TRAUMA IN THE BODY: EXPLORING NEW HOPES FOR HEALING

Bessel van der Kolk, M.D. is the founder and medical director of the Trauma Center in Brookline, Massachusetts, a professor in the department of psychiatry at Boston University Medical School, and the director of the National Child Traumatic Stress Network, which Congress established to raise the standard of care and improve access to services for traumatized children, their families, and communities. 

Dr. van der Kolk’s newest book, The Body Keeps The Score: Brain, Mind and Body in the Healing of Trauma, offers a sweeping and revolutionary new understanding of the causes and consequences of trauma and how to heal the traumatized brain through therapies such as neurofeedback, Eye Movement Desensitization and Reprocessing (EMDR) therapy, theater, yoga, and movement.

In the pages that follow, Anchor’s Elissa Melaragno offers us an in-depth and exclusive interview with Dr. van der Kolk about trauma and healing.

INTERVIEW WITH DR. BESSEL VAN DER KOLK BY ELISSA MELARAGNO

Elissa Melaragno: I read your entire book through the acknowledgments, and the very last acknowledgment was “to an affirmation of the life force which drives us human beings to create a meaningful life regardless of the obstacles we encounter.” What have you learned about this life force in the process of your work?

Dr. Bessel van der Kolk: It comes up over and over again. I just went to visit my childhood friends in the Netherlands, and I found that the more traumas they have had in their background, the more creative and successful they often become. It’s the people who have had to struggle who often see new possibilities and have no choice but to discover new options. Traumatized people and their ability to see new things accounts for some of the progress we make in our society. Oprah Winfrey is one good example. Isaac Newton had a horrendous history, but, at the same time, he was the great discoverer of calculus and many of the fundamental laws of physics. Traumatized people have to find creative solutions to existing reality. Surely, not every survivor has this amazing creative capacity, but some of them do.

Melaragno: Is it that this life force causes some to go a little deeper to try to find solutions or to succeed?

van der Kolk: Well, when you’re traumatized, it’s do or die. When you’ve been abused, hurt, or abandoned, you either go on with your life or you lie down and let life roll over you. A lot of people find ways of going on—maybe through a piece of music or a play; or through their involvement in science; or by hiding in a garden to raise flowers. A large number of survivors of childhood trauma, who I know, were avid readers as kids. They were terrified, abandoned, and continuously exposed to violence, and yet they found Harry Potter or Jane Austen. They disappeared in the stories. The imaginary worlds generated by other people allowed them to create alternate universes to the ones they were living in.

Melaragno: How would you define trauma?

Dr. van der Kolk: Trauma is something that overwhelms your coping capacities and confronts you with the thought: “Oh my God, it’s all over, and there’s nothing I can do. I’m done for. I may as well die.”  

Melaragno: You write: “Traumatized people do not recognize their bodies as a source of pleasure and comfort or even as 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, the whole world. As 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 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 world view.” You used a term called interoception as a scientific name for this self-sensing ability. Can you talk a little bit about that?

van der Kolk: Neuroscience research has shown that the only way you can change your survival orientation in your brain is by accessing your interoceptive world—the part of your brain that allows you to observe yourself. In my book, I make quite a big deal of it. Accessing the interoceptive world is not a strong skill in the Western traditions. Getting to know yourself and to feel yourself—being still—is not part of the dominant culture of Western civilization. Basically, our culture suggests if you feel bad, simply take a swig of something or take a pill to make whatever symptom go away. There is very little understanding here in the West that you can actually change your own physiology. I was first confronted with this in China, later in Japan and South Africa, and then I realized that much of the rest of the world has found ways of dealing with the self, opening oneself up to oneself. Most of my serious colleagues are into meditation or yoga because they have come to realize that that’s the only way you can consciously change your brain. You have to go inside and be still by yourself. Our culture is constantly forcing people to be distracted by stuff in order for them not to feel themselves. 

But the only way you can be yourself is to know yourself. When you’re traumatized, it becomes even more difficult to know yourself because trauma is actually NOT the story of what happened a long time ago; trauma is residue that’s living inside of you now; trauma lives inside of you in horrible sensations, panic reactions, uptightness, explosions, and impulses. Because trauma lives inside of you, getting to know yourself can be the scariest thing to do. It takes an enormous amount of courage to visit and befriend yourself and to feel what that uptightness is about. Having the courage to let yourself relax and to notice the flow of your body is central for recovery.

