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

by Peter A. Levine

In distress and trauma, I believe that a positive feedback loop, with extremely negative consequences, is set up. Indeed, most of us recognize that primal negative emotions readily turn into self-reinforcing, runaway positive feedback loops. Fear and anger can readily explode into terror and rage.

In the reciprocal enervation discovered by Sherrington, the nervous system operates primarily as a negative feedback system much like—but infinitely more complicated than—a house thermostat. Self-regulation of the complex nervous system exhibits what are called emergent properties, which are often somewhat unpredictable and rich in nuance. They frequently lead to finding new and creative solutions and are cherished when they happen in life and in psychotherapy.

Turning earlier theories on their heads, we are now aware that, rather than being the hierarchical, top-dog commander in chief, our thoughts are a complex elaboration of what we do and how we feel. Thought can indeed be said to function as an “explanation” to ourselves: a reminder of what we are doing and feeling. Thinking and symbolizing help us to make categories of events, people or locations, such as “safe” and “dangerous.”

As hunters and gatherers, survival meant being fully in our bodies just like the babies. Excessive mental rumination would have surely meant sudden death or slow starvation.

Having an intimate relationship with, and understanding of, your physical sensations is critical because they, in signaling action, guide you through the experiences and nuances of your life. If one has been traumatized, however, one’s sensations can become signals not for effective action but, rather, for fearful paralysis, helplessness or misdirected rage.

While attempting to shut down distressing sensations, one pays the price of losing the capacity to appreciate the subtle physical shifts that denote comfort, satisfaction or warning of clear and present danger. Sadly, as a result, the capacity for feeling pleasure, garnering relevant meaning and accessing self-protective reflexes also shuts down. You can’t have it both ways; when feelings of dread are held at bay, so are the feelings of joy.

The body/mind keeps flowing through new encounters with vitality, bouncing back into the stream of things unless there is a significant disruption. In this case, the person is knocked off that normal course—whether it is from a single episode, such as a disaster, an accident, surgery or rape, or from a chronic stressor, such as abuse or ongoing marital stress. When such disruptions fail to be fully integrated, the components of that experience become fragmented into isolated sensations, images and emotions. This kind of splitting apart occurs when the enormity, intensity, suddenness or duration of what happened cannot be defended against, coped with or digested. Personal vulnerability, such as age, genetics and gender also account for this psychic implosion. The result of this inability for the body/mind to integrate is trauma, or at the very minimum, disorientation, a loss of agency and/or a lack of direction. Trapped between feeling too much (overwhelmed or flooded) or feeling too little (shut down and numb) and unable to trust their sensations, traumatized people can lose their way. They don’t “feel like themselves” anymore; loss of sensation equals a loss of a sense of self. As a substitute for genuine feelings, trauma sufferers may seek experiences that keep them out of touch—such as sexual titillation or succumbing to compulsions, addictions and miscellaneous distractions that prevent one from facing a now dark and threatening inner life.

Helping clients cultivate and regulate the capacity for tolerating extreme sensations, through reflective self-awareness, while supporting self-acceptance, allows them to modulate their uncomfortable sensations and feelings.

I believe that the people who are most resilient, and find the greatest peace in their lives, have learned to tolerate extreme sensations while gaining the capacity for reflective self-awareness.

After being traumatized, a child’s relationship with his or her body often becomes formless, chaotic and overwhelming; the child loses a sense of his internal structure and nuance. As the body freezes, the “shocked” mind and brain become stifled, disorganized and fragmented; they cannot take in the totality of experience and learn from it. These children, who have become “stuck” at some point along a once meaningful and purposeful course of action, engage in habitually ineffective and often compulsive patterns of behavior. These often play out in symptoms like those of attention deficit hyperactivity disorder or obsessive-compulsive disorder. The child’s uncoordinated fragmented efforts are not registered as normal, explicit, narrative memories but rather are encoded in the body as implicit, procedural memories including discomfort, constriction, distress, awkwardness, rigidity, flaccidity and lack of energy. Such memories are encoded not primarily in the neocortex but, instead, in the limbic system and brain stem. For this reason behaviors and memories cannot be changed by simply changing one’s thoughts. One must also work with sensation and feeling—really with the totality of experience.

