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How to Develop Emotional Superglue
Fear, Trauma, and Piecing Together the Human Psyche
Sometimes a breakdown can be the beginning of a kind of breakthrough, a way of living in advance through a trauma that prepares you for a future of radical transformation.
—Cherríe Moraga
The issue of trauma is central to our identities. Who we are is shaped by the experiences we have. When those experiences are traumatic, they inevitably influence the ways in which we speak, think, and act. What constitutes a traumatic experience differs from person to person. There is little doubt about the traumatic nature of events such as being a victim of a violent crime, abuse, or sexual assault; participating in military combat; and being in a physically traumatic accident. Other life experiences may be quite upsetting, but are less clearly defined as trauma: your first romantic breakup, leaving your parents’ home as a young adult, going through a divorce, losing your job. Our experiences of events such as these differ depending on our coping mechanisms and the intensity of the situation. But regardless of the trauma, our outward reaction only hints at what’s going on inside the brain.
I have counseled rape victims who are utterly devastated and unable to cope, and others who are shocked, but seemingly not traumatized. There is no one way or right way to react to trauma. While the person who appears to be mildly affected may seem better off initially, who is to say that a breakdown might not have been a more effective way of expressing and dealing with the incident in the long run?
Any person who has experienced any disappointment, sadness, or loss knows how unforgettable such experiences can be. Eventually, we may choose to move on—but do we, really? Can we ever really move on from an event that has become indelibly incorporated into our brains? One that has etched itself into our memory like initials in wet cement? The unforgettability of such traumas is twofold: They may register in your memory and always feel close at hand, coloring the way in which you see the world, or they may seep into your deeper memory (your unconscious memory), but reappear at the slightest provocation.
Take the example of Jeanine, a fifty-year-old divorced woman of considerable charm and beauty. Jeanine had never been able to find a man with whom she could settle down despite having numerous relationships. She had divorced her husband because he was too boring for her, and she had looked upon her single life as an opportunity to “do this over, but do it right this time.” Yet, regardless of how much any man loved her, and despite her devotion and dedication, no one ever committed to her. Gradually, she began to feel that she would never be able to attract someone who would want to be with her. Each disappointment was anchored in her memory, and these accumulated memories formed an unconscious paradigm in her mind: “Why am I not worth it?”
Jeanine had been sexually abused repeatedly when she was fifteen by an uncle who had helped to raise her. She was reluctant to use the term abuse, however, because she enjoyed his attention and the initial thrills of his touch in the secrecy of his bedroom. When her aunt began to suspect what was going on, her uncle spoke negatively about Jeanine in front of his wife and talked directly with Jeanine less frequently. At the tender age of eighteen, she ran away with a romantic acquaintance to Rio, where she was stopped at the border. When her uncle found out that she had been caught, she had to return home. These early experiences had colored the filter through which she viewed men and life.
Although she was not one to overtly hold any resentment, and she had very admirably overcome these adversities with a good sense of humor, a life full of friends, and a stable job, Jeanine held deep within her memory her initial experiences with men: “Do not get too close, because you will be used,” and “If you try to get what you want, you will be stopped.” These messages had become a part of her memory, and memories are the filters through which we live life. Jeanine’s biggest challenge was that she had never confronted her fears. Deep down, she was afraid that she was a bad person and a sexually promiscuous woman, and she did not want to see this any more clearly.
Every time Jeanine met a man, these memories would seep into her behavior, and eventually these men would pick up on it. They would become confused, and they often left on good terms because there was nothing they could actually complain about. Both she and they were unaware of how these past traumas had set up fears in Jeanine’s brain that inevitably caused the men to also become afraid and then to want out of the relationship.
The traumas we experience in life may have consequences we are entirely conscious of, but we should never assume that we have fully grasped the unconscious impact of these events until we have examined them. The impact is sometimes obvious, but most times subtle, and grappling with these traumas requires grappling with the fears that have become stimulated on account of them.
Every bad situation sets up the brain to anticipate any similar bad situation. While this is protective, it is also obstructive when the fear system becomes too automatic and nonspecific. It is not helpful if, for several years after a car accident, a woman develops panic attacks whenever she is in a car. Or when, after being mugged at night, a man is too afraid to walk after dark again. Caution is helpful. Too much caution is destructive and can severely limit your life.
Any trauma, then, causes a disruption of a person’s life, not just in terms of what we see, but also at the level of the brain. In this chapter, we will take a closer look at what happens in the brains of traumatized individuals, how this relates to fear, and what we can do about this once we understand the potential impact of trauma in our lives. We will explore how people like Jeanine can come to know the inner workings of their minds and what they can do about them.
When researchers look at the brains of children who have been maltreated, it appears that the major structural problem lies in the corpus callosum—the fiber tract that connects the right and left halves of the brain. This is the brain bridge. It appears that this connecting group of brain fibers is smaller in children who are mistreated or abused. The potential impact is substantial. The consequences of a broken bridge in a child include disconnection between thinking and feeling, loss of the sense of self, excessive worry, feeling as though something is missing (called the gap), and chronic fatigue syndrome.
Our brains rely on effective communication between both hemispheres. Thinking (a left hemisphere phenomenon) and feeling (a right hemisphere phenomenon) need to act in concert for us to make sensible decisions. If the connection between the brain’s hemispheres is damaged, information from each hemisphere cannot cross the midline, and thinking and feeling are not integrated. The result is that people are disconnected from their feelings and they experience a sense of numbness. They feel as though they’re fine when they are not. They only realize that they aren’t okay when their lives begin to fall apart. Then they wonder, “Why is this happening?”
