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The Body Keeps the Score – Bessel van der Kolk

Bessel Book bodykeepsscore “The Body Keeps the Score” by Bessel van der Kolk, MD, will “permanently change how psychologists and psychiatrists think about trauma and recovery,” as trauma scholar Dr. Ruth Lanius writes.  She was the first to call developmental trauma a “hidden epidemic,” source of my book’s subtitle “Silent Epidemic.” Dr. van der Kolk repeats this in his new book.  [FN1]

And it is about the body. “Infants are psycho-biological beings, as much of the body as of the brain,” writes Prof. Ed Tronick, author of the Still Face Experiment. “Without language or symbols, infants use every one of their biological systems to make meaning of their self in relation to the world.  Van der Kolk shows that those same systems continue to operate at every age, and that traumatic experiences, especially chronic toxic experience during early development, produce psychic devastation.”

I reported van der Kolk’s work on developmental trauma and on getting the military to recognize PTSD in March 2014.  When the New York Times damned van der Kolk’s insistence on body work in June 2014, I roasted them.  In this book, van der Kolk makes his case much better than anyone else could.

I’m having trouble reading the book; I keep starting to sob. That started on page 3 where Dr. van der Kolk describes his heart-breaking childhood experience in bombed-out post-war Holland, with his father prone to violent rages, and his mother acting out her childhood trauma on him. I could feel that little boy, what he’s been going through all these years, and see the depths of what he has accomplished by giving his life so passionately to heal himself and all the rest of us.

These are “good sobs;” they feel good, because once again van der Kolk has told the truth about reality where few dare. Half the human race has had significant childhood trauma, and most of them are in complete denial and live in a state of dissociation, aka freeze or numbness. People in trauma, he writes, feel “numb” to most of life. One patient felt “emotionally distant from everybody, as though his heart were frozen and he was living behind a glass wall. He could not feel anything except his momentary rages, and his shame.”

Dr. Stephen Porges calls van der Kolk’s book a “courageous journey into the parallel dissociative worlds of trauma victims and the medical and psychological disciplines.” As van der Kolk and Porges have said before, medical and psychological experts have been just as much in denial and dissociated regarding the serious nature of trauma as are the traumatees.  “As our minds desperately try to leave trauma behind, our bodies keep us trapped in the past with wordless emotions and feelings,” Porges says. “Van der Kolk offers hope by describing treatments and strategies that have.. helped his patients reconnect their thoughts with their bodies.”

Why all the denial?  “We don’t really want to know what soldiers go through in combat,” writes van der Kolk. “We do not really want to know howe many children are being molested and abused in our own society and how many couples – almost a third –engage in violence at some point…. We want to think… of our own country as enlightened civilized people. We prefer to believe that cruelty occurs only in faraway places like Dafur…”

Solutions for Recovery

Bessel van der KolkLet’s get right to what everyone wants to know.  Here are Dr. van der Kolk’s “Paths to Recovery,” which I think of as  “body solutions” :

— Healing starts with owning our “self,” 100% total acceptance of our self, exactly as we are today, no guilt, no self condemnation. It means developing pride in who we are; only by accepting ourselves as we are now, do we become free to change. We must respect our body for putting us into trauma freeze; it was the only way to defend us, as Stephen Porges says at the end of my blog last week.

– Recognize that language is a “miracle and tyranny,” van der Kolk says. “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, the body needs to learn that the danger has passed.” At some point we must let go of all the verbiage as yackety-yack largely in the conscious frontal cortex and logical left brain.

Instead, we must grasp that there is something more fundamental underneath all that, lead by our body sensations, non-verbal subconscious, and non-logical right brain. The body literally needs to have many, often thousands, of new, good physical experiences, such as being taught to physically move or defend itself, just where it could not during the original trauma. Only these can create a “visceral” certainty of safety, to race the old experiences of danger.

