Trauma & Art

Health continued….

Health, freedom and wakeful presence       

 “Ultimately, healing flows from within. The word itself originates from “wholeness.” To be whole is much more than to experience the absence of disease. It is the full and optimal functioning of the human organism, according to its nature-gifted possibilities. By such standards, we live in a culture that leaves us far short of health.” Gabor Mate. M.D.

In the previous post I referred to an article by Dr Gabor Mate, in which he writes that ‘the separation of mind and body is an erroneous view, incompatible with science. Personality traits—that is, psychological patterns—conduce to disease because the brain circuits and systems that process emotions exert a profound influence on our autonomic nerves, as well as our cardiovascular, hormonal, and immune systems: In reality, they are all conjoined. The recent, but no longer new, discipline of psychoneuroimmunology has delineated the many neurological and biochemical mechanisms that unite all these seemingly disparate systems into one super-system.” He also cites a report in Science Daily from the University of Virginia: “In a stunning discovery that overturns decades of textbook teaching, researchers have determined that the brain is directly connected to the immune system by vessels previously thought not to exist. The discovery could have profound implications for diseases from autism to Alzheimer’s to multiple sclerosis.”

Unresolved trauma also impacts our development and health in the present and in the years to come. This would seem common sense, but there is also a lot of scientific evidence today of the deleterious impact of the residual effects of trauma across generations. Post traumatic stress symptomatology is only one cluster of issues that are often conducive to other health problems like autoimmune conditions. Gabor Mate writes: “It is impossible to overstate the impact of childhood trauma on adult mental and physical health. Myriad studies have demonstrated that early-life suffering potentiates many illnesses, from mental diseases such as depression, psychosis, or addiction to autoimmune conditions to cancer. One Canadian study demonstrated that childhood abuse raised the risk of cancer nearly 50 percent, even when controlled for lifestyle habits such as smoking and drinking.”

Therefore, it is probably wise to bear in mind that most symptoms or health conditions are usually caused by multiple factors, and thus, need to be investigated and tackled through different routes and complementary approaches. When we view all our experience, our bodily organs and functions included, as complex, interconnected and embedded, a holistic approach seems to be the more reasonable and effective way to address things. Our environment influences our physiology, which in turn influences our mental states and psychology and vice versa; so, isolating symptoms or problems doesn’t help us get to the root causes, and as a result, rarely resolves a problem. What usually happens is the management of symptomatology or decrease of intensity of an experience, and often an unresolved condition or symptom mutates into something else creating vicious cycles as time goes by.

The complexity and interconnectedness of our living experience and the fact that presenting symptoms can be the result of many factors seems to require a more open minded and a multi-faceted approach. Health and wholeness are dependent on healthy nutrition, an environment free of toxins and pollution, non toxic relationships, resolution of old traumas, a sense of belonging, safety and freedom, and more. Often life and dietary changes and our own informed and empowered involvement in our healing are required if we want more than symptoms management. We need to keep an open mind, and also, become more informed and connected to our intuition when it comes to our health. While we seek professional assistance and guidance, we need to also bear in mind that giving our power away to authority of any kind is not necessarily a wise or safe approach.

Dr Kelly Brogan, whose book I am engaging with currently, describes how textbook mental symptoms or disorders can actually represent ordinary physical imbalances that are routinely undiagnosed or misdiagnosed. She writes: “They are what I call the psychiatric pretenders, five physiologic conditions that can leave you with symptoms that are indistinguishable from depression and other so called mental disorders……..” These five pretenders are thyroid imbalances; gluten and dairy sensitivity; blood sugar instability; effects from medications and vitamin B12 deficiency. In relation to B12 deficiency Brogan writes: “Here are some of the reasons that vitamin B12 is so important: B12 supports myelin, the sheath around nerve fibers that allows nerve impulses to conduct. So when this vitamin is deficient, it’s suspected of driving symptoms such as an impaired gait, loss of sensation, signs of dementia and even multiple sclerosis. But what about B12’s role in psychiatric symptoms such as depression, anxiety, fatigue, and even psychosis? The role of Vitamin B12 in neuropsychiatric syndromes can best be explained by two basic biological mechanisms: methylation and homocysteine recycling….”

