The Body Keeps The Score 3 – Mind and Brain

It discusses similarities between behaviors of patients with traumatic histories, regardless of their respective diagnosis. Hallucinations versus memories. Attitudes towards psychiatric patients by medical professionals. The DSM, drugs such as anti-depressants and anti-psychotics, placebos and hormone levels.

This chapter has exactly the kind of information I have been looking for, written in understandable English. I’ve been wrestling through studies and dissertations that have been underwriting the same things, but unable to make the translation into what these very scientific treatises mean in practice. It’s been eye-opening.

The Main Take-Away’s

The brain-disease model overlooks four fundamental truths:

(1) our capacity to destroy one another is matched by our capacity to heal one another. Restoring relationships and community is central to restoring well-being;

(2) language gives us the power to change ourselves and others by communicating our experiences, helping us to define what we know, and finding a common sense of meaning;

(3) we have the ability to regulate our own physiology, including some of the so-called involuntary functions of the body and brain, through such basic activities as breathing, moving, and touching; and

(4) we can change social conditions to create environments in which children and adults can feel safe and where they can thrive.

When we ignore these quintessential dimensions of humanity, we deprive people of ways to heal from trauma and restore their autonomy. Being a patient, rather than a participant in one’s healing process, separates suffering people from their community and alienates them from an inner sense of self. Given the limitations of drugs, I started to wonder if we could find more natural ways to help people deal with their post-traumatic responses.

“The Body Keeps the Score: Mind, Brain and Body in the Transformation of Trauma” by Bessel van der Kolk

More than half the people seeking psychiatric care have been through trauma.

Anti-depressants and anti-psychotics are not a cure. Though they may helpful in in symptom relief, they do not help dealing with root causes of mental illness, such as past trauma.

Common behaviors in patients with traumatic histories such as hyper-arousal, hyper-vigilance, overreactions (mood swings, outburst over seemingly small things) or under reactions (freezing, disassociating) and what are deemed hallucination, may have physical reasons. Not just psychological ones as is commonly thought.

Medical professionals do not often take past trauma into account. Their dispassionate viewing of patients and their tendency to discount historical trauma when it comes to diagnosing or treating patients may lead to repeats of root cause traumas.

Overall Impression of Chapter 2

I’m feeling incredibly ambiguous about this chapter. Not because it’s ambiguous in and of itself. Quite the opposite. My ambiguity stems from something within myself. This chapter confirms things I have suspected for decades. But my lack of medical knowledge and automatic trust in medical professionals have always led me to believe that my suspicions were somehow wishful thinking.

Theoretically I can manage my disease and function as usual. As long as I mindfully put into practice what I have been taught. Check my thinking and behavior constantly.

That these practices don’t seem to work for me long term, is somehow my own self-destructive behavior. By challenging the validity of the instructions of my specialists, I prove that I have a personality disorder. Blindly following instructions is also a sign of a personality disorder. Pretending to agree and then not following instructions, is healthy. It’s all rather confusing.

This chapter has thrown a wrench in that belief. That’s where my ambivalence comes from. Is this yet another example where I should have trusted my gut, what my body has been telling me for years?

And if so, what can I start doing to change that in a way that won’t lead to another extreme; trusting my gut and body solely.

Seeking Psychiatric Care and Trauma

“We now know that more than half the people who seek psychiatric care have been assaulted, abandoned, neglected, or even raped as children, or have witnessed violence in their families.”

“The Body Keeps the Score: Mind, Brain and Body in the Transformation of Trauma” by Bessel van der Kolk

I had to read this sentence multiple times. Initially my mind just blanked. I have that sometimes when I read or hear things that are actually positive for me personally in some way. I think it’s my mind’s defense mechanism to save me from false hope. My body keeps the score – and is doing its best to prevent more psychological blows.

How is this sentence positive for me personally? Yes, it’s horrible to realize how many of us are impacted this heavily by trauma. But it does address a common misconception here in Aruba, and other small communities with limited resources.

Just a few weeks ago I was told that Respaldo, Aruba’s National Mental Health Care provider, doesn’t feel that attending the 34th Boston International Trauma Conference is of value. Because in their opinion trauma is a specialism. According to them, too few patients have been diagnosed with a trauma disorder. So it is up to the individual employees if they’re interested enough to attend.

Is Aruba Exceptional?

