[Full Audiobook] The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma | Part 1+2

Brief Summary

This YouTube transcript discusses the pervasive impact of trauma on individuals and society, highlighting its effects on mental and physical health, relationships, and the ability to function in daily life. It explores the neurobiological changes caused by trauma, emphasizing the importance of understanding the brain's response to threat and the need for effective treatment approaches. The text also addresses the challenges in diagnosing and treating trauma, particularly in children, and advocates for a shift towards recognizing the social and relational contexts of trauma.

• Trauma affects individuals, families, and communities, leaving traces on minds, emotions, and biology.
• New scientific disciplines like Neuroscience, developmental Psychopathology, and interpersonal neurobiology have led to an explosion of knowledge about the effects of psychological trauma.
• Effective trauma treatment involves top-down (talking, reconnecting), bottom-up (body-based experiences), and medication approaches.
• Early childhood experiences, especially attachment and Attunement, play a crucial role in shaping resilience and mental health.
• The medical model's focus on chemical imbalances overlooks the importance of relationships, social conditions, and individual agency in healing from trauma.

Prologue: Facing Trauma

Trauma is a widespread issue, affecting individuals from all walks of life, not just soldiers or refugees. Research indicates that many Americans have experienced childhood sexual abuse, physical abuse, or domestic violence. While humans are resilient, trauma leaves lasting marks on individuals, families, and societies, impacting mental and emotional well-being, capacity for joy and intimacy, and even biological and immune systems. Trauma affects not only those directly exposed but also those around them, leading to issues such as PTSD in soldiers, depression in their wives, and insecurity in their children.

The Unbearable Nature of Trauma

Trauma is defined as unbearable and intolerable, causing victims to suppress memories of their experiences. This suppression requires significant energy, and the survival-oriented part of the brain is not good at denial. Traumatic experiences can be reactivated by slight hints of danger, leading to intense emotions, physical sensations, and impulsive actions. Survivors may fear they are damaged beyond redemption.

The Birth of New Sciences

The author's interest in medicine began with an understanding of how the body functions, but a psychiatry rotation revealed a gap in knowledge about the origins of mental health problems. Neuroscience, developmental Psychopathology, and interpersonal neurobiology have emerged, leading to increased understanding of psychological trauma's effects. Trauma causes physiological changes, including recalibration of the brain's alarm system, increased stress hormone activity, and alterations in information filtering. It also compromises the brain area responsible for the physical feeling of being alive.

Possibilities to Reverse the Damage

Increased knowledge about trauma has opened up possibilities to alleviate or reverse its damage. Three avenues for healing include top-down approaches (talking, reconnecting), medicines or technologies to shut down inappropriate alarm reactions, and bottom-up approaches that allow the body to have experiences contradicting the helplessness resulting from trauma. A combination of these approaches is often necessary. The author's work at the Trauma Center has involved treating thousands of traumatized individuals and conducting research to explore the effects of traumatic stress and determine effective treatments.

Gaining Control Over the Residues of Past Trauma

People can gain control over the residues of past trauma and return to being masters of their own ship through talking, understanding, human connections, drugs, and physical experiences that contradict the helplessness, rage, and collapse associated with trauma. The author has no preferred treatment modality but practices all forms of treatment discussed in the book, each capable of producing profound changes depending on the problem and the individual. The book serves as a guide and an invitation to face the reality of trauma, explore how best to treat it, and commit to preventing it as a society.

Lessons From Vietnam Veterans

The author's first day as a staff psychiatrist at a veterans' clinic involved treating a Vietnam veteran named Tom, who suffered from nightmares, flashbacks, and emotional outbursts. Tom's experiences reminded the author of his own childhood in postwar Holland and his father's and uncle's puzzling behavior after their war experiences. Tom's loyalty to his dead comrades kept him from living his own life, leading the author to realize the complexities of trauma and the need to unravel its mysteries.

