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Articles Tagués ‘traumatisme’

How Trauma Lodges in the Body,


The following is the audio and transcript of an onbeing.org interview between Krista Tippett and Bessel van der Kolk.

KRISTA TIPPETT, HOST: The psychiatrist Bessel van der Kolk is an innovator in treating the effects of overwhelming experiences on people and society. We call this “trauma” when we encounter it in life and news, and we tend to leap to address it by talking. But Bessel van der Kolk knows how some experiences imprint themselves beyond where language can reach. He explores state-of-the-art therapeutic treatments, including body work like yoga and eye movement therapy.

He’s been a leading researcher of traumatic stress since it first became a diagnosis in the wake of the Vietnam War, and from there, was applied to other populations. A conversation with this psychiatrist is a surprisingly joyful thing. He shares what he and others are learning on this edge of humanity about the complexity of memory, our need for others, and how our brains take care of our bodies.

DR. BESSEL VAN DER KOLK: I think trauma really does confront you with the best and the worst. You see the horrendous things that people do to each other, but you also see resiliency, the power of love, the power of caring, the power of commitment, the power of commitment to oneself, the knowledge that there are things that are larger than our individual survival. And in some ways, I don’t think you can appreciate the glory of life unless you also know the dark side of life.

MS. TIPPETT: Bessel van der Kolk is a professor of psychiatry at Boston University Medical School, and he helped found a community-based trauma center in Brookline, Massachusetts. As medical director there, he works with people affected by trauma and adversity to re-establish a sense of safety and predictability in the world, and to reclaim their lives. Bessel van der Kolk was born in the Netherlands. His own father spent time as religious prisoner in a German concentration camp during World War II. I spoke with him in 2013.

MS. TIPPETT: I always start my conversations with this question, whoever I’m speaking with. I’m just wondering, was there a religious or spiritual background to your childhood?

DR. VAN DER KOLK: Yeah, multiplicity. My parents were fundamentalist Christians in some good and some not so good ways. As an adolescent, I spent a fair amount of time in a monastery in France called Taizé.

MS. TIPPETT: Oh, you did? Oh, interesting. So you went to Taizé just…

DR. VAN DER KOLK: Because I loved the music.

MS. TIPPETT: Yeah. This field you’re in of trauma, traumatic stress, nowadays, this language is everywhere, right? This language of “trauma” and “traumatic stress” has made its way into culture, movie, TV scripts, the news, public policy discussions. I’ve read a few different accounts of how you stumbled into this field. How do you trace the beginnings of your research into traumatic stress?

DR. VAN DER KOLK: Well, it starts in a very pedestrian way. I mean, as characters from a generation that it was generally recommended that people have their own heads examined, which, I think, is sort of a good idea if you try to help other people. So psychoanalysis was the way to do that back then. And the only program that paid for that was the VA. So I went to work for the VA for the same reason that soldiers go to the VA, namely, to get their benefits package.

MS. TIPPETT: This was in the 1970s? Is that right?

DR. VAN DER KOLK: It was in the 1970s, yeah. And like many of my colleagues, I was just there to — as a step in my career. And then the very first person I saw was a Vietnam veteran who had terrible nightmares. I happened to have studied nightmares up to that point and some sleep studies, and I knew a little bit how to treat it, so I gave him some medicines to make the nightmares go away.

Two weeks later, he came back, and I said, “So how did the medicines work?” And he said, “I did not take your medicines because I realized I need to have my nightmares because I need to be a living memorial to my friends who died in Vietnam.” And that statement was the opening of my fascination about how people become living testimonials for things that no longer exist, but they need to hold it in their hearts and minds and bodies and brains. The loyalty to the dead, the loyalty to what was just blew me away.

And the veterans really touched me very deeply both for what they had done, how ashamed they were about what they had done, how they went in idealistically, how they came back broken, how they relied on their comrades. And they reminded me, I think, of the uncles and my father, who I grew up with in the Netherlands after the Second World War. So it resonated with me.

MS. TIPPETT: At that time, I believe there was no formal connection made between military service and problems after discharge, right? This diagnosis hadn’t happened?

DR. VAN DER KOLK: Well, it comes and goes. I became quite interested in history of how Western culture has looked at trauma. And people were very aware of it in the 1880s, and after the Civil War, and during the First World War, and during the Second World War. And then, in between, it gets forgotten. And so, the way – the time that I got into the field, happened to be a time of ignorance again. It was come and go.

MS. TIPPETT: After the Vietnam War.

DR. VAN DER KOLK: Yeah.

MS. TIPPETT: And my understanding from your writing that this diagnosis of PTSD, the term we use now, came about because of post-Vietnam War advocacy.

DR. VAN DER KOLK: Yeah, absolutely. And so later on, I became aware of all sorts of colleagues who had been working with abused kids and rape victims. And they had been trying to get a diagnosis in. And that group was too small to have any political clout. And it’s really the Vietnam veterans that brought this in and the power of the large numbers of psychiatrists and patients at the VA. That was strong enough to make it an issue and a diagnosis.

MS. TIPPETT: So I think that language you used a moment ago about that first veteran you spoke with, that he was a living testimonial to his memories and to something that had happened, which no longer was happening but utterly defined him, is a good way in to how you define trauma. So I’d like to spend a moment on that. I mean, start with me. How do you describe what this is, trauma, as you deal with it, as you study it, as you treat it?

DR. VAN DER KOLK: Well, what I think happens is that people have terrible experiences and — we all do. And we are a very resilient species. So if we are around people who love us, trust us, take care of us, nurture us when we are down, most people do pretty well with even very horrendous events. But particularly traumas that occur at the hands of people who are supposed to take care of you, if you’re not allowed to feel what you feel, know what you know, your mind cannot integrate what goes on, and you can get stuck on the situation. So the social context in which it occurs is fantastically important.

MS. TIPPETT: Something that’s very interesting to me in how you talk about trauma, the experience of trauma, what it is, is how the nature of memory is distorted, that memories are never precise recollections, but that in general, as we move through the world, memories become integrated and transformed into stories that help us make sense. But in the case of traumatic memories, they’re not integrated, and they’re not even really remembered as much as they’re relived.

DR. VAN DER KOLK: That’s correct. There’s actually a very old observation, and it was made extensively in the 1890s already by various people, including Freud. That’s really what you see when you see traumatized people. Now, these days, the trauma is a popular subject. People say, “Tell me about your trauma.” But the nature of our trauma is that you actually have no recollection for it as a story in a way.

Many victims, over time, get to tell a story to explain why they are so messed up. But the nature of a traumatic experience is that the brain doesn’t allow a story to be created. And here, you have an interesting paradox that it’s normal to distort your memories. Like, I’m one out of five kids. When we have a family reunion, we all tell stories about our own childhood, and everybody always listens to everybody else’s stories — says, “Did you grow up in the same family as I did?”

MS. TIPPETT: Right. There are five versions of every story.

DR. VAN DER KOLK: Yeah. There’s all these very, very different versions, and they barely ever overlap. So, people create their own realities in a way. What is so extraordinary about trauma, is that these images or sounds or physical sensations don’t change over time. So people who have been molested as kids continue to see the wallpaper of the room in which they were molested. Or when they examine all these priest-abuse victims, they keep seeing the silhouette of the priest standing in the door of the bathroom and stuff like that. So it’s these images, these sounds that don’t get changed. So it’s normal to change.

My old teacher, George Vaillant, did a study that you may have heard about. It’s called the Grant Study. And from 1939 to 1942, they followed the classes at Harvard every five years, and it’s going on to this day. Most of them went off to war in 1942, and almost all of them came back in 1945, and they were interviewed. And then they have interviews in 1989, 1990, 1991. It turns out that the people who did not develop PTSD, which was the vast majority, tell very different stories, let’s say, in 1990 than back in 1945. So now it was a glorious experience, it was a growth experience, and how good it was, how close they were to people, and how patriotic they felt. And it’s all sort of cleaned up.

MS. TIPPETT: Right. But it’s become a coherent narrative.

DR. VAN DER KOLK: But it’s very coherent, and it’s a nice story, and it’s good to listen to it, and relatives have all heard it a million times, but — because we make happy stories in our mind. People who got traumatized continue to have the same story in 1990 as they told back in 1945, so they cannot transform it. When we treat people, you see the narrative change, and people start introducing new elements.

I compare it very much to what happens when people dream. Maybe dreaming is very central here, actually, in that the natural way in which we deal with difficult stuff is we go to sleep and we dream, and next day we feel better. It’s very striking how we get upset and say, “I’m going to move to Florida, bummer day in Boston in the winter.” And the next morning, you wake up, and you shovel out your car, and everything’s fine.

And so sleep is a very important way in which we restore ourselves. And that process of that restoration that occurs during REM sleep — dream sleep — is probably an important factor in why traumatic memories do not get integrated.

MS. TIPPETT: And also, that gets at the fact that it’s not just cognitive, right? It’s not just a story that you could tell. I mean, it may eventually become a story, but that it’s body memory. It’s a neural net of memory. It’s not just about words that you can formulate.

DR. VAN DER KOLK: Yeah. It’s amazing to me what a hard time many people I know have with that. This is not about something you think or something you figure out. This is about your body, your organism, having been reset to interpret the world as a terrifying place and yourself as being unsafe. And it has nothing to do with cognition, with — you can say to people, “You shouldn’t feel that way,” or, “You’re not a bad person,” or, “It wasn’t your fault.” And people say, “I know that, but I feel that it is.”

