The Body Keeps the Score – Looking into the Brain

In a little over a week, I and the (mental) health director of the Jeffry Stijn Foundation for Mental Health and Patient Advocacy, will be attending the 34th Annual Boston International Trauma Conference virtually. A few days ago I decided to read Bessel van der Kolk‘s “The Body Keeps the Score” and journal as I read.

I was planning on writing a summary post after I was done. But Chapter 3: Looking into the Brain. The Neuroscience Revolution, demanded immediate attention.

Here’s an excerpt from the original post.

I am told they work according to evidence-based approaches, yet when I show evidence, by world-renowned scientists and research institutes such as Harvard, it’s still not enough. What will it take?

And even if there would be irrefutable proof, what then?

Being Asked to Provide Evidence, Then Promptly Ignoring the Evidence

This is particularly triggering to me for a rather bizarre reason. I come from a family where law is heavily respected and a large part of my family have studied law. And the other side of my family comes from generations of people who have studied at University. So logic and proof were par for the course from both sides of my family.

Since childhood, I learned a very important lesson, that I still haven’t completely unlearned. If I can’t prove something, it can’t be true. That’s fine in legal professions or in academic circles. But not when it comes to dealing with children and their emotions and reactions.

A Plea to Anyone Who Deals With Traumatized People

Most people don’t react differently for no reason. I beg of anyone, whether you’re a parent or a partner or even a therapist, to please stop putting the burden of proof on the person who’s traumatized. They’re traumatized; that’s all the proof you need in order to support them in their journey to find the proof they need to resolve their experiences.

And if along the way you help them find proof that can be used in a court of law, or to help them get therapies that actually work, that’s just a bonus.

I recommend that anyone who experiences flashbacks has loved ones who experience flashbacks or treats people with flashbacks, reads this chapter.

What Happens in the Brain During Flashbacks

“Harvard Medical School was and is at the forefront of the neuroscience revolution, and in 1994 a young psychiatrist, Scott Rauch, was appointed as the first director of the Massachusetts General Hospital Neuroimaging Laboratory. After considering the most relevant questions that this new technology could answer and reading some articles I had written, Scott asked me whether I thought we could study what happens in the brains of people who have flashbacks.”

“The Body Keeps the Score: Mind, Brain and Body in the Transformation of Trauma” by Bessel van der Kolk

After some of van der Kolk’s patients had told him about their flashbacks and “how upsetting it was to be suddenly hijacked by images, feelings, and sounds from the past,” he and his research team took brain scans of people while they were experiencing a flashback. And compared them to brain scans of the same people when they were feeling safe.

This research was done at Harvard Medical School. Their programs and research when it comes to neurobiology and the brain are hailed world-wide.

The Limbic Area & the Amygdala

“Our study clearly showed that when traumatized people are presented with images, sounds, or thoughts related to their particular experience, the amygdala reacts with alarm—even […] years after the event. 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.”

“The Body Keeps the Score: Mind, Brain and Body in the Transformation of Trauma” by Bessel van der Kolk

The limbic area is what is known as the emotional brain. It’s an area that is activated by intense emotion. Within this area is also the amygdala. The area of the brain that “warn[s] us of impending danger and to activate the body’s stress response.”

Broca’s area – The Speech Center

“Our most surprising finding was a white spot in the left frontal lobe of the cortex, in a region called Broca’s area. In this case the change in color meant that there was a significant decrease in that part of the brain. 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. Without a functioning Broca’s area, you cannot put your thoughts and feelings into words. Our scans showed that Broca’s area went offline whenever a flashback was triggered. In other words, we had visual proof that the effects of trauma are not necessarily different from—and can overlap with—the effects of physical lesions like strokes.”

“The Body Keeps the Score: Mind, Brain and Body in the Transformation of Trauma” by Bessel van der Kolk

I clearly remember sitting next to a therapist in the passenger seat of his car as part of exposure therapy. I was experiencing a terrible flashback. All he did was constantly ask me to tell him what was going on. I couldn’t speak. I couldn’t put it into words. His frustration grew until he finally said “if you won’t talk to me, I can’t help you.” These words haunt me to this day.

