HEALING UNRESOLVED TRAUMA
Our society is now becoming much more aware of the effects of trauma through the media: suffering of military personnel returning with PTSD (posttraumatic stress disorder) from Afghanistan (and Iraq for those in the US), the prevalence of sexual abuse and domestic violence, the Canada-wide investigation of the effects of the residential school system on the residents and on subsequent generations by the Truth and Reconciliation Commission of Canada, to name a few. According to Statistics Canada “the lifetime prevalence of PTSD is approximately 8% in the population,[while the]12-month prevalence in the U.S. is 3. According to David Kinchin, the author of Post Traumatic Stress Disorder (2005), the incidence of PTSD can be as high as 15% in the armed forces and in the emergency services (fire, police, and ambulance5%.”
Many first responders (police, paramedics, firemen) who experience or witness life-threatening situations, intense violence and car accidents, have a higher risk of suicide as seen by 32 suicides amongst Canadian paramedics during the 9 months before the beginning of February 2015. While it makes sense that first responders have higher stress levels because of the frequent intense situations they are involved in, it is not only first responders who are at risk for being traumatized. Acute, or shock, trauma can result from a traffic accident, surgery, a fall, an animal attack, a mugging, rape or other violent event. Domestic violence, childhood and sexual abuse, and other chronic assaults can lead to a complex traumatized condition. Witnessing violence can also be traumatizing.
As a society we are not well educated in resolving trauma or even knowing that as individuals we may be traumatized. The predominant individualistic attitudes of our culture can prevent people asking for help, often feeling ashamed that they are unable to cope with the symptoms of stress and unresolved trauma.
While the medical profession sees trauma as an injury to the body, physiologically trauma is not so much the event as the effect on the body’s nervous system and the instinctive fight, flight or freeze survival states. When the fight or flight response to a threatening event is not able to successfully complete, as in PTSD (posttraumatic stress disorder) or an automobile accident, rape, or other life-threatening event, the nervous system becomes overwhelmed and gets ‘stuck’ resulting in symptoms such as persistent anxiety or panic, nightmares, flashbacks, depression, hopelessness, terror, dread, hyper- or hypo vigilance, chronic pain, muscular spasms, nervous tics, chronic digestive ailments, and other chronic conditions including fibromyalgia and chronic fatigue syndrome. The onset of these persistent symptoms may be months after the threatening event. One common way of coping with these distressing conditions is by medicating with drugs, smoking, alcohol, gambling, overwork and other addictions.
Defense or Survival Responses
We have a sequence of innate, automatic, responses available to deal with threat, each response being mediated by a different nervous system. The first response is to engage at a social level, attempting to calm the situation. If this fails, the fight/flight system is engaged, activating very high and instantly available energy in the muscles, with changes in posture ready to fight or flee. Stress hormones are produced which support this change. If fighting or fleeing are successful, then the body calms down and there is no residual effect. However, if not successful, then a third and the most primitive innate nervous system takes over, essentially shutting the body down as in “playing” or “feigning” death. This is a very low energy state, and in mammals, particularly humans, can be lethal in itself. In the wild, if a deer, say, is attacked and cannot fight or successfully escape, it will go into this collapsed state. If the predator leaves without killing the deer, the deer will shake, often repeating the movements it was making just before being brought to the ground. When this process is complete, the body will return to its normal and flexible state and the deer will not be traumatized.
We can see this recovery process in infants and young children who hurt themselves and are then picked up and held by a caring adult. The child will often cry, sob, and shake for a period of time. Then, suddenly, all is well. The child looks interested in his or her surroundings and returns to play and exploring without any after effects. The child is not traumatized – the nervous system has returned to normal.
Frequently, after an automobile accident, some surgeries, dental procedures, life-threatening events, or events perceived as life-threatening, such as rape, violent attacks, war, natural disasters, to name some, the survival response is interrupted and the body stays in a state of high alert and high energy with feelings of anxiety and panic attacks, or stays stuck in a state of low energy and depression with feelings of hopeless, fear, terror, or dread. Sometimes the nervous system can cycle erratically between extremes of high arousal and low energy, or stay in one extreme for a long period and then spontaneously move to the other extreme for an extended extreme as in bipolar (manic-depressive) disorder. Equally confusing is when both states (high arousal and depression) can be activated at the same time.
To complicate matters, when a trauma is unresolved, the survival system will be activated by situations that are perceived as life-threatening even though they are not. A loud noise in a peaceful environment can send a military veteran into a state of intense alertness and preparedness for fight; a particular voice tone, smell, expression, can similarly activate the survival responses of a victim of violence or rape. These responses are body memories to an event that is not integrated into a person’s narrative memory.
