Episode 68: Dr. Bessel van der Kolk, Author of The Body Keeps the Score- Brain, Mind and Body in the Healing of Trauma

Intro Voices  00:04

Where do I go? It only happened once. I think I was singled out. The phone calls began about one month ago. What is hazing? Something happened to me when I was younger. I'm worried about my safety. He said he was sorry. Can someone help me? Where can I get help? Can someone help me?   This is You Matter, a podcast for the NYU community developed by the Department of Public Safety.  

Karen Ortman  00:36

Hi, everyone, and welcome back to You Matter, a podcast created to teach, inspire and motivate members of the NYU community who have been victimized in some form or fashion and to identify resources both on and off campus that can help. I am your host Karen Ortman, Associate Vice President of Campus Safety Operations at the Department of Public Safety, and a retired law enforcement professional. Today I welcome Bessel van der Kolk, MD, a clinician, researcher and teacher best known for his work with post traumatic stress. He is the author of The New York Times Best Seller The Body Keeps the Score. Dr. van der Kolk has been active in the field of mental health since the 1970s, and currently serves as medical director at the Trauma Center in Boston. Dr. van der Kolk, welcome to You Matter.

Dr. Bessel van der Kolk  01:27

Thank you.

Karen Ortman  01:29

How did you become an expert on the subject of trauma?

Dr. Bessel van der Kolk  01:34

By treating a lot of traumatized people. That's how you become an expert, the people you treat.

Karen Ortman  01:41

So how long have you been treating people who suffer from trauma?

Dr. Bessel van der Kolk  01:47

Well, of course, everybody who ever becomes a clinician treats people who suffer from trauma, because trauma is such a pervasive issue in our world, but consciously for about 40 years.

Karen Ortman  02:02

Okay. How about we define what trauma actually is?

Dr. Bessel van der Kolk  02:08

Trauma is an experience that leaves you dumbfounded, overwhelmed, and befuddled, that continues to live on in your orientation to the world after that.

Karen Ortman  02:26

Is it accurate to say that trauma has a range of effects on people?

Dr. Bessel van der Kolk  02:31

Oh, it has a pervasive effect on people.

Karen Ortman  02:35

So there are varying degrees of trauma? 

Dr. Bessel van der Kolk  02:43

In some ways all traumatic experiences are the same in that they mess up people's organism in a way. It has disorientation of different things, it changes something in the way you experience yourself or the people around you. It changes your stress hormones, it changes your brain, it changes your perceptions, it changes your orientation, and has a pervasive effect of human beings.

Karen Ortman  03:18

And does it affect people differently? What is traumatic to me? Would it necessarily be traumatic to somebody else?

Dr. Bessel van der Kolk  03:28

Not necessarily. No. As a law enforcement person, you know, you get trained to be exposed to all kinds of situations. Something that might freak me out, may not freak you out. As an example, of course, I'm a medical doctor so I have some exposure to corpses and wounded people. If I come across a torn up body on the side of the road, my prior training and your prior training might help us to probably stay validly calm, and in a mode of, what can I do about it? If you have never been exposed to something like this, your helplessness and your terror of seeing a thing like that may push you over the edge.

Karen Ortman  04:20

Got it? Does trauma have to be inflicted through physical violence or something as severe as physical violence in order to be traumatic?

Dr. Bessel van der Kolk  04:35

I'm not quite sure what you have in mind. What else might you think about?

Karen Ortman  04:40

You can grow up in an abusive home. As a child, you can move on into adulthood, and that abuse no longer exists in your life. You now have a family of your own. There are some people who, although they are no longer being abused as adults perceive their experience as a child as very traumatic even 30, 40 years later. Does that make sense as it relates to your experience and your understanding of what trauma is?

Dr. Bessel van der Kolk  05:19

If you were abused and neglected as a child, it will affect you. Whether you are aware of that or not is a different question. Some people will say, oh, I grew up with an alcoholic father, and look, I'm just fine. But, maybe your own kids would not agree with that.

