I’ve been experiencing an increase in some of my chronic symptoms of dryness in the past few weeks, some of which have been excessive and unexplained. I realized a few days ago that some of these symptoms were spiking because of traumatic events from my childhood. In other words, my symptoms in the present are being influenced by experiences from the past. This is actually more common than we realize and I want to show you how my symptoms represent a subtle and difficult-to-recognize version of a trauma response. It’s like the winter apple you see on the tree in February that is an almost unrecognizable version of its former self. It has been influenced by the weather. Note* (1)When you hover over images you will see descriptions and metaphors in all but the first image
What I find helpful with this perspective is that when we recognize such patterns it gives us something we can work with to begin to address and work with symptoms.
The Trauma Pattern
I. Present Symptoms
I’ve been able to attribute most of my symptom exacerbations of recent weeks to certain foods I’ve experimented with after a year on GAPS and to a try-out with a mini trampoline (4 minutes was too much). Writing about the 10-year course of my symptoms of dryness in the last post was also a trigger and I experienced the onset of hemorrhoids the day I began to write. The small area that was affected persisted for 3 days, to my disbelief, and then resolved within hours of publishing the post. I’m slowly learning that this is not a coincidence, but a change of physiological state.
I’ve had other symptoms in the 2 weeks since that post which have also seemed excessive (a day of bladder irritability and small amount of blood in my urine (cystitis); a non-painful, non-infectious red-eye with no vision changes, which can be seen with some autoimmune diseases; and a recurrence of pain in my left shoulder and neck). I’ve had all of these in the past but very infrequently and not in a long time. I began to feel irritable and felt frustrated, and powerless in the face of these unexplainable spikes. I was also afraid they would worsen. After a few weeks I noticed a shift from frustration to a depressed exhaustion and my limbs became extra heavy during my afternoon naps. For a couple days earlier this week I noticed the desire to just stay in bed (I didn’t) and that I had lost my creative impulse (I had no desire to write a blog post). This sequence – from irritability and fear, to powerlessness and frustration, and then to exhaustion – is a sequence you see in trauma. Each shift represents a change of physiological state rather than a random set of unexplainable symptoms.
II. The Present Situation
I have a series of lab tests to complete following an appointment with a new doctor 2 weeks ago. I’ve had to wait for the kits to arrive and for a specific day in my menstrual cycle, so the process has taken longer than usual.
The new doctor I am seeing was kind and connecting, knowledgeable and spacious, and I’m consulting her out of curiosity (rather than from a place of stress or distress, which could certainly have exacerbated my symptoms). Given the years of experience I have with my illness, I’m not expecting any cures or magical solutions, but perhaps she’ll be able to suggest treatment that supports the other things I’m already doing. I was a little anxious, which is normal for me, but I wasn’t afraid of her opinions or her initial treatment suggestions. And although I don’t like getting my blood drawn, I’m not particularly anxious about it.
But the fact is that some part of me IS afraid.
A conversation with David on Tuesday night helped me recognize this. What I started noticing as we talked was the part of me that does not trust the medical system. Or doctors. Or what will be recommended if I have any abnormal lab results. Some part of me does not feel safe or empowered within the medical model. Or its perspectives.
While some aspects of these fears are based on my experiences as a medical doctor, chewing on this with David helped me realize that it was more than that. I found myself noticing a sense of feeling alone, which I hadn’t been aware of. When I stayed with this initial and unexpected insight an image emerged. It had nothing to do with David or having to go to the lab by myself, but with the time I was hospitalized as a child and felt completely and utterly alone.
II. The Past
Hospitalization can be Traumatizing
The images that emerged in my talk with David were of the time I was hospitalized for asthma around the ages of 5 or 6. The internal snapshots I still see most vividly include a large white-walled ward of empty cribs with metal bars. I see it as though from the ceiling near the doorway and I have the sense that all the beds are empty except for one. That little girl who is me is all alone. In another image I see a little girl in a wheelchair returning from Xray. Also me. Also alone. And every image is filled with straight lines. The walls, the corners, the doorways. The shiny rails on the cribs. It is Institutional. Sterile. Cold. And lonely.
