Childhood Trauma Psychedelics EMDR Dr Bessel van der Kolk

Well, I sometimes think that our biggest problem that we face, the biggest legacy issue, is that for over 100 years we've called these things mental health problems. And I slightly wonder, as I've explored your work and your colleagues' work, if this is a kind of misnomer. This isn't something we say because we don't have anything better to say because we didn't yet understand the problem. Because the more and more we talk about this, the more it becomes apparent that the things that we categorize as mental health problems, like anxiety or depression, I mean, take, for example, the guy running from the lion, are rooted in the physiology. They're rooted in the neurobiology, the anatomy. And if we had framed these things from the beginning as an imbalance in, if you like, the communication between different parts of the brain, I wonder if we would be so confused at this point. And I wonder if it would have been so difficult for pioneers such as yourself to bring this work forward. Yeah. No, I'm not critical about it because, you know, humans are incredibly complex and we can only talk about it as a neurological problem once we know a little bit about the neurology. What people don't realize is that 30 years ago trauma was not on the map. When we created the diagnosis of PTSD in 1980, we said this is an extraordinary event outside the ordinary human realm of human experience. That was our definition in 1980. And then we started looking at it and we go like, there's trauma everywhere. And what was astounding is we had been blind to domestic violence. We had been blind to incest. We had been blind to child abuse. We just didn't see it. So here are people who are working with people who are upset and nobody asked about, did anybody beat you up? Did anybody rape you? It did not exist. The textbooks of psychology and psychiatry had no talk about rape, incest, domestic violence. Like, we were so blind, you know. And then, so this field is 40 years old. And then somebody finds out that doing cognitive behavioral treatment makes people 10% better and they say, oh, we have found the treatment of choice and everybody should do CBT. No, that's the first little thing that appears to make a little bit of difference. We are very young and we don't know anything. And maybe a little bit of CBT might be helpful, but it doesn't solve the problem. And then we learned about neurobiology and people say, oh, it's an limbic system. Yeah. But then we learned, 10 years later, we learned something else. And we learned about how the vagus nerve works. And then people say, oh, the vagus nerve, everything, now we have the answer. No, because just above the vagus nerve, there's all kinds of other brain structures that still make it more complicated. So, we use the language that we have access to by the technology that happens to be available at that particular point. And we're usually about 10 years behind. So, we're already using the technology for how to use language that already is outdated by the time you follow that. Well, I mean, you have, thankfully for many of us, including myself, the pioneering work that you've done and your colleagues has led to there being pockets of professionals who do understand this formulation, and it has increased, and are attempting to provide treatments based on this deeper, more causal formulation of the problem. And you mentioned treatments that might work. What are you advocating at the moment? What would you recommend to people who are listening today who are resonating with your description of the problem? How should we be addressing it? For me, the big window into the new world was EMDR. EMDR is a crazy treatment. You ask people to remember stuff, you don't have them talk about it, and you ask them to move their fingers, eyes from side to side, and follow your fingers. Bizarre. And like everybody else, I said, don't do that. That's crazy stuff. And then, you know, I get to see that it works, and we do the first study funded by NIH on how well EMDR works, and it works spectacularly well to deal with trauma. And I go like, wow, that's interesting. You do this weird thing, eye movements, that doesn't fit with any of the paradigms we have, and you bring about dramatic changes in people. So for me, this was like, oh, so bizarre things may work. And then people say, oh, I benefit from yoga for my trauma. And I go like, really? Putting your butt up in the air and twisting your body into a pretzel is helpful for dealing with old stuff. And, you know, being a little weird guy, I like to explore these weird things. I go to NIH always six times, because you always get rejected the first five times, so it's very labor-intensive. And the last time we get a grant, and it shows us that yoga has a more profound effect on trauma than any drug that people have ever studied. So when you ask me, what do you think is the best treatment, I go, no, we are on a journey. We're in a journey of discovery, and let's see what works for you. And let's explore what works. And let's not say, I have found the answer. And then a very important thing that I also learned is that we talk, usually talk about people as a unitary self. And then Dick Schwartz amplifies something that earlier people like and Jung has, but it becomes very popular now, because these things have always been said before. And he said, we have multiple parts. And in order to protect ourselves from feeling so horrible and helpless, we develop defense mechanisms. So we become very controlling and uptight. And that