#787 - Bessel van der Kolk - The Surprising Solutions To Heal Trauma Without Medication

31:23That results in you basically not connecting with your life. The emotions, but It's not black or white of course, it's okay to distract yourself. It's okay to not confront all the misery of the world all the time. I totally understand that and actually encourage it when something bad happens to people, they could do something else to not develop it. That's actually another very important research piece of research that's just beginning to to make it into our consciousness by far and in the other sigil about how your sensory experiences, your feeling things, your senses, and doing things that make you alive to your sense, help you to get out of habitable ways of doing things.

32:16For 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 a yoga, you really pay attention to the internal sensory worlds and that seems to be a very important avenue for you to feel that you can meet yourself and be in control of yourself. Let's 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 habitable system. So basically the brain is a predictive organ.

33:03The 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 sort of change my I'm taking you, but ordinarily, I go into a habit of doing the same thing, talking the same with thing, but if your habits no longer work for you, you always blow up at your kids or you always freeze it from your boss, you need to get a new habit and the new habits get formed by actively the sensory system in your brain. It's an opposite of what you do with screens. You dalded yourself into your brain with screens by doing action, meditation, yoga, probably martial arts, stuff like that.

33:54You really activate new habits. Talk to me. There'll be a lot of people listening. You 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 RNs, you know, A lot of people who have never been to psychiatrists are crazy as lunas and people who are beat psychiatrists, they are the most sensible people.

34:43So, pathology is when you miss the boat, when you keep doing things that mess up your life and the life of people about you. That's the pathology. I'm sorry. You wouldn't necessarily give that a psychiatric label, but all somebody's friends will say, Do you get 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 You know these are you know these are questions that should be asked more often In part because we have so few answers at this point is that it's very clear that fibromyalgia, crony pain, autoimmune diseases, I'm not saying that autoimmune diseases are caused by trauma, but they're certainly a made much worse by trauma.

35:45It makes you much more vulnerable to develop them. All these somatic responses have been identified, but barely studies and barely really systematically

36:01And they're clearly trauma related and their clearly body related. But because they are so little attention in the research world on how we process bodily experiences, this is very largely still an unknown territory. And my foundations, I started the time of research foundation actually is particularly interested in promoting studies on these sorts 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 it, how could it make anything better? I don't understand why that wouldn't be something which is a contributing factor.

36:58It 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 a vocabulary for it, you don't know how to do it.

37:47But 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 have been traumatized. To me, it's just fascinating that people have studied eyesight. People have won Nobel Prize in studying vision. People have won Nobel Prize 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 first, the interferes we board on, but they're finding.

38:30Alia, 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 your trauma says you lose your core sense of safety and internal integrity. As a the greatest challenge is how you induce a sense of total safety in the organism that a person lives in. I certainly judge it by my own experience, having many other people since the time, having body work done in you, working with yoga, tai chi chi gong, everything you have done activates your, your, your own body is sort of step number one, sitting in a hot tub, being able to be touched, being able to just let go is the first step to to to shut down a alarm system that's always active here.

39:44Presumably 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 shutdown people. And one of the surprising findings of our MDMA study was that very shutdown people actually came to life on MDMA. Just like, wow. Now, why would you think what could your hypothesize would be the reason for that? What we hypothesize is that MDMA changes people's awareness of themselves. Now we can talk to some what they call bio -babbling. We can talk about the serotonous receptors in the brain.

40:34You'll say, oh, he must be very smart. He knows about serotonous receptors. But that doesn't really explain anything. Now I have some words to use to explain it. The brain is incredibly complex organ, but we're beginning to get some little understanding about what might be going on to be today. 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 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, meditation, can be very stressful.

41:23Because as you shut down all external input, you feel yourself. Finging yourself can be a very scary and unpleasant experience, actually. Which a lot of people don't want to do. So they turn on the TV and they have a lot of 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 you do, they turn up the volume, they make all of noise, they don't want to feel what's inside of them, they just want to go all the stuff out there. And that's because they're scared of themselves.

42:05And 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 is 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 night time. Yep. Yep.

