# The Body Keeps the Score ## Metadata * Author: [Bessel van der Kolk](https://www.amazon.comundefined) * ASIN: B00IICN1F8 * ISBN: 0670785938 * Reference: https://www.amazon.com/dp/B00IICN1F8 * [Kindle link](kindle://book?action=open&asin=B00IICN1F8) ## Highlights Research by the Centers for Disease Control and Prevention has shown that one in five Americans was sexually molested as a child; one in four was beaten by a parent to the point of a mark being left on their body; and one in three couples engages in physical violence. — location: [52](kindle://book?action=open&asin=B00IICN1F8&location=52) ^ref-15020 --- quarter of us grew up with alcoholic relatives, and one out of eight witnessed their mother being beaten or hit.1 — location: [54](kindle://book?action=open&asin=B00IICN1F8&location=54) ^ref-19318 --- Trauma affects not only those who are directly exposed to it, but also those around them. — location: [59](kindle://book?action=open&asin=B00IICN1F8&location=59) ^ref-48360 --- the shame of utter weakness and vulnerability. — location: [65](kindle://book?action=open&asin=B00IICN1F8&location=65) ^ref-31861 --- Feeling out of control, survivors of trauma often begin to fear that they are damaged to the core and beyond redemption. — location: [69](kindle://book?action=open&asin=B00IICN1F8&location=69) ^ref-63280 --- new disciplines are neuroscience, the study of how the brain supports mental processes; developmental psychopathology, the study of the impact of adverse experiences on the development of mind and brain; and interpersonal neurobiology, the study of how our behavior influences the emotions, biology, and mind-sets of those around us. — location: [79](kindle://book?action=open&asin=B00IICN1F8&location=79) ^ref-5830 --- trauma produces actual physiological changes, including a recalibration of the brain’s alarm system, an increase in stress hormone activity, and alterations in the system that filters relevant information from irrelevant. — location: [82](kindle://book?action=open&asin=B00IICN1F8&location=82) ^ref-2895 --- understand why traumatized people so often keep repeating the same problems and have such trouble learning from experience. — location: [85](kindle://book?action=open&asin=B00IICN1F8&location=85) ^ref-53147 --- not the result of moral failings or signs of lack of willpower or bad character—they are caused by actual changes in the brain. — location: [86](kindle://book?action=open&asin=B00IICN1F8&location=86) ^ref-543 --- There are fundamentally three avenues: 1) top down, by talking, (re-) connecting with others, and allowing ourselves to know and understand what is going on with us, while processing the memories of the trauma; 2) by taking medicines that shut down inappropriate alarm reactions, or by utilizing other technologies that change the way the brain organizes information, and 3) bottom up: by allowing the body to have experiences that deeply and viscerally contradict the helplessness, rage, or collapse that result from trauma. — location: [90](kindle://book?action=open&asin=B00IICN1F8&location=90) ^ref-42524 --- When he got upset he was afraid to be around his family because he behaved like a monster with his wife and two young boys. The noise of his kids made him so agitated that he would storm out of the house to keep himself from hurting them. Only drinking himself into oblivion or riding his Harley-Davidson at dangerously high speeds helped him to calm down. — location: [129](kindle://book?action=open&asin=B00IICN1F8&location=129) ^ref-32764 --- that by faking it he would learn to become his old self again. — location: [144](kindle://book?action=open&asin=B00IICN1F8&location=144) ^ref-27682 --- He now had a thriving law practice and a picture-perfect family, but he sensed he wasn’t normal; he felt dead inside. — location: [144](kindle://book?action=open&asin=B00IICN1F8&location=144) ^ref-16043 --- disconnected from their loved ones and unable to find any real pleasure in their — location: [153](kindle://book?action=open&asin=B00IICN1F8&location=153) ^ref-5565 --- “I realized that if I take the pills and the nightmares go away,” he replied, “I will have abandoned my friends, and their deaths will have been in vain. I need to be a living memorial to my friends who died in Vietnam.” — location: [166](kindle://book?action=open&asin=B00IICN1F8&location=166) ^ref-32961 --- How do horrific experiences cause people to become hopelessly stuck in the past? — location: [171](kindle://book?action=open&asin=B00IICN1F8&location=171) ^ref-277 --- In one terrifying moment, trauma had transformed everything. — location: [176](kindle://book?action=open&asin=B00IICN1F8&location=176) ^ref-55005 --- “traumatic neuroses,” today we call posttraumatic stress disorder—PTSD. — location: [193](kindle://book?action=open&asin=B00IICN1F8&location=193) ^ref-42095 --- chronic vigilance for and sensitivity to threat. — location: [194](kindle://book?action=open&asin=B00IICN1F8&location=194) ^ref-24136 --- “The nucleus of the neurosis is a physioneurosis.”2 In other words, posttraumatic stress isn’t “all in one’s head,” as some people supposed, but has a physiological basis. — location: [195](kindle://book?action=open&asin=B00IICN1F8&location=195) ^ref-22796 --- We had only one real textbook, he said: our patients. — location: [200](kindle://book?action=open&asin=B00IICN1F8&location=200) ^ref-32276 --- human beings are experts in wishful thinking and obscuring the truth. I remember him saying: “The greatest sources of our suffering are the lies we tell ourselves.” — location: [202](kindle://book?action=open&asin=B00IICN1F8&location=202) ^ref-10055 --- Congo. It is hard enough for observers to bear witness to pain. Is it any wonder, then, that the traumatized individuals themselves cannot tolerate remembering — location: [207](kindle://book?action=open&asin=B00IICN1F8&location=207) ^ref-31809 --- afterward. I could easily imagine how Tom’s rage about his friend’s death had led to the calamity that followed. It took him months of dealing with his paralyzing shame before he could tell me about — location: [227](kindle://book?action=open&asin=B00IICN1F8&location=227) ^ref-59075 --- Since time immemorial veterans, like Achilles in Homer’s Iliad, have responded to the death of their comrades with unspeakable acts of revenge. — location: [228](kindle://book?action=open&asin=B00IICN1F8&location=228) ^ref-8066 --- Trauma, whether it is the result of something done to you or something you yourself have done, almost always makes it difficult to engage in intimate relationships. After you have experienced something so unspeakable, how do you learn to trust yourself or anyone else again? Or, conversely, how can you surrender to an intimate relationship after you have been brutally violated? — location: [233](kindle://book?action=open&asin=B00IICN1F8&location=233) ^ref-35938 --- One of the hardest things for traumatized people is to confront their shame about the way they behaved during a traumatic episode, whether it is objectively warranted (as in the commission of atrocities) or not (as in the case of a child who tries to placate her abuser). — location: [237](kindle://book?action=open&asin=B00IICN1F8&location=237) ^ref-18401 --- It’s hard enough to face the suffering that has been inflicted by others, but deep down many traumatized people are even more haunted by the shame they feel about what they themselves did or did not do under the circumstances. — location: [243](kindle://book?action=open&asin=B00IICN1F8&location=243) ^ref-5805 --- They despise themselves for how terrified, dependent, excited, or enraged they felt. — location: [244](kindle://book?action=open&asin=B00IICN1F8&location=244) ^ref-59172 --- The result can be confusion about whether one was a victim or a willing participant, which in turn leads to bewilderment about the difference between love and terror; pain and pleasure. — location: [247](kindle://book?action=open&asin=B00IICN1F8&location=247) ^ref-57694 --- He desperately wanted to love his family, but he just couldn’t evoke any deep feelings for them. — location: [250](kindle://book?action=open&asin=B00IICN1F8&location=250) ^ref-31971 --- He could not really feel anything except for his momentary rages and his shame. — location: [252](kindle://book?action=open&asin=B00IICN1F8&location=252) ^ref-26158 --- always felt as though he were floating in space, — location: [256](kindle://book?action=open&asin=B00IICN1F8&location=256) ^ref-31635 --- I unwittingly paraphrased something Sigmund Freud had said about trauma in 1895: “I think this man is suffering from memories.” — location: [280](kindle://book?action=open&asin=B00IICN1F8&location=280) ^ref-37609 --- traumatized people have a tendency to superimpose their trauma on everything around them and have trouble deciphering whatever is going on around them. — location: [306](kindle://book?action=open&asin=B00IICN1F8&location=306) ^ref-55059 --- When people are compulsively and constantly pulled back into the past, to the last time they felt intense involvement and deep emotions, they suffer from a failure of imagination, a loss of the mental flexibility. Without imagination there is no hope, no chance to envision a better future, no place to go, no goal to reach. — location: [313](kindle://book?action=open&asin=B00IICN1F8&location=313) ^ref-25263 --- People who have not shared the traumatic experience cannot be trusted, because they can’t understand it. Sadly, this often includes spouses, children, and co-workers. — location: [331](kindle://book?action=open&asin=B00IICN1F8&location=331) ^ref-2844 --- They felt fully alive only when they were revisiting their traumatic past. — location: [342](kindle://book?action=open&asin=B00IICN1F8&location=342) ^ref-28943 --- But most of our patients were unable to make their past into a story that happened long ago.7 — location: [355](kindle://book?action=open&asin=B00IICN1F8&location=355) ^ref-45567 --- psychopharmacology, the administration of drugs to alleviate mental illness. — location: [362](kindle://book?action=open&asin=B00IICN1F8&location=362) ^ref-33609 --- incest was extremely rare in the United States, occurring about once in every million women.8 Given that there were then only about one hundred million women living in the United States, I wondered how forty seven, almost half of them, had found their way to my office in the basement of the hospital. — location: [366](kindle://book?action=open&asin=B00IICN1F8&location=366) ^ref-53868 --- the majority of Americans experience a violent crime at some time during their lives, — location: [379](kindle://book?action=open&asin=B00IICN1F8&location=379) ^ref-61629 --- More than half of all rapes occur in girls below age fifteen.11 — location: [380](kindle://book?action=open&asin=B00IICN1F8&location=380) ^ref-61283 --- In other words, for every soldier who serves in a war zone abroad, there are ten children who are endangered in their own homes. — location: [383](kindle://book?action=open&asin=B00IICN1F8&location=383) ^ref-32643 --- For real change to take place, the body needs to learn that the danger has passed and to live in the reality of the present. — location: [396](kindle://book?action=open&asin=B00IICN1F8&location=396) ^ref-12389 --- The greater the doubt, the greater the awakening; the smaller the doubt, the smaller the awakening. No doubt, no awakening. —C.-C. Chang, The Practice of Zen — location: [400](kindle://book?action=open&asin=B00IICN1F8&location=400) ^ref-50051 --- What you are is an expression of History. — location: [403](kindle://book?action=open&asin=B00IICN1F8&location=403) ^ref-4424 --- Thorazine), that could “tranquilize” patients and make them less agitated and delusional. — location: [412](kindle://book?action=open&asin=B00IICN1F8&location=412) ^ref-26268 --- We now know that more than half the people who seek psychiatric care have been assaulted, abandoned, neglected, or even raped as children, or have witnessed violence in their families. — location: [432](kindle://book?action=open&asin=B00IICN1F8&location=432) ^ref-20036 --- could it be that these “hallucinations” were in fact the fragmented memories of real experiences? — location: [454](kindle://book?action=open&asin=B00IICN1F8&location=454) ^ref-64129 --- Could people make up physical sensations they had never experienced? Was there a clear line between creativity and pathological imagination? Between memory and imagination? — location: [455](kindle://book?action=open&asin=B00IICN1F8&location=455) ^ref-36052 --- If you do something to a patient that you would not do to your friends or children, consider whether you are unwittingly replicating a trauma from the patient’s past. — location: [470](kindle://book?action=open&asin=B00IICN1F8&location=470) ^ref-46465 --- As a group the patients were strikingly clumsy and physically uncoordinated. — location: [472](kindle://book?action=open&asin=B00IICN1F8&location=472) ^ref-30746 --- “The greatest sources of our suffering are the lies we tell ourselves,” — location: [490](kindle://book?action=open&asin=B00IICN1F8&location=490) ^ref-15321 --- You can be fully in charge of your life only if you can acknowledge the reality of your body, in all its visceral dimensions. — location: [495](kindle://book?action=open&asin=B00IICN1F8&location=495) ^ref-60049 --- In 1968 the American Journal of Psychiatry had published the results of the study from the ward where I’d been an attendant. — location: [496](kindle://book?action=open&asin=B00IICN1F8&location=496) ^ref-64397 --- from infinitely variable expressions of intolerable feelings and relationships to a brain-disease model of discrete “disorders.” — location: [500](kindle://book?action=open&asin=B00IICN1F8&location=500) ^ref-7173 --- Many psychiatrists were relieved and delighted to become “real scientists,” just like their med school classmates who had laboratories, animal experiments, expensive equipment, and complicated diagnostic tests, and set aside the wooly-headed theories of philosophers like Freud