Entendiendo y SANANDO tus traumas / Audiolibro completo

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¡Bienvenidos a un profundo viaje de conocimiento y reflexión! 📘 En este video exploraremos los reveladores conceptos, un material esencial que ha iluminado a millones alrededor del mundo y ha sido traducido a 20 idiomas.

nos sumerge en una profunda exploración del trauma, sus consecuencias y las múltiples vías para la sanación. En este video, desglosaremos sus enseñanzas más valiosas, descubriremos innovadores enfoques terapéuticos y exploraremos cómo el conocimiento y la comprensión del trauma pueden catalizar la transformación y la resiliencia.

🧠 Temas Clave que Abordaremos:

Impacto del trauma en mente y cuerpo.
Estrategias y tratamientos para la recuperación.
Análisis y reflexiones sobre casos reales y prácticas de sanación.

¿Por qué Verlo?
Si eres un profesional de la salud mental, sobreviviente de trauma, o simplemente alguien interesado en comprender los intricados laberintos de la mente humana y el impacto del trauma en nuestra vida, este video te ofrecerá insights valiosos y te abrirá puertas a nuevas perspectivas y posibilidades de sanación y crecimiento.

Lo que Descubrirás:
Innovadores enfoques terapéuticos y científicos sobre el trauma.
Reflexiones sobre la resiliencia humana y el poder de la sanación.
Herramientas y estrategias para enfrentar y superar el trauma.

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[Music] facing trauma it is not necessary to be a soldier or visit a refugee camp in Syria or the Congo to encounter trauma traumas happen to us, our friends, our family members and our neighbors the studies of the centers Disease control and prevention have shown that one in five Americans was

Sexually abused as a child, one in four was physically abused by a parent to the point of leaving some mark on their body, and one in three couples resorted to physical violence, a quarter of us grew up with alcoholic relatives and

One in eight has witnessed their mother being beaten. As human beings, we are an extremely resilient species. Since time immemorial, we have been recovering from incessant wars , countless disasters, both natural and man-made. man and of violence and betrayals in our own lives but traumatic experiences leave their mark both on a

Large scale in our stories and cultures and close to home in our families with dark secrets that pass imperceptibly from generation to generation they also leave their mark on our mind and in our emotions in our ability to enjoy and maintain

Intimate relationships and even in our biology and our immune system trauma not only affects those who are directly exposed to it but also those around them soldiers who return home after The wives of men who suffer from post-traumatic stress disorder (PTSD) often

Suffer from depression, and the children of mothers with depression are at risk of growing up with insecurity and anxiety after being exposed. Violence in childhood often makes it difficult to establish stable and trusting relationships in adulthood. Trauma by definition is unbearable and intolerable. Most rape victims of

Combat soldiers and children who have suffered sexual abuse suffer. So much when they think about what they have experienced that they try to get it out of their heads, they try to act as if nothing had happened to move on, it takes a lot of energy to continue functioning carrying on their backs

The memory of terror and guilt for weakness and vulnerability. absolute Although we all want to continue moving forward and leave the trauma behind, the part of our brain that guarantees our survival, below our rational brain, is not very good at denial. After the traumatic experience, this part can reactivate at

The slightest hint of danger immobilize the altered brain circuits and secrete enormous amounts of stress hormones this precipitates unpleasant emotions intense physical sensations and impulsive and aggressive actions these post-traumatic reactions seem incomprehensible and overwhelming as they feel out of control trauma survivors begin to fear that they are damaged in their The first

Time I remember wanting to study medicine was at summer camp when I was 14, my cousin Michael kept me up all night telling me about the complex functioning of the kidneys, which secrete waste material from the body. body and then reabsorb the chemicals that keep the system in medical rotation in psychiatry, however,

I was surprised by the contrast between the incredible complexity of the mind and the ways in which human beings are connected and linked to each other with how little psychiatrists knew about the problems they were treating. How to know so much one day about the brain, mind and

Love as what we know about the other systems that make up our body obviously We are still very far from having this type of detailed knowledge but the birth of three new branches of science has generated an explosion of knowledge about the effects

Of psychological trauma abuse and abandonment these new disciplines are neuroscience the study of how the brain supports mental processes developmental psychopathology the study of the impact of negative experiences on the development of the mind and brain and interpersonal neurobiology the study of How our behavior influences

The emotions, biology and mentality of the people around us, research in these new disciplines has revealed that trauma produces real physiological changes including the recalibration of the brain’s alarm system An increase in the activity of stress hormones and alterations in the system that distinguishes relevant information

From irrelevant information. We know how trauma affects the brain that transmits the physical sensation of being alive. These changes explain why traumatized people develop hypervigilance in the face of threats to life. Costa of spontaneity in their daily lives also help us

Understand why traumatized people often suffer repeatedly from the same problems and why it is so difficult for them to learn from experience. We know that their behavior is not the result of any moral effect or a lack of willpower or bad character is caused by

Real changes in the brain. This greater knowledge about the basic processes underlying trauma has also opened up new possibilities for alleviating or even reversing its damage. We can now develop methods and experiments that use the brain’s own natural neuroplasticity to help survivors feel completely alive

In the present and move forward with their lives. There are fundamentally three ways, one from top to bottom, talking, reconnecting with others, allowing us to know and understand what is happening to us while we process memories. from trauma two by taking drugs to silence inappropriate alarm reactions

Or using other technologies that change the way the brain organizes information and three from the bottom up allowing the body to have experiences that profoundly and instinctively contradict helplessness, rage or fear. collapse resulting from trauma knowing which is best for each individual survivor is an empirical question most people

I have worked with have needed a combination of all three in this I have worked my entire life in this endeavor I have had the support of my colleagues and students of the trauma Center that I founded 30 years ago together we have treated thousands of children and adults with trauma Victims

Of child abuse of natural disasters of wars of accidents and human trafficking people who have been attacked by acquaintances and by strangers we have a long tradition of talking deeply about our patients at weekly treatment team meetings and carefully following how different treatments work for each of them

Individually our main mission has always been to assist the children and adults who have come to our center to be treated but from the beginning we have also dedicated ourselves to research to explore the effects of traumatic stress in various populations and determine which

Treatments work best for whom we have received research grants from the National Institute of Mental Health of the National Center for Complementary Medicine and alternative of the disease control centers and several private foundations to study the effectiveness of many different forms of treatment from medications to conversational therapy yoga emd

Er theater and neurofeedback the challenge is the following How to regain control over the remains of the traumas of the past and take back ownership of our own life, conversations, understanding and human connections help and drugs can calm

Overactive alarm systems but as we will also see, the traces of the past can be transformed by having physical experiences that directly contradict helplessness, rage and fear. collapse that are part of the trauma thus recovering self-control I do not have any favorite treatment because

There is no single approach that works for everyone but I practice all forms of treatment. that I describe in this book, each of them can produce profound changes depending on the nature of the problem in question and the Constitution of each person. I wrote this book

To serve as a guide and as an invitation, an invitation to face the reality of trauma, to explore the best way to deal with it and to commit as a society to using every means we have to prevent it part one rediscovering trauma chapter 1 lessons from

Vietnam veterans i became what i am now at age 12 on a cold, cloudy day in winter of 1975 was a long time ago but what they say about the past is not true looking back now I realize that for the last 26 years I have been peering into that deserted alley

Caled hosseini the kite runner some people’s lives seem to flow as in a narrative mine has had several stops and starts This is what trauma does it interrupts the plot it just happens and life goes on no one prepares you for it Jessica stern Daniel a memoir of terror my first

Day as a staff psychiatrist at the Boston clinic from the Veterans Affairs Administration United States It was the Thursday after the 4th of July weekend in 1978 while hanging a reproduction of my favorite Breugel painting The Blind Leading the Blind on the wall

Of my new office I heard some commotion in the reception area at the end of the hall after a while a large, disheveled man in a stained three-piece suit with a copy of Soldier of Fortune magazine under his arm burst into my office, he was so upset and

So clearly hungover that I I asked him how I could help that mass. I asked him to sit down and tell me what I could do for him. His name was Tom. 10 years before, Marin had been serving in

Vietnam. He had spent the holiday weekend locked in his law office in downtown Washington. Boston drinking and looking at old photographs instead of with his family knew from previous years that the noise, the fireworks, the heat, and the picnic in his sister’s yard with all

The expansive foliage of early summer as a backdrop all of which made him He remembered Vietnam would drive him crazy when it got so bad, he was afraid to be with his family Because he behaved like a

Monster with his wife and two small children The noise of the children upset him so much that he had to leave the house in a rage to avoid making them angry. damage He only calmed down by drinking Para Olvidar or

Driving his Harley Davidson at dangerous speeds at night. It didn’t give him much respite either since he constantly woke up with nightmares about an ambush in a field in Nam in which all the members of his platoon died or ended up injured He also suffered terrible

Flashbacks in which he saw dead Vietnamese children. The nightmares were so horrible that he feared falling asleep so he often stayed awake most of the night drinking. In the morning his wife would often find him lying on the couch in his living room. Tom told me that he had graduated from college in

1965 with the best grades in his class in line with family tradition of military service he enlisted in the Marine Corps immediately after graduating his father had served in World War II in General Patton’s army and Tom never questioned his father’s expectations Intelligent athletic and obvious leader Tom felt Powerful and effective,

After completing basic training, a team member who felt prepared for almost anything in Vietnam quickly became the platoon leader in charge of eight other Marines. Surviving wading through the mud under machine gun fire can leave people with a fairly positive perception of themselves and their peers at the

End of their military mission Tom graduated with honors and all he wanted was to leave Vietnam behind Apparently that’s what he did he went to college thanks to the relief act for veterans la ge bill and graduated from law school married his high school sweetheart Y

Tom was worried about how hard it was for him to feel real affection for his wife, even though her letters had kept him alive in the madness of the jungle. Tom mechanically lived a

Normal life, hoping that pretending would allow him to learn to love again. to be the same as before now He had a law firm and a picture-perfect family but he didn’t feel normal he felt dead inside Although Tom was the first veteran that I knew on a professional level, many aspects of

His story were familiar to me in the Netherlands of the postwar period playing in bombed buildings with a father who had so fervently opposed the Nazis that he was sent to an internment camp my father never spoke about his experience in the war but from time to time

He suffered attacks of explosive rage that as As a small child, they surprised me. How could it be that the man I heard creeping down the stairs every day to pray and read the Bible while the rest of the family slept could have such a terrifying temperament. How could someone

Whose wife was dedicated to the pursuit of justice? social being so full of rage I witnessed the same disconcerting behavior with my uncle who was captured by the Japanese in the Dutch East Indies (present-day Indonesia) and sent as slave labor

To Burma where he worked on the famous bridge over the river which he also did not mention war and he also suffered uncontrollable fits of anger. While listening to Tom I wondered if my uncle and father had suffered nightmares and flashbacks if they too felt disconnected from

Their loved ones and unable to experience true pleasure in life in somewhere in the back of my mind I must also have memories of my terrified and often frightening mother whose childhood trauma was sometimes alluded to and who I now believe she frequently reenacted

Had the disturbing habit of fainting when I asked her what her life was like. life as a little girl and then blaming me for making her feel so bad reassured by my obvious interest Tom

Calmed down and told me how scared and confused he was he was afraid of becoming like his father who was always angry and hardly ever spoke to his children except to compare them unfavorably with their companions who had lost their lives at Christmas 1944 during the Battle of the

Bulge. As the session drew to a close, I did what doctors usually do. I focused on the part of Tom’s story that I thought I had understood his nightmares when I was studying medicine. I worked in a sleep laboratory observing patients’ sleep cycles

And I collaborated in writing some articles on pills. I also participated in some early studies on the beneficial effects of psychoactive drugs that were being started. to be used in the 70s so although I did not fully understand the extent of

Tom’s problems, nightmares were something I knew better and as a fervent believer that chemistry can give us a better life I prescribed a drug that I knew was effective for reduce the incidence and severity of nightmares I scheduled a follow-up visit for

Tom in two weeks. When he returned for the next visit, I asked him anxiously how the drug had gone. He told me that he had not taken any pills, trying to hide my irritation. I asked why I realized that if I took the pills and the nightmares

Went away he told me I would be abandoning my friends and their death would have been in vain I must be the living one of My friends who died in Vietnam I was perplexed Tom’s loyalty to The dead were preventing him from living his own life just as his father’s devotion to

His friends had prevented him from living his own. The experiences of the father and son on the battlefield had made the rest of his life irrelevant. How it had happened and What we could do about it That morning I realized that I would probably spend the rest of my

Professional life trying to unravel the mysteries of trauma How horrible experiences cause people to remain hopelessly stuck in the past What happens in the mind and brain of the people who keep her paralyzed trapped in a place from which they desperately want to escape

Why that man’s war did not come to an end in February 1969 with the hug of his parents at Boston’s Logan International Airport after his long flight from danang Tom’s need to live his life as a tribute to his peers made me understand that he was suffering from a pathology

Much more complex than simply having bad memories or altered brain chemistry or altered fear circuits in the brain before the ambush in the rice field Tom had been a devoted friend and Loyal a person who enjoyed life with many interests and pleasures in a

Terrifying time the trauma had transformed everything during my time in the administration for veterans affairs see I knew many men who responded in kind In a similar way, when faced with even minor frustrations, our veterans would instantly show extreme rage. The public areas of the clinic were marked with the impacts

Of their fists on the drywall, and security officers were busy protecting agents and veterans rage receptionists obviously their behavior scared us but I was also intrigued at home my wife and I faced similar problems with our young children who often had tantrums when we asked them

To eat the spinach or get some socks So why the immature behavior of my children did not bother me at all but I was deeply concerned about what was happening to the veterans leaving aside their size Obviously with the potential to do

Much more damage than my two little ones at home the reason was that I was fully confident that with proper care my children would gradually learn to handle frustrations and disappointments, however I was quite skeptical about my ability to help my veterans reacquire the self-control and self-regulation skills that they had

Unfortunately lost in the war. Nothing in my psychiatric training had prepared me to handle any of the challenges that Tom and his companions presented. I went down to the medical library to consult books on neuroses, war neuroses, battle fatigue, or any other term or diagnosis I

Could think of that would shed some light. light on my patients To my surprise in the vaa library there was not a single book on any of these disorders 5 years after the last American soldier left Vietnam The problem of war trauma was still not on

Anyone’s agenda finally In the Cway Library at Harvard Medical School, I discovered the book The Traumatic Neurosis of War, published in 1941 by a psychiatrist named Abraham Kardashian. In it, the author described his observations on veterans of the First World War and was

Published in advance of the wave of soldiers with shell shock who were expected to be discharged in World War II. Ciner described the same phenomenon I was seeing after the war. These patients were overcome by a sense of worthlessness. They became unsociable

And detached. Even though they had previously had normal functioning what ciner called traumatic neuroses is now known as post-traumatic stress disorder PTSD kardiner observed that people who suffered from traumatic neuroses developed a chronic state of vigilance and a sensitivity to threat his summary particularly caught my attention the

Core of the neurosis is a physioneuro two In other words, post-traumatic stress is not entirely in the person’s head as many people assumed, but rather has a physiological basis. Kardiner then understood that the symptoms have their origin in the response of the entire body to

The original trauma. Kardiner’s description corroborated my own observations which was reassuring but gave me few clues on how to help veterans the lack of literature on the subject was a handicap but my great teacher elvin sembrad had taught us to be skeptical

Of textbooks alone We had a single manual, it said our patients should only trust in what we could learn from them and from our own experience This sounds too simple but although Semrad pushed us to trust in self-knowledge he also warned us about

How difficult this process is since human beings are experts in wishful thinking and obscuring The truth is, I remember him saying that the greatest source of our own suffering is the lies we tell ourselves. Working on life, I soon discovered how painful

It can be to face reality and this applied to both my patients and myself. I really didn’t. We want to know what soldiers suffer in battle. We really don’t want to know how many children are touched and sexually abused in our society or how many couples.

It seems that a third of them resort to violence at some point during their relationship. We want to think about our families as a safe place in a heartless world and in our country as a place inhabited by tolerant and civilized people we prefer to think that

Cruelty only happens in distant places like Darfur or the Congo it is already hard enough for observers to witness the pain So someone cares It is surprising that the very people who have suffered a trauma cannot bear to remember it and that they often resort

To drugs, alcohol or self-mutilation to block out something so unbearable to know. Tom and the rest of the veterans became my first teachers on my path to understand how life is shattered after these painful experiences and to discover How to allow

Trauma and loss of self to feel fully alive again. The first study I did at the eba began by systematically asking veterans what had happened to them in Vietnam . Knowing what had pushed them over the edge and why some had been broken as a result

Of that experience while others had been able to move on with their lives. Three most of the men I interviewed had gone to war feeling prepared. United by the rigor. of basic training and shared danger they exchanged photographs of

Their relatives and girlfriends putting up with each other’s flaws and were willing to risk their lives for their friends most confided their dark secrets to a friend and some went so far as to share shirts and shirts. socks with the rest, many of the men maintained friendships

Similar to those of Tom with Alex, he met Alex, an Italian from Malden Massachusetts on his first day in the country and they immediately became close friends, they drove the jeep together, listened to the same music and read to each other. letters from their relatives getting drunk together and

Chasing the same Vietnamese girls in bars after about three months in the country one day Tom was leading his team on a foot patrol through a field just before sunset suddenly a hail of gunfire He began to fall from the green wall of the jungle that surrounded them, reaching one

By one the men around him. Tom told me how he watched with helpless horror how all the members of his platoon died or were wounded in a matter of seconds. I could never

Get the image of the back of Alex’s head out of my mind with him face down in the rice paddy with his feet in the air Tom cried remembering he was the only real friend I had later that night Tom kept

Hearing the screams of his men and Watching their bodies fall into the water, any sound, smell or image that reminded him of that ambush, like the sound of the fireworks on the 4th of July, made him feel just as paralyzed, terrified and enraged as the day a

Helicopter evacuated him from the field, but Even worse for Tom than the recurring flashback of the ambush was Perhaps The memory of what happened next was easy to imagine how Tom’s rage at the death of his friend led to the misfortune that occurred after he

Spent months trying to overcome the remorse that he felt. They paralyze him before he can tell me about it. Since time immemorial, veterans like Achilles in Homer’s Iliad have responded to the death of their companions with atrocious acts of revenge the day after the ambush Tom

He went in a state of hysteria to a neighboring village and killed children, shot an innocent farmer and raped a Vietnamese woman. After that it was completely impossible for him to return home in

A normal way. How can you stand in front of your Beloved and tell her that you have violently raped a woman like her or watching your son take his first steps reminding you of the child you murdered Tom lived through Alex’s death as if part of himself had been destroyed

Forever the good honorable and reliable part the trauma whether It is the result of something that has been done to us as if it is something that we have done We almost always make it very difficult to establish intimate relationships after experiencing something so atrocious How to learn to trust

Yourself or another person or vice versa How to Surrender to an intimate relationship After being brutally raped Tom continued to come loyally to the visits as I became his lifeline in the father he never had in an alx who had survived the ambush

It takes enormous trust and a lot of courage to allow yourself to remember One of the most difficult things for people who have suffered a trauma is to confront the regrets of how they behaved during the traumatic episode, whether it is objectively justified as

In the commission of atrocities or not, as in the case of a child trying to appease your abuser one of the first people to write about this phenomenon was Sarah hay who had her office next to mine at the Bea clinic in an article titled When

The patient reports atrocities four when the patient reports atrocities that was one One of the great impulses for the definitive creation of the diagnosis of PTSD described the enormous and intolerable difficulty of talking about and listening to the horrendous acts that soldiers often commit

In the course of their war experiences. It is difficult enough to cope with the suffering inflicted on other people. But many deeply traumatized people suffer even more from the remorse they feel for what they did or did not do under certain circumstances. They appreciate themselves by how terrified, dependent,

Excited or furious they felt in later years. There is a similar phenomenon among victims of child abuse, most of them have excruciating remorse for the things they did. To survive and maintain a connection with the person who abused

Them, this is especially applicable if the abuser was a person close to the child. someone on whom the child was dependent as is the case so often the result can be confusion about whether the victim was a victim or a willing participant which in turn causes confusion

About the difference between love and terror pain and pleasure we will return to this dilemma later in this book desensitization Perhaps The worst of Tom’s symptoms was that he felt emotionally desensitized he desperately wanted to love his family but could not evoke any

Deep feelings for them he felt emotionally distant from everyone as if his heart Even though he was frozen and lived behind a glass wall, this desensitization extended to himself and he couldn’t really feel anything except his momentary rage and remorse.

He described how he barely recognized himself when he looked in the mirror to shave when he heard himself defending himself. A court case was observed from a distance and he wondered how this guy who looked like him and spoke like him could argue

So convincingly when he won a case he pretended to feel gratified and when he lost it it was as if he had seen it coming and resigning himself to defeat before it happened, despite being a very effective lawyer, he always felt as if he were floating in space without purpose or

Direction. The only thing that occasionally mitigated this feeling of aimlessness was intense involvement in a particular case. During the course of our treatment Tom had to defend a mobster accused of murder throughout that trial he is totally absorbed in devising a strategy to win the case and there were several occasions when he

He got up at night to immerse himself in something he was really passionate about. It was like being in a fight. He said he felt totally alive and nothing else mattered after winning that case. However, Tom lost all his energy and direction. The nightmares returned, as did his attacks of rage. so

Intensely that he had to go to a motel to make sure he didn’t hurt his wife or children, but being alone was also terrifying because the demons of war were coming back in full force. Tom tried to stay busy, working, drinking, and taking drugs, doing

Whatever he wanted . something to avoid facing his demons he continued watching Soldier of Fortune fantasizing about enlisting as a Mercenary in one of the many regional wars that devastated Africa that Spring he took his Harley and headed towards the Kancamagus Highway in New Hampshire

The vibrations the speed and the danger of riding a motorcycle helped him compose himself to the point of being able to leave the motel room and return to his family the reorganization of perception another study I conducted at the ba clinic began as research on nightmares

But ended up exploring how trauma changes people’s perception and imagination Bill, a former doctor who had lived through the harsh fighting in Vietnam a decade earlier, was the first person targeted in my study on nightmares. After graduating, he enrolled in a theological seminary and was assigned his first parish. in a

Congregational church in a suburb of Boston he was doing well until he and his wife had their first child. Shortly after the baby was born his nursing wife returned to work while he stayed at home working on his weekly sermon and others. parish duties and taking care of the

Newborn the first day he was left alone with the baby he began to cry and suddenly he found himself inundated with unbearable images of children dying in Vietnam Bill had to call his wife to take care of the baby and he came to the clinic in a state of panic. He described how

He kept hearing the sound of children crying and seeing images of burned and bloody children’s faces. My fellow doctors thought he was probably stung because the manuals of the time said that hallucinations The auditory and visual symptoms were symptoms of paranoid schizophrenia.

The same texts that gave this diagnosis also indicated the cause. Bill’s psychosis was probably triggered by his sensation of feeling displaced in his wife ‘s affections by his new son that day when he arrived at the doctor’s office. admissions I saw Bill surrounded by

Worried doctors ready to give him a powerful antipsychotic drug and send him to a locked room. They described his symptoms and asked my opinion. Having previously worked in a unit specializing in the treatment of schizophrenics, I was

Intrigued. There was something about him. diagnosis that didn’t fit me I asked bill if I could talk to him and after listening to his story I unconsciously paraphrased something that Sigmund Freud said about trauma in 1895 I think this man suffers from his memories I told bill I would try to

Help him and after offer him medication to control his panic, I asked him if he would like to come back in a few days to participate in my study on nightmares. He accepted that as part of the study, the participants took a Rorschach test. Unlike tests

That require answers to direct questions, the answers of The Rorschach test is almost impossible to fake. This test is a unique way to observe how people construct a mental image from a stimulus that has no meaning. An inkblot.

Like human beings, we are creatures that always look for meaning in things we tend to create a certain type of image or story From those ink stains just like when we are in a meadow on a summer day and we see images in the clouds floating in the sky what people

Build with those stains can tell us a lot about how your mind works by looking at the second card of the rorschach test Bill exclaimed in horror is that boy I saw flying through the air in Vietnam in the middle I see the burned flesh the wounds and the blood gushing out

Everywhere panting and with sweat on his forehead he was in a panic situation similar to the one that initially brought him to the Bea clinic Although I had heard veterans describe their flashbacks this was the first time I witnessed one at that time in my consultation Bill was

Evidently seeing the same images smelling the same odors and feeling the same physical sensations that he felt during the original event 10 years after helplessly holding a dying child in his arms Bill was reliving the trauma in response to the sight of a stain of ink Experiencing Bill’s flashback firsthand in my office

Helped me become aware of the agony that the veterans I was trying to treat often suffered and helped me reassess how important it was to find a solution to the traumatic event itself. although horrendous it had a beginning a middle and an end but the flashbacks

From what you can see could be even worse you never know when they are going to hit you again and you have no way of knowing when they will end it took me years to learn how to deal effectively with

Flashbacks And in this process Bill turned out to be one of my most important mentors when we gave the Rorschach test to 21 other veterans the response was consistent 16 of them when they saw the second card reacted as if they were experiencing war trauma the second

Rorschach card is the first which contains color and usually provokes the so-called color shock in response. The veterans interpreted this card with descriptions such as my friend Jim’s intestines after a mortar shell destroyed him and my friend Dani’s neck after a projectile blew his mind while we were having lunch none of them

Mentioned dancing monkeys or fluttering butterflies or men on motorcycles or any of the ordinary and sometimes outlandish images that most people see while most of the old-timers were very upset by the images The reactions of the remaining five were even

More alarming. They simply went blank, it’s nothing. Only one said, a lot of ink. They were obviously right, but the response of a normal human being to an ambiguous stimulus is to use the imagination to read something from Through these Rorschach tests we learned that

Traumatized people tend to superimpose their trauma on everything around them and that they have a hard time deciphering what is happening around them. There seemed to be little ambiguity. We also learned that trauma affects the imagination. Five men who saw nothing in the inkblots had

Lost the ability to play with their minds, but so did the other 16, since by seeing scenes from the past in those inkblots they were not showing the mental flexibility that is the hallmark of the imagination. They simply reproduced an old reel imagination is absolutely critical

To our quality of life our imagination allows us to escape our routine daily existence by fantasizing about traveling eating sex falling in love or having the last word all the things that make life interesting imagination gives us the opportunity to contemplate new possibilities is an essential launching pad for our

Hopes to become reality ignites our creativity mitigates Boredom relieves our pain enhances our pleasure and enriches our most intimate relationships when people are constantly and compulsively drawn back into the past to the last time they felt intense involvement and deep emotions suffer from a lack of imagination a loss of

Mental flexibility without imagination there is no hope there is no possibility of contemplating a better future there is no place to go there is no goal to achieve rorschach tests We were also taught that traumatized people look at the world in a fundamentally different way than other people.

For most of us, a man walking down the street is just someone taking a walk. A rape victim will nevertheless see a person who is going to Abuse it and they will panic. A Severe teacher can be an intimidating presence to a normal child, but to a child

Whose father hits you may represent a torturer and send you into a fit of rage or leave you cowering in a corner stuck in trauma. Our clinic was flooded with veterans seeking psychiatric help however due to a severe lack of qualified doctors the only

Thing we could do was to put the majority on a waiting list even while they continued to mistreat them among drunks, as well as an alarming number of suicides. They authorized me to set up a group with young Vietnam veterans to serve as a holding tank while waiting to

Be able to start treatment with them. really at the opening session for a group of veterans the first man to speak stated flatly I don’t want to talk about the war I responded that the participants could talk about anything they wanted after half an hour

Of unbearable silence a veteran finally began to speak of their helicopter accident To my surprise the rest immediately came back to life talking intensely about their traumatic experiences they all came back the following week and the week after that in the group

They found a resonance and meaning to what had previously been only sensations of terror and emptiness, they felt a renewed sense of camaraderie that had been so important in their war experience. They insisted that I be part of their newly created unit and gave me a Marine Captain’s uniform for my

Birthday, looking back on that gesture. revealed part of the problem you were in or out you belonged to the unit or you were nobody after the trauma the world is clearly divided between those who know and those who don’t people who have not shared the traumatic experience are not

Trustworthy because they cannot understand it sadly this often includes wives children and co-workers later I led another group on this occasion they were Paton army veterans men over 70 years old all old enough to be my parents we met on Mondays at 8 in the morning in Boston, snow storms

Sometimes paralyze public transportation, but to my surprise they all came even when there was a blizzard, some of them walking arduously several kilometers through the snow to get to the VVA clinic for Christmas, they gave me a gift a wristwatch from the 1940s, as was the case with

The previous group of Marines, I couldn’t be their doctor. Unless I became one of them. No matter how emotional those experiences were, the limits of group therapy became clear when I asked Those men who talked about the problems they faced in their

Daily lives, their relationships with their wives, their children, their friends and family, their dealings with their bosses and having a satisfying job, their high alcohol consumption, their usual response was to shy away. the theme resist And instead tell again How

A dagger was stuck in the heart of a German soldier in the Hürtgen forest or how his helicopter was shot down in the jungles of Vietnam whether the trauma had happened 10 years ago or more 40 my patients could not build a bridge between their War experiences and their current lives in

A way the event that caused them so much pain had also become their only source of meaning they only felt fully alive when they remembered their traumatic past diagnose post-traumatic stress in that early period in the clinic of the failure label let’s go to veterans with all types of diagnoses alcoholism

Substance abuse depression mood disorder even schizophrenia and probability even dedicating all our efforts it was clear that in reality we were achieving very The powerful drugs I prescribed often left them so confused that they could barely function when a traumatic event often inadvertently triggered itself. In

1980, a turning point occurred. turning point when a group of Vietnam veterans with the help of New York psychoanalysts Chim Shatan and Robert J Lifton successfully lobbied the association of psychiatry to create a new diagnosis, post-traumatic stress disorder (PTSD

), which described a set of symptoms common to a greater or lesser degree to all of our veterans, systematically identifying the symptoms and grouping them together into a disorder that finally gave a name to the suffering of people nullified by the terror and helplessness with the conceptual framework of

Tpt the ground was already fertile for a radical change in our way of understanding our patients in the long run. This led to an explosion of studies and attempts to find effective treatments, inspired by the possibilities it presented. With this new diagnosis, I proposed

To the clinic a study on the biology of traumatic memories. The memories of people who suffer from PTSD were different from those of others. For most people, the memory of an unpleasant event fades over time or It transforms into something more benign but

Most of our patients were unable to consider their past as a story that had happened a long time ago the first line of the grant denial letter said like this tpt has never been shown to be relevant to The mission of the Veterans Affairs Administration has since, of course, been organized around

The diagnosis of PTSD and brain damage, and significant resources have been devoted to the application of evidence-based treatments to veterans. war traumatized but at that time things were different and not being willing to continue working in an organization

Whose vision of reality was so different from mine, I resigned in 1982 and took up my new position at the Massachusetts Mental Health Center and University Hospital. from Harvard where I studied to become a psychiatrist my new responsibility was to teach a new area

Of ​​study psychopharmacology the administration of drugs to alleviate mental illness in my new job I was confronted almost daily with problems that I thought I had left behind in the clinic Fibas, my experience with war veterans had made me so sensitive

To the impact of trauma that I now listened in a very different way to the depressed and anxious patients who told me their stories of sexual abuse and family violence, especially I was surprised by the The number of female patients who reported that they had suffered

Sexual abuse as children was disconcerting because the standard psychiatric manuals of the time stated that incest was very rare in the United States and that it only occurred in one in a million women. that there were only about 100 million women

At that time living in the United States, I wondered how almost half of them had managed to find my office in the hospital basement, and the manuals said there was little consensus on the role of father-daughter incest as source of severe subsequent psychopathology

My patients with histories of incest were far from not suffering from subsequent psychopathology, they were deeply depressed, confused, and often engaged in strangely self-harming behaviors such as cutting themselves with razor blades. The books still practically endorsed incest by explaining that this incestuous activity reduces the possibility

Of suffering psychosis on the part of the subject and allows a better adjustment to the outside world. In reality, however, it turned out that incest had devastating effects on the well-being of women. In many ways, these patients were not so different from the veterans who had just been treated

. leave behind in Bea’s clinic They also had nightmares and flashbacks, they also alternated between occasional outbursts of explosive rage and long periods of emotional disconnection, most of them had had many relationship problems with others and found it difficult to maintain

Serious relationships, as we know in the war. It is not the only misfortune that ruins the lives of human beings. While approximately a quarter of soldiers serving in war zones are expected to develop serious post-traumatic problems, the majority of Americans suffer

A violent crime at some point in their lives and some more detailed reports have revealed that 12 million women in the United States have been Victims of rape more than half of all rapes occur in girls under the age of 15 for many people the war begins at

Home Each year approximately 3 million children in the United States are considered victims of child abuse and neglect. One million of those cases are serious and credible enough to compel local child protective services or juvenile courts to address them. take

Action In other words, for every soldier who serves in a war zone abroad there are 10 children in danger in their own home. This is especially tragic because it is very hard for a growing child to recover when faced with terror and pain. not the enemy but

Their own caregivers a new focus in the three decades since I met Tom I have learned a great deal not only about the impact and manifestations of trauma but also about how to help people with trauma find themselves again Since the early 1990s,

Brain imaging tools have begun to show us what really happens in the brains of traumatized people. This has proven essential to understanding the damage inflicted by trauma and has guided us in formulating Completely new paths to recovery We have also begun to understand how overwhelming experiences affect

Our deepest sensations and relationship with our physical reality The essence of who we are We have learned that trauma is not just an event that occurred at some point in the world. The past is also the trace left by an experience in the mind, brain

And body. This trace has permanent consequences on the way in which the human organism manages to survive in the present. Trauma generates a fundamental reorganization of the management of perceptions by the mind and brain changes not only how and what we think

But also our own ability to think. We have discovered that helping trauma victims find the words to describe what has happened to them is deeply meaningful, but often the act of Telling the story does not necessarily alter the physical and hormonal responses of a body that remains hypervigilant, ready to be

Assaulted or raped at any moment. For real change to occur, the body must learn that the danger has passed and live in the reality of our present. Research to understand trauma has led us to think differently not only about the structure of the mind but

Also about the process by which it heals chapter 2 revolutions in the understanding of the mind and brain the greater the doubt the greater it is the awakening the less the doubt the less the awakening without a doubt there is no awakening cc chang the practice of sen vibes in that small portion