Tom's Need to Live Out His Life as a Memorial

Tom's need to live out his life as a memorial to his comrades taught the author that he was suffering from a condition much more complex than simply having bad memories or damaged brain chemistry. The author was intrigued by the extreme rages of veterans and their loss of self-control, which led him to seek literature on war Neurosis and discover Abram cardner's work on traumatic Neurosis. Cardner's description corroborated the author's observations, but provided little guidance on how to help the veterans.

Excruciating to Face Reality

It can be excruciating to face the reality of trauma, both for patients and for observers. Society often avoids acknowledging the extent of violence and abuse, preferring to believe that cruelty occurs only in faraway places. Traumatized individuals themselves cannot tolerate remembering their experiences and may resort to drugs, alcohol, or self-mutilation to block out unbearable knowledge. Tom and his fellow veterans became the author's first teachers in understanding how lives are shattered by overwhelming experiences and how to enable them to feel fully alive again.

Trauma and the Loss of Self

The first study the author did at the VA started with systematically asking veterans what had happened to them in Vietnam. Most of the men had gone to war feeling well prepared, drawn close by the rigors of basic training and the shared danger. Many of the men had friendships similar to Tom's with Alex. Tom led his squad on a foot patrol through a rice patty just before Sunset. Suddenly a hail of gunfire spurted from the green wall of the surrounding jungle hitting the men around him one by one.

Acts of Revenge

Maybe even worse for Tom than the recurrent flashbacks of the Ambush was the memory of what happened afterward. The day after the Ambush Tom went into a frenzy to a neighboring Village killing children shooting an innocent farmer and raping a Vietnamese woman. Tom experienced the death of Alex as if part of himself had been forever destroyed the part that was good and honorable and trustworthy. Trauma makes it difficult to engage in Intimate Relationships.

Confront Their Shame

It takes enormous trust and courage to allow yourself to remember. One of the hardest things for traumatized people is to confront their Shame about the way they behaved during a traumatic episode. 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.

Numbing

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 only thing that occasionally relieved this feeling of aimlessness was intense involvement in a particular case.

Reorganization of Perception

Another study I conducted at the VA started out as research about nightmares but ended up exploring how trauma changes people's perceptions and Imagination. Bill a former medic who had seen heavy action in Vietnam a decade earlier was the first person enrolled in my nightmare study. On the very first day he was left alone with the baby it began to cry and he found himself suddenly flooded with unbearable images of dying children in Vietnam.

Suffering From Memories

I think this man is suffering from memories. As part of that study, we gave our participants a roar shock test. The roar shock provides us with a unique way to observe how people construct a mental image from what is basically a meaningless stimulus a blot of ink. On seeing the second card of the Roar shock test Bill exclaimed in horror this is that child that I saw being blown up in Vietnam in the middle you see the charred flesh the wounds and the blood is spurting out all over.

Reliving the Trauma

Experiencing Bill's flashback firsthand in my office helped me realize the agony that regularly visited the veterans I was trying to treat and helped me appreciate again how critical it was to find a solution. The traumatic event itself however harass RIS had a beginning a middle and an end but I now saw that flashbacks could be even worse. It took me years to learn how to effectively treat flashbacks and in this process bill turned out to be one of my most important mentors.

Traumatized People Look at the World in a Fundamentally Different Way

We learned from these Roar shock tests that traumatized people have a tendency to superimpose their trauma on everything around around them and have trouble deciphering whatever is going on around them. 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.

The Very Event That Caused Them So Much Pain

Somehow the very event that caused them so much pain had also become their sole source of meaning. They felt Fully Alive only when they were revisiting their traumatic past. A turning point arrived in 1980 when a group of Vietnam veterans aided by the New York psychoanalysts Heim shatan and Robert J lyton successfully lobbied the American Psychiatric association to create a new diagnosis post-traumatic stress disorder PTSD.

