Trauma Recovery: Keys to the Healing Journey Provide Renewed Hope for Humanity
By Ronnie Biemans, Dec 15 2016 03:00PM
Several weeks ago, I found myself reading a compelling and heart-rending front page story in the Washington Post entitled "A Seven Year Search for Justice", the story of Danielle Hicks-Best and her difficult life journey after being sexual assaulted at the age of 11.
As I read the story I felt myself growing more and more outraged at her abuse and violation at such a young age and at the travesty of justice that would allow a young girl to be charged and treated as a criminal for reporting sexual assaults. Her recollection and reporting of the crimes were not believed despite the undeniable physical evidence of recent sexual trauma and her age. She was treated as a false reporter. As a result of poor advice and a systemic mishandling of her case, Danielle was declared a ward of the court and was in and out of juvenile facilities and secure treatment centers for years. Danielle was victimized not only by those who assaulted her but also by the system that failed to believe her, took her away from her family, and failed to provide effective and appropriate treatment. We have to do better.
This is not a new story. Sexual violence and other forms of traumatic abuse are prevalent, often handled poorly in the moment and in the years that follow, as victims seek help, treatment, and justice.
I found it so discouraging to be reading Danielle's story 25 years after I first started working with survivors of incest and child abuse in my early days as a therapist. In the mid-1980s we thought we had started a revolution. We were finally talking not only about rape and sexual assault, but also about father-daughter incest and other forms of child abuse. A flood of interest followed the publication of Judith Herman's book, Father-Daughter Incest. Scholarly books and papers by trauma researchers and therapists such as Bessel Van der Kolk, Christine Courtois, and Frank Putnam were published as professional trainings and research in the trauma field exploded. It was a heady time for those of us in the mental health field. We felt we were on the cutting edge. We thought we knew what we were doing and we did the best that we could with our limited, but growing understanding of trauma and trauma recovery. Then came the backlash, the fight over "false memories" and for a while, it all seemed to come tumbling down. Trauma recovery took a back seat to the next mental health craze and did not return until the nation became interested in the mental health of our veterans returning home from Afghanistan and Iraq.
Trauma and Body-Mind Response: The Basics
Over the past thirty years, therapists and researchers have continued to treat those suffering from traumatic experiences. Through trial and error as well as disciplined research, they have found reason for hope. Trauma focused studies, as well as the explosion of discoveries about the human brain, have brought a deeper understanding of trauma and its impact on the brain and body, our health, and our ability to fully experience and enjoy life. More recently we are learning how trauma can be transmitted to the next generation.
Psychological trauma is defined in the Merriam-Webster dictionary as a "disordered psychic or behavioral state resulting from severe mental or emotional stress or injury." Trauma is essentially a "locked in" stress response, a biological and psychological response that occurs when a deeply distressing or disturbing threat is perceived and experienced. For humans and animals alike, when a threat is perceived, the body's stress response kicks in. The central nervous system works closely with the endocrine system to initiate the body's natural fight-flight-freeze response, which can get you out of a life threatening situation. The body is primed, ready to defend and get you to safety. The adrenal gland secretes the hormone adrenaline, arouses the sympathetic nervous system and reduces activity in the parasympathetic nervous system. Further changes follow that ensure the body is activated for survival by decreasing digestion and elimination and increasing perspiration, heart rate and blood pressure. Cortisol is released allowing the body to maintain steady supplies of blood sugar for energy and the immune system is suppressed. Typically once the threat is over, the parasympathetic branch of the central nervous system takes control again and brings the body back into a balanced state. In trauma response, the stress response can become biologically fixated. The traumatized person can become highly reactive to trigger stimuli that remind them of the traumatic event or become prone to numbing or tuning out completely so as to avoid being overwhelmed. The body is continuously revved up and the restorative functions of the parasympathetic nervous system are compromised. Over time, this takes a toll on the psyche and the body; health and human relationships suffer.
