In an Unspoken Voice

by Peter A Levine

  The next somatic tool is designed to help posttraumatic stress disorder survivors learn that even when they feel paralyzed, there is a latent active response of running and escaping inside of them. A new experience of this dormant defense contradicts the traumatic encounter with being frozen and trapped (see Figure 6.4). It is essential for the therapist to have a pillow placed on the floor that is firm and thick enough to safely absorb the impact of vigorous running movements if they should occur. Begin by asking the client to run in place from a seated position. Encourage him to gently alternate his legs, lifting and stepping down, as he attends to the way his hips, legs, ankles and feet organize themselves from the inside out. The key element is to have the client stay fully aware of his legs as he makes this movement. In other words, the client needs to remain present to his bodily experience, rather than just mechanically performing or dramatizing the act of running. This is not role-playing, but rather an intentional heightening of kinesthetic and proprioceptive perception, telling a client how his body and brain together are designed to protect him by engaging innate escape movement patterns. Later, when the client brings up traumatic material that involves feeling paralyzed and unable to escape, have him put his story aside and, again, feel his legs. Have him begin to run in place as before in order to incorporate his new empowered awareness. In this way, the direct experiencing of “body wisdom” develops as the muscles discharge their latent energy.

  Figure 6.4 Safely practicing the running escape response to counter feeling trapped and helpless. It is important to cultivate the awareness of running.

  Tummy Talk

  It has long been known that the brain can influence our internal organs. When this process goes awry, one becomes the unfortunate bearer of what has been referred to as psychosomatic illness. The principal idea of the one-way effect of mind over body evolved as the “psychosomatic paradigm” of the 1930s through 1950s. Today, it remains conventional wisdom, and few doctors deny that an overwrought mind and unsettled emotions affect the human body in the form of “functional” disorders, which include high blood pressure, gastrointestinal symptoms, chronic pain, fibromyalgia and migraines, as well as a multitude of other, so-called idiopathic diseases. In 1872, however, long before the rise of psychosomatic medicine, the amazing Charles Darwin realized that there was a vital two-way connectivity between brain and body:

  When the heart is affected it reacts on the brain; and the state of the brain reacts through the pneumo-gastric on the heart; so under any excitement, there will be much mutual action and reaction between these, the two most important organs in the body.75 [italics mine]

  The “pneumo-gastric” nerve Darwin speaks of is none other than the vagus nerve described in Porges’s polyvagal theory. The primitive (unmyelinated) vagus nerve of the immobilization system connects the brain with most of our internal organs. This enormous nerve is the second largest nerve in our body, comparable in size to the spinal cord. In particular, this nerve largely serves the gastrointestinal system, influencing ingestion, digestion, assimilation and elimination. It also significantly affects the heart and lungs, as Darwin clearly recognized.

  Furthermore, embedded within the lining of the gastrointestinal wall itself there is a massive plexus of nerves. This complex network of sensory, motor and interneurons (those nerve cells that connect between the sensory and motor neurons) integrates the digestive and eliminative organs so that they function coherently.m This intricate system has about the same number of neurons and white matter as does a cat’s brain. Because of this complexity, it has sometimes been called the second or enteric brain; the other three are the reptilian (instinctual), the paleomammalian (limbic/emotional) and the primate (enlarged, rational) neocortex. The enteric nervous system is our oldest brain, evolving hundreds of millions of years ago. It produces many beneficial hormones, including 95% of the serotonin in the body,n and thus is a primary natural medicine factory and warehouse for feel-good hormones.76

  Amazingly, as much as 90% of the vagus nerve that connects our guts and brains is sensory! In other words, for every one motor nerve fibero that relays commands from the brain to the gut, nine sensory nerves send information about the state of the viscera to the brain. The sensory fibers in the vagus nerve pick up the complex telecommunications going on in the gut and relay them, first up to the (mid) brain stem and then to the thalamus. From there, these signals virtually influence the entire brain, and subliminal “decisions” are made that profoundly influence our actions. Many of our likes and dislikes, our attractions and repulsions, as well as our irrational fears, are the result of these implicit computations in our internal states.

  It can be said that humans have two brains: one in the gut (the enteric brain) and the “upstairs brain,” sitting within the vaulted dome of the cranium. These two brains are in direct communication with each other through the hefty vagus nerve. And if we go with the numbers—nine sensory/afferent nerves to every one motor/efferent nerve—our guts apparently have more to say to our brains (by a ratio of 9:1) than our brains have to say to our guts!p

  Let’s look more deeply at the functions of this massive nerve, which not only connects organs and brain, but functions primarily in the direction of gut to brain. Why is it even important for the body to talk to the brain in the first place? From the perspective of evolution (and the general parsimony of nature), it is unlikely that such a myriad of nerve fibers would be allotted to making bidirectional communication possible if that linkage weren’t vitally important.