Of time that is yours but that portion of time is not only your own life it is the sum of all the others Lives simultaneous with yours what you are is an expression of history Robert pen

Warren World Enough and Time in the late 60s During a gap year between my first year of medicine and my second I accidentally witnessed the profound transition of the medical approach Regarding mental suffering, I got a fantastic job as an assistant in a research unit

At the Massachusetts Mental Health Center mmhc where I was responsible for organizing recreational activities for patients. The mhc had long been considered one of the best psychiatric hospitals in the city. jewel in the crown of Harvard Medical School’s teaching empire. The goal of the research

In my unit was to determine between psychotherapy and medication the best way to treat young patients who had suffered a first mental outbreak diagnosed as schizophrenia the conversation-based cure a derivation of Freud’s psychoanalysis remained the main treatment for mental illness in the mm mhc However in the early 1950s a

A group of French scientists had discovered a new component Chlor Promac sold under the name Zorin that could calm patients and reduce agitation and delusions. This gave hope for developing drugs to treat serious mental problems such as depression, panic, anxiety. and the manias as well as managing some of the

Most disturbing symptoms of schizophrenia as an assistant I was not involved in the unit’s research and I was never told what treatment any patient received they were all more or less my age Harvard students from the emit and from Boston University some

Had attempted suicide others had cut themselves with knives or razor blades several had attacked their roommates or had terrified their parents or friends with their unpredictable and irrational behavior my job was to keep them involved in normal activities for college students Like eating at the local pizzeria Camping in a

Neighboring state forest Attending Red Socks games and Sailing on the Charles River Totally new to this field I would sit enthralled during unit meetings trying to decipher the complicated discourse and logic of the patients I also had to learn to manage their

Irrational outbursts and terrified abandonments one morning I found a patient standing like a statue in his room with one arm raised in a defensive position with his face paralyzed with fear he remained there motionless for at least 12 hours the doctors told me the name

Of his pathology catatonia but none of the books I consulted said anything we could do we simply let the trauma run its course before dawn I spent many nights and weekends in the unit which exposed me to things the doctors never saw during their

Brief visits when the patients couldn’t sleep often wandered in their tight robes to the darkened nursing station to talk. The quiet of the night seemed to help them open up and they told me stories about how they had been beaten assaulted abused often their own parents sometimes relatives classmates or neighbors shared memories

Of lying in bed at night helpless and afraid listening to their mother being beaten by their father or her boyfriend listening to their parents shout horrible threats listening to each other the sound of furniture breaking others told me about their parents who came home drunk How

They listened to their footsteps on the landing waiting for them to come in they would take them out of bed and punish them for some imaginary offense several of the women remembered being awake in bed without move around expecting the Inevitable that a brother or father would abuse them during morning rounds

The young doctors presented their cases to their supervisors a ritual that the unit assistants could observe in silence they rarely mentioned stories like the ones I had heard without However, many subsequent studies have confirmed the truth of those

Median Confessions and we now know that more than half of the people who need psychiatric care have been assaulted, abandoned, abused or even raped in childhood or have witnessed violence in the home, but these experiences seemed left aside during rounds I was often surprised by how coldly they discussed patients’ symptoms

And how much time they spent trying to manage their suicidal ideation and self-destructive behaviors rather than trying to understand the possible causes of their despair and helplessness . It was surprising how little attention was paid to their achievements and their aspirations to the people

They cared about who loved or hated what motivated them and occupied them what kept them blocked And what made them feel at peace the ecology of their life years later as a newly minted doctor graduate, I was confronted with a particularly harsh example of the medical model prevailing at

That time. I was moonlighting and working in a Catholic hospital performing physical examinations on women who had been admitted to receive electroconvulsive treatment for depression. Because I was curious, I consulted their medical records and asked them about their lives. Many of them told me stories about painful marriages, difficult children, and guilt about

Having an abortion. When they spoke, they shone visibly and often thanked me profusely for having listened to them. Some of them They asked if they still needed the electroshocks after having lifted so much weight. I always felt sad at the end of those meetings knowing

That the treatments I would administer to them the next morning would erase all the memories of our conversation. I didn’t last long in that job. days I was off at the mmhc I used to go to the cway medical library to learn more about the patients I was supposed to

Help one saturday afternoon I came across a treatise that is still revered today the dementia prx manual by eugen bleuer written in 1911 Bleuer’s observations were fascinating among the bodily hallucinations in schizophrenia the sex cues are by far the most frequent and the most important these patients feel the outbursts and The joys

Of normal and abnormal sexual satisfaction but most often they can conjure obscene and disgusting practices with the most extravagant fantasies male patients have semen extracted painful erections are stimulated female patients are raped and injured in the most diabolical way despite the meaning of many of these hallucinations

Most correspond to real sensations This It made me think our patients had hallucinations, the doctors routinely asked them about them and wrote them down as indications of how disturbed they were, but if the stories I had heard in the

Wee hours of the morning were true, it could be that those hallucinations were actually fragmented memories . of real experiences were simply inventions of a sick brain there was a clear line between creativity and pathological imagination between memory and imagination that day these questions still had no answers but research has

Shown that people who have been mistreated in the childhood often feel sensations such as abdominal pain that have no physical cause hear voices that warn them of danger or accuse them of heinous crimes there was no doubt that Many patients in the unit

Engaged in strange violent and self-destructive behaviors, especially when they felt frustrated or confused . or misunderstood people, they had tantrums, they threw plates, they broke windows and cut themselves on broken glass. At that time, I had no idea why someone would react

To a simple request, let me clean that thing from your hair in anger or terror, I followed the instructions of the more experienced nurses who told me when to leave them alone or if that didn’t work to restrain the patients I was both surprised and alarmed by the satisfaction I sometimes

Felt after managing to hold a patient on the floor so that a nurse could give him a injection and little by little I realized that much of our professional training was aimed at helping us maintain control in the face of frightening

Or confusing realities Silvia was a beautiful 19-year-old Boston University student who used to sit alone in the corner of the unit looking scared to death and practically mute but whose reputation as the girlfriend of a prominent Boston mobster gave her an aura of mystery after

Refusing to eat for more than a week and rapidly beginning to lose weight so the doctors decided to feed her It took three people to hold her down, another to place the rubber tube in her throat, and a nurse to introduce liquid food

Into her stomach. Later, during a midnight confession, Silvia spoke timidly and hesitantly as a girl about her brother’s sexual hesitation. and her uncle Then I realized that our show of attention for her was probably more like a gang rape. This experience and others

Like it helped me formulate this rule for my students: If you do something to a patient you would not do to your friends or your children consider that perhaps you may unconsciously be reproducing a trauma from your past in my role as recreational manager I observed other things

As a group the patients were surprisingly clumsy and physically uncoordinated when we went camping the majority remained without doing anything While I was setting up the tents, we almost capsized during a storm on the Charles River. Because everyone was huddled under

The Sotavento, unable to understand that they had to change positions to balance the boat. At volleyball games, the staff members were always very busy. Better coordinated than patients. Another characteristic they shared was that even their most relaxed conversations seemed unnatural. They lacked the natural flow of gestures and facial expressions typical among

Friends. The importance of these observations did not seem evident to me until I met body therapists Peter Levin and pat ogden in later chapters I will comment at length How trauma is maintained in people’s bodies understanding suffering after that year

In the research unit I returned to the Faculty of Medicine And then as a newly graduated doctor I returned to the mmh to train as a psychiatrist a specialty in which I hoped to be accepted many famous psychiatrists had studied there such as Eric Candel who later won the

Nobel Prize in Physiology and Medicine Alan Hobson discovered the brain cells responsible for the generation of Dreams in a laboratory in the basement of the hospital while I was studying there and the first studies on the chemical bases of depression were also carried out at the mhc,

But for many of the residents the main attraction was the patients. We spent 6 hours a day with them and then met in groups with the most experienced psychiatrists to share our experiences. observations pose questions and compete to make The most witty observations our great professor elvin semrad actively discouraged us from reading

Psychiatry manuals during the first year this diet of intellectual starvation surely explains why most of us later became voracious and prolific readers writers Semrad did not want our perceptions of reality to be obscured by the pseudo-zeros of psychiatric diagnoses I remember

Asking him once What would he call this schizophrenic or schizoaffective patient? He paused and, touching his chin as if he were in deep reflection, he told me I think I would call him Michael mcintire semrad taught us that most human suffering

Is related to love and loss and that the job of therapists is to help people recognize, experience and endure the reality of life with all its pleasures and suffering the main source of suffering is the lies we tell ourselves

He said inviting us to be honest with ourselves with every facet of our experience he used to say that people can never improve without knowing what they already know and without feeling what they already feel I remember my surprise upon hearing this distinguished and elderly Harvard professor confess

How comforted he felt when he felt his wife’s butt against him when he went to bed at night, revealing to him that we recognize the reality of our body in all its visceral dimensions, our profession, however I was going in another direction. In 1968, the American Journal

Of Psychiatry had published the results of a study from the unit in which I worked as an assistant, demonstrating unequivocally that schizophrenic patients who had been given only drugs had better results than those who had spoken three times . times a week with Boston’s best therapists, this study was one of

Several stepping stones on a path that gradually changed the way medicine and psychiatry approached psychological problems from infinitely variable expressions of intolerable feelings to a model of brain pathology. of discrete disorders, the way medicine addresses human suffering has always been determined by the technology available in

At a certain point before the Enlightenment, aberrant behaviors were attributed to God, sin, magic, witches and diabolical spirits. It was not until the 19th century that French and German scientists began to investigate behavior as an adaptation to the complexities of the world. Thus a new paradigm emerged: anger, lust, pride,

Greed, avarice and laziness, as well as the rest of the problems that human beings have always tried to manage, became considered disorders that could be resolved with the administration of the appropriate chemical substances. Psychiatrists were relieved and delighted to become real scientists just like their colleagues in

The Faculty of Medicine who had laboratories, experiments on animals, expensive equipment and complicated diagnostic tests, leaving aside the vague theories of philosophers like Freud and Jung, an important manual of psychiatry even said the cause of mental illness is currently considered an aberration of the brain a chemical imbalance like my colleagues I

Enthusiastically accepted the pharmacological revolution in 1973 I became the first chief resident of psychopharmacology at the emm hc he may also have been the first Boston psychiatrist in administering lithium to a manic depressive patient I read John Kate’s work with lithium in Australia

And a hospital committee authorized me to approve it with lithium a patient who had had manic episodes every May for 35 years and depressed with ideas suicides every November stopped suffering from these cycles and remained stable During the three years that he was under my care

I was also part of the first research team in the United States to test the antipsychotic drug clozaril on chronic patients who were parked in the units of the behind old asylums some of their responses were miraculous people who had spent much

Of their lives locked in their own terrifying realities were able to return to their family and community patients trapped in darkness and despair were beginning to respond to the beauty of human contact and the pleasures of work and play these incredible results

Made us optimistic and believed that we could finally conquer human misery antipsychotic drugs were important in reducing the number of people living in psychiatric hospitals in the United States who They went from more than 500,000 in 1955 to less than

100,000 in 199 for young people who did not know the world before the arrival of these treatments. The change is almost unimaginable. When I was in my first year of medicine, I visited Kanaki State Hospital in Illinois and I watched as a burly unit assistant showered dozens of

Dirty, naked, incoherent patients in an unfurnished day room full of gutters to evacuate water. This memory now seems more like a nightmare than something I’ve seen with my own eyes. My first Employment After completing my residency in 1974 I served as the penultimate director

Of a formerly venerable institution, the Boston State Hospital that had previously housed thousands of patients and had expanded on hundreds of acres with dozens of buildings including greenhouses, gardens, and workshops, most of which which were already in ruins at that time, during my stay there, the patients gradually dispersed towards the community,

A term that served to name the anonymous shelters and residences to which the majority ended up going. Ironically, the hospital began to be called ailum asylum, a word that also means sanctuary. and which little by little adopted a sinister connotation, in reality

It offered a community of refuge in which everyone knew the name and idiosyncrasies of each patient in 1979 Shortly after he went to work at the clinic at the gates of the Boston State Hospital It closed forever and became a ghost town. During

My time at Boston State Hospital, I continued working in the mmhc psychopharmacology laboratory, which at that time was orienting its research in another direction in the 1960s. Scientists at the National Institutes of Health began developing techniques to isolate and measure hormones and neurotransmitters in the blood and brain. Neurotransmitters are

Chemical messengers that carry information between neurons, allowing us to interact effectively with the world now that Scientists were finding evidence for the association between abnormal levels of norepinephrine and depression and between abnormal levels of dopamine and schizophrenia. There was hope that we could develop drugs

Targeting specific brain abnormalities. This hope was never fully realized, but our efforts to measure How drugs could affect mental symptoms caused another profound change in the profession. The need for researchers to have an accurate and systematic way to communicate their findings resulted in the development of

So-called diagnostic criteria for research to which I contributed as a Modesto research assistant. In the long run, these criteria became the basis of the first system to systematically diagnose psychiatric problems. The Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric Association,

Commonly known as the Bible of Psychiatry. prologue to the emblematic dsem ya abai of 1980 was appropriately Modest And recognized that this diagnostic system was imprecise so imprecise that it should never be used for forensic or insurance purposes, as we will see,

This modesty turned out to be tragically short-lived inescapable shock worried about so many issues that remained pending about traumatic stress I was intrigued by the idea of ​​whether the emerging field of neuroscience could provide answers. So I began attending meetings of the

American College of Neuropsychopharmacology (ACNP) in 1984. The ACNP offered many interesting lectures on drug development a few hours before taking On my flight back to Boston, I heard a presentation by Steven Meer of the University of Colorado, who had collaborated with Martin Seligman of the University of Pennsylvania. The topic was impotence in

Animals. Mayer and Seligman had repeatedly administered painful electric shocks to dogs locked in cages. They called unavoidable electric shocks. As a dog lover, I immediately knew that I would never have been able to carry out this study, but I was curious about

How that cruelty would have affected the animals after administering several cycles of electric shocks. The researchers opened the cage doors. and then they applied shocks to the dogs again. The group of control dogs that had not received them immediately

Ran away, but those that had been subjected to the shocks without being able to escape made no attempt to get out. Even though the door was wide open, they simply remained there moaning . and defecating the mere opportunity to escape does not necessarily make traumatized animals or

Traumatized people take the path to freedom like the dogs of meer and seligman many traumatized people simply give up rather than experience the risk with new options remain locked in the fear you already know meer’s story struck me what had been done to those poor dogs was exactly what had happened to my

Traumatized human patients they too had been exposed to someone or something that inflicted terrible pain on them a pain they had no pain of way to escape I did a quick mental review of the patients I had treated almost all of them had been trapped or immobilized in one way or

Another unable to act to avoid the Inevitable their fight or flight response had been thwarted and the result was agitation or a Extreme collapse Mayer and Seligman also discovered that traumatized dogs secrete more stress hormones than normal. This confirmed what we were beginning to know about the biological basis of traumatic stress.

A group of young researchers including Steve Southwick and John Crystal Yale Aries Shalev Hadasa Medical School Jerusalem Frank Putnam National institute of mental health na mh and later roger pittman of harvard were also discovering that traumatized people continued to secrete large amounts of

Stress hormones long after the real danger and rachel yehuda of mount sinai in new york confronted us with apparently paradoxical findings in the His findings only began to make sense when his research clarified that cortisol ends the stress response by sending a safety signal and that in PTSD the stress hormones cortisol levels

Are low. The body’s stress hormones do not actually return to baseline once the threat has ended. Ideally, our stress hormone system should provide an extremely rapid response to the threat and then immediately return us to a state of equilibrium in PTSD patients without However, the stress hormone system

Cannot achieve this balance, the signals of fight, flight or freeze continue once the danger has passed and, as in the case of dogs, they do not return to the normal situation, instead the continued secretion of hormones Stress is expressed in the form of agitation and panic and in

The long term it wreaks havoc on health. I missed the plane that day because I had to talk to Steve Mayer. His workshop offered clues not only to my patients’ underlying problems but also potential keys to their resolution. For example, he and Seligman discovered that the only

Way to get traumatized dogs out of the electric bars when the doors were open was to repeatedly drag them out of the cages so they could physically experience Getting Out. I was wondering if we could also help my patients. Regarding their fundamental belief that they could do nothing to defend themselves, perhaps

My patients also needed to have physical experiences to regain a visceral sense of control. What if they could be taught to physically move to escape a potentially threatening, trauma-like situation ? in which they had been trapped

And paralyzed as I will describe in part five on treatment of this book this was one of the conclusions that I eventually reached other animal studies carried out with mice rats cats monkeys and elephants yielded more intriguing data for example When the

Researchers made a loud, intrusive sound, the mice that had been raised in a warm nest with plenty of food immediately ran home, but another group raised in a noisy nest with little food supply also returned home even after a certain amount of time had passed. In

More pleasant environments, frightened animals return home regardless of whether the home is a safe or scary place. I thought about my patients with abusive families who returned again and again to suffer pain again. Traumatized people are condemned to seek refuge

In what familiar if yes Why And is it possible to help them stick to safe and pleasurable places and activities trauma addicts the pain of pleasure and the pleasure of pain one of the things that surprised my partner Mark Greenberg and me when I led groups of

Therapy for Vietnam veterans was seeing how despite their feelings of horror and grief many of them seemed to come back to life when talking about their helicopter crashes and their dying comrades Former New York Times correspondent Chris Heges Que He covered several brutal conflicts and titled his book War is a Force

That Gives Us Meaning . boredom when they are not angry under duress or doing some dangerous activity my patient Julia was brutally raped at gunpoint in a hotel room when she was 16. Shortly afterward she got involved with a violent pimp who the prostitute

Regularly beat her, she was there several times in jail for prostitution but always returned to her pimp Finally her grandparents intervened and paid for an intense rehabilitation program. After successfully undergoing treatment at the hospital, she began working as a receptionist and studying sociology at a local university. She did a term paper

On the liberating possibilities of prostitution for which she read the memoirs of several famous prostitutes little by little she abandoned all other subjects a brief relationship with a classmate quickly ended badly according to her he hated her to death

And his boxer briefs horrified her Then she left with a drug addict whom she met on the subway who first hit her and then began to harass her. She finally found the motivation to return to treatment when she was brutally attacked again. Freud had a term for

These traumatic recreations, the compulsion to repeat himself and many of his followers. They believed that reenactments were an unconscious attempt to gain control of a painful situation and could ultimately lead to its mastery and resolution. There is no evidence to support

This theory; repetition only leads to more pain and more self-hatred in In reality, even reliving the trauma repeatedly in therapy can reinforce worry and fixation. Mark Greenberg and I decided to learn more about attractors, that is, about the things that

Attract us, motivate us and make us feel alive. Normally, attractors have the mission of making us feel alive . better so why so many people are attracted to dangerous or painful situations in the end we found a study that explained how activities that cause fear

Or pain can later become exciting experiences in the 70s Richard solomon of the University of pennsyvania already showed that The body learns to adapt to all types of stimuli. We can get hooked on drugs because they instantly make us feel good, but activities such as steam baths, running marathons or skydiving, which

Initially can cause discomfort and even terror, can be very pleasurable in the long run. This gradual adjustment indicates that a new chemical balance has been established in our body so that marathon runners, for example, achieve a feeling of well-being and euphoria

When they push their body to the limit at this point, just as we begin with drug addiction. We eagerly want to do the activity and experience withdrawal syndrome when we cannot do it in the long run. People are more concerned about the pain of withdrawal than about the

Activity itself. This theory could explain why some people hire others to beat them. or they burn themselves with cigarettes or why they are only attracted to people who hurt them fear and aversion in a perverse way can be transformed into pleasure solomon launched the hypothesis

That endorphins are morphine-like chemicals that the brain secretes in response to Stress plays a role in the paradoxical addictions he described. I thought about his theory again when my library habit led me to an article titled Pain in men wounded in battle published in 1946 after observed

That 5% of seriously wounded soldiers on the Italian front did not ask for morphine a surgeon named Henry K beacher speculated that strong emotions can block pain were applicable Bacher’s observations of people with PTSD Mark greenberg Roger pittman Scott

Or and I decided to ask eight veterans who fought in Vietnam if they would be willing to perform a standard pain test while they watched scenes from different movies. The first video we showed them was of Oliver Stone’s graphically violent 1986 movie Platoon

, and while it was shown we measured how long. How long could the veterans remain with their right hand in a bucket of ice water? Then we repeated this process with a quiet and forgotten film. Seven of the eight veterans kept their hand in the ice water 30 times longer for

Plato. produced by viewing for 15 minutes of a war movie was equivalent to that caused by the injection of 8 mg of morphine, approximately the same dose that someone admitted to the emergency room for intense chest pain would receive. We concluded that Bacher’s speculation that

Intense emotions can block The pain was a result of the release of morphine-like substances manufactured in the brain. It suggested that for many traumatized people, reexposure to stress can provide similar relief from anxiety. It was an interesting experiment,

But it didn’t fully explain why Julia kept coming back to her. pimp violent calm the brain The 1985 acnp Congress was even more inspiring than the previous year’s edition. Professor Jeffrey Gry of King’s College gave a talk on the amygdala, the set

Of brain cells that determine whether a sound, an image or a bodily sensation is perceived as a threat Grey’s data showed that the sensitivity of the amygdala depended at least in part on the amount of serotonin in the neurotransmitters of that part of the brain

Animals with low serotonin levels were hyperreactive to the stressful stimuli such as loud sounds while higher serotonin levels reduced their fear system making them less likely to become aggressive or freeze in response to potential threats. This important finding surprised me. My patients always exploded in

Response to small provocations and felt devastated by the slightest rejection I was fascinated by the possible role of serotonin in PTSD other researchers had shown that dominant male monkeys had much higher levels of serotonin in the brain than lower Rank animals

But that their serotonin levels fell when they were prevented them from maintaining eye contact with the monkeys to whom they felt superior, while the lower-ranking monkeys who were given serotonin supplements emerged from the crowd to assume leadership the social environment interacts with brain chemistry manipulating a monkey to

Occupy a lower position in the dominance hierarchy caused their serotonin to decrease while chemically enhancing serotonin elevated those who were previously subordinates in rank. The implications for traumatized people were obvious as Grey’s animals with low levels of serotonin were If we could find a way to increase serotonin levels in the

Brain, perhaps we could solve both problems simultaneously. At the same conference in 1985, I learned that some pharmaceutical companies were developing two new products to do just that but since none were yet available I briefly experimented with the supplement l tryptophan sold in health food stores and which is a chemical precursor

To the body’s serotonin the results were disappointing one of the drugs investigated never made it to the market the other It was fluoxetine, which under the name Prozac became one of the most successful psychoactive drugs ever created. On Monday, February 8, 1988, Prozac

Was launched by the pharmaceutical company Eli Lily. The first patient I saw that day was a young woman with a horrible story of childhood abuse he was struggling with bulimia he basically spent the day binge eating and purg I wrote him a prescription for this new medication and

When he came back on Thursday he told me these last few days have been very different I have eaten when I have been hungry and the rest of the day I did my homework was one of the most impressive sentences

I have ever heard Never in my consultation on Friday I saw another patient who was prescribed Prozac the previous Monday, she was a woman with chronic depression Mother of two school-aged children worried about her defects as a mother and wife and canceled by the demands of parents who mistreated her

Many times as a child. After two days of taking prosac she asked me if she could skip the visit the following Monday, which was President’s Day, and finally she explained never I have taken my children

My husband always does skiing and they have that day off. It would be great if they had good memories of having a good time together. I was a patient who found it difficult just to get to the

End of the day. After that visit, I called a person from him and Lili and I told him you have a drug that helps people stay in the present instead of being stuck in the past. Subsequently Lily gave me a small grant to study the effects of prozac on

TPT in 64 people 22 women and 42 men, the first study on the effects of this new type of drugs on PTSD, our team at the Trauma Clinic recorded 33 non-veterans and my collaborators, former colleagues at the UA clinic, recorded 31 war veterans

Over eight weeks. half of each group took prozac and the other half took placebo the study was double blind neither we nor the patients knew what substance they were taking so our preconceptions could not bias our assessments all participants

In the study improved including those who took placebo at the same time. At least to some extent, most PTSD studies detect a significant placebo effect: people who muster up the courage to participate in a study free of charge in which they are constantly stuck with needles

And in which they only have 50% chances of taking an active drug are intrinsically motivated to solve their problem. Perhaps their reward is only the attention they are given the opportunity to answer questions about how they feel and what they think. But perhaps

A mother’s kisses that soothe the scratches on their son are also only placebo prozac worked significantly better than placebo in the trauma clinic patients slept better They had better control of their emotions and worried less about the past than those who

Took a sugar pill surprisingly however prozac did not had no effect on the war veterans at the baa clinic the PTSD symptoms in his case did not change these results have been maintained in the majority of subsequent pharmacological studies conducted with veterans Although some show modest improvements, the majority experience no improvement

I have never been able to explain it and I cannot accept the most common explanation according to which receiving a pension or disability benefits prevents people from getting better. After all, the amygdala knows nothing about pensions, simply about threats, however, medications like prozac and others.

Related drugs such as Zoloft, Celexa, SIM, Balta and Paxil have contributed significantly to the treatment of trauma-related disorders. In our study with Prozac, we used the Rorak test to measure how traumatized people perceive their environment. These data gave us important information . about how this type of drugs can work with known formally

As selective serotonin reuptake inhibitors is GS before taking prozac the emotions of these patients controlled their reactions I remember a Dutch patient for example who was not part of the study with prozac that came to see me to be treated for

A rape she suffered as a child and as soon as she heard my Dutch accent she had no doubt that I was going to rape her. Prozac made a big difference, giving TT patients a sense of perspective and helping them to regain considerable control over his

Impulses Jeffrey gry must have been right when serotonin levels rose most of my patients became less reactive The Triumph of Pharmacology It didn’t take long for pharmacology to revolutionize psychiatry drugs allowed doctors to be more effective and represented a tool beyond conversational therapy the drugs also

Produced income and profits the scholarships from the pharmaceutical companies allowed us to have laboratories full of energetic university students and sophisticated instruments the psychiatry departments that had always been located in the basements of Hospitals began to rise

Both in their location and in their prestige, a reflection of this change occurred in the mmhc where in the early 90s the hospital swimming pool was covered to have more space for a laboratory and the indoor basketball court was divided into different cubicles for a new

Mediation clinic. For decades doctors and patients had democratically shared the pleasures of splashing in the pool and passing the ball on the court. I spent hours in the gym with the patients when I was an assistant in the unit. It was the only place where we could

Recover a certain sense of physical well-being, an island in the midst of misfortune to which we faced daily now had become a place to fix patients the pharmacological revolution that began with so much promise in the end It may have done as much

Harm as good the theory that mental illness is basically caused by chemical imbalances in the brain disorders that can be corrected with specific fos has been widely accepted by both the media, the public and the medical profession in many places drugs

Have displaced therapy and have allowed patients to eliminate their problems without resolving the underlying causes antidepressants can make a difference in the world by assisting in daily functioning and if you have to choose between taking a sleeping pill or getting blackout drunk

Every night to get a few hours of sleep there is no question which option is preferable for people exhausted from trying for alone with yoga classes, work routines or simply enduring medication can often bring relief Savior SSRIs can be very useful in making traumatized people less enslaved

By their emotions but they should only be considered as appendages to an overall treatment afterward. After conducting numerous studies of drugs for PTSD, I have come to realize that psychiatric medications have a serious drawback because they can divert attention from the treatment of underlying problems. The brain disease model takes

Control of their feelings out of patients ‘ hands. destiny and puts doctors and insurance companies in charge of solving their problems. In the last three decades, psychiatric medications have become the mainstay of our culture with dubious consequences. Let’s think about antidepressants if they were as effective as they have been.

Although the number of antidepressants continues to grow, this has not led to a reduction in hospital admissions for depression, the number of people treated for depression has tripled in both countries. last decades And currently one in 10 Americans takes antidepressants the new generation of antipsychotics such as abilify

Risperdal di prexa and seroquel are the most sold drugs in the United States in 2012 the public sector spent 1526 280,000 on abilify more than on any other medication in Third place was an antidepressant that sold more than $1 billion in

Pills. Although it has never been shown to be superior to other antidepressants such as Prozac, for which there are much cheaper generics, Medicaid, the United States Federal health program for poor people spend more on antipsychotics than on any other

Type of drugs in 2008 the most recent year for which complete data exists funded $3.6 billion for antipsychotic medications up to 150 million in 1999 the number of people under age 20 at who have been prescribed antipsychotic medications funded by medicate tripled between 1999 and 2008 on November 4, 2013 Johnson and Johnson

Agreed to pay more than $2.2 billion in criminal and civil penalties to resolve allegations that he improperly promoted the antipsychotic risperdal among adults children and people with developmental disabilities but no one holds the doctors who prescribed it responsible half a million children in the United States currently take antipsychotic drugs children

From low-income families are four times more likely to take antipsychotic medications that children who have Private insurance medications are often used to make children who have suffered abuse and neglect more docile in 2008, 19,045 children up to age 5 were prescribed antipsychotics through medicade a study

Based on data from Medicare from 13 states revealed that 12.4 percent of children in foster care take antipsychotics compared to 1.4 percent of medicare-eligible children. Overall, these medications make children more docile and less aggressive but also interfere with motivation, play and curiosity are essential elements

To mature and become healthy and beneficial members of society. Children who take them also run the risk of suffering from morbid obesity and developing diabetes. Meanwhile, overdoses caused by the combination of psychiatric medications and Painkillers continue to increase as drugs have become so profitable. Major

Medical journals rarely publish studies on the treatment of mental health problems without drugs. Professionals who explore these treatments are marginalized because studies of non-drug treatments are considered alternative. They are not usually funded Unless they include what are called manual protocols in which patients and therapists go through closely prescribed sequences that allow little

Adaptation to the individual needs of patients, general medicine is firmly determined to improve our lives with chemicals. and the possibility of actually changing our physiology and inner balance by non-pharmacological means is only rarely considered adaptation or disease the brain disease model ignores four

Fundamental truths one our ability to destroy each other coincides with our ability to heal each other restore health relationships and community is essential to restoring well-being two, language gives us the power to change ourselves AND to change others by communicating our experiences helping us define what we know and finding common meaning

Three we have the ability to regulate our own physiology including some of the so-called involuntary functions of the body and brain through basic activities such as breathing moving and touching and four we can change social conditions to create environments in which

Children and adults can feel safe and in which they can thrive when we forget these dimensions par excellence of humanity we deprive people of new ways to overcome trauma and regain their autonomy being a patient rather than a participant

In the healing process itself separates suffering people from their community and isolates them from their inner self having Given the limitations of drugs I began to wonder if we could find more natural ways to help people manage their post-traumatic responses

Chapter 3 analyzing the brain the evolution of neuroscience if we could look through the skull at the brain of a conscious person and If the areas of optimal excitability were illuminated we should see on the brain surface a luminous point with fantastic,

Undulating edges with a size and shape in constant fluctuation surrounded by more or less deep darkness covering the rest of the hemisphere Ivan Pavlov can be seen a lot looking Yogi Berra In the early 90s, new brain imaging techniques gave us the never

Before imagined possibility of understanding in a sophisticated way how the brain processes information. Giant machines worth several million dollars based on advanced physics and computer science quickly became Neuroscience In one of the most popular areas of research, PET positron emission tomography and later fMRI allowed scientists to visualize how different parts

Of the brain are activated when people perform certain tasks or when they remember events from the past. For the first time we could see the brain processing memories, sensations and emotions And we began to map those of the mind and consciousness Previous technology of measuring

Brain chemicals such as serotonin or norepinephrine allowed scientists to observe what fueled the activity neural, which is like trying to understand the engine of a car by studying gasoline, neural images allowed us to see inside the engine, which is why they also transformed our knowledge about trauma. Harvard Medical School

Was and is at the forefront of the neuroscience revolution and In 1944, a young psychiatrist Scott Rauch was named the first director of the neuroimaging laboratory at Massachusetts General Hospital. After considering the most relevant questions that this new technology could answer and reading some articles I had written, Scott asked me

If I thought we could studying the brains of people who have flashbacks I had recently completed a study on how trauma is remembered described in Chapter 12 in which the participants constantly told me how distressing it was to be suddenly assaulted by images, feelings and sounds from the past when several They said

They would like to know what trick their brain was playing on them during those flashbacks. I asked eight of them if they would be willing to go back to the clinic and remain motionless in a scanner, a completely new experience that I described in detail while

They sat with everyone. participants and painstakingly constructed a script that recreated their trauma moment by moment we deliberately tried to compile isolated fragments of their experience specific images sounds and feelings rather than the entire story Because this is how trauma is experienced Rita also asked participants to describe a

Scene in which they felt safe and in control one person described their morning routine another sitting on the porch of a Vermont farm looking at the hills later we would use this script for a second scan to obtain a baseline measurement once participants

Checked for accuracy of the scripts reading them in silence less overwhelming than listening to them or pronouncing them Rita was preparing a recording that I played while they were in the scanner this would be an aos type script and You are about to go to bed you hear your mother and

Father screaming at each other you are terrified And you have a knot in the stomach you and your brothers peis crowded at the top of the stairs you look over the railing And you see pad holding your

Mad for elzo mias ellaa to free yourself your Mad crying spitting and snorting like an animal your face lights up and you feel a lot of heat all over your body When your mother breaks free she runs

To the living room and breaks a very expensive Chinese vase you shout at your parents to stop but they ignore you your mother runs upstairs and you hear how she breaks the television your little brothers try to

Help her hide in a closet your heart is beating hard and you are shaking in this first session we explained the purpose of the radioactive oxygen that the participants would breathe by more or less metabolically activating some parts of their brain their oxygen level would change

Immediately which would be recorded by the scanner we would control their blood pressure and heart rate throughout the entire process to be able to compare these physiological signs with brain activity. After a few days the participants came to the imaging laboratory.

