The devastating effects of trauma [and the return of Freud, albeit unnamed?]

Ezra Klein, This Conversation Will Change How You Think About Trauma, NYTimes, Aug 24, 2021.

Klein interviews Bessel van der Kolk about his book, The Body Keeps the Score (2014). I've not yet read the interview, but Klein's introduction makes the book sound very Freudian without mentioning that (dreaded) name.

I’ll be honest of my own history of it here. “The Body Keeps the Score” is one of those books people have told me to read for a long time. But I thought I knew what it was about. I’d heard it discussed so many times, and I’d read it written about. So even though I hadn’t read it, I thought I knew it: trauma lodges in the body, we carry a physical imprint of our psychic wounds, it’s all very hard to heal. Got it.

But I was really wrong about that. The core argument is — I want to use the word “subversive” here. Certainly subversive in how it will leave you thinking about yourself and those around you. It is about traumatic experiences: sexual assault, incest, emotional physical abuse, war and much, much more. They can disconnect our body and our mind. That is when an experience becomes a trauma — when it disconnects us.

And this is a part I didn’t understand from the way the book is talked about. The devastating argument it makes is not that the body keeps the score, it’s that the mind hides the score from us. The mind — it hides and warps these traumatic events and our narratives about them in an effort to protect us. Human beings are social animals. And our minds evolve to manage our social relationships.

So when we face an event that could rupture our relationship with the community or the family, particularly for children of the family that we depend on, the mind often talks us out of it. It obscures the memories or convinces us our victimization was our fault or it covers the event in a shame so thick, we refuse to discuss it. But our body — and that’s an imprecise term here. But the parts of us that are more automatic that manage and respond to threat — our body doesn’t forget that. Our mind can’t talk that part of us into feeling safe again. And it’s this disconnection of mind and body where trauma lives.

From the beginning of the interview:

EZRA KLEIN: You have this very powerful line in the book from the writer Jessica Stern where she says, quote, “Some people’s lives seem to flow in a narrative. Mine had many stops and starts. That’s what trauma does — it interrupts the plot.” Tell me a bit about how trauma interrupts the plot.

BESSEL VAN DER KOLK: Well, trauma is really a wound that happens to your psyche, to your mind, to your brain. Suddenly you’re confronted with something that you are faced with horror and helplessness. That nothing prepares you for this and you go like, oh, my God. And so something switches off at that point in your mind and your brain. And the nature of trauma is that you get stuck there. So instead of remembering something unpleasant, you keep reliving something very unpleasant.

So the job of overcoming trauma is to make it into a memory where your whole being knows this happened a long time ago, it’s not happening right now. But the nature of traumatic stress is that you keep reacting emotionally and physiologically as if these events are happening right now.

More later, possibly.

Later:

EZRA KLEIN: Tell me a bit about the conditions under which an event that could be traumatic becomes a trauma. And in particular, I was very struck by how much of your research suggests that trauma is an event plus a kind of instigated social crisis. There are objectively catastrophic events, like 9/11, that were less likely to cause trauma because they were shared by the community. Where, on the other hand, things like child sexual abuse is very reliably traumatic because it disconnects you from your family. So could you talk a bit about the social structure of trauma?

BESSEL VAN DER KOLK: Yeah. So what we tend to leave out of most of our discussions about human functioning is to what degree we are primates. We have brains in order to get along with each other, to be with other people, to connect with other people. That’s really what we are fundamentally all about. And so, much of trauma is about a rupture of the safety of the people who are supposed to protect you and the people who are supposed to come to your help.

So basically, the way that we are wired is that we are wired to not be able to do everything by ourselves, but to be able to look for help and for other people to take over when we can no longer do the job ourselves. And that’s perfectly normal. But if, at that point, the people you can count on most are not there for you, let you down, have been killed, or whatever, then it’s entirely up to you. It’s a much harder thing to deal with terrible situations. [...]

And sometimes, in order to survive, you need to keep your realities [INAUDIBLE] the people around you. And so when you go through a terrible reality like 9/11 in New York or terrible natural disasters, oftentimes people get very close together because it’s out there, everybody can see it, people help each other. Part of our nature is to be altruistic and to be generous when people are in distress.

