In an Unspoken Voice

by Peter A Levine

  Eventually, Damasio designed some clever tests that were able to pinpoint Elliot’s deficit and provide clues as to why his life was such a disaster. One of these tests was a type of card game where strategies of risk and gain were played off against one another. When needing to shift his strategy from high risk–high gain (with a probable overall loss) to moderate risk–modest gain (with ultimate gain), Elliott was unable to learn and sustain the transition. Just like the overall outcome in his life, Elliot was an abject failure; he simply could not learn when it mattered. Damasio speculated that his patient was unable to emotionally experience the consequences of his decisions or acts. He could reason perfectly well, except when something of importance was at stake. Essentially, Damasio reasoned that Elliot had lost the ability to feel and to care. He was therefore unable to make (e)valuations, integrate them into meaningful consequences and then act upon them. He was emotionally rudderless.

  Damasio puzzled about the possibility that Elliot was a contemporary Phineas Gage. Both physicians, Harlow and Damasio, though separated by more than a century, speculated that their patients had lost their capability to balance instinct and intellect. However, rather than idly pondering this possibility, Damasio and his wife, Hannah, set out on a medically oriented archeological expedition. They located Gage’s preserved skull, ignominiously gathering dust on a shelf in an obscure museum at Harvard Medical School. In a study more like a suspenseful TV crime scene investigation replete with dramatic forensic analysis than a stodgy academic experiment, the Damasios were able to borrow the pierced skull and subject it to sophisticated computer-driven analysis. Using powerful imaging techniques, they were able to predict precisely where the wayward projectile would have ripped through his brain, throwing him to the ground and forever mutilating his personality. With breathtaking anticipation, Gage’s resurrected “virtual brain” revealed devastating destruction of the same tract of nerve cells as were malfunctioning in Elliot’s brain. The mystery was solved! The severing of the brain pathway between the emotional circuits and reason, though extreme in one case and apparently more subtle in the other, was dreadfully injurious to the person’s function and spirit, turning them into wastrels. Their brains were no longer triune but rather tripartite, cut off from the vital communication networks that link up the brains into a coherent whole.

  Sandwiched between the frontal lobes and the adjacent limbic regions (the site of both Gage’s violent lobotomy and Elliot’s dysfunctioning neurons) is a folded structure called the cingulate gyrus. This region is pivotal in the integration of thought and feeling.129 Said another way, it is the structure that connects the primitive, rough, raw and instinctual underbelly with the most complex, refined, computational lobes of the neocortex. The cingulate and its associated structures, such as the insula, are what may hold the key to being a fully human animal—in being of one mind, though with three brains.

  Both Gage and Elliot lacked a functioning connection between their instinctual and their rational brains. As a consequence of this, they were both lost. Without instinct and reason (warp and weft) woven together on the enchanted loom of the brain, they lacked what it means to be a wholly human being.

  The picture of Gage, painted by Harlow, was of a man enslaved by his instinctual whims, “at the same time both animal and childlike.” Then, in 1879, a neurologist named David Ferrier added an experimental perspective to this condition by removing the frontal lobes of monkeys. He discovered that “instead of showing interest and actively exploring their surroundings [as before], curiously prying into all that came within the field of their observation, they remained apathetic, dull, or dozed off to sleep.”130

  Unfortunately, Ferrier’s primate research was not headed by the Portuguese neurologist Egas Moniz, who later devised a similar operation on humans, which he called a prefrontal leucotomy. With the advent of this procedure, the scandalous field of “psychosurgery” was birthed. However, these “cures” were usually worse, far worse than the “disease.” And this procedure created multitudes of irreversible zombies. Moniz, as I mentioned earlier, shared the Noble Prize for his horrendous and blatantly pseudo-scientific, freakish work, which “docilized” tens of thousands of patients worldwide. The procedure was most popular in the United States, where Walter Freeman (ironically, the father of one of my graduate advisors, Walter B. Freeman Jr.) invented a procedure called a prefrontal lobotomy. Bizarrely, this treatment, according to the senior Freeman, “was simple enough to be conducted in the offices of any general physician.” Basically, in his own words, his method consisted of “knocking them out with an electric shock” and then (in a “medical procedure” reminiscent of Phineas Gage’s accidental lobotomy by tamping iron) “thrusting an ice pick into the crease of the eyelid and into the frontal lobe of the brain and making the lateral cut by swinging the thing from side to side … an easy procedure, though definitely a disagreeable thing to watch.” (Note Freeman’s curious and callous use of “them” and “thing,” as well as his choice of “surgical instrument”—an ice pick!)

