Yoga and PTSD: The Low-Down (and some personal experience.)

If you've ever experienced the very "unique" journey that is post-traumatic stress disorder, you may have already been inundated with various thoughts, opinions, and even scientific research on the many methods, both traditional and non-traditional, which are available to you to help manage symptoms. I have too.  I'm a female combat veteran, which means that, like many female vets, I got a nice double whammy of both combat and military sexual trauma (there's an acronym for it now, MST. Thanks, Obama.)  I witnessed the worst that I had seen of humanity thus far; it changed something so fundamentally deep in my psyche that I could feel the shift as it happened.  Everything about the world that I had believed was different.    We are not safe. The world is evil. Human beings destroy each other.

The biggest hurdle that I faced, and that I can see other trauma survivors facing, is the sense of injustice at the core of struggling with symptoms.  No one asks to experience trauma; no one asks to be attacked or assaulted, no one asks to witness horrifying deaths, no one wants to hurt another human being, and we definitely don't ask to be hurt by others.  The idea that we now have to work to heal from something that wasn't our fault in the first place can be completely disempowering.  Hey world; hit me with your best shot, and when you're done, don't worry; I'll clean up the mess.  

Meeting my husband over five years ago ignited a change in me, because, for the briefest of moments, I could see a flicker of a future for myself in those first interactions we had together.  I already had a previous failed marriage under my belt, and numerous disastrous relationships.  I had, at best, a difficult time accessing my feelings; at worst, I was a zombie, completely unable to plug in to parts of myself that had been natural before I had joined the military.  Meeting my husband was the spark, and the spark turned into this thought:  This is my life; the only one precious life that I have.  And being the victim of the circumstances that had wounded me was stealing bits of life from me every day that I remained disconnected, angry, paranoid, and depressed. 

Experiencing trauma in the various ways it can manifest in your life can feel as if control is being taken from you, as if you're truly powerless in the face of the chaotic forces that govern the world, other people, and our own psyche.  Making the decision to heal, to shift your perspective on suffering, to move forward instead of simply continuing to survive, is not ignoring what you've been through, nor is it shouldering an unfair burden of pain that's been thrust upon you. It is simply re-taking your power over your own experience.  Trauma can sometimes force us to see the world as black and white, good or evil, all or nothing, and this dichotomous view is the bedrock of our perceptions, and thus our symptoms.   There are things that we won't ever have control over...but this doesn't mean we control nothing. We have, at the very least, power over our own perspective, our own experience, and our own lives. 
  
Traditional treatments for PTSD usually combine medication and psychotherapy. Everyone is different, and responds differently to these treatments. For me, medication only worsened my symptoms, and therapy worked some of the time; at other times it felt stagnant, a repeat and retread of psychoanalytical ground already covered.  When I began practicing yoga again (for I had been a regular practitioner for a time before joining the military) I noticed that a regular, dedicated practice had more of a positive impact on me than the traditional methods most health care facilities offer to Veterans. 

Here are my observations on some of the more prominent symptoms we trauma survivors might share. 

HYPERAROUSAL
Being in a constant state of "fight or flight" or being triggered into this state by external stimuli creates a high concentration of certain hormones in the body, namely cortisol and adrenaline.  Many trauma survivors suffer from insomnia, irritability, anger management issues, impulsiveness, difficulty concentrating and increased aggression, all side effects of a mind and body swimming in un-metabolized stress hormones.  With PTSD especially, the brain has been hardwired with an extra sensitive stress response, meaning that because of our experiences, we have a lower threshold for what sets us off than does the average bear. Most people hear a soft "click" from outside against their house while lying in bed at night, dismiss it as the wind or a stray tree branch, and fall back asleep.  I've spent entire nights wide awake, heart pounding, ready to grab the revolver in my nightstand because I'm certain that someone is trying to break in to the house, based on a quiet, ambiguous night-time noise.

HOW YOGA HELPS
From a simple exercise perspective, moving your body and increasing your heart rate even slightly aids in metabolizing the flood of stress hormones out of your system and returning the body to hormonal equilibrium. Evolutionarily our stress response developed as a survival method; we get a massive boost of adrenaline to give us the energy needed to flee from the stampeding wooly mammoth about to step on our face. The idea is that in the "fleeing" or "fighting" part of the scenario, our body, through it's intense physical action, is also processing the release of hormones and metabolizing them, using them for their intended purpose and thus eventually processing them OUT of the system. Most of us don't run a marathon after we wake up at 1am in the morning with a jolt of adrenaline because we thought we heard something outside our house.  So the physical movement and breath work in a dedicated, regular yoga practice encourages this break down of released chemicals to happen naturally, lowering your hormonal levels back to a state of homeostasis.  And yoga can be modified to do this, even if you have injuries or disabilities that prevent you from participating in classic workouts you used to enjoy.

