05. How Do You Know You're Alive?

Hi friends,

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

Can you believe we’ve already finished our first book together? We’ve been on a profound journey exploring some of the foundational pillars of human flourishing: close social relationships, life and happiness satisfaction, meaning and purpose, character and virtue, and physical and mental health. 

This month, we’re digging into the connection between physical and mental health by reading the New York Times #1 reigning bestseller, The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma written by Dr. Bessel van der Kolk, one of the world’s foremost experts on trauma.

Why the focus on trauma, you ask? Well— can we really talk about holistic wellness without interrogating what makes us unwell to begin with?

And as we discovered from last month’s read, most of us can and will move on from traumatic experiences (whether by ourselves or with professional support) with a more resilient mindset. 

However, some of us were more susceptible to anxiety, depression or anger even before the traumatic event occurred– and for those more emotionally vulnerable amongst us, the struggle is not just real, it’s often dire.

Dr. Martin Seligman, who we spent last month reading, urges us to become emotionally stronger, recognizing that life is tough.

But, here is where Dr. van der Kolk pops in, wags his finger, and says, “Uh. Uh. Uh.”

It’s a little more complicated for some to simply just “become tougher and endure.” 

In his book, Dr. van der Kolk meticulously lays out his thesis: that trauma constitutes a distinct form of memory, one separate from the memory used to remember where we stored our keys or whether we switched off the oven. These ordinary, banal memories are ephemeral and will fade over the course of ordinary life. But trauma acts as a literal mental ambush that collapses the past and present, and when the brain is triggered (consciously or subconsciously) it produces physiological effects whether or not the traumatic event is even consciously remembered. This means while the mind may not remember, the body registers and stays on alert, constantly reliving the threat of a now-nonexistent danger. 

Aka… while you may consciously try to tough it out, the body is keeping score.

Here I think of the words asked at the beginning of writer Toni Cade Bambara’s book, Salt-Eaters. In it, the protagonist asks, “Are you sure, sweetheart, that you want to be well?… Just so’s you’re sure, sweetheart… and ready to be healed, cause wholeness is no trifling matter.”

Indeed.

Not only is it no trifling matter, it figuratively and literally determines how we formulate our sense of self.

In 2004, Dr. von der Kolk’s colleague Dr. Ruth Lanuius posed an interesting question: We know what happens neurologically when trauma survivors are triggered, but “what happens in the brains of trauma survivors when they are not thinking about the past?” 

She “recruited a group of sixteen ‘normal’ Canadians to lie in a brain scanner while thinking about nothing in particular… She then repeated the same experiment with eighteen people who had histories of severe, chronic childhood abuse. 

What is the brain doing when you have nothing in particular on your mind? 

It turns out that you pay attention to yourself: The default state activates the brain areas that work together to create your sense of ‘self…’  

When Dr. Lanuius looked at the scans of her normal subjects, she found activation of DSN regions… the midline structures of the brain, starting out right above our eyes, running through the center of the brain all the way to the back. All these midline structures are involved in our sense of self. The largest bright region at the back of the brain is the posterior cingulate, which gives us a physical sense of where we are—our internal GPS. It is strongly connected to the medial prefrontal cortex (MPFC)... [though] this connection doesn’t show up on the scan because the fMRI can’t measure it. It is also connected with brain areas that register sensations coming from the rest of the body: the insula, which relays messages from the viscera to the emotional centers; the parietal lobes, which integrate sensory information; and the anterior cingulate, which coordinates emotions and thinking. All of these areas contribute to consciousness.” (pg. 144-145 - Kindle)

In contrast, patients suffering from chronic PTSD had almost no activation in any of these self-sensing areas. 

Dr. van der Kolk writes, “In response to the trauma itself, and in coping with the dread that persisted long afterward, these patients learned to shut down the brain areas that transmit the visceral feelings and emotions that accompany and define terror. Yet in everyday life, those same brain areas are responsible for registering the entire range of emotions and sensations that form the foundation of our self-awareness, our sense of who we are. What we witnessed here was a tragic adaptation: In an effort to shut off terrifying sensations, they also deadened their capacity to feel fully alive.”  

This is important, but why specifically?

Because, he writes, “If the memory of trauma is encoded in the viscera, in heartbreaking and gut-wrenching emotions, in autoimmune disorders and skeletal/muscular problems, and if mind/brain/visceral communication is the royal road to emotion regulation, this demands a radical shift in our therapeutic assumptions.” (pg. 146-147 - Kindle)

And here is where the techie in me can’t help but get excited. Because what tech and/or tech-enabled solutions do the best, are to bring about innovations that disrupt assumptions. And when the techie in me looks around at some of the most accessible mental health tools currently available in the market, I realize a glaring hole (…ahem market opportunity).

While apps like Calm (valued at $250M) and Headspace (valued at $3B) make the assumption all of us can quiet our monkey-minds, observe the observer, and engage with the present…what if some of us don’t have a relationship with our observer in the first place?

Maybe there hasn't been a focus on this because the west is in an ideological golden era of mindful presence? Maybe it’s because Oprah has spent the last decade interviewing gurus that teach the metaphysics of meditation? Maybe it’s because so many Palo Alto based CEOs are themselves going through their own spiritual awakenings through the use of expensive biohacking and longevity optimization tools? 

Whatever is the case, globally, there are millions of trauma survivors disengaged from both body and mind ready for something to reactivate them back into their lives… back into their ability to flourish. 

Neuroscientist Antonio Damasio writes in his book, The Feeling of What Happens, “Sometimes we use our minds not to discover facts, but to hide them. . . . One of the things the screen hides most effectively is the body, our own body, by which I mean the ins of it, its interiors. Like a veil thrown over the skin to secure its modesty, the screen partially removes from the mind the inner states of the body, those that constitute the flow of life as it wanders in the journey of each day…

He goes on to describe how this ‘screen’ can work in our favor by enabling us to attend to pressing problems in the outside world. Yet it has a cost: ‘It tends to prevent us from sensing the possible origin and nature of what we call self.’" (pg 149 - Kindle)

Technologically, there are many fitness apps focused on making the physiological body well, but how many use the body as a treatment for mental health?

As always, this is where things get interesting, but I’m past my promised word count.

Let’s dig in deeper next week.

With gratitude,