Full transcript of “[Full Audiobook] The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma | Part 1+2”. Click a timestamp to open the video at that moment. Need another video? Use the YouTube transcript generator.
0:00 prologue facing trauma one does not have be a combat Soldier or visit a refugee camp in Syria or the Congo to encounter trauma trauma happens to us our friends our families and our neighbors research by the Centers for Disease Control and prevention has shown that one in five Americans was sexually molested as a child one in four was beaten by a parent to the point of a mark being left on their body and one in three couples engages in physical violence a quarter of us grew up with alcoholic relatives and one out of eight witnessed their mother being beaten or hit point1 as human beings we belong to an extremely resilient species since time immemorial we have rebounded from our Relentless Wars countless disasters both natural
0:46 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 and immune systems trauma affects not only those who are directly exposed to it but also those around them soldiers returning home from combat May frighten their families with their rages and emotional absence the wives of men who suffer from PTSD tend to become depressed and the children of depressed mothers are at risk of growing up
1:31 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 molested become so upset when they think about what they 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 weakness 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
2:17 reactivated at the slightest hint of danger 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 post-traumatic 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 the first time I remember being drawn to study medicine was at a summer camp when I was about 14 years old my cousin Michael kept me up all night explaining the intricacies of how kidneys work how they secrete the body's waste materials and then reabsorb the chemicals that keep the system in Balance I was riveted by his account of the miraculous way the body functions
3:05 later during every stage of my medical training whether I was studying surgery Cardiology or Pediatrics it was obvious to me that the key to Healing was understanding how the human organism works when I began my Psychiatry rotation however I was struck by the contrast between the incredible complexity of the mind and the ways that we human beings are connected and attached to one another and how little psychiatrists knew about the origins of the problems they were treating 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 we are obviously 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
3:52 Neuroscience the study of how the brain supports mental processes developmental Psychopathology the study of the impact of adverse experiences on the development of mind and brain and interpersonal neurobiology the study of how our Behavior 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 is the brain area that communicates the physical embodied feeling of being alive these changes explain why traumatized individuals
4:37 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 behaviors 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 this vast increase in our knowledge about the basic processes that underly trauma has also opened up new possibilities to Pate or even reverse the damage we can now develop methods and experiences that utilize the brain's own natural neuroplasticity to help survivors feel Fully Alive in the present and move on with their lives there are fundamentally three Avenues one top down by talking re connecting with others and allowing
5:24 ourselves to know and understand what is going on with us while processing the memories of the trauma two by taking medicines that shut down inappropriate alarm reactions or by utilizing other technologies that change the way the brain organizes information and three bottom up by allowing the body to have experiences that deeply and viscerally contradict the helplessness Rage or collapse that result from trauma which one of these is best for any particular Survivor is an empirical question most people I have worked with require a combination this has been my life's work in this eort effort I have been supported by my colleagues and students at the trauma center which I founded 30 years ago together we have treated thousands of traumatized children and adults victims of child abuse natural
6:12 disasters Wars accidents and human trafficking people who have suffered assaults by Intimates and strangers we have a long tradition of discussing all our patients in great depth at weekly treatment team meetings and carefully tracking how well different forms of treatment work for particular individuals our principal Mission has always been to take care of the children and adults who have come to us for treatment but from the very beginning we also have dedicated ourselves to conducting research to explore the effects of traumatic stress on different populations and to determine what treatments work for whom we have been supported by research grants from the National Institute of Mental Health the national Center for complimentary and alternative medicine the Centers for Disease Control and a number of private foundations to study the efficacy of many different forms of treatment from
6:58 medications to talking yoga EMDR theater and neuro feedback the challenge is how can people gain control over the residues of past trauma and return to being masters of their own ship talking understanding and human connections help and drugs can dampen hyperactive alarm systems but we will also see that the imprints from the past can be transformed by having physical experiences that directly contradict the helplessness rage and collapse that are part of trauma and thereby regaining selfmaster I have no preferred treatment modality as no single approach fits everybody but I practice all the forms of treatment that I discuss in this book each one of them can produce profound changes depending on the nature of the particular problem and the makeup of the
7:44 individual person I 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 using every means we have to prevent it part one the rediscovery of trauma chapter 1 lessons from Vietnam veterans I became what I am today at the age of 12 on a frigid overcast day in the winter of 1975 that was a long time ago but it's wrong what they say about the past looking back now I realize I have been peeking into that deserted alley for the last 26 years khed hosi The Kite Runner some people's lives seem to flow in narrative mine had
8:31 many stops and starts that's what trauma does it interrupts the plot it just happens and then life goes on no one prepares you for it Jessica Stern denial A Memoir of Terror he Tuesday after the 4th of July weekend 1978 was my first day as a staff psychiatrist at the Boston veterans administration clinic as I was hanging a reproduction of my favorite bral painting the blind mind leading the blind on the wall of my new office I heard a commotion in the reception area down the hall a moment later a large disheveled man in a stained three-piece suit carrying a copy of Soldier of Fortune Magazine under his arm burst through my door he was so agitated and
