Bessel van der Kolk Quotes
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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.
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The first time I heard Robert Anda present the results of the ACE study, he could not hold back his tears. In his career at the CDC he had previously worked in several major risk areas, including tobacco research and cardiovascular health. But when the ACE study data started to appear on his computer screen, he realized that they had stumbled upon the gravest and most costly public health issue in the United States: child abuse. He had calculated that its overall costs exceeded those of cancer or heart disease and that eradicating child abuse in America would reduce the overall rate of depression by more than half, alcoholism by two-thirds, and suicide, IV drug use, and domestic violence by three-quarters. 20 It would also have a dramatic effect on workplace performance and vastly decrease the need for incarceration.
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In 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.
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People who are very upset sometimes say they are “losing their minds.” In technical terms they are experiencing the loss of executive functioning.
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Since then, however, scientific methods have confirmed that changing the way one breathes can improve problems with anger, depression, and anxiety and that yoga can positively affect such wide-ranging medical problems as high blood pressure, elevated stress hormone secretion, asthma, and low-back pain.
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The great challenge is finding ways to reset their physiology, so that their survival mechanisms stop working against them.
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The natural state of mammals is to be somewhat on guard. However, in order to feel emotionally close to another human being, our defensive system must temporarily shut down. In order to play, mate, and nurture our young, the brain needs to turn off its natural vigilance . . . Many traumatized individuals are too hypervigilant to enjoy the ordinary pleasures that life has to offer, while others are too numb to absorb new experiences — or to be alert to signs of real danger . . . Many people feel safe as long as they can limit their social contact to superficial conversations, but actual physical contact can trigger intense reactions. However … achieving any sort of deep intimacy — a close embrace, sleeping with a mate, and sex — requires allowing oneself to experience immobilization without fear. It is especially challenging for traumatized people to discern when they are actually safe and to be able to activate their defenses when they are in danger. This requires having experiences that can restore the sense of physical safety.
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People have a range of capacities to deal with overwhelming experience. Some people, some kids particularly, are able to disappear into a fantasy world, to dissociate, to pretend like it isnt happening, and are able to go on with their lives. And sometimes it comes back to haunt them.
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The roots of resilience . . . are to be found in the sense of being understood by and existing in the mind and heart of a loving, attuned, and self-possessed other.
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Among schizophrenic body hallucinations, the sexual ones are by far the most frequent and the most important. All the raptures and joys of normal and abnormal sexual satisfaction are experienced by these patients, but even more frequently every obscene and disgusting practice which the most extravagant fantasy can conjure up. Male patients have their semen drawn off; painful erections are stimulated. The women patients are raped and injured in the most devilish ways. . . . In spite of the symbolic meaning of many such hallucinations, the majority of them correspond to real sensations. This made me wonder: Our patients had hallucinations—the doctors routinely asked about them and noted them as signs of how disturbed the patients were. But if the stories I’d heard in the wee hours were true, could it be that these “hallucinations” were in fact the fragmented memories of real experiences? Were hallucinations just the concoctions of sick brains? Could people make up physical sensations they had never experienced? Was there a clear line between creativity and pathological imagination? Between memory and imagination? These questions remain unanswered to this day, but research has shown that people who’ve been abused as children often feel sensations (such as abdominal pain) that have no obvious physical cause; they hear voices warning of danger or accusing them of heinous crimes.
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Most great instigators of social change have intimate personal knowledge of trauma. Oprah Winfrey comes to mind, as do Maya Angelou, Nelson Mandela, and Elie Wiesel. Read the life history of any visionary, and you will find insights and passions that came from having dealt with devastation.
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In patients with histories of incest, the proportion of RA cells that are ready to pounce is larger than normal. This makes the immune system oversensitive to threat, so that it is prone to mount a defense when none is needed, even when this means attacking the body’s own cells.
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In patients with histories of incest, the proportion of RA cells that are ready to pounce is larger than normal. This makes the immune system oversensitive to threat, so that it is prone to mount a defense when none is needed, even when this means attacking the body’s own cells. Our study showed that, on a deep level, the bodies of incest victims have trouble distinguishing between danger and safety. This means that the imprint of past trauma does not consist only of distorted perceptions of information coming from the outside; the organism itself also has a problem knowing how to feel safe.
