Bessel van der Kolk: Fluid, Alive, and Optimistic

Tami Simon: You’re listening to Insights at the Edge. Today my guest is Doctor Bessel van der Kolk. Dr. van der Kolk has been active as a clinician, researcher, and teacher in the area of post-traumatic stress since the 1970s. Past president of the International Society for Traumatic Stress Studies, professor of psychiatry at Boston University Medical School, and medical director of the trauma center at the Justice Resource Institute in Brookline, Massachusetts, Dr. van der Kolk has taught at universities and hospitals across the United States and around the world. He’s the author of the New York Times bestselling book The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma.

In this episode of Insights at the Edge, Dr. van der Kolk and I spoke about his three decades of research that inform the book, The Body Keeps the Score. We also talked about how an essential part of healing trauma is the development of “interoception,” a self-sensing ability that enables us to feel what we’re experiencing in any given moment. We talked about how trauma healing needs to occur at the level of the organism, and how certain modalities such as EMDR, neurofeedback, yoga, and working with psychodramatic structures can help people become unstuck and discover a fluid, alive inner world. Finally we talked about what supports trauma healing at a cultural level and why, in spite [of] all of the pain and suffering he has witnessed, Dr. van der Kolk remains optimistic about the power of the life force to promote healing. Here’s my conversation with Dr. Bessel van der Kolk:

Dr. van der Kolk, I wanted to begin by talking a little bit about you, if that’s OK? About your biographical story and that you were born in 1943 in the Netherlands right in the midst of World War II. What I’d love to know a bit about is how the world that you were born into, the family that you were born into—how you feel that shaped your life’s work? Really, this work of helping people heal from trauma, what the connection is?

Van Der Kolk: Well, that’s what therapists like to do. They like to construct life stories and say, “Oh, it all makes sense,” but I’m one of five siblings and the only person in my family who is remotely interested in this subject. Yes, the Second World War had a big impact on my vision of the world, but so did it on my brother who is [in] the Ministry of the Environment in the Netherlands, my brother who’s a book editor so you cannot make these linear connections.

TS: OK, but on the inside how did your experience of being born in the Netherlands at that time, do you feel, inform this—

BK: [Laughs.] I don’t believe in these things.

TS: OK. Well, this is very interesting.

BK: We have multiple impacts on our lives. We have character—psychologists are very good at saying, “Oh, now I understand!” But, how about my siblings? It’s all multifactorial, and I think therapists like to say, “Oh, because your mother was like that you turned out like Donald Trump.” No. Not everybody that has a mother like Donald Trump ends up like Donald Trump.

TS: OK. We can move along, although I can’t help but feel like there was something in that environment, the amount of trauma in that environment, that must have somehow influenced you personally in some way.

BK: Yes, I’m sure, but compared to people in Bangladesh or people down the street from here in Boston I’ve had an exquisite childhood. These meaning-making things don’t really work. It goes deeper than that, other than historical data. I was a very good student. I was very interested in biology and in classical languages. I’ve always had a love for science and of poetry and history, and my love for studying trauma is very much founded in the gifts that were given to me, that I came with.

TS: Now, Dr. van der Kolk, you spent three decades really, I think, doing the research and creating the theoretical framework that became The Body Keeps the Score, an incredible book that broke a lot of new ground. I just want to begin by getting our listeners on the same page with you. Why did you call the book The Body Keeps the Score?

BK: Because the body keeps the score. Because I think psychologists, therapists, and psychiatrists tend to ignore the fact that the function of our mind is to keep our bodies going, and that trauma gets stored in heartbreak and gut-wrenching sensations in your body and frozen musculature and an inability to move. My answer to your opening question is therapists like to explain things, but explaining things doesn’t change anything. Trauma is lodged in your immune system, in your reactions, in your perceptions, in the way you react to people around you, your hormonal systems, and the sensations in your body. It’s all very visceral and that’s where it plays itself out.

What has been gratifying for me is to get those—again, at living at this time of the world and being at Harvard at a time that it got its first new imaging machine and doing the first neuro-imaging study of what a traumatized brain looks like—being in this interesting history gave me a perspective of, “Oh, that’s what’s going on.” It sits in these very primitive survival areas of the brain that set the way that you hold your body.

TS: OK, now, I want to dig in deeply with you to this whole body level of trauma and how it’s stored there, but before we do I have to push this one more time. This meaning-making function—are you saying that this desire that we have as humans to make meaning and meaningful narratives out of our life is just really not all that valuable? Is that what you’re saying? Am I hearing you correctly?