9:17 so clearly hung over that I wondered how I could possibly help this hulking man I asked him to take a seat and tell me what I could do for him his name was Tom 10 years earlier he had been in the Marines doing his service in Vietnam he had spent the holiday weekend Hol Up in his downtown Boston Law Office drinking and looking at Old photographs rather than with his family he knew from previous years experience that the noise the fireworks the Heat and the picnic in his sister's backyard against the backdrop of dense early summer foliage all of which reminded him of Vietnam would drive him crazy when he got upset he was afraid to be around his family because he behaved like a monster with his wife and two young boys the noise of
10:03 his kids made him so agitated that he would storm out of the house to keep himself from hurting them only drinking himself into Oblivion or riding his Harley-Davidson at dangerously high speeds helped him to calm down nighttime offered no relief his sleep was constantly interrupted by nightmares about an ambush in a rice Patty back in n in which all the members of his platoon were killed or wounded he also had terrifying flashbacks in which he saw saw dead Vietnamese children the nightmares were so horrible that he dreaded falling asleep and he often stayed up for most of the night drinking in the morning his wife would find him passed out on the living room couch and she and the boys had to tiptoe around him while she made them breakfast before taking them to school filling me in on his background Tom said that he had
10:50 graduated from high school in 1965 the valedictorian of his class in line with his family tradition of military service he enlisted in the Marine Corps immediately after graduation his father had served in World War II in General Patton's Army and Tom never questioned his father's expectations athletic intelligent and an obvious leader Tom felt powerful and effective after finishing basic training a member of a team that was prepared for just about anything in Vietnam he quickly became a platoon leader in charge of eight other Marines surviving slogging through the mud while being strafed by Machine Gun fire can leave people feeling pretty good about themselves and their comrades at the end of his Tour of Duty Tom was honorably discharged and all he wanted
11:36 was to put Vietnam behind him outwardly that's exactly what he did he attended College on the GI Bill graduated from law school married his high school sweetheart and had two sons Tom was upset by how difficult it was to feel any real affection for his wife even though her letters had kept him alive in The Madness of the Jungle Tom went through the motions of of living a normal life hoping that by faking it he would learn to become his old self again he now had a thriving law practice and a picture perfect family but he sensed he wasn't normal he felt dead inside although Tom was the first veteran I had ever encountered on a professional basis many aspects of his story were familiar to me I grew up in postwar Holland
12:22 playing in bombed out buildings the son of a man who had been such an outspoken opponent of the Nazis that he had been sent to an interment Camp my father never talked about his War experiences but he was given to outbursts of explosive rage that stunned me as a little boy how could the man I heard quietly going down the stairs every morning to pray and read the Bible while the rest of the family slept have such a terrifying temper how could someone whose life was devoted to the pursuit of social justice be so filled with anger I witnessed the same puzzling behavior in my uncle who had been captured by the Japanese in the Dutch East Indies now Indonesia and sent as a slave laborer to Burma where he worked on the famous bridge over the river Quai he also rarely mentioned the war and he too
13:08 often erupted into uncontrollable rages as I listened to Tom I wondered if my uncle and my father had had nightmares and flashbacks If They too had felt disconnected from their loved ones and unable to find any real pleasure in their lives somewhere in the back of my mind there must also have been my memories of my frightened and often frightening mother whose own childhood trauma was sometimes alluded to and I now believe was frequently reenacted she had the unnerving habit of fainting when I asked her what her life was like as a little girl and then blaming me for making her so upset reassured by my obvious interest Tom settled down to tell me just how scared and confused he was he was afraid that he was becoming just like his father who was always angry and rarely talked with his
13:54 children except to compare them unfavorably with his comrades who had lost their lives around Christmas 1944 during the Battle of the Bulge as the session was drawing to a close I did what doctors typically do I focused on the one part of Tom's story that I thought I understood his nightmares as a medical student I had worked in a sleep laboratory observing people's sleep/ dream cycles and had assisted in writing some articles about nightmares I had also participated in some early research on the beneficial effects of the psychoactive drugs that were just coming into use in the 1970s so while I lacked a true grasp of the scope of tomk problems the nightmares were something I could relate to and as an enthusiastic believer in Better Living Through Chemistry I prescribed a drug that we
14:40 had found to be effective in reducing the incidence and severity of nightmares I scheduled Tom for a followup visit 2 weeks later when he returned for his appointment I eagerly asked Tom how the medicines had worked he told me he hadn't taken any of the pills trying to conceal my irritation I asked him him why I realized that if I take the pills and the nightmares go away he replied I will have abandoned my friends and their deaths will have been in vain I need to be a living Memorial to my friends who died in Vietnam I was stunned Tom's loyalty to the dead was keeping him from Living his own life just as his father's Devotion to his friends had kept him from Living both father's and Sons experiences on the battlefield had
15:26 rendered the rest of their lives irrelevant how had that happened and what could we do about it that morning I realized I would probably spend the rest of my professional life trying to unravel the mysteries of trauma how do horrific experiences cause people to become hopelessly stuck in the past what happens in people's minds and brains that keeps them Frozen trapped in a place they desperately wish to escape why did this man's War not come to an end in February 1969 when his parents embraced him at Boston's Logan International Airport after his long flight back from denong Tom's need to live out his life as a memorial to his comrades taught me that he was suffering from a condition much more complex than Simply Having bad memories or damaged brain chemistry or altered fear circuits in the Brain
16:13 before the ambush in the rice Patty Tom had been a devoted and loyal friend someone who enjoyed life with many interests and Pleasures in one terrifying moment trauma had transformed everything during my time at the VA I got to know many men men who responded similarly faced with even minor frustrations our veterans often flew instantly into extreme rages the public areas of the clinic were pockmarked with the impacts of their fists on the drywall and security was kept constantly busy protecting claims agents and receptionists from enraged Veterans of course their behavior scared us but I also was intrigued at home my wife and I were coping with similar problems in our toddlers who regularly through temper tantrums when told to eat their spinach
