Trauma and the body’s unspoken voice

SENSATION-THE BODY’S UNSPOKEN VOICE THAT HOLDS THE KEY TO RESOLVING TRAUMA

A fascinating observation is that animals in the wild that are frequently exposed to life threatening events do not develop symptoms of post traumatic stress, provided that they have discharged the residual energy mobilized during the trauma. Animals discharge this high level of arousal through involuntary movements such as shaking, trembling and deep breathing following successful escape. It is interesting to note that we as human beings have the same physiological mechanisms embedded in the nervous system to allow us to discharge the effect of stress and trauma. HOWEVER, we have a highly developed part of the brain, the cortex, that leads us to override these instinctive responses and which in turn often leads us to remain trapped in a debilitating cycle of trauma. We can however be helped out of this state by an approach to trauma resolution called somatic experiencing.

THE BASIS OF SOMATIC EXPERIENCING^tm (SE)

Our nervous systems always go through cycles of activation and deactivation. We wake, we sleep, we work, we rest, we get bored and we do something interesting. If it gets too much we do something to calm down. When these cycles of activation or deactivation are not too extreme, we feel comfortable. Our nervous system is cycling within a window of tolerance that feels ok. When the activation is higher than this range of tolerance, we may feel stressed, anxious, excited, panicky or aggressive and so forth. When the activation is too low, we may feel constricted, stuck, numb, depressed, demotivated and so on.

The human brain has many parts, two of which the cortex and sub cortex or if you like an “upstairs brain” and a “downstairs brain.” The “upstairs brain” handles rational thought, language, learning and reason. The “downstairs brain” is involved with bodily functions such as heart rate, muscle tension, coordination and balance and breathing. The downstairs brain is concerned with survival and controls the physiological response to threat.  Two important structures in this circuit are located in the mid brain, namely the amygdyla, small walnut shaped structures located directly in from the ear on each side of the brain. The amygdyla alert us to threatening situations. If we experience something as a threat, the amygdyla fire and put the body on “red alert,” as if something in our brain dialed an emergency number. The amygdyla communicate with both the “upstairs brain” and “downstairs brain” when we are under threat.

To understand the interaction between the brain and the activation and deactivation of the nervous system during threatening situations, imagine there was a rabbit in a field that suddenly became aware that a dog was about to attack him. His amygdyla send a message via a short cut to the “downstairs brain” to trigger the rabbit to flee. A flood of stress hormones is discharged into the bloodstream and the rabbit would take off running wildly to escape. If the dog got him trapped in a corner, with no way of escape, he would go into a freeze and remain motionless. Even if he wanted to run, he would be unable to. He would feel stiff, tense and alert. If the dog did catch him, there may be a shift in his nervous system, which would make him numb, spacey, cold and heavy. He may feign death and go limp in the dog’s mouth. He may feel as if all this were happening in a dream and as if he was outside his own body. Sometimes a well-fed dog may become bored with the game and drop the rabbit. The rabbit would dash off in wild flight as soon as he got a chance, discharging the energy primed in his muscles during the flight or fight response, before the freeze took over.

At other times, if the dog does not actually catch the rabbit and he is frozen in the corner, with the dog lurking nearby but not able to find him, the predator may not see the prey and may move off. In that case, the rabbit would discharge the energy in his charged nervous system by shaking, tingling, trembling and taking a number of spontaneous deep breaths. He would complete the thwarted movements he was making as he went into the freeze and then would hop away as if nothing happened. Animals which discharge the freeze have been shown not to develop posttraumatic stress, but animals that don’t do this are less fortunate.

THE SOMATIC AND AUTONOMIC NERVOUS SYSTEM

The somatic nervous system controls our voluntary movements. The autonomic nervous system regulates our internal organs. The autonomic nervous system has two branches, the sympathetic nervous system and the parasympathetic nervous system. The sympathetic nervous system is that part that activates us. It is like the accelerator in the body. It increases our muscle tone and heart rate. The parasympathetic nervous system deactivates us and slows us down. It allows us to sleep, relax, experience spiritual ecstasy and functions like the brake in the body. Activity in the viscera and circulatory system are under the control of the autonomic nervous system at all times. Trauma has a deep impact on the autonomic nervous system, which rapidly shifts our energy and blood flow patterns when we need to deal with the unexpected.  It moves the body into a high state of activation (fight or flight) or it moves the body into shut down when we need to conserve energy or feign death according to our survival needs. For example if we are sick, bleeding or injured we often need to rest and conserve energy as we heal.

