In an Unspoken Voice

by Peter A Levine

  People need to disengage the emotional and mental associations from the raw physical sensations they have come to experience as precursors of disaster but that are, ultimately, sensations of vitality. Reestablishing these enlivening affects is a central core of effective trauma treatment. Interestingly, it is also found in ancient healing practices, such as meditation, shamanism and yoga.

  Taking the Plunge

  When the first plane hit the building, only ten stories above her office, the explosion sent a shock wave of terror through her body. People’s immediate reaction to such terrifying events is to arrest, orient and then escape. This usually entails an intense urge to run. However, trapped eighty stories above ground with thousands of other people, Sharon needed to inhibit this primal reaction. Against the intense impulses to flee, she compelled herself to stay “calm” and walk in an orderly line down the stairs along with dozens of other terrified individuals; this was the case even though her body was “adrenaline-charged” to run at full throttle. Surely Sharon also felt the potential for any one of the other trapped office workers to suddenly panic and start a stampede that would further imperil them all. They, like her, also had to restrain their powerful primal urge to run. As Sharon slowly recounts the details of the escape, while feeling her bodily response, step-by-step, she recalls encountering yet another moment of stark terror when she found the door at the seventieth floor locked and impassable.

  Because of the physical comfort she found in contacting the spontaneous, expansive gestures and the images of the Hudson River, I now trust that Sharon can more safely face some of this highly charged material without becoming overwhelmed and consequently retraumatized.f In following her “body story,” islands of safety (Steps 1 through 3 in Chapter 5) are beginning to form in Sharon’s stormy trauma sea. The safety experienced from these internal islands allows her to deal with increasing levels of arousal and to move through them without undue distress.

  From this assessment, I guide her back to the moment of the explosion and then have her locate where and how that violent imprint feels in her body. As she attends to this “felt sense,” she becomes aware of an overall feeling of agitation in her legs and arms and tight “lumps” in her gut and throat. She says that she feels stuck. Here I introduce her to using the “voo” sound as a way to help her dissolve and transform the stuck sensations (see Chapter 6). As she focuses on those uncomfortable physical sensations (with the help of the vibratory sounds), the inclination to try to understand or explain them is reduced. With keenly focused attention, I guide her away from interpreting what she is feeling because I do not want the meaning to come from a mental place. The body needs to tell what’s on its “mind” first in order for new perceptions to arise in present time. (This warning about “premature cognition” was displayed on a bumper sticker I recently saw: “Reality: It’s not what you think!”)

  Sharon quietly takes some moments to reflect. In suspending the compulsion for understanding, she experiences a sudden “burst of energy coming from deep inside my belly.” Does it have a color, I ask? “Yes, it’s red, bright red, like a fire.” Though visibly startled by its intensity, she does not recoil from its potency. Her experience shifts into (what she recognized as) a strong urge to run, concentrated in her legs and arms. However, with the very thought of running she again “freezes.” I sense that she is caught between the real and necessary desire to escape and her “unconscious” mind, which associates fleeing with being trapped. As on the stairwell, she had to restrain her powerful escape impulse and walk slowly—even though she was in mortal danger. This dilemma was compounded with the shock of finding the door locked on the seventieth floor. Then, when she eventually reached the mezzanine, the south tower collapsed and she was thrown violently into the air. Finally, there was the stark horror of finding herself lying semiconscious on a dead body.

  Two Brains

  Sharon was caught in a conflict between two very different centers in her brain: the raw, primitive self-preservation messages from the brain stem and limbic system were demanding that she run for her life, while her frontal cortex was sending messages of inhibition and restraint. It was telling her to be “reasonable” and walk calmly in an orderly line. In our session, it was crucial to separate the terrifying expectations of being trapped from her somatic biological impulses to act on and “metabolize” that survival energy. In order to uncouple the two, I ask if she can focus on the intense “electricity” she describes experiencing in her body and imagine taking it somewhere where she had previously enjoyed running. She stiffens in response to that invitation. She says, “It would make me feel too anxious.” I then surprise her by asking her where she feels the anxiety and what it feels like (see the Epilogue to this case). Disarmed, Sharon blurts out, “I don’t know. Oh, it’s my neck and shoulders and my chest feels like I can’t breathe … My legs are so tight that … I don’t know, they feel like they could …”

  “Like what?” I ask.

  “Like they want to run,” she responds. Then, with a little reassurance, she begins to feel the sensations of running along a path in her favorite park. After a few minutes, I observe a gentle trembling in her legs. I ask her what she is feeling, to which she responds, “I could really feel the running; it was full-out … and I don’t feel the anxiety anymore.”

  “OK, Sharon,” I interject, “but what do you feel?”

  “Well, actually I feel good, relieved … I feel tingly and relieved; and my breath feels really deep and easy; and my legs are warm and relaxed.” A tear gently streaks down her cheek. Her face and hands have an even pink color.

