Sunday, October 13, 2013

Pain and Pastures


Flora* walked into my office with an air of confidence. Her light brown hair and fair complexion gave her a youthful look, even as her saucer blue eyes gave away a deep sadness within. A tattoo circled her wrist like a bracelet, a delicate design of leaves and letters. She began to tell me how she had been diagnosed with bipolar disorder several years earlier and that she had been quite depressed for a while now. The medication she had been taking had seemed to help at first, but not so much anymore. She began to tell me about her rigid religious upbringing and her history of physical abuse, but I interrupted her. I asked if I could talk for a moment about how I work before she went much further. Because while telling her story is of great importance, how she tells it may be even more significant.
I asked her to take a moment and look around the room, to gaze out the window at the blue sky outside. I waited in silence as her eyes surveyed the room, then moved to the tree outside my upstairs office window. At last, her eyes came back to meet mine, and I noticed a slight shift in her breathing. I said I’d like to explain some things about the somatic therapy that I offer, and asked if we could do an experiment.
“For just a moment, see if you can tune in to the sensation of your body in contact with the sofa, behind you and beneath you. Can you tell me what you notice about your sense of your weightedness?” I spoke softly, working to meet her gaze with my care.
“I feel some weight coming back into my legs. I hadn’t been aware of them a minute ago.”
I reflected her response and noticed with her that her awareness of having legs was returning. “What’s your temperature like? Is it warm or cool, or neutral?”
“I feel a little cooler. I was pretty warm there at first.” The color in her face was evening out as we spoke.
“How about your breathing? What’s your breathing like?”
“Pretty shallow. But it’s getting deeper.”
“See if you can tune in to that for a moment, breathe into it a bit?”
She paused, and I noticed with her that her body took a full, deep breath. Her shoulders moved just slightly downward.
By the end of our session, we talked easily, and I invited Flora to compare how she was feeling now with how she was feeling when she first came in.
“I feel a lot more relaxed, at ease.” She stretched her long arms out in front of her and yawned. “My breathing is deeper; I can feel it. This is really different. I’ve been to a lot of counselors and every time I’ve started therapy I’ve always had to start by spilling out all the details of my history. It’s a relief to not have to go into all that right away.”
Trauma as I define it is anything that overwhelms the body’s ability to regulate itself. Our flight/flight/freeze response is located in the sympathetic nervous system, marked by elevated heart rate, shallow breathing, narrowed peripheral vision, and tightened muscles that are ready to run or fight at a moment’s notice. It can be triggered by any threat, real or imagined. Flora was clearly in a state of sympathetic arousal or “activation” as she entered my office and began to tell me her story.
If you’ve ever been in a near car-crash and swerved suddenly to avoid it, it was this physiological response, your survival instinct, that was triggered to help you escape the danger. Cortisol and adrenaline flood your body, and you swerve to avoid a collision. You might pull over to collect yourself and notice that your whole body is shaking. This is the way it re-regulates itself, discharging the sympathetic activation that surged into your bloodstream a moment earlier. We tend to want to shut it down, to move on, because it can be uncomfortable, but it turns out it’s important to let it finish. It’s our body’s way of dispelling the experience and recovering its innate regulation. The body knows how to recover.
This normal response to threat is built in at the most primitive level of our brain function. It is meant to be activated quickly and then discharged or released quickly. However, if the danger persists, for example if we are trapped in a stressful circumstance, or for whatever reason we are unable to fight or flee, the body’s next best approach is to “freeze.” People sometimes call this immobilized feeling “depressed” or “stuck” or “numb.” If this response goes on for a while, it can become more chronic, without release, and the body can become disregulated, resulting in a variety of symptoms including anxiety or panic, depression, insomnia. If it goes on longer, still louder symptoms can emerge, perhaps even those of bipolar disorder or dissociation.
With our experiment, I invited Flora to notice her body’s response in order to help it regulate itself before we went further. Sometimes people can do this, and sometimes they can’t, depending on the kind of trauma they have experienced and how their body has responded to it. If they can’t, then I take other more indirect approaches, still openly working to find some regulation in the body. I might work with someone for several sessions before moving toward their story, simply helping to “resource” the body, finding sources of comfort in daily life, or places in the past that brought them a feeling of wholeness, of “being themselves,” grounded in the experience of the present moment.
For Flora, we discovered that there was a place where she grew up, largely in isolation, a field near where some cows grazed. She could walk far into the pasture and lie down under the shade of some trees. She would stare up at the sky and notice how blue it was. Whenever we began to slowly move toward talking about the physical abuse she suffered at the hands of her fundamentalist Christian parents, we could change gears and put her back, in her mind’s eye, into that pasture. Her body would begin to shift, to release, as she recalled the vibrant color of the sky, the sound of the breeze moving the leaves, the fragrance of the blossoms nearby, and the warmth of the sun on her skin. It was a source of deep regulation for her body.
Over time, Flora’s body began to discharge the physical elements of the trauma stored deep inside her. She worked hard to integrate the emotional and spiritual components of her life’s narrative as well, and to cease being a victim of her past. With the oversight of her physician, she was able to wean off of her medications. As the symptoms of her bipolar disorder resolved, she came to see them as pointers to her trauma rather than lifelong mental illness. By the time we finished our work, the flashbacks were fewer, and if they did arrive, she was able to separate the past from the present. She had tools on board that she could employ to process her feelings, thoughts, and sensations.
Flora and I worked together for two or three years, moving back and forth in each session between body “resources” like the pasture near her home, or her love of the ocean, or the feel of her dog curled up next to her, and the deeply painful memories of the abuse. We explored the sensations in her body of activation and regulation, and moved toward the careful expression of the dark memories, which had been so overwhelming in her previous therapies. We worked to balance it with things that brought her life, groundedness, hope. The memories became less intense over time, more integrated, physically and emotionally, as we paid close attention to her body’s ability to move back and forth between a certain level of activation and the deep regulation she was beginning to experience.
I’ve worked as a therapist for about fifteen years now, “somatically” with people like Flora for about ten. I have found that working with the body is essential for resolving traumatic memory. I have been helped tremendously by the work of Christine Barber, Peter Levine, Maggie Phillips, Dan Siegel and Bonnie Badenoch, to name a few. I have come to believe that the complexity and variety of mental illnesses described in the DSM-5 (my profession’s diagnostic manual) reflects how individual bodies respond to their respective traumas. I have seen the symptoms of these various diagnoses largely eliminated by working with sensations in the body and moving toward integration of implicit and explicit memory, sensation, emotion, mind and spirit. I have worked with a number of people who were diagnosed bipolar, like Flora, and who were able to move beyond their symptoms toward substantial healing. They are the real heroes.


