Book Review-In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness
Trauma is – in more ways than one – that unspoken voice. In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness is what Gabor Mate describes (in the intro) as Peter Levine’s magnum opus. Gabor Mate is no stranger to trauma work, having written several books, including The Myth of Normal. In an Unspoken Voice isn’t Levine’s most popular work – that’s Waking the Tiger. Trauma, Levine writes, is a fact of life. He continues with, “It does not, however, have to be a life sentence.” Said differently, we are all traumatized by things that happen in our lives, but we don’t need to remain in the trauma. We can enable our minds to integrate and find meaning from the trauma and allow our bodies to release it.
The idea that our bodies would release trauma is consistent with Bessel van der Kolk’s work in The Body Keeps the Score. There are ways that our biology reacts to, and in some ways holds on to, trauma. Robert Sapolsky in Why Zebras Don’t Get Ulcers demonstrates that, in animals, stress does have a physiological response, and this psychological response can activate different genes.
Several decades ago, genetics were all the rage. The thinking went that the genes were the blueprints of the body, and thereby they dictated who you would become. It was like a great clock was set in motion. Great work has been done to develop a map of the human genome – and to interpret the signposts in the form of genes. However, as we’ve learned more, we’ve realized that the blueprints are subject to modification by the environment. Epigenetics is the study of how our genes are activated – or not – based on our environment. In identical twin studies, we still find a striking amount of differences (and spooky similarities). In The Nurture Assumption and No Two Alike, Judith Rich Harris explains how it is possible for twins with identical genetics to end up so different. Small differences matter.
In The Rise of Superman, Steven Kotler explains how people do seemingly superhuman feats. The answer is that they continue to make small, incremental changes over a long period of time. It’s the same thing that Anders Ericsson explains in Peak – purposeful practice and attempts to improve may only make small changes every day, but over time, these changes matter. Einstein said that “compound interest is the eighth wonder of the world.” It’s that compounding of skills that pulls people apart. Someone randomly tries an activity and likes it. From there, they invest more in growing in that direction. Add a few decades, and you see radically different people.
With trauma, the arc is bent differently. But those genetics that are enabled can be disabled. The weight of trauma can be discharged by the body, and people can move forward – if they’re taught how.
The real challenge with trauma isn’t in the external circumstances that have been foisted upon us. The real challenge is how we react to those circumstances. Being traumatized is about the times when the events are happening – but trauma lingers after the event. In the normative case, trauma results in a healing process. When the body and mind’s response are effective, it can lead to post-traumatic growth. (See Transformed by Trauma for more.) It’s the same as Nassim Nicholas Taleb explains in Antifragile. We need stressors to become stronger – but they need to be of magnitudes and timing that we can leverage to our advantage.
When we can’t integrate the traumatic experience into our experiences and beliefs about the world, we encounter post-traumatic stress disorder (PTSD). (See Trauma and Recovery for more.) All trauma involves loss and often disrupts our beliefs. We have to deal with both.
The Battlefield of the Mind
We tend to conceptualize our minds as a single consciousness that operates as a concerted whole. However, our brain evolved over time in periods that have led to a conceptualization of a triune brain – three parts. The most vivid analogy is Jonathan Haidt’s Elephant-Rider-Path model, which places a small rational (conscious) rider, on top of an emotional elephant, walking down a default (and easy) path. (See The Happiness Hypothesis and Switch for more.) While not completely analogous to our understanding of the brain’s evolution, it highlights the gap between emotions and reason – and helps us to understand that earlier parts of our evolution will win when there’s a battle in our mind.
I’d be remiss if I didn’t acknowledge the truth that we overlook the neurons that exist outside of our brains. There is much to be learned and understood about how the nerves in our guts are connected to and influence our thoughts. However, the research and consistency are much weaker here. (See The Heartmath Solution for a bit of this.)
The challenge, as Levine puts it, is when lower-level parts of our brain are telling us to run, and the higher-order parts are pushing for us to be restrained – or any variation where different aspects of our brain disagree. The result is a battlefield of conflict that can be as traumatic as the circumstances themselves.
Fight, Flight, or Freeze
At the most basic level, the reptilian parts of our brain seek to decide whether a stressor should cause us to fight, run away, or freeze. We fight when we believe we’re stronger and the injuries we sustain will be minor. We flee when we believe that we’re weaker or will sustain too many injuries. Freezing doesn’t seem to make much sense on the surface. Why would we give up and just “let whatever happen”? The answer is layered.
At the first layer, our brains and animal brains are wired to detect motion. (See Incognito and The Tell-Tale Brain for more.) If we freeze, it’s possible that the stressor – predator – may not even discover we’re here. Thus, there will be no conflict.
The second layer is that we may believe we’ll ultimately be harmed less if we don’t fight or flee. Consider the mouse that is being played with by the cat who goes limp as the cat loses interest. The mouse can run away when the cat is no longer focused. Clearly this is a risky gambit – but one that may be advantageous at times.