In relation to thyroid imbalances Brogan writes that an unbalanced thyroid and not unbalanced brain chemicals is one of the most common “pretenders”, particularly in women today, and that hypothyroidism (an overwhelmed and thus underperforming thyroid) is one of the most under diagnosed conditions…… She suggests that “the vast majority of symptoms that occur with a thyroid disorder could easily come under a “depression” diagnosis. Most of us never think about our thyroid, but this butterfly-shaped gland located at the base of the neck has important functions, including playing a key role in metabolism, digestion, elimination, appetite, energy, temperature, sleep, and mood. Hypothyroidism occurs when the thyroid gland is underactive because of nutrient deficiency or inflammation and doesn’t produce enough thyroid hormone. …….This conversion to active thyroid hormone is dependent on specialized enzymes, optimal cortisol (your stress hormone), and certain nutrients such as iron, iodine, zinc, magnesium, selenium, B vitamins, vitamin C, and vitamin D. In our fast-paced, nutrient-depleted world filled with toxic substances, this one hormonal conversion step alone can be easily impaired. And while you may not feel the attack in your thyroid per se, you’ll definitely feel it in your mood, energy, and cognition. When the thyroid is responding to stressors, you can experience an array of depression like symptoms, including fatigue, constipation, hair loss, low mood, foggy thinking, feeling cold all the time, low metabolism, weight gain, dry skin, muscle aches, and an intolerance for exercise. You’re wearing socks to bed, pooping only once a week, and penciling in your eyebrows because the hair has gone missing. And then there’s the special consideration of postpartum thyroiditis, a condition that 10% of women develop after delivery.”

Kelly Brogan describes her own experience of postpartum thyroiditis: “It’s a condition that I was diagnosed with nine months after the birth of my first child, and one that invited me to reexamine my lifestyle, and then later my entire life. This is whole-person medicine. ………” She also discusses hyperthyroidism and presents a case study related to of a woman who was confronting surgery. Like Hashimoto’s, Graves’ disease is an autoimmune condition in which the immune system responds to perceived danger by hyper-stimulating the thyroid gland. She writes: Natascha came to me for relief from the following symptoms: night sweats, hair loss, tearfulness, forgetfulness, palpitations, weight loss, agitation, low libido, and vaginal dryness. She also reported one to two months of very low mood and hopelessness. My prescription? An anti-inflammatory/ ancestral diet, advice to minimize toxicant/ environmental exposures, and encouragement to eat natural fats for brain support…..”

But a more holistic health approach requires cultures and contexts with more respect for alternative perspectives and new findings. It also requires courage to step out of the frame or not be so over dependent on prescribing pharmaceuticals only or removing organs. Gabor Mate writes: “If we wish to take full responsibility for health in our society, we must not only be vigilant guardians of our personal well-being, we must also work to change structures, institutions, and ideologies that keep us mired in a toxic culture.” It is the same in families, at work and educational contexts. But by stepping out the box we come up against a certain status quo. It can be scary. We can experience reactivity, ridicule or pushback in any context, where we may have a different take on things even when it comes to our own health and bodies. Increased awareness over the levels of democracy and freedom operating in any context can safeguard us, and also, allow us to move with more freedom and make the choices that can facilitate smoother coexistence, as for instance, in a work or class context that we are not ready to leave, while also, work to change things. Being aware of power structures and limitations in how much we can be, say or do at any given moment or how much another can deliver, embrace or tolerate gives us more freedom in terms of how we navigate situations. A wakeful knowing allows us to set boundaries and protect ourselves, but also, make sounder and more courageous decisions.

I know from personal experience that had I been more awake and less exhausted and worn down in a somewhat recent educational environment. I would have been better able to not only observe deficits of freedom and democracy in terms of tolerance of ideas that were perhaps deemed less conservative or deviating from the status quo, but more importantly to not underestimate the potential consequences that could derive from those particular dynamics. From a place of wakeful knowing I could have decided on the best route. Being more awake could have assisted me not only in “gauging” the levels of freedom and openness of the environment, but also, in evaluating if “upsetting” people around ideas like aversive and unconscious racism and biases, or the importance of visiting early trauma or references to indigenous people and soul wounding or the body’s capacity to heal, were in the end worth the hassle and if it served my health, long term plans and life purpose. Residing in a more integrated and wakeful state might have protected me from the consequences of over-estimating the breadth of freedom and democracy that was truly available and allowed me to be flexible and fierce, at the same time.  I read somewhere online that ‘Nice loses in academia, not because one needs to be mean, but because one needs to be fierce.“ Unfortunately, integration and wakeful presence are processes and states that require and conduce readiness, knowing, guidance, support, time, clarity and healing.

References:

Kelly Brogan, M.D., 2019, Own Your Self, Hay House, Kindle Edition.

