“People with serious mental health conditions are at high risk for experiencing chronic physical conditions. [And] people with chronic physical conditions are at risk of developing poor mental health,” according to the Canadian Mental Health Association. This seems to be supported by the World Health Organization, which defines health as “a state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity.”
“There is no health without mental health.” -World Health Organization
Meadows Senior Fellow Bessel van der Kolk has written extensively on this connection, specifically as it relates to trauma. His New York Times bestselling book The Body Keeps the Score explores how trauma can trigger a cascade of mental and physical effects — and offers therapies and activities to help.
Dr. van der Kolk describes how unresolved trauma can lead to replaying traumatic events, with the accompanying physical effects — elevated blood pressure, migraines, numbness, or disembodied feelings. “As long as the trauma is not resolved, the stress hormones that the body secretes to protect itself keep circulating, and the defensive movements and emotional responses keep getting replayed,” he says. The Body Keeps the Score digs into the complex brain processes behind such responses. These can “leave traces on our minds and emotions, on our capacity for joy, and even our biology and immune systems.”
The amygdala, the part of the brain Dr. van der Kolk calls “the body’s smoke detector,” determines whether a sensory input (sound, sight, sensation) is perceived as a threat. It serves to “warn us of impending danger and to activate the body’s stress response.” When activated by any reminder of traumatic experience, this response puts the body on red alert, amping up blood pressure, heart rate, and breathing and readying the body to fight or take flight.
Trauma, he writes, “increases the risk of misinterpreting whether a particular situation is dangerous or safe” and “recalibrates the body’s alarm system.” That may lead patients to experience a nearly constant elevation in stress hormone levels. The amygdala is overseen by the medial prefrontal cortex, which Dr. van der Kolk calls “the watchtower” — it balances the startled response of the amygdala with reason.
“Long after a traumatic experience is over, it may be reactivated at the slightest hint of danger and mobilize disturbed brain circuits and secrete massive amounts of stress hormones,” he writes. “The emotions and physical sensations that were imprinted during the trauma are experienced not as memories but as disruptive physical reactions in the present.”
While some trauma survivors may experience a frequently activated fight-or-flight response, others may simply shut down when faced with a perceived threat. Some patients report “blanking out” or experience numbness or sensory insensibility. This disconnection between body sensations and their origin is known as “alexithymia.”
“We know that trauma compromises the brain area that communicates the physical, embodied feeling of being alive,” he writes.
“Trauma victims cannot recover until they become familiar with and befriend the sensations in their bodies,” he explains. The alternative is living in a body that is always on guard. One therapy he employs is EMDR (eye movement desensitization and reprocessing), which helps trauma survivors “integrate” that experience, rather than trying to repress or numb it.
Dr. van der Kolk recommends varied practices that help patients reintegrate the physical and mental: meditation and yoga, other disciplined physical activities like dance or kickboxing, and even choral singing or theater.
The experiences he details in his book show varied paths to healing for patients, but many he describes found freedom from PTSD symptoms such as flashbacks, uncontrolled emotional outbursts, panic attacks, and/or feeling disembodied through a combination of therapies that address both the mental and the physical.