Even though they are not in touch with their feelings, the emotion or feeling circuits in the brains of people who have been traumatized are still active, they just don’t consciously experience these emotions. One of these feeling circuits is fear. When thinking and feeling are disconnected, fear cannot be reached or understood. Traumatized people cannot make sense of their fear. A child whose brain bridge has been damaged suffers from feelings of fear, but doesn’t know why. These children seem restless for no apparent reason and often need to self-soothe because they feel so much internal unrest.
In his book Descartes’ Error, neurologist Antonio Damasio explains how a sense of self is critically dependent on the integration of thinking and feeling, and that without this integration, our ability to make decisions is compromised. Emotions carry important information that can influence decisions. Without this information, we lack the fuel necessary to move others or ourselves.
Here is one example from my clinical experience. Sally was a Harvard sophomore whose parents had divorced when she was five. Her mother had left her father when he had one too many affairs. Sally blamed her father for her unhappy childhood. Her anger was so extreme that she couldn’t deal with it consciously, so she ignored her feelings of rage.
When she began therapy at the age of nineteen, she ignored the fact that she never developed successful relationships despite the reality that she was strikingly beautiful, incredibly smart, and loving. Superficially, she liked herself for being “more like a guy” in that she was incredibly rational, always “not that emotional,” and all of the other stereotypical characteristics that one associates with men. She had many guy friends to help her neutralize the immense fear that she had of her rage toward men.
She was completely cut off from her feelings of anger, although she was able to identify it superficially. She did not realize that this immense anger actually frightened her, and that the fear was what kept her disconnected from her emotional life. As a result, she was never open to dating, because when she started to develop feelings for someone, her fears about relationships with men became activated. So she put out a friendly vibe instead of a romantic one, and therefore struggled to attract romance to her life.
Her parents’ divorce left her to cope with an incredible amount of anger, and she “chose” to ignore this by disconnecting her thinking and feeling. But did she really choose this? Or was her brain bridge damaged as a result of childhood trauma? In all likelihood, Sally probably did suffer damage to this part of her brain. Even as an intelligent Harvard student, she mocked the notion of connecting with her feelings, and she avoided taking any courses that required creativity.
The brain bridge has also been shown to play a role in worry. What is worry? Worry, as most people would describe it, is being unable to stop thinking about negative things. It is the brain’s way of coming up with stories to continually occupy our minds. What most worriers do not realize is that these stories are not the actual issue; the underlying cause of these stories is the problem. When a child has been traumatized, the brain bridge is disrupted, and the child starts to develop worry stories to distract him- or herself from focusing on the traumatic experience. Worry is like a stuck record; it is akin to circuits that carry the flow of electricity because the electricity has nowhere else to go. Usually, thinking and feeling come together to make sense of the world, and this decreases worry. When the brain bridge is disrupted, however, the thinking circuits continually fire and are unable to quiet down.
Excessive worry is a sign that emotional information from the right hemisphere is trying to make it over to the left hemisphere, but can’t. So the left, thinking hemisphere starts to look for stories to account for this absence. In fact, studies have shown that in order for us to think about threat, threatening information has to go from the right to the left hemisphere. In people who worry excessively, this crossing over via the brain bridge occurs much more slowly. Thus, children who are maltreated may also worry much more and may appear to be overly concerned about things that are beyond their control.
Ricky was a thirty-year-old man who was filled with emotion and an exquisite ability to think in the deepest ways, but he was unable to integrate his thoughts and feelings, which felt like two completely separate mental experiences to him. He had been sexually abused as a child, an event that he had pushed to the recesses of his unconscious thought. He wasn’t constantly plagued by memories of it, and he did not feel that the experience affected his choices or relationships in any way.
Yet any time Ricky sought out romantic relationships, he found himself with sociopathic women or prostitutes—women who also were disconnected from their emotions—because it made him feel better about his own disconnection. In the rare instance when he was in a relationship with someone who was emotionally healthy or relatively self-assured, the woman posed an immense threat because she reminded him of the connection between both hemispheres that he had spent his life trying to avoid. Of course, this wasn’t an intentional choice: He secretly grappled with the idea that he did not actually “feel” for people, and this compounded his fears of ever getting close to anyone.
When he was with lovers who were extremely emotional, he would have mixed feelings. Although he would sometimes enjoy it, he also found it difficult to cope with. He remembered having been sexually abused as a child by a man he knew, but he could not recall any specific details. Emotions exert a strong influence over memory. Strong emotions create strong memories—up to a point. If the emotion was immense fear or shame, the brain is less likely to want to recall this tornado to disrupt its otherwise peaceful existence.
Ricky had problems remembering the abuse because, in part, his emotions had crossed over very slowly from the right to the left side of his brain as a child, and his thinking and feeling had become increasingly disconnected. He had no idea of how to connect thinking and feeling. He felt as though his brain was going to explode.
Although Ricky knew about this disconnection within himself—he could identify it—knowing this was not enough for him. His self-esteem spoke for itself. He ran from each opportunity for a romantic relationship. For him, emotional, intellectual, and sexual intimacy needed to come from different individuals, because getting them from one person was too threatening.
