Pain
is Inevitable. Suffering is Optional - We All Experience Trauma, but Only
Some of Us are Traumatised
By Stefan Chmelik
MRCHM MBAcC MATCM MBHMA DipCHM DipAc LicOHM DipCHM (Dermatology) ClinAc
(Nanjing) CST I/II
Stefan
is founder of the New Medicine Group, ten specialist physicians who work
together on complex disease. He teaches at the LCTA and has a particular
interest in dermatology.
‘Suffering emerges from craving life to be other than it is’
Sidharta Gautama, The Buddha
In the integrated practice where I work, we continue to become more interested
and aware of the role of trauma and suffering in patients with chronic
health problems. Very typically, these are the people who have 'seen everyone,
done everything', and are labelled variously as heart sink, thick-file
or washing machine (because they go round and round) patients.
They do indeed suffer with a seemingly wide variety of disease labels,
including persistent pain - especially fibromyalgia and pelvic syndromes,
anxiety, depression, chronic fatigue, sexual dysfunction, addiction, eating
disorders, psycho-social issues and heightened intolerance and allergy.
Their lives are also frequently blighted by more generalised issues, such
as difficulty forming lasting relationships, feelings of low self-worth
and a lack of meaning or purpose to their lives.
However, what often binds these people together is their self-perceived
sense of suffering, and their increased vulnerability due to a relative
lack of adaptogenic capacity. In other words, they can't cope with their
lives. Any new stress, even positive ones, increases the adaptive load
to the point where their system cannot cope, or the barrel starts to flow
over, as one of my colleagues Leon Chaitow puts it.
It seems that these are the people who react badly to almost any treatment
or intervention, as even if it is what they 'need', it is just another
stress to cope with. The reptilian brain, our early brain that governs
autonomic nervous system function, goes into arousal and keeps looking
for danger, and will keep doing so until it can be down regulated.How
do you down regulate the system?
‘Trauma is physiological - biology becomes pathology’
Peter A Levine
Trauma is a very personal experience, in more ways than are even immediately
obvious. By it's very nature, trauma is most likely to occur when we are
isolated, either literally or metaphysically. An experience that one person
might find traumatic might be shrugged off by another, or even the same
person at a different time or situation in their life.
In terms of down-regulating, non-specific therapy to avoid re-traumatisation
seems to be important. That is, work that does not have a fixed or specific
purpose or goal (is not led by a 'diagnosis') so is not experienced as
an intervention. Therefore, rather than therapeutic massage, massage that
has no purpose other that being enjoyable might be used for a period,
just allowing the person to 'be'. Trauma and suffering is often linked
to either past experience or future fantasy, so bringing the person back
to the present may be vital, assisting them to live in the 'now'.
Breathing is an essential component of down-regulation. The majority of
deregulated, or traumatised patients exhibit breathing pattern disorder,
as diagnosed through the use of the Nijmegen questionnaire (Van Dixhoorn/Vansteenkiste).
A common pattern observed in women with pelvic syndromes (Wise) is paradoxical
breathing. This is where the person, unknowingly, contracts the pelvic
diaphragm when they believe they are relaxing it, and vice-versa.
Correction of this dysfunctional breathing requires the practice of certain
breathing techniques over a period of several months (Chaitow). What is
important is that the techniques used are not trying to 'achieve' anything,
other than attempting to help the body return to a state of normal autonomic
breathing.
Pain is inevitable. Suffering is optional.
This method is similar to the purpose of mindfulness meditation and breathing.
Shinzen Young, a modern teacher of Buddhist Vipassana (mindfulness or
insight meditation) has reduced this principle to a formula:
suffering = pain x resistance
Any experience or treatment that is cathartic may simply send the person
into a state of over arousal and re-traumatisation. Cathartic work is
likely to only be possible once a persons system has been down regulated
to the point where they are capable of experiencing stress or trauma without
the barrel overflowing.
Dramatic spiritual or meditation practices or psychoanalytical/psychospiritual
approaches are therefore best avoided in the first stages of dealing with
trauma. The aim of Vipassana meditation is not to bring anything up, but
rather to just experience your existence as you are living it at this
moment (Kabbat-Zinn)
Raja Selma (2004), who teaches the trauma therapy of Somatic Experiencing
which is based on the work of Peter Levine, says: ‘Our capacity to
embody higher spiritual energies depends on the extent to which our brains
and bodies can hold and contain a high charge without triggering traumatic
reactions, such as anxiety or migraine. Working through traumatic reactions
in our physical bodies...becomes a necessary step towards an embodied
spirituality...Breaking into these compensations physically or energetically,
from either end so to speak, without addressing possible underlying traumatic
responses, can lead to unfavourable outcomes for clients.’
Trauma from abuse in TCM
Several authors agree that sexual abuse and Post Traumatic Stress Disorder
(PTSD) primarily affects Heart and Liver, causing Fire (Jarrett/Sinclair-Lian
and Nityamo). Levine (1997) also recognises the psychophysiology of trauma.
My clinical experience is that PTSD causing Liver & Heart Fire may
not be reflected in the standard methods of diagnosis within TCM - so
the patient may not have the classic signs of Liver or Heart Fire. My
methodology for assessing the presence of Fire due to suspected repressed
emotional trauma is to use temperature monitoring, as according to Lyttleton
(2004, p. 67), a spiking chart indicates Liver and Heart Fire. Once this
has been recognised, herbs or acupuncture can be used that address this
pathology.Early experience and trauma
Schore (1999) suggests that the neurobiology of the adult is shaped by
the nature of contact/attachment between mother and baby in the first
2 years of life. Our neural pathways are formed at a very early age. Early
experience is critical in how we experience trauma throughout the rest
of our lives.