and Jung. — location: [506](kindle://book?action=open&asin=B00IICN1F8&location=506) ^ref-32765 --- “The cause of mental illness is now considered an aberration of the brain, a chemical imbalance.”5 — location: [508](kindle://book?action=open&asin=B00IICN1F8&location=508) ^ref-49103 --- Antipsychotic drugs were a major factor in reducing the number of people living in mental hospitals in the United States, from over 500,000 in 1955 to fewer than 100,000 in 1996.7 — location: [518](kindle://book?action=open&asin=B00IICN1F8&location=518) ^ref-7466 --- (Ironically, the hospital was started as an “asylum,” a word meaning “sanctuary” that gradually took on a sinister connotation. It actually did offer a sheltered community where everybody knew the patients’ names and idiosyncrasies.) — location: [526](kindle://book?action=open&asin=B00IICN1F8&location=526) ^ref-7999 --- Neurotransmitters are chemical messengers that carry information from neuron to neuron, enabling us to engage effectively with the world. — location: [531](kindle://book?action=open&asin=B00IICN1F8&location=531) ^ref-57915 --- abnormal levels of norepinephrine were associated with depression, and of dopamine with schizophrenia, there was hope that we could develop drugs that target specific brain abnormalities. — location: [533](kindle://book?action=open&asin=B00IICN1F8&location=533) ^ref-10636 --- Research Diagnostic Criteria, — location: [536](kindle://book?action=open&asin=B00IICN1F8&location=536) ^ref-28220 --- American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM), which is commonly referred to as the “bible of psychiatry.” — location: [537](kindle://book?action=open&asin=B00IICN1F8&location=537) ^ref-9471 --- so imprecise that it never should be used for forensic or insurance purposes.8 As we will see, that modesty was tragically short-lived. — location: [539](kindle://book?action=open&asin=B00IICN1F8&location=539) ^ref-33014 --- Steven Maier of the University of Colorado, who had collaborated with Martin Seligman of the University of Pennsylvania. His topic was learned helplessness in animals. Maier and Seligman had repeatedly administered painful electric shocks to dogs who were trapped in locked cages. They called this condition “inescapable shock.” — location: [544](kindle://book?action=open&asin=B00IICN1F8&location=544) ^ref-5607 --- the dogs who had earlier been subjected to inescapable shock made no attempt to flee, even when the door was wide open—they just lay there, whimpering and defecating. The mere opportunity to escape does not necessarily make traumatized animals, or people, take the road to freedom. — location: [550](kindle://book?action=open&asin=B00IICN1F8&location=550) ^ref-27387 --- Like Maier and Seligman’s dogs, many traumatized people simply give up. Rather than risk experimenting with new options they stay stuck in the fear they know. — location: [552](kindle://book?action=open&asin=B00IICN1F8&location=552) ^ref-22422 --- Their fight/flight response had been thwarted, and the result was either extreme agitation or collapse. — location: [556](kindle://book?action=open&asin=B00IICN1F8&location=556) ^ref-3969 --- traumatized people keep secreting large amounts of stress hormones long after the actual danger has passed, — location: [560](kindle://book?action=open&asin=B00IICN1F8&location=560) ^ref-55660 --- Ideally our stress hormone system should provide a lightning-fast response to threat, but then quickly return us to equilibrium. — location: [564](kindle://book?action=open&asin=B00IICN1F8&location=564) ^ref-26550 --- In PTSD patients, however, the stress hormone system fails at this balancing act. Fight/flight/freeze signals continue after the danger is over, and, as in the case of the dogs, do not return to normal. Instead, the continued secretion of stress hormones is expressed as agitation and panic and, in the long term, wreaks havoc with their health. — location: [565](kindle://book?action=open&asin=B00IICN1F8&location=565) ^ref-2791 --- Scared animals return home, regardless of whether home is safe or frightening. — location: [578](kindle://book?action=open&asin=B00IICN1F8&location=578) ^ref-3337 --- Are traumatized people condemned to seek refuge in what is familiar? — location: [579](kindle://book?action=open&asin=B00IICN1F8&location=579) ^ref-36961 --- Freud had a term for such traumatic reenactments: “the compulsion to repeat.” — location: [594](kindle://book?action=open&asin=B00IICN1F8&location=594) ^ref-20731 --- believed that reenactments were an unconscious attempt to get control over a painful situation and that they eventually could lead to mastery and resolution. There is no evidence for that theory—repetition leads only to further pain and self-hatred. In fact, even reliving the trauma repeatedly in therapy may reinforce preoccupation and fixation. — location: [595](kindle://book?action=open&asin=B00IICN1F8&location=595) ^ref-62462 Implications for Hendricks’ theory --- we start to crave the activity and experience withdrawal when it’s not available. In the long run people become more preoccupied with the pain of withdrawal than the activity itself. — location: [605](kindle://book?action=open&asin=B00IICN1F8&location=605) ^ref-56146 --- Seven of the eight veterans kept their hands in the painfully cold water 30 percent longer during Platoon. We then calculated that the amount of analgesia produced by watching fifteen minutes of a combat movie was equivalent to that produced by being injected with eight milligrams of morphine, about the same dose a person would receive in an emergency room for crushing chest pain. — location: [616](kindle://book?action=open&asin=B00IICN1F8&location=616) ^ref-64630 --- that for many traumatized people, reexposure to stress might provide a similar relief from anxiety. — location: [620](kindle://book?action=open&asin=B00IICN1F8&location=620) ^ref-63621 --- the amygdala, a cluster of brain cells that determines whether a sound, image, or body sensation is perceived as a threat. — location: [624](kindle://book?action=open&asin=B00IICN1F8&location=624) ^ref-37966 --- Animals with low serotonin levels were hyperreactive to stressful stimuli (like loud sounds), while higher levels of serotonin dampened their fear system, making them less likely to become aggressive or frozen in response to potential threats.18 — location: [626](kindle://book?action=open&asin=B00IICN1F8&location=626) ^ref-62734 --- If we could find ways to increase brain serotonin levels, perhaps we could address both problems simultaneously. — location: [636](kindle://book?action=open&asin=B00IICN1F8&location=636) ^ref-59451 --- They slept more soundly; they had more control over their emotions and were less preoccupied with the past than those who received a sugar pill.20 Surprisingly, however, the Prozac had no effect at all on the combat veterans at the VA—their — location: [660](kindle://book?action=open&asin=B00IICN1F8&location=660) ^ref-27400 --- Drugs gave doctors a greater sense of efficacy and provided a tool beyond talk therapy. Drugs also produced income and profits. — location: [674](kindle://book?action=open&asin=B00IICN1F8&location=674) ^ref-513 --- For people who are exhausted from trying to make it on their own through yoga classes, workout routines, or simply toughing it out, medications often can bring life-saving relief. — location: [687](kindle://book?action=open&asin=B00IICN1F8&location=687) ^ref-6805 --- psychiatric medications have a serious downside, as they may deflect attention from dealing with the underlying issues. The brain-disease model takes control over people’s fate out of their own hands and puts doctors and insurance companies in charge of fixing their problems. — location: [690](kindle://book?action=open&asin=B00IICN1F8&location=690) ^ref-24033 --- even as antidepressant use continues to increase, it has not made a dent in hospital admissions for depression. The number of people treated for depression has tripled over the past two decades, and one in ten Americans now take antidepressants. — location: [694](kindle://book?action=open&asin=B00IICN1F8&location=694) ^ref-38363 --- Medicaid, the government health program for the poor, spends more on antipsychotics than on any other class of drugs. — location: [700](kindle://book?action=open&asin=B00IICN1F8&location=700) ^ref-62321 --- Children from low-income families are four times as likely as privately insured children to receive antipsychotic medicines. — location: [707](kindle://book?action=open&asin=B00IICN1F8&location=707) ^ref-22274 --- Because drugs have become so profitable, major medical journals rarely publish studies on nondrug treatments of mental health problems.31 Practitioners who explore treatments are typically marginalized as “alternative.” Studies of nondrug treatments are rarely funded unless they involve so-called manualized protocols, where patients and therapists go through narrowly prescribed sequences that allow little fine-tuning to individual patients’ needs. Mainstream medicine is firmly committed to a better life through chemistry, and the fact that we can actually change our own physiology and inner equilibrium by means other than drugs is rarely considered. — location: [715](kindle://book?action=open&asin=B00IICN1F8&location=715) ^ref-64073 --- Restoring relationships and community is central to restoring well-being; — location: [722](kindle://book?action=open&asin=B00IICN1F8&location=722) ^ref-23612 --- a common sense of meaning; — location: [723](kindle://book?action=open&asin=B00IICN1F8&location=723) ^ref-56960 --- we have the ability to regulate our own physiology, — location: [723](kindle://book?action=open&asin=B00IICN1F8&location=723) ^ref-51243 --- In other words, we had visual proof that the effects of trauma are not necessarily different from—and can overlap with—the effects of physical lesions like strokes. — location: [802](kindle://book?action=open&asin=B00IICN1F8&location=802) ^ref-6258 --- Even years later traumatized people often have enormous difficulty telling other people what has happened to them. Their bodies reexperience terror, rage, and helplessness, as well as the impulse to fight or flee, but these feelings are almost impossible to articulate. — location: [808](kindle://book?action=open&asin=B00IICN1F8&location=808) ^ref-4665 --- Trauma by nature drives us to the edge of comprehension, cutting us off from language based on common experience or an imaginable past. — location: [809](kindle://book?action=open&asin=B00IICN1F8&location=809) ^ref-4819 --- Sooner or later most survivors, like the veterans in chapter 1, come up with what many of them call their “cover story” that offers some explanation for their symptoms and behavior for public consumption. These stories, however, rarely capture the inner truth of the experience. — location: [811](kindle://book?action=open&asin=B00IICN1F8&location=811) ^ref-30665 Bokkie? --- trigger a flashback that brings them back into consciousness, apparently unmodified by the passage of time. — location: [823](kindle://book?action=open&asin=B00IICN1F8&location=823) ^ref-49147 --- during flashbacks, our subjects’ brains lit up only on the right side. — location: [825](kindle://book?action=open&asin=B00IICN1F8&location=825) ^ref-19828 --- scans clearly showed that images of past trauma activate the right hemisphere of the brain and deactivate the left. — location: [828](kindle://book?action=open&asin=B00IICN1F8&location=828) ^ref-4505 --- the two halves of the brain do speak different languages. The right is intuitive, emotional, visual, spatial, and tactual, and the left is linguistic, sequential, and analytical. While the left half of the brain does all the talking, the right half of the brain carries the music of experience. It communicates through facial expressions and body language and by making the sounds of love and sorrow: by singing, swearing, crying, dancing, or mimicking. — location: [829](kindle://book?action=open&asin=B00IICN1F8&location=829) ^ref-32218 --- The left and right sides of the brain also process the imprints of the past in dramatically different ways.2 The left brain remembers facts, statistics, and the vocabulary of events. — location: [835](kindle://book?action=open&asin=B00IICN1F8&location=835) ^ref-61159 --- The right brain stores memories of sound, touch, smell, and the emotions they evoke. — location: [837](kindle://book?action=open&asin=B00IICN1F8&location=837) ^ref-2512 --- People who are very upset sometimes say they are “losing their minds.” In technical terms they are experiencing the loss of executive functioning. When something reminds traumatized people of the past, their right brain reacts as if the traumatic event were happening in the present. But because their left brain is not working very well, they may not be aware that they are reexperiencing and reenacting the past—they are just furious, terrified, enraged, ashamed, or frozen. — location: [845](kindle://book?action=open&asin=B00IICN1F8&location=845) ^ref-31819 --- After the emotional storm passes, they may look for something or somebody to blame for — location: [849](kindle://book?action=open&asin=B00IICN1F8&location=849) ^ref-39460 --- Under normal conditions people react to a threat with a temporary increase in their stress hormones. As soon as the threat is over, the hormones dissipate and the body returns to normal. — location: [859](kindle://book?action=open&asin=B00IICN1F8&location=859) ^ref-23829 --- The stress hormones of traumatized people, in contrast, take much longer to return to baseline and spike quickly and disproportionately in response to mildly stressful stimuli. — location: [860](kindle://book?action=open&asin=B00IICN1F8&location=860) ^ref-35560 --- Some people simply go into denial: Their bodies register the threat, but their conscious minds go on as if nothing has happened. — location: [864](kindle://book?action=open&asin=B00IICN1F8&location=864) ^ref-14877 --- The physical effects on the organs go on unabated until they demand