Aug. 24, 2021
Produced by ‘The Ezra Klein Show’
“Trauma is much more than a story about something that happened long ago,” writes Dr. Bessel van der Kolk. “The emotions and physical sensations that were imprinted during the trauma are experienced not as memories but as disruptive physical reactions in the present.”
[You can listen to this episode of “The Ezra Klein Show” on Apple, Spotify, Google or wherever you get your podcasts.]
Van der Kolk, a psychiatrist by training, has been a pioneer in trauma research for decades now and leads the Trauma Research Foundation. His 2014 book, “The Body Keeps the Score,” quickly became a touchstone on the topic. And although the book was first released seven years ago, it now sits at No. 1 on the New York Times best-seller list, a testament to the state of our national psyche.
The core argument of the book is that traumatic experiences — everything from sexual assault and incest to emotional and physical abuse — become embedded in the older, more primal parts of our brain that don’t have access to conscious awareness. And that means two things simultaneously. First, that trauma lodges in the body. We carry a physical imprint of our psychic wounds. The body keeps the score. But — and I found this more revelatory — the mind hides the score. It obscures the memories, or convinces us our victimization was our fault, or covers the event in shame so we don’t discuss it.
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There’s a lot in this conversation. We discuss the lived experience of trauma, the relationship between the mind and the body, the differences between our “experiencing” and “autobiographical” selves, why van der Kolk believes human language is both a “miracle” and a “tyranny,” unconventional treatments for trauma from E.M.D.R. and yoga to psychedelics and theater, how societies can manage collective trauma like 9/11 and Covid-19, the shortcomings of America’s “post-alcoholic” approach to dealing with psychic suffering, how to navigate the often complex relationships with the traumatized people we know and love, and much more.
You can listen to our whole conversation by following “The Ezra Klein Show” on Apple, Spotify, Google or wherever you get your podcasts.
(A full transcript of the episode is available here.)
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THE EZRA KLEIN SHOW
Transcript: Ezra Klein Interviews Bessel van der Kolk
Aug. 24, 2021
Real conversations. Ideas that matter. So many book recommendations.
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Every Tuesday and Friday, Ezra Klein invites you into a conversation about something that matters, like today’s episode with Bessel van der Kolk. Listen wherever you get your podcasts.
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The Ezra Klein Show Poster
This Conversation Will Change How You Think About Trauma
The author of “The Body Keeps the Score” on how trauma transforms the body and the brain.
TRANSCRIPT
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This Conversation Will Change How You Think About Trauma
The author of “The Body Keeps the Score” on how trauma transforms the body and the brain.
[MUSIC PLAYING]
Ezra Klein
I’m Ezra Klein, and this is “The Ezra Klein Show.”
So one of the things I do for the show is I try to keep an eye on the best seller lists. And a few months ago, I began to notice something strange. “The Body Keeps the Score,” which is a book about trauma from 2014, was back up near the top of the New York Times list. It’s number one, as I write this, the book’s 147th week on the paperback nonfiction list — 147th. And if you know what this book is, that is wild.
“The Body Keeps the Score,” it is a searing read about the way trauma disconnects our minds and our bodies. And it’s pretty clearly written with a professional audience in mind. This is a book very largely aimed at other psychiatrists. That so many of us are turning to it, it says something profound about where the national psyche is in this moment of, yeah, trauma.
I’ll be honest of my own history of it here. “The Body Keeps the Score” is one of those books people have told me to read for a long time. But I thought I knew what it was about. I’d heard it discussed so many times, and I’d read it written about. So even though I hadn’t read it, I thought I knew it: trauma lodges in the body, we carry a physical imprint of our psychic wounds, it’s all very hard to heal. Got it.
But I was really wrong about that. The core argument is — I want to use the word “subversive” here. Certainly subversive in how it will leave you thinking about yourself and those around you. It is about traumatic experiences: sexual assault, incest, emotional physical abuse, war and much, much more. They can disconnect our body and our mind. That is when an experience becomes a trauma — when it disconnects us.
And this is a part I didn’t understand from the way the book is talked about. The devastating argument it makes is not that the body keeps the score, it’s that the mind hides the score from us. The mind — it hides and warps these traumatic events and our narratives about them in an effort to protect us. Human beings are social animals. And our minds evolve to manage our social relationships.
So when we face an event that could rupture our relationship with the community or the family, particularly for children of the family that we depend on, the mind often talks us out of it. It obscures the memories or convinces us our victimization was our fault or it covers the event in a shame so thick, we refuse to discuss it. But our body — and that’s an imprecise term here. But the parts of us that are more automatic that manage and respond to threat — our body doesn’t forget that. Our mind can’t talk that part of us into feeling safe again. And it’s this disconnection of mind and body where trauma lives.
So how do you reconnect them? Bessel van der Kolk is the author of “The Body Keeps the Score.” He was a leading researcher and psychiatrist active in many of the early battles to understand post-traumatic stress syndrome. But more recently, he co-founded and leads a trauma research foundation and has been studying ways to try to heal these deeper parts of our psyches, everything from movement therapies like yoga and dance to E.M.D.R. to internal family systems therapy to MDMA treatment. We talk about all of it in here.
But I do want to offer a disclaimer: the research on some of these novel treatments, it is really promising. But these are often new studies with pretty small sample sizes. So I don’t want anyone to mistake this conversation for direct advice from a psychiatrist who knows your situation and psyche. So if anything in here connects for you, talk to a professional about it. Don’t just drop the treatments you’re using or the medications you’re taking and run to something new.
But with that said, there is so much to learn from in this conversation. I really haven’t stopped thinking about it since we recorded. As always, my email, ezrakleinshow@nytimes.com if you want to send me further guest suggestions or recommendations for things we should read or look at. Again, ezrakleinshow@nytimes.com.
Bessel van der Kolk, welcome to the show.
Bessel Van Der Kolk
Hi, good being here.
Ezra Klein
You have this very powerful line in the book from the writer Jessica Stern where she says, quote, “Some people’s lives seem to flow in a narrative. Mine had many stops and starts. That’s what trauma does — it interrupts the plot.” Tell me a bit about how trauma interrupts the plot.
Bessel Van Der Kolk
Well, trauma is really a wound that happens to your psyche, to your mind, to your brain. Suddenly you’re confronted with something that you are faced with horror and helplessness. That nothing prepares you for this and you go like, oh, my God. And so something switches off at that point in your mind and your brain. And the nature of trauma is that you get stuck there. So instead of remembering something unpleasant, you keep reliving something very unpleasant.
So the job of overcoming trauma is to make it into a memory where your whole being knows this happened a long time ago, it’s not happening right now. But the nature of traumatic stress is that you keep reacting emotionally and physiologically as if these events are happening right now.
Ezra Klein
What is trauma? Is it the event itself or is it your reaction and processing, or I guess lack thereof, of the event?
Bessel Van Der Kolk
It really is a reaction that you have something horrible that’s going on. And different people have different responses. Although I must say, having done this work as long as I have, I don’t recall ever seeing somebody in my office coming for traumatic stress that I go, oh, this seems like a trivial issue. Like having your child run over by a car, you go like, oh, my God. And usually my response to hearing about people’s trauma is, oh, my God, are you still here?
Ezra Klein
I’ll say that, for me, was the hardest part of reading your book was just being faced with something I already know, but being faced with how much pain people are simply carrying around with them every day. It’s one way reading the book made me just look at the world a little bit differently. It’s just this reminder that you have no idea what somebody is carrying.
Bessel Van Der Kolk
That is so true. And of course, we do need to wear our blinders, and we cannot face up to all the bad stuff that’s happening in the world. But to give an example to what you’re saying here: when we first put this diagnosis of P.T.S.D. in a textbook, we said, this is an extraordinary event outside of the usual realm of human experience. That is the official definition. Nobody talked about how common incest is, nobody talks about how common child abuse is, how common domestic violence is. And it’s really quite startling when you get to see how much people actually are coping with.
Ezra Klein
At various points in the book, you argue that trauma is the most costly public health problem that we are dealing with. This is before the era of Covid, of course. So let’s keep that to the side. But do you want to talk for a minute about that at scale, what it means that so many people are holding these kinds of experiences and pain?
Bessel Van Der Kolk
Yeah, that statement actually came from the Centers for Disease Control, when Vince Felitti at Kaiser Permanente in San Diego did this research more than 20 years ago right now where he asked medical patients — insurance carrying, largely college educated white people — did anybody ever hit you very badly, did anybody molest you, did you witness your parents having physical fights? And the data that came back were just stunning, how much really very scary stuff the majority of people experienced in their lives.
And what their studies there slowly showed is how erosive and devastating these effects are on people’s capacity to recover also. The big issue is that people tend to think about trauma as, oh that event, and having a bad memory about something. That is not really what it is. Once you get traumatized, it changes your brain, it changes how you see the world, and it changes how your body reacts to your environment.
And so it’s not the only thing that goes from your survival system into your mind. It goes also into your body, and the stress hormones continue to erode your system. When you have been traumatized, your chances to die much earlier and to have many diseases go up very dramatically. So much of what we can think about, major social issues in the world we live in, are actually — the social elements, the contextual elements are terribly important.
Ezra Klein
Tell me a bit about the conditions under which an event that could be traumatic becomes a trauma. And in particular, I was very struck by how much of your research suggests that trauma is an event plus a kind of instigated social crisis. There are objectively catastrophic events, like 9/11, that were less likely to cause trauma because they were shared by the community. Where, on the other hand, things like child sexual abuse is very reliably traumatic because it disconnects you from your family. So could you talk a bit about the social structure of trauma?
Bessel Van Der Kolk
Yeah. So what we tend to leave out of most of our discussions about human functioning is to what degree we are primates. We have brains in order to get along with each other, to be with other people, to connect with other people. That’s really what we are fundamentally all about. And so, much of trauma is about a rupture of the safety of the people who are supposed to protect you and the people who are supposed to come to your help.
So basically, the way that we are wired is that we are wired to not be able to do everything by ourselves, but to be able to look for help and for other people to take over when we can no longer do the job ourselves. And that’s perfectly normal. But if, at that point, the people you can count on most are not there for you, let you down, have been killed, or whatever, then it’s entirely up to you. It’s a much harder thing to deal with terrible situations.
Ezra Klein
I just want to tag something you said there for the audience, because we’re going to come back to quite a bit, which is we have brains in order to get along with other people. I think that’s going to be really, really, really important to this conversation. But this gets to something that I found really rich in the book. So “The Body Keeps the Score” has — I mean, as a book, it’s a phenomenon, as a social meme, it’s a phenomenon. So I felt like I knew what it said even though I hadn’t read it until recently.
But then when I read it, what really struck me about it is how much of the book is about not just how the body keeps the score, but how and why the mind hides the score. Can you tell me a bit about that?
Bessel Van Der Kolk
Yeah, brilliant. We are created to survive. We’re also created to be loyal and to be part of a group. And sometimes, in order to survive, you need to keep your realities [INAUDIBLE] the people around you. And so when you go through a terrible reality like 9/11 in New York or terrible natural disasters, oftentimes people get very close together because it’s out there, everybody can see it, people help each other. Part of our nature is to be altruistic and to be generous when people are in distress.
But if your feelings conflict with your loyalty — let’s say, if your own mom or dad beat you up and you don’t feel safe with them — you cannot tell other people about it either because you’re supposed to love your mom or dad. And so you need to keep it to yourself. And then it starts festering inside of you. So the reason why you do psychotherapy is mainly to help people to find words for the reality that they have dealt with. And oftentimes, those are realities that are not acceptable for the people around you.
Ezra Klein
You talk about the difference between the parts of the brain that create the autobiographical self and the parts of the brain that create the experiencing self. Can you discuss that a bit?
Bessel Van Der Kolk
Yeah. So we have these layers of the brain that have different functions. So the deepest layer has to do with what Antonio Damasio calls “the housekeeping of your body”: being able to breathe, go to the bathroom, go to sleep, have an appetite, being able to engage in caregiving and sexual relationships — very elementary. We have that in common with all other mammals basically.
But then we have this meaning making systems that come on top of that, starting with the larger limbic system that has a more complex way of organizing your perceptions about reality. So basically, your limbic system is the part of your brain that forms a map inside of the world outside of you. And so your brain gets programmed by experience to know what to expect and what sort of reactions people will have to certain behaviors. And so early experiences very much shape your perceptions of the world.
So if you are terrified of the people who take care of you, it’s very likely that you will either, or combination of, really be extremely compliant with people in power and hope that they won’t hurt you, or you become chronically angry and oppositional or a combination of those two. But that imprint of, I’m not safe with people who say they care for me, becomes an imprint of how you come to perceive the world. And those are not rational thoughts, and this cannot be abolished by pointing out to people how irrational they are, because that’s the way our brain becomes hardwired to deal with the reality in which it gets formed.
Ezra Klein
It was astonishing to me, reading some of the stories in the book. I think all of us have the experience of telling a story about ourself that is not true to how we feel. But you treat patients who, the stories their minds have told or the memories their minds have hidden are really shocking. So why do victims of abuse, particularly child abuse, so often either forget what happened to them or blame themselves for it?
Bessel Van Der Kolk
So the issue there is that we need our parents or caregivers to take care of us. And so the moment we give up on our caregivers as little kids, we’re done for. And so the way the child is wired is to stay as close to the people who are supposed to take care of them as possible. And with that, they will deny the reality of being beaten. Or the imprint is very much like, I’m being beaten or I’m being molested because I’m a bad person. I must deserve it.
So your identity becomes basically, I’m fundamentally a bad and flawed human being. And if I had been a nicer child, people would have loved me and taken care of me. If I’d been a worthwhile child, people would not have done these horrible things to themselves. And actually, when you get into treating these issues, the hardest thing to actually treat in people is this deep sense of being defective, something being wrong with you.