* “Flora” is a composite of people from my work in private practice as a Marriage & Family Therapist. I have made her unrecognizable in order to protect confidentiality.

For more information about this kind of therapy, or for a referral to a practitioner in your area, you can go here or here. For further reading, you can go here.

Monday, April 8, 2013

In Celebration of Mercy

This poem was a gift from my friend Tamara, left on my doorstep on the occasion of my father's sudden death, eleven years ago this week.


In Celebration of Mercy
6 April 2002
by Tamara Thomas Duvall
I came home today.
It was a long walk
I have rested some
but mostly I have been
traveling.
My father took me in
today. He had a place for
me to hang my hat.
I can rest here.
I buried a son too soon.
I buried a wife, sometimes
it seems maybe
too late.
I tried to be heard
so I sometimes spoke loudly.
I tried to feel, I didn’t
speak. My son…
But today my father
took me home.
I can see my son, and
my wife at the table.
I can feel.
I can speak of joy.
We are all somehow
Held.
We can rest here.
My son and daughter
are still traveling,
Walking that crazy road.
Today I hope they feel
I hope they speak.
I hope they are
confident
Our father is taking us
in everyday & here
I, their dad, have
a place for my
daughter and son
We can all rest.
We will all be Home.



Tuesday, November 8, 2011

Peru Adventure, Part 3


At 4:00 am we rise to head out to the clay lick. The macaws of the Tambopata Reserve were featured in a National Geographic article in 1994. It highlighted one of the largest clay licks in the jungle, less than three hundred meters from our lodge. It attracts up to fifteen species of parrots and macaws, hundreds of birds at a time. They lick the clay in order to add something, probably salt, to their diets. But they do not come when it rains. It is dark and I am sleepy. I hear the rain. We are not going.

