Mary and Andrew adopted Molly when she was 18 months old. Her mother had been addicted to alcohol and drugs and was incapable of looking after her. She was therefore placed in the care of a sequence of foster parents until Mary and Andrew were granted permission to adopt. They were delighted. Already in their early forties, they were unlikely to have children of their own. Although they were warned that Molly had tantrums and was not yet potty trained, they received extensive training by the adoption agency about what to expect and how to respond and they believed that with patience and love, they could offer Molly the security she needed.
Their optimism was well placed. Molly has grown into a confident teenager, clever at school and good at sport. She is a credit to them. But Molly is, to use an old fashioned term, highly strung. She resents authority and has got into a lot of trouble at school for losing her temper and being rude to teachers. She tends to hang out with the more unruly children and there is a suspicion she may have been abused. She is still having trouble with her bowels, withholding her faeces and occasionally soiling her pants. She is a very fussy eater, often refusing meals. She has also cut herself. Mary and Andrew are worried. If she is like this now, what will she like in a few years time?
Nobody really knows what life was like for Molly during the first year of her life. She can’t tell them, but from what they have been able to glean from social services, it seems that her mother neglected her, leaving her alone to scream and feeding her intermittently on junk food. There may also have been some physical violence, but all of that occurred before Molly could remember.
Our nervous system is sculpted by our early attachments. Like a tree, the conditions existing in the first year of life have more effect on the development of the brain than what happens later. But we have no conscious memory or words to describe that time. The only recall any of us have of that time is expressed implicitly through our behaviour, our preferences and dislikes and the functions and sensations of our bodies. And if, like Molly, we have experienced trauma during those early years, the effects are likely to be more profound, long lasting and inaccessible. This may explain why some children are crippled by shyness, and why others tell lies or are scared of the dark, loud noises, dogs or men, and why so many suffer from illness.
The same behavioural and somatic conditioning can exist for people who have suffered trauma later in life. Under conditions of extreme stress there is a failure of the hippocampus to construct episodic memory while the cognitive brain closes down so that events are not processed or stored as a coherent narrative. In contrast, the unexplained sensory and bodily elements of the experience are processed by the amygdala and remain often for years in the brains multiple memory storage areas, awaiting the appropriate contextual trigger to release them.
Post traumatic reactions are therefore a living legacy of symptoms; a collection of overwhelming associations and implicit memories disconnected from any sense of reality. As Daniel Siegel (1999) expressed it, ‘after trauma we act, think and imagine without recognition of past experience on present reality. The past is not something that happened long ago, but we feel in danger, right here, right now’.
Our implicit, body-and-feeling based memory converts the past into an expectation of the future without our awareness. This is what Stephen Porges has termed, neuroception. It is both a blessing and a curse; a blessing because it informs the intuition we rely on to make decisions and navigate our social world; a curse because it makes the worst experiences of the past persist as emotional realities that continue to govern everything we do. Intrusive emotions such as terror, fury, dread, shame or despair are often out of all proportion to the trigger since we have no recall of the association. In the same way, intrusive bodily sensations, such as dizziness, pain, heaviness, floating, tingling, numbing, abdominal pain and bloating and reactions, like breathlessness, diarrhoea or vomiting cannot be explained by any pathology. And both condition such behaviours as avoidance, hyper-vigilance, startle, flight, deception, self harm, aggression, or addiction to food, drugs or alcohol. More a state than a story, our implicit memory system has a more powerful influence on our behaviour than our narrative memory.
Charles Darwin in his second major opus, ‘The Expression of the Emotions in Man and Animals (1872)’ noted that when the heart suffers an episode of tachycardia or arrhythmia, it affects the brain. Similarly the brain acts on the heart. We now know that neural circuits mediate the reciprocal communication between a variety of body states and brainstem structures. These not only promote emotions, but they also enable thoughts to influence body state and body state to colour our perception of the world. What, for example, does the world seem like for somebody with IBS?
For the last hundred years, psychotherapy has focused on recovering and analysing the explicit narrative of what happened, yet it is the implicit memories of neglect, abandonment and abuse – the symptoms, dreams and triggers, that leave patients disabled with fear, anger, shame and confusion. Sensorimotor psychotherapy is a body orientated psychotherapy developed by Pat Ogden. It blends psychodynamic theory with somatic interventions to help patients track their bodily sensations and learn to control them. It is less concerned with the narrative of what happened and focuses more on the feelings, emotions, beliefs, body sensations and reactions that constitute the implicit memories. So, the primary goal of sensorimotor psychotherapy is to calm the implicit sense of threat and replace it with feelings of confidence and safety by regulating arousal, fostering secure relationships and instilling a sense of agency.
You cannot change the past, but you can change what happens now and in the future. Archaeological investigation of past trauma is unnecessary and my be impossible if it happened very early in life. It may even be damaging since it could destroy the defences that have allowed the patient to cope. So, instead of interrogating the past, sensorimotor therapists work in the present and with the body to empower their patients to regulate their own feelings and bring the thinking and planning part of the brain back on line. Only then can they determine how current events might trigger certain emotions, symptoms and behaviour and learn to avoid or control those.
As the patient learns to regulate their feelings, they may ‘discover’ their own story to explain them. This narrative can then be used to evoke implicit behaviours and symptoms, which the therapist can help his patient regulate by various means; breathing exercises for shaking or trembling, mobilisation for signs of dissociation such as vacancy and helplessness, slowing the pace of conversation when the patient is becoming anxious, and asking them to place a hand over the heart or the belly to restore them to the here and now.
But in reality, the therapist may not need to do very much except to be there and provide the containing environment that allows their patient to relax and think. If the therapist is not upset by the emotion, their client will pick that up and also feel relaxed. Trauma is overcome more through relaxation, ritual, and repetition than by any dramatic insight and redemption. Sensorimotor therapists focus on the positive aspects of what happened and the patient’s potential for recovery. ‘At one time your symptoms helped you to survive, but you don’t need them now.’
Goethe once wrote what might be seen as the goal of trauma therapy:
‘If I accept you as you are, I will make you worse. If I treat you as though you are already what you are capable of becoming, I will help you become that.’
It is hard for Mary and Andrew and they will need some support. They must show Molly that they are there for her and are not frightened or angry by her emotional reactions. This will calm her down and bring her back to a place where she can think. Only then can they help her understand how to regulate her own feelings and feel better about herself.
This post was inspired by a lecture by Janina Fisher.