the body keeps the score
-
hollandalı psikiyatrist bessel van der kolk'un kitabı.
henüz birinci bölümündeyim ancak söylemem gerekir ki şimdiden bayıldım.
şöyle muhteşem bir cümle var:
"one of the hardest things for traumatised people is to confront their shame about they way they behaved during the traumatic episode."
"travmaya uğramış insanlar için en zor şeylerden biri de, travmatik olay sırasındaki davranışlarına yönelik utançla yüzleşmektir." şeklinde çevirdim.
sanırım bu başlığa çok sık uğrayacağım. -
"the scans also revealed that during flashbacks, our subjects’ brain lit up only on the right side. today there’s a huge body of scientific and popular literature about the difference between the right and left brains. back in the early nineties ı had heard that some people had begun to divide the world between left-brainers (rational, logical people) and right-brainers (the intuitive, artistic ones), but ı hadn’t paid much attention to this idea. however, our scans clearly showed that images of past trauma activate the right hemisphere of the brain and deactivate the left.
we now know that the two halves of the brain do speak different languages. the right is intuitive, emotional, visual, spatial, and tactual, and the left is linguistic, sequential, and analytical. while the left half of the brain does all the talking, the right half of the brain carries the music of experience. ıt communicates through facial expressions and body language and by making the sounds of love and sorrow: by singing, swearing, crying, dancing, or mimicking. the right brain is the first to develop in the womb, and it carries the nonverbal communication between mothers and infants. we know the left hemisphere has come online when children start to understand language and learn how to speak. this enables them to name things, compare them, understand their interrelations, and begin to communicate their own unique, subjective experiences to others.
...
under ordinary circumstances the two sides of the brain work together more or less smoothly, even in people might be said to favour one side over the other. however, having one side or the other shut down, even temporarily, or having one side cut off entirely (as sometimes happened in early brain surgery) is disabling.
deactivation of the left hemisphere has a direct impact on the capacity to organize experience into logical sequences and to translate our shifting feeling and perceptions into words. (broca’s area, which black outs during flashbacks, is on the left side.) without sequencing we can’t identify cause and effect, grasp the long-term effects of our actions, or create coherent plans for the future. people who are very upset sometimes say they are “losing their minds.” ın technical terms they are experiencing the loss of executive functioning.
when something reminds traumatized people of the past, their right brain reacts as if the traumatic event were happening in the present. but because their left brain is not working very well, they may not be aware that they are reexperiencing and re-enacting the past -they are just furious, terrified, enraged, ashamed, or frozen. after the emotional storm passes, they may look for something or somebody to blame for it. they behaved the way they did way because you were ten minutes late, or because you burned the potatoes, or because you “never listen to me.” of course, most of us have done this from time to time, but when we cool down, we hopefully can admit our mistake. trauma interferes with this kind of awareness, and, over time, our research, demonstrated why."
türkçe çevirisini yaptım:
"incelemeler, ayrıca geçmişe dönüş sırasında deneklerimizin beyinlerinin sadece sağ taraflarında ışıma olduğunu ortaya çıkardı. günümüzde, sağ ve sol beyin arasındaki farklılıklar hakkında geniş bir bilimsel ve edebi yayın bolluğu vardır. 90’lı yılların başında bazı insanların dünyayı sol beynini kullananlar (akılcı, mantıklı insanlar) ve sağ beynini kullananlar (sezgisel, sanatçı olanlar) olarak ikiye böldüğünü duymuş, ama bu fikre fazla önem vermemiştim. bununla birlikte, incelemelerimiz net bir şekilde geçmiş travma görsellerinin sağ beyin yarım küresini aktif hale getirdiğini ve sol yarım küreyi inaktif hale getirdiğini açıkça gösterdi.
