, disapproval, and indifference all are primarily conveyed by facial expression, tone of voice, and physical movements. According to recent research, up to 90 percent of human communication occurs in the nonverbal, right-hemisphere realm,2 and this was where Pesso’s work seemed primarily to be directed. As the workshop went on, I was also struck by how the contact person’s presence seemed to help Nancy tolerate the painful experiences she was dredging up.

As the narratives unfolded, group participants were asked to play the roles of significant people in the protagonists’ lives, such as parents and other family members, so that their inner world began to take form in three-dimensional space. Group members were also enlisted to play the ideal, wished-for parents who would provide the support, love, and protection that had been lacking at critical moments. Protagonists became the directors of their own plays, creating around them the past they never had, and they clearly experienced profound physical and mental relief after these imaginary scenarios. Could this technique instill imprints of safety and comfort alongside those of terror and abandonment, decades after the original shaping of mind and brain?

Since there were no other people available for role-play, Al began by asking me to select an object or a piece of furniture to represent my father. I chose a gigantic black leather couch and asked Al to put it upright about eight feet in front of me, slightly to the left. Then he asked if I’d like to bring my mother into the room as well, and I chose a heavy lamp, approximately the same height as the upright couch. As the session continued, the space became populated with the important people in my life: my best friend, a tiny Kleenex box to my right; my wife, a small pillow next to him; my two children, two more tiny pillows. After a while I surveyed the projection of my internal landscape: two hulking, dark, and threatening objects representing my parents and an array of minuscule objects representing my wife, children, and friends. I was astounded; I had re-created my inner image of my stern Calvinistic parents from the time I was a little boy. My chest felt tight, and I’m sure that my voice sounded even tighter. I could not deny what my spatial brain was revealing: The structure had allowed me to visualize my implicit map of the world. When I told Al what I had just uncovered, he nodded and asked if I would allow him to change my perspective. I felt my skepticism return, but I liked Al and was curious about his method, so I hesitantly agreed. He then interposed his body directly between me and the couch and lamp, making them disappear from my line of sight. Instantaneo...

Projecting your inner world into the three-dimensional space of a structure enables you to see what’s happening in the theater of your mind and gives you a much clearer perspective on your reactions to people and events in the past. As you position placeholders for the important people in your life, you may be surprised by the unexpected memories, thoughts, and emotions that come up. You then can experiment with moving the pieces around on the external chessboard that you’ve created and see what effect it has on you. Although the structures involve dialogue, psychomotor therapy does not explain or interpret the past. Instead, it allows you to feel what you felt back then, to visualize what you saw, and to say what you could not say when it actually happened. It’s as if you could go back into the movie of your life and rewrite the crucial scenes. You can direct the role-players to do things they failed to do in the past, such as keeping your father from beating up your mom. These tableaus can stimulate powerful emotions. For example, as you place your “real mother” in the corner, cowering in terror, you may feel a deep longing to protect her and realize how powerless you felt as a child. But if you then create an ideal mother, who stands up to your father and who knows how to avoid getting trapped in abusive relationships, you may experience a visceral sense of relief and an unburdening of that old guilt and helplessness. Or you might confront the brother who brutalized you...

Feeling safe means you can say things to your father (or, rather, the placeholder who represents him) that you wish you could have said as a five-year-old. You can tell the placeholder for your depressed and frightened mother how terrible you felt about not being able to take care of her. You can experiment with distance and proximity and explore what happens as you move placeholders around. As an active participant, you can lose yourself in a scene in a way you cannot when you simply tell a story. And as you take charge of representing the reality of your experience, the witness keeps you company, reflecting the changes in your posture, facial expression, and tone of voice.

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.

After another long silence she hesitantly began to speak: “There is always a sense of fear in everything I do. It doesn’t look like I am afraid, but I am always pushing myself. It is really difficult for me to be up here.” I reflected, “A witness can see how uncomfortable you feel pushing yourself to be here,” and she nodded, slightly straightening her spine, signaling that she felt understood. She continued: “I grew up thinking that my family was normal. But I always was terrified of my dad. I never felt cared for by him. He never hit me as hard as he did my siblings, but I have a pervasive sense of fear.” I noted that a witness could see how afraid she looked as she spoke of her father, and then I invited her to select a group member to represent him.

“A witness can see how delighted you are when you hear your mother saying that she is not taking this shit from your dad anymore and that she will take you away from him,” I told her. Maria began to sob and said, “I would have been able to be a safe, happy little girl.” Out of the corner of my eye I could see several group members weeping silently—the possibility of growing up safe and happy clearly resonated with their own longings.

But we do know that, in order to become self-confident and capable adults, it helps enormously to have grown up with steady and predictable parents; parents who delighted in you, in your discoveries and explorations; parents who helped you organize your comings and goings; and who served as role models for self-care and getting along with other people.

Defects in any of these areas are likely to manifest themselves later in life. A child who has been ignored or chronically humiliated is likely to lack self-respect. 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.

In the chapters on the biology of trauma we saw how trauma and abandonment disconnect people from their body as a source of pleasure and comfort, or even as a part of themselves that needs care and nurturance. When we cannot rely on our body to signal safety or warning and instead feel chronically overwhelmed by physical stirrings, we lose the capacity to feel at home in our own skin and, by extension, in the world.

long as their map of the world is based on trauma, abuse, and neglect, people are likely to seek shortcuts to oblivion. Anticipating rejection, ridicule, and deprivation, they are reluctant to try out new options, certain that these will lead to failure. This lack of experimentation traps people in a matrix of fear, isolation, and scarcity where it is impossible to welcome the very experiences that might change their basic worldview.

“Yes, that is what it was like. That is what I had to deal with. And that is what it would have felt like back then if I had been cherished and 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, as in “I can spontaneously interact with other people without having to be afraid of being rejected or getting hurt.”

Other traumatized patients show patterns of hyperactivity the moment they close their eyes: Not seeing what is going on around them makes them panic and their brain waves go wild. We train them to produce more relaxed brain patterns.

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.

Unlike his experience with the numerous therapists who had talked with him about how bad he felt, theater gave him a chance to deeply and physically experience what it was like to be someone other than the learning-disabled, oversensitive boy that he had gradually become. Being

Traumatized people are terrified to feel deeply. They are afraid to experience their emotions, because emotions lead to loss of control.

where someone was in physical danger, the students always sided with the aggressors. Because they could not tolerate any sign of weakness in themselves, they could not accept it in others.