Thursday, June 19, 2014

June Project: Day 11: Body Awareness

Identifying traumatic triggers is one of the great challenges of trauma therapy. Stimuli from the environment can inadvertently set off a traumatic reaction in a client. Often the client is left with the reaction but has no idea what caused it. Tracing the reaction back to the source, the trigger, can be an important task. To that end, body awareness can be a useful assistant.

---from The Body Remembers, by Babette Rothschild.

In a chapter titled "The Body As Resource," Rothschild tells of a client with chronic hip pain, which had come on a year after her husband's death. Their time together in therapy typically focused on the woman's grief, but one day, in attempt to address the pain, Rothschild employed techniques to develop body awareness. As the woman focussed on her hip pain, her heart rate soared, and she became fearful and anxious. Rothschild asked her to sit with her emotions for a bit, notice them, and as she did so her right foot pressed solidly into the floor.

"It wasn't long before she took a huge breath and began to sob, 'I drove as fast as I could. I floored the accelerator. It was an old car and I just couldn't get it to go faster!'"

The woman's husband had had a heart attack in the car she was driving, and she had been unable to get him to the hospital before he died. The memory showed itself in her gas pedal foot, which ultimately caused her chronic pain.

The body remembers, indeed. But does it also look for its own solutions?

I'd like to flip Rothschild's technique around to ask if we can find other signals to show what the body remembers, or needs. To use myself as an example, I take note of what kind of physical outlet I'm looking for, and when. My exercise preferences lend themselves to the heavy and violent, but I'll save boxing for another post. Weightlifting: I like it. I simply like to pick up heavy things and put them down, as the joke puts it. But there are some days when I need something else. It's a very specific sensory need, and as it happened to come around this week--it doesn't too often--I figured I'd analyze it.

Two of the basic functional movements the body performs include the "push" and the "pull." In brief, push requires the chest and triceps, while pulling asks more of the back and biceps.

I have noticed that this specific feeling I get requires the push. Now, you can achieve the push through any chest exercise, really--bench press, dips, pushups--but those rarely cut it for me, because there is only so much weight I can hold on to and lift. That should be enough--lifting as heavy as I can--but it's not. Somehow, I need to feel the sensation of pushing against something large and virtually unmoveable. Think a car. I have done this, in these times--hauled the family into the car to push it. The other day, when this wasn't possible, I rigged a machine in my Y and pushed more weight than I should have been able to.

Theo had been sitting in the hallway with a blood sugar low. "Theo," I said when I emerged from the room, "I just used a machine in a way that was not intended."

"Did you pick the whole thing up, Mom?" he asked. He's a stinker.

I have to guess that just as memories can surface in the body in specific ways, memories--or needs--ask the body to perform in certain ways, too. My need for "push" is so specific that I have to believe it's telling me something. Am I trying to move a metaphorical obstacle, large and heavy, out of my way? I don't know. But reading Rothschild's work, I have to believe that when the body speaks, it's telling us something.

Wednesday, June 18, 2014

June Project: Day 10: Stress Response

Now I have a name for what I did when a knife was held to my face, and when a man thrashed at my rental car and no one else was around: dissociation.

"It is possible that dissociation is the mind's attempt to flee when flight is not possible," writes Babette Rothschild in The Body Remembers, which, you'll remember, is a book I'm studying throughout the month of June. Fight, flight, or freeze are the autonomic nervous system's responses to perceived threat. Whereas those bunnies I mentioned in an earlier post run when the dogs walk by, the mind, during dissociation, finds its own method of getting away.

The process of dissociation involves a partial or total separation of aspects of the traumatic experience... One person might become anesthetized and feel no pain. Another might cut off feeling emotions. Someone else might lose consciousness or feel as if he had become disembodied. (page 65 in The Body Remembers)

Taken to an extreme, this separation can result in identity disorder. But perhaps worst of all, dissociation can reappear after the traumatic incident, compounding the already debilitating effects of anxiety. Rothschild believes the symptoms of PTSD can likely be traced back to some form of dissociation.

It's the P in PTSD (post-traumatic stress disorder) that's the most disturbing, then. The person has experienced effects such as dissociation during the traumatic incident, and then continues in an unsustainable state of hyperarousal. There is no actual fear stimulus, and yet this constant state of anxiety makes everything seem a threat. Sadly, because their built-in warning systems aren't functioning properly, "it is typical for those with PTSD to repeatedly fall prey to dangerous situations" (page 62).

