On page 350—the epilogue—of his simultaneously heartbreaking and optimism-fueled book, The Body Keeps the Score, author, psychiatrist and trauma expert Bessel van der Kolk finally says it:
“Trauma breeds further trauma; hurt people hurt other people.”
This short sentence sums up the compounding effect of a phenomenon he painstakingly unpacks for us over the preceding 349 pages of the book.
For 40 years, van der Kolk has been a kind of Don Quixote, jousting at the windmills of ignorance and interpersonal tragedy at the forefront of research for mental health, which he views insistently as a holistic, whole-body, whole-mind, whole-community scourge—one whose prevalence is as tragic as it is misunderstood.
Trauma by the Numbers
From Page One of the book, the numbers he shares starkly frame the issue.
According to research published by the CDC and Kaiser Permanente as the Adverse Childhood Experiences (ACE) study — the largest-ever of its kind, involving 50,000 patients:
“One in five Americans was sexually molested as a child; one in four was [repeatedly, physically] beaten by a parent to the point of a mark being left on their body; one in three couples engages in physical violence; and one out of eight witnessed their mother being beaten or hit.”
It goes on.
More than half the people who seek psychiatric care have been assaulted, abandoned, neglected, raped and/or witnessed violence in their families, as children.
Furthermore, most morbidly obese patients covered in the ACE study were sexually abused, as children.
And fully 81 percent of patients diagnosed with borderline personality disorder by Cambridge Hospital report severe histories of child abuse and/or neglect.
All of these horrific statistics (and others) make some perverse sense of the fact that one in ten Americans now takes antidepressants, and that prescription painkillers now kill more Americans each year than gun violence or car accidents.
ACE points to child abuse and neglect as the most common causes of drug and alcohol abuse, as well as a significant contributor to the ten leading causes of death in the United States, including diabetes, heart disease, stroke and suicide, and doubling the chances that one will suffer from cancer.
In fact, in appraising ACE’s findings, one of its principal researchers, Robert Anda, realized his group had unintentionally discovered that child abuse is—in his own words—the gravest and most costly public health issue in the United States.
As van der Kolk writes:
“He had calculated that its overall costs exceeded those of cancer or heart disease [the two greatest causes of U.S. deaths], and that eradicating child abuse in America would reduce the overall rate of depression by more than half, alcoholism by two-thirds, and suicide, IV drug use, and domestic violence by three-quarters.”
Trauma research brightly outlines a key aspect of our increasingly sophisticated picture of mental health: that our bodies, minds and communities are inextricably linked partners in healing…
…or in illness.
Big Pharma, Capitalism and Politics: Bedfellows
And yet: the ACE study didn’t result in policy change at the government level due to the fact that, as van der Kolk writes wryly, “mainstream medicine is firmly committed to a better life through chemistry,” supported by lobby-friendly subsidies, where high doses of psychotropic agents (aka drugs) are proffered in “assembly-line offices where doctors see patients they hardly know for 15 minutes and then dole out pills to relieve pain, anxiety or depression.” And yet: “…antidepressant use has not made a dent in hospital admissions for depression. The number of people treated… has tripled over the past two decades.”
He goes on to explain the prime reason for the increase: that treatment is largely informed by what insurance companies are willing to pay for, and by extension how medical practitioners earn a living, which in turn perversely informs diagnosis, as it is spelled out in the Diagnostic and Statistical Manual of Mental Disorders (more on this below).
Thus, as van der Kolk rattles off: mood swings lead to a bipolar diagnosis, and lithium or valproate; despair leads to a depression diagnosis, thence antidepressants; restlessness to ADHD and Ritalin, or other stimulants; and trauma to PTSD and SSRIs like Zoloft or Prozac—all of which he says are “completely off the mark, and none of them will begin to meaningfully describe who these patients are, and what they suffer from.”
All they do is numb us, and allow us the mercy of wading through the fog of our daily lives.
It’s not just children. Over the past decade, the Department of Defense and Veterans Affairs have spent $4.5 billion on antidepressants, antipsychotics and anti-anxiety drugs, which are now taken by a whopping 20 percent of our 1.1 million active duty troops. In fact, Major Depressive Disorder (or MDD) now ranks as the third leading global disorder, and costs the U.S. in particular some $210 billion, annually.
All to blunt the symptoms of our true illness.
A Social Problem
In appraising the underlying causes of trauma, the proverbial light bulb went off for me while reading about Stephen Porges’ Polyvagal Theory. In brief, it posits that social relationships are the primary cause of trauma, because as an inherently social species, our very survival depends (and has always depended) on them. The theory is named for our vagus nerve, which in addition to controlling mood, digestion, heart rate, reflexes and cardiovascular function, also controls our parasympathetic—i.e.: resting—nervous system, which regulates our feelings of safety, and sends the mind and body into action whenever we feel threatened.