  It may seem contradictory that this procedure can produce, as in the case of Phineas Gage, “an individual both animal and childlike”; while Ferrier’s monkeys lacked curiosity and exploration; and, with Damasio’s patient Elliot, the capacity to make valuations and to choose appropriate options was permanently destroyed. Unfortunately, the trend that followed created a Frankensteinian group of tens of thousands of lobotomized patients (and hundreds of thousands more who were zoned out on doctor-prescribed Thorazine and Hadol). Without the animal in the human and without the human in the animal, there is little we can recognize as being a vitally engaged and alive person. It is interesting that many people struggling with attention-deficit/hyperactivity disorder (ADHD), as well as many violent offenders, appear to exhibit hypo-arousal of their instinctual brains, together with a shutdown in their prefrontal cortex. In this regard the maladaptive behaviors associated with both may be attempts to stimulate themselves in order to feel more human. Unfortunately, the cost of these impulse disorders may be disastrous to both the individual and society.

  On the other hand, people who are chronically flooded by emotional eruptions can be just as limited in life. While they are less inhuman (like the Gage-Elliot zombie “body-snatchers”), their explosions can be just as corrosive to the maintenance of intimate and professional relationships, and—it goes without saying—to a coherent sense of self. Traumatized individuals are imprisoned with the proverbial worst of both worlds. At one moment, they are flooded with intrusive emotions like terror, rage and shame, while alternately being shut down, alienating them from feeling-based instinctual grounding, rendering them incapable of a sense of purpose and inept in finding a direction. These may be our clients, relatives, friends or acquaintances who are caught in either extreme, endlessly swinging between emotional convulsion and coma (blandness/shutdown). As such, they are unable to make use of their emotional intelligence. To some degree they represent, when we are under the influence of chronic stress or trauma, the Phineas Gages in all of us.

  Wholeness as Balance

  As above, so below. As below, so above.

  —Kybalion

  We are more than speaking animals; we are language creatures. However, whether we are confined by the tyranny of language, or liberated by it, is a question that is up for grabs. How we use, or abuse, language has a good deal to do with how we live our lives. Words, in and of themselves, are of little importance to an infant when it is upset. Language needs to be accompanied by close physical soothing in the form of holding, rocking and gentle sounds such as coos and ahs. It is our use of nonverbal tone and cadence that gives language its power to calm and dulcify a baby’s upset. As children develop, they begin both to understand the actual words and to be soothed by the mode in which they are uttered.

  However, words must still have a physical context in order for them to be healing and salubrious. You may recall a young boy named Elian Gonzalez, who became the pawn in an
outrageous political battle in the state of Florida. Elian’s distant cousins (Cuban exiles living in Miami), supposedly concerned for the boy’s welfare, fought vehemently against Elian’s own father (who was living in Cuba) for custody of this young child. As in Bertolt Brecht’s play The Caucasian Chalk Circle, they were literally pulling this bewildered six-year-old child apart. Eventually, the Supreme Court interceded and blocked Governor Jeb Bush’s efforts to keep Elian in the United States as a “model anti-Castro citizen” and returned him to the custody of his father.

  National Guard soldiers were ordered to remove and guard Elian against a hostile, placard-wielding mob as a female federal agent snatched him from the cousins and angry onlookers, holding him securely to her body. Clearly, this unexpected and unwanted embrace from a stranger terrified the already frightened, disoriented and brainwashed child. But then something quite remarkable happened. The agent held him firmly enough to not be ripped away by the angry mob, yet gently enough for her embrace to match the words she calmly recited in Spanish: “Elian, this may seem scary to you right now, but it soon will be better. We’re taking you to see your papa … You will not be taken back to Cuba [which was true for the time being] … You will not be put on a boat again [he had been brought to Miami on a treacherous boat ride]. You are with people who care for you and are going to take care of you.”

  These words were carefully scripted, as you might have suspected, by a child psychiatrist who had known of Elian’s history and plight. They were designed to alleviate the boy’s uncertainty and terror. It worked. However, the words alone would not have sufficed without what was obvious in the body language, presence and tone of the female FBI agent. She either instinctively knew (and/or was perhaps coached) how to hold Elian only as tightly as was necessary to protect him but loosely enough so that he wouldn’t feel trapped. With a very gentle rocking, brief eye contact and a gentle calm equipoise, she spoke—with one voice—to Elian’s reptilian, emotional and frontal brain, all at the same time. This unity of voice and holding most likely helped to prevent excessive traumatization and scarring to this child’s delicate and vulnerable psyche. In different ways and in various forms, this is what good trauma therapy does, as we saw in Chapter 8.

  Some years ago, I witnessed another example of the instinctive use of human touch with soothing words to ameliorate suffering. I was in the Copenhagen flat of my friend, Inger Agger. Inger had been the chief of psychosocial services for the European Union during the carnage in the former Yugoslavia and was no stranger to trauma and humanitarian catastrophe. So, when the BBC World News, which was on in the background, announced coverage of the East Timor conflagration, we turned to see images of refugees who were clearly dazed and disoriented as they wandered aimlessly into a refugee camp. Posted at the entrance to the camp were a group of rotund Portuguese nuns dressed in white habits.

