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

The relationship between our mind and our body is an ever-evolving story. We continue to learn how our mind and our bodies are inextricably linked. In The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma, Bessel van der Kolk walks through the research on how our physiology is changed by the traumas that we experience.

The Relationship

I’m not entirely sold that trauma becomes embodied. There isn’t a compelling case that your pinky – or any other body part – becomes the place that trauma dwells. However, it really doesn’t matter whether the trauma becomes embodied or whether the relationship between our brains and our bodies is so intertwined that the changing neural patterns changes our physiology.

It is clear that our brains are changed by trauma. We literally see the world differently and react differently. Trauma that we can’t fully process can become stuck and make it difficult for us to process any experiences – good or bad. In the attempt to make sense of the trauma, people reapply it to everything they encounter. It colors their perceptions, feelings, and everyday thoughts. While flashbacks are conscious reminders of the trauma, they often live the trauma daily as they may overreact to simple things.

Put Out the Fire

Avoidance

If there’s something stuck in your head that you don’t have the cognitive resources to process, you might try to avoid it. The weapon of choice to blunt the unarticulated pain may be alcohol, drugs, or sex – but these are the solutions, not the problems they’re often portrayed as. Addicts to these things or anything else are often trying to blunt the pain of a trauma they can’t fully understand. The tool of choice allows them to stop feeling for a while – and it is therefore the solution.

Please don’t misunderstand: it’s not a good solution. It’s not a healthy solution. However, addicts use their chosen substance or behavior as a solution, and treating it as the problem may create conflict. This is one of the reasons why Motivational Interviewing can be so useful. It allows us to reframe our perceptions around the perceptions of the person we’re working with.

To move past and heal from trauma, it’s necessary to acknowledge, experience, and bear the weight of the trauma. While this isn’t easy, it is possible. The key is creating safe spaces where people can reprocess the trauma slowly and safely. A lesser form of the kind of processing that needs to be done to escape the kind of boxes we put ourselves in when we’re disingenuous to ourselves as was discussed in The Anatomy of Peace.

Auto Homing

The tragedy that befalls some children is the automatic instinct to return home. Somewhere deep within our psyche, we expect that homes are safe places. We expect that the people who are our parents should care for us and work to keep us safe. Even when it is our caretakers who are harming us, we’ll still seek to come back home. It’s a powerful pull that few can escape.

This makes helping people who are being harmed by the very people who are supposed to be protecting them very difficult. They may find creative ways to disassociate the caretaker’s abuse from their normal expectations of home. You can be scared of daddy – and still welcome him home after his long day at work. Both are incompatible but are held in different compartments within the mind, because it’s the only way to endure the trauma.

Prediction Engines Need Data

Humans are fundamentally prediction engines. It’s what we do, and those prediction engines need data they can process. When a trauma comes, it interrupts the normal flow of processing data and thereby gums up the works for all experiences, both good and bad. Neurologically, our brains cope with an overwhelming trauma by taking parts of the brain offline – to manage how we consume the glucose. However, those areas are the very same areas that we need to be able to make sense of the trauma and convert it into the story that our prediction engine brains need.

The Rise of Superman explains how our brains have a fixed capacity for consumption of energy. To reach flow, some areas are switched offline. In trauma, different areas are switched offline, including Broca’s area – the one that’s responsible for the syntax of language. The result is we have problems explaining the trauma because the parts of our neurology that do this are quite literally unavailable to use.

Tragically, because the trauma isn’t processed, it gets stuck. When it’s run back through the processing the next time, if the variables for fear aren’t constrained, the trauma fails to be processed again, and it’s in the queue for the next day. This process can continue endlessly until the trauma can be processed either naturally or with the help of someone.

Desensitization and Safety

Albert Bandura popularized the use of desensitization as a tool for treating phobias. The idea is that you gradually expose people to situations that more closely resemble their fears. This gradual escalation allows people to come to terms with their fears and feel safer. (See more of his work in Moral Disengagement.) The problem is that for those who have experienced trauma it may not be possible to gradually move people closer to their fears. They all too quickly trigger and thereby overwhelm them.

As a result, strategies to deal with trauma are more frequently focused on revisiting the trauma in their mind – without reintroducing the specific circumstances. More importantly, the strategies that are most effective focus on pushing people into their trauma but only to the extent that they can continue to feel safe.

An opposite response to hyper activation is disassociation. That is, the trauma victim completely disconnects from their emotional selves and thereby avoids the pain of needing to deal with emotion. Unfortunately, disassociation is a rather blunt instrument, and as such, it’s not just the emotions surrounding the trauma that are deadened but all emotions to everything. In short, while people who disassociate with the trauma may lead otherwise productive lives, they bear an unimaginable weight themselves in their inability to connect with others and sustain the life-giving relationships we all need.

Triggering

Those who have suffered trauma often overreact to the things that happen naturally in day-to-day life. A smell or sound may trigger a flashback to the trauma – an instant state of fear and confusion – and as a result may cause them to react in powerful ways that are unexpected and unpredictable to those around them. The key is to create self-awareness to the degree that people know they’re triggered and give them tools to work through the effects of the triggering.

The truth is that the key to responding to being triggered is a quick awareness and response. The natural tendency when triggered is the shutdown of higher-order reasoning – but this takes a few seconds. If the neocortex – more specifically, the medial prefrontal cortex – can downregulate the triggering enough, then it can prevent the person from becoming totally flooded and losing their ability for rational thought.

