That basic tool of psychological inquiry, the Rorschach test, illustrates the reality of life for traumatized people quite poignantly. The second ink-blot card in the Rorschach series is the first to feature colour, and elicits so-called colour shock: it tends to get subjects started with the test, as the pattern-recognition capabilities of our hunter-gatherer minds kick in automatically. People in good health typically respond to the second Rorschach card by reporting seeing figures dancing in the image, or butterflies frolicking, or any of a number of whimsical interpretations. Those with a history of trauma tend to see the trauma simply replayed – images of assault, wounding, vulnerability, terrorization – or, in cases of severe or repeated trauma, nothing at all.

The standard human response to ambiguous stimulus is to recruit imagination in order to see something less ambiguous: we see shapes in clouds, faces in tree bark’s knots and whorls, Jesus in a slice of toast. Imagination is a crucial factor in the quality of our lives, and our healthy day-to-day functioning: it relieves boredom and frustration, fires our creativity and sense of possibility, enhances our pleasures, and enriches our intimate relationships. A 2010 study, which collected more than a quarter of a million data-points, found that we spend almost half of our waking lives letting our minds wander freely, but traumatized people have lost that basic human capacity: everyday life is either empty, devoid of the potential for satisfaction, or actively threatening to re-enact trauma. A rape victim may see a man taking a stroll in the park as a prowler in his predatory territory; a beaten child may see a teacher’s necessary lapse into sternfulness as a red flag of danger, provoking helpless cowering or rage.

Repeated trauma distils the effect. Researchers have found that if dogs are locked in cages and given an electric shock, they will flee with galvanic energy when the cage door is opened. But dogs given repeated electric shocks don’t respond to the chance of escape at all: they stay put, choosing to endure the familiar pain and terrorization over whatever else may be out there.

The fight or flight response to trauma, if thwarted repeatedly by the impossibility of escape, collapses: secretion of stress hormones in survivors of repeated trauma illustrates this graphically. Their blood shows elevated levels of each stress hormone, even in a safe therapeutic environment, and a state of ‘relaxation’: every stress hormone spiking, except cortisol, which is abnormally low.

Cortisol is the hormone which sends an ‘all-clear’ signal to the body, standing-down the fight-or-flight stress response once the threat has expired or otherwise been escaped. The blood chemistry of traumatized people shows us that, quite literally, their adverse experience is ongoing. Their trauma hasn’t expired – they haven’t escaped it – and it hasn’t been neutralized; their response to situations which threatened basic survival has become their everyday functional baseline. Trauma is literally in their blood.

Trauma changes the brain too: both its chemistry and its moment-to-moment functioning. The amygdala is a cluster of brain cells which determines whether a situation or sensation is perceived as a threat. We can think of the amygdala – and the ‘fear circuitry’ of which it’s a vital part, linking with the hypothalamus and periaqueductal grey – as a smoke detector, which is permanently powered-up and searching for signs of danger. Beyond our conscious awareness, it constantly monitors the environment for actual or potential threat, including things which we link to unpleasant experiences in the past, such as a harsh tone of voice or an aggressive posture. If we look at the location of the fear circuitry in the brain, we can see how it’s fundamental to our information-processing, seated above the brain stem and acting as first-line processor for information from the body.

Notice how close the Fear Circuitry is to what we might term the Embodiment Circuitry, particularly the brain regions which process information from our organs – the Insular Cortices. The only brain system closer to the spinal cord than the Fear Circuitry is the one responsible for all the things newborn babies need to do: sleep, breathe, and cry; feel temperature, hunger, and pain; and rid the body of toxins by excretion. Psychological illnesses tend to involve difficulties with sleep, appetite, and digestion; and with interaction, with the environment and with other people, as monitored and interpreted by the fear circuitry and the processing centres of our circuitry of embodiment.