It was very striking in our yoga study because we see yoga as one important thing that helps people who’ve been traumatized because they get back into their bodies. How hard it was for people to even during the most blissful part of the yoga practice called Shavasana, what a hard time traumatized people had at that moment to just feel relaxed and safe and feel totally enveloped with goodness, how the sense of goodness and safety disappears out of your body, basically.

MS. TIPPETT: I want to talk about yoga in a minute. That’s really — I mean, as you said, people were talking about this in the late 19th century. Freud talked about it and I guess his phrase was “hysteria.” But something that you seemed to have noticed early on is that traditional therapy was ignoring this sensate dimension of these experiences in trying to reduce it to talk therapy, which absolutely didn’t fit with the experience.

DR. VAN DER KOLK: Right, right. There’s a few people here and there in the last 150 years who do it. The great Frenchman Pierre Janet did, Wilhelm Reich, of course, who then went crazy afterwards. Here and there, people noticed the somatic dimension of it, but by and large, I think psychology training really breeds the tensions of body out of people. It’s a medical training. It’s amazing. Psychiatrists just don’t pay much attention to sensate experience at all.

Antonio Damasio, in his books, The Feeling of What Happens, in books like this, really talks about a core experience of ourselves is a somatic experience, and that the function of the brain is to take care of the body. But it’s a minority voice. It’s a small voice.

MS. TIPPETT: But it seems to me that what we’re learning from brain imaging is bearing out these kinds of observations. I mean, what are we learning? Is any of this surprising to you?

DR. VAN DER KOLK: What we see is that the parts of the brain that help people to see clearly and to observe things clearly really get interfered with by trauma and the imprint of trauma is in areas to the brain that really have no access to cognition. So it’s in an area called the periaqueductal gray, which has something to do with the sort of total safety of the body. The amygdala, of course, which is the smoke detector, alarm bell system of the brain — that’s where the trauma lands, and trauma makes that part of the brain hypersensitive or renders it totally insensitive.

MS. TIPPETT: And the Broca’s area?

DR. VAN DER KOLK: Well, in our study and some others, I mean, for me that was really the great finding early on, is that when people are into their trauma, Broca’s area shuts down. That is something that almost everybody has experienced. You get really upset with your partner or your kid, suddenly you take leave of your senses and you say horrible things to that person. And afterwards, you say, “Oh, I didn’t mean to say that.”

The reason why you said it is because Broca’s area, which is sort of the part of your brain that helps you to say reasonable things and to understand things and articulate them, shuts down. So when people really become very upset, that whole capacity to put things into words in an articulate way disappears. And for me, that is a very important finding because it helped me to realize that, if people need to overcome the trauma, we need to also find methods to bypass what they call the tyranny of language.

MS. TIPPETT: Don’t ask to be verbal, to verbalize it.

DR. VAN DER KOLK: Or to be reasonable.

MS. TIPPETT: Right.

DR. VAN DER KOLK: The trauma is not about being reasonable or to be verbal or to be articulate.

MS. TIPPETT: So it seems like there are all these impulses that we have that we’re working with all the time that get so out of whack with trauma, and so, I mean, I’ve understood that it’s not just that we have memories and that we process them in different ways, but also that we are constantly rationalizing, that we have this impulse to rationalize. But then when people are traumatized, they are actually — they also have this impulse to rationalize and then become unable to grasp the irrelevance of that memory and that feeling to the present moment.

DR. VAN DER KOLK: Yeah. So we have these two different parts of our brain, and they’re really quite separate. So we have our animal brain that makes you go to sleep, and makes us hungry, and makes us turned on to other human beings in a sexual way, stuff like that. And then we have our rational brain that makes you get along with other people in a civilized way. These two are not all that connected to each other. So the more upset you are, you shut down your rational part of your brain.

When you look at the political discourse, everybody can rationalize what they believe in and talk endlessly about why what they believe is the right thing to do while your emotional responses are totally at variance with seemingly rational behaviors. We can talk till we’re blue in the face, but if our primitive part of our brain perceives something in a particular way, it’s almost impossible to talk ourselves out of it, which, of course, makes sort of verbal psychotherapy also extremely difficult because that part of the brain is so very hard to access.

MS. TIPPETT: Yeah. We’re pretty fascinating creatures, aren’t we?

DR. VAN DER KOLK: Fascinating, disturbing, glorious, all those things.

MS. TIPPETT: All those things all at once. So I do want to talk about yoga now, which is something very important to me as well, something I’ve discovered in the last five or six years. How did you get interested — how did you discover yoga and then make that part of this kind of work?

DR. VAN DER KOLK: We actually got into yoga in a very strange way. We learned that there is a way of measuring the integrity of your reptilian brain, i.e., how the very most primitive part of your brain deals with arousal. And you measure that with something called heart rate variability, and it tells you something about how your breath and your heart are in sync with each other.

It turns out that the calmer people are, and the more mindful people are, the higher their heart rate variability is. And then we were doing that on some traumatized people, and we noticed that they had lousy heart rate variability. Then I thought, so how can we change peoples’ heart rate variability?

MS. TIPPETT: And is this something you’d naturally be aware of or not? You wouldn’t know if it was in sync or out of sync?

DR. VAN DER KOLK: No, but you can measure it and it’s fairly easy to measure it. There are like apps for your iPhone on which you can measure them. But, of course, we do it in a more sophisticated way. So we found this very abnormal heart rate variability in traumatized people. And then we heard that there were 17,000 yoga sites that claimed that yoga changed heart rate variability.

A few days later, some yoga teachers walked by our clinic and said, “Hey, do you think you can use this for some project?” And I said, “We sure can. We’d love to see if yoga changes heart rate variability.” This whole yoga thing also fits very well with the increasing recognition that traumatized people cut off their relationship to their bodies.

And I have to give a little bit of background here. Way back already in 1872, Charles Darwin wrote a book about emotions in which he talks about how emotions are expressed in things like heartbreak and gut-wrenching experience. So you feel things in your body. And then it became obvious that, if people are in a constant state of heartbreak and gut-wrench, they do everything to shut down those feelings to their body.

One way of doing it is taking drugs and alcohol, and the other thing is that you can just shut down your emotional awareness of your body. And so a very large number of traumatized people who we see — I’d say the majority of the people we treat at the trauma center and in my practice — have very cut off relationships to their bodies. They may not feel what’s happening in their bodies. They may not register what goes on with them. And so what became very clear is that we needed to help people for them to feel safe feeling the sensations in their bodies, to start having a relationship with the life of their organism, as I like to call it.

And so a combination of events really led us into exploring yoga for them. And yoga turned out to be a very wonderful method for traumatized people to activate exactly the areas of cautiousness, areas of the brain, the areas of your mind that you need in order to regain ownership over yourself. I don’t think that yoga would be the only way to do it, or I think if you only do yoga, that you can totally take care of it.

But yoga, to my mind, is an important component of an overall healing program and, again, not only yoga. You could do maybe martial arts or qigong, but something that engages your body in a very mindful and purposeful way — with a lot of attention to breathing in particular — resets some critical brain areas that get very disturbed by trauma.

MS. TIPPETT: Do you also have a yoga practice?

DR. VAN DER KOLK: I also have a yoga practice. I do. Not enough, of course. None of us ever does enough. But I try to start every day with a yoga practice.

MS. TIPPETT: Now, did I read somewhere that you also found that your heart rate variability was not in sync and was not robust enough?

DR. VAN DER KOLK:  I like to keep quiet about it. That’s true, that’s true.

MS. TIPPETT: And do you know if yoga has helped your…?

DR. VAN DER KOLK: Yeah, I have a nice, even heart rate variability now.

MS. TIPPETT: I wonder if you have ever heard of somebody named Matthew Sanford, who I’ve had on my program. He’s actually…

DR. VAN DER KOLK: No.

MS. TIPPETT: He’s a very renowned yoga teacher. He’s been paraplegic since he was 13, and he had no memory of the accident in which he was disabled, and his body remembered it. He talks about body memory. It’s the same thing you say, this imprint that trauma has not just on your mind. The other thing that he’s doing recently is actually working with veterans and also working with young women suffering from anorexia and understanding also that, although that seems to be so much an obsession with the body, they are really in a traumatic relationship with their own bodies.

DR. VAN DER KOLK: Absolutely, yes.

MS. TIPPETT: Some of the things he’s doing, which he actually did for me — I did a class with him, like just putting these very comforting weights on certain muscles, so you feel sunk into your body in a way. And I don’t know I just was thinking — I’ve been thinking about this as I’ve been reading about your research.

DR. VAN DER KOLK: Huh. It sounds very sympathetic and very right. The sense of the experiences, of feeling weight and feeling your substance…

MS. TIPPETT: Yes, feeling your substance which is bigger than just feeling a weight on your muscles, isn’t it?

DR. VAN DER KOLK: Yeah. Really feeling your body move and the life inside of yourself is critical. Personally, for example, when people ask me, “So what sort of treatments have you explored?” — I always explore every treatment that I explore for other people — what’s been most helpful for me has been rolfing.

MS. TIPPETT: Has been what?