I have no memory of my parents visiting me during that stay. It’s possible that I was too distressed to have noticed them. It’s also possible that they could not spend much time with me as both were working and visiting hours were probably significantly restricted in those days.
My perception of the experience is one of almost complete isolation except for one tender memory. I remember a kind brown-haired nurse reading a book to me. I see a large friendly striped snake on the pages, hanging down from a tree and talking with a few of his friends. Even now, it evokes a feeling of sweetness and comfort. Connection. I have a sensation of warmth in the left side of my belly. The memory conveys a sense of safety that was likely only a small part of my experience at the time but that served as a resource. A “buffer.” (For more on these theories see the Chronic Illness Model). (2)When working with trauma there are usually moments like this of peacefulness, tenderness or pleasure. You discover these when you explore and slow things down or work through a difficult place. States of dissociation are common in trauma and tend to feel pleasurable. So do experiences of connection and safety.
Hospitalization is an underestimated source of trauma in a child’s life, as described by social worker James Robertson in the 1940s and 50s (3)see more on wiki:
When James Robertson first entered the children’s ward to make observations, he was shocked by the unhappiness he saw among the youngest children … The competent, efficient doctors and nurses gave good medical care but seemed unaware of the suffering around them. They saw that children initially protested at separation from the parents, but then settled, becoming quiet and compliant. … Robertson saw this as a danger signal.
Hospitalized Children and the Trauma Response
From a trauma perspective, the process of protest described by Robertson is what healthy children unconsciously resort to. It is a natural expression of anger and the fight response. The quiet compliant state reflects a giving up, which is what happens when it is impossible for a child to get what she most needs – the comfort and safety of her parents. The state of giving up represents the trauma reaction of last resort called the freeze response. This is the trauma response you see in the post about trauma therapy with a dog named Kane.
Seeing the hospital ward as though looking at it from the ceiling is a sign of dissociation. It tells you that an event is so overwhelming and inescapable that freeze (dissociation) is the only recourse. Many people who have experienced abuse, especially in childhood when we are the most vulnerable and powerless, have also had a sense of watching things happen as though from a distance, often as if watching from the ceiling. This is a way that our nervous systems protect us from feelings too overwhelming to tolerate or manage.
Asthma as a Traumatic Event
An asthma attack can be a life-threatening event. I remember long nights, and times when I had to stop and kneel in the school entryway when everyone came in from recess, when all I could concentrate on was getting my next breath. My ribs would be sore the next day from having worked so hard and for so long for each breath.
Having health crises severe enough to require hospitalization is a potentially traumatic event that involves an experience perceived as life-threatening and inescapable. This is one way in which an asthma exacerbation, in and of itself, can be traumatizing. In addition to asthma this may occur in other situations, such as with cancer or in type 1 diabetes with very low (hypoglycemia) or high blood sugars (ketoacidosis) as easily as in a severe accident and with other experiences.
Symptom Spikes as a Trauma Response
It’s interesting to think that the spikes in my symptoms of recent weeks may have been triggered by an unconscious association between the traumatic, medically-related event of hospitalization in my childhood and a simple series of lab tests in the present.
This is how trauma works. It occurs outside of our conscious awareness and is expressed through symptoms of unresolved defenses of fight, flight, and freeze. The triggers can look trivial and seem very unrelated. Like the frozen winter apple that bears little resemblance to its former crunchy self.
Dryness: a Symptom of Fight and Flight
Fight and Flight are the way the sympathetic nervous system (SNS) protects and defends. In normal life, feeling anxious when preparing to give a speech makes many of our mouths go dry. This is a healthy component of the sympathetic nervous system response. I believe that my own symptoms of dryness reflect unresolved patterns of SNS activation. My irritability, frustration and fear associated with the past few weeks may have been a reaction to my symptoms, but more likely were an activation of my unresolved traumatic SNS response. This pattern of nervous system activity was triggered in reaction to the upcoming medical tests and I suspect this is why I had such odd spikes in my symptoms.
