In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness

by Peter A. Levine

Trauma, as Peter brilliantly recognized decades ago, does not reside in the external event that induces physical or emotional pain—nor even in the pain itself—but in our becoming stuck in our primitive responses to painful events. Trauma is caused when we are unable to release blocked energies, to fully move through the physical/emotional reactions to hurtful experience. Trauma is not what happens to us, but what we hold inside in the absence of an empathetic witness.

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.

Orthopedic patients in a recent study, for example, showed a 52% occurrence of being diagnosed with full-on PTSD following surgery.

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.

Over my lifetime, as well as in writing this book, I have attempted to bridge the vast chasm between the day-to-day work of the clinician and the findings of various scientific disciplines, particularly ethology, the study of animals in their natural environments.

Despite our apparent reliance on elaborate speech, many of our most important exchanges occur simply through the “unspoken voice” of our body’s expressions in the dance of life. The deciphering of this nonverbal realm is a foundation of the healing approach that I present in this book.

I will explain how our nervous system has evolved a hierarchical structure, how these hierarchies interact, and how the more advanced systems shut down in the face of overwhelming threat, leaving brain, body and psyche to their more archaic functions. I hope to demonstrate how successful therapy restores these systems to their balanced operation.

What Shalev discovered was that a patient whose heart rate had returned to near normal by the time of discharge from the ER was unlikely to develop posttraumatic stress disorder. On the other hand, one whose heart rate was still elevated upon leaving was highly likely to develop PTSD in the following weeks or months.† Thus, in my accident, I felt profound relief when the paramedic in the ambulance gave me the vital signs that indicated my heart rate had returned to normal. Briefly, heart rate is a direct window into the autonomic (involuntary) branch of our nervous system. A racing heart is part of body and mind readying for the survival actions of fight-or-flight mediated by the sympathetic-adrenal nervous system

We frequently shake when we are cold, anxious, angry or fearful. We may also tremble when in love or at the climax of orgasm. Patients sometimes shake uncontrollably, in cold shivers, as they awake from anesthesia. Wild animals often tremble when they are stressed or confined. Shaking and trembling reactions are also reported during the practices of traditional healing and spiritual pathways of the East. In Qigong and Kundalini yoga, for example, adepts who employ subtle movement, breathing and meditation techniques may experience ecstatic and blissful states accompanied by shaking and trembling. All of these “tremblings,” experienced in diverse circumstances and having a multiplicity of other functions, hold the potential for catalyzing authentic transformation, deep healing and awe.

Learning to live through states of high arousal (no matter what their source) allows us to maintain equilibrium and sanity. It enables us to live life in its full range and richness—from agony to ecstasy. The intrinsic relationship of these spontaneous autonomic responses to the broad phenomenon of resilience, flow and transformation is a central theme of this book.

Yet given obvious patterns in anatomy, physiology, behavior, and emotions, and since we share the same survival parts of the brain with other mammals, it only makes sense that we share their reactions to threat. Hence, there would be great benefit gained from learning how animals (particularly mammals and higher-level primates) respond to threat, and then observing how they rebound, settle and return to equilibrium after the threat has passed. Many of us humans, unfortunately, have become alienated from this innate capacity for resilience and self-healing. This, as we shall explore, has made us vulnerable to being overwhelmed and traumatized.

The previous versions of the PTSD diagnosis have been careful not to suggest a mechanism (or even a theory) to explain what happens in the brain and body when people become traumatized. This absence is important for more than academic reasons: a theory suggests rationales for treatment and prevention. This avoidance, and sole reliance on taxonomy, is an understandable overreaction to the Freudian theory’s previous stranglehold on psychology.

The indigenous peoples throughout South America and Mesoamerica have long understood both the nature of fear and the essence of trauma. What’s more, they seemed to know how to transform it through their shamanic healing rituals.

Recently, a young Iraq veteran took issue with calling his combat anguish PTSD and, instead, poignantly referred to his pain and suffering as PTSI—the “I” designating “injury.”

Rather than being a disease in the classical sense, trauma is instead a profound experience of “dis-ease” or “dis-order.” What is called for here is a cooperative and restorative process with the doctor as an assisting guide and midwife.

In a common therapy resulting from this isolating orientation, the therapist instructs the PTSD victim to assert control over his feelings, to manage his aberrant behaviors and to alter his dysfunctional thoughts. Contrast this alignment to that of shamanic traditions, where the healer and the sufferer join together to reexperience the terror while calling on cosmic forces to release the grip of the demons. The shaman is always first initiated, via a profound encounter with his own helplessness and feeling of being shattered, prior to assuming the mantle of healer. Such preparation might suggest a model whereby contemporary therapists must first recognize and engage with their own traumas and emotional wounds.†

If trauma is to be transformed, we must learn not to confront it directly. If we make the mistake of confronting trauma head on, then Medusa will, true to her nature, turn us to stone. Like the Chinese finger traps we all played with as kids, the more we struggle with trauma, the greater will be its grip upon us. When it comes to trauma, I believe that the “equivalent” of Perseus’s reflecting shield is how our body responds to trauma and how the “living body” personifies resilience and feelings of goodness.