And what many of my patients also deal with is that I must have made the story up. This is too horrendous for people to do it, I cannot believe that it’s happened to me, I must feel this way because I’m crazy. And oftentimes, that gets reinforced by the environment, or you’re just a difficult child, you’re just making up false memories. But the fact is what happens over time, the reality slowly starts filling out.
Ezra Klein
This was a real epiphany for me in reading your book, because you read about cases like this. You read about false memories or you hear about or even know people who blame themselves for horrible things done to them — child abuse or rape or a beating or whatever it might be. And you think, what would happen that brains would be defective that they would do that? That doesn’t make any sense.
But the point of your book, I think, in part is that it does make sense. There’s an evolutionary fitness reason for the brain to do that, which is that it’s a story that allows you to maintain within a family, or maintain within a workplace or maintain within a community. Because if you told the real story, it would rupture your family, it would rupture your community, it would rupture your workplace.
Bessel Van Der Kolk
Exactly. These thoughts didn’t come from me, of course, originally. All these thoughts have been thought before. But the great hero here is John Bowlby, attachment researcher, who really showed how children really need to cling to their caregivers and will do anything they can to keep a semblance of connection going so they don’t die or get totally abandoned. And the price they pay for that is very much this very profound sense of self loathing, oftentimes despising yourself, getting into a lot of difficult behaviors because I’m no good anyway. And it’s a deep sense of, I may as well put myself in danger, I may as well take drugs because I’m no good anyway.
Ezra Klein
So then you get into these cases where people are telling a story about something — either telling a story that admits something or telling a story that normalizes something — that their body doesn’t believe. And so you have these kind of two systems, like the kind of cerebral system of what somebody is sitting in front of you saying, and then the fact that they collapse into a ball at the touch of another human being or hide in drugs or have all these other coping behaviors. So can you talk about why the system that is rationalizing isn’t able to convince the body? Because you would think maybe that would be just one system all the way through. You got to live the lie. But part of what you’re getting at is you don’t live the lie, you just tell the lie.
Bessel Van Der Kolk
Yeah, you live the lie. You really believe that I’m fundamentally defective and that’s why this happens to me. So people really very deeply come to rationalize their very bad feelings. And that actually allows them to continue to survive to some degree. And that’s a different part of the brain.
But of course, your core survival part of the brain picks up the danger signs and keeps continuing to secrete stress hormones, immunological abnormalities, muscle tension, fibromyalgia — a whole bunch of physiological systems where the body continues to behave as if it’s in great danger while the mind says, don’t pay attention to him, he’s lying, he’s a terrible person. So it’s really the conflict between the body feeling very unsafe and the mind not wanting to accept the reality of what has happened to you is at the core of this, yeah.
Ezra Klein
This is a strange idea to wrap your mind around. How is it possible that your body — which on some level is controlled by your mind. I mean, it’s getting electrical signals from the brain. How is it possible that you can have such disagreements within one system?
Bessel Van Der Kolk
Well, because they are somewhat different systems. The system that helps you to sleep, for example, is a system that most of us have very little control over. And so you may rationally know that it’s important to go to sleep now and life is safe and I have nothing to worry about. But something in the back of your brain, your survival brain, seems to give you messages of, I’m in danger.
Very commonly, when people have had sexual molestation or issues like that early in their lives, they are with somebody, they have a sense of desire, and suddenly their body shuts down. And they become very angry or very frozen. And they say to themselves, there’s something deeply wrong with me because I really like this person that I’m with and I’d really like to have a good time. But my body won’t let me because the primitive survival part of the brain is still stuck back then, when they felt in danger. But the frontal lobe may not register that.
Ezra Klein
One of the main ways you say the mind hides the score is through applying shame. You write at one point that for trauma survivors, quote, “Shame becomes the dominant emotion and hiding truth a central preoccupation.” Can you talk a bit about what shame is, what it is as an emotion, and then the role it plays for people after trauma?
Bessel Van Der Kolk
Yeah, shame is really a feeling of wanting to hide how you don’t want anybody to see you. Shame comes from having feelings that are fundamentally unacceptable. Like if you’re talking very nicely to me, and I may have a feeling that I’d like to kill this guy, and you think to yourself, what a terrible person am I to want to kill somebody who’s very nice to me. And then you say, I must be crazy, there’s something wrong with me.
As it happens to be, maybe you have a particular accent or a way of talking that may remind me on a very deep level of somebody who beat me up when I was a kid, and I have this intense emotional reaction to you, and I feel like, what’s wrong with you, Bessel, that you have such a terrible reaction to this nice person, and he probably already has picked up that I’m trying to hide something from him because I feel so angry with this person who’s actually being very nice to me. So that’s the confusion and the shame that traumatized people live with.
Ezra Klein
One thing that struck me about that passage is — and I apologize because I can’t remember where I read this distinction. But I once read that guilt is an individual emotion and shame is a social emotion. Guilt is, I feel bad about something I did, and shame is that I am afraid the community will look bad upon me for something I did. And within this context of trauma often relating to things that happened that would create rupture of the community, it seems interesting and also profoundly sad that shame is such a constant companion to that, because it’s a way of fearing that your community will turn on you potentially if the truth were to be known.
Bessel Van Der Kolk
Well, we are communal creatures, and we survive terrible things by community. So the people who are able to get themselves together as, for example, New York did after 9/11 — New York had a spectacularly effective way of dealing with the trauma of 9/11. And once you have the community to go with you, you’re not ashamed of yourself anymore because your neighbor may have the same feelings of terror and fear that you have, and you don’t feel crazy, and you don’t feel like you’re worthy of exclusion.
So one of the things that is driving this whole trauma issue is that you feel cut off from your community, you do things that embarrass you, you blow up at people. Your kids want to play with you, and you get angry with the kid, and you feel bad about being angry with the kid, and you start yelling at this child, and you go like, oh, my god, what’s wrong with me that I’m yelling with the child. And you start trying to control yourself with alcohol or with drugs. And so you have these reactions that you hope people will not see. And the longer they last, the more isolated you became.
So one of the things that I’ve seen, much to my distress, is that when we started this field in our particular window of history, it was a very communal issue. It was women got together around “Our Bodies, Ourselves.” My friend Judy Herman was running incest groups. I was running groups for veterans. And they got a lot of comfort and support from each other, and they shared their very scary thoughts and their angry thoughts. They said, oh, I feel the same way. I’ve had the same experiences. I also made people very angry who I feel close to, et cetera, et cetera.
So people to be with, as the 12 step programs so brilliantly have done, give you a sense of not being alone despite the fact that you feel very damaged and ashamed about yourself.
Ezra Klein
I want to put a pin in New York in 9/11 because I want to come back to that and the question of whether or not there are things we can learn as a society, whenever it will be the case that we can begin to recover as a society from Covid and whether or not there are things we can learn in that experience for how to do it well. But I want to ask about another way that we end up hiding what we feel, which is that trauma has a way of numbing people to their feelings, to their emotions, even to very basic physical sensations. And something you talk about, which I didn’t realize, is that when that happens, it becomes hard to construct a coherent sense of a self. Can you talk about how that works?
Bessel Van Der Kolk
Yeah. When you are involved in your trauma and you are continuously reacting to stuff, you can’t trust yourself. And you don’t really know what’s right because you keep sort of getting into trouble again, you try something and you freeze, and you try something and you explode. And you do something and you feel terrible about yourself. And you don’t know where that comes from. And so you try to make sense out of this turmoil that’s going on in your sensory system. And if you’re lucky, you are talented and you’re a good basketball player, a good guitar player, a good accountant, and you can hide yourself in your particular talent where you can find a safe area for yourself. But when it comes to the complexity of dealing with teenage children or relationships, that may be too much for you and you keep falling apart. And so your identity becomes like, I cannot be with other people, I’m no good. And so that sense of trust in yourself, predicting yourself, knowing who you are, knowing how you react to things becomes very damaged.
[MUSIC PLAYING]
Ezra Klein
You have an interestingly complicated relationship to language in the book. You talk about it as both a miracle and a tyranny, and the ability to both put words to things you’ve experienced and also put words to things maybe we haven’t or ways we don’t feel about how we’ve experienced them. And so I wanted to ask it this way, because a lot of us have had experience with therapy have primarily had experience with talk therapy, where you go and you sit in a room and you get asked questions about your parents and you try to answer them. What can that do, and then what can language not do in these cases?
Bessel Van Der Kolk
Language, it’s really great when you have kids as you do or grandchildren as I do, how you can see kids develop language over time and you can see how as they develop language, they’re able to communicate about what they like, what they don’t like, and to form common realities with other people. As long as you don’t have language, you really don’t know how to form a sense of community.
So having a language that allows you to define your common reality is terribly important. And of course, traditionally, psychotherapy is very much about developing that language for yourself, which is very important. But understanding why you screwed up doesn’t necessarily stop you from being screwed up. Now I know why I freeze when somebody touches me. Now I know why I get so angry. But the anger and the freeze may still happen.
So you still need to rewire the physiological system. And much of my research has been, how do you get there. And the earlier studies we did was doing yoga. And somehow, yoga helps people develop a more harmonious sense of the internal workings and the internal body sensations. Moving together, dancing together with other people, getting a sense of rhythm, which many people around the world except in the Western world use — drumming together, singing together, making music — helps to reestablish that sense of community and being in sync with the people around you. Later on, sending neurofeedback, playing computer brain interfaces where you can actually play computer games with your own brainwaves and help your brainwaves to become more rational.
And our current research is very much also in psychedelic agents, which turn out to have a very dramatically positive effect on exactly the courses of defectiveness, self-loathing, internal confusion. And our latest data really show that MDMA particularly can really help people to get a much deeper sense of who they are and a deep sense of compassion for themselves.
Ezra Klein
We’re going to go through a bunch of these therapies. But one thing I want to ask about them as a group is that one thing lurking around your book, and certainly that I felt reading it and that I felt in my own life as I’ve looked at various modalities for things that I’ve struggled with, is that there’s a hierarchy of status to different treatments. So it’s very accepted at this point, very rational, to take a pill for depression or anxiety. Talk therapy has a very long history. Nobody looks askance at that. That’s something intellectuals do in New York, and they sit in a chair and talk about feelings. And I don’t want to say anything bad about either of those. But then you start looking some of these other things, like E.M.D.R. which we can talk about, or dance therapy or yoga. And it feels soft. You’re like, well, that’s silly, that’s holistic, that’s — and something I think the book is trying to get at is that maybe we have come to overweight certain kinds of approaches to how we feel and underweight others. So before we get into how these therapies work, can you talk about that meta level of coming to respect therapies that maybe don’t have a lot of social status right now?
Bessel Van Der Kolk
Very important point you make. It’s a cultural issue. You hear from my accent, I’m northern European, and North America is still very northern European. The world and northern Europe developed two ways of dealing with bad stuff. One of them was to drink. And so taking a pill is a respectable thing in Western culture to do, and normal people ingest stuff to make themselves feel better.
Nobody feels bad about it. Other places in the world may say, that’s weird. Then the other thing that Western people are very good at is talking. We’re not very good in singing together and moving together. You go to China after a disaster and people are doing qigong together, and so that’s interesting, or tai chi.
And you go to Brazil in [INAUDIBLE] area, and you see people practice capoeira. You go, are they practicing capoeria because it looks good to the tourists, or are they practicing capoeira because it does something to the way they relate to their bodies and their sense of self-control?
So I think to some degree, we are trapped in this post- alcoholic paradigm that the only way to change is through taking pills or by talking. But of course, once you raise kids and you hang around with kindergarten teachers, they don’t do a lot of talking. They’d also do a lot of singing together, and a lot of moving together, and a lot of tossing balls together. And a lot of things that help you get in tune and in rhythm with each other.
And that’s not really the strong point of Western culture. So it all depends on the cultural assumptions you have about what’s helpful to people.
Ezra Klein
This part of the book made an interesting connection for me. I had the journalist Anna Sale on the show a couple of months ago for her book about having difficult conversations, and something she says in that book is that we used to have more institutions, and rituals, and conventions, and structures that guided us through the hard conversations, and hard parts of life.
I mean, things like churches and civic organizations. There is a lot of singing in those places, there is a lot of dancing in those places. I mean, you go to a Jewish synagogue, a lot of singing and dancing. And one point she was making is that as some of these institutions have faded in American life, we’ve been left without a template for these conversations.
But reading your book made me think of it on another level, too. I mean, a bunch of the modalities you just talked about, like capoeira or qigong, I don’t want to suggest they don’t have therapeutic roles, but they’re not primarily seen as therapeutic. They’re just a bigger part of those cultures.
And I wonder if you think that one of the issues with trauma in America is that we have lost institutions that were comfortable with ways of being embodied, even if they didn’t frame them in a “the body keeps the score” kind of framework that we used to have. And so they were playing roles that maybe they framed themselves as religious, or civic, or something else, or communal or ritual, but they were also doing things for how we process difficult issues or allowed us to get in touch with our emotions, that they had these side benefits that we didn’t understand and never knew how to measure.
Bessel Van Der Kolk
That’s, of course, a terribly important point. But at the same time, institutions are dangerous. And sometimes you have to pay a price to keep belonging to the institution. So you may have to keep silent about an elder or a respected person doing bad things to women or to children, or to each other. So yes, there’s comfort in institutions, and yes, there is danger in institutions.
What I’m also impressed by is, in the circle that I live in, which I imagine is fairly rarefied, I see a lot of people exploring things. I see people going on meditation retreats, and singing retreats, and movement stuff, and making music together. So if you’re somewhat privileged in our culture, people oftentimes find ways of reestablishing their sense of connection, their communality.
And again, the issue of privilege and equality is a huge issue. Particularly right now with the pandemic, some people have much better opportunities and have a much easier culture that they fit in that other people do.
Ezra Klein
That point about the dark side of institutions is very important, and very well taken. But let’s talk about some of the things that you explore in the book and that people are exploring. And why don’t we start with one that folks may have heard of, but even if they have, even when I had, it’s very alien, which is E.M.D.R. Can you talk a bit about what E.M.D.R. is?
