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!

Bodies...

On my main blog, there are subjects I have revisited many a time, because I cannot quite find the words to say what it is that I mean to say.  And then there are some subjects that are revisited because there is too much to say in the first place.  Here, the subject of bodies, is one of both.

Children learn about the world through their bodies. If they are protected and nourished, they feel at home in their bodies. Living in their bodies is a source of pleasure, accomplishment, and satisfaction.

When children are sexually abused, they learn that the world, and their bodies, are not safe. Abused children experience pain, fear, and conflicting sensations of arousal. Often they leave their bodies to avoid these feelings—or numb themselves as best they can.

For abused children, the body is a place where frightening and painful things happen. They learn to always be on alert, to be ready for danger. Or they cut themselves off from their bodies and learn to ignore them, living mostly in their heads. For many survivors, the experience of trauma leaves a deep impression on the body.  (The Courage to Heal, Bass & Davis, p. 7)

Take a look at any baby and you will quickly see that children learn about the world through their bodies.  Their first discoveries are often with their own bodies ... tongues, toes, fingers, fists.  As soon as they are able, they begin exploring their world with their hands and feet, grasping and kicking aplenty.  But they also learn safety and comfort through their bodies.  They are held by their parents.  They rest against their mother's breast to nurse.  Their skin is stroked and kissed.  Touch is comfort.  Closeness is safety.

Yet for the sexual abuse survivor—from infant to adult—their own body can become a place of fear and shame, a place of horror and pain, a place to flee.

Think about that for a moment.
And another.

Children learn through their bodies even before they speak.  Children learn through their bodies before they understand what it is that they are learning.  It is no wonder, then, that sexual abuse leaves a deep impression on the body.

Sometimes that impression is known.
Sometimes is it unknown.
Sometimes it is both.

Often, it makes no sense.

Well, if you understand the whys and wherefores of how the body responds to trauma and if you consider how much we learn through our bodies, then sexual abuse survivors struggles and responses make perfect sense.  All that is part of what I would like to share.  The body's response to trauma and responses common to many.  But the basic block of all of that is understanding that sexual abuse survivors have bodily wounds that can color all that they think about and do with their bodies.

For the Christian, this struggle with the body can be more damaging, for there is a physicality about the sweet, sweet Gospel that cannot be ignored or escaped.  That physicality can both soothe and agitate.  Both.  One or the other.  Both.  And, again, it is not so much important that you understand why  or how this can be so.  It is merely important that you accept that such can be the case.

Children learn about the world through their bodies. If they are protected and nourished, they feel at home in their bodies. Living in their bodies is a source of pleasure, accomplishment, and satisfaction.

When children are sexually abused, they learn that the world, and their bodies, are not safe. Abused children experience pain, fear, and conflicting sensations of arousal. Often they leave their bodies to avoid these feelings—or numb themselves as best they can.

For abused children, the body is a place where frightening and painful things happen. They learn to always be on alert, to be ready for danger. Or they cut themselves off from their bodies and learn to ignore them, living mostly in their heads. For many survivors, the experience of trauma leaves a deep impression on the body.  (The Courage to Heal, Bass & Davis, p. 7)

It is okay of you hate your body.
It is okay of you are ashamed of your body.
It is okay if you flee from your body.

You are still without blemish and are still clean.
You are still fearfully and wonderfully made.
You are still forgiven.


I am Yours, Lord.  Save me!

A beginning...

The Courage to Heal ought to be required reading for all teachers.  All medical personnel.  All clergy.  All emergency personnel.  All mental health professionals.  All judicial system personnel.  All sexual abuse survivors.  All family and friends of survivors of sexual abuse. Well, truly everybody.  Period.

The Courage to Heal, written by Ellen Bass and Laura Davis, first published in 1988, twenty-five years ago, is an outstanding resource for everyone.    Why everyone?  Well, sexual abuse is everywhere.  It is in our homes, our schools, our companies, our parks, our restaurants, our churches, our community activities.  With reported rates of sexual abuse being 1 in 4 females and 1 in 7 males, odds are that someone in every community, store, church, business, school, and sports team has been sexually assaulted.  Yet our nation is plagued by silence on the matter.

Oh, the stories of sexual abuse have become increasing prevalent in the news, sadly.  Of late, sexual assaults by youth—and oft by youth in groups—are the ones reported.  Yet what happens to those who are assaulted is rarely discussed.

I believe that is why we could, in 2013, have a judge dismiss all but a tiny fraction of a rapist's sentence because he believed that the 14 year-old who was raped was complicit.  No matter that the law states that age of consent is 16.  No matter that the girl committed suicide because she could not bear the aftermath of the months of the teacher's abuse.  No matter.  That judge, clearly, is completely and utterly ignorant of the impact sexual abuse has on the survivor.  He failed in upholding the law, but he also failed in his duty to understand the extent of the crime.  There is a reason for the law he dismissed so easily.  An important reason.

