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

by Peter A. Levine

Because rage is about wanting to kill, it is not hard to understand how frightening this urge can be; and how the rage could turn to fear as a way of preventing such murderous impulses.

As people revisit, move through and then move out of immobility in therapy, they frequently experience some rage. These primal sensations of fury (when contained) represent movements back into life.

As traumatized individuals begin to come out of immobility, they frequently experience eruptions of intense anger or rage. But fearing that they may actually hurt others (or themselves), they exert a tremendous effort to deflect and suppress that rage, almost before they feel it. When one is flooded by rage, the frontal parts of the brain “shut down.”50 Because of this extreme imbalance, the capacity to stand back and observe one’s sensations and emotions is lost; rather, one becomes those emotions and sensations.f Hence, the rage can become utterly overwhelming, causing panic and the stifling of such primitive impulses, turning them inward and preventing a natural exit from the immobility reaction. Maintaining this suppression requires a tremendous expenditure of energy.

The vicious cycle of intense sensation/rage/fear locks a person in the biological trauma response.

While only a few humans actually die from fright, chronically traumatized individuals go through the motions of living without really feeling vital or engaged in life. Such individuals are empty to the core of their being. “I walk around,” said a gang-rape survivor, “but it’s not me anymore … I am empty and cold … I might as well be dead,” she told me on our first session. Chronic immobility gives rise to the core emotional symptoms of trauma: numbness, shutdown, entrapment, helplessness, depression, fear, terror, rage and hopelessness.

In review: Trauma arises when one’s human immobility responses do not resolve; that is, when one cannot make the transition back to normal life, and the immobility reaction becomes chronically coupled with fear and other intense negative emotions such as dread, revulsion and helplessness. After this coupling has been established, the physical sensations of immobility by themselves evoke fear.

Fear begets paralysis, and fear of the sensations of paralysis begets more fear, promoting yet a deeper

paralysis. In this way, a normally time-limited adaptive reaction becomes chronic and maladaptive. The feedback loop closes in on itself. In this downward spiral, the vortex of trauma is born. Successful trauma therapy helps people resolve trauma symptoms. The feedback loop is broken by uncoupling fear from immobility (see Figures 4.1a and 4.1b). Effective therapy breaks, or depotentiates, this trauma-fear feedback loop by helping a person safely learn to “contain” his or her powerful sensations, emotions and impulses without becoming overwhelmed. Thus, the immobility response is enabled to resolve as it is evolved to do.

Uncoupling fear and allowing the normally time-limited immobility reaction to complete is, in principle, a straightforward matter. The therapist helps reduce the duration of immobility by gently diminishing the level of fear. In other words, the therapist’s job is to aid a client to gradually uncouple the fear from the paralysis, so as to gradually restore self-paced termination. In this way the (fear-immobility) feedback loop is broken; colloquially, it runs out of gas. As a client learns to exp...

There is an important caveat to this simple “prescription.” Where trauma has been lengthy and deeply entrenched, other factors come into play: primarily, one’s very faculty for change and reengagement in life becomes impaired. This aspect has been poignantly portrayed in Louise Erdrich’s compelling novel The Master Butchers Singing Club.

This paralyzing terror is the effect of fear-potentiated immobility and leads to PTSD. This is why the phrase “time heals all wounds” simply does not apply to trauma.

The human need to gradually return from the land of the walking dead to the land of the living needs to be understood, respected and honored. Too much, too soon, threatens to overwhelm the fragile ego structure and adaptive personality. This is why the rate at which people resolve trauma must be gradual and “titrated.”

In the final analysis, I believe that it is the dynamic balance between the most primitive and the most evolved/refined parts of the brain that allows trauma to be resolved and difficult emotions to be integrated and transformed. Effective treatment is a matter of helping individuals keep the “observing” prefrontal cortex online as it simultaneously experiences the raw primitive sensations generated in the archaic portions of the brain

The key to this delicate undertaking is being able to safely sense both intense and subtle body sensations and feelings. It turns out that there is a paired brain structure that appears to do exactly that: wedged in between the limbic system and the prefrontal cortex are the insula (nearer to the limbic system) and cingulate (nearer to the cortex). Briefly, the insula receives input from the internal structures of the body, including muscles, joints and viscera. Together, insula and cingulate help us make sense of these primitive sensations by weaving

them into nuanced feelings, perceptions and cognitions.52 Accessing that function is a key to the approach of transforming trauma and difficult emot...

