At the Washington VA Medical Center, Yoga Nidra helps veterans recover from trauma.
The war within: Overcoming trauma, veterans find strength in meditation and yoga
by Samantha Michaels
Mar 05, 2010
University of Maryland
David Alan Harris uses dance movement therapy to treat soldiers with PTSD.
Dancing to Recovery
Like yoga, dance movement therapy helps trauma victims by reintegrating the mind and body. Pioneered in the 1940s at St. Elizabeths Hospital in Washington, the technique aims to promote the emotional, cognitive, physical and social integration of individuals.
David Alan Harris is a leading dance movement therapist with clinical experience in mental health and rehabilitative treatment. Best known for his work with former child soldiers in Sierra Leone, Harris discussed how dance can help trauma survivors—including veterans with PTSD.
Q: As a dance movement therapist in Sierra Leone, with whom did you work?
A: I worked in a small district with a group of about 12 former child combatants. For the most part, rebels had abducted them as small children during the civil war. In a typical scenario, rebels would assault a village by night, slaughtering the inhabitants, claiming the girls as sex slaves and taking the boys as combatants. These kids saw their families slaughtered, and in that very moment of horrific trauma—suddenly separated from all nurture, love and affection—they would have been killed if they expressed any emotion. They were forced to enter the ranks of forces that had just killed their families. One kid was forced to kill his own parents.
Q: How did the process work?
A: In our case we were using Sierra Leonean hip hop because it’s what the guys liked. We would start out dancing to a beat in unison, all of us facing inward, and one facilitator would move to the beat, maybe gesturing or punching the air, and then the dance would develop and anyone could lead. The guys transitioned seamlessly and took control of the group, and through that process they could symbolize their experience, probably unconsciously at first. We’d walk in a circle, single file to the music, and then we’d find ourselves crawling on the floor, and people would gesture as if tossing something in the middle of the room. I’d ask, “What are we doing?” and there was a consensus: we were throwing away our troubles, cleansing our troubled hearts.
Q: How does dance movement therapy help survivors overcome memories of trauma?
A: [In Sierra Leone], dance allowed the boys to create a nonverbal narrative. They were reconstituting their experience, and growing increasingly tolerant of their horrific memories.
Week after week, I observed that one or more of them would take one of my limbs and immobilize me by holding it on the floor. This action was latent with multiple levels of symbolism. First of all they were repeating their traumatic history: They had captured and detained people….I also carried an authority within the group, similar to the authority the rebel commandos had. I wasn’t mistreating them, but I think they were getting back at the rebel commandos through me. In addition, they were trying to make sure that I didn’t disappear symbolically—holding on to the caring adult who had come to play with them, the first person who offered this kind of care since their families were slaughtered. They had all experienced loss and they didn’t want it to happen again.
At the same time, their actions were threatening to me, provocative. Why? I would say teenagers everywhere are going to test our limits because there’s a part of them that wants us to give up on them, get angry and say, “You’re just a lousy person because you killed, amputated and raped people.” But we don’t do that. We have a commitment to holding them always in unconditional, positive regard, and they don’t know what to make of that. So this symbol held all of these meanings in it. Dance was a way for them to accept this unconditional positive regard, and through that process they started to change.
Q: Do you think dance movement therapy could be effective for veterans with PTSD?
A: I know there are dance therapists who work with veterans and unfortunately there isn’t much literature about it… In Sierra Leone, dance is so infused in the culture that it wasn’t very difficult to engage the boys in it. It’s likely that in our culture, the defenses people use against expressing themselves might be pretty extreme, though there are ways to engage them anyway. If these guys in Sierra Leone had expressed themselves when they saw their parents killed, they would have been shot, and they were told this again and again, but they were able to overcome the numbness…. I believe this could be replicated in other contexts with somewhat older groups.
A lot of therapeutic work in the United States is done on an individual level, and in Sierra Leone I worked in the collectivist culture of groups. But the interesting thing I would say is that in some ways, the military builds its own collectivist culture, and that strength could certainly be drawn on …. The kind of camaraderie that I expect exists in a VA hospital would be a great resource to draw on in building the kind of trust that’s necessary for exploration through movement.
Physically removed from the battlegrounds, however, his body hadn’t yet shaken the battle.