In that light I find it difficult to understand how, if it is known in other parts of the world that more than half of all psychiatric patients have (unresolved) trauma in their past, Aruba is an exception according to the authority on mental health. That Aruba has plenty of psychiatric patients, but unlike other parts of the world, most of these patients do not suffer from (unresolved) trauma. Thankfully this chapter of van der Kolk’s “The Body Keeps the Score” also provides a possible answer.

Medical Professionals and Patients with Traumatic Histories

“I was often surprised by the dispassionate way patients’ symptoms were discussed and by how much time was spent on trying to manage their suicidal thoughts and self-destructive behaviors, rather than on understanding the possible causes of their despair and helplessness. I was also struck by how little attention was paid to their accomplishments and aspirations; whom they cared for, loved, or hated; what motivated and engaged them, what kept them stuck, and what made them feel at peace—the ecology of their lives.”

“The Body Keeps the Score: Mind, Brain and Body in the Transformation of Trauma” by Bessel van der Kolk

Even though Bessel van der Kolk writes about his experiences in the 1960’s, this is still my personal experience with (mental) health care here on Aruba to this day. And unfortunately I am not alone in these experiences.

Dr. Fleur, the first (mental) health director of the Jeffry Stijn Foundation for Mental Health and Patient Advocacy, echoed this sentiment to me on multiple occasions. Unless you’ve experienced mental health issues, it is very hard to really understand or believe the devastating mental, emotional and physical effects. Mind over matter doesn’t magically work. Denial, repression and regression are not long term solutions.

Dr. Fleur was not alone in this assumption. Most people I know still believe that poor mental health is something you can just will away. It’s only when they are confronted with it themselves that perception changes.

Replication of Past Trauma by Health Care Professionals

“If you do something to a patient that you would not do to your friends or children, consider whether you are unwittingly replicating a trauma from the patient’s past.”

“The Body Keeps the Score: Mind, Brain and Body in the Transformation of Trauma” by Bessel van der Kolk

The problem with ignoring a patient’s traumatic history, or not taking covert traumas into account, is that medical professionals, despite their best intentions, may unwittingly repeat a patient’s traumatic experiences.

Whether it’s by wrestling a patient to the ground in order to administer calming drugs. Which reminds them of other situations in which the autonomy of their body was not respected. Or trivializing their feelings by not listening to their experiences. Whether it’s following protocol at all costs. For example by requiring a patient with residential mobility trauma in their past to move. Placing them in double binds by withholding therapy if they don’t adhere to protocols and norms. Or even blaming the system for not being able to provide what a patient needs; none of these situations are beneficial to the patient. Even though protocol dictates those courses of action.

Bringing Humanity Back to the Day-to-Day

“Semrad did not want our perceptions of reality to become obscured by the pseudocertainties of psychiatric diagnoses. I remember asking him once: “What would you call this patient—schizophrenic or schizoaffective?” He paused and stroked his chin, apparently in deep thought. “I think I’d call him Michael McIntyre,” he replied.”

“The Body Keeps the Score: Mind, Brain and Body in the Transformation of Trauma” by Bessel van der Kolk

For those of you who know me, my tag line is “Bringing Humanity Back in the Day-to-Day.” I’ve talked about and written often that I am more than just my mental illness. I find it demotivating when I’m faced with discrimination due to my mental illness in subtle ways. I can be perfectly justified in being angry, upset or standing up for myself. Yet it is structurally seen as a part of my disease. Even when in those situations there is absolutely nothing triggering to me.

Use my car without my permission and refuse to give it back? Damn right I’m angry and upset. Consistently cross the boundaries I set? Any normal person has issues with that. Government officials refusing to answer questions because there are no good answers? Terribly frustrating. And I know lots of people who run into the same thing who are absolutely not mentally ill.

I get that it’s easier to blame me for being difficult. Instead of being (partly) accountable. That still doesn’t mean that ALL my emotions or behavior can be set aside as invalid or unjust, just because I have a trauma disorder.

The DSM

The foreword to the landmark 1980 DSM-III was appropriately modest and acknowledged that this diagnostic system was imprecise—so imprecise that it never should be used for forensic or insurance purposes. As we will see, that modesty was tragically short-lived.

