Trauma has become one of those broad psychological terms that is often thrown around but seldom truly understood; even in the field of psychiatry, trauma has historically been a nebulous term with a wide range of symptoms and treatments. In The Body Keeps the Score, the author explores how the understanding and treatment of trauma has evolved as new technologies, research, and fields of science emerged.
Trauma can stem from a one-time event or an ongoing experience—from abuse to a severe car accident to wartime combat—and can cause a lifetime of flashbacks, nightmares, isolation, insomnia, hypervigilance, and rage. Until just a few decades ago, there was no umbrella diagnosis for trauma; instead, patients were wrongly diagnosed with depression, mood disorders, substance abuse, even schizophrenia. Incorrect diagnoses led to ineffective treatments and patients’ continued suffering.
The effects of trauma live on not only in the emotional mind and the chemical makeup and circuitry of the brain, but also in the body’s physiology. Traumatic experiences rewire the brain to cause people to be hypervigilant to threats: The slightest hint of a threat sends trauma sufferers into a fight-or-flight response, triggering stress hormones to flood their bodies and keep them in a state of hyperarousal long after the perceived threat is gone. Over time, hypervigilance and hyperarousal cause physical ailments and hamper trauma sufferers’ ability to function emotionally and socially.
Mentally and emotionally, trauma affects how survivors interact with people and the world around them.
Traumatic experiences are so overwhelming that parts of the brain go offline while others go into overdrive, and as a result, your brain fails to process the traumatic event and integrate it into the timeline of your life, as it would any other experience. Consequently, the trauma never becomes part of the past; it’s ever-present (as evidenced by the pervasive flashbacks and near-constant state of fight or flight).
Brain scans reveal that when trauma survivors experience flashbacks, their brains react as if the actual trauma were happening in that moment.
Your brain has three parts:
Together, the reptilian brain and the limbic system (the two most primitive parts of your brain) make up the emotional brain. The emotional brain alerts you to danger and, if necessary, jump-starts your pre-programmed reactions, like the fight-or-flight response, before your rational brain weighs in to determine if the threat is really a threat (e.g. you might jump back at the sight of a snake, only to realize it’s just a rope). However, trauma hinders the brain from accurately and effectively perceiving threats, so trauma survivors go through life constantly jumping in response to non-threats.
Your mind and body are inextricably connected: Emotions give you physical sensations (e.g. butterflies in your stomach) and are revealed in your facial expressions and body language. By the same token, physical sensations impact your mood and emotions—a soft, warm breeze puts you at ease, while loud, clanging noises put you on edge.
Trauma and flashbacks cause intense emotions and physical sensations that are so overwhelming that survivors cope by suppressing both their emotions and physical sensations. As a result, they become disconnected from their bodies—unable to identify and interpret their physical sensations—which makes it impossible to feel fully alive, take care of their bodies and minds, and effectively engage with other people.
When you suppress or can’t understand what your physical sensations are telling you, the body finds other ways to demand your attention: Many trauma survivors develop psychosomatic issues (physical ailments that have no physical cause) such as migraines, neck and back pain, fibromyalgia, asthma, digestive issues, irritable bowel syndrome, and chronic fatigue.
As a baby, since you’re unable to care for yourself, you must rely on your caregivers to meet your most basic needs, from food and clothing to safety and comfort. Your attachment—how well your caregivers meet your needs—determines how well you’ll take care of these needs for yourself later in life. Furthermore, the more responsive your caregivers are to you, the more responsive you’ll be to others.
Babies are wired to form an attachment to their caregivers, and the type of attachment a baby develops depends on how well her caregiver meets her needs.
Attachment and childhood experiences shape your inner maps of the world. As an adult, your inner map determines what you consider normal and familiar, how you interpret situations, and how you engage with the people and world around you. Inner maps are generally consistent through life, but they can be changed—negatively by trauma or positively through profound experiences.
Effective treatment must help trauma sufferers regain control of themselves and their thoughts, feelings, and body. Generally, this involves four steps:
There are three general approaches to treatment: the top-down approach, medication, and the bottom-up approach.
The top-down approach involves talking, connecting with other people, and opening up about your traumatic memories and their present-day effects.
Opening up about your trauma has several healing benefits.
Talk therapy is inadequate as a sole form of treatment for trauma sufferers because revisiting their trauma often brings up overwhelming emotions that can retraumatize them and increase their fixation; this is the reason that cognitive behavioral therapy, which aims to desensitize patients through repeatedly talking about the trauma, isn’t an effective treatment method.
Instead of becoming desensitized, trauma survivors need help integrating the traumatic memory into the timeline of their lives, placing it securely in the past, so they can fully accept that it’s over. This still involves revisiting the memory, but first the patient must learn to cope with the reactions that the trauma will inevitably bring up to avoid becoming overwhelmed and enable her to complete the integration.
Trauma survivors often struggle to articulate what happened to them and how it makes them feel because their brains didn’t process the event as a coherent narrative but rather as a collection of fragmented sensations. To bridge this gap, there are several other ways for trauma sufferers to express themselves, including
The top-down approach includes:
The medication approach involves using prescription drugs that inhibit trauma survivors’ overactive internal alarm systems or affect the brain’s chemistry in some other way to alleviate the symptoms of trauma. This approach goes hand-in-hand with the brain-disease model, which views mental problems as “disorders” that could be treated with drugs to adjust brain chemistry.
Although drugs can assist treatment by taming overwhelming emotions, there are several drawbacks to the rise of medications:
The bottom-up approach involves seeking physical experiences that connect the body and mind to counteract feelings of helplessness, rage, and emotional collapse that plague trauma survivors. Since trauma makes sufferers feel out of control of their bodies (e.g. hyperarousal, disconnection from physical sensations, and psychosomatic issues), helping them regain that control is vital to healing.
There are several treatments that help patients engage their bodies in healing.
Eye movement desensitization and reprocessing (EMDR) is a treatment in which patients focus on a therapist’s finger moving side-to-side while recalling their trauma and then processing whatever train of thought organically follows. While researchers don’t know exactly how EMDR works, the treatment helps people get in touch with loosely connected memories and images and then integrate their traumatic experience into a broader context.
Heart rate variability (HRV) is the balance between how your heart rate rises and falls, indicating how well you can stay calm and in control in the face of minor challenges. Trauma survivors have low HRV, creating negative effects on how they think, feel, and respond to stress, and making them vulnerable to physical issues such as heart disease and cancer, and depression. You can train yourself to change your breathing (and thus improve your HRV) through yoga as well as certain devices and smart phone apps.
Yoga teaches you to focus on your breath, listen and respond to your body, and notice how emotions can be connected to certain physical sensations. This helps trauma survivors to reconnect with their physical sensations so they can feel safe and in control of their own bodies. Additionally, yoga encourages you to be present by focusing on your breath and body sensations, and reinforces the fact that experiences are transitory (e.g. as hard as this pose may be, you only need to endure it for ten breaths).
Psychomotor therapy uses body awareness and physical expressions as a key aspect of therapy, activating the right hemisphere of the brain -- the same hemisphere where trauma is also largely imprinted. One form, called Pesso Boyden System Psychomotor (PBSP) therapy instructs a patient to physically recreate scenes of her childhood and trauma, and then essentially rewrite the story. This form of therapy doesn’t eliminate or neutralize traumatic memories, but it does create a new experience (e.g. of being loved or protected) that helps to rewrite your inner maps.
Neurofeedback aims to fix the circuitry in patients’ brains by mirror back patients’ brain waves in order to encourage certain frequencies and brain patterns while discouraging others. Different frequencies are associated with different mental and emotional states (e.g. foggy, creative, calm, relaxed, alert). Viewing brain activity as the source of their problematic behavior frees patients from self-blame, and instead puts their focus on learning new ways to process information, which is at the root of their behavior.
Theater targets many of the things trauma survivors struggle most with, providing healing experiences as well as challenges that push them to work through trauma-created mental and emotional barriers. Acting gives them a chance to embody a character that may be strong, resilient, and confident, and it makes valuable, contributing members of a community, which helps them regain a sense of worth and competence. Theater also pushes trauma sufferers to get in touch with their emotions, take full control of their bodies, and trust the other members of the theater community.
We tend to think of trauma in its most extreme forms, such as PTSD in veterans, rape victims, and survivors of tragedies like 9/11. But nearly everyone is likely to either suffer from trauma or know someone who does—whether from a tragedy or accident, domestic violence, childhood abuse, or witnessing violence as a child.
Regardless of how many years or decades have passed since the traumatic event(s), your brain and body continue to feel the effects. Trauma rewires the brain to cause people to be hypervigilant to threats and repeat the same mistakes, seemingly compulsively.
In this summary, we’ll explore different causes of trauma, the ways in which it affects the brain and body, how developments in trauma and brain research have impacted treatment approaches, and what forms of treatment are available and recommended now.
Trauma has become one of those broad psychological terms that is often thrown around but seldom truly understood; even in the field of psychiatry, as this summary will explore, it’s been a nebulous term with a wide range of manifestations.
In The Body Keeps the Score, Van der Kolk explores how the understanding and treatment of trauma has evolved using historical information, case studies, and his own experience witnessing these changes through the course of his career and his own research.
There are no clear-cut answers about trauma or the best ways to treat it. Different schools of thought in the psychiatric field have different approaches to treating trauma; some doctors rely heavily on medications, while others endorse various forms of talk therapy, including cognitive behavioral therapy and exposure therapy. Naturally, this book includes the author’s views about effective approaches and treatments, which will conflict with some practitioners’ opinions.
Trauma can stem from a one-time event or an ongoing experience. And each person who experiences trauma deals with it differently; two people who experience the same traumatic event may cope with it in entirely different ways—some people become irritable and have explosive rage, while others shut down emotionally or repress it entirely.
The range of symptoms, lack of uniformity, and occasionally the repression or denial of the traumatic event itself can make trauma difficult to identify and diagnose. As a result, there was no single diagnosis of the collective symptoms of trauma until just a few decades ago.