Bessel Van Der Kolk
EMDR is a very simple and weird technique. It is that you ask people to call up the images in their mind about horrible things that have happened to them, and to remember what they felt like in their bodies, to remember what they saw, what they heard, but you don’t talk about it. Because the moment you start talking to people, you change your story according to what you think that person wants to hear.
Talking always becomes the interpersonal process, and talking makes you adjust your reality to what people are able to listen to. So in E.M.D.R., you keep it to yourself, you see these things, and then you ask people to move their eyes from side to side in response to your fingers.
The first time I heard about it, it sounded like crazy. And my patients started to come back saying, I resolved things, I was able to just leave the memory behind. I did the first National Institute of Mental Health- funded research on E.M.D.R. Our adult onset P.T.S.D. people had like, a 78 percent cure rate. So clearly it had major positive effects.
And so that was my introduction, which I’m very grateful for, of seeing something that’s just on the surface bizarre, but has a very profound effect, that gets us out of this post-alcoholic paradigm of talking or drugs. I said look, this is interesting, this is weird. And so I got very interested in how does it work.
And so two years ago we finally did a study where we looked at what these eye movements cause. And what we saw, it changes the connectivity between different parts of the brain. And so what we saw is that it affected neural networks. And that for me was just so cool, because this really opens up the frontier of where our treatments need to go, is how do we repair these networks where the different parts of the brain are disconnected from each other.
But the result is that when people have this inkling of trauma, they feel it as if it’s still happening now. And what we saw in our neuroimaging study of E.M.D.R. is that the circuits of the brain change, so it allows the mind to go, oh yeah, this has happened to me, but it happened back then, a long time ago. It’s not happening right now. So the E.M.D.R. was my opening that there’s ways of switching neural circuits so your perspective on the issue becomes very different.
Ezra Klein
Why would moving your eyes back and forth open that pathway?
Bessel Van Der Kolk
That’s the question we don’t know, except you go back to what Darwin wrote about and Pavlov wrote about it, about conditioned responses of the brain, start to react with how you move your eyes in a certain direction when there’s danger. And there’s maybe some evolutionary circuits involved with moving your eyes in the direction of threat. We don’t know, because research funding would not really allow people to go into asking these questions at this point. I wish we would.
Ezra Klein
And one of the other things that was interesting ... I’ve not done E.M.D.R. myself, but in people I’ve known who have had a very positive reaction to it, and then in the stories you tell in your book, one of the things about it is that you don’t just tell the story of what happened to you. Oftentimes you begin to alter it.
There’s an imaginative capacity. You’re telling what happened as trauma, and then also people begin rewriting the story, saying things that didn’t happen, and that there’s some healing that seems to happen here and in some of the other modalities that we’ll talk about, from, in an open environment, imagining the way things didn’t play out.
And on some level that’s very strange to me, right? That you can heal yourself not by just understanding what happened, but talking through what didn’t happen. But it seems to be recurrent in these therapies. So can you talk a bit about the role of imagination in healing, and counterfactuals?
Bessel Van Der Kolk
I was hoping for questions like this, this is great. So the way we deal with unpleasant situations is by imagining how we can do things differently. And that’s really the glory about the brain. It’s like, oh, if you get fires in California, but I can imagine what we can do to prevent the forest fires, to anticipate how you can make a difference.
Trauma destroys that capacity to imagine how things can be different because you get trapped in that traumatic moment. So you cannot imagine anymore that things can be different. So a very big issue in helping people to overcome trauma is to experience the possibility of alternative outcomes.
In my own work, I love to use psychodrama for that. We are involved in theater programs where people actually get to play different roles and see what it feels like in our body to take a new position, to imagine being Lady Macbeth. And so to be able to embody the experience of a powerful queen, you go like, oh, that’s what a body feels like that feels powerful. So a very important part, in my mind, of therapy is to help people to embody new realities.
Ezra Klein
There’s a fascinating study you bring up, which relates I think to this very, very famous study where they are still following, actually, but this one class of men from Harvard from decades, and decades, and decades ago. But something the study found is that in the people who were traumatized by their experience in war, their memories never really changed.
They told the same story 40 years later that they told right after it happened. Whereas the people who weren’t traumatized by it, their memories kept changing. The imagination was telling and retelling the story, right? The cliché of the old war stories that never quite happened, or the fishing stories where the fish keeps getting bigger. So if you could you talk a bit about that? About the way weirdly, a healthy memory is actually a less accurate memory? Because what you need in life is not accurate memories but a story that works for you in the world.
Bessel Van Der Kolk
Exactly. My friend who ran the sleep laboratory at Harvard, Bob Stickgold, showed very clearly that, with your dreams, your dreams allow you to retain what’s most relevant and to ignore what’s irrelevant, and you slowly change your story about what happens in order to prepare yourself for the future. It’s a very complex mental phenomenon, and our memories are extremely flexible.
For example, I go to family reunions with my siblings, and we all tell stories about growing up. And we look at each other and say, you grew up in a different family for me! Have we all created a different story about our past? And that suits us. That’s the story we like to live with.
But the reality may be very different. What we first found out about trauma is that the problem with trauma is you cannot change the story. And the story is the same damn imprint, the same vision, the same body sensation as you had 10, 20, 30 years ago. And so what we need to do when we treat people is to get the normal processes of the brain to work so you can create a new story for yourself, and not get stuck on the specific sensations of back then.
Ezra Klein
Speaking of family reunions, can you talk about internal family systems therapy? I had never come along this until the book, but it’s fascinating.
Bessel Van Der Kolk
Oh well, internal family systems is not about families. It’s about how we all have families living inside of ourselves. It’s a very important evolution, the past 30 years or so. Jung already talked about the same thing, William James talked about the same thing: that we have a multiplicity of minds. Walt Whitman wrote a poem about it, said that “I contain multitudes.”
You strike me as a very loving, and kind, and intelligent, and attuned person.
Ezra Klein
Oh, thank you.
Bessel Van Der Kolk
I hope that’s all there is to you. But only the people know you best know that there is other parts of you that people don’t get to see, and there may be part of us that we may not be aware of sometimes. So that we have different ways of reacting, or engaging, that can be quite different regarding the circumstances.
And what I.F.S. particularly showed us is that when terrible things happen to you, you create ways of being in the world, personalities, that help you to cope. For example, if you get chronically humiliated, you may say to yourself, “Nobody is going to ever humiliate me anymore,” and you become this staff bully who put people down before they can put you down.
You may go home and be a very sweet and gentle person to your kid, but when you deal with a guy in the office, you may become a bully. That doesn’t mean that all of you is a bully. That means that a part of you is a bully that comes out under certain circumstances. So we never know other people until we live with them for a long period of time, because there may be very hidden parts of themselves that we may have developed back then in order to cope with particular challenges that we face growing up.
Ezra Klein
So my understanding of how I.F.S. works in practice is it identifies these almost little personalities in the brain. There are managers, who try to protect you from feeling unsafe, and the firefighters, who respond to moments of crisis, the exiles, who you’re trying to avoid, and that helps people identify these distinct parts of their personalities, and how those parts come out and contribute to different reactions.
And that seems like something that would be helpful even outside the context of therapy. In addition to all the wonderful qualities of mine you listed a minute ago, I do a lot of meditation. And one of the things that years of that is done has make me much more skeptical that there is just one of me in here. When you’re sitting there just watching your mind, the constant question is, well who thought that? Who thought thinking that would be a good idea? I didn’t want to be there.
And the mind has felt to me for a long time like it’s more of a corporation. You know, it has different divisions, and some of them have big budgets, and some small. But family systems seems to get at that too. That one thing that actually causes people frustration and shame is they are told they’re in control or should be in control of their minds.
And then it’s very frustrating, for me as somebody who has struggled a lot with anxiety and obsessive rumination, it’s very frustrating to not be able to control my own mind. Because that feels like I’m failing. And the idea that it’s actually not something I should be able to do, that it’s not just one singular mind, but a lot of different minds or something vying to be heard, there’s some relief in that. And it seems to me some real accuracy in it.
Bessel Van Der Kolk
It’s very helpful in relationships. That you can only survive a relationship if you can really understand how your partner gets very uptight, or angry, or shut off, or something, in response to certain things. And if you start understanding that it is different part. And let’s say if your wife, this probably never happens to you, but perhaps to many other people, someday may say to you, “I hate you!”
And for you to know, oh, she’s now triggered and there was something I did that caused that angry part of her to come out. I know that that angry part is not the most reasonable part of her, so this is not a time for me to start arguing with her that I’m not the most selfish person in the whole world, but you know that that part is out, and you try to help her to know that this too shall pass. And I can see that I do things that really bother you, and I’ll try to work on that.
And she can say, I can try to negotiate with a very angry, frustrated part. A little therapy might help in helping me to know where it came from, so that I don’t get so out of control angry with you when you don’t do the dishes.
Ezra Klein
The single best piece of advice I ever got on marriage is that there is no use in thinking of your partner as a single stable entity that exists separate from you. There’s only your partner in a dynamic with you. There’s only who you also bring out in your partner, that they’ll be somebody totally different with other people. But so the question always, if things are going right or wrong, is, like, which parts of the two of you are being brought out in relationship? Not just, who is this person and do I like them?
Bessel Van Der Kolk
See, and Dick Schwartz extended what you just said in your relationship to yourself. And to really understand that you may have very different reactions at different times, and to really get to appreciate that certain things make me very upset, and to really start making decisions about do I want to give in to that, or do I want to do something about it? Or how to really start getting a perspective on this landscape, and make a discovery inside of yourself.
Ezra Klein
An intervention you discuss glancingly in the book, but it sounds from something you said earlier like you’ve been doing more work on, is psychedelic therapy. It’s been a lot more research since you did the book, it sounds like you’re actually behind some of it. So given what we know now, I’m curious how you understand the role of psychedelics potentially in helping people deal with trauma?
Bessel Van Der Kolk
I think psychedelics are a true revolution. And it’s partially a revolution because we don’t know how they work. There’s all these explanations: oh, the serotonin system or the default mode network. But what has happened in the world we live in is that people pay varied attention to what happens in the mind.
And what we see in our MDMA research is that MDMA seems to really trigger a capacity to look at yourself in a more compassionate way, in the same way that MDMA is being used at parties. And when we do our work, very painful, painful, old things tend to come up. But people are able to go there and not get overwhelmed by shame, or overwhelmed by the horror.
And they’re able to go there and say, yeah, this is what happened to me. Oh my God, that was awful. And actually, I’m working on that paper right now, which I think is a very big deal, actually, is what you see is a dramatic increase in self compassion. People say, I now can really see what I went through, and how awful it was, and how I have survived it.
And what’s fascinating to me is that it gives people a sense of perspective, of who they are, and their sense of self gets very much enhanced. This is who I am, this is what I went through, and this is what I’ve learned from experience. It’s really very dramatic, and I think it’s the sort of thing that may happen with very long term psychotherapy, but I think very profound things can happen in a very short period of time.
Ezra Klein
I’m very fascinated by the space, both for personal and professional reasons. And something I was thinking about, in the context of some of the other treatments you bring up, is the why. And I’m thinking here less about MDMA, which as you say has a profound self compassion effect, and more about things like mushrooms and LSD.
But something that came to mind, so Robin Carhart-Harris, who is at UCSF now and is one of the leading researchers on psychedelics, he’s put forward this model which argues that the mechanism by which psychedelics work is that they sort of relax our mind’s confidence in its own internal models, and pattern matching, and stories, which then allows us to kind of experience some of these deeper emotions we have and begin assigning meaning and stories to them, too.
Which sounds actually a lot like E.M.D.R., sounds a lot like, in a way, what internal family systems work is doing. That ability to begin sensing something else and then trying to tell a story about it that your brain will actually believe, and begin to give weight to. And I wonder if you think there’s something to that, that it’s a relaxing of the model that is helpful here?
Bessel Van Der Kolk
Well, certainly Carhart-Harris has done more work on it than any of the rest of us. And I think his formulation approximates what we see here. I think the big thing in terms of trauma, is that when you’re traumatized you live in a very narrow world. A world of fear, and trying to stay under control, and being afraid to get out of control, or being afraid to get overwhelmed.
So your world becomes more and more constrained. Pierre Janet already wrote it about 150 years ago. How you get narrow minded, and what Janet said back then also, he says, when you get traumatized, the mind has a hard time continuing to grow. The mind gets stuck in its effort to try to control itself, it becomes very hard to open your mind up to new things.
So when you’re traumatized, you oftentimes tend to have the same patterns over and over again. You have a hard time learning from experience. Your mind closes down. I think what psilocybin, ayahuasca, LSD do is they open up a new universe inside of yourself that somehow you need to cope with.
The way you phrased it is a little bit too deliberately cognitive for my mind. The mind does something to become aware — but even aware is too conscious — of that I’m a much smaller piece in the much larger universe, and a universal experience through these substances, which Carhart-Harris and Pollan and those people who also write about, is how you get to see your relative position in the universe.
At the same time as you experience yourself as quite unique and special, you also get to see the rest of the universe as also being unique and special. And universally, regardless of the culture, you always end up with a feeling of, I’m a part of a much larger universe. But I’m an essential part of that part of the universe.
Which is, of course, the opposite of being traumatized. When you’re traumatized, you go, I’m messed up, nobody else is, everybody’s having a life and I don’t, and you feel alienated. And that sense of what all these mind altering substances do, of opening yourself up, being a part of a larger whole, is very significant also.
Ezra Klein
So MDMA combined with therapy is now in phase III trials in the F.D.A. for treating post-traumatic stress disorder. You have psilocybin at other levels of the regulatory process. There’s very much a vogue for all this. Do you worry that it has risks we’re not paying attention to?