BK: No. I think it’s what we do, and we do need to make meaning out of it. Of course, one of the things that happens with trauma is that people cannot make meaning out of it because trauma is fundamentally meaningless, and yet people will make meaning out of it. The meaning that people make out of trauma is, “I’m a terrible person. I’m a weakling. I’m no good. I’m damaged goods.” Our creaturehood forces us to make meaning out of things and the meaning that you make out of trauma is oftentimes a very distorted interpretation, depending on where you are and who you’re trying to placate and how old you are and stuff like that.

TS: So you’re getting underneath the story to what’s happening in the body—you talked about being able to see through FMRI what a traumatized brain looks like.

BK: FMRIs and through your eyes and through your fingertips and through all kinds of measures. That doesn’t mean the story is not important because when you’re traumatized, you cannot tell a story. So finding words for your experience is terribly important, but it’s not the story—it’s finding words for your internal experience, knowing what’s going on inside of you.

The [important thing] here is that trauma is not a story about the past because the past is over, really no longer relevant except in as far as you automatically replay the past and re-experience the past right now. Trauma is about the present. It’s about your present experience, and overcoming trauma means having to come to terms with the present moment.

TS: OK. If trauma is about our somatic experience, let’s just say, this body-level experience in the present moment—[van der Kolk makes a dissenting noise.] No? Well, you can be quite nuanced, you can help me.

BK: [it’s] somatic, mental, physiological, perceptual—it’s that you get stuck at a certain point. Pierre Janet, who was the first person who really wrote beautifully about trauma in 1889, says, “All traumatized people are fixated, had their lives changed, stopped at the moment of trauma, and have a hard time going on. They get stuck there.” On multiple levels. Your immune system may continue to fight something that isn’t happening anymore, and your mind is becoming angry about things that are not happening any more right now but you project on people right now. The word I like to use is “your organism.” Your whole being gets stuck somewhere back there interfering with being fully alive for the present.

TS: It does seem like some people whose organism is stuck are in some way holding on, if you will, or unable to let go. You actually begin your book, The Body Keeps the Score, with the story of a Vietnam vet that you worked with who didn’t want to let go of the trauma because he thought it was some kind of betrayal to his loyalty to the other [soldiers].

BK: Right. Yes.

TS: I’m curious to know more about this: this not letting go when we’re stuck.

BK: Again, this is not a conscious decision. It is not something people decide, or it’s not a defense mechanism. It happens at a deeper level of your brain. Something breaks, and then you cannot accumulate new things. It’s not a decision. It’s a very primitive, animal-like part of ourselves. Just like [if] you adopt a dog from the pound, a dog will continue to react not because a dog decides, but because a dog continues to be set to experience things in particular way.

This will happen to human beings also. Telling a story about what happened is good thing to do because it gives you a context, it gives you an explanation why you’re so messed up. It explains, it gives you an alibi, but it doesn’t change things. It doesn’t change the deeper things.

TS: Tell me more what’s happening at the organismic level when someone is experiencing trauma?

BK: Well basically, the areas of your brain that have to do with safety, relaxation, belonging, purpose, [and] direction get affected. So you keep feeling things and reacting to things in a way that are bizarre, shameful, embarrassing to yourself or to people around you. Then you go to a therapist and the therapist helps you to explain why you feel that way. This can be very helpful, but explaining it doesn’t make it go away. The big challenge is, how do you actually rewire the brain and the mind to the body so that you feel safe?

TS: Do you think of all trauma as one big pot, if you will? Or do you have categories that are important to you—like, this kind of trauma is really different than that kind?

BK: Well, there’s two main categories and that is—we got into this field via trauma, via veterans, and [it] was the money for studies close to veterans, so that’s our model population. Then gradually what emerged is that there are many more traumatized people besides soldiers. Those are kids, and those are kids who grow up in the context of deprivation and not being met, not being seen, being hit, being molested, et cetera, et cetera. That understanding hasn’t really fully made it into our understanding. People still talk about trauma primarily, but as the research evolves slowly what becomes clear is that most of the reactions that we see in people are not so much a result of a trauma, [an] event, but an attachment system in which they were threatened.

TS: How does this understanding that there are really these two different types of trauma—that we need to honor developmental trauma, this trauma of growing up in a childhood where no one was attuned to you, let’s say as an example—how does that understanding change how we look at the treatment of trauma?

BK: The treatment of trauma—change that to the approach, understanding, and diagnosis, actually, because our diagnostic is so miserable and so unscientific we have really become non-diagnosticians because we have diagnosed things that don’t make any sense and have very little scientific validity actually. The issue is to become a diagnostician again, to see what is going on with this particular person. What is working and what is not working? Our current diagnoses doesn’t even capture that.

A person may be very good at their work and be a good musician, be very sweet to other people at the workplace, but he just can’t engage with relationships, he become[s] too frightened. That’s not a result of trauma. It’s a result of attachment patterns that allowed him to survive as kid that continue into adulthood.