Despite the range of causes, symptoms, and severity, all trauma sufferers have common neurological and physiological effects that last until effective treatment can heal both the mind and the body.
(Shortform note: Trauma is the umbrella term for the mental, emotional, neurological, and physical response to an intensely distressing or disturbing traumatic event. Posttraumatic stress disorder (PTSD) is the diagnosis most commonly associated with trauma, but as we’ll discuss, not every trauma survivor fits the definition of PTSD; other disorders that can result from traumatic experiences include Acute Stress Disorder (ASD), childhood trauma disorders, dissociative disorders, and adjustment disorders.)
Many of the early documented cases of trauma were in soldiers returning from combat in world wars I and II. But at the time there was no trauma diagnosis, so their physical tics, memory loss, panic attacks, and unpredictable rage were diagnosed as shell shock, war neuroses, or battle fatigue.
Early in Van der Kolk’s career, in the late 1970s, he worked as a staff psychiatrist at the Boston Veterans Administration Clinic. There he met a Vietnam veteran named Tom who, despite now having a beautiful family and successful law practice, was struggling with alcoholism, bouts of rage, and feelings of inner torment.
Tom constantly had nightmares of the ambush he experienced in Vietnam, during which everyone in his platoon was killed or wounded. Afraid of the nightmares, Tom would stay up most of the night drinking to dull his pain and memories. He was easily upset and worried about getting angry around his family because he had trouble controlling his actions when he was upset. The only things that seemed to bring Tom some sense of calm were speeding dangerously on his motorcycle and drinking heavily.
Tom’s story made the author wonder how and why people who experienced trauma remain seemingly trapped in the past, constantly reliving the traumatic event.
The Traumatic Neuroses of War, which psychiatrist Abram Kardiner published in 1941, offered some insight on Tom in its description of “traumatic neuroses” that cause a chronic hypervigilance to threat. The book explained that traumatic neuroses—which today we’d call PTSD—have a physiological basis, meaning that the symptoms of trauma come from the body’s response to the original trauma. In other words, trauma isn’t just in sufferers’ heads—it also leaves its mark on their bodies. We’ll explore this more in later sections.
When van der Kolk met Tom, the symptoms of PTSD were still described and diagnosed separately—as depression, mood disorders, alcoholism, substance abuse, and schizophrenia. In 1980 a group of Vietnam veterans and psychoanalysts lobbied the American Psychiatric Association to create a diagnosis called posttraumatic stress disorder.
PTSD is defined as the result of a horrendous event involving death or serious injury—or the threat of either—to the patient or someone else, causing intense feelings of fear and helplessness. PTSD covers a cluster of symptoms, including:
Once the diagnosis was created, this opened the door for new research, understanding, and approaches to treatment.
Soon after the diagnosis was created, van der Kolk started working with female patients who had been sexually abused as children and noticed that they had many symptoms in common with the veterans, such as nightmares and flashbacks, intense rage, periods of emotional collapse, and difficulty maintaining meaningful relationships.
He realized that trauma could be caused by much more than battlefield tragedies. Violent crimes, rape, and abuse could bring on many of the same symptoms of PTSD visible in veterans.
Trauma doesn’t look the same on everyone: The type of trauma and age at which you experience it both impact the effects. For example, the trauma symptoms that child abuse victims exhibit are vastly different from those of people who experience trauma as adults. Psychiatrists can’t fully understand patients’ mental and emotional disorders unless they understand the myriad ways different types of trauma affect the mind, brain, and body.
One study compared the symptoms of three groups of traumatized people: People who experienced childhood physical or sexual abuse by caregivers, recent domestic violence victims, and recent natural disaster survivors. Researchers saw a clear difference among the three groups, especially between survivors of child abuse and natural disasters, which are on opposite sides of the spectrum (considering age during the trauma, time elapsed since the trauma, and the intentional versus random causes of trauma). Those who were abused as children had a range of symptoms that the natural disaster survivors largely didn’t have, including trouble concentrating, self-loathing, difficulty with intimate relationships, self-destructive habits, large gaps in their memories, and an array of medical problems.
Child abuse survivors largely don’t fit the definition of PTSD, and there have been multiple proposals to create diagnoses that describe non-PTSD trauma victims. However, those attempts failed, leaving those patients to receive inaccurate diagnoses and inadequate treatments.
Because psychiatry deals with the complex human mind, diagnoses and treatments can’t be as precise as other branches of medicine that deal with strictly biological and physiological systems.
The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) was the first uniform system for psychiatric diagnoses, and it remains the so-called bible of psychiatry. The DSM is the basis for insurance claims, research funding, and academic programs. It’s regularly revised and republished, but many psychiatrists and mental health organizations still oppose the diagnostic approach of the DSM, saying the diagnoses define disorders by their symptoms instead of their root causes.
To better understand how this approach is flawed, think of it in terms of medicine: Before the late 1800s, doctors diagnosed illnesses based on symptoms like fevers and pustules. But after the discovery of bacteria, the medical field shifted to target the bacteria that caused the symptoms instead. Many different ailments can produce the same symptoms—anything from dehydration to pneumonia could cause a fever—so a symptoms-oriented approach is too vague to lead you to the root issue.
It’s not just about finding the right label; the diagnosis determines the treatment (for example, you wouldn’t treat pneumonia simply with fluids).
Furthermore, looking solely at biological and genetic sources of mental disorders gives an incomplete and inaccurate view. Social relationships and environments are a critical aspect of human psychology, so the psychiatrists must take those factors into account when diagnosing and treating patients. Dysfunctional social relationships are not only the consequence but also the cause of many mental disorders.
The effects of trauma are three-pronged: the mind (mental and emotional), the brain (brain wave frequencies and neurological reactions), and the body. First, we’ll explore how trauma impacts the mind.
One of the lasting impacts of trauma is an inability to develop intimate relationships with others: After experiencing such suffering at the hands of another person, how can you trust anyone again?
Additionally, how can anyone possibly understand how you feel, with the exception of other trauma survivors? These two questions cause many trauma survivors to be extremely isolated.
What’s more, many trauma survivors feel paralyzing shame about their own behavior during a traumatic episode. In some cases, the survivor may have lashed out in response to the trauma and subsequently feels shame about it; for instance, the day after Tom’s platoon was ambushed in Vietnam, he killed children and raped women in a nearby village in a vengeful rage. The shame of his actions later haunted him mercilessly.
In other cases, trauma survivors feel shame about their behavior—regardless of any rational reality of whether they could’ve acted any differently. This is often the case with children who submit to their abusers. Many trauma survivors are even more haunted by shame at what they did or didn’t do during the traumatic event—whether they were scared, dependent, enraged, or excited—than by the atrocity of their abusers’ actions.
One of the most assaulting symptoms of trauma is flashbacks, when survivors relive fragments of the traumatic experience. Flashbacks are even worse than the traumatic event itself, because while the traumatic event had a definitive beginning, middle, and end, the flashbacks can come at any time and you never know how long they’ll last.
Traumatic experiences are so overwhelming that the mind breaks them up into fragments of sights, sounds, sensations, emotions, and thoughts (we’ll discuss this more in a later section). Consequently, long after the trauma is over, seemingly ordinary things can trigger flashbacks—a particular smell, a word or phrase, a physical position, or an image that is somehow associated with the traumatic event.
Ordinary stimuli suddenly take on a new meaning because they’re associated with the trauma, and are thus perceived as a threat. You may look at a man walking down the street as simply that, but a rape survivor can see the same man and perceive him as a would-be attacker.
Trauma inhibits the imagination in one of two ways: First, trauma can cause victims to superimpose images of their trauma on neutral stimuli.
For example, in a study of trauma survivors, 21 veterans took a Rorschach test. Also known as the ink blot test, subjects look at a nondescript ink blot and describe what they see in it, as if they’re finding animals and other images in the shapes of clouds. Rorschach tests indicate how you create a mental image and association from meaningless stimuli.
About three-quarters of the veterans saw gory and brutal wartime images in the ink blots—like disemboweled or decapitated comrades and fatally burned children—whereas non-traumatized people typically see benign things like butterflies or people. Seeing traumatic images in ordinary things makes it difficult or impossible to accurately interpret day-to-day situations.
Second, trauma can cause victims to basically freeze or suppress their imaginations. For example, the other veterans saw absolutely nothing in the ink blots, which was even more alarming to the researchers because it indicated that traumatized people can lose the ability to let their minds imagine.
Both groups of veterans had stopped allowing their minds to create new meaning, either by replaying old traumatic images or by seeing blanks. Imagination is vital to quality of life, because it allows you to envision the future, come up with new possibilities, and ultimately have hope.
Flashbacks are so intense that trauma sufferers try to avoid them at all costs; they may compulsively go to the gym and push themselves to the brink as a distraction, take drugs or drink alcohol to dull the memories, or put themselves in dangerous situations so they can feel some sense of control over chaos.
But despite their efforts, trauma survivors can never escape flashbacks until they’ve healed from their trauma, and the more they experience flashbacks, the more they remain fixated and stuck in that event; the more they’re stuck in the past, the less able they are able to experience the present, and they tend to go through life feeling numb and simply going through the motions.
As a result, trauma survivors often feel more alive and engaged when they are describing or somehow reenacting their trauma—as in when veterans share combat stories, or when abuse survivors end up in similarly abusive relationships.
Freud called this “the compulsion to repeat.” He believed that trauma survivors engage in these reenactments in an unconscious attempt to gain control over a situation that haunts them, in (unconscious) hopes of eventually reaching a resolution. However, there is no evidence to back up Freud’s theory, and in fact, repetition—even in therapy—leads to pain, self-hatred, and continued fixation on the trauma.
Your body can adapt to and become dependent upon all different kinds of stimuli—whether it’s immediately pleasurable, like a recreational drug, or something that’s initially uncomfortable or scary, like marathon running or parachute jumping. When the body adapts it establishes a new chemical balance.
When that substance or experience is not available, your body becomes chemically imbalanced and you feel the pain of withdrawal. Over time, people become more motivated by the avoidance of withdrawal rather than the pleasure of the experience itself.
