In an Unspoken Voice

by Peter A Levine

  His hand begins to tremble, and he looks to me for some reassurance. “Yes, Vince, just let that happen. It’s a good thing. It’s your muscles starting to let go. Try to keep your mind focused there, with your arm and with the trembling. Just let your arm move the way it wants to.” The trembling goes on for a while and then stops; Vince’s forehead breaks out in sweat.

  As Vince moves to the edge of the bracing pattern, some of the “energy” held in his muscular-defense pattern begins to release. This includes the involuntary autonomic nervous system reactions, such as shaking, trembling sweating and temperature changes.m Because these are subcortically based actions, the person does not have a feeling of control over their reactions. This may be quite unsettling. My function here is that of a coach and midwife, helping Vince to befriend these “ego alien” sensations, especially since he is wholly unaccustomed to involuntary reactions that he can’t control.

  “What is this, why is it happening?” Vince asks me in the voice of a frightened child.

  “Vince, I’m going to ask you to just close your eyes for a minute now and go inside your body. I’ll be right here if you need me.” After some moments of silence his hands and arm begin to extend outward, his whole arm, shoulders and hands are now shaking more intensely. “It’s OK for that to happen,” I encourage; “just let it do what it needs to do and keep feeling your body.”

  “It feels cold then hot,” he replies as he continues to reach out, moving now to about forty-five degrees. Then he halts abruptly. Amazed that he can reach out so far, his eyes open wide. At the same time, he seems agitated; his face suddenly turns pale. He complains of feeling sick.

  Instead of backing off, I coach him to stay present with his physical sensations. He starts to breathe rapidly. “Oh my god, I know what this is.”

  “Yes, good,” I interrupt, “but let’s just stay with the sensations for a little longer, then we’ll talk about it—is that OK?”n

  Vince nods and moves his arm back and forth from his shoulder as thought he were sawing a piece of wood in slow motion. In this slow movement, Vince is beginning to explore the inner movement held in check and locked in a bracing pattern. He is now separating two conflicting impulses, one involving reaching out and the other, pulling away in revulsion. (I observe the revulsion as a particular pattern involving the retraction of his lip to one side and the hint of his head slightly turning away.) The trembling increases and decreases again, then settles. Tears flow freely from his eyes. He takes a deep spontaneous breath and then reaches out, fully, in front. “It doesn’t hurt at all!” This concurs with what I have found with chronic pain. There is generally an underlying bracing pattern, and when the bracing pattern resolves, the pain dissolves.

  Vince opens his eyes and looks at me. Clearly complete with the bottom-up processing, he is now able to form new meanings. He tells me about the following event. About eight months earliero he had gone shopping for his wife. As he came out of the supermarket, he heard a loud crash. Across the street, a car had smashed into a light pole. He dropped his bag and ran to the accident. The driver, a woman, sat motionless in an apparent state of shock. The motor of the car was running, so he reached across her inert body to turn off the ignition, standard procedure to prevent fires or explosion. Just as he started to turn the key he saw a young child in the passenger seat, his head decapitated by an air bag. And then Vince told me why his shoulder got frozen: “I was fine before I saw the kid … I’m used to doing things like that, things that are dangerous … but when I saw the kid, part of me wanted to grab my arm back and turn away … I felt like puking … and the other part just stayed there and did what I had to do … Sometimes it’s really hard to do what you have to do.” “Yes,” I agreed, “it’s hard and you and your buddies keep doing it anyway … Thank you.”

  “Hmm,” he added when he left, “I guess I have to learn to mind my body.” Vince had learned that mind and body are not separate entities—that he was a whole person. He said he wanted to learn more about himself and came in for three more sessions. He learned how to better handle stressful and conflicting situations and, needless to say, didn’t need the operation.