Back to the knife and the rental car: I shut down. I became calm, and where my male friend ran when he saw the knife, I stayed. In both cases, though I wouldn't recommend this to others, I saw it through and was able to diffuse the situation.

But reading about trauma brings back another memory where my stress response surprised me. You could say that the situation was a safe one, and yet certain aspects triggered memories and, also, fear. The details are personal, but I will describe my response, which was first to plot out an escape route. Think Sherlock Holmes narrating each detail of what he sees: my mind went to each door, and to where my children were, and then, Holmes-like, plotted a route to grab them and get out. This took maybe three seconds.

But then my tongue went numb, so my flight response, I guess, was paralyzed. I sat with my flight plan ready but unable to be executed. I thought it was all the weirdest thing until I started reading Rothschild's books.

Had I completely frozen, which is a real response, one way to recover is to just move a finger, according to Rothschild. Just telling your body that you can actually move helps get it on its way. Body awareness is a big part of recovery, and I'll get into that more tomorrow.

Friday, June 13, 2014

Posture (June Project, Day 6)

And today, the somatic nervous system (SomNS) in brief, again with a focus on psychotherapist Babette Rothschild's writing in order to understand the connections between trauma and exercise. Think of this as the notes I take for myself--an amateur study of one woman's life's work. There's so much more to these concepts than I can flesh out here, but I want to try to grasp the scope of the theories before diving into the part I'm interested in most. (See "june project" label for previous entries.)

"The autonomic nervous system... directs blood flow away from viscera and skin to the muscles for the duration of fight, flight, and freezing responses. The somatic nervous system directs the musculature to carry out that response." page 53 of The Body Remembers.

Rothschild points out that the SomNS operates via neural impulses, making any contraction of muscle an active state. "Relaxation, usually thought of as an active process, 'Hey, just relax,' is actually a passive state." (page 51)

And isn't nothing always the hardest to do? I've always pitied people going cold turkey on cigarettes or substances, because they have no work to be done--rather, the absence of a thing. Their goal is to not do something, with a sense of accomplishment coming from accomplishing nothing. Whew.

To jump, then, to another fascinating bit in her books,: the connection between the SomNS and what Rothschild calls "The mechanism by which traumatic events can be remembered implicitly through the encoding of posture and movement."

Posture. I've undertaken informal studies of this myself, of actors and homeless people acting. Why, if we can become someone else, do we not? Why not act more confident than we are? At least a smidgeon?

"Because it would be exhausting," said a friend of mine, an actor in NYC. But Rothschild has done some fascinating work in this area.

While laying out the idea that increased muscle strength helps clients with PTSD, she speculates that part of the success of this technique may include a protective mechanism. "More tone across your chest or back can help you to feel more protection--armor--between yourself and others," she writes in 8 Keys to Safe Trauma Recovery.

She goes on to tell of a client who would suffer extreme stress at family events that involved a buffet table. The mere act of turning her back to the rest of the room caused such anxiety that she'd hardly eat.

Rothschild experimented: Could she try throwing those shoulders back and standing in a confident stance? This helped, but having her chest exposed didn't. How about shoulder blades together but shoulders curved forward, bracing her chest? It was a stiff and strange posture, both admitted, but it worked. She could make her way through family gatherings without anxiety, though still a bit stiff.

In an article called "Applying the Brakes," Rothschild recalls the phrase "weak in the knees," which speaks to an actual fear response. When a client of hers felt this condition come on, R had her press her feet into the floor. (Reading this, I'm kicking myself for not thinking of this technique for my 89-year-old client. Isometric exercises can be terribly effective, and I've had capable adults "push" the wall or against their own knees to create the same effect.) Once the client felt the strength in her knees, she calmed down. Following a state of hyperarousal due to a rush of stress hormones, her hippocampus could relax and function properly, allowing her to clear her head and make better use of the rest of the therapy session.

Again, I can't see why the average person in a state of stress can't try these posture techniques. I knew I had picked the right person to study when I read in Rothschild's introduction to 8 Keys to Safe Trauma Recovery that her "professional goal is to become obsolete." In her work, Rothschild insists that her clients understand what helps them, so they can call on these tools when needed. I approach my clients in exactly the same way; education is as much a part of an hour with me as exercise. Make no mistake: they get a workout. But my goal is to have them reach a point when they no longer need me, or can break away for a time.

