How Trauma Manifests In The Body With Dr. Melanie Somerville [Episode 40]

 

Learn about trauma and how it manifests in the body with celebrity mental health expert and host Dr. James Flowers, his lovely co-host Robin French, and our dynamic Integrative Wellness director Dr. Melanie Somerville! We are also giving expert insight on Lady Gaga’s heartbreaking revelation of being raped and impregnated at 19, leading to a “total psychotic break.”

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Listen to the podcast here

 

How Trauma Manifests In The Body With Dr. Melanie Somerville [Episode 40]

Welcome everyone to Understanding the Human Condition. I’m your host, Dr. James Flowers, and this is my beautiful, lovely co-host, Robin French.

Thank you, Dr. Clowers Flowers.

Dr. What?

Clower Flowers. I said Dr. Clowers.

How long have we worked together?

Too long.

You’re not sitting next to me.

I know I gave you some space after last week. I was afraid to get that close. Is Melanie too close for you?

No, she’s great. Good distance.

I was trying to snuggle because we were looking at the screen last week and I was afraid that we had thought we needed to tuck in and get in the Zoom.

You were almost in my lap.

I was in your space. Anyhow, moving on.

We could do a home podcast with that.

Was I one of your former clients?

Let’s talk about our VIP guest.

I am so excited. We have great news. We have Dr. Melanie Somerville, the director of our integrative wellness program at J. Flowers Health Institute, and a long-time personal friend and colleague. Welcome.

Thank you.

Thanks, Dr. Flowers.

It’s weird calling you Dr. Somerville, but welcome.

It’s weird calling you Dr. Flowers.

It’s great to be here. I’m really excited. Thank you so much.

Thanks for being here. Obviously, you’re busy all day, every day with patients, and thanks for taking this little space out. I think this is going to be a great episode, everybody.

Thrilled to be here.

Melanie has a calming superpower that can put almost anyone at ease, which is essential when talking about life-altering events that leave us wounded and in pain. Dr. Somerville is a chronic pain expert. Robin, tell us a little bit more about Dr. Somerville.

 

I’d love to. Dr. Melanie Somerville is a clinician who specializes in treating individuals with chronic pain, and substance use disorders, who may be progressing through midlife transitions, or experiencing other conditions that prevent the full and joyful experience of life. Her work is informed by Gestalt and attachment theories, somatic experiencing, and mindfulness. She is a firm believer in the power of the individual to understand themselves and sees her role as the facilitator of awareness. Dr. Somerville believes change cannot occur without awareness and with it, choices can be made. Welcome.

Thank you.

It seems like COVID has been putting a magnifying glass on mental health problems. People worldwide are, they have mental, psychological, and emotional pain that they may not have acknowledged in the past. All of a sudden they start feeling pain, like physical manifestations of pain. Can you tell us how this happens and why and how does trauma manifest in our daily lives?

Sure. In many ways, we can look at trauma on a continuum and sometimes you hear the expression little T and big T trauma. Little T would be smaller things that are really distressing. Big T trauma would be what we would normally think like war and violence. The definition of trauma is the experience of an event that we’re not mentally, physically, emotionally, or spiritually prepared for and that is completely overwhelming to the point where we feel helpless, overpowered, in danger, fearful, or completely shut down.

Thus, we’re not able to follow through with the appropriate action that we’d have taken to avoid the trauma, we cannot get away from it. Obvious trauma is assault, sexual or physical, witnessing or being a victim of domestic or community violence, being at the mercy of a natural disaster, childhood neglect, and abuse, whether that’s physical or sexual abuse. Also things like chronic illness or being fired from your job or a difficult breakup.

Even the isolation that we’ve experienced through COVID-19. Those things too can be overwhelming and debilitating. Just imagine being like the parent or even the child of someone in the hospital during COVID. We couldn’t visit people in the hospital, or being in the hospital and not having the care and comfort of your relatives there. That in itself can be traumatic too. That might be considered, not to devalue anyone’s pain, but that could be more your little T-trauma that’s still traumatic and difficult to understand and manage. We don’t have some of our resources.

