Brain, Mind, and Body in the Healing of Trauma
by Bessel van der Kolk
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0] Introduction
We often associate trauma with the experiences of soldiers in war or refugees dis-
placed by violence. But the unfortunate reality is that trauma happens all around
us, every day. According to the Centers for Disease Control and Prevention (CDC),
about 20% of people living in the United States were sexually abused as children,
and a quarter were physically beaten to the extent that marks were left on the body.
Because people are naturally resilient, we can survive, and even thrive, after such
traumatic events, but they may also end up impacting our mental, emotional, and
even physical health. Trauma has societal and interpersonal consequences as well.
Whether or not you’ve gone through serious trauma, you’ve probably interacted
with someone who has.
- The first two parts of this Snapshot explain the latest research on the effects that stressful experiences have on our brains and bodies.
- The third part further explores the specific impact early childhood trauma has on developing brains.
- The next part examines the mechanisms through which traumatic memories influence us in the years, and even decades, after the traumatic events are over.
- Finally, the Snapshot discusses some of the most thoroughly researched treatments for trauma.
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Part 1] The Rediscovery of Trauma
On July 5, 1978, a man named Tom staggered into the reception area at a psychia
trist’s office. He was hungover after a weekend drinking alone in his office, a cop-
ing mechanism to avoid the combination of explosive fireworks sounds, humid
summer air, and dense foliage in his backyard that came with Independence Day.
Taken together, these things reminded him of his time fighting in the Vietnam War.
Tom’s flashbacks arrived with triggering moments in his waking life and also
struck as recurring nightmares.
When the psychiatrist suggested taking pills to help the flashbacks go away,
Tom refused, explaining that without these reminders of the trauma, he would be
leaving behind friends who had died in the war. Though Tom had been home from
Vietnam for almost a decade, he was still committed to reliving his experience
there, even to the detriment of his own well-being.
At the time, there was little understanding of how to treat Tom’s condition, now
known as post-traumatic stress disorder (PTSD). First officially recognized as a diagnosis in 1980,
PTSD can manifest as
- flashbacks,
- nightmares,
- substance abuse,
- depression,
- mood disorders, and
- hallucinations.
a] Revolutions in understanding mind and brain
Since it was first identified, we have gained a vast amount of knowledge about how and why PTSD occurs, thanks to psychological research and technological ad-
vancements in brain imaging.
In the mid-1980s, Steve Maier and Martin Seligman produced groundbreaking
research about the impact of traumatic experiences in animals. They found that after experiencing repeated electric shocks, the animals’ fight-or-flight responses dwindled, leaving them with no desire to escape future harm.
A few years later, a handful of studies focused on the hormone levels of people
with PTSD.
The researchers showed that even long after their traumatic experiences had passed, patients’ bodies continued to secrete high levels of stress hormones instead of returning to equilibrium. In effect, people with PTSD are constantly on edge, which makes it nearly impossible for them to recognize what is safe and what is dangerous. The symptoms associated with PTSD are a result of this clouded reality.
b] The neuroscience revolution
The emergence of brain imaging technology in the 1990s advanced PTSD research by leaps and bounds. Positron-emission tomography (PET) and its successor, functional magnetic resonance imaging (fMRI), have given scientists the ability to see which parts of the brain are activated by various stimuli and memories.
This imaging has helped us understand PTSD by verifying the different functions of the left and right hemispheres of the brain.
- For example, imaging has demonstrated that when someone with PTSD is having a flashback, parts of the left hemisphere that organize experiences into a coherent reality shut down.
- Meanwhile, right-brain areas that deal with strong emotions and sensations take over. This distorted sense of reality often leads people to lose foresight about the potential consequences of their actions.
Part 2] This Is Your Brain on Trauma
Noam was 5 years old when he witnessed the first plane fly into the World Trade Center from his classroom about a quarter mile away. Noam, his classmates, and
his family all survived. Noam never suffered from PTSD as a result of seeing this
tragedy unfold.