Let’s return to the smoke detector. People with damaged amygdalae – from a rare genetic condition – have been found to be apparently desensitized to fear, and combat veterans with brain injuries to this region seem resistant to developing PTSD. But our fear circuitry is also vulnerable to imbalances in our cocktail of neurochemicals: the amygdala is particularly sensitive to serotonin, the neurotransmitter which influences the functioning of almost all of our forty million brain cells, and plays an important role in regulating mood, appetite, sleep and dreaming.

Researchers have found that manipulating serotonin levels in the amygdala produces changes in response to stress and potential threat. Animals with low amygdala serotonin are hyper-reactive to loud noises, whilst those with higher levels act as if they have a dampener on their fear system, making them less likely to respond to stimuli by cowering or becoming aggressive. Other research has found that dominant-male monkeys have much higher brain serotonin than subordinates, but that preventing dominant males from making eye contact with lower-ranking monkeys caused the high serotonin levels to drop through the floor. Researchers have even been able to explore how social environment interacts with the brain’s chemical balance: manipulating a monkey into a lower position in the hierarchy makes brain serotonin drop; chemically enhancing serotonin levels, by contrast, makes previously subordinate monkeys behave dominantly.

So the vicious circle of adversity, so familiar to those working with traumatized clients – harm leading to self-sabotage, self-isolation, and self-harm – has a basis in brain chemistry. But serotonin-manipulating drugs like SSRI’s tend to have limited benefit for this patient-group, because trauma affects not just neurochemical balance but the measurable functioning of the brain.

When abuse and trauma have made a person’s threat-detection systems hyper-alert to danger, their rational brains lose the power to override in-the-moment emotions. This can be observed by measuring brain activity: indeed, some of the very first reports on EEG patterns, conducted on “behaviour problem children” in 1938, showed slower-than-normal waves in their frontal lobes, indicative of a degraded level of executive functioning (and slow-wave prefrontal activity is now recognized as a biomarker for ADHD).

More recent EEG research show that the brains of traumatized subjects function differently. A 2000 study by Australian researchers compared how people responded to what they called “the oddball paradigm”, where subjects were shown different series of related images, with one ‘oddball’ image – a trombone in a series of chairs and tables, for example. The EEG patterns of subjects with histories of adversity and trauma were quite different to the control group: their brain waves were loosely coordinated and didn’t form coherent patterns – specifically those which help us focus on tasks by filtering out irrelevant information.

These two EEG readouts show brain activity patterns in response to stimulus: healthy subjects on the left, and the same response in patients with trauma histories on the right. When presented with new information, regions of the brain collaborate in a synchronized pattern (left). Patients with trauma-histories (right) show less co-ordination: their brains’ ability to filter relevant information is degraded, and subjects have difficulty focusing on the task in hand (McFarlane et al, 2000).

In 1889 Pierre Janet observed that “Traumatic stress is an illness of not being able to be fully alive in the present”. More recently, the movie The Hurt Locker explored how soldiers may be able to operate with superhuman focus when they’re under extreme stress but, safely back home, are overwhelmed by making simple choices in a supermarket. The brain-activity patterns in these EEG readouts show why many traumatized people have trouble engaging with their everyday lives. The strong initial spike in the left-hand image shows how healthy brains focus on new information: it has no equivalent on the right. The well-defined downward spike in the left-hand image reflects ability to assimilate and analyze data: by contrast the traumatized brain-waves make a half-hearted attempt then de-cohere and scatter.

Types of brain wave

Brain waves are categorized by amplitude – their varying heights on a graph – and by their wavelengths, measured as frequency: this is the number of times a waveform rises and falls in one second. The strength and speed of brain waves – the rate and intensity of their firing – are dictated by our state of arousal. Delta waves are the slowest, in the range of 2-5 Hertz, and are usually seen in sleep. If you’re awake and have slow-wave activity, your thinking will be foggy, your judgement will be skewed and you’ll have poor impulse control. Eighty per cent of children diagnosed with ADHD, and many people with PTSD, have excessive slow waves in their frontal lobes.