Karen Ortman  05:40

So is that trauma?

Dr. Bessel van der Kolk  05:44

There's the impact of trauma on people, but people are not always aware of it. Quite a lot of people say, no, it didn't bother me, I just blow up at people and they get angry, and I can't stand relationships, but I'm fine.

Karen Ortman  06:02

So you can suffer from trauma and not be aware of it?

Dr. Bessel van der Kolk  06:07

Absolutely. Yeah.

Karen Ortman  06:09

Are there people who go through life that suffer trauma, and never know that they suffered trauma?

Dr. Bessel van der Kolk  06:17

Most people I would say. I would say that very few people grow up in violent alcoholic households who say oh, I grew up in a violent, alcoholic household and this is how it has affected me. It takes a great deal of self-awareness and self-exploration, to know how you got to be who you are. 

Karen Ortman  06:44

You've said in previous interviews that, what is striking about trauma, is it gets discovered and then forgotten. What does that mean?

Dr. Bessel van der Kolk  06:56

Well, the history of all this is that, indeed, there's a tendency everywhere to minimize trauma. For example, when I started to work with Vietnam veterans in 1978, but there was not a single book on war trauma in the library of the VA. When I and my colleagues said, oh, the trauma that happen to Vietnam shaped their minds and brains, everybody sort of treated us as if we had gone off the deep end. Even though there was vast literature on what happened in the Second World War, and vast literature of what happened in the First World War, the moment to the war's over, people just go on and pretend like it didn't happen. Domestic Violence. When we defined PTSD for the first time back in 1980, we said it's an extraordinary event that occurs outside of the usual realm of human experience. That was complete nonsense. Domestic violence is ubiquitous. About a third of all couples engage in violent activities, at least. Trauma is everywhere. About one out of five women gets raped. Yet we were so blind to it, that people said is extraordinarily rare and unusual. That that perception still persists to a large degree. In psychiatry, psychology, there's a substantial number of people who know about trauma, but some people don't know about trauma at all, you can take a course to become a licensed psychologist and never learn anything about trauma.

Karen Ortman  08:48

When trauma is left unaddressed, how does it manifest itself in one's body internally or externally?

Dr. Bessel van der Kolk  09:00

Well, trauma, it lives on. That's the nature of trauma, it really shapes your perceptions, and so you automatically will become frightened, upset or angry in the face of things that other people may not get upset and frightened about. Your hormones get triggered and your action patterns get triggered, and you behave like a scared or frightened animal. You will feel embarrassed about it or blame other people. People go like, oh my god, she's going nuts or he's going nuts, better be careful, but these people have these automatic reactions, becoming angry, frightened, upset, etc., etc.

Karen Ortman  09:47

Can trauma ever serve a constructive purpose?

Dr. Bessel van der Kolk  09:53

Yeah, yeah. For example, if you get traumatized in the war, maybe it will make you a more cautious person before you send people off to war. If you get molested, you may become more conscious if you're a hospital administrator, about a danger of sexual violence and stuff like that.

Karen Ortman  10:17

Does the impact of trauma differ for children as compared to adults?

Dr. Bessel van der Kolk  10:22

Yes. When you're a child, you have a growing and developing mind and brain. If the trauma occurs, it inserts itself in the developing mind brain, and has a more profound a pervasive effect. When you're already a well formed individual, and suddenly a terrible happens to you, it just tends to affect a smaller part of the overall system. 

Karen Ortman  10:47

You said earlier that trauma affects changes to the brain. How does that happen?

Dr. Bessel van der Kolk  10:56

Well, it changes the way that your brain perceives the world. Your danger signals become different. Your capacity to observe yourself becomes different. Your capacity to make use of what happens your body to take care of yourself changes. I mean, it's just, there's not the right forum to explain all of that, it just has a very pervasive effect on many different brain functions, as I spell out in my book, actually.

Karen Ortman  11:30

Can the traumatic effects on the brain ever be reversed?