Together, these two tools—somatic resonance and subtle observation—are of incalculable power and benefit. In the words of the analyst Leston Havens, “Perhaps the most striking evidence of successful empathy is the occurrence in our bodies of sensations that the patient has described in his or hers.”87 During the 1970s, I developed a model that allowed me to “track” the processes whereby my clients processed experiences. This model, which I call SIBAM, is based on the intimate relationship between our bodies and our minds. The model examines the following five channels, with the first letters of each element making up the acronym. Sensation Image Behavior Affect Meaning

my five-element model is the essence of “bottom-up,” sensorimotor processing aimed at guiding the client through different “language” and brain systems, from the most primitive to the most complex; from physical sensations to feelings, perceptions and, finally, to thoughts. Sensation, Image, Affect and Meaning are tracked by the client, while Behavior is directly observed by the therapist.

The Sensation Channel In this channel, I refer to physical sensations that arise from within the body, from receptors lying in the interior of our organisms. These sensations are also known in the literature as interoceptive. They ascend via nerve impulses from the interior of the body to the thalamus in the upper brain stem, where they are transferred to many, if not most, regions of the brain. Four subsystems, or categories, make up the sensation channel in order of increasing depth: the kinesthetic, the proprioceptive, the vestibular and the visceral receptors.

The Kinesthetic Receptors The first subsystem within the sensation channel is kinesthesia. The kinesthetic sense signals the state of tension of our muscles† and relays this information to the brain. When you feel “uptight,” it is because you are receiving excess nerve impulses coming from muscles in your shoulders and other areas—such as neck, jaw or pelvis—as well as from an overactive mind.

The Proprioceptive Receptors The second subsystem, called proprioception, gives us positional information about our joints. Together, kinesthesia and proprioception tell us where we are ...

The Vestibular Receptors The vestibular subsystem derives from microscopic hairs embedded within the semicircular canals of the inner ear. There are two of these canals positioned at right angles to each other. When we move (accelerate and decelerate in any direction), fluid in these canals “sloshes” over the hairs, bending them. Each hair is connected to a receptor, and these receptors then send afferent impulses to the brain stem. Information from this sense lets us know our position with respect both to gravity and to any change in velocity (i.e., acceleration and deceleration).

The Visceral Receptors The fourth subsystem, which provides the deepest level of interoception, derives from our viscera and blood vessels. In Chapter 6 I described the vagus nerve, which connects the brain stem to most of our internal organs. This massive nerve is second only to the spinal cord in total number of neurons. Over 90% of these nerve fibers are afferent: that is, the vagus nerve’s main function is to relay information from our guts upward to our brains.

Visceral sensations also originate from receptors in the blood vessels—as sufferers from migraines know all too well, the abrupt dilation of blood vessels (after strong constriction) causing their excruciating pain. However, we are also receiving all sorts of other ambient information from our blood vessels. We feel relaxed and open when our blood vessels and viscera gently pulse like jellyfish, causing sensations of warmth and goodness to surge through our bodies. When the vessels and viscera are constricted, we feel cold and anxious.

The Image Channel While image commonly refers to visual representation, I use it more generally to refer to all types of external sense impressions, which originally come from stimuli that arise from outside the body and that we have also incorporated into the brain as sense memory. These external (“special”) senses include sight, taste, smell, hearing and the tactile sense.‡ Counter to common parlance, I use the same word—Image—to categorize all of these external senses. Indeed, the I in the SIBAM model could refer, equally, to any of the externally generated Impressions (i.e., visual, auditory, tactile, olfactory, etc.).

So if we have been touched inappropriately, it will be necessary to separate the actual tactile impression from our internal response to this stimulus in each new situation in order to free ourselves from reflexively reacting from past experience. The visual impression, or Image, is the primary way modern humans access and store external sense information, unless they are visually impaired. The largest portion of our sensory brain is dedicated to vision.

At the moment a trauma takes place, all of a person’s senses automatically focus on the most salient aspect of the threat. This is usually a visual image, though it could also be sound, touch, taste or smell. Many times it is a combination of several or, even, all of the above sense impressions simultaneously. For example, a woman molested by an alcoholic uncle may panic on seeing a man who looks vaguely like him or whose breath smells of alcohol and who walks with a loud, lumbering gait. These fragmentary snapshots come to represent the trauma. They become, in other words, the intrusive image or Imprint.

