Fibromyalgia, Trauma and Therapy - The Gestalt Mindfulness Website

For as long as I have been working with trauma victims, I have been interested in the effects of trauma on the body. More and more research is being done into the possible links between trauma and conditions such as arthritis, lupus and Fibromyalgia. What I want to talk about here is how traumatic experiences in childhood may leave some people highly susceptible to Fibro in later life, and what can be done about it. On the way we’ll take a look at what trauma is, how it affects us in both mind and body, and meet three Doctors who have been instrumental in helping people deal with it.

What is Trauma?

Putting it very simply, trauma is what happens when you are overwhelmed by the fear you feel in a situation. When you cannot do anything to protect or save yourself and have no choice but to endure and hope to survive.

Despite what you might think, you don’t have to be a battle-hardened soldier in a war zone to come face-to-face with trauma. Being at home will do. Especially if that home is a place of violence, beatings, sexual assaults, anger or humiliation.

And it doesn’t have to happen directly to you – witnessing the type of incidents described above can leave someone deeply traumatised. Particularly if it happened to a loved one or parent

Also, trauma doesn’t have to be one single life-threatening event. Repeated abuse or neglect can cause equally profound traumas with devastating effects in later life. I’m choosing my words with some care here because I don’t want to give the impression that one kind of trauma is more valid or more important than another – they are not.

In fact, comparisons are rather pointless because it’s not the event so much as what you feel during the event that makes it traumatic. So many domestic trauma victims believe their suffering isn’t worth anything because it didn’t happen in a war zone or because nobody died. It is not that simple. Terror is Terror. Fear is Fear. It is our response to it that matters.

Blamed for being normal

For as long as I can remember we have been told that humans do one of two things when confronted with danger: we fight or we run. Either way we act to save ourselves and survive. Anything else is abnormal. A failure.

But that’s not the whole story. Let me introduce you to our first doctor: For many years Dr Steven Porges was the Director of the Brain-Body Centre at the University of Illinois, Chicago, and in 1994 he proposed the Polyvagal Theory which has dramatically changed the way we think about trauma. The Polyvagal theory centres on something called the Vagus Nerve.

This nerve is one of the largest in your body, starting at the base of your brain and going down to wrap around most of your vital organs. In particular your heart, lungs, stomach and colon. It is thought that this is why we get so many ‘gut reactions’ to our emotional states. Your heart sinks, you get butterflies in your stomach, you lose control of your bowels etc. You feel these things because the Vagus nerve is affecting your internal organs as it responds to threats and danger.

Dr Porges’ theory looks at the different parts of the Vagus nerve and what they do. As well as acknowledging the Fight or Flight responses, Dr Porges outlines a third one: Freeze. Total immobilisation or ‘playing dead’ in order to survive. Trapped by an attacker (in whatever situation) breathing becomes shallow, heart rate plunges and digestion stops. You disengage and shut down until it’s over. In short, you dissociate.

You cannot stop this from happening. It’s controlled by an old part of your brain called the limbic system. By ‘old’ I mean that it evolved a long time before the more ‘human’ parts of our brains. We’ll be meeting two very important parts of the limbic system, the amygdala and the hippocampus, a bit later.

Unfortunately, society has not been quick to recognise this freeze response. In the first world war, soldiers who froze during battle were called cowards. Many were killed by firing squad for it. In the second world war they were ‘lacking moral fibre’ and imprisoned. After all, anybody with any guts would ‘stand and fight’ wouldn’t they?

Sadly, this terrible attitude filtered into society, meaning that any victim of violence who froze and didn’t fight back was ultimately blamed for what happened. It didn’t matter if the attacker was twice the size of their victim, or whether the victim was a woman or a child. Victims have been forced to carry the guilt for what happened to them, making the whole experience even more traumatic.

Now, I really want to make this point:

Freezing, when under attack, when you are scared, is Normal

Your body will do this for you and you cannot control it. It is especially important to understand this if you have ever had this kind of experience:

If you froze during your attack, you weren’t ‘being weak’ or ‘just letting it happen’. You actually had no control over this. Becoming immobile was your body taking over and making you stay still in order to keep you alive. This is an old evolutionary response – all mammals have it – and it happens to keep you from dying. Awareness and memory subside until it’s all over and you can recover and escape.

But that’s not the end of it.

