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In an Unspoken Voice
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Oct-Nov 2024 BOTM: In an Unspoken Voice by Peter Levine
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CatherineAda
(last edited Sep 12, 2024 02:30PM)
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rated it 4 stars
Sep 12, 2024 02:29PM
First, I started reading this book thinking it was the September one. Good thing I did, because I'm only on page 52 and while fascinating material, it's slow going. The subtitle sums up the content of those first pages: HOW the Body Releases Trauma and Restores Goodness. Literally, in biological reactions. On page 19 is a color graphic of a naked man with his organs diagrammed and explained. The title is "Sympathetic-Adrenal Components of Fight or Flight". If the rest of the book follows suit, this will be an interesting medical education for me. That said, Levine tries hard to humanize his writing with case studies and research, and his own personal experience. It's a good thing I'm starting this book early. I might be done by end of October!
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The author, Peter Levine, recounts an incident in 2005 where he step into the crosswalk and next thing he knows he is waking up on the ground surrounded by people, a beige car with a damaged windshield that has evidently just hit him, a former paramedic and a doctor who holds his hand. Then, he is riding in an ambulance to a hospital. His heart rate is down from this initial elevated rate the former paramedic mentioned. He says, thank God I won’t be getting PTSD. He credits a technique he says he created and has been teaching for 40 years from saving him from getting PTSD. Mainly, it seems this amounts to allowing himself to shake and shutter naturally.
So ... my thoughts about this book. Levine's work is generally written for professionals in the field, and this one is no exception. He does provide some specific suggestions for patients dealing with trauma, such as the ones he recommends to help patients get "grounded" in their bodies when they shower, for example.His keen insight for therapists provides specific advice. For example, his comment about client's perceptions of a therapist's positive feedback resonated with me. Levine points out that a client may see the positive feedback and/or empathy as a potential threat. I know I felt that way in my early years as a patient. Any positive feedback - not just from a therapist - felt threatening. But Levine also notes that conversely (for example) a codependent people pleaser may feel lost or threatened by the therapist's LACK of response. Kind of a damned if you do, damned if you don't scenario, but excellent insight.
On page 241, there is a wonderful explanation about how all life behaves. Even a single celled organism like an amoeba will approach something positive like food and avoid or move away from something negative like poison. We are hardwired to seek out the safe and nurturing/positive. I see that observation as telling in people suffering complex trauma; we are conditioned to experience the negative as what we deserve, or what gives us attention and reinforcement as we grow. So, the positive becomes threatening as we learn to move against our hardwired instincts.
For me, I read the book hoping to gain better awareness of and treatment approaches for the necessary 'body work' I am currently doing. This book was a challenge for me, but acknowledging my wounds and moving toward healing is often a challenge.
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I'll post separately for each section of the book, so it isn't a massive monolithic screed.
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Short Version: Levine shares many quotations, that seem to shed no light on the topic, but rather suggest he may have a difficult to satiate need to be highly regarded/esteemed.
Long Version
An epigraph is an inscription on a building, statue, tomb, monument, or a short, pithy quote at the beginning of a piece of writing. I'm a word guy ... and will share the Greek roots (it helps me remember the word): epi means "on" and graphein means "to write", so a literal approximation is literally the writing on a thing ... an inscription.
The fact that the first section of the book is entitled Epigraph tells me that this is one of those books ... a book that includes introductory quotes for every single chapter. Now, I like the notion of a brief pithy quote ... something particularly relevant to the core topic. But let's be honest. 19 times out of 20, a book that includes quotes does not limit itself to particular relevant quotes, nor brief quotes. The kind of author that does that decides--in the most charitable cases--that due to some misguided notion of "completeness" they have to have a quote for every chapter. Thinking back on all such quotes in such books, ask yourself this. Did the author mine a wide swath of the Western canon (or more global literature) for some diamond in the rough aphorism that applies to this particular chapter and really boils down the topic to its essence, ... or did they just put something (not always particularly short) that seems ... well, ... at least somewhat linked to the topic, potentially? In my memory, the vast majority of quote are this tangentially related stuff that I don't appreciate.