Later, when I tried to explain to him what happened, he completely dismissed me and that I couldn’t speak at that time. It was all me. I was refusing to cooperate, so there was no point in treating me.

Brodman’s Area 19 – The Visual Cortex

“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, lit up in our participants. This is a region in the visual cortex that registers images when they first enter the brain. We were surprised to see brain activation in this area so long after the original experience of the trauma. Under ordinary conditions raw images registered in area 19 are rapidly diffused to other brain areas that interpret the meaning of what has been seen. Once again, we were witnessing a brain region rekindled as if the trauma were actually occurring.”

“The Body Keeps the Score: Mind, Brain and Body in the Transformation of Trauma” by Bessel van der Kolk

I have no words to accurately describe this. I usually wake up every few hours from nightmares. It’s been like this for more than 8 years now. The frequency of my flashbacks has diminished, but a few years ago they were almost constant.

It’s terrifying. A tiny part of me knows that what I’m re-experiencing is in the past. But that doesn’t help in stopping the flashback from overwhelming me in the here and now.

Deactivation of the Left Side of the Brain During a Flashback

“[…] our scans clearly showed that images of past trauma activate the right hemisphere of the brain and deactivate the left.”

“The Body Keeps the Score: Mind, Brain and Body in the Transformation of Trauma” by Bessel van der Kolk

I think this part affected me the most. I cannot begin to express the feeling of absolute loss of rationality during a flashback. To now realize that half of my brain is deactivated during flashbacks is still hard. Rationally I understand, but my body, my feelings scream in denial. It’s a war. In my core I don’t want to accept this. Even if my brain knows perfectly well that it’s based on research. They’re facts.

“Deactivation of the left hemisphere has a direct impact on the capacity to organize experience into logical sequences and to translate our shifting feelings and perceptions into words. (Broca’s area, which blacks out during flashbacks, is on the left side.) 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.”

“The Body Keeps the Score: Mind, Brain and Body in the Transformation of Trauma” by Bessel van der Kolk

When I’m not in a flashback, I am perfectly capable of logic and reasoning, and I can easily put perceptions into words. When I’m triggered, I lose this ability. Yet my environment expects me to still be able to do what I can’t. And honestly, I expect it of myself too. Asking my environment to lower their expectations of me has proven impossible. But I can lower my own expectations of myself.

Denial: the Silent Killer

“We now know that there is another possible response to threat, which our scans aren’t yet capable of measuring. Some people simply go into denial: Their bodies register the threat, but their conscious minds go on as if nothing has happened. However, even though the mind may learn to ignore the messages from the emotional brain, the alarm signals don’t stop. The emotional brain keeps working, and stress hormones keep sending signals to the muscles to tense for action or immobilize in collapse. The physical effects on the organs go on unabated until they demand notice when they are expressed as illness. Medications, drugs, and alcohol can also temporarily dull or obliterate unbearable sensations and feelings. But the body continues to keep the score.”

“The Body Keeps the Score: Mind, Brain and Body in the Transformation of Trauma” by Bessel van der Kolk

This. Just this. I was not in denial of acute and chronic traumas in my past. The treatment I received for those worked well, and I still put the lessons I learned then into practice. But I was in denial about my root trauma. Until I collapsed spectacularly about 5 years ago. But the effects of denial started long before that.

Going Against a Hundred Years of Literature

“For a hundred years or more, every textbook of psychology and psychotherapy has advised that some method of talking about distressing feelings can resolve them. However, as we’ve seen, the experience of trauma itself gets in the way of being able to do that. No matter how much insight and understanding we develop, the rational brain is basically impotent to talk the emotional brain out of its own reality. “

“The Body Keeps the Score: Mind, Brain and Body in the Transformation of Trauma” by Bessel van der Kolk

I’ve been trying to explain this to therapists and my environment for as long as I can remember. The assumption that because I can talk about distressing feelings and situations, and can rationally analyze what happens to me when I’m not in a flashback or unhealthy survival mode, has been a hinder.

I wonder why this is so difficult for people to accept. This is my reality. Yet over and over again I’m offered more talk therapy. And then given more diagnoses to try and explain why the talk therapy isn’t working. My greatest breakthroughs in recovering from acute trauma were during somatic therapies.

