In an Unspoken Voice

by Peter A Levine

  In the particular methodology I describe in these pages, the client is helped to develop an awareness and mastery of his or her physical sensations and feelings. My observations, in visiting a few indigenous cultures, suggest that this approach has a certain kinship with various traditional shamanic healing rituals. I am proposing that a collective, cross-cultural approach to healing trauma not only suggests new directions for treatment, but may ultimately inform a fundamentally deeper understanding of the dynamic two-way communication between mind and body.

  Over my lifetime, as well as in writing this book, I have attempted to bridge the vast chasm between the day-to-day work of the clinician and the findings of various scientific disciplines, particularly ethology, the study of animals in their natural environments. This vital field reached a pinnacle of recognition in 1973 when three ethologists—Nikolaas Tinbergen, Konrad Lorenz and Karl von Frisch—shared the Nobel Prize in Physiology or Medicine.*

  All three of these scientists utilized patient and precise observation to study how animals express and communicate through their bodies. Direct body communication is something that we reasoning, language-based human animals do as well. Despite our apparent reliance on elaborate speech, many of our most important exchanges occur simply through the “unspoken voice” of our body’s expressions in the dance of life. The deciphering of this nonverbal realm is a foundation of the healing approach that I present in this book.

  To convey the nature and transmutation of trauma in the body, brain and psyche, I have also drawn upon selected findings in the neurosciences. It is my conviction that clinical, naturalistic animal studies and comparative brain research can together greatly contribute to the evolution of methodologies that help restore resilience and promote self-healing. Toward this end, I will explain how our nervous system has evolved a hierarchical structure, how these hierarchies interact, and how the more advanced systems shut down in the face of overwhelming threat, leaving brain, body and psyche to their more archaic functions. I hope to demonstrate how successful therapy restores these systems to their balanced operation. An unexpected side effect of this approach is what might be called “Awakening the Living, Knowing Body.” I will discuss how this awakening describes, in essence, what happens when animal instinct and reason are brought together, giving us the opportunity to become more whole human beings.

  I aim to speak to the therapists who seek a better understanding of the roots of trauma in brain and body—such as psychological, psychiatric, physical, occupational and “bodywork” therapists. I also hope to reach the many medical doctors who are confounded by patients presenting inexplicable and mutable symptoms, the nurses who have long worked on the frontlines caring for terrified, injured patients and the policy makers concerned with our nation’s problematic healthcare. Finally, I look for the larger audience of voracious readers of a wide variety of subjects—ranging from adventure, anthropology, biology, Darwin, neuroscience, quantum physics, string theory, relativity and zoology to the “Science” section of the New York Times.

  Inspired by a childhood of reading Sherlock Holmes, I have attempted to engage the reader in the excitement of a lifelong journey of mystery and discovery. This voyage has carried me into a field that is at the core of what it means to be a human being, existing on an unpredictable and oftentimes violent planet. I have been privileged to study how people can rebound after extreme challenges and have borne witness to the resilience of the human spirit, to the lives of countless people who have returned to happiness and goodness, even after great devastation.

  I will be telling some of this story in a way that is personal. The writing of this book has presented me with a very exciting challenge. I offer an account of my own experience as a clinician, scientist and inner explorer. My hope is that the occasional use of storytelling will help to create an accessible work that engages the clinical and scientific, but is sparse on jargon and is not unduly tedious and pedantic. I will utilize case vignettes to illustrate various principles, as well as invite the reader to participate in selected awareness exercises that embody these principles.

  While directed to clinicians, physicians and scientists, as well as to interested laymen, ultimately this book is dedicated to those who have been tormented by the hungry ghosts of trauma. To these people, who live in a cage of anxiety, fear, pain and shame, I hope to convey a deeper appreciation that their lives are not dominated by a “disorder” but by an injury that can be transformed and healed! This capacity for transformation is a direct consequence of what I describe in the next section.

  The Self-Regulating, Self-Knowing Body

  In spite of my confusion and disorientation after the crosswalk accident, it was my thoroughly ingrained knowledge of trauma that led me first to request that the off-duty paramedic back off and allow me some space, and then to trust my body’s involuntary shaking and other spontaneous physical and emotional reactions. However, even with my extensive knowledge and experience, I doubt whether I could have done this alone. The importance of the graceful pediatrician’s quiet support was enormous. Her noninvasive warmth, expressed in the calm tone of her voice, her gentle eyes, her touch and scent, gave me enough of a sense of safety and protection to allow my body to do what it needed to do and me to feel what I needed to feel. Together, my knowledge of trauma and the support of a calm present other allowed the powerful and profoundly restorative involuntary reactions to emerge and complete themselves.

  In general, the capacity for self-regulation is what allows us to handle our own states of arousal and our difficult emotions, thus providing the basis for the balance between authentic autonomy and healthy social engagement. In addition, this capacity allows us the intrinsic ability to evoke a sense of being safely “at home” within ourselves, at home where goodness resides.