Unwilling to Keep Working in an Organization

Unwilling to keep working in an organization whose view of reality was so at odds with my own I handed in my resignation in 1982. My experience with combat veterans had so sensitized me to the impact of trauma that I now listened with a very different ear when depressed and anxious patients told me stories of molestation and Family Violence.

The War Begins at Home

As we now know war is not the only Calamity that leaves human lives in Ruins. For many people the war begins at home. It is very difficult for growing children to recover when the source of Terror and pain is not enemy combatants but their own caretakers. We have learned that trauma is not just an event that took place sometime in the past it is also the imprint left by that experience on mind brain and body.

Revolutions in Understanding Mind and Brain

In the late 1960s, the author witnessed a transition in the medical approach to mental suffering, from Psychotherapy to medication. As an attendant on a research Ward, the author observed patients with schizophrenia and learned to deal with their irrational outbursts and terrified withdrawal. The quiet of the night seemed to help them open up and they told me stories about having been hit assaulted or molested.

The Medical Model in Action

As a young doctor, the author was confronted with an example of the medical model in action, doing physical examinations on women who'd been admitted to receive electroshock treatment for depression. The author learned more about the patients by reading Eugene bler's textbook dementia precox, which made the author wonder if the patients' hallucinations were fragmented memories of real experiences.

Helping Us Stay in Control

The author gradually realized how much of our professional training was geared to helping us stay in control in the face of terrifying and confusing realities. 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 past. As a group the patients were strikingly clumsy and physically uncoordinated.

The Greatest Sources of Our Suffering

Seid taught us that most human suffering is related to love and loss and that the job of therapist is to help people acknowledge experience and bear the reality of life with all its pleasures and heartbreak. The greatest sources of our suffering are The Lies We Tell ourselves. Healing depends on experiential knowledge. You can be fully in charge of your life only if you can acknowledge the reality of your body in all its visceral Dimensions.

Brain Disease Model of Discreet Disorders

In 1968 the American Journal of Psychiatry had published the results of the study from the Ward where I'd been an attendant they showed unequivocally that schizophrenic patients who received drugs alone had a better outcome than those who talked three times a week with the best therapists in boston3. A major textbook of Psychiatry went so far as to State the cause of mental illness is now considered an aberration of the brain a chemical imbalance.

The Pharmacological Revolution

The author eagerly embraced the pharmacological revolution. Antipsychotic drugs were a major factor in reducing the number of people living in Mental Hospitals in the United States from over 500,000 in 1955 to fewer than 100,000 in 1996. Researchers need for a precise and systematic way to communicate their findings resulted in the development of the so-called research diagnostic criteria to which I contributed as a lowly research assistant.

Inescapable Shock

Preoccupied with so many lingering questions about traumatic stress I became intrigued with the idea that the nent field of Neuroscience could provide some answers and started to attend the meetings of the American College of neuropsychopharmacology acnp in 1984. Meyer and Seligman had repeatedly administered painful electric shocks to dogs who were trapped in locked cages they called this condition inescapable shock.

The Mere Opportunity to Escape

The mere opportunity to escape does not necessarily make traumatized animals or people take the road to Freedom. Like Meyer and seligman's dogs many traumatized people simply give up rather than risk experimenting with new options they stay stuck in the fear they know. The only way to teach the traumatized dogs to get off the electric grids when the doors were open was to repeatedly drag them out of their cages so they could physically experience how they could get away.

Addicted to Trauma

Many traumatized people seem to seek out experiences that would repel most of us. Impatients often complain about a vague sense of emptiness and boredom when they are not angry under duress or involved in some dangerous activity. Freud had a term for such traumatic reenactments the compulsion to repeat. Repetition leads only to further pain and self-hatred.

Pain in Men Wounded in Battle

Having observed that 75% of severely wounded soldiers on the Italian front did not request morphine a surgeon by the name of Henry Kay beer speculated that strong emotions can block pain. We concluded that Beer's speculation that strong emotions can block pain was the result of the release of more f-like substances manufactured in the brain.