What Happens in the Brain During Flashbacks

“Harvard Medical School was and is at the forefront of the neuroscience revolution, and in 1994 a young psychiatrist, Scott Rauch, was appointed as the first director of the Massachusetts General Hospital Neuroimaging Laboratory. After considering the most relevant questions that this new technology could answer and reading some articles I had written, Scott asked me whether I thought we could study what happens in the brains of people who have flashbacks.”

“The Body Keeps the Score: Mind, Brain and Body in the Transformation of Trauma” by Bessel van der Kolk

After some of van der Kolk’s patients had told him about their flashbacks and “how upsetting it was to be suddenly hijacked by images, feelings, and sounds from the past,” he and his research team took brain scans of people while they were experiencing a flashback. And compared them to brain scans of the same people when they were feeling safe.

This research was done at Harvard Medical School. Their programs and research when it comes to neurobiology and the brain are hailed world-wide.

The Limbic Area & the Amygdala

“Our study clearly showed that when traumatized people are presented with images, sounds, or thoughts related to their particular experience, the amygdala reacts with alarm—even […] years after the event. 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.”

“The Body Keeps the Score: Mind, Brain and Body in the Transformation of Trauma” by Bessel van der Kolk

The limbic area is what is known as the emotional brain. It’s an area that is activated by intense emotion. Within this area is also the amygdala. The area of the brain that “warn[s] us of impending danger and to activate the body’s stress response.”

I have written before that trauma can affect people physically. “Exposure to complex trauma in early childhood leads to structural and functional brain changes. […] Proven structural changes include enlargement of the amygdala, the alarm center of the brain.”

Broca’s area – The Speech Center

“Our most surprising finding was a white spot in the left frontal lobe of the cortex, in a region called Broca’s area. In this case the change in color meant that there was a significant decrease in that part of the brain. 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. Without a functioning Broca’s area, you cannot put your thoughts and feelings into words. Our scans showed that Broca’s area went offline whenever a flashback was triggered. In other words, we had visual proof that the effects of trauma are not necessarily different from—and can overlap with—the effects of physical lesions like strokes.”

“The Body Keeps the Score: Mind, Brain and Body in the Transformation of Trauma” by Bessel van der Kolk

I remember clearly sitting next to a therapist in the passenger seat of his car as part of exposure therapy. I was experiencing a terrible flashback. All he did was constantly ask me to tell him what was going on. I couldn’t speak. I couldn’t put it into words. His frustration grew until he finally said “If you won’t talk to me, I can’t help you.” These words haunt me to this day.

Later, when I tried to explain to him what happened, he completely dismissed me and that I couldn’t speak at that time. It was all me. I was refusing to cooperate, so there was no point in treating me.

“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 on common experience or an imaginable past.”

“The Body Keeps the Score: Mind, Brain and Body in the Transformation of Trauma” by Bessel van der Kolk

I can talk about what happened to me. What was done to me? But in order to do that I need to shut off all feeling. Which is triggering in itself. It turns out I’m not alone in this. It’s called denial and comes up a little later in this chapter.

Brodman’s Area 19 – The Visual Cortex

“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, lit up in our participants. This is a region in the visual cortex that registers images when they first enter the brain. We were surprised to see brain activation in this area so long after the original experience of the trauma. Under ordinary conditions raw images registered in area 19 are rapidly diffused to other brain areas that interpret the meaning of what has been seen. Once again, we were witnessing a brain region rekindled as if the trauma were actually occurring.”

“The Body Keeps the Score: Mind, Brain and Body in the Transformation of Trauma” by Bessel van der Kolk

I have no words to accurately describe this. I usually wake up every few hours from nightmares. It’s been like this for more than 8 years now. The frequency of my flashbacks has diminished, but a few years ago they were almost constant.

It’s terrifying. A tiny part of me knows that what I’m re-experiencing is in the past. But that doesn’t help me in stopping the flashback from overwhelming me in the here and now.

“Similar sensations often trigger a flashback that brings them back into consciousness, apparently unmodified by the passage of time.”