EMDR (Eye Movement Desensitization and Reprocessing) is van der Kolk’s next step, to integrate the right and left sides of the brain. In trauma often neural pathways between them have been frozen; in developmental trauma from infancy, these pathways may not have developed well and must be developed now.  By moving the eyes back and forth, we simulate Rapid Eye Motion (REM) sleep, which the brain uses to take events of “now” (today) out of short-term memory, where feelings like fight-flight and trauma reside, and put them into long-term memory.  Instead of feeling as if our trauma is happening again now, it begins to feel like an old story that loses its sting.

Yoga then teaches us how to inhabit our bodies right here, right now; that’s why it’s been used as a path to enlightenment for thousands of years.  Easy to say, but the challenge is to actually practice it rigorously and regularly; only then comes the benefit.

Neurofeedback programs done by trained neurofeedback specialists really help.  Dr. van der Kolk also recommends the computer (and smart phone) -based electronic feedback system EmWave by HeartMath, which trains users to synchronize breathing and heart rates, known as heart rate variability (HRV). In good HRV, heartrate speeds up when we breathe in and slows when we breathe out.  But in trauma we lose HRV coherence; breathing is very rapid and shallow, and heart rate de-synchronizes from the breath, also hazardous to physical health.

Finding Your Voice:  As Bruce Perry says, “Patterned, repeated rhythmic activity”  can re-tune a traumatized brain stem.   Dr. van der Kolk likes  “communal rhythms” such as drum circles and dance.  He particularly likes theater work because it gives the players a substantial voice and a character they can use to express all their feelings in a way everyone can accept.

Trauma Experts Praise “Body Keeps the Score”

“This is an absolutely fascinating and clearly written book by one of the nation’s most experienced physicians in the field of emotional trauma. Equally suitable for primary care doctors and psychotherapists wishing to broaden their range of helpfulness, or for those trapped in their memories, ‘The Body Keeps the Score’  helps us understand how life experiences play out in the function and the malfunction of our bodies, years later.
– Vincent J. Felitti, MD
Chief of Preventative Medicine Emeritus, Kaiser Permanente San Diego;  Co-Principal Investigator, ACE study

“Breathtaking in its scope and breadth, ‘The Body Keeps the Score’ is a seminal work by one of the preeminent pioneers in trauma research and treatment. This essential book unites the evolving neuroscience of trauma research with an emergent wave of body-oriented therapies and traditional mind/body practices. These new approaches and ancient disciplines build resilience and enhance the capacity to have new empowered bodily (interoceptive) experiences that contradict the previous traumatic ones of fear, overwhelm and helplessness. They go beyond symptom relief, and connect us with our vital energy and here-and-now presence. A must read for all therapists and for those interested in a scholarly, thoughtful, tome about the powerful forces that affect us as human beings in meeting the many challenges of life including accidents, loss and abuse.
– Peter A. Levine, PhD, Author, In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness.

“This book is a tour de force. Its deeply empathic, insightful, and compassionate perspective promises to further humanize the treatment of trauma victims, dramatically expand their repertoire of self-regulatory healing practices and therapeutic options, and also stimulate greater creative thinking and research on trauma and its effective treatment. The body does keep the score, and Van der Kolk’s ability to demonstrate this through compelling descriptions of the work of others, his own pioneering trajectory and experience as the field evolved and him along with it, and above all, his discovery of ways to work skillfully with people by bringing mindfulness to the body (as well as to their thoughts and emotions) through yoga, movement, and theater are a wonderful and welcome breath of fresh air and possibility in the therapy world.”
– Jon Kabat-Zinn, Professor of Medicine emeritus, UMass Medical School, Author of “Full Catastrophe Living.”

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Kathy’s news blogs expand on her book “DON’T TRY THIS AT HOME: The Silent Epidemic of Attachment Disorder—How I accidentally regressed myself back to infancy and healed it all.” Watch for the continuing series each Friday, as she explores her journey of recovery by learning the hard way about Attachment Disorder in adults, adult Attachment Theory, and the Adult Attachment Interview.