University of Pennsylvania researcher Richard Solomon theorizes that people can become addicted to endorphins, the chemicals secreted in your brain in times of stress (e.g. during traumatic events). This could explain why trauma survivors seek out stressful situations: It relieves the anxiety and boredom—essentially withdrawal from the stress—they feel in day-to-day life.
There are two ways people respond to a traumatic event: with effective action or immobilization.
Effective action involves two aspects:
Immobilization, on the other hand, is the inability to escape, protect yourself, or process the event—whether you are physically held down during abuse, stuck in a car during an accident, or in a war zone with nowhere to escape the violence. People who are immobilized remain stuck in a state of shock and helplessness, and they’re unable to move on after the event.
After suffering inescapable trauma, many trauma survivors develop learned helplessness—a feeling of chronic helplessness—and give up trying to escape or improve their circumstances in any situation. They remain immobilized. Trauma has curbed their fight-or-flight instinct, and instead of risking the unknown, they remain in the familiar fear.
An experiment by Steven Maier of the University of Colorado and Martin Seligman of the University of Pennsylvania showed this effect in dogs: The researchers administered electric shocks to dogs who were stuck in locked cages. Then they opened the cages and administered more shocks to these dogs, as well as to a control group of dogs who hadn’t been shocked previously. The dogs who hadn’t been locked in cages ran away as soon as they were shocked, but the dogs who had been trapped made no effort to escape—they simply lay there, afraid and defecating.
The traumatized dogs also had abnormally high levels of stress hormones. Again, there is a parallel with trauma survivors; when traumatized people face a perceived threat, their stress hormones spike disproportionately and take more time to return to a baseline level long after the threat has passed. Even among trauma survivors who don’t consciously or outwardly react to a perceived threat, their bodies still react by sounding the alarm to release stress hormones—and elevated stress levels cause people to suffer attention and memory problems, agitation, and sleep issues, and leads to long-term health problems.
Maier and Seligman found that the only way to reverse the effect for the dogs was to repeatedly drag them out of their cages to give them the physical experience of escaping the shocks. This experiment begs the question: Do traumatized people need a physical experience to overcome their trauma and give them a feeling of control? We’ll explore that in later chapters.
The advent of brain-imaging technology in the early 1990s gave scientists new insight into the way brains process information, memories, sensations, and emotions. With these tools, researchers learned that trauma leaves an imprint on the mind, brain, and body that has long-term effects on how you survive in the present. Trauma not only changes how and what you think but also your capacity to think.
In the face of trauma, part of your brain shuts down and causes you to lose your ability to articulate your feelings, your sense of time, your ability to make sense of your body’s sensations, and your ability to store that information. The emotional brain takes over, kicking up your emotional arousal, physiological reaction, and muscle activity. All this causes the trauma to be stored as fragments of sensory information—sounds, smells, sensations, and images—instead of a coherent narrative. This is the basis for flashbacks.
In one study, eight trauma survivors recreated scenes of their traumas—essentially triggering flashbacks—as they had their brains scanned to see the reactions. The researchers found that participants’ amygdalas (the cluster of brain cells that interprets sounds, images, and sensations to distinguish threats) activated in response to the flashback as if the danger was present in that moment; no matter how many years have passed since the traumatic event actually occurred, trauma survivors’ brains continue to function as if they face a constant threat of danger.
The amygdala rings the alarm of impending danger, and the body releases stress hormones and nerve impulses that make blood pressure, heart rate, and oxygen intake rise in preparation for fight or flight. Trauma survivors are in a constant state of arousal and fight-or-flight, which causes physical issues and hampers their ability to function emotionally and socially.
During the brain scan experiment, the researchers also found that flashbacks cause the brain’s speech control center to go offline. The brain’s response to flashbacks is similar to its response to a traumatic event, and as we’ll learn later, parts of the brain that coordinate speech and other social functions freeze during trauma in order to put more energy toward functions necessary for survival (e.g. fight or flight).
This part of the brain is called Broca’s area, and it’s key to articulating thoughts and feelings (Broca’s area is often affected in stroke victims). Additionally, trauma survivors’ difficulty with speech lasts beyond the confines of a flashback: Years after a traumatic event, survivors struggle to express what happened.
With time, most develop what the author calls a “cover story,” an outline of the basic events, but these cover stories fail to capture the depth of the experience.
While speech is inhibited during flashbacks, another part of the brain called Brodmann’s area 19 was activated in participants’ brains during the flashbacks.
Under normal circumstances, Brodmann’s area 19 processes images as you see them in the world around you, immediately sending them to other areas of the brain to interpret the images’ meanings. However, in trauma survivors, Brodmann’s area 19 lights up during flashbacks, meaning that the brain responds to flashbacks as if the traumatic event is occurring in reality, not just in memory. As with the amygdala’s response, this indicates that trauma survivors experience flashbacks as intensely as the actual traumatic event.
In addition, the flashbacks activated the right hemisphere of participants’ brains while deactivating the left. As they pertain to memories, the right and left hemispheres of the brain operate very differently.
Activating the right hemisphere and shutting off the left means trauma survivors can’t put their feelings (right side) into words (left side). When the two hemispheres are disconnected, people can’t process experiences, grasp cause and effect, understand long-term consequences, or make plans for the future.
When a flashback is triggered, the right brain acts as if the traumatic event is occurring in the present, and the left is unable to provide the logic that it’s merely a reenactment of the past. This leaves trauma survivors unable to process their traumatic experience and integrate it into the timeline of their lives, which is why the events feel ever-present—they can’t effectively put them into the past.
Just as the brain processes traumatic events differently than ordinary experiences, it stores the memories of those events differently as well. Traumatic memories and ordinary memories differ in several ways.
First, because traumatic memories don’t get integrated into your life timeline, they remain essentially frozen in time. This causes people to remember trauma much more accurately than regular memories; for example, one study found that WWII soldiers with PTSD had nearly perfect memories of their wartime traumas more than four decades later.
Second, events that cause a negative reaction such as stress, fear, or dislike—triggering the body to release adrenaline—are preserved best in your memory. Up to a point, the more adrenaline your body secretes, the better you remember the event (even if you don’t remember all the details, you’ll vividly recall how it made you feel). However, if the experience is overwhelmingly terrifying and inescapable, your body shuts down in response. This can lead to repressed memories, which we’ll discuss in the next section.
Third, traumatic memories are disorganized; they aren’t processed as a coherent narrative, with a beginning, middle, and end. Traumatic memories return in sensory fragments and, consequently, cause people to have physical reactions to traumatic memories.
Often traumatized people initially can’t bring themselves to talk to anyone about the event. Most experience flashbacks and, over time, are able to make some sense out of the spurts of sensory memories. Eventually, many survivors develop a so-called “cover story” that they can relay to others, which gets across the main facts of the story but doesn’t capture the intensity of the experience and leaves out enough detail to avoid triggering a flashback.
Talk therapy and cognitive behavioral therapy take the view that when survivors tell the story of their traumas, it eventually desensitizes them to the trauma. However, the author’s research disputes the fact that merely talking about the event is enough to lessen the severity of flashbacks, stress, and other post-traumatic symptoms. As we’ll learn later, trauma survivors need to learn to cope with the overwhelming emotions their memories bring and ultimately have to integrate the traumatic event into the timeline of their life in order to move past it.
When a traumatic experience is so terrifying that the victim shut down, she may not remember the event at all until a sensation associated with the trauma triggers memory fragments or flashbacks.
Despite some controversy around the validity of repressed memories—especially in legal cases, including some against priests accused of sexual abuse—memory loss has been well documented among traumatized people who’ve been through natural disasters, accidents, war, concentration camps, kidnapping, torture, and abuse. It’s most common in childhood sexual abuse survivors, and it tends to be more severe if the abuse happened at a younger age and by someone the child knew.
As long as memories are inaccessible, they remain well preserved, but the more you retrieve and retell a memory, the more it gets altered. This is because your mind is programmed to make meaning out of things, so it shapes accessible memories to make sense according to your experiences.
Your brain’s primary function is to ensure your survival. This entails:
Your brain has three parts that work together to achieve its primary functions.
Trauma alters the balance between these three parts, ramping up activity in some areas and weakening others. As we’ll see, trauma causes the more primitive parts of your brain to be overactive, while hindering the parts responsible for empathy, creativity, and abstract thought—which are critical to thriving in a community and in everyday life.
The reptilian brain is the most primitive part of your brain and develops while you’re in the womb. It’s responsible for the things babies can do: breathe, eat, sleep, wake, cry, feel temperature, sense hunger, feel pain, urinate, and defecate.
As basic as the primitive brain’s functions are, they can often be impacted by psychological issues such as trauma—resulting in sleep problems, loss of appetite, digestion issues, and sensitivities to touch and arousal.
The next part of the brain that develops—mostly in the first six years of life—is the limbic system, also called the mammalian brain. This part of the brain houses emotions, watches for danger, detects joy or fear, decides what’s important for survival, and manages how you navigate complex social networks.
This area of the brain is largely shaped by your experiences. For example, if most of your childhood experiences make you feel safe and loved, your brain will be conditioned to feel safe to play, explore, and cooperate. However, if you’re constantly scared and feel unwanted, your brain will operate in fear and feelings of abandonment, and continue to operate this way into adulthood.
The reptilian brain and the limbic system together comprise the emotional brain, which is responsible for your well-being. Your emotional brain looks out for danger and opportunity, alerting you with hormones that fire off physical sensations (e.g. when you feel your chest tighten in response to panic) to get you to react immediately.
The emotional brain works quickly and fairly simply so that you can react as soon as possible in case of immediate threats; it interprets information in a general way, and may jump to conclusions based on the rough perception of threat. For instance, your emotional brain makes you jump back at the sight of a snake … before your rational brain realizes that it’s actually just a rope.
