Title: The Body Keeps the Score. Brain, Mind, and Body in the healing of trauma Author: Bessel A. Van Der Kolk, M.D 2014 Source: [The Body keeps the score](evernote:///view/463671/s5/b5578199-f382-4699-a0d0-814a4a76f73f/57ba5125-cfd0-4795-9c56-4f9115b91ae9/) Reading on Google play books - [https://play.google.com/books/reader?id=lYKFKgAAAEAJ&pg=GBS.PA9](https://play.google.com/books/reader?id=lYKFKgAAAEAJ&pg=GBS.PA9) Related Notes: - [How Mental Illness Impacts Our Bodies -The School of Life Articles | Formerly The Book of Life](evernote:///view/463671/s5/56a29083-70b9-4b98-892d-9ebe78638003/c24bc1f0-1ab8-482a-b3ed-5d0ab50ef081/) Relate to [[🏠 Trauma]], #Trauma --- Content # PART ONE: THE REDISCOVERY OF TRAUMA **Trauma impact not only immediate victims, but their family members and next generations.** **Children of depressed mothers have risk of growing up insecure and anxious.** - The wives of men who suffer from PTSD tend to become depressed, and the children of depressed mothers are at risk of growing up insecure and anxious. Having been exposed to family violence as a child often makes it difficult to establish stable, trusting relationships as an adult. **Trauma changes brain physiologically.** - Research from these new disciplines has revealed that 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. **Three ways to manage and help trauma victims, (1) talking about it, (2) medication, (3) allow body to experience those trauma** - We can now develop methods and experiences that utilize the brain’s own natural neuroplasticity to help survivors feel fully alive in the present and move on with their lives. 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. ## 1. LESSONS FROM VIETNAM VETERANS **Sometimes, patients feel bad about getting better.** - When he returned for his appointment, I eagerly asked Tom how the medicines had worked. He told me he hadn’t taken any of the pills. Trying to conceal my irritation, I asked him why. “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.” ### TRAUMA AND THE LOSS OF SELF **Trauma causes one to lose trust in self and others. Become closed up.** - 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? **Shame experienced for allowing trauma to happen to themselves.** - 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. They despise themselves for how terrified, dependent, excited, or enraged they felt. In later years I encountered a similar phenomenon in victims of child abuse: Most of them suffer from agonizing shame about the actions they took to survive and maintain a connection with the person who abused them. ### NUMBING **Victims of trauma feel emotionally numb unable to connect with people.** - Maybe the worst of Tom’s symptoms was that he felt emotionally numb. He desperately wanted to love his family, but he just couldn’t evoke any deep feelings for them. He felt emotionally distant from everybody, as though his heart were frozen and he were living behind a glass wall. ### THE REORGANIZATION OF PERCEPTION **Once traumatised, victims become wary and project their trauma on everything. Like chinese saying "bitten by snake once, 10 years wary about ropes"**. - We learned from these Rorschach tests that traumatized people have a tendency to superimpose their trauma on everything around them and have trouble deciphering whatever is going on around them. There appeared to be little in between. We also learned that trauma affects the imagination. The five men who saw nothing in the blots had lost the capacity to let their minds play. But so, too, had the other sixteen men, for in viewing scenes from the past in those blots they were not displaying the mental flexibility that is the hallmark of imagination. They simply kept replaying an old reel. **Not being able to imagine about future, and possibilities, lock us up with the present/past.** - Imagination is absolutely critical to the quality of our lives. Imagination gives us the opportunity to envision new possibilities—it is an essential launchpad for making our hopes come true. **Imagination is critical to our qualities of lives. Like in SF, the ideal future is about imagination, creating a better future, and give us hope to move on.** - 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. **This is interesting, related to persecutory delusions, what if delusions are also caused by trauma. (Related to my delusional disorder patients)** - traumatized people look at the world in a fundamentally different way from other people. For most of us a man coming down the street is just someone taking a walk. A rape victim, however, may see a person who is about to molest her and go into a panic. A stern schoolteacher may be an intimidating presence to an average kid, but for a child whose stepfather beats him up, she may represent a torturer and precipitate a rage attack or a terrified cowering in the corner. ### STUCK IN TRAUMA **Victims find support in support group, but danger of being stuck in their trauma by forming a group. They felt alive only when revisiting their traumatic past** - They insisted that I had to be part of their newfound unit and gave me a Marine captain’s uniform for my birthday. In retrospect that gesture revealed part of the problem: You were either in or out—you either belonged to the unit or you were nobody. After trauma the world becomes sharply divided between those who know and those who don’t. 