DR. VAN DER KOLK: Rolfing. Rolfing is called after Ida Rolf. It’s a very deep tissue work where people tear your muscles from your fascia with the idea that, at a certain moment, your body comes to be contracted in a way that you habitually hold yourself. So your body sort of takes on a certain posture. And the idea of rolfing is to really open up all these connections and make the body flexible again in a very deep way.

I had asthma as a kid. I was very sickly as a kid because I was part of this group in the Netherlands. Finally, after the war in the Netherlands, during which I was born, about 100,000 kids died from starvation, and I was a very sickly kid. I think I carried it in my body for a long time, and rolfing helped me to overcome that, actually. So now I became flexible and multipotential again.

And for my patients, I always recommend that they see somebody who helps them to really feel their body, experience their body, open up to their bodies. And I refer people always to craniosacral work or Feldenkrais. I think those are all very important components about becoming a healthy person.

MS. TIPPETT: But they’re not that easy to find. They’re still kind of around the edges, Feldenkrais and craniosacral. Isn’t it strange how, in Western culture, in a field like psychotherapy — or even I see this a lot in religion — in Western culture, we turn these things into these chin-up experiences. We separated ourselves; we divided ourselves. I see this — I mean, yoga is everywhere now, right? And people are discovering all kinds of ways, as you say. There are all kinds of other ways to reunite ourselves, but…

DR. VAN DER KOLK: But it’s true. Western culture is astoundingly disembodied and uniquely so. Because of my work, I’ve been to South Africa quite a few times and China and Japan and India. You see that we are much more disembodied. And the way I like to say is that we basically come from a post-alcoholic culture. People whose origins are in Northern Europe had only one way of treating distress. That’s namely with a bottle of alcohol.

North American culture continues to continue that notion. If you feel bad, just take a swig or take a pill. And the notion that you can do things to change the harmony inside of yourself is just not something that we teach in schools and in our culture, in our churches, in our religious practices. And of course, if you look at religions around the world, they always start with dancing, moving, singing…

MS. TIPPETT: Yeah. Crying, laughing.

DR. VAN DER KOLK: Physical experiences. And then the more respectable people become, the more stiff they become somehow.

MS. TIPPETT: I’m Krista Tippett, and this is On Being. Today, with psychiatrist Bessel van der Kolk. He investigates state-of-the-art therapeutic treatments, including body work like yoga and eye movement desensitization and reprocessing therapy — or EMDR.

MS. TIPPETT: I also would like to ask you just about this EMDR because I had not heard of this before.

DR. VAN DER KOLK: Oh, really?

MS. TIPPETT: No, I hadn’t.

DR. VAN DER KOLK: Well, EMDR is a bizarre and wondrous treatment. And anybody who first hears about it, myself included, thinks this is pretty hokey and strange. It’s something invented by Francine Shapiro, who found that, if you move your eyes from side to side as you think about distressing memories, that the memories lose their power.

And because of some experiences, both with myself, but even more with the patients of mine who told me about their experiences, I took a training in it. It turned out to be incredibly helpful. Then I did what’s probably the largest NIH-funded study on EMDR. And we found that, of people with adult-onset traumas, a one-time trauma as an adult, that it had the best outcome of any treatment that has been published.

What’s intriguing about EMDR is both how well it works and then the question is how it works, and that got me into this dream stuff that I talked about earlier, and how it does not work through figuring things out and understanding things. But it activates some natural processes in the brain that helps you to integrate these past memories.

MS. TIPPETT: I mean, it sounds so simple. And even when I was reading about it, moving your eyes back and forth — I mean, is this something that you can do for yourself? Or is there something more complex going on?

DR. VAN DER KOLK: I imagine it can be done, but it’s usually better if you do it with somebody else who sort of stays with you, helps you to focus, makes eye movement for you by having somebody else follow your fingers. But it is astoundingly effective treatment. And it’s interesting that, even in the most biased studies, EMDR keeps coming up as this very effective treatment. It’s been very difficult to get funding to find out the very intriguing underlying mechanisms of it. And I think if we really find out the mechanism for EMDR, we’ll understand how the mind works much better. It’s an outstandingly effective treatment.

So if people have had one terrible thing that they cannot get out of their minds, that, for me, is the treatment of choice. Of course, the people who come to see me in my practice oftentimes have had multiple traumas at the hands of their intimates also, so then it gets much more complicated than just a memory issue. But if it’s just a car accident or a simple assault, it’s astoundingly effective.

MS. TIPPETT: That’s fascinating. Something else I read is you were reflecting on Hurricane Hugo, hurricanes in general or natural disasters, this phenomenon we see of people helping each other, of getting out there and helping each other — and you also look at that and see that it’s not just that people are helping each other; they’re moving their bodies. Again, there’s this physical involvement kind of as antidote to the helplessness of the situation, which is so manifest.

DR. VAN DER KOLK: Good. I’m really glad you read it because people talk a lot about stress hormones. Our stress hormones are sort of the source of all evil. That’s definitely not true. The stress hormones are good for you. You secrete stress hormones in order to give you the energy to cope under extreme situations. So it gives you that energy to stay up all night with your sick kid or to shovel snow in Minnesota and Boston and stuff like that.

What goes wrong is, if you’re kept from using your stress hormones, if somebody ties you down, if somebody holds you down, if somebody keeps you imprisoned, the stress hormones keep going up, but you cannot discharge it with action. Then the stress hormones really start wreaking havoc with your own internal system. But as long as you move, you are going to be fine. As we know, after these hurricanes and these terrible things, people get very active, and they like to help, and they like to do things, and they enjoy doing it because it discharges their energy.

MS. TIPPETT: So we are healing ourselves. We don’t realize that, but we know how to…

DR. VAN DER KOLK: We are using our natural system, basically. We’re not only healing; we’re coping. We’re just dealing with what we need to cope with. That’s why you have that stuff. That’s why we survive as a species. What was disturbing in Hurricane Hugo, which was my first encounter quite a long time, and what we saw again in New Orleans, is how these victimized populations were prevented from doing something, and that’s really what the observation was.

MS. TIPPETT: Right. And that that compounded the trauma.

DR. VAN DER KOLK: Yeah. So I get flown into Puerto Rico after Hurricane Hugo because I’ve written a book about trauma. I knew nothing about disasters, but nobody else knew anything either, so they flew me in. And what struck me — I landed in Puerto Rico, and everybody is busy doing stuff and building things, and everybody’s too busy to talk to me because they’re trying to do stuff. But on the same plane that I flew in with, officials from FEMA came in, who then made announcements, “Stop your work until FEMA decides what you’re going to get reimbursed for.”

And that was the worst thing that could have happened because now these people were using the energy to fight with each other and to pick war with each other instead of rebuilding their houses. That’s, of course, similar what happened in New Orleans, where people also were kept from being agents in their own recovery.

MS. TIPPETT: I wonder how you look at this world we live in now where it feels like there’s an acceleration of what you might call collective traumatic events or tragedies. It seems to be more and more predictable that around the corner there will be a bombing or a school shooting or a terrible event that’s involved with the weather. How does what you know about trauma help you think about this or…?

DR. VAN DER KOLK: I’m not sure if I share that view with you. I think there’s so much more news, so we’re much more aware of whatever happens at any particular moment. And of course, the news media, when you wake up in the morning, find the worst thing that happens somewhere in the world to serve it to you for breakfast. So we get served much more. I don’t think there’s more trauma, actually.

MS. TIPPETT: You don’t think more bad things happen? You just think that…?

DR. VAN DER KOLK: When I read about how Abe Lincoln grew up — he’d lost his mother, and they moved to houses all the time, and they were starving, and he had nothing. I mean, you read the stories about all the immigrants, all those people who died, and the number of assaults in New York City and around the country. I don’t think we live in the worst world. And I think people are also much more conscious today than they were, let’s say, 100 years ago.

No, I really have studied the history of trauma. My favorite human folly is the First World War. If you think the world is bad right now, think about the First World War. Unbelievable. So I don’t think things are necessarily worse, and I think — when I go around the country, and I see the number of programs that very goodhearted people have for school kids, etc., I’m continuously astounded by the amount of integrity and creativity and good will that I see everywhere around me.

At the same time that you see something as horrendous as in Philadelphia — the school system of the public schools in Philadelphia abolished arts programs, gymnastics, counseling, and music programs. I go, “Where have these people been in order to have a minded focuses?” You need to move your body. You need to sing with other people. And if you think that your kids are going to do better if you keep them stock-still in a classroom taking tests, you don’t know anything about human beings.

So you still hear about horrendous things all the time, but I see a great deal of consciousness at the same time. And I see that people are really trying to carve out more consciousness and more democracy in various places around the world.

MS. TIPPETT: I mean, you’re right. It’s all these things at once. But let’s say — something I’m aware of is how — and this would be different from the First World War era where we get these pictures, these vivid images with this immediacy brought to us, right? And I personally — and I think this is true collectively too — I don’t know what to do with those images. And what I often — it’s so disturbing, and then there’s also this impulse that you just have to cut yourself off from that feeling because I can’t do anything for that particular picture. And then there’s this guilt and this feeling that that’s not a satisfactory reaction. I mean, it’s altogether…

DR. VAN DER KOLK: See, there’s a very dark side to this also and that is that there’s a certain tropism, a movement towards misery in our lives so that, if things become too quiet, it becomes boring. When you see the preview of coming attractions in the movie theater, you go like, “Oh my god. What are these people watching?” People are drawn towards horrendous stuff all the time. So it is part of that dark side of human nature to want to live on that edge. It’s very hard. It’s hard to deal with.

