The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) “deals in categories, not in pain,” in the incisive words of psychiatrist and researcher Daniel Siegel. Central to Peter Levine’s teaching is that trauma cannot be reduced to the diagnostic traits compiled by the DSM under the rubric of PTSD, Posttraumatic Stress Disorder. Trauma is not a disease, he points out, but rather a human experience rooted in survival instincts. Inviting the full, if carefully graded, expression of our instinctive responses will allow the traumatic state to loosen its hold on the sufferer. Goodness, the restoration of vitality, follows. It springs from within. “Trauma is a fact of life,” Levine writes. “It does not, however, have to be a life sentence.” In our suffering lies also our salvation. As he shows, the same psychophysiological systems that govern the traumatic state also mediate core feelings of goodness and belonging.
Peter’s astonishing awareness of and attention to nuanced detail as he observes and describes his clients’ “unfreezing” are at the heart of his teaching, as are his techniques to guide and facilitate his process. Reading this manuscript, I was impressed by how often I experienced “aha” moments as I recalled my own observations in my work with traumatized and often addicted people. I could now understand and interpret these observations in a new way—and not only my clinical observations, but also my own personal experience. And that’s important, for, as Peter recognizes, the therapist’s attuning to his or her own experience serves as an essential guiding light leading the healing process along the right path.
Peter Levine and the reader complete their mutual journey with an exploration of spirituality and trauma. There is, he writes, “an intrinsic and wedded relationship” between the two. For all our rootedness in a physical body, we humans are spiritual creatures. As the psychiatrist Thomas Hora astutely pointed out, “all problems are psychological, but all solutions are spiritual.”
With this book Peter Levine secures his position in the forefront of trauma healing, as theorist, practitioner and teacher. All of us in the therapeutic community—physicians, psychologists, therapists, aspiring healers, interested laypeople—are ever so much richer for this summation of what he himself has learned.
GABOR MATÉ, MD
Author of In the Realm of Hungry Ghosts:
Close Encounters with Addiction
PART I
Roots: A Foundation to Dance On
We must go down to the very foundations of life. For any merely superficial ordering of life that leaves its deepest needs unsatisfied is as ineffectual as if no attempt at order had ever been made …
—I Ching, Hexagram #34
“The Well” (circa 2500 BC)
CHAPTER 1
The Power of an Unspoken Voice
When a man has learned within his heart what fear and trembling mean, he is safeguarded against any terror produced by outside influences.
—I Ching, Hexagram #51 (circa 2500 BC)
NO MATTER HOW SELF-ASSURED WE ARE, in a fraction of a second, our lives can be utterly devastated. As in the biblical story of Jonah, the unknowable forces of trauma and loss can swallow us whole, thrusting us deep into their cold dark belly. Entrapped yet lost, we become hopelessly frozen by terror and helplessness.
Early in the year 2005, I walked out of my house into a balmy Southern California morning. The gentle warmth and soft sea breeze gave a lift to my step. Certainly, this was the kind of winter morning that makes everyone in the rest of the country (with the possible exception of Garrison Keillor of Lake Wobegon) want to abandon their snow shovels and move to the Southland’s warm, sunny beaches. It was the beginning of a perfect kind of day, a day when you feel certain that nothing can go wrong, when nothing bad can possibly happen. But it did.
A Moment of Truth
I walked along, absorbed in happy anticipation of being with my dear friend Butch for the celebration of his sixtieth birthday.
