How The Body Keeps The Score: An Interview with Dr. Bessel van der Kolk

Bessel van der Kolk, M.D., a clinician, researcher, teacher, and inspiring speaker, has been active in the study of post-traumatic stress disorder since the 1970s. Published in the fields of dissociative problems, borderline personality and self-mutilation, cognitive development in traumatized children and adults, and the psychobiology of trauma among others, he is also the president of the International Society for Traumatic Stress Studies, professor of psychiatry at the Boston University Medical School, and the medical director of the Trauma Center at the Justice Resource Institute in Brookline, Mass.


In his book, “The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma,” he reveals how trauma rearranges the brain’s wiring, including areas dedicated to pleasure, engagement, control, and trust. In an effort to apply his findings in a way that improves people’s lives, he shows how these areas can be reactivated through inner focus and compassion, combined with a little help from technology.

 

Brain World: How do you define trauma

Bessel van der Kolk: Trauma is an experience that basically leaves people stuck in a state of helplessness and terror. Trauma starts with the feeling of “Oh my god, my life is over.” Mind and brain become overwhelmed, resulting in a change over how you perceive danger, and what you consider relevant and irrelevant to your survival.

BW: What causes trauma?

BvdK: Horrifying experiences. Being beaten, being humiliated in front of other people, being bullied, being molested. Essentially, it’s a situation characterized by the inability to take the actions necessary to protect yourself. Trauma is about being in a state where you feel that nothing you do can stop what’s happening to you.

BW: Don’t we all have some level of trauma?

BvdK: Bad things happen to us all, but hopefully, with time, you are able to resume your life and develop new interests. Having PTSD is a different issue, because you start doing irrational things, or behaving in ways where you don’t live fully in the present. This makes other people respond with: “How can you become this upset, or this angry, or this freaked out about a minor issue?” The reason is that your brain has changed and causes you to interpret minor things as a threat to your very existence.

One of the most difficult parts of being a traumatized person is that your behaviors annoy or frighten the people around you and make you feel ashamed of yourself. Trauma survivors need help regulating those reactions. Yelling at people to stop feeling that way, or trying to talk them out of it does not work.

BW: Scientifically, what’s happening in the brain?

BvdK: Many different things. When something life-threatening happens to you, you secrete stress hormones that are supposed to mobilize you for fighting back. If you are held down and prevented from restoring your safety and control, these stress hormones may begin to work against you and disrupt the workings of your mind, instead of activating your muscles to move.

Basically our stress hormones are meant to help us move, or fight back, and get out of the situation. If they keep being secreted, they keep you in a state of hyperarousal or put you in a state of helpless collapse. When this happens over time, the filtering system of the brain is changed so you become hypersensitive to certain sounds. You have difficulty filtering irrelevant information. Gradually, you start feeling threat everywhere. Instead of being focused on what is going on right now, your mind stays on the alert for threat, while you basically feel helpless to do anything about it.

The amygdala (the “smoke detector” of the brain) tends to continually fire, telling you “You’re in danger,” and your anterior cingulate, which is supposed to filter out irrelevant information, doesn’t function very well, so things that other people see as simply unpleasant or irritating, are perceived as a threat to your very existence.

The medial prefrontal cortex (the watchtower of your mind, meant to help you to calmly survey what is going on and provide you with a feeling of “I know what I’m doing”) tends to get deactivated as well, so you get trapped in your reactions without having much control over them.


BW: So can we assume that the root of the problem is information processing?

BvdK: Yes, I think one can say that.

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