Dr. Bessel van der Kolk  11:39

I think what's interesting is that the National Institute of Health fund studies to show how screwed up you are. Part of the NIH is not to study how you can help people. So, it's very hard to find the necessary money to show how the brain changes for the better, after treatment. A few studies have been done like that, but certainly, there's a number of very effective interventions that can undo the effects of trauma.

Karen Ortman  12:15

Can trauma, like it affects the brain, can it affect internal organs?

Dr. Bessel van der Kolk  12:22

Well, it ultimately, it affects the signaling between different parts of the body. People who are traumatized have a much harder, higher incidence of gastrointestinal problems, or have genital urinary problems, so the pathways of danger signals that come from the brain can go and affect body organs. Yeah.

Karen Ortman  12:53

I know you said earlier that you worked with Vietnam vets, and the post-traumatic stress that they suffered. Are there are other contributing factors that inspired you to study the effects of trauma on people beyond that?

Dr. Bessel van der Kolk  13:19

Many, many different things. I've always, even as a small child in Holland where I grew up, you have one program where you learn a lot about classical literature, you learn Greek, you learn Latin, but there's not a program where you learn about part science, you learned a lot about science early on. I was a sort of kid who wanted to both learn about ancient literature and Greek, and wanted to learn about biology. So from very early on I've always been very interested in both science and cultural factors, and trauma certainly brings that together. Of course, like everybody else, I had my own share of traumatic experiences in my family, but we all do.

Karen Ortman  14:10

Is the only way to rid yourself of trauma through medical intervention?

Dr. Bessel van der Kolk  14:19

Oh, certainly not, though, I think people have been traumatized since time immemorial. Particularly when you travel about a world you see how other people deal with trauma. You see how, for example, I was very involved in the truth and vaccination process in South Africa, and you saw how Bishop Tutu would sing and move and dance with people and it was extraordinarily helpful. You go to Buenos Aires, and you see people in Argentina dealing with their trauma by doing Tango dancing. There's many different ways in which people can calm their bodies down, and we gain a sense of community. In fact, I think medicine, as a profession, has actually less to offer than many other things. Okay? Religious people may have more to offer, because religion offers you a sense of community and purpose and mutuality that medicine doesn't. That says mutuality and reciprocity is a very important part of recovering from trauma.

Karen Ortman  15:37

You've spoken in the past about comorbidity between trauma, drugs and alcohol, and that research has shown that it's almost impossible to become a drug addict without suffering some form of childhood trauma.

Dr. Bessel van der Kolk  15:54

That's correct.

Karen Ortman  15:55

So, understanding that this conclusion is based upon research, do you believe this to be the case based upon your experience working with trauma patients? Have you observed this to play out in your own practice with your clients?

Dr. Bessel van der Kolk  16:16

You know, you see things clinically, but you don't know to what degree you can generalize from one, or two, or three, or five individual cases. When you study 17,000 people, you see everybody who is drug addicted, also has a history of childhood trauma, then you start being able to generalize from individual examples.

Karen Ortman  16:42

Yeah, that's interesting to me. We talked about you working with veterans of war, and the trauma associated with war. Some of those veterans are addicted to drugs and alcohol. Do you presume that their trauma was also as the result of childhood trauma, in addition to their experience in combat?

Dr. Bessel van der Kolk  17:08

Actually, the original definition of PTSD, which has some role to play, was that it was all about combat trauma. Then, we saw some other stuff and we conveniently ignored it. Today, of course, we realize that people who join a volunteer army are, by and large, people who try to escape from pretty tough situations, so the history of people who enlist in military is much larger than the general population. And from the CDC right now, for example, people like to quote this statistic, which I don't know if it's true or not, that 22 people, 22 veterans kill each other every day. It turns out that it's true, whether they were exposed to combat or not. What they're probably dealing with is much more pervasive long term trauma that starts off with extreme poverty, deprivation, growing up in violence, that then you go to the army to escape that stuff. It can be extraordinarily helpful with that. As a law enforcement person, you probably know how putting on a uniform and having a clear task and becoming very good at what you do is enormously helpful for people. By and large, the military often plays a very positive role in people's development. After coming out of chaos and unpredictability you can have much more predictable life. So it can actually play a very positive role. But if you have a history childhood trauma and you get that comfort of comradeship, and belonging, and being skilled, and then your best friend gets killed, or you do something horrible that your conscious cannot live, in defense, which happens often then, of course, all the stuff combines together to create a lot of trouble in people's lives.