42:42It's interesting how does it go to evolve? I see things sort of going up and down and it's been very much on the environment you live in. When I go to Bay Area, I see a lot of people doing the sort of things I'm talking about. seems to be some consciousness about it maybe Austin Texas maybe another place is very so geographically happening in different places at different times yeah yeah you've got an odd sort of domain centric trickle trickle down effect and the UK as his tradition will be last to do it but I know some very very mightful UK or 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.

43:25Always interesting how in many ways I just came back from two months in Australia. I think of India is a mess in Australia who said, I said, no, it's very much like the America, we're just slightly more screwed up in the US. It's likely.

43:44And you know it's interesting and friends might just vote to be said, can you help the friend of mine who is 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. And it's interesting, I go to Europe quite a bit also. And, you know, 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. I think our world being is unpredictable and of times scary does keep us on edge a little bit here 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 if you're downtrodden it's a big like yeah I mean I 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.

44:50And it was two 2 p .m. something like that. There was an Icelandic girl that I was going on holiday with Anna. I she was an Anna going to be an hours time and I was like, I'm in Rome. I'm getting in a 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 to a clock. And I presume that this must be as lunch break. And I saw him spend probably 35 to 40 minutes of what I'm going to guess is maybe a 50 hour hour long lunch break just with a glass large glass of red wine sat outside, just sipping it.

45:26Some 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 Spurning creativity that you would have in that you know the caffeine fuels Americas. Yeah. Yeah, but As you sort of imply his life is slightly better than really enjoyable pretty pretty enjoyable lunch break Okay, so we've allowed ourselves to feel safe But you know learning how to be mean for many people that's a major enterprise To discover what makes him feel safe actually These are the situations that make me feel safe.

46:10These are the modalities that work for me. Yeah, the experiences. I always call it the journey. It's always a pilgrimage to find out what works for you. For example, I really am very fond of body workers and people are very good massage people. very good to learn that it's safe to be touched. They get comforted out of touch. But sometimes for some people, music does. For some people to have been part of volleyball game, or being part of a dojo with partial arts, makes a film. 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.

46:56what comes after that? It comes after that. So what comes up? That keeps getting in the way and then you need to really explore what is in the way and begin to talk and have language for yourself. You know, whenever I meet a person like that, I get really upset. Whenever Christmas comes along, I get really depressed and I really don't want to go home or go home, but I feel always the best afterwards. I wonder what that's about. And he asks 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?

47:44I'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 prisoners were 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 you know what I think 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.

48:50The technique used to be hypnosis for a hundred 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 trans 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 view the alter your perspective on things and 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 be spent Christmas with my older brother until he and I have a conversation about what really happens between them.

49:47One 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 at Witten, lived with the sadness of your limitations or the pain of your transgressions. Oh wow. 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, who's a pick -up artist, dude, and he's kind of now transcended that.

50:36He'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 bodywork 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.

51:17What's the role of sort of communion and conversation and other people here? So tricky issue. Now, it's therapist always talk about relation And then my reaction is, it's not a media relationship. A relationship is, if I look out for you and you look out for me. But in therapy, it's in some way not entirely. It's a one -way street. Hey, 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.

52:02You 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, often times you'll eventually become very impoverished. But the relationships you have with real people and not so much with your therapist. Your therapist becomes a War 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.

52:44Abigail Shryer recently wrote a book called Bad Therapy. She went on Joe's show. She came on the show. What do you think therapy looks like when it's at its best? I'm also, I see a lot of terrible therapy going also. I do a lot of the provision in various countries. I meet therapists all the time who says, how do I manage these patients? 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 read your 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.

53:35But 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 probably say in my book, I experience 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. In psychiatry, people are not at all expected to do their own therapy. The drugs that they give to people, I almost got fired from my medical school because I used to tell my residents, you know, they give these drugs to people, you should take yourself to see what it does to your mind.

54:30And Dean said, one more comment like Yes, the racial faculty part. 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.

55:14But one of the things that he did was he went through, he went through the list of pharmacology treatments and medicines alphabetically. And I think he got to see. And then when he got to see, he took something, I can't remember the name of it. It's like Kat's word or something. He took 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 the American psychology and he tried all himself also And he did some weird things.

56:02The things that we do for science. No, but we should. You know, I don't see you can be a teacher scientist. You still make selections of what's important, what's unimportant, and still your emotional brain labels what's important, what's unimportant. 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 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.