“The Body Keeps the Score: Mind, Brain and Body in the Transformation of Trauma” by Bessel van der Kolk

That stress responses cause the body to flood itself with epinephrine which

“[…] triggers the release of blood sugar (glucose) and fats from temporary storage sites in the body. These nutrients flood into the bloodstream, supplying energy to all parts of the body,”

https://www.health.harvard.edu/staying-healthy/understanding-the-stress-response

has never been considered in my case. I have spent years of my life in fight/flight mode. And still am in that mode multiple times a day. Is it in any way possible that that is the cause? I don’t know. Once you’ve been diagnosed with a disorder, few seem willing to consider the possibility they may be wrong.

Physical Manifestations of Stress and Trauma

“[…] finding that traumatized people keep secreting large amounts of stress hormones long after the actual danger has passed.”

“The Body Keeps the Score: Mind, Brain and Body in the Transformation of Trauma” by Bessel van der Kolk

Dr. Fleur is currently researching the links between the body and mental health. One of the areas is hormones and the physical reactions to them. It’s long been known that chronic stress puts your health at risk. I wonder what the long-term effects of the secretion of large amounts of stress hormones on my health has been.

Stress Hormone System

“[…]cortisol puts an end to the stress response by sending an all-safe signal, and that, in PTSD, the body’s stress hormones do, in fact, not return to baseline after the threat has passed. Ideally our stress hormone system should provide a lightning-fast response to threat, but then quickly return us to equilibrium. In PTSD patients, however, the stress hormone system fails at this balancing act.

Fight/flight/freeze signals continue after the danger is over, and, as in the case of the dogs, do not return to normal. Instead, the continued secretion of stress hormones is expressed as agitation and panic and, in the long term, wreaks havoc with their health.”

“The Body Keeps the Score: Mind, Brain and Body in the Transformation of Trauma” by Bessel van der Kolk

I know that my fight/flight/freeze signals continue long after the danger or perceived danger is over. I’ve been told this is in my head. That there is no way my body is affected by this. That I’ve managed to suppress my agitation and panic well enough for years at a time to function, has always been seen as impossible. I’m making things up. It’s strange to now read that it’s a known part of PTSD.

Strong Emotions can Block Pain

“We concluded that Beecher’s speculation that “strong emotions can block pain” was the result of the release of morphinelike substances manufactured in the brain. This suggested that for many traumatized people, reexposure to stress might provide a similar relief from anxiety.”

“The Body Keeps the Score: Mind, Brain and Body in the Transformation of Trauma” by Bessel van der Kolk

I’ve kept going, even when very ill. Or not gone to see a doctor until the pain got too much to bear. I don’t notice if I am running a fever, until my body suddenly starts craving certain fast foods. I never really understood this part. But since I’ve been suppressing strong emotions most of my life, is it possible that that is how I managed to function for so long?

That it is my way to bring relief from anxiety? That the times when I could no longer suppress these emotions, and I was unable to function again, were physical manifestations? Not solely psychological ones as I have been led to believe?

Serotonin Levels

“The implications for traumatized people were obvious. Like Gray’s low-serotonin animals, they were hyperreactive, and their ability to cope socially was often compromised.”

“The Body Keeps the Score: Mind, Brain and Body in the Transformation of Trauma” by Bessel van der Kolk

Low serotonin and its relationship to hyper-reactivity as well as social interactions, is another subject I’m hoping Dr. Fleur will be able to shed more light on in the future. Personally I have not had much positive effects from SSRI’s, though I take them religiously. As my psychiatrists says “baat het niet dan schaadt het niet” (if it doesn’t help, it won’t hurt). But what if it’s not helping AND hurting?

Drugs and Placebos

“Now a new paradigm was emerging: Anger, lust, pride, greed, avarice, and sloth—as well as all the other problems we humans have always struggled to manage—were recast as “disorders” that could be fixed by the administration of appropriate chemicals. Many psychiatrists were relieved and delighted to become “real scientists,” just like their med school classmates who had laboratories, animal experiments, expensive equipment, and complicated diagnostic tests, and set aside the wooly-headed theories of philosophers like Freud and Jung. A major textbook of psychiatry went so far as to state: “The cause of mental illness is now considered an aberration of the brain, a chemical imbalance.”

“The Body Keeps the Score: Mind, Brain and Body in the Transformation of Trauma” by Bessel van der Kolk

I will write about this extensively in times to come. In my opinion a lot of trauma is due to human rights violations. Especially not being fee and equal to others and our personal rights and freedoms being violated or restricted. This is a social problem, but the outcomes for the individuals involved lead to poor mental health or mental illness. Which is considered a personal issue. Not a social one.