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. ### DIAGNOSING POSTTRAUMATIC STRESS **PTSD was a lobbied diagnosis?** - A turning point arrived in 1980, when a group of Vietnam veterans, aided by the New York psychoanalysts Chaim Shatan and Robert J. Lifton, successfully lobbied the American Psychiatric Association to create a new diagnosis: posttraumatic stress disorder (PTSD), which described a cluster of symptoms that was common, to a greater or lesser extent, to all of our veterans. **In summary, Trauma changes the brain and perceptions** - "Trauma results in a fundamental reorganization of the way mind and brain manage perceptions. It changes not only how we think and what we think about, but also our very capacity to think. We have discovered that helping victims of trauma find the words to describe what has happened to them is profoundly meaningful, but usually it is not enough. The act of telling the story doesn’t necessarily alter the automatic physical and hormonal responses of bodies that remain hypervigilant, prepared to be assaulted or violated at any time. 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. Our search to understand trauma has led us to think differently not only about the structure of the mind but also about the processes by which it heals." ## 2. CHAPTER 2 - REVOLUTIONS IN UNDERSTANDING MIND AND BRAIN [[🏠 Trauma]] [[Always watch out for history of abuse, traumas in patient history]] - "However, many later studies have confirmed the relevance of those midnight confessions: 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.1" - "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" - Like Martin Seligman's research on Learned Helplessness, traumatised people have thwarted fight/flight responses. Traumatised patients continue to secret large amounts of stress hormones even after the trauma event. - Scared animals all run back to their homes, regardless of whether home is safe or frightening. ## Addicted to Trauma: The Pain of Pleasure and the Pleasure of Pain - In traumatised people , reexposure to stress may provide similar relief from anxiety. - Strong emotions - release of morphinelike substances - Prozac works. Due to adjusting the serotonin levels. - Serotonin levels affect behaviors - "The SSRIs can be very helpful in making traumatised people less enslaved by their emotions, but they should only be considered adjuncts in their overall treatment"(23) ## 3. LOOKING INTO THE BRAIN: THE NEUROSCIENCE REVOLUTION - For patients with history of trauma, their amygdala is hyperactive. Recalling the past as if is happening now. - The speech center "Broca" is silent, like Stroke patients, as if there is no words to describe what is happening - In summary, medication can dull the sensations, but the brain continue to react the same way as if being tramatised. - When there is a flashback, there is a temporary disconnection between the Left (logical) and Right (Emotional) side, thus there is an inability to makes sense of cause and effect of what has happened. # PART TWO: THIS IS YOUR BRAIN ON TRAUMA ## 4. Chapter 4 - RUNNING FOR YOUR LIFE: THE ANATOMY OF SURVIVAL - Reptilian brain -> Mammalian brain (The Emotional Brain) -> Frontal Lobes / neocortex - Neocortex - reasoning, also seat of empathy, mirror neurons. ![[Screenshot 2023-10-30 at 8.19.10 PM.png]] - The emotional brain is first to interprete incoming information, to assess if stimulant is dangerous or not. - Trauma experience causes brain changes. Every time flashbacks, it re-experience the traumatic event, and the more it wire the brain. It bring you back to that past. - Patient cope by depersonalisation, / detached or numb. it may reduce the sensitivity but also detract you from living in the present. ## 5. BODY-BRAIN CONNECTIONS ## 6. LOSING YOUR BODY, LOSING YOUR SELF ## # PART THREE: THE MINDS OF CHILDREN ## 7. GETTING ON THE SAME WAVELENGTH: ATTACHMENT AND ATTUNEMENT ## 8. TRAPPED IN RELATIONSHIPS: THE COST OF ABUSE AND NEGLECT ## 9. WHAT’S LOVE GOT TO DO WITH IT? ## 10. DEVELOPMENTAL TRAUMA: THE HIDDEN EPIDEMIC ## # PART FOUR: THE IMPRINT OF TRAUMA ## 11. UNCOVERING SECRETS: THE PROBLEM OF TRAUMATIC MEMORY ## 12. THE UNBEARABLE HEAVINESS OF REMEMBERING # PART FIVE: PATHS TO RECOVERY ## 13. HEALING FROM TRAUMA: OWNING YOUR SELF ## 14. LANGUAGE: MIRACLE AND TYRANNY ## 15. LETTING GO OF THE PAST: EMDR ## 16. LEARNING TO INHABIT YOUR BODY: YOGA ## 17. PUTTING THE PIECES TOGETHER: SELF-LEADERSHIP ## 18. FILLING IN THE HOLES: CREATING STRUCTURES ## 19. REWIRING THE BRAIN: NEUROFEEDBACK ## 20. FINDING YOUR VOICE: COMMUNAL RHYTHMS AND THEATER ## EPILOGUE: CHOICES TO BE MADE ##