Rhythms of Recovery: Integrative Medicine for PTSD and Complex Trauma

As I worked with my patients—those whom our profession often stigmatizes as “difficult and dangerous,” the so-called borderline or suicidal patients—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 o 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 50s. 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 treating 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 of 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 tradition to the repertoire of post-war healing.

After my fellowship, I continued with my private practice in Boston. The late 80s 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, 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 1996, 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. For this edition, despite my passion for the subject, space limitations required that I cut significantly into the sections on the history of medicine and healing. Those interested may find these sections in the first edition of the book.

The reissue of my book Rhythms of Recovery: Integrative Medicine for PTSD and Complex Trauma in its second edition is evidence of how much the field of trauma treatment has advanced. With the Adverse Childhood Events (ACEs) research, we recognize that most mental and chronic physical illnesses have their 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 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 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, clinical outcomes are at best limited and often fail. For example, the adverse effects of wheat (gluten) on mental health have been known for over 2,000 years. During WW2, Great Britain and other European countries had a grain shortage. 

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 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 that causes or contributes to 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 drugs to individuals 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 natural lithium regulate circadian rhythm and mood and protect brain neurons at low doses, with no side effects, 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 provides 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 (HBOT) to restore oxygen-deprived brain cells. Both methods are among many that provide aggressive yet non-invasive techniques to restore normal metabolic function for the brain under stress. 

Vitamin D is the most validated vitamin for mood, pain, and an immune system under stress, vital support, especially among people living north of the 37th parallel, where deficiency is nearly 100%. Providing people with vitamin D is a cost-effective public health intervention for treating mental health and pain. 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) if they can afford them. 

There remain far too many specious applications of dangerous and ineffective psychotropic medications. The serotonin deficit theory of posttraumatic stress disorder (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 selective serotonin reuptake inhibitors (SSRIs) and SNRIs include libido suppression, weight gain, long-term blunting of affect, discontinuation syndrome, and a significantly increased risk of death in people over 65. We need our mitochondria to “breath,” yet research suggests that SSRIs suppress mitochondrial respiration. Emerging research points to the increased risk of depression and dementia with chronic benzodiazepine, 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 are likewise nearly free of the ferment of fear of psychedelics and cannabis. We can reengage with research and early insights about their benefits. 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 the little psychoactive mushroom Amanita Muscaria that led to her beholding the goddess and god alike. The contributions of medicine to spirituality are bidirectional. Traumatic experiences often obliterate the sense of hope, meaning, purpose, and belonging to the transpersonal universe. The psychedelic pathway may help many find their way within once again. 

Perhaps our most significant task is to ensure adequate training (more than the current one to two stress and trauma courses provided at the MS/PhD and MD levels) and overcome our 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 genuinely 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 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 treat correctly. Adults with PTSD and complex trauma are often misdiagnosed as borderline or bipolar (our current diagnosis du jour). People with psychosis have high rates of traumatic exposure, coupled with food allergies; their fate is often sealed, absent a keen diagnosis and treatment plan. Children who score high on ACEs are called oppositional and defiant, or if they cannot focus, they have attention-deficit hyperactivity disorder. 

Without integrative treatment, the trauma lens falls short or even fails. As I propose in this book, the integrative medicine trauma model of recovery is not easy or quick. Our patients often feel helpless to change. But we can help them to overcome the learned helplessness and engage a team to support each person in the context of family and community. I am convinced that the pathway described in this book, supported by evidence from past and present, will support our shared success for the benefit of those who seek our help.