Largely to support the first layer, evolution has supplied a strategy – tonic immobility. It’s a mechanism whereby motor impulses are suppressed, and the animal becomes motionless. What’s important, in Levine’s view, is that at the termination of this process, it’s necessary for animals – including humans – to shake off the excess energy that they’ve held back. He believes that without the discharge of this energy, people will become stuck. Perhaps at some level, the body never fully releases the tonic immobility and remains, in some ways, frozen.
Fundamentals of Fear
Richard Lazarus explains how we come to fear – and what we can do about it – in Emotion and Adaptation. He separates the stressor from the stress consistent with our fight, flight, or freeze response. He suggests that, for every stressor, we evaluate the probability of a negative outcome and its impact, and we dampen this with our perception of our coping capabilities. This is consistent with and extends the concept, because he recognizes that, between the stressor and the response, we can choose our response. Daniel Kahneman in Thinking, Fast and Slow says that System 1 (lower-level thinking) can choose to engage System 2 (rational thought) or not. In the best case scenario, our thinking is integrated to the point that our emotional, reptilian, responses trust the neocortex and want to engage these resources for assistance when problems are too novel.
The point here isn’t to criticize historic responses that may not have engaged higher-order thinking. Rather, the point is that it’s possible – and that possibility exists even in the post-processing of an event. It is, in fact, one of the key ways that we can learn to process trauma better. We use our neocortex to downregulate the emotional response.
Cage the Elephant
Many well-intended people suggest that trauma be directly confronted. Effectively, they’re picking a fight with an elephant. If you’re in a sailboat, and you need to go to a point that’s directly into the wind, you can’t point your boat in that direction and hope that things work out. Sailboats tack into the wind, moving closer and closer – but never directly challenging the wind. Similarly, when we’re trying to help others address trauma, it’s almost never effective to try to address the traumatic experience and tell them to just “accept it,” “suck it up,” or “it wasn’t that bad.”
Rather than enter into a direct confrontation with our feelings, a different tack is to listen to them. To seek to understand them. To be curious about their origins. Once we’ve made peace with what we feel – and the reasons why we feel it – we can slowly shift our thinking from confrontation to cooperation. The reasons driving the emotion don’t have to be right. They just must be acknowledged for their perception.
While our emotions are subject to influence from the neocortex, the degree to which we can influence them is complicated.
Medial Prefrontal Cortex Dampening
The amygdala is the core of our immediate, reptilian, responses. It’s the driver of emotions, including fear. It’s subject to the influence of the medial prefrontal cortex. In short, we can talk ourselves out of being so afraid, but only if the medial prefrontal cortex and the amygdala have a functioning relationship.
The tricky part of this relationship is that a fear response necessarily focuses resources. As Why Zebras Don’t Get Ulcers explains, digestion, immune response, and reproduction are all substantially turned down to save energy for fighting or fleeing in the face of stress. The same can be said of the brain. Fear can change which portions of the brain are given the oxygen and glucose they need to do their job. In short, a spike of fear can shut down the medial prefrontal cortex before it can respond.
Luckily, this can be trained. There’s enough oxygen and glucose available ambiently for the medial prefrontal cortex to down-regulate the amygdala – if it reacts quick enough. Some of the frequently documented outcomes of low-blood sugar is irritability and a reduction in willpower. (See The Power of Habit and Willpower for more.) In the context of the medial prefrontal cortex having enough resources to do its job quickly enough to not get shut down, this makes perfect sense. Low blood sugar means there’s less ambient energy for the medial prefrontal cortex to draw upon to wrest control before it’s shut down.
Trauma Feedback Loop
The problem that can lead to persistent trauma comes down to a negative cycle of overwhelming emotions and avoidance. Because the traumatic event isn’t able to be processed – it’s overwhelming – people avoid reactivating memories of the trauma to prevent being overwhelmed. This avoidance indirectly makes the trauma worse and makes it harder to deal with.
The trauma is wrapped in another layer of overwhelming emotions when it’s pushed away. Like a candle gaining wax when dipped, it gets larger and larger, bit by bit. The process increases in frequency: the more we push it away, the more potential triggers appear. It’s like White Bears and Unwanted Thoughts explains: we can’t block out a thought, because to do so requires that we consider the thought first.
The heart of helping people with trauma is to separate the overwhelming aspect of the trauma – including the emotion of being overwhelmed. That means slowly re-exposing people to the traumatic memory at levels they can accept – and learn from. The longer the process of reinforcement happens, the harder it is to maintain safety and unwind the trauma feedback loop.
A natural tool that humans use for traumatic events is dissociation. (It was previously known as disassociation.) This cognitive process has us remembering the events as if they happened to other people. Many people claim to be experiencing events from outside of their body. This is an adaptive solution to an impossible traumatic event in many cases. However, the problem is that dissociation can become maladaptive if it continues after the event has stopped.
When we’re trying to help others through trauma, we want to be on the lookout for situations where the person starts the dissociation process. While it’s often internally experienced as seeing things from a third perspective, in the room it appears like the person is shutting down and beginning to stare off into space or at a distant, fixed object.