Lady Gaga’s Revelation

Talking about someone who has long-term chronic pain, someone who’s in the news right now is Lady Gaga. Lady Gaga is speaking out about the lasting pain and trauma of being sexually assaulted as a teenager. This is in a new docu-series called The Me You cannot See. In this, she said that she suffered from a total psychotic break years after being left pregnant by the alleged rapist. Melanie, something you and I hear all the time is I’ve had MRIs and I’ve had CAT scans and CT scans, and there’s no results from them.

What Lady Gaga was saying in this docu-series is that she’s had so many MRIs with no findings, but yet she has this absolute horrific physical pain, and many times I’ve seen her interviewed talking about being on stage and being in physical pain and how she makes it through even her performances with her physical pain and fibromyalgia. The body remembers and she had a pretty significant trauma.

She’s had this trauma and lived through this trauma for year after year after year, and she’s never been vocal about this. She’s never really talked about this and now she’s talking about it in this new documentary series and I’m so proud of her. I remember living in Austin and she was performing in Austin, Dallas, and Houston doing a concert series in Houston. A concert series in Dallas, and a concert series in Austin. She rented a house in Austin in the same neighborhood that we lived in.

I never knew that.

She had a little convertible Porsche and she would drive it around but she would go to the airport every afternoon and get in a helicopter. The helicopter would fly her to Houston, land at the Toyota Center, and she would perform, and then they’d helicopter back to Austin. She’d go out, get in her Porsche from the airport, and drive out, and she’d go out in town and party, and do fun. She’d just walk in a bar in Austin on Sixth Street or on South Congress, and would play with the crowd or whatever band was playing.

She talked about the pain that she was in. One of the physical pains that she was in, and one of the things that was important for her was to have this home base in Austin. She had her gym moved in from these big eighteen-wheelers came into the neighborhood and just completely decorated this house in the way that she wants it, put a fitness center in it. She worked out every day and had people surrounding her that love her and care for her and do the things necessary that she needed to have massage therapy and Tai Chi and yoga and all of those things. Then after the Houston concert series, she flew to Dallas every day and back to Austin.

Trauma And Chronic Pain

She did her final in three in Austin. She went off to another place. I don’t remember where it was. Same thing, she stayed right between three cities and would helicopter to each city. That helped her with her balance. She said, “I can do this and come home to what I feel like is the closest thing to my own bed.” Dr. Somerville, tell our readers how this unhealed trauma really that she’s experiencing affects our physical health because what a perfect example of someone that has physical pain, other than Lady Gaga, this huge public figure who is in this amount of chronic pain that she’s in, and then reveals this unhealed trauma.

I’m just going to say her story is similar to so many people that I’ve worked with in my work in chronic pain, working with people with chronic pain. It’s amazing that she’s making the connection for so many people that trauma manifests in the body because that’s been some struggle. As you know working with chronic pain, some people don’t recognize that something that happened to me can manifest later as insomnia, vague aches, and pains, and sensitivity to touch or sound.

Trauma manifests in the body.

It’s been a hard sell so to speak sometimes to the client or to the patient that this physical pain they want to have an MRI that says this is the reason for your pain instead of this physical pain is the result of the abuse that you suffered as a child. Once a person can get to that, healing can begin to happen. For her to be an icon for many of those people in chronic pain is really wonderful. I can think of 3 or 4 recent clients that had real difficulty understanding that some of the childhood and especially childhood I think is intractable, that childhood trauma and manifest so strongly.

Also, sexual abuse can manifest so strongly in those physical symptoms that maybe she can be a bridge for some of those people that are waking up and watching that video and saying, “I have some of these same symptoms and yes, this happened to me as a child.” Make that link between the physical and the emotional.

I read in the Harvard Mental Health newsletter several years ago that more than 70% of females who have long-term chronic pain syndrome are victims of sexual abuse at some point in their lives, 70%.

