Effects of a weekly yoga class. After twenty weeks, chronically traumatized women developed increased activation of critical brain structures involved in self-regulation: the insula and the medial prefrontal cortex.
YOGA AND THE NEUROSCIENCE OF SELF-AWARENESS
During the past few years brain researchers such as my colleagues Sara Lazar and Britta Hölzel at Harvard have shown that intensive meditation has a positive effect on exactly those brain areas that are critical for physiological self-regulation.19 In our latest yoga study, with six women with histories of profound early trauma, we also found the first indications that twenty weeks of yoga practice increased activation of the basic self-system, the insula and the medial prefrontal cortex (see chapter 6). This research needs much more work, but it opens up new perspectives on how actions that involve noticing and befriending the sensations in our bodies can produce profound changes in both mind and brain that can lead to healing from trauma.
After each of our yoga studies, we asked the participants what effect the classes had had on them. We never mentioned the insula or interoception; in fact, we kept the discussion and explanation to a minimum so that they could focus inward.
Here is a sample of their responses:
“My emotions feel more powerful. Maybe it’s just that I can recognize them now.”
“I can express my feelings more because I can recognize them more. I feel them in my body, recognize them, and address them.”
“I now see choices, multiple paths. I can decide and I can choose my life, it doesn’t have to be repeated or be experienced like a child.”
“I was able to move my body and be in my body in a safe place and without hurting myself/getting hurt.”
LEARNING TO COMMUNICATE
People who feel safe in their bodies can begin to translate the memories that previously overwhelmed them into language. After Annie had been practicing yoga three times a week for about a year, she noticed that she was able to talk much more freely to me about what had happened to her. She thought this almost miraculous. One day, when she knocked over a glass of water, I got up from my chair and approached her with a Kleenex box, saying, “Let me clean that up.” This precipitated a brief, intense panic reaction. She was quickly able to contain herself, though, and explained why those particular words were so upsetting to her—they were what her father would say after he’d raped her. Annie wrote to me after that session: “Did you notice that I have been able to say the words out loud? I didn’t have to write them down to tell you what was happening. I didn’t lose trust in you because you said words that triggered me. I understood that the words were a trigger and not terrible words that no one should say.”
Annie continues to practice yoga and to write to me about her experiences: “Today I went to a morning yoga class at my new yoga studio. The teacher talked about breathing to the edge of where we can and then noticing that edge. She said that if we notice our breath we are in the present because we can’t breathe in the future or the past. It felt so amazing to me to be practicing breathing in that way after we had just talked about it, like I had been given a gift. Some of the poses can be triggering for me. Two of them were today, one where your legs are up frog like and one where you are doing really deep breathing into your pelvis. I felt the beginning of panic, especially in the breathing pose, like oh no that’s not a part of my body I want to feel. But then I was able to stop myself and just say, notice that this part of your body is holding experiences and then just let it go. You don’t have to stay there but you don’t have to leave either, just use it as information. I don’t know that I have ever been able to do that in such a conscious way before. It made me think that if I notice without being so afraid, it will be easier for me to believe myself.”
In another message, Annie reflected on the changes in her life: “I slowly learned to just have my feelings, without being hijacked by them. Life is more manageable: I am more attuned to my day and more present in the moment. I am more tolerant of physical touch. My husband and I are enjoying watching movies cuddled together in bed . . . a huge step. All this helped me finally feel intimate with my husband.”
CHAPTER 17
PUTTING THE PIECES TOGETHER: SELF-LEADERSHIP
This being human is a guest house. Every morning is a new arrival. A joy, a depression, a meanness, some momentary awareness comes as an unexpected visitor. . . . Welcome and entertain them all. Treat each guest honorably. The dark thought, the shame, the malice, meet them at the door laughing, and invite them in. Be grateful for whoever comes, because each has been sent as a guide from beyond.
—Rumi
A man has as many social selves as there are individuals who recognize him.
—William James, The Principles of Psychology
It was early in my career, and I had been seeing Mary, a shy, lonely, and physically collapsed young woman, for about three months in weekly psychotherapy, dealing with the ravages of her terrible history of early abuse. One day I opened the door to my waiting room and saw her standing there provocatively, dressed in a miniskirt, her hair dyed flaming red, with a cup of coffee in one hand and a snarl on her face. “You must be Dr. van der Kolk,” she said. “My name is Jane, and I came to warn you not to believe any the lies that Mary has been telling you. Can I come in and tell you about her?” I was stunned but fortunately kept myself from confronting “Jane” and instead heard her out. Over the course of our session I met not only Jane but also a hurt little girl and an angry male adolescent. That was the beginning of a long and productive treatment.
