The Body Keeps the Score -notes

70 Highlights | 36 Notes

Highlight (Yellow) | Location 196

This vast increase in our knowledge about the basic processes that underlie trauma has also opened up new possibilities to palliate or even reverse the damage. | Location 699

patients often complain about a vague sense of emptiness and boredom when they are not angry, under duress, or involved in some dangerous activity.

Highlight (Orange) | Location 707

Freud had a term for such traumatic reenactments: “the compulsion to repeat.” He

Highlight (Orange) and Note | Location 829

Because drugs have become so profitable, major medical journals rarely publish studies on nondrug treatments of mental health problems.31 Practitioners who explore treatments are typically marginalized as “alternative.” Studies of nondrug treatments are rarely funded unless they involve so-called manualized protocols, where patients and therapists go through narrowly prescribed sequences that allow little fine-tuning to individual patients’ needs. Mainstream medicine is firmly committed to a better life through chemistry, and the fact that we can actually change our own physiology and inner equilibrium by means other than drugs is rarely considered.

Highlight (Orange) and Note | Location 835

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 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 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.

There are other, better, cheaper, more rewarding approaches.

Highlight (Orange) | Location 994

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.

Highlight (Orange) | Location 1316

Both Stan and Ute had become hypersensitive and irritable after the accident, suggesting that their prefrontal cortex was struggling to maintain

Highlight (Orange) and Note | Location 1435

How many mental health problems, from drug addiction to self-injurious behavior, start as attempts to cope with the unbearable physical pain of our emotions? If Darwin was right, the solution requires finding ways to help people alter the inner sensory landscape of their bodies. Until recently, this bidirectional communication between body and mind was largely ignored by Western science, even as it had long been central to traditional healing practices in many other parts of the world, notably in India and China. Today it is transforming our understanding of trauma and recovery.

Mindfulness training, again! Get going!

Highlight (Orange) and Note | Location 1465

Polyvagal refers to the many branches of the vagus nerve—Darwin’s “pneumogastric nerve”—which connects numerous organs, including the brain, lungs, heart, stomach, and intestines.) The Polyvagal Theory provided 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 explained why a kind face or a soothing tone of voice can dramatically alter the way we feel. It clarified 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 helped us understand why focused attunement with another person can shift us out of disorganized and fearful states.

What we hear and see from others does much to set our tone. Often hard to be both upbeat and honest.

Highlight (Orange) | Location 1508

Highlight (Orange) | Location 1567

HOW WE BECOME HUMAN

Highlight (Orange) and Note | Location 1614

Sadly, our educational system, as well as many of the methods that profess to treat trauma, tend to bypass this emotional-engagement system and focus instead on recruiting the cognitive capacities of the mind. 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 last things that should be cut from school schedules are chorus, physical education, recess, and anything else involving movement, play, and joyful engagement.

Words and explanations are not the most important things.

Highlight (Orange) and Note | Location 1674

I discovered that my professional training, with its focus on understanding and insight, had largely ignored the relevance of the living, breathing body, the foundation of our selves.

This is true of many training programs. Often "safer" to ignore the body.

BEFRIENDING THE BODY

Highlight (Orange) and Note | Location 1910

In order to change, people need to become aware of their sensations and the way that their bodies interact with the world around them. Physical self-awareness is the first step in releasing the tyranny of the past.

Pay attention to body signals for good mental and physical health.

Highlight (Orange) | Location 2012

MEN WITHOUT MOTHERS

Highlight (Orange) and Note | Location 2014

The first time I visited the famed Tavistock Clinic in London I noticed a collection of black-and-white photographs of these great twentieth-century psychiatrists hanging on the wall going up the main staircase: John Bowlby, Wilfred Bion, Harry Guntrip, Ronald Fairbairn, and Donald Winnicott. Each of them, in his own way, had explored how our early experiences become prototypes for all our later connections with others, and how our most intimate sense of self is created in our minute-to-minute exchanges with our caregivers.

Great British psychiatrists

Highlight (Orange) | Location 2067

Most parents relate to their babies

Highlight (Orange) | Location 2413

Nonetheless, learning to recognize irrational thoughts and behavior can be a useful first step.