Twenty-five years the information in The Courage to Heal has been available, and yet even mental health professionals are not always aware of the impact of sexual abuse or how to help survivors.  Twenty-five years and yet those who are in vocations of caring for others are rarely aware of the impact of sexual abuse or how to help survivors.  Twenty-five years and yet parents and family members are not always aware of the impact of sexual abuse or how to help survivors.  Twenty-five years.  That, in and of itself, is criminal to me.

We know the importance of and teach stop, drop, and roll.  We know the importance of and teach CPR.  We know the importance of and teach having a dedicated driver when drinking with friends. But we do not know about the impact of sexual abuse on the body, the mind, and the emotions or teach about it when every two minutes in America sexual abuse is taking place.  Right now as you are reading this. Right now in your community.

Every. Two. Minutes.

I have written veiled things on my blog.  I have posted veiled things on Facebook, when I have been on there.  I have posted articles of sexual assaults to show how it happens everywhere and posted articles and videos to show its impact.  Yet there is rarely ever any engagement on the topic and, going by site statistics, those posts are rarely read.

My friend, while recently trying to help me through a bad spell, talked to me about the subject of bodies with regard to receiving the gifts of Christ.  While I cannot remember, due to my compromised brain, what  she said, my first thought was Oh, how I wish someone, anyone, had said that to me years and years and years ago!  My second was that I want to write specifically about the impact of sexual abuse rather than hiding my thoughts beneath and between lots of other words.

Nearly two weeks have passed and each time I set out to start writing, a panic attack set in.  I am weak. I am frightened.  And I am most decidedly not brave.  Yet still I want to write.

I thought about writing specifically on my personal blog, but I want to write in such a way so that if ever anyone wanted to learn something about sexual abuse an its impact, then that information via my experience and my reading of The Courage to Heal would be labeled and navigable.  So, I am going to write here.  If for none else then for me.  So, while I may cross post entries, this is where I will be writing the things I wish to say, the things I wish others will learn to that those like me might have a better chance at healing sooner rather than later.

Since picking up this book, I have come far, but I have much, much further to go.  The things I have learned in counseling, I have to re-learn daily.  The truth that has broken through the lies has to be re-told daily.  For the lies persist.

I want to finish by including the first part of the chapter Effects: Recognizing The Damage:

The long-term effects of sexual abuse can be so pervasive that it's sometimes hard to pinpoint exactly how the abuse affect you.  I can permeate everything: your sense of self, intimate relationships, sexuality, parenting, work, even your saint.  As one survivor explained:

"It's like those pictures I remember from Highlights for Children magazine. T he bicycle was hidden in a tree, a banana was growing from someone's ear, and all the people were upside-down.  The caption underneath said, 'What's wrong with this picture?' But so many things were disturbed and out of place, it was often easier to say, 'What's right with this picture!'"

Many survivors have ben too busy surviving to notice the ways they were hurt by the abuse.  But you cannot heal until you acknowledge the impact of the abuse.

Because sexual abuse is just one of many factors that shaped your development, it isn't always possible to isolate its effects from the other influences on your life.  If you have trouble trusting people, is it because you were molested when you were nine, because your mother was an alcoholic, or because you were left alone for hours every day as a small child?  It's the interplay of hundreds of factors that make us who we are today.

The way abuse was handled when you were a child has a lot to do with its subsequent impact.  If a child's disclosure is met with compassion and effective intervention, the healing begins immediately.  But if no one noticed or responded to your pain, you were left feeling abandoned and alone.  If you were blamed, were not believed, or suffered further trauma, the damage was compounded.  And the ways you oped with the abuse may have created further problems.

...

The effects of child abuse can be devastating, but they do not have to be permanent. (The Courage to Heal, Bass and Davis, pp. 3-4)

The effects of child abuse can be devastating, but they do not have to be permanent.
The effects of child abuse can be devastating, but they do not have to be permanent.
The effects of child abuse can be devastating, but they do not have to be permanent.

In thinking about what my friend said about our bodies being how we receive the gifts of Christ, what I believe is important for others to understand is that receiving the sweet, sweet Gospel can be painful and/or difficult for those who have been sexually abused.  That doesn't have to make sense to you.  I hope to help in that area.  But, if nothing else, I hope that you might learn that a child of God might long for the healing of the Living Word and the Lord's Supper and yet flee from it at the same time.  And in learning such you might accept such.  And in accepting such you might help that child of God on his or her journey of healing.

I want to write about topics that still terrify me, that still shame me, because, in my experience, people view sexual abuse as a mental health problem, rather than a whole person problem.  They overlook its effects on the body and on the spirit ... and especially on faith.

I would like to finish by noting that the young girl I mentioned above is a sexual abuse victim.  Bass and Davis are very specific and very careful to delineate between who is a victim and who is a survivor.  If you have died as a consequence of sexual abuse, you are a victim.  Everyone else is a survivor.  If you are alive, you are a survivor, no matter where you with regard to healing.  You are alive.  You are a survivor.  To see someone as a victim, to treat her or him as such, can hurt that person further.  To view yourself as such, can obstruct your own healing.  That is lesson Number One.

I ... I am a survivor.


I am Yours, Lord.  Save me!