The uncharitable motivation of many of these authors seems to be trying to convince you that they are ... some sort of intellectual. If they just have a smarty pants quote that relates ... I can appreciate that. But if it's long, doesn't really shed any particular light, and isn't really an interesting quote ... why? No, bad quotes don't make me think the author is smart. They out the author as a little bit of a narcissist, ... a little self-important.
Yeah, so we're about to talk about trauma and he begins with the quote: In all things in nature, there is something of the marvelous.. Yeah ... trauma ... marvelous ... I was just thinking that. So, ... not particularly apropos.
I see there is an epigraph, cringe, and read it, and cringe again, and suppress the negative thoughts, proceeding with benefit-of-the-doubt charity. But in hindsight, that gut reaction was about right.
Yes, this screed would all be a hellacious overreaction to one line. My point is, I was turned off from the outset ... and didn't care for his quotations.
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The forward is by Dr. Gabor Mate, who calls this book Levine's magnum opus, and a summation of his life's work, ... his best writing. My self-serving translation: Yes, indeed this is the only Levine book you need to read. No need to go back and read Waking the Tiger. Gabor goes on to summarize the book fairly well in just a few minutes, though it isn't always clear where the thoughts are those of Mate or Levine.
This section did say something that gave me pause. Trauma is not what happens to us, but what we hold inside in the absence of an empathetic witness.
This line seems to directly contradict Dr. Bruce Perry's take on trauma that healing must begin with a shift to asking 'What happened to you?' rather than 'What’s wrong with you?'
Gabor's line alone might be read as implying that you need to talk through your trauma with someone empathetic, such as a therapist, to release what you "hold inside". Instead, he says the opposite: The salvation then is to be found in the body. ... Hence, talking cures that engage the intellect or even the emotions do not go deep enough.
This exemplifies the often jarringly poor flow of logic in the book, where it sometimes seems necessary to jump the rails to establish a line connecting the dots. You are expected to know what he means because his words don't convey it unambiguously nor concisely. I'm not one who will give an author credit for what he must have meant but did not actually say. That kind of thing is for clergy. But, it seems you can't read this book otherwise. To Levine, what you "hold inside" from trauma is physical, ... not mental, ... not emotional.
I like Bruce Perry's take, and certainly do not like the contradiction here. Perhaps Levine meant something more nuanced here that may not necessarily be a contradiction of Perry, but the actual words were a direct contradiction, and I'm not going to give him credit for nuance he did not have. In hindsight, it seems Levine is often found directly discrediting anything that is not his own approach.
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Levine starts with a useless quote from the I Ching ... which he says is "circa 2500 BC". The I Ching is not circa 2500 BC. If you're going to quote it, ... Google it, Dr. Levine. Historians actually date the I Ching to about the 9th century BCE. Historian think writing was invented in China around 1250 BCE. The I Ching was merely a kind of a divination scheme in that earliest time frame that it emerged. You'd throw sticks over a drawing of a set of patterns of lines (termed hexagrams) and interpret a good or bad omen, depending on how the sticks fell across certain lines. This is like asking: should I eat a burrito?, shaking up your Magic 8 Ball, a 20-sided fortune dice floating in water encased in a round case that looks like an 8-ball, that only shows 1 of the 20 fortunes, and it reads: As I see it, yes. Throwing dice for an omen doesn't seem overly profound. Later, closer to 3rd century BCE, the Ten Wings was incorporated into the I Ching which does have some philosophical aphorisms. Do the quotes matter this much? No. My point is that this guy exaggerated by a couple of millennia. The oldest known writing that tells a story, not just recording/accounting for a transaction, was 2400 BCE. But, Levine had to date back beyond that. Why? Maybe he's just inept, but I think he is trying to push the timeline was back, exaggerating by over 100%, because it served his purposes trying to say we had super ancient wisdom but have lost it, and now he, Peter Levine, has rediscovered the lost wisdom of the ages. Yes, I've digressed. Just saying it rubbed me wrong from the get go. And, I think the quote is stupid and wrong.