  When we need to engage in life-saving actions, the amount of charge and adrenaline that floods our bodies is vast. When Vince attempted to save the passenger in the car wreck, there were two simultaneous, but opposing, survival actions: one to do whatever possible to save her life, and the other, to pull away from the horror. In this intense conflict, Vince’s nervous system and muscles locked up; his shoulder froze. In being able to “feel through” and separate out the conflicting impulses, first to reach forward and then to pull away in horror, the vast survival energy,p instead of both acting against itself, was discharged in the waves of shaking sweating and nausea.

  Enter Dr. Pavlov

  Ivan Pavlov, who was awarded the Nobel Prize in Physiology or Medicine in 1904 for his prodigious work on the conditioned reflex, was thrust into a study of experimental (traumatic) breakdown by a chance event. The great Leningrad flood of 1924 caused the water to rise in his basement laboratory, precipitously close to the level of his caged experimental dogs. This terrified them but left them physically uninjured. When he resumed his experiments, he was startled to find that they had lost their previously acquired conditioned reflexes. While this was of obvious interest to Pavlov, another set of observations altered the future of his investigatory work. A significant proportion of the animals, though physically unscathed, broke down emotionally, behaviorally and physiologically. This included cowering and shaking in the corner of their cages, while other previously tame animals struck out viciously at their handlers. In addition, physiological changes such as elevated and depressed heart rates under mild stress and full startle reactions to mild stimuli (such as to tones or to the approach of the experimenter) were observed.

  The flood evoked two conflicting tendencies, as suggested in Pavlov’s definition: “the collision between the two [intense] contrary processes, one of excitation and the other of inhibition.” In another example, the simultaneous impulse to eat and to suffer an intense electrical shock (when the shock is paired with eating) results in breakdown for hungry animals. With the existence of two opposing impulses, one to stay and eat and the other to escape a highly noxious event, there will likely be breakdown.

  In summary, the motor expression of two intense instinctual responses creates a conflict and results in frozen states, such as the stasis in Vince’s shoulder. Normally, muscles that extend operate reciprocally with those that flex. In the traumatic state, however, agonist and antagonist operate against each other, creating frozen (immobility) states. This may lead to debilitating symptoms in almost any part of the body. The energy bound in inhibited (thwarted) responses is so powerful that it can cause an extreme bracing that often has profound effects. For example, when people jump from burning buildings to a trampoline net far below, the bones in their legs may actually fracture during the fall instead of on impact. This is because both the extensor and flexor muscles contract simultaneously, with inordinate intensity.

  In times of war or natural disasters, the instinctual impulse for self-preservation often collides with those for the protection of one’s comrades. In World War I the prevalence of shell shock was tremendously high in the trenches. The foot soldiers were literally trapped and barraged with loud explosives for days to weeks on end. Instinctually, they were “urged” to run wildly to escape or to stay under fire and fight for the preservation of the group. In fact many soldiers were killed by unwisely running to escape (or were shot for supposed cowardice). In the few motion pictures taken of shell-shocked soldiers from World War I, one sees the tortured, twisted, convulsive consequences of such chronic thwarting. One wonders how many soldiers developed trauma and enduring guilt symptoms because they chose to protect themselves by leaving the wounded to fend for themselves. In any case, courage is a more complex phenomenon than is generally appreciated.

  Trauma through a Ch
ild’s Eyes

  In a lifelong career of working with adults, I have occasionally been asked to see the children of my clients. I was frequently astonished by how, with the briefest of interventions, children rebounded from what would otherwise have been a devastating lifelong debilitation. These children, unshackled from the yoke of trauma, were free to develop with confidence, resilience and joy. I have cowritten two books on the prevention and somatic treatment of childhood trauma. One of them is geared to therapists, medical personnel and teachers,105 while the other is geared primarily toward teaching parents effective emotional first-aid tools.106

  In this section, I offer the tender stories of three overwhelmed children: Anna, Alex and Sammy. Their vignettes illustrate the principle that less is more and speak to the innate resilience of the human spirit.

