Bessel van der Kolk: Trauma isn’t the event, it’s the response

In the preamble to the definition of PTSD, we write

these people have been exposed to an extraordinary event that is outside of normal human experience

So it turned out that this is not an unusual experience at all

The trauma is not the event that happens, the trauma is how you respond to it

The degree to which when you're traumatized, your body keeps mobilizing itself to fight

You have all kind of immunological abnormalities, you have endocrine abnormalities, and that really devastates your health

your physical health, at the long range of that the physical problems are longer lasting

than the mental problems. One of the largest mitigating factors against getting traumatized is who is there for you

at that particular time. I did the first study on Prozac for PTSD, the first study for Zoloft for PTSD, and a

number of other conventional drugs. What we found is that it didn't work very well

Hi, my name is Bessel van der Kolk. I'm a psychiatrist, neuroscientist, the author of the book, The Body Keeps His Core

I got interested in trauma on my first day working at the Veterans Administration

By the very first day that I met Vietnam veterans, I was just blown away

These were guys who were my age, who were clearly smart and competent and had done very good things

flying helicopters and running boats and doing good stuff in the military

and they clearly were just a shadow of their former self. And what particularly intrigued me is that they had nightmares about what had happened

and also that they kept referring back to their dead comrades. Their hearts seemed to be with the people who were no longer around

and what struck me immediately is they had a very hard time connecting with new people after the war

What also struck me is how their bodies were clearly affected by trauma

These were guys who used to be athletic and now they were slumped over and they were uptight

and their voices were uptight and they were sort of passive much of the time

And then people told them something that was disappointing and they went from zero to ten

and blew up and became extremely angry. And it was just at the time that

that we were having two small children who were a little bit like that

Little babies go from zero to ten, but I know that when a baby becomes very upset, within

10 minutes you can sort of hold them and calm them down. And these soldiers were very much like little babies, except the stuff that's supposed to

happen to allow you to not overreact to the minor things seemed to have been destroyed

or something seems to have happened to them that made it very hard for them to modulate

their responses to their environment. And what was also really striking is that they had a hard time being in any way meaningfully

involved in the present. They had a hard time loving their wives and girlfriends

They had a hard time really connecting with their kids. So something seems to have been destroyed by their capacity to engage and possibly even

to learn new experiences. 1978 was the year that I first saw veterans, and that was also the time that my colleagues

and I soon joined them, started to think about how is what these guys suffer from different

from what other people who are in sexuality textbooks, because clearly they were different

and I couldn't find a textbook to describe them. From that time that I first started to work for the VA, a group of us started to define

what trauma is and started to define what happens to people. In the preamble to the definition of PTSD, we write, these people have been exposed to

an extraordinary event that is outside of normal human experience. And in retrospect, that shows us how ignorant and narrow-minded we were because it turned

out that this is not an unusual experience at all. That one out of five women in America

has a history of sexual molestation. Even a lot of men have histories of sexual molestation

One out of four kids get beaten very hard by their parents. One out of eight kids see

physical fights between their parents. When we started to work with Indo City kids, the

The amount of trauma that these kids experienced was just unspeakable. So somehow we had managed to turn a completely blind eye how what happens in people's environment

creates the mind and creates who people become and creates certain forms of pathology

It was a real wake-up call. And there was a lot of debate of what a trauma is to this day

And even sometimes when I define it in the way we officially do, people still don't like

what I say. But basically what the trauma is, is something that happens to you that makes you so upset

that it overwhelms you. It freaks you out and you cannot, you just stand there or sit there or lie there or whatever

and you are at a loss about to do. You feel terrible, helpless, hopeless, and you collapse

Basically, there's an internal state of, oh my god. So it's not somebody being mean to you or nasty to you or it is really bad stuff

But the trauma is not the event that happens. The trauma is how you respond to it

Let me give you an example. As a medical student, I was trained to deal with all kinds of very difficult situations

And I remember vividly during my internship that a kid was brought in, a little child

with third degree burn wounds all over his body. But I was trained as a medical student about what to do

So rather than freaking out, I thought, okay, I need to get my IV going, I need my fluids going

I focused on what to do. So that exposure to these horribly burned kids was not a trauma for me because I was

not paralyzed in my actions because I had been trained to deal with it

And of course, that happens to policemen, that happens to people in the service, it happens

to physicians, nurses, et cetera. It's that you get trained on what to do and not to get overwhelmed by your feelings, but

to actually be able to continue to act and do something. And when you're traumatized, you just are unable to do anything

It a subjective experience and what may be traumatic for you may not be traumatic for me vice versa and vice versa depending on our personality and our training An event becomes traumatic if your response is oh my God when there is nothing you can

think of, you can do to stave off the inevitable, where you basically collapse in a state of

confusion, maybe rage, maybe collapse, because you are unable to function in the face of

this particular threat. An event like that may not become a trauma in the long range if at the moment that you

collapse, other people around you come over and say, oh, I see that you're really in bad shape

