#787 - Bessel van der Kolk - The Surprising Solutions To Heal Trauma Without Medication 01:09:40

Hello friends, welcome back to the show. My guest today is Bessel van der Kolk. He's a psychiatrist, researcher, and an author. Trauma is often discussed as a mental and psychological issue, but what if it affects more than just the mind? What does it mean if your body is holding on to trauma, and how might these memories manifest outside of our brains? Explain.

Expect to learn what is meant by the body keeping the score, what is wrong with the traditional way that we talk about trauma, how you can learn to be more self-compassionate, how trauma manifests and masks itself as illnesses, the best therapies and modalities for understanding and releasing trauma, and much more. Trauma...

is a bit of a weird word for me, actually. I've sat in many a sauna in Austin and heard people talking about their ancestral trauma and dealing with past wounds and stuff, and it kind of gave me a bit of an ick. And yet, the more that I have looked at it, the more I've become open-minded to the psychological injuries that we all go through. Often before we're even able to remember them or verbalize them, and the importance of making ourselves feel safe and secure and

and emotionally robust. And Bessel's work is really fantastic. I love that he takes a sort of holistic, integrated approach. He is not trying to throw drugs at the problem. He is trying to do it from a much more careful, integrated modality. And yeah, he's a fascinating guy. I mean, he's broken the internet. The Body Keeps the Score, this book, absolutely broke the internet. And there's so much to take away from today. So I really, really hope that you enjoy this one.

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Let's say that someone has never been exposed to your ideas in The Body Keeps the Score. How do you introduce your thesis? How do I introduce my things? I usually show movies, Hollywood movies.

Because, you know, when you make a movie, you have to show it correctly. When you see somebody getting stuck and somebody being

Traumatized like scenes from the Hurt Locker or other movies about veterans coming home or about kids who have been molested. Usually movies capture it pretty well. You can really see how the way that people move and people hold their bodies and how people's bodies react to the world around them is very visible actually. Right, so you're trying to demonstrate an outward exposure

in terms of how the body looks, of an internal emotional state. Yeah, it should be how we can beat each other. We look at each other and hopefully you look pretty calm and when I see you getting upset or something, I'll go, oh, I'm saying something is upsetting him. And so we give signals to each other. And of course, as a body-oriented therapist, you get pretty good in beating bodily signals. So that...

Everybody understands they see someone that stands in a particular way, has a facial expression in a particular way, is holding themself. That doesn't sound that surprising. If that's the case, why is the traditional way that we try to think about trauma wrong? What does the traditional paradigm get wrong? It is interesting indeed that it's so obvious. And I actually have gotten...

My bookstores sold 5 million copies. I've hardly had any blowback of people saying that I'm getting it wrong. I mean, it's really obvious. But we come from a world of medicine where we try to define things very carefully. Medicine, of course, is a very disembodied profession. We deal with the body, but we really don't know about the body. And psychology is about the minds and how people think.

and about their behavior. But psychology has also traditionally been a very disembodied profession. And the people who, to my mind, really get it are theater directors, teachers, yoga instructors, martial arts people, musicians, because in the real world, you really get to see how bodies really move together through the world.

What is the difference between trauma and stress, then? Stress is what it's like to be human. We're wired for stress. We're wired to rise to the occasion. We're wired to have hard days and broken relationships. And, you know, life is rough for us.

actually all of us in one form or another, but when that stress is over, you can like, wow, I'm feeling better now. And the issue with trauma is that trauma is an assault on one's being that really changes the way you feel, experience yourself, how you experience the world around you. And so trauma really changes the way you move through the world and who you are.

So stress is a temporary thing. We have great biology of stress and there's basically nothing wrong with stress. That's how we have come as far as we have as human beings. But trauma gets you stuck and frozen in that particular spot of being enraged or fearful or terrified or something like that. Is there a link between trauma

Trauma and chronic stress? Is that just another word for the same thing? Yeah, you know, it gets difficult.

Like chronic stress, if you work on a project, if you're in the military, can actually be quite enjoyable in a way because you feel that all your capacities are being used. You see this after disasters, that people who work on cleaning up disasters tend to feel very close to the people who they work with.

have gone through the experience with, gives me a sense of intimacy also. And so, but the big issue that is being left out in most psychology texts and most conceptualizations is that we're basically, we are social creatures. We don't exist by ourselves. We don't,

And we're always thinking about other people, redefining ourselves through who we belong to, what ethnic group we belong to, our religions, our neighborhoods, et cetera, et cetera. So we are social species. And in trauma, usually those connections with other people break down. The very first study I did on Vietnam veterans, what we found is that they actually were doing quite well during the war.

But what if one of their best friends got killed?

That really was what blew them up and disintegrated. It was really the loss of that social connection that really made something traumatic. We saw this again in studies after 9-11 in New York. It's a horrendous event, and all of us who are old enough to remember it, most of us still are, really remember very vividly what happened at the time. But very few people got PTSD.

because there was such an enormous amount of social support and nobody blamed anybody. And then it turned out that the people with PTSD were the people who were in domestic violence relationships or who did not feel home, safe at home, actually.

