Taking leave of our senses

Ezra Hewing looks into trauma and suggests that dissociation, as activated in REM sleep, may explain both the treatments that work best and why trauma can result in shutdown.

CONTROVERSY dogs the concept of psychological trauma – what constitutes it, what causes it and how should it be treated? At the root of it lies a longstanding disagreement among psychologists studying memory and therapists working in clinical settings about how memories of traumatic events are formed and whether they can always be recalled or may sometimes be repressed by the person who experiences them – which, in turn, has given rise to diverse opinions about how trauma can be effectively treated.

Competing claims have also reshaped the scope of the term psychological trauma, which extends far beyond the definition that psychiatrists use to make a diagnosis. While events with the potential to cause anxiety and fear affect us all, sometimes intrusive memories, thoughts, flashbacks and nightmares persist long after the event, in which case psychiatry categorises them as symptoms of post-traumatic stress disorder (PTSD). Such symptoms can also arise vicariously in people who hear others describing experiences of a highly distressing nature – perhaps in their roles as counsellors, therapists or workers in health and social care, and particularly if they have a strong tendency to empathise.

Symptoms of PTSD can cause hypervigilance, extreme anxiety and panic attacks, anger outbursts and relationship problems. Some people, in an attempt to reduce or seek relief from these symptoms, and the distress they cause, may turn to self-harm or alcohol and other drugs. This, in turn, may increase the risk of reliance on these means of coping with symptoms and the development of addictions. More recently, dissociation, derealisation and depersonalisation in response to traumatic events have also become subjects of interest to those studying and treating trauma.

Psychological trauma as recognised within the fields of psychology and psychiatry commonly becomes more loosely defined when used by others offering advice, self-help resources or counselling and psychotherapy. In the latter cases, the term trauma may include any event which causes a person discomfort or distress, leading to the avoidance of close relationships, or to placating and pleasing others for fear of losing relationships. The range of events which may give rise to these behaviours has widened to encompass financial insecurity, difficult relationships with caregivers when young, bereavements and breakups. Physician and author Gabor Maté, who has received wide acclaim and recognition for his work with communities affected by homelessness, addiction and trauma, maintains that all addictions result from traumatic events experienced in childhood and has a particularly wide definition of trauma.¹ He views it as the stress arising from feeling unsafe as a child and lacking the emotional connection with a trusted caregiver which could allow them to express feelings of fear or anger, without repercussions or dismissal. Maté claims that other conditions, including ADHD, autoimmune diseases and cancers, are also caused by chronic stress after childhood trauma.²

Since the recent pandemic and subsequent lockdown, and anxiety over the unexpected war against Ukraine, the term collective trauma has become common to describe the experience of large groups of people, including nations. Theorists see the presence of collective trauma in the stories people share about historical events which have affected their families and communities, such as the holocaust and slavery, which in turn have shaped how individuals see themselves.³ It is sometimes claimed that the effect of these events is passed from one generation to the next through our genes – termed transgenerational trauma. The study of epigenetics, which is concerned with changes in gene expression not resulting directly from mutations of DNA sequences, provides some support for this idea.⁴ While this should not be conflated with the idea that the memory of a traumatic experience is passed on through genetic inheritance, it is true that the expression of genes can change in response to stress, and there is some evidence that this can be passed on from a mother to a child.

How do we treat trauma?

The National Institute for Care and Health Excellence (NICE) recommends PTSD be treated, as ever, with cognitive-behavioural therapy (CBT), in the form of trauma-focused CBT; eye movement desensitisation and reprocessing (EMDR); antipsychotic drugs, in addition or if the aforementioned haven’t worked; or certain SSRI antidepressants, if preferred by the patient.⁵

CBT may often take the form of exposure therapy, which, as the name suggests, involves exposure to objects, images or places associated with the onset of the trauma symptoms. Exposure therapy relies on the insight from behavioural psychology that a conditioned response – the flashbacks and anxious feelings which occur when a person is reminded of the traumatic event – gradually fades or is ‘extinguished’ when the person exposed to the feared stimulus realises that nothing terrible happens or becomes too exhausted to react or has learned to inhibit their fearful responses when reminded of the event. As we might expect, exposure therapy is an uncomfortable process and, amongst those who undergo it, there is a high dropout rate. Critics claim it is unethical and cruel.