Restoring the balance and rhythm between instinct and reason also plays a central part in healing the mind/body split. Integration of brain and body, of right and left cerebral hemispheres, and of primitive and evolved brain regions promotes wholeness and makes us fully human.

Until the core physical experience of trauma—feeling scared stiff, frozen in fear or collapsing and going numb—unwinds and transforms, one remains stuck, a captive of one’s own entwined fear and helplessness. The sensations of paralysis or collapse seem intolerable, utterly unacceptable; they terrify and threaten to entrap and defeat us. This perception of seemingly unbearable experiences leads us to avoid and deny them, to tighten up against them and then split off from them. Resorting to these “defenses” is, however, like drinking salt water to quench extreme thirst: while they may give temporary relief, they only make the problem drastically worse and are, over the long haul, counterproductive.

To resist the immediate defensive ploy of avoidance, the most potent strategy is to move toward the fear, to contact the immobility itself and to consciously explore the various sensations, textures, images and thoughts associated with any discomfort that may arise. When working with traumatic reactions, such as states of intense fear, Somatic Experiencing®* provides therapists with nine building blocks. These basic tools for “renegotiating” and transforming trauma are not linear, rigid or unidirectional. Instead, in therapy sessions, these steps are intertwined and dependent upon one another and may be accessed repeatedly and in any order. However, if this psychobiological process is to be built on firm ground, Steps 1, 2 and 3 must occur first and must follow sequentially. Thus, the therapist needs to: 1. Establish an environment of relative safety. 2. Support initial exploration and acceptance of sensation. 3. Establish “pendulation” and containment: the innate power of rhythm. 4. Use titration to create increasing stability, resilience and organization. Titration is about carefully touching into the smallest “drop” of survival-based arousal, and other difficult sensations, to prevent retraumatization. 5. Provide a corrective experience by supplanting the passive responses of collapse and helplessness with active, empowered, defensive responses.

6. Separate or “uncouple” the conditioned association of fear and helplessness from the (normally time-limited but now maladaptive) biological immobility response. 7. Resolve hyperarousal states by gently guiding the “discharge” and redistribution of the vast survival energy mobilized for life-preserving action while freeing that energy to support higher-level brain functioning. 8. Engage self-regulation to restore “dynamic equilibrium” and relaxed alertness. 9. Orient to the here and now, contact the environment and reestablish the capacity for social engagement.

The therapist who provides only a sense of safety (no matter how effectively) will only make the client increasingly dependent—and thus will increase the imbalance of power between therapist and client. To avoid such sabotage, the next steps are aimed at helping the client move toward establishing his or her own agency and capacity for mastering self-soothing and feelings of empowerment and self-regulation.

To become self-regulating and authentically autonomous, traumatized individuals must ultimately learn to access, tolerate and utilize their inner sensations.

“Touching in” to positive experiences gradually gives a client the confidence to explore her internal bodily landscape and develop a tolerance for all of her sensations, comfortable and uncomfortable, pleasant and unpleasant.

With a gentle rocking back and forth, oscillating between resistance and acceptance, fear and exploration, the client gradually sheds some of her protective armoring.

This back-and-forth switching of attention (between the fear/resistance and the unadulterated physical sensations of immobility) deepens relaxation and enhances aliveness. It is the beginning of hope and the acquiring of tools that will empower her as she begins to navigate the interoceptive (or the direct felt experiencing of viscera, joints and muscles) landscape of trauma and healing. These skills lead to a core innate transformative process: pendulation.

You will probably notice that the vase and face alternate but cannot be perceived at the same time. This is a useful concept in understanding how fear is uncoupled from immobility. When one experiences pure immobility, one cannot (like vase and face) also feel fear at the same time. This facilitates expansion and the gradual discharge of activation

While trauma is about being frozen or stuck, pendulation is about the innate organismic rhythm of contraction and expansion. It is, in other words, about getting unstuck by knowing (sensing from the inside), perhaps for the first time, that no matter how horrible one is feeling, those feelings can and will change.

Confidence builds with the skill of pendulation. One surprisingly effective strategy in dealing with difficult sensations involves helping a person find an “opposite” sensation: one located in a particular area of the body, in a particular posture, or in a small movement; or one that is associated with the person’s feeling less frozen, less helpless, more powerful and/or more fluid.

