Understanding how trauma affects the brain

Dear friends -

The theme of the Canadian Association for Suicide Prevention conference that Andrew and I attended in Winnipeg this past fall was traumatic experience and its relationship to suicide risk. Someone said to me recently that mental illness or injury is what happens when a person’s central nervous system is overwhelmed. I like the simplicity and concreteness of this definition. It brings it down to the level of a physics equation: If enough force is applied to a bone in a particular direction, the bone will break. The amount of force will depend on the shape of the individual bone, how strong or brittle it is, and the direction in which the force is applied. The same applies to people’s minds.

If Internal + External Resources > Trauma, the result is Coping or Thriving
If Internal + External Resources < Trauma, the result is Mental Injury or Illness

Some at the conferences talked of people they had known who had survived incredibly tumultuous and traumatic childhoods and many ups and downs in their adult years, but then died by suicide following what seemed like a much lesser event such as the end of romantic relationship or (as in Cliff's case) a perceived threat to job security. They hypothesized that this was because it was the straw that broke the camel's back, something that finally overwhelmed the person's remaining inner resources.

Since attending the conference, I’ve read an excellent book, Traumatic Experience and the Brain, in which David Ziegler describes the neurological damage that can be caused by traumatic experience and childhood neglect. He provides a helpful description of what traumatic experience does to a brain and the long-term consequences that can result. One presenter at the conference spoke about the increased suicide risk that occurs for some people with mild to moderate brain damage. Ziegler seems to be talking about a similar degree of neurological damage occurring as the result of trauma or childhood neglect.

Ziegler comments at several points in his book about the length of time it takes to do neurological reparative therapy with children who have experienced severe long-term trauma or neglect, and that government is increasingly reluctant to pay for that type of long-term treatment. If it takes one to three years for a young child to develop more functional relationships and more adaptive ways of responding to the world, how long might it take for an adult for whom beliefs, emotional responses, and patterns of reaction have become deeply ingrained? And where in our health care system are the provisions for that type of treatment and the people equipped to provide it?

He also says, "The most serious finding concerning the effects of trauma is that neglect appears to be the most pervasive and persistent form of trauma when considering implications with a lifelong trajectory.... The implications for safety, nourishment, and the pivotal issue of attachment can be profound." (pp.40-1) Yet those of us who haven't experienced childhood neglect, including many therapists, don't understand the reality of that experience and its affects, don’t take it as seriously as more dramatic events such as physical or sexual assault, and aren't equipped to treat it.

Not all people who are at risk of or have died by suicide were neglected or abused as children or have experienced traumatic events. For some, perhaps particularly teenagers and young adults, the onset of a severe mental illness can, in and of itself, overwhelm their internal and external resources leading to a suicidal crisis. For others, repeated or ongoing experiences of mental illness, particularly schizophrenia, bipolar disorder, and mixed anxiety-depression, lead to the same outcome.

It’s also apparent that mental injury in and of itself doesn’t necessarily heighten someone’s suicide risk. Victims of torture, for example, are generally found to still have a relatively low risk of suicide, while war veterans and victims of childhood neglect and abuse have a markedly higher risk. I wonder whether the difference is the degree to which each takes the blame for the trauma and their ability to cope with the resulting mental injuries — that is, the amount of shame the individual experiences.

What’s been important for me to learn through this:

Neurological injuries are as real and debilitating as physical injuries, but more difficult to recognize.

Two people can experience the same event and emerge with different injuries, or one may not be injured at all — this is just as true mentally as it is physically.

Effective treatment for neurological injuries is possible. As for most injuries, the potential for healing is greatest when treatment is received soon after the injury occurs, but treatment later in life can also be of great benefit.

The length and intensity of the treatment required is relative to the severity of the injury. Brief or solutions-focused therapies are not effective treatments for severe or long-standing injuries.

Knowing that one is injured — that there are real, physiological reasons for one’s experience and behaviour — and having others recognize this, too, can provide immense relief in and of itself. Knowing that it’s not your fault — that this isn’t just an individual failure to think positively enough or see things from the right perspective, it’s the symptom of a physiological injury — and that there are things you can do to mitigate or ameliorate your experience is a message that many more people who have survived neglect and trauma need to hear.