Always learning. Try the posture technique. See what happens, and let me know.

Thursday, June 12, 2014

June Project: Day 5: The Nervous System and Bunnies

It is fitting, perhaps, that today's foray into the workings of the nervous system was interrupted repeatedly with jolts out of the chair. "Bunny!" "Chipmunk!" "Two chipmunks!" Our yard is a veritable zoo, which never ceases to overwhelm us with its cute factor. Even the slimy frog that visits my kitchen window is soooooooo CUTE. But anyway: these times are lessons on how to stay motivated on day 5 of a monthlong project, even when you're not really feeling it.

My study of muscle tension as therapy in Babette Rothschild's work needs to begin with nervous system response, even though I keep flipping to the really fascinating stuff in the book that finally arrived from the UK.

Okay, can't resist. Here's one to tie you over (from page 5 of The Body Remembers):

A woman whose 3-year-old daughter had died four years prior was recalling, in a therapy session, a medical visit that had been particularly challenging. The details eluded her, but as she spoke, Rothschild noticed the woman's head jerking subtly to the right. The woman was unaware of the movement, and R suggested she allow it to develop. "Slowly the movement became bigger, becoming an obvious turn of the head to the right. When her head made its full turn, Carla began to cry."

And then she remembered. At the medical visit in question, an x-ray of her daughter had been displayed to the right, but the woman couldn't bring herself to look at it. The x-ray, and the visit, had made clear that the daughter wouldn't live.

As the title says, The Body Remembers.

This reminds me of the first year following Theo's diagnosis of type 1 diabetes. Each Friday, when I'd visit the school to refill supplies, I'd have to fight back tears. I could say these came out of nowhere, in a sense, because at home, I handled supplies all day long; but of course, the response was deeply-rooted in a type of grief. There were other times, too, when this grief would hit, yet the regular attendance of tears each Friday caught me off guard every time.

Trauma of any sort can manifest itself in physical symptoms, with some of the most dramatic including the freeze response, where a part of the body can go numb, or get stiff and "stuck." Though the trauma may have originated in what feels like an emotional problem--verbal abuse, the death of a loved one--these deep feelings find their way through bodily processes.

We'll focus on just one today: the autonomic nervous system (ANS). When the limbic system of the brain detects a threat, it engages the endocrine system and the ANS in the work of preparing to fight, flee, or, if neither of those can be accomplished, freeze.

"PTSD is characterized, in part, by chronic ANS hyperarousal. The system is always stressed.... When SNS arousal is constantly high, adding a news stress shoots it up even higher... This difficulty is familiar to many with PTSD who wonder why they cannot handle daily stress like everyone else or like they used to be able to." (page 50)

Explains a lot, doesn't it? Of course, this is just an armchair summary of complex processes, but I think it can serve to articulate the situation of people under chronic stress. (And even those bunnies in the yard, who exhibit a type of freeze response when unable to flee.) In future posts, I'll get to what interests me most, which is what Rothschild suggests to be done about it: work those muscles.

Wednesday, June 11, 2014

Brain Drain: Stopped

A recent article in a local paper instructs us parents to "stop the brain drain!" and "keep kids' brains engaged until school starts again." To that end, the writer suggests such non-parallel tips as "Read" and "Educational apps."

First one: done, done, and done some more. My kids read, and I've grown weary of explaining why this is not a good thing Any benefit to their brains is outweighed by the decrease in lifespan caused by sitting all day, if I'd let them.

Another good tendency gone bad in same kids is the abandonment of a fine idea after a short burst of effort. Maybe most kids are like this, but I can only speak to the brilliance of mine, who, if they'd follow through, would be president by now, or at least a relatively unknown yet respected indie filmmaker.

Knowing my children, then, and wanting to "stop the brain drain!", I suggested we undertake together what would become known as The June Project. We'd each choose a challenge to work on daily--something that couldn't potentially be finished by June 11. I gave the example of the guy who undertook a yearlong photo-a-day challenge back when you couldn't see right away what the photo would look like; he would have to wait or hope for the best moment of each day to capture. This kind of thing makes you appreciate the diligence and discipline that all good ideas require, and was just what my little guys needed.