The brain bridge damage that Ricky likely suffered as a result of childhood trauma left his thoughts and feelings disconnected, and this set him up for his adult relationships. Because he was unable to connect his thoughts and feelings, he felt he had no right to be angry when the women he dated had affairs or mistreated him.
With therapy, he gradually began to stop or limit some of this self-destructive behavior, but the challenge that connecting with his emotions presented was significant.
As we’ve learned, damage to the brain bridge can affect how feelings and memories are integrated and connected. When memories are formed, much of their emotional content is lost in storage. For nontraumatized people, remembering childhood may bring on a whole flood of emotions associated with certain events. But when a person has experienced significant trauma, the emotions attached to it are either held back or stored even more deeply than thoughts. As a result, when a person experiences trauma early in life, he or she may not be able to recall aspects of childhood or emotions associated with certain events; that is, there is a deficit in the memories. Some things are remembered while others are not, to an even greater extent than in the general population. Traumatized people may in fact be storing their brain bridge disruptions as their memories.
Beyond discrete major life events, another form of childhood trauma is more generalized but nevertheless as impactful: emotional neglect. This may lead to a sense of desperation or sadness that is too much for the thinking brain to process. As a result, this sadness becomes stored in the brain as a partial memory. Since memories are an indicator of the past, and since the past contributes to how we define ourselves, disrupted memories lead to a disrupted sense of self.
For most nontraumatized people, the past is only partly remembered, but the brain creates a sense of continuity by filling in the gaps between experiences so there is an internal sense of coherence. This ability of the brain to fill in the dots has been shown in a literal way by drawing two horizontal lines very, very close together. At some point, even when there is a gap, the brain sees them as a single line. This is also what the brain does with our past experiences. It makes them single and continuous so that we feel an inner sense of continuity.
When someone has been traumatized, the gaps between experiences are too large and the brain is unable to create a coherent story about the past. Trauma victims suffer from the immense fear that they are not whole, that pieces of themselves or their lives are missing. They often experience panic attacks or immense anxiety as a result of this. How can they exist in the present when they have no continuous past? Did they fake their way to where they are? These are the kinds of tortured questions that their brains ask in the present because they cannot make sense of the past.
At birth, the brain is pretty much a blank slate, and our experiences contribute colors, pictures, and textures to this slate, creating a lifetime filled with memories. Having a past that you remember creates a sense of internal continuity. It provides a marker of where you have been and where you are going. Since traumatized individuals cannot remember parts of the past, they lose these markers. As a result, when they have reason to recall something that is in the gap, they suddenly feel disoriented, as if the environment is unfamiliar. The feeling is similar to what some people feel when they go to a party that they are anxious about attending, or when they get lost. Imagine being lost in the middle of a forest and losing sight of the path you took to get where you are. Imagine how frantically that might make you search for a way out. These fears are akin to experiencing a gap between memories. This gap itself is anxiety provoking and can lead to a frantic but fruitless search to fill it with memories of what actually happened. As a result, the fears associated with this gap can multiply with the increasing realization that the gap is not going to be filled. What, then, ends up happening?
People either make up stories to fill these gaps or walk around feeling “broken” in some way. Their pasts have riddled their identities with holes, and they feel as though they have been shot multiple times, but never died. To a certain extent, they have to make up stories. I remember first meeting Alison, a woman who said she was sexually abused when she was five years old. She told the story of how her family (which seemed quite “normal” by conventional standards) held ritual abuse ceremonies in the backyard of their home, in a quiet suburb of Washington, DC. She related how her family members chanted magical incantations, progressively taking away her self-esteem. She talked about how she was convinced that on one or two occasions, aliens were invited to attack her sexually, and that she could not bear to remember the details, except that there were scars to prove it.
The more bizarre her stories became, the more frustrated I grew, because I did not believe her, and I could not connect with her because of it. When I challenged her story, she withdrew and became distant, so I pulled back and just listened. I sought consultation from a colleague who had worked extensively with patients like Alison. He advised that as absurd as her stories might sound, I needed to listen to them. So I did. For the next three years, I heard them every week. And one day, in the middle of her third year of therapy, she burst into tears and began to sob uncontrollably midway through a story. When she was able to speak again, she told me that she had suddenly realized how important it was to her that I had listened to her stories, and she also told me that they had all been lies. She was afraid that she now had no license to feel as she did.
I explained to her that they were not lies, but rather interpretations of a real feeling that she’d experienced. They reflected something that had truly gone on in her life at that time. The real story that eventually came out was not that she’d been abused, but that her parents had favored her brother so much that she felt as though she did not exist. Their favoritism was so great that she had wished that she was a boy and wanted to disown her own gender. As a result, her stories of being assaulted by aliens were amended to be about being infiltrated by self-doubt and negativity about her gender, making her hate herself for not being the child she felt her parents wanted.
Suddenly, she had filled in this gap caused by disruption of the brain bridge, and when a critical amount of emotional information was able to cross over to the thinking side, her story made more sense, to me and to her. Since then, she has become incredibly functional and is in a very satisfying romantic relationship.
Even in people without a history of trauma, experiencing a gap can be a significant psychological limitation that can lead to frantically sampling all of their past experience without finding the answer to the question of being human. They might sample different sexual experiences or different drugs, for example, without examining how this sampling behavior prevents a sense of depth. Being human, in my experience, involves coming to terms with these gaps. In traumatized individuals, however, the emotions within these gaps are intensified, and this accentuates the feeling of being broken in some way. Experiencing any one thing in depth is too scary, because it feels like a deep hole.
