How I Came to Believe My Migraines Were the Result of Childhood Trauma
Twenty years of daily migraines, plus seemingly unrelated intermittent unexplained pain in my hands and a year of Achilles tendinosis (a chronic inflammation of my Achilles tendons). I've tried countless doctors, medications and therapies with no relief at all. That's my life story. Could it be that all of these ailments are related, and that they are actually a psychological problem rooted in trauma? And if so, how many other chronic pain sufferers are actually untreated trauma survivors as well?
A 2010 Psychology Today article addresses this phenomenon. In it, a physician reported suffering nausea so intense he could hardly move. Ultimately, he was diagnosed with mild PTSD and treated with an anxiety medication. The nausea went away. There's a part of this story that is broadly accepted, and a part that goes out on a limb as mere theory, but put together, they might explain and even relieve chronic pain in many Americans.
Before delving into the notion that psychological causes can lead to physical problems, reflect on all of the normal, healthy ways in which everyone experiences this. When you are embarrassed, you might blush. When you are worried, you might feel a knot in the pit of your stomach or in your throat. Perhaps your heart will beat faster. You might say you know something "in your gut." And of course, when you feel sad, you cry.
Psychiatrists already recognize several ways in which psychological problems can turn up as physical maladies. Previously, the American Psychological Association split such problems out into several different diagnoses: conversion disorder, somatization disorder and pain disorder, to name a few.
Each of these diagnoses was distinct, but similar in that the patient had physical symptoms that were medically unexplainable. A pain disorder presents as pain that disrupts everyday life functioning, whereas a conversion disorder is one in which the patient suffers from neurological symptoms like numbness, blindness or paralysis without an apparent cause. A somatization disorder was diagnosed when the patient presented with an entire host of symptoms—pain, gastrointestinal distress, and sexual/reproductive and neurological symptoms—with no apparent cause.
The fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the official bible of all psychiatric illnesses, dropped these categories and replaced them with Somatic Symptom Disorder, which is "characterized by somatic symptoms that are either very distressing or result in significant disruption of functioning, as well as excessive and disproportionate thoughts, feelings and behaviors regarding those symptoms. To be diagnosed with SSD, the individual must be persistently symptomatic (typically at least for six months)."
In each of these cases, the patient is not faking or intentionally causing the symptoms. What's more, these problems can be tricky to diagnose and treat, because the patient (and even the doctors) do not connect the physical symptoms with a psychological problem.
Another common point of difficulty is some patients' resistance to the idea that their physical problems are psychological in nature. When you are suffering a very real pain, you might not want to hear that the problem is actually in your head.
What causes this phenomenon? Some postulate that the root cause might be trauma. The earliest understanding of such processes came from Pierre Janet in 1889. But modern experts like Bessel van der Kolk, the medical director of the Trauma Center at the Justice Resource Institute and author of The Body Keeps the Score: Brain, Mind, and Body in the Treatment of Trauma, have the benefit of understanding what occurs in the brain during and after trauma.
In his book, Van der Kolk precedes his explanation of trauma with a description of the brain "from the bottom up" beginning with what is often known as the reptilian brain. This primitive part of our brain, located in our brain stem, is responsible for all of the functions newborn babies can do at birth (eat, sleep, pee, poop, breathe, etc.).
Above that, one finds the "mammalian brain," or the limbic system. This part of the brain deals with emotions and detecting danger, among other things. These two parts of the brain work together as what Van der Kolk calls the "emotional brain." When you feel a gut feeling or a tightness in your throat, these parts of your brain sent you that signal.
The top layer of the brain, the frontal cortex, includes the part of the brain that makes humans unique. Van der Kolk calls it the "rational brain." This part of your brain inhibits inappropriate actions and gives you a sense of time and the capacity for empathy. It allows you to mirror others around you, sitting or standing in a similar way, syncing the rhythm of our voices with theirs, and picking up on their emotions.
All of these parts of your brain work together when you are confronted with danger. If you've ever encountered a rattlesnake on a trail, you might notice you jump back and feel physical sensations of fright or shock a moment before you are able to find the word "Snake!" to warn your hiking companions. Before the rational part of your brain fully comprehended the snake, your limbic system—specifically a part of the brain called the amygdala—already took action.
When the amygdala sounds the alarm, your body receives a jolt of stress hormones (cortisol and adrenaline). Assuming your amygdala has a good grip on what is actually dangerous and what isn't, all is well. Sometimes though, your amygdala responds to the threatening rattlesnake, and seconds later, your rational brain (the prefrontal cortex) realizes it's just a non-venomous gopher snake... or just a garden hose.
Trauma patients lose that crucial balance between the amygdala and pre-frontal cortex, so that every single coiled garden hose might send them into a panic as if a menacing rattlesnake was about to strike.
After the fact, PTSD patients might suffer flashbacks, in which they feel they are reliving the trauma. Images of a PTSD sufferer experiencing a flashback have revealed that the part of his brain that understands the passage of time went offline, making it feel as if the traumatic event would continue happening forever. As a result, Van der Kolk writes, "Being traumatized means continuing to organize your life as if the trauma were still going on—unchanged and immutable—as if every new encounter or event is contaminated by the past."
Simultaneously, another part that went offline was the thalamus, the part of the brain that integrates sensory images, smells and sounds into a coherent story and filters out sensory data that is unimportant. Meanwhile, the amygdala went into overdrive.
However, trauma victims are not all the same. Another trauma victim having a flashback went entirely numb, with decreased activity in almost every part of the brain. Rather than being flooded with overwhelming sensory input of the traumatic event, this person depersonalized. Depersonalization is a form of dissociation people often describe by saying they felt they were hovering over themselves, looking down on their bodies.