Gabor Mate, M.D, article from https://www.yesmagazine.org/issue/good-health/2015/11/16/gabor-mate-how-to-build-a-culture-of-good-health/

Songs, Polyvagal Theory and inner critters

1. “Some have likened the mind/brain to a kind of committee. Frankly, I think it’s more like a jungle! We can’t get rid of the critters in there………. but we can tame and guide them”  Rick Hanson, PhD

“…….. if you want to help yourself feel less concerned, uneasy, nervous, anxious, or traumatized – feelings and reactions that are highly affected by “reptilian,” brainstem-related processes – then you need many, many repetitions of feeling safe, protected, and at ease to leave lasting traces in the brainstem and limbic system structures that produce the first emotion, the most primal one of all: fear. Or to put it a little differently, your inner iguana needs a LOT of petting! ……… So be aware of the ongoing background trickle of anxiety in your mind, the subtle guarding and bracing with people and events as you move through your day. Then, again and again, try to relax some, remind yourself that you are actually alright right now, and send soothing and calming down into the most ancient layers of your mind.

Also, soothe your own body. Most of the signals coming into the brain originate inside the body, not from out there in the world. Therefore, as your body settles down, that sends feedback up into your brain that all is well – or at least not too bad. Take a deep breath and feel each part of it, noticing that you are basically OK, and letting go of tension and anxiety as you exhale; repeat as you like…..  Throughout, keep taking in the good of these many moments of petting your inner lizard. Register the experience in your body of a softening, calming, and opening; savor it; stay with it for 10-20-30 seconds in a row so that it can transfer to implicit memory…….. Some have likened the mind/brain to a kind of committee. Frankly, I think it’s more like a jungle! We can’t get rid of the critters in there………. , but we can tame and guide them…….” From Just One Thing (Rick Hanson)

2. “We can create environmental or social structures that mimic a mammalian idealized model versus mimicking a reptilian model because a reptilian model is going to create isolation; it’s not going to foster boldness. A mammalian environment will be empowering of others, more of a shared environment, and have more empathy and care for others”  (http://stephenporges.com/images/nicabm2.pdf)

Hiding in Plain Sight: Polyvagal Theory in Contemporary Song Lyrics by Stephen Porges, PhD, at: https://www.youtube.com/watch?v=CXezqZj-Jr4

“Polyvagal” by Alice Minguez at: https://www.youtube.com/watch?v=MsWe1lmCY_c

Brief notes on polyvagal theory and trauma responses from an older post (11-1-2016)

Significant advances in neuroscience have taken place, which have shown that humans like other animals respond to incoming stimuli with relatively predictable behaviours and responses, and that under stress or threat, people will resort to more primitive defences. During trauma, attack or threat the natural interaction and flow of the body is disrupted because the system initially gets into a survival mode ready for fight or flight. When there is no possibility for fight or flight, people freeze, like an animal caught in the headlights. Our fourth survival mechanism is to faint and go to a partial paralysis. Unfortunately, prolonged trauma or stress can turn these responses on all the time or way too often, with detrimental effects for our bodies and lives. Trauma is about past learning and top-down processes hijacking our bottom-up processes. It is about past experiences influencing our evaluation and understanding of new incoming stimuli. People who have suffered trauma often automatically respond to trigger-situations that remind them of past events with responses they had engaged in during trauma, which may often be inappropriate and self-sabotaging. Pat Ogden writes ‘survivors may be competent and focused most of the time, but they may suddenly collapse into primitive and inflexible states of immobilization when confronted with situations that remind them of the past. Some may remain aware of what they are feeling, what is going on around them, about potential escape routes, and physical impulses to protect themselves, whereas others space out and lose contact with both their internal sensations and what is going on around in their environment’.  Trauma impacts health tremendously and makes us more vulnerable to physiological dysregulation. Trauma is all about our physiology, and  as Pat Ogden writes survivors’ symptoms tell their story.  Stephen Porges’ polyvagal theory enhances our understanding of how our nervous system responds to threat and trauma and stresses the importance of physiological states in understanding the mind.

Stephen Porges found that there are actually three autonomic nervous systems or circuits –not two as previously believed. The autonomic nervous system mostly works without our control and it regulates functions, such as breathing, digesting food, heart rate. It also responds to trauma and threat. At this point it is necessary to expand a bit on the term autonomic. Stephen Porges writes that the term autonomic dates back to the 1900s, but ‘our new mammalian autonomic nervous system has a whole new component of voluntary input’. He claims ‘it’s not simply autonomic meaning automatic – it’s really a hybrid system that as we get more mammalian, we’re using more voluntary or higher brain structures to choreograph how our visceral systems work’. What this practically means is that we can change our breathing, control what is coming out of the mouth or in it, turn on our cortex and calm the limbic area of the brain, diffuse pain, soothe our digestive system, etc. Porges further states that the acoustic environment, what we listen to, can impact and alter our physiological state through neural regulation of the middle-ear muscles. He refers to the findings that trauma survivors describe hypersensitivities to sounds and vibrations that others do not feel. They also avoid crowded places like malls or supermarkets, etc. He explains that our nervous system has evolved to pick up and interpret certain features in the environment like acoustic features or gestures in order to evaluate risk.