He briefly cites the biblical story of Jonah. He's just all over the place as if these quotations add any value. Stupid.
Finally, he begins in earnest with a personal story of a traumatic event from 2005 in southern California, on a day with weather he describes as perfect. I stepped out into a crosswalk. The next moment, paralyzed and numb, I'm lying on the road, unable to move or breathe. I can figure out what just happened. How did I get here? Out of a swirling fog of confusion and disbelief, a crowd of people rushes toward me.
He sees a car looming over him with a shattered windshield and realizes he must have gotten hit by the car when he stepped into the crosswalk.
A man emerges from the crowd, gets on his knees and identifies himself as an off duty paramedic. This man checks him out, suggesting he not move his head, to make sure that if he has a spinal injury, he doesn't cause himself permanent paralysis. He takes his pulse and asks him questions to gauge his level of awareness or possible concussion. Levine asks him to back off, and assures him he won't move his head, and will answer his other questions later. Then, a few minutes later, a woman emerges from the crowd to sit beside him, and identifies herself as a doctor. She asks if she can help. He asks her to stay with him, and she holds his hand, kindly as he says. A trembling wave of release moves through me, and I take my first deep breath.
When he told the paramedic both with my hands and words to back off ... he was obvious breathing and moving. It is conspicuous that he mentioned not being able to breathe initially, but did not mention starting to breathe again, until after he had spoken to a paramedic and minutes later spoken to a doctor, and then held her hand. Speaking from experience, when you come to, and are truly unable to breathe, you tend to remember exceedingly that feeling ... the interminable duration of it ... unable to call out or to respond to anyone ... wondering if/when you will start breathing again, or if you won't, with a steadily growing sense of urgency ... and you vividly remember the feel of the moment your body finally starts to breathe again, ... and yet he mentions nothing until after talking to a couple people and a few minutes pass. So, ... my Spidey sense notices that ... unable to breathe. I'll leave it at that.
He says he can't believe this happened to him, and it will interfere with his plans to go to a birthday party, and then my body continues to shutter. Reality sets in. In a little while, a softer trembling begins to replace the abrupt shutters. I feel alternative waves of fear and sorrow. It comes to me as a stark possibility that I may be seriously injured. Perhaps I will end up in a wheel chair, crippled and dependent. Again, deep waves of sorrow flood me. I'm afraid of being swallowed up by the sorrow, and hold onto the woman's eyes. ... I feel a flicker of hope--then a rolling wave a fiery rage. My body continues to shake and tremble ... alternately icy cold and feverishly hot. A burning red fury erupts from deep in my belly.
He then hears sirens as an ambulance arrives. The woman/doctor rides goes with him into the ambulance as they ride to the hospital. He goes into more excessive detail about feeling various feelings in his body ... which he stresses that he "allows" to happen. He asks the ambulance paramedic to tell him his pulse rate, and when she allegedly initially declines, he tells her that he is a "doctor". He is not a medical doctor.
He heart rate is in the normal range, and his blood pressure is only just slightly elevated. He tells her: thank God I won't be getting PTSD ? I explained how my shaking and following my self-protective responses had helped me to reset my nervous system and brought me back into my body ... this way I am no longer in fight or flight mode.
Then ... they keep talking in a thoroughly improbable conversation that seems sounds like a sales brochure. You mean I can get 15% off if I invest $129 today, and you'll even waive the $129 if I sign up for a monthly subscription at an introductory rate of $X. Yes, in fact (blah, blah). It goes along those lines. Makes me gag, but I digress, yet again.
This guy seems to think something magical happened because he "let" his body do what it was doing, as if that was a willful act, and avoided what he implies might otherwise have been likely PTSD.