So after ruling out some finishable ideas, we came up with these:

  • Theo (age 10): write a story. I read the beginning, which reminded me yet again that the kid has a gift. He has an innate sense of the rhythm of words, and this is something that comes only with voracious reading (yes, I know), and even then, not always. I love seeing him huddle over his little desk.
  • Simon (age 13): read the 754-page Team of Rivals. Definitely not finishable by the end of June, though Simon will often willingly work past our allotted time. I started a blog for him so that he'd also have to summarize what he read. I'm quite amazed at the retention going on. The kid reads constantly, but he's not the kind of A student you figure is storing all the info. But he is, and he can summarize it in a fun way. Go see, and leave a comment to totally make his day:
  • Me (age 43): study the topic of muscle tension and trauma therapy. See my previous post for details.
Each day this month, we set aside at least 30 minutes to work on these ideas. Some of that, for me at least, involves staring out the window; even then, I trust we'll all learn, or remember, that part of success at anything is just showing up. What's best, though, is seeing the creative afterglow. Even though they know I bought a little prize for each of them for the end of June, this sense of accomplishment is almost reward enough.

Sunday, June 8, 2014

Tension Relieves Tension: The June Project

Two memories: one, twenty minutes into meditation at a Buddhist temple, thinking, "Jesus, my legs hurt," and two, seeing stars during a session of Christian contemplative prayer. Pulsing, color-changing stars, so fascinating that I knew I was about to either go unconscious or fall over; I opened my eyes and there was the teacher, sitting up but fast asleep.

Meditation, prayer, relaxation--each person holds their own interpretation, but typically, these would involve quiet and calm. If I say I'm stressed, you say take a day off and sit by the lake. If I'm stressed and want to exercise, you say yoga. Indeed, these activities contain qualities that would soothe the maddest of souls; I've always thought that the primary reason people come out of a yoga session feeling wonderful is not due to the downward dog, but to the deep breathing. Who takes the time to breathe fully during a busy day?

But as my memories indicate, I've never been good at traditional calming down. There's an element of attention deficit here, for sure, as evidenced by my behavior during a recent performance of St. Matthew Passion, which will forever threaten to end my marriage. ("I don't need to defend Bach," said my weary husband.) But look at the activities I've chosen as hobbies--boxing, powerlifting--which make you stop and say hmmm. I do a good deal of sitting in a chair looking out the window, but to truly reset myself, I pick up heavy things and put them down.

So when I picked up Babette Rothschild's 8 Keys To Safe Trauma Recovery by chance--the library had set it out as an unpopular pick, about to be thrown out, and I was preparing to moderate a session on writing about trauma--one chapter caught my attention.

Called simply "Get Moving," this section purposed to detail the positive benefits of exercise for trauma recovery. Usually I'd bypass these sections, because as a personal trainer I've heard it all before; it's preaching to the choir for me to read about boosting serotonin, self-confidence, and healthier blood levels. Exercise is all it's cracked up to be, everyone knows as much--trick is, the theories only apply if you actually do it.

But then I read this section:

Muscle tension is an underrated ally. While relaxation can be valuable at times, without muscle tension you would be unable to stand, walk, sit, or hold this book in your hands... Though most people would assume relaxation is the state that helps trauma recovery most, a good portion of traumatized individuals do not do well with relaxation. In a relaxed state, they may actually become more anxious or even panicked.

Rothschild goes on to describe several cases in which the client attempted relaxation techniques but remained paralyzed by anxiety (one woman's symptoms actually worsened). Once she got them lifting weights or even assuming a steadier posture, their lives turned around. "When they were physically stronger," she writes, "they became emotionally stronger, as well."

The mind-body connection has always fascinated me, especially in my theatre practice. Seeing homeless men, in character, stand tall and confident always made me wonder if posture and strength was a key to self-esteem and, in turn, to their own success. Reading The World's Strongest Librarian by Josh Hangarne, who manages his Tourette Syndrome with kettlebells and heavy lifting, showed yet another winning model.

The examples are endless, but for now, I'd like to delve into this subject through Rothschild's work. Her book The Body Remembers should be arriving here soon, and just in time: my kids and I are embarking on what we call The June Project, in which we take a half hour each day to pursue a goal.

This is mine: to understand how muscle tension can relieve emotional tension. How tension can help us relax--my own little self-assigned dissertation, as it were. Come along on this journey and leave all your worries behind.