Theta waves have slightly faster frequency than Delta waves, and are something we all experience, when we’re on the brink between sleep and waking, with our minds unfettered from the ordinary demands of life: if you’ve ever had a eureka moment as you drop off to sleep, or wake from a dream, you can thank increased theta-wave activity in your brain. The freedom to make illogical connections during theta-wave activity has a downside however: depression is associated with theta frequencies, perhaps suggesting why when you’re down, anything and everything seems like proof of the impossibility of change.

Alpha waves, in the range of 8-12 Hertz, produce a sense of peace and calm: people who are either too numb or too agitated to achieve a state of focused calm – such as that produced by yoga or mindfulness meditation, of which more later – have unusually low alpha-wave activity. Beta waves are the fastest frequencies, and are associated with focused attention, problem solving, and the accomplishment of complex tasks: they’re typically seen in a range of 13-20 Hertz. Beta waves faster than that are associated with agitation, anxiety, and tensing of muscles: when we are scanning the environment for danger and physically preparing for it. Beta-wave activity remains in the normal range when we’re oriented to the world around us, and relatively comfortable in it; faster beta frequencies occur when a person is over-alert to their surroundings, excessively interpreting everyday stimuli and responding to them as if they’re extraordinary, and threatening.

Measuring patterns of brain activity in soldiers before and after combat tours shows how exposure to traumatic stress changes the the brain’s ability to function effectively. Soldiers whose EEG’s were analyzed four months before each successive deployment to Iraq and Afghanistan, and four months afterward, showed progressive decreases in alpha activity in brain areas which monitor the state of the body and regulate sleep and hunger – this area usually has the highest rates of alpha activity, associated with relaxation. Progressive exposure to combat reduced these soldiers’ ability to relax and left them in a state of persistent agitation. At the same time, the frontal areas of their brains, which began with high levels of fast beta-waves showed a progressive slowing with each deployment. Their patterns of frontal-wave activity came to resemble those of children with ADHD, whose executive functioning and capacity for focused attention is harmfully degraded.

This frontal-lobe shutdown is most pronounced in full-blown PTSD. One EEG study measured brain activity in response to direct eye contact. The prefrontal cortex helps us to assess people with whom we’re making contact, and our mirror neurons help to interpret their intentions – whether they’re friendly, concerned, agitated or potentially dangerous. In healthy research subjects the prefrontal cortex lit up with each new eye-to-eye contact, but subjects with PTSD did not activate any part of their frontal lobe. Instead, there was activation deep inside their emotional brains, in the primitive area known as the Periaqueductal Grey, which makes up part of the fear circuitry: this region generates the startle response, hypervigilance to stimuli, cowering, and other self-protective behaviours. In response to simply being looked at, traumatized people go straight into life-or-death survival, with their brains’ mechanisms for social engagement entirely offline.

For people with histories of trauma, arousal – a system which provides us with the energy and focus to meet everyday challenges – becomes an enemy: it no longer helps focus attention and concentrate energies, but instead causes agitation, restlessness, and ultimately exhaustion. To find out how to correct these imbalances, let’s delve a little deeper into the biology of self-regulation, of response to safety and danger. Almost all mental suffering involves trouble with regulating arousal – being chaotically excited or closed-off and shut-down – and difficulties with creating and maintaining workable and satisfying relationships: usually one feeds the other and a suffering person’s life is a combination of both. We’ve seen, demonstrated in measurable brain activity, and respiratory and cardiac functioning, how traumatic experiences recruit the body’s defence systems and cause them to become over-active in ways that are harmful to health and wellbeing in the long term.

The challenge for those working with traumatized clients is how to reverse that process, how to help someone reset their system to a healthy baseline when it’s been forced to a state of high alert. To find out how, we need to look at the deepest level of trauma response, the ancient mechanisms buried deep in our brains which are fundamental to both our physiological functioning, in moment to moment regulation, as well as in response to situations of life-threatening stress.

