The Body Keeps The Score by Bessel A. Can see Kolk

The Body Keeps The Score

Health, Mental health, Psychology, Trauma
7.2/1019 min read

12/24/23

  • - Brain, mind, and body in the healing of trauma

  • - Prologue - facing trauma

  • - Part 1 - the rediscovery of trauma

  • - Chapter 1 - lessons from Vietnam veterans

  • - “The greatest source of our suffering are the lies we tell ourselves.”

  • - 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

  • - Chapter 2 - revolutions in understanding mind and brain

  • - “You live through that little piece of time that is yours, but that piece of time is not only your own life, it is the summing-up of all the other lives that are simultaneous with yours… what you are is an expression of History.” - Robert Penn Warren

  • - “The greatest sources of our suffering are the lies we tell ourselves”

  • - You can be fully in charge of your life only if you can acknowledge the reality of your body, in all its visceral dimensions

  • - Many traumatized people simply give up. Rather than risk experimenting with new options they stay stuck in the fear they know

  • - Traumatized people keep secreting large amounts of stress h promotes long after the actual danger has passed

  • - Cortisol puts an end to the stress response by sending an all-safe signal

  • - Drugs have displaced therapy and enabled patients to suppress their problems without addressing the underlying issues

  • - The number of people treated for depression has tripled over the past two decades, and one in ten Americans nOw take antidepressants.

  • - Being a patient, rather than a participant in one's healing process, separates suffering people from their community and alienates them from an inner sense of self.

  • - Chapter 3 - Looking into the brain: the neuroscience revolution

  • - Part Two - This is your brain on trauma

  • - Chapter 4 - Running for your life: the anatomy of survival

  • - “Prior to the advent of brain, there was no color and no sound in the universe, nor was there any flavor or aroma and probably little sense and no feeling or emotion. Before brains the universe was also free of pain and anxiety.” - Roger Sperry

  • - During disasters young children usually take their cues from their parents. As long as their caregivers remain calm and responsive to their needs, they often survive terrible incidents without serious psychological scars.

  • - Traumatized people become stuck, stopped in their growth because they can't integrate new experiences into their lives.

  • - It is amazing how many psychological problems involve difficulties with sleep, appetite, touch, digestion, and arousal. Any effective treatment for trauma has to address these basic housekeeping functions of the body.

  • - 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. Sensing, naming, and identifying what is going on inside is the first step to recovery.

  • - Trauma is the ultimate experience of 'this will last forever.'

  • - Visiting the past in therapy should be done while people are, biologically speaking, firmly rooted in the present and feeling as calm, safe, and grounded as possible. ('Grounded' means that you can feel your butt in your chair, see the light coming through the window, feel the tension in your calves, and hear the wind stirring the tree outside.) Being anchored in the present while revisiting the trauma opens the possibility of deeply knowing that the terrible events belong to the past.

  • - Chapter 5 - Body-Brain Connections

  • - 'Man and the higher animals . . . [also] have instincts in common. All have the same senses, intuition, sensation, passions, affections, and emotions, even the more complex ones such as jealousy, suspicion, emulation, gratitude, and magnanimity.' - Charles Darwin

  • - The fundamental purpose of emotions is to initiate movement that will restore the organism to safety and physical equilibrium.

  • - 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. For us humans, it means that as long as the mind is defending itself against invisible assaults, our closest bonds are threatened, along with our ability to imagine, plan, play, learn, and pay attention to other people's needs.

  • - 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.

  • - Human beings are astoundingly attuned to subtle emotional shifts in the people (and animals) around them. Slight changes in the tension of the brow, wrinkles around the eyes, curvature of the lips, and angle of the neck quickly signal to us how comfortable, suspicious, relaxed, Or frightened someone is.

  • - When the message we receive from another person is 'You're safe with me,' we relax. If we're lucky in our relationships, we also feel nourished, supported, and restored as we look into the face and eyes of the other.

  • - 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 created), 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.

  • - 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). Usually it's a combination of both.

  • - 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.

  • - Social support is the most powerful protection against becoming overwhelmed by stress and trauma.