Yes, and that also ties to people who hurt themselves too. I was just reading in Bessel van der Kolk’s seminal book, The Body Keeps the Score, he says the same thing that a great number of women who self-harm were themselves victims of some sexual or childhood abuse.

That’s why it is so important to look at comprehensive diagnostic evaluations, Robin, because you have someone who for years has lived an amazing, successful life, but suffered from depression and anxiety and grief and trauma and chronic pain and not really understanding early on, not understanding that connection between the mind and the body. The only way we feel pain is through the nervous system. That’s how the pain signal travels to the brain. When our nervous system is activated by not sleeping and by agitation and anger and frustration.

Triggers to the trauma, that constant alertness or orientation toward feeling in danger that keeps that cortisol going in the body. That cortisol has been linked to greater health problems. Blood pressure, diabetes, insomnia. The cortisol is very elevated when there’s persistent trauma that hasn’t been integrated.

You bet. Through that diagnostic evaluation, all of those things are looked at and tweezed apart and uncovered and discussed. It allows the person to move into a treatment approach with a clear set of diagnoses. Only if this had happened to her, this evaluation had happened to her or so many other people early on. It just solves a lot of problems and prevents roadblocks down the road.

Self-Harm

That was a great segue, I was going to mention that Lady Gaga also discussed her impulses to self-harm. She says it’s a very real thing to feel like there’s a black cloud following you wherever you go, telling you that you’re worthless and should die. I used to scream and throw myself against the wall. I was going to ask you what’s happening there. What role does trauma play in those impulses to self-harm?

That trauma in the body can cause us to feel really anxious, unfocused, and agitated. To relieve that tension that’s in the body, sometimes people resort to cutting, pulling their hair, hitting themselves, and burning themselves. It’s a way to relieve tension. Again, I’m going to reference Dr. Bessel van der Kolk. He says that people are trying the best they can to provide some relief to the pain that they’re in. It sounds really strange to those of us who haven’t experienced it, but even in some of the patients that I’ve worked with, especially with eating disorders, that cutting somehow is a relief to the anxiety and can be a form of control, believe it or not.

Trauma in the body can cause us to feel really anxious, unfocused, and agitated.

It really requires some really sensitive clinical intervention when someone is doing that, because it’s very easy for family or people close to demonize that and say, “That’s horrible,” to really react negatively when really the person needs someone who understands. “I understand your need to try and cope with the tension or the agitation or your stress that you’re feeling, and this is the best way how right now.” Instead of shaming them even more for it.

Therapy Models 

Talk about some of the therapy models that you prefer to use when working with a chronic pain patient.

Like Robin said, I really use a lot of mindfulness and a lot of somatic experiencing. I’m trained in sensory motor psychotherapy, and it’s really helping people get back into their bodies because when the body has been violated, as it is in trauma, or when the psyche has been violated, it’s very easy for us to get up in our heads and to try to think our way out of this problem. It’s not possible to think your way out. You have to be in the body. I think I talked about this this morning in our morning reflection, that when we’re focusing on our physical sensations, we’re in the present moment.

Our minds are not fixated on what happened in the past, and we’re not worried about what’s going to happen in the future, but we’re right here, right now, and we’re listening to the birds singing outside, or we’re listening to our tummy rumble as it digests our food, or we’re paying attention to the breath as it enters our nose. I’m making it sound like it’s such an easy thing, and you start very slowly with people, and very gently, and very carefully, so that people feel like they’re grounded, so they can feel safe, they don’t feel triggered.

I never ask a patient coming in to say, “Close your eyes, let’s do a mindfulness, breathing session.” Closing their eyes might feel really dangerous and really scary. I think working with gently reinvestigating the body and becoming friends with the body, even becoming friends with those things that we want to get rid of like anxiety. I think some of our Eastern philosophies, I know Thich Nhat Hanh will say something like, “Invite your anxiety to come in and sit down. Just sit down and let me investigate this anxiety and be curious about it.”