MS. TIPPETT: It’s very hopeful that you spend your life working with trauma, with victims in this research. But you have a pretty refreshingly, hopeful feeling about us as a species.

DR. VAN DER KOLK: Well, you see, part of that I get from my patients. What is so gratifying about this work is that you get to see the life force. People go through horrendous stuff everywhere all the time, and yet, people go on with their lives.

MS. TIPPETT: And you see that, you experience that again and again.

DR. VAN DER KOLK: I see it all the time. I see kids who grew up under terrible circumstances, and some of them do terribly. But then last week, we had our conference here, our annual conference in Boston, and somebody presented her work on doing meditation in maximum security jails. And you see these really bad-ass guys come to life because of this meditation program.

And I see people getting better with another program that I’m involved with is a Shakespeare program for juvenile delinquents here in Brookshire County where the judge gives kids a choice between going to prison or being condemned to be a Shakespeare actor.

And, I go to the Shakespeare program, and these actors do a beautiful job with these kids, and you see these kids come to life as they’re being valued as an actor and a person who is able to talk. What I see is the huge potential that people have to crawl out of their holes.

MS. TIPPETT: I read your research, and I think about this whole picture that we’ve been discussing of all the different ways people are reaching out for methods to become more self-aware — yoga, meditation, using these insights of neuroscience. Sometimes I wonder if, 50 years from now or 100 years from now, people might look back on therapy, the way we’ve done it for 50 years or whatever, and see it as a really rudimentary step towards a much more profound, reaching for awareness and consciousness, mindfulness.

DR. VAN DER KOLK: Well, I think people have always done good therapy, and our culture and our insurance structure is not really geared towards really very good therapy nor is our psychological training, which is there to fix people and get rid of their disorder as fast as possible. But therapy as in people really getting to know themselves very well and examining themselves and being seen and being heard and being understood has always been around. And I think it will always be around.

And I don’t think we’ll ever talk about it as necessarily primitive because the intimate interchange of people really talking about their deepest feelings and their deepest pain and having persons listen to it has always been, and I think it always will be, a very powerful human experience.

MS. TIPPETT: So the language people sometimes use about trauma would be — there’s a lot of spiritual language that we intuitively grasp for, “soul stealing.” I wonder how you think about the human spirit in the context of what you know about trauma and resilience and healing.

DR. VAN DER KOLK: That’s a very tough question.

MS. TIPPETT: I know. I think you’re up to it, though.

DR. VAN DER KOLK: Something that I tended to stay away from. But, I think trauma really does confront you with the best and the worst. You see the horrendous things that people do to each other, but you also see resiliency, the power of love, the power of caring, the power of commitment, the power of commitment to oneself, to the knowledge that there are things that are larger than our individual survival.

And some of the most spiritual people I know are exactly traumatized people, because they have seen the dark side. And in some ways, I don’t think you can appreciate the glory of life unless you also know the dark side of life. And I think the traumatized people certainly know about the dark side of life, but they also, because of that, see the other side better.

MS. TIPPETT: You said somewhere that PTSD has opened the door to scientific investigation of the nature of human suffering. That’s a profound step, right? I mean, to me, that’s the spiritual way to talk about this field with a profound understanding of what the word “spiritual” means.

DR. VAN DER KOLK: Yeah. Well, I think this field has opened up two areas. One is the area of trauma and survival and suffering, but the other one is also — people are studying the nature of human connections and the connection between us, also, from a scientific point of view.

As much as trauma has opened up things, I think the other very important arm of scientific discovery is how the human connection is being looked at scientifically now and what really happens when two people see each other, when two people respond to each other, when people mirror each other, when two bodies move together in dancing and smiling and talking.

There’s a whole new field of interpersonal neurobiology that is studying how we are connected with each other and how a lack of connection, particularly early in life, has devastating consequences on the development of mind and brain.

MS. TIPPETT: And it’s true isn’t it from your study that, that if people learn to inhabit their bodies, to be more self-aware, that these qualities and habits can serve, can create resilience, can serve when trauma hits. Is that right?

DR. VAN DER KOLK: Absolutely. So if you particularly — there’s two factors here. One is how your reptilian brain — if you breathe quietly in your body and you feel your bodily experience, and stuff happens to you, you notice that something is happening out there, and you say, “Oh, this really sucks. This is really unpleasant.” But it’s something that is not you. So you don’t necessarily get hijacked by unpleasant experiences.

The big issue for traumatized people is that they don’t own themselves anymore. Any loud sound, anybody insulting them, hurting them, saying bad things, can hijack them away from themselves. And so what we have learned is that what makes you resilient to trauma is to own yourself fully. And if somebody says hurtful or insulting things, you can say, “Hmm, interesting. That person is saying hurtful and insulting things.”

MS. TIPPETT: But you can separate your sense of yourself from them.

DR. VAN DER KOLK: Yeah, but you can separate yourself from it. I think we are really beginning to seriously understand how human beings can learn how to do that, to observe and not react.

MS. TIPPETT: I think I just want to come back as we close to this idea that somehow, the point of all of this, the take-home for you, and I’m not finding the quote, is that we have to feel safe, that we have to feel safe and that we have to feel safe in our — that has to be a bodily perception, not just a cognitive perception. And that somehow everything comes back to that.

DR. VAN DER KOLK: It is the foundation, but you need to actually feel that feeling. You need to know what is happening in your body. You need to know where your right toe is and where your pinkie is. Your body — you need to sort of be aware of what it’s doing.

MS. TIPPETT: It’s very nitty-gritty. Is that what you’re saying?

DR. VAN DER KOLK: It’s very, very basic but sorely lacking in our diagnostic system is simple things like eating and peeing and pooping because they’re the foundation of everything, and breathing. These are foundational things, all of which go wrong when you get traumatized. The most elementary body functions go awry when you are terrified.

So trauma treatment starts at the foundation of a body that can sleep, a body that can rest, a body that feels safe, a body that can move. And I love the example of your guy who’s paraplegic and who does yoga because, even when your body is impaired, he can still learn to own it and to have it.

MS. TIPPETT: Yes. he says he’s not cured, but he’s healed. And here’s a striking statement you’ve made that “victims are members of society whose problems represent the memory of suffering, rage, and pain in a world that longs to forget.”

DR. VAN DER KOLK: Did I say that?

MS. TIPPETT: You did.

DR. VAN DER KOLK: That’s brilliant.

MS. TIPPETT:  And I find that so worthy of reflection.

DR. VAN DER KOLK: Well, that’s the literature we read, that’s the movies we watch, and that’s what we want to be inspired by. That’s what we observe is that spirit. Toni Morrison and Maya Angelou and these people can talk very articulately about having dealt with and stared adversity in the face and still maintain that humanity and faith. That’s what’s it all about.

Bessel van der Kolk is medical director of the Trauma Center at the Justice Resource Institute in Brookline, Massachusetts. He’s also a professor of psychiatry at Boston University Medical School. His books include Traumatic Stress: The Effects of Overwhelming Experience on the Mind, Body, and Society and The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma.

On Being is Trent Gilliss, Chris Heagle, Lily Percy, Mariah Helgeson, Maia Tarrell, Marie Sambilay, Bethanie Mann, Selena Carlson, and Rigsar Wangchuck. On Being was created at American Public Media. 

Peter Levine on Freedom from Pain

Tami Simon speaks with Dr. Peter Levine and Dr. Maggie Phillips. Dr. Phillips is the director of the California Institute of Clinical Hypnosis and is author of Finding the Energy to Heal and Reversing Chronic Pain. Dr. Levine is the developer of the groundbreaking Somatic Experiencing® approach to healing trauma. With Sounds True, they have coauthored a book and accompanying CD called Freedom from Pain. In this episode, Tami speaks with Maggie and Peter about the prevalence of chronic pain today, how physical pain may relate to past trauma, and the stages that pain sufferers commonly experience. They also offer inspiring real-world examples and insights about the keys for solving “the puzzle of pain.” (59 minutes) 

The paradox of trauma is that it has both the power to transform and resurrect. –Peter A. Levine

Tami Simon: You’re listening to Insights at the Edge. Today I speak with Peter Levine and Maggie Phillips. Maggie Phillips is a licensed psychologist and currently serves as director at the California Institute of Clinical Hypnosis. She has authored numerous papers and articles as well as the books Finding the Energy to Heal: How EMDR, Hypnosis, TFT, Imagery, and Body-Focused Therapy Can Help Restore Mindbody Health and Reversing Chronic Pain: A 10-Point All-Natural Plan for Lasting Relief.

Peter Levine has spent 45 years studying and treating stress and trauma; is the developer of somatic experiencing, a naturalistic approach to healing trauma; and has practiced and taught at treatment centers, hospitals, and pain clinics throughout the world. With Sounds True, Peter Levine and Maggie Phillips have released a new book and an accompanying CD called Freedom from Pain: Discover Your Body’s Power to Overcome Physical Pain.