Despite the recommendations made for CBT, EMDR and drug treatments, there is a lack of evidence to make conclusive claims for their effectiveness, or to make valid comparisons between approaches to treatment, including newer techniques for treating PTSD, such as memory reconsolidation, somatic experiencing, and the rewind technique.^6,7 Methods which focus on changing thinking and interpretation of surroundings rarely bring about permanent relief. Critics of EMDR also point to the lack of agreement on the mechanism by which it may result in an alleviation of symptoms.

Given all this, it is unsurprising that people may look online, instead, for answers. An online search for explanations and solutions will return podcast interviews, blogs and best-selling publications from people described as trauma experts. Appearing at online summits alongside long-renowned alternative medicine advocate Deepak Chopra, who attracts audiences of millions, clinicians such as Peter Levine, who holds PhDs in biophysics and psychology, psychiatrist Bessel van der Kolk and the aforementioned physician Gabor Maté have attained a celebrity status as trauma experts amongst their followers, lay people and professionals alike. What they have in common is a focus on treating the impact of trauma on the body.

Fluid memories

Bessel van der Kolk is lauded as the author of  The Body Keeps the Score, the bestselling book on the causes and treatment of trauma.⁸ But van der Kolk’s ideas, in particular his commitment to the Freudian notion that memories are repressed, are controversial. Earlier in his career, van der Kolk served as an expert witness in court cases, where he testified that traumatic memories of sexual abuse can be repressed and blocked from conscious recall until the memories are triggered by an event and remembered at a later date.

However, the study of memory demonstrates that our recollection of past events is seldom entirely accurate. This is partly because a memory is not a carbon copy of an event as it happened at the time, but is reconstructed and modified each time it returns to our awareness. It is also possible to forget memories, or suppress and avoid reminders of past events, nuances which critics say are often ignored by advocates of repressed memory theory.⁹

And this is not just true of events which have genuinely taken place. Psychologist Elizabeth Loftus has repeatedly demonstrated that it is possible to induce false memories of an event. In one of her early experiments, the false memory of getting lost in a shopping mall as a child came to be believed by adults, particularly when it was suggested to them that an older relative had witnessed the event. These findings gave rise to the term false memory syndrome to describe memories which arose in response to suggestions from a therapist that a client had been abused but had repressed any memory of the event.^10,11

In some instances, after the therapist’s suggestions, clients would report dreams of childhood abuse, which the therapist would confirm as evidence of repressed memories of childhood abuse surfacing.10 The human givens understanding that dreaming during REM sleep discharges emotional arousal about worries or concerns we have not expressed during the day suggests, on the contrary, that, if clients have dreams of childhood abuse after a therapy session in which this was suggested to them, it is because of worrying after the session about whether child abuse had truly occurred or not.12 A recent study of 2,326 clients who had undergone therapy found that, when the therapist discussed repressed memories of abuse, the client was 20 times more likely to report recovered memories of abuse.¹³

While this study does not report which method was used for recovering supposed repressed memories, commonly used techniques include the exploration and interpretation of dreams using hypnosis. Human givens pioneers Joe Griffin and Ivan Tyrrell have made the case that hypnosis is a means of artificially accessing a waking trance state, akin to REM sleep.¹⁴ When we enter such a trance, we are rendered susceptible to suggestions from the therapist, as borne out in a systematic review of 59 studies, which found that false memories occurred in over 50 per cent of cases where therapists used dream interpretation or hypnosis.¹⁵

Despite the controversies surrounding false memories, van der Kolk has maintained his conviction that traumatic memories can be repressed, arguing that the study of memory in clinical settings does not replicate the way in which traumatic memories are formed in the real world. Van der Kolk also defines dissociation as memories of trauma organised not as coherent logical narratives”, but found in “fragmented sensory and emotional traces … images, sounds, and physical sensations”.