Unresolved and untreated trauma may ultimately lead to suicide. Although annual deaths due to suicide (700,000 reported) are nearly twice as large as those due to homicide (400,000), there is much less coverage of suicide and its causes. There’s a good chance suicide rates are under reported. And it goes without saying that the number of suicide attempts are much higher.

Placebo Effect

“Everyone in the study—even those who had received the placebo—improved, at least to some degree. Most treatment studies of PTSD find a significant placebo effect. People who screw up their courage to participate in a study for which they aren’t paid, in which they’re repeatedly poked with needles, and in which they have only a fifty-fifty chance of getting an active drug are intrinsically motivated to solve their problem. Maybe their reward is only the attention paid to them, the opportunity to respond to questions about how they feel and think. But maybe the mother’s kisses that soothe her child’s scrapes are “just” a placebo as well.”

“The Body Keeps the Score: Mind, Brain and Body in the Transformation of Trauma” by Bessel van der Kolk

I can, at times, suppress my anxiety. I’ve tried a plethora of benzoids and sleep medication. Unfortunately most of these, except one, give me a ‘freeze’ feeling which actually makes me feel worse. The one that doesn’t affect me in that way, has led to nystagmus with daily use. These days I use it sporadically as a placebo; it allows me to trick my body into believing it’s getting help suppressing anxiety. The after effects are the same whether I take them or not. Exhaustion and inability to rest for a few days.

Medication Does Not Always Work

Surprisingly, however, the Prozac had no effect at all on the combat veterans at the VA—their PTSD symptoms were unchanged. These results have held true for most subsequent pharmacological studies on veterans: While a few have shown modest improvements, most have not benefited at all. I have never been able to explain this, and I cannot accept the most common explanation: that receiving a pension or disability benefits prevents people from getting better. After all, the amygdala knows nothing of pensions—it just detects threats.

“The Body Keeps the Score: Mind, Brain and Body in the Transformation of Trauma” by Bessel van der Kolk

I would love to one day find out if my brain, especially my amygdala and hippocampus, has been affected as I now suspect. Unfortunately these types of brain imaging options are not available to people in small communities with limited resources.

Drugs: Income and Profit

“Drugs gave doctors a greater sense of efficacy and provided a tool beyond talk therapy. Drugs also produced income and profits. Grants from the pharmaceutical industry provided us with laboratories filled with energetic graduate students and sophisticated instruments. Psychiatry departments, which had always been located in the basements of hospitals, started to move up, both in terms of location and prestige.”

“The Body Keeps the Score: Mind, Brain and Body in the Transformation of Trauma” by Bessel van der Kolk

I am a proponent of science and scientific advancement. But as van der Kolk noticed in his own places of employment, the downside of this influx was that there were less social interactions between medical staff and patients. The communal swimming pool and basketball court gave way to the laboratories and research centers.

Drug Revolution: More Harm Than Good?

“The drug revolution that started out with so much promise may in the end have done as much harm as good. The theory that mental illness is caused primarily by chemical imbalances in the brain that can be corrected by specific drugs has become broadly accepted, by the media and the public as well as by the medical profession. In many places drugs have displaced therapy and enabled patients to suppress their problems without addressing the underlying issues.”

“The Body Keeps the Score: Mind, Brain and Body in the Transformation of Trauma” by Bessel van der Kolk

All I can say is that this is my personal experience as well. Not just when it comes to mental health. Most specialists I know tend to prescribe medication or surgery, even if the patient asks for less invasive forms of treatment.

But I’ve noticed a disturbing trend among patients too. Doing the work, facing trauma, confronting triggers and feeling emotions is hard. Taking a pill is not. That it doesn’t solve anything in the long-term doesn’t matter. As long as there is some improvement or relief right now.

Psychiatric Drugs: The Downside

After conducting numerous studies of medications for PTSD, I have come to realize that psychiatric medications have a serious downside, as they may deflect attention from dealing with the underlying issues. The brain-disease model takes control over people’s fate out of their own hands and puts doctors and insurance companies in charge of fixing their problems.

“The Body Keeps the Score: Mind, Brain and Body in the Transformation of Trauma” by Bessel van der Kolk

For over 25 years I have been confronted with this. Despite often being told that I was in charge of my own recovery process, in reality this was only so if I adhered to the current norms and protocols. If what I might need happened to be covered by insurance companies. Not whether these treatments were in my best interest.