A few key conditions allowed Noam to move on from what he saw in a healthy
way.
First, he had the opportunity to exercise his natural fight-or-flight response as
he and his classmates moved to safer locations.
- Then, once at home, surrounded by supportive family,
- he instinctively processed the events by drawing what he saw. In one image, Noam depicted the collapsing twin towers surrounded by trampo-
- lines, so the people inside could jump down to safety.
- The ability to feel control when reacting to danger is of utmost importance. People are most likely to develop PTSD when they are prevented from taking necessary action in a traumatic moment. If escape isn’t possible, the brain will naturally continue to seek it out, even when the actual danger has passed.
- It is also important to have a set of healthy coping mechanisms for dealing with stressful experiences.
- These can include talking, moving your body, and making art, Noam’s tool of choice.
a] Body–brain connections
Though Darwin’s On the Origin of Species gets more attention, his later book The
Expression of Emotions in Man and Animals provides key insights to understanding the brain–body connection.
Darwin observed, in both humans and other animals, that the job of emotions is to keep us safe.
He also explored the idea that emotions influence the state of our heart and gut through the nervous system. Generally we are able to cope with feelings when they stay in the brain,
but when an emotional state begins to negatively impact physical well-being — as with nausea, for example — our experiences become unbearable. At this point, people often cope by numbing themselves with drugs or alcohol, or engaging in other dangerous behaviors.
More than a century later, researcher Stephen Porges expanded on Darwin’s
ideas. Porges found that
humans’ sense of safety depends largely on sensing the emotional state of those around us.
Simply hearing supportive words from a familiar person in a moment of stress can make you feel significantly more at ease.
The importance of keeping balance in one’s internal and interpersonal health cannot be overstated. Almost all forms of mental illness can be traced back to difficulty regulating emotional states and maintaining stable relationships.
b] Losing your body, losing yourself
Before Sherry had even spoken a word to her new therapist, her body language — shoulders turned in, head down — told him she was afraid. Her arms, she explained, were covered with scabs that she couldn’t stop picking.
Growing up, Sherry’s household often held about a dozen foster children at a
time. While her mother tasked Sherry with caring for many of these kids, she also
repeatedly made comments about how Sherry didn’t belong in the house or the
family.
With her therapist, Sherry confessed to feeling numb. Picking at her skin was the only way she could feel a connection to her body. With the goal of stimulating
Sherry’s bodily sensations, her therapist recommended massage therapy. When
the massage therapist got started by working on Sherry’s feet, however, Sherry
yelled out, asking where the therapist had gone. Her brain was unable to register
feeling in that part of her body.
Sherry’s case is just one example of how trauma can numb our senses and pre
vent people from experiencing healthy levels of connection with their surround-
ings. When someone can’t trust their perception of reality, they struggle to feel safe and their bodies often struggle to regulate basic functions such as sleep and appetite.
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Part 3] The Minds of Children
You’ve probably heard of Rorschach, or inkblot, tests in which people are shown abstract shapes and asked to interpret what they see. To study the effects of trauma on children, two researchers used a similar approach, with pictures of innocent everyday scenes. One card showed a man fixing a car while two kids watched, smiling. When presented with this image, children who hadn’t been traumatized told stories about, for example, a successful repair followed by a McDonald’s trip.
Those who had lived very difficult childhoods, however, came up with tales about
the kids hitting the man with tools or kicking out the jack so that the car would
crush him.
John Bowlby’s attachment theory offers insight into parental influence on a
child’s lifelong well-being. Bowlby’s research shows that we are born with the in-
stinct to deeply connect to caregivers. These relationships, called primary attachment bonds, are key to a child’s survival, particularly in their early years.
If these primary bonds are reliable and nurturing, the child can logically expect the same from others, creating a foundation of trust.
