The Physical Effects of Trauma On The Brain

Oz - "You see, I never had a family of my own...
so I guess I just wanted to give the citizens of Oz everything."

Elphaba - "So you lied to them."

Oz - "Elphaba!
Where I come from we believe all sorts of things that aren't true.
We call it... history.
A man's called a traitor or a liberator
A rich man's a thief or philanthropist
Is one a crusader?  Or ruthless invader?
It's all in which label is able to persist
There are precious few at ease, with moral ambiguities
So we act as though they don't exist."

- Wicked the Musical

There are cycles that proliferate themselves and these are the hardest to break.  The older I get the more that I begin to understand there is science behind the cyclic patterns of trauma.  By educating myself, I have to believe that I can save myself.

"People abused as children show reduced brain volume in regions governing emotion, learning and memory.  Deficits that make them more vulnerable to relapse and relapses of greater severity."
-Bill Hickaway, June 2014, "Brain Retains Signs of Childhood Trauma," Yale News

Art titled, "Anxiety Attack" source listed below

According to a 2014 study done by the Yale School of Medicine child abuse has scientifically proven long-term effects on cognition and brain function that persist far past adolescence and into adulthood.  There are several factors that impact the severity of this including whether or not the trauma was a single instance or if the abuse was frequent/long-term (chronic).  As a survivor of chronic child abuse who was diagnosed with post-traumatic stress disorder in 2002 I am all too aware of the way one's brain becomes less of a systematic processing center and more of an intangible maelstrom of concepts, timelines, survival and the abstract.  When living with the residual effects of child abuse it's extremely easy to become isolated in what can feel like an intangible mental cycle.  Sometimes, we repeat past mistakes without genuinely even realizing what we are doing until the repercussions are indisputable.

The cold truth is that people who have suffered from abuse and neglect as children have brains that developed differently.  Our developmental process occurred differently than those who were consistently taught to bond with others through skin on skin contact, reassurance and all of the other protective learning experiences our caretakers should give.   These experiences that our parents or caregivers are supposed to provide have more than sentimental value.  They teach us interaction and nurture our capacity for survival.  From the moment an infant cries in order to seek a response and they receive it their brains are developing methods of survival that involve reaching out and having their needs (both physical and mental) met.  Abused children are often times denied these fundamental exchanges early on.  The results are staggering and long-term.

Did you know that people exposed to long-term abuse and bullying as children age faster on a cellular level?  According to a study done by the Department of Psychology and Neuroscience of Duke University where DNA samples were taken from thousands of children being exposed to or victims of violence at a young age these kinds of trauma actually expedite the aging process on a cellular level.  The study's lead author Idan Shalev is quoted as saying, "Those kids are actually older than they're supposed to be."  Shalev continued on to tell LiveScience that these subjects were already aging prematurely and would be at risk for a premature death.  To reach this conclusion the scientists of Duke University looked to a strand of DNA called telomeres.  These strands can act as a molecular clock of sorts when they are monitored for vigor by length.  Through the process of cell division (as we age) the telomeres that protect the genes of our chromosomes grow shorter.  The study consistently showed that children between ages 5 and 10 that had been exposed to abuse had telomeres that had shortened much faster.  This is likely due to the inflammation caused by chronic stress.

Stress is the hard line to the heart of the issue.  We are discovering more and more each day that constant duress has overwhelming effects on development, cognitive ability and physical health.  Though many people associate their childhood and adolescence as a time they might refer to as "the good all days" spent with little obligation and therefore the least amount of stress they may experience in their lifetime;  a victim of childhood abuse is not so fortunate.  The developmental years of a child abuse victim can be fraught with constant panic and the overwhelming demand to adapt in order to survive.  The years that should have involved learning to interact through positive reinforcement, prepare for adulthood and safely discover or test boundaries are spent instead anticipating at any moment the need to fight or fly.  These years of learning are consumed instead by recovering mentally and physically from the infliction of trauma.  

"At a neural level, uncertainty and inaction is counter-instinctual.  We are hard wired to work out and respond to threats to our survival as quickly as possible.  That hard wiring is in the limbic system of our brain.  It's home to the hypothalamic pituitary adrenal access which releases adrenaline in response to a perceived threat.  It prepares you for violent physical action.  Most of us know this as fight or flight."

