A PSYCHIATRIST’S VIEW OF CHILDHOOD ABUSE

Psychological trauma is defined by the Diagnostic and Statistical Manual (DSM)-5 as a threat to your life or physical integrity or of someone close to you. Over half of people in the U.S. have been affected by psychological trauma at some time in their lives, and this number has increased since the newest version of the DSM (DSM-5) dropped the requirement that the event be experienced with an “intense feeling of fear, horror, or helplessness.” Childhood sexual abuse is the most common cause of posttraumatic stress disorder (PTSD) in women. Sixteen percent of women in the U.S. are exposed to sexual abuse at some time in their lives, defined as unwanted sexual contact such as rape or fondling. The most common cause of PTSD in men is assault. There are a much larger number of civilians in this country with PTSD than former combat veterans suffering with PTSD.

Psychological trauma is associated with a range of adverse physical and health outcomes. These include PTSD and depression, dissociative and anxiety disorders, alcohol and substance abuse, and loss of work productivity. Trauma victims, especially those with PTSD and depression, also use more health resources and have increased rates of heart disease, asthma, and other physical health problems.

The effects of psychological trauma are real disorders, not manifestations of a poor attitude, or moral weakness. Psychological trauma-related mental disorders are diseases. Just like for diabetes or heart disease, you cannot simply “will” yourself out of the effects of psychological trauma. That is where the mental health profession comes in.

After a traumatic event, traumatized persons often try to put it behind them, put it out of their minds, forget about it. But unfortunately the trauma has a mind of its own, so to speak. It keeps jumping back into consciousness, sometimes when you’d least expect it. Patients are kept in an endless loop of replaying the memory of the events over and over.

Traumatized people try to think their way out of their disease. But could you think your way out of diabetes? Or heart disease? No way. Why should it be any different for psychological trauma? It’s not any different.

It’s not uncommon for trauma survivors to put on “a brave face,” or a false persona, to cover up the trauma. They look okay on the outside, but inside they are frozen in time, stuck in the grief related to their trauma. They may become super-achievers in an attempt to distract themselves from memories of the trauma or to cover up the feelings of inadequacy and shame that unfortunately are invariably associated with trauma, even when the victims are not to blame. They try to avoid the memories and the pain, through work, or less adaptively through alcohol or drugs, or the distraction of affairs. Eventually the music stops and they fall off the chair.

Sometimes the suppressed trauma comes out in other ways. Even though the mind suppresses the trauma, it’s still there in the body, and the body expresses it through something like a gastric ulcer or a heart attack. Other times it comes out suddenly in the form of a flashback.

How do things in the world affect us? How do we taste, hear and feel, and how can these things influence our emotions, our sense of self and others?

Studies showed that previously healthy journalists who watched executions of prisoners were often affected for years afterward by mental health problems, even though they didn’t personally know the person being executed, even though they were not physically harmed or injured in any way (at least on the outside). Why is it that passively watching something like an execution can have such a devastating impact on us? Why is it that the witnessing of a terrible event, acting through our vision, hearing, smell, and other senses, can change our lives, possibly forever?

Isn’t that amazing?

This brain area sends the information on to the rest of the brain. For instance, if you smell rotting meat, invisible pieces of the meat waft in the air (because they are so small they can get blown around easily), travel through your nose, and are detected by the brain as having something wrong with them.

When we smell something, small amounts of substances are emitted from the object we smell that physically enter our nose and travel through little holes in the top of our nose, in an area called the cribriform plate. They next land on a part of the brain, the olfactory cortex, that is responsible for smell.

The olfactory cortex then sends a signal to the fear area of the brain, called the amygdala, that says, “Danger, danger! We’ve got rotten meat here that may contain bacteria and kill you if you eat it. I don’t care how hungry you are, don’t do it!”

The location of the amygdala in the brain is deep in the temporal lobe next to the hippocampus as shown in this figure. It sounds the alarm, causing hormones like cortisol and norepinephrine to flood the body. This results in increases in heart rate and blood pressure and breathing. It also causes shifts in where energy is sent to in the body, that may help us survive. We’ll talk in more detail below about exactly what happens in the body during the fear response.
Different parts of the brain work together to process what’s going on in the world. They have to work together as an effective team. If they didn’t, we wouldn’t survive.

Everything we see, smell, hear, taste and touch gets processed by different parts of the brain. If the brain detects a threat, it activates the fear response. If you walk down a path in the jungle and see a lion, a series of things happen in your brain that end up with the thought, “Get the heck out of here!”

The vision of the lion comes in through the eyes and is sent to a part of the brain called the primary visual cortex, or occipital lobe, which is in the very back of the brain. It then goes to the secondary visual association cortex, right next to it, where a more complicated processing of the vision takes place. The lion growls, and the noise comes in through the ears and is sent to the auditory cortex, a part of the brain in the temporal lobe that processes sounds.

The parts of the brain involved in memory, the hippocampus and frontal/anterior cingulate cortex, pull this information together and compares it to prior experiences of encountering a lion. If there’s a match, the information is sent to the amygdala, which cranks up your heart rate, blood pressure, and breathing. Your brain then tells you “Let’s get out of here!” Otherwise, you might become lunch.