I stepped out into a crosswalk …
… The next moment, paralyzed and numb, I’m lying on the road, unable to move or breathe. I can’t figure out what has just happened. How did I get here? Out of a swirling fog of confusion and disbelief, a crowd of people rushes toward me. They stop, aghast. Abruptly, they hover over me in a tightening circle, their staring eyes fixed on my limp and twisted body. From my helpless perspective they appear like a flock of carnivorous ravens, swooping down on an injured prey—me. Slowly I orient myself and identify the real attacker. As in an old-fashioned flashbulb photo, I see a beige car looming over me with its teeth-like grill and shattered windshield. The door suddenly jerks open. A wide-eyed teenager bursts out. She stares at me in dazed horror. In a strange way, I both know and don’t know what has just happened. As the fragments begin to converge, they convey a horrible reality: I must have been hit by this car as I entered the crosswalk. In confused disbelief, I sink back into a hazy twilight. I find that I am unable to think clearly or to will myself awake from this nightmare.
A man rushes to my side and drops to his knees. He announces himself as an off-duty paramedic. When I try to see where the voice is coming from, he sternly orders, “Don’t move your head.” The contradiction between his sharp command and what my body naturally wants—to turn toward his voice—frightens and stuns me into a sort of paralysis. My awareness strangely splits, and I experience an uncanny “dislocation.” It’s as if I’m floating above my body, looking down on the unfolding scene.
I am snapped back when he roughly grabs my wrist and takes my pulse. He then shifts his position, directly above me. Awkwardly, he grasps my head with both of his hands, trapping it and keeping it from moving. His abrupt actions and the stinging ring of his command panic me; they immobilize me further. Dread seeps into my dazed, foggy consciousness: Maybe I have a broken neck, I think. I have a compelling impulse to find someone else to focus on. Simply, I need to have someone’s comforting gaze, a lifeline to hold onto. But I’m too terrified to move and feel helplessly frozen.
The Good Samaritan fires off questions in rapid succession: “What is your name? Where are you? Where were you going? What is today’s date?” But I can’t connect with my mouth and make words. I don’t have the energy to answer his questions. His manner of asking them makes me feel more disoriented and utterly confused. Finally, I manage to shape my words and speak. My voice is strained and tight. I ask him, both with my hands and words, “Please back off.” He complies. As though a neutral observer, speaking about the person sprawled out on the blacktop, I assure him that I understand I am not to move my head, and that I will answer his questions later.
The Power of Kindness
After a few minutes, a woman unobtrusively inserts herself and quietly sits by my side. “I’m a doctor, a pediatrician,” she says. “Can I be of help?”
“Please just stay with me,” I reply. Her simple, kind face seems supportive and calmly concerned. She takes my hand in hers, and I squeeze it. She gently returns the gesture. As my eyes reach for hers, I feel a tear form. The delicate and strangely familiar scent of her perfume tells me that I am not alone. I feel emotionally held by her encouraging presence. A trembling wave of release moves through me, and I take my first deep breath. Then a jagged shudder of terror passes though my body. Tears are now streaming from my eyes. In my mind, I hear the words, I can’t believe this has happened to me; it’s not possible; this is not what I had planned for Butch’s birthday tonight. I am sucked down by a deep undertow of unfathomable regret. My body continues to shudder. Reality sets in.
In a little while, a softer trembling begins to replace the abrupt shudders. I feel alternating waves of fear and sorrow. It comes to me as a stark possibility that I may be seriously injured. Perhaps I will end up in a wheelchair, crippled and dependent. Again, deep waves of sorrow flood me. I’m afraid of being swallowed up by the sorrow and hold onto the woman’s eyes. A slower breath brings me the scent of her perfume. Her continued presence sustains me. As I feel less overwhelmed, my fear softe
ns and begins to subside. I feel a flicker of hope, then a rolling wave of fiery rage. My body continues to shake and tremble. It is alternately icy cold and feverishly hot. A burning red fury erupts from deep within my belly: How could that stupid kid hit me in a crosswalk? Wasn’t she paying attention? Damn her!
A blast of shrill sirens and flashing red lights block out everything. My belly tightens, and my eyes again reach to find the woman’s kind gaze. We squeeze hands, and the knot in my gut loosens.