My career has been in thriller fiction, and it’s a rare potboiler whose action scenes fail to exploit the fight-or-flight response, the activation of the sympathetic nervous system to release adrenaline into the bloodstream, preparing the body for explosive physical action. But what happens when fight or flight aren’t possible? I once saw a news report of a plane trying to land in high winds, its wings flipping like a see-saw, the whole fuselage getting broadsided nose to tail across the runway. A TV news crew happened to be in the terminal, and interviewed passengers as they disembarked: they reported people screaming and yelling, waving their arms and straining at their seatbelts; or else sitting motionless with their eyes closed. “How did I cope?” one man said. “I didn’t. I passed out.”

We can see this fear-response most graphically in – of all things – footage from the selfie-cam of a theme park ride.

I’m struck by the way she stops interacting with her friend as terror takes over, and by the change in her facial expression to one of helpless misery just before she collapses. Violent movement brings her back to consciousness, as if a predator has dropped her from its jaws, and immediately she turns to her friend and shouts, with wide, frightened eyes.

What’s apparent here is not the fight-or-flight response but what happens either side of it: our first line response to danger, to exhibit distress and call for help, and then – because fight or flight aren’t possible – the last-ditch survival strategy from deep in our evolutionary past. Our most recently-evolved response to threat is characteristic of mammals: yelling for help, signalling to members of our tribe with urgent vocalisation and full-stretch facial muscles that danger is amongst us. Our most ancient stress response is activated when calling for help doesn’t work, and when fight or flight aren’t possible: when a person is isolated, immobilized, held down – like a theme-park rider in a body harness, a passenger strapped into a plane seat, or a victim of sexual assault.

The young woman on the theme-park ride alternates between the most evolved mammalian defence of social engagement – calling out, using the whites of her widened eyes to send a galvanizing distress signal – and the ultimate threat response of both mammals and reptiles, playing dead: her face goes blank, her eyes close, her muscles relax and her body becomes limp as a rag-doll as she loses consciousness. She’s skipped the fight-or-flight responses in between because they’re no use: she’s immobilized, harnessed, as if caught in the jaws of a predator; so it’s that ancient response to overwhelming terror, to apparent life-threatening attack, which takes over, removing her consciousness entirely. Crucially for treating trauma, the very different responses to traumatic stress that we see here are controlled by the same physiological and neuroceptive apparatus: the vagal nervous system, whose trunk is the tenth cranial nerve.

It has two branches, and we can see the relative evolution of each in their physical structure: the most recent branch has a coating of fat and protein on the nerves called myelination, which allows faster and more controlled responses to stimuli; the more ancient branch is bare, and this difference is connected to the two branches’ relative function. The most recent branch, the ventral vagal complex or VVC, connects our brains to our facial muscles, our middle ears, and our vocal machinery: everything we need for social engagement, from listening to others and responding sensitively and emotively, to eliciting the same interactions to our own needs. Unsurprisingly, for a nervous system so closely connected to emotional engagement, it runs from the brain to the heart, where it acts in a crucial way on the heart’s natural pacemaker: without the VVC acting as a brake, our hearts would beat too fast to sustain life.

The more ancient branch of the vagal system, the Dorsal Vagal Complex or DVC, runs down the spine and connects the subdiaphragmatic organs – the kidneys, stomach, and intestines – with the brain, playing a crucial role in their homeostatic regulation. Both vagal branches are intimately involved in birthing and raising our young: the Dorsal Vagal Complex activates during labour, emptying the bowels, shutting off registration of pain once critical thresholds are breached. The Ventral Vagal Complex is what makes us smile automatically at young babies, cluck and coo to them, stimulating their own mammalian VVCs – connecting the muscles of the middle ear, face, and larynx – to develop their own social engagement capacities.

