Wednesday, December 9, 2020
Sunday, April 26, 2020
Sunday, April 5, 2020
When it comes to asking for help, it is important to notice where we experience our distress. We often notice our overwhelming emotions and our intense thinking patterns when it comes to stressful situations. It is important to start with how our body experiences the threat of the COVID-19 pandemic, particularly its impact on our nervous system. Everything that happens to us starts with how our nervous system receives it. Our body comes with a built in autonomic nervous system (ANS) that provides many vital functions including helping us experience safety. Relying on neuroception, a term coined by Porges, the ANS helps our body differentiate between safety, danger, and a life threat. Our nervous system gets affected by what happens around or inside us. For example, the cues of danger that many of us sense by just making a short trip to our neighborhood grocery store is enough to dysregulate our nervous system. It is very difficult to function optimally when we are in a constant state of dysregulation caused by the threat of the coronavirus. As human beings, we need a sense of safety. We can’t thrive without it.
At times like this, we need to help our body feel safe and learn how to regulate our nervous system. We need to protect ourselves from getting infected by the virus or recover from it without getting paralyzed by fear and stress. Luckily, by providing the right resources, our body can become a vessel of safety to settle ourselves. A settled body can become a protective container during these turbulent times.
Our best ally to help our nervous system deal with the COVID-19 pandemic or any life challenge is accessing resources. What is a resource? A resource is power. It is anything in the universe that can empower us, support our wellbeing, help us feel safe and create a healthy connection with others. A resource is not only about what can help us thrive but also how helping ourselves can positively impact others and the Earth. A resource can be as simple as listening to calming music that can relax us or practicing physical distancing with others that can reduce our exposure to the coronavirus. We all have resources, and some of us might need support to identify them. It is very difficult to identify resources if we feel anxious, overwhelmed, or dealing with chronic habits of negative thinking.
We can create a list of the resources that can assist us dealing with the impact of this pandemic. We can create it on our own, with the help of a therapist or a trusted person. Again, it is okay to reach out and ask for help even when it comes with resource making. As we make this list, we can bring awareness to what it is like on the inside knowing we have resources. For many, resource-making can be an act of self-care that can lead to a sense of aliveness. It can also be empowering and help our body experience a sense of safety. Peace, serenity, and a sense of safety can be very empowering for the immune system. In addition, resources can help us collectively. For example, a collective breath is a resource that can help us pause and change our old way of living. As our life story with COVID-19 unfolds, let’s reflect and realize a crisis is not always about danger but also the opportunity to transform.
© Dr. Payam Ghassemlou MFT, Ph.D. is a Licensed Marriage and Family Therapist (Psychotherapist), in private practice in West Hollywood, California. www.DrPayam.com www.SomaticAliveness.com
Wednesday, January 1, 2020
Saturday, July 20, 2019
For many LGBTQ (lesbian, gay, bisexual, transgender, queer/questioning) people growing up was distressing due to homophobia and transphobia. Schools felt like a scary place for those who were scapegoated as queer. LGBTQ people of color reported even worse experiences due to the additional stress of racism and racial bullying. Many of the gay men’s personal narratives that I have heard are not vastly different from my own. Regardless of national origin or skin color, we are part of a tribe with similar stories of growing up in a homophobic and transphobic world where our true essence was repeatedly assaulted. As LGBTQ people, we have connected around the theme of “love is stronger than hate” which raised awareness about our injustice and suffering. Addressing these issues have helped people to become more concerned about the mistreatment of not only LGBTQ kids, but also any youngsters who do not flow with the mainstream. More work needs to be done to make the world a safer place for marginalized people. Anyone dealing with oppression does not deserve to suffer in silence and needs encouragement to reach out and get support. Love and healing is more accessible than our painful moments want us to believe.