Soothing the Brain

Jeffrey gray gave a talk about the amigdala a cluster of brain cells that determines whether a sound image or body sensation is perceived as a threat. Animals with low serotonin levels were hyperreactive to stressful stimuli like loud sounds while higher levels of Serotonin dampen Their Fear system making them less likely to become aggressive or Frozen in response to potential threats.

Prozac Was Released

On Monday February 8th 1988 Prozac was released by The Drug Company Eli Lily. You have a drug that helps people to be in the present instead of being locked in the past. Prozac worked significantly better than the placebo for the patients from the trauma Clinic they slept more soundly they had more control over their emotions and were less preoccupied with the past than those who received a sugar pill.

The Triumph of Pharmacology

It did not take long for pharmacology to revolutionize Psychiatry. Drugs gave doctors a greater sense of efficacy and provided a tool Beyond talk therapy. The drug Revolution that started out with so much promise May in the end have done as much harm is good. The theory that mental illness is caused primarily by chemical imbalances in the brain that can be corrected by specific drugs has become broadly accepted by the media and the public as well as by the medical profession.

Adaptation or Disease

The brain disease model overlooks four fundamental truths. Our capacity to destroy one another is matched by our capacity to heal one another restoring relationships and Community is Central to restoring well-being. Language gives us the power to change ourselves and others by communicating our experiences helping us to Define what we know and finding a common sense of meaning. We have the ability to regulate our own physiology including some of the so-called involuntary functions of the body and brain through such basic activities as breathing moving and touching.

Looking Into the Brain

In the early 1990s novel brain Imaging techniques opened up undreamed of capacities to gain a sophisticated understanding about the way the brain processes information. Harvard Medical School was and is at the Forefront of the Neuroscience Revolution and in 1994 a young psychiatrist Scott Rouch was appointed as the first director of the Massachusetts General Hospital neuroimag laboratory.

The Agony That Regularly Visited the Veterans

Experiencing Bill's flashback firsthand in my office helped me realize the agony that regularly visited the veterans I was trying to treat and helped me appreciate again how critical it was to find a solution. There were some puzzling dots and colors on the scan but the biggest area of brain activation a large red spot in the right lower center of the brain which is the lyic area or emotional brain came as no surprise.

Speechless Horror

Our most surprising finding was a white spot in the left frontal lobe of the cortex in a region called broka area in this case the change in color meant that there was a significant decrease in that part of the brain. Our scans showed that broka area went offline whenever a flashback was triggered in other words we had visual proof that the effects of trauma are not necessarily different from and can overlap with the effects of physical lesions like Strokes all trauma is preverbal.

The Right Hemisphere of the Brain

Our scans clearly showed that images of past trauma activate the right hemisphere of the brain and deactivate the left. We now know that the two halves of the brain do speak different languages the right is intuitive emotional visual spatial and tactual and the left is linguistic sequential and analytical. The left and right sides of the brain also process the imprints of the past in dramatically different ways.

Stuck in Fight or Flight

What had happened to Marsha in the scanner gradually started to make sense. 13 years after her tragedy we had activated the sensations the sounds and images from the accident that were still stored in her memory. The Insidious effects of constantly elevated stress hormones include memory and attention problems irritability and Sleep Disorders.

The Greater the Doubt

In the late 1960s, the author witnessed a transition in the medical approach to mental suffering, from Psychotherapy to medication. As an attendant on a research Ward, the author observed patients with schizophrenia and learned to deal with their irrational outbursts and terrified withdrawal. The quiet of the night seemed to help them open up and they told me stories about having been hit assaulted or molested.

Running for Your Life

On September 11th 2001 5-year-old gome Saul witnessed the first passenger plane slam into the World Trade Center from the windows of his first grade classroom at ps234 less than 1,500 ft away. This 5-year-old boy a witness to unspeakable Mayhem and disaster just 24 hours before he made that drawing had used his imagination to process what he had seen and begin to go on with his life.

