‘Stella was only four when she lost her mother.  Her father struggled to bring up the family alone but when he got married, his wife had her own children and did not have the  time or patience for Stella and her brothers.  They went to live with their grandmother, but when Stella was just 12, she too became seriously ill and Stella was left to bring up her brothers by herself.  She felt isolated and overwhelmed.  She remembered it as the time when her stomach pains first started.  They were associated with a sensation which she described as blackness. 


Then she met Jed and fell in love.  He felt the same. She relaxed.  They got married and had two daughters.  7 years later, Jed had an affair with a woman at work.  Stella didn’t get annoyed.  She just became numb.  The blackness returned and with it her pain.  She no longer had any meaning in her life.’     



In the psychological literature,  the diagnosis of post traumatic stress disorder tends to be restricted to people who have had life threatening or abusive experience.  This is unfortunate.  Trauma is much more widespread and covers anything that affects or upset us.  Our responses to a particular incident are highly idiosyncratic and depend on our personal history.  Indeed most of my patients suffer from the meaning of what has happened to them or as Freud put it, people suffer mainly from reminiscences.     


When people are traumatised, they can lose themselves in what has happened (see my blogs on ‘Why falling in love can be so traumatic’, 23rd September;  ‘Not all in the mind, what happens when trauma goes into the body’, 24th September and ‘Why traumatic life events can make people mad’, 1st October).  Identity is overwhelmed,  individuality subsumed.  The self fuses with the trauma.  The intrusive thoughts, sleeplessness, ‘nightmares’, rumination, depression are all indicative of total preoccupation with what has happened. The self, in essence, becomes the trauma identity.  This might for example explain how prisoners come to identify with their captors, how people remain with those who have abused them and why there can seem to be such a perverse drive to repeat the trauma – what Freud termed ‘compulsion repetition’. 


So if the self is invaded and occupied by the trauma, the body becomes an instrument of propaganda. 


The events and situations that affect us on a daily basis are expressed in the body and mediated through subtle changes in the activities of the sympathetic and parasympathetic nerves and the endocrine glands.  If what happens is within the range of familiarity, the  bodily reactions are processed instantaneously and subconsciously by the mind; the feelings are ‘recognised’, categorised and converted into emotions by being put into context.  ‘This makes me angry.  I feel anxious about that.’  The emotion then drives resolution and the whole experience is stored for future reference. 


But if something happens that is so alien to our experience, so overwhelming that it cannot be processed, so awful it cannot be resolved, then it remains locked in the body as an illness, the symptoms of which persecute the individual as the trauma previously did.  ‘The pain is killing me.  It never lets me rest.  I cannot bear it any longer.’   


Unless the context can be accessed, emotion cannot be generated. Without emotion, the  traumatised self has no sense of  meaning. It is little wonder, therefore, that victims of trauma experience ‘annihilation’.  ‘Trauma denies the person the right to have a place in the world.’  For much of the time they are ‘numb’.  If  they do feel emotion,  it is quite indiscriminate and meaningless.  There is little difference between anger, fear, or sadness; only arousal and panic.


Since the meaning of what has happened is so unacceptable to their self construct, it  cannot be worked through and resolved.  It therefore remains split,  sometimes acceptable, sometimes not.  Thus like an argument between entrenched protagonists, it is acted out endlessly, seeking some redress, some sense of understanding or forgiveness.  Films shot in hospitals after the first world war reveal how shell-shocked soldiers re-enacted the circumstances of their trauma in brief  biopics; the endless grimacing of an infantryman  who had bayoneted his enemy in the mouth, the private who hid under the bed at the sight of a French officer’s kepi.  Similar traumatic representations are played out in our present day clinics and surgeries;  the apoplexy of situations impossible to stand,  the hunger strikes,  the intolerable shame of uncontained bowels,  the pain that tortures the soul.       