“The Body Keeps the Score: Mind, Brain and Body in the Transformation of Trauma” by Bessel van der Kolk

Since I was a little kid it was explained to me that I would experience things that would scare me or make me nervous. I was told and believed that this would go away with the passage of time. Mostly they never did.

Deactivation of the Left Side of the Brain During a Flashback

“[…] our scans clearly showed that images of past trauma activate the right hemisphere of the brain and deactivate the left.”

“The Body Keeps the Score: Mind, Brain and Body in the Transformation of Trauma” by Bessel van der Kolk

I think this part affected me the most. I cannot begin to express the feeling of absolute loss of rationality during a flashback. To now realize that half of my brain is deactivated during flashbacks is still hard. Rationally I understand, but my body, my feelings scream in denial. It’s a war. In my core I don’t want to accept this. Even if my brain knows perfectly well that it’s based on research. They’re facts.

“Deactivation of the left hemisphere has a direct impact on the capacity to organize experience into logical sequences and to translate our shifting feelings and perceptions into words. (Broca’s area, which blacks out during flashbacks, is on the left side.) 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.”

“The Body Keeps the Score: Mind, Brain and Body in the Transformation of Trauma” by Bessel van der Kolk

When I’m not in a flashback, I am perfectly capable of logic and reasoning, and I can easily put perceptions into words. When I’m triggered, I lose this ability. Yet my environment expects me to still be able to do what I can’t. And honestly, I expect it of myself too. Asking my environment to lower their expectations of me has proven impossible. But I can lower my own expectations of myself.

Trauma Interferes with Awareness

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 somebody to blame for it. They behaved the way they did because you were ten minutes late, or because you burned the potatoes, or because you “never listen to me.” 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, and, over time, our research demonstrated why.

“The Body Keeps the Score: Mind, Brain and Body in the Transformation of Trauma” by Bessel van der Kolk

I REALLY want to skip ahead and read the research into this. Not just for myself. By now I’m fairly aware of my reactions and behavior. I still can’t always stop it from happening, but I have always tried to go back and explain my reactions. These days the people closest to me accept this of me. And when they experience it themselves, have started to reciprocate. It’s a process. One that is incredibly helpful to me.

The Essence Does Not Equal Integration

“I am continually impressed by how difficult it is for people who have gone through the unspeakable to convey the essence of their experience. It is so much easier for them to talk about what has been done to them—to tell a story of victimization and revenge—than to notice, feel, and put into words the reality of their internal experience. Our scans had revealed how their dread persisted and could be triggered by multiple aspects of daily experience. They had not integrated their experience into the ongoing stream of their life. They continued to be “there” and did not know how to be “here”—fully alive in the present.”

“The Body Keeps the Score: Mind, Brain and Body in the Transformation of Trauma” by Bessel van der Kolk

I can’t adequately explain the impact of this on me. I can convey the essence of my experience. So in that sense I’m much further along than some. Yet when I do convey the essence, it’s treated as though it’s nothing. Reading that an expert in the field of trauma is impressed by people who can is ambiguous. Maybe because I trivialize myself in this. I don’t find it impressive at all; it is a basic necessity in order to survive for me.

The Personal

I am told they work according to evidence-based approaches, yet when I show evidence, by world-renowned scientists and research institutes such as Harvard, it’s still not enough. What will it take?

And even if there would be irrefutable proof, what then?

Being Asked to Provide Evidence, Then Promptly Ignoring the Evidence

This is particularly triggering to me for a rather bizarre reason. I come from a family where law is heavily respected and a large part of my family have studied law. And the other side of my family comes from generations of people who have studied at University. So logic and proof were par for the course from both sides of my family.

Since childhood, I learned a very important lesson, that I still haven’t completely unlearned. If I can’t prove something, it can’t be true. That’s fine in legal professions or in academic circles. But not when it comes to dealing with children and their emotions and reactions.

A Plea to Anyone Who Deals With Traumatized People

Most people don’t react differently for no reason. I beg of anyone, whether you’re a parent or a partner or even a therapist, to please stop putting the burden of proof on the person who’s traumatized. They’re traumatized; that’s all the proof you need in order to support them in their journey to find the proof they need to resolve their experiences.

And if along the way you help them find proof that can be used in a court of law, or to help them get therapies that actually work, that’s just a bonus.