You know, I've been a trauma neurosurgeon for about 25 years now, so I think about trauma all the time. And I've seen the term trauma enter the zeitgeist in a way over the past decade or so that was a bit unexpected. I mean, we're halfway through the 2020s, and trauma is everywhere, it seems. Childhood trauma, it affects millions of Americans. It's on our TV and our movie screens.
It's all over social media. Four signs. Three signs that you do. Okay, I want to eat in two clear indicators that you're in a relationship where there is trauma bonding. And more and more of us are signing up for therapy and mental health treatment. And when we do so, we are often talking about our trauma. Now, fundamentally, I think this is probably a good thing because it did not get enough attention for a long time. And the reason that it is getting more attention has a lot to do with our guests today.
Dr. Bessel van der Kolk. He is a Dutch psychiatrist. He has been studying post-traumatic stress in its treatments for more than 50 years. I think it's fair to say that he is a bit of a founding father of trauma studies. And in doing so, he has become a bit of an academic renegade as well. I remember one of my colleagues saying, oh, Bessel, you and trauma. After you croak, nobody will ever talk about trauma anymore. Wow.
Well, clearly, we're all still talking about it. In fact, in 2014, Professor Vander Kolk authored a book called The Body Keeps the Score. And to call the book a hit is an understatement. Even as I record this podcast today, that book is currently sitting at number four on the New York Times nonfiction bestseller list.
This is the 226th week it's been on that list. And yet, despite the book's blockbuster success, Vanderkal feels that his ideas still have not broken through to the mainstream of his field.
The point of Vanderbilt's book is stated plainly in the title. Just think about this. The body keeps the score. The pain we experience from our trauma does not just live in our heads. It's actually stored in our bodies in a way, even if we don't recognize it. It manifests physically in our backs and our hips and our guts and our digestive system, our hearts even, sometimes even in the illnesses we develop.
And Vander Kolk argues that because trauma is fundamentally a physical experience, the healing must also be a physical experience. In his book, he writes this, trauma victims cannot recover until they become familiar with and befriend the sensations in their bodies.
So today, we're going to talk about what that looks like, what treatments are available, and I'm talking about things from dance classes to somatic therapy to cutting-edge psychedelic research. And we're going to get really to the heart of this word, trauma. We're going to unpack what trauma really means. I'm Dr. Sanjay Gupta, CNN's chief medical correspondent, and this is Chasing Life.
You obviously have been writing for a long time. The book which we're going to talk a lot about has actually been around for 10 plus years now. I got this sense, Doctor, that there was this concern on your part that maybe some of these ideas were not being accepted in the more clinical, hospital, mainstream sort of settings. But it just seems like what you've been talking about for a long time, everyone else is sort of catching up with. Is that your sense of things as well?
I'm certainly also reflecting on how when I started this work, my colleagues thought I'd gone crazy. I was on the research floor in one of the Harvard teaching hospitals. And I remember one of my colleagues saying, oh, Bessel, you and trauma. After you croaked, nobody would ever talk about trauma anymore. Wow. I said, I hope so. That would be actually my goal is we'll take care of it. And very consistently,
My academic colleagues certainly must have pooped the idea. And clearly, the book is doing unbelievably well beyond anybody's expectations, most of all mine. And I think it's lay people who recognize themselves. And I hear for people all the time, this is me, this is my family, I recognize it. Psychiatry is inching towards it, but it's been very, very slow.
those colleagues that you're referencing at Harvard, what do you think they would say about the book now? Something has happened to psychiatry just very sad. It has become a head maiden of the drug industry.
But what has happened to the profession is they started to make money, which psychiatry had never done before. And it takes psychiatry. We got hijacked by its field to, to drugs are the answers. Well, drugs really are maybe helpful, but they're not the answer at all. And it's really said that over the years, when they saw it, Harvard, for example, is that they used to teach psychotherapy. Now the last psychotherapy program for psychiatrists got closed down.
This raises a few questions, but let me let me ask this. When you say the drugs may be good, maybe not that good, you know, talking about Prozac or Zoloft, can you give some context for that? I think a lot of times these drugs are presented as sort of a, if not a panacea, then certainly very effective. But how do you sort of describe the effectiveness of these medications for patients? They take the edge off.