Karen Ortman  19:12

How important is lifestyle in overcoming trauma?

Dr. Bessel van der Kolk  19:20

I think I'm not quite sure what you mean with lifestyle?

Karen Ortman  19:23

A healthy lifestyle; exercise, eating better foods. 

Dr. Bessel van der Kolk  19:26

Of course, that' has a profound effective. A very common effect of trauma is to become quite passive and to feel quite helpless, so if you have an active practice of dancing, making music, doing yoga, doing theater, that really helps your body to be engaged in the present. Having a body that's really focused on living as fully as you can in the present is extremely helpful. Watching a screen can be very bad thing for your mental health.

Karen Ortman  20:02

Can you repeat that?

Dr. Bessel van der Kolk  20:04

Watching a screen all day, watching TV all day, is very bad for your mental health, because it has further ingrained that sense of physical passivity and physical helplessness.

Karen Ortman  20:17

And I presume it would be the same sitting looking at a smartphone or an iPad or...

Dr. Bessel van der Kolk  20:25

Same thing, they're not good for people, by and large. You know?

Karen Ortman  20:28

How effective are drugs in the treatment?

Dr. Bessel van der Kolk  20:29

They're not very effective at all actually. Part of what is striking is that, you know, that's part of what I write in my book, when I became a psychiatrist, there were very few drugs that were effective. Since that time, psychiatry became a drug pushing type discipline, where it is this mythology that every human's piece of suffering and unhappiness can be counteracted by a drug. It turned out to be completely not true. Psychiatry really came to a dead end, and it's basically a broken profession, because it gets married to drugs being the answer, and drugs aren't the answer. drugs can be somewhat helpful sometimes, but it will not help you resolve your trauma.

Karen Ortman  20:34

No? To your knowledge, are there a large quantity of drugs that are prescribed to address trauma?

Dr. Bessel van der Kolk  21:29

Well, yeah. I give the statistics in my book. At the time I wrote my book it was like billions and billions of dollars, by and large, a waste of money.

Karen Ortman  21:39

Can trauma be passed on to a child from a parent?

Dr. Bessel van der Kolk  21:44

Absolutely. You know, we all notice from experience that if your mom or or your dad's Vietnam veteran who blows up all the time and gets drugged, it affects you in a major way. If mom is a rape victim who is frozen and not affectionate, and uptight, that affects you in a major way also. Of course, we know from epigenetics that trauma gets passed on via alterations of your genes actually.

Karen Ortman  22:18

I'm curious as to what your position is on the following. Like I said earlier, I'm I was in law enforcement for a very long time, and I worked with victims my entire career. As you know, when someone's the victim of child abuse, whether it be physical, emotional, sexual, what have you, they're the victim in the case, and the offender is typically a parent or somebody who's very close to the family. That child has to testify in a court of law in front of their abuser. You know, I recognize that, in many instances, that's what is required for constitutional reasons and all other legal reasons, but my concern always lies with that victim who, in my opinion, is being re-victimized by having to actually stand up in court and tell their story.

Dr. Bessel van der Kolk  23:25

The kid doesn't have to testify the perpetrator it present. And his testimony is oftentimes held in camera. 

Karen Ortman  23:35

Not always though.

Dr. Bessel van der Kolk  23:37

Not always, but in enlightened places, like Massachusetts, where I live, which is fairly enlightened place, kids don't testify in courtrooms with the perpetrator being present.

