The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma

As human beings we belong to an extremely resilient species. Since time immemorial we have rebounded from our relentless wars, countless disasters (both natural and man-made), and the violence and betrayal in our own lives. But traumatic experiences do leave traces, whether on a large scale (on our histories and cultures) or close to home, on our families, with dark secrets being imperceptibly passed down through generations. They also leave traces on our minds and emotions, on our capacity for joy and intimacy, and even on our biology, including our genetics and immune systems. Trauma affects not only those who are directly exposed to it, but also those around them. For example, soldiers returning home from combat may frighten their families with their rages, violence, and emotional absence. The wives of men who suffer from posttraumatic stress disorder (PTSD) tend to become depressed, and the children of depressed mothers are at risk of growing up insecure and anxious. Having been exposed to family violence as a child often makes it difficult to establish stable, trusting relationships as an adult.

Trauma, by definition, is unbearable and intolerable. Most rape victims, combat soldiers, and children who have been beaten or molested become so upset when they think about what they have experienced that they try to push it out of their minds, trying to act as if nothing happened, and move on. It takes tremendous energy to keep functioning while carrying the memory of terror, and the shame of utter helplessness and vulnerability. While we all want to move beyond trauma, the part of our brain that is devoted to ensuring our survival (deep below our rational brain) is not very good at denial. Long after a traumatic experience is over, it may be reactivated by the slightest trigger and mobilize disturbed brain circuits and secrete massive amounts of stress hormones. This precipitates unpleasant emotions, intense physical sensations, and impulsive and aggressive actions. These posttraumatic reactions feel incomprehensible and overwhelming. Feeling out of control, survivors of trauma often begin to fear that they are damaged to the core and beyond redemption.

Psychiatrist Dr. van der Kolk is the founder and medical director of the Trauma Center in Brookline, Massachusetts, professor of psychiatry at Boston University School of Medicine, and director of the National Complex Trauma Treatment Network. During his psychiatry rotation in medical school, Dr. van der Kolk was amazed at how little psychiatrists knew about the origins of the problems they were treating. He asked himself “Would it be possible one day to know as much about brains, minds, and love as we do about the other systems that make up our organism?” He says we are still years from attaining that sort of detailed understanding, but the birth of three new branches of science has led to an explosion of knowledge about the effects of psychological trauma, abuse, and neglect. Those new disciplines are neuroscience, the study of how the brain supports mental processes; developmental psychopathology, the study of the impact of adverse experiences on the development of the mind and brain; and interpersonal neurobiology, the study of how our behaviour influences the emotions, biology, and mindsets of those around us. Research from these new disciplines has revealed that trauma produces actual physiological changes, including a recalibration of the brain’s alarm system, an increase in stress hormone activity, and alterations in the system that filters relevant information from irrelevant. We now know that trauma compromises the brain areas that communicate the physical, embodied feeling of being alive. These changes explain why traumatized individuals become hypervigilant to threat at the expense of spontaneously engaging in their day-to-day lives. They also help us understand why traumatized people so often keep repeating the same problems and have such trouble learning from experience. We now know that their behaviours are not the result of moral failings or signs of lack of willpower or bad character – they are caused by actual changes in the brain.

Dr. van der Kolk wrote this book to serve as both a guide and an invitation – an invitation to dedicate ourselves to facing the reality of trauma, to explore how best to treat it, and to commit ourselves, as a society, to use every means we have to prevent it.

The recent vast increase in our knowledge about the basic processes that underlie trauma has opened up new possibilities to palliate or even reverse the damage. We can now develop methods and experiences that utilize the brain’s own natural neuroplasticity to help trauma survivors feel fully alive in the present and move beyond trauma. There are fundamentally three avenues to healing: 1) top-down: by talking, reconnecting with others, and allowing ourselves to know and understand what is going on with us, while processing the memories of trauma; 2) by taking medications that shut down inappropriate alarm reactions, or by utilizing other technologies that change the way the brain organizes information; and 3) bottom-up: by allowing the body to have experiences that deeply and viscerally contradict the helplessness, rage, or collapse that result from trauma, and help us regain self-mastery. Which one of these is best for any particular survivor is an empirical question. Most people Dr. van der Kolk works with require a combination.

We do not really want to know the extent of trauma in our society. We want to think of families as safe havens in a heartless world and of our own country as populated by enlightened, civilized people. We prefer to believe that cruelty exists in faraway places. 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? In the case of abuse, there can be confusion about whether one was a victim or a willing participant, which in turn leads to bewilderment about the difference between love and fear; pain and pleasure. 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, friends, and co-workers. Trauma is not just an event that took place sometime in the past; it is also the imprint left by that experience on mind, brain, body, and soul. This imprint has ongoing consequences for how the human being manages to survive in the present moment. Trauma results in a fundamental reorganization of the way the mind and brain manage perceptions, and involves physical sensations and often unrecognized medical conditions. It changes how we think and what we think about, but also our very capacity to think. For healing to take place, the body and mind needs to learn that the danger has passed and it is safe to live fully in the reality of the present, expressed by our true Self.

Imagination is absolutely critical to the quality of our lives. Our imagination enables us to leave our routine everyday existence by fantasizing about travel, food, sex, and falling in love – all the things that make life interesting. Imagination gives us the opportunity to envision new possibilities – it is an essential launchpad for making our hopes and dreams come true. It lights up our creativity, relieves our boredom, alleviates our pain, enhances our pleasure, and enriches our most intimate relationships. When people are compulsively and constantly pulled back into the past from trauma to the last time they felt intense involvement and deep emotions, they suffer from a failure of imagination – a loss of mental flexibility. Without imagination there is no hope, no chance to envision a better future, no place to go, no goal to reach. The true Self cannot be expressed.

The way medicine approaches human suffering has always been determined by the technology available at the time. In the past, aberrations in behaviour were ascribed to God, sin, magic, witches, and evil spirits. Then a new paradigm began emerging: anger, lust, pride, greed, avarice, and sloth – as well as all the other problems we humans have always struggled to manage – were recast as “disorders” that could be fixed by the administration of appropriate chemicals – medications. A major textbook of psychiatry went so far as to state: “The cause of mental illness is now considered an aberration of the brain, a chemical imbalance.” Dr. van der Kolk refers to this as the brain-disease model.

Psychiatric medications gave doctors a false sense of efficacy and provided a tool beyond talk therapy. Drugs also produced enormous income and profits for doctors and pharmaceutical companies. The drug revolution that started out with so much promise actually causes more harm than good. The theory that mental illness is caused primarily by chemical imbalances in the brain that can be corrected by specific drugs has become broadly accepted, by media and the public, as well as by the medical profession. In many places drugs have displaced talk therapy and enabled patients to suppress their thoughts, emotions, physical sensations, and behaviours without addressing the underlying issues – to the detriment of patients and society. The brain-disease model takes control over people’s fate out of their own hands and puts doctors and insurance companies in charge of “fixing” their problems. Over the past three decades, psychiatric medications have become a mainstay in our culture, with dubious consequences. Consider the case of antidepressants. If they were indeed as effective as we have been led to believe, depression should by now be a minor issue in our society. Instead, even as antidepressant use continues to increase, it has not made a dent in hospital admissions for depression. The number of people treated for depression has tripled in the past two decades, and one in ten Americans now take antidepressants. Because drugs have become so profitable, major medical journals rarely publish studies on nondrug treatments for mental health problems. Practitioners who explore nondrug treatments are typically marginalized as “alternative”. Mainstream medicine is firmly committed and completely delusional in their assumption that we can achieve a better life through pharmaceuticals for mental health.

The brain-disease model overlooks four fundamental truths: (1) our capacity to destroy one another is matched by our capacity to heal one another. Restoring relationships and community is central to restoring well-being; (2) language gives us the power to change ourselves and others by communicating our experiences, helping us to define who we are, what we know, and finding a common sense of meaning; (3) we have the ability to regulate our own physiology, including some of the so-called involuntary functions of the body and the brain, through such basic activities as breathing, moving, and touching; and (4) we can change social conditions to create environments in which children and adults can feel safe and where they can thrive. When we ignore these quintessential dimensions of humanity, we deprive people of ways to heal from trauma and restore their autonomy. Being a patient supressed by psychiatric medications, rather than an active participant in one’s healing process, separates suffering people from their community and alienates them from an inner sense of Self.

In the early 1990s, novel brain-imaging techniques opened up undreamed-of capacities to gain a sophisticated understanding about the way the brain processes information. Gigantic multimillion-dollar machines based on advanced physics and computer technology rapidly made neuroscience into one of the most popular areas for research. Positron emission tomography (PET) and, later, functional magnetic resonance imaging (fMRI) enabled scientists and doctors to visualize how different parts of the brain are activated when people are engaged in certain tasks or when they remember events from the past. For the first time, we could watch the brain as it processed memories, sensations, and emotions, and begin to map the circuits of mind and consciousness. The earlier technology of measuring brain chemicals, like serotonin or norepinephrine, had enabled scientists to look at what fueled neural activity. Neuroimaging made it possible to see inside the brain. By doing so, it has transformed our understanding of trauma.

Our rational, cognitive brain, the neocortex, is actually the youngest part of the brain and occupies only about 30 percent of the area inside our skull. The rational brain is primarily concerned with the world outside us: understanding how things and people work, and figuring out how to accomplish our goals, manage our time, and sequence our actions. Beneath the rational brain lie two evolutionary older and to some degree separate brains, the reptilian brain (brainstem and cerebellum) and the limbic brain (hippocampus, amygdala, hypothalamus, and cingulate gyrus), which are in charge of everything else: the moment-by-moment registration and management of our body’s physiology and the identification of comfort, safety, threat, hunger, fatigue, desire, longing, excitement, pleasure, and pain. The brain is built from the bottom up. It develops level by level within every child in the womb, just as it did in the course of evolution. The most primitive part, the part that is already online when we are born, is the ancient animal brain, often called the reptilian brain. It is located just above the place where our spinal cord enters the skull. The reptilian brain is responsible for all the things that newborn babies can do: eat, sleep, wake, cry, breathe, and feel temperature, hunger, wetness, and pain; and rid the body of toxins by urinating and defecating. The brainstem and the hypothalamus (which sits directly above it) together control the energy levels of the body. They coordinate the functioning of the lungs and heart, and also the endocrine and immune systems, ensuring that these basic life-sustaining systems are maintained within the relatively stable internal balance, known as homeostasis.