Marsha, a 40-year-old teacher from a suburb of Boston, was the first. first volunteer to undergo the scan, her script took her back 13 years to the day she went to pick up her 5-year-old daughter Melissa from a day camp. When Marsha was leaving, she heard an insistent beep

Telling her that Melissa’s seat belt was not fastened properly. When Marsha tried to fasten it correctly, she ran a red light and a car crashed into hers from the right, instantly killing her daughter in the ambulance to the hospital. The 7-month-old baby that Marsha was carrying in her womb was also

Passed away overnight Marsha went from being a happy woman who was the joy at every party to a tortured and depressed person full of guilt. She stopped teaching classes to move to the school administration department because working directly with

Children was difficult. It was unbearable, as happens to many parents who have lost their children. The children’s happy smiles became powerful triggers, even hidden behind the bureaucracy. She barely managed to get through the day in a useless attempt to keep her feelings

At bay. She worked. day and night I was next to the scanner while Marsh was inside and could follow his physiological reactions on a monitor the moment we started playing the tape his heart started to race and his blood pressure went up a lot just

By listening. the script activated the same physiological responses that occurred during the accident 5 years ago when the tape ended and the walking heart rate and blood pressure returned to normal we played the second script get out of bed and brush your

Teeth this time its rhythm heart rate and blood pressure did not change representation of the brain under trauma the bright spots in a the limbic brain and b the visual cortex showed increased activation in the representation c the speech center shows

Markedly reduced activation upon exiting the scanner marsha seemed Defeated, out of her mind and paralyzed, she breathed shallowly with her eyes wide open and her shoulders hunched. The spitting image of vulnerability and helplessness we tried to comfort, but I wondered if anything

We had seen would compensate for her affliction after the eight participants continued the same. process Scott rou got to work with his mathematicians and statisticians to create composite images that compared the activation created by the flashbacks with the brain in a

Neutral situation. After a few weeks he sent me the results that you will see below I put the scans on the During the next few months I looked at them every afternoon, it occurred to me that this was how the first astronomers must have felt when looking through the

Telescope at a new constellation. There were some confusing dots and colors on the scanner, but the largest area of ​​brain activation was A large Red Zone in the lower right center of the brain, which is the limbic area or emotional brain, was no surprise. We already knew that

Intense emotions activate the limbic system, specifically an area of ​​this called amygdala. We depend on the amygdala to warn us about imminent dangers and to activate the body’s stress response, our study clearly showed that when traumatized people are shown images, sounds or ideas related to their particular experience, the amygdala reacts

With alarm. Even as in Marsha’s case 13 years after the event the activation of this fear center triggers the cascade of stress hormones and nerve impulses that raise blood pressure, heart rate and oxygen consumption preparing the body to escape or fight the monitors connected to marsha’s arms recorded this

Physiological state of agitation Although she never completely lost sight of the fact that she was lying calmly in the scanner an indescribable horror our most surprising finding was a white spot in the left frontal lobe of the cerebral cortex in a region called

Broca’s area in this case the color change meant that there was a significant decrease in that part of the brain, Broca’s area is one of the speech centers of the brain that is usually affected in stroke patients when the blood supply to this region is cut off without a

Well-functioning Broca’s area we cannot put our ideas or feelings into words, our scans showed that Broca’s area shut down when a flashback was triggered. In other words, we got real proof that the effects of trauma are not necessarily different from the effects of physical injuries like strokes. and that can overlap with these

All traumas are verbal PR Shakespeare captures this state of indescribable terror in Macbeth when the corpse of the murdered King is revealed Oh horror horror horror neither tongue nor heart can conceive or name this confusion has just made his masterpiece

Under extreme conditions the People may shout obscenities Call for their mother Scream in terror or simply remain silent Victims of attacks and accidents remain mute and paralyzed in the emergency room Traumatized children lose their tongues and refuse to speak Photographs of combat soldiers show men with empty gaze staring silently into space

Even years later traumatized people find it very difficult to tell others what has happened to them their body relives terror, rage and helplessness as well as the impulse to fight or flee But these feelings are Virtually impossible to articulate by nature, trauma

Leads us to understand disconnected from language based on common experience or an imaginable past. This does not mean that people cannot talk about a tragedy that has happened to them sooner or later. Survivors like the veterans in Chapter 1 create what many call a cover story that offers some explanations of

Their symptoms and behavior for public consumption. These stories rarely capture the inner truth of the experience, however, and it is extremely difficult to organize the stories. own traumatic experiences in a coherent story in a narrative with a beginning, middle and end Even an experienced reporter like the famous CBS correspondent

Ed Marrow had difficulty conveying the atrocities he saw when the Bbal concentration camp was liberated from the Nazis in 1945 I beg you to believe what I have said I have told what I saw and heard but only part of it for most things I have no

Words when words fail the terrifying images capture the experience and come back as nightmares and flashbacks unlike After the deactivation of Broca’s area in our participants, another region lit up. Brodman’s area 19 is a region of the visual cortex that registers images when they first enter the brain. We were surprised to see

Brain activation in this area so long later. first experience of trauma in normal situations the raw images recorded in area 19 quickly spread to other brain regions that interpret the meaning of what has been seen again we were seeing

A brain region activated as if the trauma were really happening as we will see In Chapter 12, in which we will talk about memory, other unprocessed fragments of the trauma such as sounds, smells and other physical sensations are also recorded separately from the story

Itself. Similar sensations often trigger a flashback that brings them back to consciousness. Apparently unchanged by the passage of time, moving to one side of the brain, the scans also revealed that During the flashbacks, only the right side of our subjects’ brains lit up.

There is currently a lot of scientific and popular literature on the differences between the right and left brains. In the early 90’s I heard that some people had started dividing the world between left brain people (logical rational people) and right brain people intuitive and artistic people but I didn’t pay

Much attention to that idea however our scans clearly showed that images of past traumas activate the right hemisphere of the brain and deactivate the left. We currently know that the two hemispheres of the brain speak different languages: the right is intuitive, emotional, visual, spatial and tactile, and the left is linguistic,

Sequential and analytical. While the hemisphere the left brain is concerned with conversation the right brain is concerned with the music of experience communicating through facial expressions and body language and composing the sounds of love and grief singing swearing

Shouting dancing or imitating the right brain is the one that develops first in the womb and transmits non-verbal communication between mothers and their children we know that the left hemisphere connects when children begin to understand language and learn to speak this allows them name things compare them understand their interrelationships and begin to

Communicate your unique, subjective experiences to others the left and right hemispheres of the brain also process traces of the past in drastically different ways the left brain remembers facts statistics and the vocabulary of events We turn to it to explain our experiences and put them in order. The right brain stores sound,

Tactile, olfactory memories and the emotions they evoke. It reacts automatically to voices, facial features and gestures, and places experienced in the past. What it remembers seems like an intuitive truth. It is the way things work even when we describe the

Virtues of a loved person to a friend our feelings can be deeply mixed if, for example, her face reminds us of the aunt we loved when we were 4 years old, under normal circumstances both sides of the brain work together in a more or less fluid way. Even in

People in whom one side predominates more than the other, however, having one side or the other disconnected, even temporarily, or having one side completely disconnected, as happened at the beginning of brain surgery, is limiting. Deactivation of the left hemisphere has

A direct impact on the ability to organize experience into logical sequences and Translate our changing feelings and thoughts into words Broca’s area that shuts down During flashbacks is on the left side without sequencing we cannot identify the cause and the effect understand the long-term effects of our actions or make

Coherent future plans people who are very distressed say they are losing their minds in technical terms they are experiencing the loss of executive functioning when something reminds traumatized people of the past their right brain Reacts as if the traumatic event is happening in the present but because their left brain

Is not working very well They may not be aware of being re-experiencing terrified angry ashamed or paralyzed when this emotional storm has passed they may search for something or someone Who is to blame? They have behaved this way because we

Were 10 minutes late or because we burned the potatoes or because you never listen to me. Obviously most of us have done this at some point. But when it happens we usually admit our mistake. Trauma interferes with this type. of consciousness and over time our

Research has shown why trapped in fight or flight what happened to Marsha in the scanner little by little began to make sense 13 years after her tragedy we activate sensations sounds and images of the accident that were still stored in his

Memory when these sensations came to the surface they activated his alarm system that made him react as if he were in the hospital again hearing that his daughter had died the passage of those 13 years the accelerated heart rate was erased and the increase in

Blood pressure reflected his agitated state of alarm. Adrenaline is one of the critical hormones to help us fight or escape in a dangerous situation. The increase in Adrenaline was responsible for the drastic acceleration of the heart rate and the increase in pressure. blood

Of our participants my while listening to the narrative of their trauma under normal conditions people react to a threat with a temporary increase in stress hormones as soon as the threat disappears the hormones dissipate and the body returns to normal

Stress hormones of Traumatized people, on the other hand, take much longer to return to baseline and create spikes quickly and disproportionately in response to mildly stressful stimuli between The insidious effects of having permanently elevated stress hormones include memory and attention problems, irritability, and sleep disorders. They also contribute to many

Long-term health problems depending on the more or less vulnerable body system of each person. Now we know that there is another possible response to the threat that our scanners cannot yet measure some people simply resort to denial their bodies register threat but their conscious mind continues as if nothing had happened

However Although the mind can learn to ignore the messages from the emotional brain the signals of alarm do not stop, the emotional brain continues to function and the stress hormones continue to send signals to the muscles so that they tense up to act or freeze, collapsing,

The physical effects on the organs continue unabated until they demand attention, expressing themselves as illness. Medications, drugs and alcohol can also temporarily turn off or cancel out unbearable sensations and feelings, but the body still keeps track. We can interpret what happened to Marsha in the scanner from different

Perspectives, each of which has implications for treatment. focus on the obvious neurochemical and physiological alterations and say that he suffers from a biochemical imbalance that is reactivated as soon as he remembers the death of his daughter, then

We can look for a drug or a combination of drugs that annuls the reaction or, in the best of cases, restores the chemical balance based on the results of our scans some of my colleagues at mgh began researching drugs to make people

Less responsive to the effects of high adrenaline we can also say that marsha is hypersensitized after repeating the details of the trauma over and over again With a therapist your biological responses could be overridden so that you could realize and remember that this was then AND this

Is now instead of reliving the story over and over again for 100 years or more all psychology and psychotherapy manuals have suggested that Talking about distressing feelings can resolve them, however, as we have seen, the experience of trauma itself

Interferes with our ability to do so, no matter how much knowledge and understanding we develop, the rational brain is basically incapable of removing the emotional brain from its reality by always speaking. I am impressed to see how difficult it is for people who have suffered something indescribable

To convey the essence of their experience. For them, it is much easier to tell what has been done to them, to tell a story of victimization and revenge, than to realize, feel and put into words the reality of their internal experience our standards revealed that their terror persisted and

Could have been triggered by multiple aspects of their daily experience they had not integrated their experience into the continuous flow of their life they were still there and they did not know How to be here fully alive in the present at the end from TR years of having participated in our study

Marsha came to see me as a patient I treated her successfully With the emdr described in chapter 15 part two this is what our brain is like under trauma chapter 4 running to save your life anatomy of survival before appearance of the brain there was no color or sound in the universe

Nor were there flavors or aromas And probably few sensations and no feelings or emotions before the brains the universe did not know pain or anxiety Rogers Perry on September 11, 2001 noam saul He witnessed the first passenger plane crash

Into the World Trade Center from the windows of his first-grade class at PS 234, less than 1,500 feet away. He and his classmates ran with their teacher through the streets. stairs to the lobby where most of them met their parents who had just dropped them off at

School a few minutes before. Noam, his older brother and his father were three of the dozens of people who ran for their lives through the rubble, the ashes and the smoke of the bass Manhattan that morning after 10 days I visited his family who are friends of mine and that afternoon his

Parents and I went to walk through the eerie darkness of the still smoking hole in which the tower once stood, making our way through the staff of rescue who worked tirelessly under intense lights when we returned home Noam was still awake and showed me a drawing

He had made on September 12 at 9 in the morning the drawing represented what he had seen the day before a plane crashed into the tower one fireball firemen and people jumping from the windows of the Tower but at the bottom he had drawn something more a black circle at the foot

Of the buildings I had no idea what it was so I asked him a trampoline he told me what he was doing there Noam explained to me a trampoline so that the next time people have to save themselves there will be no danger. I was surprised that a 9-year-old boy, witness to

Indescribable chaos and disaster just 24 hours before making that drawing, used his imagination to process what he had seen and move on with his life noam was lucky his entire family had emerged unscathed he had grown up surrounded by love and was able to understand that the tragedy

They had witnessed had come to an end During disasters children usually continue If their parents remain calm and respond to their needs, they often survive terrible incidents without suffering serious psychological scars, but Noam’s experience allows us to see two critical aspects of the adaptive response to threat that is basic

To human survival. When disaster struck he was able to take an active role in escaping it, becoming an agent of his own rescue and once he reached the safety of his home the alarms in his brain and body went off allowing him to release

His mind to understand what had happened and even imagine a creative alternative to what he had seen a trampoline to save lives drawing by noam 5 years old created after witnessing the 9/11 attack on the World Trade Center reproduced the image that tortured so many

Survivors people jumping to escape from hell but he added something to save lives a trampoline at the foot of the collapsed building Unlike noam, traumatized people remain stuck and their growth is stopped by not being able to integrate new experiences into their lives I was

Very touched that the veterans from Paton’s army they gave me a watch from World War II but it was a sad reminder of the year in which their lives effectively stopped 1944 being traumatized means going on with your life as if the trauma remained unchanged and immutable

Since each new encounter or event is contaminated by the past trauma affects the entire human organism the body the mind and the brain in PTSD the body continues to defend itself from a threat that belongs to the past overcoming PTSD means being able to put an end to this

Continuous mobilization of the stress and restore the entire organism so that it feels safe after the trauma the world is lived with a different nervous system Now the survivor’s energy is focused on eliminating internal chaos to the detriment of spontaneously living his life these attempts

To control unbearable physiological reactions They can result in a whole series of physical symptoms such as fibromyalgia, chronic fatigue and other immune diseases. This explains why it is critical that the treatment of trauma encompasses the entire organism, the body, the mind and the organized brain to survive. Page 57 shows the

Entire body’s response to threat when the brain’s alarm system goes off automatically, triggering pre-programmed physical escape plans in the oldest parts of the brain, such as in other animals, the nerves and chemicals that make up our brain. basic brain structure are directly connected to our body when the

Old brain takes over it partially turns off the higher brain our conscious mind and prepares the body to run hide fight or sometimes freeze for when we are fully aware of our situation our body may already be in motion if

The fight flight freeze setup goes well and we escape from danger we regain our internal balance and gradually regain our senses if for some reason the normal response is blocked for example when people is held trapped or prevented from taking effective action whether in a war zone a traffic accident domestic violence

Or rape the brain continues to secrete substances the stress chemicals and the electrical circuits of the brain continue to light up in vain long after If the event in question happens, the brain can continue sending signals to the body to escape from a threat

That no longer exists. Since at least 1889, when French psychologist Pierre Janet published the first scientific article on traumatic stress, it has been recognized that survivors of traumas tend to continue the action or futilely attempt to carry out the action that began when

The event occurred. Being able to move and do something to protect yourself is a critical factor in determining whether or not a horrible experience will leave lasting scars effective action against paralysis effective action the result of fight flight ends

The threat paralysis keeps the body in a state of shock that cannot be escaped and of learned helplessness when faced with danger people automatically secrete hormones to increase their resistance and escape The brain and body are programmed to rush home where

Safety can be restored and stress hormones can rest In these trapped men who were evacuated far from home after Hurricane Catrina the levels of stress hormones remained elevated and Se They turned against the survivors by continuously stimulating fear, depression, rage, and physical illness. In this chapter I will go into more

Detail about the brain’s response to trauma. The more neuroscience discovers about the brain, the more aware we are of which is a huge network of interconnected pieces organized to help us survive and progress. Knowing how they work together is essential

To understanding how trauma affects each part of the human organism and can serve as an essential guide to overcoming traumatic stress. top the most important task of our brain is to guarantee our survival even under the most miserable conditions everything else is secondary To this end the brain must one generate

Internal signals that register what our body needs such as food rest protection sex and shelter two create a map of the world to tell us where to meet these needs three generate the energy and actions necessary to get us there four warn us of

Dangers and opportunities along the way and five adapt our actions according to the requirements of the moment and since human beings are mammalian creatures that can only survive and thrive in groups all of these imperatives require coordination and collaboration psychological problems appear when our signals don’t work when our maps don’t take us

Where we need to go when we are too paralyzed to move when our actions don’t match our needs or when our relationships break down all the brain structures I describe play a role in these essential functions and as

We will see trauma can interfere with all of them our rational and cognitive brain is actually the youngest part of the brain and occupies only approximately 30% of the space inside the skull the rational brain is basically concerned with the outside world understanding how things

And people work and knowing how to meet our goals managing our time and sequencing our actions underneath the rational brain are two brains that are evolutionarily older and to a certain extent separate managers responsible for everything else, the moment-to-moment recording and management

Of our body physiology and the identification of Comfort, security, Threat, hunger, fatigue, desire, desire, activation, pleasure and pain, the brain is built from below, it develops level by level in each child in the womb as during evolution. most primitive part

The part that is already connected when we are born is the Ancient animal brain often called the reptilian brain is located in the brain stem just above the place where the spinal cord enters the skull the reptilian brain is responsible for everything what newborns can do

Eat sleep wake up cry breathe notice temperature hunger moisture and pain and rid the body of toxins by urinating and defecating the brain stem and The hypothalamus directly above jointly control the body’s energy levels coordinate the functioning of the heart and lungs as well as the endocrine

And immune systems ensuring that these basic life systems remain within the relatively stable internal balance known as homeostasis breathing eating sleeping peeing and pooping are so fundamental that their importance is forgotten easily when we think about the complexities of the mind and behavior however if we have disturbed sleep or our

Lungs do not work well or if we always have or if the fact that they touch us makes us want to scream as it usually happens to children and traumatized adults the entire body is thrown into imbalance it is surprising to see how many psychological problems involve

Difficulties with sleep appetite touch digestion and activation any effective treatment of trauma must include these basic functions of maintaining order of the body just above the The reptilian brain is the limbic system, also known as the mammalian brain. Because all animals that live in groups and care for their young have one,

The development of this part of the brain really begins when the baby is born. It is the center of emotions . The Danger Monitor the judge of what is pleasant or frightening the arbiter of what is important or not important for survival is also the command post for meeting

The challenges of living in our complex social networks the limbic system is made up of a function of experience along with the child’s own genetic makeup and innate temperament, as all parents with several children know from birth, children react with an intensity

And in a different way to similar events, everything that happens to a baby forms part of the emotional and perceptual map of the world that your developing brain creates, as my colleague Bruce Perry explains, the brain is formed based on Its use is another way to describe

Neuroplasticity, the relatively recent discovery that neurons fire together wire together. when a circuit turns on repeatedly it may be a faulty configuration the response most likely to occur if we feel safe and loved our brain specializes in exploration play and cooperation if we

Feel afraid and unwanted it specializes in handling feelings of fear and abandonment When we are babies and children we learn about the world by moving, grabbing things and crawling and discovering What happens when we scream, smile or protest we are constantly experimenting with our surroundings How our interactions change the way

Our body feels If we go to a 2-year-old girl’s birthday party we will see how the little girl asks for our attention, plays with us, experiments with us without needing language at all. These first explorations configure the limbic structures dedicated to emotions

And memory. But these structures They can also be significantly modified by subsequent experiences for the better in the case of a beautiful friendship or a beautiful first love or for the worse in the case of a violent attack, incessant harassment or abandonment. Together, the

Reptilian brain and the limbic system make up what what I will call the emotional brain throughout In this book, the emotional brain is at the center of the central nervous system and its main task is to seek our well-being. If it detects danger or a special opportunity, such as a

Promising partner, it warns us by releasing a stream of hormones, the resulting visceral sensations that can range from a mild dizziness to a panicked squeeze in the chest will interfere with everything the mind is focused on and will make us move physically and mentally in another direction,

Although they are very subtle, these sensations exert a great influence on the small and big decisions we make. throughout our lives what we choose to eat where we like to sleep and with whom the music we prefer whether we like gardening or singing in a choir who

We make friends with and who we hate the cellular organization and biochemistry of the emotional brain are simpler than those of the neocortex, our rational brain evaluates incoming information in a more global way, as a result, it draws conclusions from approximate resemblances, unlike the rational brain, which is organized to order sets of

Complex options. The most typical example would be jumping with fear when seeing a snake to realize later that it is simply a coiled rope the emotional brain initiates pre-programmed escape plans such as fight or flight responses these muscular and physiological reactions

Are automatic they are set in motion without us thinking or planning, making our abilities conscious and rational reach them later often long After the threat has passed we finally reach the upper layer of the brain the neocortex we share this

Outer layer with other mammals but in humans it is much thicker in the second year of life the frontal lobes that make up most of the neocortex begin to develop rapidly ancient philosophers considered 7 years old as the age of reason for us the first

School year is the prelude of things to come a life organized around the capabilities of the lobe frontal sit and stay still control sphincters be able to use words before acting understand abstract and symbolic ideas plan for tomorrow and be in tune with teachers and classmates the frontal lobes

Are responsible for the qualities that make us unique in the realm animals allow us to use language and abstract thought enable us to absorb and assimilate large amounts of information and assign meaning to it despite our enthusiasm for the linguistic prowess of chimpanzees and monkeys resus only humans master the

Necessary words and symbols to create the spiritual and historical community contexts that make up our lives The frontal blood cells allow us to plan and reflect, imagine and represent future scenarios, help us predict what will happen if we perform an action

Such as applying for a new job or stopping doing another. rent make decisions possible and underlie our amazing creativity generations of frontal lobes working closely together have created the culture that has allowed us from canoes made from logs to horse-drawn carriages and letters to

Jets hybrid cars and email They have also given us noam’s trampolines that save lives looking at ourselves in the mirror of others interpersonal neurobiology the frontal lobes crucial to understanding trauma are also the center of empathy our ability to put ourselves in the place of another person one of the truly sensational discoveries

Of modern neuroscience occurred in 1944 when by a chance accident a group of Italian scientists identified specialized cells in the cortex that they ended up calling mirror neurons. The researchers connected electrodes to individual neurons in the premotor area of a monkey and then computer-monitored precisely which neuron

Lit up when the monkey picked up a peanut or banana at a given time, a researcher He was putting the food in a box when he looked at the computer, the monkey’s brain cells were lighting up at the exact point where the motor neurons were, but the

Monkey was not eating or moving, he was looking at the researcher and his brain was indirectly reflecting . Like in a mirror their actions followed many other experiments around the world and it soon became clear that mirror neurons explained many

Previously unexplained aspects of the mind such as empathy, imitation, synchrony and even the development of language. One writer compared mirror neurons to neural WiFi We not only capture the movement of another person but also their emotional state and their intentions. When people are

In sync, they usually adopt the same posture or sit in the same way and their voices end up adopting the same rhythm, but our mirror neurons also tell us. They make us more vulnerable to the negativity of others so that we respond to their anger with Fury or their depression lowers our

Mood. Later I will talk more about mirror neurons because trauma almost always involves not being seen, not having that reflection in the mirror and not being taken into account, the treatment must reactivate the ability to safely reflect others and reflect ourselves in them, but it

Must also prevent the negative emotions of others from being intercepted, like anyone who has worked with people with brain damage. or who has cared for their parents with dementia, they will have learned the hard way that the proper functioning of the frontal lobes is

Crucial to maintaining harmonious relationships with the rest of human beings. We also realize that they can think and feel differently than others. It is a huge step in the development of children between two and three years old. They learn to understand the motives of others

To be able to adapt and be safe in groups that have different perceptions, expectations and values. Without flexible and active lobes, people become creatures of habit and their relationships become superficial and routine they lack invention and innovation discovery and wonder the three-part triune brain the brain develops from the bottom

Up the reptilian brain develops in the womb and organizes basic functions to guarantee life actively responds to threats throughout our lives the limbic system is basically organized in the first 6 years of life But it continues to evolve based on

Its use trauma can have a great impact on its functioning throughout life the cortex prefrontal develops last and is also affected by exposure to trauma including not being able to filter out irrelevant information throughout life is vulnerable to blocking in response to threat our frontal lobes may also

Sometimes not always avoid that we do things that will put us in a commitment or that we will hurt others we do not have to eat every time we are hungry kiss all the people who Arouse our desire or explode every time we are angry but it is exactly at

This limit between the impulse and acceptable behavior where many of the problems begin The more intense the visceral and sensory input, the less capacity the rational brain has to cushion it identify the pig, the cook and the smoke detector, danger is

Part of life and the brain is in charge. to detect it and organize our response, sensory information about the outside world reaches us through the eyes, nose, ears and skin, these sensations converge in the thalamus, an area within the limbic system that acts as

The brain’s cook, the thalamus mixes all the information from our perceptions to prepare a very homogeneous autobiographical soup an integrated and coherent experience of this is what is happening to me then the sensations go in two directions towards the amygdala two small

Almond-shaped structures that are at a deeper level in the limbic system in the unconscious brain and towards the frontal lobes reaching our conscious awareness the Neuroscientist Joseph calls the path to the amygdala the downward path, which is very fast, and

The path to the frontal cortex the upward path, which takes several milliseconds longer in the midst of a highly threatening experience; however, processing by the thalamus may be defective. what we see, sounds, smells and touch are encoded as isolated and dissociated fragments and the processing of normal memories disintegrates time freezes

And it seems that the current danger will last forever the central function of the amygdala to which I consider how the brain’s smoke detector is to identify whether incoming information is relevant to our survival. It does so quickly and automatically with the help of the

Return of the hippocampus, a nearby structure that relates new information to past experiences when the amygdala perceives a threat a potential collision with another vehicle a person on the street who appears dangerous Sends an instant message to the hypothalamus and brain stem,

Drawing on the stress hormone system and the autonomic nervous system sna to orchestrate a whole-body response such as The amygdala processes the information it receives from the thalamus more quickly than the frontal lobes. It decides whether the incoming information

Is a threat to our survival before we are even aware of the danger. By the time we realize what is happening, our body may already be In motion, danger signals from the amygdala trigger the release of powerful stress hormones such as cortisol and adrenaline that increase heart rate, blood pressure and

Breathing rate, preparing us to fight or escape once the danger has passed. body returns to its normal state quite quickly but when recovery is blocked the called defend itself by making people siit and excited the brain emotion is the first to interpret

Incoming information information senses about the ent and the ist rebid through the eyes the ears touch the kinesthetic perception etc. It converges in the thalamus where it is processed and then passes to the amygdala to interpret its emotional meaning. This occurs at lightning speed. If a threat is detected,

The amygdala sends messages to the hypothalamus to secrete stress hormones to defend against the threat. Neuroscientist Joseph Ledu he calls it the downward path the second neural pathway the path of his life runs from the thalamus through the hippocampus and the

Anterior cingulate to the prefrontal cortex the rational brain for a conscious and much more refined interpretation this takes several microseconds longer if the interpretation The threat from the amygdala is too intense or if the filtering system of the higher areas

Of the brain is too weak, as is often the case in PTSD, people lose control over automatic emergency responses such as prolonged startles or outbursts. of aggression Although the smoke detector is usually very good at detecting danger, trauma increases

The risk of misunderstanding whether a specific situation is dangerous or safe can we get along with others Only when we can accurately assess whether their intentions are good or dangerous can the minor Misinterpretation can lead to painful misunderstandings in

Personal and work relationships. Functioning effectively in a complex work environment or in a home full of unruly children requires the ability to quickly assess how people feel and continually adapt our behavior accordingly. defective alarm systems cause outbursts or freezes in response to innocuous comments or facial expressions

Control the stress response the watchtower if the amygdala is the brain’s smoke detector the frontal lobes and specifically the medial prefrontal cortex located directly above our eyes could be the watchtower that offers a view of the scene

From above. The smoke we are smelling is the sign that our house is burning and we have to run away or it comes from the steak that we put on a fire that was too intense. The amygdala does not make these assessments, it only prepares us to fight or flee even before

The frontal lobes can weigh it with their evaluation. As long as we are not too upset, the frontal lobes can restore balance and help us realize that we are responding to a situation. false alarm And abort the stress response Generally the

Executive abilities of the prefrontal cortex allow us to observe what is happening, predict what will happen if we perform a certain action and make a conscious decision, be able to calmly and objectively analyze our ideas, feelings and emotions, a capacity

That I will call mindfulness throughout the book and then taking the time necessary to respond allows the executive brain to inhibit organizing and modulating the pre-programmed automatic reactions in the emotional brain. This ability is crucial to preserving our relationships with other human beings while our frontal lobes function properly, we are unlikely

To lose our temper every time the waiter brings us our order late or an insurance company agent leaves us waiting on the phone. The surveillance tower also tells us that others’ anger and threats depend on their emotional state when this system fails we become conditioned animals the moment we detect danger

We automatically go into light or flight mode in PTSD the critical balance between the smoke detector amygdala and the medial prefrontal cortex the watchtower changes radically Further complicating the control of emotions and impulses, studies based on neuroimaging of people in highly emotional states reveal that intense fear, sadness and anger increase the activation

Of subcortical brain regions in emotions and reduce activity in several areas of the frontal lobe especially the medial prefrontal cortex when this occurs the inhibitory abilities of the frontal lobe fail and people lose their minds they may startle in response to any loud sound get very angry over small frustrations

Or become paralyzed When someone touches them up and down or from bottom to top the structures of the emotional brain decide what we perceive as dangerous or safe. There are two ways to change the threat detection system from top to bottom through modulatory messages from the

Medial prefrontal cortex, not just the prefrontal cortex or below. up through the reptilian brain through breathing, movement and touch, effective stress management depends on the balance between the smoke detector and the surveillance tower. If we want to better manage our emotions, our brain gives us two options, we can learn to regulate them

Accordingly . top-down or bottom-up knowing the difference between Top-down and bottom-up regulation is crucial to understanding and treating traumatic stress Top-down regulation involves strengthening the watchtower’s ability to monitor our body sensations, conscious meditation and yoga can help us do this Bottom-up regulation means recalibrating the autonomic nervous system, which, as we have

Seen, originates in the brainstem, we can Access the sna through breathing, movement or touch. Breathing is one of the few bodily functions that is under conscious and autonomous control. In part five of this book we will explore concrete techniques

To increase the top-down and bottom-up action of the rider and the horse. For now I would like to emphasize that Emotion is not opposed to reason Our emotions assign value to experiences and therefore are the basis of reason Our own experience is a product

Of the balance between our rational and emotional brains When these two systems are in balance we feel like ourselves However, when our survival is at stake, these systems can function relatively independently if, for example,

We are driving talking to a friend and suddenly we see out of the corner of our eye that they are looming. a truck we will instantly stop talking we will press the brake and turn the steering wheel to

Avoid danger if our instinctive actions have saved us from the collision we can resume the conversation where we left off whether we are able to do so or not depends largely on how quickly our The neuroscientist Paul McLean, author

Of the description of the three parts of the brain that I have used here, compared the relationship between the rational brain and the emotional brain with that between a more or less competent rider and his horse. Rebellious As long as the weather is calm and the path is clear of obstacles,

The rider may notice excellent control, but unexpected sounds or threats from other animals can cause the horse to run, forcing the rider to hold on to save his life in the same way. When people feel that their survival is at

Stake or when they suffer from anger, nostalgia, fear or sexual desire, they stop listening to the voice of reason and there is little point in reasoning with it when the limbic system decides that something is a matter of life or death. Paths between the frontal lobes and the limbic system become

Confusing. Psychologists often try to help people use perception and understanding to manage their behavior. However, neuroscientific research shows that very few psychological problems are the result of problems with understanding. They originate in the pressures of the deeper brain regions on which our perception

And attention are based. When the alarm of the emotional brain continues to signal that we are in danger, there is no possible understanding that can silence it. This reminds me of the comedy in which a patient who

He has relapsed into an anger management program seven times and praises the virtues of the techniques he has learned. They are fantastic and work very well as long as you are not really angry when our emotional and rational brains are in conflict like when we are angry at

Someone. who we love, afraid of someone on whom we depend or desire a person who has exceeded the limits, a fight occurs, this battle is represented above all in the theater of visceral experience, the guts, the heart, the lungs and will cause physical discomfort and

Psychological discomfort. In Chapter 6 we will see How the brain and the viscera interact in safety and danger, something key to understanding the different physical manifestations of trauma. I would like to end this chapter by examining two more brain scans that illustrate some of the main characteristics of traumatic stress reliving. trauma

In a timeless way re-experiencing the images the sounds and the emotions and the dissociation Stan Jute’s brains under the trauma on a beautiful morning in September 1999 Stan and youth Lawrence a professional couple in their 40s were leaving their house in London Ontario

Canada to attend a business meeting in Detroit halfway there they encountered intense fog that reduced visibility to zero in a millisecond they immediately hit the brakes and was able to stop on the shoulder of the highway narrowly missing a truck Huge another

18-wheeler was thrown over their car. Vans and cars began to collide. People who had gotten out of the vehicles were run over while they were running for their lives. Deafening crashes continued to occur and with each jolt they felt that this would be the one that would

Kill them. would kill Stan and Ute were trapped in the thirteenth car of the 87 vehicles that collided in Cadena The worst traffic accident in the history of Canada then there was an eerie silence Stan tried to open the doors and windows but the truck that flew away and fell

On the trunk of his car preventing him from getting out suddenly someone started banging on the roof of his car a girl was screaming get me out of here I’m burning helplessly they saw how he died while his car was consumed in flames the next thing they knew was that a

Truck driver was on the roof of his car with a fire extinguisher broke the windshield to get them out and Stan He came out through the opening when he turned to help his wife, he saw Ute paralyzed in the seat. Stan and

The driver took her out and an ambulance took them to the emergency room, apart from some cuts, they left the house physically unharmed that night, neither Ute nor Ute wanted to sleep, it seemed to them. that if they relaxed

They would die they were irritable nervous and on edge that night and many more afterwards they drank large quantities of wine to block out the fear they could not stop the images that were torturing them or the incessant questions and if they had left earlier and if they had not stopped

After three months, they asked for help from Dr. Ruth Lanius, a psychiatrist at the University of Western Ontario. Dr. Lanius, who had been Sid’s student at the Mia Trauma Center a few years earlier, told us that Stan and Ute wanted to visualize their brains with a fMRI

Before starting treatment fMRI measures neuronal activity by analyzing changes in blood flow in the brain and, unlike positron emission tomography, does not require radiation exposure Dr. Lanius used the same type of script-based images that we had used at Harvard capturing the images are the smells and other sensations that Stan

