Undergoing an accident or other surgical trauma, (most especially where orthopaedic treatment follows which immobilises the sufferer for periods), according to trauma specialist, Peter Levine can have a massive negative impact. The following passages from his book In An Unspoken Voice concern the impact of this immobilisation on children in particular and also explore how the experience or expression of rage or anger in response is actually a positive life generating reaction that affords recovery when it is not suppressed and can be channelled in such a way to prevent ongoing paralysis or immobilisation.
“In a recent medical study, more than 52 percent of orthopaedic patients being treated for broken bones were shown to develop full blown posttraumatic stress disorder with a majority not recovering and worsening over time. (many of these orthopaedic procedures)… follow frightening accidents, stressful ambulance rides endured while one is strapped down and terrifying and depersonalising emergency room visits. Further, many of the patients have also undergone immediate surgeries, and often in an agitated state. This chain of events often preceeds immobilisation and is followed by painful rehabilitation regimens. (Children admitted to the hospital after such injuries)… are at high risk for posttraumatic stress even after minor injuries.
In many hospitals there is still inadequate attention to preventing undue fear in people who must undergo painful procedures or general anaesthesia. Indeed, some of those ill-fated individuals partially awaken during anaesthesia and many develop some of the most horrific and complex PTSD symptoms. In the words of one nurse “I feel a cosmic hollowness, as if my soul has left my body (dissociation) and can’t return…. horrifying nightmares are my companion… often shocking me awake. When my eyes pop open, there is still no respite because the walls and ceiling turn blood red.” This riveting description illustrates the horror of enduing the terror, extreme pain, and being unable to move or communicate one’s situation.
Biologically, the orthopaedic patients, soldiers, rape victims and hospitalised children are reacting like wild animals fighting for their life after being frightened and captured. Their impulse to attack in an “aggravated rage” or to flee in frantic desperation is not only biologically appropriate, in fact, it is a frequent biological outcome. As a captured and terrified animal comes out of immobility, its survival may depend on its violent aggression toward the still present predator. In humans, such violence, however has produced tragic consequences to the individual and society. I had the opportunity to speak with the mother of Ted Kaczynski (the “Unabomber,” whose vendetta was waged against the impersonalisation of technology) and with the father of Jeffrey Dahmer (a serial killer who dismembered his victims). They both told me horrific stories of how their young children were “broken” by terrifying hospital experiences. Both parents described how, after terrifying hospitalisations, each of their children retreated into his own world. While such experiences of rage leading to peverted violence are (fortunately) rare, the terror and anger invoked by medical procedures is (unfortunately) not.
Levine goes on to explain how such anger and rage can, instead, become turned in upon the self, if not allowed to be released somehow leading to increased introversion, paralysis, suppression, passivity and resignation. It also leads to a state of ‘flipping’ “between outbursts of ‘impotent’ and misdirected rage” in response to later challenges.
In his own near death accident Levine explains he experienced
“a rolling wave of energy’ as my body continued its shaking and trembling” he then “felt a burning red fury erupting from deep within my belly”. I really wanted to kill the girl who’d hit me, and I thought
How could that stupid kid hit me at a crosswalk? Wasn’t she paying any attention? Damn her!
He speaks of the desire to kill her which was an impulse that frightened him even more and how the fear turned to a desire to prevent such a reaction. but
“by allowing my body to do what it needed to do – by not stopping the shaking while tracking my inner body sensations – I was able to allow and contain the extreme survival emotions of rage, and terror without becoming overwhelmed. Containment, it must be understood, is NOT suppression, it is rather a building of a larger more resilient vessel to hold those difficult affects. And mercifully, this way I came through the accident’s aftermath unscathed by trauma and more resilient to future challenges.
As people revisit, and move through and them move out of immobility in therapy, the frequently experience some rage. Those primal senastions of fury (when contained) represent movements back into life. However (such sensations) .. can be frightening if they occur abruptly. In effective therapy the therapist supports and carefully guides the patient through this powerful process.. slowly, by using a graduated approach so that the client is not overwhelmed.
Ultimately rage is about the urge to kill… and when it gets re-enacted (most often by rape or abuse victims) it leads to yet more trauma…”rage counter attack is one consequence of repetitive fear based immobilization and its re-enactment and containment is something that must be skilfully handled in any trauma healing therapy.”
I personally have been further traumatised by therapists who were not able to contain the rage that erupted as I tried to move out of an immobility response. In his book, Levine explains how bound up energy remains tightly wound inside the body like a coil and may take a lot of time to release. Trauma is stored as a vibrational charge that may need to be processed slowly over a very long time. Building a safe loving trustworthy container with a good therapist cannot be underestimated. If we are taken into trauma too quickly we might not be able to contain it. We also experience all the sensations of fear we felt at the time. Slowly over time, survivors who were immobilised need to contain and feel the fear of death which overwhelmed them as they faced terrible traumatic injury and pain. Such things are a nightmare to live with and try to come out of when we lack the necessary adequate supports and holding.
Emerging From The Dark Night 