16:58 or to put on warm socks why was it then that I was utterly unconcerned about my kids immature Behavior but deeply worried by what was going on with the Vets aside from their size of course which gave them the potential to inflict much more harm than my two-footers at home the reason was that I felt perfectly confident that with proper care my kids would gradually learn to deal with frustrations and disappointments but I was skeptical that I would be able to help my veterans reacquire the skills of self-control a ND self-regulation that they had lost in the war unfortunately nothing in my psychiatric training had prepared me to deal with any of the challenges that Tom and his fellow veterans presented I went down to the medical library to look for books on war Neurosis shell shock battle
17:45 fatigue or any other term or diagnosis I could think of that might shed light on my patients to my surprise the library at the VA didn't have a single book about any of these conditions 5 years after the last American Soldier left Vietnam the issue of wartime trauma was still not on anybody's agenda finally in the countway library at Harvard Medical School I discovered the traumatic Neurosis of War which had been published in 1941 by a psychiatrist named Abram cardner it described carder's observations of World War I veterans and had been released in anticipation of the flood of shellshock soldiers expected to be casualties of World War ii1 cardner reported the same phenomena I was seeing after the war his patients were overtaken by a sense of futility they
18:30 became withdrawn and detached even if they had functioned well before what cardner called traumatic Neurosis today we call post-traumatic stress disorder PTSD cardner noted that suffers from traumatic Neurosis develop a chronic vigilance for and sensitivity to threat his summation especially caught my eye the nucleus of the Neurosis is a physion Neurosis to in other words post-traumatic stress isn't all in one's head as some people supposed but has a physiological basis cardner understood even then that the symptoms have their origin in the entire body's response to the original trauma carder's description corroborated my own observations which was reassuring but it provided me with little guidance on how to help the
19:15 veterans the lack of literature on the topic was a handicap but my great teacher Elvin seid had taught us to be skeptical about textbooks we had only one real textbook he said our patience we should trust only what we could learn from them and from our own experience this sounds so simple but even as seid pushed us to rely upon self- knowledge he also warned us how difficult that process really is since human beings are experts in wishful thinking and obscuring the truth I remember him saying the greatest sources of our suffering are The Lies We Tell ourselves working at the VA I soon discovered how excruciating it can be to Face Reality this was true both for my patience and for myself we don't really want to know
20:01 what soldiers go through in combat we do not really want to know how many children are being molested and abused in our own Society or how many couples almost a third as it turns out engage in violence at some point during their relationship 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 occurs only in Far Away places like darur or the Congo it is hard enough for observers to Bear witness to pain is it any Wonder then that the traumatized individuals themselves cannot tolerate remembering it and that they often resort to using drugs alcohol or self-mutilation to block out their unbearable knowledge Tom and his fellow
20:46 veterans became my first teachers in my quest to understand how lives are Shattered by overwhelming experiences and in figuring out how to enable them to feel fully alive again trauma and the loss of self the first study I did at the VA started with systematically asking veterans what had happened to them in Vietnam I wanted to know what had pushed them over the brink and why some had broken down as a result of that experience While others had been able to go on with their lives point three most of the men I interviewed had gone to war feeling well prepared drawn close by the rigors of basic training and the shared danger they exchanged pictures of their families and girlfriends they put up with one another's flaws and they were prepared to risk their lives for their friends most of them confided their dark secrets to a buddy and some went so far
21:32 as to share each other's shirts and socks many of the men had friendship similar to Tom's with Alex Tom met Alex an Italian guy from Malden Massachusetts on his first day in country and they instantly became close friends they drove their Jeep together listened to the same music and read each other's letters from home they got drunk together and chased the same Vietnamese bar girls after about 3 months in country Tom LED his squad on a foot patrol through a rice patty just before Sunset suddenly a hail of gunfire spurted from the green wall of the surrounding jungle hitting the men around him one by one Tom told me how he had looked on in helpless horror as all the members of his platoon were killed or wounded in a matter of seconds he
22:19 would never get one image out of his mind the back of Alex's head as he lay face down in the rice Patty his feet in the air Tom wept as he Rec called he was the only real friend I ever had afterward at night Tom continued to hear the screams of his men and to see their bodies falling into the water any sounds smells or images that reminded him of the Ambush like the popping of firecrackers on the 4th of July made him feel just as paralyzed terrified and enraged as he had the day the helicopter evacuated him from the rice Patty maybe even worse for Tom than the recurrent flashbacks of the Ambush was the memory of what happened afterward I could easily imagine how Tom's rage about his friend's death had led to the Calamity
23:06 that followed it took him months of dealing with his paralyzing shame before he could tell me about it since time immemorial veterans like Achilles and Homer's Iliad have responded to the death of their comrades with unspeakable acts of Revenge the day after the Ambush Tom went into a frenzy to a neighboring Village killing children shooting an innocent farmer and raping a Vietnamese woman after that it became truly impossible for him to go home again in any meaningful way how can you face your sweetheart and tell her that you brutally raped a woman just like her or watch your son take his first step when you are reminded of the child you murdered Tom experienced the death of Alex as if part of himself had been forever destroyed the part that was good