People who experience childhood trauma are six times more likely to develop chronic fatigue syndrome as adults. In fact, many people, including Mary, Ricky, and Alison—find themselves sleeping for up to twelve hours a day without understanding why they are so tired. It is understandable how fatiguing worry can be when the brain bridge is disrupted, and how this ongoing search for an inner sense of continuity can be exhausting.
Many of the phenomena that I mention here—from a feeling of internal fragmentation to preoccupation with worry—are not just experienced by people who suffered childhood trauma. But in children who have been abused, their effects are exaggerated.
We often are told that we should be present in our lives, but how can we be present when there are constant internal distractions? Why do our brains create these distractions? To be present is to look into a pool of calm water and see your reflection unperturbed. To be distracted is to throw multiple rocks into that pool and see yourself in bits and pieces.
When severe trauma occurs, any reminder of the trauma, no matter how distant, is a potent distracter that is equivalent to throwing multiple rocks into that still pool of water. Traumatic reminders create earthquakes in the brain. They destroy any attention directed toward the present, sometimes from outside of an individual’s awareness.
Have you ever wondered why you make the same mistakes over and over again? Why you keep choosing the same kind of romantic partner and experiencing the same kind of trauma? When we discussed the effects of conditioning, we examined one possibility: Your brain is trained to look for the same thing once the circuitry for your preferences has been established. However, here we will examine another possibility.
Transference happens when our past experiences unconsciously intrude upon a present moment. That is, we “transfer” what happened in the past to the present without realizing it. When we get angry with someone, we may in fact be angry with him or her, but the magnitude of our anger may be related to a similar past experience. For example, Joe, a client I was seeing, became enraged with his wife because he had invested a lot of time and energy in her business, but she was not able to make it viable. She had spent much of her energy trying to make it work, but could not succeed. He became so angry that on one occasion, he grabbed her by the shoulders and shook her. She was petrified, in part because this anger seemed to come completely out of nowhere. Over time, however, Joe came to understand that his anger was in part related to his wife, but mostly to his mother, who, like his wife, had not been home most of the time due to being involved with her own career. Rather than discuss his ambivalence with his mother, he became angry with his wife and transferred this anger onto her. It was only when he began to separate his wife (who was quite doting and caring even though she was so busy with her work) from his mother that he was able to help the relationship develop. It took a long time for him to “detach,” or view the situation differently, however, because he was unable to be flexible in his thinking to shift his perspective from the past, because his anger toward his mother was so significant.
Another example is Angela, who repeatedly sought out neglectful relationships after breaking up with her boyfriend of six years. When she described her latest boyfriend to me, he did not seem neglectful at all. In fact, he seemed to really care about her, but she could not see this. “He’s just never around enough,” she would complain. When we explored her feelings more deeply, we recognized that once they had settled down together, she had started to bombard him with accusations about how she knew he was going to be neglectful, to the point that he started to avoid her to avoid this conversation. She had placed a filter of the past over her current situation and created her past all over again. Once she realized this, she backed off from this perspective, and her boyfriend reengaged in the relationship.
What you think of as “the same old problem” in your relationships may not actually exist. The same old problem may be your lens. Our lenses are filters formed by the past and through which we view all current and future experience. These filters are memories stored in the brain that are stimulated and join attention circuits when something related to them is happening in the present. Trauma can affect this lens, so all you see is past trauma projected onto the present.
To a certain extent, we all do this. But in traumatized people, the filter of the past is more fixed, and the flexibility needed to let go of it is compromised. Research has shown that having this flexibility in thinking can help reduce stress. When it is absent, stress levels are sky-high. It is almost as if the brain is frozen in the past and can’t let go despite experiencing soaring stress levels.
Psychological tests in trauma survivors of political violence have shown that the absence of this flexibility prevents recovery. If you are glued to your memories or caught in them like a deer in the headlights, shifting your attention elsewhere feels impossible.
This inability to shift attention elsewhere is also seen in cancer survivors with post-traumatic stress disorder (PTSD), whose inability to shift attention or change behavior learned in the past distinguishes them from cancer survivors without PTSD. That is, if the trauma of having cancer fixes you in the fears associated with it, even if you survive, the fears do not go away. For these fears to dissipate, you have to shift your attention away from them. While this sounds like an easy enough exercise, it is not if you have been traumatized, because trauma fundamentally changes how your brain behaves.
One of the basic brain changes that occurs is that the orbitofrontal cortex shrinks. This brain region is widely known to be involved in flexibility in thinking and behavior. If it is rendered less functional by trauma, flexibility feels impossible to the person. Add to this the other, more deeply embedded structures in the brain—like the basal ganglia—that are also involved in flexibility of thinking, and you can see the added burden that trauma inflicts upon survivors.
In addition to impairing flexibility in thinking, trauma also affects the brain’s ability to attend to things. The difference is that when someone has been traumatized, both superficial and deeper attentional systems in the brain are affected.
Brain circuits at the surface as well as deep within the brain are coordinated to allow us to focus our attention on something. For example, if you want to attend to your work and get things done, these different circuits help you to attend to whatever you need to. Or, if you need to learn new information, both of these systems steady your attention. Or, if you’re reading this book, both of these systems act in concert to allow you to attend to reading.