-Dr. Sean Richardson, "Mental Toughness:  Think Differently About Your World," Tedx Talks, 2011

Fight or flight response is designed as a defense mechanism for the occasional event in which our lives or the lives of our loved ones may be in danger.  Every living creature strives to minimize risks to the survival of themselves.  We are trained to mitigate situations that might hazard the proliferation of our species.  Arguably, if you are constantly exposed to risk you are being ineffectual to that end.  

When your fight or flight response is activated there are some very real physical effects.  Most obviously your heart rate increases as almost thirty hormones are released into your blood stream.  Your muscles smooth over in anticipation for physical exertion and to allow more oxygen into your bloodstream and lungs.  Veins in your skin quite skillfully constrict, sometimes causing your skin to chill, in order to more effectively distribute blood supply.  Your immune system and digestion momentarily slow way down to focus your body's energy towards your muscles that will tense and energize with the new attention your body is giving.  In a nutshell, your body effectually becomes a super computer capable of task managing it's resources by anticipating what you need most at that moment.

This organic, intuitive choreography happens in an instant but this is not a level of homeostasis that can long be maintained.  When activated long-term or with constant repetition the effects on the body are monstrously grueling, as we are learning.  Take a look at this image below of a CT scan done on two different three year old children.  The child on the right suffered from severe sensory deprivation and neglect.  Their brain is significantly smaller than average and has abnormal cortex development.

If neglect can cause such augmentation in brain development so early on then what effects might hyper-stimulation of the flight or fight response portend?  In referencing the studies of Dr. Bruce Perry M.D, Ph. D from 2000 and 2009 we begin to see that constant anxiety inflicted by chronic child abuse has many over-arching effects on brain development.  This is so much the case that chronic stimulation of these parts of the brain can cause a persistent fear state that can "wear out" other parts of the brain such as the hippocampus which is involved in cognition and memory.  This brings me back to my initial point about the long-term impairment abuse can have on an adult victim's memory.

"Chronic activation of the neuronal pathways involved in the fear response can create permanent memories that shape the child's perception of and response to the environment.  While this adaptation may be necessary for survival in a hostile world, it can become a way of life that is difficult to change, even if the environment improves."

-Child Welfare Information Gateway, 2009, "Understanding the Effects of Maltreatment on the Brain Development" 

This means that fear becomes the rule instead of the exception.  When the need to analyze situations for danger becomes habitual early on out of necessity the way a person interacts with the people and the world around them is altered  --- possibly for the remainder of their lives.  This is extremely important to bear in mind when interacting with victims of abuse.  Studies from the Child Trauma Academy elaborate to say that behaviorally many times abuse victims develop the need for what is called hyper-arousal or perhaps more relateably referred to as hyper-vigilance.  This is the process wherein over-exposure to trauma sensitizes the pathways of the victim's brain to the fear response.  Over time it begins to triggers the fear response without conscious thought.  The brain develops so that is constantly alert and consumed by searching for non-verbal cues or environmental threats.  This can impede a child's ability to learn and eventually an adult's ability to learn or focus on tasks at hand.  

One can become dissociated with verbal cues actually stated when due to hyper-vigilance the "listener" is actually making deductions on implications and body language.  As someone diagnosed with hyper-vigilance I can tell you there is a fine line I walk where at times I take in everything around me while other times I'm so exhausted trying to process all the information I've taken in that even the most obvious of signals don't register.  As you can imagine, this can greatly impair someone's ability to take in and respond to fresh information or environmental change.  Though a person is attempting to assess a threat in order to prevent it by consuming too much information and over-processing it they may actually be preventing themselves from doing just that.

So to recap what do we know about the real, physical effects of abuse on brain development, physical health and memory retention?