notice when they are expressed as illness. Medications, drugs, and alcohol can also temporarily dull or obliterate unbearable sensations and feelings. But the body continues to keep the score. — location: [866](kindle://book?action=open&asin=B00IICN1F8&location=866) ^ref-24676 --- For a hundred years or more, every textbook of psychology and psychotherapy has advised that some method of talking about distressing feelings can resolve them. However, as we’ve seen, the experience of trauma itself gets in the way of being able to do that. — location: [877](kindle://book?action=open&asin=B00IICN1F8&location=877) ^ref-27546 --- It is so much easier for them to talk about what has been done to them—to tell a story of victimization and revenge—than to notice, feel, and put into words the reality of their internal experience. — location: [880](kindle://book?action=open&asin=B00IICN1F8&location=880) ^ref-50116 --- They had not integrated their experience into the ongoing stream of their life. They continued to be “there” and did not know how to be “here”—fully alive in the present. — location: [883](kindle://book?action=open&asin=B00IICN1F8&location=883) ^ref-33929 --- traumatized people become stuck, stopped in their growth because they can’t integrate new experiences into their lives. — location: [915](kindle://book?action=open&asin=B00IICN1F8&location=915) ^ref-13485 --- These attempts to maintain control over unbearable physiological reactions can result in a whole range of physical symptoms, including fibromyalgia, chronic fatigue, and other autoimmune diseases. — location: [920](kindle://book?action=open&asin=B00IICN1F8&location=920) ^ref-2883 --- fight/flight/freeze — location: [930](kindle://book?action=open&asin=B00IICN1F8&location=930) ^ref-1398 --- In order to do that, brains need to: (1) generate internal signals that register what our bodies need, such as food, rest, protection, sex, and shelter; (2) create a map of the world to point us where to go to satisfy those needs; (3) generate the necessary energy and actions to get us there; (4) warn us of dangers and opportunities along the way; and (5) adjust our actions based on the requirements of the moment. — location: [949](kindle://book?action=open&asin=B00IICN1F8&location=949) ^ref-24016 --- The reptilian brain is responsible for all the things that newborn babies can do: eat, — location: [964](kindle://book?action=open&asin=B00IICN1F8&location=964) ^ref-53115 --- However, if your sleep is disturbed or your bowels don’t work, or if you always feel hungry, or if being touched makes you want to scream (as is often the case with traumatized children and adults), the entire organism is thrown into disequilibrium. — location: [969](kindle://book?action=open&asin=B00IICN1F8&location=969) ^ref-4146 --- Any effective treatment for trauma has to address these basic housekeeping functions of the body. — location: [971](kindle://book?action=open&asin=B00IICN1F8&location=971) ^ref-63092 --- neurons that “fire together, wire together.” — location: [980](kindle://book?action=open&asin=B00IICN1F8&location=980) ^ref-18918 --- If you feel safe and loved, your brain becomes specialized in exploration, play, and cooperation; if you are frightened and unwanted, it specializes in managing feelings of fear and abandonment. — location: [981](kindle://book?action=open&asin=B00IICN1F8&location=981) ^ref-4923 --- Taken together the reptilian brain and limbic system make up what I’ll call the “emotional brain” throughout this book. — location: [988](kindle://book?action=open&asin=B00IICN1F8&location=988) ^ref-35406 --- the top layer of the brain, the neocortex. — location: [1000](kindle://book?action=open&asin=B00IICN1F8&location=1000) ^ref-25908 --- The frontal lobes are responsible for the qualities that make us unique within the animal kingdom. — location: [1005](kindle://book?action=open&asin=B00IICN1F8&location=1005) ^ref-9394 --- They enable us to use language and abstract thought. — location: [1006](kindle://book?action=open&asin=B00IICN1F8&location=1006) ^ref-7752 --- The frontal lobes allow us to plan and reflect, to imagine and play out future scenarios. They help us to predict what will happen if we take one action (like applying for a new job) or neglect another (not paying the rent). — location: [1009](kindle://book?action=open&asin=B00IICN1F8&location=1009) ^ref-42177 --- mirror neurons. — location: [1016](kindle://book?action=open&asin=B00IICN1F8&location=1016) ^ref-4856 --- The monkey’s brain cells were firing at the exact location where the motor command neurons were located. But the monkey wasn’t eating or moving. He was watching the researcher, and his brain was vicariously mirroring the researcher’s actions. — location: [1018](kindle://book?action=open&asin=B00IICN1F8&location=1018) ^ref-58103 --- mirror neurons explained many previously unexplainable aspects of the mind, such as empathy, imitation, synchrony, and even the development of language. — location: [1021](kindle://book?action=open&asin=B00IICN1F8&location=1021) ^ref-46398 --- we pick up not only another person’s movement but her emotional state and intentions as well. When — location: [1023](kindle://book?action=open&asin=B00IICN1F8&location=1023) ^ref-52315 --- The limbic system is organized mainly during the first six years of life but continues to evolve in a use-dependent manner. — location: [1035](kindle://book?action=open&asin=B00IICN1F8&location=1035) ^ref-26298 --- The neuroscientist Joseph LeDoux calls the pathway to the amygdala “the low road,” which is extremely fast, and that to the frontal cortex the “high road,” which takes several milliseconds longer in the midst of an overwhelmingly threatening experience. — location: [1048](kindle://book?action=open&asin=B00IICN1F8&location=1048) ^ref-52207 --- Time freezes, so that the present danger feels like it will last forever. — location: [1051](kindle://book?action=open&asin=B00IICN1F8&location=1051) ^ref-8915 --- The central function of the amygdala, which I call the brain’s smoke detector, is to identify whether incoming input is relevant for our survival. — location: [1052](kindle://book?action=open&asin=B00IICN1F8&location=1052) ^ref-61371 --- autonomic nervous system (ANS) — location: [1056](kindle://book?action=open&asin=B00IICN1F8&location=1056) ^ref-57732 --- body state received by the eyes, ears, touch, kinesthetic sense, etc., converges on the thalamus, where it is processed, and then passed on to the amygdala to interpret its emotional significance. — location: [1060](kindle://book?action=open&asin=B00IICN1F8&location=1060) ^ref-6789 --- (Our watchtower also tells us that other people’s anger and threats are a function of their emotional state.) — location: [1087](kindle://book?action=open&asin=B00IICN1F8&location=1087) ^ref-48123 --- There are two ways of changing the threat detection system: from the top down, via modulating messages from the medial prefrontal cortex (not just prefrontal cortex), or from the bottom up, via the reptilian brain, through breathing, movement, and touch. — location: [1096](kindle://book?action=open&asin=B00IICN1F8&location=1096) ^ref-5040 --- Top-down regulation involves strengthening the capacity of the watchtower to monitor your body’s sensations. — location: [1101](kindle://book?action=open&asin=B00IICN1F8&location=1101) ^ref-22123 --- Bottom-up regulation involves recalibrating the autonomic nervous system, (which, as we have seen, originates in the brain stem). We can access the ANS through breath, movement, or touch. — location: [1102](kindle://book?action=open&asin=B00IICN1F8&location=1102) ^ref-29871 --- However, neuroscience research shows that very few psychological problems are the result of defects in understanding; most originate in pressures from deeper regions in the brain that drive our perception and attention. — location: [1118](kindle://book?action=open&asin=B00IICN1F8&location=1118) ^ref-55776 --- emotional brain keeps signaling that you are in danger, no amount of insight will silence it. — location: [1120](kindle://book?action=open&asin=B00IICN1F8&location=1120) ^ref-50246 --- Dissociation is the essence of trauma. The overwhelming experience is split off and fragmented, so that the emotions, sounds, images, thoughts, and physical sensations related to the trauma take on a life of their own. — location: [1152](kindle://book?action=open&asin=B00IICN1F8&location=1152) ^ref-31806 --- As long as the trauma is not resolved, the stress hormones that the body secretes to protect itself keep circulating, and the defensive movements and emotional responses keep getting replayed. — location: [1154](kindle://book?action=open&asin=B00IICN1F8&location=1154) ^ref-31209 --- They have no idea why they respond to some minor irritation as if they were about to be annihilated. — location: [1156](kindle://book?action=open&asin=B00IICN1F8&location=1156) ^ref-39876 --- Feeling numb during birthday parties for your kids or in response to the death of loved ones makes people feel like monsters. As a result, shame becomes the dominant emotion and hiding the truth the central preoccupation. — location: [1174](kindle://book?action=open&asin=B00IICN1F8&location=1174) ^ref-12511 --- The challenge is not so much learning to accept the terrible things that have happened but learning how to gain mastery over one’s internal sensations and emotions. — location: [1180](kindle://book?action=open&asin=B00IICN1F8&location=1180) ^ref-41425 --- Stan’s amygdala made no distinction between past and present. — location: [1185](kindle://book?action=open&asin=B00IICN1F8&location=1185) ^ref-61084 --- Both Stan and Ute had become hypersensitive and irritable after the accident, suggesting that their prefrontal cortex was struggling to maintain control in the face of stress. — location: [1194](kindle://book?action=open&asin=B00IICN1F8&location=1194) ^ref-16541 --- The context and meaning of an experience are determined by the system that includes the dorsolateral prefrontal cortex (DLPFC) and the hippocampus. — location: [1200](kindle://book?action=open&asin=B00IICN1F8&location=1200) ^ref-8160 --- Knowing that whatever is happening is finite and will sooner or later come to an end makes most experiences tolerable. The opposite is also true—situations become intolerable if they feel interminable. — location: [1204](kindle://book?action=open&asin=B00IICN1F8&location=1204) ^ref-63745 --- Trauma is the ultimate experience of “this will last forever.” — location: [1206](kindle://book?action=open&asin=B00IICN1F8&location=1206) ^ref-34955 --- blank stares and absent minds, the outward manifestation of the biological freeze reaction. — location: [1237](kindle://book?action=open&asin=B00IICN1F8&location=1237) ^ref-34331 --- Ute had dissociated her fear and felt nothing. — location: [1239](kindle://book?action=open&asin=B00IICN1F8&location=1239) ^ref-2775 --- When you can’t be fully here, you go to the places where you did feel alive—even if those places are filled with horror and misery. — location: [1260](kindle://book?action=open&asin=B00IICN1F8&location=1260) ^ref-24018 --- We must most of all help our patients to live fully and securely in the present. In order to do that, we need to help bring those brain structures that deserted them when they were overwhelmed by trauma back. — location: [1263](kindle://book?action=open&asin=B00IICN1F8&location=1263) ^ref-41809 Trauma is what dissociates us from the present. Rather than remembering things that happened in the past as a beginning, middle and end, we instead experience them viscerally. The brain shuts down, bit by bit: first goes the neocortex, the outer part of the brain that’s responsible for reason, creative thought and planning. Next goes the limbic system that’s responsible for feeling, social adaptation and most intuition. Lastly the lizard brain (brain stem) which is responsible for basic survival, including fight/flight/freeze. Without the limbic and neocortex to to make sense of experiences, the traumatised person can be stuck without time, feeling like their experience will never end. Typically new experiences filter through the thalamus into the the hippocampus, and then through the cingulate cortex into the neocortex, so we can make sense of them. Extreme stressors can bypass this entirely, and take the “low road” to the amygdala. --- Angry expressions and threatening postures caution them to back off. Sadness attracts care and attention. Fear signals helplessness or alerts us to danger. — location: [1289](kindle://book?action=open&asin=B00IICN1F8&location=1289) ^ref-47956 --- If an organism is stuck in survival mode, its energies are focused on fighting off unseen enemies, which leaves no room for nurture, care, and love. — location: [1299](kindle://book?action=open&asin=B00IICN1F8&location=1299) ^ref-2523 --- “Heart, guts, and brain communicate intimately via the ‘pneumogastric’ nerve, the critical nerve involved in the expression and management of emotions in both humans and animals. — location: [1303](kindle://book?action=open&asin=B00IICN1F8&location=1303) ^ref-40783 --- When the mind is strongly excited, it instantly affects the state of the viscera; so that under excitement there will be much mutual action and reaction between these, the two most important organs of the body.” — location: [1304](kindle://book?action=open&asin=B00IICN1F8&location=1304) ^ref-43688 --- Of course we experience our most devastating emotions as gut-wrenching feelings and heartbreak. As long as we register emotions primarily in our heads, we can remain pretty much in control, but feeling as if our chest is caving in or we’ve been punched in the gut is unbearable. — location: [1307](kindle://book?action=open&asin=B00IICN1F8&location=1307) ^ref-63431 --- autonomic nervous system (ANS): the sympathetic, which acts as the body’s accelerator, and the parasympathetic, which serves as its brake. — location: [1319](kindle://book?action=open&asin=B00IICN1F8&location=1319) ^ref-400 --- The sympathetic nervous system (SNS) is responsible for arousal, including the fight-or-flight response (Darwin’s “escape or avoidance behavior”). — location: [1322](kindle://book?action=open&asin=B00IICN1F8&location=1322) ^ref-60034 --- “sympathetic” because he observed that it functioned with the emotions (sym pathos). — location: [1324](kindle://book?action=open&asin=B00IICN1F8&location=1324) ^ref-18360 --- The SNS moves blood to the muscles for quick action, partly by triggering the adrenal glands to squirt out adrenaline, which speeds up the heart rate and increases blood pressure. — location: [1324](kindle://book?action=open&asin=B00IICN1F8&location=1324) ^ref-46175 --- The second branch of the ANS is the parasympathetic (“against emotions”) nervous system (PNS), which promotes self-preservative functions like digestion and wound healing. — location: [1326](kindle://book?action=open&asin=B00IICN1F8&location=1326) ^ref-25671 --- It triggers the release of acetylcholine to put a brake on arousal, slowing the heart down, relaxing muscles, and returning breathing to normal. — location: [1327](kindle://book?action=open&asin=B00IICN1F8&location=1327) ^ref-9043 --- The Polyvagal Theory — location: [1341](kindle://book?action=open&asin=B00IICN1F8&location=1341) ^ref-17138 --- knowing that we are seen and heard by the important people in our lives can make us feel calm and safe, and why being ignored or dismissed can precipitate rage reactions or mental collapse. — location: [1343](kindle://book?action=open&asin=B00IICN1F8&location=1343) ^ref-34554 --- a deeper level we barely exist as individual organisms. — location: [1355](kindle://book?action=open&asin=B00IICN1F8&location=1355) ^ref-29576 --- Our brains are built to help us function as members of a tribe. We are part of that tribe even when we are by ourselves, whether listening to music (that other people created), watching a basketball game on television (our own muscles tensing as the players run and jump), or preparing a spreadsheet for a sales meeting (anticipating the boss’s reactions). Most of our energy is devoted to connecting with others. — location: [1356](kindle://book?action=open&asin=B00IICN1F8&location=1356) ^ref-41099 --- we find that almost all mental suffering involves either trouble in creating workable and satisfying relationships or difficulties in regulating arousal (as in the case of habitually becoming enraged, shut down, overexcited, or disorganized). — location: [1359](kindle://book?action=open&asin=B00IICN1F8&location=1359) ^ref-10154 --- Being able to feel safe with other people is probably the single most important aspect of mental health; safe connections are fundamental to meaningful and satisfying lives. — location: [1366](kindle://book?action=open&asin=B00IICN1F8&location=1366) ^ref-4755 --- The critical issue is reciprocity: being truly heard and seen by the people around us, feeling that we are held in someone else’s mind and heart. — location: [1369](kindle://book?action=open&asin=B00IICN1F8&location=1369) ^ref-22896 --- determines which one of these is activated at any particular time. Whenever we feel threatened, we instinctively turn to the first level, social engagement. We call out for help, support, and comfort from the people around us. — location: [1394](kindle://book?action=open&asin=B00IICN1F8&location=1394) ^ref-19773 --- if no one comes to our aid, or we’re in immediate danger, the organism reverts to a more primitive way to survive: fight or flight. — location: [1395](kindle://book?action=open&asin=B00IICN1F8&location=1395) ^ref-36632 --- We are then in a state of freeze or collapse. — location: [1398](kindle://book?action=open&asin=B00IICN1F8&location=1398) ^ref-12036 --- When the “ventral vagal complex” (VVC) runs the show, we smile when others smile at us, we nod our heads when we agree, and we frown when friends tell us of their misfortunes. When the VVC is engaged, it also sends signals down to our heart and lungs, slowing down our heart rate and increasing the depth of breathing. As a result, we feel calm and relaxed, centered, or pleasurably aroused. — location: [1402](kindle://book?action=open&asin=B00IICN1F8&location=1402) ^ref-36223 --- we will activate the ultimate emergency system: the dorsal vagal complex (DVC). This system reaches down below the diaphragm to the stomach, kidneys, and intestines and drastically reduces metabolism throughout the body. Heart rate plunges (we feel our heart “drop”), we can’t breathe, and our gut stops working or empties (literally “scaring the shit out of” us). This is the point at which we disengage, collapse, and freeze. — location: [1417](kindle://book?action=open&asin=B00IICN1F8&location=1417) ^ref-43865 --- Danger turns off our social-engagement system, decreases our responsiveness to the human voice, and increases our sensitivity to threatening sounds. Yet — location: [1429](kindle://book?action=open&asin=B00IICN1F8&location=1429) ^ref-53695 --- That is why so many abused and traumatized people feel fully alive in the face of actual danger, while they go numb in situations that are more complex but objectively safe, like birthday parties or family dinners. — location: [1432](kindle://book?action=open&asin=B00IICN1F8&location=1432) ^ref-53971 --- the brain is a cultural organ—experience shapes the brain. — location: [1450](kindle://book?action=open&asin=B00IICN1F8&location=1450) ^ref-26177 --- Immobilization is at the root of most traumas. — location: [1456](kindle://book?action=open&asin=B00IICN1F8&location=1456) ^ref-5713 --- women who had an early history of abuse and neglect were seven times more likely to be raped in adulthood. — location: [1465](kindle://book?action=open&asin=B00IICN1F8&location=1465) ^ref-36049 --- Despite the well-documented effects of anger, fear, and anxiety on the ability to reason, many programs continue to ignore the need to engage the safety system of the brain before trying to promote new ways of thinking. — location: [1486](kindle://book?action=open&asin=B00IICN1F8&location=1486) ^ref-9381 --- chorus, physical education, recess, and anything else involving movement, play, and joyful engagement. — location: [1488](kindle://book?action=open&asin=B00IICN1F8&location=1488) ^ref-17924 --- top-down approaches (to activate social engagement) with bottom-up methods (to calm the physical tensions in the body). — location: [1497](kindle://book?action=open&asin=B00IICN1F8&location=1497) ^ref-18385 --- interpersonal rhythms, — location: [1500](kindle://book?action=open&asin=B00IICN1F8&location=1500) ^ref-35305 --- Over the years our research team has repeatedly found that chronic emotional abuse and neglect can be just as devastating as physical abuse and sexual molestation. — location: [1518](kindle://book?action=open&asin=B00IICN1F8&location=1518) ^ref-56802 --- How can traumatized people learn to integrate ordinary sensory experiences so that they can live with the natural flow of feeling and feel secure and complete in their bodies? — location: [1564](kindle://book?action=open&asin=B00IICN1F8&location=1564) ^ref-24658 --- What is your brain doing when you have nothing in particular on your mind? It turns out that you pay attention to yourself: The default state activates the brain areas that work together to create your sense of “self.” — location: [1574](kindle://book?action=open&asin=B00IICN1F8&location=1574) ^ref-38456 --- The Mohawk of self-awareness. — location: [1585](kindle://book?action=open&asin=B00IICN1F8&location=1585) ^ref-62677 --- In an effort to shut off terrifying sensations, they also deadened their capacity to feel fully alive. — location: [1595](kindle://book?action=open&asin=B00IICN1F8&location=1595) ^ref-45776 --- The lack of self-awareness in victims of chronic childhood trauma is sometimes so profound that they cannot recognize themselves in a mirror. Brain scans show that this is not the result of mere inattention: The structures in charge of self-recognition may be knocked out along with the structures related to self-experience. — location: [1600](kindle://book?action=open&asin=B00IICN1F8&location=1600) ^ref-30820 --- “You can’t do what you want till you know what you’re doing.” — location: [1605](kindle://book?action=open&asin=B00IICN1F8&location=1605) ^ref-9481 --- “Sometimes we use our minds not to discover facts, but to hide them. … One of the things the screen hides most effectively is the body, our own body, by which I mean the ins of it, its interiors. Like a veil thrown over the skin to secure its modesty, the screen partially removes from the mind the inner states of the body, those that constitute the flow of life as it wanders in the journey of each day.”6 — location: [1617](kindle://book?action=open&asin=B00IICN1F8&location=1617) ^ref-23672 --- Damasio calls these housekeeping areas of the brain the “proto-self,” because they create the “wordless knowledge” that underlies our conscious sense of self. — location: [1648](kindle://book?action=open&asin=B00IICN1F8&location=1648) ^ref-34459 --- yet we acknowledge their involvement every time we use one of the common expressions that link strong emotions with the body: “You make me sick”; “It made my skin crawl”; “I was all choked up”; “My heart sank”; “He makes me bristle.” — location: [1657](kindle://book?action=open&asin=B00IICN1F8&location=1657) ^ref-44598 --- Agency starts with what scientists call interoception, our awareness of our subtle sensory, body-based feelings: the greater that awareness, the greater our potential to control our lives. — location: [1671](kindle://book?action=open&asin=B00IICN1F8&location=1671) ^ref-2248 --- Knowing what we feel is the first step to knowing why we feel that way. — location: [1672](kindle://book?action=open&asin=B00IICN1F8&location=1672) ^ref-45539 --- to draw out the sensory information that is blocked and frozen by trauma; to help patients befriend (rather than suppress) the energies released by that inner experience; to complete the self-preserving physical actions that were thwarted when they were trapped, restrained, or immobilized by terror. — location: [1685](kindle://book?action=open&asin=B00IICN1F8&location=1685) ^ref-15643 --- Our gut feelings signal what is safe, life sustaining, or threatening, even if we cannot quite explain why we feel a particular way. — location: [1687](kindle://book?action=open&asin=B00IICN1F8&location=1687) ^ref-26191 --- However, traumatized people chronically feel unsafe inside their bodies: — location: [1692](kindle://book?action=open&asin=B00IICN1F8&location=1692) ^ref-59252 --- Self-regulation depends on having a friendly relationship with your body. Without it you have to rely on external regulation—from medication, drugs like alcohol, constant reassurance, or compulsive compliance with the wishes of others. — location: [1703](kindle://book?action=open&asin=B00IICN1F8&location=1703) ^ref-45906 --- Somatic symptoms for which no clear physical basis can be found are ubiquitous in traumatized children and adults. They can include chronic back and neck pain, fibromyalgia, migraines, digestive problems, spastic colon/irritable bowel syndrome, chronic fatigue, and some forms of asthma. — location: [1713](kindle://book?action=open&asin=B00IICN1F8&location=1713) ^ref-9341 --- Traumatized children have fifty times the rate of asthma as their nontraumatized peers. — location: [1715](kindle://book?action=open&asin=B00IICN1F8&location=1715) ^ref-40429 --- Without a trace of irony she’d then complain that the cold wind at Logan International Airport made her eyes water. Her body felt the sadness that her mind couldn’t register—she was leaving our young family, her closest living relatives. — location: [1723](kindle://book?action=open&asin=B00IICN1F8&location=1723) ^ref-41699 --- Psychiatrists call this phenomenon alexithymia—Greek for not having words for feelings. — location: [1725](kindle://book?action=open&asin=B00IICN1F8&location=1725) ^ref-59697 --- They tend to register emotions as physical problems rather than as signals that something deserves their attention. — location: [1732](kindle://book?action=open&asin=B00IICN1F8&location=1732) ^ref-59857 --- My brain doesn’t feel.” — location: [1745](kindle://book?action=open&asin=B00IICN1F8&location=1745) ^ref-28846 --- This research confirms what our patients tell us: that the self can be detached from the body and live a phantom existence on its own. — location: [1771](kindle://book?action=open&asin=B00IICN1F8&location=1771) ^ref-8951 --- Angry people live in angry bodies. — location: [1776](kindle://book?action=open&asin=B00IICN1F8&location=1776) ^ref-42142 --- In order to change, people need to become aware of their sensations and the way that their bodies interact with the world around them. Physical self-awareness is the first step in releasing the tyranny of the past. — location: [1777](kindle://book?action=open&asin=B00IICN1F8&location=1777) ^ref-9658 --- How can people open up to and explore their internal world of sensations and emotions? In my practice I begin the process by helping my patients to first notice and then describe the feelings in their bodies—not emotions such as anger or anxiety or fear but the physical sensations beneath the emotions: pressure, heat, muscular tension, tingling, caving in, feeling hollow, and so on. I also work on identifying the sensations associated with relaxation or pleasure. I help them become aware of their breath, their gestures and movements. I ask them to pay attention to subtle shifts in their bodies, such as tightness in their chests or gnawing in their bellies, when they talk about negative events that they claim did not bother them. — location: [1779](kindle://book?action=open&asin=B00IICN1F8&location=1779) ^ref-45967 --- The most natural way for human beings to calm themselves when they are upset is by clinging to another person. — location: [1791](kindle://book?action=open&asin=B00IICN1F8&location=1791) ^ref-43484 --- The prefrontal cortex (PFC) normally helps us to assess the person coming toward us, and our mirror neurons