Right above the reptilian brain is the limbic brain. It’s also known as the mammalian brain, because all animals that live in groups and nurture their young possess one. Development of this part of the brain truly takes off after a baby is born. It is the seat of the emotions, the monitor of danger, the judge of what is pleasurable or scary, the arbiter of what is or is not important for survival purposes. It is also a central command post for coping with the challenges of living within our complex social networks. The limbic brain is shaped in response to experience, in partnership with the infant’s own genetic makeup and inborn temperament. As all parents of more than one child quickly notice, babies differ from birth in the intensity and nature of their reactions to similar events. Whatever happens to a baby contributes to the emotional and perceptual map of the world that its developing brain creates. This is another way of describing neuroplasticity, the relatively recent discovery that neurons that “fire together, wire together”. When a circuit fires repeatedly, it can become a default setting – the response most likely to occur. If you feel safe and loved, your brain becomes specialized in exploration, play, and cooperation; if you are frightened and unwanted, it specializes in managing feelings of fear and abandonment.

The emotional brain, which is the reptilian brain combined with the limbic brain, initiates preprogrammed escape plans, like in fight or flight responses. These muscular and physiological reactions are automatically set in motion without any thoughtful planning on our part, leaving our conscious, rational capacities to catch up later, often well after the threat is over.

The top layer of the brain is the neocortex. In the second year of life, the frontal lobes, which make up the bulk of our neocortex, begin to develop at a rapid pace. Around age seven, life is organized around frontal lobe capacities: sitting still; keeping sphincters in check; being able to use words rather than acting out; understanding abstract and symbolic ideas; planning for tomorrow; and being in tune with parents, teachers, and classmates. The frontal lobes are responsible for the qualities that make us unique within the animal kingdom. They enable us to use language and abstract thought. They give us our ability to absorb and integrate vast amounts of information and attach meaning to it. Only human beings command the words and symbols necessary to create the communal, spiritual, and historical contexts that shape our lives. The frontal lobes allow us to plan and reflect, to imagine and play out future scenarios. They help us to predict what will happen if we take one action or neglect another. They make choice possible and underlie our astonishing creativity. The frontal lobes also allow us to consciously regulate our emotional brain.

Crucial for understanding trauma, the frontal lobes are also the seat of empathy – our ability to “feel into” someone else. Research shows that mirror neurons in the frontal lobes are responsible for empathy, imitation, synchrony, and the development of language when watching others. Our mirror neurons pick up on another’s movements, emotional state, and intentions. When people are in synch with each other, they tend to stand or sit in similar ways, and their voices take on similar rhythms. But our mirror neurons also make us vulnerable to others’ negativity, so that we respond to their anger with furry or are dragged down by their depression. Trauma almost invariably involves not being seen, not being mirrored, and not being taken into account because these mirror neurons are not active. Trauma treatment needs to reactivate the mirror neurons and therefore the capacity to safely mirror, and be mirrored, by others, but also to resist being hijacked by others’ negative emotions. Well-functioning frontal lobes are crucial for harmonious relationships with our fellow humans. As children, we learn to understand others’ motives, so we can adapt and stay safe in groups that have different perceptions, expectations, and values. Without flexible, active frontal lobes people become creatures of habit, and their relationships become superficial and routine. With trauma, invention, innovation, discovery, and wonder are lacking. When healthy, our frontal lobes can stop us from doing things that will embarrass us or hurt others; however, the more intense the visceral, sensory input from the emotional brain, the less capacity the frontal lobes of the rational brain has to put a damper on it.

Intense emotions activate the emotional brain, in particular, the amygdala. We depend on the amygdala to warn us of impending danger and to activate the body’s stress response. Activation of this fear center triggers the cascade of stress hormones and nerve impulses that drive up blood pressure, heart rate, and oxygen intake – preparing the body for fight or flight. Broca’s Area is one of the speech centers of the brain, which is often affected in stroke patients when the blood supply to that region is cut off. This area goes offline in flashbacks of trauma. Without a functioning Broca’s Area, you cannot put your thoughts and feelings into words. Even years later, traumatized people often have enormous difficulty telling other people what has happened to them. Their bodies reexperience terror, rage, and helplessness, as well as the impulse to fight or flee, but these feelings are almost impossible to articulate. Trauma by nature drives us to the edge of comprehension, cutting us off from language based an imaginable past. This doesn’t mean that people can’t talk about a tragedy that has befallen them. Sooner or later, most survivors come up with what many of them call their “cover story” that offers some explanation for their symptoms or behaviour for public consumption. These stories, however, rarely capture the inner truth of the experience. It is enormously difficult to organize one’s traumatic experiences into a coherent account – a narrative with a beginning, middle, and an end. When words fail, haunting images capture the experience and return as nightmares and flashbacks. In contrast to the deactivation of Broca’s Area, another region, Brodmann’s Area 19, lights up on a scan in trauma patients during flashbacks. This is a region in the visual cortex that registers images when they first enter the brain, so this is the brain rekindling trauma as if the trauma were actually occurring. These scans show that during flashbacks, 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 speak different languages. The right is intuitive, emotional, visual, spatial, and tactual, and the left is linguistic, sequential, and analytical. The left and right sides of the brain process the imprints of the past in dramatically different ways. The left brain remembers facts, statistics, and the vocabulary of events. We call on it to explain our experiences and put them in order and into words. The right brain stores memories of sight, sound, touch, taste, smell, and the emotions they evoke. It reacts automatically to voices, facial features, gestures, and places experienced in the past. What it recalls feels like intuitive truth – the way things are. Under ordinary circumstances the two sides of the brain work together more or less smoothly, even in people who might be said to favour one side over the other. However, having one side or the other shut down, even temporarily, is disabling. Deactivation of the left hemisphere due to trauma has a direct impact on the capacity to organize experience into logical sequences and to translate our shifting feelings and perceptions into words. 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”. In 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 reenacting the past – they are just furious, terrified, enraged, ashamed, or frozen. After the emotional storm passes, they may look for something or someone to blame for it. 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 due to a sustained sympathetic nervous system (stress) response.

The most important job of the brain is to ensure our survival, even under the most miserable conditions. Everything else is secondary. In order to do that, our brains need to: (1) generate internal signals that register what our bodies need, such as food, rest, protection, sex, and shelter; (2) create a map of the world to point us where to go to satisfy those needs; (3) generate the necessary energy and actions to get us there; (4) warn us of dangers and opportunities along the way; and (5) adjust our actions based on the requirements of the moment. All of these imperatives require coordination and collaboration with other people. 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 or we freak out, when our actions don’t correspond to our needs, or when our relationships break down.

When the brain’s alarm system is turned on, it automatically triggers preprogrammed physical escape plans in the emotional brain. The nerves and chemicals that make up our basic brain structure have a direct connection with our body. When the emotional brain takes over, it partially shuts down the rational brain, our conscious mind, and propels the body to run, hide, fight, or, on occasion, freeze via the sympathetic nervous system. If this response is effective and we escape the danger, we recover our internal equilibrium and gradually regain our senses. If for some reason the normal escape 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 stimulating the secretion of stress chemicals, and the brain’s electrical stress circuits continue to fire in vain. Long after the actual event has passed, the brain may keep sending signals to the body to escape a threat that no longer exists. 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.

Danger is a normal part of life, and the brain is in charge of detecting it and organizing our response. Sensory information about the outside world arrives through our eyes, nose, ears, tongue, and skin. These sensations converge in the thalamus, an area connected to the limbic brain. The thalamus combines all the input from our perceptions into a fully integrated, coherent experience of “this is what is happening to me”. The sensations are then passed on in two directions – down to the amygdala, two small almond-shaped structures that lie deeper in the unconscious limbic brain, and up to the frontal lobes, where they reach our conscious awareness. However, processing by the thalamus can break down, and when they do so, sights, sounds, smells, tastes, and touch, are encoded as isolated, dissociated fragments, and normal memory processing disintegrates. Time freezes, so that the present danger feels like it will last forever.

The central function of the amygdala is to identify whether an incoming input is relevant for our survival. It does so quickly and automatically, with the help of feedback from the hippocampus, a nearby structure that relates the new input to past experiences. If the amygdala senses a threat, it sends an instant message down to the hypothalamus and the brain stem, recruiting the sympathetic nervous system, which is part of the autonomic nervous system, to orchestrate a whole-body stress response. Because the amygdala processes the information it receives from the thalamus faster than the frontal lobes do, it decides whether incoming information is a threat to our survival even before we are consciously aware of the danger. By the time we realize what is happening, our body may already be on the move. The amygdala’s danger signals trigger the release of powerful stress hormones, including cortisol and adrenaline, which increase heart rate, blood pressure, and rate of breathing, preparing us to fight or run away. Once the danger has passed, the body returns to its normal state fairly quickly. But when recovery is blocked, the body is triggered to defend itself, which makes people feel agitated and aroused. Trauma increases the risk of the amygdala misinterpreting whether a particular situation is dangerous or safe. You can get along with other people only if you can accurately gauge whether their intentions are benign or dangerous. Even a slight misreading can lead to painful misunderstandings in relationships at home, school, or at work. Functioning effectively in a complex home, school, or work environment requires the ability to quickly assess how people are feeling and continuously adjust your behaviour accordingly. Misread or unread signals due to trauma lead to blowups or shutdowns in response to innocuous comments or facial expressions.

As long as you are not too upset, your frontal lobes can restore your balance by helping you realize that you are responding to a false alarm and abort the stress response consciously. Ordinarily, the executive capacities of the prefrontal cortex in the frontal lobes enable people to observe what is going on, predict what will happen if they take a certain action, and make a conscious choice. Being able to hover calmly and objectively over our thoughts, feelings, and emotions (ie – mindfulness) and then take our time to respond allows the executive brain to inhibit, organize, and modulate the hardwired automatic reactions preprogrammed into the emotional brain. This capacity is crucial for preserving our relationships with our fellow human beings. As long as our frontal lobes are working properly, we are less likely to lose our temper or shut down. When that system breaks down due to trauma, we become like conditioned animals: the moment we perceive danger, we automatically go into fight-flight-or-freeze mode via the unregulated stress response. In PTSD, the critical balance between the amygdala and frontal lobes shifts radically, which makes it harder to control emotions and impulses. Neuroimaging studies of human beings in highly emotional states reveal that intense fear, sadness, and anger all increase the activation of the emotional brain and significantly reduce the activity in the frontal lobes. When that happens, the inhibitory capacity of the frontal lobes break down and the emotional brain is in control without regulation. Traumatized people may then startle in response to any loud sound, become enraged by small frustrations, or freeze when someone touches them.

Effectively dealing with stress depends upon achieving a balance between the amygdala and the frontal lobes. If you want to manage your emotions better, your brain gives you two options: you can learn to regulate them from the top-down or 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 frontal lobes to regulate your emotions. Mindfulness meditation and yoga can help with this. Bottom-up regulation involves recalibrating the autonomic nervous system through breath, movement, or touch. Breathing is one of the few body functions under both conscious and autonomic control. Our self-experience is the product of the balance between our rational and emotional brains. Whenever the emotional brain decides that something is a matter of life or death, the pathways between the frontal lobes and the emotional brain become extremely tenuous. Emotions give shape and direction to the human experience, and their primary expression is through the muscles of the face and body. These facial and physical movements communicate our mental state and intentions to others: angry expressions and threatening postures caution them to back off; sadness attracts care and attention; and fear signals helplessness or alerts us to danger. We instinctively read the dynamics between other people simply from their tension or relaxation, their postures and tone of voice, and their changing facial and body expressions. Emotions propel us into action. This invites us to focus on emotions and movements, not only as problems to be managed in therapy, but also as assets that need to be organized to enhance one’s sense of purpose.