Melaragno: So, it’s about self-observance.

van der Kolk: Observing yourself, knowing yourself, being curious about yourself, befriending yourself, taking care of yourself. One of the most striking things that comes out of all the research of trauma is not so much these typical trauma things that people talk about like nightmares and flashbacks. One of the most striking things is the idea of having a hateful relationship to your body: not taking care of your body by abusing alcohol so you don’t feel anything; by smoking dope day and night so you don’t feel anything; by injecting drugs into yourself so you don’t feel anything; by having sex with inappropriate people so you don’t feel anything; by frantically wandering around to make feelings in your body go away. In contrast, the only way to resolve trauma is to get to know yourself and cherish yourself. That is very hard to do as long as your body feels unsafe. Most traumatized people try to get away from their bodies as fast as they can because their bodies stir them up. The body is where the panic is—the fear and the rage. But you need to get to know your rage and your fear and to learn to take care of it.

Melaragno: A common psychological term I’ve heard with trauma is dissociation—is that what you’re describing?

van der Kolk: Dissociation is a temporary putting aside, not knowing, and not noticing. It’s a way to survive. Blocking things out allows many traumatized people to go on. It may be very helpful in order to make it through the crisis, but in the long range, living your life in a dissociative way only keeps the trauma alive. As a result, you allow other people to hurt you or you depend on others to take care of your feelings. This also happens to societies and communities that keep pretending nothing is going on. Such denial, in fact, keeps the trauma alive by keeping us from confronting it and dealing with it.

Melaragno: You discuss many good practices in your book and spend quite a bit of time talking about yoga and meditation, which tend to encourage people to get deeper in their bodies. Is that then part of the healing process?

“To feel and know your body safely is an essential ingredient of healing.”

van der Kolk: To feel and know your body safely is an essential ingredient of healing. The critical factor there is the issue of time. When you’re traumatized, time stops, and you feel like it will last forever. When a love relationship breaks up, you feel terrible and think it will never go away. Once you make the effort to observe yourself, you notice that your body sensations continually shift. We have living bodies. I remember this French movie with a guy who finds out his wife has an affair, and he’s really very angry. He goes to bed, and he says, “I won’t work any more and be a member of this family.” That stance is forced to come to an end when he needs to go pee, which gets him out of the bed. At some moment, you simply have to move. When you meditate you notice uncomfortable sensations, uncomfortable thoughts, and you go back to your breathing. Then you notice that your thought has shifted to something else. If you feel a cramp you notice it, and something else happens. There is that continuously evolving living organism that doesn’t get stuck. A very important part of healing from trauma is to get that sense of every moment is different from the next moment.

Melaragno: In the chapter “Healing from Trauma, Owning Yourself,” you cover six important ways to connect with what is going on inside oneself: managing hyper-arousal, mindfulness, relationships, communal rhythms and synchrony, touch, and taking action. 

van der Kolk: Well, let’s start with the fact that we are collective creatures. We don’t exist as individuals. Our brain is meant to be in synchrony with other brains. Interaction with other brains fundamentally shapes who we are. When we cry, we’re supposed to get a response, and when we laugh, somebody is supposed to laugh with us. Those are the rhythms of life by which we the brain develops. If kids are left by themselves, as occurs in orphanages and drug abusing households, their brains do not develop properly and are damaged. There’s very rich research now on how sounds, facial movements, and the synchrony and the rhythms between faces and voices are what gets the basic brain structures online. If you don’t get that synchrony, certain parts of your brain that are supposed to develop to be in sync with other people get damaged. So, you have a hard time with other people as you grow up, a hard time getting confident about other people, getting pleasure from other people, being in sync, and enjoying a sense of community with others. You feel lonely, isolated, and miserable. Our brains are meant to be in sync, and the big challenge often in traumatic stress is the question of how you create a brain that can be back in sync with other people. In order to do that, you need to first of all notice yourself. As long as you don’t notice yourself, you are like a chicken with his head cut off. You just run around like an automatic animal that responds and gets enraged. But when you know what’s going on with you, you start to get some choices like “Maybe I should not react to this” or “Maybe I should not touch her.” You need to have a quiet mind in order to get ownership of yourself, and therefore the cultivation of mindfulness and self-observance is absolutely critical. This is easier done if there is somebody out there who could help you with it. Someone who can see you, who can notice what goes on with you, who can help you to name things,  who can help you say, “This is what’s happening to me.” You don’t need someone to name how screwed up you are, how you need to be fixed. You need to just notice yourself, just notice, just notice without judgment. 