56:58And let's have a look at the 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 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, 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. You know, it is not a culture we live in.

57:35A culture we live in is that people adhere to a particular treatment. Let's say you're Freudian psychiatrist and that becomes your answer to everything. And you see that oftentimes in therapy, I see the many my colleagues who are in a are about my age who have studied the same treatment their entire lives. 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 worked for the people who didn't work for, they keep doing your things. And a lot of therapists tend to be like that, they find one little thing and they continue with the same thing.

58:14And what my programmer has always been very much about is we learn a lot of different things. And so therapists tend not to evaluate on the vagalabase or something, and I'm very much promoting these days, to on the vagalabase, 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 of frazzled, despite the fact you have done most of, how do we deal with that? Does a yoga practice help for that? Let's see, maybe a neurofeedback practice helps to calm that brain down by changing the rib -y ring of your brain.

59:00So 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 I best handle up particular circumstances. You mentioned that you tried every modality that you put into 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 sacradrama, where you can have a virtual three -dimensional experience of how things could have been different back then.

59:45So that's my clinical practice. What was most helpful for me, I think, of all things I've done, was Rolfi. I was born in 1943 on the conditions pretty similar about the kids that you crane our experiencing right now. And that became 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 living in a semi sickly body and what was extraordinary helpful for me was getting involved. Rolfing is a very intense form of bodywork where my body was sort of rearranged to be more flexible and not be stuck in that frightened little kid part of me.

1:00:40Nothing to do with cognition. It's just my body was freed up to respond differently to the world. So it's very different from how I was trained with the Ferdinand Sacco Analysis, basically. Yes. I think you would have been 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. Well, but so for me the body piece was very important, but you know, I did the first studies on Crohn's egg. I started off being a very promising young psychiatrist because I identified Crohn's egg as being useful. I did the first study on it and these days I'm not much of a psych pharmacologist anymore.

1:01:22Like I started off believing like my profession did at the time, that maybe chemicals will be answered. And as our work progressed, it's a very good, and it's 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, everything is political. What gets funded is political, what gets paid attention to is political.

1:02:07And so, but in terms of what I'm working on this, exciting, it's psychedelics. Because I think psychedelics bring the mind back into psychiatry and allows it to look mental processes to 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 the secondary has become legal, I worry that it will get totally screwed up. I'll kind of pharmaceutical companies trying to create new concoctions so they can make an optimal amount of money, people getting circular drugs without any contextual input. They're just giving a drug without helping people to process them.

1:02:57And I'm very, very concerned that this is very likely to get screwed up in the same way. Now, you know, I'm old enough to be part of the first LSD revolution. And it was very exciting then also. But a totally people blame the Nixon administration for a good reason, but the people were doing this Saturday, we're not the most responsible people either. Yeah, well, I mean, look at the original introduction of MDMA, you know, over a hundred years ago. Yeah. 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.

1:03:38Yeah. Well, some people did actually, there was a little bit of research before it was, but But here's a good example of what happens in politics. So I've been a senior medical student at the University of Chicago, and my last rotation was drug addiction rotation, and there would be more or less invented methodo treatment for heroin addiction. My boss, Chuck Schuster, was a very lovely guy who I've been interested in to work with, and he 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, what your brain?

1:04:21I go, eh? You know better than death, but because it is so politically, I think to say, he was the lead person saying that he's right, but what 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 and body 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. Special Vandecolk, ladies and gentlemen, best of all, you're fantastic.

1:05:06I 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. Hmm? Oh, where should people go? My research foundation is our time recently. It does org is our website and always love stuff happening. Hell yeah, that's all. I appreciate you. Thank you. Thank you. Thank you, guys. Bye. And Doug, here we have the Lemo Emo in its natural habitat helping people customize their car insurance and save hundreds with Liberty Mutual. Fascinating. It's accompanied by his natural ally Doug. Uh, Lemoo, is that guy with the binoculars watching us?

1:05:46Cut the camera. They see us. Only pay for what you need at LibertyMutual .com. Liberty Liberty Liberty Liberty Liberty Liberty Savings very under it and by Liberty Mutual Insurance Company and affiliate exclusive to Massachusetts.