The left (reasoning) brain literally has 'no access to the body' - so
any experience that has been somatised (placed in the body) from an early
age, including birth, cannot be accessed by using the left-brain. The
right (feeling) brain, which can access the body to reveal these experiences,
needs to feel.
Therefore, maybe it is the case that all therapy/healing takes place between
right brain contact of the patient and therapist, and that early experience/trauma
probably can't be just talked away, but requires a combined mind-body
based approach.
David Haas runs First Expression, which offers Infant Centred Family Work
(ICFW): ‘Trauma can occur at any period in our life but perhaps the
time when we are most vulnerable is in early life. Our early development
and mental models of the world are based on our experience of the world
around us and in particular the nature of our relationship with our primary
carers.’
There are two major forms of memory; implicit and explicit. Implicit memory
can be considered to cover generating emotions, behavioural responses,
perception and body sensations and feeling. It does not require our conscious
attention. Explicit memory requires conscious attention and involves the
hippocampus. It deals with factual and autobiographical memory.
Autobiographical memory requires a part of the brain to mature sufficiently,
around the second birthday, to allow this form of recollection to occur.
Siegel and Hartzell
The part referred to is the prefrontal cortex, especially the orbitofrontal
cortex. During an overwhelming event the connections to the hippocampus
become inhibited so although implicit memories become encoded the autobiographical
memories do not.
The result is that whenever we do not have autobiographical memory of
an event we are left with just the feelings and sensations. Without resolution
these events may continue to affect our lives in social, romantic, and
work relationships.
Box:
Other approaches which claim to help with trauma and relaxation include:
EMDR (Eye Movement Desensitisation and Reprocessing)
CBT (Cognitive Behavioral Therapy)
Autogenic Training
Cranial osteopathy, Cranio-sacral therapy
Hoffman Process
Hypnotherapy
Re-birthing
The Myofascial Network and Bodywork
The fascia is made up of continuous layers of membrane. If you could dip
someone in a bath of acid that dissolved everything except for fascia,
you would be left with a perfect, but semi-transparent, version of them.
The fascia may well be where trauma, and all body memory resides. Modern
research suggests this is where the acupuncture pathways traverse, and
in some ways corresponds to concepts of the Cou Li, Luo Mai and Gao Huang
in TCM. There are a number of techniques that have evolved alongside a
developing understanding of the nature of fascia, particularly Cranial
work and Rolfing.
‘Rolfing is a bodywork system that initiates the restructuring of
the body through connective tissue manipulation and movement education.
Working within a ten-session framework, Rolfing aims to bring the body
back into alignment by freeing restrictions in the myofascial network.’
Liesl D Hinkly, New Medicine Group.
Cranial work emphasises the experience of the 'cranial pulse', a measurable
phenomenon created by the alternating flexion-extension of the occiput
and sacrum, and the movement of the cerebrospinal fluid.
Trauma can manifest in many ways on the physical, emotional and psychological
levels. Since the fascia connects every part of the body it is possible
for the bodyworker to work directly and indirectly with locked and embedded
trauma.
The release of holding patterns changes the physical properties of the
fascia, offering the body the possibility to return to its original equilibrium
before the advent of the trauma. Natural re-structuring and a return to
relaxed and efficient movement patterns follow, as the body's ability
to self-regulate is re-established.
Websites:
New Medicine Group
http://www.newmedicinegroup.com
Leon Chaitow
http://www.leonchaitow.com/
Infant Centred Family Work
http://www.first-expression.co.uk
For information about training in Somatic Experiencing
http://www.traumahealing.com/
Hoffman Process
http://www.hoffmaninstitute.co.uk/
References:
Chaitow, L. Bradley, D. Gilbert, C (2002). Multidisciplinary Approaches
to Breathing Pattern Disorders. Churchill Livingstone.
Jarrett, L. (1995). Chinese Medicine and the Betrayal of Intimacy. American
Journal of Acupuncture 23, no1
Kabat-Zinn, J (2001). Full Catastrophe Living. Dell Publishing.
Levine, P. A. (1997). Waking the Tiger. North Atlantic Books.
Lyttleton, J. (2004). Treatment of Infertility with Chinese Medicine.
Churchill Livingstone.
Schore AN (1999). Affect Regulation and the Origin of the Self: The Neurobiology
of Emotional Development. Lawrence Erlbaum Assoc.
Selma, R. Trauma, body, energy and Spirituality. Positive Health, May
2004.
Sinclair-Lian, Nityamo. (2006). Developing a Traditional Chinese Medicine
Diagnostic Structure for Post-Traumatic Stress Disorder. Journal of Alternative
and Complementary Medicine. Vol. 12, No. 1: 45-57
Van Dixhoorn J, Duivenvoorden HJ (1985). Efficacy of Nijmegen questionnaire
in recognition of the hyperventilation syndrome. Journal of Psychosomatic
Research. 29:199-206.
Vansteenkiste J, Rochette F, Demedts M (1991). Diagnostic tests of hyperventilation
syndrome. European Respiratory Journal 4:393-399
Wise, D. Anderson, R. A Headache in the Pelvis. California State University.
Bibliography
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Levine P (1997). Waking the Tiger: Healing Trauma. North Atlantic Books.
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Schore AN (2003). Affect Regulation and the Repair of the Self. W.W. Norton
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