Let me help you. Let me take over for you and do things that you cannot do yourself

And so the greatest protector against the trauma is the people around you, whether they're

able to protect you and to do what needs to be done, or whether the people around you

actually make it worse by continuing to do terrible things to you or blaming you for

your responses. Trauma is actually, unlike what we first thought, extremely common

At least one out of eight kids in America witness physical violence between their parents

A larger number of kids get hit in very nasty ways by their own caregivers

A very large number of people in general, but women in particular, have sexual experiences

that were clearly unwanted and that left them helpless and befuddled, confused and enraged

because they had no choice about what they were doing. These experiences are extremely common

So people usually think about the military when they talk about trauma

but I like to say somewhat unscientifically that for every soldier who gets PTSD in a war zone

there's at least 30 children who get traumatized at home. The nature of trauma is that an experience enters

into your ears, into your skin, into your eyes, into sensations. And it goes down into a very primitive part of your brain that automatically interprets

what is going on. That's not your frontal lobe. What your frontal lobe, your conscious cognitive self, that is a later issue

The first thing is a somatic response. So something happens to you, your survival brain makes the first interpretation and says

Is this dangerous or is this safe? That decision is made for you by that primitive survival brain

And that's what we learned a lot about when we studied trauma is the power of that primitive

brain which occupies a very large part of our brain that really automatically makes decisions

for us. And on the basis of the messages we get from our body, our cognition interprets in a particular

way, depending on our prior experiences. But the message comes from our hormones and our physiological impulses that have to do

with survival. We're talking about staying alive. And so when you're being raped or you're being beaten or you see your parents getting killed

your body starts automatically going to a state trying to make yourself survive

One of the states is going to fight flight, to get up and to punch people and to become

very angry. And that's oftentimes when people are traumatized, those fight-flight responses continue to get

activated in response to situations where people in their environment says, hey, hey

cool, this is not so bad. But people have these automatic responses

Or on a more primitive level even, is that people's brain shuts down and they lose track

of themselves and they basically make themselves disappear. Very much like animals can do that also in the wild

They can sort of collapse and play possum, as it were. And playing possum is exactly what happens to people

Also, when you beat a kid enough, that kid starts collapsing and no longer responds to

its environment. So it is either fight flight or collapse, none of which have anything to do with cognition

And doing cognitive therapy with that is really a misunderstanding of what happens with traumatized people

automatic responses and they don't have these responses because they're stupid or because

they don't understand what's going on. Most people actually do understand that their reactions are completely out of whack

They don't need to be told that. But because they react in such an extreme way, they feel deeply ashamed about themselves

because they say to themselves, I'm a nut cake. I screamed at people

I collapsed when I had to stand up for myself. And so you have these automatic responses that are not a product of your cognitive assessment

They're a product of your animal brain trying to stay alive in the face of something that that part of your brain interprets as a life threat

Even though the people around you by now go, this is not a life threat at all

We come into the world being able to do what little babies can do

And what can little babies do? They can breathe. They can sleep. They can suck

They can feel hungry, they can poop, they can pee, they can cry, and that's about it

So we call that the housekeeping of the body. Little babies already can do that

And little babies, their system gets very activated, so babies will scream and they'll

cry and it'll look catastrophic. And then the people around them pick them up and soothe them and calm that part of the

brain down. Much of the imprint of trauma is in a very primitive survival part of your brain that's

already in place in little babies. In fact, what the research recently has been showing, there's a little area, way, just

way the base of your skull, periaqueductal gray, that I like to call the cockroach brain

There's a part of you that just picks up what's dangerous and what's safe

And now it turns out that when you're traumatized, that little part of your brain, which is usually

very quiet for most of us, continues to just send messages to you when you're traumatized

And so there's always this sort of message you get from deep down inside of your body

of I'm in danger, I'm not safe. So you're always uptight, always on alert, and you spend much of your energy trying to

suppress those feelings of fear in order not to embarrass yourself in order to be able

to work with what you do. And so it's very primitive. that middle of the primitive part of your brain, you develop a limbic system

And your limbic system basically creates an internal map of the world that tells you what

out there is safe, what is dangerous. So if you say to me, boy, after this interview is over, let's go to the store and plow down

the street and have a nice lager beer, I go like, wow, that's so cool, because I love

that bar. And I don't love that bar. So, already in my internal mind, I have a map of what is safe and what's dangerous

And that map is created by the experiences we have So the brain is a use organ And the brain gets formed on the basis of the experiences that we have particularly in the first few years of your life

So if you're a little kid and you grow up in very safe surroundings

and people are delighted to see you, and people say, isn't she cute

Isn't she wonderful? You grow up with the sense of, I'm so cute

and people love me because that becomes the map of your world. That's how people respond to you