Footnotes

FN  Van der Kolk, Bessel, MD., “The Body keeps the Score: Brain, Mind, and Body in the Healing of Trauma,” Peguin Press Viking, New York, 2014  http://www.amazon.com/The-Body-Keeps-Score-Healing/dp/0670785938#reader_0670785938

Bessel van der Kolk, M.D. is the founder and medical director of the Trauma Center in Brookline, Massachusetts. He is also Professor of Psychiatry at Boston University School of Medicine and Director of the National Complex Trauma Treatment Network. When he is not teaching around the world, Dr. van der Kolk works and lives Boston, Massachusetts.

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Thanksgiving in Cambodia

#15 in my book blogs from “Don’t Try This at Home,” Chapter 3

Cambodia Napalm“Once again”  I thought, “Fall 2008 surely was the end of my world. Surely it could get no worse than this.”  So ended “Isolation Row,” my last post three weeks ago from my book.  Little did I know that 2008 could, and did, get a whole lot worse.  The gods of Pain had barely gotten started on my file.

By September 2008 I couldn’t take any more isolation row as prescribed by my first two therapists or I’d have bonked one. Meanwhile back in the real world the bills were mounting, so I worked out my nervous energy (read “anxiety”) in a whirl of new business projects. Remember the Newport Beach financier who took me on as her protege to write her book – but then all her banks collapsed?  Like writing a book about nuclear war in the middle of a nuclear war?  Well, I just went at it again.

Wrestling my demons to the bathroom floor, I forced myself to write a three-page memo to a company in San Diego, offering to market their power plants in Asia.  I e-mailed it to the Vice President, left a message, and nearly passed out when he returned my call next day.  He said the memo was “brilliant,” and two days later I was in his office.  Negotiations with his staff, however, dragged on for months as they did not have his vision, to put it mildly. They wanted to await the November 2008 election as they worried the new Administration wouldn’t support nuclear energy (it didn’t). They worried the banking collapse meant there would be no financier appetite for new ventures (there wasn’t).

Meanwhile my friends at the South Korean central bank were calling in a tizzy (wouldn’t you), worried the U.S. financial system melt down would take them with it. They had a Seoul government rep in Los Angeles take me to dinner. He asked me to write a white paper for South Korea to take to a world financial summit next spring on how to prevent the meltdown of the global foreign exchanges. No pressure, of course, just in my spare time. This minor project didn’t resolve neatly or quickly either.

In other words, “nuclear war” just kept happening, which did little to bolster my nearly-expired self-confidence or bank account. At least it pushed therapy with its “Inner Child” poppycock off my agenda during September-October 2008, easy to do because all that failed therapy only made my emotional pain worse.

And now for Mom

BVH-00701395 Then back on the East Coast there began a train of events which pushed me, my crisis, and any emotional needs for help (not being met by failed therapy anyway) well and truly off the agenda. Actually more like buried my stuff under a very large landslide.

Mom.

Mom had been “home alone” in Florida since Dad passed away in June and my younger sister the Wall Street lawyer in New York thought we should check on Mom regularly. In mid-September, in the middle of furious negotiations in San Diego over the fate of the national electricity grid, it was my turn to make a two-day visit.

Mom was never eager to see me (a long story for next week), so sis and I made my trip a surprise. Landing in Miami, I hopped a cab and phoned Mom en route to her place to say, “Surprise! I’m on the way.” Her reaction shocked me, even at that late date. “You can’t do this to me,” she yelled, “I don’t want you here! I don’t want to see you, leave me alone!” By the time she hung up she was in hysterics.

I phoned sis in New York from the cab. “Could you talk to Mom?” I said. “I’m afraid to give her heart failure, plus now I feel really awful; maybe this wasn’t a good idea?” But my poor sister Linda had spent so much time in the last six months commuting to Florida to tend our parents that she was worried about the stress on her job. Someone had to see Mom, and I was elected.

