Book Club Notes on “The Body Keeps Score” by Bessel van der Kolk M.D.

the body keeps the score

Book Club Notes on “The Body Keeps Score” by Bessel van der Kolk M.D.

My top takeaways from “The Body Keeps Score” is that there are many different types of trauma that a person can (and most likely will) experience during their life–from childhood abuse and/or emotional neglect to an auto accident, war, terrorist attack, or sudden death of a loved one.

Much of trauma is a normal (albeit uncomfortable) neurological response to a dangerous situation. Once a person experiences a trauma, on a subconscious level, their brain (on a subconscious level) begins to not only organize their world view, but also creates actions around their response to these traumas in an attempt to keep them safe.  This can lead to a lot of problematic behaviors if they are trying to numb out or escape from remembering what happened, or it can lead to them feeling “crazy” because we are unable to numb out and feel stuck in a state of being hyperaroused, such as feeling chronically anxious, on edge, and hypervigilant about people, places, and things that perhaps may not even seem related to our trauma.

And while there is a lot of emotional and physical pain associated with trauma, we can overcome it.  This is done by understanding that what we are experiencing is largely neurological, and that we aren’t “crazy” or somehow beyond help.  That once we can bring awareness to our feelings and actions, and see them as more of a defense mechanism than something that makes logical sense, then we can start to regain control of our brain, our body–and thus, our life.

The big gift in trauma is self-awareness, but it’s a gift that we must work hard at unwrapping.  …But boy is it worth it.

I hope you enjoy this book as much as I did.   My full notes are below.

 

Full notes on “The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma”:

There are different types of trauma.  Trauma can be an event, or it can be ongoing.  It can happen to people when they are children, or when they are adults.  Chronic emotional abuse and neglect can be just as devastating as physical abuse and sexual molestation.  We all need to be seen and known, and not having anywhere to feel safe is devastating at any age—but particularly for children.

 

Trauma in childhood. People may talk about their trauma in childhood, but odds are they don’t fully realize the lasting effects of that trauma. If a child grows up with parents that are traumatizing (whether or not these parents are intentionally or unintentionally this way) it creates an internal map for these children and how they see the world and how they function in it.  They either become a product of their environment or the rebel against it.

 

Children become attached to whoever functions as their primary caregiver.  Children have a biological instinct to attach—they have no choice. Whether their parents or caregivers are loving and caring or distant, insensitive, rejecting, or abusive, children will develop a coping style based on their attempt to get at least some of their needs met.

 

Caregivers don’t just feed and comfort us, they shape the way our rapidly growing brain perceives reality. Our interactions convey what and who is safe and what and who is dangerous. The information forms the template of how we think of ourselves and the world around us.

 

But the nature of that attachment—whether it is secure or insecure—makes a huge difference over the course of a child’s life. Secure attachment develops when care giving includes emotional attunement. One of our primary needs that we all must get met is knowing we matter—especially when we are children.  And children will go to almost any length to feel seen and connected (aka significant).

 

Attachment styles.  There are 4 attachment styles between children and their caregiver(s) (and unexamined attachment styles tend to stay with us. Meaning, avoidant children become avoidant adults, etc.)

4 Types of Attachment Styles:

 1. Secure: The child gets upset and then get comforted when the primary caregiver returns.

2. Avoidant: The child is passive and withdrawn.

3. Anxious: The child screams, yells, clings, cries, and draws attention to themselves.

4. Disorganized: The child is seeking closeness, but avoiding the parent—which puts them in a scramble to where there is no solution.

 

Attachment is key. Knowing that we matter.

Traumatized children are often oppositional and defiant and hyperactive or numbed out.

Was the different worldview of normal children what accounted for their resilience and on a deeper level, how each child actually creates her map of the world.  And is it possible to help the minds and brains of brutalized children to redraw their inner maps and incorporate a sense of trust and confidence in the future?

Dissociation. Manifests as feeling lost, overwhelmed, abandoned, and disconnected from the world and in seeing oneself as unloved, empty, helpless, trapped, and weighed down.  Maternal disengagement and misattunement during the first 2 years of life is correlated to dissociative symptoms in early adulthood.

If you cannot tolerate what you know or your feelings, the only option is denial and dissociation.

 

Childhood trauma often happens due to parent’s acting upon (and out) due to their unresolved trauma.  Children with disorganized attachment have no one to turn to—and they are faced with an unsolvable dilemma—their mothers are simultaneously necessary for survival and a source of fear. Not knowing who is safe or whom they belong to, they may become intensely affectionate with strangers or may trust nobody.