And basically that stays with you for much of the rest of your life. If you're a little kid and people say to you, as I hear all the time

I wish you hadn't been born. I tried to abort you, but I fail

You just really ruined my life. You just have always been pain in the ass

That becomes your map of the world. And a little kid doesn't say when you're three years old or five years old

Mom, you're crazy saying that about me. because a little kid doesn't have other ways of looking at the world

So the world that you live in is the only world that it is. And if you're being treated as a difficult, unpleasant person

that becomes your perception of yourself, I'm fundamentally a bad, defective person

And that, people's cognition does not make that go away. People can tell you until you're ruined if it's

oh, you're wonderful, you're terrific. I've known a whole bunch of people like that

who were very abused and neglected as kids, who have become amazing musicians, artists, athletes

The world adores them, and deep inside, they still feel like crap, that they're defective people

because that imprint stays with them. My colleagues and I started to look

at these traumatized soldiers, primarily. We actually went back over what had been written before

The library at the VA I was working Didn't have a single book about war trauma, war neurosis, any of these things

So I went down to the old Harvard Medical Library, and I dug up a book that was written in 1941

by a guy by the name of Abram Kardner, who had been working with First World War soldiers

And he writes about his First World War soldiers back a long time ago

He writes, these guys suffer from a physiognorosis. Their bodies continue to re-experience the trauma

trauma, and he says, and the trauma keeps coming back, keeps revisiting them in the form of

nightmares and flashbacks. They keep reliving what happened back there. They cannot leave

it behind. And the trauma keeps coming back either as images or as behaviors. That's when

people behave again as if they are getting raped or getting assaulted, even though they

are not getting raped or getting assaulted. So what we defined, but people had seen that

before us, all the way back to well over 100 years, at the core of trauma is that you get stuck

And that event keeps coming back in terms of images, behaviors, and physical sensations

So that became at the core of our definition of PTSD. The second piece is that having been constantly bombarded with this horrifying stuff makes

you preoccupied with, how do I go on with my life? And so you work very hard on avoiding things that make you lose your senses

And so people avoid it and people suppress it. And people actually learn to not feel things in their bodies

And they stifle internal sensations, internal feelings. So that's the second piece is on the one side, it's this fight flight keeps going on

The other thing is you calm yourself down, you try to suppress yourself, you try not to feel

and so at the end, you don't feel very alive. And the third thing is that you continue to be hyperaroused

You just keep being bombarded, you keep overreacting to all kinds of things in general

That's the original definition of PTSD, and that is still the definition

as you find in the textbook still, But what we discovered is that the whole impact of trauma

is much larger and it also affects the way you feel about yourself, the way you feel about other people

the way you are able to notice yourself, the way you experience yourself

And it has a lot of self distortions and distortions of your body also

And then over time, we again, we discovered something because these things always have been noted before

the degree to which when you're traumatized, your body keeps mobilizing itself to fight

And that you have all kind of immunological abnormalities, you have endocrine abnormalities

and that really devastates your health, your physical health. At the long range, oftentimes the physical problems

are longer lasting than the mental problems. The other thing that we discovered

which is still an area of some controversy in the field, not for me, but for my colleagues who are in power

is that trauma affects the mind of the brain very differently depending on the age at which you are

So if something terrible happens to me right now, I have a whole well-developed brain

and my brain isn't really growing all that much anymore, so I'll get an imprint of the trauma

that is pretty much superimposed on a relatively well-functioning brain. If you're two, three, or four years old

your mind and your brain is growing. What various of my research friends have shown

is that trauma at different ages affects different ways of wiring the brain

and it gets very complex. And it's like my friend Marty Teicher

has really shown that trauma at age three changes the brain very differently than trauma at age five

and trauma at age 14, and that the brain keeps growing and evolving

And so different events have a different imprint of the brain. That's one aspect

And the other thing that is terribly important is not only what's happening to you

but what's happening to your environment. And by and large, as I said before

if you are really freaked out as a kid, and your parents are there for you

and they smile at you and say, I'll take care of it, don't worry about it, honey

I know what to do. Or you have a doctor who really knows what they're doing

who you can trust. you go like, okay, I can relax now

because even if I can't take care of it, other people can take care of it for me

One of the largest mitigating factors against getting traumatized is who is there for you

at that particular time. When you feel constantly threatened, of course, you don't trust anybody

but there is a reason to not trust people. The tradition in mental health is to dismiss people

the reality of people's lives. For example, it's only in the past few years

that people are beginning to talk about the impact of poverty or the impact of racism or the impact of unemployment

And people have sort of been labeling people, oh, there's something wrong with you, let me fix you