Karen Ortman  23:53

But what about those who must for whatever reason,

Dr. Bessel van der Kolk  23:58

... testimony, because kids are dependent on their parents to take care of them for safety, kids don't ordinarily turn on their parents. It's so scary because you can get put in foster care, you get so nervous, you get abandoned, so you cannot get true testimony under those conditions.

Karen Ortman  24:19

My position, not being a psychiatrist, or in the medical field, but just as a caring person who was a member of law enforcement, was always concern for that child being re-victimized. Is that an accurate assessment, that the child is being re-victimized by having to go through that process?

Dr. Bessel van der Kolk  24:41

Absolutely. A very valid assessment.  I think you having an empathy card is as good a qualification to make that judgement, as going through medical school for 26 years. The whole issue, of course, is that as a child you are dependent on your parents, and that makes life so complicated. We have abusive and neglectful parents, and no 4, 5, 6, 7-year-old kids will say, I'm a perfectly alright kid, but my mom or my dad are really crazy and this has nothing to do with me. A child will always blame themselves, and take it upon themselves, and DO IT WE BEAR. Human beings are fundamentally very loyal people and certainly stay loyal to the people who are hurting them.

Karen Ortman  25:26

Yeah, absolutely. Why is shame so often associated with trauma?

Dr. Bessel van der Kolk  25:35

Well, it is because when you get traumatized you have these reactions that seem out of line; that you get very angry, or get very scared. People around you don't get angry or don't get scared. That combined with what actually already has happened to you makes you feel like, I'm a creep, I'm a weird person, I'm inadequate, I'm a terrible person. As a chorus, and we learned this from Jean Piaget, the first child development person, is that when you're three, four years old, everything that happens in the world is because of you. You don't have the capacity to say, oh, but a kid over there would react differently. If somebody says to you, your cutest kid in the world, when you're three years old you actually say good, all is good in the world. You don't say, oh, I'm average. You know? If somebody says you're a piece of shit when you're three years old, that means that you are a piece of shit. It like, I know, actually, you're crazy and I'm not; a three-year-old isn't able to do that.

Karen Ortman  26:46

Let's talk about The Body Keeps the Score. First, tell me about the title. How did you come up with the title?

Dr. Bessel van der Kolk  26:55

Well, I came up with the title because one of, actually not my patients, I don't say in the book, one of Judy Herman's patients told that to her. Judy and I are very good friends, and she tells me that story andi was like, wow, the body keeps the score. Like everything else, you learn from your patients more than from your textbooks, so my patients taught me, my body keeps score. The science very much overtime supported that, it changes the areas of your brain that measure their bodily sensations, that part of your mind tries to move on, but your body continues to bear the imprints of the trauma, and so your body automatically reacts while your mind says that's crazy, nothing bad happened to me, but your body really does carry it out. The back of your brain is all about surviving, so it's the back of your brain which has no words, which has no consciousness. It just has hunger, and arousal, and sleep, and appetite, and anger; it's just sheer emotions. While you're back there, your primitive brain is trying to help you to survive a lot of ghosts, like that's crazy, you shouldn't feel that way. But you do, so it's an internal struggle between different parts of you basically.

Karen Ortman  28:28

All as it pertains to trauma.

Dr. Bessel van der Kolk  28:32

Yeah, to reality as it were.

Karen Ortman  28:37

For someone who's listening, and perhaps has not heard of your book, can you share some takeaways that you think would be meaningful to somebody who has experienced trauma and is just hearing about your book for the first time?

Dr. Bessel van der Kolk  28:56

What is there such people? So my book has been on the New York Times bestseller list for 117 weeks now. It's been translated to 38 languages, so I'm surprised that anybody might not have heard of it. If they haven't, I explain how trauma affects brain functioning, and how these, apparently, irrational and strange things that people experienced, are perfectly explainable when you understand child development and the brain. Then I have a very long session on all the things we can do about it. It's very much based on being a clinician; I assist my patients, help my patients. I am also very much a scientist, and as our understanding about the brain evolved, we started to look at methods that can help you to change the brain to help your brain to become more normal.

