Keenan: This is your male brain on trauma

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A decade ago, Dutch psychiatrist Dr. Bessel van der Kolk wrote a landmark book on the neurobiology of trauma. It was called The Body Keeps the Score. You may have heard of it since it spent 245 weeks on the New York Times bestseller list and has been translated into 43 languages.

In that now-classic work, van der Kolk reported on his experiences treating Vietnam combat veterans in therapy groups. “Despite their feelings of horror and grief,” he wrote, “many of them seemed to come to life when they talked about their helicopter crashes and their dying comrades.”

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While it is understandable that these experiences would be seared into their memories, he observed that many of the veterans still sought out painful experiences, even in their current lives. He wrote that traumatized patients “often complain about a vague sense of emptiness and boredom when they are not angry, under duress, or involved in some dangerous activity.” He explains that Freud called this “the compulsion to repeat” and said it may be “an unconscious attempt to get control over a painful situation.” Experts say that this attempt is rarely successful.

Fast forward a decade since the book’s publication. I decided to check out what Dr. van der Kolk is doing now. I was delighted to see that, at age 81, he is the lead author of a new academic paper on the use of the drug MDMA for treating post-traumatic stress disorder. He’s also on the faculty for a professional development video course called Mastering the Treatment of Trauma.

It is presented by the Connecticut-based National Institute for the Clinical Application of Behavioral Medicine. Their courses are for working professionals, and I haven’t taken any of them, but the organization makes a great deal of helpful information available on its website, nicabm.com.

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In a video related to the course, van der Kolk tackles thorny issues like the compulsion to repeat using ideas that have emerged since he wrote his landmark book. One example is the brain’s “default mode network” (DMN), which is basically where your mind spends its time when it’s not focused on specific talks. While first proposed in 2001, the existence of the DMN, which resides in a set of interconnected brain regions, was only verified using functional magnetic resonance imaging (fMRI) technology in 2016.

Van der Kolk believes that “traumatized people in an ordinary state do not access their default mode network. That means, under ordinary conditions, they don’t feel quite at home with themselves. But when they get re-exposed to their trauma, that network gets activated. And so you feel alive when you get exposed to your trauma, and you feel not alive when there is no trauma going on. So your brain gets rewired.”

Do male and female brains differ with respect to the DMN? A new study by researchers at Stanford University, led by Srikant Ryali, took an interesting approach to this question. They created an artificial intelligence (AI) model to examine brain scans. According to a report on the Stanford Medicine website, “When the researchers tested the model on around 1,500 brain scans, it could almost always tell if the scan came from a woman or a man.”

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AI is notorious for telling us things without explaining itself. Notably, these researchers used a new technique called Explainable AI (XAI) to force their model to clarify how it could tell men from women from brain scans. We can expect to see XAI techniques used in many more studies in the future.

In their paper in Proceedings of the National Academy of Sciences, the researchers write, “Significantly, we found that brain features associated with the DMN most reliably distinguished between female and male brains.” They went on to suggest that “Sex-specific differences in the DMN may also influence how females and males recall past experiences, form self-concepts, or engage in perspective-taking.”

Gender-specific differences were also found in the striatum and limbic network. According to a press release from Stanford Medicine, these “are involved in learning and how we respond to rewards.”

These findings may have both clinical and societal implications. Van der Kolk explains on his website that “As a society, we cannot afford to ignore trauma and keep our heads in the sand. There are, in fact, countries where governments have taken the science of trauma (and its prevention and treatment) seriously, with results to prove how well that works. For example, Norway has fifty-one citizens per hundred thousand in jail; the US, 951. Their students also have higher test scores and higher graduation rates from high school and college, and their society has a fraction of our crime rate.”

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The brain scans in the Stanford study were from young adults aged 20 to 35. By that age, the brain is pretty fully developed, so this research doesn’t explain if the differences are genetic, hormonal, or related to differing life experiences of men and women. There’s plenty of room for future research, and we’re fortunate that people like Bessel van der Kolk are ready and eager to do it.

Dr. Tom Keenan is an award-winning journalist, public speaker, professor in the School of Architecture, Planning and Landscape at the University of Calgary, and author of the best-selling book Technocreep: The Surrender of Privacy and the Capitalization of Intimacy.

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