artık biliyoruz ki beynin iki yarım küresi farklı diller konuşmaktadır. sağ yarım küre sezgisel, duygusal, görsel, uzamsal ve dokunsal, ve sol yarım küre ise sözel, sıralı ve anatiliktir. beynin sol yarısı tüm konuşmayı yaparken beynin sağ yarısı deneyimlerin ezgisini taşır. aşkın ve üzüntünün sesini yaparak yüz ifadeleri ve beden dili ile iletişim kurar: söyleyerek, küfrederek, ağlayarak, dans ederek ya da taklit ederek. sağ beyin ilk rahimde gelişir ve annelerle bebekler arasındaki sözsüz iletişimi yürütür. sol yarım kürenin çocukların dili anlamaya ve konuşmayı öğrenmeye başladıklarında devreye girdiğini biliyoruz. bu, onların nesnelere isim vermesini, nesneleri karşılaştırmayı, aralarındaki karşılıklı ilişikiyi anlamasını ve diğerleriyle kendine özgü, benzersiz iletişim kurmaya başlamalarını sağlar.
...
insanlar arasında bir tarafın diğerine baskın olduğu söylense bile normal koşullarda beynin iki yarısı hemen hemen düzenli şekilde birlikte çalışır. bunun yanı sıra, geçici bir süre için de olsa, beynin bir yarısının devre dışı kalması ya da bir tarafın tamamen kesilerek çıkarılması (erken dönem beyin ameliyatlarında zaman zaman olmuştur) diğer insanların yapabildiği şeylerin yapılmasını zorlaştırır.
sol yarım kürenin inaktifleştirilmesi, deneyimleri mantıksal bir sıraya koymada ve değişen duygu ve algılarımızı kelimeler dökmede doğrudan etkiye sahiptir (sol tarafta bulunan broca bölgesi geçmişe dönüşlerde devre dışıdır.) sıralama olmadan biz sebebi ve sonucu* belirleyemez, eylemlerimizin uzun dönemdeki etkisini kavrayamaz ve geleceğe yönelik tutarlı planlar yapamayız. çok endişeli* insanlar kimi zaman “akıllarını kaybedeceklerini” söylerler. teknik terimlerle ifade edersek onlar işlevsel fonksiyon kaybı yaşamaktadırlar.
bir şey, travmatize insanlara geçmişi hatırlattığında, onların sağ beyinleri sanki travma şimdi gerçekleşiyormuş gibi tepki verir. ancak bu esnada sol beyinleri çok iyi çalışmadığı için, geçmişi yeniden deneyimlediklerinin ve yeniden canlandırdıklarının farkında olmayabilirler -onlar sadece o an öfkeli, dehşete düşmüş, utanmış ya da donup kalmışlardır. duygusal fırtına geçtikten sonra, onlar suçlayacak bir şey ya da birini ararlar. daha önce davrandıkları gibi davrandılar, çünkü siz 10 dakika geç kaldınız ya da siz patatesleri yaktınız ya da siz* “söylediklerime asla kulak vermedin.” elbette, çoğumuz bunu zaman zaman yapmışızdır, ama sakinleştiğimizde, umarız hatamızı kabul edebiliriz. travma ise bu tür bir farkındalığı önlemek için araya girer ve araştırmamız bunun nedenini ilerleyen zamanlarda gösterdi." -
"antipsychotic medications such as risperdal, abilify, or seroquel can significantly dampen the emotional brain and thus make patients less skittish or enraged, but they also may interfere with being able to appreciate subtle signals of pleasure, danger, or satisfaction. they also cause weight gain, increase the chance of developing diabetes, and make patients physically inert, which is likely to further increase their sense of alienation. these drugs are widely used to treat abused children who are inappropriately diagnosed with bipolar disorder or mood dysregulation disorder. more than half a million children and adolescents in america are now taking antipsychotic drugs, which may calm them down but also interfere with learning age-appropriate skills and developing friendships with other children. a columbia university study recently found that prescriptions of antipsychotic drugs for privately insured two- to five-year-olds had doubled between 2000 and 2007. only 40 percent of them had received a proper mental health assessment.
until it lost its patent, the pharmaceutical company johnson and johnson doled out lego blocks stamped with the word “risperdal” for the waiting rooms of child psychiatrists. children from low-income families are four times as likely as the private insured to receive antipsychotic medicines. ın one year alone texas medicaid spent $96 million on antipsychotic drugs for teenagers and children – including three unidentified infants who were given the drugs before their first birthdays. there have been no studies on the effects of psychotropic medications on the developing brain. dissociation, self-mutilation, fragmented memories, and amnesia generally do not respond to any of these medications."
