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

by Bessel van der Kolk

If the amygdala is the smoke detector in the brain, think of the frontal lobes—and specifically the medial prefrontal cortex (MPFC),12 located directly above our eyes—as the watchtower,

(Our watchtower also tells us that other people’s anger and threats are a function of their emotional state.)

When that system breaks down, we become like conditioned animals: The moment we detect danger we automatically go into fight-or-flight mode.

Top down or bottom up. Structures in the emotional brain decide what we perceive as dangerous or safe. There are two ways of changing the threat detection system: from the top down, via modulating messages from the medial prefrontal cortex (not just prefrontal cortex), or from the bottom up, via the reptilian brain, through breathing, movement, and touch.

Effectively dealing with stress depends upon achieving a balance between the smoke detector and the watchtower. If you want to manage your emotions better, your brain gives you two options: You can learn to regulate them from the top down or from the bottom up.

Top-down regulation involves strengthening the capacity of the watchtower to monitor your body’s sensations. Mindfulness meditation and yoga can help with this. Bottom-up regulation involves recalibrating the autonomic nervous system, (which, as we have seen, originates in the brain stem).

The neuroscientist Paul MacLean, who developed the three-part description of the brain that I’ve used here, compared the relationship between the rational brain and the emotional brain to that between a more or less competent rider and his unruly horse.

Feeling numb during birthday parties for your kids or in response to the death of loved ones makes people feel like monsters. As a result, shame becomes the dominant emotion and hiding the truth the central preoccupation.

Stan’s brain scan shows his flashback in action. This is what reliving trauma looks like in the brain: the brightly lit area in the lower right-hand corner, the blanked-out lower left side, and the four symmetrical white holes around the center.

It activated just as if the car crash were happening in the scanner, triggering powerful stress hormones and nervous-system responses.

dorsolateral prefrontal cortex (DLPFC)

The DLPFC is located to the side in the front brain, while the MPFC is in the center.

The structures along the midline of the brain are devoted to your inner experience of yourself, those on the side are more concerned with yo...

The DLPFC tells us how our present experience relates to the past and how it may affect the future—you can think of i...

Trauma is the ultimate experience of “this will last forever.”

Stan’s scan reveals why people can recover from trauma only when the brain structures that were knocked out during the original experience—which is why the event registered in the brain as trauma in the first place—are fully online.

As I’ve said, the thalamus functions as a “cook”—a relay station that collects sensations from the ears, eyes, and skin and integrates them into the soup that is our autobiographical memory. 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: images, sounds, and physical sensations that are accompanied by intense emotions, usually terror and helplessness.

In normal circumstances the thalamus also acts as a filter or gatekeeper. This makes it a central component of attention, concentration, and new learning—all of which are compromised by trauma.

People with PTSD have their floodgates wide open. 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.

Blanking out (dissociation) in response to being reminded of past trauma. In this case almost every area of the brain has decreased activation, interfering with thinking, focus, and orientation.

Depersonalization is one symptom of the massive dissociation created by trauma.

He observes that we humans share some of the physical signs of animal emotion. Feeling the hair on the back of your neck stand up when you’re frightened or baring your teeth when you’re enraged can only be understood as vestiges of a long evolutionary process.

In other words: If an organism is stuck in survival mode, its energies are focused on fighting off unseen enemies, which leaves no room for nurture, care, and love.

Darwin also wrote about body-brain connections that we are still exploring today. Intense emotions involve not only the mind but also the gut and the heart: “Heart, guts, and brain communicate intimately via the ‘pneumogastric’ nerve, the critical nerve involved in the expression and management of emotions in both humans and animals.

As long as we register emotions primarily in our heads, we can remain pretty much in control, but feeling as if our chest is caving in or we’ve been punched in the gut is unbearable.

All of the little signs we instinctively register during a conversation—the muscle shifts and tensions in the other person’s face, eye movements and pupil dilation, pitch and speed of the voice—as well as the fluctuations in our own inner landscape—salivation, swallowing, breathing, and heart rate—are linked by a single regulatory system.

the autonomic nervous system (ANS): the sympathetic, which acts as the body’s accelerator, and the parasympathetic, which serves as its brake.

working together they play an important role in managing the body’s energy flow, one preparing for its expenditure, the other for its conservation.

The sympathetic nervous system (SNS) is responsible for arousal, including the fight-or-flight response

Almost two thousand years ago the Roman physician Galen gave it the name “sympathetic” because he observed that it functio...

The SNS moves blood to the muscles for quick action, partly by triggering the adrenal glands to squirt out adrenaline, which speeds up the h...

The second branch of the ANS is the parasympathetic (“against emotions”) nervous system (PNS), which promotes self-preservative functions like digestion and wound healing. It triggers the release of acetylcholine to put a brake on arousal, slowing t...

Whenever you take a deep breath, you activate the SNS. The resulting burst of adrenaline speeds up your heart, which explains why many athletes take a few short, deep breaths before starting competition. Exhaling, in turn, activates the PNS, which slows down the heart.

A measurement called heart rate variability (HRV) can be used to test the flexibility of this system, and good HRV—the more fluctuation, the better—is a sign that the brake and accelerator in your arousal system are both functioning properly and in balance.

In 1994 Stephen Porges,

introduced the Polyvagal Theory,

(Polyvagal refers to the many branches of the vagus nerve—Darwin’s “pneumogastric nerve”—which connects numerous organs, including the brain, lungs, heart, stomach, and intestines.)

The Polyvagal Theory provided us with a more sophisticated understanding of the biology of safety and danger, one based on the subtle interplay between the visceral experiences of our own bodies and the voices and faces of the people around us.

It explained why a kind face or a soothing tone of voice can dramatically alter the way we feel. It clarified why knowing that we are seen and heard by the important people in our lives can make us feel calm and safe, and why being ignored...

In short, Porges’s theory made us look beyond the effects of fight or flight and put social relationships front and center in our understanding of trauma.

Human beings are astoundingly attuned to subtle emotional shifts in the people (and animals) around them. Slight changes in the tension of the brow, wrinkles around the eyes, curvature of the lips, and angle of the neck quickly signal to us how comfortable, suspicious, relaxed, or frightened someone is.

Our mirror neurons register their inner experience, and our own bodies make internal adjustments to whatever we notice.

Our culture teaches us to focus on personal uniqueness, but at a deeper level we barely exist as individual organisms. Our brains are built to help us function as members of a tribe.

Most of our energy is devoted to connecting with others.

A few years ago I heard Jerome Kagan, a distinguished emeritus professor of child psychology at Harvard, say to the Dalai Lama that for every act of cruelty in this world there are hundreds of small acts of kindness and connection. His conclusion: “To be benevolent rather than malevolent is probably a true feature of our species.”

Being able to feel safe with other people is probably the single most important aspect of mental health;

You don’t need a history of trauma to feel self-conscious and even panicked at a party with strangers—but trauma can turn the whole world into a gathering of aliens.

In the past two decades it has become widely recognized that when adults or children are too skittish or shut down to derive comfort from human beings, relationships with other mammals can help. Dogs and horses and even dolphins offer less complicated companionship while providing the necessary sense of safety.

After trauma the world is experienced with a different nervous system that has an altered perception of risk and safety.

Porges coined the word “neuroception” to describe the capacity to evaluate relative danger and safety in one’s environment.