becomes our character structure, in order to keep that terrified, frightened part of me under control. And then when I can't control it any longer, I feel completely out of control. And this person who's always uptight and careful, suddenly starts drinking or taking cocaine. And we call that a firefighter. When the whole system breaks apart, there's something else jumps in to keep you under control. And you start understanding that people do what they can in order to survive, feeling completely disintegrated. And then you get to see that, oh, some people cut themselves in order to stay under control. And I go, that's interesting. For some people, cutting seems to be a helpful way of coping. The long range is probably also great. Other people find that starving myself gives me more sense of control. And then people say to these people who starve themselves, you better eat. If you don't want to die, you have to eat. But they don't understand that this learning to not eat started off as a self-preservative way of surviving whatever they tried to survive. And so that you get to see that a lot of weird things that people do are, in essence, self-protective ways of desperately trying to not succumb to complete helplessness. And so you get to see how complex people's adaptations are. And to help people, to respect people for whatever complex adaptations you have, and say, I wish you wouldn't kill people in order to survive. And let's try to do something about it. But this rage that you have, where does it come from? Where does this rage start? And then the critical element, and that is something I feel quite strongly about. I'd be surprised that I would change my mind about it before I croak. And that the critical issue is the development of self-compassion for that creature that you inhabit. And to really get to understand, I developed these habits and these coping mechanisms in an attempt to desperately stay in control of myself. Yeah, I think that it's one of the most helpful ideas that people I see in treatment take on, is when we move from this delusion that we are just one entity. As I was saying before, I have this kind of dialogue with Benjamin. But really, the model that I sometimes think of is the hung parliament, which we had in Great Britain for a while over this Brexit fiasco. And it's really just, you know, it's a lot of people shouting. And yeah, they need to come to a decision. Because as you said, the brain's job is to move the body, really. They're like, now speaking is moving my body. I've got to come to a decision. And a lot of the stress that I think people who've been fragmented by traumatic experiences, even traumatic with a small t, just, you know, the difficulties of life, a lack of nourishment in childhood. I don't call these things small t's. Okay. I actually, Francine Superior was the person who invented it. I love Francine. She died two years ago. But, you know, being neglected by your mom, and being ignored as a kid, is not a minor little thing. You know, every child has the birthright to be adored. And what I see my grandchildren, when they walk into a room, everybody goes like, Oh, my God, isn't she cute? And I think that is what kids need. And that's normal. And we are wired for to be adored as kids. But if, as a number of people I've treated, if they say, Oh, ----, I tried to abort you as a kid, because I knew what a terrible kid you were. That is a trauma. And that becomes your identity. That's not a minor little thing, man. That's huge. I agree. And I think that one of the difficulties with this field is the word trauma has begun to be bandied about left, right and center, almost become a marketing tool for a lot of industry and people don't really understand what it means. You know, to me, I don't particularly like those distinctions, but I try and help people who want to say, Well, I've never been in a car crash. I've been divorced, I don't have any trauma. Really, I think anyone who's had an unfinished reaction to something, anyone who's got an invisible lion around the corner, has experienced what we could define as trauma. And Peter Levine's catchphrase, I think, was trauma is in the body, not in the event, which I think. So, you know, we can end up with these fragmented parts, this kind of rowdy, hung parliament. And I think it's one of the most important ideas to take on. I sometimes say to people, Well, you're familiar with this, because you'll say you'll go to work, and you'll sit down with a colleague, and you'll say, Oh, you know, part of me really wanted to stay in bed this morning. And so we know this, it's part of our language, but we, we kind of think we don't know, we think it only applies to people who are massively, I don't know, schizophrenic or borderline personality disorder, or dissociative identity disorder or something. But it's not, I think it's a part of all of us. And I think you're right that Schwartz's work and Nina Fisher with the similar work has shown us in our field, how important it is to layer these integrations from working with the brain into the cognitive, into the executive, and so on. And I suspect that's why your answer to the question, well, what do you do about this, is quite manifold, it's quite complicated. Yeah, you know, it comes up all the time. You know, I was recently talking with Eve Ensler, who, the author of The Vagina Monologues, and other things, her name is now V. And I love her, and I love the work that she does. And she's gone through a long trajectory. And at the end says, I've done that treatment, I've done that treatment, I've done that