I have been asking for help in dealing with the underlying issues for decades. And for decades I have been treated for symptoms instead. I’d like to experience dealing with trauma for once. Instead of being asked to participate in ‘treatments’ that have steadily made my symptoms worse.

Psychiatric Drugs and Children

“Half a million children in the United States currently take antipsychotic drugs. Children from low-income families are four times as likely as privately insured children to receive antipsychotic medicines. These medications often are used to make abused and neglected children more tractable. […] These medications make children more manageable and less aggressive, but they also interfere with motivation, play, and curiosity, which are indispensable for maturing into a well-functioning and contributing member of society. Children who take them are also at risk of becoming morbidly obese and developing diabetes. Meanwhile, drug overdoses involving a combination of psychiatric and pain medications continue to rise.”

“The Body Keeps the Score: Mind, Brain and Body in the Transformation of Trauma” by Bessel van der Kolk

I’d like to find the numbers for Aruba and other small communities with limited resources. Considering the trend when it comes to prescribing medication instead of treatment to adults, I’m afraid the trend when it comes to children may be even greater.

Profitability and Research

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

“The Body Keeps the Score: Mind, Brain and Body in the Transformation of Trauma” by Bessel van der Kolk

Norms, protocols and medicine as an alternative to experiencing healthy interpersonal interactions – I have been fighting this extensively for years. Mostly in vain as it turns out. My fight has been seen as part of more disorders, either in my personality or as part of spectrum disorders.

Similarities between Patients with Traumatic Experiences

“Scared animals return home, regardless of whether home is safe or frightening. I thought about my patients with abusive families who kept going back to be hurt again. Are traumatized people condemned to seek refuge in what is familiar? If so, why, and is it possible to help them become attached to places and activities that are safe and pleasurable?”

“The Body Keeps the Score: Mind, Brain and Body in the Transformation of Trauma” by Bessel van der Kolk

These are questions I have been asking for years. As have many people I know. Others have chosen to ignore this as much as possible. I don’t believe we’re doomed to make the same mistakes over and over. But in my experience, whenever I have tried to get out of what I deemed were unsafe, but familiar situations, it’s rarely been supported. Let stand understood.

Seeking Out Feelings, Even if They’re Inexplicable

“Many traumatized people seem to seek out experiences that would repel most of us, and patients often complain about a vague sense of emptiness and boredom when they are not angry, under duress, or involved in some dangerous activity.”

“The Body Keeps the Score: Mind, Brain and Body in the Transformation of Trauma” by Bessel van der Kolk

This is another subject I’ll be writing about more extensively in the future. It’s a similarity I have seen often, and have definitely experienced myself. Duress especially is what has kept my emptiness at bay often. I wonder if at the end of the day that is why I stayed in toxic jobs or relationships longer than I should have. The lack of duress brings the emptiness.

And have I been breaking this pattern, or am I just creating a situation where I will encounter duress, because speaking out as I do about taboo subjects creates a greater risk of others trying to constrain my freedom of speech or coerce me into compliance by social and/or economic threats. If not physical ones?

Regaining a Sense of Control

“Did my patients also need to have physical experiences to restore a visceral sense of control? What if they could be taught to physically move to escape a potentially threatening situation that was similar to the trauma in which they had been trapped and immobilized? As I will discuss in the treatment part 5 of this book, that was one of the conclusions I eventually reached.”

“The Body Keeps the Score: Mind, Brain and Body in the Transformation of Trauma” by Bessel van der Kolk

I am deathly curious about chapter 5. Because this has been my personal experience. I’ll defer to writing about those experiences till I read chapter 5.

The Body Keeps The Score 3 – Mind and Brain – Final Thoughts

I’ve now read about 10% of “The Body Keeps the Score” by Bessel van der Kolk. In these past few days I have come to more insights and realizations than I have in 30 years of professional help. The medical articles, studies and dissertations I have been attempting to decipher for the past 4 years, are suddenly much more understandable.

Their relationships to Bessel van der Kolk’s work, to myself as a complex trauma experience expert, and their ramifications for patients such as I, is glaringly obvious now. I feel like a great weight has been lifted off my shoulders. Simultaneously I am painfully aware of the uphill battle it is going to be to get (mental) health professionals, insurance companies and policy makers in small communities with limited resources, such as Aruba, to even look at research such as this.