‘Trauma is playing out in the theatre of the body’

Kal Kseib meets Dr Peter Levine, the founder of the ‘Somatic Experiencing’ approach to trauma.

What separates trauma from day-to-day stress?
We can take care of day-to-day stress by having a good night’s sleep, taking a walk, being with friends, going to bed, resting. We wake up feeling refreshed. In trauma, when something happens that is traumatic, you don’t wake up refreshed. It continues to linger and, of course, that happens in degrees. Sometimes something devastating happens to us that we don’t rebound from. One good night’s sleep doesn’t do the trick. I think it was in the Korean War, the term they gave to trauma was ‘operational fatigue’. Soldiers would be told, ‘well you’re tired, do what grandma said, get to bed early, get a good night’s sleep and you’ll be fine’. That’s not true with trauma. It continues to haunt us.

You’re the founder of the Somatic Experiencing (SE) approach to overcoming trauma. How did that come about?
A lot of my original work was studying animal behaviour in the wild and seeing how prey animals shake off predation, and I noticed very similar reactions in animals as in humans as they were resolving and transforming their traumatic experiences. Classically, trauma is experienced in the form of flashbacks, being on edge, hypervigilance, all of those kinds of things. But what I also discovered is that often, rather than having flashbacks, we start developing symptoms in our body. We start developing pain, we start developing susceptibility to infection and illness, heart arrhythmia – it affects the entire physical being. We probably wouldn’t have survived as a species had we not been able to somehow learn from threatening encounters… essentially this is the body’s normal response to a very abnormal situation.

In a nutshell, how would you define SE?
Most people think of trauma as something that happens in the brain. It is registered in the brain, no question about that, but it’s also something that fundamentally goes on in the body. So, for example, if you see something frightening or terrifying – somebody being hit by a car or something like that – your body twists, your guts twist. Most of the time when that happens we go back to normal but in many cases it stays fixed in the body. And the most fundamental thing that I’ve discovered in my nearly 45 years of developing SE is that until the experience in the body changes – until you have a new experience that literally contradicts that of fear, terror, overwhelming helplessness – the trauma continues to replay itself over and over in the present. 

So just trying to change people’s thoughts isn’t going to work?
If you’re just trying to get the person to notice their faulty thinking and try and change that, it may be of some help but ultimately it’s not going to touch the roots of trauma… those roots are within the body, usually as fear and helplessness. Until that changes you can alter some of the thoughts but you’re still fundamentally traumatised.

Sounds like the emphasis is on the here and now.
Yes. We don’t go looking to dredge up memories from the past. Of course images and feelings and sensations from the past will arise – but we don’t go fishing for it. We first help people find these different experiences of where they were overwhelmed and helpless, then help them to rediscover what it is that might have given them more agency. And that’s one of the differences. In a way you take that new experience in the body and transmit it back in time to the trauma. So really it doesn’t have to do with remembering the trauma or replaying the trauma – the term I use is ‘revisiting’ or ‘touching into’ the trauma. Because if we experience the same kind of overwhelm now in the brain and the nervous system as we did when the trauma first overwhelmed us, the brain really can’t tell the difference. So it’s like the trauma is happening over again. That’s something that we don’t want for sure, and I make sure my trainees know that right from the very beginning.

What evidence base is there for SE?
This is something we’ve gradually built to begin to make it possible to be part of standard practice. The first randomised control was actually carried out in Israel under strict protocol and it had tremendous benefit for PTSD symptoms with this group. It took a year to get it published in the Journal of Traumatic Stress – the gold standard for research and trauma. Today, there are now hundreds of outcome studies which have trialled using somatic experiencing with trauma patients.

What would you say are the core ingredients of trauma?
That in a way is simple. Trauma is experiencing fear in the face of helplessness. Fear plus helplessness equals trauma. And also that there’s no person there with you at that time, an empathic other that’s witnessing and helping you witness what you’re experiencing. In situations where a child, for example, is neglected, traumatised or abused, that compassionate other is usually not there and so that’s another condition for long-lasting trauma. In the US, for instance, it’s been well documented that children coming from the Mexican border are separated from their parents. They’re left alone basically in cages. Isolation. Helplessness. Fear. It’s not only heartless but it shows a complete lack of understanding of child development.

And such primal experiences will continue to be replayed, manifesting in different ways until they’re worked through?
Yes, until they’re worked through. Freud had the idea when he wrote about repetition compulsion that the reason that we get into these situations is to help us rework them. And that’s both true and not true. It gives us an opportunity to rework them, but you have to have that opportunity. So that really means having somebody there – the empathic witness – to be with us and guide us through. You definitely don’t want to be just repeating trauma, that’s not very helpful.

