Positive Health Online

Introduction

Trauma may result from exposure to a Traumatic Event. A Traumatic Event is an unexpected event which may be actually life-threatening or perceived to be so. Shock Trauma is an Autonomic Nervous System (ANS) response to Traumatic Event(s).

With society facing escalating violence the public are becoming more commonly exposed to highly stressful situations and the illness known as Post Traumatic Stress Disorder (PTSD) is becoming more widely known, although it has been recognised since WW1 when it was known as "shell shock".

However, Shock Events are far more common than terrorist bombs and can still have profound effects on people. Effects of shock are often missed by doctors and therapists. Such things as surgery, falls, car accidents and physical, emotional or sexual abuse, and less obvious events such as fever or poisoning may well traumatise people. Such trauma happens when the shock mechanisms of the nervous system do not return to normal homoeostatic control.

It is important to note the difference between clinical shock (the medical use of the term), where there is greatly reduced blood flow, rapid shallow breathing and danger of collapse, coma or death, and the wider definition of shock which includes the above but also a wide range of less acute symptoms, for example panic attacks, depression, hysteric states, numbness in parts of the body, amnesia, fainting, dizziness, and poor concentration.

Defence Mechanisms

There is a very ancient part of the human brain which has been termed the hind brain or "Reptilian Brain". One of its functions is to be on the lookout for danger. Incoming stimuli from the environment are checked by this part of the brain for signals that may indicate we are in imminent danger. This system operates in probably all creatures from reptiles through to humans. Put simply, danger signals put the body on alert; there are many biochemical changes happening very rapidly, many brought about by the hormone Adrenaline – there is a simple, immediate assessment of the level of danger – should we run away (flight) or face up to it (fight)? In these situations there is often an altered sense of time – it seems to slow down, probably because the responses of the reptilian brain are much quicker that our normal state of consciousness, and our metabolism is speeded up. You may have experienced this for yourself in a potentially life threatening accident - a fall or car crash, for example.

If both of the flight/fight options are blocked there is a third option – "playing dead" or tonic immobility. In animals attacked by predators this may give them a chance to escape when the attacker is not looking. Humans who have been in this situation (being mauled by a lion for example) report an altered state of consciousness - a dream-like state where they feel no pain, a detachment from the situation, to the extent that they may observe their body from a distance – an out of body experience. Whilst this process of Dissociation seems to work well for animals, it can cause problems for humans, as we will see later.

Consequences of shock trauma

Repeated exposure to situations where one is unable to react appropriately (ie flight or fright) to events which are perceived as threatening can lead to a state of hyperarousal. Also the rage or fear which is unexpressed at this time can become buried in the nervous system and may appear in full force when restimulation of the original shock occurs. In some individuals, whose capacity to deal with stress is reduced, or who are in a situation where they cannot respond appropriately, they may become traumatised. For example, most people will jump if they hear a sudden loud noise nearby. If this is repeated, and nothing untoward happens to them, their response will be "toned down" upon successive exposures to the same noise.

In individuals suffering from Post Traumatic Stress Disorder, the response to the loud noise will not reduce and may even increase. So even minor stressors may trigger the Dissociation response – the separation of different components of experience, eg thoughts, feelings, body sensation. In a way, dissociation protects one from painful, frightening or life threatening events by preventing the experiencing of the whole event. Frequently, dissociative behaviour may be triggered by seemingly trivial events which have some element which links them eg rape, surgery, lacerating wounds, dentistry and injections have a common theme of invasion of the body. So memories of a rape may be activated by a simple jab of a syringe, or worse still, the memory of the rape is not activated, but the feelings or body sensations that went with it are, and it is difficulty to connect these symptoms with the rape.

It is not difficult to see that there could be many such restimulatory events in everyday life that could make life extremely difficult for the person with Shock Trauma. A person might have symptoms, ranging from mild jitteriness to extreme fear reactions: at first sight they might seem to have severe psychiatric disorders. Indeed in severe dissociation, where the isolated ideas themselves develop into separate identities, we have the condition known as multiple personality disorder.

On a more everyday level, the doctor's surgery is crowded with people with illnesses of the digestive system, nervous system, cardiovascular system, and the endocrine system. These are potentially shock-related. Treating isolated symptoms of shock trauma will only result in the shifting of symptoms – in these cases many GPs will label patients "hypochondriac". Some clues to the presence of shock trauma are quite easy to spot with practice:

* Extreme stillness (immobility)
* Hyperactivity (tending towards fight or flight)
* Changes in the pupil (dilated or contracted, staring eye but feeling unfocussed)
* Facial changes ("stunned" look, flashes of rage)
* Paradoxical breathing (eg breathing into belly, out in chest)
* Fragmented experience

Because shock trauma involves cognitive, behavioural, emotional and biological disturbances patients ideally need to be treated by therapists who can see the whole problem or by a team of specialists working closely together. In other words, an holistic approach. Sadly this is not common, and much shock trauma goes untreated or misdiagnosed.

Shock shatters one's ordinary sense of self – one's personal bubble breaks – some people describe it as a sense of having no skin.