The Polyvagal Theory, developed by psychologist and neuroscientist Dr. Stephen Porges, provides us with a more sophisticated understanding of the biology of safety and danger – one based on the subtle interplay between the visceral experiences of our own bodies, and the voices and faces of the people around us. It explains why a kind face or a soothing tone of voice can dramatically alter the way we feel. It clarifies why knowing that we are seen and heard by the important people in our lives can make us feel calm and safe, and why being ignored or dismissed can precipitate rage reactions or mental collapse. It helps us understand why focused attunement with another person can shift us out of disorganized and fearful states. It also suggests new approaches to healing that focus on strengthening the body’s system for regulating arousal. Human beings are astoundingly attuned to subtle emotional shifts in the people around them. Slight changes in the tension of the brow, wrinkles around the eyes, curvature of the lips, and angle of the neck quickly signal to us how comfortable, suspicious, relaxed, or frightened someone is. Our mirror neurons register their inner experience, and our own bodies make internal adjustments to whatever we notice. When the message we receive from another person is “you’re safe with me”, we relax. If we’re fortunate in our relationships, we also feel nourished, supported, and restored as we look into the face and eyes of the other.

Our brains are built to help us function as members of a tribe. Most of our energy is devoted to connecting with others. If we look beyond the list of specific symptoms that entail a formal psychiatric diagnoses, we find that almost all mental suffering involves either trouble in creating workable and satisfying relationships or difficulties in regulating arousal (as in the case of habitually becoming enraged, shut down, overexcited, or disorganized). Usually, it’s a combination of both. The standard medical focus on trying to discover the right drug to treat a particular “disorder” tends to distract us from grappling with how our problems interfere with our functioning as members of our tribe.

To be benevolent rather than malevolent is a true feature of our species. Being able to feel safe with other people is the single most important aspect of mental health; safe connections are fundamental to meaningful and satisfying lives. Numerous studies of disaster responses around the globe have shown that social support is the most powerful protection against becoming overwhelmed by stress and trauma. 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 heart and mind. For our physiology to calm down, heal, and grow we need a visceral feeling of safety. 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 abuse 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. Isolating oneself into a narrowly defined victim group often leads to viewing others outside of that group as irrelevant at best and dangerous at worst, which eventually leads to further alienation. Gangs, extremist political parties, and religious groups 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.

After trauma, the world is experienced with a different nervous system that has an altered perception of risk and safety. Dr. Porges coined the word “neuroception” to describe the capacity to evaluate relative danger and safety in one’s environment. When we try to help people with faulty neuroception, the challenge is finding ways to reset their physiology, so that their survival mechanisms stop working against them. This means helping them to respond appropriately to danger, but, even more, to recover the capacity to experience safety, relaxation, and true reciprocity. The Polyvagal Theory shows how the autonomic nervous system regulates three fundamental states: (1) ventral vagal (social-engagement / safety); (2) sympathetic (fight-or-flight); and dorsal vagal (immobilization / collapse). The level of safety determines which one of these is activated at any particular time. Whenever we feel threated, we instinctively turn to the first level, social-engagement. We callout for help, support, and comfort from the people around us. But if no one comes to our aid, or we’re in immediate danger, we revert 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 – we try to preserve ourself by shutting down and expending as little energy as possible. We are then frozen in a state of immobilization or collapse.

The social-engagement system depends on nerves that have their origin in the brainstem regulatory centers, primarily the vagus nerve – also known as the tenth cranial nerve – together with adjoining nerves that activate the muscles of the face, throat, middle ear, and larynx. When the ventral vagal complex (VVC) runs the show, we smile when others smile at us, we nod our heads when we agree, and we frown when others tell us their misfortunes. When the VVC is engaged, it also sends signals down to our heart and lungs, slowing down our heart rate and increasing the depth of breathing. As a result, we feel calm and relaxed, centered, or pleasurably aroused. The vagus nerve also registers heartbreak and gut-wrenching feelings. When a person becomes upset, the throat gets dry, the voice becomes tense, the heart speeds up, and respiration becomes rapid and shallow. 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 being upset in our facial expressions and tone of voice – changes meant to beckon others to come to our assistance. However, if no one responds to our call for help, the threat increases, and the emotional brain jumps in and the sympathetic nervous system takes over, mobilizing muscles, heart, and lungs for fight or flight. Our voice becomes faster and more stringent and our heart starts pumping faster. Finally, if there is 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 can’t breathe, and our gut stops working or even empties. This is the point at which we disengage, collapse, and freeze. Once this system takes over, other people, and ourselves, cease to matter. Awareness is shut down, and we may no longer even register physical pain. A different level of brain activity is involved for each response: the mammalian fight-or-flight system, which is protective and keeps us from shutting down, and the reptilian brain, which produces the collapse response.

In Dr. Porges’s grand theory, the VVC evolved in mammals to support an increasingly complex social life. All mammals, including human beings, band together to mate, nurture their young, defend against common enemies, and coordinate hunting and food acquisition. The more efficiently the VVC synchronizes the activity of the sympathetic and parasympathetic nervous systems, the better the physiology of each individual will be attuned to that of the other members of the tribe. Thinking of the VVC in this way illuminates how parents naturally help their kids to regulate themselves if they are regulated as parents. Being in tune with other members of our species via the VVC and our mirror neurons is enormously rewarding as it fosters a deep sense of pleasure and connection. We can speak of trauma when that system fails. Immobilization is at the root of most trauma. Many traumatized individuals are too hypervigilant to enjoy the ordinary pleasures that life has to offer, while others are too numb too to absorb new experiences – or to be alert to signs of real danger. 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 defense when they are actually in danger. Healing this requires having experiences that can restore the sense of physical safety. To do so, we must create a safe space where the social-engagement system can begin to reemerge. Sadly, our education system, as well as many of the methods that profess to treat trauma, tend to bypass this emotionally based social-engagement system and focus instead on recruiting the cognitive capacities of the mind. When children are oppositional, defensive, numbed out, or enraged, it’s important to recognize that such “bad behaviour” may just be repeating action patterns that were established to survive serious threats. Despite the well-documented effects of anger, fear, and anxiety on the ability to reason, many programs continue to ignore the need to engage the safety system of the brain before trying to promote new ways of thinking.

The Polyvagal Theory enabled Dr. van der Kolk to become more conscious of combining top-down approaches to activate the social-engagement system and bottom-up methods to calm the physical tensions in the body. He became more open to the value of other age-old, nonpharmaceutical approaches to healing that have long been practiced outside Western medicine, ranging from breath exercises (pranayama) and chanting to martial arts, like qigong and tai chi, to drumming, group singing, and dancing. All rely on interpersonal rhythms, visceral awareness, and vocal and facial communication, which help shift people out of fight/flight states, reorganize their perception of danger, and increase their capacity to manage relationships.

We are on the verge of becoming a trauma-conscious society. Advances in neuroscience have given us a better understanding of how trauma changes brain development, self-regulation, and the capacity to stay focused and in tune with others. Sophisticated imaging techniques have identified the origins of PTSD in the brain, so that we now understand why traumatized people become disengaged, why they are bothered by sounds and lights, and why they may blow up or withdraw in response to the slightest provocation. Understanding many of the fundamental processes that underlie traumatic stress opens the door to an array of interventions that can bring the brain areas related to self-regulation, self-perception, and attention back online. We know not only know how to treat trauma but also, increasingly, how to prevent it. Trauma remains a much larger public health issue, arguably the greatest threat to our national well-being; however, 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 being traumatized. In today’s world, where you live, more than your genetics, determines whether you will lead a safe and healthy life. People’s income, family structure, housing, employment, and educational opportunities affect not only their risk of developing traumatic stress but also their access to effective help to address it. Poverty, unemployment, inferior schools, social isolation, widespread availability of guns, and substandard housing all are breeding grounds for trauma. Trauma breeds further trauma; hurt people hurt other people.

We now know that more than half the people who seek psychiatric care have been assaulted, abandoned, neglected, or raped as children, or have witnessed this in their families. As a psychiatrist, Dr. van der Kolk was surprised at how much effort was spent on trying to medicate their symptoms rather than trying to understand the possible causes of their despair and helplessness. He was also struck by how little attention was paid to their accomplishments and aspirations; whom they cared for, loved, or hated; what motivated and engaged them, what kept them stuck, and what made them feel peace – the ecology of their lives. Dr. van der Kolk wondered if the “hallucinations” many of his patients presented with were in fact the fragmented memories of real experiences.

Whether we remember a particular event at all, and how accurate our memories of it are, largely depends on how personally meaningful it was and how emotional we felt about it at the time. The key factor is our level of arousal. The mind works according to schemes or maps, and incidents that fall outside the established patterns are most likely to capture our attention. We remember insults and injuries the best: the adrenaline that we secrete to defend against potential threats helps to engrain those incidents in our minds. When something upsetting happens, we will retain an intense and largely accurate memory of the event for a long time. Confronted with intense horror – especially the horror of “inescapable shock” – this system becomes overwhelmed and breaks down. The problem with PTSD is dissociative fragmented memories, therefore the goal of treatment is association: integrating the cut-off elements of the trauma into the ongoing narrative of life, so that the brain can recognize that “that was then, this is now”. There have been hundreds of scientific publications spanning well over a century documenting how the memory of trauma can be repressed, only to resurface years or decades later. Traumatic memories are fundamentally different from the stories we tell about the past. They are dissociated: the different sensations that entered the brain at the time of the trauma are not properly assembled into a story. In order to understand trauma, we have to overcome our natural reluctance to confront the reality of trauma amongst us and cultivate the courage to listen to the testimonies of survivors when needed.

We cannot treat the event of trauma, but what we can treat are the imprints left by that traumatic event on the body, brain, mind, and soul. Trauma robs you of the feeling that you are in charge of yourself: self-leadership, which means feeling free to know what you know and feel what you feel without becoming overwhelmed, enraged, ashamed, or collapsed. For most people self-leadership involves: (1) finding a way to become calm and focused; (2) learning to maintain that calm in response to triggering images, thoughts, sounds, or physical sensations that remind you of the past; (3) finding a way to be fully alive in the present moment and engaged with the people around you; and (4) not having to keep secrets from yourself, including secrets about the ways that you have managed to survive in the past. These goals are not steps to be achieved, one by one, in some fixed sequence. They overlap, and some may be more difficult than others, depending on individual circumstances.