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The internal system of an abuse victim differs from the non-abuse system with regard to the consistent absence of the effective leadership, the extreme rules under which the parts function, and the absenve of any consistent balance or harmony. Typically, the parts operate around outdated assumptions and beliefs derived from the childhood abuse, believing, for example, that it is still extremely dangerous to reveal secrets about childhood experiences which were endured.
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Children who don’t feel safe in infancy have trouble regulating their moods and emotional responses as they grow older. By kindergarten, many disorganized infants are either aggressive or spaced out and disengaged, and they go on to develop a range of psychiatric problems. They also show more physiological stress, as expressed in heart rate, heart rate variability, stress hormone responses, and lowered immune factors. Does this kind of biological dysregulation automatically reset to normal as a child matures or is moved to a safe environment? So far as we know, it does not.
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The challenge of recovery is to reestablish ownership of your body and your mind — of your self. This means feeling free to know what you know and to feel what you feel without becoming overwhelmed, enraged, ashamed, or collapsed. For most people this involves finding a way to become calm and focused, learning to maintain that calm in response to images, thoughts, sounds, or physical sensations that remind you of the past, finding a way to be fully alive in the present and engaged with the people around you, not having to keep secrets from yourself, including secrets about the ways that you have managed to survive.
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We become reactive and disorganized; our filters stop working—sounds and lights bother us, unwanted images from the past intrude on our minds, and we panic or fly into rages.
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If you have a comfortable connection with your inner sensations—if you can trust them to give you accurate information—you will feel in charge of your body, your feelings, and your self. However, traumatized people chronically feel unsafe inside their bodies: The past is alive in the form of gnawing interior discomfort. Their bodies are constantly bombarded by visceral warning signs, and, in an attempt to control these processes, they often become expert at ignoring their gut feelings and in numbing awareness of what is played out inside. They learn to hide from their selves.
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Trauma devastates the social-engagement system and interferes with cooperation, nurturing, and the ability to function as a productive member of the clan. In this book we have seen how many mental health problems, from drug addiction to self-injurious behavior, start off as attempts to cope with emotions that became unbearable because of a lack of adequate human contact and support.
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Therapy won’t work as long as people keep being pulled back into the past.
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Research has shown that depressed patients without prior histories of abuse or neglect tend to respond much better to antidepressants than patients with those backgrounds.
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My colleague Rachel Yehuda studied rates of PTSD in adult New Yorkers who had been assaulted or rapes. Those whose mothers were Holocaust survivors with PTSD had a significantly higher rate of developing serious psychological problems after these traumatic experiences. The most reasonable explanation is that their upbringing had left them with a vulnerable physiology, making it difficult for them to regain their equilibrium after being violated. Yehuda found a similar vulnerability in the children of pregnant women who were in the World Trade Center that fatal day in 2001. Similarly, the reactions of children to painful events are largely determined by how calm or stressed their parents are.
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The fundamental issue in resolving traumatic stress is to restore the proper balance between the rational and emotional brains, so that you can feel in charge of how you respond and how you conduct your life. When we’re triggered into states of hyper- or hypoarousal, we are pushed outside our “window of tolerance”—the range of optimal functioning.4 We become reactive and disorganized; our filters stop working—sounds and lights bother us, unwanted images from the past intrude on our minds, and we panic or fly into rages. If we’re shut down, we feel numb in body and mind; our thinking becomes sluggish and we have trouble getting out of our chairs.
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Frewen and his colleague Ruth Lanius found that the more people were out of touch with their feelings, the less activity they had in the self-sensing areas of the brain. Because traumatized people often have trouble sensing what is going on in their bodies, they lack a nuanced response to frustration. They either react to stress by becoming “spaced out” or with excessive anger. Whatever their response, they often can’t tell what is upsetting them. This failure to be in touch with their bodies contributes to their well-documented lack of self-protection and high rates of revictimization and also to their remarkable difficulties feeling pleasure, sensuality, and having a sense of meaning.