But mental health professionals have been very defective in helping people to really come to terms

with what actually has happened to them and what happening to them right now So a good amount of distrust is very well justified And very likely today if you a traumatized person you don go to a doctor and say

I was raped when I was four years old, and that's why I come to be treated

No, people come to be treated because today you blow up at your husband

And today, you cannot have a safe, satisfactory sexual relationship with your new partner

And that's why I'm coming into treatment, because the body automatically reacts to certain stimuli

And most people actually are barely aware or not aware at all that their reactions that

they're having right now are actually rooted in experiences they've had before

So if you go to a physician or a mental health practitioner who doesn't understand that

they're going to try to fix you with drugs or cognitive behavioral treatment to not do

these crazy things anymore. It usually doesn't work very well because you need to really develop a deep sense of

this is what happened to me, this is what I'm dealing with. And you need to really acknowledge like, oh my God, that was terrible what happened to

me and I need to take care of the wounds that I'm carrying inside of myself

This issue of self-compassion and really knowing that your reactions are understandable and

are rooted in you getting stuck in the past is a terribly important part of beginning

to recover from trauma. And as long as you ignore that, you're just a crazy person who has crazy reactions

The problem with trauma is that it starts off with something that happens to us or that's

done to us. But that's not where it stops, because it changes your brain

And from now, that event itself is over, but you continue to react to things as if you're

in danger. And your brain actually gets changed in a variety of different ways

And the problem then becomes that you are not able to engage or to learn or to see other

people's point of view or to coordinate your feelings with your thinking

And so yet it becomes an internal issue how the trauma continues to fester inside of you

in a variety of different sensations and perceptions. Yes, there is something wrong with you, but people don't come to see, oh, see me because

of what happened to them. People come to see me because they feel there is something really wrong with me

I cannot connect with my kids. I become angry with all my coworkers

Nobody can stand being around me because I am so reactive. Yes, trauma causes that there is something wrong with you

And my job as a psychiatrist and all the colleagues and students I have is to help you to feel

safe in your body and to feel like the trauma is over and that you don't continue to react

to all kind of things now as if somebody is trying to hit you or rape you

I think the most important thing to know is that there's a difference between trauma and stress

As I like to say to people, life sucks a good amount of the time

We all have jobs and situations that are really unpleasant. But the moment that the situation is over, it's over

You go on with your life. A trauma happens, and when it's over, your body continues to relive it

And the core issue is that your body does it. Your endocrine system, your neurohormonal system, your immunological system continues

to react as if you're back there. So there is something about the development of the mind that gets stopped at that point

Because the trauma cannot be integrated as, oh yeah, that really sucked

But it's over now. Trauma makes you think that it's still happening right now

So the big challenge of treating trauma is how do we help people to live in bodies that feel fundamentally safe

Where something unpleasant happens to you, you don't react as if you're like, it's in danger

But you go like, oh, how do I solve this? But when you're traumatized, what's very striking in a whole variety of different brain studies

what you show is that when you show a non-traumatized person something ambiguous and difficult

their cognitive brain tries to figure out what's going on. When you show this same stimulus to people who are traumatized, the emotional brain reacts like

is this dangerous or is this safe? Your brain goes into, is my life in danger

And that's an emotional reaction. What lights up in the brain is a very different part of the brain

but then when you have to solve a problem. So you're continuously trying to manage your emotional reactions

Chapter 2. Shaping Childhood Trauma. People have always noticed that people relive their trauma

But as I said before, usually people are not aware of it

Kids are not aware of that they're reliving their having been beaten

or witnessing domestic violence, and when they go to school, they react in a very angry

and defiant way with their teachers. Say, oh, this reminds me about my mom and dad fighting, making me scared

Now, they have an automatic reaction to adults who sound in any way not okay to blow up and

become very frightened. So they don't make the connection. So what happened when we created this diagnosis of PTSD, we weren't very perceptive

We're just beginning to see something for the first time. And the most obvious thing in which people relive the trauma is in nightmares

In nightmares, people see it again, or they experience the event in their dreams

That is the most obvious, and we could see it. It took us a long time to realize that people also continue to reenact the trauma in their relationships

That they may relate to their kid the same way they related to people who hurt them as

little children. And so they don't make that connection. But what allows you to make the connection is when you actually have images of what happened

back there. But most people don't have visual images. Most people have sensory reactions

They suddenly feel uptight. They feel nervous, panicky, anxious, enraged. They don't know where it comes from

After they read books like mine, they know at least where it comes from. some part of your brain that you actually cannot really know because it's beyond cognition

So, oh, that's why I'm doing that stuff. That's sort of helpful to know

But most people who are reenacting or replaying the trauma are not aware that they're recreating

or replaying the trauma. So trauma affects the developing brain different from a well-developed brain

The research is really very interesting and intriguing about this, and that's the degree

to which parents hold and modulate kids' traumatic responses. As I said before, when as a kid you get bitten by a dog, it's really very scary and very nasty