 

If a person has no internal sense of security, it is difficult to distinguish between safety and danger. If a person feels chronically numbed out, potentially dangerous situations may make you feel alive. If you conclude that you must be a terrible person, then you start expecting people to treat you horribly—and that there’s nothing you can do about it. When disorganized people carry self-perceptions like these, they are set up to be traumatized by subsequent experiences.

 

Disorganized attachment shows up in two different ways: one group of mothers seemed to be too preoccupied with their own issues to attend to their infants. They were often intrusive and hostile; they alternated between rejecting their infants and acting as if they expected them to respond to their needs. Another group of mothers seemed helpless and fearful. They often came across as sweet or fragile, but they didn’t know how to be the adult in the relationship and seemed to want their children to comfort them. They failed to greet their children after having been away and did not pick them up when the children were distressed. The mothers didn’t seem to be doing these things deliberately, they simply didn’t know how to be attuned to their kids and respond to their cues and thus failed to comfort and reassure them.  The hostile/intrusive mothers were more likely to have childhoods of physical abuse and/or witnessing DV, while the withdrawn/dependent mothers were more likely to have histories of sexual abuse or parental loss (but not physical abuse).

 

Abuse between mothers and children happens when the mothers became increasingly frustrated, defeated, and helpless in their interactions. Once the mother comes to see the child not as her partner in an attuned relationship but as a frustrating, enraging, disconnected stranger, the stage is set for subsequent abuse. The researchers expected that hostile/intrusive behavior on the part of the mothers would be the most powerful predictor of mental instability in their adult children, but it was the opposite: emotional withdrawal had the most profound and long-lasting impact. Emotional distance and role reversal (known as parentification) were specifically linked to aggressive behavior against self and others in the young adults.

 

Children have no choice but to attach to their primary caregiver and learn ways to survive their home life. Children have no choice of who their parent are, nor can they understand that there are reasons that drive their parent’s damaging behavior that has nothing to do with them.  Children have no choice but to organize themselves to survive within the families they have. Unlike adults, they have no other authorities to turn to for help—their parents are the authorities. Their very survival hinges on their caregivers. Children sense—even if they are not threatened—that their beating, molestations or other abuse if reported would lead to punishment. Instead they focus their energy on not thinking about what has happened and not feeling the residues or terror or panic. Because they cannot tolerate knowing what they have experienced, they also cannot understand that their anger, terror, or collapse has anything to do with that experience. They don’t talk, they act and deal with their feeling by being enraged, shut down, compliant, or defiant. Children are also programmed to be fundamentally loyal to their caretakers, even if they are abused by them. Terror increases the need for attachment, even if the source of comfort is also the source of terror.  Rage that has nowhere to go is redirected against the self in the form of depression, self-hatred, and self-destructive actions.

 

Our perceptions create our inner map. If we grow up with people telling us that we are loved and important, and they treat us right, it will feel uncomfortable if we later get into a relationship with someone who is abusive.  But if we grow up in a home where we are abused or ignored in childhood, or grow up in a family where sexuality is treated with disgust, our inner map contains a different message—our sense of self is marked by contempt and humiliation, and we are more likely to think that an abusive person sees us for what we are, and is treating us accordingly—and we will most likely fail to protest this mistreatment (because it feels appropriate and comfortable).

 

Trauma is isolating—like no one understands. The part of our brain that is devoted to ensuring our survival (deep below our rational brain) is not very good at denial. It may be reactivated at the slightest hint of danger and secrete large amounts of stress hormones. This precipitates unpleasant emotions, intense physical sensations, and impulsive and aggressive actions. These reactions feel incomprehensible and overwhelming. Feeling out of control, survivors feel permanently damaged to the core.

 

A traumatized person often realizes their perceptions are not rational, and this often makes them feel even more isolated. Challenging a person’s perceptions can make them feel worse, not better. It’s important to validate how people feel as well as to help them reconstruct their inner map of the world. Feeling Numb. Many feel that they are living behind a glass wall. Felt like he was floating in space, lacking a sense of purpose or direction. Many survivors of trauma come up with their “cover story” which is a story that offers up some explanation for their symptoms and behavior for public consumption.  We are often at a loss for words after trauma (which makes many victims feel that much more isolated.)

 

Trauma is confusing. There’s the trauma we go through and then the trauma we often inflict on others and ourselves as an attempt to get revenge or to diffuse the rage.  We lose our selves when we do this, and we have a hard time connecting with other and reintegrating with society.

 

With abuse, many survivors feel ashamed as to what they did in order to keep a connection with the person who abused them. This leads to confusion as to whether they were a victim or a willing participant. There is also confusion about the difference between love and terror, pain and pleasure.