The latest piece of research that came out after my book was finished is that the issue is not mindfulness alone, it’s rather mindfulness with self-compassion. See that angry part of yourself and acknowledge what that anger has done for you to survive. See that the anger has been a way of managing yourself. Thank that anger for having helped you. Then say to that anger, “Can you please step back a little bit so I can be back in charge of myself?” It is compassionately negotiating those inner parts of you. 

There’s also the issue of safety. As I alluded to before, one of the huge things in our research was seeing how the body feels chronically unsafe. We can observe this in our brain scans and in our EEGs. The back parts of our brains are agitated and hyper-aroused. Nothing in our conscious brain can control that because it’s too far down—too deep in our animal brain. How do you create an organism that feels safe? Probably the main way of doing that is touch. Touch is how we come into the world, and safety is conveyed to us by being held. Touch is not a common form of therapy, and I don’t suggest that psychotherapists introduce touching, but having a body that feels safe to be touched by somebody is an essential part of recovery. Bodywork, Feldenkrais Therapy, and CranioSacral Therapy have very legitimate, very important positions in healing from trauma. Your body cannot feel safe until it’s okay to be touched by somebody who is there for you. So, that’s an important piece. 

There is the critical question ofwhat happens after you notice what is going on with yourself. When you want to punch me in the face, notice that sensation, what does your arm want to do? What happens next? Redirect. “I ought to take a breath.” Okay, then your arm comes down. Get to know all these impulses inside of you, and see how they have their own rhythms and how they come to an end. It’s a very sensual world that we live in. Getting to know the life of your body gets killed by trauma. 

Melaragno: So, is that what you mean then by taking action?

van der Kolk: Taking action is taking action. We are meant to cook meals together, build houses, gather food, go to work, shovel snow, and make babies and take care of them. That’s all doing. We need to be able to stand up for ourselves and say, “one step further and I’ll kick you in the groin!” We have stress hormones to move, protect, and take care of ourselves. If you just say, “I can’t deal with it anymore,” you subvert that self-defensive “action-taking” part. A story, which I think is in the book, is when Nelson Mandela told me that what helped him most to become the mindful person he became was boxing. He observed body movements, got to know who the opponent was in order to anticipate their movements, and developed a mental picture of how he could defend and stand up for himself. And that takes very complex mental maneuvering. It is also just possible that martial arts may be among the very best treatments for traumatic stress because you learn to not be powerless. You learn to say, “You want to mess with me. You can try it but I may knock you out in the process.”

Melaragno: You write that your most profound experience with healing from collective trauma was witnessing the work of the South African Truth and Reconciliation Commission. 

“Tutu was a master trauma therapist.”

van der Kolk: It was stunning. South Africa was extremely violent on every level. The whole society was enraged. Everybody was after everybody. When I was there, people were getting killed all the time. So, how were they going to have a transition that would not result in a bloodbath? They very deliberately decided to make a transition to calm people’s rage down. Tutu was a master trauma therapist. I followed him and saw him at work, and he was stunning. He would come into a room with 40, 50, 60 people, and we would pray together, and we would sing together, and we would dance together. We got this sense of communal rhythm and pleasure and belonging and being in sync, and then somebody would start talking about their trauma. To talk about your trauma sometimes separates people because you are into your own misery and your overwhelming feeling of terror and rage. Tutu would just get people to that certain point, and he’d say, “Let’s get up. Let’s sing and dance.” He was a master at what we call in our work pendulation—getting people to move into safe places then into the dangerous places; getting that courage to go into deep and painful places by knowing that on the other hand there are feelings of safety and connection. I saw him do that well, and, of course, Mandela and Alex Borraine were like that too. When the transition happened, the urge to kill and take revenge was temporarily suspended because people felt loved and heard. They very deliberately wanted to make sure that the birth of South Africa was not a bloodbath as it was in India for example. They learned from India that if a nation gets born out of bloodbath, it will never recover. It was an astounding spiritual process founded on science and understanding how the brain and trauma works.

