Monday, October 12, 2009

Why Can't People Just Get Over It?!

Ever known somebody that seems to be stuck on a particularly painful event or situation in the past? Notice how most of the focus returns to that precipitating event and they circle the drain absorbed in anxiety and pain? Now, the discussion about what keeps people stuck can take up hundreds of blogs. But to start, I would like to share with you some things that are critical to our understanding about the development and treatment of trauma as well as our compassion and treatment of those that have been traumatized, the walking wounded.

I had the wonderful opportunity last week to hear a leading researcher in the impact and treatment of trauma (this includes, but is not limited to, physical, sexual, and emotional abuse as a child or adult, combat, significant stress like a death or huge financial loss, etc), Bessel van der Kolk. Dr. van der Kolk spent 28 years at Harvard and now has his own institute in the Boston area. I will try to highlight some of the really important stuff.......

When we are born, our brain has a lot of development still left to do, a lot of the old brain (what we share with the animals) is in there and ready to fire and our frontal lobe, well, its under construction. Our frontal lobe is new brain, its the part of our brain that is huge in defining our personalities. Its what makes me "Sarah." One of the system that is relatively intact when we are born is our fight or flight system, this is what gets kicked into high gear when we perceive a threat (it is important for compassion and education purposes to know that most of the perceiving of such things is done unconsciously, or in other words, by old brain, NOT by the frontal lobes). We develop a second system as little people that allows us to self regulate, basically to calm down. This system is developed through interaction with the environment and primarily through interaction with the primary caregivers. If the environment is chaotic, abusive or neglectful that system is underdeveloped, so that creates an internally anxious, hypervigilant, stressed out person. Most, about 80%, of this systems nerves are efferent, meaning they go from the body to the brain! This is why telling people to think differently and "move on" is useless, and often cruel. The conscious, thinking part of their brain didn't cause this and therefore can't fix it. Someone in this position isn't remembering what happened, they are reliving it. It is important to note that negligence can be very distructive, for it is often viewed as less detrimental. For example, there are many children of alcoholics that had a "happy" drunk or a "calm drunk" for a parent, as opposed to a violent one. It appears as though their systems are also significantly impacted, most likely because an impaired parent is often not present emotionally, intellectually, and on many subtle levels, interacts with their children very differently. Adult children raised in these environments often see the world as negative, they often feel very anxious, they find that they are often controlling and judgmental, in other words, the world and its inhabitants are continued to be interpreted (by their survival focused brain) as lacking. When this system is working, the frontal lobes stay online during stress. The person is able to stay in the present, to know that they are safe and to address their environment appropriately. If you can do this, be grateful.

So, what happens if this system is faulty? Well, if one cannot internally physiologically and emotionally self-regulate they seek out external means of doing so. Substance abuse and addictions of various sorts, food, smoking, compulsive relationships, perfectionism (big in US culture), all work to physiologically alter one's internal experience. Down the healthier avenue, one may seek out exercise, body movement meditations such as yoga and tai chi, mediation and prayer, etc.

One is more likely to be retraumatized as an adult if this system did not fully develop. The foundation is not there and so the stress response takes over. For example, those who survived 9/11 but came from troubled childhoods were more likely to develop PTSD (Post Traumatic Stress Disorder-a severe, pervasive, anxiety condition) than those who weren't. They simply have different brains.

We can treat this! There are techniques and evidenced-based approaches that are making an impact. For example, EMDR (Eye Movement Desensitization and Reprocessing), somatic experiencing, other therapies that focus on the physiology are showing wonderful results. Stay tuned. I am passionate about the treatment of trauma and will have more to say!

5 comments:

Stephen Matheson said...

Very interesting. I'm curious, technically, about the use of the term 'efferent.' In neuroscience, 'efferent' refers to information leaving the brain and going to the body. Motor pathways, for example, are efferent pathways. Sensory pathways, bringing information into the CNS, are afferent. So you probably mean 'afferent,' unless the point is that the pathways in question act on the brain and change it. But anyway, very interesting post.

Anonymous said...

Hi Sarah!

First of all, thank you for the wonderful blog. It actually makes me understand my condition better from a scientific perspective. I am an undergrad biochemistry student as well as a childhood cancer survivor. When I am stressed or presented with a certain stimulus that triggers my memory, I flashback to my child state, which I find scary and fascinating at the same time. Interestingly, the duration of the flashback can vary pending on the effectiveness of the stimulus that I see or hear. But, the emotions, primarily fear, are always overwhelming. Either way, it is interesting to read about the current research on traumas, and I am looking forward to hear more!

Sarah Matheson said...

Steve,

Thank you for the clarification! You are absolutely right. They have the same definitions in neuropsychology!

Sarah Matheson said...

Anonymous,

I do believe that knowledge is power.It sounds like you have had some profound experiences. Evolution has provides us with amazing brains! We are wired very efficiently to survive. It is just that when our brain misinterprets something in our current experience as a threat, it kicks the body's resources into high gear! When there isn't anything to fight, or run from, all of that power has no where to go.....it usually results in strong fear and even sometimes panic. VERY overwhelming. There are some interesting resources on psychological trauma out there with some decent scientific research. I am glad you found my blog helpful.

Sarah Matheson said...

Just wanted to leave a post with my correct "identity".