Highlight (Orange) and Note | Location 2544

Psychiatry, as a subspecialty of medicine, aspires to define mental illness as precisely as, let’s say, cancer of the pancreas, or streptococcal infection of the lungs. However, given the complexity of mind, brain, and human attachment systems, we have not come even close to achieving that sort of precision. Understanding what is “wrong” with people currently is more a question of the mind-set of the practitioner (and of what insurance companies will pay for) than of verifiable, objective facts.

What the doctor sees, thinks, feels, and remembers has a strong effect on the diagnosis and treatment

Highlight (Orange) | Location 2754

were twice as likely to suffer from cancer and

Highlight (Orange) and Note | Location 2952

Eighty two percent of the traumatized children seen in the National Child Traumatic Stress Network do not meet diagnostic criteria for PTSD.15 Because they often are shut down, suspicious, or aggressive they now receive pseudoscientific diagnoses such as “oppositional defiant disorder,” meaning “This kid hates my guts and won’t do anything I tell him to do,” or “disruptive mood dysregulation disorder,” meaning he has temper tantrums. Having as many problems as they do, these kids accumulate numerous diagnoses over time. Before they reach their twenties, many patients have been given four, five, six, or more of these impressive but meaningless labels. If they receive treatment at all, they get whatever is being promulgated as the method of management du jour: medications, behavioral modification, or exposure therapy. These rarely work and often cause more damage.

Traumatized kids are often misdiagnosed...

Highlight (Orange) | Location 3139

Frontline mental health workers—overwhelmed and underpaid social workers and therapists alike—seem to agree

Highlight (Orange) | Location 3145

Economists have calculated that every dollar invested in high-quality home visitation, day care, and preschool programs results in seven dollars of savings on welfare payments, health-care costs, substance-abuse treatment, and incarceration, plus higher tax revenues due to better-paying jobs.37

But for me the real hero of this story is Pierre Janet, who helped Charcot establish a research laboratory devoted to the study of hysteria

Highlight (Orange) | Location 3469

Army chief of staff General Douglas MacArthur commanded the troops, supported by six tanks. Major Dwight D. Eisenhower was the liaison with the Washington police, and Major George Patton was in

Highlight (Orange) | Location 3472

Highlight (Orange) | Location 3543

also suggested they look at an article published in The Lancet in 1944, which described the aftermath of the rescue of the entire British army from the beaches of Dunkirk in 1940.

Highlight (Orange) and Note | Location 3812

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 inside ourselves.

Trying to befriend and sympathize with myself

Highlight (Orange) and Note | Location 3817

Some 80 percent of the fibers of the vagus nerve (which connects the brain with many internal organs) are afferent; that is, they run from the body into the brain.6 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 every religious practice that I know of, but that is suspiciously eyed as “alternative” in mainstream culture.

Highlight (Orange) and Note | Location 3828

The more you stay focused on your breathing, the more you will benefit, particularly if you pay attention until the very end of the out breath and then wait a moment before you inhale again. As you continue to breathe and notice the air moving in and out of your lungs you may think about the role that oxygen plays in nourishing your body and bathing your tissues with the energy you need to feel alive and engaged.

Conscious breathing really helps.

Highlight (Orange) | Location 3915

Unresolved trauma can take a terrible toll on relationships. If your heart is still broken because you were assaulted by someone you loved, you are likely preoccupied with not getting hurt again.

Highlight (Orange) | Location 3917

This poses a real challenge for recovery. Once you recognize that posttraumatic reactions started off as efforts to save your life, you may gather the courage to face your inner music (or cacophony), but you will need help to do so. You have to find someone you can trust enough to accompany you, someone who can safely hold your feelings and help you listen to the painful messages from your emotional brain. You need a guide who is not afraid of your terror and who can contain your darkest rage, someone who can safeguard the wholeness of you while you explore the fragmented experiences that you had to keep secret from yourself for so long. Most traumatized individuals need an anchor and a great deal of coaching to do this work.

Highlight (Orange) | Location 3928

There is no one “treatment of choice” for trauma, and any therapist who believes that his or her particular method is the only answer to your problems is suspect of being an ideologue rather than somebody who is interested in your getting better

Highlight (Orange) and Note | Location 4196

Since I have started to integrate mindfulness and yoga into my practice, I use these medications less often, except occasionally to help patients sleep more restfully.

