Trauma and the Brain

Link to the Huffington Post:
Link to the Huffington Post: “How Brain Science Can Help Explain Discrepancies in a Sexual Assault Survivor’s Story”

At a recent conference about trauma and the brain’s response to it, Bonnie Martin – a licensed professional counselor who specializes in brain-based therapy, based in the Washington, D.C. area – made this statement regarding survivors of trauma, specifically survivors of abuse who suffer from mental illnesses:

There is nothing wrong with this person. There is something wrong with what happened to this person.

A large percentage of children and adults who have been victims of abuse and/or assault develop a mental illness [or more than one, e.g. depression, anxiety, personality disorders, paranoia, eating disorders, PTSD, etc.] Everyone copes with trauma differently and no one should be shamed for how they have chosen to cope and survive. However, one common theme in victims’ behavior is confusion or an inability to properly remember the events surrounding their assault(s). During the trauma, a victim will enter either “fight, flight, or freeze”. The brain’s activity changes as a way to protect itself. Later, remembering specific details or following a linear chronology as they tell their story can be very hard for many victims.

Because complex trauma and the brain is a fairly new study, the majority of people a victim will come into contact with do not have a proper education on how the brain is affected – in the moment and in the aftermath – by trauma.

A relatively new area of the literature on human response to trauma, particularly the trauma experienced during sexual violence, is that of “tonic immobility.” Defined as self-paralysis, or as the inability to move even when not forcibly restrained, tonic immobility has long been studied in non-human animals as the “freeze” response to extreme stress. Recently, it has been observed in the laboratory as a stress response in humans, as well. This finding explains the reaction of many victims of sexual violence, who report that they felt like they could not escape, even when no weapon was present.

Additionally, due to an entire cascade of hormonal changes, which includes oxytocin and opiates, associated with pain management, adrenaline, commonly associated with “fight or flight,” and cortisol, functional connectivity between different areas of the brain is affected. In particular, this situation affects pathways important for memory formation, which means that an individual can fail to correctly encode and store memories experienced during trauma. While an individual generally will remember the traumatic event itself (unless alcohol or drugs are present in the system), these memories will feel fragmented, and may take time to piece together in a way that makes narrative sense (Kathryn Gigler, source linked above).

It is not uncommon for family, friends, law enforcement, etc. to disbelieve a victim because their story has discrepancies or changes over time. It may appear to them that the victim is lying or merely seeking attention and cannot keep their story straight. In reality, to be simplistic, the brain is working to retrieve data that was potentially temporarily “lost” or suppressed during the trauma and, in the process of remembering and healing, that information will not be clear or linear. Inconsistencies are not lies but evidence that a traumatic experience has occurred.

Behavioral patterns in individuals who have experienced sexual violence mirror those seen in other traumatized populations, like combat veterans. This pattern of symptoms, known as post-traumatic stress disorder, or PTSD, can include emotional numbness, intrusive memories of the traumatic event, and hyperarousal (increased awareness of one’s surroundings, or constantly being “on guard”).

Research shows that the majority of individuals who experience sexual assault demonstrate at least some of these symptoms of PTSD immediately after the assault and through the two weeks following the assault. Nine months after the assault, 30 percent of individuals still reported this pattern of symptoms. Overall, it is estimated show that nearly one-third of all victims of sexual assault will develop PTSD at some point in their lives (Kathryn Gigler, source linked above).

There is nothing wrong with a victim of sexual or domestic abuse, of rape or sexual exploitation. What was done to them is what is truly wrong. Their reactions and behaviors – however confused or disjointed they may seem – are the body’s natural response to trauma.

Along with a misunderstanding of how memory recall after trauma works, many people will ask a victim, “Why didn’t you fight? Why didn’t you scream?” Or a victim will say to me, “I tried to fight but I couldn’t. I wish I could have done something. I feel like just lying there will look like I wanted it to happen but I really couldn’t move.”