The Bear in the woods

As we’ve seen, trauma is commonly thought of as something extreme. Something which happens during wars, natural disasters, major accidents, things like that. Big things. Things which most of us would be left shocked, distraught or changed by. Like being confronted by a very large, hungry bear when you’re alone in the woods, and cannot outrun it. Great big hairy trauma with an appetite!

But for children it’s an entirely different matter. Because for many children, the bear comes home every night, filling the home with anything from anger and violence to sexual abuse and neglect. Whether having it inflicted on them directly, or witnessing it done to a sibling or parent, the outcome is devastating for any child.

This brings us to doctor No. 2: Dr Vincent Felitti is the co-principal investigator of the Adverse Childhood Experiences (ACE) Study. This long-term analysis of over 17,000 adults revealed an astonishing relationship between our emotional experiences as children and our physical and mental health as adults.

Importantly, the ACE study showed that traumatic emotional experiences during childhood are strongly linked to organic disease in later life such as severe obesity, ill-health (including depression, heart disease, chronic lung disease and cancer), shortened lifespan and suicide.

So as you can see, the traumas we suffer as children affect us not just mentally but physically as well. And it can take years of struggling to cope before the body finally breaks down and illness sets in.

Just as an aside, think about this: According to the Office for National Statistics, in 2019 there were 55,080 children either on a child protection register or subject to a child protection plan in England and Wales. Children whose home-lives place them under threat of significant abuse. This figure only includes the children who have come to the authorities’ attention. There will be more who have slipped through the net. The effects of trauma for these children are irreversible. This timebomb isn’t ticking any more. It’s already gone off.

So what? I’ve got Fibro. It’s neurological, isn’t it?

Yes, but repeated or extreme childhood trauma can change our neurological structure. It’s time to meet your amygdala, a tiny part of your brain which is associated with threat identification and emotional memory. It’s the ‘fire alarm’ in our heads, and it can sense danger even before we become consciously aware of it.

Ever had the hairs stand up on your neck but not known why? That’s your amygdala doing its job. The problem is, extreme or repeated trauma can cause the amygdala to stay on high alert long after the threat has gone, and it won’t shut down.

Stress hormones actually kill cells in another part of the brain called the hippocampus. This bit looks after memories of things like facts and events. Damage to the hippocampus makes it harder for us to consolidate and keep our memories. You become anxious, confused and you have trouble remembering.

Does that sound familiar? Let me show you part of the conclusion reached by two researchers from McGill University in Canada, Lucie Low and Petra Schwienhardt:

“Exposure of the developing brain to perinatal stress, and glucocorticoids during critical periods of development may affect the long-term function of areas involved in stress regulation such as the hippocampus and amygdala and help explain the “fibrofog” and anxiety disorders prevalent in FM.”

(Low And Schwienhardt 2012)

“Glucocorticoids” in this instance means cortisol. This hormone is released whenever we feel stressed. Its primary job is as an anti-imflammarory, in case we get injured by the bear. However, the damage it does to neural cells in the hippocampus can significantly reduce our ability to learn and remember.

Now it’s time for our third Doctor. This time it’s Dr Bessel van der Kolk. I can’t keep typing that out every time so I’m going to call him Dr Bessel. I’m sure he won’t mind. Dr Bessel is the is a professor of psychiatry and founder of the Trauma Center in Brookline, Massachusetts. He is also author of a superb book called ‘The Body Keeps The Score’. I recommend it to anyone affected by issues raised in this article.

For forty years Dr Bessel has worked with military veterans with Post-traumatic stress disorder (PTSD). Indeed, that’s how his research started. But that same research has led him to working with other kinds of trauma victims, like the ones described above who have suffered trauma in a domestic setting rather than a military one.

As you would expect, his patients suffer with extreme mental and emotional issues as a result of their trauma. But they also suffer with physical ones as well. Because of this, Dr Bessel’s work embraces the concept of the ‘whole person’, working with both the emotional and bodily aspects of their condition. This is what he has to say about conditions like Fibromyalgia:

“When people are chronically angry or scared, constant muscle tension ultimately leads to spasms, back pain, migraine headaches, fibromyalgia, and other forms of chronic pain. They may visit multiple specialists, undergo extensive diagnostic tests, and be prescribed multiple medications, some of which may provide temporary relief but all of which fail to address the underlying issues. Their diagnosis will come to define their reality without ever being identified as a symptom of their attempt to cope with trauma”

(Dr Bessel van der Kolk 2014)

There’s one part of that which sticks with me: “…a symptom of their attempt to cope with trauma”. Are the symptoms of Fibromyalgia our bodies’ way of telling us that something much bigger is wrong?