And experienced while trapped in the car Stan was first and immediately had a flashback just like Marsha in our Harvard study came out of the scanner sweating with a racing heart and skyrocketing blood pressure This is how I felt during the accident he said

I was sure I was going to die and there was nothing I could do to save myself instead remembering the accident as something that had happened three months before Stan was reliving it dissociation and recollection dissociation is the essence of the trauma the overwhelming experience is

Divided and fragmented so that the emotions, sounds, images, thoughts and physical sensations related to the trauma take on a life of their own the sensory fragments of memories slip into the present where they are literally re-experienced As long as the

Trauma is not resolved, the stress hormones that the body secretes to protect itself continue to circulate and the defensive movements and emotional responses continue to be reproduced. Unlike Stan, however, many people may not realize the relationship between their sensations and crazy reactions and the traumatic events that are being

Reproduced have no idea why they respond to a minor irritation like If they were about to be annihilated, the flashbacks and recollections are in some ways worse than the trauma itself, a traumatic event has a beginning and an end at some point ends but for people with

TT flashbacks can occur at any time whether they are awake or sleeping there is no way of knowing when it will happen again or how long it will last people who suffer flashbacks usually organize your life trying to protect yourself from them you can compulsively go

To the gym or lift weights without ever being strong enough take drugs to disconnect or cultivate a false sense of control in extremely dangerous situations such as participating in motorcycle races bungee jumping or working as an ambulance driver fighting Constantly fighting against invisible dangers is exhausting and leaves them tired, depressed and

Worn out. If the elements of the trauma are reproduced over and over again, the stress hormones that accompany them imprint those memories even more deeply in the mind. Ordinary, daily events become less and less. not being able to

Deeply assimilate what is happening around them prevents them from feeling fully alive it becomes more difficult to feel The joys and annoyances of normal life it is more difficult to concentrate on the tasks at hand not being fully alive in the present It keeps them more imprisoned

In the past. Triggered responses manifest themselves in various ways. Veterans can react to the slightest sign, such as finding a lump in the road or seeing a child playing in the street. If they were in a war zone, they are easily startled. and victims of childhood sexual abuse may anesthetize

Their sexuality and then feel deeply guilty by becoming aroused by sensations or images that remind them of the abuse even when those sensations are natural pleasures associated with specific parts of their body if forced people who have experienced a trauma to

Tell their experience, in some cases their blood pressure may rise while in others migraines may occur, other people may remain emotionally blocked and not notice any obvious changes, however in the laboratory it does not cost us anything. detect how their

Heart races and how stress hormones invade their entire body these reactions are irrational and are totally out of people’s control the intense and practically uncontrollable needs and emotions make people feel like they are going crazy and who do not belong to the human race, feeling paralyzed during our children’s birthday party

Or in response to the death of a loved one makes us feel like monsters. As a result, remorse becomes the dominant emotion and hiding the truth in The main concern is that traumatized people are rarely aware of the origin

Of their isolation. This is where therapy comes into play, which consists of beginning to release the emotions generated by the trauma, being able to feel, having the ability to observe ourselves connected, however The bottom line is that the brain’s threat perception system has changed And the imprint of the past dictates physical reactions

The trauma that started there is now enacted on the battlefield of our own body Usually without a conscious connection between what happened then and what is happening now inside us, the challenge is not so much to learn to accept the terrible things that have happened

But to learn to master internal sensations and emotions. Feeling, naming and identifying what is happening inside is the first step towards recovery. smoke detector working on overdrive Stan’s brain scan shows a flashback in action This is what a

Trauma memory looks like in the brain: the very bright area in the lower right corner, the lower left area that appears white, and the four white holes. symmetrical around the center you may recognize the amygdala on and the left brain off from the Harvard study described

In chapter 3 Stan’s amygdala did not distinguish between the past and the present it was activated as if the traffic accident was happening in the scanner triggering The powerful stress hormones and nervous system responses were responsible for his sweating and tremors, his rapid heart rate and high blood pressure, totally

Normal and potentially life-saving responses. If a truck has just crashed into your car, it is important to have a detector. of efficient fire because we don’t want to be caught off guard by a raging fire, but if we get hysterical every time we smell smoke, it becomes something intensely

Disturbing. Yes, we have to detect when someone is getting angry with us, but if our amygdala fires, we can be afraid. chronic to people hating us or we may feel as if people are chasing us the timekeeper saturates Stan and Ut had become hypersensitive

And irritable after the accident which suggested that their prefrontal cortex was struggling to maintain control in situations of stress Stan’s flashback precipitated a more extreme reaction the two blank areas of the front of the brain at the top of the image are the right and left dorsolateral prefrontal cortex when these

Areas are deactivated people lose perception of time and remain Trapped in the moment without a perception of the past, present or future, two brain systems are important for the mental processing of trauma: those related to emotional intensity and context. Emotional intensity is defined by the fire alarm, the amygdala and its counterbalance. the

Watchtower the medial prefrontal cortex the context and meaning of an experience are determined by the system that includes the dorsolateral prefrontal cortex cpfdl and the hippocampus the cpfdl is located on the lateral side of the frontal brain while the cpfm is located in the

Center the structures found in the central line of the brain are dedicated to our inner experience relative to ourselves and the lateral ones have to do with our relationship with what surrounds us the CP fdl tells us how much of our current experience is related

To the The past and how it can affect the future is like the brain’s timekeeper knowing that whatever is happening has an end and that sooner or later it will come to an end makes most experiences tolerable, the opposite is also true. Certainly

, situations become intolerable when they seem endless. Most of us know from sad personal experiences that terrible grief is usually accompanied by the feeling that this state of misery will last forever and that we will never get over our loss. Trauma is the ultimate experience of that feeling that this will last forever

Mri flashback image notice how much more activity appears on the right side than on the left side Stan’s scan reveals Why people can only overcome trauma when the brain structures that were left out combat during the original experience that is why

The event registered in the brain as trauma in the first place are reconnected in therapy the past must be reviewed when people are biologically speaking firmly rooted in the present and feeling fully calm, safe and with our feet on the ground with

Our feet on the ground means that we notice our butt when we sit we see the light coming through the window we feel the tension in our calves and we hear the wind moving the leaves of the trees being anchored in The present while revisiting the trauma opens the possibility

Of knowing deeply that those terrible events belong to the past for that to happen the watchtower the cook and the timekeeper of the brain must be connected the therapy will not work as long as people continue to be dragged towards the past the

Thalamus stops working if we look at Stan’s flashback scan again we will see two more white holes in the lower part of the brain they are his right and left thalamus blank during the flashback the same as during the original trauma as I mentioned the The thalamus

Works like a cook, an antenna that captures the sensations of the ears, eyes and skin and integrates them into the soup that is our autobiographical memory. The breakdown of the thalamus explains why trauma is remembered basically not as a story, a story with a beginning, a development and

An end, but rather as isolated sensory traces, images, sounds and physical sensations that are accompanied by intense emotions Generally of terror and helplessness in normal circumstances the thalamus also acts as a filter or guard, this makes it a central component of attention

. concentration and new learning all of which are affected by trauma while reading these lines you may be listening to music in the background or traffic rumbling or you may feel a slight nibble in your stomach telling you that it is time to take a stand up if necessary.

Able to stay focused on this page The thalamus is helping you distinguish between sensory information that is relevant and information that you can safely ignore. In Chapter 19 on neurofeedback I will describe some of the tests we use to measure the

Functioning of this brain system. input as well as ways to reinforce it, people with TT have the floodgates completely open as they lack filters, they suffer a constant emotional overload in order to cope with it, they try to disconnect and develop

Tunnel-shaped vision and hyperfocus. If they cannot disconnect naturally, they may resort to drugs or alcohol to isolate themselves from the world, the tragedy is that the price they pay for closing themselves off It also includes closing off sources of pleasure and joy depersonalization separation of the self

Let’s look at Ut’s experience in the scanner Not all people react to trauma in exactly the same way but in this case the difference is especially dramatic because I was sitting next to Stan in the wrecked car he responded to the script of his trauma by blocking his mind went

Blank and almost half of his brain showed markedly reduced activity his heart rate and blood pressure did not increase when we asked him how he felt during the scan he told me I felt the same as I did at the time of the accident I didn’t feel anything The medical term for the

Ute response is called depersonalization Anyone who works with traumatized men, women or children will sooner or later be faced with blank stares and absent minds the outward manifestation of the biological blocking reaction depersonalization is a symptom of the enormous dissociation created by the trauma Stan’s flashbacks came from his

Frustrated efforts to escape the accident driven by the script all those dissociated and fragmented sensations and emotions returned drastically to the present but instead from fighting to escape ute had dissociated his fear and did not feel anything I frequently see depersonalization in my office when patients tell me horrible stories without any feeling

The office runs out of energy and I must make enormous efforts to continue providing care to a lifeless patient it forces you to work much harder to keep the therapy alive and I usually pray that the hour passes quickly after seeing the ute scan I started to have a

Very different approach to patients who go blank with almost all areas of the brain disconnected Obviously they cannot think, feel deeply, remember or understand what is happening. Conventional talk therapy in these circumstances is practically useless. In Gunny’s case, it was impossible to guess. Why he responded so differently to Stan

Was using a survival strategy that his brain She learned in childhood to cope with her mother’s harsh treatment Ute’s father died when she was 9 years old and her mother used to abuse and humiliate her at some point Ute discovered that she could blank her mind

When her mother yelled at her 35 years later Being trapped in her wrecked car, Ute’s brain was automatically put into the same survival mode, the challenge for people like Ute is to become alert and involved again, a difficult but inevitable task

If they want to get their life back, Ute recovered, he wrote. wrote a book about his experience and created a successful journal called mental fitness. This is where a bottom-up approach to therapy is fundamental. The goal is actually to change the patient’s physiology . basics such as

Heart rate and breathing patterns we help patients evoke and perceive their bodily sensations by pressing on acupressure points rhythmic interactions with other people are also effective throwing a beach volleyball bouncing on a ball of beats touching the drumming or dancing to music desensitizing is the other side of the

Coin in PTSD many survivors start as they are with explosive flashbacks and then go desensitized into their daily lives although reliving the trauma is dramatically frightening and potentially self-destructive over time A lack of presence can be even worse. It is a particular problem with children. Children who behave badly receive attention. Those who

Are blank do not bother anyone and their future is allowed to be lost little by little. Learn to live in the present. The challenge in treating trauma is not only to manage the past but even more so to improve the quality of daily experience. One reason

Traumatic memories become dominant in TT is that it is very difficult to feel truly alive in the present. when we can’t be completely Here we go to places where that we felt alive Although those places are full of horror and sorrow Blank brain

Dissociation in response to the memory of a past trauma in this case almost all areas of the brain have reduced activation interfering with thinking, focus and orientation many Traumatic stress treatment approaches focus on desensitizing patients to their past in the hope that re-exposure to their

Traumas will reduce emotional outbursts and flashbacks. I believe this is based on a misunderstanding of what is happening in traumatic stress most of us must help our patients to live completely and safely in the present to do so we must help them recover the brain structures that left them abandoned when the trauma

Overwhelmed them desensitization can make us react less but if we cannot feel the satisfaction of doing normal things like taking a walk cooking or playing with our children life passes us by chapter 5 connections between the body and the brain life is based on rhythm

We vibrate our heart pumps blood we are a machine with rhythm that is what we are Mickey hart towards the end of his career in 1872 Charles Darwin published The Expression of Emotions in Man and Animals Until recently most of the scientific debate about Darwin’s theories had

Focused on the origin of species 1859 and the Descent of Man 1871 But the Expression of Emotions is an extraordinary exploration of the foundations of emotional life filled with observations and anecdotes resulting from decades of research as well as close stories

From Darwin’s children and his household pets. It is also an emblematic book for its illustrations. It was one of the first to include photographs. Photography was still a relatively new technology and like most scientists, Darwin wanted to use the newest techniques to illustrate his ideas. It still exists in print, available in a

Recent edition. With a fantastic introduction and comments by Paul Ekman, a modern pioneer in the study of emotions, Darwin begins his presentation by describing the common organization of all mammals. Including human beings, the lungs, the kidneys, the brain, the digestive organs and the sexual organs that They support and allow life to continue

Although many current scientists accuse him of anthropomorphism. Darwin supports animal lovers when he proclaims that man and the higher animals also have instincts in common. They all have the same senses, intuition, sensations, passions, affections and emotions, even the most complex such as jealousy, suspicion, emulation, gratitude and magnanimity. Observe

That humans share some of the physical signs of animal emotion; we feel the hair on the back of our neck stand on end when we are afraid or we clench our teeth when we are angry. It can be understood as the vestiges of a long evolutionary process when

A man looks with contempt Charles Darwin 1872 for Darwin the emotions of mammals are fundamentally rooted in biology they are the indispensable source of motivation to initiate action the emotions of Latin movere move give form and orientation to everything we do and

Its primary expression is carried out through the facial and body muscles. These facial and physical movements communicate to others our mental state and our intention. Expressions of anger and threatening postures warn them to stop. to bother sadness attracts

Faith effect and attention fear indicates helplessness or warns us of danger we instinctively read the dynamics between two people simply from their tension or relaxation their postures and tone of voice the change in their facial expressions yes We watch a movie in a language we do not

Understand, yet we can assume the quality of the relationship between the characters. We can often interpret other mammals, monkeys, dogs, horses, in the same way. Darwin goes further and observes that the fundamental purpose of emotions is to initiate a movement that allows the body

Regain security and physical balance here is what Comments on the origin of what we would currently call PTSD behaviors to avoid or escape from danger have clearly evolved to make each organism competitive in terms of survival but a flight or avoidance behavior Inappropriately prolonged would leave the animal at

A disadvantage in the sense that preservation of the species requires reproduction which in turn depends on feeding, shelter and mating activities all of which are reciprocal of avoidance and flight. In other words If an organism is stuck in survival mode, its energies are focused on fighting invisible enemies, which

Leaves no room for nurturing, care and love for human beings. It means that while the mind is defending itself against invisible attacks from us, Intimate bonds are threatened along with our ability to imagine, plan, play, learn, and pay attention to the needs of other people. Darwin also wrote about the connections between

Body and mind that we continue to explore today. Intense emotions involve not only the mind. but also the gut and the heart The heart, gut and brain communicate intimately through the pneumogastric nerve, the critical nerve involved in the expression and management of emotions in both humans and animals when the mind is

Highly excited . This immediately affects the State of the viscera so that under activation there will be much more and mutual reaction between both the two most important organs of the body. The first time I saw this fragment I read it with great enthusiasm. Obviously we experience our

Most devastating emotions as feelings and anguishing pains as long as we register the emotions basically in our head we can more or less control but sensations like our chest sinking or being hit in the belly are unbearable we will do everything possible to make these terrible visceral sensations disappear either by desperately clinging

To another being human by becoming desensitized with drugs or alcohol or taking a knife to our skin to replace overwhelming emotions with definable sensations How many Mental Health problems from drug addiction to self-harming behavior begin as an attempt to cope with the unbearable physical pain of our emotions If Darwin was right, the

Solution requires finding ways to help people Modify the inner sensory landscape of their body. Until recently, much of Western science ignored this two-way communication between the body and mind. Although it has been fundamental in health practices, Traditional healing in many other places around the world particularly in India

And China is currently transforming the way we understand trauma and recovery a window into the nervous system all the little signs we instinctively register during a conversation muscle changes and tensions in the other person’s face, your eye movements and pupil dilation, as well as the tone and speed of your

Voice, as well as the fluctuations in your own internal landscape, salivation, swallowing, breathing and heart rate, are linked by a single regulatory system. They are the product of synchrony between the two branches of the autonomic nervous system: the sympathetic one, which acts as the

Body’s accelerator, and the parasympathetic one, which acts as the brakes. These are the reciprocal systems that Darwin talked about. And together they play an important role in management. of the energy flow of the body, one prepares to spend it and the other to conserve it. The sympathetic nervous system

Is responsible for activation, including the fight or flight response. Darwin’s escape or avoidance behavior almost 2000 years ago, the Roman physician Galen told him I call him sympathetic because he observed that it worked with emotions without pauses. The esns moves blood to the muscles

So that they act quickly, in part by causing the adrenal glands to release adrenaline. What it does accelerates the heart rate and increases blood pressure. The second branch of the ANS is the paraas sympathetic nervous system against emotions or PNS, which promotes

Self-preservation functions. It triggers the release of acetylcholine to stop the activation, reducing the heart rate, relaxing the muscles and recovering. Normal breathing, as Darwin pointed out, the activities of feeding, sheltering and mating depend on the PNS. There is a simple way to experience both systems for ourselves. When we breathe

Deeply, we activate the SES. The resulting burst of Adrenaline speeds up the heart, which explains why so many athletes perform Take short, deep breaths before starting a competition. Breathing, for your part, activates the PNS, which slows down the heart rate. If you do

A yoga or meditation class, the instructor will surely ask you to pay particular attention to expiration since long, deep breaths help. to calm down when we breathe we are continually accelerating and slowing down the heart and because of this the interval between the two heartbeats is never exactly the same a measurement

Called heart rate variability can be used prc to check the flexibility of this system and a good wrc the more fluctuation the better it is a sign that the brake and accelerator of our activation system are working properly and balanced for us acquiring an

Instrument to measure the brc was a great breakthrough in chapter 16 I will explain how we can use the brc to help treat TT the neuronal love code in 1994 Stephen porges researcher at the University of Maryland at the time we began our research on the BRC who

Currently works at the university of New Carolina introduced the polyvagal theory based on Darwin’s observations and added another 140 years of scientific discoveries to those first knowledge polyvagal refers to the different branches of the vagus nerve Darwin’s pneumogastric nerve that connects various organs including the brain, lungs, heart,

Stomach and intestines polyvagal theory allowed us to understand with greater sophistication The biology of safety and danger based on the subtle interplay between the visceral experiences of our own body and the voices and faces of the people around us

Explained why a friendly face or a relaxing tone of voice can drastically alter how we feel. We felt clarified Why knowing that we are seen and heard by the important people in our lives can make us feel calm and safe And why being ignored or left out

Can precipitate angry reactions or mental breakdown helped us understand Why being in tune with another person can take us out of a state of disorganization and fear. In short, Porges’ theory made us look beyond the effects of fight or flight and put

Social relationships front and center in our understanding of trauma. It also suggested new approaches to healing focused on strengthening the body system that regulates activation Humans are surprisingly attuned to the subtle emotional changes of people and animals around them slight changes in the tension of

An eyebrow wrinkles around the eyes curled lips and the angle of the neck quickly tell us if someone is comfortable if they are suspicious if they are relaxed or scared our mirror neurons register their inner experience and our body makes internal adjustments based on what

We perceive thus the muscles of our face give clues to others about If we are calm or excited if our heart is racing or calm and if we are about to throw noos at them or run away when the message we receive from the other person

Is with me Are you sure we relax if we are Lucky in our relationships we also feel nourished supported and restored when we look into the face and eyes of the other person our culture teaches us to focus on personal uniqueness but at a deeper level

We practically do not exist as individual organisms our brains are designed to help us function as members of a tribe we are part of that tribe even when we are alone whether we are listening to music that other people have created watching a

Basketball game on television and our muscles tense When players run and jump Or preparing a spreadsheet for a sales meeting anticipating our boss’s reactions, we spend most of our energy connecting with others if we look beyond the list of specific symptoms included in psychiatric diagnoses. In formal studies

We find that almost all mental suffering involves either problems in creating relationships that work and are satisfactory or difficulties in regulating activation, as happens when we usually get angry, block ourselves, become overexcited or disorganized. Generally it is a combination

Of both in the medical approach. The standard of trying to discover the right drug to treat a particular disorder often distracts us from trying to resolve the interference of our problems with our functioning as members of our tribe, security and reciprocity. A

Few years ago I heard Jerome Kagan, professor emeritus of child psychology at Harvard, say to the Dalai Lama that for every act of cruelty in this world there are hundreds of Small acts of kindness and connection his conclusion was being benevolent instead of malevolent is

Probably a true characteristic of our species being able to feel safe with other people is probably the aspect most important of Mental Health safe connections are fundamental to having a meaningful and satisfying life many studies of disaster responses around the world have shown that social support is

The most powerful protection against cancellation caused by stress and trauma social support is not the same as simply being in the presence of other people the critical issue is reciprocity being truly heard and seen by the people around us feeling

That we have someone’s support in their mind and in their heart so that Our physiology calms down, heals and grows. We need a visceral sense of security. No doctor can write a prescription for friendship and love. These are complex, hard-won abilities. You don’t need to

Have a traumatic history to feel self-conscious and even terrified at a party with strangers. Trauma can make the world seem like an alien party. Many traumatized people find themselves chronically out of sync with those around them. Some find solace in groups where they can remember their war experiences of rape or torture with

Others with a similar past or experiences. in a shared history of trauma and victimization mitigates their acute sense of isolation but Generally at the price of having to deny their individual differences, membership can only be achieved by conforming to the common code. Isolation in a narrowly defined group of victims promotes

A view of others as irrelevant at best and dangerous at worst which in the long run only causes more isolation gangs extremist political parties and religious cults may provide comfort but rarely promote the mental flexibility necessary to be fully open to what life has to offer And therefore

Cannot free their members from their traumas well-functioning people are able to accept individual differences and recognize the humanity of others in The last two decades it has been widely recognized that When adults or children are too scared or blocked to get comfort from humans, relationships with other mammals can

Help, dogs and horses, and even dolphins offer less complicated company, providing the necessary sense of security. Dogs and horses In particular, three levels of safety are currently widely used to treat some groups of patients with trauma. After trauma we experience the world with a different nervous system in which the perception

Of risk and safety is altered. Georges coined the word neuro to describe the ability to evaluate the relative danger and safety in our environment when we try to help people. With a defective neuro, the main challenge is to find ways to reset

Their physiology so that their survival mechanisms stop working against them. This means helping them respond appropriately to danger, but even more than that, it means recovering the ability to feel safe. relaxation and true reciprocity I have interviewed extensively and treated six people who survived plane crashes two said

They lost consciousness during the accident although they had no physical injuries they mentally collapsed two went into a state of panic and remained upset long after the onset From the treatment, two remained kilos and were able to help evacuate other

Passengers from the wreckage of the burning plane. I found similar responses in survivors of rape, traffic accidents and torture. In the previous chapter we saw the radically different reactions of Stan and Ute when reliving. the accident they suffered on the freeway side

By side What does this spectrum of responses represent centered collapsed or agitated porges theory offers an explanation the autonomic nervous system regulates three fundamental physiological states the level of safety determines which of them is activated in which specific moment when we feel threatened we instinctively go to the first level of social interaction,

We ask for help, support and comfort from the people around us, but if no one comes to our aid or we are faced with immediate danger, the body switches to a more primitive way of living, fighting. or escape we fight our attacker or we run to a safe place however if this

Fails we cannot escape we are held back or trapped the organism tries to preserve itself by blocking it this is where the vagus nerve comes into play with its different branches and I will briefly describe its anatomy because it is essential To understand how we handle

Trauma, the social interaction system depends on the nerves that originate in the regulatory centers of the brain stem, basically the vagus, also known as the tenth cranial nerve, along with adjacent nerves that activate the muscles of the face, the throat, the middle ear. and

The larynx when the ventral vagal complex cba B directs the function we smile when others smile at us we nod our heads when we agree and we frown when friends tell us about their misfortunes when the cb is activated it also sends signals to the heart and the lungs

Reducing the heart rate and increasing the depth of breathing as a result we feel calm and relaxed centered or pleasantly activated the vagus nerve with its many branches the vagus nerve which Darwin called the pneumogastric nerve registers sorrows and painful feelings when a The person feels a certain discomfort in the throat

The voice becomes dry the heart races and breathing becomes rapid and shallow three responses to the threat one the social interaction system an alarmed monkey signals the danger and asks for help CV two fight or flight shows its teeth the face of rage and terror sns

Three collapses the body detects defeat And withdraws cbd any threat to our safety or social connections triggers changes in the areas enervated by the c when something distressing happens automatically our facial expressions and tone of voice denotes our concern And these changes serve to ask others to come and help us, however,

If no one responds to our request for help, the threat increases and the oldest limbic brain comes into action, the sympathetic nervous system takes control by mobilizing heart muscles. and lungs to fight or escape our voice speeds up and becomes more strident and our heart

Begins to pump faster if there is a dog in the room it will move and growl because it can smell the activation of our sweat glands finally if there is no escape and we cannot do anything to stop The Inevitable we will activate the definitive emergency system the

Dorsal vagal complex cvd this system reaches below the diaphragm to the stomach, kidneys and intestines and drastically reduces the metabolism of the whole body The heart rate is reduced we notice how the heart drops we cannot breathe and the intestines stop working or are

Literally emptied they are scared shitless This is the point at which we become deactivated we collapse and become paralyzed fight or flight in front of to collapse as we saw in Stan and Ute’s brain scans. Trauma is expressed not only as fight or flight but also as a disconnection and

An inability to connect with the present. Each response involves a different level of brain activity. fight or flight of mammals that protects us and prevents us from deactivating and the reptilian brain that produces the response in the form of collapse we can see the

Difference between these two systems in any large pet store kittens puppies mice and gerbils play constantly and when They are tired, they huddle skin to skin, while snakes and lizards remain motionless in the corners of their cages without responding to the environment. This type of immobilization generated by the reptilian brain characterizes many

People with chronic trauma, unlike the panic and rage of mammals that makes recent survivors of trauma so frightened and frightens others themselves almost everyone knows what the typical escape response is like driver anger a sudden threat precipitates an intense impulse to move and attack the Danger

Disconnects our social interaction system, reduces our ability to respond to the human voice and increases our sensitivity to threatening sounds. However, for many people, panic and rage are preferable to the opposite, disconnecting and becoming dead to the world. going or fighting at least makes them feel that they have energy, which is why

So many abused and traumatized people feel fully alive in the face of real danger and remain blocked in situations that are more complex but objectively safe, such as birthday parties or family dinners. When fighting or running does not solve the threat, we activate the last resort, the reptilian brain, the definitive emergency system.

This system usually starts when we are physically immobilized, such as when an attacker has us cornered or when a child cannot escape from a caregiver who is holding him. frightens collapse and disconnection are controlled by the cvd an evolutionarily ancient part of the

Sympathetic nervous system associated with digestive symptoms such as diarrhea and nausea also reduces heart rate and induces shallow breathing once this system takes control other people and us We stop caring about ourselves, consciousness turns off and we may no longer physically register pain. How we become human beings according to Porges’s great theory.

In mammals, C evolved to support them in an increasingly complex social life. All mammals, including mammals. Human beings group together to mate, feed their young, defend themselves against common enemies, and coordinate hunting and food acquisition. The more effectively the brain synchronizes the activity of the sympathetic and parasympathetic nervous systems, the better

The physiology of each individual is tuned to that of the rest. of tribe members consider cob in this way Explain how parents naturally help their children regulate themselves newborns are not very social they spend most of their time sleeping and wake

Up when they are hungry or wet after eating They may spend some time looking around complaining or observing but they soon fall back asleep following their own inner rhythm. Very soon in life they are quite at the Mercy of the alternating tides

Of their sympathetic and parasympathetic nervous system and their reptilian brain is basically the one that directs the show but day by day as we coo and smile and pamper them we stimulate the growth of synchronicity in your developing baby these interactions help our babies’ emotional activation systems synchronize with their environment the

Cbb controls sucking swallowing facial expression and the sounds produced by the larynx when these functions are stimulated in a child are accompanied by a feeling of pleasure and security that helps create the foundation for all future social behavior like

My friend Ed tronic me taught a long time ago the brain is a cultural organ experience shapes the brain being synchronized with other members of our species through CV is extremely rewarding what begins as a synchronized game between mother and child continues

With the rhythm of a good game of basketball, the synchrony of a tango and the harmony of a choral song or the interpretation of a piece of jazz or chamber music all of this fosters a deep sense of pleasure and connection. We can talk about trauma when this system fails

When we beg for our lives but our assailant ignores our pleas when we are terrified children and we hear from the bed our mother scream for her boyfriend’s beating when we see our friend Trapped under a piece of metal that we are not

Strong enough to lift when we want to push the priest who is abusing us but we are afraid of being punished immobilization is at the origin of most traumas When this happens it is likely that the ced takes control the heart rate is reduced breathing

Becomes shallow and like zombies we lose contact with ourselves Steve Porks helped me realize that the natural state of mammals is to be somewhat on guard, however, to feel emotionally close to other human beings, our defensive system must temporarily disconnect to play, prepare and feed our little ones the brain must disconnect its

Natural vigilance many traumatized people are too vigilant to enjoy the ordinary pleasures of life while others are too blocked to absorb new experiences or to be alert to signals of real danger when the brain’s smoke detectors malfunction people stop running when they should be trying to escape or fight when they

Should be defending themselves a major study on adverse childhood experiences ago , which I will describe in more detail in the Chapter 9 showed that women who had an early history of abuse and neglect were seven times more likely to be raped in adulthood; women who as children had witnessed

Their mother being abused by their partner had many more likely to be Victims of domestic violence many people feel safe as long as they can limit their social contact to superficial conversations but actual physical contact can trigger intense reactions however as Porges points out to achieve any type of deep intimacy

An intense hug sleeping with a friend and sex requires allowing oneself to experience immobilization without fear. For traumatized people, it is especially difficult to differentiate when they are truly safe and to be able to activate their defenses when they are

In danger. This requires having experiences that can restore the feeling of physical safety, a topic that I will return to. to touch on several times in the following chapters new approaches to treatment if we understand that traumatized children and adults become stuck in

Fight or flight or in a Chronic disconnection how do we help them Deactivate these defense maneuvers that on one occasion guaranteed their survival some people who work with trauma survivors have a gift And they know how to do it intuitively Steve grew

Used to run the game show at the trauma Center Steve often walked around the clinic with a brightly colored beach ball and when he saw angry or paralyzed children in the waiting room he would give them a big smile, the children rarely responded. Then a little later

He would track and Fish would throw the ball near where the child in question was sitting. When he approached to pick it up, Steve pushed it towards the child who often returned it to him with little

Enthusiasm. Little by little, they ended up passing it to each other and it didn’t take long for smiles to appear on both of their faces from a few simple, rhythmically synchronized movements. Steve had created a small safe place in which the social interaction system could begin to re -emerge

What they would get by simply sitting in those chairs talking about the failures in their life is one thing. Clara yelling at someone who is already out of control can only lead to further dysregulation in the same way that our dog shrinks when we yell and

Wags his tail when I hum we respond. to shrill voices with fear, anger or disconnection and to funny tones with openness and relaxation We simply cannot avoid responding to these indicators of safety or danger, unfortunately our educational system as well as

Several of the methods that TR supposedly treat tend to avoid this system of Social interaction And instead they focus on recruiting the cognitive abilities of the mind. Despite the well-documented effects of anger, fear and anxiety on the ability to reason, many programs continue to ignore the need to activate the brain’s safety system.

Brain before trying to promote new ways of thinking the last thing that should be eliminated from school schedules are choirs, physical education, recess and everything that involves movement, play and fun interaction when children are contrary they are defensive they are

Incapable If they react or are angry, it is also important to recognize that this bad behavior can reproduce behavior patterns that were established to survive serious threats, even if they are intensely distressing or unpleasant. Porges’s work has had a profound effect on the way my colleagues and I We organize

The treatment of abused children and traumatized adults at the Trauma Center. It is true that we would probably have developed a therapeutic yoga program for women at some point since yoga has been shown to work very well in helping them calm down and reconnect

. with his dissociated body we would also probably have experimented with a theater program in inner-city schools in Boston, with a karate program for rape survivors called Impact model maging, self-defense program, and with play techniques and body modalities such as stimulation. sensory that are now being

Used with survivors around the world in part five we explored these techniques among others but the polyvagal theory helped us understand and explain why all of these disparate techniques and nothing with initials worked it also allowed us to be more aware of the combination From top-down approaches

To activate social interaction to bottom-up methods to calm physical tensions in the body, we were more open to valuing other, older, non-pharmacological approaches to health that have long been practiced outside of Western medicine since the breathing exercises, pranayama and chanting, to martial arts such as

Kgon and drumming, to group singing and dancing, everything is based on interpersonal rhythms, visceral awareness, and vocal and facial communication that help people get out of fight-flight states to reorganize your perception of danger and increase your ability to manage

Relationships the body keeps score if the memory of the trauma is encoded in the viscera in heartbreaking and painful emotions in autoimmune disorders and skeletal problems muscular and if the communication between the mind, the brain and the viscera is what it is based on

The regulation of emotions we must radically change our therapeutic hypotheses chapter 6 lose our body lose ourselves be patient with everything that is to be resolved in your heart and try to love your own questions live the questions

Now Maybe little by little without realizing it you will get closer one day in the future towards the answer reiner María rilke letters to a young poet sherry entered my office with her shoulders slumped and her chin practically touching her chest Before even saying a word, his body

Was telling me that he was afraid to face the world. I also noticed that his long sleeves only partially covered the scabs that he had on his forearms. After sitting down, he told me in a strident monotone that he couldn’t stop. from picking the skin on her arms and chest

To bleeding according to Sherry’s earliest memories her mother had run a foster home and her house was often filled with up to 15 frightened disruptive strange children who would disappear As soon as they arrived, Sherry had grown up caring for

These transient children, feeling like there was no room for her and her needs. I know I wasn’t wanted. She told me. I’m not sure when I first realized that, but I’ve thought about things that my mother She told me and the signs were always there she told me you know I don’t think

You belong to this family I think they gave us the wrong daughter and she told me with a smile on her face but of course people usually pretend to be joking when they say something seriously Over the years our research team has repeatedly proven that emotional abuse and

Chronic neglect can be just as devastating as physical and sexual abuse. Sherry turned out to be a living example of these findings. where to go to feel safe is devastating at any age but it is particularly destructive in young children who are still searching for their place in the world sherry had graduated

From college but now she had a boring office job she lived alone with her cats and did not She had close friends. When I asked her about men, she told me that her only relationship had been with a man who kidnapped her on a college vacation in Florida, held her

Captive and raped her repeatedly for five consecutive days. She remembered cowering in terror and almost paralyzed. all that time until she realized she could try to escape she escaped by simply walking while he was in the bathroom when she called her mother to

Come pick her up her mother refused to answer the call sherry was finally able to get home with the help from a center for victims of domestic violence, Sherry told me that she had started picking her skin because it gave her some relief from her paralysis. The

Physical sensations made her feel more alive. But she was also deeply ashamed. She knew she was addicted to these actions, but she couldn’t stop. Before doing so, she had consulted several Mental Health professionals before me and had been asked repeatedly about her suicidal behavior. She

Had also been subjected to involuntary hospitalization by a psychiatrist who refused to treat her unless she promised not to return. to pick their skin again however in my experience patients who cut themselves or pick their skin like sherry are rarely suicidal they are simply trying to do something to feel better the

Only way they know how it is a difficult concept for many people to understand As I mentioned in the previous chapter, the most common response to anxiety is to look for people we like and trust to help us and give us the courage to move forward. We can also

Calm down by doing a physical activity such as cycling or walking. At the gym we begin to learn these ways of regulating our feelings from the first moment someone feeds us When we are hungry They cover us When we are cold or rock us when we have hurt ourselves or

We are afraid but if no one has ever looked at you with love or given you a smile when they see you or if no one has run to help you And instead of that they have told you stop crying or I will give you reasons

To cry then you must discover other ways to take care of yourself you are likely to experiment with anything drugs alcohol bulimia or cutting that will bring you any kind of relief. Although Sherry obediently came to each visit and answered my questions with great sincerity, I did not feel

That we had the kind of vital connection that is necessary for the therapy to work I suggested that Lis see a massage therapist that I had previously worked with during the first visit Lis placed Sherry on the massage table and then stood at the end

Of the table gently holding Sherry’s feet. sherry was lying there with her eyes closed sherry suddenly started screaming in panic where are you somehow sherry had lost track of lis Although lis was right there holding sherry’s feet with her hands sherry was one of the

First patients that I They taught the extreme disconnection from the body that so many people with histories of trauma and abandonment experience. I discovered that my professional training focused on understanding and perception had overlooked the importance of the living,

Breathing body, the foundation of our self. Sherry knew that picking his skin was something destructive and had to do with his mother’s abandonment, but understanding the origin of the impulse did not help him control it, losing his body, once I was aware of it, I was surprised to discover how many

Patients told me that they could not feel areas whole body parts I sometimes asked them to close their eyes and tell me what I had put in their outstretched hands. Whether it was a car key, a quarter or a can opener, they often couldn’t guess what they had in their

Hands from their sensory perceptions. They didn’t work, I mentioned it to my friend Alexander McFarlan from Australia, who had observed the same phenomenon in his laboratory in Adelaide. He had studied the following question: How do we know that we are holding a car key without looking at it?