Trauma, which is where this field started and to some degree got stuck—the trauma is an event that is horrific, like a rape or an assault or seeing your best friend blown up or stuff like that. That becomes a memory and that memory gets stuck. That is actually very easy to deal with, a particular memory. Something like EMDR is extraordinarily helpful for that, and has about an 80 percent cure rate for people who indeed have that one trauma and nothing else.

But it evolves as so much trauma occurs in the context of relationships and that the relationships are the big issue. How do you feel safe in the relationships? What are your perceptions of the world of who you are in relationship to other people as you grow up?

TS: You ran a research study on EMDR and here I am hearing you say 80 percent of people with a specific type of shock trauma can actually be healed with EMDR. That’s a very strong statistic. You would think that more people would be using it if that’s actually true.

BK: That’s what we found. Of course about more than a hundred thousand people have been trained to do the EMDR so a fair number of people know about it. [But here] you get into the whole politics of this world. This very miserable thing happened of so-called “evidence-based treatments.” that people took the most simple treatments and said, “After a number of weeks comparing my method with people getting nothing, I get a 10 percent improvement. That means I have an evidence-based treatment.” No, it means that your treatment is definitely doing nothing.

What started to happen—I see this all the time in our field—is that people start to define themselves according to their methods and according to what they’re trying to heal. People call themselves an EMDR therapist or an IFS therapist or a cognitive behavioral therapist—that means, “I specialize in that particular tool.” But the issue is not you own two carpets, or who specializes in soy, or in hamburger—you don’t need a carpet in order to build a house. These tools are all useful for particular people and particular conditions, that’s all how it all works out. People have these conflicts and competition between different schools of thought rather than focusing on, “How can I get my patient better?” [Instead,] they focus on how my method works actually.

EMDR data [is] very clear that this is a historically effective treatment, but people started to rebel against it. Wiggling your fingers is stupid and crazy, but the data [is] there. The question when you do research is, do facts actually matter? Are people ever persuaded by facts?

TS: I like facts.

BK: Yes. Just look at the current political climate. See how much people love facts.

TS: OK. I believe you that it’s not necessarily in evidence.

BK: People are primarily run by emotions and they use facts in order to bolster their arguments, by and large.

TS: Yes. I think you’re making an important point. Now, I want to talk for a moment more about EMDR because I think it’s very possible that some of our listeners are familiar with it but some aren’t. In answering this question of explaining EMDR and how it works, what I’d love to know is what’s happening at the organismic level where the trauma, where the stuck place is, how does it get shaken loose through EMDR?

BK: Right. Great question. Let’s start with how talking works. How does talking shake the trauma loose? You know the answer to the question?

TS: It doesn’t.

BK: No. How does project work?

TS: I will not know the answer to that. I’m asking you the questions Dr. van der Kolk.

BK: Nobody knows the answer to the question but they do some weird—people say, “Oh, I need to know how it works!” The thing is, nobody knows how any of these things work.

It’s too bad you called me today because tonight I hope to get the results in from our neuroscience study of EMDR. We have been working for five years on the study and tonight we open up the data more about what happens on the [combination of] EEG and the FMRIs with EMDR. The hypothesis is it promotes 40 megahertz [inaudible] cortical rhythms which integrates your limbic memories with your frontal lobe.

TS: OK. Now explain to our—this is going to be an easier question—to our listeners who are unfamiliar with EMDR what an EMDR therapist is doing and what’s happening for me if I go to an EMDR therapist?

BK: When you go to EMDR, you call up your images, feelings, memories about what happened back there, and you don’t necessarily talk about it. As you hold that thought in mind, your therapist creates alternating movements. You move your eyes back and forth, or sometimes you tap yourself on different parts of your body, and as that happens the brain sets up new associative networks.

For example, when I learned EMDR—something quite bad actually happened to me and preoccupied me, and then I did eye movements and next thing came up was a scene about a dinner table when I was eight years old, and next thing a scene of playing in a playground in school, and then a scene of going to the beach with my friends and then a scene of throwing some stone through a window in a tennis club with my brother. My mind sort of created these weird new—memories came up and it was very much like being in a hypnopompic state, the state you’re in on Sunday morning when you wake up and you don’t quite want to get out of bed yet and you’re able to sleep late. You have all these unconnected thoughts running through your mind.

After you’ve done that and people go back to the the original thing it has lost its power. You say, “Yes it happened,” but the emotional power of it has been lost, is gone. This is actually interesting because when people first started to talk about trauma, like Freud back in 1893, he said trauma is about people not being able to make associations. That the event is stuck and not associated to other things. What the EMDR seems to do is it seems to associate the trauma with other life experiences so it just becomes part of the big soup of our memories of our lives.