help to pick up his intentions. However, the subjects with PTSD did not activate any part of their frontal lobe, which means they could not muster any curiosity about the stranger. — location: [1807](kindle://book?action=open&asin=B00IICN1F8&location=1807) ^ref-14277 --- used Thematic Apperception Test. The TAT is a so-called projective test, which uses a set of cards to discover how people’s inner reality shapes their view of the world. — location: [1835](kindle://book?action=open&asin=B00IICN1F8&location=1835) ^ref-38107 --- the traumatized kids came up with gruesome tales. One girl said that the little girl in the picture was about to smash in her father’s skull with a hammer. — location: [1852](kindle://book?action=open&asin=B00IICN1F8&location=1852) ^ref-27227 --- We could only conclude that for abused children, the whole world is filled with triggers. As long as they can imagine only disastrous outcomes to relatively benign situations, anybody walking into a room, any stranger, any image, on a screen or on a billboard might be perceived as a harbinger of catastrophe. In this light the bizarre behavior of the kids at the children’s clinic made perfect sense.2 — location: [1869](kindle://book?action=open&asin=B00IICN1F8&location=1869) ^ref-59318 --- labels: “conduct disorder” or “oppositional defiant disorder” — location: [1874](kindle://book?action=open&asin=B00IICN1F8&location=1874) ^ref-10506 --- or “bipolar disorder.” ADHD was a “comorbid” diagnosis for almost all. Was the underlying trauma being obscured by this blizzard of diagnoses? — location: [1875](kindle://book?action=open&asin=B00IICN1F8&location=1875) ^ref-7981 --- Scientists study what puzzles them most, so that they often become experts in subjects that others take for granted. (Or, as the attachment researcher Beatrice Beebe once told me, “most research is me-search.”) — location: [1885](kindle://book?action=open&asin=B00IICN1F8&location=1885) ^ref-22130 --- Bowlby himself told me that just such boarding-school experiences probably inspired George Orwell’s novel 1984, which brilliantly expresses how human beings may be induced to sacrifice everything they hold dear and true—including their sense of self—for the sake of being loved and approved of by someone in a position of authority. — location: [1888](kindle://book?action=open&asin=B00IICN1F8&location=1888) ^ref-31569 --- his radical claim that children’s disturbed behavior was a response to actual life experiences—to neglect, brutality, and separation—rather than the product of infantile sexual fantasies. Undaunted, he devoted the rest of his life to developing what came to be called attachment theory.3 — location: [1897](kindle://book?action=open&asin=B00IICN1F8&location=1897) ^ref-39326 --- “Every life is a piece of art, put together with all means available.” — location: [1904](kindle://book?action=open&asin=B00IICN1F8&location=1904) ^ref-3458 --- John Bowlby realized that children are captivated by faces and voices and are exquisitely sensitive to facial expression, posture, tone of voice, physiological changes, tempo of movement and incipient action. — location: [1908](kindle://book?action=open&asin=B00IICN1F8&location=1908) ^ref-18115 --- Children are also programmed to choose one particular adult (or at most a few) with whom their natural communication system develops. This creates a primary attachment bond. The more responsive the adult is to the child, the deeper the attachment and the more likely the child will develop healthy ways of responding to the people around him. — location: [1910](kindle://book?action=open&asin=B00IICN1F8&location=1910) ^ref-44892 --- research has firmly established that having a safe haven promotes self-reliance and instills a sense of sympathy and helpfulness to others in distress. — location: [1919](kindle://book?action=open&asin=B00IICN1F8&location=1919) ^ref-1969 --- Infants hear and learn musicality from their mother’s talk, even before birth.”4 — location: [1928](kindle://book?action=open&asin=B00IICN1F8&location=1928) ^ref-44508 --- I watched a mother playing with her two-month-old son, who was propped in an infant seat facing her. They were cooing to each other and having a wonderful time—until the mother leaned in to nuzzle him and the baby, in his excitement, yanked on her hair. The mother was caught unawares and yelped with pain, pushing away his hand while her face contorted with anger. The baby let go immediately, and they pulled back physically from each other. For both of them the source of delight had become a source of distress. Obviously frightened, the baby brought his hands up to his face to block out the sight of his angry mother. The mother, in turn, realizing that her baby was upset, refocused on him, making soothing sounds in an attempt to smooth things over. The infant still had his eyes covered, but his craving for connection soon reemerged. He started peeking out to see if the coast was clear, while his mother reached toward him with a concerned expression. As she started to tickle his belly, he dropped his arms and broke into a happy giggle, and harmony was reestablished. Infant and mother were attuned again. This entire sequence of delight, rupture, repair, and new delight took slightly less than twelve seconds. — location: [1937](kindle://book?action=open&asin=B00IICN1F8&location=1937) ^ref-54587 --- when infants and caregivers are in sync on an emotional level, they’re also in sync physically. — location: [1946](kindle://book?action=open&asin=B00IICN1F8&location=1946) ^ref-14794 --- equilibrium has been restored when the physiology calms down. — location: [1950](kindle://book?action=open&asin=B00IICN1F8&location=1950) ^ref-24125 --- John Gottman say, “Mothers stroke, and fathers poke.”) Learning how to manage arousal is a key life skill, and parents must do it for babies before babies can do it for themselves. — location: [1952](kindle://book?action=open&asin=B00IICN1F8&location=1952) ^ref-62023 --- combined with the cultivation of competency builds an internal locus of control, — location: [1956](kindle://book?action=open&asin=B00IICN1F8&location=1956) ^ref-51281 --- Securely attached children learn what makes them feel good; they discover what makes them (and others) feel bad, and they acquire a sense of agency: that their actions can change how they feel and how others respond. — location: [1958](kindle://book?action=open&asin=B00IICN1F8&location=1958) ^ref-2927 --- In contrast, children with histories of abuse and neglect learn that their terror, pleading, and crying do not register with their caregiver. Nothing they can do or say stops the beating or brings attention and help. In effect they’re being conditioned to give up when they face challenges later in life. — location: [1961](kindle://book?action=open&asin=B00IICN1F8&location=1961) ^ref-63294 --- it does not require extraordinary talent to be what he called a “good enough mother.” — location: [1969](kindle://book?action=open&asin=B00IICN1F8&location=1969) ^ref-54438 --- This is one reason abused children so easily become defensive or scared. Imagine what it’s like to make your way through a sea of faces in the school corridor, trying to figure out who might assault you. — location: [1988](kindle://book?action=open&asin=B00IICN1F8&location=1988) ^ref-21246 --- The need for attachment never lessens. Most human beings simply cannot tolerate being disengaged from others for any length of time. People who cannot connect through work, friendships, or family usually find other ways of bonding, as through illnesses, lawsuits, or family feuds. Anything is preferable to that godforsaken sense of irrelevance and alienation. — location: [1993](kindle://book?action=open&asin=B00IICN1F8&location=1993) ^ref-11821 --- securely attached infants are distressed when their mother leaves them, but they show delight when she returns, and after a brief check-in for reassurance, they settle down and resume their play. — location: [2008](kindle://book?action=open&asin=B00IICN1F8&location=2008) ^ref-49196 --- In one pattern, called “avoidant attachment,” the infants look like nothing really bothers them—they don’t cry when their mother goes away and they ignore her when she comes back. However, this does not mean that they are unaffected. In fact, their chronically increased heart rates show that they are in a constant state of hyperarousal. — location: [2013](kindle://book?action=open&asin=B00IICN1F8&location=2013) ^ref-18703 --- “dealing but not feeling.”12 — location: [2016](kindle://book?action=open&asin=B00IICN1F8&location=2016) ^ref-14661 --- In another pattern, called “anxious” or “ambivalent” attachment, the infants constantly draw attention to themselves by crying, yelling, clinging, or screaming: They are “feeling but not dealing.” — location: [2019](kindle://book?action=open&asin=B00IICN1F8&location=2019) ^ref-15314 --- unless they make a spectacle, nobody is going to pay attention to them. — location: [2021](kindle://book?action=open&asin=B00IICN1F8&location=2021) ^ref-53002 --- work because they elicit the best care a particular caregiver is capable of providing. Infants who encounter a consistent pattern of care—even if it’s marked by emotional distance or insensitivity—can adapt to maintain the relationship. — location: [2025](kindle://book?action=open&asin=B00IICN1F8&location=2025) ^ref-61558 --- In school avoidant children are likely to bully other kids, while the anxious children are often their victims.15 — location: [2029](kindle://book?action=open&asin=B00IICN1F8&location=2029) ^ref-45754 --- (about 15 percent of those they studied) who seemed to be unable to figure out how to engage with their caregivers. — location: [2033](kindle://book?action=open&asin=B00IICN1F8&location=2033) ^ref-27256 --- Main called this pattern “disorganized attachment.” Disorganized attachment is “fright without solution.”19 — location: [2042](kindle://book?action=open&asin=B00IICN1F8&location=2042) ^ref-39768 --- In a study of attachment patterns in over two thousand infants in “normal” middle-class environments, 62 percent were found to be secure, 15 percent avoidant, 9 percent anxious (also known as ambivalent), and 15 percent disorganized.21 — location: [2050](kindle://book?action=open&asin=B00IICN1F8&location=2050) ^ref-62782 --- Kids from lower socioeconomic groups are more likely to be disorganized, — location: [2054](kindle://book?action=open&asin=B00IICN1F8&location=2054) ^ref-41275 --- remember a videotape Beatrice Beebe showed me.28 It featured a young mother playing with her three-month-old infant. Everything was going well until the baby pulled back and turned his head away, signaling that he needed a break. But the mother did not pick up on his cue, and she intensified her efforts to engage him by bringing her face closer to his and increasing the volume of her voice. When he recoiled even more, she kept bouncing and poking him. Finally he started to scream, at which point the mother put him down and walked away, looking crestfallen. She obviously felt terrible, but she had simply missed the relevant cues. — location: [2066](kindle://book?action=open&asin=B00IICN1F8&location=2066) ^ref-32210 --- difficult child who makes her feel like a failure, and give up on trying to comfort her child. — location: [2074](kindle://book?action=open&asin=B00IICN1F8&location=2074) ^ref-23006 --- (Living with an irascible, withdrawn, or terrified spouse is likely to impose a major psychological burden on the partner, including depression.) — location: [2090](kindle://book?action=open&asin=B00IICN1F8&location=2090) ^ref-20964 --- I have always wondered how parents come to abuse their kids. After all, raising healthy offspring is at the very core of our human sense of purpose and meaning. What could drive parents to deliberately hurt or neglect their children? Karlen’s research provided me with one answer: Watching her videos, I could see the children becoming more and more inconsolable, sullen, or resistant to their misattuned mothers. At the same time, the mothers became increasingly frustrated, defeated, and helpless in their interactions. Once the mother comes to see the child not as her partner in an attuned relationship but as a frustrating, enraging, disconnected stranger, the stage is set for subsequent abuse. — location: [2108](kindle://book?action=open&asin=B00IICN1F8&location=2108) ^ref-10188 --- Infants with seriously disrupted emotional communication patterns with their mothers at eighteen months grew up to become young adults with an unstable sense of self, self-damaging impulsivity (including excessive spending, promiscuous sex, substance abuse, reckless driving, and binge eating), inappropriate and intense anger, and recurrent suicidal behavior. — location: [2114](kindle://book?action=open&asin=B00IICN1F8&location=2114) ^ref-50154 --- “What cannot be communicated to the [m]other cannot be communicated to the self.” — location: [2131](kindle://book?action=open&asin=B00IICN1F8&location=2131) ^ref-63039 --- Being in synch means resonating through sounds and movements that connect, which are embedded in the daily sensory rhythms of cooking and cleaning, going to bed and waking up. Being in synch may mean sharing funny faces and hugs, expressing delight or disapproval at the right moments, tossing balls back and forth, or singing together. — location: [2158](kindle://book?action=open&asin=B00IICN1F8&location=2158) ^ref-48320 --- Truth, like love and sleep, resents Approaches that are too intense.1 — location: [2201](kindle://book?action=open&asin=B00IICN1F8&location=2201) ^ref-11593 --- I call this Auden’s rule, and in keeping with it I deliberately did not push Marilyn to tell me what she remembered. — location: [2203](kindle://book?action=open&asin=B00IICN1F8&location=2203) ^ref-55210 --- Our study showed that, on a deep level, the bodies of incest victims have trouble distinguishing between danger and safety. This means that the imprint of past trauma does not consist only of distorted perceptions