Restoring Joy and Treating PTSD, with Dr. Bessel van der Kolk
Dr. Bessel van der Kolk, one of the world's foremost psychiatrists specializing in PTSD, explains the disorder's many effects and symptoms.
Bessel van der Kolk is a psychiatrist noted for his research in the area of post-traumatic stress since the 1970s. His work focuses on the interaction of attachment, neurobiology, and developmental aspects of trauma’s effects on people. His major publication, Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body, and Society, talks about how the role of trauma in psychiatric illness has changed over the past 20 years.
Dr. van der Kolk is past President of the International Society for Traumatic Stress Studies, Professor of Psychiatry at Boston University Medical School, and Medical Director of the Trauma Center at JRI in Brookline, Massachusetts. He has taught at universities and hospitals across the United States and around the world, including Europe, Africa, Russia, Australia, Israel, and China.
His most recent book is The Body Keeps the Score: Brain, Mind, and Body in the Treatment of Trauma.
Bessel van der Kolk: PTSD was a diagnosis that my generation first created in order to remind the VA to take care of veterans and to really say to the VA these guys are messed up because of Vietnam. And initially people said these guys were always messed up; it must be some other thing. And the way that we organized the diagnosis was around the issue of memory. About that you have flashbacks to witnessing people getting killed, to the horror stuff that they saw in the war. That is not really the primary issue that people came in with; the issue that people came in with was that they had a very hard time getting along with other people, not blowing up at people, becoming scared and frozen, having no feelings for their kids, feeling numb with their girlfriends and general problems with engagement with other human beings and getting triggered and becoming very angry and very upset and very out of sort.
And the memory issue was also an issue but it really is not what people suffer most from, it really is about having difficulty feeling alive in the present, feeling engaged, feeling a sense of pleasure, of joy, of even exuberance at the right moment of just feeling like boy it's good to be alive. And in the years since that time we have understood a lot about what happens in the brain that interferes with the capacity to feel alive in the present.
The primary symptoms are becoming upset, becoming triggered, they're particular sounds, smells, images, bring back states in which people act again as if they're being traumatized. What happens in kids is it's not so much memory issues but becoming upset, becoming angry, being assaultive, being oppositional, not trusting people, unable to concentrate, to pay attention, to engage in anything. And particularly when you're traumatized as a kid, kids are very egocentric and they think that the universe is all about them; that's what it's like to be a kid. And so if terrible things happen to you you feel like this is happening to you because you are a terrible person so this becomes part of your identity. I'm a person who makes bad things happen and I'm also a person who other people cannot possibly care for because people who were supposed to take care of me are not taking care of me.
And so kids develop something more like what we call developmental trauma disorder, in which it invades very many areas of functioning. It doesn't mean that adults who get traumatized may not also have those feelings. Often times traumatized adults often feel ashamed, blame themselves for what has happened to them. When they get raped they say I must have done something wrong to make this happen to me. So the issue of shame and blame is also a very big issue for adults.
Something like three quarters of the U.S. population experiences traumatic events and may actually be triggered by particular things. If you grew up with an alcoholic parent the likelihood that you will have certain traumatic triggers, have certain fears of intimacy, certain uptightness about getting out of control just like that parent went out of control is quite common. And in fact one out of five American women have been sexually molested at some point or another. One out of four Americans have been quite severely beaten by their caregivers. So these are common things. These are common things in the general population. And so most of us either have been painted by that brush ourselves or know people in our environments to whom that has happened and we are living with the consequences thereof. And the reason why I wrote this book actually is to not only draw people's attention to what we know, but also to really draw attention to the fact that we can do something about it and that we have learned a great deal about how to intervene and help people to come back to life.
After you get traumatized you feel defective, you feel there's something wrong with you and you hope that people won't notice. And you also don't believe that anybody can help you. And finding help in fact is not always that easy. How do you know when relationships keep failing? When you fall in love with somebody and on the third date you blow up or you become frightened or you find something with that person and it bugs the hell out of you. Your sense of compassion to yourself and other people goes out of the window. So you become very intolerant of other people, you become very intolerant of yourself and so you live in an intolerant environment. And your kids don't dare talk to you; you see them becoming frightened; you see them walk out of the room when they see you sit there. You turn on the television and you scream at people not to bother you. And this reactivity to people, this being bugged by people, this inability to tolerate other points of view, this inability to see that other people may look at the world differently than you do is a pretty good hallmark that you have something to work on and that you need to actually learn to notice yourself and to notice what goes on inside of you that makes you so chronically angry and irritated.
