‘The body keeps the score’, Bessel van der Kolk
(October 2013 by Tonya Alexandri)

‘Some day the body will present the bill, for it is incorruptible as a child, who still whole in spirit, will accept no compromises or excuses and it will not stop tormenting us until we stop evading the truth’. Alice Miller

I remember my shock when some years ago I finally understood why I had no memory of most of my sixth grade year and no final school report, nothing to prove that I had existed for most of that school year. It was as if I had been yanked out of my childhood and school reality for almost a year and then had been posited in another country, to begin high school. Like many survivors of childhood trauma my memory of my childhood was fragmented with gaps as if big chunks of my life history were missing. On the other hand, countless traumatic incidents stood out vividly in my mind, but they seemed to float like islands in a dark sea of painful and sad experiences. I was coping through dissociating traumatic memories and experiences, minimizing severe trauma and denying the impact of this experience, but this came at a high price because even though we may often have little or no conscious awareness of our traumatic experiences, the trauma continues to register its effects in our body. Although I coped and functioned well through partial amnesia and dissociation my body refused to be ignored, constantly reminding me of the abuse, as if the frequent physical discomfort and pains were ‘nagging at me’ to face the truth. Apart from sleep difficulties, high levels of stress and anxiety I suffered from endless alternating physical pains and aches with no organic base. The symptoms were endless and they alternated rapidly, but I endured and ignored as many as I could, having decided, that I would not allow symptoms with no organic base to determine my life. I also paid huge bills to doctors who offered no explanation or help.

My body

‘My mother knew that my stomach aches concealed small sorrows, and at such times she would let me snuggle close to her’ Kathe Kollwitz
http://www.moma.org/collection/artist.php?artist_id=3201

In early childhood bodily symptoms that disguised the abuse and despair appeared in the form of severe asthma attacks and never ceasing colds. Some theories would suggest that I had become the identified patient in the family, which would suggest that my parents focused on me to relieve their tensions and conflict, or it could be suggested that my vulnerable health had a homeostatic influence on the family dynamics. From another perspective my asthma was more like a cry for help and the direct result of the abuse and the fear, the confusion and constant anxiety I had to withstand at such an early age. Stone (2004) writes that ‘if children don’t tell with words, they tell through their behaviour’… ‘They are terrified to go to sleep, and wake up screaming from nightmares…..They develop asthma….’ Survivor, Lily Pike writes ‘all my life I suffered from frequent sore throats, laryngitis and other respiratory problems… Since I have remembered the hand around my throat that stifled my cries…….and have healed from the memory….I only rarely get throat infections or lose my voice’ (cited in Mullinar and Hunt, 1997). Researchers believe that increased stress and anxiety cause the body to release harmful chemicals that can increase inflammation in the lungs. If a child is constantly exposed to a stressful environment, this inflammation can become permanent, which can result in asthma (http://www.slideshare.net/pcawv/linkages-between-child-abuse-and-asthma-presentation-to-wvac-may-14-2013). As I grew older my severe asthma metamorphosed into laryngitis, constant colds and sore throats. Teaching long hours only seemed to exacerbate the problem and at some point, I seemed to have ‘exhausted my voice’ and I was even advised to have surgery on my vocal cords…by an eager doctor to operate. As I embarked on my healing journey and made connections between the symptoms and the memories the physiological manifestations disappeared or were drastically reduced. Later on in my life and for many years I woke up in pain every morning, feeling stiff and sore all over, which I learnt to endure or ignore and which I usually shook off as the day and I moved on. As the years went by it felt as if these alternating pains and aches had become an inherent part of me, sewn in my muscles and woven in my structure. I now know that it was my body remembering and that many of my physical pains and aches were forms of re-experiencing the trauma; somatic flashbacks, which involved physical pain and symptomatology and which were directly linked to traumatic memories.