TS: When someone suffers a trauma and in the language of this discussion “becomes stuck,” why does one person become stuck and another person could experience the same thing and that doesn’t happen, they don’t become stuck? What’s going on in the stuck versus unstuck?

BK: Well, people often ask this question. Now, we never ask this question in our clinic. When people come to see me, my reaction is always, “Oh my God. How did you make it this far? How did you go on with your life after that?” My reaction is always like, “I have no idea if I would have been able to cope with whatever happened to you more than you did.”

Probably it’s true that some people have an identical trauma, like get gang-raped at age 15, and do OK. How you define “OK” is another question. Does it show up somewhere in their lives? I don’t know. I have a number of people in my practice—you see much of my practice is of people who I read about in the New York Times. I hear about them because many of them are very successful people and everybody would call them resilient, except they see me because they go home and mutilate themselves, or they go home because they have some very complex sexual perversion or something. When you say somebody’s really resilient, I wouldn’t call anybody resilient unless I get to really, really know them really well.

TS: Clearly there are people who are resilient and maybe you’ve met some of them in your life.

BK: I meet them every day. Every one of my patients is resilient.

TS: OK. Tell me more about this quality of resilience. Let’s say somebody’s listening and they’re like, “I want to be more resilient. That’s what I want.”

BK: Well actually people need to get in touch with their resilience because they already are resilient. The fact that you get up in the morning and do whatever you do means that you’re resilient.

TS: Good point.

BK: People are amazingly resilient. That’s why I sort of pushed back on your opening question. What really intrigues me about trauma is my encounter with the life force. To meet people who go on despite unbelievable hardships. That you meet enormous courage and willingness for people to try out things. Traumatized people usually get horribly mistreated mental health systems. People tell them they’re going to fix them and do stuff for them and majority of treatments are terrible, but they still keep hanging in there, go on to try to find other treatments. What you see is the life force of people continuing to struggle to carve out a life for themselves.

That, of course, is what you want to make use of as a therapist—that innate capacity to go on. A number of my colleagues teach, let’s say, Shakespeare in the prison. They get to love their prisoners because they work together and they really uncover enormous resiliency that’s inside of people. Yes, they may have murdered somebody in the context of doing so, but you still find it amazing, the eagerness to have a life, to create something.

TS: One of the things you talk about in The Body Keeps the Score is the power of people developing a skill that you call “interoception,” and that this can be incredibly helpful in healing trauma.

BK: That actually is essential. It is something that you look for: whether people are able to reflect on themselves, to know what they’re feeling, to know what’s going on inside of them, to know their reactions to things around them.

What you see in traumatized people and politicians is that they just react. They don’t know what they’re feeling. They project their feelings on other people. So they lack that essential interoceptic capacity where they can look after themselves and know, “Oh, this is what’s going on with me and that’s why I’m doing something.”

TS: Now, this word interoception, I don’t think is a word that most people, unless they’ve studied your work or similar work in the field, are familiar with. So I want to be sure that I understand that I’m engaging in interoception when I’m connecting at an organismic level with my experience—when I just kind of know what I’m thinking?

BK: There’s nothing fancy about it.

TS: OK.

BK: It’s like you have soup for lunch and you go like, “Wow, that tastes really good. That soup tastes much better than the soup I had yesterday. I wonder what the ingredients are that makes my palate respond this particular way?” It’s very similar to mindfulness. There’s a certain part of your brain—which I call it in my book the “Mohawk” of the brain; that’s the part of the brain that’s devoted to your taking care of yourself, you knowing what’s going on inside of yourself, which is activated by mindfulness.

The trouble is that this capacity to look inside and to feel yourself becomes very hard when you’re traumatized because once you go inside, you meet all these demons that you have stored inside yourself. Traumatized people often have a very hard time reflecting on themselves, feeling themselves, noticing themselves, and their internal work becomes very dangerous. Yet, the only way you can get better is by having this compassionate, self-observing capacity. That really is the goal of treatment, is to create a compassionate, self-observing person.

TS: It’s interesting that you’re not just describing it as mindfulness but that you’re emphasizing this self-compassionate quality as well.

BK: It doesn’t come from me; a lot of people in this field actually are discovering that. For example, in the Mind and Life Institute there’s a German researcher by the name of Tania Singer who is a mindfulness researcher. She says interest in mindfulness is not all that useful by itself, but she finds out in her research if you combine mindfulness with self-compassion, people get better. The self-compassion part is a very critical part. To my mind, that’s really the only capacity that needs to be cultivated in therapy, basically.

TS: OK. That’s a big statement.

BK: Yes.

TS: Did you say the only capacity? Or the most important? Or the main?