That's interesting. Being able to go home at night and feel safe in your own home with the people you're with is a very powerful protection against getting messed up by outside events. Yeah, the role of casting off the stress. My favorite example of this is if

Anyone that's listening has an intense phone call. They're on the phone to somebody and they, it's a difficult work call or they're really trying to think things out, but it's audio only. They're not on zoom. Uh, you'll find yourself like a puppet master has gotten ahold of you and made you stand up from your seat and you'll find yourself walking around the room. Yeah. But if you have somebody who you trust and care for, who is the next room, you

You tell them, honey, listen to what just happened to me, what this asshole did to me. And when your honey says, boy, I don't know how you can stand that, and the person backs you up, you feel much better inside. But if your honey says, well, I'm not surprised he said that to you because I see the same stupid thing that you do all the time and he's absolutely right in the way he talks to you, then it really becomes a much more invasive issue. The social reception makes a huge difference.

Why would it be the case? Can you think of an adaptive reason or an explanation for why individuals going through trauma would shield themselves from other people around them, given that people around them are exactly the thing they need to improve their relationship to that emotional state? That's because they have learned that the people around them at some points could not be trusted.

The people who were closest to them hurt them or pushed them away or didn't want anything to do with them or criticized them all the time. So, you know, it is really what you learn during your trauma is that I thought I could trust people, but I can't. I trust that people will be there for me, but I can't. And that becomes, so you get very suspicious about people

people reaching out to you because you have had experiences that people do terrible things to you. And so that may become part of your woof and warp of your brain, actually. What's your definition of trauma? Is it an event which occurs outside the bounds of normal human experience? Oh, you started off. And it was a crazy definition because the majority of people have had trauma in their lives.

I keep looking for people who come from a perfectly normal family and I still have a hard time finding them actually. We all have major challenges. My organization, the Trauma Research Foundation, is putting out a statement right now and we're still really wrestling with the idea, how do you define trauma? And the trauma is really that you get hurt by something

And you get changed by it. But that something may be any variety of things. It may be a rape, yeah, very clear. It may be seeing your kid being run over, killed, very clear. But sometimes it's just being chronically ignored and dismissed. That eventually really gets into you and that becomes part of your framework of with who you see the world in.

When it comes to the body keeping the score, what do you mean? How does the body actually register this? What is the mechanism? How does it manifest? The brain registers it, but your body experiences it and your body lives it out. So what happens is that you don't remember the trauma so much as you continue to react as if you're being traumatized.

So let's say you have been sexually assaulted and you go on with your life and say, oh, it was just one incident. I'm really stupid for getting involved in it. It's not happening. And then you get excited about somebody who you want to be with. And then that person touches you and your body freezes. Or you start crying. Or you become really angry. And...

Your body reacts as if you're getting assaulted. You don't make that connection, say, oh, I really like this guy and I'd like to be involved with him, but my memory of the trauma interferes. It's an automatic mind process that gets in the way of your letting go at that point. Yeah, you say that trauma robs you of the feeling that you are in charge of yourself.

It's like a harrowing, harrowing, but accurate statement, I think. Yeah. And so, you know, people defend themselves against that and say, oh, it is because he did something wrong or because he talked to me the wrong way or, but at the end, uh,

I'm just writing our new book, finished the last chapter of our new book. And I started with a quote from Marcel Proust. In order to change, you need to see the world with new eyes. So at the end, if you really want to recover from trauma, we need to help people to change their perceptions of the world. We're not going to change the world out there, but we're going to change what they see and how they experience themselves and the people around them.

Well, ultimately, we are not in control of what is going to happen to us in life. We really only have control over our reactions. Well, we don't even have control of our reactions. At some point, you need to go to the bathroom. At some point, you need to not hold your breath. At some point, you need to go to sleep. Some people will make you angry and other people will make you feel all warm inside. You don't have much control over your reactions. You have some control over...

how you behave. And that's really the difference between little kids and adults. Little kids do whatever happens to them and they react to it. As adults, we get a prefrontal cortex and hopefully most of the time we can make decisions about how we react, even though our bodies tell us, don't trust this guy. You can still talk to that person as if you trust him.

This is something I really want to dig into. And I think a lot of people listening will resonate with this. They are thoughtful, inquisitive, reflective people. They like their cerebral horsepower and their cognitive ability. They understand that something can occur and they can control their behavior. And yet at the same time, they have a degree of control over their behavior, even if they don't have a degree of control over their reaction and the way it makes them feel.

At the same time, we also need to be aware and give respect and integrate and become noticing of the emotions that arise inside of us. And I can see a degree of tension between these two things. The person that wants to feel like they're in control of their life and has agency, the person who also wants to appreciate and integrate the signals that their body is giving them, but not be at the mercy of them. How do you think about the tension between these things?

What traumatist people often have discovered is how little control they have. And in some ways, the people who become my patients are among the most conscious people you ever hope to meet because they're willing to explore themselves.

And most people are not so eager to do that. They want to stick with their habits in life and push away anybody who interferes with their usual habits. And the people who come to my office say, I cannot stand what's happening inside of me anymore. And I need to actually become in charge more of my own reactions.

So therapy actually is a very courageous act of confronting your internal demons and confronting the pain and hurt of your life, actually. So it seems to me that when we're talking about trauma,

People have a reaction to an event which typically would not engender that reaction. They are trauma sensitive. They are overly reactive in a scenario that maybe doesn't warrant it because of something which they have learned in their past. Is that a correct framing? I wouldn't say learned. Something has been installed in them from the past.