And certainly, antidepressants can be very helpful for some people, but then the research showed is that if you have serious trauma history in your background and you take antidepressants, depression tends not to become better. If you have no previous trauma, then so resetting the serotonin system may be quite helpful.
I would say, even if you have a trauma history, it might move you a little bit in the right direction, but it certainly doesn't open you up to be alive and ready to meet the world. So, medications are okay. They're just a small, useful part of what you have to offer to people, but everything else disappeared.
Let's talk about some basics. Again, there's so many questions. But how are the mind and body really connected? If you had to describe that, what is the connection? Well, we are our bodies. And I always say, hey, hang out with a newborn baby sometime. And it's just pure body has no concept to the world. And then the baby has experiences and that creates a map of the world.
So the experiences tell them, oh, when I do that, that will happen. So your baby becomes a predictive organ and that becomes your map of who you are in the relationship to world after you. And that becomes the mind eventually. It also becomes your neuroendocrine system and your immune system, which are all affected together. So one of the things that we
have not studied nearly enough yet, is the degree to which this early trauma really affects all kinds of disease processes. Because your mind also gets the experience of the world. This is a dangerous place. And so you see changes in stress hormones, you see changes in connectivity between different brain areas. So you get a brain that is geared for the conditions that you live under.
And so if the conditions live under are adverse, you get a brain that gets prepared for adversity. And sometimes that can help people to become very alert and very aware of what's going on about them. And sometimes it leads to creativity.
But most of the time it leads to people having reactions that care people about them, that doesn't help in collaboration, that gets to the way of getting things done. So that earlier organization of the brain
the mind, one's perceptual system, the whole layers on top of each other, continues to exert this influence for the rest of people's lives. It matters very much at what age this sort of trauma might occur then, when the brain is still developing. Yeah, and what we know, and it's really not being incorporated in psychiatry at all, is that different experiences and different
ages has a different impact on different brain developments. So the brain is continuing in developing for a very long time and that certain insults affect you and make the law at age four and again at age 13 but not in between. And so in some ways our science is way ahead of our clinical practice and our clinical understanding.
Just some of the basic terms trauma. I mean, that's a word that people, you know, use all the time nowadays. How do you define the term trauma? I am, my colleagues actually, define trauma as an overwhelming experience that leaves you in a state of be vulnerable to the helplessness. Like if you're unable to do something to protect yourself, to activate your arthritis bones, then
pathway gets activated of helplessness and collapse. So this issue of physical helplessness is central to the trauma that can really collapse in the face of it. But that evokes actually is another piece that
We only get to talk in terms of trauma. And that is like Oprah Winfrey wrote his book with my friend, Prosperi. What happened to you? And indeed, what happened to you is very important. But even more important is, who was there for you?
Now you see it's in your practice. People go through terrible experiences of surgery, but if they have a loving family that's come visit them, if the nursing care staff takes really care of them, they can surrender to the very scary process of undergoing surgery. So a very important aspect of almost everybody who I see who has been traumatized is that somebody didn't show up for them.
For example, a very common story is having violent parents and having the other parents not do anything to intervene. And for many people, that parent not intervening is actually more hurtful to them than the actual act that's appropriate.
I just want to say for anybody who's listening to this podcast and if this rings very familiar for you and maybe is even triggering for you, please know that there's help out there and you should read
The book, because I think this is going to ring true for a lot of people. I certainly, I think even as I read it, I felt like there were times when it's like, how does he know all this? I guess because maybe there's a collective human experience that maybe has more similar notes than I think people realize. This really is important. So basically everybody who I know well,
has had traumatic experiences. We have little pieces that really got stuck.
Most of them are pretty well functioning, and they can do okay relationships, but are seeks that trigger them, that make them irrational. And we know that it's about people in our environment. Oh, we'll go off for dinner over there, but we should not waste that particular topic. I don't know how to say this eloquently, but what is the point sometimes of, if not reliving the trauma, then at least digging it up again?