Karen Ortman  29:58

So if somebody is out there who has been traumatized and a loved one says to them, just get over it, they should definitely read your book?

Dr. Bessel van der Kolk  30:16

The one who says get over it should read my book.

Karen Ortman  30:17

I agree.

Dr. Bessel van der Kolk  30:19

Also, it's a really stupid thing to say actually.

Karen Ortman  30:22

But this is often a response that his victims get from a friend, family, whomever, when talking about their trauma.

Dr. Bessel van der Kolk  30:32

It's a reasonable response, you know, if somebody reacts to very minor things and that ruin the party. And of course people will round them say, hey, get over, it's just nothing. It's nothing for you, but for the other person the question is, how do you get over it? That's the big question.

Karen Ortman  30:51

Yeah, exactly. Is there anything that I haven't asked you that you would like to share?

Dr. Bessel van der Kolk  30:58

We have learned a lot about treatments, but I'd like to say that this field is only about 30 years old, and every year we learn new things. You may run into people who think that they have the answer, or we're doing evidence based treatments. Well evidence based treatments, we can only study things that are very simple and simplistic, and this is what's called evidence based treatments. In fact, we need to go way beyond what's currently practiced, to really explore much more extensively how people can calm their bodies down. Where you start off is helping people to actually feel what they feel and to know what they feel. You start very much with helping people to find language for the experience. You have to be very patient to help people to find words for what's basically the unspeakable.

Karen Ortman  32:01

When you say feel how you feel,

Dr. Bessel van der Kolk  32:04

Yeah.

Karen Ortman  32:06

Can you explain how somebody can do something that sounds so simple, but have difficulty doing just that?

Dr. Bessel van der Kolk  32:20

I think most of our culture is not a culture of introspection and reception. Certainly not in the past four years, we saw that very clearly played out in national scene of a complete lack of self-awareness. A lot of people were perfectly alright with the complete lack of self-awareness. Learning to become self-aware and to understand what's going on inside of you, and where it's come from, and what actually you have is a very important part of learning to become the captain of your own ship, basically. As long as you have no language for your own sensations, your own emotions, your own life experiences, you really are not very much present as an individual. So finding language for yourself is very important. The second thing is that your body continues to react to the environment, as if you're getting traumatized, and causes you to shut down and to become very angry and become very frightened. You need to learn to calm your body down. Learning how to calm your body down, probably has some to do with your BODY. Some people just sit in the chair, and yet, he actually needs to do something and learn what you can do to make your body feel peaceful. You need to learn how to breathe, learn how to be touched, learn how to touch, need to learn how to maneuver your way through the world and establish a sense of safety in your body without drugs. The drugs are really a way of sort of obscuring these issues, but not resolving them.

Karen Ortman  34:05

Any parting words of wisdom for our listeners, given your wealth of experience and expertise?

Dr. Bessel van der Kolk  34:15

Yeah. Find somebody who you can trust, who with them, you can have reciprocal relationship where you look after each other, you can be honest with each other. Find out what gives you a sense of pleasure. gives you a sense of agency. What helps you to feel, like maybe you're doing this webcast gives you a sense of agency. Do something with your life that gives you a sense of I'm having an impact. I'm doing something. I'm both taking care of myself and taking care of other people at the same time.

Karen Ortman  35:01

I like it. Thank you so much for joining me today.

Dr. Bessel van der Kolk  35:05

Good luck to you.

Karen Ortman  35:05

Best wishes to you as well. Thank you to my guest, Dr. van der Kolk, and to all of our listeners for joining us for today's episode of You Matter if any information presented was triggering or disturbing, please feel free to contact the Wellness Exchange at 212-443-9999 or NYU's Department of Public Safety and their Victim Services Unit at 212-998-2222. Please share, like, and subscribe to You Matter on Apple Podcasts, Google Play, Tune in or Spotify.