Pendulation carries all living creatures through difficult sensations and emotions. What’s more, it requires no effort; it is wholly innate.

At the same time, too rapid or large a magnitude of expansion can be frightening, causing a client to contract precipitously against the expansion.

When this natural resilience process has been shut down, it must be gently and gradually awakened. The mechanisms that regulate a person’s mood, vitality and health are dependent upon pendulation.

It can be said that the experience of fear derives from the primitive responses to threat where escape is thwarted (i.e., in some way—actual or perceived—prevented or conflicted).54 Contrary to what you might expect, when one’s primary responses of fight-or-flight (or other protective actions) are executed freely, one does not necessarily experience fear, but rather the pure and powerful, primary sensations of fighting or fleeing.

Step by step, our bodies learned that we were not helpless victims, that we had survived our ordeals, and that we were intact and alive to the core of our beings. Along with instilling active defensive responses (which reduces fear), individuals learn that when they experience the physical sensations of paralysis, it is with less and less fear—each time trauma loosens its grip. With such a body-based epiphany, the mind’s interpretation of what happened and the meaning of it to one’s life and who one is shifts profoundly.

My clinical observations, drawn from more than four decades of work with thousands of clients, have led me to the solid understanding that the “physio-logical” ability to go into, and then come out of, the innate (hard-wired) immobility response is the key both to avoiding the prolonged debilitating effects of trauma and to healing even entrenched symptoms.55 Basically, this is done by separating fear and helplessness from the (normally time-limited) biological immobility response as described in Chapter 4. For a traumatized individual, to be able to touch into his or her immobility sensations, even for a brief moment, restores self-paced termination and allows the “unwinding” of fear and freeze to begin.

Of equal importance in resolving trauma is therapeutic restraint in not allowing the unwinding to occur precipitously. As with the nontitrated chemical reaction, abrupt decoupling can be explosive, frightening and potentially retraumatizing to the client. Through titration, the client is gradually led into and out of the immobility sensations many times, each time returning to a calming equilibrium (the “Alka-Seltzer fizzle”). In exiting from immobility, there is an “initiation by fire”; the intense energy-packed sensations that are biologically coupled with undirected flight and rage-counterattack are released. Understandably, people commonly fear both entering and exiting immobility, especially when they are not aware of the benefit of doing so. Let us look more deeply into these fears.

Those few fortunate ones who can crawl into a warm bed, lie absolutely still, and drift quickly off into a restorative sleep are bestowed a most precious blessing. However, for many (perhaps even a majority), bedtime is often fraught with anxiety. It can become a nightmare in itself. In frustration, you may try to lie still while “counting sheep.” Mind spinning, you are unable to let go and surrender into Morpheus’s waiting arms. And then when some people awaken during (or shortly after) REM sleep, their bodies are still literally paralyzed by the neurological mechanisms designed to inhibit running or fighting (or even actively moving) in a dream for self-protection and prevention against hurting someone else. Waking up from this normal “sleep paralysis” can be terrifying, particularly when people experience themselves detaching from their bodies, a frequent component of immobility.

Although avoidance of immobility is understandable, it has a price. Whatever experiences you turn away from, your brain-body registers as dangerous; or colloquially, “that which we resist persists.” Thus, the time-honored expression, “time heals all wounds,” simply does not apply to trauma.

The fear of rage is also the fear of violence—both toward others and against oneself. The exiting of immobility is inhibited by the following double bind: to come back to life, one must feel the sensations of rage and intense energy. However, at the same time, these sensations evoke the possibility of mortal harm. This possibility inhibits sustained contact with the very sensations that bring relief from the experience of immobility, thereby leading to resolution.

Because the rage associated with the termination of immobility is both intense and potentially violent, frequently traumatized people inadvertently turn this rage against themselves in the form of depression, self-hatred and self-harm. The inability to exit from the immobility response generates unbearable frustration, shame and corrosive self-hatred. The therapist must approach this Gordian knot carefully and untangle it through deliberate and careful titration, along with reliance on the experience of pendulation and a resolve to befriend intense aggressive sensations.

It is no surprise, then, that traumatized individuals constrict and brace against their rage as socialized animals. But let us look at the cumulative consequence of suppressing rage. Tremendous amounts of energy need to be exerted (on an already strained system) to keep rage and other primitive emotions at bay. This “turning in” of anger against the self, and the need to defend against its eruption, leads to debilitating shame, as well as to eventual exhaustion.