In this episode of Insights at the Edge, Peter, Maggie, and I spoke about the prevalence of chronic pain in modern society and how physical pain may relate to past trauma. We also talked about the stages that pain sufferers commonly experience, and we talked about bracing patterns and a subsequent progression into what they refer to as the “pain trap.” Peter and Maggie explained the concept of self-regulation in dealing with physical pain and shared real world examples of its effectiveness. Finally, they discussed the primary keys to solving what they call the “puzzle of pain.” Here’s my very helpful conversation with Peter Levine and Maggie Phillips.

In reading your book Freedom From Pain, one of the things I discovered was how many people are actually in chronic pain, and it made me think of all the people I interact with during the day and questioning how many of them might actually be in pain. The grumpiness that I sometimes sense in people—maybe they’re suffering from back pain or something like that. So how prevalent is chronic pain in our society today?

Peter Levine: To give you an idea of the scope of the problem, more people are suffering from chronic pain than from diabetes, cancer, and heart disease combined. So if you’re going through your day at a checkout line, at an [car] mechanics—and some of the people that are your coworkers, your colleagues, that you know—a significant proportion of those people are suffering, usually silently, from chronic pain. And unfortunately, most doctors don’t really have much education or an understanding of where to refer people who are seeking help from chronic pain.

So every day we’re meeting—a fair percentage of the people that we come into contact with are suffering from chronic pain.

TS: Now, you talk about chronic pain as a puzzle, “the puzzle of pain,” that it’s not easy to understand as we might think. Can you help me understand that? Why is chronic pain so puzzling?

Maggie Phillips: Well, I would say that chronic pain is puzzling because it’s so complex. There’s no one source of pain. In fact, there are multiple factors that contribute to it. So we look at chronic pain from the standpoint of trauma because in our clinical practice, [our] combined practice over many years, we have found that [when] people are not responding to the usual treatments, it’s almost always because they have some type of unresolved trauma that is being held in the body.

And so the key, what we found really works for people, is to help identify the source of trauma, to help them find ways to release it for themselves that are safe and comfortable and helps them to expand their body experience. We’ve been very successful [in helping] those people move out of pain, or at least to a place where it’s manageable and they can live a good life.

TS: Help me understand how physical pain relates to past trauma. That’s not obvious to me.

PL: Well first, I want to add one other thing: pain in itself becomes traumatic. And anybody who’s suffered from chronic pain of any kind is also experiencing trauma. But in trauma, what happens is our body stiffens to protect ourselves. Our shoulders get tight, our back stiffens, or alternatively, we collapse in helpless defeat. Trauma is something that happens in the body. And tension is one of the main causes of pain, one of the main consequences of trauma.

So the body has become locked in a protective encasement to protect itself from an external threat, from an emotional conflict, which is terrible. Then that tension that gets locked in our body actually generates the pain, and then the pain generates further bracing because we brace against the pain. And that bracing causes further pain, further trauma, more pain. So it’s a feedback loop. You could say it’s a positive feedback loop with negative consequences. So that trauma leads to pain, the pain leads to trauma, pain leads to fear, and fear leads to more bracing, which leads to more trauma.

There are many ways in which the trauma could have arisen in the first place. Often people—sometimes when they’ve had a relatively minor car accident—somebody comes and hits them from behind—the body is thrown into a state of paralyzed bracing because at that moment, you don’t know how serious that impact is. So your body is protecting yourself from being splattered. And we forget how to undo that. As a matter of fact, after an accident, we get a lot of adrenaline, so we feel really high, we feel really good, and we go on not even resting, and then we maybe find it difficult to sleep that night. Then, over the next few days, the pain starts to lock in.

So this is one of the very, very common causes of pain, but it’s not necessarily, or even likely, [due] to an actual physical injury. The minor impacts are generally not due to any injury to the spine or any injury to the soft tissue, but to the bracing pattern. All trauma involves the bracing pattern. So in this program, we help people learn to identify in their bodies those bracing patterns so that they can undo them. You can say that trauma is something that happens in the body and the mind—the body and the brain and the mind—that doesn’t unhappen. And so in this series, in this program, we help people to learn to release those bracing patterns and to not stiffen against the pain—therefore not causing the pain to recycle.

MP: I want to address what you said, Tami, about it being counterintuitive. It’s not obvious, and that’s true of many people that we see. Generally, people will come in many months, and sometimes years, after the accident or injury that really might have started the pain problem. So they don’t—what they’re involved with is what’s going on with them now. And stress, of course, makes anything or everything worse. It can exacerbate any kind of medical condition.

So lots of times they’re thinking, “Well, I must have had trouble with repetitive injury at work. Maybe that’s why my shoulder’s hurting—it’s that I’ve been doing more computing than usual. And yet I don’t understand. I’ve gone to all of the doctors. I’m doing everything they’ve told me to do, and I’m not getting better. And the doctors don’t understand either. They don’t know what to make of why I’m not recovering.” That would be a situation where we would start talking to the person about the role of trauma. We might not even use that word, but we might say, “Let’s talk about this part of your body.” If it’s a shoulder injury or a shoulder pain that the person has: “Let’s talk about as far back as you can remember any type of injury that happened to your shoulder.” It’s in more of a conversational way [that] we will usually help people uncover the earlier sources of the injury.

As Peter was saying, anytime there’s an injury or a threat, the threat, of course, is one of danger, but because we’re animals, the threat is to our survival. That’s how the body experiences it. The body can’t discriminate between, “Oh, well, I’m not really hurt in this accident because I can still move. I can still walk around, so I must be OK.” The body is going to feel the impact as a threat, and then, as Peter was saying, is going to respond with complex bracing patterns. When those are held in the body and not released over time—and then, of course, we encounter other stresses, so it’s not just maybe one trauma; it may be cumulative trauma that’s built up over time. The good news about what we’re doing is that it doesn’t really matter how many traumas or when the trauma started. It’s really about working with the person’s body experience to the point where they can experience release and relief.

PL: Yes. Exactly. So they are perpetuating the pain cycle unconsciously. And as people become aware of that pattern, then they’re able to release it. Also—and there’s considerable research on this—that people who have early trauma and abuse, trauma issues, are much more likely to develop pain later in life. So that’s one of the reasons that make it complicated: because it can come in any number of different directions. But the key is: the final common pathway is in the body, and how the body braces against what was originally a threat, but now becomes bracing against itself. It’s, again, recycling and reactivating that stress and maintaining it as chronic pain.

TS: Let’s talk a little bit more about the bracing pattern because I’m imagining that most people can relate to that. That’s something that they can feel to some degree inside of themselves, how they brace themselves in different situations. So why do we brace ourselves? I mean, I get it in terms of a car accident because I don’t want to get hurt. But it sounds like what you’re describing is a response that happens in all kinds of traumatic situations.

MP: Yes, that’s right. For example, if you take, as Peter was saying, early childhood trauma. Let’s just go with physical, emotional, or sexual abuse, or some combination of all three. What happens is that in our young bodies, we don’t have enough cognition to be able to mitigate what’s going on or to understand it. So we’re just thrown into these primitive states where we have what we can think of as reflexive responses, where there’s no thinking mind involved.

So if we’re being hit or assaulted or threatened in some cases, then what will happen is that the body just automatically, reflexively responds. And it responds by bracing, because that is just the way animals [of all kinds] respond. They’re going to form this kind of constriction as a way of protection. As one of my clients was saying the other day, it’s like a coat of armor. And it’s their [sense of] “I know I’m trying to protect myself, but this time I don’t really have anything to protect myself from. I have a good life, I’ve lowered my stress, I’m using the tools that I’ve learned from you. So why do I keep protecting myself, keep bracing?”

And that’s where the second level of bracing comes in, if you want to look at it that way—which is that after a while, we get so frightened of what comes up inside of us, when we’re reminded of a danger or threat, that we react, again, protectively and reflexively. So again, we’re not thinking about, “Well, there’s really no danger here.” We’re just reacting. So we initially brace against what we perceive as being real danger and what the body certainly identifies that way. And then later on, it’s self-perpetuating, because the person becomes scared of their inner experience or the constriction and pain in their body, and so they’ll brace again.

PL: So let me give an example with an emotion. Let’s just say somebody was molested, abused as a child. The natural response is that of the anger. And so when the anger may begin to arise, even before the person is consciously aware of it, they push the anger down because of the fear of the anger, the fear that they might hurt themselves or hurt somebody because that’s what anger is. It’s about the impulse to strike out. So they push down on the anger. But then what happens, of course, is the anger pushes up even more, and then the person pushes down on the anger, and how do we do that? Again, we do that with our muscles. So whether it’s the bracing pattern or whether it’s emotions, such as anger or fear or sorrow that we’re frightened about, we brace against those equally.

So again, it doesn’t matter whether it’s emotional or physical. The net response is to brace, is to suppress and hold and check. And the more we do that, the more it pushes, and the more we resist, what we resist persists. Again, this is perpetuating the pain, and again, the pain is perpetuating more fear, and more fear is perpetuating more tension or more collapse and more pain, and on and on and on.

The key is in breaking this cycle whenever we can, so even if something has been chronic for years and it comes from very early trauma, still, through the tools and awareness that we’ve developed through the program, people learn to touch into these sensations, to touch into these feelings and befriend them, really, not to suppress them, not to be overwhelmed with them, not to mindlessly express it, but to touch them, to become more in tune with our natural instincts. And this is what frees us, ultimately, from it, and it’s what the last chapter of the book [and] CD are about. It’s about coming back to wholeness, which is really, in a way, the surprising gift that trauma does give us—because when we’re able to transform it, we are gifted with things we wouldn’t have access to had we not had these challenges to deal with in our lives.