These are not higher level cognitive processes, these are elementary activities that have to do with the area of the brain involved in the housekeeping of the body, as Antonio Damasio calls it.

What is that from a neuroscientific sense? Oh, it is your ventral tegmental area, your amygdala, your pericardial gray, the precuneus. It's a back part of your brain that we have in common with all animals that help us to perceive what's happening to us on an elementary level, the same way that your dog hears a thunderstorm and crawls underneath a couch.

We have the same brain as the dogs have. And on top of that, we have a big frontal lobe that hopefully makes us slightly more capable of managing our emotions than dogs do. But many people don't.

Yes, I've met many people who don't have any more emotional control than dogs do. And I think that tension between wanting to feel like the architects of our own life and understanding that we have a limbic system, which very much is the elephant that we sit on top of. And it's not the elephant that's got blinders on. It's us, the rider. But we have this belief that we're the one that's in control. I think that tension is where

Um, some people are probably resistant to ideas like this because it feels disempowering. It feels like there is a, an architect pulling their strings. Well, yeah, yes and no. No, with any sort of self reflection, we all know that, uh, we all are aware of that in a way. Uh, you know, it just, no, there may be some people who don't want to go there, but,

I mean, I understand that may not be the truth, but I think that it explains, at least to me, you know, I don't like the idea that I'm not in charge. I don't, and I will find ways to resist that belief. Even if I know that it's true, I try and sort of finagle and find ways to go through things. So I guess when you mentioned it earlier on,

Different people reacting to the same event will react in different ways. Some people will be traumatized and others won't be. - Yeah, people make a big deal out of that. You know, having the practices I do, wanting the center that I have for 50 years, I never meet somebody who has been traumatized by a goal like, boy, that's a pretty silly thing to get traumatized by. You know,

Usually, if you dig deeper to what people have been exposed to, you go like, my God, and you're still here. You're still able to tell the story. It is not like, oh, something happens and everybody else is fine and you got traumatized by it. Usually, if you really look at the details of what happens, you see that it really was a very painful experience. And my reaction almost invariably was,

hearing the story about the people I worked with, what they have gone through, is like, oh my God, how the hell did you survive? And I never have the feeling that, oh, I would have done much better than they did. This is something else I really wanted to dig into, which is the...

minimization and the shame that people feel around them not having anything worthy of being labeled as, oh no, you know, that was when I was a child. Oh, you know, it was just one time. Oh, it was whatever. Talk to me about that. Talk to me how that can hide in the dark some of the things we've experienced. You know, we all want to be normal.

You know, one thing that came up in the last few days is how almost everybody wants to tell other people, I came from a very happy family.

And you don't really want to know that your father was a drunk and your mom spent half her time in bed and stuff like that. So we want to be normal. We want to be acceptable. And so we make a construct of ourselves of people who are in charge of ourselves and who have always been loved by the people we're close to. That is how we like to experience ourselves. It's not very true, but, you know, we like to look good.

to the world. Yeah. No one, no one wants to admit just how insane they are. I think there's two layers. There's two layers to this that I was thinking about when looking at your work, the first one being the minimization and the shame, uh, that we have around situations that have happened to us in the past. And the second one being the shame around being triggered by seemingly small events in the present. Yeah.

Yeah. And you say to yourself, don't be stupid. You become very judgmental about yourself and very ashamed about your own reactions. You're ashamed you don't want anybody to see you for who you are. It's the story that we tell ourselves about our reactions that seems to be the really unnecessary degree of suffering that we've laid on top of all of this. Yeah. You know, yeah.

No, it's a way of coping. And so dismissing things is a very good initial reaction. Like, I want to go on with my life and push it behind me. I don't want this to define me. It's a healthy thing to do. And for a while, it oftentimes helps many people until you have a kid or you...

on a relationship or something that really comes closer to what happened to you. And then you start feeling the old feelings and having the old reactions again. And you go like, what the hell is wrong with me? You usually start with, what the hell is wrong with this person who I'm hooked up with? You usually blame it on the other person. After a while, if you've seen that one relationship after another ends up the same way, you go like, maybe it's something to do with me.

But that's not the automatic reaction. The automatic reaction is, oh, it's because you are pa-pa-pa. Well, yeah, there's a quote, if all of your exes are assholes, it might not be them that's the asshole. You are the common denominator between all of your exes. That's a good summary of it. Okay, so one of the things I've been thinking is whether...

experiencing traumatic events and having trauma sensitivity predisposes us to being more sensitive to future traumas. Does this become a recursive loop in that way? Oh, absolutely. Well, generally, it's also true that some people will be traumatized

become very good at stuff. So let's look at the positive thing first. I have met a number of nurses or kindergarten teachers who are spectacular nurses, spectacular kindergarten teachers, because they were traumatized as kids. And they know what they would have needed back then

And so they give to people what they felt they didn't get themselves as good. That is one adaptation that happens sometimes. But more often, people are out of touch and repeat that trauma early on. But I meet quite a lot of people where deep down I think to myself, I don't say it because...

Most people don't have a good sense of humor about it. So go back and thank your abusive parents for having been abusive because it made you very good how to take care of dysfunctional people around you.

I suppose if every trauma made you more susceptible to future traumas, you would just have a lineal graph over time of people getting more and more traumatized as they get into older age. They would just continue to accumulate and continue to get sensitive and continue to be accumulated and continue to get sensitive. Yeah, that's of course not how it goes because people also have lives.

