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

by Peter A. Levine

Porges’s theory states that, in humans, three basic neural energy subsystems underpin the overall state of the nervous system and correlative behaviors and emotions. The most primitive of these three (spanning about 500 million years) stems from its origin in early

fish species.† The function of this primitive system is immobilization, metabolic conservation, and shutdown. Its target of action is the internal organs. Next in evolutionary development is the sympathetic nervous system. This global arousal system has evolved from the reptilian period about 300 million years ago. Its function is mobilization and enhanced action (as in fight or flight); its target in the body is the limbs. Finally, the third, and phylogenetically most recent, system (deriving from about 80 million years ago) exists only in mammals. This neural subsystem shows its greatest refinement in the primates, where it mediates complex social and attachment behaviors. It is the branch of the parasympathetic nervous system that regulates the so-called mammalian or “smart” vagus nerve, which is neuroanatomically linked to the cranial nerves that mediate facial expression and vocalization. This most recently acquired system animates the unconsciously mediated muscles in throat, face, middle ear, heart and lungs, which together communicate our emotions, both to others and to ourselves.

Nervous systems are tuned to assess potential risk in the environment—an unconscious evaluative process that Porges calls “neuroception.”‡ If one perceives the environment to be safe, one’s social engagement system inhibits the more primitive limbic and brain stem structures that control fight or flight.

Immobility and hyperarousal are, as I have explained, organismic responses to threat and prolonged stress. When they are operative, danger (in the case of fight or flight) and doom (with immobility) are what an individual perceives—regardless of the reality of the external situation.

Highly traumatized and chronically neglected or abused individuals are dominated by the immobilization/shutdown system. On the other hand, acutely traumatized people (often by a single recent event and without a history of repeated trauma, neglect or abuse) are generally dominated by the sympathetic fight/flight system. They tend to suffer from flashbacks and racing hearts, while the chronically traumatized individuals generally show no change or even a decrease in heart rate. These sufferers tend to be plagued with dissociative symptoms, including frequent spacyness, unreality, depersonalization, and various somatic and health complaints. Somatic symptoms include gastrointestinal problems, migraines, some forms of asthma, persistent pain, chronic fatigue, and general disengagement from life.

The insula and the cingulate are the parts of the brain that receive sensory information from receptors inside the body (interoception) and form the basis of what we feel and know as our very identity.

I found that many (perhaps even a majority of) persons exhibit some symptoms of both systems.

Therapists are rarely trained to make such observations (though they can get a little coaching from watching episodes of the TV series Lie to Me).

This last-ditch immobilization system is meant to function acutely and only for brief periods. When chronically activated, humans become trapped in the gray limbo of nonexistence, where one is neither really living nor actually dying. A therapist’s first job in reaching such shut-down clients is to help them mobilize their energy: to help them, first, to become aware of their physiological paralysis and shutdown in a way that normalizes it, and to shift toward (sympathetic) mobilization. The next step is to gently guide a client through the sudden defensive/self-protective activation that underlies the sympathetic state and back to equilibrium, to the here-and-now and a reengagement in life.

When one is able to ride the sometimes bucking bronco of one’s arousal sensations through, and begin to befriend them in a slow and

steady way, one is gradually able to discharge the energy that had been channeled into hyperarousal symptoms.

Many traumatized individuals, and especially those who have been chronically traumatized, live in a world with little or no emotional support, making them even more vulnerable. After a devastating event—be it violence, rape, surgery, war or an automobile accident—or in the aftermath of a childhood of protracted neglect and abuse, traumatized

individuals, even those who share a residence with a friend, family member or intimate partner, tend to isolate themselves. Alternatively, they cling desperately to other people in the hope that they will somehow help and protect them. Either way, they are bereft of the real intimacy—the salubrious climate of belonging—that we all crave and need in order to thrive. Traumatized individuals are, at the same time, terrified of intimacy and shun it.