Traumatized People Become Stuck

Traumatized people become stuck stopped in their growth because they can't integrate new experiences into their lives. Being traumatized means continuing to organize your life as if the trauma were still going on unchanged and immutable. Trauma affects the entire human organism body mind and brain. Healing from PTSD means being able to terminate this continued stress mobilization and restoring the entire organism to safety.

The Whole Body Response to Threat

When the brain's alarm system is turned on it automatically triggers pre-programmed physical escape plans in the oldest parts of the brain. If for some reason the normal response is blocked the brain keeps secreting stress chemicals and the brain's electrical circuits continue to fire in vain. Being able to move and do something to protect oneself is a critical factor in determining whether or not a horrible experience will leave long lasting scars.

The Brain From Bottom to Top

The most important job of the brain is to ensure our survival even under the most miserable conditions. The rational brain is primarily concerned with the world outside US understanding how things and people work and figuring out how to accomplish our goals manage our time and sequence our actions. Beneath the rational brain lie two evolutionarily older and to some degree separate brains which are in charge of everything else.

The Emotional Brain

The Reptilian Brain and lyic system make up what I'll call the emotional brain throughout this book. The emotional brain is at the heart of the central nervous system and its key task is to look out for your welfare. The emotional brain's cellular organization and biochemistry are simpler than those of the neocortex our rational brain and it assesses incoming information in a more Global way as a result it jumps to conclusions based on rough similarities.

The Neocortex

Finally we reach the top layer of the brain the neocortex we share this outer layer with other mammals but it is much thicker in US humans. The frontal loes are responsible for the qualities that make us unique within the animal kingdom. They enable us to use language and abstract thought. The frontal loes allow us to plan and reflect to imagine and play out future scenarios.

Interpersonal Neurobiology

The frontal loes are also the seat of empathy our ability to feel into someone else. In a lucky accident a group of Italian scientists identified specialized cells in the cortex that came to be known as mirror neurons. We pick up not only another person's movement but her emotional state and intentions as well. Trauma almost invariably involves not being seen not being mirrored and not being taken into account.

The Triune Three-Part Brain

The brain develops from the bottom up The Reptilian Brain develops in the womb and organizes basic life sustaining functions. The lyic system is organized mainly during the first six years of life but continues to evolve in a used dependent manner. The prefrontal cortex develops last and also is affected by trauma exposure including being unable to filter out irrelevant information.

Identifying Danger

Danger is a normal part of life and the brain is in charge of detecting it and organizing our response. Sensory information about the outside world arrives through our eyes nose ears and skin. The phalus stir all the input from our perceptions into a fully Blended autobiographical soup an integrated coherent experience of this is what is happening to me.

The Brain Smoke Detector

The central function of the amigdala which I call the brain smoke detector is to identify whether incoming input is relevant for our survival. The amydala processes the information it receives from the thalamus faster than the frontal loes do it decides whether incoming information is a threat to our survival even before we are consciously aware of the danger.

Controlling the Stress Response

If the amydala is the smoke detector in the brain think of the frontal loes and specifically the medial prefrontal cortex mpfc located directly above our eyes as the Watchtower offering a view of the scene from on high. As long as you are not too upset your frontal loes can restore your balance by helping you realize that you are responding to a false alarm and abort the stress response.

Top Down or Bottom Up

In PTSD the critical balance between the amydala smoke detector and the mpfc Watchtower shifts radically which makes it much harder to control emotions and impulses. If you want to manage your emotions better your brain gives you two options you can learn to regulate them from the top down or from the bottom up. Top-down regulation involves strengthening the capacity of the Watchtower to monitor Your Body Sensations.

The Rider and the Horse

Emotion is not opposed to reason. Our emotions assign value to experiences and thus are the foundation of reason. Our self-experience is the product of the balance between our rational and our emotional brains. As long as the weather is calm and the path is smooth the rider can feel in excellent control but unexpected sounds or threats from other animals can make the horse bolt forcing the rider to hold on for dear life.