In order to regain control over yourself, you need to revisit the trauma: sooner or later you need to confront what has happened to you, but only after you feel safe and will not be retraumatized by it. The first order of business is to find ways to cope with feelings overwhelmed by the physical sensations and emotions associated with the past. Understanding why you feel a certain way does not change how you feel, but it can keep you from surrendering to intense reactions. However, the more traumatized we are, the more our rational brains take a backseat to our emotions.

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 are triggered into states of hyper- or hypoarousal, we are pushed outside our “window of tolerance” – the range of optimal functioning. We become reactive and disorganized, and our filters stop working. As long as people are either hyperaroused or shut down, they cannot learn from experience. Even if they manage to somewhat stay in control, they become so uptight that they are inflexible, stubborn, and depressed. Recovery from trauma involves the restoration of executive functioning and, with it, self-confidence and the capacity for playfulness and creativity. If we want to change posttraumatic reactions, we have to access the emotional brain and do “limbic system therapy”: repairing faulty alarm systems and restoring the emotional brain to its ordinary job of being a quiet background presence that takes care of the housekeeping of the body, ensuring that you eat, sleep, connect with intimate partners, protect your children, and defend against danger. The only way we can access the emotional brain is through self-awareness – by activating the medial prefrontal cortex, the part of the brain that notices what is going on inside us and thus allows us to feel what we’re feeling – in other words, interoception. Neuroscience research shows that the only way we can change the way we feel is by becoming aware of our inner experience and learning to befriend what is going on inside ourselves.

How well we get along with ourselves and others depends largely on our self-awareness and internal leadership skills – how well we listen to the different parts of ourselves, make sure they are taken care of, and keep them from sabotaging each other. Every major school of psychology recognizes that people have different subpersonalities. Therapists who are trained to see people as complex human beings with multiple characteristics and personalities can help them explore their system of inner parts and take care of the wounded facets of themselves. The cultivation of mindful self-leadership is the foundation for healing from trauma. Mindfulness not only makes it possible to survey our internal landscape with compassion and curiosity but can also actively steer us in the right direction for self-care. All systems – families, organizations, and nations – can operate effectively only if they have clearly defined and competent leadership. The internal family of subpersonalities is no different: all facets of ourselves need to be attended to. The internal leader must wisely distribute the available resources and supply a vision for the whole that takes all parts into account. The internal family of traumatized people lacks effective leadership. They have protective parts that attempt to control the emotions from trauma. This requires enormous amounts of energy to attempt to keep the system under control; however, is vulnerable to overwhelm. Each of these parts is an internal protector that attempts to maintain an important defensive position. In their desire to protect the injured parts, the protective parts unintentionally do harm. The protective parts operate around outdated assumptions and beliefs derived from trauma. Beneath the surface of the protective parts of trauma survivors there exists an undamaged essence – the soul – a Self that is confident, curious, fearless, and calm. Once the protective parts can trust that it is safe, the Self will spontaneously emerge, and the parts can be intuitively guided in a healing process. Rather than being a passive observer, the intuitive Self can help reorganize the inner system and communicate with the parts in ways that help those parts trust that there is someone inside who can handle things. Helpless passivity is replaced with determined Self-led intuitive action. People are then no longer locked in the past and a whole range of new possibilities open for them. Neuroscience research shows that this is not just a metaphor. Mindfulness increases activation of the medial prefrontal cortex involved in self-awareness and decreases activation of structures like the amygdala that trigger our emotional responses. This increases our control over our emotional brain and supports integration. Connecting with the Self helps all parts to function in harmony and balance.

Dr. van der Kolk finds the lack of psychiatric literature on how to actually help people heal disturbing, but his greatest teacher, a professor at Harvard, said “We have only one real textbook. Our patients. We should only trust what we can learn from them – and from our own experience.” This teacher also said: “The greatest sources of our suffering are the lies we tell ourselves.” He urges us to be honest with ourselves about every facet of our experience. Dr. van der Kolk found this was true for both his patients and himself. His teacher also taught him 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 – and to connect to their true Self. He often said that people can never get better without knowing who they are, what they are here for, what happened to them, and where they are at now, and truly feeling what they feel. You can only be fully in charge of your life if you can acknowledge the reality of your body, in all its visceral dimensions, as well as your mind and soul, in all its complexity.

The first systematic system to diagnose psychiatric problems is the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM). The foreword to the landmark 1980 DSM-III was appropriately modest and acknowledged that this diagnostic system was imprecise – so imprecise that is never should be used for forensic or insurance purposes. That modesty was tragically short-lived. The diagnoses in the DSM-V, published in 2013, describe surface phenomena that completely ignores the underlying causes. The DSM largely lacks what in the world of science is known as “reliability” – the ability to produce consistent, replicable results. In other words, it lacks scientific validity. 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. The sources of psychological suffering in the DSM-V were identified “as located within individuals” and overlooked the “undeniable social causation of many such problems”. It is simply a “symptom-based diagnosis” system that was readily opposed by many doctors who were motivated to find the root cause of disease and disorders. Humans are social animals, and mental problems involve not being able to get along with other people, not fitting in, not belonging, and in general not being able to get on the same wavelength. Everything about us – our brains, our minds, our bodies – is geared toward collaboration in social systems. This is our most powerful survival strategy, the key to our success as a species, and it is precisely this that breaks down in most forms of mental suffering. It is important not to ignore the foundations of our humanity: relationships and interactions that shape our minds, brains, and bodies and that give substance and meaning to our entire lives. To properly diagnose and treat mental illness, we must understand the process of development, the social determinants of health, and how all of these factors work together in an ongoing way over time.

The consequences of caretaker abuse and neglect are very common and complex, and underlie most psychiatric disorders, yet the decisions makers who determine the shape of our diagnostic system have so far decided not to recognize this evidence. To this day, after twenty years and four subsequent revisions, the DSM and the entire system based on it fail victims of child abuse and neglect – just as they ignored the plight of veterans before the PTSD diagnosis was introduced in 1980.

The DSM definition of PTSD is quite straightforward: a person is exposed to a horrendous event that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others, causing intense fear, helplessness, or horror, which results in a variety of manifestations: intrusive reexperiencing of the event (flashbacks, nightmares, feeling as if the event were still occurring), persistent and crippling avoidance (of people, places, thoughts, or feelings associated with the trauma, sometimes with amnesia of part of it), and increased arousal (insomnia, hypervigilance, aggression, or irritability). This description suggests a clear story line: a person is suddenly and unexpectedly devastated by an atrocious event and is never the same again. The trauma is over, but it keeps being replayed in continually recycling memories and in a reorganized nervous system. Even though this is not commonly screened for by most doctors, when a PTSD diagnosis is achieved, it can be treated quite effectively. In the case of troubled children with histories of abuse and neglect who show up in clinics, schools, hospitals, and police stations, the traumatic roots of their behaviours are less obvious, particularly because they rarely talk about having been hit, abandoned, or molested, even when asked. These kids obtain numerous psychiatric diagnoses over time, all ignoring the root of the problem. Before they reach their twenties, many patients have been given four, five, six, or more of these meaningless diagnostic labels. If they receive any treatment at all, they get whatever is being promoted as the latest method of management: medications, behavioural modification, and/or exposure therapy. These rarely work and often cause more damage. It became obvious to Dr. van der Kolk and his colleagues that they need a diagnosis that actually captures the reality of the person’s experience.

They discovered a consistent profile in their pediatric trauma patients: (1) a pervasive pattern of dysregulation; (2) problems with attention and concentration; and (3) difficulties getting along with themselves and others. These children’s moods and feelings rapidly shifted from one extreme to another – from temper tantrums and panic to detachment, flatness, and dissociation. When they got upset (which was often), they could neither calm themselves down nor describe what they were feeling. Having a biological system that keeps pumping out stress hormones to deal with real or imagined threats leads to physical problems: sleep disturbances, headaches, unexplained pain, oversensitivity to touch or sound. Being so agitated or shut down keeps them from being able to focus their attention and concentration. To relieve their tension, they engage in chronic masturbation, rocking, drugs, violence, or self-harming activities (biting, cutting, burning, and hitting themselves, pulling their hair out, picking at their skin until it bleeds). It also leads to difficulties with language processing and fine-motor coordination. Spending all their energy on trying to stay in control, they usually have trouble paying attention to things, like schoolwork, that are not directly related to survival, and their hyperarousal makes them easily distracted. Having been frequently ignored or abandoned leaves them clinging and needy, even with the people who have abused them. Having been beaten, molested, and otherwise mistreated, even if it was only a single time, they cannot help but define themselves as defective and worthless. They come by their self-loathing, sense of defectiveness, and worthlessness honestly. They cannot trust anyone. Finally, the combination of feeling fundamentally despicable and overreacting to slight frustrations makes it difficult for them to make friends. Dr. van der Kolk and his colleagues developed a diagnosis for this – Developmental Trauma Disorder – to capture the full range of what was experienced by these children, and offer a single diagnosis that would firmly locate the origin of their problems in a combination of trauma and compromised attachment.

For abused children, the whole world is filled with triggers. We are profoundly social creatures; our lives consist of finding our place within the community of human beings. As we grow up, we gradually learn to take care of ourselves, both physically and emotionally, but we get our first lessons in self-care from the way we are cared for. Mastering the skill of self-regulation depends to a large degree on how harmonious our early interactions with our caregivers are. Children whose caregivers are reliable sources of comfort and strength have a lifetime advantage. Children are programmed to choose one particular adult (or at most, a few) with whom their natural communication system develops. This creates a primary attachment bond. The more responsive the adult is to the child, the deeper the attachment and the more likely the child will develop healthy ways of responding to the people around them. Having a safe haven promotes self-reliance in the child, and instills a sense of sympathy and helpfulness to others in distress. From the intimate give-and-take of the attachment bond children learn that other people have feelings and thoughts that are both similar to and different from their own. In other words, they get “in sync” with their environment and with the people around them, and develop the self-awareness, empathy, impulse control, and self-motivation that make it possible to become contributing members of the larger social culture. These qualities are missing in traumatized children.