When it lets up, we go out for a later hike and see lots of monkeys. We add three more species to our list: Red Howler, Squirrel, Brown Capuchin. We also see a Blue-throated Piping Guan and a Razor-billed Curassow, turkey-like birds from the same family. These birds are a sentimental favorite of mine and they delight me. The sound of a nearby herd of peccaries captures our attention. We track them and then wait. Suddenly our guide grabs my shoulders and points me toward them, so that I can get a better look. I practically climb backward over the top of him to peek out from behind his shoulder instead. They come close enough to make eye contact. The Ficus trees are huge and magnificent, also Ironwood and Kapok.


The next morning it is still drizzly but we head to the clay lick anyway. Quite a few birds arrive despite the less than ideal conditions. We see a large White Cayman carrying a fresh caught catfish the size of its own head and climbing out of the river on the bank across from us. It holds the fish steady for a long while before heading back into the river. They disappear into the brown water.

It is fun to be a part of this group I am with at last, and our next hike, in the late afternoon, turns into a night walk. Near the equator, the dark falls quickly; there is no twilight to speak of. The jungle at night holds even more secrets than in the daylight and we hear lots of eerie noises. We follow a loud plaintive sound and find the poison arrow frog responsible. We lure a tarantula from its den for a photo op.



It is Friday now and we head out for our final visit to the clay lick. It is a clear morning and we set up to wait for the dawn and the birds. They do not disappoint. We see at least ten species of parrots and macaws. Hundreds of them. Blue-and-Yellow Macaw, Red-bellied Macaw, Scarlet Macaw, Chestnut-fronted Macaw, Blue-headed Macaw, Orange-cheeked Parrot, Blue-headed Parrot, Yellow-crowned Parrot, Mealy Parrot. 

The cacophony of their squawking overtakes the quiet of the dawn. We notice that they arrive in a particular order, the same order as they did the day before. The rain has kept their numbers down for the last two mornings, so maybe they are excited to be back. Their flocking behavior and loud calls are also protection from predators. We see a Roadside Hawk perched in a tree nearby and so do they.



The time has passed quickly here and by late morning we are stepping onto the motorized canoes for the trip downriver. It takes two days to get back to Puerto Maldonado so we will stop over at Refugio Amazonas. Along the way we watch a capybara family along the bank of the river. Our spotter thinks he sees a jaguar and we drift toward the river’s edge to get a look. Long gone.

We arrive in time to get to the canopy tower before sunset. From our vantage point above the jungle we see patches of crazy bright blue and identify Paradise Tanagers in the branches below. Our guide laughs as he tells us about the Americans he brought here who saw those birds and used the word “ridiculous” to describe them. And so they are, in such gaudy adornment, seven distinct bright colors in all. We see a Purple-throated Fruitcrow perched at the top of another tree. This is not actually a crow, but a member of the Cotinga family, a large group of fruit-eating birds. Looking over the top of the jungle's canopy we watch as the sky turns pink and the sun reflects golden light below us. It is our final twilight in this magnificent setting.

Our last morning comes and my hammock gently sways as I look out the open deck of our lodging. The air is thick but not as hot at this hour. The Pono Palm trees give me a sense of where I am and the sound of the Screaming Piha has become familiar. He is another cotinga, and after glimpsing him in the dense woods yesterday I can picture him advertising himself to the females in the area. There are so many remarkable sounds in the jungle and I wish I could hold on to them. Before long we motor down the Tambopata River to head out. As I watch the river go by, I already feel homesick for this awe-inspiring place I am leaving.

Wikipedia photo - Paradise Tanager




Thursday, November 3, 2011

Peru Adventure, Part 2

     Today it feels odd to be solo. Still, my sense of adventure is with me. The flight from Cusco to Puerto Maldonado takes about 35 minutes. We are transported by van to a location five minutes from the airport to pack and reorganize. Thirty minutes later we leave for a tour of the town, including a ride across the new suspension bridge over the Rio Madre de Dios. It looks like a smaller and out of context version of the Golden Gate. We are told that thanks to this bridge, which just opened, the highway now stretches from coast to coast, all the way to the other side of Brazil, some 4500 km (2800 miles).

