Time Heals Not

PTSD has been described as the failure of time to heal all wounds, because the experience of trauma, for some individuals, is encoded entirely in the amygdala without reference to time and space. The cerebral cortex, which helps to shut off the floods or cascades of hormones, cannot be accessed. For people with PTSD, flashbacks of the traumatic experience occur when the flood gates of the amygdala are triggered to open. Then sights, sounds, smells, and feelings of the trauma return unexpectedly and intrusively, causing the person to experience yet again aspects of the original trauma as if it were happening in the here and now. ¹⁰

For example, a woman survives a severe car accident that occurs during a storm. She develops intrusive flashbacks of the pressure of the seatbelt on her chest at the time of the accident, symptoms which have persisted long after the physiological damage to her chest muscles has healed. She comes to massage therapy complaining of chest pain for which she has no clear explanation. She also is baffled by the fact that the chest pain gets worse when it rains. At the time of the accident it was raining heavily. The intense fear and pain experienced and encoded in the amygdala was encoded with the accompanying sensory awareness of rain.

Now she has a conditioned response: A sensory stimulation (especially rain) reminds her (however subtly and unconsciously) of the car accident and triggers chest pain. In addition, at the moment she is flooded with the memory, she again experiences many of the sensations that occurred during the accident: sweating, racing heart, intense fear, and shallow breathing. This woman may now actively find ways to avoid stimulus that triggers these floods of stress hormones, such as staying indoors when it rains, or self-medicating with drugs and alcohol. It is not uncommon for individuals with PTSD to develop addictions to alcohol or drugs, to work extremely long hours, or find other ways to reduce or ignore the unwanted and frightening sensations.

Bessel van der Kolk¹¹ refers to the normal neural encoding of experiences as narrative memory (located in space and time, without the intrusive neurohormonal cascade) and the kind of memory that people with PTSD suffer from as traumatic memory. He theorizes that the fundamental task of therapy-whether it is psychotherapy or massage therapy-is to help clients regain a sense of safety in their bodies, free of the flooding of stress hormones. Perhaps Freud was right when he said, "The task of therapy is to transform neurotic misery into ordinary unhappiness."

In talk therapy, or psychotherapy, intrusive neural symptoms are transformed, in the context of a safe, boundaried, therapeutic relationship. By encouraging the client to talk about the traumatic event, the unpleasant memories get reencoded from traumatic memory into narrative memory. In other words, people learn to use their left brains (cortex) to coordinate their right-brained feelings. This prevents the discharge of stress hormone from the amygdala. Once talk therapy has helped the client establish some degree of narrative memory and experience of safety, clients may face intrusive body sensations with a massage therapist. Massage therapy can help clients to reframe their experience of trauma from a kinesthetic perspective.

Seratonin, along with the body's natural painkillers or opiates, is produced in the brain. Since PTSD clients cannot easily access the seratonin needed to soothe the fight or flight response, medications such as Prozac, Zoloft, and Paxil (known as SSRIs, or selective seratonin reuptake inhibitors) are often used to help control inappropriate reactivity to internal stimuli such as impulsivity, aggression, and involuntary preoccupation with traumatic memories.¹²

Some clients may, with such therapy, be able to enhance their bodies' seratonin pump. Other clients, who have severe PTSD, may require SSRI medication on an ongoing basis in order to balance their reactions to general life stressors. Massage therapy in the hands of a skilled practitioner also can aid the coordination of the left and right hemispheres of the brain, thereby reducing intrusive symptoms and inducing the creation of self-soothing strategies for clients with PTSD.

Benefits of Touch

There are no specific physical manipulation techniques for working with trauma clients. Swedish massage can be as effective and enlightening to a client as the most advanced fascial mobilization. No matter the technique, massage therapy can inadvertently trigger traumatic memory, which, as massage therapists know, also can be a powerful tool for healing and growth.¹³ For example, there is ample documentation that touch stimulation is essential for babies to thrive. The results of Tiffany Field's research on preterm infants is most compelling, where each was given 15-minute massages three times a day for 10 days while still in incubators.¹⁴ The treated infants gained 47 percent more weight and were hospitalized for 6 days less. They performed better on the Brazelton Neonatal Behavior Assessment Scale.¹⁵ The babies averaged 12 points higher on the mental scale and 13 points higher on the motor scale than the control group. In another experiment,¹⁶ rat pups were stimulated with tiny wet paintbrushes, a procedure designed to mimic the licking of newborn litters by their mothers. The rat pups which were "licked" with the paintbrushes thrived similarly to those which had received normal care by mothers. Those that received no stimulation became ill, had small growth rates, and failed in many instances to thrive.

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