  Most of us have experienced butterflies in our stomach when asked to make a public speech. On the other hand, some people are known for “having gall,” while others are quite “bitter” or “bilious.” And then too, at times we may have “knots in our guts” and are “twisted up inside.”q Or we may be “heavyhearted” or nursing a “heartache.” And blessed are the times when we have surrendered to the pure mirth of a spontaneous “belly laugh.” Or, again, we may be “openhearted and filled with warmth in our bellies,” feeling an inner peace and love for the whole world. On the occasions when we have accomplished notable achievements, our chests may “swell with pride.” Such is the variety of poignant messages emanating from our viscera.

  When aroused to fight or flight (sympathetic arousal), our guts tighten, and the motility of the gastrointestinal system is inhibited. After all, there is no sense in spending a lot of metabolic energy on digestion when it is best used to speed up the heart’s rhythm and to strengthen its contraction, as well as to tense our muscles in readiness for impending action. When we are mortally threatened, or when the threat is internal (say, from the flu or from eating a bacterially infected food), our survival response is to vomit or to expel the contents of our intestines with diarrhea, and then to lie still so as to conserve energy. It seems possible that prey animals also resort to this reaction when a predator suddenly springs on it from within striking distance. In this case, the violent expulsion of the animal’s intestinal contents may actually lighten its weight and give it a better chance of escaping. This fraction-of-a-second advantage could mean the difference between life or death. I have seen this happen on several occasions when a mountain lion has lunged at a group of deer drinking from the North St. Vrain River, which runs behind my Colorado home.

  The powerful effects of both the sympathetic and the vagus nerves on the viscera serve critical survival functions. The activation of these two systems is meant to be brief in response to acute emergency. When they become stuck (in either sympathetic overdrive or vagal overactivity), the survival function is drastically subverted: one may end up suffering from a painfully knotted gut, as in the case of persistent sympathetic hyperarousal, or be tormented by spasms of twisting cramps and disruptive diarrhea in chronic vagal hyperactivity.r When equilibrium is not restored, these states become chronic, and illness ensues.

  Together, these complex systems (the vagus and the enteric plexus), not unlike a great marriage, put gut and brain in either blissful har
mony or in dreadful unending battle. When there is a coherent balance between the two, the hedonic (concerned with pleasure or pleasurable sensations) fulcrum is tipped toward heaven; when the regulatory relationship is disordered, the gates of hell are opened wide like the great maw of misery.

  The Medium Is the Message

  Our nervous system assesses threat in two basic ways. First of all, we use our external sense organs to discern and evaluate threat from salient features in the environment. So, for example, a sudden shadow alerts one to a potential risk, while the large looming contours of a bear or the sleek, crouching silhouette of a mountain lion let one know that one is in grave danger. We also assess threat directly from the state of our viscera and our muscles—our internal sense organs. If our muscles are tense, we unconsciously interpret these tensions as foretelling the existence of danger, even when none actually exists. Tight muscles in the neck and shoulders may, for example, signal to the brain that you are likely to be hit. Tense legs, along with furtive eyes, may tell you that you need to run and escape, and taut arms may signal that you’re ready to strike out. We suffer even greater distress when our guts are persistently overstimulated by the vagus nerve. If we are nauseated, twisted in our guts, feel our muscles collapsing, and lack in energy, we feel helpless and hopeless—even though there is no actual decimating threat. In other words, the churning itself signals grave threat and dread to the brain, even when nothing is currently wrong—at least not externally.

  Our muscular and visceral states color both our perceptions and our evaluation of the intentions of others. While we may believe that certain individuals will do us no harm, we still feel endangered.s

  Even something as neutral as a room, a street corner or a sunlit meadow may seem ominous. Conversely, experiencing relaxed (and well-toned) muscles and belly can signal safety even when a person’s daily affairs are in turmoil. As an illustration of this point, I overheard a person saying after receiving a full-body massage, “The world’s not such a bad place after all. I feel terrific.” While a wonderful massage is a great way to give a person a new way of feeling good, it will take a major shift in the ongoing dialogue on the brain-gut highway to free up more than ephemerally the congestion caused by chronic stress and trauma.

  The intense visceral reactions associated with threat are meant to be acute and temporary. Once the danger has passed, these reactions (be it inhibition of gastric motility by the sympathetic nervous system or violent overstimulation of motility by the primitive vagus nerve) need to cease in order to return the organism to equilibrium, fresh and flowing in the here and now. When balance is not restored, one is left in acute and, eventually, chronic distress.

  In order to prevent trauma as well as to reverse it when it has already occurred, individuals must become aware of their visceral sensations.t In addition, our gut sensations are vital in orchestrating positive feelings of aliveness and in directing our lives. They are also the source of much of our intuition. As we can learn from traditional, shamanic and spiritual practices, embraced for thousands of years throughout the world, feelings of goodness are embodied directly as visceral sensations. When we ignore our “gut instincts,” it is at our own great expense, if not peril.

