Rhythms of Recovery: Trauma, Nature, and the Body

As I worked with my patients–those whom our profession often stigmatizes as “difficult and dangerous,” the so-called borderline or suicidal patient–I listened to them with my hands, and mind. I did so as they traversed their bodily terrain of dissociated pain and found their inner rhythms that had long ago been thrown off their axis by traumatic events.

In the ‘80s and even into the ‘90s, Mindfulness meditation (Vipassana) was still nascent and closeted in the conventional mental health arena, and even referrals to 12-step programs were not the norm. The application of nutrition for mental health, called Orthomolecular medicine (the use of micronutrients for brain/mind health), had been around since the 50’s yet the use of nutrition for the brain was considered (and still is, in some circles) the province of a few eccentrics.

During the 80s, we entered an important conceptual crossroads in the treatment of trauma. Dr. Judith Herman had published Father-Daughter Incest, the pioneering work that helped, yet again, to clear the fog of social dissociation and denial that surrounded the reality about the prevalence and damage caused by family sexual violence. At the same time, Dr. John Wilson navigated cultural boundaries by collaborating with Native communities and introducing greater numbers of war veterans to the Lakota healing ritual of the sweat lodge, thus bringing an ancient restorative ritual to the repertoire of post-war healing.

After my fellowship, I continued with my private practice in Boston. The late 80’s brought a new reckoning-the ubiquity of sexual abuse and mind control by (predominantly male) therapists, psychiatrists, gurus, and clergy. As I contend in this book, there is a profound relationship between patients’ sexual and mental abuse and the patriarchal fear of the (women’s) body and the taboo on therapeutic touch.

This manuscript follows my evolution as a clinician-healer. I finished the first edition in ’96, and the original publisher found it too radical in its suppositions. Instead of making the changes required for publication, I put the manuscript away and headed back to work in the jungle. But like many events in our lives, this disappointment had its silver lining.

Nearly 15 years later, a new opportunity to publish this book, intact, under the expert guidance of Anna Moore at Routledge emerged, just as my thinking and clinical observations had evolved even further. I added chapters on additional subjects: Nutritional and Herbal Medicine, Detoxification and Psychedelic (entheogenic) Medicine.

The reissue of my book Rhythms of Recovery: Trauma Nature and the Body in the “classics” edition is evidence of how much the field of trauma treatment has advanced. With the Adverse Childhood Events research, we recognize that most mental (and most chronic physical) illness has its etiology in traumatic events and chronic stress. The analysis and recommendations I suggested nearly ten years ago in the first edition have found a significant, if not universally, accepted place in trauma treatment.

Some innovations that have found their clinical footing: The recognition that circadian rhythm is a neurohormonal disruption in trauma and can be re-regulated with light, and specific lifestyle changes of exercise, diet, nutrients, and herbal medicine. The practice of yoga and mindfulness in schools and prisons, and for post-disaster fieldwork and the diversity of methods adapted to the needs of culturally diverse peoples is now widespread and incorporated, almost without a blink.

The recognition of somatic and energy therapies (and acupuncture) involving both touch and non-touch methods acting along a spectrum of exposure and self-regulation methods are more widely implemented; clinicians know more about how to refer and and people seeking training in body psychotherapies have many options.

Nutritional psychology/psychiatry is blossoming yet again. Since the first edition of this book, I have increasingly focused on applying nutrition to trauma treatment and helping people reduce and eliminate pharmaceutical use. I am convinced that if we do not provide the right fuel for the brain, mind, and body, then clinical outcomes are at best limited, and often fail.

For example, the adverse effects of wheat (gluten) on mental health have been observed for over 2000 years. The effects of gluten on psychosis were more recently identified when, during WW2 in Great Britain and other European countries there was a shortage of grains.

This shortage, in turn, led to significant improvement in the mental health of institutionalized patients. Even with substantive science about gluten’s contribution to psychosis, depression and dementia, we are just now implementing strategies for the sensitivities beyond celiac disease. Yet this too often remains the circumstance for the fortunate few who can afford tailored advice and tests.

That high fructose corn syrup leads to inflammation underlying depression is also well established. Yet our residential treatment programs, detoxification centers, schools, public health agencies, and shelters where the rates of mental illness are high still serve cheap, refined, grains and corn syrup-rich foods, no doubt worsening the illness they are trying to treat.

Dr. Gerson’s illumination of the extensive gut-brain axis, appropriately called the Second Brain, supports my clinical experience that there is always digestive dysfunction in mental distress. When we restore digestive health, we provide the pillar for improving mental health.