Mindfulness practice and yoga help trauma victims.

Highlight (Orange) | Location 4239

Nursing kept him frazzled, explosive, and on edge, but he had no idea that these problems had anything to do with what he had experienced in Vietnam.

Highlight (Orange) and Note | Location 4294

Dr. Spencer Eth, who ran the psychiatry department at the now-defunct St. Vincent’s Hospital in Greenwich Village, was curious where survivors had turned for help, and early in 2002, together with some medical students, he conducted a survey of 225 people who had escaped from the Twin Towers. Asked what had been most helpful in overcoming the effects of their experience, the survivors credited acupuncture, massage, yoga, and EMDR, in that order.1 Among rescue workers, massages were particularly popular.

What helped most, according to those who needed care

Highlight (Pink) and Note | Location 4437

There are other ways to access your inner world of feelings. One of the most effective is through writing. Most of us have poured out our hearts in angry, accusatory, plaintive, 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 judgment—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.

In contrast, EMDR, as well as the treatments discussed in subsequent chapters—internal family systems, yoga, neurofeedback, psychomotor therapy, and theater—focus 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.

Trauma needs special non-verbal care, not too fast or pushy.

Highlight (Orange) and Note | Location 4868

In a series of elegant studies Stickgold and his colleagues showed that the sleeping brain can even make sense out of information whose relevance is unclear while we are awake and integrate it into the larger memory system. 13The brain is busy during sleep

Highlight (Orange) and Note | Location 5019

Dave’s visit eventually grew into a very active yoga program, and in due course we received the first grant from the National Institutes of Health to study the effects of yoga on PTSD. Dave’s work also contributed to my developing my own regular yoga practice and becoming a frequent teacher at Kripalu, a yoga center in the Berkshire Mountains in western Massachusetts. (Along the way, my own HRV pattern improved as well.)

Yoga practice for mind and brain health

Highlight (Orange) and Note | Location 5022

We could simply have used any of a number of reasonably priced handheld devices that train people to slow their breathing and synchronize it with their heart rate, resulting in a state of “cardiac coherence” like the pattern shown in the first illustration above.9 Today there are a variety of apps that can help improve HRV with the aid of a smartphone.10 In our clinic we have workstations where patients can train their HRV, and I urge all my patients who, for one reason or another, cannot practice yoga, martial arts, or qigong to train themselves at home. (See Resources for more information.)

Train breathe for improved health

Highlight (Orange) and Note | Location 5046

Many of our patients are barely aware of their breath, so learning to focus on the in and out breath, to notice whether the breath was fast or slow, and to count breaths in some poses can be a significant accomplishment.13

Becoming able to focus on your breath

Highlight (Orange) and Note | Location 5052

In our studies we keep seeing how difficult it is for traumatized people to feel completely relaxed and physically safe in their bodies. We measure our subjects’ HRV by placing tiny monitors on their arms during shavasana, the pose at the end of most classes during which practitioners lie face up, palms up, arms and legs relaxed. Instead of relaxation we picked up too much muscle activity to get a clear signal. Rather than going into a state of quiet repose, our students’ muscles often continue to prepare them to fight unseen enemies. A major challenge in recovering from trauma remains being able to achieve a state of total relaxation and safe surrender.

Working to achieve total relaxation

Highlight (Orange) and Note | Location 5107

As I often tell my students, the two most important phrases in therapy, as in yoga, are “Notice that” and “What happens next?” Once you start approaching your body with curiosity rather than with fear, everything shifts.

Trauma makes you feel as if you are stuck forever in a helpless state of horror. In yoga you learn that sensations rise to a peak and then fall. For example, if an instructor invites you to enter a particularly

Highlight (Orange) and Note | Location 5530

One day he told me that he’d spent his adulthood trying to let go of his past, and he remarked how ironic it was that he had to get closer to it in order to let it go.

Highlight (Orange) | Location 5614

Feeling safe means you can say things to your father (or, rather, the placeholder who represents him) that you wish you could have said as a five-year-old.