The Adverse Childhood Experiences (ACE) Study is collaboration between the Centers for Disease Control and Kaiser Permanente. It is one of the largest investigations ever conducted to assess associations between childhood traumatic experience and health and well-being later in life. In the initial phase of the study conducted from 1995 to 1997, more than 17,000 participants completed a standardized physical examination and provided detailed information about their childhood experience of abuse, neglect, and family stressors. ACE Study findings suggest that certain experiences are major risk factors for illness, poor quality of life, and death. Almost two-thirds of ACE study participants reported at least one adverse childhood experience, and more than one in five reported three or more such experiences. The study's pyramid model illustrates how adverse childhood experiences are the foundation of later health and socio-behavioral problems.
Trauma's genetic aftermath: transgenerational transmission
In her recent article in the New Republic, The Science of Suffering, Judith Shulevitz describes research suggesting that children are inheriting the impact of trauma from their parents, particularly in populations that have endured extreme abuses, such as the Cambodian refugees from the Pol Pot regime, World War II Holocaust survivors, Native Americans, and the American descendants of Africans enslaved in this country. She says:
"The children of the traumatized have always carried their parents "suffering under their skin" .... " researchers are increasingly painting a picture of a psychopathology so fundamental, so, well, biological, that efforts to talk it away can seem like trying to shoot guns into a continent, in Joseph Conrad's unforgettable image from Heart of Darkness. By far the most remarkable recent finding about this transmogrification of the body is that some proportion of it can be reproduced in the next generation. The children of survivors-a surprising number of them, anyway-may be born less able to metabolize stress. They may be born more susceptible to PTSD, a vulnerability expressed in their molecules, neurons, cells, and genes."
Shulevitz says that researchers have identified genetic variations that may magnify the impact of trauma. It is abundantly clear that in order to interrupt multi-generational cycles of abuse, suffering, and dysfunction in families, we will need to address "the biological aftershocks of trauma". The impact of man's inhumanity to man does not go away and the effects can linger and be passed on for generations. Shulevitz comments further and somewhat pessimistically:
"There is biological PTSD, and familial PTSD, and cultural PTSD. Each wreaks damage in its own way. There are medicines and psychotherapies and the consolations of religion and literature, but the traumatized will never stop bequeathing anguish until groups stop waging war on other groups and leaving members of their own to rot in the kind of poverty and absence of care that fosters savagery."
So where does this leave us?
Hope Lies in Treatment and Recovery
In his recent book, The Body Keeps the Score, Bessel Van der Kolk delivers a message of hope. There is a path to recovery that can foster resilience and may well be fostered in the next generations with appropriate attention, education, and care. He says:
"People can learn to control and change their behavior, but only if they feel safe enough to experiment with new solutions. The body keeps the score: If trauma is encoded in heartbreaking and gut wrenching sensations, then our first priority is to help people move out of fight-or-flight states, reorganize their perception of danger and manage relationships."
Van der Kolk describes four essential elements to healing:
• Our capacity to destroy one another is matched by our capacity to heal one another. Restoring relationships and community is central to restoring well-being;
• Language gives us the power to change ourselves and other by communicating our experiences, helping us to define what we know , and finding a common sense of meaning;
• We have the ability to regulate our own physiology including some of the so called involuntary functions of the body and brain through such basic activities as breathing, moving and touching and
• We can change social conditions to create environments in which children and adults can feel safe and where they can thrive.
"Give sorrow words: the grief that does not speak knits up the o'er wrought heart and bids it break" - William Shakespeare
Therapy approaches that encourage expression, that give a voice to the experience of the traumatized person, allowing them to bear witness, are an important strategy in recovery. Where spoken language fails, other means such as art, music, and dance can be helpful. The heart can often express through the arts what cannot be expressed directly through the spoken word. While often a good first step, there are limits to using this approach alone. The effects carried in the body can sabotage a talk-therapy approach. Learning to soothe the nervous system, and building the body's capacity to calm itself and not be locked into a heightened, reactive, or dissociative numbing response, will go a long way to enabling those in recovery to acknowledge and tolerate discomfort, manage it, and reclaim their body and nervous system.
Body Mind Approaches
Working directly and creatively with the body's response to stress and trauma recollection has proven successful in moving recovery forward for countless survivors. Van der Kolk emphasizes the importance of teaching awareness and building tolerance to discomfort. Many of these approaches have their roots in mindfulness techniques, and some focus directly on retraining the brain and nervous system.
