Trauma Education Essentials

Book Reviews

Monthly Book Reviews

Book reviews written by Dana Ross, MD, MSc, FRCPC. 


Trauma and Recovery by Peter Levine

This is a book that builds on itself, ideas expanding into other ideas, opening up vistas that are thought-provoking and challenging. The book starts out with a very clear review of the categories of memory which I have learned about 1000 times and still they just won’t stick. I’m undecided if being unable to remember the different categories of memory is a concerning issue or not!
 
In case you also need a refresher, Levine explains that memory can be subdivided into 2 types: explicit (conscious memories) and implicit (unconscious memories). Each category can be further subdivided:
 
Explicit:

  • Declarative: factual information, voluntary
  • Episodic: autobiographical, often spontaneous 

Implicit:

  • Procedural: movement patterns including learned motor actions like bike riding, basic survival responses like fight/flight etc., and approach or avoidance patterns of behaviour
  • Emotional: often experienced in the body as physical sensations.
  • He notes that traumatic memories are by and large procedural and emotional.

 
The ideal situation is a fluid relationship between implicit and explicit memory that allows for a coherent sense of self in the here and now. Trauma has the ability to disrupt this fluidity, keeping people stuck in past experiences with a limited ability to “weave a fresh new adult narrative”.
 
One of the major themes in the book is that memory is mutable and our memories are continuously being reconstructed. Traumatic memories however, can often be fixed and static, and can, “erupt involuntarily as raw tatters of experience”. They can “arise as fragmented splinters of inchoate and indigestible sensations, emotions, images, smells, tastes, thoughts, and so on.”
 
Levine guides the reader through a series of stages in the healing process and explains the work that needs to be done in therapy with such fragmented experiences. The first step involves observation of the full person, taking in information from non-verbal cues. The second step is ‘guided somatic awareness’ with the therapist gently re-introducing the person to their own body sensations in a paced manner with the goal of bringing down the current activation level. Another significant point throughout the book is that people must be adequately grounded and regulated before beginning to work directly with traumatic memory.
 
The third stage involves somatic uncoupling of body sensations and traumatic memory to allow for restoration and completion through embodied action. Levine provides a couple of very helpful and detailed case examples to explain what this actually looks like in therapy. It is really impressive how this book is so rich and layered, and yet so practical.
 
The final stage involves working through feelings such as guilt, rage, grief, and loss, and also focuses on experiencing reconnection with others. Essentially, trauma is a full body experience requiring a full body approach to healing that includes a significant amount of body-focused work, as well as emotional and cognitive processing, and relational connection.  

The book also includes chapters looking at issues related to the neuroscience of memory, the pitfalls of false memories, intergenerational trauma, and the pharmacology of memory erasure. I found his critique of prolonged exposure therapy in the treatment of trauma to be compelling and an important issue for all trauma therapists to be aware of and reflect on.
 
I love his explanation of the Egyptian legend of Isis and Osiris, in which Osiris is murdered by his enemies who dis-member him by cutting up his body into pieces and burying them far and wide throughout the kingdom. Isis then found and gathered all the parts of his body and brought these “members” back together, in essence, she “re-membered” him.

Levine reflects on the similarity between that legend and the symptoms of traumatized people who often describe disembodied and dissociated parts of their experiences. Treatment aims to coalesce, reconnect and transform traumatic memory; to bring together disjointed parts of self into a coherent whole. Levine summarizes the healing journey by writing that the goal of treatment is, “The transformation of procedural memories, from immobility and helplessness to hyperarousal and mobilization, and finally to triumph and mastery.”

Dana Ross