treatment. And then she says, at the end, what was most helpful for me was ayahuasca. And I go, see, that was your path. And the next person who I meet, another friend, maybe I won't mention her name, but pretty public, the person who taught me neurofeedback, also had a horrendous traumatic background. And for her, neurofeedback was the best answer. And I know other people who did resolve most stuff with EMDR. You came to one of my, or one or more of my psychodrama workshops. For me, my own psychodrama experience was extremely powerful. Did it change everything? No, it's a very powerful component of my own journey. And so I think it's true in your journey also, Benjamin, is that we take one piece at a time, and we grow. And it's not like, oh, my God, I found the answer. It's not like, we're not a religion. It's not like the moment you find that particular religion, that you'll go to heaven. You take care of pieces of owning yourself, basically. Yeah, I think that's definitely true. And one of the things that, you know, a theme in what you're talking about actually is kind of innovation. It's one of the things I notice in your book is that there's a lot of references to things like brain scans, and EMDR often uses equipment. Neurofeedback is very much a computer-based piece of equipment. This whole field would be totally different without the equipment to do brain scanning. But there's another side to innovation that's emerging, which I think is fascinating, which is this research that you're doing into using substances as a therapy. And I wonder if there's anything you can tell us about where you think the field is going. I mean, we've talked about the last 30 years, and particularly the last five or 10 years. What do the next five to 10 years look like? Well, you know, we are creatures of fashion, and we go from one new thing after another, and we abandon old things. Like, I studied the history of trauma very carefully, and the way the early people treated trauma was through hypnosis. And I've read numerous case histories of people really getting cured with hypnosis. Today, nobody does hypnosis anymore. So things come and go. And then when I was a college student, I lived in a psychedelic world. And like every good college student who went to school in the 60s, I took LSD and mushrooms, as did every one of my colleagues and friends who have become a major scientist. And when I asked my friends, what effect do you think the psychedelics have had on you, on your, who you are today? Every one of my friends says, you know, the psychedelics were profoundly important for my, who I became, because as a scientist, I needed to see that the universe is much larger than the universe that contains me. And LSD helped me to see that there is lots of things we don't know, and it helped me to explore that. And so when Vic Doblin and Michael Mithoffer started to explore psychedelics, I warned them. I said, you know, people I know who did this stuff had gone to jail and never worked. So I said to them, don't do it. And they said, thank you very much for your opinion. And they did it. And they really are showing something that doesn't surprise me a bit, that if you take psychedelic agents very carefully, under very controlled conditions, and I can't say that enough, because I run a laboratory that does that right now, needs to be extremely careful, then when you take these drugs, you live in a different mind. And you see yourself in a different way. And you feel oftentimes calm, particularly if you have really good therapy around you. And you can explore yourself in ways you've never explored yourself. And, you know, I'm the spokesperson for MAPS right now. So I can't, and they told me specifically, until the paper gets published, we don't want you to tell the specific results yet. So I won't do that. But it had extremely good results, like extremely good results. And it was also very surprising to me how the 12 sites around the US in which the studies were conducted, there was not a single serious adverse side effect. And that, I think, is quite remarkable, because playing around with these substances is not an innocent little thing. I think, you know, every time you open up your mind to explore the dark recesses of pain and trauma, you really, it's an act of great courage. And it is also potentially dangerous. So it needs to be done extremely carefully. But much to my delight, the results are really outstanding. That's amazing. And is that the study with MDMA? That's MDMA, right? How about this parallel studies going on with psilocybin? As far as I know, nobody's formally studying ayahuasca, but certainly the anecdotes about ayahuasca are also very positive. But again, don't mess around with this. I want to actually say something about it, because ketamine is one of these substances also, and ketamine is legal. And so the moment it became legal, people set up these clinics where you can go and get your ketamine, and you can go home and take ketamine. I think this is a terrible thing. In fact, I have a friend who went through a really hard time, and he went to a ketamine clinic to deal with his extreme depression. And he went home and he killed himself. And so this stuff should be done under very careful, protective circumstances. You shouldn't do it by yourself. You really should do it when people are around you to help you with all this stuff that comes up. And that makes perfect sense in the Andes when people do ayahuasca. You don't say, hey, go take this stuff. There's a whole ceremony about it, and the ceremony is very important.