Acclaimed psychiatrist Bessel van der Kolk, author of The Body Keeps the Score, has studied trauma for 50 years. Though we once considered trauma to be exclusive to veterans and people growing up in extreme circumstances, we now know it is widespread. And not only is it all over our society, it’s all over our bodies. Van der Kolk discusses the physiology of trauma and the pathway to healing.

BESSEL VAN DER KOLK: Trauma is so ubiquitous that if you think you have never seen it, you have not looked. We meet people who fly off the handle. We meet people who shut down. We meet people who are very difficult. You know, it is a rare family that doesn't have a drug addict, alcoholic, disturbed person. You know, one thing I like to say when I give a lecture, And sometimes one or two people raise their hands. I say, "Can I please come to your family for Thanksgiving? 'Cause I've never been to a normal family."

My name is Bessel van der Kolk. I'm a psychiatrist, neuroscientist. I have been studying trauma for about 50 years now. I've treated a whole variety of different traumatized populations, see trauma in many different countries around the world, and I am the author of the book "The Body Keeps the Score."

It's important for people to realize that not every mental health professional knows what we're talking about here. The mainstream system of psychiatry, psychology is that there is something wrong with you and I need to fix you. That's a very different attitude than dealing with trauma.

Around that time that I first started to work for the VA, a group of us started to define what trauma is and started to define what happens to people. 1978 was the year and the Vietnam War was over by about six or seven years. The very first day that I met Vietnam veterans, I was just blown away. They kept referring back to their dead comrades. Their hearts seemed to be with the people who were no longer around. They had a hard time loving their wives and girlfriends. They had a hard time being in any way meaningfully involved in the present. These were guys who were my age, who were smart and competent, but they clearly were just a shadow of their former self. And what was also really striking is they were sort of passive much of the time, and then people told 'em something that was disappointing, and they went from 0 to 10 and blew up and became extremely angry. Something seemed to have happened to them that made it very hard for them to modulate their responses to the environment.

My colleagues and I started to think about how is what these guys suffer from different from what other people who are in psychiatry textbooks suffer from? So I dug up a book that was written in 1941 by Abram Kardiner, who had been working with World War soldiers. He wrote, "These guys suffer from a physioneurosis: Their bodies continue to re-experience that very terrible, frightening situation, and that event keeps coming back in terms of images, behaviors, and physical sensations." So that became the core of our definition of PTSD. We write, "These people have been exposed to an extraordinary event that's outside of normal human experience." And in retrospect, that shows us how ignorant and narrow-minded we were, because it turned out that this is not an unusual experience at all. Trauma is actually, unlike what we first thought, extremely common.

One out of five women in America has a history of sexual molestation. Even a lot of men have histories of sexual molestation. One out of four kids get beaten very hard by their parents. One out of eight kids see physical fights between their parents. People usually think about the military when they talk about trauma, but when we started to work with inner city kids, the amount of trauma that these kids experienced was just unspeakable.

The nature of trauma is that an experience enters into your ears, into your skin, into your eyes, and it goes down into a very primitive part of your brain that automatically interprets what's going on. Is this dangerous or is this safe? An event becomes traumatic when there is nothing you can do to stave off the inevitable and your body starts automatically going to a state of fight, flight, or collapse. The lingering effect of trauma is that you continue to react to mild stressors as if your life is in danger, and so you tend to become hyperreactive. Somebody may irritate you in the supermarket, you may develop road rage. You may have a difficult time putting up with misbehavior from your spouse or your kids. And most people actually are barely aware or not aware at all that their reactions that they're having right now are actually rooted in experiences they've had before. That event itself is over, but you continue to react to things as if you're in danger.

So the big challenge of treating trauma is how do we help people to live in bodies that feel fundamentally safe? The tradition in mental health is to dismiss the reality of people's lives. For example, it's only in the past few years that people are beginning to talk about the impact of poverty or the impact of racism or the impact of unemployment, and people have sort of been labeling people, "Oh, there's something wrong with you, let me fix you." But if you go to a physician or a mental health practitioner who doesn't understand that, they're going to try to fix you with drugs or cognitive behavioral treatment to not do these crazy things anymore- it usually doesn't work very well.

What was very clear is that being in a relationship where people can hear you, where you can talk about how badly you feel, where you can talk about your guilt, and where you can start opening up to particular things that happened to you, that was actually quite helpful because you need to really develop a deep sense of, "This is what happened to me. This is what I'm dealing with and I need to take care of the wounds that I'm carrying inside of myself." This issue of self-compassion and really knowing that your reactions are understandable and are rooted in you getting stuck in the past, is a terribly important part of beginning to recover from trauma.

Most of us are survivors of one thing or another, some much worse than others, and so if people say "What do you wish your legacy were?" I'd say, "I want our society to know about trauma and to really do all the things that are necessary so that people who grow up under extreme adverse conditions can develop a brain and a mind that can help them to become full-fledged members of society." That's our big issue- and that's the big challenge that we have.