Isolation and Self-Care


Isolation and Self-Care

From Virtual symposium 2020

By Bessel van der Kolk

May/June 2020


If we want to maintain our sanity right now, with so many of us in lockdown because of the coronavirus and divorced from the ordinary structures of our lives, we must understand what our brains need to function properly. First, we need to stay connected with each other. How? Through our voices and faces. After all, that’s the primary mode of human communication. So if we take advantage of technologies that allow us to experience the presence of others, our anxiety goes down. That’s what all the work on attachment theory tells us. We need to do more than stare passively at the TV without a mutual engagement of familiar voices and faces.

Some communities have even gone beyond that while still maintaining physical distancing. In my neighborhood, we’re in the process of setting up a way to cook and care for each other. We drop off food at each other’s houses, and then have suppertime together through FaceTime so we can talk to each other over a meal, as if we were together.

Another aspect of understanding our brains and taking care of ourselves is having a regular physical practice, where we move our bodies and maybe do it online with other people. If you don’t move your body, your soul will rot. After all, a big part of the definition of trauma is immobility. We’ve understood for a long time that trauma is about being in a physical state where you can’t do anything. So being able to do things—projects, knitting, cooking, art—is critical to staying alive in these times and engaging the core brain functions that keep human connection alive. We’ve all seen enlivening moments on the internet, like the Italians singing to each other from their balconies. On my street in Boston, we’re beginning to sing to each other too, even though it doesn’t come quite as naturally for people here.

We can learn a lot about handling the aftermath of the pandemic by looking at what we know about trauma. As my hero, Pierre Janet, wrote in 1904, trauma is living your current life as if you’re still in the past. Healing from trauma is not about memory reconsolidation: it’s about learning to have a body that’s fully alive in the present. Even in a restrictive time like this, there are many practical things we can do to address that. One is honoring something we’ve known for centuries—the importance of structure. I lived in a Catholic monastery for a while and experienced this structure in liturgy, as we gathered for Mass at 4:30 a.m., and at noon for singing and chanting.

Dividing up your day is an important thing to do. When the temporal structure breaks down, we break down.

As we face our life right now with the coronavirus, we have to understand the wisdom of the liturgy and give our lives the structure our brain craves. At 8:00 in the morning, I’ll start the day with meditation or yoga. And from 9:00 to 9:30, I’m dancing with my kids. And then from 11:00 to 12:00, I’m going to FaceTime with one or two of my friends. I’ll work after that, and then at 4:00 in the afternoon, I’ll start cooking a meal I can leave on a friend’s porch to enjoy with them over video.

Dividing up your day is an important thing to do. When the temporal structure breaks down, we break down. So dividing up time in clear rhythms is what we do to help people with trauma. It’s what kindergarten teachers do, and what we need to do for ourselves when we’re on lockdown or sheltering in place.

At a time like this, it’s important to realize that our conscious brain is a small part of who we are. As psychotherapists, we may talk and explain and have opinions about things—and we should certainly appreciate the marvels of our prefrontal cortex—but knowing why you’re screwed up doesn’t usually solve deep emotional issues: it just gives you options to begin to do something about it.

As a dear psychoanalyst friend once said to me, “Before I was analyzed, I was an asshole. Now I’m a well-analyzed asshole.” In other words, you may begin to understand why you’re doing things, but that doesn’t necessarily change the automatic perceptions and reactions you have. Beyond theories and analyses, our great challenge is how we use our frontal lobes to help us change the reactions of other parts of the brain, like our limbic systems and stems, so we can get out of our dysregulated habitual states.

Therapists need to know how to address different parts of the brain; analyzing from the frontal lobe isn’t enough. When your baby wakes up screaming in the middle of the night, you can tell her, “Honey, please don’t scream in the middle of the night because mommy has to go to work, and I can’t sleep if you’re screaming.” But the small child won’t be able to take that in. A lot of adults are like that, too. They have intense reactions, and people telling them they shouldn’t feel that way or need to change doesn’t have much effect. Instead, the main challenge of becoming a trauma therapist is learning how to help people calm down and manage these deep subcortical reactions. That’s why more and more trauma therapists are getting into movement, breathing, music, rhythms, singing, and other things that change our visceral relationship to ourselves and our core regulatory systems.

Our brain stems allow us to do what little babies do: sleep, eat, breathe, poop, pee. Therapists tend not to take histories of those things because it’s all in the basement of the brain, where the housekeeping of the body takes place. But that’s where the dysregulation is likely to take place. When people are traumatized, it’s hard to breathe regularly, hard to have a normal appetite, hard to have normal sleep patterns. They may have abnormal bowel habits that don’t get attention because psychologists and social workers don’t ask about those things.

If you really want to help yourself and your clients, pay attention to breathing, moving, sleeping. Understanding processes like those is largely the province of people like kindergarten teachers, yoga teachers, martial arts teachers, singing teachers, music teachers. They may not have gone to psychotherapy school, but they help a lot of people, because as long as the core system in the back of the brain is firing like crazy, or not firing at all, it’s very hard for other parts to function well. Increasingly, a greater understanding of the autonomic nervous system is changing our perspective of what therapy is all about.

***

Bessel van der Kolk, MD, is the founder of the Trauma Center and the bestselling author of The Body Keeps the Score.

Let us know what you think at letters@psychnetworker.org.

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