What Resets Our Nervous System After Trauma
Peter Levine, PhD

Dr. Levine: When I first started developing my approach to trauma, I noticed how many different kinds of seemingly ordinary events couldPeter Levin: The Origin of SE cause people to develop symptoms that would be later defined as trauma, as PTSD.

I also was really curious why animals in the wild don’t develop the same symptoms – because the parts of the brain that respond to stress are quite similar in all mammals, including humans. And if animals became so easily traumatized, they probably would never survive because they would lose their edge. They wouldn’t survive, nor would the species survive.

So I realized there must be some powerful innate mechanism that helps people rebound; that sort of resets our nervous system after highly arousing encounters with stress. And I discovered that these reactions that reset the nervous system are identical with animals and with people. The difference is that we learn to override it because of our fear of powerful sensations.

“I discovered that these reactions that reset the nervous system are identical with animals and with people. ”
I know it is an oversimplification, but the basic idea is to guide people to help them recapture this natural resilience. We can do this through helping them become aware of body sensations. And as they become aware and are able to befriend their body sensations, they are able to move out of these stuck places.

I realized that trauma was about being stuck in these high levels of arousal or in low-level, shut-down levels of arousal and dissociation. So it really became a matter of learning how to help the people to contain these sensations and help them to move through, back into life, to discharge, as it were, these high-levels of activation.

“It really became a matter of learning how to help the people to contain these sensations and help them to move through, back into life, to discharge, as it were, these high-levels of activation.”
In animals – and in humans – I noticed that trauma has a particular type of sequence involving shaking and trembling.

We can help move these people out of these high states of hyper-arousal back into balance, back into equilibrium, and how to help people come out of shut-down and dissociation, and come back into life. We discovered that it was possible to do this in a safe way; in a way that really largely ensured that people weren’t overwhelmed.

Back in the 1970’s, there were some cathartic therapies that would lead to really big reactions, and often people would feel better after that – probably, at least in large part, because there was a releasing of endorphins and catecholamines, adrenalin-like hormones, and neurotransmitters, and so people, in a way, felt a tremendous relief, even a high. But then they would go back into the same trauma patterns afterward.

So I realized that, if you just overwhelm the person, the nervous system really can’t tell the difference between the trauma and just being overwhelmed/overloaded in the same way.

“If you just overwhelm the person, the nervous system really can’t tell the difference between the trauma and just being overwhelmed/overloaded”
So that really is the basis of the core aspects of somatic experiencing. And because it was a naturalistic way of approaching things – learning from animals in the wild, from ethology (I actually called my first book Waking the Tiger, dealing with trauma) – to awakening those resilient instincts that exist within us because we are mammals.

The Nine-Step Method for Transforming Trauma

The first thing is to create a sense of relative safety. You have to help the person feel just safe enough to begin to go into their bodies.

Then, from that sense of relative safety created by the therapist and the environment, we help the person to support initial exploration and acceptance of sensations. And we do it, again, only a little bit at a time, so they “touch into their sensations” then come back into the room, into themselves.
“From that sense of relative safety created by the therapist and the environment, we help the person to support initial exploration and acceptance of sensations.”

The third step is a process I call “pendulation.” That’s a word I made up – what it means is that when people first begin to experience their body sensations, they actually feel worse for a moment. It is probably largely because they have avoided their sensations. So when they feel them, they feel worse.

This is like a contraction. But what I have discovered is when you help support people, they discover that with every contraction there is an expansion. So if they learn to stay with these sensations just momentarily long enough, it will contract but then it will expand. And the rhythm between contraction and expansion, that gives people the sense of, “Oh my God, I’m going to be able to master this!” you know?

“Pendulation is the rhythm between contraction and expansion . . . titration is about carefully touching into the smallest drop of survival-based arousal.”
So, again, when they get the sense or rhythm of contraction/expansion, it needn’t then become threatening. It just becomes, “Oh, okay, I’m contracting, and now I’m expanding.”

The fourth step, which is really the first, and the second, and the third, and the fourth, fifth, sixth, seventh and eighth, is what I call “titration.” And by titrating, by just dosing one small amount of experience at a time, this creates an increase in stability, resilience, and reorganization of the nervous system. So titration is about carefully touching into the smallest drop of survival-based arousal.

Dr. Buczynski: So sort of like a homeopathic approach to trauma? A homeopathic dose level of approaching body experiences?

Dr. Levine: Yes! Yes, that’s it! Yes, that is a really good analogy – and it may be more than just an analogy. You know, we have a number of homeopaths, particularly in the European and South American trainings – and, you know, they get it, they really get it; you know, the idea of the smallest amount of stimulus that get the body engaged in its own self-defense mechanisms.

Then the fifth step is to provide corrective experiences by helping them have active experience that supplants or contradicts the passive response of collapse and helplessness. So as they recover active responses, they can feel empowered – they develop active defensive responses.
“As they recover active responses, they can feel empowered – they develop active defensive responses.”

When animals are in the immobility response, when they are in the shut-down state, it’s normally time-limited.

I was out on the beach the other day and some of the kids on the beach do this for fun – they will take one of the pigeons and hold it. They will come up very quietly behind the pigeon, hold around its wings so it can’t move, and then turn it over and it goes into this complete immobility response. It doesn’t move. It looks like it is dead – it is so-called “playing possum.”

But then, if they [the kids] leave it for a moment upside-down there on the sand, after a few seconds, it pops out of this immobility state and flies off as though nothing had happened.

But if you frighten the animal when it is coming up or if you frighten it when it is coming in, it stays in that immobility a longer amount of time, a much longer amount of time – particularly if you re-frighten it.

So the thing is that we frighten ourselves. Normally the exiting out of immobility is time-limited. You go in and you go out. When people are coming out of immobility, if they are frightened of those sensations, fear then puts them back into immobility.

So I call it “fear-potentiated immobility.”

In this step, we uncouple the fear from the immobility and the person comes out of the immobility, back into life. And, again, when they come out there is usually a lot of activation, a lot of arousal. When the person comes out, we have to be prepared to help them contain that sensation of arousal and then move through that, back into homeostasis, balance and social engagement. So that is the sixth step.

“We uncouple the fear from the immobility and the person comes out of the immobility, back into life.”

And the seventh step is to help them discharge and regulate the high arousal states, and redistribute the mass of the vital energy mobilized for life-preserving action, while freeing that energy to support higher-level brain functions.

Step eight is engaging self-regulation to restore dynamic equilibrium and relaxed alertness. I like that word better than “homeostasis” because homeostasis implies a static state, and this dynamic equilibrium is always shifting. So we go into a high level of arousal, but dynamically we turn to a balanced equilibrium.

And then the ninth step is to help the person reorient in the here and now – help them to make contact with the environment, the room, wherever they are – the emergency room if it is the emergency room, the recovery room if it is the recovery room. We help them to reestablish the capacity for social engagement.

Thailand Tsumani Surveys – Summary of Results
Foundation for Human Enrichment

Analysis prepared July 2006

The following report summarizes the results from surveys administered to 66 Tsunami survivors. Of these 66, a total of 53 persons participated in one or more SE sessions facilitated by Foundation for Human Enrichment Staff. Another 13 surveys were completed by Tsunami survivors who did not participate in SE sessions. There were 22 survivors who were surveyed in February 2005 and again in February 2006. Thus, a small number of participants were located and have one year follow-up data (n=22). This summary highlights several of the key findings from the 53 survivors who participated in SE sessions and summarizes some of the data from the one year follow-up. Detailed tables which report the totality of responses are available. All of the results should be interpreted with caution given the small sample size and lack of an equivalent comparison group. Approximately one-third of the survey respondents were male and two-thirds were female. The age of participants ranged from 2 to 75 years with an average age of 39.

According to survey data, the vast majority of participants (89%) received one SE session and 11% of participants received two or more sessions.

While the number of responses was small (n=22), 36% of those surveyed approximately one year after the Tsunami were living in the Nam Kem Village. Thirty-two percent were living in the Re-settlement Foundation Housing on pubic land, 18% were still living in camp, and 5% were living in re-settlement houses on their previously owned property.

SYMPTOMS BEFORE TREATMENT

Before receiving treatment, the most frequently reported symptom was physical pain in the body. Of those with reported symptoms, physical pain comprised 45% of the first reported symptom. The second most commonly reported symptom was sleep problems (comprising 30%). Other commonly reported symptoms included worry/anxiety/fear, auditory/visual flashbacks, and other injuries to the body.
The most common symptom observed by a therapist was flat affect. The second most common observed symptom included anxiety. Of those with observed symptoms, flat affect comprised 38% of the first observed symptom. Other commonly observed symptoms included problems with posture and breathing problems.

IMPROVEMENT IMMEDIATELY
AFTER TREATMENT

Participants’ symptoms were assessed immediately after the first SE Session (n=53). Results included:

  • After the session 67% of participants showed complete or partial improvement in reported symptoms
  • After the session 95% of participants exhibited complete or partial improvement in therapist observed symptoms

IMPROVEMENT A FEW DAYS
AFTER TREATMENT

Participants’ symptoms also were ranked a few days after an SE Session (n=16). On average, survivors were assessed within six days of their initial session. Results should be interpreted with caution given the small sample size. Results included:

  • A few days after the session, 90% of participants showed complete or partial improvement in reported symptoms.
  • A few days after the session, 84% of participants exhibited complete or partial improvement in therapist observed symptoms

IMPROVEMENT ONE YEAR
AFTER TREATMENT

Participants’ symptoms also were ranked one year after the first SE Session (n=22). Again, results should be interpreted with caution given the small sample size. Results included:

  • A year after the session, 90% of participants showed complete or partial improvement in reported symptoms.
  • A year after the session, 96% of participants exhibited complete or partial improvement in therapist observed symptoms

Participants were also asked about commonly experienced symptoms at the one year follow-up. Results included:

  • 86% of participants reported no appetite problems
  • 82% of participants reported no sleep problems
  • 90% of participants reported no nightmares
  • 75% of participants reported that they were not on medication after the Tsunami

Gender and Age Analyses
Differences in symptoms and improvement among participants were examined based on gender and age group. While sample sizes were small, the following themes were identified:

  • On average females (n=34) reported higher levels of physical body pain compared to men (n=19). For example, 50% of women reported physical pain as their first reported symptom compared to 37% of men.
  • Interestingly, females showed greater improvement than males in symptoms. After the first session, an average of 71% of females showed complete or partial improvement in reported symptoms compared to 59% of males. These findings were similar when men and women were assessed a few days after the session and after one year.
  • When survivors from different age groups were compared, it was found that those age 40 to 49 reported the highest levels of physical pain in the body. Specifically, 62% of symptoms among 40 to 49 year olds were characterized as physical pain. Other age groups (Ages 2 to 15, 20 to 39, and 50 to 75) reported less frequency of physical pain.
  • Participants from different age groups showed about the same level of improvement of symptoms after participation in SE Sessions.

IN THEIR OWN WORDS
The survey also collected information about participants’ individual experiences. The stories and comments from participants detailed heart wrenching stories of the death of family members, losing homes, and discussed high levels of the survivors’ anxiety and fear. Some of the comments included:

  • Comment #1 – one month after Tsunami: “His mother, sister, and grandmother died in the waves. Father was trying to hold all their hands but couldn’t. He was tumbled by waves and survived by clinging to a floating refrigerator. Has been searching for grandmother’s body. Sees the wave when he closes his eyes.”
  • Comment #2 – one month after Tsunami: “Was village leader in charge of roads. His mother died in waves, body not found. He was a fisherman. Said he’d never go back to the water. Afraid doctors will want to amputate his leg since they are doing many amputations.”
  • Comment #3 – one year after Tsunami: “Family worried he’ll die because he’s not eating. Described ghost in his stomach. At follow-up he said the ‘ghost was gone’. ”
  • Comment #4 – one year after Tsunami: “Lonely. Miss living in village and seeing friends. Afraid another tsunami coming.”
  • Comment #5 – one year after Tsunami: “Daughter (age 8) drowned. Has no other children. Lives with her mother in the village. Have rebuilt on the land where previous house was.”
  • Comment #6 – one year after Tsunami: “Feels stronger, relies on her friends in the village for comfort because she knows she’s not the only one afraid. Would move far away if she had the money.”
  • Comment #7 – one year after Tsunami: “She lives right at the edge of the sea and was saved by clinging to a coconut tree. Now only that one tree remains. Each day she offers the tree a fresh flower.”