So What does Trauma actually do to us?

When we talk about things like inner peace, balance and stability, we’re actually talking about something called Allostasis. This is the brain trying to maintain inner stability whilst things are changing all around you. Keeping all your bodily functions like heartbeat, digestion, breathing on an even keel. If you’re feeling technical, Allostasis is what the brain does to keep the body in Homeostasis, triggering all sorts of processes to keep the physical body from going into crisis.

When you get stressed, you are under something called Allostatic load. Think of it as an actual burden on your whole body as you try to cope with the ongoing stresses in your life. When you are under Allostatic Load (and most of us are) your body starts releasing cortisol and adrenalin into your system, as well as sugar. These are great if you need to biff a bear and run off, but when you can’t, and the stress continues, they just stay swimming around in your system.

The thing about Allostatic Load is that it is continuous and normally undetectable. Until things get really bad, you don’t know it’s happening.

If a threat is repeated long enough, or is severe enough, then, as we’ve seen, things change in your brain. If the trauma is repeated, or you don’t get a chance to discharge it and recover (i.e. calm down and get back to normal) then the brain can default to these states, staying like it long after the danger has gone away. You stay on ‘Red Alert’, and this causes things like:

Hypervigilance (always worried something’s about to happen)
Dissociation (Feeling like you are outside your body or parts of your body are disconnected)
Feeling you cannot breathe or get enough air in
Thoughts keep invading, and your mind keeps racing
Clumsiness, bumping into things (dyspraxia)
Difficulty staying present and grounded
Shaking or trembling without understanding why
Constant muscle tension leading to chronic pain

Recognise any of them? You should. Many of them are listed symptoms of fibro. And for many people, they all started in childhood.

There is no doubt that, as adults, were are shaped by our childhoods. The idea that education, both academic and moral, is everything we need for a secure future isn’t enough. The idea that children are resilient, that they ‘bounce back’ or that nothing affects them is not true.

What is true is that children are great at adapting. They will accept the world as given (let’s face it, they have little choice) and work around it. They will trust the grown-ups and take the blame, suffering the consequences. What is also true is that the identification of children as separate beings, as something other than the thinking, feeling, rational adults they have yet to become, is ridiculous.

If a child loses a limb or an eye it affects them for the rest of their lives. We can see how the consequences will carry forward into adulthood. That’s why we have laws keeping children from working in dangerous adult workplaces, and a culture which seeks to keep them physically safe.

But what about when a child loses the capacity to feel safe? When it loses, not a limb, but the capacity to trust its environment, the ability to evaluate things as they really are, and to know when they are in danger and when they are not? Whether it’s in a war-torn street in Syria, or an abuse-ridden home in the UK, the outcome is the same: that child loses something. For life. We just cannot see it from the outside.

Does this mean I’m stuck with it, then?

You cannot change the past, and if there was a magic wand for Fibro we’d all be waving it like windmills. But the situation is very far from hopeless. Let me give you three statements from Dr David Berceli, another trauma specialist who has had a lot of success in treating patients:

There is trauma – terrible things happen to humans

We can overcome trauma – because we are wired to survive

Healing Trauma is about meeting the body – bodily symptoms need a bodily treatment.

We’ve covered quite a bit of information so I think it’s time for a brief recap. What have we found out so far? Well, we know:

That in trauma, the brain is on constant ‘red alert’. This means the brain and the body behave as though the danger is constantly present, constantly happening.
That trauma, especially early trauma, has a great many physical effects on our bodies, many related to chronic and painful conditions.
That re-living the trauma (either through flashbacks or though remembering the events) can bring back many of these physical symptoms.
That many trauma victims feel cut off from their bodies.

This last point is key. Because, in treating trauma, what really seems to help is getting back in touch with your body – via your senses – and staying in the present. Learning that right here, right now, you are safe. Learning how to recognize the sensations and emotions of safety in your body. Learning to stay grounded in the peaceful ‘here and now’ to help stop our body fighting the battles of our past.

This may sound very simple, and in principle it is. But it works. We don’t have to relive the events, or talk about them, or even understand what happened to us. Indeed, some traumas may have occurred so early on that they cannot be consciously remembered. But your body keeps the score.