The superficial system is related to the short-term memory system in the brain, which is housed in the dorsolateral prefrontal cortex, or DLPFC. This system processes content that has just been learned or observed. If you are given a new telephone number to remember, or if you are given instructions to convey to someone, the DLPFC is responsible for holding on to this information. If, in the midst of this, you suddenly look out the window and see a car accident and you have never been in a car accident, your DLPFC will be disrupted and you will likely forget the telephone number or be distracted by the crash. But what if you had been in a car accident before? Would this make a difference in how your brain responded?
The answer is yes. It turns out that having prior personal exposure to a trauma also causes disruption in the deeper brain areas that coordinate attention. That is, the ventral emotion-processing regions, such as the amygdala and ventrolateral prefrontal cortex, are also disrupted. So what? Well, this means that areas of the brain that are more difficult to reach immediately are also affected, and so the effects of trauma on attention are more deeply rooted. This is one of the reasons that the distraction is so strong when traumatized individuals are exposed to reminders of their trauma. When trauma victims encounter reminders, the distraction travels far and wide in the brain’s attentional system.
Victims of trauma already have a fragmented sense of self, as we learned earlier. When they remember more of their trauma, they disrupt these pathways of attention that carry emotional information. Thus, they feel even more fragmented. This creates too much anxiety for them to handle. This is the reason that in therapy, a therapist generally proceeds very cautiously with people who have been traumatized. Even when patients want to “face what happened,” they cannot tolerate the intensity of the feelings that have been held back and repressed for all those years, and they often flee from the situation. The consequences of this distraction can be far-reaching, and they can be seen in the story of Liz.
Liz was sexually abused as a child by her aunt. She was able to cope well with most distractions, since they did not distract her at the level of the amygdala. When she fell in love with a woman as an adult, however, her amygdala became activated by the dilemma. To escape the disconnection between thinking and feeling, and to escape the distractions of her trauma that were triggered by her love affair with a woman, Liz would often hide in what she believed to be the “real” nature of the universe. This was a place where chaos was alive and where things flowed without boundaries. As long as life reflected her internal chaos, she felt there was some company for her inner self. She created chaos to mirror her internal distraction rather than trying to decrease the internal distraction.
Although she was in love with a woman and this relationship brought her much in the way of integration, dedication, love, and comfort, Liz could not face this. So she chose to also sleep with men to create more chaos in her life. If Liz developed a peaceful love with this woman, she would have to confront her anger with the aunt who had abused her. This was too difficult for her.
Activating her amygdala with memories of being with a woman was too anxiety provoking for her. In fact, Liz considered herself to be the more dominant partner sexually in the relationship, but when the time came to dominate her lover, she would experience strong feelings of disgust that went far beyond a healthy level of fear or apprehension. Because she could not accept the idea that someone could love her completely, she needed to run away from time to time.
So Liz continued to have sex with men and only limited sexual experiences with the woman she loved. In fact, in their limited sexual experiences, she rarely was an active participant. She unwittingly repeated her childhood behavior of being a passive participant in a relationship, in part because this passivity meant that she was not a lesbian but was being made to be, and in part because she unconsciously blamed herself for the abuse because she had experienced pleasure when her aunt had stimulated her sexually. As a result, Liz would disappear for long periods at a time, and she engaged in unprotected sex with her male partners. Her recklessness was an attempt to re-create the carefree childhood that she never got to have. Shame enhances risky behaviors in adults, and in traumatized individuals, it is constantly evoked by this inner sense of fragmentation and the inability to attend to any one thing for a sustained amount of time.
Most of us fill our lives with distractions that hold our attention so we can deal with the intrusive memories of negative life events. This can obviously be helpful because it calms the brain, but it can also be harmful when trauma is able to exert its power unconsciously. In traumatized individuals, there is a constant need to master this distraction. Because it is occurring in the ventral attentional system, the distraction is deep and difficult to access.
The problems with thinking that accompany PTSD are extensive and fairly defining. Having a constant reminder of background trauma affects thinking in specific ways. These include being slow to prepare for a thought or action, taking time to switch attention, taking time to react, and reacting when there is no reason to react. Life for these individuals is a series of inaccurate or late reactions that feed into how they experience their lives.
Liz was acutely aware of how this affected her judgment, but could not do anything about it. She allowed people who used her to continue to use her, and she felt threatened by people who loved her. In some way, she perpetuated the familiar and rejected the unfamiliar. The unfamiliar was associated with a new fear, whereas the familiar was an old fear. The problem was that these old fears were slowly but surely eroding her being.
Usually, when we are about to react to something for no reason, the brain will pull the brake. For PTSD sufferers, there is no brake. The reaction, once begun, will be performed at full throttle, in part because reminders of the trauma put the brain in overdrive and it will start to process stimuli whether they are relevant or not. This leads to a lot of chaos in the brain’s functioning.
The insula maps out gut feelings, making them conscious and, therefore, overtly understandable. It is also involved in the registration of disgust. Studies have shown that, compared to women who have not been traumatized, women who are victims of intimate partner violence have increased insula activation when exposed to negative stimuli, indicating a heightened level of disgust and, possibly, a greater translation of gut feelings into conscious thoughts. This heightened level of emotionality and constant translation of gut feelings can also be distracting.
