How the body keeps the score on trauma | Bessel van der Kolk for Big Think+

(text clicks) (thoughtful music) - Trauma is so pervasive that if you

think

you've never seen it, you haven't looked at it. We know people who go crazy. We meet people who close down. We know people who are very difficult. You know, it's a rare family that doesn't have a drug addict, alcoholic or disturbed person. You know, one thing I like to say when I give a lecture is, "Are there normal people, who come from normal families, in the audience?" And sometimes one or two people raise their hands. I say, "Can I come with your family for Thanksgiving?

Because I've never been with a normal family." My name is Bessel van der Kolk. I am a psychiatrist, neuroscientist. I've been studying

trauma

for about 50 years. I have treated a variety of different

trauma

tized populations, seen trauma in many different countries around the world, and am the author of the book "The Body Keeps the Score." (thoughtful music) It's important for people to realize that not all mental health professionals know what we're talking about here. The dominant system of psychiatry-psychology is that something is wrong with you and I need to fix you. That's a very different attitude than dealing with trauma.

When I started working for the VA, a group of us started defining what trauma is and started defining what happens to people. 1978 was the year and the Vietnam War was over in about six or seven years. The first day I met the Vietnam veterans I was impressed. They kept referring to their dead comrades. Their hearts seemed to go out to the people who were no longer there. They had a hard time loving their wives and girlfriends. They had a hard time being meaningfully involved in the present. They were kids my age, intelligent and competent, but clearly they were just a shadow of their former selves.

And what was also really surprising is that they were passive most of the time. And then people told them something that was disappointing, and they went from zero to 10 and they exploded and got really angry. Something seemed to have happened to them that made it very difficult for them to modulate their responses to the environment. My colleagues and I started

think

ing about how what these guys suffer is different from what other people in psychiatry textbooks suffer from. So I dug up a book written in 1941 by Abram Kardiner, who had been working with World War soldiers. He wrote: "These boys are suffering from a physioneurosis.

Their bodies continue to re-experience that terrible and terrifying situation, and that event

keeps

coming back in terms of images, behaviors and physical sensations." So that became the core of our definition of PTSD. We wrote: "These people have been exposed to an extraordinary event that is outside the normal human experience." And in retrospect, that shows us how ignorant and narrow-minded we were because it turned out that this is not an unusual experience at all. In reality, trauma is, unlike what we first thought, extremely common. One in five women in the United States has a history of sexual abuse.

Many men even have a history of sexual abuse. One in four children receives severe beatings from their parents. One in eight children sees physical fights between their parents. People often think of the military when they talk about trauma, but when we started working with inner-city kids, the amount of trauma these kids experienced was simply indescribable. The nature of trauma is that an experience goes into your ears, into your skin, into your eyes and down into a very primitive part of your brain that automatically interprets what is happening. Is this dangerous or is it safe? An event becomes traumatic when there is nothing you can do to avoid the inevitable and your

body

automatically begins to enter a state of fight/flight or collapse.

The lingering effect of trauma is that you continue to react to mild stressors as if your life is in danger. And that's why you tend to become hyperreactive. Someone may irritate you in the supermarket. You may develop road rage. You may find it difficult to tolerate bad behavior from your spouse or children. And most people are actually barely aware or not aware at all that the reactions they are having right now are actually rooted in experiences they have had before. That event itself is already over, but you continue to react to things as if you were in danger.

So the big challenge in trauma treatment is how do we help people live in bodies that feel fundamentally safe? The tradition in mental health is to dismiss the reality of people's lives. For example, it's only in recent years that people have started to talk about the impact of poverty, the impact of racism, or the impact of unemployment. And people have been labeling people: "Oh, something's wrong with you. Let me fix you." But if you go to a doctor or a mental health professional who doesn't understand that, they will try to cure you with medication or cognitive behavioral treatment so you don't do this crazy thing again.

It usually doesn't work very well. What was very clear is that being in a relationship where people can listen to you, where you can talk about how bad you feel, where you can talk about your guilt and where you can start to open up about where those feelings come from, how old they are. It's feelings and how you develop these feelings in response to particular things that happen to you, that was actually very helpful because you really need to develop a deep sense of, "This is what happened to me. This is what I'm dealing with." . and I need to take care of the wounds that I carry inside of me." This issue of self-compassion and really knowing that your reactions are understandable and rooted in you being stuck in the past is a terribly important part of beginning to recover from trauma.

Most of us are survivors of one thing or another, some much worse than others. So if people say, what do you wish your legacy was? I would say, I want our society to know about trauma and really do everything. what is necessary so that people who grow up in extreme and adverse conditions can develop a brain and a mind that can help them become full members of society. That is our great problem and that is the great challenge we have. thoughtful music)