of information coming from the outside; the organism itself also has a problem knowing how to feel safe. — location: [2234](kindle://book?action=open&asin=B00IICN1F8&location=2234) ^ref-7163 --- If our parents or grandparents keep telling us we’re the cutest, most delicious thing in the world, we don’t question their judgment—we must be exactly that. And deep down, no matter what else we learn about ourselves, we will carry that sense with us: that we are basically adorable. As a result, if we later hook up with somebody who treats us badly, we will be outraged. It won’t feel right: It’s not familiar; it’s not like home. — location: [2243](kindle://book?action=open&asin=B00IICN1F8&location=2243) ^ref-5957 --- But if we are abused or ignored in childhood, or grow up in a family where sexuality is treated with disgust, our inner map contains a different message. Our sense of our self is marked by contempt and humiliation, and we are more likely to think “he (or she) has my number” and fail to protest if we are mistreated. — location: [2246](kindle://book?action=open&asin=B00IICN1F8&location=2246) ^ref-16495 --- When you try to talk me into being more reasonable I only feel even more lonely and isolated—and it confirms the feeling that nobody in the whole world will ever understand what it feels like to be me.” — location: [2263](kindle://book?action=open&asin=B00IICN1F8&location=2263) ^ref-62522 --- This doesn’t mean, however, that our maps can’t be modified by experience. — location: [2271](kindle://book?action=open&asin=B00IICN1F8&location=2271) ^ref-2633 --- Generally the rational brain can override the emotional brain, as long as our fears don’t hijack us. — location: [2283](kindle://book?action=open&asin=B00IICN1F8&location=2283) ^ref-12626 --- Yet even though she’d drawn a girl who was being sexually molested, she—or at least her cognitive, verbal self—had no idea what had actually happened to her. Her immune system, her muscles, and her fear system all had kept the score, but her conscious mind lacked a story that could communicate the experience. — location: [2300](kindle://book?action=open&asin=B00IICN1F8&location=2300) ^ref-51471 --- calming techniques, such as focusing on breathing deeply—in and out, in and out, at six breaths a minute—while — location: [2308](kindle://book?action=open&asin=B00IICN1F8&location=2308) ^ref-40106 --- When her father started to touch her, she made herself disappear; she floated up to the ceiling, looking down on some other little girl in the bed. — location: [2334](kindle://book?action=open&asin=B00IICN1F8&location=2334) ^ref-23862 --- Children are also programmed to be fundamentally loyal to their caretakers, even if they are abused by them. — location: [2350](kindle://book?action=open&asin=B00IICN1F8&location=2350) ^ref-37326 --- have never met a child below the age of ten who was tortured at home (and who had broken bones and burned skin to show for it) who, if given the option, would not have chosen to stay with his or her family rather than being placed in a foster home. — location: [2352](kindle://book?action=open&asin=B00IICN1F8&location=2352) ^ref-13712 --- Hostages have put up bail for their captors, expressed a wish to marry them, or had sexual relations with them; victims of domestic violence often cover up for their abusers. Judges often tell me how humiliated they feel when they try to protect victims of domestic violence by issuing restraining orders, only to find out that many of them secretly allow their partners to return. — location: [2354](kindle://book?action=open&asin=B00IICN1F8&location=2354) ^ref-30122 --- In order to know who we are—to have an identity—we must know (or at least feel that we know) what is and what was “real.” — location: [2371](kindle://book?action=open&asin=B00IICN1F8&location=2371) ^ref-4049 --- Trauma is not stored as a narrative with an orderly beginning, middle, and end. As I’ll discuss in detail in chapters 11 and 12, memories initially return as they did for Marilyn: as flashbacks that contain fragments of the experience, isolated images, sounds, and body sensations that initially have no context other than fear and panic. When Marilyn was a child, she had no way of giving voice to the unspeakable, and it would have made no difference anyway—nobody was listening. — location: [2388](kindle://book?action=open&asin=B00IICN1F8&location=2388) ^ref-14324 --- The preamble to the DSM-III warned explicitly that its categories were insufficiently precise to be used in forensic settings or for insurance purposes. — location: [2414](kindle://book?action=open&asin=B00IICN1F8&location=2414) ^ref-27238 --- We were struck by how many of our patients who were diagnosed with borderline personality disorder (BPD) told us horror stories about their childhoods. BPD is marked by clinging but highly unstable relationships, extreme mood swings, and self-destructive behavior, including self-mutilation and repeated suicide attempts. — location: [2434](kindle://book?action=open&asin=B00IICN1F8&location=2434) ^ref-8344 --- Undeterred, Judy and I decided to finance the study ourselves, and we found an ally in Chris Perry, the director of research at Cambridge Hospital, who was funded by the National Institutes of Mental Health to study BPD and other near neighbor diagnoses, so called personality disorders, in patients recruited from the Cambridge Hospital. — location: [2437](kindle://book?action=open&asin=B00IICN1F8&location=2437) ^ref-34281 --- Traumatic Antecedents Questionnaire (TAQ). — location: [2445](kindle://book?action=open&asin=B00IICN1F8&location=2445) ^ref-23316 --- BPD group’s problems—dissociation, desperate clinging to whomever might be enlisted to help—had probably started off as ways of dealing with overwhelming emotions and inescapable brutality. — location: [2469](kindle://book?action=open&asin=B00IICN1F8&location=2469) ^ref-21682 --- that unless you understand the language of trauma and abuse, you cannot really understand BPD. — location: [2474](kindle://book?action=open&asin=B00IICN1F8&location=2474) ^ref-63259 --- 81 percent of the patients diagnosed with BPD at Cambridge Hospital reported severe histories of child abuse and/or neglect; in the vast majority the abuse began before age seven. — location: [2475](kindle://book?action=open&asin=B00IICN1F8&location=2475) ^ref-38564 --- if you carry a memory of having felt safe with somebody long ago, the traces of that earlier affection can be reactivated in attuned relationships when you are an adult, whether these occur in daily life or in good therapy. However, if you lack a deep memory of feeling loved and safe, the receptors in the brain that respond to human kindness may simply fail to develop. — location: [2507](kindle://book?action=open&asin=B00IICN1F8&location=2507) ^ref-55873 --- 525 adult patients at five sites around the country to see if particular populations suffered from different constellations of problems. Our populations fell into three groups: those with histories of childhood physical or sexual abuse by caregivers; recent victims of domestic violence; and people who had recently been through a natural disaster. — location: [2525](kindle://book?action=open&asin=B00IICN1F8&location=2525) ^ref-41367 --- most of their morbidly obese patients had been sexually abused as children. — location: [2557](kindle://book?action=open&asin=B00IICN1F8&location=2557) ^ref-37125 --- The result was the monumental investigation of Adverse Childhood Experiences (now know at the ACE study), a collaboration between the CDC and Kaiser Permanente, with Robert Anda, MD, and Vincent Felitti, MD, as co–principal investigators. — location: [2562](kindle://book?action=open&asin=B00IICN1F8&location=2562) ^ref-53869 --- more than a quarter of the U.S. population is likely to have been repeatedly physically abused as a child. — location: [2576](kindle://book?action=open&asin=B00IICN1F8&location=2576) ^ref-3489 --- To the questions “Did an adult or person at least 5 years older ever have you touch their body in a sexual way?” and “Did an adult or person at least 5 years older ever attempt oral, anal, or vaginal intercourse with you?” 28 percent of women and 16 percent of men responded affirmatively. — location: [2577](kindle://book?action=open&asin=B00IICN1F8&location=2577) ^ref-37790 --- adverse experiences are interrelated, even though they’re usually studied separately. People typically don’t grow up in a household where one brother is in prison but everything else is fine. They don’t live in families where their mother is regularly beaten but life is otherwise hunky-dory. — location: [2585](kindle://book?action=open&asin=B00IICN1F8&location=2585) ^ref-22873 --- For example, high ACE scores turned out to correlate with higher workplace absenteeism, financial problems, and lower lifetime income. — location: [2592](kindle://book?action=open&asin=B00IICN1F8&location=2592) ^ref-44022 --- As the ACE score rises, chronic depression in adulthood also rises dramatically. For those with an ACE score of four or more, its prevalence is 66 percent in women and 35 percent in men, compared with an overall rate of 12 percent in those with an ACE score of zero. — location: [2594](kindle://book?action=open&asin=B00IICN1F8&location=2594) ^ref-37652 --- From a score of zero to a score of six there is about a 5,000 percent increased likelihood of suicide attempts. — location: [2601](kindle://book?action=open&asin=B00IICN1F8&location=2601) ^ref-25973 --- People with an ACE score of four were seven times more likely to be alcoholic than adults with a score of zero. — location: [2605](kindle://book?action=open&asin=B00IICN1F8&location=2605) ^ref-36461 --- For those with an ACE score of six or more, the likelihood of IV drug use was 4,600 percent greater than in those with a score of zero. — location: [2606](kindle://book?action=open&asin=B00IICN1F8&location=2606) ^ref-13447 --- At an ACE score of zero, the prevalence of rape was 5 percent; at a score of four or more it was 33 percent. — location: [2607](kindle://book?action=open&asin=B00IICN1F8&location=2607) ^ref-17506 --- They were twice as likely to suffer from cancer and four times as likely to have emphysema. — location: [2616](kindle://book?action=open&asin=B00IICN1F8&location=2616) ^ref-21891 --- the gravest and most costly public health issue in the United States: child abuse. He had calculated that its overall costs exceeded those of cancer or heart disease and that eradicating child abuse in America would reduce the overall rate of depression by more than half, alcoholism by two-thirds, and suicide, IV drug use, and domestic violence by three-quarters. — location: [2637](kindle://book?action=open&asin=B00IICN1F8&location=2637) ^ref-47086 --- Childhood abuse isn’t something you “get over.” — location: [2656](kindle://book?action=open&asin=B00IICN1F8&location=2656) ^ref-43935 --- If Anthony were admitted to a hospital, he would likely be diagnosed with a host of different psychiatric disorders: depression, oppositional defiant disorder, anxiety, reactive attachment disorder, ADHD, and PTSD. None of these diagnoses, however, would clarify what was wrong with Anthony: that he was scared to death and fighting for his life, and he did not trust that his mother could help him. — location: [2671](kindle://book?action=open&asin=B00IICN1F8&location=2671) ^ref-9843 --- When I asked her what had helped her most, she answered, “The horse I took care of.” — location: [2681](kindle://book?action=open&asin=B00IICN1F8&location=2681) ^ref-25579 --- Technology always produces new directions for research, and when it became possible to do genetic testing, psychiatry became committed to finding the genetic causes of mental illness. Finding a genetic link seemed particularly relevant for schizophrenia, a fairly common (affecting about 1 percent of the population), severe, and perplexing form of mental illness and one that clearly runs in families. — location: [2696](kindle://book?action=open&asin=B00IICN1F8&location=2696) ^ref-25129 --- And yet after thirty years and millions upon millions of dollars’ worth of research, we have failed to find consistent genetic patterns for schizophrenia—or for any other psychiatric illness, for that matter. — location: [2699](kindle://book?action=open&asin=B00IICN1F8&location=2699) ^ref-24155 --- Recent research has swept away the simple idea that “having” a particular gene produces a particular result. It turns out that many genes work together to influence a single outcome. — location: [2703](kindle://book?action=open&asin=B00IICN1F8&location=2703) ^ref-39191 --- genes are not fixed; life events can trigger biochemical messages that turn them on or off by attaching methyl groups, a cluster of carbon and hydrogen atoms, to the outside of the gene (a process called methylation), making it more or less sensitive to messages from the body. — location: [2705](kindle://book?action=open&asin=B00IICN1F8&location=2705) ^ref-13879 --- how much a mother rat licks and grooms her pups during the first twelve hours after their birth permanently affects the brain chemicals that respond to stress—and modifies the configuration of over a thousand genes. The rat pups that are intensively licked by their mothers are braver and produce lower levels of stress hormones under stress than rats whose mothers are less attentive. They also recover more quickly—an equanimity that lasts throughout their lives. They develop thicker connections in the hippocampus, a key center for learning and memory, and they perform better in an important rodent skill—finding their way through mazes. — location: [2710](kindle://book?action=open&asin=B00IICN1F8&location=2710) ^ref-54756 --- Suomi identified two personality types that consistently ran into trouble: uptight, anxious monkeys, who become fearful, withdrawn, and depressed even in situations where other monkeys will play and explore; and highly aggressive monkeys, who make so much trouble that they are often shunned, beaten up, or killed. — location: [2731](kindle://book?action=open&asin=B00IICN1F8&location=2731) ^ref-54888 --- discovered a wide range of genetically driven behaviors. For example, the uptight monkeys (classified as such on the basis of both their behavior and their high cortisol levels at six months) will consume more alcohol in experimental situations than the others when they reach the age of four. The genetically aggressive monkeys also overindulge—but they binge drink to the point of passing out, while the uptight monkeys seem to drink to calm down. — location: [2735](kindle://book?action=open&asin=B00IICN1F8&location=2735) ^ref-29508 --- The uptight, anxious females don’t play well with others and thus often lack social support when they give birth and are at high risk for neglecting or abusing their firstborns. But when these females belong to a stable social group they often become diligent mothers who carefully watch out for their young. — location: [2739](kindle://book?action=open&asin=B00IICN1F8&location=2739) ^ref-62998 --- In real life it is impossible to tell whether people’s aggressive or uptight behavior is the result of parents’ genes or of having been raised by an abusive mother—or both. — location: [2744](kindle://book?action=open&asin=B00IICN1F8&location=2744) ^ref-23181 --- Young monkeys who are taken away from their mothers at birth and brought up solely with their peers become intensely attached to them. They desperately cling to one another and don’t peel away enough to engage in healthy exploration and play. What little play there is lacks the complexity and imagination typical of normal monkeys. — location: [2746](kindle://book?action=open&asin=B00IICN1F8&location=2746) ^ref-57941 --- This leads to the conclusion that, at least in monkeys, early experience has at least as much impact on biology as heredity does. — location: [2752](kindle://book?action=open&asin=B00IICN1F8&location=2752) ^ref-27952 --- the short and long serotonin transporter alleles). — location: [2753](kindle://book?action=open&asin=B00IICN1F8&location=2753) ^ref-60421 --- short allele has been associated with impulsivity, aggression, sensation seeking, suicide attempts, and severe depression. — location: [2754](kindle://book?action=open&asin=B00IICN1F8&location=2754) ^ref-34345 --- Monkeys with the short allele that were raised by an adequate mother behaved normally and had no deficit in their serotonin metabolism. Those who were raised with their peers became aggressive risk takers. — location: [2755](kindle://book?action=open&asin=B00IICN1F8&location=2755) ^ref-18271 --- 10 Similarly, New Zealand researcher Alec Roy found that humans with the short allele had higher rates of depression than those with the long version but that this was true only if they also had a childhood history of abuse or neglect. — location: [2757](kindle://book?action=open&asin=B00IICN1F8&location=2757) ^ref-54844 --- Children who are fortunate enough to have an attuned and attentive parent are not going to develop this genetically related problem. — location: [2759](kindle://book?action=open&asin=B00IICN1F8&location=2759) ^ref-26994 --- We soon confirmed what we had suspected: The vast majority came from extremely dysfunctional families. More than half had been emotionally abused and/or had a caregiver who was too impaired to care for their needs. — location: [2786](kindle://book?action=open&asin=B00IICN1F8&location=2786) ^ref-37623 --- the children and adolescents in the survey were mirrors of the middle-aged, middle-class Kaiser Permanente patients with high ACE scores that Vincent Felitti had studied in the Adverse Childhood Experiences (ACE) Study. — location: [2789](kindle://book?action=open&asin=B00IICN1F8&location=2789) ^ref-21305 --- The DSM definition of PTSD is quite straightforward: A person is exposed to a horrendous event “that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others,” causing “intense fear, helplessness, or horror,” which results in a variety of manifestations: intrusive reexperiencing of the event (flashbacks, bad dreams, feeling as if the event were occurring), persistent and crippling avoidance (of people, places, thoughts, or feelings associated with the trauma, sometimes with amnesia for important parts of it), and increased arousal (insomnia, hypervigilance, or irritability). — location: [2799](kindle://book?action=open&asin=B00IICN1F8&location=2799) ^ref-41405 --- Eighty two percent of the traumatized children seen in the National Child Traumatic Stress Network do not meet diagnostic criteria for PTSD. — location: [2810](kindle://book?action=open&asin=B00IICN1F8&location=2810) ^ref-1982 --- Having a biological system that keeps pumping out stress hormones to deal with real or imagined threats leads to physical problems: sleep disturbances, headaches, unexplained pain, oversensitivity to touch or sound. Being so agitated or shut down keeps them from being able to focus their attention and concentration. — location: [2826](kindle://book?action=open&asin=B00IICN1F8&location=2826) ^ref-38563 --- Having been chronically beaten, molested, and otherwise mistreated, they can not help but define themselves as defective and worthless. They come by their self-loathing, sense of defectiveness, and worthlessness honestly. Was it any surprise that they didn’t trust anyone? — location: [2833](kindle://book?action=open&asin=B00IICN1F8&location=2833) ^ref-47153 --- Neither the mother’s personality, nor the infant’s neurological anomalies at birth, nor its IQ, nor its temperament—including its activity level and reactivity to stress—predicted whether a child would develop serious behavioral problems in adolescence.20 The key issue, rather, was the nature of the parent-child relationship: how parents felt about and interacted with their kids. — location: [2877](kindle://book?action=open&asin=B00IICN1F8&location=2877) ^ref-4210 --- aroused. The children of unpredictable parents often clamored for attention and became intensely frustrated in the face of small challenges. — location: [2888](kindle://book?action=open&asin=B00IICN1F8&location=2888) ^ref-38267 --- This set up a vicious cycle: Their chronic arousal, coupled with lack of parental comfort, made them disruptive, oppositional, and aggressive. Disruptive and aggressive kids are unpopular and provoke further rejection and punishment, not only from their caregivers but also from their teachers and peers.23 — location: [2893](kindle://book?action=open&asin=B00IICN1F8&location=2893) ^ref-17421 --- Sroufe informally told me that he thought that resilience in adulthood could be predicted by how lovable mothers rated their kids at age two.24 — location: [2897](kindle://book?action=open&asin=B00IICN1F8&location=2897) ^ref-53187 --- But there is an upside: By the time girls get to middle school, most have begun to master a whole set of social skills, including being able to identify what they feel, negotiating relationships with others, pretending to like people they don’t, and so on. And most of them have built a fairly steady support network of girls who become their stress-debriefing team. — location: [2930](kindle://book?action=open&asin=B00IICN1F8&location=2930) ^ref-41659 --- The abused, isolated girls with incest histories mature sexually a year and a half earlier than the nonabused girls. Sexual abuse speeds up their biological clocks and the secretion of sex hormones. — location: [2938](kindle://book?action=open&asin=B00IICN1F8&location=2938) ^ref-42873 --- When DSM-5 was published in May 2013 it included some three hundred disorders in its 945 pages. — location: [2951](kindle://book?action=open&asin=B00IICN1F8&location=2951) ^ref-56345 --- Disruptive Mood Regulation Disorder,26 Non-suicidal Self Injury, Intermittent Explosive Disorder, Dysregulated Social Engagement Disorder, and Disruptive Impulse Control Disorder.27 — location: [2952](kindle://book?action=open&asin=B00IICN1F8&location=2952) ^ref-60184 --- DSM largely lacks what in the world of science is known as “reliability”—the ability to produce consistent, replicable results. In other words, it lacks scientific validity. — location: [2962](kindle://book?action=open&asin=B00IICN1F8&location=2962) ^ref-40053 --- If doctors can’t agree on what ails their patients, there is no way they can provide proper treatment. — location: [2968](kindle://book?action=open&asin=B00IICN1F8&location=2968) ^ref-47940 --- You would not want to have your appendix removed when you are suffering from a kidney stone, and you would not want have somebody labeled as “oppositional” when, in fact, his behavior is rooted in an attempt to protect himself against real danger. — location: [2969](kindle://book?action=open&asin=B00IICN1F8&location=2969) ^ref-32110 --- “To fully understand how we become the persons we are—the complex, step-by-step evolution of our orientations, capacities, and behavior over time—requires more than a list of ingredients, however important any one of them might be. It requires an understanding of the process of development, how all of these factors work together in an ongoing way over time.”34 — location: [2993](kindle://book?action=open&asin=B00IICN1F8&location=2993) ^ref-50573 --- In the early 1970s psychologist David Olds was working in a Baltimore day-care center where many of the preschoolers came from homes wracked by poverty, domestic violence, and drug abuse. — location: [3014](kindle://book?action=open&asin=B00IICN1F8&location=3014) ^ref-42603 Economic argument for investing in home visitation for at-risk kids. --- Economists have calculated that every dollar invested in high-quality home visitation, day care, and preschool programs results in seven dollars of savings on welfare payments, health-care costs, substance-abuse treatment, and incarceration, plus higher tax revenues due to better-paying jobs. — location: [3019](kindle://book?action=open&asin=B00IICN1F8&location=3019) ^ref-57557 --- These countries have already made a commitment to universal health care, ensuring a guaranteed minimum wage, paid parental leave for both parents after a child is born, and high-quality childcare for all working mothers. — location: [3025](kindle://book?action=open&asin=B00IICN1F8&location=3025) ^ref-5198 --- Could this approach to public health have something to do with the fact that the incarceration rate in Norway is 71/100,000, in the Netherlands 81/100,000, and the US 781/100,000, while the crime rate in those countries is much lower than in ours, and the cost of medical care about half? — location: [3026](kindle://book?action=open&asin=B00IICN1F8&location=3026) ^ref-62584 --- Seventy percent of prisoners in California spent time in foster care while growing up. The United States spends $84 billion per year to incarcerate people at approximately $44,000 per prisoner; the northern European countries a fraction of that amount. — location: [3028](kindle://book?action=open&asin=B00IICN1F8&location=3028) ^ref-57243 --- Over the subsequent week images kept flooding into his mind, and he was afraid of breaking down completely. He thought about taking a knife and plunging it into his leg just to stop the mental pictures. Then the panic attacks started to be accompanied by seizures, which he called “epileptic fits.” He scratched his body until he bled. He constantly felt hot, sweaty, and agitated. Between panic attacks he “felt like a zombie”; he was observing himself from a distance, as if what he was experiencing were actually happening to somebody else. — location: [3060](kindle://book?action=open&asin=B00IICN1F8&location=3060) ^ref-20152 --- popped into his head, and, as he said, he would “lose it.” A week before I interviewed him, his girlfriend had pushed a finger into his mouth and playfully said: “You give good head.” Julian jumped up and screamed, “If you ever say that again I’ll fucking kill you.” Then, terrified, they both started to cry. This was followed by one of Julian’s “epileptic fits,” in which he curled up in a fetal position, shaking and whimpering like a baby. While telling me this Julian looked very small and very frightened. — location: [3090](kindle://book?action=open&asin=B00IICN1F8&location=3090) ^ref-50508 --- In a 1996 case I had convinced a federal circuit court judge in Boston that it was common for traumatized people to lose all memories of the event in question, only to regain access to them in bits and pieces at a much later date. — location: [3107](kindle://book?action=open&asin=B00IICN1F8&location=3107) ^ref-36722 --- The extraordinary capacity of the human mind to rewrite memory is illustrated in the Grant Study of Adult Development, which has systematically followed the psychological and physical health of more than two hundred Harvard men from their sophomore years of 1939–44 to the present. — location: [3115](kindle://book?action=open&asin=B00IICN1F8&location=3115) ^ref-64019 --- The men were interviewed in detail about their war experiences in 1945/1946 and again in 1989/1990. Four and a half decades later, the majority gave very different accounts from the narratives recorded in their immediate postwar interviews: With the passage of time, events had been bleached of their intense horror. — location: [3118](kindle://book?action=open&asin=B00IICN1F8&location=3118) ^ref-4665 --- those who had been traumatized and subsequently developed PTSD did not modify their accounts; their memories were preserved essentially intact forty-five years after the war ended. — location: [3120](kindle://book?action=open&asin=B00IICN1F8&location=3120) ^ref-31499 --- The key factor is our level of arousal. — location: [3123](kindle://book?action=open&asin=B00IICN1F8&location=3123) ^ref-42555 --- the more adrenaline you secrete, the more precise your memory will be.3 But that is true only up to a certain point. Confronted with horror—especially the horror of “inescapable shock”—this system becomes overwhelmed and breaks down. — location: [3132](kindle://book?action=open&asin=B00IICN1F8&location=3132) ^ref-29293 --- When memory traces of the