When people are traumatized, they may become dissociated from their feelings or emotions. A person may appear to be spacey, or will simply deny that anything is wrong even though daily functioning is disrupted. Dissociation allows a traumatized person to be distanced from feelings that are too difficult for the brain to process all at once. Although this can be a useful defense mechanism, there comes a time when being dissociated does not serve a person well, because he or she may pursue the same type of dysfunctional relationship over and over again without realizing what happened previously. When researchers examined the brains of traumatized people who were dissociated versus those who were not, they found that dissociated people experienced different brain responses to conscious and unconscious fear. Dissociation is thought to involve prefrontal circuits in the brain that are turned on to prevent connecting with inner fears. As such, it protects against any fears that are presented consciously.
It turns out that dissociation can turn off conscious fears that activate the prefrontal cortex, but it cannot turn off unconscious fears that activate the amygdala, insula, and left thalamus. These parts of the brain continue to fire when dissociation occurs. Even though we can dissociate from our conscious fears, we cannot dissociate from our unconscious fears. The importance of this is underscored in the example below.
Mary was a forty-year-old woman who had been sexually abused by her first husband. She was raped several times before she eventually sought help when the level of violence escalated and resulted in her jaw being broken. The relationship finally ended in a divorce.
Mary eventually began dating again and met a man, Aaron, whom she thought was very attractive, loving, and caring. He was hot-tempered, however, and she said that when they fought, he would grit his teeth, glare at her, shake his fist at her, and occasionally shake her by the shoulders. She accepted this behavior.
The relationship became serious and the two of them decided to move in together. Mary still didn’t speak to him about his anger and never really connected with her own fears. She practiced yoga regularly, and used breathing exercises to calm herself down whenever she became afraid of his anger.
After three months of dating, Mary and Aaron got into a huge argument. Aaron went through his usual routine of screaming, gritting his teeth, shaking his fist at her, and grabbing her by the shoulders. But this time, when she did not respond, he punched her in the face, fracturing several of her facial bones. At no time prior to or during the attack did Mary expect the upcoming violence.
When she entered therapy, she spent the first two years performing a very logical deconstruction of her relationships, not once showing any emotional impact. She teared up when she talked about the end of those relationships, and she became sad when she talked about the violence, but she never once showed any loss of control. One day in the middle of the third year, however, she came in infuriated by her boss’s abusive behavior. He had been raising his voice in front of other people, banging on his desk in his office, and flinging papers at her. I asked her if this reminded her of other men in her life, and then the penny dropped.
Mary recognized that for all these years, she had been dissociating from her fears because they were too much to handle. Rather than face them, she chose to “get a handle on them”—but this handle only reached her conscious feelings. She never really acknowledged her deepest awareness and fears.
What followed was months of intense emotionality—at times verging on a need for hospitalization—but Mary recognized that she could not hold back any longer. She had long held this emotional knowledge of being abused as a deficiency within herself, and, as a result, she never sought to reach for anything that would cause her to have to express herself deeply. As a result, her relationships had been superficial, her jobs had been mediocre, and her entire life had been one characterized by coping rather than freely expressing who she was. Within months of recognizing this, she left her job, got a very senior position at a new company, met another man, and ended that relationship long before the anticipated violence became an issue. Instead of using dissociation as a defense, she trusted her gut instincts.
This case illustrates how trauma can use dissociation from fear as a way to protect a person from overwhelming feelings, but until people connect with their deepest and unconscious fears, they are not truly protected because they are not accessing knowledge that could be helpful in making future decisions.
When traumatic memories are formed, they are etched into the cement of our brains because high anxiety drives them in. In fact, one study showed that if you give people morphine soon after a traumatic event, the impact of that event over time will be much less. By relaxing the person soon after he or she experiences trauma, you prevent the memories from having as strong a hold on the brain.
People with PTSD have a smaller hippocampus—the part of the brain that is involved in long-term memory. Somehow, their ability to remember is compromised, and trauma shapes the way in which the brain develops memory systems. A smaller hippocampus is one result of this memory shaping. Early on, soon after the trauma, blood flow is increased in memory systems involving the hippocampus and amygdala, signaling that memory changes are taking place, but the long-term effects of trauma are decreased blood flow to the hippocampus. Severe stress increases the circulating blood levels of a hormone called cortisol. It is believed that cortisol is, in part, responsible for the smaller hippocampus suppressing memory.
More recent studies have shown that it is not the entire hippocampus that is smaller in PTSD. In fact, if we divide the hippocampus into front and back parts, it is the back part that is affected. It is this part of the brain that is responsible for storage, processing, and retrieval of memories of space and time.
The smaller hippocampus in traumatized people leads to what is called an exaggerated startle response. That is, people startle at the slightest provocation, even when it is not necessary. This sets up a cycle of stress. In my experience, this startle sometimes leads to a paralysis of function in traumatized people, even when they are not physically reactive. Can you imagine being startled at the slightest provocation over and over again? (Talk about chronic fatigue!)
Working memory refers to short-term memory. For example, when we remember a telephone number just after being given it, these numbers are held in working memory. As we function in our daily environments, working memory is continually updated as we send new information to our brains. In between, working memory has to be maintained for long enough that relevant tasks can be done or information can be sent to long-term memory. In people who are severely traumatized, there is malfunction in the updating system, and even when the system is supposed to be quiet, it starts to update. This may be why concentration is affected and why engaging in day-to-day tasks is difficult for those who suffer from PTSD.