• Brain volume in memory retention areas are physically decreased, subsequently increasing likelihood for abuse and substance abuse relapse
• Victims of childhood abuse and violence typically age faster on a cellular level making them more likely to experience health issues and premature death
• Experiencing chronic duress early on alters fundamental cognitive and physical development to the point the physical brain can actually grow to be small or abnormal
• Chronic duress can lead to atrophy in the body and brain that persists long after childhood
• Victims of abuse and anxiety can interact with people and their environments by being constantly on guard for threats to the point that they can exhaust their ability to interact with the world in "real time" and the hormones are physically altered

So, we get it.  There are some dire physical effects that are sustained by chronic stress and the impact of severe abuse in the developmental stages of a human life.  However, that is not my only point.   Imagine if you can, a life wherein you have maintained survival by being vigilant and alert in order to respond to physical and mental trauma that is almost constant.  In the later years of your life this stage of development, that significantly constructed the entire first two decades, becomes something that is not easily approachable, significant or relative to others.  Instead of being able to reminisce about the mostly happy early stages of your life with your peers you feel the need instead to redirect conversations like these or remove yourself from them entirely.  Imagine trying to soften or entirely black out memories from the first two decades of your life in order to avoid a cognitive response that will inflict anxiety in an instant.  Deadening your capacity to remember painful events becomes a necessary method in which to adjust and function.  The repercussions of this can be fruitful but they can also be devastating.

To give you some back history if you don't already have it I was the victim of child abuse for fifteen years and, as I said, was diagnosed with post-traumatic stress disorder at the age of sixteen.  I was hospitalized in the ER twice during High School because my anxiety was so severe that it had caused gastrointestinal problems that resulted in my stomach being coated and treated with medication the first visit.  The second time was so severe I required an IV for a couple of hours and was given medication intravenously as well as more than one prescription for nausea and acid reflux.   

Most recently, in the past year I was diagnosed again with an anxiety disorder after suffering a major depressive episode and put on anxiety medication I have to take twice daily.  I will be seeing an endocrinologist in January for continual hormonal issues that I am currently on a prescription for after several blood tests and examinations. I have had a plant-based diet for many years in order to counter the gastrointestinal issues I experienced early on.  I was originally told I would be on stomach medication for the remainder of my life and may even have to have my stomach removed if the problems persisted.  To summarize I have battled with the physical and mental effects of chronic mental, physical and sexual abuse for my entire life.

When there is an affliction to our cognitive abilities it's easy to write this kind of pestilence off as abstract and hypothetical in nature.  When someone loses an appendage it's easy for us to see, become horrified and empathize with that physical loss.  When someone suffers mentally those wounds and ailments are much more difficult to not only relate to but acknowledge as real.  With the exponential advancement of not only technology but science we are beginning to understand that our emotions and mental states have far reaching effects on our physical well-being that go beyond elusive, silly metaphysical connotations.  

Likewise, as a survivor of trauma and abuse I have never been comfortable being looked at as someone with a mental illness or disability of any kind.  Not only does such a moniker come with public criticism but an internal evaluation of self as well.  Society as a whole seems readily willing to gloss over or overlook completely those that aren't easily defined by their mental impediments but still struggle to live with them.  There are the sane and not sane.  We see a man on the corner talking to himself collecting garbage and we're quick to write them off as an insane lost cause.  Is there no modicum of sanity or anything else in between on some sliding scale of sorts?   If not how can we vary level of treatments?  How can we learn to treat ourselves?

The good news is not only can we seek help but we can make efforts to treat ourselves.  In almost every study I've referenced here the thought was that the effects of abuse (with great effort) were reversible.  Just as the brain can acclimate to or learn to anticipate stress it can un-adapt.  It is very easy to feel at war with external factors that trigger a neurological response.  It's easy to tell ourselves that the response is not chemical or physical but that we inherently lack some kind of emotional component all together that would allow us to improve.  I argue that with great, great effort and long-term consistency we can improve and change.  Part of that process is acknowledging the physical augmentation that must be undone.  The ether of anxiety, doubt and pain can be parted when a structure of solid physical habits is built from within.  The pain I find myself cycling through is symptomatic of behaviors ingrained so deeply that they have actually become physical in nature.  I have developed differently and instead of pretending I haven't I am going to have to work with this fact.  I can not ignore a dimension of myself and simultaneously improve upon it.