When reworking such embedded sensory images, a process of diffusing the adrenalin charge of the compressed “trauma snapshot” is necessary in order to uncouple associations that are symptomatic. An important therapeutic technique “expands and neutralizes” this fixation and helps the person recover the multisensory experience he or she may have had prior to the threat that caused the fragmentation. The following vignette illustrates this principle of expanding the “visual aperture.”

The Behavior Channel Behavior is the only channel that the therapist is able to observe directly; all others are reported by the client. Although the therapist is able to surmise much about a client’s inner life from a resonance with her own sensations and feelings, such inferences cannot take the place of the client also accessing and communicating his own sensations, feelings and images to the therapist.§

Behavior occurs on different levels of awareness, ranging from the most conscious voluntary movements to the most unconscious involuntary patterns.

The most conscious behaviors are the voluntary ones: that is, the overt gestures that people generally make with their hands and arms when they are trying to communicate. These movements are the most superficial level of behavior. People frequently use voluntary gestures to convey “pseudo-feeling” states to others.

Facial expressions are at the next level of behavior and are generally considered to be largely involuntary.

Giving clients feedback about their facial expressions can help them contact emotions of which they may be partially or fully unaware.

The third level of less conscious awareness in the behavior category is posture.

Sir Charles Sherrington, the grandfather of modern neurophysiology, alleges that “much of the reflex reaction expressed by the skeletal musculature is not motile, but postural, and has as its result not a movement but the steady maintenance of an attitude.”89 I would add that postures are the platforms from which intrinsic movement is initiated. In the words of A. E. Gisell, a student of Sherrington’s, “the requisite motor equipment for behavior is established well in advance of the behavior itself.” In underscoring how important posture is in the generation of new behaviors, sensations, feelings and meanings, Gisell added, “The embryogenesis of mind must be sought in the beginnings of postural behavior.”90

We all subconsciously mirror the postures of others and register them as sensations in our own bodies. This occurs presumably through the operation of mirror neurons and postural resonance. Since spontaneous postural changes are generally subtle, it takes a lot of practice to observe them.

Autonomic Signals (Cardiovascular and Respiratory) Visible autonomic behaviors include respiratory and cardiovascular signposts. Breathing that is rapid, shallow and/or high in the chest indicates sympathetic arousal. Breathing that is very shallow (almost imperceptible) frequently indicates immobility, shutdown and dissociation. Breathing that is full and free with a complete expiration, and a delicate pause before the next inhalation, indicates relaxation and settling into equilibrium.

Next are signs from the cardiovascular system, which include heart rate and the tone of the smooth muscles lining certain blood vessels. Heart rate can, as I have said, be monitored by observing the carotid pulse, which is visible as a pulsation in the neck.

The therapist can identify the tonus of the blood vessels by noting alterations in skin color, although doing so requires a refined level of perception.

The next observation point is pupil size. A very wide pupil is associated with high sympathetic arousal, while a very small pupil can be indicative of immobility and dissociation.

Visceral behavior refers to the motility of the gastrointestinal tract, whose movements can actually be “observed” by the sounds that it makes. The wonderful onomatopoetic word for these intestinal rumblings and gurglings is borborygmus (plural: borborygmi). An entire system of body-therapy is based upon listening to a spectrum of these gut sounds with an electronic (fetal) stethoscope while different parts of the body are touched and gently manipulated.94

cold hands generally indicate fear and stress; while warm ones signify relaxation. Flushed skin can reflect emotions like rage, shame and embarrassment. What is not widely known is that flushed skin can also be the sign of a strong release of energy and a movement toward greater aliveness.

The Affect Channel The two subtypes in the fourth channel are the categorical emotions and the felt sense, or contours of sensation-based feeling.

Emotions include the categorical ones described by Darwin and refined in extensive laboratory studies by Paul Ekman. These distinct emotions include fear, anger, sadness, joy and disgust.

Another level of affect—the registration of contours of feeling—is, perhaps, even more important to the quality and conduct of our lives than are the categorical emotions. Eugene Gendlin extensively studied and described these softer affects and coined the term felt sense.95 When you see dew on a blade of grass in the morning light or visit a museum and delight in a beautiful painting, you’re usually not experiencing a categorical emotion. Or when meeting a good friend you haven’t seen for months, you’re probably not feeling fear, sorrow, disgust or even joy. Contours are the sensation-based feelings of attraction and avoidance, of “goodness” and “badness.” You experience these nuances countless times throughout the day. While it’s easy to imagine a day without perceiving any of the categorical emotions, try for a moment to conjure up a day without any felt sense affects. On such a day you would be as lost as a ship at sea with no rudder or bearings. These contours guide us throughout the day, giving us orientation and direction in life.