Fatigue: a Symptom of the Freeze Response
My couple days of exhaustion and depression with low motivation, heavy limbs, and lack of creative impulse are a reflection of a freeze response. They may have been triggered by the pending lab testing. They could also have been triggered following a few weeks of unsuccessful fight and flight: unsuccessful because it couldn’t help me resolve my symptom spikes and possibly also unsuccessful in avoiding a medical appointment, even though I had scheduled it out of curiosity and not out of fear. When fight and flight are unsuccessful, our nervous systems give up and resort to shutting down and immobilizing.
Clues that Symptoms and Trauma are Linked
The links between present symptoms and trauma from the past are not always clear, but there are clues that help us see patterns in our symptoms. Recognizing the patterns can be part of the process of healing.
The speed with which symptoms can sometimes begin and resolve, give us clues. A telling sign that my symptom exacerbations of exhaustion were a trauma response is that they started to improve within a few minutes of deciding to follow an impulse for pleasure (I realized I wanted to watch an empowering, connecting movie I’d recently seen with David called “How to Train your Dragon“). When I felt the impulse to watch the movie and imagined Hiccup, the main character, connecting with his dragon, something softened and melted in me. It was immediate. The hard edges of despair and physical fatigue softened a little and proceeded to lift a little more when we watched the movie. My nap the next day was no longer heavy limbed. And I was excited about getting started on this blog post. Emotional connection, which was a key component of this movie for me, makes us feel safe. It is a nervous system response that can shift us out of freeze as well as out of fight/flight. If I’d been exhausted from overdoing, it would have taken me more than a few minutes to recover.
A similar clue to the role of a trauma response in my symptoms occurred when my hemorrhoids resolved within hours of publishing the last post.
When I had the sense that I felt alone when thinking about my upcoming lab tests it was unexpected. Being surprised by an insight is a good indication that we are not trying to figure something out or fit a square peg into a round hole to explain our symptoms out of sheer desperation or need. When I saw the image of my hospitalization I felt a subtle sense of relief. It’s a feeling that arises when we come upon the truth. The truth, even when painful, can be settling. Calming. I felt less worried about my symptoms and immediately gained a little distance, perspective and curiosity. These are indications that we are no longer completely caught in a trauma response.
The Trauma Response is not “Psychosomatic”
I believe that the freeze response creates physiological changes that make some of us with chronic illnesses of all kinds feel tired, whether this is through adrenal fatigue, mitochondrial dysfunction, reduced oxygenation or any multitude of other ways, just as it creates the death-like physiological state of freeze in the opossum. These processes are real. They occur outside of our awareness and reflect unresolved patterns of nervous system regulation. Although they involve mind and body because emotions and physiology are both affected by traumatic events, they are not “psychosomatic” as we’ve come to use the term.
The lack of objective tests to document symptoms does not mean an illness doesn’t exist. It reflects the fact that we do not understand the causes and processes enough to know what to test for. Difficult and disabling symptoms of chronic illness, chronic pain, and other unexplained symptoms are not willfully created. They are not the result of “malingering,” and are not an attempt to get attention. They are not “all in our heads,” but “all in our brains.”
I’ve been working with my symptoms using a variety of tools in the past couple weeks (see more in the post on 10 under-utilized tools for treating chronic illness):
Mindfulness. I try to be as curious about symptoms (as much as I’m able, although I’m not always successful!) and to watch and learn from a place with as little judgement as possible. Combined with a conversation with David, this is what helped me eventually recognize the links between my symptoms and past events. Mindfulness is helpful for gaining a sense of distance from trauma and symptoms without dissociating into the freeze response of depression or being overwhelmed from sitting within the intensity of the original unresolved emotions of fight and flight.
Meditation. I’ve meditated for an hour about 5 or 6 times in the past few weeks, usually when I’ve had an active symptom, such as first thing in the morning when I awoke with an aching bladder and at dawn another day when my dry eye was actually red and inflamed.
I’ve been using meditation as a way to sit with fear and discomfort, which is so common when working with symptoms. It helps me choose my actions (or nonaction) from a place of choice rather than reactivity. This is what Cesar is doing with trauma therapy when he stands next to Kane in a calm, quiet way while the dog’s fear cycles through. Although my bladder ached intermittently during the first day, it improved with meditating and resolved more quickly than in the past when it has been irritable for days or weeks. To my surprise, the redness in my eye resolved during the hour that I meditated, when it has lasted for half a day or a full day or more in the past.