However, a great part of this interpretation is not on the level of cognitive awareness. So, Porges and other neuroscientists, physicians and therapists believe that when people become aware that the body reacts and colours their perception of the world, this knowledge will inform their life narrative, and can potentially allow change to take place. He goes on to provide a personal example of how his decision to have an fMRI brought on a panic attack making him aware of a vulnerability he was not previously aware of and how understanding this resulted in his not subjecting himself to a state of immobilized fear, but finding a way to deal with the situation constructively. So for instance, having a stomach ache may not be the result of gastric distention, but might be triggered by context and environment. Past trauma and learning may be triggering physiological reactivity and causing us symptoms that we are unaware of. Porges believes that if people become knowledgeable about the features of their body’s responses, which involves their being aware of their subcortical reactivity then the higher cortical areas of their brain can start inhibiting them at a natural level. Knowledge of how our body works and of our mental beliefs can shape our physiological responses. Dan Siegel writes that reframing stress alone ‘can alter the biological effects of stress by harnessing more flexible neural circuitry than reactive brainstem systems utilized to deal with threat, which means the ability to know one’s own mind – to have mindsight abilities – can help us change the physiology of taxing experiences. He suggests that through interoception, which means perceiving within, we can gain access to our body’s wisdom.

So as mentioned above, the ANS has in the past been conceptualized as consisting of two branches the sympathetic that activates fight-flight responses during threat and the parasympathetic nervous system, which refers to a calm state. However, Porges views the ANS as three hierarchically organized subsystems that determine our responses to environmental stimuli. Polyvagal theory consists of the word ‘poly’ that means many and vagal, which refers to the vagus nerve, a big cranial nerve that exits from the brainstem and sends information about the organs in the body to the central nervous system. The vagus nerve is part of the parasympathetic nervous system, but it can also shape the sympathetic and it regulates inner body feelings, pain thresholds, cortisol level secretion, the heart, face, lungs and abdominal viscera. Stephen Porges writes that ‘the vagus nerve directly supports the behaviours needed to engage or disengage with the environment’ (cited in Bridges, 2015) and if it is left on too long it can potentially lead to anxiety, discomfort and pain, insomnia, digestive problems, and many other health issues.

The three circuits/ subsystems of the ANS are the a) ventral parasympathetic branch of the vagus nerve (social engagement), which corresponds to optimal arousal b) the sympathetic system (mobilization), which corresponds to hyperarousal, and the c) dorsal parasympathetic branch of the vagus nerve (immobilization), which corresponds to hypoarousal. The most recent uniquely mammalian subsystem is the ventral vagus, which originates in the brainstem and determines the person’s consciousness. Porges calls this system the social engagement system, because it provides us with the capacity to communicate more flexibly and it regulates areas in the body, like the heart and the muscles in our face and head that are used in social interaction, without mobilizing our more primitive defensive responses. Others have referred to our capacity to tend and befriend, in times of stress, which elicits oxytocin release and activates the social engagement system that is embedded in our mammalian brain. This circuit has the capacity to down regulate stress responses. Stephen Porges writes: “The social engagement features, such as, prosody, facial expressivity, gesture within a quiet safe environment provide opportunities to help soothe…… and down regulate sympathetic activity, adrenal activity.”

However, when we are threatened or stressed out and the social engagement system proves ineffective it is overridden by the sympathetic system, which activates fight-flight responses. We experience symptoms like shallow breathing, dry mouth, and our hypothalamus causes the secretion of increased levels of hormones like adrenaline and cortisol that increase arousal and facilitate mobilization. If we manage to fight or run from our predators or danger, hyperarousal may return to an optimal level once the danger has passed, but ‘mobilization is not always possible and trauma is all about unsuccessful attempts to flea or fight’ (Stephen Porges). When both social engagement and fight-flight responses fail then the other branch of the parasympathetic nervous system, the dorsal branch of the vagus nerve is triggered into action by hypoxia, lack of oxygen in the body tissues, which causes immobilization, such as feigning death, behavioural shutdown and even syncope. This mode is regulated by the oldest branch of the vagus nerve, which we share with reptiles. Immobilization, bradycardia and apnoea are parts of this older reptilian defence system. For instance, in reptiles like lizards and snakes, immobilization is the primary fear defense strategy. In this state of immobilization our body becomes slower, our digestion, bladder, bowel control, sight and vision go offline, our heart rate decreases, and we feel numb and separated from our sense of self. Reduced blood flow to the brain causes dissociative features. Therefore, ‘what we want is a state of homeostatic balance between our older sympathetic system, which gets our cardiovascular system working and ready for fight or flight, and our new social engagement system’ (S. Porges), which inhibits more primitive defensive responses and allows us to soothe our physiology and navigate ourselves out of potentially unsafe situations without shutting down and becoming immobilised.