Over the last two decades the number of people treated for depression has tripled. Ten-percent of the US population takes antidepressants—Medicaid alone spent $3.6 billion on antipsychotics in 2008. With the growing epidemic of opioid addiction ravaging communities throughout the country, those numbers are only moving in one direction. The amount of money we spend on self-medication is staggering.
Such drugs are predominantly band aids for lacerations in need of suturing. Part of the issue rests in our brain’s inherent penchant for dualism: the notion that an ethereal me resides in the bodily me—forget the body; treat the ether. Only our bodies do not work that way.
Boston-based psychiatrist Bessel van der Kolk is an expert of the effects of trauma. He didn’t set out to achieve this goal. Since he began clinical work in the seventies he noticed that the root causes of most ailments were not being addressed. Once a fan of pharmaceuticals, he’s watched that industry rely on quick fixes and growing profits.
Yet, as he writes in The Body Keeps the Score,
You can be fully in charge of your life only if you can acknowledge the reality of your body, in all its visceral dimensions.
We like to consider our species a thinking animal; it makes sense that we associate our brain with intelligence and rational decision-making. But that organ is part of our nervous system, in a constant feedback loop with our body. Bodily messages first reach our reptilian complex, the ‘emotional brain’ at the seat of our spinal cord. It takes longer for the messages to travel all the way to the crown.
A lot happens in those milliseconds. Consider what an emotion is: a feeling. We ‘sense’ something going on. The feeling becomes an emotion when we give it life through language. If we can’t find words for the feeling, we cannot communicate it to ourselves, much less anyone else.
Van der Kolk writes that this has been a problem in courts, for example. Victims of abuse cannot remember exact events. Their memory isn’t faulty; that’s just how our brains work. When our sympathetic nervous system is aroused adrenaline is secreted. The more adrenaline, the better you remember (as in, don’t touch that stovetop again). Yet this only works to a point. When an ‘inescapable shock’ occurs, such as a father raping his daughter, the memory system is overwhelmed and shuts down.
We often think of the ‘self’ as a unified construct. As van der Kolk writes, it is anything but. We are actually a series of selves vying for attention dependent upon the circumstances. Our brain is a complex interplay of competing regions. Under normal circumstances our rational and emotional memories work in conjunction. When experiencing trauma, the hippocampus, responsible for memories and spatial mapping, and the thalamus, which integrates the experience into our autobiographical self, shut down.
That’s the reason traumatic experiences are recalled in bits and pieces. That’s also why people who have suffered from, say, PTSD will become a different person when hearing fireworks. Certain smells, images, and sounds trigger them. Since the traumatic experience has not been integrated into their autobiographical system, their autonomic nervous system is overwhelmed. They have no language to describe it. Fight, flight, or freeze becomes their default mode.
Decades of clinical work with countless patients have taught van der Kolk that integration is the road to healing. He writes,
Working with trauma is as much about remembering how we survived as it is about what is broken.
Talk therapy, for example, often focuses on the experience itself. And many find solace in this; veterans bond over shared stories of dismemberment and torture. This is an important first step, being able to express what has been inexpressible. Remembering that you’ve survived that experience, and realizing that you’ve actually come out the other side stronger, is where healing begins.
This is critical information because trauma predominantly operates at the unconscious level. Van der Kolk realized that most every trauma patient exhibits abnormal activation of their insula, the brain region that “integrates and interprets the input from the internal organs.” The insula tells the amygdala, where the fight-flight-freeze mechanism is triggered, that something is wrong. The feeling has no recognizable origin, leaving the victim confused and uncertain.
Van der Kolk ends his wonderful book by surveying a range of treatments that help create a dialogue between the two selves: “the one that keeps track of the self across time and the one that registers the self in the present moment.” He continues,
Being traumatized is not just an issue of being stuck in the past; it is just as much a problem of not being fully alive in the present.
Which is why yoga is foremost among the remedies providing relief and self-understanding. The intense focus on one’s breathing, especially, for victims of anxiety and trauma, long exhalations that allow you to enter parasympathetic mode, creates a sense of wellbeing and trust. Chronic pain that is indicative of trauma sufferers is mitigated by the combination of stretching, breathing, and meditation.
Other therapeutic measures that van der Kolk champions include neurofeedback, eye movement desensitization and reprocessing (EMDR), internal family systems therapy (IFS), PBSP psychomotor therapy, and communal theater.
My career revolves around movement as a yoga and fitness instructor and educator. Van der Kolk’s book is one of the most important works on the body, and mind, I have read. Many of us have dealt with anxiety or trauma on numerous levels. Given the national dependence on pills and prescriptions, as well as avoidance of discussing these topics, we are not creating an environment for healing. As van der Kolk says, “fear destroys curiosity and playfulness.” If this fear is persistent in our society, our children will continue the vicious cycle of hiding what needs to be expressed. As he concludes near the end of his book,
Since 2001 far more Americans have died at the hands of their partners or other family members than in the wars in Iraq and Afghanistan. American women are twice as likely to suffer domestic violence as breast cancer. The American Academy of Pediatrics estimates that firearms kill twice as many children as cancer does. All around Boston I see signs advertising the Jimmy Fund, which fights children’s cancer, and for marches to fund research on breast cancer and leukemia, but we seem too embarrassed or discouraged to mount a massive effort to help children and adults learn to deal with the fear, rage, and collapse, the predictable consequences of having been traumatized.