23:51 and honorable and trustworthy trauma whether it is the result of something done to you or something you yourself have done almost always makes it difficult to engage in Intimate Relationships after you have experienced something so unspeakable how do you learn to trust yourself or anyone else again or conversely how can you surrender to an intimate relationship after you have been brutally violated Tom kept showing up Faithfully for his appointments as I had become for him a Lifeline the father he'd never had and Alex who had survived the Ambush takes enormous trust and courage to allow yourself to remember one of the hardest things for traumatized people is to confront their Shame about the way they behaved during a traumatic episode whether it is objectively warranted as in the commission of atrocities or not
24:38 as in the case of a child who tries to Plate her abuser one of the first people to write about this phenomenon was Sarah Haley who occupied an office next to mine at the VA clinic in an article entitled when the patient reports atrocities for which became a major impetus for the ultimate creation of the PTSD diagnosis she discussed the well nigh int able difficulty of talking about and listening to the horrendous acts that are often committed by soldiers in the course of their War experiences it's hard enough to face the suffering that has been inflicted by others but deep down many traumatized people are even more haunted by the shame they feel about what they themselves did or did not do under the circumstances they despise themselves for how terrified dependent excited or enraged they felt in later years I
25:25 encountered a similar phenomenon in victims of child abuse abuse most of them suffer from agonizing Shame about the actions they took to survive and maintain a connection with the person who abused them this was particularly true if the abuser was someone close to the child someone the child depended on as is so often the case the result 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 Terror pain and pleasure we will return to this dilemma throughout this book numbing maybe the worst of Tom's symptoms was that he felt emotionally numb he desperately wanted to love his family but he just couldn't evoke any deep feelings for them he felt emotionally distant from everybody as though his
26:11 heart were frozen and he were living behind a glass wall that numbness extended to himself as well he could not really feel anything except for his momentary rages and his shame he described how he hardly recognized himself when he looked in the mirror to shave when he heard himself arguing a case in court he would observe himself from a distance and wonder how this guy who happened to look and talk like him was able to make such cogun arguments when he won a case he pretended to be gratified and when he lost it was as though he had seen it coming and was resigned to the defeat even before it happened despite the fact that he was a very effective lawyer he always felt as though he were floating in space lacking any sense of purpose or Direction the only thing that occasionally relieved
26:58 this feeling of aimlessness was intense involvement in a particular case during the course of our treatment Tom had to defend a mobster on a murder charge for the duration of that trial he was totally absorbed in devising a strategy for winning the case and there were many occasions on which he stayed up all night to immerse himself in something that actually excited him it was like being in combat he said he felt Fully Alive and nothing else mattered the moment Tom won that case however he lost his energy and sense of purpose the nightmares returned as did his rage attacks so intensely that he had to move into a motel to ensure that he would not harm his wife or children but being alone too was terrifying because the Demons of the war returned in full force Tom tried to stay busy working drinking
27:44 and drugging doing anything to avoid confronting his demons he kept thumbing through Soldier of Fortune fantasizing about enlisting as a mercenary in one of the many Regional Wars then raging in Africa that spring he took out his Harley and roared up the Canam Magus Highway in New Hampshire the vibrations speed and danger of that ride helped him pull himself back together to the point that he was able to leave his motel room and return to his family the reorganization of perception another study I conducted at the VA started out as research about nightmares but ended up exploring how trauma changes people's perceptions and Imagination Bill a former medic who had seen heavy action in Vietnam a decade earlier was the first first person enrolled in my nightmare study after his discharge he
28:31 had enrolled in a Theological Seminary and had been assigned to his first Parish in a Congregational Church in a Boston suburb he was doing fine until he and his wife had their first child soon after the baby's birth his wife a nurse had gone back to work while he remained at home working on his weekly sermon and other Parish duties and taking care of their newborn on the very first day he was left alone with the baby it began to cry and he found himself suddenly flooded with unbearable images of dying children in Vietnam Bill had to call his wife to take over child care and came to the VA in a panic he described how he kept hearing the sounds of babies crying and seeing images of burned and bloody children's faces my medical colleagues thought that he must surely be psychotic
29:19 because the textbooks of the time said that auditory and visual hallucinations were symptoms of paranoid schizophrenia the same text that provided this diagnosis also to cause Bill psychosis was probably triggered by his feeling displaced in his wife's affections by their new baby as I arrived at the intake office that day I saw Bill surrounded by worried doctors who were preparing to inject him with a powerful antis psychotic drug and ship him off to a locked Ward they described his symptoms and asked my opinion having worked in a previous job on a ward specializing in the treatment of schizophrenics I was intrigued something about the diagnosis didn't sound right I asked Bill if I could talk with him and after hearing his story I unwittingly paraphrased something Sigman Freud had
30:04 said about trauma in 1895 I think this man is suffering from memories I told Bill that I would try to help him and after offering him some medications to control his Panic asked if he would be willing to come back a few days later to participate in my nightmare study5 he agreed as part of that study we gave our participants a roar shock test point six unlike tests that require answer aners to straightforward questions responses to the roar shock are almost impossible to fake the roar shock provides us with a unique way to observe how people construct a mental image from what is basically a meaningless stimulus a blot of ink because humans are meaning making creatures we have a tendency to create some sort of image or story out of those ink blots just as we do when we lie in a
30:49 meadow on a beautiful summer day and see images in the clouds floating high above what people make out of these blots can tell us a lot about how their mind work on seeing the second card of the Roar shock test Bill exclaimed in horror this is that child that I saw being blown up in Vietnam in the middle you see the charred flesh the wounds and the blood is spurting out all over panting and with sweat beating on his forehead he was in a panic similar to the one that had initially brought him to the VA Clinic although I had heard veterans describing their flashbacks this was the first time I actually witnessed one in that very moment in my office bill was obviously seeing the same images smelling the same smells and feeling the same physical Sensations he