When confronted with a threat, the first thing the vagus nerve apparently stimulates is our uniquely human prefrontal cortex, by telling it to look for social engagement in the form of help, support or comfort. It’s only when we don’t receive these things that the less evolved limbic system we share with other mammals kicks into gear, preparing us for fight or flight. And finally, when we can neither escape nor vanquish our perceived threats, our ultra-primitive lizard brain (aka brain stem) preserves our mind by shutting it down, which is precisely what happens to countless trauma victims who receive no succor from other humans, and who can’t fight off or escape those who threaten us.
Tragically, this is true of no group more than young children.
It makes total sense. The younger we are, the less agency we have to escape those who then end up causing us the greatest—often life-long—harm of all: our caretakers. [Remember the statistics I shared about childhood sexual and physical abuse?] Denied social safety and unable to escape largely due to age, psychological immaturity and the legal structures that favor binding us to even abusive or negligent caretakers, too many of us have no path but to shut down.
Regrettably, too many of us also never manage to reconnect with our pre-traumatic wholeness.
Van der Kolk puts it tersely:
“Social support is a biological necessity, not an option, and this reality should be the backbone of all prevention and treatment.”
Note the word “prevention.”
Psychologist Diana Fosha agrees:
“The roots of resilience are to be found in the sense of being understood by and existing in the mind and heart of a loving, attuned and self-possessed other.”
And as I’ve written before at length, I believe the three fundamental drivers of all human activity are love, belonging and purpose, none of which can be removed without robbing us of a core need. What I didn’t realize at the time I stumbled across this triad of forces is that all of them are social in nature: giving and receiving love, finding acceptance and belonging among others, and discovering then aiming our life purpose within the context of our communities, while we have the capacity to act in the world.
In his book, van der Kolk points to common, largely unconscious destructive acts to underscore the primacy of our social nature. He writes:
“People who cannot connect through work, friendships, or family usually find other ways of bonding, as though illness, lawsuits, or family feuds. Anything is preferable to that godforsaken sense of irrelevance and alienation.”
Healing Pathways
Richard Schwartz, Ph.D.—the creator of the Internal Family Systems (IFS) approach to healing—offers a ray of hope for the traumatized. IFS posits that there are “many selves”—aspects of our personality—that emerge within us over a lifetime of experience to protect the esssential [or true] self from harm, including “managers” who help us avoid unpleasant people and thoughts; “firefighters” who respond to emergencies to protect us when we fall; and “exiles” that consist of damaged narrative aspects of self that the other selves will do anything to prevent from being triggered (hence their exile).
In Schwartz’s own words:
“Usually [the “exiles”] are your most sensitive, creative, intimacy-loving, lively, playful and innocent parts. By exiling them when they get hurt, they suffer a double whammy — the insult of your rejection is added to their original injury [aka trauma].”
In appraisal of Schwartz’s work, van der Kolk points to the means out of exile:
“Beneath the surface of the protective parts of trauma survivors there exists and undamaged essence, a Self that is confident, curious, and calm, a Self that has been sheltered from destruction by the various protectors that have emerged in their efforts to ensure survival. Once those protectors trust that it is safe to separate, the Self will spontaneously emerge, and the parts can be enlisted in the healing process.”
In other words, we have the capacity to heal ourselves, because we carry within us a pure kernel of luminous self that has been protected from—and precedes—our trauma(s).
In practice, IFS has returned countless people to health. And yet, as effective as it’s proven to be, IFS is far from the only consequential healing practice practitioners have uncovered. In his book, van der Kolk devotes chapters to a number of far-ranging and empirically transformative therapies, all of which aim to restore a form of self-leadership—the ultimate goal of healing trauma. They include, in brief:
- EMDR, which appears to stimulate a REM-like dream state, during which all humans process new learnings, and consolidate them as memories;
- Yoga, which for thousands of years has physically stimulated the vagus nerve, 80 percent of which is afferent (that is, it runs from body to brain, not vice versa), thus allowing us to retrain our arousal [trauma] systems;
- Role-playing “Structures”, an invented word for theater of sorts that creates human agency by allowing participants to rewrite past narratives through re-enacting traumas with others, thereby crafting empowering alternative scripts to embodied experience;
- Meditation, which among countless other benefits, increases our interoception—or self-awareness—beneath the level of conscious thought; and similarly,
- Psychedelic therapies and Neurofeedback, both of which engender “twilight states”, during which theta waves bridge between external and internal worlds, safely allowing us to re-experience trauma through the lens of new associations—or insights.
There are others.
But beyond these amazing-if-largely-fringe advances in the mainstream treatment of trauma, our ultimate goal should be to reduce its underlying causes.
Final Thoughts
The quote with which I began this article bears repeating:
“Trauma breeds further trauma; hurt people hurt other people.”