When their loneliness becomes too stark, traumatically disconnected individuals may seek increasingly more unrealistic (and sometimes dangerous) “hook-ups.” They see each new relationship possibility (or impossibility) as providing the caring protection that will calm their inner anxieties and buoy up their fragile sense of self. Having had a neglectful or abusive childhood predisposes them to chaotic relationships. These individuals continue to look for love “in all the wrong places”—a folly the song reminds us of. Even when one’s idealized (fantasy) rescuers become abusive, one seems oblivious to the early signs of that abuse and becomes increasingly ensnared in a damaging liaison precisely because it is so familiar or “like family.”

what often happens is that a client’s dependency upon the therapist escalates and gets entirely out of hand–as shown so conspicuously in the gem of a film What About Bob? (1991).

Traumatized individuals are not made whole through the therapeutic relationship alone. Even with the best of intentions, and highly developed empathic skills, a therapist often misses the mark here. The polyvagal theory and the Jacksonian principle of dissolution help us to understand why and how this happens.70 When the traumatized person is locked in either the immobilization response or the sympathetic arousal system, the social engagement function is physiologically compromised; the former, in particular, both inhibits sympathetic arousal and can almost completely suppress the social engagement system.

According to the polyvagal theory, being in shutdown (immobility/freezing/or collapse) or in sympathetic/hyperactivation (fight or flight) greatly diminishes a person’s capacity to receive and incorporate empathy and support. The facility for safety and goodness is nowhere to be found. To the degree that traumatized people are dominated by shutdown (the immobility system), they are physiologically unavailable for face-to-face contact and the calming sharing of feelings and attachment. And while immobilization is rarely complete (as it is, for example, in catatonic schizophrenia), its ability to suppress life and one’s capacity for social engagement is extreme.

It is not surprising that, try as they may,

many traumatized clients are little able to receive support and caring from their well-intentioned therapists—not because they don’t want to, but because they are stuck in the primitive root of immobility with its greatly reduced capability for reading faces, bodies and emotions; they become cut off from the human race.

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 systems (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.

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 insulaj is strongly inhibited during shutdown and dissociation, and it confirmed that these traumatized individuals are unable to feel their bodies, to differentiate their emotions, or even to know who they (or another person) really are.72 On the other hand, when subjects are in a state of sympathetic hyperarousal, 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.

A related, and seminal, research study was carried out by Bessel van der Kolk.73 He and his colleagues read a traumatic story to a

group of clients and compared two brain regions in each (measured with fMRI). 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 latter is the primary language center—the part of the brain that takes what we are feeling and expresses it with words. That trauma is about wordless terror is also demonstrated in these brain scans. Frequently when traumatized people try to put their feelings into words—as when, for example, one is asked by the therapist to tell about his or her rape—they speak about it as though it had happened to someone else (see the story of Sharon in Chapter 8). Or clients try to speak of their horror, then become frustrated and flooded, incurring more shutdown in Broca’s area, and thus enter into a retraumatizing feedback loop of frustration, shutdown and dissociation. This language barrier in traumatized 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 debilitat...

Whatever increases, decreases, limits or extends the body’s power of action, increases, decreases, limits or extends the mind’s power of action. And whatever increases, decreases, limits or extends the mind’s power of action, also increases, decreases, limits or extends the body’s power of action. —Spinoza (1632–1677), Ethics

The following somatically based awareness exercises begin this process by helping individuals move out of shutdown and dissociation. The first is a simple exercise that clients can do by themselves to help enliven their body-sense and minimize shutdown, dissociation and collapse.

This exercise, and those that follow, are meant to be done regularly, over time, for maximum benefit—and therapists should practice the exercises themselves.

For ten minutes or so (a few times a week), take a gentle, pulsating shower in the following way: at a comfortable temperature, expose your body to the pulsing water. Direct your awareness into the region of your body where the rhythmical stimulation is focused. Let your consciousness move to each part of your body. For example, hold the backs of your hands to the shower head, then the palms and wrists, then your head, shoulders, underarms, both sides of your neck, etc. Try to include each part of your body, and pay attention to the sensation in each area, even if it feels blank, numb, or uncomfortable. While you are doing this, say, “This is my arm, head, neck,” etc. “I welcome you back.” You can also do this exercise by gently tapping those same parts of your body with your fingertips. When done regularly over time, this and the following exercises will help reestablish awareness of your body boundary through awakening skin sensations.

