Bessel van der Kolk , MD| The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma [Best of]

These last few years have dealt a lot of blows to our state of mind, body, and health. On some level, it’s been hard to escape trauma. Even if you can’t point to a big capital-T thing that happened, we live in a perpetual sea of micro-moments that unsettle, upset and shake us in a way that leaves a mark. Whether we know it’s there or not, whether we realize or acknowledge it, it’s affecting us. You, me, pretty much everyone on some level. 

Question is, what do we do about that? This is the very question I explore with my guest this week, Bessel van der Kolk, legendary trauma researcher, psychiatrist, and author of a book that has been locked into the #1 spot on the New York Times bestseller list for years now, The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. In 1984, Bessel established one of the first clinical/research centers in the US dedicated to study and treatment of traumatic stress in civilian populations, while also training researchers and clinicians specializing in the study and treatment of traumatic stress. He was a member of the first neuroimaging team to investigate how trauma changes the brain. 

Bessel’s efforts led to the establishment of the Trauma Research Foundation, developing new treatment models that are widely taught and implemented nationwide, a research lab that studied the effects of neurofeedback and MDMA on behavior, mood, and executive functioning, and numerous trainings nationwide to a variety of mental health professional, educators, parent groups, policymakers, and law enforcement personnel.

You can find Bessel at: Website | Instagram | Episode Transcript

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Episode Transcript:

Bessel van der Kolk, MD: [00:00:00] The thing that people don’t talk enough about, to my mind, is that when you get traumatized, it makes it very difficult to learn important new life skills and to grow and to mature in some ways, because you keep sort of getting stuck. I’m a little child who’s getting hurt, and you don’t have the opportunity to really feel, oh, that’s what it feels like to be an adult who is more or less in charge of their own lives.

 

Jonathan Fields: [00:00:24] So these last few years, they’ve dealt a lot of blows to our state of mind and body and health. And on some level, it’s been hard to escape some form of trauma, even if you can’t point to a big capital T thing that happened. We live in this perpetual sea of micro moments that unsettle, upset, and shake us in a way that can leave a mark whether we know it’s there or not, whether we realize or acknowledge it. It’s affecting so many of us you, me, pretty much everyone. On some level. The question is, what do we do about that? This is the very question I explore with my guest this week, Bessel van der Kolk, legendary trauma researcher, psychiatrist, and author of a book that has been locked onto the number one spot on the New York Times bestseller list for years now. The body keeps the score, and the very fact that it has been there speaks to the pervasiveness of what so many have been feeling. In 1984, Bessel established one of the first clinical research centers in the U.S. dedicated to the study and treatment of traumatic stress in civilian populations, while also training researchers and clinicians specializing in the study and treatment of traumatic stress. He was a member of the first neuroimaging team to investigate how trauma actually changes the brain, and his efforts led to the establishment of the Trauma Research Foundation, developing new treatment models that are widely taught and implemented nationwide. A research lab that studies the effects of neurofeedback and MDMA on behavior and mood and executive functioning, and numerous trainings nationwide to a variety of mental health professionals and educators. Parent groups, policymakers, and even law enforcement personnel. A quick alert before we dive into this deeply important and valuable conversation. Trauma comes from many different experiences, some of them deeply disturbing and potentially triggering in this conversation, which is focused much more on how trauma affects us and what we can do about it. More broadly, Bessel does occasionally reference specific experiences in detail to provide context. We wanted to give you a heads up so that you can make the best choice about how and whether to listen. Really excited to share this best of conversation with you. I’m Jonathan Fields and this is Good Life Project.

 

Jonathan Fields: [00:02:44] Ah, excited to dive in. As we have this conversation, we are in the middle of a, shall we call it interesting window in the human condition or season right now, over the last few years where the word trauma is being used increasingly in the experience of trauma certainly has settled on so many more people than I probably ever before in our lifetimes. But even before this moment, as you’ve written and spoken about, the experience of trauma has affected a relatively large part of the population, sometimes without us even realizing that’s what’s going on.

 

Bessel van der Kolk, MD: [00:03:16] Oh, all the time. Like, I collaborate with some Russian scientists on some brain issues and they say, oh, there’s no trauma in Russia. And they go, that’s really good to know. That is really was not quite my impression when I was there. But as long as there’s too much trauma, people cannot see it. It’s just part of the whole condition. I think it’s only because a substantial number of people did not get traumatized that we could actually start differentiating between ordinary life conditions and what’s traumatic. But for throughout history, for so much of the time, one war has followed another and one disastrous fall to another. And these days we actually try to believe that life can be safe and predictable.

 

Jonathan Fields: [00:04:02] Mhm. Yeah. I’m curious, you know, and I want to talk just for a moment about sort of like pre-pandemic days. If it’s such a large percentage of us at some point are navigating and living with some, some form of trauma. I wonder if you asked and if you took a random sample of 1000 people and said, are you living with some level of trauma? I wonder if there would be a large difference between people who actually would be clinically living with it and people who would identify with actually having like said, yes, I am living with it. Like whether there’s a big gap there in terms of awareness.

 

Bessel van der Kolk, MD: [00:04:37] Yeah, it’s a it’s a big because we know from any number of surveys that about one out of 4 or 1 of five women has been sexually molested. That about a quarter of all kids have been physically assaulted by an adult at some point or another. And so the figures are really quite stupendous. But, you know, we cannot dwell on that. And so the vast majority of people will say, oh, it wasn’t so bad or it didn’t matter all that much. And that is a way of coping and not getting stuck. And it’s good for us to try to go on even after terrible things have happened. But then when you have kids, at some point your kids may start asking you, why do you always get so upset when we talk about this particular subject? Or why do you get so uptight when this particular thing comes up? And it’s really only when you deal with people who don’t do not have the same sort of assumptions as you do that they go, oh, maybe I my reaction isn’t quite as, uh, as sane as I expected. Yeah. Yeah.

 

Jonathan Fields: [00:05:44] Mhm. So it’s almost like we develop coping mechanisms or compartmentalize in order to be able to just step back into our lives and effectively get through the day.