  Anna and Alex: A Picnic Gone Wrong

  Eight-year-old Anna has enormous brown eyes. She could have been a model for one of the popular Keane paintings of almond-eyed children. The school nurse has just brought her in to see me. Pale, head hanging and barely breathing, she is like a fawn frozen by the bright lights of an oncoming car. Her frail face is expressionless, and her right arm hangs limply, as if it were on the verge of detaching itself from her shoulder.

  Two days earlier, Anna went on a school outing to the beach. She and a dozen of her classmates were frolicking in the water when a sudden riptide swept them swiftly out to sea. Anna was rescued, but Mary (one of the mothers who volunteered for the outing) drowned after courageously saving several of the children. Mary had been a surrogate mom to many of the neighborhood kids, including Anna, and the entire community was in shock from her tragic death. I had asked the school nurse to be on the lookout for children who displayed a sudden onset of symptoms (e.g., pain, head and tummy aches and colds). Anna had already been to see the nurse three times that morning, reporting severe pain in her right arm and shoulder.

  One of the mistakes often made by trauma responders is to try to get children to talk about their feelings immediately following an event. Although it is rarely healthy to suppress feelings, this practice can be traumatizing. In these vulnerable moments, children (and adults as well) can easily be overwhelmed. Previous traumas can resurface in the aftermath of an overwhelming event, creating a complex situation that may involve deep secrets, untold shame, guilt feelings and rage. For this reason, my team sought out, and learned, some of Anna’s history from several helpful elementary school teachers (and the nurse) prior to seeing the child. In this way, we could have information that either was consciously unknown to the child or might be dangerous to uncover given her fragile state.

  We learned that at age two, Anna was present when her father shot her mother in the shoulder and then took his own life. An additional detail that compounded Anna’s symptoms was provoked by an experience she had prior to the picnic. She had been infuriated when Mary’s sixteen-year-old son Robert bullied her twelve-year-old brother. There was a strong possibility that Anna had been harboring ill will toward Robert before the drowning, and was seeking retribution at that time. This raised the likelihood that Anna might feel profound guilt about Mary’s death—perhaps even believing (through magical thinking) that she was responsible for it.

  I ask the female nurse to gently cradle and support Anna’s injured arm. This could help Anna contain the frozen “shock energy” locked in her arm, as well as heighten the child’s inner awareness. With this support, Anna would be able to slowly (i.e., gradually) thaw and access the feelings and responses that could help her come back to life.

  “How does it feel to be inside of your arm, Anna?” I ask her softly.

  “It hurts so much,” she answers faintly.

  Her eyes are downcast, and I say, “It hurts bad, huh?”

  “Yeah.”

  “Where does it hurt? Can you show me with your finger?” She points to a place on her upper arm and says, “Everywhere, too.” There’s a little shudder in her right shoulder followed by a slight sigh of breath. Momentarily, her drawn face takes on a rosier hue.

  “That’s good, sweetheart. Does that feel a little better?” she nods, then takes another breath. After this slight relaxation, she immediately stiffens, pulling her arm protectively toward her body. I seize the moment.

  “Where did your mommy get hurt?” She points to the same place on her arm and begins to tremble. I say nothing. The trembling intensifies, then moves down her arm and up into her neck. “Yes, Anna, just let that shaking happen, just like a bowl of Jell-O—would it be red, or green, or even bright yellow? Can you let it shake? Can you feel it tremble?”

  “It’s yellow,” she says, “like the sun in the sky.” She takes a full breath, then looks at me for the first time. I smile and nod. Her eyes grasp mine for a moment, then turn away.

  “How does your arm feel now?”

  “The pain is moving down to my fingers.” Her fingers are trembling gently. I speak to her quietly, softly, rhythmically.

  “You know, Anna, sweetheart … I don’t think there is anybody in this whole town that doesn’t feel that, in some way, it was their fault that Mary died.” She briefly glances at me. I continue, “Now, of course that’s not true … but that’s how everybody feels … and that’s because they all love her so much.” She turns now and looks at me. There is a sense of self-recognition in her demeanor. With her eyes now glued on me, I continue, “Sometimes, the more we love someone, the more we think it was our fault.” Two tears spill from the outside corners of each eye before she slowly turns her head away from me.