A sequel to this shower exercise involves bringing boundary awareness into the muscles. You start by using a hand to grasp and gently squeeze the opposite forearm; then you squeeze the upper arm, the shoulders, neck, thighs, calves, feet, etc. The important element is to be mindful of how your muscles feel from the inside as they are being squeezed. You can begin to recognize the rigidity or flaccidity of the tissue as well as its general quality of aliveness. Generally, tight, constricted muscles are associated with the alarm and hypervigilence of the sympathetic arousal system. Flaccid muscles, on the other hand, belie how the body col...

These two exercises are best done regularly, several times per week. As body consciousness grows, so, too, will a more palpable sense of boundary awareness, as well as greater aliveness.

Most psychotherapists work with clients when both are sitting in chairs. Since sitting requires little proprioceptive and kinesthetic information to maintain an erect posture, the body easily becomes absent, disappearing from its owner.

In contrast, a standing position requires one to engage in at least a modicum of interoceptive activity and awareness to maintain one’s balance via proprioceptive and kinesthetic integration. Often, this simple change in stance can make the difference between whether or not a client is able to stay present in the body while processing difficult sensations and feelings.

The following is another technique to help clients remain conscious of their bodily sensations while at the same time learning how to manage assertion and aggression.

This type of movement requires a fairly sophisticated proprioceptive ability (joint position) and sense of muscle tension (kinesthesia).

The next progression of this exercise involves more of a give and take between the therapist and the client, each of you alternately pushing and receiving the movement.

When one’s body is able to experience a relaxed sense of strength, one’s mind is able to experience a relaxed sense of focused alertness.

The next somatic tool is designed to help posttraumatic stress disorder survivors learn that even when they feel paralyzed, there is a latent active respo...

embedded within the lining of the gastrointestinal wall itself there is a massive plexus of nerves. This complex network of sensory, motor and interneurons (those nerve cells that connect between the sensory and motor neurons) integrates the digestive and eliminative organs so that they function coherently.m This intricate system has about the same number of neurons and white matter as does a cat’s brain. Because of this complexity, it has sometimes been called the second or enteric brain; the other three are the reptilian (instinctual), the paleomammalian (limbic/emotional) and the primate (enlarged, rational) neocortex. The enteric nervous system is our oldest brain, evolving hundreds of millions of years ago. It produces many beneficial hormones, including 95% of the serotonin in the body,n and thus is a primary natural medicine factory and warehouse for feel-good hormones.76 Amazingly, as much as 90% of the vagus nerve that connects our guts and brains is sensory! In other words, for every one motor nerve fibero that relays commands from the brain to the gut, nine sensory nerves send information about the state of the viscera to the brain. The sensory fibers in the vagus nerve pick up the complex telecommunications going on in the gut and relay them, first up to the (mid) brain stem and then to the thalamus. From there, these signals virtually influence the entire brain, and subliminal “decisions” are made that profoundly influence our actions. Many of our likes and di...

When aroused to fight or flight (sympathetic arousal), our guts tighten, and the motility of the gastrointestinal system is inhibited. After all, there is no sense in spending a lot of metabolic energy on digestion when it is best used to speed up the heart’s rhythm and to strengthen its contraction, as well as to tense our muscles in readiness for impending action.

The activation of these two systems is meant to be brief in response to acute emergency. When they become stuck (in either sympathetic overdrive or vagal overactivity), the survival function is drastically subverted: one may end up suffering from a painfully knotted gut, as in the case of persistent sympathetic hyperarousal, or be tormented by spasms of twisting cramps and disruptive diarrhea in chronic vagal hyperactivity.r

Our nervous system assesses threat in two basic ways. First of all, we use our external sense organs to discern and evaluate threat from salient features in the environment. So, for example, a sudden shadow alerts one to a potential risk, while the large looming contours of a bear or the sleek, crouching silhouette of a mountain lion let one know that one is in grave danger. We also assess threat directly from the state of our viscera and our muscles—our internal sense organs. If our muscles are tense, we unconsciously interpret these tensions as foretelling the existence of danger, even when none actually exists.