Children become attached to whoever functions as their primary caregiver. But the nature of that attachment – whether it is secure or insecure – makes a huge difference over the course of a child’s life. Secure attachment develops when caregiving includes emotional attunement. Attunement starts at the most subtle physical levels of interaction between babies and their caretakers, and it gives babies the feeling of being cared for and understood. Mirror neurons in the frontal lobes start functioning as soon as babies are born. Imitation is our most fundamental social skill. It assures that we automatically pick up and reflect the behaviour of our parents, teachers, and peers. Babies can’t regulate their own emotional states. Securely attached children learn from their parents what makes them feel good; they discover what makes them (and others) feel bad, and they acquire a sense of agency: that their actions can change how they feel and how others respond. Securely attached children learn the difference between situations they can control and situations where they need help. Securely attached children, when they grow up, their history of reliable responsive caregiving will help to keep fear and anxiety at bay. Barring exposure to some overwhelming life event – trauma – that breaks down the self-regulatory system, they will maintain a fundamental state of emotional security throughout their lives. Secure attachment also forms a template for children’s relationships. They pick up what others are feeling and early on learn to tell a game from reality, and they develop a good sense for phony situations and dangerous people. Securely attached children usually become pleasant playmates and have lots of self-affirming experiences with their peers. Having learned to be in tune with other people, they tend to notice subtle changes in voices and faces and to adjust their behaviour accordingly. They learn to live within a shared understanding of the world and are likely to become valued members of the community.

This upward spiral can, however, be reversed by abuse or neglect, or other trauma. Traumatized kids are often very sensitive to changes in voices and faces, but they tend to respond to them as threats rather than as cues for staying in sync. This is one reason why traumatized children so easily become defensive or scared. Children who overreact to their peers’ aggression, who don’t pick up on other kids’ needs, who easily shut down or lose control of their impulses, are likely to be shunned and left out of sleepovers and play dates. Eventually they may learn to cover up their fear by putting up a tough front. Or they may spend more and more time alone, watching TV or playing video games, falling even further behind on interpersonal skills and emotional regulation. Children with histories of abuse and neglect learn that their terror, pleading, and crying do not register with their caregivers. Nothing they can do or say stops the beating or brings attention and help. In effect, they’re being conditioned to give up when they face challenges later in life.

Children have a biological instinct to attach – they have no choice. Whether their parents or caregivers are loving and caring, or distant, insensitive, rejecting, or abusive, children will develop a coping style based on their attempt to get at least some of their needs met. Two coping mechanisms are “avoidant attachment” and “anxious attachment”. If a child is neglected, they may become avoidant to their feelings and withdraw. They are “dealing without feeling”. Other children who are neglected may make a scene to get attention. They are “feeling without dealing”. These are attempts to adapt to maintain the relationship in the face of neglect. Attachment patterns often persist into adulthood. Anxious children tend to grow into anxious adults and are more likely to be victims of bullying, while avoidant children are likely to become adults who are out of touch with their own feelings and those of others, and more likely to become bullies. However, development is not linear, and many life experiences can intervene to change these outcomes.

There is another group of children who have no one to turn to because their caregiver(s) are a source of survival but also the source of fear and violence. They can neither approach the secure strategy or shift their attention to the avoidant or anxious strategies. This is the case with abused children. Not knowing who is safe or whom they belong to, they may be intensely affectionate with strangers or may trust nobody. This pattern is called “disorganized attachment” – fear without solution. Kids from lower socioeconomic groups are more likely to be disorganized attached with caregivers who are severely stressed by economic and family instability, and are therefore more prone to violence. Children who don’t feel safe have trouble regulating their moods and emotional responses as they grow older, and are therefore more likely to repeat the vicious cycle of abuse. By kindergarten, many disorganized children 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 hormones responses, and lowered immune factors, and go on to develop a range of physical problems. Parents who are traumatized may be too emotionally unstable and inconsistent to offer much comfort and protection. Traumatized parents raised traumatized children. If you have no internal sense of security, it is difficult to distinguish between safety and danger. If you conclude that you must be a terrible person because your parents were violent with you, you start expecting other people to treat you horribly. You feel that you probably deserve it, and anyway, there is nothing you can do about it. When people carry self-perceptions like these, they are set up to be traumatized by subsequent experiences. While all parents need all the help they can get to raise secure children, traumatized caregivers need help to be attuned to their children’s needs at the most basic level. Traumatized caregivers often don’t realize that they are out of tune with their children and others. They often don’t realize that being violent with their children will traumatize them for life.

How is it that parents come to be violent with their kids? After all, raising healthy offspring is at the very core of our human sense of purpose and meaning. What could drive parents to deliberately hurt or neglect their children? One reason is that the parent sees the child, not as a partner in an attuned relationship, but as a frustrating, enraging, disconnected stranger that needs to be controlled because of their own fear of losing control of the situation. Parents who are scared of losing control of their children use violence and fear as a means to control them. This is trauma. This is child abuse. This is our cultural norm. This is intergenerational trauma, passed down in a vicious cycle of abuse. This is perpetuated ignorance and defiance of the law and the literature. Kids who are beaten as children, even out of strict discipline, even a single time, grow up with an unstable sense of self, self-damaging impulsivity (including excessive spending, promiscuous sex, substance abuse, reckless driving, self-harm, and binge eating), inappropriate and intense anger, violence towards others, and recurrent suicidal behaviour. Parents remain oblivious and governments remain complacent, and the cycle of abuse continues.

Highly conscious parents often become alarmed when they discover attachment research, worrying that their occasional impatience or their accidental lapses in attunement may permanently damage their kids. In real life, there are bound to be misunderstandings, inept responses, and failures of communication. Because mothers and fathers miss cues or are occasionally preoccupied with other matters, their kids are sometimes left to their own devices to discover how they can calm themselves down. Within limits, this is not a problem. Kids eventually need to learn to handle frustrations and disappointments. With “good enough” caregivers, children learn that broken connections can be repaired. The critical issue is whether they can incorporate a feeling of being viscerally safe with their caregivers. This is different than abuse. These are momentary disconnections by loving parents that do not use violence and fear to control their children. In this situation, children can learn and grow without trauma.

Intimate physical interactions between parents and their babies lay the groundwork for a baby’s sense of self – and, with that, a lifelong sense of identity. The way a parent holds their child underlies the ability to feel the body as the place where the psyche lives. This visceral and kinesthetic sensation of how our bodies are met lays the foundation for what we experience as real. But things can go seriously wrong when parents are unable to tune in to their baby’s physical reality. Having to discount their inner physical sensations and needs, and trying to adjust to its caregiver’s needs, means the child perceives that “something is wrong” with the way they are. Children who lack physical attunement are vulnerable to shutting down the direct feedback from their bodies – the seat of pleasure, purpose, and direction.

The need for attachment never lessens. Most human beings simply cannot tolerate being disengaged from others for any length of time. People who cannot connect through work, friendships, or family usually find other ways of bonding, such as through illnesses, lawsuits, or family feuds. Anything is preferable to that godforsaken sense of irrelevance and alienation. People will go to almost any length to feel seen and connected.

The phenomenon of “dissociation” is manifested in feeling lost, overwhelmed, abandoned, and disconnected from the world, and in seeing oneself as unloved, empty, helpless, trapped, and weighed down. There is a strong correlation between parental disengagement and misattunement in the first two years of life and dissociative symptoms in early adulthood. Children who live in secure relationships learn to communicate not only their frustrations and distress but also their emerging selves – their interests, preferences, and goals. Receiving a compassionate response cushions children (and adults) against extreme levels of frightened arousal. But if your caregiver ignores your needs, or resent your very existence, you learn to anticipate rejection and withdrawal. You cope as well as you can by blocking out your caregiver’s hostility or neglect, and act as if it doesn’t matter, but your body is likely to remain in a state of high alert and stress, prepared to ward off violence, deprivation, or abandonment. Dissociation means simultaneously knowing and not knowing. What cannot be communicated to the caregiver, cannot be communicated to the self. If you cannot tolerate what you know or feel what you feel, the only option is denial and dissociation. A devastating long-term effect of this shutdown is not feeling real inside. When you don’t feel real, nothing matters, which makes it impossible to protect yourself from danger. Or you may resort to extremes in an effort to feel something – even cutting yourself, doing drugs, or getting into fights with others. Lack of safety within the early caregiving relationship leads to an impaired sense of inner reality, excessive clinging, and self-damaging behaviour. For this reason, treatment needs to address not only the imprints of specific traumatic events but also the consequences of not having been mirrored, attuned to, and given consistent care and affection – the dissociation and loss of self-regulation.

Early attachment patterns create the inner maps that chart our relationships throughout life, not only in terms of what we expect from others, but also in terms of how much comfort and pleasure we can experience in their presence. Our relationship maps are implicit, etched into the emotional brain and not reversible simply by understanding how they were created. However, the realization of unhealthy attachment styles may help you to start exploring other ways to connect in relationships – both for your own sake and in order to not pass on an insecure attachment or abuse to your own children. You can choose to break the cycle. Being in sync with oneself and with others requires the integration of our body-based senses – vision, hearing, smell, touch, taste – and body-mind-soul balance. If this did not happen in infancy and early childhood, there is an increased chance of later sensory integration problems and disconnect with true Self.

As children, we start off at the center of our own universe, where we interpret everything that happens from an egocentric vantage point. Children have no choice but to organize themselves to survive within the families they have. Unlike adults, they have no other authorities to turn to for help – their parents are the authorities. Their survival hinges on their caregivers. Children sense – even if they are not explicitly threatened – that if they talked about their beatings or molestation to teachers or other adults, they would be punished at home. Instead, they focus their energy on not thinking about what has happened, and not feeling the residues of terror and panic in their bodies. Because they cannot tolerate knowing what they have experienced, they also cannot understand that their anger, terror, or collapse has anything to do with that experience. They don’t talk; they act and deal with their feelings by being enraged, shut down, compliant, or defiant. Children are also programmed to be fundamentally loyal to their caregivers, even if they are abused by them. Terror increases the need for attachment, even if the source of comfort is also the source of terror. Of course, clinging to one’s abuser is not exclusive to childhood. Learning to trust is a major challenge. Erasing awareness and cultivating denial are often essential to survival, but the price is that you lose track of who you are, of what you are feeling, and of what and whom you can trust.

Adults who were abused or neglected as children can still learn the beauty of intimacy and mutual trust, or have a deep spiritual experience that awakens them to a more expansive universe. In contrast, previously uncontaminated childhood maps can become so distorted by adult trauma that all roads are rerouted into terror and despair. These responses are not rational and therefore cannot be changed simply by reframing irrational beliefs. Our maps of the world are encoded in the emotional brain, and changing them means having to reorganize that part of the central nervous system. Nonetheless, learning to recognize irrational thoughts and behaviour can be a useful first step. Generally, the rational brain can override the emotional brain, as long as our fears don’t hijack us. But the moment we feel trapped, enraged, or rejected, we are vulnerable to activating old maps and to follow their directions. Only after learning to bear what is going on inside supported by safety, can we start to befriend, rather than obliterate, the emotions that keep our maps fixed and immutable.