Published in Traumatology, Vol. 14, No. 3, September 2008.
The journal version of the article can be ordered in electronic or hard copy format from http://articleworks.cadmus.com/buy?c=1143143&p=1168488&fromsearch=true.

Somatic Therapy Treatment Effects with Tsunami Survivors
Catherine Parker, Ronald M. Doctor, and Raja Selvam1

This is an uncontrolled field study of the outcome effects of a somatically based therapy with tsunami victims in southern India. One hundred and fifty (150) participants, prescreened for trauma symptoms, received 75 minutes of somatic therapy and training in affect modulation and self-regulation. The results indicate a reliable and significant treatment effect at immediate, 4-week, and 8-month follow-up assessments. At the 8-month follow-up, 90% of participants reported significant improvement or being completely free of symptoms of intrusion, arousal, and avoidance. The results support the effectiveness and reliability of this modified version of Somatic Experiencing Therapy in working with trauma reactions and invite future controlled trials of this therapy .

Keywords: posttraumatic stress; somatic therapy; somatic experiencing therapy; IES; post-tsunami symptoms
1From the Department of Psychology, California State University, Northridge, California (CP, RMD); Pacific Graduate Institute, Carpinteria, California (RS).
Contributions to this research among the authors were equal.
Address correspondence to: Ronald M. Doctor, PhD, Department of Psychology, California State University, Northridge, 18111 Nordoff Street, Northridge, CA 91330; e-mail: rdoctor@csun.edu.
The authors wish to express their gratitude to members of the 2005 Trauma Vidya international trauma team to India: Emil Borgir, Daniel Bruce, Rosemary Carpendale, Alexandre Duarte, Giselle Genillard, Lisa LaDue, Beth Nielsen, Jacqueline Ramirez, Lucia Ribas, Jeanne Du Rivage, Lida Ruiter, and Ronnie San Jose. The authors also thank the members of the follow-up research team in India: K. Lakshmanan and L. Jeyanthi from Auroville.
This is a study examining the durability of a somatically based treatment approach to trauma on survivors of the devastating tsunami that hit southern India in the Tamil Nadu region in 2004. Catastrophic natural events such as this one produce high levels of terror, fear, despair, and loss, much of which eventually lead to the development of posttraumatic stress disorder (PTSD). PTSD is among the most common psychological reactions in survivors of disasters (Reyes & Elhai, 2004), but those who survive are also at risk for developing a variety of health problems and other psychological disorders, such as anxiety, depression, and substance abuse (American Psychological Association, 2006). In addition, studies suggest that PTSD has other serious and lasting effects, which include nonspecific stress, chronic problems in relationships, psychosocial resource losses, and problems specific to youth, such as separation anxiety, violence, and eating disorders (Norris, Perilla, & Murphy, 2001; Reyes & Elhai, 2004). 2
The rates of PTSD among survivors can vary significantly depending on the sample studied and the type of disaster (van der Kolk, McFarlane, & Weisaeth, 1996). But we know that situations where sudden, unpredictable life-threatening events pervade a community (such as hurricanes, tsunami, violence or floods, etc.) are likely to produce high levels of PTSD (Karamustafalioglu et al., 2006). For example, individuals involved in the Buffalo Creek disaster, where a dam broke and flooded an entire community, had a 59% incidence of PTSD symptoms among survivors and a lifetime rate of 25% symptomatic at a 14-year follow-up. Likewise, participants in the Vernberg, LaGreca, Silverman, and Prinstein (1996) study of factors predictive of PTSD symptomotology following Hurricane Andrew revealed effects on all five identified factors used to predict or mitigate PTSD development: frightening event, loss/disruption, social support, coping strategies, and supportive social environment. The hurricane caused most of these factors to occur, and, as expected, 86% of the children studied reported mild PTSD symptoms whereas 55% reported moderate to severe levels of symptoms. The tsunami that spread across Southeast Asia, India, and Africa was one of the deadliest natural disasters in history. The result was a death toll of more than 320,000 individuals (Bronisch et al., 2006). In studies of survivors, the following symptoms have been noted: dissociation, hyperarousal, flashbacks, sleep disturbances, illusions, loss of appetite, grief, suicidality, and difficulty concentrating (Bronisch et al., 2006).
According to Somatic Experiencing Therapy, a neurobiology-based somatic approach to working with trauma, trauma resides in the nervous system and not in the event itself (Heller & Heller, 2004). Lower brain centers become engaged during threatening events and executive functions become less active. A dominant neurological reaction occurs involving orienting, fight, flight, or freeze reactions. These reactions are conditioned to aspects of the life-threatening event and subsequent exposure to similar events can trigger an involuntary portion of the terror reaction in the body (Ledoux, 1996). Bodyoriented approaches, such as Somatic Experiencing Therapy (Levine & Frederick, 1997), attempt to gain careful access to these involuntary responses, build awareness of the bodily reactions, and actually “process” them to an “adaptive resolution.” Descriptive and subjective data collected in Thailand on tsunami survivors using Somatic Experiencing Therapy showed that immediately after this therapy 67% of the participants reported partial or complete remission and 90% reported partial or complete improvement at a 1-year follow-up (Leitch, 2007).
With this in mind, we set about using a modified form of Somatic Experiencing Therapy with survivors of the southern India area of Tamil Nadu where devastation was enormous. This study is the report of that effort. A more detailed description of the project may be obtained online (Selvam, 2005).
Method
Participants

The participants were 204 volunteers from 13 fishing villages in 3 districts (Nagapattinam, Cuddalore, and Vilupuram) in Tamil Nadu. The final count, however, for these analyses was 150 participants, because the Vilupuram district did not receive all follow-up assessments and therefore was not included here. Of the 150 participants, 40 were men and 110 were women, with a mean age of 41.6 years. Participants had responded to notices and advertisements in local venues asking for volunteers who had been affected by the tsunami and wanted treatment. Each 3
trauma team member met individually with each participant for approximately 75 minutes.
Prior to treatment contact, each participant was asked to complete a brief set of assessment questionnaires. These questionnaire responses, before and after treatment, and at 4-week and 8-month follow-ups, constitute the data for this study. First, a 17-item Post-Tsunami Symptom Checklist was completed for symptoms that occurred after the tsunami. The Post-Tsunami Symptom Checklist items identified possible emotional and bodily stress reactions that had been gleaned from reports by tsunami survivors from nearby villages. Reliability measures were not taken on this list, but we assume there was good face and construct validity because of the nature of the item selection. Responses to this checklist were coded as dichotomous yes or no answers. Second, 5 of the 17 checklist items were taken from the Impact of Events Scale–Revised–Abbreviated (IES–R–A). These items provided a separate measure closely linked to the Diagnostic and Statistical Manual of Mental Disorders (fourth edition, text revision; American Psychological Association, 2004) main criteria for PTSD (see Horowitz, Wilner, & Alvarez, 1979) in terms of intrusion, hyperarousal, and avoidance criteria. Only volunteers who scored (i.e., said yes to) more than 8 of the 17 items were taken as treatment participants and assumed to be experiencing trauma-related symptoms and assumed to be under personal stress at the time of treatment. Third, a Presenting Post-Tsunami Symptoms completion task asked each participant to list up to three presenting symptoms from which they wanted relief from and whether they had received any medical attention for the same. Almost all tsunami survivors treated had received medical attention for their symptoms but without lasting relief to their symptoms. Because the number of presenting symptoms identified varied from one to three for each participant, the symptoms were combined and averaged into one score for each participant. Fourth, Overall Stress Improvement (change in overall stress from the tsunami), Presenting Symptoms, and IES–R–A items were measured with a modified Subjective Units of Distress (SUD) scale after the treatment and at each follow-up (Wolpe, 1990). The modified SUD units in this study, because of the nature of the population, ranged from 0 to 4, with 0 =worse, 1 =same, 2 =somewhat better, 3 =a lot better, and 4 =completely well. Additionally, at the 8-month follow-up alone, participants were asked to judge percentage changes in Overall Stress Improvement, Presenting Symptoms and IES–R–A items using 0 to 100 paises (in local currency, 100 paises equal 1 rupee). The Overall Stress Improvement scores were treated as a self-report global measure of overall change since treatment in their capacity for self-regulation and were treated as separate from changes in specific symptoms. At only the 8-month follow-up participants were asked to indicate their type of family, marital status, education, occupation, and types of loss experienced during the tsunami.

Design and Procedure
All participants received a modified1 form2 of Somatic Experiencing Therapy treatment from therapists trained for 3 years or more in this work. In all, 11 therapists participated, and assignment of respondents was on a random basis. Name, age, and sex of the participant were coded, but more personal questions were considered intrusive and insensitive in this culture and were not asked at this first session. A four-stage treatment protocol was developed for this single treatment intervention, and all therapists adhered to the protocol as judged by supervisor observations and therapist reports. The protocol consisted of four distinct stages. The first stage focused on containment of physiological arousal associated with tsunami and the aftermath experiences. Containment involved increasing awareness of bodily arousal reactions while, at the same time, building feelings of being grounded and connected and safe with the therapist. Bodily reactions were purposely slowed to avoid anxiety bursts. This first phase was emphasized in the treatment and participants were asked to practice it after the treatment session on a regular basis. Second, narratives were built of the tsunami experiences for what was remembered, felt, what 4
they did or did not do, and, most important, what they sensed in their bodies in the remembrances. “Pendulation” of awareness between being grounded and being safe and the terror-survival responses in their bodies was established on a gradual basis (Levine & Frederick, 1997). Pendulation eventually allowed for processing or release of these involuntary body reactions associated with the event. Third, participants were educated (as they pendulated) on the neurophysiology of stress and trauma in a simple manner that emphasized how the body stores experience and does not release it until the conditions are proper. Education was also aimed at normalizing the experience away from judgments and pathological categorizations and at emphasizing the need to practice regularly after the treatment experience. Finally, tracking of bodily experience helped guide participants toward discharge and better self-regulation of the body experience and state. Tracking the changes helped them see actual resolution of body-held experiences as a standard for future more stress-free behavior.
At each follow-up session, participants were asked to rate changes in Presenting Post-Tsunami Symptoms identified at the first session on a 5-point SUD-type scale previously described. Changes since the treatment in the items on the IES–R–A scale as well as their global Overall Stress Improvement were also rated on the 5-point scale at each follow-up. Two Indian field workers, trained in scale administration, conducted each follow-up session on an individual basis with participants. All questionnaire items and instructions had been translated into Tamil prior to data collection so that comprehension was not a problem.
The data were collapsed into three broad categories related to Degree of Loss and Degree of Traumatization for purposes of data analysis. Degree of Loss was partitioned into low, medium, and high ranges with low being 1 (loss of family, property, financial status, injury, or witness to significant loss), medium being 2 or 3, and high being 4 or 5 types of loss. Degree of Traumatization was determined by the number of yes symptoms checked on the Post-Tsunami Symptom Checklist. Here low represented 8 to 10 symptoms checked, medium represented 11 to 12, and high represented 13 or higher. Thus, two new variables were created, Degree of Traumatization and Degree of Loss.