BK: Well, the most important. Main. Yes. The most basic is to learn feel yourself deeply and compassionately. That’s what it’s all about.

TS: OK, now—

BK: It’s very hard to do.

TS: For someone who’s suffered a certain amount of trauma, you said when they go inside and interocept, look for their inner experience, they may find something like demons, I think is what you said.

BK: Right.

TS: I’m curious to know a little bit more. Might someone who suffered a lot of trauma just find like numbness? Nothing. It’s just numb.

BK: Numbness; that’s a very big thing. My conference this year, a large part of my conference—I’ve lead this conference for 28 years. This year a large part of the conference was actually focused on what we know about numbing and an internal lack of a sense of self and a sense of capacity, finding nothing when you go inside, and how to cultivate it. Yes. What to do with it.

TS: So since this quality of self-compassionate awareness, if you will, of what’s going on inside of us is so important and one of the most important objectives of therapy, tell me how a good trauma therapist helps somebody develop a self-compassionate posture towards their either numb or difficult experience?

BK: Very simple. Develop it yourself.

TS: You mean when the therapist has it—

BK: That’s all.

TS: Then it’s contagious?

BK: Yes. If you don’t have it as a therapist, you can’t encourage other people to do it. I see it all the time. “How do I get my patient to use it?” What do you do yourself? How are you doing it yourself?

TS: OK, that seems to me necessary, but is it sufficient? Is that enough? I do that as a therapist, I have a deeply self-compassionate attitude towards my own experience.

BK: It’s a very, very important beginning step.

TS: OK.

BK: Then you become curious about, if you know yourself so well, why isn’t it working for that person? Then you start working with that person on what gets in the way.

TS: Was it a journey for you—

BK: They become a diagnostician also. A part of what we find [that] gets in the way is that there’s all kinds of really very messed up stuff in the brain that causes people to be numbed out that eventually goes into neurofeedback, for example. Anyway, most of my last five chapters of my book are all about different ways of getting there.

TS: I was going to ask you a question. In my own life it’s been quite a journey to be self-accepting, self-compassionate towards my own experience. And I’m curious for you, since this is such an important quality that you discovered that you would need as a clinician, what was that journey like for you, developing that quality?

BK: I always feel like I owe people refunds for the first 20 years of my practice. [Tami laughs.] One thing that my editors, who are in my book, [say] about the irony of this field is that the teacher pays the student the fees for getting better; your patients teach you and life teaches you. We basically get a license that we’re trained to malpractice, and then slowly over time you learn it, but it takes a long time.

What is helpful for me, and I’m incredibly fortunate, is that because of probably initial brain scans or some other work that I did, a lot of people were eager to teach me stuff. I had easy access to many people like Peter Levine, and Pat Ogden at El Paso, and Dick Schwartz, and all these people who did these amazing treatments and they’d say, “Would you like to try it?” Sure. So I got to really experience how transformative they were. As my friend Beatrice Beebe, the attachment researcher likes to say, “All research is research at the end.” Of course we’re always looking to cure ourselves, and therapists become therapists to cure themselves also.

TS: It sounds like after the first 20 years, a new dawning of a self-compassionate attitude towards yourself started to take hold more in your experience—it sounds that way—and that these different methods were helpful. But was there some kind of shift in you? How did that shift happen inside you?

BK: It was a very slow shift. A pivotal moment for me was the founding meeting of the USA Body Psychotherapy Conference. I was invited as a neuroscientist to teach body people about the brain, and the moment I walked into that meeting, I saw a whole bunch of people who looked much healthier than the neuroscientists and the psychoanalysts and the cognitive behavior people I’d hang out with. Their bodies moved more fluidly, calmly. That meeting was a very big meeting for me because I saw people work with the body that clearly were doing things that I’d never seen happen, and then they started to work with me. They opened up things inside of me that I never had access to before.

TS: OK. That’s good. You mentioned neurofeedback, and similar to EMDR I think some of our listeners may be familiar but other people may be, “What? What was that?” Dr. van der Kolk said neurofeedback, what is that? How does that work?”

BK: Yes. [Laughs.]

TS: Once again, we don’t know. We don’t know how it works.

BK: How does your car work? How do airplanes work? So, you can harvest the brainwaves that people generate at all times by putting little electrodes on the skull. You can hook the electrodes up to a computer, [and] you can register the brainwaves so you can read people’s brainwaves. Then in a neurofeedback program, you can translate those brainwaves into a computer game and you can set it in such a way that you can give your brain rewards for creating certain patterns of neuronal activity.

