06. But, What If I Don't Know I'm Hungry?

Hi friends,

Welcome to the sixth dispatch of How Humans Flourish, a research-informed newsletter on how humans thrive. 

For the month of February, we are digging deep into The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma, by Dr. Bessel van der Kolk, one of the world’s most prolific trauma experts.

To get into the heart of Dr. Bessel’s work is to answer the question asked in this fun and very East Coast email I received last week (I’ve received consent to repost here):

Hey Melissa, gotta hand it to ya, I’ve been enjoying this newsletter. But I gotta say, I'm starting to scratch my head. Aside from folks with some real heavy-duty mental health stuff going on, seems like the research is telling us that those psychotropic drugs aren't all they're cracked up to be, just a tad better than popping placebos. And talk therapy? Sure, it does its thing to a certain extent, but let's face it, those tools aren’t exactly self-reinforcing. Stop the therapy, and those benefits? Poof, they vanish into thin air over time. So, what's the deal, huh? What's it really mean to have good mental health in the real world? Give me the lowdown.

I love this letter for a lot of reasons, but I especially appreciate the question that gets to the heart of the matter: practically, how do we maintain a healthy sanity amidst a world full of upheaval, chaos, and 24/7 news cycles?

Last week, we learned that our sense of self– from where we are in relation to the objects around us to our sense of being an individual separate from others– is anchored by a connection to our body. For example: we understand we have an arm by feeling and interpreting the physical sensation of it, and through healthy communication between our brain and arm, we are able to twist, bend, and throw it the safest way we know how. 

Sometimes, though, the feelings in our body are so intense, so devastating, so scary, we either seek to numb them or override them with an even more intense sensation. This may offer a bit of reprieve, but it also offers a loss of awareness of what is actually happening in and to the body…the sense of being fully and sensually alive. 

Dr. van der Kolk writes, “If you are not aware of what your body needs, you can’t take care of it. If you don’t feel hunger, you can’t nourish yourself. If you mistake anxiety for hunger, you may eat too much. And if you can’t feel when you’re satiated, you’ll keep eating… This is why cultivating sensory awareness is critical… people need to learn that they can tolerate their sensations, befriend their inner experiences, and cultivate new action patterns.” (pg 398 - Kindle)

Dr. van der Kolk is very adamant that talking about one’s trauma is critical for healing to begin (we cannot heal what we cannot name), but talking is just the beginning. There are a modicum of tools we can use to live with the memories of the past without being overwhelmed by them in the present.

He writes, “One of the ways the memory of helplessness is stored is as muscle tension or feelings of disintegration in the affected body areas: head, back, and limbs in accident victims, genitalia in victims of sexual abuse… When people are chronically angry or scared, constant muscle tension ultimately leads to spasms, back pain, migraine headaches, fibromyalgia, and other forms of chronic pain. They may visit multiple specialists, undergo extensive diagnostic tests, and be prescribed multiple medications, some of which may provide temporary relief but all of which fail to address the underlying issues.” (pg. 388 - Kindle)

A good biological marker to observe in trauma survivors is heart rate variability (HRV), which is what happens when the amount of time between your heartbeats fluctuates slightly. It is also a measure of how well the autonomic nervous system is working. “When our autonomic nervous system is well balanced, we have a reasonable degree of control over our response to minor frustrations and disappointments, enabling…control over our impulses and emotions… Poor HRV—that is, a lack of fluctuation in heart rate in response to breathing—not only has negative effects on thinking and feeling, but also on how the body responds to stress. Lack of coherence between breathing and heart rate makes people vulnerable to heart conditions in addition to mental problems such as depression and PTSD.” (pg. 389-390 - Kindle)

Dr. van der Kolk began exploring modalities that allow survivors disengaged from their bodies to both intentionally control their breathing as well as to notice the subtleties of their bodily sensations moment by moment. He incorporated yoga, martial arts, and qigong as powerful tools within his practice.  

I ended my last newsletter by asking about apps that engage the body as a tool to heal mental health, because not everyone can afford a session with Dr. van der Kolk, and yet the need for millions of trauma survivors is evident. 

The best example I’ve seen is Yoga with Adriene started in 2012 on Youtube, with the goal of providing no-cost online yoga courses for people practicing at home. She grew a consistent but small following until 2020’s infamous lockdown. As people needed a way to integrate the devastatingly isolating experience of quarantine, her following grew from a few thousand to over 12.5 million subscribers. Her videos have amassed over a billion views and she’s expanded her offerings to include a paid online community and app. 

Which brings me back to the question asked at the beginning of this newsletter: What's it really mean to have good mental health in the real world?

Simply put: it’s the ability to feel all sensations without being overwhelmed by them. To understand and contextualize that painful memories, like anything else, are simply a part of the ongoing, evolving experience of being alive. 

More so, we acknowledge these sensations for what they are without allowing them to dominate our lives. In the profound words of Rumi, “This being human is a guest house, every morning a new arrival. A joy, a depression, a meanness, some momentary awareness comes as an unexpected visitor…Welcome and entertain them all. Treat each guest honorably. The dark thought, the shame, the malice, meet them at the door laughing, and invite them in. Be grateful for whoever comes, because each has been sent as a guide.” 

With gratitude,

P.s. Treatments mentioned in these newsletters should be seen as options rather than suggestions. As each of us is unique, so is our healing toolkit. That being said, Dr. van de Kolk is a big proponent of both EMDR and Internal Family Systems therapy. I've personally benefited greatly from EMDR therapy.