If the opposite is true — for example, if neglect or emotional abuse is present — the child will instead tend to be suspicious of others and have trouble forming relationships, even into adulthood.
a] Adverse childhood experiences
Between 1995 and 1997, Vincent Felitti and Robert Anda surveyed more than
17,000 adult patients at the Kaiser Department of Preventive Medicine about adversity in their childhoods. The findings of this study were shocking. Though the patients had identities we associate with privilege and stability — white, middle class, well educated — two-thirds reported experiencing at least one of 10 types of childhood trauma.
For example, more than one in four respondents reported being repeatedly
physically abused growing up. And having one adverse childhood experience
9 (ACE) greatly increased the likelihood of having more: 87% of those with at least one ACE reported two or more.
But it wasn’t just the prevalence of traumatic experiences that made this study
revolutionary. Because the respondents were adults, Felitti and Anda were able to
study correlations between childhood trauma and adult health.
Those who experienced six or more ACEs were twice as likely to have cancer and four times as likely to have emphysema than those with zero, even when controlling for other factors.
Those who reported four ACEs were seven times more likely to develop alcoholism than those with none.
emphysema - a condition in which the air sacs of the lungs are damaged and enlarged, causing breathlessness.
b] The case for diagnosis
Children who have experienced chronic trauma need a lot of support.
A diagnostic category called developmental trauma disorder (DTD) has been proposed to garner funding for further study into treatment for this population.
This new category is necessary because, as data from the National Child Traumatic Stress Network shows, the vast majority of kids with histories of abuse and
neglect (82%) do not meet the criteria for PTSD.
As a result, they are more often diagnosed with mood or behavioral disorders. Treatments for these conditions do not address the cause of the child’s problems.
There is indeed sufficient data to define the symptoms of DTD:
- emotional dysregulation,
- trouble concentrating, and
- difficulty with social interactions.
Based on these symptoms and a known history of trauma, a DTD diagnosis would provide crucial resources to kids who are otherwise falling through the cracks.
Trauma experts presented their case for DTD as a new diagnostic category to the
American Psychiatric Association (APA) in 2009 but were rejected on the claim
that the diagnosis was too niche — despite the fact that an estimated one million
children are abused or neglected each year in the United States.
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Part 4] The Imprint of Trauma
In 2001 Julian was on the phone with his girlfriend, Rachel, when she told him
about what she’d read in that morning’s edition of The Boston Globe. The article explained that a priest named Shanley was being investigated for child molestation.
Rachel thought she remembered Julian mentioning working with that priest as a
child and asked him about it.
In the past, Julian had recalled Shanley only as a supportive mentor, but this
news brought back an overwhelming wave of dark memories. He realized that he
had been one of the victims. In the weeks after his conversation with Rachel, Julian began to experience panic attacks, dissociation, and seizures, and started scratching his body uncontrollably. Julian was unable to keep his job, and he started having flashbacks, particularly in sexual situations with his girlfriend.
Traumatic memories differ from regular ones because our brain becomes over-
whelmed during moments of shock, unable to save coherent versions of events.
Instead of stories, we remember only sensory and emotional fragments. As a result of the distinct format of these memories and their dark nature, it is difficult for our brains to process and sort them as we do other experiences.
a] The importance of remembering
Erich Maria Remarque’s 1929 novel All Quiet on the Western Front describes the impact of World War I on the mental health of an entire generation of men. The protagonist, home from war, no longer feels emotions and just wants to be left alone.
This work was one of the first attempts to characterize traumatized soldiers and
veterans as something other than weak.
Remarque’s message met considerable pushback in its time and wasn’t taken
seriously even decades later. In the early 1980s, the U.S. Department of Veterans
Affairs treated Vietnam veterans for only the physical manifestations of their PTSD, such as stomach cramps and chest pains. The medical establishment ignored nightmares, flashbacks, and the underlying causes of these symptoms.
Fortunately, the past few decades have been marked by the expansion of main-
stream mental health services.
Therapists and other professionals provide safe places for those who have experienced trauma to talk about it openly. As people work through what happened to them out loud, they can better leave it in the past.
Mental health professionals can also connect patients to other forms of treatment,
such as body work and medication.