Melaragno: Now, when you said it was founded on science, did Bishop Tutu do some research? Or do you mean that his work just happened to line up with the scientific understanding?

van der Kolk: That’s how science works. People figure out how to do something and then afterwards our scientific studies clarify how it works. For example, the trauma therapy called EFT, which I call tapping, tapping acupressure points. Nobody knows yet how it works. There is also such a thing as chi. We empirical, Western medical people have no idea what these acupressure points actually are or what chi is. They may or may not exist. But I feel confident somebody will figure it out someday.

Melaragno: It goes back to that life force in the end, doesn’t it? There’s something in that about finding a way.

van der Kolk: We’re creatures, and creatures will do terrible things to each other and then need to find ways of surviving. Every culture finds ways to go on. I strongly suspect that most martial arts that developed in Japan were developed to help samurai to recover from their interminable wars. Studying martial arts makes perfect sense from a trauma point of view. I’m pretty sure that the tango in Argentina came out of those miserable sailors who had to risk being killed sailing to round Cape Horn coming together with the prostitutes. Somehow they said we have to make ourselves feel better. They started to dance the tango, and, to my mind, the tango sounds like a perfect way of helping to deal with deregulated bodies because you need to learn to pay attention to yourself and another. I think around the world people have discovered various things most of which does not really involve a lot of talking actually. 

Melaragno: Yet here in the West we have a lot of talk therapy, don’t we?

van der Kolk: We yack and we drink. But talking is important. It is interesting to me because I taught in China, and I sometimes get Chinese students here. Their Qigong is wonderful, but they don’t talk. As long as you don’t talk, you can’t deal with your shame. The power of talking is that you can learn to tell the truth. Talking has a very important function, and it is not always present in all other cultures. Going within and finding words to express yourself is a very important part of healing from trauma. By finding words you can create symbols and connections, and you can communicate with other people who say, “Oh, that’s what it’s like for me also” or “Oh, it’s slightly different for me.” Words open up interpersonal communication. In most other cultures, words are more stylized, more prescribed. So, we [in the West] have definite things to offer.

Melaragno: Continuing that thought, you write in the book, “Trauma devastates the social engagement system and interferes with cooperation, nurturing and the ability to function as a productive member of the clan. People who feel safe in their bodies can begin to translate the memories that previously overwhelmed them into language.” And then you talk about story writing, “Telling the story is important, without stories memory becomes frozen and without memory you can not imagine how things can be different.” What can you suggest to caregivers in the field who are exposed to trauma? How can an aid worker best serve others and how can they care for themselves in the process?

van der Kolk: I think the most important thing in taking care of yourself is to stay in touch with the things and the people that you love. Also, it is important to talk about what you’re going through; what you’re worried about; what you see and what you notice. Be in touch with people and find words for despair and contempt and hatred because that’s the hard part of it. As we like to say, “All parts are welcome.” Fear, dejection, hope, strength, rage—they all have their place. And in serving others, just because a person is despondent does not mean that you have to “fix” them. All you need to do is to help them to access those parts that help them survive, and, as I talk about elaborately in my book, to discover what role their despondency, rage, and self-destructive parts play in their survival.

I oftentimes in a way wonder why people do what I call “trauma tourism.” Having gone to school on the south side of Chicago, which, to my mind, is still one of the worst places on Earth, I don’t really need to travel very far away from home to see an urgent need for trauma care. I just came back from visiting Europe and was in Japan and Australia earlier this year, and it seems like those societies are doing a much better job dealing with the seeds of trauma than we do in the US. And, so, I’m a little suspicious about US people going abroad to spread our gospel. I wish people would stay at home more and look at what’s going on right here. School systems in Japan, Korea, Australia, and Europe are more advanced, and parents are helped to stay home to raise their kids or to find highly subsidized care for them. It’s probably pretty heretical to urge US aid workers to stay home until we clean up south central Los Angeles, Detroit, Baltimore, Chicago, and rural Appalachia. I think maybe it’s best to start off being a change agent in your own community.

Melaragno: When you say “a change agent in your own community,” I think that maybe part of the alienation we experience in our culture is that we can live in a community and not know each other’s stories. You say that story or the ability to speak about our experience is very important, can you tell us a little bit more about that?

van der Kolk: Well, trauma is about not being able to tolerate feeling what you feel and knowing what you know. It’s about not being able to stand what you feel and what you know. We’re much better at seeing what’s wrong with other people, and we’re pretty blind to ourselves. Getting to know ourselves and seeing what we’re hiding from is really the beginning of change. 