That's such an important part. But I saw earlier in my career, as did my friend, Judy Herman, that when you get people into talking about your trauma, the danger is that it becomes the identity, rather than something to be resolved. And so continuing to talk about your trauma is not good for you. It is helpful to be able to talk and find language for yourself.
But then is, how do we change it? I came for the world of saccharinolysis, where we talked endlessly, and then we discovered medications and brain chemistry, so it became the second pillar, but became important me over time is that no, we need to lay these memories to rest.
And we need to have people experiences that directly contradict their hopelessness or their isolation that occurred at that time. So, over time, it became a much more body-oriented and experientially oriented person. I think talking is important, having somebody know you, see you, understand you, is terribly important. But you then also need to do something to restore that sense of yourself.
I want to make sure we're defining some of the terms correctly. Somatic therapy, we've been using that term today, soma, you know, body, right? I think it's Latin, the Latin derivation is body. So body therapy, is that what somatic therapy is? But obviously we know we're talking about the body and the mind.
They'll be talking about, I'd say, does really the work of my friends, Peter Levine and Pat Ogden, who really discovered that traumatized people can very frozen their bodies. They hold the trauma in their bodies. That's actually true. And they find that heavy people move and opening themselves up and allowing themselves to become aware of how their body functions. And a very important part of trauma is also that so much trauma is sexual trauma.
And that messes up your sense of touch, something I'm still actually doing a study in right now, and that when you have been sexually arrested, the issue of touch becomes very contaminated. And I also am very aware, belly to belly contact, is the primary way in which we primates comfort ourselves. Now we don't do belly contact psychotherapy, but the issue of touch is a terribly important comforting issue.
And when you lose your capacity to feel safer with human touch, you miss out on a lot.
And so, a very important part of heating from particularly child to sexual abuse is to help your body to learn to be comforted by human touch. The first thing I studied in that regard is called something EMDR, which is a very crazy treatment where you ask people to move their eyes from side to side
It sounds crazy, but our results were so good that we really looked at what happens in the brain and it looked like moving your eyes back and forth, activate some circuitry in the brain that allows your brain to realize that what you're talking about was in the past and not in the present. So it trains the brain circuitry. And the next thing I studied was yoga. And yoga turned out to be a very good way of resetting your relationship to your body.
and then psychedelics and neurofeedback. So I've always studied things like what else can we do to reset that system?
because just talking about it is not enough. And also, if you keep talking about it, it becomes your default mode network. And that's a really very big thing is that once you start living in, this is what happened to me. And this is who I am, very complex issue. I first saw it in my Vietnam veterans, that they hated the war and complained about the war, but the only time they felt alive was when they talked about it.
When you say that these things, these changes happen in the brain, for example, in response to EMDR. By the way, what does that stand for? EMDR? I move from the desensitization and reprocessing. So when you say there's changes in the brain, is this based on the outcomes that you see, or are you measuring something in the brain specifically when people undergo EMDR? You first measure a clinical outcome, and then we were able to see how the brain circuitry changes during the eye movements.
We'll be back with Dr. Bessel van der Kolk in just a moment.
I'm Anderson Cooper. Grief isn't talked about much, but that's what my podcast is all about. This is All There Is, season three. In the past year, I've listened to about 6,000 voicemail messages you've left for me after season two, and most of the ones sent in so far this season. When I listen to your messages, it makes me feel less different and alone. My grief is deep and real, and it has brought me to my knees. Listen to All There Is with Anderson Cooper, wherever you get your podcasts.
You know, the title of the book is so good. The body keeps the score because I think this idea that if you've had these traumatic experiences at some point in your life, maybe you don't think about it at all. You know, it's not part of your identity. It's not something that comes up in conversation. But the point, I think, you wrote the book, but the body keeps the score.
Why? Why evolutionarily did the body decide to keep the score? Like why couldn't I just move on from that? Like what purpose did it serve to be continuously traumatized by that as I was for so long?
Yeah, my position has always been that trauma is a breakdown of adaptation. It's not an evolutionary useful situation. It's useful to deal with the immediate aftermath of the trauma because you become hyper-alert, you become hyper-energized, so you have energy to deal with stuff. But if it lasts, I think in nature, animals who get traumatized die.