Our gut feelings signal what is safe, life-sustaining, or threatening, even if we cannot quite explain why we feel a particular way. Our sensory interiority continuously sends us subtle messages about the needs of our organism. Gut feelings also help us to evaluate what is going on outside of us. 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 yourself. However, traumatized people chronically feel unsafe inside their bodies. 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. The more people try to push away and ignore internal warning signs, the more likely the warning signs are to take over and leave them bewildered, confused, and ashamed. People who cannot comfortably notice what is going on inside become vulnerable to respond to any sensory shift either by shutting down or by going into a panic – they develop a fear of fear itself. We now know that panic symptoms are maintained largely because the individual develops a fear of the bodily sensations associated with panic attacks. The attack may be triggered by something they know is irrational, but fear of the sensations keeps them escalating into a full-body emergency. The experience of fear derives from a primitive response to threat where escape is thwarted in some way. People’s lives will be held hostage to fear until that visceral experience changes. The price for ignoring or distorting the body’s messages is being unable to detect what is truly dangerous or harmful for you and, just as bad, what is safe or nourishing. Self-regulation depends on having a friendly relationship with your body. Without it you have to rely on external regulation – from medication, drugs, alcohol, constant reassurance, or compulsive compliance with the wishes of others. Stress commonly shows up in physical manifestations that try to demand our attention. Somatic symptoms for which no clear physical basis can be found are ubiquitous in traumatized children and adults. They can include chronic pain, fibromyalgia, migraines, digestive problems, irritable bowel syndrome, chronic fatigue, and some forms of asthma. Traumatized children have fifty times the rate of asthma as their non-traumatized peers. Studies have shown that many children and adults with fatal asthma attacks were not aware of having breathing problems before the attacks.

Many traumatized children and adults simply cannot describe what they are feeling because they cannot identify what their physical sensations mean. Psychiatrists called this phenomenon “alexithymia” – not having words for feelings. Not being able to discern what is going on inside their bodies causes them to be out of touch with their needs, and they have trouble taking care of themselves, whether it involves eating the right food at the right time or getting the sleep they need. Alexithymics substitute the language of action for that of emotion. They tend to register emotions as physical problems rather than as emotional signals that deserves their attention. Instead of feeling angry or sad, they experience muscle pain, bowel issues, or other symptoms for which no cause can be found. About three quarters of patients with anorexia nervosa, and more than half of all patients with bulimia, are bewildered by their emotional feelings and have great difficulty describing them. Suppressing their feelings makes it possible to attend to business in the outside world, but at a price. They learn to shut down their once overwhelming emotions, and, as a result, they no longer recognize what they were feeling. The more people are out of touch with their feelings, the less activity they have in the self-sensing areas of the brain, the medial prefrontal cortex. 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. One step further down on the ladder to self-oblivion is depersonalization – losing your sense of yourself – which is common during traumatic experiences. People with alexithymia can get better only by learning to recognize the relationship between their physical sensations and their emotions.

Trauma victims cannot recover until they become familiar with and befriend the sensations in their bodies. Being frightened means that you live in a body always on guard. Angry people live in angry bodies. The bodies of child-abuse victims are tense and defensive until they find a way to relax and feel safe. In order to change, these people need to become aware of their sensations and the way that their bodies interact with the world around them. Physical self-awareness in the present moment is the first step in releasing the trauma of the past. They need to first notice and describe the physical sensations in their bodies (not the emotions) – heat, muscular tension, tingling, caving in, feeling hallow, and so on. Then to work on identifying the sensations associated with relaxation and pleasure. They need to become aware of their breath, gestures, and movements. To pay attention to subtle shifts in their bodies, such as tightness in their chests and gnawing in their bellies, when they talk about negative events. Noticing sensations in the body for the first time can be quite distressing, and it may precipitate flashbacks in which people curl up or assume defensive postures. These are somatic reenactments of the unprocessed trauma and most likely represent the postures they assumed when the trauma occurred. Images and physical sensations may deluge patients at this point, and the therapist must be familiar with ways to stem torrents of sensation and emotion to prevent them from becoming retraumatized by accessing the past. Unfortunately, all too often, drugs are prescribed to suppress thoughts, emotions, and physical sensations instead of teaching people the skills to deal with such distressing reactions. Of course, medications only blunt sensations and do nothing to resolve them. The most natural way for human beings to calm themselves when they are upset is by clinging to another person. This means that patients who have been physically or sexually violated face a dilemma: they desperately crave touch while simultaneously are terrified of body contact. The mind needs to be re-educated to feel physical sensations, and the body needs to be helped to tolerate and enjoy the comforts of touch. Individuals who lack emotional awareness are able, with practice, to connect their physical sensations to psychological events. Then they can slowly reconnect with themselves.

Many traumatized people are unable to make eye contact. They feel disgusting and they can’t stand having others see how despicable they are. This is shame. In brain scans of such patients, the prefrontal cortex with mirror neurons that connects us to each other does not light up. Instead, there is intense activation in their primitive emotional brains which generates startle, hypervigilance, cowering, and other self-protective behaviours. There is no activation in any part of the brain that is involved in social engagement. In response to being looked at, they simply go into survival mode.

Some 80 percent of the fibres of the vagus nerve (which connects the brain with many internal organs) are afferent; that is, they run from the body into the brain. This means that we can directly train our arousal system by the way we breathe, chant, and move – a principle that has been utilized since time immemorial in places like China and India, and in all spiritual practices. Research shows that just ten weeks of yoga practice markedly reduced PTSD symptoms of patients who had failed to respond to any medication or other treatment. Neurofeedback can be particularly effective for children and adults who are so hyperaroused or shut down that they have trouble focusing and prioritizing. Learning how to breathe calmly and remaining in a state of relative physical relaxation, even while accessing painful and horrifying memories, is an essential tool for recovery. When you consciously take a few slow, deep breaths with long exhalations, you will notice the effects of the parasympathetic brake on your arousal. The more you focus on the breath and the benefits it brings to the body and mind, the more profound the relaxation effect. Since emotional regulation is the critical issue in managing the effects of trauma, it would make an enormous difference if those who worked with traumatized people in health care, schools, the workplace, and in families were thoroughly schooled in emotional regulation techniques. Mainstream Western psychiatric and psychological professionals have paid scant attention to self-management to the extreme detriment of their patients. In contrast to the effective Western reliance on drugs and verbal therapies, other traditions from around the world rely on mindfulness, movement, rhythms, and action. Yoga in India, tai chi and qigong in China, and rhythmical drumming throughout Africa are just a few examples. The cultures of Japan and Korea have martial arts, which focus on the cultivation of purposeful movement and being centered in the present – abilities that are damaged in traumatized individuals. Aikido, judo, tae kwon do, kendo, and jujitsu, as well as capoeira from Brazil, are examples. These techniques all involve physical movement, breathing, and meditation. Aside from yoga, few of these popular non-Western healing traditions have been systematically studied for the treatment of PTSD.

Scientific studies have confirmed what yogis have known for millennia: changing the way one breathes can improve problems with anger, depression, and anxiety, and that yoga can positively affect a wide range of medical problems, such as high blood pressure, elevated stress hormones, asthma, chronic pain, and PTSD. A major challenge in recovering from trauma remains being able to achieve a state of total relaxation and safe surrender. Yoga can help with this. One of the clearest lessons from contemporary neuroscience is that our sense of ourselves is anchored in a vital connection with our bodies. We do not truly know ourselves until we can feel and interpret our physical sensations; we need to register and act on these sensations to navigate safely through life. While numbing or sensation-seeking may make life tolerable, the price you pay is that you lose awareness of what is going on inside your body and, with that, the sense of being fully, sensually alive. Yoga is a terrific way to regain a relationship with the interior world and with it a caring, loving, sensual relationship to the Self. If you are not aware of what the body needs, you can’t take care of it. This is why cultivating sensory awareness is such a critical aspect of trauma recovery. Most traditional therapies downplay or ignore the moment-to-moment shifts in our inner sensory world. But these shifts carry the essence of the organism’s responses: the emotional states that are imprinted in the body’s chemical profile, in the viscera, in the contraction of the striated muscles of the face, throat, trunk, and limbs. Traumatized people need to learn that they can tolerate their sensations, befriend their inner experiences, and cultivate new action patterns. In yoga, you focus your attention on your breathing and on your sensations, moment to moment. You begin to notice the connection between your emotions and your body. You begin to experiment with changing the way you feel. Simply noticing what you feel fosters emotional regulation, and it helps you to stop trying to ignore what is going on inside you. Once you start approaching your body with love and curiosity rather than with fear and resistance, everything shifts. Being aware that all experience is transitory changes your perspective of yourself and what is possible. People who feel safe in their bodies can begin to translate the memories that previously overwhelmed them into language.

Discovering your Self in language is always an epiphany, even if finding the words to describe your inner reality is an agonizing process. Anyone who enters talk therapy, however, almost immediately confronts the limitations of language. Neuroscience research has shown that we possess two distinct forms of self-awareness: one that keeps track of the self across time and one that registers the self in the present moment. The first, our autobiographical self, creates connections among experiences and assembles them into a coherent story. This system is rooted in language. Our narratives change with the telling, as our perspective changes and as we incorporate new input. The second system, moment-to-moment self-awareness, is based primarily in physical sensations, but if we feel safe and are not rushed, we can find words to communicate that experience as well. These two ways of knowing are localized in different parts of the brain that are largely disconnected from each other. Only the system devoted to moment-to-moment self-awareness, which is based in the medial prefrontal cortex, can change the emotional brain. The first system creates a story for public consumption, and if we tell that story often enough, we are likely to start believing that it contains the whole truth. But the second system registers a different truth: how we experience the situation deep inside. It is this second system that needs to be accessed, befriended, and reconciled. Trauma stories lessen the isolation of trauma, and they provide an explanation for why people suffer the way they do. They allow doctors to make diagnoses, so that they can address problems like insomnia, rage, nightmares, or numbing. Stories can also provide people with a target to blame. Blaming is a universal human trait that helps people feel good while feeling bad. It is excruciatingly difficult to put the feeling of no longer being yourself into words. Language evolved primarily to share “things out there”, not to communicate our inner feelings, our interiority. We can get past the limitations of words by engaging the self-observing body-based self system, which speaks through sensations, tone of voice, and body tensions. Being able to perceive visceral sensations is the very foundation of emotional awareness. When you follow the interoceptive pathways to your innermost recesses – things begin to change.

There are other way to access your inner world of feelings. One of the most effective is through writing. Most of us have poured our hearts out in angry, accusatory, or sad letters after people have betrayed or abandoned us. Doing so almost always makes us feel better, even if we never send them. When you write to yourself, you don’t have to worry about other people’s judgement – you just listen to your own thoughts and let their flow take over. Later, when you reread what you wrote, you often discover surprising truths. With writing you can connect those self-observing and narrative parts of your brain without worrying about the reception you’ll get in the moment. The object of writing is to write to yourself, to let yourself know what you have been trying to avoid.