Like any other mammal, we respond to threats by adopting an alarm state. Our predicament as human beings is that we hold onto that alarm state and are often unable to mobilise our Flight/Fight/Freeze resources. We are often in situations where flight or fight are not options (eg a car crash) – we may then freeze (tonic immobility), which may help us to escape pain, but builds up a charge in the nervous system. After a shock event it is common to see animals shaking, which gets rid of the charge, and results in no trauma. All too often humans are unable to do this and the charge builds, the sympathetic nervous system remains activated. The neuro-endocrine axis is disturbed – the pathways by which the nerves receive information from the body and the processing of this information normally results in the return of the body to homeo- stasis. In shock trauma this does not happen and the sympathetic nervous system is dominant, with the consequent release of stress hormones over a prolonged period of time, rather than the short term, normal response – one of the consequences of this is suppression of the immune response, leaving the body more vulnerable to infectious diseases, allergies and even cancers. Another consequence is psychosomatic problems such as anxiety, phobias, panic attacks or depersonalisation or "spacing out" and amnesia.

In PTSD there is actual damage to the Hippo campus, a part of the brain responsible for our orientation in space and time. It seems that this damage is caused by sustained high levels of cortico- steroids, and may not be reversible. This is very distressing to the individual, as the traumatic event becomes "free floating" – it may attach itself to other unconnected events which have any features that may trigger the trauma.

As mentioned above, trauma symptoms divide into 2 types: anxiety/panic (including phobias and obsessive behaviour) and dissociation (spacing out, amnesia, feeling numb). Those who had the anxious reaction will tend to avoid any situation that could create anxiety, while by contrast, the dissociators tend to be drawn unconsciously into situations which reenact the original trauma.

Working with shock

Past strategies to deal with shock trauma have included Desensitisation, Cathartic release and Debriefing. Debriefing (the sharing of the story – retelling the story tends to reduce the charge attached to it) has had a limited success, but the response to Desensitisation and catharsis is poor and can sometimes create Retraumatisation. One of the problems is that shock resides principally in the reptilian brain, which does not respond well to rational argument and explanation. What it understands is closeness of other beings, safe touch and a sense of physical safety. These elements are crucial in working with shock, also a great deal of patience, for shock work must proceed slowly – attempts to push the process can lead to a worsening of the problem (retraumatisation). The result in the example given was achieved after a good deal of prior work, and represents a very simple example of shock trauma.

The primary focus of the work is always on safety. Safety with the therapist – at the very least this will mean working together for a good number of sessions to establish trust. Safety in everyday life includes what are generally termed Resources, which could include having a job, financial security, a relationship, a spiritual belief, a hobby, contacts with people and other "support systems", and this is essential before working through deep Shock Trauma. Also, safety in relationship to the trauma itself – although this sounds odd, imagine falling down on a slippery surface and breaking an ankle. The mere thought of falling could be overwhelming. The therapist must find ways of making this less threatening, by perhaps teaching them to fall from a kneeling position, or by breaking their fall with their hands. Again, all this must be done slowly, otherwise the increased stress on the nervous system could lead to an increase in symptoms and new symptoms appearing.

Sometimes trauma may radically transform a life. It is important to realise that even seemingly terrible events can have some positive aspect hidden within. It can be empowering to find new resources that may have been created by the trauma.

It is not only single, high-intensity events that are traumatic. On-going situations such as the child with the alcoholic father, or the neglected child may suffer continuous high stress levels. (As an aside I should mention that trauma in children may be doubly significant since it may have profound impacts on later life, depending on the stage in child development at which the trauma occurs.)

In situations of continuing high stress levels in child or adult it is necessary to reduce the high level of activity of the Sympathetic nervous system before attempting any further work. CranioSacral therapy seems ideal for this. It is wise to reduce this "charge" of the nervous system as soon as possible after any trauma – Bach "Rescue Remedy" or appropriate homeopathic remedies are useful "first aid" (carry them with you!). CranioSacral therapy seems especially useful in any musculoskeletal injuries, and also is especially good at releasing trauma "frozen!" in the body's connective tissues.

Another common response in Shock Trauma is Dissociation – mind and body sensations become split off from each other. It is a coping mechanism – being "in the body" can be too painful, physically or emotionally. One of the first things body workers can do is to help people regain a sense of their body in a safe environment, and to break down the whole body response, and help make this more manageable for the client. For example, the client who is "shaking all over" would be helped to discover areas of their body where they are not shaking.

People with Shock Trauma come to Therapists in a stuck place – with physical and emotional problems trapped in what could be called a Trauma Vortex a frozen part within. The task is to unravel that vortex, and release the trapped Life Energy within.

Conclusion

Shock Trauma is complex. Symptoms may be so disconnected that precipitating events may be hard to spot, and this is one area where the experience of a properly trained and experienced body therapist or body psychotherapist is important. Attempting to correct individual symptoms that are a result of Shock Trauma usually is ineffective – Symptoms recur or new ones take the place of the old.

Treatment requires slow, sensitive work over a period of time. I have been deliberately vague about techniques in this article, since application of technique without knowledge and experience can reinforce Shock Trauma. Ultimately the aim is to achieve a state where the client can have control: can experience the sensations of the original Trauma, without being overwhelmed, physical symptoms reduce or disappear, the nervous system homeostasis is restored, and memory of the event returns to the "Timeline Sense", and takes its proper place in the past, no longer haunting the present.

I wish to thank Marianne Bentzen of the Bodynamic Institute, Copenhagen, Denmark for her inspiration and teaching.