Melaragno: So, it’s about knowing our own story.

van der Kolk: Not so much “knowing our own story.” (Although, it’d be great if American kids learned in school that, under Jim Crow, Black people were treated pretty much like ISIS treats its underlings.). The most important issues are to know our reactions, be curious about our own blindness and uptightness, and get to know what triggers us and throws us off balance. 

Melaragno: I had an interesting experience back in October at Kripalu Center for Yoga & Health in a seminar I did with Joan Borysenko. In a writing exercise, she said to take an experience or trauma in our lives and to turn in into a hero’s story with a beginning, middle, and end. She said that some of us might be in the middle of the darkest point of our story—in Dante’s terms, we might still be in the Inferno or the Purgatorio, nowhere near the Paradiso. She then said “[to] make the hero’s ending up because the brain doesn’t know the difference.” I’ve used this exercise a couple of times when I felt like I was in a no-win situation. By completing the story with a positive ending, my stress reduced and my perspective of the situation changed for the better. How do you feel about that—about the fact that the brain doesn’t know the difference? Somehow it’s not lying to oneself; it’s just seeing a possible future.

van der Kolk: Imagination is our greatest asset as human beings, and as long as you can imagine other realities, you are okay. If you are in jail and you can imagine learning to do new things and skills—if you can imagine Shakespeare playing in your mind as you’re locked up—you have alternative realities, and you’re not really a victim of the present. What’s so hard about trauma is that it tends to kill the imagination. In Chapter 18 of the book, I describe the psycho-dramatic structures that I use. People create situations in which others play real parents and ideal parents, and they have the experience of what it would’ve been like if, when they were 3 years old or 8 years old, something else would’ve happened and somebody would’ve been there for them. It is unspeakably profound. It is almost as if this three-dimensional alternative reality may be as powerful as the reality. 

“We live by our imagination.”

We are imaginative creatures. We live by our imagination. There is the imagination of the health aide worker and the imagination for me as a trauma therapist. I see a shriveled-up, unhappy person here, and I imagine what that person will be like after I’m through with them. Imagination is really our loadstone. So, how do you foster imagination? How do you open it up? For some people, writing is good. For other people, movement works. I love theater as a way of opening it up. Some people need neurofeedback to make their brain quiet enough to start imagining new possibilities. As long as they are frantic and locked up in the horror of the present, they cannot move beyond it. The whole issue is: how do you create a mindful brain that can be opened up to imagining new things?

So, for example, in the Structure Instruction I give, somebody is chosen to be the ideal mother. She touches and holds you and says, “If I’d been your ideal mother back then when you were three years old, I would’ve held you like this and protected you. I would not have become drunk. I would not have left you alone, and I would’ve protected you against your dad.” This can be a very powerful experience because it activates the imagination as a way out. There are two critical aspects. First is about how to create a mind that is open to imagining. And second is determining what the optimal methods are to stimulate imagination.

Melaragno: You write, “Trauma remains… the greatest threat to our public health… We seem too embarrassed to mount a massive effort to help children and adults learn to deal with the fear, rage and collapse, the predictable consequences of having been traumatized.” 

van der Kolk: It’s more expensive than cancer or heart disease: lost work, unemployment, drug addiction, hospitalization, chronic illness, family violence, two and a half million people in jail, and all those kids who have parents in jail. It’s a vast public health issue, and all of it interferes with learning and with being productive and engaging. The ideal person is a tax-paying member of society. We pay something so we can build roads, theaters, and hospitals, etc. Many traumatized people grow up to be sick. So, resources are used for drug rehabilitation, chronic illness, unemployment, and prisons. All terrible ways to spend too few resources.

Melaragno: Because most of the people in these situations are there because they have been traumatized. 

van der Kolk: Absolutely, show me a person in jail who has not been traumatized. Eighty percent of prisoners in California have spent time in the foster care system. They were unwanted and did not have a steady caregiver. These are huge things that are continuously pushed off the radar screen. Drug addiction is a function of child abuse. It’s possible to become a drug addict without child abuse, but it’s very hard. 

Melaragno: I would think just that would be enough for the National Institute of Mental Health to fund your neurofeedback research. This is a difficult conversation to end, but it is important to realize how much more there is we can do to support healing from trauma for individuals, communities, and nations. I hope our readers enjoy it as much as I have. Thank you, Dr. van der Kolk.

van der Kolk: Thank you. §