Meanings are the labels we attach to the totality of experience—that is, to the combined elements of sensation, image, behavior and affect.

Later in life, rather than a client freely accessing the full spectrum of developing sensations and feelings, conclusions are drawn based on meanings born out of past trauma or early conditioning. I have called this kind of limiting prejudgment premature cognition.

Using the SIBAM model, the therapist can help the client work through the first four channels of awareness in order to reach new meanings. When cognition is suspended long enough, it is possible to move through and experience flow via these different channels (and subsystems) of Sensation, Image, Behavior and Affect. Then it is probable for fresh new Meanings to emerge out of this unfolding tapestry of body/mind consciousness. As an example, a client may start with specific fixed beliefs such as “my spouse is not behaving properly” or “I am unlovable.” The therapist, rather than trying to talk them out of the belief, may instead encourage the client to examine the physical loci of these thoughts, to notice which areas are tense, which are open and spacious, and to locate any feelings of collapse. More importantly, perhaps, clients are also asked to note a vacancy of feeling. A common example (especially in clients who have had sexual trauma) is the sense that one cannot feel one’s pelvis at all, or that it is disconnected from one’s torso or legs. A client asked to scan his body from head to toe might convey an uncanny absence of pelvic sensations. Of course, such an absence gives the therapist an idea of what the client is avoiding.

To acquire knowledge, one must study; but to acquire wisdom, one must observe. —Marilyn vos Savant

The therapist who is familiar with bodily feelings has a privileged window onto the primal life of the psyche and soul. No amount of talk alone can match this vantage point. Long before the advent of psychiatry, the French philosopher Pascal noted that “the body has its reasons that reason can not reason.” The Austrian Wittgenstein, in this same tradition, wrote that “the body is the best picture of the mind.” And the Australian F. M. Alexander, around the turn of the nineteenth century, made an extensive study of peoples’ postures and concluded, “When psychologists speak of the unconscious, it is the body that they are talking about.”

Somatically oriented therapists provide their clients with carefully paced feedback in the form of invitations to explore their emerging bodily sensations. This feedback is based largely on the therapist’s ability to observe and track the postural, gestural, facial (emotional) and physiological shifts throughout a session in order to bring them into a client’s conscious awareness. This allows both client and therapist to uncover unconscious conflicts and traumas that are well beyond the reach of reason. Freud seems to have grasped this concept in his early work when he says, “The mind has forgotten, but the body has not—thankfully.” Yes, thankfully! Though Freud seems to have abandoned this premise, his student Wilhelm Reich spent his entire career studying how conflicts are lodged in the body.

This is a case where symptoms did not emerge full-blown for twelve to eighteen months after the traumatic experience. Hence, it was not readily apparent that they were sequelae to a precipitating event. For reasons largely unknown, it is not uncommon for symptoms to be delayed by six months or even one and a half to two years. In addition,

symptoms may only manifest after yet another traumatic encounter occurs—sometimes years later.

This process is an example of expanding the “aperture” of an image to its pretraumatic state (as described in Chapter 7). Up to the moment before the impact of the jet, it had been a perfect day, infused with vibrant colors and gentle scents. These sense impressions still exist somewhere in the catacombs of consciousness, but they have been overridden by the traumatic fixation. Gradually restoring the full spectrum of the disparate parts of an image is an integral component of resolving trauma.c

People need to disengage the emotional and mental associations from the raw physical sensations they have come to experience as precursors of disaster but that are, ultimately, sensations of vitality. Reestablishing these enlivening affects is a central core of effective trauma treatment. Interestingly, it is also found in ancient healing practices, such as meditation, shamanism and yoga.

By imagining—with full engagement in her bodily experience—the sense that she was running, unfettered, in a safe place, she was able to complete the frozen action locked in her body.g Just having Sharon imagine running would not have had much of an effect. However, first approaching the place where she was trapped, revisiting (touching into) that moment of terror and then experiencing the (new) possibility of completing that motor act was the therapeutic denouement.98 Having felt her highly charged physically sensations, just as they were, not as she feared or imagined they were, was the linchpin to uncoupling the catastrophic thoughts, as well as the emotions of terror and panic, from her actual physical experience.