Against trauma, physical activity helps more than medicine, says psychiatrist

Trauma can arise from very different circumstances, such as participation in armed conflicts, episodes of violence, abuse, abandonment, among others. Perhaps the great lesson is that each person reacts differently to these aggressions and that it can often take a long time for them to find the tools that will help them to sort out their mental mess.

In his book “The Body Keeps the Marks”, Dutch-born, US-based psychiatrist Bessel Van der Kolk dissects these and other issues, and argues that it is possible to treat post-traumatic stress through bodily activities and, more than that, that medications tend not to work for most individuals.

In an interview with Sheet, he says that a shortcut to this encounter with himself can be the combination of two different activities, such as capoeira and psychoanalysis, each in its own front. The first will help to master physical reactions. “We are bodies, and we have a brain to take care of these bodies,” says the psychiatrist. The latter, in turn, helps to understand what are the situations and triggers that trigger these reactions.

For the physician, there is still a huge distance between the clinic and research in the field of psychiatry, with therapists who do not understand how science is done, on the one hand, and, on the other hand, researchers who have lost contact with human beings. He, through the book, in addition to his own performance, tries to fill this gap.

One of the topics of interest to Van der Kolk at the moment is psychedelic therapy with MDMA (ecstasy), which, he explains, helps the person to create a state of self-reflection and self-reflection, with the help of the therapist, to face obstacles and reorganize the mind.

In your book, Mr. advocates a way to treat trauma that comes from the body, with techniques like yoga and meditation to get your head in order. Is the lack of connection between body and mind one of the reasons for the emergence of trauma? We are bodies, and we have a brain to take care of those bodies. The brain’s job is to make you eat, sleep, go to the bathroom, etc. In a trauma, the signals sent to the body serve to say that we are in danger, abandoned and that terrible things can happen. Then the whole body responds to the world as if the trauma lasted. It’s not that people are stupid, it’s not that they don’t understand. The body automatically continues to behave as if the person is about to be murdered. Then it is necessary to work to calm that body. I cannot prescribe that you calm down; you need to learn to calm down on your own. You need to work on your breathing, your body, to reinstill that control over the functioning of the organism.

Mr. states that meditation and yoga should not be called “alternative treatments.” When you understand the neurobiology of trauma, you start to say that drugs are alternative treatments. That’s because we have mechanisms intrinsic to the body that calm us down and restore our health. In Brazil, this culture is much more alive than in the USA. Even if something terrible happens, people can still sing together, walk together, dance together and resynchronize the body. The source of joy and pleasure for the human being is a matter of rhythm and synchrony between ourselves and other bodies. In many places people put bodies aside and treated them as some sort of unwanted appendage. But you are your body, and you need a body to feel alive.

Mr. recalls in the book an argument by Darwin, who tried to unite psychic sensations with physiological characteristics. Ah yes, Darwin was a very smart guy, despite being British (laughs).

In the book you say that trauma is not just a matter of being tied to the past, but of not being able to fully live in the present, and that behavioral therapy, meditation and physical activities help to put the person in the present moment. How does psychoanalysis enter this story? There are two dimensions here. The first is to try to understand what their reactions are like and when they happen. This can be very helpful as you have a way to work through the issue. Now, by simply understanding your mental clutter you don’t eliminate it. Understanding is helpful, it gives you an idea of ​​what you have to do, but what you really need to do is reset your body’s alarm system. What is more useful: capoeira or psychoanalysis? I would say it’s one thing added to the other. We have a body that responds to what is concrete, that defends itself. Understanding what triggers your trauma, the triggers, and how it happens helps you to be more self-possessed until you can plan how you want to live your life.

and mr. discourages the use of psychotropic medications, especially in patients who have not undergone other treatments. They don’t work! (laughs) I was the first head of the psychopharmacology department at Harvard, I was one of the guys who defended drugs the most… That was in the beginning. They work for some people for a while and for some conditions, but they don’t work well for treating trauma. It’s pretty sad when you see someone stuck, taking a bunch of pills without moving just because other alternatives haven’t been tried.

What about MDMA (ecstasy)? Isn’t it a promising drug? Psychedelic drugs are promising. My lab is currently psychedelic, we study these agents. It’s not legal here in the US or Brazil, but I and a few other people are licensed to do these studies. In fact, the psychedelic experience can give you a deep sense of the organization of your inner world and still treat yourself with self-compassion, self-acceptance. People become more receptive, love each other more, and become less reactive. It’s really useful!

Is there still a lot of resistance in the psychiatric world regarding the therapeutic use of psychedelics? There is resistance everywhere.

Are they very conservative? In fact, I’m the most conservative. We do psychedelic-assisted psychotherapy. The moment these drugs become approved they will be the target of actions aimed only at generating profit. They will sell the pills, but they will not provide the therapy. With these drugs we create the condition in which people fall into this state of deep self-reflection, and for eight hours, on several occasions, we help these people to face the challenges that arise. We help the person to get into a mental state where therapy can actually happen. I am very afraid that these drugs will be used outside of that context.

Is the future of psychiatry tied to psychedelics? No, they just help. From time to time people come across something and say, “This is the answer to everything!” They work for some people, and for others they don’t. We need to analyze this question very soberly.

In the biological sciences there is a movement towards a more integrated and systemic view of the organism and the interaction between living beings. Is psychiatry also on this path? It is very difficult to know what will happen. I’m amazed and saddened by the fact that in almost every scientific laboratory they don’t understand how the clinical part works, and that most clinicians, the therapists, understand almost nothing about science. They are two worlds that do not talk to each other. My colleagues and I are some of the only ones doing research and caring for patients. And patient care is very far from science, ahead of it. The way we put these two things together has been quite complex. Most people who start doing science lose touch with the human experience. Integrating the two is a challenge, and my book was an attempt in that direction.

Will many of us come out of the pandemic traumatized? Oh no. Human beings are very adaptable creatures. We’ve survived the most horrendous things and I think that impact will be absorbed. Maybe we’ll only see a 10% increase in cases today, something quite different than everyone leaving traumatized.

A more chronic issue is political polarization in countries like the US and Brazil. What kind of mental health consequences might this have? It is difficult to process this kind of information. It’s a pretty noisy affair. There is no parallel between what is happening now and what happened during the rise of fascism in the 1930s. People are much better off financially than they were then. I don’t understand how this is reflected in current times.

interviewee

Bessel Van der Kolk, 77, was born in the Netherlands and settled in the US. He received a medical degree from the University of Chicago (1970) and a degree in psychiatry from Harvard (1974). He is currently a professor at Boston University, with experience in the study of how children and adults adapt to traumatic experiences and what are the treatment possibilities, including some less conventional ones, such as yoga and meditation.