But if your feelings conflict with your loyalty — let’s say, if your own mom or dad beat you up and you don’t feel safe with them — you cannot tell other people about it either because you’re supposed to love your mom or dad. And so you need to keep it to yourself. And then it starts festering inside of you. So the reason why you do psychotherapy is mainly to help people to find words for the reality that they have dealt with. And oftentimes, those are realities that are not acceptable for the people around you. [...]

So the issue there is that we need our parents or caregivers to take care of us. And so the moment we give up on our caregivers as little kids, we’re done for. And so the way the child is wired is to stay as close to the people who are supposed to take care of them as possible. And with that, they will deny the reality of being beaten. Or the imprint is very much like, I’m being beaten or I’m being molested because I’m a bad person. I must deserve it.

So your identity becomes basically, I’m fundamentally a bad and flawed human being. And if I had been a nicer child, people would have loved me and taken care of me.

A bit later Van Der Kolk mentions John Bowlby, who was trained as a psychoanalyst:

But the great hero here is John Bowlby, attachment researcher, who really showed how children really need to cling to their caregivers and will do anything they can to keep a semblance of connection going so they don’t die or get totally abandoned. And the price they pay for that is very much this very profound sense of self loathing, oftentimes despising yourself, getting into a lot of difficult behaviors because I’m no good anyway. And it’s a deep sense of, I may as well put myself in danger, I may as well take drugs because I’m no good anyway.

Therapy:

EZRA KLEIN: We’re going to go through a bunch of these therapies. But one thing I want to ask about them as a group is that one thing lurking around your book, and certainly that I felt reading it and that I felt in my own life as I’ve looked at various modalities for things that I’ve struggled with, is that there’s a hierarchy of status to different treatments. So it’s very accepted at this point, very rational, to take a pill for depression or anxiety. Talk therapy has a very long history. Nobody looks askance at that. That’s something intellectuals do in New York, and they sit in a chair and talk about feelings. And I don’t want to say anything bad about either of those. But then you start looking some of these other things, like E.M.D.R. which we can talk about, or dance therapy or yoga. And it feels soft. You’re like, well, that’s silly, that’s holistic, that’s — and something I think the book is trying to get at is that maybe we have come to overweight certain kinds of approaches to how we feel and underweight others. So before we get into how these therapies work, can you talk about that meta level of coming to respect therapies that maybe don’t have a lot of social status right now?

BESSEL VAN DER KOLK: Very important point you make. It’s a cultural issue. You hear from my accent, I’m northern European, and North America is still very northern European. The world and northern Europe developed two ways of dealing with bad stuff. One of them was to drink. And so taking a pill is a respectable thing in Western culture to do, and normal people ingest stuff to make themselves feel better.

Nobody feels bad about it. Other places in the world may say, that’s weird. Then the other thing that Western people are very good at is talking. We’re not very good in singing together and moving together. You go to China after a disaster and people are doing qigong together, and so that’s interesting, or tai chi.

And you go to Brazil in [INAUDIBLE] area, and you see people practice capoeira. You go, are they practicing capoeria because it looks good to the tourists, or are they practicing capoeira because it does something to the way they relate to their bodies and their sense of self-control?

So I think to some degree, we are trapped in this post- alcoholic paradigm that the only way to change is through taking pills or by talking. But of course, once you raise kids and you hang around with kindergarten teachers, they don’t do a lot of talking. They’d also do a lot of singing together, and a lot of moving together, and a lot of tossing balls together. And a lot of things that help you get in tune and in rhythm with each other.

And that’s not really the strong point of Western culture. So it all depends on the cultural assumptions you have about what’s helpful to people.

EZRA KLEIN: This part of the book made an interesting connection for me. I had the journalist Anna Sale on the show a couple of months ago for her book about having difficult conversations, and something she says in that book is that we used to have more institutions, and rituals, and conventions, and structures that guided us through the hard conversations, and hard parts of life.