Recognizing an object in the palm of our hand requires perceive its shape, weight, temperature, texture and position, each of these different sensory experiences is transmitted to a different part of the brain that must then reintegrate them into a single perception. McFarlan discovered that

People with PTSD often found it difficult to reconstruct the image when our senses are dulled . of feeling totally alive in an article titled What is an emotion by William James, the father of American psychology, described a surprising case of sensory insensitivity in a woman he interviewed, I have no human sensations,

He told her I am surrounded by everything. that I could make my life happy and pleasant but I do not have enough faculty of enjoyment and feeling, all my senses, every part of my own self, it is

As if they were separated from me and I could not allow myself any feelings, this impossibility seems to depend on an emptiness that I feel. in the front of my head and be due to decreased sensitivity over the entire surface of my body since I seem to

Never really reach for the objects I touch. All of this may seem unimportant but it results in a terrifying result that is the impossibility of having any feelings and any kind of enjoyment Although I experience the need and desire to have them which turns my

Life into an understandable torture, this response to trauma raises an important question: How can traumatized people learn to integrate ordinary sensory experiences in order to live with the natural flow of your feelings and feel safe and complete in your body How do

We know we are alive many of the first neuroimaging studies in traumatized people were like those we saw in chapter 3 focused on How subjects react to reminders trauma specifics later my colleague Ruth lanius who performed the

Brain scans on Stan and youth Lawrence raised a new question what happens in the brains of the trauma survivors when they are not thinking about the past her studies on the resting brain the default neural network opened a whole new chapter in understanding how trauma affects self-awareness specifically sensory self-awareness

Doctor lanius selected a group of 16 normal Canadians to do a brain scan while they were not thinking about anything in particular. This is not easy to achieve while we are awake, our brain does not stop, but he asked them to focus their attention

On their breathing and try to empty their mind. to the maximum then repeated the same experiment with 18 people who had had histories of severe chronic abuse during childhood What is our brain doing when we have nothing concrete on our mind it turns out that

We pay attention to ourselves the default state activates the brain areas that They work together to create our perception of self. When Ruth analyzed the scans of normal subjects, she observed activation of regions of the brain that previous researchers had described. I like to call it the ridge of self-awareness.

The eyes run through the center of the brain to the back of the head. All of these midline structures are involved in our perception of self. The bright region in the back of the brain is the posterior cingulate, which gives us the

Physical perception of where we are. Our internal GPS is. strongly connected to the medial prefrontal cortex cpfm the watchtower I mentioned in chapter 4 this connection does not appear in the scanner because fMRI cannot measure it it is also connected to the brain areas that

Register sensations coming from the rest of the body the insula which transmits messages from the viscera to the emotional centers the parietal lobes that integrate sensory information and the anterior cingulate that coordinates emotions and thinking all these areas contribute to

Consciousness the difference with the scans of the 18 chronic PTSD patients with trauma serious symptoms experienced in early childhood were striking, there was practically no activation of any of the self-perception areas of the brain the mcfc the anterior cingulate the parietal cortex and the insula

Are not illuminated at all the only area that showed slight activation was the posterior cingulate which is responsible for basic spatial orientation, there could only be an explanation for these results in response to the trauma itself and to manage the fear that persisted

Long after these patients had learned to disconnect the areas of the brain that transmit the visceral feelings and emotions they accompany and define terror however in our daily lives these same brain areas are responsible for registering the entire range of emotions and sensations that form the foundations of our self-awareness the perception

Of Who we are what we were seeing was a Tragic adaptation in an effort to turning off frightening sensations also numbed your ability to feel fully alive localization of the self the crest of self-awareness starting from the front of the brain on the right is composed of the orbital prefrontal cortex the

Medial prefrontal cortex the anterior cingulate the posterior cingulate and the insula In people with histories of chronic trauma the same regions show clearly reduced activity making it difficult to register internal states and evaluate the personal relevance of incoming information. The disappearance of medial prefrontal activation could explain why so many

Traumatized people lose consciousness. notion of purpose and direction I used to be surprised how often my patients asked me for advice on the most ordinary things And then how rarely they followed them Now I understand that the relationship with their own inner reality was deteriorated How

They could make decisions or make any plans started if they couldn’t define what they wanted or more precisely what the sensations in their body that are the basis of their behavior were trying to tell them. all emotions the lack of self-awareness in victims of chronic childhood trauma is sometimes

So profound that they cannot recognize themselves in a mirror brain scans show that it is not the result of a mere lack of attention the structures responsible for self-recognition may have been knocked out together With those related to

My own experience, when Rud Lanius showed me his study, a phrase from my classical secondary education came to mind. The mathematician Archimedes, speaking about the lever, supposedly said, Give me a point of support and I will move the world, or as Mos Felden Cris said. the great body therapist

Of the 20th century you cannot do what you want until you know what you are doing the implications are clear to feel present You must know where you are and be aware of what happens to you if the self-perception system breaks down we must find ways to reactivate it The

Self-perception system was fascinating to see how Sherry improved with her massage therapy. She felt calmer and more confident in her daily life and was also more relaxed and open with me. She was really involved in her therapy and I was truly curious about her behavior. Her thoughts.

And her feelings stopped picking at her skin and when summer came she began to spend some afternoons sitting outside on the stairs of her house Chatting with her neighbors She even joined a church choir a wonderful experience of group synchrony was more or less

In this time when I met Antonio Damasio in a small think tank organized by Dan Schacter the chairman of the Harvard psychology department in a series of brilliant scientific articles and books Damasio clarified bodily emotions and survival Damasio a neurologist who had treated hundreds of people with different forms of brain damage

He became fascinated with consciousness and with the identification of the areas of the brain necessary to know what we feel. He has dedicated his career to mapping the elements responsible for our experience of self, the feeling of What happens is, for me, his book more important and reading it

Was a revelation Damasio begins by pointing out the deep division between our perception of the self and the sensory life of our body as He explains poetically that sometimes we use our mind not to discover facts but to hide them, one of the things that the screen hides most Effectiveness

Is the body, our own body, and by that I mean its interior like a veil thrown over the skin to ensure its modesty. The screen partially eliminates from the mind the internal states of the body, those that constitute the flow of life as it wanders. for each day’s journey

Continues to describe how this screen can act in our favor allowing us to attend to the pressing problems of the outside world however it has a price it usually prevents us from perceiving the possible origin and nature of what we call the self based on the Centennial work

Of William James Damasio states that the core of our self-awareness lies in the physical sensations that convey the internal states of the body. Primordial feelings provide a direct experience of our own living body without words, unadorned and connected

To nothing more than pure existence. These ordial feelings. they reflect the current state of the body in several dimensions on a scale that goes from pleasure to pain and originate at the level of the brain stem and not in the cerebral cortex all felt emotions are complex

Musical variations of primordial feelings our sensory world takes shape even before we are born in the womb we feel the amniotic fluid against our skin we hear the loving sounds of blood flow and the digestive tract at work we adapt to our mother’s movements after birth physical sensation Defines our relationship with ourselves

And with What surrounds us begins with our humidity, our hunger, our satiety and our drowsiness, a cacophony of incomprehensible sounds and images presses on our Immaculate nervous system and even after acquiring consciousness and language our system of Body perception gives us crucial feedback on our moment-to-moment state. Its

Constant humming communicates changes in our viscera and in the muscles of our face, torso and extremities that signal pain and comfort as well as needs such as hunger and sexual arousal. What happens around us also affects our physical sensations. Seeing someone we know. Listening to specific sounds, a song, a siren, or

Noticing a change in temperature changes our focus of attention and without us being aware of it, it influences our thoughts and our subsequent actions. As we have seen, the job of the brain is to constantly monitor and evaluate what is happening inside and

Around us. These evaluations are transmitted through chemical messages in the bloodstream and through electrical messages to our nerves, causing subtle or drastic changes throughout the body and in the brain these changes usually happen without our conscious contribution O Our knowledge the subcortical regions of the brain are surprisingly efficient

At regulating our breathing our heart rate digestion hormone secretion and the immune system however these systems can become saturated if we face a constant threat or Even in the face of the perception of a threat, this explains the wide variety of physical problems that researchers have documented in traumatized people. However, our

Conscious self also plays a vital role in maintaining our inner balance. We must record our physical sensations and act accordingly. of them to keep our body safe realizing that we are cold pushes us to put on a sweater feeling hungry or noticing net toan near areas that control basic organizational functions such as

Breathing, appetite, elimination and sleep-wake cycles this is because the The consequences of having emotions and attention are completely related to the fundamental task of managing life within the organism. One cannot manage life and maintain homeostatic balance without data about the current state of the organism’s body. Damasio calls these

Organizational areas of the brain the protoy. because they create the wordless knowledge underlying our conscious perception of the self the self under threat in 2000 Damasio and his colleagues published an article in the world’s leading scientific journal Science in which they described how recalling an intense negative emotion causes significant changes in

The brain areas that receive nerve signals from the muscles, gut and skin – areas crucial for regulating basic bodily functions – the team’s brain scans showed that remembering a past emotional event makes us actually re-experience the visceral sensations we had during the original event, each type of

Emotion produced a characteristic pattern different from the others. For example, a specific part of the brain stem was active in sadness and anger but not in happiness or fear. All of these brain regions are located below the limbic system to which emotions are usually assigned

, however we see their implication every time we use one of the common expressions that relate intense emotions to the body you make me sick my skin breaks down I was speechless with emotion my heart sank it makes my nerves stand on edge The elemental ego system in the

Brainstem and limbic system is massively activated when people face the threat of being annihilated, causing an overwhelming sense of fear and terror accompanied by intense physiological activation for people who are reliving. a trauma nothing makes sense they are trapped in a life or death situation a state of paralyzing fear or

Blinding rage the mind and body are constantly activated as if they were in imminent danger they startle at the slightest noise and become frustrated with small irritations They have chronically disturbed sleep and food usually loses its sensory pleasures, this in turn can trigger desperate attempts to silence these feelings through paralysis and

Dissociation How do people regain control when their animal brain is stuck in a fight for survival if what happens deep inside our animal brain dictates how we feel And if our bodily sensations are orchestrated by subconscious subcortical brain structures how much control over them can we really have

Agency being masters of our life agency is the technical term to describe the feeling of being in charge of our life knowing where we are knowing that we have a lot to do. say about what happens to us knowing that we have the ability to shape our circumstances the veterans who were punching

The walls of the Bea clinic were trying to assert their agency to make something happen but they ended up feeling even more out of control and many of these Men so self-confident in the past were caught in the cycle between frenetic activity and immobility. Agency begins with what scientists call interoception, the

Knowledge of our subtle bodily sensory sensations. The greater this knowledge, the more potential we have to control. our life knowing what we feel is the first step to knowing why we feel that way if we are aware of the constant changes in our

Internal and external environment we can mobilize to manage them but we cannot do it Unless our watchtower the CP FM learns to observe What happens inside us, that is why the conscious practice that reinforces the cpfm is a cornerstone in overcoming trauma.

After watching the wonderful movie The Emperor’s Voyage, I found myself thinking about some of my patients: penguins are stoic and adorable and it is tragic. See how since time immemorial they have walked arduously 70 miles inland from the sea, endured indescribable adversity to reach the breeding ground, losing many viable eggs and then

Almost dying of hunger. Returning to the ocean, if penguins had our frontal lobes they would have used their small flippers. to build igloos they would have devised a better division of labor and reorganized their food supply many of my patients have survived

Trauma with enormous courage and persistence only to suffer the same problems again and again the trauma has broken down their inner compass and has robbed them of the imagination they need to create something better the neuroscience of selfhood and agency validates the type of

Somatic therapies that my friends peter levine and pat ogden have developed. i will discuss these and other sensorimotor approaches in more detail in part five but basically its objective is threefold: to bring out the sensory information that is blocked and paralyzed by the trauma, to help patients

Accept instead of suppressing the energies, release this inner experience, complete the physical actions of self-preservation that were left undone while they were trapped inside . or paralyzed by terror, our feelings tell us what is safe, what is vital, or threatening, even if we cannot explain why we feel a particular way, our

Sensory interiority continually sends us subtle messages about our body’s needs, feelings also help us to evaluate what is happening around us they warn us that the guy who is approaching us looks Creepy but they also tell us that a west-facing room surrounded by lilies makes us feel calm

When we have a comfortable connection with our inner sensations if we trust that give us exact information we feel that we are in control of our body, our feelings and our Self. However, traumatized people feel chronically insecure within their

Body. The past is alive in the form of constant internal discomfort. Their body is continually bombarded by alarm signals. visceral and in an attempt to control these processes they often become expedient in ignoring their instincts and numbing the awareness of what is happening.

Going on inside they learn to hide from themselves The more people try to lose sight of and ignore internal warning signals the more likely they are to take control and be left bewildered, confused and embarrassed by people who cannot comfortably feel what is happening

To them . It happens inside they become vulnerable to responding to any sensory change, either by disconnecting or with panic attacks, they develop fear of fear itself. We know that these panic symptoms remain largely because the individual develops a fear of the bodily sensations associated with the attacks. panic attack can be

Triggered by something that the person knows is irrational but the fear of the sensations causes it to escalate to an emergency situation throughout the body dead from fear and paralyzed by fear collapsing and becoming paralyzed describe precisely how They perceive terror

And trauma are their visceral basis the experience of fear is derived from primitive responses to threat where escape is somehow thwarted people become hostage to fear until this visceral experience changes the price of ignoring and to distort the body’s messages

Is to be unable to detect what is really dangerous or harmful to us and just as bad as it is safe or empowering self-regulation depends on maintaining a cordial relationship with our body without it we have to depend on external regulation medication

Drugs such as alcohol, constant reassurance or compulsive compliance with the wishes of others, many of my patients do not respond to stress by recognizing and naming it, but rather develop headaches with migraines and asthma attacks. Sandy, a middle-aged nurse, told me that as a child she felt

Terrified. and alone because her alcoholic parents didn’t see her she dealt with it by becoming obedient to everyone she depended on including me her therapist when her husband made an inconsiderate comment she would have an asthma attack by the time she realized

That she couldn’t breathe it was too late for the inhaler to take effect and they had to take her to the emergency room eliminating our internal cries for help does not stop our stress hormones from moving our body Even if Sandy had learned to ignore her

Relational problems and block her signals of distress Physical sensations appeared through symptoms that required her attention. Her therapy focused on identifying the link between her physical sensations and her emotions. I also encouraged her to sign up for a

Kickboxing course. She did not have to go to the emergency room any day. During the TR years in which she was a patient of mine, traumatized children and adults have many somatic symptoms for which no physical basis can be found. Clear may include chronic back and neck pain fibromyalgia

Migraines digestive problems spastic colon or irritable bowel syndrome chronic fatigue and certain forms of asthma traumatized children have an asthma rate 50 times higher than their non-traumatized peers several studies have shown that many children and adults with fatal asthma attacks were not aware of having had breathing problems before

The attacks alexithymia inability to put words to feelings I had a widowed aunt with a painful attic history who became honorary grandmother of our children used to come to visit us frequently, visits always marked by a lot of activity making curtains arranging the kitchen shelves sewing the children’s clothes and very little

Conversation always She was willing to please but it was difficult to guess what she liked to do After several days of sharing kind comments the conversation stopped and I had a hard time filling the long silences on the last day of one of her visits I took her to the airport

And there I she gave a dry hug goodbye as tears fell down her cheeks without a trace of irony she complained that the cold wind at Logan International Airport made her cry her body felt the sadness that her mind couldn’t register she was saying goodbye to

His young family and his closest living relatives call this phenomenon alexithymia, a Greek term that means not being able to put words to feelings. Many traumatized children and adults simply cannot describe what they feel because they cannot identify the

Meaning of their physical sensations. They may seem angry but deny that they are angry. Not being able to discern what is going on in their body makes them lose control of their needs and have a hard time taking care of themselves. right time or sleeping the necessary hours like my

Aunt, alexithymics replace the language of action with that of emotion if you ask them how they would feel If they saw a truck coming in their direction at 130 km per hour, most people would say me would be terrified or paralyzed by fear an alexithymic might respond How would

I feel I don’t know get out of the way usually register emotions as physical problems rather than as signs that something deserves their attention instead of feeling angry or sad they experience muscle pain intestinal irregularities or other symptoms for which no cause can be found. Approximately three-quarters of patients with anorexia

Nervosa and more than half of patients with bulimia felt bewildered by their emotional feelings and had a hard time describing them when the researchers showed images from angry or distressed faces to people with alexithymia, they couldn’t guess what those people were feeling. One of the first people who taught me about

Alexithymia was psychiatrist Henry Crystal, who had worked with more than 1,000 Holocaust survivors to try to understand psychic trauma. massive crystal who was also a concentration camp survivor observed that many of his patients were professionally successful but their intimate relationships left much to be desired and were distant

Suppressing their feelings had allowed them to attend to tasks in the world but at a price they learned to silence their once overwhelming emotions and as a result they no longer recognized what they were feeling few of them were interested in therapy Paul freen of

The University of Western Ontario performed a series of brain scans on people with PTSD who suffered from alexithymia one of the participants He told her I don’t know what I feel it’s like my head and my

Body are not connected I’m living in a tunnel in the fog no matter what happens I have the same reaction insensitivity nothing taking a bubble bath or getting burned or being raped is the same feeling my brain doesn’t feel anything freuen and his partner Ruth lanius discovered

That the more disconnected people were from their feelings, the less activity they had in the self-perception areas of the brain, as traumatized people often have a hard time perceiving what is happening in their body, they lack a nuanced response to frustration react to stress by

Becoming numb or excessively angry Whatever their response they often cannot tell what is upsetting them This inability to connect with their body contributes to their well-documented lack of self-protection and high rates of of revictimization as well as their notable difficulties in feeling pleasure, sensuality and purpose, people with

Alexithymia can improve if they learn to recognize the relationship between their physical sensations and their emotions in the same way that color blind people can only penetrate the world of color. Learning to distinguish and appreciate shades of gray as my aunt and

Henry Crystal’s patients tend to be reluctant to do, most seem to have unconsciously decided that it is better to continue visiting doctors treating illnesses that cannot be cured than to carry out the painful task of coping to the demons of the past depersonalization one step

Further down the ladder of Your forgetfulness is depersonalization, that is, losing track of oneself. Ute’s brain scan in chapter 4 is in its own whiteness a clear example of depersonalization depersonalization is common during traumatic experiences on one occasion I was mugged at night in a park near my house and floating above

The scene I saw myself lying on the snow with a small wound on my head surrounded by three armed teenagers with knives I dissociated the pain from his stab wounds in my hands and did not feel the slightest fear as I calmly negotiated for the return of my empty wallet. I suppose

I did not develop PTSD in part because I was curious about that experience that I had studied so closely in other people. and partly also because I had my hopes that I could make a portrait of my attackers to show to the police. Obviously,

They were never caught, but my revenge fantasy. It probably gave me a satisfying sense of agency. Traumatized people are not so lucky and they feel separated from their body, a particularly good description of depersonalization is that of the German psychoanalyst Paul Schilder, who in 1928 wrote in Berlin for depersonalized people, the world

Seems strange, peculiar, strange, dreamlike, sometimes the objects are of a strangely small size, sometimes the sounds are flat. They seem to come from afar. In the same way, emotions also suffer a notable alteration. Patients complain that they cannot experience either pain or pleasure. They have

Become strangers to themselves. I was fascinated to learn that a group of neuroscientists from the University of Geneva had induced similar out-of-body experiences by delivering gentle electrical currents to a specific point in the brain at the temporal-parietal junction in

One patient it caused the sensation of being suspended from the ceiling looking down at her body in another it induced the disturbing sensation that there was someone behind her this research confirms what our patients tell us that the self can separate from the body and live a

Ghostly existence on its own in the same way as lanius and freen as well as a group of researchers from the University of groningen the netherlands performed brain scans on people who had dissociated their terror and discovered that the brain’s fear centers simply shut

Down as soon as they remembered the event making friends with our body trauma victims cannot recover until they become familiar with and accept the sensations in their body being scared means living in a body that are always on guard angry people live

In angry bodies the body of victims of child abuse is tense and defensive until they find a way to relax and feel safe to change people must be aware of their feelings and the way their body interacts with the world around them

Physical self-awareness is the first step in freeing oneself from the tyranny of the past How people can open up and explore their inner world of sensations and emotions in my practice I begin this process by helping my patients first notice and then to describe the

Bodily sensations they feel, not the emotions such as anger or anxiety or fear, but the physical sensations behind the emotions, pressure, heat, muscle tension, tingling, collapse, emptiness, etc. I also work on identifying the sensations associated with relaxation or pleasure, I help them.

To be aware of their breathing, their gestures and movements, I ask them to pay attention to subtle changes in their body such as pressure in the chest or nibbling in the belly when they talk about negative events that they say did not affect them, noticing sensations for the first time.

It can be quite distressing and can precipitate flashbacks in which people curl up or adopt defensive postures. They are somatic representations of undigested traumas and in most cases they represent the postures they adopted when the trauma occurred. The images and physical sensations can overwhelm patients at that moment and the therapist must be

Familiar with ways to contain this torrent of sensations and emotions to prevent them from retraumatizing the school teachers, nurses and police officers. good at calming terror reactions Because many of them are confronted almost daily with out of control or painfully disorganized people too often yet

Drugs like abilify ciprex AND seroquel are prescribed instead of teaching people the techniques to manage these reactions distressing physical symptoms obviously medications only mitigate the sensations and do nothing to resolve them or convert them from toxic agents into allies the

Most natural way for human beings to calm down when they are upset is by clinging to another person this means that patients who have been attacked physically or sexually they face a dilemma they desperately crave contact but at the same time physical contact

Terrifies them they must reeducate their mind to feel physical sensations and they must help their body to tolerate and enjoy the benefits of contact people who lack emotional awareness are able with practice to connect their physical sensations with psychological events then little by little they can reconnect with themselves connect with themselves

Connect with others I will finish this chapter with a final study that demonstrates the cost of losing our body after That Ruth Ianius and her resting brain scanning group focused on another everyday question What happens to people with chronic trauma when they maintain

Face-to-face contact Many patients who come to my office are unable to maintain contact visual I immediately realize their distress because of their difficulty in meeting my gaze. They always feel disgusting and cannot stand me seeing how despicable they are. I have never seen these intense feelings of shame reflected in

Abnormal brain activation. Ruth lanius clearly demonstrated new that the mind and the brain are indistinguishable what happens in one is recorded in the other Ruth bought an expensive device that presents a video character to the person in the scanner in this case the person looked like

The kind Richard J la The figure can be approached from the face, looking directly at the person or at an angle of 45, averting the gaze. Thus, the effects of direct eye contact on brain activation can be compared with the effects of averted gaze. The most striking difference

Between normal controls and survivors of chronic trauma was in the activation of the prefrontal cortex in response to direct mir Ada the prefrontal cortex normally helps us evaluate the person approaching us and our mirror neurons help us identify

Their intentions however the subjects with PTSD they did not activate any part of their frontal lobe, which means that they did not show any curiosity towards the stranger. They simply reacted with intense activation within their emotional brain in the primitive areas known as periaqueductal gray matter, which generates startles, hypervigilance, and shrinking.

And other self-protective behaviors there was no activation of any part of the brain involved in social interaction in response to being looked at they simply went into survival mode What does this mean for your ability to make friends and get along with

Others What does it mean For their therapy, can people with PTSD trust a therapist with their deepest fears? To have true relationships, we must be able to perceive others as individual people, each with their own motivations and intentions. Although we need to

Be able to stand on our own, we also need to recognize that others people have their own agendas trauma can make all this seem blurry and gray part three the mind of children chapter 7 getting on the same wavelength attachment and attunement the

Roots of resilience must be sought in the feeling of being understood and of exist in the mind and heart of another loved person attuned and self-possessed Diana fosa the children’s clinic of the Massachusetts mental health center was full of disturbed

And disruptive children they were savages who could not sit still and who hit and bit others children sometimes even the staff came running towards you they hit you and then ran away terrified some masturbated compulsively others hit things pets

Themselves they were thirsty for affection but at the same time also angry and defiant girls especially could be painfully d Neither those who were always contrary nor the most insecure seemed to be able to explore or play as children their

Age usually do. Some had barely developed self-awareness and could not even recognize themselves in a mirror. At that time, I knew very little about children apart from what my two preschool children were teaching me but I was lucky to have my partner Nina Fish Mary who had

Studied with j in Geneva and had raised five children piayet based her theories of child development on direct observation and meticulous of the children themselves Starting with her own children and Nina brought this spirit to the incipient trauma Center of the mmhc Nina was married to the

Former chairman of the Harvard psychology department Henry murrey one of the pioneers of personality theory and actively supported All the young teachers who shared her interests were fascinated by my stories about war veterans because they reminded the disturbed children I worked with in the Boston public schools.

Nina’s privileged position and her personal charm gave us access to the clinic. child psychiatrists directed by child psychiatrists with little interest in trauma Henry Marray had become famous, among other things, for designing the widely used thematic apperception test, the tat is

What is called a projective test that is based on a set of cards to discover how The inner reality of people shapes their vision of the world. Unlike the rosak cards that we used with the veterans, the tat cards represent realistic scenes. But ambiguous and

In some ways disturbing, a man and a woman looking at each other sadly, a child looking at a broken violin. asks the subjects to tell stories about what is happening in the photo what has happened before and what will happen next in most cases their interpretations

Quickly reveal the issues that concern them Nina and I decided to create a set of cards specifically for children Based on images we cut out of magazines in the clinic’s waiting room, our first study compared 12 children between 6 and 11 years old from the clinic with a group of

Children from a nearby school who were most similar to them in terms of age. race intelligence AND family constellation What differentiated our patients was the mistreatment they had suffered in their family included a boy bruised by the blows repeatedly inflicted by his mother

A girl whose father sexually abused her when she was 4 years old two boys who had been repeatedly tied to a chair and whipped and a girl who, at the age of 5, had seen her mother being raped,

Dismembered, burned and put in the trunk of a car, a prostitute , the mother’s pimp was suspected of sexually abusing the girl, the children of Our control group also lived in poverty in a depressed area of ​​Boston where they regularly witnessed

Shocking violence. While we were conducting the study, one boy from his school poured gasoline on a classmate and set him on fire, another fell into the crossfire. While he was walking to school with his father and a friend, he was injured in the groin and his friend died. Taking into

Account his exposure to this high baseline level of violence, his responses to the cards would vary from those of hospitalized children. our cards showed a familiar scene two smiling children Looking at their father repairing a car all the children who

Looked mentioned the danger to the man who was under the vehicle while the control children told stories with benign endings the car was being repaired and the father And the children might go to McDonald’s afterwards. The traumatized children told some horrible stories. One girl said.