 

Many traumatized people lose their sense of purpose and direction. They’ll ask for advice about ordinary things and then not take it. The problem is that their relationship with their inner reality was impaired. How could they make any decisions or put any plan into action if they couldn’t define what they wanted or what the sensations in their bodies, the basis of all emotions were trying to tell them? The lack of self-awareness is sometimes so profound that they cannot recognize themselves in a mirror.

 

Trauma involves flashbacks. Trauma is not stored as a narrative with a beginning, middle and end. Flashbacks contain fragments of the experience, isolated images, sounds, and body sensations that initially have no context other than fear and panic.

 

Trauma is upsetting. Triggered responses manifest in various ways. Veterans may react to the slightest cue—like hitting a bump in the road or seeing a kid playing in the street as if they were in a war zone. They startle easily and become enraged or numb. They may avoid people and physical contact.

 

These intense and barely controllable urges and emotions make people feel crazy and makes them feel they don’t belong to the human race. Feeling numb during birthday parties or in response to the death of a loved one makes people feel like monsters. As a result, shame becomes the dominant emotion and hiding the truth the central preoccupation.

 

Trauma often leads to a disconnection from ourselves. Alexithymia: not having words for feelings.  Many traumatized people simply cannot describe what they are feeling because they cannot identify what their physical sensations mean. They may look furious but deny that they are angry. They may appear terrified but say they are fine.  Not being able to discern what is going on inside their bodies causes them to be out of touch with their needs and they have trouble taking care of themselves—whether it involves eating the right amount at the right time, or getting the sleep they need. Alexithmic people substitute the language of action for that emotion. When asked how they would feel if they saw a truck coming at them 80 miles per hour, most people would say that they’d be terrified or frozen with fear. An alexithymic might reply, “I don’t know how I’d feel—I’d get out of the way.”  They tend to register emotions as physical problems rather than signals that something deserves their attention.  Instead of feeling angry or sad, they experience muscle pain, bowel issues, or other symptoms with no cause can be found.

 

Traumatized people have trouble sensing what is going on in their bodies, and respond to stress as spaced out or with excessive anger, and they often can’t tell what is upsetting them. This failure to be in touch with their bodies contributes to their well-documented lack of self-protection and high rates of revictimization, difficulty feeling pleasure, sensuality, and having a sense of meaning.

 

Trauma often goes misdiagnosed and mistreated. How their problems are defined (the diagnosis) will determine their care. Many patients receive 5-6 different unrelated diagnoses in the course of their psychiatric treatment depending upon which symptoms the clinician focuses on.  If they have mood swings, they may be diagnosed as bipolar, if they have despair, they may be diagnosed as having major depression, restlessness and lack of attention=ADD/ADHD. If they take a trauma history, they may be diagnosed as PTSD. None of these are totally off the mark, but they don’t address the complete picture.

 

  • Problems with the DSM. DSM-V criteria takes a 19th century view of illnesses, which classified them according to their surface manifestations—such as boils and blisters. Then, once bacteria was discovered, treatments were aimed at getting rid of the bacteria instead of just treating the boils and fevers. (This ignores the causes and treats the symptoms.)

 

The DSM lacks “reliability” (the ability to produce consistent, replicable results.) Meaning, scientific validity.  If doctors can’t agree on what ails their patient, there is no way they can provide proper treatment. When there’s no relationship between diagnosis and cure, a mislabeled patient is bound to be a mistreated patient.

 

Psychiatry aspires to define mental illness with precision—like this is cancer of the pancreas, or strep throat, however, given the complexity of the mind, body, and human attachments, this level of precision isn’t possible. Understanding what is “wrong” with people is more a question of the mindset (and training) of the practitioner (and what insurance companies will pay for) than of verifiable, objective facts. The first serious attempt to create a manual of psychiatric diagnoses occurred in 1980 with the release of the 3rd edition of the DSM. The preamble to the DSM-III warned explicitly that its categories were insufficiently precise to be used in forensic settings or for insurance purposes. Nonetheless, the DSM became an instrument of enormous power—insurance companies require DSM diagnosis for reimbursement and academic programs are organized around DSM cateogires. A psych diagnosis has serious consequences: diagnosis informs treatment, and getting the wrong treatment can have disastrous effects. Also a diagnostic label is likely to attach to people for the rest of their lives and have a profound influence on how they define themselves.

 

Trauma is largely neurological. When people are really upset, they often feel like they are “losing their mind.”  In technical terms, they are experiencing the loss of executive functioning.