In Wednesday’s talk at The Hallam Institute of Psychotherapy, Patrick Loftus explained how the creation of images in art can  transform the trauma and so gain reconciliation by achieving emotional potential.  Art  can generate a meaningful object, an object that a person can own and use to make sense of their world.  This or the process of producing it becomes  an expression of the self, separate from the trauma, and can form a nidus of regeneration for a disintegrated identity – a nucleus of meaning, fixed in time and space, linking mind and matter.  Writing poetry or short stories can surely serve the same function; space to think, time to reflect.  Narrative makes sense of experience and facilitates integration.  In his book, Nature Cure, Richard Mabey described how being out in the country, observing wild birds and animals life created a focus of imagination, that helped to take him out of his depression.   


Music does something more.  Yesterday’s programme on Music and The Brain on Radio 3 described how music, like language, is charged with affect.  Tone, pitch and cadence integrate body and mind, releasing emotion.  As one contributor commented, ‘Without a body, there is no emotion.’    


The musical qualities of an infant’s babble – proto-speech – imparts such pleasure to the listener; their cry such alarm.  But a Beethoven quartet, a Mozart Aria or a Bach fugue, Ella Fitzgerald, Elton John even Jon Bon Jovi (You give love a bad name!) optimise the emotional stimulation. Performers often talk of surfing the emotional wave.  For trauma patients, music can awaken anaesthetised and paralysed emotions, providing a medium for thoughts to take flight,  but there is a risk of  being overwhelmed with uncontained feeling.  This is where rhythm comes in.    


Rhythm is so important in trauma management.  Rhythm entrains and organises.  It creates a structure for the music.  It contains the emotion by creating a cognitive map.  Last week at lunchtime in the Wigmore Hall, I watched how the clarinettist, Martin Frost, was so immersed in the Brahms Quintet that his body appeared to be making love, but the technicalities, the timing, the rhythm organised his brain keeping him focussed and on track. 


Our whole existence is dominated by rhythms.  Heart rate, walking, breathing, brain waves, circadian rhythms, cycles of brain activity during sleep.  It is surely no coincidence that the ‘beat’ of  most musical compositions (0.7 to 2 Hz) corresponds to the rhythm of the heart and that of walking or jogging, or that of rocking.  Both music and jogging release endorphins, calming the brain and body. 


Speed the rhythm up and the music is more exciting.  Slow it down and it becomes sad and contemplative.  Two new and effective trauma therapies also, like music, tap into these physiological rhythms.  These are Emotional Freedom Technique (EFT), which involves rhythmic tapping over acupressure points,  and Eye Movement Desensitisation and Reprocessing (EMDR), which involves  rhythmic movements of the eyes.  A century ago, hypnotists used to get their subjects to focus on a swinging fob-watch.  Now EMDR therapists move their finger back and forth in front of their subjects face.  The regular movements seem to focus the mind, distracting troubled people from their preoccupations and inducing a feeling of calm.  In the same way, the ‘musical’ mantras and breathing exercises  (pranayama) of transcendental meditation relax tension by helping people to stay in the moment.   Children with learning difficulties often soothe themselves by rocking and respond positively to music.         


The emotion and rhythm of music has a powerful capacity to bind people together.  Singing, dancing, marching, chanting, recitation are all very bonding experiences.  Along with making love, another rhythmic emotional activity, making music generates deep feelings of trust and confidence.  When people are upset, they retreat into themselves.  Isolated in their fear, traumatised people are as disconnected from other people as they are from their emotions and their bodies.            


There’s nothing new under the sun.  Slowly – too slowly it seems – we are rediscovering with the confirmation of neuroscience what was so essential to our tribal ancestors,  that rituals involving singing, dancing, legend, play acting and charismatic suggestion, can not only serve as a powerful cohesive force,  but can also help people cope with the tribulations of their lives.  Our challenge is to harness this age old feature of human society to heal the fragmentation and illness that is such a pervasive aspect of our modern existence.