I titled this newsletter “The Body Is A Trailhead” because I’ve spent the past five years writing about and teaching about trauma-informed medicine. To me, trauma-informed medicine is an umbrella term that incorporates more than just following the body as a trailhead and getting curious about physical symptoms or disease.
The umbrella of trauma-informed medicine also includes:
-Understanding the impact of childhood trauma on adult onset disease
-Recognizing that a high trauma burden creates chronic nervous system dysregulation which impacts every cell in the body (it’s NOT all in your head; it’s in your body)
-The value of effective, cutting edge trauma treatment in potentially improving disease outcomes
-Bringing a trauma-informed lens to helping patients deal with relationships that may be exacerbating symptoms (especially wounded boundaries, developmental trauma, and narcissistic abuse)
-Approaching patients with a heavy trauma burden in ways that help them keep their agency, autonomy, and choice
-Acknowledging that it’s not just individual trauma or relational trauma that has been shown to be causally related to physical illness. Some traumas, like systemic racism or homophobia or war trauma- are collective traumas that cannot be healed at the individual level, no matter how much therapy you do.
The Physiology of Trauma
So what do I mean by “The Body Is A Trailhead?” There are many good trauma healing methods that are increasing in mainstream popularity that approach the body from a place of inquiry, including but not limited to Internal Family Systems (IFS) and Somatic Experiencing. [The New York Times just reported on somatic therapies this week, if you’re curious.]
This is not to suggest that every illness or physical symptom is caused by emotional trauma. But the long term impact of trauma stored in the body means a highly active amygdala, which activates the hypothalamus, pituitary gland, and adrenal glands to secrete high doses of stress hormones, which lead to chronic nervous system dysregulation. This causes chronic inflammation and disables the body’s natural self-healing mechanisms, which increases the likelihood of developing or exacerbating almost every disease we know in medicine. This cascade of trauma-related physiological events creates the conditions that exacerbate almost any kind of preexisting physical vulnerability or illness; and it creates the conditions for new physical issues to take root.
The Body Is An Ally
When we use language like “the body keeps the score” or “the body bears the burden,” we imply that the body is some passive aggressive bully that punishes us if we’ve been innocently traumatized. But what if it’s just the opposite? What if our body is a super sensitive, highly attuned ally that doesn’t miss a beat and won’t let us get away with spiritually bypassing our traumas, emotionally bypassing our feelings, overworking to push down our memories, staying in relationships that are not good for us, letting people cross our boundaries or exploit us without accountability, living in an oppressive culture that is not conducive to thriving, or trying to survive in an increasingly poisoned, exploited, and life-denying environment?
When we approach the body as a trailhead, we need not curse the body when it reacts to internal or external traumas that threaten to make us sick. We can lean into the physical symptoms compassionately, as if the body is actually an ally that might have a message for us. We can get curious about whether this physical symptom or illness might be trying to protect us in some way, even if it’s also harming us and causing us to struggle.
Maybe the body is helping us getting some unmet needs met, like a chance to rest and be less productive. Maybe it’s giving us a valid reason to avoid a toxic person in our lives. Maybe it’s helping us prioritize self care rather than depleting ourselves caring for others. Maybe it’s taking the pressure off of fulfilling a creative or professional dream or goal. Maybe it’s keeping us away from an unhealthy work environment while also earning us a disability check.
Maybe there’s a relationship to past or present trauma. Maybe the physical symptom has nothing to do with trauma and everything to do with living next door to a toxic waste dump or having a house full of mold or DNA with a congenital mutation. But even then, if there’s also a history of trauma, the chronically dysregulated nervous system can exacerbate physical issues that may be caused by something else entirely.
The Link Between Trauma & Disease
Some people don’t like to acknowledge the very clear science linking childhood trauma to adult onset disease or ongoing trauma to ongoing illnesses that don’t respond well to conventional medical treatment. We’d rather take a pill, get a surgery, or try an herb, supplement, or special diet than risk feeling the pain of our emotional traumas, which is understandable, because nobody likes to feel hard feelings, like fear, worthlessness, helplessness, hopelessness, despair, grief, or loneliness. But unfortunately, the “quick fix” culture of both conventional medicine and some aspects of the wellness industry simply doesn’t help traumatized people achieve optimal health outcomes. No matter how many drugs, supplements, functional medicine tests, yoga classes, personal training sessions, green juice cleanses, or meditation retreats you might try, if you have trauma in your body and you’re not using the body as a trailhead to try to understand what it wants you to know, it’s possible that the little whispers will become rebel yells.