 

The brain on trauma: the limbic brain and visual cortex show increased activation and the speech center shows markedly decreased activation.  …Intense emotion activates the amygdala. Our rational, cognitive brain is the youngest part of our brain and only occupies about 30% of our skull. It is primarily concerns with the world outside of us: understanding how things and people work and figuring out how to accomplish goals, manage our time, and sequence our actions.

 

The brain is built from the bottom up. The most primitive part—the reptilian brain is located in the brain stem, just above the place where our spinal cord enters the skull. It’s responsible for hunger, thirst, pain, crying, breathing, riding the body of toxins (urinating/defecating).  The brain stem and hypothalamus (which sits directly above it) controls the energy levels of the body. Coordinates endocrine and immune systems and keeps internal balance known as homeostasis.

 

Right above the reptilian brain is the limbic system. (Mammal brain.)  It is the seat of emotions, the monitor of danger, the judge of what is pleasurable or scary, the arbiter of what is or is not important for survival purposes. The limbic system is shaped in response to experience, in partnership with the infant’s own genetic makeup and inborn temperament. Whatever happens to a baby contributes to the emotional and perceptual map of the world that its developing brain creates. Neurons that fire together, wire together (aka neuroplasticity).

 

If you feel safe and loved, your brain becomes specialized in exploration, play, and cooperative; if you are frightened and unwanted, it specializes in managing feelings of fear and abandonment.

In this book, the emotional brain=reptilian brain and limbic system. The emotional brain is at the heart of the central nervous system, and its key task is to look out for your welfare. If it detects danger, or a special opportunity, it alerts you by releasing a squirt of hormones. The result is a visceral sensation (ranging from mild queasiness to the grip of panic in your chest) and will interfere with whatever your mind is currently focused on and gets you moving—physically and mentally—in a different direction.

Well-functioning frontal lobes are crucial for harmonious relationships with our fellow humans.  Without flexible, active frontal lobes, people become creatures of habit and their relationships become superficial and routine. Invention, innovation, discovery, and wonder are all lacking.

 

Frontal Lobes: Our frontal lobes can also (sometimes but not always) stop us from doing things that will embarrass us or hurt others. We don’t have to eat every time we are hungry, or blow up every time we are angry, or kiss anybody who arouses our desires.

 

But it is exactly on that edge between impulse and acceptable behavior where most of our troubles begin.  The more intense the visceral, sensory input from the emotional brain, the less capacity the rational brain has to put a damper on it.

Past trauma and the ongoing threat perception system of the brain effects people’s current reactions.  The amygdala makes no distinction between past and present once triggered—even if the trigger isn’t the same as the original trauma.  (An extreme response is worth looking at and examining what other times did we feel like this?)

 

The challenge is not so much learning to accept the terrible things that have happened but learning how to gain mastery over one’s internal sensations and emotions. Sensing, naming, and identifying what is going on inside is the first step to recovery.

 

Amygdala: It’s important that our amygdala is working correctly. It’s like a smoke detector for danger.  We don’t want to get caught unaware by a raging fire, but we also don’t want to go into a frenzy every time you smell smoke.  …We need to detect whether someone is getting upset with us, but if the amgdala goes into overdrive, we may become chronically scared that people hate us or that we feel they are out to get us.

 

Therapy only works if a person is grounded in the present moment (can feel their butt in the chair, see the light coming thru the window, etc.) and feel calm and safe. Being anchored in the present while revisiting the trauma opens the possibility of deeply knowing that the terrible events belong to the past. If a person is in a flashback or doesn’t feel calm or safe (feels defensive/aggressive and unsafe/not believed) then therapy won’t work (at best) and at worst can make a person feel retraumatized.

 

Thalamus: Our Thalamus is like a cook.  It takes in info from all the senses and then blends it with our autobiographical memory. Breakdown of the thalamus explains why trauma is primarily remembered not as a story with a beginning, middle, or end, but as isolated sensory imprints: images, sounds, physical sensations that are accompanied by intense emotions usually terror and helplessness.

 

In normal circumstances, the thalamus also acts as a filter or gatekeeper. This makes it a central component of attention, concentration, and new learning—all of which are compromised by trauma. People with PTSD have their floodgates wide open. Lacking a filter, they are on constant sensory overload. In order to cope, they try to shut themselves down and develop tunnel vision and hyperfocus. If they can’t shut down naturally, they may enlist drugs or alcohol to block out the world. The tragedy is that the price of closing down includes filtering out sources of pleasure and joy as well.

