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The fundamental issue in resolving traumatic stress is to restore the proper balance between the rational and emotional brains, so that you can feel in charge of how you respond and how you conduct your life. When we're triggered into states of hyper- or hypoarousal, we are pushed outside our "window of tolerance"---the range of optimal functioning. We become reactive and disorganized; our filters stop working---sounds and lights bother us, unwanted images from the past intrude on our minds, and we panic of fly into rages. If we're shut down, we feel numb in body and mind; our thinking becomes sluggish and we have trouble getting out of our chairs.

As long as people are either hyperaroused or shut down, they cannot learn from experience. Even if they manage to stay in control, they become so uptight [...] that they are inflexible, stubborn, and depressed. Recovery from trauma involves the restoration of executive functioning and, with it, self-confidence and the capacity for playfulness and creativity.

— The Body Keeps the Score by Bessel van der Kolk, Bessel A. Van Der Kolk (Page 205)

Understanding why you feel a certain way does not change how you feel. But it can keep you from surrendering to intense reactions (for example, assaulting a boss who reminds you of a perpetrator, breaking up with a lover at your first disagreement, or jumping into the arms of a stranger).

— The Body Keeps the Score by Bessel van der Kolk, Bessel A. Van Der Kolk (Page 205)

Culture shapes the expression of traumatic stress.

— The Body Keeps the Score by Bessel van der Kolk, Bessel A. Van Der Kolk (Page 187)

Doctors shape how their patients communicate their distress: When a patient complains about terrifying nightmares and the doctor orders a chest X-ray, the patient realizes that he'll get better care if he focuses on his physical problems.

— The Body Keeps the Score by Bessel van der Kolk, Bessel A. Van Der Kolk (Page 188)

Nobody can "treat" a war, or abuse, rape, molestation, or any other horrendous event, for that matter; what has happened cannot be undone. But what can be dealt with are the imprints of the trauma on body, mind, and soul: the crushing sensations in your chest that you may label as anxiety or depression; the fear of losing control; always being on alert for danger or rejection; the self-loathing; the nightmares and flashbacks; the fog that keeps you from staying on task and from engaging fully in what you are doing; being unable to fully open your heart to another human being.

— The Body Keeps the Score by Bessel van der Kolk, Bessel A. Van Der Kolk (Page 203)

The essence of trauma is that it is overwhelming, unbelievable, and unbearable. Each patient demands that we suspend our sense of what is normal and accept that we are dealing with a dual reality: the reality of a relatively secure and predictable present that lives side by side with a ruinous, ever-present past.

— The Body Keeps the Score by Bessel van der Kolk, Bessel A. Van Der Kolk (Page 195)

Social support is a biological necessity, not an option.

— The Body Keeps the Score by Bessel van der Kolk, Bessel A. Van Der Kolk (Page 167)

Our patients did not have the option to run away or escape; they had nobody to turn to and no place to hide. Yet they somehow had to manage their terror and despair. They probably went to school the next morning and tried to pretend that everything was fine. Judy and I realized that the BPD group's problem---dissociation, desperate clinging to whoever might be enlisted to help---had probably started off as ways of dealing with overwhelming emotions and inescapable brutality

— The Body Keeps the Score by Bessel van der Kolk, Bessel A. Van Der Kolk (Page 139)

If we look beyond the list of specific symptoms that entail formal psychiatric diagnoses, we find that almost all mental suffering involves either trouble in creating workable and satisfying relationships or difficulties in regulating arousal (as in the case of habitually becoming enraged, shut down, overexcited, or disorganized). Usually it's a combination of both. The standard medical focus on trying to discover the right drug to treat a particular "disorder" tends to distract us from grappling with how our problems interfere with our functioning as members of our tribe.

— The Body Keeps the Score by Bessel van der Kolk, Bessel A. Van Der Kolk (Page 78)

Many treatment approaches for traumatic stress focus on desensitizing patients to their past, with the expectation that reexposure to their traumas will reduce emotional outbursts and flashbacks. I believe that this is based on a misunderstanding of what happens in traumatic stress. We must most of all help our patients to live fully and securely in the present. In order to do that, we need to help bring those brain structures tha deserted them when they were overwhelmed by trauma back. Desensitization may make you less reactive, but if you cannot feel satisfaction in ordinary everyday things like taking a walk, cooking a meal, or playing with your kids, life will pass you by.

— The Body Keeps the Score by Bessel van der Kolk, Bessel A. Van Der Kolk (Page 73)

You are six years old and ready for bed. You hear your mother and father yelling at each other. You are frightened and your stomach is in a knot. You and your younger brother and sister are huddled at the top of the stairs. You look over the banister and see your father holding your mother's arms while she struggles to free herself. Your mother is crying, spitting and hissing like an animal. Your face is flushed and you feel hot all over. When your mother frees herself, she runs to the dining rom and breaks a very expensive Chinese vase. You yell at your parents to stop, but they ignore you. Your mom runs upstairs and you hear her breaking the TV. Your little brother and sister try to get her to hide in the closet. Your heart pounds and you are trembling.

— The Body Keeps the Score by Bessel van der Kolk, Bessel A. Van Der Kolk (Page 40)

In many places drugs have displaced therapy and enabled patiens to suppress their problems without addressing the underlying issues.

— The Body Keeps the Score by Bessel van der Kolk, Bessel A. Van Der Kolk (Page 36)