Emotional Stuffing

The goal in responding to triggering isn’t to prevent emotions or deny they exist. It’s better to think of this from the perspective of accepting the emotions for what they are and trying to place them in a broader context. Stuffing the emotions or denying them has negative consequences to the body and the long-term mental health of the person.

One can accept emotions – without allowing them to overwhelm oneself.

The Elephant and the Horse

I’ve stated repeatedly that my favorite mental metaphor is Jonathan Haidt’s Elephant-Rider-Path model. (See The Happiness Hypothesis and Switch.) However, what I learned here is that this is really more derivative than I might have first expected. Paul MacLean – the same guy that developed the three part description of the brain (where others, like Daniel Kahneman in Thinking, Fast and Slow, use two parts) – apparently first described the rational brain as a rider and the emotional brain as a horse.

Since horses are much more common in the US – and particularly in the Midwest, where I live – I always tell a story of my father riding a horse through a fence to explain why the elephant is really in charge. While I love the alliteration of the emotional elephant, it’s much more practical to think in terms of a rider on top of a horse, since I’ve myself seen that – and I’ve also ridden horses.

Integration

Desensitization is only one route to the true goal. The true goal is to integrate experiences, integrate the feelings with the rational thought. Connecting experiences into a story-like narrative that makes things make sense. While desensitization works for most people, it’s not the solution for everyone. Even cognitive behavior therapy (CBT), which is widely regarded as the most effective psychological technique, doesn’t appear to work with PTSD patients.

CBT is designed to reshape thinking patterns, but its roots in desensitization leaves it susceptible to the limits of preventing the patient from becoming emotionally triggered or flooded which, is particularly challenging when working with people who have a history including trauma – which is, unfortunately, many of us. As a result, there needs to be great care taken to create and recreate safe spaces. It’s necessary to have constant vigilance around feelings of fear and be willing to step back as many times as necessary until the process of reexperiencing the trauma is safe enough to be processed and integrated into our thinking.

Writing It Down

In Opening Up, we learned of the therapeutic effects of writing and how writing conveys positive health benefits. The question might rightly come whether it’s the expression of the trauma that results in improvement or if there’s something magical about writing it down that leads to results. The answer seems to be that there’s something about the writing process that conveys the benefits.

Breaking this down a bit, there doesn’t seem to be controlled study of interventions related to verbally communicating a solution versus not. As a result, it’s hard to say whether writing or talking about a traumatic experience would be better; however, Opening Up explains the paradoxical relationship where people were more likely to be open when they were being recorded when compared to being face-to-face with someone. If we step aside from the conversation of whether it must be written or can be spoken, we can look at the broader question of whether it’s the conversion into language that is important.

As it turns out, it seems that dance, painting, and other artistic forms don’t seem to convey the same results as writing does. As a result, we can say that writing it down matters – without forgoing the possibility that talking about it may be just as valuable. This is particularly true of folks who may find it difficult to write because they become overwhelmed and there’s no one there to help them downregulate when their self-regulation capacities are overwhelmed.

Helping Your Younger Self

It’s been reported by many that one of the ways that recovering people seem to relieve the trauma is by visualizing their current self reentering the trauma and protecting the younger version of themselves from the trauma. While this cannot be a literal representation of the truth, conceptually, it’s powerful.

Bandura was also known for his work on self-efficacy. Martin Seligman and Steven Maier worked on learned helplessness – and the importance of the belief of some degree of control or influence over circumstances. (See The Hope Circuit for more.) Ultimately, the consensus seems to be that one’s belief in their ability to influence their environment is important to mental health. The idea of protecting oneself bends the arc of influence back on itself.

By recognizing their power today and using it as a tool to support their image of their younger self, they’re leveraging their own power to heal the old wounds that were inflicted upon them. Psychically speaking, that young boy or girl is still inside the adult versions of ourselves. That child version can either feel safe or they can feel fear. If they feel fear, it will continue to express itself in terms of our health. (See Why Zebras Don’t Get Ulcers for more.)

Relationships

The other way that you can avoid feeling helpless is through the benevolence of others. You can avoid being stuck if someone or something will bail you out. Many religious beliefs have an all-powerful being who is capable of rescuing believers from any situation. The result of believing in religion has been well studied and has a confirmed positive effect – even if there has been some difficulty separating the effect due to the religion itself and the effect caused by having a cohesive group of relationships.

We are, and always have been, social creatures. We need others to survive, and when we feel isolated from others, we’re the most susceptible to depression and suicide. The isolation need not be physical – it’s more frequently the result of feelings of social isolation.

One of the challenges with traumatized people is that they trauma they face was most frequently inflicted by others. Whether the trauma is war, physical abuse, or sexual abuse, trauma is most often caused by others – and as a result, it can reorient our perspectives on relationships and trust. We can find that we feel as if we can’t trust anyone, so we isolate ourselves. (See Trust=>Vulnerability=>Intimacy, Revisited for more.)

Abuse inflicts not only the initial trauma, but it also robs them of the ability to develop and maintain the kind of intimate relationships that will improve their long-term health and allow them to be more mentally stable. Learning to trust is a long road, particularly when you’ve been betrayed.

Hurting People Hurt People

One of the truths that you’ll hear in recovery circles is that hurting people hurt people. That is, those who are hurting you are likely hurt themselves. Whether you hurt them or they were hurt by others before you arrived, the results are the same. People who are hurting tend to lash out at others and harm them. Unfortunately, when this happens, The Body Keeps the Score, and they go on hurting others. Perhaps you can break the chain and stop the cycle.

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