What Levine calls containment, others might call “holding space.” (See Alone Together.) Richo would call it “allowing.” (See How to Be an Adult in Relationships.) Containment provides a safe space to recall and process traumatic events. It’s the heart of therapeutic relationships – and good friendships. Trauma, as defined in this context, is a response to an overwhelming situation. Containment creates a larger capacity so that the traumatic events no longer have the capacity to overwhelm.
The process of creating the space includes the traditional aspects of what The Heart and Soul of Change calls therapeutic alliance but also psychological safety. (See The Fearless Organization and The 4 Stages of Psychological Safety.) It’s creating relational trust and belief that, no matter what happens, the person will remain safe. (For more on trust, see Trust => Vulnerability => Intimacy, Revisited.)
Moments and Moods
Emotions can be intensely painful. What is difficult to see in those moments is that emotions, by their very nature, will fade. Just because someone is acutely feeling a loss doesn’t mean they’ll feel it the same way forever. In fact, you cannot feel the same way forever. When processing trauma, it’s peaceful to know whatever the current feeling, it will change.
Moods are something a bit different in that they last longer than emotions. They are, however, still not the degree of permanence they’re often assigned. As a part of our burnout work, we encourage people to do an exercise that’s titled “Hindsight 20-20.” The short of the exercise is to look back at a traumatic event that’s more than five years old and recall what you felt then vs. what you feel now. They’re almost always radically different. The point of the exercise is to help people realize how their emotions, moods, and perspectives will change over time. Most people who do the exercise say that they knew things were different, but they didn’t think it applied to their circumstances today. Others have commented on how intellectually they were aware, but they didn’t realize how wrapped up in the current emotions they had become.
Reality Is Not What You Think
Our perceptions are our subjective reality, but that doesn’t make them objective reality. Each person has their perspective of the world, what they see of it. The problem is that this doesn’t make everyone’s reality match our own. One of the key points in conflict resolution is to address the differences in perspectives among the parties. Incognito, The Tell-Tale Brain, and The Hidden Brain all argue that what we experience as reality is a fiction that our minds create. It’s what we form our beliefs about the world from and why, when our experience of the world differs from our expectations, it’s often painful to readjust.
Humans are, at their core, prediction-generating machines. (See Mindreading.) Many believe that consciousness is the solution to the need to be better at prediction and therefore survival. However, because reality is self-generated, it sometimes becomes so misaligned with objective reality that a correction is needed. Evolution provided for several mechanisms for this. Our reaction to humor is the most positive reward we get to our brains detecting an error – and correcting for it. The short is that when we laugh, we’re responding to the detection of the misunderstanding of what the comic said. Intentional misdirection or not, we get a dopamine reward for detecting and correcting the error. (See Inside Jokes for more.)
Other forms of error detection don’t leave us feeling better. Consider the glass funhouse at carnivals. You can proceed through the maze with a hand in front of you safely detecting the presence of a glass pane in front of you – or you can boldly go and accept the invariable nose bumps in the process.
Feelings Are Only Feelings
Feelings feel real. They feel like they’re reality. Here, I’m using feelings as an encompassing term for both emotions and perceptions. Collectively, we give them too much weight. In How Emotions Are Made, Lisa Feldman Barrett shares a story where she went on a date before getting physically ill, and how, at the time, she had misinterpreted the feelings that she was having for attraction. In A Beautiful Mind, John Nash develops a technique – after struggling with imaginary people for much of his life – for asking someone he knows is real if the other person with them is real to ensure that the people he’s speaking with are real.
No matter how real our feelings appear to be – whether emotion or perception – that doesn’t make them real. Nor does it stop us from treating them as real.
The placebo effect is well known in medical research. The control group, by nature of their having some hope, often improve. (See The Psychology of Hope, The End of Hope, and Warning: Psychiatry Can Be Hazardous to Your Mental Health for more.) However, Levine reveals that the placebo effect may be triggering our brain to manufacture natural pain killers. To understand how this works, you need to know that opioids bind to specific receptors in our brain – the same receptors that natural endorphins bind to. Science discovered a drug, Naloxone, that competitively binds with the same receptors – without the feelings of pleasure. Competitive binding really means that it’s more effective at binding to the receptors than the naturally occurring compounds – and the synthetic opioids that we’ve developed. Today, it’s used to help prevent overdose.
Here’s the tricky part: Levine’s brother, Jon, while studying pain patients, treated half with morphine and the other half with saline (placebo). Both reported pain reduction. Then he gave both the naloxone, and both reported that their pain was higher. Jon’s study was replicated by others. The implication is that, with the idea that there was a resolution in sight, the brain naturally started producing the neurotransmitters that it associated with happiness and less pain. The naloxone took that away, just like it took away the artificial high of the morphine.
That further lends credence to the idea that we have much more control over our responses than we generally believe. It turns out that our minds and bodies can speak In an Unspoken Voice.