Highlight (Orange) | Location 5696

Highlight (Orange) and Note | Location 5896

Since then the field of neurofeedback has grown by fits and starts, with much of the scientific groundwork being done in Europe, Russia, and Australia. Even though there are about ten thousand neurofeedback practitioners in the United States, the practice has not been able to garner the research funding necessary to gain widespread acceptance. One reason may be that there are multiple competing neurofeedback systems; another is that the commercial potential is limited. Only a few applications are covered by insurance, which makes neurofeedback expensive for consumers and prevents practitioners from amassing the resources necessary to do large-scale studies.

Our minds can learn if we give them a chance

Highlight (Orange) and Note | Location 5937

I cut myself up really badly with the lid of a tin can. They took me to the emergency room, but I couldn’t tell the doctor what I had done to cut myself—I didn’t have any memory of it. The ER doctor was convinced that dissociative identity disorder didn’t exist. . . . A lot of people involved in mental health tell you it doesn’t exist. Not that you don’t have it, but that it doesn’t exist.”

Diagnosis is still a messy area

Highlight (Orange) and Note | Location 5950

If you’re still in it, it’s hard to talk about it. I wasn’t able to attach in the way that you need to attach and open up in the way that you need to open up in order to have any type of relationship with a therapist.” This was a stunning revelation: So many patients are in and out of treatment, unable to meaningfully connect because they are still “in it.” Of course, when people don’t know who they are, they can’t possibly see the reality of the people around them.

Because most of these patients suffered from alexithymia, it was not easy for them to report their response to the treatments. But their actions spoke for them: They consistently showed up on time for their appointments, even if they had to drive through snowstorms. None of them dropped out, and at the end of the full twenty sessions, we could document significant improvements not only in their PTSD scores,10 but also in their interpersonal comfort, emotional balance, and self-awareness.11 They were less frantic, they slept better, and they felt calmer and more focused. In any case, self-reports can be unreliable; objective changes in behavior are much better indicators of how well treatment works.

Giving the mind a chance to help the mind

Highlight (Orange) and Note | Location 5988

How did his brain come to derive comfort from fishing rather than from compulsive sexual behavior? At this point we simply don’t know. Neurofeedback changes brain connectivity patterns; the mind follows by creating new patterns of engagement.

From within can come a better way

Highlight (Orange) | Location 6072

The net effect is that arousal, which is supposed to provide us with the energy

Highlight (Orange) and Note | Location 6146

In my practice I use neurofeedback primarily to help with the hyperarousal, confusion, and concentration problems of people who suffer from developmental trauma. However, it has also shown good results for numerous issues and conditions that go beyond the scope of this book, 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 in mood disorders, and more.

Neurofeedback is underused in the U.S. Possibly too inexpensive to seem profitable.

Highlight (Orange) | Location 6284

One tragic example of this orientation is the rampant prescription of painkillers, which now kill more people each year in the United States than guns or car accidents.

A major source of death

Highlight (Orange) and Note | Location 6554

Our increasing use of drugs to treat these conditions 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? 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, pay attention, and make choices? Do they have a sense of purpose? What are they good at? How can we help them feel in charge of their lives?

Important questions

Highlight (Orange) and Note | Location 6640

Self-regulation can be taught to many kids who cycle between frantic activity and immobility. In addition to reading, writing, and arithmetic, all kids need to learn self-awareness, self-regulation, and communication as part of their core curriculum. Just as we teach history and geography, we need to teach children how their brains and bodies work. For adults and children alike, being in control of ourselves requires becoming familiar with our inner world and accurately identifying what scares, upsets, or delights us.

Breathing is a tool anyone can use to calm down

Highlight (Blue) | Location 6644

Emotional intelligence starts with labeling your own feelings and attuning

Highlight (Orange) and Note | Location 6655

Games like Simon Says lead to lots of sniggering and giggling—signs of safety and relaxation. When teenagers balk at these “stupid games,” we nod understandingly and enlist their cooperation by asking them to demonstrate games to the little kids, who “need their help.”

Helping those who are younger is a lovely tool.

Highlight (Orange) and Note | Location 8123

B. A. van der Kolk, et al., “Yoga as an Adjunctive Therapy for PTSD,” Journal of Clinical Psychiatry 75, no. 6 (June 2014): 559–65.

Study of yoga as PTSD therapy