 

Mirror neurons. Explains empathy, imitation, synchrony, and the development of language. Mirror neurons are like “neural WiFi” we pick up not only another person’s movement but their emotional state and intentions as well. When people are in sync with each other, they tend to stand or sit in similar ways, and their voices take on the same rhythms. But mirror neurons also make us vulnerable to others’ negativity, so that we respond to their anger with fury or are dragged down by their depression.  Because trauma almost invariably involves not being seen, not being mirrored, and not being taken into account, treatment needs to reactivate the capacity to safely mirror, and be mirrored, by others, but also to resist being hijacked by others’ negative emotions.

Two ways to implement change: Top down or bottom up.  Structures in the emotional brain decide what we perceive as dangerous or safe. There are two ways of changing the threat detection system:  from the top down (via modulating messages from the medial prefrontal cortex—mindfulness, meditation, and yoga can help) or the bottom up via the reptilian brain (through breathing, movement, and touch) which helps to recalibrate the autonomic nervous system.

 

Autonomic Nervous System (ANS) Includes both the sympathetic and parasympathetic nervous systems.

 

The sympathetic nervous system (SNS) acts as the body’s accelerator, includes fight or flight (or what Darwin referred to as escape or avoidant behavior). Function with the use of emotions.

 

Parasympathetic (PNS) works against emotions, and promotes self preservation functions like digestion and wound healing. Exhaling helps to calm us down (inhaling helps to activate adrenaline).

 

We can access the ANS through breath, movement, or touch. Breathing is one of the few body functions under both conscious and autonomic control.

 

The neuroscientist Paul MacLean compares the relationship between the rational brain and the emotional brain to that between a more or less competent rider and his unruly horse. As long as the weather is calm and the path is smooth, the rider can feel in excellent control. But unexpected sounds or threats from other animals can make the horse bolt, forcing the rider to hold on for dear life. Likewise, when people feel that their survival is at stake or they are seized by rages, longings, fear, or sexual desires, they stop listening to the voice of reason and it makes little sense to argue with them. (CD)

Ex: a person whose been in anger mgmt classes for 7 times extols the virture of the techniques by saying they are great and work terrific as long as you are not really angry.

When our emotional and rational brains are in conflict (as when we’re enraged with someone we love, frightened by someone we depend on, or lust after someone who is off limits) a tug or war ensues, and gives us a visceral experience—our gut, heart and lungs and will lead to both physical discomfort and psychological misery.

Adrenaline. Insults and injuries are remembered the best because the adrenaline that we secrete to defend against potential threats helps to engrave those incidents into our minds.  …Even if the content of the remark fades, our dislike for the person who made it usually persists.

 

When something reminds traumatized people of the past, their right brain reacts as if the traumatic event were happening in the present. But because their left brain isn’t working well, they may not be aware that they are re-experiencing and reenacting the past—they are furious, terrified, enraged, ashamed, or frozen. After the emotional storm passes, they may look for something or somebody to blame for it. “Look at what you made me do.”  Most of us have blamed others for our behavior from time-to-time, but once we cool down, hopefully we can admit our mistake. However, trauma interferes with this kind of awareness.

CD45 cells are the “memory cells” of the immune system.  There is a RA to RO ratio. RA cells have been activated by past exposure to toxins and they quickly respond to environmental threats they have encountered before. RO cells, in contrast, are kept in reserve for new challenges—they are turned on to deal with threats the body has not met previously. In patients with a history of incest, the proportion of RA cells that are ready to pounce is larger than normal. This makes the immune system oversensitive to threat, so that it is prone to mount a defense when none is needed, even when this means attacking the body’s own cells.

The different types of memory:

Traumatic memories: are precipitated by specific triggers (like Julian’s girlfriend’s comment, or Irene’s bed). When one element of a traumatic experience is triggered, other elements are likely to follow. Traumatic enactment serves no function—it’s reactive.

Ordinary memories: are social—they are stories that are told for a purpose.

Complete memory: a memory that is accompanied by the appropriate feelings. (This is what happened, this is how I felt.)

When people are unable to integrate their traumatic memories, they seem to lose their capacity to assimilate new experiences as well. It is as if their personality stops at a certain points and cannot enlarge any more by the addition or assimilation of new elements. Unless they become aware of the split off elements and integrate them into a story that had happened in the past but was now over, they would experience a slow decline in their personal and professional functioning.

 

People don’t experience trauma in the same way.  Not all people experience trauma in the same way. Some are on hyper alert, and some go numb and have decreased activation.  Blank stares, absent minds are the outward manifestation of the “freeze” reaction.  Much of how we react to trauma (which survival mode we go into) as adults is how we learned to react to trauma as children.  If we numb out as kids, then we may numb out as adults.  The challenge for people like this is to become alert and engaged—a difficult, but unavoidable task if they want to recapture their lives. The acting out kids get attention, but the numbed out ones don’t bother anyone and left to lose their future bit by bit.