And some people are able to arrange to have lives that are more or less predictable and where they can play a useful role and where they shield themselves against unpleasant surprises, more or less. Easier to do when you're a somewhat privileged person, harder to do when you're poor and brown, let's say. Is there anything...

that we can do during difficult events to minimize the way that they imprint on us? You know, my agenda, I like to say as often as I can, is that in every school from K through 12, we should have weekly classes and laboratories on understanding ourselves, to learn about

how our brain functions, how our body functions, what happens to us when somebody touches us, what happens when we throw a ball, what happens when you make music together, what happens when you interact with people. And to my mind, a very important part of the solution is teaching every kid from the beginning

of classes. The four are reading, writing, arithmetic, and self-regulation, and make yourself an important part of the study that we do. And I think our society would change if all of us would learn that systematically, that we learn about brains and neuroscience and how brains interact with each other and experience what it's like to...

to play ball with other people, to be involved in rhythmical activities, what does music do for me, what does things like these crazy Qigong movements do for me, what is it like for me to sing with other people, how do I affect other people? All this stuff should be part of our basic training, as it oftentimes, okay, of course, is for many privileged people who actually go to schools and live in households where people learn stuff like that.

Yeah, I understand that self-regulation is a great tool for dealing with and making yourself feel better. Yeah, but also understanding yourself. Really knowing, oh, when I get upset, listening to that piece of music makes me feel better. Or I found that when I sit in front of a piano and play some music, that I calm myself down. If somebody, if I can play volleyball with somebody. And to really, that...

In your course of your education and your growing up, you really learn what makes you feel good and what can you do for yourself when somebody upsets you. Yeah, yeah. I'm really trying to work out how much of that I really want you to dig into. Is that an ability to simply cope with the emotions that come up or is it something which will...

reduce down the echo that it continues in the future, or is that one and the same? - What I'm talking about really is that we raise conscious human beings who are really aware of themselves, aware of their own reactions, who are aware of the people around them and what effect they have on other people. And this really becomes a serious area of study to live in a more conscious society.

How can people learn to be more self-compassionate? We live in a meritocracy. People want to achieve things. They want to grow and improve. And yet a lot of this seems to rely on self-compassion. What's your advice? You know, self-compassion really comes from having been met and having been seen.

And that becomes your framework of yourself. So if you come from indeed a loving, kind, and responsive family, it's likely that you do feel self-compassionate. And you learn that when I fall down, somebody will be there to pick me up. People don't yell at me and scream at me for falling down, but they're really there for me in a way. That's how you learn to be there for yourself also. And

A huge thing that we see in our work is having a history of abuse and neglect early on in your life really more or less guarantees that you see yourself as defective and wrong and not a good person and disgusting and that sort of stuff. An extremely difficult thing to treat. The first thing that I've actually seen work for that

was the research of which I was the PI on psychedelics MDMA, where we saw that psychedelics really dramatically increased people's capacity for self-compassion, where they really were able in the psychedelic states to go to whatever happened to them

and to really feel very deeply what happened back then, and to go, yeah, that's what happened to this kid. This kid was only three years old and did the best he could, or he was only eight, or he didn't know how to deal with his bullies in high school, and he felt so weak and stupid, but that's all he could do. So on psychedelics, you really, MDMAs,

particularly we see this emergence of this capacity to really accept yourself for what has happened to you and not blame yourself for things. And I've never seen it to the same degree with any other former treatment I've studied. That's really beautiful to think about the person that you were when that thing happened to you and to say something like,

you did your best. You want to pick that person up and give them a hug. - But it's not cognitive, it's not like a frontal lobe, it's really, in psychedelics, you really deeply experience yourself on a very deep level, and it's not an outside person telling you it wasn't your fault, or you were just born, 'cause you never believe that, really. But it's yourself really feeling what happened to you and getting an internal sense of time

So you don't no longer identify with that kid who was being bullied or who was being put down or whatever. You say, oh, I'm so sorry that you, I, back then, had to go through that.

You say that we shouldn't keep secrets from ourselves. And it seems to me that what we're doing with psychedelics, also breathwork practices, in some ways, anything that allows you to sort of both dysregulate and regulate a little bit under control and make yourself feel safe to tap into these things. Yeah.

It breaks down the secret wall that we are able to construct around those things. This doesn't feel safe. I can't think about that thing. I don't want to go back to that place. And it helps you to sink into that more. Yeah. And to my mind, this is becoming a very urgent social issue.

I don't know whether you have heard or seen the new book by Johnson Heights. He was on the show a couple of weeks ago. It's a very important book.

that we are basing our kids behind screens and not to explore and not to feel things, and we give kids a false reward system by screens where they don't have to do anything. And I think screens will have major negative effects on self-knowledge and self-experience, actually. And I think we really need to listen very carefully what Jonathan has to say about that. Yeah.

Digital anesthetic is one of the ways that I think about it. People who...

are going through something emotionally uncomfortable can distract themselves with their screens. That results in you basically not connecting with your life. The emotions... - It's not black and white, of course. It's okay to distract yourself. It's okay to not confront all the misery of the world all the time. So I totally understand that and actually encourage it that when something bad happens to people, they could do something else

to not dwell on it. And there's actually another very important piece of research that's just beginning to

"Make it into our Consciousness" by Farb and Sindel Siegel about how your sensory experiences, your feeling things, your senses, and doing things that make you alive to your senses, help you to get out of habitual ways of doing things. For example, I did the first study on yoga for trauma,

and we had amazingly positive results. And now with the evolution of neuroscience, I'm beginning to understand more and more why yoga can be so effective because in yoga, you really pay attention to the internal sensory world. And that seems to be a very important avenue for you to feel that you can meet yourself and be in control of yourself.