It makes sense that traumatic memories often emphasise sensory details of an event over others: to the amygdala, registering the risks of being threatened with a knife by an assailant who smells of alcohol may take priority over remembering their face for a later date. And it’s also true that the recall of traumatic events can be accompanied by bodily sensations, tremors, racing heart, hyperventilation, etc, or be expressed as physical illness, particularly if this is more culturally acceptable than disclosing a traumatic experience or mental illness to others. But it seems a step too far to conclude that these physical and sensory experiences are evidence that traumatic memories are repressed and stored in the body beneath consciousness.

How to make sense of it all

So, where to look for clarity and explanation of what occurs at a physiological level when a person is traumatised, which might also explain why some treatment methods work and some are not so successful? Is there a common denominator that can inform our thinking? We do know that the symptoms of PTSD are more likely to arise when REM sleep is lost on account of insomnia experienced after a traumatic event.¹⁶ This is unsurprising for HG practitioners, who understand that REM sleep is essential for de-arousing emotions which have not been discharged during the day. If insomnia, perhaps caused by intrusive recollections of the traumatic event, prevents us from getting the REM sleep needed to de-arouse fearful or anxious expectations, the amygdala, the brain’s ‘security officer’, can be left in a hypervigilant state, constantly on the lookout for potential threats to our safety when we are awake. Particularly concerning, if the intense emotional arousal which accompanies nightmares interrupts and wakes a person from REM sleep, any fears and worries which persist can give rise to suicidal thoughts.¹⁶

Could it be that treatments which focus on the body are working on physiological features of REM sleep – in particular, the locking of the body’s muscles, termed muscle atonia, which prevents us from moving, as dreaming safely acts out our waking concerns? And that this might be relevant for the success of such treatments? Before exploring why this might be the case, let us first revisit the steps of the rewind technique and its relationship with REM sleep.

The rewind technique

HG practitioners and students will be familiar with the steps of the rewind technique, which I will briefly recap here. Practitioners ensure that the anxiety, fear or anger connected with the trauma events can be felt by the client. (We call this activating the template.) Clients are guided into a deeply relaxed state by imagining themselves in a place where they can feel calm and where, shortly, they will ‘see’ a film of the trauma on the screen of a television, laptop, tablet or even mobile phone. They are then asked to imagine seeing, feeling or, in whatever way works for them, floating up out of their body and being aware of ‘watching’ themselves calmly pressing the fast-forward button of the remote control and playing the ‘film’ of the traumatic events from before they occurred through to when they were over (termed a state of double disassociation from the events). Clients are next guided to imagine floating back into their bodies at the end point and to rewind, as if in the film, back to before the start and then, ‘watching’ the screen this time, to fast-forward again through the events.

When fast-forwarding on the screen, clients are still dissociated – ie observing their activity rather than actively experiencing it – but no longer double dissociated; when rewinding, they are not dissociated but attention is taken up cognitively by the novel experience of re-experiencing the events backwards. This process is repeated until clients no longer feel an emotional response to the events.

REM and rewind

How do these steps of the rewind technique, as we practise it, reflect the process which occurs during REM sleep? First, the therapist must ensure that emotional arousal linked to the trauma is live (rather than just narrated) and thus ready to be discharged, just as it is in dreaming. While this is an explicit step in the protocol for the human givens version of the rewind technique, it may not be so in other trauma treatments.

Guiding clients’ attention away from their traumatic experience by inducing dissociation mirrors the dissociation which occurs when we fall asleep and our attention is withdrawn from sensory experience of the world around us.