This social engagement system is implicated in the first stage of response to trauma: we widen our eyes and tense our facial muscles to signal danger, we yell for help. The VVC’s cardiac regulation function is activated too: its ‘braking’ effect on heart-rate eases off, allowing the heart to beat faster and move more blood to the tissues in preparation for a fight or flight response, without incurring the physiological costs of invoking the adrenal system. The DVC activates if fight or flight doesn’t work, or isn’t available as an option: it shuts off digestion to conserve resources, voiding the bowels to do so, and makes us appear limp and lifeless. If we don’t lose consciousness then we dissociate from reality, so that we’re no longer responding to stimuli and therefore not depleting what may turn out to be crucial resources.

A question greatly exercising those responsible for the welfare and wellbeing of young women, on college campuses and in the military, is why self-defence training against sexual assault doesn’t seem to be effective. Leaving aside the question of why those charged with reducing the incidence of sexual assault are putting the onus upon women to defend themselves rather than on perpetrators not to offend, it’s a problem that’s been apparent in courtrooms since female soldiers first began attempting to prosecute sexual assaults they’d suffered. Defence lawyers have had a field day with such cases: hasn’t the complainant been trained in hand-to-hand combat and military martial arts? Haven’t large sums of public money been spent on equipping this woman with the physical skills to defend herself? I’ve seen a horrendous courtroom transcript, where a cross-examining lawyer runs through literally hundreds of self-defence techniques, forcing a rape plaintiff from the military to admit that she’d been trained in each yet didn’t deploy any of those skills during the alleged assault. She must be lying about trying to resist, the court decided, and her attacker was acquitted, only to rape again two months later.

The numbers tell the story here: sexual assault statistics from combat divisions of the military mirror those of the civilian population. Even people who are skilled at fighting off attackers find their own bodies and minds working against them at the critical moment. We can see why if we look at the evolution of sexual assault self-defence training for young women on college campuses in America. American universities charge astronomical fees, and are keen to reassure parents of prospective female students that their daughters will be safe: such self-defence programs have been running for some time in consequence, yet incidence of sexual assault remains woeful. A recent study of 800 young women at Canadian universities who’d undergone such training found that almost six per cent experienced sexual assault over the next year, compared to almost ten per cent of students who’d received no training.

Why such a small reduction? To find out, researchers began to look at the role of the vagal complexes in situations of traumatic stress. They found that when women are being sexually assaulted, their polyvagal system kicks-in just as we saw in the theme-park clip. Their first response is to use the ventral vagal complex to attempt social engagement: when saying no doesn’t halt the assault, they try to ‘ask for help’, by reasoning with their attacker, appealing to them as from one member of a tribe to another – you don’t need to do this or your girlfriend will be angry. As the assault proceeds with physical force, and fight or flight cease to be options, the ancient dorsal-vagal response activates: the body goes limp, heartbeat slows and breathing becomes light and shallow, eyes close or glaze over as the mind dissociates from the reality of what’s happening. She didn’t defend herself, the rapist says in court, but he’s wrong: that’s exactly what a limp and lifeless victim is doing, as their reptilian vagal system shuts them down to minimize the registration of pain and terror and conserve resources, until escape is possible.

So researchers seeking to improve self-defence training looked at how the military teaches soldiers under fire to override their stress responses and stay alert and functional. They found that training for combat involves recreating the exact situations where skills will be deployed – which is why the military builds exact reconstructions of Iraqi streets and Afghan villages – and then repeats the training over and over again, literally drilling it into soldiers’ psyches until their responses aren’t automatic but learned; until their response to threat is to activate skill-sets rather than polyvagal defences. A 2014 study at the University of Oregon therefore devised a self-defence training program where participants practised techniques for a total of 20 hours over ten weeks, rather than the six-hour total of the Canadian study. In addition, Oregon participants spent ninety minutes each week in group discussion, invoking the social engagement branch of the polyvagal complex to reinforce retraining of the dorsal vagal response to overwhelm. In fairness this was a smaller study, but in the first year after completing the training not one participant was sexually assaulted, compared to almost six per cent who’d undergone the shorter Canadian training.