“risperdal, abilify, ya da seroquel gibi antipsikotik ilaçlar duygusal beyni dikkat çekici ölçüde güçten düşürür ve bu da hastaların gerginliğini ve öfkesini azaltır, ama bu ilaçlar aynı zamanda zevk, tehlike ya da tatmine dair küçük ama önemli sinyallerin algılanmasını engelleyebilir. ayrıca kilo alımına sebep olarak diyabet oluşum ihtimalini artırır, ve hastaları fiziksel olarak uyuşuk hale getirir ki bu da yabancılaşma duygularını daha da artırır. bu ilaçlar bipolar bozukluk ya da duygudurum düzensizliği bozukluğu ile yanlış bir şekilde tanı konulmuş istismara uğramış çocukları tedavi etmede kullanılıyor. amerika’da* yarım milyondan fazla çocuk ve olgunlaşma çağındaki genç, onları sakinleştiren ama yaşlarına uygun yetenekleri öğrenmelerine ve diğer çocuklarla arkadaşlık kurmalarına engel olan antipsikotik ilaçlar kullanıyor. columbia üniversitesinde yapılan yakın tarihli bir araştırma, 2000 ila 2007 yılları arasında özel sigortadan yararlanan 2 ila 5 yaş arasında bulunan çocuklara antipsikotik ilaçların reçete edilmesinin iki katına çıktığını gösterdi. bunların sadece yüzde kırkı düzgün bir akıl sağlığı değerlendirmesine tabi tutuldu.
patentini kaybedene kadar*, ilaç şirketi johnson and johnson, çocuk psikiyatristlerinin bekleme odaları için üzerinde “risperdal” ibaresi olan lego setleri dağıttı. düşük gelirli ailelerin çocuklarına, özel sigortalılara nazaran dört kat daha fazla antipsikotik ilaçlar reçete ediliyor. sadece bir yıl içinde texas medicaid gençler ve çocuklarla için antipsikotik ilaçlara 96 milyon dolar harcadı -bunlar arasında daha bir yaşına gelmeden ilaç verilen 3 kimliği açıklanmayan bebek de bulunuyor. gelişmekte olan beyinde psikotropik ilaçların etkisi üzerine herhangi bir araştırma bulunmuyor. çözülme, kendine zarar verme, parçalanmış hafıza, ve amnezi bu tür ilaçların hiçbirine yanıt vermez.”
çevirisini kendim yaptım. -
“the greatest sources of our suffering are the lies we tell ourselves.”
hollandalı psikiyatrist bessel van der kolk'a ait kitap. -
geçmişinize göre okuması zorlaşan veya kolaylaşan kitap. travmanın trajik yanının bilemediğimiz kadar yaygın olması olduğunu düşününce, yalnızca geçmişte travma yaşamış kişiler için değil geçmişinde travma olduğunu düşündüğünüz yakınlarınızı anlamanız için de faydalı olacağını düşündüğüm kitap.
kitabı kindle'dan okuduğumdan ve altını çizemediğimden bu entry'yi altını çizmeye niyetlendiğim yerlere dönebilmek birde kitabı bitirmem için kendi kendime bir nevi accountability olarak kullanacağım.
trauma, whether it is the result of
something done to you or something you yourself have done, almost always
makes it difficult to engage in intimate relationships. after you have
experienced something so unspeakable, how do you learn to trust yourself or
anyone else again? or, conversely, how can you surrender to an intimate
relationship after you have been brutally violated?