Pleasure. Our nervous systems are designed to alternate between activity and rest, activation and recovery. This is how our bodies are set up to recover from trauma. When trauma goes unresolved it’s because we’ve gotten stuck in survival mode and in places of fear and reactivity or freeze. Allowing ourselves to follow impulses for pleasure helps our nervous systems shift when they get stuck. Trauma is a common occurrence with being human. Our abilities to fight, flee and freeze are designed to maximize our chances of survival during impossible situations. And like other animals, we are also designed to heal from it.
Working with Trauma & Buffers. I could have seen a trauma therapist to work with this specific event from my childhood (such as EMDR, Somatic Experiencing, and Sensorimotor Psychotherapy – see links on the FAQ page) but instead I used skills I’ve been slowly developing over the years with trauma therapy I’ve already done. In addition to the other tools I describe in this section, I spent 5 to 10 minutes letting myself “look” at the resourcing images of the nurse and the snake and noticing what feelings emerged. Giving ourselves time to flesh out and taken in the resources we DID have during a traumatic event is an important aspect of resolving trauma. Letting my body experience the sensations of safety, tender kindness and connection is a way of letting my nervous system recognize more fully and concretely that I really was okay. And that I survived. This is the beauty of the often hidden “buffers” and resources in our lives and during difficult or traumatic events (see more about buffers in The Chronic Illness Model).
Acupuncture and Craniosacral Therapy. I saw my acupuncturist to help minimize the impact of my symptom spikes and did a craniosacral session as a way of supporting my ability to stay open, curious and less reactive.
Writing. Writing about my experience in this blog post has felt empowering and given me a way of relating to the past and present. Writing sometimes helps me watch a little more easily from the place of a calm observer, which gives me a little distance and curiosity about the process. Telling our stories is one way of mobilizing around experiences where we have gotten stuck or frozen (4)Pennebaker, J.W., S.D. Barger, and J. Tiebout, Disclosure of traumas and health among Holocaust survivors. Psychosom Med, 1989. 51(5): p. 577-89.
Diet. I saw more clearly this week how I am not yet ready to introduce new things into my diet or to try to add more intense forms of exercise. I also saw the benefit of changing how I eat in the past year. It’s been a way of reducing the overall stress on my system. This may be making it easier to identify symptom exacerbations and triggers because my baseline of symptoms is not as severe and ever-present as it used to be. I would also guess that my inflammation is decreased and that my body is more nourished, enabling my body to shift out of states of physiological reactivity more easily when triggers occur.
Take Home Points about Symptoms and Trauma
- Symptoms represent physiological states of unresolved fight, flight, and freeze.
- Symptoms reflect a chronic trauma response in disguise.
- If unresolved trauma influences chronic illness, working with trauma should be an important treatment tool (5)You can find a list of different approaches for working with trauma, and links to practitioners around the world, on the FAQ page.
- Links between present day symptoms and the original traumatic event(s) can be difficult to recognize.
- The way symptoms present, exacerbate and resolve give us clues to their cause and origins.
- Images, sensations and impulses related to symptoms help identify, and address, underlying traumas and triggers.
- Symptom triggers can become increasingly subtle with time.
- The trauma response – and symptoms – can be triggered by present events even when there is no threat.
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References [ + ]
|1.||↑||When you hover over images you will see descriptions and metaphors in all but the first image|
|2.||↑||When working with trauma there are usually moments like this of peacefulness, tenderness or pleasure. You discover these when you explore and slow things down or work through a difficult place. States of dissociation are common in trauma and tend to feel pleasurable. So do experiences of connection and safety|
|3.||↑||see more on wiki|
|4.||↑||Pennebaker, J.W., S.D. Barger, and J. Tiebout, Disclosure of traumas and health among Holocaust survivors. Psychosom Med, 1989. 51(5): p. 577-89|
|5.||↑||You can find a list of different approaches for working with trauma, and links to practitioners around the world, on the FAQ page|