 

After trauma, many people are either hypervigilant or numb.  If they are hypervigilant, then they cannot enjoy the ordinary pleasures that life has to offer.  If they are numb, then they have trouble absorbing new experiences or to be alert to signs of real danger. When the amygdala malfunctions, people no longer run when they should be trying to escape or fight back when they should be defending themselves.

 

It can be really challenging to help people to deactivate these defense mechanism that once ensured their survival.  …This isn’t about stopping a behavior like yelling, it’s about deactivating a defense mechanism.

Four Main Points to Know About Trauma:

  1. People are not patients, but participants in their healing, and need to restore their autonomy.
  1. Victims of trauma continue to be “there” instead of “here.”
  1. You can only be fully in charge of your life only if you can acknowledge the reality of your body, in all its visceral dimensions.
  1. People who suffer from flashbacks (and I think the vast majority of us do) often (consciously or unconsciously) organize their lives around trying to protect against them. They might workout trying to be strong enough to fend off an attacker, numb themselves with drugs, or try to cultivate an illusory sense of control in highly dangerous situations like bungee jumping, sky diving, etc.) fighting unseen dangers is exhausting and leaves them fatigued, depressed and weary. If the elements of trauma are replayed again and again, the accompanying stress hormones engrave those memories ever more deeply in the mind. Ordinary day-to-day events become less and less compelling. Not being able to deeply take in what is going on around them makes it impossible to feel fully alive. It becomes hared to feel the joys and aggravations of ordinary life, harder to concentrate on the tasks at hand. Not being fully alive in the present keeps them more firmly imprisoned in the past.

 

Spectrum of responses from trauma:

Spectrum of responses from trauma:  frantic, collapsed, or focused. Depends on level of danger:

First level of response is “fawn/friend” We call out for help, support, and comfort from people around us. If no one comes to our aid, or we’re in immediate danger then the 2nd level is activated. (ventral vagal complex—VVC)

Second level is activated: fight or flight. If this fails (we can’t run) the sympathetic nervous system is activated (SNS). (Mammal brain)

Third level of response is activated: freeze/collapse where the organism tries to preserve itself by shutting down and expending as little energy as possible.  (DVC—dorsal vagal complex—shock/numb. Heart rate plunges, feel our heart drop, can’t breathe, gut stops working)

 

  • Losing your sense of self. Agency and a sense of control helps a person not develop PTSD.

 

Angry people live in angry bodies. The bodies of trauma victims are tense and defensive until they find a way to relax and feel safe. Begin by describing physical sensations beneath the emotions—pressure, heat, muscular tension, tingling, caving in, feeling hollow, etc.

 

  • Then work on identifying sensations associated with relaxation or pleasure. Help them become aware of their breath, their gestures, and movements. Ask them to pay attention to subtle shifts in their bodies, such as tightness in their chests, gnawing in their bellies—especially when they talk about negative events that they claim did not bother them. The most natural way for human beings to calm themselves when they are upset is by clinging to another person. This is hard if the person was physically or sexually violated, because they are often terrified of bodily contact.

 

  • The power of hitting rock bottom. Therapy often starts due to some inexplicable /problematic behavior : not sleeping/eating, fear of others, partner cheating the 4th time, etc. Jumping into the fix the problem isn’t the solution, it takes time and patience to allow the reality behind such symptoms to reveal itself.  Because the issue is rarely what’s on the surface—it’s what is driving the surface behavior that is the issue—and that takes a bit to get at.

 

  • Many traumatized people find themselves chronically out of sync with the people around them. Many find comfort in groups where they can talk about what happened to them with others who have gone through something similar. This helps alleviate their searing sense of isolation, but usually at the price of having to deny their individual difference. Isolating oneself into a narrowly defined victim group promotes a view of others as irrelevant at best and dangerous at worst—which eventually only leads to further alientation. Well functioning people are able to accept individual differences and acknowledge the humanity of others. Gangs, cults, (religion), extreme political parties create a “me vs you” mentality which doesn’t foster mental flexibility needed to be open to life and life experiences.

 

  • If relationships with people don’t help, relationships with other mammals can. (Animal therapy)

 

  • TAT (thematic Apperception Test). Set of cards that show pictures, and people are to tell a story about what happened previously and what happens next. In most cases, their interpretations quickly reveal the themes that preoccupy them.

 

After trauma, people tend to automatically keep repeating certain actions, emotions, and sensations related to trauma.

