A blog by Alastair Mordey.
Muay Thai is Thailand’s traditional martial art. It is often called the art of eight limbs because it uses not just the fists, but also elbows, knees and shins to deliver blows. I have used Muay Thai as part of a treatment system for addicted young men for some years now. People have commented on the wisdom of using such a brutal martial art to help addicted young men climb out of their self-defeating lifestyles. And when you consider the fact that many of the men we treat have significant traumas – this is a salient point. But what we are starting to learn about trauma has changed our understanding of how we work with it.
In our Muay Thai programme we build young men up very slowly. Very few of them have ever fought in the ring, and most of them never will. They train hard, and they spar lightly. If talented, then of course, they can test themselves against the Thai instructors and learn exactly what defeat tastes like without being seriously injured in the process. A very few (three so far) have gone on to have amateur fights after discharging from our facility. But most don’t. They don’t ring fight because they don’t want to. And this is an important point.
In today’s world, particularly in the UK, young men are being increasingly sucked into violence that they have no previous experience of and which quickly overwhelms them with tragic consequences. Knife crime is now epidemic in the UK’s inner cities and in the US guns have long since replaced fists as the most effective way to settle disputes in many neighbourhoods. The fact is, a physical test which confirms one’s physical limits and abilities in very black and white way – such as sparring – can serve as a potent reality check. The young man can then say, “OK, this is how far I can go – and no further”. In other words – this is not a computer game. Small, manageable doses of pain go a long way to building a real understanding of the effects and ramifications of worse violence.
But Muay Thai and other martial arts such as wrestling, jui-jitsu, boxing and judo, are not just effective as a reality check. They also have significant potential as a modality for treating trauma and addiction. In early sobriety, martial arts like Muay Thai can help addicted young people learn about discipline, delayed gratification, the facing of fear and above all – how to mount some kind of successful challenge against a ‘stuck’ position. This external fight mirrors an internal fight which has been raging for a long time in most addicted people, but which has now been forgotten. To understand this fully we must delve into what trauma is, how it works, how it is linked to addiction.
Our knowledge of traumatic stress has been greatly increased over the last twenty years by a number of writers. Peter Levine first outlined the role that the body’s ‘freeze’ response plays in the causation of trauma, and wrote about it in his 1997 book Waking the Tiger. DrGabor Maté, an addiction physician, also wrote specifically about how addiction is a self-medication for childhood trauma in his 2009 book, In the Realm of Hungry Ghosts. More recently the psychiatrist Besel Van Der Kolk wrote The Body Keeps The Score, a book whichinvestigated the role of the fight-flight response still further. Multiple studies, most notably the ACE study conducted by the Center for Disease Control, have also found strong links between an adverse childhood and addiction in adolescence and early adulthood.
All of these writers and researchers have also emphasized the necessity of going beyond traditional talk therapy in treating trauma and addiction, and outlined the importance of somatic work. Somatic work or body-based therapy is where we work directly on the body, or more specifically, on the nervous system, in order to ameliorate the symptoms of trauma – rather than relying solely on talk therapy. The reason they suggest this, is because traumatic stress is highly physical in its manifestations.
According to Levine, trauma is caused by the body’s freeze response, which is technically known as the immobility response. This response is controlled by the autonomic nervous system, which is divided into the Sympathetic Nervous System (SNS) and the Parasympathetic Nervous System (PNS). The SNS is so-called because it works with the emotions. Van der Kolk describes it as ‘the accelerator’. It regulates the release of hormones like adrenaline which can make us temporarily superhuman in moments of need, and capable of fighting or fleeing very effectively. The PNS, in contrast, works as the brake. It regulates the release of acetylcholine and puts things back together again after the abnormal levels of arousal that terrifying encounters inevitably produce. As Levine points out, when encountering horrors, sometimes we don’t fight or flee – we freeze. This immobility response is completely involuntary and occurs when we are absolutely sure we are going to die or be seriously harmed (or if we are witnessing the same thing happening to others). This traumatized state can be induced by a surprising number of scenarios that people might not necessarily assume are traumatic, like invasive surgery for example. Ultimately, it depends on how the individual perceives what is happening to them.
The evolutionary purpose of this ancient function of the mammalian and reptilian brain areas is two-fold. Firstly, it makes our impending death less painful by helping us to completely disassociate ourselves from our own body. Secondly, if there is any possibility at all of evading death or injury by keeping very still (what Levine calls ‘playing possum’) then this is probably the best bet once fight or flight have been judged as utterly hopeless. Upon surviving a near-death experience or a perceived near-death experience, some people don’t come out of their ‘deep freeze’ but remain stuck. Their physiology is ramped up into overdrive because their hyper aroused SNS was firing on all cylinders at the moment that they became frozen.
This model does not see trauma as a purely mental phenomenon but rather, as a highly visceral experience. Alarming messages that are registered by the brain are carried back and forth across the whole body by the polyvagal nerve, which links the brain with the stomach, the intestines, the heart, and the lungs. All of these body parts are intricately involved in regulating our feelings of danger and safety. And as anyone who has experienced a traumatic betrayal will tell you, a broken heart really does feel like a broken heart. And being ‘gutted’ is also a very accurate description of what it feels like to be horrendously let down. So trauma is not just a mental ‘dis-ease’ but a very somatic experience as well. It’s ‘encoded in the viscera’, in the guts, so to speak.
Besel Van der Kolk’s work has showed us that trauma can be exacerbated or healed respectively, by the way that we relate to others and the way we perceive ourselves in relation to others. Our mirror neurons can read the malevolence in other people’s faces and in their body language. It is this ability to read the motivations of other human beings in such a complex and nuanced way that really compounds traumatic physiology in humans. When we find that someone has acted in a deliberately evil manner it becomes more than just a temporary threat. It is an ongoing existential threat. It destroys our sense of trust in the world because now we are cursed with the practical knowledge of good and evil and we know full well that it could happen again. When it comes to treating trauma then, we are dealing with someone who is stuck in a confrontation they feel they cannot win, and one in which their relation to others is key. And this brings us back to the boxing.
Muay Thai, and other full contact martial arts, are mildly to moderately stressful. They are ‘real’, to use a clichéd term. And with regard to young men in particular, this is no bad thing. In fact, it is therapeutic. Research on young male rats suggests that group exposure to mild to moderate stress levels increases pro-social behaviour. It seems that mild stress actually brings young male rats closer together. They learn to cooperate more than they would in an overly harmonious or unstressed environment. This is also reflected in their brains, which display elevated levels of oxytocin (the ‘bonding’ chemical) when they are placed in moderately stressful situations with a group of their fellows.
When we consider the fact that re-visiting the trauma (through talk therapy) is often counter-productive – something Van der Kolk, Levine and others agree on, then we can start to appreciate the tonic effect that using your body, whilst being in a group, and whilst being moderately stressed and challenged – can have on our mental health. In short, done correctly, this kind of stimulating environment is more therapeutic for young men than sitting around emoting.
Whereas traditional talk therapy often lunges around in the dark, emphasizing the need to talk about or verbalize an event in order to achieve ‘closure’, Levine realized that, if anything, this did more harm than good. Talking about a traumatic event does nothing but re-live it in imagistic terms. What we must do instead (according to Levine) is confront the dragon by a side-door. We must re-visit a replica, or symbolic representation of it. Like the Greek hero Perseus who slayed the Gorgon Medusa, we must attack it while looking at it in a mirror. If we remember that trauma is an unsatisfactory conclusion, a failure to complete the body’s natural fight-flight response, then we can appreciate the fact that those who manage to effectively fight back, or even to effectively run away, are to some extent executing a successful response to that life threatening event. They are completing the gestalt, going full circle, or bringing the process to a close, as Van der Kolk explains in The Body keeps the Score;
“Being able to move and do something to protect oneself is a critical factor in determining whether or not a horrible experience will leave long lasting scars.”
People mummified in the glacier of ongoing traumatic stress continue to vibrate with the nervous energy of ‘unfinished business’. Regardless of whether this freeze is the result of trauma that is self-imposed, or trauma visited upon them by external malevolence, they become helpless and resigned to their fate and enter a frozen state. All of this necessitates a response because, in the language of the famous psychologist Carl Jung, ‘whatever we run from grows bigger’. A Jungian solution, therefore, would be to confront the dragon. The young man who was beaten, must pick up the gloves once more. The man who came home to find his wife and kids gone without so much as a note, must learn to be a father again. And the veteran who cannot resign himself to the fact that he could not save his comrade must rescue somebody else instead. In assuming such responsibilities, ironically, we come back to our selves. In facing the dragon, we are coming home. In developing others, we are developing ourselves. In the words of the notoriously hard-core Thai monk of the forest meditation tradition – Ajarn Man; “right where our suffering arises, is where the suffering will cease.”