The emotional brain jump-starts your preprogrammed reactions, like the fight-or-flight response, which get your body in motion before you have time to think or plan. This can be a life-saving reflex when you need a quick reaction, but it can also cause issues when your emotional brain misjudges a threat—and trauma alters the emotional brain’s ability to accurately and effectively perceive threats, so trauma survivors go through life constantly jumping in response to non-threats.
The neocortex is your rational brain, and it’s the last area of the brain to develop, between the ages of 2 and 7. The neocortex is mostly made up of the frontal lobes, which manage language, abstract thought, imagination, creativity, empathy, and the ability to plan the future and reflect on the past.
The frontal lobes house mirror neurons, which allow you to pick up on other people’s actions, emotions, and intentions. On the plus side, mirror neurons give you the tools necessary for empathy. On the down side, they also make you sensitive to other people’s negativity and vulnerable to getting sucked into another person’s anger or depression; trauma survivors almost always have issues with not feeling seen or considered by others—not receiving empathy—so effective treatment must teach trauma sufferers to feel safe mirroring and being mirrored by others, while also resisting being overly vulnerable to other people’s negativity. (We’ll explore this more in later chapters.)
Trauma hinders many aspects of the neocortex, which is vital for healthy interpersonal relationships, long-term planning, and resilience (imagination makes hope possible).
As shown in the example of being afraid of a snake, only to realize that it’s a rope, the different parts of your brain must work together to help you successfully navigate the world.
As you go through your day, your thalamus is the part of your brain in the limbic system that takes all the sensory information—the sights, sounds, and smells around you—and puts it together into a fully-formed perception of what you’re experiencing. The thalamus filters information into what’s relevant and what’s not, making it vital for concentration and learning.
Under normal circumstances, the thalamus passes information to two places:
1. The amygdala, in the emotional brain, which quickly determines whether the information qualifies as a threat. Think of the amygdala as a smoke detector—it’s quick to react, but can sometimes confuse some burnt toast for a full-blown fire.
As explained earlier, if the amygdala deems something to be a threat, it triggers the stress-hormone system and autonomic nervous system (ANS) to release stress hormones, including cortisol and adrenaline. This raises your heart rate, blood pressure, and rate of breathing to get your body ready for fight or flight.
2. The frontal lobes (your rational brain)—specifically the medial prefrontal cortex (MPFC)—where the information reaches your conscious awareness. The MPFC acts as the watchtower, where logic can weigh in and let you know to calm down if that snake is, in fact, just a rope.
It takes slightly longer (we’re talking milliseconds) for information to reach the MPFC, so your body will react first and think later. If the MPFC determines that there is, in fact, no real threat, it stops the stress hormones and preprogrammed response that the amygdala triggered.
During trauma the thalamus shuts down, which is why survivors remember traumatic events as fragmented sensations—which are triggered in flashbacks—instead of linear stories. After the event, the thalamus can’t effectively filter between important and irrelevant information, so trauma sufferers are constantly on sensory overload; to cope, they tend to try developing tunnel vision and block out the excess information, but in the process, they tend to also filter out pleasure and joy.
Additionally, trauma sufferers don’t have a healthy balance between the amygdala, which can be hypersensitive and hyperreactive, and the MPFC, which can be too weak to temper the amygdala, so they easily go into panic mode for unnecessary reasons. Aside from living in constant stress, and suffering the physical damage that results, this makes it difficult to maintain relationships with other people if you can’t effectively gauge whether their intentions are good or threatening.
Your mental and physical states are inextricably connected. Both positive and negative emotions can give you physical sensations—like when the hair on the back of your neck stands up in the face of a threat, or you feel butterflies in your stomach when you’re excited.
Other people pick up on your mental and emotional state through your facial expressions and body language, and likewise, you read other people’s emotions and intentions through their physical expressions. However, if your mind and emotions are hijacked by a hypervigilance to danger—as is the case with trauma sufferers—it prevents you from relaxing enough to connect with other people; they don’t read an open, welcoming state in your posture, and you mistakenly see them as threatening.
Researcher Stephen Porges’s Polyvagal Theory explains how our social interactions with others, and the way we read each others’ body language, impacts our emotions—for instance, why hearing a soothing voice can calm you, and why feeling ostracized by other people can make you angry or cause you to shut down. Your mirror neurons (which help you pick up on other people’s actions, emotions, and intentions and are responsible for empathy) interpret people’s emotions through their body language, and then your body adjusts in response. This function helps humans live and function in communities.
The Polyvagal Theory shows how critical social relationships are to your emotional well-being, and in order to have relationships, you must feel safe—safe enough to play, open up to someone, mate, and nurture children. Feeling safe is the most important factor in good mental health; it requires social support and reciprocity, feeling seen and heard by the people around you.
Many trauma survivors struggle to feel truly understood, seen, and heard by those around them, and thus seldom feel safe and comfortable in social settings. Some trauma sufferers find a community in fellow trauma survivors, but confining yourself to a community of fellow victims, while comforting, ultimately leads to further isolation from the rest of society.
Healing from trauma means restoring the ability to feel safe and experience reciprocity. For trauma survivors who especially struggle to feel safe with people, animals—particularly dogs and horses—are used in treatment because they offer companionship and safety without the complexities of human relationships.
Trauma sufferers’ hypervigilance to threats makes direct eye contact with other people intimidating, rather than intimate. People with PTSD were put through a brain scanner and shown images of a cartoon figure making direct eye contact, and the part of their emotional brains that lit up (called the Periaqueductal Gray) is responsible for startling, cowering, hypervigilance, and other protective behaviors.
Non-trauma sufferers, by contrast, had a more socially oriented response; their mirror neurons were activated to interpret the cartoon character’s intentions. Trauma robs people of the ability to view other people as anything but a potential threat.
Feeling safe is an emotion, but it’s inextricably tied to physiological responses. There are three levels of safety that determine how you react to a threat; each level is associated with a different part of the nervous system.
The first level is social engagement, meaning that you call to others for help and comfort. At this level, the ventral vagal complex (VVC) is at work, coordinating your facial muscles to communicate your distress to others through facial and verbal expressions.
The VVC develops during infancy, as parents smile and talk to their babies, and is essential for social relationships because it operates your nonverbal communication. The better your VVC works—helping others intuitively understand your state of mind—and the better you can read others’ nonverbal cues, the better you’ll function in a community.
If no one responds or there’s no time to call for help, you reach the second level: fight or flight. In this state, your social-engagement system is shut off, making you less responsive to human voices and more responsive to threatening sounds.
This response activates your mammalian brain, specifically the sympathetic nervous system (SNS). The SNS manages arousal by triggering adrenaline to increase heart rate and blood pressure to prepare your body for swift action.
If you’re unable to fight or escape—suffering from immobilization, as we discussed in an earlier section—then you reach the third level, where your brain and body do the only thing they can to survive: freeze or collapse. Collapse is a function of your reptilian brain and causes you to shut down—the most basic form of survival in the face of inescapable circumstances.
The parasympathetic nervous system (PNS) kicks in, which is responsible for slowing down bodily functions in the interest of self-preservation; the PNS slows your heart rate and manages functions like digesting food and healing wounds. In times of collapse, a part of the PNS called the dorsal vagal complex (DVC) slows metabolism, makes your breathing shallow, and even empties your bowels. In this state, you dissociate from yourself and may not even be aware of pain.
Depersonalization is a form of dissociation. After a trauma, many survivors may be explosive—a result of level 2’s fight or flight—and later evolve to become more numb and depersonalized.
In order to re-engage in social relationships and community, trauma survivors who have had level 2 and 3 reactions need help rewiring their brain’s and body’s responses from the hypervigilance or collapse that helped them survive their traumatic events.
Talk therapy is ineffective for people who have engaged in depersonalization because they have disconnected so thoroughly from the event that talking about it isn’t productive. Treatment strategies that incorporate physical sensations tend to be most effective for both level 2 and level 3 survivors; this can include breathing exercises or rhythmic motions like bouncing on a yoga ball or drumming. We’ll dive deeper into treatment methods later in the summary.
As a baby, your interactions with your caregivers help you develop the ability to read people’s moods and emotions through their nonverbal cues, including body posture, tone of voice, and eye contact. Your ability to do this is critical in social interactions throughout your life.
Think of a recent conversation you had with someone who you knew was upset simply by reading their body language. What could you discern through their facial expressions, tone of voice, posture, and other nonverbal clues?
How did you feel before that conversation compared to after the conversation? How did your perception of the other person’s mood impact your own mood?
Think of how you use this skill of intuition in group settings, such as a family dinner or work meeting. Describe a situation when a group’s effectiveness or difficulty reading each other’s emotions impacted the group’s ability to communicate, work together, or accomplish a task.
Just as trauma causes victims to view others as threatening and struggle to make eye contact, describe a couple ways that your own experiences impact the way you interact with others. (e.g. Perhaps you assume people are upset when they’re in a quiet mood because you’ve had a close relationship with someone who shut down or went silent when they were angry.)
Recognizing the physical sensations in your body—as basic as feeling cold or hungry—is at the core of your sense of self: How can you know what you enjoy, need, or want if you don’t understand how you feel on the most basic level?
Before you develop language or consciousness, your physical awareness begins in the womb—feeling your mother’s movements and hearing the whooshing of fluids flowing around you. As you get older, physical sensations continue to provide information about your internal condition and your environment. Effectively reading sensory cues is essential to staying safe and healthy.
Many trauma survivors suffer major disconnection from their bodies, which makes it impossible for them to feel fully alive, take care of their bodies and minds, and effectively engage with other people.
Some survivors lose feeling in whole areas of their bodies, and can’t even determine what kind of object they’re holding in their palm by touch alone. Some survivors of chronic childhood trauma are so disconnected from their bodies that they can’t even recognize themselves in the mirror.
Researchers asked people to think about nothing—just focus on their breathing—while scanning their brains. Non-trauma sufferers had activation in the areas of the brain that give you the physical sense of where you are, register the physical sensations throughout your body, communicate your physical sensations to your emotional centers, integrate your sensory perceptions, and coordinate your thoughts and emotions. Together, all these brain functions create self-awareness and consciousness.