 

Bessel van der Kolk, MD: [00:05:53] Humans are coppers, you know, like. Yeah, I think the only cockroaches have been more successful than we have been. And part of that is just go on despite the fact of whatever is happening. Yeah, yeah, yeah.

 

Jonathan Fields: [00:06:06] So given that if we let’s let’s take that example you just shared, you know, like somebody goes through something earlier in life and then they, they set aside, they cope and they, they do whatever they need to do to feel like they can move through each day and be okay. And then, you know, maybe a decade or two later they’re in a different place. Maybe they have kids and, you know, the kids or someone else starts saying, you’re reacting this way and like, like and why? Because it doesn’t match the circumstance. Yeah. When somebody gets to that moment, how do you I guess the question is, how do you distinguish between a reaction or a symptom that might be the outgrowth of some sort of genuine illness or other Experience versus something that is an either immediate or or latent manifestation of trauma.

 

Bessel van der Kolk, MD: [00:06:54] Well, but does a genuine expression, of course, people who got frozen or scared or upset or angry. That is a that is a symptom, that is a, you know, and that’s not only a psychological thing, it’s also biological. You stress hormones get activated, your heart starts beating in a different way. Your immune system changes in response to all that. So yeah, these are all very real things that that mark us as human beings. Yeah, yeah.

 

Jonathan Fields: [00:07:24] Let’s talk about the word trauma itself. Where is the line between trauma and something that happens to us that is upsetting or jarring? Or when do we cross the line into that thing that we call capital T trauma?

 

Bessel van der Kolk, MD: [00:07:35] Yeah, that’s it’s not that easy. And indeed, I feel that the word trauma is getting too widely used right now to label too many different things, but a complex issue that we have run into that still hasn’t been settled in the scientific community either, is that we started off defining trauma as an extraordinary event outside of the ordinary human experience. That was back in 1980. And in retrospect, I go like, how blind can we have been that we did not really know about how widespread rape is? We did not know how widespread child abuse was. And and people say, oh, it’s mainly soldiers who go to war, who get traumatized. And then we woke up and said, actually, it’s a ubiquitous it’s all the way around us and the way we defined trauma at that point, which I think I’m still with, actually is some horrendous event that stops you in your track and makes you go, oh my God, and makes you feel, renders you completely helpless and to give up, basically. So That marks you. And then to some degree, you get stuck there in that your brain gets on the alert to always expect that to happen and to keep reacting as it is still happening.

 

Bessel van der Kolk, MD: [00:08:57] So that’s a trauma that’s different from the normal, stressful events that people have in their lives. Almost all of us get our heart broken at some point in the course of our lives. It is very painful and it’s still part of being a human being. People get fired from their jobs or laid off. It is awful and painful, but once you have a new job, you’re probably going to be okay. People get divorced. Very painful, but sooner or later people recover themselves and don’t repeat the old thing again. So the difference between a trauma and a very stressful life event is that after the stress is over, you have the capacity to start anew. A trauma is that you feel stuck that your body still feels like whenever anything sexual comes up, you feel like you’re being raped, or whenever you hear a loud noise, you react as if your life is in danger. And so there’s something has shifted where you get stuck at that moment of history. And the job of therapy is actually to help people, to get unstuck and to come into the present.

 

Jonathan Fields: [00:10:04] Right? So, so if we use if we look at it that way, I mean, you’re referencing sort of an event or a moment, um, an incident. Yeah. If we shift the lens to what’s been going on for the last couple of years around the world, and the way that we sort of step into every day and what we all experience and feel, can we expand that, then is living through this season of history right now. While it may not be a unique event, certainly people may have experienced within this season very specific events that were deeply traumatizing. But for for those who feel like they haven’t actually identified that, but they’re waking up and living through this day with extraordinary levels of groundlessness and uncertainty and high stakes and the loss of their model of the world, potentially loss of people around them. Can this sustained, like living in this sustained state over a period of time, also yield a similar traumatic effect?

 

Bessel van der Kolk, MD: [00:10:59] Well, time will tell. We don’t know at this point, but you know, we have seen it already. Let’s call the pandemic a common thing. There’s only one. The politics, to my mind, is as traumatizing as the pandemic actually is. But you may or may not want to go there. But, you know, last June, when it looked like the worst of Covid was over and we started to meet again with people, you very, very quickly went back to normal. And so the Omicron thing is once again making us tight. It’s wreaking havoc with intimate relationships. And I wonder what the effect it has on kids and not being able to play with other kids and teenagers not being able to date. I think it has all kind of developmental effects, but I imagine that once we get a green light that we can go out and we can play. Almost everybody will go back to leading relatively normal lives. And if at some point the political system in America somehow found a way of collaborating and making things work, I think we very quickly would reinstate a sense of safety also. So we are a resilient species, but it’s curious to see what will happen in the long range. I’ve been quite interested, for example, in what happens in the aftermath of cataclysmic events. For example, Second World War, which I as a baby, I was present for that, not consciously but unconsciously. And it is really amazing how quickly people got better from the Second World War and how quickly after the first pandemic or the last pandemic in 1918, 1919 and the First World War, which were disastrous events. How in the 20s people were rock and rolling and doing jazz and drinking. And by and large, society didn’t change all that much, and not many lessons were learned either from all the bad stuff. So people do have an amazing capacity to go back to where they came from, basically after something bad happens.

 

Jonathan Fields: [00:13:08] Yeah, I mean, I certainly hope that’s the case. It’s interesting. I know you bring up the example of you as a very young child, post-World War two. I’ve heard you speak about recent, and we’re going to circle back to this a little bit later in our conversation. But the work that you’ve been doing around psychedelics, but that through some of your own personal work with psychedelics, it’s taken you back to post-World War Two and reacquainted you with the fact that you experienced things that that maybe you didn’t even realize in your own life were traumatizing. And, you know, decades later and you had essentially, you know, like, put them behind you in theory, but through this fairly recent experience, realize, oh, they’re actually not entirely behind me. Yeah.