I really don't think it's an evolutionary, the adaptive response. It's an illness response at the end leads to our herd not surviving. I remember reading this idea that everyone has some degree of trauma, but there's capital T trauma and there's unpleasant life events that we all go through. How do you explain the difference between these?
Well, the difference is that trauma is clearly identifiable and it is a very big event and it also is relatively treatable, like things like EMDR and neurofeedback really can help to calm the whole system down. But the small tea trauma at the end is the most painful trauma because that is how you get treated by your environment, how you live in your environment and small tea trauma is about your identity.
about who you become. It's not about an event, it's about how you construct your reality in the context of what's happening around you. And so if you're chronically neglected or beaten, you develop an identity of, I must be a terrible person because otherwise it wouldn't have happened to me. And you get this identity of being unfundamentally worthless,
When I walk into a room, I'm sure nobody will like me, but I'll somehow compensate for it by being extra charming, but deep down, it won't make a difference, because these early adaptations may become major characterological issues. And that becomes leading much more of a critical challenge. So what do you do for somebody in the scenario you just described?
That is very psychedelics became dramatically helpful. For most of the past 10 years, I spent my time on doing psychedelic research. We did a very large research project, and we showed that MDMA, ecstasy was a spectacularly helpful treatment for trauma, particularly for childhood trauma, which I had not expected.
And so we published at least five major articles, one of which won the prize in magazine science as one of the 10 most important breaks of the year, about three years ago. And the FDA just turned it down to legalizes. And I think that's a real tragedy. And I think the reason why they turned it down in part is because we do psychedelic assisted psychotherapy.
And I think the FDA just didn't have a mindset to understand that people need to be held and cared for while they're also taking drugs. We're just certified drugs and we don't know about all this other stuff. At the end of our study, 87% of our participants had chronic childhood trauma. Wow. And they did astonishingly well.
That is the big finding of the study. We can help people to change their ingrained perception and identity of themselves. First of all, we talk about ketamine when you talk about psychedelics. I mentioned MDMA. The study we did was MDMA.
also its ecstasy but MDMA is still illegal and I don't use illegal substances so in my practice I use ketamine now and so do many of my colleagues and we have very good results also in fact I'm curious how ketamine which is chemically completely different substance from
MDMA or syncybin, they all seem to have similar results of opening up that white, new perceptions, new understandings, but chemically they have very different ages.
But people discovered about psychedelics is it opens physical windows. So the brain develops on the basis of experience. And if we don't get the right input to the right time, our brain may not develop the capacity to do that. You need to get the input to the right time. And that's a huge issue in our field, of course, because a lot of people have had bad experiences and something happens to them that did not get something in there.
including something like to call drinking the milk of human kindness. And as some people just didn't get kindness at the right time and they don't get comforted by kindness. The research now shows everyone's psychedelics opens up this clinical window for a moment so the brain can actually take in information and reorganize itself on the basis of
of information that comes much later in your development that we were not able to do before. That is a fascinating way of describing it. This idea that there are these pathways and these pathways should have been accessed at certain times in our life.
Activated. Activated, and certain times in our life, whether it be kindness, I think, the milk of kindness. And if you take these psychedelics, at least one of the proposed mechanisms is that maybe it can activate these pathways and someone would be willing to accept the milk of kindness, as you call it. Is this last? Is this a durable effect? Yes, that's very striking, actually. Also, we saw it in NVMe, is that once you might get reset,
It's a v-set. Once you have gone scuba diving, you never forget scuba diving. Again, you think of antidepressants as being a daily pill with side effects and things like that. You're saying a single treatment or maybe just a few treatments with ketamine can reset the brain? Absolutely. Yeah. That's actually true. It's interesting we had a proposition for here in Massachusetts to legalize psychedelic medications.
I was fairly active in promoting it. And I'm not surprised that people voted it down. Because the notion that we all grow up telling our kids, don't take drugs. And we still follow Nancy Vega, like just say no to drugs. And now to say, I said, did my editorial, you know, this may be a very good treatment for fentanyl, the fentanyl epidemic, because people take fentanyl because they feel so terrible.