The paradox of trauma is that it has both the power to destroy and the power to transform and resurrect.

I have also worked with several rapists who graphically described precisely how they knew (from a woman’s posture and gait) who was fearful (or propped up with false bravado) and would thus be easy prey.

by learning how to track their own sensations, therapists can avoid absorbing the fear, rage and helplessness of their clients. It is important to understand that when therapists perceive that they must protect themselves from their clients’ sensations and emotions, they unconsciously block those clients from therapeutically experiencing them. By

distancing ourselves from their anguish, we distance ourselves from them and from the fears they are struggling with. To take a self-protective stance is to abandon our clients precipitately. At the same time, we also greatly increase the likelihood of their exposure to secondary or vicarious traumatization and burnout. Therapists must learn, from their own successful encounters with their own traumas, to stay present with their clients.

“Perhaps the most striking evidence of successful empathy,” says the analyst Leston Havens, “is the occurrence in our bodies of sensations that the patient has described in his or hers.”14

This observation supports the basic Darwinian tenet that the human ability to rapidly read bodies and to respond both unequivocally and instantaneously is highly advantageous. Reading others’ bodies predisposes us to actions that increase our chances of survival. In order to be effective and immediate, such postural resonance bypasses the conscious mind.

neurologist Antonio Damasio adds that “emotions are practical action programs that work to solve a problem, often before we’re conscious of it. These processes are at work continually, in pilots, leaders of expeditions, parents, in all of us.” Therapeutic approaches that neglect the body, focusing mainly on thoughts (top-down processing), will consequently be limited. I propose instead that, in the initial stages of restorative work, bottom-up processing needs to be standard operating procedure. In other words,

addressing a client’s “bodyspeak” first and then, gradually, enlisting his or her emotion, perception and cognition is not merely valuable, it’s essential.

In the therapy situation, the therapist must strike a balance between mirroring a client’s distress enough for them to learn about the client’s sensations, but not so much as to increase the client’s level of fear as in contagion panic. This can only happen if the therapist has learned the ins and outs of his or her own sensations and emotions and is relatively comfortable with them.

In addition to the well-known fight and flight reactions, there is a third, lesser-known reaction to threat: immobilization. Ethologists call this “default” state of paralysis tonic immobility (TI).

Trauma occurs when we are intensely frightened and are either physically restrained or perceive that we are trapped. We freeze in paralysis and/or collapse in overwhelming helplessness.

It may help therapists (and their clients) to know that immobility appears to serve at least four important survival functions in mammals. First, it is a last-ditch survival strategy, colloquially known as “playing opossum.”

Second, immobility affords a certain degree of invisibility: an inert body is much less likely to be seen by a predator. Third, immobility may promote group survival: when hunted by a predator pack, the collapse of one individual may distract the pack long enough for the rest of the herd to escape. Last, but by no means least, a fourth biological function of immobility is that it triggers a profoundly altered state of numbing. In this state, extreme pain and terror are dulled: so if the animal does survive an attack it will be, even though injured, less encumbered by debilitating pain and thus possibly able to escape if the opportunity arises.

The same is most likely true for a rape or accident victim.22 In this state of analgesia, the victim may witness the event as though from outside his or her body, as if it were happening to someone else (as I observed in my accident). Such distancing, called dissociation, helps to make the unbearable bearable.

While Livingstone attributes this gift to his “benevolent creator,” one need not invoke “intelligent design” to appreciate the biologically adaptive function of diminishing the sharp edges of serious pain, terror and panic. If one is able to stay broadly focused and perceive things in slow motion, one is more likely to be able to take advantage of a potential escape opportunity or think of an ingenious strategy to evade the predator.

While traumatized humans don’t actually remain physically paralyzed, they do get lost in a kind of anxious fog, a chronic partial shutdown, dissociation, lingering depression, and numbness. Many are able to earn a living and/or raise a family in a kind of “functional freeze” that severely limits their enjoyment of life.

This brings me to the central question: what determines whether acute exposure to a (potentially) traumatizing event will have a long-term debilitating effect as in posttraumatic stress disorder? And how does understanding the dynamics of the immobility response postulate clinical solutions to this crucial question?

In a carefully thought-out and well-controlled experiment, the authors demonstrated that if an animal is both frightened and restrained, the period during which it remains immobilized (after the restraint is removed) is dramatically increased. There is a nearly perfect linear correlation between the level of fear an animal experiences when it is restrained, and the duration of immobility.27

This is an instructive glimpse of how animals negotiate immobility and how the consensual sexual act and orgasmic release involve some immobility in the absence of fear. Immobility, in the absence of fear, is benign and even pleasurable, as in the example of a mother cat carrying its limp kitten securely in its mouth.