 

Bessel van der Kolk, MD: [00:13:51] And that’s actually, of course, something that we all discover. If you go onto a lengthy meditation retreat or you go do ayahuasca ceremonies or your long-term relationship with somebody, you discover new dimensions of yourself that you didn’t know before. And you know, none of us is completely in touch with every aspect of our development and what has shaped us over time. And that’s but indeed, in my own experience with psychedelics, I did go to places that I was unaware were still alive inside of me. Yeah. And so do. So do. So do the study participants we work with is that they start off with one particular incident that bothers them. And then before too long, all kinds of other stuff comes up. That was no, not in their consciousness anymore.

 

Jonathan Fields: [00:14:46] Than the psychic onion begins to peel itself. Yeah.

 

Bessel van der Kolk, MD: [00:14:51] I mean, we are very complex creatures as human beings.

 

Jonathan Fields: [00:14:54] Yeah, indeed. And we’ll be right back after a word from our sponsors. I want to talk a bit about what trauma actually does to us. And I’m also curious whether there’s a potential addendum to that and whether there is a what is trauma potentially do for us as well. But when when we talk about the effect of trauma, you use the word stuck. You know, we get to a point where we literally cannot move forward. Take me deeper into what you actually mean by that. What’s happening inside of us? That brings us to that point.

 

Bessel van der Kolk, MD: [00:15:24] What happens inside of us is that our we can pretty much say our brain gets reoriented to be on guard against the return of that particular event. And so your focus of attention goes elsewhere and you becomes hard for you to, in a relaxed way, take in new information, because things tend to get filtered through that danger system of, will this hurt me or this hurt me? And so your central orientation becomes much more into survival than into sort of embracing the reality around you. And so if you go into a relationship and you have are accustomed to getting hurt in relationships, you are likely to become defensive and to shut down in response to challenges instead of saying, oh, that’s interesting, you feel differently about this than I do. Oh, let’s see how we can work this out together. But once you feel that your life is in danger, you go like, get the hell away from me or don’t touch me or you become unable to integrate new experiences in some ways. And that’s the getting stuck piece is a thing that people don’t talk enough about. To my mind is that when you get traumatized, it makes it very difficult to learn important new life skills and to really to grow and to mature in some ways, because you keep sort of getting stuck on. I’m a little child who’s getting hurt and you don’t have the opportunity to really feel, oh, that’s what it feels like to be an adult who is more or less in charge of their own lives, saying, yeah.

 

Jonathan Fields: [00:17:12] Yeah, I mean, what you’re describing sounds like there’s this time-shifting element to it. It’s almost like when a certain trigger happens, it brings you back in time, and you lose the ability to come back to the present moment and see sort of more of an objective sense of what’s really happening around you. Is that accurate?

 

Bessel van der Kolk, MD: [00:17:30] Yeah, that’s absolutely correct. I often times show a videotape of a woman before and after treatment, and before the treatment when she talks about a fairly simple trauma, a very bad car accident. Her whole body is clearly there. Her shoulders are crunched up, her face is frightened, and she’s just describing something that happened a long time ago. But her mind, her brain, feels like it’s happening right now. And then after treatment, she goes like, oh yeah, this is the 2nd of February, 13 years ago. And that happened. And then that car hit me and I was flooded. And she talks about it as a memory of something that happened. And that’s over. And her body no longer gets activated to physically relive what happened back there.

 

Jonathan Fields: [00:18:21] So that’s a really interesting distinction. It’s like the difference between literally putting yourself back in the moment versus reflecting back on it almost as an observer.

 

Bessel van der Kolk, MD: [00:18:31] Yeah, and putting yourself back in the moment is not not like I want to put myself back in the moment, but. Right, right. Primitive, primitive survival part of my brain takes over and it feels like it’s happening right now. And even though it may be a tiny sliver of my frontal lobe knows this is not real, this person is not a rapist, or this person is not trying to kill me. You lose control over that rational brain and your body reacts as if it’s really happening again. Mm.

 

Jonathan Fields: [00:19:01] So you brought up the body and the brain, and I know you’ve done work with imaging and actually seeing what’s happening in the brain. Can you actually see in real-time or physiological changes in the brain in a trauma response.

 

Bessel van der Kolk, MD: [00:19:14] Oh, absolutely. You can see it in the brain when people, you know, people don’t do that these days anymore because we really are kind of traumatized people in the scanner, so we really don’t blast people with the memory of their. Of their rape, let’s say. But early on when neuroimaging stuff came online, we didn’t know all these parameters yet. And so in our early experiments, we actually induced flashbacks into people and which nobody would be allowed to do anymore today for good reason. And when we saw that, we saw big changes in the brain that the rational part of the brain, the left frontal part of the brain sort of went offline. And very primitive areas of the brain having to do with survival came online. And basically what you saw disappear is the rational verbal self that allows us to understand what we are. And you see it very clearly in the brain scans. Yeah.

 

Jonathan Fields: [00:20:15] Mmm, Yeah, I know you write in The Body Keeps the Score. There’s a line that really stayed with me that trauma effectively compromises the brain area that communicates the physical, embodied feeling of being alive.

 

Bessel van der Kolk, MD: [00:20:27] Yeah, I’m not sure if I quite say that, but it was more like knowing who you are. Having that perspective on yourself as a as a person, rather than being somebody who’s hijacked by your agitation or your fear or your terror or your emotions, you lose that observing, rational part of yourself. Now, I hang out with grandchildren these days, and it’s really interesting to see how little, very small children have no frontal lobe. They just do whatever they feel like doing, and then they start getting a frontal lobe. And I just love seeing the process of how every two weeks, there’s a new little piece acquired of knowing and understanding yourself and fitting in with other people. And basically when you deal with traumatized people, they are very much like very small kids. Who gets triggered into You see kids all the time. Every two-year-old has regular meltdowns or temper tantrums, etc. because that’s how your brain is wired at that point before you have a big frontal lobe. And it’s not a disaster because your mom holds you and makes you feel safe. But as soon as at some point in your life, you need to learn to do this yourself. And that’s why you have that frontal lobe for it. And that really that gets very compromised when you get traumatized. So you become like a three-year-old and then meltdown again. Yeah.