It's a very sobering moment to realize that your own mind may be working against you and enabling your abusers to harm you.  If you have been designed since childhood to endure pain instead of fly because there was a time you could not fly or fight the door has been left open for pain to be inflicted to a degree that should never be permitted.  The association with love and pain becomes intermingled in a way that is unhealthy.  When you are able to soften the blows of your abusers you unconsciously begin doing half their work for them.  You enable the cycle unwittingly and conclusions or solutions that may be obvious to others come very slowly if they ever come at all.  Once someone inclined to abuse finds someone physically inclined to being abused the effects can be cyclic and tumultuous.  It's easier for abuse victims with these physical cognitive impairments to quite literally forget, excuse or dull the memories of being harmed in order to proliferate and nurture the good times even if they are far more infrequent or even just as frequent as the abusive episodes.  Things that a developmentally healthy person might have a hard time ever forgetting are easy for a person with a history of abuse to romanticize, excuse away or validate.

By revising history, and being in a constant state in which you are struggling to survive you can miss brightly colored red flags all together.  There is quite a lot of danger in subjecting yourself to a new trauma when you haven't even healed from old wounds.  The effects can be devastating even deadly on a truly depressed person who is so lost by their own mind literally urging them to react.  So desperate to do something a depressed person's reactions can be viciously harmful to others and even themselves.

After almost twenty nine years of struggling with these issues it is apparent to me that earnest, physical action is needed in order to combat depression, anxiety and the long-term damage that chronic abuse, anxiety and depression can cause.  I thought because I was able to work a full-time office job despite my constantly pounding heart that I had overcome my past.  My past and the abuse that riddled the majority of it "was old news" that I didn't want to burden anyone else with.  Yet, I keep making mistakes, each one leaving me more battered than the last despite my struggles to do exactly the opposite!  Why?  The conclusion that I've come to is that I am physically hardwired to suffer.  This has been my existence for almost three decades now and I've become so accustom to it that I literally can not tell when I should fight or fly.  I literally can not tell what pain is necessary, what is avoidable, and what is absolutely unacceptable.  In truth, it's hard for me to tell at all until I am literally so incapacitated that I at times can not function or when I can move it is only to reach out to self-medicate and self-harm.  I shouldn't need trauma to alert me to run, that defeats the purpose of having fight or flight to avoid the trauma entirely.

So what can I or anyone like me do?  Here is my opinion and my conclusion.

There are always going to be external factors that may endanger us or compromise our emotional and mental stability to varying degrees.  The only control we have over these factors is how well we avoid them or how well we adapt to them when they can not be avoided.    That means the work begins on an internal level.  We have to rewire our minds instead of rewriting history into a version that's more easily able to handle.  We have to face the ugly crevices of reality no matter how big or small and truly adapt to them instead of creating an adaptation of what's real and a false sense of security.

I have begun to realize that my fight is not with the people that harmed me, not with life's injustice or impermanence but with my control over myself.  I have to learn what should have been instinctual and reaffirmed within the first minutes of my life.  I have to learn that it's okay to look out for myself and not suffer.  There are many ways to begin rewiring myself on a physical level.

• Exercise
• Meditation
• Compassionate affirmation
• Regular sleep
• Avoiding substances that aggravate depression and anxiety like caffeine or alcohol
• Socializing with friends and loved ones in a safe neutral environment
• Using grounding techniques to rewire the brain from racing thoughts to the present
• Medication and treatment from a doctor as necessary
• Being conscious of red flags and willing to acknowledge them

These aren't assumptions these are methods that are grounded in medical science.

Living with the effects of chronic abuse and anxiety can be excruciating.  I have days that I literally would rather be unconscious than feel my heart thudding uncontrollably and my mind racing to the point I am panicking and don't know how to stop it.  I get angry at myself for making cyclic mistakes and I get beyond frustrated that I was not able to see those mistakes coming.  There are days I tear myself apart or cry on the bathroom floor and feel isolated from everything around me.  There are days I'm terrified that the wounds are too deep, that the abuse went on too long and I am doomed to a life of anxiety and loneliness.  There are days I feel hatred must be my footholds and others I'm exhausted by own frustration.  There are days I feel isolated because my physical appearance does not match the mutilated self-image that I have internally.  There have been many days like that in part because I was unaware the self-proliferating cycle was consuming my energy in order to spin on like a water wheel.