  This capacity is especially important when we are frightened or injured. Most every mother in the world, knowing this instinctively, picks up her frightened child and soothes him or her by rocking and holding the child close to her body. Similarly, the kind eyes and pleasant scent of the woman who sat by my side bypassed the rational frontal cortex to reach directly into the recesses of my emotional brain. Thus, it soothed and helped to stabilize my organism just enough so that I could experience the difficult sensations and take steps toward restoring my balance and equanimity.

  What Goes Up … Can Come Down

  In 1998, Arieh Shalev carried out a simple and important study in Israel, a country where trauma is all too common.2 Dr. Shalev noted the heart rates of patients seen in the emergency room (ER) of a Jerusalem hospital. These data were easy to collect, as charting the vital signs of anyone admitted to the ER is standard procedure. Of course, most patients are upset and have a high heart rate when they are first admitted to the ER, since they are most likely there as victims of some terrifying incident such as a bus bombing or motor vehicle accident. What Shalev discovered was that a patient whose heart rate had returned to near normal by the time of discharge from the ER was unlikely to develop posttraumatic stress disorder. On the other hand, one whose heart rate was still elevated upon leaving was highly likely to develop PTSD in the following weeks or months.† Thus, in my accident, I felt profound relief when the paramedic in the ambulance gave me the vital signs that indicated my heart rate had returned to normal.

  Briefly, heart rate is a direct window into the autonomic (involuntary) branch of our nervous system. A racing heart is part of body and mind readying for the survival actions of fight-or-flight mediated by the sympathetic-adrenal nervous system (please see Diagram A after this page for a detailed depiction of the physiological pathways underlying the classic fight or flight response). Simply, when you perceive threat, your nervous system and body prepare you to kill or to take evasive countermeasures to escape, usually by running away. This preparation for action was absolutely essential on the ancient savannahs, and it is “discharged” or “used up” by all-out, meaningful action. In my case, however, lying injured on the road
and then in the confines of the ambulance and the ER—where action was simply not an option—could have entrapped me. My global activation was “all dressed up with nowhere to go.” If, rather than fulfilling its motoric mission in effective action, the preparation for action was interfered with or had lain dormant, it would have posed a great potential to trigger a later expression as the debilitating symptoms of posttraumatic stress disorder.

  What saved me from developing these symptoms was the ability to bring down my fight-or-flight activation by discharging the immense survival energy through spontaneous trembling. This contained discharge, along with my awareness of the self-protective impulse to move my arms and shield my head, helped return my organism to equilibrium. I was able to surrender to these powerful sensations while remaining fully aware of my spontaneous bodily reactions, and with the pediatrician’s steady presence and “holding of the space,” I could restore my nervous system to equilibrium. By staying aware while “tracking” my spontaneous bodily reactions and feelings,‡ I was able to begin the process of moving through and out of the biological shock reaction. It is this innate capacity for self-regulation that let me regain my vital balance and restored me to sanity. This capacity for self-regulation holds the key for our modern survival—survival beyond the brutal grip of anxiety, panic, night terrors, depression, physical symptoms and helplessness that are the earmarks of prolonged stress and trauma. However, in order to experience this restorative faculty, we must develop the capacity to face certain uncomfortable and frightening physical sensations and feelings without becoming overwhelmed by them. This book is about how we develop that capacity.

  Shake, Rattle and Roll … Shiver, Quiver and Quake

  The shaking and trembling I experienced while lying on the ground and in the ambulance are a core part of the innate process that reset my nervous system and helped restore my psyche to wholeness. Without it I would have surely suffered dearly. Had I not been aware of the vital purpose of my body’s strange and strong sensations and gyrations, I might have been frightened by these powerful reactions and braced against them. Fortunately, I knew better.

  I once described, to Andrew Bwanali, park biologist of the Mzuzu Environmental Center in Malawi, Central Africa, the spontaneous shaking, trembling and breathing that I and thousands of my therapy clients have exhibited in sessions as they recover from trauma. He nodded excitedly, then burst out, “Yes … yes … yes! This is true. Before we release captured animals back into the wild, we try to be sure that they have done just what you have described.” He looked down at the ground and then added softly, “If they have not trembled and breathed that way [deep spontaneous breaths] before they are released, they will likely not survive in the wild … they will die.” His comment reinforces the importance of the ambulance paramedic’s questioning the routine suppression of these reactions in medical settings.

  We frequently shake when we are cold, anxious, angry or fearful. We may also tremble when in love or at the climax of orgasm. Patients sometimes shake uncontrollably, in cold shivers, as they awake from anesthesia. Wild animals often tremble when they are stressed or confined. Shaking and trembling reactions are also reported during the practices of traditional healing and spiritual pathways of the East. In Qigong and Kundalini yoga, for example, adepts who employ subtle movement, breathing and meditation techniques may experience ecstatic and blissful states accompanied by shaking and trembling.