 

Jonathan Fields: [00:21:50] It’s interesting the way you describe that. We had a number of years back, adolescent psychologist on the show who described sort of emerging research that shows that actually frontal lobes really don’t fully form until later than people had imagined closer to 25 years old. And he described it as being until you’re about 25 years old, you pretty much all gas and no brake.

 

Bessel van der Kolk, MD: [00:22:11] Well, that’s a bit extreme. But yeah, the beauty actually is when you when you track kids over time, how you see that brakes are coming online more and more, and it’s a marvelous thing to process. But even your 18 year old is still able to do a fair amount of rational thinking. Although I wouldn’t be surprised that a fair number of 18-year-olds these days who sneak out in the middle of the night and violate a lot of Covid things because their brains is pushing them to do other things besides being careful.

 

Jonathan Fields: [00:22:45] But indeed, if we think about the frontal lobes, the sort of rational, the executive function part of the brain being the one that also gives shape and reason and self-regulation, it also sounds like that would be the part of the brain that would be in no small part in control of kind of tamping down or stifling or compartmentalizing of coping as somebody moves through life. You know, if we start with a smaller element in the brain and then it sort of becomes fully formed and has the opportunity to take the lead through the vast majority of the middle years of our lives when we move into the into later years of our lives, my understanding of just brain physiology, that region of the brain, also tends to lose a certain amount of capacity and dominance. Would that potentially then also signal a lost ability to sort of put aside earlier experiences that may have been really difficult for people and have them recur later in life? Yeah.

 

Bessel van der Kolk, MD: [00:23:43] This is something that I studied and looked at quite a long time ago, so I have no recent experience with it. Or I’m also also not aware of recent research on the area, but when I first paid attention to that, I was confronted with quite a few people in nursing homes who were beginning to start to become demented, and their trauma pathology became much more prominent that I had seen. I’ve seen quite a few people who were like concentration camp survivors or child abuse survivors who were functioning quite well. And then as their minds start to go to some degree, the pressures from the deeper parts of the brain really came out, and they might become very paranoid and very scared and very upset and very angry about clearly things that belong to way a long time ago in their lives. And of course, once people have are somewhat demented, it becomes very hard to process that and take care of that. So then they get overmedicated, as many older people are, and it leads to a not very, very good ending. Yeah.

 

Jonathan Fields: [00:24:49] Mhm. Yeah. I mean I would imagine also that the way that we tend to deal with these experiences, if we’re not introduced along the way to many of the methodologies that you’ve explored. And we’re going to dive into that. The weight of sort of the psychic load, the cognitive load of keeping these things at bay, even if you don’t realize that it’s weighing heavily on you or draining you, it’s got to be extraordinary to a certain extent, especially to carry that over time. I would imagine the burden really mounts. Would that be right?

 

Bessel van der Kolk, MD: [00:25:18] I think it’s a very profound point that you’re making. And that’s I see this all the time in my practice. Is that because of my condition of my life, I see people who can’t afford to pay for treatment. So there are people who are who are functioning quite well and oftentimes have horrendous trauma histories. And they really made me realize how much more work it takes for them to function well than for a person who doesn’t have a trauma history, because they need to keep these things at bay and they need to control it. And it takes an enormous amount of effort. And we can see this again on various ways of measuring brain function, how the capacity to focus and to pay attention is decreased. So you need to work much harder to get information in and to learn stuff. It’s hard work.

 

Jonathan Fields: [00:26:08] Yeah. Yeah, I would imagine. And at the same time you’re seeing people who very often are. They have means they can they can work with you. And also I’m assuming are probably very fairly, you know, in certain domains of life, high functioning, quote, successful, maybe they’re very accomplished. And yet I wonder if even, you know, if you can show up in a part of life and present as high functioning, successful, quote, normal or typical? And yet, does this eventually have to find a release valve? I mean, could you look at another part of that person’s life and say, oh, that’s where this is showing up?

 

Bessel van der Kolk, MD: [00:26:44] Uh, yeah. I think it’s important to realize that what you see is not what you get, and that all of us have parts. And like, for the whole time, you and I will be talking. We’ll probably both come across as very thoughtful and sensible people. But the people who are married to us know better than that.

 

Jonathan Fields: [00:27:05] Much better.

 

Bessel van der Kolk, MD: [00:27:07] And so and that’s how how we are it is how we function, and we may be very good at what we do, but it doesn’t mean that there is not other areas of life that may be very challenging, like having taken care of a little baby, or taking care of a sick spouse, or taking care of somebody who is too demanding of our time. Et cetera. Et cetera. It might really release some some issues for us, and we may turn out to be cruel and nasty and mean or shut down. And we don’t know that about each other until we know each other under many different circumstances. Yeah.

 

Jonathan Fields: [00:27:45] Mhm. Yeah. That makes a lot of sense. We’ve been talking a lot about how the, how trauma sort of settles in the brain and our behavior and the way we relate to others. But a lot of your work has been focused on, well, what happens from the neck down. You know, how do how does this, how does this settle into our physical body? And what does that look like? What shape does it take? And also what does it do to the relationship between our cognitive self and also what happens in our body. I’m curious because it seems like your work, and that’s been an intense part of your focus for quite a long time now. But that was not the approach to trauma in the therapeutic world for a really long time. And to no small extent, it seems like it’s still not necessarily the dominant approach. I’m curious what your on ramp into saying. We have to look at the body also was.

 

Bessel van der Kolk, MD: [00:28:35] Yeah I don’t know what the on ramp was. It was you know it’s a little bit like there it is. Uh you work with yourself, you work with the patients, you work with the old guys who first described trauma. Darwin is a great example that Darwin taught us about. Emotions and emotions are signals from the body on how to move. And you see it in traumatized people that their bodies move in a particular direction and they react in a particular way. And it’s not a mental event, it’s a physical, reactive events, and I imagined my having gone to medical school has helped, to some degree, to know how these systems are all connected with each other. And when we get frightened, we secrete stress hormones and our bodies become tense. And we have sensations in our body that warn us about danger. And the interesting thing that happened at the World’s Trauma conference in Melbourne in the year 2000, I first introduced the notion of that trauma is being held in the body. I entered that conference as this great hero of the field, and I left that conference without, with two friends who still talk to me. People said he’s gone off the deep end. He’s talking about a body. How crazy. And I’ve been really surprised how difficult it has been for people to to realise that the, the great therapy that became the popular therapy is being taught is cognitive behavioural Behavioral therapy, where people are being told not to have these stupid thoughts. And I go like, that’s really weird. I’ve tried it out with my wife, for example, I tried to point out how irrational her thinking is, and it never goes over very well. And I don’t know how doctors and their patients can do that together. Like you shouldn’t think that stupid thought. It doesn’t make any sense to me. But yeah.