“One day I was standing in line at a [store] and I smelled burning rubber,” he said. “All of a sudden my brain turned on a switch: I started sweating, my heart started pounding, hyper vigilance kicked in. Everything went into war mode, just standing in line trying to buy chips and soda.”
Like a growing number of veterans, this 26-year-old infantryman was diagnosed with post-traumatic stress disorder (PTSD), a severe anxiety condition which results from trauma. Estimated to afflict more than 300,000 Iraq and Afghanistan veterans, PTSD is often treated with counseling and medication.
But in George’s case, salvation came with meditation, not medication.
“With meditation, I had a break from the anxiety attack that had become my life,” he said.
In January, the Department of Defense announced it would allocate $1 billion of its 2011 budget to research and care for traumatic brain injuries like PTSD. As the number of PTSD cases skyrockets and the military devotes more funds to treating them, George’s story provides a glimpse into the promise of alternative therapies like meditation and yoga.
“Even if we’re army strong, we’re still human,” said Sue Lynch, executive director of There and Back Again, a non-profit organization that uses yoga, meditation and a number of other therapies to promote wellness among servicemen. “We have emotions which are going to come out somehow, so why not learn tools to shift recovery into a positive experience of self-care?”
Invisible Wounds: Military Veterans and Mental Health
Since the beginning of the Iraq and Afghanistan wars, mental health has been a growing concern for the military. Between 2001 and 2007, one in seven combat veterans sought help for mental illness, and according to VA records, about half of these cases involved PTSD. One in five patients seen last year in VA’s health care facilities had a mental health diagnosis.
Experts believe the prevalence of PTSD may be even greater, because VA records exclude a number of patients, including veterans treated at storefront VA Centers, active-duty soldiers, and veterans who have not sought treatment.
PTSD can manifest as nightmares, flashbacks, insomnia, anger, depression or hyper vigilance. Attempting to deal with these symptoms, many veterans withdraw from friends and family.
“In order to do the things we did over there, and to live with the things we saw, you’ve got to be angry,” said George, one of 47 soldiers injured during a car bombing in Iraq. “It’s a disgusting feeling that’s part of war culture, and only war culture. When you come home you’re told to forget about it, because you can’t act or feel that way. You try to detach that anger from yourself, though it’s a part of you and your brain.”
Soldiers undergo physical training before deployment, but they often lack emotional tools to cope with trauma.
“When things break down it’s along other axis as well—emotional and spiritual dimensions,” said Colonel Brian M. Rees, a medical corps command surgeon who served in Afghanistan and Iraq.
Yoga: Reintegrating mind with body
To overcome the breakdown, some veterans use yoga.
“In combat there’s trauma and you feel helpless, and then you go to the VA and you’re on medication and you feel helpless,” said Lynch, a veteran of Operation Iraqi Freedom. “Yoga gives control to the vets, allowing them to take charge.”
During war, a soldier’s mind may go blank to avoid stress—a survival mechanism which often lingers with negative consequences after conflict.
“Victims of trauma carry a brokenness, a division of mind and body that needs to be reintegrated,” said David Alan Harris, an award-winning therapist who worked with former child soldiers in Sierra Leone.
The term “yoga” is derived from the Sanskrit word “yuj,” which means “to unite” or “to integrate.” Often incorporating exercise, breathing and meditation, it promotes balance.
“Body-based techniques help PTSD patients self-sooth,” said Rebecca Milliken, a licensed counselor and dance movement therapist who has worked with prison inmates. “They identify parts of their bodies that feel safe and relaxed, so when a flashback comes, they can go to a safe place in their minds.”
For Eric Fretz, a Navy veteran who served three deployments off the Persian Gulf, yoga helped relieve severe stress and depression.
“I’d be out running and thinking about stuff, and I’d start crying, and I couldn’t stop,” he said. “That’s off-putting for somebody who’s never had an issue of emotional control…Yoga became a life vest, and I was clinging to it.”
At some VA medical centers, veterans take classes in Yoga Nidra, an ancient practice that resembles guided meditation. The technique uses relaxation and breathing exercises to deconstruct the thoughts and emotions which trigger PTSD.
Yoga classes provide group support for veterans who have withdrawn from family and friends.
“The kind of camaraderie that exists in a VA hospital among veterans would be a great resource to draw on in building the trust that’s necessary for exploration through movement,” said Harris.
Still, yoga instructors face a challenge: some soldiers are skeptical of the practice.