I hear my shirt ripping. I am startled and again jump to the vantage of an observer hovering above my sprawling body. I watch uniformed strangers methodically attach electrodes to my chest. The Good Samaritan paramedic reports to someone that my pulse was 170. I hear my shirt ripping even more. I see the emergency team slip a collar onto my neck and then cautiously slide me onto a board. While they strap me down, I hear some garbled radio communication. The paramedics are requesting a full trauma team. Alarm jolts me. I ask to be taken to the nearest hospital only a mile away, but they tell me that my injuries may require the major trauma center in La Jolla, some thirty miles farther. My heart sinks. Surprisingly, though, the fear quickly subsides. As I am lifted into the ambulance, I close my eyes for the first time. A vague scent of the woman’s perfume and the look of her quiet, kind eyes linger. Again, I have that comforting feeling of being held by her presence.
Opening my eyes in the ambulance, I feel a heightened alertness, as though I’m supercharged with adrenaline. Though intense, this feeling does not overwhelm me. Even though my eyes want to dart around, to survey the unfamiliar and foreboding environment, I consciously direct myself to go inward. I begin to take stock of my body sensations. This active focusing draws my attention to an intense, and uncomfortable, buzzing throughout my body.
Against this unpleasant sensation, I notice a peculiar tension in my left arm. I let this sensation come into the foreground of my consciousness and track the arm’s tension as it builds and builds. Gradually, I recognize that the arm wants to flex and move up. As this inner impulse toward movement develops, the back of my hand also wants to rotate. Ever so slightly, I sense it moving toward the left side of my face—as though to protect it against a blow. Suddenly, there passes before my eyes a fleeting image of the window of the beige car, and once again—as in a flashbulb snapshot—vacant eyes stare from behind the spiderweb of the shattered window. I hear the momentary “chinging” thud of my left shoulder shattering the windshield. Then, unexpectedly, an enveloping sense of relief floods over me. I feel myself coming back into my body. The electric buzzing has retreated. The image of the blank eyes and shattered windshield recedes and seems to dissolve. In its place, I picture myself leaving my house, feeling the soft warm sun on my face, and being filled with gladness at the expectation of seeing Butch that evening. My eyes can relax as I focus outwardly. As I look around the ambulance, it somehow seems less alien and foreboding. I see more clearly and “softly.” I have the deeply reassuring sense that I am no longer frozen, that time has started to move forward, that I am awakening from the nightmare. I gaze at the paramedic sitting by my side. Her calmness reassures me.
After a few bumpy miles, I feel another strong tension pattern developing from the spine in my upper back. I sense my right arm wanting to extend outward—I see a momentary flash; the black asphalt road rushes toward me. I hear my hand slapping the pavement and feel a raw burning sensation on the palm of my right hand. I associate this with the perception of my hand extending to protect my head from smashing onto the road. I feel tremendous relief, along with a deep sense of gratitude that my body did not betray me, knowing exactly what to do to guard my fragile brain from a potentially mortal injury. As I continue to gently tremble, I sense a warm tingling wave along with an inner strength building up from deep within my body.
As the shrill siren blasts away, the ambulance paramedic takes my blood pressure and records my EKG. When I ask her to tell me my vital signs, she informs me in a gentle professional manner that she cannot give me that information. I feel a subtle urge to extend our contact, to engage with her as a person. Calmly, I tell her that I’m a doctor (a half-truth). There is the light quality of a shared joke. She fiddles with the equipment and then indicates that it might be a false reading. A minute or two later she tells me that my heart rate is 74 and my blood pressure is 125/70.
“What were my readings when you first hooked me up?” I ask.
“Well, your heart rate was 150. The guy who took it before we came said it was about 170.”
I breathe a deep sigh of relief. “Thank you,” I say, then add: “Thank God, I won’t be getting PTSD.”
“What do you mean?” she asks with genuine curiosity.
“Well, I mean that I probably won’t be getting posttraumatic stress disorder.” When she still looks perplexed, I explain how my shaking and following my self-protective responses had helped me to “reset” my nervous system and brought me back into my body.
