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Freud had a term for such traumatic reenactments: "the compulsion to repeat." He and many of his followers believed that reenactments were an unconscious attempt to get control over a painful situation and that they eventually could lead to mastery and resolution.
Bessel van der Kolk -
Diagnostic reliability isn’t an abstract issue: If doctors can’t agree on what ails their patients, there is no way they can provide proper treatment. When there’s no relationship between diagnosis and cure, a mislabeled patient is bound to be a mistreated patient. You would not want to have your appendix removed when you are suffering from a kidney stone, and you would not want have somebody labeled as “oppositional” when, in fact, his behavior is rooted in an attempt to protect himself against real danger.
Bessel van der Kolk
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Some people’s lives seem to flow in a narrative; mine had many stops and starts. That’s what trauma does. It interrupts the plot. . . . It just happens, and then life goes on. No one prepares you for it.
Bessel van der Kolk -
It was already well known that intense emotions activate the limbic system, in particular an area within it called the amygdala. We depend on the amygdala to warn us of impending danger and to activate the body’s stress response.
Bessel van der Kolk -
It was early in my career, and I had been seeing Mary, a shy, lonely, and physically collapsed young woman, for about three months in weekly psychotherapy, dealing with the ravages of her terrible history of early abuse. One day I opened the door to my waiting room and saw her standing there provocatively, dressed in a miniskirt, her hair dyed flaming red, with a cup of coffee in one hand and a snarl on her face. “You must be Dr. van der Kolk,” she said. “My name is Jane, and I came to warn you not to believe any the lies that Mary has been telling you. Can I come in and tell you about her?” I was stunned but fortunately kept myself from confronting “Jane” and instead heard her out. Over the course of our session I met not only Jane but also a hurt little girl and an angry male adolescent. That was the beginning of a long and productive treatment.
Bessel van der Kolk -
A trauma can be successfully processed only if all those brain structures are kept online. In Stan’s case, eye movement desensitization and reprocessing (EMDR) allowed him to access his memories of the accident without being overwhelmed by them. When the brain areas whose absence is responsible for flashbacks can be kept online while remembering what has happened, people can integrate their traumatic memories as belonging to the past.
Bessel van der Kolk -
In the practice called free writing, you can use any object as your own personal Rorschach test for entering a stream of associations. Simply write the first thing that comes to your mind as you look at the object in front of you and then keep going without stopping, rereading, or crossing out.
Bessel van der Kolk -
The single most important issue for traumatized people is to find a sense of safety in their own bodies.
Bessel van der Kolk
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Trauma on body, mind, and soul: the crushing sensations in your chest that you may label as anxiety or depression; the fear of losing control; always being on alert for danger or rejection; the self-loathing.
Bessel van der Kolk -
That happens only when you feel safe at a visceral level and allow yourself to connect that sense of safety with memories of past helplessness.
Bessel van der Kolk -
How did his brain come to derive comfort from fishing rather than from compulsive sexual behavior? At this point we simply don’t know. Neurofeedback changes brain connectivity patterns; the mind follows by creating new patterns of engagement.
Bessel van der Kolk -
Our increasing use of drugs to treat these conditions doesn’t address the real issues: What are these patients trying to cope with? What are their internal or external resources? How do they calm themselves down? Do they have caring relationships with their bodies, and what do they do to cultivate a physical sense of power, vitality, and relaxation? Do they have dynamic interactions with other people? Who really knows them, loves them, and cares about them? Whom can they count on when they’re scared, when their babies are ill, or when they are sick themselves? Are they members of a community, and do they play vital roles in the lives of the people around them? What specific skills do they need to focus, pay attention, and make choices? Do they have a sense of purpose? What are they good at? How can we help them feel in charge of their lives?
Bessel van der Kolk -
After having been traumatized, people automatically keep repeating certain actions, emotions, and sensations related to the trauma.
Bessel van der Kolk -
Most seem to have made an unconscious decision that it is better to keep visiting doctors and treating ailments that don’t heal than to do the painful work of facing the demons of the past.
Bessel van der Kolk
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The most important predictor of how well his subjects coped with life’s inevitable disappointments was the level of security with their primary caregiver during the first two years of life. Resilience could be predicted by how lovable mothers rated their kids at age two.
Bessel van der Kolk -
We can assume that parents do the best they can, but all parents need help to nurture their kids. Nearly every industrialized nation, with the exception of the United States, recognizes this and provides some form of guaranteed support to families.
Bessel van der Kolk -
Anyone who has come into contact with extreme pain, suffering or death has no trouble understanding Greek drama.
Bessel van der Kolk -
Many treatment approaches for traumatic stress focus on desensitizing patients to their past, with the expectation that reexposure to their traumas will reduce emotional outbursts and flashbacks. I believe that this is based on a misunderstanding of what happens in traumatic stress. We must most of all help our patients to live fully and securely in the present. In order to do that, we need to help bring those brain structures that deserted them when they were overwhelmed by trauma back. Desensitization may make you less reactive, but if you cannot feel satisfaction in ordinary everyday things like taking a walk, cooking a meal, or playing with your kids, life will pass you by.
Bessel van der Kolk -
All of these brain regions are below the limbic system, to which emotions are traditionally assigned, yet we acknowledge their involvement every time we use one of the common expressions that link strong emotions with the body: “You make me sick”; “It made my skin crawl”; “I was all choked up”; “My heart sank”; “He made me bristle.”
Bessel van der Kolk -
Psychological problems occur when our internal signals don’t work, when our maps don’t lead us where we need to go, when we are too paralyzed to move.
Bessel van der Kolk
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Left my CBT therapist to work with a psychodynamic psychiatrist and I joined a Pilates class.
Bessel van der Kolk -
A protective part of him knows how to be competent at his job and how to get along with colleagues. But he may habitually erupt in rage at his girlfriend or become numb and frozen when the pleasure of surrendering to her touch makes him feel he is losing control.
Bessel van der Kolk -
Recent research has swept away the simple idea that “having” a particular gene produces a particular result. It turns out that many genes work together to influence a single outcome.
Bessel van der Kolk -
While you need to be able to stand up for yourself, you also need to recognize that other people have their own agendas. Trauma can make all that hazy and grey.
Bessel van der Kolk