Until very recently, intervention for trauma disorders has focused on trying to work with the fight-or-flight system: trying to recalibrate the amygdala’s perception of danger with talk therapy, using embodiment and breathing techniques to calm the autonomic nervous system’s adrenal high-alert, and there’s still a place for these. But recognising that many traumatic experiences involve not fight-or-flight but what happens when fight and flight aren’t available – during domestic violence, for example, or sexual assault and abuse – is key to achieving lasting interventions with traumatized clients. If we look at the physical signs and symptoms of trauma disorders – flat affect, a monotone voice and blank facial expression, as the ventral vagal complex stays locked in inhibition, slowing the heart-rate to bradycardia in its over-activation; chronic gastro-intestinal problems and shallow breathing, as the dorsal vagal complex inhibits digestion to conserve resources, and constricts the bronchi to promote the appearance of lifelessness – we can see how the neuroceptive mind/body vagal systems, which operate without conscious awareness, have been recruited by trauma-sufferers for defensive purposes and remain activated after the danger is past.

Our culture teaches us to believe that we’re individual and special, but at a deep physiological level we operate as linked organisms – not lone wolves but members of a tribe. So when our Ventral Vagal Complex is engaged – chatting with a friend or problem-solving with a colleague, by human interaction which mobilizes the muscles of the face, middle ear, and vocal apparatus – our heart-rate slows, our bronchi open up and our breathing deepens. Consequently we feel relaxed, confident, calm and centred.

But someone suffering the effects of trauma interacts completely differently. Their Ventral Vagal Complex is acting as if still under threat: the flattened affect of blank face and expressionless voice, the difficulty traumatized people have in following a voice or tuning-out background noise – these show how their VVC has become stuck in defence mode. Their facial muscles, and those controlling hearing and speech, are clamped-down by the same nerve complex which is constricting their bronchi and slowing their heart to conserve resources.

Meanwhile and for the same reason their Dorsal Vagal Complex is slowing digestion, making them vulnerable to GI disorders in the long-term, whilst impairing ability to take effective nourishment from day to day. The characteristics common to most psychological disorders – monotonous voice, expressionless face, stomach aches and pains, a problematic relationship with food – seem obviously implicated.

Information flow in the vagal complexes is primarily from the body to the mind. Around eighty percent of traffic along the vagal nerves runs from the organs back to the brain, where it’s processed and responded to: our bodies quite literally tell us what to think and how to feel. What does this look like? In 2004 the brains of sixteen healthy volunteers were scanned and imaged while they relaxed and let their minds rest. Even though the research subjects were thinking about nothing in particular, the researchers found consistently strong activation in these brain regions:

This pattern of activity is known as the Default State Network; these are the areas which light up on a brain scan when we’re resting and letting our minds idle. As plainly illustrated, most of the things which make us feel human – thinking and feeling, and connecting the two; processing and remembering information; being able to make decisions and modify our behaviour; feeling our sense of self in our bodies – are handled by regions which are active and engaged in the brain even when we’re doing nothing. In the default state, information from the body’s organs lights up the insula, which relays it to the emotional centres at the front of the brain. Together, they generate the matrix of awareness, of being at the centre of our own experiences, which makes us feel alive.

By contrast, then, here’s what lit up in the brains of volunteers with PTSD:

The only activity in the Default State Network of these volunteers’ brains was a basic awareness of where they were, the spatial information necessary to escape: which way to the door of the brain-imaging lab, what direction to take in the corridor outside. If someone with a history of trauma tells you that they feel dead to the world and to themselves, this is what they mean. There’s nothing going on inside: all of the things which make us feel human, the brain activity we take for granted as we’re going about our lives – even when we’re doing nothing, letting our minds slip out of gear for a moment – these are shut-down by traumatization. Thinking, feeling, planning and making decisions, having the ability to interact socially, feeling emotions and connection to others, experiencing a sense of self in our bodies: all of these are out of reach to a person whose minds have been locked-down by adverse experience. So how to help people out of this lock-down and back to life?