Anger and irritation is a very important piece. The other thing is those were the symptoms I talked about that we first saw in Vietnam veterans and that continues to be the big thing in child abuse survivors, car accident victims, soldiers, et cetera, et cetera, is the feeling of not being able to engage; that life doesn't mean very much; that my joy is gone. And then it's very easy to say I've always been like that. And then for me it becomes very important to help people to viscerally remember, to be a member of that football team in school or to play your French horn in the band or to make love for the first time or something that at one point gave you great joy now no longer means anything to you. And when those feelings have stopped that means that something is frozen inside of you. And then it's time to deal with that in order to unplug the river of life basically.
Directed/Produced by Jonathan Fowler, Elizabeth Rodd, and Dillon Fitton
One of the world's foremost psychiatrists specializing in PTSD, Dr. Bessel van der Kolk visits Big Think to discuss the history of the disorder, its varying effects on sufferers of all ages, and forms of treatment that can "help people to come back to life." To understand PTSD, says Dr. van der Kolk, you have to understand the nature of trauma and the ways in which traumatic triggers can vaporize anyone's joie de vivre. His latest book "The Body Keeps the Score" was written to draw attention to how traumatic disorders can be avoided.
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The pandemic has many people questioning whether they ever want to go back to the office.
If one thing is clear about remote work, it's this: Many people prefer it and don't want their bosses to take it away.
When the pandemic forced office employees into lockdown and cut them off from spending in-person time with their colleagues, they almost immediately realized that they favor remote work over their traditional office routines and norms.
As remote workers of all ages contemplate their futures – and as some offices and schools start to reopen – many Americans are asking hard questions about whether they wish to return to their old lives, and what they're willing to sacrifice or endure in the years to come.
Even before the pandemic, there were people asking whether office life jibed with their aspirations.
We spent years studying “digital nomads" – workers who had left behind their homes, cities and most of their possessions to embark on what they call “location independent" lives. Our research taught us several important lessons about the conditions that push workers away from offices and major metropolitan areas, pulling them toward new lifestyles.
Legions of people now have the chance to reinvent their relationship to their work in much the same way.
Big-city bait and switch
Most digital nomads started out excited to work in career-track jobs for prestigious employers. Moving to cities like New York and London, they wanted to spend their free time meeting new people, going to museums and trying out new restaurants.
But then came the burnout.
Although these cities certainly host institutions that can inspire creativity and cultivate new relationships, digital nomads rarely had time to take advantage of them. Instead, high cost of living, time constraints and work demands contributed to an oppressive culture of materialism and workaholism.
Pauline, 28, who worked in advertising helping large corporate clients to develop brand identities through music, likened city life for professionals in her peer group to a “hamster wheel." (The names used in this article are pseudonyms, as required by research protocol.)
“The thing about New York is it's kind of like the battle of the busiest," she said. “It's like, 'Oh, you're so busy? No, I'm so busy.'"
Most of the digital nomads we studied had been lured into what urbanist Richard Florida termed “creative class" jobs – positions in design, tech, marketing and entertainment. They assumed this work would prove fulfilling enough to offset what they sacrificed in terms of time spent on social and creative pursuits.
Yet these digital nomads told us that their jobs were far less interesting and creative than they had been led to expect. Worse, their employers continued to demand that they be “all in" for work – and accept the controlling aspects of office life without providing the development, mentorship or meaningful work they felt they had been promised. As they looked to the future, they saw only more of the same.
Ellie, 33, a former business journalist who is now a freelance writer and entrepreneur, told us: “A lot of people don't have positive role models at work, so then it's sort of like 'Why am I climbing the ladder to try and get this job? This doesn't seem like a good way to spend the next twenty years.'"
By their late 20s to early 30s, digital nomads were actively researching ways to leave their career-track jobs in top-tier global cities.
Looking for a fresh start
Although they left some of the world's most glamorous cities, the digital nomads we studied were not homesteaders working from the wilderness; they needed access to the conveniences of contemporary life in order to be productive. Looking abroad, they quickly learned that places like Bali in Indonesia, and Chiang Mai in Thailand had the necessary infrastructure to support them at a fraction of the cost of their former lives.
With more and more companies now offering employees the choice to work remotely, there's no reason to think digital nomads have to travel to southeast Asia – or even leave the United States – to transform their work lives.
During the pandemic, some people have already migrated away from the nation's most expensive real estate markets to smaller cities and towns to be closer to nature or family. Many of these places still possess vibrant local cultures. As commutes to work disappear from daily life, such moves could leave remote workers with more available income and more free time.
The digital nomads we studied often used savings in time and money to try new things, like exploring side hustles. One recent study even found, somewhat paradoxically, that the sense of empowerment that came from embarking on a side hustle actually improved performance in workers' primary jobs.
The future of work, while not entirely remote, will undoubtedly offer more remote options to many more workers. Although some business leaders are still reluctant to accept their employees' desire to leave the office behind, local governments are embracing the trend, with several U.S. cities and states – along with countries around the world – developing plans to attract remote workers.