Eye Movement Desensitization and Reprocessing (EMDR) is a physiologically based therapy developed by Francine Shapiro in the late 1980's. EMDR helps a person see disturbing material in a new and less distressing way. EMDR seems to have a direct effect on the way that the brain processes information. Normal information processing is resumed, so that following a successful EMDR session, a person no longer relives the images, sounds, and feelings when a distressing event is brought to mind. You still remember what happened, but it is less upsetting. The patient is coached to track back- and- forth hand movements with their eyes. EMDR appears to be similar to what occurs naturally during dreaming or rapid eye movement (REM) sleep phases.
Neurofeedback is a type of biofeedback that uses displays of brain activity to teach self-regulation of brain function. Sensors are placed on the scalp to measure activity, with measurements conveyed by video or sound. Neurofeedback has been demonstrated to regulate central nervous system-related problems.
Yoga is a physical, mental and spiritual discipline that has over 100 different schools of practice. It is successfully used by therapists to teach stress management and body calming by utilizing different postures, and working with the breath and meditation. For more information, click here.
Somatic experiencing is a body mind strategy developed by Peter Levine, PhD, that involves the introduction of small amounts of traumatic material over time and therapist-guided observation of physical responses to that material, such as shallow breathing. The therapist checks in with the client to assess and record bodily sensations that may be imperceptible to the practitioner, such as feelings of heaviness, tightness, or dizziness. Practitioners proceed carefully and cautiously to avoid retraumatizing or triggering the client, and they help people to develop and employ self-regulating strategies. A key component to enhancing one's ability to self-regulate is the practice of alternating between the sensations associated with trauma and those that are a source of strength and comfort. The therapist helps the client find or create places of safety, whether that is a place in the body that is not activated by the trauma, or an imagined place to retreat to in one's mind. Experiencing the sensations related to the traumatic event in a safe way can assist a person to fully process the trauma.
Sensorimotor psychotherapy is a gentle, body-centered therapy developed by Pat Ogden, PhD, that focuses on teaching how to pay attention and become more aware of sensations within the body. With guidance and practice, one learns how to use the body as the door to awareness, so that buried feelings and memories can come to the surface. That heightened awareness allows release from the old patterns that remain stuck and prevent us from living life fully.
Creating a Safe and Supportive Community
In a better world we would not do terribly cruel, unmentionable things to one another. Until that day comes perhaps we can hold on to the knowledge that out of darkness can come light. That from each horror can come greater wisdom. Humanity is capable of learning from its mistakes and evolving. We can nurture and protect our children by forming resilient, responsive communities. We can support those most vulnerable in society by ensuring a living wage, creating a quality health system that is available to all that provides high quality physical and behavioral health care, by healing trauma, and creating opportunities for perpetrators to make amends through trust and reconciliation processes. Healing trauma is possible and indeed necessary, to correct the damage done and ensure that we do not pass its legacy on to the next generation. As Van der Kolk says:
"Many of our most profound advances grew out of experiencing trauma: the abolition of slavery from the Civil War, Social Security in response to the Great Depression, and the GI Bill, which produced our once vast and prosperous middle class, from World War II. Trauma is now our most urgent public health issue, and we have the knowledge necessary to respond effectively. The choice is ours to act on what we know."
"Humanity has come to a crossroads - we can either destroy the world or we can create a good future. ..... In these challenging times, it is tempting to retreat into our own personal existence, hoping the world's woes will not affect us too harshly. However, none of us can escape the social, political, spiritual, and environmental challenges of this time. Whether intentionally or not, we are all forced to contemplate the nature of our existence, and more importantly, the nature of humanity." -Sakyong Mipham Rinpoche, Basic Goodness & Humanity's Future/Shambhala Sun - May 2015
About the Author:
Informed by over 25 years of professional training and work experience as well as her many years of meditation and yoga practice, Ronnie Biemans, M.A., L.C.P.C., is guided by a core philosophy to focus on strengths, not deficits or pathology. By discovering, restoring and optimizing each person’s unique ability to thrive and meet the demands, of today’s fast-paced, stressful world, those who have encountered physical and emotional health challenges can discover ways to improve their lives and well being. Operating from her home office and in other community settings, Ronnie provides guidance and support to individuals, families and groups seeking to live healthy, balanced lives.