 

Jonathan Fields: [00:30:27] I mean, in the context of trauma, I guess it seems like over the last decade or two decades really, though, thought has. Well, I guess let me ask the question, not just assume since like that time where you stepped onto the stage and shared your ideas over, you know, 22 or so years ago now, do you feel like there has been a substantial evolution of thought, or do you still feel like you’re sort of climbing up a hill? I’m trying to convince people like this matters. We have to focus in on it.

 

Bessel van der Kolk, MD: [00:30:52] Well, it’s very hard to get a sense of that because, you know, we all live in very small circles. You know, I haven’t seen a live human being, aside from my wife, for For over a week, you know, and so do a lot of talking. Everybody you talk with on the web is friendly towards me. So in my little universe, everybody is on the same wavelength. Is everybody on the same wavelength? Absolutely not. But how generalized it is, I don’t know. Just before the pandemic, I was in some workshop and a woman said I was recently fired. Being the yoga teacher at Kaiser Permanente in Oakland, California, and they said, we no longer support working with the body. And I go, that is really tragic. If in Oakland, California, people cannot pay attention to body what is happening in Kansas City and in Dallas. And so there seems to be a lot of resistance to getting that. But I don’t know how people get by their opposition because to my mind, it’s so obvious. This has to do with your relationship to this creature that you inhabit, that body that you inhabit. Yeah.

 

Jonathan Fields: [00:32:05] Mhm. And we’ll be right back after a word from our sponsors. I want to talk about some of the physical modalities. But before we get there I’m still curious about this thing about talk therapy or CBT. And by the way for those listening I didn’t just say CBD. This is cognitive behavioral therapy. Not not the cannabinoid. Um, but in my mind, the back of my mind, there’s a script that’s playing and tell me if this is wrong, because I think it may be, which is in order for us to move through a past trauma and rather than stifle it down or compartmentalize, but really process it and find a way to be okay, do we not have to, in some meaningful way, sit down and revisit the experience and go through some sort of conversational sense making experience around it? Does that not have to actually be a part of the process in some way, shape or form.

 

Bessel van der Kolk, MD: [00:33:00] It is a critical question. And depending on what day you ask me this question, I’ll give you a different answer. It is so complex. Basically, the way to overcome a trauma is to have an experience that completely and viscerally contradicts the traumatic experience. Like, if you have been completely helpless at some point, to really feel a sense of physical power in your body is a great counterbalance and to a rewiring of that network in your brains, where you can actually have the sense of, I can stand up for myself, I can defend myself. And at the same time, I think knowing where you have been is terribly useful and important, and finding words for yourself is terribly important. I’m. I’m a talk therapist. I mean, I talk with people and we wonder about what’s going on inside of ourselves. I wonder about her reactions. And I think knowing yourself is very important. And being able to say, this is what happened to me and this is my reaction to it back then, makes it possible for people to make a distinction between now and then. When I was a little kid, I was beaten up and my parents were always drunk.

 

Bessel van der Kolk, MD: [00:34:17] I couldn’t count on anybody. And luckily today I’m living with somebody who is sober and who is thoughtful, and I can feel the difference between these two so that I’m not this not I’m just making up a story here. But to really know what happened back then and how it’s different from what’s happening right now is important. I think one of the important parts of talk therapy is it helps you to not have secrets from yourself, because when you’re traumatized, you always feel terrible about how inadequate you were, how helpless you were, how there was nothing you could do. And every time I said it’s a source of shame. I was too weak, I was too small, I was too whatever to do something. And it makes you want to hide yourself and just go like, oh, but I’m really very smart and ba ba ba ba. I need to cover up for it. And to actually go back and to really allow yourself to know what happened back then is a very powerful experience.

 

Jonathan Fields: [00:35:22] That makes a lot of sense.

 

Bessel van der Kolk, MD: [00:35:23] But it’s absolutely necessary. I don’t know. I imagine there’s people who have had terrible childhoods who have never dealt with it, and they were doing okay. Yeah, you have to be careful to making absolute rules here.

 

Jonathan Fields: [00:35:35] Right? And I wonder if there’s a much more fluid relationship, like do you see in your practice where, um, somebody where a complementary physical practice allows somebody, does it have an effect which almost ripples up into the brain, into the language centers in the brain which we’re integrating. The physical actually gives them access to language to then tell the story, um, that would allow them to start to integrate and process this experience in a way where if you just sat there in conversation, um, there’s something that doesn’t get unlocked from a language standpoint, which then is a barrier to actually processing this. Have you seen that dynamic happen?

 

Bessel van der Kolk, MD: [00:36:19] Oh, yeah. Yeah, I think you put it extremely well. I think, you know, Darwin, go back to Darwin, who really started this whole thing, even though he never got acknowledged for this particular piece. He says, we feel our emotions in our body, and the reason why we have emotions is to propagate the species and to and to survive as part of our evolutionary heritage. And how do we experience our body through sensations? And heartbreaking and gut wrenching experiences are warning signs to tell us, don’t go there because terrible things will happen to you again when you get traumatized. You live with your gut wrenching, your heartbreak, and you live with a body that’s uptight. You’re always afraid to get hurt. And working with the body, to my mind, is an essential part of therapy. Finding somebody who can actually allow you to feel the comfort of touch is really important. I know many people who are terrified of touch, and if you don’t like touch, you miss out on one of the most powerful human experiences primate experiences of connection and safety. So as long as your body doesn’t feel safe to be touched, you are at a great disadvantage for you to have a satisfying good life. And I wish that I knew a organization of body workers to whom we could all send people. I happen to have two very good body workers in my life to work with me regularly. But finding them is difficult. And of course they don’t get reimbursed by the insurance companies because they don’t know how important it is for you to have a comfortable relationship to that creature, who you are. But I think the way to learn that is with people who actually work with your body, including maybe your karate instructor and your yoga instructor and your martial arts instructor, and you, tango dance instructor. All these people help your body to be in sync with itself and with bodies around you.