Injustice and trauma that were inflicted on LGBTQ people as result of growing up in an oppressive environment deserve empathy and healing. When it comes to healing, psychotherapy offers a variety of approaches to work with trauma, including the ordeal of growing up gay in a heterosexist world. Many mental health professionals who work with LGBTQ clients often rely on a “top-down” approach, which focuses on the highest form of cognition that involves changing thoughts. Moreover, it challenges clients’ negative belief systems and their cognitive distortions. Many clients have benefited from cognitive restructuring in psychotherapy and developed skills in identifying and disputing irrational or maladaptive thoughts. In my clinical experience, when it comes to healing from years of assault on one’s core identity including feelings of shame and humiliation for same sex attraction, a cognitive approach is neither enough nor always possible. For many queer trauma survivors whose thinking brain gets hijacked by trauma memories and their bodies default to a fight-flight-freeze response, a body-centered approach or bottom-up processing is necessary to calm their arousal systems. Relying on the thinking brain as the only path to deal with the root cause of trauma symptoms is not effective. The brain parts that are responsible for reflexes, memories, and automatic survival responses are in the deeper regions of the brain, and trauma informed therapy needs to begin by focusing on those areas.
Educating clients about a bottom-up approach, and the basic working of the nervous system can help enhance and clarify the somatic focused therapy process. For many LGBTQ clients, trusting a professional or an authority figure might not be easy due to their history with a discriminatory health care system, religious bigotry, police violence, school trauma, and family betrayal. Establishing a therapeutic alliance with LGBTQ clients can be facilitated by explaining the therapeutic process including the key role the nervous system can play in trauma recovery and asking their permission to provide somatic-focused therapy.
Our body comes with an already built-in autonomic nervous system (ANS) that provides many vital functions. The ANS is the part of the nervous system that governs the fight, flight, or freeze instinct and is responsible for the unconscious bodily functions like breathing, digesting food, and regulating the heart rate. It also plays an important role of supplying information from our organs to our brain. The ANS is central to our experience of safety, connection with others, and our ability to bounce back from life’s overwhelming experiences. Relying on neuroception, a term coined by Dr. Porges, our ANS is able differentiate between safety, danger, and a life threat. Neuroception, as Deb Dana (author of The Polyvagal Theory in Therapy) explains, is automatic, and it does not go through the thinking part of our brain. Everything from sound to smell to temperature in our environment, people’s tone of voice, and eye contact can influence our neuroception. It is like a “guardian angel” that helps us take immediate action in the face of danger or threat. The goal of neuroception is to keep us safe and alive.
Pat Ogden’s, Stephen Porges’, Bessel van der Kolk’s, and Peter Levine’s research and writings have expanded my understanding of the autonomic nervous system as a relational system that has been shaped by experience. We now know previous negative experiences and traumas can significantly affect how our nervous system accurately assesses safety, danger, or a life threat. This can explain why many LGBTQ people with history of being judged, humiliated, and violated often suffer from anxiety that stems from faulty neuroception.
Neuroceptive conditioning based on previous homophobic and transphobic mistreatment can cause many LGBTQ people to feel unsafe even where there is no real threat. What we hold inside in the aftermath of trauma can cause us to over-react in a safe environment or not react correctly in a dangerous situation. A body inclusive therapy can help to support the ANS to move out of a dysregulated state into a biological state of safety and connection.
There are many body-oriented methods for trauma healing including Somatic Experiencing (SE) which was founded by Peter A. Levine, Ph.D. His curiosity about animals in the wild getting exposed to life-threating situations without getting PTSD while humans frequently succumb to the disorder was the start of SE’s development. SE is a body first approach that helps people discover where they are stuck in the fight, flight, or freeze responses, and how they can “resolve these fixated physiological states.” SE is a powerful trauma healing medium that includes working with sensations, movements, postures, and gestures as a way of deepening resilience and to reset the nervous system. According to Dr. Levine, the ANS can become dysregulated due to “the thwarted responses of fight, flight, or freeze” in the aftermath of trauma. A body-oriented approach like SE can help stop trauma to become “a life sentence” through “gently releasing thwarted survival energy bound in the body.” To do this, Dr. Levine developed SIBAM as a method to accurately track a client’s inner experience. In his writing, he described SIBAM as an acronym for: “Sensation (Internal-Interoceptive), Image, Behavior (both voluntary and involuntary), Affect (feelings and emotions) and Meaning (including old/traumatic beliefs and new perceptions). These five elements are the channels of experience that occur during a session.”