  In states of immobilization and shutdown, the sensations in our guts are so dreadful that we routinely block them from consciousness. But this strategy of “absence” only maintains the status quo at best, keeping both brain and body hopelessly stuck in an information traffic jam. It is a recipe for trauma and a diminished life, a cardboard existence. The following is another simple exit strategy for undoing the brain/gut knot.

  An Effective Sound: “Voo”

  The first seat of our primal consciousness is the solar plexus, the great nerve-centre situated behind the stomach. From this centre we are first dynamically conscious.

  —D. H. Lawrence, Psychoanalysis and the Unconscious

  Along with multitudes of other people, I have experienced various chanting and ancient “sounding” practices that facilitate healing and help open the “doors of perception.” Singing and chanting are used in religious and spiritual ceremonies among every culture for “lightening the load” of earthly existence. When you open up to chant or sing in deep, resonant lower belly tones, you also open up your chest (heart and lungs), mouth and throat, pleasurably stimulating the many serpentine branches of the vagus nerve.u

  Certain Tibetan chants have been used successfully for thousands of years. In my practice, I use a sound borrowed (with certain modifications) from some of these chants. This sound opens, expands and vibrates the viscera in a way that provides new signals to a shut-down or overstimulated nervous system. The practice is quite simple: make an extended “voooo …” (soft o, like ou in you) sound, focusing on the vibrations stimulated in the belly as you complete a full expiration of breath.

  In introducing the “voo” sound to my clients, I often ask them to imagine a foghorn in a foggy bay sounding through the murk to alert ship captains that they are nearing land, and to guide them safely home. This image works on different levels. First of all, the image of the fog represents the fog of numbness and dissociation. The foghorn represents the beacon that guides the lost boat (soul) back to safe harbor, to home in breath and belly. This image also inspires the client to take on the hero role of protecting sailors and passengers from imminent danger, as well as giving him or her permission to be silly and thereby play. Most important are the image’s physiological effects. The sound vibrations of “voo” enliven sensations from the viscera, while the full expiration of the breath produces the optimal balance of oxygen and carbon dioxide.77

  Begin the exercise by finding a comfortable place to sit. Then slowly inhale, pause momentarily, and then, on the out breath, gently utter “voo,” sustaining the sound throughout the entire exhalation. Vibrate the sound as though it were coming from your belly. At the end of the breath, pause briefly and allow the next breath to slowly fill your belly and chest. When the in breath feels complete, pause, and again make the “voo” sound on the exhalation until it feels complete. It is important to let sound and breath expire fully, and then to pause and wait for the next breath to enter (be taken) on its own, when it is ready. Repeat this exercise several times and then rest. Next, focus your attention on your body, primarily on your abdomen, the internal cavity that holds your organs.

  This “sounding,” with its emphasis on both waiting and allowing, has multiple functions. First of all, directing the sound into the belly evokes a particular type of sensation while keeping the observing ego “online.” People often report various qualities of vibration and tingling, as well as changes in temperature–generally from cold (or hot) to cool and warm. These sensations are generally pleasant (with a little practice, at least). Most important, they contradict the twisted, agonizing, nauseating, deadening, numbing sensations associated with the immobility state. It seems likely that the change in the afferent messages (from organs to brain) allows the 90% of the sensory (ascending) vagus nerve to powerfully influence the 10% going from brain to organs so as to restore balance.v

  Porges concurs on this key regulatory system: “The afferent feedback from the viscera provides a major mediator of the accessibility of prosocial circuits associated with social engagement behaviors.”78

  The salubrious sensations evoked by the combination of breathing and the sound’s reverberations allow the individual to contact an inner security and trust along with some sense of orientation in the here and now. They also facilitate a degree of face-to-face, eye-to-eye, voice-to-ear, I-thou contact and thus make it possible for the client to negotiate a small opening into the “social engagement system,” which is then able to help him or her to develop a robust resilience through increasing cycles of sympathetic arousal (charge) and discharge and thereby to deepen regulation and relaxation. Charles Darwin, I can happily imagine, would have knowingly winked his approval at the “voo” clinical application of his astute, anatomical and physiological 1872 o
bservation.

  Another exercise can provide clients with a way to manage and regulate distressing arousal symptoms. This “self-help” technique is taken from a system of “energy flows” called Jin Shin Jyutsu.w Figures 6.5A–D demonstrate a simple Jin Shin sequence to help clients learn to regulate their arousal and deepen their relaxation.79 Again, I suggest that therapists experiment first on themselves before teaching these exercises to their clients. Encourage your clients to practice at home, first at times when they are not upset and then when they are. Each position can be maintained for two to ten minutes. What the client looks for is a sensation of either energy flow or relaxation.

  Jin Shin Jyutsu Energy Flows

  Figure 6.5a These figures show the arm/hand positioning that help to establish energy flows between upper and lower body segments. These exercises promote relaxation.

  Figure 6.5b

  Figure 6.5c These figures show the arm/hand positioning for containing arousal and promoting self-compassion.