What If Healing Your Mind Starts in Your Body?
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See store or sleepnumber.com for details. 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 not your fault. It's all over social media. For.

Four signs. Three signs that you do. Okay, I want to give you 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 guest today.

Dr. Bessel van der Kolk. He is a Dutch psychiatrist. He has been studying post-traumatic stress and 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 van der 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, van der Kolk feels that his ideas still have not broken through to the mainstream of his field. I was at a dinner with the current chairman of psychiatry at Harvard, and he says, oh, you wrote a book? Oh, I'd never heard of that.

The point of van der Kolk'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 van der 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. That's right. 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 croak, nobody will ever talk about trauma anymore." - Wow. - I said, "I hope so. That would be actually my goal, that we'll take care of it." And very consistently, my academic colleagues, certainly in Boston, have pooh-poohed the idea.

And clearly the book is doing unbelievably well beyond anybody's expectation, most of all mine. And I think it's lay people who recognize themselves. And I hear from 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 that's very sad. It has become a handmaiden of the drug industry. What has happened to the profession is they started to make money, which psychiatry had never done before. And I think psychiatry got hijacked by its fealty 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, but I saw at 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 ask this. When you say that 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

a serious trauma history in your background and you take antidepressants, your 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 sort of 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 we 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 of 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 brain becomes a predictive organ and that becomes your map of who you are in relationship to the 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 to experience 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 you 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 around them. And sometimes it leads to creativity.

But most of the time it leads to people having reactions that scare people about them, that doesn't help in collaboration, that gets in the way of getting things done. So that earlier organization of the brain

The mind was a perceptual system. They're all 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 been incorporated into psychiatry at all, is that different experiences and different

has a different impact on different brain developments. So the brain is continually developing for a very long time, and that certain cells affect your amygdala 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 and my colleagues actually define trauma as an overwhelming experience that leaves you in a state of befuddlement and helplessness. Like if you're unable to do something to protect yourself, to activate your fight-flight response, then a pathway gets activated of helplessness and collapse.

So this issue of physical helplessness is central to the trauma that you really collapse in the face of it. But that evokes actually is another piece that barely gets talked in terms of trauma. And that is like Oprah Winfrey wrote this book with my friend Bruce Perry, What Happened to You? And indeed, what happened to you is very important. But even more important is who was there for you? Yeah.

You see it in your practice. People go through terrible experiences in surgery, but if they have a loving family that comes visit them, if the nursing staff takes really good 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 a violent parent and having the other parent 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 perpetrated. 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, there's help out there and, and you should read the book because I think, I think this is going to ring true for a lot of people. I, I, it 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, there's a, there's a collective human experience that maybe has more similar notes than I think people realize. Yeah.

This is really an important point. Basically, everybody who I know well has had traumatic experiences. Who have little pieces that really got stuck

Most of them are pretty well functioning and they can do okay relationships, but there are things that trigger them, that make them irrational. And we know that about people in our environment. Oh, we'll go out for dinner over there, but we should not base 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 point. But I saw earlier in my career, as did my friend Julie Herman, that when you get people into talking about their trauma, the danger is that it becomes their 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 it's, how do we change it? I came from the world of psychoanalysis, where we talked endlessly, and then we discovered medications and brain chemistry, so it became the second pillar. But what became important to 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 helplessness or their isolation that occurred at that time. So over time, I 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. So 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. Yeah.

So, we're talking about, I'd say this is really the work of my friends Peter Levine and Pat Ogden, who really discovered that traumatized people get very frozen in their bodies. They hold the trauma in their bodies, and that's absolutely 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 molested the issue of touch becomes very contaminated

And I also am very aware of belly-to-belly contact. It's the primary way in which we primates comfort ourselves. Now, we don't do belly-to-belly contact in 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. Yeah.

And so a very important part of healing from particularly childhood 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 activates 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. Hmm.

So it changed 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 the war.

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? Eye movement 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? No, you first measure 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. This podcast is supported by Sleep Number.

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I'm Anderson Cooper. Grief isn't talked about much, but that's what my podcast is all about.

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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, 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 adaptive response. It's an illness response that 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. Things like EMDR and neurofeedback really can help.

to calm that whole system down. But the small t 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 t 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 this wouldn't have happened to me. And you get this identity of being: I'm fundamentally 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. These early adaptations may become major characterological issues. And that becomes really much more of a clinical challenge. So what do you do for somebody in the scenario you just described? That is very psychedelic-ish.

It became dramatically helpful. For most of the past 10 years, I've 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 MDMA.

at least five major articles, one of which won the prize in magazine science as one of the 10 most important breakthroughs of the year about three years ago. And the FDA just turned it down to legalize it.