But if your parents pick you up and say, oh, I'm so sorry, let's go and take care of it

and we'll give you some extra special food, that dog bite doesn't become a big issue

because the foundation of your safety has not been destroyed. A study I like to quote actually

and teach people about, is a study that was done in London

right after the Second World War. Because London was being bombed by the Nazis

The Brits decided, let's send the kids in London who were being bombed out to the bucolic English countryside

to live with very nice people. And when the war is over, they'll come back

and they won't have seen all these dead people and dead corpses and all the bombing

They'd be much better off. And so after the war, Anna Freud, of all people

Sigmund Forrest's daughter, and her friend Dorothy Burlingame, did a study of what happened to these kids

It turned out that the kids who stayed in London with their parents did just fine

because the safety of kids is determined by how safe they feel with their parents

Well, the kids who went to the countryside, like Oliver Sacks, who some of your listeners

may also be a great fan of, like I am, he was shipped to the countryside

and in his autobiography, Oliver Sacks writes, one of the two most traumatic events in my life

was being shipped off to the countryside, and I was a really scared and upset kid

who was primarily preoccupied with the, that my parents are still alive

but I didn't see them anymore. What trauma also has really taught us

is the degree to which we are profoundly interconnected and interdependent people

and we are relational creatures. And as long as our relationships are intact, by and large, we're pretty good with trauma

Who knows that? The U.S. Marine Corps and the Armed Services, they take a bunch of people who are obviously

who sometimes escape their own horrible childhood environments and join the military

and they go into the military. And what does the military do for them

They create a sense of cohesion, a sense of predictability, a sense of safety

And so through all these exercises that you do in the army

you feel very connected with your group. And when you go to war with your group

you feel very safe that your body is there to protect you

and that really protects you against getting traumatized. And the very first study I did

before we knew anything about trauma, was the discovery that the PTSD started for many

soldiers when they saw their best friend being blown up, because they really had a sense

of safety and cohesion, because they had a friend, but then that friend got killed, the

whole world collapsed, and they no longer had the safety that came with the group

And so what you see with many traumatized people is that they continue to really pull

towards reconnecting with people who have had similar experiences because when you say

I was raped and I was raped too, you go like, you know what I'm talking about

You're special. I can be safe with you as opposed to all these people who have no idea what I'm talking about

The lingering effect of childhood trauma is that you continue to react to mild stressors

as if your life is in danger. You tend to become hyper reactive

People see your reactions as exaggerated. Somebody may irritate you in the supermarket

and may yell at this person. You may develop road rage. You may have a difficult time putting up

with misbehavior from your spouse or your kids. And you have exaggerated emotional responses

The other thing is, it oftentimes is very hard to negotiate intimate relationships

Negotiating both of our needs, your needs and my needs actually, is a very complex phenomenon

How do we make compromises? How do we make both of us happy at the same time

When you have a childhood trauma, that oftentimes becomes very difficult. Very difficult to say, okay, honey

if that's what you need, I wouldn't want to do that, but I'm fine with you

if you do that, and these issues of boundaries, and who's responsible for what

is, becomes a very hard thing to negotiate oftentimes. The big question for me continues to be

how do you help kids in particular, who have been exposed to enormous amount of violence

life threats, people who don't pay attention to them, how do you help these kids get a sense of self

a sense of agency so they can actually make a life for themselves where they can learn

acquire skills, acquire competencies so they become full-fledged human beings. What the data show is that the long-term effects of child abuse and neglect, which is rampant

in our country, is the biggest public health issue in America. Let me give you an example

There are other societies that are much more trauma-savvy than we are

where there is not an enormous amount of income inequality, where parents actually are helped to take care of their kids

where health care is universal, where child care is universal. One of these places is Holland, which

happens to be my native country, which I left when I was 18 years old, and which has become a very nice place

So in a culture like that, that really looks at what are the antecedents for getting people

to be dysfunctional. They do all these things to help people to take care of their kids

And so in the Netherlands right now, the incarceration rate is 58 per 100,000 people

In the US, it's 950 per 100,000 people. So the big issue is a political issue

How do we rearrange our society to really know about trauma and to really do all the things that are necessary

so that people who grow up under extreme adverse conditions can develop a brain and a mind that can help them

to become full-fledged members of society instead of on the edge as drug addicts and disabled people

or people who need to go to jail. That's our big issue, and that's the big challenge that we have

Chapter 3, how to treat trauma. I was raised in the mainstream culture as a professor, prestigious institutions

And what's mainstream culture? The culture we live in is that when you feel bad, you take a swig of alcohol

Or you take a swig of something to make that feeling go away. I call our medical culture right now a post-alcoholic culture where if you feel bad, you take something to make that feeling go away