Bessel Van Der Kolk
I think societies have had a very difficult time legalizing and dealing with the outflow of these massive mind-expanding agents. And I’m very curious to what degree we’re able to stay reasonable about it, to be careful about it, to not have it get out of control. And I’m really delighted with Rick Doblin, who runs the Multidisciplinary Association for Psychedelic Studies, M.A.P.S., which forms part of his studies. He is working very hard to keep it very careful. But I’m very worried that things will get out of control, yeah.
Ezra Klein
You were very much part of the rise of just pharmaceuticals to treat mental illness. You did one of the early studies on Prozac. And in the book, you have a very complicated relationship with these drugs, which you prescribe and believe they can help people. But you also worry that we overuse them, that we use drugs to ignore signals, or numb signals the body is sending, so that it becomes easier to not do things. How do you think about that space now?
Bessel Van Der Kolk
So I was a very young person. So I worked in the hospital and did a lot of the early studies and did some myself, and there was an enormous promise that chemicals were the answers. And people said, mental illness is a chemical illness, and if we just find the right chemical, we’ll cure it.
And billions of dollars on the chemical studies really haven’t yielded all that much in terms of understanding or treating mental illness. But the sad thing is that psychiatry as a profession became addicted to drugs. And so the notion that oh, if you just find the right symptom, you’ll find the right drug, still prevails among many professionals.
There are chemicals that can be somewhat helpful. They can help you to sleep better, to be less uptight. But they’re chemicals that really interfere with your natural capacity to deal with these things. And for me, very quickly after I did these early studies with not bad results, they certainly did not promise total happiness, really started to concentrate on what inborn mechanisms we have to deal with our own anxiety, and with our depression.
And so I really discovered the world of the body and tantric traditions, the yoga traditions and breathing traditions, and musical traditions that show that we actually are capable of rearranging our own internal physiological systems. And I wish that in every classroom in America they would teach the four Rs: reading, writing, arithmetic and self regulation, from kindergarten through 12th grade, of what can we do to calm ourselves down, to stay focused? What sort of activities can we engage in to feel in control of ourselves?
And so that we get away from this culture of, if you don’t feel right you take a drug, instead of if you don’t feel right you go for a bicycle ride. If you don’t feel right you go to yoga class. If you don’t feel right, you may need to do some body work to help your body to calm, or you need to go to do some tango dancing, or you need to do something to rearrange your relationship to your internal physiological state.
Ezra Klein
Where do you think psychiatry and mental health as a profession is in its evolution? And I mean it in this way, that it all feels very scientific. And there’s a lot of studies and you can read journals. And at the same time, including when reading your book, it’s remarkable how crude the tools we have are. I mean, we have medications that do things that we don’t really understand, but seem to have some help for some people.
We have things like E.M.D.R., which do things we don’t understand, but help some people, or theater therapy, or yoga. We know exercise is good. We don’t always exactly know why. Now we’re exploring psychedelics, which have profound effects and seem to, with the right level of integration, help with trauma. We’re very like, kind of throwing stuff against the wall and finding some things unexpectedly work in ways we don’t fully understand.
So do you think that there are just limits to what we can access in the kind of deep psyche? Or do you think that 100 years from now, or 50 years from now, our treatments today are just going to seem incredibly crude, like we just had not discovered germ theory or something?
Bessel Van Der Kolk
All of the above, and none, to some degree. I don’t think we are throwing everything against the wall. We’re doing actually the opposite. We’re looking for yet another drug doing the same old stuff that we have done. We are looking at yet another talk therapy that will make people into sensible human beings.
We have, as a discipline, completely ignored our early data, when we first started to image trauma in the brain, that trauma sits on the right side of the brain. And so these right brain phenomena are lasting phenomena. And so the time has come to really start looking at what else can we do, because basically the funding has been very much focused on talking therapies and drug therapies.
So no, we haven’t thrown things against the wall. I’m still waiting for the study of comparing tango dancing with cognitive behavioral therapy. I’m a scientist, it’s an empirical question. But I put my money on tango dancing over C.B.T., by and large, for some people. So I think we need to explore much more.
Is the world open for it? Yes and no. For example, I was able to start a foundation, and rather than become a recipient of funding, I’m able to fund some studies. Now the very first study we are funding is a study of touch and trauma. Everybody who knows anything about trauma, is that some of these people have very varied and oftentimes very anomalous responses to human touch.
People have won Nobel prizes about vision, Nobel prizes about audition. Touch is basically off the wall. The main way that people get comfort in life is through being touched. Once you have been touched inappropriately, touch maybe can defeat this. Let’s study touch.
We are synchronous human beings. The source of pleasure in our lives is to be in sync with each other. The reason why I like talking with you is because, whenever you ask a question, I go, “Boy this guy really gets it.” I feel you’re in sync with me, which gives me a tremendous sense of pleasure. So being in sync with people is critical for our sense of fun, of feeling alive. So how can we increase people’s sense of synchronicity with other human beings?
So I don’t know how it will work itself out, because in the world we live in, everything gets monetized. And so we tend to be able to study very expensive technical treatments more than simple treatments. And so where things will go, God knows. But boy, are we missing the boat on exploring a much larger number of options. Yes, up to now we have.
Ezra Klein
On the point of touch, that there are a couple lines in your book that have really etched themselves in me. And one in particular here where you say that “the things that calm adults are the same things that calm children. Being held, being rocked, and being shushed.” And I don’t know. I just found that very moving.
Bessel Van Der Kolk
It’s true! You see it through to have your own kid go — yeah, he’s very young. But I need to do the same thing for him as I need myself.
Ezra Klein
But at some point, we make it very difficult for adults to ask for those things. You can maybe ask your partner, and that’s it. Particularly, I’ll speak more for men here, because I understand male relationships a little bit better, but you really, as a man, you can’t go to your male friends and ask to be rocked and shushed. [LAUGHTER]
Bessel Van Der Kolk
Yeah, a little bit, the culture has something to do with it.
Ezra Klein
Yeah, and it just strikes me as a shame. To the point you were just making, we spend so many billions of dollars, and so much effort to get the medications we think will help, and to see psychiatrists. And we’ve also cut ourselves off from a lot of just very cheap things, right? We have culturally cut ourselves off from a lot of touch, right? We often live in very atomized ways.
I mean there’s very kind of cheap, natural things that are part of our deep history that we give to our children, or at least in many homes, that, I don’t know, we’ve just decided are a little somehow uncouth, and we suffer for it.
Bessel Van Der Kolk
A very big part of what you’re talking about is our socially stratified system, and our humongous income inequality. I sent my kids to schools where there was a lot of theater, music, dancing, creative writing, sports. They were always moving and creating things. The poorer you are, the less you get any of these things.
Ezra Klein
We’re going to come back, we’re definitely going to come back at the end to the bigger question of inequality. But before we do that, I want to reverse the way we’ve been looking at this. We’ve been talking about the way traumatized people are disconnected from their communities. And I want to talk a little bit about what it means to be in community with somebody who is traumatized.
A lot of the patients you talk about in the book, a lot of the behaviors that traumatized people exhibit, they’re very alienating to those around them. They’re difficult, they can be dangerous. Can you just talk a bit about what trauma is like for those who love someone who is traumatized?
Bessel Van Der Kolk
It is very hard to be with someone who is traumatized, who suddenly shuts down, suddenly blows up. And it takes an enormous toll on relationships. And oftentimes partners get blamed for the other party’s behavior. And so it really finds its way into relationships.
And so, groups of survivors become very important. Groups of incest survivors, groups of people who were molested by Catholic priests, people who struggle with addiction, helping each other say, I know what you’re talking about. I’m not here primarily to condemn you, but to keep you company in your struggle. For a survivor, it’s terribly important.
In a couple’s relationship, that’s harder, because you have a job to do, raising kids, et cetera, et cetera. But these support groups can be very good to give people a sense of being a member of the human race. And once you stop feeling like a member of the human race, your chances for wanting to survive become very slim.
Ezra Klein
How do you advise people to deal with the very difficult question of what you can ask of someone they love? I mean, the tension between recognizing the reality that people’s actions are often largely out of their control. They don’t want to treat us badly, they don’t want to disconnect, they don’t want to pull back, and also that we don’t want to be mistreated, or taken advantage of, or hurt.
And that there is something you can ask of some people, right? Sometimes you can ask somebody to treat you better. And then sometimes you need to recognize that there is healing that has to happen before they’re going to be able to do that. But it’s often hard to know which situation is which. Do you have advice for people who feel like they’re in that situation?
Bessel Van Der Kolk
Yeah. I think that’s really — to a large degree that’s what relationships are all about. It’s the continuous negotiation of, what can we be for each other? A relationship is about being there for each other. So my job, if you and I are in a relationship, is indeed to try to create situations in which you can feel safe and be productive.
But your demands may be too much for me. And I need to be able to say, honey, I cannot do it. I really need to sleep in a bedroom by myself if you wake up screaming in nightmares all night, and it must be very hard for you if I cannot sleep in the same bed with you. But we both have needs. And these are very hard to negotiate. And I think you need to have a lot of consciousness, and a lot of awareness to actually be able to sit down and to identify these issues, and to talk about these issues.
But that is the nature of relationships. What can I do, what can I not do, what are the expectations, to what degree can I fulfill these obligations, and to what degree do you need to get the resources for yourself from somebody else? Because I’m depleted, I cannot give you what you’re asking for.
Ezra Klein
So I want to go back then to this question of the broader society that you were talking about a minute ago, with schools and inequality. On one level, it’s clear I think that providing child care, and pre-K, and well funded schools, and universal health care, and better access to mental health services would help make a society that is better at helping people.
But on some level, that also can’t be the whole answer, because a lot of middle and upper class people’s lives are full of trauma, too. So I’m curious what you think are the structures and institutions, or even just social mores, that would help us become healthier, and help people either be traumatized less often or help them more once they are?
Bessel Van Der Kolk
It’s of course, very complex, and nobody has the answers. But creating situations where parents can safely take care of their kids is terribly important. And of course, that is much easier when you have money than if you don’t have money. So almost every other society has universal health care and has support, which we lack.
So for me, this is really a very big issue. Yes, it’s because of the system we live in, the majority of people I treat are people who come from relatively fortunate circumstances. Because if you come from very low education and you don’t have a high school diploma, there’s no way you will find a way of getting to see an experienced mental health professional.
Ezra Klein
What interventions for kids do you think would do the most good? I mean, if you could wave your wand and put some new structures into law that they have elsewhere, or that they don’t have elsewhere, what would the first couple of them be?
Bessel Van Der Kolk
Well first of all, child care, that you don’t have to be locked up with the same person all the time. It’s very important for a kid to have the experience of being exposed to more than one adult, and to see that other people have different ways of doing business. So you can actually see, oh my mom gets very upset, as opposed to, oh, that’s the world I live in.
The second piece is to be involved in rhythmical activities with other kids. Moving together with other kids, dancing together with other kids, playing with other kids, exploring the world with other kids, is so at the core of what creates a healthy mind and a healthy brain. That means that there is space, and that people can actually explore things safely. You can actually go out with your friends and try things out, so you don’t live in an environment where there is so much danger outside the door, or inside the door, that you cannot play anymore.
So I would say the most important thing for traumatized kids is to go to places where they can play. And that is, even in some very well known children’s institutions, there are hardly any places to play. Hardly any place to move around. To sing, to play, to dance, to run. So kids are supposed to really move. And move with other kids.
And basically, our systems are made to move in synchrony with the people around us. When you get traumatized, you get out of sync on every most elementary level. What does the military do? They have people move together and march together, to get them back in sync with each other.
Ezra Klein
And it sounds to me like you think the same is actually true for adults, that you need space to play, to move, to be in synchronicity with others, to sing, to dance, to have what gets called collective effervescence.
Bessel Van Der Kolk
Absolutely. Of course, you get more frozen as we grow older. But cooking with people, serving meals to people, pouring that wine to other people, still that moving together is a terribly important way of feeling our communality with other human beings.
Ezra Klein
And then I want to return to a question I said we’d tackle here at the end, which is you talked about the ways in which the post- 9/11 period in New York City was actually well handled from the perspective of trauma. One thing that led to us doing this podcast is your book has been back up, all the way up on the bestseller lists.
And I don’t think that’s an accident. I think that has to do with people sensing a lot is wrong in themselves and in society, as we do and, in some cases, don’t recover from the coronavirus. So we’ve just been through a society- wide trauma, we are still going through it. But at some point, there’s going to be the potential maybe for recovery. Are there lessons from New York City after 9/11 for countries when they finally can turn to trying to recover from this pandemic?
Bessel Van Der Kolk
To my mind, the biggest lesson from New York was, for one thing, everybody knew the reality of what had happened. And nobody blamed anybody on the inside. So that immediately puts the issue of secrecy and shame off the map, which is fairly rare when it comes to trauma.
The next thing is that people actually did things. People got together in neighborhood groups, they got together with their family. And there’s a lot of communality in New York. New York temporarily became a very kind city. People really were lovely with each other. They made space for each other. It was almost unrecognizable.
The other thing is that money poured into New York. Something like half of all Americans donated money. So there was no dearth of resources. So many people who are traumatized have no resources. They have no money. We don’t have universal health care. If you don’t have good insurance, it’s very hard to get many of the treatments that I talk about.
So the issue of access and resources is huge. And if we wanted to have good health care systems, we need to have universal health care. We cannot have one health care system for the rich and a completely different health care system for the poor.
Ezra Klein
I think that’s a good place to end. So always, our final question. What are the three books that have influenced you that you would recommend to the audience?
Bessel Van Der Kolk
Yeah. Eve Ensler, who now calls herself V, wrote a beautiful book called “The Apology.” Her whole work comes from having been severely molested by her dad. And I think her book, and her other work also, is an extraordinary testimony of courage, of facing up to yourself, and to your experience, and then going on. She’s just marvelous.
