Traumatic events, such as fire, earthquake, bombing, and hurricane, occur daily. Such devastating circumstances often cause an acute reaction of fear and terror for individuals who experience them. War, rape, and physical assault or abuse, whether of a child or an adult, produce equally frightening results, known as post-traumatic stress. It occurs when traumatized individuals cannot safely assign to the past what has happened in their life. The experience of trauma undermines one's expectations of safety and security in the world. Traumatized individuals continue to be aware of what others know to be true but tend to keep hidden from their consciousness: That life is fragile and can be gone or forever changed in an instant, and that our expectation of control in the world is often an illusion.

As they struggle to make sense of what has happened to them, the majority of individuals who experience severe trauma develop such acute, short-term symptoms as sleep disturbances and physical pain. Others, unfortunately, develop chronic symptoms related to their experience of trauma. These symptoms, when they occur together, are indicative of Post-Traumatic Stress Disorder, or PTSD. The impact of such symptoms has a neurobiological basis and crosses physical, emotional, and spiritual boundaries. Such clients present significant challenges to the massage therapistŐs skills and knowledge in the treatment room.

This article examines the signs and symptoms of chronic PTSD and the role of the massage therapist in dealing with them. The overall goal in the massage treatment of PTSD is to help the client to become safely "embodied within the self." Massage therapists can teach clients safe and effective ways of self-soothing and stress management. People who have been traumatized are no longer at home in their bodies. Talk therapy alone does not always adequately address the fear and mistrust that has been encoded into their bodies. In a multidisciplinary context, massage therapy can help bring clients back into themselves by increasing their ability to feel safety and mastery in the world, to be freely curious without fear, to feel comfortable with their body, and to experience boundaried intimacy with another human being.

Clinical Manifestations

It is important for massage therapists to understand the clinical manifestations and neurobiology of trauma, in order to understand the risks and benefits which massage therapy treatment offers to clients with PTSD. Many clients have traumatic histories and exhibit the signs and symptoms of PTSD, whether or not the massage therapist is aware. In a national comorbidity survey of more than eight thousand subjects, Kessler, et al,² found that 6.5 percent of the subjects studied had a lifetime prevalence of PTSD and another 2.8 percent had a 30-day prevalence of PTSD. Women were at twice the risk of men in developing PTSD, and those with PTSD were at increased risk of developing other psychiatric disorders, such as anxiety and mood disorders.³ Given that approximately 75 percent of massage therapy clients are women,⁴ and given that a large majority come into massage therapy treatment for what is generally described as "stress," the percentage of clients presenting with PTSD may likely be much higher than the 9.3 percent suggested by these figures.

Saakvitne and Pearlman⁵ postulate that the experience of trauma undermines five basic human needs:

1. The need to be safe.
2. The need to trust.
3. The need to feel some control over one's life.
4. The need to feel of value.
5. The need to feel close to others.

Nowhere is this more evident than in the extraordinarily intimate surroundings of the massage therapy treatment room. Clients who, from time to time, experience emotional reactions to being touched often respond to simple human soothing. Crying, being held, being reassured by the massage therapist-"There, there. It's over now. You are safe with me"-most often brings the client back from the terror of remembered trauma and sadness to present reality. The world and the massage proceed as before.

Those who have experienced a deeply traumatic event may not be so easily soothed by simple words or touch. For them, trauma continues to live on in their body and spirit, as if it were still happening in the here and now. Soothing seems hollow, not to be trusted. The loss of confidence in the body's ability to keep them safe is experienced as the ultimate betrayal of all that they have come to know and trust about the world and other people. The longing for safety remains but is buried very deeply under the guard of perpetual mistrust and fear.

Continued...