Say more about that. Why is that so important? What is it about the attention being deployed?

Because we all get into habits. Our brain creates a habitual system. Basically, the brain is a predictive organ. The brain tells us, when I talk to you in Austin, Texas, I can expect certain things. And if you do something that is very different from what I expect, I have to change my mind.

taken you, but ordinarily I go into a habit of doing the same thing and talking the same thing. But if your habits no longer work for you, you always blow up at your kids or you always freeze in front of your boss, you need to get a new habit. And the new habits get formed by activating the sensory system in your brain.

It's the opposite of what you do with screens. You dull the sensory system in your brain with screens by doing action, meditation, yoga, probably martial arts, stuff like that. You really activate new habits. Talk to me. There'll be a lot of people listening who go, okay, Bessel, that sounds...

Spot on. That makes sense to me. I understand how our emotions and our reactivity can become hypersensitized. But this goes quite a few steps further. How does trauma manifest as an illness, an illness that people would typically recognize? What are the ways that can happen? Well, you know, of course, I'm an MD and a professor in medical school, so I know the medical model, but...

In our work, I don't have a medical model. Not your disease and your irons. A lot of people who have never been to a psychiatrist are crazy as loons, and people who have been to a psychiatrist are the most sensible people I know. So pathology is where you miss the boat, where you keep doing things that mess up your life and the life of people around you. That's the pathology.

And so you wouldn't necessarily give that a psychiatric label, but somebody's friends will say, they're doing it again. Yeah. Talk to me about some of the more typical illnesses that people would not think stress and trauma in this way contribute to and yet can. Stuff like fibromyalgia. Yeah.

These are questions that should be asked more often, in part because we have so few answers at this point. It's very clear that fibromyalgia, chronic pain,

I'm not saying that autoimmune diseases are caused by trauma, but they certainly are made much worse by trauma. It makes you much more vulnerable to develop them. All these somatic responses have been identified but barely studied and barely really systematically looked at what can you do and how can you best take care of it. But they're clearly trauma-related.

And they're clearly body-related. But because there is so little attention in the research world on how we process bodily experiences, that this is very largely still an unknown territory. And my foundation that I started, the Time of Research Foundation, actually is particularly interested in promoting studies on these sort of things that have not been studied or funded before.

It seems interesting to me or totally unsurprising that chronic elevated concern and worry and inflammation in the mind and the body would not make, how could it make anything better? I don't understand why that wouldn't be something which is a contributing factor. It clearly is. But I think our

academic work is not there to really systematically explore body sensations and how to change people's

relationship to their bodily experience. Well, I suppose that testing that is very difficult. You know, here is a dose of a drug. We gave this many people in this cohort that dose for this long. These are the results. These are the self-reports. For you to say, Chris, how does your body describe to me the sensation? What's the inner texture of your mind like today? But, you know,

You can study it if you put your mind to studying it. At the beginning, you don't have vocabulary for it, you don't know how to do it, but you learn how to do it. For example, the very first study that we funded from our foundation is a study on the impact of touch.

and various forms of touch on a group of people who have no trauma and a group of people who have been traumatized. To me, it's just fascinating that people have studied eyesight, people have won Nobel Prizes studying vision, people have won Nobel Prizes in audition, but touch has barely been studied. That's very interesting. What did you find? Oh, we're still in the middle of the study. Actually, we're funding it.

And next week, I hope to hear the first report on what they're finding. Hell yeah. Okay. So when it comes to modalities and getting better, both dealing with in the moment and unwinding the broader patterns, what are the principles? Is there a framework? What is it that people need to focus on when it comes to treating trauma? Well, the main focus is...

When you're traumatized, you lose your core sense of safety and internal integrity. And so the greatest challenge is how you induce a sense of total safety in the organism that a person lives in. And certainly, judging by my own experience and many other people since that time, having body work done in you

working with yoga, tai chi, qigong, everything that activates your relationship to your own body is sort of step number one.

sitting in a hot tub, being able to be touched, being able to just sort of let go is the first step to shut down an alarm system that's always active. Presumably if that isn't shut down, no further work can be done. That is my sense, yeah. But also very striking actually is that up to now,

Basically, all of our treatments didn't work all that well with very shut down people. And one of the surprising findings of our MDMA study was that very shut down people actually came to life on MDMA. Wow. Why would you think, what could you hypothesize would be the reason for that? What we hypothesize is that the MDMA changes people's

awareness of themselves, you know, we can talk

do some what I call bio-babble. We can talk about the serotonin receptors in the brain. You'll say, oh, he must be very smart. He knows about serotonin receptors, but doesn't really explain anything. Now I have some words to use to explain it. The brain is an incredibly complex organ, but we're beginning to get some little understanding about what might be going on to make that happen. Okay, so that's step one. What does step two look like? Step two is to

be able to feel what you feel.