 

Jonathan Fields: [00:38:22] Yeah. I mean, it is really interesting how it’s it’s both a reconnection to the physical body and all the benefits that come from that. And you have this seamless feedback mechanism because that then activates something in the brain, which gives you more access to be able to process cognitively, which probably also frees you to reconnect with the feelings in your physical body of not just vigilance and fear, but pleasure and joy and pleasure.

 

Bessel van der Kolk, MD: [00:38:47] And the word pleasure hardly ever makes it to the index of a psychology textbook. The words pleasure and joy is like, pleasure and joy, that’s what crazy people talk about. No, actually, it’s part of life.

 

Jonathan Fields: [00:38:59] Yeah, well, I mean, that was when, uh, you know, Marty Seligman stood in front of the APA. What was it, 96 and said, you know, we have a cake that’s half baked. It’s not just about illness. It’s about flourishing.

 

Bessel van der Kolk, MD: [00:39:10] Yeah.

 

Jonathan Fields: [00:39:11] It seems like that is getting more attention these days, though. I’d love to talk about some of these physical modalities that you write about and talk about and integrate into your practice. One of them, eMDR, which I thought was really fascinating. I was exposed to it years ago, and I couldn’t wrap my head around what this actually was and what it was doing and why it might be effective, but it seems like there’s been a substantial amount of research around it really, over the, you know, since then. Talk to me a bit about what this modality is and how and why it actually has an effect on us.

 

Bessel van der Kolk, MD: [00:39:41] Well, eMDR for me was my gateway drug. It was really the thing that made me go like, this doesn’t make any sense. This is crazy. How can people possibly do that? And then I was the first, and to this point, the only researcher funded by NIH to study eMDR. And it was spectacularly effective. And it got like, wow, that’s interesting. We don’t know how it works. It’s a bizarre technique, wiggling your fingers in front of people’s eyes and somehow people get better. That’s interesting. So maybe our paradigms are not the right paradigms. And the paradigm of psychology is you either give somebody a drug or you talk about something, and maybe life is bigger than either of those two dimensions. And so eMDR was really like, wow, this is interesting because I had never seen as good results in my research and then my clinical practice also as I had with the eMDR. And so that’s when I started to go off the deep end and say, maybe strange stuff works when people say drumming works and go, let’s find out when drumming works and when people say tango dancing works, let’s study it. And tango dancing works. And so what we find is that there are other dimensions that our culture does not embrace, and that we are not being taught to embrace because the culture we live in. And then one of the advantages of going traveling a bit is you go to China, and the first time I went to China was still Mao, China and a horrendously oppressive place. And you see all these people getting up in the morning and going to the park and doing tai chi together. Right. And you go, why are they in their therapist’s office talking about how their mother mistreated them? And they’re all sitting in parks going, woo! And I go sit in the park and I make the same movements.

 

Bessel van der Kolk, MD: [00:41:34] And they go like, huh? I feel so much calmer. I feel so much more capable of dealing with the world. These people know something that we don’t know. And so the world is a much richer place than what we learn in school. So the universe India was interesting, actually. So we did a study. It turned out that people who had no childhood trauma or only adult trauma, basically almost all of them got cured with a few sessions of eMDR, even though their stories were quite horrendous. And then I tried to get money to see how eMDR works. I couldn’t get the research money for it. And finally, after many years, some former students of mine have a lab in in London, Ontario. Outstanding lab actually, and we did a study there with eye movements. And we saw that the eye movements changed, the brain circuitry changes the way that information is processed in the brain. And you look at that like like, wow, that’s how it works. It’s about neural networks. And how do we change the neural network? So you perceive the world in a different way. And what if you saw that eMDR does it activates the left temporal parietal junction, which is an area that allows you to observe yourself. And it makes a connection with your right insula, which is part of your body brain that allows you to notice what happens to your body. And you see that these eye movements seem to activate some brain networks that we don’t know how else to activate it. And that may be true for many other things also. So there’s many more unknowns than there are knowns still at this point.

 

Jonathan Fields: [00:43:18] Mmm, Yeah. For those, by the way, that no familiarity with eMDR. We’re talking about a modality that effectively, and you could probably describe it a lot more intelligently, articulately than me, but effectively, your simple eye movements that that would seem from the outside in to be how could this possibly do anything? And yet it can have this really profound effect?

 

Bessel van der Kolk, MD: [00:43:39] Yeah, basically that’s true. You see, basically in eMDR, you don’t ask people to tell you the story, because the moment you start telling a story, your main focus becomes, does this person like me? Does this person believe what I’m saying? Does this person get it? So the focus goes on the outside. And so we could do with eMDR is so remember what you saw. You don’t have to tell me. Remember what you smelled. Remember what you heard. Remember you felt in your body. Remember how big you were. And so you go deep inside. You activate this interoceptive pathways, which is terribly important. So it’s not. How can I tell you the story? But can I notice what happens to me inside? And then you make the eye movements and then some process starts. That is still incredibly interesting, is you go into a dream like states where your mind starts forming associations. So the first time I did eMDR was done on me. Something quite nasty had happened to me actually just before, and I had images of sitting in my family dining room table and playing in the playground in primary school and playing with some friends later on, completely unrelated issues. And a little while we go back to the original traumatic event and I got like, yeah, it happens, but it’s time to go on. And something in my mind just let go of that really very nasty experience. Yeah, shit happens. And that, of course, is ideally what happens when something bad happens. Okay. Time to dust yourself off and go on. And somehow eMDR makes that possible. And it’s still I’m disappointed that not more people are really digging much deeper in this because it’s such a remarkable phenomenon.