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. They said, we 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. Could you mention MDMA? The study we did was MDMA, also known as 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 a completely different substance from MDMA or psilocybin or LSD, they all seem to have similar results of opening up that mind to new substances.

perceptions, new understandings. But chemically they're very different agents. What people discovered about psychedelics is it opens critical windows

So the brain develops on the basis of experience. And if we don't get the right input at the right time, our brain may not develop the capacity to do that. You need to get the input at the right time. And that's been a huge issue in our field, of course, because a lot of people have had bad experiences and something happened to them that did not get something in there, including something I like to call drinking the milk of human kindness.

and that some people just didn't get kindness at the right time and they don't get comforted by kindness. The research now shows every one of the psychedelics opens up this clinical window for a moment so the brain can actually take in information and reorganize itself on the basis 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 at 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. Does this last? Is this a durable effect?

Yes, that's very striking actually. Also, we saw that in MDMA is that once you might get reset, it is reset. Once you have gone scuba diving, you never forget scuba diving.

So 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 absolutely 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 Reagan, like, "Just say no to drugs," and now to say, and I did in my editorial, "This may be a very good treatment for fentanyl, the fentanyl epidemic, because people take fentanyl because they feel so terrible. Nobody takes fentanyl for the hell of it."

You and I wouldn't take fentanyl. Our lives are too failed and too interesting 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 wrote in my editorial for the Boston Globe, you know, with all these people who feel so out of it and so disconnected, uh,

the psychedelic ages may have the potential of having a great positive effect on the 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 assault. EMDR is a wonderful treatment to soften and integrate that one-time memory, that specific event.

When people feel like fundamentally, I always feel like I'm a piece of shit. Or fundamentally, even though I know you're a nice guy, I'm still uptight and scared. So this ingrained living in an internal terrifying experience, the psychedelics is very good for that to open that up for people. This is going to 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. Like in the, I guess the question really is like, what's the, what's the downside? I mean, maybe, maybe having some trauma and all that, just normal part of life, you know, 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 human beings. These are the people I'm talking about. Yeah. And wouldn't it be great if that person could get a feeling, oh my God, I was really a beautiful kid back then. And too bad what that kid went through. And you change your whole orientation towards yourself...

of being a person who deserves nurturing and who enjoys being nurtured. And I've seen that. That's what I see in 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, that's not the end. That would be where traditional therapy stops. Like, oh, and because of that, I never felt like it, wouldn't I? So that's the understanding piece. And now if you get real treatments, for example, psychedelics, you'll go like, oh, I always hated myself.

for being so small and not fighting back. But I was three years old, and I was just this little kid. I did the best I could. Oh, my God. And you change your attitude about yourself. And now when your 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 ever

where we actually look what happened in people's brains as they relive their trauma. You couldn't do that today anymore because it was a very traumatizing experience to lie in a 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 Broca's area shut down.

So you were not able to talk anymore, very much like as if you had a 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. What we saw on our scan is that people became more

overwhelming feelings in the right 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 this 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 sitting there, oh, let me tell you how I had the gunshot wound. And you can see that in the brain, but over time, the brain 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. Absolutely.

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. That really was what first got me interested in this whole field. I immediately saw that their bodies are frozen or hyperreactive 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 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 what your mind is capable of creating in terms of creating a story about what happens. But the experience is not in your physiology, imprinted on your 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 when you treat traumatized people is that that story changes. And often, certainly with psychedelics, but also with everything else we do, new elements come up. And these new elements come in that people had completely suppressed. 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 establishment has 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 research

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 the 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 another 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, etc. But in every square, in every park in China, people are 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 dancing,

All this stuff that none of us would ever do as in us, ah, that's for crazy people in 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. All 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. That's right. Doing yoga, EMDR, doing the tango, doing Tai Chi. Right. Trying to realign your mind and your body is worth doing. Yeah.

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. So 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 bestselling 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 Aaron Mathewson, Jennifer Lai, Grace Walker, Lori Gallaretta, Jesse Remedios, Sophia Sanchez, and Kira Dering. Andrea Kane is our medical writer. Our senior producer is Dan Bloom. Amanda Seeley is our showrunner. Dan DeZula is our technical director. And the executive producer of CNN Audio is Steve Liktai.

With support from Jameis Andrest, John D'Onora, Haley Thomas, Alex Manassari, Robert Mathers, Laini Steinhardt, Nicole Pesaru, and Lisa Namarou. Special thanks to Ben Tinker and Nadia Kanang of CNN Health and Katie Hinman.

There's a reason the Sleep Number smart bed is the number one best bed for couples. It's because you can each choose what's right for you whenever you like. Firmer or softer on either side, Sleep Number does that. One side cooler and the other side warmer, Sleep Number does that too. You have to feel it to believe it. Sleep better together. And now save 50% on the new Sleep Number limited edition smart bed. Limited time. Exclusively at a Sleep Number store near you.

See store or sleepnumber.com for details.

This week on The Assignment with me, Adi 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 mixed 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.