Seen through that lens, the world’s interpersonal woes, primary among them war, violence, persecution, mistrust, psychological abuse, exploitation, neglect and the psychological suffering—aka trauma—that each of them inflicts upon its victims, are mostly if not exclusively caused by people who themselves were victims of prior trauma.
Trauma is a very vicious cycle—one that goes by many names, such as “kick the cat”, “displaced aggression”, “scapegoating”, “whipping boy”, “fall guy”, “xenophobia” and even “road rage”.
Van der Kolk, who in addition to decades of research has continuously run a private psychiatry practice specifically to treat victims of trauma, adds: “Most bullies themselves have been bullied, and they despise kids who remind them of their own vulnerability.”
While most of the statistics shared in van der Kolk’s book are American [he was born and raised in the Netherlands], and one could argue that the socio-political-capitalist system in the U.S. promotes (or tolerates) an extreme version of suffering, human biology is universal, including the way we record and interpret experience. Thus trauma is not an exclusively American phenomenon.
How, then, do we re-establish agency in the face of trauma, experienced?
Van der Kolk warns us against an over-reliance on clinical diagnosis and medication, citing “serious consequences”.
“Diagnosis informs treatment, and getting the wrong treatment can have disastrous effects. Also, a diagnostic label is likely to attach to people for the rest of their lives and have a profound influence on how they define themselves.”
He adds that the National Institutes of Mental Health—America’s lead federal research body on mental disorders—is finally “re-orienting its research away from DSM categories”. This is critical because as the authoritative global source of diagnosis and treatment, the Diagnostic And Statistical Manual Of Mental Disorders has hitherto resisted integrating mind, body, and social context into a holistic understanding of mental illness and treatment.
In other words, we are finally awakening to a richer understanding of what causes trauma in the first place, and how to not only heal it through practices like those outlined above, but to further prevent it from taking root, not the least of which is accomplished by healing our social connections, rather than simply masking expressions of trauma with numbing pharmaceuticals.
As van der Kolk warns:
“Being a patient, rather than a participant in one’s healing process, separates suffering people from their community and alienates them from an inner sense of self.”
I have written before about the real butterfly effect, insofar as our actions have immeasurable impacts on others. In it, I focused on our positive capacity to engender beauty in the world, with gestures as simple as a smile or a kind word. The underlying point is simple: all the energy we put into social life matters.
To turn van der Kolk’s observation on its ear: healing breeds healing; whole people help other people.
I read long ago somewhere that we are the sum of the five people with whom we spend the most time. Certainly, at the outset of our lives, those individuals are the biological or representative families in which we are raised. Later on, we seek what is familiar, in the form of people who reinforce the narratives our early experiences set for us—healthy or otherwise.
When we befriend people from whom we feel we can learn and thrive, and who support us, especially our emotional needs, we predispose ourselves toward healing outcomes.
It’s plausible that whether or not we are aware of it or admit as much, most of us have experienced trauma in some form and to varying degree. No one escapes life unscathed. The question is: how much agency do we feel is in our possession to take the reins of our own healing?
This is what is meant by self-leadership.
We all recognize those who exhibit this “teflon” quality when we encounter them: people who seem internally lit, or unperturbed by all the psychological illness around them, such as anger, selfishness, fear, or malicious acts. The Dalai Lama comes to mind, as an extreme example.
In fact, he has articulated his perspective quite clearly: “If you want others to be happy, practice compassion. If you want to be happy, practice compassion.”
Compassion is social currency.
Negative feelings and acts are all illnesses—departures from our foundational state: the “undamaged essence, a Self that is confident, curious, and calm, a Self that has been sheltered from destruction” that Robert Schwartz identified in his psychiatric work.
The core of our being is love. In fact, love is the only true thing. I wrote about the concept over two years ago, and everything I have experienced since has only reinforced that belief.
If this is true, then, how do we “come home”, both within ourselves and in the company of others? Here, the great Persian poet Rumi has sound advice:
“This being human is a guest house. Every morning is a new arrival. A joy, a depression, a meanness, some momentary awareness comes as an unexpected visitor… Welcome and entertain them all. Treat each guest honorably. The dark thought, the shame, the malice, meet them at the door laughing, and invite them in. Be grateful for whoever comes, because each has been sent as a guide from beyond.”
Or, if you prefer everyone’s favorite pacifist, Mahatma Gandhi:
“If we could change ourselves, the tendencies in the world would also change.”
The root to healing trauma in the world is to heal the self rather than numb it. This is our prime weapon against inflicting cyclical pain upon others, and equally, from rejecting them for whatever trauma they have endured, and passed on, in their cries for help.
Sometimes those cries destroys worlds.
And as we all know, destructive acts are as ubiquitous as the traumas that have caused them.
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This post was previously published on medium.com.
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Photo credit: bill wegener on Unsplash