  All of these “tremblings,” experienced in diverse circumstances and having a multiplicity of other functions, hold the potential for catalyzing authentic transformation, deep healing and awe. Although the fearful trembling of anxiety does not in itself ensure a resetting and return to equilibrium, it can hold its own solution when guided and experienced in the “right way.” The distinguished Jungian analyst Marie-Louise von Franz notes: “The divine psychic core of the soul, the self, is activated in cases of extreme danger.”3 And, in the Bible, it is said that “God is found where you have trembled.”

  What do all of these involuntary shakes and shivers have in common? Why do we quake when frightened or tremble in anger? Why do we quiver at sexual climax? And what might be the physiological function of trembling in spiritual awe? What is the commonality of all these shivers and shakes, quivers and quakes? And what have they to do with transforming trauma, regulating stress and living life to its fullest?

  These gyrations and undulations are ways that our nervous system “shakes off” the last rousing experience and “grounds” us in readiness for the next encounter with danger, lust and life. They are mechanisms that help restore our equilibrium after we have been threatened or highly aroused. They bring us back down to earth, so to speak. Indeed, such physiological reactions are at the core of self-regulation and resilience. The experience of emergent resilience gives us a treasure beyond imagination. In the words of the ancient Chinese text, the I Ching,

  The fear and trembling engendered by shock comes to an individual at first in such a way that he sees himself placed at a disadvantage … this is only transitory. When the ordeal is over, he experiences relief, and thus the very terror he had to endure at the outset brings good fortune in the long run.4

  Learning to live through states of high arousal (no matter what their source) allows us to maintain equilibrium and sanity. It enables us to live life in its full range and richness—from agony to ecstasy. The intrinsic relationship of these spontaneous autonomic responses to the broad phenomenon of resilience, flow and transformation is a central theme of this book.

  When, on the other hand, these “discharges” are inhibited or otherwise resisted and prevented from completion, our natural rebounding abilities get “stuck.” Being stuck, after an actual or perceived threat, means that one is likely to be traumatized or, at least, to find that one’s resilience and sense of OK-ness and belonging in the world have been diminished. Again, in the prescient words of the I Ching:

  This pictures a situation in which a shock endangers a man and he suffers great losses. Resistance would be contrary to the movement of the time and for this reason unsuccessful.5

  On that sunny winter morning of my accident, I was able—with the help of the kind pediatrician—to allow those physiological processes to complete moment-by-moment, moving time forward and releasing the highly charged “survival energy” lurking in my body and seeking its intended expression. This immediate emotional and “physical” first-aid prevented me from getting “stuck,” or locked in a vicious cycle of suffering and disability. How did I know what to do, as well as what to avoid, in this extremely stressful and disorienting situation? The short answer is that I have learned to embrace and welcome, rather than to fear and suppress, the primitive trembles, shakes and spontaneous body movements. The longer answer takes me back to the beginning of my last forty years of professional life as a scientist, a therapist and a healer.

  Diagram A This is a detailed depiction of the physiological pathways underlying the classic fight-or-flight response. The illustrator was the late Dr. Frank Netter, one of the foremost medical illustrators.

  Diagram B This Netter illustration shows the intricate and robust relationship between the viscera and the brain. The dorsal vagus nerve (the tenth cranial nerve at the back/dorsal part of the brain stem) mediates the immobilization system. It acts upon most of the visceral organs. The (ventral/front) nucleus ambiguus mediates the social engagement system through its connections with the middle ear, face and throat.

  * Tinbergen’s was for his study of animals in their natural environments, Lorenz’s for his study of imprinting and Von Frisch’s for his study of how the dance of honey bees communicates the location of pollen to the rest of the hive.

  † Edward Blanchard and his colleagues questioned Shalev’s data. However, in their study the vast majority of subjects were women and were only subjects who had sought treatment. Women tend to have more of a “freezing” stress response associated with the vagus nerve (which lowers heart rate)—in contrast to men,
who tend to have a dominant sympathetic adrenal response. See Blanchard, E., et al. (2002). Emergency Room Vital Signs and PTSD in a Treatment Seeking Sample of Motor Vehicle Accident Survivors. Journal of Traumatic Stress, 15 (3), 199–204.

  ‡ These varied reactions included shaking, trembling and the restoration of biological defensive and orienting responses (including head and neck movements and the protective bracing of my arms and hands to protect my head).

  CHAPTER 2

  Touched by Discovery

  The right way to wholeness is made up of fateful detours and wrong turnings.

  —C. G. Jung

  To be touched by the revelation of love or scientific discovery is among the greatest and most wondrous blessings of being alive. While the year 1969 was a dud for romance, it was for me a time of thrilling scientific illumination. While a momentous technical event occurred in outer space that year, for me, an awakening in inner space changed the course of my life.

  At summer’s beginning my friends and I sat glued to the TV screen, our jaws dropped in awe. The Eagle lunar module had landed on the Bay of Tranquility, and Neil Armstrong assuredly stepped onto the lunar surface. Transfixed, we listened to the immortalized (though grammatically challenged) phrase: “One small step for man, one giant leap for mankind.” Men not only walked on the moon, they leaped in technological exuberance! Images of Earth were relayed from our nearest celestial neighbor, offering a visual reminder that we were not at the center of the universe.