they felt a renewed sense of the comradeship that had been so vital to their
war experience. they insisted that ı had to be part of their newfound unit and
gave me a marine captain’s uniform for my birthday. ın retrospect that
gesture revealed part of the problem: you were either in or out—you either
belonged to the unit or you were nobody. after trauma the world becomes
sharply divided between those who know and those who don’t. people who
have not shared the traumatic experience cannot be trusted, because they
can’t understand it. sadly, this often includes spouses, children, and coworkers.
semrad taught us that most human suffering is related to love and loss
and that the job of therapists is to help people “acknowledge, experience,
and bear” the reality of life—with all its pleasures and heartbreak. “the
greatest sources of our suffering are the lies we tell ourselves,” he’d say,
urging us to be honest with ourselves about every facet of our experience. he
often said that people can never get better without knowing what they know
and feeling what they feel.
the mere opportunity to escape does not
necessarily make traumatized animals, or people, take the road to freedom.
like maier and seligman’s dogs, many traumatized people simply give up.
rather than risk experimenting with new options they stay stuck in the fear
they know.
ı was riveted by maier’s account. what they had done to these poor dogs
was exactly what had happened to my traumatized human patients. they, too,
had been exposed to somebody (or something) who had inflicted terrible
harm on them—harm they had no way of escaping. ı made a rapid mental
review of the patients ı had treated. almost all had in some way been
trapped or immobilized, unable to take action to stave off the inevitable.
their fight/flight response had been thwarted, and the result was either
extreme agitation or collapse.
ıdeally our stress hormone system should provide a lightning-fast
response to threat, but then quickly return us to equilibrium. ın ptsd
patients, however, the stress hormone system fails at this balancing act.
fight/flight/freeze signals continue after the danger is over, and, as in the
case of the dogs, do not return to normal. ınstead, the continued secretion of
stress hormones is expressed as agitation and panic and, in the long term,
wreaks havoc with their health.
ı was
very moved when the veterans of patton’s army gave me a world war ıı
army-issue watch for christmas, but it was a sad memento of the year their
lives had effectively stopped: 1944. being traumatized means continuing to
organize your life as if the trauma were still going on—unchanged and
immutable—as every new encounter or event is contaminated by the past. after trauma the world is experienced with a different nervous system.
the survivor’s energy now becomes focused on suppressing inner chaos, at
the expense of spontaneous involvement in their lives. these attempts to
maintain control over unbearable physiological reactions can result in a
whole range of physical symptoms, including fibromyalgia, chronic fatigue,
and other autoimmune diseases. this explains why it is critical for trauma
treatment to engage the entire organism, body, mind, and brain.
ıf for some reason the normal response is blocked—for example, when
people are held down, trapped, or otherwise prevented from taking effective
action, be it in a war zone, a car accident, domestic violence, or a rape—the
brain keeps secreting stress chemicals, and the brain’s electrical circuits
continue to fire in vain.2
long after the actual event has passed, the brain may
keep sending signals to the body to escape a threat that no longer exists.
since at least 1889, when the french psychologist pierre janet published the
first scientific account of traumatic stress,3
it has been recognized that trauma
survivors are prone to “continue the action, or rather the (futile) attempt at
action, which began when the thing happened.” being able to move and do
something to protect oneself is a critical factor in determining whether or not
a horrible experience will leave long-lasting scars.
effectively dealing with stress depends upon achieving a balance
between the smoke detector and the watchtower. ıf you want to manage your
emotions better, your brain gives you two options: you can learn to regulate
them from the top down or from the bottom up.
knowing the difference between top down and bottom up regulation is
central for understanding and treating traumatic stress. top-down regulation
involves strengthening the capacity of the watchtower to monitor your body’s
sensations. mindfulness meditation and yoga can help with this. bottom-up
regulation involves recalibrating the autonomic nervous system, (which, as
we have seen, originates in the brain stem). we can access the ans through
breath, movement, or touch. breathing is one of the few body functions under
both conscious and autonomic control. ın part 5 of this book we’ll explore
specific techniques for increasing both top-down and bottom-up regulation.
when our emotional and rational brains are in conflict (as when we’re
enraged with someone we love, frightened by someone we depend on, or lust
after someone who is off limits), a tug-of-war ensues. this war is largely
played out in the theater of visceral experience—your gut, your heart, your
lungs—and will lead to both physical discomfort and psychological misery.
flashbacks and reliving are in some ways worse that the trauma itself. a
traumatic event has a beginning and an end—at some point it is over. but for
people with ptsd a flashback can occur at any time, whether they are awake
or asleep. there is no way of knowing when it’s going to occur again or how
long it will last. people who suffer from flashbacks often organize their lives
around trying to protect against them. they may compulsively go to the gym
to pump iron (but finding that they are never strong enough), numb themselves
with drugs, or try to cultivate an illusory sense of control in highly dangerous
situations (like motorcycle racing, bungee jumping, or working as an
ambulance driver). constantly fighting unseen dangers is exhausting and
leaves them fatigued, depressed, and weary.
ıf elements of the trauma are replayed again and again, the accompanying
stress hormones engrave those memories ever more deeply in the mind.
ordinary, day-to-day events become less and less compelling. not being able
to deeply take in what is going on around them makes it impossible to feel
fully alive. ıt becomes harder to feel the joys and aggravations of ordinary
life, harder to concentrate on the tasks at hand. not being fully alive in the
present keeps them more firmly imprisoned in the past.
triggered responses manifest in various ways. veterans may react to the
slightest cue—like hitting a bump in the road or a seeing a kid playing in the
street—as if they were in a war zone. they startle easily and become
enraged or numb. victims of childhood sexual abuse may anesthetize their
sexuality and then feel intensely ashamed if they become excited by
sensations or images that recall their molestation, even when those sensations
are the natural pleasures associated with particular body parts. ıf trauma
survivors are forced to discuss their experiences, one person’s blood
pressure may increase while another responds with the beginnings of a
migraine headache. still others may shut down emotionally and not feel any
obvious changes. however, in the lab we have no problem detecting their
racing hearts and the stress hormones churning through their bodies.
these reactions are irrational and largely outside people’s control.
ıntense and barely controllable urges and emotions make people feel crazy—
and makes them feel they don’t belong to the human race. feeling numb
during birthday parties for your kids or in response to the death of loved ones
makes people feel like monsters. as a result, shame becomes the dominant
emotion and hiding the truth the central preoccupation.
they are rarely in touch with the origins of their alienation. that is
where therapy comes in—is the beginning of bringing the emotions that were
generated by trauma being able to feel, the capacity to observe oneself
online. however, the bottom line is that the threat-perception system of the
brain has changed, and people’s physical reactions are dictated by the
imprint of the past.
the trauma that started “out there” is now played out on the battlefield of
their own bodies, usually without a conscious connection between what
happened back then and what is going on right now inside. the challenge is
not so much learning to accept the terrible things that have happened but
learning how to gain mastery over one’s internal sensations and emotions.
sensing, naming, and identifying what is going on inside is the first step to
recovery
the two white areas in the front of the brain (on top in the picture) are
the right and left dorsolateral prefrontal cortex. when those areas are
deactivated, people lose their sense of time and become trapped in the
moment, without a sense of past, present, or future.16
two brain systems are relevant for the mental processing of trauma:
those dealing with emotional intensity and context. emotional intensity is
defined by the smoke alarm, the amygdala, and its counterweight, the
watchtower, the medial prefrontal cortex. the context and meaning of an
experience are determined by the system that includes the dorsolateral
prefrontal cortex (dlpfc) and the hippocampus. the dlpfc is located to
the side in the front brain, while the mpfc is in the center. the structures
along the midline of the brain are devoted to your inner experience of
yourself, those on the side are more concerned with your relationship with
your surroundings.