Instead of polarizing our experiences, this is a really good experience and this is a really bad experience. This is an experience I’m having. It doesn’t have to be good or bad. This is just where I am right now. If we can get people to tolerate that, then they can tolerate their emotions a little bit better. They can tolerate some of the bodily sensations through grounding, through breathing. We can then begin to work and process some of the trauma. It’s a very gradual process.

It really is. In fact, you just implemented in our morning grand rounds, I’ll call it our clinical meeting every morning prior to starting the day you started a morning meditation. Tell the audience that’s listening about your morning reading and your morning meditation guidance.

Our morning meditation is a way for our staff to just come together and be present, to acknowledge our presentness and our being instead of our doing. Like we are very good at doing and that’s what our day is about. We have to do things during our day. Starting our day with being kind of sets a slate for intentionality, for purpose. I think it’s self-care. It’s a moment of being in our bodies, breathing, settling in, grounding ourselves. Sometimes I’ll do a little guided meditation, but I’ll read from, Thich Nhat Hanh is my favorite, I love Thich Nhat Hanh.

Meditation is self-care. It’s a moment of being in our bodies, breathing, settling in, and grounding ourselves.

Sometimes I’ll read Pema Chodron, Eckhart Tolle is a big proponent of The Power of Now, if anybody’s familiar with that. Just a little inspirational reading about caring for ourselves, and that kindness to others starts when we’re kind to ourselves. All of our work with others, and that’s so important as a clinician to take care of my self-care, my mental health, my physical health so that I’m emotionally available to the difficult clients that we encounter at J. Flower Health. I offer that to the entire staff, because all the work we do is a lot of doing, and it can be really stressful in taxing because we’re helping heal some really difficult conditions.

Research shows that meditation is so important for us, but why is it that it’s so difficult for us to work this into our daily lives?

We have an expectation. We expect it to be a certain way instead of reorganizing our thoughts. Again, it’s about polarity in our experience. We either want the experience to be good or bad instead of sitting for ten minutes, and it’s what it is. Sometimes when you sit in meditation, your mind goes crazy, and you keep thinking, “I got to do this certain paper.” Sometimes you’re able to watch your thoughts. When you can do that with equanimity. When you can do it with, “Thoughts come on in you’re here you’re running my mind this morning you’re interrupting my being and that’s okay.”

Some mornings you’re able to be with what is you’re able to focus on your breath a little bit more and your presence. It is what it is and you don’t say, “That was an awesome meditation.” You’re just with it. The meditation is the meditation. it’s not a good meditation or a bad meditation it’s just the meditation and the more that we can bring some of those equanimity experiences into our lives, the less reactive we are. That helps with mindfulness in the workplace.

Acceptance And Commitment

There you go. Talk to us a little bit more about acceptance and commitment therapy and what you do with that.

Acceptance and commitment therapy is it’s a well-researched behavioral therapy that focuses on helping people identify their values, and how they want to show up in life, and doing that despite some difficulties with chronic pain being one of the main ways that I use ACT. There are six concepts of ACT. I think it’s present-moment awareness. It brings some mindfulness and acceptance. A lot of the difficulties that we experience in our lives are because we cannot accept what is. We cannot accept reality. “I’m getting married today and it’s raining.”

I can either accept that it’s raining and be happy and get married anyway, or I can throw a fit and ruin my wedding day because it’s something I cannot change. We have present-moment awareness. We have acceptance. We have something called self as context, which has to do with the scripts that we write about ourselves and who we are in the different contexts of our lives. Cognitive fusion, how we fuse to certain thoughts that we have.

If Dr. Flowers passes me in the hallway and doesn’t say hello, I could get all offended and think, “He doesn’t like me or he’s mad at me.” Instead of, “Maybe he’s busy.” Cognitive fusion allows us a little bit of questioning our thoughts and the way we fuse to our thoughts. Let’s see, cognitive fusion, I’m not sure how many I’ve done so far. We have our values. Identifying values is how we want to show up in the world. It’s not a goal if I want to run a marathon. It’s a goal of I want to be physically fit and challenge myself physically.