  • - 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. For our physiology to calm down, heal, and grow we need a visceral feeling of safety. No doctor can write a prescription for friendship and love: These are complex and hardearned capacities.

  • - In order to feel emotionally close to another human being, our defensive system must temporarily shut down. In order to play, mate, and nurture our young, the brain needs to turn off its natural vigilance.

  • - Women who had an early history of abuse and neglect were seven times more likely to be raped in adulthood. Women who, as children, had witnessed their mothers being assaulted by their partners had a vastly increased chance to fall victim to domestic violence.

  • - Chapter 6 - Losing Your Body, Losing Your Self

  • - 'Give me a place to stand and I will move the world.' - Archimedes

  • - 'You can't do what you want till you know what you're doing.' - Moshe Feldenkrais

  • - To feel present you have to know where you are and be aware of what is going on with you.

  • - Knowing what we feel is the first step to knowing why we feel that way. If we are aware of the constant changes in our inner and outer environment, we can mobilize to manage them.

  • - The more people try to push away and ignore internal warning signs, the more likely they are to take over and leave them bewildered, confused, and ashamed. People who cannot comfortably notice what is going on inside become vulnerable to respond to any sensory shift either by shutting down or by going into a panic-they develop a fear of fear itself.

  • - 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.

  • - 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.

  • - Part Three - The Minds of Children

  • - Chapter 7 - Getting on the Same Wavelength: Attachment and Attunement

  • - 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.

  • - Pierre Janet: 'Every life is a piece of art, put together with all means available.'

  • - As we grow up, we gradually learn to take care of ourselves, both physically and emotionally, but we get our first lessons in self-care from the way that we are cared for.

  • - Newborns can focus their eyes only on objects within eight to twelve inches-just enough see the person who is holding them.

  • - 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.

  • - Kids will go to almost any length to feel seen and connected.

  • - Chapter 8 - Trapped in Relationships: The Cost of Abuse and Neglect

  • - “The 'night sea journey' is the journey into the parts of ourselves that are split off, disavowed, unknown, unwanted, cast out, and exiled to the various subterranean worlds of consciousness.... The goal of this journey is to reunite us with ourselves. Such a homecoming can be surprisingly painful, even brutal. In order to undertake it, we must first agree to exile nothing.” —Stephen Cope

  • - Generally the rational brain can override the emotional brain, as long as our fears don't hijack us.

  • - Chapter 9 - What’s Love Got To Do With It?

  • - A diagnostic label is likely to attach to people for the rest of their lives and have a profound influence on how they define themselves. I have met countless patients who told me that they 'are' bipolar or borderline or that they 'have' PTSD, as if they had been sentenced to remain in an underground dungeon for the rest of their lives, like the Count of Monte Cristo.

  • - The more isolated and unprotected a person feels, the more death will feel like the only escape

  • - 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.

  • - Chapter 10 - Developmental Trauma: The Hidden Epidemic

  • - 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 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. Under some conditions being an anxious mom can provide much needed protection. The aggressive mothers, on the other hand, did not provide any social advantages: very punitive with their offspring, there is lots of hitting, kicking, and biting. If the infants survive, their mothers usually keep them from making friends with their peers.

  • - After a single traumatic incident —a dog bite, an accident, or witnessing a school shooting-children can indeed develop basic PTSD symptoms similar to those of adults, even if they live in safe and supportive homes. As a result of having the PTSD diagnosis, we now can treat those problems quite effectively.

  • - 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 fraction of that amount. Instead, they invest in helping parents to raise their children in safe and predictable surroundings.

  • - Part 4 - The Imprint of Trauma

  • - Chapter 11 - Uncovering Secrets: The Problem of Traumatic Memory

  • - We remember insults and injuries best: The adrenaline that we secrete to defend against potential threats helps to engrave those incidents into our minds. Even if the content of the remark fades, our dislike for the person who made it usually persists.