Results
The three primary dependent variables in this study were the Presenting Post-Tsunami Symptoms scores, Overall Stress Improvement scores, and the IES–R–A scores. Using SPSS, a mixed design analysis of variance (ANOVA) was performed for each dependent variable to determine changes during three assessment periods (immediate, 4 weeks, and 8 months). The grouping variables were by district, gender, Degree of Loss, and Degree of Traumatization. Assumptions regarding normality of sampling distributions, homogeneity of variance–covariance matrices, linearity, and multicollinearity were met in all cases.
The Time (of assessment) effect on Presenting Post-Tsunami Symptom scores was significant, F(2, 118) =14.42, p <.05, partial η2 =.20, indicating reliable improvement during the three follow-up assessment periods. Likewise, there was a significant district-by-time effect on Presenting Post Tsunami Symptom scores. Cuddalore improved at a greater rate than Nagapattinam, although both showed significant improvement. The test for gender effects was not significant and Degree of Loss and Degree of Traumatization scales did not show differential effects over Time although all levels of these variables improved significantly over Time. A mixed-design ANVOA was performed on the IES–R–A ratings at the 4-week and 8-month follow-ups but not the immediate post-treatment assessment. The post-treatment assessment was not considered an appropriate and meaningful measure because participants could not report on experiences that they had not yet had (such as sleep difficulties, etc.). District, gender, and Degree of Loss were used as grouping variables. Degree of Traumatization contained the IES–R–A items 5 so it was excluded from this set of analyses. There was a significant Time effect on IES–R–A scores, indicating reliable improvement over Time. However, district, gender, and Degree of Loss were not associated with IES–R–A score improvement over Time. The SUD ratings measuring Overall Stress Improvement produced significant effects by district, with Cuddalore showing greater improvement than Nagapattinam, F(1, 148) =8.64, p <.05, partial η2 =.06. Sex of the participant was not significant with Overall Stress Improvement over Time but Degree of Loss did show an interactive effect, F(2, 294) =8.26, p <.05, η2 =.05, with high and medium scores making greater improvement than low scores on Degree of Loss. Degree of Traumatization did not interact with Time but Overall Stress Improvement showed significant and sustained improvement over Time, F(2, 146) =6.88, p <.05, η2 =.09. Improvement Ratings
In Table 1, the frequency distributions of self-reported changes on Presenting Post-Tsunami Symptoms across participants at the 4-week and 8month follow-ups are presented. At 4 weeks, the participants reported that 74.2% of the presenting symptoms were somewhat better, a lot better, or completely resolved. At 8 months, the corresponding percentage was higher at 85.2%. In Table 2, the frequency distribution of percentage changes in the variable Overall Stress Improvement (improvement in overall stress from the tsunami), measured only during the 8-month follow-up, is presented. A total of 94.4% of the respondents at the 8-month follow-up reported 50% or more improvement in their overall level of stress from the tsunami.

Table 1. Participant Ratings on Improvement on Post-Tsunami Symptoms on Modified SUD at 4-Week and 8-Month Follow-up
Rating Category 4 Weeks 8 Months
0 =Worse 5.6% 10.7%
1 =The same 20.3% 4.1%
2 =Somewhat better 28.0% 16.4%
3 =A lot better 24.5% 41.8%
4 =Completely well 21.7% 27.0%

Memory, Trauma & Healing
by Peter A. Levine, Ph.D.

The brain’s function is to choose from the past, to diminish it, to simplify it, but not to preserve it.
— Henri Bergson
from The Creative Mind, 1911
For therapists, the current controversy surrounding so-called false ”recovered” traumatic memories raises a number of compelling questions. Where do these ‘false’ memories come from and what is their function? More importantly, what role does memory play in the understanding and treatment of trauma?

Around 1900, the French philosopher Henri Bergson gleaned deep insights into the nature of memory that are just now being appreciated by contemporary researchers and clinicians. Bergson theorized that there are two fundamentally different forms of memory; one conscious, the other unconscious. Neuroscientist Daniel Schacter (1996), in a readable volume entitled Searching for Memory, describes his examination of a patient with a serious head injury. This man (called Mickey) had little memory of his recent experiences. Schacter asked Mickey a series of obscure questions such as ”Who holds the worlds record for shaking hands” and ”Where was the first baseball game played?” Not surprisingly, Mickey did not know the answers to these questions. Schacter then gave them to him. When asked the same questions twenty minutes later in another room, Mickey correctly answered Teddy Roosevelt and Hoboken, New Jersey, etc., to the trivia questions. However, he had no recollection of how he got this information and thought that perhaps it might have been from his sister. Although he had an implicit memory of his meeting with Schacter twenty minutes earlier, he had no explicit memory of it.

Similar observations and extensive experiments have been carried out by experimental psychologists, cognitive neuroscientists and clinicians, confirming that we humans have two distinctly different forms of memory; one explicit and conscious, the other implicit and unconscious. The description by Schacter of Mickey’s strange behavior illustrates the curious ”dissociation” between the conscious and unconscious aspects of memory.

Of particular significance in working with and understanding trauma, is a form of implicit memory that is profoundly unconscious, and forms the basis for the imprint trauma leaves on the body/mind. The relationship between implicit and explicit aspects of an experience is an important dynamic in the resolution of trauma and in the question of false memory.

Memory as Procedure The type of memory utilized in learning most physical activities (walking, riding a bike, skiing, etc.) is a form of implicit memory called ”procedural memory.” Procedural or ”body memories” are learned sequences of coordinated ”motor acts” chained together into meaningful actions. You may not remember explicitly how and when you learned them, but, at the appropriate moment (like Mickey’s trivia knowledge), they are (implicitly) ”recalled” and mobilized (acted out) simultaneously. These ”motoric memories” (action patterns) are formed and orchestrated largely by involuntary structures in the cerebellum and basal ganglia.

Procedures are primarily non-conscious, and attempts at conscious learning are generally counter-productive. Imagine trying to learn how to ride a bicycle, ski or have sex from written instructions. It cannot be done. A book may point you in the direction of where to begin, but the learning occurs through instinct, trial and error.

Trauma is about procedures the organism executes when exposed to overwhelming stress, threat and injury. The failure to neutralize these implicit procedures and restore homeostasis is at the basis for the maladaptive and debilitating symptoms of trauma.

Completion and Remembering

Acts must be carried out to their completion. Whatever their point of departure, the end will be beautiful. It is (only) because an action has not been completed that it is vile.
— Jean Genet, from Thief’s Journal

In response to threat and injury, animals, including humans, execute biologically based, non-conscious action patterns that prepare them to meet the threat and defend themselves. The very structure of trauma, including activation, dissociation, and freezing are based on the evolution of reptilian, mammalian and primate predator/prey survival behaviors. When threatened or injured, organisms draw from a ”library” of possible motoric responses supported by adjustments in the autonomic and visceral nervous systems. In response to threat and injury we orient, dodge, duck, stiffen, brace, retract, fight, flee, freeze, collapse, etc. All of these coordinated responses are somatically based-they are things that the body does to protect and defend itself. It is when these orienting and defending responses are overwhelmed that we see trauma.

The bodies of traumatized people portray ”snapshots” of their unsuccessful attempts to defend themselves in the face of threat and injury. It is because they have been overwhelmed that the execution of their normally continuous responses to threat have become truncated. Trauma is fundamentally a highly activated incomplete biological response to threat, frozen in time. For example, when our full neuromuscular and metabolic machinery prepares us to fight or to flee, muscles throughout the entire body are tensed in specific patterns of high energy readiness. When we are unable to complete the appropriate actions and discharge the tremendous energy generated by our survival preparations, this energy becomes fixated into specific patterns of neuromuscular readiness. Afferent feedback to the brain stem generated from these incomplete neuromuscular/ autonomic responses maintains a state of acute and then chronic arousal and dysfunction in the central nervous system. Traumatized people are not suffering from a disease in the normal sense of the word. They have become fixated in an aroused state. It is difficult (if not impossible) to function normally under these circumstances.

Residual incomplete responses (the ”snapshots” of unsuccessful attempts at defense) are the basis of (implicit) traumatic memory. Just as Mickey was unable to remember the source of his trivia information, trauma is not ”remembered” in an explicit, conscious form. It is coded as implicit procedures based on biological survival reactions. These incomplete procedures seek completion and integration, not (explicit) remembering. The compulsion that so many trauma survivors have to ”remember” is often a misinterpretation of the profound urge to complete the highly charged survival responses that were aborted or truncated at the time they were overwhelmed. This is a significant factor in the genesis of spurious memory.

In an attempt to rationalize their highly activated (incomplete) survival responses, traumatized people will often create explicit stories that energetically match their internal experience . These ”memories” may be accurate only in the sense that they are metaphors for what is stored implicitly. Many survivors of trauma need an ”explanation” for their disturbing internal states. For example, I have worked with numerous people who came to me fairly certain that they had been molested or raped as children. In many cases the people were correct, but not in all of them. Several clients had created interpretations that seemed to explain their symptoms, but, in fact, they had been traumatized by early childhood surgical procedures. To a child, a frightening surgical procedure can be experienced very much like a rape.

Whether you can remember a traumatic event explicitly is not highly significant for healing to take place. Trauma is implicit. What is significant in the resolution of trauma is the completion of incomplete responses to threat and the ensuing discharge of the energy that was mobilized for survival. When the implicit (procedural) memory is activated and completed somatically, an explicit narrative can be constructed; not the other way around. In this way, survivors can begin to re-member, i.e., to associate the dissociated aspects of their body experience and thaw the frozen energy that is at the core of their trauma. In doing this, they begin to integrate implicit experience into coherent conscious narratives. These stories are neither true nor false. They contain a balance of elements, some of which are historically accurate, some are symbolic of feeling states, while the primary function of others is to promote the healing process.

Jody

Twenty-five years ago Jody’s life was shattered. While walking in the woods near her boy friend’s house, a hunter came up to her and began a conversation. It was mid-September. There was a chill in the air–her boyfriend and others thought nothing when they saw someone apparently chopping wood. A madman, however, was smashing Jody’s head again and again with his rifle. The police found Jody unconscious. Chips from the butt of the rifle lay nearby where they had broken off in the violent attack.

When I first saw Jody two years ago, the only recollection she had of the event was scant and confused. She vaguely remembered meeting the man and then waking up in the hospital some days later. Jody had been suffering from anxiety, migraines, concentration and memory problems, depression, chronic fatigue and chronic pain of the head, back and neck regions (diagnosed as fibromyalgia). She had been treated by physical therapists, chiropractors, and various physicians. The year before I saw her she had slipped and fallen on her back while ice skating. After this event she was barely able to function.

Jody, like so many head-injured and traumatized individuals, grasped desperately and obsessively in an attempt to retrieve memories of her trauma. She seemed driven by the unconscious belief that if she could only capture the memory, she would somehow be released from the shattering grip of her experience. In our first session Jody struggled to remember, to piece together vague images from the hospital and the faint recollection of talking with the hunter; but nothing would come; only intense frustration….grasping, grasping….trying to go back to the scene and return with the whole self she knew before the injury.

When I suggested to Jody that it was possible to experience healing without having to remember the event, I saw a flicker of hope and a momentary look of relief pass across her face. We talked for a while, reviewing her history and struggle to function. After traumas such as Jody experienced, previously normal people often feel that they are pushed to the edge of insanity. Jody was haunted by the unthinkable fear that she was damaged forever.

Focusing on body sensations, Jody slowly became aware of various tension patterns in her head and neck region. With this focus on the ”felt sense,” she began to notice a particular (internal-kinesthetic) urge to turn and retract her neck. In allowing this ”intention” to execute as slow gradual ”micro movements” she experienced a momentary fear, followed by a strong tingling sensation.

By allowing these involuntary ”intentional movements” to emerge and ”gradually” to complete, Jody began a journey into and beyond the deeply unconscious implicit ”memory traces” of her traumatic assault. In learning to move within a dynamic tension between flexible control and surrender to these involuntary movements, she began to experience gentle shaking and trembling throughout her body. Thus began, ever so gently, the discharge of her truncated energy (not from explicit memory-she had none at this time). Jody’s implicit memory was leading her home.

In later sessions, her head would turn away, while her arms and hands moved slowly upward and outward in a protective stance. These spontaneous movements were sometimes accompanied by brief animal-like shrieks almost identical to the distress calls recorded in species as diverse as birds and monkeys. She then felt the impulse in her legs to run, followed by more aggressive postures. She bared her teeth slowly, and, using her hands as if they were claws, experienced the urge to strike back at her assailant. Jody then became aware of (vestibular) sensations of falling. She felt the impact of the fall, followed by sensations of pain and bruising on the front and back of her head.

