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

by Bessel van der Kolk

If we are aware of the constant changes in our inner and outer environment, we can mobilize to manage them. But we can’t do this unless our watchtower, the MPFC, learns to observe what is going on inside us. This is why mindfulness practice, which strengthens the MPFC, is a cornerstone of recovery from trauma.12

The neuroscience of selfhood and agency validates the kinds of somatic therapies that my friends Peter Levine13 and Pat Ogden14 have developed.

in essence their aim is threefold: to draw out the sensory information that is blocked and frozen by trauma; to help patients befriend (rather than suppress) the energies released by that inner experience; to complete the self-preserving physical actions that were thwarted when they were trapped, restrained, or immobilized by terror.

Gut feelings also help us to evaluate what is going on around us. They warn us that the guy who is approaching feels creepy, but they also convey that a room with western exposure surrounded by daylilies makes us feel serene.

If you have a comfortable connection with your inner sensations—if you can trust them to give you accurate information—you will feel in charge of your body, your feelings, and your self.

However, traumatized people chronically feel unsafe inside their bodies: The past is alive in the form of gnawing interior discomfort. Their bodies are constantly bombarded by visceral warning signs, and, in an attempt to control these processes, they often become expert at ignoring their gut feelings and in num...

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.

We now know that panic symptoms are maintained largely because the individual develops a fear of the bodily sensations associated with panic attacks.

The experience of fear derives from primitive responses to threat where escape is thwarted in some way. People’s lives will be held hostage to fear until that visceral experience changes.

Suppressing our inner cries for help does not stop our stress hormones from mobilizing the body.

Somatic symptoms for which no clear physical basis can be found are ubiquitous in traumatized children and adults. They can include chronic back and neck pain, fibromyalgia, migraines, digestive problems, spastic colon/irritable bowel syndrome, chronic fatigue, and some forms of asthma.

ALEXITHYMIA: NO WORDS FOR FEELINGS

Her body felt the sadness that her mind couldn’t register—she

Psychiatrists call this phenomenon alexithymia—Greek for not having words for feelings.

Many traumatized children and adults simply cannot describe what they are feeling because they cannot identify what their physical sensations mean.

They tend to register emotions as physical problems rather than as signals that something deserves their attention.

psychiatrist Henry Krystal,

Suppressing their feelings had made it possible to attend to the business of the world, but at a price. They learned to shut down their once overwhelming emotions, and, as a result, they no longer recognized what they were feeling.

Whatever their response, they often can’t tell what is upsetting them. This failure to be in touch with their bodies contributes to their well-documented lack of self-protection and high rates of revictimization23

One particularly good description of depersonalization comes from the German psychoanalyst Paul Schilder, writing in Berlin in 1928:

They have become strangers to themselves.”

neuroscientists at the University of Geneva25 had induced similar out-of-body experiences

This research confirms what our patients tell us: that the self can be detached from the body and live a phantom existence on its own.

Physical self-awareness is the first step in releasing the tyranny of the past.

Noticing sensations for the first time can be quite distressing, and it may precipitate flashbacks in which people curl up or assume defensive postures. These are somatic reenactments of the undigested trauma and most likely represent the postures they assumed when the trauma occurred.

The mind needs to be reeducated to feel physical sensations, and the body needs to be helped to tolerate and enjoy the comforts of touch.

The prefrontal cortex (PFC) normally helps us to assess the person coming toward us, and our mirror neurons help to pick up his intentions.

However, the subjects with PTSD did not activate any part of their frontal lobe, which means they could not muster any curiosity about the stranger. They just reacted with intense activation deep inside their emotional brains, in the primitive areas known as the Periaqueductal Gray, which generates startle, hypervigilance, cowering, and other self-protective behaviors.

The TAT is a so-called projective test, which uses a set of cards to discover how people’s inner reality shapes their view of the world.

These images were not selected because they had some hidden meaning that sensitive people could uncover; they were ordinary images of everyday life.

By the late 1940s Bowlby had become persona non grata in the British psychoanalytic community, as a result of his radical claim that children’s disturbed behavior was a response to actual life experiences—to

Undaunted, he devoted the rest of his life to developing what came to be called attachment theory.

I love the expression of the great French psychiatrist Pierre Janet: “Every life is a piece of art, put together with all means available.”

As we grow up, we gradually learn to take care of ourselves, both physically and emotionally, but we get our first lessons in self-care from the way that we are cared for.

Mastering the skill of self-regulation depends to a large degree on how harmonious our early interact...

Children whose parents are reliable sources of comfort and strength have a lifetime advantage—a kind of buffer against ...

Children become attached to whoever functions as their primary caregiver. But the nature of that attachment—whether it is secure or insecure—makes a huge difference over the course of a child’s life.

Secure attachment develops when caregiving includes emotional attunement. Attunement starts at the most subtle physical levels of interaction between babies and their caretakers, and it gives babies the feeling of being met and understood.

mirror neurons, the brain-to-brain links that give us our capacity for empathy. Mirror neurons start functioning as soon as babies are born.

Imitation is our most fundamental social skill. It assures that we automatically pick up and reflect the behavior of our parents, teachers, and peers.

Associating intense sensations with safety, comfort, and mastery is the foundation of self-regulation, self-soothing, and self-nurture,

A secure attachment combined with the cultivation of competency builds an internal locus of control, the key factor in healthy coping throughout life.7

Securely attached kids learn the difference between situations they can control and situations where they need help.

In contrast, children with histories of abuse and neglect learn that their terror, pleading, and crying do not register with their caregiver. Nothing they can do or say stops the beating or brings attention and help. In effect they’re being conditioned to give up when they face challenges later in life.

The way a mother holds her child underlies “the ability to feel the body as the place where the psyche lives.”

But things can go seriously wrong when mothers are unable to tune in to their baby’s physical reality. If a mother cannot meet her baby’s impulses and needs, “the baby learns to become the mother’s idea of what the baby is.”

Having to discount its inner sensations, and trying to adjust to its caregiver’s needs, means the child perceives that “something is wrong” with the way it is. Children who lack physical attunement are vulnerable to shutting down the direct feedback from their bodies, the seat of pleasure, purpose, and direction.

Abused kids are often very sensitive to changes in voices and faces, but they tend to respond to them as threats rather than as cues for staying in sync.

Somebody recognized him; somebody knew his name. A little while later Jack confessed, “You know, that is what makes it worthwhile.” Kids will go to almost any length to feel seen and connected.

We now have reliable ways to assess and identify these coping styles, thanks largely to the work of two American scientists, Mary Ainsworth and Mary Main,