The other book that comes to mind is “Love at Goon Park.” It’s a book about Harry Harlow and his laboratory, his discovery of attachment in monkeys. So just a marvelous book about us as human beings, being very much like interactive with other people. And Harry Harlow is a very flawed human being discovering that.
Another book that I think is great, an Australian guy by the name of [Richard] Flanagan, who wrote a book called “The Narrow Road to the [Deep] North,” about war experiences and how war experiences impact on people and get split off. I could just go on, and on, and on. Karl Marlantes’s book about “What It’s Like to Go to War” is an extraordinary description, up there with Tolstoy’s, about the war experience, and his own journey to recovery. Those are just three or four examples.
Ezra Klein
Bessel van der Kolk, your book is “The Body Keeps the Score,” it’s remarkable. Thank you very much.
Bessel Van Der Kolk
Thank you. It’s a pleasure.
“The Ezra Klein Show” is a production of New York Times Opinion. It is produced by Jeff Geld, Roge Karma and Annie Gelvin. Fact checking by Michelle Harris, original music by Isaac Jones and mixing by Jeff Geld.
[MUSIC PLAYING] EZRA KLEIN: I’m Ezra Klein, and this is “The Ezra Klein Show.”
So one of the things I do for the show is I try to keep an eye on the best seller lists. And a few months ago, I began to notice something strange. “The Body Keeps the Score,” which is a book about trauma from 2014, was back up near the top of the New York Times list. It’s number one, as I write this, the book’s 147th week on the paperback nonfiction list — 147th. And if you know what this book is, that is wild.
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“The Body Keeps the Score,” it is a searing read about the way trauma disconnects our minds and our bodies. And it’s pretty clearly written with a professional audience in mind. This is a book very largely aimed at other psychiatrists. That so many of us are turning to it, it says something profound about where the national psyche is in this moment of, yeah, trauma.
I’ll be honest of my own history of it here. “The Body Keeps the Score” is one of those books people have told me to read for a long time. But I thought I knew what it was about. I’d heard it discussed so many times, and I’d read it written about. So even though I hadn’t read it, I thought I knew it: trauma lodges in the body, we carry a physical imprint of our psychic wounds, it’s all very hard to heal. Got it.
But I was really wrong about that. The core argument is — I want to use the word “subversive” here. Certainly subversive in how it will leave you thinking about yourself and those around you. It is about traumatic experiences: sexual assault, incest, emotional physical abuse, war and much, much more. They can disconnect our body and our mind. That is when an experience becomes a trauma — when it disconnects us.
And this is a part I didn’t understand from the way the book is talked about. The devastating argument it makes is not that the body keeps the score, it’s that the mind hides the score from us. The mind — it hides and warps these traumatic events and our narratives about them in an effort to protect us. Human beings are social animals. And our minds evolve to manage our social relationships.
So when we face an event that could rupture our relationship with the community or the family, particularly for children of the family that we depend on, the mind often talks us out of it. It obscures the memories or convinces us our victimization was our fault or it covers the event in a shame so thick, we refuse to discuss it. But our body — and that’s an imprecise term here. But the parts of us that are more automatic that manage and respond to threat — our body doesn’t forget that. Our mind can’t talk that part of us into feeling safe again. And it’s this disconnection of mind and body where trauma lives.
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So how do you reconnect them? Bessel van der Kolk is the author of “The Body Keeps the Score.” He was a leading researcher and psychiatrist active in many of the early battles to understand post-traumatic stress syndrome. But more recently, he co-founded and leads a trauma research foundation and has been studying ways to try to heal these deeper parts of our psyches, everything from movement therapies like yoga and dance to E.M.D.R. to internal family systems therapy to MDMA treatment. We talk about all of it in here.
But I do want to offer a disclaimer: the research on some of these novel treatments, it is really promising. But these are often new studies with pretty small sample sizes. So I don’t want anyone to mistake this conversation for direct advice from a psychiatrist who knows your situation and psyche. So if anything in here connects for you, talk to a professional about it. Don’t just drop the treatments you’re using or the medications you’re taking and run to something new.
But with that said, there is so much to learn from in this conversation. I really haven’t stopped thinking about it since we recorded. As always, my email, ezrakleinshow@nytimes.com if you want to send me further guest suggestions or recommendations for things we should read or look at. Again, ezrakleinshow@nytimes.com.
Bessel van der Kolk, welcome to the show.
BESSEL VAN DER KOLK: Hi, good being here.
EZRA KLEIN: You have this very powerful line in the book from the writer Jessica Stern where she says, quote, “Some people’s lives seem to flow in a narrative. Mine had many stops and starts. That’s what trauma does — it interrupts the plot.” Tell me a bit about how trauma interrupts the plot.
BESSEL VAN DER KOLK: Well, trauma is really a wound that happens to your psyche, to your mind, to your brain. Suddenly you’re confronted with something that you are faced with horror and helplessness. That nothing prepares you for this and you go like, oh, my God. And so something switches off at that point in your mind and your brain. And the nature of trauma is that you get stuck there. So instead of remembering something unpleasant, you keep reliving something very unpleasant.
So the job of overcoming trauma is to make it into a memory where your whole being knows this happened a long time ago, it’s not happening right now. But the nature of traumatic stress is that you keep reacting emotionally and physiologically as if these events are happening right now.
EZRA KLEIN: What is trauma? Is it the event itself or is it your reaction and processing, or I guess lack thereof, of the event?
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BESSEL VAN DER KOLK: It really is a reaction that you have something horrible that’s going on. And different people have different responses. Although I must say, having done this work as long as I have, I don’t recall ever seeing somebody in my office coming for traumatic stress that I go, oh, this seems like a trivial issue. Like having your child run over by a car, you go like, oh, my God. And usually my response to hearing about people’s trauma is, oh, my God, are you still here?
EZRA KLEIN: I’ll say that, for me, was the hardest part of reading your book was just being faced with something I already know, but being faced with how much pain people are simply carrying around with them every day. It’s one way reading the book made me just look at the world a little bit differently. It’s just this reminder that you have no idea what somebody is carrying.
BESSEL VAN DER KOLK: That is so true. And of course, we do need to wear our blinders, and we cannot face up to all the bad stuff that’s happening in the world. But to give an example to what you’re saying here: when we first put this diagnosis of P.T.S.D. in a textbook, we said, this is an extraordinary event outside of the usual realm of human experience. That is the official definition. Nobody talked about how common incest is, nobody talks about how common child abuse is, how common domestic violence is. And it’s really quite startling when you get to see how much people actually are coping with.
EZRA KLEIN: At various points in the book, you argue that trauma is the most costly public health problem that we are dealing with. This is before the era of Covid, of course. So let’s keep that to the side. But do you want to talk for a minute about that at scale, what it means that so many people are holding these kinds of experiences and pain?
BESSEL VAN DER KOLK: Yeah, that statement actually came from the Centers for Disease Control, when Vince Felitti at Kaiser Permanente in San Diego did this research more than 20 years ago right now where he asked medical patients — insurance carrying, largely college educated white people — did anybody ever hit you very badly, did anybody molest you, did you witness your parents having physical fights? And the data that came back were just stunning, how much really very scary stuff the majority of people experienced in their lives.
And what their studies there slowly showed is how erosive and devastating these effects are on people’s capacity to recover also. The big issue is that people tend to think about trauma as, oh that event, and having a bad memory about something. That is not really what it is. Once you get traumatized, it changes your brain, it changes how you see the world, and it changes how your body reacts to your environment.
And so it’s not the only thing that goes from your survival system into your mind. It goes also into your body, and the stress hormones continue to erode your system. When you have been traumatized, your chances to die much earlier and to have many diseases go up very dramatically. So much of what we can think about, major social issues in the world we live in, are actually — the social elements, the contextual elements are terribly important.
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EZRA KLEIN: Tell me a bit about the conditions under which an event that could be traumatic becomes a trauma. And in particular, I was very struck by how much of your research suggests that trauma is an event plus a kind of instigated social crisis. There are objectively catastrophic events, like 9/11, that were less likely to cause trauma because they were shared by the community. Where, on the other hand, things like child sexual abuse is very reliably traumatic because it disconnects you from your family. So could you talk a bit about the social structure of trauma?
BESSEL VAN DER KOLK: Yeah. So what we tend to leave out of most of our discussions about human functioning is to what degree we are primates. We have brains in order to get along with each other, to be with other people, to connect with other people. That’s really what we are fundamentally all about. And so, much of trauma is about a rupture of the safety of the people who are supposed to protect you and the people who are supposed to come to your help.
So basically, the way that we are wired is that we are wired to not be able to do everything by ourselves, but to be able to look for help and for other people to take over when we can no longer do the job ourselves. And that’s perfectly normal. But if, at that point, the people you can count on most are not there for you, let you down, have been killed, or whatever, then it’s entirely up to you. It’s a much harder thing to deal with terrible situations.
EZRA KLEIN: I just want to tag something you said there for the audience, because we’re going to come back to quite a bit, which is we have brains in order to get along with other people. I think that’s going to be really, really, really important to this conversation. But this gets to something that I found really rich in the book. So “The Body Keeps the Score” has — I mean, as a book, it’s a phenomenon, as a social meme, it’s a phenomenon. So I felt like I knew what it said even though I hadn’t read it until recently.
But then when I read it, what really struck me about it is how much of the book is about not just how the body keeps the score, but how and why the mind hides the score. Can you tell me a bit about that?
BESSEL VAN DER KOLK: Yeah, brilliant. We are created to survive. We’re also created to be loyal and to be part of a group. And sometimes, in order to survive, you need to keep your realities [INAUDIBLE] the people around you. And so when you go through a terrible reality like 9/11 in New York or terrible natural disasters, oftentimes people get very close together because it’s out there, everybody can see it, people help each other. Part of our nature is to be altruistic and to be generous when people are in distress.
But if your feelings conflict with your loyalty — let’s say, if your own mom or dad beat you up and you don’t feel safe with them — you cannot tell other people about it either because you’re supposed to love your mom or dad. And so you need to keep it to yourself. And then it starts festering inside of you. So the reason why you do psychotherapy is mainly to help people to find words for the reality that they have dealt with. And oftentimes, those are realities that are not acceptable for the people around you.
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EZRA KLEIN: You talk about the difference between the parts of the brain that create the autobiographical self and the parts of the brain that create the experiencing self. Can you discuss that a bit?
BESSEL VAN DER KOLK: Yeah. So we have these layers of the brain that have different functions. So the deepest layer has to do with what Antonio Damasio calls “the housekeeping of your body”: being able to breathe, go to the bathroom, go to sleep, have an appetite, being able to engage in caregiving and sexual relationships — very elementary. We have that in common with all other mammals basically.
But then we have this meaning making systems that come on top of that, starting with the larger limbic system that has a more complex way of organizing your perceptions about reality. So basically, your limbic system is the part of your brain that forms a map inside of the world outside of you. And so your brain gets programmed by experience to know what to expect and what sort of reactions people will have to certain behaviors. And so early experiences very much shape your perceptions of the world.
So if you are terrified of the people who take care of you, it’s very likely that you will either, or combination of, really be extremely compliant with people in power and hope that they won’t hurt you, or you become chronically angry and oppositional or a combination of those two. But that imprint of, I’m not safe with people who say they care for me, becomes an imprint of how you come to perceive the world. And those are not rational thoughts, and this cannot be abolished by pointing out to people how irrational they are, because that’s the way our brain becomes hardwired to deal with the reality in which it gets formed.
EZRA KLEIN: It was astonishing to me, reading some of the stories in the book. I think all of us have the experience of telling a story about ourself that is not true to how we feel. But you treat patients who, the stories their minds have told or the memories their minds have hidden are really shocking. So why do victims of abuse, particularly child abuse, so often either forget what happened to them or blame themselves for it?
BESSEL VAN DER KOLK: So the issue there is that we need our parents or caregivers to take care of us. And so the moment we give up on our caregivers as little kids, we’re done for. And so the way the child is wired is to stay as close to the people who are supposed to take care of them as possible. And with that, they will deny the reality of being beaten. Or the imprint is very much like, I’m being beaten or I’m being molested because I’m a bad person. I must deserve it.
So your identity becomes basically, I’m fundamentally a bad and flawed human being. And if I had been a nicer child, people would have loved me and taken care of me. If I’d been a worthwhile child, people would not have done these horrible things to themselves. And actually, when you get into treating these issues, the hardest thing to actually treat in people is this deep sense of being defective, something being wrong with you.
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And what many of my patients also deal with is that I must have made the story up. This is too horrendous for people to do it, I cannot believe that it’s happened to me, I must feel this way because I’m crazy. And oftentimes, that gets reinforced by the environment, or you’re just a difficult child, you’re just making up false memories. But the fact is what happens over time, the reality slowly starts filling out.
EZRA KLEIN: This was a real epiphany for me in reading your book, because you read about cases like this. You read about false memories or you hear about or even know people who blame themselves for horrible things done to them — child abuse or rape or a beating or whatever it might be. And you think, what would happen that brains would be defective that they would do that? That doesn’t make any sense.
But the point of your book, I think, in part is that it does make sense. There’s an evolutionary fitness reason for the brain to do that, which is that it’s a story that allows you to maintain within a family, or maintain within a workplace or maintain within a community. Because if you told the real story, it would rupture your family, it would rupture your community, it would rupture your workplace.
BESSEL VAN DER KOLK: Exactly. These thoughts didn’t come from me, of course, originally. All these thoughts have been thought before. But the great hero here is John Bowlby, attachment researcher, who really showed how children really need to cling to their caregivers and will do anything they can to keep a semblance of connection going so they don’t die or get totally abandoned. And the price they pay for that is very much this very profound sense of self loathing, oftentimes despising yourself, getting into a lot of difficult behaviors because I’m no good anyway. And it’s a deep sense of, I may as well put myself in danger, I may as well take drugs because I’m no good anyway.