I mean, things like churches and civic organizations. There is a lot of singing in those places, there is a lot of dancing in those places. I mean, you go to a Jewish synagogue, a lot of singing and dancing. And one point she was making is that as some of these institutions have faded in American life, we’ve been left without a template for these conversations.

But reading your book made me think of it on another level, too. I mean, a bunch of the modalities you just talked about, like capoeira or qigong, I don’t want to suggest they don’t have therapeutic roles, but they’re not primarily seen as therapeutic. They’re just a bigger part of those cultures.

And I wonder if you think that one of the issues with trauma in America is that we have lost institutions that were comfortable with ways of being embodied, even if they didn’t frame them in a “the body keeps the score” kind of framework that we used to have. And so they were playing roles that maybe they framed themselves as religious, or civic, or something else, or communal or ritual, but they were also doing things for how we process difficult issues or allowed us to get in touch with our emotions, that they had these side benefits that we didn’t understand and never knew how to measure.

Psychedelics:

BESSEL VAN DER KOLK: I think psychedelics are a true revolution. And it’s partially a revolution because we don’t know how they work. There’s all these explanations: oh, the serotonin system or the default mode network. But what has happened in the world we live in is that people pay varied attention to what happens in the mind.

And what we see in our MDMA research is that MDMA seems to really trigger a capacity to look at yourself in a more compassionate way, in the same way that MDMA is being used at parties. And when we do our work, very painful, painful, old things tend to come up. But people are able to go there and not get overwhelmed by shame, or overwhelmed by the horror.

And they’re able to go there and say, yeah, this is what happened to me. Oh my God, that was awful. And actually, I’m working on that paper right now, which I think is a very big deal, actually, is what you see is a dramatic increase in self compassion. People say, I now can really see what I went through, and how awful it was, and how I have survived it. [...]

So your world becomes more and more constrained. Pierre Janet already wrote it about 150 years ago. How you get narrow minded, and what Janet said back then also, he says, when you get traumatized, the mind has a hard time continuing to grow. The mind gets stuck in its effort to try to control itself, it becomes very hard to open your mind up to new things.

So when you’re traumatized, you oftentimes tend to have the same patterns over and over again. You have a hard time learning from experience. Your mind closes down. I think what psilocybin, ayahuasca, LSD do is they open up a new universe inside of yourself that somehow you need to cope with.

The way you phrased it is a little bit too deliberately cognitive for my mind. The mind does something to become aware — but even aware is too conscious — of that I’m a much smaller piece in the much larger universe, and a universal experience through these substances, which Carhart-Harris and Pollan and those people who also write about, is how you get to see your relative position in the universe.

After talking about his early work on Prozac [and, I assume, other similar chemical agents] Van Der Kolk goes on:

There are chemicals that can be somewhat helpful. They can help you to sleep better, to be less uptight. But they’re chemicals that really interfere with your natural capacity to deal with these things. And for me, very quickly after I did these early studies with not bad results, they certainly did not promise total happiness, really started to concentrate on what inborn mechanisms we have to deal with our own anxiety, and with our depression.

And so I really discovered the world of the body and tantric traditions, the yoga traditions and breathing traditions, and musical traditions that show that we actually are capable of rearranging our own internal physiological systems. And I wish that in every classroom in America they would teach the four Rs: reading, writing, arithmetic and self regulation, from kindergarten through 12th grade, of what can we do to calm ourselves down, to stay focused? What sort of activities can we engage in to feel in control of ourselves?

And so that we get away from this culture of, if you don’t feel right you take a drug, instead of if you don’t feel right you go for a bicycle ride. If you don’t feel right you go to yoga class. If you don’t feel right, you may need to do some body work to help your body to calm, or you need to go to do some tango dancing, or you need to do something to rearrange your relationship to your internal physiological state. [...]

I’m still waiting for the study of comparing tango dancing with cognitive behavioral therapy. I’m a scientist, it’s an empirical question. But I put my money on tango dancing over C.B.T., by and large, for some people. So I think we need to explore much more.

Touch:

EZRA KLEIN: On the point of touch, that there are a couple lines in your book that have really etched themselves in me. And one in particular here where you say that “the things that calm adults are the same things that calm children. Being held, being rocked, and being shushed.” And I don’t know. I just found that very moving.

