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OCTOBER 29, 2015 The Jewish Home APRIL 3, 2020 | The|Jewish Home
Dr. Deb
What is Trauma? By Deb Hirschhorn, Ph.D.
M
ental health trauma shows up as the inability of the brain to place memories of experiences where they belong. Usually, memories get stored in the hippocampus. However, in trauma, this is disrupted. The “smoke alarm,” as Bessel van der Kolk calls the amygdala, sends screeching signals to the rest of the brain that there is a serious problem here as a real trauma is unfolding. This is part of our survival mechanism. This puts our fight or flight activity into high gear. Calories and blood are diverted to muscles so we can run and take physical action. Well, that diversionary process stops the memory from being fully recorded. What we have left is more like a few key slides rather than the full video. The hippocampus may never get the complete memory back. Normally, the hippocampus records lots of detail and emotion along with a time stamp. We get our sense of the chronology of our lives from the hippocampus. The timestamp enables us to feel that an older memory is older. It may fade or change a bit over time. We don’t quite recall every one of the people that was present for a given experience years later, for example. All that changes in trauma. The amygdala first tells the thalamus what’s happening, and the thalamus immediately activates the hypothalamus, which starts up the stress response. One of the components of the stress response is the production of cortisol which goes, like a magnet, to the hippocampus. Over years of being bathed in cortisol, the hippocam-
pus actually shrinks. (Don’t worry; with proper healing, it can get back to its size.) Nevertheless, the hippocampus wants to do its job. It just is impaired at the moment. So instead of a detailed, panoramic picture or video of what’s happening, it focuses on just the key fragments that it wants you to remember. They’re out of context but often sharp and clear. And often, blurred, instead. And no timestamp.
What are the Symptoms of Trauma and Anxiety? Here are some PTSD symptoms: • Flashbacks • Hypervigilance • Poor sleep • Excessive sleep (in conjunction with other symptoms) • Easily triggered • Nightmares • Intrusive thoughts you don’t want to think about • Disturbing visions or memories in fragments • Dissociation • Feeling emotionally numb Let’s define items from the above list which may need a little clarification: Flashbacks: Remember, the memory was not completely captured by the hippocampus. There are missing pieces to the story. Instead of a videotape, we have a few snapshots. The emotional context and the timestamp are often missing as well as so many parts of the story. Our brain, however, wants to get everything neat and organized, so it keeps presenting to us the fragments that it does have in an attempt to have us fill in what was
missing. Our experience of this is anything but a process of creating order. Instead, it feels terrifying to keep seeing, unexpectedly, these fragmented pictures. The worst part of this is that these flashes do not feel like “memory.” That is because they were not encoded with the timestamp in the first place. So they keep feeling like they’re happening now – and that, alone, is even more disturbing, frightening, or anger-producing. Hypervigilance: The amygdala has not been reassured that things are fine. On the contrary, there are very few neural pathways between the cortex, which is the thinking part of our brains, and the amygdala. In addition, when the traumatic event(s) occurred, the amygdala actually stops the cortex from communicating with the thalamus. The reason is that in emergencies, we can’t afford to waste time thinking, so it shuts off any communication there might have been. For this reason, the amygdala, always watchful, creates more of that eyes-wideopen experience for us, often making us jump at random sounds and flinch at harmless words. The amygdala’s speed will not be suppressed by rational information. Triggered. This is the word therapists often use to describe the experience of the amygdala’s smoke alarm going off when the person or thing that set it off really has very little resemblance to the original event or person. The slightest similarity can trigger that reaction. This bit about “very little resemblance” has a name. It’s called “generalization.” That’s what happens to people diagnosed with “Generalized
Anxiety Disorder.” Generalization means that every single thing, practically, becomes a source of fear, irritation, or anger. It will take very little to set off a person who suffers from it. Intrusive thoughts are another way the amygdala fires. Repeatedly. And then some more. The biggest problem with this is that we try to avoid them, of course. But avoidance is not possible, and the more we avoid, the more they rush in with a vengeance. Dissociation. This is not only what happened at the moment of the trauma but can happen repeatedly to a person over years. There are several ways that a person can dissociate: (1) A feeling of disconnection from reality which is called derealization; (2) a feeling of disconnection from oneself which is called depersonalization; (3) a disconnection from emotions so a person is feeling flat with no highs, no lows, and not much else, either; (4) not remembering experiences or not being aware even in the moment of what is happening. This last one happens to all of us from time to time. When it gets in the way of normal life, then we look at the possibility of trauma underlying it. Numbing. When, instead of going into fight or flight mode, the person goes into freeze mode, they must feel trapped with no other option. Freeze mode is governed by a different system from the fight or flight one; it’s a lower order, more rudimentary system but works protectively for someone who really does feel trapped. Numbing is a repeated return to that state. It is a more severe form of dissociation discussed above.
