Dissociation, trauma and the brain : when pain becomes wordless

The following excerpt is from Peter Levine.  It explains how essential the experience of feeling bodily sensations is to the unwinding and healing of trauma but also how and why traumatic imprints become wordless and very difficult to access through talk therapy alone.  It is an essential understanding for many of us with PTSD or Complex PTSD.

“Shut down and dissociated people are not “in their bodies”, being as we have seen, nearly unable to make real here and now contact no matter how hard they try.  It is only when they can first engage their arousal system (enough to begin to pull them up, out of immobility and dissociation), and then discharge that activation, that it becomes physiologically possible to make contact and receive support.  Fortunately, there is a way to escape the immobilisation system’s domination of the two less primitive systems – a way that practitioners must learn to exercise.

The therapeutic solution is supported by Lanius and Hopper’s fMRI work….This compelling research, recording activity in the part of the brain associated with the awareness of bodily states and emotions, makes a clear differentiation between sympathetic arousal and dissociation in traumatised subjects.  The brain area associated with awareness of bodily states and emotions is called the right anterior insula and is located in the frontal part of the limbic (emotional) brain, squeezed in directly under the prefrontal cortex – the locus of our most refined consciousness.  The research showed that the insula is strongly inhibited due to shut down and dissociation, and it confirmed that these traumatised individuals are unable to feel their bodies, to differentiate their emotions, or even to know who they (or another person) really are.  On the other hand, when subjects are in a state of sympathetic hyper-arousal, this same area is highly activated.  This dramatic increase in the activity of the right anterior insula strongly suggests a clear differentiation of little or no body awareness in immobility/shutdown and dissociation to a kind of hyper-sensation in sympathetic arousal.  In addition, the sympathetic state, at least, provides the possibility of coherent awareness, processing and resolution.

A related, and seminal study, was carried out by Bessel van der Kolk.  He and his colleagues read a traumatic story to a group of clients and compared two brain regions in each.  The researchers found that the amygdala, the so called fear or “smoke detector”, lit up with electrical activity; at the same time, a region in the left cerebral cortex, called Broca’s area, went dim.  The later is the primary language centre – the part of the brain that takes what we are feeling and expresses it in words. That trauma is about wordless terror is also demonstrated in these brain scans.  Frequently, when traumatised people try to put their feelings into words – as when, for example, one is asked to tell about his or her rape – they speak about it as though it happened to someone else.  Or clients try to speak of their horror, then become frustrated, or flooded, incurring more shutdown in Broca’s area, and thus enter into a re-traumatising feedback loop of frustration, shutdown and dissociation.

This language barrier in traumatised individuals makes it especially important to work with sensations – the only language that the reptilian brain speaks.  Doing so both helps people to move out of shutdown and dissociation and diminishes a client’s frustration and flooding when working with traumatic material.

The body must be doing something to keep the insula, the cingulate cortex, and Broca’s area  online.  Even though the capacity for engagement is inhibited by the sympathetic nervous system, it is not thoroughly squelched in the debilitating way it was by the more primitive immobility system.  In sympathetic arousal, clients are better able to respond to their therapists promptings and suggestions, as well as to be more receptive to his or her calming presence.  In turn, it is this very receptivity that helps to attenuate the sympathetic arousal.  When a client begins to make a breakthrough out of immobility and into sympathetic arousal, the astute therapist seizes this momentary opportunity, first by detecting the client’s shift and then by facilitating the awareness of his or her transition.  Theh therapist endeavours to enlarge the client’s awareness of what is going on in him or herself while simultaneously helping the client avoid being overwhelmed by the intense sympathetic arousal.  Such guidance helps clients move out of immobility and through complete cycles of activation, discharge/deactivation and equilibrium.  In this way the client learns that what goes up (gets activated) and will, come down. Clients learn to trust that moderate activation unwinds on its own when one doesn’t avoid and recoil from it; that is, when one doesn’t interfere with the natural course of one’s sensations of arousal.  Thus a therapist can seize the day – by giving the client the gift of this bodily experience.”

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