     The van takes us back over the bridge and about an hour’s drive down a red dirt road to a small port on the Tambopata River. We embark on motorized canoes for the trip upriver to the Refugio Amazonas, our destination for tonight. I am traveling with three other solo tourists who met one another while trekking the Inca Trail and have been traveling together since. Thomas is from Ireland, Michelle from New Zealand, and Melissa from Australia. I first noticed them at the Cusco airport early this morning. Now they have included me in their number and I feel welcome. I am happy that we all speak English, though certainly different versions.


Photo credit to Rich Vial

     I see my first Capped Heron today and it is stunning. After some engine trouble on the way, a thunderstorm, and a couple of stops for wildlife viewing, we arrive at Refugio around 4:30. We hike about fifteen minutes to what truly feels like a refuge when it appears at the end of the trail.

     I relax in the open lounge area of the lodge and crack open my copy of Birds of Peru. I feel proud of Tom and Ted and the others who put this book into my hands after so many years of work. I am moved in my spirit to be here.

     The heat and humidity is summer in Louisiana on steroids. Furthermore, in the jungle, preventing bug bites is essential, and keeping skin covered is the best way to prevent bug bites. So I am getting used to long sleeves and pants and socks in weather that calls for shorts and flip flops back home. Later, I sleep under a mosquito net and am happy to peel off some layers to cool off a bit. My body is remembering how to sweat profusely.

     I am introduced at dinner to a new guide and to the two Americans I will travel with tomorrow the rest of the way to the research center. They are attorneys from San Diego and I realize later how fortunate it is that they booked the last room available there and planned to arrive on just the day I need a ride. Even though my traveling companions have spoken forms of English today, I feel glad to meet Americans. We are instantly comfortable.

     After dinner we are told we will rise at 5:30 for a hike to the oxbow lake nearby and some sunrise birding. I am glad to learn that I am not just hitching a ride, but will have a day of exploring along the way.

     At sunrise from a dug-out canoe, we see Joatzin, Blue-green Macaws, Mealy Parrots, White-winged Swallows, Yellow-headed Vulture, Smooth-billed Ani, and Black-capped Donacobius. There are long-nosed bats hanging like leaves on the underside of a tree trunk that leans over the water. On the hike back from the lake we see a Saddle-back Tamarin and a Squirrel Cuckoo.




     By late morning we are in another motorized canoe heading toward the research center. The Tambopata River is wide but shallow enough to require a spotter on the bow of the boat for navigation. It is the end of the dry season, the air is weighted with humidity, and thunderheads signal the coming rains. The peaks of the Cordillera range appear in the distance. The last two hours of the trip, there are no signs of human habitation. On one side of the river is National Reserve, on the other National Park. Nothing but jungle stretching from horizon to horizon.



     We disembark at the river’s edge and are greeted by a troop of Black Spider Monkeys. They are making their way on a highway of upper canopy over our heads. After watching them move on, we begin our hike into the jungle. When we reach the clearing and the lodge, Carol is right there, coming toward me as I climb the stairs. “My friend!!” I shout as I run to embrace her.

     “You’re here!” she says with jubilation. In an age of cell phones and instant connectivity, it feels strange that we have not been in contact for two days while I’ve made my way into the jungle wilderness of Peru to meet her. We are hungry for news from each other and we instantly sit for our stories. “What happened?” she asks, and we begin.



Saturday, October 29, 2011

Peru Adventure, Part 1

This morning I sip my first Inca Cola and tonight my first Pisco Sour. And I only cry three times in between.
The first time I heard of these beverages was 1978, when I was supposed to have traveled here to Peru with an expedition from LSU´s Museum of Zoology. My friends wrote to me, on paper, of their adventures. I enrolled in a marine biology field course on the Gulf coast instead, and missed the experience.

Some thirty-three years later, I arrive in Lima, thanks to my adventuring friend Carol. She knew me when I passed up that first trip. She came here just a few years later herself, and has been coming ever since. Now she does these tours for a living, and had space on one that I couldn’t pass up.
Because I signed up late, I am booked on a flight separate from the group from Lima to Puerto Maldonado this morning. After changing planes in Cusco, I am to arrive an hour late, still in plenty of time to join the group for the motorized canoe trip up the Tambopata River. 

