Neuroscience was brought into the field of trauma by the outspoken (and sometimes controversial) psychiatrist Bessel van der Kolk. Ever since his work with the Veterans Administration in the 1970s put him on the path to studying trauma, he’d begun to challenge the conventional psychiatric framework of trauma treatment in ways that more cognitively focused researchers tended to ignore.
When I started working on van der Kolk’s clinical team as a new supervisor in 1996, I had a weekly front-row seat to his determination to change the way the field approached trauma treatment. In 1994, when his paper “The Body Keeps the Score” was published in the American Journal of Psychiatry, the message that trauma often lives nonverbally in the body and brain was a source of tremendous discomfort in a field that didn’t yet recognize body-based treatments as reputable. However, the advent of brain-scan technology allowed him to conduct the research needed to support his arguments.
In van der Kolk’s groundbreaking 1994 study, 10 subjects volunteered to remember a traumatic event while undergoing a PET scan of their brain. As they began to recall these events, the scan revealed a surprising phenomenon: the cortical areas associated with narrative memory and verbal expression became inactive or inhibited, and instead there was increased activation of the right hemisphere amygdala, a tiny structure in the limbic system thought to be associated with storage of emotional memories without words. These volunteers had begun the scan with a memory they could put into words, but they quickly lost their ability to put language to their intense emotions, body sensations, and movements.
No wonder our clients were having such difficulty putting their experiences, even present-day ones, into words! No wonder they had difficulty remembering the past without becoming overwhelmed! Psychotherapy from the time of Freud had been premised on the assumption that putting words to emotions and painful past experiences would set us free, but this research (and the many replications since) told a different story. If the experiences are traumatic, if the emotions exceed the client’s affect tolerance, then the parts of the brain needed for differentiating past from present go offline and become inaccessible. Retraumatization now made sense: if we purposefully or inadvertently trigger old traumatic responses, brain areas responsible for witnessing and verbalizing experience decrease activity or shut down, and the events are reexperienced in body sensations, impulses, images, and intense emotions without words.
This changes everything, I remember thinking when van der Kolk first described his findings—and it did. Accustomed to using words as the primary treatment tool, talk therapists had to find other approaches, ones that weren’t so dependent on language and narrative and could therefore address the brain and body shutdown demonstrated in van der Kolk’s study.
Read more about the evolution of trauma treatment in Janina's full article, "Putting the Pieces Together: 25 Years of Learning Trauma Treatment," in the May/June 2014 issue of Psychotherapy Networker magazine.
Bessel van der Kolk