My last few blog posts have focused on the relationship between body and mind. Most massage therapists are very interested in how one informs the other. In keeping with that theme, I recently read a fascinating book about Post Traumatic Stress Disorder, “The Body Keeps The Score: Brain, Mind, and Body in the Healing of Trauma” by Bessel Van Der Kolk, M.D. In it, Van Der Kolk explores the physiological changes in the body and minds of people who have experienced traumatic situations, essentially providing a more scientific explanation for the visceral and very physical reactions to emotional triggers exhibited by sufferers of trauma. These reactions in the body can keep us trapped in a feedback loop of defensive or non-productive behavior, hindering our capacity to heal emotionally. Van Der Kolk convincingly argues that since the nervous system after trauma is altered, we can utilize the nervous system in order to remap the brain and heal from past experience. In very simplified terms, we can use the body to reprogram our minds.
Van Der Kolk bases much of his book on his work with war veterans and survivors of childhood abuse. These extreme definitions of trauma provide very vivid examples of how the body and mind can react to shocking and stressful situations. However, for my purposes I would like to expand the breadth of how we talk about trauma. Fear or hurt in reaction to almost anything can leave dramatic marks on our psyches, resulting in traumatic effects. A “traumatic incident” can encompass a wide spectrum, from a car accident to a teacher’s harsh reprimand. Shame around sexual desire or sexual rejection can cause trauma. Even a tired father absentmindedly refusing a hug during childhood can leave a scar. A situation that appears benign to one participant can leave a painful impression for a lifetime on another participant, if not dealt with.
Multiple studies show that trauma produces physiological changes in the brain (please refer to the aforementioned book for specifics – it is dense and full of research articles and case studies). Trauma activates the right-brain, which is responsible for emotion and creativity, and deactivates the left-brain, which governs rational thought, language and historical sequencing. This shutting down of the left-brain activity explains why when faced with an emotional trigger, we may not be able to put into words what we are feeling or experiencing. Rational thought escapes us, the lines between past and present become blurred and we are incapable of understanding that we are not in actual danger in the present moment, as we were back when we initially suffered the traumatic event. There is an accompanying increase in stress hormone activity, or a recalibration of the brain’s “alarm system”, which becomes chronic, keeping us in a constant state of sympathetic nervous system activity, or “fight or flight”. Here is a basic idea of how this works: the thalamus in the brain combines our perceptive input into a coherent picture of what is actually happening. This can take two pathways in the brain. The first is what neuroscientist Joseph LeDoux calls “the low road”, down to the amygdala in the limbic brain. Van Der Kolk refers to the amygdala as our smoke detector, as one of its main functions is to determine whether input is relevant for our survival or not. This function is quick and automatic, and if danger is sensed, the amygdala can instantly trigger the release of the stress hormones cortisol and adrenaline and recruit the nervous system to produce a whole-body response. The second pathway, “the high road”, is much slower than the first. The input here is directed up to the frontal cortex, for a conscious interpretation of the situation. We can then judge whether the threat is real through conscious assessment: we observe what is happening, predict what might happen in various scenarios and then make a choice to act. The problem is that the low road gets first dibs on interpreting the incoming information, so we can ostensibly get into nervous system activation before we can consciously assess whether there is real danger or not. Trauma increases the risk of misinterpreting the signals and thalamus processing can break down, so those with PTSD have a much harder time making sense of the input, often over-reacting to innocuous comments or facial expressions. In addition, the medial prefrontal cortex of trauma victims is often shut down. This affects our sense of being fully alive and the sense of who we are. For this reason, trauma sufferers often feel “dead inside” or feel like they “are not themselves” after the trauma.
The topic of trauma is incredibly complex and I have obviously simplified things for the purposes of this blog. The vagus nerve plays an important role, and that will be the subject of another post. However, I hope I have begun to make clear that trauma sufferers often repeat behaviors not out of a lack of willpower but due to actual changes in the brain. This is why talk therapy alone is often not enough to resolve the problem. If the emotional brain is wreaking havoc on the nervous system, no amount of insight and understanding will silence our “danger signals”. Naming a trauma and connecting with another person can be an important part of healing the sense of isolation often felt by victims. However, adjunctive therapies are almost always necessary. Trauma involves constant sensory overload and makes us feel chronically unsafe in our own bodies. In order to recover we need to become familiar with and befriend our bodily sensations again; we need to feel IN our bodies and in the present moment. Developing our sense of interoception, the awareness of our subtle body-based feelings, can help us change our relationship to our bodily sensations and learn to identify past versus present. Van Der Kolk suggests going about this in two ways: recalibrating both the low and high roads. We can regulate the nervous system activation through breath, movement and touch. We can also strengthen the capacity of the frontal lobes to monitor body sensations through mindfulness meditation or yoga. Our perceptual and emotional map is nurtured and shaped by our experiences. In other words, “neurons that fire together, wire together”; this is the neuroplasticity of the brain. We can use the concept of neuroplasticity to remap our brains and regain our agency after traumatic experiences.
In summary, after trauma we experience the world through a different nervous system. However, we can rewire our brains in order to regain a sense of normalcy. In the next post, I will elaborate on some effective ways to accomplish this, including how massage therapy comes into play. Massage therapy by itself will not resolve trauma, nor is it the most effective adjunctive therapy for all conditions. However, it can be an incredibly powerful tool to develop body awareness, ground us in the present moment and reestablish boundaries and a sense of safety in touch.