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

by Bessel van der Kolk

During disasters young children usually take their cues from their parents. As long as their caregivers remain calm and responsive to their needs, they often survive terrible incidents without serious psychological scars.

Five-year-old Noam’s drawing made after he witnessed the World Trade Center attack on 9/11.

Being traumatized means continuing to organize your life as if the trauma were still going on—unchanged and immutable—as every new encounter or event is contaminated by the past.

Trauma affects the entire human organism—body, mind, and brain.

After trauma the world is experienced with a different nervous system.

This explains why it is critical for trauma treatment to engage the entire organism, body, mind, and brain.

When the brain’s alarm system is turned on, it automatically triggers preprogrammed physical escape plans in the oldest parts of the brain.

When the old brain takes over, it partially shuts down the higher brain, our conscious mind, and propels the body to run, hide, fight, or, on occasion, freeze.

By the time we are fully aware of our situation, our body may already be on the move.

If for some reason the normal response is blocked—for example, when people are held down, trapped, or otherwise prevented from taking effective action, be it in a war zone, a car accident, domestic violence, or a rape—the brain keeps secreting stress chemicals, and the brain’s electrical circuits continue to fire in vain.2 Long after the actual event has passed, the brain may keep sending signals to the body to escape a threat that no longer exists.

Being able to move and do something to protect oneself is a critical factor in determining whether or not a horrible experience will leave long-lasting scars.

The most important job of the brain is to ensure our survival, even under the most miserable conditions. Everything else is secondary. In order to do that, brains need to: (1) generate internal signals that register what our bodies need, such as food, rest, protection, sex, and shelter; (2) create a map of the world to point us where to go to satisfy those needs; (3) generate the necessary energy and actions to get us there; (4) warn us of dangers and opportunities along the way; and (5) adjust our actions based on the requirements of the moment.4

And since we human beings are mammals, creatures that can only survive and thrive in groups, all of these imperatives require coordination and collaboration.

Our rational, cognitive brain is actually the youngest part of the brain and occupies only about 30 percent of the area inside our skull.

The rational brain is primarily concerned with the world outside us: understanding how things and people work and figuring out how to accomplish our goals, manage our time, and sequence our actions.

Beneath the rational brain lie two evolutionarily older, and to some degree separate, brains, which are in charge of everything else: the moment-by-moment registration and management of our body’s physiology and the identification of comfort, safety, threa...

The brain is built from the bottom up. It develops level by level within every child in the womb, just as it ...

The most primitive part, the part that is already online when we are born, is the ancient animal brain, often called the reptilian brain. It is located in the brain stem, just above the place where our spinal cord enters the skull. The reptilian brain is responsible for all the things that newborn babies can do: eat, sleep, wake, cry, breathe; feel te...

The brain stem and the hypothalamus (which sits directly above it) together control the energy levels of the body. They coordinate the functioning of the heart and lungs and also the endocrine and immune systems, ensuring that these basic life-sustaining systems are mainta...

Breathing, eating, sleeping, pooping, and peeing are so fundamental that their significance is easily neglected when we’re considering the complexities of mind and behavior. However, if your sleep is disturbed or your bowels don’t work, or if you always feel hungry, or if being touched makes you want to scream (as is often the case w...

It is amazing how many psychological problems involve difficulties with sleep, appetite, touch, digestion, and arousal. Any effective treatment for trauma has to address ...

Right above the reptilian brain is the limbic system. It’s also known as the mammalian brain, because all animals that live in groups...

It is the seat of the emotions, the monitor of danger, the judge of what is pleasurable or scary, the arbiter of what is or is ...

It is also a central command post for coping with the challenges of living within our...

The limbic system is shaped in response to experience, in partnership with the infant’s own genetic m...

Whatever happens to a baby contributes to the emotional and perceptual map of the world that its developing brain creates. As my colleague Bruce Perry explains it, the brain is formed in a “use-dependent manner.”5 This is another way of describing neuroplasticity, the relatively recent discovery that neurons that “fire together, wire together.”

When a circuit fires repeatedly, it can become a default setting—the response most likely to occur. If you feel safe and loved, your brain becomes specialized in exploration, play, and cooperation; if you are frightened and unwanted, it specializes in managing feelings of fear and abandonment.

These early explorations shape the limbic structures devoted to emotions and memory, but these structures can also be significantly modified by later experiences: for the better by a close friendship or a beautiful first love, for example, or for the worse by a violent assault, relentless bullying, or neglect.

Taken together the reptilian brain and limbic system make up what I’ll call the “emotional brain” throughout this book.6

Finally we reach the top layer of the brain, the neocortex.

The ancient philosophers called seven years “the age of reason.”

Crucial for understanding trauma, the frontal lobes are also the seat of empathy—our ability to “feel into” someone else.

One of the truly sensational discoveries of modern neuroscience took place in 1994, when in a lucky accident a group of Italian scientists identified specialized cells in the cortex that came to be known as mirror neurons.8

He was watching the researcher, and his brain was vicariously mirroring the researcher’s actions.

One writer compared mirror neurons to “neural WiFi”9—we pick up not only another person’s movement but her emotional state and intentions as well.

But our mirror neurons also make us vulnerable to others’ negativity, so that we respond to their anger with fury or are dragged down by their depression.

trauma almost invariably involves not being seen, not being mirrored, and not being taken into account. Treatment needs to reactivate the capacity to safely mirror, and be mirrored, by others, but also to resist being hijacked by others’ negative emotions.

The Triune (Three-part) Brain. The brain develops from the bottom up. The reptilian brain develops in the womb and organizes basic life sustaining functions. It is highly responsive to threat throughout our entire life span. The limbic system is organized mainly during the first six years of life but continues to evolve in a use-dependent manner. Trauma can have a major impact of its functioning throughout life. The prefrontal cortex develops last, and also is affected by trauma exposure, including being unable to filter out irrelevant information. Throughout life it is vulnerable to go off-line in response to threat.

Without flexible, active frontal lobes people become creatures of habit, and their relationships become superficial and routine. Invention and innovation, discovery and wonder—all are lacking.

Danger is a normal part of life, and the brain is in charge of detecting it and organizing our response.

These sensations converge in the thalamus, an area inside the limbic system that acts as the “cook” within the brain.

The thalamus stirs all the input from our perceptions into a fully blended autobiographical soup, an integrated, coherent experience o...

The sensations are then passed on in two directions—down to the amygdala, two small almond-shaped structures that lie deeper in the limbic, unconscious brain, and up to the frontal...

The neuroscientist Joseph LeDoux calls the pathway to the amygdala “the low road,” which is extremely fast, and that to the frontal cortex the “high road,” which takes several milliseconds longer in ...

However, processing by the thalamus can break down. Sights, sounds, smells, and touch are encoded as isolated, dissociated fragments, and normal memory processing disintegrates. Time freezes, so th...

The central function of the amygdala, which I call the brain’s smoke detector, is to identify whether incoming in...

the hippocampus, a nearby structure that relates the new input to past experiences.

If the amygdala senses a threat—a

it sends an instant message down to the hypothalamus and the brain stem, recruiting the stress-hormone system and the autonomic nervous system (ANS) to orchestrate a whole-body response. Because the amygdala processes the information it receives from the thalamus faster than the frontal lobes do, it decides whether incoming info...

While the smoke detector is usually pretty good at picking up danger clues, trauma increases the risk of misinterpreting whether a particular situation is dangerous or safe.