BESSEL VAN DER KOLK: It’s true! You see it through to have your own kid go — yeah, he’s very young. But I need to do the same thing for him as I need myself.

EZRA KLEIN: But at some point, we make it very difficult for adults to ask for those things. You can maybe ask your partner, and that’s it. Particularly, I’ll speak more for men here, because I understand male relationships a little bit better, but you really, as a man, you can’t go to your male friends and ask to be rocked and shushed. [LAUGHTER]

BESSEL VAN DER KOLK: Yeah, a little bit, the culture has something to do with it.

EZRA KLEIN: Yeah, and it just strikes me as a shame. To the point you were just making, we spend so many billions of dollars, and so much effort to get the medications we think will help, and to see psychiatrists. And we’ve also cut ourselves off from a lot of just very cheap things, right? We have culturally cut ourselves off from a lot of touch, right? We often live in very atomized ways.

I mean there’s very kind of cheap, natural things that are part of our deep history that we give to our children, or at least in many homes, that, I don’t know, we’ve just decided are a little somehow uncouth, and we suffer for it.

Play is important, but not only for kids:

BESSEL VAN DER KOLK: Well first of all, child care, that you don’t have to be locked up with the same person all the time. It’s very important for a kid to have the experience of being exposed to more than one adult, and to see that other people have different ways of doing business. So you can actually see, oh my mom gets very upset, as opposed to, oh, that’s the world I live in.

The second piece is to be involved in rhythmical activities with other kids. Moving together with other kids, dancing together with other kids, playing with other kids, exploring the world with other kids, is so at the core of what creates a healthy mind and a healthy brain. That means that there is space, and that people can actually explore things safely. You can actually go out with your friends and try things out, so you don’t live in an environment where there is so much danger outside the door, or inside the door, that you cannot play anymore.

So I would say the most important thing for traumatized kids is to go to places where they can play. And that is, even in some very well known children’s institutions, there are hardly any places to play. Hardly any place to move around. To sing, to play, to dance, to run. So kids are supposed to really move. And move with other kids.

And basically, our systems are made to move in synchrony with the people around us. When you get traumatized, you get out of sync on every most elementary level. What does the military do? They have people move together and march together, to get them back in sync with each other.

EZRA KLEIN: And it sounds to me like you think the same is actually true for adults, that you need space to play, to move, to be in synchronicity with others, to sing, to dance, to have what gets called collective effervescence.

BESSEL VAN DER KOLK: Absolutely. Of course, you get more frozen as we grow older. But cooking with people, serving meals to people, pouring that wine to other people, still that moving together is a terribly important way of feeling our communality with other human beings.

Is anyone thinking systematically about a future based on the kinds of things these guys are talking about? Why not?

Addendum: Brain quickie:

Ezra Klein: You talk about the difference between the parts of the brain that create the autobiographical self and the parts of the brain that create the experiencing self. Can you discuss that a bit?

Bessel Van Der Kolk: Yeah. So we have these layers of the brain that have different functions. So the deepest layer has to do with what Antonio Damasio calls “the housekeeping of your body”: being able to breathe, go to the bathroom, go to sleep, have an appetite, being able to engage in caregiving and sexual relationships — very elementary. We have that in common with all other mammals basically.

But then we have this meaning making systems that come on top of that, starting with the larger limbic system that has a more complex way of organizing your perceptions about reality. So basically, your limbic system is the part of your brain that forms a map inside of the world outside of you. And so your brain gets programmed by experience to know what to expect and what sort of reactions people will have to certain behaviors. And so early experiences very much shape your perceptions of the world.

So if you are terrified of the people who take care of you, it’s very likely that you will either, or combination of, really be extremely compliant with people in power and hope that they won’t hurt you, or you become chronically angry and oppositional or a combination of those two. But that imprint of, I’m not safe with people who say they care for me, becomes an imprint of how you come to perceive the world. And those are not rational thoughts, and this cannot be abolished by pointing out to people how irrational they are, because that’s the way our brain becomes hardwired to deal with the reality in which it gets formed.