By completing these various defensive, distress and orienting responses, Jody was able to construct a sense of how she (her body) prepared to react in that fraction of a second when she was attacked. She became aware of head pulling back and away, a flash of the rifle butt coming toward her, her hands and arms moving upwards, the frozen impulse to run and the sense of running, the deep sense of fighting (trembling), the smash on her head, a quick whiff of the assailant’s peculiar odor-then, the fall forward onto her face and the repeated blows to the back of her head. In being able to stretch out, in time, this highly impacted shock imprint, she not only implicitly ”remembered” the event, but began to experience deep organic discharge and her body’s innate capacity to defend and protect itself. In moving ahead in time from where it had been arrested twenty-five years ago, Jody proceeded gradually toward the restoration of her shattered self.

In the Theater of the Body

While explicit memory is accessed primarily through cognition, implicit memory must be reached through the body. The ”felt sense,” as Gendlin calls it, (though we use it daily) is relatively undeveloped in most ”post-industrial” adults. This ”felt sense” is made up of kinesthetic, proprioceptive, vestibular and visceral (autonomic) information channels. Afferent flow enters the brain stem as non-conscious (instinctual) information, and is then elaborated upon by the limbic (emotional) and neo-cortical (cognitive) brain structures. Through the felt sense, interoceptive information (which forms the unconscious background of all experience), can be integrated and brought into a conscious figure.

Jody, through her felt sense, was able to extract the ”intention” signal to move her head from the background noise of random tension. To reiterate; intentional movement is non-conscious — it is experienced as if the body was moving on its own volition, not by conscious effort. By following these intentional impulses, various spontaneous (but organized) micro-movements were initiated. This was accomplished by the discharge of the incomplete survival response in the form of gentle shaking and trembling movements, along with beads of cold, then warm perspiration.

Jody was becoming deeply resourced by her biological capacity to defend herself, as well as by the discharge of energy and her new-found ability to move between conscious control and surrender to the realm of involuntary sensation. In that fraction of a second, when the madman raised his rifle, Jody’s primitive body/mind oriented and sorted hastily through the possible defensive procedures available to her. Although she did not get to execute most of these implicit procedures at that time, her body had been energetically prepared to do so. In completing these life preserving actions twenty-five years later, she released that bound energy and added to her resources the felt realization that she had, in fact, attempted to defend herself.

Out of Africa

I recently described the particular type of spontaneous shaking, trembling and breathing that Jody and other clients exhibit in their sessions, to Andrew Bwanali, park biologist of the Mzuzu Environmental Center in Malawi, Central Africa. He nodded excitedly, then burst out;

”Yes…..yes…..yes! That is true. Before we release captured animals back into the wild, we make absolutely sure that they have done just what you have described.” He looked down at the ground, then added softly; ”If they have not trembled and breathed that way before they are released, they will not survive…. they will die.” Although humans rarely die from trauma, their lives are severely diminished by its effects. Fortunately, trauma does not have to be a life sentence.

Renegotiation – Somatic Experiencing

”Renegotiation” is a word I termed to describe the process of healing or resolving trauma. It is the gradual, resourced discharge of the highly compressed survival energies, accompanied by a ”retrospective” completion of biological defensive and orienting responses that were frozen at the time of overwhelm. It is not a cathartic reliving of the traumatic event, a method that can lead to re-traumatization.

Somatic Experiencing (SE) is the name I have given to this work. It is a naturalistic approach to the healing of trauma developed over the last twenty-five years. SE is based on the understanding of why animals in the wild, though their lives are threatened routinely, are rarely traumatized. Their ability to discharge fully the highly activated energies mobilized for survival and then reorient (resume normal functioning) points to an innate, instinctual capacity for the resolution of trauma. This innate capacity is shared by humans, and is a potent resource when appropriately utilized.

The foundation of Somatic Experiencing is built upon a tradition of somatic education and body-oriented psychotherapy. It draws upon the neurobiological study of the multi-directional interconnection between the body, brain and mind. Post traumatic stress is viewed not as a permanent neuropsychological disease, but as a functional and largely reversible distortion in the multi-dimensional somatic and autonomic pathways that meld the mind and body. SE examines the critical pathways whereby afferent information from muscles, joints and viscera is fed back sequentially to primitive portions of the brain to regulate survival behaviors.

This approach uses education about and awareness of body sensations as a primary tool to alter these pathways. When appropriate, gentle manipulation of the muscles, joints and viscera is employed. The biological strategies that enable animals to restore homeostasis after being aroused by threat are learned by traumatized individuals. Empowered with these innate resources, people can transform trauma. This healing journey occurs primarily biologically and archetypally, not cognitively and biographically.

The Physiology of Trauma

When Jody began to gradually access and discharge the activation bound in the muscles of her head, neck and shoulders, allowing the completion of truncated protective and defensive responses, her nervous system was able to alter its regulatory ”set point” for arousal. Most psychiatric researchers believe that the brain chemistry is permanently altered as a result of trauma. For example, it is thought that neurons in the Nucleus Locus Coerulius (NLC), (part of the Reticular Activating System-RAS), become stuck in a fully activated state. As a result, this nucleus sends adrenergic (adrenaline-like) fibers into both the limbic and neocortical brain systems, maintaining high arousal levels throughout the brain. In order to combat this phenomenon, medical research is looking for potential drugs that would specifically block NLC-RAS activity.

What is being overlooked, however, is that the NLC receives a major portion of its input from sensory receptors in the head, face, neck and visceral organs. When a person perceives threat through primitive brain structures, muscles in the head, neck and viscera are activated in readiness to initiate the appropriate survival responses. At the same time, fibers from the NLC are busy arousing the entire brain through the RAS. Simultaneously, fibers from the brain stem and limbic system further activate muscles in the head, face, neck and viscera-which, in turn, send more impulses back inward to the NLC,…etc., etc.

If an organism is unable to completely discharge the escalating nervous system activation through life preserving action (i.e., fight or flight), then that mobilized energy will become locked in the somatic (head, face, neck, viscera) — NLC loop. A classic ”snowball rolling down the hill” positive feedback system is created that will reverberate until the survival responses are completed and the energy discharged. If not, the activation will develop into the complex symptoms of trauma. For this reason, preventative measures are vital after overwhelming events. Without them, somatic and dissociative symptoms will form to bind the highly activated, but undischarged survival responses. The formation of trauma symptoms is a non-conscious adaptation whose purpose is to prevent the organism from being further overwhelmed. Though it is much easier to prevent trauma, it is still possible to resolve many of the effects of even deeply entrenched traumatic symptoms.

Each time Jody was able to complete the truncated defensive and protective actions locked in her head and neck and discharge the energy bound there, she was able to remove ”fuel” from the NLC/RAS-neuromuscular feedback loop. This resulted in a gradual, progressive deactivation of the global arousal system governing her brain and body.

Memory and Healing

Jody’s essential experience of herself began to change as she completed and integrated the truncated implicit procedures. The question of whether she remembered what actually happened is largely irrelevant. In completing the implicit survival procedures, she began to form a fresh narrative. This new story incorporated archetypal imagery, sensations, feelings of death, renewal and rebirth, as well as images from the event. As she gently trembled and quivered, visions of quaking aspens replaced the fearful images of her assault.

One of the paradoxical and transformative aspects of implicit traumatic memory is, that once it is accessed in a resourced way (through the felt sense), it, by its very nature, changes. Out of the shattered fragments of her deeply injured psyche, Jody discovered and nurtured a nascent, emergent self. From the ashes of the frantically activated, hypervigilant, frozen, traumatized girl of twenty-five years ago, Jody began to reorient to a new, less threatening world. Gradually she shaped into a more fluid, resilient, woman, coming to terms with the felt capacity to fiercely defend herself when necessary, and to surrender in quiet ecstasy.

Understanding Childhood Trauma
Dr. Peter A. Levine

Although anyone – regardless of strength, capability, or experience – can be traumatized by a threatening event, those at greatest risk are infants and young children.

Johnny, age five, proudly riding his first bicycle, hits loose gravel and careens into a tree. He is momentarily knocked unconscious. Getting up amid a flow of tears, he feels disoriented and somehow different. His parents hug him, console him, and put him back on the bike, all the while praising his courage. They do not realize how stunned and frightened he is.

Years after the soon forgotten incident, John driving with his wife and children, swerves to avoid an oncoming car. He freezes in the midst of the turn. Fortunately, the other driver is able to maneuver successfully and avoid catastrophe.

One morning several days later, John begins to feel restless while driving to work. His heart starts racing and pounding; his hands become cold and sweaty. Feeling threatened and trapped, he has a sudden impulse to jump out of the car and run. He realizes the ”craziness” of his feelings, and gradually, the symptoms subside. A vague and nagging apprehension, however, persists throughout most of his day at work. Returning home that evening without incident, he feels relieved.

The next morning, John leaves early to avoid traffic and stays late, discussing business with some colleagues. When he arrives home he is irritable and edgy. He argues with his wife and barks at the children. He goes to bed early, yet wakes up covered with sweat in the middle of the night and faintly recalling a dream in which his car is sliding out of control. More fretful nights follow.

Delayed Traumatic Reactions

John is experiencing a delayed reaction to the bike accident he had as a child. Incredible as it may seem, posttraumatic reactions of this type are common. After working for more than 20 years with people suffering from trauma, I can safely say that at least 75 percent of my clients have traumatic symptoms that remained dormant for a significant period of time before surfacing. For most people, the interval between the event and the onset of symptoms is between 6 and 18 months; for others, the latency period lasts for years or even decades. In both instances, the reactions are often triggered by seemingly insignificant events.

Of course, not every childhood accident produces a delayed traumatic reaction. Some have no residual effect at all. Others, including those viewed as ”minor” and forgotten incidents in childhood, can have significant aftereffects. A fall, a seemingly benign surgical operation, the loss of a parent through death or divorce, severe illness (particularly one accompanied by high fever or poisoning), even circumcision and other routine medical procedures can all cause traumatic reactions later in life depending on how the child experiences them at the time they occur.

Of these traumatic antecedents, medical procedures are by far the most common and potentially the most impacting. Many clinical proceedings needlessly amplify the fear of an already frightened child. Infants about to undergo some routines, for example, are strapped into ”papooses” to keep them from moving. A child struggling so much that he or she needs to be tied down, however, is a child too frightened to be restrained without suffering consequences. Likewise, a child who is severely frightened is not one to be anesthetized, at least not until a sense of tranquility has been restored. Children can even be traumatized by insensitively administered enemas or thermometers.

Much of the trauma associated with these and other medical procedures could be prevented if healthcare providers encouraged parents to stay with their children, to explain as much as possible in advance, and to delay interventions until their children are calm. The problem is that too few professionals really understand what trauma is about and what lasting and pervasive effects these procedures can have. Although medical personnel are often concerned, they may need more information-from you, the consumer.

What Causes Trauma?

At the root of a traumatic reaction is the 280-million-year-old heritage that we share with nearly every crawling creature on earth – a heritage that resides in the area of the nervous system known as the reptilian brain. Primitive responses that originate in this portion of the brain help the organism protect itself against circumstances that are potentially damaging or dangerous to survival. Animals in the wild routinely encounter such events, and routinely respond to them. Human beings, however, due to our more sophisticated brain structure, have an astounding proclivity for overriding these primitive responses. Thus, whereas animals are fairly quick to recover from potentially traumatic encounters, we are not. Whether or not a person will be traumatized depends largely on the individual’s ability to respond to a threatening event in a specific way, with specific results.

When the reptilian brain perceives danger, it activates an extraordinary amount of energy – a phenomenon akin to an ”adrenaline rush.” This, in turn, triggers a pounding heart and other bodily changes designed to give the organism every advantage it needs to defend itself. The catch is that to avoid being traumatized, the organism must use up all the energy that has been mobilized to deal with the threat. Whatever energy is not discharged does not simply go away; instead, it lingers, creating the potential for traumatic reaction to occur. The fewer resources the organism has to meet the situation, the more undischarged energy there will be, and the greater the likelihood that trauma symptoms will develop in the future.

In short, an untraumatized outcome to a threatening situation depends on one’s ability to remain engaged in action, to respond effectively, and to discharge the energy that has been mobilized, thereby allowing the nervous system to return to its accustomed level of functioning. Even life-threatening events may not be traumatic for people who can respond and process them in a natural and effective way. And although anyone – regardless of strength, capability, or experience – can be traumatized by a threatening event, those at greatest risk are infants and young children.