What, then, would you say are the core ingredients necessary for recovery from trauma?
The key feature is having new experiences in the body in the here and now. These are experiences that neutralise, that contradict those experiences of overwhelming hopelessness. This overwhelm is rooted in the body and so we work with the body using different tools to help the person gradually. When you’re in a state of trauma it’s like you’re on a little tiny island, and then you have these enormous waves crashing in every direction, threatening to hit and wipe you off the island and drown you in the sea. One of the key things when working with all kinds of trauma is to be able to have the person have at least some experience of relative safety – to know they’re okay. So you have this one tiny island but then you find another island – another part of the body’s experience – and then another and another. And then these islands merge together so you’re working towards this solid land mass even though the turbulent seas of trauma are all around.

Is it ever possible to delineate psychological trauma that is locked up in physical form, from physical trauma itself?
Actually I find they’re convergent. So, for example, one can be traumatised by having an accident or seeing someone having an accident. Our basic core resilience is very much influenced by our experiences as infants and as babies. When we are attended to and when our distress is co-regulated, then we build an internal resilience to later stress and later traumas. That’s very important and I think the whole issue of attachment is also something that psychologists are trying to study more seriously now. So those are again the things that in part give a basic capacity for resilience.

So our early life experiences essentially shape our response to trauma?
There was a man named Dr Vincent Felliti who developed a scale called the Adverse Childhood Experiences (ACE) scale. It includes nine questions and if you have three of the nine things happen to you in your childhood, not only will you be magnitudes more susceptible to anxiety, to depression, to suicidality and so forth, you’re also five times more likely to develop things like obesity, diabetes, heart disease and cancer. So it affects our whole being and our whole health. This was the discovery that really shook the world in a way, and it’s taken the world a while to catch up to it.

What role does memory play in trauma?
An effect of trauma is that memories are not explicit. In other words, it’s not like ‘I remember when I was two years old and such and such happened’. The body, though, is still holding those memories, which we term ‘emotional memories’ – they’re implicit. An example of emotional memory could be going to a party and being introduced to somebody. If all of a sudden you feel rage or fear out of the blue, you may wonder where it came from. Maybe it’s something about the person’s features or perhaps the smell of smoke or alcohol that immediately throws you back into something that happened maybe decades before. This is how these implicit memories grab us.

Again, in SE we don’t work on remembering – what we’re doing is working with the memory as it presents itself in the now. The title of my latest book, Trauma and Memory: Brain and Body in a Search for the Living Past, is about how the past lives in us. An inner fear of our relationships to ourselves and to others exists as a consequence of our not being able to take in fresh or new information. So if you somehow reminded me of someone who was once a threat to me, we’re not really able to connect. The idea then is to help the person come out of these stuck places so that they can reconnect to themselves and reconnect to others.

‘Medically Unexplained Symptoms’ are on the rise and, by definition, very poorly understood. To what extent can SE bring clarity to such cases?
These symptoms are actually very amenable to work with because they are playing out in the theatre of the body. Over the years I’ve literally worked with thousands of clients with these conditions and somatic experiencing works very well with them. The first person I worked with was Nancy in 1969. She had been suffering from all kinds of physical symptoms – chronic pain, fibromyalgia, chronic fatigue, irritable bowel, migraine, severe PMS and urinary problems – as well as panic anxiety and agoraphobia to the extent that she couldn’t leave the house. She was sent from doctor to doctor, specialist to specialist but nothing helped and they couldn’t find any medical reason for all of these symptoms. At that time there were only really two drugs – one antidepressant and one anti-anxiety drug – and neither had made much difference in alleviating her key symptoms. Eventually she was referred to me and I worked with her to help her renegotiate, rather than relive, the trauma that happened to her. When she was four years old she was held down by doctors and nurses and they forced an ether mask onto her face; the mask can also bring on hallucinations and she felt as though she was suffocating. Her body had wanted to do anything it could do to escape but she couldn’t because she was being held down – she was overwhelmed. In working with her, when she was able to actually experience what her body wanted to – which was to run and escape – her anxiety began to ease. And then over several weeks through working with the energy of her self – protective responses, her fight or flight responses, body sensations, feelings and images, and then connecting them to thought patterns – the majority of the symptoms either disappeared or were greatly reduced.