That the girl in the photo was about to smash the father’s head open with a hammer a 9- year-old boy who had been severely physically abused told an elaborate story about how the boy in the photo kicked the jack off the car So the vehicle crushed the father and

His blood stained the entire garage. When we told these stories, our patients showed a lot of agitation and disorganization. We had to take several breaks to go to the Water Fountain and walk around a little before showing them the next card. It was not appropriate. It is surprising that almost all of them

Had been diagnosed with ADHD and the majority were taking Ritalin. Although the drug obviously did not seem to reduce their activation in this situation, the abused children gave similar responses to an apparently innocuous image of the silhouette of a pregnant woman in front of a window

When We showed it to the 7-year-old girl who had suffered sexual abuse at the age of 4. She talked about penises and vaginas and repeatedly asked Nina questions like how many people have you fucked, like several of the other girls in the study who had suffered sexual abuse. She was so upset

That we had to stop. A 7-year-old girl in the control group captured the melancholic tone of the image. Her story It was about a widow who looked sadly out the window, missing her husband, but in the end the woman found a loving man who was a good father to his baby, card after

Card we saw that despite his alertness to problems, children who had not been victims of abuse continued to trust in an essentially benign universe, could imagine ways out of bad situations, seemed They felt protected and safe in their own family. They also

Felt loved by at least one of their two parents, which seemed to make a substantial difference in their willingness to do schoolwork and learn. The images from the children in the clinic were alarming. most innocent I stirred up intense feelings of danger, aggression, sexual excitement and terror. We had not selected these

Images because they had some hidden meaning that sensitive people could discover. They were ordinary images of daily life. We could only conclude that for abused children the whole world is full of triggers as long as they only imagine disastrous outcomes for relatively benign situations any person entering a

Room any stranger any image on a screen or billboard can be perceived as the harbinger of a catastrophe before this the strange behavior of the children at the clinic childhood made absolute sense. To my surprise, the unit staff’s conversations rarely mentioned the children’s actual horrible experiences and

The impact of those traumas on their feelings on their thinking on their self-regulation. Instead, their medical records were filled with diagnostic labels. conduct disorder or defiant disorder or position for angry or rebellious children or bipolar disorder . different views

Of the world of normal children could explain their resilience and at a deeper level How each child actually creates his map of the world the other equally crucial question was is it possible to help the minds and brains of abused children to redraw their inner maps and incorporating the

Feeling of esper and confidence in the future men without mothers the scientific study on the vital relationship between children and mothers was initiated by some upper-class Englishmen who were separated from their families as children and sent to boarding schools where they grew up in a

Regulated environment with other children of the same gender the first time I visited the well-known tavistock clinic in London I was able to see the collection of black and white photographs of those great patras of the 20th century hanging on a wall leading to the main stairs

John bolby wilfred bayon Harry gant trip Ronald fbn and Donald winnicott each of them in their own way had explored How our first experiences become the prototype of all the connections that we will later maintain with other people and how the

Most intimate perception of ourselves is created from the exchanges that we have minute by minute with our caregivers, scientists study What baffles them the most so that they often become experts on topics that other people take for granted or, as attachment researcher Beatrice Bib once told me, most research is a search

For ourselves, those men who They studied the role of mothers in the lives of their children. They were also sent to boarding school at a vulnerable age, sometimes between 6 and 10 years old, long before they had to face the world alone. Bolby himself told me that

Those experiences in The boarding school probably inspired George Orwell’s novel 1984, which brilliantly expresses how human beings can be induced to sacrifice everything they consider dear and true, including their perception of themselves, in order to be loved and receive the

Approval of someone they are in. a position of authority as Bolby was a close friend of the Murris I had the opportunity to speak with him about his work Every time he visited Harvard he was born

Into an aristocratic family his father was a surgeon to the king’s household and he studied psychology medicine and psychoanalysis in the temples of the British ruling class after studying at the University of Cambridge he worked with delinquent boys in the isen of London, a notoriously criminalized neighborhood

That was badly destroyed during the German bombing of the city during World War II and after having served in it observed the effects of wartime evacuations and group daycares that separated young children from their families; he also studied the effect of hospitalization and showed that even brief separations at

That time parents were unable to keep their children for nights caused suffering to children in the late 1940s Bolby became persona non grata to the British psychoanalytic community as a result of her radical view that children’s disordered behavior was a response to their actual life experiences, neglect, abuse. and separation,

More than the product of childhood sexual fantasies, undaunted, he dedicated the rest of his life to developing what became known as attachment theory, a secure base. When we come into this world, we cry to announce our presence, followed by someone interacting

With us. It bathes us and envelops us. and it fills our stomach and in the best of cases our mother can put us on her belly or on her chest to maintain delicious skin- to-skin contact. We are deeply social creatures. Our life consists of finding our place

In the community of beings. humans, I love the expression of the great French psychiatrist Pierre Janet, every life is a work of art created with all the means available. As we grow up, we progressively learn to take care of ourselves both physically and emotionally, but

We learn the first lessons of self-care from the way we Mastering the ability to self-regulate depends largely on how harmonious our first interactions with our caregivers were. Children whose parents are a reliable source of comfort and

Strength have a lifelong advantage, a kind of buffer against the worst that fate can offer. John Bolby realized that children are captivated by faces and voices and are exquisitely sensitive to facial expression posture tone of voice physiological changes The tempo of movement and incipient lation observed this innate ability as A product

Of evolution essential for the survival of these defenseless creatures, children are also programmed to choose a specific adult or several with whom they develop their natural communication system. This creates a primary attachment bond. The more the adult responds

To the child, the more deeper the attachment and the more likely the child will develop healthy ways of respond to the people around him Bolby frequently visited Regen Park in London where he made systematic observations of the interactions between children and their

Mothers while the mothers sat quietly on a park bench Knitting or reading the newspaper the children separated to exploring Occasionally looking over her shoulder to make sure mom was still watching but when a stranger stopped and caught the

Moms interest with the latest whisper the children would run back to the mothers and stay close to them making sure they still had their attention When babies and young children notice that their mothers are not fully focused on them, they become nervous when they disappear from

Their sight and may begin to cry inconsolably, but when they return they calm down and continue playing bolby. He considered attachment as the secure base from which a child goes out into the world in the last five decades, research has clearly established that having a safe haven fosters

Self-sufficiency and instills a sense of solidarity and kindness toward people who suffer from the most intimate giving and receiving of the bond of attachment. Children learn that other people have feelings and thoughts that are similar and different to

Their own, in other words they synchronize with their environment and with the people around them and develop self-knowledge, empathy, impulse control and self-motivation that allows them to become members of society who contribute to the broader social culture these were the qualities that the children in our

Children’s clinic sorely lacked the dance of attunement children develop attachment to the person who acts as their primary caregiver but the The nature of this attachment, whether it is secure or insecure, makes a big difference throughout the child’s life. Secure attachment develops when care includes

Emotional attunement. Attunement begins at the most subtle levels of interaction between babies and their caregivers and It gives babies the feeling that they are known and understood as Attachment researcher Colwin Trevar of Edinburgh says the brain coordinates rhythmic body movements and guides them to act appropriately with

Other people’s brains. They listen and learn musicality from their mother’s speech even before they are born. In Chapter 4 I described the discovery of mirror neurons. The brain-to-brain relationships that give us the ability to be empathetic. Mirror neurons

Begin to function as soon as babies are born. When researcher Andrew Melov of the University of Oregon pursed his lips or stuck out his tongue at 6-hour-old children, they immediately imitated his actions. Newborns can focus their gaze only on objects that are 20

Or 30 cm away, enough to see them. the person holding them imitation is our most fundamental social skill ensures that we immediately pick up the behavior of our parents our teachers and our peers most parents relate to their

Babies in such a spontaneous way that they are almost unaware of how This attunement occurs , but the invitation of a friend, the etronic attachment researcher, allowed me to observe this process more closely through a one-sided vision glass at the

Harvard Human Development Laboratory. I was able to observe a mother playing with her two-year-old son. months Sitting in a baby chair in front of her, they were cooing to each other and having a lot of fun until

The mother leaned down to caress him with her nose and the baby, with all his enthusiasm, pulled the mother’s hair. The mother caught him off guard and screamed in pain, pushing him away. With his face twisted in

Anger, the child let go of her immediately. And they physically separated for both of them. The source of pleasure had become a source of distress. Obviously scared, the baby put his hands to his face so as not to see his mother angry. The mother. in turn, realizing that her baby was

Unwell, she focused on him again, making relaxing sounds to calm the situation, the baby continued with his eyes covered but his desire for connection soon reappeared he began looking a little to see if the field was clear while his mother approached him with a worried expression as

She began to tickle his belly he lowered his arms and burst into a rage. joyful laughter was restored , whereby the harmony baby and mother were once again in sync, this whole sequence of pleasure, rupture, repair, and pleasure again lasted approximately less than 12 seconds. Other researchers

Have shown that when babies and their caregivers are in sync at the level Emotionally they are also physically, children cannot regulate their emotional states, even less the changes in heart rate, hormonal levels or the activity of the nervous system that accompanies

Emotions. When a child is in synchrony with his caregiver, his joy and connection are reflected in your heart rate stable and at a lower level of stress hormones your body is calm as well as your emotions as soon as this music is altered as it usually happens on any normal day

All these physiological factors change we can also know that the balance has been restored when the physiology It calms down, we calm babies, but parents soon begin to teach their children to tolerate Higher levels of arousal, a task usually assigned to parents. I once

Heard psychologist John Gotman say that mothers caress and fathers push. Learning to handle activation is a key life skill and parents should do it for their babies Before babies can do it for themselves if the nibbling sensation in the tummy makes the child cry soon the breast or bottle arrives if the child

Is scared someone rocks him until he calms down If his intestines erupt someone cleans him and dries him associate intense sensations with security Comfort and mastery is the basis of self-regulation of self-relationship and autochrome I will make a later in this book Secure attachment

Combined with the cultivation of competence creates an internal center of control the key factor for healthy coping throughout life Securely attached children learn what makes them feel good discover what makes them and others feel bad others and gain a sense of

Agency learn that their actions can change how they feel AND how others respond Securely attached children learn the difference between situations they can control and situations in which they need help learn that they can play a role active when

Faced with difficult situations, on the other hand, children with histories of abuse and abandonment learn that their terror, their begging and their cries are not registered in their caregivers. Nothing they do stops the blows or elicits attention or help, they are actually being conditioned.

To give up when faced with challenges later in life become real Pediatrician and psychoanalyst Donald Winnicott contemporary of Bolby is the father of modern studies of synchronization His careful observations of mothers and children began with the way mothers held their babies suggested that these physical interactions established the basis

For the baby’s perception of self and with it the sense of identity for its entire life. The way in which a mother holds her child is the basis of the ability to sense the body. As the place in which the psyche lives, this visceral and kinesthetic sensation of how our bodies come together

Establishes the basis for what we experience as real. Winnicott believed that the vast majority of mothers synchronize well with their babies, it does not require extraordinary talent. to be what he called a good enough mother but things can go really wrong when mothers

Cannot tune into the physical reality of their baby if a mother cannot satisfy her baby’s impulses and needs the baby learns to be the idea that the mother has on him by having to discard his internal sensations and try to adjust to the needs of his

Caregiver the child perceives that there is something wrong with his way of being Children who lack physical attunement are vulnerable to disconnecting the direct return of their body the center of the pleasure the purpose and direction in the years since the introduction of

Bolby and winnicott’s ideas attachment research around the world has shown that the vast majority of children are securely attached when they grow up their past of reliable care and Responsible helps them keep fear and anxiety at bay. Unless they end up

Exposed to an overwhelming life event, a trauma that disrupts their self-regulatory system, they also form a template for their children’s relationships. They pick up on what others are feeling and soon learn to differentiate . the game of reality and develop good intuition to detect

False situations or dangerous people Children with secure attachments generally become pleasant playmates and have many self-affirming experiences with their peers Having learned to attune themselves to other people They tend to appreciate subtle changes in the voices and faces of others and adapt their behavior accordingly.

They learn to live within a shared worldview and are likely to become valued members of the community. This upward spiral, however, can be reversed with abuse or neglect, abused children are often very sensitive to changes in voices or faces but often respond to them as threats rather than cues to

Stay in sync, Dr. Set Polak of the University of Wisconsin showed. a series of faces to a group of normal 8-year-old children and compared their responses with those of a group of abused children of the same age. When looking at this spectrum of expressions from angry to sad,

The abused children were hyperalert to the slightest traces of anger. This is one of the reasons why abused children become so easily defensive or frightened. Imagine what it must be like to walk through a sea of ​​faces in the school hallway trying to guess

Who might attack us, children who overreact to bullying. aggression from peers who do not understand the needs of other children who become easily disconnected or lose control of their impulses are likely to be pushed aside and not invited to sleepovers or playtime.

In the long run they can learn to hide their fear by putting a tough façade Or they may spend more and more time alone watching television or playing on the computer, even falling behind in terms of interpersonal skills and emotional self-regulation the need for

Attachment never diminishes most human beings They simply cannot tolerate being without interacting with others for a certain period of time, people who cannot connect through work, friends or family usually find other ways to connect, such as through illnesses, lawsuits or family quarrels, anything is preferable to this [ __ ]

Feeling of irrelevance and isolation a few years ago on Christmas Eve I was called to examine a 14-year-old boy in Safol County Jail Jack had been arrested for breaking into the house of neighbors who had gone on vacation the burglar alarm was on ringing when the police

Found him in the living room the first question I asked Jack was who he expected to visit him for Christmas in prison no one ever told me no one pays attention it turns out he had been caught in other raids many times before I knew the police and the police knew him,

With a certain delight in his voice, he told me that when the police saw him in the middle of the room, they shouted, ” Wow, it’s Jack again.” The little son [__] someone recognized him, someone knew his name

A little later, Jack confessed. know This is what makes it worth it children will do almost anything to feel seen and connected live with the parents we have children have a biological instinct to attach they have no choice whether their parents or caregivers are loving

And attentive or distant insensitive If they are rejected or abused, children will develop a way of coping by trying to at least satisfy some of their needs. Currently, we can evaluate and identify these forms of improvement in a reliable way. Thank you

All to the work of two American scientists Mary Ainsworth and Mary Maine and their colleagues who for many years observed couples made up of mothers and babies for thousands of hours. Based on these studies, Ainsworth created a research tool called the strange

Situation that evaluates how a child reacts. baby before temporary separation from his mother, just as Bolby had observed, children with secure attachment become upset when their mother leaves them but are delighted when she returns and after a brief reception to feel secure again

They calm down and resume their play. But with children who have an insecure attachment the picture is more complicated, those whose primary caregiver is unresponsive or rejecting them learn to deal with their anxiety in two different ways. The researchers observed that some seemed

Chronically dissatisfied and demanding with their mothers while others They were more passive and withdrawn in both groups. Contact with their mothers did not calm them. They did not return to the game with satisfaction. As happens in the case of secure attachment, in a pattern called avoidant attachment,

Children appear as if nothing bothered them. They do not cry when their mother leaves and they ignore her when she returns however this does not mean that they are not actually affected by their chronically elevated heart rate shows that they are in a permanent state of hyperarousal my

Colleagues and I call this pattern coping without feeling many of the mothers of Children with this avoidant pattern seem to not like touching their children, have a hard time rocking and hugging them, and do not use their facial expressions and voice to create pleasant back-and-forth rhythms with their babies in another

Pattern called anxious or ambivalent attachment. Babies call constantly paying attention to themselves crying screaming clinging or screaming is the feeling without dealing they seem to have come to the conclusion that if they don’t put on a show no one pays attention to them they get

Very upset when they don’t know where their mother is but they get little comfort when she returns and Although they do not seem to enjoy your company, they remain passive or angrily focused on it. Even in situations where other children would prefer to play, attachment researchers think that

The three secure, avoidant, and anxious organized attachment strategies work because they get the best attention of a caregiver. is able to provide children who have a coherent model of care even if it is marked by emotional distance or insensitivity

Can adapt to maintain the relationship this does not mean that there are no problems attachment patterns often persist into adulthood children Anxious people tend to become anxious adults, while those with an avoidant pattern are likely to become

Adults who are detached from their own feelings and those of others, like when you say spanking, there’s nothing wrong with it. He gives it to me and This has made me the successful person I am today in school. Children who follow the avoidance pattern are likely to bully other children

While anxious children are often their victims. However, development is not linear and many life experiences can influence and change these results But there is another group whose adaptation is less stable, a group that constitutes the majority of the children we treat

And a substantial proportion of the adults who have been seen in psychiatric clinics for approximately 20 years Mary Maine and her Berkley colleagues They began to identify a group of children, 15% of all those they studied, who seemed incapable of knowing how to interact

With their caregivers. The critical problem was that the caregivers themselves were a source of anguish and terror for them. Children in this situation did not They have no one to turn to and they find themselves facing an unsolvable dilemma. They need their mother to survive but at the same time she is

A source of fear. They cannot approach the safe and ambivalent strategy or change their attention to the avoidance strategy or flee if we observe We see these children in daycare or in an attachment laboratory look at their parents as they enter the room and then walk towards them.

On the other hand, unable to choose between seeking an approach and avoiding the parent, they may rock on their hands and knees, appear to be in a trance, remain paralyzed with their arms raised, or get up to greet their parent and then fall to the ground, not knowing who it is. secure

Or to whom they belong, they may be very affectionate with strangers or trust no one Main called this pattern disorganized attachment disorganized attachment is fear without solution becoming disorganized inside conscientious parents are often alarmed when they discover attachment theory and become They worry that their occasional impatience or ordinary lapses in attunement

May cause permanent harm to their children. In real life, there will always be misunderstandings, inappropriate responses and communication failures. Sometimes mothers and fathers do not send certain signals well or they are simply worried about other issues and children often

Must discover on their own How to calm down within certain limits This is not a problem children must Learn to handle frustrations and disappointments with good enough caregivers children learn that broken connections can be restored critical question is whether they can incorporate a visceral sense of security with their parents or

Other caregivers in a study of attachment patterns with more than 2,000 young children in normal middle-class environments 6 2% were found to be secure 15% showed a pattern of avoidance 99% an anxious pattern also known as ambivalent and 15% a disorganized pattern

It is interesting to note that this large study showed that the gender of the child and their basic temperament have little effect on the attachment style for example children with a difficult character are not more likely to develop a disorganized style children

From lower socioeconomic groups whose parents are often They are very stressed by economic and family instability children who do not feel secure in childhood have difficulty regulating their mood and emotional responses as they grow older in daycare, many disorganized children are aggressive or seem absent or

Disinterested and end up developing a series of psychiatric problems. Asa also show greater physiological stress expressed in the heart rate, the variability of this. responses of stress hormones and lower immunological factors, this type of biological dysregulation automatically returns to a normal situation when the child matures or moves to a

Safe environment. From what we know so far, parental abuse is not the only cause . disorganized attachment parents who are worried about their own trauma such as domestic abuse, rape, or the recent death of a parent or brother or sister may also be too emotionally unstable to offer comfort

And protection. If all parents need all help possible to raise secure children traumatized parents in particular need help getting in sync with their children’s needs caregivers often don’t realize they are out of sync I clearly remember

A video Beatriz showed me and showed a mother young man playing with his 3 month old baby everything was going well until the baby withdrew and turned his head indicating that he needed a break

But the mother did not take the signal and intensified her efforts to interact with him by approaching him and raising her voice when he She backed away even more, she continued jumping and touching him, finally the baby started screaming, at which point the mother missed him and left. Apparently downcast, she obviously

Felt terrible. But she had simply overlooked some important signs. It’s easy to imagine how this guy Repeated out-of-synchronization over and over again can progressively lead to chronic disconnection. Anyone who has raised a colicky or hyperactive baby knows how quickly stress builds up when nothing you do

Seems to make any difference. never being able to calm his mothers who were Holocaust survivors and had PTSD had a significantly higher rate of serious psychological problems after these traumatic experiences. The most reasonable explanation is that their upbringing had endowed them with a vulnerable physiology and it was difficult for

Them to regain their balance after the rape. Yuda observed a similar vulnerability in the children of pregnant women who were in the World Trade Center that fateful day in 2001. Likewise, children’s reactions to painful events are largely determined by how calm or stressed their parents are. My former student Glenn

Sax, currently chair of the department of child and adolescent psychiatry at New York University, showed that when children Children were hospitalized for treatment of severe burns. The development of PTSD could be predicted based on how secure they felt

With their mothers. The security of their attachment to their mothers determined the amount of morphine needed to control their pain. The more secure the attachment. fewer painkillers needed another companion Claude Chemtob, who directs the family trauma research program at New York University Langone Medical Center, studied 112

New York City children who directly witnessed the terrorist attacks of September 11, 2001. Children whose mothers were diagnosed with PTSD or depression during follow-up were six times more likely to suffer significant emotional problems and 11 times more likely to be hyperaggressive in response to their experience. Children whose

Fathers had PTSD also showed behavioral problems, but Chem found that this The effect was indirect and was transmitted through the mother Living with an irascible, withdrawn or frightened spouse is likely to impose a significant psychological burden on the couple including depression if

We do not have an internal sense of security it is difficult to distinguish between security and danger if We feel chronically paralyzed. Potentially dangerous situations can make us feel alive. If we come to the conclusion that we are terrible people, because if

Our parents don’t treat us that way, we begin to expect other people to treat us horribly. We probably deserve it. In any case we can’t do anything about it when disorganized people have this type of perception about themselves they are more predisposed to being traumatized by subsequent experiences long-term effects

Of disorganized attachment in the early 1980s my colleague Carlen Lions Ruth researcher Harvard’s attachment program began recording face-to-face interactions between mothers and children at six, 12 and 18 months, and recorded them again when the children were 5 years old. And again when they were seven or

Eight, all of them belonged to 100% high-risk families. met federal poverty criteria and almost half of the mothers were single mothers disorganized attachment presented in two different ways in one group mothers seemed too preoccupied with their own problems to care for their children were often intrusive and hostile alternated between rejecting

Their children and expecting them to respond to their needs in the other group the mothers seemed helpless and fearful they often seemed sweet or fragile but did not know how to be the adult in the relationship and seemed to want their children to comfort them they did not greet their children After

Being absent and not being picked up when the children were unwell, it didn’t seem like they were doing it deliberately. They just didn’t know how to tune in to their children and respond to their cues and therefore weren’t able to comfort them or make them feel

Safe. Intrusive hostile mothers were more likely to report histories of childhood physical abuse or to have witnessed domestic violence while dependent withdrawn mothers were more likely to present stories of sexual abuse or loss of a parent but not physical abuse I have always wondered how

It is possible for parents to abuse their children after all raising healthy offspring is the essence of perception human of purpose and meaning What can lead parents to do or deliberately abandon their children Carlen’s research gave me an answer watching his videos I could see how the children became increasingly inconsolable, sullen or

Resistant to their mothers who were not in sync with the At the same time, the mothers were increasingly frustrated, defeated and incapable in their interactions. When the mother ends up seeing her child not as the other party in a synchronized relationship but as a frustrating, irritating and disconnected stranger,

It is fertile ground for subsequent abuse. approximately 18 years ago when these children were about 20 years old Lions Ruth did a follow-up study to see how the children were doing with severely altered emotional communication patterns with their mother. At 18 months

Of age they grew up to be young adults with an unstable self-perception. themselves with impulsivity including excessive consumerism promiscuous sex substance use reckless driving and binge eating inappropriate and intense anger and recurrent suicidal behavior Carlen and her colleagues expected intrusive hostile behavior on the part

Of mothers to be the most powerful predictor of mental instability in their adult children but found the opposite emotional withdrawal had a deeper and lasting impact emotional distance and role reversal when mothers expected their children to care for them were specifically related to aggressive behavior

Towards themselves and against others in young adults dissociation knowing and not knowing lions Ruth was especially interested in the phenomenon of dissociation whose manifestation is feeling lost overwhelmed abandoned and disconnected from the world and seeing oneself as an unloved person empty useless trapped and suffocated discovered A surprising and unexpected relationship

Between maternal disaffection and lack of synchrony during the first two years of life and dissociative symptoms in early adulthood Lions Ruth concludes that children who are not really seen or known by their mothers are at increased risk. From growing up as adolescents

Incapable of knowing and duty, children who live in secure relationships learn to communicate not only their frustrations and afflictions but also their emerging self, their interests, preferences and goals. Receiving an empathic response protects children and adults from extreme levels . of fear activation but if our caregivers ignore our needs

Or are upset that we exist we learn to anticipate rejection and withdrawal we handle it as best we can by blocking the mother’s hostility or abandonment as if it doesn’t matter but our body is likely to remain in a state of heightened alert prepared to

Fight back the blows deprivation or abandonment dissociation means simultaneously knowing and not knowing as bolby wrote what you cannot communicate to a mother you cannot communicate to yourself if you cannot tolerate what you know or feel what you feel, the only option is denial and

Dissociation, perhaps the most devastating long-term effect of this disconnection is not feeling real inside, a pathology that we saw in the children at the children’s clinic and that we observed in the children and in adults who come to the trauma center when we don’t feel real, nothing matters and

That makes it impossible to protect ourselves from danger or we can go to extremes to try to feel something, whether it’s cutting ourselves with a razor blade or getting into a fistfight with strangers, Carlen’s research demonstrated that dissociation is learned early,

Late abuse or other trauma did not give rise to dissociative symptoms in young adults Forty abuse and trauma gave rise to many other problems but not dissociation Chronic or aggression towards oneself the critical underlying issue was that these patients did not know how to

Feel safe the absence of security in the early relationship with their caregiver led to a lower sense of inner reality excessive clinging and self-injurious behavior poverty single parenthood or psychiatric symptoms Maternal studies did not predict these symptoms. This does not mean that child abuse is irrelevant, but rather that the

Quality of first care is equally important to prevent Mental Health problems independently of other traumas. For this reason, treatment must address not only the traces of traumatic events. specific but also the consequences of not having reflected ourselves in any mirror that they have not tuned into us or that they have not

Cared for and loved us in a constant manner dissociation and loss of self-regulation restoring synchrony early attachment patterns create the internal maps that we apply In our relationships throughout life, not only in terms of what we expect from others but

Also in terms of the comfort and pleasure that we can experience in their presence, I doubt that the poet E Cummings could have written these happy lines I like my Body When It is with your body mu better and nerves more They are not reversible

By simply understanding how they were created, we can realize that our fear of intimate relationships has to do with our mother’s postpartum depression or the fact that she was abused, but it is likely that knowing this alone will help us. Open to a

Happy and trusting interaction with others, however, knowing can also explore other avenues for conning in relationships for ourselves and to stop an insecure attachment for our children in various approaches to healing damaged attachment systems through rhythmicity training. and reciprocity being in sync with oneself and with others requires the integration

Of our bodily senses vision hearing touch and balance if this does not happen in childhood we will have a greater chance of suffering from sensory integration problems later and trauma and abandonment are by no means the only pathways to them. Being in sync means resonating through connecting sounds and movements that are embedded

In the daily sensory rhythms of cooking and cleaning, going to bed and getting up, being in sync can mean sharing happy faces and hugs expressing pleasure or disapproval at appropriate times passing the ball over and over or singing together at the trauma center

We develop programs to teach parents connection and synchronization and my patients have told me other ways to get in sync by doing things that They range from singing in a choir or learning ballroom dancing to joining a basketball team playing jaz in a group or joining a

Chamber music group all of these activities develop the sense of synchronization and communal pleasure chapter 8 trapped in relationships the cost of abuse and abandonment the descent into hell is the journey towards the parts of ourselves that are separated from us that are unknown, unwanted, outlawed and exiled in the different underground worlds

Of consciousness the goal of this journey is to reunite with ourselves Even this return home can be surprisingly painful, even brutal. To do it, we must first agree not to exile anything. Stephen c. Marilyn was a tall, athletic-looking woman of three or a few years old who

Worked as an instrumentalist nurse in a nearby city. She told me that a few months ago she had She started playing tennis at her health club with a Boston firefighter named Michael. She usually stayed away from men, she told me, but little by little she had become

Comfortable enough with Michael to accept his invitations to go out for pizza afterward. from matches they talked about tennis movies about his nieces and nephews nothing too personal Michael clearly enjoyed her company but she told herself he didn’t really

Know her one Saturday night in August after tennis and pizza she told him invited me to stay at her apartment she told me she felt tense and unreal as soon as they were alone she remembered asking him to go little by little but then she didn’t know exactly what happened after a few

Glasses of wine and a rerun of Law & Order Apparently they stayed asleep on the bed Approximately 2 in the morning Michael turned over in his sleep when Marilyn felt his body touching hers he exploded punching him scratching and biting him and yelling at him bastard bastard

Michael, startled, picked up his things and ran after he left Marilyn was sitting up in her bed for an hour shocked by what had happened she felt deeply humiliated and hated herself for what she had done and now she came to ask me for help to overcome her terror of

Men and her inexplicable attacks of rage my work with veterans I had prepared myself to listen to painful stories like Marilyn’s without trying to jump right in to solve the problem. Therapy usually begins with some inexplicable behavior. Attacking a boyfriend

In the middle of the night. Feeling terrified. When someone stares at you and finds you covered in blood after cutting yourself. with a piece of glass or deliberately throwing up every meal it takes time and patience to allow the reality behind these symptoms to come to light

Terror and callousness when talking to her Marilyn told me that Michael was the first man she invited to her house For more than 5 years but this was not the first time she had lost control when a man spent the night with her she repeated that she always felt tense and

Numb when she was alone with a man and there had been other occasions when Marilyn also told me that she felt like she was living life mechanically except when she was at the club playing tennis OR in the operating room working she used to feel numb

A few years ago she discovered that she could mitigate this feeling of numbness by scratching herself but she was frightened to discover that she was cutting herself deeper and deeper more often to feel relief she had also tried it with alcohol But this reminded her of her father

And his way compulsive drinking which made her feel that way instead she played tennis frantically whenever she could which made her feel alive when I asked her about her past Marilyn said she supposed she must have had a happy childhood but she collected very few things. Before

She was 12, she told me that she must have been a shy teenager until she had a violent confrontation with her alcoholic father at the age of 16 and she ran away from home. She managed to study at

The high school in her city and graduated in nursing. without any help from her parents she felt ashamed for having slept with anyone at that time and described it as Looking for love in the wrong places as I usually do with my new patients I asked her to draw me

A portrait of her family and when I saw her drawing reproduced above I decided to go little by little Marilyn clearly harbored some terrible memories but could not allow herself to recognize what her own drawing revealed she had drawn a wild and terrified girl trapped in a kind of Cage and

Threatened not only by three horrifying figures, one without eyes but also by a huge erect penis invading her space and yet this woman said that she must have had a happy childhood as the poet Oden wrote Truth like Love and sleep the truth like love and sleep suffers

From too intense looks I call it the rule of oden and in accordance with it I deliberately decided not to pressure Marilyn to tell me what she really remembered. I have learned that it is not important for me to know all the details of a patient’s trauma the critical

Is that the patients themselves learn to tolerate feeling what they feel and knowing what they know. This can take weeks or even years. I decided to begin Marilyn’s treatment by inviting her to join a therapy group where she could find support and acceptance before facing the problem. engine

Of her mistrust shame and anger as expected Marilyn arrived at the first group meeting looking terrified more or less like the girl in her family portrait was withdrawn and did not establish contact with anyone I chose that group for her because its members had always

Helped and They welcomed the new members who were too afraid to speak. They knew from their own experience that revealing secrets is a gradual process. But this time they surprised me by asking so many intrusive questions about their love life that the situation reminded me of their

Drawing of the girl being attacked. almost as if Marilyn had unconsciously chosen this group to repeat her traumatic past. I intervened to help her set some boundaries about what she would talk about and she began to feel more comfortable after three months. Marilyn told the

Group that she had tripped and fallen. several times on the sidewalk between the subway and my office I was afraid that her eyesight would begin to fail, she had also lost many tennis balls lately I thought again about her drawing and the wild girl with huge terrified eyes, perhaps it was a

Kind of conversion reaction according to which patients express their conflicts by losing the function of some part of their body. Many soldiers in both world wars suffered paralysis that could not be attributed to physical injuries and I have seen cases of hysterical blindness

In Mexico and India, however as a doctor I have not I was willing to conclude without further evaluation that it was just in her head. I referred her to some colleagues at the ENT clinic in Massachusetts and asked them to examine her thoroughly. After a few weeks,

The results came back. Marilyn suffered from retinal lupus erythematosus. an autoimmune disease that was impairing his vision and he needed immediate treatment I was paralyzed Marilyn was the third person that year who I had suspected had a history of incest

And who had been diagnosed with an autoimmune disease, a disease in which that the body begins to attack itself after I made sure that Marilyn was receiving the appropriate medical treatment. I consulted with two of my colleagues at Massachusetts General Hospital, psychiatrists

Scott Wilson and Richard Kadin who ran the immunology laboratory. I told them the story of Marilyn showed them the drawing I had made and asked them to collaborate in a study. They generously contributed their time and, defraying the considerable cost of the

Complete immunological analyses, we recruited 12 women with histories of incest who were not taking any medication plus 12 women who They had never been traumatized and were also not on medication. A Surprisingly Hard to Find Control Group Marilyn was not part of the study

We generally do not ask our clinical patients to participate in our studies when the study was completed and we analyzed the data Rich informed us that the group of Incest survivors had abnormalities in their cd45 to eo ratio Compared to their

Non-traumatized peers, cd45 cells are the memory cells of the immune system, some of them called ra cells have been activated by past exposure to toxins and rapidly respond to environmental threats. that have previously encountered Ro cells are instead kept in reserve for new challenges they are activated to deal with threats that the

Body has never encountered before the r ratio ro is the balance between cells that recognize known toxins and cells that wait for new information to activate in patients with histories of incest the proportion of r cells ready to jump is higher than

Normal This makes the immune system overly sensitive to the threat so that it is ready to mount a defense even if not necessary even when it means attacking the cells of the body itself. Our study showed that at a deep level, the body of

Incest victims has a hard time distinguishing between danger and safety. This means that the trace of past trauma does not only consist of distorted perceptions of information coming from outside the body itself. The past is imprinted not only in our minds and in the misinterpretation of

Innocuous events like when Marilyn attacked Michael because he accidentally touched her while he was sleeping , but also in the core of our being in the security of our body a broken world map How do people learn what is safe and what is not what is inside and what is outside

What we should resist And what we can accept the best way to understand the impact of abuse and abandonment childish is Listening to what people like Marilyn can teach us one of the

Things that stayed clear to me When I started to know her is that she had her own vision of how the world works when We are children we start in the center of our own universe where we interpret everything that happens From an egocentric point of view, if our parents and grandparents

Constantly tell us that we are the most beautiful and most delicious thing in the world, we do not question their opinion. We must be exactly that and inside us, whatever we learn about ourselves, this always accompanies us. feeling basically we are adorable therefore

If later we start dating someone who treats us badly we will feel disgusted it will not be good it will not seem Familiar we will not feel at home but if in our childhood we suffer abuse or abandonment or we grow up in a family in which sexuality is treated with repulsion

Our internal map will contain another message our perception of ourselves will be marked by contempt and humiliation and we are more likely to think that it has an effect on me and we will not protest if we are treated poorly Marilyn’s past conformed Her view on every relationship was

Convinced that men didn’t give a damn about other people’s feelings and that they always got what they wanted in women, they couldn’t be trusted either, they were too weak to stand up for themselves and they sold their bodies for money. that men would take care of them if they had

A problem they would never lift a finger to help them this worldview manifested itself in the way Marilyn interacted with her colleagues at work she was suspicious of the motives of everyone who was kind to her and she warned them at the slightest deviation

From nursing regulations that she was a bad seed, fundamentally a toxic person who made bad things happen to the people around her. When I started treating patients like Marilyn, I used to question their way of thinking. and I was trying to help them see the

World in a more positive and more flexible way. One day a woman named Cathi put the dots on my ses. A member of a group had arrived late for a session because her car had broken down and Cathi immediately left. He felt guilty I saw how dilapidated your car was

Last week I should have offered to take you His self-criticism reached such an extreme that a few minutes later he took responsibility for his own sexual abuse I asked for it I was 7 years old

And I loved my father I wanted him he wanted me and I did what he wanted me to do it was my fault when I intervened to comfort him saying come on you were just a girl it was

Your father’s responsibility to set the limits Cathi turned to me and said you know vessel I know how important it is to you be a good therapist So when you make stupid comments like this I usually thank you deeply. After all, I suffered incest, I was taught to take care of the needs

Of older, insecure men, but after two years I trust you enough to tell you that these comments make I feel terrible, yes it’s true, I instinctively blame myself for everything bad that happens to the people around me. I know it’s not. I feel really stupid

For feeling this way, but that’s how it is when you tell me these things to make me see reason. I feel more alone and isolated and this reaffirms in me the feeling that no one in the world will

Ever understand. What it feels like to be me. I sincerely thanked him for his comment and since then I have tried not to tell my patients that they should not feel that way. in which they feel c taught me

That my responsibility goes much further, I must help them reconstruct their inner world map, as I mentioned in the previous chapter. Attachment researchers have shown that our first caregivers not only feed us, they clothe us and comfort us when we are badly also shape the way our rapidly developing brain

Perceives reality our interactions with our caregivers tell us What is safe and what is dangerous who we can count on And who will leave us stranded what we should do to meet our needs this information It is embedded in the fabric of our

Brain circuits and forms the template for our perception of ourselves and the world around us. These inner maps are remarkably stable over time. This does not mean, however, that our maps cannot be modified with experience. A deep loving relationship , especially during adolescence when the brain once again goes through a period of

Exponential change, can really change us. The same thing happens with the birth of a child, since our children usually teach us to love adults who were still abused or abandoned as children . They may learn the beauty of intimate relationships and mutual trust or have

A profound spiritual experience that opens doors to a greater universe. Previously uncontaminated childhood maps may become so distorted by rape or assault in adulthood that All paths are modified towards terror or despair. These responses are not reasonable and therefore cannot be changed simply

By restructuring irrational beliefs. Our world maps are encoded in our emotional brain and changing them means having to reorganize this part of the central nervous system. development in the treatment portion of this book, however learning to recognize irrational thoughts and behavior can be a useful first step. People

Like Marilyn often discover that their assumptions are not the same as those of their friends, hopefully their friends and peers. They will be told with words and not actions that their distrust and self-hatred make collaboration difficult. But this rarely happens and

Marilyn’s experience was typical. After attacking Michael he had no interest in fixing things so he ended up losing both a friend and a friend. her favorite partner to play tennis with is at this point when intelligent and brave people like Marilyn who maintain their curiosity

And determination after several failures begin to seek help Generally the rational brain can take precedence over the emotional brain as long as our fears do not kidnap us for For example, the fear of being stopped by the police can instantly transform into gratitude when

The police officer warns us that there is an accident ahead, but the moment we feel trapped, angry or rejected, we are vulnerable to activating old maps and following their directions. Change begins when we learn to take control of our emotional brain. This means learning to observe and tolerate the heartbreaking and painful sensations

That are part of misfortune and humiliation. Only when we learn to endure what happens inside us can we begin to accept instead of canceling. the emotions that make our maps fixed and immutable learning to remember a year after Marilyn joined

The group another member Mary asked permission to talk about what happened to her when she was 13 Mary worked as a prison guard and kept a sadomasochistic relationship with another woman wanted the group members to know about his past hoping that they would be more tolerant of

His extreme reactions such as his tendency to disconnect or explode at the slightest provocation with great difficulty in expressing herself Mary said that one night when she was 13 years old She was raped by her older brother and a group of his friends the rape resulted in a pregnancy

And her mother performed an abortion on her at home on the kitchen table the The group very sensitively tuned in to Mary and what she was saying and comforted her in her sobs. I was deeply moved by their empathy. They were comforting Mary in the way they surely would have

Wanted someone to comfort them when facing their traumas for the first time when The session ended. Marilyn asked if she could talk for a few minutes about what she had experienced during the session. The group nodded and she said, upon hearing this story, I wonder if I also suffered

Sexual abuse. My jaw dropped, considering her family portrait I had always assumed . Of course she was aware of it at least to some extent she had reacted like an incest victim in her response to Michael and chronically behaved as if the world

Was a scary place however although she had drawn a girl who was being sexually abused She, or at least her cognitive and verbal self, had no idea what really happened to her. Her immune system, her muscles, her fear system had all kept track,

But her conscious mind had no story that could communicate that experience represented her trauma in her life but had no narrative to refer to as we will see in chapter 12 Traumatic Memory differs from normal Memory in complex ways and involves several layers of the

Mind and brain from Mary’s story and also due to the nightmares What followed Marilyn began individual therapy with me in which she began to address her past. At first she experienced waves of intense and overwhelming terror. She tried to stop for several weeks,

But when she saw that she couldn’t sleep and that she was missing work, she resumed our sessions, as she told me later . my only criterion for knowing if a situation is harmful is feeling this is going to kill me

If I don’t get out of here I started teaching Marilyn relaxation techniques like focusing on deep breathing inhale and exhale inhale and exhale at a rate of six breaths per minute following At the same time, she combined the sensations of breathing in her body

With the activation of acupressure points that helped her not feel overwhelmed. We also worked on mindfulness, learning to keep her mind alive, allowing her body to feel the things it didn’t even want to imagine. Little by little she allowed Marilyn to step back and observe her experience instead

Of being immediately hijacked by her feelings. She had tried to mitigate or eliminate those feelings with alcohol and exercise but now she was beginning to feel safe enough to begin to remember what had happened to her. As a child, having more control over her

Physical sensations, she also began to be able to differentiate between the past and the present. Now, if she felt the touch of another person’s leg in the middle of the night, she could recognize that it was Michael’s leg. of the handsome tennis partner she had invited to her apartment, that leg did not

Belong to anyone else and its touch did not mean that someone was trying to abuse her. Staying calm allowed her to fully physically know that she was a 34-year-old woman and not a little girl when Marilyn finally began to access her memories. They emerged as flashbacks

Of the wallpaper in her room as a child. She realized that it was what she focused on when her father raped her when she was 8 years old. His abuse terrified her beyond her ability.