How to Tell If Your Child Has Been Traumatized

Any unusual behavior that begins shortly after a severely frightening episode may indicate that your child is traumatized. Compulsive, repetitive mannerisms – such as repeatedly zooming a toy car into a doll – are an almost sure sign of an unresolved reaction to a traumatic event. (The activity may or may not be a literal replay of the trauma.) Other signs of traumatic stress include persistent controlling behaviors, tantrums, uncontrollable rage attacks, hyperactivity, an exaggerated startle reflex, recurring night terrors or nightmares, thrashing while asleep, bedwetting, inability to concentrate in school, forgetfulness, excessive belligerence or shyness, withdrawal or fearfulness, extreme clinginess, and stomachaches or other ailments of unknown origin.

To find out whether an uncustomary behavior is indeed a traumatic reaction, try mentioning the frightening episode and see how your child responds. A traumatized child will not want to be reminded of the predisposing event – or conversely, once reminded, will become excited, or fearful and unable to stop talking about it. A traumatized child may also respond with silence.

Reminders are revealing retrospectively as well. Children who have ”outgrown” unusual behavior patterns have not necessarily discharged the energy that gave rise to them. In fact, the reason traumatic reactions can hide for years is that the maturing nervous system is able to control the excess energy. By reminding your child of a frightening incident that precipitated altered behavior in years past, you may well stir up signs of traumatic residue.

Reactivating a traumatic symptom need not be cause for concern. The physiological processes involved, primitive as they are, respond well to interventions that both engage them and allow them to follow their natural course of healing. Children are wonderfully receptive to experiencing the healing side of a traumatic reaction. Your job is simply to provide an opportunity for this to occur.

Resolving a Traumatic Reaction

Creating opportunities for healing is similar to learning the customs of a new country. It is not difficult – just different. It requires you and your child to shift from the realm of thought or emotion to the much more basic realm of physical sensation, where the primary task is to pay attention to how things feel and how the body is responding. Right opportunity, in short, revolves around sensation.

A traumatized child who is in touch with internal sensations is paying attention to impulses from the reptilian core. As a result, the youngster is likely to notice subtle changes and responses, all of which are designed to help discharge excess energy and to complete feelings and responses that were previously blocked. Noticing these changes and responses enhances them.

The changes can be extremely subtle: something that feels internally like a rock, for example, may suddenly seem to melt into warm liquid. These changes have their most beneficial effect when they are simply watched, and not interpreted. Attaching meaning to them or telling a story about them at this time may shift the child’s perceptions into a more evolved portion of the brain, which can easily disrupt the direct connection established with the reptilian core.

Bodily responses that emerge along with sensations typically include involuntary trembling, shaking, and crying. If suppressed or interrupted by beliefs about being strong (grown up, courageous), acting normal, or abiding by familiar feelings, these responses will not be able to effectively discharge the accumulated energy.

Another feature of the level of experience generated by the reptilian core is the importance of rhythm and timing. Think about it…everything in the wild is dictated by cycles. The seasons turn, tides come in and go out, the sun rises and sets. Animals follow the rhythms of nature – mating, birthing, feeding, hunting, sleeping, and hibernating in direct response to nature’s pendulum. So, too, do the responses that bring traumatic reactions to their natural resolution.

For human beings, these rhythms pose a twofold challenge. First, they move at a much slower pace than we are accustomed to. And second, they are entirely beyond our control. Healing cycles can only be opened up to, watched, and validated; they cannot be evaluated, manipulated, hurried, or changed. When they do not get the time and attention they need, they are rarely able to complete their healing mission.

Immersed in the realm of instinctual responses, your child will undergo at least one such cycle. How can you tell when it is complete? Tune in to your child. Traumatized children who remain in they sensing mode without engaging their thought processes feel a release and opening; their attention then focuses back on the external world. You will be able to sense this shift in your child, and know that a healing has occurred.

Resolving a traumatic reaction does much more than eliminate the likelihood of reactions emerging later in life. It fosters an ability to move through threatening situations with ease. It fosters, in essence, a natural resilience to stress. Certainly, a nervous system accustomed to moving into stress and then out of it is far healthier than a nervous system burdened with an ongoing, if not accumulating, level of stress. And just as certainly, children who are encouraged to attend to their instinctual responses are rewarded with a lifelong legacy of health and vigor.

First Aid for Accidents and Falls

Accidents and falls are a normal and often benign part of growing up. Occasionally, however, they may place a child at risk for developing a traumatic reaction. Witnessing a mishap of this sort will not necessarily clue you in to its degree of severity. For one thing, a child can be traumatized by events that seem insignificant to an adult; for another, signs of traumatic impact can be easily covered up by a child who believes that ”not being hurt” will keep Mommy or Daddy happy. Your best ally in responding appropriately you your child’s needs is an informed perspective.

Here are some guidelines:
1. Attend to your own responses first, inwardly acknowledging your concern and fear for your child. Take a full breath, and exhale slowly while deeply sensing the feelings in your body. If you still feel upset, do it again. The time it takes to establish a sense of calm will be minuscule compared with the increase in your capacity to attend fully to your child. Accepting the accident as an accident will help you move in to give your child support, whereas being overly emotional or smothering may frighten your child at least as much as the accident itself.
2. Keep your child still and quiet. Should injuries require that your child be moved, support or carry him, even if he appears able to move on his own. (Remember, a child who shows his strength may be denying the fear he feels.) If your child seems to need extra warmth, drape a sweater or blanket over his shoulders and truck.
3. Encourage a sufficient interlude of safety and rest, particularly if your child shows signs of shock or daze (glazed eyes, pale complexion, rapid or shallow breathing, trembling, disorientation, talking as if he were somewhere else), or if his demeanor is overly emotional or overly ”tranquil.” Help your child know what to do by being relaxed, quiet, and still yourself. If you decide to hold him, do so in a gentle and non restricting way. Gently placing a hand in the center of his back, behind his heart, can communicate support and reassurance without interfering with his natural bodily responses. Excessive patting or rocking is unnecessary, and may interrupt the recovery process.
4. As the dazed look begins to wear off, gently guide your child’s attention to his sensations. Softly ask him how he feels ”in his body.” Slowly and quietly, repeat his answer as a question – ”You feel OK in your body?” – and wait for a nod or other response. Be a little more specific with your next question: ”How do you feel in your tummy (head, arm, leg)?” If he mentions a distinct sensation, gently ask about its location, size, shape, color, weight, and other characteristics; do not, however, suggest any form of movement. In response to his answer, gently guide him to the present moment: ”How does the lump (hurt, ‘owie,’ rock, fire) feel now?”
5. Allow a minute or two of silence between questions. This will permit any cycle that may be moving through to come to completion before your child’s attention is broken by another question. If sensing the moment of completion seems too uncertain, watch your child for cues, such as a deep relaxed breath, the cessation of crying or trembling, a stretch, a smile, or the making or breaking or eye contact. (Note: The completion of this cycle may not spell the end of the recovery process, so be sure to keep your child focused on his sensations for a few more minutes. Another cycle may well begin.)
6. Do not stir up discussion about the accident. There will be plenty of time for telling stories about it, playing it through, or drawing pictures of it later. Now is the time for rest and discharge.
7. Validate your child’s physical responses throughout this period of time. Children often begin to cry or tremble as they come out of shock. Parents often desire to dive in to stop the crying or trembling. Resist that impulse. The physical expression of distress needs to continue until it stops on its own or at least levels out, which may take only a minute. Indeed, studies have shown that children who cry after an accident have fewer problems recovering from it.
8. Your task at this time is to let your child know that crying and trembling are normal, healthy reactions. A reassuring hand on his back or shoulder, along with a statement such as ”That’s OK” or ”That’s good. Just let that scary stuff shake right out of you,” can help immensely. The key is to avoid disrupting the responses by shifting your child’s position, distracting his attention, holding him too tightly, or positioning yourself too far away to help him feel safe.
9. Finally, attend to your child’s emotional responses. Once he appears safe and calm, or even later, set aside time for storytelling or for reenacting the incident. Begin by encouraging him to tell you his experience of what happened. He may be feeling anger or fear, or perhaps sadness, embarrassment, or guilt. Tell him, in turn, about a time when you or someone you know felt the same way or had a similar accident. Let your child know that whatever he is feeling is OK and worth paying attention to.
While applying these first-aid measures, try not to be overwhelmed by worries about ”doing it right.” Trauma that cannot be prevented can be cured, because trauma is an interrupted process that is naturally inclined to move to completion whenever it is able to. It can remain interrupted for weeks, months, years, even decades without losing its inherent capacity to move to resolution. And that is the path it will take whenever the opportunity arises.

Healing Past Trauma

Healing trauma is in many ways similar to preventing it (see ”First Aid for Accidents and Falls”). Helping your child move through an established traumatic reaction, however, may be more time-consuming and may require several processing sessions.

To begin, reengage your child in the traumatic material. Remind her of the event by asking her to tell you about it or to draw a picture of it. If you do not know what precipitated the trauma, or if your child had no conscious memory of it, do not be concerned; the key to healing is in the energetic content of the experience, not the experience itself. If your child is immersed in repetitive play, use this as your entree. You can safely assume that your youngster is engaged in the traumatic material any time her behavior seems symptomatic of trauma See accompanying article).

Next, help your child focus on her sensations by gently asking questions about how she feels ”in her body.” Using her words, repeat each answer in the form of a question, allowing plenty of time to pass before speaking. This will help her reconnect with the healing impulses from the reptilian core. If shaking, trembling, or other bodily responses occur, be sure to validate them, for they are an extremely efficient means of discharge.

Remember that this level of experience entails no thinking – only sensation – and that changes will happen at a slower-than everyday pace. Try to reflect these soft, gentle, slow non-thinking characteristics in your demeanor and tome of voice. To help your child sustain a connection with this level of experience, keep all attention focused on physical sensations, encourage her to be gentle with herself and to take things slowly, and provide a safe, stable environment appropriate to her level of comfort (which may be different from your own).

Be on the lookout for three things. The first is any sign of release or opening up. Use this evidence to completion as your cue to move along. If you find that you have moved too fast, do not worry. Part of the grace in healing trauma is that you always get a second chance…and a third…and as many more as you need.

Also watch for any sign that your child is becoming overly emotional or upset. In the time that has elapsed since the traumatizing event, your child’s nervous system may have organized the excess energy in such a way that its release could temporarily frighten her. To help your child move through this point of overload, try distracting her with a comment about something in the room – a treasured toy or favorite activity. When she regains her composure, draw her attention back to how she feels in her body. Or, if you prefer, resolve to pursue the matter at some future time.

Third, watch for signs of fatigue. The sensations, while subtle, can bring about a profound – and exhausting – change in your child’s nervous system. Do not try to push the river; if your child gets tired, stop and encourage her to rest or take a nap. Be prepared to stay nearby in case she feels vulnerable. After a few moments, engage your child in another processing session. If she is still tired, put off the remedial work until another day.

Whenever you are working with your child, try to avoid drawing conclusions about what happened to her. These types of thoughts, by activating more evolved portions of the brain, will interfere with your ability to giver her the support she needs in the moment. You can always analyze the situation at a later time. One cautionary note: If you suspect that your son or daughter may have been sexually abused, be sure to enlist the aid of a trained professional to help you both.

Trauma is mysterious and frightening primarily because it is not well understood. And it is not well understood because it is too often approached from levels of experience that are far more abstract than, and in some ways incompatible with, the nonverbal realm in which it develops. The secret is to access the primitive messages emerging from the reptilian brain; the rest is simple.

Think of your child’s traumatic experience as a pool of water captured behind a wall of mud on a hillside. If you poke a hole in this will of mud, the water will flow down the hill. If there is any way at all for the excess energy from your child’s aroused state to ”flow down the hill,” it will. And if it can start to flow in manageable quantities, the outcome will surely be healing. Trust in the outpouring!

Nature’s Lessons in Healing Trauma
by: Dr. Peter A. Levine

Trauma is a Fact of Life

A single brief exposure to an overwhelming event can throw a normally functioning individual into an abyss of emotional and physical suffering. Whether or not a person rebounds from this dark edge of near insanity or tumbles more deeply into the ”black hole” of trauma remains a mystery. Modern psychiatry has little understanding of why one individual helplessly succumbs to a traumatic circumstance, while another remains unscathed or even fortified from the same event.