You play computer games with your own brainwaves, basically. You don’t move anything, you don’t try anything, your brain gets feedback from the computer in the form of lights and sounds and movement on the computer. Your brainwaves play with the computer basically, and you just sit passively by while the computer gives you feedback about, “That’s good, yes, do more of that.” So your brain automatically—it’s a little bit like training a dog. You give them little cookies and walk them and you lift them up in time to take them to the bathroom. You do the same thing with your brain. You sort of train your brain to create new brainwave patterns.

TS: OK. I want to just close a loop, if you will, and make sure I really understand this because you talked about how this quality of being able to be compassionate towards our experience and be in touch with our experience is so critical for healing trauma. So what is it? Now we’re in touch with our experience, we’re self-compassionate, we know what’s happening at any given moment—I feel irritated, I feel angry, I loved the taste of the anchovies that they put in that salad dressing, whatever it might be—

BK: I think it’s so you notice it.

TS: Yes?

BK: By noticing it, you activated that medial prefrontal cortex, which is your self-observing platform of your brain. Next thing you soon say, “OK, now I feel really upset and panicky,” and you activate another part of your brain, the dorsolateral prefrontal cortex, it’s the time keeper of your brain. You go, “OK, now I feel—” Notice what happens next. Notice that I’m going to take a deep breath. Notice when I stand up. Notice when I move my foot. Notice when I just sit here, still, and what happens to my mind when it happens. You start noticing that you have a fluid, alive inner world basically, and that it’s OK to feel panicky because nothing lasts.

The issue where people get stuck when they get traumatized is to become afraid to feel what they feel and to know what they know. The whole goal of treatment is to make people feel safe enough so they can allow themselves to feel what they feel and to know what they know, and to know that everything keeps changing inside. The disease of post-traumatic stress is a disease of your timing system of your margin brain having broken down so that you cannot allow yourself to notice how things continuously change.

TS: The timing system. What do you mean by that?

BK: Our interview is going to be over in a little while.

TS: Yes, that’s true.

BK: I know—that’s why I may be hungry, or need to go for a walk, need to go to the bathroom, [but I can say to myself,] “It’s OK, you can talk to this lady, because in a few minutes it will be over and you can do something else.” Once you know that nothing lasts, you can put up with what’s happening right now.

TS: This is so helpful, and this idea of a fluid, alive inner world as you—the goal, if you will, is that fair to say? Of a healing process, is knowing that, feeling that, being in touch moment-to-moment with a fluid, alive inner world? Is that fair to say?

BK: Yes, that’s right. Yes.

TS: OK. What about the sense that somebody might have—there are times when I feel this fluid, alive inner world and I feel kind of overwhelmed by it. Whether it’s the ecstasy of it, the speed of it, the ephemeral nature of it, I just feel a little overwhelmed. It’s so alive. It’s so—

BK: Well, notice that and then notice that, “Oh shit, I’m sitting in front of a traffic light and now it’s a traffic jam and that feeling has disappeared again.” Things will change. Things will change.

Of course, the reason why I’ve gone into neurofeedback is that some people’s nervous system is so hyperaroused or so continuously shut down that they cannot get there. When we look at their EEGs you go like, “Wow! It’s amazing that this person is even functioning at all,” because so many different parts of the brain are not talking to other parts of the brain.

When there is so much disruption, you start doing neurofeedback and then what we see happen—we just published a paper on it in a magazine called PLOS ONE, a major neuroscience journal. What you see happening is an increase in exact functioning, an ability to become flexible, to find new solutions for problems, to inhibit yourself from doing things that will get you into trouble, that will hurt other people. Basically, what you notice is a sharp [increase] in the capacity to be mindful and to be creative as we calm different parts of the brain down and connect them with each other.

TS: Now we’ve talked about neurofeedback and we’ve talked about EMDR, and in your book, The Body Keeps the Score, you profile more than a dozen different approaches to this organismic level of transformation. I thought it was very interesting that you included a strong section on yoga. I think most of the time people don’t associate yoga as a trauma-healing modality. They think of it as something else, but not that.

BK: Right, but that’s changing. We did first research, funded by NIH, on yoga for PTSD. Based on our observations about disturbance of heart rate variability, disturbances of people’s capacity to notice what goes on in their bodies, we did this yoga study. We basically found that yoga—our outcome was better than any medication ever studied for PTSD. Of course, after we published our article, I didn’t see psychopharmacology clinics transforming themselves into yoga studios, but if you’d go with data that’s what you would do.

TS: OK. I’m going to just at the moment repeat myself that I like the facts, and I believe these facts so they fit my emotions, so I’m emotionally behind these facts as well, about yoga. Makes a lot of sense.

BK: Right. Right. See, that’s how it needs to go.

TS: Exactly.

BK: As long it doesn’t resonate facts I developed.