By contrast, trauma survivors who showed that their brain activity reflected their lack of sensory awareness. The survivors’ brains showed only a mild activation in the area that gives you your basic orientation in space; the only thing trauma survivors’ brains registered was a general sense of where they were—but not how their body felt laying in the imaging machine, or how the cool air and the smell of the room made them feel.
During a traumatic event, victims learn to cut off the connection between physical sensations, such as abuse, and emotional reactions, such as fear. The trouble is that this response continues long after the event is over, and inhibits survivors from experiencing physical sensations and their accompanying emotions—both positive and negative—in everyday life. Unable to register warmth, arousal, hunger, or pain, trauma survivors end up feeling numb.
Agency is the feeling of being in control of your life—knowing where you are (literally and figuratively), that you’re in control of your actions, and that you can affect your circumstances.
Trauma sufferers tend to lose their sense of agency when they’re disconnected from their physical sensations: If they can’t register what they’re feeling, then they can’t figure out why they’re feeling that way, and they can’t do anything about it. For example, if you can’t recognize that your body is tense, then you can’t use that clue to intuit that you’re feeling stressed, and you can’t do anything to manage that stress. By the same token, you can’t interpret or act on what you need to take care of yourself—both physically and emotionally—and it’s nearly impossible to find a sense of purpose or direction in life.
The inability to identify emotions is called alexithymia; in Greek, this literally means having no words for feelings. Not only do people with alexithymia fail to recognize their own emotions, but they can’t read others’ emotions, either. Researchers found that when they showed pictures of angry faces, people with alexithymia couldn’t figure out what the people in the pictures were feeling.
Trauma survivors can’t even trust their bodies to provide accurate information, because they’re wired to be hypervigilant and hyperreactive to perceived threats. In response, survivors may reject and suppress physical sensations, ultimately leaving them feeling confused by and out of control of what’s going on inside themselves.
Another problem is that these suppressed needs don’t simply go away—the body finds other ways of expressing them to demand your attention: Many trauma survivors develop psychosomatic issues (physical ailments that have no physical cause) such as migraines, neck and back pain, fibromyalgia, asthma, digestive issues, irritable bowel syndrome, and chronic fatigue.
Many child abuse victims dissociate as a means of surviving their traumas: The experience of being raped or beaten is too much to bear psychologically, so they detach their minds from their bodies so they don’t have to experience the abuse. Even in cases of emotional abuse, children learn to block out the hostility or neglect as if they’re unaffected, even while internally they’re in a physical state of high alert.
Dissociation causes the abuse victims to deny certain feelings and sensations, and over time they lose sight of what’s real and what’s not. When you’re not in tune with yourself physically and emotionally, you begin to not feel real; if you don’t know how you feel, you lose your sense of who you are.
Often children can’t tolerate acknowledging their abuse, so they suppress their feelings. Consequently, they don’t understand that the fear, rage, or emotional shutdowns they experience in the aftermath are related to the abuse. Instead, they redirect those feelings toward themselves and become depressed, self-hating, and self-harming. Until they learn to associate those feelings with the acknowledgement of their abuse, they can’t work through them or begin healing their trauma.
In order to regain control of their bodies and minds to finally move past trauma, sufferers must learn to read and respond to their physical sensations. They must first become aware of their sensations, then work on identifying them and learn to respond to what their bodies are telling them.
Effective treatments include mindfulness practices that increase survivors’ awareness of their bodies. These treatments aim to help trauma sufferers:
We’ll explore these in further depth in later sections.
Recognizing the physical sensations in your body—as basic as feeling cold or hungry—is at the core of your sense of self, but for most people it’s so natural that you probably don’t even think about it. Use this exercise to notice your body awareness.
Take a moment and focus on your body. Write all the sensations you notice—the feel of the chair against your back, your empty stomach growling, the smell of the room, the tension in your shoulders.
Notice your current emotional state. How are your physical sensations affecting your emotions?
Now let’s look at the reverse: Describe a recent instance when you noticed a physical sensation (e.g. tense muscles, headache, clenched jaw) that clued you into your emotional state.
From the moment you’re born, every interaction with your caregivers helps form your understanding of the world and teaches you how to have relationships with others; this comes through your attachment and attunement to your caregiver, which we’ll describe below. In fact, the biggest predictor of your ability to cope with challenges in life is the security you feel with your primary caregiver during the first two years of your life.
As a baby, since you’re unable to care for yourself, you must rely on your caregivers to meet your most basic needs, from food and clothing to safety and comfort. Your attachment—how well your caregivers meet your needs—determines how well you’ll take care of these needs for yourself later in life. Furthermore, the more responsive your caregivers are to you, the more responsive you’ll be to others.
Babies are programmed to form an attachment no matter what, so the quality of that attachment depends upon the kind of caregiver they have.
Caregivers’ own traumas and mental health issues can impede their ability to care for and provide secure attachment. Children without a healthy attachment tend to dissociate and shut down when they’re older; they feel numb or not real, and may resort to dangerous behavior or self-harm in order to feel something.
Children whose caregivers are responsive to their needs form secure attachments. Securely attached children are most resilient in the face of life’s challenges: They understand when they have control over a situation and when things are out of their hands, and they have a sense of agency, giving them the confidence that they have control over their actions and can impact their circumstances.
In a study of how babies reacted to short-term separations from their mothers, researchers found that securely attached babies showed distress when their mothers left the room, but were excited when their mothers returned and quickly settled and continued playing in their mothers’ company.
When caregivers don’t reliably meet a baby’s needs, it creates an insecure attachment. Insecure attachments create psychological issues, as we’ll see, but insecure attachments are still considered organized attachments (as are secure attachments, as opposed to disorganized attachments, which we’ll discuss next) because the caregiver’s behavior is consistent and the baby can learn what to expect and how to cope.
There are two forms of insecure attachments, depending upon how the baby adapts to her caregiver’s shortcomings:
1. Avoidant attachment is typically a reaction to mothers who don’t enjoy touching, cuddling, or holding their babies, and who fail to use their voices and facial expressions to communicate with their babies. These babies are quiet and withdrawn, and never seem to get upset.
In the study, avoidantly attached babies didn’t cry when their mothers left and didn’t react when they returned. However, despite their calm exterior, avoidantly attached infants’ heart rates remained high, revealing that they’re constantly in a state of hyperarousal.
Avoidantly attached babies become adults who are not in touch with their feelings or others’ feelings, and they often become bullies.
2. Anxious or ambivalent attachment forms when babies conclude that the only way to get attention is to cry and fuss constantly.
Anxious babies are clingy and demanding. In the study, these babies were very distressed when their mothers left but didn’t calm down when they returned, and remained focused on their mothers instead of resuming play.
Unsurprisingly, anxious babies tend to grow into anxious adults, who tend to be the victims of bullying by their avoidantly attached peers.
Although insecure attachments are psychologically problematic, the consistent style of caregiving provides some stability. By contrast, babies whose caregivers cause them fear or distress have a disorganized attachment.
When a baby is afraid of her caregiver, she is stuck between needing that caregiver for survival and simultaneously being scared of the caregiver. As a result, the baby doesn’t know how to engage with her caregiver. This is the most psychologically damaging form of attachment.
There are two types of caregivers that foster disorganized attachment:
Children with disorganized attachment often become aggressive or disengaged and exhibit related physical symptoms, including increased heart rate, high stress hormone levels, and decreased immune system. As adults, people with disorganized attachment can’t distinguish whom they can trust from whom they should fear, so they may either be overly affectionate with strangers or distrustful of everyone.
A caregiver’s emotional attunement—being in sync with the baby’s needs, which helps the baby feel understood and taken care of—is a critical aspect of developing secure attachment. If a baby feels hungry and her caregiver promptly offers a bottle, or the baby feels overwhelmed and her caregiver soothes her, the baby learns that those intense sensations can be satiated and return to comfort and safety; when those babies grow up, they’ll be better able to self-soothe and self-nurture and less inclined to feel distressed in the face of other intense sensations.
On the other hand, babies and children who face abuse and neglect learn that their needs will not be met, no matter how much they cry. This conditions them to become adults who give up in the face of obstacles.
Emotional attunement also fosters physical attunement. Babies can’t calm themselves down through mindful breathing or relaxation exercises. Instead, their caregivers’ competency and attunement provide the comfort and safety that allows babies to calm down: When a baby feels emotionally in sync with her caregiver, her body reflects it with calm breathing, a steady heartbeat, and low stress hormone levels.
Pediatrician and psychoanalyst Donald Winnicott suggests that when a caregiver can’t meet a baby’s needs, the baby adjusts to meet the mother’s capabilities. The baby learns to deny her own inner sensations, eventually learning that there’s something wrong with the way she is. As these babies grow up, they continue rejecting what their bodies tell them; as we discussed earlier, when people are disconnected from their physical sensations, they lose their sense of joy, purpose, and direction in life.
Abuse or neglect can reverse the positive effects of even the most secure attachment. Like adults, abused children become hypervigilant to threat and see danger in everything.
Traumatized children’s hypervigilance, overreactions, aggressions, and tendencies to shut down emotionally make it difficult to have friendships. As a result, traumatized children learn to hide their vulnerabilities with a tough and aggressive attitude or by isolating themselves; both scenarios exacerbate their trouble with social skills and self-regulation, creating a vicious cycle.
The author conducted a study with a group of 6- to 11-year-olds who had experienced trauma, and another group who hadn’t. He showed all the children pictures depicting a scene—including a man working under a car while two children watched, and a pregnant woman looking off in the distance—and asked them to tell the story of what’s going on in the picture. Children who hadn’t been through trauma told stories with benign endings; even if the story had some sadness or threat of danger, they could also imagine a happy ending. But the traumatized group imagined violent and scary stories even from the most ordinary images.
Trauma in adulthood alters your ability to interpret the world around you, but trauma in childhood interferes with the formation of the maps you use to understand the world.
