The Ripple Effect: Reflecting on The Body Keeps the Score and Learning to Understand What Hurts - Chapter 2: Revolutions in Understanding Mind and Brain
This entry continues my reflections on “The Body Keeps the Score” as part of an ongoing attempt to understand myself through its lens.
🧠Clinical Encounters
This chapter begins with Bessel recounting a year off between his first and second years of med school, where he was working in a mental health center and organized recreational activities for patients. He describes the revolution of Thorazine and some of the cases of the patients there, ranging from schizophrenia to catatonia.
But it was his night and weekend shifts that he witnessed what attending psychiatirists could not. Patients would come into the nursing station to talk. They bravely detailed their trauma to him; from listening to their mothers being physically abused by their father and the sound of things breaking, to stories of assault or molestation, to being dragged out of bed by drunken parents, or being hit by their partners.
In the sixties, we did not have the statistics, but Bessel notes that now, we are aware that more than 50% of those who seek psychiatric care have experienced some kind of trauma. This understanding is crucial as, at the time, these stories were never brought up during the sessions with the doctors that the patients had. The focus was on managing their symptoms—to stave off the self-harm and suicidality, or ease the burden of despair.
He goes on to detail a particularly harrowing story of his time at a Catholic hospital. He left the job quickly, seemingly shaken by the task of performing physical examinations on women who’d been admitted for electroshock treatment. During their exams, they’d talk about their stress and things weighing on them. While they would be relieved by talking about the pain points in their lives, sometimes even wondering if they still needed the treatment, they’d have no recollection of the experience after it was administered.
Eugene Bleuler once noted in the early 1900s that schizophrenic body hallucinations—particularly the sexual ones—were the most frequent and most important. This led Bessel to question whether the brain could make up physical sensations that the body had never experienced; whether all of their patients with hallucinations were full concoctions, or perhaps a memory was to blame. This is still a question without an answer at the time of publication (2014; though, now in 2025, I’m still not finding answers to this through cursory searching), but we do know that people who were abused often have lingering sensations that have no determinable physical cause.
Sylvia was a nineteen-year-old who was in treatment. She was attractive, intelligent, and had a reputation for mafia ties. Typically, she sat alone in a corner, looking terrified. At one point, she had stopped eating and experienced rapid weight loss, leading to force-feeding. He details that force-feeding took three people to hold her down, one to push the rubber feeding tube down her throat, and a nurse to pour in the nutrients. Eventually, Sylvia would tell him at the nurses’ station one evening about abuse she had experienced at the hands of her family members, which left Bessel with the harrowing realization that their “care” might have felt like a group assault.
This was a contributing experience to a rule Bessel formulated for his students:
“If you do something to a patient that you would not do to your friends or children, consider whether you are unwittingly replicating a trauma from the patient’s past.”
In the next section, Bessel goes on to detail some time spent under Semrad and some pivotal turning points in psychology and psychiatry. He notes that we approach issues that were determined by technology available, from the divine, magical, or evil energies to the shift to disorder classifications in the nineteenth century. For the first time, thanks mainly to the efforts of France and Germany, we moved more towards a measurable science over the speculations and musings of philosophers like Freud and Jung. His discussion of the pharmacological impact on his field starts with hope. Still, he concludes in this section that this hope fell short, but did contribute significantly to the Diagnostic and Statistical Manual of Mental Disorders (DSM).
He calls out the forward on the 1980 DMS-III and notes that it is so inaccurate that it should never be used for forensic or insurance purposes. It was a short-lived disclaimer, and further information can be expected in a future chapter.
In the next section, he begins to outline the “inescapable shock” experiment. My understanding of this experiment, as detailed by Bessel and as I learned in my university psych courses, is that two groups of dogs were placed in cages connected to an electric grid. In the control group, the dogs were shocked only when the cage was opened, causing them to run out as one might expect. Dogs in the test group, however, had shocks administered constantly. When their cage doors were open, they failed to run out to safety. It was also found that the dogs in the test group produced significantly more stress hormones than the control group.
The dogs in the test cages, who were being shocked, could be taught that there was safety—by force. It required repeatedly dragging them out of their cages so they could physically experience what it meant to be safe and how to get away.
Another test was conducted on mice, rats, cats, monkeys, and elephants that I was previously unaware of. The researchers would play a distressing sound to see how animals would behave. Those raised in a warm nest with plenty of resources went straight home. The other group, raised in a noisy nest with few resources, also ran for home, regardless of whether they’d managed to find a safe, pleasant environment after leaving.
Scared animals always return home—even if home is not safe.
Bessel likens this to his traumatized patients. They had no way of escaping something that was harming them, and all had been trapped in some way. They had been immobile and unable to take any fight or flight actions, resulting in extreme agitation or total collapse. People who have been traumatized also continue to have large amounts of stress hormones pumping through their bodies, even if the danger had passed a long while ago. Cortisol production, however, is lower in cases of PTSD; it is responsible for sending the all-clear, and it demonstrates that the body’s stress hormones do not return to baseline as would be typical in the case of regular stressful events.