The Insular Cortices are a brain region which have been studied only recently: the twin hemispheric insuale are buried too deep in the brain to measure their signals with electrodes, and only with the advent of new imaging technologies has it been possible to study their functioning and activity in any depth. Many of the sensory signals conveyed by the vagus nerves terminate in the insula: it’s also strongly connected to the amygdala, and strongly implicated in anxiety and unhelpful arousal. When a group of anxiety-prone resesarch subjects were shown slides of emotional faces, much more activity was seen in the insula and amygdala than with a control group; similarly research groups of sufferers of social anxiety, phobia, and PTSD showed strong activation of the insula and amygdala in response to images of faces expressing fear. The insula is also activated during sexual arousal, in both men and women; it plays a crucial role in appetite, and the ability to taste and smell; and it’s ground zero for our conscious awareness of visceral activity – when you focus on your breathing or heartbeat, it’s your insula which allows you to do so. Interestingly, the insula is also strongly activated by social engagement, particularly when social expectations of fairness are violated.

When a healthy vagal complex is sending signals of satisfaction and wellbeing to the insula, the frontal brain lights up with activity, generating a flow of information traffic – emotional, empathic, concerned with how we experience ourselves and people around us – from the mammalian frontal brain to the ancient seats of consciousness, even when a person is at rest. Ask that person to concentrate on something simple – a symbol, such as a plus sign, or a moving finger – and another region at the back of the brain lights up: the precuneus. Just like the insula, and the polyvagal system itself, this has been studied only recently: researchers have begun to associate the precuneus with a sense of selfhood and agency, of being at the helm of one’s life.

Groundbreaking studies of the precuneus have identified significantly decreased activity in people with autism, and atrophy and reduced precuneal volume in those suffering Alzheimer’s. In 2015, a group of Japanese researchers found that people who scored highest on indices of happiness and life-satisfaction had significantly more volume in the precuneus than people experiencing dissatisfaction with their lives. An active precuneus, exercised by the sense of participation in life generated by healthy frontal-lobe activity, may prove to be the key marker of lifelong happiness and satisfaction.

So all of these relatively recent discoveries may generate new understanding of trauma and how to treat it, helping those unlucky enough to experience it – even repeatedly, like survivors of domestic violence and childhood sexual abuse – regain their sense of selfhood and agency in life. The array of methods developed by both centres of excellence, like the Trauma Clinic at Harvard University’s teaching hospital, and by grass-roots organizations like domestic violence units and rape crisis centres, have been utilized and developed because they’ve been found to work: these include choral singing, stimulating the vagal branches running to the vocal apparatus and middle ear; theatre programs, which add the vagal connections to the facial muscles; and yoga classes, stimulating the vagal complexes’ information flow from the visceral organs back to the brain, and working to open up the bronchi – constricted by a locked-down vagal system – to stimulate and coordinate respiration with cardiac function.

The passenger strapped into a plane seat during a scary landing, the victim of domestic violence or sexual assault who is held down and terrorized, even the girl on the theme-park ride: all of these people experience fear in their bodies, as their organs alert their brains to danger and threat. Achieving lasting interventions with traumatized clients involves recognition that neuroceptive mind/body systems, which operate without conscious awareness, have been recruited for defensive purposes, and remained in a state of heightened activation. Illnesses of traumatic stress don’t benefit in lasting ways from top-down approaches (like neurotransmitter manipulation with medication, or cognitive training) because they’re not all in the mind – they’re quite literally in the body. Ironically, it may turn out to be new technologies in neuroscience, allowing us to study brain function in unprecedented detail and depth, which prove that working from the bottom-up, with the organs which tell our brains how we are and how our moment to moment, is the key to bringing lasting change, health, and happiness to trauma-damaged lives.