 

Jonathan Fields: [00:45:31] Yeah, and it must be, I mean, for what I’m listening to, to you describe this, there must be a really interesting tension for you to sort of function in a space where you’ve taken on the lens of, well, look, I may not necessarily be able to tell you exactly how or why it works, but why not at least run the experiment and see if it helps in a larger paradigm where you’re not often given the freedom to do that, or the funding to do that, or the ability to, then even if you do it, publish your findings in a way where people will take it seriously and and put momentum and resources behind it. I wonder how you just personally sort of like being in the space that you’re being, and with the frame that you have of openness, feel about the larger paradigm?

 

Bessel van der Kolk, MD: [00:46:14] I think it’s a temperamental issue. So I grew up in a country that has basically no trees, and it’s continuously underwater and where the elements play with you and these stupid people. Where I come from in the 16th century started building ships, little ramshackle ships, and they start sailing across the ocean. Three quarters of the people died. Now you go to the shores of India and Malaysia. You see all these grave markers? All Dutch people. And they kept exploring. And, you know, the Portuguese did the same thing. And people went to the West and America did the same thing. We are explorers as human beings. And so I enjoy exploring, and I know that sometimes it may kill you if you go to unknown territories, but life is not interesting if you don’t explore. And it’s interesting to me that not everybody has that temperament. All my friends do. But the disciplines are very much, let’s make a discipline just the way, just the right way of doing it. It’s the wrong way of doing it, you know? Yeah. That’s what you believe right now. But no, I grew up in a fundamentalist household, and I knew that fundamentalist beliefs are strongly held, but they keep changing And, you know, and I’ve never believed in fundamentalism in psychology and psychiatry. Today we know one thing. And ten years from now, we’ll laugh at what we found ten years ago. That’s the way it goes. Yeah.

 

Jonathan Fields: [00:47:46] To hold that that point of view, that lens on the practice, I would imagine. Well, it sounds like it’s just kind of hardwired into you. It’s the way that you are, um, that, uh, you know, like, if you sort of were told this is the way that we do things and we don’t challenge it, that’s not something that would ever settle well with you. Yeah. So we talked about Amr, and you also mentioned, you know, like when you go to other countries, you know, you see, and I remember actually being in Hong Kong a number of years ago and waking up early in the morning and walking around and seeing hundreds of people out at like 630 in the morning, doing tai chi, often in their like, like 60s 70s, 80s, 90s. And I was mesmerized by it and really wondered, why does this not happen all over the place? And when we look at around the world, at healing traditions, it almost always involves movement and rhythm and breath and something that, that that in some way brings your mind into the present moment. You know, you’ve looked at yoga, you’ve talked about dance as well. I wonder whether you’ve also looked at is is there something about not just the physical movement part of it and the reconnecting with your body, but when you do it in a communal space, when you’re all doing it together, is there something about that that also plays a role in some sort of unfolding or opening or healing or processing?

 

Bessel van der Kolk, MD: [00:49:01] See, that’s the definition of joy is to be in sync with other people. You know, when we go through periods of mourning, we get together and we sing together with people and not in the US or the Netherlands so much anymore. But in other countries, people sing together, dance together. I was involved in the truth and reconciliation process in South Africa, and I followed Bishop Tutu, who just died, and he was the best trauma therapist I’ve ever seen. He sang with people. He moved with people. He wept with people. And they went through it together. And when they went through it by themselves, through remembering their torture, it was agony. But when you do it with Bishop Tutu, who smiles with you and dances with you and cries with you, it becomes like, we are in this together and you get a sense of joy and communality, which is so critical to for all of us as human creatures, as mammals, we need to be in sync with each other. That’s who we are, you know? I mean, as you get older, you see the other people understand. That, of course, is basic training in the military. You know, these 18 year olds who join the military are not the cream of the crop. They are not the people who anybody would particularly like to have in their class. And they go through these extremely difficult exercises. And after 12 weeks of moving together with people and climbing with people and marching and singing, the garlic. We are amazing. I’ll die for you because I love you, man. Because you have climbed these things with me and it is based on synchrony with other people. So at the core of who we are, you know.

 

Jonathan Fields: [00:50:39] Yeah, I mean, it really, it’s it’s in every tradition. So in a somewhat past life for me, I actually owned a yoga center in New York City and taught a flow vinyasa style of yoga for seven years. And, and I remember the experience of doing that, you know, being in a room with 50 bodies in dark lighting and everybody moving together and flowing together and exploring the same physical like postures and movements and, you know, the collective breath where you could hear 50 people inhaling and exhaling simultaneously. And there were it didn’t always happen, but there were certainly moments where there was something transcendent about what happened in that room, where it was like, we all left the room together.

 

Bessel van der Kolk, MD: [00:51:22] You become each other. It’s like, yeah, when you when you watched LeBron James scoring the three pointer? You sort of feel like you’re doing it if you’re in a yoga class. I’m a really stiff old white guy, but I’m surrounded by young, flexible people, and when they can do that, I feel like I’m doing it too, you know? So you vicariously get to take on what other people around you do, and you get this collective sense of agency and joy. It’s very profound. Yeah.

 

Jonathan Fields: [00:51:52] I think back almost to, um, what was the phrase Emile Durkheim used? Collective effervescence. You know, when we’re in that space together, whether it’s singing or moving or breathing or all of it, it’s just it changes us in some way. It’s interesting to hear that that may also play an important role in integrating trauma in our lives. I know some of the more recent work that I want to touch into that you’ve been looking at is what’s been going on in the world of psychedelic medicine and substances and the context of trauma. And I’m curious where you are with that right now, Certainly in the news cycle, we’re hearing increasingly about the work that’s being done at Johns Hopkins and other institutions in different domains. What are you seeing emerging from that world in this context?

