Trauma, Memory and the Brain

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Trauma changes our brains on a fundamental level, the psychologically traumatised brain causes inscrutable eccentricities which can (and do) cause it to overreact – or misreact – to stimulus and the realities of life. These neurological “misreactions” become established in part due to the effect that trauma has on the release of certain stress-responsive hormones, such as norepinephrine, along with the effect upon various areas of the brain involved in memory – particularly the amygdale and the hippocampus.

The amygdale is the part of the brain responsible for communicating the emotional importance and evaluation, via the thalamus, of sensory information to the hippocampus. In accordance with the amygdales evaluation the hippocampus will activate to a greater or lesser degree, and functions to organise this information and integrate it with previous similar sensory events. Under a normal range of situations and conditions this system works well and effectively to consolidate memories according to their emotional priority and content. However, at the extreme upper end of this hormonal activation, as with traumatic situations, a breakdown occurs. Overwhelming emotional significance registered by the amygdale actually leads to a decrease in hippocampal activation, this results in some of the traumatic input not being organised properly, not being stored as a unified whole, and not being integrated with other memories. This results in isolated sensory images and bodily sensations that are not localised in time or even in situation, nor integrated with other events. In effect these fragments of memory float about in the mind, ready to reappear at any moment.

To make matters even more complex, trauma may temporarily such down Brocas area, the region of the brain which translates experience into language, the means that we more often use to relate our experience and feelings to others and even to ourselves.

Regular memories are formed and are subject to meaningful modification, they can be retrieved when needed and can be conveyed to others through language and expression. In contrast, traumatic memories include chaotic fragments, which are sealed off from modification or modulation. Such memory fragments are wordless, placeless, and eternal. Long after the trauma has receded into the past the brains record of them may remain a fractured mass of isolated and confused emotion, images and sensations which can ring through the person like an alarm at any moment.

These sensations and feelings may not be labelled as part as belonging to memories from long ago, in fact they may not be labelled at all, as they may have been formed without language. They merely are, they come forward to take over the body giving no explanation, no narrative, no place or time, they are free-form and ineffable.

The traumatised brain has, effectively, a broken warning device in its limbic system. A bit like an old fuse box where the fuses tend to melt for no reason, reacting to an emergency when there is none.

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What is PTSD ?

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PTSD has a unique position as the only psychiatric diagnosis (along with acute stress disorder ) that depends on a factor outside the individual, namely, a traumatic stressor. A patient cannot be given a diagnosis of PTSD unless he or she has been exposed to an event that is considered traumatic. These events include such obvious traumas as rape, military combat, torture, genocide, natural disasters, and transportation or workplace disasters. In addition, it is now recognized that repeated traumas or such traumas of long duration as child abuse , domestic violence, stalking, cult membership, and hostage situations may also produce the symptoms of PTSD in survivors.

A person suffering from PTSD experiences flashbacks, nightmares, or daydreams in which the traumatic event is experienced again. The person may also experience abnormally intense startle responses (hypervigilance) , insomnia , and may have difficulty concentrating. Trauma survivors with PTSD have been effectively treated with group therapy or individual psychological therapy, and other therapies have helped individuals, as well. Some affected individuals have found support groups or peer counseling groups helpful. Treatment may require several years, and in some cases, PTSD may affect a person for the rest of his or her life.

Causes

When PTSD was first suggested as a diagnostic category for DSM-III in 1980, it was controversial precisely because of the central role of outside stressors as causes of the disorder. Psychiatry has generally emphasised the internal weaknesses or deficiencies of individuals as the source of mental disorders; prior to the 1970s, war veterans, rape victims, and other trauma survivors were often blamed for their symptoms and regarded as cowards, moral weaklings, or masochists. The high rate of psychiatric casualties among Vietnam veterans, however, led to studies conducted by the Veterans Administration. These studies helped to establish PTSD as a legitimate diagnostic entity with a complex set of causes.