And it turned out that taking something didn't make the feelings go away

but wriggling your fingers in front of people eyes as you think about the trauma made the trauma go away And I go like wow this is really interesting When I first got to see trauma and got intrigued with it

I looked at the treatments that we have. And so I did the first study on Prozac for PTSD

the first study for Zoloft for PTSD, and a number of other conventional drugs

What we found is that it didn't work very well. And we published those data in prestigious medical journals

And people said, boy, Van der Kolk is a great psychopharmacology researcher

But our results showed that they don't work very well. Somehow, psychiatry never got the message that said

no, drugs are not particularly helpful. And the VA still spends billions of dollars on drugs that don't work

They were unable to go through a trajectory that I and most of my colleagues went through

like, okay, if it doesn't work, let's do, see what else can work

People always ask me, how can you put up with all this misery that you hear

And I agree, it's not easy. But one of the things that helps you is to really understand that people do the best they can

That somebody who is enraged in response to a minor thing is not becoming enraged because they just are unpleasant, difficult people who don't try

No, they try. People try to survive. Every person tries to have the best possible life they can have

And sometimes it goes really wrong. But for example, when you're a little kid and you don't feel like anybody's there to

help you when you become distressed, you may learn that banging your head against the wall

or stabbing yourself, or burning yourself, or starving yourself may make you feel better

And so what you discover is that people do all kinds of things that seem pretty weird

sometimes on the surface to protect themselves. There was a moment in sort of the history of our field that was particularly poignant

in this regard. Vince Felletti, who is the internist who did the ACE study, the Adverse Childhood Experiences

study, had a very important experience that he shared with all of us, which makes perfect

sense to me. He had a weight loss program, and that's all he did. He was very proud of his weight loss program

And then one day, a woman came to his office who had lost something like 150 pounds or

something in the course of the weight loss program. And she came back three months later, and she had regained almost all of her weight

He said, I didn't know people could gain so much weight in such a short period

What happened to you? And she says, you know, Dr. Fellaini, your weight loss program was terrific

And I became svelte, and people's reaction to me completely changed. So after my last visit to you, when you complimented me about how well I was doing, I went back

to my office and one of my co-workers said, boy, you look really hot

Would you like to go on a date tonight? And the moment he said that, I started to eat

And I haven't stopped eating because what I realized is overweight is overlooked

And the way I dealt with my childhood sexual abuse is to make myself grossly obese so nobody

would have an interest in me in a sexual way. So that was one of these openings

You get to see that some of the behaviors that we may condemn or be upset about actually

are behaviors that start off trying to take care of yourself. That actually is also true for drug abuse

People say, it's a biological illness, but it's not so simple. But if I say to you right now, oh, I have a little needle with some heroin in it

you feel good, would you like to try it?" You'd say, you're crazy. I'm not going to take heroin

But if you are in despair and you don't know if you're going to make it through the night

and I say, I have a little drug here that can help you make it through the night, you're like

please, please give it to me. That's where drug addiction comes from. That's also to a large degree

where opioid epidemic comes from. It's also the stuff being made available to people. But, you know

Now, among my colleagues who have privileged lives, they don't become drug addicts because

they have good lives. They don't need to cure something in terms of how upset they are

But since time immemorial, people take drugs in order to deal with unbearable sensations

The military had a huge drug problem during the Vietnam War because people take these

drugs in order not to feel their pain. If we really want to take care of drug abuse

we really have to look at social situations and circumstances that make people feel desperate

and hopeless. Very good psychotherapy, not to fix people, but helping people to know what they're feeling

find ways in which to cope with those feelings was really quite helpful

But it's very clear is that being in a relationship where people can hear you

where you can talk about how badly you feel, where you can talk about your guilt

and where you can start opening up where these feelings come from

how old these feelings are, and how you develop these feelings in response to particular things that happened to you

that was actually quite helpful. Finding words for your internal experience, which is oftentimes very difficult for traumatized people

They actually have impairment of being able to know themselves, being able to discover who they are

and how they got these reactions is very helpful. And then for me, the opening to a new world came

when some people in my clinic started to do something very strange, something called EMDR

Eye movement desensitization and reprocessing. A technique where you ask people to call up the memory

of what you saw back then, what you heard back then, what you felt back then

but you don't ask people to talk about it. Because the moment you start talking about something

you get more preoccupied whether the person you're talking to understands you, likes you, is disgusted with you

So it becomes an interpersonal process. This, you ask people to just feel it and notice it

And then what you do is that you ask people to follow your fingers as you move your fingers

from side to side in front of their eyes. And my first reaction with my students

and junior colleagues who do it is like, man, stop this crazy nonsense

This is a crazy method. And then I got to see some of the results

I go like, wow, this is interesting. This is different. And so I did a study funded by NIH

funded because people saw me as a very good psychopharmacologist, not a guy who had gone off the deep end

doing crazy methods like EMDR. And everybody expected that we'd find that the drugs are much better than EMDR