In the case of molestation and other forms of previous abuse, a substratum of self-reproach has already been laid beneath a later trauma during adulthood. Indeed, because immobility is experienced as a passive response, many molestation and rape victims feel tremendous shame for not having successfully fought their attackers. This perception and the overwhelming sense of defeat can occur regardless of the reality of the situation: the relative size of the attacker doesn’t matter; nor does the fact that the immobility might have even protected the victim from further harm or possibly death.† And I haven’t even included here the additional blanket of confusion and shame that occurs within the complex dynamics of secrecy and betrayal in the incestuous family. As traumatized individuals begin to reown their sense of agency and power, they gradually come to a place of self-forgiveness and self-acceptance. They achieve the compassionate realization that both their immobility and their rage are a biologically driven, instinctual imperative and not something to be ashamed of as if it were a character defect.

Because of its profound importance in the resolution of trauma, I’ll repeat myself: the fear that fuels immobility can be categorized, broadly, as two separate fears: the fear of entering immobility, which is the fear of paralysis, entrapment, helplessness and death; and the fear of exiting immobility, of the intense energy of the “rage-based” sensations of counterattack.

when the skillful therapist assists clients in uncoupling the fear from the immobility by restoring “self-paced termination of immobility,” the rich reward is the client’s capability to move forward in time.

As fear uncouples from the immobilization sensations, you may scratch your head and ask, where does the fear go? The short and confounding answer is that when titrated, “fear” simply does not really exist as an independent entity. The actual acute fear that occurred at the time of the traumatic event, of course, no longer exists. What happens, however, is that one provokes and perpetuates a new fear state (one literally frightens oneself) and becomes one’s own self-imposed predator by bracing against the residual sensations of immobility and rage. While paralysis itself need not actually be terrifying, what is frightening is our resistance to feeling paralyzed or enraged.

individuals may even experience blissful states similar to those reported in studies about near-death experiences. In exiting immobility, people may report that they feel “tingling vibrations all over my body” or “I feel deeply alive and real.” As

the innate response of paralysis naturally resolves, sensations of “pure energy” are accepted; the individual opens into a mother lode of existential relief, transformative gratitude and vital aliveness.

Step 7. Resolve arousal states by promoting discharge of the vast survival energy mobilized for life-preserving action As one’s passive responses are replaced by active ones in the exit from immobility, a particular physiological process occurs: one experiences waves of involuntary shaking and trembling, followed by spontaneous changes in breathing—from tight and shallow to deep and relaxed. These involuntary reactions function, essentially, to discharge the vast energy that, though mobilized to prepare the organism to fight, flee or otherwise self-protect, was not fully executed.

an amount of energy (arousal) similar to what was mobilized for fight-or-flight must be discharged, through effective action and/or through shaking and trembling.

A direct consequence of discharge of the survival energy mobilized for fight-or-flight is the restoration of equilibrium and balance (as in the previous example of the spring). The nineteenth-century French physiologist Claude Bernard, considered the father of experimental physiology, coined the term homeostasis to describe “the constancy of the internal environment [milieu intérieur] as the condition for a free and independent life.”57 More than a hundred and fifty years later, this remains the underlying and defining principle for the sustenance of life. However, since equilibrium is not a static process, I will use the term dynamic equilibrium instead of homeostasis to describe what happens when the nervous system becomes hyperaroused in response to threat and is then “reset,” only to be aroused and reset once again. This continual resetting both restores the prethreat level of arousal and promotes the shifting state (process) of relaxed alertness. Over time this contributes to the building of a robust resilience. Finally, the interoceptive experience of equilibrium, felt in viscera and in your internal milieu, is the salubrious one of goodness: that is, the background sense that—whatever you are feeling at a given moment, however dreadful the upset or unpleasant the arousal—you have a secure home base within your organism.

Trauma could appropriately be called a disorder in one’s capacity to be grounded in present time and to engage, appropriately, with other human beings. Along with the restoration of dynamic equilibrium, the capacity for presence, for being in “the here and now,” becomes a reality. This occurs along with the desire and capacity for embodied social engagement.

The social engagement branch of the nervous system is probably both cardioprotective and immuno-protective. This may be why individuals with strong personal affiliations live longer, healthier lives. They also maintain sharper cognitive skills into old age. Indeed, one study examining the effects of playing bridge in reducing dementia symptoms concluded that the main independent variable was socialization (rather than computational skills per se).‡