LGBTQ people who grow up with mistreatment can discover the tales of their abuse written in their nervous system. The queer body remembers the experience of growing up in a world with cruelty. Having over two decades of providing LGBTQ affirmative psychotherapy along with research and numerous trainings on body-mind therapy, I have learned cruelty and cumulative stress of mistreatment can become embodied during a person's life and affect the working of the ANS. For example, one gay high school student with symptoms of anxiety disclosed to me that he hears several homophobic remarks a day along with experiencing bullying and harassment. Such ongoing stress from homophobia can activate his sympathetic system (“stress response” or “fight or flight” response). Naturally as a target of hate and mistreatment, he wants to defend himself or escape the abusive situation. Often due to lack of protection for many LGBTQ youngsters, during such abusive situations neither fighting nor fleeing can resolve the overwhelming situation. As a result, the energy that gets locked inside him for not being able to fight or flee causes trauma symptoms. In other words, the thwarted or incomplete fight and flight responses can become “trapped” within the youngster’s body and dysregulate his nervous system. Such a dysregulated nervous system is likely to get stuck on “high” or hyper-arousal. Anxiety, panic attacks, rage, hyperactivity, mania, hypervigilance, sleeplessness, exaggerated startle response, digestive problems, and many other symptoms are the result of a dysregulated nervous system that is stuck on “high” or hyper-arousal.
On the other hand, there are those of us whose nervous systems can stuck on “low” or hypo-arousal, which can result from being terrorized growing up with no hope of protection or escape. For example, faced with isolation, confusion, bullying, physical attacks, and ongoing lack of safety is too stressful for any child to endure, especially when there is no empathic other to help the kid. Such experience is often beyond the youngster’s “window of tolerance” (a term coined by Dr. Daniel Siegel). This is when the dorsal vagal (dorsal branch of the vagus nerve as discussed by Dr. Porges’ Polyvagal Theory) can shut down the entire system, and the mistreated youngster can go into freeze. In other words, the child suffers in silence with numbness or dissociation as his only available survival mechanism. Dorsal vagal is instrumental in activating the “shutdown” of the body in cases of overwhelming fear which can result from trauma. This automatic survival mechanism can become a long-standing pattern of how individuals might cope with fear and stress in life. For instance, people whose nervous system is stuck on “low” or hypo-arousal when faced with life stresses can default to shutting down, disassociation, chronic isolation, detachment, numbness, and suicidal thoughts.
As stated, trauma symptoms are the trapped energy from the "incomplete defensive response" (fight, flight, or freeze) and healing involves helping the body to release such thwarted responses. Working with many members of LGBTQ community, I have noticed when the nervous system gets stuck on freeze, when numbness and detachment become a gay man’s dominant state, he is more likely to engage in risky behaviors as a temporary relief from inner deadness. Thrill seeking behaviors such as, excessive gambling, hypersexuality, and crystal meth (crystal methamphetamine) use are few examples of how some gay men escape the emotional flatness that results from experiencing the hypo-arousal state. The same behaviors can also be used to cope with ongoing activation of the fight or flight response. One person might turn to substance abuse or other perilous behaviors to escape his inner deadness while another person might use it to dampen his anxiety that often results from being stuck in a state of hyper-arousal. It is important to note that the trauma is at the root cause of such a maladaptive way of coping.