“There’s a soldier culture of manliness that isn’t a perfect fit for yoga,” said Fretz, who added that the poses can ultimately leave “even the toughest guys whimpering.”
Transcendental Meditation: Targeting the Mind
A number of military physicians also believe meditation can help veterans recover from PTSD. Some experts say Transcendental Meditation (TM) is particularly beneficial.
Practiced twice daily for 15 minutes, TM is a self-awareness technique of Indian origin. Sitting with eyes closed, participants enter a state of restful awareness. The physical effects are helpful for PTSD patients who operate under heightened stress levels.
“Severe stress can shut down the prefrontal cortex, which is like the commander-in-chief of the brain,” said Dr. Sarina Grosswald, the executive director of PTSD and stress-related disorders for the David Lynch Foundation. “TM rebalances the brain chemistry.”
During TM, the body reaches a level of rest equivalent to deep sleep—undergoing a reduction in heart rate, breath rate and blood flow to the limbs. At the same time, blood flow to the brain increases, reactivating the prefrontal cortex and improving communication with other areas of the brain.
“TM creates the brain waves associated with settled-ness,” said Grosswald. “As you experience it over and over, these brain connections get stronger, and the connections related to trauma begin to fade away.”
Dissatisfied with his medication, George relieved pain with drugs and alcohol before discovering TM. With meditation, he reconnected with himself.
“Practicing TM was like being in the zone—like when you’re ready to kiss somebody, you both know it’s right and a spark flies in your chest,” he said. “Except it was something I triggered within myself, something I did to myself. Within the first month I realized I was an individual that I’d been ignoring.”
Despite success stories, experts face obstacles as they promote TM on a greater scale. Rees has led scientific studies to gain support, but he said people don’t always recognize TM’s distinctive benefits.
“There is a lack of differentiation between TM and other meditative techniques,” he said.
Still, he continues to recommend TM to military patients.
“We should be exploring TM,” he said. “It’s a stone that has remained unturned.”
Investing in mental armor
Secretary of Veterans’ Affairs Eric Shinseki called PTSD treatment “central to the VA’s mission” when the White House announced a proposed $125 billion budget for the Department of Veterans’ Affairs in February. Spending requests allocate $5.2 billion for mental health, an 8.5 percent increase in current spending.
The military is examining alternative PTSD therapies, but meditation and yoga advocates say they should do more.
“It’d be great if yoga could be part of our out-briefing,” said Fretz. “In general, the resources for returning veterans could be allocated better.”
A combination of medicines, psychotherapy and mind-body approaches may be most effective.
“We have suffered from an either-or approach that’s very western,” said Rosa E. Garcia-Peltoniemi, a clinical psychologist at The Center for Victims of Torture. “We say it’s either the body or the mind, but in actuality, it’s both.”
Therapists suggest that yoga and meditation can be preventative measures, not simply therapies.
According to Grosswald, the military takes an academic approach to stress reduction, requiring soldiers to complete stress management courses before deployment. If soldiers were equipped with meditation and yoga, they might be less likely to develop PTSD during combat.
“You can teach somebody something from a book, but a lot of that goes out the window when trauma happens,” she said. “With TM, you’re training the brain so the threshold for stress is different… Soldiers could come back to a baseline quicker, responding in a clearer way.”
However, meditation and yoga classes require trained instructors, which may be in short supply. Fretz said he had access to two yoga instructors in Iraq, but most soldiers are not so lucky.
“If the instructors leave, then the yoga stops,” he said.
Although the Department of Veterans’ Affairs has hired 6,000 new mental health professionals since 2005, raising the number to 19,000, experts say more therapists are needed. A person learns TM through one-on-one instruction with a trained practitioner, which can be expensive.
Still, advocates say it is ultimately cost-effective.
“Health care costs and professional resources can be saved because people wouldn’t spend years going through health counseling in VA medical centers,” said Grosswald.
For George, the investment in meditation has been worth it. TM relieved his PTSD symptoms, but it also led to less expected improvements. After learning the technique, he became a faster typist and a better drummer. Dyslexic since childhood, he noticed that reading was more pleasurable. He stopped drinking and began to prioritize himself.
“I really do treat myself like my best friend now,” he said. “Medications took away the symptoms, but they didn’t leave me the same. TM has left me better.
