BESSEL VAN DER KOLK: I was raised in the mainstream culture where if you feel bad, you take something to make that feeling go away. Around that time that I first started to work for the VA, I looked at the treatments that we have. I did the first study on Prozac for PTSD, the first study for Zoloft for PTSD, and a number of other conventional drugs. What we found is they didn’t work very well. Our conventional way of thinking about it is not working. I thought, “Okay, if it doesn’t work, let’s see what else could work.”
My name is Bessel van der Kolk. I am a physician, I’m a psychiatrist. I have been studying trauma for about 50 years now.
The nature of trauma is that something happens to you, your survival brain makes the first interpretation and says, is this dangerous or is this safe? So it’s very important to really be aware that these reactions emanate for your body. And so, the big challenge of treating trauma is how do we help people to live in bodies that feel fundamentally safe? What was very clear is that very good psychotherapy is actually quite helpful. Not to fix people, but helping people to acknowledge, oh my God, that was terrible what happened to me. 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 is a terribly important part of beginning to recover from trauma.
Can I talk about something else before we talk about MDMA? Because MDMA is so sexy.
Okay. For me, the opening to a new world came when some people in my clinic started to do something very strange, called EMDR. Eye movement desensitization and reprocessing. You ask people to call up the memory of what you saw back then, what you felt back then. And then what you do is that you ask people to follow your fingers as you move your fingers from side to side. And my first reaction was like, “Man, stop this crazy nonsense, this is a crazy method.” And then I got to see some of the results, I go like, “Wow, this is interesting.” Wiggling your fingers and full of people’s eyes as they think about the trauma made the trauma go away. This crazy eye movement desensitization actually change the circuitry of the brain to interpret your current reality from a different angle. This had amazing effects on people being able to let go of what happened. They say, “Yes, that’s what’s happened to me. And it happened a long time ago. It’s not happening right now.” That was the first time that I saw a non-conventional technique have a very profound effect.
And then we studied yoga. Maybe if you do yoga, you can open up your relationship to your body. You learn how to breathe calmly, you learn to pay attention to yourself, you get to see how different movements and different postures affect you. And so you form a deep relationship with your internal sensory system. Yoga, at the end, was a more effective treatment for PTSD than any of the drugs we had studied. But I’ve yet to see a psychopharmacology clinic being transformed to a yoga studio.
The next thing that we studied was theater and movement. And it turns out that playing different roles in your body helps you to feel that your body can feel differently, depending on how you organize your relationship to yourself. When my voice gets too gravelly, let me know and I’ll drink some water.
BIG THINK STAFF: It’s feeling a little gravelly, so why don’t-
VAN DER KOLK: Okay. It’s good? All right.
So, I live in the Berkshires and we have a great program here, called “Shakespeare in the Courts” where if you’re a juvenile delinquent in this county, you have a 50% chance that a judge will condemn you to become a Shakespearian actor. That’s civilization, huh? The Shakespeare program is enormously helpful because it helps people to feel their bodies and to feel what it feels like to be a king, what it feels like to be a warrior. And you get to really have a deep experience of yourself in different possibilities.
The next piece that I studied is that you can actually put electrodes on your skull so that when you make brainwaves that help you to be calm and focused, you get a little reward. We did very well with neurofeedback. So we can shape your brain to actually have a different configuration to be open to new experiences. And then, about 15 years ago, two guys came to talk to me and they said, “Bessel, you know a lot about trauma. But do you think about his idea? We are thinking about psychedelics. What do you think about psychedelics for trauma?” And I go like, “Wow! You’re speaking for my heart,” because of course, I’m a child of the sixties and we dabbled in LSD and psychedelic substances. Wouldn’t it be great if he could do psychedelic substances to see if these substances can open up people’s minds? To see that the reality that they live in is just a small part of the reality that is. But, I said, “Don’t do it. It will destroy your career. These drugs are illegal.” And they said, “Thank you very much for your opinion. We’ll try it anyway.”
They got permission to do a study of MDMA, also known as ecstasy or molly, for trauma. And it worked out pretty well. Able to collect a large amount of money to do a very large and extremely expensive study. Lots of different sites around the US, one in Israel, when in Canada. So let me tell you how to study is set up. After all the preparation, you have a whole day of taking ecstasy while you lie on a bed with two therapists in your room for eight hours. What we see in the people who get the drug is amazing. People are able to go to places they have never felt safe to go. This is not a picnic. They see the horrible things that’s happened to them. But MDMA allows people to see themselves with compassion. All these measures we have about self-perception and self-awareness just shoot up. And rather than blaming themselves, they’re able to say, yes, this what happened to me, but it’s over.
Part of what has kept me so busy all these years is how can we find a treatment that allows the basic sense of defectiveness and self-loathing to be controlled. And now it looks like we have found something that causes a very substantial drop in PTSD. Probably more than just about anything else we have studied. But what’s important here is that one size doesn’t fit all. Different people need very different things. What worked for my last patient very well may not work for you. Everything is an experiment in life. And healing from trauma is an experiment.