The Three E’s of Trauma (Part II)
As you may recall, the first article in this series described Noam, a young boy who witnessed the events of 9-11 firsthand. Remarkably, Noam had few long-lasting impacts from the experience. This was puzzling to many, including professionals working with Noam and other 9-11 survivors. It seemed notable that Noam, his dad, friends, and countless other New Yorkers were able to run from the danger to the safety of their homes. It also seemed that far fewer than expected developed long-lasting trauma related symptoms. What professionals theorized – and what has now been verified through the use of fMRI and PET technology – is that trauma is considerably less likely (though still possible) when flight or fight responses are successful and when the “freeze” response is avoided.
While this has always seemed logical, we are beginning to understand why this occurs. Since September 11, 2001 trauma research has advanced at a breathtaking pace. MRI scans now allow researchers to see which areas of the brain react to trauma, and just as importantly, which areas don’t. With these MRI images, we can hypothesize why the third “E” of trauma, “a lasting adverse Effect on an individual’s functioning,” occurs. First, we can see that during trauma, much of the left side of the brain often goes offline while the right side increases in activity. This is important because the right side stores memories of sound, smell, and other sensations along with the emotions they evoke, and also reacts to things intuitively. The left side of the brain is in charge of communication, sequencing events, and most importantly, analyzing and predicting. When this side shuts down, we lose our ability to identify cause and effect, explain the meaning of our experiences, or formulate appropriate responses. Without the left side, we don’t grasp time, sequence, or responses that are not automatic. We are limited to the right side that only knows how to react to the sounds, smells, sensations, and emotions setting us up to only guess at how to evoke beneficial change.
A second adverse trauma reaction that can be observed in MRI scans is the absence of activity in several specific areas of the brain. Broca’s area, which is responsible for turning experience into speech, shows little or no activity. Since humans give meaning to experience through the use of language, a nonfunctioning Broca’s area leaves us with no way to interpret or explain our experience. It’s not that we can’t form the words, it’s that we don’t have the words. Even if later we become able to create our “cover story” to explain the event, we remain unable to understand what the event meant or why it impacted us as it did. An area in the pre-frontal cortex responsible for judging and assessing threat or danger also becomes inactive, and areas responsible for understanding the concepts of past, present, and future, along with the passage of time, go silent. When these areas do not do their job, we lose the ability to determine how much danger we are actually in and also cannot determine if the real threat is now or if we are reacting to past events that we have been triggered to re-experience.
Additionally, and possibly most concerning of all, the thalamus becomes inactive. The thalamus is responsible for collecting sensations sent from our eyes, ears, nose, mouth and skin (our five senses) and blending these sensations into something that tells us “this is what is happening to me.” Other parts of the brain then take this interpretation, give it meaning, notice the emotion attached to it, and process it into what we call a memory. Without the thalamus, we have little ability to form a cohesive memory. When the thalamus shuts down, as MRI images show often occurs during trauma, the experience remains a mish-mash of difficult sensations-sights, smells, images, emotions- that are relived over and over and over, never becoming an interpretable or even understandable memory, and never fading into the past as memories are designed to do.
In contrast, other areas of the brain become over active, most notably, the amygdala. The amygdala is responsible for sounding the alarm when any threat of danger is detected. Remember, the pre-frontal cortex is in charge of assessing this risk, and it is often offline during trauma. This means there is no “watch tower” to calm the amygdala’s alarm bell. Instead, it fires and re-fires, dumping dose after dose of stress hormones into the system, stimulating stronger and stronger fight or flight responses. When these responses become impossible and freeze occurs, the entire system is at risk for breaking down. This paints a rather bleak picture of rraumatic response, perhaps making it difficult to understand the enthusiasm that this growing understanding brings. The encouraging news is that understanding what occurs within the various regions of the brain also creates a deeper understanding of how to treat the symptoms and even more importantly, heal the experiences. With the growing body of research has come a growing set of resources for healing.
Van der Kolk, B. The body keeps the score. (2014). Penguin Random House, NY, NY.
ABOUT THE AUTHOR
LIcensed Independent Mental Health Practitioner
Provisional Licensed Alcohol and Drug Counselor
- Keri Brugger, LIMHP, PLADC began working at Wholeness Healing Center in October 2016. She sees clients in the Grand Island office and also takes referrals from the Boone/Nance/Greely county areas. Keri sees individuals of all ages as well as couples and families. She has experience planning and facilitating a wide variety of process and psycho-educational groups.
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