The Body Keeps The Score: Lessons from Trauma Treatment
The first chapter of The Body Keeps The Score looks at how van der Kolk came to be interested in the problem of trauma treatment from his work with Vietnam veterans. He discusses an early case that had a big impact on him, and led him to search for answers. He also talks about how little was available in the literature on trauma and PTSD, and what he learned from his early clients.
What interested me in this chapter were three main ideas that might resonate if you are someone who suffers from trauma or PTSD.
Trauma as living life as a memorial to the past that is maintained in a culture of denial.
How we recognize trauma in the present: loss of self, numbing, reorganization of perception, stuck in trauma
Towards a new understanding: helping the whole person, body and mind, understand that the trauma is over
Living life as a memorial to the past in a culture of denial
A traumatic memorial to the past
One of Bessel van der Kolk’s early and memorable clients who was a veteran helped him understand that one function of a traumatic, PTSD reaction is to maintain loyalty to the people who didn’t make it, or whose lives were altered irrevocably, in the traumatic event(s). We see this in war veterans, in survivors of abuse, and even in survivors of medical trauma or chronic illness.
In my practice, I might see this as loyalty to the family and its secrets, or guilt at surviving or even the possibility of thriving. Our symptoms, as much as they do not feel like we can consciously control them, are also a means of tying us to the past and keeping us from moving forward. Sometimes the symptoms themselves are the protestation of loyalty to something that is not healthy for us.
Trauma in a culture of denial
This idea struck me as so important as a gestalt therapist. The radical notion of our theory is that nobody is dealing with their psychic problems in a vacuum. PTSD, traumatic reactions and all kinds of difficulties we face in life are the result of a disturbance at the boundary between ourselves and the world, and the context or culture in which we are living plays a role in our health or struggle. A culture that denies what happened, or denies the symptoms are important, is part of the problem.
What is that culture of denial in trauma? At some level, we who were not traumatized don’t really want to know it is as bad as it is. This is both personal and cultural.
We turn away from trauma
When we think about traumatic incidents, there is a natural human reaction to close down. Some of these stories are so hard to think about, and if you love the person who is talking to you, or even if you are highly sensitive or empathic, you can feel like this is too much.
And where does this leave the person who is holding his or her own trauma, with difficulty? They can feel isolated and alone.
Culturally, we also move away. If we really knew the difficulty people have faced, if civilians knew the horrors of war or if people who grew up in non-abusive households knew what it like to be abused by a parent or a sibling, I think many of us would have a hard time accepting what goes on day after day.
I was interested to see No Visible Bruises by Rachel Louise Snyder make it to the top 5 non-fiction books of the year according to the New York Times’ 2019 list, and I will be reading it in 2020. In it she not only makes the connection between the damage caused by war and by domestic violence, but also raises the question of how this true epidemic is not receiving the attention it deserves. This is the culture of denial, too.
The adoptees that I see in my practice also feel the effects of living in a culture of denial, which they are more and more questioning and adult adoptee voices make it further into the mainstream. That is the denial of the loss at the heart of adoption. When that loss is fully felt not only does it lead to the possibility of healing for the triad member doing the work, but a reevaluation of what they thought about adoption and what they believe about it now.
The culture of denial is the field experience in which we become re-traumatized, and one way to step out of it is to get treatment and alter your own world, which then affects the world we live in. When adoptees come out of the fog, when people who suffer abuse really understand as adults what happened to them and find healthier and more realistic understanding of the past, when veterans do the difficult work of assessing their responsibility and the responsibility of the others around them, something can shift.
How we see trauma in the present
Loss of self as a coping mechanism in trauma
During the trauma or the period of multiple traumas, you may have had to step away from yourself to survive. Perhaps you disassociated, and lost yourself that way. Maybe you felt things you didn’t want to feel or did things you didn’t want to do and now feel ashamed of yourself. Confronting shame is difficult. Van der Kolk says, “They despise themselves for how terrified, dependent, excited, or enraged they felt, “and speaks for the client who experienced relationship violence or childhood abuse of the “agonizing shame about the actions they took to survive and maintain a connection with the person who abused them” p. 13.
Others whose trauma is more of loss and abandonment might drain themselves of their fullness and then maintain the belief that I’m not enough, I wasn’t enough to not be abandoned, I wasn’t good enough to get what I wanted.
The result is often a confusion of who am I, a victim or willing participant, did I deserve this? Sometimes to have a simple answer to the question, we again leave parts of ourselves behind that don’t fit a simple narrative. And we are less than we were, and have lost all or parts of ourselves.
Numbing
Numbing is something we do in the present as a response to traumatic triggers. The good news is that in our ability to numb we can have some control over what comes in, and it is a support for ourselves.
The bad news is that it keeps us from engaging in our life in a fluid way, and by numbing as a chronic response we limit ourselves, maintain the loss of self, and avoid opportunities to grow in ways that could be healing. In particular we avoid working on the symptoms and material of our trauma when it would be possible to grow by doing so.
This does not mean we need to stop the numbing immediately, but that in therapy and with careful attention to our process we can start to notice how we numb, what makes us want to numb, and how much we need to do it in the present. If we are interested in whether we need to keep the past alive, to make that memorial to the past, we may discover that we don’t need to numb as fully as we thought, and then something new can take hold.
Reorganization of Perception
Van der Kolk talks about how veterans wold have flashbacks or numbing in Rorschach (inkblot) tests, and that
we learned from these Rorschach tests that traumatized people have a tendency to superimpose their trauma on everything around them and have trouble deciphering whatever is going on around them. p. 17
Numbing and not sensing fully go hand in hand. When I numb myself I tighten my muscles and push in from the surface of my skin. All that tightening and holding reduces my sensitivity. Sensing is a surface/boundary activity that requires feeling into the boundary of self and other with sensitivity.
Gestalt pays attention to the moving, sensing, perceiving, feeling body, and how all those functions are working when we are faced with traumatic triggers. As with numbing, by noticing how we support ourselves by not noticing what is going on, and what perceiving aspects or elements of our trauma might be doing for us, we get some clues about how to proceed.
Stuck in Trauma
Lastly, van der Kolk talks about how his patients were stuck in trauma, without the ability to come fluidly into the the here and now. Therapy was a way for his patients to bridge the gap and land more fully in their current lives. .
Towards a new understanding, with the body
Lastly, this chapter asserts that for real change to happen, “the body needs to learn that the danger has passed and to live in the reality of the present.” p. 21
In gestalt therapy we call explore all the reasons this structure has come into being. We look at how it has helped the person cope in their current life, where it might have come from in the original event. Then we experiment. This is the safe emergency of therapy. We make space for you to check out a perception, allow more breath to come in when beginning to be triggered, or share a detail you have never shared with your therapist. You can open up the possibility to try something new, that could be small or large, and could have ripples of healing and growth in your life.
Stay tuned for next month, when I will read chapter 2, and respond to Revolutions in Understanding Mind and Brain. You can also take a look at the first post in this series here.
