The Body Keeps the Score

by Bessel van der Kolk MD

  In the early 1970s psychologist David Olds was working in a Baltimore day-care center where many of the preschoolers came from homes wracked by poverty, domestic violence, and drug abuse. Aware that only addressing the children’s problems at school was not sufficient to improve their home conditions, he started a home-visitation program in which skilled nurses helped mothers to provide a safe and stimulating environment for their children and, in the process, to imagine a better future for themselves. Twenty years later, the children of the home-visitation mothers were not only healthier but also less likely to report having been abused or neglected than a similar group whose mothers had not been visited. They also were more likely to have finished school, to have stayed out of jail, and to be working in well-paying jobs. Economists have calculated that every dollar invested in high-quality home visitation, day care, and preschool programs results in seven dollars of savings on welfare payments, health-care costs, substance-abuse treatment, and incarceration, plus higher tax revenues due to better-paying jobs.37

  When I go to Europe to teach, I often am contacted by officials at the ministries of health in the Scandinavian countries, the United Kingdom, Germany, or the Netherlands and asked to spend an afternoon with them sharing the latest research on the treatment of traumatized children, adolescents, and their families. The same is true for many of my colleagues. These countries have already made a commitment to universal health care, ensuring a guaranteed minimum wage, paid parental leave for both parents after a child is born, and high-quality childcare for all working mothers.

  Could this approach to public health have something to do with the fact that the incarceration rate in Norway is 71/100,000, in the Netherlands 81/100,000, and the US 781/100,000, while the crime rate in those countries is much lower than in ours, and the cost of medical care about half? Seventy percent of prisoners in California spent time in foster care while growing up. The United States spends $84 billion per year to incarcerate people at approximately $44,000 per prisoner; the northern European countries a fraction of that amount. Instead, they invest in helping parents to raise their children in safe and predictable surroundings. Their academic test scores and crime rates seem to reflect the success of those investments.

  PART FOUR

  THE IMPRINT OF TRAUMA

  CHAPTER 11

  UNCOVERING SECRETS: THE PROBLEM OF TRAUMATIC MEMORY

  It is a strange thing that all the memories have these two qualities. They are always full of quietness, that is the most striking thing about them; and even when things weren’t like that in reality, they still seem to have that quality. They are soundless apparitions, which speak to me by looks and gestures, wordless and silent—and their silence is precisely what disturbs me.

  —Erich Maria Remarque, All Quiet on the Western Front

  In the spring of 2002 I was asked to examine a young man who claimed to have been sexually abused while he was growing up by Paul Shanley, a Catholic priest who had served in his parish in Newton, Massachusetts. Now twenty-five years old, he had apparently forgotten the abuse until he heard that the priest was currently under investigation for molesting young boys. The question posed to me was: Even though he had seemingly “repressed” the abuse for well over a decade after it ended, were his memories credible, and was I prepared to testify to that fact before a judge?

  I will share what this man, whom I’ll call Julian, told me, drawing on my original case notes. (Even though his real name is in the public record, I’m using a pseudonym because I hope that he has regained some privacy and peace with the passage of time.1)

  His experiences illustrate the complexities of traumatic memory. The controversies over the case against Father Shanley are also typical of the passions that have swirled around this issue since psychiatrists first described the unusual nature of traumatic memories in the final decades of the nineteenth century.

  FLOODED BY SENSATIONS AND IMAGES

  On February 11, 2001, Julian was serving as a military policeman at an air force base. During his daily phone conversation with his girlfriend, Rachel, she mentioned a lead article she’d read that morning in the Boston Globe. A priest named Shanley was under suspicion for molesting children. Hadn’t Julian once told her about a Father Shanley who had been his parish priest back in Newton? “Did he ever do anything to you?” she asked. Julian initially recalled Father Shanley as a kind man who’d been very supportive after his parents got divorced. But as the conversation went on, he started to go into a panic. He suddenly saw Shanley silhouetted in a doorframe, his hands stretched out at forty-five degrees, staring at Julian as he urinated. Overwhelmed by emotion, he told Rachel, “I’ve got to go.” He called his flight chief, who came over accompanied by the first sergeant. After he met with the two of them, they took him to the base chaplain. Julian recalls telling him: “Do you know what is going on in Boston? It happened to me, too.” The moment he heard himself say those words, he knew for certain that Shanley had molested him—even though he did not remember the details. Julian felt extremely embarrassed about being so emotional; he had always been a strong kid who kept things to himself.

  That night he sat on the corner of his bed, hunched over, thinking he was losing his mind and terrified that he would be locked up. Over the subsequent week images kept flooding into his mind, and he was afraid of breaking down completely. He thought about taking a knife and plunging it into his leg just to stop the mental pictures. Then the panic attacks started to be accompanied by seizures, which he called “epileptic fits.” He scratched his body until he bled. He constantly felt hot, sweaty, and agitated. Between panic attacks he “felt like a zombie”; he was observing himself from a distance, as if what he was experiencing were actually happening to somebody else.

  In April he received an administrative discharge, just ten days short of being eligible to receive full benefits.