Again, the answer to those questions is a better understand of how the brain works during trauma. Have you heard of “playing possum”? It is similar to that. Most people know “fight or flight” but not everyone understands the third potential response which is “freeze”. In order to protect the body, the brain essentially leaves the body immobile. This is called tonic immobility. “Tonic immobility (TI) describes a state of involuntary paralysis in which individuals cannot move or, in many cases, even speak” (Sexual Assault May Trigger Involuntary Paralysis, Francine Russo).

Dr. Jim Hopper explains tonic immobility in greater detail in his Washington Post article, Why Many Rape Victims Don’t Fight or Yell:

Freezing occurs when the amygdala – a crucial structure in the brain’s fear circuitry – detects an attack and signals the brain stem to inhibit movement. It happens in a flash, automatically and beyond conscious control.

It’s a brain response that rapidly shifts the organism into a state of vigilance for incoming attacks and avenues of escape. Eyes widen, pupils dilate. Hearing becomes more acute. The body is primed for fight or flight. But as we shall see, neither fight nor flight necessarily follows.

Simultaneously with the freeze response, the fear circuitry unleashes a surge of “stress chemicals” into the prefrontal cortex, the brain region that allows us to think rationally – to recall the bedroom door is open, or that people are in the dorm room next door, for example, and to make use of that information. But the surge of chemicals rapidly impairs the prefrontal cortex.

What may seem like a failure on the part of the victim is actually what their brain did in its attempt to keep them alive. “Women, men and children who are sexually assaulted and think they should have resisted but did not may also be prone to feeling guilt and shame”, which may also increase their risk of experiencing PTSD (Francine Russo). Consider: 70% or more of victims experience tonic immobility during their assault only to then be blamed for not “fighting back”. What we as a society can do is become better educated – and spread that knowledge to others – so that victims find support. Education is key to ending victim blaming.

Finally, flashbacks are a way that the brain attempts to make sense of the trauma which occurred.

A flashback is the result of this ‘brain mush’ that happens at the moment of trauma. A flashback comprises all the fragments of memory of that event that were not integrated by the thalamus in the first place, or were not encoded or stored properly by the under-performing hippocampus. The brain shuts down to protect us: during trauma we experience a sense of ‘depersonalisation’ and ‘derealisation’ which is the outward manifestation of all these brain areas being shut down—the ‘timekeeper’, ‘dictionary’, ‘cook’ and ‘librarian’. The good news is that during trauma our attention and focus is narrowed and we feel outside ourselves—this helps to reduce the psychological distress we are exposed to at the time. But afterwards, it is difficult for our brain to fully process what happened to us given that so much of it was offline while it was happening. The brain can struggle to move through to the recovery and integration phase when memory systems were not properly functioning at the time (Managing Flashbacks by Carolyn Spring).

I tell fellow survivors regularly, “Whatever you did to survive was the right thing to do because you’re still here.” A police officer said that to me after one of my assaults. I experienced a mild form of tonic immobility. I wondered afterward why in the world I did not scream or fight back. It was broad daylight! I felt guilty for my apparent apathy. Discovering that it was actually my brain’s attempts to keep me safe alleviated so much of that guilt. The human brain is a remarkable organ. It does things instantaneously and we are still only just starting to understand the extent to which it protects us.

For information related to trauma and children’s brain development, read The Amazing Brain.

For a more in-depth look at trauma and the brain, I highly recommend Understanding the Neurobiology of Trauma and Implications for Interviewing Victims. I have heard one of the contributing authors – Christopher Wilson – speak on the topics addressed in this post and it was extremely informative.

For a visual on how the different parts of the brain work, check out Dr. Siegel’s hand model of the brain video. It’s simple enough for kids (and adults like me who are a decade removed from biology class) to understand and the basic principles he explains (i.e. “flipping your lid”) can be helpful when trying to understand what happens to the brain during an assault.

For more information on PTSD and victimized behaviors:

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Trauma and the Brain (video)

Why Victims Don’t Report and Why Shaming Them is Detrimental 

The Role of Environment and Response in PTSD Recovery

Understanding the Behavior Common to Survivors of Sexual Abuse 

Coping Strategies: Flashbacks, Painful Memories and Panic Attacks

Understanding and Identifying Dissociation in Children and Adults

Understanding Post-Trauma Guilt and Shame

Effects of Abuse, various

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