TS: OK. One of the other modalities that you talked about that I was completely unfamiliar with before I read The Body Keeps the Score is something that you called psychodramatic structures. I thought of almost like a re-scripting through a theatrical performance.

BK: That’s correct.

TS: Yes. I thought, how does that work? And how is that getting underneath the story if we’re just kind of enacting theatrically a new story? Describe to our listeners what this modality is and your hypothesis of how it works.

BK: Of all the chapters in my book this is the most puzzling one, and the one that both my publisher and my editor wanted me to throw out. And yet I do these weekends—I do about three weekends per year where I do nothing but this with small groups of people, and it always ends up in spectacular changes.

This method I learned from an old dancer actually—Albert Pesso. It’s based on the notion that if you put your internal world out into three-dimensional space, it becomes very vivid, so you can see how different characters that have been in your life, who have been important to you, unimportant to you,—when you put them in space, it becomes much richer. Then what we do is something that is very central to the issue of trauma also. When you get traumatized you have a breakdown in your imagination that things can be different. If you have been chronically neglected as a kid, you don’t believe that anybody will ever love you or care for you. You cannot imagine what it’s like to be loved.

The reason I got into this method is that we always focus on what bad thing has happened to you, but we have never been able to focus very much on what is missing. When you don’t know what it feels like to be held and loved it’s hard to imagine it. If you don’t know what it’s like to light up a room when you walk into it—which all of us deserve to get as kids—you cannot imagine a room will light up when you walk in there, so you walk into every room of your life as somebody who will not light up a room. What you do in these psychodramatic structures is you recreate certain critical people in relation to your life in three-dimensional space and you create ideal parents.

That ideal parent is chosen; it’s one of the group members, and the ideal parent says, “If I’d been there when you were three years old and this happened to you, I would have protected you.” That person touches you as you have that feeling. The capacity of recreating this in three-dimensional space and being able to imagine what it would be like if when you were three years old there would have been a person who would’ve helped you in that particular way or would have protected you is—I’ve never seen it fail. It’s invariably a very profound experience that opens up new possibilities in people’s minds.

I’m cautious about it because I’m a researcher and I always like to submit everything I do to serious scientific tests. I wouldn’t know how to do that with this. It’s too complex. It’s moment-to-moment observing stuff, but it’s a beautiful way of treating people.

TS: What’s interesting when you talk about working at the organismic level in something like yoga or EMDR or neurofeedback, I’m kind of with you in terms of how we’re getting down below our cognitive functioning. We’re getting deep down into the organism itself. When you talk about this psychodramatic structure, I think, “Well wait a second. Isn’t there going to be a part of me—this person who I know is a member of the group is holding me and petting my head and telling me that I’m so lovable and stuff like that, isn’t there going to be some part of me that goes, ‘Come on, I don’t believe that. That’s not true.'”

BK: No, the person doesn’t tell you it’s your loved one. The person says, “If I’d been back there, I would have protected you.” The things that we’re missing get provided in people’s imagination. Nobody in the room is psychotic. Everybody there knows that they’re just imagining something, but boy does it feel real.

TS: Right. This tells us something very interesting about imagination and our organismic level of functioning. Don’t you think?

BK: Yes. We are a symbolic species, and we are people who live by our imagination. When you were preparing to talk to me you started to imagine what it would be like—

TS: Yes.

BK:—To talk to me and you started to prepare yourself for it. And maybe did work out, or it didn’t work out, but you continuously imagine in your mind what the outcome will be. What you do in so many of these dramatic therapies is to explore things. Like, “Let’s see what will happen if we do that.” Or “Let’s explore the possibility of—”. There’s also my last chapter’s about the theater chapter of what it’s like to be Julius Caesar in a Shakespeare play, or what it’s like to be Willy Loman in a play. Or it’s like my son who was Rocket in West Side Story and got to experience what it’s like to be a tough, Hispanic gang member in New York in the 1960s or something, or 50s. To really explore what it feels like to try something else on a very visceral level.

I think that’s one of the great open frontiers in our field, is that we tend to be very passive and reflect and think about things, but we don’t act. Moving on with life is to take new actions. A very powerful point of getting over trauma is to act in ways that are different from the way you’ve acted. We talk about multiple mugging where women are taught to fight and to do karate.

Of course, the people who really know this [are] the US Army, who take a bunch of good-for-nothing raw recruits at age 17 and 18 and by having them act in a certain way and move and do things, form them into a fantastic fighting force in 12 weeks’ time. Those guys really know how to deal with the transformation of adolescents in a way that no psychotherapist has ever even begun to equal. They don’t do it by, “Let me talk about your feelings of what it’s like to be a US Marine,” no, “Let’s make you into a US Marine and you’re going to climb and you’re going to crawl and you’re going to do things,” and before long, it’s in your body and it’s there. It says, “I’m a tough guy. I can do things.” Being able to instill these things in people’s viscera is terribly important.