  When Julian entered my office almost a year later, I saw a handsome, muscular guy who looked depressed and defeated. He told me immediately that he felt terrible about having left the air force. He had wanted to make it his career, and he’d always received excellent evaluations. He loved the challenges and the teamwork, and he missed the structure of the military lifestyle.

  Julian was born in a Boston suburb, the second-oldest of five children. His father left the family when Julian was about six because he could not tolerate living with Julian’s emotionally labile mother. Julian and his father get along quite well, but he sometimes reproaches his father for having worked too hard to support his family and for abandoning him to the care of his unbalanced mother. Neither his parents nor any of his siblings has ever received psychiatric care or been involved with drugs.

  Julian was a popular athlete in high school. Although he had many friends, he felt pretty bad about himself and covered up for being a poor student by drinking and partying. He feels ashamed that he took advantage of his popularity and good looks by having sex with many girls. He mentioned wanting to call several of them to apologize for how badly he’d treated them.

  He remembered always hating his body. In high school he took steroids to pump himself up and smoked marijuana almost every day. He did not go to college, and after graduating from high school he was virtually homeless for almost a year because he could no longer stand living with his mother. He enlisted to try to get his life back on track.

  Julian met Father Shanley at age six when he was taking a CCD (catechism) class at the parish church. He remembered Father Shanley taking him out of the class for confession. Father Shanley rarely wore a cassock, and Julian remembered the priest’s dark blue corduroy pants. They would go to a big room with one chair facing another and a bench to kneel on. The chairs were covered with red and there was a red velvet cushion on the bench. They played cards, a game of war that turned into strip poker. Then he remembered standing in front of a mirror in that room. Father Shanley made him bend over. He remembered Father Shanley putting a finger into hi
s anus. He does not think Shanley ever penetrated him with his penis, but he believes that the priest fingered him on numerous occasions.

  Other than that, his memories were quite incoherent and fragmentary. He had flashes of images of Shanley’s face and of isolated incidents: Shanley standing in the door of the bathroom; the priest going down on his knees and moving “it” around with his tongue. He could not say how old he was when that happened. He remembered the priest telling him how to perform oral sex, but he did not remember actually doing it. He remembered passing out pamphlets in church and then Father Shanley sitting next to him in a pew, fondling him with one hand and holding Julian’s hand on himself with the other. He remembered that, as he grew older, Father Shanley would pass close to him and caress his penis. Paul did not like it but did not know what to do to stop it. After all, he told me, “Father Shanley was the closest thing to God in my neighborhood.”

  In addition to these memory fragments, traces of his sexual abuse were clearly being activated and replayed. Sometimes when he was having sex with his girlfriend, the priest’s image popped into his head, and, as he said, he would “lose it.” A week before I interviewed him, his girlfriend had pushed a finger into his mouth and playfully said: “You give good head.” Julian jumped up and screamed, “If you ever say that again I’ll fucking kill you.” Then, terrified, they both started to cry. This was followed by one of Julian’s “epileptic fits,” in which he curled up in a fetal position, shaking and whimpering like a baby. While telling me this Julian looked very small and very frightened.

  Julian alternated between feeling sorry for the old man that Father Shanley had become and simply wanting to “take him into a room somewhere and kill him.” He also spoke repeatedly of how ashamed he felt, how hard it was to admit that he could not protect himself: “Nobody fucks with me, and now I have to tell you this.” His self-image was of a big, tough Julian.

  How do we make sense of a story like Julian’s: years of apparent forgetting, followed by fragmented, disturbing images, dramatic physical symptoms, and sudden reenactments? As a therapist treating people with a legacy of trauma, my primary concern is not to determine exactly what happened to them but to help them tolerate the sensations, emotions, and reactions they experience without being constantly hijacked by them. When the subject of blame arises, the central issue that needs to be addressed is usually self-blame—accepting that the trauma was not their fault, that it was not caused by some defect in themselves, and that no one could ever have deserved what happened to them.

  Once a legal case is involved, however, determination of culpability becomes primary, and with it the admissibility of evidence. I had previously examined twelve people who had been sadistically abused as children in a Catholic orphanage in Burlington, Vermont. They had come forward (with many other claimants) more than four decades later, and although none had had any contact with the others until the first claim was filed, their abuse memories were astonishingly similar: They all named the same names and the particular abuses that each nun or priest had committed—in the same rooms, with the same furniture, and as part of the same daily routines. Most of them subsequently accepted an out-of-court settlement from the Vermont diocese.

  Before a case goes to trial, the judge holds a so-called Daubert hearing to set the standards for expert testimony to be presented to the jury. In a 1996 case I had convinced a federal circuit court judge in Boston that it was common for traumatized people to lose all memories of the event in question, only to regain access to them in bits and pieces at a much later date. The same standards would apply in Julian’s case. While my report to his lawyer remains confidential, it was based on decades of clinical experience and research on traumatic memory, including the work of some of the great pioneers of modern psychiatry.

