A traumatic life event is indelibly laid down in neurological memory which is easily triggered by experiences that have even the slightest association with the particular tragedy. Trauma memories are coded with exaggerated negative emotions of distress. For example, we may not recall sharing a cup of coffee in a restaurant a few years ago, but if someone comes into the restaurant and shoots three people that day, we will likely recall the incident in vivid detail for the rest of our lives. Subsequently, when we see this restaurant or a similar one, or perhaps share any cup of coffee, this traumatic recollection may be elicited with intense and potentially horrifying emotion.

Historically the emotional state of heightened stress helped humans to focus on danger, react and remember the experience so that it could be avoided in the future. Prior to the existence of civilized man, periods of intense, threatening stress were intermittent and soon passed. Today, many people have a lifestyle that entails chronic stress, but perhaps they encounter less frequent physical threat than early man. This stressful lifestyle may readily push trauma survivors into episodes of intense and reactive emotional dysregulation. The reactive and repetitive occurrence of trauma memory can lead to poor long-term emotional and physical health. It may also promote automatic response patterns, which likely had survival value for early mankind, but close off creative and complex thinking.

BRAIN CHEMISTRY RESPONSE TO TRAUMA

Corticoid Releasing Factor (CRF) is the initial brain chemical that responds to signals from our environment and it cascades through our bodies so that we may react adaptively. CRF promotes Cortisol-a prolific stress neurochemical. Cortisol stimulates norepinephrine (NE) another prevalent activating neurochemical. Cortisol and NE are our brain’s chief stress response agents. When these stress chemicals are too high, which is often the case in trauma survivors, they essentially shut down the judgment center of the brain and stimulate the emotional reactivity centers. If you are running from a tiger this reaction makes good adaptive sense, but if not, precipitously elevated stress chemicals negatively impact several key areas of the brain that result in PTSD symptoms. The brain centers for social judgment, emotional modulation, short-term memory and hormonal stress reactivity are particularly poorly impacted.

Serotonin levels in our bodies decrease in response to an increased biochemistry of stress. Because Serotonin is a modulating neurotransmitter that impacts other neurochemical systems and several brain and body functions, including sleep, a decrease in Serotonin in response to increases in CRF, Cortisol and NE can lead to dysregulation of brain neurotransmitters that results in increased depression, anxiety and disrupted sleep, which is where mood and cognitive regulation capacities are nightly restored. Increases in CRF may negatively impact the reward center leading to decreases in another neurotransmitter, Dopamine, which is associated with a sense of pleasure, clear thinking and movement. In other words, the experience of trauma and its subsequent flash back episodes of remembering cause dramatic and repetitive increases in biochemical stress reactions in the body that can dysregulate and disrupt essential body and brain functions.

Even our genes are involved in the neurochemical reactions to extreme stress. Genetic variance in several brain systems is related to resistance to the negative psychological aftermath of trauma. For instance, certain CRF “genetic snips,” segments of the CRF receptor genes, can vary. Some of the genetic divergence seems to result in an inherent resilience to tragedy. Resilience is related to one’s ability to assimilate negative experience in meaningful ways and move on to positive life participation.

UNDERSTANDING POSSIBLE NEGATIVE CONSEQUENCES OF TRAGEDY

PTSD is associated with anxiety, depression, poor anger management, impulsivity, and memory deficits. If trauma is severe or prolonged, or if one is genetically sensitive (i.e. highly emotionally reactive) alteration in body, brain and genetic chemistry may become permanent. Pathways of traumatic memory in the brain become deeply etched in remembered connections between neurons, which are sculpted by intense and frequent episodes of vivid recollection. It is thought that each graphic recollection of trauma, each flashback episode, serves to create a memory footprint. The unhappy result may be chronic emotional reactivity and intensity. This state of affairs is too often accompanied by a decreased ability to inhibit impulsivity, to thoughtfully tame aggression, and to execute socially appropriate decision-making. Memories coded with intense emotional distress take a person back to tragedy and away from present life, and the physical toll is enormous. The heightened stress chemistry at the time of trauma and each trauma memory episode, sets off a succession of stressful and potentially damaging physical events including increased heart rate, blood pressure, etc. Unfortunately, memories of past heartache usurp one’s energy and focus in the present moment.

Our extended memory places an event into the fabric from which we weave our sense of self. Memories that are terribly upsetting are left coded in our brains as sensations, images and physical reactivity. Tragic memory that is left, or blocked without some linguistic sense made of it (usually shared with a confidant), is likely to be reenacted in some mindless, automatic way. If these memory episodes become habitual, then emotional distress is likely to become characteristic of one’s personal and social self. To continue well, traumatic happenings must be integrated into a meaningful interpretation of our life history. This painful effort may leave us with a sad sense of wisdom.

It is clear that each side of our brain specializes in different functions, but they both collaborate to integrate and code information into memory. Tragedy so overwhelms the emotional reactivity centers that information flow and interaction between the right and left-brains is disrupted. The location of the language center is primarily in the left-brain. This side of the brain is also associated with circuitry that promotes more positive emotion and behaviors of approach. The right side of the brain is thought to have more impact on negative emotional states and avoidant behaviors. Of course many functions move across left and right brain hemispheres, but it is the left hemisphere’s ability to name feeling states that facilitates integration of conscious memory and assists with emotional self-regulation and trauma recovery.