Traumatic memories: are precipitated by specific triggers. When one element of a traumatic experience is triggered, other elements are likely to follow. Traumatic enactment serves no function—it’s reactive.

Freud saw/thought that lack of verbal memory is central in trauma and that if a person does not remember, he is likely to act out. “He reproduces it not as a memory but as an action; he repeats it, without knowing, of course, that he is repeating, and in the end, we understand that this is his way of remembering.”

“The talking cure” 1893 Freus and Breuer, that individual hysterical symptom immediately and permanently disappeared when we had succeeded in bringing clearly to light the memory of the event by which is was provoked.” When the patient has described that event in the greatest possible detail and had put the affect into words.”

There needs to be an “energetic reaction” to traumatic events, and if there isn’t the affect “remains attached to the memory” and cannot be discharged.  Tears and acts of revenge are how most people “discharge” their trauma.

If people don’t consciously remember they react.

Finding words to describe what has happened to you can be transformative, but it does not always abolish flashbacks or improve concentration, stimulate vital involvement in your life or reduce hypersensitivity to disappointments and perceived injuries.

 

Nobody wants to remember trauma—we all want to live in a world that is safe, manageable, and predictable.

Breaking the Silence. We may think that we can control our grief, our terror, or our shame by remaining silent, but naming offers the possibility of a different kind of control. …When Adam was put in charge of the animal kingdom in the Book of Genesis, his first act was to give a name to every living creature. If you’ve been hurt, you need to acknowledge and name what happened to you.

Alexithymia: not being able to sense and communicate what is going on with you.

Helen Keller was wild and untamed. Lost in herself and her dark world.  It took 10 weeks for her teacher trying to connect before the breakthrough occurred.  Helen later recalled that moment in “The Story of My Life” “Water! That word startled my soul, and it awoke, full of the spirit of the morning…until that day my mind had been like a darkened chamber, waiting for words to enter and light the lamp which is thought. I learned a great many words that day.” Learning the names of things enabled the child not only to create an inner representation of the invisible and inaudible physical reality around her but also to find herself: six months later she started to use the first-person “I.”

Harvard psychologist Jerome Kagan once said, “The task of describing most private experiences can be likened to reaching down to a deep well to pick up small fragile crystal figures while you are wearing thick leather mittens.”  We can get past the slipperiness of words by engaging the self-observing, body-based self system, which speaks through sensations, tone of voice, and body tensions. Being able to perceive visceral sensations is the very foundation of emotional awareness.

In 2002 Dr. Spencer Eth interviewed  225 people who had escaped the Twin Towers. When asked what had helped they recover the most, the survivors credited acupuncture, massage, yoga, and EMDR (in that order). And massage was particularly helpful among rescue workers.  The survey suggests that the most helpful interventions focused on relieving the physical burdens generated by trauma.

Trauma makes people feel like either some body else, or like no body.  People often lose the ability to speak. In order to overcome trauma, you need help to get back in touch with your body, and with your self.

Our sense of ourselves is anchored in a vital connection with our bodies. We do not truly know ourselves unless we can feel and interpret our physical sensations; we need to register and act on these sensations to navigate safely throughout life. If you are unaware of what your body needs, you can’t take care of it. If you don’t feel hunger, you can’t nourish yourself. If you mistake anxiety for hunger, you may eat too much. And if you can’t feel when you are full, you’ll keep eating. This is why cultivating sensory awareness is such a critical aspect of trauma recovery. Traumatized people need to learn that they can tolerate their sensations, befriend their inner experiences, and cultivate new action patterns.

In yoga, you focus your attention on your breathing and your sensations moment to moment. You begin to notice the connection between your emotions and your body. You begin to experiment with changing the way you feel. Will taking a deep breath relieve that tension in your shoulder? Will focusing on your exhalations produce a sense of calm?

 

Once you start approaching the body (and perceptions) with curiosity rather than fear, everything shifts.

“This being human is a guest house. Every morning is a new arrival. A joy, a depression, a meanness, some momentary awareness comes as an unexpected visitor.  Welcome and entertain them all.  Treat each guest honorably. The dark thought, the shame, the malice, meet them at the door laughing, and invite them in. Be grateful for whoever comes, because each has been sent as a guide from beyond.”  -Rumi

Neurofeedback and Alpha and Theta wave brain training helps to calm a person down and get them out of fight or flight mode.

Moving forward into healing:

No one can “treat” away, abuse, rape, molestation, or any other horrendous event—what has happened cannot be undone. But what can be dealt with are the imprints of the trauma on the 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.  Trauma robs you of the feeling that you are in charge of yourself. The challenge of recovery is to reestablish ownership of your body and mind—to feel what you feel without becoming overwhelmed, enraged, ashamed, or collapsed.