Ricky, Liz, and Mary didn’t appear to truly grasp their anger on a day-to-day basis. While they recognized that they were temperamental, they usually remembered their angry reactions in an understated way, partly because they could not hold on to this information. Perhaps more disturbing to me was their lack of awareness of others taking advantage of them. In part because Ricky, Liz, and Mary were financially successful, the people in their lives constantly used them for money. These trauma survivors seemed to “forget” past incidents and allowed friends and family members to use them time and again. When reminded of previous incidents, they could identify what had happened, but were not emotional about the negative outcome. This kind of denial is common in traumatized individuals.
Often, several traumatic events may converge. In Ricky’s case, he had been sexually abused as a child. Also, his mother had been relatively absent. His thoughts and feelings were rarely synchronized because these multiple traumatic events were even more difficult to bear. Intelligent people who are traumatized will fill in the gaps in their lives with almost believable stories. But deep down, they are always unsettled by something not jelling. Faulty working memory and hippocampal damage are partly responsible for these gaps in remembering. One study has shown that the greater the trauma, the greater the loss of memory specificity. People who are traumatized do not have great specific memories. As a result, they have a less coherent sense of the past.
Alexithymia is a condition in which people have less ability to experience and/or express emotion. In severely traumatized people, this inability to feel or express emotions becomes more severe. As a result, traumatized people will often seek out highly evocative (and frequently provocative) situations in order to experience emotions that will relieve their feelings of fear and anxiety. Furthermore, corresponding brain regions will activate or deactivate depending on the severity of the alexithymia. Also, people who have experienced severe trauma have a decreased level of emotional awareness.
There are two main divisions of the ACC: the dorsal, thinking part, and the ventral, emotional part. In people without a history of trauma, the activation of the ventral ACC increases as emotional awareness increases. In traumatized individuals, however, the opposite occurs. The more aware they are, the less the ventral ACC activates. Overall, traumatized individuals have a lower level of emotional awareness than nontraumatized individuals. This lack of emotional awareness can significantly impair decision-making processes that require emotion.
As we have discussed, in order to overcome our fears, we have to develop extinction so we learn not to be afraid of neutral stimuli that are associated with a negative outcome. For example, if a woman was sexually abused by a man with dark hair, with extinction she may eventually come to be less reactive to men with dark hair. In life, when trauma has not occurred, we learn to overcome our fears by learning how to extinguish responses to previously feared neutral situations. After a few successes, we can extinguish our fears. But in traumatized individuals, this extinction does not occur as readily.
This is, in part, because their brains are usually on hyperalert when a feared situation is replicated in any way (by war movies for war veterans, by romance for the sexually abused, by cars for victims of motor vehicle accidents). This state of hypervigilance correlates with an increase in amygdala activation. Usually, when we reexperience situations like these, the medial prefrontal cortex and ACC activate to extinguish or remove our fear responses. In people with PTSD, they do not activate. That is, certain brain regions that ordinarily help us identify situations as harmless are turned off.
Can you imagine how fatiguing this must be? No wonder PTSD is associated with chronic fatigue. The brain is constantly in overdrive and has to use a tremendous amount of energy to sustain its daily operations. The emotional operating margins are slim in people with PTSD.
It is clear that the effects of trauma can last for a long time. One study that used MRI to measure blood flow in survivors of the 9/11 terrorist attacks found that, compared to people who were two hundred miles away from the incident, people who were within one and a half miles of the attacks still showed increased amygdala activation three years later when they were shown images of fearful faces. This suggests that the effects of trauma can not only be long lasting, but also that the more directly one is involved in a trauma, the longer its impact lasts.
Thus, the effects of trauma in adulthood are widespread, affecting the brain systems related to short- and long-term memory, attention, emotion, and the various systems that coordinate these functions.
Following are some of the ways you can change your fear response if you have been a victim of trauma. It is important to remember that apart from these suggestions, techniques such as psychotherapy and eye movement desensitization and reprocessing, a technique involving the manipulation of eye movement, have been found to be helpful. Also, antidepressant treatments and changes in the environment can reverse the effects of stress on hippocampal nerve growth.
Meditation involves an inward journey, one that can be very frightening to a person who has been traumatized. As the journey proceeds, traumatized individuals may come across fragments of their traumatic memories that compound the already huge distraction. In fact, at first, it is very difficult for traumatized individuals to meditate for any length of time. Being still means confronting the inner chaos that for so long has been mirrored in chaotic external activity. But as trauma victims learn to bear their inner journeys, when undertaken without forcing any connection or trying to make meaning, there emerges a new possibility of a sense of self beyond concrete narratives. This sense of self is constructed through the “feeling” of the inward journey. By maintaining attentional focus on a mantra or an object, for example, a trauma victim can continually redirect him- or herself back to a place of calm, away from the narratives that are otherwise disrupting life. In so doing, the narratives are trained by meditation to quiet down, and they become less distracting, allowing for a more peaceful environment in which to address the past trauma and reintegrate a sense of self.
There is growing evidence that meditation can be utilized to effect change in trauma victims. One study in which traumatized adolescents used a combination of meditation, guided imagery, and breathing techniques showed that they scored much lower in PTSD symptoms than those who did not use these techniques. These symptom improvements remained at three months.
One case history that came to the attention of the media was that of Trisha Meili, who revealed her identity as the Central Park Jogger—the victim of a brutal assault and rape in New York City’s Central Park in 1989—in a presentation at Spaulding Rehabilitation Hospital in Boston in May 2003. Jon Kabat-Zinn, PhD, a professor at the University of Massachusetts Medical School, presented Meili’s case history and revealed that mindfulness and meditation had been important in her rehabilitation process. She reported that her self-discovered practice of mindfulness helped restore her emotional and physical functioning. In their presentation, they emphasized the importance of meditation in rehabilitation from trauma.