 

Bessel van der Kolk, MD: [00:52:34] Well, I actually run a lab, one of the sites for the large MDMA study. Uh, so I run the the small Boston site. So I’m part of that world. And when psychedelics were first talked about, I very quickly, immediately realized that they have great potential, because when you traumatize, you get to live in a very narrowly defined world. And, you know, I belong to a generation of grew up in the 60s. So everybody I knew was did some LSD. Not not a lot, but enough to really have an imprint of it. And you know, I am most of my age mates know from experience that that you get the experience of the world is so much larger than the world that I inhabit. And so the psychedelics do is really the exposure to that. You’re a small part of a much larger universe. And that is a very deep part of it. And so I immediately thought psychedelics must be very helpful for trauma, but they were declared illegal. And you don’t want to work with illegal substances. And I think I didn’t think they would get it by the FDA to get permission to do it. And so there comes my honoring Rick Doblin and Michael Mithoefer, who who sued the FDA and worked so hard to get permission to do studies. And, you know, they were up against serious obstacles. And and so they did a very carefully designed studies and they came out very well. And so I’m part of the state’s three studies or the last part before it hopefully becomes legalized. And we see indeed Remarkable results. But we also see is that going into yourself, into these dark places, can be extraordinarily painful and can be frightening. And all of us who do this work are very committed to making sure that this doesn’t get done outside of very clearly defined therapeutic settings.

 

Bessel van der Kolk, MD: [00:54:43] And unfortunately, living in a capitalist society we live in. There clearly is a lot of money. And then there are hills, and what we see more and more is profit making people taking over and being extraordinarily careless about the circumstances under which these drugs gets established. And I’m very, very worried that we’ll see here a bunch of reports of very bad events and that that will cause these drugs to be not legalized at some point. So it’s a very delicate balance, but doing it the way we are, which is that people have three sessions over a three month period. So a lot of time to get to know each other, to process things. And then three sessions that start at 830 in the morning. The session ends at 5:00 in the afternoon. People stay overnight with a board attendant. Next day they get debriefed. So it’s a very, very intense process with two therapists who are there for you all the time. Usually not much talking happens, but stuff comes up and and people are really helped to tolerate the pain and whatever manifestation comes up. And with that, what we see is a dramatic improvement in people’s capacity to to feel compassion for themselves, to understand what goes on inside of them, to have more language for themselves, to regulate their emotions better, to appreciate more how other people thinking and feeling may be different from their own. So it really seems to affect some very core, higher level mental functioning that which I think is actually the engine. Why the PTSD gets better. Also that this relationship to yourself is changed under these agents. You get to see yourself in a different context if the environment is safe. Mm. 

 

Jonathan Fields: [00:56:41] Yeah. That that last part I think is is key. Right. I had a conversation with Adam Gazzaley, who’s like runs a lab in UCSF and now along with Robin Carhart-harris, they have a huge, you know, division focusing in on psychedelics. And it’s interesting because he was really focusing on a lot of what you’re talking about. He’s like, you know, whether this is dangerous, whether it’s therapeutic, whether it’s effective or not. It seems that like everybody talks about this phrase set and setting and he’s and he’s like, I want to invest a huge amount of resources in understanding. What does that actually mean? Like what are of the 500 variables? Can we actually identify what matters, what leads to positive and consistent therapeutic outcomes so that we can actually turn this into something that is, that can scale and is replicable and is safe. And actually we we truly understand what this is. And he was saying, you know, he said, look, I don’t actually know if this is possible, but I’m raising my hand to devote at least the next ten years of my life to trying to figure it out. And I think it feels like we’re at a really interesting moment in the context of how we’re looking at these molecules in potentially making profound differences in intractable things that we experience as human beings.

 

Bessel van der Kolk, MD: [00:57:53] Yeah, they have enormous potential, including part of what we are seeing with the pandemic is how many people are leaving their jobs. And people say, I don’t want to do this anymore. And that’s, of course, what happened in the 60s when people started to take LSD. They got like, do I really want to spend my life doing this.

 

Jonathan Fields: [00:58:14] So what’s old is new again, right?

 

Bessel van der Kolk, MD: [00:58:17] Subversive effects on society. You know, like this? Yeah.

 

Jonathan Fields: [00:58:20] I mean, subversive on the one hand. But maybe actually, this is the existential questioning that we’ve all needed to dive into. Maybe not in such a disruptive way, but maybe this has been brewing for a long time. It’s just sort of like peeling the Band-Aid off and the net effect. Maybe, maybe it’ll be a good thing, both individually and for society. We’ll see.

 

Bessel van der Kolk, MD: [00:58:37] I guess I’m just very grateful that I have the privilege of being part of this evolution, actually. Is that because it’s so interesting to see what will come out of it? And as always, there’s all these very interesting characters who are involved in these, these pioneering efforts. So it’s a great company.

 

Jonathan Fields: [00:58:56] Yes, indeed. It feels like a good place for us to come full circle in our conversation. So sitting here in this container of Good Life Project., if I offer up the phrase to live a good life, what comes up?

 

Bessel van der Kolk, MD: [00:59:06] Yeah, Feel like you are you’re where you need to be. This is the right place. Where my body is, where it’s supposed to be. And what I’m doing right now is, is significant. It gives me a sense of agency, of pleasure, of making a contribution, of feeling alive. I’m using my talents. I’m using my education. I’m using my life experience to connect and to make not only my life, but the life of people around me worth living. Yeah, but it’s always the connectivity part is always a big part of it. We are as primates. We are intertwined with other people. And so you never live the good life all by yourself. It’s always like we’re doing something together that makes sense, and that’s a very important piece of the whole thing.

 

Jonathan Fields: [00:59:57] Mm. Thank you. Hey, before you leave, if you loved this episode, Safe bet, you’ll also love the conversation we had with Ellen Hendriksen about social anxiety and how to move through it. You’ll find a link to Ellen’s episode in the show notes. And of course, if you haven’t already done so, please go ahead and follow Good Life Project. in your favorite listening app. And if you found this conversation interesting or inspiring or valuable, and chances are you did. Since you’re still listening here, would you do me a personal favor? A seven-second favor and share it? Maybe on social or by text or by email? Even just with one person? Just copy the link from the app you’re using and tell those you know, those you love, those you want to help navigate this thing called life a little better so we can all do it better together with more ease and more joy. Tell them to listen, then even invite them to talk about what you’ve both discovered. Because when podcasts become conversations and conversations become action, that’s how we all come alive together. Until next time, I’m Jonathan Fields, signing off for Good Life Project.

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