The ‘old’ part of your brain doesn’t do words. Or explanations. Or theories. It does feelings and sensations (terror, danger). It does reactions and responses (fight, flee, freeze). It does awareness. Right now it’s constantly aware of danger, because that danger, when it happened, was so intense or prolonged that it got ‘locked in’.

So the way to put that right is to give yourself some new experiences and make sure that your brain and body become aware of them. This means slowly learning to stay grounded when traumatic feelings and sensations are threatening to overwhelm you again.

The really great news is that it can be done. It has been done with hundreds of survivors by people like the three doctors I talked about earlier. Dr Bessel van der Kolk in particular is a world-renown pioneer in these treatments. Here are some basic techniques used in helping someone deal with their trauma.

Grounding – As confusion and distress are often accompanying symptoms it is useful to develop skills which enable a client to find their way back to ‘now’. Using sensory techniques such as Mindfulness to raise body awareness is very useful, particularly during flashbacks or times of extreme distress.
Personal Resources – Helping a client discover ways to support themselves away from the therapy room. These might include things like practical activities, utilizing their environment, or internal resourcing such as visualization, yoga, meaningful beliefs or imagined outcomes (focusing on the positive, of course!)
Body Process and Awareness – This is really a step on from the body awareness used in grounding and involves developing a better knowledge of yourself so that you can understand the relationships between thoughts (memories, for example), emotions and bodily sensations (trembling, chronic pain, etc). This is so they can become more aware of themselves holistically (i.e. that thoughts, feelings and sensations do not happen in isolation) and use this knowledge to monitor their needs and self-soothe when necessary.
Shame – Addressing a client’s shame is paramount. Sexual trauma especially can leave a client with catastrophic shame issues. Yet in some cases these are overlooked or treated as chronic depression, leaving the client feeling even more convinced that nobody really understands. It is important not to ignore this very important emotion.

The aim is to help you recognize what it feels like to be safe and calm. To relate these inner sensations to your environment, which is a safe place. This allows your brain to re-learn that the danger has passed and you don’t need to be on red alert right now.

This is a slow process, but it has to be. A trauma which has been taking place over months or years will need care and patience to overcome it. But it can be done.

Symptoms of Survival

Since I’ve been involved with the Wight Fibro Group I have heard the same questions which I berated myself with for years:

Why have I got this?

Why can’t I just get over it?

What’s WRONG with me?

I’ve watched people get stressed and upset because they cannot stop it happening, cannot seem to have any control over it, and worst of all, feel ashamed for having to ask for help because of it.

Absurd as it sounds, the symptoms of trauma are the symptoms of survival. They are your brain and your body trying to protect you and keep you safe and alive.

And you made it. It hurts, but you made it. You survived.

The thing to do now is to convince your survival systems that they can stand down. They don’t have to be tense, or keep releasing cortisol, sugar and adrenaline. They don’t have to keep running at ‘Action Stations’.

This process is not about miracle cures. Nobody is about to ‘pick up their bed and walk’ just like that. But it is about healing: A slow, gentle, caring process which helps you to trust your body, and your body to trust you.

All the best,

Chris.

Chris Pilling M.Sc is a psychotherapist living on the Isle of Wight.

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References

Burke N.N., Finn D.P., McGuire B.E., Roche M., “Psychological stress in early life as a predisposing factor for the development of chronic pain: Clinical and preclinical evidence and neurobiological mechanisms”., J Neurosci Res. 2017 Jun;95(6):1257-1270. doi: 10.1002/jnr.23802. Epub 2016 Jul 12.

Low L, Schweinhardt P., “Early life adversity as a risk factor for fibromyalgia in later life”., Pain Res Treat. 2012;2012:140832. doi: 10.1155/2012/140832. Epub 2011 Oct 12.

Nutt DJ, Malizia AL., “Structural and functional brain changes in posttraumatic stress disorder”., J Clin Psychiatry. 2004;65 Suppl 1:11-7.

Van der Kolk. B. (2014). “The body keeps the score”. Penguin. New York.

Wilson. J. P., (2006). “The Posttraumatic self”. Routledge. New York.

Office for National Statistics (2020), “Child abuse in England and Wales: March 2020”, https://www.ons.gov.uk/peoplepopulationandcommunity/crimeandjustice/bulletins/childabuseinenglandandwales/march2020, UK Govt. Online Publication.