Mary was my first encounter with dissociative identity disorder (DID), which at that time was called multiple personality disorder. As dramatic as its symptoms are, the internal splitting and emergence of distinct identities experienced in DID represent only the extreme end of the spectrum of mental life. The sense of being inhabited by warring impulses or parts is common to all of us but particularly to traumatized people who had to resort to extreme measures in order to survive. Exploring—even befriending—those parts is an important component of healing.
DESPERATE TIMES REQUIRE DESPERATE MEASURES
We all know what happens when we feel humiliated: We put all our energy into protecting ourselves, developing whatever survival strategies we can. We may repress our feelings; we may get furious and plot revenge. We may decide to become so powerful and successful that nobody can ever hurt us again. Many behaviors that are classified as psychiatric problems, including some obsessions, compulsions, and panic attacks, as well as most self-destructive behaviors, started out as strategies for self-protection. These adaptations to trauma can so interfere with the capacity to function that health-care providers and patients themselves often believe that full recovery is beyond reach. Viewing these symptoms as permanent disabilities narrows the focus of treatment to finding the proper drug regimen, which can lead to lifelong dependence—as though trauma survivors were like kidney patients on dialysis.1
It is much more productive to see aggression or depression, arrogance or passivity as learned behaviors: Somewhere along the line, the patient came to believe that he or she could survive only if he or she was tough, invisible, or absent, or that it was safer to give up. Like traumatic memories that keep intruding until they are laid to rest, traumatic adaptations continue until the human organism feels safe and integrates all the parts of itself that are stuck in fighting or warding off the trauma.
Every trauma survivor I’ve met is resilient in his or her own way, and every one of their stories inspires awe at how people cope. Knowing how much energy the sheer act of survival requires keeps me from being surprised at the price they often pay: the absence of a loving relationship with their own bodies, minds, and souls.
Coping takes its toll. For many children it is safer to hate themselves than to risk their relationship with their caregivers by expressing anger or by running away. As a result, abused children are lik
ely to grow up believing that they are fundamentally unlovable; that was the only way their young minds could explain why they were treated so badly. They survive by denying, ignoring, and splitting off large chunks of reality: They forget the abuse; they suppress their rage or despair; they numb their physical sensations. If you were abused as a child, you are likely to have a childlike part living inside you that is frozen in time, still holding fast to this kind of self-loathing and denial. Many adults who survive terrible experiences are caught in the same trap. Pushing away intense feelings can be highly adaptive in the short run. It may help you preserve your dignity and independence; it may help you maintain focus on critical tasks like saving a comrade, taking care of your kids, or rebuilding your house.
The problems come later. After seeing a friend blown up, a soldier may return to civilian life and try to put the experience out of his mind. A protective part of him knows how to be competent at his job and how to get along with colleagues. But he may habitually erupt in rage at his girlfriend or become numb and frozen when the pleasure of surrendering to her touch makes him feel he is losing control. He probably will not be aware that his mind automatically associates passive surrender with the paralysis he felt when his friend was killed. So another protective part steps in to create a diversion: He gets angry and, having no idea what set him off, he thinks he’s mad about something his girlfriend did. Of course, if he keeps blowing up at her (and subsequent girlfriends), he will become more and more isolated. But he may never realize that a traumatized part is triggered by passivity and that another part, an angry manager, is stepping in to protect that vulnerable part. Helping these parts to give up their extreme beliefs is how therapy can save people’s lives.
As we saw in chapter 13, a central task for recovery from trauma is to learn to live with the memories of the past without being overwhelmed by them in the present. But most survivors, including those who are functioning well—even brilliantly—in some aspects of their lives, face another, even greater challenge: reconfiguring a brain/mind system that was constructed to cope with the worst. Just as we need to revisit traumatic memories in order to integrate them, we need to revisit the parts of ourselves that developed the defensive habits that helped us to survive.
THE MIND IS A MOSAIC
We all have parts. Right now a part of me feels like taking a nap; another part wants to keep writing. Still feeling injured by an offensive e-mail message, a part of me wants to hit “reply” on a stinging put-down, while a different part wants to shrug it off. Most people who know me have seen my intense, sincere, and irritable parts; some have met the little snarling dog that lives inside me. My children reminisce about going on family vacations with my playful and adventurous parts.
When you walk into the office in the morning and see the storm clouds over your boss’s head, you know precisely what is coming. That angry part has a characteristic tone of voice, vocabulary, and body posture—so different from yesterday, when you shared pictures of your kids. Parts are not just feelings but distinct ways of being, with their own beliefs, agendas, and roles in the overall ecology of our lives.
How well we get along with ourselves depends largely on our internal leadership skills—how well we listen to our different parts, make sure they feel taken care of, and keep them from sabotaging one another. Parts often come across as absolutes when in fact they represent only one element in a complex constellation of thoughts, emotions, and sensations. If Margaret shouts, “I hate you!” in the middle of an argument, Joe probably thinks she despises him—and in that moment Margaret might agree. But in fact only a part of her is angry, and that part temporarily obscures her generous and affectionate feelings, which may well return when she sees the devastation on Joe’s face.