If you doubt that trauma and disease are strongly linked or wish to deny this scientific reality, consider what California Surgeon General and pediatrician Nadine Burke Harris, MD said in her groundbreaking TEDMED talk:
“In the mid-’90s, the CDC and Kaiser Permanente discovered an exposure that dramatically increased the risk for seven out of 10 of the leading causes of death in the United States. In high doses, it affects brain development, the immune system, hormonal systems, and even the way our DNA is read and transcribed. Folks who are exposed in very high doses have triple the lifetime risk of heart disease and lung cancer and a 20-year difference in life expectancy. And yet, doctors today are not trained in routine screening or treatment. Now, the exposure I’m talking about is not a pesticide or a packaging chemical. It’s childhood trauma.”
She’s referring to the landmark 1990 study of 17,421 patients, conducted by Dr. Vince Felitti at Kaiser Permanente and Dr. Bob Anda at the U.S. Centers for Disease Control (CDC), who collaborated on the ACE study, which has resulted in over seventy peer-reviewed scientific articles. While some chronically ill patients find this data disheartening- and I get how hard it can be to hear this- I share it because, while it’s sad and scary, I also find this data to be hopeful. While we need more data to prove that treating trauma can reduce symptoms or even cure certain diseases, anecdotally, the stories of seemingly miraculous remissions from diseases that previously failed to respond to treatment (even cancer and heart disease) is growing by leaps and bounds.
In my book Sacred Medicine, I weave the threads between energy medicine, shamanism, spiritual healing, and healing trauma, making the case that many chronic or life-threatening illnesses that conventional medicine finds difficult or impossible to treat are the result of the autonomic nervous system dysregulation caused by unhealed trauma.
So many of us carry not just the “Big T” traumas that can lead to a high Adverse Childhood Experience (ACE) score. (Find out your ACE score here). But even more destructively sometimes, the “little t” traumas of everyday life that happen as the result of developmental trauma, when we fail to get our core developmental needs met. If you’re not sure if you have any developmental trauma in your body, try this quiz from my book Sacred Medicine, which I put together with a team of trauma therapists, since no standardized quiz yet exists in academic medicine.
DEVELOPMENTAL TRAUMA QUIZ
Before your 18th birthday:
Did you often feel that at least one of your parents wasn't capable of connecting with you in a loving and bonding way, leaving you with poor self-esteem, chronic shame, or the feeling that you're somehow damaged?
Did you often feel like you could not trust one or both of your parents to attune to you, protect you, and meet your needs?
Did you often feel like you had to the be the grown up or caregiver in the family when you were still the child?
Did you often feel like one or both of your parents smothered you, engulfedyou, dominated you, or wouldn't let you individuate, make your own choices, and become your own person?
Did you often feel like you were expected to be a perfect, high achieving, good girl/boy who made your parents proud or you'd be severely judged, rejected, punished, shamed, or abandoned?,
Do you live with a persistent feeling of nameless dread or terror without understanding why?
Do you prefer being alone to being around people, fear and avoid closeness with people, or struggle to maintain intimate relationships?
Were you raised without good boundaries or the ability to say no, set limits, or protect yourself?
Did you grow up feeling like you were an imposition or burden to one or both parents?
Do you seek out spirituality or have frequent mystical or esoteric "out of body" kinds of experiences?
Do you struggle to know what you need or ask others to help you get your needs met?
Do you frequently feel overwhelmed, struggle with adult responsibilities, or fixate on your one big problem, assuming that if it could only be solved, everything would be fine?
Did your mother have a difficult pregnancy or traumatic birth, or were you born prematurely or hospitalized at an early age?
Did one or both parents fail to help you normalize, feel, process, and handle difficult emotions?
Did one or both parents feel hurt or rejected when you tried to pull away, rebel, or become your own person?
Were one or both parents self-absorbed, narcissistic, or unable to see you as separate from them?
Do you tend to stay "in your head" or over-intellectualize, rather than being in your body or your emotions?
Is it hard for you to manage conflict, express displeasure, or stand up for yourself?
Do you try to stay below the radar, make yourself invisible, or otherwise keep yourself small and safe?
Would you identify as highly sensitive, an empath, or neurodiverse?
Do you struggle with low energy, diminished life force, lack of motivation, difficulty staying focused, achieving tasks, or feeling pleasure, or following your dreams?