TS: Now, there are many things you’re saying here that I think are quite radical. I’m just going to start with the first layer, which is that our physical chronic pain is not necessarily just physical. I know someone, for example, who has very, very bad chronic back pain. His approach is to, you know, get different kinds of injections, etc. I don’t think he’s looking at early trauma in his life as an aspect of what might be going on with his back pain. He thinks it’s a physical problem.

MP: Let me just give you an example, maybe, of one of the people we talk about in the book, a client that we talk about in the book. This is a man who had 27 knee surgeries before he even came in for treatment. And he, before that, had been very physically fit. In fact, he was a fitness trainer. He was certified in that. And then later on, he drove a truck as a manager, supervising people in the field to install air-conditioning devices. He had two car accidents while he was driving in that job. But the problem started when he, at the age of 18, had a terrible motorcycle accident and almost lost one of his legs.

He convinced the doctor not to take it off. And that was where the multiple surgeries came in. They tried to repair his leg, but when I saw him, he wasn’t talking about that experience at all. It took two or three sessions before I could even find out that there was this important event that was back in his youth. This was 30 or 40 years later, when he had had already two knee replacements. Both of them had failed. He came in because he had absolutely unbearable pain. And it was the first time in all those 27 procedures he had been able to manage his pain somehow. A lot of it was heavy, heavy narcotics. But it wasn’t working because—and I was able to explain this to him later—because of how much trauma you’ve had, your dissociative protection, the walls that protect you from feeling everything that’s happening in your body, have broken down. They can no longer protect you.

So once we started exploring—and of course, you have to do this very carefully with somebody who has multiple traumas. And to be honest with you, that is most of us—have more than one traumatic event in our lives. It’s pretty rare if we don’t. That includes physical, but as Peter was saying, emotional, psychological, sometimes spiritual—there are many, many different kinds of trauma. We also look at everyday trauma that keeps getting repeated for people. He had some of that. He had some childhood abuse that he had not told anyone about, and that came to light. Also, his mother, who had MS, had died when he was about nine years old, and that loss was very heavy for him.

So as we were able to explore these different kinds of experiences and helped him find where they were stored in his body, but also—and this is very important—we don’t just help people get in touch with trauma. That would be overwhelming and retraumatizing. The last thing anybody needs in chronic pain is more trauma. So what we want to do is touch into the trauma as it’s held in the body today and at the same time find resources in the body that can heal the trauma as it’s being held. But it’s helping the body experience expand so that, as Peter was saying, ultimately it’s that sense of wholeness, when we’re able to claim and experience and feel all our experience at the same time. That’s how we find wholeness. So it has to be resources that help the person recover and rebound from the trauma. At the same time, they’re also touching into these wounds from the past.

PL: And getting back to the question that you asked, Tami, some people, they have back problems, and of course they think there’s something physically wrong with their back. For example, they may go to see an orthopedic surgeon, and they may look at the X-rays or the MRIs or the CT scans, and the doctor says, “Well, look. We can see where this problem is coming from.” And that is a possibility. But some studies were done where people who had identical radiographic findings—so in other words, the two backs look exactly the same—one person was in severe pain, and the other person had no pain at all. Why is that? Well, again, these are the things we address in this program.

There are times when you have to have surgery. You know—when the legs are going numb, you’ve gone past where other methods can help, most likely. So it’s important to be working with a physician as well as working psychologically or working with the body to enlist its own healing responses. So you do want to, of course, have advice from a physician. But again, at the same time, I think people—very often, the doctor says, “Look, do you see the X-rays? Your back is a mess.” Then [the idea] that that is the cause becomes locked into the person’s mind. Unfortunately, many times, when surgeries are done when it wasn’t really necessary, it actually leads to more pain.

So in the program, we do try to help lead people through these questions, to be able to ask questions of the physicians, and to get second, maybe sometimes even third, opinions to separate what the possibilities are. Because when you’re in pain, people will do almost anything to get out of pain. And if surgery is suggested, maybe the person will go right to surgery when there really is breathing room to explore other possibilities, such as what we describe in the program.

TS: Now Peter, you said something very interesting. You said two different people with the same basic X-rays—one could be in pain, and one could not be in pain. How do you explain that?

PL: Well, again, we don’t know all the reasons for that, but it’s very likely—but I don’t believe studies were done specifically on this hypothesis—that the people with the higher pain are the ones who have the greater trauma histories or the greater bracing patterns. But again, remember the bracing pattern, no matter what causes it, it causes more pain. So again, there are certain indications where surgery is absolutely necessary. But my experience, and those of many orthopedic surgeons that I have spoken to—really feel that that is a minority of the people who see them for pain. So we try to get a dialogue, an effective dialogue, a positive dialogue between physicians and patients.

TS: It sounds like that’s the place where the pain is made worse. It’s amplified because of this bracing pattern. And Maggie, you were talking about how in the somatic experiencing method that you and Peter teach, there’s a way to interrupt this pattern right here in the present. So talk to me about that. How do we do that?

MP: Right, OK. Let me give you an example, and then I’ll talk from that. You mentioned back pain, and it’s so common, so I’ll use that as an example. Working with a—I think he’s probably about 38 years old now—and he has had back surgery before he worked with me. The reason he got in touch with me is because the back surgery made him worse. Basically, it caused more pain, and of course, Peter and I know, more bracing. And I’ll get to that in a moment. So that’s why he said, “I need help. I don’t understand what is going on. Other people that have had this same surgery and went to the same physical therapist that I did, they’re doing fine. Why is it that I am struggling like this?” After talking to him, I assured him that he was not malingering. It wasn’t all in his head. In fact, there were probably some very good reasons as to why he wasn’t recovering—and that we needed to look at them together so we could help him recover from those.

Well, as we begin to work together, it turns out that what he did after the surgery was that he braced against the pain and the fear of the surgery itself in ways that other people don’t always brace. Now, why is that? This is where we had to get a little bit creative and help him be willing. The main word that Peter and I use is “curious.” We try to help people develop curiosity about what could explain this. It doesn’t mean that something is wrong with me. It means that maybe something is right with me, that my body is simply trying to help me in ways that I don’t recognize, and it can be sometimes that the mind is fighting back against what the body is trying to do.

So that was true in his case. What he would do is sort of beat himself up internally that he wasn’t working hard enough in physical therapy, or he wasn’t exercising enough; he was getting lazy. He had this kind of inner critical pattern that went on that really further kept him bracing against himself. So he began to recognize—as we unfolded some of this—that his body was tense when he would have these onslaughts of criticism or when he would push himself further. He happened to be a surfer, and he was a competitive surfer before all of this started happening. So he was used to pushing his body, and he didn’t recognize that now, when he pushes after he’s been traumatized by the surgery as well as the injury before that, that he’s getting a third layer of bracing and constriction. And so what he’s learning to do now is to recognize it.

So part of our approach really is a mindful one. That is, we train people how to get curious about their experience, how to accept it, and how to connect with it. So he has learned some of those skills, and now, when he gets scared, he goes back to his surgeon. The last time this happened, he called me up in a panic and said, “The surgeon told me I might need more surgery, and maybe I should just go ahead and do that because maybe I’m just not progressing enough.” I said, “OK, wait a minute. Stop right now, and tell me what’s happening inside you as you tell me about your visit to the surgeon.”

And he was able, because he’d learned the skills and been practicing them, he was able to say, “Wow. I’m just really tight, really tense. I feel like I’m really wound up tight, and also I have this pain.” And he not only had pain in the core of his body, which is sometimes related to internal fear, then he also had the increase of fear in his back—fear and therefore pain in his back, just from talking about the visit to the surgeon. So as he was able to recognize that, he’s learned some ways of breathing, which we include in the program. Just focusing on his breath in a very neutral way, he was able to slow down and calm down. After about two minutes, he said, “You know, I think that was just my fear working against me.”

He said, “I know it’s not a good idea for me to think about having another surgery. I need to do a lot more homework and a lot more work on myself before I make those kinds of decisions.” So that’s just an example of how you can work with somebody who’s going through that kind of bracing, double-bracing, triple-bracing, pain trap that we then can help them out of by learning to work with their body in a different way.

PL: And in this pain trap, self-blame is a hook. What we try to do, and I think we have done, is really help people understand that this is not due to a mental weakness, that there are reasons for that, and that as they can identify what the reasons are and work with them, then they get freedom from the pain. So what we do is—people who are in chronic pain are in the pain trap. What we try to do is help them find where they are trapped and then help them find ways to find the exit from that trap.

TS: It seems that part of the trap is that when you’re feeling terrible in your body, the last place you want to go is to your body. You don’t want to pay attention to your body; you want to escape from it. So how do you help people cross that divide?

PL: Well, Maggie was talking about curiosity. You know the expression about curiosity and the cat, right? At least in Kansas, they say that. “Let the cat [come] to realization of its own highest potential.” As we get people to be curious, truly to be able to explore these things, that in itself reduces the fear and a lot of the tension because a lot of the fear is the kind of “Oh my God,” the kind of catastrophic thinking. So as people are able to explore and find the roots of the problem and to deal with them, well, then that’s when the pain reduces or even resolves.