A dedicated yoga practice can also increase serotonin production, the hormone responsible for feelings of well-being and happiness. A majority of the body's serotonin (90%) is produced in our gastrointestinal tract (which is why eating makes us so damn HAPPY).  Most yoga sequences include twisting, bending, and stretching poses that are designed to massage, balance, and encourage healthy GI tract behaviors, one of which is regular serotonin production.  A component of the "blissed out" yoga vibe that attracts many over-stressed students to a regular practice is the amazing calming effect that can be experienced directly after class.  A more reliable and more regular serotonin production may help you relax enough to bring you down from a hyperaroused state, make you calmer, less "trigger happy", and heaven forbid, may help you actually sleep through the night. 

DISSOCIATION

I see an umbrella of symptoms falling under dissociation, or what may be described as "the disconnection or separation of something from something else or the state of being disconnected."  Experiencing trauma has emotional and psychological effects as well as physical, yet during a traumatic experience, these emotions are often suppressed in favor of survival instinct and base function. This is also an evolved trait; when being chased by a cheetah, taking a moment to pause and introspect on your emotional state could cost you your life. We're meant to, first and foremost, survive life-threatening encounters, and the emotional wounding that occurs during trauma is then meant to be processed and managed once we're safe again.

However, in prolonged stressful situations (such as combat) or in terms of extreme life-threatening experiences that dehumanize a person (such as physical or sexual assault) where a survivor can become re-triggered constantly even after the experience is over, the feeling of being "safe again" never seems to come around.  In an analogy to the physical body, think of it as being wounded on your arm. The wound may be manageable at first, but if you don't take time to stop and clean it, bind it, and properly take care of it, it may keep bleeding out.  You can't stop and do what you know you should do to take care of it; you still feel threatened and aren't willing to experience the vulnerability and exposure that comes with healing.  Your only option, then, is to slap a tourniquet on your arm, completely cutting off the blood flow, and deal with the wound later when you feel "ready."  This obviously isn't ideal; but it may, for the moment, allow you to keep going.

The issue, then, turns into this; if you're constantly triggered, constantly experiencing life threatening situations, and are unable to EVER deal with these emotional wounds later, you eventually begin partitioning off parts of your emotional self in order to keep functioning.   For many survivors, once they get to a point where they eventually can stop and assess themselves in an attempt to deal with what’s happened to them, they're faced with a myriad of emotional wounds that may be overwhelming.  Going to therapy, for me, initially felt like I was about to open a closet door that I knew was stuffed full of nasty things that would come tumbling down on my head the moment I opened it, trapping me beneath it all. It sometimes felt easier to just leave the door closed. 

However, being disconnected from these experiences on an emotional level left me feeling nothing at all, as there isn't a way to only feel some of your emotions and not others. I struggled with connecting to experiences around me that I used to enjoy because my emotional self was covered in tourniquets, cut off from my basic ability to feel feelings.   This deadness, this numbness and inability to engage life around me, was a type of soul-decaying boredom and depression that many survivors find leads them to substance abuse, reckless behavior, and in some very sad cases, suicide. 

 
HOW YOGA HELPS
There are many therapies out there that are meant to help with the dissociative aspects of PTSD.  Some of them involve writing or talking about specific experiences in an attempt to re-experience the trauma, bring the original emotional response back to the surface in a controlled environment, and then allow the survivor to "ride out" the feelings that re-surface.  These feelings, allowed to be fully expressed and explored, eventually dissipate, leading to a catharsis of sorts in the survivor. 

Yoga essentially does this as well, in a manner that can be empowering for those struggling with their sense of personal power and control.  Yoga begins by inviting participants to explore an awareness of their body without judgment, and asking questions as a practitioner moves through a sequence of poses.   How do my hamstrings feel today? What does the mat feel like when my toes grip into it? How does my breath feel in my nostrils as I inhale?  A mindful approach to experiencing a thing without deciding if it's good or bad (or whether or not you're good or bad at it) is the beginning of a shift in perspective about your own experience of the world at large. You're not being told how to feel, or how not to feel; you're being invited to take control over your own experience, and simply witness it as it happens.  You're given space to, essentially, ride it out. 