TS: Which leads me to a final area that I want to talk about, which is what kinds of changes do you envision, in your imagination and your positive imagination, that we could make as a culture? Whether that’s in terms of our educational system or cultural norms, if you will, that will help us heal the pervasiveness of trauma in our world today—that will help people be more fluid alive in their inner world. How does the culture need to change?

BK: Well that of course is a political question. That is, who are we as a political unit and what are our priorities? Of course, that has taken a major blow in the last few months. That is whether we really respect people; respect people’s capacities and people’s vulnerabilities.

This whole educational system of course is terrible. There’s all the things that are helpful for people—moving, interacting, creativity, collaboration—are increasingly being shunned by the educational system in favor of tests. We don’t need to give kids tests. I never took tests, particularly growing up. I had a very, very classical education. Greek and Latin, far off languages and such. Kids definitely want to learn if they live in an environment that is safe, that promotes curiosity, where you’re asked to write. I wrote a lot of plays as a kid growing up. When you do and you act and you see the results of your labor, and you see the results of collaboration, then you start feeling good about yourself. If you just sit there and take tests starting in kindergarten that you can pass or fail and you have no interactions, that’s a terrible thing to do.

In my day-to-day life it’s interesting to see all these different parts of our health delivery system. I teach at a medical school, and I see that people are being taught these very strange diagnostic systems that [have] no scientific validity and so-called evidence based treatments. And they all die on the vine because it’s so ungratifying because they never see people getting better. I see other communities like the Internal Family Systems Community where people feel alive and optimistic and very respectful of their patients, and I work with my theater groups and they’re lively and interesting.

What I keep seeing is that people get paid to do treatments that don’t work, people don’t get paid for treatments that do work. It’s just the great irony of our society. You get paid to give people drugs but you don’t get paid to really work with people. I know a whole bunch of people I know who say, “Oh it’s really great, they let me into the VA and I’m able to do yoga with veterans now.” I say, “Oh, are they paying you?” They say, “No, no. They pay the psychopharmacologists but they don’t pay the yoga teachers.” That’s what I see all around. The things that require creativity and openness do not get supported—both in school systems and the health systems.

TS: Well we’re going to have to change that.

BK: Good luck. That means political action.

TS: Yes. Ready to go. Now, Dr. van der Kolk, I want to call this conversation we’ve had “Fluid, Alive, and Optimistic.” That’s what I’d like to call the conversation, if that’s OK with you?

BK: Yes. Fine.

TS: To end on this note of this third quality, optimistic, you mentioned the life force and how it’s something you see and you believe in—its strength, its indestructibility if you will. But I’m curious to know, in your own words because you sound in a way very realistic but also optimistic, what optimism means to you and how it stays so alive in you?

BK: Just be careful here because what I also see is unspeakable pain and suffering.

TS: I know that.

BK: Side by side. Side by side. You know what’s a big thing, is that once you see people get better when you do these things, that makes you optimistic. Once you see that being brutally honest with yourself and about what works and what doesn’t work, and having colleagues around you who can be brutally honest with you, who are not gilding the lily and primarily ideologues.

One of the core things of how you grow as a therapist is take videotapes of your work. Look at your work. Look at what you do. Don’t just talk about what you do but actually look at what you do, because you’ll see yourself doing all kinds of really weird things and so you miss the boat half the time. Show your videotapes to your colleagues. Not all your colleagues, but the colleagues you trust, and think together about what you can do better.

It’s all about being deeply honest. Overcoming trauma is about being deeply honest about what you feel and what you know and what has happened to you. That’s how we’ll grow. Once you see that being really honest with what you do and what happens to your patients will actually work, you’ll become optimistic.

TS: Tell me, just to connect this for a moment, how deeply deep honesty is an important part of healing trauma. Why is that?

BK: Well, trauma is all about not wanting to know what you know and not wanting to feel what you feel because you think it’s too much. And to a large degree it is too much, and when it happened it was too much. The whole issue of therapy is you need to create a place where it becomes safe to feel and know what you couldn’t feel and know when this actually happened to you. The issue of the creation of a safe place inside of yourself and with your therapist, whoever you work with, that makes it possible to go to these very dark places. It’s critical.

TS: I’ve been speaking with Dr. Bessel van der Kolk, who’s written the New York Times bestselling book The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. Dr. van der Kolk, thank you so much for making the time for this conversation and for inspiring me. Thank you.

BK: You’re welcome. Good luck. OK. Bye bye.

TS: Bye bye. SoundsTrue.com; many voices, one journey. A fluid, alive inner world. Thanks for listening.