As discussed earlier, as a “bottom-up” approach, SE focuses on the brain stem and its survival-based functions first rather than insight and emotions. Dr. Levine developed SIBAM to chart this “bottom-up” process, working from body to emotions and cognitions. The SE session involves teaching the client to track body sensation including the sensations related to the traumatic event. Experiencing body sensations related to homophobic or transphobic events in a safe way allows the client to process the trauma. Often the client might experience discharge of the traumatic energy through heat, vibration, shaking, or tears. Such healing approach can reset the nervous system and restore inner balance. For example, Cyrus (names and other details have been changed in respect for privacy and confidentiality) a cisgender gay Iranian man who grew up suffering from homophobia and racism, came to therapy to work on his “coming out issues.” After he felt safe enough to address his traumas, our work progressed in helping him to develop awareness of “felt sense” of his internal states. We worked slowly and paused periodically to notice any sensations, movements, impulses, images, gesture, or feelings. Sometimes he experienced an uncomfortable heavy sensation in his chest and stayed with it short of getting overwhelmed. Other times he noticed spontaneous movement of his body rocking from side to side which felt soothing for him. We paid attention to any subtle movement or protective responses that was coming up. For example, one of the protective responses that was not available at the time of dealing with school bullies was emerging. I invited Cyrus to notice the movement of his hands and what might be coming up. He described sensing strength in his arms and an impulse to use his hands to push back. By slowing down the process, he was able to work with that impulse. By tracking his body sensations and movements, Cyrus was able to move through painful events and discharge the trauma energy by spontaneous trembling and shaking. In addition, alternating, or “pendulating,” between the sensations associated with the traumatic event and those that are a source of safety and strength was part of the process that supported his ability to self-regulate. Eventually, our work together led to the embodiment of his pride in being a gay person of color. It also helped Cyrus not letting his past traumas become a life sentence. He discovered love and a sense of safety is more accessible than his past wants him to believe.
On the path to recovering from trauma and living a passionate life, one needs resources. In Sensorimotor psychotherapy, Pat Ogden describes resources as, “anything that enhances the quality of our lives or provides what we need to meet life’s challenges.” She also discusses in details different categories of resources including internal resources and external resources. It is important to note, a resource needs to be tailored to the needs of the individual. For instance, some clients might find certain body movements helpful. Their body might respond positively to such an experience by releasing tension. Other clients might notice feeling lighter in their body after watching a comedy or playing with their pets. No one should feel judged for not finding certain resources helpful. One size does not fit all.
One of the resources that can benefit gay men is the discovery and the embodiment of the meaning of their gayness or queerness. In one of my articles, “Gays in Search of Meaning,” I discussed by embracing what is inherently purposeful about our gayness, we can start to live a more soulful life. Helping gay men to connect to their gay essence and find the numinous qualities inherent in being gay can be an enlightening process. Gay people have an advantage as far as enlightenment is concerned. Most gay people grow up feeling "different," and that differentness helps to not identify with the collective. As Eckhart Tolle, the author of The Power of Now, suggested,
"...realization that you are different from others may force you to disidentify from socially conditioned patterns of thought and behavior. This will automatically raise your level of consciousness above that of the unconscious majority, whose members unquestioningly take on board all inherited patterns. In that respect, being gay can be a help. Being an outsider to some extent, someone who does not fit in with others or is rejected by them for whatever reason, makes life difficult, but it also places you at advantage as far as enlightenment is concerned."
It is important to note concepts like soul, enlightenment, or spirituality can be triggering for many LGBTQ people who were harmed by homophobic religions. Throughout human history, many religious institutes have committed atrocities against LGBTQ people. In the name of their god, they have murdered queer people or denied them their human rights. For many LGBTQ people who were target of hate by homophobic institutions, knowing their right to a soulful life with depth and purpose can be a resource. Such awakening can become embodied when it is done within the context of somatic therapy. In my experience, many gay men have added meaning and a sense of aliveness to their lives by participating in body inclusive psychotherapy while working on discovering a deeper meaning of being gay. Such feeling of aliveness and its underlying bodily sensation is in contradiction to the fear and humiliation that many gay men had to endure growing up in a heterosexist world. In Body Keeps the Score, Dr. Bessel van der Kolk writes about a body-centered approach to healing allows “the body to have experiences that deeply and viscerally contradict the helplessness, rage, or collapse that result from trauma.”
Finally, how far the LGBTQ community has come in the struggle for equal rights reflects how brave we are as a community. Our bravery can continue by facing traumas we experienced growing up in oppressive environments that did not nurture our true essence. Not every LGBTQ person felt traumatized growing up, but those who did can benefit from the vitality and the sense of liberation that comes with incorporating somatic work as part of the healing process As Resmaa Menakem, the author of My Grandmother’s Hands stated, “Healing does not happen in your head. It happens in your body.”