EZRA KLEIN: So then you get into these cases where people are telling a story about something — either telling a story that admits something or telling a story that normalizes something — that their body doesn’t believe. And so you have these kind of two systems, like the kind of cerebral system of what somebody is sitting in front of you saying, and then the fact that they collapse into a ball at the touch of another human being or hide in drugs or have all these other coping behaviors. So can you talk about why the system that is rationalizing isn’t able to convince the body? Because you would think maybe that would be just one system all the way through. You got to live the lie. But part of what you’re getting at is you don’t live the lie, you just tell the lie.
BESSEL VAN DER KOLK: Yeah, you live the lie. You really believe that I’m fundamentally defective and that’s why this happens to me. So people really very deeply come to rationalize their very bad feelings. And that actually allows them to continue to survive to some degree. And that’s a different part of the brain.
But of course, your core survival part of the brain picks up the danger signs and keeps continuing to secrete stress hormones, immunological abnormalities, muscle tension, fibromyalgia — a whole bunch of physiological systems where the body continues to behave as if it’s in great danger while the mind says, don’t pay attention to him, he’s lying, he’s a terrible person. So it’s really the conflict between the body feeling very unsafe and the mind not wanting to accept the reality of what has happened to you is at the core of this, yeah.
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EZRA KLEIN: This is a strange idea to wrap your mind around. How is it possible that your body — which on some level is controlled by your mind. I mean, it’s getting electrical signals from the brain. How is it possible that you can have such disagreements within one system?
BESSEL VAN DER KOLK: Well, because they are somewhat different systems. The system that helps you to sleep, for example, is a system that most of us have very little control over. And so you may rationally know that it’s important to go to sleep now and life is safe and I have nothing to worry about. But something in the back of your brain, your survival brain, seems to give you messages of, I’m in danger.
Very commonly, when people have had sexual molestation or issues like that early in their lives, they are with somebody, they have a sense of desire, and suddenly their body shuts down. And they become very angry or very frozen. And they say to themselves, there’s something deeply wrong with me because I really like this person that I’m with and I’d really like to have a good time. But my body won’t let me because the primitive survival part of the brain is still stuck back then, when they felt in danger. But the frontal lobe may not register that.
EZRA KLEIN: One of the main ways you say the mind hides the score is through applying shame. You write at one point that for trauma survivors, quote, “Shame becomes the dominant emotion and hiding truth a central preoccupation.” Can you talk a bit about what shame is, what it is as an emotion, and then the role it plays for people after trauma?
BESSEL VAN DER KOLK: Yeah, shame is really a feeling of wanting to hide how you don’t want anybody to see you. Shame comes from having feelings that are fundamentally unacceptable. Like if you’re talking very nicely to me, and I may have a feeling that I’d like to kill this guy, and you think to yourself, what a terrible person am I to want to kill somebody who’s very nice to me. And then you say, I must be crazy, there’s something wrong with me.
As it happens to be, maybe you have a particular accent or a way of talking that may remind me on a very deep level of somebody who beat me up when I was a kid, and I have this intense emotional reaction to you, and I feel like, what’s wrong with you, Bessel, that you have such a terrible reaction to this nice person, and he probably already has picked up that I’m trying to hide something from him because I feel so angry with this person who’s actually being very nice to me. So that’s the confusion and the shame that traumatized people live with.
EZRA KLEIN: One thing that struck me about that passage is — and I apologize because I can’t remember where I read this distinction. But I once read that guilt is an individual emotion and shame is a social emotion. Guilt is, I feel bad about something I did, and shame is that I am afraid the community will look bad upon me for something I did. And within this context of trauma often relating to things that happened that would create rupture of the community, it seems interesting and also profoundly sad that shame is such a constant companion to that, because it’s a way of fearing that your community will turn on you potentially if the truth were to be known.
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BESSEL VAN DER KOLK: Well, we are communal creatures, and we survive terrible things by community. So the people who are able to get themselves together as, for example, New York did after 9/11 — New York had a spectacularly effective way of dealing with the trauma of 9/11. And once you have the community to go with you, you’re not ashamed of yourself anymore because your neighbor may have the same feelings of terror and fear that you have, and you don’t feel crazy, and you don’t feel like you’re worthy of exclusion.
So one of the things that is driving this whole trauma issue is that you feel cut off from your community, you do things that embarrass you, you blow up at people. Your kids want to play with you, and you get angry with the kid, and you feel bad about being angry with the kid, and you start yelling at this child, and you go like, oh, my god, what’s wrong with me that I’m yelling with the child. And you start trying to control yourself with alcohol or with drugs. And so you have these reactions that you hope people will not see. And the longer they last, the more isolated you became.
So one of the things that I’ve seen, much to my distress, is that when we started this field in our particular window of history, it was a very communal issue. It was women got together around “Our Bodies, Ourselves.” My friend Judy Herman was running incest groups. I was running groups for veterans. And they got a lot of comfort and support from each other, and they shared their very scary thoughts and their angry thoughts. They said, oh, I feel the same way. I’ve had the same experiences. I also made people very angry who I feel close to, et cetera, et cetera.
So people to be with, as the 12 step programs so brilliantly have done, give you a sense of not being alone despite the fact that you feel very damaged and ashamed about yourself.
EZRA KLEIN: I want to put a pin in New York in 9/11 because I want to come back to that and the question of whether or not there are things we can learn as a society, whenever it will be the case that we can begin to recover as a society from Covid and whether or not there are things we can learn in that experience for how to do it well. But I want to ask about another way that we end up hiding what we feel, which is that trauma has a way of numbing people to their feelings, to their emotions, even to very basic physical sensations. And something you talk about, which I didn’t realize, is that when that happens, it becomes hard to construct a coherent sense of a self. Can you talk about how that works?
BESSEL VAN DER KOLK: Yeah. When you are involved in your trauma and you are continuously reacting to stuff, you can’t trust yourself. And you don’t really know what’s right because you keep sort of getting into trouble again, you try something and you freeze, and you try something and you explode. And you do something and you feel terrible about yourself. And you don’t know where that comes from. And so you try to make sense out of this turmoil that’s going on in your sensory system. And if you’re lucky, you are talented and you’re a good basketball player, a good guitar player, a good accountant, and you can hide yourself in your particular talent where you can find a safe area for yourself. But when it comes to the complexity of dealing with teenage children or relationships, that may be too much for you and you keep falling apart. And so your identity becomes like, I cannot be with other people, I’m no good. And so that sense of trust in yourself, predicting yourself, knowing who you are, knowing how you react to things becomes very damaged.
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EZRA KLEIN: You have an interestingly complicated relationship to language in the book. You talk about it as both a miracle and a tyranny, and the ability to both put words to things you’ve experienced and also put words to things maybe we haven’t or ways we don’t feel about how we’ve experienced them. And so I wanted to ask it this way, because a lot of us have had experience with therapy have primarily had experience with talk therapy, where you go and you sit in a room and you get asked questions about your parents and you try to answer them. What can that do, and then what can language not do in these cases?
BESSEL VAN DER KOLK: Language, it’s really great when you have kids as you do or grandchildren as I do, how you can see kids develop language over time and you can see how as they develop language, they’re able to communicate about what they like, what they don’t like, and to form common realities with other people. As long as you don’t have language, you really don’t know how to form a sense of community.
So having a language that allows you to define your common reality is terribly important. And of course, traditionally, psychotherapy is very much about developing that language for yourself, which is very important. But understanding why you screwed up doesn’t necessarily stop you from being screwed up. Now I know why I freeze when somebody touches me. Now I know why I get so angry. But the anger and the freeze may still happen.
So you still need to rewire the physiological system. And much of my research has been, how do you get there. And the earlier studies we did was doing yoga. And somehow, yoga helps people develop a more harmonious sense of the internal workings and the internal body sensations. Moving together, dancing together with other people, getting a sense of rhythm, which many people around the world except in the Western world use — drumming together, singing together, making music — helps to reestablish that sense of community and being in sync with the people around you. Later on, sending neurofeedback, playing computer brain interfaces where you can actually play computer games with your own brainwaves and help your brainwaves to become more rational.
And our current research is very much also in psychedelic agents, which turn out to have a very dramatically positive effect on exactly the courses of defectiveness, self-loathing, internal confusion. And our latest data really show that MDMA particularly can really help people to get a much deeper sense of who they are and a deep sense of compassion for themselves.
EZRA KLEIN: We’re going to go through a bunch of these therapies. But one thing I want to ask about them as a group is that one thing lurking around your book, and certainly that I felt reading it and that I felt in my own life as I’ve looked at various modalities for things that I’ve struggled with, is that there’s a hierarchy of status to different treatments. So it’s very accepted at this point, very rational, to take a pill for depression or anxiety. Talk therapy has a very long history. Nobody looks askance at that. That’s something intellectuals do in New York, and they sit in a chair and talk about feelings. And I don’t want to say anything bad about either of those. But then you start looking some of these other things, like E.M.D.R. which we can talk about, or dance therapy or yoga. And it feels soft. You’re like, well, that’s silly, that’s holistic, that’s — and something I think the book is trying to get at is that maybe we have come to overweight certain kinds of approaches to how we feel and underweight others. So before we get into how these therapies work, can you talk about that meta level of coming to respect therapies that maybe don’t have a lot of social status right now?
BESSEL VAN DER KOLK: Very important point you make. It’s a cultural issue. You hear from my accent, I’m northern European, and North America is still very northern European. The world and northern Europe developed two ways of dealing with bad stuff. One of them was to drink. And so taking a pill is a respectable thing in Western culture to do, and normal people ingest stuff to make themselves feel better.
Nobody feels bad about it. Other places in the world may say, that’s weird. Then the other thing that Western people are very good at is talking. We’re not very good in singing together and moving together. You go to China after a disaster and people are doing qigong together, and so that’s interesting, or tai chi.
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And you go to Brazil in [INAUDIBLE] area, and you see people practice capoeira. You go, are they practicing capoeria because it looks good to the tourists, or are they practicing capoeira because it does something to the way they relate to their bodies and their sense of self-control?
So I think to some degree, we are trapped in this post- alcoholic paradigm that the only way to change is through taking pills or by talking. But of course, once you raise kids and you hang around with kindergarten teachers, they don’t do a lot of talking. They’d also do a lot of singing together, and a lot of moving together, and a lot of tossing balls together. And a lot of things that help you get in tune and in rhythm with each other.
And that’s not really the strong point of Western culture. So it all depends on the cultural assumptions you have about what’s helpful to people.
EZRA KLEIN: This part of the book made an interesting connection for me. I had the journalist Anna Sale on the show a couple of months ago for her book about having difficult conversations, and something she says in that book is that we used to have more institutions, and rituals, and conventions, and structures that guided us through the hard conversations, and hard parts of life.
I mean, things like churches and civic organizations. There is a lot of singing in those places, there is a lot of dancing in those places. I mean, you go to a Jewish synagogue, a lot of singing and dancing. And one point she was making is that as some of these institutions have faded in American life, we’ve been left without a template for these conversations.
But reading your book made me think of it on another level, too. I mean, a bunch of the modalities you just talked about, like capoeira or qigong, I don’t want to suggest they don’t have therapeutic roles, but they’re not primarily seen as therapeutic. They’re just a bigger part of those cultures.
And I wonder if you think that one of the issues with trauma in America is that we have lost institutions that were comfortable with ways of being embodied, even if they didn’t frame them in a “the body keeps the score” kind of framework that we used to have. And so they were playing roles that maybe they framed themselves as religious, or civic, or something else, or communal or ritual, but they were also doing things for how we process difficult issues or allowed us to get in touch with our emotions, that they had these side benefits that we didn’t understand and never knew how to measure.
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BESSEL VAN DER KOLK: That’s, of course, a terribly important point. But at the same time, institutions are dangerous. And sometimes you have to pay a price to keep belonging to the institution. So you may have to keep silent about an elder or a respected person doing bad things to women or to children, or to each other. So yes, there’s comfort in institutions, and yes, there is danger in institutions.
What I’m also impressed by is, in the circle that I live in, which I imagine is fairly rarefied, I see a lot of people exploring things. I see people going on meditation retreats, and singing retreats, and movement stuff, and making music together. So if you’re somewhat privileged in our culture, people oftentimes find ways of reestablishing their sense of connection, their communality.
And again, the issue of privilege and equality is a huge issue. Particularly right now with the pandemic, some people have much better opportunities and have a much easier culture that they fit in that other people do.
EZRA KLEIN: That point about the dark side of institutions is very important, and very well taken. But let’s talk about some of the things that you explore in the book and that people are exploring. And why don’t we start with one that folks may have heard of, but even if they have, even when I had, it’s very alien, which is E.M.D.R. Can you talk a bit about what E.M.D.R. is?
BESSEL VAN DER KOLK: EMDR is a very simple and weird technique. It is that you ask people to call up the images in their mind about horrible things that have happened to them, and to remember what they felt like in their bodies, to remember what they saw, what they heard, but you don’t talk about it. Because the moment you start talking to people, you change your story according to what you think that person wants to hear.
Talking always becomes the interpersonal process, and talking makes you adjust your reality to what people are able to listen to. So in E.M.D.R., you keep it to yourself, you see these things, and then you ask people to move their eyes from side to side in response to your fingers.
The first time I heard about it, it sounded like crazy. And my patients started to come back saying, I resolved things, I was able to just leave the memory behind. I did the first National Institute of Mental Health- funded research on E.M.D.R. Our adult onset P.T.S.D. people had like, a 78 percent cure rate. So clearly it had major positive effects.
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And so that was my introduction, which I’m very grateful for, of seeing something that’s just on the surface bizarre, but has a very profound effect, that gets us out of this post-alcoholic paradigm of talking or drugs. I said look, this is interesting, this is weird. And so I got very interested in how does it work.