I'm thinking ... W. T. F? You were walking along and then ... next thing you knew ... you're lying on the road, not knowing what happened, and you're surrounded by people checking to see if you're OK, a paramedic, a doctor, and then an ambulance in quick succession to haul you to an ER. So, you were never in a fight nor flight mode. You came to, unaware of a threat that had already completely passed without you being conscious of it in real-time, ... and you're already surrounded by crowd there to help you ... by a whole set of professionals, lying there on the ground on what you yourself called a perfect day. Repeat: you are blissfully thinking of a birthday party you're headed to ... and then you are surrounded by professionals ready to help you. At what point were you ever conscious of any sort of threat? You were not. At what point did you consider whether you should fight off the car? Never happened. At what point did you consider whether to run away. You never did. At what point did you consider whether to freeze? You never did. You were still walking and had a collision with a car. So, you think you "followed your self-protective responses" and prevented PTSD ... but when would you flash back to the horror of an impeding injury where you were saying holy sh@$(#t!!! and went through a set of considerations worrying about what action you should take to save yourself? Should I stop/freeze walking forward into the car?
Should I jump back (flight) to the curb?
Should I just jump (flight) into the air to take a lesser blow?
Should I yell (fight) to get the drivers attention?
Should I wave hands (fight) to get their attention?
Should I try to fight and punch the car?
Did you go through a moment where you assessed a set of actions you could take and realized that none of them was going to work?
Did you figured out your best option (yelling and waving, as you jump high back in the direction of the sidewalk) and still think that the chances were more likely than not that you were going to get hit hard enough to sustain permanent life-altering/-ending consequences?
Do you replay that impossible scenario over and over second guessing what you chose to do, gob-smacked by the impossibly quandary the situation presented?
If something bad happened, you will reflect on that and be upset by the outcome.
But, you were never in that frightening dilemma zone where you had to make an impossible decision. Hence, you will never flash back to that. You never actually choose fight/flight/freeze/fawn. The event was simply over and you were not even conscious ofwhat happened in real-time. You blinked and the next thing you knew, you were laying on the ground on a perfect day surrounded by medical professionals trying to help you, with no decisions/actions of consequence left to make.
The notion that this guy was ever going to have PTSD from this event is ... charitably, a little misguided. The notion that he is a leading professional in the field who wrote a book with this as the poster child event demonstrating how to prevent PTSD is ... absolutely asinine. Charity isn't possible.
I'm sorry this happened to him. Not discounting that's a "traumatic event". But I don't see the seed of PTSD there at all.
I'm sure he'll have something useful to say in the book. I do feel like trauma haunts you when you were stuck in the imminent dread of a seemingly impossible dilemma zone. But, he didn't face that in this story.
Can PTSD result from a terrible thing that happened, where you were never conscious of the threat or any related decision in real-time, and all actions/consequences are already over by the time you are conscious of it?
I'm sure you'd think about such an adverse event over and over in your mind, and no doubt be saddened by any adverse consequences that did manifest. Going forward, I bet Peter Levine now looks both ways at least once if not three times before he steps into the street. But I don't see that as PTSD. Let me know if you have a relevant story to the contrary. I think its an important question.
I don't think this is the same thing as a solder stepping on a land mine in Vietnam. A solder in Vietnam was probably pretty damn worried before his first day of boot camp, and then saw people injured in training, ... without an enemy even present. He went to the front lines. Heard the news. Heard stories. People were dying ... including from land mines. He had it in his head pretty persistently that he could die. How do you balance watching the tree line ahead with watching each step, and in dim light in a jungle, tired from marching for days, not eating well, and sleeping poor while you hear shots and explosions in the distance, ... and your trying to judge if the grass at your feet harbors anything worse than the trees.
This might be a little closer to a child today in Vietnam stepping on a land mine. Even then, they may have been told to watch their step for mines that might still be out there, ... but assume they hadn't been warned and it isn't really on their minds. Does that child who was walking along and then wakes up in a clinic without a leg suffer from PSTD?
Does is need to be an imminent threat where you choose fight/flight?
Does it have to be a cerebral thought?
Can it be a mere instinctual decision?
I think it's an interesting question. I've never heard it posed in all these books. I think it matters.
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After another stupid quotation, Levine likens his own random therapy "discovery" to that of putting the first human on the moon, ... except that he denigrates Neil Armstrong for being grammatically challenged.
This guy …
His "moment" is spontaneously commanding a client run from a "tiger" he says is chasing her, while she emotionally caught up in the retelling of a traumatic event.
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