“This way,” I go on, “I am no longer in fight-or-flight mode.”
“Hmm,” she comments, “is that why accident victims sometimes struggle with us—are they still in fight-or-flight?”
“Yes, that’s right.”
“You know,” she adds, “I’ve noticed that they often purposely stop people from shaking when we get them to the hospital. Sometimes they strap them down tight or give them a shot of Valium. Maybe that’s not so good?”
“No, it’s not,” the teacher in me confirms. “It may give them temporary relief, but it just keeps them frozen and stuck.”
She tells me that she recently took a course in “trauma first-aid” called Critical Incident Debriefing. “They tried it with us at the hospital. We had to talk about how we felt after an accident. But talking made me and the other paramedics feel worse. I couldn’t sleep after we did it—but you weren’t talking about what happened. You were, it seemed to me, just shaking. Is that what brought your heart rate and blood pressure down?”
“Yes,” I told her and added that it was also the small protective spontaneous movements my arms were making.
“I’ll bet,” she mused, “that if the shaking that often occurs after surgery were allowed rather than suppressed, recovery would be quicker and maybe even postoperative pain would be reduced.”
“That’s right,” I say, smiling in agreement.
Horrible and shocking as this experience was, it allowed me to exercise the method for dealing with sudden trauma that I had developed, written about and taught for the past forty years. By listening to the “unspoken voice” of my body and allowing it to do what it needed to do; by not stopping the shaking, by “tracking” my inner sensations, while also allowing the completion of the defensive and orienting responses; and by feeling the “survival emotions” of rage and terror without becoming overwhelmed, I came through mercifully unscathed, both physically and emotionally. I was not only thankful; I was humbled and grateful to find that I could use my method for my own salvation.
While some people are able to recover from such trauma on their own, many individuals do not. Tens of thousands of soldiers are experiencing the extreme stress and horror of war. Then too, there are the devastating occurrences of rape, sexual abuse and assault. Many of us, however, have been overwhelmed by much more “ordinary” events such as surgeries or invasive medical procedures.1 Orthopedic patients in a recent study, for example, showed a 52% occurrence of being diagnosed with full-on PTSD following surgery.
Other traumas include falls, serious illnesses, abandonment, receiving shocking or tragic news, witnessing violence and getting into an auto accident; all can lead to PTSD. These and many other fairly common experiences are all potentially traumatizing. The inability to rebound from such events, or to be helped adequately to recover by professionals, can subject us to PTSD—along with a myriad of physical and emotional symptoms. I dread to think how my accident might have turned out had I lacked my knowledge or not had the good fortune to be helped by that woman pe
diatrician and her scent of holding kindness.
Finding Method
Over the past forty years, I have developed an approach to help people move through the many types of trauma, including what I went through that February day when I was struck by a car. This method is equally applicable directly after the trauma or many years later—my first serendipitous client, described in Chapter 2, was able to recover from a trauma that occurred about twenty years prior to our sessions together. Somatic Experiencing®, as I call the method, helps to create physiological, sensate and affective states that transform those of fear and helplessness. It does this by accessing various instinctual reactions through one’s awareness of physical body sensations.
Since time immemorial, people have attempted to cope with powerful and terrifying feelings by doing things that contradict perceptions of fear and helplessness: religious rituals, theater, dance, music, meditation and ingesting psychoactive substances, to name a few. Of these various methods for altering one’s way of being, modern medicine has accepted only the use of (limited, i.e., psychiatric) chemical substances. The other “coping” methods continue to find expression in alternative and so-called holistic approaches such as yoga, tai chi, exercise, drumming, music, shamanism and body-oriented techniques. While many people find help and solace from these valuable approaches, they are relatively nonspecific and do not sufficiently address certain core physiological mechanisms and processes that allow human beings to transform terrifying and overwhelming experiences.
In an Unspoken Voice Page 2