31:35 had felt during the original event 10 years after helplessly holding a dying baby in his arms bill was reliving the trauma in response to an ink blot experiencing Bill's flashback firsthand in my office helped me realize the agony that regularly visited the veterans I was trying to treat and helped me appreciate again how critical it was to find a solution the traumatic event itself however harass RIS had a beginning a middle and an end but I now saw that flashbacks could be even worse you never know when you will be assaulted by them again and you have no way of telling when they will stop took me years to learn how to effectively treat flashbacks and in this process bill turned out to be one of my most important mentors when we gave the roar shock test to 21 additional veterans the
32:21 response was consistent 16 of them on seeing the second card reacted as if they were experiencing wartime trauma the second Roar shock card is the first card that contains color and often elicits so-called color shock in response the veterans interpreted this card with descriptions like these are the bowels of my friend Jim after a mortar shell ripped him open and this is the neck of my friend Dany after his head was blown off by a shell while we were eating lunch none of them mention dancing monks fluttering butterflies men on motorcycles or any of the other ordinary sometimes Whimsical images that most people see while the majority of the veterans were greatly upset by what they saw the reactions of the remaining five were even more alarming they simply
33:08 went blank this is nothing one observed just a bunch of ink they were right of course but the normal human response to ambiguous stimuli is to use our imagination to read something into them we learned from these Roar shock tests that traumatized people have a tendency to superimpose their trauma on everything around around them and have trouble deciphering whatever is going on around them there appeared to be little in between we also learned that trauma affects the imagination the five men who saw nothing in the blots had lost the capacity to let their minds play but so too had the other 16 men for in viewing scenes from the past in those blots they were not displaying the mental flexibility that is the Hallmark of imagination they simply kept replaying an old real imagination is absolutely
33:56 critical to the quality of our lives our imagination enables us to leave our routine everyday existence by fantasizing about travel food sex falling in love or having the last word 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 come true it fires our creativity relieves our boredom alleviates our pain enhances our pleasure and enriches our most intim Intimate Relationships when people are compulsively and constantly pulled back into the past to the last time they felt intense involvement and Deep Emotions they suffer from a failure of imagination a loss of the mental flexibility without imagination there is
34:42 no hope no chance to Envision a better future no place to go no goal to reach the roar shock tests also taught us that traumatized people look at the world in a fundamentally different way from other people for most of us a man coming down on the street is just someone taking a walk a rape victim however may see a person who is about to molest her and go into a panic a Stern school teacher may be an intimidating presence to an average kid but for a child whose stepfather beats him up she may represent a torturer and precipitate a rage attack or a terrified cowering in the corner stuck in trauma our Clinic was inundated with veterans seeking psychiatric help however because of an acute shortage of qualified doctors all
35:27 we could do was put most of them on a waiting list even as they continued brutalizing themselves and their families we began seeing a sharp increase in arrests of Veterans for violent offenses and drunken brawls as well as an alarming number of suicides I received permission to start a group for young Vietnam veterans to serve as a sort of holding tank until real therapy could start at the opening session for a group of former Marines the first man to speak flatly declared I do not want to talk about the war I replied that the members could discuss anything they wanted after half an hour of excruciating silence one veteran finally started to talk about his helicopter crash to my amazement the rest immediately came to life speaking with great intensity about their traumatic
36:14 experiences all of them returned the following week and the week after in the group they found resonance and meaning in what had previously been only sensations of Terror and emptiness they felt A Renewed sense of the comrad ship that had been so vital to their War experience they insisted that I had to be part of their Newfound unit and gave me a marine Captain's uniform for my birthday in retrospect that gesture revealed part of the problem you were either in or out you either belong to the unit or you were nobody after trauma the world becomes sharply divided between those who know and those who don't people who have not shared the traumatic experience cannot be trusted because they can't understand it sadly this often includes spouses children and co-workers later I led another group
37:02 this time for veterans of Patton's army men now well into their 70s all old enough to be my father we met on Monday mornings at 8:00 in Boston winter snowstorms occasionally paralyzed the public transit system but to my amazement all of them showed up even during blizzards some of them trudging several miles through the snow to reach the VA clinic for Christmas they gave me a 1940s GI issue wristwatch watch as had been the case with my group of Marines I could not be their doctor unless they made me one of them moving as these experiences were the limits of group therapy became clear when I urged the men to talk about the issues they confronted in their daily lives their relationships with their wives children girlfriends and family dealing with their bosses and finding satisfaction in
37:48 their work their heavy use of alcohol their typical response was to bulk and resist and instead recount yet again how they had plunged a dagger through the heart of a German soldier in the hen forest or how their helicopter had been shot down in the jungles of Vietnam whether the trauma had occurred 10 years in the past or more than 40 my patience could not bridge the gap between their wartime experiences and their current lives somehow the very event that caused them so much pain had also become their sole source of meaning they felt Fully Alive only when they were revisiting their traumatic past diagnosing post-traumatic stress in those early days at the VA we labeled our veterans with all sorts of diagnoses alcoholism substance abuse depression mood disorder even schizophrenia and we tried every