Because human responses to potential threat vary so greatly, it is difficult to identify or classify sources of trauma. Most people (both lay and professional) associate trauma with events like war, extremes of physical, emotional or sexual abuse, crippling accidents, or natural disasters. However, many ”ordinary” or seemingly benign events can be equally traumatic. For example, so-called minor ”whiplash” automobile accidents frequently lead to bewildering and debilitating physical, emotional, and psychological symptoms. Common invasive medical procedures and surgeries (particularly those performed on frightened children who are restrained while being anesthetized), can be profoundly traumatizing. Children often become fearful, hyperactive, clinging, withdrawn, ”bed-wetters”, or impulsively aggressive after such ”routine” events. Sometimes the effects from these experiences do not show up for months or even years. They may appear in the form of ”psychosomatic” complaints (such as head and tummy aches) or as inexplicable anxiety or depression.

Many people express their symptoms by compulsively ”acting them out”. The parents of convicted mass murderer Jeffrey Dahmer and Ted Kaczinski (the alleged ”Unabomber”) have given poignant and sobering descriptions of the formative effects that childhood medical procedures had on their sons. Dahmer’s father and Kaczinski’s mother both describe the profound disconnection, despair, isolation, and bizarre behaviors that their children began to exhibit after being terrified by medical procedures. Following a hernia operation at age four, young Jeffrey Dahmer seemed to ”snap.” He later began to repeatedly cut and remove the intestines from dead animals. This behavior can be viewed as an attempt by the boy to overcome and master the helpless terror induced by the surgical procedure that he experienced as an evisceration. At the tender age of nine months, a terrified Kaczinski was strapped to a table after resisting a physical examination. Years later, the sight of an immobilized tree shrew captured by his father drove Kaczinski into fits of hysterical rage and terror. The perplexed parents of these two men have spent anguished hours contemplating what effect these events may have had on their sons lives.

In a more ”ordinary” story from the pages of Reader’s Digest entitled Everything is not Okay, a father describes his son Robbie’s ”minor” knee surgery: The doctor tells me that everything is okay. The knee is fine, but everything is not okay for the boy waking up in a drug induced nightmare, thrashing around on his hospital bed– a sweet boy who never hurt anybody, staring out from his anesthetic haze with the eyes of a wild animal, striking the nurse, screaming ‘Am I alive?’ and forcing me to grab his arms….staring right into my eyes and not knowing who I am.

Unfortunately, stories like this are commonplace events often leading to the formation of tragic psychic scars. I am not attempting here to excuse or even explain the violent and abhorrent actions of anyone. Whether ”ordinary” events can account for the extreme behaviors of some people is a question that needs to be addressed, but it is not the point I am making. What is vitally important for us to understand is that events which hardly seem traumatic can be as traumatizing as the horrors of war. Dr. David Levy (writing in 1946) found that children in hospitals for routine reasons often experienced the same kinds of severe symptoms as ”shell-shocked” soldiers that had to be brought back from the front lines in Africa and Europe. Sadly, our medical establishment has been slow to acknowledge and incorporate this extremely vital information, which, if implemented, could prevent unnecessary suffering from the debilitating effects of trauma. It is evident that what makes an event potentially traumatizing is the perception (conscious or unconscious) that it is life-threatening.

It has only been in the past ten to twenty years that trauma has been widely recognized, although its essence was long ago powerfully captured by the Homeric Greeks, the ancient Sumerians, and through the eyes of Shamans from many indigenous cultures. Recent scientific research has been instrumental in helping to reframe trauma in a modern context, thus removing some of the stigma attached to it. New studies and medical treatment have inspired a modicum of hope for the alleviation of this particular kind of suffering. Psychiatry has not, however, captured the essential nature of trauma, nor has it uncovered if, or by what means, it can be healed.

The leading edge of theoretical and clinical work on Post Traumatic Stress Disorder (PTSD) takes a disturbingly mechanical view of human trauma, and is, I believe, fundamentally misleading. For example, there has been a recent attempt to find a causal link between trauma and brain pathology. Vietnam veterans with long standing PTSD, when autopsied after death, showed ”shrinkage” in the hippoccampus ( a region of the limbic/emotional brain involved in learning). This phenomenon has been corroborated by laboratory research that detected significant hippocampal shrinkage in the brains of animals who had been subjected to extreme and protracted stress. The pessimistic implication drawn from these studies is that the symptoms of PTSD, including memory lapses, anxiety, the inability to modulate emotion and control violence, are all due to brain damage–in short, that PTSD is an irreversible (incurable) form of brain disease. Though the evidence appears compelling, I am convinced that the aforementioned ”brain damage” and other bio-chemical changes are secondary effects that are not only preventable, but in many cases reversible.

When faced with threat, the body and mind mobilizes a vast amount of energy in preparation for the ”fight or flight” response. This preparedness is supported by an increase and diversion of blood flow and release of ”stress hormones” like adrenaline and cortisol. It seems probable that the prolonged excess of cortisol (or even a deficit which may be characteristic of depression in chronic PTSD), is what leads eventually to the hippocampal brain damage. The shrinkage does not happen suddenly. It is the long term, i.e., unresolved chronic trauma and stress that alters the cortisol levels which, in all likelihood, leads (over time) to the brain shrinkage. Even with long-term (chronic) trauma, there is a strong possibility that the hippocampal degeneration may be reversible. The shrinkage appears to be due to dendrite loss which may be (at least partially) restored if the chemical stressors are de-activated and returned to normal levels. Therefore, it is essential to help support and guide individuals in the aftermath of overwhelming life events in order to preventuntold tragedy.

A positive aspect of recent medical research on trauma is that it raises critical questions concerning the damage that is being inflicted upon a generation of children ravaged by wars throughout the world, and by violence in our inner cities. Unless we can learn to resolve the effects of trauma, we may be creating a generation of hyperactive, learning impaired, violence-prone, brain-damaged ”citizens”, whose actions will pale Hollywood’s wildest nihilistic fantasies. This tendency is by no means limited to war and violence torn areas of the globe. Many middle class children and adults suffer from anxiety, depression, and psychosomatic disorders. Some of them are prone to violence or are functioning at greatly reduced potentials due to the effects of what we have termed ”common everyday occurrences.” Unresolved trauma leads to re-enactment, and is a major factor in the escalation and perpetuation of violent behavior. Solving this threat to local and global social stability is and will be one of our greatest challenges.

Another positive aspect of the aforementioned generally limited and pessimistic line of trauma research is that it affords ‘legitimacy’ to the very real suffering of people with PTSD. Rather than being told ”It’s all in your head”, some people may be (arguably) comforted by being told that ”It’s all in your (damaged) brain.” The research also points to the far-reaching social consequences of trauma, and raises the question that we, as a culture, must answer: how do we as individuals, as a people, as a nation, and as a global community, plan to care about our collective traumatic experiences? It is obvious that we have not adequately addressed this question: one needs to look no further than the unconscionable percentage of homeless people (at least forty percent) that are Vietnam veterans.

Some of the negative implications of the disease-oriented view of trauma are: 1) It is scientifically misleading by confusing cause and effect. A disturbance in the natural biological process does not necessarily lead to incurable pathology. 2) It obscures (or ignores) the innate resiliency of the human organism (when supported and guided appropriately) to rebound and heal in the aftermath of overwhelming life events 3) It fails to recognize our capacity as human beings to support and empower each other in the process of transforming trauma. In summary, the over-emphasis on pathology (on what is wrong) impedes the healing process by diverting attention from our innate capacities to self-regulate and restore balance and vitality. In short, we are dis-empowered by the absence of regard for what is right with our organisms.

Nature’s Lessons

It is through the study of the natural world and mythology that we may begin to understand the critical role of biology and instinct in the formation and resolution of trauma. We are living, breathing, pulsing, self-regulating, intelligent organisms, not merely complex chemistry sets. We need to identify with our animal roots and dare to inhabit the Serengeti plain that dwells in our collective soul. There, we will become aware of many things. Our senses will rise from their slumber, and we will behold the crouching cheetah as it readies itself to attack the swift, darting, impala. Track your own responses as you watch the fleet cheetah in a seventy mile an hour surge, overtake its prey. You notice that the impala falls to the ground an instant before the cheetah makes contact. It is almost as if the animal has surrendered to its pending demise.

It’s Physiology – Not Pathology

The fallen Impala is not dead. Although on the ‘outside’ it appears limp and motionless, on the ‘inside’ its nervous system is still activated from the seventy-mile-an-hour chase. Though barely breathing, the Impala’s heart is pumping at extreme rates. Its brain and body are being flooded by the same chemicals (e.g. adrenaline and cortisol) that helped fuel its attempted escape.

It is possible that the impala will not be devoured immediately. The mother cheetah may drag its fallen (apparently dead) prey behind a bush and seek out its cubs, who are hiding at a safe distance. Herein lies a short window of opportunity. The temporarily ”frozen” impala has a chance to awaken from its state of shock, shake and tremble in order to discharge the vast amount of energy stored in its nervous system, then, as if nothing had happened, bound away in search of the herd. Another function of the frozen (immobility) state is its analgesic nature. If the impala is killed, it will be spared the pain of its own demise.

Three little girls (described in US News and World Report, Nov. 11, 1996) are sitting in plastic molded chairs in the hospital waiting room. They seem calm, betraying nothing of the horror they experienced the night before. The children were tied up, the three year old threatened with a gun, and then they watched as their teenage sister was shot in the head (though not killed). They appear ”calm” on the outside, but their physiology’s tell a very different story. Hearts still racing at one hundred beats per minute, their blood pressure remains high. Inside their heads, the biological stress chemicals are saturating their brains. Like the fallen Impala, these ”frozen” kids, while appearing calm (if not unresponsive), are still internally prepared for the extremes of activation necessary to initiate the flight or fight procedures they never had a chance to execute. Those chemicals are now turning against their very futures. The increased heart rate is associated with the hair-trigger fight/flight response, and is played out in the hostile/withdrawing behaviors that will characterize their bleak and agitated days at school and sleepless nights at home. Bruce Perry of Children’s Hospital at Bayhn College of Medicine gives teachers and parents of traumatized children devices that allow them to monitor the child’s heart rate at a distance. This way they can refrain from making demands that are likely to cause the children to explode in rage or withdraw in fear. He also prescribes clonidine, a drug that seems to help block the fight or flight response.

I believe both of these approaches can be of some use. Unfortunately, by focusing on pathology and the suppression of symptoms, the essential biological ingredient of resolving trauma is missed-that is, completion of the thwarted fight or flight defensive procedures and the close human contact that is required to support this completion. Without completion and resolution, people remain frightened, isolated and hopeless. When completion occurs, like the impala, a person can be transformed and rejoin the herd.

Completion

Acts must be carried through to their completion. Whatever their point of departure, the end will be beautiful. It is (only) because an action has not been completed that it is vile.
— Jean Genet, from Thief’s Journal

Though it appears that we have separated ourselves from animals, like the impala and cheetah, human responses to threat are biologically formed. They are innate and instinctual functions of our organisms. For the impala, life-threatening situations are an everyday occurrence, so it makes sense that the ability to resolve and complete these episodes is built into their biological systems. Threat is a relatively common phenomenon for humans as well. Though we are rarely aware of it, we also possess the innate ability to complete and resolve these experiences. From our biology comes our responses to threat, and it is also in our biology that the resolution of trauma dwells.

In order to remain healthy, all animals (including humans) must discharge the vast energies mobilized for survival. This discharge completes our activated responses to threat, and allows us to return to normal functioning. In biology, this process is called homeostasis: it is the ability of an organism to respond appropriately to any given circumstance, and then return to a base line of what could be called ”normal” functioning.