  It was clear to both Inger and me that the alert nuns were instinctively scanning and “triaging” for the refugees, particularly children, who were the most disoriented and in shock. The nun closest to that person would move swiftly, though noninvasively, to that dazed individual and take him into her arms. We watched, with tears streaming down our faces, as the nuns gently held and rocked each one, seemingly whispering something into their ears. And we imagined what they might have been saying—in all likelihood something similar to what the FBI agent had told Elian. However, in stark contrast to what these images were portraying, the BBC commentator pronounced that “these unfortunate souls would be scarred for life,” implying that they would be sentenced to live forever with their traumatic experience. He was missing the point graphically being made by the body language of the nuns and the refugees who were fortunate enough to be enfolded in the goodness of these compassionate women.

  This powerful scene illustrates just what it takes to help people thaw, come out of shock and return to life—to set them on their journey of recovering and coping with their misfortune. The work of my nonprofit organization, the Foundation for Human Enrichment, whose volunteers responded in the aftermath of the devastating tsunami in Southeast Asia and Hurricanes Katrina and Rita in the United States, was a more immediate and personal example.131 Here again, it was the weaving of the most immediate and direct physical contact, together with the simplest of words spoken at the right moment, that helped people move out of shock and terror so that they could retain their sense of self, thereby beginning the process of dealing with their terrible losses.

  In all of these examples, the brain stem’s reptilian and rhythmic needs, the limbic system’s need for emotional connection, and the neo-cortex’s need to hear consistent calming words converge were all met. We are reassured that whatever we are feeling now, it will pass.

  A counterexample was clearly illustrated when the world saw graphic images of dozens of dead and mutilated women’s and children’s bodies carried out of bombed Beirut buildings in the dreadful 2006 Israel-Hezbollah war. Following the televised photos, U.S. Secretary of State Condoleezza Rice spoke mechanically in legalese, instead of words of compassion and sorrow, only compounding an already dreadful report. With these visual and auditory images, a metaphorical metal spike is launched, searing through the cingulate gyrus, splitting the (once) triune brain into contradictory shards reminiscent of Phineas Gage. What a pity, when gentle, kindhearted words could have been offered instead, imparting a sense of hope and help unknown already on its way.

  The preceding chapters have all skirted around the phenomenon of instinct. However, in this chapter, we have no longer neglected this lodestar, finally giving instinct its due.

  * Cannon also mounted a well-reasoned critique of James’s theory by arguing that feedback from the viscera would be too slow and not specific enough to account for different emotions. (These questions will be addressed in Chapter 13.)

  † In psychology, appetitive means acquiring.

  ‡ For an authoritative memoir see M. Macmillan, “Restoring Phineas Gage: A 150th Retrospective,” Journal of the History of the Neurosciences (2000), 9, 42–62.

  PART IV

  Embodiment, Emotion and Spirituality: Restoring Goodness

  My belief is in the blood and flesh as being wiser than the intellect. The body-unconscious is where life bubbles up in us. It is how we know that we are alive, alive to the depths of our souls and in touch somewhere with the vivid reaches of the cosmos.

  —D. H. Lawrence

  CHAPTER 12

  The Embodied Self

  The Body is the Shore on the Ocean of Being.

  —Sufi saying

  Let’s now return for a moment to my personal story of being struck by the teenager’s car. The outcome of my accident could easily have been horrific, utterly devastating. Instead it turned out to be transformative. Despite having been acutely terrified, disoriented and dissociated, I was spared the dreadful repercussions of PTSD. What saved me from succumbing to prolonged trauma symptoms? Along with the method I have described throughout this book were the conjoined twin sisters of embodiment and awareness. This asset, even beyond its crucial role in regulating stress and healing trauma, is a master tool for personal enrichment and self-discovery. My job here is to entice you to take your body seriously enough to learn a bit more about its promptings. Yet I also want to encourage you to hold it lightly enough to engage it as a powerful ally in transforming intense “negative” or uncomfortable emotions—and so to experience what it’s like to truly embody goodness and joy.

  Since these twin sisters of mercy are so essential to the prevention and healing of trauma, let’s consider what embodied awareness looks like and feels like. Though we don’t usually bring conscious awareness to the multitude of internal bodily sensations happening moment by moment, these experiences are frequently referred to in common parlance. We “bite into and chew on” tough issues. There are things that we cannot “swallow or stomach,” while others make us “want to puke.” And of course most of us have experienced “butterflies in our stomachs.” Sur
ely the sensation of being bloated, constricted or “tight-assed” catches our awareness and has its emotional meaning. We may be “tight-lipped” on one occasion and “loose-lipped” on another. Or we may just feel open in our bellies and chest or even “breathless with excitement.” Such are the poignant messages from our muscles and viscera.

  All human experience is incarnate, that is to say, “of the body.” Our thoughts are guided by our sensations and emotions. But how you know when you are angry? Or, do you know how you know when you are happy? Typically, people tend to ascribe a mental causation to an emotion; for example, I am feeling (angry, sad, etc.) because he/she did this (said this, forgot to do this, etc.). However, when people learn to focus on what is going on in their bodies in the here and now, they typically report, “My stomach is tight,” or “My chest feels bigger—my heart is more relaxed and open.” These physical cues let us know not only what we are feeling but also what to do to remedy difficult sensations and emotions. They also inform us that we are alive and real.