And so two years ago we finally did a study where we looked at what these eye movements cause. And what we saw, it changes the connectivity between different parts of the brain. And so what we saw is that it affected neural networks. And that for me was just so cool, because this really opens up the frontier of where our treatments need to go, is how do we repair these networks where the different parts of the brain are disconnected from each other.
But the result is that when people have this inkling of trauma, they feel it as if it’s still happening now. And what we saw in our neuroimaging study of E.M.D.R. is that the circuits of the brain change, so it allows the mind to go, oh yeah, this has happened to me, but it happened back then, a long time ago. It’s not happening right now. So the E.M.D.R. was my opening that there’s ways of switching neural circuits so your perspective on the issue becomes very different.
EZRA KLEIN: Why would moving your eyes back and forth open that pathway?
BESSEL VAN DER KOLK: That’s the question we don’t know, except you go back to what Darwin wrote about and Pavlov wrote about it, about conditioned responses of the brain, start to react with how you move your eyes in a certain direction when there’s danger. And there’s maybe some evolutionary circuits involved with moving your eyes in the direction of threat. We don’t know, because research funding would not really allow people to go into asking these questions at this point. I wish we would.
EZRA KLEIN: And one of the other things that was interesting … I’ve not done E.M.D.R. myself, but in people I’ve known who have had a very positive reaction to it, and then in the stories you tell in your book, one of the things about it is that you don’t just tell the story of what happened to you. Oftentimes you begin to alter it.
There’s an imaginative capacity. You’re telling what happened as trauma, and then also people begin rewriting the story, saying things that didn’t happen, and that there’s some healing that seems to happen here and in some of the other modalities that we’ll talk about, from, in an open environment, imagining the way things didn’t play out.
And on some level that’s very strange to me, right? That you can heal yourself not by just understanding what happened, but talking through what didn’t happen. But it seems to be recurrent in these therapies. So can you talk a bit about the role of imagination in healing, and counterfactuals?
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BESSEL VAN DER KOLK: I was hoping for questions like this, this is great. So the way we deal with unpleasant situations is by imagining how we can do things differently. And that’s really the glory about the brain. It’s like, oh, if you get fires in California, but I can imagine what we can do to prevent the forest fires, to anticipate how you can make a difference.
Trauma destroys that capacity to imagine how things can be different because you get trapped in that traumatic moment. So you cannot imagine anymore that things can be different. So a very big issue in helping people to overcome trauma is to experience the possibility of alternative outcomes.
In my own work, I love to use psychodrama for that. We are involved in theater programs where people actually get to play different roles and see what it feels like in our body to take a new position, to imagine being Lady Macbeth. And so to be able to embody the experience of a powerful queen, you go like, oh, that’s what a body feels like that feels powerful. So a very important part, in my mind, of therapy is to help people to embody new realities.
EZRA KLEIN: There’s a fascinating study you bring up, which relates I think to this very, very famous study where they are still following, actually, but this one class of men from Harvard from decades, and decades, and decades ago. But something the study found is that in the people who were traumatized by their experience in war, their memories never really changed.
They told the same story 40 years later that they told right after it happened. Whereas the people who weren’t traumatized by it, their memories kept changing. The imagination was telling and retelling the story, right? The cliché of the old war stories that never quite happened, or the fishing stories where the fish keeps getting bigger.
So if you could you talk a bit about that? About the way weirdly, a healthy memory is actually a less accurate memory? Because what you need in life is not accurate memories but a story that works for you in the world.
BESSEL VAN DER KOLK: Exactly. My friend who ran the sleep laboratory at Harvard, Bob Stickgold, showed very clearly that, with your dreams, your dreams allow you to retain what’s most relevant and to ignore what’s irrelevant, and you slowly change your story about what happens in order to prepare yourself for the future. It’s a very complex mental phenomenon, and our memories are extremely flexible.
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For example, I go to family reunions with my siblings, and we all tell stories about growing up. And we look at each other and say, you grew up in a different family for me! Have we all created a different story about our past? And that suits us. That’s the story we like to live with.
But the reality may be very different. What we first found out about trauma is that the problem with trauma is you cannot change the story. And the story is the same damn imprint, the same vision, the same body sensation as you had 10, 20, 30 years ago. And so what we need to do when we treat people is to get the normal processes of the brain to work so you can create a new story for yourself, and not get stuck on the specific sensations of back then.
EZRA KLEIN: Speaking of family reunions, can you talk about internal family systems therapy? I had never come along this until the book, but it’s fascinating.
BESSEL VAN DER KOLK: Oh well, internal family systems is not about families. It’s about how we all have families living inside of ourselves. It’s a very important evolution, the past 30 years or so. Jung already talked about the same thing, William James talked about the same thing: that we have a multiplicity of minds. Walt Whitman wrote a poem about it, said that “I contain multitudes.”
You strike me as a very loving, and kind, and intelligent, and attuned person.
EZRA KLEIN: Oh, thank you.
BESSEL VAN DER KOLK: I hope that’s all there is to you. But only the people know you best know that there is other parts of you that people don’t get to see, and there may be part of us that we may not be aware of sometimes. So that we have different ways of reacting, or engaging, that can be quite different regarding the circumstances.
And what I.F.S. particularly showed us is that when terrible things happen to you, you create ways of being in the world, personalities, that help you to cope. For example, if you get chronically humiliated, you may say to yourself, “Nobody is going to ever humiliate me anymore,” and you become this staff bully who put people down before they can put you down.
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You may go home and be a very sweet and gentle person to your kid, but when you deal with a guy in the office, you may become a bully. That doesn’t mean that all of you is a bully. That means that a part of you is a bully that comes out under certain circumstances. So we never know other people until we live with them for a long period of time, because there may be very hidden parts of themselves that we may have developed back then in order to cope with particular challenges that we face growing up.
EZRA KLEIN: So my understanding of how I.F.S. works in practice is it identifies these almost little personalities in the brain. There are managers, who try to protect you from feeling unsafe, and the firefighters, who respond to moments of crisis, the exiles, who you’re trying to avoid, and that helps people identify these distinct parts of their personalities, and how those parts come out and contribute to different reactions.
And that seems like something that would be helpful even outside the context of therapy. In addition to all the wonderful qualities of mine you listed a minute ago, I do a lot of meditation. And one of the things that years of that is done has make me much more skeptical that there is just one of me in here. When you’re sitting there just watching your mind, the constant question is, well who thought that? Who thought thinking that would be a good idea? I didn’t want to be there.
And the mind has felt to me for a long time like it’s more of a corporation. You know, it has different divisions, and some of them have big budgets, and some small. But family systems seems to get at that too. That one thing that actually causes people frustration and shame is they are told they’re in control or should be in control of their minds.
And then it’s very frustrating, for me as somebody who has struggled a lot with anxiety and obsessive rumination, it’s very frustrating to not be able to control my own mind. Because that feels like I’m failing. And the idea that it’s actually not something I should be able to do, that it’s not just one singular mind, but a lot of different minds or something vying to be heard, there’s some relief in that. And it seems to me some real accuracy in it.
BESSEL VAN DER KOLK: It’s very helpful in relationships. That you can only survive a relationship if you can really understand how your partner gets very uptight, or angry, or shut off, or something, in response to certain things. And if you start understanding that it is different part. And let’s say if your wife, this probably never happens to you, but perhaps to many other people, someday may say to you, “I hate you!”
And for you to know, oh, she’s now triggered and there was something I did that caused that angry part of her to come out. I know that that angry part is not the most reasonable part of her, so this is not a time for me to start arguing with her that I’m not the most selfish person in the whole world, but you know that that part is out, and you try to help her to know that this too shall pass. And I can see that I do things that really bother you, and I’ll try to work on that.
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And she can say, I can try to negotiate with a very angry, frustrated part. A little therapy might help in helping me to know where it came from, so that I don’t get so out of control angry with you when you don’t do the dishes.
EZRA KLEIN: The single best piece of advice I ever got on marriage is that there is no use in thinking of your partner as a single stable entity that exists separate from you. There’s only your partner in a dynamic with you. There’s only who you also bring out in your partner, that they’ll be somebody totally different with other people. But so the question always, if things are going right or wrong, is, like, which parts of the two of you are being brought out in relationship? Not just, who is this person and do I like them?
BESSEL VAN DER KOLK: See, and Dick Schwartz extended what you just said in your relationship to yourself. And to really understand that you may have very different reactions at different times, and to really get to appreciate that certain things make me very upset, and to really start making decisions about do I want to give in to that, or do I want to do something about it? Or how to really start getting a perspective on this landscape, and make a discovery inside of yourself.
EZRA KLEIN: An intervention you discuss glancingly in the book, but it sounds from something you said earlier like you’ve been doing more work on, is psychedelic therapy. It’s been a lot more research since you did the book, it sounds like you’re actually behind some of it. So given what we know now, I’m curious how you understand the role of psychedelics potentially in helping people deal with trauma?
BESSEL VAN DER KOLK: I think psychedelics are a true revolution. And it’s partially a revolution because we don’t know how they work. There’s all these explanations: oh, the serotonin system or the default mode network. But what has happened in the world we live in is that people pay varied attention to what happens in the mind.
And what we see in our MDMA research is that MDMA seems to really trigger a capacity to look at yourself in a more compassionate way, in the same way that MDMA is being used at parties. And when we do our work, very painful, painful, old things tend to come up. But people are able to go there and not get overwhelmed by shame, or overwhelmed by the horror.
And they’re able to go there and say, yeah, this is what happened to me. Oh my God, that was awful. And actually, I’m working on that paper right now, which I think is a very big deal, actually, is what you see is a dramatic increase in self compassion. People say, I now can really see what I went through, and how awful it was, and how I have survived it.
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And what’s fascinating to me is that it gives people a sense of perspective, of who they are, and their sense of self gets very much enhanced. This is who I am, this is what I went through, and this is what I’ve learned from experience. It’s really very dramatic, and I think it’s the sort of thing that may happen with very long term psychotherapy, but I think very profound things can happen in a very short period of time.
EZRA KLEIN: I’m very fascinated by the space, both for personal and professional reasons. And something I was thinking about, in the context of some of the other treatments you bring up, is the why. And I’m thinking here less about MDMA, which as you say has a profound self compassion effect, and more about things like mushrooms and LSD.
But something that came to mind, so Robin Carhart-Harris, who is at UCSF now and is one of the leading researchers on psychedelics, he’s put forward this model which argues that the mechanism by which psychedelics work is that they sort of relax our mind’s confidence in its own internal models, and pattern matching, and stories, which then allows us to kind of experience some of these deeper emotions we have and begin assigning meaning and stories to them, too.
Which sounds actually a lot like E.M.D.R., sounds a lot like, in a way, what internal family systems work is doing. That ability to begin sensing something else and then trying to tell a story about it that your brain will actually believe, and begin to give weight to. And I wonder if you think there’s something to that, that it’s a relaxing of the model that is helpful here?
BESSEL VAN DER KOLK: Well, certainly Carhart-Harris has done more work on it than any of the rest of us. And I think his formulation approximates what we see here. I think the big thing in terms of trauma, is that when you’re traumatized you live in a very narrow world. A world of fear, and trying to stay under control, and being afraid to get out of control, or being afraid to get overwhelmed.
So your world becomes more and more constrained. Pierre Janet already wrote it about 150 years ago. How you get narrow minded, and what Janet said back then also, he says, when you get traumatized, the mind has a hard time continuing to grow. The mind gets stuck in its effort to try to control itself, it becomes very hard to open your mind up to new things.
So when you’re traumatized, you oftentimes tend to have the same patterns over and over again. You have a hard time learning from experience. Your mind closes down. I think what psilocybin, ayahuasca, LSD do is they open up a new universe inside of yourself that somehow you need to cope with.
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The way you phrased it is a little bit too deliberately cognitive for my mind. The mind does something to become aware — but even aware is too conscious — of that I’m a much smaller piece in the much larger universe, and a universal experience through these substances, which Carhart-Harris and Pollan and those people who also write about, is how you get to see your relative position in the universe.
At the same time as you experience yourself as quite unique and special, you also get to see the rest of the universe as also being unique and special. And universally, regardless of the culture, you always end up with a feeling of, I’m a part of a much larger universe. But I’m an essential part of that part of the universe.
Which is, of course, the opposite of being traumatized. When you’re traumatized, you go, I’m messed up, nobody else is, everybody’s having a life and I don’t, and you feel alienated. And that sense of what all these mind altering substances do, of opening yourself up, being a part of a larger whole, is very significant also.
EZRA KLEIN: So MDMA combined with therapy is now in phase III trials in the F.D.A. for treating post-traumatic stress disorder. You have psilocybin at other levels of the regulatory process. There’s very much a vogue for all this. Do you worry that it has risks we’re not paying attention to?
BESSEL VAN DER KOLK: I think societies have had a very difficult time legalizing and dealing with the outflow of these massive mind-expanding agents. And I’m very curious to what degree we’re able to stay reasonable about it, to be careful about it, to not have it get out of control. And I’m really delighted with Rick Doblin, who runs the Multidisciplinary Association for Psychedelic Studies, M.A.P.S., which forms part of his studies. He is working very hard to keep it very careful. But I’m very worried that things will get out of control, yeah.
EZRA KLEIN: You were very much part of the rise of just pharmaceuticals to treat mental illness. You did one of the early studies on Prozac. And in the book, you have a very complicated relationship with these drugs, which you prescribe and believe they can help people. But you also worry that we overuse them, that we use drugs to ignore signals, or numb signals the body is sending, so that it becomes easier to not do things. How do you think about that space now?
BESSEL VAN DER KOLK: So I was a very young person. So I worked in the hospital and did a lot of the early studies and did some myself, and there was an enormous promise that chemicals were the answers. And people said, mental illness is a chemical illness, and if we just find the right chemical, we’ll cure it.
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And billions of dollars on the chemical studies really haven’t yielded all that much in terms of understanding or treating mental illness. But the sad thing is that psychiatry as a profession became addicted to drugs. And so the notion that oh, if you just find the right symptom, you’ll find the right drug, still prevails among many professionals.