  • - Chapter 12 - The Unbearable Heaviness of Remembering

  • - No notes

  • - Part 5 - Paths to Recovery

  • - Chapter 13 - Healing From Trauma: Owning Your Self

  • - Nobody can 'treat' a war, or abuse, rape, molestation, or any other horrendous event, for that matter; what has happened cannot be undone. But what can be dealt with are the imprints of the trauma on body, mind, and soul: the crushing sensations in your chest that you may label as anxiety or depression; the fear of losing control; always being on alert for danger or rejection; the self-loathing; the nightmares and flashbacks; the fog that keeps you from staying on task and from engaging fully in what you are doing; being unable to fully open your heart to another human being.

  • - Trauma robs you of the feeling that you are in charge of yourself.

  • - Understanding why you feel a certain way does not change how you feel. But it can keep you from surrendering to intense reactions.

  • - The more frazzled we are, the more our rational brains take a backseat to our emotions.

  • - 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 'whiteknuckle sobriety') that they are inflexible, stubborn, and depressed. Recovery from trauma involves the restoration of executive functioning and, with it, self-confidence and the capacity for playfulness and creativity.

  • - Neuroscience research shows that the only way we can change the way we feel is by becoming aware of our inner experiences and learning to befriend what is going inside ourselves.

  • - Learning to breathe calmly and remaining in a state of relative physical relaxation, even while accessing painful and horrifying memories, is an essential tool for recovery.

  • - The more you stay focused on your breathing, the more you will benefit, particularly if you pay attention until the very end of the out breath and then wait a moment before you inhale again.

  • - Simply noticing our annoyance, nervousness, or anxiety immediately helps us shift our perspective and opens up new options other than our automatic, habitual reactions.

  • - When we pay focused attention to our bodily sensations, we can recognize the ebb and flow of our emotions and, with that, increase our control over them.

  • - Physical sensations are transient and respond to slight shifts in body position, changes in breathing, and shifts in thinking.

  • - If the people whom you naturally turn to for care and protection terrify or reject you, you learn to shut down and to ignore what you feel.

  • - The most natural way that we humans calm down our distress is by being touched, hugged, and rocked.

  • - I check in where they are in their body right now. I ask them if there is anything they want me to pay attention to. All the while, I’m assessing their posture; whether they look me in the eye; how tense or relaxed they seem; are they connecting with me or not.

  • - Chapter 14 - Language: Miracle and Tyranny

  • - Communicating fully is the opposite of being traumatized

  • - There are other ways to access your inner world of feelings. One of the most effective is through writing. When you write to yourself, you don't have to worry about other people's judgment —you just listen to your own thoughts and let their flow take over. Later, when you reread what you wrote, you often discover surprising truths.

  • - Writing is different. If you ask your editor to leave you alone for a while, things will come out that you had no idea were there. You are free to go into a sort of a trance state in which your pen (or keyboard) seems to channel whatever bubbles up from inside. You can connect those self-observing and narrative parts of your brain without worrying about the reception you'll get.

  • - Chapter 15 - Letting Go of the Past: EMDR

  • - EMDR loosens up something in the mind/brain that gives people rapid access to loosely associated memories and images from their past. This seems to help them put the traumatic experience into a larger context or perspective. People may be able to heal from trauma without talking about it. EMDR enables them to observe their experiences in a new way, without verbal give-and-take with another person.

  • - Focused, trauma-specific therapy for PTSD like EMDR could be much more effective than medication.

  • - Increasing our time in REM sleep reduces depression, while the less REM sleep we get, the more likely we are to become depressed.

  • - PTSD is notoriously associated with disturbed sleep, and self-medication with alcohol or drugs further disrupts REM sleep.

  • - Seeing novel connections is the cardinal feature of creativity.

  • - Chapter 16 - Learning to Inhabit Your Body: Yoga

  • - “As we begin to re-experience a visceral reconnection with the needs of our bodies, there is a brand new capacity to warmly love the self. We experience a new quality of authenticity in our caring, which redirects our attention to our health, our diets, our energy, our time management. This enhanced care for the self arises spontaneously and naturally, not as a response to a 'should.' We are able to experience an immediate and intrinsic pleasure in self-care.” - Stephen Cope

  • - If you are not aware of what your body needs, you can't take care of it. If you don't feel hunger, you can't nourish yourself. If you mistake anxiety for hunger, you may eat too much. And if you can't feel when you're satiated, you'll keep eating.