Another complication is that unresolved trauma can lead a person into situations that repeat the original threat, a process called trauma re-enactment.
While recovery of the nervous system from a single ‘shock’ trauma, such as an automobile accident, can be a fairly simple process, earlier unresolved traumas can extend the process. Robert Scaer observed that childhood sexual abuse had a profound impact on recovery from the effects of whiplash injuries.
PTSD (post-traumatic stress disorder) is characterized by flashbacks, nightmares, hypervigilance, intense bouts of rage and/or crying, disorientation, emotional numbing, avoidance of situations associated with the trauma, is often a consequence of life-threating situations such as war, kidnapping, rape, sexual and physical assault, car or plane crashes, childhood neglect or sudden death of a loved one.
Long-term memory is stored in two ways:
Explicit memory, what we usually think of as memory, holds all the memories of which we are conscious: our stories, our memories of events including images, conversations, facts, thoughts, sounds, smells. It is also referred to as narrative or declarative memory.
Implicit memory, also called procedural memory, holds information that we are not normally consciously aware of. It holds the memory of how to do actions like riding a bike, walking, and strong emotional memories, particularly fear. It is not conceptual nor linguistic and can be hard to access through verbal means.
Normally explicit memory (what happened) is integrated with implicit memory (how the body responded). However during a traumatic event, explicit memory may shut down so that we have fractured or no conscious memory of the event, yet our implicit memory will still function. So subsequent events, like a noise or a smell that is similar to a noise or smell during the traumatic event, will trigger the implicit memory to react to a benign event as if it were threatening. Because there is no explicit memory of the original event, this may appear to be a ‘crazy’ or, at least, incongruent response.
Events That Can Lead to Unresolved Trauma
Unresolved trauma will reside in the body if the normal fight or flight response is unable to complete by either successfully repelling an attack or running/getting away.
– high impact events such as automobile, motorbike, bicycle, skiing, accidents
Symptoms and Conditions
The fight, flight, freeze survival responses are designed to be in operation for a very short time, i.e. minutes. If they are engaged for a longer period without completion, they can lead to many chronic conditions:
– hypervigilance, hyperarousal, hypersensitivity
Recent research in the fields of brain functioning, mammalian responses to life-threatening events (animals in the wild do not become traumatized), the neurobiology of the fight/flight/freeze survival systems, trauma and body-centred therapies have led to effective treatments of these often perplexing and persistent conditions.
We are learning more each day about treating the effects of trauma. A whole body approach that integrates mind, emotions and body is finding great success in healing trauma and returning the person to a more flexible and alive state.
Full Aliveness. The essence of this treatment is process based, i.e. facilitating the movement to completion of stuck or interrupted survival responses in an effective way by engaging the body’s own healing systems. The process of healing takes place in a gently paced way in a safe relational environment that ensures the client does not become retraumatized by being overwhelmed by memories and/or body sensations. Attention is paid to body sensations and feelings rather than focusing on thinking processes and beliefs because trauma resides in the unconscious survival nervous system. In addition, trauma can also shut down access to speech. Constant retelling or repeated re-enacting the traumatic incident can retraumatize and keep a person stuck in a traumatized state. Allowing and facilitating the survival systems to heal in an organic way returns aliveness to the body.
When the nervous system is stuck in the freeze response, access to relationship with other people may be compromised with feelings of isolation and disconnection, an inability to bond and maintain close relationships. One of the greatest supports in recovering from unresolved trauma is to be in the presence of a safe and empathic person.
For a single event shock trauma, such as a car accident, recovering full aliveness is a fairly simple and straightforward process. For more complex trauma where there has been repeated unresolved traumatizing events, such as childhood abuse, domestic abuse, bullying, living in a war, terrorist, or a chronic violent environment, the process will take longer.
The healing process can be supported by mindful practices such as meditation, yoga, or breath awareness; by involvement with a safe community and/or a spiritual practice; by body work such as massage and chiropractic; and by exercise and a healthy diet. These activities increase activation of the frontal lobes of the brain to mediate, dampen and slow the high arousal fear response which leads to the symptoms of PTSD. Mindfulness processes also help the client to become aware of PTSD triggers before they lead to high arousal symptoms.
Trauma resolution methodology can be a modality in itself and also an adjunct to counselling, medical treatment, massage, chiropractic, yoga and other healing modalities.
Statistics Canada report on PTSD: