The brain is an organ in the body.

I can’t count how many times I’ve said this to clients and how many times I’ve had to remind myself of this. It’s very common with trauma folk to have a problematic relationship with their bodies.

Yesterday, one of my clients went into their repetitive crisis pattern.  At least once a month, this person has a substantial crisis.  This last one happened while they were travelling for work. They dissociated in the airport and had a hard time getting home.  The good news is that they didn’t get drunk as they had in the past.  When we were discussing the event, the client said it “just came out of the blue” and gave some reasons why the dissociation might have been cued—which were reasonable.  Since we are working hard on their relationship with their body, I asked about their eating, hydration and sleep over the preceding days.  All were inadequate. They had skipped breakfast to make their flight, stayed up late the night before to finish a report and hadn’t had any fluids all day.  Going back further, we discovered the last time they had effectively eaten, hydrated and slept was when they were at home before the business trip, which was five days earlier.  Until we discussed this, they had no awareness.

I may have focused on the cueing at the airport, the trauma memories, the panic attack or the dissociation.  All of these are of interest, but they aren’t the right focus.  This person had become physically unable to remain skillful in a stressful situation.  When their body collapsed, the old patterns took over.

The problem is that clients can feel dismissed and invalidated if we ask about basic body care.  So it’s important to let them know we aren’t ignoring the loud trauma symptoms, but we are looking for drivers that make them more vulnerable to dysregulation.  It’s very helpful if our clients know DBT (Dialectical Behavior Therapy) but even if they do, the fact that without physical regulation emotional regulation can be impossible is usually minimized or ignored. 

It’s often more interesting to explore those loud and dramatic trauma symptoms and miss the basic PLEASE skills.  But in my experience, the DBT PLEASE skills aren’t always focused tightly enough. Trauma folk can stop eating, drinking and sleeping with little awareness that it’s happening and no awareness that it can make emotional regulation impossible.

We are dealing with cartesian dualism, the idea that the mind and the body are separate.  But we are also dealing with survival strategies of disconnection from pain.  Dualism is the norm in many cultures, and severe and early trauma can permanently damage or disrupt a person’s awareness of their bodies.

I find that even knowing this and making it a focus of treatment it can be hidden.

Eating is a good example.  Anorexia can be a significant issue even when the client presents as obese.  Purging can be reported as being so upset and crying so hard that it causes the client to vomit.  However, starving is a very good way to shut down emotions.   It’s often a go-to for people who are struggling with memories and other PTSD symptoms.

I have to remind myself when my client is presenting with their repetitive crisis, to check on basic physical care.  Many times in session I’ve stopped and asked clients to drink some water or eat something.  It helps.   It’s hard to face the possibility (for both myself and my client) that this person may always have the habit of shutting off physical distress. 

The brain is an organ in the body. If the body is thirsty, starving and exhausted the brain is too.