Attachment, childhood experiences, and childhood traumas shape your inner maps of the world. As an adult, your inner map determines what you consider normal and familiar, how you interpret situations, and how you engage with the people and world around you: If something falls in line with your inner map, it must be right—whether it’s abuse and mistreatment or love and appreciation.
Inner maps are generally consistent throughout life, but it’s possible for them to change through profound experiences, such as an intimate, loving relationship during adolescence (a time of great change in your brain) or the birth of a child. By the same token, traumatic experiences can distort otherwise healthy inner maps.
Your inner map is housed in your emotional brain, so reconstructing it requires treatment that alters the responses of your central nervous system (recall from earlier sections that your emotional brain houses the amygdala, or the smoke detector, which sounds the alarm for your nervous system to release stress hormones in the face of a threat). Although logic from the rational brain can begin to help you rework your inner map, powerful emotions like fear, rejection, rage, or vulnerability will cause your emotional brain to take control and use your (flawed) inner map to guide you.
In 1990, a massive study of Adverse Childhood Experiences (known as the ACE study) revealed that childhood dysfunction and trauma—including abuse, neglect, and parental absence—are highly correlated with mental, emotional, and physical problems later in life.~~ ~~
First, the researchers found that so-called adverse experiences are seldom isolated; if you have a parent in prison or witness your mother being abused, other family issues are likely also present. And the more of these adverse experiences are present, the higher the so-called ACE score, and the worse the effects.
Patients who had higher ACE scores were more likely to have
One of the researchers in the ACE study, Vincent Felitti, saw a pattern in his own work of morbidly obese patients who had suffered childhood incest and other traumas. He determined that for these patients, they had become obese as a solution to their traumas, because it made them feel safer to be physically larger or to be considered less attractive.
Without understanding the root of the patients’ obesity, doctors look at the solution the patients had developed to survive as the problem. This misunderstanding leads most of these patients to ultimately fail in their weight-loss efforts; the same often happens in addiction recovery, because the addiction is a symptom of other deep-seated issues.
When looking at children who have severe behavior issues as a result of abuse, there are elements of both nature and nurture; life experiences can switch on or off certain genes to make them react differently to emotions and experiences. In other words, stressful experiences can make you more susceptible to subsequent stress. (The genetic modifications that result from life events can also be passed on to your children, which is known as epigenetics.)
What’s more, these trauma-caused genetic modifications can have a stronger influence on behavior than pre-existing genetic abnormalities, meaning that the role of nurture is at least as strong as nature.
One long-term study followed 180 families, beginning three months before first-time mothers had their babies and checking in periodically for 30 years. The study found that the biggest factor in whether a child developed behavioral problems later in life was the parent-child relationship—more than the mother’s personality or the baby’s brain abnormalities, IQ, or temperament.
Various programs in the U.S. and other countries have invested in supporting families by providing safe, nurturing, stimulating environments for children. Economists calculate that these programs more than pay for themselves by reducing the number of those children who later end up incarcerated, seek public assistance, and need assistance with healthcare costs or substance abuse treatment programs.
As the fields of science and psychology have evolved, so have the understanding and treatment of trauma. There are three general approaches to treatment.
The goal of treatment is to regain control of yourself and your thoughts, feelings, and body. Generally, this involves four steps:
First we’ll explore top-down trauma treatments and discuss their benefits and drawbacks. In the following chapters, we’ll do the same with the medication approach and the bottom-up approach.
Talk therapy alone isn’t adequate to heal trauma—and if the patient isn’t yet ready to cope with the emotions that come up, it can retraumatize her and increase fixation on the trauma. What’s more, it can be difficult for trauma survivors to articulate what happened to them, because their brains didn’t process the event as a coherent narrative but rather as a collection of fragmented sensations.
However, talking and acknowledging your trauma is a critical piece of the healing process for a few reasons. First, talking about your trauma breaks the silence and isolation of keeping it a secret; although many trauma survivors are inclined to suppress their traumatic memories in an attempt to gain control over the overwhelming emotions they bring up, failing to acknowledge your trauma and the reactions it triggers only inhibits you from managing it.
Second, talking about your experience and emotions relieves the incredible amount of energy and attention required to suppress them and allows you to work through your psychological wounds. Bottling up such overwhelming feelings doesn’t make them go away, and in the meantime it saps your energy from engaging in the present and pursuing goals; as a result, you’re likely to feel bored and disengaged from life. Despite your efforts to suppress the trauma, your chronic hypervigilance is continuing to trigger stress hormones—causing physical ailments such as headaches, muscle pain, and digestive issues, as well as irrational emotions and behavior. You can’t deal with these symptoms until you’ve identified what’s causing them.
Third, when you open up to other people, you create the opportunity to feel heard and understood, which activates your limbic brain and helps in the physiological healing process. Sharing your experience with others can help break down the isolation of trauma and reconnect you with your community.
On the other hand, if someone fails to respond or understand, it can be further damaging. Non-trauma survivors often can’t handle or don’t want to hear the details of terrible wartime tragedies or child abuse, so trauma survivors withdraw or develop a more palatable narrative for public consumption. This is why trauma sufferers need safe spaces to share their experiences in order to recover. Therapists are great sources of support, as are groups like Alcoholics Anonymous, Narcotics Anonymous, and Adult Children of Alcoholics.
Trauma survivors carry two parallel stories about their experiences, from two forms of self-awareness:
The two systems are located in different parts of the brain that are largely disconnected, so these two forms of self-awareness don’t always align: You may tell others that you are happy, but your body language is slumped and hints at the fact that you feel unhappy. Trauma victims develop a coherent narrative of their trauma that they tell others, but it doesn’t capture—and may even downplay—the terror of their experience.
If you focus too heavily on your autobiographical self-awareness, you may begin to believe that it’s the whole truth, lose sight of your internal truth, and suppress your moment-to-moment self-awareness. In order to heal, trauma survivors must reconnect with their moment-to-moment self-awareness and come to terms with how the experience of their trauma felt, reconciling that with the brave-faced narrative they’ve developed in order to endure.
Trauma survivors can become so overwhelmed by their traumatic memories that the language area of their brain shuts down and they’re rendered speechless. In other cases, survivors may try to tone down their retelling of a traumatic event so that it doesn’t trigger them.
Since it can be so difficult to connect your inner experiences to language, there are methods you can use to help bridge that divide.
The “Switching” Phenomenon
When people express difficult or intimate things, they’re accessing different physiological and emotional states. As a result, their manner of speaking or writing can change profoundly.
The pitch, tone, and volume of a person’s voice may change dramatically between when she’s talking about the schedule of her day and when she’s talking about a deep secret or traumatic experience. Likewise, her handwriting may change from flowy cursive to rigid block letters, and from straight up-and-down to slanted (when people write about their deepest fears, their handwriting tends to be more childlike).
Furthermore, some people may even show changes in their personality: They may morph from shy to aggressive, or docile to domineering.
Everyone has various parts of themselves, or subpersonalities: Among them, you have a part that is loving and affectionate that comes out when you’re around family and friends, as well as a part that is aggressive and confrontational, which only comes out when you’re angry. We all have many different parts, each with distinct beliefs, roles, emotions, and sensations. Collectively, they make you the complex, multifaceted person that you are.
Internal family systems therapy (IFS) looks at all these parts as members of a family, all with different levels of wisdom, maturity, excitability, and pain. Healthy internal leadership skills allow you to manage your different parts, so that they remain balanced and don’t work against each other. However, in trauma survivors, some parts take on the pain of the trauma and others take on protective roles in response, ultimately working against each other, causing intense inner conflict and, in extreme cases, dissociative identity disorder (DID).
Everyone has a part that is childlike and joyful, but if you experience childhood abuse that part of you may become frozen with the pain and fear from that abuse. As a result, that part—or family member—becomes toxic to the rest of you and is locked away, becoming what IFS calls an exile.
In response, other parts work to protect you from the pain the exile carries by any means necessary, whether by dissociation or behavioral changes, perhaps preventing you from developing intimate relationships with other people who could hurt you like your abuser did. These parts are called managers, and they use control as a means of coping.
Other parts take over to try to protect you whenever something triggers your exiled emotions. These are called firefighters; they’ll destroy the house to put out the fire. For example, firefighters may cause you to binge drink or engage in some other impulsive behavior to dull the pain of a triggered exile.
All these parts are trying to work to protect the whole—you—from feeling the full force of your trauma. But the way certain parts must adapt in response to trauma can cause dysfunction in the whole family or network of parts; when any network is dysfunctional (think of a company, for example), it needs strong leadership to steer it straight.
IFS approaches healing through developing self-leadership of your parts. IFS takes the view that the parts have protected an undamaged inner Self, and that—with guidance—once the protective parts trust that it is safe and the trauma is over, they can make way for the Self to resurface. Through mindfulness, the Self must then take on leadership of all the parts, making sure each one heals and regularly has its needs met through self-reflection, exploration, and self-care; IFS therapy aims to help a patient develop inner relationships between her Self and her parts.
The philosophy of cognitive behavioral therapy (CBT) is that repeatedly exposing a patient to the source of her fear and anxiety will eventually desensitize her and make her realize that her fear is irrational. However, the author maintains that CBT is an inadequate treatment for trauma because it overwhelms, retraumatizes, or worsens patients’ fixation on the event. Even when CBT effectively reduces a patient’s fear and anxiety, she’s likely to still suffer from physical problems, guilt, and other mental and emotional issues.
Rather than desensitization, trauma survivors need help integrating the traumatic memory into the timeline of their lives, placing it securely in the past, so they can fully accept that it is over. This still involves revisiting the memory, but only once the patient learns to cope with the reactions that the trauma will inevitably bring up, to avoid becoming overwhelmed and enable her to complete the integration.
As we explained earlier, trauma lives in the emotional brain, which triggers physical responses and is not governed by logic as the rational brain is. Trauma sufferers tend to develop thoughts that are irrational—for instance, that they were at fault for their assault or that they acted in a cowardly way but submitting to abuse. These irrational thoughts should be considered cognitive flashbacks; they’re thoughts that the survivor had during or shortly after the trauma that are being triggered by memories or stress.
