"It feels like being trapped in a cage. You're certain something is in there with you because you can feel it, smell it, but you can't see it. So you just keep frantically looking around this cage, waiting for it to pounce. Except the cage is like...your own brain and everything around you might be the thing that will hurt you. I just want someone to let me out."
My patient understood trauma well. Traumatic disorders are deeply distressing, a constant battle with your own mind and body. While past therapeutic intervention centered on the notion that trauma must involve actual or threatened death or serious injury, most practitioners are coming around to the idea that trauma can result from any situation where someone is overwhelmed by frightening emotions. The more helpless and frightened one is, the more likely they are to be traumatized.
But, it is more than helplessness. Though some studies are currently looking at possible traumatic responses in domesticated animals, many wild and domestic animals go through life or death experiences on a regular basis without having long-term traumatic reactions.
Humans are the control freaks of the animal kingdom. This control freakishness may be part of the reason we end up with trauma more often than our animal counterparts.
What Symptoms Come with Trauma or Post Traumatic Stress Disorder?
- Shock/denial that the event occurred or denial that it bothers you
- Unwanted emotions, including fear, sadness, anger, irritability and helplessness
- Frightening thoughts, often intrusive
- Guilt/shame about event
- Constant fight or flight responses or sense of impending danger
- Numbness, disconnection or feeling “unreal”
- Trouble trusting others
- Withdrawal or isolation
- Flashbacks (reliving the event in the form of an involuntary memory)
- Physical pain or muscle tension
- Trouble concentrating
Intervening in trauma cases can be a complex process, mostly because individuals respond so differently. What is traumatic to one person may not be traumatic to another. The trauma response itself is the result of individual factors including how vulnerable the person is due to past experiences, and how well they happen to be able to cope.
Traumatized individuals are often encouraged to talk about the traumatic event, first in smaller amounts then in its entirety. This is thought to slowly decrease the amount of nervous system arousal--or fight and flight response--that happens when thinking about the event. This approach is essentially a type of systematic desensitization, or exposure therapy that has the added benefit of assimilating memories. Over time the physical and emotional symptoms decrease to manageable levels, though many suffer recurrences when faced with similar situations in the future.
But, this is not the only model for treatment. Some researchers are embracing alternative theories of trauma in order to provide additional paths to healing.
Innate Physical Response to Trauma: Adaptive Shivering
Dr. Peter Levine approaches trauma in a different way. In Waking the Tiger, Levine argues that humans are uniquely susceptible to traumatic response. Because of the way our triune brain is put together, our huge neocortex has the ability to effectively shut down physical responses that overwhelm us1.
Levine states all bodily systems have a start and an end point. If your liver stops mid-cycle, you'd have issues. If your kidneys changed their response before pushing toxins to the bladder, you'd have issues. Hell, if you try to stop peeing before your bladder is empty, you can end up with intense pain.
The nervous system--where fight or flight originates--may also have a physical completion point that has to occur before the system can return to normal. When faced with a highly stressful situation, we respond immediately and subconsciously to meet that threat with a huge influx of stress hormones which prepare us to fight, flee or freeze. When the threat has passed, we release the excess energy and move on.
So, how do you know when you've hit this magical completion point?
Levine believes that the end of a fight or flight cycle looks a lot like the shiver or trembling responses seen in almost every animal after traumatic events. In humans, we most often see this in children after a crying spell; a cathartic shuddery sigh of relief that signals the end of the episode. But as we get older, we learn to push feelings aside and rationalize sensations cognitively, as opposed to letting them run their course.
"I'm not a control freak! I just don't want to feel that way for one more moment...so I won't."
In the animal kingdom, the response looks something like this:
- Deer standing on plain
- Lion approaches
- Fight or flight response activated, deer bounds away
- Lion gets close, seizes deer, shakes it
- Deer goes into parasympathetic "freeze response", where it is alert, but becomes immobile and does not feel pain
- Lion drags immobile deer off plain, releases it to enjoy later and walks away (to get cubs or play poker or whatever)
- Deer comes out of freeze response, trembles for a few moments to reset the system and bounds away as fast as his little legs can carry him
In our human species it looks more like this:
- Man standing on plain
- Lion approaches
- Fight or flight activated, man runs
- Lion overtakes man, seizes him, shakes him
- Man goes into freeze response, alert but immobile
- Lion drags man off plain, releases him and walks away
- Man unfreezes suddenly, still highly anxious, skips final release of arousal and runs immediately because, "That fucker could come back!"
According to Levine, it is the ability of our highly evolved brain to worry about the future that hinders physical release responses in the present. Levine believes that when the neocortex gets in the way of completing a panic cycle, the fear response can get stuck in the "on" position, because there was no physical signal to trigger the end of the cycle.
Some may be more susceptible to have this sticky switch if they have a history of trauma or depression or other neurological events that hinder release. This may also apply to domesticated animals if those cycles are likewise interrupted. But how this "stuck switch" model plays out is a variable process that may have more or less weight in individual cases.