Our first response to the perception that something is dangerous is that we orient to the source of the threat. There is a sense of stiffening, bracing, narrowing of our attention and a search for the direction of the impending danger as well as a search for an escape route.  We may be aware of our typical responses to threat such as stiff, tense muscles and a racing heart, as well as sweating, changes in breathing and sometimes feeling butterflies in the stomach and nausea. It is important to remember that when we are under threat, the autonomic nervous system, which controls our circulation and the activity of the viscera, shifts nervous energy within the body to enable us to survive.

The body prepares for fight or flight and stress chemicals and stress hormones are released. When we are under threat, our survival responses take over, and we do not consciously control the shifts in our autonomic nervous system. For example, if you are out hiking in the bush and meet an aggressive leopard, you need a quick response rather than thinking “how interesting. A beautiful animal with big teeth is running towards me …” Your amygdala respond as if saying  “Run!” If you are assaulted, your amygdyla may scream “run” or “fight. Get mad! Defend yourself!” So when we feel threatened, the downstairs brain prepares us to fight and flee by triggering fear or rage. Our muscles are primed for action. There is also a shift within the autonomic nervous system.  Blood flow patterns change and we may become pale with fright or white with fear. We may experience sensations in the viscera, especially the gut as the body may expel the contents of the digestive or urinary system and blood is shifted to energise the muscles needed to flee or ward off the threat. We brace, stiffen, or tense to protect ourselves. If we cannot use this energy to move because we are restrained, injured or forced to inhibit the response (as for instance being under armed attack or undergoing a medical procedure), the muscles move into collapse and the body begins to shut down. The parasympathetic nervous system induces a state in which muscles become weak and flaccid, we feel numb, cold and heavy and we may seem dead. Shifts occur via the autonomic nervous system to conserve energy. The breathing slows and becomes almost imperceptible. The heart rate drops. We may enter a dream like state and may feel spaced out. This is known as dissociation.

These responses are intended to be short lived. When the threat has passed, we humans, like animals need to discharge the patterns of motion primed when we went into the freeze. This discharge also needs to happen in the viscera, mediated by the autonomic nervous system. We human beings have a wonderfully complex nervous system. We have the same innate mechanisms in the nervous system to deal with threat and to recover from it as the animals . However, we also have the ability to think and to imagine what may have happened. We can override our body’s responses aimed at defusing the trauma.

Something that is seldom appreciated is that our brains receive input from the environment, but also from our bodies. Mental processes are a product of the brain and body, which interact through nerve impulses and chemicals in the nervous system and bloodstream. The vagus nerve carries impulses from the brain to the viscera and from the viscera to the brain. This nerve is almost as thick as the spinal cord. In fact 90% of the fibres in this enormous nerve carry messages TO the brain. So our viscera act as a second brain and we in turn speak about a gut feel or gut instinct.

Sensations become linked to the trauma. When we are threatened elements of the situation that do not belong together become connected. For example, if you are driving in a car and there is a yellow postbox, a pink house and a kitten in your surroundings and you crash, it is as if your brain takes a photograph of these elements and links them. So things like the kitten, which in fact have nothing to do with the crash, become connected or coupled to the trauma. The somatic sensations we feel, especially immobility, also become connected or associated with the trauma. Later on, these disconnected elements of the situation have the effect of triggering the somatic and emotional responses we felt during the trauma. So our sensation of immobility, for example as we fall asleep, becomes scary to us. Under normal conditions immobility can be pleasant and relaxing. But when it is coupled with trauma, the sensation of immobility triggers a perception that we are still in danger and we re-experience the somatic and emotional reactions we initially had in the distressing situation. This abnormal response to immobilization keeps us trapped in a cycle of traumatic stress.