To endure it So she had to take it out of her memory bank at the end of the day she had to continue living with that man her father who had abused her Marilyn remembered seeking protection

From her mother but when she ran towards her and tried to hide by burying her face in Her lap only received a weak hug in return. Sometimes her mother remained silent. Other times she screamed or scolded Marilyn angrily for making Dad so angry. The terrified girl found no one.

That would protect her that would give her strength or shelter as Roland Sumit wrote in his classic study The child sexual abuse accommodation syndrome child sexual abuse accommodation syndrome initiation intimidation stigmatization isolation helplessness and self-blame are based on terrifying reality of child sexual abuse any attempt by

The child to divulge The secret will be met with the conspiracy of silence and the discredit of an adult do not worry about things like this this could never happen in our family How

Can you think something so terrible I do not want to go back to never hear you say something like that again most children never ask and never say anything after 40 years doing this job I still hear myself say this is incredible when patients tell me about their childhood they are often

As incredulous as I am how can some parents to inflict such torture and terror on their own child some continue to insist that they must have imagined the experience or that they are exaggerating all are ashamed of what happened to them and feel guilty To some extent they

Firmly believe that these terrible things were done to them because they are terrible people now Marilyn began to explore how that helpless girl had learned to disconnect and comply with what was asked of her she had managed to do it by making herself disappear as soon as she heard

Her father’s footsteps in the hallway outside her room she put her head in the clouds again A patient of mine who had a similar experience made a drawing that represents how this process works when her father started to touch her she made herself disappear she floated to the ceiling looking down at that

Other girl who was in the bed she was happy that it wasn’t really her she was another girl who was being abused, looking at those heads separated from her body by an impenetrable Fog really opened my eyes to the experience of dissociation that is so common among victims of incest. Marilyn herself

Realized that as an adult she continued to float until the ceiling when finding herself in a sexual situation in the period in which she had been most sexually active on occasions a partner had told her how incredible she had been in bed that she was almost unrecognizable

And had even spoken in a different way often she she didn’t remember what had happened but at other times she got angry and aggressive she didn’t know who she really was sexually so little by little she stopped hanging out with boys until Michael arrived hating your home children

Can’t choose their parents nor can they understand that the parents may simply be too depressed, angry or numb to pay attention to them or that their parents’ behavior has too little to do with them the children have no choice but to organize themselves to survive

In the family they have of the adults they have no choice There is no other authority to turn to for help. Their parents are the authority. They cannot rent an apartment or go live with anyone else. Their survival depends on their caregivers. The children perceive, even if they are not explicitly threatened,

That if they talk about their beatings or their abuses with teachers will be punished instead they focus their energy on not thinking about what has happened to them and on not feeling the residue of terror and panic in their body as they cannot tolerate knowing what they have experienced nor can they understand

That their anger their terror or their collapse Have something to do with that experience they do not speak they act and deal with their feelings being angry disconnected docile or defiant children are also programmed to be fundamentally loyal to their caregivers Even if

They abuse them terror increases the need for attachment Although the source of Consuelo is also the source of terror, I have never met a child under 10 years old who, having been tortured at home and having broken bones and burns on the skin as proof and having the option,

Did not choose to stay with his family in Instead of going to a foster home, obviously clinging to the abuser is not exclusive to childhood. There have been hostages who have paid bail for their captors, expressed their desire to marry them or have had sexual relations with them.

Victims of domestic violence often cover up for their abusers judges often tell me how humiliated they feel when they try to protect victims of domestic violence by issuing restraining orders and end up discovering that many of them secretly allow

Their partner back Marilyn took a long time to Being able to talk about her abuse, she was not prepared to violate her loyalty to her family, deep inside she still thought that she still needed her to protect her from her fears. The price of this loyalty is unbearable feelings

Of loneliness, despair and the inevitable rage of helplessness. The anger that has nowhere to go is redirected towards oneself in the form of depression, self-hatred and self-destructive acts, one of my patients told me It’s like hating your home. Your kitchen, your pots and pans, your bed, your chairs, your

Table, your blankets, nothing seems safe to you. and even less so your own body, learning to trust is a great challenge. One of my other patients, a school teacher whose grandfather raped her several times before she was 6 years old, sent me the following email. I began to consider the danger of going

To you. driving home after our visit and then hitting the road I realized I had broken the No Attachment to You or My Students rule during our next visit he told me it had also been violated by his lab professor At the

University I asked him if he sought help and if he reported him I couldn’t cross the street to get to the clinic he replied that I desperately wanted to receive help but being there I felt inside me

That they would only hurt me more And surely that would have been the case naturally I had to hide what happened to my parents and everyone after I told him I was worried about what was happening to him

He wrote me another email I’m trying to remind myself that I didn’t do anything to deserve that treatment I don’t remember anyone looking at me like that before and telling me said that he was worried about me and I treasure it that someone I respect and who understands

Everything I’m going through can care about me to know who we are to have an identity we must know or at least feel that we know what it is and what it was real we must observe what we see around us and label it correctly we must also be able to trust

Our memories and be able to distinguish them from our imagination losing the ability to make these distinctions is a sign of what psychoanalyst William nerland has called soul murder erasing the Awareness and cultivating denial is often essential for

Survival but the price is that you lose track of who you are, what you are feeling and what and who you can trust Replaying the trauma Marilyn had a flashback of her childhood trauma in a dream in which she felt like she was suffocating and couldn’t breathe,

Her hands were wrapped with a white cloth and then she felt like they were lifting her up with the towel around her neck and she couldn’t touch her feet on the floor. She woke up in a panic. thinking that he was going to die

His dream reminded me of the nightmares that war veterans had told me seeing the concrete, unadulterated images of faces and body parts that they had seen on the battlefield these dreams were so terrifying that they tried not to fall asleep at night Only daytime naps

That they did not associate with nighttime ambushes seemed halfway safe during this phase of therapy. Marilyn was repeatedly inundated with images and sensations related to the dream in which she was suffocating. She remembered sitting in the kitchen. at 4 years old with

Swollen eyes a sore throat and a bleeding nose while her father and brother laughed at her and called her a silly girl one day Marilyn told while I was brushing my teeth last night a feeling of agitation overwhelmed me I felt like a fish out of water I

Violently contorted my body as if I was fighting against the lack of air I cried and choked while I brushed my teeth I felt more and more panic in my chest and I noticed great agitation I had to

Try with all my might not to scream no no no no no standing in front of the sink then he lay down and she fell asleep but woke up like clockwork every two hours for the rest of the

Night the trauma is not stored as a narrative with a beginning, middle and end. As I will describe in more detail in chapters 11 and 12, memories come first. They arrive, as in the case of Marilyn, in the form of flashbacks that contain fragments of the experience, isolated images,

Sounds and bodily sensations that initially have no context other than fear and panic. When Marilyn was a child, she had no way of giving voice to the indescribable. Although That wouldn’t have changed anything either because there was no one to listen to her like many other survivors

Of childhood abuse. Marilyn exemplified the will to live and take ownership of her own life the energy that counteracts the annihilation of trauma little by little I came to understand that the only thing that allows you to work Healing traumas is the admiration for my patients’ desire to survive

That allowed them to endure the abuse and then endure the dark nights of the soul that inevitably occur on the path to recovery chapter 9 what does love have to do with this initiation bullying stigmatization isolation helplessness and self-balancing are based on the terrifying reality of childhood sexual abuse Don’t worry about

Things like this this could never happen in our family How can you think something so terrible I never want to hear you say this again most children never ask and never tell Roland sumit the sex accommodation syndrome How to organize ideas around people like

Marilyn Mary and cathy and What we can do to help them the way we define their problems our diagnosis will determine the focus of their treatment These types of patients usually receive five or six different and unrelated diagnoses during their psychiatric treatment.

If their doctors focus on their mood swings, they will identify them as polar and prescribe lithium or valproate. If their doctors are more impressed by their desperation, they will tell them that suffer from major depression and will treat them with antidepressants if doctors focus on their agitation and inattention they

Can classify them as ADHD and treat them with Ritalin or other stimulants and if medical staff include a trauma in the history and the patient offers relevant information You may be diagnosed with PTSD. None of these diagnoses will be completely wrong,

But none of them will completely describe who these patients are and what happens to them. Psychiatry as a subspecialty of medicine aspires to define mental illness as precisely as, for example, pancreatic cancer or lung infection due to streptococcus, however, taking

Into account the complexity of the mind, the brain and the human attachment systems, we have not even come close to this level of precision. Understanding what happens to people is more a matter of the mentality of the professional and the insurer that will bear the costs that of

Verifiable and objective facts the first serious attempt to create a systematic manual of psychiatric diagnoses occurred in 1980 with the publication of the third edition of the diagnostic and statistical manual of mental disorders the official list of all mental diagnoses recognized by the American Psychiatric Association, the preamble of the DSM Trio

Explicitly warned that its categories were not precise enough to be used in forensic or insurance contexts, however little by little it became an instrument with enormous power for insurance companies . require a DSM diagnosis to reimburse costs until recently all research funding was based on DSM diagnoses and

Academic programs are organized around DSM categories DSM labels quickly became present in the general culture as well millions of people know that Tony Soprano suffered from panic attacks and depression and that Carry Mathson from Homeland suffers from bipolar disorder. The manual has practically become an industry that

Has represented revenues of more than 100 million US dollars for the American Psychiatric Association. The question It has brought comparable benefits to the patients whom a psychiatric diagnosis should in principle serve. It has serious consequences. It influences treatment, and receiving the wrong treatment can have disastrous effects. Likewise, a diagnosis

Is a label that is likely to stick to the person for the rest of their life and has a profound influence on the way people define themselves I have met numerous patients who have told me that they are bipolar or have borderline personality or PTSD

As if they had been sentenced to remain in an underground dungeon for the rest of his life as the Count of Monte Cristo none of these diagnoses take into account None of the unusual talents that many of our patients develop or the creative energy they

Have mustered to survive the diagnoses all too often are mere counts of symptoms that make patients like Marilyn Cathy or Mary likely to be seen as out-of-control women who need to be straightened out dictionary Defines diagnosis as the act or

Process of identifying or determining the nature and cause of an illness or injury by means of evaluation of the patient’s history and review of laboratory data B opinion derived from such evaluation tried to change the way we diagnose patients with

Chronic trauma histories How a trauma history is created at 75 I began collaborating with psychiatrist Judith Herman who had just published her first book Father daughter incest incest father daughter we were both working in the hospital of Cambridge one of Harvard’s teaching hospitals, and sharing an interest in how trauma had affected the

Lives of our patients, we began meeting regularly to share our notes. We were surprised to see how many of our patients diagnosed with borderline personality disorder (BPD) told us. horrible stories from his childhood bpd is characterized by the tendency to cling to others but in extremely unstable relationships extreme mood swings

And self-destructive behavior that includes self-mutilation and repeated suicide attempts to discover if there was really a relationship between childhood traumas and The tpl designed a formal scientific study and sent a funding request to the National Institute of Health. But it was denied, however, Judi and I were determined and funded the study ourselves.

We found an ally. Chris Perry, director of research at the Cambridge hospital, funded by the National Institute of Health to study BPD and other diagnoses close to the so-called personality disorders in selected patients from the Cambridge hospital had collected several volumes of valuable data on these people but

Had never asked them about child abuse and neglect although not hid his skepticism about our proposal, he was very generous with us and arranged interviews with 55 patients from the hospital’s outpatient department and agreed to compare our findings with data from the large database that he had compiled

. judy was How to create a trauma history you can’t ask a patient directly if they were abused as a child or were beaten by their father How many people would trust a stranger with this sensitive information considering that people are universally embarrassed by trauma?

Who has suffered, we designed an instrument for the interviews, the questionnaire on Cat’s traumatic history. The interview began with a series of simple questions: where does he live and with whom, who pays the bills and who cooks and cleans, little by little he moved towards more

Revealing questions, who does he trust? in your daily life, for example when you get sick, who goes shopping or takes you to the doctor, who you talk to when you are sick, in other words, who provides you with emotional support and

Practical some patients gave us surprising answers my dog ​​my therapist or no one We then asked them similar questions about their childhood who lived at home How often they moved Who was their main caregiver many of the patients mentioned frequent changes of

Address that caused them to have to changing schools in the middle of the year, several had primary caregivers who had been incarcerated, admitted to a mental hospital or had enlisted in the army, others had moved from foster home to foster home or had

Lived with a set of different relatives. section of the questionnaire addressed relationships in childhood who in your family was affectionate with you who treated you as a special person this was followed by a critical question one that to my knowledge has never been

Asked before in a scientific study was there a person with the that they felt safe growing up one in four patients we interviewed did not remember anyone with whom they felt safe as a child we marked no one on the sheets and we did not comment on it but we were

Very surprised Imagine being a child and not having any source of security making your way through the world without protection and without being seen the questions followed who made the rules at home and made sure there was discipline How the children were kept in line by talking, watering them with spankings

Or locking them up how their parents settled their differences by then the floodgates Many patients are volunteering detailed information about their childhood. One woman had witnessed the rape of her sister. Another told us that she had had her first sexual experience at age 8 with her grandfather. Men and women described

Being awake for a while. the night and hearing his parents scream and break the furniture a young man had entered the kitchen and found his mother in a pool of blood others talked about when they were

N’t going to pick them up from school or when they came home they found her empty and they spent the night alone a woman who worked as a cook had learned to cook for her family

When her mother was imprisoned for a drug case another was 9 years old when she had to [ __ ] and hold the steering wheel of the car because her mother was drunk I was swerving down a four-lane highway in H-peak, our patients had no choice to run

Or escape, they had no one to turn to and nowhere to hide, yet somehow they had to deal with their terror and their desperation probably. They went to school the next morning and tried to pretend that everything was going well. Judi and I realized that the

BPD group’s problems with dissociation, desperately clinging to anyone who was willing to help, probably started as a way of coping with overwhelming emotions. and a brutality that they could not escape from after our interviews Judi and I met to code our patients’ responses that is, transform them into numbers for

Computer analysis and Chris Perry compared them with the large amount of information about those patients that he had stored in the Harvard mainframe one Saturday morning he left us a message asking us to come to his office. There we found a huge pile of

Documents on top of which Chris had placed a drawing by Gary Larson of a group of scientists studying dolphins and Confused by their sounds, the data convinced them that without understanding the language of trauma and abuse, one cannot really

Understand BPD, as we later published in the American Journal of Psychiatry on 81. Per of the patients diagnosed with BPD at the Cambridge hospital, they narrated serious histories of childhood abuse and neglect in the vast majority the abuse began before the

Age of 7 This finding was especially important because it suggested that the impact of the treatment depends at least partially on the age at which it begins subsequent research by Martin Teer of the McLean Hospital demonstrated that different forms of abuse have different impacts on

Different brain areas in different phases of development, although many studies have since reproduced our findings, I still regularly receive scientific articles to review that say things like it has been hypothesized that patients with borderline personality may have a history of childhood trauma. turns a hypothesis

Into a scientifically established fact our study clearly reinforced John Bolby’s conclusions when children feel permanently angry or guilty or have a chronic fear of being abandoned they come to those feelings honestly due to their experience when, for example, children fear of being abandoned is not a counterreaction

To their intrinsic homicidal urges but is more likely to be because they have been physically or psychologically abandoned or have been repeatedly threatened with abandonment. When children are permanently full of rage it is due to rejection or a Rough treatment When children experience intense inner conflict regarding their anger, it is

Probably because expressing it may be forbidden or may even be dangerous. Bolby observed that when children must deny powerful experiences they have had, this creates serious problems for them, including mistrust. Chronic towards other people inhibition of curiosity distrust of one’s own senses and tendency to find everything unreal as we will see

This has important implications for treatment a study expanded our ideas Beyond the impact of specific horrible feelings the approach to the diagnosis of PTSD to look at the long-term effects of brutality and neglect on relationships with caregivers also raised another critical question: what treatments are effective for people

With a history of abuse, especially those with chronic suicidal thoughts and those who are injured? deliberately self-injured when I was still a student on one occasion I was woken up around 3 in the morning three days in a row to sew up a

Woman who opened her throat with any sharp object that fell into her hands, she told me with a certain triumphalism that cutting it made her feel very bad better since then I haven’t stopped wondering why why some people deal with their discomfort by playing three sets of tennis

OR drinking a strong martini and others cut their arms with razor blades study showed that having a history of childhood sexual and physical abuse It was a strong predictor of repetitive suicide attempts and actions such as cutting, and I wondered if

Their suicidal ideation had started when they were very young and they had found themselves planning their escape hoping to die or causing harm to themselves. It begins as a desperate attempt. To regain some control, Chris Perry’s database included follow-up information on all patients treated in the hospital’s outpatient clinic,

Including reports of suicidal and self-destructive behavior TR years after treatment. Approximately two-thirds of the patients had now markedly improved. The question was which group members had benefited from the treatment and which had continued to engage in suicidal and self-destructive behavior. Comparing the patients’ continued behavior

With our interviews, Cat provided us with some answers. The patients who continued to engage in self-destructive behavior had told us that they did not. They remembered feeling safe with no one as children. They had reported feeling abandoned, moved from one place to

Another and generally had to solve their problems on their own. I came to the conclusion that if one has the memory of feeling safe with someone a long time ago, the traces of this Early affection can be reactivated with harmonized relationships when one is an adult, whether they occur

In daily life or in the framework of good therapy. However, if we do not have the deep memory of having felt loved and safe, the brain receptors that respond to kindness human simply They may not develop if this is the case How people can learn

To calm down and feel grounded in their body again this has important implications for therapy and I will return to this point in part 5 dedicated to treatment The power of diagnosis our study also confirmed that there was a traumatized population quite distinct from war soldiers and accident victims for whom the diagnosis

Of PTSD was created, people like Marilyn and Cathy as well as Jud and I studied, and the children at the MHC outpatient clinic that I described in Chapter 7 do not necessarily remember their traumas one of the

Criteria for diagnosis of PTSD Or at least they are not bothered by specific memories of their abuse but continue to behave as if they are still in danger they go from one extreme to the other

They have a hard time focusing on a task and they continually attack others and themselves To some extent their problems overlap with those of war soldiers but are also very different in the sense that their childhood trauma has prevented them from developing some of the mental abilities

That soldiers possessed before their trauma occurred. Some of us were aware of this . to see Robert Spitzer who, after having guided the development of the DSM, was in the process of revising the manual. He listened carefully to what we told him. He told us that

It was likely that doctors who spend their days treating a specific population of patients They could develop considerable expertise in understanding their ailments. He suggested that we do a study. A field trial to compare the problems of different groups of

Traumatized people. Spitzer put me in charge of the project. First, we developed a rating scale that incorporated all the different symptoms of trauma. that had been described in the scientific literature, then we interviewed 525 adult patients in five different parts of the

Country to see if specific populations suffered different constellations of problems. Our populations were divided into three groups: those who had a history of physical or sexual abuse in childhood. on the part of their caregivers who were recent victims of domestic violence

And recent victims of a natural disaster, there were clear differences between those groups in particular where victims of sexual abuse and adults who had survived natural disasters were at the extreme ends of the spectrum. who had suffered abuse

As children tended to have concentration problems complained of always living on the edge and were full of self-hatred found it very difficult to negotiate intimate relationships, sometimes going from high-risk and unsatisfactory indiscriminate sexual relations to a total sexual block They also had many memory gaps, often engaged in

Self-destructive behaviors, and had suffered many medical problems. These symptoms were relatively rare in survivors of natural disasters. Each major DSM diagnosis had a working group responsible for suggesting revisions for the new edition. I presented the results. from the

Field trial to our work group on PTSD in the DSM quauro and we voted 19 to two to create a new trauma diagnosis for victims of interpersonal trauma extreme stress disorders without other specification or complex TT to summarize then we anxiously await

The publication of dsm4 in May 1994 but to our surprise the diagnosis that our group had overwhelmingly approved did not appear in the final version none of us were consulted it was a Tragic exclusion meant that a large number of patients could not be diagnosed accurately and that doctors and researchers could not

Scientifically develop appropriate treatments for them a treatment cannot be developed for a pathology that does not exist not having a diagnosis confronts therapists with a serious dilemma How do we treat people who are struggling with the consequences of the abuse, betrayal and abandonment when we are forced to diagnose people with depression,

Panic disorder, bipolar illness or borderline personality that does not really represent what they suffer. The consequences of abuse and neglect by a caregiver are much more common and complex than the impact of hurricanes or motor vehicle accidents, however those responsible

Who determined the shape of our diagnostic system decided not to recognize this evidence today 20 years and four revisions later the DSM and the entire system based on it ignore the victims of child abuse and neglect just as they ignored the plight of

Veterans before PTSD was introduced in 1980 it was the hidden epidemic How it becomes to a newborn baby with all its potential and its infinite capabilities in a 30- year-old drunken wanderer, as happens with many great discoveries, the internist Vincent Felitti

Accidentally found the answer to this question in 1985. Feli was the director of the Department of Preventive Medicine at resident of San Diego, which at the time was the largest medical screening program in the world, also ran an obesity clinic that used a technique called

Supplemental absolute fasting to produce dramatic weight loss without surgery one day . presented in his office, Feli accepted her complaint that obesity was her biggest problem and signed her up for the program. Over the next 51 weeks, her weight went from 185 kg to

59 kg. However, when Feli saw her after a few months, she had gained more weight. than she thought was biologically possible. In such a short time what had happened, it turned out that her new slim body had attracted a co-worker who began flirting with her and then

Suggested having sex. She went home and started eating. gorge sleepwalking when Feli explored this extreme reaction he discovered a long history of incest with his grandfather it was only the second case of incest that Feli had encountered in his

Medical practice of 23 years and yet 10 days later he heard a similar story when he and his team They began to analyze it more closely and were surprised to discover that most of their morbidly obese patients had suffered sexual abuse in childhood. They also

Discovered many other family problems. In 1990, Feli went to Atlanta to present data from the team’s first 286 patient interviews. At a meeting of the North American Association for the Study of Obesity, he was surprised by the harsh response of some experts. Why

Did he believe these patients? He did not realize that he would invent any explanation to justify their failed lives. However, an epidemiologist at the center for disease control and prevention CDC encouraged Feli to begin a much larger study based on

The general population and invited him to join a small group of researchers at the CDC Center, the result was the Monumental Study on Adverse Childhood Experiences known as The AC study, a collaboration between the CDC and Kaiser Permanente with doctors Robert Anda and Vincent Felitti as co-directors of the study, more than 50,000

Kaiser patients annually passed through the Department of Preventive Medicine for a complete review that included filling out an extensive medical questionnaire Feli and Anda spent more than a year developing 10 new questions to cover carefully defined categories of adverse childhood experiences including physical and sexual abuse, physical and emotional neglect,

And family dysfunction such as having divorced parents with 25,000 consecutive patients were then asked if they would be willing to provide information about childhood events. 17,000 said their answers were then compared to the detailed medical information available at Kaiser on all patients. The AC study revealed that

Traumatic life experiences during childhood and adolescence are much more common than one would expect. Respondents were primarily well-educated, middle-aged, middle- class white people with enough financial security to have good lives. average insurance and yet only a third of them stated that they had not had

Adverse childhood experiences. One in 10 respondents responded affirmatively to the question about their parents or another adult in the home. They often or very often swore at them, insulted them or belittled them more. Of a quarter of them responded affirmatively to the question: Some of

Their parents often or very often pushed them, grabbed them, hit them, threw things, and some of their parents often or very often hit them so hard that they left marks or injuries on other people, probably more. of a quarter of the United States population is repeatedly

Physically abused in childhood to questions any adult or person at least Five years old May you touched your body in a sexual way and any adult or person at least 5 years older than you tried to keep oral or vaginal intercourse with you 28 percent of women

And 1% of men responded affirmatively one in eight people responded affirmatively to the child witness questions sometimes often or very often about how they pushed, hit, or threw something at As a child, his mother witnessed comadre on occasions, often

Or very often, being kicked, being hit with fists or with a blunt object, each affirmative answer was counted as one point, so the possible score was around 10, for example. a person who suffered frequent verbal abuse who had an alcoholic mother and whose parents were divorced would have a score of two

Or more one of each six respondents Had a score of four or more ago in summary Feli and his team observed that adverse experiences are interrelated Although they are usually studied separately, it is not common for people to grow up in a family in which a brother is in prison

But everything Everything else goes well people do not live in families where the mother is abused but life is otherwise rosy Incidents of abuse are never isolated events and for each additional adverse experience reported The toll in the form of damages Later

Increases Feli and his team found that the first place where the effects of childhood trauma become evident is at school. More than half of people with an AC score of four or more points reported having learning or behavioral problems in school. compared

To the 3% of those who had a score of zero when they matured, these children did not leave behind the effects of their early experiences, as Feli observes, traumatic experiences are usually lost in time and end up hidden in the form of guilt, secrets and social taboos, but the

Study revealed that the impact of trauma permeated the adult lives of these patients; for example, elevated AC scores were correlated with increased work absenteeism, more financial problems, and lower lifetime income. In terms of personal suffering, the results were devastating as the score increases Chronic depression in

Adulthood also increases drastically in the case of those who had an AC score of 4 or more, its prevalence is 60 and per. in women and 35 percent in men compared to 12 percent in those who had an AC score of c0, the probability of taking antidepressant medication

Or analgesics also increased proportionally, as Feli has highlighted, we may be dealing today with experiences that happened 50 years ago. years at a much higher cost, antidepressants and pain relievers make up a significant part of the growing national health care expenditure. Ironically,

Research has shown that patients with depression without a prior history of abuse or neglect tend to respond much better to antidepressants than patients with those stories recognized suicide attempts increase exponentially with AC scores from a score of zero to one of six there is a 5,000 times greater probability of attempting suicide

The more isolated and unprotected a person feels the more death will seem to them The only way out when the media relates the environment with a 30% increase in the risk of suffering from cancer makes the headlines. However, these other, much more

Drastic data are overlooked as part of their initial medical evaluation. study participants had ever been considered an alcoholic person people with an AC score of cu were seven times more likely to be alcoholics than adults with a score of zero injection drug use increased exponentially in the case

Of People with an AC score of six or more were 1,600 times more likely to use dangerous drugs than people with a score of zero. Women in the study were asked if they had been raped as adults with an AC score. from zero

The prevalence of rape was 5% with a score of five or more it was 30% Why girls who have suffered abuse or neglect are more likely to be raped in adulthood the answers to this question have implications that go beyond rape, for example, many studies have shown that girls who witness domestic violence

In childhood have a much higher risk of ending up having violent relationships as well, while in the case of boys who witness domestic violence, the risk of end up abusing their partners increases sevenfold more than 12 percent of study participants had seen their mother abused. The list of high-risk behaviors

Predicted by the AC score included smoking, obesity, unwanted pregnancies, having multiple partners. Finally, the toll to be paid in the form of major health problems was surprising: people with an Ace score of six or more were 15% or more likely than those with an Ace score of zero to

Suffer from any of the following. The top 10 causes of death in the United States, such as chronic obstructive pulmonary disease (COPD), ischemic heart disease and liver disease, were twice as likely to suffer from cancer and four times more likely

To suffer from emphysema. The constant stress on the body takes its toll. When Problems Are Really Solutions 12 years after having treated her for the first time, Feli returned to see the woman whose drastic weight loss and regain led to her investigation.

She told him that she had subsequently undergone bariatric surgery, but that after losing 44 kg He began to have suicidal ideations. He needed five psychiatric hospitalizations and three cycles of electroshock to control his suicidal ideations. Feli highlights that obesity, which is considered a major public health problem, can actually be a

Personal solution for many people. Think about its implications if we misunderstand. that for a person it is a solution as a problem that must be eliminated, not only is it likely that they will fail in the treatment As happens in anti-addiction programs, but

Other problems may appear. A woman who had been raped told Feli that being overweight is ignored. and this is what i need weight can protect men too Feli remembers two State prison guards who participated in his program for obese people quickly regained the

Weight they had lost because they felt much safer being the bigger guys From the module, another patient became obese after his parents divorced and he went to live with his alcoholic grandfather. He explained that he didn’t eat because he was hungry and all that was simply a

Place to be safe. Since daycare, they always hit me when I got fat and left them. of hitting me the lace study group concluded although it is widely known that it is harmful to health, adaptations such as smoking, drugs or obesity are very difficult to

Abandon, too little consideration is given to the possibility of many long-term risks for health can also be beneficial in the short term we often hear from patients Talking about the benefits of these health risks, the idea that the problem is the solution,

Although it is understandably a problem for some, fits with the fact that in biological systems opposing forces routinely coexist, so we see the problem with the that the patient feels is usually only the marker of the real problem that remains buried in

Time hidden by the patient’s guilt Secrecy and sometimes amnesia and often clinical discomfort child abuse The largest public health problem in the United States The first time I heard Robert Anda present the results of the study, I couldn’t hold back the tears in his career at the CDC. He had already worked previously

In several areas of major risk, conducting, for example, a study on tobacco and cardiovascular risks, but when the data from the AC study began to appear on his computer he realized that they had found the most serious and expensive public health problem in the United States

Child abuse he estimated that its total cost exceeded the cost of cancer or heart disease and that eradicating child abuse in the United States would reduce the global rate of depression by more than half, that of alcoholism by two-thirds, and that of suicide,

Intravenous drug use, and domestic violence by three-quarters would also have a drastic effect on performance. labor and the need to imprison people when the health authorities’ report on smoking and health was published in 1964, it triggered a legal and medical campaign

That has lasted for decades and has changed the lives and long-term health prognoses of millions of people the number of American smokers fell from 42 percent of adults in 1965 to 19 percent in 2010 and it is estimated that between 1975 and 2000 approximately 800,000

Deaths from lung cancer were avoided, however, the study did not have this effect on everyone. Follow-up studies and articles continue to be published around the world . But the daily reality of children like Marilyn and those in outpatient clinics and residual treatment centers around the country

Remains practically the same. They are simply now administered large doses of psychotropic agents that make them more manageable but that also reduce their ability to experience pleasure and curiosity to grow and develop emotionally and intellectually and to become productive people for society chapter 10 developmental trauma the epidemic

Hides the idea that adverse childhood experiences cause substantial alterations in development It is more a clinical intuition than a fact based on research. It is known that there is no evidence of developmental alterations causally preceded in time by any type of traumatic syndrome. Fragment of the writing of the American

Psychiatric Association in which it denies the creation of the diagnosis of developmental trauma disorder may 2011 research on the effects of early abuse tells a different story in that early abuse has lasting negative effects on brain development our early experiences sculpt our brain abuse It is a chisel that shapes

The brain to deal with conflict but at the cost of deep and lasting wounds, child abuse is not something that can be overcome, it is an evil that we must recognize and confront if we really want to do something about the cycle of rampant violence in this

Country Martin Teicher doctor of medicine scientific American there are hundreds of thousands of children like the ones I will describe now who absorb enormous resources often without appreciable benefits end up crowding our prisons the lists of social services and our clinics the

General public knows them just as statistics tens of thousands of teachers probation department officials social workers judges and Mental Health professionals spend their lives trying to help them and the taxpayer pays the bills anony was

Only two and a half years old when he was referred to our trauma Center for a children’s center because the staff at that center couldn’t handle his biting, pushing, his refusal to nap, his intractable crying, his head banging, and his rocking, he didn’t feel

Safe with any staff member and fluctuated between collapsing into complete despondency and a furious defiance when we met him and his mother he clung anxiously to her hiding his face While she was telling him don’t be little he was startled when a door slammed shut

In the hallway and then he hid further in her lap When her mother got rid of him, she sat in a corner and started hitting her head. She does it to annoy me.