And what we found is that this crazy eye movement decentralization had amazing effects on people being able to let go of what happened Say say yes that what happened to me and it happened a long time ago

It's not happening right now. That was the first time that I saw a non-conventional technique have a very profound effect

And that really had a very deep effect on my thinking about treatment of trauma

And of course, my colleague said, PESOL has gone off the deep end

And the data on EMDR was still better than any data of the treatment outcome that anybody

had studied. But people didn't want to go there because it's such a crazy method

So I tried to get money to study what those eye movements do to the brain

It took us about 15 years to collect money from other sources to finally do that study

where we were able to show that you move your eyes from side to side, that you actually

We change brain circuits that changes the executive function of the brain, the default

mode network of the brain, and the salience network of the brain

So what we discovered with all the other things that happened in neuroscience is that this

strange eye movement that sounds so bizarre actually changed the circuitry of the brain

to interpret your current reality from a different angle. What I discovered at this point is that our conventional way of thinking about it is not

working, but strange stuff works. And then a bunch of yoga teachers come to talk to me and say, we do yoga for PTSD and

seems to help people. And that made sense to me on some level

Maybe if you do yoga, yoga can open up your relationship to your body, to your physical self

how to breathe calmly, you learn to pay attention to yourself, you get to see how different movements

and different postures affect you. And so you form a deep relationship

to your internal sensory system. Trauma is carried in the sensations of your body

in heartbreak and gut wrench. And that you have been able to see in the brain

is that your connection with your body becomes weaker and weaker so you don't feel your body anymore

so you don't feel your pain anymore. The problem is that if you don't feel your pain anymore, you don't feel your pleasure

anymore either. I was reading an extraordinary case report of somebody who lost all sensations in their

skin, in their bodies. And it's a very, very rare thing to happen to people

And what people discovered is if you cannot have a sensation in your skin, you cannot

have a sensation of pleasure. An association of pleasure is carried by the corpuscles in our skin

So we need to get pleasurable sensations coming from our body to get a sense of pleasure and joy

And that was really interesting to me also because traumatized people, and that's left

out of the definition, have a tremendous problem experiencing pleasure and joy

I applied a number of times to study that. And at the end, we did get funded to do the very first yoga study for PTSD

And what turned out is that the way the data looked to me, yoga at the end was a more effective

treatment for PTSD than any of the drugs we had studied. And we did a number of yoga studies

We published them in respected medical journals. But I've yet to see a psychopharmacology clinic being transformed into a yoga studio

So even though it's pretty clear that needing to feel safe in your body and to own your body

and to feel all the sensations in your body is a critical aspect of healing from PTSD

The next thing that we studied was theater and movement. And it turns out that playing different roles in your body helps you to feel that your body

can feel differently depending on how you organize your relationship to yourself

So I live in the Berkshires, and we have a great program here called Shakespeare in the

Courts, where if you're a juvenile delinquent in this country, you have a 50% chance that

the judge will condemn you to become a Shakespearean actor. That's civilization

And the Shakespeare program is enormously helpful because it helps people to feel their

bodies, and to feel what it feels like to be a king, and to feel like to be a warrior

and to feel what it feels like to feel you. And you get to really have a deep experience of yourself in different possibilities

We learned that you can actually put electrodes on your skull, and you can harvest your brain

waves and project them on a computer screen, and then you can program the computer screen

So that when you make brainwaves that help you to be calm and focused, the computer game

is working. And if your brain makes waves that don't do that, there's no computer game

So your brain wants to play the computer game. But the moment you develop brainwaves that are not helpful to you, the screen goes blank

So your brain sort of wants to do the right thing. And you can actually train people to make the right brainwaves

And that's another piece of research that I feel very proud of, because it's very hard

to find funding for it. But we really showed that we can change people's brain and brain connections by playing computer

brains, games with your own brain, which is another important project that I'm working

on and trying to implement in various communities. And also, I did a study of foster care children who are extremely out of control kids, who

who have no prognosis to probably ever function very well because they're just too disorganized and too hurt

And we did very well with Neurofeedback to help them to calm their brains down

and to learn and to be in classrooms and to have friends

So there's all these things that at this point are still called alternatives, that unless we go there

our patients continue to get stuck on not getting better. You have to keep looking

About 15 years ago, two guys came to talk to me, Rick Doblin and Michael Mithoffer

and they said, Bessel, you know a lot about trauma. What do you think about this idea

We are thinking about psychedelics. What do you think about psychedelics for trauma

And I go like, wow, that you're speaking from my heart. Because, of course, I'm a child of the 60s

And like everybody else who I know who grew up with me, we dabbled in LSD and psychedelic substances