There are chemicals that can be somewhat helpful. They can help you to sleep better, to be less uptight. But they’re chemicals that really interfere with your natural capacity to deal with these things. And for me, very quickly after I did these early studies with not bad results, they certainly did not promise total happiness, really started to concentrate on what inborn mechanisms we have to deal with our own anxiety, and with our depression.
And so I really discovered the world of the body and tantric traditions, the yoga traditions and breathing traditions, and musical traditions that show that we actually are capable of rearranging our own internal physiological systems. And I wish that in every classroom in America they would teach the four Rs: reading, writing, arithmetic and self regulation, from kindergarten through 12th grade, of what can we do to calm ourselves down, to stay focused? What sort of activities can we engage in to feel in control of ourselves?
And so that we get away from this culture of, if you don’t feel right you take a drug, instead of if you don’t feel right you go for a bicycle ride. If you don’t feel right you go to yoga class. If you don’t feel right, you may need to do some body work to help your body to calm, or you need to go to do some tango dancing, or you need to do something to rearrange your relationship to your internal physiological state.
EZRA KLEIN: Where do you think psychiatry and mental health as a profession is in its evolution? And I mean it in this way, that it all feels very scientific. And there’s a lot of studies and you can read journals. And at the same time, including when reading your book, it’s remarkable how crude the tools we have are. I mean, we have medications that do things that we don’t really understand, but seem to have some help for some people.
We have things like E.M.D.R., which do things we don’t understand, but help some people, or theater therapy, or yoga. We know exercise is good. We don’t always exactly know why. Now we’re exploring psychedelics, which have profound effects and seem to, with the right level of integration, help with trauma. We’re very like, kind of throwing stuff against the wall and finding some things unexpectedly work in ways we don’t fully understand.
So do you think that there are just limits to what we can access in the kind of deep psyche? Or do you think that 100 years from now, or 50 years from now, our treatments today are just going to seem incredibly crude, like we just had not discovered germ theory or something?
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BESSEL VAN DER KOLK: All of the above, and none, to some degree. I don’t think we are throwing everything against the wall. We’re doing actually the opposite. We’re looking for yet another drug doing the same old stuff that we have done. We are looking at yet another talk therapy that will make people into sensible human beings.
We have, as a discipline, completely ignored our early data, when we first started to image trauma in the brain, that trauma sits on the right side of the brain. And so these right brain phenomena are lasting phenomena. And so the time has come to really start looking at what else can we do, because basically the funding has been very much focused on talking therapies and drug therapies.
So no, we haven’t thrown things against the wall. I’m still waiting for the study of comparing tango dancing with cognitive behavioral therapy. I’m a scientist, it’s an empirical question. But I put my money on tango dancing over C.B.T., by and large, for some people. So I think we need to explore much more.
Is the world open for it? Yes and no. For example, I was able to start a foundation, and rather than become a recipient of funding, I’m able to fund some studies. Now the very first study we are funding is a study of touch and trauma. Everybody who knows anything about trauma, is that some of these people have very varied and oftentimes very anomalous responses to human touch.
People have won Nobel prizes about vision, Nobel prizes about audition. Touch is basically off the wall. The main way that people get comfort in life is through being touched. Once you have been touched inappropriately, touch maybe can defeat this. Let’s study touch.
We are synchronous human beings. The source of pleasure in our lives is to be in sync with each other. The reason why I like talking with you is because, whenever you ask a question, I go, “Boy this guy really gets it.” I feel you’re in sync with me, which gives me a tremendous sense of pleasure. So being in sync with people is critical for our sense of fun, of feeling alive. So how can we increase people’s sense of synchronicity with other human beings?
So I don’t know how it will work itself out, because in the world we live in, everything gets monetized. And so we tend to be able to study very expensive technical treatments more than simple treatments. And so where things will go, God knows. But boy, are we missing the boat on exploring a much larger number of options. Yes, up to now we have.
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EZRA KLEIN: On the point of touch, that there are a couple lines in your book that have really etched themselves in me. And one in particular here where you say that “the things that calm adults are the same things that calm children. Being held, being rocked, and being shushed.” And I don’t know. I just found that very moving.
BESSEL VAN DER KOLK: It’s true! You see it through to have your own kid go — yeah, he’s very young. But I need to do the same thing for him as I need myself.
EZRA KLEIN: But at some point, we make it very difficult for adults to ask for those things. You can maybe ask your partner, and that’s it. Particularly, I’ll speak more for men here, because I understand male relationships a little bit better, but you really, as a man, you can’t go to your male friends and ask to be rocked and shushed. [LAUGHTER]
BESSEL VAN DER KOLK: Yeah, a little bit, the culture has something to do with it.
EZRA KLEIN: Yeah, and it just strikes me as a shame. To the point you were just making, we spend so many billions of dollars, and so much effort to get the medications we think will help, and to see psychiatrists. And we’ve also cut ourselves off from a lot of just very cheap things, right? We have culturally cut ourselves off from a lot of touch, right? We often live in very atomized ways.
I mean there’s very kind of cheap, natural things that are part of our deep history that we give to our children, or at least in many homes, that, I don’t know, we’ve just decided are a little somehow uncouth, and we suffer for it.
BESSEL VAN DER KOLK: A very big part of what you’re talking about is our socially stratified system, and our humongous income inequality. I sent my kids to schools where there was a lot of theater, music, dancing, creative writing, sports. They were always moving and creating things. The poorer you are, the less you get any of these things.
EZRA KLEIN: We’re going to come back, we’re definitely going to come back at the end to the bigger question of inequality. But before we do that, I want to reverse the way we’ve been looking at this. We’ve been talking about the way traumatized people are disconnected from their communities. And I want to talk a little bit about what it means to be in community with somebody who is traumatized.
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A lot of the patients you talk about in the book, a lot of the behaviors that traumatized people exhibit, they’re very alienating to those around them. They’re difficult, they can be dangerous. Can you just talk a bit about what trauma is like for those who love someone who is traumatized?
BESSEL VAN DER KOLK: It is very hard to be with someone who is traumatized, who suddenly shuts down, suddenly blows up. And it takes an enormous toll on relationships. And oftentimes partners get blamed for the other party’s behavior. And so it really finds its way into relationships.
And so, groups of survivors become very important. Groups of incest survivors, groups of people who were molested by Catholic priests, people who struggle with addiction, helping each other say, I know what you’re talking about. I’m not here primarily to condemn you, but to keep you company in your struggle. For a survivor, it’s terribly important.
In a couple’s relationship, that’s harder, because you have a job to do, raising kids, et cetera, et cetera. But these support groups can be very good to give people a sense of being a member of the human race. And once you stop feeling like a member of the human race, your chances for wanting to survive become very slim.
EZRA KLEIN: How do you advise people to deal with the very difficult question of what you can ask of someone they love? I mean, the tension between recognizing the reality that people’s actions are often largely out of their control. They don’t want to treat us badly, they don’t want to disconnect, they don’t want to pull back, and also that we don’t want to be mistreated, or taken advantage of, or hurt.
And that there is something you can ask of some people, right? Sometimes you can ask somebody to treat you better. And then sometimes you need to recognize that there is healing that has to happen before they’re going to be able to do that. But it’s often hard to know which situation is which. Do you have advice for people who feel like they’re in that situation?
BESSEL VAN DER KOLK: Yeah. I think that’s really — to a large degree that’s what relationships are all about. It’s the continuous negotiation of, what can we be for each other? A relationship is about being there for each other. So my job, if you and I are in a relationship, is indeed to try to create situations in which you can feel safe and be productive.
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But your demands may be too much for me. And I need to be able to say, honey, I cannot do it. I really need to sleep in a bedroom by myself if you wake up screaming in nightmares all night, and it must be very hard for you if I cannot sleep in the same bed with you. But we both have needs. And these are very hard to negotiate. And I think you need to have a lot of consciousness, and a lot of awareness to actually be able to sit down and to identify these issues, and to talk about these issues.
But that is the nature of relationships. What can I do, what can I not do, what are the expectations, to what degree can I fulfill these obligations, and to what degree do you need to get the resources for yourself from somebody else? Because I’m depleted, I cannot give you what you’re asking for.
EZRA KLEIN: So I want to go back then to this question of the broader society that you were talking about a minute ago, with schools and inequality. On one level, it’s clear I think that providing child care, and pre-K, and well funded schools, and universal health care, and better access to mental health services would help make a society that is better at helping people.
But on some level, that also can’t be the whole answer, because a lot of middle and upper class people’s lives are full of trauma, too. So I’m curious what you think are the structures and institutions, or even just social mores, that would help us become healthier, and help people either be traumatized less often or help them more once they are?
BESSEL VAN DER KOLK: It’s of course, very complex, and nobody has the answers. But creating situations where parents can safely take care of their kids is terribly important. And of course, that is much easier when you have money than if you don’t have money. So almost every other society has universal health care and has support, which we lack.
So for me, this is really a very big issue. Yes, it’s because of the system we live in, the majority of people I treat are people who come from relatively fortunate circumstances. Because if you come from very low education and you don’t have a high school diploma, there’s no way you will find a way of getting to see an experienced mental health professional.
EZRA KLEIN: What interventions for kids do you think would do the most good? I mean, if you could wave your wand and put some new structures into law that they have elsewhere, or that they don’t have elsewhere, what would the first couple of them be?
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BESSEL VAN DER KOLK: Well first of all, child care, that you don’t have to be locked up with the same person all the time. It’s very important for a kid to have the experience of being exposed to more than one adult, and to see that other people have different ways of doing business. So you can actually see, oh my mom gets very upset, as opposed to, oh, that’s the world I live in.
The second piece is to be involved in rhythmical activities with other kids. Moving together with other kids, dancing together with other kids, playing with other kids, exploring the world with other kids, is so at the core of what creates a healthy mind and a healthy brain. That means that there is space, and that people can actually explore things safely. You can actually go out with your friends and try things out, so you don’t live in an environment where there is so much danger outside the door, or inside the door, that you cannot play anymore.
So I would say the most important thing for traumatized kids is to go to places where they can play. And that is, even in some very well known children’s institutions, there are hardly any places to play. Hardly any place to move around. To sing, to play, to dance, to run. So kids are supposed to really move. And move with other kids.
And basically, our systems are made to move in synchrony with the people around us. When you get traumatized, you get out of sync on every most elementary level. What does the military do? They have people move together and march together, to get them back in sync with each other.
EZRA KLEIN: And it sounds to me like you think the same is actually true for adults, that you need space to play, to move, to be in synchronicity with others, to sing, to dance, to have what gets called collective effervescence.
BESSEL VAN DER KOLK: Absolutely. Of course, you get more frozen as we grow older. But cooking with people, serving meals to people, pouring that wine to other people, still that moving together is a terribly important way of feeling our communality with other human beings.
EZRA KLEIN: And then I want to return to a question I said we’d tackle here at the end, which is you talked about the ways in which the post- 9/11 period in New York City was actually well handled from the perspective of trauma. One thing that led to us doing this podcast is your book has been back up, all the way up on the bestseller lists.
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And I don’t think that’s an accident. I think that has to do with people sensing a lot is wrong in themselves and in society, as we do and, in some cases, don’t recover from the coronavirus. So we’ve just been through a society- wide trauma, we are still going through it. But at some point, there’s going to be the potential maybe for recovery. Are there lessons from New York City after 9/11 for countries when they finally can turn to trying to recover from this pandemic?
BESSEL VAN DER KOLK: To my mind, the biggest lesson from New York was, for one thing, everybody knew the reality of what had happened. And nobody blamed anybody on the inside. So that immediately puts the issue of secrecy and shame off the map, which is fairly rare when it comes to trauma.
The next thing is that people actually did things. People got together in neighborhood groups, they got together with their family. And there’s a lot of communality in New York. New York temporarily became a very kind city. People really were lovely with each other. They made space for each other. It was almost unrecognizable.
The other thing is that money poured into New York. Something like half of all Americans donated money. So there was no dearth of resources. So many people who are traumatized have no resources. They have no money. We don’t have universal health care. If you don’t have good insurance, it’s very hard to get many of the treatments that I talk about.
So the issue of access and resources is huge. And if we wanted to have good health care systems, we need to have universal health care. We cannot have one health care system for the rich and a completely different health care system for the poor.
EZRA KLEIN: I think that’s a good place to end. So always, our final question. What are the three books that have influenced you that you would recommend to the audience?
BESSEL VAN DER KOLK: Yeah. Eve Ensler, who now calls herself V, wrote a beautiful book called “The Apology.” Her whole work comes from having been severely molested by her dad. And I think her book, and her other work also, is an extraordinary testimony of courage, of facing up to yourself, and to your experience, and then going on. She’s just marvelous.
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The other book that comes to mind is “Love at Goon Park.” It’s a book about Harry Harlow and his laboratory, his discovery of attachment in monkeys. So just a marvelous book about us as human beings, being very much like interactive with other people. And Harry Harlow is a very flawed human being discovering that.
Another book that I think is great, an Australian guy by the name of [Richard] Flanagan, who wrote a book called “The Narrow Road to the [Deep] North,” about war experiences and how war experiences impact on people and get split off. I could just go on, and on, and on. Karl Marlantes’s book about “What It’s Like to Go to War” is an extraordinary description, up there with Tolstoy’s, about the war experience, and his own journey to recovery. Those are just three or four examples.
EZRA KLEIN: Bessel van der Kolk, your book is “The Body Keeps the Score,” it’s remarkable. Thank you very much.
BESSEL VAN DER KOLK: Thank you. It’s a pleasure.
“The Ezra Klein Show” is a production of New York Times Opinion. It is produced by Jeff Geld, Roge Karma and Annie Gelvin. Fact checking by Michelle Harris, original music by Isaac Jones and mixing by Jeff Geld.
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