Somatic Experiencing was originally conceived to help people with Post Traumatic Stress Disorder (PTSD). Is SE now heading more towards addressing Medically Unexplained Symptoms?
Well, I don’t know how many it is in the UK, but upwards of 20 million people are suffering from these kinds of symptoms in the US – some more serious than others. So understanding how to reach these people and help them to heal by releasing that pain from the body would be a huge step. And so we’re working on an app for people who have these kinds of conditions to help them resolve their issues, and will go into the first major test phase probably within the next month.

Do you consider trauma to be more or less prevalent in today’s world?
If you’re working in trauma you’re never going to run out of business. The ability of man to harm others is virtually limitless – but so is goodness. And goodness is an inner feeling. Rumi, the Sufi poet said, ‘there is another voice that doesn’t use words. Listen.’ And that’s the wisdom of our bodies. The capacity to heal is greater than the capacity to be traumatised. Sometimes I say the bad news is that trauma is a fact of life. The good news is that trauma doesn’t have to be a life sentence – that we can return to the grace and flow that’s innate within us and that our healing capacity is innate. We just need to know how to tap it.

So are we moving closer toward a society that acknowledges trauma, or one that turns its back on it?
I would say both. I would say that at this point people are, in a way for the first time, really beginning to speak out about trauma. Here in the UK you have Prince Harry, who is talking about trauma and mental illness with Oprah Winfrey. It’s now in the public eye in a way that it has never been up until now. At least that’s my overall perception. Now the question then, of course, is what does it take to identify and help heal the trauma? And I think that’s really not well understood at this point.

What resistance do you encounter to the methods you’ve developed?
That’s an interesting question. I’m not even sure it’s resistance primarily but rather not knowing the ‘how’ and the ‘when’. When I first started to talk about this, for instance, I would be giving a lecture and a quarter of the way through people would get up and leave, and I found out later that they were mainly psychiatrists. They were saying ‘this is very dangerous; these people [patients] need to be on medication’. Now, if I give a lecture in front of a crowd of a thousand people with maybe 150 doctors there, nobody leaves. There’s interest, there’s openness.

If something threatens to change your perception of the world, you’re going to defend it tooth and nail. It’s just the way human beings are wired. We get stuck in our own beliefs. It takes a long time for change to happen and when it does, it takes many, many more years – decades – for that change to become standard practice. If you have one group of people that says, ‘this is an incurable brain disease, the only thing you can do is treat it with drugs!’ and other people that say ‘wait a minute, human beings have this innate capacity to rebound in the aftermath of overwhelming situations’, there are going to be inevitable turf wars. When I first wrote Waking the Tiger I was really shocked by the hundreds of letters I received from people saying, ‘reading that book changed my life’. It helped them to normalise the reactions their body was having – to discharge the shock, to discharge the trauma. And they were afraid of not knowing what to do or what to say, or being diagnosed as crazy. So just in reading that and normalising the reaction it made a difference, at least for the people who wrote to me.

What is the most important lesson life has taught you recently?
When you’re traumatised, nobody can take care of that for you, you have to do the healing. But at the same time you can’t do it alone. It’s so important to have that empathic witness there with you. And it doesn’t necessarily have to be a therapist, it could be somebody close, somebody you know or somebody who’s a friend. And I see that this would really make society quite different, if people understood that we all have the capacity to heal.

There’s an exercise I developed for groups of people working together. I have people just walking around in a room and being aware of how their feet contact the ground, from their ankles all the way up from to the top of their heads. Then what I have them do is just for a moment when they encounter somebody, to make eye contact, if it feels safe enough, and when they make the eye contact to see in the other person’s eyes that they have the capacity to heal from even the deepest traumas. And then of course they’re looking at you, at your eyes and seeing that capacity in you. I’m not saying it takes away the trauma but you can really see a fundamental change within people’s perception at the end of this exercise because even more than having the trauma is the fear that we can’t do anything about it, that it will plague us for the rest of our lives. Trauma is a fact of life but it does not have to be a life sentence. Working with it, transforming it can take us back to flow, grace, connection and compassion.

And is that how you would define success?
Therapeutically, success is when people come back to their feeling of being alive and real. Really what we’re looking for – our primary goal if you will – is to help the person come back to their vitality, maybe even to be more vital than before the trauma happened. On a personal level, I’ve been asking myself ‘have I done enough?’ and I think I can finally now say ‘yes’. The question I’m working on now is ‘am I enough’? That’s work in progress.

Dr Kal Kseib DPsych is a chartered psychologist. [email protected]

Read his other interviews for us via https://thepsychologist.bps.org.uk/search/site/Kseib

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