  This was the beginning of Sharon’s separating the powerful biological urge to escape from her mental and emotional expectation that she would again be trapped and overwhelmed. By imagining—with full engagement in her bodily experience—the sense that she was running, unfettered, in a safe place, she was able to complete the frozen action locked in her body.g Just having Sharon imagine running would not have had much of an effect. However, first approaching the place where she was trapped, revisiting (touching into) that moment of terror and then experiencing the (new) possibility of completing that motor act was the therapeutic denouement.98

  Having felt her highly charged physically sensations, just as they were, not as she feared or imagined they were, was the linchpin to uncoupling the catastrophic thoughts, as well as the emotions of terror and panic, from her actual physical experience. During this process, which lasted almost two hours, and which was punctuated with cycles of soft trembling and gentle sweating, she gradually developed the capacity to tolerate her sensations until they came to their natural completion. I believe evidence exists supporting the idea that this fulfilled and successful action “switched” certain critical brain circuits, allowing her to experience the possibility of meaningful, effective action rather than helpless anxiety.99 In this way her immobilizing anxiety transformed into a “flowing wave of warm energy.” The vast “life or death” energy of survival had metamorphosed, through cycles of trembling discharge, into feelings of aliveness and goodness.

  After directly experiencing this relief as a sensation in her body (a sensation that directly contradicted her paralyzing terror) Sharon regained a sense of aliveness and the felt reality that she had, indeed, survived and that her life had a future with expanding possibilities. She no longer felt trapped in the horror of the event; it began to recede to the past where it belonged. And it was now possible to travel on the subway to hear her favorite music at Lincoln Center. A new and different meaning for her life arose out of a new and different experience at the instinctual bodily level.

  This was the story Sharon’s body told. It is reminiscent of Antonio Damasio’s prose:

  We use our minds not to discover facts but to hide them. One of the things the screen hides most effectively is the body, our own body, by which I mean, the ins and outs of it, its interiors. Like a veil thrown over the skin to secure its modesty, the screen partially removes
from the mind the inner states of the body, those that constitute the flow of life as it wanders in the journey of each day.100

  Epilogue

  Our feelings and our bodies are like water flowing into water. We learn to swim within the energies of the [body] senses.

  —Tarthang Tulku

  To review, human beings have been designed over millennia, through natural selection and social evolution, to live with and to move through extreme events and loss, and to process feelings of helplessness and terror without becoming stuck or traumatized. When we experience difficult and particularly horrible sensations and feelings, our tendency, however, is to recoil and avoid them. Mentally, we split off or “dissociate” from these feelings. Physically, our bodies tighten and brace against them. Our minds go into overdrive trying to explain and make sense of these alien and “bad” sensations. So, we are driven to vigilantly attempt to locate their ominous source in the outside world. We believe that if we feel the sensations, they will overwhelm us forever. The fear of being consumed by these “terrible” feelings leads us to convince ourselves that avoiding them will make us feel better and, ultimately, safer. There are many examples of this in our lives: we may avoid a café or certain songs that remind us of a former loved one or avoid the intersection where we were rear-ended a year ago.

  Unfortunately, the opposite is true. When we fight against and/or hide from unpleasant or painful sensations and feelings, we generally make things worse. The more we avoid them, the greater is the power they exert upon our behavior and sense of well-being. What is not felt remains the same or is intensified, generating a cascade of virulent and corrosive emotions. This forces us to fortify our methods of defense, avoidance and control. This is the vicious cycle created by trauma. Abandoned feelings, in the form of blocked physical sensations, create and propel the growing shadow of our existence. As we saw with Sharon, when we focus in a particular way on physical sensations, in a short period of time they shift and change; and so do we.

  Premature Cognition

  Sharon’s misdirected beliefs (though largely subconscious) are efforts to understand, to make sense of her experience and to help her justify why she feels so bad. These “explanations” will do nothing to help her move through her fright response and complete the inhibited actions that form the basis of her continued trauma response (the how). Mentation, at this stage, only interferes with resolution. For this reason I coach her to resist the seduction to understand and, instead, to fully engage with what she is now physically feeling in her body. The consequence of “premature cognition” is to take the person out of his or her sensate experience before it completes and has the opportunity to generate new perceptions and new meanings.

  The Experience of Anxiety Is Not Universal

  If you ask several anxious people what they are feeling, they may all say that they are feeling “anxiety.” However, you are likely to get several different responses if they are then queried with the epistemological question, “How do you know that you are feeling anxiety?” One may state, “I know because something bad will happen to me.” Another will say that he is feeling strangulated in his throat; another that her heart is leaping out of her chest; and yet another that he has butterflies or a knot in his gut. Still other people might report that their neck, shoulders, arms or legs are tight; yet others might feel ready for action; while still others might sense that their legs feel weak or that their chests are collapsed. All but the first reply are specific and varied physical sensations. And if the person who feared that “something bad will happen to me” was directed to do a scan of her body, she would have discovered some somatic/physical sensation driving and directing that thought. With a little practice we can actually start to separate out emotions, thoughts and beliefs from the underlying sensations. We are then astounded by our capacity to tolerate and pass through difficult emotional states, such as terror, rage and helplessness, without being swept away and drowned. If we go underneath the overwhelming emotions and touch into physical sensations, something quite profound occurs in our organism—there is a sense of flow, of “coming home.” This is a truth central to several ancient spiritual traditions, particularly certain traditions in Tibetan Buddhism.101