This migration, whether domestic or international, has the potential to enrich communities and cultivate more satisfying work lives.
The potential of CRISPR technology is incredible, but the threats are too serious to ignore.
- CRISPR (Clustered Regularly Interspaced Short Palindromic Repeats) is a revolutionary technology that gives scientists the ability to alter DNA. On the one hand, this tool could mean the elimination of certain diseases. On the other, there are concerns (both ethical and practical) about its misuse and the yet-unknown consequences of such experimentation.
- "The technique could be misused in horrible ways," says counter-terrorism expert Richard A. Clarke. Clarke lists biological weapons as one of the potential threats, "Threats for which we don't have any known antidote." CRISPR co-inventor, biochemist Jennifer Doudna, echos the concern, recounting a nightmare involving the technology, eugenics, and a meeting with Adolf Hitler.
- Should this kind of tool even exist? Do the positives outweigh the potential dangers? How could something like this ever be regulated, and should it be? These questions and more are considered by Doudna, Clarke, evolutionary biologist Richard Dawkins, psychologist Steven Pinker, and physician Siddhartha Mukherjee.
Why mega-eruptions like the ones that covered North America in ash are the least of your worries.
- The supervolcano under Yellowstone produced three massive eruptions over the past few million years.
- Each eruption covered much of what is now the western United States in an ash layer several feet deep.
- The last eruption was 640,000 years ago, but that doesn't mean the next eruption is overdue.
The end of the world as we know it
Panoramic view of Yellowstone National Park
Image: Heinrich Berann for the National Park Service – public domain
Of the many freak ways to shuffle off this mortal coil – lightning strikes, shark bites, falling pianos – here's one you can safely scratch off your worry list: an outbreak of the Yellowstone supervolcano.
As the map below shows, previous eruptions at Yellowstone were so massive that the ash fall covered most of what is now the western United States. A similar event today would not only claim countless lives directly, but also create enough subsidiary disruption to kill off global civilisation as we know it. A relatively recent eruption of the Toba supervolcano in Indonesia may have come close to killing off the human species (see further below).
However, just because a scenario is grim does not mean that it is likely (insert topical political joke here). In this case, the doom mongers claiming an eruption is 'overdue' are wrong. Yellowstone is not a library book or an oil change. Just because the previous mega-eruption happened long ago doesn't mean the next one is imminent.
Ash beds of North America
Ash beds deposited by major volcanic eruptions in North America.
Image: USGS – public domain
This map shows the location of the Yellowstone plateau and the ash beds deposited by its three most recent major outbreaks, plus two other eruptions – one similarly massive, the other the most recent one in North America.
The Huckleberry Ridge eruption occurred 2.1 million years ago. It ejected 2,450 km3 (588 cubic miles) of material, making it the largest known eruption in Yellowstone's history and in fact the largest eruption in North America in the past few million years.
This is the oldest of the three most recent caldera-forming eruptions of the Yellowstone hotspot. It created the Island Park Caldera, which lies partially in Yellowstone National Park, Wyoming and westward into Idaho. Ash from this eruption covered an area from southern California to North Dakota, and southern Idaho to northern Texas.
About 1.3 million years ago, the Mesa Falls eruption ejected 280 km3 (67 cubic miles) of material and created the Henry's Fork Caldera, located in Idaho, west of Yellowstone.
It was the smallest of the three major Yellowstone eruptions, both in terms of material ejected and area covered: 'only' most of present-day Wyoming, Colorado, Kansas and Nebraska, and about half of South Dakota.
The Lava Creek eruption was the most recent major eruption of Yellowstone: about 640,000 years ago. It was the second-largest eruption in North America in the past few million years, creating the Yellowstone Caldera.
It ejected only about 1,000 km3 (240 cubic miles) of material, i.e. less than half of the Huckleberry Ridge eruption. However, its debris is spread out over a significantly wider area: basically, Huckleberry Ridge plus larger slices of both Canada and Mexico, plus most of Texas, Louisiana, Arkansas, and Missouri.
This eruption occurred about 760,000 years ago. It was centered on southern California, where it created the Long Valley Caldera, and spewed out 580 km3 (139 cubic miles) of material. This makes it North America's third-largest eruption of the past few million years.
The material ejected by this eruption is known as the Bishop ash bed, and covers the central and western parts of the Lava Creek ash bed.
Mount St Helens
The eruption of Mount St Helens in 1980 was the deadliest and most destructive volcanic event in U.S. history: it created a mile-wide crater, killed 57 people and created economic damage in the neighborhood of $1 billion.
Yet by Yellowstone standards, it was tiny: Mount St Helens only ejected 0.25 km3 (0.06 cubic miles) of material, most of the ash settling in a relatively narrow band across Washington State and Idaho. By comparison, the Lava Creek eruption left a large swathe of North America in up to two metres of debris.