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Part 5] Paths to Recovery
Options for healing from trauma include steps a person can take on their own and some that involve professional help. The goal of all these tools is the same: working toward facing your trauma so that you can move on from it.
Specifically, recovery tools should help you build these four capacities:
1.Finding calm focus.
2.Remaining calm and focused despite external circumstances.
3.Being fully present in your body.
4.Keeping an inner awareness and staying honest with yourself.
Here are two strategies you can try on your own:
1.Meditation and mindfulness. These tools help you stay present in your body
by focusing on your breathing. Slowing your breathing also calms you on a
physiological level.
2.Reaching for relationships. When facing your difficult past (or present), it is
crucial to have a social support system. Trusted friends and family provide
the sense of safety the body needs to return to equilibrium after stress or
trauma.
Confronting trauma on your own is a great start to managing it, but most people
need professional help to fully recover. Here are a few treatment options that have proven effective for many people.
1.Talk therapy. It is vital to open up about trauma to make sense of it. We are often taught to be ashamed of trauma and that we should hide it away. But
keeping things inside actually takes a huge amount of energy and is detri
mental to our other pursuits. Therapists can lend a trustworthy ear and help
steer conversations in productive directions. Together, you can create a
cohesive story about what happened where there used to be only fragments.
2.Eye movement desensitization and reprocessing.
Words are sometimes not enough to heal.
Eye movement desensitization and reprocessing (EMDR) allows for subconscious reprocessing of traumatic memories.
In this treatment, the patient moves their eyes back and forth, following the therapist’s finger.
The patient goes into a state that’s similar to REM sleep,
in which the brain has its greatest capacity for processing information.
While the patient is in this REM-like state, the therapist guides them through their traumatic memories. This gives the brain a better chance to organize them in a manageable manner.
3.Yoga. People with PTSD can become disconnected from their bodies. Yoga
can help relieve muscle tension as well as rebuild connections with one’s
physical senses. Yoga is essentially moving meditation; coordinating actions
with the breath can aid with emotional and bodily regulation.
Like a therapist, a yoga instructor should be someone with whom you can build a trusting relationship.
4.Self-leadership. All of us are made up of different parts:
the inner child, the protective parent, and the goofy friend, for example.
Managing these different parts is a crucial skill called self-leadership. It can be helpful to explicitly name these different parts of yourself and work to ensure that each is receiving sufficient attention.
By improving your capacity for self-leadership, you can learn to recognize the needs of each part of yourself and understand the purposes and strengths of each.
5.Structures. The dynamics of past trauma usually rest in our heads. Creating
structures involves bringing trauma to three-dimensional life through role-
playing.
In group therapy, the patient (or protagonist) assigns peers to var-
ious roles, such as mother, father, brother, best friend, ideal father, or ideal
mother, and directs their actions.
Enacting structures in the safe context of
group therapy allows people to address and feel control over relationships that have hurt them.
This is by no means an exhaustive list of treatment options for PTSD. It’s impor-
tant to meet with a mental health professional and explore the options that are best for your individualized needs.
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Conclusion
The research of the past few decades has helped mental health workers and re-
searchers greatly expand their understanding of trauma,
but as a society, our collective mental health seems to be worsening.
When you consider the structural circumstances, this is hardly a surprise:
- Social safety nets like public housing are underfunded;
- mass incarceration is a huge problem, particularly in black communities;
- health care is not accessible to all.
The fact is that the treatment and prevention of trauma cannot be separated from
politics.
If we expect people to live safe and supportive lives, we need to ensure
that they have access to the basic necessities: healthy food, clean water, stable shelter, good education, and health care.
As long as our government fails to prioritize services for all Americans, the public health crises of chronic trauma and PTSD will live on.
We can do our part by forming supportive relationships with one another, seeking help when we need it, and advocating for the funding of social services. Above all, remember that experiencing trauma is not a death sentence.
Leaders such as Maya Angelou and Nelson Mandela have moved on from great personal devastation to make important contributions to society. There is always hope for healing, in ourselves and in the world.