The problem was that if I couldn’t make it work, I was the problem.

“Why do you always have to fight with her? Couldn’t you just be sweet?” sis wanted to know.  Now, my sister is a famously nice person with a permanent glowing smile through thick and thin — but not when it came to anything which upset Mom. No one in our family would dispute a cousin’s recent statement that “your mom was a very strong-willed person, and a very emotional person.” Well, when Mom wasn’t happy, no one was happy, as the saying goes (it’s hackneyed for a reason).

It had to be my bad if things weren’t going swimmingly. “I can’t leave work any more and it’s your job to visit Mom so just get it done,” sis said point blank. Naturally I agreed; I thought it was our job to make Mom happy and so it must be my fault if she weren’t. I didn’t even notice until years later when I finally put this incident under a microscope that there was no room for anyone to even consider the collateral damage to me.

Doing the Right Thing, I ignored the arrows lacing into my heart and the terrified looks from the cab driver and dissolved in silent sobs in the back seat. We duly arrived at Mom’s place, whereupon she had to calm down so as not to cause any lifting of eyebrows amongst the upscale neighbors. The visit proceeded in an uneasy truce and I returned to my project negotiations in California.

Mozart’s Requiem – Again

Kathy @ 2008 Requiem AnaheimOn October 5, 2008 I again performed Mozart’s Requiem, this time as soprano soloist, in Anaheim.  After the previous events of 2008, you can already see my glazed stare in this photo taken minutes after the performance.

Three days later, as my last dream to accomplish something with my life by reestablishing my international business was in play, my phone rang again from back East, just as it had the day after I sang the “Requiem” the previous May.

This time it was my sister, calling to say Mom had been hospitalized in Miami with chest hemorrhaging and heart failure. She had smashed her ribs in a bad fall at home while the live-in nurse was watching TV.  Yes, this actually happened a second time.  Whenever I sing Mozart’s Requiem, a parent begins to die.

Again, time to leave the biz meetings and get back on the plane from California to Florida; truth is verily stranger than fiction. I would be afraid to ever sing that Mozart piece again, if I had any more parents.  Mozart’s Requiem was my favorite work for most of my life, and I don’t have any more parents, but I have not sung it again to this day.

Now my emotional crisis, the battle royal in therapy, the economic disaster, and my high-stakes attempts to jump-start my career were wiped off the agenda.  Now it was all about Mom in earnest.

I’d worried over the years that Mom lacked perspective; one rarely heard her speak of the eternal nature of love or the immortality of the soul.  I’d long been concerned that she might not be at peace when the time came.  Indeed.  Peace, to paraphrase Henry Kissinger, was the light at the end of the tunnel which turned out to be an oncoming train.

October and November 2008 with Mom in Florida were my psychological Cambodia.  It was going to get a whole lot worse, and “better” had just been summarily wiped off the agenda.

First came the genocidal doctors with the insurance hounds at their heels. Their sole concern seemed to be to remove Mom from whichever ward she was on, before the Medicare police could find her and cut their funding to the hospital in retaliation for the doctors allowing Mom to stay anywhere too long. They moved Mom from ward to ward, forcing her to undergo vigorous physical therapy to prove she should be hospitalized at all, which for a woman her age in her condition was in fact brutality. Finally Mom collapsed after physical therapy.

As a result our intrepid doctors summarily booted her out of the regular hospital wing and moved her to the hospice wing, where they said, mincing no words, she had an allotment of a few weeks before she’d have to leave, one way or the other.  Ouch.  “Welcome to the U.S. health care system” said my sister by phone.

To be clear, no one thought Mom would die; she had a bright mind and a strong constitution. Rather, my sister was up north working the retirement homes in New York 24 x7 to find a place into which to move Mom. We all thought she was just headed for a stressful plane flight.

