Bessel van der Kolk, MD, presented a history of trauma studies (Esalen, 2011). He was a past President (1991-1992) of the Int’l Society for Traumatic Stress Studies, http://www.istss.org/History/2099.htm. The workshop began by mentioning an op-ed piece for the New York Times that was published in May 1972 titled Post-Vietnam Syndrome. In his editorial, Shatan described what came to be called post-traumatic stress disorder, and told how he had noticed these symptoms in the Vietnam veterans that he and his colleagues had been seeing in “group rap” sessions (Shatan, 1972; 1978a). This was the beginning of trauma studies. The Traumatic Neuroses of War (A. Kardiner, 1941) influenced the development of these studies.
At that time, the Veterans Administration was intent on blaming the genetics of combatants or their family background for their problems. But women who had been incest victims and were working at the VA hospitals brought awareness to the similarity of symptoms between incest survivors and war trauma. They were mostly responsible for putting the diagnosis of PTSD “on the line” to the VA, insisting that disregulation from trauma is due to war, not genetics or family background. No longer was treatment of memories, flashbacks, and nightmares going to be avoided.
Bessel uses the Rorschach test to help him determine a person’s perception of the world because, he says, you cannot talk people out of their perceptions. This is interesting because the Rorschach is not valid as a measurement tool for anything but schizophrenia, I learned in my graduate program in psychology. The Rorschach is a psychological test in which subjects’ perceptions of inkblots are recorded and then analyzed using psychological interpretation, complex scientifically derived algorithms, or both. Some psychologists use this test to examine a person’s personality characteristics and emotional functioning. It has been employed to detect an underlying thought disorder, especially in cases where patients are reluctant to describe their thinking processes openly. Traumatized people:
a. see things that non-traumatized people do not see.
b. have lives that are controlled by something outside of themselves.
c. process the world through how people make them feel versus reason.
Mild TBI (brain trauma) and PTSD are nearly indistinguishable. The brain becomes very sensitized to stimuli but the person cannot take in the larger sense of reality. Traumatized people can deal with intense experiences but cannot deal with life. The universal language of trauma is characterized by strange movements of the body. He also said that studies show how animals with low levels of serotonin are very reactive to their environments versus those with normal levels who take longer periods of time to react to stimuli.
On March 6, 1989, Prozac was released. Prozac is a drug that helps you to be here, Bessel said. After 8 weeks of taking Prozac, the Rorschach of his patients changed except the score for helplessness. The patients were now able to think of other things. Prozac makes it possible for people to do psychotherapy. SSRIs catapulted Bessel and Peter’s careers, he said. But he sees the limits of psychopharmacology and would now rather teach people how to self-regulate. “Psychiatry sold its soul to the drug companies long ago… It is a hard thing to see your whole profession going down the drain. Do something else.”
“The way you hold your body determines how your mind perceives.”
“The story is just the way you explain the trauma but it does not heal the animal brain. “
“Language shapes your feelings,” said Bessel. “The culture shapes the diagnosis.”
“Some veterans would rather die on the battlefield than undergo treatment for trauma because of the re-traumatization.”
“No one who is a good trauma therapist does stories anymore – or just stories. That does not get people to feel safe at the end.”
PTSD is the adult trauma diagnosis, in contrast to people who were hurt or molested as children when their brain was developing. Chronic child trauma is a different issue than PTSD. Prozac works exceptionally well with childhood trauma. “There is a difference between adult trauma and child trauma. Adult trauma is relatively easy to treat with yoga. At the same time yoga is fraught with danger and pain for childhood sexual trauma. What yoga can do is modulate the person to make it tolerable to skate on the edge of the trauma. People can be triggered in yoga and they need to, as in touch, be able to move away from it. And re-approach it gently as often as is necessary. Here they can learn that shit happens but it does not have to dominate their lives.”
Peter Levine demonstrated with a participant in the workshop, saying that whatever we are experiencing will shift since the restorative function of the body will take over given the opportunity. There is a contraction/expansion rhythm in the body and people naturally shift out of the trauma as they get unstuck. Slowly have them move into the uncomfortable position and then move out of it. “Just notice what that toe might want to do if it could.”
He explains that predation is a normal event and that humans are in the middle of the predator and prey cycle. We need the energy of the predator as much as the energy of the prey. He noted that most predators need the stimulation of the resistance of their prey, also saying that nausea is a critical period of collapse and is a part of the opiate response in trauma. Also, the social instinct gets shut down in trauma.
Dana Moore gave a discussion on the lawn at lunch. Dana is a psychotherapist and Kripalu Yoga teacher and a staff member at the Boston Trauma Center. He conducts teacher trainings on trauma sensitive yoga and regularly teaches workshops and retreats with trauma expert Bessel Van der Kolk MD. He talked about the structure of yoga classes at the trauma center in Boston where they have one week training courses for yoga teachers. These are the “domains” of a trauma yoga class:
1) Environment. There must be absolute privacy (no open windows), low level lighting, and a comfortable room temperature.
2) Assists. No deepening assists. No feel good assists. Always create safety. Use the non-manipulative Kripalu method of having people push into your touch so that they always control what is going on. All triggers are pre-verbal (I would say pre-conscious). Another person’s look can be a trigger, even the misperception of assault can be triggered. Yoga for trauma is not a talking experience, it is not meant to be psychotherapy. But all students must have a therapist and although in class they don’t have to interact with others, still they can feel connected. If they are in an environment where they witness other people feeling safe and doing the poses and who keep breathing, the somatic connection with other people’s bodies synchronizes them and creates internal safety.
3) Asanas. A lot of stillness in these types of classes, where the objective is self-care, and range of motion, although it is still educational and intellectual about the body, for example, what the muscles are doing. There are six basic movements of the spine that take practitioners through all the joints of the body in terms of range of motion. It is important that their attention is brought to feel that “this is MY ankle, this is MY wrist” to connect them with their body existentially, similar to SE’s “taking ownership of the body.” The teach self-regulation techniques using the breath, as in not forcing the breath but noticing the breath. Closing the eyes has just the opposite effect for a traumatized person as it activates the brain and may trigger them so teach them to look for the safe places in their bodies.
4) Class dynamics. Class size is small, the space is cave-like, and it is particularly important where the yoga teacher stands, that the teacher stays in one place.
5) Teacher characteristics. Energy, look, and voice are all important.
6) Language. Avoid words that contain double meanings. Be prepared for people to get triggered, expect it. Use a scale of request/demand in language. Bessel said not to make trauma explicit in the teaching of the class.