the dlpfc tells us how our present experience relates to the past and
how it may affect the future—you can think of it as the timekeeper of the
brain. knowing that whatever is happening is finite and will sooner or later
come to an end makes most experiences tolerable. the opposite is also true
—situations become intolerable if they feel interminable. most of us know
from sad personal experience that terrible grief is typically accompanied by
the sense that this wretched state will last forever, and that we will never get
over our loss. trauma is the ultimate experience of “this will last forever.”
look again at the scan of stan’s flashback, and you can see two more white
holes in the lower half of the brain. these are his right and left thalamus—
blanked out during the flashback as they were during the original trauma. as
ı’ve said, the thalamus functions as a “cook”—a relay station that collects
sensations from the ears, eyes, and skin and integrates them into the soup that
is our autobiographical memory. breakdown of the thalamus explains why
trauma is primarily remembered not as a story, a narrative with a beginning
middle and end, but as isolated sensory imprints: images, sounds, and
physical sensations that are accompanied by intense emotions, usually terror
and helplessness.
people with ptsd have their floodgates wide open. lacking a filter,
they are on constant sensory overload. ın order to cope, they try to shut
themselves down and develop tunnel vision and hyperfocus. ıf they can’t shut
down naturally, they may enlist drugs or alcohol to block out the world. the
tragedy is that the price of closing down includes filtering out sources of
pleasure and joy, as well.
after seeing ute’s scan, ı started to take a very different approach
toward blanked-out patients. with nearly every part of their brains tuned out,
they obviously cannot think, feel deeply, remember, or make sense out of
what is going on. conventional talk therapy, in those circumstances, is
virtually useless.
she was utilizing a survival strategy her brain had learned in
childhood to cope with her mother’s harsh treatment. ute’s father died when
she was nine years old, and her mother subsequently was often nasty and
demeaning to her. at some point ute discovered that she could blank out her
mind when her mother yelled at her. thirty-five years later, when she was
trapped in her demolished car, ute’s brain automatically went into the same
survival mode—she made herself disappear.
the challenge for people like ute is to become alert and engaged, a
difficult but unavoidable task if they want to recapture their lives. this is where a bottom-up approach to therapy becomes essential. the aim is actually to change the
patient’s physiology, his or her relationship to bodily sensations.
numbing is the other side of the coin in ptsd. many untreated trauma
survivors start out like stan, with explosive flashbacks, then numb out later
in life. while reliving trauma is dramatic, frightening, and potentially selfdestructive, over time a lack of presence can be even more damaging.
the challenge of trauma treatment is not only dealing with the past but, even
more, enhancing the quality of day-to-day experience. one reason that
traumatic memories become dominant in ptsd is that it’s so difficult to feel
truly alive right now. when you can’t be fully here, you go to the places
where you did feel alive—even if those places are filled with horror and
misery
ıf an organism is stuck in survival mode, its energies are
focused on fighting off unseen enemies, which leaves no room for nurture,
care, and love. for us humans, it means that as long as the mind is defending
itself against invisible assaults, our closest bonds are threatened, along with
our ability to imagine, plan, play, learn, and pay attention to other people’s
needs.
of course we experience our most devastating emotions as gutwrenching feelings and heartbreak. as long as we register emotions
primarily in our heads, we can remain pretty much in control, but feeling as if
our chest is caving in or we’ve been punched in the gut is unbearable. we’ll
do anything to make these awful visceral sensations go away, whether it is
clinging desperately to another human being, rendering ourselves insensible
with drugs or alcohol, or taking a knife to the skin to replace overwhelming
emotions with definable sensations. how many mental health problems, from
drug addiction to self-injurious behavior, start as attempts to cope with the
unbearable physical pain of our emotions?
social support is not the same as merely being in the presence of others.
the critical issue is reciprocity: being truly heard and seen by the people
around us, feeling that we are held in someone else’s mind and heart. for our
physiology to calm down, heal, and grow we need a visceral feeling of
safety. no doctor can write a prescription for friendship and love: these are
complex and hard-earned capacities. you don’t need a history of trauma to
feel self-conscious and even panicked at a party with strangers—but trauma
can turn the whole world into a gathering of aliens.
many traumatized people find themselves chronically out of sync with
the people around them. some find comfort in groups where they can replay
their combat experiences, rape, or torture with others who have similar
backgrounds or experiences. focusing on a shared history of trauma and
victimization alleviates their searing sense of isolation, but usually at the
price of having to deny their individual differences: members can belong
only if they conform to the common code.