My experience, beginning with Nancy (in Chapter 2) and then working with so many more traumatized clients, has taught me that the very key to resolving trauma is being able to uncouple and separate the fear from the immobility.

Such a combination of wild agitation, deathly white complexion and frantic dissociation (staring wide-eyed as though without recognition) accurately describes acute human fright paralysis. While traumatized individuals may not exhibit all of these characteristics all of the time, they do form the undercurrent of traumatic shock as PTSD.

Contrast this to trauma, where intense fear (and other strong negative affects), when coupled with the immobility response, becomes entrapping and therefore traumatic. This difference suggests a clear rationale for a trauma therapy model that separates fear and other strong negative affects from the (normally time-limited) biological immobility response. Separating the two components breaks the feedback loop that rekindles the trauma response. This, I am convinced, is the philosopher’s stone of informed trauma therapy.

It should be no surprise, given the nature of fear-induced immobility, that a majority of rape victims predictably describe feeling paralyzed (sometimes also suffocated) and unable to move. Being held down and terrorized by someone much larger, stronger and heavier is virtually guaranteed to induce long-lasting immobility and, thus, trauma. Rape not only forces one to keep still, it induces an inner immobility because of the terror (fear-potentiated immobility). In one study, 88% of the victims of childhood sexual assault and 75% of the victims of adult sexual assault reported moderate to high levels of paralysis during the assault.35 In addition, because of the high levels of dissociation, it is likely that many victims do not remember feeling paralyzed or deny the paralysis because they feel so guilty for not having “fought back.”

This story speaks to modern cultures that tend to judge immobilization and dissociation in the face of overwhelming threat as a weakness tantamount to cowardice. Beneath this castigating judgment lies a pervasive fear of feeling trapped and helpless. This fear of fear and helplessness, and of feeling trapped, can come to dominate a person’s life in the form of persistent and debilitating shame. Together, shame and trauma form a particularly virulent and interlocked combination. Self-blame and self-hatred are common among molestation and rape survivors, who judge themselves harshly for not “putting up a

fight,” even where fight was not a viable survival option. However, both the experience of paralysis and the critical self-judgment about “weakness” and helplessness are common components of trauma. In addition, the younger, the more developmentally immature or insecurely attached the victim is, the more likely it is that he or she will respond to stress, threat and danger with paralysis rather than active struggle. People who lack solid early attachment bonding to a primary caregiver, and therefore lack a foundation of safety, are much more vulnerable to being victimized and traumatized and are more likely to develop the entrenched symptoms of shame, dissociation and depression.

additional confused and chaotic burden. Shame becomes deeply embedded as a pervasive sense of “badness” permeating every part of their lives.

While the principles of uncoupling fear from immobility discussed in this chapter apply to these cases, the therapeutic process is generally much more complex. It requires a broader skill for negotiating the therapeutic relationship so that the therapist does not get tangled up in taking on the (projected) role of the perpetrator(s) or rescuer.

Such is the nature of exit from immobility, where induction has been repetitive and accompanied by fear and rage. Humans, in addition, reterrorize themselves out of their

(misplaced) fear of their own intense sensations and emotions.

To review, fear both greatly enhances and extends immobility and also makes the process of exiting immobility fearful and potentially violent. An individual who is highly terrified upon entering the immobility state is likely to move out of it in a similar manner. “As they go in, so they come out” was an expression that Army M.A.S.H. medics used when describing the reactions of their war-wounded patients.

David Levy, in 1945, studied hospitalized children, many of them being treated for injuries requiring immobilization, such as splints, casts and braces. He found that these unfortunate children developed shell-shock symptoms similar to those of the soldiers returning from the war fronts in Europe and North Africa.42

The immobilization effects Levy observed in children also occur in adult patients. In a recent medical study, more than 52% of orthopedic patients being treated for broken bones were shown to develop full-blown posttraumatic stress disorder, with a majority not recovering and worsening over time.

Biologically, the orthopedic patients, soldiers, rape victims and hospitalized children are reacting like wild animals fighting for their life after being frightened and captured. Their impulse to attack in an “aggravated rage” or to flee in frantic desperation is not only biologically appropriate; in fact, it is a frequent biological outcome. As a captured and terrified animal comes out of immobility, its survival may depend on its violent aggression toward the still-present predator. In humans, such violence, however, has produced tragic consequences to the individual and society. I had the opportunity to speak with the mother of Ted Kaczynski (the “Unabomber,” whose vendetta was waged against the impersonality of technology) and with the father of Jeffrey Dahmer (a serial killer who dismembered his victims). They both told me horrific stories of how their young children were “broken” by terrifying hospital experiences. Both parents described how, after terrifying hospitalizations, each of these children retreated into his own world. While such experiences of rage leading to perverted violence are (fortunately) rare, the terror and anger evoked by medical procedures is (unfortunately) not.