The mother said, when we asked her about her past, she told us that her parents had abandoned her and that she grew up with a series of relatives. They hit her, ignored her and began to sexually abuse

Her at the age of 13. She became pregnant by an alcoholic boyfriend who left her when she told him she was pregnant with him. Anthony was just like her father. She said she was useless. She had had several violent fights. with several boyfriends but she was sure they had all occurred

Too late at night for Anthony to notice. If Anthony had been admitted to a hospital he would surely have been diagnosed with a number of different psychiatric disorders depression oppositional defiant disorder anxiety reactive attachment disorder adhd and PTSD, however, none of these diagnoses would clarify what was happening to Anthony. He was

Scared to death and was fighting for his life and did not trust that his mother could help him. Then we have María, a 15-year-old girl of Latin origin, one of the more than half million children in the United States growing up in foster care or residential treatment programs Maria

Is obese and aggressive has a history of physical and emotional sexual abuse and has lived in more than 20 different foster care settings since she was 8 years old the bunch medical records that she carried under her arm described her as taciturn, vengeful, impulsive, reckless and aggressive towards herself with

Extreme mood swings and an explosive character. She described herself as useless trash rejected after several suicide attempts. María entered one of our residential treatment centers she was initially taciturn and withdrawn and became violent when people got too close to her after other approaches failed she was enrolled in

An equine treatment program where she cared for her horse daily and learned dressage After 2 years I spoke with María at her graduation and she was accepted into a secondary school. When I asked her what had helped her the most, the horse I took care of told me

That first she started to feel safe with her horse, he was there waiting patiently for her every day. Apparently happy to see her, he began to feel a visceral connection with another

Creature and began to talk to her like a friend. Little by little, he began to talk to the other children in the program and eventually to his counselor. Virginia is a 13-year-old adopted white girl. She was separated. from her biological mother for her drug use. After her first adoptive mother

Fell ill and died, she went from foster home to foster home before being adopted again. Virginia was seductive with any man who crossed her path. and described various sexual and physical abuse with several babysitters and foster caretakers she came to our Residential treatment program after 13 hospitalizations for suicide attempts the

Staff described her as isolated controlling explosive sexualized intrusive vengeful and narcissistic she described herself as disgusting and claimed to want to be dead The diagnoses in her history were bipolar disorder intermittent explosive disorder reactive attachment disorder attention deficit disorder hyperactive subtype adhd oppositional defiant disorder

And substance abuse disorder But who Virginia really was how we could help her have a life we ​​can only hope to solve the problems of these boys and girls if we correctly define what happens to them and do more than develop new drugs to control or

Trying to find the Gene responsible for their disease the challenge is to find ways to help them lead a productive life and thereby save hundreds of millions of dollars for taxpayers this process begins by facing the facts defective genes with these

Widespread problems and these dysfunctional parents would fit The temptation to attribute their problems simply to defective genes was always producing new directions for research, and when genetic testing became possible, psychiatry was committed to finding the genetic causes of mental illness. Finding a genetic link seemed especially

Relevant in the case of schizophrenia, a fairly common form that affects 1% of the population, serious and disconcerting mental illness and that clearly destroys families and yet after 30 years and research that has cost millions and millions of dollars,

It has not been We have not been able to find any coherent genetic pattern for schizophrenia or any other psychiatric illness. By the way, some of my colleagues have worked hard to discover the genetic factors that predispose people to develop traumatic stress. This search

Continues, but so far it has failed to provide any answers. Solid recent research has debunked the simple idea that having a particular gene produces a particular outcome. It turns out that several genes can jointly contribute to influencing a single outcome and even more importantly, genes are not fixed, life events can trigger them.

Biochemical messages that can connect or disconnect them by adding methyl groups a union of carbon and hydrogen atoms on the outside of the gene a process called methylation making them more or less sensitive to the body’s messages although

Life events can change the behavior of the Gene does not alter its fundamental structure, the methylation patterns However, they can be passed on to descendants, a phenomenon known as epigenetics. Again, the body keeps score at the deepest levels of the organism. One of the

Most cited epigenetics experiments has been the one carried out by the Research by Michael Minnie of McGill University, who studied newborn rat pups and their mothers, discovered that the amount of licking and care a mother devotes to her pups during their first

12 hours of life permanently influences brain chemistry. that responds to stress and modifies the configuration of more than 1,000 genes rat pups that are licked a lot by their mother are braver and produce lower levels of stress hormones under stressful situations than those whose mothers are less attentive also recover faster equanimity

That lasts a lifetime they develop thicker connections in the hippocampus, a key center for learning and memory, and have better results in an important ability in rodents to find their way through mazes we are beginning to learn that experiences Stressors also influence gene expression in humans: Children

Whose pregnant mothers were trapped in unheated homes during Quebec’s long ice storm had significant epigenetic changes compared to children of mothers whose heat was restored after a period of time. day mos sif magil researcher compared the epigenetic profiles of hundreds of children born at the extremes of

Social privilege in the United Kingdom and measured the effects of childhood abuse in both groups social class differences were associated with clearly different epigenetic profiles But the abused children in both groups had in common specific modifications in 73 genes

According to the sif itself. Important changes can occur in our body not only with chemicals and toxins but also with the way our social world speaks to our innate world. monkeys clarify ancient questions about nature versus nurture one of the clearest ways

To understand how the quality of nurture and environment affects gene expression It results from the work of Stephen Suomi, head of the Clinical Laboratory of Comparative Ethology at the National Institutes of Health. For more than 40 years, Suomi has been studying the transmission

Of personality through generations of resus monkeys, which share 95 percent of their genes with humans. a number surpassed only by chimpanzees and bonobos, as well as humans. Resus monkeys live in large social groups with complex alliances and status relationships and

Only those members who can synchronize their behavior with the demands of the troop. Resus monkeys survive and thrive. They are also like humans in their attachment patterns, their babies depend on intimate physical contact with their mothers and as Bolby observed in human beings

They develop by exploring their reactions to their environment, running towards their mothers as soon as they feel scared or lost once they are They become more independent Playing with their peers is the main way to learn to get along in life Suomi identified two personality types

That constantly get into trouble: tense and anxious monkeys who become scared, withdrawn and depressed Even in situations in which other monkeys They play and explore and the highly aggressive monkeys who create so many problems that they often avoid them are beaten or killed both types are biologically different from their peers abnormalities in

Activation levels stress hormones and brain chemistry metabolism such as serotonin can be detected at two weeks of age and neither their biology nor their behavior usually change when they mature. Suomi discovered a wide range of genetically based behaviors, for example, tense monkeys classified as such based on their behavior and

Their cortisol levels. at 6 months they consume more alcohol in experimental situations than the others when they reach the age of 4 years the genetically aggressive monkeys also overindulge but drink uncontrollably to the point of being unconscious while the

Tense monkeys seem to drink to calm themselves and yet the environment Social also contributes significantly to behavior and biology. Tense and anxious females do not play well with others and therefore often lack social support when they give birth and are at

High risk of abandoning or abusing their firstborn, but when these Females belong to a stable social group usually become diligent mothers who attentively care for their offspring under certain conditions being an anxious mother can provide much- needed protection aggressive mothers on the other hand had no social advantage very punitive with

Their offspring hit hit and They bite a lot. If the offspring survive, their mothers usually prevent them from making friends with their peers. In real life, it is impossible to determine whether the behavior of aggressive or tense people is the result of their parents’ genes or of having

Grown up with an Abusive mother, or both. things but in a monkey laboratory we can take newborns with vulnerable genes away from their biological mothers and place them with collaborative mothers to raise them or in play groups with similar young monkeys who are removed

From their mothers at birth and raised exclusively with their peers they develop a strong attachment to them they cling desperately to each other and do not detach themselves enough to initiate healthy explorations and play therefore they lack the complexity and imagination typical

Of normal monkeys these monkeys grow up tense they are scared in the new situations and lack curiosity regardless of their genetic predisposition, monkeys raised by peers overreact to the slightest stress, their cortisol increases much more in response to loud noises than that of monkeys raised by their mothers, their

Serotonin metabolism is even more abnormal than that of monkeys genetically predisposed to aggression but who were raised by their mothers, this leads us to the conclusion that at least in the case of monkeys early experience has at least the same impact on biology as

Inheritance monkeys and humans share the same two variants of the serotonin gene known as the long and short alleles of the serotonin transporter in humans the short allele has been associated with impulsivity aggression sensation seeking suicide attempts and severe depression suomi showed that at least in monkeys the environment

Shapes how these genes affect behavior the monkeys with the short allele that were raised with a suitable mother behaved normally and did not show any deficits in their metabolism of Serotonin Those who were raised with their peers became aggressive Daredevils. Likewise, researcher Alex Roy of New Zealand discovered that humans

With the short allele had higher rates of depression than those with the long version. But this was only applicable if They also had a childhood history of abuse or neglect. The conclusion is clear. Children who are lucky enough to have a parent who is attuned and attentive

Will not develop this problem related to genetics. Suomi’s work confirms everything we have learned from our peers who study. attachment in humans and from our own clinical research, secure and protective early relationships are critical to protecting children from long-term problems, and even parents with

Their own genetic vulnerabilities can pass this protection on to the next generation as long as they have adequate support national network for childhood traumatic stress Almost all medical diseases from cancer to retinitis pigmentosa have support groups that promote the study and treatment of that specific pathology but until 2001 when the national network

For the childhood traumatic stress through an act of the US Congress there was no global organization dedicated to the research and treatment of traumatized children in 1998 I received a call from Adam cumings of the Nathan cumings foundation telling me that

They were interested in studying the effects of trauma on learning I told them that although very good work had been done on this topic, there was no forum in which to implement the resulting findings, the biological or moral mental development of traumatized children

Was not being systematically taught to child care professionals, pediatricians or pediatricians. in the faculties of psychology or social work Adam and I agreed that we had to fix this problem. About 8 months later we organized a think tank with representatives from the Department of Health and Human Services and the

United States Department of Justice. The advisor in health issues from Senator Ted Kennedy and a group of my colleagues who specialize in childhood trauma we all knew the basics of how trauma affects the developing mind and brain and we were all aware that

Childhood trauma is radically different from traumatic stress in adults fully developed the group concluded that if we really wanted to put the issue of childhood trauma firmly on the map there had to be a national organization that promoted the study of childhood trauma

As well as the education of teachers judges ministers foster parents doctors probation officers nurses and Mental Health professionals meaning anyone who works with children who have suffered abuse and trauma Bill Harris a member of our task force had a lot of experience with legislation on children’s issues and went to work with

The senator’s staff Kennedy to give our ideas form into law the bill creating the national network for childhood traumatic stress passed the senate with overwhelming bipartisan support and since 2001 has grown from a collaborative network of 17 centers to counting With more than 150 centers nationwide led by Duke University

And USA coordinating centers, the network includes universities, hospitals, tribal agencies, detoxification programs, Mental Health clinics and colleges, each of the centers in turn collaborates with the systems local schools with hospitals welfare agencies centers for homeless people Juvenile Justice programs and houses for Victims of domestic violence with a total of more than

8,300 members affiliated with the network created and in operation we had the means to establish a clearer profile of the Traumatized children in every part of the country My colleague Joseph Espinola of the Trauma Clinic led a study in which they examined the records of approximately 2,000

Children and adolescents from agencies across the network. We soon confirmed what we had suspected: more than half had suffered emotional abuse. or had a caregiver still too deteriorated to care for their needs almost 50% had temporarily lost their caregivers due to prison treatment programs or military service AND had been cared for by

Strange foster parents or distant relatives almost half reported having witnessed domestic violence , and a quarter had also suffered sexual or physical abuse. In other words, the children and adolescents in the study mirrored the middle-aged, middle-class Kaiser permanent patients with high Ace scores that Vincent Feli had analyzed in the study

On adverse childhood experiences The power of diagnosis in the 1970s there was no way to classify the wide range of symptoms of the hundreds of thousands of veterans returning from Vietnam, as we saw in the introductory chapters of the book, this forced doctors

To improvise the treatment of their patients and prevented them from being able to systematically study which approaches actually worked the adoption of the diagnosis of PTSD by the third dse in 1980 led to extensive scientific studies and the development of effective TR that turned out to be

Relevant not only to war veterans but also for victims of a range of traumatic events such as rape, assault and motor vehicle accidents. An example of the powerful power of having a specific diagnosis is that between 2007 and 2010 the Department of Defense spent more than 2.7 billion of U.S. dollars

On PTSD treatment and research in veterans, while in fiscal year 2009 the Department of Veterans Affairs spent $24.5 million on internal PTSD research, the DSM’s definition of PTSD PTSD is quite straightforward: it is when a person is exposed to a horrifying event

That involves actual or threatened death or serious harm or a threat to the physical integrity of oneself or others, causing fear, helplessness, or horror. intense resulting in a variety of manifestations intrusive re-experiencing of the event flashbacks nightmares feeling that the event is happening again

A persistent and disabling avoidance of people places thoughts or feelings associated with the trauma sometimes with Amnesia of the important parts and a increased arousal insomnia hypervigilance or irritability this description suggests a clear conclusion a person is suddenly and unexpectedly devastated by a horrific event and is never

The same again the trauma may be over but continues to replay itself in the form of continuous cyclical memories in a nervous system reorganized how Relevant was this definition for the children we were seeing after a single traumatic incident, a dog bite, an accident, or

Witnessing a school shooting. Children can develop basic symptoms of PTSD similar to those of adults, even if they live in safe and secure homes. understanding thanks to having the diagnosis of PTSD we can now treat these problems quite effectively in the case

Of disturbed children with histories of abuse and neglect who appear in clinics, schools, hospitals and police stations the traumatic roots of their behaviors are less obvious especially because they rarely comment on being hit, abandoned or touched even when asked by 82 percent of traumatized children seen in the

National network for childhood traumatic stress does not meet the otic criteria for PTSD, as they tend to be disconnected and suspicious or aggressive, they now receive pseudoscientific diagnoses such as oppositional defiant disorder, which means this kid hates me and won’t do anything I

Tell him to do. or disruptive mood dysregulation disorder which means he throws tantrums from having so many problems these children accumulate numerous diagnoses over time before they turn 20 Many patients have received four five six or more of these labels that impress but mean nothing If they receive any treatment,

They are given whatever has been promulgated as a daily management method, behavioral modification medications or exposure therapy, which rarely work and cause more harm as the National Child Traumatic Stress Network treats more and more people. With more and more children, it became increasingly

Clear that we needed a diagnosis that would encompass the reality of their experience. We started with a database of approximately 20,000 children who were being treated at various centers within the network and compiled all the research articles we found on

Children. Victims of abuse and neglect were selected until we were left with 130 especially relevant studies that included more than 100,000 children and adolescents from around the world. Subsequently, a central working group of 12 doctors and researchers specialized in childhood trauma met twice a year during 4 years to prepare a proposal

For a proper diagnosis that we decided to call developmental trauma disorder. By organizing our findings we discovered a consistent profile a pervasive pattern of dysregulation problems with attention and concentration difficulties in getting along with oneself and others moods and the feelings of these children quickly went from one extreme to another

From tantrums and panic to detachment, monotony and dissociation when they got angry, most of the time they could not calm down or describe what they were feeling, having a biological system that permanently pumps out stress hormones. to cope with real or imagined threats causes physical problems sleep disorders headaches unexplained pain

Extreme sensitivity to touch or sound being so agitated or disconnected prevents them from being able to focus attention and concentrate to relieve their tension they perform chronic masturbation a rocking or self-injurious activities biting cutting burning and hitting pulling out hair peeling the skin

Until it bleeds this also causes difficulties with language processing and fine motor coordination as they dedicate all their energy to maintaining control they often find it difficult to pay attention to things that are not directly important for survival such as school work

And their hyperarousal makes them easily distracted the fact that they are frequently ignored or abandoned makes them clingy and needy children even with people who have abused them by hitting them repeatedly being subjected to sexual abuse and from other types of abuse, they cannot help defining themselves as defective

And useless, they come to hate themselves and feel really defective and useless, who is surprised that they do not trust anyone, finally the combination of feeling fundamentally despicable and reacting excessively to the slightest frustration makes it difficult for them to make

Friends we published the first articles on our initial findings we developed a validated rating scale and collected data from approximately 350 children and their parents or foster parents to establish that this diagnosis developmental trauma disorder included

The entire range of things that were happening to these children this would allow us to give them a single diagnosis Unlike giving them multiple labels and would firmly locate the origin of their problems in a combination of trauma and compromised attachment. In February 2009

We sent our proposal again diagnosis of developmental trauma disorder to association of psychiatry stating the following in a cover letter: children who develop in a context of constant danger of abuse and in inadequate parenting systems are not well treated in current diagnostic systems that emphasize

Behavioral control without recognition of interpersonal trauma studies on the consequences of childhood trauma in the context of abuse or neglect by caregivers consistently demonstrate chronic and serious problems with emotion regulation impulse control attention and cognition dissociation interpersonal relationships and self-schemas go relational without a trauma-sensitive diagnosis these

Children are currently being diagnosed with an average of three to eight comorbid disorders the continued application of multiple different comorbid diagnoses in traumatized children has serious consequences challenges parsimony obscures etiological clarity and runs the risk of relegating treatment and intervention to a small part of the child’s psychopathology rather than

Promoting a comprehensive treatment approach Shortly after presenting our proposal I gave a talk on trauma disorder of development in Washington DC at a meeting of Mental Health commissioners from across the country offered their support for our initiative by writing a letter to the aeap.

The letter began by highlighting that the National Association of Directors of State Mental Health Programs served 6.1 million annually of people with a budget of 29 mem 500 million us dollars and concluded we call on the aap to add developmental trauma to its list of

Priority areas to better clarify and characterize its course and clinical sequelae and to highlight the important need to include the developmental trauma in patient assessment i was confident that with this letter the aap would take our proposal seriously, but a few

Months after sending our proposal matthew friedman executive director of the national center for TT and chair of the subcommittee of the DSM in question informed us that ttd was unlikely to be included in the DSM W the consensus he wrote was that no

New diagnosis was needed to fill any existing Diagnostic Niche one million children who are neglected and abused every year in the United States is a Niche diagnosis the letter went on to say the notion that adverse experiences in early childhood lead to

Substantial alterations in development is more of a clinical intuition than a research-based fact is a statement that is often made but that It is not supported by prospective studies. In fact, we included several prospective studies in our proposal. Let’s see a couple of

Them below. How relationships shape development. Since 1975, for almost 30 years, Alan Shoff and his colleagues followed 180 children and their families in the study. Longitudinal risk and adaptation risk assessment in Minnesota At the time the study began, there was intense debate about the role of nature versus nurture and temperament versus environment

In human development, and this study sought to answer these questions. Trauma was not yet a popular topic and child abuse and neglect were not the central focus of that study at least initially until they emerged as the most important predictors of human functioning.

Working with local medical and social agencies, the researchers recruited first-time Caucasian mothers. who met the poverty criteria to receive public assistance but who came from different contexts and different types and levels of support available to raise their children. The study began TR months before the children were born and followed the

Children for 30 years until the birth of their children. adulthood assessing and when appropriate measuring all important aspects of their functioning and all significant circumstances in their life considered several fundamental questions How do children learn to pay attention while

They regulate their arousal by, for example, avoiding extreme ups and downs and keep their impulses under control What kind of support they need and when they need it After extensive interviews and testing of prospective parents the study really took off in the neonatal unit

Where the researchers observed newborns and interviewed the nurses who cared for them, then made home visits 7 and 10 days after their birth. Before the children began the first grade of primary school, they and their parents were thoroughly evaluated

A total of 15 times after the children were interviewed and performed various tests at regular intervals until the age of 28 with continued contributions from mothers and teachers SRU and their peers discovered that quality of care and biological factors

Are closely related It is fascinating to see how the Minnesota results They corroborate, although with much greater complexity, what Stepen Suomi discovered in his primate laboratory, there was nothing unalterable, neither the personality of the mother nor the logical anomalies of the babies

At birth nor their cei nor their temperament, including their level of activity and their reactivity. to stress predicted whether the child would develop serious behavioral problems in adolescence, the key issue, however, was the nature of the parent-child relationship, the way

Parents felt and interacted with their children, as happened with the monkeys in Suomi, the combination of children. vulnerable and inflexible caregivers resulted in clingy and uptight children, insensitive, overbearing and intrusive behavior by parents at six months was a predictor of hyperactivity and attention problems in daycare and beyond focusing

On several facets of development especially in relationships with teacher and peer caregivers Zaru and her peers found that nurturers not only help keep arousal within manageable limits but also help children develop their own ability to regulate their arousal children who were regularly Pushed to the limits of

Excessive activation and disorganization, they did not properly tune their inhibitory and excitatory brain systems and grew up fearing losing control in the face of anything disconcerting. It was a vulnerable population and by the end of adolescence, half had mental problems. The diagnoses were patterns. Of course, children who received constant care became

Well-regulated children, while erratic parenting produced chronically physiologically activated children. Children of unpredictable parents tended to demand attention and became intensely frustrated at any small challenge. Their persistent activation made them chronically anxious . Constantly seeking reassurance interfered with play and exploration. Consequently, they grew up chronically nervous and not daring. Early parental abandonment

Or harsh treatment generated behavioral problems at school and was indicative of problems with peers and a lack of Empathy towards the discomfort of others, this gave rise to a vicious circle, its Chronic activation combined with the absence of parental comfort turned them into

Disturbed, oppositional and aggressive children. The disturbed and aggressive children are not popular and cause more rejection and punishment not only from the from their caregivers but also from their teachers and peers, Ser Rouf also learned a lot about resilience the ability to overcome

Adversity from Far away the best indicator of how these subjects had dealt with life’s inevitable disappointments was the level of security established with their primary caregiver During the first two years of life sarruf informally told me that he thought resilience in adulthood could be predicted by how caring mothers assessed their children at

Age 2 the long-term effects of incest in 1986 Frank putnam and Penelope Tricket, her colleague at the National Institute of Mental Health, began the first longitudinal study on the impact of sexual abuse on female development before the results of this study were published.

Study our knowledge about the effects of incest was based entirely on the reports of children who had recently disclosed their abuse and on the accounts of adults who I reconstructed years or even decades later how incest had affected them no study

Had ever followed the girls as they mature to examine how sexual abuse could influence their school performance, their relationships with peers and their self-concept, as well as their later love life. Putnam and Tricket also looked at long-term changes in hormones. stress, reproductive hormones, immune function, and

Other physiological measures of their subjects. They also explored protective factors such as intelligence and support from family members and peers. The researchers carefully recruited 84 girls referred by the District of Columbia Department of Social Services who had a confirmed history of sexual abuse by a Relative were combined with a

Control group of 82 girls of the same age, race, socioeconomic status, and family constellation who had not been abused. The average age of onset was 11 years in the following 20 years. These two groups were thoroughly evaluated six times once a year for the first 3 years and then at ages

18, 19 and 25 their mothers participated in the first evaluations and their own children participated in the last one. A remarkable 96 percent of the girls now remained women. In the study from the beginning the results were unequivocal. In comparison with girls of the same age, race

And social circumstances, girls who had suffered abuse presented a wide range of profoundly negative effects such as cognitive deficits, depression, dissociative symptoms , altered sexual development, high rates of obesity and self-mutilation dropped out of secondary school in a greater proportion than the Control group suffered more major illnesses and used

Health care more also showed abnormalities in the responses of their stress hormones had an earlier onset of puberty and accumulated different psychiatric diagnoses Apparently Unrelated The follow-up study revealed many details about how abuse affects development. For example, each time they were evaluated,

The girls in both groups were asked to talk about the worst thing that had happened to them in the previous year when telling their stories. The researchers They observed how they altered while measuring their physiology during the first assessment. All the girls reacted with distress after 3 years

In response to the same question. The girls who had not suffered abuse again showed signs of distress, but those who had suffered abuse disengaged. and their biology was desensitized fit with these observable reactions during the first assessment all the girls presented

An increase in cortisol the stress hormone TR years later cortisol was reduced in the abused girls while they recounted the most stressful event of the previous year with the Over time, the body adjusts to chronic trauma. One of the consequences of desensitization is

That teachers, friends, and other people probably don’t notice that the girl is wrong. She may not even register it herself. By desensitizing, she stops reacting to the distress. As she should. For example, by carrying out protective measures, Putnam’s study also captured the widespread long-term effects of incest on friendship and marital life

Before the onset of puberty. Girls who had not suffered abuse generally had several such friends. like some friend who acted as a kind of spy to inform them about what those strange creatures called fufa are like. Once they entered adolescence, their contact with the Boys gradually increased. However, before puberty, girls who were

Abused rarely had close friends, boys or girls, but Adolescence brought with it many chaotic and often traumatizing contacts with not having friends in primary school makes a crucial difference. We already know how cruel girls at 9, 10 and 11 can be.

Years is a complex and unstable time in which friendships can suddenly go awry and alliances dissolve into exclusions and betrayals. But there is a positive side. By the time they reach secondary school, most girls have begun to master a whole set of

Social skills including knowing how to identify what they feel, negotiating relationships with others, pretending to like people they don’t like, etc. And most of them have built a fairly stable support network of girls who become their stress management team when little by little

They enter into the world of sex and dating these relationships provide space for reflection gossip and conversations about what it all means girls who have suffered sexual abuse have a completely different developmental path they do not have friends of either sex Because they can’t trust, they hate themselves and their biology works

Against them, leading them to overreact or become desensitized. They can’t keep up in normal envy-based games of inclusion and exclusion in which players must continue to look good. stressful situations the other children Generally they do not want anything to do with them

They are simply too strange But this is only the beginning of the problem girls who are abused and who are isolated with stories of incest mature sexually a year and a half earlier than girls who do not have suffered abuse sexual abuse accelerates their biological clocks and the

Secretion of sex hormones at the beginning of puberty girls who have been abused have levels of testosterone and androstenedione, the hormones that fuel sexual desire, three to five times higher compared to girls. girls in the Control group the results of the

Putnam and tricket study continue to be published but have already created a very valuable roadmap for doctors who deal with girls who have suffered sexually in the trauma Center for example one of our doctors indicated on a Monday morning that a patient named ayesha had been raped

Again over the weekend she escaped from her community apartment at 5 p.m. on saturday she went to a place in boston frequented by drug addicts and then left with a bunch of kids in a car at 5am on Sunday she was gang raped like many of the teenage girls we

See aesha doesn’t know how to articulate what she wants or needs and doesn’t know how to protect herself instead she lives in a world of actions trying to explain her Behavior in terms of victim-perpetrator is not helpful nor are labels like depression oppositional defiant disorder

Intermittent explosive disorder bipolar disorder or any of the other options our diagnostic manuals offer us. Putnam’s work has helped us understand how he experiences the world. aesha why can’t she tell us what’s wrong with her Why

Is she so impulsive and lacking in self-protection And why does she see us as scary and intrusive instead of as people who can help her he DSM led a real jumble of diagnoses when the dsmv was published in May 2013 included some 300 disorders in its 945 pages offering a

Veritable jumble of possible labels for problems associated with severe childhood trauma including some new ones such as disruptive mood regulation disorder non-suicidal self-injury Intermittent explosive disorder Dysregulated social interaction disorder and disruptive impulse control disorder Before the 19th century, doctors classified diseases according to their superficial manifestations such as fevers and

Pustules, which was not unreasonable considering how little they had available, this changed. When scientists such as Luis Pasteur and Robert Coog discovered that many diseases were caused by bacteria invisible to the naked eye, medicine was transformed by their attempts to discover ways to eliminate these organisms instead of simply treating

The blisters and fevers they caused with the dsmg psychiatry has clearly regressed towards the medical practice of the early 19th century even though we know the origin of many Of the problems identified by its diagnoses, they describe superficial phenomena,

Completely ignoring the underlying causes. Even before the publication of the DSM, the American Journal of Psychiatry published the results of validity tests of several new diagnoses, indicating that the DSM largely lacks What in the scientific world is known as reliability, the ability to produce consistent and replicable results, in other words, lacks

Scientific validity. Curiously, the lack of reliability and validity did not prevent the dsmb from being published despite the practically Universal consensus that it did not. It represented no improvement over the previous diagnostic system that the ae ap earned 100 million

US dollars with the dsm4 and that it plans to earn a similar amount Because all Mental Health professionals, many lawyers and other professionals are required to purchase the latest edition could be the reason we have this new diagnostic system the reliability of

Diagnosis is not an abstract issue if doctors cannot agree on what ails their patients there is no way they can provide them with adequate treatment when they do not There is a relationship between diagnosis and cure. A poorly labeled patient will be doomed to be a

Poorly treated patient in the same way that we would not want to have appendicitis operated on if what we have is a kidney stone. Nor would we want to label someone as oppositional when in reality their behavior emanates from his attempt to protect himself against a real danger in a statement made

Public In June 2011 the British Psychological Society complained to the aap that the sources of psychological suffering in the DSM G were identified as located within individuals through high the undeniable social causes of many of these problems this was added to a wave of protests by American professionals Including leaders of the

American Psychological Association and the American Counseling Association Why are relationships or social conditions excluded If only we consider biological and genetic defects as the cause of mental problems and ignore abandonment, abuse and deprivation we are just as likely to fall into as many dead ends as previous generations who

Blamed everything on terrible mothers the most surprising rejection of the DSM bird wine of the National Institute of Mental Health of the United States, which funds most of the psychiatric research in this country, in April 2013, a few weeks before the

DSMB was formally launched, the director of this institute Thomas Insel announced that his agency could no longer support diagnoses based on DSM symptoms instead the Institute would focus its funding on the so-called research scope criteria er dooc 33 for its acronym in

English to create a cross-sectional study framework between current diagnostic categories for example one of the scopes of the National Institute of Mental Health are the activation systems modulator activation circadian rhythm sleep and wakefulness that in several patients are altered to different degrees such as the dsmv the rdoc framework conceptualizes mental illnesses merely

As brain disorders this means that future research that will be financie will explore the brain circuits and other neurobiological measurements that lie behind mental problems. Insel sees it as a first step toward the kind of precision medicine that has transformed the diagnosis and treatment of cancer. Mental illness, however,

Is nothing like Cancer Human beings are social animals and mental problems involve not being able to get along with other people Not fitting in, not feeling integrated and in general not being able to be on the same wavelength in the human being, the entire brain, mind

And body. It is oriented towards collaboration in social systems, it is our most powerful survival strategy, the key to our success as a species, and this is precisely what does not work in most forms of mental suffering, as we saw in part two.

Neural connections in the brain and body are vitally important to understanding human suffering but it is important not to ignore the foundations of our humanity, the relationships and interactions that make up our minds and brains when we are young

And that provide substance and meaning to All our lives, people with a history of abuse, neglect or serious deprivation will continue to go unnoticed and largely untreated. Unless we heed Allan Ruof’s warning to fully understand how we became the people we are, complex evolution. and step by step of our

Orientations, capabilities and behavior over time, it takes more than a list of ingredients, no matter how important each one of them is, it requires understanding the development process How all of these factors work together continuously over time. of time Mental health professionals working on the front lines,

Overburdened and underpaid social workers and therapists alike, seem to agree with our approach. Shortly after the aap refused to include developmental trauma disorder in the DSM, thousands of doctors from across the country sent small contributions to the Trauma Center to help us

Conduct a large scientific study known as a field trial to further study TTT. This support has allowed us to interview hundreds of children, parents, foster parents, and Mental Health professionals in five different centers of the network in recent years with

Scientifically designed tools for conducting interviews the first results of these studies have already been published and more will appear during the printing of this book What difference would the diagnosis of ta TD make, a difference would be that it would center research and treatment, not to

Mention funding, in the central principles underlying the changing symptoms of children and adults with chronic trauma: widespread biological and emotional dysregulation, non-existent or altered attachment, difficulties in concentrating and staying on track, and enormous lack of coherent personal identity and competence these issues

Transcend and include almost all diagnostic categories but a treatment that does not put them in the front row in a central position will be more likely to miss the mark. Our great challenge is to apply the lessons of neuroplasticity. flexibility of brain circuits to

Reprogram the brain and reorganize the mind of people who have been programmed by life to perceive others as threats and themselves as useless social support is a biological need not an option and this reality should be the backbone of all prevention and treatment, recognizing the profound effects of trauma and deficiencies on

Child development should not lead to blaming parents. We can assume that parents are doing the best they can, but all parents need help. to raise their children almost all industrialized countries with the exception of the United States recognize this and provide some

Type of guaranteed support to families James Heckman, winner of the Nobel Prize in economics in 2000, has shown that quality early childhood programs that that involve parents and promote basic skills in disadvantaged children are more than profitable in terms of improving outcomes. In the early 1970s, psychologist David HS worked at

A day center in Baltimore where many of preschoolers came from homes plagued by poverty, domestic violence and drug use aware that addressing children’s problems at school alone was not enough to improve their conditions at home began a home visiting program in which trained nurses helped

Mothers provide a safe and stimulating environment for their children and in the process imagine a better future for themselves 20 years later the children of the mothers who received these visits were not only healthier but were less likely to say they had

Been abused or abandoned than a similar group whose mothers had not received such visits. They were also more likely to have completed school, not to have gone to prison, and to have better-paying jobs. Economists have calculated that every dollar spent on home visits from High quality day care and

Preschool programs represent seven dollars in savings on social services, healthcare, detoxification and incarceration treatments, plus higher tax revenues due to better-paying jobs. When I go to Europe to teach, they often contact me. officials from the ministries of health of the Scandinavian countries, the United Kingdom, Germany or the

Netherlands To ask me to spend an afternoon with them to explain the latest studies on the treatment of traumatized children and adolescents and their families, many of my colleagues ask me the same thing These countries have already decided in favor of universal health care, guaranteeing a minimum wage, paid parental leave for

Both parents, and high-quality child care for all working mothers. Could this approach to public health have something to do with it? with the fact that the incarceration rate in Norway is 711 00 people, in the Netherlands 811 00 and in the

United States 7811 0000 while the crime rate in these countries is much lower than ours the cost of medical care approximately half 70 percent of California prisoners grew up in foster care United States spends $84 billion a year to incarcerate people at a cost of approximately $44,000 per prisoner

Northern European countries a fraction of this How much they instead invest in helping parents raise their children in safe, predictable environments. Their academic test scores and crime rates appear to reflect the success of these investments.