The Body Keeps the Score – but we knew that

18693771Yesterday I finished Bessel van der Kolk’s monumental work, The Body Keeps the Score: Brain, Mind and Body in the Healing of Trauma. This book, the result of more than three decades of research, direct service, and tireless curiosity by this Dutch psychiatrist, tracks the development of the profession’s understanding (or more often, lack of understanding) of post-traumatic stress. The most important piece for me: that the effective treatment of trauma requires not just a top-down approach (i.e., the use of talk therapy or other language and mind-based techniques), but a bottom-up approach as well. In short, the traumatized person needs healing that addresses their bodies as well as their minds.

Van der Kolk covers many bottom-up approaches, including yoga, theater, body psychotherapies like Somatic Experiencing, and even massage, and delves into the neuroscience, clinical data, and long-term outcomes of how it all works. The book is a tremendous win for bodymind modalities like Rubenfeld Synergy, which works with gentle touch and movement to help clients reconnect with their bodies and access the memories, emotions, and stories that live there. But it’s also a validation for me of the practices I’ve been doing with my more traumatized clients.

For those who suffer from the common long-term effects of PTSD, getting into your body is no mean feat. Dissociation – the sense of “leaving your body,” even to the point of feeling like you’re observing it from the outside – can happen easily; I’ve seen a few clients who “zone out” or dissociate merely from being asked to pay attention to their feet. Numbing, another common symptom, means such clients often can’t feel their body much at all – nor the emotions connected to it. For people who have flashbacks and experience what happened to them not as a story that happened long ago, but as an immediate, present, and intensely terrifying series of sensory impressions, anything that gets them in touch with their bodies too quickly – such as touch – is out of the question.

Among the multitudinous pearls of wisdom I got from this book was a word for what I do when this is the case: pendulation. Taken from Peter Levine, Dr. van der Kolk’s friend and colleague who developed Somatic Experiencing, pendulation refers to helping a traumatized person dip a toe, as it were, in and out of the intensity of memory. By guiding the client toward the experience that needs integration, then backing away from it before their tolerance runs out, a practitioner can help a traumatized person gradually approach and come to befriend previously intolerable feelings.

So if you come to me with a trauma history, I might keep us in chairs for a while rather than going to the table right away. I might ask you to pay attention to your breath, but might back off even from that if I sense that you’re starting to feel anxious or “leaving the room.” It’s a delicate balance, but little by little, we get back in touch with ourselves, and regain the strength, as van der Kolk repeatedly says, “to know what we know and feel what we feel.”

 

 

Owning yourself fully: Bessel van der Kolk and healing trauma through the body

Image by Run Jane Fox on Flickr

Image by Run Jane Fox on Flickr

The big issue for traumatized people is that they don’t own themselves anymore. Any loud sound, anybody insulting them, hurting them, saying bad things, can hijack them away from themselves. And so what we have learned is that what makes you resilient to trauma is to own yourself fully.

-Bessel van der Kolk

In the course of thinking about Rubenfeld Synergy Method in the context of trauma, I’ve been looking at the marvelous Bessel van der Kolk, known by many in the area as the head of the Trauma Center at the Justice Resource Institute in Brookline, MA. Krista Tippett interviewed him for On Being late last year, and the result is a remarkable look into the man’s life, work, and personality. He has been working with trauma since his time with Vietnam veterans at a VA hospital during his training as a psychiatrist. It was there that he first became fascinated with the idea what trauma is and what it does for us: a soldier refused to take the drugs prescribed for nightmares, because to him, the nightmares were a way of keeping the memory of his friends alive.

His recent book, The Body Keeps the Score, is being cited more and more in the healing circles I travel in. It is an exploration of a lifetime working with people who have become living memorials in some way: their bodies unchanging testaments of traumatic events. Trauma, he says, happens when the mind is unable to synthesize a narrative about what has happened, and the events get “stuck” in the body, replaying themselves. Even Darwin, as early as 1872, wrote “how emotions are expressed in things like heartbreak and gut-wrenching experience. So you feel things in your body. And then it became obvious that, if people are in a constant state of heartbreak and gut-wrench, they do everything to shut down those feelings to their body.”

I have seen this phenomenon in my practice, where clients often cannot feel what is happening in their bodies, or are unaware of what their bodies are doing, or they “leave the room,” in essence, dissociating whenever their awareness is called to their bodies. The experiences that they have had there are too intense to be repeatedly endured, and they have found ways to disconnect from their somatic experience. And so the process of addressing trauma somatically starts with helping people reconnect with their bodies in ways that can begin to feel safe.

van der Kolk has worked with yoga, eye movement therapy, and other somatic practices to help people return to their bodies. “It was very striking in our yoga study,” he says, “even during the most blissful part of the yoga practice called Shavasana, what a hard time traumatized people had at that moment to just feel relaxed and safe and feel totally enveloped with goodness, how the sense of goodness and safety disappears out of your body basically.” In his work, as in Rubenfeld Synergy, van der Kolk has found that “something that engages your body in a very mindful and purposeful way — with a lot of attention to breathing in particular — resets some critical brain areas that get very disturbed by trauma.” It can take a while to help someone reconnect with their own breath, to have a sense of their skin and bones and muscles, to have a relationship to their own sensations and emotions that is not simply another way of triggering the trauma. But the research is clearer and clearer that returning people to their bodies is a clear route out of the cycle.

One of my favorite bits of the interview was about stress hormones and their value, and how what really prevents overwhelming experiences from becoming trauma is movement:

“The stress hormones are good for you. You secrete stress hormones in order to give you the energy to cope under extreme situations…What goes wrong is, if you’re kept from using your stress hormones, if somebody ties you down, if somebody holds you down, if somebody keeps you imprisoned, the stress hormones keep going up, but you cannot discharge it with action. Then the stress hormones really start wreaking havoc with your own internal system.

But as long as you move, you are going to be fine. As we know, after these hurricanes and these terrible things, people get very active and they like to help and they like to do things and they enjoy doing it because it discharges their energy.”

This links back to a post I wrote years ago that continues to be popular, about trauma and streaming. When action is possible in a moment of crisis, it is less likely to become “stuck.” But when trauma is repeated, or when movement or action isn’t safe, then the event or events can become “frozen” in the body, stuck in a repeat loop until we can return a sense of safety to the body, and a sense of consciousness to the ongoing experience of being embodied.

Except for a small number of practitioners, the connection between trauma and the body is a minority voice in psychology. Luckily, it is expanding, but it has taken some time. I am hoping to connect with Dr. van der Kolk and the Trauma Center soon to talk about how Rubenfeld Synergy can contribute to this process of healing from trauma. For now, I recommend listening to the whole interview here , or reading the transcript here.