MP: And we also find it helpful to explain sometimes what’s going on in the body in terms of animal behavior because it helps them normalize what’s happening. So most people have had pets, for example. Even if they haven’t been lucky enough to be in the wilds of Africa and to see animals in their habitats, they’ve seen their pets become threatened.

So we talk about it in terms of “Have you ever seen your dog or cat stiffen up at times when maybe you didn’t understand what was going on?” And they stop everything—the animal stops everything. They’re completely frozen, completely still. And it takes them a while before they can ascertain that it’s a garbage truck, or that whatever it is they’re responding to isn’t really life-threatening. Then they will move automatically, and the key there is “move.” They will move their bodies through and past the fear and the bracing to the other side of that. As Peter was saying, they’re free at that point.

So most people can understand that, and we tell them, “Well, and that’s what’s going on sometimes in you” and that your main enemy may be fear, and at a primitive level, just like my dog is afraid that she may get completely overwhelmed by a garbage truck, the fear is—at the deepest level—is that I won’t survive. Something is so terrible that it will kill me, or it will ruin me and overwhelm me and destroy me. And so once we can help people understand where those really deep survival fears come from, and they are curious about their bodies and how their bodies can help them through this, then we can get them into a place of more hope—because I think that’s where the hope comes from.

PL: And you know, animals are doing things all the time to relieve tension and stress. Dogs, cats—the way they stretch, the way they yawn. What they’re doing, essentially, is dissolving the stress that may have occurred in a threatening situation, such as being frightened by a loud sound. And again, they go through the whole day regulating their level of tension through stretching and through other similar kinds of movements, gentle shaking and trembling, and again, people don’t know that this is actually helping them come back into equilibrium, come back into inner balance. They fight against it. And guiding people through this, they get to say, “Oh my gosh, the thing that I was frightened about is exactly the thing that’s making the tension and the pain disappear.”

TS: Now, you introduce a term in the Freedom from Pain approach that I think is really interesting: the term “self-regulation.” And in the book, it states, “Self-regulation is the cornerstone of our approach.” So can you explain to me what you mean?

PL: What goes up will come down. Animals are threatened on a routine basis in the wild. A predator is always stalking prey, and prey is always trying to get away from a predator to not be eaten. And what happens is after an encounter—well, in a successful encounter—the prey animal, let’s say a rabbit, runs away and escapes from the coyote. But another thing is possible, and you see this, for example, with an opossum, because the opossum doesn’t really have the speed to escape, so what it does is it “plays opossum.”

Well, it’s not playing opossum. It’s a profound physiological response that actually inhibits the aggression and the eating behavior of a predator. So in other words, instead of running, this charge, this energy, this arousal, it goes into this shock response, this immobility response. But the nervous system is still supercharged. It’s sort of like our brake and our accelerator. Our accelerator is going on at a hundred miles an hour, and we have the brake put on at the same time, so it keeps us paralyzed.

But underneath the stillness of the coyote, of the opossum, underneath this stillness is this tremendous arousal of the fight-flight fear, sympathetic adrenal response. And so the animal has an innate ability—and so do we because really, ultimately, we are animals—to discharge that aroused state and to bring us back to equilibrium so that we don’t take that into the next day or even to the next moment. So we always go back to neutral; we always go back to balance. This is built in; it’s innate. That’s what self-regulation is about. And, as I said before, many people have learned to not trust that. We help people learn to re-gather trust for these mechanisms, which will take them back into healing.

MP: Right. And the example I gave earlier about the young man with the back problem—one of the things that he learned to do was to regulate not only his fear, but also the kinds of movements that he was doing. I asked him to show me some of the movements. For example, you learn a lot by asking someone, “Well, have you been given exercises for recovering from this surgery?” or whatever they’re dealing with. I asked him to show me what are some of the exercises, “Show me one exercise that you usually do.”

And he showed me, and he was moving so quickly, and with jerky motions, that I knew there was no way that the exercise was really doing him much of any good because he wasn’t really connected to his body experience. So I helped him learn. I said, “Let’s see if we can find a feeling of balance in your body as you’re doing the exercise, even if you just do one little part of it. Let’s find out what difference it makes.” So I had him slow down his movement and make it very intentional instead of like a reflex, like being afraid to touch a hot stove, and you draw back quickly. That was the kind of movement he was making.

As he slowed down, and we added in some breathing, and some rhythmic breathing, that helped the movement become more smooth and easy. After about two or three minutes, he says, “I haven’t felt like this in months.” He says, “I certainly haven’t felt like this since the surgery.” I said, “Well, what are you learning right now that may explain that?” He said, “Well, I can see I am not connected with my body. I’m not working with my body at all. I’m not even in my body.” So that’s what we found that a lot of people need help with is the simple practice—and it’s an early exercise in our program—of reclaiming and reinhabiting our body.

TS: Have you ever encountered people who were in such dire chronic pain that you couldn’t help them at all—that they were beyond help?

PL: I can’t think of any that were beyond help. No. I mean, in over 40 years, there have been cases where a surgery had to be done. Even when surgery is necessary, you still can help reduce the pain somewhat and also help increase their recovery after the surgery. But especially when there wasn’t a tissue damage site, not everybody is completely free of pain, but I can’t think of anybody that was in such pain that they weren’t able to get some significant relief.

MP: Yes. I would agree. First of all, I just categorically don’t believe that anyone is beyond help. They can always learn something from what we are offering them. Why? Because it makes sense to them once they understand what’s going on. And understanding what’s going on, as we’ve been explaining in this interview, gives them a sense of empowerment. It gives them a sense of choice. So, they may decide to go on with the surgery with the understanding that they can use the tools that we’re teaching to help them recover from it if that’s what the best choice is for them.

Now, there are a couple of people that I have found very difficult to work with. That’s a different issue. There are some people who really, I believe, have had attachment or relational trauma very early, so their problem is they can’t trust anyone to help them. They want desperately to believe that someone can give them some tools that will really make a difference or that somebody cares enough about them that they want to try to help them out of pain. But for their own good reasons, in being traumatized and abused, it’s very hard for them to persist long enough against the fear that they have about trusting you, that you’re not going to be one more person that lets them down or manipulates or exploits them in some way.

And so when we get into cases like that, it’s much more complex. But I don’t ever believe that anyone is beyond help, and it’s very important, I believe, to keep trying to repair the relationship that you’re forming with the person at the same time you are offering them tools. You can’t just be a mechanic. Neither Peter nor I believe in that at all. We put as much thought and care into the relationship as we do into the tools we’re teaching.

PL: And we’ve tried to convey some of that feeling in the program itself. So even though obviously we’re not seeing each person individually, we try to convey that kind of openness and invitation to people because, like we said at the beginning, people with early trauma can tend to have higher instances of chronic pain. And these are people who have not been understood, or not been cared about, or [have] people who have given up on them in the past. Obviously, this doesn’t in any way substitute for individual therapy, but it certainly can be a very helpful adjunct. It can be something that both clients and therapists can use to help continue the therapy outside of the individual session work.

TS: Now, I’m going to take this just a little bit further because I have personally known people who have really suffered from chronic pain, and I’m imagining one of those people listening to our conversation and feeling, “You know, I just feel like my situation is hopeless. I’ve tried for so long, and now a book-and-CD is going to help me? A series of exercises are going to help me? I just don’t buy it. I’m just in pain.” What would you say to such a person?

PL: Well, helplessness is a characteristic of trauma. And so when we help people begin to—and we have a chapter on depression—to move out of helplessness and depression, then, you know, it’s kind of like, “OK, if it’s a cloudy, rainy day, there’s nothing you can do, if you want sun, except to wait for it to change.” And so we have this mood of resignation and depression.

Well, actually, if we can do something that can change the depression, then the light on the problem will be different. Now, look, I don’t think anyone who has had chronic pain doesn’t at some time feel, myself included, “I’m never going to get better. This is going to go on forever.” It’s a normal part of the process. But again, if we can help people deal with the resignation, then they have a brighter light to shine on the problem and on the tools that might be able to help them. Now, some of the tools—and we’re very clear about this—won’t work for you.

But we have given, hopefully, a number of tools that—at least some of them will work for most people. Hopefully, something will work for everybody. The only thing we could say is, “Look, we hope you give this a try. Of course, it’s not a guarantee.” And it’s something that—in our total 80 years of clinical experience, we’ve found that these kinds of tools are helpful. And we sincerely believe that they will be helpful as we present them here, not for every single person, as much as everybody would want, but I think that most people can get something out of the program.

MP: Yes. I tell people that my job is to help them find at least one tool that they haven’t been able to find or to use successfully before that really makes a significant difference in their pain. And I take that really seriously as a challenge with each person that I work with. And that’s our challenge with people who are going to consider the Freedom from Pain program—is that we believe that we have put together the best of our thinking, the best result of 80 years of combined clinical practice of things that have worked with people that have never had hope before in many cases. We teach people to try something once. The very first possibility and invitation is “Are you willing to try this one tool to see if it can make a difference?” And if it doesn’t, move on, because there are at least probably 40 more tools in this program, and one of them is going to work for you.