When we humans are under threat, we associate fear and immobility. The two become connected. When the freeze is not discharged, we experience messages that we are still immobilized. We experience this immobility as a sign we are still under threat. We search desperately for the source of the threat and become hyper vigilant and watchful. We sense that the defensive responses in our bodies are primed, but not yet completed or used. We remain poised to defend ourselves and discharge this energy either by fighting back or fleeing. Thus our autonomic nervous system remains deregulated and primed to respond to a threat, even though the threat has passed. The reptilian, “downstairs brain” does not know time. Thus trauma lingers and produces ongoing symptoms. The traumatised person may feel chronically anxious. The person may feel disconnected from life and people. Although humans seldom die of fright, they may feel dead inside, emotionally shut down and numb. Because of the effect of trauma on the autonomic nervous system, patterns in the autonomic nervous system are altered for prolonged periods and may cause autoimmune diseases, thyroid symptoms, chronic pain, eczema and autoimmune functional diseases. This dysregulation of the nervous system happens whether the person recalls the event or not. Even birth trauma can result in long-term dysregulation of the nervous system and the autoimmune symptoms associated with trauma.

A WAY OUT

Dr Peter Levine, a biologist, states “Traumatic symptoms are not caused by the event itself. They arise when residual energy from the experience is not discharged from the body. This energy remains trapped in the nervous system where it can wreak havoc on our bodies and minds.” . Dr Peter Levine developed an approach for dealing with trauma that allows us as humans to discharge the deregulation in the nervous system in small steps that does not re traumatise the person. Any flooding or overwhelming of the nervous system is avoided. In fact, the client does not need to know or tell the story. When a person is pressed to describe a traumatic event, instead of resolving the experience, it may actually reinforce the fear and stress that are part of the recollection. The body has an inherent memory of the trauma and of its unfinished response that can be recognized through sensation. Sensation is the only language that the “downstairs brain” speaks and understands. Trauma is not encoded in words or language, but is experienced in the body, muscles, nerves and viscera. This experience is reflected by sensation and must be addressed on this level.

The key to resolving trauma lies in the body, specifically in experiencing the sensations and impulses associated with the trauma in very, very small steps and allowing the nervous system to discharge the pent up energy in the nervous system through feeling the sensations of trembling, shaking, tingling or warmth that indicates discharge and resetting of the nervous system is taking place. We work gently, helping the person to experience a small surge of activation, process it and then another small surge, and so on until balance is restored and the normal functioning of the nervous system takes over.

Experiencing small manageable doses of the traumatic energy is known as titration. Titration is a key element of resolving trauma to enable us to tolerate and discharge the energy mobilized in the threatening situation. When we think of a prey animal, which was pursued by the predator, as the prey comes out of the freeze, if the predator is still around, it will not give the prey a second chance. So as the prey animal becomes mobile again, it is fierce enough to kill. As humans, we may experience intense rage or panic. It is vital that the traumatised person is guided to experience and discharge these strong sensations insmall surges which resolve little by little, otherwise we frequently override these recovery responses because they are intense and we feel uncomfortable with them.

Somatic Experiencing works towards restoring the nervous system’s inherent capacity to self-regulate by facilitating the release of energy and natural survival reactions stored during a traumatic event. When we balance trauma-oriented sensations with resource states we restore wellbeing by supporting the nervous system’s innate capacity to return to balance.

Time does not resolve trauma. The undischarged somatic responses to trauma have the capacity to linger for years. But trauma does not have to be a life sentence. Trauma needs to be addressed as a disruption in the nervous system, rather than a psychological problem or weakness.

With the guidance of a skilled therapist who understands the process within the nervous system, healing does not have to be an ordeal.

References : Levine Peter, PhD. 2010. In an unspoken voice. How the body releases trauma and restores goodness. California. North Atlantic Books.

Elaine Miller-Karas. Trauma resiliency model ^tm http://traumaresourceinstitute.com/wp-content/uploads/2012/11/What-is-TRM_-Description-for-website-2012.pdf

 

Compiled by DR. B.L. WADE

OLIVE BRANCH TRAUMA CENTRE

Olive Branch 37 Wordsworth Avenue Farrarmere Benoni
Tel: 072 122 4766 / 011 849-7473.
Email: drwade@olivebranch.co.za
Dr Barbara Wade is an accredited member of Saaswipp (the South African Association of Social Workers in Private Practice) and practices in the field of individual and family therapy, as well as specializing in all forms of trauma