And to really be, you know, that's what, for example, mindfulness practice would be good for. It's not as hot a topic as it was a few years ago, but mindfulness is very big. And what is also true is that doing mindfulness exercise, doing meditation can be very stressful because as you shut down all external input, you feel yourself. And feeling yourself can be a very scary and painful

unpleasant experience actually, which a lot of people don't want to do. So they turn on the TV and they have low input in order not to feel themselves. But if you cannot live in silence with yourself,

you're not okay. And that's what you see with soldiers who come back from Iraq and Afghanistan. First thing they do, they turn up the volume, they make a little noise, they don't want to feel what's inside of them, they just want to go, all that stuff out there. And that's because they're scared of themselves. And so learning how to, and most of us need guides for that, somebody who encourages us to do it and

has with us to say, well, I know it's difficult, but I'll help you to meet yourself. And that's a really important thing. Yeah. It's a common realization of mine that on the days when I haven't allowed my mind to talk to me during the day, it usually comes back and gets its revenge when I'm trying to go to sleep on a nighttime. Yep. Yep. No, it's, uh, it's interesting how this is going to evolve.

I see things sort of going up and down. It depends very much on the environment you live in. When I go to the Bay Area, I see a lot of people

doing the sort of things I'm talking about there seems to be some consciousness about it maybe Austin Texas maybe another place it's very sort of geographically happening in different places at different times yeah you've got an odd sort of domain centric trickle trickle down effect and the UK as is tradition will be last to

to do it. But I know some very, very mindful people in the UK. I know some mindful people too. It's a slow adoption state though. Apparently the Atlantic is a little bit bigger to get health and wellness things to go across it. Oh, it's interesting how in many ways, I just came back from two months in Australia. I think Australia is, I met some Australians who said,

I said, you know, Sweden is so much like America. We're just slightly more screwed up in the US. Slightly. And, you know, it's interesting. A friend of mine just wrote to me and said, can you help this friend of mine who's writing about all the trauma in America? And I said, well, I'll talk to him, but he also should talk about the enormous creativity and the innovation that continues to come out of our culture.

and maybe the two of them are two sides of the same coin. It's interesting, I go to Europe quite a bit also, and standard of living is great in Europe, I think standard of life is great, but they're not quite as sharp and innovative as America is. I think

our world being as unpredictable and oftentimes scary does keep us on edge a little bit here in the US. Again, the same theme as we talked about before. If you're privileged, it's a great place to be creative, but if you're downtrodden, it's a different city. Yeah, I mean, I love Italy. Rome is my favorite city on the planet and

I'll never forget the first time that I went from Leonardo da Vinci airport to the center of Rome on the Metro. And it was 2 p.m., something like that. There was an Icelandic girl that I was going on holiday with. And I, she was going to be an hour's time. And I was like, I'm in Rome. I'm getting an espresso and I'm going to sit outside and eat a croissant. So sure enough, I find a local cafe and this dude comes in, in a business suit, no tie. And it's,

two o'clock and I presumed that this must be his lunch break. And I saw him spend probably 35 to 40 minutes of what I'm going to guess is maybe a 50 or hour long lunch break just with a glass, large glass of red wine, sat outside, just sipping it. Some people were coming in and out. Maybe he was a local. He sort of had a little chat to them. And yeah, that culture does not engender the permanent ambient anxiety and vigilance of a

spurning creativity that you would have in the, you know, the caffeine fueled Americas. Yeah. But as you sort of imply his life is slightly better, pretty enjoyable, pretty, pretty enjoyable lunch break. Okay. So we've allowed ourselves to feel safe. Learning how to be mean for many people, that's a major enterprise action to discover what makes them feel safe, actually. Um,

These are the situations that make me feel safe. These are the modalities that work for me.

Yeah, the experiences. I always call it a journey. It's always a pilgrimage to find out what works for you. For example, I really am very fond of body workers. People are very good massage people. Very good to learn that it's safe to be touched. They get comfort out of touch. But sometimes for some people, music does it. For some people, it doesn't.

being part of a volleyball game or being part of a dojo with martial arts makes you feel. So you need to really discover it's an enterprise for yourself. It's important to know that about yourself. And after we've started to feel into those emotions, step two, we've sat with that. What comes after that?

So what comes up that keeps getting in the way and then you need to really explore what gets in the way and begin to talk and have language for yourself and say, "No, whenever I meet a person like that, I get really upset," or, "Whenever Christmas comes along, I get really depressed and I really don't want to go home," or, "I go home but I feel always depressed afterwards. I wonder what that's about."

I need to ask questions of yourself and what has informed your personality to be the way it has become. Yeah. Does having the understanding reduce the power of that response? I'm just thinking when Christmas comes around, I feel uncomfortable to go home. That's because throughout my childhood, I didn't feel that safe at Christmas. And there was always this competition between me and my brother or whatever, whatever.