What are the actions? Action is the last part of that, acceptance and commitment therapy. What are the actions that I do in the service of my goals? “I have chronic back pain, but I really want to go on a walk with my friend.” I plan that walk with my friend and I go on the walk, maybe I can only walk for ten minutes instead of twenty minutes, but my value is the friendship that comes from being with my friend on the walk. I value that and I take that walk even though I have low back pain. Does that make sense?

Absolutely.

Yeah.

It’s a very powerful tool to use with people. I’ve used it in a lot of group settings.

Case Study

A lot of what you’re doing now is a one-on-one. I’m not doing a whole lot of group right now, but doing a lot of one-on-one tailored to each individual chronic pain person that you’re working with. Walk us through a little bit about your approach to working from beginning to end with someone and give us maybe a case study of someone you’ve worked with with chronic pain.

You’re really putting me on this one.

I know.

Actually, can I talk a little bit about a current gentleman? It’s not chronic pain, it’s actually depression. It’s chronic, long-term depression. He’s presenting as just a helpless man who wants us to fix him.

Who’s had trauma, right?

Has had some trauma, yes. As a clinician, and you begin to know as you start to work with someone and build that therapeutic alliance, how much you can push and how much you can say and how something will go off. I always try to be tentative. I’m not sure if this sounds like you. Wait for them to say, “No, that doesn’t fit or yeah, that does fit.” This man lost his wife and has been pretty much functioning as a mom and dad for his three kids for about 16 years and he’s put all of his energy into his family and very little energy on himself and his own self-care and who he is in the world and what he wants.

It’s all about his kids and I think that’s causing him depression because he doesn’t have balance in his life. It’s all about his kids and what they want and what they want to do. I’ve introduced the idea a little bit and in groups it is different. I’ll explain act the way I just explained it to you in a group. I probably wouldn’t go into that detail individually, but I would say something like, there are some things that you might want to do in your life and couch those as values, like how you want to be in your life. Ask him to talk about what are those things and that you have depression also.

The idea is to be willing to do those things despite having depression. You want to act in the service of those values. He’s frightened to begin dating. He’s frightened to find out who he is without his kids. His kids are growing, they’re going to be gone soon and out of the house. What is his role going to be now? What is his meaning and purpose? That’s also a huge part of our human existence is what do we live for? What is worth living for? What is our meaning and purpose? If you don’t have meaning and purpose in life, you’re probably not going to have a very fulfilling life. I don’t know if that answers your question, but having him identify things he’s willing to do despite having depression.

Is he able to identify any of those at this point?

He’s working on it. There’s also some relational codependency in that family system, and so that’s a whole other podcast that we could talk about codependency. Helping people recognize that we’re all responsible for our own stuff. When our kids are grown up, they’re responsible for their stuff and we’re responsible for ours. Allowing them to have their experience while we have our experience is actually healthy human functioning. If you haven’t been functioning that way, it can feel very scary to give up what you perceive as your control, even though maybe not direct control.

Rapid Fire Questions

Thank you so much. Before we go, we always like to ask a couple of fun questions. To lighten up the mood just a little bit. What do you like to do on your time off?

You’re going to laugh. I’m a knitter. I’m waiting for grandchildren, so I’ve decided to knit a layette anyway, even though neither of my children are married. I’m knitting a baby blanket.

How fun, you’re going to save it in the day. That is so cool.

I like to be outside. I do a little bit of running, even though I’m not as prolific as I used to be.

Boy, we both used to be prolific runners. We went on many long runs together. That’s right.

How long did you say you guys have known each other?

Twenty-some odd years.

About 25 years.

Yeah, about 25 years. What’s your bucket list? What do you have left on your bucket list?

Bucket list. Live in France.

There you go. Not anytime soon.

Not anytime soon. No in the next 5 or 10 years.  I’d love to jump out of an airplane. I’m scared to death of it.