Being cut off from sensory experience when we dissociate during dreaming ensures that the amygdala cannot be alerted by any new sources of distraction from the world around us. The same purpose is served during the rewind, when attention must become dissociated from the emotions relating to the traumatic event.

Our orientation response, which draws our attention to new stimuli in our environment when we are awake, fires repeatedly when we are dreaming. Joe Griffin, co-founder of the human givens approach, suggests that the orientation response is also triggered during the rewind technique, which, as it involves mental representation of fast-forwarding trauma events on a screen and then physically going backwards through them, is a highly unfamiliar experience. This results in temporary amnesia (just as when we are suddenly distracted by the firing of the orientation response when awake, and when we forget our dreams). During the amnesia induced in the rewind, the executive control network of the cerebral cortex and the hippocampus can work with the calmed amygdala to create a new context for understanding the trauma, changing its meaning and allowing it to be recoded accordingly.¹⁷ Practitioners aid this by offering reframes or new suggestions, such as “This event is in the past/ you can know how to handle such a situation differently if it occurs again/ you can enjoy flying again” or whatever is appropriate.

Griffin describes how using methods (such as moving the fingers to and fro in front of someone’s eyes or tapping the face) that lead the orientation response to fire, thus distracting attention and causing temporary amnesia, account for how EMDR and the Emotional Freedom Technique (EFT, colloquially known as tapping) may also provide relief from the symptoms of trauma and anxiety.^17,18 With our focus on REM sleep, we can take this understanding even further, to evaluate techniques and approaches to treating trauma which involve dissociation.

It is worth pointing out at this stage that, in his book, van der Kolk favours EMDR for treatment of trauma, along with learning to ‘inhabit the body’ in a healthy way, through practices such as yoga. He agrees that EMDR draws upon REM sleep for its mechanism of effect.¹¹ However, misquoting a paper by dream researcher Rosalind Cartwright, he makes the mistaken claim in The Body Keeps The Score that, “increasing our time in REM sleep reduces depression, while the less REM sleep we get, the more likely we are to become depressed”.¹¹ In fact, the study he cites shows the exact opposite – as every HG practitioner knows, if REM sleep is reduced, depression lifts – allowing needs to start being met once more, which is crucial to recovery.¹¹ The error is unfortunate, given the wide readership and influence of van der Kolk’s book.

Using dissociation

Peter Levine is another ‘trauma expert’ influenced by the psychoanalytic belief that memories of trauma are repressed beneath conscious awareness. In particular, Levine’s ideas follow those of Freudian psychoanalyst Wilhelm Reich, who held that emotions become blocked and trapped in the body. It is well established that there can be bodily expressions of psychological concerns, often in the form of functional neurological conditions or non-organic symptoms of illness. However, as HG practitioners know, in normal circumstances, unexpressed emotions are most commonly de-aroused during REM sleep without need to ‘release’ them from the body.

Levine argues for a ‘bottom up’ approach, which encourages clients to become aware of the physical sensations (termed interoception) which accompany traumatic memories, one step at a time, until they feel relaxed enough to narrate the memory. He called the technique he developed for doing this somatic experiencing. Advocates say it is a form of gradual desensitisation, which Levine terms ‘titration’.²⁰

One somatic experiencing practitioner, who uses shiatsu massage to help people overcome traumatic memories preventing them from engaging in physical and sexual intimacy, told me how he uses the approach. After speaking to clients about their difficulties, he explains that, during the massage, they may notice physical sensations or recall past traumatic events, and that any associated feelings of anxiety are completely natural. He then begins massaging their feet and, as they progressively relax, gently encourages them to notice any physical symptoms and let them pass.

The process clearly mirrors aspects of REM sleep that we may become consciously aware of on waking suddenly from a traumatic dream, such as the recall of traumatic events (albeit in metaphorical form) and the experience of anxiety, because discharge of the emotional arousal has been interrupted. I suggest, too, that discussing clients’ difficulties with intimacy and priming them to notice any physical sensations during the massage has the effect of activating clients’ expectations. Using massage to help the client relax keeps the amygdala in a state of low emotional arousal, so that traumatic memories can be safely processed.

By encouraging clients to observe the physical sensations associated with the trauma, the practitioner is helping them to dissociate and observe their symptoms at one remove. In human givens parlance, clients are helped to access their observing selves, whereby they are aware of having the experience of symptoms rather than being immersed in the experience. Receiving a shiatsu massage, particularly for someone who had been avoiding physical intimacy, would be sufficiently unfamiliar to fire the orientation response, inducing the temporary amnesia which allows the trauma pattern previously aroused by the amygdala to be cleared out of consciousness, so that the cerebral cortex and hippocampus can provide a new context and meaning for those events. Practitioners of somatic experiencing claim that, once the client can narrate a traumatic memory without becoming overwhelmed, its meaning can be changed and integrated into narrative memory – as happens after the rewind technique, when the HG practitioner offers reframes while the client is still deeply relaxed.

Leaving the past

While it does not involve massage or physical movements, the same steps can be seen in Levine’s account of working with a woman he names Nancy, who was suffering with panic attacks, as well as a range of physical conditions. While Levine guided her progressively to relax the muscles in her neck and jaw, he was encouraged to see Nancy’s heart rate beginning to slow down. However, Levine writes, his sense of relief was short-lived, as her heart rate then plummeted to 50 beats per minute and her face became pale. Nancy then called out, “I’m dying. Don’t let me die!” In response, Levine commanded Nancy to envisage herself escaping from her situation, telling her, “There’s a tiger chasing you! Run! Run fast! Climb up those rocks and escape!” Nancy later reported that, after seeing herself climbing up the rocks, she looked back down, but instead of seeing the tiger, she saw herself as a four-year old, being held down and anaesthetised by doctors and nurses for a tonsillectomy.²⁰

Again, the steps Levine describes mirror the process of REM sleep and the rewind. While it is not explicitly stated, there is Nancy’s expectation that the physical symptoms will be resolved. Nancy is then helped into a relaxed state. Although unplanned, the physical sensations and panic of being held down and unable to escape are activated. Then the orientation response is fired by the novelty of Nancy climbing up rocks to ‘escape’. This metaphor provided by Levine also mirrors the language of dreaming, whereby the unfulfilled expectation of being able to get away from the doctors and nurses who were holding her down is completed in metaphorical form.

Dissociation also takes place, first as Nancy ‘sees’ herself climbing the rock and then as Nancy looks back at ‘the tiger’ but sees the event as one which occurred in the past. She sees it from the viewpoint of an adult who, unlike her four year-old self, understands that tonsillectomies protect us from infections and breathing problems. After a few more sessions, Nancy reported that many of her symptoms had lifted and, when Levine came across her two years later, said she had experienced no further panic attacks. Levine attributed the change to a new memory of “power and agency instead of hopelessness and defeat”. I think that this is significant, for reasons I shall return to.

Why do we freeze?

Nancy’s reaction to becoming relaxed, whereby her heart rate suddenly dropped, and she called out that she was dying, prompted Levine to investigate a behaviour in animals which results in temporary paralysis, termed tonic immobility. This is distinct from the freeze response, which occurs when movement is halted to prevent us being seen by a potential predator and precedes instinctive fight or flight. Tonic immobility is often explained as feigning death (thus also known as thanatosis, a name derived from Thanatos, the ancient Greek god of death). It is the last available means of defence when fight or flight has failed, and escape from a predator becomes impossible.²¹ In humans, this response is commonly termed immobilisation or shutdown.

Levine believes that polyvagal theory, the work of his long-time collaborator, neuroscientist Stephen Porges, offers the best explanation for why this occurs. Porges claims there are three pathways in the autonomic nervous system which emerged in evolutionary order: starting with the oldest, the dorsal vagus (the dissociative state of immobilisation or shutdown); the sympathetic nervous system (mobilisation, including fight or flight); and the ventral vagus, which Porges claims evolved in mammals to facilitate social engagement and connection. He explains the dorsal and ventral vagus as two pathways within the parasympathetic nervous system. The aim, in therapy based on polyvagal theory, is to help people find safe ways to move from immobilisation/shutdown or fight and flight into social engagement and connection.²⁰ However, this theory is not supported by what biologists know about the vagal nerve and immobilisation or shutdown.

Paul Grossman of University Hospital Basel criticises Porges’ research methods and sets out the evidence which contradicts the basic premises of polyvagal theory.^22,23 Biologists have known for about a century that both the dorsal and ventral nerves evolve together in reptiles, and these nerves have more recently been identified in lungfish too.^23,24 This means that Porges’ claims that the dorsal vagal nerve evolved first, and that the ventral vagal nerve evolved in mammals only to support social engagement and connection must be wrong. Furthermore, there is no evidence that the dorsal vagal nerve controls the immobilisation response; indeed there is evidence to the contrary.²⁴ So Levine’s successful work with Nancy is unlikely to be explained by polyvagal theory and we need to look elsewhere to understand how dissociation and immobilisation/shutdown occur.

Which freeze do we mean?

The amygdala, which we are so familiar with as HG practitioners, does not work alone. It works in conjunction with another brain structure called the periaqueductal gray (PAG), which has a front (ventral) area and a back (dorsal) area.²⁵ The front PAG sends messages via the brainstem to freeze and then resume movement.²⁶ The back PAG controls defensive behaviours when we cannot escape from a threat.²⁵

When the amygdala first detects a threat, it instructs the front PAG to freeze all movement while the threat is risk assessed.^25,26 Then, whether the cortex determines that there is no threat, or the amygdala overrides the cortex to activate the fight-or-flight response, a message is passed to the front PAG to switch off the freeze response, so that we can relax or take action, respectively.^25,27

By contrast, the back PAG takes over from the amygdala and front PAG when fight or flight has not worked or is impossible.²⁷ Triggered by the fear and shock of close physical contact with a predator, evoking panic, it is this type of ‘freeze’ response which is involved in immobilisation and shutdown.²⁷

While we might assume that symptoms of panic accompany the fight-and-flight response, research suggests there are good reasons to think that this is mistaken. First, fight or flight is activated by the front PAG, while panic is evoked by the back PAG – they are distinct structures.^27,28 Second, while fight or flight involves the hypothalamic-pituitary-adrenal axis and the release of cortisol stress hormones, this response is switched off when the back PAG and panic take over.25 Additionally, medication may reduce anxiety but has no effect on panic.^29,30

Another difference between the front and back PAG is that, while the front PAG’s freeze and fight-or-flight response is hardwired, the back PAG can be conditioned by traumatic experiences.²⁷ Thus, if the memory of trauma in which fight or flight was not possible is reactivated, it can trigger panic attacks and, if the physiological arousal is not calmed down, immobilisation and shutdown.

The discovery that these different kinds of freeze responses have distinct underpinning brain circuits has cast doubt over the concept of a ‘defence cascade’, where freeze is followed by fight or flight, and then, if necessary, immobilisation and shutdown.³¹ Instead, these freeze responses appear to form two pathways. The first takes the form of anxiety-fuelled alertness to potential threats and serves our need for security. The second is characterised by fear and panic when trapped, reflecting our loss of control.²⁷

Some psychologists say that immobilisation or shutdown (sometimes called ‘playing possum’ after the Virginia opossum, which feigns death) is a survival strategy intended to fool predators into perceiving intended prey as dead and possibly diseased, therefore best left alone. But others, including primatologist Jane Goodall and her husband Hugo van Lawick, say that an animal caught by a predator goes into trance, ceasing to move, having accepted its death.³² At this point, the back PAG takes over from the amygdala; immobilisation and shutdown are activated, and the body releases opioid painkillers to alleviate the anticipated physical suffering of death. But what, if anything, happens to alleviate the intense psychological stress?