As we sit still on the tarmac at the Lima airport, listening to the announcement about the flight delay, I become concerned about making my connection. When we arrive in Cusco over an hour behind schedule, my connecting flight well on its way, I race to the LanPeru counter to implore them to put me on the very next flight. The woman I find tells me the next flight is tomorrow. This is the first time I cry, but not the last.

Lucelia, the gate agent, looks at me with compassion. My mind races through possible scenarios as it dawns on me that I will not be with the group for the lodge tonight or the six hour canoe trip tomorrow to the research station. I explain my situation, that the group will move on without me into the jungle and I do not know how I will reconnect with them. I am not sure that if I miss the boat trip tomorrow that there will be other boats going that way for days. 


I follow Lucelia as she begins working to reschedule my flight. The new direction of the changed trip begins to settle in, and I wait, thirty minutes or more, for the arrangements to be completed. I lean against a wall, the possibility of being stranded in Cusco for a week dawning on me. I cover my face and sob silently into my hand. This is my second cry.

I grieve the loss of the trip I expected and imagine new scenarios for my week. Perhaps a writing retreat in Cusco is what this trip will be, instead of a jungle adventure. I guess that wouldn't be so bad. Lucelia appears again and gives me my new boarding pass, and a hotel voucher, along with ten soles for a taxi, “Five to go now, five to come back here tomorrow.” With this, she tips her hand to the taxi drivers outside who will certainly ask more from this green Gringa tourista. Message received.

It is the second taxi who accepts my bargaining for “cinco (5) soles” after beginning at quince (15). I get to the hotel and rush to find the internet to email Carol and also to get from her earlier email the emergency contact numbers. I print the page of phone numbers and head to my room. 

After reaching the second person I call, who speaks fairly good English, I learn that the arrangements have been adjusted. And there is a boat going all the way to the research station on Tuesday. Carol knows where I am. Someone will meet me at the airport tomorrow morning and I can begin my jungle adventure. I will meet up with the group in two days. I begin to breathe. 

Once I hang up, I weep for the third time today. Except these tears signal release, relief, discharge. I feel grateful, and rescued. My body is shifting gears. I begin to enjoy the idea of the next two days on my own. I think of that Spanish phrasebook I almost bought at the LA airport. I head out to explore Cusco at dusk, and come back to enjoy my first Pisco Sour.


Thursday, July 28, 2011

This is Summer


Farley and I are at Hileman Landing, swimming in our favorite spot. The mercury is rising the closest to 90˚F it has been this year. I am grateful for the sounds of summer: the bullfrog, the mourning dove, the song sparrows. The water feels warm and cool at the same time—the cold spots surprise and the warms spots caress. The heat of the sun soothes my shoulders as I stand up on the rocky bottom and listen.

I stand in the water of the Willamette River’s oxbow listening to these sounds and saying aloud, “This is summer, this is summer,” as if to invite it to stay with me long enough to make the coming winter bearable. The warm water reminds me of summers past. As I speak my mantra I am aware that in my years in the South, this was spring. Summer was something else entirely.

The warm spots remind me of the Tchefuncta River and the swims that helped the eternal summers to be bearable in Louisiana. In my mind’s eye I once again see Brown Thrashers poking around at my mother’s, beneath the lanky pine tree forest that was her yard. The Cardinals and Blue Jays provide splashes of color at her feeders.

What we called “Lake” Emfred is actually a bayou, branched off the Tchefuncta's  languid main channel. There are two docks next to the boat ramp, one high and one low. The high one on the left is where I would sit to watch for snakes and turtles in the black water in winter, and jump in cannonball style to cool off in summer. Across the bayou the cypress swamp gives the appearance of an island but with little solid ground between the many “knees.” You could pole a pirogue through there to the river easier than finding footing for a hike. Looking to the right of the dock, the bayou has better access to the larger waterway, still through a dark and tangled swamp, an area I loved exploring by canoe.




The three days per summer that I get to be in the water at Hileman take me back to that place of sense memory and I relish it. Most of my Oregonian friends would never swim here, since the bottom is muddy in places and the water is not crystal clear. Most lakes here are translucent and deep and quite cold. After our swim, Farley and I hike out to where the car is parked and meet a family heading in with swimsuits and fishing poles. They ask if they are going the right way to the swimming hole and I reassure them about their direction. They ask how’s the water, and I say great, adding a caveat, “But I’m from Louisiana, so my standards are not high!” We laugh and walk on.