ısolating oneself into a narrowly defined victim group promotes a view
of others as irrelevant at best and dangerous at worst, which eventually only
leads to further alienation. gangs, extremist political parties, and religious
cults may provide solace, but they rarely foster the mental flexibility needed
to be fully open to what life has to offer and as such cannot liberate their
members from their traumas. well-functioning people are able to accept
individual differences and acknowledge the humanity of others.
ın the past two decades it has become widely recognized that when
adults or children are too skittish or shut down to derive comfort from human
beings, relationships with other mammals can help. dogs and horses and
even dolphins offer less complicated companionship while providing the
necessary sense of safety. dogs and horses, in particular, are now extensively
used to treat some groups of trauma patients. social support is not the same as merely being in the presence of others.
the critical issue is reciprocity: being truly heard and seen by the people
around us, feeling that we are held in someone else’s mind and heart. for our
physiology to calm down, heal, and grow we need a visceral feeling of
safety. no doctor can write a prescription for friendship and love: these are
complex and hard-earned capacities. you don’t need a history of trauma to
feel self-conscious and even panicked at a party with strangers—but trauma
can turn the whole world into a gathering of aliens.
many traumatized people find themselves chronically out of sync with
the people around them. some find comfort in groups where they can replay
their combat experiences, rape, or torture with others who have similar
backgrounds or experiences. focusing on a shared history of trauma and
victimization alleviates their searing sense of isolation, but usually at the
price of having to deny their individual differences: members can belong
only if they conform to the common code.
ısolating oneself into a narrowly defined victim group promotes a view
of others as irrelevant at best and dangerous at worst, which eventually only
leads to further alienation. gangs, extremist political parties, and religious
cults may provide solace, but they rarely foster the mental flexibility needed
to be fully open to what life has to offer and as such cannot liberate their
members from their traumas. well-functioning people are able to accept
individual differences and acknowledge the humanity of others.
ın the past two decades it has become widely recognized that when
adults or children are too skittish or shut down to derive comfort from human
beings, relationships with other mammals can help. dogs and horses and
even dolphins offer less complicated companionship while providing the
necessary sense of safety. dogs and horses, in particular, are now extensively
used to treat some groups of trauma patients.
porges’s theory provides an explanation: the autonomic nervous system
regulates three fundamental physiological states. the level of safety
determines which one of these is activated at any particular time. whenever
we feel threatened, we instinctively turn to the first level, social
engagement. we call out for help, support, and comfort from the people
around us. but if no one comes to our aid, or we’re in immediate danger, the
organism reverts to a more primitive way to survive: fight or flight. we fight
off our attacker, or we run to a safe place. however, if this fails—we can’t
get away, we’re held down or trapped—the organism tries to preserve itself
by shutting down and expending as little energy as possible. we are then in a
state of freeze or collapse
any threat to our safety or social connections triggers changes in the
areas innervated by the vvc. when something distressing happens, we
automatically signal our upset in our facial expressions and tone of voice,
changes meant to beckon others to come to our assistance.11 however, if no
one responds to our call for help, the threat increases, and the older limbic
brain jumps in. the sympathetic nervous system takes over, mobilizing
muscles, heart, and lungs for fight or flight.12 our voice becomes faster and
more strident and our heart starts pumping faster. ıf a dog is in the room, she
will stir and growl, because she can smell the activation of our sweat glands.
finally, if there’s no way out, and there’s nothing we can do to stave off
the inevitable, we will activate the ultimate emergency system: the dorsal
vagal complex (dvc). this system reaches down below the diaphragm to the
stomach, kidneys, and intestines and drastically reduces metabolism
throughout the body. heart rate plunges (we feel our heart “drop”), we can’t
breathe, and our gut stops working or empties (literally “scaring the shit out
of” us). this is the point at which we disengage, collapse, and freeze.