‘Somatization’

‘What blows the mind or breaks the heart the body knows; it becomes a museum filled with artifacts from childhood’ Linda Sanford

It is now well known that trauma and abuse are physiological and psychological experiences, which impact our central nervous system and produce biological changes that have an impact on our entire physical, emotional and spiritual well being and sense of safety. Traumatic experience manifests physically in our body and ‘our body does not automatically return to normal functioning just because the trauma has ended’ (Haddock, 2001). However, this somatization of unprocessed abuse and trauma, which is the experience of physical pain or physical symptoms for which there is no medical explanation, can cause long term and debilitating health problems. This happens because when trauma occurs, the part of the brain that is responsible for recording context and making meaning of a situation shuts down, and our more primitive defenses are employed.  In other words, in order to respond to the threat, our brain turns off the thinking and remembering functions to put all its energy into survival responses. As a result, the context and narrative (story) linked to the trauma is lost, and what is left are post traumatic stress symptomatology and medically unexplained physical pain headaches, gynaecological and gastrointestinal problems, chronic muscle tension, cardiovascular problems, etc. More specifically, Herman (1997) claims that chronically traumatized people complain of numerous types of somatic symptoms, like tension, headaches, gastrointestinal disturbances, abdominal, pelvic or back pains, rapid heartbeats, nausea, chocking. Engel (1989) also posits that somatic symptoms that may be psychologically originated include sore throats, difficulty swallowing, vaginal and anal pain and infections, skin disorders, numbness or tingling in limbs. Levine and Frederick (1997) mention that ‘loss of skin sensation is a common physical manifestation of the numbness and disconnection people experience after trauma’. Sanford (2006) further claims that ‘if the original trauma involved the invasion of the body, the person may feel distinct physical pain in the injured area. It has also been found that people who suffer from PTSD may also have multiple somatic complaints and health problems. Babette Rothschild (2000) claims that PTSD is not just a psychological condition, but a disorder with important somatic components and that when healing trauma it is crucial to give attention to both the body and the mind; because traumatic events exact a toll on the body as well as the mind. In addition, there is growing evidence that stress and dissociation influence somatic experience and bodily functions and that chronic stress causes long term chemical changes within the body, which further lead to disease processes.

Bodily awareness and healing

‘Trauma is stored in the tissue of the body until the day it is expressed and resolved’ Linda Sanford

‘Body symptoms may arise from a traumatic reaction to some past event we may not remember because the effects of trauma become fixated’ and very often even if ‘survivors remember little or nothing of the events they are still plagued by physical sensations and emotional reactions that make no sense in the current context’ (Levine & Frederick, 1997; Rothschild, 2000). Also, dissociated memories have sensory, emotional and cognitive elements that may be experienced as physical. For example, ‘localized pain may depend on the reactivation of a previously dissociated traumatic memory linked to sensorimotor responses during the past traumatic experience, which caused a lack of integration of somatoform experiences, reactions and functions in the first place’ (Bob et al., 2013). So even though survivors may not have any conscious memory their health problems often reflect past traumatic experiences waiting for resolution. Therefore, understanding our physical pains and sensations is important in order to heal trauma because physical symptoms and pain are often clues about what the body has endured. Research is constantly proving that the body keeps a record of what has happened and. these research findings are influencing new therapeutic techniques that include the body so that people can begin to understand themselves, heal the trauma, feel safer in their own minds and bodies, and reduce symptoms.
Levine & Frederick (1997) highlight the significance of bodily awareness and the important role that the exploration of our physical sensations plays in understanding, healing and recovering from trauma. Van der Kolk also suggests that helping people recover from trauma needs to consist of helping people to stay in their bodies and to understand the physical sensations of past trauma that they re-experience (cited in Rothschild, 2000). Through my own personal experience of healing I have come to understand that my aches and pains actually construct a visual map of what I have been through and that the symptoms and aches across time reflect what I have suffered, as if clusters of traumatic memories manifest themselves in my body as specific physical symptoms or sensations. And it is also through the ongoing process of healing that I have learnt that I can either ignore the physical symptoms or stay with the discomfort and pains and process the surfacing material and memories, which allows me to deal with the symptoms, gain deeper insight and make links between pains, bodily sensations, emotions, thoughts and traumatic incidents. Engel (1989) suggests that the emotional and mental splitting from the body that meant survival during the abuse eventually backfires, and in order to recover, one has to re-learn to integrate the body with the mind and emotions with thoughts. In her book on the psychophysiology and treatment of trauma The Body Remembers Rothschild also claims that when trauma splits mind and body, implicitly remembered images, emotions, somatic sensations, and behaviours become disengaged from explicitly stored facts and meanings about the traumatic event-whether these events are consciously remembered or not, so healing trauma requires a linking of all aspects of the event. The implicit and the explicit must be bridged in order to create a cohesive narration of the events, as well as to place them in the proper slot in the client’s past (Rothschild, 2000).