The difference between quakes and faults
The volume of dense rock equivalent (DRE) ejected by the Huckleberry Ridge event dwarfs all other North American eruptions. It is itself overshadowed by the DRE ejected at the most recent eruption at Toba (present-day Indonesia). This was one of the largest known eruptions ever and a relatively recent one: only 75,000 years ago. It is thought to have caused a global volcanic winter which lasted up to a decade and may be responsible for the bottleneck in human evolution: around that time, the total human population suddenly and drastically plummeted to between 1,000 and 10,000 breeding pairs.
Image: USGS – public domain
So, what are the chances of something that massive happening anytime soon? The aforementioned mongers of doom often claim that major eruptions occur at intervals of 600,000 years and point out that the last one was 640,000 years ago. Except that (a) the first interval was about 200,000 years longer, (b) two intervals is not a lot to base a prediction on, and (c) those intervals don't really mean anything anyway. Not in the case of volcanic eruptions, at least.
Earthquakes can be 'overdue' because the stress on fault lines is built up consistently over long periods, which means quakes can be predicted with a relative degree of accuracy. But this is not how volcanoes behave. They do not accumulate magma at constant rates. And the subterranean pressure that causes the magma to erupt does not follow a schedule.
What's more, previous super-eruptions do not necessarily imply future ones. Scientists are not convinced that there ever will be another big eruption at Yellowstone. Smaller eruptions, however, are much likelier. Since the Lava Creek eruption, there have been about 30 smaller outbreaks at Yellowstone, the last lava flow being about 70,000 years ago.
As for the immediate future (give or take a century): the magma chamber beneath Yellowstone is only 5 percent to 15 percent molten. Most scientists agree that is as un-alarming as it sounds. And that its statistically more relevant to worry about death by lightning, shark, or piano.
Strange Maps #1041
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Measuring a person's movements and poses, smart clothes could be used for athletic training, rehabilitation, or health-monitoring.
In recent years there have been exciting breakthroughs in wearable technologies, like smartwatches that can monitor your breathing and blood oxygen levels.
But what about a wearable that can detect how you move as you do a physical activity or play a sport, and could potentially even offer feedback on how to improve your technique?
And, as a major bonus, what if the wearable were something you'd actually already be wearing, like a shirt of a pair of socks?
That's the idea behind a new set of MIT-designed clothing that use special fibers to sense a person's movement via touch. Among other things, the researchers showed that their clothes can actually determine things like if someone is sitting, walking, or doing particular poses.
The group from MIT's Computer Science and Artificial Intelligence Lab (CSAIL) says that their clothes could be used for athletic training and rehabilitation. With patients' permission, they could even help passively monitor the health of residents in assisted-care facilities and determine if, for example, someone has fallen or is unconscious.
The researchers have developed a range of prototypes, from socks and gloves to a full vest. The team's "tactile electronics" use a mix of more typical textile fibers alongside a small amount of custom-made functional fibers that sense pressure from the person wearing the garment.
According to CSAIL graduate student Yiyue Luo, a key advantage of the team's design is that, unlike many existing wearable electronics, theirs can be incorporated into traditional large-scale clothing production. The machine-knitted tactile textiles are soft, stretchable, breathable, and can take a wide range of forms.
"Traditionally it's been hard to develop a mass-production wearable that provides high-accuracy data across a large number of sensors," says Luo, lead author on a new paper about the project that is appearing in this month's edition of Nature Electronics. "When you manufacture lots of sensor arrays, some of them will not work and some of them will work worse than others, so we developed a self-correcting mechanism that uses a self-supervised machine learning algorithm to recognize and adjust when certain sensors in the design are off-base."
The team's clothes have a range of capabilities. Their socks predict motion by looking at how different sequences of tactile footprints correlate to different poses as the user transitions from one pose to another. The full-sized vest can also detect the wearers' pose, activity, and the texture of the contacted surfaces.
The authors imagine a coach using the sensor to analyze people's postures and give suggestions on improvement. It could also be used by an experienced athlete to record their posture so that beginners can learn from them. In the long term, they even imagine that robots could be trained to learn how to do different activities using data from the wearables.
"Imagine robots that are no longer tactilely blind, and that have 'skins' that can provide tactile sensing just like we have as humans," says corresponding author Wan Shou, a postdoc at CSAIL. "Clothing with high-resolution tactile sensing opens up a lot of exciting new application areas for researchers to explore in the years to come."
The paper was co-written by MIT professors Antonio Torralba, Wojciech Matusik, and Tomás Palacios, alongside PhD students Yunzhu Li, Pratyusha Sharma, and Beichen Li; postdoc Kui Wu; and research engineer Michael Foshey.
The work was partially funded by Toyota Research Institute.