The more “yes’s” you got, the heavier your developmental trauma burden may be. Many people may not recognize that these kinds of childhood wounds may be as destructive or sometimes even more destructive to your long term health than a high ACE score. While some ACE traumas may be one time events, developmental trauma tends to happen every day. Some of the worst traumas are the things that didn’t happen to us as children, rather than the things that did.
Survivors of childhood developmental trauma may wind up as adults:
-Not feeling safe
-Settling for very conditional love or no love at all (because unconditional love was not on the menu)
-Free to individuate without being controlled
-Able to ask for help, receive from others, share responsibilities rather than doing it all themselves, or get their needs met
-Able to handle the pressures and responsibilities of adulthood
-Not supported to become their own person.
It’s possible to have an ACE score of zero and still have trauma in our systems because of the way we were parented.
The Nervous System & Disease Outcomes
Thanks to Stephen Porges and Polyvagal Theory, we now know so much more about what happens in the body, in the autonomic nervous system, in the immune system, in the presence of chronic inflammation, and in end organs affected by chronic sympathetic nervous system hyper-arousal and/or chronic dorsal vagal hypo-arousal. (Watch this video made by The Trauma Foundation if you don’t know what I mean.) This nervous system dysregulation can lead not only to practically every mental health diagnosis in the DSM-V, but also to a host of medical conditions, like:
-fibromyalgia
-chronic pain syndromes
-chronic fatigue
-dysautonomia
-migraines
-allergies
-irritable bowel syndrome
-environmental sensitivities
-autoimmune diseases
Although we would need much more research to establish a link, chronic nervous system dysregulation and its physiological aftermath related to untreated trauma may even create the conditions to be a risk factor for post-viral syndromes like long COVID.
Even the #1 and #2 killers- heart disease and cancer- are impacted by trauma and its effects on how the body’s natural self-healing mechanisms break down and make the body susceptible to blocked coronary arteries and out of control malignancies. The scientific link between untreated childhood trauma and adult onset chronic disease is bulletproof at this point. According to the copious ACE studies, almost every physical illness is more likely in those with a high trauma burden, and longevity is shortened by as much as twenty years in those who never get their traumas treated.
The good news is that trauma is treatable, and it’s never too late to begin healing it. While trauma can make us feel imprisoned by our emotional and physical symptoms, there is a way to examine the body as a trailhead, get curious and walk down that path of exploration, and examine whether there could be a link between your physical illness and a trauma history. Sadly, there’s no quick fix like an easy pill that will dissolve trauma or a one time treatment that will solve everything. I know psychedelics are all the rage, but even that is not an easy solution or one without its own risks and potential for retraumatization, especially because of the lack of regulation, safety, and accountability among those administering psychedelics.
Because healing trauma is kind of the wild, wild West right now, even the experts in trauma have a hard time finding consensus about what works most effectively to treat trauma and the effects it can have on the body/mind/spirit. Effective trauma treatment can be expensive, time consuming, emotionally wrenching, and risky if done poorly. So don’t trust anyone who tells you there’s a quick, painless, easy solution.
With that disclaimer, I do believe treating trauma effectively and improving our health- and our longevity- as a result is possible. More research is needed to prove that effective trauma treatment can reverse physical illness, but early studies are promising. Until we know more, we can approach the body as a trailhead and heal and unburden the exiles that can dysregulate the nervous system, doing what we can to help the body’s natural self-healing mechanisms flip back on- since the daily maintenance of repair is not a priority to a bodily system that think you’re getting chased by a tiger. This does not guarantee cure by any means, but it can facilitate healing- and that’s worth pursuing in its own right.
Healing is not the same thing as curing. We can heal without being cured, and we can be cured without being healed. In medical school and residency, most of our training focused on curing. Very little attention was focused on healing. You might heal a fracture or heal a gaping surgical wound. But healing a person? Nah. Woo woo, hocus pocus horsesh*t.
But healing and curing are inherently different. Curing means "eliminating all evidence of disease," while healing means "becoming whole." The way I see it now- we can heal the trauma that may predispose us to chronic or life-threatening illness- and that may or may not impact our physical health directly. Even if it doesn’t, approaching the body as a trailhead for emotional healing and healing trauma is one avenue many people seeking better outcomes have yet to try. Whether or not the health of the body responds, intimacy with ourselves, our bodies, our traumatized parts, and each other is a gateway to more self compassion, self care, self love, and connection with others who walk beside us on our healing journeys.
This is so powerful and validating.