So it really is a question of helping people feel empowered and also teaching people that a lot of this is about choice. The choice is not about being in pain. That’s not what we’re saying. We’ve had a lot of people that have had terrible things happen to them, and it’s amazing that they’re still alive. Their suffering is overwhelming, and we have great empathy with that. However, it is a question of choice about what they are willing to try, about what they’re willing to experiment with. And on the basis of those experiments, we are able to learn, as they learn, what happens as they encounter the tool or work with the tool, and then we can modify it. We can modify it so that the tool begins to work in a more and more effective way.

And so really, we’re not telling people that we’re miracle workers. Far from it. We’re just saying we believe in the tools, and we believe in the method, and we want you to find one thing that will work for you.

TS: Now, Peter, you said something very interesting: that hopelessness, depression is actually part—is intrinsic to the trauma experience. Can you explain that?

PL: Yes. Well, look at the opossum. The opossum goes in this immobility response where it’s motionless. Then when the coyote goes off and goes away, it comes out of this and goes off to finish its day. Now, humans go into this immobility response, but we sometimes find it more difficult to come out of it. And the experience of this immobility response is of helplessness. It is of helplessness.

So as people learn to actually complete this and to come back into life, then the helplessness is reduced. So helplessness, you could say, is a psychological component or a psychological aspect of the biological immobility response, which we share with all mammals. Actually, we share it even with many insects. This is a very powerful survival response.

But if we get stuck in it, we don’t come out of it. Instead of perceiving that we feel immobile and that that’s a physical thing in the body and that it can change, we tend to psychologize it as feeling helpless. When we can change the physiology, then the psychology will follow.

MP: Just another word about this is that I think most people are familiar with “fight, flight, and freeze.” They know that these are the three survival responses that we have inherited as animals on this earth. One of the things that we do is to educate them as to which symptoms, so to speak, are connected to each of those incompleted or thwarted responses. In other words, unlike the animals in the wild, we can’t keep running and running and running away from a danger. I mean, how do you run away from a car accident if you’re involved in it? You can’t. How do you run away from somebody who’s trying to abuse you? Fight back? You can’t complete the fight response because of the same kinds of issues. But freeze—like Peter was saying about the opossum—that is the only avenue that’s left open to human beings in many cases.

And so we educate people about this, and we tell them that if you’ve been in the freeze response for a long time, and it’s been held in your body as this huge constriction and immobility, then you are going to go into a state of collapse and frozenness at the emotional level that takes the form of depression. At the physical level, it can take the form of massive constriction that creates terrible pain that you don’t get relief from. So I think that education is really, really important for people to understand that.

PL: Yes. Because out of education comes self-compassion because when you see that there’s a reason, you first of all have more compassion—there’s less self-blame, and second, it gives you a clear pathway or some pathways to explore to come out of this and to return to reregulate, to find our inner balance again.

TS: We started by talking about the puzzle of pain and how it’s a lot more complicated than somebody might think at first. It’s not just, “I’m in physical pain, and I need someone to fix my body.” I think this conversation has helped underscore, highlight, and show the complexity of the puzzle of pain. So here, as we’re coming to a conclusion, if you had to summarize what you think the keys are to solving this puzzle for an individual, if you could just give them a small key ring of the most important keys to solving the puzzle of pain, what would be the keys on that key ring?

PL: First would be that one size doesn’t fit all. The tools that work with one person may not work with another. And to be open to explore different possibilities.

MP: The second key might be healing through the body, that we understand that you’ve disconnected from your body—for good reason—as an attempt to regulate the suffering you’ve had that just feels unbearable. And yet, the challenge is to find out how a connection with your body can make all the difference, can bring you into contact with resources that you’ve never found before.

PL: And that there are tools that can help us befriend, re-friend, our bodies and begin to come out of the pattern, the body patterns, the tension patterns that are actually generating a significant portion of the pain, if not the entire pain.

TS: Wonderful. Maggie Phillips and Peter Levine summarizing solving the puzzle of pain with three keys. Thank you so much for that terrific summary and mostly for the important work you’re doing and for the program you’ve put together: Freedom from Pain: Discover Your Body’s Power to Overcome Physical Pain. It’s a book and a CD of guided practices, a self-guided program that people can work with in their own way to overcome physical pain. Thank you both so much.

PL: By the way, thank you, Tami, for [helping] us until we finally did it.

TS: Wonderful. That was a great conversation. Peter Levine has also created a series of audio programs with Sounds True on Sexual Healing: Transforming the Sacred Wound, and a program for guiding your children through trauma called It Won’t Hurt Forever. He’s also written a book that also has an accompanying CD, Healing Trauma: A Pioneering Program for Restoring the Wisdom of Your Body.

Intégration du Cycle de la vie

L’Intégration du Cycle de la vie est une technique nouvelle qui permet une guérison rapide chez les adultes ayant subi des maltraitances ou des négligences au cours de leur enfance.

Cette nouvelle méthode repose sur la capacité innée du corps et du psychisme à se guérir lui-même. L’Intégration du Cycle de la Vie utilise une technique psychologique intitulée “pont d’affect” afin de trouver quel souvenir est connecté au problème du patient. Le thérapeute guide le patient à travers son souvenir, en l’aidant à y apporter ce qui est nécessaire pour résoudre ce souvenir. Une fois le souvenir résolu, le thérapeute ramène le patient à travers le temps jusqu’au présent en utilisant une Ligne du Temps constituée d’images successives de souvenirs de la vie du patient. Cette Ligne du Temps de souvenirs et d’images prouve au corps et au psychisme du patient que le temps a passé et que la vie est différente aujourd’hui. Cette “preuve” s’inscrit à un niveau plus profond que lors d’une thérapie classique par la parole.

Pendant une séance d’Intégration du Cycle de la Vie, les patients produisent et visionnent un “film” de leur vie.

En thérapie par Intégration du Cycle de la Vie, l’avancée du patient dans le temps est faite visuellement, comme si le patient visualisait un “film” de sa vie. Ce “film” est généré spontanément par l’inconscient du patient et montre une séquence de scènes, dont un certain nombre sont liées au problème actuel. En regardant ce “film” de sa vie, le patient voit comment le passé continue d’affecter sa vie et ses choix au présent. Ce voyage à travers le temps, des souvenirs passés jusqu’au présent, est habituellement répété de trois à huit fois par séance. Les patients âgés ou ayant vécu des enfances traumatiques nécessiteront plus de répétitions du protocole ICV pour nettoyer l’empreinte cérébrale de leurs souvenirs traumatiques et “réécrire” leur modèle de vie de façon plus adaptée. Chaque répétition du protocole montre au patient un “film” différent en mouvement. L’ICV fonctionne bien aussi avec des personnes ayant de la difficulté à se souvenir de leur passé. Pendant une thérapie par ICV, les patients qui ont commencé avec des trous de mémoire quant à leur passé finissent par pouvoir relier les différents épisodes de leur vie en un tout cohérent.

Parler des maltraitances passées en thérapie ne suffit pas nécessairement pour passer à autre chose.

Il est bien connu des thérapeutes que les adultes ayant subi des maltraitances ou des négligences dans leur enfance passent des années de thérapie à raconter leurs traumas et exprimer leurs émotions à ce sujet, tout en éprouvant des difficultés à les surmonter. La raison en est que les personnes qui ont été traumatisées alors que leur système neuronal était en plein développement se retrouvent souvent “formatés” dans le sens d’une tendance à interpréter les événements de façon négative. Les adultes qui ont été maltraités dans leur enfance ont souvent une mauvaise image d’eux-mêmes, un dialogue interne continu négatif, et des tendances anxio-dépressives chroniques. Ces traits restent souvent intacts même s’ils ont réussi à s’épanouir par ailleurs dans leur vie et quelque soit le nombre d’années de thérapie par la parole qu’ils ont faites.

Les adultes qui ont été maltraités dans leur enfance réagissent souvent de façon stéréotypée, dysfonctionnelle et parfois auto-destructrice.

Les adultes ayant subi des traumas infantiles continuent souvent d’être “réactivés” dans leur vie actuelle. Lorsque les gens sont “réactivés”, ils réagissent souvent par des comportements teintés par le passé qui ne les aident pas dans la situation actuelle et qui peuvent être destructeurs. Répéter ces comportements auto-destructeurs guidés par les souvenirs traumatiques n’amène que la personne à se sentir encore plus mal et encore plus désespérée.

La thérapie par Intégration du Cycle de la Vie guérit complètement et en profondeur sans retraumatiser.

Enfin il existe une thérapie qui peut modifier tout ceci sans retraumatiser. L’Intégration du Cycle de la Vie est une thérapie très douce qui est efficace à un niveau profond, neuronal, afin de changer les comportements influencés par les souvenirs passés et les stratégies défensives dépassées. La thérapie par ICV aide à reconnecter les émotions désagréables et les comportements dysfonctionnels aux souvenirs des événements passés dont ces émotions et comportements sont issus.  Le fait de faire ces connexions à un niveau profond du corps et du psychisme permet de “restaurer” le système neuronal de façon à ce qu’il soit plus en harmonie avec la situation actuelle. Cette “restauration” survient très rapidement pour la plupart des gens. Après une thérapie par ICV, les gens remarquent qu’ils réagissent spontanément aux situations de stress de façon adaptée à leur âge. Après plusieurs séances d’ICV, les patients ont décrit qu’ils se sentaient mieux dans leur vie, s’acceptaient mieux, et étaient davantage capables de profiter de leurs relations affectives.