38:36 treatment in our textbooks but for all our efforts it became clear that we were actually accomplishing very little the powerful drugs we prescribed often left the men in such a fog that they could barely function when we encouraged them to talk about the precise details of a traumatic event we often inadvertently triggered a full-blown flashback rather than helping them resolve the issue many of them dropped out of treatment because we were not only failing to help but also sometimes making things worse a turning point arrived in 1980 when a group of Vietnam veterans aided by the New York psychoanalysts Heim shatan and Robert J lyton successfully lobbied the American Psychiatric association to create a new diagnosis post-traumatic stress disorder PTSD which described a
39:21 cluster of symptoms that was common to a greater or lesser extent to all of our veterans system a atically identifying the symptoms and grouping them together into a disorder finally gave a name to the suffering of people who were overwhelmed by horror and helplessness with the conceptual framework of PTSD in place the stage was set for a radical change in our understanding of our patients this eventually led to an explosion of research and attempts at finding effective treatments inspired by the possibilities presented by this new diagnosis I proposed a study on the biology of traumatic memories to the V did the memories of those suffering from PTSD differ from those of others for most people the memory of an unpleasant event eventually Fades or is transformed
40:07 into something more benign but most of our patients were unable to make their past into a story that happened long ago 7 the opening line of the grant rejection read it has never been shown that PTSD is relevant to the mission of the Veterans Administration since then of course the mission of the VA has become or organized around the diagnosis of PTSD and brain injury and considerable resources are dedicated to applying evidence-based treatments to traumatized War veterans but at the time things were different and unwilling to keep working in an organization whose view of reality was so at odds with my own I handed in my resignation in 1982 I took a position at the Massachusetts Mental Health Center the Harvard teaching hospital where I had trained to become a psychiatrist my new
40:53 responsibility was to teach a fledgling area of study psychop pharmacology the administration of drugs to alleviate mental illness in my new job I was confronted on an almost daily basis with issues I thought I had left behind at the VA my experience with combat veterans had so sensitized me to the impact of trauma that I now listened with a very different ear when depressed and anxious patients told me stories of molestation and Family Violence I was particularly struck by how many female patients spoke of being sexually abused as children this was puzzling as the standard textbook of Psychiatry at the time stated that incest was extremely rare in the United States occurring about once in every million women point8 given that there were then only about 100 million women living in the United States I wondered how 47 almost half of
41:39 them had found their way to my office in the basement of the hospital furthermore the textbook said there is little agreement about the role of father-daughter incest as a source of serious subsequent Psychopathology my patients with incest histories were hardly free of subsequent Psychopathology they were were profoundly depressed confused and often engaged in bizarrely self-harmful behaviors such as cutting themselves with razor blades the textbook went on to practically endorse incest explaining that such incestuous activity diminishes the subject's chance of psychosis and allows for a better adjustment to the external world nine in fact as it turned out incest had devastating effects on women's well-being in many ways these patients were not so different from the veterans I had just left behind at the
42:26 VA they ALS o had nightmares and flashbacks they also alternated between occasional bouts of explosive rage and long periods of being emotionally shut down most of them had great difficulty getting along with other people and had trouble maintaining meaningful relationships as we now know war is not the only Calamity that leaves human lives in Ruins while about a quarter of the soldiers who serve in war zones are expected to develop serious post-traumatic problems tend the majority of Americans experience a violent crime at some time during their lives and more accurate reporting has revealed that 12 million women in the United States have been victims of rape more than half of all rapes occur in girls below age 15.11 for many people the war begins at home each year about 3
43:12 million children in the United States are reported as victims of child abuse and neglect 1 million of these cases are serious and credible enough to force local Child Protective Services or the courts to take action point 12 in other words for every soldier who serves in a war zone Zone abroad there are 10 children who are endangered in their own homes this is particularly tragic since it is very difficult for growing children to recover when the source of Terror and pain is not enemy combatants but their own caretakers a new understanding in the three decades since I met Tom we have learned an enormous amount not only about the impact and manifestations of trauma but also about ways to help traumatized people find their way back since the early 1990s brain Imaging tools have started to show
43:58 us what actually happens inside the brains of traumatized people this has proven essential to understanding the damage inflicted by trauma and has guided us to formulate entirely new avenues of repair we have also begun to understand how overwhelming experiences affect our innermost Sensations and our relationship to our physical reality the core of who we are we have learned that 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 and body this imprint has ongoing consequences for how the human organism manages to survive in the present trauma results in a fundamental reorganization of the way mind and brain manage perceptions it changes not only how we think and what we think about but
44:44 also our very capacity to think we have discovered that helping victims of trauma find the words to describe what has happened to them is profoundly meaningful but usually it is not enough the act of telling the story doesn't necessarily alter the automatic physical and hormonal responses of bodies that remain hypervigilant prepared to be assaulted or violated at any time for real change to take place the body needs to learn that the danger has passed and to live in the reality of the present our search to understand trauma has led us to think differently not only about the structure of the mind but also about the processes by which it heals chapter 2 revolutions in understanding mind and brain the greater the doubt the greater The Awakening the smaller the doubt the
45:31 smaller the Awakening no doubt no Awakening C Chong the practice of Zen you live through that little piece of time that is yours but that piece of time is not only your own life it is the summing up of all the other lives that are simultaneous with yours what you are is an expression of History Robert pen Warren World enough and time in the late 1960s during a year off between my first and second years of medical school I became an accidental witness to a profound transition in the medical approach to mental suffering I had landed a plum job as an attendant on a research Ward at the Massachusetts Mental Health Center where I was in charge of organizing recreational activities for the patients mmhc had long been considered one of the finest
