A Better Approach to Healing Trauma
Does the body remember our past hurts? And if so, where do they go?
Seemingly trivial childhood events, humiliations, disappointments, mistakes. Over the course of our lives, our bodies become impacted by emotional experiences we are supposed to know how to navigate. A natural to response to these painful experiences is to avoid thinking about them. As life goes on the layers build up. A difficult break-up, infidelity, chronic workplace dynamics, illness or the death of a loved one. All leave traces in our bodies, and often the scarring inhibits our ability to sit with our thoughts. Yet too often, despite our avoidance, the energy is nonetheless at work in our bodies.
In his latest work, The Body Keeps Score, Clinical psychiatrist, Bessel Van der Kolk, discusses the embodiment of trauma and the ways in which body memory can interfere with the benefits of mindfulness. In his view, traumatic experiences literally change the wiring in our brains, affecting our physiology, social behaviour and capacity for self-analysis from that time forward. In these cases, commonly used therapies–such as Cognitive Behavioural Therapy, which draw on the rational brain–can be difficult for some patients to access.
Psychomotor therapies, which bypass the rational brain and tap into the primitive, could be the way forward. Yoga, dance, qigong, and voice work are just some of the physical practices that can reach the primitive brain to heal trauma where it is deeply embedded in our physiology. This then opens the way for the healing process of mindfulness to take place.
The problem as Van der Kolk sees it, is the reluctance of conventional practice to shift away mindfulness therapies. So why the resistance?
The Problem with Mind
Mindfulness refers to the process of becoming aware of the thoughts, feelings and sensations in our body. The aim is to take a clear view of them, without judgement, and accept them rather than block them. But the mind has limitations, and rational pathways are not always useful.
As we sit to centre our minds in a practice or therapy session, many people encounter a range of distracting sensations. Worries, discordant thoughts, and uncomfortable sensations come uninvited as we embark on our inward journey. Mostly, we can sit with them until they pass. But for some, they don’t pass. Rather, the uncomfortable sensations persist, becoming so unbearable that it is impossible to continue.
As a Clinical psychiatrist, Bessel Van der Kolk has dedicated his life to the study and treatment of trauma and post-traumatic stress disorder. For those who have experienced trauma, the practice of mindfulness can become physically intolerable. The physical sensations experienced as the mind turns to focus on itself are overwhelming; to a point where intense agitation and physical pain or illness occur. For others with PTSD, the experience of physical discomfort has meant that they have learnt to dissociate themselves from feeling anything at all. The benefits of mindfulness then become inaccessible.
These experiences in a therapy setting can leave traumatised patients feeling alienated and frightened and are the key reason why people in need of healing will not seek out and continue with mindfulness centred practices and therapies.
Van der Kolk is not alone in his observations on the limitations of mindfulness as a therapeutic practice. The problem seems to lie in the way the practice has been relocated from its context as a Buddhist spiritual practice and applied undiscerningly across a broad spectrum of client cases.
Jill Margo, in Mindfulness Under the Microscope, writes:
The practice is unregulated and the common view that if it does no good, at least it will do no harm, may not be accurate.
While talking therapies may seem a safe and practical treatment option, the absence of quality control could lead to unintentional harm where patients are not ready for this process.
Shifting Conventional Treatment Pathways
Cognitive Behavioural Therapy (CBT) and Exposure Therapy are both used in the treatment of trauma. CBT is a heady processing tool, using a kind of Socratic dialogue to guide a patient to a logical understanding of the relationship between thoughts, feelings and actions, and the ways in which we can change these. Exposure therapy involves repeated exposure to the trauma trigger, with the aim of desensitising the emotional response. Van der Kolk explores conventional treatments at length in his work.
It [recovery] is only partly an issue of consciousness. Much has to do with unconscious parts of the brain that keep interpreting the world as being dangerous and frightening and feeling helpless. You know you shouldn’t feel that way, but you do, and that makes you feel defective and ashamed…trying to find a chemical to abolish bad memories is an interesting academic enterprise, but it’s unlikely to help many patients. Your whole mind, brain and sense of self is changed in response to trauma. ~ Interview with David Bullard#
Since beginning his career in the 1970s, Van der Kolk has observed hundreds of patients in a post-traumatic state. From post war emotional wounding to victims of childhood abuse, violent attacks and psychological scarring. Van der Kolk believes that psychiatric conditions and self-destructive behaviours that ensue are a result of embedded trauma.
Drug and alcohol dependence, self-harm, eating disorders, mood imbalances, and social behaviours–such as unhealthy sexual relationships–all are borne out of a desire to flee the physical pain created by exposure to the body memory of trauma. Many of the difficult sensations can be traced to a disturbance in the nervous system, and this is where the healing work can begin.
“…Your whole mind, brain and sense of self is changed in response to trauma.”
The Vagus Nerve and Embodied Trauma
Our gut feelings signal what is safe, life sustaining, or threatening; even if we cannot quite explain why we feel a particular way. ~ Van der Kolk, The Body Keeps Score
Acute physical sensations and responses are often triggered when trauma is revisited, and this is largely to do with the function of the Vagus Nerve. The Vagus nerve, also known as the wandering nerve, comes from the Latin ‘Vagus’ meaning straying or wandering. It is the primary nerve in the parasympathetic nervous system, and functions without our conscious effort; always at work as we go about life. When the parasympathetic nervous system is upset, our body is in a chronic state of imbalance.
The Vagus nerve connects the gut (stomach and intestines), heart and brain, and operates as a kind of phone line between them, sending messages up to the brain from the gut. This makes sense of ‘gut feelings’, and explains why we feel our emotions–especially anxiety, fear and sadness–so keenly in our bodies. ‘Gut wrenching’ and ‘heart wrenching’, are physical sensations borne of these emotions.
Beyond these three organs systems, the system extends to connect with our greater visceral complex, meaning all our major organs, including lungs, spleen, liver, kidney, pancreas, and the reproductive system in women.
This is the love nerve in your body; it is the caretaking nerve in your body. ~ Steve Porges, The Polyvagal Perspective
When emotional pain resides in the body, the primary nurturing function of this system is compromised. Anxiety, depression and digestive upsets are common first signs, with a plethora of health issues close behind. But Van der Kolk is hopeful about recovery and draws our attention to heart rate variability as a clue to what is going on in our deeper body system.
HRV and The Healing Power of Responsiveness
Heart rate variability is the fluctuation in intervals between each heartbeat. Steady heart rate was formerly understood to mean better health, but we now know that heart rate variability is a sign of the bodies responsiveness and healthy self-regulatory processes. It means the heart is responding to and working with the body to create homeostasis.
Many people who have not processed emotional pain have been found to experience a lack of variance, highlighting Van der Kolk’s reasoning that trauma freezes the body in a kind of chronic pain avoidance. But the good news is we can work on toning these deeper systems. Strengthening heart rate variance, toning the Vagus nerve, and even resetting neural pathways are aspects of our physiology which are not beyond our reach. In fact, there are a range of day to day things we can do to improve these fundamental building blocks for health. Singing, humming and chanting, yoga, tai chi, laughter, prayer, exercise, deep breathing and positive social engagement have all been shown to change these deep systems for the better. And make us smile along the way.
The Traces of Everyday Hurts
While many of us will never face the horrific wounding experienced by those at the heart of Van der Kolk’s work, we are all touched by painful moments. There is no doubt that talking therapies and mindfulness can make a phenomenal change in the right person at the right time. But if you are finding these aren’t working, it could be a sign that pain has slipped beyond your rational grasp. Body therapies and daily toning practices can help release these hurts, bringing them back into view, where you can begin to make peace with them.