How Does Someone Get “Stuck" With Trauma Symptoms? A Chemical Model
Unlike a deer on the plain, we may suffer for months, years or indefinitely. And this response may be experienced anywhere within the body, from back pain, to numbness at the site of the trauma, to headaches to flashbacks and other trauma symptoms discussed above. But why would this happen?
Trauma is complicated at the level of the brain. There are major changes to hippocampal functioning which may affect the hypothalamic-pituitary-adrenal (HPA) axis, a system involved in stress responses. Memory formation is altered, often favoring shortcuts to the amygdala which may trigger pain or fear responses without conscious understanding of where those things are coming from. The neurochemical soup that comes out of this is one that can take quite some time to resolve because it is difficult to purge stress hormones when they are being replaced faster than you get rid of them. And all those stress hormones can lead to additional anxiety or depression cycles which are more difficult to recover from.
But there might be another reason.
Dr. Candace Pert, a neuroscientist involved in the discovery of the opiate receptor, agrees with Levine that memories can be stored physically. According to Pert in Molecules of Emotion, this storing of memory may happen on a molecular level through neuropeptide ligands in receptor cells2.
"Uh...say what now?"
A ligand is like a key for receptor cells in the body and the brain. Essentially, it is a set of chemical instructions that tells the cell how to behave. Should the cell divide? Self destruct? Alert other bodily systems by producing new chemicals? Should the cell trigger the brain to store a memory of what is occurring around us right now?
Anything that happens to us triggers the release of a number of these chemical messengers with their sets of cellular instruction. Pert believes that repressed memories--like those common in trauma--may be explained as specific sets of chemical information that was stored in a cell, or series of cells.
Not that they would actually be logical memories, per se. More a specific combination of chemical information which, once released, triggers feelings that the brain has to make sense of. This molecular "holding onto information" may happen for a number of reasons, including that the detoxification pathways that would normally handle those chemicals are altered, or if you believe Levine, because the final step of traumatic release was interrupted prematurely, before it could send messages of release to the cells. Repressed thought in this view is a molecular reaction where information is held in incomplete cycles due to input from ligand molecules.
So why aren't more people aware of this? Maybe because there are only so many easy-to-understand-ways to say, "Hey, your neuropeptides are acting like assholes."
This relationship has led others including researcher and chiropractor Steven Zodkoy, author of Misdiagnosed, to embrace practices such as the Neuro Emotional Technique (NET) for the treatment of trauma. In NET, a combination of visualization, diet and acupressure techniques seek to release trauma trapped in specific areas of the body through improving the way the body releases those chemicals as a whole3. However, while many studies have found benefits to using NET for the treatment of stress and trauma, most agree that more research should be conducted before generalizing it to the population at large.
Release of Information: How The Body Releases and Reduces Stress
Levine sees panic attacks and other unwanted symptoms as valves to release small amounts of this trapped energy over time, purging smaller quantities of chemicals from the cells as opposed to flooding a sensitive system with chemical information that might overwhelm it. Unfortunately, the body learns to produce more stress hormone in response to the symptoms themselves, particularly the reliving experiences such as flashbacks. According to Dr. Daniel Siegel, author of Mindsight, those flashbacks are the brain's way of trying to integrate all that information into explicit memory from fragmented form4. However, because of interrupted sleeping patterns, this is not always possible immediately.
The traumatic event and the panic cycle is like blowing up a balloon until it appears it may pop. If released at once, all that trapped air would surely create a loud noise and scare the hell out of anyone. No one wants to pop that; it’s much too frightening and overwhelming. So instead, you tie it and poke a hole. While much of the air will trickle out (eventually), the stretch of the rubber guarantees that some will remain inside. This pocket of unspent air changes the shape of the balloon enough to alter the way it functions, even at rest.
And trauma does change the way we function and colors how we see the world through the interplay of chemicals, brain changes and hormonal input. Trauma creates unconscious shortcuts in the brain that change how we respond to future situations. Once a shortcut exists, small triggers such as a smell or a sound, can force someone directly into fight or flight before they even recognize what is happening. And those shortcuts may exist whether people remember the event at all.
So what do we do with all this information? Check out the next post: Post-Traumatic Stress Disorder and Treatment Alternatives. Because no matter how the response comes about, there are a number of different ways to treat it.
What do you think about this theory on traumatic response?
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- Pieces of Memory: Trauma, Fragmented Images and Flashbacks
- Post-Traumatic Stress Disorder and Treatment Alternatives
- "Knock, Knock. Who's There? PTSD. Oh Shit." One Woman's Struggle With Depression, Suicide and Post-Traumatic Stress Disorder
- What Is Depression? Examining the Link Between The Physical and The Emotional (Part 1)
- Is Depression A Physical Illness? The Link Between Depressive Symptoms and Brain Changes (Part 2)
- Lies Your Brain Tells You: Why We Have Scary Thoughts
- 8 Anxiety Symptoms You've Probably Experienced (and why they are surprisingly necessary for survival)
- How to Deal With Fears, Phobias and Intrusive Thoughts: Exposure Therapy