Healing post traumatic stress disorder with regeneration

Imagine you’ve just experienced the worst day of your life; it has been traumatic, but you’ve survived and made it through to see another day. Then imagine waking up the next day, only to experience that same thing all over again. And then again, the day after that. It’s like some twisted version of Groundhog Day, a life stuck in the past, with the future seemingly lost. This is the existence of someone suffering from post traumatic stress disorder (PTSD).

PTSD, is a term that came into use during the 1970s, as veterans of the Vietnam war were presenting in large numbers, to health care providers, with a cluster of related physical and psychological symptoms. Initially considered a controversial diagnosis, PTSD was officially recognized as a reality, by the American Psychiatric Association in 1980, with its inclusion in the Diagnostic and Statistical Manual of Mental Disorders (DSM-III).

Since its recognition as a serious disorder with major health consequences, the PTSD diagnosis has been extended beyond war veterans, and is now commonly used to describe the trauma sustained through any kind of violence, particularly those relating to sexual violence and child abuse. It is a condition that can be sustained in a one-off event such as a car accident or with ongoing trauma, such as living with domestic violence and childhood neglect. In these ongoing situations, the disorder is referred to as complex PTSD.

In his best-selling book of 2014, The body keeps the score: brain, mind and body in the healing of trauma, psychiatrist Bessel van der Volk, draws on thirty years of dedicated research and observation, to describe the phenomenon of what happens to people who have not had the opportunity to process traumatic events. In the second half of his book, van der Kolk details the wide range of effective therapies that can be used to successfully treat PTSD and in keeping with the books title, The body keeps the score, these therapies are body-centred, in that physical contact, or movement is often engaged (think yoga or acupuncture).

This emphasis on using the body to heal PTSD, comes from van der Kolk’s realisation, early in his work, that while talking about the trauma, or using medication like antidepressants, can definitely provide some relief, they are not enough to heal the trauma. This is because trauma produces physiological changes in the body and brain, that in the absence of proper support to process the trauma, are then hard-wired in. Thus, re-wiring the brain, to a new reality that involves a sense of safety, requires work at the body level.

Using MRI scans and tracking the hormones of trauma victims, van der Kolk was able to obtain evidence, that for a person with PTSD, the body maintains the physiology of a nervous system on high alert, even though the traumatic event may have been twenty years ago. Unsurprisingly, the amygdala, that part of the brain tasked with warning us of impending danger and activating the body’s stress response, is highly activated in people with PTSD, to the point of always being on line. Small triggers — sounds, smells or any sensory data that reminds the sufferer of the original trauma — are enough to set off full activation of the body’s stress system.

The health consequences of this are wide ranging; anything from insomnia, constant anxiety, flashbacks and nightmares to chronic illnesses and cardiac events. Sufferer’s often find relaxation impossible and it is common, if not universal, that PTSD is a precursor to abuse of alcohol and drugs as sufferer’s search for relief from their symptoms.

A particularly harrowing case study, in a book otherwise filled with similarly heart-breaking personal histories, van der Kolk discusses a patient named Marsha, who had lost her five-year-old daughter, after accidentally running a red light. Thirteen years after this tragedy, Marsha was barely making it through each day. The sound of a child’s laughter was an intolerable trigger, and Marsha worked day and night in distraction, as the only way to distance herself from the tragedy, one that lived on in her physiological and emotional experience, as though it had only happened the day before.

In Marsha’s case, Van der Kolk was able to successfully treat her, using EMDR (Eye Movement Desensitisation and Reprocessing), a trauma processing modality developed by psychologist, Francine Shapiro, in 1987. EMDR involves the clinician moving an index finger slowly back and forth before a patient’s eyes, while the patient recounts details of the trauma in short bursts. The clinician meanwhile, manages the narrative, intervening to insert messages of comfort that suggest the patient is safe and the event is over.

EMDR can be remarkably effective, even curative, for many patients, effectively giving them their life back, and is fascinating in its mechanism of operation. Given traumatic memories get compartmentalised in the right hemisphere of the brain, the location of the amygdala, they fail to be fully integrated in both hemispheres, which is the case for memories that have been fully processed, and allowed to become the past. In contrast, the traumatised brain gets stuck and the memories stay ever present. With EMDR, the process of facilitating eye movement back and forth, helps with this integration between hemispheres, as the patient is exposed to aspects of the traumatic memory.

But what if EMDR does not work for you? There are many options, which van der Kolk describes in detail, but some of the most easily accessed are listed below:

Yoga

Yoga has been proven to be one of the most effective treatments for PTSD.

Van der Kolk, believes that as trauma produces uncomfortable, and in some cases unbearable, symptoms of nervous arousal in sufferers, they begin to detach from their bodies, using the distraction of work or alcohol and drugs. Yoga, allows patients to get back in touch with their bodies, to tolerate discomfort for small amounts of time, when holding a pose. This puts them in a better place to feel the trauma and process it, ultimately returning to a place where they feel safe inhabiting their body.

Theatre

The magic of theatre and acting, is that the actor gets to inhabit a new character, leaving their own selves behind, to fully embody the character’s words, gestures and demeanour. Van der Volk uses theatre groups to get his patients to remember, on a profoundly physical level that they have agency over their body and selves. Pretending, acting and physically moving, indeed feeling, as though you are someone more powerful and in control, embodying that persona, sets up your physiology as though that were the case.

Write your trauma story

Victims of trauma are often isolated in their experiences. The social requirement to function normally, means that society is often blind to what PTSD patients are going through, and in addition, patients can experience shame at not being able to move on, often not understanding their brain has become rewired as a ‘trauma brain’. Taking the time to tell your story, is an excellent way to gain access to your inner world of feelings, and to gain insight to what happened. Given many trauma victims blame themselves, not just for the traumatic event but for their inability to get past it, writing in this way helps to clarify to the sufferer how little choice they had in the trauma process, and this in itself can be liberating.

Meditation

Like yoga, meditation allows PTSD sufferers the opportunity to inhabit and experience their body as a safe place. Focussing on the breath, or individual sensations, calms the nervous system and builds tolerance to PTSD symptoms, without being overwhelming. This can be an extraordinary relief to sufferers and such relaxation techniques, if practiced regularly, have the capacity to re-wire the brain to the present, as a place experienced as safe..