Timeless Reliving

On a fine September morning in 1999 Stan and ute Lawrence a professional couple in their mid-30s set out from their home in London Ontario to attend a business meeting in Detroit. Then came the Eerie silence. Stan struggled to open the doors and windows but the 18-wheeler that had crushed their trunk was wedged against the car.

Dissociation and Reliving

Instead of remembering the accident as something that had happened 3 months earlier Stan was reliving it. Dissociation is the essence of trauma the overwhelming experience is split off and fragmented so that the emotions sounds images thoughts and physical Sensations related to the trauma take on a life of their own.

The Timekeeper Collapses

Stan scan reveals why people can recover from trauma only when the brain structures that were knocked out during the original experience which is why the event registered in the brain as trauma in the first place are fully online. 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.

The Thalamus Shuts Down

Look again at the scan of Stan flashback and you can see two more white holes in the lower half of the brain these are his right and left Thalamus blanked out during the flashback as they were during the original trauma. In normal circumstances the thalamus also acts as a filter or gatekeeper this makes it a central component of attention concentration and new learning all of which are compromised by trauma.

Depersonalization

Let's now look at uda's experience in the scanner not all people react to trauma in exactly the same way but in this case the difference is particularly dramatic since Ute was sitting right next to Stan in the wrecked car. The medical term for uda's response is depersonalization. With nearly every part of their brains tuned out they obviously cannot think feel deeply remember or make sense out of what is going on conventional talk therapy in those circumstances is virtually useless.

Learning to Live in the Present

The challenge of trauma treatment is not only dealing with the past but even more enhancing the quality of day-to-day experience. One reason that traumatic memories become dominant in PTSD is that it's so difficult to feel truly alive right now. Desensitization may make you less reactive but if you cannot feel satisfaction in ordinary everyday things like taking a walk cooking a meal or playing with your kids life will pass you by.

Body Brain Connections

In 1872 Charles Darwin published the expression of the emotions in man and animals. Darwin starts his discussion by noting the physical organization common to all mammals including human beings the lungs kidneys brains digestive organs and sexual organs that sustain and continue life. Darwin goes on to observe that the fundamental purpose of emotions is to initiate movement that will restore the organism to safety and physical equilibrium.

Heart Guts and Brain Communicate Intimately

Heart guts and brain communicate intimately via the numri nerve the critical nerve involved in the expression and management of emotions in both humans and animals. If Darwin was right the solution requires finding ways to help people alter the inner sensory landscape of their bodies. All of the little signs we instinctively register during a conversation the muscle shifts and tensions in the other person's face eye movements and pupil dilation pitch and speed of the voice as well as the fluctuations in our own inner landscape salivation swallowing breathing and heart rate are linked by a single regulatory system.

The Autonomic Nervous System

All are a product of the synchrony between the two branches of the autonomic nervous system ANS the sympathetic which acts as the body's accelerator and the parasympathetic which serves as its breakpoint. The sympathetic nervous system SNS is responsible for arousal including the fight ORF flight response. The second branch of the ANS is the parasympathetic against emotions nervous system pns which promotes self-preservative functions like digestion and wound healing.

The Polyvagal Theory

In 1994 Steven porges introduced the polyal theory which built on Darwin's observations and added another 140 years of scientific discoveries to those early insights. The polyvagal theory provided us with a more sophisticated understanding of the biology of safety and danger one based on the subtle interplay between the visceral experiences of our own bodies and the voices and faces of the people around us.

Three Responses to Threat

The autonomic nervous system regulates three fundamental physiological States the level of safety determines which one of these is activated at any particular time. Whenever we feel threatened we instinctively turn to the first level social engagement we call out for help support and comfort from the people around us. But if no one comes to our Aid or we're in immediate Danger the organism reverts to a more primitive way to survive fight or flight.

How We Become Human

In pores' Grand Theory the vbc evolved in mammals to support an increasingly complex social life. The more efficiently the VVC