Don't be a fake fentanyl for the hell of it. You and I wouldn't take fentanyl. Our lives just too failed to do stupid stuff like that. But if you take fentanyl, it's because you don't feel joy enough. You don't feel pleasure enough. You don't feel enough connection with other people. And so, paradoxically, I've got my editorial for the Boston Globe. You know, with all these people, I feel so out of it and so disconnected.
the psychedelic ages may have the potential of having a positive effect on our opioid epidemic. For most people, that's too big a leap to make. We've talked about a few things. EMDR, even yoga, things to sort of reset and reconnect the body and the brain, the body and the mind.
How big a deal is something like ketamine then in this? Is it a much more effective sort of option than EMDR, for example? How do you give context? We don't know yet. If somebody has a specific incident that they can identify that car accident or that result,
EMDR is a wonderful treatment to soften and integrate that one-time memory that's specific event. When people feel like, fundamentally, I always feel like I have a piece of shit. Or fundamentally, even though I know you're a nice guy, I'm still uptight and scared. To serve this ingrained living in an internal, terrifying experience, the psychedelics are very good for that, to open that up for people.
This is gonna seem like a weird question, but that notion that you always sort of feel like a piece of shit, that you've never felt good enough. For some people, that's incredibly motivating. That's maybe tools. They got a chip on their shoulder. I'm only half sort of joking here. I guess the question really is, what's the downside? I mean, maybe having some trauma and all that just normal part of life, and we have to deal with it.
I would disagree. I think, you and I both know people who are wildly successful, who get prizes, who get, and as we know them, we know they're very deeply miserable humans. These are people I'm talking about. Yeah, and would they be great if that person could get a feeling, oh my God, I was a really beautiful kid back then. And too bad that the kid went through and you change your whole orientation to it yourself.
of being a person who deserves nurturing and who enjoys being nurtured. And I've seen that. That's when I see my practice actually.
And I don't want to keep hammering this point, though. I guess what I'm... And I think anybody who thinks about these topics, they can't help but put themselves or someone that they love into these shoes. But to what end? This guy who is a brilliant economist, whatever it might be. But now he sort of comes up and recognizes that his father or her father was never around for them when they were a child. Oh, just till the end.
That would be where traditional therapy stops, like, oh, and because of that, I never felt like, wouldn't I? So that's the understanding piece. And now, if you get wheeled treatments, for example, psychedelics, you'll go like, oh, I always hated myself from being so small and not fighting back. But I was three years old. And I was just a little kid. I did the best I could.
Oh my God, and you change your attitude about yourself. And now when the kids come over for Christmas, you actually talk to your kids in a loving way. What does trauma, like the sort of trauma you've been describing, what does that do to our brains in the moment? We did, as far as I know, the only study where we actually looked what happened in people's brains as they relived their trauma.
You could do that today anymore because it was a very traumatizing experience to lie in the scanner, feeling like you're being raped all over again. But we did that study. And what we found is that basically the whole left hemisphere disappeared, which means that your thinking capacity disappeared, particularly brokers area shut down,
so you were not able to talk anymore, as if you had to stroke. We all have been there, actually, that when we get really angry, really upset, we don't sound very rational anymore, and not very logical anymore, as we saw in our skin, is that people became
overwhelming feelings in the very temporal, parietal area, and make that stuff over here, and a shutdown of the left hemisphere. So that is what happens in the moment of trauma. And psychologists tend to not understand it because they have never worked in emergency rooms. We have worked in emergency rooms. And we know what very traumatized people look like. They are out of it.
they're trembling, they're frozen, they're not saying, oh, let me tell you how I had to gunshot wounds. And that conceded in the brain. But over time, the brain that makes adjustments to it, and then you get to see other abnormalities. You end up seeing people who want to see you. And I say that because I think for a lot of people talking about these topics is hard. They don't want to talk about trauma. They don't want to acknowledge it themselves. They don't want to relive it.
Why is that important to talk about it? Why is it important not to just brush these things aside or push them down? Well, the importance is that your body will react. You know, that's really what first got me into this whole field. I immediately saw that their bodies are frozen or hyper-reactive and this is a physiological event. And as long as you don't know what that event is about,
you say it is your fault because you said that to me or it's so you externalize your problems or you say I'm just messed up. So you create a narrative but the narrative is a cover story. The narrative is
but your mind is capable of creating a story about what happens. The experience is not in physiology, imprinted in physiology, but your explanation for it is your rational brain trying to understand and communicate what's going on with you.