original sounds, images, and sensations are reactivated, the frontal lobe shuts down, including, as we’ve seen, the region necessary to put feelings into words,4 the region that creates our sense of location in time, and the thalamus, which integrates the raw data of incoming sensations. — location: [3135](kindle://book?action=open&asin=B00IICN1F8&location=3135) ^ref-16890 --- At this point the emotional brain, which is not under conscious control and cannot communicate in words, takes over. The emotional brain (the limbic area and the brain stem) expresses its altered activation through changes in emotional arousal, body physiology, and muscular action. — location: [3138](kindle://book?action=open&asin=B00IICN1F8&location=3138) ^ref-32410 --- Under ordinary conditions these two memory systems—rational and emotional—collaborate to produce an integrated response. But high arousal not only changes the balance between them but also disconnects other brain areas necessary for the proper storage and integration of incoming information, such as the hippocampus and the thalamus. — location: [3140](kindle://book?action=open&asin=B00IICN1F8&location=3140) ^ref-56506 --- traumatic experiences are organized not as coherent logical narratives but in fragmented sensory and emotional traces: images, sounds, and physical sensations. — location: [3143](kindle://book?action=open&asin=B00IICN1F8&location=3143) ^ref-23083 --- But there was little or no story. — location: [3145](kindle://book?action=open&asin=B00IICN1F8&location=3145) ^ref-64565 --- Once considered an affliction of unstable or malingering women (the name comes from the Greek word for “womb”), hysteria now became a window into the mysteries of mind and body. — location: [3151](kindle://book?action=open&asin=B00IICN1F8&location=3151) ^ref-38155 --- just before Lelog passed out, he saw the wheels of the cart approaching him and strongly believed he would be run over. He noted that “the patient … does not preserve any recollection. … Questions addressed to him upon this point are attended with no result. He knows nothing or almost nothing.”13 Like many other patients at the Salpêtrière, Lelog expressed his experience physically: Instead of remembering the accident, he developed paralysis of his legs.14 — location: [3168](kindle://book?action=open&asin=B00IICN1F8&location=3168) ^ref-47846 --- the difference between “narrative memory”—the stories people tell about trauma—and traumatic memory itself. — location: [3186](kindle://book?action=open&asin=B00IICN1F8&location=3186) ^ref-60323 --- She meticulously reproduced, rather than remembered, the details of her mother’s death. — location: [3195](kindle://book?action=open&asin=B00IICN1F8&location=3195) ^ref-50731 --- Traumatized people simultaneously remember too little and too much. On the one hand, Irène had no conscious memory of her mother’s death—she could not tell the story of what had happened. On the other she was compelled to physically act out the events of her mother’s death. Janet’s term “automatism” conveys the involuntary, unconscious nature of her actions. — location: [3196](kindle://book?action=open&asin=B00IICN1F8&location=3196) ^ref-56777 --- The traumatic enactment serves no function. In contrast, ordinary memory is adaptive; our stories are flexible and can be modified to fit the circumstances. Ordinary memory is essentially social; it’s a story that we tell for a purpose: in Irène’s case, to enlist her doctor’s help and comfort; in Julian’s case, to recruit me to join his search for justice and revenge. — location: [3207](kindle://book?action=open&asin=B00IICN1F8&location=3207) ^ref-8840 --- nothing social about traumatic memory. — location: [3210](kindle://book?action=open&asin=B00IICN1F8&location=3210) ^ref-47788 --- “dissociation” to describe the splitting off and isolation of memory imprints that he saw in his patients. — location: [3212](kindle://book?action=open&asin=B00IICN1F8&location=3212) ^ref-39186 --- unless they became aware of the split-off elements and integrated them into a story that had happened in the past but was now over, they would experience a slow decline in their personal and professional functioning. This phenomenon has now been well documented in contemporary research. — location: [3217](kindle://book?action=open&asin=B00IICN1F8&location=3217) ^ref-24797 --- H]e reproduces it not as a memory but as an action; he repeats it, without knowing, of course, that he is repeating, and in the end, we understand that this is his way of remembering.”24 — location: [3243](kindle://book?action=open&asin=B00IICN1F8&location=3243) ^ref-45819 --- Our bodies are the texts that carry the memories and therefore remembering is no less than reincarnation. — location: [3285](kindle://book?action=open&asin=B00IICN1F8&location=3285) ^ref-45394 --- In 1922 the British government issued the Southborough Report, whose goal was to prevent the diagnosis of shell shock in any future wars and to undermine any more claims for compensation. — location: [3311](kindle://book?action=open&asin=B00IICN1F8&location=3311) ^ref-16691 --- By 1932 the nation was in the middle of the Great Depression, and in May of that year about fifteen thousand unemployed and penniless veterans camped on the Mall in Washington DC to petition for immediate payment of their bonuses. The Senate defeated the bill to move up disbursement by a vote of sixty-two to eighteen. A month later President Hoover ordered the army to clear out the veterans’ encampment. Army chief of staff General Douglas MacArthur commanded the troops, supported by six tanks. Major Dwight D. Eisenhower was the liaison with the Washington police, and Major George Patton was in charge of the cavalry. — location: [3320](kindle://book?action=open&asin=B00IICN1F8&location=3320) ^ref-11642 --- Doctors shape how their patients communicate their distress: When a patient complains about terrifying nightmares and his doctor orders a chest X-ray, the patient realizes that he’ll get better care if he focuses on his physical problems. — location: [3365](kindle://book?action=open&asin=B00IICN1F8&location=3365) ^ref-38278 --- Consciousnessraising groups and survivor groups were formed, and numerous popular books, including The Courage to Heal (1988), a best-selling self-help book for survivors of incest, and Judith Herman’s book Trauma and Recovery (1992), discussed the stages of treatment and recovery in great detail. — location: [3386](kindle://book?action=open&asin=B00IICN1F8&location=3386) ^ref-17303 --- Total memory loss is most common in childhood sexual abuse, with incidence ranging from 19 percent to 38 percent. — location: [3414](kindle://book?action=open&asin=B00IICN1F8&location=3414) ^ref-23074 --- dissociative amnesia: “an inability to recall important personal information, usually of a traumatic or stressful nature, that is too extensive to be explained by normal forgetfulness.” — location: [3416](kindle://book?action=open&asin=B00IICN1F8&location=3416) ^ref-9296 --- Dr. Linda Meyer Williams, which began when she was a graduate student in sociology at the University of Pennsylvania in the early 1970s. Williams interviewed 206 girls between the ages of ten and twelve who had been admitted to a hospital emergency room following sexual abuse. — location: [3419](kindle://book?action=open&asin=B00IICN1F8&location=3419) ^ref-2070 --- Seventeen years later Williams was able to track down 136 of the children, now adults, with whom she conducted extensive follow-up interviews.20 More than a third of the women (38 percent) did not recall the abuse that was documented in their medical records, while only fifteen women (12 percent) said that they had never been abused as children. More than two-thirds (68 percent) reported other incidents of childhood sexual abuse. — location: [3421](kindle://book?action=open&asin=B00IICN1F8&location=3421) ^ref-30268 --- One in ten women (16 percent of those who recalled the abuse) reported that they had forgotten it at some time in the past but later remembered that it had happened. — location: [3427](kindle://book?action=open&asin=B00IICN1F8&location=3427) ^ref-58976 --- memories that are retrieved tend to return to the memory bank with modifications.22 As long as a memory is inaccessible, the mind is unable to change it. But as soon as a story starts being told, particularly if it is told repeatedly, it changes—the act of telling itself changes the tale. — location: [3432](kindle://book?action=open&asin=B00IICN1F8&location=3432) ^ref-4020 --- The mind cannot help but make meaning out of what it knows, and the meaning we make of our lives changes how and what we remember. — location: [3435](kindle://book?action=open&asin=B00IICN1F8&location=3435) ^ref-11977 --- There were two major differences between how people talked about memories of positive versus traumatic experiences: (1) how the memories were organized, and (2) their physical reactions to them. — location: [3475](kindle://book?action=open&asin=B00IICN1F8&location=3475) ^ref-37258 --- Weddings, births, and graduations were recalled as events from the past, stories with a beginning, a middle, and an end. — location: [3476](kindle://book?action=open&asin=B00IICN1F8&location=3476) ^ref-303 --- traumatic memories were disorganized. — location: [3478](kindle://book?action=open&asin=B00IICN1F8&location=3478) ^ref-22909 --- remembered some details all too clearly — location: [3478](kindle://book?action=open&asin=B00IICN1F8&location=3478) ^ref-27607 --- could not recall the sequence of events or other vital details — location: [3479](kindle://book?action=open&asin=B00IICN1F8&location=3479) ^ref-15423 --- Traumatic memories are fundamentally different from the stories we tell about the past. They are dissociated: — location: [3492](kindle://book?action=open&asin=B00IICN1F8&location=3492) ^ref-13084 --- Perhaps the most important finding in our study was that remembering the trauma with all its associated affects, does not, as Breuer and Freud claimed back in 1893, necessarily resolve it. — location: [3494](kindle://book?action=open&asin=B00IICN1F8&location=3494) ^ref-45454 --- Without this split, I wouldn’t have been able to come back to life.” — location: [3514](kindle://book?action=open&asin=B00IICN1F8&location=3514) ^ref-23754 --- “Otherwise, someone [in the camps] who has been tormented by thirst for weeks would never again be able to say: ‘I’m thirsty. Let’s make a cup of tea.’ — location: [3515](kindle://book?action=open&asin=B00IICN1F8&location=3515) ^ref-419 --- “I want to tell you what a flashback is like. It is as if time is folded or warped, so that the past and present merge, as if I were physically transported into the past. — location: [3570](kindle://book?action=open&asin=B00IICN1F8&location=3570) ^ref-47468 --- I don’t go to therapy to find out if I’m a freak I go and I find the one and only answer every week And when I talk about therapy, I know what people think That it only makes you selfish and in love with your shrink But, oh how I loved everybody else When I finally got to talk so much about myself — location: [3602](kindle://book?action=open&asin=B00IICN1F8&location=3602) ^ref-49247 --- Nobody can “treat” a war, or abuse, rape, molestation, or any other horrendous event, — location: [3605](kindle://book?action=open&asin=B00IICN1F8&location=3605) ^ref-22049 --- But what can be dealt with are the imprints of the trauma on body, mind, and soul: — location: [3606](kindle://book?action=open&asin=B00IICN1F8&location=3606) ^ref-1829 --- Trauma robs you of the feeling that you are in charge of yourself, — location: [3610](kindle://book?action=open&asin=B00IICN1F8&location=3610) ^ref-10534 --- For most people this involves (1) finding a way to become calm and focused, (2) learning to maintain that calm in response to images, thoughts, sounds, or physical sensations that remind you of the past, (3) finding a way to be fully alive in the present and engaged with the people around you, (4) not having to keep secrets from yourself, including secrets about the ways that you have managed to survive. — location: [3613](kindle://book?action=open&asin=B00IICN1F8&location=3613) ^ref-35161 --- In order to regain control over your self, you need to revisit the trauma: — location: [3628](kindle://book?action=open&asin=B00IICN1F8&location=3628) ^ref-34128 --- the rational brain, which expresses itself in thoughts, the emotional brain manifests itself in physical reactions: gut-wrenching sensations, heart pounding, breathing becoming fast and shallow, feelings of heartbreak, speaking with an uptight and reedy voice, and the characteristic body movements that signify collapse, rigidity, rage, or defensiveness. — location: [3631](kindle://book?action=open&asin=B00IICN1F8&location=3631) ^ref-22438 --- When we’re triggered into states of hyper- or hypoarousal, we are pushed outside our “window of tolerance”—the range of optimal functioning.4 We become reactive and disorganized; our filters stop working—sounds and lights bother us, unwanted images from the past intrude on our minds, and we panic or fly into rages. — location: [3644](kindle://book?action=open&asin=B00IICN1F8&location=3644) ^ref-35945 --- As long as people are either hyperaroused or shut down, they cannot learn from experience. Even if they manage to stay in control, they become so uptight (Alcoholics Anonymous calls this “white-knuckle sobriety”) that they are inflexible, stubborn, and depressed. — location: [3647](kindle://book?action=open&asin=B00IICN1F8&location=3647) ^ref-35490 --- The rational, analyzing part of the brain, centered on the dorsolateral prefrontal cortex, has no direct connections with the emotional brain, where most imprints of trauma reside, but the medial prefrontal cortex, the center of self-awareness, does. — location: [3654](kindle://book?action=open&asin=B00IICN1F8&location=3654) ^ref-2472 --- “interoception”—Latin for “looking inside.” — location: [3660](kindle://book?action=open&asin=B00IICN1F8&location=3660) ^ref-64231 ---