some gifted people who work with trauma survivors know how to do
this intuitively. steve gross used to run the play program at the trauma
center. steve often walked around the clinic with a brightly colored beach
ball, and when he saw angry or frozen kids in the waiting room, he would
flash them a big smile. the kids rarely responded. then, a little later, he
would return and “accidentally” drop his ball close to where a kid was
sitting. as steve leaned over to pick it up, he’d nudge it gently toward the
kid, who’d usually give a halfhearted push in return. gradually steve got a
back-and-forth going, and before long you’d see smiles on both faces.
from simple, rhythmically attuned movements, steve had created a
small, safe place where the social-engagement system could begin to
reemerge. ın the same way, severely traumatized people may get more out of
simply helping to arrange chairs before a meeting or joining others in tapping
out a musical rhythm on the chair seats than they would from sitting in those
same chairs and discussing the failures in their life.
recognizing an object in the palm of your hand requires
sensing its shape, weight, temperature, texture, and position. each of those
distinct sensory experiences is transmitted to a different part of the brain,
which then needs to integrate them into a single perception. mcfarlane found
that people with ptsd often have trouble putting the picture together.2
when our senses become muffled, we no longer feel fully alive. ın an
article called “what ıs an emotion?” (1884),3
william james, the father of
american psychology, reported a striking case of “sensory insensibility” in a
woman he interviewed: “ı have . . . no human sensations,” she told him. “[ı
am] surrounded by all that can render life happy and agreeable, still to me the
faculty of enjoyment and of feeling is wanting. . . . each of my senses, each
part of my proper self, is as it were separated from me and can no longer
afford me any feeling; this impossibility seems to depend upon a void which
ı feel in the front of my head, and to be due to the diminution of the sensibility
over the whole surface of my body, for it seems to me that ı never actually
reach the objects which ı touch. all this would be a small matter enough, but
for its frightful result, which is that of the impossibility of any other kind of
feeling and of any sort of enjoyment, although ı experience a need and desire
of them that render my life an incomprehensible torture.”
this response to trauma raises an important question: how can
traumatized people learn to integrate ordinary sensory experiences so that
they can live with the natural flow of feeling and feel secure and complete in
their bodies?
there could be only one explanation for such results: ın response to the
trauma itself, and in coping with the dread that persisted long afterward,
these patients had learned to shut down the brain areas that transmit the
visceral feelings and emotions that accompany and define terror. yet in
everyday life, those same brain areas are responsible for registering the
entire range of emotions and sensations that form the foundation of our selfawareness, our sense of who we are. what we witnessed here was a tragic
adaptation: ın an effort to shut off terrifying sensations, they also deadened
their capacity to feel fully alive.
the disappearance of medial prefrontal activation could explain why so
many traumatized people lose their sense of purpose and direction. ı used to
be surprised by how often my patients asked me for advice about the most
ordinary things, and then by how rarely they followed it. now ı understood
that their relationship with their own inner reality was impaired. how could
they make decisions, or put any plan into action, if they couldn’t define what
they wanted or, to be more precise, what the sensations in their bodies, the
basis of all emotions, were trying to tell them?
the lack of self-awareness in victims of chronic childhood trauma is
sometimes so profound that they cannot recognize themselves in a mirror.
brain scans show that this is not the result of mere inattention: the structures
in charge of self-recognition may be knocked out along with the structures
related to self-experience.
when ruth lanius showed me her study, a phrase from my classical high
school education came back to me. the mathematician archimedes, teaching
about the lever, is supposed to have said: “give me a place to stand and ı
will move the world.” or, as the great twentieth-century body therapist
moshe feldenkrais put it: “you can’t do what you want till you know what
you’re doing.” the implications are clear: to feel present you have to know
where you are and be aware of what is going on with you. ıf the self-sensing
system breaks down we need to find ways to reactivate it. -
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