Humans are also just as likely to return to what is familiar.
This is observable in the way that people with PTSD or other trauma-related disorders tend to seek out experiences to fight the sense of emptiness and boredom they feel when not under duress by involving themselves in some dangerous activity. A version of this very phenomenon can be seen when veterans talk about situations that might have horrified the average civilian listener. We can see it in how people in toxic relationships or predatory prostitution situations return to their abuser.
Freud called this “the compulsion to repeat.”
Bessel calls it “traumatic reenactment.”
But repetition does not resolve trauma—it re-traumatizes.
Even within the relative safety of the therapist’s office, reliving trauma keeps the trauma alive and ever-present.
🩹Pain, Endorphins, and Empathy
We now know that physical pain releases endorphins, which soothe both the body and the emotions by blocking unpleasant sensations. I can give a personal attestation: my past self-harm numbed despair and gave a sense of control where I felt I was constantly sinking, at the whims of parental and authority figures in my life. Each time I reached for this to cope, my threshold decreased, and I needed it more and more frequently.
While it may not be covered in this book, it is now known that even suicidality can have roots in survival and preservation of the self. Endorphins can be addictive, and it’s noted that risk-taking, substance abuse, and self-harm can become habitual.
While I wouldn’t equate my struggle to substance addiction, when friends who are in recovery talk about relapse lurking at the edges of their self-control, I feel like I can understand in ways that others may not. Even years later, I can still feel that pull.
🧬Serotonin, Prozac, and Limits of Medication
We learned some time ago that the amygdala is responsible for perceiving threats. Data shows that sensitivity in this part of the brain is at least somewhat dependent on serotonin.
Low Serotonin → hyperreactivity to stress
High Serotonin → dampened fear and aggression
In monkeys, it was found that dominant males had higher levels of this chemical, while low-ranking males had lower levels. When the lower-ranking monkeys were given serotonin supplements, they rose in rank, while previously higher-ranking individuals were now lower on the hierarchy and thus produced less serotonin. This is seen in traumatized people as well. In PTSD, we see hyperreactivity and a lowered ability to cope socially.
Enter Prozac, the drug of choice in 1988.
The effects of Prozac and other SSRIs on depressed states are well-documented and common knowledge in the public. In PTSD, the data is a little less concrete.
An important note to start is that, in the studies of Prozac’s effect on PTSD, everyone improved. That includes the placebo control—there is a significant placebo effect with PTSD. For the average patient at Bessel’s Trauma clinic, Prozac worked significantly better: they were less preoccupied, slept better, and regulated better. However, Prozac had no effect at all at the VA, and PTSD symptoms were unchanged. This discrepancy has been replicated in other studies and remains unexplained. While the standard narrative is that receiving a pension or disability prevents people from getting better, the parts in play only detect threats.
The triumph and pervasiveness of pharmacology have serious downsides and might detract from healing the underlying issue.
“The brain-disease model takes control over people’s fate out of their own hands and puts doctors and insurance companies in charge of fixing their problems.”
💊Of Pharmacology and Profit
One such example he notes of the dubious consequence of pharmacology is the case of antidepressants. We are led to believe that these are effective “happy pills”, but if that were true, depression should be a minor issue in society. However, the prescription rate of these drugs continues to increase. It has not made a notable decrease in hospital admissions for depression, and, counter to the claims, the number of people being treated has increased significantly.
Half a million children in the United States take antipsychotic medications.
Families below the poverty line are four times more likely to receive antipsychotics.
These are often used to make traumatized children more manageable—but also interfere with normal developmental behaviors such as motivation, curiosity, and play.
These children are far more likely to become morbidly obese and develop diabetes, while drug overdoses related to painkillers and psychiatric meds continue to rise.
It is easy to assume that Bessel is strictly anti-pharmaceutical, but that is not the sense I get from what I have read. Instead, I find that he is simply critical of overuse. Some drugs have their place: propranolol to block the adrenal hijacking, sedatives to help curb fight hijacking, or combat flashbacks. But, in many cases of trauma, they are not a fix.
“The brain-disease model overlooks four fundamental truths:”
Our capacity to destroy one another is matched by our capacity to heal one another.
Language gives us the power to change ourselves and others.
We can regulate our physiology.
We can change social conditions to create environments where people feel safe and can thrive.
The limitations of drugs in trauma impel us to find more natural, healing, and lasting treatments.
Non-pharmacological treatments are underfunded, underpublished, and often dismissed. But they may be the most healing.
🚨Disclaimer:
These posts reflect personal insights drawn from reading and research performed on a single person’s journey to self-understanding.
This is not medical advice or a professional diagnosis.
Not an expert—just a curious idiot with a lightboard full of “good enough” days and a stack of books that seek to provide insight into what is happening within me from a scientific standpoint.