  • - Once you start approaching your body with curiosity rather than with fear, everything shifts

  • - Chapter 17 - Putting The Pieces Together: Self Leadership

  • - “This being human is a guest house. Every morning is a new arrival. A joy, a depression, a meanness, some momentary awareness comes as an unexpected visitor. ... Welcome and entertain them all. Treat each guest honorably. The dark thought, the shame, the malice, meet them at the door laughing, and invite them in. Be grateful for whoever comes, because each has been sent as a guide from beyond.” — Rumi

  • - “A man has as many social selves as there are individuals who recognize him.” —William James

  • - Trying to control a child's behavior while failing to address the underlying issue-the abuse —leads to treatments that are ineffective at best and harmful at worst.

  • - MIT scientist Marvin Minsky, a pioneer of artificial intelligence, declared: 'The legend of the single Self can only divert us from the target of that inquiry... [It can make sense to think there exists, inside your brain, a society of different minds. Like members of a family, the different minds can work together to help each other, each still having its own mental experiences that the others never know about.”

  • - As Schwartz states: 'If one accepts the basic idea that people have an innate drive toward nurturing their own health, this implies that, when people have chronic problems, something gets in the way of accessing inner resources. Recognizing this, the role of therapists is to collaborate rather than to teach, confront, or fill holes in your psyche.'

  • - Chapter 18 - Filling In The Holes: Creating Structures

  • - “The greatest discovery of my generation is that human beings can alter their lives by altering their attitudes of mind.” - William James

  • - Nobody grows up under ideal circumstances-as if we even know what ideal circumstances are. As my late friend David Servan-Schreiber once said: every life is difficult in its own way. But we do know that, in order to become self-confident and capable adults, it helps enormously to have grown up with steady and predictable parents; parents who delighted in you, in your discoveries and explorations; parents who helped you organize your comings and goings; and who served as role models for self-care and getting along with other people.

  • - Chapter 19 - Rewiring The Brain: Neurofeedback

  • - “The faculty of voluntarily bringing back a wandering attention, over and over again, is the very root of the judgement, character, and will.” - William James

  • - Chapter 20 - Finding Your Voice: Communal Rhythms and Theater

  • - “Acting is not about putting on a character but discovering the character within you: you are the character, you just have to find it within yourself—albeit a very expanded version of yourself.” - Tina Packer

  • - Our sense of agency, how much we feel in control, is defined by our relationship with our bodies and its rhythms: Our waking and sleeping and how we eat, sit, and walk define the contours of our days. In order to find our voice, we have to be in our bodies—able to breathe fully and able to access our inner sensations. This is the opposite of dissociation, of being 'out of body' and making yourself disappear. It's also the opposite of depression, lying slumped in front of a screen that provides passive entertainment. Acting is an experience of using your body to take your place in life.

  • - Music brings together people who might individually be terrified but who collectively become powerful advocates for themselves and others. Along with language, dancing, matching, and singing are uniquely human ways to install a sense of hope and courage.

  • - As a culture we are trained to cut ourselves off from the truth of what we’re feeling.

  • - “Training actors involves training people to feel deeply, but to convey that feeling at every moment to the audience, so the audience will get it—and not close off against it.” - Tina Packer

  • - Epilogue - Choices To Be Made

  • - Poverty, unemployment, inferior schools, social isolation, widespread availability of guns, and substandard housing all are breeding grounds for trauma. Trauma breeds further trauma; hurt people hurt other people.

  • - People can learn to control and change their behavior, but only if they feel safe enough to experiment with new solutions.

  • - Our increasing use of drugs to treat these conditions doesn’t address the real issues.

  • - As long as we feel safely held in the hearts and minds of the people who love us, we will climb mountains and cross deserts and stay up all night to finish projects. Children and adults will do anything for people they trust and whose opinion they value. But if we feel abandoned, worthless, or invisible, nothing seems to matter. Fear destroys curiosity and playfulness.

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