Tuesday, July 5, 2011

The Predator and Its Prey



The sky was blue and the sun was out as I left my favorite coffee shop to walk back to my office. The new summer air had a mild warmth to it, with a coolness in the occasional breeze. Suddenly I heard a ruckus across the street, birds squawking loudly, and I looked over to see what was going on. There were two crows in the middle of the sidewalk in front of the record store, one attacking something and the other one standing by, watching with interest. The way the smaller birds were shouting I took the prey to be their fledgling. 

My heart raced, my hand clutched my chest, and my eyes were glued to the scene. The crow let up for a moment and the prey bolted. As it raced away I realized it was not a bird but a mouse. It scurried behind a nearby utility post that I knew would provide little protection. The noisy starlings were not upset because they were losing a fledgling; they were cheering for the crow, perhaps hoping for a bite of mouse themselves.

The crow bounced over nonchalantly to where the mouse had hidden. Within seconds, it had grabbed the mouse and pulled it back onto the sidewalk. The crow used its beak to hold the mouse and at the same time to pound it against the concrete. It didn’t use its claws, like birds of prey use their talons. With the crow’s method, the mouse got away several times, but it was never long before it was recaptured and pecked brutally again in its soft parts.

Time slowed down as I beheld this violent episode. I could not turn away. It was in fact over within the space of a couple of minutes. I turned to walk on only when it became clear that the crow had won. I was gripped by the horror of the mouse’s fate, eaten alive by this crow, whose motive was not at all evil, but only the satisfaction of its hunger and the nourishment of its body. The mouse had become a meal.

As I walked slowly on, a flood of thoughts and feelings swirled within me. I recalled Barbara Kingsolver’s novel, Prodigal Summer, where her protagonist observes that in the natural world by the luck of the draw some are born predators and others prey. She realizes she must reconcile this reality as part of the design and function of nature, whether she likes it or not. Without one or the other, a delicate balance is thrown off. 

She eventually concludes that as a human manager of her own slice of the natural world, she must respect these roles even in the smallest decisions she makes. She decides she can kill the bugs the spider would eat but not the spider. The wolves in the wilderness she inhabits must be protected as the top predators, but she understands that she can take out a deer for her own sustenance and its population will adjust, because it is designed to serve as prey. It’s how nature works.

My mind bounced again. I tend to think of crows as carrion-eaters, not hunters, but I was reminded that they both hunt and scavenge. After all, they are omnivores and also opportunists; they make their living any way they can.

My thoughts skipped then from respecting the role of the predator to the sad fate of the prey. I couldn’t get the image of the mouse being eaten alive out of my mind. I thought, how in the world can this be okay for the mouse? I can’t imagine a worse fate. I began reflecting on my understanding of the physiology of the fight-flight-freeze response, gained in the course of my work with somatic therapy.

It occurred to me that the mouse has all the same equipment that we do. Thinking physiologically, I ran through the events for the mouse. It was scurrying away as a result of its sympathetic nervous system’s activation: its heart sped up, breathing became shallow, peripheral vision narrowed. All of its reserves and resources were turned toward the act of fleeing from the crow. And flee it did, several times. 

Once running (or fighting, if that had been possible) failed to protect it from the attack, the next step physiologically was automatic dissociation, or “freeze.” With this, the mouse’s heart rate and breathing slowed and endorphins were released to block its perception of pain. Fairly quickly, as the endorphins reached its brain, the mouse was completely sedated and lost consciousness.

As I went through these steps in my brain, I noticed my own release of a long deep breath, as my body began to discharge the impact of the scene I had witnessed. My heart had also sped up, my breathing had become shallow and my vision focused. As I became mindful of my breathing, it returned to normal and I once again felt the warm summer air. My vision opened up to the green leaves of the trees I walked under. I became aware that we can experience the brutality of nature as an aberration, but it is the way of the natural world, as seen in this predator-prey relationship. 

My thoughts settled into the understanding that this world is a complex web of living and dying; one life is given up to sustain another. And I could see that the design is a good one. In fact, how very merciful, in the end, that the prey species would be given such helpful protection from suffering in the midst of its vital role of nourishing the cycle of life.