Neurofeedback training can improve creativity, athletic control, and inner awareness, even in people who already are highly accomplished, but it can also help with various mental illnesses. Sophisticated computerized electroencephalogram (EEG) analysis, known as quantitative EEG (qEEG), can trace brainwave activity millisecond by millisecond, and its software can convert that activity into a coloured map that shows which frequencies are highest or lowest in key areas of the brain. The qEEG can also show how well brain regions are working together. Patients find it helpful to visualize the patterns of localized electrical activity in their brains. They can see different brain areas that need to be trained to generate different frequencies and communication patterns. These explanations help them shift from self-blaming attempts to control their behaviour to learning to process information differently. It is very empowering to watch how you can change your brain activity by changing your mental and emotional states. Often patients have excessive activity in their amygdala in their right temporal lobe, the fear center of the brain, combined with low frontal lobe activity. This means that their hyperarousal emotional brains dominate their mental life. Research shows that calming the fear center decreases trauma-based problems and improves executive functioning. Alpha-theta training is a particularly fascinating neurofeedback procedure, because it can induce hypnogogic states – the essence of hypnotic trance. When theta brainwaves predominate in the brain, the mind’s focus is on the internal world, a world of free-floating imagery, like that induced during meditation. Alpha brainwaves may act as a bridge from the external world to the internal, and vice versa. In alpha-theta training these frequencies are alternately rewarded with therapeutic benefits.

The challenge in PTSD is to open the mind to new possibilities, so that the present is no longer interpreted as a continuous reliving of the past. Trance states, during which theta activity dominates, can help to loosen the conditioned connections between particular stimuli and responses, and allow for new associations to be created. Some patients report unusual visual imagery and/or deep insights into their life; others simply become more relaxed and less rigid. Any state in which people can safely experience images, feelings, and emotions that are associated with dread and helplessness is likely to create fresh potential and a wider perspective. About half of traumatized people develop substance abuse problems. Neurofeedback has been shown to resolve addiction as well as improve PTSD symptoms. Research shows that 20 sessions of neurofeedback results in 40 percent decrease in PTSD symptoms in patients with chronic histories of trauma who had not responded to talk or drug therapy. Most intriguing is the marked effect of neurofeedback on executive functioning – the capacity to plan activities, to anticipate the consequences of one’s actions, to move easily between one task and another, and to feel in control over one’s emotions, which is shown to have about a 60 percent increase in trauma patients. No other treatment has shown such marked improvement in executive functioning, which predicts how well a person will function in relationships, in school, and at work. Neurofeedback is also good for numerous other issues, including relieving tension headaches, improving cognitive functioning following a traumatic brain injury, reducing anxiety and panic attacks, learning to deepen meditation states, treating autism, improving seizure control, self-regulation of mood disorders, and more. The literature on neurofeedback lacks any negative study, suggesting that neurofeedback plays a major therapeutic role in many different areas. If any medication had demonstrated such a wide spectrum of efficacy it would be universally accepted and widely used.

Eye movement desensitization and reprocessing (EMDR) loosens up something in the mind and brain that gives people rapid access to associated memories and images from their past. It involves recalling a traumatic memory while simultaneously engaging in bilateral brain stimulation, such as moving the eyes back and forth following a therapist’s finger. This helps them put the traumatic experience into a larger context or perspective. With EMDR, people may heal from trauma without even talking about it. EMDR enables them to observe their experiences in a new way, without verbal give-and-take with another person. EMDR can help even if the patient and the therapist do not have a trusting relationship. This is important because trauma rarely leaves people with an open, trusting heart. EMDR actually integrates the traumatic material rather than desensitizes them to it.

Memories evolve and change. Immediately after a memory is laid down, it undergoes a lengthy process of integration and reinterpretation – a process that automatically happens in the mind and brain without any input from the conscious self. When the process is complete, the experience is integrated with other life events and stops having a life of its own. With PTSD patients, this process fails and the memory remains stuck – unprocessed and raw. Unfortunately, few psychologist and psychiatrists are taught during their training how the memory-processing system in the brain works. This omission can lead to misguided approaches to treatment, like drugging patients with medications for symptoms while ignoring the root causes. In contrast to phobias, posttraumatic stress is the result of a fundamental reorganization of the central nervous system based on having an experienced an actual threat of annihilation, which reorganizes self-experience as helpless and the interpretation of reality as the entire world being a dangerous place. A far as research knows, simply exposing someone to the old trauma does not integrate the memory into the overall context of their lives, and it rarely restores them to the level of joyful engagement with people and pursuits they had prior to the trauma. In contrast, EMDR, as well as internal family systems, yoga, neurofeedback, psychomotor therapy, and theatre, focuses not only on regulating the intense memories activated by trauma but also on restoring a sense of agency, engagement, and commitment through ownership of body and mind. The most remarkable feature of EMDR is its capacity to activate a series of unsought and seemingly unrelated sensations, emotions, images, and thoughts in conjunction with the original memory. This way of reassembling old information into new packages is the way we integrate ordinary, nontraumatic day-to-day experiences.

EMDR is related to rapid eye movement (REM) sleep – the phase of sleep in which dreaming occurs. Research shows that sleep and dreaming play a major role in mood regulation. The eyes move rapidly back and forth in REM sleep, just as they do in EMDR. Increasing our time in REM sleep reduces depression and mental illness, in general. PTSD is notoriously associated with disturbed sleep, and self-medication with drugs and alcohol further disrupts REM sleep. Today we know that both deep sleep and REM sleep play important roles in how memories change over time. The sleeping brain reshapes memory by increasing the imprint of emotionally relevant information while helping irrelevant memories fade away. Dreams keep replaying, recombining, and reintegrating pieces of old memories for months and even years. Dreams help to forge new relationships between apparently unrelated memories, allowing novel connections – the cardinal feature of creativity and emotional healing. Dreams constantly update the unconscious realities that determine what our waking minds pay attention to. The inability to recombine experience is one of the striking features of PTSD. Perhaps most relevant to EMDR, in REM sleep we activate more distant associations than in either non-REM sleep or the normal waking state.

Unlike conventional exposure treatment, EMDR spends very little time revisiting the original trauma. The trauma itself is certainly the starting point, but the focus in on stimulating and opening up the associative process. In contrast to patients who take psychiatric drugs – whose memories are merely blunted, not integrated, and still cause considerable anxiety – those who receive EMDR no longer experience the distinct imprints of the trauma: it simply becomes a story of a terrible event that happened long ago.

Theatre offers the opportunity to confront painful realities of life and symbolic transformation through communal action. Love and hate, aggression and surrender, loyalty and betrayal are the stuff of theatre and the stuff of trauma. As a culture we are trained to cut ourselves off from the truth of what we are feeling. Traumatized people are terrified to feel deeply. They are afraid to experience their emotions, because emotions lead to loss of control. In contrast, theatre is about embodying emotions, giving voice to them, becoming rhythmically engaged, taking on and embodying different roles. Theatre involves a collective confrontation with the realities of the human condition. Theatre gives trauma survivors a chance to connect with one another by deeply experiencing their common humanity. Traumatized people are afraid of conflict. They fear losing control and ending up on the losing side once again. Conflict is central to theatre – inner conflicts, interpersonal conflicts, family conflicts, social conflicts, and their consequences. Trauma is about trying to forget, hiding how scared, enraged, or helpless you are. Theatre is about finding ways of telling the truth and conveying deep truths to your audience. This requires pushing through blockages to discover your own truth, exploring and examining your own internal experience so that it can emerge in your voice and body on stage.

Art, music, and dance therapists do beautiful work with trauma patients who attest to the effectiveness of expressive therapies. However, at this point science knows very little about how they work or about the specific aspects of traumatic stress they address, and it would present an enormous logistical and financial challenge to do the research necessary to establish their value scientifically. The capacity of art, music, and dance to circumvent the speechlessness that comes with terror may be one reason they are used as trauma treatments in cultures around the world.

In order to become self-confident and capable adults, it helps enormously to have grown up with steady and predictable parents; parents who delighted in you, in your discoveries and explorations; parents who helped you organize your comings and goings; and who served as role models for self-care and getting along with other people. Defects in any of these areas are likely to manifest themselves later in life. It traps people in a matrix of fear, isolation, and scarcity where it is impossible to welcome the very experiences that might change their basic worldview. Psychomotor therapy harnesses the extraordinary power of the imagination to transform the inner narratives that drive and confine our functioning in the world. With the proper support, the secrets that once were too dangerous to be revealed can be disclosed to the therapist and eventually to the people who actually hurt and betrayed us. It also gives the person a chance to change the narrative and create a different outcome. Trauma causes people to remain stuck in interpreting the present in light of an unchanging past. Psychomotor therapy involves recreating a scene from past trauma that may or may not be precisely what happened, but it represents the structure of your inner world. The structures in psychomotor therapy hold the possibility of forming virtual memories that live side by side with the painful realities of the past and provide sensory experiences of feeling seen, cradled, and supported that can serve as antidotes to memories of hurt and betrayal. In order to change, people need to become viscerally familiar with realities that directly contradict the static feelings of the frozen or panicked self of trauma, replacing them with sensations rooted in safety, mastery, delight, and connection. The healing tableaus of psychomotor therapy offer an experience that many participants have never believed was possible for them: to be welcomed into a world where people delight in them, protect them, meet their needs, and make them feel at home.

With cognitive behavioural therapy (CBT), patients are gradually desensitized from their irrational fears by bringing to mind what they are most afraid of, using their narratives and images, or they are placed in actual (but safe) anxiety-provoking situations, or they are exposed to virtual-reality, computer-simulated scenes. The idea behind CBT is that when patients are repeatedly exposed to the stimulus without bad things happening, they gradually will become less upset; the bad memories will have become associated with “corrective” information of being safe. Exposure sometimes helps to deal with fear and anxiety, but it has not been proven to help with guilt or other complex emotions. Those who complete CBT usually have fewer PTSD symptoms, but they rarely recover completely: most continue to have substantial problems with their health, work, families, or mental well-being. A thorough analysis of all the scientific studies of CBT shows that it works about as well as being in a supportive therapeutic relationship. The poorest outcome in exposure treatments occur in patients who suffer from “mental defeat” – those who have given up. 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. Patients can benefit from reliving their trauma only if they are not overwhelmed by it.

Desensitization to our own or other people’s pain tends to lead to an overall blunting of emotional sensitivity. MDMA, also known as ecstasy or molly, is a synthetic drug with stimulant and mild psychedelic effects, and is known to increase concentrations of a number of important hormones, including oxytocin (the “love hormone”), vasopressin, cortisol, and prolactin. Most relevant for trauma treatment, it increases people’s awareness of themselves; they frequently report a heightened sense of compassionate energy, accompanied by curiosity, clarity, confidence, creativity, and connectedness. MDMA decreases fear, defensiveness, and numbing, as well as helps to access inner experiences. MDMA enables patients to stay within their window of tolerance so they can revisit their traumatic memories without suffering overwhelming physiological and emotional arousal. MDMA combined with psychotherapy has been shown to have profound effects on releasing trauma with lasting benefits. By being able to observe the trauma from a calm mindful state with MDMA, mind and brain are in a position to integrate the trauma into the overall fabric of life. This is very different from traditional desensitization techniques, like CBT, which are about blunting a person’s response to past horrors. MDMA is about association and integration – making a horrendous event that overwhelmed you in the past into a memory of something that happened long ago.