But one of the things you see all the time, we need to feed time with these people, is that that story changes and often certainly psychedelics was also with everything else. We do new elements come up and these new elements come in that people had completed the best.
I'm just curious for people for whom the body keeps the score. Maybe they have chronic back pain, which is a very common thing or chronic hip pain or something like that. People have said that trauma is held in the hips. That's why their hips are tight. Is there truth to that?
Up to this point, our research establishments have such a strong separation between body and mind that I think we have not studied this nearly enough. So one of the things that I see anecdotally in our
psychedelic study, we did not collect data on that, unfortunately, is how many traumatized people have autoimmune disorders, fibromyalgia, chronic pain. And some people tell us from time to time, it has very much disappeared or very much changed. I would actually love to see a study of the effect on psychedelics on chronic pain and even on autoimmune function.
People who are listening to this podcast now and say, okay, look, I completely get what Doctor is saying. Is there anything they can start to do at home even by themselves? What can they do to be of some benefit at home? It's not an interesting issue. Last time I was in China.
People in China are not allowed to talk about the cultural revolution, not allowed to talk about their family history, et cetera. But in every square, in every park in China, people doing Qigong, Tai Chi, and various forms of visualized dancing. They know something we don't know.
And how many people actually seem to benefit from doing martial arts, from Tango dancing, from Capoeira, all this stuff that none of us would ever do as an as crazy people Brazil. I think these are methods that people have evolved to deal with trauma in other cultures. So my research
Showed that stuff like yoga may just be helpful for you. Right, right. Look, there's potentially a lot of benefits from doing these things. I think reading your book, you've never said that this is going to help everybody, but the harm, the side effect profile, if you will, is so low.
Doing yoga, EMDR, doing the tango, doing Tai Chi, trying to realign your mind and your body, it's worth doing. I feel like we started this conversation with this idea that the medical establishment can be somewhat obstinate in terms of accepting new ideas, but even among my colleagues, when I told them I was going to be interviewing you, there was a genuine and sincere excitement about that.
I'm lucky to talk to you. I really appreciate your time. I feel very lucky to talk to you also, actually.
That was the psychiatrist Dr. Bessel van der Kolk, author of the best-selling book, The Body Keeps the Score. You know, I think it's important to take away from this conversation that no matter how old we get, no matter what has happened in our lives, no matter how bad it has been, we human beings are always capable of remarkable change and positive growth.
And the other thing I want you all to remember is that if you've experienced a traumatic event in your life, and most of us have, and if you're struggling to cope, the first step to healing is to try and reach out to someone. That might be a therapist, a doctor, a trusted friend. There are people who want to help us get back to the best version of ourselves. But sometimes we just have to take the first leap.
Chasing Life is a production of CNN Audio. Our podcast is produced by Erin Mathewson, Jennifer Ly, Grace Walker, Lori Gallaretta, Jesse Remedios, Sophia Sanchez, and Cara Daring. Andrea Kane is our medical writer. Our senior producer is Dan Bloom. Amanda Celia is our show runner. Dan Dazula is our technical director and the executive producer of CNN Audio is Steve Licktai.
With support from Jamis Andreste, John D'Enora, Haley Thomas, Alex Manissary, Robert Mathers, Lainey Steinhardt, Nicole Pesserou, and Lisa Namiro. Special thanks to Ben Tinker and Nadia Kanang of CNN Health and Katie Hinman. This week on the assignment with me, Audie Cornish. The truth is that many of us warned about this.
Reverend Gabriel Salguero, pastor of the Gathering Place in Orlando, Florida. What are the kinds of messages you have been getting? I got a call from somebody saying that they're not going to go to church because they're afraid. Many pastors are concerned that it will impinge on our religious liberty to serve immigrant communities and make status communities. What does it feel like to be on the front lines of the immigration debate? Listen to the assignment with me, Audie Cornish, streaming now on your favorite podcast app.