Where’s My Daughter?

Adam & Eve Expulsion_from_GardenBut then there was Mom herself, who in essence began to snarl when I arrived back in Miami and continued to do so for six weeks. It wasn’t that she was in pain; the nurses saw to her meds.  She said herself that she was not in pain.

Mom, simply put, did not want to see me, as she had in fact clearly stated earlier and for decades. In fact about seven and a half minutes into each of my weekly Sunday phone calls to her, Mom had had a certain habit of hanging up on me – for about 25 years.

Curiously now, however, Mom was also hanging up on her friends and relatives as they called.  She folded the phone even on bridge partners from the retirement home who sounded anxious to see her and terrified that they themselves were next for hospice. But Mom flat out refused to see them, didn’t care anymore what anyone thought and did precisely as she felt.  Not only with me, but with all sorts of folks.

Mom had always been known to put on a happy face and be entertaining with her jokes to friends at her retirement complex or with shoe store clerks.  Now, actually it was remarkable to watch the change.  Apparently she was done with appearances, for why bother?

The nurses and I kept telling Mom in detail how we were going to get her to New York, I’d fly with her on the plane, she’d be fine with Linda.

The problem was, however, that Mom had never been willing to discuss questions such as “why and for what do we live.”  She’d always dismissed them as impractical nonsense from fools who haven’t worked as hard for a dollar as she.  She was pragmatic to the point of scorning theory as idiocy.  But in life as in science there’s a reason for theory, and when the time came for faith and belief, Mom didn’t seem to have enough inside upon which to base a view of ‘Now what?’

“Oh God, it is fearful thing, to see the human soul take wing,” as Byron put it, especially when it doesn’t have a wing to wing it.

Mom seemed to get no comfort from God, nor even be aware of the subject, for starters.  She also seemed to get no comfort out of seeing my sister’s loving smile.  Even the appearance of Linda’s two handsome sons from New York did almost nothing to lighten Mom’s face.  She seemed to get no comfort out of having brought her family, and my sister’s family, into being, of having friends (who never set foot in the hospital due to the hang-ups) of having a very long and until just these weeks, healthy and prosperous life, nice clothes, fine homes, and international vacations.  All of the things she always said were so important didn’t seem to bring her much joy in the end.

I had to spend a lot of hours watching this and felt driven to make sense of it.  As best I could grasp, Mom was terrified of something but I couldn’t dismiss it as fear of death since people do die in peace.

All this would have been gut-wrenching to watch just as an observer.  But then, I was not an observer.  I was the designated pin cushion.  Mom had made no bones for decades that she pretty much didn’t want me anywhere, least of all in that hospice at the end.

It got to where I’d arrive in her hospital room each morning and Mom would roll over and turn her face away.  When the nurses were dressing her or when she wanted something, she would raise her voice and say, “Where’s my daughter?” whether I were standing right before her, or down the hall on a business call to San Diego or Seoul.  When I’d say, “I’m right here, Mom,” she’d growl, “Not you. Where’s Linda?”

Now look, Adam and Eve had a Perfect Parent, but a 50% failure rate when producing their kids. Moral: Babies are really easy to damage.

Yes it felt bad at my end – but what if this were my paranoia?  What if Mom in reality was a fine (if not Perfect) parent, but I (like Eve) were somehow damaged, and had some mess in my head which made me project my own neurosis onto Mom?  I sure didn’t want to do a re-run of that dreadful “Mommie Dearest” or demonize my own mother…

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This is from Kathy’s forthcoming book “DON’T TRY THIS AT HOME: The Silent Epidemic of Attachment DisorderHow I accidentally regressed myself back to infancy and healed it all.” Watch for the continuing series of excerpts from the rest of her book each Friday, as she explores her journey of recovery by learning the hard way about Attachment Disorder in adults, adult Attachment Theory, and the Adult Attachment Interview.

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