Whilst physical confrontation is not for everybody, the analogy of creating inner strength through manageable doses of stress – preferably in groups – still holds. This principle is known as hormetic growth. The more we stress an object the more resilient it becomes. Actually, resilience is a somewhat limited way of describing this growth. Exposure to stress actually has the potential to make us anti-fragile – a concept developed by the writer and philosopher Naseem Nicholas Taleb. Things which are anti-fragile are not merely resilient or robust, they are the opposite of fragile. They don’t just survive stressors, they become stronger and better after being exposed to stressors. Muscle tearing and subsequent growth after weight lifting is the obvious example. But there are also mental, emotional, social and psychological muscles we can develop. As long as the stress is manageable, and performed within the support network of a brotherhood (or sisterhood) with a common purpose – deliberately imposed stress can leave us more expanded than we were before. In this light we have to honestly ask ourselves as psychological professionals – “have we been using a fragility model?”
Nevertheless, there are of course, young men who are not inclined or well-suited to such rough and tumble. But the same principles of anti-fragility still apply, even when you shift the focus to another kind of challenge. With this in mind we also pioneered a triathlon training programme which provided an equal (if not greater) challenge. Like Muay Thai, triathlon provided an intense but manageable crucible of suffering for our young men. It provided the opportunity to test themselves…against themselves (but within the support network of a recovery group).
Serious physical challenge, adventure and odyssey are things that are almost entirely missing in society today. Triathlon and combat sports do something to put this back. Swimming in the sea is daunting when the sea is rough, even if it’s only for one kilometre. Or try jumping into the Mekong river at 6.30am. It’s an experience you won’t forget. It’s surprising how few people (including young men) can actually do this, and being able to deal with such arduous feats of athleticism is life-affirming – and frankly – what young men should be doing.
Nevertheless, some addiction ‘experts’ continue to deny the efficacy of this type of physically oriented treatment programme. “What about exercise addiction?” they groan. Well, let’s weigh it up. A compulsive need to over-exercise versus death by opiate overdose or a life sentence for murder earned during a three-day meth bender. I know which one I’m opting for. “Well what about issues with body image then?” they chunter on. “What about becoming obsessed with their own body?” This is a better question, and there is a very good response to it.
A little bit of body awareness goes a long way for young men who have been marooned in a sedentary life. It goes a long way to boosting confidence, of a very limited and basic type admittedly, but at least it’s something. Self-esteem comes from achievements which have been earned, not through being gassed up with unrealistic ideas of how ‘special’ you are, by weak willed adults who want to curry favour with you. Often, the completion of exacting physical tasks provides a basic level of achievement for young men in a way that it doesn’t for other people. For young men with no discipline, physical achievements are perhaps the easiest way to learn discipline. And don’t underestimate the power of physical discipline to serve as a blue print for other, more complex forms of delayed gratification.
We have found that our intense activity-based programme has yielded results. By 2018 we produced five ironman triathletes, with dozens of others going on to complete shorter races, as well as producing several amateur Muay Thai fighters. Our sobriety rates at one year have been good. In the ‘revolving door’ publicly funded London services I once worked in, the sobriety rates at 12 months were less than one per cent. Here, they are over twenty-five per cent, which, as anyone who has been in the field of addiction treatment for any length of time will tell you – is very high.
Recently, we began a tract in our treatment programme which mandates participation in Brazilian Jui-Jitsu (BJJ) classes. In our view Jui-Jitsu’s philosophy offers an even greater expansion on this general methodology of using physical challenge to overcome adversity, bond the group, and increase feelings of belonging, purpose, self-efficacy and stress management. Jui-Jitsu, like Muay Thai, brings people into close physical contact with one another. Instead of strikes (which can be confronting to say the least) BJJ focuses on grappling technique and skill. This has the effect of neutralizing the strength differences between individuals, genders, and age groups to a considerable degree. It is our belief that this modality will go on to have even greater success than our Muay Thai and triathlon programmes. We will test the data as we go along.
One thing we can say for sure is that if young men do not find the challenge they need within their wider culture then they will find it in a subculture – or act it out with a psycho-pathology. We’re not going to eradicate knife crime with talk therapy, and I have come to believe that we will not make serious in-roads into treating trauma and addiction with talk therapy either. All of these conditions require radical action to be reduced, and they need the powerful effects of a motivated ‘tribal group’ to prevent against their return. Once again, Besel Van der Kolk has some wise words regarding this, which summarizes the philosophy I live by quite nicely;
“Our culture teaches us to focus on personal uniqueness, but at a deeper level we barely exist as individual organisms. Our brains are built to function as members of a tribe.”
Alastair Mordey is a pioneer of addiction treatment centres in Asia. He was the co-founder and chief clinical architect of The Cabin Group, and is current programme director of The Beach, Thailand. In 2020 Alastair will be opening Alpha (Thailand) a men’s addiction treatment programme focused on Brazilian Jui-Jitsu and body-based therapies.