Boston Trauma Centre director Bessell van der Kolk believes that traumatic events affect people’s bodies as much as their brains. He explained to Lynne Malcolm why self-awareness is at the centre of his unconventional approach to therapy.
At this time of year, Anzac Day reminds us of the many cases of post-traumatic stress disorder (PTSD) experienced by war veterans. Meanwhile, the stories emerging from the Royal Commission into Institutional Responses to Child Sexual Abuse highlight the trauma caused by abuse.
Bessel van der Kolk, professor of psychiatry at Boston University, has spent 40 years studying and treating people haunted by their stressful experiences. His latest book, The Body Keeps the Score, explores his contention that the key to understanding trauma lies in the connection between the brain and the body.
He suggests that standard talking and drug therapies are not effective enough in resolving trauma. Van der Kolk’s unconventional approach to healing trauma is based on the idea that it has nothing to do with cognition, but rather is your body resetting itself in response to a stressful experience, interpreting the world as a more frightening and dangerous place.
By investigating the brains of PTSD patients using medical imaging, Van der Kolk and his colleagues found that deeply traumatic experiences literally rearrange the brain’s wiring.
‘What we found is that when people remember their trauma, their frontal lobe basically went offline, the speech centre of their brains disappeared, and the survival, animal part of the brain lit up,’ he says. ‘What we saw on the brain scans—something that we see in our clinical practice also—is that people lose touch with their current environment and go into survival mode.
‘In fact, the brain is changed to the point that you keep reacting to all kinds of situations that are pretty neutral to other people, as if you are in danger.’
Van der Kolk gives the example of a patient whose daughter bled on her pillow after having a tonsillectomy. This in turn made the mother recall her daughter being held down for the operation, triggering memories of when she herself was held down and sexually assaulted as a child.
‘At that point she became that little girl: frozen, perspiring, mute, terrified,’ says Van der Kolk. ‘There must have been a part of her brain that knew that I was in the room, but not much of her. Most of her became that little girl ... reliving her memory.’
The example highlights one of the common characteristics of trauma inducing situations: a sense of helplessness and an inability to move in response to stressful experiences.
‘Standing helplessly by when your kid is being run over, when you see somebody getting hurt, when you see your friend being blown up and not being able to do anything to avert the inevitable creates a state of horror,’ says Van der Kolk. ‘Horror has to do with immobilisation and that horrendous experience really seems to break certain filtering systems in the brain. That causes people to relive the old trauma.’
This is why child abuse so often causes lasting psychological damage. Normally our brains are wired to be comforted and consoled by others, but in situations of child abuse, the source of comfort is also the source of terror.
‘That sets up all kinds of very complex circuits in the brain and in the mind ... and then you start doing things to yourself to make your feelings disappear, to calm yourself down,’ says Van der Kolk. ‘You may do things like taking razor blades and cutting yourself, and that somehow changes the chemical balance in the body. Or you may bang your head against a wall or you may masturbate chronically, just to make these horrible feelings disappear.’
According to Van der Kolk, the function of the brain is to take care of the body, so when people are traumatised and feel scared, threatened or enraged, all of these things are experienced at a bodily level.
Van der Kolk also believes his theory can explain why some people seem to go from one trauma to another, often putting themselves back in harm’s way.
‘When you always feel in danger you shut off that smoke detector in your brain, you try not to detect things,’ he says. ‘So there is an organisation of the brain to compensate for that hyper-arousal, for that hyperactivity, and people shut themselves down.
‘Because of that, they may not pick up what is dangerous and what is safe, and they sleepwalk into dangerous situations. Or in fact they may feel more alive in dangerous situations.’
Van der Kolk treats many children who have been traumatised by abuse and takes issue with common therapeutic approaches such as exposure therapy or cognitive behavioural therapy, where patients are often asked to speak about upsetting experiences.
His approach begins with helping children to feel safe before having them do physical activities like jumping on trampolines or walking over balance beams. This helps them generate an elementary self awareness, tuning into their bodies and their sensations, feeling what pleasure is and what sensations they want to avoid.
‘We try to calm that system down so their minds actually can start beginning to come online so they can reflect on themselves,’ he says. ‘Once kids get a better sense of where their bodies are and what's happening inside of them, they start being able to talk about themselves as a person with a past, a present and a future.’
Van der Kolk's approach to treating traumatised people is considered unconventional and lacking in scientific rigour by some mainstream psychiatrists. For his part, van der Kolk says he supports any therapy which pays close attention to physiological states. One of these is yoga, because it has been found to change heart rate variability
‘We had better results with yoga in people with chronic PTSD than any medication that I or anybody else had ever studied,’ he says. ‘That, of course, is pretty interesting and exciting, and not so good news for psychiatry, because psychiatrists are unlikely to transform themselves into yoga instructors. But is yoga helpful? Absolutely.’
The Boston Trauma Center director also believes in the healing power of community, rhythm and touch, a realisation he came to while working with the Truth and Reconciliation Commission in South Africa.
According to him, singing, moving and dancing together can create a sense of safety and belonging that make it possible for people to confront their trauma.
‘The whole issue of self-regulation, calming your brain down and helping your brain to be focused in the present is central,’ he says. ‘The key brain area that is necessary to be online to get over your trauma is your capacity to observe yourself and to notice yourself.
‘So any intervention that helps you to really know where you are and what you are and what you're feeling would be helpful. That may range as far as martial arts, where you need to know exactly where your body is in order to do it well, to mindfulness meditation, where also you're focusing yourself.’
Although van der Kolk has listened to disturbing stories of trauma over many years he says he finds his work very satisfying.
‘It's exhilarating. It confronts you with the life force ... Basically everybody who I treat is an awesome person; is a person who when I sit with them I go like, boy, “If I'd had your history, if what has happened to you would have happened to me, I have no idea how I would have survived.”’