In an ancient story, a man asked a boy carrying a candle in the darkness of the night, “Where did that light come from?” The boy blew the candle out and replied, “Tell me where it has gone, and I shall tell you whence it came.” We are faced with a similar question: where does awareness go when we dissociate from the most intense emotional experience of powerlessness, perhaps anticipating death?

Taking leave of our senses

Dissociation is part of everyday life. We might be planning a meal for invited guests, focusing our attention on what food we already have in the cupboard or fridge, and then dissociating briefly to recall what it was that one of the guests told us about their dietary requirements. Or perhaps we have a challenging task that needs sorting, and we can’t help but turn our attention to it periodically, even when we are in the middle of doing something else. These, and other milder forms of dissociation, such as daydreaming, or trying to put ourselves in someone else’s shoes, allow us to be more adaptable and creative. It is no surprise, therefore, that therapeutic interventions draw upon dissociation too, although therapists may not think of it this way. As clinical psychologist and author Michael Yapko puts it, “Dissociation has a much broader clinical relevance than many clinicians learn if they only study dissociative disorders, particularly when it is structured to help people go beyond the moment.”³³

When clients’ attention is directed away from their worries, or a negative take on life is reframed, they are better able to consider new perspectives. And it is when attention is dissociated from strong emotions that a client is helped to find a new context for traumatic memories.

But what happens when we cannot find the solution to a perceived threat, once it is right on top of us (as was the case for Nancy when she was a child about to have her operation)? Dreaming during REM sleep is nature’s answer to unresolved expectations, and, as we know, chronic stress from unmet needs increases the demand for dreaming. I suggest that, when fighting back or attempting escape has failed, and all autonomy is lost, the natural response is to dissociate, seeking relief in a waking state akin to REM sleep. When this happens, just as in REM sleep, we take leave of our senses, dissociating from the world around us; the body becomes paralysed and immobilisation and shutdown take over. Researchers have identified evidence which can support this contention.

An evolutionary connection

A paper by Ioannis Tsoukalas of Stockholm University proposes an evolutionary connection between immobilisation and REM sleep, based on the large number of features they share in common, including a similar pattern of brain waves, with some originating in the hippocampus. ³⁴ In both there is a release of the neurotransmitter acetylcholine, involved in ‘switching on’ REM sleep in areas of the brainstem and forebrain, including the hippocampus and amygdala. In both, there is reduced serotonin activity in the area associated with ‘switching off’ REM sleep.

There is also, in both cases, a surge in heart rate and respiration, albeit that this gradually declines during immobilisation, while fluctuating at elevated levels during REM sleep. Muscle tone and reflex signals between nerves decrease, while eye and face muscles and limbs jerk independently. Immobilisation in both states can last for up to 20 minutes, or in rare cases even longer. A form of immobilisation is experienced on waking from REM sleep still in sleep paralysis.

Tsoukalas observes that both immobilisation and dreaming are responses to emotional arousal: “Dreaming during REM sleep is usually driven by a central emotion or emotional concern that is contextualised and elaborated in a series of loosely related scenarios. This concern can be a trauma that the person has suffered, a stressful situation, or some minor nuisance of everyday life… which usually results in a therapeutic outcome.”³⁴

Research has also shown that, after a night where REM sleep is lost to insomnia, we dissociate more often the next day, whereas the better our sleep, the more able we are to remain focused, and the less often our attention drifts.³⁵

“A sort of dreaminess”

Accounts of dissociation and immobilisation resemble the experience of dreaming, too. Perhaps the most famous account comes from the journals of explorer David Livingstone where he describes, as if it were a dream, the experience of dissociating when attacked by a lion:

“I heard a shout. Starting and looking half round, I saw the lion just in the act of springing upon me. I was on a little height; he caught my shoulder as he sprang and we both came to the ground below together. Growling horribly close to my ear he shook me as a terrier does a rat. The shock produced a stupor similar to that which seems to be felt by a mouse after the first shake of the cat. It caused a sort of dreaminess, in which there was no sense of pain nor feeling of terror, though quite conscious of all that was happening. It was like what patients partially under the influence of chloroform describe, who see all the operation, but feel not the knife. This singular condition was not the result of any mental process. The shake annihilated fear, and allowed no sense of horror in looking round at the beast. This peculiar state is probably produced in all animals killed by the carnivora; and if so, is a merciful provision by our benevolent Creator for lessening the pain of death.”³⁶

Livingstone’s experience fits with what we have seen of immobilisation and shutdown so far. There is physical contact and helplessness as the lion catches his shoulder in its jaws, which activates immobilisation. Livingstone writes of a stupor which causes “a sort of dreaminess”, which is as close to a description of a waking REM trance state as you could conjure. Then there is the analgesic effect of immobilisation alleviating pain. But he also describes feeling free from terror, which, while similar to the effect many people report after a successful rewind, differs from the experience of immobilisation after a traumatic event. In fact, Livingstone’s description of being attacked by a lion sounds almost pleasurable! And I think this tells us something about the role of autonomy and self-concept in determining our response to dissociation.

Livingstone was motivated by missionary zeal, a desire to end the East-African slave trade and a strong religious belief in life after death. Livingstone’s sense of personal autonomy allowed him to tolerate the uncertainty of events, including death in the jaws of a lion. Contrast this with Levine’s client, Nancy, who, when held down by nurses and doctors, was too young to make sense of or accept what was happening to her. With her sense of control and autonomy completely compromised, it is unsurprising that the immobilisation-shutdown response took over. When she re-experienced it during Levine’s intervention, Nancy even cried out that she didn’t want to die. She is not, as some psychologists assume of the shutdown response, playing dead at all.³¹ And when Levine’s intervention results in a positive outcome, he attributes the change to a new memory of “power and agency instead of hopelessness and defeat”. In other words, Nancy’s sense of autonomy, compromised at the time of the tonsillectomy, was restored.²⁰

Concluding thoughts

When we are faced with potential threats, the front area of PAG, in concert with the amygdala, ensures that we remain prepared to fight back or take flight, and that dissociation cannot occur. But when fight or flight does not work and autonomy is lost, the back area of the PAG takes over and dissociation, immobilisation and shutdown follow. Dreaming is nature’s solution to emotional arousal, so it is reasonable to assume that, when our nervous system becomes emotionally overwhelmed, the need for REM sleep takes priority.

If immobilisation and shutdown result when a person dissociates, entering a waking state akin to REM sleep, it could help to make sense of other conditions, considered unexplainable. For instance, the ‘resignation syndrome’ seen in the Yazidi child refugees in Sweden could be explained by immobilisation after trauma in their home countries and uncertainty over their immigration status as refugees. Non-epileptic, or functional, seizures, for which childhood sexual abuse, anxiety and PTSD are major risk factors, often occur after recalling highly unpleasant memories.³⁷ In a recent study, people described freezing before the onset of such seizures, indicating the likelihood of a connection with immobilisation and shutdown.³⁸

That these and other conditions are related, and can be understood as a retreat from chronic stress into a state akin to REM sleep, known in human givens parlance as the REM state, is a reminder that waking reality and dreaming are more closely connected than we often credit. As human givens pioneers Joe Griffin and Ivan Tyrrell write, “One of the most fruitful discoveries arising from Joe’s work has been the realisation that the REM state can be – and routinely is – activated outside the dream state.”

They further add that, “for our understanding of human psychology to progress – and even for our future as a thriving species to be ensured (as far as human effort and interventions can influence such a possibility) – it will be vital to understand more about the REM state and its role in our evolution and mental health.”³⁹ To add to this growing understanding, we can now see how REM sleep explains immobilisation and shutdown, and how approaches to trauma treatment which involve the body work with the REM state, too.