For most people this involves:

  1. Finding a way to become calm and focused
  2. Learning to maintain that calm in response to images, thoughts, sounds, or physical sensations that remind your of the past
  3. Finding a way to be fully alive in the present and engaged with the people around you
  4. Not having to keep secrets from yourself, including secrets about the ways that you have managed to survive.

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 hypo arousal, we are pushed outside of 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 or 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. In order to change our reactions, we must do limbic system therapy, and access the emotional brain.

The only way that we can consciously access the emotional brain is through self-awareness.

The only way to change the way we feel is by becoming aware of our inner experience and learning to befriend what is going on inside ourselves.

Befriending the emotional brain. Reconnecting with ourselves. “You can’t do what you want till you know what you’re doing.” – Moshe Feldenkrais Generally, our rational brain can override the emotional brain, as long as our fears don’t hijack us. The moment we feel trapped, enraged, or rejected, we are vulnerable to activating old maps and following their directions.

Change begins when we learn to “own” our emotional brains. That means learning to observe and tolerate the heartbreaking and gut-wrenching sensations that register misery and humiliation. Only after learning to bear what is going on inside can we start to befriend rather than obliterate the emotions that keep our maps fixed and immutable.

 

–           Starts with awareness that this is a neurological thing and not a rational thing.

–           To draw out the sensory information that is blocked and frozen by trauma.

–           To help patients befriend (rather than surpress) the energies released by that inner experience.

–           To complete the self-preserving physical actions that were thwarted when they were trapped, restrained, or immobilized by terror.

 

The implications are clear: to feel present you have to know where you are and be aware of what is going on with you. (This takes IQ and EQ.) If the self-sensing system breaks down we need to find ways to reactivate it.  Knowing what we feel is the first step to knowing why we feel that way.

If you have a comfortable connection with your inner sensations—if you can trust them to give you accurate information—then you will feel in charge of your body, your feelings, yourself.

–           Dealing with hyperarousal. Research supported by the NIH have shown that 10 weeks of yoga practice markedly reduced the PTSD symptoms who had failed to respond to any medication or to any other treatment.

–           Learning breathing techniques help to nourish our tissues and keep us relaxed and present.

–           The core of recovery is self-awareness. The most important phrases in trauma therapy are “notice that” and “what happens next?” (replace judgment and fear with curiousity)

–           Traumatized people are often afraid of feeling. (they drink/use drugs, have casual sex/fear intimacy, and avoid many social activities.) Learn to pay attention to physical sensations and then label them. “When I feel anxious, I feel a crushing sensation in my chest.”

–           Try to observe how particular thoughts are stored in the body. Does “my mother says she loves me” feel like when someone broke into your home?

–           Tip toe past the amygdale (kaizen)

–           Remind yourself that you are safe—stay grounded

–           Studies show that having a good support netword constitutes the single most powerful protection against becoming traumatized.  Safety and terror are incompatible.

–           Visualization.

–           Affirmations that you are safe and secure. Someone bigger and stronger is taking care of things so you can safely go to sleep.

–           Music and dancing can help get around the amygdale

–           The most natural way that people calm down during distress is being touched, hugged, and rocked (aerial yoga)

–           This makes us feel intact, safe, protected, and in charge.

 

(((HUGS)))

Dana 🙂

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Dana

I am a self-help junkie, former advocate for victims of domestic violence, current psychiatric RN, as well as being a recovering victim of Narcissistic abuse.

My goal is to educate, empower, and inspire other abuse victims in understanding more about what happened to them (and how to prevent it from happening again), as well as how to go on and rebuild an amazing life.

Even though I have had a lot of "in the trenches" experience with highly manipulative people of all kinds, I consider myself to be a student of Narcissism, mindset, motivation, healing, and life in general, and am by no means an expert on any of these topics.

It's for these reasons, that when you are reading my information that I encourage you to hold to what helps, and let the rest go.
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About Dana 254 Articles
I am a self-help junkie, former advocate for victims of domestic violence, current psychiatric RN, as well as being a recovering victim of Narcissistic abuse. My goal is to educate, empower, and inspire other abuse victims in understanding more about what happened to them (and how to prevent it from happening again), as well as how to go on and rebuild an amazing life. Even though I have had a lot of "in the trenches" experience with highly manipulative people of all kinds, I consider myself to be a student of Narcissism, mindset, motivation, healing, and life in general, and am by no means an expert on any of these topics. It's for these reasons, that when you are reading my information that I encourage you to hold to what helps, and let the rest go.

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