I have a number of friends who are very well-known scientists actually, and I have asked all of

my friends, did you top acid as a college student also? And everyone of my friends said, sure did

And I said, so how do you think it has affected your career

And everyone of my friends says, you know, I think I've become the creative scientist

that I am because I took these substances because it allowed me to see that the reality that I was raised in the reality that I see is a very small part of the overall reality that I is

Those sort of answers make me feel very curious because one thing that all of us who know

about trauma know is that when you get traumatized, you start living in a very narrow reality

The reality of the war in Iraq, the reality of your incest, that colors everything you do

And so you become intellectually and emotionally quite a constricted person because you are

always afraid to get hurt and you still feel like I'm about to get hurt again

So that becomes your world. I said to them, wouldn't it be great if we could do psychedelic substances to see if

these substances can open up people's minds and to see that the reality that they live

in is just a small part of the reality that there is

And then I said, don't do it. You're crazy. These drugs are illegal

I knew a whole bunch of people who did LSD and psilocybin research back when I was young

It helps me around a little bit because I saw that revolution back then

I had Timothy Leary's office at Harvard for a period of time

I know what happened to all these guys. I said to Rick and Michael, don't do it

It will destroy your career. You'll never get permission. And they said, thank you very much for your opinion

We'll try it anyway. And they tried anyway. And through great challenges and lawsuits, et cetera

they got permission to do a study of MDMA for trauma. And it worked out pretty well

And they got permission to do a second study again. Very hard to do. And they did very well

And then, Rick Doblin was able to collect a large amount of money, largely from Silicon

Valley people, to do a very large and extremely expensive study of MDMA, also known as Ecstasy

or MOLLE. When that happened, they asked me if I wanted to be the principal investigator of one of

the sites, the sites in Boston. And I said, boy, I admire you so much for having been able to get the study of the ground

I would love to see what it does. But the main reason why I want to be involved in the study

is to warn people not to get carried away because last time people got carried away

and the whole world collapsed. And this time we need to be extremely careful

so that if we find something, we do it very carefully and we don't get the backlash

We did the study. Lots of different sites around the US, one in Israel, one in Canada

We saw remarkable results. The paper was published in Nature Medicine, a very prestigious medical journal, that shows

that the MDMA causes a very, very substantial drop in PTSD, probably more than just about

anything else we have studied. Although I'm not 100% sure of that, but very dramatic

And then what comes up for me is, yeah, the PTSD score is interesting, but what we see

in the people we work with is much more profound than just PTSD

So let me tell you how the study is set up. People apply to be in the study

It's a very tough study to be in. It takes about nine months to do it

You come in, you get tested up the zoo, you go off all your medications, you do a lot

of tests, you have a number of preparatory sessions, and then finally, after all the

preparation, you have a whole day of taking ecstasy while you lie on the bed in the eye

shade with two therapists in your room for eight hours and then stuff happens, which

I'll talk about in a second. You sort of calm down from the experience, you stay overnight

The next day we interview people again, we interview people several times in between

You have your next experience a month later, a number of sessions in between, and you have

your next experience again. It's not surprising that our control group, where people get an inactive substance, also

do very well because people get very intensive psychotherapy alongside the drug

So half people get a drug, half people don't get a drug. But what we see in the people who get the drug is amazing

What we see is that people are able to go to places they have never felt safe to go to

This is not a picnic. People go and see their rape. They see their molestation, they see the horrible things that happened to them

But what MDMA does, it allows people to see themselves with compassion

And rather than blaming themselves or getting freaked out, they go like, oh yeah, that's

what happened to me back then. It was horrible. But what we see is a profound transformation of the personality, not just PTSD

And so I was very lucky that the organization asked me to yze what's called the secondary

data, which I'm doing right now. And the secondary data are, wow, they're just mana for my soul

Because it brings the mind back into psychiatry. After people take MDMA, they're able to talk about themselves

They're able to have compassion for themselves. much better able to say, this is what's going on with me

So all these measures we have about self perception and self awareness just shoot up and people become owners of their own lives

And they're able to say, yes, this is what happened to me, but it's over

And then we look at the whole issue of executive functioning, being able to make plans, being able to attune to other people

Being able to feel alive, big changes. People come to life. And when people are in difficult relationships

they say, honey, that's your problem. That's not my problem. And people sometimes leave abusive relationship

and they say, I don't need this abusive relationship. I'm okay. I can take care of myself

And you see very profound existential transformations in people. And I think that's really at the end holds the promise

that people can leave the trauma behind and not say I'm a veteran who still screwed up

Yes, I was a veteran back then, I was 18 years old, but today I'm 23 years old or 48 years old or 60

and I'm a plumber and an artrician, movie maker, whatever. And that's part of my experience

but it doesn't define who I am anymore. It's remarkable. so

let's go

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