We suffer even greater distress when our guts are persistently overstimulated by the vagus nerve. If we are nauseated, twisted in our guts, feel our muscles collapsing, and lack in energy, we feel helpless and hopeless—even though there is no actual decimating threat.

Our muscular and visceral states color both our perceptions and our evaluation of the intentions of others. While we may believe that certain individuals will do us no harm, we still feel endangered.s

The intense visceral reactions associated with threat are meant to be acute and temporary. Once the danger has passed, these reactions (be it inhibition of gastric motility by the sympathetic nervous system or violent overstimulation of motility by the primitive vagus nerve) need to cease in order to return the organism to equilibrium, fresh and flowing in the here and now. When balance is not restored, one is left in acute and, eventually, chronic distress. In order to prevent trauma as well as to reverse it when it has already occurred, individuals must become aware of their visceral sensations.t

As we can learn from traditional, shamanic and spiritual practices, embraced for thousands of years throughout the world, feelings of goodness are embodied directly as visceral sensations. When we ignore our “gut instincts,” it is at our own great expense, if not peril. In states of immobilization and shutdown, the sensations in our guts are so dreadful that we routinely block them from consciousness.

Along with multitudes of other people, I have experienced various chanting and ancient “sounding” practices that facilitate healing and help open the “doors of perception.” Singing and chanting are used in religious and spiritual ceremonies among every culture for “lightening the load” of earthly existence. When you open up to chant or sing in deep, resonant lower belly tones, you also open up your chest (heart and lungs), mouth and throat, pleasurably stimulating the many serpentine branches of the vagus nerve.u Certain Tibetan chants have been used successfully for thousands of years. In my practice, I use a sound borrowed (with certain modifications) from some of these chants. This sound opens, expands and vibrates the viscera in a way that provides new signals to a shut-down or overstimulated nervous system. The practice is quite simple: make an extended “voooo …” (soft o, like ou in you) sound, focusing on the vibrations stimulated in the belly as you complete a full expiration of breath. In introducing the “voo” sound to my clients, I often ask them to imagine a foghorn in a foggy bay sounding through the murk to alert ship captains that they are nearing land, and to guide them safely home. This image works on different levels. First of all, the image of the fog represents the fog of numbness and dissociation. The foghorn represents the beacon that guides the lost boat (soul) back to safe harbor, to home in breath and belly. This image also inspires the client to tak...

carbon dioxide.

Begin the exercise by finding a comfortable place to sit. Then slowly inhale, pause momentarily, and then, on the out breath, gently utter “voo,” sustaining the sound throughout the entire exhalation. Vibrate the sound as though it were coming from your belly. At the end of the breath, pause briefly and allow the next breath to slowly fill your belly and chest. When the in breath feels complete, pause, and again make the “voo” sound on the exhalation until it feels complete. It is important to let sound and breath expire fully, and then to pause and wait for the next breath to enter (be taken) on its own, when it is ready. Repeat this exercise several times and then rest. Next, focus your attention on your body, primarily on your abdomen, the internal cavity that holds your organs.

Another exercise can provide clients with a way to manage and regulate distressing arousal symptoms. This “self-help” technique is taken from a system of “energy flows” called Jin Shin Jyutsu.w

In 1932 Sir Charles Sherrington received the Nobel Prize in Physiology or Medicine for showing that the nervous system is made up of a combination of excitatory and inhibitory nerve cells. It is the balance of these two neural systems that allows us to move our limbs in a smooth, coordinated, accurate way. Without inhibition, our movements would be wildly spastic and uncoordinated. While Sherrington’s work was primarily on the sensory/motor system (at the level of the spinal cord), the balancing of excitatory systems by inhibitory ones occurs throughout the nervous system and is considered a fundamental principle of it.