In the National Geographic video ”Polar Bear Alert” (available at video stores), a frightened bear is run down by a pursuing airplane, shot with a tranquilizer dart, surrounded by wildlife biologists, and then tagged. As the massive animal comes out of its shock state it begins to tremble, peaking with an almost convulsive shaking–its limbs flailing (seemingly) at random. The shaking subsides and the animal takes three spontaneous breaths which seem to spread through its entire body. The (biologist) narrator of the film comments that the behavior of the bear is necessary because it ”blows off stress” accumulated during the capture. If this sequence is viewed in slow motion it becomes apparent that the ”random” leg gyrations are actually coordinated running movements – it is as though the animal completes its running movements (truncated at the moment it was trapped), discharges the ”frozen energy,” then surrenders in a full bodied ”orgiastic” breath.

I was first made aware of the profound significance of these kinds of physiological reactions in the healing of trauma quite by accident. In 1969, a psychiatrist referred a patient to me who was suffering from acute anxiety and panic attacks. The attacks had become so severe that the woman (Nancy) was unable to leave her home unaccompanied. The psychiatrist, who knew of my interest in mind/body healing (a fledgling field at that time), thought that perhaps she would benefit from techniques I had developed that utilized sensory awareness as a way to deep relaxation.

Relaxation was not the answer. In our first session, as I naively and with the best of intentions attempted to help her relax, Nancy went into a full-blown anxiety attack. She appeared paralyzed and unable to breathe. Her heart was pounding wildly, and then it slowed to almost a stop. I became quite frightened as we entered together into her nightmarish attack.

Surrendering to my own intense fear, yet somehow managing to remain present, I had a fleeting vision of a tiger jumping toward us. Swept along by the experience, I exclaimed loudly, ”You are being attacked by a large tiger. See the tiger as it comes at you. Run toward that tree; climb it and escape!” To my surprise, her legs started trembling in running movements. She let out a bloodcurdling scream that brought in a passing police officer (fortunately my office partner somehow managed to explain the situation). She began to tremble, shake, and sob in waves of full-bodied convulsions.

Nancy continued to shake for almost an hour. She recalled a terrifying childhood memory. At the age of three, she had been strapped to a table for a tonsillectomy. The anesthetic was ether. Unable to move, feeling suffocated (common reactions to ether), she had terrifying hallucinations. This early experience had a deep impact on her. Nancy was threatened, overwhelmed, and as a result, had become physiologically frozen in what biologists call the ”immobility response”. In other words, her body had literally resigned itself to defeat, and the act of escaping could not exist. In this pervasive state of ”core anxiety,” Nancy lost her real and vital self, as well as a secure and spontaneous personality. Though she hadn’t literally died, parts of herself had suffered a kind of death.

After the breakthrough that occurred in our initial visit, Nancy left my office feeling, in her words, ”Like she had herself again.” Although we continued working together for a few more sessions, where she gently trembled and shook, the anxiety attack she experienced that day was her last.

Out of Africa

I recently described the particular type of spontaneous shaking, trembling and breathing that Nancy and other clients exhibit in therapy sessions to Andrew Bwanali, park biologist of the Mzuzu Environmental Center in Malawi, Central Africa. He nodded excitedly, then burst out;

”Yes…..yes…..yes! That is true. Before we release captured animals back into the wild, we make absolutely sure that they have done just what you have described.” He looked down at the ground, then added softly; ”If they have not trembled and breathed that way before they are released, they will not survive…. they will die.” Although humans rarely die from trauma, if we do not resolve it, our lives can be severely diminished by its effects. The result for many of us is often described as a ”living death.”

Waking the Tiger

The DSM Four (the diagnostic manual used by psychiatrists and psychologists) defines ”panic anxiety reactions” as follows: The attack has a sudden onset and builds to a peak rapidly (usually within ten minutes), and is often accompanied by a sense of imminent danger or impending doom and with an urge to escape. Symptoms include palpitations, sweating, trembling (which sufferers usually try to suppress), sensations of shortness of breath, a feeling of choking, chest pain or discomfort, nausea or abdominal stress, dizziness or lightheadedness, fear of losing control or ”going crazy.

Over three million Americans suffer from regular panic attacks, a majority being women–the more likely prey when it comes to our species. We see in the definition of panic anxiety-the sense of imminent danger or impending doom associated with an urge to escape. This is the essence of trauma; the urge to escape coupled with the perception of not being able to.

At the time I met Nancy, I was studying animal predator-prey behaviors. I was intrigued by the similarity between Nancy’s paralysis when her panic attack began, and what happened to the impala discussed previously. Most prey animals use the immobility response when attacked by a larger, more powerful predator from which they can’t escape. I am quite certain that these studies strongly influenced the fortuitous vision of the imaginary tiger. For several years after that I worked to understand the significance of Nancy’s anxiety attack and her response to the image of the tiger. I now know that it was not the dramatic emotional catharsis and reliving of her childhood tonsillectomy that was catalytic in her recovery, but the discharge of energy she experienced when she flowed out of her passive, frozen immobility response into an active, successful escape. The image of the tiger awoke her instinctual, responsive self. The other insight I reaped from Nancy’s experience was that the resources which enable a person to succeed in the face of a threat can be used for healing. This is true not just at the time of the experience, but even years after the event.

I learned that to heal trauma it was unnecessary to dredge up and relive memories. In fact, severe emotional pain can be re-traumatizing. What we need to do to be freed from our symptoms and fears is to arouse our deep physiological resources and consciously utilize them. If we remain ignorant of our power to change the course of our instinctual responses in a proactive rather than reactive way, we will continue being frozen, imprisoned, and in pain.

As I continued to work with people suffering from anxiety reactions and so-called ”psychosomatic” conditions like migraines, muscular syndromes (e.g., fibromyalgia, back and neck pain), functional gastrointestinal disorders, severe PMS, asthma and even some epileptic seizures, the more I became convinced that these symptoms are the nervous system’s attempt to bind (or contain) the intense survival energies that remain in the body/mind as the result of unresolved trauma. When these energies could be gradually discharged, physiologically, in gentle trembling (often accompanied by mounting chills of apprehension, readiness, and an experience of ”breaking through” expansively into warm beads of moist perspiration), the symptoms would often be dramatically reduced or even eliminated. Sometimes, though not always, images of the event(s) would appear indicating possible source(s). They were not necessary for healing to occur. The images were often, but not always accurate depictions of an event. This led me to conclude that so-called ”traumatic memories” are not necessarily the actual story of what happened. They are accurate in the sense that the images match the ”energetic intensity” of an experience. They also satisfy the deep yearning we humans have to know what happened to us. This is an important key to unlocking the mystery of traumatic memories, and avoiding the pitfalls created by ”false memories.” For example, it is critical that we understand that many peoples’ (unconscious) experience of medical procedures is quite similar to the experience of rape. Any suggestion of rape or molestation by a therapist (or by media exposure) can influence traumatized people to create ”false memories” in order to explain any ”rape-like” experience.

The Root of Many Disorders

It is estimated that as many as thirty to forty million Americans (twelve to fifteen percent of the population) have experienced persistent anxiety. Another twelve million have been troubled by a milder form of anxiety known as ”restless leg syndrome” (an explanation for this jitteriness of the legs due to incomplete survival responses can be gleaned from the image of Nancy as she escapes from the tiger). Add to this figure twelve and a half million people who suffer from obsessive-compulsive disorder (a condition that keeps people in a constant alert state known as hyper-vigilance), ceaselessly searching for threat even when none exists.

Stress-related illness (mental and physical), may account for the vast majority of symptoms for which people seek medical help. Serious psychiatric disorders (involving anxiety, depression, sleep disturbances, and substance abuse) are on the rise in America and in other industrialized nations. In 1994, the conservative Archives of General Psychiatry reported that half of the entire American adult population meets the formal diagnostic criteria that denote serious psychiatric illness. Since World War Two, the rates of adolescent depression and suicide have both tripled. As startling as these statistics are, even more alarming is the sharp rise in violence among our youth. Concurrently, hyperactivity and Attention Deficit Disorder (ADD) are approaching epidemic proportions. Various school districts are reporting that as high as ten to twenty percent of their elementary school population is regularly using Ritalin (a type of amphetamine prescribed by doctors to counteract hyperactivity and ADD). The trouble with Ritalin (and other drugs used for similar purposes), is that not only are they potentially addictive and dangerous, they fail to get to the root of the problem. I believe that a substantial percentage of violence-prone children (as well as many of those diagnosed as hyperactive or having ADD) are actually suffering from the effects of unresolved trauma. The behaviors they exhibit (which we term disorders) are often manifestations of hyper-arousal and hyper-vigilance, both which are core symptoms of trauma.

The tacit acceptance of drugs as the answer to this epidemic is frightening as well as misleading. These so-called disorders are not diseases like pneumonia or juvenile diabetes. Why are we not profoundly disturbed by the creation of future generations of chemically-dependent citizens? Will America become known as the ”Prozac Nation,” unable to function without mood elevators and anti-depressants? Perhaps this situation already exists. When viewed in the context of this increasing chemical dependence, our government’s purported ”War on Drugs” appears ludicrous at best. With a significant proportion of children and adults hooked on powerful (legal) ”mind-altering” substances (not to mention alcohol and illegal drugs), it forces us to ask the question: what has gone wrong?

The prevailing psychiatric view of these disorders is that they are ”biological diseases.” The standard treatment is pharmacological. Drugs can certainly be a useful component in treating these afflictions, however, the prevalent confusion between biological maladaption and ”brain disease” obscures the global affect that unresolved stress and trauma have on our organisms.

When we overwhelmed by threat, our bodies and nervous systems activate life-preserving survival responses. If we are unable to complete these innate ”action plans,” then we cannot discharge the vast amount of energy mobilized to do so. When this occurs (like Nancy), we retain in our bodies and minds undischarged residual energy, which, in turn, manifests itself as the symptoms of trauma. Most symptoms of trauma are found in the descriptions of many psychiatric and so-called ”psycho-somatic diseases” and syndromes. Why we humans have become so vulnerable to trauma is a complex question that I have addressed in depth in a recent book, Waking the Tiger–Healing Trauma. What I want to emphasize here is not only can much untold suffering be prevented, but the expenditure of billions of dollars a year (over forty-four billion on depression alone) can be reduced significantly.

The longer traumatic activation has been unresolved, the more difficult or more time consuming it is to resolve it. Many people know something about basic first aid: how to stop bleeding, what to do if someone is burned, or how to help choking victims, and how to do CPR. Very few of us know how to be present and offer the energetic and emotional support necessary to ensure that stressful or overwhelming events will not lead to the debilitating and chronic symptoms of trauma. These are skills we must all develop if we yearn to be ”thrivers” (not victims or merely survivors) of trauma. Trauma ”first aid” must be applied on a societal level as well if we are serious about stemming the rising tsunami of violence that threatens our survival as a species. If we are to continue evolving, we must first learn to master our innate resources, those that empower us to be fully human.

Medusa

Mythology teaches us about courageously meeting challenges. Myths are stories that simply and directly touch the core of our being. They remind us about our deepest longings, and reveal to us our hidden strengths and resources. They are also maps of our essential nature, pathways that connect us to each other, to nature, and to the cosmos. If we let them, they can lead us home. The Greek myth of Medusa (the Gorgon), captures the very essence of trauma and describes its transformation. It is the weaving together of myth and biology (”Mytho-biology”) that will help us solve the mystery of trauma.

In the Greek myth, those who looked directly into Medusa’s eyes were promptly turned to stone….frozen in time. Before setting out to vanquish this snake-haired demon, Perseus sought council from Athena. Her advice to him was simple; under no circumstances look directly at the Gorgon. Taking Athena’s advise to heart, Perseus used the shield on his arm to reflect the image of Medusa and was then able to cut off her head without being turned to stone.

If trauma is to be healed, we must learn not to confront it directly. This can be a hard lesson to learn. If we make the mistake of confronting trauma head on, then Medusa will do to us what Medusas do. True to her nature, she will turn us to stone. Like the Chinese finger traps we all played with as kids, the more we struggle with trauma, the greater will be her grip upon us……. There is more to this myth:

Out of Medusa’s wound, two entities emerged. Pegasus, the Winged Horse and Chrysaur, the Warrior with the golden sword. The horse is a symbol of the body and instinctual knowledge; the wings symbolize

transformation. The golden sword represents penetrating truth and clarity. Together, these aspects form the archetypal qualities and resources that a human being must mobilize in order to heal the Medusa called trauma.