Of course, this makes, gut sense. Digestion requires a parasympathetic state, the holy grail of trauma. Genomics (and nutrigenomics) leads us to personalized medicine which allows us to match the best diets and medicines to individual confirming what we already know about indigenous and cultural wisdom worldwide– that there is no one right diet for everyone.

Nutritional developments extend into the specific use of brain fuel. Vitamins, and minerals like lithium (not the pharmaceutical) regulate circadian rhythm, mood and protect brain neurons at low doses and gives us options long ago introduced by Indigenous peoples who routinely soak in lithium-rich “laughing” springs.

The well-established association between trauma, TBI, depression and dementia onset provide us with a path to help the brain survive. Dr. Michael Lewis’s pioneering work with veterans using high dose Omega 3 fatty acids (fish oil) supports this approach, along with Dr. James Harch’s application of Hyperbaric oxygen therapy to restore oxygen-deprived neuronal connections.

Both methods are among many that provide aggressive, yet non-invasive approaches to restore normal metabolic function for the brain under stress. Perhaps the one most validated, cost-efficient vitamin for mood and an immune system under stress is optimizing Vitamin D, a vital support especially among people living north of the 35th parallel where deficiency is nearly a 100%. How easy to include Vitamin D in a public health delivery model.

Fortunately, our advances in nutritional and herbal medicine research provide options to our clients and patients who clamor for alternatives to pharmaceuticals (and their side effects) and, to be able to afford them.

There remain far too many specious applications of dangerous and ineffective psychotropic medications. The serotonin deficit theory of PTSD which emerged in 1988 (concurrent with the arrival of fluoxetine), has yet to be proved. While short-term acute pharmacotherapy has its appropriate place, increasing evidence points to the dangers (and failures) of chronic pharmacotherapy for mental illness.

It is well-established that side effects of SSRI’s and SNRI’s include libido suppression, weight gain, long-term blunting of affect, discontinuation syndrome and significant increased risk of death in people over 65. Just when we need our mitochondria to “breath”, research suggests that SSRI’s suppress mitochondrial respiration. Emerging research points to the increased risk of depression and dementia with chronic use of benzodiazepines, proton pump inhibitors and NSAIDS, used at high rates by trauma survivors for anxiety, GERD and pain, respectively.

Just as we emerge from the domination of over-prescribing pharmaceuticals, we likewise now free of the ferment of fear and able to reengage with the early insights about the benefits of cannabis and psychedelic medicine. We benefit from an unbiased examination of the utility (and contraindications) of nature’s gifts for trauma recovery. Some researchers of the classics even suggest that it was not an apple that Eve ate in the Garden of Eden but instead, the little psychoactive mushroom, Amanita Muscaria that led to her beholding the goddess and god alike.

The contributions of medicine to spirituality are bidirectional. Each essential to the effective treatment of the dis-ease called traumatic stress that all too often obliterates the sense of hope, meaning, purpose, and belonging to the transpersonal universe. The psychedelic pathway may prove to help many find their way within once again.

Perhaps our most significant task is to ensure adequate training (more than the current 1-2 stress and trauma courses provided at the MS/Ph.D. and MD levels) and overcome our personal segregation of mind /body and spirit. Dr. James Lake, one of the seminal thinkers in the integrative medicine for mental health field, has informed our quest for evidence and rigor while asking that we truly integrate rather than add merely a patchwork of methods to existing paradigms.

His extensive reviews and critique of the scientific literature provide a logical approach to reliable implementation while forging a new way of thinking that helps us overcome the cognitive compartmentalization into which we are all inducted during our clinical education.

This book is both a philosophy of care and a roadmap to applying specific interventions. One of my goals is that as practitioners, we overcome the persistent failures to diagnose and therefore treat correctly.

Adults with PTSD and complex trauma are often misdiagnosed as borderline or Bipolar (our current diagnosis du jour. People with psychosis are shown to have high rates of traumatic exposure and coupled with food allergies, their fate is often sealed, absent a keen diagnosis and treatment plan. Children who score high on ACE’s are called oppositional and defiant or, if they cannot focus, they have ADHD. Without integrative treatment, the trauma lens falls short or even fails.

The trauma model of recovery as I propose in this book is not easy nor quick. Our patients often feel helpless to change. This is where we are well positioned to help them to overcome the learned helplessness and engage a team to support each person in context of family and community. I am convinced that the pathway described in this book, supported by evidence past and present, will support our shared success for the benefit of those who seek our help.