Would you really? I went on a 40th birthday party many years ago with someone else who was turning 40 in California. There were about eight of us and we flew to California to jump out of an airplane. We were going to do it tandem and we got there and they talked us into doing it, whatever it’s called, free jump. We were like, “Yes.” We went into this seven-hour class all day on a Saturday on this 40th birthday to learn how to jump out of this airplane by ourselves. I was like, “I’m going to do this. I’m going to conquer my fear. I can do it.” All day long, it’s like, “You can die. You will die if you don’t. You can die if you don’t. If you don’t do this, you’ll die.” All day long for seven hours teaching you how to do all that.

That’s what you heard, Dr. Flowers.

I would have went to the bathroom, but not come back.

Let me tell you, all seven of us, the plane started, we walked outside, and everybody is excited. We all get to the airplane door and the door opens for us to get on and every one of us looked at each other.

No way.

We did not get in and get out. Can you believe it?

I thought for sure you had jumped out of a plane.

No, I have not. Not yet.

Mindfulness Session

Before we leave this, can you do a mindfulness session with us? Just a brief one so that everybody can experience that.

Sure. I’ll give you a little taste of what we do in our office. We’ll just start by settling into wherever you are, wherever you’re maybe listening to this, and feel where you are. If you’re standing, feel your feet on the ground. If you’re sitting, feel your butt in the chair. You can close your eyes, but you don’t have to close your eyes. You can relax your gaze.

If you’re driving, drive.

Don’t close your eyes if you’re driving or listening to this. You can do this whatever you’re doing, right? The idea is to drop into being and let go of doing just for a minute and then we start by noticing the breath. As you breathe, you don’t need to change your breathing or do anything different, but as you breathe in, most of us breathe in through our nose, breathe in through your nose, and notice the temperature of the air at the tip of your nose, because it’s a little bit cooler than our body temperature.

If you really pay attention, you’ll notice the air as it enters your nose, travels up your nose, through your nasal passages, down your esophagus, into your chest, and down into your diaphragm if you’re doing diaphragmatic breathing, but you may not get that far. Just notice the breath as it comes in and goes out.

You may notice your mind already wandering or thinking, and that’s okay, minds wander, that’s what they do. Just come back to your breath. Wherever in that cycle you are, whether it’s breathing in, the air traveling down your esophagus, just noticing. Maybe allowing yourself to notice tension in your body and relaxing your jaw, your shoulders away from your ears, your belly, and your glutes. Just taking a minute to breathe in, breathe out. When you’re ready, come back to your present moment. Go back to doing and remember this little mini-mindful moment from Melanie.

There you go. From Dr. Melanie.

We’re talking about Mindful Mondays perhaps with Melanie Somerville.

There you go. That’s our next show. Absolutely. You are amazing. It’s always amazing working with you and thank you for all that you do with the clients and patients with whom you work every single day. You have done just countless amazing jobs with so many chronic pain patients. I know it’s one of your passions, so thank you for what you do. You’re healing for your mindfulness.

It’s a pleasure, I love it.

Robin, how does someone find J. Flowers Health Institute?

That’s easy. JFlowersHealth.com.

There you go.

Thank you again for joining us.

Thank you.

Our clients love you and so do the staff.

Thank you.

Thanks, everybody. Thanks, Melanie.

Wait, one more thing you guys, before we sign off. I’d like to remind everyone watching or reading to us that there are numerous platforms to find our podcasts, YouTube, Apple Podcasts, SoundCloud, Spotify, Stitcher, and iHeart Radio. Please share this episode on social media or with someone you think it would help.

I just want to remind everybody before we go that a clear diagnosis is the key to the most effective treatment possible. Thanks, everybody.

 

Important Links

• Dr. Melanie Somerville’s Linkedin Profile
• The Body Keeps the Score
• The Power of Now
• Understanding The Human Condition’s YouTube Page
• Understanding The Human Condition’s Apple Podcasts page
• Understanding The Human Condition’s SoundCloud page
• Understanding The Human Condition’s Spotify page
• Understanding The Human Condition’s iHeart Radio page