The reflection of Medusa we must perceive and respond to in order to vanquish and transform her vast energies is mirrored in our instinctual natures. Once in touch with this primordial wisdom, we will be able to be present in our own organisms as well as with those of another. This innate wisdom allows us to not only master trauma, but to experience ourselves and others fully. Without it, confusion or over-control will rule all of our relationships.

In another version of this same myth, Perseus stores the drops of blood from Medusa’s wound in two vials. Those from one vial have the power to kill, the other, to raise the dead and restore life. What is revealed here is the dual nature of trauma: first, its destructive ability to rob victims of their full capacity to live and enjoy life. Second, the paradox of trauma–its power to transform and resurrect. Whether trauma will be a cruel and punishing Gorgon, or a vehicle for soaring to the heights of transformation and mastery depends upon how we approach it.

Because we are human animals, trauma is a fact of life. It does not, however, have to be a life sentence. It is possible to learn from the animal experience, and rather than brace against our instincts, embrace them. With guidance and support, we are capable of emulating the impala, and learning to shake and tremble our way back to the herd. In being able to harness these primordial and intelligent instinctual energies we can move through trauma and transform it.

Compassionate Presence

Eight-year-old Anna has enormous brown eyes. She could have been a model for one of David Keane’s popular paintings of almond-eyed children. The school nurse has just brought her in to see me. Pale, head hanging in defeat, barely breathing–she is like a fawn frozen by the bright lights of an oncoming car. Her frail face is expressionless, and her right arm hangs limply, as if it was on the verge of detaching itself from her shoulder.

Two days earlier, Anna went on a school outing to the beach. She and a dozen of her classmates were frolicking in the water when a sudden riptide swept them swiftly out to sea. Anna was rescued, but Mary (one of the mothers who volunteered for the outing) drowned after courageously saving several of the children. Mary had been a surrogate mom to many of the neighborhood kids, including Anna, and the entire community was in shock from her tragic death. We had asked the nurse to be on the lookout for children who displayed a sudden onset of symptoms (e.g., pain, head and tummy aches, and colds). Anna had already been to see the nurse three times that morning, reporting severe pain in her right arm and shoulder.

One of the mistakes often made by ”trauma responders” is to try to get children to talk about their feelings immediately following an event. Although it is rarely healthy to suppress feelings, this practice can be re-traumatizing, because in these vulnerable moments children (and adults as well) can be easily overwhelmed. Previous traumas can re-surface in the aftermath of ”overwhelm”, creating a complex situation that may involve ”deep secrets”, untold shame, guilt feelings, rage, and pain. For this reason, we sought out and learned some of Anna’s history from several helpful elementary school teachers prior to seeing the child. The following information was revealed:

At age two, Anna was present when her father shot her mother in the shoulder and then took his own life. More recently, Anna had been infuriated when Mary’s sixteen-year-old son Robert had bullied her twelve-year-old brother. There was a strong possibility that Anna harbored ill will towards Robert, and sought retribution. This raised the likelihood that Anna might feel profound guilt about Mary’s death-perhaps even responsible for it.

I ask the nurse to gently cradle and support Anna’s injured arm. This will help Anna contain the frozen ”shock energy” locked in her arm, as well as heighten the child’s inner awareness. With this containment and support, like the impala, Anna will be able to slowly, gradually, thaw, and access the feelings and responses that will help her come back to life.

”How does it feel to be inside of your arm, Anna?” I ask her softly.

”It hurts so much” she answers faintly. Her eyes are downcast, and I say,

”It hurts bad, huh?”

”Yeah.”

”Where does it hurt? Can you show me with your finger?” She points to a place on her upper arm and says, ”Everywhere, too.” There’s a little shudder in her right shoulder followed by a slight sigh of breath. Momentarily, her drawn face takes on a rosy hue.

”That’s good, sweetheart-does that feel a little better?’ She nods slightly, then takes another breath. After this slight relaxation, she immediately stiffens, pulling her arm protectively towards her body. I seize the moment.

”Where did your mommy get hurt?’ She points to the same place on her arm, and begins to tremble. Nothing more is said. The trembling intensifies, then moves down her arm and into her neck. ”Yes, Anna, just let that shaking happen-just like a bowl of jello-would it be red, or green, or even bright yellow? Can you let it shake? Can you feel it tremble?”

”It’s yellow,” she says, ”like the sun in the sky.” She takes an almost full breath, then looks at me for the first time. I smile and nod. Her eyes grasp mine for a moment, then turn away.

”How does your arm feel now?”

”The pain is moving down to my fingers.” Her fingers are trembling gently. I speak to her quietly, softly, rhythmically.

”You know, Anna sweetheart….I don’t think there is anybody in this whole town that doesn’t feel like that in some way it was their fault that Mary died.” She glances at me briefly, and I continue-”Now, of course that’s not true…but that’s how everybody feels…and that’s because they all love her so much.” She turns now and looks at me. There is a sense of self-recognition in her demeanor. With her eyes now glued on me, I continue…”Sometimes, the more we love someone, the more we think it was our fault.” Two tears spill slowly from the outside corners of each eye before she slowly turns her head away from me.

”And sometimes if we’re really angry at someone when something bad happens to them, then we also think that it happened because we wanted it to happen.” Anna looks me straight in the eye, and I say, ”And you know, when a bad thing happens to someone we love or hate, it doesn’t happen because of our feelings. Sometimes bad things just happen…and feelings, no matter how big they are, are only feelings.” Anna’s gaze is penetrating and grateful. I feel myself welling with tears. I ask her if she wants to go back to her class now. She nods, looks once more at the three of us, then walks out the door, her arms swinging freely.

Alex (like several of the children who witnessed the tragedy from the beach), was having trouble sleeping and eating. His father brought him to us because the youngster had barely eaten in the last two days.

As we sit together, I ask him if he can feel the inside of his tummy. He places his hand gently on his belly, and, with a sniffle, says ”Yes.”

”What does it feel like in there?”

”It’s all tight like a knot.”

”Is there anything inside that knot?”

”Yeah. It’s black….and red….I don’t like it.”

”It hurts, huh?”

”Yeah.”

”You know, Alex, it’s supposed to hurt…but it won’t hurt forever.” Tears cascade down the boy’s cheeks, and color returns to his face and fingers. That evening, Alex ate a full meal. At Mary’s funeral Alex wept openly, smiled warmly, and hugged his friends.

Because trauma is ”locked” in the body, it is in the body that it must be accessed and healed. With proper support, the body will discharge the locked-in energy as surely as a stream flows to the sea. Words are used as compassionate reflections, not as explanations. We don’t need to help each other ”get our feelings out,” we need to be compassionately present for one another. This kind of acknowledgment creates the ambiance that will allow the frozen sensations and feelings to soften and flow at their natural pace. Don’t Push the River.

In healing trauma, the body’s ”felt sense” is the equivalent of Perseus’ shield. Through the reflection of our own body awareness, we can master the innate resources that transform trauma. Everything we need waits inside…we must learn to be the heroes of our own healing…not just heroes that say ”no” to being victimized and seek vindication, but Heroes that say ”yes” to Pegasus, and soar to new heights of evolutionary freedom. Medusa is fear…fear turns us to stone. It is time for human beings to leave the ”Stone Age.” behind. Trauma is something we all share. Like the blood from Medusa’s wound, it is a potential gift….a natural vehicle for personal, societal and global transformation.

Connection

Live not in separation
— E.M. Forster

Trauma is about broken connections. Connection is broken with the body/self, family, friends, community, nature, and spirit, perpetuating the downward spiral of traumatic dislocation. Healing trauma is about restoring these connections.

Some years ago, I had the privilege of teaching at the Hopi Guidance Center located at Second Mesa, Arizona. I teach my work by using direct personal experience. Initially, I became aware that there seemed to be a strong resistance among tribal members to participate experientially. I knew that the people were shy, and that they have strong cultural taboos regarding self-disclosure (especially to outsiders). What I didn’t know was that they have a world-view so different from mine that I nearly missed it entirely.

I discovered that it was the use of ”I” that troubled and perhaps even confused the Hopi. When I framed an experiential demonstration in the third person (indicating the healing needs of others), people participated more freely. In Anglo-European cultures, it is the needs of the autonomous ego that dominate perception. In the Hopi culture, it is the needs of the tribal community that are primary. The Hopi are not alone in this world view. In many aboriginal cultures, the entire group shares the pain of an injured individual. Because of this felt connection, the healing of a single person naturally becomes the responsibility of the entire group. Specific rituals are performed involving the whole community. The Hopi say that if (trauma) is not dealt with quickly by the whole group, then its negative consequences will affect the tribe for seven generations.

When it comes to healing trauma, the ”limitations” I experienced among the Hopi turned out to be vital strengths. I realized that the participation of an entire community is a fundamental resource in the process of healing a traumatized individual. What happens to cultures whose sole focus is self-involvement and autonomy? What lies in store for countries made up of isolated individuals who have little feeling for being a ”people?” They become, as we have, particularly vulnerable to the disconnection that results from traumatic experiences. I mention again these facts: forty percent of America’s homeless are Vietnam veterans-perhaps half of our population is suffering from major mental illness-we are entrenched in an explosion of violence among our youth that may result in the dissolution of many urban areas-we grow increasingly dependent on legal and illegal drugs in an attempt to cope with this situation. These disturbing statistics all speak, at least in part, to our inability as a culture to heal trauma.

How much of our present dilemma is a result of our own free choice as expanding human beings wishing to evolve toward autonomy, individuality, and pentium-paced technology? How much is a result of the constricting downward spiral of fewer and fewer choices created by traumatic disconnection? I don’t know the answer to these ”chicken or the egg” questions, but I believe that the future of the human species may be predicated upon the unification of tribal connection with individual freedom and autonomy. Our strength and adaptability as human beings lies in the integration of instinct, emotion, and rational thought. If we choose to abandon our instincts, we limit our evolutionary choices–we distance ourselves from the innate resources necessary to experience our connection to others and to the natural world. Without this connection we are choosing to live in a spiritual void. Without this connection we cannot heal trauma–we can only build tenuous superstructures around it in a feeble attempt to protect ourselves from its devastation.

There is much we can do to heal trauma and create a pathway towards connection. As individuals, families, and professionals, we can be present for our children in the aftermath of potentially traumatic experiences. Automobile accidents, injuries, serious illness, emergency and necessary medical procedures, violence, natural disasters, and loss (from death or separation) do not have to leave children frozen. Children possess an innate and vibrant resiliency that can enable them to rebound from ”overwhelm” and injury. In a 1994 article published in Mothering Magazine called Understanding Childhood Trauma, and in a forthcoming book, It Won’t Hurt Forever, I discuss first-aid for trauma–how to provide the support and guidance necessary to help children resolve and prevent traumatic reactions. It is possible for all of us to learn a few simple (compassionate) guidelines that can be employed to help children (and adults) move through the intense fear often associated with injuries and medical procedures. If this information is incorporated into our existing medical and paramedical model, it could prevent much unnecessary suffering and reduce health care costs dramatically.

On the societal and global levels, the cycle of war, violence, and trauma repeats itself, escalating into an ever-increasing threat to civilized existence. The Foundation for Human Enrichment is involved in the formative stages of several projects whose goal is to work with the traumatic roots of violence (see We Are All Neighbors: Healing the Roots of Violence). By addressing trauma in infants and children, we hope to transform the generational cycle of traumatic re-enactment. By bringing together the parents and infants of both recent and historical adversaries (ethnic, racial, religious, economic, geographic, inner-city), it may be possible to re-establish the broken connections that exist between alienated groups. Once the connections are made, the likelihood that the perpetual cycle of violence and suffering can be resolved will be greatly enhanced. If anyone can help us overcome the horrors of violence and war, it is our children.

”Give me a place to put my lever,” decried Archimedes, ”and I will move the world.” Dominated by conflict, destruction, and trauma, we may find this fulcrum, this focal point, in the tender, physical, rhythmic pulsation between a mother and her infant. When the primary connection is strong and vital, the world outside becomes a less threatening, more hospitable place. When the broken connection between the body, mind, and spirit is restored, when the severed bonds between people and nature have been re-woven, we can begin, as a species, to feel at home on this beautiful planet Earth.