It has been a few months since Natalie first came to see me.  As her story unfolds, it becomes apparent that she has been attempting to deal with childhood trauma for most of her life.  This is not a new insight for her, it is the reason she came to see me in the first place.

Like so many others I see, she was tired of living in pain and fear.  She wanted to connect with people in meaningful ways but had difficulty developing close intimate relationships both plutonic and amorous.  She carried with her a great sense of loss, a deep sadness which she described as permeating throughout her body.  She often thinks about taking her life – what is known as suicidal ideation.  Most of her life has been marked with a sense that something was wrong.  Her self-image was of a flawed and broken self.  Natalie difficulty articulating her positive qualities.

While Natalie does not consciously know it yet, she has shown tremendous courage to arrive at this point in her life.   I see this time and time again, that people with the most horrible upbringings somehow find the courage to try for a better life.  Sometimes this can take several attempts – the path forward is often not as linear as we would like to believe.  For Natalie like many others, change is precipitated by apprehension and fear. As I said it takes courage to arrive at this point.   It is just that now the fear of staying the same is greater than the fear of change.

Like many other trauma survivors Natalie is under the impression that the cause of trauma is a type of memory impairment.  It is an understandable belief given that until recently most mental health professionals viewed trauma in similar terms.  However, recent technological advances have shed new light on our understanding of brain functioning and how it relates to trauma.

Trauma first and foremost is the dysregulation of the central nervous system (CNS).  Trauma overwhelms a person, sometimes physically, sometimes emotionally and sometimes psychologically.  Sometimes it is all three at once.  Once the person is overwhelmed, the central nervous system goes into threat mode – the fight/flight/freeze response is activated.  If the experience of being overwhelmed is intense enough or if the person is repeatedly traumatized, then the CNS learns to adapt as if the environment contains a constant threat.  One of Natalie’s symptoms is that she is often hypervigilant of her environment.  She unknowingly is scanning her environment for potential threats.  The more she scans the stronger the neural and chemical networks become which keeps the CNS dysregulated.

While the dysregulation of the central nervous system is the common factor that binds all forms of trauma together it is not true to think of trauma as one size fits all.  For example, someone who has been sexually abused may need to have counselling specific to sexual matters, while someone who has been repeatedly criticized as a child might need to deal with esteem issues and lack of self-worth.  Therefore, there can be multiple different forms of treatment specific to the persons needs.

Usually, a good place for treatment to begin is by helping a person elicit their own natural relaxation response  It often involves helping a person to feel safe, secure, and grounded while operating from a position of empowerment – in trauma treatment its often referred to as window of tolerance.  Typically, trauma survivors oscillate between two extremes, one is being over-stimulated (fight/flight) and the other under- stimulated (freeze).  The following infographic helps highlight how the CNS can be dysregulated and some of the things a person can do in order to help regulate it.

Window of Tolerance 

Window of Tolerance

We used to believe that trauma was a form of memory impairment – the memory was stuck in some way.  To heal, the memory had to be resolved in some manner.  While memories can get stuck particularly because of trauma (think of seeing a violent act which gets replayed over and over in the mind). This perspective has been outdated as recent advances in brain imaging and related technologies have increased our understanding of trauma.  Aligning with these advances are a more sophisticated understanding of how our memory systems work.

A simplified account is that memory can be divided into two broad categories.  One of which is explicit memory.  This is the type of memory that is typically thought as “memory”.  It consists of knowing facts, recalling past experiences or information which forms in consciousness.

There is another type of memory system referred to as the implicit memory system.  Largely it is an unconscious process – for example knowing how to walk or to ride a bike.  These types of memories are typically learned through repetition and practice.  Explicit and implicit memories access different areas of the brain which is important to recognize.  See the graphic below.

Different Types of Memory Systems

Implicit and Explicit Memory

The relationship of these different types of memory systems to trauma is as follows.  A single incident of trauma such as witnessing a murder, rape, being in a war zone etc. taps into the explicit memory system.  The defining feature is that the central nervous system becomes overwhelmed and goes into a flight / fight or freeze response which is a good protective response in these circumstances.

The difficulty comes about because the fight /flight or freeze response gets stuck in the on position.  A car backfires, the unexpected noise activates the same regions of the brain where a memory of a bomb explosion killing friends exists.  The activation sees the threat response in full swing and the person has difficulty coping.  Without treatment, the threat response becomes more frequent and more ingrained.  So much so that the person is constantly viewing the world at large as a threat – as if a bomb is about to explode.

Another category of trauma which is equally important to understand is complex trauma.  It is the most frequent form of trauma but receives much less attention in the public sphere than the former category.  Complex trauma is not related to the severity of the trauma – single incidents of trauma can be just as severe and vice versa.  Complex trauma refers to trauma which has been built up over time via multiple incidents.

Repeated incidents of childhood sexual abuse or repeatedly being beaten as child are two categories, we normally associate with childhood trauma.  In these sorts of examples, it is relatively easy to see how trauma might be formed.  But imagine a young child who consistently does not receive affection or is not nurtured.  In cases like these there is no big single event rather the trauma forms because of the consistency of emotional neglect.  For a child, the neglect may be experienced as profound. So much so that the child’s ability to form a secure attachment to its primary caregivers may be severely disrupted.

One of the consequences of growing up in this type of environment is that the child is constantly seeking attention, nurturance, and love from their primary caregivers.  Despite the child’s best efforts, they are constantly thwarted and as such begin to operate on the premise that they will always be thwarted.  Largely it takes root deep in the unconscious and carried forward to adulthood.  Literally the child is caught between a rock and a hard place. On the one hand seeking attention and on the other not receiving it.  It must be stated that this is appropriate for a child as it serves a protective mechanism and helps the child navigate difficult and troubled waters.

There are two important characteristics to understand the dynamic outlined above.  The first is that being constantly thwarted promotes a deeply ingrained unconscious habit of looking for potential situations where this may or may not occur.  A good way to conceptualize it is that the child unconsciously learns to adapt to their environment by constantly being on the lookout – just like Natalie scanning her environment.  It is this mechanism of constantly being on alert which ties into the central nervous systems flight/fight/freeze response.

There is a lot which goes into the treatment of trauma which often takes a lot of time and effort for a person to function optimally in life.  If you believe you have suffered trauma in your life, a good place to begin to help yourself is by eliciting the relaxation response.  If your anxious (over-stimulated) slow down and if your lacking energy (under-stimulated) do something active like physical exercise as the infographic earlier in the article suggests.

Ps: Natalie is doing well.