46:17 psychiatric hospitals in the country a jewel in the crown of the Harvard Medical School teaching Empire the goal of the research on my ward was to determine whether Psy Psychotherapy or medication was the best way to treat young people who had suffered a first mental breakdown diagnosed as schizophrenia the talking cure and offshoot of Freudian psychoanalysis was still the primary treatment for mental illness at mmhc however in the early 1950s a group of French scientists had discovered a new compound chlorpromazine sold under the brand name thorine that could tranquilize patients and make them less agitated and delusional that inspired hope that drugs could be developed to treat serious mental problems such as depression Panic anxiety and Mania as
47:02 well as to manage some of the most disturbing symptoms of schizophrenia as an attendant I had nothing to do with the research aspect of the ward and was never told what treatment any of the patients was receiving they were all close to my age college students from Harvard MIT and Boston University some had tried to kill themselves others cut themselves with knives or razor blades several had attacked their roommates or had otherwise terrified their parents or friends with their unpredictable irrational behavior my job was to keep them involved in normal activities for college students such as eating at the local pizza parlor camping in a nearby State Forest attending Red Sox games and sailing on the Charles River totally new to the field I sat in wrapped attention
47:48 during Ward meetings trying to decipher the patient complicated speech and logic I also had to learn to deal with their irrational outbursts and terrified withdrawal one morning I found a patient standing like a statue in her bedroom with one arm raised in a defensive gesture her face Frozen in fear she remained there immobile for at least 12 hours the doctors gave me the name for her condition Catatonia but even the textbooks I consulted didn't tell me what could be done about it we just let it run its course trauma Before Dawn I spent many nights and weekends on the unit which exposed me to things the doctors never saw during their brief visits when patients could not sleep they often wandered in their tightly wrapped bathrobes into the darkened
48:34 nursing station to talk the quiet of the night seemed to help them open up and they told me stories about having been hit assaulted or molested Often by their own parents sometimes by relatives classmates or neighbors they shared memories of lying in bed at night helpless and terrified hearing their mother being beaten by their father or a boyfriend hearing their par parents yell horrible threats at each other hearing the sounds of furniture breaking others told me about fathers who came home drunk hearing their footsteps on the landing and how they waited for them to come in pull them out of bed and punish them for some imagined offense several of the women recalled lying awake motionless waiting for the inevitable a brother or father coming in to molest
49:20 them during morning rounds the young doctors presented their cases to their supervisors a ritual that the ward attendants were allowed to observe in silence they rarely mention stories like the ones I'd heard however many later Studies have confirmed the relevance of those Midnight Confessions we now know that more than half the people who seek psychiatric care have been assaulted abandoned neglected or even raped as children or have witnessed violence in their families point1 but such experiences seem to be off the table during rounds I was often surprised by the dispassionate way patient symptoms were discussed and by how much time was spent on trying to manage their suicidal thoughts and self-destructive behaviors rather than on understanding the possible causes of their Despair and helplessness I was also struck by how
50:06 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 at peace the Ecology of their lives a few years later as a young doctor I was confronted with an especially Stark example of the medical model in action I was then Moon lighting at a Catholic Hospital doing physical examinations on women who'd been admitted to receive electroshock treatment for depression being my Curious immigrant self I'd look up from their charts to ask them about their lives many of them Spilled Out stories about painful marriages difficult children and guilt over abortions as they spoke they visibly brightened and often thanked me effusively for listening to them some of
50:53 them wondered if they really still needed electroshock after having gotten so much off their chests I always felt sad at the end of these meetings knowing that the treatments that would be administered the following morning would erase all memory of our conversation I did not last long in that job on my days off from the Ward at mmhc I often went to the countway Library of Medicine to learn more about the patients I was supposed to help one Saturday afternoon I came across A Treatise that is still revered today Eugene bler 1911 textbook dementia precox blers observations were fascinating among schizophrenic body hallucinations the sexual ones are by far the most frequent and the most important all the raptures and joys of Normal and abnormal sexual satisfaction
51:40 are experienced by these patients but even more frequently every obscene and disgusting practice which the most extravagant fantasy can conjure up male patients have their semen drawn off painful erections are stimulated the women patients are raped and injured in the most devilish ways in spite of the symbolic meaning of many such hallucinations the majority of them correspond to real Sensations point2 this made me wonder our patients had hallucinations the doctors routinely asked about them and noted them as signs of how Disturbed the patients were but if the stories I'd heard in the wee hours were true could it be that these hallucinations were in fact the fragmented memories of real experiences were hallucinations just the concoctions
52:25 of sick brains could people make up physical Sensations they had never experienced was there a clear line between creativity and pathological imagination between memory and Imagination these questions remain unanswered to this day but research has shown that people who've been abused as children often feel Sensations such as abdominal pain that have no obvious physical cause they hear voices warning of danger or accusing them of heinous crimes there was no question that many patients on the ward engaged in violent bizarre and self-destructive behaviors particularly when they felt frustrated thwarted or misunderstood they threw temper tantrums hurled plates smashed windows and cut themselves with shards
53:10 of glass at that time I had no idea why someone might react to a simple request let me clean that goop out of your hair with Rage or Terror I usually followed the lead of the experienced nurses who signaled when to back off or if that did not work to restrain a patient I was surprised and alarmed by the satisfaction I sometimes felt after I'd Wrestled a patient to the floor so a nurse could give an injection and I gradually realized how much of our professional training was geared to helping us stay in control in the face of terrifying and confusing realities Sylvia was a gorgeous 19-year-old Boston University student who usually sat alone in the corner of the ward looking frightened to death and virtually mute but whose reputation as the girlfriend of an important Boston mafioso gave her an aura of Mystery