  The Transformative Power of Sensation

  To understand the transforming power of direct sensate experience, it is necessary to “dissect” certain emotions such as terror, rage and helplessness (see Chapter 13). When we perceive (consciously or unconsciously) that we are in danger, specific defensive postures necessary to protect ourselves are mobilized in our bodies. Instinctively we duck, we dodge, we retract and stiffen, we prepare to fight or flee; and when escape seems impossible, we freeze or fold into helpless collapse. All of these are specific innate bodily responses, powerfully energized to meet extreme situations. They allow a woman weighing one hundred and twenty pounds to lift a car off her trapped child. It is the same primal force that propels a gazelle to sprint at seventy miles per hour in order to escape the pursuing cheetah.

  These survival energies are organized in the brain and specifically expressed as patterned states of muscular tension in readiness for action. However, when we are activated to this level and, like Sharon, are prevented from completing that course of action—as in fighting or fleeing—then the system moves into freeze or collapse, and the energized tension actually remains stuck in the muscles. In turn, these unused, or partially used, muscular tensions set up a stream of nerve impulses ascending the spinal cord to the thalamus (a central relay station for sensations) and then to other parts of the brain (particularly the amygdala), signaling the continued presence of danger and threat. Said simply, if our muscles and guts are set to respond to danger, then our mind will tell us that we have something to fear. And if we cannot localize the cause of our distress, then we will continue to search for one; a good example of this was Sharon’s struggle to understand her experience. We see this in Vietnam vets who are terrified by the sounds of the 4th of July fireworks, even though they “know” rationally that they are not in any danger. Other examples are people who fear driving a car after they have been involved in an accident or people who fear even leaving the house because they do not know where these danger signals are originating from. In fact, if we cannot find an explanation for what we are feeling, we will surely manufacture one, or many. We’ll often blame our spouses, children, bosses, neighbors (be they next door or another nation) or just plain bad luck. Our minds will stay on overdrive, obsessively searching for causes in the past and dreading the future. We will stay tense and on guard, feeling fear, terror and helplessness because our bodies continue to signal danger to our brains. Our minds may or may not “agree,” but these red flags (coming from nonconscious parts of the brain) will not disappear until the body completes its course of action. This is how we are made—it is our biological nature, hardwired into brain and body.

  These bodily reactions are not metaphors; they are literal postures that inform our emotional experience. For example, tightness in the neck, shoulders and chest and knots in the gut or throat are central to states of fear. Helplessness is signaled by a literal collapsing of the chest and shoulders, along with a folding at the diaphragm and weakness in the knees and legs. All of these “postural attitudes” represent action potentials. If they are allowed to complete their meaningful course of action, then all is well; if not, they live on in the theatre of the body.

  If frightening sensations, such as the ones Sharon was experiencing, are not given the time and attention needed to move through the body and resolve/dissolve (as in trembling and shaking), the individual will continue to be gripped by fear and other negative emotions. The stage is set for a trajectory of mercurial symptoms. Tension in the neck, shoulders and back will likely evolve over time to the syndrome of fibromyalgia. Migraines are also common somatic expressions of unresolved stress. The knots in the gut may mutate to common conditions like irritable bowel syndrome, severe PMS or other gastrointestinal problems such as s
pastic colon. These conditions deplete the energy resources of the sufferer and may take the form of chronic fatigue syndrome. These sufferers are most often the patients with cascading symptoms who visit doctor after doctor in search of relief, and generally find little help for what ails them. Trauma is the great masquerader and participant in many maladies and “dis-eases” that afflict sufferers. It can perhaps be conjectured that unresolved trauma is responsible for a majority of the illnesses of modern mankind.

  Renegotiation

  The concept of renegotiation is completely different from cathartic “traumatic reliving,” or flooding, a common form of trauma therapy still used after “critical events” like rapes, natural disasters and horror, like the World Trade Center attack that Sharon experienced on 9-11. Recent studies suggest that these therapies often do little to help and can actually be retraumatizing.102

  One of the pitfalls of various trauma therapies has been their focus on the reliving of traumatic memories along with the intense abreaction of emotions. In these exposure-based treatments, patients are prodded into the dredging up of painful traumatic memories and abreacting emotions associated with these memories, specifically those of fear, terror, anger and grief. These cathartic approaches fall short as they often reinforce sensations of collapse and feelings of helplessness.

  Adam: Holocaust Survivor

  Adam was a financially successful businessman in his mid-sixties when I worked with him. He had a wife and family and was the owner of a multinational electronics company. As a quiet, kindly person, he was well liked by his employees and his acquaintances; yet Adam had no truly intimate friendships. Recently, his first grandchild was born. By all outward appearances, life has been good. It was the suicide of his son at the age of twenty-seven years that has broken this man of fierce, though subdued, determination. It has reduced him to obsessive self-blame and self-hatred.