  “And sometimes if we’re really angry at someone, then when something bad happens to them, then we also think that it happened because we wanted it to happen.” Anna looks me straight in the eye. I continue, “And you know, when a bad thing happens to someone we love or hate, it doesn’t happen because of our feelings. Sometimes bad things just happen … and feelings, no matter how big they are, are only feelings.” Anna’s gaze is penetrating and grateful. I feel myself welling with tears. I ask her if she wants to go back to her class now. She nods, looks once more at the three of us, and then walks out the door, her arms swinging freely—in rhythm with her stride.

  Alex, like several of the children who witnessed the tragedy from the beach, was having trouble sleeping and eating. His father brought him to us because the youngster had barely eaten in the last two days.

  As we sit together, I ask him if he can feel the inside of his tummy. He places the hand gently on his belly and, with a sniffle, says, “Yes.”

  “What does it feel like in there?”

  “It’s all tight like a knot.”

  “Is there anything inside that knot?”

  “Yeah. It’s black … and red … I don’t like it.”

  “It hurts, huh?”

  “Yeah.”

  “You know, Alex, it’s supposed to hurt because you love her … but it won’t hurt forever.”

  Tears cascade down the boy’s cheeks, and color returns to his face and fingers. That evening, Alex eats a full meal. At Mary’s funeral Alex weeps openly, smiles warmly and hugs his friends.

  Sammy: Child’s Play

  You can discover more about a person in an hour of play

  than in a year of conversation.

  —Plato

  Just as neither Vince nor his medical practitioners were able to associate his persistent frozen shoulder with a horrific event, often, children’s symptoms or changes in their behavior can present puzzling questions that baffle parents and pediatric professionals alike. This is especially true when the child has “good enough” parents that provide a stable and nurturing home environment. Sometimes the child’s new actions, although anything but subtle, are a mystery. The bewildered family might not connect the child’s conduct or other symptoms with the source of his terror.

  Rather than expressing themselves in easily comprehensible ways, kids frequently show us that they are suffering inside in the most frustrating ways. They do this through thei
r bodies. They may act bratty, clinging to parents or throwing tantrums. Or they might struggle with agitation, hyperactivity, nightmares or sleeplessness. Even, more troubling, they may act out their worries and hurts by steamrolling over a pet or a younger, weaker child. For other children, their distress may show up as head and tummy aches or bedwetting, or they may avoid people and things they used to enjoy in order to manage their unbearable anxiety. Parents ask where in the world these childhood symptoms can possibly come from?

  The very emblem of youth—“ordinary” events, such as falls, accidents and medical procedures—when unresolved are suspects as hidden culprits that underlie a child’s angst. This was certainly the case with the toddler Sammy.

  Since children by their nature enjoy play, therapists and parents can help them to rebound, moving beyond their fears to gain mastery over their scariest moments through the vehicle of guided play. As children express their inner world through play, their bodies are directly communicating with us.

  Here is the story of Sammy, a two-and-a-half-year-old boy, where setting up a play session led to a reparative experience with a victorious outcome. There are suggestions provided after this case story for therapists, medical professionals and parents. The following is an example of what can happen when an ordinary fall, requiring a visit to the emergency room for stitches, goes awry. It also shows how several months later, Sammy’s terrifying experience was transformed through play into a renewed sense of confidence and joy.

  Sammy has been spending the weekend with his grandparents, where I am their houseguest. He is being an impossible tyrant, aggressively and relentlessly trying to control his new environment. Nothing pleases him; he displays a foul temper every waking moment. When he is asleep, he tosses and turns as if wrestling with his bedclothes. This behavior is not entirely unexpected from a two-and-a-half-year-old whose parents have gone away for the weekend—children with separation anxiety often act it out. Sammy, however, has always enjoyed visiting his grandparents, and this behavior seemed extreme to them.