BIOCHEMICAL/PHYSIOLOGICAL CAUSES. Present neurobiological research indicates that traumatic events cause lasting changes in the human nervous system, including abnormal secretions of stress hormones. In addition, in PTSD patients, researchers have found changes in the amygdala and the hippocampus—the parts of the brain that form links between fear and memory. Experiments with ketamine, a drug that inactivates one of the neurotransmitter chemicals in the central nervous system, suggest that trauma works in a similar way to damage associative pathways in the brain. Positron emission tomography (PET) scans of PTSD patients suggest that trauma affects the parts of the brain that govern speech and language.

SOCIOCULTURAL CAUSES. Studies of specific populations of PTSD patients (combat veterans, survivors of rape or genocide, former political hostages or prisoners, etc.) have shed light on the social and cultural causes of PTSD. In general, societies that are highly authoritarian, glorify violence, or sexualize violence have high rates of PTSD even among civilians.

OCCUPATIONAL FACTORS. Persons whose work exposes them to traumatic events or who treat trauma survivors may develop secondary PTSD (also known as compassion fatigue or burnout). These occupations include specialists in emergency medicine, police officers, firefighters, search-and-rescue personnel, psychotherapists, disaster investigators, etc. The degree of risk for PTSD is related to three factors: the amount and intensity of exposure to the suffering of trauma victims; the worker’s degree of empathy and sensitivity; and unresolved issues from the worker’s personal history.

PERSONAL VARIABLES. Although the most important causal factor in PTSD is the traumatic event itself, individuals differ in the intensity of their cognitive and emotional responses to trauma; some persons appear to be more vulnerable than others. In some cases, this greater vulnerability is related to temperament or natural disposition, with shy or introverted people being at greater risk. In other cases, the person’s vulnerability results from chronic illness, a physical disability, or previous traumatization—particularly abuse in childhood. As of 2001, researchers have not found any correlation between race and biological vulnerability to PTSD.

Symptoms

  • Traumatic stressor: The patient has been exposed to a catastrophic event involving actual or threatened death or injury, or a threat to the physical integrity of the self or others. During exposure to the trauma, the person’s emotional response was marked by intense fear, feelings of helplessness, or horror. In general, stressors caused intentionally by human beings (genocide, rape, torture, abuse, etc.) are experienced as more traumatic than accidents, natural disasters, or “acts of God.”
  • Intrusive symptoms: The patient experiences flashbacks, traumatic daydreams, or nightmares, in which he or she relives the trauma as if it were recurring in the present. Intrusive symptoms result from an abnormal process of memory formation. Traumatic memories have two distinctive characteristics: 1) they can be triggered by stimuli that remind the patient of the traumatic event; 2) they have a “frozen” or wordless quality, consisting of images and sensations rather than verbal descriptions.
  • Avoidant symptoms: The patient attempts to reduce the possibility of exposure to anything that might trigger memories of the trauma, and to minimize his or her reactions to such memories. This cluster of symptoms includes feeling disconnected from other people, psychic numbing, and avoidance of places, persons, or things associated with the trauma. Patients with PTSD are at increased risk of substance abuse as a form of self-medication to numb painful memories.
  • Hyperarousal: Hyperarousal is a condition in which the patient’s nervous system is always on “red alert” for the return of danger. This symptom cluster includes hypervigilance, insomnia, difficulty concentrating, general irritability, and an extreme startle response. Some clinicians think that this abnormally intense startle response may be the most characteristic symptom of PTSD.
  • Duration of symptoms: The symptoms must persist for at least one month.
  • Significance: The patient suffers from significant social, interpersonal, or work-related problems as a result of the PTSD symptoms. A common social symptom of PTSD is a feeling of disconnection from other people (including loved ones), from the larger society, and from spiritual or other significant sources of meaning.

Hypervigilance

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One of the diagnostic criteria for PTSD is hypervigilance. Hypervigilance is watchfulness or checking one’s surroundings that is over and above what is normal or reasonable. Hypervigilance takes many forms. It is what makes some of us always choose an aisle seat or one where our back is to a wall. It’s what makes some of us carry defensive weapons such as guns, knives, mace or pepper spray, a police whistle or a mobile phone set to 999. It makes some of us cross the street to avoid suspicious people. Some of us have alarm systems, multiple locks, window locks, high fences, guard dogs, etc. Another form of hypervigilance is studying people very carefully in an attempt to look deeply into their soul to determine exactly what they are made of. Hypervigilance is included in the cluster of symptoms referred to as “increased arousal”. This cluster also includes difficulty sleeping, irritability or outbursts of anger, difficulty concentrating, and exaggerated startle response.

This increased arousal stems directly from our trauma and the form it takes is shaped directly by the nature of our trauma. If we have difficulty sleeping, it may be because we were afraid to go to sleep or stay asleep for fear of an attack of some sort while we were not conscious to repel it or avoid it. If we are irritable, it may be to warn people to keep their distance or to not behave in ways that might trigger us. If we can’t concentrate it may be because we are too busy trying to monitor all inputs from possible dangers. If we startle easily it may be because we learned to jump quickly to get out of harm’s way. And if we are hypervigilant it is probably because we saw our environment as having multiple and unpredictable dangers that we should be on constant alert for. In fact, much of the time our hypervigilance helps to keep us safe.

However, the “hyper” in hypervigilance suggests that we do more than is normal or reasonable. It is too much because it is an inconvenience or an encumbrance. While it is probably true that we with PTSD are indeed safer because of all the precautions that we take, it is probably also true that our hypervigilance does often get in the way. It may be that we deprive ourselves of going certain places and of partaking in certain events. For example, we don’t go to an event because we can’t get an aisle seat, or because we don’t know what kind of people are going to be there. Sometimes we see people looking at us and we think that they are judging us or are hostile toward us. Sometimes we are afraid to eat certain foods because we are afraid of being poisoned or made ill. And, there are probably numerous other examples of ways in which hypervigilance inconveniences us.

Dealing with PTSD symptoms

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1: Understanding the symptom.

The first thing to do is understand what happens to you and why. Ask professionals and do your own research from reliable sources about the symptom.

Understand something about what happens to your body when the symptom is triggered. For example, if you experience panic attacks, why do they happen? – what is the physical process which makes you feel so awful? – how can the physical reactions be controlled?

When you have information about why the symptom happens, then you have something to work with

2: Understand yourself.

When you have information about why a symptom happens, compare this to how you feel and how the symptom is triggered in your life. How does it start? – how does your body react? – what are you thinking? You may be surprised at the similarities.

3: Think of a plan.

When you know why something happens and the real effect it has on you, you are in a position to develop a coping plan.

Emphasis is on ONE THING AT A TIME! Don’t try to rush it!

A common reaction to many symptoms is to try and ‘get away’ from them. Perfectly natural. But you can not do that if you want to control them and reduce their impact on your life.

For example, if a symptom occurs and the trigger is being in a public place, you need to develop an awareness of what the REAL situation is rather than what you THINK it is. So, imagine the scenario in an objective way. Is there a REA L threat to you? Are people REALLY interested in you? Are people REALLY bothered if you are there or not? You HAVE as much right as anyone else to be there!

Another example may be flashbacks. Perhaps your reaction is to get away from them – forget them. But you know what they are so you can do something about them. They are pictures in your mind – they are NOT the REAL situation you are in. So instead of trying to shy away from them, what would happen if you looked at them from an objective viewpoint? Really looked at them? Rationalised why they are happening? Perhaps understanding that a picture is only a picture and can not harm you.

Whatever plan you develop for a symptom is flexible. You can change it to suit you at any time. The important thing is to have a plan in the first place.

On thing of note is that you may not be able to make the symptom go away forever. It may still be present in some form for a very long time. You will need to accept this, but your attitude to it is the key. If the symptom happens, try not to get stressed – just let it pass then carry on.

4: Using the plan.

It is important that you realise that things take time and persistence. There is no ‘magic. With a plan you are informed and ready.

The first few times you use your plan you may find it extremely difficult, and it may be disturbing. STOP! DO NOT force yourself.

Try it again, and again – small steps. Also, you may have ups and downs. One time your plan may work and a few tries later it becomes very disturbing or difficult. That is OK. Just keep trying it.

If your plan doesn’t work at all, reassess the information you have and think of another plan – KEEP IT SIMPLE!

Conclusion

Not everything works for everybody all the time. The important thing is to think about the things that you need to do and how to overcome symptoms that stop you doing them.

We could go in-depth, but the important thing is you understand the general principle.

Stigma of PTSD
Groundng and triggers
Grounding for flashbacks

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