Trauma and the Brain, Lesson Two...

In the first post on trauma and the brain, I wanted to show how the trauma of sexual abuse affects the brain and thus the body.  Sexual abuse is an assault on the whole body, the whole being, not just an act of penetration or molestation in one particular spot of the body.  It is also a trauma that is not fixed at one point in time.

In the post, Post Traumatic Stress Disorder (PTSD) is introduced.  I would like to post a few more thoughts on this:

People with PTSD continue to cycle through rounds of distress. Memories of the trauma remain stored in the amygdala and the hypothalamus—the primitive, instinctual parts of the brain that are concerned with survival. These areas of the brain (also called the “old” brain) can only react; they are not able to think, reason, plan, or compare. The old brain responds instantly to danger, overriding the thinking parts of the brain. This ability to react immediately—without thinking—can save our lives, but at a cost.

The old brain deeply imprints information related to danger and survival, and since it does not have the capacity to integrate the experience of trauma and cannot differentiate the past from the present, it continues to react as if you are still in danger. Whenever you experience anything that is reminiscent of the initial trauma, the amygdala and the highly attuned structures surrounding it are activated, triggering a new cascade of stress chemicals.

For survivors of child sexual abuse, smelling a particular cologne, seeing the shadow of a man at sunset, sensing a sudden movement out of the corner of the eye, or being touched in a particular way can set off an intense alarm reaction in which the initial panic, helplessness, and terror are re-experienced in the present.

As time goes by, PTSD symptoms can become more ingrained, and for some people, traumatic memories grow more intrusive. Survivors often vacillate between a state of hypervigilance, in which all of the body’s distress signals are on “red alert,” and the opposites, shutting down completely. Over the years, survivors of child sexual abuse may be increasingly numb, agitated, or a combination of the two. (The Courage to Heal, Bass & Davis, p. 244-245, emphasis mine)

It may be difficult to understand, but these responses can go unnoticed by the sexual abuse survivor and those in his/her life.  Sometimes, they are so subtle, so very instinctive. Separation. Capitulation. Fear.  My example with the smell of beer, avoiding it without knowing, avoiding what would come after I smelled it.

And then there are other times when the response is so profound it cannot be unnoticed, even if it is not understood.

A few years ago, an anesthesiologist came to introduce himself before a procedure.  I was extremely agitated, not about what was going to happen, but about the fact that I was clad only in a thin gown, with no underwear.  To be blunt, underwear makes a profound difference in my level of comfort.  Since then, I have learned to ask for surgical underwear before hand and to have it put on before I awake.  But then I did not know of that option or have the courage to insist on it when others didn't see the need, as was the case the following year with another procedure.

The anesthesiologist, a man, put his hand on my shoulder, slipping between my gown to rest upon my skin.  His fingers were splayed downward, his fingertips resting on the upper part of my breast.  I became so terrified that I was sedated immediately, instead of the plan of doing so once in the procedure room.  Since I was in a surgical clinic, rather than a hospital, the protocol was to not even use versed outside the procedure rooms.

I can understand that, for some, touch is seen as comforting. But it is not.  And when touch becomes a trigger, it is harmful.  Would that it were I could help others understand that they should stop and think what might be comforting for the other person rather than what is comforting to them.

Fortunately it is possible to gradually move the trauma that has been locked in the old brain to the higher, reasoning part of the brain that holds our language centers—the cerebral cortex. Unlike the old brain, the cerebral cortex has the capacity to integrate new information and to change. Once trauma memories are integrated into this more advanced part of the brain through tools such as imagery, the creative arts, and body-based therapies—along with psychotherapy—survivors of abuse learn, on the deepest level, that the abuse happened in the past and that it is over.

As a result, automatic stress response and other PTSD symptoms can be significantly reduced and, in some cases, eliminated altogether. (p. 245)

Once, when I was recovering from an asthma attack, a man came over and put his arm around me to ask if I was okay.  I screamed, "Don't touch me!"  And then was flooded with shame.  I was in church, after all.  

I did not know the man.  And my counselor, in debriefing the experience, stated that it is not appropriate for a strange man to put his arm around a woman he does not know no matter the location or the circumstance.  But I, rather bitterly replied, that my efforts to set boundaries for my body were never respected in church.  There is all this touching ... a hand to the small of the back as you pass through a door, a hand on the shoulder in greeting, a hand on the arm.  That doesn't include hugs ... the full body hug, the opposite shoulder to shoulder half hug, the side hug.  And even hand shakes.  

After the pit bull attack, which only exacerbated my problems, I needed a safety zone to be around others.  When I would go to church, because I am oft wobbly or walking slowly with my cane, ushers would reach out and take ahold of me.  Without asking.  Sometimes, even after asking and hearing my response of: "No, thank you."  I asked the pastors to speak with the ushers.  But this was not something that was easily accomplished, since there were no formal usher meetings or training.  I can appreciate that my pastors did not understand the severity of the problem.  

Sometimes, I would cry aloud.  But usually, when it happened, I would stuff all of that terror and panic and helplessness and shame and failure and self-loathing into a tiny ball and then breakdown in the parking lot afterward.  I would struggle to get home. I would vomit.  I would become insensible, caught in this storm of emotions and sensations that I could not understand or process.

Ultimately, I told them I could not come back to church without knowing for certain I would not be touched.

No touching.  No hugging.  Period.  

This has been a very difficult to set.  Yet the longer I have gone with having mostly full control of my body, the better I have been.  One of my pastors still sticks his hand out nearly every time I see him.  No matter how many times I ask him not to do so.  I struggle with the pressure to shake his hand and the desire to scream that I want it to be my choice.  There are also two people who have hugged me. However, for the most part, I have carved a bit of safety, a bit of certitude about my body.  This has helped me to then have the clarity and the courage to take other small steps toward understanding what has and is happening to my body that I might progress in healing.

The greatest help others have given to me in this is to let me know that my choice, the setting of this boundary is okay.  

Telling me that I am okay—that my feelings are okay, that my responses are okay, that my coping mechanisms are okay—is Gospel to me, is mercy, is love that I can hear, that I can understand.

Healing is possible.  It is hard work and often far, far longer a process than you would wish, but healing to some degree is possible.  And peace, the peace of Christ, in all circumstances is a promise.

I am Yours, Lord.  Save me!