53:57 after she refused to eat for more than a week and rapidly started to lose weight the doctors decided to force feed her it took three of us to hold her down another to push the rubber feeding tube down her throat and a nurse to pour the liquid nutrients into her stomach later during a midnight confession Sylvia spoke timidly and hesitantly about her childhood's sexual abuse by her brother and Uncle I realized then our display of caring must have felt to her much like a gang rape this experience and others like it helped me formulate this rule for my students if you do something to a patient that you would not do to your friends or children consider whether you are unwittingly replicating a Trauma from the patient past in my role as Recreation leader I noticed other things
54:43 as a group the patients were strikingly clumsy and physically uncoordinated when we went camping most of them stood helplessly by as I pitched the tents we almost capsized once in a Squall on the Charles River because they huddled rigidly in the Lee unable to grasp that they needed to shift position to balance the boat in volleyball games the staff members invariably were much better coordinated than the patients another characteristic they shared was that even their most relaxed conversations seemed stilted lacking the natural flow of gestures and facial expressions that are typical among friends the relevance of these observations became clear only after I had met the body-based therapists Peter LaVine and Pat Ogden in the later chapters I'll have a lot to say about how trauma is held in people's
55:28 bodies making sense of suffering after my year on the research Ward I resumed medical school and then as a newly minted MD returned to mmhc to be trained as a psychiatrist a program to which I was thrilled to be accepted many famous psychiatrists had trained there including Eric kandell who later won the Nobel Prize in physiology and Medicine Alan Hobson discovered the brain cells responsible for the generation of Dreams in a lab in the hospital basement while I trained there and the first studies on the chemical underpinnings of depression were also conducted at mmhc but for many of us residents the greatest draw was the patients we spent six hours each day with them and then met as a group with senior psychiatrists to share our observations pose our questions and compete to make the wittiest remarks our
56:15 great teacher Elvin sred actively discouraged us from Reading Psychiatry textbooks during our first year this intellectual starvation diet May account for the fact that most of us later became voracious readers and prolific writers seid did not want our perceptions of reality to become obscured by the pseudo certies of psychiatric diagnosis I remember asking him once what would you call this patient schizophrenic or schizo effective he paused and stroked his chin apparently in deep thought I think I'd call him Michael McIntyre he replied SE taught us that most human suffering is related to love and loss and that the job of therapist is to help people acknowledge experience and bear the
57:00 reality of life with all its pleasures and heartbreak the greatest sources of our suffering are The Lies We Tell ourselves he' say urging us to be honest with ourselves about every facet of our experience he often said that people can never get better without knowing what they know and feeling what they feel I remember being surprised to hear this distinguished Old Harvard Professor confess how comforted he was to feel his wife's bum against him as he fell asleep at night by disclosing such simple human needs in himself he helped us recognize how basic they were to our lives failure to attend to them results in a stunted existence no matter how lofty our thoughts and worldly accomplishments healing he told us depends on experiential knowledge you can be fully
57:47 in charge of your life only if you can acknowledge the reality of your body in all its visceral Dimensions our profession however was moving in a different direction in 1968 the American Journal of Psychiatry had published the results of the study from the Ward where I'd been an attendant they showed unequivocally that schizophrenic patients who received drugs alone had a better outcome than those who talked three times a week with the best therapists in boston3 the study was one of many Milestones on a road that gradually changed how medicine and Psychiatry approached psychological problems from infinitely variable expressions of Intolerable feelings and relationships to a brain disease model of of discreet disorders the way medicine approaches human suffering has always been determined by the technology
58:33 available at any given time before the enlightenment aberration in Behavior were ascribed to God sin magic witches and evil spirits it was only in the 19th century that scientists in France and Germany began to investigate Behavior as an adaptation to the complexities of the world now a new paradigm was emerging anger lust Pride greed avarice and cloth 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 point for many psychiatrists were relieved and delighted to become real scientists just like their med school classmates who had Laboratories animal experiments expensive equipment and complicated diagnostic tests and set aside the wooly-headed theories of philosophers
59:19 like Freud and Yung 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 five like my colleagues I eagerly embraced the pharmacological revolution in 1973 I became the first chief resident in psychopharmacology at mmhc I may also have been the first psychiatrist in Boston to administer lithium to a manic depressive patient I'd read about John Cade's work with lithium in Australia and I received permission from a hospital committee to try it on lithium a woman who had been manic every May for the past 35 years and suicidally depressed every November stopped cycling and remained stable for the 3 years she was under my care I was
1:00:07 also part of the first US research team to test the antipsychotic closural on chronic patients who were warehoused in the back Wards of the old insane asylums 6 some of their responses were miraculous people who had spent much of their lives locked in their own separate terrifying realities were now able to return to their families and communities patient mired in darkness and despair started to respond to the beauty of human contact and the pleasures of work and play these amazing results made us optimistic that we could finally conquer human misery antipsychotic drugs were a major factor in reducing the number of people living in Mental Hospitals in the United States from over 500,000 in 1955 to fewer than 100,000 in 1996. 7 for people today who did not know the world before the Advent of these treatments
1:00:53 the change is almost unimaginable as a first year medical student I visited Kaki State Hospital in Illinois and saw a Burly Ward attendant hos down dozens of filthy naked incoherent patience in
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