There is also other evidence supporting the use of meditation in recovery from trauma. Victims of Hurricane Katrina who completed a four-hour workshop on meditation followed by an eight-week home-study program reported an improved sense of well-being that was significantly correlated with the total number of minutes of daily meditation practice they undertook.
Although we can’t be certain why meditation is effective for trauma victims, it is possible that focusing attention on something else decreases the fear and pain caused by the trauma. Meditation may also increase the coordination between the different brain regions that are disrupted as a result of trauma, and people may then be able to reintegrate thoughts and feelings that were previously disconnected.
As outlined in this chapter, trauma can affect attention in a number of ways.
Ricky, Liz, and Mary all had chaotic lives before their attention was harnessed; however, their attention could be harnessed only when their emotions allowed them to harness it. This occurred as they learned to process difficult emotions, engaging the thinking circuits that were otherwise engaged in pointless worrying.
Since trauma causes a disruption between thinking and feeling, and since this disruption leads to distraction, the key intervention is to reintegrate difficult emotions. Difficult emotions “attack” the traumatized brain, however, causing exaggerated responses—either too much emotionality or complete dissociation.
Thus, generally speaking, there are two ideas to be aware of:
Distraction can be effective in reducing trauma’s consequences, such as flashbacks and anxiety. It is different from dissociation in that you allow your brain time-limited, conscious relief by replacing the traumatic flashbacks with another engaging—but positive—experience. Eating a great meal, spending time with friends, playing a video game, and shopping are all examples of distractions. They work because they take the focus off the trauma and flashbacks and train the brain to focus on other things. Ideally, identifying a growth opportunity and planning for it prior to executing it are very productive ways to use distraction. Although processing the trauma is important, relieving your brain of the constant stress is also important and will allow you to process the trauma more effectively.
Starting slowly is critical to undoing the destructive effects of trauma. Effective therapy has to be trauma focused. Similarly, if you are looking to help yourself, your efforts should be trauma focused. First, write down the specific limitations that trauma is creating for you. Then, reexamine this from multiple perspectives. Finally, determine what is most easily changed, and change it. For many people, even approaching this is petrifying. They may fall into the prudence trap and do nothing at all. Caution is a result of the amygdala activating. Being overly cautious occurs when the amygdala activates to the point of burning itself out. Then, the entire brain’s functioning is paralyzed. It is important to recognize that often, action cleanses us more than more thinking does. When looking to deal with problems, then, it is critical that you do not keep them academic, but rather actually experiment with them in day-to-day situations. The steps are:
Most of us do not choose to have our thinking and feeling disconnected. It is a defense against the fear that if we connect our thinking and feeling, we will go crazy. The truth is, “craziness” usually results from not expressing feelings. So, if you have the chance to express yourself, do so. The basic idea here is to express yourself progressively over time, and only to people you trust. The exercises that follow help to integrate thinking and feeling. Another way to do this is to each week select a movie that explores a theme relevant to your own trauma. Watch the movie and allow yourself to respond to it in an emotionally honest way. You can do the same with songs, as well. Use keywords to search the Internet for relevant songs, and then listen to them to find one that reflects the feeling you are looking to connect with.
Documenting your life can be a rich and fulfilling experience if you continue to add layers of complexity. For example, you can keep track of the important events in your life over the span of several years and assess how variables correlate from year to year. The table below offers a sample of how you can keep track of your life experiences from year to year. Any number of combinations can be created.
| This Year | Year 2 | Year 3 | |
| Income | |||
| Number of lovers | |||
| Number of satisfying | |||
| Relationships | |||
| Number of vacations | |||
| Happiness rating | |||
| Serendipitous moments | |||
| Challenging events |
| Year 4 | Year 5 | |
| Income | ||
| Number of lovers | ||
| Number of satisfying | ||
| Relationships | ||
| Number of vacations | ||
| Happiness rating | ||
| Serendipitous moments | ||
| Challenging events |
To augment this table, you can also create wish tables for the next ten years and compare them with the past. This will not only allow you to feel more integrated, but will also connect you with a sense of the future. It is very important that you learn to focus on the things you want and not only on the things you do not want. To help you do this, I suggest that you start a journal called The Book of Dos (as opposed to don’ts). In this book, write down only things that you would like to accomplish in the coming week.
So you don’t repress your memories, also start a journal of past traumas called Lessons Learned. While all of these books and tables may sound like a lot of work, they will eventually help your life become much more efficient.
Although the efforts outlined above are important and will help you to focus, too much effort can also cause you to fatigue easily. The trick here is to allocate effort during a part of your day, and then to let your practice show itself as you proceed through your day. If you apply effort all day, it will be like struggling in quicksand. Try to apply yourself to changing your life in a way that is predominantly exploratory and punctuated with effort. Effortful psychological practices should probably not take up more than two hours in a day.
Trauma causes disruption to your inner life. As a result, the past, present, and future become discontinuous and identity becomes fractured. This scatters attention and increases fear. The disconnection is reflected in brain activations where the brain bridge between thinking and feeling is damaged, and the memory and attention centers are, in effect, altered in adulthood. To reestablish our brain bridges and to reprogram our memory centers, we have to confront those fears gradually while at the same time allowing ourselves to build a better future.