  NORMAL VERSUS TRAUMATIC MEMORY

  We all know how fickle memory is; our stories change and are constantly revised and updated. When my brothers, sisters, and I talk about events in our childhood, we always end up feeling that we grew up in different families—so many of our memories simply do not match. Such autobiographical memories are not precise reflections of reality; they are stories we tell to convey our personal take on our experience.

  The extraordinary capacity of the human mind to rewrite memory is illustrated in the Grant Study of Adult Development, which has systematically followed the psychological and physical health of more than two hundred Harvard men from their sophomore years of 1939–44 to the present.2 Of course, the designers of the study could not have anticipated that most of the participants would go off to fight in World War II, but we can now track the evolution of their wartime memories. The men were interviewed in detail about their war experiences in 1945/1946 and again in 1989/1990. Four and a half decades later, the majority gave very different accounts from the narratives recorded in their immediate postwar interviews: With the passage of time, events had been bleached of their intense horror. In contrast, those who had been traumatized and subsequently developed PTSD did not modify their accounts; their memories were preserved essentially intact forty-five years after the war ended.

  Whether we remember a particular event at all, and how accurate our memories of it are, largely depends on how personally meaningful it was and how emotional we felt about it at the time. The key factor is our level of arousal. We all have memories associated with particular people, songs, smells, and places that stay with us for a long time. Most of us still have precise memories of where we were and what we saw on Tuesday, September 11, 2001, but only a fraction of us recall anything in particular about September 10.

  Most day-to-day experience passes immediately into oblivion. On ordinary days we don’t have much to report when we come home in the evening. The mind works according to schemes or maps, and incidents that fall outside the established pattern are most likely to capture our attention. If we get a raise or a friend tells us some exciting news, we will retain the details of the moment, at least for a while. We remember insults and injuries best: The adrenaline that we secrete to defend against potential threats helps to engrave those incidents into our minds. Even if the content of the remark fades, our dislike for the person who made it usually persists.

  When something terrifying happens, like seeing a child or a friend get hurt in an accident, we will retain an intense and largely accurate memory of the event for a long time. As James McGaugh and colleagues have shown, the more adrenaline you secrete, the more precise your memory will be.3 But that is true only up to a certain point. Confronted with horror—especially the horror of “inescapable shock”—this system becomes overwhelmed and breaks down.

  Of course, we cannot monitor what happens during a traumatic experience, but we can reactivate the trauma in the laboratory, as was done for the brain scans in chapters 3 and 4. When memory traces of the original sounds, images, and sensations are reactivated, the frontal lobe shuts down, including, as we’ve seen, the region necessary to put feelings into words,4 the region that creates our sense of location in time, and the thalamus, which integrates the raw data of incoming sensations. At this point the emotional brain, which is not under conscious control and cannot communicate in words, takes over. The emotional brain (the limbic area and the brain stem) expresses its altered activation through changes in emotional arousal, body physiology, and muscular action. Under ordinary conditions these two memory systems—rational and emotional—collaborate to produce an integrated response. But high arousal not only changes the balance between them but also disconnects other brain areas necessary for the proper storage and integration of incoming information, such as the hippocampus and the thalamus.5 As a result, the imprints of traumatic experiences are organized not as coherent logical narratives but in fragmented sensory and emotional traces: images, sounds, and physical sensations.6 Julian saw a man with outstretched arms, a pew, a staircase, a strip poker game; he felt a sensation in his penis, a panicked sense of dread. But there was little or no
story.

  UNCOVERING THE SECRETS OF TRAUMA

  In the late nineteenth century, when medicine first began the systematic study of mental problems, the nature of traumatic memory was one of the central topics under discussion. In France and England a prodigious number of articles were published on a syndrome known as “railway spine,” a psychological aftermath of railroad accidents that included loss of memory.

  The greatest advances, however, came in the study of hysteria, a mental disorder characterized by emotional outbursts, susceptibility to suggestion, and contractions and paralyses of the muscles that could not be explained by simple anatomy.7 Once considered an affliction of unstable or malingering women (the name comes from the Greek word for “womb”), hysteria now became a window into the mysteries of mind and body. The names of some of the greatest pioneers in neurology and psychiatry, such as Jean-Martin Charcot, Pierre Janet, and Sigmund Freud, are associated with the discovery that trauma is at the root of hysteria, particularly the trauma of childhood sexual abuse.8 These early researchers referred to traumatic memories as “pathogenic secrets”9 or “mental parasites,”10 because as much as the sufferers wanted to forget whatever had happened, their memories kept forcing themselves into consciousness, trapping them in an ever-renewing present of existential horror.11

  The interest in hysteria was particularly strong in France, and, as so often happens, its roots lay in the politics of the day. Jean-Martin Charcot, who is widely regarded as the father of neurology and whose pupils, such as Gilles de la Tourette, lent their names to numerous neurological diseases, was also active in politics. After Emperor Napoleon III abdicated in 1870, there was a struggle between the monarchists (the old order backed by the clergy), and the advocates of the fledgling French Republic, who believed in science and in secular democracy. Charcot believed that women would be a critical factor in this struggle, and his investigation of hysteria “offered a scientific explanation for phenomena such as demonic possession states, witchcraft, exorcism, and religious ecstasy.”12