These two alternative responses can be described as fight or flight (a mammalian brain response) in the former case vs. freeze (a reptilian brain response) in the latter. When we feel that fighting or fleeing are useless, we might shut down, employing the freeze response. This might be the case for a rape victim, held down by her attacker, or a victim of child abuse who has no ability to fight or escape his parents.
In his book, In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness, Peter A. Levine writes that, "Trauma occurs when we are intensely frightened and are either physically restrained or perceive that we are trapped."
Levine postulates that since we share so many parts of our brains with animals, we also respond to life-threatening situations like animals. In an actual life-or-death situation, such as being chased by a predator, freezing can serve several functions. In addition to potentially saving one from a predator, freezing triggers a numbing sensation that makes unbearable pain more bearable. This occurs in the form of endorphins that numb physical pain, as well as dissociation that numbs psychological pain.
Levine claims that experiencing a freeze reaction will not necessarily lead to a long-term debilitating condition like PTSD—but it might. Central to his theory is the observation that an animal in the wild, if it freezes but survives a predator's attack, will then tremble or shake, effectively "discharging" the trauma and returning to its normal state. He believes humans must do the same.
In a fight-or-flight state, the body sends signals to muscles to act that are then aborted when the body freezes. Levine believes one must complete these aborted actions. This is nearly identical to the teachings of John F. Barnes, a physical therapist who teaches a form of bodywork called Myofascial Release. Barnes calls the completion of aborted actions "unwinding," and the shaking and trembling one experiences following a trauma "thawing."
For me, the suggestion that I had suffered any trauma seemed ridiculous when it was first suggested by a massage therapist a decade ago. She told me my body was entirely shut down, and asked if anything happened in my childhood. I found the very suggestion baffling.
Some trauma victims deal with their pain by retaining no conscious memory of the traumatic event. This might take the form of a rape victim retaining no conscious memory of her rape. In my case, I remember my childhood fully, but I looked back on it as a relatively pleasant, privileged childhood with no real problems. Nobody in my family drank, did drugs or hit anybody.
Only in recent years have I realized that the "discipline" in our house was constant verbal abuse, plain and simple. As a kid, I never questioned whether my parents were right in disciplining me or whether they used the right methods to do so. As an adult, I have more perspective, allowing me to look back and question core beliefs I have about myself, human relationships, and the world that were formed in my childhood.
It should be noted that sometimes children suffer trauma even when they have two loving parents. For example, hospital procedures can be quite traumatic.
My neurologist commented that my body seems to be in a constant state of fight or flight. For Van der Kolk and Levine, healing trauma requires bringing patients back from freeze or fight or flight to "social engagement."
Van der Kolk describes brain scans of trauma victims showing that the parts of the brain that provide self-awareness, sensing our bodily perceptions and integrate our sensory awareness, were not functioning. "There could only be one explanation for such results," he writes. "In response to the trauma itself, and in coping with the dread that persisted long afterward, these patients had learned to shut down the brain areas that transmit the visceral feelings and emotions that accompany and define terror."
Well, that describes me. Until recently, I had very limited awareness of my own bodily sensations and emotions. To be sure, I was not in as bad a state as some of Van der Kolk's patients who could not even identify an object he placed in their hands with their eyes closed, but I could not feel the incredible tightness of the muscles in my back, nor could I access my emotions most of the time. (When I sought therapy after my brother died in 2008, my therapist asked me how I felt, and I had no idea.)
Van der Kolk and Levine start by helping patients begin to feel their bodies again. For reasons relating to neuroscience, simply talking to a patient about past trauma cannot actually access the parts of the brain where the trauma is stored, but feeling sensations in one's body can.
I did not enter into such therapy knowingly, as I still had not labeled my experiences "trauma." (After all, I was never raped, molested or physically harmed.) Instead, I stumbled into the help I received when I moved to a new state and a Google search turned up a massage therapist a few blocks from my house. I went to him out of convenience.
I've used massage to help make my migraines more bearable for years, but never one like the man who finally helped me. He is trained in several modalities, including John F. Barnes Myofascial Release and Cranio-Sacral Therapy. He kept telling me I was not "in my body," which annoyed me no end at first because I did not understand it.
After five months, I was finally able to pay attention to the sensations in my body as he worked on me. I was able to feel the tightness in my back for the first time in years. It hurt! Suddenly, one day during a massage, a wave of emotion rose out of my psoas muscle, where he was working, and overtook me. I was shaking and crying like a baby, and my head felt numb and hot.
I was so embarrassed, I wanted to hide under the massage table. But it was the beginning of a new part of my life. I believe that sensation was the discharge of trauma that Levine describes.
My healing is still a work in progress, but I've noticed many new things in the months that followed that breakthrough. First, I am more aware of my physical body. I can finally feel the tightness all through my neck, back, shoulders, legs, feet, arms, and hands. It feels like a straitjacket. And I catch myself clenching muscles all over my body when I am stressed, which is pretty much all the time. Sometimes I am able to unclench them voluntarily, and other times I am not.
By tuning into my body, I am now able to access my emotions, for better and for worse. I am more emotional than a pregnant woman watching a Hallmark commercial these days, and I can finally tell when I am sad, lonely, afraid, or hurt. I have a harder time detecting anger, let alone expressing it. But I also feel joy more strongly than ever before.
Van der Kolk recommends mindfulness meditation, breathing, yoga, and massage as ways to help trauma patients, in addition to traditional therapies administered by psychologists and/or psychiatrists. Levine recommends his own version of healing, which he calls Somatic Experiencing.
If these men are correct in their theories, then there is hope for the countless patients who visit doctor after doctor with unexplained physical symptoms and currently find no relief. The question is why the medical community is not more adept at helping these patients get the care they actually need.