I'm wondering what the final step to close this loop is. It's not the final step. I think knowing why you're screwed up does not necessarily make you less screwed up. But it does give you choices. Like if you really remember what Christmas was like and you allow yourself to remember it because we prefer to think, oh, we all come from very happy families and let me show you pretty pictures of,

Christmas bunnies or whatever. And you go like, no, it wasn't so great. You can go, maybe this year I should not go home for Christmas. Maybe this year I'll go to Mexico for Christmas. So you start being able to make choices. But it doesn't abolish it. And I think what abolishes it is certain techniques,

that allow you to go deep down there. The technique used to be hypnosis for 100 years. Hypnosis has sort of been wiped off the map

nobody's doing it anymore. I'm sure it will come back because being in a trance is very important because you need to get out of your ordinary consciousness to be able to observe things in a somewhat dispassionate way. Something like EMDR can get you there, a variety of other techniques. And again, on psychedelics also, you can really alter your perspective on things and you need to

You need to have experiences. Once you have a language, you can create experiences for yourself that are different. So you can say, maybe this year I will not spend Christmas with my older brother until he and I have a conversation about what really happens between the two.

One of my favorite quotes is from Ken P. Rinpoche, and he says, ultimately in life, happiness comes down to choosing between the discomfort of becoming aware of our mental afflictions and the discomfort of becoming ruled by them. I went to an office in Harvard Square. It's my first office after I finished my training. And the bathroom wall a patient had written, live with the sadness of your limitations or the pain of your transgressions.

Live with the sadness of your limitations or the pain of your transgressions. Just because we're throwing quotes at each other, one other one from last year that stopped me in my tracks from Neil Strauss, the guy that wrote The Game. He was a pickup artist dude, and he's kind of now transcended that. He's actually coming on the show in a couple of weeks. He said, unspoken expectations are premeditated resentments.

Interesting. And I think that that's absolutely true. So what you've said, you mentioned about giving yourself language, giving yourself the language to be able to understand and make sense of why might this be the case.

everything that we've spoken about so far, except for body work, and you can do things in classes, but the unpacking and the unpicking of these stories hasn't yet, you haven't yet talked about it being in relation to somebody else, about opening up and explaining this story to somebody else. What's the role of communion and conversation and other people here? It's a tricky issue. Therapists always talk about relation. And then my reaction is,

It's not really a relationship. A relationship is if I look out for you and you look out for me. But in therapy, it's some way, not entirely, it's a one-way street. As a therapist, I look after you and you don't have to look after me. I use my reactions to understand you better, but I don't expect you to take care of me or to...

be considerate of me all that much. And so, yes, I think the interpersonal aspect is terribly important. You need to feel that somebody is on your side, that somebody has your back. And I think relationships become important and when you're traumatized, oftentimes your relationships become very impoverished, but the relationships you have with real people and not so much with your therapist. Your therapist becomes a

role model to some degree maybe, but most of all it becomes a deeply accepting sense who helps you to be curious and open about yourself and who gives you the courage to meet yourself actually. That's what I would say. There's a lot of criticism and skepticism at the moment about therapy and therapy culture. Abigail Schreier recently wrote a book called Bad Therapy. She went on Joe's show. She came on this show. What

What do you think therapy looks like when it's at its best? - I see a lot of terrible therapy going also. And I do a lot of supervision in various countries. And I meet therapists all the time who says, "How do I manage this patient?" And I go, "You don't manage other people. "I can barely manage myself. "I cannot manage other people at the same time. "But I can help you to feel yourself

to understand yourself and to really go deep inside. And I have some tricks in my book of a variety of different techniques that will help you to go deeper into yourself. But in order to do so, you have to become subject of that yourself. So you have to go through it.

yourself and really have explored, deeply explored your own mind, your own history, your own psyche. I can proudly say in my book, I experienced every technique I write about and I know what it is for me. Some of them are more helpful than others, but it's very important for a therapist to become the subject of therapy themselves. And that's no longer a requirement.

Is that right? Yeah. In psychiatry, people are not at all expected to do their own therapy. How interesting. Or the drugs that they give to people. I almost got fired from my medical school because I used to tell my residents, you know, when you give these drugs to people, you should take it yourself to see what it does to your mind.

And the dean said, one more comment like that, and we shall take it to Portland. Francis Galton, who was the man that invented eugenics back in the 1900s, early 1900s,

such a fascinating, absolutely fascinating guy. He submitted a patent for how to cut a birthday cake so that you don't ever get it to go hard. So rather than cutting it in slices, you cut a bit down the middle and then you push the two outer parts together. His sister was born with a spinal condition, so she laid on a

table while he spoke to her and he educated her through speaking to her. He was a very quirky guy. It's very worth looking into his history. But one of the things that he did was he went through the list of pharmacology treatments and medicines alphabetically. And I think he got to C. And then when he got to C, he took something, I can't remember the name of it. It's like Katzwood or something. He took something that caused

caused him to shit himself so badly that five decades later when he wrote his autobiography, he still had memory of like this violent diarrhea. Yeah.

I'm doing a thing on William James right now, the Federal of American Psychology, and he tried it all himself also. And he did some weird things. The things that we do for science. No, but we should.

I don't think you can be a detached scientist. You still make selections of what's important, what's unimportant, and still your emotional brain labels what's important, what's unimportant. Yeah.

Okay. So we're talking about therapy being one of those things, which when done well can be fantastic when done badly and sometimes is done badly, uh, doesn't necessarily help. I think one of the questions I had coming in was how much of the modalities that you're suggesting are dealing with symptoms or able to unpick deeper responses. And it seems to me like

They, most of the effective ones do both that they create a state in which you can then move a little step deeper and I can feel, I can still feel safe and this is okay. And let's have a look at this story. What's the emotion that's coming up? And then that's okay. So we move one step deeper. Okay. What's the story? Why might this be the case? I can use a little bit of executive functioning without ripping myself completely.

out of the emotion, but I can still use, bring a little bit of the front brain in and start to see this for what it is. Okay, what might be a good way for me to continue? How can I stress test this? How is this true? And that is,

That seems like a good model to me. It seems like a nice balance of control and of ease. That makes a lot of sense. Yeah. You know, it is not the culture we live in. The culture we live in is that people adhere to a particular treatment.