Our sense of who we are is constantly updated by life experience that is coded into memory. Long-term memory consolidation is a process, mostly happening during sleep, that may take weeks, months or even years. This entails the integration of relevant memory into a memory bank of self-experience. Memory is primarily coded from short- term to long-term memory during REM (dream) sleep. There seems to be an ossicilation between left and right brain centers during REM sleep when the left brain is activated to retrieve memory from the right short-term memory center. Then the left brain becomes activated so that the new information is sorted into the file of past memories and woven into the memory bank of self-history. For trauma survivors, dreams can become a struggle to sort through terrifying life tragedy as the brain strains to place the unimaginable into some sort of reasonable self-memory.

Unfortunately traumatic recall may not be erased, but our understanding of how memory is stored in the brain can be incredibly important in helping people to assimilate horrible misfortune so as to be able to continue with life. Recent studies have carefully looked at how we can recall an experience. It is now known that memories form in stages. At first a memory is only a pattern of electrical signals etched in the brain. If there is a strong emotional reaction to an event, then proteins, stress hormones and neurochemicals, will strengthen these patterns in the brain so that they are imprinted and can be easily recalled. Revisiting an upsetting memory may temporarily elicit this electrochemical pattern so that it may be amended by new information. New perspective during recollection may alter the memory pattern as it is recoded and returned to the long-term memory bank. This of course has implications for possible healing in the recounting of tragedy. Perhaps with the presence of a caring therapist, or trusted person in ones life, the way that we view the tragedy may be changed to a more peaceful and accepting perspective so that courage may be found to continue making a good effort with life.

MAKING GOOD SENSE OF BAD TIMES

All experience is emotionally tagged at the level of perceived significance. Emotions help to organize, amplify and attenuate behavior, thinking and reactions. Knowing how to recognize and temper certain kinds of emotion is essential for an intentional, thoughtfully positive and productive life. Intention has a specific set of circuitry in the brain. It enables us to pursue the future in the context of today, even a dark today. With intention there is hope. People may manage feeling states in many ways, and often their strategies are mindless and self-destructive. The lives of those who have suffered deeply are rather like those of a hothouse flower. They must be carefully and consistently tended so as to avoid emotional reactivity which can become intensified following tragedy. The brain must come to grips with assimilating a piece of unimaginable life experience. Going forward is most often a dynamic process and an ongoing effort. Finding a carefully chosen route onward is the task at hand. There must be intention to live again following tragedy.

The personal meaning, level of trauma exposure, availability of social support and genetic characteristics are primary factors determining how one copes with terrible misfortune. Some trauma survivors are present at the scene of the tragedy or are in some way vividly exposed to its images or sounds. This exposure results in a firmly imprinted memory of the horrifying event. Having loving, patient social support can be essential for survival and regaining emotional balance. Disappointingly, some people find that close association to tragedy feels menacing to their own sense of personal safety. Visiting with a friend or family member who is grieving or suffering isn’t always an easy or happy time. Yet, one may feel re-empowered through connections of trust, partnership, attunement, and shared exchange that facilitate peaceful mood regulation and decrease negative emotion. Rebuilding relationships with one’s self and others may be painstaking because the process of mnemonic integration of unspeakable suffering takes time and courage.

While it is a good idea for all of us to think before reacting to feelings, if you are a trauma survivor who experiences very strong feeling signals, then you must strategize how you want to feel and react to stressful situations. By setting up life routines and thought patterns that positively impact our mood states, we can consciously control how we feel more of the time. A recent Harvard University study found that close positive attachment is the single most important predictor of life happiness because feeling understood positively affects our brain chemistry. Moreover, the same brain pathways that seek to understand others can be marshaled to understand ourselves with compassion and respect so as to become more self reflective and peaceful.

Finding a way of thinking about past tragedy that merges into a sense of meaningful life history can be unfathomable for many people. Those with a history of trauma routinely find themselves automatically using the life-changing episode as a marker event, so that other events are marked as happening before or after the tragedy. They may ask themselves, how do I live well after I have been devastated by loss? The answer is that it is necessary to speak about what has happened or to find another way to bear witness to the tragedy so as to rebuild a life that may be a tribute to the person lost or to live in a way that is a testament against treachery and injustice.

Realizing that our feeling and memory system is shaped to some extent by life experience is essential to self-determination. As scientists are more able to image and clarify how our genes and brain pathways work, we can use this knowledge to help a trauma survivor achieve a more balanced and peaceful emotional state. Although we can do this with medication, it has onerous side effects. A healthier alternative would be to cultivate an active understanding of one’s self that sets up effective life habits that address a broken life. Thus, a system once overwhelmed with stress may become a more equilibrated self-state that will decrease in dissipated energy and facilitate intentional focus. “In a dark time, the eye will begin to see”(Theodore Roethke).

(A study summarized in the June, 2009 Atlantic Monthly regarding sequential ten yearly assessments of selected “most promising” Harvard graduates from the 1940s.)

- Dr. Linda Klaitz, Medical Psychologist