It is my feeling and opinion that by becoming aware of the physical causation of anxiety, depression and cyclic abuse that we can take responsibility for and then break the patterns causing us pain.  We can rewire our minds so that each day is not an internal battle for happiness.  Those battles should be the exception, not the rule.  I believe that we can achieve tranquility through active acknowledgement of the mental and emotional wounds and then through treatment of them.  I truly believe that I can overcome the habitual pain by devoting to the idea of recovery and by treating my mental wounds with the same care and understanding I would approach anything physical.

I am no stranger to revised history.  When I was extracted from my home with deep-tissue wounds at the age of fifteen my mother tried to tell people they were self-inflicted.  Years later she has apologized profusely at times and pretended utterly as though nothing occurred at all even though she has since divorced my step-father after the abuse climaxed and I was removed.  The ironic thing is it isn't what happened that keeps us apart now it's her inability to completely accept what happened.  It has made it so that a relationship between mother and daughter is untenable perhaps forever.  Even now, you would think a person like myself would be so wary to life's snares and cruelty but at times I find myself forgiving all to easily the pain inflicted upon me to the point I let myself be very deeply wounded by the people I let close.  I don't pretend I have all of the answers but I do hope that on my seemingly constant quest for recovery, truth and real happiness that I can share my findings and help someone other than myself.

There is a saying that, "History is written by the victors."  This quote is attributed to great politicians like Winston Churchill, Napoleon Bonaparte and Niccolò Machiavelli.  I implore you to not the let the victor continue to be the trauma.  I implore you to not rewrite your history however ugly you may find it but to face it with bravery, compassion and ownership.  The future is yours to compose.  You can not feel loved truly or avoid the feeling of isolation if you do not embrace the truth and allow others to embrace your truth scars and all whether they be self-inflicted or brutally received.  We must refuse to settle or turn a blind eye to the pain inside of us because in allowing ourselves to hurt when we interact we share that hurt.  When we allow ourselves to keep hurting we proliferate and spin the wheel.  Instead, with work, we can bring to the table a desire to heal, receive love and ultimately experience internal happiness.  This isn't just my wish and the unrelenting goal I have for myself it's my desire for anyone struggling with this.  It's even my desire for the people that have hurt me, some of whom I still love.  No one will ever be able to rebuild you if you are not willing to renovate yourself instead of living in a dilapidated shell, condemned and falling apart.

I leave you with this final thought.

"There is no single, eternal and immutable "truth" about past events and their meaning.  The unending quest of historians for understanding the past - that is revisionism - that is what makes history vital and meaningful."

-Historian James McPhereson, Pulitzer Prize Winner

Revising history is considered part of the scholarly process.  History is often times revised not to corrupt the truth but to tell it.  With research stereotypes are undone.  With the work of scientists and historians the lies of politicians are unearthed and a more apt perspective is restored.  That's right, considering our past can not only be cathartic but we can learn about truth instead of letting outside sources foster misinformation.  The effects of physical abuse, depression and anxiety are real but with effort and a thirst for knowledge and truth we can revise who we are.  We can become more genuine, more healthy and maybe even make history instead of being ruled by it.

Copyright 2014, Ginger Rogers

References:

Child Welfare Information Gateway, 2009, "Understanding the Effects of Maltreatment on Brain Development," Series, Issue Briefs

Bill Hathaway, June 2014, "Brain Retains Signs of Childhood Trauma - and a Warning for Substance Abusers," Yale News

Alice Park, April 2012, "How Bullying and Abuse May Age Children Prematurely," Time Magazine

Stephanie Pappas, April 2012, "Bullying, Child Abuse Hastens Aging in Kids," Live Science

Dr. Sean Richardson, November 2011, "Mental Toughness:  Think Differently About Your World," TedX Talks Victoria

Julia Layton, September 2005, "How Fear Works," How Stuff Works, Life Science

Anxiety Attack Artwork

Additional Reading Material:

Historical Revisionism on Wikipedia

15 Small Steps You Can Take to Reduce Your Anxiety, Psych Central