Let's say you're a Freudian psychiatrist and that becomes your answer to everything. And you see that oftentimes in therapy, I see that many of my colleagues who are about my age who have studied the same treatment their entire lives. And

They found that data 30 years ago, but they're still doing the same stuff. Instead of saying, now let's see what else works and what works for the people who didn't work for it, they keep doing the same thing. And a lot of therapists tend to be like that. They find one little thing and they continue with the same thing. And what my program has always been very much about is we learn a lot of different things and, uh,

And so therapists tend not to evaluate on a regular basis something I'm very much promoting these days, to on a regular basis see, so how far have we come? What has been accomplished? And what hasn't been accomplished? And what do we know can help with that? Let's say if you are chronically anxious and frazzled, despite the fact you've done a lot of stuff, how do we deal with that? Does

A yoga practice helps with that? Let's see. Maybe a neurofeedback practice helps to calm the brain down by changing the wiring of your brain. So it's very important, and that's not happening right now in any program that I know of, where people learn about multiple options and learn about what options are best under what particular circumstances.

You mentioned that you tried every modality that you put in The Body Keeps the Score. Which is the one that you have found to be either most impactful or the one that you keep coming back to most regularly? I come back to basically all of them. My favorite clinical activity is psychodrama.

where you can have a virtual three-dimensional experience of how things could have been different back then. So that's my clinical practice. What was most helpful for me, I think, of all things I've done, was rolfing. I was born in 1943 under conditions pretty similar to what the kids in Ukraine are experiencing right now. And that became a

imprinted on me. I was a very sickly child.

Like many people of my generation at the end of the war, a lot of kids died. And I was a sickly kid. And I was sort of living in a semi-sickly body. And what was extraordinarily helpful for me was getting rolfed. Rolfing is a very intense form of body work where my body was sort of rearranged to be more flexible and not be stuck in that frightened little kid position.

part of me. Nothing to do with cognition. It is just my body was freed up to respond differently to the world.

So it's very different from how I was trained with Freudian psychoanalysis, basically. Yes. I think Freud might have been surprised if he got turned into a pretzel at some point and was made to be more limber than when he walked in. For me, the body piece was very important. But I did the first studies on Prozac.

I started off being a very promising young psychiatrist because I identified Prozac as being useful. I did the first study on it. And these days, I'm not much of a psychopharmacologist anymore. I started off believing, like my profession did at the time, that maybe chemicals will be the answer. And as our work progressed, it was very clear that chemicals may play a minor role, but not the definitive role in helping people to heal.

Looking to the future, I know that you have a lot of studies that you're either involved in or funding at the moment. You've got this new book coming out. What, from a modality and research perspective, what are you most excited about? Well, it all depends on the culture we live in. At the end of

Everything is political. What gets funded is political. What gets paid attention to is political. And so in terms of what I'm working on that's exciting, it's psychedelics.

because I think psychedelics bring the mind back into psychiatry, it allows you to look at mental processes that change, and it allows people to discover things about themselves that nothing else that I've seen does so. But at the same time, as psychedelics become legal,

I worry that it will get totally screwed up. What kind of pharmaceutical companies try to create new concoctions so they can make an optimal amount of money? People getting psychedelic drugs without any contextual input. They're just giving a drug without helping people to process them. And I'm very, very concerned that this is very likely to get screwed up in the same way that...

I'm old enough to be part of this first LSD revolution. And it was very exciting then also. But totally people blame the Nixon administration for good reason. But the people who are doing psychedelics were not the most responsible people either. Yeah. Well, I mean, look at the original introduction of MDMA. Yeah.

you know, over a hundred years ago. We've come full horseshoe back around to exactly where we started, except for the fact that it was regulated for a century and no one actually got to do any research with it. Yeah. Well, some people did actually. There was a little bit of research before. But here's a good example of what happens in politics. So I'm a senior medical student at the University of Chicago. And my last rotation was a drug addiction rotation.

where we more or less invented methadone treatment for heroin addiction. My boss, Chuck Schuster, was a very lovely guy, interesting to work with, and we used to smoke dope from time to time. That's normal for those days. He became Nixon's health czar. He goes on television and he says, these drugs wash your brain. I go, eh?

You know better than that. But because it is so politically advising to say, he was the lead person saying that he's bought your brain. He knew better than that. Perverse incentives everywhere. What can you tell us about this new book? The new book is very much about, it's called Come to Your Senses.

And it's about really the critical issue of introspective embodied self-awareness. How do we become aware of ourselves and how we change our relationship to ourselves?

And that's really what the book is about. Very cool. Bessel van der Kolk, ladies and gentlemen. Bessel, you're fantastic. I love your energy. I love the fact that you're so dedicated to this. Where should people go? They want to keep up to date with the stuff you're doing. Where should people go? TomResearchFoundation.org is our website. And there's always a lot of stuff happening. Hell yeah. Bessel, I appreciate you. Thank you. Thank you, Chris. Bye. Bye. Bye.