CBT attempts to correct this “dysfunctional thinking” by reframing the thoughts. But just like you can’t make a trauma survivor edit her visual flashbacks, you won’t make much headway arguing with her cognitive flashbacks.
You can’t approach trauma with logic (e.g. “it wasn’t your fault,” “you were just a child,” “you had no control over the situation”) and you can’t reason your way through your emotions because you’re working with the emotional brain: Understanding why you feel something won’t prevent you from feeling it. But understanding that your trauma is triggering certain emotions can help you begin to resist intense overreactions in everyday situations (e.g. exploding at your spouse for an innocent comment that reminds you of your abusive father).
Therapy for trauma must help patients reestablish a balance between the emotional brain and the rational brain, instead of letting the hyperreactive emotional brain send them into overdrive or cause them to shut down in response to minor threats. In order to do this, patients must practice self-awareness, or interoception, to notice what’s going on inside themselves.
Let’s explore several strategies you can use to cope with the intense emotions and regain control of your mind and body.
As we’ve discussed, trauma survivors remain hypervigilant, are easily sent into a fight-or-flight response, and take longer to calm down after a perceived threat has passed. To heal, they must gain control over their arousal system, which is possible through mindful breathing and movement.
Slow, deep breaths with long exhales trigger the parasympathetic nervous system to slow your heart rate. Yoga, chanting, martial arts, and rhythmic drumming can all help trauma sufferers gain and maintain a sense of calm, even in the face of flashbacks and the emotions they arouse.
Mindfulness means having a self-awareness of your emotions, your body, and your responses. Traumatized people are haunted by seemingly ever-present sensations that remind them of their traumas, so they’re constantly either avoiding them, repressing them, or succumbing to them. Self-awareness gives trauma survivors the power to face those sensations and then move on from them.
It begins by merely noticing how you’re feeling; as you pay closer attention to your emotions and the ways they shift—based on your thoughts, perceptions, breathing, or body posture—it becomes clearer that feelings are short-lived. That realization takes the power away from the emotion and gives you the option to decide how to respond, rather than feeling like a victim of your emotions and resorting to the habitual reactions you’ve developed to survive and cope.
Once you’ve begun noticing your feelings and physical sensations, label them and notice how certain emotions are tied to specific physical reactions. Again, noticing and identifying these sensations gives you the power to endure them, because you know that they are temporary and that you have the power to change them.
Mindfulness has many documented benefits, including
Humans are hard-wired to connect with others and be engaged members of communities. Consequently, strong, supportive relationships are the best protection against trauma and the biggest factor in healing from trauma. By the same token, trauma at the hands of a person who’s supposed to be a source of love and support is the most damaging because it undermines your ability to form new relationships that are necessary for healing.
If someone who’s supposed to love and protect you instead hurts and scares you, you adapt by shutting down and repressing how you feel. As you attempt to form new relationships, you’re likely to fear that this person will also hurt you in some way, so you shut down, turn away, or try to beat her to the punch by hurting her first.
In order to recover, you need someone whom you can not only trust with your emotional baggage, but who will also help you carry the load and work on unpacking it. Therapists are trained to help trauma sufferers in this way through three primary steps toward recovery:
Several factors can help you determine if a therapist is the right fit for you.
Just as babies need to feel attuned with their caregivers, humans thrive on feeling in sync with others. Trauma survivors often lose attunement with those around them when they collapse or shut down for survival; they can benefit greatly from activities that put them back in sync with others in a visceral way, such as kickboxing, dancing, choral singing, and the martial arts practice of aikido. Even forms of play can give people a sense of connection and physical attunement with each other.
In contrast to oft-prescribed medications that simply numb people to overwhelming sensations, physical touch—including hugs and rocking—is a powerful way to calm people and make people feel safe, protected, and empowered.
Since trauma and tension are held in the body, so-called bodywork such as massage and Feldenkrais (a therapeutic method of movement) can help patients literally feel—and then release—sensations and tensions in their body that they may even be unaware of until it’s relieved. Physical touch can also add to a patient’s physical self-awareness and help them feel more in tune and in control of their mind and body.
As we discussed earlier, people who are able to take action to help themselves or others in a trauma are more resilient, while those who are immobilized (e.g. trapped in a car accident, held down in an assault, or stuck in a war zone) are more likely to suffer from the trauma; the stress hormones their bodies secreted to give them the power and energy to do something had no outlet, so they continue to pump into the body and trigger fight-or-flight responses or collapse. Treatments such as body-based therapies, sensorimotor psychotherapy, and somatic experiencing help patients essentially complete the actions they weren’t able to perform during the traumatic event, and thus resolve their trauma.
First patients learn to gradually dip into their traumatic sensations and memories in a process called pendulation. With this method, patients find “islands of safety” in their bodies that they can retreat back to when traumatic memories become overwhelming; this can mean focusing on their hands, paying attention to their exhales, or touching acupressure points. Over time they can build up their tolerance for revisiting the trauma and the physical sensations it triggers.
Revisiting the trauma triggers physical impulses from the event (for example, running or pushing someone away) that the patient was unable to do during the trauma, so the patient will make subtler moves like twisting or backing away. The next step in treatment is to explore and modify those movements so patients can complete the actions they couldn’t do during the event, so they can get a sense of what it would’ve felt like to escape or fight back; this gives patients the sense of agency and the ability to protect themselves, of which the trauma robbed them.
Several of the same techniques trauma survivors use to manage their overwhelming emotions can be useful in stressful day-to-day situations. Try these strategies next time you’re stressed, anxious, or angry.
Throughout history, available technology dictated the understanding and treatment of mental and emotional issues. Before the Enlightenment, mental illness and emotional issues were attributed to God, demons, sin, magic, and witchcraft. In the 19th Century, scientists began viewing behavior as a result of people’s adaptation to the complex world around them.
In the early 1950s, French scientists discovered a chemical compound that could make psychiatric patients less agitated and delusional. This introduced the brain-disease model of viewing mental problems as “disorders” that could be treated with drugs to adjust brain chemistry.
The brain-disease model and growth of pharmacology changed the field of psychiatry in several ways.
However, the availability of drugs has become a substitution for therapy in many instances, and has allowed patients to treat their symptoms without addressing the root problems. Reliance on medication also prevents patients from feeling empowered in their own healing, and instead places the power in the hands of the prescribing doctors and insurance companies.
Pharmacology has become the mainstream form of psychiatric medicine. The profitability of medications deters medical journals from publishing studies on non-drug treatments for mental health issues, and many such studies struggle to get funding in the first place. As a result, many patients never consider or get the chance to explore other means of healing.
The brain-disease model behind pharmacology ignores four fundamental truths.
Ignoring these truths means depriving people of the power to heal themselves and regain control over their minds, bodies, and experiences. Reliance on pharmacology makes people patients, at the hands of someone else’s power to heal them, instead of participants in their own healing process, which connects them with their sense of self.
Medications are widely used to treat symptoms of trauma, which can make it easier to control your emotions and behavior. However, drugs are most effective when incorporated with other forms of treatment because they can also dampen positive feelings and they don’t help you learn how to self-regulate.
Each family of drugs has different pros and cons.
Psychoactive drugs—including LSD and MDMA (ecstasy)—have been used to tame patients’ emotional reactions in this process. MDMA raises your self-awareness while decreasing fear, defensiveness, and numbing; this combination made it a great fit for trauma patients. Several studies using MDMA to aid in trauma sufferers’ psychotherapy had positive short- and long-term results, but it must be used carefully and in tandem with therapy.
Selective serotonin reuptake inhibitors (SSRIs)—including Prozac, Zoloft, Effexor, and Paxil—make patients feel calmer and less overwhelmed, making life seem more manageable. These effects can help patients engage in therapy, but they can also go too far and make patients feel that their emotions are being blunted.
Drugs that affect the autonomic nervous system—such as propranolol and clonidine—block the effects of adrenaline, which fuels arousal and reactivity to stress, and helps reduce nightmares and insomnia. Since trauma survivors suffer from hyperarousal and high levels of stress hormones, this can help keep their rational brains engaged, rather than letting the emotional take over in response to trauma triggers; however, the author prefers patients use yoga and mindfulness to achieve these results.
Benzodiazepines—a type of tranquilizing drug that includes Klonopin, Valium, Ativan, and Xanax—calm you down and help quell worry, similar to alcohol. However, like alcohol, they also lower your inhibitions and may cause you to say things you wouldn’t say sober. Additionally, benzodiazepines are highly addictive, may impede patients’ ability to process their traumas, and can cause withdrawals that can worsen trauma symptoms.
Anticonvulsants and mood stabilizers—such as lithium and valproate—have some benefits, including easing hyperarousal. (Shortform note: The author doesn’t elaborate on the effects of this class of drug beyond this.)
Second-generation antipsychotic drugs—including Risperdal, Abilify, and Seroquel—block the dopamine system, which is responsible for arousal as well as motivation and rewards; while this can calm intense fear and anger, they also blunt your ability to feel pleasure. Furthermore, these drugs can cause weight gain, raise your risk of diabetes, and make you physically inert.
The bottom-up approach to treatment uses physical experiences that connect the body and mind. This empowers patients to inhabit their bodies, be present, and learn how they can affect their emotions—all of which help them to counteract feelings of helplessness, rage, and emotional collapse.
Eye movement desensitization and reprocessing (EMDR) is a treatment in which patients revisit their trauma while focusing on a therapist’s finger moving side-to-side. In contrast to exposure therapy, which aims to desensitize patients through repeatedly revisiting the traumatic memory, EMDR uses the trauma as merely a starting point leading to other, seemingly unrelated thoughts and memories.
While researchers don’t know exactly how EMDR works, the treatment helps people get in touch with loosely connected memories and images and then integrate their traumatic experience into a broader context. After EMDR treatment, patients are able to look at the traumatic event as they would another memory—something that’s in the past, that doesn’t have power over them in the present. Furthermore, one study showed that not only was EMDR more effective than Prozac, but several months after EMDR, patients continued to improve.