What happens, then, as practice becomes more regular? Parts of the body are physiologically linked to our stress response, and thus stimulating, stretching, and opening those parts of the body may trigger memories or feelings of the trauma experienced while you're in the middle of a yoga class.  The difference here is that you're in a mindful state; you're controlling the process, so to speak, and having practiced a nonjudgmental awareness of your own body, (which is an easy first step for many) you may be better able to experience an emotion or memory of your trauma in a similar nonjudgmental and open awareness.  The memories and emotions are not "taken away" from you once this happens, but the re-triggering of your stress response at their resurgence is blunted and eventually dissipates.   I used to have a very physical, visceral response to thinking about or talking about certain memories of my combat tour; and while those memories still create an emotional response in me now, it's not the shaking, adrenaline pumping, anger soaked trigger that it used to be.  I've heard many therapists liken surviving trauma to losing a parent or loved one.  It changes you; you don't ever "get over it", but you learn to live your life and move on with the experience becoming a part of you.  And this is how it is with all experiences, for our lives are meant to be made up of our interactions with the world around us, regardless of whether they bring us joy or make us suffer.  These are the things that carve out who we are, and denying them is to deny what makes us human and alive.

For me, a regular yoga practice became much like a journey into my own self.  Stepping onto the mat became an invitation to explore things that I had once believed beyond my control or ability to manage.   What seemed overwhelming once is now a part of me that I know intimately, and revisit regularly to make sure that all the tourniquets have come off.  Sometimes I still find things deep in a practice that I had forgotten were even there.  But for me, this is what it means to be truly alive; to be wholly unafraid to touch my own experience, to explore what it means to be who I am and how I change throughout my life.  Doing the work that leads to the healing I've experienced and will hopefully continue to experience feels less like an injustice now, and more like a deep and satisfying privilege that I may never have taken part in had I not experienced what I did.   The suffering can be deep; but so can the healing, and subsequent joy of coming out on the other side. 

Finding the calm in the storm

My husband handed me a section of his Wall Street Journal one morning. “You should read this.”

I took it, bemused at the chaotic sketch at the top of the article; a mob of yoga practitioners dodging each others’ headstands and downward facing dog-ing onto each others’ heads.   The article catalogued the trials and tribulations that many larger yoga studios are facing; crowded classes, small spaces, and a very un-zen-like atmosphere overall.  (for the full article, see here.)

I think we can all agree that our lives tend towards the chaotic.  We have insanely demanding jobs (sometimes more than one), we have family and social obligations; it can seem like there's a never-ending pile of things that demand our time.   I know that a lot of practitioners take yoga to unplug from their demanding lives, to take a little “me” time in the whirlwind of their obligations to other things.   This is a great way to approach yoga, and there’s nothing wrong with it at all.   We habitually escape our stressful lives through vacations or day trips or even an hour-long massage or workout at the gym. Physically separating yourself from what stresses you out can be a quick way to relieve the symptoms of overload.

From a yogic perspective, the goal of finding of “zen” or “inner-peace” is less about creating a set of external circumstances that result in peace (say, a perfect yoga class where you have plenty of space to move) and more about connecting to an internal peace that is always accessible to you, regardless of external circumstances.    One of the many modern and more simplified interpretations that is often discussed today is mindfulness, or non-judgement.  It not only applies to not judging people or things, as we so often do, but it applies to our environment, our state of mind, and our selves.  We can see our environment, become upset by it because it violates an expectation we have (i.e. “I came here to relax and this environment does not relax me!”).  This results in elevated adrenaline and cortisol levels, not to mention a disappointing practice that does not give us the desired results, but only adds to the stress cocktail we've already been brewing in. 

It can be difficult to realize that it's not always possible to change your external circumstances.    When we feel anxious over our lack of control over our situation, these moments are an opportunity to experience what's occurring without expectation or judgement, either positive or negative.  Attaching value judgements on experiences removes us from the actual experience of the thing; when we decide an experience is "good", we lump it in with other "good" experiences and create assumptions about it that remove us from living in that moment, feeling what's happening now and learning from it.  When we label something as "bad", we want to avoid it, to run from it, and again; we miss out on the real experience and what we can learn, and possibly an opportunity to gain a deeper connection to ourselves in the process.   

Our brains like to label and compartmentalize everything, so this mindset takes practice, but a crowded yoga classroom where things aren’t “perfectly relaxing” is an excellent place to practice it.  And once you get to that point, it’s easy to feel compassion. This is where indignation becomes a willingness to make space for others and share union, share yoga, with other human beings.    Someone accidentally stepping on your mat doesn’t ruin your day.  Accidentally brushing your neighbor's foot in a half moon pose gets you a smile and instant forgiveness, instead of irritation and shame.  We’re all here, imperfect, in a wholly imperfect world; would we rather have to escape our lives for brief moments to only feel scraps of peace and calm, or would we rather walk through the maelstorm, carrying that peace and calm inside of us regardless of what we have to face each day?

Inner peace is not a journey or a search; it’s not always escaping your life to find a calm beach somewhere under blue skies, where your worries are far away.  It truly can be an experience in the middle of the chaos; the calm center in the midst of the hurricane.