Every major school of psychology recognizes that people have subpersonalities and gives them different names.2 In 1890 William James wrote: “[I]t must be admitted that . . . the total possible consciousness may be split into parts which coexist, but mutually ignore each other, and share the objects of knowledge between them.”3 Carl Jung wrote: “The psyche is a self-regulating system that maintains its equilibrium just as the body does,”4 “The natural state of the human psyche consists in a jostling together of its components and in their contradictory behavior,”5 and “The reconciliation of these opposites is a major problem. Thus, the adversary is none other than ‘the other in me.’”6
Modern neuroscience has confirmed this notion of the mind as a kind of society. Michael Gazzaniga, who conducted pioneering split-brain research, concluded that the mind is composed of semiautonomous functioning modules, each of which has a special role.7 In his book The Social Brain (1985) he writes, “But what of the idea that the self is not a unified being, and there may exist within us several realms of consciousness? . . . From our [split-brain] studies the new idea emerges that there are literally several selves, and they do not necessarily ‘converse’ with each other internally.”8 MIT scientist Marvin Minsky, a pioneer of artificial intelligence, declared: “The legend of the single Self can only divert us from the target of that inquiry.9 . . . [I]t can make sense to think there exists, inside your brain, a society of different minds. Like members of a family, the different minds can work together to help each other, each still having its own mental experiences that the others never know about.”10
Therapists who are trained to see people as complex human beings with multiple characteristics and potentialities can help them explore their system of inner parts and take care of the wounded facets of themselves. There are several such treatment approaches, including the structural dissociation model developed by my Dutch colleagues Onno van der Hart and Ellert Nijenhuis and Atlanta-based Kathy Steel, that is widely practiced in Europe and Richard Kluft’s work in the United States.11
Twenty years after working with Mary, I met Richard Schwartz, the developer of internal family systems therapy (IFS). It was through his work that Minsky’s “family” metaphor truly came to life for me and offered a systematic way to work with the split-off parts that result from trauma. At the core of IFS is the notion that the mind of each of us is like a family in which the members have different levels of maturity, excitability, wisdom, and pain. The parts form a network or system in which change in any one part will affect all the others.
The IFS model helped me realize that dissociation occurs on a continuum. In trauma the self-system breaks down, and parts of the self become polarized and go to war with one another. Self-loathing coexists (and fights) with grandiosity; loving care with hatred; numbing and passivity with rage and aggression. These extreme parts bear the burden of the trauma.
In IFS a part is considered not just a passing emotional state or customary thought pattern but a distinct mental system with its own history, abilities, needs, and worldview.12 Trauma injects parts with beliefs and emotions that hijack them out of their naturally valuable state. For example, we all have parts that are childlike and fun. When we are abused, these are the parts that are hurt the most, and they become frozen, carrying the pain, terror, and betrayal of abuse. This burden makes them toxic—parts of ourselves that we need to deny at all costs. Because they are locked away inside, IFS calls them the exiles.
At this point other parts organize to protect the internal family from the exiles. These protectors keep the toxic parts away, but in so doing they take on some of the energy of the abuser. Critical and perfectionistic managers can make sure we never get close to anyone or drive us to be relentlessly productive. Another group of protectors, which IFS calls firefighters, are emergency responders, acting impulsively whenever an experience triggers an exiled emotion.
Each split-off part holds different memories, beliefs, and physical sensations; some hold the shame, others the rage, some the pleasure and excitement, another the intense loneliness or the abject compliance. These are all aspects of the abuse experience. The critical insight is that all these parts have a function: to protect the self fr
om feeling the full terror of annihilation.
Children who act out their pain rather than locking it down are often diagnosed with “oppositional defiant behavior,” “attachment disorder,” or “conduct disorder.” But these labels ignore the fact that rage and withdrawal are only facets of a whole range of desperate attempts at survival. Trying to control a child’s behavior while failing to address the underlying issue—the abuse—leads to treatments that are ineffective at best and harmful at worst. As they grow up, their parts do not spontaneously integrate into a coherent personality but continue to lead a relatively autonomous existence.
Parts that are “out” may be entirely unaware of the other parts of the system.13 Most of the men I evaluated with regard to their childhood molestation by Catholic priests took anabolic steroids and spent an inordinate amount of time in the gym pumping iron. These compulsive bodybuilders lived in a masculine culture of sweat, football, and beer, where weakness and fear were carefully concealed. Only after they felt safe with me did I meet the terrified kids inside.
Patients may also dislike the parts that are out: the parts that are angry, destructive, or critical. But IFS offers a framework for understanding them—and, also important, talking about them in a nonpathologizing way. Recognizing that each part is stuck with burdens from the past and respecting its function in the overall system makes it feel less threatening or overwhelming.
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