People have always used drugs to deal with traumatic stress. Each culture and each generation has its preference – alcohol, cannabis, cocaine, heroin, opioids, tranquilizers. When people are desperate, they will do just about anything to feel calmer and more in control. Mainstream psychiatry follows this tradition with antidepressants, antipsychotics, sedative hypnotics, and antianxiety drugs. However, most drugs cannot “cure” trauma; they can only dampen the expression of a disturbed physiology. And they do not teach the lasting lessons of self-regulation. They can help to control thoughts, feelings and behaviours, but always at a price – because they work by blocking the chemical systems that regulate engagement, motivation, pain, and pleasure, and interfere with trauma processing. Psychiatric medications often have serious side effects, like disrupting sleep, causing weight gain and headaches, increasing the chance for diabetes, and making patients physically inert, which increases their sense of alienation. These medications are often prescribed in absence of any other form of therapy and are often harmful to the patient. Psychedelics, like MDMA and psilocybin, are shown by extensive research to help patients overcome trauma, and integrate their thoughts, emotions, and physical sensations, with lasting benefits.

We all know what happens when we feel humiliated: we put all our energy into protecting ourselves, developing whatever survival strategies we can. We may repress our feelings; we may get furious and plot revenge; we may decide to become so powerful and successful that nobody can ever hurt us again. Many behaviours that are classified as psychiatric problems, including some obsessions, compulsions, and panic attacks, as well as most self-destructive behaviours, started out as strategies for self-protection. These adaptations to trauma can interfere with the capacity to function such that health care providers and patients themselves often believe that full recovery is beyond reach. Viewing these symptoms as permanent disabilities narrows the focus of treatment to finding the proper drug regimen, which can lead to lifelong dependence with harmful side effects. It is much more productive to see aggression or depression, arrogance or passivity as learned behaviours in response to trauma. Somewhere along the line, the patient came to believe that they could only survive if they were tough, invisible, or absent, or that it was safer to give up. Like traumatic memories that keep intruding until they are laid to rest, traumatic adaptations continue until the human organism feels safe and integrates all the parts of itself that are stuck in fighting or warding off the trauma. The act of survival comes at a price: the absence of a loving relationship with their own bodies, minds, and souls. Traumatized people must recruit their own strength, connect to their true Self, and love themselves enough to enable themselves to heal.

It is one thing to process memories and patterns of trauma, but it is an entirely different matter to confront the inner void – the energetic holes in the soul that result from not having been wanted, not having been seen, not having been loved, and not having been allowed to speak the truth. If your parents’ faces never lit up when they looked at you, it’s hard to know what it feels like to be loved and cherished. If you come from an incomprehensible world filled with secrecy and fear, it’s almost impossible to find the words to express what you have endured. If you grew up unwanted and ignored, it is a major challenge to develop a visceral sense of agency and self-worth. These create energetic gaps in our essence – our true Self – our soul that need to be acknowledge and healed with intention, attention, and self-love.

We are fundamentally social creatures – our brains our wired to foster working and playing together. Trauma devastates the social-engagement system and interferes with cooperation, nurturing, and the ability to function as a productive member of the tribe. In his book, Dr. van der Kolk shows us how many mental health problems, from drug addiction to self-injurious behaviour, start off as attempts to cope with emotions that became unbearable because of a lack of adequate human contact and support. Yet institutions that deal with traumatized children and adults all too often bypass the emotional-based social-engagement system that is the foundation of who we are and instead focus narrowly on correcting “faulty thinking” or “chemical imbalances”, and on suppressing unpleasant thoughts, emotions, and behaviours with medications that do more harm than good. People can learn to control and change their thoughts, emotions, and behaviours, but only if they feel safe enough to explore new solutions. The body keeps the score – so does the soul. If trauma is encoded in heartbreaking and gut-wrenching sensations, then our first priority is to help people move out of fight-or-flight states, reorganize their perception of danger, and manage relationships. Where traumatized children are concerned, the last things we should be cutting from school schedules are the activities that can do precisely that: chorus, physical education, recess, art, theatre, and anything else that involves movement, play, and other forms of joyful engagement.

Dr. van der Kolk admits that his own profession of psychiatry compounds rather than alleviates the problems of mental illness and trauma. Many psychiatrists today work in assembly-line offices where they see patients they hardly know for fifteen minutes and then dole out pills to relieve pain, anxiety, depression, or other symptoms. Their message seems to be “Leave it to us to fix you; just be compliant and take these drugs and come back in three months – but be sure not to use alcohol or illegal drugs to relieve your problems”. Such negligence in treatment makes it impossible to develop self-care, self-love, and self-leadership.

The increased use and abuse of psychiatric drugs to treat mental illnesses 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? Do they love themselves? Do they have a relationship with their soul? 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 and make good choices? Do they have a sense of purpose? What are they good at? How can we help them feel in charge of their lives? Once psychiatrists start asking themselves these questions, they can start helping their patients actually heal.

Once our society truly focuses on the needs of our children, all forms of social support for families – a policy that seems so controversial – will gradually come to seem not only desirable but also doable. What difference would it make if all children had access to high-quality day care where parents could safely leave their children as they went off to work or school? What would our school systems look like if all children could attend well-staffed schools that cultivated cooperation, self-regulation, perseverance, and concentration (as opposed to focusing on passing tests, which likely happen once children are allowed to follow their natural curiosity and desire to excel, and are not shut down by hopelessness, fear, or distracted by hyperarousal)? All children need a sense of confidence in themselves as well as a confidence that others will know, affirm, and cherish them. Without that we can’t develop a sense of agency that will enable us to assert: “This is who I am; this is what I believe in; this is what I stand for; this is what I will devote myself to.”

As long as we feel safely held in the hearts and minds of the people who love us, we will climb mountains and cross deserts, and dedicate ourselves to finishing projects. Children and adults will do anything for people they trust and whose opinion they value. But if we feel abandoned, worthless, or invisible, nothing seems to matter. Fear destroys curiosity and playfulness. In order to have a healthy society we must raise children who can safely play and learn, connect with each other and safe adults, and foster a sense of Self. There can be no growth without curiosity and no adaptability without being able to explore, through trial and error, who you are, what you are here for, and what matters to you. People who feel safe and meaningfully connected with themselves and with others, have little reason to squander their lives doing drugs or staring numbly at television; they don’t feel compelled to stuff themselves with carbohydrates or assault their fellow human beings. As research shows, child abuse and neglect is the single most preventable cause of mental illness, the single most common cause of preventable drug and alcohol abuse, and a significant contributor to leading causes of death, such as diabetes, heart disease, cancer, stroke, and suicide – all due to traumatic stress.

The greatest hope for traumatized children is to receive a good education in schools where they are seen and known, where they learn to regulate themselves, and where they can develop a sense of agency. At their best, schools can function as islands of safety in a chaotic world. They can teach children how their bodies and brains work, and how they can understand and deal with their emotions. Schools can play a significant role in instilling the resilience necessary to deal with the traumas of families and neighbourhoods. If parents are forced to work two jobs, or if they are violent, or too impaired, overwhelmed, or depressed to be attuned to the needs of their kids, schools, by default, have to be the places where children are taught self-leadership and an internal locus of control. It is standard practice in many schools to punish children for tantrums, spacing out, or aggressive outbursts – all of which are often symptoms of traumatic stress. When that happens, the school, instead of offering a safe haven, becomes yet another traumatic trigger. Angry confrontations and punishment can at best temporarily halt unacceptable behaviours, but since the underlying stress system is not laid to rest, they are certain to erupt again at the next provocation. In such situations, the first step is acknowledging that the child is upset; then the teacher should calm them down with emotional regulation techniques, then explore the cause and discuss possible solutions. Predictability and clarity of expectations are critical; consistency is essential. Children from chaotic backgrounds often have no idea how people can effectively work together, and inconsistency only promotes further confusion. Trauma-sensitive teachers soon realize that calling a parent about a misbehaving kid is likely to result in a beating at home and further traumatization. Dr. van der Kolk’s goal in all these efforts is to translate brain science into everyday practice, so that we, as a society, can raise healthy children in a safe world.

The cycle of violence and trauma in our society continues generation after generation. We see it in our governments with their choice of investing in war rather than poverty relief. We see it in our policing and judicial systems that use force and incarceration, rather than rescue and rehabilitation. We see it in our schools that use punishment rather than guidance. We see it in our families who continue to use violent discipline over loving kindness without consequences. This is fear at work in our society. We need to move from fear to love in all layers of society. This is possible by raising our awareness, and committing to healing and prevention. This requires an understanding of the evidence around trauma, the various methods available to us to overcome our traumas, and the systems that need to be adjusted to prevent further trauma. This requires individual choice and collective action. We can choose to do this together.

In my experience, the healing of trauma is one of the most important things we can do as adults. It is our responsibility to understand our traumas and to overcome them. Our fears come from our traumas. Our fears and traumas create patterns and behaviours in our lives that affect every aspect of our existence. Moving beyond fear and trauma allows us to connect with ourselves and each other more deeply. Most of my traumas were in childhood. My parents were loving much of the time, but chose to use old-fashioned methods of fear and violence to attempt to control me. I was a gentle, intelligent boy who did not need that kind of abuse. It took me decades of focused effort to overcome the beatings as a child. I recall playing soccer with my brothers where the ball accidently bounced over a bush and bumped into the window of the house. My father freaked out, chased me around enraged, and whipped me with his belt until he felt that I learned the lesson. I was absolutely terrified and confused. It was an accident and I was sorry. I felt helpless. I knew what was happening was wrong, so I called the police this time. The policeman who came did absolutely nothing, which added another layer of trauma. I felt abandoned. To this day, I still cannot imagine how an adult can justify beating a child, for any reason. Children are just trying to navigate this world and require gentle guidance, not violence, to facilitate this. Violence always leads to trauma. And trauma leads to further violence. It is time we understand this and choose to break the cycle. The intergenerational trauma in my family ends with me. As a highly conscious individual, I understand the vicious cycle of abuse, and will raise my children with nonviolence. This is possible, and research shows that this is how we can heal as a community. Several years ago, I showed my parents the movie Wisdom of Trauma by Dr. Gabor Maté to help them understand this. However, this had limited effect on them as they are still traumatized from their childhood and have not dealt with it. It shows their level of consciousness at this time. We can choose to raise our awareness around trauma, in ourselves, and in society. We can choose to heal. We can choose to break the cycle.