Researchers believe that EMDR’s effectiveness is related to how the eye movement mimics the way eyes move during the rapid eye movement (REM) phase of sleep, when dreaming occurs. Dreams connect and recombine unrelated pieces of memories and information, reshaping and reintegrating memories over time; EMDR appears to do something similar with traumatic memories.
Unlike other forms of therapy, EMDR patients don’t have to verbalize the memories they’re having in order for EMDR to work; they can go through the whole process without saying a word. Additionally, an EMDR patient doesn’t need to trust or even like her therapist in order for the treatment to be effective. This makes EMDR especially valuable for trauma survivors, who often struggle to trust others.
EMDR has been shown to be less effective for people who were traumatized as children. As we discussed earlier, childhood trauma creates unique mental and physiological problems, and EMDR can’t necessarily resolve deep-seated betrayal and abandonment issues.
Heart rate variability (HRV) is the balance between how your heart rate rises and falls. As a reminder, inhaling activates the sympathetic nervous system (SNS), which increases heart rate and fuels arousal, while exhaling stimulates the parasympathetic nervous system (PNS), which slows your heart rate and aids body functions like digestion and healing of wounds. A healthy balance between your arousal and relaxation—your HRV—indicates that your autonomic nervous system (ANS) is in good working order, and that helps you stay calm and in control in the face of minor challenges.
Poor HRV means your breathing and heart rate are out of sync, which has negative effects on how you think, feel, and respond to stress; it can make you vulnerable to physical issues such as heart disease and cancer, as well as depression and PTSD. Trauma survivors have low HRV, which helps explain why they are hyperreactive to minor threats and stresses.
You can train yourself to change your breathing (and thus improve your HRV) through yoga as well as certain devices and smart phone apps. Improved HRV can help with depression, anxiety, and anger issues as well as high blood pressure, high stress hormone levels, lower back pain, and asthma.
Several aspects of yoga make it an incredibly healing treatment for trauma survivors. First, yoga’s inherent focus on the breath—moving with each inhale and exhale, noticing whether your breath is fast or slow, and counting breaths in certain poses—improves HRV.
Second, yoga teaches you to listen and respond to your body, ultimately helping trauma survivors be more aware of and comfortable in their bodies. Often trauma survivors learn to shut out and dissociate from their physical sensations, so yoga can help them reconnect with their bodies. You need to feel connected with your body in order to have a sense of self; if you can’t understand what your body is telling you (e.g. are you hungry, or are you anxious?) then you can’t identify how you feel or what you need, and you won’t be able to properly take care of yourself. Feeling safe in your body also helps you articulate your emotions and even traumatic memories that were previously overwhelming.
Third, yoga teaches you to notice the emotions that are connected to certain physical sensations; this is especially critical for trauma sufferers, because certain physical sensations and poses can trigger flashbacks (for example, many sexual assault survivors panic in poses that have them lying on their backs with their feet up in the air). As long as trauma sufferers approach yoga at a slow pace and avoid becoming overwhelmed, the practice can help them work through those intense emotions.
Finally, yoga and body awareness improve trauma sufferers’ sense of time. Trauma causes people to feel stuck in their traumatic memory, and they struggle to be present; yoga encourages you to be present by focusing on your breath and body sensations, and reinforces the fact that experiences are transitory (e.g. as hard as this pose may be, you only need to endure it for ten breaths).
Yoga’s positive effects can even be seen in the brain: A study of women with histories of intense trauma found that 20 weeks of yoga increased activity in the insula and medial prefrontal cortex (MPFC), where trauma survivors typically have abnormally low activity. The insula takes sensory information and signals the amygdala if it needs to trigger a fight-or-flight response, and the MPFC is the watchtower that logically weighs information and balances out the response of the amygdala (the smoke detector). In other words, yoga strengthens the parts of the brain that help prevent you from overreacting to minor threats.
Another form of therapy, called Pesso Boyden System Psychomotor (PBSP) therapy, allows you to physically recreate scenes of your childhood and trauma, and then essentially rewrite the story. Creating a physical representation of traumatic memories activates the right hemisphere of the brain—the same hemisphere where trauma is also largely imprinted.
This psychomotor therapy typically happens in a group, with one person—called the protagonist—at the center. As the protagonist talks about her experiences, the therapist periodically makes witness statements, which are observations of how the protagonist’s body language changes as she brings up certain details (e.g. slumping over as she talks about how her father left her family). This helps the protagonist feel seen and understood, making it safer and more comfortable to dig deeper.
When the protagonist begins to feel overwhelmed, the therapist can ask if she’d like to choose a contact person to sit next to her; if so, she gets to choose who in the group is her contact person and where exactly they’ll sit. The presence of the contact person is meant to offer a sense of safety and comfort as the protagonist continues to delve into her painful memories.
As the protagonist continues telling her memories, members of the group are chosen to stand in as key characters from the story, such as parents and siblings, allowing the protagonist an opportunity to say something to her father that she couldn’t say as a child, for instance. Furthermore, the protagonist instructs these actors where exactly to stand and which direction to face; this activates the right hemisphere’s spatial abilities, and it can offer insight about the protagonist’s feelings toward these people (e.g. instructing an abusive father to stand far away and face out demonstrates the protagonist’s fear of or anger toward him, while instructing a nurturing mother to sit nearby indicates the protagonist’s feelings of safety around her).
In addition, other group members also stand in as ideal versions of those characters, so the protagonist can create a loving, attentive version of her father. She can then tell him something she wishes she could’ve told her father or, better yet hear him say something loving and reassuring that she never heard from her father.
Actively directing and participating in your memories in this way allows you to explore your memories and emotions in a way that’s deeper than simply talking about it. Creating and rewriting these scenes also empowers protagonists to experience what it would’ve been like if those events had gone differently and gives them a chance to complete actions they were unable to do during the actual events.
This form of therapy doesn’t eliminate or neutralize traumatic memories, but it does create a new experience (e.g. of being loved or protected) that helps to rewrite your inner maps. Those inner maps are the foundation for future behavior, so altering them can change your default from being distrustful and fearful of intimacy to allowing others to get close to you and feeling safe.
Think of the brain as a network of electrical circuits that fires off jolts of electricity in order to carry out its functions—creating thoughts, stimulating behavior, arousing physical responses—just like switching on a light. When the circuits are out of order, it creates mental and emotional disorders. Neurofeedback aims to fix the circuitry in patients’ brains.
Neurofeedback is a method that involves hooking up patients to machines that track their brain waves and mirror them back in order to encourage certain frequencies and brain patterns while discouraging others. Patients may watch an animation that looks like a video game, with spaceships moving around the screen randomly; when the patient is calm and focused, for example, the spaceships start moving in a more orderly way than when the patient is tense and anxious. Think of neurofeedback like the feedback you get from someone’s facial expressions when you’re having a conversation: You’re subtly encouraged to continue when the person smiles and nods, but if they frown or zone out you get the cue to change the topic.
Neurofeedback is also able to target frequencies in certain areas of the brain in order to increase focus, alertness, and other states. Each type of brain wave is related to a different state of being.
After enough sessions of neurofeedback (depending upon the patient), the brain is trained to sustain those new brain wave patterns and treatment can end, with perhaps sporadic tune-up sessions.
Neurofeedback can be an empowering form of treatment because patients can see a visual representation on the scans of the brain activity behind their dysfunctional or problematic behavior. Seeing the source of their issues in these brain scans allows patients to free themselves from self-blame and attempts to control their behavior, and instead puts their focus on learning new ways to process information, which is at the root of their behavior.
We’ve discussed how survivors of childhood trauma face unique challenges because their traumas often interfered with their ability to establish psychological building blocks like healthy inner maps and a sense of being loved and wanted; as a result, healing isn’t just a matter of working through the scars of their trauma but also rewiring their instincts and brain functions. Medications and traditional talk therapy are inadequate to restore these basic brain functions after the early years of brain development have passed, so more research is needed to see if neurofeedback can achieve that.
Theater targets many of the things trauma survivors struggle with most, making it a challenging and effective form of therapy.
First, it gives patients a chance to escape from the ailments, circumstances, and feelings they face every day and embody a different character—someone strong, resilient, and confident. But in order to do that, they must work through many of the challenges that come with trauma, such as getting in touch with emotions, exploring conflicts between characters, and exposing vulnerability. These are some of the hardest things for trauma sufferers to do—because they’re inclined to suppress emotions and avoid conflicts—but are essential to acting.
Second, actors must be in full control of their bodies and their physical expressions. Even standing up straight and projecting their voices through the theater can be a major challenge to trauma sufferers, who typically try to be invisible. Feeling that you have full control and ownership of your body is key to having a sense of agency, a necessary aspect of healing for trauma survivors.
Third, being part of a theatrical production makes patients a valuable, contributing member of a community (in this case, the theater group), which helps them regain a sense of worth and competence. Competence is a powerful antidote to the helplessness that trauma instills.
Additionally, beyond simply being a part of the community, theater and music create a communal rhythm and synchronization. From religious hymns to protest chants, communal singing and movement give a sense of strength, hope, and a visceral feeling of being part of something bigger than yourself.
Being part of that community requires that you trust the other members of that community, and in yourself—both huge challenges to trauma survivors. Actors must trust in each other to perform convincing scenes, and must trust in themselves to commit to their character and lines, revealing their vulnerability in front of an audience.
Awareness of trauma and its effects is steadily increasing, as more research is published and more treatments become available. However, there is much room for change in the way our society addresses and prevents trauma.
Unemployment, poverty, struggling schools, inadequate housing, social isolation, and relatively easy access to firearms all create fertile grounds for trauma—and still, we see cuts to food stamps, opposition to universal healthcare and stricter gun laws, high rates of incarceration, and an overdependence on medications.
Schools are a natural place to make improvements in order to help address and prevent the next generation of trauma. The author recommends several changes that can help children who are exposed to trauma at home and in their communities.